v wmmmmsmmm§ Ms •• .-, •,- .,v.'.V>'.v.■' • •,.........■••'.',',' • •'• • ">v «#W'■■•'■■■ •'• •' ■■ ■ • •■•••:' TOOKIXi;:;'.'!.'.'.'. . • ■ ,■•,•'• ;,-'v!v''!vWV,ViV''v'-v- ■ ■ v ■''.. •;■:.■:•;•:•:■:■.■:.■.■■.■. . fe*!!:W NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland DOMESTIC MEDICINE: OR, A TREATISE ON THE PREVENTION AND CURE OF DISEASES, BY REGIMEN AND SIMPLE MEDICINES: WITH AN APPENDIX, ■ CONTAINING A DISPENSATORY FOR THE USE OF PRIVATE PRACTITIONERS, BY WILLIAM BUCHAN, M. D. fELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, EDINBURGH. ADAPTED TO THE Climate and Difeafes of America, BY ISAAC CATHRALL, PHILADELPHIA: ► ... PRINTED BT RICHARD FOLIFELL, FOR S. CAMPBELL, NEW-YORK. *797- -l 11 V is V P R E F A C Eu XA.MONG the motives which have induced me to re- publish Dr. Buchan's book on Domestic Medicine, is that . of rendering it more extenfively ufeful to the; inhabitants of the United States of America, by accom- modating it to their difeafes. Although it contains a comprehenfive defcription of the difeafes incident to the nations of Europe, and is too well known by its celebrity to the world, to require any encomium from me, yet the variety to which difeafes are fubject from climate, makes it fomewhat deficient when applied to thofe of America : To fupply that defect is the objecl: of this publication. How far I have fiicceeded in the accomplifhment of my defign, mull be decided by the candour of the public, to whofe judgment it is now with .diffidence fubmitted, without any farther apology \hm a concioufnefs of meaning well, and a defire or foiici- ting that portion of indulgence, which is due to every attempt to promote the good of mankind. Ifaac CathralL Philadelphia, ^upT.ft 20, 1797. CONTENTS. PART I. Of the general Caufes of Difeafes. CHAPTER I. .F Children Page 23 F—Tjifeafed Parents 26 —Clothing of Children 28 --Food cf do. 32 —Exercife of do. 36 —Effects of unwholefome Air upon do. 41 —-Nurfes CHAPTER II. Of the Laborious, £:c. —the Sedentary —the St-a J tout; CHAPTER III. Of Aliment CHAPTER IV. Of Air CHAPTER V. Of E::crcile CHAPTER VI. OfSbcp , 75 —Clothing 76 CHAPTER VII. Of Intemperance 79 CHAPTER VIII. Of Cleanlinefs 32 CHAPTER IX. Of Infection 86 43 45 5* 55 6- 7* CHAPTER X. Ofthe-Paffions 89 —Anger ibid. —Fear 90 —Grief 92 —?j0v.e 94 —Religious Melancholy 95 CHAPTER XI. Of common Evacuations 95 —Stool ibid. —Urir.e 9? —Peri'piration 98 Are affecled by Changes in the Atmofphere ibid. —Wet Clothes —Wet Feet —Night Air —Damp Beds —Damp Houfes —Sudden Transitions from Heat to Cold 102 99 ibid. ICO ibid. 101 PART II. Of Difeafes. CHAPTER XII. Ox the Knowledge and Cure of Difeafes CHAPTER XIII. Of levers in General n CHAPTER XIV. |Of Intermitting Fevers i or A?ues 112 1.05 iol CONTENTS. CHAPTER XV. Of an Acute continual Fever ii8 CHAPTER XVI. Of the Pleurify —Baftard do. —Paraphrenias CHAPTER XVII. Of a Peripneumony, or Inflammation of the Lungs , 122 I2S CHAPTER XVIII. flammation of the Brain 192 CHAPTER XXIX. " Of the Opthalmia, or In- flammation of the Eyes 194 CHAPTER XXX. ' Of the Quinfey, or In- flammation of the Throat 198 —Ma!ignant do. 202 126—Cynanche Parotidsea, 205 Of Confumptions 128 CHAPTER XIX. Of the Slow or Nervous Fever CHAPTER XX. Of the Malignant, Putrid, or Spotted Fever 141 CHAPTER XXI. Of the Miliary Fever 147, Of the Cholic or Mumps CHAPTER XXXI. Of Colds and Coughs 205 —Common Cough 208 137,-—Hooping-Cough 21© CHAPTER XXXII. Inflammation of the Sto- mach, & other Vifcera 213 —Of the Interlines 215 CHAPTER XXII. | Of the Remitting Fever 150: CHAPTER XXIII. | Of the Yellow Fever 152 CHAPTER XXIV. " Of theSrr.aIl.pox —Inoculation 1^4 CHAPTER XXV. Of the Chicken-Pox 182 CHAPTER XXVI. Of the "leases 183, —Scarlet lever 186,—Vomiting 217 Inflammation of the Kid- nies 22! —Of the Bladder 223 —Of the Liver 224 CHAPTER XXXIII. 167 Of the Cholera Morbus, and other exceffiveDif- charges from the Sto- mach and Bowels #226 —a Diarrhoea;, cr Loofe- nefs 228 23^ -Bilious Fever 187 CHAPTER XXVII. Of the Eryhpelas, or St. Anthony's Fire 188 CHAPTER XXVIIi.. <>: the Phren:l.is, or la- CHAPTER XXXIV. Of the Diabetes, and other Diforders of the Kid- nies and Bladder 232 —Supprefiion of Urine 234 —the GravJ and Stone i\k CONTENTS. CHAPTER XXXV. Of Invcluntr y Difchar- 4 ges of Blood 2,38 —Bleed irg at the, Nofe 240 —the Bleeding and Blind Piles 242 Spirting of Blood 244 Vomiting of do. 246, Bloody Urine 247 Dyfentery, or Bloody- Flux 248 Cceliac Paffion 2531 CHAPTER XXXVI. Of the Head-Ach 253 —• 'looth-Ach 256 —Ear-Ach 258 Pain of the Stomach, jOf Surgery —Bleeding/ —Inflammations Abfceffes —Wounds Burns Bruifes —Ulcers LIE and 342 343 344 345 348 351 355 356 36©| 362! 368 369 370 3»7 ibid. 3^9 39* 393 395 LIII. CHAPTER Of Diflocations Diflocations of the Jaw of the Neck ----of the Ribs i ——of the Shoulder 4^0 ----of the Elbow ibid. ——rf the Wrift and 397 39^ -209 Fingers ---of the Thigh - ---of the Knees ----of the Ancles ——of the Toes 401 ibid. ibid. ibid. ibid. CHAPTER LIV. &c. ■—the Apthee or Thrufh ibid. —Acidities ^ 37J Or Broken Bone., —Galling and Excoria- |__Strains tion 371'—Ruptures —Stoppage at the Nofe 77^: -Vomiting ibicL; CHAPTER LV. .—a Loofenefs 374 Of Cafuaities .—the Vomiting and |—Subftances ftopt be- Purging of Children $75^ tween the Mouth ana .—Eruptions 377 j Stomach —the Hives 378;—Drowned Pylons '—the Spafmodic do. 379 —Noxious Vapour. .—Teething 380 Effects of extreme Cola 415 —the Rickets 382!---------Heat 41$ —Convulfions 3841---------Driakingcold —Water in the Head, or j Water in WarmWea- Dropfy of the Brain 385j ther A17 401 404 4D0 407 411 4T3 & CONTENTS, CHAPTER LVI. Of Fainting Fits, & other Cafes which require immediate Affiftance 418 —Intoxication 421 «— Suffocation and Strangling 422 —Perfons falling into Con- vulfion Fits 424 CHAPTER LVII. Cautions concerning cold Bathing and Drinking the Mineral Waters, 426 CONTENTS OF THE APPENDIX. Introduction 437 Lift of Simples 441 Medical Preparations. Balfams 443 Bolufies ibid. Cataplafms & Sinapifms 444 Clyfters 445 Coiiyria, or Eye-Waters 446 Confections 447 C'oi: fr.rves and Preferves ibid. Decoctions 448 Draughts 449 Electuaries 45° Euriufions 45l L;.fruas 452 Fomentations ibid. Gargles 453 Infufions 454 Juleps 455 Mixtures 456 Ointments, Liniments, Cerates 457 jPills, 459 Plaiflers, 461 Powders 462 Syrups, 464 Tinctures, Elixirs, &c. 465 Vinegars 468 Waters by Infufion, &c. 469 Simple Diftilled Waters ibid. Spiritous diftilled Waters 4.70 Wheys 471 Wines ibid. A GloflTary 473 Index 476 ADVERTISEMENT. SIXTEEN years have elapfed, ftrice the fir ft edition of thi^ book appealed. During that period, the author has taken oo . *?.fion to improve-fever! i..\ and use- ful, yet I found it impoflible to avoid fome terms of at; but thofe arc, in general, either explained, er are fuch as .. >it people u::- 14 PREFACE. derftand. In fhort, I have endeavoured to conform my ftilc to the capacities of mankind in general; and, if my readers do not flatter cither thcmfelves or me, with feme degree of fuccefs. On a medical fubjeet, this is not fo eafy a matter as fome may imagine. To make a (how of learning, is eafier than to write plain fenfe, efpecially in af fcience, which has been kept at fuch a diftance from common ob- fervation. It would, however, be no difficult matter to prove, that every thing valuable in the practical part of medicine, is within the reach of common abilities. It would be ungenerous not to exprefs my warmeft acknowledg- ments to thofe gentlemen, who have endeavoured to extend the ufe- fulnefs of this performance, by tranflating it into the language of their refpective countries. Moft of them have not only given ele- gant tranfiations of the book, but have alfo enriched it with many ufeful obfervations ; by which it is rendered more complete, and better adapted to the climate and the conftitutions of their country- men. To doctor Duplanii of Paris, phyfician to the count d'ArtoL, I lie under particular obligations; as this gentleman has not only considerably enlarged my treatife ; but, by his very ingenious and ufeful notes, has rendered it fo popular on the continent, as to oc- cafion its being tranflated into all the languages of modern Europe. The book has not more exceeded my expectations in its fuccefs^ than in the effects it has produced. Some of the moft pernicious practices, with regard to the treatment of the fick, have already given place to a more rational conduct; and many of the moft hurtful prejudices, which feemed to be quite infurmountable, have, in a great meafure, yielded to better information. Of this, a ftron- ger inftance cannot be given, than the inoculation of the fmall- pox. Few mothers, fome years ago, would fubmit to have their children inoculated, even by the hand of a phyfician ; yet nothing is more certain, than that of late, many of them have performed this operation with their own hands; and as their fuccefs has been equal to that of the moft dignified inoculators, there is little rea- fon to doubt that the practice will become general. "Whenever this fhall be the cafe,' more lives will be faved by inoculation alonej than are at prefent by all the endeavours of the faculty. INTRODUCTION. THE improvements in medicine, fince the revival of learning, have not kept pace with thofe of the other arts. The reafon is obvious. Medicine has been ftudied by few, except thofe who intended to live by it as a trade. Such, either from a miftaken zeal for the honor of medicine, or to raife their own importance, have endeavoured to difguife and conceal the art. Medical authors have generally written in a foreign language ; and thofe who were une- qual to this talk, have even valued themfelves upon couching, at leaft, their prefcriptions, in terms and characters, unintelligible to the reft of mankind. The contentions of the clergy, which happened foon after the reftoration of learning, engaged the attention of mankind, and pav- ed the way for that freedom of thought and enquiry, which has fince prevailed in moft parts of Europe, as to religious matiers. Every man took a fide in thofe bloody difputes ; and every gentle- man, that he might diftinguifh himfelf on one fide or other, was in- ftru£ted in divinity. This taught people to think and reafon for themfelves in matters of religion, and at laft destroyed that com- plete and abfohue dominion, which the clergy had obtained over the minds of men. The ftudy of law has likewife, in the moft civilized nations, been juftly deemed the necefTary part of the education of a gentleman. 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 ornament to him. The different branches of philofophy have alfo of late been uni- verfally 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 investigation of truth; induces ha- bits of reafoning and judging properly; opens an inexhaustible fource of entertainment; paves the way to the improvement of arts and agriculture; and qualifies men for acting with propriety in the moft important ftations of life. Natural History is likewife become an object of general atten- tion. And it well deferves to be fo. It leads to difcoveries of the greatest importar.ee. Indeed, agriculture, the moft ufeful of all arts, is only a branch of r: i v:al history, and can never arrive at a high degree of improvement, where the ftudy of that fcience is ne- glected. Medicine, however,has not been reckoned a necefTary part of the education of a gentleman. No fufficient reafon can be.affigned for this c niTtj::. No fcience lays open a more extsnfiye field of ufeful C 16 INTRODUCTION. knowledge, or affords more ample entertainment'to aft inquifitive mind. Anatomy, Botany, Chemistry, and the Materia Medica, are all branches of natural hiftory, and are fraught with fuch amnfo ment and utility, that the man who entirely neglects them, has but a forry claim, either to tafte or learning. If a gentleman has <•. turn for obfervation: fays an elegant and fenfible writer*, furely the natural hiftory of his own fpecies is a more interesting fub- jeet, and prefents a mora ample field for the exertion of genius, than the natural hiftory of fpiders and cockle-fhells. We do not mean that every man fhould become a phyfician. This would be an attempt as ridiculous as it is impofiible. All we plead for, is, that men of fenfe and learning, fhould be fo far ac- quainted with the general principles of medicine, as to be in a con- dition to derive from it fome of thofe advantages with which it is fraught; and at the fame time to guard themfelves againft the des- tructive influences of Ignorance, Superstition, and Quackery. As matters ftand at prefent, it is eafier to cheat a man out of his life than of a fhilling, and almost impofiible either to detect or punifh the offender. Nothwithftandiug this, people will fhut their eyes, and take every thing upon truft that is adminiftered by any pretender to medicine, without daring to alk him a reafon for any part of his conduct. Implicit faith, every where elfe the object of ridicule, is ftill facred here. Many of the faculty are, no doubt, worthy of all the confidence that can be repofed in them; but as this can never be the character of every individual in any profef- fion, it would certainly be for the fafety, as well as the honour of mankind, to have fome check upon the conduct of thofe to whom they intruft fo valuable a treafure as health. The veil of my'ftery, which ftill hangs over medicine, renders it not only a conjectural, but even a fuipicious art. This 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 bet- ter known, in order to fecure the general esteem of mankind. Its precepts are fuch, as every wife man would chufe to obferve, and it forbids nothing, butwhat is incompatible with true happinefs. Difguifing medicine, not only retards its improvement as a* fci- ence, but expofes the profeflion to ridicule, and is injurious to the true interests of fociety. An art founded on obfervation never can arrive at any high degree of improvement, while 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 improvement of medicine, than thofe of the fa- culty alone in a great many. Any man can tell when a medicine gives himeafe, a; well as a phyfician ; and if he only knows the name and dofe of the medicine, and the name of the difeafc, it is # Obfervations on the duties and offices of a phyfician, if INTRODUCTION. *7 fufficient to perpetuate the fact. Yet the man who adds one fingle fact to the ftock of medical obfervations, does more real fervice to the art, than he who writes a volume in fupport of fome favourite hypothefis. Very few of the valuable difcoveries in medicine have been made by phyficians. They have, in general, either been the effect of chance or of neceffity, and have been ufually oppofed by the facul- ty, tijl every one elfe was convinced of their importance. An im- plicit faith in the opinions of teachers, an attachment to fyftems and eftablifhed forms, and the dread of reflexions, will always operate upon thofe who follow medicine as a trade. Few improve- ments are to be expected from a man who might ruin his character1 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 effects on medicine would foon appear. Such men would have no feparate intereft from that of the art. They would detect and expofe affuming ignorance under the mafk of gravity and importance, and would be the judges and pa- trons of modeft merit. Not having their understandings perverted in their youth by falfe theories, unawed by authority, and unbiaf- fed by intereft, they would canvafs with freedom the moft univer- sally received principles in medicine, and expofe the uncertainty of many of thofe doctrines, of which a phyfician dares not fo much as feem to doubt. No argument, continues he, can be brought againft laying open medicine, which does not apply with equal, if not greater force, to religion ; yet experience has fhown, that, fince the laity have af- ferted their right of enquiry into thefe fubjects, theology, confider- ed as a fcience,has been improved, the interests of real religion have been promoted, and the clergy have become a more learned, a more ufeful, and a more refpectable body of men, than they ever. were ih the days of their greatest power and fplendour. 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 philofophy out of the fchools, and fubjeded it to the rools of common fenfe- But they never consider that medicine, at prefent, is in nearly the fame fituation as philofophy was in at that time, and that it might be as much improved by being treated in the fame manner. In- deed, no fcience can either be rendered rational or ufeful, without being fubmitted to the common fe^rfe and reafon of mankind. Thefe alone ftamp a value upon fcience; and what will not bear the teft of thefe, ought to be rejected. It will be faid, that diffufing medical knowledge among the peo- ple, might induce them to tamper with medicine, and to truft to their own (kill inftead of calling a phyfician. The reveffe of this is true. Pcrfons who have moft knowledge in'thefe matters arc i8 INTRODUCTION. commonly moft ready both to afk and to follow advice, when it is necefTary. The ignorant are always moft apt to tamper with medi- cine, and have the leaft confidence in phyficians. Instances of this are daily to be met with among the ignorant peafan'ts, who, while they absolutely refufe to take a medicine which has been prefcri- £>ed by a phyfician, will fwallow, with grcedinefs, any thing that is recommended to them by their credulous neighbours. Where men will Set even with knowledge, it is certainly more rational to afford them all the light we can, than to leave them entirely ia the dark: It may alfo be alleged, that laying medicine more open to man- kind would leffen their faith in it. This would indeed be the cafe. •with regard to fome; but it would have a quite contrary efleet upon others. Many people who have the utmoft dread and horror of every thing prefcribed by a phyfician, will readily take a medicine which they know, and whofe qualities they are in fome meafure acquainted with. Hence it is evident, that the dread arifes from the doctor, not from the drug. Nothing ever can or will infpire mankind with an abfolute confidence in phyficians, but an open? frank, and undifguifed behaviour. While the leaft fhadow of myf- iery remains in the conduct of the faculty, doubts, jealcufies, and fufpicions, will arife in the minds of men. Cafes will fometimes occur, where a prudent phyfician may find :t 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 affect the general argument in favour of candour and gpennefs. A man might as well allege, 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 always know where difguife is necefTary ; but it ought never to appear on the face of his general conduct. The appearance of myftery rn the conduct of phyficians not only renders their art fufpicious, but lays the foundations of quack- ery. No two characters can be more different than that of the ho- nest phyfician and the quack; yet they have been much confound- ed. The line betwixt them is not fufficiently apparent; at leaft it is too fine for the general eye. Few perfons are able to diftinguifh fufficiently between the conduct of that man who administers a fecret medicine, and him who writes a prefeription in myftical cha- racters and in an unknown tongue. Thus the conduct of the honeft phyfician, which needs no difguife, gives a fantlion to that of the villain, whofe whole' confequenee depends upon fecrecy. No laws will ever be able to prevent quackery, while people believe that the quack is as honeft a man, and as well qualified, as i.'ae phyfician. A very fmall degree of medical knowledge, however, would be fufficient to break this fpell'; and nothing elfe can effec- tually undeceive them. It is the ignorance and credulity of the multitude, with regard to medicine, which render them fuch an INTRODUCTION. *9 (safy prey to every one, who has the hardinefs to attack them on this quarter. Mor can the evil be remedied by any other means but making them wifer. The moft effectual way to destroy 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 under- stand them, it would enable him to know when the medicine had the defired effect; would infpire him with confidence in the phyfi- cian; and make him dread and deteft every man who pretended to cram a fecret-medicine down his throat. Men, in the different dates of fociety, have very different views of the fame object. Some time ago it was the practice of this coun- try, for every perfon to fay his prayers in Latin, whether he knew any thing of that language or not. This conduct, though facred in the eyes of our ancestors, appears ridiculous enough to us ; and fome parts of ours will feem as ftrange to pofterity. Among thefe, we may reckon the prefent mode of medical prefcription, which will fome time hence appear to have been completely ridiculous, and a very high burlefque upon the common fenfe of mankind. But this practice is not only ridiculous; it is likewife dangerous. However capable phyficians may be of writing Latin, apothecaries are not always in a condition to read it, and dangerous mistakes, in confequence of this, often happen. But fuppofe the apothecary eVer fo able to read the phyfician's prefcription, he is gengrafly otherwife employed^ and the bufinefs of making up prefcriptions is left entirely to the apprentice. By this means, the greatest man in the kingdom, even when he employs a firft-rate phyfician, in re- ality trufts his life in the hands of an idle boy, who has not only the chance of being vefjr ignorant, but likewife giddy and carelefs. Miftakes will fometimes happen in fpite of the greatest care ; but, where human lives are concerned, all poffible methods ought cer- tainly to be taken to prevent them. For this reafon, the prefcrip- tions of phyficians, inftead of being couched in mystical characters, and a foreign language, ought, in my humble opinion, to be con- ceived in the moft plain and obvious terms imaginable. Diffusing medical knowledge among the people, would not only tend t© improve the art, and to banifh quackery, but likewife to render medicine more univerfally ufeful. However long medicine may have been known as a fcience, many of its moft important purpofes to fociety have either been overlooked, or very little at- tended to. The cure of difeafes is a matter of great importance ; but the preferration of health is ftill greater. This is the concern of every man, and furety what relates to it, ought to be rendered as plain and obvious to all as poffible. Men cannot be fufficiently on their guard againft difeafes, who are totally ignorant of their caufes. Nor can the legiflature, in whofe power it is to do much more for preferring the public health, than can ever be done by the faculty to INTRODUCTION. exert that power with propriety, and to the greatest 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 respective fta-f tions; which is always eafier than to remove their effects. 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, is to live miferably : But it might with equal propriety be faid, that to live rationally, is to live mifera- bly. If phyficians obtrude their own ridiculous whims upon man- kind, or lay down rules inconfiftent with reafon or common fenfe, they will be defpifed. But this is not the fault of medicine. It pror pofes no rules, but fuch as ar"e perfectly confiftent with the true enjoyment of life, and conducive to the real happinefs of mankind. Medicine has hitherto hardly been considered as a popular fci- ence, but as a branch of knowledge folely confined to a particular fet of men, while all the reft have been taught, not only to neglect, but even to dread and defpife it. But it will appear, upon a more ftrict examination, that no fcience better deferves their attention, 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. This, I am fatisfied, ■will feldom be the cafe with fenfible people : and, fuppofe it were, they mult foon be undeceived. A fhort time will (how their error, and a little more reading will infallibly correct it. A fingle in- ftance will (how the abfurdity of this notion. A fenfible lady, rather than read a medical performance, which would inftruct her in the management of her children, must leave them entirely to the care and conduct of the moft ignorant, credulous, and ftuper-; ftitious 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 chil- dren. 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 necefTary, to hirelings, who are either too carelefs to do their duty, or too ignorant to know it. More lives are loft by the careleffncfs and inattention of parents and nurfes, than are faved by the faculty. The joint and well-condu£ted en- deavours of private perfons and the public, for !;he prefervation of infant lives, would be of more advantage to foc\ety, than the whole art of medicine, 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. Phyfi- cians, like other people, muft live by their employment, and the poor muft either want advice altogether, or take up with that INTRODUCTION. 2r which is worfil than none. There are not, however, any where i wanting well-difpofed people, of better fenfe, who are willing to fupply the defect of medical advice to the poor, did not their fear of doing ill often fupprefs their inclination to do good. Such people are often deterred from worthy actions, by the foOlifh alarms founded in their ears by a fet of men, who, to raife their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the fick, which is not conducted by the precife rules of medi- cine. Thefe gentlemen mult, however, excufe me for faying, that I have often known fuch well-difpofed perfons do much good ; and that their practice, which is generally the refult of good fenfe and obfervation, affifted by a little medical reading, is frequently more rational, than that of the ignorant retainer to phytic, who defpifes both reafon and obfervation, that he may go wrong by rule ; and who, while he is doling his patient with medicines, often neglects other things of far greater importance. Many things are necefTary for the fick, befides medicine. Nor is the perfon who takes care to procure thofe for them, of lefs im- portance than a phyfician. The poor oftner perifh in difeafes, for want of proper nursing, than of medicine. They are frequently in wr.nt of even the neceffaries of life, and ftill more foof what is pro- per for a fick bed: No one can imagine, who has not been a witnefs of thefe fituations, how much good a well-difpofed perfon may do, by only taking care to have fuch wants fupplied. There certainly cannot be a more necefTary, a more noble, or a more godlike ac- tion, than to administer to the wants of our fellow-creatures in diftrefs. Perfons who do not chufe to adminifter medicine to the fick, may neverthelefs direct their regimen. An eminent medical au- thor has faid, that by diet alone ail the intentions of medicine may be anfwered. No doubt a great many of them may; but there are other things befide diet, which ought by no means to be ne- glected. Many hurtful and destructive 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 in- to their minds fome juft ideas of the importance of proper food, frefh air, cleanlinefs, and other pieces of regimen necefTary in dif- eafes, would be a work of great merit, and productive of many happy 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 benevo- lent in relieving diftrefs; to eradicate dangerous and hurtful pre- judices ; to guard the ignorant and credulous againft the frauds and impofitions of quacks and impoftors; and to (how men what is in their own power, both with regard to the prevention and cure pf difeafes. are certainly obj«cts worthy of the phyfician's attcn- INTRODUCTION. tion, Thefe were the leading views in compofihg and publiifhing the following fheets. They were fuggefted by an attention to the conduct of mankind, with regard to medicine, in the courfe of a pretty long practice 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 poffeffed of fome fuch plain directory for regulating their conduct. How far he has fucceeded in his endeavours* to fupply this deficiency, muft be left for others to determine ; but if they be found to contribute, in any meafure, towards alleviating the calamities of mankind, he will think his labour very well beftowed. PART I, OF THE General Caufes of Difeafes. CHAPTER I. OF CHILDREN. r g ^HE better to trace difeafes from their original caufes, we mail I take a view of the common treatment of mankind, in the ftate of infancy. In this period, the foundations of a good or bad constitution are generally laid ; it is therefore of importance, that parents be acquainted with the various caufes which may injure the health of their offspring. It appeals from the annual registers of the dead, that almost one half of the children born in Britain, die under twelve years of age. To many, indeed, this may appear a natural evil, but, On due ex- amination, 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 not the cafe. It may feem strange, that man, notwithftanding his fuperior rea- fon, ihou\d fall fo far fliort of other animals, in the management of his young: But our furprife will foon ceafe, if we confider that brutes, guided by instinct, never err in this refpect; while man, trufting folely to art, is feldom right. Were a catalogue of thofe infants, who perifh annually by art alone, exhibited to public view, it would aftonifh moft people. If parents are above taking care of their children, others muft be employed for that purpofe: Thefe will endeavour to recommend themfelves by the appearance of extraordinary fkill and addrefs. By this means fuch a number of unneceffary and deftrudfive arti- cles have been introduced into the diet, clothing, &c. of infants, that it is no wonder fo many perifh. Nothing can be more preposterous than a mother who thinks it beneath her to take care of her own child, or who is 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 animal is the nurfe of its own offspring, and they thrive accordingly. Were 24 OF CHILDREN. thfbrutes to bring up their young by proxy, they would (hare the fame fate with thofe of the human fpecies. We mean not, however, to impofe it as a talk upon every mother to fuckle her own'child. This is in fome cafes implacable, and would inevitably prove deftruaive both to the mother and child. Women of delicate conftitutions, fubjed to hyftenc fits, or other nervous affections, make 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 often unable to fuckle their own children. Almost every mother would be in a condition to give fuck, did mankind live agreeably to nature : but whoever confiders how far many mothers deviate from her diftates, will not be furprifed to find fome of them unable to perform that neceffary office. Mothers who do not eat a fufficient quantity of folid food, nor enjoy the be- nefit of free air and exercife, can neither have wholefome juices themfelves, nor afford proper nourifhment to an infant : Hence children, 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 perforin fo tender and agreeable an office*. But, fuppofe it to be out o£ her power, fhe may, neverthelefs, be of great fervice to her child. The bufinefs of nuvfing, is by no means confined to giving fuck. To a woman who abounds with milk, this is the eafieft part of it. Numberlefs other offices are neceffary for a child, which the mo- ther ought at leaft to fee done. A mother who abandons the fruit of her womb, as foon as it is born, to the fole care of an hireling, hardly deferves that name. A child, by being brought up under the mother's eye, not only fecurcs her affection,*" but may reap all the advantages of a parent's care, though it be fuckled by another. How can a mother be better em- ployed than in fuperiutending the nurfery? This is at once the moft delightful and important office ; yet the moft trivial bufinefs or in- fipid amufements are often preferred to it! A strong proof both of the bad tafte and wrong education of modern females. * Many advantages would arlfe to fociety, as well as to individuals, from mothers fuckling their own children. It would prevent the tempta- tion which poorwo-.nen are laid under, of abandoning their children, te fuckle tlic.il' of the rich, for the fake of gain : By which means, fociety lofes many of its moft ufeful members, and mothers become in fome fenfe the murderers of their own offering. I am ftire 1 fpeak within the truth, when I fay, that not one in twenty of thofe.childrenlive, who are thus abandoned by their mothers. For this reafon, nemother fhould be allowed to fuckle another's child, till her own is either dead, or fit to be weaned. A regulation of this kind would fave many lives among the poorer fort, and could do no hurt to the rich, as moft women who make good nurfes are able to fuckle two children in fueceffion upon the fame milk. OF CHILDREN. 25 It is indeed to be regretted, that more care is not bestowed in teaching the proper management of children to thofe whom nature has dcfigned for mothers. This, inftead of being made the princi- pal, is feldom considered as any part of female education. Is it any wonder, when females fo educated come to be mothers, that they fhould be quite ignorant of the duties belonging to that character ? However ftrangeit 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, of what is to be done for it, as the: infant itfelf. Indeed, the moft ignorant of the fex are generally rec- koned moft knowing in the bufinefs of nurfingl 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 acquifi- tion of trifling accomplifhments, employed in learning 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 nou- rifhingfoed; how to exercife their tender bodies, fo as beft to pro- mote their growth and ftrength : Were thefe made the objects o£ female inftruction, mankind would derive the greatest advantages from it. But while the education of females, implies little more, , than what relates to drefs and public fhow, we have nothing to ex- pect from them, but ignorance,even in the moft important concerns- Did mothers reflect on th^ir own importance, and lay it to heart, they would embrace every opportunity of informing themfelves of the duties, which they owe to their infant offspring. It is their pro- vince, not only to form the body, butalfo to give the mind its moft early bias. They have it very much in their power, to make men: healthy or valetudinary, ufeful in life, or the pefts of fociety. But the mother is not the only perfon concerned in the manage- ment of children. The father has an equal intereft in their welfare, and ought ro affift in every thing that refpe&s either the improve- ment of the body or mind. It is a pity that the men fhould be fo inattentive to this matter. Their negligence is one reafon why females know fo little of it- Women will ever be desirous to excel in fuch accomplifhments as recommend them to the other fex. But men generally keep at fuch a diftance from even the fmalleft acquaintance with the affairs, of the nurfery, that many would reckon it an affront, were theyfup- •X- Tacitus, the celebrated Roman historian, complains greatly of'the- degeneracy of the Roman ladies in his time, with regard to the care of their offspring. He fays, that, in former times, the greatefl; women in Rome ufed to account it their chief glory to keep the houfe and attend their children 5 but that now the young infant was committed to the fbie care of fome poor Grecian wench, or other menial fervant. We are afraid, wherever luxury and effeminacy prevail, there will be too much •round for this complaint. D a 6 OF CHILDREN. pofe'd to know any thing of them- Not fo, however, with the ken* nel or the ftables: A gentleman of the firft rank is not afhamed to give direftions concerning the management of his dogs or hbrfes, yet would blufh, were he furprifed in performing the fame office for that being, who derived its existence from himfelf, who is the heir of his fortunes, and the future hope of his country. Nor have phyficians themfelves been fufficiently attentive to the management of children: This has been generally considered as the fole province of old. women, while men of the firft charaaer inphy- fic, have refufed to vifit infants, even when fick. Such condua in the faculty, has not only caufed this branch of medicine to be ne- gleaed, but has alfo encouraged the-other-fex toaffume an abfolute title to prefcribe for children, in the moft dangerous difeafes. The confeqiience is, that a phyfician is feldoin called, till the good wo- men have exhaufted all their (kill; when his attendance can only ferve to divide the blame, and appeafe the difconfolate parents. Nurfes 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 ol children are generally acute, and the leaft delay is dangerous. Were phyficians more attentive to the difeafes of infants, they would not only be better qualified to treat them properly 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 un- der flood as many imagine. It is true, children cannot -tell their complaints; but the caufes of them may be pretty certainly difco- vered, by obferving the fymptoms, and putting proper questions to the nurfes. Befides, the difeafes of infants, being lefs complicated, are eafier cured than thofe of adults'*. Of Difeafed Parents. ONE great fource of the difeafe* of children is, the1 unhealthi- nefs of parents. It would bf as reafonable to expea a rich crop, from a barren foil, as that strong and healthy children fhould be bcrn of parents, whofe conftitutiqns have been worn out with in- temperance or difeafe. Roufleau obferves, that on the constitution of mothers depends originally that of their offspring. No one who believes this, will be Furprifed, on a view of the female world, to find difeafes and death fo frequent among children. A delicate,,female, brought up within ■X- The common opinion, that the difeafes df infants are hard to difco- ver, and difficult to cure, has deterred many phyficians from paying that attention to them which they deferve—lean, however,irom experience-, declare, that this opinion is withoutWowndation, and that they are nei* ther fo difficult to diicover, nor ft ill to cure, as thofe of adults. » OF CHILDREN, 27 Poors', an utter stranger to exercife and open air, who lives on tea and other flops, may bring a child into the world, but it will hardly t be fit to live. The firft blaft of difeafe will nip the tender plant in _,thebud: Or, fhould it ftruggle through a few years exiftence, its feeble frame, fhaken with convulfions from every trivial caufe, will be unable to perform the common funaions of life, and prove a burden to fociety. If, to the delicacy of mothers, we add the irregular lives of fa- thers, we fhall fee further caufe to believe, that children are often hurt by the constitution of their parents. A fickly frame may be originally induced by hardfhips or intemperance, but chiefly by the latter. It is impofiible that a courfe of vice fhould not fpoil the beft conftitution: and, did the evil terminate here, it would be a juft pu- »ifhment for the folly of the fufferer ; but when once a difeafe is contr-aaed and rivetted in the habit, it is entailed on posterity.' What a dreadful inheritance is the gout, the fcurvy, or the 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 expenfe of inheriting his difeafes I '*♦>.. 41' - .* ' No perfon who labours under any incurable malady ought to marry. He thereby not- only lhortens his own life, but tranfmits mifery to others: but when both parties are deeply tainted with the fcrophula, the fcurvy, or the likef the effeas muft be ftill worfe. If fuch havs any iffue, they muft be miferable indeed. Want of attention to thefe things, in forming connexions for life, has rooted out more families than plague,- famine^ or the fword ; and as longas thefe connexions are "formed from mercenary views, the evil will be continued*. In our matrimonial contraas, it is amazing fo little regard is had to the health and form of the Objea. Our fportfmen know, that the generous courfer cannot bo bred out of the foundered jade, nor the fagacious fpaniel out of the fnarlyig -cur. This is fettled upon immutable laws. The man who marries a woman of a fickly conftitution, and defcended of unhealthy parents, what- - ever his views may be, cannot be faid to aa a prudent part. A difeafed woman may prove ferule; fhould this be the cafe, the family muft become an infirmary: what profpea of happinefs the father ©f fuch a family has, we fhall leave any one to judgef • -)f The Lacedemonians condemned their king Archidatnus, for having married a weaK, puny woman ; becaufe, faid they, inftead of propa- 'viiing a race of heroes, you will fill the throne with a progeny of changelings. t The Jews, by their laws, were, in certain cafes, forbid to have any manner of commerce with the difeafed; and indeed to this all wife legiflators ought to have a fpecial regard. In fome countries, dif- eafed perfoiis have actually been forbid to marry. This is an evil, of a complicated kind, a natural deformity, and political mifchicf -} and therefore requires a public confederation, c8 OF CHILDREN. Such children as have the misfortune to be borri of difeafed parents, require to be nurfed with greater care than others. This is the only way to make amends for the defeas of conftitution ; and it will often go a greai length. A healthy nurfe, wholefome air, and fufficient exercife, wili do wonders. But when thefe are negleaed, little is to be expeaed from any other quarter. The defeas of conftitution cannot be fuppliedby medicine. Thofe who inherit any family-difeafe ought to be very circum- fpea in their manner of living. They fhould confider well the nature of fuch difeafe, and guard againft it by a proper 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 wholh eradicated. This is a fubjea very little regarded, though of the greatcll importance. Family-conftitutions are as capable of improvement as family-eftates ; and the libertine, who im- pares the one, does greater injury to his pofterity, than the prodi- gal, who fquanders away the other. Of the Clothing of Children. THE clothing'of an infant, is fo fimple a matter, thnt it is fur- prifing how any perfon fhould err in it; yet many children lofe their lives, and others are deformed, by inattention to this article. Nature knows no ufe of clothes to an infant but to keep it warm. All that is neceffaiy for this purpofe, is to wrap it in a foft loofe covering. Were a mother left to the diaates of nature alone, fhe would certainly purfue this courfe. But the bufinefs of dreAm^ an infant has long been out of the hands of mothers, and has atTaft become a fecret, which none but adepts pretend to understand. From the moft early ages it has been 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 em- ployed in it, ftrove to out-do one-another in the different branches of their profeffion. The dreffing of a child came of courfe to be confidered as the midwife's province, who, no doubt imagined, that the more dexterity fhe could fhow in this article, the more her fkill would be admired. Her attempts were fecouded by the vanity of parents, who, too often defirous of making a fhow of the infant as foon as it was born, were ambitious to have as much finery heaped upon 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 bandages to a broken limb; and the poor child, as foon as it came into the world, had as many rollers and wrappers applied to its body, as if every bone had been fractur- OF CHILDREN i9 ed in the birth; while thefe were often fo tight, as not only to gall and wound its tender frame, but even to obftrua the motion of the heart, lungs, and other organs neceffary for life. In moft parts of Britain, the praaice of rolling children, with fo many bandages, is now, in fome meafure, laid aside ; but it would ftill be a difficult talk to purfuade the generality of mankind, that the (hape of an infant does not entirely depend on the midwife. So far, however, are all her endeavours to mend the fliape, from being fuccefsful, that they conftamly 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 children to death. The truth is, they hardly know fuch a thing as a deformed child. Neither fhould we, if we followed their example. Savage nations never think of mana- cling their children. They allow them the full ufe of every organ, carry them abroad in the open air, wafh their bodies daily in cold water, &c. By this management, their children become fo strong and hardy, that,by the time our puny infants get out of the nurfe's arms, their's are able to {hift for themfelves*'. Among brute animals, no art is neceffary to procure a fine fhape. Though many of them are extremely delicate when they come in- to the world, yet we never find them grow crooked for want of fwaddiing bands. Is nature lefs generous to the human kind ? No: but we take the bufinefs out of nature's hands. Not only the analogy of other animals, but the very feelings of infants tell u-, they ought to be kept eafy and free from all pref- fure. They cannot indeed tell their complaints ; but they can fhow •gns of pain ; and this they never fail to do, by crying, when hurt by their clothes. No fooner are they freed from their bracings, than they feem pleafed and happy; yet, ftran; e infatuation! the'moment they hold their peace,they are again committed to their chains. If we consider the body of an infant as a bundle of foft pipes, replenifhed with fluids in continual motion, the danger of preffure will appear in the strongest light. Nature, in order to make way for the growth of children, has formed their bodies foft and flexi- ble ; and left they fhould receive any injury from preffure in the womb, has furrounded the foetus every where with fluids. This iaows the care which nature takes, to prevent all unequal preffure vn the bodies of infants, and to defend them againft every thing that might in the leAi cramp or confine their motions. Even the bones of an infant are fo foft and cartilaginous, that they readily yield to the flightcft preffure, and eafily affume a bad ■X- A friend of mine, who war, feveral years on the coaft of, Africa, tells me, that the natives neither put any clothes upon their children, nor apply to their bodies bandnges of any kind, but lay them on a pallet, and fuffer them to tumble about at pleafure ; yet they are all ftrait, and feldom have any difeafe, ^mHtUmu+a£\~*}u n i-, - ^F/ 30 OF CHILDREN. ihape, which can never after be remedied. Hence it is, that fo many people appear with high fhoulders, crooked fpines, and flat breafb, who were as well proportioned at their birth as others, but had the misfortune to be fqueezed out of fhape by the appli- cation of flays and bandages. Preffure, by obftruaing the circulation, likewife prevents the equal distribution of nourifhmentlo the different parts of the bo- dy, by which means the growth becomes unequal. One part grows too large, while another remans too fmall; and thus in time the whole frame becomes difproportioned and misfhapen. #To this we muft,add, that when a child is cramped in its clothes, it naturally fhrinks from the part that is hurt; and, by putting its body into un- natural postures, it becomes deformed by habit. Deformity of body, may indeed proceed from weaknefs or dif- eafe; but in general, it is the effea of improper clothing. Nine tenths, at leaft, of the deformity among mankind, muft be imputed to this caufe. A deformed body is not only difagreeable to the* eye, but by a bad figure, both the animal and vital funaions muft be impeded, and of courfe health impaired. Hence few people remark- ably misfbapen are ftrong or healthy. The new motions which commence at the birth, as the circula- tion of khe whole mafs of blood through the lungs, refpiration, the peristaltic: motion, &c. afford another flrong argument for keeping the body of an infant free from all preffure. Thefe organs not hav- ing been accuftomed to move, are easily flopped ; but when this happens,-death muft enfue. Hardly any method could be deviled more effeaually to flop thefe motions, than bracing the body too tight with rollers* and bandages. Were thefe to be applied in the fame manner to the body of aa adult, for an equal length of time, they could hardly fail to hurt the digeftion, and make him fick. How much more hurtful they muft prove to the tender bodies of infants, we fhali leave any one to judge. Whoever confiders thefe things, will not be furprifed, that fo many children die of convulsions foon after the birth. Thefe fits are generally attributed to fome inward caufe; but in faa, they , opener proceed from our own imprudent condua. I have known a child feized with convulfion-fit^ foon after the midwife had done fwaddlingit, who, upon takirtg off the rollers and bandages, vvt.s immediately relieved, and nevejr had the difeafe afterwards. Nunvrour. enamplea of this might heaven, were they neceffary! ^ 1; would be fafcr to fix on the-clothes of an infant with firings than jams, as thefe often gall and irritate their tender (kins, and oc abou diforders. Pins have been found flicking above half an i..ch hvn the brv.ly of a child, after it had died of convulfion fits, vlnch; in ,t'I r.rob.^iiity, proceeded from that caufe. - Tins I- by no means inveighing pgainft a thing that does not haD- .*", jy\X'" ?:!'t/ot-Britain, at this day. a r..ll-r, eight or ten feet m iengM, ;S T,L m! t!girly round the child's bady as low, as it is b„" OF CHILDREN. 31 Children aTe not only hurt by the tightnefh of their clothes, but fclfo 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 iucreafed. But tills is not ail; the child is generally laid itt bed with the mother, who is often likewife feverilh ; 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 ail thefe are combined, which does not feldom. happen, they muft increafe the fever to fuc-h a degree, as will en- danger the life of the infant. '• The danger of keeping infants too hot will further appe-ar, if we ' consider, that after they have been ior fometime in the fituation mentioned above, they are often fent into the country to be nurfed in a cold houfe. Is it any wonder, if a child, from fuch a transi- tion, catches a mortal cold-, or contraas fome other fatal difeafe? ^ When an infant is kept too hot, its lungs, not being fufficiently expanded, are apt to remain weak and flaccid for life ; hence pro- ceed coughs, coufumptions, and other difeafes of the bread. It would anfwer little purpofe, to fpecjfy the particular pieces of drefs, proper for an infant. Thefe will always vary in different countries, according to custom and the humour of parents. Ths great rule to be obferved is, that a child have no mote clothes than are neceffary to keep it warns, and that they be quite eafy for its body. Stays are the vtrv bane of infants. A volume would hot fuffice to point out all the bad effeas of this ridiculous piece of drefs, both on children and adults. The madnefs in favour of flays, feems however, to be fomewhat abated; and it is to be hoped that the world will, in time, become wife enough to know, that the human fhape does not folely depend upon whale-bone and bend- leather*. The clothes of children ought to be kept thoroughly cle.nn Children perfpire more than adults; and if their clothes be not frequently changed, they become very hurtful. Dirty clothes net only fret and gall the tender ikins of infants, but likewife occafion ill fmells ; and what is worfe, tend to produce vermin and cuta- neous difeafes. Cleanlinefs is not only agreeable to the eye, but tends greatly to preferve the health of children. It promotes the ;> -n'; iration, and by that means, frees the body from fuperfluous humours, * Slays made of bend-leather, are worn by all the women of lower ft.ition,in many parts of England. There are ftill mothers mad enough, to lace their daughters very. ttetit, in order to improve their fhape. As reafoning would be totally loft upon fuch people, I fliaH beg leave, juft to afk them, Why there are ten deformed women for one man? and likewife, to recommend tn their perufal, a fhort .jnoral precept, which forbids us to deform the Lu; man body. ."■ c"' v" *"" 32 OF CHILDREN. which, if retained, could not fail to occafion difeafes* No mother or nurfe can have any excufe for allowing a child to be dirty. Po- verty may oblige her to give it coarfe clothes; but if fhe does not keep them clean, it muft be her pwn fault. Of the Food of Children. NATURE not only points out, the proper food for an infant, but aaually prepares it. This does not prevent fome, who think themfelves wifer than nature, from attempting to bring up their children, without her provision. Nothing can fhow the difpofition which mankind have to depart from nature, more, than their en- deavouring to bring up children without the breaft. The mother's mill?, or that of a healthy nurfe, is unquestionably the beft food for an infant. Neither art nor nature can afford a proper fubfli- tute for it. Children may feem to thrive for a* few months with- out the breaft; but when teething, the fmall-pox,and other difeafes, incident to childhood, come on, they generally perifh. ■ A child, foon after birth, fhows an inclination to fuck ; and it fhould be gratified. The mother's milk does not always come im- mediately after the birth; but this is the way to bring it: Befidcs, the firft milk that the child can fquceze out of the breaft, anfwers the purpofe of cleanfing, better than all the drugs in the lapotheca- ry'sfhop,and at the fame time prevents 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, fhould be drugs. This is beginning with medicine by times, and no wonder, if they generally end with it. It fometimes happens, indeed, that the child does not difcharge the meconium fo foon as could be wifhed ; this.has induced phyficians, in fuch cafes, to give fomething of an opening nature, to cleanfe the firft paffages. Midwives have improved upon this hint, and never fail to give fyrups, oils, &c. whether they be neceffary or not. Cram- ming an infant with fuch indigestible fluff, as foon as it is born, can hardly fail to make it fick, and is more likely to occafion dif- eafes, than to prevent them. Children are feldom long after- the birth without having paffige both by ftool and urine ; though thefe evacuations may be wanting for fome time, without danger. But if children muft have fomething before they be allowed the breaft, let it be a little thin water-pap, to which may be added an equal quantity of new milk ; or rather water alone, with the addi- tion of a little raw fugar. If this be given without any wines or fpiceries, it will neither heat the blood, load the ftomach, nor oc- cafion gripes. Upon the firft fight of an infant, almoft every perfon is struck wkh the idea of its being weak, feeble, and wanting fupport. This OF CHILDREN. U fuggefts the need of cordials. Accordingly, wines are univerfally mixed with the firft food of children. Nothing can be more falla- cious than this way of reafoning, or more hurtful to infants than the condua founded upon it. Children require very little food for fome time after the birth ; and what they receive fhould be thiri, weak, light, and of a cooling quality. A very fmall quantity of wine is fufficient to heat and inflame the blood of an infant; but every perfon converfant 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 little of fome food, that is eafy of digestion, as water-pap, milk-pottage, weak broth, with bread in it, and fuch like. This will eafe the mother, will accustom.the child by degrees to take food, and will render the weaning both lefs difficult and lefs dangerous. All great and fud- den tranfitions are to be avoided in nurfing. For this purpofe, the food of children ought not only to be fimple, but to refemble, as nearly as poffible, the properties of milk*. Indeed, milk itfelf, fhould make a principal part of their food, not only before they are weaned, but for a long time after. Next to milk, v\re would recommend good light bread. Bread may be giv£n to a child as foon as it fhows an inclination to chew; and it may at all times be allowed as much plain bread, as if will eat. • The- very chewing of bread will promote the cutting of the teeEh, and the difcharge of faliva, while by mixing with the nutfe's milk in the ftomach, it will afford an excellent nourifhment. Chil- dren difcover an early inclination to chew whatever is put into their hands. Parents obferve the inclination, but generally mistake the objea. Inftead of giving the child fomething, which may ai once exercife its gums and afford it nourifhment, they commonly put into its hands apiece of hard metal, or impenetrable coral. A cruft of bread is the beft gum-flick. It anfwers the purpofe better than any thing elfe, and 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 prepared in- to 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 unboiled. Milk is both more whole- fome and nourifhing this way than boiled, and is lefs apt to occa- fion coftivenefs. For a child farther advanced, bread may be mixed in veal or chicken broth, made into puddings, or the like. Bread is a proper food for children at all times, provided it be plain, made #■ A mixture of one-fourth milk, and three-fourths barley-water,-. with the addition of fome ioaf-fugar, is a good fubftitutefor the iflilkof the mother.■ (I.C.) E 34 OF CHILDREN. —— . _ of wholefome grain, and well fermented j but when enriched with fruits, fugars, or fucli things, it becomes very unwholefomc. 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 wholly on vegetable food, it is apt to four their ftomachs; but on the other hand, too much flefh ,heats the body, and occafions fevers and other inflammatory difeafes. This plainly points out a due mixture of animal and vegetable food, as the moft' proper for children. Few things prove more hurtful to infants, than the common me- thod of fweetening their food. It entices them to take move than they ought to, which makes them grow fat and bloated. It Js pret- ty certain, if the food of children were quite phin, that they would never take more than enough. Their exceffes arc entirely owing f to nurfes. If a child be gorged with food at all hours,Tand 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 may be hurt by coo little as 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 accustomed to eat in the night; neither fhould it have too much at a time. Children thrive beft with fmall quanti- ties of food frequently given- This neither overloads the ftomach, nor hurts the digeftion, and is certainly moft agreeable to nature. Writers on nurfing have inveighed with fuch vehemence againft giving children too much food, tint many parents, by endeavour- ing to fhun that error, have run into the oppofite extreme, and ru- ined the constitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Na- ture has many ways of relieving herfelf when overcharged -, but a child, who is pinched with hunger, will never become a flrong 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. This is the principal evil, and claims our ftriaeft attention. Many people imagine that the food they themfelves love-, can- not 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 children, we could not endure. Befides, mi* ny things may by habit, agree very well with the ftomach of a grown perfon, which would be hurtful to a child ; as hi Thus, by gaining a few years from childhood, v/e 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 obfervation, we need only look into the gteat manufaauring towns, where we fhall find a puny degenerate race of people, weak and fickly all their lives, feldom exceeding the middle period of life ; or if" they do, being unfit for bufinefs, they become a burden to fociety. Thus, arts and manufaaures, 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, mould not be fet too early to work. Every perfon converfant in the breed of horfes, or Other, working animals, knows, that if they be fet to hard labour too foon, they will never turn out to ad- vantage. This is equally true, with refpea to the human fpecies. There are neverthelefs, various ways of employing young people without hurting their health. The eafier parts of gardening, huf- bandry, or any bufinefs carried on without doors, are moft proper. Thefe are employments which moft young people are fond of, and fome parts of them may always be adapted to their age, tafte, and ftrength*. Such, parents as are under the neceffity of employing their chil- dren within doors, ought to allow them fufficient time for aaive di- verfions without. This would both encourage them to do more work, and prevent their conftitutions from being hurt. Some imagine, that exercife within doors is fufficieot; but they are greatly miftaken. One hour fpent in running, or any other exercife without doors, is worth ten within. When children can- not go abroad, they may indeed be exercifed 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 excels, is of uxcellent fervice to young people. It cheers the fpirits, promotes perfpiration, strengthens the limbs, Sec. I knew an eminent phyfi- cian, who ufed to fay, that he made his children dance, inftead of giving them phyfic. It were well if mors people followed his ex- ample. The cold-bath may be canfidered as an aid to exercife. By it the body is braced and strengthened, the dfcuiation and fecretiorw ♦ I have Been told that in China, where the police is the beft in the world, all the children are employed in the eafier part of gardening am? fcuibandry; is feeding, g^th?rin2 ftgae; yff t?u. iailc^ .t,ld ,-,,rh l;£, " of children: 4i promoted, and, were it conduaed with prudence, many difeafes, as the rickets, fcrophula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and ro- buft, were no strangers to the ufe of the cold bath ; and, if we may credit report, the praaice of immerfing children daily in cold wa- ter muft have "been very common among our ancestors. The greateft objeaion to the ufe of the cold batharifes from the fuperftitious prejudices of nurfes- Thefe are often fo strong, that it is impofiible to bring them to make a riroper ufe of it. I have known fome of them who would not dry a child's fkin after bathing it, left it fhould destroy the effea of the water. Others wilhevea put cloths dipt in the water upon the child, and either put it to bed, or fuffer it to go about in that condition. Every child when in health, fhould at leaft have its extremi- ties daily 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 fchrophula, its whole body ought to be frequently 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 dipped only once at a time, fhould be taken out immediately, and have its fkin well rubbed with a dry cloth. The Effecls of unwbolefome Air upon Children, FEW things prove more deflrliaive to children, than confined or un wholefome 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 rendered fo extremely pernicious, that it becomes a poifon to infants. Want of wholefome air is likewife deftruaive 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 hardly any accefs. Though grown people, who are hardy and robuft, may live in fuch fituations, yet they generally prove fatal to their off- fpring, few of whom arrive at maturity, and thofe who do, are weak and deformed. As fuch people are not in a condition to carry (heir children abroad in the open air, we muft lay our account with lofing the greater part of them. But the rich have not this excufe. 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 mother 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 mother furely. needs air as well as her children 5 and how can fhe be better employed than in attending them I 4* OF CHILDREN. A very bad cuftom prevails, of making children fleep in fmalf apartments, or crowding two or three beds into one chamber. In- ftead of this, the nurfery ought always to be the largest and beft aired room in the houfe. When children are confined in fmall apartments, the air not only becomes unwholefome, but the heat relaxes their folids, renders them delicate, and difpofes them to colds and many other diforders. Nor is the cuftom of wrapping them up too clofe in cradles, lefs pernicious. One would think tfu-t rcurfes were afraid left children fhould fuffer by breathing free air, as many of them aaually cover the child's face while afleep, and others wrap a covering over the whole cradle, by which means, the child is forced to breathe the fame air over and over, all the time it fleeps. Cradles indeed are on many accounts hurtful to children, and it would be better if the ufe of them were totally laid afidef. A child is generally laid to fleep with all its clothes en ; and if a number of others are heaped above them, it muft be overheated y by whjch means it cannot fail to catch cold on being taken out of the cradle, and expofed to the open air, with only its ufual clothing, which is too frequently the cafe. Children who are kept within door9 all day, and fleep all night in warm clofe apartments, may, with great propriety, be compar- ed to plants, nurfed in a hot-houfe, inftead of the open air. Though fuch plants may, by this means, be kept alive for fome time, they will never arrive at that degree of strength, vigour and magnitude,, which they would have acquired in the open air, nor would they be able to bear it afterwards, fhould they be expofed to it. Children, brought up in the country,who have been accuflomed 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 hurtful to their healths All fchools and feminafies of learning ought, if poffible, to' be fo fituated as to have frefh, dry, wholefome air, arid fhould never be too much crowded. Without entering into a detail of the particular advantages of wholefome air to children, or of the bad confequences which pro- ceed from the want of it, I fhall only obferve, that, of feveral thou- sands of children that have been under my care, I do not remem- ber one inftance of a fingle child, who continued healthy in a clofe confined fituation; but have often known the moft obftinate difeafes cured by removing them from fuch a fituation to an open free air. t It is amazing how children efcape fuffbeation, confidering the man- ner in which they are often rolled up in flannels, &c. I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I begged for a little free air to the poor babe ; but thoughfthis indulgence W3s granted during my ftay, I found it always on my return in the fame fituation. Death foon freed the infant from all its miferies ; but it was not in my power to free the minds of its parents from thofe prejudices which proved fatal to them child. I OF CHILDREN. Of Nurfes. IT is not here intended to lay down rules for the choice of nurfes. This would be wafting time. Common fenfe will direa everyone to choofe a woman who is healthy, and has plenty of milk*. If fhe be at the fame time cleanly, careful, and good-natured, fhe can hardly fail to make a proper nurfef. After all, however, the onlv certain proof of a igood nurfe, is a healthy child upon her breaft. But, as the mifcondua of nurfes often proves fatal to children, it will be of importance to point out a few of their moft baneful er- rors, in order to roufe th? attention of parents, and to make them 'look more ftriaiy into the condua of thofe to whom they commit the care of their infant offspring. Though it admits of fome exceptions, yet, we may lay it down cs a general rule, that every woman who nurfes for hire ought to be carefully looked after, otherwife fhe will not do her duty. For this reafon, parents ought always to have their children nurfed un- der their own eye, if poffible; and where this cannot be done, they fhould be extremely circumfpea in the choice of thofe perfons to whom they injruft them. It is folly to imagine that any womani who abandons her own child to fuckle another for the fake of gain, fhould feel all the affeaions of a parent towards her nurfling; yet fo neceffary are thefe affeaionsin a nurfe, that, but for them, the human race would be extina. One of the moft common faults of thofe who nurfe for hire, is to dofe children with ftupefaaives, or fuch things as lull them afleep. An indolent nurfe, who does not give a child fufficient ex- ercife in the open air to make it fleep, and does not choofe to be disturbed by it in the night, will feldom fail to procure for it a dofe of laudanum, diacodium, faffron, or, what anfwers the fame pur- pofe, a dram of fpirits, or other flrong liquors. Thefe, though they be certain poifon to infants, are every day adminiftered by many who bear the charaaer of very good nurfes;}:. A nurfe who has not milk enough, is apt to imagine that this de- fe& may be fupplied by giving the child wines, cordial-waters, or uther strong liquors. This is an egregious mistake. The only thing that has any chance to fupply the place of the nurfe's milk, muft te fomewhat nearly of the fame quality, as cow's milk, afs's milk, •X- I have often known people fo impofed upon, as to give an infant to a nurfe to be fuckled who had not one drop of milk in her breaft. f In addition to thefe qualifications, fhe mould be clear of any defor- mity about her eyes, fuch as fquintiiig, &c. as claildren are Very liable to contract unpleafant habits from their nurfes. (I. C.) t If a mother on vifiting her child at nurfe finds it always afleep, I would advife her to remove it immediately; otherwife, it will foon fleep its laft. 44. OF CHILDREN. or the like, with good bread. It never can be done by the help of flrong liquors. Thefe, inftead of nourifhing an infant, never fail to produce the contrary.effca. Children are often hurt by nurfes fuffering them to cry long and vehemently. This ftrains their tender bodies, and frequently oc- casions ruptures, inflammations of the throat, lungs, &c A child never continues to cry long without fome caufe, which might al- ways be difcovered by proper attention ; and the nurfe who can Shear an infant cry till it has almost fpent itfelf, without endeavour* jng to pleafe it, muft be cruel indeed, and is unworthy to be in- trusted with the care of an hurmn creature. Nurfes who deal much in'medicine are always to be fufpeaed. They trust to it, and neglea their duty. I never 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 de- feas in food, air, exercife and cieanlinefo. Allowing children to continue long wet, is another very perni- cious cuftom of indolent nurfes. This is not only difagreeable, but it galls, and frets the infant, and by relaxing the folids, occafions fchrophuhs, rickets, and other difeafes. A dirty nurfe is always to be fufpeaed. . 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 infeaious disorder. Accordingly, they take every method to drive them in. In this way many children lofe their lives ; as nature is oppofed in the very method that fhe takes to relieve them. A nurfe fhould never flop any eruption without proper advice, or being well affured that it as not of a critical nature. Ac any rate, it is never to be done with- out previous eyacuations. Loofe ftools are another method by which nature often prevents which may not be induced by intenfe thinking. But the moft affliaing of all the difeafes which attack the ftu- dious is the hypochondriac. This difeafe feldom fails to be the companion of deep thought. It may rather be called a complica- tion of maladies than a fingle one. To what a wretched condition are the beft of men often reduced by it! Their strength and appe- tite fail; a perpetual gloom hangs over their minds; they live in the conftant dread of death, and are continually in fearch of re- lief from medicine, where it is not to be found. Thofe who la- bour under this diforder, though they are often made the fubjea of ridicule, juftly claim our highest fympathy. Hardly any thing can be more prepofterous than for a perfon to make ftudy his fole bufinefs. A mere ftudem is feldom an ufe- H Sg OF THE LABORIOUS, THE SEDENTARY, ^Tmember of fociety. He often neglects the moft importanMlu- ties of life, in order to purfue studies of a very trifling nature. It rarely happens, that any ufeful invention is the effect of mere ftu- dy. The farther men dive into profound refearchef, they generally deviate the more from common fenfe, and too often lofe fight of It altogether. Profound fpeculations, inftead of making men, v. iter or better, generally render them abfolute fceptics, and overwhelm them with doubt and uncertainty. All that is neceffary for man to know, in order to be happy, is eafily obtained ; and the reft, like the forbidden fruit, ferves only to increafe his mifery. Studious perfons,' in order to relieve their minds, muft not only difcontinue to read and write, but engage in fome employment or diversion, that will fo far occupy the thought as to make them.for- get the bufinefs of the clofet. A folitary ride or walk are fo far from relaxing the mini, that they rather encourage thought. Nothing can divert the mind, when it gets into a train of ferious thinking, but attention to fubjeas cf a more trivial nature. 1 hefe prove a kincl of phy to the mind, and consequently relieve it. Learned men often contraa a contempt for what they call tri- fling company. They are afhamed to be feen with any butphilofo- phers. This is no proof of their "being, fo. No man deferves that riame who is afhamed to unbend his mind, by aflbe'iating with the che'crful'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 neceffaiily much within doors,they fhould make choice of a large and well-aired place for ftudy. This would net only prevent the bad effeas 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, that he ufed to retire to a dark cave to compofe his tragedies, and of Demoflhcnes, that he chofe a place for ftudy where nothing could be either^heard or, feen. With all deference to fuch venerable names, we cannot help condemning their tafte. A man may furely .think'to as good pur- pofe in an elegant apartment as in a cave ; and may have as happy conceptions where the all-cheering rays of the fun render the air wholefome, as in places where they never enter. Thofe who read or write much fhould be very attentive to their. pofture. They ought to fit and fland by turns, always keeping as nearly in-an ere& pofture as poffible. Thofe who diaate may do it walking. It has an excellent effea frequently to read or fpeak aloud. This not only cxercifes the lungs, but almoft the whole bo- dy. Hence ftudious people are greatly benefited by delivering dif- courfes in public. Public fpeakers, indeed, fometimes hurt them- felves by overaaing their part ; but this is their own fault. The martyr to mere vociferation merits no fympathy. The morning has been reckoned the beft time for ftudy. It is b. But it is alfo the moft proper feafon for exercife, while the fto- AND THE STUDIOUS. 50 rnach is empty, and the fpirits refrefhed with fleep. Studious peo- ple fliould fometimes fpend the morning in walking, ridingV or' fome manly diverfions without doors. This would make them re- turn to ftudy w ith greater alacrity, and would be of mote fervice than twice the time after their fpirits are worn out with fatigue. It isH*ot:fufficient to take diverfion only when we can think no Icnger. Every ftudious perfon fnould make it a part of his bufinefs, and fhould let nothing interrupt his hours of recreation more than thofe of ftudy. Mufic has a very happy effea in relieving the mind when-fa- tigued with ftudy. It would be well if every ftudious perfon were fo far acquainted withthat.fcience as to amufe himfelf after fevere thought, by playing fuch'airs as have- a tendency to raife the fpi- rits, and infp'ire cheerfulnefs and good humour. It is a reproach to learning, that any of her votaries, to relieve the mind after ftudy, fhculd betake themfelves to the ufe of flrong liquors. This indeed is a remedy ; but it is a defperate one, and al- ways proves deftruaive.- Would fuch perfons, when their fpirits are low,'get-oh horfebacks and ride .ten or a do^en miles, they would find it a more effeaual remedy, than any cordial medicine, or strong liquors. The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with ftudy, or other ferious bu- finefs, I mount my horfe, and ride ten or twelve miles into the coif.itry, where I fpend a day, and fometimes two, with a cheerful friend; after which I never fail to return to town with new vigour, and to purfue my ftudies or bufinefs with frefh alacrity! It is to be* regretted, that learned men, while in health, pay fo little regard to thefe things ! There is not any thing more com- mon than to fee a miferable objea over-run with nervouSrdifeafes, bathing, walking, riding, and doing everything for health after it is gone ; yet, if any one had recommended thefe things to him by way of prevention, the advice would, in all probability, have been treated with contempt, or at leaft, with negka. Such is the weak- ness and folly of mankind, and fuch the want of fore fight, even in thofe who ought to be wifer than others. With regard to'the'diet'of the ftudious, we fie no reafon why they fhould abftain from any k:nd of food that is wholefome, pro- vided they ufe it in moderation. They ought, however, to be fpa- ring in the ufe of every thing that is four, windy, rancid, or hard of digeftion. Their fuppers fhould always be light, or taken foon in the evening. Their drink may be water, fine malt-liquor, not too flrong, good cyder, wine and water, or, iftroubted with acidities, water mixed with a little brandy, rum, or any other genuine fpirit. With regard to thofe kinds of exercife which are*:moft proper for the ftudious, they fhould not be too violent, nor carried to ex- ceffiye fatigue. They ought to be frequently varied fo as to give aaion to all the different parts of the body; and fhouldj as often as 60 OF ALIMENT. poffible, be taken in the open air. In general, riding on horfeback, ■walking, working in a garden, or playing at fome aaive diverfions, are the beft. We recommend the ufe of the cold-bath to the ftudious. It will, in fome meafure, fupply the place of exercife, and fhould not be negleaed by perfons of a relaxed habit, efpecially in a warm feafon. No perfon ought either to take violent exercife, or to ftudy im- mediately after a full meal. CHAPTER III. Of Aliment. "T TNWHOLESOME food, and irregularities in diet, occafion \^J many difeafes. There is no doubt but the whole conftitu- tion of body may be changed by diet alone. The folids may be braced or relaxed, have their fenfibility, motion, &c. greatly in- creafed or diminifhed, by different kinds of aliment. A very fmall attention to thefe things will be fufficient to fhow, how much the prefervation of health depends upon a proper regimen of the diet. Nor is an attention to diet neceffary for the prefervation of health only: it is likewife of importance in the cure of difeafes. E*ery Intention in the cure of many difeafes, may be anfwered by diet alone. Its effeas, indeed, are not always fo quick as thofe of me- dicine, but they are generally more lafting : befides, it is neither fo difagreeable to the patient, nor fo dangerous as medicine, and is always more eafily obtained. Our intention is not to inquire minutely into the nature and properties of the various kinds of aliment in ufe among mankind; nor to fhow their effeas upon the different conftitutions of the hu- man body ; but to mark fome of the moft pernicious errors which people are apt to fall into, with refpea both to the quantity and qualities of their food, and to point out their influence upon health. It is not eafy to afcertain the exaa quantity of food proper for every age, fex, and conftitution : but a fcrupulous nicety here is not neceffary. The beft rule is to avoid all extremes. Mankind were never 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 is the chief rule with regard to the quantity, yet the quality of food merits a farther confideration. There are many ways iy which provifions may be rendered unwholefome. Bad feafons may either prevent the ripening of grain, or damage it afterwards. Thefe, indeed, are atts of Providence, and we muft fubmit to them ; but no punifhment can be too fevere for thofe OF ALIMENT; 6t who fuffer provisions to fpoil by hoarding them, on purpofe to raife the price, or who promote their own intereft by adulterating the neceffaries of life*. Animal, as well as vegetable food, may be rendered unwhole- fome, by being kept too long. All animal fubftances have a con- ftant tendency to putrefaaion ; and, when that has proceeded too far, they not only become offensive to the fenfes, but hurtful to health. Difeafed animals, and fuch as die of themfelves, ought ne- ver to be eaten. It is a common praaice in fome grazing countries, for fervants and poor people to eat fuch animals as die of difeafe, or are killed by accident. Poverty may oblige people to do this; but they had better eat a fmaller quantity of what is found and wholefome : it would both afford a better nourifhment, and be at- tended with lefs danger. The injunaions given to the Jews, not to eat any creature which died of itfelf, feem to have a ftria regard to health; and ought to be obferved by Chriftians as well as Jews. Animals never dte of themfelves without fome previous difeafe ; but how a difeafed animal fhould be wholefome food, is inconceivable: even thofe which die by accident muft be hurtful, as their blood is mixed with the flelh, and foon turns putrid. Animals which feed grofsly, as tame ducks, hogs, &c. are nei- ther fo eafily digefted, nor afford fuch wholefome nourifhment as others. No animal can be wholefome which does not take fufficient exercife Moft of our flailed cattle rre crammed with grofs food, but not allowed exercife nor free air; by which means they indeed grow fat, but their juices, not being properly prepared or aliimi* lated, remain crude, and occafion indigeltion , 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. For this reafon, butchers fhould be feverely reprimanded who over-drive their cattle. No perfon «ould choofe to eat the flefh of an animai which had died in a high fever; yet that is the cafe with all over-drove cattle ; and the fever is of- ten raifed even to the degree of madnefs. But this is not the only way by which butchers render meat un- wholefome. The abominable cuftom of filling the cellular mem- brane of animals with air, in order to make them appear fat, is every day praaifed. 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 a perfen of any delicacy at every thing which ■* The poor are generally the firft who fdFer by unfound provifions j but the lives of the labouring poor are of great importance to the ftate ; befides, difeafes occafioned by tuiwholefomefood often prove infectious, by which means they reach people in every ftation. It is therefore the intereft of all to calffe care :hr.t r.o fpoil: provifions of any kind be ex.- pofec] tp fale. 62 OF ALIMENT. comes from the fhambles. Who can bear the thought of eating meat which has been blown up with air from the lungs of a dirty fellow, perhaps labouring under the very worst of difeafes ? Butchers have likewife a method of filling the cellular mem- k branes of animals with blood. This makes the meat feem fatter, and likewife weigh more, but it is a very pernicious cuftom, as it both renders the meat unwholefome and unfit for keeping. I fet dom fee a piece of meat from-the fhambles, where the blood is not diftufed through the cellular texture. I fhall not fay that this is al- ways the effea of defign; but I am certain it is not the cafe with animals that are killed for domeftic ufe, and properly blooded.' Veal feems to be -moft frequently fpoilt in this way. Perhaps that may in fome meafure be owing to the praaice of carrying calves from a great diftance to'market, by which means their tender flefli is bruifed,and many of their veffels burft. No people in the world eat fuch quantities of animal food as the Englifh, which is one reafon why they are fo generally tainted with the fcurvy and its numerous train of confequences, indigeftion, low fpirits, hypochondriacifm, &c. Animal food was furely defigned for man, and with a proper mixture of, vegetables, it will he found the moft wholefome ; 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 flefli in twenty-four hours, and this ought to confift of one kind only. The moft obftinate fcurvy has often been cured by a vegetable' diet; nay, milk alone will frequently do more in that difeafe than any medicine. If vegetables and milk were more ufed in diet, we fhould have lefs fcurvy, and likewife fewer putrid and inflammato-.. ry fevers. Frefh vegetables, indeed, come to be daily more ufed in diet: This laudable praaice we hope will continue to gain ground. Our aliment ought neither to be too moift nor-too dry. Moist aliment relaxes the folids, and renders the body feeble. Thus, fe- males, who live much on tea, and other watery diet, generally be- come weak, and unable to digeft folid food : Hence proceed hyfte- rics, and all their confequences. On the other hand, food that is too dry, renders the folids in a manner rigid, and the humours vif- cid, which difpofes the body to inflammatory fevers, fcurvies, and the like. Much has been faid on the HI effeas 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. Moft delicate perfons, who are the greateft tea-drinkers, cannot eat any thing in the morning. If fuch perfons, after faffing ten or twelve hours, drink four or five eups of tea, without eating almoft any bread, it muft hurt them. Good tea, taken in moderate quantity, not too ftrong, nor too hot, nor drank upon an empty ftomach, will feldom do harm ; but if it be bad, or fubftituted in the room of folid food, it muft have many ill effeas. OF ALIMENT. ffj. The arts of cookery render many things unwholefome, which • are not fo in their own nature. By jumbling together a number ofe different ingredients, in order to make a poignant Luce or rich foup, the compofition proves almost a poifon. Ali high feafoning, pickles, &c are only incentives to luxury, and hurt the ftomach. Iz i;j were well, if cookery as an art were prohibited. Plain roasting or boiling is all that the ftomach requires. Thefe alone are fufficienS for people in health, and the fick have ftill lefs need of a cook. The liquid part of oar aliment likewife claims our attention^ Water is -not only the bafis of moft liquors, but alfo cornpofes 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 cf foreign bodies. Water takes up parts of moft bodies with which it comes into contaa ; by thitJ means, it is often .impregnated with metals or minerals of a hurtful or poifonous nature. Hence the inhabitants of 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 in their necks. This difeafe is generally imputed to the fnow-water ; but it is rather owing to the minerals in the mountains through which the waters pafs. When water is impregnated with foreign bodies, it generally appears by its weight, colour, tafte, fmell, heat, or fome other fenfible quality. Our bufinefs is to choofe fuch water, for common ufe, as is lighteft, and without any particular colour, tafte, or fmell. In moft places of Britain the inhabitants have their choice of wa- ter ; and few things would contribute more to health than a duo, attention to this article. Indolence often induces people to make ufe of the water that is nearest, without confideringits qualities. Before water be brought into great towns, the ftriacift attention ought to be paid to its qualities, as many difeafes may be occa- fioned or aggravated by bad water ; and when once procured at a great 'expenfe, people are unwiliing^to give it up. The common methods of rendering water clear by filtration, or foft, by expofing it to the fun and air, &c. arc generally known. We fhall only advife all to avoid waters which ftagnate long in fmall lakes,ponds,or the like; as fuch waters often become putrid,by the corruption of animal and vegetable bodies with which they abound. Even cattle frequently fuffer by drinking, in dry feafons, water which has flood long in fmall refervoirs, without being fupplied. by fprings or frefhened with fhowers. All wells ought to be kept clean, and to have a free communication with the air. Fermented liquors, though exclaimed againft by many,writers, continue to be the cdtomon drink of almoft every perfon who can afford them : We fhall rather endeavour to affift people in the choice of thofe liquors, th?.n pretend to condemn wiiat cuftom has » fo firmly eftablifned. It is not the moderate ufe of found ferment 64 OF ALIMENT. liquors which hurts mankind : It is excefs, and ufing fuch as are ill prepared or vitiated. . Fermented liquors, which are too flrong, hurt digestion ; and the body is fo far from being strengthened by them, thac it is weak- ened and relaxed. Many imagine that hard labour could not be fupported without drinking flrong liquors : This is a very errone- ous notion. Men who never tafte strong liquors are not only able to endure more fatigue, but alfo live much longer, than thofe who ufe them daily. But, fuppofe strong 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 fyftem, and difpofes the body to numberlefs difeafe?. But fermented liquors may be too weak as well as too ftrong : when that is the cafe, they muft be either drank new, or they be- come four and dead ; when fuch liquors are drank new, the fer- mentation not being over, they generate air in the bowels, and oc-j cafion flatulencies; and, when kept till ftale, they four on the fto- mach, and hurt digestion. For this reafon, all mait-diquors, cider, &c. ought to be of fuch strength, as to keep till they are ripe, and then they fhould be ufed. When fuch liquors are kept too long, though they fhould not become four, yet they generally contraa a hardnefs, which renders them unwholefome. All families, who can,ought to prepare their own liquors. 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 objea both to the makers and venders cf liquor is, to render it intoxicating. But it is well known that this may be done by other ingredients than thofe which ought to be ufed for making it flrong. 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 praaice is very common, and that all the ingredients ufed for this purpofe are of a narcotic or ftupefaaive quality. But as all opiates are poifonous, 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. Were fermented liquors faithfully prepared, kept to a proper age, and ufed in moderation, they would prove real bleffings to mankind. But, while they are ill prepared, various ways adulte- rated, and taken to excefs, they muft have many pernicious effects. We recommend it to families, not only to prepare their own liquors, but their bread. Bread is fo neceffary a part of diet, that too much care cannot be beftowed in order to have it found and wholefome. For this purpofe, it is not only neceffary that it be made of good grain, but likewife properly prepared, and kept free from all unwholefome ingredients. This is not always the cafe with bread prepared by thofe who make a trade of vending it. Their object is rather to pleafe the eye, than to confult the h^lth* OF ALIMENT. 6c fhe 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 constitu- tions would far exceed our defign. We fhall only mention the fol- lowing eafy rules with refpea to the choice of aliment. Perfons, whofe foiids are weak and relaxed, ought to avoid all vif- cid food, or fuch things as are hard of digestion. Their diet ought to be nourifhing, and they fliould take fufficient exercife in the open air. Such as abound with blood fhould be fparing in every thing that is highly nourifhing, as fat meat, rich wines, ftrong ale, and fuch like. Their food fhould oonfift mostly of bread and other vegetable fubftances ; and their drink ought to be water, whey, or fmall-beer- Fat people fhould not eat lreely of oily nourifhing diet. They ought frequently to ufe radifh, garlic, fpices, or fuch things as are heating and promote perspiration and urine. Their drink fhould be water, cofTae, tea, or the like ; they ought to take much exer- cife, and little fleep. Thofe who are too lean muft follow an op- pofite courfe. Such as are troubled with acidities, or whofe food is apt to four on the ftomach, fhould live much on animal food; and thofe afflia- ed with hot alkaline eruaations, ought to ufe a diet confiftkig chiefly of acid vegetables. People affcaed with the gout, low fpirits, hypochondriac or hyfteric diforders, ought to avoid all flatulent food, every thing that is vifcid, or hard of digestion, all falted or fmoke-dried provifions, and whatever is auftere, acid, or apt to four on the ftomach. Their food fhould be light, fpare, cool, and of ;m opening nature. The diet ought to be fuited to the age,~conftitution, and manner of life: A fedentary or ftudious perfon fhould live more fparingly than one who labours hard without doors. Many kinds of food will nourifh a peafant very wSll, which would be almost indigestible to a citizen ; and the latter will live upon a diet on which the former would starve. - Diet ought not to be. too uniform. The conftant ufe of one kind of food might have fome bad effeas. Nature teaches us this, by the great variety of aliment which fhe has provided for man, and likewife by giving him an appetite for different kinds of food. Thofe who labour under any particular difeafe, ought to avoid fuch aliments as have a tendency to increafe it: For example, a gouty perfon fhould not indulge in rich wines, ftrong foups or gra- vies, and fhould avoid all acids. One who is troubled with the gravel ought to fhim all auftere and aftringent aliments; and thofe who are fcorbutic fhould be fparing in the ufe of falted provifions. In the firft period of life, our food ought to be light, nourifhing, andtfrequently taken. Food that is folid* with a fufficient degree f 66 OF ALIMENT. of tenacity, is moft proper for the ftate of manhood., The diet fuited to the laft period of Hfe, when nature is upon the decline, approaches nearly to that of the firft. It fhould be lighter and more fucculent than that of vigorous age, and likewife more frequently taken. It is not only neceffary for health that our diet be wholefome, but alfo that it be taken at regular periods. Some imagine long faft- ing will atone for excefs ; but this, inftead of mending the matter, generally makes it worfe. When ihe ftomach and inteflines are over-diftended with food, they lofe their proper tone, and, by long fafting, they become weak, and inflated with wind, thus, either gluttony of fafting destroys the powers ofdigeltion. The frequent repetition of aliment is not only neceffary for re- pairing the continual wafte of our bodies, but likewife to keep the fluids found' and fweet. Our humours, even in the mofl healthy ftate, have a conftant tendency to putrefaaion, which can only be prevented by frequent fupplies of frefh nourifhment: when that is wanting roo long, the putrefaaion often proceeds fo far as to occa- •fion very dangerous fevers. From hence we may learn the neceffi- ty 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. v Long fafting is extremely hurtful to young people ; it not only vitiates their humours, but prevents their growth. Nor is it lefs in- jurious to the aged. Moft perfons, in the decline of life, are afflia- ed with wind: This complaint is not only increafed, but rendered dangerous, and often fatal, by long fafting. Old people, when their ftomachs are empty, are frequently feized with giddinefs, head- achs, and faintnefs. Thefe complaints may generally be removed by a piece of bread and a glafs of wine, or taking any other folid food ; which plainly points out the method of preventing them. Many of the fudden deaths, which happen in the advanced pe- riods of life, are occafioned by fafting too long, as it exhaufts the fpirits, and fills the bowels with wind ; we would therefore advife people in the declineof life, never to allow their ftomachs to be too long empty. Many people take nothing but »few cups of tea and a little bread, from nine o'clock at night till two or three next after- noon. Such may be faid to faft almost three-fourths of their time. This can hardly fail to ruin the appetite, and fill the bowels with wind ; all which might be prevented by a folid breakfaft. It is very common to eat a light breakfaft and a heavy fupper. This cuftom ought to be reverfed. When people fup late, their fupper fhould be very light; but the breakfaft ought always to be folid. If any one eats alight fupper, goes foon to bed, and rifes'be- times 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 fuffer fo much from fafting as the weak and delicate; but they run great hazard from its opp^ite, OF AIR. 6y viz. repletion. Many difeafes, efpecially fevers, are the effect of a .plethora, or too great fulnefs 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 diftended, and ob- ftruaions and inflammations enfue. Hence fo many people arefciz- ed with inflammatory and eruptive fevers after a feafl or debauch. All great and fudden changes in diet are dangerous. What the ftomach has been long accuftumed to digest, though lefs whole- fome, will agree better with it than food of a more falutary nature which it has not been ufed to. When a change becomes neceffary, it ought to be made gradually ; a fudden tranfition from a poor and low, to a rich and luxurious diet, or the contrary, might fo dilturb the funaions of the body, as to endanger health, or even to occafion death itfelf. When we recommend regularity in diet, we condemn not every fmall deviation. It is next to Impofiible 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 be prudent •to vary a little, fometimes-taking more, fometimes lefs, than the ufual quantity of meat and drink, if due regard be hv.d to modera- tion. C HAPTER IV. Of Air. UNWHOLESOME air is a very common caufe of difeafes. Few are aware of the danger arifing from it. People gene- rally pay fome attention to what they eat and drink, but feldom. ,regard what goes into the lungs, though the latter often proves more fuddenlv fatal-than the former. Air, as well as water, takes up parts of moft bodies with whic;h it comes into contaa, and is often fo replenifiied with thofe of a, noxious quality, as to occafion immediate death. -But fuch^violent effeas feldom happen, as people are generally on their guardagainft them. The lefs perceptible influences of bad air, prove more ge- nerally hurtful to mankind ; we fhall point out fome of thefe, and .ihow from whence the danger chiefly arifes. Air may become noxious many ways. Whatever greatly alters its degreeof heat, cold, moisture, &c. renders it unwholefome. Ve- ry cold air obftruas the perfpiration, conftringes the folids, and occafions rheumatifms, coughs, and catarrhs, with other difeafes of |he throat and breaft. Air that is too moiit deftroys the elalti- 68 • OF AIR. city or fpring of the folids, induces phlegmatic or lax constitutions, and difpofes the body to agues; or intermitting fevers, dropsies, &c Wherever great numbers of people are crowded into one place, ifj;he air has net a free circulation, it foon becomes unwholefome. Hence it is that delicate perfons are fo apt to turn fick or faint in crowded churches, affemblies, or any place where the air is in- jured by breathing, fires, candles, or the like. In great cities, fo many things tend to contaminate 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 is like\fife loaded with fulphur, fmoke, and other exhalations, befides the vapours continually arising from innumerable putrid fubftances, as dung- hills, flaughter-houfes, &c. All poffible care fhould be taken to keep the ftreets ol 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 the air of a city than dirty ftreets. It is vcy common in this country to have church-yards in the middle of populous cities. Whether this be the effect 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. Habit alone reconciles us to thefe things; by means of which the moft ridiculous, nay, pernicious cuftoms, often become facred. Thou- fands of putrid carcaffes, fo near the furface of the earth, in a place whete the air is confined, cannot fail to taint it; and fuch air, when breathed into the lungs, muft occafion difeafes*. Burying within churches is a praaice ftill more deteftable. The air in churches is feldom good, and the effluvia from putrid car- caffes muft render it ftill worfe. Churches are commonly old build- ings with arched roofs. They are feldom opened above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occafions that damp, mufty, unwholefome fmell < which one feels upon entering a church, and renders it a very un- fafe place for the weak and valetudinary. Thefe inconveniences might, in a great meafure, be obviated, by prohibiting all perfom from burying within churches, by keeping them clean, and permit- ting a stream of frefh air to pafs frequently through them, by open- ing oppofite doors and windows. Wherever air ftagnates long, it becomes unwholefome. Hence perforate confined in jails not only contraa malignant fevers them- felves, but often communicate them to others. Nor are many of the holes, for we cannot call them houfes, poffefled by the poor |n great towns, much better than jails. Thefe low dirty habitations *■ In moft eaftern countries, it wascuftomary to bury the dead at fome. diftauce from any town. As this practice obtained among the Jews, the Greek', and alfo the Romans, it is ftrange that the weftern parts of Eu- rope fhould not feave followed their example in a cuftom fo truly laudable! 'OF AIR. 69 are th,e very lurking-places of bad air and contagious difeafes. Such as live in them feldom enjoy good health; and their children com- monly die young. In the choice of a houfe, thofe who have it ia their power ought to pay the greateft attention to open free air. The various methods which luxury has invented to make "houfes clofe and warm, contribute 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 op- pofite 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 frefli air from the open windows through the day. This would expel any noxious vapour, and promote the health of the inhabitants. In hofpitals, jails, fhips, &c. where that cannot be conveniently- done, ventilators fhould be ufed. The method of expelling foul, and introducing frefh air, by means of ventilators, is a moft falu- tary invention, and the moft ufeful of all modern medical improve- ments. It is capable of univerfal application, and is fraught with numerous advantages, both to thofe in health and ficknefs. In all places where numbers of people are crowded together, ventilation becomes abfolutely neceffary. Air which ftagnates in mines, wells, cellars, &c. is extremely noxious, and ought to be avoided as the moft deadly poifon. It of- ten kills almoft as quickly as lightning. For this reafon, people fhould be very cautious in opening cellars that have been long (hut, or going down into deep wells or pits, efpecially if they have been kept clofe covered*. s Many people who have fblendid houfes, choofe to fleep in fmall apartments. This is very imprudent. A bed-chamber ought always to be well aired ; as it is generally occupied in the night only, when all doors and windows are fhut. If a fire be kept in it, the danger from a fmall room becomes ftill greater. Numbers have been ftifled when afleep by a fire in a fmall apartment, which is always hurtful. Thofe who are obliged, on account of bufinefs, to fpend the day in clofe towns, ought, if poffible, to fleep in the country. Breath- ing free aiif in the night will, in fome meafure, make up for the want of it through the day. This praaice would have a greater effea in preferving the health of citizens than is commonly ima- gined. , Delicate perfons ought, as much as poffible, to avoid the air ot great towns. It is peculiarly hurtful to the aftmatic and confump- tive. Such perfons fhould avoid cities as they would the plague. * We have frequent accounts of perfons who lofe their lives by g.ing down into deep wells and other places where the air ftagnates ; all thefe accidents might be prevented by only letting down a lighted cam&be- fore them, and flopping when they perceive it go out; yet thwumple precaution is firldom ufed. 7» OF AIR. The hypochondriac are likewife much hurt by it. Perfons, fo much affliaed with this malady while in town, that it feemed impofiible •'for them to live, have, upon removing to the country, been imme- diately relieved. The fame obfervation holds as to nervous and hy- fteric women. Many people have it not in their power to change their fituation in quest of better air. All we can fiiy to fuch perfons 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 ob- ■ftructing the free current of air, render fuch places damp and un- wholefome. Proper attention to air and cleanlinefs would tend more to preferve the. health of mankind, than all the endeavours -of the faculty. Surrounding houfes too clofely with planting, or thick wood*, likewife tends to render the a%r unwholefome. Wood not only ob- ftruas the free curient of air; but fends forth great quantities of moift exhalations, which render it conftantly damp. Wood is ve- ry agreeable at a proper diftance from a houfe, but fhould never •be planted too near it, efpecially in a flat country. Many gentle- men's feats in England are very unwholefome from the great quan- tity of wood which furroundi them. Houfes fituated in low ma^fhy countries, or near large lakes of ftagnating water, are likewife unwholefome. Waters which ftag- nate not only render the air damp, but load it with putrid exhala- tions, which produce the moft dangerous and fatal difeafes. Thofe obliged to inhabit marfhy countries, ought to make choice of the driest fituation they can find., to live generoufly, and to pay the ftriaeft 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 common, that one can hard- 3y enter the chamber where a patient lies, without being ready to faint, from the hot fuffocating fmell. How this muft affea 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 adminiftered with prudence. We are not to throw open doors and windows at random upon the fick. Frefh air is to be let into the chamber gradually, and, rif poffible, by opening the windows of fome other apartment. The.air of a fick perfon's chamber may be greatly frefhened, and the patient much revived, by fprinkling the floor, bed, &c frequently with vinegar, juice of lemon, or any other ftrong ve- getable acid. & Where numbers of fick are crowded into the fame houfe, or, into the fame apartment, the frequent admiffion of frefh air be- comes abfolutely neceffary. Infirmaries, hofpitals, &c. are often OF EXERCISE. yi rendered fo obnoxious, for vant of proper ventilation, that the fick run more hazard from them than from the difeafe. This is particularly the cafe when putrid fevers, dyfenteries, and other infeaious difeafes prevail. Phyficians, furgeons, and others who attend hofpitals, ou<*ht, for their own fafety, to take care that they be properly ventilated. Such perfons as are obliged to fpend moil of their time amongst the fick, run great hazard of being themfelves infected when the air is tad. All hofpitals, and places of reception for the fick, ought to have an open fituation, at fome diftance from any great town, and patients under an infeaious difeafe ought n.ver to come near the reit. CHAPTER V. Of Exercife* ' MANY people look upon the neceffity man is under of earn- ing his bread by labour, as a curfe. But it is evident from the ftruaure of the body, that exercife is not lefs neceffary than food for the prefervation of health: thofe whom poverty obliges to labour for daily bread, are not only the moft, healthy, but gene- rally the moft happy part of mankind. Induftry feldom fails fo place fuch above want, and aaivity ferves them inftead of phyfic. This is peculiarly the cafe with thofe who live by the culture of the ground. The great increafe of inhabitants in.infant colonies, and the longevity of fuch as follow agriculture every where, prove it to be the moft healthful as well as the moft ufeful employment. The love of aaivity fhows itfelf very early in man. So ftrOng is this principle, that a healthy vouth cannot be restrained from exercife, even by the fsar of puniihment. Our love of motion is a ftrong proof of its utility. Nature implants no difpofition in vain. It feems to be a law throughout the animal creation, that' no creature, without exercife, fhould enjoy health, or be able to find fi^>fiftence. Every creature, except man, tikes what is ne- cefTary. He alone, and fuch animals as are under his direaion, deviate from this original law, and they fuffer accordingly. Inaaivity never fails to induce an univerfal relaxation of the folids, which difpofes the body to innumerable difeafes. When m the folids are relaxed, neither the digeftion, nor any of the fee re- turns, can be duly performed. In this cafe, the worft confequen- ces muft enfue. How can perfons who loll all the day in eafy chair*, and fleep all night on beds of down, fail to be relaxed ? 7a OF EXERCISE. Nor do fuch greatly mend the matter, who never stir abroad but in a coach, fedan, or fuch like. Thefe elegant pi-• x s of luxury are become fo common, that the inhabitants of great towns 1 em to be in fome danger of lofing the ufe of their limbs altogether. It is now below any one to walk, who can afford to be carried. How ridiculous would it feem, to a perfon unacquainted with modern luxury, to behold the young and healthy fwinging along on the fhoulders of their fellow-creatures ! or to fee a fat carcafe, over- run with difeafes occafioned by inaaivity, dragged thrc *^h the' ftreets by half a dozen horfes* ! Glandular obftruaions, now fo common, generally proceed from inaaivity. Thefe are the moft obftinate of maladies. So long as the liver, kidnies, and other glands, duly perform their func- tions, health is feldom impaired; but when they fail, nothing can reftore it. Exercife is almoft the only cure we know for glandular obftruaions ; 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 exercife, glandular difeafes are very little known ; whereas the indolent and inaaive are fektom free from them. Weak nerves are the conftant companions of inaaivity. Nothing but exercife and open air can brace and strengthen the nerves, or prevent the endlefs train of difeafes which proceed from a relaxed ilate of thefe organs. We feldom hear_thie aaive or laborious com- plain of nervous difeafes; thefe are referved for the fons of eafe and affluence. Many have been completely cured of thefe diforders by being reduced 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 impofiible to enjoy health, where the perspira- tion is not duly carried on; but that can never be the cafe where" exercife is negleaed. When the matter which ought to be thrown off by perfpiration is retained in the body, it occafions fevers, rheu- matifm, &c. Exercife alone would prevent many of thofe difeafes which cannot be cured, and would remove others where medicine proves ineffeaual. Doaor Cheyne fays, that the weak and valetudinary ought to make exercife a part of their religion. We recommend this not only to the weak and valetudinary, but to all thofe whofe bufinefs does not oblige them to take fufficient exercife, as fedentary artifi- -X- It is not necefiity, but faflnon, which makes the ufe of carriages fo common. Many people have not exercife enough to keep their humours from ftagnation, who yet dare not venture to make a vifit to their next neighbours, but in a coach or fedan, left they fhoiild be look- ed down upon. Strange, that men fliould be fuch fools as to be laughed •out of the ufe of their limbs, or to throw away their health, in order to gratify a piece of vanity, or to comply with a ridiculous fafliion J OP EXERCISE. 73 ^cers*, fhop-keepers, ftudious perfons, &c. Such ought to ufe ex- ercife as regularly as they take food. This might generally be done without any interruption to bufinefs or real lofs of time. No piece of indolence hurts the health more than the modem cuftom of lying a-bed too long in the morning. This is the general praaice in great towns. The inhabitants of cities feldom rife be- fore eight or nine o'clock; but the morning is undoubtedly the beft time for exercife, while the ftomach is empty, and the body refrefhed with fleep. Befides, the morning-air braces and ftrength- ens the nerves,*and,in fome meafure,anfwers the purpofe of a cold- bath. Let anyone who has been accuftomed to lie a-bed till eight or nine o'clock, rife by fix or feven, fpend a couple of hours in walking, riding, or any aaive diverfion without doors, and he will find his fpirits cheerful and ferene through the day, his appe- tite keen, and his body braced and strengthened. Cuftom foon renders early-rifing agreeable, and nothing contributes more to the prefervation of health. The inaaive are continually complaining of pains of the fto- mach, flatulencies, indigeftions, &c. Thefe complaints, which pave the way to many others, are not to be removed by medi- cines. They can only be cured by a vigorous courfe of exercife, to which .indeed they feldom fail to yield. Exercife, if poffible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercising the body within doors, as the dumb-bell, dancing, Twing- ing, &c. It is not neceffary to adhere ftriaiy to any particular kind of exercife. The beft way is to take them by turns, and to life that longest which is moft fuitable to the ftrength and confti- tution. Thofe kinds of exercife which give aaion to moft of the bodily organs, are always to be preferred, as walking, running, riding, fencing, digging, fwimming, and fuch like. It is much to be regretted, that aaive and manly diversions are how fo little praaifed. Diversions make people take more ex- ercife than th~y other wife would do, and are of the greateft fer- vice to fuch as are not under the neceffity of labouring for their * Sedentary occupations ought chiefly to be followed by Women. They bear confinement much better than men, and are fitter for every kind of bufinefs which does not require much ftrength. It is ridiculous enough to fee a lufty fellow making pins, needles, or watch.wheels, While many of the laborious parts of husbandry are carried on by the 6ther fex. We want men for laborious employments, while one half of the other fex are rendered ufelefs for want of occupations fuited to their ftrength, &c. Were girls bred to mechanical employments, we would not fee fuch numbers proftitute themfelves for bread, nor find fuch a want of men for the important purpofes of navigation, agriculture, &c. An eminent filk manufacturer told me, that he found women anfwei1 better for that bufinefs than men ; and that he had lately taken a greaf many girls apprentices as filk-weavers. I hope this example will be fo\» lowed by many others. 74 OF EXERCISE. br^ad. As aaive diverfions lofe ground, thofe of a fedentary kind feem to pre-, il. Sedentary diverfions are of no other ufe but to confume time. Inftead 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, hunting, mooting, playing at cricket, hand-ball, &c Thefe exercife the limbs,, promote perforation, and the other fecretions.They like- wife ftrengthen the lungs, ;:nd give firmnefs and agility to the :whole body. Such as can, ought to fpend two or three hours a-day on horfe- back; thofe who cannot ride, fhould employ the fame time in walking. Etf&rcife fhould never be continued too long. Over- fatigue^prevents the benefit of exercife, and inftead of strengthen- ing the body, tends to weaken it: Every man fhould lay himfelf under fome fort of neceffity to take exercife. Indolence, like other vices when indulged, gains ground, andut length becomes agreeable. Hence, many who were fond of exercife in the early part of life, become quite averfe from it af- terwards. This is the cafe of moft hypochondriac and gouty peo- ple, 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 employment. Whether fuch laws were defigned for the prefervation of he; 1th, or the en- couragement of manufaaures, is of no importance.. If gentlemen were frequently to amufe and exercife themfelves in this way,it might have many good effeas. The')-' would at leaft derive as much honour from a few maftcfly fpecimens of their own work- manfhip, as from the charaaer of having ruined moft or* their companions by gaming or drinking. Befides, men of leifure, by applying themfelves to the mechanical arts, might improve them, to the great benefit of fociety. Indolence not only occafions difeafes, and renders men ufelefs to fociety, but promotes all nrannei of vice. To fay a man is idle, is little better than calling him vicious. The mind, it not engaged in fome ufeful purfuit, is conftantly in queft of idle pleafures, or -impreffed with the npprehenfion of fome imaginary evil. From • thefe fources proceed moft of the miferies of mankind. Certainly man was never intended to be idle. Inaaivity frustrates the very ■ defign of his creation ; whereas an aaive life is the beft guardian of virtue, and the greateft prefervative of health. - "[75 3 CHAPTER VI. Of Sleep and Clothing. (T* LEEP, as well as diet, ought to be duly regulated. Too li' tie i^3 'fleep weakens the nerves, exhaults the fpirits, and occafions difeafes ; and too much renders the mind dull, the.body grofs, and difpofes to apoplexies, lethargies, and other complaints of a similar nature. A medium ought 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. Befides, the real quantity of fleep cannot be meafured by time ; as one perfon will be more refrefhed by five or fix hours of 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 certainly fufficient, and no one ought to exceed eight. Thofe v/ho lie a-bed more than eight hours may fliimber, but they can hardly be faid to fleep ; fuch generally tofs and dream away the fore-part of the night, fink to reft towards morning, and doze till noon. The beft way to make fleep found and refrefhing is to rife betimes. The cuftom of lying a-bed for nine or ten hours, not only makes die fleep lefs refrefhing, but relaxes the folids, and greatly weakens the confti- tution. Nature points out night as the proper feafon for fleep. Nothing more certainly destroys the conftitution than night-watching. It is great pity that a praaice fo deftruaive to health fliould be fo much m fafhion. How quickly the want of reft in due feafon will blaft the moft blooming complexion, or ruin the belt conftitution, is evident from the ghaftly countenances of thofe, who, as the phrafe is, turn day into night, and night into day. To make fleep refrefhing, the following things are requifite : Firft, to take fufficient exercife in the open air; to avoid ftrong tea or coffee ; next, to eat a light fupper ; and lastly, 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 aaive and laborious complain of reitlefs nights. It is the indolent and flothful who generally l^ave thefe complaints. Is it any wonder that a bed of down fhould not be refrefhing to a perfon who fits all day* in an eafy chair ? A great part of the pleafure of life confifts in alternate reft and motion ; but they who neglea the latter can never relifh the former. The labourer enjoys more true luxury in plain food and found fleep, than is to be found in fumptuous tables and downy pillows, where exercife is wanting. That light fuppers caufe found fleep, is true even to a proverb. Many periods, if they exceed the leaft at that meal, are fure to have uneafy nights ; and, if they-fall afleep, the load and onprcffion 76 OF SLEEP AND CLOTHING. on their ftomach and fpirits occafion frightful dreams, broken and disturbed repofe, the night-mare, &e. Were the fame perfons to go to bed with a light fupper, or fit up till that meal was pretty well digefted, they would enjoy found fleep, and rife refrefhed and cheerful. There are indeed fome people who cannot fleep unlefa they have ate fome folid food at night, but this does not imply the neceffity of a heavy fupper ; befides, thefe are generally perfons who have accuftomf d themfelves to this method, and who do not take a fufficient quantity of folid food and exercife. Nothing more certainly disturbs our repofe than anxiety. When the mind is not at eafe, one feldom enjoys found fleep. That Greatest of human bleffings flies the wretched, and vifits the hap- py, the cheerful, and the gay. This is a fufficient reafon why every man fhculd 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 generally reckoned moft refrefhing. Whether this be the effea of habit or not, is hard to fay; but as moft people are accuftomed to go early to bed when young, it may be prefumed that fleep, at this feafon, will prove moft refrefhing to them ever after. Whether the fore- part of the night be beft for fleep or not, furely the fore-part of the day is fittest both for bufinefs and amufement. I hardly ever knew ar. early rifer who did not enjoy a good ftate of health*. Of Clothing. THE clothing ought to be fuited to the climate. Cuftom has :< very great influence in this artilcle ; but no cuftom can ever change the nature of things fo far, as to render the fame clothing fit for an inhabitant of Nova Zembla and Jamaica. It is not ne- ceffary to obferve an exaa proportion betwixt the quantity of clothes we wear, and the degree of latitude which we inhabit; but, at the fame time, proper attention ought to be paid it, as well as to the opennefs of the country, the frequency and vio- lence of ftorms, &c. In youth, while the perfpiration is free, it is lefs neceffary to cover the body with a great quantity of clothes ; but, in the de- cline of life, when the fkin becomes rigid, the clothing fhould be increafed. Many difeafes in the latter period of life proceed from a defect of perfpiration : thefe may, in fome meafure, be prevent- ->- Men of every occupation, and in every fituation of life, have lived io a good oUi age ; nay, fome have enjoyed this bleffing whofe plan of ii\ing was by no means regular : but it confifts with obfvrvation, that «ll very old men have been early rifers. This is the only circumftanct i*U"HdingJf»ngevity, to Much J never knew 411 exception-. OF SLEEP AND CLOTHING. e3 by a fuitable addition fo the clothing, or by wearing fuch as are better calculated for promoting the difcharge from the fkin, as clothes made of cotton, flannel, £:c. The clothing ought to be fuited to the feafon of the year. Clo- thing may be warm enough for fummer, which is not fufficient for winter. The greateft caution 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 rigour, and we have frequently cool weather even after the commencement of the fummer months. It would likewife be prudent not to make the change all at once, but to do it gradually ; and indeed the changes of apparel in this climate ought to be very inconsiderable, efpeci- ally 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 have con- fidered clothes in this view; their fafhion and figure have been continually varying, with very little regard either to health, cli- mate, or conveniency. Even the human fhape is often attempted to be mended by drefs,' and thofe who know no better believe that mankind would be monsters without its affiftance. All attempts of this nature are highly pernicious. The moft deftruaive of them in this coun- try is that of fqueezing the ftomach and bowels into as narrow a compafs as poffible, to procure, what is falfely called a fine fhape. By this pra6tice the aaion of the ftomach and bowels, the motion of the heart and lungs, and almoft all the vital funaions, are ob- ftruaed. Hence proceed indigestions, fyncopes, or fainting fits, coughs, confumptions of the lungs, and other complaints fo com- mon among females. The feet likewife often fuffer by preffure. How a fmall foot came to be reckoned genteel, I will not pretend to fay ; but this notion has made many perfons lame. Almoft nine-tenths of man- kind are troubled with corns: a difeafe that is feldom or never occafioned but by ftrait fhoes. Corns are not only very trouble- fome, but, by rendering people unable to walk, they may likewife be confidered as the remote caufe of other difeafesf. * That colds kill more than plagues, is an old obfervation ; and, with regard to this country, it holds ftri&ly true. Every perfon of difcernment, will perceive, that moft of the colds which prove fo def„ tru£tive to the inhabitants, are owing to their imprudence in changing clothes. A few warm days in March or April induce them to throw off their winter garments, without confidering that our moft penetrating colds generally happen in May. t We often fee perfons quite lame by the nails of their toes havir.^ grown into the flefli, and frequently hear of mortifications proceeding from this caufe. All thefe, and many other inconveniencies attending the feet, myft be imputed folely te the ufe of fhorr, and ftrait ftiaes. 78 OF SLEEP AND CLOTHING. ~The fize and figure of thefhoe ought certainly to be adapted to, the foot. In children the feet are as well fhaped as the hands, and the motion of the toes as free and eafy as that of the fingers; yet few perfons in the advanced periods of life are abk to make any ufe of their toes. They are generally, by narrow fhoes, fqueeaed all-of-a-heap, and often laid over one-another in fuch a manner a* to be rendered altogether incapable of motion. Nor is the high heel lefs hurtful than the narrow toe. A lady may feem taller for walking on her tiptoes, but fhe will never walk well in this man- ner. Jt ftrains her joints; distorts her limbs, makes her Hoop, and utterly deftroys all her eafe and gracefulnefs of motion : It is -entirely owing to fhoes with high heels and narrow toes, that not one female in ten can be faid to walk well. In fixing on the clothes, due care fliould -be taken to avoid all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free motion and ufe of the parts about which they* are bound, but likewife obftrua the circulation of the blood, which, prevents the equal nourifhment and growth of thefe parts, and oc- cafions various difeafes. Ti^ht bandages about the rieck, as flocks* cravats, necklaces, &c. are extremely dangerous. They obftrua the' blood in its courfe from the brain, by which means head-achs, ver- tigos, apoplexies, and other fatal difeafes are often occafioned- Theperfeaion of drefs is to be eafy and clean. Nothing can be more ridiculous, than for any one to make himfelf a flave to fine clothes. Such an one, and many fuch there are, would rather re- main as fixt as a ftatue from morning till night, than difcompofe a fingle hair or alter the pofition of a pin. Were we to recommend- any particular pattern for drefs, it would be that which is worn by the fociety of Friends, commonly called Quakers. They are always neat, clean, and often elegant, without any thing fuperfluous. What others lay out upon tawdry laces, ruffles and ribbands, they heftow.upon fuperior cleanlinefs. Finery is only the affeaationoS dreTsj "and very often covers a great deal of dirt. . Clothing ought not only to be fuited to the climate, the feafon of the year, and the period of life ; but likewifq to the temperature and conftitution. Robuft perfons are able to endure qither cold or heat better than the delicate ; cowfequently, may be lefs attentive to their clothing. But the precife quantity of clothes neceffary for any perfon cannot be determined by reafoning. It is entirely a mat- ter of experience, and every man is the belt judge for himfelf, what quantity of clothes is neceffary to keep him warm*. •* Boerhaave ufed to fay, that no-body fuffered by cold, fave fools end beggars 5 the latter not being able to procure clothes, and the for.. mer not having fenfe to wear them. In many cafes where the powers of medicine had been tried in vain, I have cured the patient by recom mending thick fhoes, a flannel waiftcoat and drawers, a pair of under ftockmgs, or a flannel petticoat, to be worn during the cold feafon at le VI. '■'■' I 79 ] CHAPTER VII. Of Intemperance. ROUSSEAU, obferves, that temperance and exercife are the two beft phyficians. He might have added, that if thefe were duly regarded, there would be little occafion for any other. Tem- perance may justly be called the parent of health ; yet numbers of mankind aa as if they thought difeafes and death too flow in their > progrefs, and by intemperance and debauch feem to folicit their approach. The danger of intemperance appears from the very conftruaion of the human body. Health depends on that ftate of the folids and fluids which fits them for the due performance of the vital func- tions ; and while thefe go regularly on, we are found and well; but whatever disturbs them, neceffarily impairs health. Intempe- rance never fails to diforder the whole animal economy -< It hurts the digestion, relaxes the nerves, renders the different fecretions irregular, and occafions numberlefs difeafes. The analogy between the nourifhment of plants and animals af- fords a striking proof of the1 danger of intemperance. Moisture''and manure greatly promote vegetation ; yet an over-quantity of cither will entirely destroy it. The beft things become hurtful, nay, de- ftruaive, when carried to excefs. Hence we learn that the highest degree of human wifdom confifts in regulating our appetites and paffions fo as to avoid all extremes. It is that chiefly which entitles us to the charaaer of*rational beiags. The fhvetoT appetite is the difgrace of human nature. TJie Author of Nature hath endued us with various paffions, for fhe propagation of the fpecies, the prefervation of the indi- vidual, &c. 'Intemperance is the abufe of 'thefe paffions ; and moderation confifts in the proper regulation of them.' Men, not contented with fatisfying the fimple calls of Nature, create arti- ficial wants, and' are "perpetually in fearch 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 drunkard, and the debauchee, feldom flop in their ca- reer, till their money or their conftitution fails: Then indeed they fee their error when too late. It is impossible to lay down fixt rules with regard to diet, on ac- count of the different conftitutions of mankind. The moft ignorant perfon, however, certainly knows what is meant by excefs ; -and every man, if he choofes, can avoid it. The great rule of diet is to ftudy fimplicity. Nature delights in the moft fimple food, and every animal, except man, follows her sdiaates. Man alone riots at large, and ranfacks the^whole creation in queft of luxuries, to his own deftruaion. "For my part," fays Ad- So OF INTEMPERANCE difon, "when I behold a fafhionable table fet out in all its magnifi- cence, I fauey that I fee gouts and dropfies, fevers and lethargies, With other innumerable diftempers, lying in ambufcade among the dimes." . Nor is intemperance in other things lefs deftruaive than in diet. How quickly doesthe immoderate purfuit of carnal pleasures,or the abufe of intoxicating liquors, ruin the beft conftitution! Thefe vices generally go hand in hand. Hence 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 hatting with fwift pace to an untimely grave. Did men reflea on the painful difeafes,and prema- ture deaths, which are daily occafioned by intemperance, they would fhrink back with horror from the indulgence of their darling pleafures. Intemperance does not hurt its votaries alone: The innocent too Often feel the effeas of it. How many wretched orphans 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 decent manner ? How often do we behold the mother, with her infants, pining in want, while the cruel father is indulging his infatiate appetites ? Families are not only reduced to mifery, but even extirpated by 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 conten- ted with his humble fare, can boaft a numerous offspring, while his pampered lord, funk in eafe and luxury, often languifhes with* out an heir to his ample fortunes. Even ftates and empires feel the influence of intemperance, and rife or fall as it prevails. Inftead of mentioning the different kinds of intemperance, and pointing out their influence upon health, we fhall only, by w%y of example, make a few obfervations on one particular fpecies of that vice, viz. the abufe of intoxicating liquors. Every aa of intoxication puts Nature to the expenfe of a fevef, in order to difcharge the poifonous draught. When this is repeat- ed almoft every day, it is eafy to forefee the confequences. That conftitution muft be ftrong indeed, which is able long to hold out under a daily fever ! but fevers occafioned by drinking do not always go off in a day: They frequently end in an inflammation of the breaft, liver, or brain, and produce fatal effeas. Though the drunkard fhould not fall by an acute difeafe, he feldom efcapes thofe of a chronic kind. Intoxicating liquors, when ufed to excefs, weaken the bowels and fpoil the digeftion ; they destroy the power of the nerves, and occafion paralytic and cort- vulfive diforders. Hence obftruaions, atrophies, dropfies, and con- fumptions of the lungs. Thefe are the common ways in whioji drunkards make their exit. Difeafes of this kind, when brough.fr on by hard drinking, feldom admit of a cure. OF INTEMPERANCE. 81 Many people injure their health by drinking, who feldom get drunk. The habit of foaking, though its effeas be not fo violent, is not lefs pernicious. When the veffels are kept constantly full and upon the ftretch, the different digeftions can neither be duly per- formed, nor the humours properly prepared. Hence, moft people of this charaaer are affliaed with the gout, the gravel, ulcerous fores in the legs, &c. If thefe diforders do not appear, they are feized with low fpirits, hypochondriacal affeaions, and other fymptoms of in- digestion. Confumptions are now fo common, that it is thought one-tenth of the inhabitants of great towns die of that difeafc. 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 people of England, cannot fail to render the blood fizy and unfic for circulation ; from whence proceed obftruaions, and inflammations of the lungs. There are few great ale-drinkers who are not phthifical: nor is that to be wondered at, confidering the glutinous and almoft indigestible nature of ftrong ale. Thofe who drink ardent fpirits or ftrong wines run ftill greater hazard ; thefe liquors heat and inflame the blood, and tear the tender veffels of the lungs to pieces ; yet fo great is the confump- tion of them in this country, that one would almoft be induced to think the inhabitants lived upon them*. The habit of drinking proceeds frequently from misfortunes in life. The miferable fly to it for relief. It affords them indeed a temporary eafe. But, this folace is fhort-lived; and when it is over, the fpirits fink as mmch below their ufual tone as they had before" been raifed above it. Hence, a repetition of the dofe becomes ne- ceffary, and every frefh dofe makes way for another, till the uiv happy wretch becomes a Have to the bottle, and at length falls a facrifice to what at firft perhaps was taken only as a medicine. No man is fo dejeaed as the drunkard when his debauch is gone off. Thofe who have the greateft flow of fpirits while the glafs circu- lates freely, are of all others the moft melancholy when fober, and often put an end to their exiftence in a fit of fpleen or ill humour. Drunkennefs not only proves deftruaive to health, but likewife to the faculties of the mind. It is strange that creatures who value themfelves on a fuperior degree of reafon to that of brutes, fhould take pleafure in finking fo far below them. Were fuch as volun- tarily deprive themfelves of the ufe of reafon, to continue ever * We may form fome notion of the immenfe quantity of ardent fpL rits confirmed in Britain from this circumftance, that in the city of Edin- burgh and its environs, befides the preat quantity of foreign fpirits duly entered, and the ftill greater quantity which is fuppofedto be fmuggled, it is computed that above twothoufand private (tills are conftantly .em- ployed in preparing a poifonous liquor called molaffes. The common people have got fo unlverfally into the habit of drinking this bafe fpirit, that when a porter or labourer is feen reeling along the ftreets, they fay, fce has got molaffed, L *2 OF CLEANLINESS. aftefin that condition, it would feem but a juft pumfcmenr. Though this be iiot the confequence of one aa of intoxication, it feldom fails to fHcceed a courfe of it. By a habit of drinking, the greateft genius is often reduced to a mere idiot*. ' Intoxication, is peculiarly hurtful to young perfons. It heats their blood, impairs their ftrength, and obftruas their growth ; befides, the" frequent ufe of ftrong liquors in the early part of life deftroys any benefit that might ante from them afterwards. Thefe 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. Drunkennefs is not only in itfelf a moft abominable vice, but is an inducement to manyothers. There is hardly any crime fohorrid that the drunkard will not perpetrate for the love of liquor. We have known mothers fell their children's clothes, the food that they fhould have ate, and afterwards even the infants.themfelves, in order to purchafe the draught. CHAPTER VIII. Of Cleanlinefs. •'' THE want of cleanlinefs admits of no excufe. Where water can be had for nothing, every perfon can be clean. The continual difcharge from our bodies by perfpiration, renders fre- quent change of apparel neceffary. »' changing apparel greatly pro- motes the fecretion from the fkin, fo neceffary for health. When that matter which ought to be carried off by perfpiration, is either retained in the body, or reforbed from dirty clothes, it muft occa- fion difeafes. Difeafes of the fkin are chiefly owing to want of cleanlinefsf. They may indeed be caught by infeaion, or brought on by poor i #• It is" amazing that improvements in arts, learning, and politenefs, have-not put the barbarous cuftom of drinking to excef> out of fafhion* it is indeed lets common in South Britain than it was formerly ; but it ftill prevails, very much in the North, where this relic of barbarity is mistaken for hofpitahty.. There no man is fuppofed to entertain his guefts well, who does not make them drunk. > or'cing people to dr'.nk, is certainly the greateft piece of rudenefs that any man can be guilty of. Manlinefs, complaifance, 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 of'drinking to excefs has long been out of fafliion in France ; and, as it begins to lole ground among the politer part of the Englifh, we hope it will foon be banilhed from every part of this ifland. f Mr. Pot, in his furgical obfervations, mentions a difeafe which he calls the chimney-f.veepers, cancej:, as it is almoft peculiar to that unr bappy fet of people. 1 his he attributes to neglect of cleanlinefs, an^l with great juitice. I am convinced, if that part of the body which is riie feat of this cruel difeafe was kept clean by frequent warning, it wouW never happen. , * OF CLEANLINESS. 83^ living, unwholefome food, Src. but they v. ill feldom continue long where cleanlinefs prevails. To the fame caufe muft we impute the various kinds of vermin which infeft the human body, houfes, Sec. Thefe may,always be banifhed by cleanlinefs alone, and wherever they abound, we have reafon to believe it is negleacd. One common caufe of putrid and malignant fevers is the Want of cleanlinefs. Thefe fevers commonly begin among the inhabi- tants of clofe dirty houfes, who breathe" unwholefome air, take lit- tle exercife, and wear dirty clothes. There the infeaion is gene- rally hatched, which often fpreads far and wide, to'the deftruaion oi many. Hence cleanlinefs may be con fidered as an objea of pub- lic attention-.- It is not fufficient that I he clean myfelf, while the want of it in my neighbour affects my health as well as his own. If dirty people cannot be removed as a common miifance, they ought at leaft to be avoided as infeaious. All who regard their health fhould keep at a diftance even from their habitations. In places- where great numbers of people are colleaed, cleanli- nefs becomes of the greateft imgortance. It is well known th;:t in- feaious'difeafes are communicated 'by. tainted air. Every thing, therefore, which tends to pollute the air,.or fpread the infeaion, ought with the utmoft cire to be guarded againft. For this reafon, in great towns,, no fifth of any kind, fhould be permitted to lie up- on the llri'cts. Nothing, is more apt to convey infeaion than the excrements of. the dife.-;fed. - ' In many great towns the ftreets are little better than dunghills, being frequently covered withafhes, dung, and naftinefs of every kind. Even flaughter-houfes, or killing-ihambles are often to be feen in the very centre of great towns.. The putrid blood, excre- ments, &c with which thefe places are generally covered, cannot foil to taint the air, and render it unwholefome. How eafily might this be prev.j;r:ed by aaive magiftrates, who have it always in their power^o make properlaws relative to things of this nature, and to enforce the obfcrvan.ee of them ! We are forry, that the importance of general cleanlinefs, does not kern to be fufficiently underftood by the magiftrates of moft great towns in Britain; though health,pleafure, and delicacy, :\>l confpire to recommend an attention to it. Nothing can be more agreeable to the ftnfes, more to the honour of the inhabitants, or more conducive to their health, than a clean town ; nor c;m any thing imprefs a stranger with a more difrefpeaful idea of any peo- ple, than its oppofite. Whatever pretenfions people may make to lean-iing, politenefs, or civilization, while they neglea cleanlinefs, they are in a ftate of-barbarity*. '* •* In ancient Rome the greateft men did not think elear.lir.efs an object unworthy .of their attention. Pliny fays, the Cloaca, or com- mon fewers, for the conveyance of filth and naftinefs from the city, were the greateft of ali the public works ; and beftows higher encomiums up- on Tarquinius, Agrippa, and others who made and improved them', than on thofe whoatchieved the greateft conqnefts. g4 OF CLEANLINESS. = The peafants in moft countries hold cleanlinefs in 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 likewife extremely carelefs with refpea to change of apparel, keep- ing their houfes, &c. clean. This is merely the effea of indolence' quid a dirty difpofition. Habit may indeed render it lefs difagreea- ble to them, but no habit can ever make it falutary to wear dirty clothes or breathe unwholefome air. In camps, the ftriaeft regard fhould be paid to cleanlinefs. By negligence in this matter, infeaious difeafes are often fpread amongft a whole army ; and frequently more die cf thefe, than by the fword. The Jews during their encampments in the wilder- sicfs, received particular inftruaions with refpea to cleanlinefs*. The rules enjoined them ought to be obferved by all in the like fituation. Indeed, the whole fyftem of laws delivered to that peo- ple, has a manifest tendency to promote cleanlinefs. Whoever considers the nature of their climate, the difeafes to which they were liable, and their dirty difpofition, will fee the propriety of fuch laws. In moft eastern countries, cleanlinefs makes a great part of their 4 religion. The Mahometan, as well as the Jcwifh religion, enjoins various bathings, wafhings, and purifications. Thefe might be de- figned to represent inward purity ; but they were at the fame time calculated for the prefervation of health. However whimfical thefe wafhings may appear to fome, few things would tend more to pre- vent difeafes than a proper attention to many of them. Were eve- ry perfon, for example, after vifiting the fick, handling a dead bo- dy, or touching any thing that might convey infeaion, to wafh before he went into company, or fat down to meat, he would run lefs hazard either of catching the infeaion himfelf, or of commu- nicating it to others. Frequent wafhing not only removes the filth and fordes which adhere to the fkin, but likewife promotes the perfpiration, braces the body, and enlivens the fpirits. How refreshed, how cheerful, and agreeable does one feel on being fhaved, wafhed, and fhifted; efpecially when thefe offices hrve been negkaed longer than ufual! The eastern cuftom of wafhing the feet, though lefs neceffary in this country, is a very agreeable piece of cleanlinefs, and contri- butes greatly to the prefervation of health. The fweat and dirt with which thefe parts arc frequently covered, cannot fail to ob- ftrua the perfpiration. This piece of cleanlinefs would often pre- ■# " Thou fhalt have a place alfo without the camp, whither thou fhalt go forth abroad ; and thou fhalt have a paddle upon thy weapon : and it fhall be when thou fhalt eafe thyfelf abroad, thou fhalt dig therewith, and fhalt turn back, and cover that whichcometh from thee, &c."Deut. chap, xxiii. ver. 12, 13. OF CLEANLINESS. 85 vent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being expofed to cold or wet through the day, they would feldom experience the ill effeas which often proceed from thefe caufes. A proper attention to cleanlinefs is no where move neceffary than on fhipboard. If epidemical distempers 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 like- ly means to prevent their fpreading and to prevent their returning 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 brimftone. Infeaion will lodge a long time in dirty clothes, and afterwards break out in the moft terrible man- ner. In places where great numbers of fick people are colleaed to- gether, cleanlinefs ought to be moft rcligioufly obferved. The very fmell in fuch places is often fufficient to make one fick. It is eafy to imagine what effea that is likely to have upon the difeaf- ed. In an hofpital or infirmary, where cleanlinefs is negleaed, a perfon in perfea health has a greater chance to become fick, than a fick perfon has to get well. Few things are more unaccountable than that neglect, 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. If cleanlinefs be neceffary for perfons in health, it is certainly more fo for the fick. Many dif- eafes may be cured by cleanlinefs alone : moft of them might be mitigated by it; and, where it is negleaed, the flighteft diforders are often changed into the moft malignant. The fame miftaken care whicii prompted people to prevent theleaft admiflion of frefh air to the fick, feems to have induced them to keep them dirty. Both thefe deftruaive prejudices will, we hope, be foon entirely eradicated. Cleanlinefs is agreeable to our nature. We cannot help approv- ing it in others, even though we practife it not ourfelves. It fooner attraas our regard than even finery itfclf, and often gains efteem where that fails. It is an ornament to the highest as well as the loweft flation, and cannot be difpenfed with in either. Few vir- tues are of more importance to fociety than general cleanlinefs. It ought to be carefully cultivated every where ; but in populous cities, it fhould be almoft revered*. •3f As it is impofiible to be throughly clean without a fufficient quan- tity of water, the magiftrates of great towns lhould be particularly at- tentive to this article. Moft great towns in Britain are fo fmiated as (to be eafiJy fupplied with water ; and thofe perfons who will not make -!■[ 86.- ] CHAPTER IX. Of Infcclion. MANY difeafes are infeaious.. Every perfon alight, therefore, as far as he can, to avoid all communication with the difeaf- ed. The common praaice of vifiting the fick, though often well meant, has many ill confequences. We cannot help blaming fucjj as endanger their own or their neighbours'lives by a mistaken fnendfhp or an impertinent curiofity. The houfes of the fick, efpecially in the country, are generally crowded from morning tih night with idle vifitors. It.is customa- ry, in fuch places, for fervants and young people to wait upon the Ack'by turns, and even to fit upwith them ail night. It would be a miracle indeed fliould 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 hadnot had the fmall-pox, to wait upon a patient in that difeafe ;- yet many £ other fevers .are almoft as infeaious as the fmall-pox, and not lefs .* fatal. .Some imagine that Severs prove more fatal in villages than in great towns, for want; of proper medical afiiftance. This may fometimes be the- cafe ; but we think it oftener proceeds from the caufe above-mentioned. Were a plan to be laid down for communicating infeaion,- it could not be done more efHauaily than by the common method of visiting the fick. S :ch vifitors not only endanger' themfelves and their conneaidns, but likewife hurt the fick. By crowding the houfe, they render the air unwholefome, and by tl^r private whifpers and difmal countenances disturb the imagination of ths pr.ient, and deprefs his fpirits. Perfons who are ill, efpecially in levers, ought to be kept as quiet aspcffiblc. The fight of ft range faces, and every thing that disturbs the mind, hurts them. l^e common practice in country places of inviting great num- bers of people to funerals, and crowding them into the fame apart- ment where the corpfe lies, is another w.~y of fpreading in- feaion. The infeaion does not always die with the patient. Eve- ry thing that comes into contaa with his body while alive, receives the contagion, and fome of them, as clothes, blankets, &c. will re- tain ic for a long time. Perfons who die of infeaious diforders, a proper ufe of it, after it is brought to their hand, deferve to be punch- ed. The ftreets of great towns, where water can be had, ought to be wafheu every day. This is the only efrlvhial method for keeping them thoroughly clean; and upon trial, we are persuaded it will be found the cheapest. . » OF INFECTION. f7 ought not to lie lo/ig unburied ; and people fliould keep as much as poffible at a diftance from them. .'It would tend greatly to prevent the fpreading of infeaious dif- eafes, if thofe in health were kept at a proper dift.ince from the fick. The Jewifh legiflator, among many other wife inftitutionu for preferving health, has been peculiarly attentive to the means of preventing infeaion, or defilement as it is called, either from a difeafed perfon or a dead body. In many cafes the difeafed were to be feparated from thofe in health ; and it was deemed a crin-iti even to approach their habitations. If a petfen only touched a difeafed or dead body, he was appointed to waft himfdf in wattr, and .to keep for fome time at a diftance from fociety. Infectious difeafes are often communicated by clothe?. It is ex- tremely dangerous to wear apparel which hao beea worn by the deceafed, unlefs it has been well wafht-d and fumigated, as infec- tion may lodge a long time in it, and afterwards produce very tra- gical effeas. This (hows the danger of buying at random the clothes which have been worn by othsr people. Infeaious diforders are frequently imported. Commerce, toge- ther with the riches of foreign climes, brings their difeafes. Thefe do often more than counterbalance all the advantages of that trade by means of which they are introduced. It is to be regretted, that $' fo little care is commonly beftowed, either to prevent the intro- duaion or fpreading of infeaious maladies. Some attention in- deed is generally paid to the plague; but other difeafes pafs un-i regarded*. Infeaion is often fpread through cities, by jails, hofpitals, See. Thefe are frequently situated in the very middle of populous towns; and when infeaious difeafes break out ill them, it is ipipoffible for the inhabitants to efcape. Did magiftrates pay any regard to the health of the people, this evil might be eafily remedied. Many are the caufes which tend to diffufe infeaion through populous crfies. The whole atmofphere of a large town is one con- taminated mafs, abounding with various kinds of infeaion, and muft be pernicious to health. Such as are obliged to live in large: cities, ought to choofe an open fituation ; to avoid narrow, dirty, *• 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 ealily be done by appointing a phyfician at every considerable fea-port, to infpett the fliip's company, pafjengers, &c. before they came afliore, and, if any fever or other in- fectious diforder prevailed, to order the'fhip to perform a fliort quaran- tine, and to fend the lick to fome hofpital or proper place to be cured. He might likewife order all the clothes, bedding, &c. which had been ufed by the lick.during the voyage, to be either dcltroyed, or thoroughly cleaiifed by fumigation, &c. before any of it were fent afliore. Afciieme of this kind, if properly conducted, would prevent many fevers, and other infectious difeafes, from being brought by failors into fea-port towns, and by this means diifufed alt over the country* 83 OF INFECTION. 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 infeaious dif- eafes, were proper nurfes every-wheve employed to take care of the fick. This might often fave a family, or even a whole town, from being infeaed by one perfon. Not that people fhould abandon their friends or relations in diftrefs, but only be on their guard againft'being too much in company with thofe who are affliaed with difeafes of an infeaious nature. Such as wait upon the fick in infeaious difeafes run very great hazard. They fhould fluff their nofes with tobacco, or fame other ftrong fmelling herb, as rue, tanfy, or the like. They o'ught like- wife to keep the patient very clean, to fprinkle the room where he lies with vinegar, or other ftrong acids, frequently to admit a ftream of frefh air into it, and to avoid the fmell of his breath as much as they can. They ought never to go into company without having changed their clothes and wafhed their hands ; otherwife, if the difeafe be infeaious, they vail in all probability carry the contagion along with them*. A due attention to thofe things which tend to diffufe infeaion would be of great importance in preventing difeafes. As moft dif- eafes are in fome degree infeaious, no one fliould continue long with the fick, except the neceffary attendants. I mean not howe- * ver, by this caution, to deter thofe whofe duty or office leads them to wait upon the fick, from fuch a laudable and neceffary employ- ment. Many things are in the power of the magistrate which would tend to prevent the fpreading of infeaion ; as the promoting of public cleanlinefs; removing jails, hofpitals, burying grounds, and other places where infeaion may be generated, at a proper dif- tance from great townsf ; widening the ftreets ; pulling down ufelefs walls, and taking all methods to promote a free circulation of air through every part of the town, &c. Public hofpitals, or proper places of reception for the fick, provided they were kept elean, well ventilated, and placed in am open fituation, would like- wife tend to prevent the fpreading of infeaion. Such places of * There is reafon to believe that infection is o^ten conveyed from •nc place to another by the careleffneis of the faculty themfelves. Many hyficians affect a familiar way of fittin- upon the patientrs bedfide, and olding his arm for a confider.ibie time, if the patient has the fmall-pox, or any other Uifeftious difeafe, there is no doubt but the doctor's hands, *iothes, &c.will carry away fome of the infection ; and, if he goes di- rect y to vifit another >.itient without wafhing his hands, changing his clothes, orbt'ng expofed to the open air, which is not feldom the cafe, is it any wonder that he fliould carry the difeafe along with him ? Phy- ficians not only endanger others, but alfo themfelves, by this practice. And indeed they fometimes fuffer for their want of care. t The ancients would not fuffer even the temples of their gods where ihc,*frk referred, to be built within the wdl- uf a city, I OF THE PASSIONS. 89 reception would prevent the poor, when fick, from being vilited by their idle or officious neighbours. They would likewife render it unneceflary for fick fervantsto be kept in their matters houfes. Masters had better pay for having their fervants taken care of in ari hofpital, than run the hazard of having an infeaious difeafe diffu- fed among a numerous family. Sick fervants and poor people, when placed in hofpitals, are not only lefs apt to diffufe infec- tion among their neighbours, but have likewife the advantage of being well attended. We are not, however, to learn that hofpitals, inftead of pre- venting infection, may become the means of difrufing it. When they are placed in the middle of great towns; when numbers of patients are crowded together into fmall apartments; when there is a conftant communication kept up between the citizens and the patients; and when cleanlinefs and ventilation are negleaed, they become nefts for hatching difeafes, and every one who goes mtd them, not only runs a rifle of receiving infeaion himfelf, but like- wife of communicating it to others. This is not the fault of hof- pitals, but of thofe who have the management of them. It were to be wifhed, that they were both more numerous, and upon a more refpeaable footing, as that would induce people to go into them with lefs reluaance. This is the more to be defired, becaufe moft of the putrid fevers and other infeaious diforders break out among the poor, and are by them communicated to the better fort. Were proper attention paid to the firft appearances of fuch diiordeis, and the patients early conveyed to an hofpital, we fhould feldom fee a putrid fever, which' is almoft as infeaious as the plague, become epidemic. CHAPTER X. Of the Paffions. rT^HE paffions hive great influence both in the caufe and cure A of difeafes. How the mind affeas the body, will, in all proba- bility ever remain a fecret. It is fufficient for us to know, that there is eftablifhed reciprocal influence between the mental and corpo- real part?, and that whatever injures the one, diforders the other. Of Anger. THE pafllon of anger ruffles the mind, distorts the countenance, hurries on the circulation of the blood, and diforders the whole vital and animal funaions. ft often occafions fevers, and other acute drfofes ; and fometimes even fudden death. This paffron M 2* OF THE PASSIONS. is"peculiarly huitful to the delicate, and thofe of weak nerves. Such perfons frequently lofe their lives by a violent fit of anger, and I would advife them to guard againft the excefs of this paffion with the utmoft care. It is not indeed always in our1 power to prevent being angry ; but we may furely avoid harbouring refentment in our breaft. Re- fehtrncnt, preys upon the mind, and occafions the moft obstinate chronica,! diforders which gradually wafte theconftitutiom Nothing fhows true greatnefs of mind more than to forgive injuries; it promotes the peace of fociety, and greatly conduces to our own cafe, 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 re- fentment, but to endeavour at all times to keep their minds calm and icrene. Nothing tends fo much to the health of the body a* * conftant tranquillity of mind. Of Fear. THE influence of fear, both in occafioning and aggravating difeafes, is very great. No man ought to be blamed for a decent concern abriut life ; but too-great a defire to preferve it is often the caufe of lofing it. Fear and anxiety, by depreffing the fpirits, not only difpofe us to difeafes, but often render thofe difeafes fatal which an undaunted mind would overcome. Sudden fear has generally violent effeas. Epileptic fits, and Cther convulfive diforders, are often occafioned by it. Hence the danger of that praaice, fo common among young people, of frightening one another. Maiiy have loft their lives, and others have been rendered mifeiable, by frolics of this kind. It is dange- rous to tamper with the human paffions. The mind may eafily be thrown into fuch diforder as never again to aa with regularity. But the gradual effeas of fear prove more hurtful. The con- ftant dread of fome future evil, by dwelling upon the mind, often occafions the very evil itfelf. Hence it comes to pafs, that fo many die of thofe very difeafes of which they long had a dread, or which had been impreffed on their minds by fome accident, or foolifh prediaion. 'I his, for example, is often the cafe with women in child-bed. Many of thofe who die in that fituation are impreffed with the notion of their death a long time before it happens ; and there is reafon to believe that this impreflion is often the caufe of it. The methods taken to imprefs the minds of women with ap- prehensions of the great pain and peril of child-birth, are very hurtful. Few women die in labour, though many lofe their lives after it j which may be, thus accounted for, A woman after deli- OF THE FASSlOtiS. $i Terry/finding herfelf weak and exhaufted, immediately apprehends fhe is in danger ; but this fear feldom fails to obftrua the neceflu- ^fy 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 many others. Evej-y woman of their acquaintance who is with child dreads the fame f.ite, and the difeafe becomes epidemical by the mere force cf ima- gination. This fhould induce pregnant women to defpife fear, and by all means to avoid thofe tattling goffipV who are -continually buzzing in their ears the misfortunes of others. Every thing that may in the leaft alarm a pregnant ot child-bed \voman, ought with the greateft care to be girarded againft. Many women have loft their lives in child-bed by the old fu- perftitious cuftom, ftill kept up in moft parts of Britain,.of tolling the parifhbell for every perfon who dies. People who think them- felves in danger ate very inquifitive ; 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 dif- ficult matter to pcrfuade them of the contrary. But thiscufjom is not pernicious to.child-bed-women only. It is hurtful in many other cafes. When low fevers, in which it is difficult to fupport the patient's fpirits, prevail, what muft be the effea of a funeral peal founding five or fix times a day in his ears? No doubt his imagination will fuggeft that Others died of the dif- eafe under which he labours. This apprehension will "have a. great- er tendency to deprefs his fpirits, than all the cordiahVpf rhe.dic.iiie will have to raife them. - *; * If we have not fenfe enough to abolifh this ufelefs piece of cere- mony, we ought to keep the fick as much from hearing it as poffible, and from every other thing that may tend to alarm them. So far however is-thisfrom being generally attended to, that many mnke it,their bufinefs to vifit the fick, on purpofe to whifger difmal fto- ries in their ears. Such may pafs for fympathizing friends, but they are their enemies. All who wifh well to the fick ought to keep fuch perfons at the greatest diftance from them. A cuftom has long prevailed among phyficians, of prognosti- cating, or foretelling the iffue of the difeafe. Vanity introduced this praaice, and ftill Tupports it, in fpite of common .fenfe and the fafety of mankind. I have known a ph\ fician barbarous enough to boaft, that he pronounced more fentences than all his Majefty's judges. Would to God that fuch fentences were not often equal- ly fatal! It may indeed be alleged, that the doaor does not de- clare his opinion before the patient. So much the worfe. A fenfi- ble patient had better hear what the doaor fays, than learn it from *he difconfolatet looks, the watery eyes, and the broken whifpers 92 OF THE PASSIONS. of thofe about him. It feldom happens, when the dodi-r gives an unfavourable opinion, that it can be concealed from the patient. The very embarraflment which the friends and attendants fhow m difguifing what he has faid, is generally fufficient to difcover the truth. Heaven has concealed from mortals their fate ; and we do not fee what right any man has to announce the death of another, ef- pecially if fuch a declaration has a chance to kill him. Mankind are indeed very fond of prying into future events, and feldom fail to folicit the phyfician for his opinion. A doubtful anfwer, 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 destroy 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. There are cafes where the phyfician ought to give intimation of the patient's danger to fome of his near conneaions; though even this ought always to be done with the greatest caution : but it ne- ver can be neceffary in any cafe that the whole town and country fhould know, immediately after the doaor has made his firft vifit, that he nas no hopes of his patient's recovery. Perfons whofe im- pertinent curiofity leads them to queftion the phyfician with regard to the fate of his patient, deferve no anfwer. The vanity of foretelling the fate of the fick is not peculiar to the faculty. Others follow their example, and thofe who think themfelves wifcr 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 fym- pathizing behaviour than by medicine, and fliould never negledl to adminifter that greateft of all cordials, Hope. Of Grief GRIEF is the moft deftruaive of all the paffions. Its effeas zrz permanent, and w;hen it finks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, fel- dom 1 tt long ; but grief often changes into a fixed melancholy, which preys upon the fpirits, and wattes the conftitution. This paffion ought not to be indulged. It may generally be conqueied at the beginning; but when it has gained ftrength, all attempts to remove it are vain. No perfon can prevent misfortunes in life ; but it fhow s true greatnefs of mind to bear them with ferenity. M?ny perfpns make OF THE* PASSIONS. 93 a merit of indulging grief, and when misfortunes happen, they obstinately refufe all confolation, till the mind, overwhelmed with melancholy, finks under the load. Such cpndua is not only de- ftruaive to health, but inconfiftent with reafon, religion, and com- mon fenfe. Change of ideas is as neceffary for health as change of pofture. When the mind dwells long upon one fubjea, efpecially of a dif- agreeable nature, it hurts the whole funaions of me body. Grief indulged fpoils the digeftion and deftroys the appetite ; hence the fpirits are depreffed, the nerves relaxed, the bowels inflated with wind, and the humouTs, for want of frefh fupplies of chyle, vitia- ted. Many an excellent conftitution has been ruined by a family- misfortune, or any thing that occafions exceifive grief. It is utterly impofiible, that any perfon of a dejeaed mind fhculd enjoy health. Life may indeed be dragged out for a few years : but whoever would live to a good old age, muft be gcod- .humoured and cheerful. This indeed is not altogether in our own power; yet our temper of mind, as well as our aaions, de- pends greatly upon ourfelves. We can either affociate with cheer- ful or melancholy companions, mingle in the amufements and offices of life, or fit ftill and brood over our calamities as we choofe. Thefe, and many fuch things, are certainly in our power, and from thefe the mind generally takes its caft. The variety of fcenes which prefent themfelves 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, unlets fixed down by habit, delights in contempla- ting new objeas. This at once points out the method of reliev- ing the mind in diftrefs. Turn die attention frequently to new objeas. Examine them for fome time. When the mind begins to recoil, fhift the fcene. By this means, a conftant fucceffi,on of new ideas may be kept up, till the difagreeable ones entirely disap- pear. Thus travelling, the ftudy of any art or fcience, reading or writing on fuch fubjeas as deeply engage the attention, will fooner expel grief than the moft fprightly amufements. As the body cannot be healthly unlefs it be exercifed; neither can the mind. Indolence nourifhes grief. When the mind has no- thing elfe 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 bufi- nefs, when misfortunes happen, we ought to 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 not to be negleaed. Thefe, by lead- ing the mind infenfibly to the contemplation of agreeable objeas, help to difpel the gloom which misfortunes caft over it. They make time feem lefs tedious, and have many other happy effeay. 9+ OF THE PASSIONS, ' ~Some perfons, when overwhelmed with grief, betake themfdvas to drinking. This is making the cure worfe than the difeafe. It feldom fails to end in the ruin of fortune, charaaer, and confti- tution. Of Love. r LOVE is perhaps the strongest of all the paffions; at leaft, when It becomes violent, it is lefs fiibje& to the controul either of the underftanding or will, than any of the reft. Fear, anger, and feve- ral other paffions are neceffary for the prefervation of the indivi- dual, but love is neceffary for the continuation of the fpecies itfelf: It was therefore proper that this paffion fhould be deeply rooted in the human breaft. Though love be a ftrong paffion, it is feldom fo rapid in its prd- grefs as feveral of the others. Few perfons fall defperately in love all-at-once. We would therefore advife every one, before he tam- pers wi»h 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 increasing it. He ought immediate- ly to fly the company of' the beloved objea ; to apply his mind attentively to bufinefs or ftudy; to take every kind of amufement; and above all, to endeavour, if poffible, to find another objea which may engage Iris affeaions, and which it may be in his power to obtain. There is no paffion with which people is fo ready to tamper as lore, although none is more dangerous. Some men make love for amufe- ment, others from mere vanity, or on purpofe to fhow their confe- quence with the fair. This is perhaps the greateft piece of cruel- ty, which any one can be guilty of. What we eagerly with for we eafily credit. Hence, the too credulous fair are often betrayed into a fituation wich is truly deplorable, before they are able to difcover that the pretended Iovct was only in jeft. But there is no jeftirtg with this paffion. When love has got to a certain height, it admits of no other cure but the poffeffion of its objea, which in this cafe ought always if poffible to be obtained*. -* The conduct of parents with regard to the difpofal of their chil- dren in marriage is often very blameable. An advantageous match is the conftant aim of parents ; while their children often fuffer a real mar- tyrdom betwixt their inclinations and duty. The firll thing which pa- rents ought to confult in dilpofing of their children in marriage, is cer- tainly their inclinations. Were due regard always paid to thefe, there would be rewer unhappy couples, and parents would not have fo oftea ' i a '? rr fhe weather in this country, than liappened while I was writing thefe notes. This morning, Auguft 14, i/il-,, the thermometer in the iiiade was down at hfty-three J agrees, and a very few days ago it Itood above eighty. No one who reflecTs on fuch great and fudden (flanges in the atmofphcre, will be furprifed, to find colds, coughs, rheums, with other affections of the breaft and bvw?ls? f6 coirune:* in this country. [ >°« ] » Night Air. THE perfpiration is often obftruaed by night-air ; even in fum- mer, this ought to be avoided. The dews which fall plentifully af- ter the hotteft day, make the night more dangerous than when the weather is cool. Hence, in warm countries, the evening-dews are more hurtful than where the climate is more temperate. It is very agreeable after a warm day, to be abroad in the cool, evening; but this is a pleafure to be avoided by all 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 therefore advife travellers, labourers, and all who are much heated by day, carefully to avoid them. When the perfpiration. has been great, thefe become dangerous in proportion. By not at- tending to this, in flat marfhyjcountries, where the exhalations and dews are copious, labourers are often feized with intermitting fe- vers, quinfeys, and other dangerous difeafes. Damp Beds. BEDS become damp,cither from their not being ufed, standing in damp houfes, or in rooms without fire. Nothing is snore to be dreaded by travellers than damp beds, which are very common ill all places where fuel is fcaree. 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 restored ; but if he be put into a cold room, and laid on a damn bed, it will be more ob- ftruaed, and the worft confequences will enfue. Travellers fliould avoid inns which are noted for damp beds, as they would a houfe infeaed with the plague, as no man, however robuft, is proof againft the danger ari'fing from them. „ But inns are, net the only places w;here damp beds are to be met with. Beds kept in private families for thereccy.i'um- of ftra.rT-i:s are often equally dangerous. All kinds of linen and bedding, when not frequently ufed, become damp. How then is it poflime that beds, v\ hi-eh are not flspt in above tv/o or three times a year, fliould be fafe ? Nothing is more#common than to hear people complain of having caught cold by changing their bed. The reafon is obvi- ous : Were they careful never to fleep in a bed but what was fre- quently ufed, they would feldom find any ill confequences from a change. Nothing is more to he dreaded by a delicate perfon, when on a rifit,,than being laid in a bed which is kept on purpofe for ftrangers. That ill-judged piece of complaifance becomes a real injury. All OF THE COMMON EVACUATIONS. 101 the bad confequences from this quarter might eafily be prevented in private families, by causing their fervants to fleep in the fpare- beds, and relign them to strangers when they come. In inns, where the beds are ufed almoft every night, nothing elfe is neceffary than to keep the rooms well feafoned by frequent fires, and the linen dry. That baneful cuftom, faid to be praaifed in many inns, of damping fheets, and preffsng them, in order to fave wafhing, and afterwards laying them on the beds, ought, when difcovered, to he punifhed with feverity. It is really a fpecies of murder, and will often prove as fatal as poifon or gun-fhot. Indeed, no linen, efpecially if it has been wafhed in winter, ought to be ufed until it has been expofed for fome-time to the fire ; nor is this opera- tion lefs necefTary for linen wafhed in fummer, if it has lain by for any length of time. This caution is the more needful, as gen- tlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay little regard to a circumstance of more importance*. Damp Houfes FREQUENTLY produce the like ill-confequences ; for this reafon, thofe who build,fliould be careful to choofe a dry fituation. A houfe which ftands on a damp, marfhy foil or deep clay, will ne- ver be thoroughly dry- All houfes, unlefs where the ground is ex- ceeding dry, fliould have the firft floor a little raifed. Servants and others, who are obliged to live in cellars and funk stories, fel- dom continue long in health : Matters ought furely to pa y 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, plasterers, &c. have done with it: Such houfes are not only dangerous from their dampnefs, but like- wife from the fmell of lime, paint, &c. The aflhmas, confump- tions, and other difeafes of the lungs, fo incident to people who work in thefe articles, are fufficient proofs of their being unwhole- fome. Rooms are often rendered damp by an unfcafonable piece of cleanlinefs ; I mean the pernicious cuftom of wafhing them imme- diately before company is put into them. Moft people catch cold, if they fit but a very fhort time in a room that has been lately wafh- -jf If a perfon fufpetts that his bed is clamp, the fimple precaution of taking oft the flieets and lying in the blankets, with all, or moft of his clothes on, will prevent all danger. I have praftifed this for many years, and never have been hurt by damp beds ; though no conftitution, without care, is proof agaijpfl; their baneful influence, 102 OF THE COMMON EVACTUATIONS. cd ; the delicate ought carefully to avoid fuch a fituation, and even the robuft are not always proof againft its influence*. Sudden Tranfitions fnwi Heat to Coll PERSPIRATION is frequently obftruaed by fudden tran .» tions from heat to cold. Colds are feldom caught,unlefs when peo- ple have been too much heated. Heat rarities the blood, quickens tfce circulation, and increafes the perfpiration ; but when thefe are Suddenly checked, the confequences muft be bad. It is impoflible , for labourers not to be too hot upon fome occafions ; but it is ge- nerally in their power to let themfelves cool gradually, to put on their clothes when they leave off work, to make choice of a dry place to reft themfelves in, and to avoid fleeping in the open fietts. Thefe eafy rules, if obferved, would often prevent fevers and other fatal diforders. It is very common for people, when hot, to drink freely of cold water, or fmall liquors. This conds*a is extremely dangerous. Thirft indeed is hard to bear, frequently gets the better of reafon,- -y[ and makes us do what our judgment difapproves. Every peafant, however, knows, if his horfe^be permitted to drink his belly-full of / cold water after violent exercife, and be immediately put into the liable, or suffered 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. Thirft may be quenched many ways without fwallowing large quantities of cold liquor. The fields afford a variety of acid fruits and plan!:?, the very chewing of which would abate thirft. Water kept in the mouth for feme time, and fpit out again, if frequently repeated, will have the fame effea. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirft more effeaually, and make the danger lefs. When a perfon is extreme- \ ly hot, a mouthful of brandy, or other fpirits, if it can be obtained, ought to be preferred to any thing elfe. 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 what he drank be thoroughly warmed upon his ftomach. It would be tedious to enumerate all the bad effeas which flow from drinking cold liquors when the body is hot. Sometimes this has occafioned immediate death. Hoarfenefs, quinfeys, and fevers of various kinds, are its common eonfequenjees. Neither'fs it Life * People imagine, if a good fire is made in a room, after it has been wafheel, that there is no danger from fitting in it; but this increafes. the danger. 1 he evaporation excited by the fire generates cold, and ren- ders the d'-mp more active. . OF THE COMMON EVACUATIONS. 103 when warm, to eat freely of raw fruits, falladsi or the like. Thefe, indeed, have not fo fudden an eflea on the body as cold liquors, but they are notwithstanding" dangerous, and ought to be avoided. Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is ex- tremely dangerous. Colds, coughs and inflammations of the breaft, are the ufua! efTeas of this condua : Yet nothing is more com- mon than for people, after they have drank warm liquors for feve- ral hours, to walk or ride a number of miles in the coldest night, or to ramble about in the ftreets*. People are very apt, when a room is hot, to throw open a win- dow, and to fit near it. This is a moft dangerous praaice. A per- fon 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 confumptions have often been occafioned by fitting or Handing thinly clothed near an open window. Nor is flecping with open windows lefs to be dreaded. That ought ne- ver to be done, even in the hottest feafon, unlefs the window is at a diftance. Mechanics frequently contraa fatal difeafes, by work- ing ftript at an Open window, and I would advife all of them to beware of fuch a praaice. Few tilings expofe people mor-c to catch cold, than keeping their own houfes too warm ; fuch perfons may be faid to live in a fort t>f hot-houfes; they can hardly ftir abroad to visit a neighbour, but at the hazard of their li.es. Were, there no other reafon for keeping houfes moderately cool, that alone is fufficient: *But no houfe that is too hot can be wholefome ; heat destroys the fpring and elafticity of the air, and renders it lefs fit for expanding the lungs, and the other purpofes of refpiration. Hence confumptionts and other difeafes of the lungs prove fo fatal, to people who work in forges, glafs-houfes, and the like. Some are even fo fool-hardy, as to plunge thcmfelves when hot in cold water. Not only fevers, but madnefs itfelf, has frequently been the effea of this condua. Indeed, it looks too like the aaion of a madman to deferve a ferious confederation. The refult of all thefe obfervations.is, that every one ought to avoid, with the utmost attention, all fudden tranfitions from heat to cold, and to keep the body in as uniform a temperature as pof- fible ; or, where that cannot be done, to take care to let it cool gradually. People may imagine that too ftria an attention to thefe things » Tiie tap-rooms in London and other great towns, where fuch Clum- bers, of people fpend their evenings, are highly pernicious. '1 he i-roa:^ of a number of people, crowded into a low apartment, w ith the add.tion of fires, candles, the fnioke of tobacco, and the fumes of hot liquor, &c. muft not only render it hurtful to continue in inch places, butdan- "erous to go out of them into a cold and chilly atinofbht-re. 104 OF THE COMMON EVACUATIONS. would tend to render them delicate. So far is this from being my defign, that the very firft rule propofed for preventing colds, is to harden the body, by enuring it daily to the open air. I fhall put an end to this part of my fubjea, by giving an ab- ftraa of the advice of Celfus, with refpea different method of treatment. O ^r J06 OF THE KNOWLEDGE "females are liable to many difeafes which do nrt afflift the other fev • befides the nervous fvftem being more irritable in them t:ian in men, their difeafes require to be treated with greater caution. The" aie lefs able to bear large evacuations; and all stimulating medicines ou-ht to be adminiftered to them with a fparing hand. Particular conftitutions not only difpofe perfons to peculiar dil- eafes, but likewife render it neceffary to treat thefe difeafes m a peculiar manner. Adelicate perfon,for example, with weak nerves, who lives rr.oftly within doors, muft not be treated, under any dif- eafe, precifely in the fame manner as one who is hardy and robuft,. and who is much expofed to the open air. The temper of mind cught to be carefully attended to. rear, anxiety, and a fretful temper, both occafion and aggravate difeafes. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When it is affiled, the beft me- dicine is to footh the paffions, to divert the mind from anxious thought, and to keep the patient as eafy and cheerful as poffible. Attention ought likewife to be paid to the climate, or place where the patient lives, the air he breathes, his dlet,_&c. Saen 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 cf cities, have many maladies to which the more happy ruftics are entire ftrangers. Perfons who feed grofsly, and indulge in ftrong liquors, are liable "to difeafes which do not affea the temperate and abftemious, &c. It has already been obferved, that the different occupations and fituations in life difpofe men to peculiar difeafes. It is therefore necefTary to enquire into the patient's occupation, manner of life, &c. This will not only affift us in finding out the difeafe, but will likewife direa us in the treatment of it. It would be very impru- dent to treat the laborious and the fedentary precifely in the fame manner, even fuppofing them to labour under the fame difeafe. It will be proper to enquire, whether the difeafe be constitution- al or accidental; whether it has been of long or fhort duration ; whether it proceeds from any gre^t and fudden alteration in the diet, manner of life, &c. The ftate of the patient's body, and of the other evacuations, ought alfo to be enquired into ; and whether he can with eafe perform all the vital and animal funaions, as breathing, digeftion, &c. Laftly, it will be proper to enquire what difeafes the patient has formerly been liable to, and what medicines were moft benoffebl to him ; if he has a flrong averfion to any particular drug, £:c. As many of the indications of cure may be anfwered by diet 2lone, it is always the firft thing to be attended to in the treatment cf difeafes. Thofe who know no better, imagine that every thing which goes by the name of a medicine poffeffes fome wonderful povtfcr or fecret charm, and think, if the patient fwallows enough •f drugs, that, he muft do well. This miftake has many ill confe- AND CURE OF DISEASES. 107 qucnces; it makes people trust to drugs, and neglea their own en- deavours; befides, it difcoura^es all attempts to relieve the fick where medicines cannot be obtained. Medicines are no doubt ufeful in their place, and, when admi- riiftered with prudence, they may do much good ; but when they are put in place of every thing elfe, or adminiftered at random,- which is not feldom the cafe, they muft do mifchief. We therefore v. ifh to call the attention of mankind from the purfuit of fecret medicines, to fuch things as they are acquainted with. The proper regulation of thefe may often do much good, and there is little danger of their ever doing hurt. Every difeafe weakens the digestive powers. The diet oughr, therefore, in all difeafes, to be light and of eafy digeftion. It would be as prudent for a perfon with a broken leg to attempt to valk, as for one in a fever to eat tlie fame kind of food, and in the fame quantity, as when he w.as in perfea health. Even abftinence alone will often cure a fever, especially when it has been occafioned by excefs in eating or drinking. In. all fevers attended with inflammation, as pieurifies; peripneu- monics, &c. thin gruels, wheys, watery infufions of mttcilaginous' plants, roots, Sec. are not only proper for-the patient's food, but they are likewife the beft medicines which can be adminiftered. In fevers of a flow, nervous, or putrid kind, where there are no fymptoms of inflzmtr.r.tion, and where the patient muft be fup- ported withcordia-.i, that intention can always be more effeaually anfwered by nourifiling diet and generous wines, than by any me- dicines yet known. Nor is a proper attention to di:t of lefs importance in chronic than in acute difeafes. Perfons aifliaed with low fpirits, wind, weak nerves,-and other hypochondriacal affeaions, generally find more benefit frcv the ufe of folid food and generous liquors, than from all the cordial and carminative medicines which can be ad- miftered to them. The fcurvy will fooner yield to a proper vege- table diet, than to all the antifcorbutic remedies cf the fhops. In confumptions, when the ftomach is fo much weakened as to be unable to digest, the folid fibres of animals, or even to aflimilate the juices of vegetables, a diet confifting chiefly of milk will not only fupport the patient; but will 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 induced 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 difeafes, 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. , Exercife may likewife in many cafes be confidered as a medicine. Sailing, or riding on horfeback, for example, will be of more ferr io3 OF FEVERS IN GENERAL. yice in the cure of confumptions, glandular obftruaions, Sec. than any medicine yet known. In difeafes which proceed from a relaxed ftate of the folids, the cold bath, and other parts of the gymnastic regimen, will be found equally beneficial. Few things are of greater importance in the cure of difeafes fhan cleanlinefs. When a patient is fuffered to-lie in dirty clothes, -whatever perfpires from his body is again reforbed, or taken'up anto it, which ferves to nourifh the difeafe and increafe the danger. Many difeafes may be cured by cleanlinefs alone ; moft of them may be mitigated by it, and in all of them it is highly necefTary both for 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 difeafes. Regimen will often cure difeafes without medicine, but medicine will feldom fucceed where a proper regimen is negleaed. For this reafon,in the treatment of difeafes, we have always given the firft place to regi- men. Thofe who are ignorant of medicine may confine themfelves to it only. For others, who have more knowledge, we have recom- mended 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 underitanding ; nor even by them without the greateft precaution. CHAPTER XIII. Of Fevers in General. MORE than one half of mankind are faid to perifh by fevers, Their moft general caufes are infeElion, errors in diet, un- 'wholefome air, violent emotions of the mind, excefs or fuppreffion of ufual evacuations, external or internal injuries, and extreme degrees of heat or cold. As moft of thefe have already been treated of at considerable Jength, and their effeas fhown, we fhall not now refume the con- sideration of them, but only recommend it to all, as they would wifh to avoid fevers and other fatal difeafes, to pay the moft punc- tual attention to thefe articles. Fevers are not only the moft frequent of all difeafes, but they are likewife the moft complex. In the moft fimple fpecies of fever there is always a combination of feveral different fymptoms. The oiftinguifhing fymptoms of fevers are, increafed heat, frequency of pulfe, lofs of appetite, general debility, pain in the head, and a difficulty in performing fome of the vital or animal funblions. The other fymp- toms, ufually attendant on fevers are, naufea, thirft, anxiety, de- lirium, wearinefs, wafting of the flefh, want of fleep, or the fleep difturbed and not refrefhing. When the fever comes on gradually, the patient generally com- OF FEVERS IN GENERAL. plains firft of langour or liftleffnefs, forenefsof the flefh or the bones, heavinefs of the head, lofs of appetite, ficknefs, with clamminefs of the mouth; after fome time come on exceffive heat, violent thirft, rcftleffnefs, &c. When the fever attacks fuddenly, it always begins with an un- eafy fenfation of exceffive cold, accompanied with debility and lofs of appetite ; frequently the cold is attended with fhivering, oppreflion about the heart, and ficknefs at ftomach, or vomiting. Fevers are divided into continual, remitting, intermitting, and fuch as are attended with cutaneous eruption or topical inflam- mation, as the fmall-pox, erysipelas, &c. By a continual fever is meant that which never leaves the patient during the whole courfe of the difeafe, or which fhows no remarkable increafe or abate- ment of the fymptoms. This kind of ftver is likewife divided into acute, flow, and malignant. 1 he fever is called acute when its pro- grefs is quick, and the fymptoms violent ; but when thefe are more gentle, it is generally denominated flow. When with livid or petechial fpots, the fever is called malignant, putrid, or petechial. A remitting fever differs from a continual only in degree. It has frequent increafes and decreafes, or exacerbations and remif- fions, but never wholly leaves the patient during the courfe of the difeafc. Intermitting fevers or agues are thofe, which, during the time that the patient may be faid to be ill, have evident intervals or remissions of the fymptoms. As a fever is only 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 obfcrve with diligence which way Nature points, and to endeavour to affift her operations. 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, expeaoration, vomit, or fome other evacuation. There is reafon to believe, that if the efforts of Nature, at the beginning of a fever, were duly attended to and promoted, it would feldom continue long; but when her attempts are either neglea- ed or .counteraacd, it is no wonder if the difeafe proves fatal. 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 water, &c. the fymptoms in a few hours difappear, and the danger is prevent- ed. When fevers of a putrid kind threaten, the beft method of ob- viating their effeas is by repeated vomits. Our defign is to mark the moft obvious fymptoms in fevers, and to point out the proper treatment of the patient with refpea to his diet, drink, air, &c. in the different ftagesof the difeafe. In thefe articles, the inclinations of the patient will, in a great meafure, direa our condua. Almoft every perfon in a fever complains of great thirft, and calls out for drink, efpecially of a cooling nature. This at once I TO OF FEVERS IN GENERAL. points out the ufe of ivr.hr, and other cooling liquors. Wint \*, fo likely to abate the heat, remove fpafms and obftruaions pro- mote perfpiration, hiereafe the quantity of urine, and, in fliort, produce every fulutary effea, in an ardent or inflammatory fever, as drinking; plentifully of v. ater, thin gruel, or any other we-k liquor, cf"which'water is the balis ? The neceffity of diluting li- quors is pointed out by the dry tongue, the parched ft:in, and the burning heat, as well as by the unquenchable thirft of th-: patient. Many cooling lus;ors, which are extremely grateful to pitiemg in a fever, may be prepared from fruits ; as decoaions of tama- rinds, apple-tea, orange-whey, and the like Mucilaginous liquors might alfo be prepared from marfhmallow-roots, linfeed, lime- tree buds, and other mild vegetables. Thefe liquors, efpecially when acidulated, are highly agreeable to the patient, and fliould never be denied him. At the beginning of a fever, the patieot generally -complains of great laffuude or wearinefs, and has no inclination to move. This evidently fhows the propriety of keeping him eafy, and, if poffible, in bed. Lying in bed relates the fpafms, abates the violcr.ee of the circulation, and gives Nature an opportunity of exerting all her force to overcome the difeafe. The bed alone would often remove a fever at the beginning ; but when the patient ftruggles with the difeafe, inftead of driving it off, he only fixes it the dee- per, and renders it more dangerous. This obfervation is too often verified in travellers, who happen, when on a journey, to be feized with a fever. Thiir anxiety to get home induces them to travel with the fever upon tfcem, which condua feldom fails to render it fatal. ' In fevers, the mind as well as the body fliould be kept eafy. Company is feldom agreeable to the fick. Every thing that disturbs the imagination increafes the difeafe; for which reafon, every per- fon in a fever ought to be kept perLaiy quiet, and neither allow- ed to fee nor hear a::y thing that may in the leaft affea or difcom- pofe his mind. - Though the patient in a fever has the greateft inclination for drink, yet he feldom has any appetite for folid food ; hence, the impropriety of urging him to take viauals, '13 evident. Much folid food in a fever is every way hurtful: It oppreffes Nature, and in- ftead of nourifhing the patient, ferves only to feed the difeafe. What food the patient takes fhould hi in fmall quantity/ lieftit, and of eafy digeftion. It ought to be chiefly of the vegetable kind, as panada, roafted apples, gruels, and fuch like. • Poor people, when any of their family are taken ill, run direaiy to .their rich neighbours for cordials, and pour wine, fpirits, &c. into the patient, who, perhaps, never had been accuftomed to tafto fuch liquors when in health. If there be any degree of fever, this condua muft increafe it, and if there be none, this is the rea- dy way to raife one. Stuffing the patient with fweet-meats and OF FEVERS IN GENERAL. IIS other delicacies, is likewife very pernicious. Thefe are always harder to digeft Chan common food, and hurt the ftomach. Nothing is more defired -by a patient in a fever,-than frefh air. It not-only removes his anxietyj but cools the blood, revives the fpirits, and proves every way beneficial. Many patients are in a '"manner ftitled to death in fevers for want of frelh air ; yet fuch is the unaccountable infatuation of moft people, that the moment they think a perfon in a fever, they imagine he fliould be kept in a clofe chamber, into whiclr not one particle of frefh air'muft be ad- mitted. Inftead of this, there ought to be a conftant stream cf frefh air into a fick perfon's chamber, fo as to keep it moderately cool. Indeed, its degree of warmth cught never to be greater than is agreeable to one in pcrfea health. Nothing fpoils the-air of a iick perfon's chamber, or hurts the pa- "tient more, than a number of people breathing in it. When the blood is inflamed, air that has been breathed repeatedly will great- ly increafe the difeafe. Such air not only iofes its fpring, and be- comes unfit for the purpofe of refpiration, but acquires a noxious quality, which renders it in a'manner poifonous to the fick. In fevers, when the patient's fpirits are low and deprefied, he is not only to be fupported with cordials, but every method fliould be taken to cheer and comfort his mind. Many, from a miitakert zeal, when they think a perfon in danger, inftead of folacing his mind with the hopes and confolations of religion,, fright him with the views of hell and damnation. It would be unfuitable here tc* dwell upon the impropriety and dangerous confequences of this condua. Amciig common people, the very nameofti fever generally fug- gefts the neceffity of bleeding. This notionfeems to have taken its rife from moft fevers in this country having been formerly of an inflammatory nature ; but true inflammatory fevers are no.v feldom to be met with. Sedentary occupations, and a different manner of living, have fo changed the ftate of difeafes in Britain, that there is now hardly one fever in ten where the lancet is neceffary. In low, nervous fevers, which are now fo common, bleeding is really hurt- ful, as it weakens the patient, finks his fpirits, &e. We would re- commend this general rule, never to bleed at the beginning of a fever, unlefs there be evident figns of inflammation. Bleeding is an excellent medicine when necefTary, but fliould never be wan-. '.only performed. It is likewife a common notion, that fweating is always neceffary in the beginning of a fever. When the fever proceeds from an ob- ftruaed perfpiration, this notion is not ill-founded. If the patient only lies in bed, bathes his feet and legs in warm water, jL\\d drinks freely of water-gruel, or any bthsr weak diluting liquor, he will feldom fail to perfpire freely. The warmth of the bed, and the diluting drink, will relax the universal fpafm, which generally af- feas the fkin at the beginning of a fever; it will open the pore-;, 112 OF INTERMITTING FEVERS, and promote the perfpiration, by means of which the fever may often be carried off. But inftead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as fpirits, fpiceries, &c. which increafe the fpafms, and render the difeafe more dangeious. In all feveTS, a proper attention fhould be paid to the patient's longings. Thefe are the calls of Nature, and often point out what may be of real ufe. Patients are not indeed to be indulged in every thing that the fickly appetite may crave ; but it is generally right to let them have a little of what they eagerly defire, though it may not feem altogether proper. What the patient longs for, his fto- mach will generally digeft ; and fuch things have fometimes a very happy effea. When a patient is recovering from a fever, great care is necef- fary to prevent a relapfe. Many perfons, by too foon imagining themfelves well, have loft their lives, or contraaed other difeafe* of an obftinate nature. As the body after a fever is weak and de- licate, it is neceffary to guard againft catching cold. Moderate exercife in the open air will be of ufe, but great fatigue is by all means to be avoided; agreeable company will alfo have a good effea. The diet muft be light, but nourifhing. It fliould be taken frequently, but in fmall quantities. It is dangerous at fuch a time to eat as much as the ftomach may crave. CHAPTER XIV.- Of Intermitting Fevers, or Agues. INTERMITTING fevers afford the beft opportunity both of obferving the nature of a fever, and alfo the effeas of medicine.'. No perfon can be at a lofs to diftinguifh an intermitting fever1 from any other, and the proper medicine for it is now almoft uni- verfally known. The feveral kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quar-' tan, &c. CAUSES.----Agues are occafioned by effluvia from putrid ftagnating water. This is evident from their abounding in rainy feafons, and being moft frequent in coiyitrjes where the foil is marfhy. This difeafe may alfo be occafioned by eating too much ftone fruit, by a poor watery diet, damp houfes, evening dews, ly- ing upon the damp ground, watching, fatigue, deprefling paffions, and the like. When the inhabitants of a high country remove to a low one, they are generally feized with intermitting fevers, and to fuch the difeafe is moft apt to prove fatal. In a word, whatever relaxes the folids, diminifhes the perfpiration, or obftruas the' OF INTERMITTING FEVERS. 113 circulation in the capillary or fmall veffels, difpofes the body to agues. SYMPTOMS.----An intermitting fever generally begins with a pain cf the head and loins, wearinefs of the limbs, coldnefs of the extremities, stretching, yawning, with fometimes great ficknefs and vomiting; to which fucceed fhivering and violent fhaking. Afterwards the fkin becomes moift, and a prof ufe fweat breaks out which generally terminates the fit or paroxyfm. Sometimes the difeafe comes on fuddenly, when the perfon thinks himfelf in perfect health ; but it is more commonly preceded by liftleffnefs, lofs of appetite, and the fymptoms mentioned above. REGIMEN.----While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile tea ; or, if his fpirits be low, fmall wine-whey, fharpened with the juice of lemon. All his drink fhould be warm, as that will affift in bringing on the fweat, and coafequently fhorten the paroxyfra*. Between the paroxyfms the patient muft be fupported with food that is nourifhing, but light and eafy of digeftion, as veal or chick- en broths, fago, gruel with a little wine, light puddings, and fuch- like. His drink may be fmall negus, acidulated with the juice of lemons or oranges, and fometimes a little weak punch. He may likewife drink infufions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now-and-then take a glafs of fmall wine, in which gentian root, centaury, or fome other bitter, has been in- fufed. As the chief intentions of cure in an ague are to brace the folids, and promote perfpiration, the patient ought to take as much exer- cife between the fits as he can bear. If he is able to go abroad, rid- ing on horfeback, or in a carriage, will be of great fervice. But if he cannot bear that kind of exercife, he ought to take fuch as his ftrength will permit. Nothing tends more to prolong an intermit- ting fever, than indulging a lazy, indolentuiifpofition. Intermitting fevers, under a proper regimen, will often go off without medicine ; and when the difeafe is mild, in an open dry country, there is feldom any danger from allowing it to take its courfe ; but when the patient's ftrength feems to decline, or the paroxyfms are fo violent that his life is in danger, medicine ought immediately to be adminiftered. This, however, fhould never be done till the difeafe be properly formed, that is to fay, till the pa- tient has had feveral fits of fhaking and fweating. MEDICINE-----The firft thing to be done in the cure of an intermitting fever, is to cleanfe the ftomach and bowels. This ren- ders the application of other medicines more fafe and efficacious. #■ Dr. Lind fays, that twenty or twenty-five drops of laudanum put into a cup of the patient's drink, and given about half an hour after the coinmencemeatof thehotfit, promotes the fweat. fhorrens the tit, re- lieves the head, and tends greatly to remove the difeafc. P 114 OF INTERMITTING FEVERS. In this difeafe, the ftomach is generally loaded with cold vifcid phlegm, and frequently great quantities of bile are difcharged by vomit; which points out the neceffity of fuch evacuations. Vomits are therefore to be adminiftered before the patient takes any other medicine. A dofe of ipecacuanha will generally anfwer this pur- pofe very well. A fcruple or half a dram of the powder will be fufficient from an adult, and for a younger perfon the dofe muft be lefs in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit fhould be taken two or three hours before the return of the fit, and may be repeated at the diftance of two or three days. Vomits not only cleanfe the ftomach, but increafe the perfpiration and all the other fecretions, which render them of fuch importance, that they of- ten cure intermitting fevers without the affiflance of any other me- dicine. Purging medicines are ufeful and often necefTary in intermitting fevers. A fmart purge has cured an obstinate ague, after the bark and other medicines had been ufed in vain. Vomits are more fuitable in this difeafe, and render purging lefs neceffary; but if the pa- tient be afraid to take a vomit, he ought to cleanfe the bowels by a dofe or two of Glauber's fait or jalap. Bleeding may fometimes be proper at the beginning of an inter- mitting fever, when exceffive heat, a delirium, &c. give reafon to fufpea an inflammation; but as the blood is feldom in an inflam- matory ftate in intermitting fevers, this operation is rarely neceffary. When frequently repeated, it tends to prolong the difeafe. After proper evacuations, the patient may fafely ufia the Peruvian bark, whicji may be taken in any way that is moft agreeable to him. No preparation of the bark feems to anfwer better than the moft fimple form in which it can be given, viz. in powder. Two ounces of the beft bark,finely powdered, may be divided into twenty-four dofes. Thefe may either be made into boluffes as they are ufed, with a little fyrup of lemon, or mixed in a glafs of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient*. In an ague which returns every day, one of the above dofes may be taken every two hours, or oftener during the interval of the fits. By this method, the patient will be able to take five or fix dofes between each paroxyfm. In a tertian or third-day ague, it will be fufficient to take a dofe every third hour during the interval, and in a quartan every fourth. If the patient cannot take fo large a dofe of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young perfon, a fmaller ■* It has lately been obferved, that the red bark is more powerful than that which has for fome time been in common ufe. Its fuperior efficacy feems to arife from its being of a more perfeft growth than the quill bark, and consequently more fully impregnated with the medical properties »f the plant. OF INTERMITTING FEVERS. "5 Quantity of this medicine will be fufficient, and the dofe muft be adapted to the age, conftitution, and violence cf the-fymptoms*. The above quantity of bark will frequently cure an ague ; the patient, however, ought not to leave off taking the medicine as foon as the paroxyfms are flopped, but fliould continue to ufe it till'tliere is reafon to believe the difeafc entirely overcome. Moft failures in the cure are owing to patients not continuing to ufe the medicine long enough.' They are generally direaed to take it till the fits are flopped, then to leave it off, and begin again at fome diftance of time ; by which means the difeafe gathers ftrength, and often re- turns with as much violence as before. A relapfe may be prevented by the patient's continuing to take fmall dofes of the medicine fcr fome time after the fymptoms disappear. This is the moft fafe me- thod of cure. An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of cauion-dle- flowers, and an handful of coriander-feed, all ifuifed together in a t mortar, may be ufed in form or infufion of tesbf > About half an handful of thefe ingredients may be put into a tea-pot, and an Englifh pint of boiling water poured on them. A cup of this infu- fion, drank three or four times a day, will 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 of the above, or any other proper infufion of bitters, a fmaller quan- tity of bark than is generally ufed, will be fufficient to cure an aguef. Thofe who cannot fwallow the bark in fubftance, may take it in decoaion or infufion. An ounce of bark in powder may be in- fufed in a bottle of white wine for four or five days, frequently fhaking the bottle, afterwards let the powder fubfide, and pour off the clear liquor. A wine-glafsful may be drank three or four *• In Intermitting fevers of an obftinate nature, I have found it ne- ceffary to throw in the bark much faster. The benefits arifing from this medicine, depend chiefly upon alargequan.tity of it being adminiilered in a fliort time. Several ounces of bark given in a few days will do more than as many pounds taken in the courfe of fome weeks. When this medicine is intended either to flop a mortification, or cure an obftinate ague, it ought to be thrown in as fall as the ftomach can poflibly bear it. Inattention to this circumttance has hurt the reputation of one of the beft medicines of which we are in poifeflion. • f There is reafon to believe, that fundry of our own plants or barks, which are very bitter and aftringent, would fucceed in the cure of in- termitting fevers, efpecially when aflifted by aromatics. "But as Peruvian bark has been long approved in the cure of this difeafe, and is now to be obtained at a very reafonable rate, it is of lefs importance to fearch after new medicines. We eannot however omit taking notice, that Peru- vian bark is very often adulterated, and that it requires confiderable fldil to dlftinguifli between the genuine and the falfe. This ought to make people very cautious of whom they purchafe it. n6 OF INTERMITTING FEVERS. times a day, or oftener, as there is occafion. If a decoaion be mere agreeable, an ounce of the bark, and two drams of Oiake- root bruifed, with an equal quantityof fait of wormwood, may be boiled in a quart of water, into an Englifh pint. To the strained ' liquor may be added an equal quantity of red wine, and a glafs of it taken frequently.. In obftinate agues, the bark will be found much more effica- cious when affifted by brandy, or other warm cordials, than taken alone. This I have had frequently occafion toobfervein a coun- try where intermitting fevers were endemical. The bark feldom fuccceds 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 inflamma- tory nature, it will be fafer to keep out the aromatics, and to add fait of tartar in their flead. But in an obftinate tertian or quarun, in the end of autumn or beginning of winter, warm and cordial medicines are abfoli^tely neceffary*. As autumnal a&d, winter agues generally prove much more ob- ftinate than thofe" which attack the patient in firing or fummer, it will be neceffary to continue the ufe of medicines longer in the former than in the latter. A perfon who is feized with an inter- mitting 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 feafon. He ought likewife to take.care not to be much abroad in wet weather, efpecially in cold cafterly winds. When agues are not properly cured, they often degenerate into obftinate chronical difeafes, as the dropfy, jaundice, &c. For this reafon, all poffible care fhould be taken to have them radically cured, before the conftitution has been too much weakened. Though nothing is more rational than the method of treating intermitting fevers, yet, by fome ftrange infatuation, more charms and whimflcaf remedies are daily ufed for removing this than any other difeafe. There is hardly an old woman who is not in poflef- fion of a nostrum for ftoppirfg 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 beft 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 diforder. Some, indeed, try bold, or, rather, fool-hardy experiments to * In obftinate agues, when the patient is old, the habit phlegmatic; the feafon rainy, the fituation damp, or the like, h will be neceffary to inix with two ounces of the bark, half an ou'?fe of Virginian fnake- root, and a quarter of an ounce of ginger, or fome other warm aromatic; but when the fymptoms are of an inflammatory nature, half an ounce of fait of wormwood, or fait of tartar, may be added to the above quan- tity of bark. OF INTERMITTING FEVERS. 117 cure agues, as drinking great quantities of 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 de- gree of inflammation, or the leaft tendency to it, fueh experiments may prove fatal. The only patient whom I remember to have loft, in an intermitting fever, evidently killed himfelf by drinking ftrong liquor, which fome perfon had perfuaded him would prove an in- fallible remedy. Many dirty tilings are extolled for the cure of intermitting fe- vers, as fpiders, cobwebs, fnuffings of candles, &c. Though thefe may fometimes fucceed, yet their very naftinefs is fufficient to fet them afide, efpecially w,hen cleanly medicines will anfwer the pur- pofe better. The only medicine that can be depended upon, for thoroughly curing an intermitting fever, is the Peruvian bark. It may always be ufed with fafety; and I can honeftly declare, that in all my praaice, I never knew it fail, when combined with thcy medicines mentioned above, and duly perfifted in. Where agues are endemical, even children are often affliaed with that difeafe. Such patients are very difficult to cure, as they ca"n feldom be prevailed upon to take the bark, or any other difa- greeable medicine-f-. One method of rendering this medicine more palatable, is to make it into a mixture with diftilled waters artd fy rup, and afterwards to give it an agreeable fharpnefs with the elix- ir or fpirit of vitriol. This both improves the medicine, and takes off the naufeous tafte. In cafes where the bark cannot be admini- ftered, the falme mixture may be given with advantage to children^. 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 hartfhofn. Exercife is likewife of considerable ferviee ; and when the difeafe proves obftinate, the child ought, if poffible, to be remo- ved to a warm, dry air. The food ought to be nourifhing, and fometimes a little generous wine fhould be allowed. To children, and fuch as cannot fwallow the bark, or when the ftomach will not bear it, it may be given by clyster. Half an ounce of the extraa of bark, diffolved in four ounces of warm-water, with the addition of half an ounce of fweet-oil, and fix or eight drops of laudanum, is the form recommended by Dr. L-ind for an adult, and this to be repeated every fourth hour, or oftener, as the occafion fhall require. For children, the quantity of extraa and ■* Arfnic is among the number of thefe bold, injudicious remedies; and ought never to be ufed in i.\:y cafe of intermitting fever what- ever. (I.C.) f When children cannot take the medicine recommended, they may be frequently cured by giving ten or fifteen drops of laudanum, accor- ding to the age of the patient, about half an hour before the cold ftage commences. (I. C.) i; See Appendix, Saline mixture. 118 OF AN ACUTE CONTINUAL FEVER. laudanum muft be proportionally leffened. Children have been cured of agues by making them wear a waiftcoat with powdered bark quilted between the folds of it ; by bathing them frequently in a ftrong decoaion of the bark, and by rubbing the fpine with ftrong fpirits,for with a mixture of equal parts of laudanum, and the fa- ponaceous liniment. This difeafe is very common, and few patients in an ague apply to phyficiaris.unlefs in extremities. There are many cafes in which the difeafe is very irregular, being complicated with other difeaf- es; or attended with fymptoms which are both very dangerous and very difficult to understand. All thefe we have purpofely paffed over, as they would only bewilder the generality of readers. When the difeafe is very irregular, or the fymptoms dangerous, the pa- tient ought fmmediately to apply to a phyfician, and ftriaiy to fol- low his advice. To prevent agues, people muft endeavour to avoid their caufes. Thefe have been already pointed out in the beginning of this fec- tion ; we fhall therefore only add one preventive medicine, which may be of ufe to fuch as are obliged to live in low marfhy coun- tries, or who are liable to frequent attacks of this difeafe. Take an ounce of the beft Peruvian bark ; Virginia fnake-root, and orange-peel, of each half an ounce ; bruife them 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 glals of it twice or thrice a-day. This is recommending a dram ; but the bitter ingredients in a great meafure take off the ill effeas of the fpirit. Thqfe who do not choofe it in brandy, may infufe it in wine ; and fuch as can bring themfelves to chew the bark, will find that method fucceed very well. Gentian root, or calamus aromaticus may alfo be chewed by turns for the fame pur- pofe. All bitters feem to be antidotes to agues efpecially thofe that are warm and aftringent. CHAPTER XV. Of an Acute Continual Fever. THIS fever is termed acute, ardent, or inflammatory. It moft commonly attacks the young, or perfons about the prime or vigour of life, efpecially fuch. as live high, abound with blood, and whofe fibres are ftrong and elastic. It feizes people at all feafons of the year ; but is moft frequent in the fpring and beginning of fummer. CAUSES.----An ardent fever may be occafioned by any thing that overheats the body, or produces plethora, as violent exercife, fleeping in the fun, drinking ftrong liquors, eating fpiceries, a full diet, with little exercife, &c. It may likewife be occafioned by OF AN ACUTE CONTINUAL FEVER. 119 whatever obftruas the perfpiration, as lying on the. damp ground, drinking cold liquor when the body is hot, night watching, or the like. SYMPTOMS.-----A rigour or chilinefs generally ufhers in this fever, which is foon fuccceded by great heat, a frequent and full pulfe, pain of the head, dry fkin, rednefs of the eyes, a florid countenance, pains in the back, loins, &c. To thefe fucceed dif- ficulty of breathing, ficknefs, 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 roug^h: A delirium, exceffive reftleffnefs, great oppreffion of the breaft, with laborious refpiration, starting of the tendons, hickough, cold clammy fweats, and an involuntary difcharge of urine, are very dangerous fymptoms. As this difeafe is always attended with danger, the beft medi- cal affiftance ought to be procured as foon as poffible. A phyfician may be of ufe at the beginning, but his fkill is often of no avail afterwards. Nothing can be more unaccountable than the condua of thofe who have it in their power, at the beginning of a fever, to procure the beft medical affiftance, yet put it off till things come to an extremity. When the difeafe, by delay or wrong treat- ment, has become incurable, and has exhauiled the ftrength of the patient, it is in vain to hope for relief from medicine. Phyfi- cians may indeed affift Nature ; but their attempts muft ever prove fruitlefs, when fhe is no longer able to co-operate with their endeavours. REGIMEN.----From the fymptoms of this difeafe, it is evi- dent, that the blood and other humours require to be diluted ; that the perfpiration, urine, faliva, and all trie-other fecretions, are in too fmall quantity ; that the veffels are rigid, and the heat of the whole body too great: all thefe clearly point out the neceffity of a regimen calculated to dilute the blood, allay the exceffive heat, remove the fpafmodic ftriaurs of the veffels, and. promote the fecretions. Thefe important purpofes may be greatly promoted by drinking plentifully of diluting liquors ; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-cea, Sec. 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 curd feparates. If no orange can be had, a lemon, a little cream of tartar, or a few fpoonfuls of vinegar, will have the fame effea. Two or three fpoonfuls of white wine may be occafionaily 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 plea- fant drink, and may be ufed at difcretion. The common pectoral rio OF AN ACUTE CONTINUAL FEVER. decoaion is likewife a very proper drink in this difeafe. A tea- cupful of it may be taken every two hours, or oftener, if the pa- tient's heat and thirft be very great*. The above liquids, 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 difeafe, by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to choofe thofe 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 lighrybread boiled in water; to which may be added a few grains cf common fait, and a little fugar, which will render it more palatable. He may eat roafled 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 muft al- ways be done in fuch a manner as not to endanger his catching "cold. It is too common in fevers to load the patient with bed-clothes, under the pretence of making him 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 perfpiration. Sitting up-right in bed, if the patient is able to bear it, will of- ten have a good effea. It relieves the head, by retarding the mo- tion of the blood to the brain. But this pofture ought never to be continued too long : and if the patient is inclined to fweat, it will be more fafe to let him lie, only raifing his head a little with pil- lows. Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rofe-water, with a little nitre diffoived in it, will greatly re- frefh the patient. This ought to be done frequently, especially if the weather is hot. The patient's mouth fliould 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 fre- quently to be bathed in lukewarm water ; efpecially if the head is affeaed. The patient fhould be kept as quiet and eafy as poffible. Com- pany, noife, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that afleas the fenfes, ought to be avoided. His attendants fhould be as few as poffible, and they ought not to be too often changed. His inclinations fhould rather #■ See Appendix, Peroral Decoclion. OF AN ACUTE CONTINUAL FEVER. 121 be Toothed than contradiaed ; even the promife of: what he craves wiH often fatisfy him as much as its reality. MEDICINE.----In all this and other fevers, attended with a hard, full, quick putfe, bleeding is of the greateft importance. This operation ought always to be performed as foon as the fymp- toms of an inflammatory fever appear. The quantity of blood to be taken away, however, muft be in proportion to the ftrength of the patient and the violence of the difeafe. If, after the firft bleed- ing, the fever fhould rife, and the pulfe become more frequent and hard, there will be a neceffity for repeating it a fecond, and per- haps a third, or even a fourth time, which may be done at the dif- tance of twelve, eighteen, or twenty-four hours from each other, as the fymptoms require*. If the heat and fever be very great, forty or fifty drops of the dulcified or fweet fpirit of nitre may be'made into a draught, with an ounce of rofe-water, two ounces of com- mon water, and half an ounce of fimple fyrup, or a bit of Ioaf-fu- gar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or fix hours will be fufficient. If the patient be affliaed with reaching, or an inclination to vomit, it will be right to affift Nature's attempts, by giving him weak camomile-tea, or lukewarm water to drink. If the body be bound, a clyster of milk and water, with a little fait, and a fpoonful of fweet-oil or frefh butter in it, ought daily to be adminiftered. 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 pfunes, roasted apples, and the like. If about the tenth, eleventh, or twelfth day, the pulfe becomes more foft, the tongue moifter, and the urine begins to let fall a reddifh fettlement, there is reafon to expea 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 ftupor, trembling of the nerves, flarting of the tendons, Sec. there is reafon to fear that the confequences will be fatal. In this cafe, blisters muft be applied to the head, ancles, infideof the legs or thighs, as there may be occafion; poultices of wheat-bred, 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, negus, fago-gruel with wine in it, and fuch like. A proper regimen is not only necefLry curing the fever, but likewife after the patient begins to recover. By negieaing this, many relapfe, or fall into other difeafes, and continue valetudinary for life. Though the body is weak after a fever, yet the diet for fame time ought to b~ rather cleanfing than of too nourifhing a * During the time bleedings are employed, brrsk"purging with glau- bcr fair? fhould not be omitted. (I. C) Q OF THE FLEURISY. nature. Too mueli food,drink, exercife, company, Sec. are en; -iuT- Iy to be avoided. The mind ought to be kept eafy, and the patient fhould not purfue ftudy, or any bufinefs that requires intenfe •' thinking. If the digeftion isbad, or the patient feized at times v.'ith f°verifl> heats, an infufion of bark in cold wate,r will be of ufe. It will flrengfhen the ilomach, and hgip to fubdue the remains of the fever. When the.pa;:it.".t's ftrength is pretty well recovered, he ought to take fome gentle laxative. An ounce of tamarinds and a dram of fena may be boiled for a few minutes in an Englifh pint of wa- ter, and an ounce of manna diffolved in the*decoction ; afterward* it may be strained, and a tea-cupful drank every hour till it ope- rates. This dofe may be repeated twice or thrice, five or fix days intervening betwixt each dofe. Thofe% who fellow laboriou-' employments ou~ft not to return ., top foon'to their labour after a fever, but fliould keep eafy till their ftrength and fpirits are fufficiently recruited. C EI A P'T E R XVI. Of the Pleurify. ''TpHE the pleurify is an inflammation of that membrance cal- JL led the pleura, which lines the in fide of the breaft. ft is dif- tinguifhed into the moid and dry. "In the former, the patient fpits ' freely; in the latter, little, or none at all. There ig likewife % . fpecies of this difeafe, which is- called the fpurious or baflard pleurify, . in which the pain is more external, and chiefly affects the .mufcles , between the ribs. Ihe pleurify prevails among labouring people, efpecially fuch as work without doors, and are of a iije^uine con- ftitution. It is molt frequent in the fpring feafon. CAUSES.----The pleurify may be occafioned by whatever obftwias the perfpiration ; as cold northerly wind-s ; drinking cold liquors when the body is hot; fleeping without-doors on the damp ground ; wet clothes; plunging the body into- cold water, or ex- pofing it to the cold air, when covered with fweat, &c. It may be occafioned by drinking ftrong liquors ; by the ftoppage of ufual evacuations; as old ulcers, rffues, fweating of the feet or hands, v'ec. the fudden striking in of any eruption, as the itch, the mea- lies, or the frmdl-por;. Thofe who have been accuftcmed to bleed < at a. certain ftafou of the year, are apt, if they i.eglea it, to be feized with a They likewife prove fatal to fingers, and all who have occafion to make frequent and violent exertions of the lungs. -----Cold. More confumptive patients date the beginning of their diforders from wet feet, damp beds, night air, wet clothes, R 130 OF CONSUMPTIONS or catching cold after the body had been heated, than from all other caufes. Sharp,' faline, and aromatic aliments, which heat and inflame the blood,, are likewife frequently the caufe of confumptions. We fhall only add, that this difeafe is often owing to an heredita- ry taint, or a fcrophulous habit; in which cafe it is generally in- curable. SYMPTOMS.----This difeafe generally begins with a dry cough,which often continues for fome months. If a difpofition tovo- mit after eating be excited by it, there is ftill greater reafon to fear an approaching confumption. The patient complains of a more than ufual degree of heat, a pain and oppreffion of the breaft, ef- „ pecially 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 tfiirft great. There is generally a quick, foft, fmall pulfe; though fometimes the pulfe is pretty full, and rather hard. Thefe are the common fymptoms of a beginning confumption. Afterwards the patient begins to fpit a greenifh, white, or bloo- dy matter. His body is extenuated by the heaic fever, and colli- quative fweats, which mutually fucceed one another, viz. the one towards night, and the other in the morning. A loofenefs, and an exceffive difcharge of urine, are often troublefome fymptoms at this time, and greatly weaken the patient. There is a burning heat- in the palms of the hands, and the face generally flufhes after eat- ing ; the fingers become 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 fwallowing, and the cold- nefs of the extremities, {how the immediate approach of death, which the patient feldom believes to be fo near. Such is the ufu- al progrefs of this difeafe, which, if not early checked, commonly fees all medicine at defiance. REGIMEN..----On the firft appearance of a confumption, if the patient lives in a large town, or any place where the air is con- fined, he ought immediately to quit it, and to make choice of a fituation in the country, where the air is pure and free. Here he muft not remain inaaive, but take every day as much exercife as he can bear. The beft method of taking exercife is to ride on horfeback, 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 carri- age. A long journey, as it amufes the mind by a continual change of objeas, is greatly preferable to riding the fame ground over and over. Care however muft be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finifh his ride in the morning, or at leaft before dinner ; other wife it will oftener do harm than good. It is a pity that thofe who attend the fick feldom recommend OP CONSUMPTIONS. *P riding in this difeafe, till the patient is either unable to bear it, or the malady has become incurable. Patients are likewife apt to tri- fle with every thing that is in their own power. They cannot fee how one of the common aaions of life •fhould prove a remedy in an obftinate difeafe, and therefore they rejedt E, while they gree- dily hunt after relief from medicine, merely becaufe they do not understand it. Thofe who have ftrength and courage to undertake a pretty long voyage, may expea great advantage from it. This, to my knowledge, has frequently cured a confumption after the patient was, to all appearance, far advanced in that difeafe, and where me- dicine had proved ineffeaual. Hence it is reafonable to conclude, that if a voyage were undertaken in due time, it would feldom fail to perform a cure*. Such as -try this method of cure ought to carry as much frefh provifions along with them as will ferve the whole time they are at fea. As milk is not eafily obtained in this fituation, they ought to live upon fruits, rye and Indian mufli, and the broth of chick- ens, or other young animals, which can be kept alive on board. Such voyages fhould be undertaken, if poffible, in the mildest fea- fon, and towards a warmer climatef. Thofe who have not courage for a long voyage may travel into a more fouthern climate, as the fouth of France, Spain or Portu- gal ; and if they find the air of thefe countries' agree well with them, they fhould continue there, at leaft till their health be con- firmed. ' Next to proper ahr and exercife, we would recommend a due attention to diet. The patient fhould eat nothing that is either heating or hard of digestion, and his drink muft be of a foft and cooling nature. All the diet ought to be calculated to nourifh and fupport the patient. For this purpofe, he muft keep chiefly to,the ufe of vegetables and milk. Milk alone is of more value in this dif- eafe than the whole materia medica. Affes' milk is commonly reckoned preferable to any other; but it cannot always be obtained; befides, it is generally taken in a very fmall quantity; whereas* to produce any effeas, it ought to make a confiderable part of die patient's diet. It is hardly to be expeaed, that a gill or two of affea milk, drank in the fpace of * The greateft benefit derived to consumptive patients in going to fea, is in proportion to the time they are on the ocean, the temperaturepf the latitude they fail in, which fhould be agreeably warm. Therefore, a long voyage, commenced at "an early period of this difeafe, or what would be more beneficial, a continuance for ten or twelve months, on the ocean, a patient in fuch a fituation, with tolerable accommoda„ tion, would in all probability effect a recovery. (I. C.;) t Though I do not remember to have feen one inftance of a genuine confumption of the lungs cured by medicine, yet I have known a Weft.. India voyage work wonders in that dreadful diforder, 132 OF CONSUMPTIONS. twenty-four hours, fhould be able to produce any confiderable change in the humours of an adult; and when people do not per- ceive its effeas foon, they lofe hope, and fo leave it off. Hence, this medicine, however valuable, very feldom performs a cure. The rea- fon is obvious; it is commonly ufed too late, is taken in too fmall quantities, and is not duly perfifted in. I have known very extraordinary effeas from afTes' milk in ob- ftinate coughs, which threatened a confumpiion 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 expeaed to fucceed ? Affes' 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 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 comfumptive cafes have been per- formed by women's milk. Could this be obtained in fufficient quan- tity, we would recommend it in preference to any other. It is better if the patient can fuck it from the breaft, than to drink it after- wards. I knew a man who was reduced to fuch a degree of weak- nefs in a confumption, as not to be able to turn himfelf in bed. His wife was at that time givingjuck, and the child happening to diejhe fucked her breafts,' not with a view to reap any advantage from the milk, but to make her eafy. Finding himfelf greatly bene- fited by it, he continued to fuck her till he became perfeaiy well, and is at prefent a ftrong and healthy man. Some prefer butter-milk ; it is a very valuable medicine if the ftomach be able to ber.r it. It does not agree with every perfon at firft ; and is often laid aside without a fufficient trial. It fhould at firft be taken fparingly, and the quantity gradually increafed, until it comes to be almoft the fole fodd. I never knew it fucceed unlefs where the patient almoft lived upon it. Cows' milk is moft readily obtained of any, and though it be not fo eafily digelted as that of affes' or mares', it may be rendered ligh- ter by adding to it an equal quantity of barley-water, or allowing it to ftand for fome hours, and afterwards taking off the cream. If it fliould, notwithftanding, prove heavy on the ftomach, a fmall quantity of brandy or rum, with a little fugar, may be added, which will render it both more light and nourifhing. Milk mav for fome time difagree with a ftomach that has not OF CONSUMPTIONS. 133 been accustomed to digest 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 food and ftrong liquors, to leave them off all at once. This might be dangerous. It will be neceffary for fuch to eat .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 ought like- wife to drink a little wine made into negus, or diluted with twice or thriee its quantity of -water, and to make it gradually we;.ker till they can leave it off altogether. Thefe muft be ufed only as preparatives to a diet confuting chiefly of milk and vegetables, which the fooner that the patient can be brought to bear, the better. Rice and milk or barley and miik, boiled with a little fugar, make very proper'food. Ripe fruits roafted, baked, or boiled, are likewife proper, as goofe or currant berry tarts, apples roafted, or boiled in milk, &c. The jellies, con- ferves, and preferves, &c. of ripe fubacid fruits, ought to be eaten plentifully, as the jelly of currants, conferve of'rofes, preferred plums, cherries, &c. Wholefome air, proper exercife, and a diet confifting chiefly of thefe and other vegetables, with milk, is the only courfe that can be depended on in a beginning confumption. Jf the patient has ftrength and fufficient refolution to perfift in this courfe, he will feldom bedifappointedof a cure. In the populous town of Sheffield, where confumptions are very common, I have frequently feen confumptive patients, who had; been fent to the country with orders to ride, and live upon milk! and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the cafe, efpecially when the difeafe was hereditary, or far advanced ; but it was the only method in which fuccefs was to be expeaed : where it failed., I never knew medicine fucceed. If the patient's ftrength and fpirits flag, he muft be fupported by ftrong broths, jellies, and fuch-like. Some recommend fhell-fifh in this diforder, and with fome reafon, as they are nourifhing and reftorativc*. All the food and drink ought however to be taken in fmall quantities, left an overcharge of frefh chyle fliould opprefs the lungs, and too much accelerate the-circulation of the blood. The patient's mind ought to be kept as eafy and cheerful as poffible. Confumptions are often occafioned, and always aggrava- ted, by a melancholy caft of mind ; for which reafon, mufic, cheer- ful company, and every thing that infpires mirth, are highly be- neficial. The patient ought feldom to be left alone; as brooding over his calamities is fure to render them worfe. * I have often known perfons of a confumptive habit, where the fymptoms were not violent, reap great benefit from the ufe of oyiters. They generally ate them raw, and drank the juice along with them. / 134 OF CONSUMPTIONS. MEDICINE.----Though the cure of this difeafe depends chief- ly upon regimen and the patient's own endeavours, yet we fhall mention a few things which may be of fervice in relieving fome of the more violent fymptoms. In the firft ftage of a confumption, the cough may fometimes be appeafed by bleeding; and the expeaoration may be promoted by the following medicines. Take frefh fquills, gum-ammoniac, and powdered cardamurn feeds, of each a quarter of an ounce ; beat them together in a mortar, and ii the mafs proves too hard for pills, a little of any kind of fyrup may be added to it. This may be formed into pills of a moderate fize, and four or five of them taken twice or thrice a-day, according as the patient's fto- mach will bear them. The lac ammoniaa/i?!, or milk of gum ammoniac, as it is called, is likewife a proper medicine in this ftage of the difeafe. It may be ufed as direaed in the pleurify. A mixture made of equal parts of lemon-juice, fine honey, and fyrup of poppies, may likewife be ufed. Four ounces of each of thefe may be fimmered together in a fauce-pan, over a gentle fire, and a table-fpoonful of it taken at any time when the cough is trou- ble fomeN It is common in this ftage of the difeafe to load the patient's ftomach with oily and balfamic medicines. Thefe, inftead of re- -' moving the caufe of the difeafe, tend rather to increafe it, by heating the blood, while they pall the appetite, 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 fharp and cleanfing nature ; as oxymel, fyrup of lemon, &c. x Acids have peculiarly good effeas in this difeafe; they both tend to quench the patient's thirft and to cool the blood. The ve- getable acids, as apples, oranges, lemons, &c. appear to be the moft proper. I have known patients fuck the juice of feveral le- mons every day with manifest advantage, and would for this rea- fon recommend acid vegetables to be taken in as great quantity as the ftomach will bear them. For the patient's drink, we would recommend infufions or the bitter plants, as ground-ivy, the lefler centaury, camomile flowers or water-trefoil. Thefe infufions may be drank at pleafure. They ftrengthen the ftomach, promote digeftions, and at the fame time anfwer all the purpofes of dilution, and quench thirft much better than things that are lufcious or fweet. But if the patient fpits blood, he ought to ufe, for his ordinary drink, infufions or decoaions of the vulnerary roots, plants, &c*. There are many other mucilaginous plants and feeds, of a heal- ing and agglutinating nature, from which decoaions or infufions * See Appendix, Vulnerary decoction. OF CONSUMPTIONS, T;^ may be prepared with the fame intention ; as the otfehes, the quince-feed, coltsfoot, linfeed, farfaparilla, &c. Simple infufion or boiling is all that is neceffary, and the dofe may be at difcretion. The conferve of rofes is here peculiarly proper. It may either be put into the decoaion above prefcribed, or eaten by itfelf. No benefit is to be expeaed from trifling dofes of this medicine. I ne- ver knew it of any fervice unlefs where three or four ounces at leaft were ufed daily for a confiderable time. la this way I have feen it produce very happy effeas, and would recommend it wher- ever there is a difcharge of blood from the lungs. When the fpitting up of grofs matter, oppreffion of the breaft, and the heaic fymptoms, fhow that an impofthume is formed in the lungs, we would recommend the bark, to fupport the ftrength of the patient. An ounce of the bark in powder :"..ay be divided into eighteen or twenty dofes, of which one may be taken every three hours through the day, in a little fyrup, or a cup of horehound-tea. If the bark fhould happen to purge, it may be made into an eleauary, with the conferve of rofes, thus : Take old conferve of rofes a quarter of a pound, bark in powder an ounce, fyrup of orange or lemon, as much as will make it of the confiftence 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 infufe it in cold water. This feems to be the beft menstruum for extraaing its vir- tues. Half an ounce of bark in powder may be infufed for twen- ty-four hours in half an Englifh pint of water. Afterwards let it be paffed through a fine strainer, and an ordinary tea-cupful of it taken three or four times a-day. We would not recommend the bark while there are any fymp- toms of an inflammation of the breaft ; but when it is certainly ' known that matter is colleaed there, it is one of the beft medicines; which can be ufed. Few patients indeed have refolution enough* to give the bark a fair trial at this period of the difeafe, otherwife. we have reafon to believe that fome benefit might be reaped from it. When it is evident that there is an impofthume in the braaft, and the matter can neither be fpit up nor carried off by abforption, die 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, &c. When it happens to burst within the lungs, the matter maybe difcharged by the mouth. Sometime* indeed the bursting of the vomica occafions immediate death, by fuffocating the patient. When the quantity of matter is great, anil the patient's ftrength exhaufted, this is commonly the cafe. At any rate, he is ready to fall into a (woon, and fhould have volatile falts. or fpirits 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 i3<5 OF CONSUMPTIONS. this time ought to be light, but restorative, as chicken-broths, fago- gruel, rice-milk, &c. the drink, butter-milk, or whey, fweetcned with honey. This is likewife a proper time for ufing the Peruvian bark, which may be taken as direaed above. If the vomica or impofthume fhould difcharge itfelf into the cavity of the breaft, betwixt the pleura and the lungs, there is no way of getting the matter out but by an incifion, as has already been ob- ferved. As this operation muft always be perfomed by a furgeon, it is not neceffary here to dcfcribe it. We fhall only add, 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. Thofe who are of a fretful temper, who indulge in fpirituous liquors, or who breathe an unwholefome air, are moft liable to this difeafe. We would chiefly recommend, for the cure of a nervous con- fumption, a light and nourifhing diet, plenty of exercife in a free open air, and the ufe of fuch bitters as brace and strengthen the ftomach ; as the bark, gentian root, camomile, horehound, &c. Thefe may be infufed in water or wine, and a glafs of it drank frequently. It will greatly affift the digeftion, and promote the cure of this difeafe, to take twice a-day twenty or thirty droops of the elixir of vitriol in a giafs of wine or water. The chalybeate wine is likewife an excellent medicine in this cafe. It strengthens the folids, and powerfully affifts Nature in the preparation of good blood*. Agreeable amufements, cheerful company, and riding about, are however preferable to all medicines in this difeafe. For which rea- fon, when the patient can afford it, we would recommend a long journey of pleafure, as the moft likely means to reftore his health. What is called zfymptomatic confumption cannot be cured without firft removing the difeafe by which it is occafioned. Thus, when a comfumption proceeds from.fhe fcrophula or king's evil from the fcurvy, the afthma, the venereal difeafe, &c. a due attention muft be paid to the malady from whence it arifes, and the regimen and medicine direaed accordingly. When exceffive evacuations of any kind occafion a confump- tion, they muft not only be restrained, but the patient's ftrength muft be restored by gentle exercife, nourifhing diet, and generous cordials. "Young and delicate mothers often fall into confumptions, by giving fuck too long. As foon as they perceive their ftrength and appetite begin to fail,they ought immediately to wean the child, or provide another nurfe, otherwife they cannot expea a cure. * See Appendix, Chalybeate wine. OF THE NERVOUS FEVER. lzi Let all, as they v ifh to avoid confumptions, take as much exer- cife w'ithout-door, as they can,'avoid unwholefome air, and ftudy fobriety. Confumptions owe their prefent increafe not a littlato the faihion of fitting up late, eating hot fuppers, and fpending every evening over a bowl of hot punch or other ftrong liquors. Thefe liquors, when too freely uCbd, not only hurt the digeftion, and fpoil the appetite, but heat and inflame the blood, and, fet the whole conftitution on fire. CHAPTER XIX. Of the Slow or Nervous Fever. NERVOUS fevers have increafed greatly of late yeaps in this. country, owing, doubtlefs, to our different manner of living, and the increafe of fedentary employments ; as they commonly attack perfons of a weak, relaxed habit, who neglea exercife eat li*tle folid food, ftudy hard, or indulge in fpirituous liquors. CAUSES.----Nervous fevers may be occafioned "by whatever depreffes the fpirits, or impoverifhes the blood ; as'grief, fear anxiety, want of fleep, intenfe thought, living on poor watery diet^ unripe fruits, cucumbers, melons, mufhrooms, &c. They may like- wife be occafioned by damp, confined, or unwholefome air. Hence they are very common in rainy feafons, and prove moft fatal to thofe who live in dirty low houfes, crowded ftreets, hofpitals, jails, or fuch-like places. Perfons whofe conftitutions have been broken by exceffive ve- nesy, frequent falivations, too free an ufe of purgative medicines, or any other exceffive evacuations, are moft liable to this difeafe. Keeping on wet clothes, lying on the damp ground, exceffive fatigue, and whatever obftructs. the perfpiration, or caufes a fpaf- modic ftriaure of the folids, may likewife occafion nervous fe- vers. We fhall only add, frequent and greatW-gularities in diet. Too great abstinence, as well as excefs, is hurtful. Nothing tends fo much to preferve the body in a found ftate as a Tegular diet; nor can any thing contribute more to occafion fevers of the worft kind than its oppofite. SYMPTOMS.----Eow fpirits, want of appetite, weaknefs wearinefs after motion, watchfulnefs, deep fighing, and dejeaion of mind, are generally the forerunners of this difeafe. Thefe are fucceeded by a quick low pulfe, a dry tongue without any con- siderable thirft, chillnefsand flufhing in turns, Sec. After fome time, the patient complains of a gi-ldinefs and pain of the head, has a naufea, with reachings and vomiting ; the pulfe is quick, and fometimes intermitting ; the uriae pale, relembling o 13S OF THE NERVOUS FEVER. dead fmall beer, and the breathing is difficult, with opprcffion of the breaft, and flight alienations of mind. If towards the ninth, tenth, or twelfth day, the tongue becomes more moift,with a plentiful fpitting,.a gentle purging, or a moifture upon the fkin ; or if a fuppuration happens in one or both ears, or large puftules break out about the lipi and nofe, there is reafon to hope for a favourable criiis. But if there is an exceffive loofenefs,or wafting fwcats, with fre- quent fainting fits ; if the tongue, when put out, trembles excef- flvely, and the extremities feel cold, with a fluttering or flow creep- ing pulfe ; if there is a starting of the tendons, and almoft total lofs of fight and hearing, and an involuntary difcharge by ftool and urine, there is great reafon to fear that death is approaching. REGIMEN1.----It is very neceffiry in this difeafe to keep the patient cool and quiet. The leaft motion will fatigue him, and will be apt to occafion wearinefs and even faintings. His mind ought not only to be kept eafv, but foothed and comforted with hopes of a fpeedy recovery. Nothing is more hurtful in low fevers of this kind than preferring to the patient's imagination gloomy or fright- ful ideas. Thefe of themfelves'often occafion nervous fevers, and muft likewife aggravate them. The patient muft not be kept too low. His ftrength and fpirits ought to be fupported by nourifhing diet and generous cordials. For this purpofe, his gruel,panado, or whatever food he takes, muft be mixed with wine, according as the fymptoms may require. Pretty ftrong wine-whey, or fmall negus, fharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mu(lard- whey is likewife a very proper drink in this fever, and may be ren- dered an excellent cordial-medicine by the addition of a propec quantity of white-wine*^ Wine, in this difeafe, if it could be obtained genuine, is almoft the only medicine that would be neceffary. Good wine poffeifci all the virtues of the cordial, medicines, while it is free from ma- ny of their bad qualities. I fay good wine ; for, however com- mon this article of luxury is now become, it is rarely to be ob- tained genuine, efpecially by the poor, who are obliged to pur- chafe it in. fmall quantities. I have often feen patients in low nervous fevers, where the pulfe could hardly be felt, with a conftant delirium, coldnefs of theex- tremities, and almoft every other mortal fymptom, recover, by t ufing in whey, gruel and negus, a bottle or two of ftrong wine every day. Good old found claret ia the beft, and may be made into negus, or given by itfelf, as circumftances require. In a word, the great aim in this difeafe is to fupport the pa- tient's strength, by giving him frequently fmall quantities of the above, or oj.er drinks of a warm and cordial nature. He is not, S e Appendix, Milliard-whey. OF THE NERVOUS FEVER. 139 however, to be over-heated either with liquet or clothes; and his food ought to be light, and given in fmall qu. ntities. MEDICINE_____Where a naufea, load, and ficknefs'at fto- mach prevail at the beginning of the fever, it will be neceffary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few fpoonfuls of the vomiting julepf, will generally anfwer this purpofe very well. This may- be repeated any time before the third or fourth day, if 1! j above fymptoms continue. Vomits not only clean the ftomach, but, by ahe 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 roufing. S.uch as dare not venture upon a vomit, may clean the bowels by an infufion of fenna and manna. In all fevers, the great point is to regulate the fymptoms, fo as to prevent them from going to either extreme, 'i hus, 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 neceffary. But in nervous fevers, where nature flags, and the folids relaxed, wine, with other cordials fliould be plentifully adminiftered. It is neceffary ro caution people againft bleeding in this difeafe, ■a-s there is generally at the beginning an univerfal ftriaure upon the veffels, and fometimes an ©ppreffion and difficulty of breath- ing, which fuggeft the idea of a plethora, or too great a quantity of blood. I have known even fome of the faculty deceived by their own feelings in this refpea, fo far as to infift upon being bled, when it was evident, from the confequences, that the opera- . tion was improper. Though bleeding is generally improper in this difeafe, yet blis- tering is highly neceffary. Blifters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be bliftered on the neck or head, and it will be the fa- feft courfe, while the inftnfibility continues, as foon as the dif- charge occafioned by one blifter abates, to apply another to fome other part of the body, and by that means, keep up a continual fucceffion of them till he be out of danger. I have been more fenfible of the. advantage of blistering in this than in any other difeafe. Blifters not only ftimulate the folids to aaion, but likewife occafion a continual difcharge, which may, in fome meafure, fupply the want of critical evacuations^ which feldom happen in this kind of fever. They are moft proper, ei- ther towards the beginning, or after fome degree of ftupor has come on; in which laft cafe, it will always be proper to blifter the head. If the patient is costive through the courfe of the difeafe, it will be neceflary to procure a ftool, by giving him every other, day , t See Appendix, Vomiting Julep. 14© OF THE' NERVOUS FEVER. a clyster of milk and water, with a little fugar, to which may be added a fpoonful of common fait, if the above does not operate, Should a violent loofenefs come on, it maybe checked by fmall Quantities of Venice treble or Eudauum, giving the patient for his ordinary drirk the white decoaion '. A miliary eruption fometimes breaks out about the ninth or tenth day. As eruptions arc ofttn critical, great care fh en Id be taken not to letard 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 fuppor- ted by gentle cordial;., as wine-whey, fmall negus, fago-gruel, with a little wine in it, and fuch-lik-. He ought not to be kept too warm; yet a kindly breathing fweat fhould by no means.be checked. Though blifters, and the ufo of cordial liquors are the chief things to be depended on in this kind of fever; yet, for thofe who may choofe co ufe them, we fhall mention one or two of the forms of medicine which are commonly prefcribed in itj-. In defperate cafes, where the hickough and starting of the ten- dons have already come on, we have fometimes feen extraordinary effeas from large dofes of mufk frequently repeated. Muflc is doubtkfs an antifpafmodic, and may be given to the quantity of a fcruple three or four times a-day, or oftener if neceflary. Some- times it may be proper to add to the mufk a few grains of cam- phire, and fait of hartfhorn, as thefe tend to promote perfpiration and che difcharge of urine. Thus, fifteen grains of mufk, with three grains of camphire, and fix grains of fait of hartfhorn, may be made into a bolus with a little fyrup, and given as above. If the fever fhould happen to intermit, which it frequently does towards the decline, or if the patient's ftrength fhould be wafted with colliquative fweats, &c. it will be neceffiry to give him the Peruvian bark. Half a drachm, or a whole drachm, if the 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. Should the bark in'Tub- t ftance not fit eafy on the ftomach, an ounce of it in powder may be infufed in a bottle of Lifbon or Rhenifii wine for two or three days, afterwards it may be {trained, and a glafs of it taken frequently!. * See Appendix, White Decoction. t When the patient is low, ten gVains of Vii-olnian fnake root, and the fame quantity of contrayerva-ruct, with five gra-n.s of Ruffian caftor, all in fine powder, may be made into a boius with a little of the cordial confection or fyrup of faffron. One of thefe may be taken every four or five hours. The following pov der may be ufed with the fine intention : Take wild Valerian-ioot in powder one fcruple. lain on ami cairoi' eath four grains. Mix thefe by nibbing tiiem together in a mortar, and give one in a enp of wine-vhey thrte'oi" four times a-day. \ Th* bark may likewife be very properly adminiftered, along with other cordials, in the following manner : Of bark an ounce, orange- peel half an ounce, Virginian fnake-roct two drachms, f.rh-on cue PUTRID OR SPOTTED F^VER. 141 Some give the bark in this and other fevers, where there are no fymptoms of inflammation, without any regard to the remiffion or intermiffion of the fever. How far future obfervation may tend to eftablifli this praaice, we will not pretend to fay; but we have reafon to believe that the bark is a very univerfal febrifuge, and that it m?.y be administered with advantage in moft fevers where bleed- ing is not neceffary, or where there are no fymptoms of topical inflammation. CHAPTER XX. Of the Malignant Putrid or Spotted Fever. THIS may be called the peftilential fever of Europe, as, in many of its fymptoms, it bears a great refemblance to the plague. Perfons of a lax habit, a melancholy difpofition, and thofe whofe vigour has been wafted by long fafting, watching, hard la- bour, exceffive venery, frequent falivations, Sec. are moft liable to if, CAUSES.----This fever is occafioned by foul air, from a number of people being confined in a narrow place, not properlv ventilated ; from putrid animal 2nd vegetable effluvh, Sec. Hence it prevails in camps, jails, hofpitals, and infirmaries, efpecially where fuch places are too much crowded, and cleanlinefs is ne- gleaed. A clofe conftitution of the air, with long rainy or foggv wea- ther, likewife occafions thefe fevers. They often fucceed great in- undations in low and marfhy countries, efpecially when thefe are "" preceded or followed by a hot and fultry feafon. Living too much upon animal food, without a proper mixture of vegetables, or eating fiih or flefh that has been kept too long, are • apt to occafion this kind of fever. Sailors on long vovage?, end the inhabitants of befieged cities, are very often vifitedVith this-dif- eafb. Corn that has been greatly damaged by rainy feafons or )c\vr keeping, and water which has become putrid by ftagnation, &c\ may likewife occafion this fever. Dead carcafes tainting the air, efpecially in hot feafons, are very apt to occafion thefe difeafes. Hence, this kind of fever often pie- vails in countries which are the fcenesof war and bloodffed. Thi> fhows the propriety of removing burying^ground slaughter-houfes, Sec. to a proper diftance from great towns. Want of cleanlinefs is a very general caufe of thefe fevers. Hence (bachm. Let all of them be powdered, and infufed in an Englifh pint of the beft brandy for three or four (lavs. Afterwards the J'qiior jrm be drained, and two tea-ipoonf uls of it'given three or rb;u time.- a d-r, in a glafs of fmall wiie or negus. i4& PUTRID OR SPOTTED FEVER. they prevail amongft the poor inhabitants of large towns, who breathe a confined, unwholefome air,and neglea cleanlinefs. Such mechanics as carry on dirty employments, and are conftantly con- fined within doors, are very liable to this difeafe. We fhall only add, that malignant, or fpottcd fevers, are highly « infeaious, and often communicated by contagion. All perfons ought to keep at a diftance from thofe affeaed with fuch difeafes, unlefs their attendance is absolutely neceffary. SYMPTOMS.----The malignant fever is generally preceded by ^ a remarkable weaknefs or lofs of ftrength, without any apparent* \ caufe. This is fometimes (o great, that the patient can fcarce walk, or even fit upright, without being in danger of f linting away. His mind too is greatly dejected ; he fighs, and is full of dreadful apprehensions. There is a naufea, and fometimes a vomiting of bile ; a violent pain of the head, with a ftrong pulfation or throbbing of the tem- poral arteries ; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noife in the ears, the breath- 1 ing is laborious, and often interrupted with a figh; the patient complains of a pain about the region of the ftomach, and in his back and loins ; his tongue is at firft white, but afterwards it ap- pears black and chaped ; and his teeth are covered with a black cruft. 'He fometimes paffes worms both upwards and downwards, is affeaed with tremors or fhaking, and often becomes delirious. If blood is let, it appears diffolved, or with a very fmall degree of cohefion, and foon becomes putrid : the ftools fmell extremely fcetid, and are fometimes of a greenifh, black, or reddifh caft. Spots of a pale purple, diin, or black colour, often appear upon the fkin, and fometimes there are violent haemorrhages, or dif- charges of blood from the mouth, eyes, nofe, Sec. ' Thefe fevers may be diftinguifhed from the inflammatory, by the fmallnefsof the pulfe, the great dejeaion of mind, the diffol- ved ftate of the blood, the petechia?, or purple fpots, and the putrid fmell of the excrements. They may likewife be diftinguifhed from the low or nervous fever by the heat and thirft being greater, the urine of a higher colour, and the lofs of ftrength, deje&ion of mind, and all the other fymptoms, more violent. Sometimes the inflammatory, nervous, and putrid fymptoms are fo blended together, as to render it very difficult to determine to which clafs the fever belongs. In this cafe, the greateft caution and fkill are requisite. Attention muft be paid to thofe fymptoms which are moft prevalent, and both the regimen and medicines adapted to them. Inflammatory and nervous fevers may be converted into malig- nant and putrid, by too hot a regimen or improper medicines. The duration of putrid fevers is extremely uncertain ; fometimes *i they terminate between the feventh and fourteenth day, and at other times they are prolonged for five or fix weeks. Their dura- PUTRID OR SPOTTED FEVER. 143 tion depends greatly upon the conftitution of the patient, and the manner of treating the difeafe. The moft favourable fymptoms are, a gentle loofenefs after the fourth or fifth day. with a warm, mild fweat. Thefe, when con- tinued for a confiderable time, often carry off the fever, and fhould never be imprudently flopped. Small miliary puftules appearing between the petechia, or purple fpots, are likewife favourable, as alfo hot fcabby eruptions about the mouth ahd nofe. It is a good fign when the pulfe rifes upon the ufe of wine, or other cordials, and the nervous fymptoms abate ; deafnefs coming on towards the decline of the fever, is often a favourable fymptom*, as are abfeeffes in the groin or parotid glands. Among the unfavourable fymptoms,may be reckoned an exceffive loofenefs, with a hard fwelled belly; large black or livid blotches breaking Out upon the fkin ; aptha; in the mouth; cold clammy fweats ; blindneff ; change of the'voice; a wild flaring of the eyes ; difficulty of fwallowing ; inability to put out the tongue ; and a conftant inclination to uncover the breaft. When the fweat and faliva are tinged with blood, and the urine is black, or depofita a black footy fedimeiit, the patient is in great danger. Starting of the tendons, and foetid, ichorous, involuntary ftools, attended with coldnefs of the extremities, are generally the forerunners of death, REGIMEN.----In the treatment of this difeafe, we ought to endeavour as far as poffible, to fupport the patient's ftrength and fpirits; and to affift Nature in expellin.-r the caufe of the difeafe, by gently promoting perfpiration and the other evacuations. Putrid fevers are often occafioned by unwholefome air, and of courfe they muft be aggravated by it. Care fhould be taken to pre- vent air from stagnating in the patient's chamber, to keep is cool, and renew it frequently, by opening the doors or window* of fome adjacent apartment. The breath and perfpiration of per- fons in perf a health foon render the air of a fmall apartmenc noxious j but this will fooner happen from the perfpiration and breath of a perfon in this difeafe. Befides the frequent admiffion of frefh air, we recommend the ufe of vinegar, verjuice, juice of lemon, Seville orange, or any ve- getable acid that can be moft readily obtained. Thefe ought fre- quently to be fprinkled upon the floor, the bed, and every parr of the room. They may alfo be evaporated with a hot iron, or by boil- ing, &c. The frefh fkins of lemons or oranges ought to be laid in dnferent parts of the room, and fhould be frequently held to the patient's nofe. I he ufe of acids in this manner would prove very refrefliiug to the patient, and tend to prevent the infeaion froiw fpreading among thole who attend him. Strong fcented herbs, a* rue, tanfy, rofemary.wormwood'j&c. may be laid i» different parts of the houfe, and fmelled to by thofe who go near the patient. Deafnefs is not always a favourable fymptom in this difeafe Per- haps it y «m!y f» wheu occukmed by abfeeffes formed within the ears- i.:4 PUTRID-OR SPOTTED FEVER. The p-.tient muft be kept cool, quiet and eafy. The leaft noife will affea his head, and the fnialleit fatigue will be apt to make him fair.t. Few things are of greater importance in this difeafe than acids, which ought to be mixed with all the patient's food, as well sn drink. Orange, lemon, or vinegar whey, are all very proper, and may be drank by turns, according to the patient's inclination. They may be rendered cordial by the addition of wine in fuch quantity as the patient's ftrength feems to require. When he is very low, he may drink negus, with only one half water, and fharpened with* tlie juice of orange or lemon. In fome cafes, a glafs of clear wine may now and then be allowed. The moft proper wine is Rhenifli; but if the body be open, red-port or clarc is to be preferred. When the body is bound, a tea-fpoonful of the cream of tartar may be put into a cup of the patient's drink, as there is occafion; or he may drink a decoaion of tamarinds, which will both quench his thirft, and promote a difcharge by ftool. If camomile-tea will fit upon his ftomach, it is a very proper drink. It may be ilnrpened by adding to evgry cup of the tea ten Or fifteen drops of the elixir of vitriol. The food muft be light, as panado cr groat gruel, to which a little wine may be added, if the patient be weak and low ; and they ought all to be fharpened with the juice cf orange, the jelly of cur- rants, or the like. The patient ought likewife to eat freely of ripe fruits, as roafted apph.s, currant or gcofeberry tarts, preferved cherries, or plumbs, &c. Taking a little food or drink fupports the fpirits : for which rea- fon, the patient ought frequently to be fippiag fmall quantities of. fome of the acid liquoi s mentioned above, or any that may be more agreeable to his palate or more readily obtained. If he is delirious, his feet and hands ought to be frequently fo- mented with a ftrong infufion of camomile flowers. This, or an infufion of the bark, to fuch as can afford it, cannot fail to have a good effea. Fomentationsof this kind relieve the head, by relax- ing the vefi'els in the extremities. MEDICINE.----If a vomit be given at the beginning of this fever, it will hardly fail to have a good effect; but if the fever has gone on for fome days, and the fymptoms are violent, vomits are not quite fo fafe. The body however is always to be kept gently open by clyfters, or mild laxative medicines. Bleeding is feldom neceflary in putrid fevers. If there be figns of an inflammation, it may fometimes be permitted at the firft on- fct; but the repetition of it generally proves'hurtful. Blifters are never to be ufed unlefs in tht greateft extremities. Jf the petechia? or fpots fhould suddenly difappear, the patient's pulfe fink remarkably, and a delirium, with other bad fymptoms; come on, bliftering may be permitted. In this cafe, blifters are.to be applied to the h:.;d, and infide of the legs or thigh?. But as they PUTRID OR SPOTTED FEVER. are fometimes apt to occafion a gangrene, we would rather recom- mend warm cataplafms or poultices of muftard and' vinegar to be applied to the feet, having recourfe to blifters only in the utmost extremities. It is common in the beginning of this fever to give the emetic tartar in fmall dofes, repeated every fecond or third hour, til! it fhall either vomit, purge, or throw the patient into a fweat. This praaice is very proper, if not pufhed fo far as to weaken the patient. A ridiculous notion has long prevailed, of expelling the poifon- ous matter of malignant difeafes by trifling dofes of cordial or ulexipharmic medicines. In confequence of this notion, the con- trayerva-root, the cordial confeaion, the mithridate, &c. have been extolled as infallible remedies. Thefe feldom do much good. Where cordials are neceflary, none is fuperior to good wine; and we again recommend it both as the fafeft and beft. Wine acids and antifeptics are the only things to be relied on in the cure of malignant fevers. In the moft dangerous fpecies of this difeafe, when it is atten- ded with purple, lived, or black fpots, the Peruvian bark muft be adminiftered. I have feen it, when joined with acids, prove fuccefs- ful, even in cafes where the petechia had the moll threatening afpea. But, to anfwer this purpofe, it muft not only be given in large dofes, but duly perfifted in*. The beft method of administering the bark is certainly in fub- flance. An ounce of it in powder may be mixed with half an Englifli pint of water, and the fame quantity of red wine, and fhar- pened with the elixir or the fpirit of vitriol, which will both make it fit eafier on the ftomach, and sender it more beneficial. Two or three ounces of the fyrup of lemon may be added, and two ta- ble-fpoonfuls of the mixture taken every two hours, or oftener, if the ftomach is able to bear it. Thofe who cannot take the bark in fubftance may infufe 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 vi- triol, as above. Nothing can be more beneficial 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 drachm of the fait of wormwood, diflblved in an ounce and an half of frefh lemon-juice, and made into a draught with an ounce of fimple finnamon water, and a bit of fugar, may be given, as often as necefTary. If fwellings of the glands appear, theif fuppuration is to be promoted by the application of emollient poultices. As foon as there is any appearance of matter in them, they ought to be raid open, sind the poultices continued. ■jf In fevers of this type, accompanied with great prostration of ftrength, Madeira wine fhould be adminiftered with an unfparing hand, beginning with fmall quantities, and gradually increafing from one ,to two bottles, in the courfe of twenty-lour hours. (I. C ) T 146 PUTRID OR SPOTTED FEVER. I have known large ulcerous fores break out in various parts of the body, in the decline" of this fever, of a livid gangrenous ap- pearance, and a moft putrid cadaverous fmell. Thefe gradually healed ; and the patient recovered by the plentiful ufe of bark and wine, fharpened with the fpirits of vitriol. For preventing putrid fevers, we would recommend a ftria re- gard to cleanlinefs; a dry fituation ; fufficient exercife in the open air; wholefome food, and a moderate ufe of generous liquors. In- feaion 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 fingle vifit to a patient in it; others have caught it by lodging for one night in a town where it prevailed ; and fome by attending the 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 apartment, as remote from the reft of the family as poffible; to be kept extremely clean, and to have frefh air frequently let into his chamber; whatever comes from him fhould be immediately removed, his linen frequently changed, and thofeinhealthoughttoavoidallunneceffary communication with him. Any one who is apprehenfive of having caught the infeaion, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile tea. This may be repeated in a day or two, if the apprehenfions ftill continue, or any unfavourable fymptoms appear. He ought likewife to take an infufion of the bark and camomile flowers for his ordinary drink ; and before he goes to bed, he may drink an Englifh pint of pretty ftrong negus, or a few glaffes of generous wine. I have frequently followed this courfe, when malignant fevers prevailed, and have recommended it to others with conftant fuccefs. People generally fly to bleeding and purging as antidotes againft infeaion ; but thefe are fo far from fecuring them, that they often, by debilitating the body, increafe the danger. Thofe who wait upon the fick in this difeafe ought always to have a piece of fpunge or a handkerchief dipt in vinegar, or juice of lemon, to fmell to while near the patient. They ought to wafh their hands, and, if poffible, to change their clothes, before they go into companyf. * The late Sir John Pringle expreffed a concern left thefe cautions fhould prevent people from attending their friends or relations wheil afflicted with putrid fevers. I told him I meant only to difcourage unneceffarx attendance, and mentioned a number tf inftances where putrid fevers had proved.fatal to perfons who were rather hurtful than, Leneficial to the fick. He agreed with me, thatagooddoclor and a care- ful nurfe were the only neceflary attendants; and that all others not only endangered themfelves, but, generally, by their folicitude and ill- directed care, hurt the fick. f Thefe are prudent precautions, particularly cleanlinefs ; as to moft «f the others, recommended by our judicious author, they feemed to C H7 3 CHAPTER XXI. Of the Miliary Fever. THIS fever takes its name from the fmall puftules or bladders which appear on the fkin, refembling, in fhape and fize, the feeds of millet. The puftules are either red or white, and fre- quently 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 moisture on the fkin, greatly promotes the eruption ; but, when the fkin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary difeafe; but it is muchoftencr only a fymptom of fome other malady, as the fmall-pox, meafles, ardent, putrid, or nervous fevers, Sec. In all thefe cafes it is generally the effea of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phlegmatic, or perfons of a relaxed habit. The young and the aged are more liable to it than thofe in the vigour and prime of. life. It is likewise more incident to women than men, efpecially the delicate and indolent, who keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be feized with this difeafe in childbed, and often loofe their lives by it. CAUSES-----The miliary fever is fometimes occafioned by vio- lent paffions or affeaions of the mind ; as exceffive grief, anxiety, thoughtfulnefs, &c. It may be occafioned by exceffive watching, great evacuations, a weak watery diet, rainy feafons, eating too freely of cold, crude unripe fruits, as plums, cherries, cucumbers, melons, Sec. Impure waters, or provifions which have been fpolied by rainy feafons, long keeping, Sec. may caufe miliary fevers. They may alfo be occafioned by the floppage of any cuftomary evacuation, as iffues, fetons, ulcers, the bleeding piles in men, or the menftrual flux in women, &c. This difeafe in childbed-women is fometimes the effea of great coftivenefs during pregnancy ; it may likewife be occafioned by their exceffive ufe of green trafh, and other unwholefome things, in which pregnant women are too apt to indulge. But its moft ge- neral caufe is indolence. Such women as lead a fedentary life, ef- pecially during pregnancy, and at the fame time live grofsly, can hardly efcape this difeafe in childbed. Hence it proves extremely fatal to women of fashion, and likewife to thofe women in manu- faauring towns, who, in order to affift their hufbands, fit clofe have little or no effeft during the late yellow fever, which provailedin i Philadelphia. We believe the beft prefervative, if it could be attained, is a cheerful and undisturbed ftate of mind. (I. C) i48 OF THE MILIARY FEVkR. within doors for almoft the whole of their time. But among wo- men who are aaive and laborious, who live in the country, and fake fufficient exercife without doors, this difeafe is very-little known. " SYMPTOMS.----When this is a primary difeafe, it makes its attack like moft other eruptive fevers, with a flight fliivering, which is fiicceeded by heat, lofs of ftrength, faintiftmefs, fighing, a low quick pulfe, difficulty of breathing, with great anxiety and oppref- fion of the breaft. The patient is refllefs, and fometimes delirious; the tongue appears white, and the hands fhake, with often a burn- ing heat in the palms ; in childbed-women the milk generally goes away, and other difcharges flop. The patient feels an itching or pricking pain under the fkin, after wlwch innumerable fmall puftules of a red or white colour begin to appear. Upon this the fymptoms generally abate, the pulfe be- comes more full and foft, the fkin grows moifter, and the fweat, aa the difeafe advances, begins to have a peculiar factid fmell; the , great load on the breaft, and oppreffion of the fpirits, generally go off, and the customary evacuations gradually return. About the fixth or feventh day from the eruption, the puftules begin to dry and fall off, which occafions a very difagreseable itching in the fkin. It is impoflible to aTcertain the exaa time when the puftuk*9 will either appear or go off. They generally come out on the third or »fourth day, when the eruption is critical; but when fympto> matical, 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 again, the danger is very great. In childbed-women the puftules are commonly at firft filled with clear water, afterwards they grow yellowish. Sometimes they are interfperfed with puftules of a red colour. When thefe only appear jhe difeafe goes by the name of a rafh. REGIMEN----In all eruptive fevers, of whatever kind, the chief point is to prevent the fudden difappearing of the puftules, and to promote their maturation. For this purpofe the patient muft be kept in fuch a temperature, as neither to pufh out the eruption too fa ft, nor to caufe it to retreat prematurely. The diet and drink ought therefore to be in a moderate degree nourifhing and cordial 5 but neither ftrong nor heating. The patient's chamber ought nei- ther to be kept too hot nor cold ; and he fliould not be too much covered with clothes. Above all, the mind is to be kept eafy and cheerful. Nothing fo certainly makes an eruption go in as fear, or the apprehenfioij of danger. The food muft be weak chicken-broth with bread, panado, fago, pr groat-gruel, &c. to a gill of which may be added a fpoonful or two of wine, as the patient's strength requires, with a few grains of fait and a little fugar. Good apples roafted or boiled, with other ririe frujts of tin opening cooling nature, may be eaten, OF THE MILIARy FEVER. 149 The drink may 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 decoaion mentioned below". When the patient's fpirits zre low, and the eruption does not rife fufficiently, his drink muft be a little more generous ; as wine- whey, or fmall negus, fharpened with the juice of orange or lemon, and made ftronger or weaker as circumstances may require. . Sometimes the miliary fever approaches towards a putrid nature, in which cafe the patient's ftrength muft be fupported with gene- rous cordials, joined with acids; and, if the degree of putrefcence be great, the bark muft be given. If the head be much affeaed, the body muft be kept open by emollient clyftersf. / MEDICINE.----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 fpirits flag, it will be neceffary to fupport the patient with cordials, and to apply blifters. The moft proper cordial, in this cafe, is good wine, which may either be ta- ken in the patient's food or drink ; and if there lie figns of putre- fcence, the bark and acids may be mixed with wine, as direaed in the putrid fever. Some recommend bliftering through the whole courfe of this difeafe; and where Nature flags, and the eruption comes and goes, it may be neceffary to keep up a ftimulus, by a continual fucceflion of fmall blifters, but not above one at a time. If the pulfe finks re-* markably, the puftules fall in, and the head is affeaed, it will be neceffary to apply feveral blifters to the moft fenfible parts, as the infide of the legs and thighs, &c. ' -X- Take two ounces of the fhavinrrs of .hartfhorn,- and the fame quan- tity of farfaparilla, boil them in two En^'ifn^quam of water. To the ftrained-dt-coclion add a little white fb^.'-r, and let the'patient take it for his ordinary drink. ' t In the Commerckim I.iterarium for the year 1735, w e have the hif- tory of an epidemical miliary fever, which'raged at Strafburgh in the months of November, December, and January ; from which \w learn the neceffity of a temperate regimen in this malad,y, and likewife that phyficians are not always the firft who difcover the proper treatment of difeafes. " This fever" made terrible havock everf among men of robuft cranftitutions, and all medicine proved in vain. They were feized in an inflant with fhivering, yawning, ftretching and pains in the back, fuc- ceeded by a moft intenfe heat; at the fame time there was a great lofs of ftrength and appetite. On the feventh or ninth day the miliary erup- tions appeared, or fpots like fl-eebites, with great anxiety, a delirjum, reftleffHcf;, and tofiing in bed. Bleeding was fatal. While matters were in tl^is unhappy fituation, a midwife, of her own accord, gave to a patient, in the height of the difeafe, a clyfter of rain-water and butter without fait, and for his ordinary drink a quart of fpring water, half a pint of generous wine, the juice of a lemon, and fix ounces of the whiteft fu- gar, gently boiled till a fcum arofe, and this with great fuccefs; for the belly was foon loofened, the grievous fymptoms vanifhed, and the patient was rellored to his fenfes, and fnatched from the jaws of death." This practice was imitate-d by others with the like happy effects. 150 OF THE REMITTING FEVER. Bleeding is feldom neceffary in this difeafe, and fometimes it does much hurt, as it weakens the patient, and depreffes his fpirits. • It is never to be attempted unlefs by the advice of a phyfician. It has been customary to treat this difeafe in childbed-women by plentiful bleeding, and other evacuations, as if it were highly in- flammatory. But this praaice is generally very unfafe. Patients in this fituation bear evacuations very ill. And indeed the difeafe feems often to be more of a putrid than of an inflammatory nature. Though this fever is often occafioned in childbed-women by too hot a regimen, yet it would be dangerous to leave that off all of a fudden, and have recourfe to a very cool regimen, and large evacuations. Supporting the patient's fpirits, and promoting natural evacuations, is here much fafer than having recourfe to artificial ones; as thefe byfinkingthe fpirits,feldom fail to increafe the danger. If the difeafe proves tedious, or the recovery flow, the bark may be taken in fubftance, or infufed in wine or water, as the patient inclines. The miliary fever, like other eruptive difeafes, requires gentle purging, which fliould not be negleaed as foon as the fever is gone off, and the patient's ftrength will permit. To prevent this difeafe, a pure dry air, fufficient exercife, and wholefome food, are neceffary. Pregnant women fhould guard againft coftivenels, and take daily as much exercife as they can bear, avoiding all green trafhy fruits, and other unwholefome things; and when in childbed, they ought ftriaiy to obferve a cool regimen. CHAPTER XXII. Of the Remitting Fever. THIS fever takes its name from a remiffion of the fymptoms, which happens fometimes fooner, and fometimes later, but generally before the eighth day. The remiffion is commonly pre- ceded by a gentle fweat, after which the patient feems gready re- lieved, but in a few hours the fever returns. Thefe remiffions return at very irregular periods, and are fometimes of longer, fometimes of fhorter duration; the nearer however that the fever approaches to a regular intermittent, the danger is the lefs. CAUSES.----Remitting fevers prevail in low marihy countries abounding with wood and flagnating water; but they prove moft fatal in places where great heat and moifture are combined, as in fome parts of Africa, Bengal in the Eaft Indies, &c. where remit- ting fevers are generally, of a putrid kind, and prove very fatal. They are moft frequent in clofe calm weather, efpecially after rainy feafons, great inundations, or the like. No age, fex, or conftitution, OF THE REMITTING FEVER. »5* is exempted from the attack of this fever ; but it chiefly feizes per- fons of a relaxed habit, who live in low dirty habitations, breathe an impure ftagnating air, take little exercife, and ufe unwholefome diet. SYMPTOMS----The firft fymptoms of tlTis fever are generally yawning, ftretching, pain, and giddinefs in the head, with alternate fits of heat and cold. Sometimes the patient is affeaed with a delirium at the very firft attack. There is a pain, and fometimes a fwelling, about the region of the ftomach, the tongue is white, the eyes and fkin frequently appear yellow, and the patient is often affliaed with bilious vomitings. The pulfe is fometimes a little hard, but feldom full, and the blood, when let, rarely fh laudanum,as alfo barley-water, toaft-water,apple-watcr,lemortade, camomile tea, and a variety of other drinks during the inflamma- tory period. After thefe, fmall dofes of tinaure of Peruvian bark, with fpirit of lavender-compound, were adminiftered with a good effea, paticularly when the fymptoms of violent inflamma- tion of the ftomach did not contra-indicate its ufe. It was efpe- cially ferviceable to fuch patients who had been accuftomed to an irregular mode of life, and drank to excefs of fpirituous liquors ; for, when every other article was immediately rcjeaed, it generally continued on the ftomach. The mucilaginous vitriolic mixture* was ufed to advantage, and fmall quantities of wine, porter, cy- der, or brandy and water,'was of fervice, by giving tone to the debilitated ftomach. Frefh buttermilk was frequently found grateful to the fick, and very beneficial as an anti-emetic, even when from the fymptoms it might be concluded, that the ftomach was highly inflamed. Like- wife, a tea-fpoonful of cream-tartar, diffolved in fugar and water, was known to flay on the ftomach and pafs through the bowels, when every other medicine and drink wasinftantly rejected. This medicine was adminiftered with a view to remove coftivenefs, which fhould always be guarded againft in this difeafe ; but the patient finding it fo effectual in flopping vomiting, he frequently had recourfe to it without being costive, with the fame good effea. In Teveral other cafes it was made ufe of, but was too often in- ftantly rejeaed. Caftor-oil, adminiftered under similar circum- stances, had the like effea ; but this was not often the cafe,- al- though I have frequently known it to continue on the ftomachs of people violently fea-fick, and remove coftivenefs, when drink of every kind was immediately thrown up. During exceffive fick- nefs at the ftomach, the moft agreeable medicine and drinks were lefs frequently rejected than thofe of an unpleafant quality. No fooner did a draught of any liquid reach the ftomach, than it was inftantly rejeaed. It is not to be apprehended that this arofe from the quality, but rather from the quantity. On this account, the patient fhould not take more than a table-fpoonful at a time. His ownfealing, with refpea to fulnefs and ficknefs at the ftomach, (hould determine the frequency and quanticy of drink, ltowever infatiably thirfty he may be. In conjunaion with thefe1 precau- tions, the body fhould be-kept as quiet as poffible ; for the leaft accelerated motion of it, frequently brought on a fit of vomiting. Coftivenefs and flatulency were extremely diftrefling in this difeafe. To remove them was always very difficult, particularly when there was much ficknefs at the ftomach, with vomiting; for ' Which is mucilage of giim_arabic; acidulated wuh elixir of viuijl. 1 164 OF THE YELLOW FEVER. the intestines were frequently very fluggifh in their aaion, and the ftomach generally rejeaed every clafs of purgative medicines, When this was the cafe, there was no alternative but that of keeping the bowels open by clyfters. Thefe were fubjea to confi* dearable inconvenience, when they could be adminiftered ; but this was not often the cafe. They frequently cleared but the lower part of the intestines, whilst thofe approximating the ftomach,. were generally diftended with faeces, and an inceffant fource of irritation to the ftomach. Whenever, therefore, a chance of fuccefs in the administration of purgative medicines occurred, they were always attempted. They generally cleared the whole traa of in- ' teftinal canal, and frequently procured a mitigation of the vomit- ing. If rejeaed, they were not frequently repeated, left they might exhauft the ftrength of the patient without contributing to nis relief. Keeping the intestinal canal clear of fseces, in fome mea- fure-, obviated flatulency. But in an advanced period of the dif- eafe, the ftomach and inteftines were fo much debilitated, that they frequently had not energy fufficient, when apparently clear of fseces, to expel the wind either upwards or downwards, but it continued, as it were,ftationary, and tormented thepatient. Dur- ing this ftate, when the ftomach was tolerably tranquil, a ftrongin- fufion of fennel-feed was adminiftered, mixed in a fmall quan- tity of brandy, with advantage, particularly when alternated with fome agreeable tonic,' fuch as the mucilaginous vitriolic mixture already recommended, if nothing contra-indicated its ufe, or a, fmall quantity of a ftrong infufion of fpices. They fometimes afforded relief; but thofe fymptoms too frequently baffled every attempt to remove them. Another circumftancc was, the extreme reftleffnefs and want of fleep. Generally, by quieting the former, the fatigue from the long wakefulnefs will frequently induce the latter. This indi- > cation was moft effeaually anf^ered by opium. The propriety of employing it, has engaged the attention of many of the tropi- cal writers. By one it is much approved of ;* by another it is condemned during the inflammatory period, as being highly fli- mulating and acrid. The ufe of it, fays one, muft be attended V with imminent dangerf. In the fubfequent flages, good effeas have been experienced from the ufe of opium, particularly in the fecond and laft flages of the difeafe. In the former it induced fleep, refrefhing the patient, and enabling him, in fome meafure, to refill the extreme violence of the difeafe. In the latter, it afforded corffo- lation by lulling the inquietude, and fmoothing the avenue to death. ^ To divert the gloomy thoughts of the patient, was attended with almoft infurmcuntable difficulties. However, it fhculd be always attempted by the moft encouraging language ?.nd affur- ance of a complete recovery; for on tins, the favourable termi- nation of the difeafe much depends. The patient fhould not be * Hillary's 0bfervativ3?j page 16©. + Dr. Mofely. OF THE YELLOW FEVER. 165 told that he has the yellow fever ; for I have known a patient, in this difeafe, faint from an unguarded expreffion, and afterwards die apparently from a flight attack. No art could perfuade him that his diffolution was not approaching with hafty fpeed. Therefore, greatcircumfpeaionfliouldbe obferved, and the patient encouraged with as much consistency and boldnefs as poffible. Moft of the.fick that were flightly indifpofed, would feize the leaft dubious expref- fion of the phyfician, refpeaing their recovery. I come now to the third and laft indication ; which is, to fup- port the finking tone and perifhing vigour of the fyftem. This indication is applicable to the fecond, but more particularly to the laft ftage of the difeafe. The latter, being an augmentation of the fymptoms of the former, fometimes much diverfified, requires more powerful remedies. Whenever a change was perceived in the fyftem, indicating that debility was commencing, the nature of the difeafe muft be considered as materially different, confe- quently requiring a particular mode of treatment. The patient fhould not be reftriaed to a vegetable diet or watery drinks, efpe- ciaJly if there are no violent fymptoms indicating inflammation of the ftomach. Stimulants fliould be employed both, external and internal, fuch as blifters to different parts ef the body, in or- der to excite the fyftem.- The application, when deferred to a more advanced period, was rather of differvice; for the ftrength of the patient was fo far e.ffiaufted, that the bliftered parts foon became black and fphacelated, fometimes attended with profufe hasmcrrhagy. Their application was difcentinucd in the laft ,ftage of the difeafe. Wafhing the whole body in brandy and water-, or when that could not be complied with, the face, breaft and h::nds, always proved very refrefhing to the fick ; cold water thrown over the head and fhoulders, morning and evening, frequently had a good effea, by giving vigour to the fyf- tem. It likewife invariably induced fleep, with a gentle moifture on the fkin. In addition to the external stimulants already men- tioned, muftard poultices maybe applied to the feet; and when there are no fymptoms contra-indicating the life of internal remedies, fuch as violent fymptoms of inflammation in the ftomach, they fhould be adminiftered ; and one would imagine, from the declin- ing vigour of the fyftem, that bark and wine would be ufefuh* The .former of which, in fome eafes, was ferviceable, particularly when the funaions of the ftomach were not much deranged ; but naufea and vomiting were fo invariably prefent, that in almoft all cafes, in whatever manner or form it was"adminiftered, it always, at leaft in my praaice, proved darimentalj-. This efpecially hap- * The intermittent and remittent fevers, mentioned in a note in the hiflory of this difeafe, were cured by emetics and the bark; the latter continued very well on the ftomach. t Except to ufe it in fmall dofes to quiet the perturbed ftomach, giv- en u.ulcr the circumstances former! v mentioned. ,66 OF THE YELLOW FEVER. pened, when the bark was given by the mouth. It commonly deranged the ftate of the ftomach in fuch a manner, that it was not fufceptible of retaining any other medicine or drink. When adminiftered in the form of clyfters, mixed with London porter and laudanum, it did not feem to have any good effea. They ge- nerally produced a painful fenfation over the whole abdomen. This was fometimes the cafe, even when a common laxative clyfter was given, fo that the patient could fcarcely retain it a moment. Dur- ing the time bark was employed, wine was given, beginning with claret or any other weak wine » but if there was great defea iri the vigour of the fyftem, Madeira was foon found neceffary. If wine could not be taken by the patient, brandy, diluted with wa- ter, porter, or cyder, was fubftituted. Thefe fhould be in- creafed in quantity, according to the ftate of the ftomach and de- gree of feeblenefs in the pulfe, at the fame time the elixir of vi- triol was employed as a tonic. The bark, the moft powerful of all tonics, was found to difagree with the ftomach, and was there- fore always omitted, except during the convalefcent ftate, and an entire dependence was placed in the medicine recommended, to- gether with the wine or its fubftitute. Thefe fliould be adminif- tered in large quantities, and continued, until the pulfe, from be- ing fmall and finking, became full, round, and tolerably ftrong; the heat more equally diffufed, the delirium abating, and the pa- dent becoming more cheerful. Such were frequently the eftedls of thofe ftimulants ; and even when the ftrength appeared almoft exhaufted, they would revive and keep up the fpark of life, and fometimes in the moft deplorable cafes, reftore perfea health and ' vigour. Great caution fhould be obferved in the administration of wine. . When the moft urgent fymptoms are mitigated, and fome of them removed, the quantity may be gradually diminifhed. Should j' the dangerous fymptoms return* it may be' augmented with cau- tion. This praaice was more expedient if the patient could take fome nourifhment that was light and agreeable, fuch as panada, or gruel; or if there was a flight return of appetite, fome preparation of animal foodmould be given, fuch as weak broth, and at times f| a few oysters, if the ftomach would bear them. Great caution was to be obferved in rrmking ufe of folid food. If any is advifable, oyf- ters certainly are the moft proper, as they are the moft eafy of di- . geftion, and afford a fuffici«nt quantity of nourifhment. It is proper to take notice of the condua to be obferved by the patient during the convalefcent flate. This was generally te- dious.. When the difeafe had been remedied by profufe evacua- tions, the recovery was confiderably protraaed and precarious. The patient acquired ftrength but flowly, and fometimes had a tendency to the dropfy. During recovery, patients fliould be very circumfpea in their condua, for fear of a relapfc of fever. They fliould chocfc food moft eafy of digeftion; ea^ moderately, ani OF THE SMALL-POX. 167 take a dofe of bark, two or three times a-day, to aflift digeftion, and invigorate the debilitated fyftem. A moderate Quantity of wine may oe allowed; gentle exercife fhould be conjoined, the bowels kept open, and the night-air avoided. — - - ■ ■ CHAPTER XXIV. Of the Small-Pox. THIS difeafe, which originally came from Arabia, is now be- come fo general, that very few efcape it at one time of life or another. It is a moft contagious malady ; and has for many years proved the fcourge of Europe. ' The fmall-pox generally appears towards the fpring. They are frequent in fummer, lefs fo in autumn, and leaft of all in winter. Children are moft liable to this difeafe ; and thofe whofe food is un- wholefome, who want proper exercife, and abound with grofs humours, run the greateft hazard from it. This difeafe is diftinguifhed into the diftina and confluent kind ; the latter of which is always attended with danger. There are like- wife other diftinaions of the fmall-pox ; as the cryftalline, the bloody, Sec. -. , CAUSES.----The fmall-pox is commonly caught by infeaion. Since the difeafe was firft brought into Europe, the infeaion has never been wholly extinguifhed, nor have any proper methods, as far as I know, been taken for that purpofe ; fo that now it has ber come in a manner constitutional. Children who have over-heated themfelves by running, wrestling, &c. or adults after a debauch, are moft apt to be feized with the fmall-pox. SYMPTOMS.----This difeafe is fo generally known, that a minute defcription of it is unneceffary. Children commonly look a little dull, feem liftle'fs and drowfy for a few days before the more violent fymptoms of the fmall-pox appear. They are more inclined to drink than ufual, have little appetite for folid food, com- plain of wearinefs, and, upon taking exercife, are apt to fweat. Thefe are fucceeded by flight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomiting, Sec. The pulfe is quick, with a great heat of the fkin, and reftleffnefs. When the patient drops afleep, he wakes in a kind of horror, with a fudden flart, which is a very common fymptom of the approach- ing eruption ; as are alfo convulfion-fits in very young children. About the third or fourth day from the time of fickening, the fmall-pox generally begin to appear; fometimes they appear fooner, but that is no favourable fymptom. At firft they very nearly refem- ble flea-bites,andarefooneftdifcc»vTeredon the face, arms, and breaft. The moft favourable fymptoms are a flow eruption, and an abate- t68 OF THE SMALL-POX. ment of the fever as foon as the puftules appear. In the diftificl kind of fmall-pox, flie puftules feldom appear before the fourth day from the time of fickening, and they generally keep coming out gradually for feveral days after. Puftules which are diftina, with a florid red bafis, and which fill with thick purulent matter, firft of a whitifh, and afterwards of a yellowifh colour, are the beft. A livid brown colour of the puftules is an unfavourable fymp- tom ; as alfo when they are fmall and flat, with black fpecks in the middle. Puftules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger* It is likewife a very bad fign when they run into one another. It is a moft unfavourable fymptom when petechia, or purple, brown or black fpots are interfperfed among the puftules. Thefe are figns of great danger. Bloody ftools or urine, with a fwelled belly, are bad fymptoms; as is alfo a continual ftrangury. Pale urine and a violent throbbing of the arteries of the neck are figns of an approaching delirium, or of •convulfion-fits. When the face does not fwell, or falls before the pox come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and, at the fame time,the hands and feet begin to fwell, the patient generally does well; but when thefe do not fucceed to each other, there is danger. The tongue covered with a brown- cruft is an unfavourable fyitfptom. Cold fhivering fits coming on at the height of the difeafe are likewife unfavourable. Grinding of the teeth, when it proceeds from an affeaion of the nervous fyftem, is a bad fign ; but fometimes it is occafioned by worms, or a difordered ftomach. REGIMEN.----When the firft fymptoms of the fmall-pox ap- pear, people are ready to be alarmed, and often fly to the ufe of medicine, to the great danger of the patient's life. I have known children to be bled, bliftered and purged, during the fever which preceded the eruption of the fmall-pox, to fuch a degree, that Nature was not only disturbed in her operation, but rendered un- able to fupport the puftules after they were out; fo that the pa- tient, exhaufted by mere evacuations, funk under the difeafe. When convulsions appear, they give a dreadful alarm. Imme- diately fome noftrum is applied, as if this were a primary difeafe ; whereas it is only a fymptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off be- fore the aauad appearance of the fmall-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit*. * Convulfion-fitsare very alarming ; but their effefts are often falutary. T'hey feem to be one of the means made ufe of by Nature, for breaking the force of a fever. I have always obferved the fever abated, and fome- times quite removed, after one or more con'vullion-fits. This readily ac- counts for convulfions being a favourable fymptom in the fever which precedes the eruption of the fmall-pox, as every thing that mitigates this fever leffens the eruption. OF THE SMALL-POX. 169 All that is, generally fpeaking, neceffary, during the eruptive fe- ver,' is to keep the patient cool and eafy, allowing him to drink freely of fome weak diluting liquors ; as balm-tea, barley-water, clear whey, gruels, Sec. He fhould not be confined to bed,' but fhould fit up as much aS he is able, and lhould have his feet and legs frequently bathed in lukewarm water. His food ought to be very light; and he fhould be as little disturbed with company as, pof- fible. Much mifchief is done at this period, by confining the patient too foon to his bed, and plying him with warm cordials or fudorific medicines. Every thing that heats and inflames the blood, increafes the fever, and puflies out the puftules prematurely. This has num- berlefs ill effeas. It not only increafes the number of puftules, but likewife tends to make them run into one another; and when-they have been pufhed out with too great violence, they generally fall in before they come to maturity. Women, as foon as they fee the fmall-pox begin to appear, com- monly ply their tender charge with cordials, faffron, and marigold- teas, wine, punch, and even brandy itfelf. All thefe are given with a view, as they term it, to throw out the eruption from the heart. This, like moft other popular mistakes, is the abufe of a very juft obfervation, that when there is a moijlureon the fkin, the pox rife better, and the patient is eafier, than when it continues dry and parched* But that is no reafon for forcing the patient into a fweat. Sweating never relieves unlefs where it comes fpontaneoufly, or is the effect of drinking weak diluting liquors. Children are often fo peevifh, that they will not lie a-bed with- out a nurfe conftantly by them. Indulging them in this, has many bad effeas both upon the nurfe and child. Even the natural heat of the nurfe augments the fever of the child ; but if fhe, too, proves feverifh, which is often the cafe, the danger muft be increafed*. Lying feveral children, who have the fmall-pox, in the fame bed, has many ill confequences. They ought, if poffible, never to be in the fame chamber, as the perfpiration, the heat, the fmell, &c. all tend to augumentthe fever, and to heighten the difeafe. It is com- mon among the poor, to fee two or three children lying in the fame bed, with fuch a load of puftules, that even their fkins flick to- gether. One can hardly view a fcene of this kind, without beirig fickened by the fight. But how muft the effluvia affea the poor patients, many of whom perifhed by this ufagef ? ■X- I have known a nurfe, who had the fmall-pox before, fo infected by lying conftantly a-bed with a child, in a bad kind of fmall-pox, that fhe had not only a great number of puftules, which broke out all over her body, but afterwards a malignant fever, which terminated in a number of impofthumes or boils, and from which fhe narrowly efcaped with her life. We mention this, to put others upon their guard againft the danger of this virulent infection. f This obfervation is likewife applicable to hofpitals, work-houfes, &c. where numbers of children happen to have the fmall-pox at the fame time. I have feen above forty children cooped up in one apartment, Y 17o OF THE SMALL-POX. A very dirty cuftom prevails among the lower clafs of people, of . allowing children in the fmall-pox to keep on the fame linen dur- ing the whole period of that loathfome difeafe. This is done, left they fliould catch cold.; but it has many ill confequences. The linen becomes hard by the moisture which it abforbs, and frets the tender fkin. It occafions a bad fmell, which is very pernicious both • to the patient and thofe about him ;-befides, the filth and fordes, which adhere to the linen, being reforbed, or taken up again into the body, greatly augment the difeafe. A patient fhould not be, fuffered to be dirty in an internal difeafe, far lefs in the fmall-pox. Cutaneous diforders are often occafioned by naflinefs alone, and are ahvays increafed by it. Were the pa- tient's linen to be changed every day, it would greatly refrefh him. Care, indeed, is to be taken, that the linen be thoroughly dry. It ought likewife to be put on when the patient is mo'fTeool. ■■• < So ftrong is the vulgar prejudice in this Country, notwithftandiifj fj :dl that has been faid againft the hot regimen in the fmall-pox, that numbers ftill fall a fiicrifice to that error. 1 have feen poor women travelling in the depth of winter, and carrying their children along with them in the fmall-pox, and have frequently obferved others begging by the way-fide, with infants in their arms covered witli the puftules; yet I could never learn that one of thefe children died by this fort of treatment. This is certainly a fufficient proof of the fafety, at leaft, of etpofing patients in the fmall-pox to the open air. There can be no reafon, however, forexpofing them to public view. It is now very common in the environs of great towns to meet patients in the fmall-pox on the public walks. This paaice may fuit the purpofes of boasting inoculators, but is dangerous to the citizens, and contrary to the laws of humanity and found policy. ' The food in this difeafe ought to be very light, and of a cooling * nature, as panado, or bread boiled with equal quantities of milk and ; water, good apples roafted or boiled with milk and fweeterred with a little fugar, or ftu.h-!ike. The drink may be equal parts of milk and water, clear fweet whey, barley-water, or thin gruel, &c. Af- ter the pox are full, butter-milk, being of an opening and cleanfing nature, is a very proper drink. ' ,# MEDICINE.----This difeafe is generally divided into four dif- ferent periods, viz. the fever which precedes the eruption, the erup- tion itfelf, the fuppuration, or maturation of the puftules, and the fecond.iry fever. . Little mors is neceflary, during the primary fever, than to keep ' a'!i the while they had this dlfeafv, without any of them being admitted to b ,the the frefh air. No one can be" at a.lofs to fee the ^nipiopriety of fiu-.i conduct. It ought to be a rule, not only i:i' h'-fpitals for the fmall1 pox, but, likewife, for other d':iVafc>, that u> patient fhould be withia fight or hearing of ancSiier. Thi> h a matter i> which too little regard is paid. In raofl hofpitals and infirmaries, the i';;k t':c dviri«r 'and th< i dead, are often to be feen m the f-tiue up irt:?.-.- ".<... / OF THE SMALL-POX. 171 the patient cool and quiet, allowing him to drink diluting liquors, and bathing his feet frequently in warm water. Though this be generally the fafeft courfe that can be taken with infants, yet admits of a ftrong constitution and plethoric habit fometimes require bleed- ing. When a full pulfe, a dry fkin, and other fymptoms of inflam- mation render this operation neceflary, it ought to be performed ; but, unlefs thefe fymptomsare urgent, it is fafer to let it alone ; if the body is bound, emollient clyfters may be thrown in. If there is a great tiaufea,or inclination to vomit, weak camomile- tea, or lukewarm water may be drank,in order to clean the ftomach. At the beginning of a fever, Nature generally attempts a difcharge; either upwards or downwards, which, if promoted by gentla mean^, would tend greatly to abate the violence of the difeafe. Though every method is to be taken during the primary fever, by a cool regimen, &c..to prevent too great an eruption'; yet, after the puftules have made their appearance, our bufinefs is to promote the fuppuration, by diluting drink, light food, and, if Nature feems to flag, by generous cordials. When a low, creeping pulfe faintifh- nefs, and great lofs of ftrength, render cordials neceffary, we would recommend good wine, which may be made into ne,;us, wi^ an equal quantity of water, and fharpened with the juice ofora.^e, the jelly of currants, or the like. Wine-whey, fharpened as above, is likewife a proper drink in this cafe; great care, however, muft be taken not to overheat the patient by any of thefe things. This, inftead of promoting, wOuld reta/d the eruption. The rifing of the fmall-pox is often prevented by the violence of the fever. In this cafe, the cool regimen is ftriaiy to be obferved. The patient's chamber muft not only be kept cool, but he ought frequently to be taken out of bed, and to be lightly covered wilit clothes while in it. Exceffive reftleffnefs often prevents the rifing and filling of. the fmall-pox. When this happens, gentle opiates are neceflary. Thefe ought always to be adminiftered with a fparing hand. To an in- fant, a tea-fpoonful of the fyrup of poppies may be given everv five or fix hours till it has the defired effea. An adult will require a table-fpoonful to anfwer the fame purpofe. If the patient be troubled with a ftrangury, or fuppreffion of urine, which often happens in the fmali-pox, he fhould be frequently taken out of bed, and, if he be able, fhould walk aerofs the room with his feet bare. When he cannot do this, he may be frequently fet on his knees in bed, and fhould endeavour to pafs his urine as often as he can. When thefe do not fucceed, a tea-fpoonful of the fweet fpirits of nitre may be occafionaily mixed with his drink. Nothing more certainly relieves the patient, or is more beneficial in the fmall-pox,than a plentiful difcharge of urine. If the mouth be foul, and the tongue dry and chopped, it ought to be frequently wafhed, and the throat gargled with water and 4oney, fharpened with a little vinegar or currant-jelly. 172" OF TOE SMALLPOX. During the rifing of the fmall-pox, it frequently happens, that the patient is eight or ten days withcrut a ftool. This not only tends to heat and inflame the blood, but the faeces, by lodging fo long in the body, become acrid, and even putrid. From whence bad confe- quences muft unfue. It will, therefore, be proper, when the body is bound, to throw in an emollient clyfter every fecond or third day, through the whole courfe of the difeafe. This will greatly cool and relieve the patient. When petechia:, or purple, black, or livid fpots appear among the fmall-pox, tl>e bark muft immediately be adminiftered in as large dofes as the patient's ftomach can bear. For a child, two drachms 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 tablc-fpoonful of it given every 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 ro be trifled with, but muft be adminiftered as frequently as the ftomach can bear it; in which cafe, it will often produce very hap- py effeas. I have frequently feen the petechia? difappear,and fmall- pox, which had a very threatening afpea, rife and fill with laudable matter, by the ufe of the bark and acids. The patient's drink ought, in this cafe,to be generous; as wine or ftrong negus acidulated with fpirits of vitriol, vinegar,, the juice of lemon, jelly of currants, or fuch-like. His food muft confifl of ap- ples roafted or boiled, preferved cherries, plumbs, and other fruits of an acid nature. The bark and acids are not only neceffary when the petechia; appear, but likewife in the lymphatic orcryftalline fmali-pox,where the matter is thin, and not duly prepared. The Peruvian bark feems to poffefs a Angular power of afufting Nature in preparing 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 bark, acidu- lated as above, changed the colour and consistence of the matter, and produced the moft happy effeas. When the eruption fubfides fuddenly, or when the fmall-pox flrihe in, before they have arrived at maturity, the danger is very great, In this cafe, blifters muft be immediately applied to the wriftj and ancles, and the patient's fpirits fupported with eordials. Sometimes bleeding has a furprifing effea in raising the puftules 'after they have fubfided ; but it requires fkill to know when this is proper, or to what length the patient can bear it. Sharp cata- plafms, however, may. be applied to the feet and hands, as they tend to promote the fwelling of thefe parts. The moft dangerous period of this difeafe, is what we call thY OF THE SMALL-POX. l7l fecondary fever. This generally comes on when the fmall-pox be- gin 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-pdx, to re- lieve the patient by loofe ftools. Her endeavours, this way, are by no means to be counteracted, but promoted, and the 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 labori- ous, with other fymptoms of an inflammation of the breaft, the patient muft immediately be bled. The' quantity of blood to be let,, muft be regulated by the patient's ftrength, age, and the ur- gency of the fymptoms. But, in the fecondary fever, if the patient be faint-fh, the puf- tules become fuddenly pale, and if there be great coldnefs of the extremities, blifters muft be applied, and the patient muft be fup- ported with generous cordials. Wine, and even fpirits, have fome- times been given, in fuch cafes, with amazing fuccefs. As the fecondary fever is, in great meafure, if not wholly, owing to the abforption of the matter, it would feem highly confonant to reafon, that the puftules, as foon as they come to maturity, mould be opened. This is every day praaifed in other phlegmons which tend to fuppuration ; and there feems to be no caufe vf'hy it fhould be lefs proper here. On the contrary, w^e have reafon to believe, that, by this means, the fecondary fever might always be leffened, and often wholly prevented. The puftules fhould be opened when they begin to turn of a yellow colour. Very little art is neceffary for this operation. They may either be opened with a lancet or a needle, and the matter abforbed by a little dry lint. As the puftules are generally firft 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 fecond or even a third time ; for which caufe, the opera- tion muft be repeated, or rather continued as long-as there is any confiderable appearance of matter in the puftules. This operation, rational as it is, has been negleaed from a piece of miftaken tendernefs 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 is entirely without founda- tion. I have frequently opened the puftules, when the patient did not fee me, without his being in the leaft fenfible of it; but, fup- pofe it where attended with a little pain, that is nothing is compan- ion to the advantages which arife from it. Opening the puftules not only prevents the reforpticn of the matter into the blood, but likewife takes off the tenfion of the fkin, and, by that means, greatly relieves the patient. It likewife tends to prevent the pitting, which is a matter of no fmall importance. 174 OF THE SMALL-POX. Acrid matter, by lodging long in lhc puftules, cannot fail to cor- rode the tende/fkin; by which, many a handfome face becomes fo deformed as hardly to bear a refemblance to the human figure*. It is generally neceffaTy, after the fmall-pox are gone off, to purge *he patient. If, however, the?ocdy has been open through the whole courfe of the difeafe, or if butter-milk and other things of an open- ing nature have been drank freely after the height of the fmall-pox, purging becomes lefs necefTary ; but it ought never wholly to be negleaed. For very young children, an infufion of fenna and prunes, with a little rhubarb, may be fweetened with coarfe fugar, and given in fmall quantities till it operates. Thofe who are farther advanced, -- muft take medicines of a fharper nature. For example; a child of five or fix years of age may take eight or ten grains of jalap ever night, and the fame quantity of jalap in powder next morning. This may be wrought off with frefh broth or water-gruel, and may be repeated three or four times, five or fix days intervening between each dofe^ For children further advanced, and adults, the dofe muft be increafed in proportion to the age and conftitutionf. When impofthumes happen after the fmall-pox, which is not feldom the cafe, they muft be brought to fuppuration as foon as poffible, by means of emollient poultices; and when they have been opened, or have broke of their own accord, the patient muft be purged. The bark and a milk-diet will be ufeful in this cafe. When a cough, a difficulty of breathing, or other fymptoms of a confumption, fucceed to the fmall-pox, the patient muft be fent to a place where the air is good, and put upon a courfe of affes* milk, with fuch exercife as he can bear. For further direaions in diis cafe, fee the article Confumptions. Of Inoculation^ THOUGH no difeafe, after it is formed, baffles the powers of medicine more effeaually than the fmall-pox, yet more may be done before-hand, to render this difeafe favourable, than any one we know; as almoft all the danger from it may be prevented by inocu- lation. This falutary invention has been known in Europe above * Though this operation can never do harm, yet it is only neceffary when the patient has a great load of fmall-pox, or when rhe matter which they contain is of fo thin and acrid a nature, that there is reafon to apprehend bad confequences from its being too quickly reibrbed, or taken up again into the mafs of circulating humours. t I have of late been accustomed, after the fmall-pox, tp %ive one, tx\", three, four, or five grains of calomel, according to the age of the p-" uent, oyer night, and to work it-off next morning with a. suitable ddft of jalap. OF ".THE SMALL-POX. J7>' half a century; but, like moft other ufeful difcovef ies, it has till of late made b^t flow prtfgrefs. To the honour of this country, inor culation has met with a more favourable reception here, than among any of our neighbours. It is ftill, however, far from being general, which we have reafon to fear will be the cafe, s long as the prac- tice continues in the hands of the faculty. t , No^difcovery can be of general utilitv, while'the praai6e of it is kept: in the hands of a few. Had the inoculation of the fmall- pox been introduced as a fafhion, and not as a medical difcovery, or had it been praaifed by the fame kind of operators here, as it is in thofe countries from whence we learned it, it had long ago been univerfal. The fears, jealoufies, prejudices, and oppofite interefts of the faculty, are, and ever will be, the moft effeaual obftacles to the progrefs of any falutary difcovery. Hence, 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 praaice more extenfive, but more fafe, and by aaing under lefs reftraint than regular petitioners, have taught them that the patient's greateft danger arofe, not from the Vant of care, but the excefs of it. They know very little of the matter, who impute the fuccefs of modern inoculators to any fuperior fkill, either in preparing the patient or communicating the difeafe. Some of them, indeed, from a fordid defrre of engrofling the whole praaice to themfelves, pre- tend to have extraordinary fecrets or noftrums for preparing perfons for inoculation, which never fail of fuccefs. But this is only a pretence to blind the ignorant. Common fenfe and prudence alone are fufficient both in the choice of the fubjea and management of the operation. Whoever is pofleffed of thefe, may perform this office for his children,whenev:er he finds it convenient, if they be in a good ftate of health. . This fentiment is not therefultof theory, but of obfervation. Though few phyficians have had more opportunities of trying in- oculation in all its different forms, {o little appears to me to de- pend on thofe, generally reckoned important circumstances, of preparing the body, communicating the infeaion by this or the other method, &c. that, for feveral years pa ft, I have perfuaded! the parents or nurfes, to perform the whole themfelves, ~and have found that method followed with equal fuccefs, while it is free from any inconveniences thatattend the other.* * A critical fituation, too often to be met with, firft put me upon trv- ing this method. A gentleman who had loft all his children, except one foil, by the natural fmail-po:c, was determined to have him inoculated. He told me his intention, and defired I would perfaade the mother and grandmother, &c. of its propriety. But that was impofllbie. They Were not to be perfuaded; and either could not gel the better of their fears, or were determined againft convi&ion. It was always a point with me> not to perform the operation without the confent of the parties concern! ed. I therefore advifed the frither, after giving his fon a dofe or; two of rhub:irb,.t< had th? f>iuiihp-.»: of a good hi;:*', i76 OF THE SMALL-POX. " The fmall-pox may be communicated in a great variety of ways, with nearly th£ fame degree of fafety and fuccefs. ^In Turkey, from whence we learned the praaice, the women communicate the difeafe to children, by opening a bit of the fkin with a needle, and putting into the wound a little matter taken from a ripe pof- tule. On the coaft of Barbary, they pafs a thread wet with the matter through the Ikin, between the thumb and fore-finger; and, income of the flates of Barbary, inoculation is performed by rub- bing in the variolous matter between the thumb and fore-finger, or on other parts of the body. Rubbing the variolous matter upon , the fkin, has been long known in many parts of Afia and Europe, as well as in Barbery, and has generally gone by the name of buy ing the fmall-pox\ Tne prefent method of inoculating in Britain,* is to make two -.,. three flanting incifions in the arm, fo fupcrficial as not to pierce quite through the fkin, with a lancet wet with frefh matter taken from a ripe pustule ; afterwards, the wounds are clofed up, and left wi hout anv dreffing. Some make ufe of a lancet covered viith tie dry matter ; but this is lefs certain, and ought never to be -ufed unlefs where frefh matter cannot be obtained: when this is the cafe, the matter ought to be moiftened by holding the lan- cet for fome time in the fteam of warm water. Indeed, if frefh matter be applied long enough to the fkinr there is no occafion for any wound at all. Let a bit of thready, ,, about half an inch long, wet with the matter, be applied to the arm, mid-way between the fhoulder and elbow, covered with a piece of common flicking plaifter, and kept on for eight or ten days. This will feldom fail to communicate the difeafe- Wi mention this method, becaufe many people are afraid of a wound; and, doubtlefs, the more eafily the operation can be performed, it has the greater chance to become general. Some imagine, that the difcharge from a wourrcl leflens the eruption ; but there is no great ftrefs to belaid upon this notion ; befides, deep wounds of- T ten ulcerate, and become troublefome. We do not find that inoculacion is considered as a medical ope- ration in thofe countries from whence we learned it. In Turkey, it is performed by the women, and, in the Eaft-Indies, by the to open two or three of the puftules, taking up the matter with a little cotton, and. as foon as he came home, to take his fon apart, and givehis arm a flight fcratch with a pin, afterward., to rub the place well with the cotton, and take no farther notice of it. All this he punftually per- formed; and, at the ufual period, the fmall-pox made their appearance, which were of an exceedinggoodkind, and fo mild, as not to confine the boy an honr to his bed- None of the other relations knew but the difeafe < had come in the natural way, till the boy was well. * The method practifed in America, differs only in the number of in- cifions : we find, that the matter infertrd by one, is generally fufficienij to produce the defired efFe^, without the trouble and inconvenience eff three. (I. C.) OF THE SMALL-POX. 177 &rachmins. In this country, the cuftom is ftill in its infancy ; we make no doubt, but it will foon become fo familiar, that parents will think no more of inoculating their children, thaA at pre- fent they do of giving them a purge. No fet of men have it fo much in their power to render th« praaice of inoculation general, as the clergy, the greateft oppc-x fition to it ftill arifing from fome fcruples of confcience, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objeaions which weak minds may have to this falutary praaice, but to enjoin it as a duty, and to point out the danger of negleaing 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 negka the means of faving their children's lives, are as guilty as thofe who put them to death. I wifh this matter were duly weighed. No one is more ready to make allowance for human weaknefs and religious pre- judices; yet I cannot help recommending it, in the warmeft'man- ner, to parents, to consider how great an injury they do their children, by negleaing to give them this difeafe in the early pe- riod of life. The numerous advantages arifing from the inoculation' of the fmall-pox, have been pretty fully pointed out by the learned Dr. M'Kcnzie, in his Hiftory of Health.* To thofe mentioned by 4f " Many and great," fays this humane author, u a*re the danger, attending the natural infection, from all which the innoculationis quite fecure. The natural infection may invade weak or diftempered bodies, by no means clifpofed for-its kindly reception. It may attack them at a feafon of the year either violently hot or intenfely co'd- Itm^ybe communicated from a fort of fmall pox impregnated with the utmoft virulence. It may lay hold of people unexpectedly, when adangerons fort is imprudently imported into a maritime place. It may furprife U3 foon after excelfos committed in luxury, intemperance, or lewdnefs. I': may likewife feize on the innocent after indifpenfible watchittgs, hard labour, cr necefiaryjournies. And is it a trivial advantage, that all thef: unh.-.ppy circumstances can be prevented by inoculation ? By inocula- tion, numbers are faved from deformity as well as from death, in the natural fmall-pox, how often are the fineft features, and the moft beau^ tiful complexions miferabiy disfigured? Whereas, inoculation rirely leaves any ugly mark^or fears, even where the number of puftules on the face has been very confiderable, and the fymptoms by no meatis fa- vourable. And many other grievo-us complaints, that are frequently fubfequen't to the natural fort, feldom follow the artificial. Does not inoculation alfo prevent thofe inexpreffible terrors, that perpetually harrafs perfons who never had this difeafe, infomuch, that when the fmall-pox is epidemical, entire villages are depopulated, markets ruined, fles begin to turn pale on the face, and afterwards upon the body; fo that by the ninth day they entirely difappear. The fever, however, and difficulty of breathing, often continue, efpecially if the pa- tient has been kept upon too hot a regimen. Petechia;, or purple fpots, may likewife be occafioned by this error. A violent loofenefs fometimes fucceeds the meafles; in which cafe, the patient's life is in imminent danger. Such as die of the meafles generally expire about the ninth day from the invafion, and are commonly carried offby a peripneumony, or inflammation of the lungs. The moft favourable fymptoms are, i moderate loofenefs, a moift fkin. and a plentiful difchare of urine. When the eruption fuddenly falls in, and the patient is feized with a delirium, he is in the greateft danger. If the meafles turn -too foon of a pale colour, it is an unfavourable fymptom, as are alfo great weaknefs, vomiting, reftleffnefs, and difficulty of fwal- lowing. Purple or black fpots appearing among the meafles are very unfavourable. When a continual cough, with hoarfenefs, fuc- ceeds the difeafe, there is ieafon to fufpea an approaching con- fumption of the lungs. Our bufinefs in this difeafe is to affift Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid; but when they are too violent, they muft be strained by evacuations, , .md cool diluting liquors, Sec. We ought likewife to endeavour to ' f-ppeafe the moft urgent fymptoms, as the cough, reftleffnefs, aud difficulty of breathing. REGIMEN.*----The cool regimen is neceffary here as well as in the fmall-pox. The food muft be light, and the drink dilating. Acids do not anfwer fo well in the meafles as in the frtiall-pox, as they tend to exafperate the cough.- Small beer, though a good drink in the fmall-pox, is here improper. The moft fuitable liquors are decoaions of liquorice with marfh-mallow roots and farfapanlla, infufions of linfeed, or of the flowers of elder, balm-tea, clarified whey, b3rley-water and fuch-like. Thefe, if the patient be coftive, may be fweetened with honey; or, if that fhould difagree with thl ftomach, a fittle manna may occafionaily be added to them. OF THE MEASLES. 185 MEDICINE-----The meafles being an inflammatory difeafe, without any critical difcharge of matter, as in the fmall-pox, bleed- ing is commonly neceffary, efpecially when the fever runs high, with difficulty of breathing, and great oppreffion of tha breaft. But if the difeafe be of a mild kind, bleeding may be omitted*. Bathing the feet and legs frequently in lukewarm water, both tends to abate the violence of the fever, and to promote the eruption. The patient is often greatly relieved by vomiting. When there is a teodency this way, it ought to be promoted by drinking luke- warm water, or weak camomile-tea. When the cough is very troublefome, with drynefs of the throat, and difficulty of breathing, the patient may hold his head over the fleam of warm water, and draw the fleam into his lungs. He may likewife lick a little fpermaceti and fugar-candy poun- ded together ; or take now-and-then, a fpoonful of the oil of fweet almonds, with fugar-candy diffolved in it. Thefe will foften the throat, and relieve the tickling cough. If, at the turn of the difeafe, the fever affumes new vigour, and there appears great danger of fuffocation, the patient muft be bled according to his ftrength, and blifters applied, with a view :o pre- vent the load from being thrown on the lungs; where, if an inflam- mation fhould fix itfelf, the patient's life will be in imminent danger. In cafe the meafles fuddenly difappear, it will be neceffary to purfue the fame method recommended when the fmall-pox recede. The patient muft be fupported with wine and cordials. Blifters muft be applied to the legs and arms, and the body rubbed all ever with warm flannels. Warm poultices may likewife be applied to the feet and palms of the hands. When purple or black fpots appear, the patient's drink fhould be fharpened with fpirits of vitriol; and, if the fymptoms increafe, the bark muft be adminiftered in the fame manner, as direaed in the fmall-pox f. Opiates are fometimes neceffary, but fhould never be given except in cafes of extreme reftleffnefs, a'violent loofenefs, or when the cough is very troublefome. For children, the fyrup of poppies is fufficient. A tea-fpoonful or two may be occasionally given, ac- cording to the patient's age, or the violence of the fymptoms. After the meafles are gone off, the patient ought to be purged. This may be conduaed in the fame manner as direaed in the fmall-pox. If a violent loofenefs fucceeds the meafles, it may be checked by taking for fome days a gentle dofe of rhubarb in the morning, and * I do not know any difeafe wherein bleeding is more neceffary than in the meafles, efpecially when the fever runs high : in this cafe, I have always found it relieve the patient. t Wine fhould be allowed the patient, to co operate with the hark, in fapporting the vigour of the fyftem. This fhould be the practice in ail cafes ^ when there Uatendencv, as it is commonly called, to putrefaction. (I.C) A 2 186 OF THE SCARLET FEVER. an opiate over night; but if thefe do not remove it, bleeding will feldom fail to have that, effea. Patients recovering after the meafles fliould be careful what they eat or drink. Their food for fome time ought to be light, and in fmall quantities, their drink diluting, and rather of an opening na- ture, as butter-milk, whey, and fuch-like. They ought alfo to be- ware of expofing themfelves too foon to the cold air, left a fuffoca- ting catarrh, an afthma, or a confumption of the lungs fliould enfue. Should a cough, with a difficulty of breathing, and other fymp- toms of a confumption, remain after the meafles, fmall quantities of blood may be frequently let, at proper intervals, as the patient's ftrength and conftitution will permit. He ought to drink affes-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 of milk and vegetables; and if thefe do not fucceed, let him remove to a warmer climate*. Of the Scarlet Fever. THE fcarlet fever is fo called from the colour of the patient's fkin, which appears as if tinged with red wine. It happens at any feafon cf the year, but is moft common towards the end of fum- mer ; when it often feizes whole families. Children and young perfons are moft fubjea to it. It begins, like other fevers, with coldnefs and fhiveringe, without any violent ficknefs. Afterwards the fkin is covered with red fpots, which are broader, more florid, and lefs uniform than the meafles. They continue two or three days, and then difappear ; after which the cuticle, or fcarf-fkin, falls off. There is feldom any occafion for medicine in this difeafe. The patient ought however to keep within doors, to abftain from flefh, * Attempts have been made to communicate the meafles, as well as the fmall-pox, by inoculation ; and we make no doubt, but in time, the practice may fucceed. Dr. Home of Edinburgh, fays, he communicated the difeafe by the blood. Others have tried this method, and have not found it fucceed. Some think the difeafe would be more certainly com- municated, by rubbing the fkin of a patient, who has the meafles* with cotton, and afterwards applying the cotton to a wound, as in the fmall- pox -, while others recommend a bit of flannel which had been applied to the patient's fkin, all the time of the difeafe, to be afterwards laid upon the arm or Itg of the perfon to whom the infection is to be com- municated. There is no doubt, but this difeafe, as well as the fmall-pox, may be communicated in various ways; the moft probable, however, is either from cotton rubbed upon the lkin, as mentioned above, or by introducing a little of the fharp humour, which diftils from the 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 prjftice were more general, as the meafles have of late become very OF THE BILIOUS FEVER. 187 flrong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body muft be kept gently open by emollient clyfters, or cream of tartar and nitre, one or two drachms of the former, with eight or ten grains of the latter, may be taken two or three times a day. Children and young perfons are fometimes feized at the begin- ning of this difeafe with a kind of ftupor and epileptic fits. In this cafe, the feet and legs fhould be bathed in warm water % a large blifter applied to the neck, and a dofe of the.fyrup of poppies given every night till the patient recovers. The fcarlet fever is not always fo mild.* It is fometimes attended with putrid or malignant fymptoms, in which cafe, it is always dan- gerous. In the malignant fcarlet fever the patient is not only af- feaed with coldnefsand fhivering, but with languor, ficknefs, and great oppreffion ; to thefe fucceed exceffive heat, nauTea and vomit- ing, with a forenefs of the throat; the pulfe is extremely quick, but fmall and deprefTed ; the breathing frequent and laborious; the fkin hot, but not quite dry ; the tongue moift, and covered with a whitifh mucus ; the tonfils inflamed and ulcerated. When the eruption appears, it brings no relief; on the contrary, the fymp- toms generally grow worfe, and frefh ones come on, as purging, delirium, &c. When this difeafe is miftaken for a fimple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this cafe are cordials and antifeptics, as the bark, wine, fnake- root, and the like. The treatment muft be in general fimilar to that of the malignant ulcerous fore thcoatf. Of the Bilious Fever. WHEN a continual, remitting, or intermitting fever is accom- panied with a frequent or copious evacuation of bile, either by vomit or ftool, the fever 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 mofl frequent and fatal in warm countries, efpecially v\here the foil is marfhy, and * If the pulfe be full and hard, blood muft be taken from the arm or jugular vein. (I. C.) t In the year 1774, during winter, a very bad fpecies of this fever prevailed in Edinburgh. It raged chiefly among young people. The erup- tion was generally accompanied with a quiniVy, and the inflammatory fymptoms were fo blended with others of a putrid nature, as to render the treatment of thedifeafe very difficult. Many of the patients, tow ards the decline of the fever, were afflicted with large fwelhngs of the fub- maxillary glands, and not a few had a fuppuration in one or both ears. 188 OF THE ERYSIPELAS, when great rains are fuccee'ded by fultry Vcats. 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 are fymptoms of inflammation at the beginning of this fever, it will be neceffary to bleed, and to put the patient upon the cool dduting regimen recommended in the inflammatory fever. The faline draught may be frequently adminiftered, and the pa- tient's body kept open by clyfters or mild purgatives. But if the fever fhould remit or intermit, bleeding will feldom be neceffary. In this cafe, a vomit may be adminiftered, and, if the body be bound, a gentle purge; after which the bark will generally complete the cure. In cafe of a violent loofenefs, the patient muft be fupported with chicken broth, jellies of hartfhorn, and the like ; and he may ufe the white decotlion for his ordinary drink*. If a bloody flux fliould accompany this fever, it muft he treated as recommended 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 or four times a day, a table-fpoonful of Mindererus's fpiritf mixed in a cup of his ordinary drink. If the bilious fever be attended with the nervous, malignant, or putrid fymptoms, which is fometimes the cafe, the patient muft be treated in the fame manner as direaed under thefe difeafes. After this fever, proper care is neceffary to prevent a relapfe. For this purpofe, the patient, efpecially towards the end of autumn, eught to continue the ufe of the bark for fome-time after he is well. He fhould abftain from all trafhy fruits, new liquors, and every kind of flatulent aliment. CHAPTER XXVII. Of the Eryfipelas, or St. Anthony*s Fire. THIS difeafe, which in fome parts of Britain is called the rofe, attacks perfons at any period of life, but is moft common between the age of thirty and forty. Perfons of a fanguine or ple- thoric habit, are moft liable to it. It often attacks young people, and pregnant women; and fuch as have once been affliaed with it, are very liable to have it again. Sometimes it is a primary dif- eafe, 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 feizes the legs or face; efpecially the latter. It is moft common in autumn, or when hot weather is fucceeded by cold and wet. * See Appendix,. White Decoction. t See Appendix, Spirit of Mindererus. OR ST. ANTHONY'S FIRE. 189 CAUSES.-----The eryfipelas may be occafioned by violent paf- fions or affeaions of the mind; as fear, anger, &c. When the ♦ body has been heated to a great degree, and is immediately expofed to the cold air, fo that the perfpiration is fuddenly checked, an ery- fipelas will often enfue"*. It may alfo be occafioned by drinking to excefs, by continuing too long in a warm bath, or by any thing that overheats the blood. If any of the natural evacuations be ob- ftruaed, or in too fmall quantity, it may caufe an eryfipelas. The fame effea will follow from the stoppage of artificial evacuations; as iffues, Teton % or the like. "SYMPTOMS.----The eryfipelas attacks with fhivering, thirft, lofs of ftrength, pain in the head and back, heat, reftleffnefs, a quick pulfe, vomiting, and fometimes a delirium. On the fecond, third, or fourth day, the part fwells, becomes red, and fmall puftules ap- pear ; at which time the fever generally abates. When the eryfipelas feizes the foot, the parts contiguous fwell, the fkin fhines ; and, if the pain be violent, it will afcend 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 mouth and nostrils be very dry, and the pa- tient drowfy, there is reafon to fufpea an inflammation of the brain. If the eryfipelas affeas the breaft, it fwells and becomes exceed- ingly hard, with great pain, and is apt to fuppurate. There is a vio- lent pain in the arm-pit, on the fide affeaed, where an abfeefs is of- ten formed. If in a day or two, the fwelling fubfides, the heat and pain 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 affeas 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 difcuffed, but comes to a fuppuracion; in which cafe, fiftulas, 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 fe- venth or eighth day. REGIMEN.----In the eryfipelas the patient muft neither be kept too hot nor too cold, as either of thefe extremes will tend to • The country people in many parts of Britain call this difeafe a blast, 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 the damp ground, where they fall afleep, and lie fo long as to catch cold, which occafions the erfiypelas. This difeafe may indeed proceed from other caufes, but nine times out of ten it is occafioned by cold caught after the body has been greatly heated or fatigued. * igo OF THE ERYSIPELAS, * make it retreat, "which is always to be guarded againft. When the difeafe is mild, it wi'.! be fufficient to keep the patient within doors, without confining him to his bed, and to promote the perfpiration by diluting liquors, Sec. The diet ought to be flender, and of a moderately cooling and moiftening quality, as groat-gruel, panado, chicken or barley-br«j^ with cooling herbs and fruits, &c. avoiding flefli, fifh, strong 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 negus, and other things of a cordial nature. His food may be fago gruel, with a little wine, and nourifhing broths, taken in fmall quantities, and often repeated. Great care muft be taken not to overheat him. MEDICINE----In this difeafe much mifchief is often done by medicine, efpecially by external applications. People, when they fee an inflammation, immediately think that fomething ought to be applied to it. i his indeed is neceffary in large phlegmons; but in an eryfipelas, the fafer courfe is to apply nothing. Almoft all ointments, falves, and pi a Iters, being of a greafy nature, tend ra- ther to obftrua and repel, than promote and difcharge from the part. At the beginning of this difeafe, it is neither fafe to promote a fuppuration, nor to repel the matter too quickly. The eryfipelas in many refpeas refembles the gout, and is to be treated with the greateft caution. Fine wool, or very foft flannel, are the fafeft ap- plications to the part. 1 hefe not only defend it from the externa! air, but likewife promote the perfpiration, which has a great ten- dency to carry off the difeafe. In Scotland, the common people generally apply a mealy cloth to the parts affeaed, which is not improper. It is common to bleed in the eryfipelas ; but this requires cau- tion. If the fever be high, the pulfe hard and ftrong, and the pa- tient vigorous, it will be proper to bleed ; but the quantity muft be regulated by thefe circumstances, and the operation repeated as the fymptoms may require. If the patient has been accustomed to j ftrong liquors, and the difeafe attacks his head, bleeding is abfo- ; lutely neceffary. . j Bathing the feet and legs frequently in lukewarm water, when I the difeafe attacks the face Or brain, has an excellent effect. " tends to make a derivation from the head, and feldom fails to re- lieve the patient. When bathing proves ineffeaual, poultices, or fharp fynapifms, may be applied to the foles of the feet, for the fame purpofe. In cafes where bleeding is requifite, it is likewife neceffary to keep the body open. This may be effeaed by emollient clyfters, or fmall dofes of nitre and cream of tartar. Some recommend very large dofes of nitre in the eryfipelas ; but nitre feldom fits eafy on OR ST. ANTHONY'S FIRE. 191 the ftomach, when taken in large dofes. It is one of the beft me- dicines when the fever and inflammation run high. Haifa drachm of it, with one or two drachms of cream of tartar, may be given in the patients ordinary drink, four times a day. When the eryfipelas leaves the extremities, and feizes the head, fo as to occafion a delirium or ftupor, it is abfolutely necefTary to open the body. If clyfters and mild purgatives fail to have this ef- fea, stronger ones muft be given. Blifters muft likewife be applied to the neck, or behind the ears, and fharp cataplafms laid to the foles of the feet. When the inflammation cannot be difcufTed, and the part ha's a tendency to ulcerate, it will then be proper to promote fuppura- tion, which may be done by the application of emollient poultices, fuch as bread and milk, or thofe made with flaxfeed flower. When the black, livid, or blue colour of the part fhows a ten- dency to mortification, the bark muft be adminiftered. It may be taken along with acids, as recommended in the fmall pox, or in any other form, more agreeable to the patient. It muft not however be trifled with, as the patient's life is at flake. A drachm may be given every two hours, if the fymptoms be threatening, and cloths dipped in warm camphorated fpirits of wine, of the tiiidlure of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewife be proper in this cafe to apply poultices of the bark, or to foment the part affeaed with a ftrong decoaion of it. In what is commonly called the fcorbtitk eryfipelas, which con- forinues at confiderable time, it will only be neceffary to give gentle laxatives, and fuch things as promote the perfpiration. Thus, after the inflammation has been checked by opening medicines, the decoaion of woods* may be drank, after which a courfe of bitters will be proper. Such as are liable to frequent attacks of the eryfipelas, ought carefully to guard againft all violent p.iffions; to abftain from ftrong liquors, and all fat, vifcid, and highly nouriftiing food. They fhould likewife take fufficient exercife, carefully avoiding the extremes of beat or cold. Their food fhould confift chiefly of milk, and fuch fruits, herbs and roots, as are of a cooling quality; and their drink ought to be fmall-beer, whey, butter-milk, and fuch like. They fhould never fuffer themfelves to be long coftive. If that cannot be prevented by fuitable diet, it will be proper to take frequently a gentle dofe of cream of tartar, the lenitive cleauary, or fome other mild purgative. ■Jfr See Appendix, Decoction of Woods. [ i92 1 CHAPTER XXVIII. Of the Phrenitis ; or, Inflammation of the Brain. THIS is fometimes a primary difeafe, but oftener only a fymp. torn of fome other malady ; as the inflammatory, eruptive, or fpotted fever, &c. It is very common, as a primary difeafe, in warm climates, and is moft incident to perfons about the prime or vigour of life. The paffionate, the ftudious, and thofe whofe ner- vous fyftem is irritable in a high degree, are moft liable to it. CAUSES-----This difeafe is often occafioned by night-watch- ing, efpecially when joined with hard ftudy : it may likewife pro- ceed from hard drinking, anger, grief or anxiety. It is often occa- fioned by the ftoppage of ufual evacuations ; as*the bleeding piles ' in men, the customary difcharges of women, &c. Such as impru- dently expofe themfelves to the heat of the fun, efpecially by fleep- ing without doors in a hot feafon with their heads uncovered, are often fuddenly feized with an inflammation of the brain, foasto awake quite delirious. When repellants are imprudently ufed in an eryfipelas, an inflammation of the brain is fometimes the con- fequence. It may be occafioned by external injuries, as blows or bruifes upon the head, Sec. SYMPTOMS.----The fymptoms which ufually precede a true inflammation of the brain are pain of the head, rednefs of the eyes, a violent flufhing of the face, disturbed fleep, or a total want of it, great drynefs of the fkin, coftivenefs, a retention of urine, a fmall dropping of blood from the nofe, finging 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 hard and contraaed. When* the brain itfelf is inflamed, the pulfe is always foft and low; but when the inflammation only affeas the integu- ments of the brain, viz. the dura and pia mater, it is hard. A re- markable quicknefs of hearing is a common fymptom of this dif- eafe ; but that feldom continues long. Another ufual fymptom is I a great throbbing or pulfation in the arteries of the neck and tem- ples. Though the tongue is often black and dry, yet the patient feldom complains of thirft, and even refufes drink, 1 he mind chiefly runs upon fuch objeas as have before made adeepimpref- i fion on it; and fometimes, frcyn a fullen filence, the patient be- comes all of a fudden quite outrageous. A conftantJtrembling*and starting of the tendons is an unfavour- able fymptom, as are alfo a fuppreffion of urine ; a total want of , fleep ; a conftant fpitting ; a grinding of the teeth, which laft may be confidered as a kind of convulfion. When a phrenitis succeeds * OF TrlE PHRENITIS, &c. ^93 an inflammation of the lungs, of the inteftinesf or of the throat, &c. it is owing to a tranflation of the difeafe from thefe parts to the brain, and generally proves fatal. This fhews the neceffity of pro- per evacuations, and the danger of repellents in all inflammatory difeafes. '■*• The favourable fymptoms are, a free perfpiration, a copious dif- charge of blood from the nofe, the bleeding piles, a plentiful dif- charge 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 difeafe often proves fatal in a few days, it require? the moft fpeedy applications. When prolonged^ or improperly treated, A it fometimes ends in madnefs, or a kind of ftupidity, which conti- nues for life. In the cure, two things are chiefly to be attended to, viz. to leffen the quantity of blood in the brain, and to retard the^circula- ^ tion towardsNthe head. REGIMEN.----The patient ought to be kept very quiet. Com- pany, noife, and every thing that affeas the fenfes, or disturbs the imagination, increafes the difeafe. Even too'inuch light is hurtful: for.which reafon, the patient's chamber ought to be a little darken- ed, and he fhould neither be kept too hot nor cold. It is not necef- fary to exclude the company of an agreeable friend, as this has a tendency to footh and quiet the mind. Neither ought the patient to be kept too much in the dark, left it fhould occafion a gloomy melancholy, which is too often the confequence of this difeafe. The patient muft, as far as poffible, be Toothed and humoured irt everything. Contradiaion will ruffle his mind, and increafe his malady. Even when he calls for things which are not to be ob- tained, 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, ox: by fome other excufe." A little of any thing, that the mind is let upon, though not quite proper, will hurt die patient lefs than a pofitive refufal. Whatever he was delighted with when in health, may here be tried; as pleafing ftories, foft raufic, or whatever has a tendency to footh the paffions ind compofe the mind. Boerhaave propofes feveral mechanical experimcr.ts for this purpofe ; as the foft noife of water distilling by drops into a bafon, and the patient trying to reckon them, Sec. Any uniform found, if low and continued, has a tendency to pro- cure fleep, and confequently may be of fervice. The aliment^ught to be light, confifting chiefly of farinaceous ■ fubftances; as panado, and water-gruel, fharpened with jelly of currants, or juice of lemons, ripe fruits, roafted or boiled, jellies, preferves, Sec. The drink, fmall, diluting, and cooling; as whev, barley-water, or decoaion of barley and tamarinds, which latter not only render the liquor more palatable, but likewife more bene- ficial, as they are of an opening nature. B 2, ' T94 OF THE OPHTHALMIA j OR, MEDICINE.----Nothing more certainly relieves the patient than a free difcharge o( blood from the nofe. When this comes of its own accord, it is by no means to be flopped, but rather pro- moted, by applying cloths dipped in warm water to the part. Bleeding in the temporal arteries greatly relieves the head: but as this operation cannot always be performed, we recommend in its flead, bleeding in the jugular veins. When the patient's pulfe and fpirits are fo low, that he cannot bear bleeding with the lancet, leeches maybe applied to the temples. Thefe not only draw off the blood more gradually, but by being applied nearer to the part af- feaed, generally give more immediate relief. A difcharge of blood from the hemorrhoidal veins is of great • fervice, and ought by all means to be promoted. If the patient has %een fubjea to the bleeding piles, and that difcharge has been Mopped, every method mutt be tried to reftore it; as the applica- > tion of leeches to the parts, fitting over the fleams of warm water, y fharp clyfters, or fuppofitories made of honey, aloes, and rock-falt. If the inflammation of the brain be occafioned by the ftoppage of evacuations either natural or artificial, as the menfes, iffues, fetons, or fuch like, all means muft be ufed to reftore them as foon as poffible, or to Tubftitute others in their flead. The patient's body muft be kept open by stimulating clyflcrfor fmart purges ; and fmall quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the cafe be dangerous, may be ufed in the f pace of twenty-four hours. The head fhould be fhaved and frequently rubbed with vinegar and rofe-water. Cloths dipped in this mixture may likewife be ap- plied to the head*. The feet ought frequently to be bathed in luke- warm water, and foft poultices of bread and milk may be kept conftantly applied to them. If the difeafe proves obftinate, and does not yield to thefe medi- cines, it will be neceffary to apply a blifter to the whole head. CHAPTER XXIX. Of the Ophthalmia ; or, Inflammation of the Eyes. THIS difeafe may be occafioned by external injuries; as blows, burns, braifes, and the like. It may likewife proceed from duft, quick-lime, or other fubftances getting into the eyes. It is of- ten caufed by the ftoppage of customary evacuations ; as the heal- ing of old fores, drying up of iffues, the fuppreffing of gentle morn- ' ing fweats, or of the fweating of the feet, &c. Long expofure to the night air, efpecially in cold northerly winds, or whatever fud- * Even ice, when it can be procured, may be employed with advan- tage. (I. C) INFLAMMATION OF THE EYES. 195 denly checks the perfpiration, efpecially after the body has been much heated, is very apt to caufe it. Viewing fnow or other white bodies for a long time, or looking fledfaftly at the fun, a clear fire, or any bright objea, will occafion this malady. A fudden tranfition from darknefs to very bright light, will often have the fame effea. Nothing more certainly occafions an inflammation of the eyes than night-watching, efpecially reading or writing by candle-light. Drinking fpirituous liquors, an excefs of venery, are very hurtful to the eyes. The acrid fumes of metals, and of feveral kinds of fuel, are alfo pernicious. Sometimes an inflammation of the eyes pro- ceeds from a venereal taint, and often from a fcrophulous or gouty habit. It may likewife be occafioned by the hairs in the eye-lids turn- ing inwards, and hurting the eyes. Sometimes the difeafe is epide- mic, efpecially after wet feafons; and I have frequently known it prove infeaious, particularly to thofe who Jived in the fame houfe with the patient. It may be occafioned by moift air, or living in low damp honfes, efpecially in perfons who are notaccuftomed to fuch fituations. In children it often proceeds from imprudently dry- ing up of fcabbed 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. SYMPTOMS____An inflammation of the eyes is attended with an 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 quan- tities, whenever the patient attempts to look up. The pulfe is ge- nerally quick and hard, with fome degree of fever. When the dif- eafe is violent, the neighbouring parts fwell, and there is a throbbing or pulfation in the temporal arteries, Sec. A flight inflammation of the eyes, efpecially from an external caufe, is eafily cured; but when the difeafe is violent, and con- tinues long, it often leaves fpecks upon the eyes, or diranefs of fight, and fometimes total blindnefs. If the patient be feized with a loofenefs, it has a good effea ; and when the inflammation paffes from one eye to another, as it were by infeaion, it is no unfavourable fymptom. But when the difeafe is accompanied with a violent pain of the head, and conti- nues long, the patient is in danger of lofing his fight. REGIMEM-----The diet unlefs in fcrophulous cafes, can hard- ly be too fpare, efpecially at the beginning. The patient muft ■ab- stain from every thing of a heating nature. His food fhould confift chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water,balm-tea,common whey,and fuch-like. Hhcham- ber muft be darkened, or his eyes fhaded by a cover,fo as to exclude the li^ht, but not to prefs'upon the eyes. He fhould not look at a csnJ)<*, the £re^ cr any luminous objee ; and ought to avo:J *H ig6 * OF THE OPHTHALMIA; OR, fmoke, as the fumes of tobacco, or any thing that may caufe cough* ing, fneezing, 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 wherein great hurt is often done by external applications. Almoft every perfon pre- tends to be poffeffed of a remedy for the cure of fore-eyes. Thefe remedies gsnerally confift of eye-waters and ointments, with other external applications, which do mifchief twenty times for once they do good. People ought to be very cautious how they ufe fuch things, as even the preffure upon the eyes often increafes the malady. Bleeding, in a violent inflammation of the eyes, is always necef- , fary. This fhould be performed as near the part affeaed as poffible. r An adult may loofe ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the fymptoms. If not convenient to bleed in the neck, the fame quantity may be let from the arm, or any other part of the body. Leeches are often applied to the temples, or under the eyes, with' good effea*. The wounds muft be fuffered to bleed for fome hours, and if the bleeding flop foon, it may be promoted by the application of cloths dipt in warm water. In obftinate cafes, it will be necef- fary to repeat this operation feveral times. Brifk purging with glauber fait, fliould be produced, during the time bleeding is ufed; after that, the bowels may be kept open every other day, with a decoaion of tamarinds with fenna. A gentle dofe of cream of tartar, caftor-oil, or any other laxative, will anfwer the fame end. . .,. If the inflammation does not yield to thefe evacuations, blifters muft be applied to the temples, behind the ears, or upon the neck, and kept open for fome time by the mild bliftering ointment. I have feldom known thefe, if long enough kept open, fail.to remove the moft obftinate inflammation of the eyes ; but for this purpofe, it is often neceffary to continue the difcharge for feveral weeks. When the difeafe has been of long flanding, I have feen very extraordinary effeas from a feton in the neck, or between the fhoulders, efpe^Bpy the latter. It fhould be put upwardllpnd downwards, or in the direaion of the fpine, and in the middle, be- tween the fhoulder blades. It may be dreffed twice a day with yel- low 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 aero is the neck, it foon wears out, and is both more painful and troublefome than between the fhoul- ders ; befides, it leaves a difagreeable mark, and does not dilcharge fo freely. When the heat and pain of the eyes are very great, a poultice of bread and milk, foftened with fweet oil or frefh butter, may be # If leeches cannot be procured, blood may be drawn from the tem- ple by cupping. (1. C) *'• t INFLAMMATION OF THE EYES. -19 applied to them, at leaft all night; and they may be bathed with lukewarm milk and water in the morning. If the patient cannot fleep, which is fometimes the c;ffe, he may take twenty or thirty drops of laudanum, or two fpoonfuls of the fyrup of poppies, over night, more or lefs according to his age, or the violence of the fymptoms. # After the inflammation is gone off, if the eyes 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 lat- ter. A method fhould be contrived by which the eye can be quite immerfed in the brandy and water, where it fliould be kept for fome time. I have generally found this, or cold water and vine- gar, as good a flrengthener of the eyes as any of the moft celebra- ted col lyri urns. When an inflammation of the eyes proceeds from a fchrophu- • lous habit, it generally proves very obftinate. In this cafe, the pa- ■ tient's diet muft not be too low, and he may be allowed to drink fmall negus, or now-and-then a glafs of wine. The molt proper - medicine is the bark, which may be given in fubftance, or prepared as. follows : Take an ounce of the bark in powder, with two drachms 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, according to the age of the patient, may be : taken three or four times a-day. It is impossible to fay how long this medicine fhould be continued, as the cure is fooner performed . in fome than in others ; but, in general, it requires a confiderable 1 time to produce any lafting effeas. Preparations of mercr.ry may be of fingular fcrvice in opthal- miasof long continuance, but they ought always to be adrninifler- ed with the greateft caution, or by perfons of fkill in phyfic. f L- will be proper frequently to look into the eyes, to fee if any i hairs be turned inwards, or preffing upon them*. Thefe ought to : be plucked out with a pair of fmali pincers. Thofe who are liable to frequent returns of this difeafc, ought conftantly to have an iffue in one or both arms. Bleeding or purg- . ing in fpring and autumn, will be very beneficial to fuch perfons. They ought likewife to live with the greateft regularity, avoiding i ftrong liquor, and every thing of a heating quality. Above ail, let them avoid the night air and late ftudiesf. * Any foreign body lodged in the ey: may be expeditiously removed ' by parting a fmall hair-pencil,bet\veen tne eye-lid and the bali of the eye. I11 fome places, the pcafaut: do this very effectually, by ufing their tongue in the fame manner. t Asmoft people are fond of u'ing eye-waters and ointments in this and other dife-des of the ryes., wie have inferteel lb me of the moft appro- ved fornis of thefc medicine- in tlK-a^viul.... See Appendix, Eye-water and •'.ye-falve. ^ C 198 ] CHAPTER XXX. Of the .Quinfey : or, Inflammation of the Throat. P*T~^HIS difeafe is very common in Britain, and is frequently^. tended with great danger. It prevails in the winterftd fpring, and is moft fatal to young people of a fanguine tempera- ment. CAUSES-----In general it proceeds from the fame caufe aj other inflammatory diforders, viz. an obftruaed perfpiration. It is often occafioned by omitting fome part of the covering, ufually worn about the neck, by drinking cold liquor when the body ij warm, by riding or walking againft a cold northerly wind, or by any thing that greatly cools the throat, and parts adjacent. It may likewife proceed from the neglea of bleeding, purging or any customary evacuation. Singing, fpeaking loud and long, or whatever strains the throat, may likewife caufe.an inflammation of that organ. I have often known the quinfey prove fatal to jovial companions, who, after fit- ting long in a warm room, drinking hot liquors, and finging with vehemence, were fo imprudent as to go abroad in the cold night- air- Sitting with wet feet, or keeping on wet clothes, is very apt to occafion this malady. It is 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 plastered, &c. 1 know people who never fail to have a foar throat, if they fit even but a short time in a room lately wafhed. Acrid or irritating food may inflame the throat, and occafion a quinfey. It may proceed from bone?, pins, or other fharp fubftan- ces flicking in the throat, or from the caustic fumes of metals 01 minerals, as arfenic, antimony, &c taken in by the breath, fhi' difeafe is fometimes epidemic and infeaious. SYr-.iPTQ^lS.-----The inflammation of the throat'13 evident from infpeaiori, the parts appearing red and fwelled ; befides, the patient complains of pain in fwallowing. His pulfe is quick and hard, with other fymptoms of a fever. If blood be let, it is gene- rally covered with a tough coat of a whitifh colour, and the pati- ent fpits a tough phlegm. As the fwelling and inflammation <> creafe, the breathing and fwallowing become more difficult; the pain affeas the ears ; the eyes generally appearred ; and the face fwells. The "patient is often obliged fo keep himfelf in an erea pofture,_ being m danger of fulTocation; there is a conftant naufesj Or* Inclination to vomit; and the drink, inftead of palling into it: ftomach, is often returned by the nofe. The patient is fomerhnei ftarved at laft, merely from an inability to fwallow any kind of fo0*. When the breathing is laborious, y,T'ili ftrr.itnefs of the brej|j| OF THE QUINSEY. and anxiety, the danger is great. Though the pain in fwallowing be very great, yet while the patient breathes eafy, there is not fo much danger. An external fwelling is no unfavourable fymptom; but if it fuddenly falls, and the difeafe affeas the breaft, the danger is very great. When a quinfey is the confequence of fome other difeafe, which has already weakened the patient, his fituation is dangerous. A frothing at the mouth, with a fwelled tongue, a pale, ghastly countenance, and coldnefs of the extremities, are fatal fymptoms. * REGIMEN.----The regimen in this difeafe is in all refpeas the fame as in the pleurify, or peripneumony. The food muft be :■ light, and in fmall quantity, and the drink plentiful, weak and di- ; luting, mixed with acids. It is highly neceffary that the patient be kept eafy and quiet. Vi- . olent affeaions of the mind, or great efforts of the body, may prove it fatal. He fhould not even attempt to fpeak but in a low voice. Such a degree of warmth as to promote a conftant, gentle fweat, r is proper. When the patient is in bed, his head ought to be raif- ed 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, if appli- ed in due time. A judicious cuftom prevails among the peafants » of Scotland : When they feel any uneafinefs of the throat, they wrap a flocking about it all night. So effeaual is this remedy, that . in many places it paffes for a charm, and the flocking is applied ..with particular ceremonies: this cuftom fliould never be neglec- ted. When the throat has been thus wrapt up all night, it muft i; 'not be expofed to the cold air through the day, but a handkerchief "or a pieceof flannel kept about it till the inflammation be removed. The jelly of black currants is a medicine very much in esteem ,Tor complaints of the throat; and is of fome ufe. It fliould be al- ''moft conftantly kept in the mouth, and fwullowed down leifurely. **It may be mixed in the patient's drink, or taken any other way. ^ When it cannot be obtained, the jelly of red currants, or of mul- berries, may be ufed in its flead. r'; Gargles for the throat are very beneficial. They may be made of 'i'fage-tea, with a little vinegar and honey, or by adding to half an ^Englifh pint of the peaoral decoaion, two or three fpoonfuls of honey, and the fame 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 may be rendered more fharp and ^cleanfing, by adding to it a tea-fpoonful of the fpirit of fal ammo- smiac. Some recommend gargles made of a decoaion of the leaves 'or bark of the black-curraiit-bufh ; but where jelly can be had, :. thefe are unneceffary. 'S- In no difeafe is the benefit of bathing the feet and legs in luke- warm water more apparent : that praaice ought therefore never to be negleaed. If people were careful to keep warm, to wrap up & 2oo OF THE QUINSEY"; OR, their throats with flannel, to bathe their feet and legs in warm wa- ter, and to ufe a fpare diet, with diluting liquors, at the beginning of this difeafe, it would feldom proceed to a great height, or be at- tended with any danger : but when thefe precautions are neglec- ted, and it becomes violent, more powerful medicines are neceffary. MEDICINE.----An inflammation of the throat being a moft acute and dangerous diftemper, which fometimes takes off the pa- tient very fuddenly, it will be proper, as foon as the fymptoms ap- pear, to bleed in the arm, or rather in the'jugular vein, and to re- peat the operation if circumstances require. The body fliould be kept gently open by giving the patient for his ordinary drink, a decoaion of figs and tamarinds, or fmall dofes of cream of tartar 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 effeas from a bit of fal prunel, or purified nitre, held in the mouth, and fwallowed down as it melted. This promotes the difcharge of faliva, anfwers the end of a gargle, while at the fame time it abates the fever, by promoting the difcharge cf urine, &c. The throat ought to be rubbed twice or thrice a-day with a little of the volatile liniment. This feldom fails to produce fome good effeas. At the fame time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the fkin, as this application renders it very tender. Many other external applications are recommended in this difeafe, but there is none preferable to a common poultice of bread and milk. Some recommend the gum guaiacum as a fpecific in this dif- difeafe. Half a drachm of the gum in powder may be made into an eleauary with the rob of elder-berries, or the jelly of currants for a dofe, and repeated occafionaily. Blifters upon the neck or behind the ears in violent inflamma- tions of the throat are very beneficial; and in bad cafes it will be neceffary to lay a blifter quite acrofs the throat, fo as to reach from ear to ear. After the phfters are tr.ken off, the parts ought to be kept running by the application of iffue ointment, till the inflam- mation 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 fuppuration fel- dom happens. This, however, is fometimes the cafe, in fpite of all endeavours to prevent it. When the inflammation and fwelling continue, and it is evident that a fuppuration will enfue, it ought to be promoted by drawing the fleam of warm water into the throat through a tunnel, or the like. Soft poultices ought to be applied outwardly, a;;d the patient may keep a roafted fig con- ftantly in his mouth. It fometimes happens, before the tumour breaks, that the fwel- ling is fo great, as entirely to prevent any thing from getting down INFLAMMATION OF THE THROAT. 2oi into the ftomach. In this cafe, the patient muft inevitably perifh, unlefs he can be fupported in fome other way. This can only be done by nouriftiing clyfters of broth, or gruel with milk, &c. Pa- tients have often been fupported by thefe for feveral days, till the tumour has broke ; and afterwards they have recovered. Not only the fwallowing, but the breathing, is often prevented by the tumour. In this cafe, nothing can fave the patient's life, but opening the trachea, or windpipe. As that has been often done with fuccefs, no perfon, in fuch defperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a furgeon, it is not neceffary here to give any direc- tions about it. When a difficulty of fwallowing is not attended with an acute pain or inflammation, it is generally owing to an obftruaion of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with fomething that may gently ftimulate the glands, as a decoaion of figs with vine- gar and honey ; to which may be added a little muftard, or a fmall quantity of fpirits. But this gargle is never to be ufed where there are figns of an inflammation. This fpecies of angina has va- rious names among the common people, as the pap of the throat, the falling down of the almonds of the ears, Sec. Accordingly, to remove it, they lift the patient up by the hair of the head, and thruft their fingers under his jaws, &c. all which praaices are at beft ufelefs, and often hurtful. Thofe who are fubjea to inflammations of the throat, in order to avoid that difeafe, ought to live temperate. Such as do not choofe to obferve this rule, muft have frequent recourfe to purging and other evacuations, to difcharge the fuperfluous humours. They ought likewife to beware of patching cold, and fhould abftain from aliment and medicines of an aftringent or stimulating nature. Violent exercife, by increafing the motion and force of th<* blood is apt to occafion an inflammation of the throat, efpecially if cold liquor be drank immediately after it, or the body fuffered fuddenly to cool. Thofe who would avoid this difeafe, ought, therefore, after fpeaking aloud, finging, running,' drinking warm hquor, or doing any thing that may ftrain the throat, or increafe the circulation of the blood towards it, to take care to cool gradu- ally, and to wrap fome additional coverings about their necks. I have often known perfons, who had been fubjea to fore throats, entirely freed from that complaint'by only wearing a ribband, or a bit of flannel conftantly round their necks, or by wearing thick- er fhoes, a flannel waistcoat, or the like. Thefe may feem trifling but they have great effea. There is danger indeed in leaving them oft after perfons have been accuftomed to them ; but furely th■■ mconveniency of ufing fuch things for life, is not to be compar- ed with the danger which may attend the neglea of them. ' C 2 to* OF THE MALIGNANT QUINSEY ; OR, Sometimes, after an inflammation, the glands of the throat con- tinue fwelled, and become hard and callous. This complaint is not eafily removed, and is often rendered dangerous by the too frequent application of ftrong stimulating and ftyptic medicines. The beft method is to keep it warm, and to gargle it twice a-day with a decoaion of figs, fharpened a little with the elixir or fpirit of vitriol. Of the Malignant £>uinfey; Or, Putrid, Ulcerous Sore Throat. THIS kind of quinfey is but little known in the north of Britain, though, for fome time paft, it has been fatal in the more fouthern I counties : It is frequently to be met with in America. Children are more liable to it than adults, females than males, and the de> licate than thofe who are hardy and robuft. It prevails chiefly in autumn, and is moft frequent after a long courfe of damp or fultry weather. CAUSES.----This is a contagious diftemper, and generally communicated by infeaion. Whole families, and even entire vil- lages, often receive the infeaion from one perfon. This ought to put people on their guard againft going near fuch patients as la- bour under the diforder; as they endanger their own lives, and thofe of their friends and connexions. Whatever tends to produce putrid or malignant fevers, may occafion the putrid ulcerous fore throat, as unwholefome air, damaged provifions, neglea of clean- linefs, &c. SYMPTOMS.----It begins with alternate fits of fhivcring and heat. The pulfe is quick, but low and unequal, 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 diftin- guifhes this from an inflammatory difeafe. Upon looking into the throat, it appears fwelled, and of a florid red colour. Pale or afh- coloured fpots, are here and there interfperfed, and fometimes one feroad patch or fpot, of an irregular figure, and pale white colour, furrounded 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 fymptom of this difeafe. When it appears, the purging and vomiting generally ceafe. PUTRID, ULCEROUS SORE THROAT. 203 there is often a flight degree of delirium; the-face frequently appears bloated, and the infide of the nostrils red and inflamed. The patient complains of a difagreeable putrid fmell, and his breath is very offenfive. The putrid, ulcerous fore throat may be diftinguifhed from the inflammatory by the vomiting and loofenefs with which it is gene- rally ufhered in; the foul ulcers in the throat covered with a whit? or livid coat; and by the exceffive weaknefs of the patient; with other fymptoms of a putrid fever. Unfavourable fymptoms are, an obftinate purging, extreme weaknefs, dimnefs of the fight, a livid or black colour of the fpots, and frequent fhiverings, with a weak, fluttering pulfe. If the erup- tion upon the fkin fuddenly difappears, or becomes of a livid co» lour, with a difcharge of blood from the nofe or mouth, the dan- ger is very great. If a gentle fweat break out about the third or fourth day, and continue with a flow, firm, and equal pulfe ; if the floughs caft off in a kindly manner, and appear clean and florid at the bottom ; and if the breathing is foft and free, with a lively colour of the eyes, there is reafon to hope for a falutary crifis. REGIMEN-----The patient muft be kept quiet, and for the moft part in bed, as he will be apt to faint when taken out of it. His food muft be nourifhing and restorative ; as fago-gruel with red wine, jellies, ftrong broths, &c. His drink ought to be gene- rous, and of an antifeptic quality j as red wine negus, white wine whey, and fuch like. MEDICINE.-----The medicine in this kind of quinfey is en- tirely differeat from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the patient, muft be avoided. Cooling medicines, as nitre and cream of tartar, are likewife hurtful. Strengthening cordials alone can be ufed with fafety ; and thefe ought never to be negleaed. If at the beginning there is a great naufea, or inclination to vomit, the patient muft drink an infufion of green tea, camomile flowers, or carduus benediBus, in order to cleanfe the ftomach. If thefe are not fufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit. If the difeafe is mild, the throat may be gargled with an infufion of fage and rofe leaves, to a gill of which may be added a fpoonful or two of honey, and as much vinegar as will make it agreeably acid ; but when the fymptoms are urgent, the floughs large and thick, and the breath very offenfive, the following garghj may be ufed : t To fix or feven ounces of the peaoral decoaion, when boiling, add half an ounce of contrayerva-root; let it boil for fome time, and afterwards ftrain the liquor ; to which add two ounces of white wine vinegar, an ounce of fine honey, and an ounce of the 2o4 OF THE MALIGNANT QUINSEY, &c. tinaure of myrrh. This ought to be ufed as a gargle, and a little of it fhould frequently be injeaed, with a fyringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly neceffary for children, who cannot ufe a gargle. It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, or proper inhaler, the fleams of warm vinegar, myrrh, and honey. But when the putrid fymptoms run high, and the difeafe is at- tended with danger, the only medicine that can be depended up- on is the Peruvian bark. It may be taken in fubftance, if the pa- tient's ftomach will bear it. If not, an ounce of bark grofsly pow- dered, with two drachms of Virginian fnake-root, may be boiled in an Englifh pint and a half of water, to half a pint; to which a tea-fpoonful of the elixir of vitriol may be added, and an ordinary tea-cupful of it taken every three or four hours. Blifters are very beneficial in this difeafe, efpecially when the patient's pulfe and fpirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck. Should the vomiting prove troublefome, it will be proper to 'give the patient two table-fpoonful? of the faline julep every hour. Tea made of mint and a little cinnamon will be very proper for his ordinary drink, efpecially if an equal quantity of red wine be mixed with it. In cafe of a violent loofenefs, the fize of a nutmeg of diafcordium or fix or eight drops of laudanum, according to the age of the pa- tient, may be taken in cinnamon water two or three times a-day; the japonic confeaion may be taken two or three times a-day, or oftener if neceffary. If a difcharge of blood from the nofe happens, the fleams of warm vinegar may be received up the noftrils frequently; and the drink muft be fharpened with fpirits of vitriol, or tincture of jofes. In cafe of a ftrangury, the belly muft be fomented with warm water, and emollient anodyne clyfters given three or four times a-day. After the violence of the difeafe is over, the body fhould ftill Jbe kept open with mild purgatives ; as manna, fenna, rhubarb, or the like. If great weaknefs and dejeaion of fpirits, or night-fweats, with other fymptoms of a confumption, fhould enfue, we advife the patient to continue the ufe of the bark, with the elixir of vitriol, and take frequently a glafs of generous wine. Thefe, together with a milk-diet, and riding on horfeback, are moft likely for recover- ing his ftrength. [ 2oe ] The Cynanche Parotidaa : Or, the Mumps. THIS difeafe is known, in America, under the appellation of the mumps : It is more particularly incident to children than to grown people ; and afflicts the patient but once in his life : It is thought to be produced by contagion. SYMPTOMS.----It comes on with a moderate fever : this is foon followed with a ftiffnefs in the neck, and a fwelling about the angle of the lower jaw. In a fhort time, the fwelling increafes, and affeas the whole neck ; fometimes one fide only is affeaed, but generally both. It is not unfrequently attended with a flight difficulty in fwallowing. Thofe fymptoms continue to increafe until the third or fourth day. At length the fever fubfides, the fwel- ling recedes from the throat and neck ; and the testicles in men, and the breafts in women, become affeaed in a fimilar manner : for the moft part, this gradually difappears without much inconve- nience -, but when the fwelling does not come on after that of the throat and neck, the fever often becomes confiderable. REGIMEN.----This complaint feldom requires much atten- tion ; the patient muft confine himfelf to the houfe. The neck fhould be defended from cold, by the application of flannel. The diet fhould be fpare, and the drink diluting. MEDICINE.----The parts about the neck may be bathed with a mixture, confifting of half a table-fpoonful of fweet-oil, and sixty drops of laudanum. The bowels muft be kept open with cream of tartar and flower of fulphur : but when the tumour has fuddenly receded fromth? throat, in confequence of cold, or any other caufe, and the fever becomes confiderable, with pain in the head, a full and hard pulfe^'blood muft be taken from the arm, and repeated as the fymptoms may demand. A blifter may alfo be applied to the fore or back part of the neck. CHAPTER XXXI. Of Colds and Coughs. \ COLDS are the eftea of an obftruaed perfpiration : Almoft every cold is a kind of fever, which only differs in degree from fome of thofe already treated of. No age, fex, or conftitution, is exempted from this difeafc neither can any medicine or regimen prevent it. The inhabitants; of every climate are liable to catch cold, nor can the greateft cir- cumfpeaion defend them at all times from its attacks. Indeed, ao6 OF COUGHS AND COLDS. if the human body could be kept conftantly in an uniform degree of warmth, catching cold would be impofiible : but as that cannot be effeaed by any means, the perfpiration muft be liable to many changes. Such changes, when fmall, do not affea the health; but, when great, they muft prove hurtful. When oppreffion of the breaft, a fluffing of the nofe, unufual wearinefs, pain of the head, &c. give ground to believe that the perfpiration is obftruaed, or, in other words, that the perfon has caught cold, he ought immediately to leffen his diet, at leaft the ufual quantity of his folid food, and to abftain from all ftrong li- quors. 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 infufion of balm or linfeed, fharpened with the juice of orange or lemon; a decoaion of barley and liquorice, with tamarinds, or any other cool, diluting, acid liquor. His fup- per fhould be light; as fmall poffet or water-gruel, fweetened with honey, and a little toafted bread in it. If honey difagrees with the ftomach, the gruel may be fweetened with treacle or coarfe fugar, and fharpened with the jelly of currants. Thofe who have been accuftomed to generous liquors, may take wine-whey inftead of i gruel, which may be fweetened as above. ' The patient ought to lie longer than ufual a-bed, and to encou- rage a gentle fweat, which is eafily brought on towards morning, by drinking tea, or any warm diluting liquor. I have often known this praaice carry off a cold in one day, which, in all probability, had it been negleaed, would have cost the patient his life, or have ponfined him for fome months. Would people facrifice a little time to eafe and warmth, and praaife a moderate degree of abfli- nence when the firft fymptoms of a cold appear, moft of the bad effeas which flow from an obftruaed perfpiration might be pre- . | vented. But, after the difeafe has gathered ftrength by delay, all ! attempts to remove it often prove vain. A pleurify, a peripneu- mony, or a fatal confumption of the lungs, are the common effects j of colds, which have either been totally negleaed or treated im- properly. Many attempt to cure a cold, by getting drunk. But this, to fay no worfe of it, is a very hazardous experiment. No doubt it may fometimes fucceed, by fuddenly restoring the perfpiration; but when there is any degree of inflammation, which is frequently the cafe, ftrong liquors, inftead of removing the malady, increafe it. ■■ By this means, a common cold may become an inflammatory level. When thofe who labour for their daily bread 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 diforder is often fo aggravated, as to confine them for a Ipng time, or even ; to render them ever after unable to fuftain hard labour. But even OF COUGHS AND COLDS. 207 fuch of the labouring poor as can afford to take care of themfelves, are often too hardy to do it: they affea to difpife colds, and as long as they can crawl about, fcorn to be confined by what they call a common cold. Hence, colds destroy fuch numbers of man- kind. Like an enemy defpifed, they gather ftrength from delay, till they become invincible. Often travellers, rather than lofe a day in the profecution of their bufinefs, throw away their lives by pur- fuing their journey, even in the fevereft weather, with this difeafe upon them. Colds may alfo be too much indulged. When a perfon, for eve- ry flight cold, fhuts himfelf up in a warm room, and drinks great quantities of warm liquor, it may occafion fuch a general relax- ation of the folids as will not be eafily removed. It is, therefore, proper, when the difeafe will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercife ; as walking, riding on horfeback, or in a carriage, &c. An obftinate cold, which no medicine can remove, will yield to gentle exercife and a pro- per regimen of the diet. Bathing the feet and legs in warm water has a great tendency to reftore 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 the blood, and the patient fhould go immediately t» bed after ufing it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will foon* er take off a fpafm, and reftore the perfpiration, than all the hot fu- dorific medicines in the world. This is all that is neceffary for re- moving a common cold ; and if this courfe be taken at the begin- ning, it will feldom fail. But when the fymptoms do not yield to abftinence, warmth, and diluting liquors, there is reafon to fear the approach of fome other difeafe ; as an inflammation of the breaft, an ardent fever, or the like. If the pulfe, therefore, 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 powders recommended in the fcarlet fever, every three or four hours, till they give a ftool. It will likewife be proper to put a blifter on the back, to give two table-fpoonfuls of the faline mixture every two hours, and, in fhort, to treat the patient in all refpeas as for a flight fever. I have often feen this courfe, when 'obferved at the beginning, re- move the complaint in two or three day, when the patient had all the fymptoms of an approaching ardent fever, or an inflammation of the breaft. The chief fecret of preventing colds, lies in avoiding, as far as poffible, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. Thefe and other circumstances relating to this important fubje<5t, are fully treated of, under the article ObflruBed Perfpiration. 208 Of a Common Cough. A cough is generally the effea of a cold, which has either been Improperly treated, or entirely negleaed. When it proves obfti- nate, there is always reafon to fear the confequences, as this fhows a weak ftate of the lungs, and is often the forerunner of a con- fumption. If the cough be violent, and the patient young and ftrong, with a hard quick pulfe, bleeding will be proper; but in weak and relaxed habits, bleeding rather prolongs the difeafe. When the patient fpits freely, bleeding is unneceffary, and fometimes hurtful, as it tends to leffen that difcharge. When the cough is not attended with any degree of fever, and the fpittle is vifcid and tough, fharp peaoral medicines are to be adminiftered ; as gum ammoniac, fquills, &c. Two table-fpoon- fuls of the folution of the gum ammoniac may be taken two or three times a-day, more or lefs, according to the age and conftitu- tion of the patient. Squills may be given various ways : two oun- ces of the vinegar, the oxymel, or the fyrup, may be mixed with the fame quantity of fimple cinnamon-water, to which may be ad- ded, an ounce of common water and an ounce of balfamic fyrup. Two table-fpoonfuls of this mixture may be taken three or four times a-day. A fyrup 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 pleafure. When the defluxion is fharp and thin, thefe medicines rather do hurt. In this cafe, gentle opiates, oils, and mucilages, are more proper. A cup of an infufion of wild poppy leaves, and marfh- mallow roots, or the flowers of colts-foot, may be taken frequent- ly ; or a tea-fpoonful of the paregoric elixir may be put into the patient's drink twice a-day. When a cough is occafioned by acrid humours, tickling the throat and fauces, the patient fhould keep fome foft peaoral lo- zenges almoft conftantly in his mouth ; as the liquorice cakes, bar- ley-fugar, the common balfmatic lozenges, Spanifh juice, &c. Thefeblunt the acrimony of the humours, and, by taking off their ftimulating quality, help to appeafe the cough*. * In a former edition, I recommended, for an obftinate tickling cough, an oilyemulfion, made with the paregoric elixir of the Edinburgh Dif- penfatory, inftead of rhe common alkaline fpirit. I have fince beentoW by feveral practitioners, that they found it to be an excellent medicine in this diforder, and every way deftrving of the character which I had given it. Where this elixir is not kept, its place may be fupplied by ^ ding to the common oily emulsion, an adequate proportion of the Thc- biic r'mftiire, or liquid laudanum. OF A COMMON COUGH. 209 In obftinate coughs, proceeding from a flux of humours upon the lungs, it will often be necefTary, befides expeaorating medi- cines, to have recourfe to iffues, Tetons, or fome other drain*. I have often obferved the moft happy effeas from a Burgundy-pitch platter applied between the fhoulders. I have ordered this fimple remedy in the moft obftinate coughs, in a great number of cafes, and in many different conftitutions, without ever knowing it fail te give relief, unlefs where there were evident figns 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, about 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 onee a fortnight or three weeks. This is, indeed, a cheap and fimple medicine, and confequently apt to be defpifed ; but the materia medica does not afford an application more efficacious in almoft every kind of cough. It has not indeed always an immediate effea ; but, if kept on for fome time, it will fucceed where moft other medicines fail. The only inconveniency attending this plaifter, is the itching which it occafions; but furely this may be difpenfed with, con- fidering the advantage which the patient may expea to reap from the application. When the itching becomes very uneafy, the plaif- ter may be taken off, and the part rubbed with a dry cloth, or wafh- ed with a little warm milk and water. Some caution is neceffary in difcontinuing the ufs of fuch a plaifter; this, however, may be fafely done by making it fmaller by degrees, and at length quit- ting it altogether in a warm feafonf. But coughs proceed from many other caufes befides defluxions upon the lungs. In thefe cafes, the cure is not to be attempted by peaoral medicines. Thus, in a cough proceeding from a foulnefs and debility of the ftomach, fyrups, oils, mucilages, and all kinds of balfamic medicines do hurt. The flomach 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, that does not happen. The cure of this cough depends chiefly upon cleanfing and strengthening the ftomach; for which purpofe, gentle vomits and bitter purgatives are moft proper. Thus, after a vomit or two, the facred tinaure, as it is called, may betaken for a confiderable The patient fliould wear flannel next his fkin, in order to promote perfpiration. (I. C.) t Some complain that the pitch plaifter adheres too fait, while others find difficulty in keeping it on. This proceeds from the different kinds of pitch made ufe oV, and likewife from the manner of making it. I ge- nerally find it anfwers beft when mixed with a little bees-wax, and fpread as cool as poffible. The clear, hard, tranfparent pitch anfwers tha purpofe beft. D 3 2IO OF THE WHOOPING-COUGH, time, in the dofe of one Or two table-fpoonfuls, twice a-day, or aj cften as it is found neceffary to keep the body gently open. People ir.iv ma-he this tinaure themfelves, by infufing an ounce of hiera pier.? in an Englifh pint of white wine, letting it fland a few days, and then straining it. In coughs which proceed from a debility of the ftomach, the Turk is likewife of confiderable fervice. It may either be chewed, taken in powder, or made into a tinaure along with other floma- chic bitters. A nervous cough can only be removed by change of air, proper exercife, and gentle opiates. Inftead of the faponaceous pill, the paragoric elixir, &c. which are only opium difguifed, ten, fifteen, twenty, or twenty-five drops of liquid laudanum, more or lefs, as circumstances require, may be taken at bed time, or when the cough is moft troublefome. Immerfing the feet and hands in warm water will often appeafe the violence of a nervous cough. When a cough is only the fymptom of fome other maladv, it is in vain to attempt to remove it, without firft curing the difeafe "irorn which it proceeds. Thus, when a cough is cecalioned by lathing, keeping the body open, feanfying 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 vermin will generally cure the cough ; as bitter pur- gatives, oily clyfters, and fuch like. Women during the laft months of pregnancy, are often great- ly affliaed with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatu- lent food, and to wear a loofe eafy drefs. A cough is not only a fymptom, but is often likewife the fore- runner of difeafes. Thus, the gout is frequently ufheied in by a very troublefome cough, which affeas the patient for fome days before the coming on of the fit. This cough is generally removed by a paroxyfm of the gout, which fhould therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water. Of the Whooping-Cough, or Chin-Cough. This cough feldom affeas adults, but proves often fatal to chil- dren. Such children as live upon thin watery diet, who breathe unv. holefome air, and have too little exercife, are moft liable to this difeafe, and generally fuffer mofl from it. The chin-cough is fo well known, that a defcrlption of it is un- iifcc:T..ry. Whatever hurts the digefticn, obftrua; the perfpif*?. I £ Sec .^pperJ.ix, K:cr- P'cra. OR CHIN-COUGH. *i\ twn, or relaxes the folids, difpbfes to this difeafe : confequently, its cure muft depend upon cleanfing and strengthening the ftomach, bracing the folids, and at the fame time promoting perfpiration and the different feeretions. The diet muft be light, and of 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 ad- vanced, may be allowed fago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyffop, or pennyroyal tea, fweetened with honey or fugar-candy, fmall wine-whey; or, if the patient be weak, he may fometimes be allowed a little negus. One of the moft effeaual 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 in fome meafure depend on the patient's being removed from the piace where the infeaion prevails. Moft of the difeafes of children are infeaious ; nor is it- ct all uncommon to find the chin-cough pre- vailing in one town or village, when another, at a very fmall dif* tance, is quite free from it. But whatever be the caufe, we arc fure of the faa. No time ought therefore to be loft in removing the patient at fome diftance from the place where he caught the difeafe, and, if poffible, into a more pure and warm air*. When the difeafe proves violent, and the patient is'in danger of being suffocated by the cough, he ought to be bled, efpecially if there be a fever with a hard full pulfe. But as the chief inten- tion of bleeding is to prevent an inflammation of the lungs, and to render it more fafe to give vomits, it is feldom neceffary to re- peat the operation ; yet if there are fymptoms of an inflammation 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 pro- mote this difcharge, either by fmall dofes of ipecacuanha, or the vomiting julep recommendeft in the Appendixf. It is very difficult to make children drink after a vomit. I have often feen them happily deceived, by infufing a fcruple or half a drachm of the powder of ipecacuanha in a tea-pot, with 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-cupful of this may be given every ■* Some think the air ought not to be changed till the difeafe is on the deciine ; but there feems to be no fufficient reafon for this opinion, as patients haveb"?en known to reap benefit from a change of air at all periods of the difeafe. It is not fufficient to take the patient out dajly •in 9'carriage. This feldom anfwars any good purpofe ; but often does hurt, by giving him cold. t See Appendix, Vomiting Jul^p. 212 OF THE WHOOPING-COUGH, &c. quarter of an hour, or rather every ten minutes, till it operates. When the child begins to puke, there will be no occafion for drink- ing any more, as the water already on the ftomach will be fufficient. Vomits not only cleanfe the ftomach, which in this difeafe is generally loaded with vifcid phlegm, but they likewife promote the perfpiration and other fecretions, and ought therefore to be repea- ted according to the obstinacy of the difeafe. They fhould not however be flrong : gentle vomits frequently repeated are both lefs dangerous, and more beneficial than ftrong ones. The body ought to be kept gently open. The beft medicines for this purpofe are caftor oil, or flour of fulphur and cream of tartar. Thefe muft be given in fmall dofes, and repeated as occa- fion requires. Many people believe that oily, peaoral, and balfamic medicines poffefs wonderful virtues for the cure of the chin-cough, and ac- cordingly exhibit them plentifully to patients of every age and con- ftitution, without considering that every thing of this nature muft load the ftomach, hurc the digeftion, and of, courfe, aggravate the diforder". 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 feven drops of laudanum, according to the age of the pa- tient, may be taken in a cup of hyffop, pennyroyal tea, or fugar and water, and repeated occafionallyf. The garlic ointment is a well-known remedy in North-Britain ior the Chin-cough. It is made by beating, in a mortar, garlic, with an equal quantity of hogs-lard. With 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 plaifter. It fhould be renewed every night and morning at leaft, as the garlic foon lofes its virtue. This is an exceeding good medicine, both in the chin-cough and in moft other coughs of an obftinate na- ture. It ought not however to be ufed when the patient is very hot or feverifh, left it fhould increafe thefe fymptoms. The feet fhould be bathed once ever^y two or three days in luke- warm water; and a Burgundy-pitch plaifter kept conftantly be- tween the fhoulders. But when the difeafe proves very violent, it will be neceflary, inftead of it, to apply a blifter, and to keep the part open for fome time with iffue-ointment. *• Dr. Duplanil fays, he has feen many good effects from the kermes jjiineral in this complaint, the cough being frequently alleviated even by tiie iirlt dofe. The dofe for a child of one year old, is a quarter of a grain diffolved in a cup of any liquid, repeated two or three times a-day- For a child of two years, the dofe is halt" a grain ; and the quantity muft be thus increafed, in proportion to the age of the patient. + Some recommend the extract of hemlock as an extraordinary reme- dy in the whooping-cough ; but fo tar as i have been able to obferve, it is no way fuperior to opium, which, when properly adminiftered, will ©i'ten relieve fume of the moft troublefome fymptoms of this diforder. INFLAMMATION OF THE STOMACH. 213 When the difeafe is prolonged, and the patient is free from a fever, the bark, and other bitters, are the mofl ;.r->per medicines. The bark may either be taken in fubftance, or in a decoaion or infufion, as is moft agreeable. For a child, ten, fifteen, or twenty grains, recording to the age of the patient, may be given three or four times a-day. For an adult, half a drachm or two fcruples will be proper. Some give the^extraa cf the bark with cantha- rides ; but to manage this, requires c confiderable attention. It is more fafe to give a few grains cf caftcr along with the bark. A child of fix or feven yesrs of age, may take feven or eight grains of caftor, with fifteen grains of powdered b.irk, for a dofe. This may be made into a mixture with two or three ounces of any fim- ple diftilled water, and a little fyrup, and taken three or four times a-day. CHAPTER XXXII. Inflammation of the Stomach, and other Vifcera. ALL inflammations of the bowels are dangerous, and require the moft fpeedy affiftance ; as they frequently end in a fup- puration, and fometimes in a mortification, which is certain death. C.VUSES.----An inflammation of the ftcrnach may "proceed from any of the caufes which produce an inflammatory'fever ; as cold liquor drank while the body is warm, obftruaed perfpiration, or the fudden ftriking in of any eruption. It may likewife proceed from the acrimony of the bile, or from acrid and flimulating fub- ftances taken into the ftomach ; as ftrong vomits or purges, cor- rofive poifons, and fuch-like. When the gout has been repelled from the extremities, either by cold or improper applications, it often occafions an inflammation of the ftomach. Hard or indigef- tible fubftances taken into the ftomach, as bones, the ftones of fruit, &c. may likewife have that effea. SYMP TOMS-----It is attended with a fixed pain and burning heat in the ftomach ; great reftleffnefs and anxiety ; a fmali, quick, hard pulfe ; vomiting, or, at leaft, a mufea and ficknefs ; exceffive 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 of 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 too cold'. When the patient vomits every thing he eats or c!rin:;% and is ex- tremely reitlefs, has a hiccup, with an intermitting pulfe, or fre- quent fainting fits, the danger is very great. REGIMEN-----All acrimonious, heating, and irritating food 214 INFLAMMATION OF THE STOMACH. and drink are carefully to be avoided. The weaknefs of the pati- ent 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 occafion fudden death. The inclination to vomit may likewife impofe on the attendants and make them think a vomit neceflary ; but that too is almoft certain death. The food muft be light, thin, cool, and eafy of digeftion. It muft be given in fmall quantities* and fliould neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light roafted bread diffolved in boiling water, or very weak chicken-broth, are the moft proper. The drink fhould be clear whey, barley-water, water in which toafted bread has been boiled, or decoaions of emollient vegetables; as liquorice and marfh-mallow roots, far- faparilla, Sec. MEDICINE.----Bleeding in this difeafe is abfolutely 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 ope- ration feveral times, nor muft the low ftate of the pulfe deter us from doing fo. The pulfe, indeed, generally rifes upon bleeding, and as long as that is the cafe, the operation is fafe. Frequent fomentations with lukewarm water, or a decoaion 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 be fuffered to continue till they become quite cold, as either of thefe extremities 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. The warm bath, if it can be conveniently ufed, will be of great fervice. In this, and all other inflammations of the bowels, an epifpaftic, or blifter, applied over the part affeaed, is one of the beft reme- dies. I have often ufed it, and do not recollea one inftance where- in it did not give relief to the patient. The only internal medicines which we venture to rGcommend in this difeafe, are mild clyfters. Thefe may be made of warm water, or tkin water-gruel; and if the patient is costive, a little fweet-oil, honey, or manna, may be added. Clyfters anfwer the purpofe of an internal fomentation, while they keep the body open, and at the fame time nourifh the patient, who is often in this dif- eafe unable to retain any food upon his ftomach. For thefe rea- fons, they muft not be negleaed, as the patient's life may depend on them. C »>5 ] Inflammation of the Intcflines. THIS is one of the moft painful and dangerous difeafes thai mankind ar^ liable to. It generally proceeds from the fame caufes as the inflammation of the ftomach ; alfo, from coftivenefs, worms, eating unripe fruits, or jureat quantities of nuts, drinking hard windy malt liquors, as Halfbottled beer or ale, four wines,' cyder, &c. It may likewife be occafioned by a rupture, by fchir- rous tumours of the intestines, or by their oppofite fides growing together. The inflammation of the intestines is denominated Iliac Paffion, Enteritis, &c. according to the name of the parts affeaed. The treatment is nearly the fame whatever part of the inteftinal canal be the feat of the difeafe; we fhall therefore omit thefe diftinc- tions, left they fhould perplex the reader. The fymptom; here are nearly the fame as in the foregoing dif- eafe ; only the pain, if poffible, is more acute, and is fituated low- er. The vomiting is likewife more violent, and fometimes even the excrements, together with the clyfters and fuppofitories, are dif- charged by the mouth. The patient is continually belching up wind, and has often an obfbruaion of his urine. While the pain fhifts, and the vomiting only returns at certain intervals, and while the clyfters pafs downwards, there is ground to hope ; but when the clyfters andy^^j- are vomited, and the pa- tient is exceeding weak, with a low, fluttering pulfe, a pale coun- tenance, and a difagreeable or stinking breath, there is great rea- fon to fear that the confequences will prove fatal. Clammy fweats, black foetid ftools, with a fmall intermitting pulfe, and a total ceffation of pain, are figns of a mortification already begun, and of approaching death. REGIMEN.----The regimen is in general the fame as in an inflammation of the ftomach. The patient muft be kept quiet, avoiding cold, and all violent paffions of the mind. His food ought to be very light, and given in fmall quantities ; his drink weak and diluting ; as clear whey, barley-water, and fuch-like. MEDICINE.----Bleeding in this, as well as in the inflamma- tion of the ftomach, is of the greateft importance. It fliould be performed as foon as the fymptoms appear, and muft be repeated according to the ftrength of the patient, and the violence of the difeafe. A blifter is likewife to be applied immediately over the part where the moft violent pain is. This not only relieves the pain of the bowels, but even clyfters and purgative medicines, which be- fore had no effea, will operate when the blifter begins to rife. Fomentations and laxative clyfters are by no means to be omit- ted. The patient's feet and legs fhould frequently be bathed in warm water; and cloths dipped in it applied to his belly. Blad- * ii6 INFLAMMATION OF THE INTESTINES. ders filled wich 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 with fait, and foftened with fweet oil or frefh butter. Th-ffe may be adminiftered every two or three hours, or oftener, if the patient continues coftive. If the difeafe does not yield to clyfters and fomentations, re- courfe muft be had to pretty strong purgatives ; but as thefe, by irritating the bowels, often increafe their contraaion, and by that means, fiuftrate their own intention, it will be neceffary to join them with opiates, which, by allaying the pain, and relaxing the fpafmodic contraaions of the guts, greatly affift the operation of purgatives. What anfwers the purpofe of opening the body 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 a teacupful of it taken 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 peppermint or fimple cinnamon-water, to ap- peafe the irritation, and prevent the vomiting, Sec. Acids have often a very happy efffel in (laying the vomiting, and a.'peafing 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; or, when thefe cannot be obtained, with vinegar. But it often happens that no liquid whatever will flay 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 drachm, 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. 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 fainting, and if one immerfion has not the defired effea, 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 neceflary to repeat it feveral times before it has the de- fired effea. It has Tometimes happened, after all other means of procuring a ftool had been tried to no purpofe, that this v/as brought about by immerfing the patient's lower extremities in cold water, or making him walk upon a wet pavement, and dafhing his legs and thighs, with cold water. This method, when others fail, at leaft OF THE COLIC. 217 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 quickfilver. This may be given to the quantity of feveral ounces, or even a pound, but mould not exceed that*. When there is reafon to fufpea a mor- tification of the guts, this ihedicine ought not to be tried. In that cafe, it cannot cure the patient, and will only haften his death. But when the obftruaioh 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 intestinal canal. If the difeafc proceeds from a rupture, the patient muft be laid with his head very low, and the intestines returned by gentle pref- fure with the hand. If this, with fomentations and clyfters, fhould 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. Some who have died of it, have had feveral pounds of hard dry faeces taken out of their guts. They fliould likewife beware of eating too freely of four or unripe fruits, or drinking ftale windy liquors, Sec. I have known it brought on by living too much on baked fruits, which aie feldom good. It likewife proceeds frequently from cold caught by wet clothes, Sec. but efpecially from wet feet. Of the Colic. THE colic has a great refemblance to the two preceding dif- eafes, both in its fymptoms and method of cure. It is generally attended with coftivenefs and acute pain of the bowels; and re- quires diluting diet, evacuations, fomentations, Sec. Colics are varioufly denominated according to their caufes, as the flatulent, the bilious, the hyfteric, the nervous, Sec. As each of thefe require a particular method of treatment, we fhall point out their moft general fymptoms, and the means to be ufed for their relief. The flatulent, or wind-colic, is generally occafioned by an indif- creet ufe of unripe fruits, meats of hard digeftion, windy vegeta- bles, fermenting liquors, and fuch like. It may likewife proceed from an obftruaed perfpiration, or catching cold., Delicate people, whofe digeflive powers are weak, are moft liable tothiskindofcolic. *■ When quickfilver is given in too large quantities, it defeats it: own intention, as it pulls down the bottom of the ftomach, which pre- vents it getting over the pylorus. In this cafe,the patient fliould be hung up by the heels, in Order that the quickfilver may be difcha<-:H by hi* ill Oil til. E 2 21S OF THE COLIC. The flatulent colic may either affea the ftomach or inteftines. It is attended with a painful ftretching of the affeaed part. The patient feels a rumbling in his guts, and is generally relieved by a difcharge of wind, either upwards or downward ;. The pain is fel- dom 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 fliould likewife fit with his feet upon a warm hearth flone, or apply warm bricks to them ; and warm cloths may be , applied to his ftomach and bowels. This is the only colic 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 beginning, before any fymptoms of inflammation appear. We have reafonto believe, that a.colic, occafioned by wind or flatulent food, might always be cur- edby fpirits and warm liquors, if taken immediately upon per- Geiving the firft uneafinefs; but when the pain has continued for a confiderable time, and there is reafon to fear an inflammation of the bowels 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 in- flammation of the inteftines. Several kinds of food, as honey, eggs, Sec. '-occafion colics in fome particular conftitutions. I have generally found the beft me- thod of cure for thefe was, to drink plentifully of fmall diluting liquors, as water-gruel, fmall poffet, water with toafted bread foaked in it, &c. Colics which proceed from excefs and indigeftion, generally cure themfelves, by occafioning vomiting or purging. Thefe dif- charges are not to be'flopped, but promoted by drinking plenti- fully of warm water, or weak poffet. When their violence is over, the patient may take a dofe of falts or caftor-oil, to carry off the dregs of his debauch. Colics occafioned by wet feer., or catching cold, may generally be remeffed at the beginning, by bathing the feet and legs in warm water, and drinking fuch warm diluting liquors as will promote the perfpiration, as weak wine-whey, or water-gruel, with a fmall quantity of fpirits in it. Thofe flatulent colics, which prevail fo much among country people, might generally be prevented, were they to change their clothes when they get wet. They ought likewife to take a dram, * Thefe generally afford relief, but the greateft difadvantage attend- ing this practice is, that the patient is apt to become intoxicated, and liable to ilide into the practice of frequent inebriation. On this acount, a dofe of laudanum may be fubftituted, which is not quite fo fafcinatinj to the palate; as for the patient lo wifh a repetition, without an abfolute •eedfity. (I. C.) | OF THE COLIC. 219 or drink fome warm liquor after eating any kind of green trafh. We do not recommend dram-drinking, but in this cafe, fpirits prove a real medicine, and the beft that can be adminiftered. ^ A glafs of good pepper-mint water will have nearly the fame effea as a glafs of brandy, and, in fome cafes, is rather to be preferred. The bilious colic is attended with very acute pains about the re- gion of the navel. The patient complains of great thirft, and is ge- nerally 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 distemper ad- vances, the propeniity to vomit fometimes increafes, fo as to be- come almoft continual, and the proper motion of the inteftines is fo far perverted, that there are all the fymptoms of an impending iliac paffion. If the patient be young and ftrong, and the pulfe full and fre*- quent, it will be proper to bleed. Alter which give forty drops of laudanum,which fhould be repeated in an half hourif the pain does not abate. The bowels muft be kept open with caftor-oil or clyf- ters. 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 decoaion of tamarinds, are likewife very proper, or any other thin, acid, opening liquor. Befides bleeding and plentiful dilution, it will be neceffary to foment the belly with cloths dipped in warm water; and if this fliould not fucceed, the patient muft be immerfed up to the breaft in warm water. In the bilicus colic, the vomiting is often very difficult to re- ftrain. When this happens, the patient may drink a decoaion of toafted bread, or an infufion of garden-mint in boiling water. Should thefe not have the defired effea, the faline draught, with a few drops of laudanum in it, may be given, and repeated ac- cording to the urgency of the fymptoms. A fmall quantity of Ve- nice treacle may be fpread in form of a cataplafm, and applied to the pit of *he ftomach. Clyfters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewife be frequently ad- miniftered. Such as are liable to frequent returns of the bilious colic fhould ufe flefh fparingly, and live chiefly upon a light vegetable diet, They fliould take frequently a dole of cream of tartar with tama- rinds, or any other cool acid purge. The hyfteric colic bears a great refemblance to the biiious. It is attended with acute pains about the region of the ftomach, vomit- ing, &c. But what the patient vomits, in this cafe, is commonly of a greenifti colour. 'I here is a great finking of the fpirits, with de- jeaiou of mind and difficulty of breathing, which are the charac- teriftic fymptoms of this diforder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in, a few days. 220 OF THE COLIC. £:o. do hurt. Every thing that weakens the patient, or finks the fpirits, is to be avoided. If the vomiting fhould prove violent, luke- warm water, or fmall poffet, may be drank to cleanfe the ftomach. Afterwards the patient may take fifteen, twenty, or twenty-live 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 eve- ry fix hours, and drink a cup of penny-royal tea after them. If afafcetida fhould prove difagreeable, which is fometimes the cafe, a tea-fpoonful of the tinaure of caftor in a cup of penny-royal tea, or thirty or forty drops of the balfam of Peru, dropped upon a bit of Ioaf-fugar, maybe taken in its flead. The anti-hyfteric plaifter may alfo be ufed, which has often a good effea *. The nervous colic prevails among miners, fmelters of lead, plumbers, the manufaaurers of white lead, &c. It is very com- mon in the cyder counties of England, and is fuppofed to be oc- cafioned by the leaden veffels ufed in preparing that liquor. In the Weft-Indies it is termed the dry belly-ach. No difeafe of the bowels is more excruciating than this. Nor is it foon at an end. I have known it continue eight or ten days with very little intermiffion, the body all the while continuing bound in Tpite of medicine, yet at length yield, and the patient recoverf. It generally leaves the patient weak, and often ends in a palfy. The general treatment of this difeafe is nearly the fame with that of the iliac paffion, or inflammation of the guts. The body is to be opened by mild purgatives given in fmall dofes, and fre- quently repeated, and their opeiation muft be affifted by foft oily clyfters, fomentations, &c. Caftor-oil is reckoned peculiarly pro- per in this difeafe. It may both be mixed with the clyfters and given by the mouth. Barbadoes tar is faid ta be an efficacious medicine in this com- plaint. It may be taken to the quantity of two drachms three times a day, or oftener if the ftomach will bear it. Tlfts tar, mixed with an equal quantity of ftrong rum, is likewife proper for rubbing the fpinc, in cafe any tingling, or other fymptoms of a palfy are 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 difeafe, he muft take exercife.' on horfeback, and ufe an infufion of the bark in wine. When the difeafe ends in a palfy, the bath-waters are ex- tremely proper. To avoid this kind cf colic, people muft fhun all four iruits, 4 * See Appendix, Anti-hyftcric plaifter. | As the fmoke of tobneco thrown into the bowels wiil often procure, a Uool, when all other means have failed, an apparatus for this purpofe i»ught to be kept l>y every furgVon. INFLAMMATION OF THE KIDNEYS. 221 adds, auftere liquors, Sec. Thofe who work in lead ought never to goto their bufinefs fafting, and their food fhould be oily or fat. They may take a glafs of fallad 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 Ihoulcl frequently go a little out of the tainted air ; and fhould ne- ver fuffer themfelves to be costive. In the Weft-Indies, and on the coaft of Guinea, it has been found of great ufe, for preventing this colic, to wear a piece of flannel round the waift, and to drink an infufion of ginger by way of tea. Sundry other kinds of this difeafe might be mentioned, but too many diftinaions perplex the reader. Thofe already mentioned are the moft material, and fhould be attended to, as their treatment is very different. But even perlons who are not in a condition to dif- tinguifh very accurately in thefe matters, may be of fervice to pa- tients in colics of every kind, by only obferving the following general rules, viz. To bathe the feet and legs in warm water ; to apply bladders filled with warm water,or cloths dipped in it, to the ftomach and bowels ; to make the patient drink freely of diluting mucilaginous liquors ; and to give him an emollient clyfter every two or three hours. Should thefe not fucceed, the patient ought t:< be immerfed in warm water. Inflammation of the Kidneys. CAUSES.----This difeafe may proceed from any of thofe Caufes which produce an inflammatory fever. It may likewife be occafioned by wounds or bruifes of trie kidneys ; fmall flones or gravel lodging within them ; by ftrong diuretic medicines ; as fpirits of turpentine, tinaure of cantharides, &c. Violent motion, as hard riding or walking, efpecially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occafion this malady. It may proceed from lying too foft, too much on the back, involuntary contraaions, or fpafms, in the urinary veffels, &c. SYMPTOMS.----There is a fharp pain about the region of the kidneys, with fome degree of fever, and a ftupor or dull pain in the thigh of the affeaed fide. The urine is at firft clear, and afterwards of a reddifh colour ; but in the worft kind of the dif- eafe, it generally continues pale, is paffed with difficulty, and com- monly in fmall quantities at a time. The patient feels great un- eafinefs when he endeavours to walk or fit upright. He lies with moft eafe on the affeaed fide, and has generally a naufea or vomi- ting, refembling tha, the bleeding piles in men, or the menfes in women, &c. It may likewife proceed from a polypus, fchirrous concretions, or any thing that obftruas the circulation of the blood in the lungs. It is often the effea of a long and violent cough ; in which cafe, it I is generally the forerunner of a confumption. A violent degree of 1 cold fuddenly applied to the external parts of the body, will occa- \ Con an hemoptoe. It may likewife be occafioned by breathing air which is too much rnrified to be able properly to expand the lungs. This is often the cafe with thofe who work in hot places, as fur* SPITTING OF BLOOD. 245 naces, glafs-houfes, or the like. It is likewife faid to happen to fuch as afcend to the top of very high mountains, as the Peak of Teneriffe, &c. Spitting of blood is not always a primary difeafe. It is often only a fymptom, and in fome difeafes not an unfavourable one. This is the cafe in pleurifies, peripneumonies, and fundry other fevers. In a dropfy, fcurvy, or confumption, it is a bad fymptom, and fhows that the lungs 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, coldnefs of the extremities, coftivenefs, great laffitude, flatulence, pain of the back and loins, &c. As thefe fhow a general ftriaure upon the veffels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious difcharge. The above fymptoms do not attend a dif- charge of blood from the gums or fauces, by which means thefe may always be diftinguifhed from an hemoptoe. Sometimes the blood that is fpit up is thin, and of a florid red colour ; and at other times it is thick, and of a dark or blackifh colour; nothing can be inferred from this circumstance, but that the blood has lain a longer or fhorter time in the breaft before it was difcharged. Spitting of blood, in a ftrong, healthy perfon, of a found con- ftitution, is not very dangerous; but when it attacks the'tender and delicate, or perfons of a weak lax fibre, it is with difficulty re- moved. When it proceeds from a fchirrus of the lungs, it is bad. The danger is greater when the difcharge proceeds from the rup- ture of a large veffel than of a fmall one. When the extravafated blood is not fpit up, but lodges in the breaft, it corrupts, and great- ly increafes the danger. When the blood proceeds from an ulcer in the lungs, it is generally fatal. REGIMEN.----1 he patient ought to be kept cool and eafy. Every thing that heats the body or quickens the circulation, in- creafes the danger. The mind cught likewife to be foothed, and every occafion of exciting the paffions avoided. The diet fhould be foft, cooling, and flender; as rice boiled with milk, fmall broths, barley-gruels, panado, &c. The diet, in this cafe, can fcarce be too low. Even water-gruel is fufficient to fupport the patient for fome days. All ftrong liquors muft be avoided, i he patient may drink milk and water, barley-water, whey, but- ter-milk, arid fuch-like. Every thing fhould be drank cold, and in fmall quantities at a time. He fliould obferve the ftriaeft filence, or at leaft fpeak with a very low voice. MEDICINE_____This, like the other involuntary difcharges of blood, ought not to be fuddenly flopped 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, 246 VOMITING OF BLOOD. and even endanger his life ; In which cafe, proper means muft be uftu for restraining it. The body fliould be kept gently open by laxative diet ; as roaf- ted apples, ftewed prunes, and fuch-like. If thefe fliould not have th • defired effea, a tea-fpoonful of the lenitive eleauary may be takef mice or thrice a-day, as is found neceflary. If the bleeding pvnv<-\violent, ligatures maybe applied to the extremities, as di- rt -r; j fo. .. bleeding at the nofe. If the patient behot or feverifh, bleeding and fmall dofes of nitre will be of ufe ; a fcruple or half a drachm of nitre may be taken in a cup of his ordinary drink, twice or thrice a-day. His drink may be fliarpened with acids, as juice of lemon, or a few drops of the ipirit of vitriol; or he may take frequently a cup of the tinc- ture of rofes. Bathing the feet and legs in lukewarm water, has a very good effea in this difeafe. Opiates are fometimes beneficial; but muft be adminiftered with caution. Ten or twelve drops of laudaiiqty > i may be given in a cup of barley-water twice a-day, and continu- ed for fome time, provided they be found beneficial. The conferve of rofes is a very good medicine in this cafe, if taken in fufficient quantity and long enough perfifted in. It may be taken to the quantity of three or four ounces a-day ; and, if the patient be troubled with a cough, it fhould be made into an elec- tuary with balfamic fyrup, and a little of the fyrup of poppies. If stronger astringents be neceflary, fifteen or twenty drops of fc the elixir of vitriol may be given in a, glafs of water, three or four times a-day. i Thofe who are fubjea to frequent returns of this difeafe, fhould' j ] avoid all excefs. - Their diet fhould be light and cool, confiding j chiefly of milk and vegetables. Above all, let them beware of vi- , i gorous efforts of the body, and violent agitations of the mind. : I Vomiting of Blood. THIS is not fo common as the other difcharges of blood alrea- dy mentioned; but it is very dangerous, and requires particular attention. Vomiting of blood is generally preceded by pain of 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 11 dangerous. It often proceeds from an obftruaion of the menfes Jj in women j and fometimes from the ftopping of the hemorrhoidal ■ flux in men. It may be occafioned by any thing that greatly ftimu- ™ lates or wounds the ftomach, as ftrong vomits or purges, acrid poifons, fharp or hard fubftances taken into the ftomach, &c. It if ; BLOODY URINE. «4> often the effea of obftruaions in the liver, the fpleen, or fome of the other vifcera,'or external violence, as blows or hruifes, or any of the caufes which produce inflammation. In hyfteric wo- men, vomiting of blood is a very common, but no dangerous fymp- tom. A great part of the danger in this difeafe arjfes from the ex- travafated blood lodging in the bowels, and becoming putrid, by which a dyfentery or malignant fever maybe occafioned. The beft way of preventing this, is co keep the body gently open, by fre- quently exhibiting emollient clyfters. Purges muft not be given till the difcharge is ftopt, otherwife they will irritate the ftomach, and increafe the diforder. All the food and drink muft be of a mild cooling nature, and taken in fmall quantities. Even drink- ing cold water has fometimes proved a remedy, but it will fucceed better when fharpened with the weak fpirits of vitriol *. When there are figns of an inflammation, bleeding may be neceffary j but the patient's weaknefs will feldom permit it. Opiates may be of ufe ; but they muft be given in very fmall dofes, as four or five drops of 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 neceffary. Of Bloody Urine. THIS is a difcharge of blood from the veffels of the kidneys or bladder, occafioned by their being either enlarged, broken, or eroded. It is more or lefs dangerous according to the different cir- cumftances which attend it. When pure blood is voided fuddenly without interruption 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 water. If the coats of the bladder are hurt by a ftone, and the 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 motin. It may alfo proceed from ulcers of the bladder, from altone * Clyfters of cold water, with forty or fifty drops of laudanum in each, fhould be injected, and tUllne'.s Hxuiiy enjoined. (T. C ) 248 THE DYSENTERY, lodged in the kidneys, or from violent purges, or fliarp diuretic medicines, efpecially cantharides. Bloody urine is always attended with fome degree of danger: but peculiarly fo when mixed with purulent matter* as this fhows an ulcer fome where in the urinary paffages. Sometimes this dif- charge proceeds from excefs of blood, in which cafe it is rather a falutary evacuation than a difeafe. If the difcharge however be very great, it may watte the patient's ftrength, and occafion an ill habit of body, a dropfy, or a consumption. 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 operation ; a defcription of which would be foreign to our purpofe. If attended with a plethora, and fymptoms of inflam- mation, bleeding will be neceffary. The body muft likewife be kept open by emollient clyfters, or cooling purgative medicines; as ci earn of tartar, manna, or fmall dofes of lenitives ekauary. When bloody urine occurs in malignant difeafes, as the fmall- pox, feveri^ or the like, the patient's life depends on the liberal ufe of the bark and acids, as already fhown. When there is reafon to fufpea an ulcer in the kidneys or blad- der, the patient's diet muft be cool, and his drink of a foft, heal- ing, balfamic quality, as decoaions of marfh-mallow roots with liquorice, folutions of gum-arabic, &c. Three ounces of marfh- malloMwroots, and half an ounce of.liquorice, may be boiled in two hnglifh quarts of water to one ; two ounces of gum-arabic 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 difeafe has often bad con- fequences. When the flux is flopped too foon, the grumous blood, confined in the veffels, may produce inflammations, abfcefs, and ulcers. If the caufe be urgent, or the patient feems to fuffer from the lofs of blood, gentle aftringents may be necefTary. In this cafe, the patient may take three or four ounces of lime-water, with half an ounce of the tinaure of bark, three times a-day, or more frequent if neceffary. '*' . Of the Dyfentcry, or Bloody Flux. THIS difeafe prevails in the faring and autumn, h is moft com- mon in marfhy countries, where, after hot and dry fummers, it is apt to become epidemic. Perfons are moft liable to it, who are much expofed to the night air, or who live in places where ihe air is confined and unwholefome. Hence, it often proves fa- ml in camps, on fhipbeferd, in gaols, hofpitals, and fueh-like places. OR BLOODY FLUX. 249 CAUSES_____The dyfentery may be occafioned by any thing that obftruas the perfpiration ; as damp beds, wet clothes, un- wholefome diet, air, Sec. But it is moft frequently communicated by infeaion. 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 communi- cate it. SYMPTOMS.----It is known by a flux of the belly, attended" with violent pain of the bowsls^ a conftant inclination to go to ftool, and generally more or lefs blood in the ftools. It begins, like other fevers, with chillnefs, lofs of ftrength, a quick pulfe, great thirft, and an inclination to vomit. The ftools are at firft greafy and frothy, afterwards they are streaked with blood, and at laft, have frequently the appearance of pure blood, mixed with fmall filaments refembling bits of fkin. Worms are fometimes paf- fed both upwards and downwards through the whole courfe of the difeafe. When the patient goes to ftool, he feels a bearing down, as if the whole bowels were falling out, and fometimes a part of the inteftine is aaually protruded, which proves* exceeding troublefome, efpecially in children. Flatulency isa troublefome fymptom, efpecially towards the end of the difeafe. This difeafe may be diftinguifhed from a diarrhoea or loofe- nefs, by the acute pain of the bowels, and the blood which ge- nerally appears in the ftools; and from the cholera morbus, by its not being attended with fuch violent and frequent fits of vomit- ing, &c. When the dyfentery attacks the old, the delicate, or fuch as have been wafted by the gout, the fcurvy, or other lingering dif- eafes, it generally proves fatal. Vomiting and hiccuping are bad figns, as they fhow an inflammation of the ftomach. When the ftools are green, bla-k, or have an exceeding difagreeable cadave- rous fmell, the danger is very great, as it fhows the difeafe to be of the putrid kind. It is an unfavourable fymptom when clyfters are immediately returned ; but -ftill more fo, when the paffage is fo obftinately fliut, that they cannot be injeaed. A feeble pulfe, coldnefs of the extremities, with difficulty of fwallowing, and con- vulfions, are figns of approaching death. REGIMEN.:----Cleanlinefs contributes greatly to the reco- very of the patient, and the fafety of fuch as attend him. In all contagious difeafes, the danger is increafed, and the infeaion fpread, by the neglea of cleanlinefs ; but in no one,more than this. Every thing about the patient fliould be frequently changed. The excrements fliould never be fuffered to continue in his cham- ber, but removed immediately, and buried under ground. A con- ftant ftream of frefh air fhould be admitted into the chamber ; and it ought frequently to be fprinkled with vinegar, juice of lemon, or fome other ftrong acid. The patient muft not be difcournged, but his fpirits kept up in I 2 25° THE DYSENTERY, hopes of a cure. Nothing tends more to render any difeafe mor- tal, than the fears and apprehensions of the fick. All difeafes of this nature have a tendency to fink and deprefs the fpirits, and when that is increafed by fears and alarms, from thofe whom the pa- tient believestto be perfons of fkill, it cannot fail to have the worft effeas. A flannel waiftcoat worn next the fkin has often a very good effea in the dyfentery. This promotes the perfpiration without over-heating the body. Great caution is neceffiry in leaving it off. I have often known a dyfentery brought on by imprudently throw- ing off a flannel waiftcoat before the feafon was fufficiently warm. For whatever purpofe this piece of drefs is worn, it fhould never be left off but in a warm feafon. In this difeafe, the greatest attention muft be paid to the pa- £ dent's diet. Flefli, fifh, and every thing that has a tendency to turn putrid or rancid on the ftomach, muft be abftained from. Apples boiled in milk, water-pap, and plain, light pudding, with broth made of the gelatinous parts of animal?., may conftitute the prin- cipal part of the patient's food. Gelatinous broth not only anfwers the purpofe of food, but likewife cf medicine. I have often known dyfenteries, which were not of a putrid nature, cured by it after pompous medicines had proved ineffeaual*. Another kind of food very proper in the dyfentery, which may be ufed by fuch as cannot take the broth mentioned 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 or- dinary foodf. *■ The manner of making this broth is, to take a sheep's-head and feet, with the fkin upon them, and to burn the wool off with a hot iron ; afterwards to boil them till the broth is quite a jelly. A little cinna- mon or mace may be added, to give the broth an agreeable flavour, and the patient may take a little of it warm with toafted bread, three or four times a-day. A clyfter of it may likewife be given twice a-day. Such as cannot ufe the broth made in this way, may have the head and feet fkinned ; but we have reafon to believe, that this hurts the medi- cine. It is not our bufinefs here to reafon upon the nature and qualities of medicine, otherwise this might be fhown to poffefs virtues every way fuited to the cure of a djfcntery which does not proceed from a putrid ftate of the humours. Whole families have often been cured by it, af- ter they had ufed many other medicines in vain. It will, however, be proper that the patient take a vomit, and a dofe or two of rhubarb, before he begins to ufc the broth. It will likewife be neceffary to con- tinue the ufe of it for a confiderable time, and to make it the principal food. _ t The learned and humane Dr. Rutherford, late profeffor of medi- cine m the univerfity of Edinburgh, ufed to mention this food in hi« pupiic lecture with great encomiums. He direaed it to be made by tying a pjn::d or two of the finest flour, as tight as poflible, in a linen OR BLOODY FLUX. 251 In dyfentery, the patient may be allowed to eat freely of moft kinds of ripe fruit; as apples, grapes, goofeberries, currant-ber- ries, strawberries, Sec. Thefe may either be eaten raw or boiled, with or without milk, as the patient choofes. The prejudice againft fruit in this difeafe, is fo great, that many believe it to be the common caufe of dyfenterics. This is an egregious miftake. Both reafon and experience fhow, that good fruit is one of the beft medicines, both for the prevention and cure of the dyfentery. Good fruit is in every refpe£t calculated to counteraa that ten- dency to putrefaaion, from whence the moft dangerous kind of dyfentery proceeds. The patient, in fuch a cafe, ought to be al- lowed to eat as much fruit as he pleafes, provided, it be ripe*. The moft proper drink in this diforder, is whey or flaxfeedtea. 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 fharpened with cream of tartar mav 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 has been frequently quenched, are all very proper, and may be drank in turns. Camomile-tea, if the ftomach will bear it, is an exceeding proper drink. It both" strength- ens the ftomach, and by its antifeptic quality, tends to.rjrevent a mortification of the bowels. MEDICINE.----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 camo- mile tea. Strong vomits are feldom neceflary here. A fcruple, or at moft, half a drachm of ipecacuanha^is generally fufficient for an adult, and fometimes- a few grains will fuffice. The day after the rag, afterwards to dip it frequently in water, and to dridge theoutfide with flour, till a cake or cmft was formed around it, which prevents the water from foaking into it while boiling. It is then to be boiled till it becomes a hard, dry mafs, as directed above. This, when mixed with milk and water, will not only anfwer the purpofe of food, but may likewife be given in clyfters. * 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 difappointments from me- dicine, and reduced 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 fundry medicines here with no befjer fuccefs than abroad, 1 advifed him to leave off the ufe of drugs, and to truft entirely to a diet of milk and fruits, with gentle exercife. Strawberries was the only fruit he could procure at that feafon. Thefe he ate with milk twice, and fometimes thrice a-day. The confequence was, that in a fliort tim • his {tools were reduced from upwards of twenty in a-day, to three or four, and fometimes not fo many. He ufed the other fruits a; they came in, and was in a few weeks fo well as to leave that part •f the country where I was, with a view to return to America. 252 THE DYSENTERY, &c. vomit, half a drachm, or two fcruples of rhubarb muft be taken ; or, what will anfwer the purpofe rather better, an ounce or an ounce and a half of Epfom falts. This dofe may be repeated every other day, for two or three times. Afterwards fmall dofes of ipe- cacuanha maybe taken for fome time. Two or three grains of the powder may be mixed in a table-fpoonful of the fyrup of poppies, and taken three times a-day. Thefe evacuations, and the regimen prefcribed above, will of- ten be fufficient to effea a cure. Should it, however, happen other- wife, the following aftringent medicines may be ufed. A clyfter of flarch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be adminifterd twice a-day. At the fame time an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be diffolved in an Englifli pint of barley- water, over a flow fire, and a table-fpoonful of it taken every hour.* If thefe have not the defired effea, the patient may take four times a day, about the bulk of a nutmeg of the Japonic confeclion, drinking after it a tea-cupful of the decoaion of logwoodf. Perfons who have been cured of this difeafe are very liable to a relapfe; to prevent which, great circumfpeaion as to 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 fhould likewife abftain from animal food, ss fifh and flefh, and live principally on milk and vegetables. Gentle, exercife and wholefome air are likewife of importance. The patient'fhould go to the country as foon as his ftrength will permit, and take exercife daily on horfeback, or in a carriage. He may likewife ufe bitters 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 ftria atten- tion to cleanlinefs, a fpare ufe of animal food, the free ufe of found ripe fruits and other vegetables. The ni^ht air is to be carefully * The indicitinns of cure in this difeafe are more effectually anfwer- ed, by giving a drachm of Glauber falts every hour, C0 as to'clear the bo weis of hardened excrement, by exciting brjfk purging. This plan fliould be continued until the griping and tenelmus fubfide, interpofing every right at bed-time one or two grains of opium, combined with two or three of ipecacuanh-i to quiet the bowels and promote perfpiration. If the patient cannot take falts, one table fpoonful of caftor oil (hould be given, and repeated.every two c,r three hours, until it produces the defired effert of rendering the ftools more copious; and after they ap- pear in lumps or balls, the cure muft be followed up, by giving ihfution of bark, as frequent and in as I:irFe dofes as the ltomach will bear. 1 1m practice i< equally applicable to children, by accommodating the •dofes oi medicin to their age- (I. C.) j- See Appendix, DecoJlion of Logwoed. THE HEAD-ACH. 2^3 ■"* a avoided, and all communication with the fick. Bad fmells are to be fhunned, efpecially thofe which arife from putrid animal fub- ftances. The neceffaries where the Tick go fhould be carefully avoided by thofe in health. Sundry other fluxes of the belly, as the LIENTERY and CGZ- LIAC PASSION, though lefs dangerous than the dyfentery, yet merit confideration. Thefe difeafes generally proceed from a re- laxed ftate of the ftomach and inteftines, which is fometimes fo great, that the food pafles through them without almoft any fen- fible alteration; and the patient dies merely from the want of nourifhment. When the lientery or cceliac paffion fucceeds to a dyfentery, the cafe is bad. 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 different 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 cleanfing the ftomach and bowels with gentle vomits and purges ; afterwards, fuch diet as has a tendency1 to heal and strengthen the bowels, with opiates and aftringent medi- cines, will generally perfea the cure. The fame obfervation holds with refpea to a TENESMUS, or frequent defire of going to ftool. This difeafe refembles the dy- fentery fo much, both in its fymptoms and method of cure, that we think it needlefs to infift upon it. CHAPTER XXXVI. Of the Head-Ach. AC II S and pains proceed from very different caufes, and may affea any part of the body ; but we fhall point out thofe only which occur moft frequently, and are attended with the greateft danger. When the head-ach is flight, and affeas a particular part of the head only, it is called cephalalgia ; when the whole head is affeaed, cephalaa; and when on one fide only, hemicrania. A fixed, pain in the forehead, which may be covered with the end of the thumb, is called the clavis hyflericus. There are alfo other diftinaions. Sometimes the pain is inter- nal, 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 afleaed. When from a cold £54 THE HEAD-ACH. phlegmatic habit, the patient complains of a dull heavy pain, and has a fenfe of coldnefs in the part. This kind of head-ach is fometimes attended 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 fuppreffion of cuflomary evacuations; as bleeding at the nofe; fweating of the feet, &c. It may likewife proceed from any caufe that determines a great flux of blood to- wards the head ; as coldnefs of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will occafion a head-ach ; as looking long obliquely at any objea, wearing any thing tight about the neck, or the like. When a head-ach proceeds from the ftoppage of a running at the nofe, there is a heavy, obtufe, preffing pain in the fore-part of the head, in which there feems to be fuch a weight, that the pa- tient can fcarce hold it up. When it is occafioned by the cauftic matter of the veneral difeafe, it generally affeas the fkull, and of- ten produces a caries of the bones. Sometimes the head-ach proceeds from the repulsion or retro- eeffion of the gout, the eryfipelas, the fmall pox, meafles, itch, or other,eruptive difeafes. What is called a hemicrania generally proceeds from crudities or indigeftion. Inanition, or emptinefs, will alfo occafion head-achs, as in nurfes who gave fuck too long, or who did not take a fufficient quantity of folid food. There is likewife a moft violent, fixed, conftant, and almoft in- tolerable head-ach, which occafions great debility both of body and mind, prevents fleep, deftroys the appetite, caufes a vertirot dimnefs of fight, a noife in the ears, convulfions, epileptic fits, and fometimes vomiting, coftivenefs, coldnefs of the extremities, &c. The head-ach is often fymptomatic in continual and intermit- ting fevers, efpecially quartans. It is likewife a very common fymptom in hyfteric and hypochondriac complaints. 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 difeafc continues long, and is very violent, it often ■terminates in blindnefs, an apoplexy, deafnefs, a vertigo, the palfy, epilepfy, &c. The cool rcgimm in general is to be obferved. The diet ought to confift of fuch emollient fubftances as will correa the acrimo- ny of the humours, and keep the body open ; as apples boiled in milk, fpinage, turnips, and fuch-like. The drink ought to be di- luting ; as barley-water, infufions of mild mucilaginous vegeta- bles, decoaions of the fudoiifc woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm wa»< ter ; the head fhould be fhaved, and bathed with water and vine- THE HEAD-ACH. <53 gar. The patient ought as much as poffible to keep in an ere&.. pofture, and not to lie with his head too low. When the head-ach is owing to exceTs of blood, or a bilious conftitution, bleeding is neceffary. The patient may be bled in the jugular vein, and the operation repeated if there be occafion. Cupping alfo, or the application of leeches to the temples, and behind the ears, will be of fervice. Afterwards a blifter may be applied 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, iffues or perpetual blifters will be of fervice. The body ought likewife to be kept open by gentle laxatives. But when there is a dull, heavy, continual pain in the head, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are neceffary, as pills made of aloes, refin of jalap, or the like. It will alfo be neceffary 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 the ftoppage of a running at the nOfe, the patient fhculd frequently fmell to a bottle of volatile falts; he may likewife take fnuff, or any thing that will irritate the nofe, fo as to promote a difcharge from it; as the herb maftich, ground-ivy, &c. A hemicrania, efpecially a periodical one, is generally owing to a foulnefs of the ftomach, for which gentle vomits muft be adminiftered, as alfo purges of Glauber falts or jalap. After the bowels have been fufficiently cleared, chalybeate waters, and fuch bitters as strengthen the ftomach, will be neceffary. When the head-ach is To intolerable as to endanger the pa- tient's life, or is attended with continual watching, delirium, &c. recourfe muft be had to opiates. Thefe, after proper evacua- tions by clyfters or mild purgatives, may be applied both exter- nally 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 penny-royal 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 luke-warm 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 affeain'g the head. • When the pain is very violent, and does not yield to final! dofes of laudanum, the quantity may be increafed. I have known a patient v\ extreme pain take three hundred drops in twenty-four hours; but fuel* djfcs ought only to be adminiftered by pcrioru of Hull. 25ct THE TOOTH-ACH. When the head-ach is occafioned by great heat, hard labour, or violent exercife of any kind, it may be allayed by cooling me- dicines ; as the faline draughts with nitre, and the like. A little of Ward's effence, dropt into the palm of the hand, and applied to the forehead, will fometimes remove a violent head- ach ; and fo will aether, when applied in the fame manner. Of the Tooth- Ach. THIS difeafe needs no defcription. 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, from negleaing fome part of the ufual coverings of the head ; or from fitting with the head bare near an open window, or expofing it any how to a draught of celd air.. Food or drink.taken either too hot or too cold is very hurtful to the teeth. . Great quantities of fugar, or other fweet- mra.s, are likewife hurtful. Nothing is more deftruaive to the t. h than cracking nuts, or chewing any kind of hard fubftances. P.eking the teeth with pins, needles, or any thing that may hurt t!•••-• enamtd with which they are covered, does great mifchief, as the "ooth is fure to be fpoiled whenever the air gets into it. T et ding women are very fubjea to the tooth-ach, efpecially dur- ing the firft three or four months of pregnancy. The tooth-ach oiten proceeds from fcorbutic humours affeaing the 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 endeavour to , leffen the flux of humours to the part affeaed. This may be done j\ by mild purgatives, Tcarifying the gums, or applying leeches to them, and bathing the feet frequently with 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 Teldom fafe to adminifter opiates, or any kind of heating medicines, or even to draw a tooth, till proper evacu- ations have been premifed ; and thefe alone will often effea the cure. If this fails, and the pain and inflammation ftill increafe, a fup- puration maybe expeaed ; to promote which, a toafted fig fhould be held between the gum and the cheek ; bags filled with boiled camomile flowers, flowers of elder, or the like, may be applied near the part affeaed, with as great a degree of warmth as the patient can bear, and renewed as th,ey j^row cool: the patient • THE TOOTH-ACM. 25f 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, &c. Such things as promote the difcharge of faliva, or caufe the patient to fpit, are generally of fervice. For this purpofe, bitter; hot, or pungent vegetables may be chewed ; as gentian, calamus aromaticus, or pellitory of Spain. Allen recommends the root of yellow water flour-de-luce in this cafe. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes fay* he hardly ever knew it fail to eafe the tooth-ach. It ought how- ever to be ufed with caution. Many other herbs, roots and feeds, are recommended for cur- ing the tooth-ach; as the leaves or roots of millefoil or yarrow chewed, tobacco fmoked or chewed, ftaves acre, or the feeds of muftard chewed, &c. i hefe bitter, hot, and pungent thiigs, by occafioning a greater flow offaliva, frequently give eafe in the tooth-ach. Opiates often relieve the tdoth-ach. For this purpofe, a little cotton wet with laudanum may be held between the teeth ; or a piece of flicking-plaifter, about the bignefs of a fhilling, with a bic of opium in the middle of it, of a fize not to prevent the flicking of the other, may be laid on the temporal artery, where the pulfation is moft fenfible. De la Motte affirms, that there are few cafes wherein this will not give relief. If there be a hol- low tooth, a fmall pill made of equal parts of camphire and opi- um, 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 ex- ternal air. Few applications give more relief in the tooth-ach than a blifter applied between the fhoulders; or rather put behind the ears, and made fo large as to cover a great part of the lower jaw. When a tooth is carious, it is often impoffible to remove the pain without extraaing it; and, as a fpoilt tooth never becomes found again, it is prudent to draw it foon, left it fhould affea the reft. Tooth-drawing, like bleeding, is very much praaifed by mechanics ; the operation is not without danger, and ought al- ways to be performed with care. A perfon unacquainted with the ftruaure of the parts will be in danger of hurting the jaw- bone, or of drawing a found tooth inftead of a rotten one*. When the tooth-ach returns periodieally, and the pain chiefly affeas the gums, it may be cured by the bark. *' Some pretend to have found great benefit from the application ot an artificial magnet. If it be found to anfwer, though only in particular cafes, it certainly deferves a trial, as it is attended with t Jrh1,!!!^1"37 aI-W3yS r e Prevented by the operator ftriking upon the carious tooth7 FeCe °f meUK " thiS nCVer faUs C° excite ^ in ** K 2 a58 THE EAR-ACH. no expence, and no harm. Elearicity has likewife been recorn- mended, and particular inftruments have been invented for fend- ing a fhock through the affeaed tooth. Perfons who have returns of the tooth-ach at certain" feafons, as fpring and autumn, might often prevent it by taking a purge at thefe times. Keeping the teeth clean tends to prevent the tooth-ach. The beft method is to wafh them daily with fait and water, a decoaion of the bark, or with cold water alone. All brufliing and fcrap- ing of the teeth is dangerous, and unlefs it be performed with great care, does mifchief. Of the Ear-Ach. THIS diforder chiefly affeas the membrane which lines the in- ner cavity o.f the ear called the meatus auditorius. It often occa* fions great reftleffnefs, anxiety, and even delirium. Epileptic fits, and other convulfive diforders, have been brought on by extreme pain in the ear. The ear-ach may proceed from any of the caufes which pro- duce inflammation. It often proceeds from a fudden fuppreffion of perfpiration, or from the head being expofed to cold when co- vered with fweat; or from worms, or other infeas getting into the ear, or being bred there; or from any hard body flicking in the ear. Sometimes it proceeds from the tranflation of morbific matter 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 infeas, or any hard body flicking in the ear, every method muft be taken to remove them \ as foon as poffible. The membranes may be relaxed by dropping into the ear, oil of fweet almonds, or olive oil. Afterwards the ^j patient fhould be made to fneeze, by taking fnuff, or fome flrong Wm fternutatory. If this fhould not force out the body, it muft be extraaed by art. I have feen infeas, which had got into the ear, come out of their own accord upon pouring in oil, which they cannot bear. When the pain of the ear proceeds from inflammation, it muft be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewife be fomented with fleams of warm water*, or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good^ method of fomenting the P /UN OF THE STOMACH, Isfc. 2 ^ «ar is to apply it clofe to the mouth of a jug filled with warm wa- ter, or a ftrong decoaion of camomile-flowers. The patient's feet fhould be frequently bathed in lukewarm water, and he ought to take fmall dofes of nitre and cream tartar, half a drachm of the latter, and ten grains of the former three times a-day. His drink may be whey^ or a decoaion of barley and liquorice with figs or raifins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the vo- latile liniment. When the inflammation cannot be difcuffed, a poultice of bread and milk, or roafted onion6, may be applied to the ear, and frequently renewed, till the abfcefs breaks, or can be opened. Af- terwards the humours may be diverted from the part by gentle laxatives, blifters, or iffues ; but the difcharge muft not be fud- derily dried up by any external application. Pain cfthe Stomach, cifr. THIS may proceed from various caufes ; as indigeftion ; wind ; the acrimony of the bile ; fharp, acrid, or poifonous fubftances ta- ken into the ftomach, &c. It may likewife be occafioned by worms ; the ftoppage of customary evacuations ; a tranflation of gouty matter to the ftomach, the bowels, Sec. Women in the decline of life are very liable to pains of the fto- mach and bowels, efpecially fuch as are affliaed with hyfteric complaints. 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 medicine. When the pain of the ftomach is moft violent after eating, 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 mould continue chiefly to ufe it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dofe or two of rhubarb. He ought likewife to take an infufion of camomile flowers, or fome other ftomachic bitter, either in wine or water. I have often known exercife remove this complaint, efpecially failing, or a long journey on horfeback, or in a carriage. When a pain of the ftomach proceeds from flatulency, the pa- tient is conftantly belching up wind, ,and feels an uneafy diften- tion of the ftomach after meals. This is the moft deplorable dif- eafe, and is feldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that fours on the ftomach, as greens, roots, &c. This rule admits of fome exceptions. Ma- b6© PAIN OF THE STOMACH, &c. ny perfons very much *roubled with wind, have received great be- nefit from eating parched peafe, though that grain is generally fuppofed to be of a windy nature*. i his complaint may likewife be greatly relieved by labour, ef- pecially digging, reaping, mowing, or any kind of active employ- ment by which the bowels are alternately compreffed and dilated. The moft obftinate cafe of this kind I ever met with, was in a per- fon of a fedentary occupation, whom I advifed, after he had tried every kind of medicine in vain, to turn gardener j which he did, and has ever fince enjoyed good health. When a pain of the ftomach is occafioned by the fwallowing of acrid or poifonous fubftances, they muft be difcharged by vo- mit ; this may be excited by butter, oils, or other foft things, which fheath and defend the ftomach from the acrimony of its contents. When a pain of the ftomach proceeds from a tranflation of gouty matter, warm cordials are neceffary, as generous wines, French brandy, &c. Some in this cafe have drank a whole bottle of bran- dy or rum in a few hours, without being in the leaft intoxica- ted, or even feeling the ftomach warmed by it. It is impoflible to afcertain 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 benediBus. If a pain of the ftomach proceeds from the ftoppage of cuftoma- ry evacuations, bleeding will be neceffary, efpecially in fanguine and very full habits. It will likewife be of ufe to keep the body gently open by mild purgatives; as caftor oil, fenna, &c. When this difeafe affeas women, in the decline of life, after the flop- page of the menfes, making an iffue in the leg or arm w ill be of pe- culiar fervice. When the difeafe is occafioned by worms, they muft be destroy- ed, or expelled by means recommended in the following feaion ; When the ftomach is greatly relaxed, and the digeftion bad, § _ which often occafion flatulencies, the elixir of vitriol will be of •lingular fervice. Fifteen or twenty drops of it may be taken in a glafs of wine or water twice or thrice a-day. Perfons affliaed with flatulency are generally unhappy unlefs fthey be taking fome purgative medicines ; thefe, though they may give immediate eafe, weaken and relax the ftomach and bowels, and confequently increafe the diforder. Their beft method is to mix purgatives and ftomachics together. Equal parts of bark and rhubarb may be infufed in brandy or wine, and taken in fuch quan- tity as to keep the body gently open. • Tbefe are prepared by rteeping or foaking peafe in water, and af- terwards drying them in a pot ot kiln till they become quite hard. They tray be ufed at pleafure. { 26l ] CHAPTER XXXVII. Of Worms. THESE are chiefly of three kinds, viz. the tania, or tape- worm ; the teres, or round and long w orm ; and the afca- rides or round or fhort worm. There are many other kinds of worms found in the human body ; but as they proceed, in a great meafure, from fimilar caufes, have nearly the fame fymptoms, and require almoft the fame method of treatment as thefe already men- tioned, we fhall not fpend time in enumerating them. The tape-worm is white, very long, and full of joints. It is ge-^ nerally bred either in the ftomach or fmall inteftines. The round and long worm is likewife bred in the fmall guts, and fometimes in the ftomach. The round and fhort worms commonly lodge in the reBum, or what is called the end gut, and occafion a difagreeable itching about the feat. The long round worms occafion fqueamifhnefs, vomiting, a dif- agreeable breath, gripes, loofenefs, fwelling of the belly, fwoon- ings, loathing of food, and at other times a voracious appetite, a dry cough, convulfions, epileptic fits, and fometimes a privation of fpeech. Thefe worms have been known to perforate the intef- tines, and get into the cavity of the belly. The effedts of the tape- worm are nearly the fame with thofe of the long and round, but rather more violent. Andry fays, the following fymptoms particularly attend the fo- lium, which is a fpecies of the tape-worm, viz. fwoonings, priva- tion of fpeech and a voracious appetite. The round worms called efcarides, befides an itching of the anus, caufe fwoonings, and te- nefmus, er an inclination to go to ftool. CAUSES.----Worms may proceed from various caufes, but they are feldom found except in relaxed ftomachs, where the di- geftion is bad. Sedentary perfons are more liable to them than the aaive and laborious. Thofe who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally fub- jea to worms. There feems to be a hereditary difpofition in fome perfons to this difeafe. I have often feen all the children of a fami- ly fiibjea to worms cf a particular kind. They feem likewife fre- quently to be owing to the nurfe. Children of the fame family, nurfed by one woman, have often worms, when thofe nurfed by another have none. SYMPTOMS----The common fymptoms of worms are palenefs of the countenance, and at other times, an univerfal flufhing of the face ; itching of the nofe ; this however is doubt- ful, as children pick their nofes in all difeafes; starting, and grind- ing of the teeth in fleep ; fweiling of the upper lip ; the appetite 262 OF WORMS. fonutimesbad, at ether times quite voracious; loofenefs; a four or ftinking breath; a hard fwelled belly; great thirft ; the urir.e 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 pulfe; palpitations of the heart; fwoonings; drowfinefs; cold fweats; palfy; epileptic fits, with many other unaccountable nervous fymptoms, which were formerly attributed to w itchcraft, or the influence of evil fpirits. Small bodies in the excrements refem- bling melon or cucumber feeds are fymptoms of the tnpe-woim. I lately faw fome very furprifing effeas of worms in a girl a- bout 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 considerably inflamed ; and what anatomists call an intus fufceptio, or involving of one part of the gut within another, had taken place in no lefs than four different parts of the inteftinal canal.* MEDICINE_____Though numberlefs medicines are extolled for expelling and killing worms,f yet no difeafe more frequently baffles the phyfician's fkill. In general, the moft proper medicines for their expulfion are ftrong purgatives ; and to prevent their breeding, flomachic bitters, 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 feven of the lat- ter, 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 d lys, the patient may take a drachm of the powder of tin, twice or thrice a-day, mixed with fyrup or honey. Thofe who do not chufe to take calomel may make ufe of the bitter purgatives; as aloes, hiera picra, tinaure of fenna, and rhubarb, Sec. Oily medicines are fometimes found beneficial for expelling worms. An ounce of fallad oil and a table-fpoonful of common fait may be taken in a glafs of red port wine thrice a-day or often- er, if the ftomach will bear it. But the more common form of «fing oil is in clyfters. Oily clyfters fweetened with fugar or ho? • That worms exist in the human body, there can be no dou';t; and that they muft fometimes be confidered as a difeafe. is equally certain : but this is not the cafe fo often as people imag-ne. The idea that worms occafion miny difeafes, gives an opportunity to the profeffed worm- dottors of impofingon the credulity of mankind, and doing much mif- chief. They find worms in every cafe, and liberally throw in their an- tidotes, which generally confift of flrongdraflic purees: 1 have known thefe given in delicate constitutions to the dethuction of the patient, where there .was not the leaft fymptom of worms. t A medical writer, of the prefent age, has enumerated upwards of fifty Britifh plants, all celebrated for killing and expelling w orrns. OF WORMS. 263 ney, are very efficacious in bringing away the fhort round worms called afcarides, and likewife the teres. The Harrowgate water is an excellent medicine for expelling worms,-efpecially the afcarides. As this water is impregnated with fulphur, we may hence infer, that fulphur alone muft be a good medicine in this cafe; which is found to be a faa. Many prac- titioners give Jour of fulphur in very large dofes, and with great fuccefs. It fhould be made into an ekauary with honey or treacle, and taken in fuch quantity as to purge the patient. Where Harrowgate water cannot be obtained, fea-water may be ufed. If fea-water cannot be had, common fait diffolved in wa- ter may be drank. I have often feen this ufed by country nurfes with very good effea. Some flour of fulphur may be taken over night, and the falt-water in the morning. But worms, though expelled, will foon breed again, if the fto- mach remains weak and relaxed ; to prevent which, we would re- commend the bark. Half a drachm 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 likewife good for this purpofe, or a table-fpoonful of the chalybeate wine taken twice or thrice a-day. Infufions or decoaions of bitter herbs may likewife be drank; as the infufions of taufy, water trefoil, camo- mile-flowers, tops of wormwood, the leffcr centaury, &c. For a child of four or five years old, fix grains of rhubarb five of jalap, and two of calomel, may be mixed in a fpoonful of fyrup cr honey,- and given in the morning. The child fhould keep the houfe all day, and take nothing cold. This dbfe may be repeated twice a-week for three or four weeks. On the intermediate days, the child may take a fcruple of powdered tin, and ten grains of aethiops mineral in a fpoonful of treacle t .rice a-day. This dofe muft be increafed or diminifhed according to the age of the pa- tient. Biffet Tays, the great baftard black hellebore, or bear's foot, is a moft powerful vermifuge for the long round worms. He orders the decoaion of about a drachm of the green leaves, or about fif- teen grains of the dried leaves in powder, for a dofe to a child be- tween four and feven years of age. This dofe is to be repeated two or three times. He adds that the green leaves, made into a fyrup, with coarfe fugar, is almoft the only medicine he has ufeq\ for round worms for three years paft. Before preffing out the juice, he moifteus the bruifed leaves with vinegar, which correas the medicine. The dofe is a tea-fpoonful at bed-time, and one of two next morning. I have frequently knon-n thefe big bellies, which in children are commonly reckoned a fign of worms, quite removed, by giving them white foap in their pottage, or other food. Tanfy, garlic, and rue, are all againft worms, and may be ufed various ways. We might here mention many other plants, both for external and in- 264. THE JAUNDICE. ternal ufe, as the cabbage-bark, Sec. but think the powder of fm, and the purges of jalap and calomel, are more to be depended on. Ball's purging vermifuge powder is a very powerful medicme. It is made of equal parts of rhubarb, fcammony, and calomel, with as much double-refined fugar as is equal to the weight of all the other ingredients. Thefe muft be well mixed together, and re- duced 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 drachm for a dole*. Parents, who would preferve their children from worms, ought to allow them plenty of exercife in the open air ; to take care that their food be wholefome and fufficiently folid ; and as far as pof- fible 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 strengthens the ftomach, is good both for preventing and expel- ling thefe verminf. CHAPTER XXXVIII. Of the faundice. THIS difeafe is firft obfervable in the white of the eye, which ' appears yellow. Afterwards the whole fkin puts on a yellow appearance. The urine too is of a faffron hue, and dies a white ' cloth of the fame colour. There is likewife a fpecies of this dif- A eafe called the black jaundice. ' CAUSES_____The immediate caufe of the jaundice is an ob- k ftruaion of the bile. The remote or occafional caufes are, the bites of poifonous animals, as the viper, mad dog, &c. the bilious or • hyfteric colic ; violent paffions, as grief, anger, &c. Strong pur- ges or vomits will likewife occafion the jaundice. Sometimes it proceeds from obftinate agues, or from that difeafe being prema- turely flopped by aftringent medicines. In infants, it is often occa- * A powder for the tape-worm refembling this was longkeptafecret on the continent; it was lately purchaled by the French King, and will be found under the article Pcwder, in the Appendix. t It is nectffary to warn people of their danger who buy cakes, pow- ders, and other worm medicines, at random, from quacks, and give them to their children wthout proper care. The principal ingredient in molt of thefe medicines is mercury, which is never to be trifled with. I lately favvafhock'nginftance of the danger of this conduct. A girl who had 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 fwelled, and died on the follow- ing day, with jil the fymptoms of having been poifoned. 1 THE JAUNDICE. 265 Honed by the meconium not .being fufficiently purged off. Pregnant women are very fubjea to it. It is likewife a fymptom in feveral kinds of fever. Catching cold, or the ftoppage of cuftomary eva- cuations, as the naenfes, the piles, iffues, &c will occafion the jaundice. t SYMPTOMS.----The patient at firft complains of exceffive wearinefs, and has great averfion to every kind of motion. His fkin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The ftools are of a whitilh or clay co- lour, and the urine, as was obferved above, is yellow. The breath- ing is difficult, and the patient complains of an unufual load or oppreffion on his breaft. There is a heat in the nostrils, a bitter tafte in the mouth, loathing of food, ficknefs at the ftomach, vo- miting, flatulency, and other fymptoms of indigeftion. If the patient be young, and the difeafe complicated with no other malady, it is feldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropfy, or hypochondriac fymptoms, it generally proves fatal. REGIMEN.----The diet fhould be cool, light, and diluting, confifting chiefly of ripe fruits and mild vegetables ; as apples boiled or roafted, ftewed prunes, preferved plumbs, boiled fpinage, &c Veal or chicken-broth, with light bread, are likewife very pro- per. Many have been cured by living almoft wholly for fome days on raw eggs. The drink fliould be butter-milk, whey fweetened with honey, or decoaions of cool opening vegetables ; or marfh- mallow roots, with liquorice, 8db. The patient fhould take as much exercife as he can bear, either on horfeback, or in a carriage ; walking, running, and even jump- ing, are likewife proper, provided he can bear them without pain, and there be no fymptoms of inflammation. Patients have been often cured of this difeafe by a long journey, after medicines had proved ineffeaual. Amufements are likewife of great ufe in the jaundice. The dif- eafe is often occafioned by a fedentary life, joined to a dull me- lancholy difpofition. Whatever therefore tends to promote the circulation, and to cheer the fpirits, muft have a good effea; as dancing, laughing, tinging, &c MEDICINE.----If the patient be young, of a full fangume habit, and complains of pain in the right fide about the region of the liver, bleeding will be n*» eflary. After this a vomit muft be adminiftered, and if the difeafe proves obftinate, it may be re- peated once or twice. No medicines are more beneficial in the jaundice than vomitSj efpecially where it is not attended with in- flammation. 'Half a drachm 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 body muft likewife be kept open by taking a fufficient quantity of Caftile foap, or the pills for the jaundice recommended in the appendix. 266 THE DROPSY. 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 bath 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 jaun- dice ; as lice, millepedes, Sec But thefe do more harm than good, as people trufl to them, and neglea more valuable medicines; befides, they are feldom taken in fufficient quantity to produce any effeas. People always expea that fuch things fhould aa as charms, and confequently feldom perfill in the ufe of them. Vo- mits, purges, fomentations, and exercife, will feldom fail to cure the jaundice when it is a fimple difeafe ; and when complicated with the dropfy, a fchirrous liver, or other chronic complaints, it is hardly to be cured by any means. Numberlefs Britifh herbs are extolled for the cure of this dif- eafe. The author of the Medicina Britannica mentions nenr a hun- dred, all famous for curing the jaundice. The difeafe often goes off of its own accord ; in which cafe, the laft medicine is always faid to have performed the cure. I have feen confiderable benefit, in a very obftinate jaundice, from a decoaion of hempfeed. Four ounces of the feed may be boiled in two Englifh quarts of ale, and fweetened with coarfe fugar. The dofe is half an Englifh pint every, morning. It may be continued for eight or nine days. I have likewife known Harrowgate fulphur water cure a jaun- dice of very long Handing. It fhould be ufed for fome weeks, and the patient both drink and bathe. The foluble tartar is a very proper medicine in the jaundice. 0 A drachm of it may be taken every night and morning in a cup of j tea or water-gruel. If it does not open the body, the dofe may be i increafed. A very obftinate jaundice has been cured by fwallow- ing raw eggs. Perfons fubjea to the jaundice ought to take as much exercife as poffible, and to avoid all heating and aftringent aliments. CHAPTER XXXIX. Of the Dropfy. THE dropfy is a preternatural fwelling of the whole body, or fome part of it, occafioned by a colleaion of watery humour. It is diftingufhed by different names, according to the part affec- ted, as the anafarca, or a colleaion of water under the fkin ; the afcites, or a colleaion of water in the belly ; the hydrops peBoris, or dropfy of the breaft; the hydrocephalus, or dropfy of the brain, &c THE DROPSY. 267 CAUSES.____The dropfy is often owing to an hereditary dif- pofition. It may proceed from drinking ardent fpirits, or other ftrong liquors. It is true almoft to a proverb, that great drinkers die of a dropfy. Hence it is justly reckoned among the difeafes of the fedentary. It often proceeds from exceffive evacuations, as frequent and copious bleedings, ftrong purges often repeated, fre- quent falivations, &c. The fudden ftoppage of customary or ne- ceffary evacuations, as the menfes, the haemorrhoids, fluxes of the belly, Sec. may likewife caufe a dropfy.' I have known the dropfy occafioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by vio- lent exercife. A low, damp, or marfhy fituation is likewife a fre- quent caufe of it. Hence it is a common difeafe in moift, flat, fen- ny countries. It m;.y alfo be brought on by a long ufe of poor watery diet, or of vifcous 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, an empyema, or a confumption of the lungs. In fhort, what- ever obftruas the perfpiration, or prevents the blood from being duly prepared, may occafion a dropfy. SYMPTOMS.----The anafarca generally begins with a fwel- ling of the feet-and ancles towards night, which for fome time dif- appears in the morning. In the evening, the parts, if preffed with the finger, will pit. The Twelling gradualry^afcends, and occupies the trunk of the body, the arms and the head. Afterwards the breathing becomes difficult, the "urine is in fmall quantity, and the thirst great; the body 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 fymp- tom, as it fhows that the lungs are affeaed. In an afcites, befides the above fymptoms, there is a fwelling of the belly, and often a fluauation, which may be perceived by ftriking the belly on one fide, and hying the palm of the hand on the oppofite. This may be diftinguifhed from a tympanyby the weight of the fwelling, as well as by the fluauation. When the anafarca and afcites are combined, the cafe is very dangerous. Even a fimple afcites feldom admits of a radical cure. Almoft all that can be done is, to let off the water by tapping, whicl^f^dom af- fords more than a temporary relief. When the difeafe comes fuddenlyop, and the patient is young and ftrong, there is reafon however to hope for a cure, efpecially if medicine be given early. But if the patient be old, has led an irreguhr or a fedentary life, or if there be reafon to fufpea that the liver, lungs, or any of the vifcera are unfound, there is great, ground to fear that the confequences will prove fatal. REGIME ?\T____The patient muft abftain, as much as poffible, from all drink, efpecially weak and watery liquors, and muft quench his thirft with muftard-whey, or acids, as juice of lemons, oranges, a68 THE DROPSY. forrel, or fuch like. His aliment ought to be dry, of a stimulate ing diuretic quality, as toafted bread, the flefh of birds, or other wild animals roafted ; pungent and aromatic vegetables, as gar- lic, muftard, onions, creffes, horfe-radifh, rocambole, fhalot, &c. He may alfo eat fea-bifcuit dipt in wine or a little brandy. This is not only nourifhing but tends to quench thirft. Some have been aaually cured of a dropfy by a total abstinence from all li- quids, and living entirely upon fuch things as are mentioned above. If the patient muft have drink, the Spa-water, or Rhenifh wine, with diuretic medicines infufed in it, are the beft. Exercife is jf the greateft importance in a dropfy. If the pa- tient be able to walk, dig, or the like, he ought to continue thefe exercifes as long as he can. If he is not able to walk or labour, he muft ride on horfeback, or in a carriage, and the more violent , the motion, fo much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, if poffible, into a warmer climate. In a word, every method fliould be taken to promote the perfpiration, and to brace the folids. For this purpofe it will likewife be proper 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. MJLDICINE.----If the patient be young, his conftitution i 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 by fweat and urine. • For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oyxmel j of fquills, will be a proper vomit. This may be repeated as often t as neceffn y, three or four days intervening between the dofes. The patient muft not drink much after taking the vomit, other- * wife he deftroys its effea. A cup or two of camomile-tea will be fufficient to work it off. Between each vomit on one of the intermediate days, the pa- tient may take the following purge : Jalap in powder, half a drachm, cream of tartar, two drachms, calomel, fix grains, f hefe may be made into a bolus wi:h a little fyrup of pale rofes, and ta- ken early inthc morning. 1 he lefs the patient drinks after it the better. If he be much griped, he may take now and then a cup of chicken-broth. The patient may 'ikewife take every night at bed-time the fol- lowing bolus: To four or five grains of camphor add one grain * Anafarca in young people has fometimes been cured by bleedinjr, v;kv the puifu has been full and'ftrong; but in afcites, which moft ge- iu rally comes on at pi advanced period of life, when the conffitiirion is confiderubly impaired, frequently by an irregular mode of Jife, bleed- ing appears to be improper, and even in afcites, when the patier' has bee.1 young, I have teen this evacuati'cn^uftd early with njaQsicil difadvar.tage. ' '*•(!. C.) " ' THE DROPSY. 269 of opium," and as much fyrup of orange-peel as is fufficient to make them into a bolus. This will generally promote a gentle fweat, which fhould be encouraged by drinking now and then a fmall cup of wine-whey, with a tea-fpoonful of the fpirits of hartfhorn in it. A tea-cupful of the following diuretic infufion may likewife be taken every four or five hours through the day: Take juniper berries, muftard-feed, and horfe-radifh, of each half an ounce, afhes of broom 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 decoaion of feneka-root, which is both diuretic and fudorific. I have known an obftinate anafarca cured by an infufion of the afhes of broom in wine. The above courfe will often cure an incidental dropfy, if the conftitution be good ; but when the difeafe proceeds from a bad habit, or an unfound ftate of the vifcera, mercury fliould be ufed; and at the fame time the ftrength fupported by warm and nou- rifhing cordials. The fecretion of urine may be greatly fupported by nitre. Brookes fays, he knew a young woman who was cured of a drop- fy by taking a drachm of nitre every morning in a draught of ale, after fhe had been given over as incurable. The powder of fquills is likewife a good diuretic. Six or eight grains of it, with a fcru- ple of nitre, may be given twice a-day in a glafs of ftrong cinna- mon-water. Ball fays, a large fpoonful of.unbruifed muftard-fecd taken every night and morning, and drinking half an English pint of the decoaion of the tops of green broom after it, has perform- ed a cure after other powerful medicines had proved ineffeaual. I have fometimes feen good effeas from cream of tartar in this difeafe. It promotes the difcharges by ftool and urine, and will at leaft palliate, if it does not perform a cure. The patient may be- gin by taking an ounce every fecond or third day, and may in- creafe' 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 decoaion of feneka-root, as direaed above; or he may take two table-fpoon- fuls of Mindererus's fpirit in a cup of wine-whey three or four times a-day. To promote a difcharge of urine, the following infu- fion of the London hofpitals will likewife be beneficial: ■ Take of zedoary-root two drachms ; dried fquills, rhubarb, and juniper-berries bruifed, of each a drachm; cinnamon in pow- der, three drachms ; fait of worm-wood, a drachm and a half; infufe in an Englifh pint and a half of old hock-wine, and when fit for ufe, filter the liquor. A wine-glafs of it may be taken three or four times a-day. In the anafarca it is ufual to fcarify the feet and legs. By this means, the water is often difcharged ;\ but the operator muft be 2-o THE GOUT. cautiuus not to make the incifions too deep : they ought barely to pierce through the fkin, and efpecial care muft be taken, by fpi- rituous fomentations and proper digestives, to prevent a gan- grene. In an afcites, when the difeafe does not evidently and fpeedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very fimple and Tafe operation, and would often fucceed if it were performed in due time, before the fyftem become too much debilitated.* After the evacuation of the water, the patient is to be put on a courfe of ftrengthening medicines ; as the bark ; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, in- fjifed in wine, and fuch like. His diet ought to be dry and nou- rifhing, fuch as is recommended in the beginning of the chapter; and he fliould take as much exercife as he can bear without fa- tigue. He fhould wear flannel next his fkin, and daily ufe the flefti-brufh. CHAPTER XL. Of the Gout. NO difeafe fhows the imperfc-aion of medicine, or fets the ad- vantages of temperance and exercife in a stronger light, than the gout. Excefs and idlenefs are the true fources from whence it originally fprur.g, and all w ho would avoid it muft be aBive and temperate. 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 induce a paroxyfm in thofe who are fubjea to it; as intenfe ftudy ; too free an ufe of acidu- lated liquors ; night-watching ; grief or uneafinefs of mind ; an obflruaion or def'ea of any of the customary difcharges, as the menfes, fweating of the feet, perfpiration, Sec. - SYMPTOMS.----A fit is generally preceded by indigestion, drowfinefs, belching of wind, a flight head-ach, ficknefs, and fometimes vcmiting. The patient complains of wearinefs and dejeaion of fpirits, and has often a pain in the limbs, with a fen- fation as if wind or cold water were paffing down the thigh. Ihe * The very name of an operation is dreadful to moft people, and th?v wili. to try t-very thing before they have recourfe to it. This is the ration why tapping fo feldom Succeeds to our wifh. I have hadapatknt who was regularly tupped once a month for feveral years, and who ufed to est her dinner'as well after the operation, as if nothing had happen- ed. M)t died atlaii rather \*i>m out by age ihanbythe difeafe. i 4 THE GOUtY &71 appetite is often remarkably keen a day or two before the fit, u.d there is a flight pain in palling urine, and Tometimes an involun- tary fhedding of tears. Sometimes thefe fymptoms are muffi more violent, efpecially upon the near approach of a fit ; and fome ob- ferve, that as is the fever which ufhers in the gout, fo will the fit be ; if the fever be fliort and fharp, the fit will be fo likewife, if it be feeble, long, and lingering, the fit 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 be- ginning of winter, in the following manner : About two' or three in the morning, the patient is feized witii a pain in his great toe, fometimes 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 stretched, burnt, fqueezed, gnawed, or torn in pieces, Sec. The part at length be- comes fo exquilitely fenfible, that the patient cannot bear to have it touched, or even fuffer any perfon to walk acrofs 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 moifture. Towards morning he drops afleep, and generally falls into a gentle breathing fweat. This terminates the first pa- roxyfm, 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 to this difeafe. The patient is always worfe to vards night, and eatbr in the morning. The paroxyfms generally grow milder" every day, till at length the difeafe is carried off by perfpiration, urine, and the other evacuations. Infoms patients, a few days; in others, weeks, and in fome, months are required to finifh the fit. Thofe whom age and frequent fits of the gout have greatly debilitated, feldom get free from it before the approach of fummer, and fometimes not till it be pretty far advanced. REGIMEN.----No medicines yet known will cure the gout; we fhall confine our obfervations 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 diluting nature ; but where the conftitution is weak, and the patient has been accustomed to live high, this is not a proper time to retrench. In this cafe, he muft keep nearly to his ufual diet, and fhould take frequently a cup of ftrong negro, or a glafs of generdus wine. Winer whey is a very proper drink in this cafe, as it promotes the perfpiration without greatly heating the patient. It will anfwer this purpofe 572 THE GOUT. better, if a tea-fpoonful offal volatile oleofum, or fpirits of hartf- horn, be put into a cup of it twice a-day. It will likewife be pro- per, to give at bed-time, a tea-fpoonful of the volatile tinaure of guaiacum in a large draught of warm wine-whey. This will great- ly promote perfpiration through the night. As the moil fafe and efficacious method of difcharging the gou- ty matter is by perfpiration, this ought to be kept up by all means, efpecially in the affeaed part. For this purpofe, the leg and foot fliould be wrapt in flannel, fur, or wool. The hit 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 leg and foot affeaed, and cover it with a fkin of foft dreffed leather. This they fuffer to continue for eight or ten days, and fometimes tor a fortnight or three weeks, or longer, if the pain does not ceafe. I never knew any ex- ternal application anfwer fo well in the gout. I have often feen it applied when the fwelling and inflammation were very great, with violent pain, and have found all thefe fymptoms relieved by it in a few days. The wool is generally greafed, and carded or combed. They choofe the foftefl which can be had, and feldom or never remove it till the fit be entirely gone off. The patient ought to be kept quiet and eafy during the fit. Eve- ry thing that affeas the mind disturbs 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 Na- ture's method of removing fomething that might prove diflruc- tive to the body, and all that we can do, with fafety, is to promote her intentions, and affift her in expelling the enemy in her own way. Evacuations by bleeding, ftool, &c. are likewife to be ufed i with caution ; they do not remove the caufe of the difeafe, 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 bo- dy gently open by diet, or even 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 found which will do this with fafety to the patient. In pain, 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 flop the fmall-pox from rifing, and to drive them in- to the blood, as to attempt to repel the gouty matter after it has been thrown upon the extremities. The latter is as much an ef- fort of Nature to free herfelffrom an offending caufe as the for- mer, and ought equally to be promoted. When the pain is verv great, and the patient reftlefs, thirty or ' THE GOUT. 273 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, promote perfpiration, and forward the crifes of the difeafe. After the fit is over, the patient ought to take a gentle dofe or two of the bitter tinaure of rhubarb, or fome other warm fto- machic purge. He fhould alfo drink a weak infufion of ftomachic bitters in fmall wine or ale, as the 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 horfeback, 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 frequently known the gout kept off for feveral years by the bark and other aftringent medi- cines ; but, in all the cafes, where I had occafion to fee this tried, the perfons died fuddenly, and, to all appearance, for want of a re- gular fit of the gout, which, to fome conftitutions, in the decline 4 of life, is rather falutary than hurtful. Though it may be dangerous to flop a fit qf the gout by me- dicine, yet if the conftitution can be fo changed;by diet and ex- ercife, as to leffen or totally prevent its return, there certainly can be no danger in following fuch a courfe. The whole habit may be altered by a proper regimen as quite to eradicate this difeafe ; and thofe only who have fufficient refolution to perfift in fuch a courfe, have reafon to expea a cure. The courfe which we would recommend for preventing the gout, is as follows: In the firft place, univerfal temperance. In the next place, fufficient exercife*. By this we do not m> an fauntering about in an indolent manner, but labour, fweat, and toil. Thefe only can render the humours wholefome, and keep them fo. Go- ing early to bed, and rifing betimes, are alfo of great importance. It is likewifr proper to avoid night-ftudies, and all intenfe thought. The fupper fliould be light, and taken early. All ftrortg liquorsj efpecially generous wines and four punch, are to be avoided. We would likewife recommend fome dofes of magnefia alba and rhubarb to be taken every fpring and autumn ; and afterwards a courfe of flomachic bitters, as tanfey or water-trefoil tea, an in- fufion of gentian and camomile flowers, or a decoaion of burdock root, &c. 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 iffue or per- petual blifter has a great tendency to prevent the gout. If thefe * Some make a fecret of curing the gout by mufcular exercife. This fecret, however, is as old as Gelfus, who ftrongly recommends that mode of cure ; and whoever will fubmit to it, in the fulleft extent, may expect to reap folid and permanent advantages. M 2 274 THE GOUT. .vere more generally ufed in the decline of life, they would no/ 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 invigo- rates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on fome of the internal parts, proper applications to recal and fix it become abfolutely neceffary. When the gout affeas the haad, the pain of the joints ceafes, and the fwelling difjppears, while either feverc 4 head-ach drowfinefs, trem&ling, giddinefs, convulfions, or deli- rium come oq. When it feizes the lungs, great oppreffion, with cough and difficulty of breathing, enfue. If it attacks the ftomach, extreme ficknefs, vomiting, anxiety, pain in the epigaftric region, and total lofs of ftrength will fucceed When the gout attacks the head or lungs, every method muft be taken to fix it in the feet. They muft be frequently bathed is warm water, and acrid cataplafms applied to the foles. Blifleri ought likewiic to be applied to the ancles or calves of the legs. Bleeding in the feet or ancles is alfo neceffary, and warm iloma- §, chic purges. The patient ought to keep in bed for the moft part, if there be any,figns of inflammation, and fhould be very careful not to catch cold. If it attacks the ftomach with a fenfe of cold, the moft warm j cordials are neceflary ; as ftrong wine boiled up wich cinnamon -^ or other Tpices ; cinnamon w iter; peppermint-water ; and even brandy or rum. The patient fliould 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 camomile tea, or any thing that will make him vomit freely. When the gout attacks the. kidneys, and imitates gravel-pains, . the patient ought to drink freely of a decoaion of marfh-mallows» j 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 violent, twenty or thirty drops of laudanum may be taken in a cup of the decoaion. Perfons who have had the gout fhould be very attentive to any j complaints that may happen to them about the time when they have reafon to expecl a return of the fit. The gout imitates many other diforders, and by being rnift iken for them, and treated im- properly, is often diverted from its regular courfe, to the great danger of life. Thofe who never had the gout, but who, from their conftitution or manner of li ing, have reafon to exped it, ought to be very circumfpea with regard to its firft approach. If the difeafe, by wrong condua or improper medicines, be diverted from its pro- per courfe, the patient has a chance to be ever after tormentcia THE RHEUMATISM. 275 with head-achs, coughs, pains of the ftomach and inteftines; and *o fall at laft a viaim to its attack upon fome of the more noble parts. Of the Rheumatifm. THIS difeafe has often a refemblance to the gout. It generally attacks the joints with exquifite pain, and is fometimes attended with inflammation and fwelling. It is moft common in the fpring, and towards the end of autumn. It is ufually diftinguifhed into acute and chronic ; or the rheumatifm with and without a fever. CAUSES.——The caufes of a rheumatifm are frequently the fame as thofe of an inflammatory fever, viz. an, obftruaed perfpi- ration, the immoderate ufe of ftrong liquors, and the like. Sud- den changes of the weather, and all quick tranfitions from heat to 4 cold, are very apt to occafion the rheumatifm. The moft extraor- dinary cafe of a rheumatifm that I ever faw, where almoft every joint of the body was diftorted, was a man who ufed to work one part of the day by the fire, and the other part.of it in the water. Very obftinate rheumatifms have likewife been brought on by per- fons not accuftomeH to it, allowing their feet to continue long wet. The fame effeas ate produced by wet clothes, damp beds, fitting or lying on the damp ground, travelling in the night, by exceffive evacuations, or the ftoppage of customary difcharges. It is often the effea of chronic difeafes, as the fcurvy, the lues venerea, obfti- nate autumnal agues, &c. The rheumatifm prevails in cold, damp, marfhy countries. It is moft common among the poorer fort of peafants, who are ill clothed, live in low damp houfes, and eat coarfe unwholefome food, which contains but little nourifhment, and is not eafily di- gefted. SYMPTOMS.----The acute rheumatifm commonly begins with wearinefs, fhivering, a quick pulfe, reftleflhefs, thirft, and other fymptoms of fever. Afterwards the patient complains of flying pains, which increafe by the leaft motion. Thefe at length fix in the joints, which are often affeaed with Twelling and in- flammation. If blood be let in this difeafe, it has generally the fame appearance as in the pleurify. In this kind of rheumatifm, the treatment of the patient is near- ly the fame as in an acute or inflammatory fever. If he be young and flrong, bleeding is neceflary, which may be repeated accord- ing to the exigencies of the cafe. The body ought to be kept open by emollient clyfters, or cool opening liquors ; as decoaions cf tamarinds, cream of tartar whey, fenna tea, and the like. The di- et fhould be light, and in fmall quantity, confifting chiefly of ±7§ THE RHEUMATISM. roafted apples, groat-gruel, or weak chicken broth. After the fe, verifh fymptoms have abated, if the pain ftill continues, the patient muft keep his bed, and take fuch things as promote peifpiration • as wine-whey, withfpiritus Minderen, Sec. He may likewife take] for a few nights, at bed-time, in a cup of wine-whey, a drachm of the cream of tartar, and half a diachm of gum guaiacum in powder. Warm bathing, after proper evacuations, has often an exceed- ing good effea. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affeaed. Great care muft be taken that he do not catch cold after bathing. The chronic rheumatifm is feldom attended with any confider- able 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 proves extremely obftinate, and fometimes incurable. In this kind of rheumatfm the regimen fhould be nearly the fame as in the acute. Cool ;:nd diluting diet, as fletoed prunes, coddled apples, currants or goofeberries boiled in milk, is moft proper. Arbuthnot fays, " If there be a fptcific in aliment for the rheumatifm, it is cert; inly whey ; ' and adds, " that he knew a perfon fs.bjea to this difeafe, who could never be cured by any other method but a diet of whey and bread.': He fays, " that cream of tartar in wat> r-gruel, taken for feveral days, will eafe rheumatic pains confidently." This I have often experienced, but found it always more efficacious when joined with gum guai- acum, as already dinged. In this cafe, the patient may uke the dofe formerly mentioned twice-a-day, and likewife a tea-fpoonful of the volatile tinaure of gum guaiacum, at bedtime, in wine- whey. This courfe may be continued for a week, or longer, if the cafe proves obftinate, and the patient's ftrength will permit. It ought xhen to be omitted for a few days, and repeated'again. At the fame time leeches or a blifter may be applied to the part affeaed. What I have generally found anfwer better than either of thefe, in obftinate fixed rheumatic pains, is the warm plaifter*. I have likewife known a plaifter of Burgundy pitch worn for fome time on the part affeaed, give great relief in rheumatic pains. Dr. Alex- ander, of Edinburgh, fays he has frequently cured very obftinate rheumatic pains, by rubbing the part affeaed with tinaure of can- tharides. When the comriion tinaure did not fucceed, he ufed it of a double or treble ftrength. Cupping upon the part afleaed # Sec? appendix, Warm Plaifter. THE RHEUMATISM. 277 is often very beneficial, and is greatly preferable to the application of leeches. Though this difeafe "may not feem to yield to medicines for fome time, yet they ought ftill to be perfifted in. Perfons fubjea to fre- quent returns of rheumatifm, will often find their account in ufing medicines, whether they be immediately affeaed with the difeafe or not. The chronic rheumatifm is fimilar to the gout in this refpea, that the moft proper time for ufing medicines to ex- tirpate it, is when the patient is moft free from the diforder. To thofe who can afford the expenfe, I recommend the warm baths of Buxton or Matlock in Derbyfhire. Thefe have often, to my knowledge, cured very obftinate rheumatifms, and are always fafe either in or out of the fit. When the rheumatifm is Compli- cated with fcorbutic complaints, which is not feldom the cafe, the Harrowgate waters, and thofe of Moffat, are proper. They fliould both be drank and ufed as a warm bath. Several of our own domestic plants may be ufed with advan- tage in the rheumatifm. One of the beft is white muflard. A table- fpoonful of the feed of this plant may be taken twice or thrice a-day, in a glafs of water or fmall wine. The water-trefoil is like- wife 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 feve- ral other bitters are beneficial, and may be ufed in the fame way. No benefit is to be expeaed from thefe, unlefs they be taken for a confiderable time. Excellent medicines are often defpifed in this difeafe, becaufe they do not perform an immediate cure; whereas, nothing would be more certain than their effea, were they duly perfifted in. Want of perfeverance in the ufe of medicines is one reafon why chronic difeafes are fo feldom cured. Cold bathing, efpecially in fait water, often cures,the rheuma- tifm. We alfo recommend riding on horfeback, and wearing flan- nel next the fkin. Iffues are very proper, efpeqially in chronic cafes. If the pain affeas the fhoulders, an iffue may be made in the arm ; but if it affeas the loins, it fliould be put in the leg or thigh. Perlons affliaed with the Tcurvy are very fubjea to rheumatic complaints. The beft medicines in this cafe are bitters and mild purgatives. Thefe may either be taken feparately or together, as the patient inclines. An ounce of bark, and half an ounce of rhu- barb in powder, may be infufed in a bottle of wine ; and onei two, or three wine glaffes of it taken daily, as fhall be found necef- fary for keeping the body gently open. In cafes where the bark itfelf proves fufficiently purgative, the rheubarb may be omitted. Such as are fubjea to frequent attacks of the rheumatifm ought to make choife of a dry, warm fituation, to avoid the night-air, wet clothes, and wet ftet, as much as poffible. Their clothing mould be warm ; they fhould wear flannel n^xt their fkin, and make frequent ufe of the flefli-brufh. 2^8- CHAPTER XLI. The Scurvy T^REVAILS chiefly in cold northern countries, efpesially in J^. low damp fituations, near large mnfhes, or great qu.mtities of flagnating water. Sedentary people, of a dull, melancholy dif- pofition, are moft fubjea to it. It proves often fatal to failors on long voyages particularly in ftiips that are not properly ventila- ted, have many people on board, or where cleanlinels is neglec- ted. It is not neceffiry to mention the different fpecies into which this difeafe has been divided, ;u; tVy differ from one another chief- ly in degree. What is'called the land fcurvy, hov ever, is fekiom attended with thofe highly putrid fymptoms which appear in pa- tients who have been long at fea and which, we prefume are rather owing to confined ;iir want of exercife, fcarcity of water, and the uuwhof f.-»me food eaten by failors on long voyages, than to any fpeeific diff re nee in the difeafe*. CAUSES----The fcurvy is occafioned by cold, moift air ; by the long ufe of falted or fmoke-dried provifions, or any kind of food that is hard ol di< ftion, and affords little norifhment. It may alfo proceed from the fuppreffion of cufromary evacuations ; as the menfes, the baemorrhoidal flux, Sec. It is fometimes owing to a hereditary taint, in which cafe, a very fmall caufe will excite the latent diforder. Grief, fear, and other depreffing paffions, have a great tendency both to excite and aggravate this difeafe. The fame obfeivation holds with regard to neglea of cleanlinefs; badcloth- ing ; the want of proper exercife; confined air; unwholefome food ; or any difeafe which greatly weakens the body. SYMPTOMS.----This difeafe may b*e known by unufual wea- rinefs, heavinefs, and difficulty of breathing, efpecially after mo- tion ; rottennefsof the gums, which are apt to bleed'on the flight- eft touch ; a ftinking breath ; frequent bleeding at the nofe ; crackling of the joints ; difficulty of walking ; fometimes a fwel- ling, and fometimes a falling away of the legs, on which there are livid, yellow, or violet-coloured fpots ; the face is generally of a pale or leaden colour. As the difeafe advances, other fymptoms come on ; as rottennefs of the teeth, haemorrhages, or dilchar- ges of blood from different parts of the body, foul obftinate ulc s, pains in v rious parts, efpecially about the breaft, dry, fcaly erup- tions all over the body, Sec. At laft, a wafting or heaic fever comes on, and the patient is often carried off by a dyfentery, a diarrhoea, a dropfy the palfy, faiiuing fits, or a mortification of fome of the bowels. CUR PI-----We know no way of curing this difeafe but by THE SCURVY. £?£ purfuing a plan direaiy oppofite to th it which brings it on. It is occaftmed by errors in diet, air, or exercife ; and this cannot be removed but by a proper attention to thefe important articles. If the patient has been obliged to breathe a odd, d mp, or con- fined sir he fhould be removed, as foon as poffible, to a dry, open, and moder.itely w.;rm one. If there is reafon to believe that the difeafe proceeds from a fedentary life, or depreffing paffions, as grief, fear, &c. he muft take, daily, as much exercife in the open air as he can bear, and his mind fliould be diverted by cheerful company and other amu^ments. Nothing has a greater tendency either to prevent or remove this difeafe, than conftant cheerful- nefs and+goed hum >ur. But perfons affliaed with the fcurvy, are generally furly, peevifh, and morofe. When the feurvy voxnes on by a long ufe of Tilted provifions, the proper medicine is a diet confifting chiefly of frefh vegetables; as oranges, apples, lemons, limes, tamarinds, water-criffes, fcurvy- grafs, brook-lime, &c. The ufe of thefe, with milk, pot-herbs, new-bread, and frefh beer or cyder, will feldom fail to remove a fcurvy of this kind, if taken before it be too far advanced ; but to lit e this effea they muft be perfifted in for a confiderable time. When frefh vegetables cannot be obtained, pickled or preferved on -> may be ufed; and where thefe are wanting, recourfe muft be hid to the chemical acids. All the patient's food and drink, fir uld, in this cafe, be fharpened with cream of. tartar, elixir of vie. 1, vinegar, or the fpirit of fea-fait. i'!:cfe thing-, however, will more certainly prevent than cure the feurvy ; for which reafon, fea-faring people, efpecialiy on long voyages, ought to lay in pLnty of them. Cabbages, onions,goofe- berries, and many other vegetables, may be kept a long time by pickling, priferving, Sec. and when thefe fail, the chemical acids, recommended above, which will keep for any length of time, may be ufed. We have reafon to believe, if fhips were well ventilated, had good ftore of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanlinefs and warmth, that failors would be tae moft healthy people in the world, and would feldom fuffer either from the fcurvy or malignant fevers, which are fo fatal to that ufeful fet of men ; but it is too much their temper 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 muit indeed be owned, that many of them have it not in th ir power to make the provifion we are fpeaking of; but in this cafe it is the duty of their employers to make it for them ; and no m in ought to engage in a long voyage without having thefe articles feeured. I have often feen very extraordinary effeas in the land-fcurvy fr >m a milk diet. This preparation of nature, a mixture of ani- mal and vegetable properties, is the moft fit for restoring adeciy- ed conftitution. But people defpife this wholefome and nouriftiing 28o • THE SCURVY. food, becaufe it is cheap, and devour with greedinefs, flefli, and fermented liquors, while milk is only deemed fit for hogs. The moft proper drink in the fcurvy is whey o» butter-milk. When thefe cannot be had, found cyder, perry, porter or fpruce- beer, may be ufed. Wort has been found a prorer drink in the fcurvy, and may be ufed at fea, as malt will keep during the longest voyage. A decoaion of the tops of the fpruce fir is likewife pro- per. It may be drank in the quantity of an Englifli pint twice a- day. Tar-water may be ufed for the fame purpofe, or decoaions cf any of the mild mucilaginous vegetables ; as farfaparilla, marfh- mallow roots, &c. Infufions of the bitter plants, a6 ground-ivy, the leffer centaury, marfh-trefoil, &c are beneficial. The peafants in fome parts of Britain, exprefs the juice of the laft-mentioned plant, and drink it with good effea in thofe foul, fcorbutic erup- tions with which they are often troubled in the fpring feafon. Harrowgate-water is certainly an excellent medicine in the land-fcurvy. I have often feen patients who had been reduced to the moft deplorable condition by this difeafe, greatly relieved by drinking the fulphur-water, and bathing in it. The chalybeate- water may alfo be ufed with advantage, efpecially with a view to brace the ftomach after drinking the fulphur-water, which, though it fharpens the appetite, never fails to weaken the powers of digeftion. A flight degree of fcurvy may be carried off by frequently fuck- ing a little of the juice of a bitter orsnge, or a lemon. When the difeafe affeas the gums only, this praaice, if continued for fome time, will generally carry it off. We recommend the bitter orange as greatly preferable to lemon ; it feems to be as good a medicine, anil is not near fo hurtful to the ftomach. Perhaps our own forrel , may be little inferior to either of them. All kinds of fallad are good in the fcurvy, and ought to be eaten very plentifully, as fpinage, lettuce, parfley, celery, endive, rad-'~, ifh, dandelion, Sec. It is amazing to fee how foon frefh vegeta- bles: in the fpring cure the brute animals of any fcab or foulnefs which is upon their fkins. It is reafonable to fuppofe that their effeas would be as great upon the human fpecies, were they ufed in proper quantity for a fufficient length of time. I have fometimes feen good effeas in fcorbu'tic 'complaints of very long (landing, from the ufe of a decoaion of the roots of wa- ter-dock. It is ufually made by boiling a pound of the frefh root in fix Englifli pints of water, till about one-third of it be confirm- ed. The dofe is from half a pint to a whole pint of the docoaion every day. But in all the cafes where 1 have feen it prove benefi- cial, it was made much ftronger, and drank in larger quantities. The fafeft way is, for the patient to begin with fmall dofes, and increafe them both in ftrength and quantity as he finds his flo- nj&ch will bear it. It muft be ufed for a confiderable time. I have krjown fome take it for many months, and have been told of others THE SCROPHULA, OR KING's EVIL. 281 who had ufed it for feveral years, before they were fenfible of any benefit, but who neverthelefs were cured by it at length. The lepfofy, which was fo common in this country long ago, feems to have been neat a-kin to the fcurvy. Perhaps its appear- ing fo feldom now, may be owing to the inhabitants of Britatneat- ing more vegetable food than formerly, living more upon tea, and other diluting diet, ufing lefs falted meat, being more cleanly, bet- ter lodged and clothed, &c.—For the cure of this difeafe, we re- Commend the fame courfe of diet and medicine as in the fcurvy. The Scrophula, or King's Evil CHIEFLY affeas the glands, efpecially thofe of the neck. Chil- dren, and young perfons of a fedentary life, are very fubjea to it. It is one of thofe difeafes which may be removed by proper regimen, but feldom yields to medicine. The inhabitants of cold) damp, marfhy countries are moft liable to the fcrophula. CAUSES.----i his difeafe may proceed from a hereditary taint, from a fcrophulous nurfe, &c. Children who have the mis- fortune to be born of fickly parents, whofe conftitutions have been greatly injured by the pox, or other chronic difeafes, are apt to be affeaed with it. It may proceed from fuch difeafes as weaken the habit, as the fmall-pox, meafles, &c. External injuries, as blows, bruifes, and the like, fometimes produce fcrophulous ulcers ; but we believe, when this happens, that there has been a predifpofi- tion in the habit tothis difeafe. In fhort, whatever tends to relax the folids, paves the way to the fcrophula ; as the want of proper exercife, too much heat or cold, confined air, unwholefome food, bad water, the long ufe of poor, weak, watery aliments, the ne- glea of cleanlinefs, &c. Nothing tends more to induce this dif- eafe in children, than allowing them to continue long wet*. SYMPTOMS____-At firft, 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 dif- charges a thin fanies, or watery humour. Other parts of the body are likewife liable to its attack, as the arm-pits, groins, feet, hands, eyes, breafls, &c. Nor are the internal parts exempt from it. It often affeas the lungs, liver, or fpleen ; and frequently the glands of the myfentery are greatly enlarged by ic* Thofe 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 exceedingly difficult ■*- The fcrophula, as well as the rickets, prevails in large ir.anufuc tilrinj tow:'.-:, where pe<-.p!<- liv- grofs, and Je.-.d fedentary lives. N 2 282 THE SCROPHULA, OR KING's EVIL. to cure. The white fwelling of the joints feems to be of this kind. They are with difficulty brought to a fuppuration, and when open- ed, 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 meafuTe, from relaxation, the diet ought to be generous and nourifhing, but at the fame time, light and of eafy digeftion ; as well fermented bread, made of found grain, the flefh and broth of young animals, with a glafs of generous wine, or good ale. 'The air ought to be open, dry, and not too cold, and the patient fhould take as much exercife as he can bear. This is of the utmost importance. Chil- dren who have fufficient exercife are feldom troubled with the fcrophula. ME0ICINE.----The vulgar are remarkably credulous 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. We know bvst little of the nature or cure of this difeafe, and where reafon or medicines fail, fuperftition always comes in their place. Hence, in difeafes which are the moft difficult to understand, we generally hear of the greateft number of miraculous cures being performed. Here, however, the deception is eafiJy accounted for. The fcrophula, at a certain period of life, often cures of itfelf; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature. In the fame way, the insignificant noftrums of quacks and old women often gain ap- plaufe when they deferve none. Nothing is more pernicious than the cuftom of plying children in the fcrophula with ftrong purgative medicines. People imagine it proceeds from humours which muft be purged off, without con- sidering that thefe purgatives increafe the debility and aggravate the difeafe. It has indeed been found, that keeping the body gen- tly open for fome time, efpecially with fea-water, has a good ef- fea ; but this fhould only be given in grofs habits, and in fuch quantity, as to procure one, or at moft, two ftools everyday. Bathing in the fait water has likewife a very good effea ; efpe- cially in the warm feafon. I have often knowji a courfe of bathing in fait water, and drinking it in fuch quantities as to keep the bo- dy gently operkj cure a fcrophula, after many other medicines had been tried in vain. When fa-It water cannot be obtained, the pa- tient may be bathed in frefh water, and his body kept open by fmall quantities of fait and water, or fome other mild purgative. Next to cold bathing, and drinking the fait water, we recom- mend the bark. The cold bath may &e ufed in fummer, and the bark in winter. To an adult, half a drachm of the bark in powder may be given in a glafs of red wine four or five times a-day. Chil- dren, and fuch as cannor take it in fubftance, may ufe the decoc- tion made in the following manner. THE ITCH. 283 Boil an ounce of Peruvian bark and a drachm of Winter's bark; both grofsly powdered, in an Englifh quart of water to a pint: towards the end, half an ounce of fliced liquorice-root, and a hand- ful of raifins may be added, which will both render the decoaion lefs difagreeable, and make it take up more of the bark. The li^ quor muft be ftrained, and two, three, or four table-fpoonfuls, ac- cording to the age of the patient, given three times a-day. The Moffat and Harrowgate waters, efpecially the latter, ;;re •. likewife very proper medicines in the fcrophula. They ought not to be drank in large quantities, but fo as to keep the body gently open, and muft be ufed for a confiderable time. Hemlock may fometimes be ufed with advantage in the fcrophu- la. Some lay it down as a general rule, that the fea-water is moft proper before there are any fuppuration or fymptoms of tabes; the Peruvian bark, when there are running fores, and a degree of hec- tic fever; and the hemlock in old inveterate cafes, approaching to the tchirrous or cancerous ftate. Either the extraa or the frefh juice of this plant may be ufed. The dofe muft be fmall at firft, and increafed gradually as far as the ftomach can bear it. External applications are of little ufe. Before the tumour breaks, nothing ought to be applied to it, unlefs a piece of flannel or fome- thing to keep it warm. After it breaks, the fore may be dreffed with fome digestive ointment. As the yellow bafilicon mixed With about a fixth or eighth part of its weight of red precipitate of mer- cury. The fore may be drefled with this twice a-day ; and if it be very fungous, and does not digtft well, a larger proportion of the precipitate may be added. Medicines 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 puberty, he has a great chance to get well; but if he does not recover at'this time, in all probabi- lity, he never wiK. There is no malady which parents are fo apt to communicate to their offspring as the fcrophula, for which renfon, people ought to beware of marrying into families affeaed with this difeafe. For the means of preventing the fcrophula, we muft refer the reader to the obferYations on nurfing at the beginning of the book. The Itch IS commonly communicated by infeaion, yet it fe'.dom pre- vails wiicre due regard is paid to cleanlinefs, frefh air, and wholefome diet. It generally appears in form of fmall watery puf- tales, firft about the wrifts, or between the fingers; afterwards 284 < THE ITCH. < it affeas the arms, legs, thighs, &c. Thefe puftules'are attended 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 fcaly eruption. This laft is called the dry itch, and is the moft dif- ficuft to cure. The itch is feldom, a dangerous difeafe, unlefs when rendered fo by neglea, or improper treatment. If fuffered to continue too long, it may vitiate the whole mafs of blood, and, if fuddenly drove in, without proper evacuations, it may occafion fevers, in- flammations of the vifcera, or other internal diforders. The beft medicine for the itch is fulphur, ufed both externally and internally. The parts moft affeaed may be rubbed with zx\ ointment made of the flowers of fulphur, two ounces ; crude fal ammoniac finely powdered, two drachms; hog's lard, or butterj four ounces. If a fcruple or half a drachm of the effence of lemon be added, it will entirely take away the difagreeable fmell. About the bulk of a nutmeg of this may be rubbed upon the ex- tremities at bed time twice or thrice a-week. It is feldom necef- fary 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 flop too ma- ny pores at the fame time. Before the patient begins to ufe the ointment, he ought, if he be of a full habijL, to bleed or take a purge or two. It will likeydfe be proper, during the ufe of it, to take every night and morning as much of the flour of brimftone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He fhould beware of catching cold, fhould wear more clothes than ufual, and take every thing warm. The fame clothes, the linen excepted, ought to be worn all the time of ufing the ointment; and fuch clothes as havebeen worn while the patient was under the difeafe,. are not to be ufed again, -unlefs they have been fumigated with brimftone, and thoroughly, cleaned ; otherwife, they will commu- nicate the infeaion anew*. I never knew brimftone, when ufed as direaed above, fail .to cure die itch ; and I believe that if duly perfifted in, it never will fail; but if it be only ufed once or twice, and cleanlinefs neglecr ted, it is no wonder if the diforder returns. 'The quantity of oint- ment, mentioned above, will generally be fufficient for the cure of one perfon ; but if any fymptoms of the difeafe fliould appear a- gain, the medicine may be repeated. It ie both more fafe and cfli- * Sir John Pringle obferve?, th:it though thi.; difeafe may feem trifling, rhefe is no wne in'tbe army tiiat-is more rroubieibme to cure, as the in- fection oi'ten lurks in clotlies, &c. and breaks cut a fecond or even a third linxe- The f.i-iiie inconveniency occurs in private families, unlefs piiftie-war regard is .paid to the changing or cleaning of their clothes. Which hiit is by no means an eafy operation. THE ITCH. 285 cacious when perfifted in fot a confiderable time, than when a large quantity is applied at once. As moft people diflike the fmell of fulphur, they may ufe in its place the powder of white hellebore root made up into an ointment, in the fame manner, which will feldom fail to cure the itch. People ought to be extremely cautious left they take other erup- tions for the itch ; as the ftoppage of thefe may be attended with fatal confequences. Many of the eruptive diforders to which chil- dren are liable, have a near refemblance to this difeafe; and I have often known infants killed by being rubbed with greafy oint- ments that made thefe eruptions strike 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 wafh the parts affeaed with a ftrong folu- tion of the corrosive fublimate. Others ufe the mercurial ointment, without taking the leaft care either to avoid cold, keep the body open, or obferve a proper regimen. The confequences may be ea- fily gueffed. Mercurial girdles have produced bad effeas, and I would advice every perfon, as he values his health, to beware how he ufts them. Mercury ought never to be ufed as a medicine without the greateft care. Ignorant people look upon thefe gir- dles as a kind of charm, without confidering that the mercury en- ters the body. It is not to be told what mifchief is done by ufing mercurial ointment for curing the itch and killing vermin ; yet it is unne- ceffary for either : the former may be always more certainly cured' by fulphur, and the latter will never be found where due regard is paid tovcleanlinefs. iT-hofe who wifh to avoid this deteftable difeafe, ought to beware of infeaed perfons, to ufe wholefome food, and to ftudy univerfal cleanlinefs*. 286 CHAPTER XLII. The Afthma IS a difeafe of the lungs, which feldom admits of a cure. Per- fons in the decline of life are moft liable to it. It is diftinguifh- ed into the mcift and dry, or humoural and nervous. The for- mer is attended with expeaoration or fpitting ; but in the latter, the patient feldom fpits, unlefs fometimes a little tough phlegm by the mere force of coughing. CAUSES.----The afthma is fometimes hereditpry. It may likewife proceed from a bad formation of the breaft; the fumes of metals or minerals taken into the lungs ; violent exercife, ef- pecially running ; the obftruaion of customary evacuations, as the menfes, haemorrhoids, &c. the fudden retroceffion of the gout, or ftriking in of eruptions, as the fmall-pox, meafles, &c vi- olent paffions of the mind, as fudden fear or furprife. In a word, the difeafe may proceed from any caufe that either impedes the circulation of the blood through the lungs, or prevents their being duly expanded by the air. SYMPTOMS____An afthma is known by a quick laborious breathing, which is generally performed with a kind of wheezing noife. Sometimes the difficulty of breathing is fo great, that the patient is obliged to keep in an erea pofture, otherwife he is in danger of being fuffocated. A fit or paroxyfm of the afthma ge- nerally happens after a perfon has been expofed to cold eafterly winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place under ground, or has taken fome food which the ftomach could not digest, as paftries, toaft- ed cheefe, or the like. The paroxyfm is commonly ufhered in witli liftleffnefc, want of fleep, hoarfenefs, a cough, belching of wind, a fenfe of heavi- nefs about the breaft, and difficulty of breathing. To thefe fuc- ceed heat, fever, pain of the head, ficknefs and naufea, great op- preflion of the breaft, palpitation of the hearty a weak and fome- J.imes intermitting pulfe, an involuntary flow of tears, bilious vo- mitings, &c. All the fymptoms grow worfe towards night; the patient is eafier when up than in bed, and is very defirous of cool air. REGIMEN.----The food ought to be light and of eafy digef- tion. Boiled meats are to be preferred to roafted, and the flefh of young animals to that of old. All windy food, and whatever is apt to fwell in the ftomach, is to be avoided. Light puddings, white broths, and ripe fruits, baked, boiled, or roafted, are proper. Strong liquors, of all kinds, efpecially malt liquor, are hurtful. The patient mould eat a very light fupper, or rather none at all, THE ASTHMA. 287 and fhould never fuffer himfelf to be long coftive. His clothing fhould be warm, efpecially in the winter-feafon. As all diforders of the breaft are much relieved by keeping the feet warm, and promoting the perfpiration, a flannel fhirt or waiftcoat, and thick flioes, will be of Angular fervice. But nothing is of fo great importance in the afthma as pure and moderately warm air. Afthmatic people can feldom bear either the clofe heavy air of a large town, or the fharp, keen atmot- phere of a bleak hilly country ; a medium therefore between thefe is to be chofen. The air near a large town is often better than at a diftance, provided the patient be removed fo far as not to be af- feaed by the fmoke. Some afthmatic patients breathe eafier in town than in the country; but this is feldom the cafe, efpecially in towns where much coal is burnt. Afthmatic perfons who are obliged to be in town all day, ought at leaft to fleep out of it. This will often prove of great fervice. Thofe who can afford it, ought to travel into a warmer climate. Many afthmatic perfons, who cannot live in Britain, enjoy very good health in the fouth of France, Portugal, Spain, or Italy. Exercife is of very great importance in the afthma, as it promotes the digeftion, preparation of the blood, &c. The blood of afthma- tic perfons is feldom duly prepared, owing to the proper aaion of the lungs being impeded. For this reafon, fuch people ought daily to take as much exercife, either on foot, horfeback, or in a carriage, as they can bear. MEDICINE.---Almoft all that can be done by medicine in this difeafe, is to relieve the patient when feized with a violent fit. This, indeed, requires the greateft expedition, as the difeafe of- ten proves fuddenly fatal. In the parqxyfm or fit, the body is ge- nerally bound ; a purging clyfter, with a folution of afafcetidaj ought therefore to be adminiftered, and if there be occafion, it may be repeated tv/o or three times. The patient's feet and legs ought to be immcrfed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unlefs extreme weaknefs or old age fhould forbid it, is highly proper. If there be a violent fpafm about the breaft or ftomach, warm fomentations, or blad- ders filled with warjn milk and water, may be applied to the part affeaed, and warm cataplafms to the foles of the feet. The pa- titnt muft drink freely of diluting liquors, and may take a tea- fpoonful of the tinaure of caftor and of faffron mixed together, in a cup of valerian-tea, twice or thrice a-day. Sometimes a vo- mit h;is a very good effea, and fnatches the patient from the jaws of death. This, however, will be more fafe alter other evacuations have been premifed. A very ftrong infufion of roafted coffee is faid to give eafe in an afthmatic paroxyfm. In the moift afthma, fuch things as promote cxpeaoration or fpitting ought to be ufed ; as the fyrup of fquills, gum ammoniac, and fuch-like. A common fpooniul of the fyrup, or cxymel of 288 THE APOPLEXY. fquills, mixed with an equal quantity of cinnamon-water, Tnay be taken three or tour times through the day, and four Or five pills, made of equal parts of afafoetida and gum-ammoniac, at bed time*. For the convulfive or nervous afthma, antifpafmodics and bra- cers are the moft proper medicines. The patient may take a tea- fpoonful of the paregoric elixir twice a-day. The bark is fometimes of ufe in this cafe. It may be taken in fubftance, or infufed in winef. In fhort, every thing that braces the nerves, or takes off fpafm, may be of ufe in a nervous afthma. It is often relieved by the ufe of affes' milk. I have likewife known cow's milk, drank ] warm in the morning, have a very good effea in this cafe. In every fpecies of afthma, fetons and iffues have a good effea*.- ft They may either be Tet in the back or fide, and fhould never be al- lowed to dry up. Not only in the afthma, but in moft chronic difeafes, iffues are extremely proper. They are a fife and effica- | cious remedy; and though they do not always cure thedifeafe, yet they will often prolong the patient's life. CHAPTER XLIII. Of the Apoplexy. THE 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 difeafe proves often fatal; yet it may fometimes be removed by proper care. It chiefly attacks fe- dentary perfons, of a grofs habit, who ufe a rich and plentiful diet, and indulge in ftrong liquors. People in the decline of life are moft fubjea to the apoplexy. It prevails moft in winter, efpecial- ly in rainy feafons, and very low ftates of the barometer. CAUSES-----The immediate caufe of an apoplexy is a com- preffion of the brain, occafioned by an excefs of blood, or a collec- tion 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 ■X- After copious evacuations, large dofes of a»ther have been found very efficacious in removing a fit of the atthma. I have likewife known ehe following mixture produce very happy effects : To four or five ounces of the folution of gum-ammoniac, add two ounces of fimple cinnamon-water, the fame quantity of balfamic fyrup, and half an ounce of the paregoric elixir. Of this, two table-fpoonfuls may be taken eve- ry three hours. t tY hen a paroxyfm or fit of asthma ha; gone off", cold bathing maybe employed, to co-operate with the tonic medicines recommended, lu preve nt a return of the paroxyf.u. (I. C.) THE APOPLEXY. 289 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; fuppreffion of urine ; fuffering the body to cool fuddenly after having been great- ly heated ; continuing long in a warm or a cold bath ; the excef- [' five ufe of fpiceries, or high-feafoned food ; excefs of venery ; the fudden ftriking in of any eruption ; fuffering iffues, Tetons, &c. " fuddenly to dry up, or the ftoppage of any customary evacuation ; a mercurial falivation pulhed too far, or fuddenly checked by cold ; wounds or bruifes on the head ; long expofure to exceffive cold ; [ poifonous exhalations, &c. SYMPTOMS, and method of cure.-----The ufual forerunners ©f an apoplexy are giddinefs, pain and fwimming of the head; * lofs of memory; drowfinefs ; noife in the ears ; the night-mare ; a spontaneous flux of tears, and laborious refpiration. When per- fons of an apopleaic make obferve thefe fymptoms, they have rea- fon to fear the approach 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 fwelled or puffed up, and the blood-veffels, efpecially about the neck and temples, are turgid; 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 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 perfeaiy eafy and cool. His head fhould be raifed pretty high, and his feet fuffered to hang down. His clothes ought to beloofened, 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 retarded. As foon as he is placed in a proper pofture, he fhould be bJcd freely in the neck or arm, and, if there be occafion, the ope- ration may be repeated in two or three hours. A laxative clyfter, with plenty of fweet oil, or frefh butter, and a fpoonful or two of common fait in it may be adminiftered every two hoursf, and a * * I knew a woman, who, in a violent fit of anger, was feized with a fanguine apoplexy. She at firft complained of extreme pain, as if dag- gers had been thrult through her head, as flie exprelied it. Afterwards Hie became comatofe, her pulfe funk very low, and was exceeding flow. By bleeding, bliltering, and other evacuations, fhe was kept alive about a fortnight. When her head was opened, a large quantity of extravafa- ted blood was found in the left ■venteicle of the brain. A clyfter, confiftingof three ounces of gl.iuber falts diffolved in a pint of warm water, with an ounce of antimonial wine, and afuitable quan- tity of oil, would have a more powerful effect in relieving the head. (I.C.) Q 2 29c THE APOPLEXY. blifter appplied between the fhoulders, and to the calves of the legs. As foon as the fymptoms are a little abated, and the patient 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, manna diffolved in an infufion of fenna, or the like. All fpirits and other ftrong fiquors are to be avoided. Even volatile falts held to the nofe do mifchief. Vomits, for the fame reafon, ought not to-be givenj nor any thing that may increafe the motion of the blood towards the head. In the ferous apoplexy,, the fymptoms are nearly the fame, only the pulfe is not fo ftrong, the countenance is lefs florid, and the breathing lefs difficult. Bleeding is not fo neceffary here as in the former cafe. It may generally be performed once with fafety anA, advantage, but fhould not be repeated. The patient fhould be placed in the fame pofture at. diread above, and fliould have b'ili- ters applied, and receive opening clyfters in the Time manner. Purges are likewife neceffary, 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 considerable time has often carried off a ferous apoplexy. When apopleaic fymptoms proceed from opium, or other nar- cotic fubftances taken into the ftomach, vomits are neceffary. The patient is generally relieved as foon as he has difcharged the poifon in this way. ■ Perfons of an apopleaic make, or thofe who have been attack- ed by an apoplexy, 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 Ibng wet. The body muft 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 nc- gkaed ; but it ought to be taken in moderation. Nothing has & more happy effea in preventing an apoplexy than perpetual iffues or fetons ; great care however' muft be taken not to fufllr them to dry up, without opening others in their fteacL Apopleaic per- fons ought never to go to reft with a full ftomach, or to lie with- tkeir heads low, or wear any thing too tight about their necks-' 2gi 4} CHAPTER XLIV. Qf Coftivenefs, and other AffecTtons of the Stomach and Bowels. WE do not here mean to treat of thofe aftriaions of the bow- els which are the fymptoms of difeafes, as of the cholic, the iliac paffion, &c. but only to take notice of that infrequency *of ftools which fometimes happens, and which in fome particular conftitutions may occafion difeafes. Coftivenefs may "proceed from drinking rough red wines* or other aftringent liquors ; too much eKercife, efpecially on horfe- back, or from a long ufe of cold infipid food, which does not fuffi- ciently •ftimulate the inteftines. Sometimes it is owing to the bile not defccnding to the inteftines, as in the jaundice ; and atothejr times it proceeds from difeafes of the inteftines themfelves, as-a palfy, fpafms, torpor, tumours of the inteftines, &c. Exceffive coftivenefs is apt to occafion pains of the head, vomit- ing, colics, and other complaints of the bowels. It is peculiarly hurtful to hypochondriac and hyfteric perfons, as it generates wind and other grievous fymptoms. Some people can bear coftive- nefs to a great degree. I know perfons who enjoy pretty good health, yet do not go to ftool above once a-week, and others not above once a-fortnight. I have heard of fome who do not go above ence a-month. Perfons who are generally coftive fhould live upon a moiften- ing and laxative diet, as roafted or boiled apples, pears, ftewed prunes, raifins, gruels with currants, twitter, honey, fugar, and juch-like. Broths with fpinage, leeks, and other foft pot-herbs, are likewife proper. Rye-bread, or that which is made of a mix- ture of wheat and rye together, ought to be eaten. No perfon -troubled with coftivenefs fhould eat white bread alone, efpecially that which is made of fine flour. The beft bread for keeping the body foluble is what in fome parts of England they call meflin. It !is made of a mixture of wheat and rye, and is very agreeable to thofe accuftomed to it. Coftivenefs is encreafed by keeping the body too warm, and by every thing that promotes the perfpiration ; as wearing flannel, lying too long a-bed, &c. Intenfe thought and a fedentary life, •are likewife hurtful. All the fecretions and excretions are promo- ted by moderate exercife without doors, and by a gay, cheerful, fprightly. temper of mind. The drink fliould be of an opening quality. Ardent Tpirits, auf- tere and aftringent wines, as port, claret, &c. ought to be avoi- ded. Malt-liquor that is fine, and of a moderate ftrength, is very WANT OF APPETITE. proper. Butter-milk, whey, and other watery liquors, are likewife proper, and may be drank in turns, as inclination dircas. Thofe troubled with coftivenefs,«ought, if poffible, to remedy it by diet, as the conftant ufe of medicines for that purpofe is at- tended with many inconveniencies, and often with bad confequen- ces*. I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time, the cuftom becomes neceffary, and generally ends in a total relaxation of the bowels, indigeftion, lofs of appetite, wafting of the ftrength, and death. When the body cannot be kept open without medicine, we re- commend gentle dofes of caftor-oil, flour of fulphur, and cream of tartar, to be taken twice or thrice a-week-. This is not near fo injurious to the ftomach as aloes, jalap, or the other drastic pur- gatives fo much in ufe. Infufions of fenna and manna may like- wife be taken, or half an ounce of foluble tartar diffolved in water- gruel- About the fize of a nutmeg of lenitive eleauary taken twice or thrice a-day generally anfwers the purpofe very well. Want of Appetite. THIS may proceed from a foul ftomach; indigeftion ; the want of free air and exercife ; grief; fear ; anxiety ; or any of the de- preffing paffions ; exceffive heat; the ule of ftrong broths, fat meats, or any thing that palls the appetite, or is hard of digeftion; the immoderate ufe of ftrong liquors, tea, tobacco, opium,, Sec. The patient ought, if impofiible, to make choice of ,an open dry air; to take exercife daily on horfeback or in a carriage; to rife *• Dr- Arbuthnot advifes thofe who are troubled with coftivenefs to . life animal oils, as frefli butter, cream, marrow, fat bro'ths, efpecially "j thofe,made of internal parts of animals, as the liver, heart, midriff, Sec. the expreffed oils of mild vegetables, as olives, almonds, paftaches, and the fruits themfelves; all oily and mild fruits, as figs; decoctions of mealy vegetables ; thefe lubricate the inteftines ; fome faponaceous fubftances which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined fugar, &c. He obferves, that fuch lenitive fubftances are proper for perfons of «lry atrabilarian constitutions, who arefubjeft to aftrUtion of the belly, and the piles, and will operate when flronger medicinal fublfances are fometimes ineffectual ; but that fuch lenitive diet hurrs thofe uhofe bowels are weak and lax. He obferves, that all watery fnbftances are lenitive, and that even common water, whey, four milk, and butter milk have that effeft ;—that new milk, efpecially affes milk, ftimulates ftill more when it fours on the ftomach ; and that whey turned four will purge ftrongly ;—that moft garden fruits are likewife laxative; and that fome of them, as grapes, will throw fuch as take them imm»« derately into a cholera morbus, or iaeurabU diarrhoea. THE HEART-BURN. 29% betimes ; and to avoid all intenfe thought. He fhould ufe a diet of eafy digeftion ; and avoid exceffive heat and 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 Teachings fhew that the ftomach is loaded with crudities, a vo- mit will be of fervice. After this a gentle purge or two, of any of the bitter purging falts, may be taken. The patient ought next to ufe fome of the ftomachic bitters infufed in wine. Though gentle evacuations be necefTary, yet ftrong purges and vomits are to be avoided, as they weaken the ftomach, and hurt digeftion. Elixir of vitriol is an excellent medicine in moft cafes of indigef- tion, weaknefs of the ftomach, or want of appetite. From twenty to thirty drops of it may betaken twice or thrice a-day in a glafs of wine and water. It may likewife be mixed with the tinaure of the bark, one drachm of the former to an ounce of the latter, and two tea-fpoonfuls of it taken in wine or water, as above. The chalybeate waters, if drank in moderation, are generally of confiderable fervice in this cafe. The fait water has likewife good effeas, but muft not be ufed too freely. The waters of Har- rowgate, Scarborough, Moffat, and moft other Spas in Britain, may be ufed with advantage. All who are affliaed with indigef- tion and want of appetite, fhould repair to thefe places of public rendezvous. The very change of air, and the cheerful company, will be of fervice; not to mention the exercife, diffipation, amufe- ments. &c. The Heart-Burn, AS it is commonly called, is not a difeafe'of that organ, but an uneafy fenfation of heat or acrimony about the pit of the fto- mach, which is fometimes attended with anxiety, naufea, and vo- miting. It may proceed from debility of the ftomach, indigeftion, bile the abounding of an acid in the flomacjh, &c. Perfons liable to this complaint ought to avoid ftale liquors, acids, windy or greafy aliments, and fhould never ufe violent exercife foon after a plen- tiful meal. Many perfons have the heart-burn if they ride foon af- ter dinner, provided they have drank ale, wine, or any fermented liquor; but are never troubled with it when they have drank rum or brandy and water without any fugar or acid. When the heart-burn proceeds from debility of the ftomach or indigeftion, the patient ought to take a dofe or two of rhubarb • afterwards he may ufe infufions of the bark, or any other of the ftomachic bitters, in wine or brandy. Exercife in the open air will be of ufe, and every thing that promotes digeftion. £94 NERVOUS DISEASES. When.bilious humours occafion the heart-burn, a tea-fpoonful cf the fweet fpirit of nitre in a glafs of water, or a cup of tea, will generally give eafe. If it proceedsfrom the ufe of greafy aliments, a drachm of brandy or rum may be taVen. If acidity or fournefc of the ftomach occafions the heart-burn, abforbents are the proper medicines. In this cafe, an ounce of pow- dered chalk,halfan ounce of fine fugar, and a quarter of an ounce of gum-arabic, may be mixed in an Englifh quart of water, and a tea-cupful of it taken as often as is neceffary. Such as do not choofe ' \'chalk may take a tea-tfpo'onful of prepared oyfter-fhells, or of the powder called crabs-eyes, in a glafs of cinnamon or pepper-rnain| water. But the fafeft and beft abforbent is magnefia alba. This not •only aas as an abforbent, but likewife as a purgative ; whereat chalk and other abforbents of that kind, are apt to lie in the intef- flines and occafion obftruaions. This powder is not difagreeable, and may. be. taken in a cup of tea, or a glafs of mint-water. A largt" tea-fpoonful is the ufual dofe ; but it may be taken in a much great- er quantity when there is occafion. Thefe things are now generally made up into lozenges for the conveniency of being carried in the pocket, and taken at pleafure. If wind caufes this complaint, the moft proper medicines arc carminatives; as annifeeds, juniper-berries, ginger, canella alba, eardamon feeds, &c. Thefe may either be chewed, or infufed in wine, brandy, or other fpirits. One of the fafeft medicines of this kind is the tinaure made by infufing an ounce of rhubarb, and a quarter of an ounce of the leffer eardamon feeds, in an Englifli pint of brandy. After this has digefted for two or three days, it ought to be ftrained, and four ounces of white fugar-candy added to it. It muft ftand to digest a fecond time till the fugar be diffolv- ed. A table-Tpooful of it may be taken occafionaily for a dofe. I have frequently known the heart-hum cured,, particularly in pregnant women, by chewing green tea. ^.. ■ ------------------------------------------------——■— ■' CHAPTER XLV. Nervous Difeafes ARE, of all thofe incident to mankind, the moft complicated and difficult to cure. A volume would not be fufficient to ■point out their various appearances. They imitate almoft every dif- eafe ; and are feldom alike in two different perfons, or even in the fame perfon at different times. They arecontinually changing fhape; and upon every frefli attack, the patient thinks he feels fymp- toms which he never experienced before. Nor do they only affea the body; the mind likewife fuffers, and is often rendered extreme- ly weak aud peevilh. The low fpirits, timoroufnefs, melancholy> NERVOUS DISEASES. *95 and ficllenefs of temper, which generally attend nervous difor- ders, fnduce many to-believe that they are entirely difeafes of the mind; but this change of temper is rather a ccmfequence, than the caufe of nervous difeafes. CAUSES.----Every thing that tends to relax or weaken the body, difpofes it to nervous difeafes, as indolence, exceffive vene- ry, drinking too much tea, or other weak watery liquors warm, frequent and copious bleeding, purging, vomiting, Sic. Whatever hurts the digeftion, or prevents the proper affimilation of the food has likewife this effea ; as lor.g falling, excefs in eating or drink- ing, the ufe of windy, crude, or unwholefome aliments, an unfa- vourable pofture of the body, &e- Nervous diforders often proceed from intenfe application to ftudy. Few ftudious perfons are entirely free from them. Nor i* this to be wondered at; intenfe thinking not only preys upon the fpirits, but prevents the perfon from taking proper exercife, by which means the digeftion is impaired, the nourifhment preven- ted, and the folids relaxed. Grief and difappointment likewife pro- duce the fame effeas. More nervous patients date the com- mencement of their diforders from the lofs of a hufband, a favou- rite child, or from fome difappointment in life, than from any other caufe. Whatever weakens the body, or depreffes the Tpirits, may occafion nervous diforders, as unwholefome air, want olf fleep, great fatigue, difagreeable apprehenfions, anxiety, vexation-, &c. SYMPTOMS____We fhall only mention fome of the moft general fymptoms of thefe diforders, as it would be both an ufe>- lefs and an endlefs tafk to enumerate the whole. They generally begin with windy inflations or distentions of the ftomach and in- teftines 'T the appetite and digeftion are ufually bad ; yet fometimes there is an uncommon craving for food, and a quick digestion. The food often turns four on the ftomach; and the patient is troubled with vomiting of clear water, tough phlegm, or a black- ifh-coloured liquor, refembling the grounds of coffee. Excruci- ating pains are often felt about the navel, attended with a rumbling or murmuring noife in the bowels. The body is fometimes loofe, but more commonly bound, which occafions a retention of wind and greac uneafinefs. The "urine is fometimes in fmall quantity, at other times very eopious and quite clear. There is a great flraitnefs of the breaft, with difficulty of breathing ; violent palpitations of the heart; fudden flufhings of heat in various parts of the body -T at other times a fenfe of cold, as if water were poured on them ; flying ains in the arms and limbs; pains in the back and belly, refem- lingthole occafioned by gravel; the pulfe very variable, fome- times uncommonly flow, and at other times very quick; yawning, tffe hiccup, frequent fighing, and a fenfe of fuffocation, as if from a ball or lump in the thrct -y alternate fits of crying ai\d convul- aofj NERVOUS DISEASES. five laughing; the fleep is unfound and feldom refrefhing; tin patient is often troubled with the night-mare. As the difeafe increafes, the patient is molcfted w ith head-achs, cramps, and fixed 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 dulnefs of hearing; in fhort, th« whole animal funaions are impaired. J he mind is difturbed on the moft trivial occafions, and is hurried into the moft perverfe commotions, inquietudes, terror, fadnefs, anger, diffidence, &c. The patient is apt to entertain wild imaginations and extravagant fancies; the memory becomes weak, and the judgment fails. Nothing is more charaaeriftic of this difeafe than a conftant dread of death. This renders thofe unhappy perfons who labour under it, peevifh, fickle, impatient, and apt to run from one phyfi- cian to another; which is one reafon why they feldom reap any benefit from medicine, as they have not fufficient refolution to per fill in any one courfe till it has time to produce its proper ef- feas. 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 notions. REGIMEN.----Perfons affliaeft with nervous difeafes ought' never to fast long. Their food fhould be folid and nourifhing, but of eafy digeftion. Fat meats and heavy faufes are hurtful. All ex- cefs fhould be carefully avoided. They ought never to eat more at a time than they can eafily digest; but if they feel themfelves weak and faint between meals, they ought 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 ftomach, or the patient is much troubled with wind, brandy and water will anfwer better. Every thing that is windy or haid of digeftion muft be avoided. All weak and warm liquors are hurtful, as tea, coffee, punch, &c. People may find a temporary relief in the ufe of thefe, but they always increafe the malady, as they weaken the ftomach and hurt digeftion. Above all things, drams are to be avoided. Whatever immediate eafe the patient may feel from the ufe of ardent fpirits, they are fure to ag- gravate the malady, and prove certain poifon at laft. Thefe cau- tions are the more necefTary, as moft nervous people are peculiarly fond of tea and ardent fpirits ; to the ufe of which many of them fall viaims. Exercife in nervous diforders is fuperior to all medicines. Rid- ing on horfeback is generally efteemed the beft, as it gives motion to the whole body without fatiguing it. I have known patients with whom walking agreed better, and others who were moft be- nefited by riding in a carriage. Every one ought to ufe that which NEftVOUS DISEASES. a^y he finds moft beneficial. Long fea-voyages have an excellent ef- fea ; and to thofe who have fufficient tefolution, we recommend 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 journey, or a voyage, is of much more advantage than'riding fhort journeys near home. A cool and dry air is proper, as it braces and invigorates the whole body. Few things tend more to relax and enervate than hot air, efpecially that which is rendered fo by great fires, or ftoves in fmall apartments. But when the ftomach or bowels are weak, the body ought to be well guarded againft cold, efpecially in win- ter, by wearing a thin flannel waiftcoat next the fkin. This will keep up an equal perfpiration, and defend the alimentary canal from many impreffions to which it would otherwife be fubjea, upon every fudden change from warm to cold weather. Rub- bing the body frequently with a flefh-brufh, or a Coarfe linen' cloth, is beneficial, as it promotes the circulation, perfpiration, Sec. 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 to be diverted, and kept as eafy and cheerful as poffible. Nothing hurts the nervous Tyftem, or weak- ens the digeftive powers, more than fear, grief, or anxiety. MEDICINES.-----Nervous difeafes are feldom radically cured, yet their fymptoms may fometimes be alleviated, and life render- ed more comfortable by proper medicines* When the patient is costive, he ought to take a little rhubarb, or fome other mild purgative, and fhould never fuffer his body to be long bound. All ftrong and violent purgatives are to be avoi- ded, as aloes, jalap, &c. I have generally feen an infufion of fen- na and rhubarb in brandy anfwer very well. This may be made of any ftrength, and taken in fuch quantity as the patient finds necefTary. When digeftion is bad, or the ftomach relaxed and weak, the following infufion of bark and other bitters may be ufed with advantage : Take of Peruvian bark an ounce, gentians-root, orange-peel, and coriander-feed, cf each half an ounce ; let thefe ingredients be all bruifed in a mortar, and infufed in a bottle of brandy or whifkey, for the fpace of five or fix days. A table«-fpoonful of the ftrained liquor may be taken in half a glafs of water, an hour before breakfaft, dinner, and fupper. Few thing tend more to strengthen the nervous fyftem than cold bathing. This praaice, if duly perfifted in, will produce very ex- traordinary effeas; but when the liver or other vifceraare obftruc- ted, or otherwife unfound, the cold bath is improper. It is there- fore to be ufed with very great caution. The moft proper feafons are fummer and autumn. It will be fufficient, efpecially for per- fons of a fpare habit, to go into the cold baAli three qj four, timet 298 MELANCHOLY. a week. If the patient be weakened by it, or feels chilly for a Ion<> time after coming out, it is improper. In patients affliaed with wind, Ihave always obferved the great- eft benefit from the elixir of vitriol. It may be taken in the quan- tity of fifteen, twenty, or thirty drops, twice or thrice a-day in a glafs of water. This both expels wind, strengthens the ftomach, and promotes digeftion. Opiates are generally extolled in thefe maladies ; but as they only palliate the fymptoms, and generally afterwards increafe the- difeafe, we advife people to be extremely fparing in the ufe of them, left habit render them at laft abfolutely neceffary. It would be an eafy matter to enumerate many medicines which have been extolled for relieving nervous diforders;. but whoever wifhes for a thorough cure muft expea it from regimen.' alone ; we fhall therefore omit mentioning more medicines, and again re- commend the ftriaeft. attention to diet, air, exercife, aud amufe- ments. Melancholy IS that ftate of alienation or weaknefs of mind which renders people incapable of enjoying the pleafures, or performing the du- ties of life. It is a degree of infanity, and often terminates in ab- folute madnefs. CAUSES.----It may proceed from an hereditary difpofition ; intenfe thinking, efpecially where the mind is long occupied about one objea-, violent paffions or affeaions of the mind, as love, fear, joy, grief, overweening pride, and fuch-like. It may alfo be occa- fioned by exceffive venery ; narcotic or ftupefaaive poifons; a fe- dentary life ; folitude ; the fuppreffion of customary evacuations; acute fevers or other difeafes. Violent anger will change melan- choly into madnefs; and exceffive cold, efpecially of the lower ex- tremities, will force the blood into the brain, and produce all the fymptoms of madnefs. It may likewife proceed from the ufe of aliment that is hard of digeftion, or which cannot be eafily affi- milated, from a callous ftate of the integuments of the brain. To all which, we may add gloomy or mistaken notions of religion. • SYMPTOMS.----When perfons begin to be melancholy, they are timorous; watchful; fond of folitude; fretful; captious and inquifitive ; folicitous about trifles ; fometimes niggardly, and at other times prodigal. The body is generally bound ; the urine thin, and in fmall quantity; the ftomach and bowels inflated with wind ; the complexion pale ; the pulfe flow and weak. The func- tions of the mind are alfo greatly perverted ; the patient often imagines himfelf dead, or changed into fome other animal. Some have imagined their bodies were made of irlafs. or other brittle MELANCHOLY. 299 rubflan'ees, and were afraid to move left they fliould be broken to pieces. :The patient, in this cafe, unlefs carefully watched,' is apt to put an end to his own life. When the difeafe is owing to an obftruaion of customary eva- cuations, or any bodily diforder, it is eafier cured than when it proceeds from affeaions of the mind, or any hereditary nint. A difcharge of blood from the nofe, loofenefs, fcabby eruptions, the bleeding piles, or the menfes, fometimes cany off this difeafe. REGIMEN.----The diet fhould confift chiefly of vegetables of a cooling and opening quality. Animal food, efpecially falted or fmoke-dried fifh or flefh, ought to be avoided. All kinds of fhell-fifh are bad. Aliments prepared with onions, garlic, or any thing that generates thick blood, are likewife improper. All kinds of fruits that are wholefome may be eaten with advantage. Boer- haave gives un instance of a patient, who, by a long ufe of whey, water, and garden fruit, recovered, after having evacuated a great quantity of black-coloured matter. Strong.liquors of every kind ought to be avoided as 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 eaten freely, or his drink may be fweetened with it. Infufions of balm-leaves, penny-royal, the roots of wild valerian, or the flow- ers of the lime-tree, may be drank freely, either by themfelves, or fweetened with honey, as the patient fhall choofe. The patient ought to take as much exercife in the open air as he can bear. This tends to remove obftruaions, promotes the per- fpiration, and all the other fecretions. Every kind of madnefs is attended with a diminifhed .perfpiration ; all means ought there- fore to be ufed to promote that neceffary and falutary difcharge. Nothing can have a more direa tendency to increafe the difeafe than confining the patient to a clofe apartment. Were he forced to ride or walk a certain number 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 dig- ging, hoeing, planting,fowing, &c.both the body and mind would be exercifed. A long journey, or a voyage, efpecially towards 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* MEDICINE-----In the cure of this difeafe, particular atten-" tion muft be paid to the mind. When the patient is in a low ftate, his mind ought to be foothed and diverted with variety o£ amufements, as entertaining flories, pastimes, mufic, &c. This feems to have been the method of curing melancholy among the Jews, as we learn from the ftory of Saul; and it is a very ration- al one. Nothing can remove difeafes of the mincf fo effeaually, as applications to the mind itfelf, the moft efficacious of which is 300 MELANCHOLY. mufic. The patient's company ought likewife to confift of fuch perfons as are agreeable to him. People in this ftate are apt to conceive unaccountable averfions againft particular perfons ; and the very fight of fuch perfons is fufficient to diftraa their minds, and throw them into the utmost perturbation. When the patient is high, evacuations are neceffary. In this cafe, he muft be bled, and have his body kept open by purging medicines, as manna, cream of tartar, or the foluble tartar. I have feen the laft have very happy effeas. It may be taken in the dofe of half an ounce, diffolved in water gruel, every day, for fun dry weeks, or even for months, if neceffary. More or lefs may be given according as it operates. Vomits have likewife a good ef- fea ; but they muft be pretty ftrong, otherwife they will not ope- rate. Whatever increafes the evacuation of urine or promotes per- fpiration, has a tendency to remove this difeafe. Both thefe fe- cretions may be promoted by the ufe of nitre and vinegar. Half a drachm of purified nitre may be given three or four times a-day in any manner that is moft agreeable to the patient; and an ounce and a half of diftilled vinegar may be daily mixed with his drink. Dr. Locker feems to think vinegar the beft medicine that can be given in this difeafe. Camphire and mufk have been ufed in this cafe with advantage, Ten or twelve grains of camphire may be rubbed in a mortar^ with half a drachm of nitre, and taken twice a-day, or oftener, if the ftomach will bear it. If it will not fit upon the ftomach in this form, it may be made into pills with gum afafcetida and Ruffian caftor, and taken in the quantity above direaed. If mufk is to be adminiftered, 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 f but which ever of them is given, muft be duly perfifted.in, and where one fails, another may be tried. As it is very difficult to induce patients, in this difeafe, to take medicines, we fhall mention a few outward applications, which fometimes do good ; the printipal of thefe are iffues, fetons, and warm bathing. Iffues may be made in any part of the body, but they generally have the beft effea near the fpine. The difcharge from tnefe, may be greatly promoted, by dreffing them with the mild bliftering ointment, and keeping what are commonly called the orrice peafe in them. The moft proper place for a feton is be- tween the flioulder-blades;, and it ought to he placed upwards and downwards, or in the direaion of the fpine. 3oi The Palfy IS a lofs or diminution of fenfe or motion, or of both, in one or more parts of the body. Of all the affeaions called nervous, this is the moft fuddenly fatal. It is more or lefs dan- gerous, according to the importance of the part affeaed. A palTy of the heart, lungs, or any part neceffary to 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, a3 it ftiows that the difeafe proceeds from the brain. When the part affeaed feels cold, is infenfible, or waftea away, or when the judgment and memory begin to fail, there is fm'all hope of a cure. CAUSES____^The immediate caufe of palfy is any thing that prevents the regular exertion of the nervous power upon any par- ticular mufcle or part of the body, The occafional and predifpo- fing caufes are various, as drunkennefs; wounds of the brain, or fpinal marrow $ preffure upon the brain or nerves ; very cold or damp air ; the fuppreflion of customary evacuations ; fudden fear; want of exercife; or whatever greatlv relaxes the fyftem, as drink- ing much tea*, or coffee, &c. The palfy may likewife proceed from wounds of the nerves themfelves, from the poifonous fumes of metals or minerals, as mercury, lead, arfnic. In young perfons of a full habit, the palfy muft be treated in the fame manner as the fanguine apoplexy. The patient muft be bled, bliftered, and have his body opened by fharp clyfters or purgative medicines. But, in old age, or when the difeafe proceeds from, re- laxation or debility, which is generally the cafe, a quite contrary courfe muft be purfued. The diet muft be warm and invigorating, feafoned with fpicy and aromatic vegetables, as muftard, horfe-Ta- difli, &c. The drink may be generous wine, muftard, whey, or brandy and water. Friaion with the flefh-brufh, or a warm hand, is extremely proper, efpecially on the parts affeaed. Blifters may likewife be applied to the affeaed parts with advantage. When this cannot be done, they may be rubbed with the volatile lini- ment, or the nerve ointment of the Edinburgh difpenfatory. One of the beft external applications is elearicity. The fhocks, or ra- ther vibrations, fhould be received on the part affeaed ; and ihey ought daily to be repeated for feveral weeks. Cephalic fnuff, or any thing that makes the patient fneeze, is * Many people imagine, that tea has no tendency to hurt1 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 warm milk and water daily, without feeling any bad confequences ; yet the fame quantity of tea will make their hands fhake for twenty-four hours. That tea affe&s the uerves, is likewife evident, from its preventing fleep, occafioning giddinefs, dimnefs of the £ghr, ficknefs, &c. 302 TETANUS. likewifj of ufe. Some pretend to have found great benefit from rubbing the parts affeaed with nettles ; but this does not feem to be any way preferable to bliftering. If the tongue is affeaed, the patient may gargle his mouth frequently with brandy and muftard ; or he may hold a bit of fugar in his mouth wet with compound fpirits of lavender.. The wild valerian-root is a very proper medi- cine in this cafe. It may cither be taken in an infufion with fage- leaves, or half a drachm 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 offal volatile oleofum, compound fpirits of lavender, and tinaure of caftor, each half an ounce ; mix thefe together, and take forty or fifty drops in a glafs of wine three or four times a-day. A table-fpoonful of muftard-fced taken frequently is a very good medicine. The patient ought likewife to chew cinnamon-bark, ginger or other warm fpiceries. Exercife is of the utmoft importance in the palfy ; but the pa- tient muft beware of cold, damp, and moift air. He ought to wear ffannel next his fkin ; and if poffible, fhould remove into a war- mer climate, Tetanus, or the Locked-Jaw. UNDER this term may be comprehended the fpafmodic af- feaions, called emprofthotonos, opifthotonos, and trifmus, be- ing one difeafe, differing only in the degree of its violence. When the body and head are bended forwards, it is called tmproflhoto- nos; when they are carried backwards, and immovably fixed, it bears the appellation of opifthotonos; and when the body is fuf- tained in an erea position, by the mufcle on the fore and back part of the trunk aaing with equal ftrength, the difeafe is called tetanus. When the mufcles of the jaw become more particularly affeaed, it is called trifmus, or locke* jaw. Thefe fpafmodic complaints afteft both Texes, and no age is ex- empted from their violence. They affea the male oftener than the female, and more particularly thofe people who inhabit warm climates, and every climate at the warm feafon of the year. Some- times they occur in winter, independent of wounds. CAUSES.---Wounds in any part of the body are fometimes fucceeded by this difeafe. But more particularly from thofe in tendons, where a trifling injury will not unfrequently produce this complaint, when it is leaft expeaed. Whereas, at other times, a wound of confiderable magnitude, under apparently fimilar cir- cumftances, will have no fuch effea : and, even after operations in tendenous parts, it is by no means a frequent occurrence ; when at other timer, a fimple fraaure of the leg will produce it in all . TETANUS. 303 its force. Cold, when accompanied with moifture, will produce this difeafe ; particularly when the body is expofed whilev afleep* on a. damp pavement, or in a damp cellar, immediately after be- ing heated and fatigued by exercife. Children are frequehtlf feized with this difeafe in a fhort time after delivery. .-» SYMPTOMS.----This difeafe, if it is from the effeas of cold, generally comes on of a fudden. But when from a wound, it gra* dually approaches about the tenth, fourteenth, or twentieth days after the accident. It often comes on at a, time when the wound gives but lirtte uncafinefs, and is nearly healed. The patient firft complains of an uneafy fenfation at the lower part of the breaft bone,.with a ftiffnefs in the back part of the neck and mufcles, of the lower jaw, which increafe with a painful fenfation at the root of the tongue, and a flight difficulty in fwallowing. But no appear- ance of fwelling can be obferved in the throat. The mufcles of the back now become rigid. This rigidity in a fhort tjme extends to thofe of the neck, attended with a pain in the direaion of the fpine of the back. At length the head, neck, and back bone are forcibly bent backwards." The body becomes fixed in tha.t pofitiom The mufcles of the jaw are now violently affeaed, attended with an impoffibility of fwallowing. Even liquids are thrown forcibly back through the nofe. Thefe fymptoms generally take place on the fecond or third day, when the body is frequently feized with violent convulfive fpafms; and the pain at the lower part of the breaft bone increafes, which fhoots through towards the back. The mufcles of the limbs now become rigid, and the body is fo much bent backwards a3 to reft on the back part of the head ,and heels. As the difeafe advances, the convulfive fpafms become more violent. At length tetanus is produced, from the mufcles on the -fore and back part of the trunk, aaing with an equal degree of vigour, fuftaining the body in an erea pofition. The pulfe is ge- nerally frequen't with the other fymptoms of fever, particularly when the difeafe is the confequence of cold. The bowels are ge- nerally costive, attended with a retraaion of the belly. The urine is difcharged with difficulty, and fometimes a fuppreffion of thai evacuation takes place. The face appears pale, expreffive of great- anxiety and diftrefs. The patient is feldom, if ever, delirious, al- though he flumbers but little, from whichhe frequently awakes on a fudden, with violent fpafms. At length, the mufcular fyftem be- comes more generally affeaed, and one univerfal convulfion clofes the miferable exiftence of the patient. MEDICINE.-----In our attempt to cure this difeafe, the indi- cations are nearly the fame, when produced from cold or the confe- quence of a wound, except when the wound is without fwelling and inflammation. It fhould then be dilated and dreffed, with lint dipped in warm bafiiicon, or any other ftimulating application. Af- ter this, tv/o, three, of even four grains of opium fliould be given three or four time;- a day, according to the urgency of the fymp- 304 . THE EPILEPSY, Atf. toms, and tendency to induce fleep ; for aftonifhingquantitiesof this medicine may be given without having the leaft tendency to make the patient flumber. This remedy fhould be .administered early, a9 well as large quantities of Madeira wine, before the fwallowing be- comes interrupted ; and the fyftem fhould be charged with mercury, with as much expedition as poffible. For this purpofe, two or three drachms of mercurial ointment muft be rubbed into the infide of the legs, thighs, and arms, morning and evening, and likewife into the mufcles more particularly affeaed with fpafms. To co-operate *vith thofe medicines, the cold bath muft be ufed, or cold water thrown over the body. The bowels fhould be kept open with calo- mel, caftor-oil, and clyfters. All thofe remedies muft be ufed at an early period of the complaint, fo as to make as formidable an attack as poffible on this very formidable difeafe, which too frequently terminates in the death of the patient, in fpite of every effort to five him. When it is about to take place in infants, the bowels muft be opened with calomel or caftor oil. But where it has aaually taken place, little can be done. However, a fimilar plan may be ufed with that recommended in grown perfonsi —"*iSSsa»— * Of the Epilepfy or Falling Sicknefs. THE epilepfy is a fudden deprivation of all the fenfes, wherein the patient falls fuddenly down, and is affeaed with violent convul- five motions. Children, efpecially thofe who are delicately brought up, are moft fubjea to it. It more frequently attacks men than wo- men, and is very difficult to cure. When the epilepfy attacks chil- dren, there is reafon to hope that it will go off about the time of puberty. When it attacks any perfon after twenty years of age, the cure is difficult; but when after forty, a cure is hardiy to be expec- ted. If the fit continues only for a fhort fpace, and returns feldom, there is reafon to hope; but if it continues long, and returns frequent- ly, the profpea is bad. It is a very unfavourable fymptom when the patient is feized with the fits in his fleep. CAUSES.----The epilepfy is fometimes hereditary. It may likewife proceed from blows, bruifes, or wounds on the head; a colleaion of water, blood, or ferous humours in the brain ; a poly- pus ; tumours or concretions within the fkull; exceffive drinking; mtenle ftudy; excefs of venery; worms ; teething ; fuppreffion of cuftomary evacuations ; too great emptinefs or repletion ; vio- lent paffions or affeaions of the mind, as fear, joy, &c ; hyfteric af- feaions ; contagion received into the body, a* the infeaion of the finail-pox, meafles, &c. THE EPILEPSY, &c. 303 SYMPTOMS.----An epileptic fit is generally preceded by un- ufual wearinefs ; pain of the head ; duUnefs ; giddinefs ; noife in the ears ; dimnefs of fight; palpitation of the heart; difturbed fleep ; difficult breathing ; the bowels are inflated with wind ; the urine is in great quantity, but thin ; the complexion is pale ; the extremi- ties are cold ; and the patient often feels, as it were, a stream 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 his hands ; his eyes are diftorted ; he ftarts, and foams at the mouth ; his extremities are bent or twitted various ways ; he often difcharges his feed, urine, and faeces involuntarily ; and is quite destitute of all fenfe and rea- fon. "After the fit is over, his fenfes gradually return, and he com- plains of a kind of ftupor, wearinefs, and pain of his head ; but has no remembrance of what happened to him during the fit. The fits are fometimes excited by violent affeaions of the mind, a debauch of liquor, exceffive heat, cold, or the like. This difeafe, from the difficulty of investigating 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. It depends as much upon na- tural caufes as any other malady ; and its cure may often be effec- m ted by perfi fling in the uTe of proper means; REGIMEN.----Epileptic patients ought, if poffible, to breathe a pure and free air. Their diet fhould be light but nourifhing. They ought to drink nothing ftrong, to avoid fwine's flefh, water fowl, and likewife all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themfelves cheerful, carefully guarding againft all violent paffions, as anger, fear, exceffive joy, and the like. Exercife is likewife of great ufe ; but the patient muft be careful to avoid all extremes either of heat or cold, all dangerous fituations, as Handing upon precipices, riding, deep waters, and fuch like. MEDICINE.-----'The intentious of cure muft vary according to die caufe of the difeafe. If the patient be of a fanguine tempera- ment, and there be reafon to fear an obftruaion in the brain, bleed- ing and other evacuations will be neceflary. When the difeafe is oc- cafioned by customary evacuations, thefe, if poffible, muft be rello- red; if this cannot be done, others may be fubftituted in their place. Iffues or Tetons in this caTe 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 carry off theTe vermin. When the diTeaTe proceeds from teething, the body fhould be kept open by emollient clyfters, tfce feet frequently bathed in Warm wa- ter, and, if the fits prove obftinate, a blifter 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, &c. When the difeafe is hereditary, or proceeds from a wrong forma- tion of the brain, a cure is not to be expeaed. When it is owing 3°6 THE HICCUP. to a debility, or too great an irritability of the nervous fyftem, fucfc medicines as tend to brace ajid strengthen the nerves may be ufed, as the Peruvian bark, fteel, &c. The flowers of zinc have of late been highly extolled for the curC of the epilepfy. This medicine will not anfwer the expeaations which have been raifed concerning it, yet in obftinate epileptic ca- fes, it deferves a trial. The dofe is from one to three or four grains, which may be taken either in pills or a bolus, as the patient inclines. The beft method is to begin with a fingle grain four or five times a-day, and gradually to increafe the dofe as far as the patient can bear it. I have known this medicine, when duly perfifted in, prove beneficial. Mufk has fometimes been found to fucceed in the epilepfy. Ten or twelve grains of it, with the fame quantity of faaitious cinna- bar, may be made up into a bolus, and taken every night and morning. Sometimes the epilepfy has been cured by elearicity. Convulfion-fits proceed from the fame caufes, and muft be treat- ed in the fame manner as the epilepfy. There is one particular fpecies of convulfion-fits which common- ly goes by the name of St. Vitus's dance, wherein the patient is agitated with ftrange motions and gefticulations, which, by the com- mon people, are generally believed to be the effeas of witchcraft: This difeafe may be cured by repeated bleedings aud purges ; and afterwards ufing the medicines prefcribed above for the epilepfy, viz. the Peruvian bark and fnake-root, &c. Chalybeate waters are found to be beneficial in this cafe. The cold bath is likewife of An- gular fervice, and ought never to be negleaed when the patient can bear it. The Hiccup IS a fpafmodic or convulfive affeaion of the ftomach and mi- driff, arifing from any caufe that 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 gangrenes, acute and malignant fevers, a hiccup is often the forerunner of death. YiThen the hiccup proceeds from the ufe of aliment that is flatu- lent, or hard of digeftion, a draught of generous wine, or a drachm of any fpirituous liquor, will generally remove 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 fto- mach, &c. it is very dangerous. In this cafe, the cooling regimen •ught to be ftriaiy obferved. The patient muft be bled, and take CRAMP OF THE STOMACH. 307 frequently a few drops of the fweet fpirits of nitre in a cup of wine- whey. His ftomach fhould likewife betfomented with cloths dipped in warm water, or have bladders, filled with warm milk and wa- ter, applied to it. When the hiccup proceeds from a gangrene or mortification, the bark, and other antifeptics, are the only medicines which have a chance to fucceed. When it is a primary difeafe, and proceeds from a foul ftomach, loaded with a bilious humour, 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 prin- cipal of thefe is mufk ; fifteen or twenty grains of which may be made into a bolus, and repeated occafionaily. Opiates are of fer- vice ; but they muft be ufed with caution. A bit of fugar, dipped in compound fpirits of lavender, or the volatile aromatic tinaure, may be taken frequently. External applications are fometimes alfo bene- ficial ; as the ftomach plaifter, or a cataplafm of the Venice treacle v of the Edinburgh or London difpenfatory, applied to the region of the ftomach. I lately attended a patient who had almoft a conftant hiccup for above nine weeks. It was frequently flopped by the ufe of mufk, opium, wine, and other cordial and antifpafmodic medicines, but always returned. Nothing 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 feized with a vomit- ing of blood, which foon put an end to his life. Upon opening the body, a large fchirrous tumour was found near the pylorus or right •rifice of the ftomach. Cramp of the Stomach. THIS difeafe often feizes people fuddenly, is very dangerous, and requires immediate affiftance. It is moft incident to perfons in the decline of life, efpecially the nervous, gouty, hyfteric, and hypo- chondriac. If the patient has any inclination to vomit, he ought to take fome draughts of warm water, or weak camomile-tea, to cleanfe his fto- mach. After this, if he has been coftive, a laxative clyfter may be given. He ought then to take laudanum. The beft way of adminif- tering it is in a clyfter. Sixty or feventy drops of liquid laudanum may be given in a clyfter of warm water. This i; much more cer- 308 THE NIGHT-MARE. tain than laudanum given by the mouth, which is often vomited, and in fome cafes, increafesfhe pain and fpafms in the ftomach*. If the pain and cramps return with great violence, after the effeas of the anodyne clyfter are over, another, with an equal or a larger quantity of opium, may be given ; and every four or five hours a bolus, with ten or twelve grains of mufk, and half a drachm of the Venice treacle. In the mean time, the ftomach ought to be fomented with clothq dipped in warm water, or bladders, filled with warm milk and wa- ter, fhould be conftantly applied to itf. I have often feen thefe pro- duce the moft happy effeas. The anodyne balfam may alfo be rubT bed on the part affeaed ; and an antihyfteric plaifter worn upon it for fome time after the cramps are removed, to prevent their re-r turn. In very violent and lafting pains of the ftomach, fome blood ought to be let, unlefs the weaknefs of the patient forbids it. 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. Blifters 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 large plaifter of Venice treacle. Of the Night-Mare. IN this difeafe,the patient, in time of fleep, imagines he feels an un? common opprcffion or weight about his breaft or ftomach, which he can byno means fhake off. He groans,and fometimes cries out, though oftner he attempts to fpeak in vain. Sometimes he imagines him- felf engaged with an enemy, and in danger of being killed, attempts to 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 bloods from a ftagnation of blood in the brain, lungs, &c. But it is rather a nervous affeclion, and arifes chiefly from indigeftion. Perfons of weak nerves, who lead a fedentary life, and live full, are moft com- monly affliaed with the night-mare. Nothing tends more to pro- duce it than heavy fuppers, efpecially when eaten late, or the pa- tient goes to bed foon after. Wind is aSrery frequent caufe of this •* Laudanum fhould always be tried by the mouth in large dofes, as 'it tan be given without deby ; which is of the inmost confequence in fo dangerous p. difeafe. '(I. C.) t The ] .t tit may go into the warm bath, which is more effica- ficus. (I. c. SWOONINGS. 309 has it in his power, he ought to travel either by fea or land. A voyage . or a long journey, efpecially towards a warmer climate, will be of more fervice than any medicine. -K- Some- perfons afflifted with cramps pretend to reap great benefit ^rofn fmall bundles of rofemary tied all night about their feet, ancles, and knees. HYPOCHONDRIAC AFFECTIONS. 317 The general intentions of cure, in this difeafe, are to strengthen the alimentary canal, and to promote the fecretions. Thefe inten- tions will be beft anfwered by the different preparations of iron and the bark, which, after proper evacuations, may be taken as direaed in the preceding difeafe. If the patient be coftive, it will be neceffary to make ufe of fome gentle opening medicine, as pills compofed of equal parts of aloes, rhubarb, and afafcetida, with as much of the elixir proprietatis as is neceflary to form the ingredients into pills. Two, three, or four, of thefe may be taken as often as it fhall be found needful, to keep the body gently open. Such as cannot bear the afafcetida may fub- flitute Spanifh foap in its place. A cheerful glafs may have good effeas in this difeafe, but all manner of excefs is hurtful. Intenfe ftudy, and every thing that de- preffes the fpirits, are likewife pernicious. Though the general fymptoms and treatment of nervous difor- ders were pointed out in the beginning of this chapter ; yet, for the benefit of the unhappy -perfons affliaed with thefe obftinate and complicated maladies, I have treated feveral of their capital fymp- toms under diftina or feparate heads. Thefe are not to be consider- ed as different diTeafes, but as various modifications of the fame difeafe. They all arife from the fame general caufes, and require nearly the fame method of treatment. There are many other fymp- toms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I therefore omit them, and conclude this chapter with a few remarks on the means of pre- venting or avoiding nervous diforders. In all perfons thus affliaed, there is a great delicacy and fenfi- bility qf the whole nervous fyftem, and an uncommon degree of weak- nefs of the organs of digeftion. Thefe maybe either natural or ac- quired. "When owing to a defea in the constitution, they are hardly to be removed ; but may be mitigated by proper care. When in- duced by difeafes, as long or repeated fevers, profufe hemorrhages, ov the like, they prove alfo very obftinate, and will yield only to a courfe of regimen calculated to reftore and invigorate the habit. But nervous affeaions arife more frequently from caufes, which it is, in a great meafure, in our power to avoid, than from difeafes, or an original fault in the conftitution, &c. Exceffive grief, intenfe ftudy, improper diet, and neglea of exercife, are the great fources of this extenfive clafs of difeafes. Grief indulged, destroys the appetite and digeftion, depreffes the fpirits, and induces an univerfal relaxation and debility of the whole fyftem. Inftances of this are daily to be feen. The lofs of a near relation, or any other misfortune in hie, often occafions the moft complicated feries in nervous fymptoms. Such misfortunes are not to be avoided, but their effeas, by a vigorous and proper exertion of the mind, might be rendered lefs hurtful. We refer the reader to the article Grief, in the chapter on the paffions, $18 DISORDERS OF THE SENSES. The effeas of intenfe ftudy are pretty fimilar to thofe occafioned by grief. It preys upon the animal fpirits, and deftroys the appetite and digeftion. To prevent thefe effeas, ftudious perfons ought, ac- cording to the poet, to toy with their books*. They fliould never ftudy too long at a time; nor attend long to one particular fubjedt, ef- pecially if it be of a ferious nature. They ought likewife to be at- tentive to their pofture, and take care frequently to unbend their minds by mufic, diverfions, or going into agreeable company. With regard to diet, nervous difeafes may be induced either by excefs or inanition. Both of thefe extremes hurt the digeftion. When Nature is oppreffed with frefh loads of food, before The has had time to digeft and affimilate the former meal, her powers are weakened. On the other hand, when the food is not fufficiently nourifhing, or is taken too feldom, the bowels are inflated with wind. Thefe extremes are with equal care to be avoided. They both tend to induce a relaxation, and debility of the nervous fyf- tem, with all its confequences. The moft general caufe of nervous diforders is indolence. The aaive and laborious are feldom troubled with them. They are re- ferved for the children of eafe and affluence, who generally feel their keenest force. The means of prevention and cure are both in their power. If the conftitution of human nature be fuch, that man muft either labour or fuffer- difeafes, no individual has a right to expect exemption from the general rule. Thofe who are willing to take exercife, but whofe occupations Confine them to the houfe, and perhaps to an unfavourable pofture, deferve pity. We have, in the former part of this book, endeavoured to lay down rules for their condua ; 2nd where thefe cannot be complied with, their place may, in fome meafure, be fupplied by the ufe of bracing and ftrengthening medicines, as the bark, with other bit- ters ; the preparations of fleel; the elixir of vitriol, &c. CHAPTER XLVI. Diforders of the Senfes. WE do not mean to give a defcription of the organs by which the fenfes are performed; but to point out fome of the difeafes to which thefe organs are moft liable, and to fhew how they may be prevented or remedied. * Arm£tron;r on health. [ 3*9 ] Of the Eye. NO organ of the body is fubjea to more difeafes than the eye ; nor is there any one of which the difeafes are more difficult to cure^ Though more ignorant perfons pretend to cure thefe than any other ciafs of difeafes ; yet a very fuperficial acquaintance with the ftruaure of the eye, and the nature of vifion, will be fufficient to convince any one of the danger of trusting to them. Thefe difeafes often exceed the fkill of the moft learned phyfician; hence we may infer the danger of trusting them to ignorant quacks, who put out more eyes than they cure. But, though the difeafes of the eye can feldom be cured, they might often, by due care, be prevented ; and, even where the fight is totally loft, many things might be done, which are generally negleaed, to render the perfon both more ufe- ful to himfelf and to fociety*. The eyes are hurt by viewing bright or luminous objeas; keep- ing the head too long in a hanging pofture ; violent head-achs ; ex- ceffive venery; the long ufe of bitters ; the effluvia from acrid or • Volatile fubftances ; various difeafes ; as the fmall-pox, meafles, &c. but/above all, from night-watching, and candle-light ftudies. Long fafting is likewife hurtfuj to the eyes, and frequent heats and colds are no lefs pernicious. The eyes are often hurt by the ftoppage of customary evacuations ; as morning fweats ; fweating of the feet; the menfes in women ; and the bleeding piles in men. All kinds of excefs are hurtful to the fight, particularly the immoderate ufe of ardent fpirits and other ftrong liquors. In all difeafes of the eyes, efpecially thofe attended with inflam- mation, the cool regimen ought to be obferved. The patient muft abftain from all fpirituous Mquors. The fmoke of tobacco, fmoky rooms, the vapours of onions and garlic, and all vivid lights and > glaring colours, are carefully to be avoided. The drink may be wa- ter, whey, or fmall beer; and the aliment muft be light and of ea- y fy digeftion. For preventing diforders of the eyes, iffues and Tetons are of prime ufe. Every perfon, whofe eyes are tender, ought to have one or more of thefe in fome part of the body. It will likewife be of ufe to keep the body gently open, and either to bleed or purge every * It is pity thofe who have the misfortune to be born blind, or who lofe their fight when young, fliould be fuffered to remain in ignorance, or to beg. This is both crueltyaiid want of economy. There are many employments of which blind perfons are very capable, as knitting, card- ing, turning a wheel, teaching languages, &c. Nor are instances want- ing of perfons who have arrived at the highest pitch of learning, with- out having the leaft idea of.light. VVitnefs the, late famous Nicholas rSanderfon of Cambridge, and Dr. Thomas lilacklock of Edinburgh. The former was one of the firft mathematicians qj his age, and the lat- ter, belid^s being a good poet and philofophei\ is matter of all the learned languages, and a very confiderable adept in the liberal .:ui. 320 OF THE EYE.# fpring and fall. All excefs and night ftudies are to be avoided. Such as do not choofe a feton or an iffue, will find benefit from wearing a fmall Burgundy-pitch plalter between their fhoulders. A gutta ferena, or amaurofis, is an abolition of the fight without any apparent caufe or fault in the eyes. When it is owing to a decay or wafting of the optic nerve, it does not admit of a cure; but when it proceeds from a compreffion of the nerves by redundant humours, thefe may in fome meafure be drained off, and the p itimt reliev- ed. For this purpofe, the body muft be kept open with the laxative mercurial pills. If the patient be young and of a fanguine habit, he may be bled. Cupping, with fcarifications on the back part of the head, will likewife be of ufe. A running at the nofe may be pro- moted by volatile frits, ftimulating powders, &c. But the moft like* ly means for relieving the patient, are iffues or blifters kept open for a long time on the back part of the head, behind the ears, or on the neck. I have known thefe reftore fight, even after it had been for a confiderable time loft. Should thefe fail, recourfe muft be had to a mercurial falivation*. A cataraB is an obftruaion of the pupil, by the interposition of fome opaque fubftance, which either diminifhes or totally extin- guifhes the fight. It is generally an opacity of the chryftalline hu- mour. In a recent or beginning cataraa, the fame medicines are to be ufed as in the gutta ferena ; and they will fometimes fucceed. But when this does not happen, and the cataraa becomes firm, it muft be couched, or rather extraaed. I have refolved a recent ca- taraa by giving the patient frequent purges with calomel, keeping a poultice of frefh hemlock conftantly upon the eye, and a perpetu- al blifter on the neck. ■ The myopia, or fhort-fightednefs, and the pre/byopia, or feeing only at \ too great a diftance, Tire diforders which liepend on the original struc- ture or figure of the eye, therefore admit of no cure. The inconve- niencies arifing from them may however be, in fome meafure, re- medied by the help of proper glaffes. The former requires the aid of a concave, and riie latter of a convex glafs. ^ I Aflrabifmus or fquinting, depends upon an irregular contraaioh J of the mufcles of the eye from a fpafm, palfy, epilepfy, or an ill ha- bit. Children often contraa this diforder by having their eyes un- equally expofed to the light. They may likewife acquire it by imi- tation from a fquinting nurfe or play fellow, &c. As this diforder ,$ can hardly be cured, parents ought to be careful to prevent it. Al- moft the only thing which can be done for it, is to contrive a mafk -t for the child to wear, which will only permit him to fee in a straight direaion. Spots or fpechs on the eyes are generally the effea of inflammation, and often appear after the fmall-pox, the meafles, or violent ophthal- * EIe£tuary has beoii known to have a good effect in this difeafe, par- ticularly when applied to parts near the eyes. (I. C) THE EAR. 321- mias. They are very difficult to cure, and often occafion total blind- nef1?. If the fpecks are foft and thin, they_may fometimes be taken off by gentle cauftics and difcutients; as vitriol, the juice of celan- dine, &c. When thefe do not fucceed, a furgical operation may be tried: the fuccefs of which is always very doubtful. The bloodfhot eye may be occafioned by a ftroke, a fall, retching, vomiting, violent coughing, &c. I have frequently known it happen : to children in the hooping-cough. It appears at firft like a hit of fcarlet, and is afterwards of a livid or blackish colour. This difor- der generally goes off without medicine. Should it prove obftinate, the patient may be bled, and have his eyes bathed with rich led wa- ter, and the body fhould be kept open by gentle purgatives. The watery or weeping eye is generally occafioned by a relaxation or weaknefs of the glandular parts of that organ. Thefe may be braced and strengthened by bathing the eye with brandy and wa- ter, Hungary-water, rofe-water with white vitriol diffolved in it, &c. Medicines which make a revulsion are likewife proper; as mild , purgatives, perpetual blifters on the neck, bathing the feet frequent- ly in lukewarm water, Sec. When this difeafe proceeds from an obftruaion of the lachrymal dua, or natural paffage of the tears, it is called a fiftula lachryma- lis, and can only be cured by a furgical 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 hurt by exceffive noile; violentcolds in the head ; fevers, hard wax, or other fubftances fticking in the cavity of the ear; too great a degree of moifture or drynefs of the ear. Deafnefs is very often the effeclj of old age, and is incident to moft people in the decline of life. jt Sometimes it is owing to an original fault in the ftruaure or for- mation of ,the ear itfelf. When this is the cafe, it admits of no cure; and the perfon not only continues deaf, but generally likewife dumb for life*. When deafnefs is the effea of wounds or ulcers of the ears, or of old age, it is not eafily removed. When it proceeds from cold # Though thofe born deaf are generally fuffered to continue dumb, andconfequently are, in a great meafure, loft to fociety, yet nothing is more certain than that fuch perfons may be taught not only to read and write, but alfo to fpeak, and to underftand what others fay to them. ,. Teaching the dumb to fpeak will appaar paradoxical to thofe who do * not confider that the formation of founds is merely mechanical, and %: may be taught without the affiftance of the ear. This is hot only capa- S 2 3-1 THE £ar. of the head, the patient muft be careful to keep his-head warm, es- pecially in the night; he fhould likewife take fome gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bed-time. When deafnefs is the effea of a fever, it gene- ^ rally goes off after the patient recovers. If it proceeds from" dry, wax fticking in the ears, it may be foftened hf dropping oil into them''.; afterwards they muft be fyringed with warm milk and water. ., - U Ideafnefs proceeds from drynefs of the ears, which may be known by looking into them, half an ounce cf the oil of fweet al- mond6, and the fame quantity of liquid apodeldoch, or tinaure of afafcetida, may be mixed together, and a few drops of it put into j the ear every night at bed-time, ftopping tiiem 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 ve- ty well. When the ears abound with moifture, it may be drained -.;'<; diffcyan iffue or feton, which fhould be made as near the affeaed '•' pnrt* as poffible. ; /"'*■ 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. Etmuller ex- tols amber and mufk ; and Brookes"fays, he has often known hard- jjj nefs of hearing cured, by putting a grain or two of mufk into th* ear with cotton-wool. But thefe and other applications muft be va- ried, according to the caufe of the diforder. , Though fuch applications may fometimes be of fervice, yet they much oftener fail, and frequently they do hurt. Neither the eyes nor ble of demonftratidn, but u aft-nally reduced to practice by Mr. Thoma* J Braidwood, o»f.£.dinburgh. This.gentleman has, by the mere fqree of 1 genius and application, brought the teaching of dumb pt-rfons to fuch a | degree of perfection, that hisfholars are generally more forward in their education than thefe of the fame age who enjoy ail their faculties. , They nwt only resd and write with the utmost readinefs, but likewife fpeak, and are capable of holding toinerfation with any perfon in the j light. What a pity anyofthe hm-nan fpecieslhould remain inaflate of idi- *j otifm who are capable of being rendered ufeful and intelligent. W We mention this not only from humanity to thofe who have the niisfor- \ tune to be born deaf, bur alfo injustice to Mr. Braidwood, whofe fuc- cefs has far exceeded all former attempts this way ; and indeed it ex- < seeds imagination itfelf fo far, that no perfon who has not feen and ex- ' amined his pupils, can believe what they are capable of. As this gentle- 4A man, however willing, is only able toteacha few, and as the fargreat- m er part of thofe who are born deaf cannot aiford to attend him, it would q| be an aft of great humanity, as well as of public utility, to ereft an 1 academy for their benefit. I ■jfr Good effe&s have been derived from wearijtg a conical ping in the j ear, made of the ftalk of a green cabbage, which will, after a while, give J out its water, and be more conftantly applied in difTel-ving the waxrfo a* tu prepare it for fyringing with milk and water, (I. C.) TASTE AND SMELL. j!$ ears ought to be tampered with; they are tender organs, raid re* quire a very delicate touch. I chiefly recommend in deafnefs to keep the head warm. From whatever caufe the diforder proceeds this 13 always proper; and I have known more benefit from it alone, m the moft obftinate cafes of deafnefs, than from all the medicines I #.ver ufed. The Tafte and Smell ARE not of fo great importance to man in a ftate of focictAr, as She fight and hearing ; yet, as the lofs of them is attended with, in- , /conveniency, they deferve our notice. They are feldom to'be rc- $ ilored when loft; which ought to make us very attentive to their | prefervation, by carefully avoiding whatever may injure them. t As! there is a very great affinity between the organs of tasting and fmel- . -ling, whatever hurts the one generally affeas the other. Luxury is highly injurious to thefe organs. When the nofe and palate are frequently itimulated by fragrant and poignant' difhes} ' they foon lofe the power of diftinguifhing taftcs and odours with any degree of nicety. Man, in a ftate of nature, may perhaps h,ave ?> thefe faculties as acute as any other animal. The fenfe of fmelling may be diminifhed or destroyed by difeafe ; as, the moifture, drynefs, inflammation or fuppuration of that mem*- brane which lies the inflde of the nofe, commonly called the olfac- tory membrane ; the compreffion of the nerves which fupply this membrane, or fome fait in the brain itfelf at their origin. A defea, or too great a degree of folidity, of t'he fmall fpungy bones cf the t« upper jaw, the caverns of the forehead, &c. may impair the fenfe [ of fmelling. It may be injured by a colleaion of foetid matter in , thofe caverns, which keeps conftantly exhaling from them.' Few .things are more hurtful to the fenfe of fmelling than quantities of fnuff. When the nofe abounds with moifture, after gentle evacuations, fuch things as tend to take off irritation, and coagulate the thin, fharp ferum, may be applied ; as the oil of anife mixed with fine flour; camphire diffolved in oil of almonds, &c. 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 recommend . iiiuffmade of the leaves of marjoram, mixed with the oil of amber, fr marjoram and anifeed ; or a sternutatory oT calcined white vitriol; twelve grains of which may h?. mixed with two ounces of marjoram- water, and filtrated. The iteam or vapour of vinegar upon hot iron 3*4 THE TOtTCH. received up the noflrils, is of ufe for foftening the mucus, opening Obftruaions, &c. If there is an ulcer in the nofe, it ought to be dreffed with fome emollient ointment, to which, if the pain be very great, a little lau- danum may be added. If a venereal ulcer, it is not to be cured with- out mercury. In that cafe, the folution of the cofrofive fublimate in brandy, may be taken, as direaed in the gutta ferena. The ulcer Ought likewife to be wafhed with it; and the fumes of cinnabar may be received up the noflrils. If there be reafon to fufpea that the nerves which fupply the or- gans of fmelling, are inert, or want ftimulating, volatile falts, ftrong inuffs, and other things which occafion fneezing, 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, aphtha, pellicles, warts, &c. covering the tongue: it may be depraved by a fault of the faliva, which, being difcharged into the mouth, gives 'I the fame fenfation, as if the food, which the perfon takes, had real- ly a bad tafte; or it may be entirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurt- ful either to the fenfe of tafting or fmelling than obftinate colds, ef- pecially thofe which affea the head. , When the tafte is diminifhed by filth, mucus, &c. the tongue ought to be fcraped and frequently wafhed with a mixture of water, vinegar, and honey, or fome other detergent. When the faliva is vitiated, which feldom happens unlefs in fevers Or other difeafes, the curing of the diforder is the cure of this fymptom. To leave it in the mean time, if there be a bitter tafte, it may be taken away by ,t vomits, purges, and other things which evacuate bile. What is cal- led a nidorous tafte, arifing from putrid humours, is corrected by «j the juice of citrons, oranges, and other acids. A fait, tafte is cured by plentiful dilution with watery liquors. An acid tafte is deflroyed by abforbents, and alkaline falts, as powder of oyfter-fhells, fait of worm-wood, &c. J . When the fenfibility of the nerves which fupply the organs of 1 tafte is diminifhed, the chewing of horfe-radifh, 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 regularly conveyed to ■ the organs of touching; as preffure, extreme cold, &c. It may like- wife be hurt by too great a degree of fenfibility, when the nerve is not fufficiently covered by the cuticle or fcarf-fkin, or where there SCHIRRUS AND CANCER. 325 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 touching. Hence it appears to proceed from the fame general caufes as palfy and apoplexy, and requires nearly the fame method of treatment. In zflupor, or defea of touching, which arifes from an obstruc- tion of the cutaneous nerves, the patient muft firft be purged ; afte- wards fuch medicines as excite the aaion of the nerves, or stimu- late the fyftem, may be ufed. For this purpofe, the fpirits of hartf- horn,^/ volatile oleofum, horfc-radifh, &c. may be taken inwardly; the difordered parts, at the fame time, may be frequently rubbed u-ith frefh nettles or fpirit offal ammoniac. Blifters and finapifms applied to the parts will likewife be of ufe, as alfo warm bathing, efpecially in the natural hot baths. CHAPTER XLVII. Of a Schirrus and Cancer. A SCHIRRUS is a hard indolent tumour feated in fome of the glands; as the breasts, the arm-pits, &c. If the 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 zfanies or ichorous matter, of an ( abominably foetid fmell is difcharged from the fore, it is called an Open or ulcerated cancer. Perfons after the age of forty-five, par- ticularly women, and thofe who lead an indolent fedentary life, arc ,moft fubjea to this difeafe. CAUSES.——It is often owing to fuppreffed evacuations; hence it proves frequently fatal to women of a grofs habit, particularly ojd maids and widows, about the time when the menstrual flux ceafes, It may be occafioned by exceffive fear, grief, anger, religious melancholy, or any of the depreffing paffions. Hence, the unfortu- nate, the choleric, and thofe perfons who devote themfelves to a religious life in convents or monafteries, are often affliaed with it. It may be occafioned by the long-continued ufe of food that is too hard of digeftion, or of an acrid nature; bybarrennefs; celibacy; indolence; cold ; blows; friaion ; preffure, or the like. Women often fuffer from the laft of thefe, by means of their flays, which fqueeze and comprefs their breafts fo as to occafion great mifchief. Sometimes the difeafe is owing to an hereditary difpofition. SYMPTOMS.----This diforder feems often very trifling at the beginning. A hard tumour about the fize of a hazle-nut, or per- haps fmaller, is generally the firft fymptom. This will often con- tinue for a long time without feeming to increafe, or giving the pa- tient great uneafinefs; but if the conftitution be hurt, or the tu- $26 SCHIRRUS AND CANCER. ——»_ / mour irritated by preffure, or improper treatment of any kind, it begins to extend itfelf towards the neighbouring pa/ts, by pufhinj out a kind of roots or limbs. It then gets the name of cancer, from a fancied refemblance between the limbs and the claws of a crah. 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 tumour U very hard, rough, and unequal, with a protuberance, or rifing, in the middle ; its fize increafes daily, and the neighbouring veins be- come thick, knotty, and of a blackifh colour. The fkin at length gives way, and a thin, fharp ichor begins to j flow, which corrodes the neighbouring parts till it forms a large unfightly ulcer. More occult cancers arife, and communicate with 1 the neighbouring glands. The pain and flench become intollerable j «j 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 life. REGIMEN.----The diet ought to be light, but nourifhing. All ftrong liquors, and high-feafoned or falted provifions,-are to be avoided. The patient may take as 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, particularly of the affeaed part, which ought to be defen- ded from all preffure, and even from the external air, by covering ' it with fur or foft flannel. MEDICINE.-----For this difeafe no certain remedy is known. Its progrefs may fometimes be retarded, and fome of its molt dif- agreeable fymptoms mitigated, by proper applications. One misfor- tune attending the difeafe is, that the patient 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 all medicine at defiance. 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 common purging mercurial pills. Some blood may alfo be let, and the part affeaed may be gently rubbed twice a-day with a little of xhe mercurial ointment, and kept warm with fur or flannel. The food muft be light, and an Englifh pint of the decoaion of woods will ferve to make up the whole into a foft eleftuary. Two or three tea-fpoonfnls of rhismay be taken over-night, and about the fame quantity next morning, every day that the patient choofes to take a purge. The dofes of the above medicines may be iricreafed or diminifi-cd ac- VIRULENT GONORRHOEA. When the inflammatory fymptoms run high, bleeding is always neceffary at the beginning. This operation, as in other topical in- flammations, muft be repeated according to the ftrength and confti- tution of the patient, and the vehemence and urgency of the fympT toms. Medicines which promote the fecretion of urine, are proper in this f£age of the diforder. For thi« purpofe, two ounces of pounded arabic may be mixed with half an ounce of cream tartar, and di- vided into twenty-four dofes, one of which may be taken every morning and evening in a cup of the patient's drink. I have ge- nerally found this anfwer extremely well, both as to the diuretic, and for keeping the body gently open. When the pain and inflammation are feated high towards the neck of the bladder, it will be proper frequently to throw up an emollient clyfter, which, befides the benefit of procuring ftools, will ferve as a fomentation to the inflamed parts. Soft poultices, when they can conveniently be applied to the parts, are of great fervice. They may be made of the flour of lin- feed, or of wheat bread and milk, foftened 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 proper trufs for the fcrotum. It ought to be fo con- trived as to fupport the testicles, and fhould be worn from the firft appearance of the difeafe till it has ceafed fome weeks. The above treatment will fometimes remove the gonorrhoea fo quickly, that the perfon will be in doubt whether he really, labour- ed under that difeafe. This, however, is too favourable a turn to be often expeaed, and ought never to be adopted,. When the above treatment has removed the heat of urine, and forenefs of the genital parts ; when the quantity of running is con- fiderably leffened, without any pain or Twelling in the groin or tef- ticle fupervening ; when the patient is free from involuntary erec- tions ; and Iaftly, 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 treat it as a gleet with astringent medi- cines. cording as the patient finds it necefTary. We have ordered the falts to be diffolved in a large quantity of water, becaufe it renders their operation more mild. [ 342 ] . Of Gleets. A GONORkHCEA frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from relaxation, or from fome remains of the difeafe. It is of the greateft importance in the cure, to know from which caufe the gleet proceeds. When the difcharge proves very obftinate, and receives little or no check, from aftringent medincines, there is ground tofufpea that it is owing to the latter ; but if the drain is inconftant, and is chiefly obfervable when the patient is ftimulated by lafcivious ideas, or upon ftrain- '. ing to go to flocl, we may reafonably conclude diat it is chiefly \ owing to the former. '-• In the cure of a gleet, proceeding from relaxation, the principal defign is to brace, and reftore a proper degree of tenfion to the de- bilitated and relaxed veffels. For this purpoTe, befides the medi- cines recommended in the gonorrhoea, the patient may have re- courfe to fironger and powerful aftringents, as the Peruvian bark*, allum, vitriol, galls, tinaure of gum kino, &c. The injeaions may he rendered more aftringent by the addition of a few grains of al- lum, or increafing the quantity of vitriol as far as the parts are able to bear it. The laft remedy which we fhall mention in this czfe is the cold bath,'than which, there is not perhaps a more powerful bracer in the , wfiole compafs of medicine. It ought never to be omitted in this fpe- . cies of gleet, unlefs there be fomething in the conftitution of the patient which renders the ufe of it unfafe. The chief objeaionsto the ufe of the cold bath are, a full habit, and an unfound ftate of the vifcera. The clanger from theformer may always be leffened, if not re- moved, by purging and bleeding; but the latter is an insurmountable obftacle, as the preffure of the water, and thefudden contraaion of the external veflels, by throwing the blood with too much force up- on the internal parts, are apt to occafion ruptures of the veffels, or j a flux of humours upon t\e difeafed organs. But where ho objeaion of this kind prevails, the patient ought to plunge over head in wa- 'tcr every morning fafting, for three or four weeks together. He * fliould not flay long in the w^ter, and fliould have his fkin dried as foon as he comes out. The regimen proper in this cafe is the fame as in the laft ftage cf the gonorrhoea : the diet muft be drying and aftringent, and the drink, Spa, Pyrmont, or Briftol waters, with which a little claret er red wine may fometimes be mixed. Any perfon may now afford •*■ The Peruvian bark may bs combined with other aftringents, and prepared in the fwllowiisr, manner : Take of Peruvian bark bruifed, fix drachms, of fref: galls bruifed, two drachms ; boil them in a pound and an half o'' vater to a pound : to the ' ftrained liquor add three ounces of the li r.ple tincture of the bark. A (mall tea-cupful of thisrmy be taken three time., a-cfiy, adding to cadi cup fifteen cr twenty drops of the acid elixir of vitriol. THE SWELLED TESTICLE. 34% to drink thefe waters, as they can be every where prepared at almof^ no expence, by a mixture of common chalk and oil of vitriol. When the gleet does not in the fmalleft degree yield to thefe me- dicines, there is reafon to fufpea that it proceeds from ulcers*. In this cafe, recourfe muft be had to mercury, and fuch medicines aS tend to correa any predominant acrimony with which the juice* may be affeaed, as the decoaion of China, fafaparilla, faffafras, or the like. Mr., Fordyce fays, he has feen many obftinate gleets of two, three, or four years flanding, effeaually cured by a mercurial inunaion, when almoft every other medicine has been tried in vain. Dr. Chap- man feems to be of the fame opinion ; but fays* he has always found the mercury fucceed beft in this cafe when joined with terebinthi- nate and other agglutinating medicines. For which reafon, he re- commends pills made of calomel and Venice turpentinef; and de- fires that their ufe may be accompanied with a decoaion of .guaia- cum or farfaparilla. For the cure of ulcers in the urinary paffage, Tuppurating cart- dies or bougies are prepared various ways, and are generally to be bought ready made. It is needleTs to fpend time in enumerating the different ingredients of which they are compofed, or teaching the manner of preparing them. Before a bougie be introduced in- to the urethra, it fhould be. fmeared all over with fweet oil, to pre- vent it from ftimulating too fuddenly; it may be fuffered to conti- nue 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 paffages taken away, and an ob~ ftruaion of urine removed by means of bougies. Of the Swelled Tefticle. THE fwelled tefticle may proceed from infeaion lately contrac- ted, and may happen both in the firft and fecond flages of a gonorr« hcea; particularly when the running is unfeafonably checked, by * This conjecture fhould be well-founded, as the fame effea may be produced from different caufes, fuch as a Urianre in the urethra or lim- ple relaxation of the excreting veffels of that canal; in both of thefe cafes, mercury would be improper, particularly in the former, which tan only be removed by a diligent ufe of bougies. ((. C.J t Take Venice turpentine, boiled to a fufficient degree of hardnefi, half an oi:'ia>, calomel, half a drachm Let thefe be mixed afid formed into ii\ty pills of which five orfix maybe taken night and mur ning. ir-, durii'g- the u;'e oi' tiufe pills, the mouth mould jrro ,v f ire, or the breat'i becomeorFenuw.1,'they muft be difcontiuued till thefe fympto-ns difap- 344- BUBOES. cold, hard drinking, ftrong draftic purges, violent exercife, the too early ufe of aftringent medicines, or the like. 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. Fo- mentations are of Angular fervice. Poultices of bread and milk, foftened with frefh butter or oil, are very proper, and ought con-. ftantly 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 toffs, • which may eafily be contrived in fuch a manner as to prevent the weight of the tefticle from having any effea. If it fhould be found impraaicable to clear the tefticle by the cooling regimen now pointed out, and extended according to cir- cumftances, it will be neceffary to lead the patient through fuch a complete antivenereal courfe, as fhall enfure him againft any future uneafinefs. For this purpofe, befides rubbing the mercurial ointment, on the part, if free from pain, or on the thighs, as direaed in the gonorrhoea, the patient muft be confined to bed, if neceffary, for five or fix weeks, fufpending the tefticle all the while with a bag or trufs, and plying him inwardly with ftrong decoaions of .farfa- paiilla. When thefe means do not fucceed, and there is reafon to fuf- pea a fcrophulous or cancerous habit, either of which may fup- port a fchirrhous induration, after the venereal poifon is corre&ed, 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 inwardlyf. This praaice is ftrongly recommended by Doaor Stork in fchirrous and cancerous cafes ; and Mr. Fordyce assures us, that by this method he has cu- red difeafed tefticles of two or three years ftanding, even when ulce- rated, and when the fchirrous had begun to be affeaed with prick- ing and lancing pains. Buboes ARE hard tumours feated in the groin, occafioned by the vene- real poifon lodged in this part. They are of two kinds; viz. fuch as proceed from a recent infeaion, and fuch as accompany a con- firmed lues. * I have been acceftomed for fome time paft to apply leeches to in- flamed tefticles, which praaice has always been followed with the moft happy effeas. t The extraa of hemlock may be made into pills, and taken in,the n.anr.er directed under the article Cancer. CHANCRES. 34j The cure of recent buboes, that is, fuch as appear foon after im- pure coition, may be firft attempted by difperfion, and, if that fhould not fucceed, by fuppuration. To promote the difperfion of a bubo* the fame regimen muft be obfented as was direaed in the firft ftage of a gonorrhoea. The patient muft likewife be bled, and take fome cooling purges, as the decoaion of tamarinds and fenna, Glauber** falts, and the like*. If, by this courfe, the fwelKng and other in- flammatory fymptoms' abate, we may fafely proceed to the ufe of mercury, which fnuft be continued till the venereal virus is quite fubduedf. But, if the bubo fhould, from the beginnings be attended with great heat, pain, and pulfation, it will be proper to promote its fup- puration. For this purpofe, the patient may.be allowed to ufe his ordinary diet, and to take now and then a glafs of wine. Emollient cataplafms, confifting of bread and milk, or flax-feed flour, foften- ed with oil or frefh butter, may be applied to the part j and, 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 opened by either cauftic or a lancet:}:, and afterwards dreffed with digeftive ointment. Sometimes buboes can neither be difperfed nor brought to a fup^ puration, but remain hard, indolent tumours. In this cafe, the in- durated glands muft be confumed by cauftic. If they fhould be- come fchirrous, they muft be diflbived by the application of hem- lock, both externally and internally, as direaed in the fchirroHs tcf* tide. • Chdncres ARE fxperficial, callous, eating ulcers ; which may happen ei- ther with or without a gonorrhoea.' They are commonly feated about the glands, and make their appearance in the following man- . her : Firft a little red pimple arifes, which foon becomes pointed'.-,. * During the continuance of this praaice, one drachm of-the mercu- rial ointment should be rubbed every night, into the infiche of the thigh, below trie buUo. (I. C*) t For the difperfion of the bubo, a number of leeches applied to the part affefted, will be found equally efficacious as in the inflamed tef- ticle. \ The latter is more advantageous than the former ; if the bubo b& fimply punaured, and the matter difcharged gradually, foasto imitate1 its fpomanious rupture. This mode fhould always be prefer ed, wrlea: tbe patient cannot wait for it to break of itfelf, .•■*».-. *■ ■ ■ X 2 346 CHANCRES. at top, aad' is filled with a whitifh matter inclining to yellow. TfnV pijrnple is hot, and itches generally before it breaks ; afterwards it v degenerates hitp aft obftinate ulcer, the bottom of which is ufqally covered with, a, vifjekl mucus, and whofe edges gradually become har-d and; callous. Sometimes the firft appearance refemble* a fimple excoriation of tk'.*? fymptoms difappear, v\d for tc:i or dftee:! d.-y. afterwards. 1. C. 35° A CONFIRMED LUES. riot lefs than two ounces of the ftrong mercurial ointment is Suffi- cient, and not more than three or four ounces neceffary. The only other preparation of mercury which we fhall take no- tice of, is the corrofive fuolimate*. This was fome time ago brought into ufe for the venereal difeafe, in Germany, by Baron Van Swie- tdn ; and was foon after introduced into Britain by Sir JohnPrin- ^le. The method of giving it is as follows : One grain of corrofive fublimate is diffolved in two ounces of French brandy or malt fpir rits; and of this folution, an ordinary table-fpoonful, or the quan- tity of half an ounce, is to be taken twice a-day, and to be conti- nued as long as any fymptoms of the diforder remain. To thofe whofe ftomach cannot bear the folution, the fublimate may be gi- ven in form of piilf. Several roots, woods, and barks, have been recommended for curing the venereal difeafe; but none have upon experience* art- fwered the high encomiums beftowed upon them. Though no or.i ©f thefe is to be depended upon alone, yet, when joined with mer- cury, fome of them are found to be very beneficial in promoting a cure. One of the beft is farfaparilla, which may be prepared and taken according to the direaions in the appendix'!. The mezereon-rcot is found to be a powerful affiftanttn the fuo- limate, or any other m«rcurkl. It may be ufed along with the far- faparilla, as direaed in the appendix, or by itfelf. Thofe who choofe the mezereonby itfelf, may boil an ounce of the frefu bark, taken from the root, in twelve Englifli pints of water to eight-,' adding to- wards the end an ounce of liquorice. The dofe cf this is the fame as of the decoaion of farfaparilla. We have been told that the natives of America cure the vene-. real difeafe, in every ftage, by a decoaion of the root of a plant called the Lobelia. It is ufed either frefh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as thofe of the ranunculus, the ceanothus, " &c/; but whether thefe arc defigned to difguife or affift it, is doubt- ful. The patient takes a large draught of the decoaion early in the morning, and continues to ufe it for his ordinary drink through the d::yf> * This preparation of mercury is thought to be more efficacious thap any other, in venereal affections of the fkin. I. C. + The fublimate may be given in diftilled water, or any other li- quor that the patient choofes. J commonly order ten grains to be diffolv- ed in HA ounce of the fpirit of wine, for the conveniency of carriage) a'.id let the ,-atient take twenty or thirty drops of it night Mid mocnmf in half a glafs of brandy or other fpirits Mr. Debrav, an ingeniofu chemift of this place, prepares a fait of mercury much more miM a:! amufements, let not the fevere dictates of hoary age forbid the ufual * impulfe, nor damp, with ferious gloom, the feafon deftined to mirth and innocent festivity. Another thing very hurtful to females about this period of life is ftrait clothes; They are fond of a fine fhape, and foolifbly ima- gine this can be acquired by lacing themfelves tight. Hence, by fqueezing the ftomach and bowels, they hurt the digeftion, and oc- cafion many incurable maladies. This error is- not indeed fo com- 1 mon as it has been ; but, as faftftons change, it may come about. again : many females, to this day, feel the direful effects of that wretched cuftom which prevailed fome years ago, of fqueezing eve- ry girl into as fmall a fize in the middle as poffible. Human inven- tion could not poffibly have devifed a practice more destructive to healtli. N After a female has arrived at thrt period of life when the men- v " fes ufually begin to flow, and they do not appear, but, on the con- trary, her health and fpirits begin to decline, we would advife, in- ftead of fhutting the poor girl up in the houfe, and dosing her with fleel, afafcetida, and other naufeous drugs, to place her in a fitua- tion where fhe ran enjoy the benefit of free air and agreeable com- pany. There let her eat whoicfome food, take fufficient exercife, and amufe herfelf in the moft agreeable manner; and we have little reafon to fear, bet Nature, thus affifted, will do her proper work. She feldom fails, unlefs where the fault is on our fide. This difcharge in the beginning is feldom fo inftantaneous as to b furprife females unawares. It is generally preceded by fymptoms I which foretel it3 approach ; as a fenfe of heat, weight, and dull pain in the loins ; diftenfion and hardnefs of the breafts ; headach ; t lofs of appetite ; laffitude ; palenefs of the countenance ; and fome- times a flight degree of fever. When thefe.fymptoms appear about the age of which riie menstrual flux ufually begins, every thing fhould be carefully avoided which^may obstruct that neceflary and faluta- ry evacuation ; and all means ufed to promote it; as fitting fre- quently over the fleams of warm water, drinking warm diluting liquors, &c. ' After the menfes have once begun to flow, the greateft care fhould betaken to avoid every thing that may tend to obstruct them. Fe- males ought to be exceeding cautious of what they eat or drink at the time they are'out of order. Every thing that is cold, or apt to . four on the ftomach, ought to be avoided; as fruit, butter-milk, 358 THE MENSTRUAL DISCHARGE. and fuch like. Fifh, and all kinds of food that are hard of digeftion, are alfo to be avoided. As it is impoffible to mention every thing than may difagree with individuals at this time, we would recom- mend it to every female to be very attentive to what difagrees wjth herfelf, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the fex date their diforders from colds, caught while they are out of order, than from all other caufes. This ought furely to put them upon their guard, and to make them very circumfpect in their conduct at fuch times. A degree of cold that will not in the leaft hurt them at another time, will at this period be fufficient entirely to ruin their #v health and conftitutioi:. The greateft attention ought likewife to be paid to the mind, ', which fhould be kept as eafy and cheerful as poffible. Every part of ' the animal economy is influenced by the paffions, but none more fo than this. Anger, fear, grief, and other affections of the mind, often occafion obftructions of the menstrual flux, which prove ab- i folutely incurable. From whatever caufe this flux is obftructcd, except in the ftate of pregnancy, proper means fhould be ufed to reftore it. For this pur- pofe, we recommend fufficient exercife, in a dry, open, and rather cool air ; wholefome diet, and, if the body be weak and languid, generous liquors ; alfo cheerful company, and all manner of amufe- ments. If thefe fail, recourfe muft be had to medicine. When obftructions proceed from a weak relaxed ftate of thefolid^, fuch medicines as tend to promote digeftion, to brace the folids and affift the body in preparing good blood, ought to be ufed. The princi- pal of thefe are iron and the Peruvian bark, with other bitter and af- tri.igent mediaines. Filings of iron may be infufed in wine or ale, two or three ounces to an Englifli quart, and after it has flood for two or three week's, it may be filtered, and about half a wine glafs - : bf it taken twice a-day : or prepared fleel maybe taken in the dofe of half a drachm, mixed with a -little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in fubftance or infufion, as is moft agreeable to the patient. When obftructions proceed from a vifcid ftate of the blood ; or from women of a grofs or full habit, evacuations, and fuch medicines as attenuate the humours, are neceffary. The patient, in this cafe, I ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a fpare, thin . diet. Her drink fhould be whey, water, or fmall-beer, and fhe ought to take fufficient exercife. A tea-fpoonful of the tincture of black hellebore may be taken twice a-day in a cup of warm water. When obftructions proceed from affections of the mind, as grief, , fear, anger, &c. every method mould be ufed to amufe and divert the patient. And that flie may the more readily forget the caufe of u her affliction, fhe ought, if poffible, to be removed from the place where it happened. A change of place, by prcfenting the mind ' THE MENSTRUAL DISCHARGE. 359 with a variety of new objects, has often a very happy influence in relieving it from the deepefl diftrefs. A foothing, kind, and affable behaviour to females in this fituation, is alfo of the laft impor- tance. An obftructibn of the menfes is often the effect of other mala^ dies. When this is the cafe, inftead of giving medicines to force that difcharge, which might be dangerous, we ought, by all means, to en- deavour to reftore the patient's health and ftrength. When that is effected, the other will return of courfe. But the menstrual flux may be too great as well as too fmall. When this happens, the patient becomes weak, the colour pale,, the appetite and digeftion are bad, and cedematous fwellings of the feet, dropfies, and confumptions often enfue. This frequently hap- pens t» women about the age of forty-five or fifty, and is very dif- ficult to cure. It may proceed from a fedentary life ; a full diet, confifting chiefly of falted, high-feafoned, or acrid food ; the ufe of spirituous liquors; exceffive fatigue; relaxation j, a diffolved ftate of the blood; violent paffions of the mind, &c. . The treatment of this difeafe muft be varied according to its caufe. When it is occafioned by any error in the patient's regimen, an oppofite courfe to that which induced the diforder muft be pur- sued, and fuch medicines taken as have a tendency to reftrain the flux, and counteract the morbid affections of the fyftem from whence it proceeds. • To reftrain the flux, the patient fhould be kept quiet and eafy both in body and mind. If it be very violent, fhe ought to lie in bed with her head low ; to live upon a cool and flender diet, as veal or chicken broths with bread ; and to drink decoctions of nettle-roots, or the greater comfrey. If thefe be not fufficient to flop the flux,, fir "-ger aftringents may be ufed, as Japan earth, allum, elixir of vitriol, the Peruvian bark, &c*. The uterine flux may offend in quality as well as in quantity. What is ufually called the fluor albus, or whites, is a very common difeafe, and proves extremely hurtful to delicate women. This dif- charge, however, is not always white, but fometimes pale, yellow, green, or of a blackifh colour ; fometimes it is fharp and corrofive*, fometimes foul and foetid, &c. It is attended with a pale complexion, pain in the back, lofs "of appetite, fwelling of the feet, and other figns of debility. It generally proceeds from a relaxed ftate of the body, arifing from indolence, the exceffive ufe of tea, coffee, or other weak and watery diet. * Two drachms of allum and one of Japan earth, maybe pounded together, and divided into eight or nine dofes, one of which .may be tyken three times a-clay. Perfona, whofe ftomachs canrtut bear the allum, may take two table- fpoonfuls of the tinaure of rofes three or four times a-dav to each dofe of which, ten drops of laudanum may be added. If thefe fliould fail, half a drachm of the Peruvian bark, in powder with ten drops of the elixir of vitriol, may be taken, in a rlah of red wine, four times a-dav. fc . 360 PREGNANCY. To remove this difeafe, the patient muft take as much exercife as fhe can bear without fatigue. Her food fhould be folid and nourifh- ing, but of eafy digestion ; and her drink rather generous, as red port or claret, mixed with Pyrmont, Briftol, or lime-water.^ Tea and coffee are to be avoided. I have often known ftrong broths have an exceeding good effect; and fometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed*. When medicine is neceffary, we know none preferable to the bark, which, in this cafe, ought always to be taken in fubftance. In warm weather, the cold bath will be of confiderable fervice. The period of life at which the menfes ceafe to flow, is like- wife very critical to the fex. The ftoppage of any customary eva- cuation, however fmall, is fufficient to diforder the whole frame, and often to destroy life itfelf. Hence fo many women either fall into chronic diforders, or die about this time. Such of them, how- ever, as furvive it, without contracting any chronic difeafe, often become more healthy and hardy than they were before, and enjoy ftrength and vigour to a very great age. If the menfes ceafe all of a fudden, in women of "a full habit, they ought to abate fomewhat of their ufual quantity of food, ef- pecially of the more nourifhing kind, as flefli,eggs, &c. They ought likewife to take fufficient exercife, and to keep the body open. This may be done by taking, once or twice a week, Glauber's falts or caftor-oil; and if the pulfe be full and hard, ten or twelve ounces of blood fhould be taken from the arm. , ' Women of a grofs habit, at this period of life, have often ul- cerous fores break out about their ancles, or in other parts of the body. Such ulcers ought to be confidered as critical, and either fuffered to continue open, or have artificial drains fuhftjtuted in their flead. Women who will have fuch fores dried up, are of «n, foon after, carried off by acute difeafes, or fall intp thofe of a chronic nature. Pregnancy IS not a difeafe, yet that ftate is often attended with a variety of complaints which merit attention, and requires the affiftance of medicine. Some women indeed, are more healthy during their pregnancy than at any other time ; but this is by no means the ge- neral cafe: moft of them breed inforrow, and are frequently indif- pofed during the whole time of pregnancy. Few fatal difeafesr however, happen during that period ; and hardly any, except abor- tion, that can be called dangerous. We fhall, therefore, pay parti- cular attention to it, as it proves generally fatal to the child, and fometimes fo to the mother. PREGNANCY. 361, Pregnant women are often afflicted with the heart burn. The method of treating this complaint has been already pointed out. They are, likewife, in the more early periods of pregnancy, often ' harraffed with ficknefs and vomiting, efpecially in the morning. The method of relieving thefe complaints bus alfo been fhewn. The head-ach and tooth-ach are very troublefome fymptoms of pregnancy. The former may generally be removed by keeping the body gently open, by the ufe of prunes, figs, roafted apples, and (■ fuch-like. When the pain is very violent, bleeding may be necef- fary. For the treatment of the latter, we muft refer to that article.. F Several other complaints incident to pregnant women might be f mentioned, as a cough and difficulty of breathing, fuppreffion and £' incontinency of urine, &c. ; but all thefe have been taken notice I of before. Every pregnant woman is more or lefs in danger of abortion. This fhould be guarded againft with the greateft care, as it not on- ly weakens the conftitution, but renders the woman liable to the fame misfortune afterwards*. Abortion may happen at any period of pregnancy, but it is moft common in the fecond or third month. i Sometimes it happens in the fourth or fifth. If within the firft month, it is ufually called a falfe conception ; if after the feventh month, the child may often be kept alive by proper care. The common caufes of abortion are, the death of the child; weaknefs or relaxation of the mother ; great evacuations ; violent exercife ; raifing great weights ; reaching too high; jumping, or ftepping from an eminence; vomiting ; coughing; convulfion- fits ; strokes on the belly ; falls ; fevers; difagreeable fmells ; ex- cels of blood ; indolence; high living ; or the contrary ; violent paffions or affections of the mind, as fear, grief, &c. The figns of approaching abortion are, pain in the loins, or about the bottom of the belly; a dull heavy pain in the inlide of the thighs ; a flight degree of coldnefs, or fhivering ; ficknefs, palpita- tion of the heart; the breasts become fiat and foft; the belly falls; and there is a difcharge of blood or watery humours from the womb. To prevent abortion, women of a weak or relaxed habit fhould ufe folid food, avoiding great quantities of tea, and other weak and watery liquors ; rife early and go foon to bed ; fhun damp houfes ; take frequent exercife in the open air, but avoid fatigue ; and ne- ver go ibroad in damp foggy weather, if they can fhun it. -*■ Every woman who procures an abortion does it at the hazard of her life ; yet there are not a few who run this rifk, merely to prevent the trouble cf bearing and bringing up children. It is furely a moft un- •mnral crime, aud canr.oi, even in the moft abandoned, be viewed uiiiijut horror ; but in the decent matron, it is ftill more unpardona- ble. Thofe wretches who daily advertife their affiftance to women in ,hf, bu:iutfs, def-He, in my opinion', the moft feverc of.all human mi- aJhxer*, Za 362 CHILD-BIRTH. Women of a full habit ought to ufe a fpare diet, avoiding ftrertg liquors, and every thing that m.;y tend to heat the body, or in- creafe the quantity of blood. Their diet fhould, be of an opening \ v nature, confifting principally of vegetable fubftance:;. Every wo- man with child ought to be kept cheerful and eafy in her mind. Her appetites, even though depraved, ought to be indulged as far as prudence will permit. When any figns of abortion appear, the woman ought to be laid in bed on a mattrafs, with her head low. She fhould be kept quiet, .^ «nd her mind focthed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food fhould confift of broths, rice and milk, jellies, gruels made of oat-meal, ' and the like, all of which ought to be taken cold. If ihe be able to bear it, fhe fhould lofe at leaft half a pound of blood from the arm. Her drink ought to be barley water fharpened with juice of lemon; or flie may take half a drachm of powdered nitre, in a cup of wa- ter-gruel, every five or fix hours. If feized with a violent loofenefs, fhe ought to drink the decoction of calcined hartfhorn prepared. If flie be affected with vomiting, let her take frequently two table- fpoonfuls of the faline mixture. In general, opiates are of fervice ; but they ihould always be given with caution. Sanguine robuft "women who are liable to mifcarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and obferving the regimen above prefcribed, they might often efcape that misfortune. Though we recommend due care for preventing abortion, we would not be underftood as reftraining pregnant women from dieir ufual exercifes. This would generally operate the quite contraf^ way. Want of exercife not only relaxes the body, but induces a plethora, or two great a fulnefs of the veffels, which are the two principal caufes of'aborticn. There are, however, fome women of j fo delicate a texture, that it is neceffary for them to avoid almoft every kind of exercife during the whole period of pregnancy. Of Child-Birth. MANY difeafes proceed from the want of due care in child-bed; " and the more hardy part of the fex are moft apt to defpifc the ne- ceflary precautions in this ftate. This is peculiarly the cafe with young wives. They think, wl.cn the labour-pains are ended, the dinger is over ; but in'truth, it may only then be faid to be begun. Nature, if left to herfelf, will feldom fail to expel the ftetus ; but proper care and management are certainly nece'ffaiy for the reco- very of the mother. No doubt mifchief imy be done by too much as well as by too li>le care. Hsnce females who have the gfeafeii: CHILD-BIRTH. 363 number of attendants in child-;v t; ■;-"■-•■. ■., recover word*. Lac this is not peculiar to ticit.it: ; Juid-bed. Exceffive care always defeats its own intention, a:...[ is generally more dangerous than non; at ahf. During actual labour, nothing of a heating nature ought to be given. Trie wjr.nn may now and- then tave a little panado, and her drink ought to be toaft and water, or thin groat-gruel. Spirits, wines, cordial-waters, and other filings which. are given with a view to ftrengthen the mother, and promote the birth, for the moft part, tend only to increafe the fever, inflame the womb, and retard \ the labour. Befides, they endanger the woman afterwards, as they often occafion violent and mortal haemorrhages, or difpofe her to eruptive and other fevers. When the labour proves tedious and difficult, to prevent inflam- mations, it will be proper to bleed. An emollient clyfter eight likewife frequently to be adminiftered ; and the paffage ought to . be gently rubbed with a little foft pomatum or frefh butter. If na- ture feems.to fink, and the woman id greatly exhaufted with fa- \ . tigue, a c'.vaught of generous wine, or fome other cordial, may be v .given, but not otherwife. Thefe directions are fufficient in natural labours ; ;-id i.i all preternatural cafes, a fkilful fuvgeon or man- midwife, ought to be called as foon as poffible. After delivery, the woman ought to be kept as quiet and eafy.as poliible^;. Her food fliould be light and thin, as gruel, pannado, Sec. and her drink weak and diluting. To this rule, there are ma- ny exceptions. I have known ft-veral women, whofe fpirits could not be fupported in child-bed without folid food and generous li- * No more attendants fliould be admitted th.in are abf >1 'telv nec*f- fary ; and it is to be wifhed ihat thof\r would never convene about la- bours that have been accompanied with greater danger. ;,udi conver- sion renio.n fails to make the patient extremely unhappy, andconfe- tiuently impedes the labour. • (I. C.) f Though the management of women in child-bed has been practifed :>s an employment fince the ear!left accounts of rime: yet it is ftiil in molt countries on a very bad footing. Few women'tidnk of following tiii. employment till they are reduced to the neceflity of doing it f. r bre.-d. Hence not o ie in a huiuhyd of them have any education, or prop&r-kiiowied j;e of their bufinols. Moft women in child-bed. require to be managed with fkill and attention, and they are often hurt by the fupcyftiiious prejudices of ignorant and officious midlives. 1 he mif- chief done in this way is much greater than is generally imagined ; moft of which might be prevented by allowing no woman to practife mid- wifery but fuch as are properly qualified. Were due attention paid to tait, it would be the means of faving many lives. \ We cannot help taking notice of that ridiculous cuftom which ftill prevails i.i fome parts of the country, of collecting a number of wo- men together upon fuch occasion.;. Thefe, inftead of being ufeful, ferve ' .only to cruw d the houfe, and obstruct the necefLvy attendants. Befides, they hurt the patient with their noife ; and often, by their' untimely as.J i:npertiiu;;t advice, do muvh in"f»hief. 364 CHILD-BIRTH. quors; to fuch, a glafs of wine and a bit of chicken muft b: al- lowed. Sometimes an exceffive haemorrhage or flooding happens after delivery. In this cafe, the patient fhould be laid with her head low, kept cool, and be in all respects treated as for an exceffive flux of the menfes. If the flooding proves violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, fhould be applied to the belly, the loins, and the thighs: thefe muft be changed as they grow dry ; and may be difcontinu- 'I. C) X Take of crabs claw; prepared, half an ounce, purifi d nitre, two drachms, faffron powdered, half a drachm; rub them together in a mi>'-tar, aid divicie the whole into eight or nine dofes. W hen the patient is low-fprittd, or troubled with hysterical com- plaints, li.e oi'glu to take frequently twelve or fifteen drops of the tinc- pre of .-.fafe.-:-da in a cup of penny-royal tea. CHILD-BIRTH. ^S and the milk-fever, muft be treated nearly in the fame manner as an inflammation of the womb. In all thefe cafes, the fafeft courfe is plentiful dilution; gentle evacuation^, and fomentations of the parts . affected. In the milk-fever, the breasts may be embrocated with a little warm linfeed-oil, or the leaves of red cabbage may be applied to them. The child fhould be often put to the breaft, or it fhould be drawn by fome other perfon. Nothing would tend more to prevent the milk-fever, than put- ting the child early to the breaft. The cuftom of not allowing chil- ■f dren to fuck for the firft two or three days, is contrary to Nature and common fenfe, and is very hurtful both to the mother and ' child. Every mother who has milk in her breasts, ought either to fuckle her own child, or to have her breasts frequently drawn, at leaft for the firft month. This would prevent many of the difeafes which prove fatal to women in child-bed. When an inflammation happens in the breaft, attended with'red- "nefs, hardnefs, and other fymptoms of fuppuration, the fafeft appli- • ' - cation is a poultice of bread and milk, foftened with oil or frefh- butter. This may be renewed twice a-day, till the tumour be either difcuffed or brought to fuppuration. The ufe of repellents, in this cafe, is very dangerous ; they often occafion fevers, and fometimes cancers ; whereas a fuppuration is feldom attended with any danger, and has often the moft falutary effects. When the nipples are fretted or chapt, they may be anointed srith a mixture of" oil and bees' wax, or a little powdered gum-arabic may be fprinkled on them. I have feen Hungary-water, applied to the nipples, have a very good effect. Should the complaint prove obftinate, a cooling purge may be given, which generally rc- poves it. The miliary fever is a difeafe. incident to women in child-bed. Hoffman obferves, that this fever of child-bed women might gene- » rally be prevented, if they, during their pregnancy, were regular in their diet, ufed moderate exercife, took now and then a gentle laxative of manna, caftor-oil, or cream of tartar; not forgetting to bleed in the firft months, and avoid all fharp ah. When the labour is coming on, it is not to be haftened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care fliould be taken, after the birth, that the natu- ral excretions proceed regularly; and if the pulfe be quick, a lit- tle nitrous powder, or fome other cooling medicines, fliould be given. The moft fatal diforder confequent upon th livery, is the puerperal, or child-bed fever. It generally makes its attack upon the fecond ( or third day after delivery. Sometimes indeed, it comes on fooner, and at other times, though rarely, it does not appear before the fifth . or fixth day. It begins, like moft ether fevers, with a cold or.fhlvering fit, 36S CHILD-BIRTH. which is fucceeded by reftleffncf-, pain of the head, great ficknefs at ftomach, and" bilious vomiting. The pulfe is generally quick, the tongue dry, and there is a remarkable depre'flion of fpirits and lofs , of fkength. A great paia is ufually felt in the back, hips,, and i c- giorvof the womb ; a luddeachangc in the quantity or quality of the lochia alfo takes place; and the patient is frequently troubled i with a ienefnus, or conftant inclination to go to ftool. The urine, which is very nigh-coloured, is difcharged in fmall quantity, and generally with pain. The.belly fometimes fwells to a confiderable 1 bulk, and becomes fufceptible of pain from the flighteft touch* £ When the fever has continued for a few days, the fymptoms of in-., flimmation ufually fubfide, and the difeafe acquires a more putrid -\ form. At this period, if not f joner, a bilious or putrid loofenefs,, of an obftinate and dangerous nature, comes on, and accompanies the difeafe through all its future progrefs. No difeafe requires to be treated with more fkill and attention than this ; confequently, the beft affiftance ought always to be ob- tained as foon as poffible. In women of plethoric conftituthais, bleedinp will generally be proper at the beginning ;, it ought, how- ever, to be ufed with caution, and not to be repeated, unlefs where the fioms of inflammation rife high ; in which cafe, it will alfo be neceflary to apply a blifter to the region of the womb. During the rigour, or cold fit, proper means fliould be ufed to abate its violence, and fhorten its duration. For this purpofe, the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of wine-whey ; warm applications to the extremities, a3 heated bricks, boul^s or bladders filled with warm water, and fuch-like, may alfo be ufed with advantage. Emollient clyibra- of milk and water, or of chicken water, ought J to be frequently adminiftered through the courfe of the difeah.— _.i Th etc prove beneficial by promoting a difcharge from the inteftines, and alio by acting ui a khu'ly fomentation to the womb and parts adjacent. Great care however is requifite hi giving them, or. account i of the tendernefs of the parts in the pelvis at this time. To evacuate the offending bile from the feomach, a vomit is ge- j n.n-aliv c.iven. But as this is apt to increafe the irritability ci the \ ftomach, already too great, ic wftl be fafer to omit it, and to give in ; its flead, a gentle laxative, which will both tend to cool th-- body, and to procure a free dikharge of the bile. The medicine which I have always found to fucceed beft in thu difeafe, is the ihline draught. This, if frequently repeated, wiil ci- ten put a flop to the vc'-;m_ig, and, at the fame time, leffm tne violence of the fever, n it runs off by ftool, or if the patient be reftkfs, a faw drops of laudanum, or feme fyrup of poppies; may tvcafionally be ahded. If the ftools ihcuhl prove, fo frequent as to weaken and exhauft the patient, a it~rch elyfter, with'thirty or forty drops of laudanum in it, may bv adminiftered as occafion fhall require ; and thedvir.k CHILD-BIRTH. 367 may b? rice-water, in every Englifh pint of which half an ounce of gumarabic hae, been diffolved. Should thefe fail, recourfe muft be nad to Columbo^-root, or fome other ftrcng aftringent. Thou0h in general the fpod ought to be light, and the drink diluting, yet when the difeafe has been long protracted, and the patient is greatly fpent by evacuations, it will be neceffary to fup- port her with nourifhing diet and generous cordials. It was obferved, that this fever, after continuing for fome time, i often acquires a putrid form. In this cafe, the bark muft be given, i* either by itfelf, or joined with cordials, as circumftances may re- * quire. As the bark in fubftance will be apt to purge, it may be given in decoction or infufion, mixed with the tincture of rofes, or other gentle aftringents ; or, a fcruple of the extract of bark with half an ounce of fpirituous cinnamon-water, two ounces of com- mon water, and tan drops of laudanum, may be made into a draught, and given every fecond, third, or fourth hour, as fhall be found neceffary. [ When the ftomach will not bear any kind of nouriihrna-rt, the << ■ ]patient may be fupported for fome time, by clyfters of beef-tea, or : chicken-water. To avoid this fever, every worn in in child-bed ought to be kept perfectly eafy ; her food fhould be light and fimple, and her bed- chamber cool, and properly ventilated. Nothing is more hurtful than being kept too warm. She ought not to have her body bound too tight, nor rife too foon from bed after delivery; catching cold is alfo to be avoided ; and a proper attention fliould be paid to cleanlinefs. To prevent the milk-fever, the breafts ought to be frequently drawn ; and if they are filled previous to the onfet of a fever, they >i fhould, upon its firft appearance, be drawn to prevent the milk from becoming acrid, and its being abforbed in this ftate. Coftivenefs is to be avoided. This will be beft effected by the ufe of mild clyfters , and a laxative diet. ( We lhall conclude on child-bed women, by recommending it to "> them, above all things, to beware of cold. Poor women, whofe cir- cumstances oblige them to quit their bed too foon, often contract , diieafes from cold, of which they never recover. It is a pity the poor are not better taken care of in this fituation. But the better fort of women run the greateft hazard from too % much heat. They are generally kept in a fort of a bagnio for the firft eight or ten days, and then dreffed out to fee company. The danger of this conduct muft be obvious to every one. The fuperftitious and -jontemptible cuftom of obliging women to keep the houfe till they go to church, is a very common caufe of catching cold. All churches are damp, and moft o1" them cold ; 1 confequently they are the very worft places to which a woman can go to make her firft vifit,'after having* been confined in a .v„vm ! room for a month. . [ 3*8 ] Of Barrennefs. BARRENNESS may be very properly reckoned among the dif- eafes of females, as few married women who have not children en- joy a good ftate of health. It may proceed from various caufes, as high-living, grief, relaxation, &c. but it is chiefly owing to an ob- - ftruction or irregularity of the menstrual flux. It is very certain that high living prevents fecundity. We feldom find a barren woman among the labouring poor, while nothinp- is more common among the rich and affluent. The inhabitants of eve- ry country are prolific in proportion to their poverty; and it would be an eafy matter to adduce many inftances of women, who, by be- ing reduced to live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich ufe the fame fort of food and exercife as the better fort of peafants, they would feldom have caufe to envy their poor vaffals and dependants the bleffing of a numerous and healthy offspring, while they pine in forrow for the want of even a fingle heir to their extenfive domains. Affluence begets indolence, which induces a general relaxation of the folids ; a ftate highly unfavourable to procreation. To re- move this, we would recommend the following courfe : Firft, fuf- ficient exercife in the open air; fecondly, a diet confifting chiefly of milk and vegetables*; thirdly, the ufe of aftringent medicines, as fteel, allum, dragon's blood, elixir of vitriol, the Spaw or Tun- bridge waters, Peruvian bark, &c.; and lastly, above all, the cold bath. Barrennefs is often the confequence of grief, fudden fear, anxiety, , or any of the paffions which tend to obftruct the menftrual flux. When barrennefs is fufpected to proceed from affections of the mind, the perfon ought to be kept as eafy and cheerful as poffible; all difagreeable objects are to be avoided, and every method taken to amufe and entertain the fancy. *• Dr. Cheyne avers, that want o&children is oftner the fault of the :> male than of the female, and ftrongly recommends a milk and vegeta- ble diet to the former as well as the latter ; adding, that his friend Dr. _ Taylor, whom he calls the iMilk- doctor of Croydon, had brought fun- dry opulent families iu his neighbourhood, who had continued fome years after marriage without progeny, to have feveral fine children, by keeping both parents, for a confiderable t'-'.v.e, to a milk nr.d vegetable diet. t 36g 1 CHAPTER LI. Difeafes cf Children. MAN comes into the world more lielplefs than any other ani- mal, and ftands much longer in need of the protection and; care or his parents; but this care is not always beftowed upon him 5 1 and when it is, he often fuffers as much from improper manage- ment as he would have done from neglect. The officious care of | parents, nurfes, and midwives, becomes one of the rhoft fruitful' '■* fources of the diforders of infants*. It muft be obvious to every attentive perfon, that the firft difeafes of infants arife chiefly from their bowels. Nor is this in the leaft to be wondered at, as they sre m a manner poifoned with indigeftible drugs and improper diet, as foon as they come into the world. Eve- ry thing that *.he ftomach cannot digeft may be confidered as a poi- fon ; and unlefs thrown up, or avoided by ftool, it muft occafion •ficknefs, gripes, fpafmodic affections of the bowels, or what th© Women call inward fits, and at laft convulfions and doath. As thefe fymptoms evidently arife from fomewhat that irritates' the inteftines, doubtlefs the proper method of cure muft be to ex- pel it as foon as poffible. The moft fafe and effectual method pf doing this is by gentle yomits. Five or fix grains of the powder of ipecacuanha may be mixed in two table-fpoonfuls of water, and fweetened with a little fugar. A tea-fpoonful of this may be given to the infant every quarter of an hour till k operates'. , This medicine will not only cleanfe: the ftomach, but will gene-* rally likewife open the body. Should this however not happen, and if the child be coftive, fome gentle purge will hz neceffary: for this purpofe, fome manni and pulp of caffia may be diffolved in boiling . water, and given in fmall quantities till it operates ; or, what will ' anfwer rather better, a few grains of magnefia alba may he mixed in any kind of food that is given to the child, and continued till it has the defired effeat. If thff* medicines be properly adminifter- ed, and the child's belly and limbs frequently rubbed with a warm hand before the fire, the/ will feldom fail to relieve thofe affec- * Of the oificiaus and i!I-jiidg?d care of midwives, we fhall adduce on!y one rnftance, viz. the common practice of torturiBg infants by fmeezing their breafts. to draw otf the milk, as they call it. Though a fn;dl quantity of moidure isgenerally found in the breafts of infants,yet, as th-e-y are cert lirtly nrc intended to give fuck, this ought never to be drawn off. I huve feen this cruel operation bring on hardnefs, inflamma- tion, and fiippuration oi" t!i? breafts; bin never knew any if' conferen- ce* from its being omitted. When the breafts are hard, the only appli- cation that Wv* would recouiiiieml, is a foft poultice, or a little of the diachylon plaifter, f; read thin upon a bit of foft leather, about cheiizs of half 3c.-owi, and applied over eachnippb. Thefe may be fiifjjer'ed to -j.ri-iav :;..i :~? h-T.lnef-, d*t appears. A 3 THE APHTH/E OR THRUSH. tions of the ftomach and bowels from which infants fuffer lo much. Thefe general directions include moft of what can be done for relieving the internal diforders of infants. They will likewife go a confiderable way in alleviating thofe which appear externally, as the rafh, gum, Sec. Thefe, as was formerly obferved, are prin- cipally owing to too hot a regimen, and confequently will be moft commonly relieved by gentle evacuations. Indeed, evacua- tions of one kind or other conftitute a principal part of the medi- cine of infants, and will feldom, if adminiftered with prudence, in any of their difeafes, fail to give relief. Of the Meconium. THE ftomach and bowels of .a new-born infant are filled with a blackifh coloured matter pf the confiftence of fyrup, commonly called the meconium.. This is generally paffed foon after the birth, by the mere effort of Nature ; in which cafe it is not neceffary to give the infant any kind of medicine. But if it fhould be retained, ©r not fufficiently carried off, a little manna or magnefia alba may be given, or, if thefe fhould not be at hand, a common fpoonful of whey, fweetened with a little honey, or raw fugar will anfwer the purpofe. The moft proper medicine for expelling the meconium is the mo- ther's milk, which is always at firft of a purgative quality. "Were children allowed to fuck as foon as they fhew an inclination for the breaft, they would feldom have occafion for medicines, to difcharge die meconium ; but even where this is not allowed, they ought ne- ver to have daubs of .fyrup, oils, and other indigestible fluff,' cram- med down their throats. The Aphtha or Thrufly. THE aphthae are little whitifh ulcers affecting the whole infide of the mouth, tongue, throat, and ftomach of infants. Sometimes they reach through the whole inteftinal canal • 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 incumber, foft, fuperficial, and fall eafily off, they are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ought to be dreaded. It is generally thought that the aphthae owe their origin .to acid humours; but they are frequently owing to too hot a regimen both 370 ACIDITIES. 37l \ of the mother and child. It is a rare thing to find a child who is not doitd with wine, punch, cinnamon-waters, or fome other hoi; and inflaming liquors, almoft as foon as it is born. Thefe will oc- cafion inflammatory diforders even in adults ; is it any wonder then that they fhould heat and inflame the tender bodies of" infants ? The moft proper medicines for the aphthae are vomits, fuch as have been already recommended, and gentle laxatives. One drachm t of magnefia alba may be divided into fix dofes, one of which may f be given to the infant every four or five hours till they operate. Thefe powders may either be given in the child's food, or a little of the fyrup of pale rofes, and may be repeated as often as is found neceffary to keep the body open. It is common in this cafe to ad- minister calomel; but as that medicine fometimes occafions gripes, it ought always to be given to infants with caution. Many thing have been recommended for gargling the mouth and throat in this difeafe; but it is not eafy to apply thefe in very young infants ; we recommend it to the nurfe to rub the child's mouth frequently with a little borax and honey ; or with the follow- ing mixture : Take fine honey an ounce, borax a drachm, burnt al- lum half a drachm, rofe-water two drachms; mix them together. A very proper application in this cafe, is a folution 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 Acidities. THE food of children being for the moft part of an acefcent na- ture, it readily turns four upon the ftomach, efpecially if the body be any way difordered. Hence moft difeafes of children are accom- panied with evident .figns of acidity, as green ftools., gripes, &c. Thefe appearances induce many to believe, that all the difeafes of children are owing to an acid abounding in the ftomach and bow- els ; but whoever confiders the matter attentively, will find that thefe fymptoms of acidity are oftener the effect than the caufe of their difeafes. Nature evidently intended, that the food of children fhould be acefcent; and unlefs the body be difordered, or the digeftion hurt, from fome other caufe, we will venture to fay, that the afce/feent qua- lity of their food is feldom injurious to them. Acidity, however, is often a fymptom of diforders in children, and, as it is fomethnes a troublefome one, we fhall point out the method of relieving it. When^green ftools, gripes, purgings, four fmells, &c. fhew that the bowels abound with an acid, the child fhould have a little fmall broth, with light white bread in it; and fufficient exercife to promote the digeftion. It has been cuftomary in this cafe to give the GALLING AND EXCORIATION. earl-julep, chalk, crabs eyes, and other testaceous powders. Tliefc, y their abforbent quality, may correct the acidity; but they are apt to lodge in the bowels, and occafion coftivenefs, which may prove very hurtful to the infant. For this reafon, they fhould never be giv» en unlefs mixed with purgafarv medicines ; as rhubarb, manna, or fuch like. The beft medicine which we know, in ail cafes of acidity, is the powder of magnefia alba. It purges, and at the fame time corrects the acidity : by which means it not onlv removes the difeafe, but car- ries off its eaufe. It may be given in any kind of food, or in a mix- ture. When an infant is troubled with gripes, it ought not at firft to 'be dofed with brandy, fpiceries, and other hot things, but fliould have its body opened with an emollient "clyfter, or the medicine mentioned above; and at the fame time, a little brandy may be rub- bed on its belly with a warm hand before the fire. I have feldom feen this fail to eafe the gripes of infants. It it fliould happen, how- ever, not to fucceed, a little brandy or other fpirits may be mixed with thrice the quantity of warm water, and a tea-fpoonful given frequently till the infant be eafier. Sometimes a little pepper-mint- owrater wijl 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 the arms, behind the ears, and in other parts that are moiftened by the fweat or urine. As thefe' complaints are, in a great meafure, owing to want of cleanlinefs, the moft effectual means of preventing them are, to wafh the parts frequently with cold water, to change the linen often, and, in a word^to keep the child in all refpects thoroughly clean. When this is not fufficient, the excoriated parts may be fprinkled with ab- forbent or drying powders, fuch as powdered ftareh,burnt hartfhorn, tuttya chalk, crabs' claws prepared, and the like. When the parts affected are very fore, and tend to a real ulceration, add a little fu- gar of lead to the powders; or anoint the place with camphorated ointment. If the parts be wafhed with fpring-water, in which a lit- tle white vitriol has been diffolved, it will dry and heal them very powerfully. One of the beft applications for this purpofe, is to dif» folve fome fuller's earth in a fufficient quantity of hot water •, and #fter it has flood till it is cojd, to rub it gently upon the galled part* price or twice a-day. t [ 373 3 Stoppage of the Nofe. THE noflrils of infants are often plugged up with a grofs mucus, which prevents their breathing freely, and likewife renders it dif- ficult for them to fuck or fwallow. Some, in this cafe, order, after a fuitable purge,two or three grains of wliite 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 quan- tity of elaterium, be diffolved in half an ounce of marjoram-water, and applied to the nofe, as above directed, that it brings away the mucus without fneezing. In obftinate cafes, thefe things may be tried ; but I have never found any thing neceffary, befides rubbing the nofe at bed-time with a little fweet oil, or frefli butter. This refolves the filth, and renders the breathing more free. Of Vomiting. FROM the delicate ftate of children, and the great fenfibility of their organs, a vomiting or loofenefs may be induced by any thing that irritates the nerves of the ftomach or inteftines. Hence, thefe diforders arc much more common in childhood than in the more advanced periods of life. They are feldom however dangerous, and ought never to be confidered as difeafiss, unlefs when they are vi- olent, or continue fo long as to exhauft the strength of the pa- tient. Vomiting may be excited by an over-quantity of food ; by food that is of fuch a nature as to irritate the nerves of the ftomach too much; or by the fenfibility of the nerves being fo much increafed as to render them unable to bear the stimulus of even the mildeft element. When vomiting is occafioned by too much food, it ought to be promoted, as the cure will depend upon cleanfing the ftomach. This may be done either by a few grains of ipecacuanha, or a few drops of antimonial wine. When it ic owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a milder nature fubftituted in its flead. When vomiting proceeds from an increafed degree of fenfibili- ty, or too great an irritability of the nerves of the ftomach, fuch medicines as have a tendency to brace and ftrengthen that organ, and abate its fenfibility, muft be ufed. The firft cf thefe intentions may be anfwered by a flight infufion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the fecond 3/4 A LOOSENESS. * by the faline draughts, to which a few drops of liquid laudanum may be occafionaily added. In obftinate vomitings, the operation of internal medicines may be affifted by aromatic fomentations made with wine, applied warm to the pit of the ftomach; or the ufe of the ftomach-plaifter, with the addition of "a little theriaca. Of a Loofenefs. A LOOSENESS may generally be reckoned falutary when the ftools are four, flirny, green, or curdled. It is not the difcharge,but the production of fuch ftools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too fuddenly, as it often proves critical, efpecially when the child has caught cold, or an eruption on the fkin has difappeared. Some- times an evacuation of this kind fucceeds a humid ftate of the at- mofphere, in which cafe it may alfo prove of advantage, by carry- ing off a quantity of watery humours, which would otherwife tend to relax the habit. As the principal intention of the cure of a loofenefs is to evacu- ate the offending matter, it is customary to give the patient a gen- tle vomit ofipecacuanha, and afterwards to exhibit fmall and fre- quent dofes of rhubarb ; interpofing abforbent medicines, to miti- gate the acrimony of the humours. The beft purge in this-cafe, is magnpfta alba. It is abforbent and laxative, and operates without ex- citing gripes. The antimonial wine, which acts both as an emetic and purge, is alfo an excellent medicine in this cafe. By being diluted with water, it may be proportioned to the weakest conftitution ; and, not being difagreeable to the palate, it may be repeated as often as occafion requires. Even one dofe will Frequently mitigate the dif- eafe, and pave the way for the ufe of abforbents. If the patient's ftrength will permit, the medicine ought to be repeated every fix or eight hours, till the ftools begin to affume a more natural appear- ance ; afterwards a longer fpace rhay be allowed to intervene be- tween the dofes. When it is neceffary to repeat the medicine fre- quently, the dofe ought always to be a little fncreafed, as its effica-- cy is generally diminifhed by ufe. Some upon the firft appearance of a loofenefs, fly to abforbent medicines and aftringents. If thefe be adminiftered before the of- fending humours are difcharged, though the difeafe may appear to be mitigated for a little time, it foon afterwards breaka forth with greater violence, and often proves fatal. After proper evacuations, however, thek medicines may be adminifterecT with confiderable advantage. ?. PURGING OF CHILDREN.- 37$ \ Should any gripings or reftlefsnefs remain after the ftomach and bowels have been cleanfed, a tea-fpoonful of the fyrup of poppies may be given in a little fimple cinnamon-water, threfc or four times a-day till thefe fymptoms have ceafed. Of the Vomiting and Purging of Children* I 1 THIS difeafe is nearly the fame which occurs in grown people. „ It is produced by the like caufes, and requires a fimilar method of cure. It frequently appears in the month of June, hut becomes mors frequent in July, August and September, when the weather is ve- ry warm, or foon after there has been a fudden change to cool wea- i ther, attended with a north-eaft wind. The latter often takes place j during the fummer months in North-America. | In a fhort time after this change, and not unfrequently in the | courfe of one night, a number of children are taken down with this difeafe. - t But the difeafe often occurs, independent of this change, when I the weather is very warm, and it is generally brought on by over- charging the ftomach with food, which, either from its quality, or. J quantit;, and fometimes from both, irritates the ftomach, and pro- I duces violent vomiting and purging. - Children are affected with this difeafe, from an early period in life, until they are two or three years old ; but it more efpecially , exerts its destructive influence on the children of cities, and feldom affects thofe who refide in the country. It moft frequently comes on in the evening, or early in the morn- ing ; when the patient is ufually feized of a fudden with violent vo- . miting. This is foon fucceeded by purging, accompanied with a ' fever generally of the remitting kind. The matter difcharged in this • ftage of the difeafe, is generally of a green or yellow colour, large in quantity; but fometimes the ftools affume the appearance of thofe [ evacuated in a dyfentery, or flux, and attended with much griping. Towards evening the fymptoms generally increafe. The vomiting and purging are confiderably augmented, with an evident exacer- bation of fever. This is attended with head-ach, reftleffnefs, re- traction of the navel, great thirft, a quick and feeble pulfe, the countenance flufhed, particularly during a fit of vomiting, when the patient is in a profufe perfpiration, and the fkin feels cool ami clammy. Every morning the fymptoms fuffer fome abatement. As the difeafe advances, the patient becomes more exhaufted, and has a general appearance of emaciation. The vomiting or purging fome- times ceafes, but generally both continue. The ftools become lefs copious, very fcetid, and frequently of a water colour. The pulfe is generally irregular and feeble, the eyes languid, and they appear to 376 PURGING OF CHILDREN, be funk in their orbits. There is alfo a fwelling in the feet and legs. The breathing bocomes difficult; the patient drowfy and in- fenfible. The voice undergoes a confiderable alteration. Delerium, difficulty in breathing, extremities, cold, eyes glaffy, and at length convulfions follow, till death concludes the fcene. This is generally the progrefs of the difeafe, when it terminates in death, but it is fometimes protracted to an uncommon period. This is the cafe when the fymptoms are more moderate, or have been interrupted by a fhort continuance of cool weather. But at laft they return with increafing violence. The patient becomes ex- ceffively extenuated. The fwelling of the limb* and belly increafe with livid fpots on the fkin. There is a hectic bh.ih on the check-, during the exacerbation of fever, and the difeafe is frequently ac- companied with a fore mouth, which almoft always precedes the- diffoiution of the patient. MEDICINE-----The cure of this difeafe can generally be ef- fected, if affiftance is called early. The firft ftep fhould be to evacu- ate the offending matter from the ftomach and bowels, particular- ly if the patient is not much exhaufted, and if we have reafon to believe that the'irritating matter is not difcharged. This fliould be accomplifhed by ordering the patient to drink large quantities of warm water, or warm tea of any kind. But when this cannot be complied with, a few grains of ipecacuanha may be adminiftered, which will empty the ftomach, and clear the bowels. Should it not have the latter effect, caftor-oil, calomel, or magnefia may be giv- en. When the ftomach refufes thofe medicines, clyfters may be employed with advantage. When the irritating matter has been evacuated, either by the na- tural efforts of the fyftem, or by art, the vomiting rnuft be restrain- ed by giving ten or fifteen drops of laudanum, or in quantities pro- portioned to the age of the patient. The laudanum fhould be mixed in mint tea, or cinnamon water. The former, or toaft and water, fliould be the conftant drink. This medicine will have the defired effect, and mitigate pain. When the vomiting is with difficulty re- flrained, flannels rung out of aromatics infufed in brandy, muft be conftantly applied warm to the ftomach. Where thefe fail, a blifter applied to the region of the ftornach, has fometimes the moft hap- py'effect. After the difeafe has fubfided, the body muft be invigorated by stimulants and tonics. The drink muft be wine and water, or brandy and water, the latter having the addition of fugar. The pa- tient fhould alfo take one tea-fpoonful, or half a table-fpoonful of a light infufion of bark, with aromatics once in every two or three hours. The food muft be light and nourifhing, as fago, or gruel Beef fteaks, or almoft any animal food, may be taken in fmall quan- tities. The patient fhould refide in the country, and ride every day. This tends much to reftore the health. Nay, when every other re- ERUPTIONS. 377 medy has failed, a change of ah- and exercife has'entirely removed the difeafe. When it is not convenient, for the patient to ride out, he may be carried into the country during the moft agreeable part of the day. The beft way to prevent this difeafe, is for children, when at the age liable to it, to refide, during the fummer months, in the country, to avoid every excefs in eating, and to be cautious to ac- commod ite their drefs to every change of weather. Of Eruptions. CHILDREN, while on the breaft, are feldom free from erup* tions of one kind or other. Thefe are not often dangerous, and ought never to be dried up, but with the greateft caution. They tend to free the bodies of infants from hurtful humours, which, if retained, might produce fatal diforders. . The eruptions of children are chiefly owing to improper food and neglect of cleanlinefs. 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 nouriftiing 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 occafion fevers and other internal diforders. Neglect of cleanlinefs is a very general caufe of eruptive diforders. The children of the poor, and of all who defpife cleanlinefs, are almoft conftantly found to fwarm with vermin, and are generally covered with a fcab, itch, and other eruptions. When eruptions are the effect of improper food, or want of cleanlinefs, a proper attention to thefe alone, will generally be fuf- ficient to remove them, If this fliould not be the cafe,fome drying" medicines will be neceffary. When they are applied, the body ought, at the fama time, to be kept open, and cold is Carefully to be avoided. No medicine is more fafe for drying up cutaneous eruptions than fulphur, provided it be prudently ufed.. A little of the flour of fulphur may be mixed with frefh butter, or hog's lard, and the parts affected frequently touched with it. The moft obftinate of all the eruptions incident to children 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 diforders, of which they died, foon after their fcabbed heads had been healed, by the application of drying medi- cines*. The cure ought always firft to be attempted, by keeping ■* I fome time ago faw a very ftriking instance of the danger of fub-^ ftitutirisdrving medicines in the place of cleanliness and wholefome food/ B 3 378 THE HIVES. the head very clean, cutting off the hair, combiag and brufhing away the fcabs, &c. If this is not fufficient, let the head be fhaved once a-week, wafhed daily with foap-fuds, and gently anointed with a hniment made of train-oil, eight ounces, red precipitate, in fine powder, one drachm. And if there be proud flefh, it fhould be touched with a bit of blue vitriol, fprinkled with a little burnt allum. While thefe things are doing, the patient muft be confined to aregular light diet, the body fhould be kept gently open ; and cold, as far as poffible, ought to be avoided. To prevent bad con- fequences from ftopping this difcharge, it will be proper, efpeci- ally in children of a grofs habit, to make an iffue in the neck or arm, which maybe 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. To prevent this difeafe, violent cold and fudden heat muft be equally avoided. When the parts begin to look red and fwell, the patient ought to be purged, and have the affected parts frequently rubbed with muftard and brandy, or fomething of a warming na- ture. They ought likewife to be covered with flannel, and kept warm and dry. Some apply warm afhes between cloths to the fwelled parts, which frequently help to reduce them. When there is a fore, it muft be dreffed with Turner's cerate, the ointment of tutty, the plaifter of cerus, or fome other drying ointment. Thefe fores are indeed troublefome, but feldom dangerous. They gene- rally heal as foon as the warm weather fets in. Of the Hives. THIS difeafe in Scotland is called the croup, but in America it is beft known by the name of hives. It may be divided into two kinds, the humid and fpafmodic* The former is the prefent fub- in the foundling hofpital as Ackworth, where the children were grie- voufly afflicted with fcabbed heads and other cutaneous diforders. Up. on inquiry, it was found, that very little attention was paid either ta the propriety or foundnefs of their [,rovifions, and that cleanlinels was totally neglected ; accordingly, it was advifed, that they fliould have more wholefon.e food, and be kept thoroughly clean. This advice, however, was not followed. It was too troublefome to the fervants, fuperintendants. &c The bufinefs was to be done by medicine ; which was accordingly attempted, but had nearly proved fatal to the whole houfe Fevers and other internal diforders. immediately appeared ; at length, a putrid dyfentery, which proved fo infectious, that it carried off a< great many of the children, and fpread over a confiderable part of the neighbouring country. SPASMODIC HIVES. 3^9 ject of confideration, and may be known by a peculiar croaking found of the voice, like the barking of a dog, or, by fome, com- pared to the crowing of a cock, attended with a difficulty of brea- thing. This difeafe generally affects children under nine years of age, but no age is exempt from its violence. Ic generally feizes chil- dren during foggy weather, or early in the fpring when damp weather fucceeds the winter cold. SYMPTOMS.----It comes on gradually; the patient is ob- ferved to lofe his ufual gaiety, and fymptoms of fever appear, with defective, appetite, attended by a flight difficulty of breath- ing ; a dry, fhort cough with hoarfencfs, and the bowels are gene- rally coftive. The countenance appears heavy, and indicates dif- trefs. The breathing becomes quick and interrupted, and a pecu- liar croaking found of the voice is heard, particularly when the patient attempts to cough, at which time the face appears high- ly flufhed and almoft livid. The carotid and temporal ar- arteries throb greatly. The pulfe is, fometimes hard, and generally quick. As the diftafe advances, the patient becomes very reftlefs. The breathing is more interrupted and laborious, with a rattling of phlegm in the throat. The noflrils expand and contract, the fhoulders are ftrongly elevated at every infpiration, and the cheeks diftended with air "at every expiration, accompanied with great anxiety and fenfe of fuffocation. The pulfe becomes extremely feeble ; fkin clammy ; the extremities cold and livid. At length the patient is exhausted and dies. MEDICINE.----In the cure of this difeafe, if the pulfe is full and hard, blood fhould be taken from the arm or jugular vein, but the moft promising effects are to be expected from large dofes of calomel. Eight or ten grains of this medicine fliould be early ad- miniftered, combined with as many of jalap, according to the age of the patient, in order to produce copious evacuations ; after which, if the fymptoms fliould not fublide, the patient muft be vomited with tartar emetic or ipecacuanha, and the calomel fhould be repeated. Blifters muft be applied to the fore part of the neck. Thefe remedies fliould be continued until the fymptoms difappear. The patient's ftrength fliould then be reftored, by nourifhing diet and tonic medicines, fuch as bark,fteel, cold bathing, affifted by exercife. Spafmodic Hives. THIS difeafe bears fome refemblance to the preceding, in af- fecting children under fimilar circumftances, but differing in its manner of attack. It most generally comes on of a fudden during 3*o TEETHING. the heat of the day, without any apparent previous indifpofition ; or in the courfe of the evening, when children frequently a > akc from their fleep with hoarfenefs, flight cough, and great difficulty in breathing, which obliges them to affume an erect pofture, for fear of fuffocation. The face is generally flufhed, and its being dif- torted, exhibits ftrong figns of anxiety and diftrefs. Thefe fymptoms are accompanied with a peculiar croaking tone of the voice in cough- ing ; full and quick pulfe, with an increafe of heat; confiderable thirft; and, towards the clofe of the difeafe, a rattling of phlegm may be heard in the throat. The breathing becomes more interrupted and laborious, with a ftrong elevation of the fhouldcr at every inspi- ration ; great reftleffnefs ; pulfe quick, and extremely feeble; the extremities become cold, and every hope of recovery foon va- nifhes. This is the progrefs of the difeafe when it terminates in death, which generally takes place on or before the third day. But fome- times its attack is moderate, and only lafts a few.hours, and re- turns again the following evening. The feat of this complaint appears to be in the mufcles furrounding the larynx, or upper part of the wind-pipe, which are no doubt violently and fometimes permanently affected with fpafm, which ftrongly points out the propriety of the following mode of relief. If the pulfe is full and hard, blood muft be taken from the arm or jugular vein, and th< patient immediately put into the warm bath, or the feet and legs bathed in warm water. Should the fymptoms not fubfide, a blifter muft be applied to the forepart of the neck, and laudanum muft be adminiftered, toco-operate with the other remedies in remov- ing the fpafm. The bowels fliould be kept open, with calomel and jalap, and when the phlegm in the wind-pipe impedes the breath- ing, an emetic may be given. Thefe medicines muft be ufed dur- ing a fit or paroxyfm, after which the fyftem muft be invigorated, to prevent a return of the difeafe, by tonics and ftimulants, fuch as bark, wine, fteel, and Cold bathing, affifbed by nourifhing food, aud fuitable exercife. Of Teething. Dr. ARBUTHNOT obferves, that above a tenth part of infants die in teething, by fymptoms proceeding from the irritation of the tender nervous parts of the jaws, occafioning inflammations, fevers, convulfions, gangrenes, &c. Thefe fymptoms are in a great mea- fure owing to the great delicacy and exquifite fenfibility cf the ner- vous fyftem at this time of life, which is too often increafed by an effeminate education. Hence, children delicately brought up, al» ways fuffer moft in teething, and often fall by convulfive diforders. TEETHING. 381 About the fixth or feventh month the teeth generally begin to make their appearance ; firft, the incifores, or fore-teeth; next, the canini, or dog-teeth ; and, lastly, the molarts, or grinders. About the feventh year, there comes a new fet; and about the twentieth, the two inner grinders, called denies fapientue, the teeth of wifdom. Children, about the time of cutting their teeth, flaver 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 th(? gums, watching?, gripes, green ftools, the thrufh, fever, difficult breathing, and con- vulfions. Difficult teething require nearly the fame treatment as an in- flammatory difeafe, If the body be bound, it muft be opened either by emollient clyfters or gentle purgatives; as manna, magnefia al- ba, fenna, or the like The food fhould be light, and in, fmall quan- tity ; the drink plentiful, but weak and diluting, as mfufions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added. If the fever be high, bleeding will be neceffary ; but this in very young children ought always to be fparingly performed. It is an evacuation which they bear the worft of any. Purging, vomiting, or fweating agree much better with them, and are generally more beneficial. Harris, however, obferves, that when an inflammation appears, 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 convulfion fits, a blifter may be applied between the fhoulders, or one behind each ear*. Sydenham fays, that in fevers occafioned by teething, he never found any remedy fo effectual, as two, three, or four drops of fpirits ■_ of hartfhorn in a fpoonful of fimple water, or other convenient ve- hicle, given every four hours. The number of dofes may be four, five, or fix. I have often prefcribed this medicine with fuccefs, but always found a larger dofe neceffary. It may be given from five 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 plaifter between their fhoul- ders. This generally eafes the tickling cough which attends teeth- ing, and is by no means an ufelefs application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as-occafion requires, and ought to be renewed, 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 hind is to be ufed, we would recommend a lit— 1 tie" fine honey, which may be rubbed on with the finger three or • The child fhould be put into the warm bath", and a fuitable dofe of laudanum adminiftered. (I. G.) v^ 382 PICKETS. for times a-day. Children are generally at this time difpofed to ' ch w whatever they get into their hands. For this reafon, they ought iv. er to be without fomewhat that will yield a little to the preffure ol heir gums, as a cruft of bread, a wax-candle, a bit of liquorice- rot t, or fuch like. With regard to cutting the gums, we have feldom known it of g eat benefit. In obftinate cafes, however, it ought to be tried. It may be performed by any fharp body which can be with fafety in- troduced into the mouth; but the lancet, in a fkilful hand, is the moft proper. To render the teething lefs difficult, parents ought to take care that their children's food be light and wholefome, and that their " nerves be braced by fufficient exercife without doors, the ufe of the cold bath, &c. Were thefe things duly regarded, they would have a much better effect than teething necklaces, or other nonfenfical amulets worn for that purpofe. The Rickets GENERALLY attack children between fhe age cf nine month* and two years. It appeared firft in England about the time when manufactures began Xo flourifh, and ftill prevails moft in towns where the inhabitants follow fedentary employments, by which means they neglect either to take proper exercife themfelves, or to . give it to their children. CAUSES_____One caufe of the rickets is difeafed parents. Mo- . thers of a weak relaxed habit, who neglect exercife, and live upon j weak watery diet, can neither be expected to bring forth ftrong and healthy children, or to be able to nurfe them after they are brought forth. Accordingly, we find, that the children of fuch women ge- nerally die of the rickets, the fcrophula, confumptions, or fuch like difeafes. Children begotten by men in the decline of life, who are fubjeet to the gout, the gravel, or other chronic difeafes, or who have been often affected with the venereal difeafe in their youth, ( are likewife very liable to the rickets. s Any diforder that weakens the conftitution, or relaxes the habit of children, as the fmall-pox, meafles, teething, the hooping-cough, Sec. difpofes them to this difeafe. It may be occafioned by impro- per 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 nourifh the child, it cannot thrive. But children fuffer oftner by want of care in nurfes than want of food. Allowing an infant to lie or fit too much, or not keeping it thoroughly clean in its clothes, has the moft pernici- ous effects. RICKETS. 38£ The want of free air is likewife very hurtful to children in this re.pect. When a nurfe fives in a clofe, fmall houfe, where the air is damp and confined, and is too indolent to carry, her child abroad into the open air, it will hardly efcape.this difeafe. A healthy child fhouldalways be in motion, unlefs when afleep; if it be fuffered to lie, or fit, inftead of being toffed and dandled about, it will not thrive. SYMPTOMS.----At the beginning of this difeafe the child's flefh grows foft and flabby; hs ftrength is diminifhed ; it lofes its wonted cheerfiulnefs, looks more grave and compofed than is natu- ral for its age, and does not choofe to be moved. The head and belly become too large in proportion to the other parts; the face appears full, and the complexion florid. Afterwards the bones be- gin to be affected, 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 crook- ed. Thefe fymptoms vary according to the violence of the difeafe. The pulfe is generally quick, but feeble ; the appetite and digeftion i for the moft part bad; the teeth come flowly and with difficulty, and they often rot and fall out afterwards. Ricketty children gene- Jprally have great acutenefs of mind, and an understanding above their years. Whether this is owing to their being more in company of adults than other children, or to the preternatural enlargement , > of the brain, is not material. REGIMEN-----As this difeafe is always attended with evident figns of weaknefs and relaxation, our chief aim in the cure, muft be, to brace and strengthen the folids, and to promote digeftion, and the due preparation af the fluids. Thefe important ends will be beft anfwered by wholefome nourifhing diet, fuited to the age and . ftrength of the patient, open dry air, and fufficient exercife. If the child has a bad nurfe, who either neglects her duty, or does not 1 underftand it, fhe fhould be changed. If the feafon be cold, the ■ child ought to be kept warm; and when the weather is hot, it ought | to be kept cool ; as fweating is apt to weaken it ; and too great a. degree of cold has the fame effect. The limbs fhould be rubbed frequently with a warm hand, and the child kept as cheerful as : poffible. The diet ought to be dry and nourifhing, as good bread, roafted flefh, &c. Bifcuit is generally reckoned the beft bread; and pigeons, pullets, veal, rabbits, or mutton roafted or minced, are the moft proper flefh. If die child be too young for flefh-meats, he 1 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 cla- ret, mixed with an equal quantity of water. Thofe who cannot afford claret, may give the child, now and then, a wine-glafs of mild if ale, or good porter. *' MEDICINE.-----Medicines are here of little avail. The difeafe may often be cured by the nurfe, but feldom by th; phyfician. In 384 CONVULSIONS. children of a grofs habit, gentle vomits, and repeated purges of rhubarb may fometimes be of ufe, but they will feldom carry off the difeafe ; that muft depend chiefly upon fuch things as brace and strengthen the fyftem: for which purpofe, befides the regimen mentioned above, we 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 immediately after he comes out of it. If the child fliould be weakened by the cold bath, it muft be difcontinued. 1 Sometimes iffues have been found beneficial in this difeafe.— They are peculiarly neceffary for children who abound with grofs humours. An infufion of the bark in wine or ale would be of fer- vice, were it poffible to bring children to take it. Many other me- dicines have been recommended for the rickets; but there is far more danger in trusting to thefe than in neglecting them altogether. We recommend a proper regimen as the thing chiefly to be de- pended on. Of Convulfions. THOUGH more children are faid to die of convulfions than of any other difeafe, yet they are, for the moft part, only a fymptom of fome other malady. Whatever greatly irritates or ftimulates the nerves, may occafion convulfions. Hence, infants, whofe nerves are eafily affected, are often thrown into convulfions by any thing that irritates the alimentary canal; likewife, by teething ; ftrait clothes; the approach of the fmall-pox, meafles, or other eruptive difeafes. , When convulfions proceed from an irritation cf the ftomach cr '. bowels, whatever clears them of their acrid contents, or renders thefe mild and inoffenfive, will generally perform a cure: where- fore, 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 re- peated occafionaily, and the body in the mean time kept open by gentle dofes of magnefia alba. Convulfions which precede the eruption of the fm?.ll-pox cr , meafles, generally go off upon thefe makingtheir appearance. The 1 principal danger in this cafe, arifes from the fears and apprchen- ; fions of thofe who have the care of the patient. Convulfions are .. very alarming, and fomething muft be done to appeafe the affright- | ed parents, nurfes, &c. Hence the unhappy infant often undergoes j bleeding, bliftering, and feveral other operations, to the great dan- ger of its life, when a little time, bathing the feet in warm-water, 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 recommend bliftering, and the ufe of an- WATER IN THE HEAD. 38$ tifpafmodic medicines, as the tincture of foot, afafceticla, or caftor. A dofe of laudanum maybe mixed in a cup of white-wine whey,' and given occafionaily. When convulfions proceed from any external caufe, as the pref- fure occafioned by ftrait clothes or bandages, &c. thefe ought im- mediately to be removed; though, in this cafe, taking away the caufe will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the caufe which firft gave rife to the diforder continues to act. 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 rea- fon to conclude that it is a primary difeafe, and proceeds immedi- ately from the brain. Cafes of this kind happen but feldom, which is very fortunate, as little can be done to relieve the patient. When a difeafe proceeds from an original fault in the formation or struc- ture of the brain itfelf, we cannot expect that it fhould yield to me- dicine. But as this is not always the caufe, even of convulfions which proceed immediately from the brain, fome attempts fhould be made to remove them. The chief attention to be purfued for this purpofe, is to make fome derivation from the head, by blifter- ing, purging, and the like. Should thefe fail, iffues or fetons may be put in the neck, or between the fhoulders. Water in the Head, or a Dropfy of the Brain, MAY affect adults as well as children, yet, as the latter are more peculiarly liable to it, we thought it proper to place it among ithe difeafes of infants. CAUSES.----A dropfy of the brain may proceed from injuries done to the brain itfelf, by falls, blows, or the like; from an original laxity or weaknefs of the brain; from fchirrous tumors, or excre- fcences within the fkull; a thin, watery ftate of the blood ; a dimi- nifhed fecretion of urine; and, lastly, from tedious and lingering difeafes, which wafte and confume the patient. SYMPTOMS.----This difeafe has at firft the appearance of a flow fever; the patient complains 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 irregular and generally low: though he feems heavy and dull, yet he does not fleep: he is fometimes delirious, and frequently fees objects double ; towards the end of this com- monly fatal difeafe, the pulfe becomes more frequent, the pupils of the eyes are generally dilated, attended with fquinting; the cheeks flufhed, the patient becomes comatofe, and convulfions enfue. C3 ^«6 WATER IN THE HEAD. MEDICINE.—No medicine has hitherto been found fuffi- *cient to carry off a dropfy of the brain. It is laudable, however, to make fome attempts, as time or chance may bring many things to light, of which at prefent we have no idea. The medicines gene- Tally ufed are, purges of rhubarb or jalap with calomel, and blif- ters applied to the neck or back part of the head. To which we beg leave to add diuretics, or medicines which promote the fe- 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 to fnuff the powder of afarura, white helle- bore, or the like. Some practitioners have, of late, pretended, to cure this difeafe by the ufe of mercury. I have not feen a cure performed in a con- firmed dropfy of the brain* ; but in fo defperate a malady, every thing deferves a trialf, * The cure of this difeafe may fometimes be effe&ed, by attending to the following circumstance, and directing the remedies accordingly: If the pulfe is full, and the fever confiderable, which is ufually the cafe, in the firft ftage of this difeafe, blood fliould be taken from the arm, and the operation repeated if neceffary. The quantity, to be taken muft de- fend upon the urgency of the fymptoms and age of the patient: during the time of bleeding, purging fhould be produced with calomel and ja- lap, and every part of the cooling regimen ftriftiy enjoined. Blifters muft be applied to the neck, with the previous application of cupping- glaffes; the blifters fhould be fuffered to difcharge, until a reduction of the inflammatory fymptoms has been effe&ed, or until the difeafe has puf- fed into the fecond ftage. In which, anefFufion of water is fufpected to have taken place in the brain. This may be conjectured, from a quick and feeble pulfe ; together with a-continuance of the dilated pupil and fquinting eye ; the treatment muft be then varied, and the fyitem charged with mercury, in order to promote the abforption, ?nd carry off the Water; for this purpofe, one or two drachms of mercurial ointment muft be rubbed into the infide of each thigh, every morning and even- ing, until the gums are affected : This practice muft be continued until the fymptoms are removed. After this, the debilitated fyttesn fliould be invigorated by tonics, fuch as bark, fteel, exercife. nourifhing food, and cold bathing. 1. C t One reafon why this difeafe is feldom or never cured, may be, that it is feldom known till too far advanced to admit of a remedy. Did parents watch the firft fymptoms, and call a phyfician in due time, I think that fomething; might be done. But thefe fymptoms are not fuf- ficiently known and are often miftaken even by phyficians themfelves. Of this, I lately faw a ftrking inltance, in a patient attended by an eminent practitioner of this city, who had all along miftaken the difeafe •for tsething. * £ 2?Z ] ^ CHAPTER. LIL 0/" §urgery. TO defcribe all the operations cf furgery, and point out the different "difeafes in which they are neeefiVry, would extend this article far beyond the limits fet to it; we therefore confine our obfervations to fuch cafes as moft generally occur, and in which proper affiftance is either not afked, or not always to be obtained. Though an acquaintance with the ftructure of the humane body is indlfpenfably neceffary to qualify a man for being an expert fuigeon; yet many things may be done to fave the lives of their fellow-men in emergencies by thofe who are no adepts in anatomy. The peafants daily perform operations upon brute animals, which are not of ajefs difficult nature than many of thofe performed on the hiuman fpecies; yet they feldom fail of fuccefs. Every man is in fome meafure a furgeon whether he will or not. as pleurisies, peripneumonies, &c. It is likewife proper in all to- pical inflammations, as thofe of the inteftines, womb, bladder, fto- mach, kidnies, throat, eyes, &c. as alfo in the afthma, fciatic pains, coughs, head-achs' rheumatifms, the apoplexy, epilepfy, and bloody flux. After falls, blows, bruifes, or any violent hurt re- 388 BLEEDING. ceived either externally or internally, bleeding is neceffary. But in all diforders proceeding from a relaxation of the folids, and an impoyerifhed ftate of the blood, as dropfies,' cacochymies, &c. bleeding is improper. Bleeding for topical Inflammations ought always to be perfor- med as near the part affected as poffible. When this can be done with a lancet, it is to be preferred to any other method; but where ■ a vein cannot be found, recourfe muft be had to leeches or cupping. The quantity of blood to be let muft always be regulated by the ftrength, age, conftitution, manner of life, and other circumftan- ces relating to the patient. It would be ridiculous to fuppofe that a child could bear to loofe as much blood as a grown perfon, or that a delicate lady fhould be bled to the fame extent as a robuft man. From whatever part of the body blood is to be let, a bandage muft be applied between 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 leaft an inch, or an inch and half from the place where the wound is intended to be made. Perfons 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 for- mer may eafily be known from its pulfation or beating, and the latter from its feeling hard or tight, like a whip-cord under the finger. ; It was formerly a rule, even among regular praflitioners, to bleed their patients in certain difeafes till they fainted. A more ridiculous rule could not be propofed. One perfon will faint at ' the very fight of a lancet, while another will loofe almoft the whole J blood of his body before he faints. Swooning depends more upon J the ftate of the mind than of the body ; befides, it may often be ' occafioned or prevented by the manner in which the operation is performed. Children are generally bled with leeches. This, though fome- . times neceffary, is a very troublefome and uncertain practice. It Is impoffible to know what quantity of blood is taken away by | leeches; befides, the bleeding is often very difficult to flop, and the wounds are not eafily healed. Would thofe who practife bleeding take a little more pains, and accuftom themfelves to bleed ] children, they would not 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 inftance, 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; without confidering that all the blood-veffeH INFLAMMATIONS AND ABSCESSES. 389 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 is taken. But this, though a foqlifh preju- dice, is not near fo hurtful as the vulgar notion, that the firft bleeding will perform wonders. This belief makes them often postpone the operation when neceffary, in order 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 certain ftated periods or feafons has, likewife, bad effects. 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 in all topical affections, blood ought to be drawn as near the part as poffible. When it is necef- fary to bleed in the foot or hand, as the veins are fmall, and the bleeding is apt to flop 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 perform- " ing 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 neceflary to point out the different parts of the body from whence blood may be lee, as the arm, foot, forehead, temples, neck, &c. Thefe will readily occur to every intelligent; perfon, and the foregoingobfervations will be fufficient for deter- mining whtch of them is moft proper upon any particular occa- fion. In all cafes where the intention is only to leffen 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 Abfeeffes. FROM whatever caufe an inflammation proceeds, it muft ter- minate either by difperfion, fuppuration, or gangrene. It is impof- f fible to foretel, with certainty, in which of thefe ways any parti- \ cular inflammation will terminate, yet a probable conjecture may be formed with regard to the event, from a knowledge of the pa- tient's age and conftitution. Inflammations happening in a flight ';■ degree upon colds, and without any previous indifpofifioii, will moft probably be difperfed ; thofe which follow clofe upon a fe- \ vcr, or happen to perfons of a grofs habit of body, will generally [• fuppurate ; and thofe which attack very old people, or perfons of a dropfical habit, will have a ftrong tendency to gangrene. If the inflammation be flight, and the conftitution found, the difperfion ought always to be attempted. This will be beft prq* 390 INFLAMMATIONS AND ABSCESSES. moted 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-plaifter. If, nowithftanding thefe applications, the fympfomatic fever increafes, and the tumour becomes larger, with violent pain and pulfation, it will be proper to promote the fuppuration. The beft application for this purpofe is.a foft poultice, which may be re- newed once a-day. If the fuppuration proceeds but flowly, a raw onion cut fmall or bruifed may be fpread upon the poultice. When the abfcefs is ripe or fit for opening, which may eafily be known from the thinnefsof the fkin in the: moft prominent part of it, a fluctuation of matter, which may be felt under the finger, and, generally fpeaking, an abatement of the pain, it may be opened with a lancet, or by means of cauftic. The laft way in which an inflammation terminates, is in a gan- grene, or mortification, the approach of which may be known by the following fymptoms; The inflammation loofes its rednefs, and becomes, dufkifh or livid ; the tenfion of the fkin goes off, and it feels flabby ; little bladders filled with ichor of different colours fpread all over it; the tumour fubfides, and from a dufkifh com- plexion, becomes black. A quick low pulfe, with cold clammy fweats, are the immediate forerunners of death. When thefe fymptoms firft appear, the part ought to be dreffed with cataplafms made of lixivium and bran. Should the fymptoms become worfe, the part muft be fcarified, and afterwards dreffed with bafiiieum foftened with oil of turpentine. All the dreffings muft be applied warm. With regard to internal medicines, the patient muft be fupported with generous cordials, and the bark exhibited in as large dofes as the ftomach will bear it. If the mor- . tified parts fhould feparate, the v/ound will become a common ul» I cer, and muft oe treated accordingly, " This article includes the treatment of. all thofe difeafes, which, in different parts of the country, go by the names of biles, impoft- pumes, whiiloi's, CSV. They are all abfeeffes in confequence of a previous inflammation, which, if poffible, ought to be di feu fled ; but when this cannot be done, the fuppuration fhould be promo- 4 ted, and the matter difcharged by an incifion, if neceffary ; after- | wards the fore may be dreffed with yellow bafilicum, or fome other digutiye ointment. [ 39* 3 Of Wounds. NO part of medicine has been more miftaken than the treat- ment or cure of Wounds. Mankind, in general, believe that certain herbs, ointments, and plaifters are poffeffed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is, however, a fact, that no external application, whatever, contributes towards the cure of a wound, any other way than by keeping the parts foft, clean, and defend- ing them from the external air, which may be as effectually done by dry lint, as by the moft pompous applications, while it is ex- empt from many of the bad confequences attending them. The fame obfervation holds with refpect to internal applica- tions. Thefe only promote the cure of wounds as far as they tend to prevent a fever, or to remove any caufe that might obstruct or impede the operations of nature. Nature alone cures wounds.— Art can only remove obftacles, and put the parts in fuch a condi- tion as is» moft favourable to Nature's efforts. With this fimple view, we fhall confider the treatment of wound6, and endeavour to point out fuch fteps as 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 poffible, ought to be extracted, and the wound cleaned, before any dreflings be applied. When that cannot be effected with fafety, on account of the patient's weaknefs, or lofs of blood, they muft be fuffered to remain in the wound, and afterwards extracted when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breaft, the bowels, See. or where any confiderable blood-veffel is cut, a fkilful furgeon ought immediately to be cal- led, otherwife the patient may loofe 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 generally 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 twifted, in the fame manner as a countryman does a cart-rope to fecure 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 application of 39* WOUNDS. ltybtics, aftringents, &c. Cloths dipped in a folution of blue vi- triol in water, or the flyptic' water of the Difpenfarories, may be applied to the wound. When thefe cannot be obtained, ftrong fpi- rits of wine may le ufed. Some recommend the agaricK of the oak as preferable to any of the other ftyptics ; and, indeed, it deferves confiderable encomiums. It is eafily obtained, and ought to be kept in every family, in cafe of accidents. A piece of it muft be faid 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, tinctures, and hot balfams may be ufed, in or« der 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 congeal the blood, and feem, as it were, to folder up the wound, that they therefore heal it; but this is only a deception. They may ftop the flowing blood, by fearing the mouths of the veffels; but, by rendering the parts callous, they obstruct the cure. In flight wounds, which do not penetrate much deeper than the flcin, the beft application is a bit of the common black flicking- plaifter. 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 matter, and is apt to make the wound feller. In this cafe, the beft way is to fill the wound with foft lint, commonly called caddis. It, however, muft not be fluffed in too hard, other* wife it will do hurt. The caddis may be covered with a cloth dip- ped in oil, or fpread with the common wax-plaiflerf; and the whole muft be kept on by a proper bandage. Common fenfe will fuggeft the moft commodious method of applying it. •fc Dr. Tiffot, in his Advice to the People, gives the following direc- tions forgathering, preparing, and applying the agaric. " Gather in autumn," fays he, " while the fine weather lafls, the agaric of the oak, which is a kind of fungus or excrefcence iffuing from the wood of that tree. It confifts at firft of four parts, which prefent themfelves fuccef- fively : i. The outward rind or fkin, which may be thrown away. 2. The part immediately under this rind, which is the bell of all. This is to be beat well with a hammer, till it becomes foft and very pliable.—} This is the only preparation it requires, ard a flice of it of a proper fize is to be applied directly over the burfting open blood-veffels. It con- ftringes and brings them clofe together, flops the bleeding, and gene- rally falls off at the end of two days. 3. The third pare, adhering to the < fecond, may ferve to ftop the bleeding fromthefmaller veffels; and the j fourth and laft part,may be reduced to powder, as conducing to the fame purpofe."—Where the agaric cannot be had, fponge may be ufed in it.4 dead. It muft be applied in the fame manner, and has nearly the fam« ., effects. t See Appendix, Wax-plaifter. Burns. 393 The firft dreffing ought to continue on for at leaft two days ; after wltich it may be removed, and frefh lint applied as before. If ahypart of the firft dreffing flicks fc*, clofe as not to be removed with eafe or fafety to the patient, 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 off eafily at next dreffing. Afteiwards the wound may be dreffed twice a-day in the fame manner till it be •quste healed. Thofe who are fond of falves or ointments, may, after the wound is become very fuperficial, drefs it with the yel- low baftlicum ;* and if fungous, or what is called proud flefh, fhould rifein the wound, it may be checked, by mixing with the oint- ment 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, foftencd with a little fweet oil or frefh butter. This muft be applied inftead of a plaifter, and fhould be changed twice a-day. k< If the wound be large, and there is reafon to fear an inflamrha- l{- tion, the patient fliould be kept on a very low diet. He muft ab- - stain from flefh, ftrong liquors, and every thing of a heating na- ' ture. 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 ope- ration may be repeated. But when the patient has been greatly weakened 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 more fafe to allow her to ftruggle with the difeafe in her own way, than to fink the patient's " ftrei gth by exceffive evacuations. \ Wounded perfons ought to be kept perfectly quiet and eafy. | Every thing that ruffles the mind or moves the paffions, as love, 1 anger, fear, exceffive joy, &c. are very hurtful. They ought, above i all things, to abftain from venery. The body fliould be kept gently open, either by laxative clyfters, or a cool vegetable diet, as roaf- : ted apples, ftewed prunes, boiled fpinage, and fuch-like. Of Burns. IN fii-ht burns which do not break the fkin, it is customary to | hold tmfpart'near the five for a competent time, to rub it with \ fait cr lay acomnrefs upon it dipped in fpirits of wine, brandy, 1 or cold vinegar. But when the burn has penetrated fo deep as to • blifter or break the fkin, it muft be dreffed with fome of the hni- \ ment for burns, mentioned in the Appendix, or with the emol- lient and gently drying ointment, commonly called Turners • cee A.npendix, Yellow-bafiucum. ' °3 394 BURNS. cerate* This may be mixed with an equal quantity of frefli olive oil, and fpread upon a foft rag, and applied to the part affected. When this ointment cannot be bad, 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 prepared. When the burn- ing is very deep, after the firft two or three days, it fliould be dreffed with equal parts of yellow bafilicum and Turner's cerate, mixed together. When the burn is violent, or has occafioned a high degree of in- flammation, as there is reafon to fear a gangrene or mortification, the fame means muft be ufed to prevent it as are recommended in other violent inflammations. The patient, in this cafe, muft live low, and drink freely of v/cak diluting liquors. He muft likewife be bled, and have his b ody kept open. But if the burnt parts fliould become livid or black, with other fymptoms of mortification, it will be neceffary to bathe them frequently with warm camphorated v fpirits of wine, tincture of myrrh, or other antifeptics, mixed with a decoction of the bark. The bark muft be taken internally, and the patient's diet muft be generous. As example teaches better than precept, I fhall relate the treatT ment of the moft dreadful cafe of this kind that has occurred in my practice. A middle-aged man, of a good conftitution, fell into a large veffel full of boiling water, and fcalded about one-half of his body. As hrs clothes were on, the burning in fome parts were very deep before they could be got off. For the firft two days, the fcalded parts had. been frequently anointed with a mixture of lime- water and oil, which is a very proper application for recent burn- ings. On the third day, when I firft faw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyfter adminiftered. Poultices of bread and milk, foftened with frefh butter, were likewife applied to the affected parts, to abate the heat and inflammation. His fever ftill continuing high, he was bled a fecond time, was kept strictly on the cooling regimen, took the faline mixture, with fmall dofes of nitre, and had an emollient clyfter adminiftered once a-day. When the inflammation began to abate, the parts were dreffed with a digestive, compofed of brown cerate and yellow bafilicum. Where any black fpots appeared, they were flightly fcarified, and touched with the tincture of myrrh ; and, to prevent their fpreading, the bark was adminiftered. By this courfe, the man was fo well in three weeks, as to be able to art-end his bufinefs. ■ ite .^rpuidix., Tinner's- cerate. C 395 ] Bruifes ARE generally productive of worfe confequences than wounds. As danger from them does not appear immediately, they are ne- glected. We proceed to point cut the method of treatment. In flight bruifes it will be fufficient to bathe the part with warm vinegar, to which a little brandy or rum may occafionaily be ad- "ded, and to keep cloths wet with this mixture conftantly applied to it. This is more proper than rubbing it with brandy, fpirits, or wine, or other ardent fpirits, which are commonly ufed in fuch cafes. When a bruife is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food fhould be light and cool, his drink weak, and of an opening nature ; as whey fweetened with honey, decoctions of tamarinds, barley, cream- tartar-whey, and fuch-like. The bruifed part muft be bathed with vinegar and water, as directed above ; and a poultice made by boiling crumbs of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice 16 peculiarly proper when a wound is joined to the bruife. It may be renewed two or three times a-day. As the ftructure of the veffels is totally destroyed .by a violent bruife, there often enfues a great lofs or fubftance, which pro- duces an ulcerous fore very difficult to cure. If the bone be " affected, the fore will not heal before an exfoliation takes place ; that is, before the difeafed part of the bone fep.irates, and comes out through the wound. This is often a very flow operation, and may even require feveral years to be completed. Hence it happens, that thefe fores are frequently miftaken for tie king's evil, and treated as fuch, though, in fact, they proceed fc'.. iy from the injury which the folid parts received from the blow. Patients in this fituation are pestered with different advices. Every one who fees them propofes a new remedy, till the fore is fo much irritated with various and oppofite applications, that it is of- ten at length rendered ahfolutely incurable. The beft method of managing fuch fores is, to take care that the patient's conftitution does not fuffer by confinement, or improper medicine, and to ap- ply nothing to them but fome fimple ointment, fpread upon foft lint, over which, a poultice of bread and milk, with boiled camo- mile-flowers, or the like, maybe put, to nourifh the t„ it, imdkeep it foft and warm. Nature, thus affifted, will generally \.\ time ope- rate a cure, by throwing off the difeafed parts of the bone, aster which the fore foon heals. v * f 396 ] Ulcers MAY be the confequence of wounds, bruifca, or impofthume.-, improperly treated; they may likewife proceed from an ill ftate cf the humours, cr what may be called a bad habit of body. In the latter cafe, they ought not to be haftily dried up, other- * wife it may prove fatal to the patient. Ulcere happen moft com- monly in the decline of life; and perfons who neglect exercife, and live grofsly, are meft liable to them. They might often be prevented by retrenching fome part of the folid food, or by cpening artificial drains, as iffues, fetons, or the like. An ulcer may be diftinguifhed from a wound by its difcharging a thin watery humour, which is often fo acrid ss to inflame and corrode the fkin; by the hardnefs and perpendicular fituation cf its fides or edges, by the time of its duration, &c. It requires confiderable fkill to be able to judge whether cr not an ulcer ought to be dried up. In general, ail ulcers which proceed from a bad habit of body, fbculd be fuffered to continue open, at leaft till the Gonftitutibn has been fo far charged by proper regimen, pr the ufe of medicine, that they feem difpofed to leal of their cwn accord. Ulcers, which are the effect of malignant fevers, or other acute difeafes, may generally be healed with fafety after the health has been reftcred for feme time. The cure ought net to le at- tempted tc*o foon, nor at ?xy time, without the ufe of purging medicines and a proper regimen. When wounds or bruifts, have, by wrong treatment, degenerated ir.to ulcers, if the eonflituticn be good, they may generally be healed with fafety. When ulcers either accompeny chronical difeafes, cr ccme in their fte?d, they muft be / cauticaifly healed. If an ulcer conduces to the patiert'shealth, from whatever caufek proceeds, it cught net to be heeled; but if, on the contrary, it wastes the ftrength, and confumes the patient by a flew fever, it fhould be healed as foon as poffible. We recommend a ftrict attention to thefe particulars, to all who have the misfortune to labour under this diforder, particularly perfons in the decline c-f life; as often people throw away their lives by the want of it, while they v.crc extolling, and genercufly rewarding thofe, whom they ouel-t to have looked upon as their executioners. The meft proper regimen for prcmotiu^ the cure of ulcer", is to - avoid all fpices,.falted and high-feafoned fi-od, ?M ftrong liquors, snd to kflc.ii the ufual quantity of flefti-mewt. The body cught to t- kept gently open, by a diet, confiding chit fly of cooling, laxa- tive vegetables, and by chinking butrcr-milk, wLey, fweetened with honey, cr the like. The patient ought to be kept cheerful, and fhould take as much exercife as he can eaf iy bear. W^en the bcttcm and fides cf 2n ulcer iam hard and caller:J, DISLOCATIONS. 397 t they may be fprinkled, twice a day, with a little red precipitate of mercury, and afterwards drefled with the yellow bafilicum oint- ment. Sometimes it will be neceffary to have the edges of the ulcer fcarified with the lancet. $ Lime-water has frequently been known to have very happy ef- fects in the cure of obftinate ulcers. It may be ufed in the fame manner as directed for the ftone and gravel. Dr. Whytt ftrongly recommends the ufe of the folution of cor- rofive fublimate of mercury in brandy, for the cure of obftinate ill- conditioned ulcers. 1 have frequently f'und this medicii-3 prove veryfuccefsful. The dofe is a table-fpoonful night and morning; at the fame time wafhing the fore twice or thrice a-day with it. 'fhe Doctor informed me, " That he obferved wufhiiig the fore thrice a-day, with the folution of a triple ftrength, was very bene- ficial*." A fiftulous ulcer can feldom be cured without r.n operation. It muft either be laid epen fo as to have its callous parts deftroyed 1 by fome corrofive application, or they muft be entirely cut away by the knife ; but as this operation requires the hand of an expert furgeon, there is no occafion to dcilribo it. Ulcers about the cnus are moft apt to become fiftulous, and,are very difficult to cure.— Seme,- indeed, pretend to have found Ward's Fistula pafte very fuccefsful in this complaint. It is not a dangerous mcdicuie, and being eafily procured, it may deferve a trial; but as thefe ulcers generally proceed from an ill habit of body, ihcy will feldom yield to any thing except a long courfe of regimen, affiled by medicines, fitted to correal that particular habit, and to induce an.almoft to- tal change in the conftitution. C II A F. LIII. Of Diflocations. WHEN a bemeii moved out of its place, or articulation, {o as to impede its proper functions, it is faid to be luxated or diftocated. As this often happens to perfons in fituations where? no medical affiftance cin be obtained, by which means, limbs, and even lives, are frequently loft, we fhall point out the method of reducing the moft common luxations, and thofe which require immediate affiftance. Any perfon cf common fenfe and refolution, who is prefent when a diflocation b.xpais, may often be of more fervice to the patient, thr:i the moft expert furgeon can, after the fwelling and inflanxvuiti^u have come on. When thefe are prefent, ■* Jn ulcers of the lower limbs, great benefit i; often received from tight roiiers or wearing a Isced locking, as this prevents the flux of huinoi n. to t'le fores, :>r:d diipoiV-. thrui to'h»-al. ■ 398 DISLOCATION OF THE JaW. it is difficult to know the ftate of the joint, and dangerous to at- tempt a reduction ; and by waiting till they are gone off, the muf- , cles become fo relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place. A recent diflocation may generally be reduced by cxtenfion alone, which muft always be greater or lefs according to the ftrength of the mufcles which move the joint, the age, robuftnefs, and other circumftances of the patient. When the bone has been cut of its place for any confiderable time, and a fwelling or inflam- mation has come on, it will be neceffary to bleed the patient, and, after fomenting the part, to apply, foft poultices, with vinegar to it, for fome time, before the reduction is attempted. All that is neceffary, after the reduction, is to apply cloths dipt in vinegar, or camphorated fpirits of wine to the part, and to keep it perfectly eafy. Many bad confequences proceed from the ne- glect of this rule. A diflocation feldom happens without the ten- dons arid ligaments of the joint being stretched, and fometimes torn. When thefe are kept eafy till they recover their ftrength and tone, all goes on very well; but if the injury be increafed by too frequent an exertion of the parts, no wonder if they be founcj weak and difeafed ever after. Diflocation of the Jaiv. THE lower jaw may be luxated by yawning, blows, falls, chew- ing hard fubftances, or the like. It is eafily known from the pa- tient's being unable to fhut his mouth, or to eat any thing, as the teeth of the under jaw do not correfpond with thofe of the upper ; befides, the chin either hangs down, or is thrown toward one fide, and the patient is neither able to fpeak distinctly, nor to fwallow without confiderable difficulty. The ufual method of reducing a diflocated jaw, is to fet the pa- tient upon a low ftool, fo as an affiftant may hold the head firm, by preffing it againft his breaft. The operator 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 backwards, 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 the patient's chin, then turning his back to that of the pa- tient, pulls him up by the chin, fo as to fufpend him from the ground. This method often fucceeds, but we think it is dang' - rous, and, therefore, recommend the former. C 399 J Diflocation of the Neck. « THIS may happen by falls, violent blows, or the like.— In this cafe, if the patient receives no affiftance, he foon dies, • which makes people imagine the neck was broken : it is, however, \ for the moft part, only partially diflocated, and may be reduced by almoft any perfon who has refolution enough to attempt it. A complete diflocation of the neck is inftantaneous death. When the neck is diflocated, the patient is immediately depri- ved of all fenfe and motion ; his neck fwells, his countenance ap- pears bloated ; his chin lies upon his breaft, and his face is geng is longer than the other ; but when it is difplaced backward, it is ufually pufhed upward at the fame time, by which means, the limb is fhorteued, and the foot is turned inwards. When the thigh-bone is difplaced forward and downward, the patient, in order to have it reduced, muft be laid upon his back, and made faft by bandages, or held by affiftants, while, by others, an extenfion is made by means of flings fixed about the bottom of the thigh, a little above the knee. While the extenfion is made, the operator muft pufli the head 0f 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. Diflocations of the knees, ancles and toes, are reduced much in the fame manner as thofe of the upper extremities, viz. by mak- ing an extenfion in oppofite directions, while the operator replaces the bones. In many cafes, the extenfiqi alone is fufficient, and the bone will flip into its place merely by pulling the limb with fuffi- cient force. It is not hereby meant, that force alone is fufficient for the reduction of diflocations. Skill and addrefs will often fuc- ceed better than force. I have known a diflocation of the thigh re- duced by one man, after all the force that could be ufed by fix had proved ineffectual. C H A P. LIV. Of Broken Bones, fcrV. THERE is, in moft country villages, fome perfon who pretends to the art of reducing fractures. Though in general fuch perfons are very ignorant, yet fome of them are very fuccefsful; which evidently proves, that a fmall degree of learning, with a fuf- ficient fhare of common fenfe and a mechanical head, will enable a man to be ufeful in this way. We advife people never to employ E3 '.A 402 BROKEN BONES, &c. fuch operators, when an expert furgeon can be had ; but when that'is impracticable, they mull be employed ; we, therefore, re- commend the following hints to their confideration : When a large bone is broken, the patient's diet pught, in all '< respects, to be the fame as in an inflammatory fever. Ifc fhould, likewife, be kept quiet and cool, and his body open by emcllient clyfters ; or, if thefe cannot be conveniently adminiftered, by food that is of an opening quality ; as ftewed prunes, apples boiled in milk, boiled fpinage, and the like. Perfons accuftomed to live high, are not, all of a fudden, to be reduced to a very low diet. This might have fatal effects. There is often a neceffity for indulging even bad habits, in fome meafure, where the nature of the difeafe might require a different treatment. It will generally be neceffary to bleed the patient immediately after a fracture, efpecially if he be young, of a full habit, or has, at the fame time, received any bruife or contufion. This operation fhould riot 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 neceflary. If any of the large bones which fupport the body are broken, the patient muft keep his bed for feveral weeks. It is by no means ne- ceffary, however, that he fhould lie all that time, as is cuftomary, upon his back. This fituation finks the fpirits, galls and frets the patient's fkin, and renders him very uneafy. After the fecond week he may be gently raifed up, and fit feveral hours, fupported by a bed-chair, or the like, which will greatly relieve him. Great care muft be taken in raifing him up, and laying him down, that he make no exertions himfelf, otherwife the action 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 neglecting this, he is often fo galled and excori- ated, that he is forced to keep fhifting places for eafe. I have known a fractured thigh-bone, after it had been kept straight for above a fortnight, difplaced by this means, and continue bent for life, in fpite of all that could be done. It has been cuftomary, when a bone v/as 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 * Various pieces of machinery have been contrived for counteracting the force of the mufcles, and retaining the fragments of broken hones; but as defcriptioRs of thefe, without drawings, would be of little life, I fhall refer the reader to a cheap and ufeful performance on the nature and cure of fractures, lateiy publilhed by Mr Aitken, furgeon in r. din- burgh ; wherein that gentleman has not only given an account cr'the machines recommended in fraftures by former authors, but has like- wife added feveral improvements of his own, which are peculiarly ufe- ful in compound fractures, and in cafes where patients with broken boneaare obliged to be traufported from one place to another. BROKEN BONES, &c. 403 the pofture into which every animal puts its limbs when it goes to reft, and in which fewreft mufcles are upon the ftretch. It is eafily •effected, by either laying the patient upon ins fide, or making the bed fo as to favour this pofition of the limb. • Bone-fetters ought carefully to examine, whether the bone be not fliattercd or broken into fcverr.l pieces. In this cafe, it will fome- timc-i be neceffary to have the FnrS immediately taken off, otherwife I a gangrene or mortification miey enfue. The horror which attends the very idea of an amputation often occafions its being delayed in fuch cafes till too late. I have known a limb, where the bones were fhattered into more than twenty pieces, that was not amputated be- fore the third day after the accident, when the gangrene had pro- , ceeded fo far as to render the operation ufelefe. When a frifturo is accompanied with a wound, it muft be dref- fc fed, ill all refpects, as a common w^r.d. } All th~t art can do tow.reds the cure cf a broken bone, is to lay [ it perfectly ftraight, and to keep it quite eafy. All tight bandages do hurt. They had much better be warning altogether. A great ma- 1. uy cf the bad confequences which fucceed to fractured bones are owing to tight bandages. This is one of the ways in which the ex- • cefs ot art, or ratn_r the abufe of it, does more mifchief thee would be occasioned by the want of if. Some of the moft fudden cures of broken bones which were ever known, h.ippenul were no bandages if . were applied at all. Some method muft be nken to keep the mem- • ber ftcady ; but this may be done in many -ways without bracing it ' with a tight bandage. ; The bwit method of retention is by two or more fplints "made of - . leather or pasteboard. Thefe, if moistened before they be. applied, ; foon affume the fhape of the included member, and are fuiiicient, by the affiftance of a very flight bandage, for all the purpofes of re- > tention. The bandage which he would recommend, is, that made with twelve or eighteen tails. It is much eafier applied and taken |.' off than rollers, and aofwers all the purpofes of retention equally well, flie fpinits fhould always be as long as the limb, with holes cut for the ancles when-the fracture is in the leg. In frattures of the ribg, where a bandage cannot be properly ufed, an adhefive plaifter may be applied over the part. The pa- tient, in this cafe, ought to keep hi; helf quite eafy, avoiding every thing that may occafion fneezing, laughing, coughing, or the like. He ought to keep his body in a ftraight pofture, and fhould take care that his ftomach be conftantly diftended, by taking frequently , fome light food, and drinking freely of weak watery liquors. The moft proper external application for a fracture is oxycrate, or a mixture of vinegar and water. The bandages should be wet with this at every dreffing. S [ 4C4 3 Of S rains. STRAINS are often attended with worfe confeq;ir-nces than broken bones. The reafon is obvious; they arc generally neglected. When a bone is broken, the patient is~obligcd 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 fcr'fo trifling; an ailment. In this way, he de- ceives himfelf, and converts it into an incurable mrdedv, when vv<*ht have been removed by only keeping th, prrteafy for a few d.\y?. Country people gerteraiiy im.iierfc a ftrained limb in cold water. This is very proper, provided it be done immediately, and not kern- in too long. But the cuftom of keeping the part immerfcd in c«-:d water for a long time is certainly dangerous. It relaxes inftead of bracing the part, and is more likely to produce a difeafe than ic- movc one. Wrapping a garter, or fome other bandage, pictry tight about the ftrained p-irt, is likewife'of ufe. It helps to re it ore the pre r. or tone cf the veffels, and prevents the action of the parts frrmi irtcre;:!'- ing the difeafe. It fliould not, however, be applied too tight. I have frequently known bleeding near the affected part hi •-. a very good effect: but what we would recommend above all, hcf. It is more to be depended on t-ran any medicine, and feldom fails to remove the complaint*. Of Ruptures. CHILDREN and very old people -re meft liable to this.difeafe. In the former, it is generally occafioned by exceffive crying, couch- ing, vomiting, cr the like. In the latter, it is commonly the erf t'cn.-, arc recommended f< r f'rains, Tome of ■which do good, and rnh'TJ hurt. The fo.'.i.w ::.^ are Inch as mar he iiicd with the greateft i'xivty, viz.. i&c:uitii.e-s iii;id<- of fia'cbt-er • > vi.ie^ar and oatmeal, c.nr.phor^tic! ij-irii:. of wine. Mindere'rush ij.':r::, v<,l.u;e liniinent. volatile aromatic 1-inr il'.im«d with a d«>ublr qu.-ntity ol wa- ter, and the common romeiuai u ., wuh tuc additioo. of brandy 01 ip.i'.t of wine. RUPTURES. 405 very fmall part of the gut wJl occafion all thefe fymptom^; and if not returned in due time, will prove mortal. ' On the fivft appearance of a rupture in an infant, it ought to be Lid 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 gen- tle preifure. After it is returned, a piece of fticking-plaifter may be ?.pplied over the part, and a proper trufs or bandage muft be con- ftantly 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 poilible, be kept from crying, and from all violent exertions, till the rupture is quite healed. In adults, when the gut has been forced down with great vio- lence, or happens from any caufe to be inflamed, there is often great difficulty in returning it, and fometimes the thing is impracticable without an operation ; a defcripticn of which is foreign to our pur- , pofe. As I have been fortunate enough, however, always to fuc- ceed in my attempts to return the gut, without having reccuffe to any ether means than what are in the power of every man, I ihail 'brief!v mention the method which I generally purfue. /.iter the patient has been bl-'d, he muft do laid upon his back, .-:■ with his head very low, ?.nd his breech raifed high with piJows. In this fituation, haim-el-cloths, wrung out of a decoction of mallowsr and camomile flowers, or, if thefe are not at hand, of warm water, muft be applied for a confiderable rime. A clyfter made of this de-1 coction, wnh a large fpoonful of butter and a little fait, may be af- terward:- thrown up. If thefe fhould not prove fuccefsful, recourfe mnft be" had to pic fare. If the tumour be very hard, confiderable force will be neevffary ; tn.t it is not force alone which fucceeds : here. The opeiator, at the fame, time that he makes a preffure with the palms of his hand, muft with his fingers artfully conduct the gut in by the fame aperture through which it came out. The manner * of doing this can be much eoh-.r conceived that defcribed. Should [ thefe endeavours prove jnoffectueJ, clyfters of ..the fin eke of tobacco may be tried. Thefe huve been often knewn to fucceed where every c.her method failed. liy perfifting in the ufe of thefe, and fuch other means as tlie circumftances of the cafe nwy.fugrdt, molt hernias might be re- duced without an operation. Cutting for the hernia isa nice ami diffi- cult-maeier. I ad\iie furgeons tootsy every method of returning the gut before they have recourfe to too kniie. L have once and again fucceeded-by'pcrfc-.ciii'.g in my endeavours, after eminent sur- geons had declared th, i\. duct ion er die gut impracticable without an operation*. * I would here bee, leave to recrmmfii 1 it to every praah;..orr, wh?n hisp-nif.it c:,niplat'.i-i t.f.p.iiti in the belly with obftinate toltive.vis, to cMUiiii-. t!ie groins and every pkue where a rupture may happen, in order'that it may hs iiiiii:edi..uly reduced. By o^lecthn; this, many 406 CASUALTIES. An adult, after the gut has been returned, muft wear a fled ban- dage. It is needlefs to defcribe this, as it may always be had ready made from the artifts. 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 eflatc, fhould ever be without one of thefe bandages. t\rfons who have a rupture, ought carefully to avoid all violent exercife,'carrying great weights,leaping, running and the like. Tbey fliould avoid windy aliment and ftrong liquors ; and carefully guard againft catching cold. Of Cafualties. LIFE, when to all appearance loft, may often, by due care, be reftored. Accidents frequently prove fatal, merely becaufe *jj proper means are not ufed to counteract their effects. No perfo.i ought to be looked upon as killed by any accident, unlefs where tie structure of the heart, brain, or fome organ neceflary to life, is evi- dently destroyed. The action of thefe organs may be fo far impair- ed, as even to be for fome time imperceptible, when life 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 acting. Thus, when the motion of the lungs has been ftopt by unwholefome vapour, the ac- tion of the heart, by a stroke on the breaft, or the functions of the brain, by a blow on the head, if the perfon be fuffered to grow cold, he will hi all probability continue fo ; but if the body be kept warm, j as foon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will "be • reftored. It is a horrid cuftom immediately to consign over to death every perfon, who, by a fall, a blow, cr the like, is deprived of the appear- • ance cf life. The perfen, inftead of being carried into a waim houfe, j and laid by the fire, or put to a warm bed, is generally hurried away to a church, or 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 is given over for dead, and no further notice taken of him. This conduct feems to be the refult of ignorance, fupported by an ancient fuperftitious notion, which forbids the body of any nerfon killed by accident to be laid in an houfe that is inhabited. Tins conduct is contrary to all the principles cf reafon, humanity, and common fenfe. perlfli who were r.ot fufpccled to have had ruptures till after they were dead. I have known this happen, where half a dozen of the fatuhy were in attendance. SUBSTANCES STOPT, &rV. 407 When a pe; fon feems to be fuddenly deprived of life, our firft bufinefs is to enquire into the caufe. We ought carefully to ob- ferve 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. lie may be immerfed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the caufe cannot fuddenly be removed, our great aim muft be, to keep up the vital warmth, by rubbing the patient with hot cloths, or fait, and covering his body with warm fand, afhes, or the like. - As to thofe accidents, which, without immediate affiftance, would often prove fatal, and the moft likely means for relieving the fufferers, I have been anticipated by Dr. Tiffot. I fhall con- tent myfolf with felecting fuch of his obfervations as feem to be the moft important, and adding fuch of my own as have occurred in the courfe of practice. Of Subftances ftopt between the Mouth and Stomach. .. ■ , ACCIDENTS of this kind are very common, and extremely X 'dangerous, yet they are generally the effect of eareleffnefs. Chil- dren fhould be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to fwal- low. But children are not the only perfons guilty of this impru- (: dence ; many adults put pins, nails, and other fharp-pointed fub- '• fiances in their mouths upon every occafion, and fome even fleep with the former there all night : a fit of coughing, or twenty * other accidents, may force qver the fubftance before the perfon is I aware*. a When any fubftance*is detained in the gullet, there are two ways ^ of removing it, viz. either by extracting it, or pufhing it down.— • The fafeft and moft certain way is to extract it; but this is not always I the eafieft; it may be more eligible fometimes to thruft ifrdown, I', especially when the obstructing body is of fuch a nature, that there 5 is no danger from its reception into the ftomach. The fubftances, which may be pufhed down without danger, are ail common t nourifhing ones, as bread, flefh, fruits, and the like. All indigef- £ tible bodies, as cork, wood, bones, pieces of metal, and fuch-like, • ought, if poffible, to be extracted, efpecially if thofe bodies be fharp pointed, as pins, needles, fifh-bones, bits of glafs, &c When fuch fubftances have not palled in too deep, we fhould ', endeavour to extract them with our fingers, which method often • A wanui], mi one of the hofpitals of this city, lately difcharged a greatr number of pins, which (he had fwallowcd in the courfe other bufinefj, through u:i ulcer in her fide. 408 SUBSTANCES STOPT BETWEEN fucceeds. When they are lower, we muft make ufe of nippers, or a fmall pair of forctps, fuch as furgeons ufe. But this attempt to extract 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 applied, crot- chets^ kind of hooks,muft be employed.Thefe may be made at one., by bending^a piece of pretty ftrong iron-wire at one end. it muft be introduced in die flat way ; and, for the better conducting it, fhere fhould likewife 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 fecured by a firing tied to it, a circumstance not to be ! omitted in any instrument employed on fuch occafions, to avoid fuch ill accidents as have fometimes enfued from thefe inftruments flipping out of the operator's hand. After the crotchet has palled below the fubftance that obstructs the paffage, it is drawn up again, and hooks up the body along with it. The crotchet is alfo very convenient, when a fubftance, fomewhat flexible, as a pin or fifli-* bone, flicks acrofs the gullet, the hook, in fuch cafes, feizing them about their middle part, crooks, and thus difeng'ages them; or, if they are very brittle fubftances, ferves to break them. When the obstructing bodies are fmall, and only ftop up a part of the paffage, and which may either eafily elude the hook, or ftraiten it by their refiftance, a kind of rings, made either of wire, wool, or filk, may be ufed. A piece of fine wire, of a proper length, may be bent into a circle, about the middle, of about an inch di- ameter, and the long unbent fides brought parallel, and near each other : Thsfe are -to be held in 'the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obftructing body, and fo to extract it. More flexible rings maybe 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 t\ed faft to a handle of h e-n-wire, whale-bone, or any kind of j flexible wood, and by this means introduced, in order fo fnrround . the obstructing 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 obstructing body, which maybe involved by one, if another mould mifs it. Thefe rings'have one advantage, which j$, that when the fubftance to be extracted, is once laid hold of, it may then,"by turning the handle, be retained fo ftrongly in the ring thus twilled, as to be moved every way, which muft, in many \ cafes, be a confiderable advantage. ) A material employed on thefe occafions is the fponge. Its pro- , perty of fwelling cOnfide-abiy on being wot, is the principal foun- dation of its ufefulnefs here. If any fubftance is ftopt in the gullet, >ut without, filling up the whole paffage, a bit of fponge may be introduced into that part which is unftopt, and beyond the fub- ftance. The fponge foon dilates, and grows larger in this moift fitu- • THE MOUTH AND STOMACH. ation; 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 fattened, and as it is now too large to return through the fmall cavity by which, it was conveyed in, it draws out the obstructing body along with it. The compreffibility of fponge is another foundation of its ufe- fulnefs in fuch cafes. A pretty large piece of fponge may be com- prefled or fqueezed into a fmall fize, by winding a firing of tape clofely about it, which may be eafily unwound, and withdrawn, after the fponge has been introduced. A bit of fponge may like- wife be compreffed, by a piece of whale-bone fplit at one end ; but thi.; 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 causing 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 remains one more, which is, to make the patient vomit: but this can fcarcely be of any fervice, unlefs. when fuch obftructing bodies are fimply en- gaged in, and not hooked or ftuck into the fides of the gullet; as in this cafe, vomiting might occafion fome further mifchief. If the pa- tient can fwallow, vomiting may be excited by talcing half a drachm 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 ex- cite vomiting had failed. When the obftructing body is of fuch a nature, that it may with fafety be 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 whale-bone, wire, or flexible wood, with a fponge fat- tened to one end. Should it be impoffible to extract even thofe bodies which it is dangerous to admit into the ftomach, we muft prefer the leaft of two evils, and rather run the hazard of pufhing them down, than fuffer the patient to perifh in a few minutes; and we ought to fcruple this refolution the lefs, as a great many inftance_s have hap- pened, where the fwallowing of fuch hurtful and indigeftible fub- ftances has been followed by no diforder. Whenever it is manifest, that all endeavours to extract or pufh down the fubftance muft prove ineffectual, they fhould be difcon- tinued; becaufe the inflammation, occafioned by perfifling in them, might be as dangerous as the obftru&ion itfelf. Some have died 4io SUBSTANCES STOPT, CsV. in confequence of the inflammation, even after the body which caufed the obstruction had been entirely removed. While the means recommended above are ufed, the patient fhould often fwallow, or, if he cannot, he fhould frequently re- ceive, by injection, through a crooked tube or pipe that may reach down to the gullet, fome emollient liquor, as warm milk and wa- ter, barley-water, or a decoction of mallows. Injections of th , kind not only foften and footh the irritated parts, but, when thrown in with force, are often more fuccefsful in loofening the obstruction ' than ail attempts with inftruments. ' When, after all our endeavours, we are obliged to leave the ob- ftructing body in the part, the patient muft be treated as if he had an inflammatory difeafe. He fhould be bled, kept upon a low diet, and nave his whole neck furrounded with emollient poultices. The like treatment muft alfo be ufed, if there be any reafon to fufpect an inflammation of the paffages, though the obftructing body be re- moved. A proper degree of agitation has fometimes loofened the inher- ing body more effectually 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 efficacious, when the fubftance gets into the wind-pipe. In this cafe, vomiting and fneezing are likewife to be excited. Pins, which ftuck in the gullet, have been frequently difcharged, by riding on horfe-back, or in a carriage. When any indigeftible fubftance has been forced down into the ftomach, the patient fhould ufe a very mild and fmooth diet, con- fifting chiefly of fruits and farinaceous 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 nourifhed by clyf- ters of foup, jelly, and the like. When the patient is in danger of being immediately fuffocated, and all hope of freeing the paffage is vanifhed, fo that death feems at hand, if refpiratjon be not reftored, the operation of broncho- tomy, or opening of the wind-pipe, muft be directly performed. \ As this operation is neither difficult to an expert furgeon, nor very painful to the patient, and is often the only method which can be taken to preferve life in thefe emergencies, we mention it, but it fhould only be attempted by perfons fkilled in furgery. [ 4^ ] Of DrownedPerftns'. WHEN a perfon has remained above a quarter of an hour un- der water, there can be no confiderable hopes of his recovery. But as feveral circumftances may happen to have continued life, in fuch an unfortunate fituation, beyond the ordinary term, we fhould ne- ver too foon resign the unhappy, object to his fate, but try every method for his relief, as there are many well attefted proofs of the , recovery of perfons to life and health, who had been taken out of l the water, apparently dead, and who remained a confiderable time, without exhibiting any figns of life. The firft thing to be done, after the body is taken out of the water, is, to convey it, as foon as poffible, to fome convenient place, where the neceffary operations for its recovery may be per- formed. In doing this, care muft be taken not to bruife or injure the body, by carrying it in any unnatural pofture, with the head -downwards, or the like. If an adult body, it ought to be laid on a bed, or on ftraw, with the head a little raifed, and carried on a cart or on men's fhoulders, and kept in as natural and eafy a position as poffible. A fmall body may be carried in the arms. In attempting to recover perfons apparently drowned, the prin- cipal -intention to be purfued is, to reftore the natural raarmth, upon which all the vital functions depend ; and to excite thefe functions by the application of ftimulants, not only fo the fkin, but likewife to the lungs, &c. Though cold was by no means the caufe of the perfon's death, yet it will prove an effectual obftacle to his recovery. For this reafon, after stripping him of his wet clothes, his body muft be wiped dry, and placed between two blankets, made warm, with the head a little elevated ; and no more attendance admitted than areabfolutely neceffary to execute thefe directions. To renew the breathing, a ftrong perfon may blow his own breath into the patient's mouth, with all the force he can, holding his noftrils at the fame time. When it can be perceived, by the ri- fing of the cheft or belly, that the lungs are rilled with air, the per- fon ought to defift from blowing, and fliould prefs the breaft and belly, fo as to expel the air again ; and this operation may be re- peated for fome minutes, alternately inflating and depreffing the • lungs, fo as to imitate natural refpiration.* If the lungs cannot be inflated in this manner, it may be at- tempted by blowing through one of the noftrils, and at the fame * Every time the lungs are expanded, eleftricity fliould be applied, if a machine can be obtained. This is mod effe&ualiy done about the region of the heart, or between the fourth and fifth ribs. The fhocks Ihuuldbe frequently repeated, inoro'er to stimulate the heart to a^ion. 4i2 DROWNED PERSONS. time, keeping the other clofe. Dr. Monro, for this purpofe, rccom- mends a wooden pipe, fitted at one end for filling the noftril, and at the other for being blown into by a perfon's mouth, or for re- ceiving the pipe of a pair of bellows, to be employed for the fame purpofe, if neceffary.* " When air cannot be forced into the cheft by the mouth or nofe, it may be neceffary to make an opening into the wind-pipe for this purpofe. It is needlefs, however, to fpend time in defcribing this operation, as it fliould not be attempted unlefs by perfons fkilled in furgery. The body fliould now be rubbed with coarfe linen cloths, made warm, and as foon as fome warm fait, fand, afhes, grains, cr fuch- like,.can be procured, they fhould be diligently ufed with friction to every part of the body. Strong volatile fpirits fhould be fre- quently applied to the nofe, and ftimulating powders, as that of to- bacco, may be blown up the noftrils.f Tsffot 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 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 coverings over all. After fhe had remained half an hour in this fituation, her pulfe returned, flie recovered fpeech, and cried out, I freeze, I freeze} a little cherry- brandy was given her, and fhe remained buried, as it were, under the afhes for eight hours; afterwards fhe was taken out, without any other complaint except that of laffitude or wearinefs, which went off in a few days. The Doctor mentions, likewife, an inftance. of a man who was reftored to life, after he had remained fix hours under water, bv the heat of a dunghill. Till the patient fhews fome figns of life, and is able to fwallow, , it would be ufelefs and even dangerous to pour liquors into hisN mouth. ' His lips, however, and tongue, may be frequently wet ' with a feather dipt in warm brandy or other ftrong fpirits; and, as J foon as he has recovered the power of fwallowing, a little warm wine, pr fome other cordial, ought, every now and then, to be ad- ministered.:): Some recommend a vomit after the patient is a little re-animated; but if he can be made to puke, without the fickening draught, it * This can be effected with more certainty by introducing a large flexible tube or catheter, perfe&Iy open at both extremities, into the wind-pipe, and fixing the pipe of a bellows to the outer end. This mode i of inflating the lungs has the advantage over that advifed by our judi- cious author, by expanding the lungs without eidending the ftomach. [I. C.J t This practice muft be perfifted in as long as there is the moft diftant . profpea of returning life. [}■ CJ $ Bleeding, purging, and even clyftering, before and after figns of life appear, muft be employed with extreme caution, and never without the advice of a phyfician, C1- c-i NOXIOUS VAPOURS. 413 will be more fafe : this may generally be done by tickling the throat and fauces with an oiled feather, or fome other foft fub- ftance, which will not injure the parts. Tiffot, in this cafe, re- commends the oxymel of fquills, a table-fpoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or fix dofes. Where that medicine is not at hand, a ftrong infufion of fage^ camomile-flowers, or carduus benediBus, fweetened with honey, or fome warm water, with the addition of a little fait, may, he fays, fupply its place. The Doctor does not intend that any of thefe things fhould be given in fuch quantity /as to occafion vomiting. He thinks emetics, in this fituation, are not expedient. We are by no means to difcontinue 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 stimu- lating applications are ftill to be continued, and fmall quantities of fome cordial liquor ought frequently to be adminiftered. Lastly, though the perfon fhould be manifeftly re-animated, there fome- times remain an oppreffion, a cough, and feverifhnefs, which ef- fectually conftitute a difeafe. In this cafe, it will be neceffary to bleed the patient in the arm, and to caufe him to drink plentifully of barley-water, elder-flower tea, or any other foft pectoral in- fufions. Such perfons as have the misfortune to be deprived of the appear- ances of life, by a fall, a blow, fuffocation, or the like, muft be treated nearly in the fame manner as thofe who have been, for fome time, under water. I once attended a patient who was fo ftunned, by a fall from a hoife, that, for above fix hours, he fcarcely exhibited any figns of life ; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and, in a few days, was perfectly well. Dr. Alexander gives an inftance to the fame purpofe, in the Edinburgh Phyfical and Lite- rary Effays, of a man who was, to all appearance, killed by a blow on the breaft, but recovered upon being immerfed, for fome time, in warm water. Thefe, and other inftances of a fimilar nature, which might be adduced, amount to a full proof of this fact, that many of thofe unhappy perfons who loofe their lives by falls, blows, and other accidents, might be faved by the ufe of proper means duly perfifled in. Of Noxious Vapours. AIR may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle J>eing destroyed, or from fubtle exhalations with which it is im- pregnated. Thus air that has palled through burning fuel is nei- 414 NOXIOUS VAPOURS. ther capable of fupporting fire not the life of animalf,. Her.cc the danger of fleeping im clofe chambers, with charcoal fires. Some, indeed, fisppofe the danger here proceeds from the fulphureous oil contained in the charcoal, which is fet at liberty and diffufed all over the chamber ; while others imagine it is owing to the air of the room being charged with phlogifton. Be this as it may, it is a fituation carefully to be avoided. Indeed, it is dangerous to ileep in a fmall apartment with a fire of any kind. I hit civ ffw four perfons, who had been fuffocated by fleeping in an apartment where a fmall fire of coal had been left burning. The vapour which exhales from wine, cyder, beer, or other li- quors, in the ftate of fermentation, contains fomething poifonous, which kills, in the fame manner, as 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 struck dead on entering fuch places, and of others who have with difficulty efcaped. When subterraneous eaves, that have been very long fhut, arc ©peroed, or when deep wells are cleaned, which have not been emptied for feveral years, the vapours arifing from them produce the fame effects. For this reafon, no perfon ought to venture in- to a well, pit, cellar, or any place that is damp, and has been long fhut up, till the air has been fufficiently purified, by burning gun- powder in it. It is eafy to know when the air of fuch places is unwholefome, by letting down a lighted candle, throwing in burning fuel, or the like. If thefe continue to burn, people may fafely venture in ; but where they/jare 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 vapours, 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 themfelves quickly oppreffed in apartments illuminated with many candles. Such as are fenfible of their danger in thefe fituations, and re- treat feafonably from it, are generally relieved as foon as they -get into the open air, or, if they have any remaining uneafinefs, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are fo for^poifoned, as to have loft their feeling and understanding, the*"following means muft be ufed for their re- covery : The patient fiioujd be expofed to a very pure, frefli, and open air; and volatile falts*, or other ftimulating fubftances, held to his nofe. He. fhould next be bled in the arm, or if that does not fuc- ceed, in the neck. His legs ought to be put into warm water, and well rubbed* As foon as he can fwallow, fome lemonade, or wa- "EFFECTS OF EXTREME COLD. 415 ter and vinegar, with the addition of a little nitre, may be given him. Sharp clyfters may be made, by adding to the common clyfter, fyrup of buckthorn and tincture of fenna, of each two ounces; or, in their flead, half an ounce of Venice turpentine diffolved in the yolk of an egg. Should thefe things not be at hand, two or three large fpocnfuls of common fait may be put into the clyfter. The fame means, if neceflary, which were recommended in die former part of this chapter, may be ufed to reftore the circulation, warmth, &c. Mr. Toffach, furgeon at Alloa, relates the cafe of a man fuffo- cated by the fleam of burning coal, whom he recovered by blow- ing his breath into the p.itient's mouth, bleeding him in the arm, nnd caufin? him to be well rubbed and toffed about: And Dr. Frewen, of Suffex, mentions the cafe of a young man who was flupified by the linoke of fea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed. The practice of plunging perfons fuffocated by noxious vapours in cold water, would feem to be fupported by the common experi- ment of fuffocating dogs in the grotto del cani, and afterwards re- covering them, by throwing them into the neighbouring lake. Effects of extreme Cold. WHEN cold is extremely fevere, and a perfon is expofed to it for a long time, it proves mortal, in confequence of its ftopping the circulation in the extremities, and forcing too great a propor- tion of blood towards the brain ; fo that the patient dies of a kind of apoplexy, preceded by great fleepinefs. The traveller, in this fitua- tion, who finds himfelf begin to grow drowfy, fhould redouble his efforts to extricate himfelf from the imminent danger he is expofed fr\ This fleep, which he might confider as fome alleviation of hi* fufferings, would, if indulged, prove his laft. Such violent effects of cold are not common in this country; it frequently happens, however, that the hands or feet of travellers are fo benumbed or frozen, as to be in danger of a mortification, if proper means are not ufed to prevent it. The chief danger in this fituation 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 fhow> that this ,fe a moft dangerous and imprudent practice. If frozefn meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed, by rottennefs, or a kind of mortification; and the only way to recover them, is 416 EFFECTS OF EXTREME HEAT.- to immerfe them, for fome time, in very cold water. The fame obfervation holds with regard to animals in this condition. When the hands or feet are greatly benumbed with cold, they ought either to be immerfed in cold water, or rubbed with fhow, till they recover their natural warmth and fenfibility : after which, the perfon may be removed into an apartment a little warmer, and may drink fome cups of tea, or an infufion of elder-flowers fweet- ened with honey. Every perfon may obferve, when his hands were even but flightly affected 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 a perfon has been fo long expofed to the cold, that all ap- pearances of life are gone, it will be neceffary to rub him all over with fnow or cold water ; or, what will anfwer better, to immerfe him in a bath of the very coldest water. There is the greateft en- couragement to persist in the ufe of thefe means, as we are affurcd that perfons who had remained in the fnow, or had been expofed to the freezing air during five or fix fucceffivc days, and who had difcovered no marks of life for feveral hourj, have, neverthelefs, been revived. I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are fo common among the peafants, in the cold feafon, were chiefly occafioned by their fudden tranfitions from cold to heat. After they have been expofed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occafion, plunge them into warm water; by which means, if a mortification does not happen, an inflammation feldom fails to enfue. Moft of the ill confequences from this quarter might be eafily avoided, by only ob- ferving the precautions mentioned above.- The Eflfecls of extreme Heat ARE no lefs-fatal, and much more fudden than thofe of cold. In hot countries, people frequently drop down dead in the ftreets, exhausted with heat and fatigue. In this cafe, if any warm cordial can be poured into the mouth, it ought to be done. If this cannot be effected, they may be thrown up in form of a clyfter. Volatile fpirits, and other things of a ftimulating nature, may be applied to the fkin, which fhould be well rubbed with a flefh-brufh, a coarfe cloth, or other ftimulating things. Z 417 ] Effects cf Drinking Cold Water in Warm Weather. WE have opportunities almoft every fummer, of obferving the deleterious effects of cold water on the labouring part of our inha- bitants, and in particular on foreigners newly arrived in this coun- try, who are unacquainted with the danger, which commonly en- fue, from fwallowing large draughts of cokl water, when the body is heated from exercife or labour. This fluid fhould never be drank cokl in a warm day, even when mixed with fpirits, or any other liquor, as it is always accompanied with imminent danger, which frequently manifelts itfelf during the time of drinking, or immediately after ; when the patient is feized with vertigo, dimnefs of fight, violent pain, and cramp in •the ftomach, and fometimes will fall down at the pump, or ftagger away to throw himfelf down in the fhade. There he becomes reft- lefs, and toffes about in excruciating pain, attended with difficulty pf breathing, retraction of the navel, the face fuffufed and turged ■with blood, naufea, and violent efforts to vomit. As the difeafe •advances, the vigour declines, and the patient, if not relieved foon, exhibits the phamomena of dying. The breathing becomes more interrupted and laborious, the cheeks and noftrils expand at every expiration, with a rattling noife in the throat: The face at times looks pale and deadly, the patient becomes delirious, and the tone of the voice much altered; the extremities cold, pulfe quick, amU almoft imperceptible at the wrift, with an impoffibility to fwallow. At length,-death takes place in a fhort time from the attack. MEDICINE.-----The chief remedies in this complaint, are bleeding, and large dofes of laudanum. If the pulfe is full and ftrong, with a flufhed appearance of the face, twelve or fourteen ounces of blood fhould be taken from the arm, in order to relieve the difficulty of breathing, and diminifh the flow of blood to the head ; during this evacuation, forty or fifty -drops of lauda- num, or a quantity proportioned to the age of the patient, fhould be adminiftered, and in half an hour, a fmaller ox larger dofe muft be repeated, according to the urgency of the fymptoms. If laudanum cannot be procured, three or four ounces of rum or brandy may be fubftitu-ted. If the patient cannot fwallow, a tube, or a flexible catheter fhould be. paffed down the ofbphagus or gullet, and the laudanum or brandy poured through it into the ftomach. When this operation cannot be performed, clyfters of warm water, with laudanum, muft be injected. Thefe remedies frequently fucceed, particularly, if they are applied early in the complaint. When affiftance is called, and the powers of life appearfufpen3c3, every means muft be exerted to reftore them, as dire&ed fn tb; chapter drowning. G 3 [ 418 ] CHAPTER LVI. Of Fainting Fits, and other Cafes which require immediate Affiftance. STRONG and healthy perfons, who abound with blood, ar« often feized with fudden fainting fits, after violent exercife, drinking freely of warm, or ftrong liquors, exposure to great heat* intenfe application to ftudy, or the like. In fuch cafes, the patient muft be made to fmell to fome vinegar. His temples, forehead, and wrifts ought, the fame time, to be bathed with vinegar, mixed with an equal quantity of warm wa- ter ; and two or three fpoonfuls of vinegar, with four or five times as much water, may, if he can fwallow, be poured into his mouth. If the fainting proves obstinate, or degenerates into an abolition of feeling and understanding, the patient muft be bled. After the bleeding, a clyfter will be proper, and then he fhould be kept eafy and quiet, only giving him every half hour a cup or two of an infu- sion of any mild vegetable, with the addition of a little fugar and vinegar. When fwoonings, which arife from this caufe, occur frequently in the fame perfon, he fhould, in order to efcape them, confine him- felf to a light diet, confifting chiefly of bread, fruits and other vege- tables. His drink ought to be water or fmall beer. He fliould fleep but moderately, and take much exercife. But fainting fits proceed much oftener from a defect than an ex- cefs of blood. They are ready to happen after great evacuations of any kind, obftinate watching, want of appetite, or fuch-like. In thefe, an almoft directly oppofite courfe to that mentioned above, muft be purfued. The patient fhould be laid in bed, with his head low, and being co- vered, fhould have his legs, thighs, arms, and his whole body, rub- bed ftrongly with hot flannels. Hungary water, volatile falts, or ftrong fmelling herbs, as rue, mint, or rofemary, 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, malt be applied to the pit of his ftomach, and warm bricks, or bottles filled with hot wa- ter, laid to the feet. As foon as he recovers a little, he fhould take fome ftrong foup or broth, or a little bread or bifcuit foaked in 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, eliocdlate, light roaft-meats, jellies, and fuch-like. FAINTING FITS, cjrV. 419 Fainting-fits, which are the effect of bleeding, or of the violent operation of purges, belong to this clafs. Such as happen after artificial bleeding, generally terminate as foon as the patient is laid upon the bed ; indeed, perfons fubjeet to this kind, fhould always be bled lying, in order to prevent it. Should the fainting, how- ever, continue longer than ufual, volatile fpirits may be held to the nofe, and rubbed on the temples, Sec. When fainting is the effect of too flrong or acrid purges or vomits, the patient muft be treated, in all refpects, as if he had taken a poifon. He fhould be made to drink plentifully of milk, warm-water, and oil, barley-water, or fuch-like ; emollient clyf- ters will be proper, and his 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 for- mer of thefe is the caufe, the cure will be beft performed by vomi- ting, which may be promoted by caufing the patient to drink a weak infufion of camomile-flowers, carduus benedictus, or the like. When the diforder proceeds from the nature of the food, the pa- tient, as in the cafe of weaknefs, muft be revived by ftrong fmells, &c. after which he fliould be made to fwallow a large quantity of light, warm fluid, which may ferve to drown the offending matter, to foften its acrimony, and either to effect a difcharge of it by vomiting, or force it down into the inteftines. Even difagreeable fmells will fometimes occafion fwooning, efpecially in people of weak nerves. When this happens, the pa- tient fliould 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. We have already taken notice of fwoonings which arife from nervous diforders. Fainting-fits often happen in the progrefs of ftifeafes. In the be- ginning 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 be- ginning of malignant fcrers, they indicate great danger. In each of thefe cafes, vinegar ufed both externally and internally is the beft remedy during the paroxyfm, and plenty of lemon-juice and water after it. Swoonings which happen in difeafes accompanied with great evacuations, muft be treated like thofe which are owing to weaknefs, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exacerbation of a continual fever, the pa- tient muft be fupported by fmall draughts of wine and water. Delicate and hyfteric women are very liable to fwooning or fainting-fits after delivery. Thefe might be often prevented, by ge- nerous cordials, and the admiffion of frefh air. When they are oc- cafioned by exceffive flooding, it ought, by all means, to be ref- trained. They are generally the effect of mere weaknefs or ex- 43Q FAINTING FITS, Zfc. hauftion. Dr. Engjeman relates the cafe of a woman in child-bed, ** who, after being happily delivered, fuddenly fainted, and lay up- wards of a quarter of an hour apparently dead. A phyfician was fe»t for ; her own maid, in the meanwhile, being out of patience at his delay, attempted to affift herhcrfelf, and extending herfelf upon her mjftrefs, applied her mouth to heris, blew in as much breath as fhe poffibly could, and in a very fhort time the exhauftcd wo- man awaked as out of a profound fksp; when proper things being given her, fhe foon recovered. The maid being afked how fhe came to think of this expedient, faid fhe had feen it practifed at Altenhurgh, by midwives, upon children, with the happieft effea." rr We mention this cafe, chiefly, that other midwives may be in- duced to follow fo laudable an example. Many children are born without any figns of life, and others expire foon after the birth, who might, without all doubt, by proper care, be reftored to life. From whatever caufe fainting-fit* proceed, frefli air is always of the greateft importance to the patient. By not attending to this dreumftance, people often kill their friends while they are endea- vouring to fave them. Alarmed at the patient's fituation, they call in a crowd of people to his affiftance, or perhaps to witnefs his ex- it, whofe breathing exhaufts the air, and increafes the danger. There is not the leaft doubt, but this practice, 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 exhaustion, or the violence of fome difeafe. No more per- fons ought ever to be admitted into the room where a patient lies in a fwoon, than are abfolutely neceffary for his affiftance, and the windows of the apartment fhould always be opened, at leaft as far as to admit a flream of frefh air. Perfons fubjeet to frequent fwoonings, or fainting-fits, fhould neglect no means to remove the caufe of them, as their confequen- ces are always injurious to the conftitution. Every fainting-fit leaves the perfon in dejection and weaknefs; the fecretions are thereby fufpended, the humours difpofed to ftagnation, coagula- tions and obftructions are formed, and if the motion of the blood be totally intercepted, or very considerably checked, polypufes are fome- times formed in the heart or larger veffels. The only kind of fwooning* not to be dreaded, are thofe which fometimes mark the criiis in fevers > yet even thefe ought, as foon as poffible, to be Te- anovpd. C 421 3 Of Intoxication. THE effects of intoxication are often fatal. No kind of poifan. kills more certainly than an over-dofe of ardent fpirits. Sometimes* by destroying the nervous energy, they put an end to life at once j but in general, their effects are more Cow, and in many refpecta* fpnilar 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 liquor. More of thofe unhappy perfons, who die intoxicated, lofe. their lives from an inability to conduct themfelves, than from the des- tructive quality of the liquor. Unable to walk,, they tumble down, and lie in fome awkward pofture, which, obftructs the circulation. or breathing, 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, dlfcharging the contents of the ftomach, &c. The beft pofture for difcharging the contents of the ftomach is, to lay the perfon upon his belly ; when afleep, 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, twitted, or have any thing too tight about it. The exceffive degree of thirft occafioned by drinking ftrong li- quors, often induces people to quench it by taking what is hurtful. I have known fatal confequences from drinking freely of milk after a debauch of \\ ine or four punch : thefe acid liquors, together with the heat of the ftomach, having coagulated the milk, in fuch a man- ner, that it could never be digested-. 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 lukewarm water and oil; but, in this condition, vomiting may generally be excited by-only tickling the throat with the finger or a feather. Inftead of giving a detail of all the different fymptoms- of intoxi- cation which indicate danger, and propofing a general plan of treat, merrt for perfons fn this fituarion, I fhall briefly relate tire history of a cafe which lately fell under my own obfervation, wherein moft of thofe fymptoms ufually reckoned dangerous concurred, and where the treatment was fuccefsful. A young man, about fifteen years of age, had, for a hire, drank tenglaffes of ftrong brandy. He foon after fell afleep, and continu- ed in that fituation for near twelve hours, till at length, his uneafy manner of breathing, the coldnefs of the extremities, and other threatening fymptoms, alarmed his friends, and made them fend for roe. I fouad hiin. nut fleeping, bis countenance ghaftly, and hi* 422 SUFFOCATION AND STRANGLING. fkin" covered with a cold, clammy fweat. Almoft the only figns of life remaining, were, a deep laborious breathing, and a convulfive motion or agitation of his bowels. I tned to roufe him, but in vain, by pinching, fhaking, applying volatile fpirits, and other ftimulating things to his nofe, &c. A few ounces of blood were likewife taken 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 thefh things having the leaft effect, and the danger feeming to increafe, I ordered his legs to be put into warm water, and a fharp clyfter to be immediately adminiftered. This gave him a ftool, and was the firft thing that relieved him. It v(>as afterwards repeated with the fame happy effect, 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 complained much of a forenefs in his bowels, which gradually went off, by a {lender diet, and cool mucilaginous liquors. This young man would probably have been fuffered to die with- out any affiftance being called, had not a neighbour, a few days be- fore, who had been advifed to drink a bottle of fpirits to cure him of an ague, expired under very fimilar circumftances. Suffocation and Strangling MAY fometimes proceed from an infraction of the lungs, pro- duced by vifcid, clammy humours, or a fpafmodic affection of that organ. Perfons who feed grofsly, and abound in rich blood, are very -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 take frequently, a cup of diluting liquor with a little nitre in it. They fhould likewife receive die ftreams of hot vinegar into their lungs by breathing. Nervous and afthmatic perfons are moft fubjeet to fpafmodic affections of the lungs. In this cafe, the legs fhould be immerfed in warm water, and the fteams of vinegar applied as above. Warm diluting liquors fliould likewife be drank ; to a cup of which, a tea-fpoonful ©f the paregoric elixir may occafionaily be added. Burnt paper, feathers, or leather, may be held to the patient's nofe, and frefh air fhould be freely admitted to him. Infants are often fuffocated by the careleffnefs or inattention of their nurfes*. An in- ■¥• Thef; acidents are not always the effects cf ca:\.ltfuief*. I hare known an infant over-laid by its mother be.ng feized iu tbe night with &n hyfteric fk. This cught :o ftrve.as a caution ?2:ihii'r employing hyf- SUFFOCATION AND STRANGLING. 423 fant, when in'bed, fhould always be laid fo, that it cannot tumble down with its head under the bed-clothes; and, when in a cradle, its face ought never to be covered. A fmall degree of attention to thefe two fimple rules would fave the lives of many infants, and prevent others from being rendered weak and fickly all their lives, by injuries done to their lungs. Inftead of laying down a plan for the recovery of infants who are fuftbeated, or overlaid by the nurfes, I fhall give the hifkry of a cafe related by Monfieur Janin, of the Royal College of Surgery at Paris, as it was attended with fuccefs, and contains almoft every thing that can be done on fuch occafions. A nurfe having had the misfortune to over-lay a child, he was called in, and found the infant without any figns of life ; no pul- fation in the arteries, no refpiration, the face livid, the eyes open, dull, and tr.rniflied, the nofe full of fnivel, the mouth gaping ; in fliort, it was almoft cold. Whilft fome linen cloths and a parcel of afhes were warming, he had the boy unfwathed, and laid him in a warm bed, and on the right fide. He then was rubbed all over with fine linen, for fear of fretting his^ tender and delicate flcin. As foon as the afhes had received their due degree of heat, Mr. Janin burried him in them, except the face, placed him on the fide oppo- fite to that on which he had been at firft laid, and covered him with a blanket. He had a bottle of can de luce in his pocket, which he prefented to his nofe from time to time; and between whiles, fome puffs of tobacco were blown up his noftrils : to thefe fuc- ceeded the blowing into his mouth, and fqueezing tight his nofe. Animal heat began to be excited gradually ; the pulfations of the temporal artery were foon felt, the breathing became more fre- quent and free, and the eyes clofed and opened alternately. At length, the child fetched fome cries, expreffive of his want of the breaft, which being applied to his mouth, he catched at it with avi- dity, and fucked as if nothing had happened to him. Though the pulfations of the arteries, were, by this time, very well re-eftablifh- ed, and it was hot weather, yet Mr. Janin thought it advifable to icave his little patient three-quarters of an hour longer under the afhes. He was afterwards taken out, cleaned, and drefled as ufual ; to which a gentle fleep fucceeded, and he continued perfectly s well. Mr. Jariin mentions, likewife, an example of a young man who had hanged himfelf through defpair, to whom he adminiftered help, as effectually as in the preceding cafe. Mr. Glover, furgeon in Doctors Commons, London, relates the cafe of a perfon who was reftored to life after twenty-nine minutes hanging, and continued in good health for many years after. The principal means ufed to reftore this man to life, were, open- ing the temporal artery, and the external jugular; rubbing the teric women as nurfes ; and fliould likewife teach fuch women, never to lay an infant in the fame bed with themfelves, but in u fmall adjucent •ne. 424 CONVULSION FITS. back,mouth, and aec!:, with a quantity of volatile fpirits ai.d oil i adrmmftering the tobacco clyfter, by means of Kghted pipes, and ftrong frictions of the legs and arms. This courfe had been conti- asraed for about four hours, when an incifion was made into the wmd-pipe, and air blown ftrongly through a canula into the luiies. About twenty minutes after this, the blood at the artery began to run down the face, and a flow pulfe was juft perceptible at the WV'iJriie -frittions were continued for fome time longer ; his pulfe became more frequent, and his mouth and nofe being irri- tated with fpirit of fal ammoniac, he opened his eyes. Warm cor- dials v/ere then adminiftered to him, and in two days, he was fo well, as to be able to walk eight miles. Of Perfons falling into'Connnitfton Fits. THESE often constitute the laft fcene of ac-te or chronic difor- ders. When this is the cafe, there can remain but fmall hopes of the patient's recovery after falling into a fit. But when a perfon, who appears to be in perfect health, is fuddenly feized with a convul- fion fit, and feems to expire, attempts ought to be made to reftore him to life. Infants are molt liable to convulfions, and are often .carried off very fuddenly, by one or more fits about the time of teething. There are many well-authenticated accounts of .infante having -been reftored to life, after they had, to all appearance, ex- pire^ m convulfions ; but we {hall only relate the following in- stance, mentioned by 1>. J ohnfon, in his pamphlet on the pratli- *•ability of recovering perfons viflbly dead. In the parifh of St. Clements in Colchester, a child of fix months old, lying upon its mother's lap, having had the breaft, was feized with a ftrong convulfion fit, which lafted fo long, and ended with fo total a privation of motion in the body, lungs, and pulfe, that it was deemed abfolutely dead. It was ftripped, laid out, the paffing-bell ordered to be tolled, and a coffin to be made : but a neighbouring gentlewoman, who ufed to admire the child, hearing of its fudden death, haftened to the houfe, and upon ex- amining, found it not cold, its joints limber, and fancied, that a glafs flie held to its mouth and nofe was a little damped with the breath ; upon which fhe took the child in her lap, fat down before die fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour fhe felt the heart begin to beat faintly; fhe then put a little of the mother's milk into its mouth, continued to rub its .palms and foles, found the cfritd begin to move, and the milk was fwallowed; and in another quarter of an hour, fhe had the fatisfac- tion of restoring, to its difconfolate mother, the babe quite recover- ed, eager to lay hold of the breaft, and able to fuck again. The CONVULSION FITS. 425 *• child throve* had no more fits, is grown up, and at prefent alive. Thefe means, which are certainly in the power of every perfon, were fufficient to reftore to life, an infant to all appearance dead, and who, in all probability, but for the ufe of thefe fimple endea- vours, would have remained fo. There are many other things which might be done in cafe the above fhould not fucceed ; as rubr bing the body with ftrong fpirits, covering it with warm afhes or fait, blowing air into the lungs, throwing up warm ftimulating clvfters, or the fmoke of tobacco, into the inteftines, and fuch- like. When children are dead-born, or go off in a fit foon after the birth, the fame means ought to be ufed for their recovery, as in circumftances fimilar to thofe mentioned above. Thefe directions may likewife be extended to adults, attention being always paid to the age and other circumftances of the patient. The foregoing cafes and obfervations afford fufficient proof of the fuccefs which may attend the endeavours of perfons to- tally ignorant of medicine, in affifting thofe who have life fufpen- ded by an accident or difeafe. Many facts of a fimilar nature might be adduced, were it neceffary ; but thefe, it is hoped, will be fufficient to call up the attention of the public, and to excite the humane and benevolent, to exert their utmost endeavours for the prefervation of their fellow men. The Society for the recovery of drowned perfons, instituted at Am- fterdam, in the year 1767, had the fatisfaction to find that 150 perfons, in the fpace of four years, had been faved by the means pointed out by them, many of whom owed their prefervation to peafants, and people of no medical knowledge. But the means ufed with fo much efficacy in recovering drowned perfons are, with equal fuccefs, applicable to a number of cafes where the powers of life feem in reality to be only fufpended, and to remain capable of re- newing all their functions, on being put into motion again. It is (hocking to reflect, that for want of this confideration many perfons have been committed to the grave, in whom the principles of life might have been revived. The cafes wherein fuch endeavours are moft likely to be attended with fuccefs, are all thofe called fudden deaths from an invifible caufe, as apoplexies, hysterics, faintings, and many other diforders, wherein perfons, in a moment, fink down and expire. The various cafualties in which they may be tried, are fuffocations, from the fulphureous damps of mines, coal-pits, &c.; the unwholefome air of long unopened wells or caverns ; the noxious vapours arising from fermenting liquors ; the fteams of burning charcoal; ful- phureous mineral acids; arfenical effluvia, &c. The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, Sec. likewife furnifh oppor- tunities of trying fuch endeavours.. Thofe, perhaps, who to ap- pearance are killed by lightning, or by any violent agitation of the H3 426 COLD BATHING, AND paffions, as fear, joy, furprife, and fuch-like, might alfo be fre- quently recovered by the ufe of proper means, as blowing ftronclv into their lungs, &c. b } The means to be ufed for the recovery of perfons fuddenly de- prived of life, are nearly the fame in all cafes ; they are practicable by every one who happens to be prefent at the accident, and re- quire no great expenfe, and lefs (kill. The great aim is to reftore the warmth and vital motions. Tins may in general be attempted by means of heat, fri&ions, bleeding, blowing air into the lun^s, adminiftering clyfters and generous cordials. Thefe muft be varied according to circumftances* Common fenfe, and the fituation of the patient, will fuggeft the proper manner of conducting them. Above all, we recommend perfeverance. People ought never to defpair on account of difcouraging circumftances, or to leave off their endeavours as long as there is the leaft hope of fuccefs. Where much good, and no hurt can be done, no one ought to grudge his labour. CHAPTER LVII. Cautions concerning Cold Bathing, and Drinking the Mineral Waters. IT is now fafhionable for perfons of all ranks to plunge into the fea, and drink the mineral waters, I am defirous of rendering this work more extenfively ufeful, by fome practical remarks on thefe active and ufeful medicines. No part of the practice of medicine is of greater importance, or merits more the attention of the phyfician, as many lives are loft, and numbers ruin their health, by cold bathing, and an imprudent ufe of mineral waters. Without a proper difcrimination with regard to the difeafe and conftitution of the patient, the moft powerful medicine is more likely to do harm than good. The fame phyfician, who, by cold bathing, cured Augufhis, by an imprudent ufe of the fame medi- cine, killed his heir. This induced the Roman fenate to make laws for regulating the baths, and preventing the numerous evils which arofe from an imprudent and promifcuous ufe of thofe elegant and fafhionable pieces of luxury. But as no fuch laws exift in this coun- DRINKING MINERAL WATERS. 427 try, every one does that which is right in his own eyes, and of con.f. many muft do wrong. People are apt to imagine that the fimple element of water can do no hurt, and that they may plunge into it at any time with im- punity. In this, they are much miftaken. I have known apoplexies occafioned by going into the cold bath, fevers excited by flaying too long in it, and other maladies fo much aggravated by its conti- nued ufe, that they could never be wholly eradicated. Nor are ex- amples wanting, either in ancient or modern times, of the baneful confequences which have arifen from an injudicious application of the warm bath; but as warm baths are not fo common in this country, and are feldom ufed but under the direction of a phyfi- cian, I fhall not enlarge on that part of the fubje£l. Immerfion in cold water is a cuftom which lays claim to the moft remote antiquity : indeed, it muft have been coeval with man himfelf. The neceffity of water for the purpofes of cleanlinefs, and the pleafure arifing from its application to the body in hot countries, muft, very early, have recommended it to the human fpecies. Even the example of other animals was fufficient to give the hint to man. By inftincl, many of them are led to apply cold water in this manner ; and fome, when deprived of its ufe, have been known to languifli, and even to die. The cold bath recommends itfelf in a variety of cafes, and is peculiarly beneficial to the inhabitants of populous cities, who indulge in idlenefs, and lead fedentary lives. In perfons of this de- fcription, the action of the folids is always too weak, which induces a languid circulation, a crude indigefted mafs of humours, and obftructions in the capillary veffits and glandular fyftem. Cold water, from its gravity as well as its tonic power, is well calcula- ted either to obviate or remove thefe fymptoms. It accelerates the motion of the blood, promotes the different fecretions, and given permanent vigour to th'* folids. But all thefe important purpofes will be more effentially anfwered by the application of fait water. This ought to be preferred on account of its fuperior gravity, and for its greater power of ftimulating the ihin, which promotes the perfpiration, and prevents the patient from catching cold. Cold bathing is more likely to prevent, than to remove obstruc- tions of the glandular or lymphatic fyftem. Indeed, when'thefe have arrived at a certain pitch, they are not to be removed by any means. In this cafe, the coid bath will only aggravate the fymp- toms, and hurry the patient into the grave:. It is therefore, of the utmoft importance, previous to the patient's entering upon the ufe of the cold bath, to determine whether or not he labours un- der any obftinr.fi obftructions of the lungs or ether vifcera ; and 428 COLD BATHING, AND where this is the cafe, cold bathing ought ftrictly to be prohi- ted*. In what is called a plethoric ftate, or too great a fulnefs of the body, it is likewife drm^erout, to ufe the cold bath, without due preparation. In this L.ih, there is great danger of bursting a blood- veffel, or occufior.inr. an h.h.immation of the brain, or fome of the vifcera. This precaution is the more neceflary to citizens, as moft of them live full, ami arc of a grofs habit. Yet, what is very re- markable, thefe people refort in crowds every feafon to the fea- fide, and plunge in the water without the leaft confideration. No doubt they often efcape with impunity; but does thi? give a func- tion to the practife ? Perfons of this defcription ought by no means to bathe, unlefs the body has been previoufly prepared by fuitable evacuations. Another clafs of patients, who stand peculiarly in need of the bracing qualities of cold water, is the nervous. This includes a great number of the male, and almoft all the female inhabitants of great cities. Yet even thofe perfons ought to be cautious in ufing the cold bath Nervous people have often weak bow Js, and may, as well as others, be fubjeet to conjtftions and obitruftions of the vifcera; and in this c:;fe, they will not be able to bear the effects of the cold water. For them, and for all delicate p>. r-ple, the beft plan would be to accuftom themfelves to it by the moft pleafing and gentle degrees. They ought to begin with the tem- perate bath, and gradually ufe it cooler, till at length the coldest proves quite agreeable. Nature revolts againft all great tranfitions; and thofe who do violence to her dictates, have often caufe to re- pent of their temerity. Where cold bathing is practifed, there ought likewife to be tepid baths for the purpofe mentioned above. Indeed, it is the practice of fome countries to throw cold water over the patient as foon as he conies out of the warm bath ; but though this may not injure a Ruffian peafaut, v/e dare not recommend it to the inhabi- tants of this country. I he ancient Greeks and Romans, we are told, when covered with fweat and duft, ufed to plunge into rivers, without receiving the fmallelt injury. Ti ey might often efcape danger from this imprudent conduct, yet it was certainly contra- ry to found reafon. Many robuft men throw away their lives by fuch an attempt. We would not advife patients to go into the cold water when the body is chilly; as much exercife, at leaft, •X- The late celebrated Dr. Smollet has faid that, if he were persua- ded he ha(' an ulcer in the lungs, he would jump into the cold bath : he evidently fhows more courage than jdifcretio.i; and, that he was more a man of \\ it than a pliyfician, every one will allow. A r.crvous aithma, or an atrophy, maybe millaken for a pulmonary confumption ; yet, in the two former, the cold bath proves often beneficial, though I never knew it fo in the latter. Indeed, all phthifical patients I ever faw, who had tried the coid bath, were evidently hurt by it. DRINKING MINERAL WATERS. jl^ ought to be taken, as may excite a gentle glow all over the body, but by no means fo as to overheat it. To young people, and particularly to children, cold bathing is of the laft importance. Their lax fibres render its tonic powers peculiarly proper. It promotes their growth, increafes their ftrength*, and prevents a variety of difeafes incident to child- hood. Were infants early accuftomed to the cold bath, it would feldom difagree with them ; and we fliould fee fewer inftances of fcrophula, rickets, and other difeafes, which kill many, and make others miferable for life. Sometimes thefe diforders render infants incapable of bearing the fhock of cold water ; but this is owing to their not having been early and regularly accuftomed to it. It is neceffary here to caution young men againft too frequent bath- ing ; many fatal confequences refult from the daily practice of plunging into rivers, and continuing there too long. The moft proper time of the day for ufing the cold bath is, no doubt, the morning, or at leaft before dinner; and the beft mode that of quick immerfion. As cold bathing has a conftant tenden- cy to propel the blood and other humours towards the head, it ought to be a rule always to wet that part as foon as poffible. By due attention to this circumftance, violent head-achs, and other complaints, which frequently proceed from cold bathing, might be often prevented. The cold bath, when too long continued in, occafions too great a flow of blood towards the head, cramps the mufcles, and wholly • defeats the intention of bathing. Hence, by not adverting to this circumftance, expert fwimmers are often injured, and fometimes even lofe their lives. All the beneficial purpofes of cold bathing are anfwered by one immerfion at a time ; and the patient ought to be rubbed dry the moment he comes out of the water, and fhould continue to take exercife for fome time after. When cold bathing occafions chilnefs, lofs of appetite, liftleff- nefs, pain of the breaft or bowels, a proftration of ftrength, or violent head-achs, it ought to be difcontinued. Though thefe hints are by no means intended to point out all the cafes where cold bathing may be hurtful, nor to iliuftrate its extenfive utility as a medicine ; yet it is hoped they may ferve to guard people againft fome of thofe errors into which from mere inattention they are apt to fall, and thereby not only endanger their own lives, but bring an excellent medicine into difrepute. * Galen fays, that immerfion in cold water is fit only for the young of lions and bears; and recommends warm bathing, as conducive to the growth and ftrength of infants. How egregioufly do the greateft men err whenever they lofe fight of facts, and fubltitute realonmg in pbvfic in place of obfervation and experience ! C 430 ] Of Drinking the Mineral Waters. THE internal ufe of water, as a medicine, is no lefs an object of the phyfician's attention than the external. Pure elementary water is, indeed, the moft inoffenfive of all liquors, and confti- tutes a principal part of the food of every animal. But this element is often impregnated with fubftances of a very active and pene- trating nature ; and of fuch an infidious quality, that, while they promote certain fecretions, and even alleviate fome difagreeable fymptoms, they weaken the powers of life, undermine the confti- tution, and lay the foundation of worfe difeafes than thofe which they were employed to remove. Of this, every practitioner muft have feen inftances; and phyficians of eminence have more than once declared, that they have known more difeafes occafioned than removed by the ufe of mineral waters. This doubtlefs, has proceeded from the abufe of thefe powerful medicines, which evinces the neceffity of ufing them with caution. By examining the contents of the mineral waters which are moft ufed in this country, we fhall be enabled to form an idea of the danger which may arife from an improper application of them, either externally or internally, though it is to the latter of thefe that the prefent obfervations are chiefly confined. The waters moft in ufe for medical purpofes in Britain, are thofe impregnated with falts, fulphur, iron, and mephitic air, ei- ther feparatcly, or varioufiy combined. Of thefe the molt power- ful is the faline fulphureous water of Harrowgate, of which I have had more occafion to obferve the pernicious confequences, when improperly ufed, than of any other. To this, therefore, the following remarks will more immediately relate, though they will be found applicable to all the purging waters in the kingdom which are ftrong enough to merit attention. The errors which fo often defeat the intention of drinking the purgative mineral waters, and which fo frequently prove injurious to the patient, proceed from the manner of ufing them, the quan- tity taken, the regimen purfued, or ufing them in cafes where they are not proper. A very hurtful prejudice ftill prevails in this country, that all difeafes muft be cured by medicines taken into the llomach, and that the more violently thefe medicines operate, they are the more likely to have the defired effect. This opinion has proved fatal to thoufands, and will, in all probability, destroy many more before it can be wholly eradicated. Purging is often ufeful in acute difeafes, and, in chronical cafes, may pave the way for the operation of other medicines ; but it will feldom perform a cure ; and by exhausting the ftrength of the patient, will often leave him in a worfe condi- tion than it found him. That this is frequently the cafe with re- DRINKING THE MINERAL WATERS, 431 gard to the more active mineral waters, every perfon converfant in thefe matters will readily allow. Strong ftimulants applied to the ftomach and bowels for a length of time, muft tend to weaken and destroy their energy ; and what ftimulants are more active than fait and fulphur, efpecially when thefe fubftances are intimately combined, and carried through the fyftem by the penetrating medium of water ? Thefe bowels muft be ftrong indeed, which can withftand the daily operation of fuch active principles for months together, and not be injured. This is the plan purfued by moft of thofe who drink the purging mineral waters, and whofe circumftances will permit them to continue loftg enough at thofe fafhionable places of refort. Many people imagine that every thing depends on the quantity of water taken, and that the more they drink they will the fooner get well. This is an egregious error ; for while the unhappy pati- ent thinks he is by this means eradicating his diforder, he is often in fact undermining the powers of life, and ruining his conftitu- tion. Indeed, nothing can do this fo effectually as weakening the powers of digeftion by the improper application of ftrong stimu- lants. The very effence of health depends on the digeftive organs performing their due functions, and the moft tedious maladies are all connected with indigeftion. Drinking the water in too great quantity, not only injures the bowels and occafions indigeftion, but generally defeats the inten- tion for which it is taken. The difeafes for the cure of which mi- neral waters are chiefly celebrated, are mostly of the chronic kind -y and it is well known that fuch difeafes can only be cured by the flow operation of alteratives, or fuch medicines as act by inducing a gradual change in the habit. This requires length of time, and never can be effected by medicines, which run off by ftool, and operate chiefly on the firft paffages. Thofe who wifh for the cure of an obftinate malady from the mineral waters, ought to take them in fuch a manner as hardly to produce any effect whatever on the bowels. With this view a half- pint glafs may be drank at bed-time*, and the fame quantity an hour before breakfaft, dinner, and fupper. The' dofe, however, muft vary according to csreumftances. Even the quantity mention- ed above will purge fome perfons, while others will drink twice as. much without being in the leaft moved by it. Its operation on. the bowels is the only ftandard for ufing the water as an alterative. No. * When I fpeak of drinking a glafs ofthe water over night, I muft beg leave to caution thofe who follow this plan againft eating heavy flippers. The late Dr. Daultry of York, who was the firft that brought the Harrowgate waters into repute, ufed to advife his patients to drink a <*\;>.i\ before they went to bed; the confequence of which was, that kavi-,i;- eut a flefli fupper, and the water operating in the night, they were often tormented with gripes, and obliged to call for medical af- iLUnee. 43^ DRINKING THE MINERAL WATERS. more ought to be taken than barely to move the body; nor is it always neceffary to carry it this length, provided the water goes off by die other emunctories, and does not occafion a chilncfs, or fla- tulency in the ftomach or bowels. When the water is intended to purge, the quantity mentioned above may be all taken before break- faft. I would not only caution patients who drink the purging mine- ral waters over night to avoid heavy fuppers, but alfo from eating heavy meals at any time. The stimulus of water, impregnated with falts, feems to create a falfe appetite. I have feen a delicate perfon, after drinking the Harrowgate waters of a morning, eat a break- faft fufficient to have ferved two ploughmen, devour a plentiful dinner of flefh and fifn, and, to crown all, eat fuch a fupper as might have fatisfied a hungry porter. All this, indeed, the ftomach feemed to crave ; but this craving had better remain not quite fa- tisfied, than that the ftomach fhould be loaded with what exceeds its powers. To ftarve patients was never my plan ; but in the ufe of all the purging mineral waters, a light, and rather diluting diet is the moft proper ; and no perfon, during fuch a courfe, ought to eat to the full extent to what his appetite craves. To promote the operation of mineral waters, and to carry them through the fyftem, exercife is indifpenfably neceffary. This may betaken in any manner that is moft agreeable to the patient; but never to excefs. The beft kinds of exercife are thofe connected with amufement. Every thing that tends to exhilarate the fpirits, not only promotes the operation of the waters, but acts ^s a medi- cine. All who refort to the mineral waters, ought, therefore, to leave every care behind, to mix with the company, and to make themfelves as cheerful and happy as poffible. From this conduct, affifted by the free and wholefome air of thofe fafhionable places of j refort, and alfo the regular and early hours which are ufually kept, the patient often receives more benefit than from ufing the waters. I But the greateft errors in drinking the purging mineral waters arife from their being ufed in cafes where they are abfolutely im- proper, and adverfe to the nature of the difeafe. When people hear , of a wonderful cure having been performed by fome mineral water, they immediately conclude that it will cure every thing, and ac- cordingly fwallow it down, when they might as well take poifon. \ Patients ought to be well informed, before they begin to drink the more active kinds of mineral waters, of the propriety of the courfe, and fhould never perfift in ufing them when they are found to ag- gravate the diforder. In all cafes where purging is indicated, the faline mineral waters will be found to fulfil this intention better than any other medi- cine. Their operation, if taken in proper quantity, is generally mild; and they are neither found to irritate the nerves, nor debi- litate the patient fo much as other purgatives. As a purgative, thelh waters are chiefly recommended in difeafes DRINKING THE MINERAL WATERS. 4J3 of the firft paffages, accompanied with, or proceeding from, inacti-* vity of th;: ftomach and bowels, acidity, indigeftion, vitiated bile, worms, putrid fordes, the piles, and jaundice. In moft cafes of this kind they are the beft medicines that can be adminiftered. But when ufed with this view, it is fufficient to take them twice, or at moft, three times a-week, fo as to move the body three or four times ; and it will be proper to continue this courfe for fome weeks. But the operation of the more active mineral waters is not con-< fined to the bowels. They often promote the difcharge of urine, and not unfrequently increafe the perfpiration. This fhews that they are capable of penetrating into every part of the body, and of stimulating the whole fyftem. Hence arifes their efficacy in re-> moving the moft obftinate of all diforders, obftructions of the glandular and lymphatic fyftem. Under this clafs is comprehended the fcrophula or king's evil, indolent tumours, obftructions of the liver, fpleen, kidnies, and mefenteric glands. When thefe great purpofes are to be effected, the waters muft be ufed in the gradu- al manner mentioned above, and perfifted in for a length of time. It will be proper, now and then, to discontinue their ufe for a few days. The next great clafs of difeafes, where mineral waters are found to be beneficial, are thofe of the fkin, as the itch, fcab, tetters, ring- worms, fcaly eruptions, leprosies, blotches, foul ulcers, &c. Though thefe may feem fuperficial, yet they are often the moft obftinate which the phyfician has to encounter, and not unfrequently fet his fkill at defiance: but they will fometimes yield to the application of mineral waters for a fufficient length of time, and in moft cafes of this kind, thefe waters deferve a trial. The faline fulphureous waters, fuch as thofe of Moffat in Scotland, and Harrowgate in England, are the moft likely to fucceed in difeafes of the fkin; but for this purpofe, it will be neceffary not only to drink the wa- ters, but likewife to ufe them externally. To enumerate more particularly the qualities of the different mineral waters, to fpecify thofe difeafes in which they are reflec- tively indicated, and to point out their proper modes of application, would be an ufeful, and by no means a difagreeable employment ; but a3 theiimits prefcribed to thefe remarks will not allow me to treat the fubjeet at more length, I shall conclude, by obferving, that whenever the mineral waters are found to exhauft the ftrength, deprefs the fpirits, take away the appetite, excite fevers, diftend the bowels, or occafion a cough, they cught to be difcontinued. 13 APPENDIX; CONTAINING' A Lift of Simples, and of fuch Medicinal Preparations, as ought to be kept in Readinefs for private Practice ; The Method of preparing and compound- ing fuch Medicines, as are recommended in the former Part of the Book, with the Addition of feveral others of a fimilar Nature : Remarks on the Dofes, Ufes, and Manner of applying the different Preparations. INTRODUCTION, LS£i£XWSSMBJS»— IGNORANGE and Srperftitio;: have attributed c*trao;\>iKar-} medi- cal virtues io almoft every produce:. >■ oj nature. Thai fuch virtues were often imaginary, time and experience have fufficiently fheiun. Ph\- f.cians, however, from a veneration for antiquity, fill retain in their lifts of medicine, many things which owe their reputation entirely to thefuper- jlition and credulity cf our anceftors. The inflruvicnts of medicine will always be multiplied in proportion ta men's ignorance of the nature and caufe of difeafes : when thefe are fuffi- ciently underftood, the method of cure wilt be fimple and obvious. Ignorance of the real nature and permanent properties of thofe fub- ftances employed in the cure of difeafes, is another reafon nuhy they have been fo greatly multiplied. Phyfcians thought they could effect, by a number of ingredients, what could not be done by any one of them. Hence arofe thofe amazing farragos, which have fo long difgraced the medical art, and which were efteemed powerful in proportion to the number offimples that entered their cowpof.tion. The great variety offlnns into which o'rafl every article of medicine has been manufactured; affcrds and her profofthe imperfeclion of the medical cart. A drug which is perhaps avfl efficacious in thefmplefi farm in which it can be adminiftered, has been neverthelefs ferved up in ' fo many different fhape s, that one w:.v.ld be induced to think the wholi art of phyfic lay in exhibiting medicine under as many different modes as poffible. Different forms of medicir.c, :u d:::bt have their ufe ,• but they ought never to be wantonly increafed. They are by no means fo neceffary as is generally imagined. A few grains f powdered rhubarb, jalap, or ipeca- cuanha, will aFiually perform all that can be done by the different prepa- rations of lief roots, and may alfo be exhibited in as fafe a;:d agreeable a manner. ci he fame obfervation holds with regard to the Peruvian lark, and many otherfmples of which the preparations are very numerous. Multiplying the ingredients of a medicine, not only rciders it more (Xpenfvc, but alfo lefs certain, both in its dofe and operation. Nor is this all. The compound, when kept, is cpi tojpoil, or acquire qualities of a d'/l'cr-'nt nature. When a medicine is renctend mere fafe, efficacious, or 438 APPENDIX. agreeable, by the addition of ancthr. hey ca-hi, n: doubt, to be joined; in all other cafes, they are better kept c. 'hnaer. The combination of medim cines embarraffes thephf.cian, ana ■ cards the progrefs of medical know- ledge. It is impoffible to afcertain iJ-e pi ecife ffeB cf any one medicine, as long as it is combined with others, ■ a-.r of aftmilar er difftmilar na- ture. In the exhibition ofmedic'uir, regard f^uld net only be had to Simplici- ty, but likewife to elegance. Pat\nisfeidom recp much benefitfrc;v: things thai are highly dijagrceabh ;o ihdr jenfes. To tafte or fmell like a drug is become a proverb ,• and to fay truth, there is too nuuh ground for it. Indeed, no art can take av ay the difagn -able tafle and f.avour of fome drugs, without emu c>x ,..<>'roving their ij'uacy: it is pofflle, however, to render many medio;?, lefs difgujlful, and o./^ers even agreeable ; an cbjetl highly deferving t::c attention of all who adminifter medicine. The defign cf s following pages is to exhibit fuch a lift of drugs and medicines as .v re neceffary for pr.vate praclice. They are confiderably more mutf than thofe recona-arnded in the former part of the book, but fill gren>: rifhin the ticrader contained in the moft reformed dif- penfatories. Ihe fc.r<:t: n/edicini is feldom exhibited under different forms; and where differ en e medicines anfwer nearly the fame intention, there is commonly no more than one of them retained. Multiplying forms of me- dicine for the fame intention, tends rather to bewilder than affift the yauor pradlitioner, and the experienced phyfician can never be at a lofs to aut>< his prefcriptions as occafion requires. The chemical and other difficult preparations are fr the moft part emitted. All of them that are ufed by any private prac,'ii,o,ur art not worth preparing. He will buy them much cheaper than he can make them. Great care however is neceffary to obtain them genuine. They are oft< n adulterated, and ought never to be purchafed unlefs from perfons of known veracity. Such of them as are in common ufe are infected in the lift of drugs and medicines. Their proper dofes, ana manner of application, are mentioned in the practical part of the book, wherever they are prefcribed. Such articles of medicine as are to be found in the houfe or garden of almoft every peafant, as barley, eggs, onions, leffc. are likewife for the moft part omitted. It is necdlefs to fwell a lift of medicines with fuch things as can be obtained whenever they are wanted, and which fpoil by being kept. The preparations made and fold by diftillers and confectioners are alfo generally I ft out. Thefe people, by operating upon a larger plan, general- ly make things better, while it is in their power to afford them much cheeper, than they can be prepared by any private hand. The quantity ordered of ever'; medicine is as fmall as could well be pre- Pared} both to prevent ttnneceffary cxpenfe, and that the medicine might APPENDIX. 43g Hotfpoil by keeping. Alrr.ofi every medicine fuffers by being kept, andfhould be ufed as foon after it has been prepared r.s poffible. Even fimple drugs are apt to fpoil, and fhould therefore be laid np~7n fmall nuantities ; they either rot, are confumed by infects, or evaporate fo as to lofe their peculiar tafte or flavour, and often become quite infignificant. In the preparation of medicines, I have generally followed *.■'■< ■■.■" ;tn„ proved dfpenfatories ; but have taken the liberty to d.L!a j'tom .aem wherever my own obfervations, or thofe of other practical writes, at whofe judgment I could depend, fuggefted an improvement. In feveral compofiiions, the ingredient on which the efficacy cf the me- dicine principally depends is increafed, while the auxiliary>, wneh are ge- nerally ordered in fuch trifling quantities as to be of no uiiportance, are left tut, or only fuch of them retained as are neceffary to give the medicine a proper confiftence, or the like. The colouring ingredients are likewife for the meft part omitted. They increafe the bulk and price of the medicine ; without adding any thing te> its value. It would be well if they were never ufed at all. Medicines are often adulterated for the fake of a colour. Acrid and even poifonous fub- ftances are, for this purpofe, fometimes introduced into thofe medicines which ought to be moft bland and emollient. Ointment of elder, for exam- ple, is often mixed with verdegrife to give it a fine green colour, which entirely frtiftrates the intention of that mild ointment. Thofe who wifh to obtain genuine medicines fhould pay no regard to their colour. Some regard is likewife paid to expenfe. Such ingredients as greatly in- creafe the price of any compofition, without adding confiderably to its vir- tue, are generally either omitted, or fomewhat lefs expenfive fubfiituted in their place. Medicines are by no means powerful in proportion to their price. The cheapefl are often the befi ; befides, they are the leafi apt to b» adulterated, and are always moft readily obtained. With regard to the method of compounding medicines, I have general- ly followed that which feemed to be the moft fimple and natural, mention- ing the differentfieps of the procefs in the fame order in which they ought to betaken, without paying an implicit regdrd to the method of other dif- penfatories. For many of the remarks concerning the preparation, CSV. of medicines, I have been obliged to the author of the New Difpenfatory. The other ob- fervations are either fuch as have occurred to myfelf in practice, or have been fuggefied in the courfe of reading, by authors whofe names lam not able difiinclly to recollect. I have followed the alphabetical order, both with regard to the fimples and preparations. A morefcieniific method would have been agreeable to 440 APPENDIX. fomepofcfis, but lefs ufeful to the generality cf readers. The different ciaffes of medicine have no great dependence upon one another ; mid, wlxrc they have, it is hard to fay which fuculdfi and firfi or lafi ; no doubt the fimple preparations ought to precede tioe more compound. But all the, ad- vantages ariftng from this method of arrangement do not appear ecaal to that fingle one, cf being i He, on the firfi opening of the book, to find out any article, which, by the alphabetical order, is rendered quiie eufy. The dofe of every mcdieir.e is mentioned whenever it appeared necef- fary. When this is omitted, it is to be vraderjlood that the medicine may he vfed at difcretion. The dofe mentioned is always for an adult, unlefs wlci the contrary is c* pre fed. It is not an cajy matter to proportion the dcfeS cf nudLine exacbly to the different ages, confiiiutions, Life, of patients ,• but happily for mankind, mathematical exactnefs here is by no means neceffary. Several attempts have been made to afcertain the proportional dofes fir the different ages and conftitutions of patients ; but, after all that can be faid upon this fubjeet, a great deal mufi be left to the judgment andfkill of the perfon who admin fiers the medicine. The following general pro- portions may be obferved ; but they are by no means intended for exact rules. A patient between twenty and fourteen may take two-thirds of the dofe ordered for an adult ,■ frcm fourteen to nine, one-half; from nine to fix, one-third ; from fix to four, one-fourth ; from four to two, cneftxth} from two to one, a tenth ; and below one, a twelfth. Difpenfatorks are ufually written in the Latin language. Even au- thors who write in Englifh, generally give their prefcriptions in Latin ; and feme ofthemfhew fo great an attachment to that language, as firft to write their recipes in it, and afterwards tranflate them ; while others, to eompromife the matter, write the one half in Latin and the other in Eng- lifh. I have ufed the plainefi Englijb 1 could, and hope my prefcriptions will fucceed no worfe for it. N. B. The apothecary s weights, and the Englifh wine meafures, are ufed throughout the whole book, the different denominations f which wiJ appear from the follow ing table .- ■Apound contains twelve ounces. An ounce - - eight drachms. A drachm - - three fcruples. Afcruple - - twenty grains. A gallon contains eight pints. A pint - - fixieen ounces. An ounce - - eight drachms. A table-fpoonful is the meafure of half an ounce* A tea-fpoonful is one fourth of a tablefpoonfuL Sixiy drops make one tea-fpoonful. r 441 ] A LIST of SIMPLES, and of fuch MEDICINAL PRE- to be kept in Readiuefs fof PARaTIONS, as ought private Practice. AGARIC Alum Antimony, crude —-----cinnabar of --------fulphur of Balfam of Capivi -------of Peru -----oflOu f Bark, cafcarilla .----cinnamon -----Mezerion ----Peruvian -----Winter's, or eaneila alba Borax Calamine fione, levigated Caftor, Ruffian C iujlic, common <■-------lunar Earth, Fuller's •Japan —Armenian bole — French ditto Extracts of gentian -----ofg uaiacum -----of hellebore, black ----of hemlock ----of jalap of liquorice , \of Peruvian bark -----of poppies ■----of wormwood Flowers of camomile -------colt's foot -elder -rofemary •.-------damafik rofes _^_— red ditto Fruits, almonds -----bitter apple ——caffia fifiularis ----Cur.ffao oranges .----figs, dried ----•■French prunu ----Jamaica pepper -----juniper berriit -----nutmegs -----tamarinds , Gum. aloes -ammoniac, -arable -a'afoetida, —camphor -galbanum -gamboge -guaiacum -kino -myrrh -opium in tears Hartfhorn, calcined ——---fhi vings of Herbs, leffer centaury ----peppermint fpearmint •----penny-royal ■----favin ----trefoil uva urfi ———wormivood Lead, Litharge ----white ---Mar of Lemon-peel Mace Magnefia alba Manna Mercury, crude -------calcined _______JEthiop's minwof, -------calomel __——corrofive ft!'limate -----— red precipitate ---■----while ditto Mufk Oil, effential, of amber -----of anife. K 3 -of cinncwt&i 442 LIST OF SIMPLES, &rV, Oil, effential, of juniper -r----------of lemon-peel ------------of peppermint —expreffed, of almonds '----------—of linfeed Oil of olives, or Florence oil ------------of palms —of turpentine Orange-peel Oyflcr-fhells prepared Poppy-heads Refins, benzoin ----------——flowers of —'—Burgundy pitch -dragon's blood -frankincenfe —,— liquidfiorax -----white, or rofin ----fcammony Roots, birthworth -----calamus aromaticus ----contrayerva ----garlic ——gentian -----&nger -----hellebore, black, white -jalap -ipecacuanha -lily, white -liquorice -marfh-mallow -mezerion -rhubarb —farfaparilla -feneka -fquills —tormentil —turmeric —Virginianfnake -wild 'valerian —zedoary Saffron v Sal ammoniac, trial: ------------volatile Salt, Epfom -----of Glauber -----of hartfhorn -----nitre, purified, or prunel Polychrefi -——Rochel of tartar Seeds, anife -carraway -cardamom -coriander -cummin -muftard -fweetfennel -wild carrot' Senna Spanifh fiies Spermaceti Spirits, athereal, or ather -----of hartfhorn —---of lavender, compound -----ofnitre •-----ditto dulcified -----offal ammoniac —offia fait -of vinegar. -----of vitriol ■ of wine, rectified ----volatile aromatic Steel, filings of -----rufi of, prepared -----foluble, fait of Sulphur vivum -------balfam of Sulphur, flowers of Tar -----Barbadoes Tartar, cream of ----emetic ----foluble -----vitriolated Tin prepared Tutty, levigated Turpentine, Venice Verdegreafe Vitriol, green .--------blue <-------white Wax, white • i . yellow Woods, guaiacum -----logwood '—Mafras -----founders, red -----Zinc, fewers of I 443 1 MEDICINAL ^REPARATIONS. BALSAMS. THE fubjecl of this fedion is not-the natwral balfams, but certain compositions, which, from their being fnppofed to poffefs balfamic qualities, generally go by that name. , 'I his ci .ft of medicine was formerly very numerous, and held in great efteem: modern practice has reduced it to a very narrow compufs. Anodyne Balfam. _ Ta'ce of white Spanifh foap, one ounce; opium, unprepared, two drachms- rec- tified fpirit of wine, nine ounces. Digeft them together in a gentle heat for'three days ; then ftrain ofl the liquor, and add to it three drachms of camphor. This balfam is intended to eale pain. It is of Lrvice in violent firains and rheu- matic complaints, whi-n not attended wirh inflammation. It muft be rubbed with a warm hand on the part jffecled- or a linen rag moiftened with it may be applied ■to theprrt, and renewed every third or fourth hour, till the .pain abates. If the •opium is left out, this will be the faponacious balfam. ' 1 Locatelli's Balfam. Take of olive oil, one pint; Strafburg turpentine and yellow wax, of each half a ^pound ; redfaunders, fix drachms. Melt the wax with fome part of the oil over a gentle fire; then adding the remaining p-trt of the oil"and the turpentine; after- wards ml* in the fa'tinder-;, previoufly rccuced to a powder, and keep thtm ftirrmg together till the balfam is co!dl This balfam is recommended in erofions of the inteftines, the dyfentery, hemor- rhages, internal bruifes. and in fome complaints of th- bread Outwardly it is ufed for healing and cleanfing wounds and ulcers. Tlie dofe, when taken internally is from two icruples to two drachms. Toe vulnerary Balfam. Take of benzoin, powered, three ounces; fcalfam^of Peru, two ounces: hepatic aloes, in powder, halt anccrv.e: rectified fpirit of wine, two pints. Dii-elt them in a gentle heat for three days, and thjn ftrain the balfam. This balfam, or rather tincture, is applied externally to heal recent wounds and bruifes. It is likewife employed internally to remove coughs, afthma?, and other crmplaiutsot the brealt. It ia laid to eale the colic, cleanfe the kidnics, and to heal internal ulcers, &c. The dofe is from twenty tofixty drops. 1 his, though a medicine of fome value, does notdeferve the extravagant encomi- ums which have been beftowed on it. It has been celebrated under the different names of The Commanders Balfam, Pcrfian Balfam, Balfam of Berne, Wade's Balfam, Friar s Balfam, Jefuit's Drops, Turlington's Drops, &C % B O L U S E S. AS bolofcs are intended fur immediate ufe, volatile ialts and other ingredients improper for being kept are admitted into their composition. They are gene- rally compofed of powders, with a proper quantity of fyrup, conferve, or mucilage. The lighter powders are commonly made up with fyrup, and the more ponderous, as mercury, &c. with conft rve ; but thofe ot the lighter kind would be more conve- niently made up with mucilage, as it incrcafes their bulk lefs. than the other*addi* tioas, and hkevifc occafions the medicine to pafs down rn°r« eafily. 444 APPENDIX. Aftringent Bolus. Ta' e of alum, in powder, fifteen grains-; gum kino, five grains; fyrup, a fuffici- ent quantity to make a bolus. In an cxcetfive flow of the menfes, and Other violent difcharges of blood, proceedinz from relaxation, this bolus may be given every four Or five hours, till thc difthaice abates. \ Diaphoretic Bolus. Take of gum guaiacum, in powdtr, ten grains; flowers of fulphur and cream of tartar of earh oncjtruple; fimple fyrup, a fufficient quantity. In lhtimaric complaints, and diforders of the flcih, this bolus may be taken twice a-day. It wid alio be of fervice in the inflammatory quiufey. Mercurial Bolus. Take of calomel, fix grains; conferve of rofes, half a drachm. Make a bolus. What- mercury U neceffary, thisl.olus may Retaken twice or thrice a week. It may be t.tl.cn over r.ii-l-M ; and il it docs not op-rate, a few grains of jalap will be proper ni.^. u«y to a*ii) a of:. Bolus of Rhubarb and Mercury. \ Take of the heft rhubarb, in powder, from a fcruple to half a drachm ; of calomel, from four t<> fix grains; fimple f/n.p, a fufficient quantity to mAc a bolus. 'I his \- a propu-r purge in hypochondriac coniiitu'ions; but its principal intention is to expel worms. Where a itrong purge is neceflary, jalap may be ufed inftead of therhubj.rL>. PcBoral Bolus. Take of rpermaccti, a fcruple; gum ammoniac, ten grains; fait of hartfliorn, fix grains; fimple i'\ rup, as much as wil' make thrm into a bolus. Thi.* Iiolus is given in colds and coughs of long (landing, aflhmas, and beginning confumptions of the lungs. It is generally proper to bleed the patient before h« be- gins to ufe k. Purging Bolus. Take of jalnp in powder, a fcrup e; cream of tartar, two fcruples. Let them be rubbed together, and formed into a bolus, with fimple fvrup. Where a mild purge is wanted, this will anfwer the purpofe very well. If a ftrongcr dofe is neceflary, the jalap may be increafed to half a drachm or upwards. CATAPLASMS AND SINAPISMS. CATA PLASMS poflefs few or no virtues fuperior to a poultice, which may be fo made, as. in moft cafes, to fuppiy thtir place. They are chiefly intended ei- ther to act as difcutients, or to promote fuppuration; and as they may be of fervice in fome calos, we fhall giye a fpecimen of each kind. Difcutient Cataplaftn. Take of barley-meal, fix ounces; frefh hemlock leaves bruifed, two ounces; vine- gar, a fufficient quantity. Boil the meal and hemlock in the vinegar for a little, and then add two drachms of the fugar of lead. Ripening Cataplaftn. Take of white lihy root, four ounces; fat figs and raw onions, bruifed, of each one ounce; yellow bafilicum ointment, two ounces; gum galbanum, half an ounce; Jinleed meal, as much as neceflary. Boil the roofs along with thc figs in a fufficie«t quantity of water; then brnife and add to thtm the other ingredients, fo as to form the whole into a foft cataflafm. The galbanum muft be previoufly diflblvid with the yolk of an egg. APPENDIX. 445 "W here it is neeeffafy to promote fuppuration, this cataplafm may be ufed by thofe who ch.;ofe to he at the trouble and expofe of making it.. I have found no application more proper for this purpofe than a poultice of bread and milk, with a fufficient quantity of either boiled or raw onion in it, and-lokotct with oil or frefh butter. Sinapifms. Sinapifms are employed to recal the blood and fpirits to a weak part, as in the palfy end atrophy. They ,are alfo of fervice in deep feaud pains, as the fciatica, Sec. When the gout feizes the head or the ftomach, they are.applied to the feet to brin In the dyfentery or bloody flux, this clyfter may be adminiftered after every loofe ftool, to heal the ulcerated inteftines and blunt the fharpnefs of corroding humours. Forty or fifty drops of laudanum may be occafionaily added; in which cafe, it will generally fupply the place of the Af.ringent Clyfer. Turpentine Clyfter. Take of common decoction, ten ounces; Venice turpentine, diffolved with the yolk of an egg, half an dunce; Florence oil, one ounce. Mix them. This diuretic clyfter is proper in obftruciions of the urinary paflages, and in cho- Iicky complaints, proceeding from gravel. ' Vinegar Clyfter. This clyfter is made by mixing three ounces of vinegar with five of water-gruel. It anfwers all the purpofes of a common clyfter, with the peculiar advantage of being proper either in inflammatory or putrid diforders, efpecially the latter. *„* We think it unneceffary to give more examples of this clafs of medicines, as ingredients adapted to any particular, intention may be occafionaily added to one or other of the above forms. COLLY'RIA or EYE-WATERS. I7YE-WATERS have been multiplied without number, almoft every perfon pre- _i temlirg to be pofTeffed of fome fecret preparation for the cure of fore eyes. I have ex imiinedmany of them, and find that they are pretty much alike, the bafis of moft. of them being either alum, vitriol, or lead. Their effects evidently are, to brace and reftore the tone of the parts; hence they are principally of lei vice in flight inflammations, and in that relaxed ftate of the parts which is induced by ob- ftinate ones. , Cani[!ior is commonly added to thefe eompofnions; but as it feldom incorporates properly with the water, it can be of little ufe. Boles, and other earthy fubftances, as they do not diffolve in water, are likewife unfit for this purpofe. Collyrium of Alaa.i. Take of alum, half a drachm ; agitate it we>l together with thc white of one egg. This is th; Collyrium of Riverim;. It is ufed in inflammation of the eyes, to allay heat, and reftrain the flux of humours. It muft be fpread upon linen, aiid applied to the eyet; but fhould not be kept on above three or four, hours at a time. Vitriolic Collyrium. Take of white vitriol, half a drachm ; rofe-water, fix ounces. Diffolve the vi- triol in the water, and filter thc liquor. , v This, though limple, is perhaps equal in virtue to moft of the celebrated collyria. It is an ufefu' application in weak, watery, and inflamed eyes. Though tht flighter inflamniatiwii-> wrli generally yield to it, yet in thofe of a more obftinate nature, the affiftance of bleeding and blithering will often be neceffary. When a ftrong aftringent is judged pre■p-.T, a double or triple quantity of the vi- triol may be ufed. I lu\e l'etn a'Liutiou of four times the ftrength of the above ufed with manifeft advantage. Collyrium of Lead. Take fup-.r of lead, and crude fal ammoniac, of each four grains. Diffolve them in eight ci.i.ccsof common water. A\P P E N D I X. 447 Forty or fifty drops of laudanum may be occafionaily added to this collyrium, Thofe who chufe may fubftitute inftead of this the collyrium of lead recommended by GouJard; which is made by putting twenty-five drops of his Extraft of Lead to eight ounces of water, and adding a tea-fpoonful of brandy. Indeed, common water and brandy, without any other addition, will in many cafes anfwer very well as a collyrium. An ounce of the latter may be added to five «r fix ounces of the former; and the eyes, if weak, bathed with it night and morning. CONFECTIONS. CONFECTIONS containing above fixty ingredients are ftill to be found ia fome of the moft reformed difpenfacories. As moft of their intentions, however, may be more certainly, and as effectually anfwered by a few glaffes of wine or grains of opium, we fhall pafs over this clafs of medicines very flightly. Japonic ConfeBion. Take of Japan earth, three ounces; tormentil root, nutmeg, olibanum, of each two ounctc; opium diffolved in a fufficient quantity of Lifbon wine, a drachm and a half; fimple fyrup and conferve of rofes, of each fourteen ounces. Mix and make thetw into an electuary. This fupplies the place of thc Diafcordium. The dofe of this electuary is from a fcruplc to a drachm. CONSERVES AND'PRESERVES POSSESS very few medicinal properties, and may rather be claffed among, fweatmeats than medicines.—They are fometimes, however, of ufe, for reduc- ing into bolufes or pills fome of the more ponderous powders, as the preparations-of iron, mercury, and tin. Conferves are compofitions of frefh vegetables and fugar, beaten together into art,, uniform mafs. In making thefe preparations, the leaves of vegetables muft be freed from their ftalks, the flowers from their cups, and the yellow part of orange-peel taken off with a rafp. They are then to be pounded in a marble mortar, with a wooden peftle, into a fmooth wafs; after which, thrice their weight of fine fugar is commonly added by degrees, and the beating continued till they are uniformly mix- ed ; but the conferve will be better if only twice its weight of fugar be added. Thofe who prepare large quantities of conferve generally reduce the vegetables to a pulp by the means of a mill, and afterwards beat them up with fugar. Conferve of Red Rofes. q'ake a pound of red rofe buds, cleared of" their heels; beat them Well in a mor- tar, and, adding by degrees two pound* of double-refined fugar, in powder, make a conferve. , r „ After the fame man ner are prepared the conferves of orange-peel, roiemary-iioWers, fea-wormwood, of the leaves of wood-1'orrcl, GrV. . , , The conferve of rofes is one of the moft agreeable and ufeful preparations belong" ine to this clafs. A drachm or two of it, diffolved in warm milk, is ordered to be given as a gentle reftringent in weaknefs of the ftomach and hkew.fe in phthifical coughs, and fpitting of oiood. To have any confiderable effects, however, it muft be taken in larger quantities. Conferve of Sloes. This may be made by boiliag the floes gently in water, being careful to take then. outbX theVLrft; Afterwards espreffing the juice, and beating it up with three ^S^at mle b?ft "p'-ng or boiling frefh vegetables firft in water, and after- wafdfn fyrup, or a folution of fugar. The fubjeet is either prcferved mmk in he ™up\ or tlken out and dried, that the fugar may candy upon it. 1 he laft u.the moft ufual method. 44« APPENDIX Candid Orange Feel. Soak Seville orange-peel in feveral waters, till it lofes Hs hitternef,; then boil i: in a folution of double-refined fugar m wuur. till it becomes tender aud traufparent. Candid lemon-peel is prepared in the fame manner. It is needlels to add riiore of theie preparations, as t,hcy belong rather to.the art of the confectioner than that of the apotii'.c.ir •-. DECOCTIONS. WAT ER readiry extracts the gummy and faline parts of vegetables; and though its action is chiefly confined to thefe, yet the refinous aud o ly being intimately blended with the gummy and faline, are in great part taken up along with them. Hence watery decoctions and infufions of vegetables, conflitutt-. a large, and not un- ufeful, clafs of medicines. Although moft vegetables yield their virtues to water, as well by infufion as decoction, yet the latter is often neceffary, as it faves time, and does in a few minutes what the other would require hours, and fometimesdays, to effect. The medicines of this clafs are all intended for immediate ufe. Decoaion of Althea. Take of* the roots of marfh -mallows, moderately dried, three ounces; raifinsof the fun, one ounce ; water three pints. Boil the ingredients in the water till one third of it is confumed; afterwards ftrain the decoction and let it ftandfor fome time to feale." If the roots be thoroughly dried, they muft be boiled till one half of the water be confumed. In coughs, aad fharp deductions upon the lungs, this decoction may be ufed fo; o/dinary drink. . The Common Decoaion. Take of camomile flowers, one ounce; elder flowers, and fweet fennel feeds, ol each half an ounce; water, two quarts. Boil them for a little, and then ftrain the decoction. 0 A medicine equally good may be prepared by infufing the ingredients for fome hours in boiling wafer. " This decoction is chiefly intended as the bafis of clyfters, to which other ingredients may be occafionaily added. It will likewife fsrve a? a common fomentation, fbin't of wine or other things being added in fuch quantity as the cafe may require. Decoaion of Logwood. Boil three ounces of the fhavings, or chips of logwood, hi four pints of water, till one half the liquor is wafted. Two or three ounces of fimple cinr.amon-water may be added to this decoction. In fluxes of the belly, where the ftronger aftringents-are improper, a teacupful of thi* decoction may be taken with advantage three or four times a-day. DecoSion of the Bark, Boil an ounce of the Peruvian bark, grofsly powdered, in a pint and a half of water to one pint; then ftrain the decoction. If a tea-fpoonful of the weak fpirit of vitriol be added to this medicine, it will render it both more agreeable and efficacious. Compound Decoaion of the Bark. Take of Peruvian bark and Virginia fnake-,root, grofsly powdered, each three drachms. Boil them in a pint of water {o one half. To the ftrained liquor add an ounce and an half of aromatic water. Sir John Pringle recommends this as a proper medicine towards the decline of ma- lignant fevers, when the pulfe is low, the voico weak, and the head affected with a ftupor but with liyle delirium. The dofe is four fpoonfuls every fourth or fi&th hour. APPENDIX. 4451 Decoaion of Sarfaparilla* Take of frefh farfaparilla root, fliced and bruifed, two ounces; fhavingsof guai- acum^wood, one ounce. Boil over a flow fire, in three quarts of water, to one; adding towards the end, half an ounce of faffafras wood, and three drachms of liquo- rice. Strain the decoction. This may cither be employed as an afiiftant to a courfe of mecurial alteratives, or taken aft: r the mercury has been ufed for fome time. It ftrengthens the ftomach, and reftcres flafh and vigour to habits emaciated by the venereal difeafe. It may alfo be taken in the rheumatifm, and cutaneous diforders proceeding from foulnefs of the blood and juices. For all thefe intentions it is greatly preferable to the DeciP.hns cf Woods. This decoction may be taken, from a pint and ahalf to two quarts in the day. The following decoction is faid to be fimilar to that ufed by Kennedy, in the cure of the venereal difeafe, and may fupply the place of the Lifbon diet drink: Take of farfaparilla, three ounces; liquorice and mezerion root, of each half an ounce; crude antimony, powdered, an ounce and a half. Infufethefe ingredients in eight pints of boiling water for twenty-four hours, then boil them till one half of the water is confumed ; afterwards ftrain the decoction. This decoction may be ufed in thc fame manner as the preceding. Decoaion of Seneka. Take of f.neka rattle-fnake root, one ounce; water, a pint and a half. B one pint, and ftrain. , This decoctiom is recommended in the pleurify, dropfy, rheamatifm, and lome od- ftinate diforders of the ikin. The dofe is two ounces, three or four times a-day, or oftner, if the ftomach will bear it. White Decoaion. Take of thc purcft chalk, in powder, two ounces; gum arabic, half an ounce; water, three pints. Boil lo one quart, and ftrain the decoctijn. . This is a proper drink in acute difeafes, attended with, or inclining to a loofeneis, and where acidities abound in the ftomach, or bowels. It is peculiarly proper for children when afflicted with fournefs of the ftomach, and for perfons who are fubjea to the heartburn. It may be fweetened with fugar, as it is ufed, and two or three ounces of fimple cinnamon-water added to it. "Vf3- • An ounce of powdered chalk, mixed with two pints of water, will occafionaily fV-piy the place of this decoction, and alfo of the chalk julep. T DRAUGHTS. -•HIS is a proper form for exhibiting fuch medicines as are intended to operate irri. mediately, and which do not need to be frequently repeated; as purges, vomits, and a few others, which are to be taken at one dofe. Where a medicine requires to he ufed for any length of time, it is better to make up a larger quantity ot it at once, which faves both time and expenfe. Anbdyne Draught. Take of liquid laudanum, tw.nty-five drops: fimple cinnamon-water, an ounce, common fyrup, two drachms. Mix them. roM*tcnPr* tt,;i In exceffive pain, where bleeding Is not neceffary, and m great reftleffne^, tins tompofing draught may be taken and repeated occafionaily. Diuretic Draught. Take of the diuretic fait, two fcrupl«; fyrup of poppies, two drachms; fimple tmnamon-water. and common water, of each an ounce. " This draught is of fervice in an ooftruction or oeficiency ol unne. Purging Draughts. Take of mnnna, an ounce; foluble tartar, or Rochcl fair from three to fonr drachms DTfTolvein three ounces of boiling water: to winch add Jamaica F-PF^ v.itir. half an ounce. L 3 45Q APPENDIX. As manna foree times will not fit upon th-- ftomach, an oui:cc or ten drachms of thc purging falts. diffolved in four ouncs of water, may he taken inftead of the above. JI hofe who cannot take falts may ufe the- following drauoht: Takeof jalap in powder, a fcruple ; common water, an ounce; aromatic tincture iix drachms. Rub the jalap with twice its weight of fugar, and add to it the other ingredients. Sweating Draught. Take fpirit of Minderchis, twoouncts; fait of hartfhorn, five grains; fimple cirmimon-water, and fyrup of j.oppits, of each half an ounce. Make them into a draught. In recent colds and rheumatic complaints, this draught is of fervice. To promote its effects, however, the- patient ought to drink freely of warm water-gruel, or of fome other weak diluting liquor. Vomiting Draughts. Take faf ipecacuanha, in powder, a fcruole ; water, an ounce ; fimple fyrup. a drachm. Mix thorn. r J V' Perfons who require a flrongcr vomit, may add to the above half a grain* or a grainof emetic tartar. Thofe who do not chufe the powder, may take ten drachms of the ipecacuanha wine; or half an ounce of the wine; and an equal quantity of the fyrup of fquills. ELECTUARIES. T^LFCTTJARIES are generally compofed of the lighter powders, mixed with JLj fyrup, honey, conferve, or mucilage, into fuch a confiftence that the powders may neither frp^rate by keeping, nor the mafs prove too ftiff for fwallowing. They receive chiefly the milder alteratives medicine, and fuch as are not ungrateful to thc palate. Aftringent electuaries, and fuch as have pulps of fruit in them, fliould be prepa- red only in fnial! quantities; asaftringent medicines lofe their virtues by being kept in thi:. form, and the pulps of fruits are apt to ferment. - For the extraction of pulps it will be neceflary to boil unripe fruits, and ripe ones if they are dried, in a fmall quantity of water till they become foft. The pulp is then to be preffed out through a ftrong hair fieve, or thin cloth, and afterwards boiled to a due confiftence, in an earthen vcif-1, over a gentle fire, taking care to prevent the matter from burning by continually ftirring it. t he pulps of fruits that are both ripe and frefh may be prcftcd out without any previous boiling. Lenitive EleBitary. Tfake of fenna, in fine powder, eight ounces; coriander feed, alfo in powder, four ounces; pulp of tamarinds and of French prunes, each a pound. Mix the pulps and powders together, and with a fufficient quantity of fimple fyrup, reduce the whole iiitohn'elcctuary. A tea-fpoonful of this electuary, taken two or three times a-day, generally proves an agreeable fixative. It likewife ferves as a convenient vehicle for exhibiting more active medicines as jalaps, fcaraniot.y, and fuch like. This nuy fupply the place of the electuary of CaJJla. EleBuary for the Dyfentery. Take of the Japonic confection, two ounces; Locatelli's balfam, one ounce; rhubarb, in powder, half an ounce; fyrup of marfhmallows, enough to make co electuary. It is often dangerous in dyfenteries to give Opiates and aftringents, without intcr- pofing purgatives. The purgative is here joined with thefe ingredients, which ren- ders this a very fafe and ufeful medicine for the purpofes expreffed in the title. About the bulk of a nutmeg fhould be taken twice or thrice a-day, as thc fymp- toms and conftitution may require. / EleBuary for the Epilepfy. Take of Peruvian bark, in powder, an ounce ; of powdered tin, and wild vale- irun root, each half an ounce; fimple fyrup, enough to make an electuary. APPENDIX. 45i Dr. Mead directs a drachm of an electuary fimilar to this to be taken evening and morning, in the epilepfy, for the fpace of three months. It will be proper, how- ever, to difcontinue the ufe of it for a few days every now and then. I have added ♦he powdered tin, becaufe the epilepfy often proceeds from worms. EleBuary for the Gonorrhoea. Take of lenitive electuary, three ounces; jalap and rhubarb, in powder, of each two drachms; nitre, half an ounce; fimple fyrup, enough to make an electuary. During the inflammation and tenfion of the urinary paffages, which accompany a virulent gonorrhoea, thiscooling laxative may be ufed with advantage.. The dofe is a drachm, or about the bulk ef a nutmeg, two or three times a-day ; more or hfs, as may be neceffary to keep the body gently open. An electuary made of cream of tartar and fimple fyrup will occafionaily fupply the place of this. After the? imtammation is gone off, the following electuary may be ufed: Take of lenitive electuary, two ounces; balfam of capivi, one ounce; gum guaiacum and rhuburb, in powder, of each two drachms; fimple fyrup, enough to make an electuary. The dofe is the fame as of the preceding. EleBuury cj the Bark. Take of Peruvian bark, in powder, three ounces; cafcariila, half an ounce; fy- rup of ginger, enough to make an electuary. In the cure of obftinate intermitting fevers, the bark is affifted by the cafcariila. In hectic habits, however, it will be better to leave out the cafcariila, and put three drachms of crude fal ammoniac in its ftead. EleBuary for the Piles. Take flowers of fulphur, one ounce; cream of tartar, half an ounce; treacle, 3 fufficient quantity to iormi.n electuary. A tea-fpoonful of this may be taken three or four times a day. EleBuary for the Palfy. Take of powdered muftard-feed, and conferve of rofes, each an oance; fyrup of ginger, enough to make an electuary. A tea-fpoonful of this may be taken three or four times i-day. EleBuary for the Rheumatifm. Take of conferve of rofes, two ounces; cinnabar of antimony, levigated, an ounce and a half; gum guaiacum, in powder, an ounce; fyrup of ginger, a fufficient quantity to make an cltctu.try. In obftinate rheumatifms, whi.hare not accompanied with a fever, a tea-fpoonful ,of this electuary may bp taken twice a- day with confiderable advantage. EMULSIONS. E'MUI.SIONS, befide their ufe as medicines, are alfo proper vehicles for certain i fubftances, which cquld not otherwife be conveniently taken in a liquid form. I'hus camphor, triturated with almonds, readily unites with water into an emulfion, Pure oils, balfams, refins, and other fimilar fubftances, are likcvyilc rendered mif- cible with water by the intervention of mucilages. Common Emulfion. Take of fwect almond', an ounce; bitter almonds, a drachm; water two pint*. Let the almonds be blanched, and beat up in a marble mortar; adding the wuter by little and little, fo as to make an emnliion ; afterwards let it be ftrained. 4'5« APPENDIX. ****** Arabic Emulfion. This is made in the fame manner as the above, adding to the almonds, while beating, two ounces and a half of the mucilage of gum arabic. Where foft cooling liquors are neceffary, thefe emulfions may be ufed as ordinary drink. Camphorated Emulfion. Take of camphor, half a drachm; fweet almonds, half a dozen; white fugar, half an ounce, mint water, eight ounces. Grind the camphor and almonds well together in a ftone mortar, and add by degrees the mint water; then ftrain the liquor, and diffolve in it the fugar. In fevers, and other diforders which require the ufe of camphor, a table-fpoonful of this emulfion may be taken every two or three hours. Emulfion of Gum Ammoniac. Take of gum ammoniac, two drachms; water, eight ounces. Grind thc gum with the water poured upon it by little and little, till it is diffolved. This emulfion is ufed for attenuating tough, vifcid phlegm, and promoting expec- toration. In obftinate coughs, two ounces of the fyiup of poppies may be added ta it. The dofe is two table-fpoonfuls three or four times a-day. Oily Emulfion. Take of foft water, fix ounces; volatile aromatic ipirit, two drachms; Florence •il, an ounce ; fhake them well together, and add, of fimple fyrup, half an ounce. In recent colds and coughs, this emulfion is generally cf ftrvie'e; but if the cough proves obftinate, it will fucceed better when made with the paregoric elixir of the Edinburgh Difpenfatory, inftead of the volatile aromatic fpirit. A table-fpoonful of jt may be taken every two or three hours. EXTRACTS. EXTRACTS are prepared by boiling the fubjeet in water, and evaporating the ftrained decoction to a due confiftence, By thisprocefs fome of the more active parts of plants are freed from the ufelefs, indiffohible earthy matter, which makes the larger fhare of their bulk. Water, however, is not the only menftruum ufed in the preparation of extracts; fometimes it is joined with fpirits, and at other times rectified fpirit alone is employed for that purpofe. Extracts are prepared from a variety of different drugs, as the bark, gentian, jalaps, &c; but as they require a troublefome and tedious operation, it will be more con- venient for the private practitioner to purchafe what he needs of them from a profef- fed druggift, than to prepare them himfelf. Such of them as are generally ufed are infer ted in our lift of fuch drugs and medicines as are to be kept for private practice, FOMENTATIONS. FOMENTATIONS are generally intended either to eafe pain, by taking off ten- fion and fpafm , or to brace and reflore the tone and vigour of thofe parts to which they are applied. The firft of thefe intentions may generally be anfwered by warm water, and thc fecond hy cold. Certain fubftances, however, are ufually added to water, with a view to heighten its effects, as anodynes, aromatics, aftringents, &c. We fhall therefore fubjoin a few of the moft ufeful medicated fomentation:;, that peo- ple may have it in their power to make ufe of them if they choofe. Anodyne Fomentation. Take of white poppy-heads, two ounces; elder flowers, half an ounce; water, three pints. Boil till one pint is evaporated, and ftrain out the liquor. This fomentation, as its title expreffes, is ufed for relieving acute pain. APPENDIX. 453 Aromatic Fomentation. Take of Jamaica pepper, half an ounce; red wine, a pint. Boil them for a little, and then ftrain the liquor. This is intended, not only as a topical 'pplicatton for external complaints, bvt al- fo for relieving the internal parts. Pains of the howelf, which accompany dyfente- nes and diarrhoea, flatulent colics, uneafmefs of the ftomach, and reaching ;o vo- mit, are frequently abated by fomenting the abdamen and region of the 'ftomach With the warm liquor. Common Fomentation. Take tops »f wormwood and camomile flowers, dried, of each two ounces; wa- ter, two quam. After a flight boiling, pour off the liquor. Brandy or fpirit of wine may be added to this fomentation, in fuch quantity as the particular circumftances of the cafe fhall require; but thefe are not always neceflary. Emollient Fomentation. This is the fame as the common decoction. Strengthening Fomentation. Take of oak bark, one ounce; granate peel, half an ounce; alum, two drachms-; fmitli's forge w.ittr, three pints. Boil the water with the bark and peel to the con- fumption of one-third; then ftrain the decoction, and diffolve it in alum. ' this aftrii^nt liquor is employed as an external fomentation to weak parts; it *nay alfo be uied iiit-jrnally. GARGLES. HOWEVER trifling this clafs of medicines may appear, they are by no means without theii- ufe. t hey feldom indeed cure difeafes, but they often alleviate very difagreeable fymptom j; as parcliednefs of the mouth, foulnefs of the tongue and fauces, &c. they are peculiarly ufeful in fevers and fore throats. In thc latter, a garble will fometimes remove the diforder; and in the former, few things are more refrefliing cr agreeable to the patient, than to have his mouth frequently wafhed with fome foft detergent gargle. One advantage of thefe medicines is, that they are eafily prepared. A little barley- water and honey may be had any where; and if to thefe be added as much vinegar as will give thsm an agreeable fharpnefs, they wiil make a very ufeful gargle for foftning and cleanfing the mouth. Gargles hare thc befi ctVect when injected with a fyring. Attenuating Gargle. Take of water, fix ounces; honey one ounce; nitre, a drachm and a half. J.h'x them. This cooling gargle may be ufed either in the inflammatory quinfey, or in fevsrs, for cleanfing the tongue and fauces. Common Gargle. Take of rofe-water, fix ounces; fyrup of clove July-flowers, half an ounce; fpirit of vitriol, a fufficient quantity to give it an agreeable fharpnefs. Mix them. This gargle, lie fides cleanfing div tongue and fauces, acts as a gentle repellant, and will fometimes remove a flight quinfey. Detergent Gargle. Take of the emollient gargle, a pint; tincture of myrrh, an ounce; honey, t\v» ounces. Mix them. , , When exulcerations require to be cleanfed, or the excretion of tough vifcid fauva promoted, this gargle will be of fervice. 454 APPENDIX. Emollient Gargle. Take an ounce of marfhmallow roots, and two or three figs; boil them in a qua:; of water till near one half of it be confumed; then ftrain out the liquor. If an ounce of honey, and an half an ounce of fpirit of fal-ammoniac, be added to the above it will then be an exceeding good attenuating gargle. This gargle is beneficial in fevers, where the tongue and fauzes arc rough and par- ched, to foftcn thefe parts, and promote the difcharge of faliva. The learned and accurate Sir John Pringle obferves, that in the imflammatory quinfey, or ftranguiation of the fauces, little benefit arifes from the common gargles that fuch as are of an acid nature do more harm than good, by contracting the emunctories of the faliva and mucus, and thickening thofe humours; that a decoction cf figs in milk and water has a contrary effect, efpecially if fome fal ammoniac be ad- ded ; by which the fahva is made thinner, and the glands brought to fecrete more freely; a circumftance always conducive to the cure. INFUSIONS. VEGETABLES yield nearly thc fame properties to water by infufion as by de- coction ; and though they may require a longer time to give out their virtues in this way, yet it has feveral advantages over the other; fince boiling is found to diflipate the finer parts ot many hitter and aromatic fubftances, without more fully extracting their medicinal principles. The author of the New Difpenfatory obferves, that even from thofe vegetables which are weak in virtue, rich infufions may be obtained, by returning the liquor upon frefh quantities of the fubjeet, the water loading itfelf more and more with the active parts; and that thefe loaded infufions are applicable to valuable purpofes in medicine, as they contain in a fmall compafs, the finer, more fubtile. and active principles of vegetables, in a form readily mifcible with the fluids of the human bo- Bitter Infufion. Take tops of the leffer centaury and camomile flowers, of each half an ounce; yellow rind of lemon and orange peel, carefully freed from the inner white part, of each two drachms. Cut them in fmall pieces, and infufe them in a quart of boiling water. For indigeftion, weaknefs of the ftomach, or w-nt of appetite, a tea-cupful of this infufion may be taken twice or thrice a day. Infufion of thc Bark. To an ouuee of the bark, in powder, adet four or five table-fpoonfuls of brandy, and a pint of boiling water. Let them infufe for two or three days. This is one of the beft preparations of the bark for weak ftomachs. In diforders where the corroborating virtues of that medicine are required, a tearcupful of it may be taken two or three times a-d-y. Infufion cf Carduus. Infufe an ounce of the dried leaves of carduus benedictus, or bleffed thiftle, in a pint of common water, for fix hours, without heat; then filter the liquor through paper. This Ii<»ht infufion may be given, with great benefit, in weaknefs of the ftomach where the common bitters do not agree. It may be flavoured at pleafure with cin- namon, or other aromatic materials. Infufion of Linfeed, Take of linfeed, two fpoonfuls; liquorice root, fliced. half an ounce; boiling water, three pints. Let them Hand to infufe by the fire for.fome hours, and then ftrain off thr liquor. If an ounce of the leaves of colt's-foot be added to thefe ingredients, it wdl then be the peroral infufion. Both thefe are emollient mucilaginous liquors, and may be ta- ken with advantage as ordinary drink in difficulty of making water; and in coughs. and other complaints of the breaft. APPENDIX. 455 Infufion of rofes. Take of red rofes, dried, half an ounce; boiling water, a quart; vitriolic acid commonly called oil of vitriol, half a drachm; loaf fugar, an ounce. Infufe the rofes in the water four hours, in an unglazed earthen veffel; after- Wards pour in the acid, and having ftrained the liquor, add to it the fu<»ar. In an exceffive flow of the menfes, vomiting of blood, and other hjemorrhao-es a tea-cupful of this gently aftringent infufion may be taken every three or four hours. It likewife makes an exceeding good gargle. As the quantity of rofes ufed here can have little or no effect, an equally valuable medicine may be prepared by mixing the acid and water without infuiion, Infufion of Tamarinds and Senna. Take of tamarinds, one ounce ; fenna, and cryftals of tartar, each two drachms. Let thefe ingredients be infufed four or five hours in a pint of boiling water; after ■ wards let the liquor be ftrained, and an ounce or two of the aromatic tin cture added to it. Perfons who are eafily purged may leave out either the tamarinds o,r the cryf- tals «f tartar. This is an agreeable cooling purge. A tea-cupful may be jiven every ka.!f hoiu- till it operates This fupplies thc place of the decoSlion of tamarinds and fenna. Spanifh Infufion. Take of Spanifh juice, cut into fmall pieces, an ounce; fait of tartar, three'drachms. Infufe in a cjuart of boiling water for a night. To the ftrained liquor add an ounce and an half of the fyrup of poppies. In recent colds, coughs, and obftructions of the breaft, a tea-cupful of this infufion- may be taken with advantage three or four times a-day. Infufion for the Palfey. Take of horfe-radifh root fhaved, muftard feed bruifed, each four ounces; outer rind of orange peel, one ounce. Ini'ufj them in two quarts of boiling water, in a clofe veffel, for twenty-four hours. In paralytic complaints, a tea-cupful of this warm ftimulating medicine may be taken three or four times a-day. It excites the action of the folids, proves diuretic, \ and, if the patient be kept warm, promotes perfpiration. If two or three ounces of the dried leaves of maifh-trefbil be ufed inftead of the muftard, it will make the antiforbutk infufion. JULEPS. i fT^HE bafis of juleps is generally common water, or fome fimple diftilled water, 'I JL with one-third or one-fourth its quantity of diftilled fpirituous witer, and as muchfugar or fyrup as is fufficient to render the mixture agreeable. This is fharpened with vegetable or mineral acids, or impregnated with other medicines I'uitable to the intention. Camphorated Julep. Take of camphor, one drachm ; gum arabic, half an ounce; double refined fugar, an ounce; vinegar a pint. Grind the camphor with a few drops of rectified fpirit of wine till'it grows foft; then add the gum, previoufly reduced to a mucilage with equal its quantity of water, and rub them together till they are perfectly umt.-J. To- thismixture add, by little and little, the vinegar with the fugar diffolved m it, ftill continuing the trituration. .... , In hyfterical and other complaints where camphor is proper, this julep may be ta- ken ia thc dofe of a fpoofulor two as often as the ftomach will bcr ;;. Cordial jidtp. Take cf fimple cinnamon-water, four ounces; Jamaica pepper-water, two mmces volatile aromatic fpirit, and compound fpirit of lavender, of a^h two drachms; lyrup of orange-peel, an ounce. Mix them. This is given in the dofe of two fpoonfuls three or-four times X-day, .;; ciu.d-» accompanied with great weaknefs and derrcflion oflpirit*. 45<5 APPENDIX. ExpeBoralir.g Jukp. Take of the emulfion of gHm ammoniac, fix ounces; fyrup of fquills, two ounces. Mix them. In coughs, afthmas, and obftructions of the breaft, two table fpoonfuls of this julep «aay be taken every three or four hours. Mufk Julep. Rub half a drachm of mufk well together with half an ounce of ft:Tir, and add to it, gradually, of fimple cinnamon and pepper-mint water, each two ounces; of the vola- tile aromatic fpirit, two drachms. In the low ftate of nervous fevers, hiccupping, convulfions, and other fpafmodic af- fections, two u.blc-fpoonfuls of this julep may be taken every two or three hours. Saline Julep. Diflblve two drachms of fait of tartar in three ounces ef frefh lemon-juice, ftrained when the effervefcence is over, add, of mint-water, and common water, each two punces; of fimple fyrup, one ounce. This removes fickaefs at the ftomach, relieves vomiting, promotes perfpiration, and may be- ol fome fervice in fevers, efpecially of the inflammatory kind. Vomitting Julep. Diflblve four grains of emetic tartar in eight ounces of water, and add to it half 3n.ounce of the fyrup of clove July-flowers. In the beginning of fevers, where there is no topical inflammation, this julep may be given in the dofe of one table-fpoonful every quarter of an hour till it operates. Antimonial vomits ferve not only to evacuate the contents of the ftomach, but like- wife to promote the different execrations. Hence they are found in fevers to have nearly the fame ciiects as Dr. 'JameSs Powder. MIXTURES. A MIXTURE differs from a julep in this refpect, that it receives into its com- pofnion not only falts, extracts, and other fubftances diffoluble in water, but alfo earths, powders, and fuch fubftances as cannot be diffolved. A mixture is fel- dom vii agreeable medicine. It is neverthelefs neceffary. Many pi-rfons can take a misture, who arc not able to fwallow a bolus or an electuary: befides, there are me- dicines which act better in this than in any other form. Aftringent Mixture. Take" fimple cinnamon-water and common water, of each three ounces; fpirirt!- ous cinnamon-water, one ounce and a half; Japonic confection, half an ounce. Mix them.' )*% ' In dyfci'.reries which are not of long (landing, after the necefiiury evacuations, ft fpoonful or two of this mixture may be taken every four hcuro, interpofing every fe« cond or third day a dole of rhubarb. Diuretic Mixture: Tah? of mint-water, five ounces; vinegar of fquills, fix drachms} fweet fpirit of nitre, half an cum.-.'; iyrupof ginger, an ounce and a half. Mix them. ^ -^ In ohflruSiom. cf die urinary paffages, two fpoo>ifuls of this mixture.m-y be taken twice or thrice a-elay. Laxative Abforbent Mixture. f ,< Rub one drachm of nngnef-t alba in a mortar with ten «r twerve grains of the \a": Turkey rhv.'iarh,- and add to them three ounces of common water; fimple cinnamon* water, rnd fyrup of fugar, ol each, one ounce. As moft difrrfes of infants are accompanied, with acidities, this mixture may ei- ther be given virh a view to correft their, cr to t p-.-n the body. < A table-fpoonful may be taken for a dofe, and repeated ;h;-=c times a-d-y. To a very y-mg chiii half a fp^c: :V, will be ;u>'licie;it. APPENDIX. 457 When the mixture is intended to purge, the dofe may either be increafed, or the quantity of rhubarb doubled. This is one of the moft generally ufeful medicines for children with which I am acquainted. Saline Mixture. Diffolve a drachm of the fait of tartar in four ounces of boiling water; and, whe*i cold, drop into it, fpirit of vitriol, till the effervefcence ceafes ; then add, of pepper- minf-water, two ounces, fimple fyrup, one ounce. Where frefh lemons cannot be had, this mixture may occafionaily fupply the plate of the faline julep. Squill Mixture. Take of fimple cinnamon-water, five ounces; vinegar of fquills, one ounce ; fyrup of marfhmallows, an ounce andahalf. Mix them. . This mixture, by promoting expectoration, and the fecretion of urine, proves fer- viceable in afthmatic and dropfical habits. A table-fpoonful of it may be taken fre- quently. OINTMENTS, LINIMENTS, AND CERATES. NOTWITHSTANDING the extravagant encomiums which have been beftowed on different preparations of this kind, with regard to their efficacy in the cure of wound., fores, &c it is beyond a doubt, that the moft proper application to a green wound is dry lint. But though ointments do not heal wounds and fores, yet tbey ferve to defend them from the external air, and to retain fuch fubftances as may be neceffary for drying, deterging, deftroying proud flefh, and fuch-like. For thefe purpofes, however, it will be fufficient to infert only a few of the moft fimple formsj as ingredients of a more active nature can occafionaily be added to them. Telloib Bafilicum Ointment. Take ef yellow wax, white refin, and frankincenfe, each a quarter of a pbufid; melt them together over a gentle fire ; then add, of hogs'-lard prepared, one poun«r. Strain the ointment while warm. This ointment is employed for cleanfing and healing wounds and ulcers. Ointment of Calamine Take of olive oil, a pint and a half; white wax, and calamine ftone, levigated, of each half a pound. Let the calamine ftone, reduced into a fine powder, be rubbed with fome part of the oil, and afterwards added to the reft of the oil and wax, pre- vioufly melted together, continually ftirring them till quite cold. This ointment, which is commonly known by the name of Turner's Cera'.e, is an exceeding good application in burns and excoriations, from what .ver caufe. Emollient Ointment. Take of palm oil, two pounds; olive oil, a pint and a half; yellow wax, half at pound ; Venice turpentine, a quarter of a pound. Melt the wax in the oils over * ccntio fire ; then mix in the turpentine, and ftrain the ointment. e This fupplies the place of AltUa Ointment. It may be ufed for anointing inflamed parts, &c. Eye Ointments. Take, of hogs'-lard prepared, four ounces ; white w.-x, two drachm-- ; tutty pre- \, ifed, one ounce ; n.clt the wax with the 1. rd, over a gentle fire, and then Iprinkle hi the' tutty continually fiirrinp- thorn till the ointment is cold. This ointment will be more efficacious, and of a be'*< r confiftence, if two or *hre« drachms of camphor be rubbed up with a liu'e oil. md ii.;ii rately \r.:xsA with it, Ms 45^ APPENDIX. Another. . Take of camphor, and calamine ftone le\ gated, each fix drachms; vtrdegreaf* Well prepared, two drachms; hogs'-lard, and mutton fuet prepared, of eich two ounces. Rub the camphor well with the powder; afterwards mix in the lard and fuet, con'inuing the triture till they he perfettlv united. This ointment h?.s been long in efteem for d'fc-ifrs of thc eye?. It ought, however to be ufed with caution, when the eyes are much inflamed, or very tender. Iffue Ointment. Mix half an ounce of Spanifh flie?, finely powdered, in fix ounces of yellow bafili- cum ointment. This ointment is chiefly intended for dreffing blifters, in order to keep them ope» during pleafure. , Ointment of Lead. Take of olive oil, half a pint; white wax. two ounces, fugar of lead three drachms. Let the fugar of lead, reduced into a fine powder, be rubhed up with fome part of the oil, and afterwards added to the other ingredients, previoufly melted together, con- tinually ftirring them till quite cold. Thiscoo'ing and gently aftringent ointment may be ufed in all cafes where the intention is to dry and fkin over thc part, as in fcalding, &c. Mercurial Ointment. Take of quickfilver, two ounces ; hogs'-lard, three ounces; mutton fuet, ope ounce. Rub the quickfiiver with an ounce of the hogs'-lard, in a warm mortar, till the glo- bules be perfectly extinguifhed ; then rub it up with the reft of the lard and fuet, pre- viciifly melted together. Thc principal intention of this ointment is to convey mercury into the body by being rubbed upon the fkin. Ointment of Sulphur. Take of hogs'-lard prepared, four ounces; flowers of fulphur, an ounce and a half; crude fal ammoniac, two drachms; effence of lemon, ten or twelve drops. Make them into an ointment. This ointment rubbed upon the parts affected, will generally cure the itch. It is both the fafeft and beft application for that purpofe, and, when made in this way, has no difagreeable fmell. White Ointment* Take of olive oil, one pint; white wax and fpermaceti, of each three ounces* Melt them with a gentle heat, and keep them conftantly and brifkly ftirring toge- thtr, till quite cold. If two drachms of camphor, previotifly rubbed with .1 fmall quantity of oil, hz added to the above, it will make the White camphorahd Ointment. Liniment for Burns. Take equal part&of Florence oil, or of frefh drawn linfeed oil, and lime-water ; fhake them well together in a wide-mouthed bottle, fo as to form a liniment. This is found to be an exceeding proper application for recent fcalds or burns. It may either be fpread upon a cloth, or the parts affected may be anointed with it twice or thrice a-day. White Liniment. This is made in the fame manner as the white ointment, two-thirds of the wa-x being left out. This liniment may be applied in cafes of excoriation, where, on account of the Jargencfs of the furface, the ointments with lead or calamine might be improper. APPENDIX. 459 Liniment for the Piles. Take of emollient ointment, two ounces; liquid laudanum, half an ounce. Mix thefe ingredients with the yolk of an egg, and work them well together. Volatile Liniment. Take of Florence oil, an ounce; fpirit of harfhorn, half an ounce. Shake them together. ' This liniment, made with equal parts of the fpirit and oil, will be more efficacious, where the patient's(kin is able to bear it. Sir John J^ringle obferves, that in'the inflammatory quinfey, a piece of flannel moiftcned with this liniment, and applied to the throat, to be renewed every four or five hours, is one of the moft efficacious remedies ; and that it feldom fails, af- ter bleeding, cither to leffen or carry off the complaint. '1 he truth of this obfer- vation I have oficn experienced. Camphorated Oil. Rub an ounce of camphor, with two ounces of Florence oil, in a mortar, till the camphor be entirely diffolved. This antifpafmodic finiment may be ufed in obftinate rheumatifms, and ia fome other cafes accompanied with extreme pain and tenfion of the parts, PILLS. MEDICI NTS which opera'te in a frria'l dofe, and whofe difagreeable tafte, or fmell, makes it neee/Tary that they fliould be concealed from the palate are moft cqmmodiouily exhibited in this form. No medicine, however, that is in, tended to operate quickly, ought to be made into pills, as they often Lie for a con- fiderable time on the ftomach before they are diffolved,fo as to produceanv ef- fect. As the ingredients which enter the- compofition of pills are generally fo con- trived that one pill of an ordinary hze may contain about five grains o' the com- pound, in mentioning the dcfe, v, e fhall only fpecify the number of pdls to be tar ken ; as one, two, three, Ike. Compoftng Pill. Take of purified opium, ten grains; Caftile foap.haU^a drachm. Beat them to- gether, and form the whole into twenty pills. When a quieting draught will not fit upon the ftomach, one, two, or three of thefe pills may be taken a> occafion requires, •FatidPill. Take of afafcetida, half an ounce ; fimple fyrup, as much as is neceffary to form it into pills. In hyfteric complaints, four or five pills, of an ordinary Gze, may be taken twice or thrice a-day. They may likewife be of fervice to perfons afflicted with the afthma. When it is neceffary to keep the body open, a proper quantity of rhubarb, ,aloes, or jalap, may occafionaily be added to the above mafs. Hemlock Pill. Take any quantity of the extract ofhemlock, aud adding to it about a fifth part of its weight of the powder of the dried leaves, form it into piils of the ordinary The extract of hemlock may be taken from one grain to feveral drachms in the jday. The beft method, however, ®f ufing thefe pills, is to begin with one or two, and to increafe the dofe gradually, as far as the patient can bear them, withouf any remarkable degree of ftupor or giddinefs, 460 APPENDIX Mercurial Pill. ^ Take of purified quickfilver and honey, each half an ounce. Rub them together in a mortar till the globules of mercury are perfectly extinguifhed ; then add, of Caflile foap, two dFachms, powdered liquorice, or crumb of bread, a fufficient quantity to give the mafs a proper confiftence for pills. When ftronger mercurial pills are wanted, the quantity of quickfilver may be doubled. } The dofe of thefe pills is different, according to the intention with which thev are given. As an alterant, two or three may be taken daily. To raife a faiivatioii four or five will be neceffary. Equal parts of the above pill and powdered rhubarb made into a mafs, with a fufficient quantity of fimple fyrup, will make a Mercurial puroing Fill. Mercurial fublimate Pill. Diffolve fifteen grains of the corrofive fublimate of mercury in two drachms of the faturated folution of crude fal ammoniac, and make it into a pafte, in a glafs mortar, with a fufficient quantity of the crumb of biead. This mafs muft be form- ed into one hundred and twenty piils. This pill, which is the moft agreeable form of exhibiting the fublimate, has been found efficacious, not only in curing the venereal difeafe. but alfo in killing and expelling worms, after other powerful medicines have failed. For the venereal difeafe, four of thefe pills m.iy be taken twice a-day, as an al- terant three, and for worms two. Plumtners Pill. Take of calomel, or fweet mercury, and precipitated fulphur of antimony, each three drachms; extract of liquorice, two drachms. Rub the fulphur and mercury ■well together; afterwards add the extract, and, with a fufficient quantity of the mucilage of gum arabic, make them into pills. This pill has been found a powerful, yet fafe, alterative in obftinate cutaneous diforders; and has completed a cure after a falivation had failed. In venereal cafe* it has likewife produced excellent effects. Two or three pills of an ordinary fize may be taken night and morning, the patient keeping moderately warm, and drink- ing after each dofe a draught of dcco.itie>n of the woods, or of farfaparilla. Parking Pills. Take of fuccotorine aloes, and Caflile foip, each two drachms; of fimple fyrup, a fufficient quantity to make them into pills. Four or live of thefe pills will generally prove a fufficient purge. For keeping the body gently open, one may be taken night and morning. They are reckoned both deobftruent and ftomachic, and will be found to anfwer all the purpofes of Dr. Anderfon's pills, the principal ingredient of which is aloes. Where aloetic purges are improper, the following pills may be ufed: Take extract of jalap, and vitrioiated tartar, of each two drachnib ; fyrup of ginger, as much as will make them of a proper confiftence for pills. Thefe pills may be taken in the fame quantity as the above. Pill for the Jaundice. Take of Caftile foap, fuccotorine aloes, and rhubarb, of each one dr-chm. Make them into piUs with a fufficient quantity of fyrup or mucilage. Thefe piils, as their title exprefies, are chiefly inteaded for the jaundice, which, with thc affiftance of proper diet, they will often cure. Five or fix of thtm may be taken twice a-d.iy, more or lefs, as is neceffary to keep the body open, ft will be proper, however, during their ufe, to interpofe now aud then a vomit of ipecacuanha or tartar emetic. Stomachic Pill. Take extract of gentian, two drachms: powdered rhubarb and vitrio'attd tar- tar, of each enc drachm; oil of mint, thirty drops; fimple fyrup, a fufficient quantity. APPENDIX. 461 Three or four of thefe pills may be taken twice a-day, for invigorating the Jlomach, and keeping thc body gently open. Squill Pills. Take powder of dried fquills, a drachm and a half; gum ammoniac, and car- damom feeds, in powder, of each three drachms ; fimple fyrup, a fufficient quan- tity. in dropfical and afthmatic complaints, two or three of thefe pills may be taken twice a day,or oftner, if the ftomach wiil bear them. Strengthening Pill. Take foft extra<£t of the bark, and fait of ftetl, each a drachm. Make into pills. In diforders arifing from exceffive debility, or relaxation of the folids, as the ehlorofis, or green ficknef;, two of thefe pills may be taken three times a-day. PLAISTERS. PLAISTERS ought to be of a different confiftence, according to the purpofes for which they are intended. Such as are to be applied to the breafts or ftomach ought to be foft and yielding; while thofe defigned for the limbs fhould be firm and adhefive. It has been fuppofed, that plaifters might be impregnated with thc virtues of different vegetables, by boiling the recent vegetable with the oil employed for the compofition of the plaifter; but this treatment does not communicate to the oils any valuable qualifies. The calces of lead boiled with oils unite with them into a plaifter of a proper eonfiftence, which makes the bafis of feveral other plaifters. In boiling thefe compoiitions, a quantity of hot water muft be added from time to time to prevent the plaifter from burning ar growing black. This, however, fliould be done with care, left it caufe the matter to explode. Common Plaifter. Take of common olive oil, fix pints; litharge reduced to a fine powder, two pounds and a half. Boil the litharge and oil together over a gentle fire, conti- nually ftirring them, and keeping always about half a gallon of water in the veffel; after they have boiled about three hours, a little of the plaifter may be taken out and put into cold water, to try if it be of a proper confiftence : when that is the cafe, thc whole may be fuffered to cool, and the water well preffed out of it with the hands. This plaifter is generally applied in flight wounds and excoriations of the fkin. It keeps tta part foft and warm, and defends it from the air, which is all that is neceffirv in fuch ca.'es. its principal ufe, however, is to ferve as a bafis for other plaifters. Adhefive Plaifter. Take of common plaifter, half a pound; of Burgundy pitch, a quarter of a pound. Melt them together. This plaifter u principally ufed for keeping on other dreffings. Anodyne Plaifier. Melt an ounce of adhefive plaifter,and, when it is cooling, mix with it a drachm of powdered o_.-iurn, and the fame quantity of camphor, previoufly rubbed up with a little oil. . This plaifter generally gives eafe in acute pains, efpecially of the ner/ou* kind. Bliftering Plaifter. Take of Venice turpentine, fix ounces ; yellow wax, two ounces; Spauifh flies in fine powder, three ounces ; powdered muftard, one ounce. Melt the wax, and 4to A P P E N D I X. while it is warm, add to It the turpentine, taking care not to evaporate it by t<-* much heat. After the turpentine and wax are fufficiently incorporated, fprinklc in the powders, continually ftirring the mafs till it be cold. Though this plaifter is made in a variety of ways,one feldom mrets with it of a proper confiftence. When compounded with oils and other greafy fubftances, its effects are blunted, and it is apt to run; while pitch and refin render it too lyird and very inconvenient. When the bliftering plaifter is not at hand, its place may be Applied, by mix- ing, with any foft ointment, a fufficient quantity of powdered flies; or, by form- ing them into a pafte, with flour and vinegar. Gum Plaifter. Take of the common p'.iifter, four pounds; gum ammoniac and galbanum, ftrained, of each half a pound. Melt them together, and *dd,of Venice turpen- tine, fix ounces. This plaifter is ufed as a digeftive, and likewife for difcufling indolent tumours. Mercurial Plaifter. Take of common'plaifter.onc pound; of gum ammoniac, ftrained, half a pound, mel: them together, and, when cooling, add eight ounces of quck-filver, prcvi- oufly extinguifhed by triture, with three ounces of hog's lard. This plaifter is recommended in pains ofthe limbs arifing from a venereal caufe. Indurations of thc glands, and other violent tumours, are likewife found fome- times to yield to it. Stomach Plaifter. Take of gum plaifter, half a pound ; camphorated oil, an ounce and a half; Mack pepper, or capficum, where it can be had, one ounce. Melt the plaifter, and mix with it the oil; then fprinkle in thc pepper, previoufly reduced to a fine powder. An ounce or two of this plaifter, fpread upon foft leather, and applied to the region of the ftomach, will be of fervice, in flatulencies arifing from hyfteric and hypochondriac affections. A little of the exprefted oil of mace, or a few drops of the effential oil of mint, may be rubbed upon it before it is applied. This may fupply the place of the Antihyfteric Plaifter. Warm Plafier. Take of gum plaifter, one ounce; bliftering plaifter, two drachms. Melt them together over a gentle fire. This plaifter is ufeful in the fciatica, and other fixed pains of the rheumatic kind: it ought, however, to be worn for fo'nc time-, and to be renewed, at leaft •nice a-wcek. If this is found tobbfter the part, which is fometimes the cafe, it muft be made with a fmaller proportion ofthe bliftering plaifter. Wax Plaifter. Ta'icc of yellow wax, one pound; white refin,half a pound ; mutton fuet, three quarters of a pound. Melt them together. This is generally ufed inftead ofthe Mclliot Plaifter. It is a proper application after blifters, and in other cafes where a gentle digeftive is neceffary, POWDERS, THIS is one of the moft fimple forrpsin which medicine can be adminiftered. Many medicinal fubftanco, however, cannot be reduced into powder, and others are too difr^iveable to be taken in this form. Thc lighter powders may be mixed in any agreeable, thin liquor, as tea or wa- trr-gruel. The more ponderous will require a more confiftcnt vehicle, as fyrup, conferve, jellv, or honey. Gum»,ui:d o;he: i-J.-'r-'ices wtfich arc difficult to powder, fliould be pounded APPENDIX. 4^3 along with the drier ones ; but thofe which are too dry, efpecially aromatics, ought to be fprinkled, during their pulverization, with a few drops of any pro- per water. Aromatic powders are to be prepared only in fmall quantities at a timo, and kept in glafs veffels, clofely flopped. Indeed, no powders ought to be expofed to the air or kept too long, otherwife their virtues will be, in a prcat meafure, de- ftroyed. Afiringent Powder. Take of alum and Japan earth, each two drachms. Pound them together, and divide the whole into ten or twelve dofes. In an immoderate flow of the menfes, and other hemorrhages, one of thefe powders may be taken every hour, or every half hour, if the difcharge be violent. Powder of Bole. Take of bole armenic, or French bole, two ounces; cinnamon, one ounce ; tor- mentil root and gum arabic, of each fix drachma; long pepper, one drachm. Let all thefe ingredients be reduced into a powder. this warm, glutinous, aftringent powder, is given in fluxes, and other diforders where medicines of that clafs are neceffary, in the dole of a fcruplc, or half a drachm. If a drachm of opium be added, it will make thc powder of bole with opium, which is a medicine of confiderable efficacy. It may be taken in thc fame quan- tity as the former, but not above twice or thrice a day. Carminative Powder. Take of coriander-feci, half an ounce; ginger, one drachm ; nutmegs, half a drachm ; fine fugar, a drachm and a half. R.educe them into powder for twelve dofes. This powder is employed for expelling flatulencies arifing from indigeftion, par ticularly thofe to which hyfteric and hypochondriac perfons are fo liable Itm.iy likewife be given in fmall quantities to children in their food, when troubled witk gripes. Diuretic Powder. Take of gum arable, four ounces ; purified nitre, one ounce. Pound them to- gether, and divide the whole into twenty-four dofes. During the firft ftage ofthe venereal difeafe, one of thefe cooling powders may betaken three times a-day,with confiderable advantage. Aromatic Opening Powder. Take of the befi Turkey rhubarb, cinnamon, and fine fugar, each twe drachms. Let the ingredients be pounded, and afterwards mixed well together. Where flatulency is accompanied with coftivenefs, a tea-fpoonful ot this pow- der may be taken once or twice a-day, according to circumftances. Saline Laxative Powders. t Take of foluble tartar, and cream of tartar, each one drachm ; purified nitre, half a drachm- Make them into a powder. In fevers, and other inflammatory diforders, where it is neceffary to keep the bo- dy gently open, one of thefe cooling laxative powders may be taken in a little gruel, and repeated occafionaily. Steel PowcLn. Take filings of fteel, and Ioaf-fugar, of each two ounces; g'ngcr, two dra..Inn. Pound them together. In ubflructiij;i» of thc menfes, avid other caf^s where fieel i* prober, a tea- 464'' APPENDIX. fpoonful of this powder may be taken^wice a-day, and waflicd down with a lit Die wine or water. : Sudorific Powder. Tike of purified nitre and vitrioiated tartar, of each half an ounce ; opium and ipecacuanha, of each one drachm. Mix the ingredients, and reduce them to a fine powder. This is generally known by the name of Dover's Powder. It is a powerful fu- dorific. Iu obftinate rheumatifms, and other cafes where it is neceffary to excite a copious fweat, this powder may be adminiftered in the dofe of a fcruplc or half a drachm. Some patients will require two fcruples. It ought to be accompanied with the plentiful ufe of fome warm diluting liquor. Worm-Powder. Take of tin reduced into a fine powder, an ounce; iEthiop's mineral, two drachms. Mix them well together, and divide the whole into fix dofes. One of thefe powders may be taken in a little fyrup, honey, or treacle twice a- day. Aftei they have been all ufed, the following anthelmintic purge may be pro- per. Purging Worm-Powder. Take of powdered rhubarb, a fcruplc; fcammony and calomel, of each five grains. Rub them together in a mortar for one dofe. For children, the above dofe muft be leffened according to their age. If the powder of tin be given alone, its doft may be confiderably increafed. The late Dr. Alfton gave it to the amount of two ounces in three days, andfaysr when thus adminiftered, that it proved an egregious anthelmintic. He purged his patients both before they took the powder and afterwards. Powder for the Tape-Worm. Early in the morning the patient is to take in any liquid, two or three drachms, according to his age and conftitution, ofthe root of the male fern reduced into a tine powder. About two hours afterwards he is to take of calomel and refin of Lammony, each ten grains ; gum gamboge, fix grains. Thefe ingredients muft be lincly powdered, and given in a little fyrup, honey, treacle, or any thing that is iauft agreeable to the patient. He is then to walk gently about, now and then drinking a difh of weak green tea, till the worm is paffed. If the powder of the fern produces naufea, or ficknefs, it nay be removed by fucking the juice of an orange or lemon. This medicine, which had been long kept a fecret abroad for the cure of the tape i worm, was fome time age purchafed by the French King, and made public for the benefit of mankind. Not having had an opportunity of trying it, I can fay nothing from experience concerning its efficacy. It feems, however, from its ingre- dients, to be an active medicine, and ought to be taken with care. The dofe here prefcribed is fufficient for the ftrongeft patient; it muft, therefore, be reduced ac- cording to the age and conftitution. SYRUPS. CYRUP5 were fome time a^o looked upon as medicines of confiderable value, •"' I hey are at prefent regarded chiefly as vehicles for medicines of greater effi- cacv, aad are uf bruifed ginger in two pints of boiling water for twenty-four hours. After the li- quor has been ftrained, and has flood to fettle for fome time, it mav be poured off, and a little more than double its weight of fine powdered fugar diffolved i.i it. TINCTURES, ELIXIRS, &c. RECTIFIED fpirit is the direct menftruum of the refins and effential oils of vegetables, and totally extracts thefe active principles from fundry fubftan- ces, which yield them to water, either not at all, or only in part. It diffolves likewife thofe parts of animal fubftances in which their peculiar fmells and taftes refide. Hence, the tinctures prepared with rectified fpirits form an ufeful and elegant clafs of medicines, poffcfhng many of the moft effential virtues of fimples, without being clogged with their inert or ufelefs parts. Water, however, being the proper menftruum of the gummy, faline, and faccha- rine parts of medicinal fubftances, it will be neceffary, in the preparation of feveral tinctures, to make ufe of a weak fpirit, of a compofition of rectified fpirit and water. Aromatic TinBure. Infufe two ounces of Jamaica pepper hi two pints of brandy, without heat, for a few days; then ftrain off the tincfture. This fimple tincture will fufficiently anfwer all the intentions of the more coftly preparatioas of this kind. It is rather too hot to be taken by itfelf; but is very proper for mixing with fuch medicines as might otherwife prove too cold for the ftomach. Compound TinBure ofthe Bark. Take of Peruvian bark, two ounces; Seville orange-peel and cinnamon, of each half an ounce. Let the bark bepowdered, and the, other ingredients bruifed; then in- fufe, the whole in a pint and a half of brandy, for five or fix days, in a clofe veffel ; af- terwards ftrain off the tincture. This tincture is not only beneficial in intermitting fevers, but alfo in the flow ner- vous, and putrid kinds, efpecially towards their decline. The dofe is from one drachm to three or four, every fifth or fixth hour. It may bu given in any fuitablc liquor, and occafionaily fharpened with a tew drops of the fpi- rit of vitriol. Volatile Faiid TinBure. Infufe two ounces of a'ffafcetida in one pint of volatile aromatic fpirit, for eight days, in a clofe bottle, frequently fhaking it ^then ftrain the tincture. This medicine is beneficial in hyfteric diforders, efpecially when attended with Iownefs of fpirits, andfaintings. A tea-fpoonful of it may be taken in aglalsof vvuie, «r a cup of penny-royal tea. Vilatile TinBure of Gum Guaiacum. Take of gum guaiacum, four ounces ; volatile aromatic fpirit, a pint. Ififnfc with- out heat, in a veftel well Hopped, for a few days; then ftrairi off the tincture." * A-very goodtinclure of guaiacum for domeflie ufe} may I. i mtJxly irjruf. ■■* tv» tr three tma.s f the gum in a h t. 'fmir. or li anly 4*6 APPENDIX. In rheumatic complaints, a tea-fpoonful of his tin&ure may be taken in a cup *t the infufion of water-trefoil, twice or tiiri e . ■ day. TinBure of Black Hellebore. Infufe two ounces of the roots of black hellebore, bruifed, in a pint of proef fpiri-^ for ft \en or cij;h» days ; then filter the tindure through paper. A fcruple of cochi- neal may l>e infufed along with the roots, to give the tincture a colour. In obftructions of the menfes, a tea-fpoonful of this tincture may be taken in a cup 6f camomile or penny-royal tea twice a-day. Aftringent TinBure. Digeft two ounces of gum kino, in a pint and a half of brandy, for eight days; af- terviards ftrain it f >r ufe. This tincture, though not generally known, is a good aftringent medicine. With this view, an ounce, or more, of it may be taken three or four times a-day. TinBure of Myrrh and Aloes. Take of gum myrrh, an ounce and a half; Iwpatic aloes, one ounce. Let them be reduced to a powder, and infufed in two pints of rectified fpirits, for fix days, in a gentle heat; then ftrain the tincture. 1 his is principally ufed by furgeons for cleanfing foul ulcers, and reftraining the progrefs of gangrenes. It is alfo, by fome, recommended as a proper application tr green wounds. TinBure of Opium, or Liquid Laudanum. Take of crude opium, two ounces; fpirituous aromatic water, and mountain wine, of each ten ounces. Diffolve the opium, fliced, in the wine, with a gentle heat, fre- quently ftirring it; afterwards add the fpirit, and ftrain off the tindure. As twenty-five drops of this tincture contain about a grain of opium, the common dofe may be from twenty to thirty drops. Sacred TinBure, or TinBure of Hiera Picra. Take of fuccotorine aloes in powder, one ounce ; Virginian fnake-root and gingari of each two drachms Infufe in a pint of mountain wine, and half a pint of brandy, for a week, frequently fhaking the bottle, then ftrain off the tincture. This is a fafe and ufeful purge for perfons of a languid and phlegmatic habit; bur is thought to have better effects, taken in fmall dofes as a laxative. The dofe, as a purge, is from one to two ounces. Compound TinBure of Senna. Take of fenna, one ounce; jalap, coriander feeds and cream of tartar, of each half an ounce. Infufe them in a pint and a half of French brandy for a week ; then ftraia thc tincture, ;.nd idd to it four ounces of fine fugar. Thiiis an agreeable purge, and anfwers all the purpofes of the Elixir falutis, and of D ifv's Elixir. The dole is from one to two or three ounces. TinBure ofSpanifh Flics. Take of Spinifk flies, reduced to a fine powder, two ounces; fpirit of wine, on! pint. Infufe for two or three days ; then ftrain off the tincture. This is intended as an acrid ftimulant for external ufe. Parts affected with the palfy or chronic rheumatifm may be frequently rubbed with it. TinBure of the Balfam of Tolu. Take ofthe balfam of Tolu, an ounce and a half; rectified fpirit of wine, a pint* Infufe, in a gentle heat, until the balfam is diffolved; then ftrain the tincture This tincture poffeffes all the virtues of the balfam. In coughs, and other com- plaints of the breaft, a tea-fpoonful or two of it may be taken in a bit of loaf fugar. But the beft way of ufing it is in fyriip. An ounce ofthe tincture, properly mixed with two pounds of fimple fyrup, will make what ii commonly called thc Bdlfamie Syrup% APPENDIX. 467 TinBure of Rhubarb. Take of rhubarb, two ounces and a half, leffer cardamom feeds, half an ounce; trandy, two pints. Digeft for a week, and ftrain the tincture. Thofe who choofe to have a vinous tincture of rhubarb, may infufe the above in- gredients in a bottle of Lifbon wine, adding to it about two ounces of proof fpirits. It half an ounce of gentian root, and a drachm of Virginian fnake-root be added to the above ingredients, it will make the bitter tincture of rhubarb. _ All thefe tinctures are defigned as ftomachics and corroborants as well as purga- tives. In weaknefs of the ftomach, indigeftion, laxity of the inteftines, fluxes; cho- licky and fuch-like complaints, they are frequently of great fervice. The dofe i. from half a fpoonful to three or four fpoonfuls or more, according to the circumftan- ces of the patient, and the purpofes it is intended to anfwer. Paregoric Elixir. Take of flowers of benzoin, half an ounce ; »pium, two drachms. Infufe, in one pound of the volatile aromatic fpirit, for four or five days, frequently fhaking the bottle t afterwards ftrain the elixir. _ This is an agreeable and fafe way of adminiftering opium. It eafes pain, allay? tickling coughs, relieves difficult breathing, and is ufeful in many diforders of chil- dren, particularly the hooping cough. The dole to an adult is from fifty to a hundred drops. Sacred Elixir. Take of rhubarb cut fmall, ten drachms; fuccotorine aloes, in powder, fat drachms; leffer cardamom feeds, half an ounce ; French brandy, two pints. Infufe for two or three days, and then ftrain the elixir. This ufeful ftomachic purge may be taken from one ounce to an ounce and a half. Stomachic Elixir. Take of gentian root, two ounces ; Curaffao oranges, ene ounce ; Virginian fnake- root, half an ounce. Let the ingredients be bruifed, and infufed for three or four days in two pints of French brandy ; afterwards ftrain out the elixir. This is an elegant ftomachic bitter. In flatulencies, indigeftion, want of appetite and fuch-like complaints, a fmall glafs of it may be taken twice a-,d:iy. It, likewife' Relieves the gout in the ftomach, when taken in a large dofe. Acid Elixir of Vitriol. Take of the aromatic tincture, one pint ; oil of vitriol, three ounces. Mix them jrradually, and after the fxces have fubfided, filter the elixir through paper, in a glaf= funnel. This is one of the beft medicines which I know for hyfteric and hypochondriac pa- tients, afflicted with flatulencies arifing from relaxation or debility of the ftomach and inteftines It will fucceed where the moft celebrated ftomachic bitters have no effect. The dofe ir. from ten to forty drops, in a glafsof wine or water, or acup of any bitter infufion, twice or thrice a-day. It fhould be taken when the ftomach is moft empty. Camphorated Spirit of Wine. Diffolve an ounce of camphor in a pint of rectified fpirits. This folution is chiefly employed as an embrocation in bruifes, palfies, the chroni; rheumatifm, and for preventing gangrenes. The above quantity of camphor, diffolved in half a pound ofthe volatile aromatic fpirit, makes IVard'i Effence. Spirit of Mindererus. Take of volatile fal ammoniac, any quantity. Pour on it gradually, diftilled vine- V >r till the effervefcence ceafes. J his medicine is ufeful in promoting a difcharge both by thc fkin and urinary paf- fages. It is alfo a good external application in ftrains and bruifes. When intended to raile a fweat half an ounce of it in a cup of warm gruel may be given to the patient in bed every hour till it has trie defired effect. [ 4*8 ] VINEGARS. VINEGAR is an acid produced from vinous liquors by a fecond fermentation. It is an ufeful medicine both in inflammatory and putrid diforders. Its effects arc, to cool the blood, quench thirft, counteract a tendency to putrefaction, and allay in- orriinate motions of the fyftem. It, likewife, promotes the natural fecretions, and, in fome cafes, excites a copious fweat, where the warm medicines, called alexiphar- mic, tend rather to prevent that falutary evacuation. Weaknefs, faintings, vomitings, and other hyfteric affections, are often relieved by vinegar applied to the mouth and nofe, or received into the ftomach. It is of excellent ufe, alfo, in correcting maiy poifonous fubftances, when taken into thc ftomach; and in promoting their expulfion, by the different emunctories, when received into the blood. Vinegar is not only an ufeful medicine, but ferves, likewife, to extract, in tolerable perfection, the virtues of feveral other medicinal fubftances. Moft of the odoriferous flowers impart to it their fragrance, together with a beautiful purplifh or red colour. it alfo affifts, or coincides with the intention of fquills, garlic, gum ammoniac, and feveral other valuable medicines. Thefe effects, however, are not to be expected from every thing that is fold under the name of vinegar, but from fuch as is found and well prepared. The beft vinegnrsare thofe prepared from French wines. It is neceffary, for fome purpofes, that the vinegar be diftilled, but as this opera- tion requires a particular chemical apparatus, we fhall not inlcrt it. Vinegar of Litharge. Take of litharge, half a pound ; ftrong vinegar, two pints. Infufe them together in a moderate heat for three days, frequently fhaking the veffel ; then filter the li- quor for ufe. This medicine is little ufed, from a general notion of its being dangerous. There is reafon, however, to believe, that the preparations of lead with vinegar are poffef- fed of fome valuable properties, and that they may be ufed, in many cafes, with fafety and fuccefs. A p'eparation of a fimilar nature with the above has, of late, been extolled by Gou- lard, a French furgeon, as a fafe and extenfively ufeful medicine, which he calls thg ExtraSl of Sat'trn, and orders to be made in the following manner: Take of litharge, one pound; vinegar, made of French wine, two pints. Put them together into a glazed earthen pipkin, and let them boil, or rather fimmer, for an hour, or an hour and a quarter, taking care to flir them all the while with a wood- en fpatula. After the whole has flood to fettle, pour off the liquor which is upon the top into bottles for ufe. With this extract, Goulard makes his •vegeto-mineral ■water,* which he recommends Jn a great variety of external diforders, as inflammations, burns, bruifes, fprains, ul- cers, &c. He, likewife, prepares with it a number of other forms pf medicine, as poultices, plaifters, ointments, powders, &c. Vinegar of Rofes. Take of red rofes, half a pound ; ftrong vinegar, half a gallon. Infufe in a cloft yeffel, for feveral weeks, in a gentle heat; and then ftrain off the liquor. This is principally ufed an embrocation for head-achs, &c. Vinegar of Squills. Take «f dried fquills, two ounces; diftilled vinegar, two pints. InPuTe for ten days or a fortnight in a gentle decree of heat, afterwards ftrain off the liquor, anJ add to it about a twelfth part its quantity of proof fpirits. This medicine has good effedes in diforders of the breaft, occafioned by a load of viffid phlegm. It is alfo of ufe in hydropic cdes for promoting a difcharge of urine. The dofe isfrom two drachms to two oun-es, according to 'Jjc intention for which * See Collyrium of Lead. APPENDIX. 4** il is given. When intended to act as a vomit, the dole ought to be large. In other cafes, it muft not only be exhibited in fmall dofes, but alfo mixed with cinnamon-wa- ur or fome other agreeable aromatic liquor, to prevent the naufea it might other- wife occafion. WATERS BY INFUSION, ferU Lime-Water. POUR two gallons of water gradually upon a pound of frefh burnt quicklime; and when the ebullition ceafes, ftir them well together ; then fuffer the whole to ftand at reft, that the lime may fettle, and afterwards filter the liquor through pa- per, which is to be kept in veffels clofely ftopt. The lime-water from calcined oyfter-fhells, is prepared in the fame manner. Lime-water is principally ufed for the gravel; in which cafe, from a pint to tw» er more of it may be drank daily. Externally it is ufed for wafhing foul ulcers, and removing the itch, and other difeafes of the fkin. Compound Lime-Water. Take fhavings of guaiacum wood, half a pound; liquorice root, one ounce; faffa- fras bark, half an ounce; coriander feeds, three drachms; fimple lime-water, fix pints. Infufe without heat for two days, and then ftrain off the liquor. In the fame manner may lime-water be impregnated with the virtues of other ve- getable fubftances. Such impregnation not only renders the water more agreeable to the palate, but alfo a more efficacious medicine, efpecially in cutaneous diforders, and foulnefsof the blood and juices. It may be taken in the fame quantity as the fimple water. Sublimate Water. Diffolve eight grains ofthe corrofive fublimate in a pint of cinnamon-water. If a ftronger folution is wanted, a double or triple quantity of fublimate may be »fed. The principal intention of this is to cleanfe foul ulcers, and confumc proud flefh. Styptic Water. Take of blue vitriol and alum, each an ounce and a half; water, one pint. Boil them until the falts are diffolved, then filter the liquor, and add to it a drachm of the •il of vitriol. This water is ufed for ftopping a bleeding at thc nofe, and other haemorrhages; fpr which purpofe cloths or doflils dipt in it muft be applied to the part. Tar Water. Pour a gallon of water on two pounds of Norway tar, and ftir them ftrongly to- gether with a wooden rod : after they have flood to fettle for two days, pour off thc water for ufe. Though tar-water falls greatly fhort of the character which has been given of it, yet it poffeffes fome medicinal virtues. It fenfibly raifes the pulfe, increafes the fecre- tjons, and fometimes opens the body, or occafions vomiting. A pintofitmay be drank daily, or more, if the ftomach can bear it. It is generally •rdered to be taken on an empty ftomach, viz. four ounces morning and evening, and the fame quantity about two hours after breakfaft and dinner. SIMPLE DISTILLED WATERS. A GREAT number of diftilled waters were formerly kept in the fhops, and are ftill retained in fome Difpcnf.itories. But we confiier them chiefly in the light ef giateful diluents, fuitable vehicles for medicines of greater efficacy, or for render- i~o APPENDIX. ing difguftful ones more agreeable to the palate and ftomach. Wc fliall, therefore, infcrt only a few of thofe which are beft adapted to thefe intentions. The management of a ftill being now generally underftood, it is needlefs to fpend time in giving directions for that purpofe. Cinnamon Water. Steep one pound of cinnamon bark, bruifed, in a gallon and a half of water, and one pint of brandy, for two days; and then diftil off one gallon. i his is an agreeable aromatic water, poffeffing, in a high degree, the fragrance and cordial virtues of the fpice. Pennyroyal Water. Take of pennyroyal leaves, dried, a pound and a half; water, from a gallon and a • half to two gallons. Draw off, by drftillation, one gallon. This water poffeffes in a confiderable degree, the fmell, tafte, and virtues of the plant. It is given in mixtures and juleps to hyfteric patients. An infufion of the herb in boiling water anfwers nearly the fame purpofes. Peppermint Water. This is made in the fame manner as the preceding. Spearmint Water. This may alfo be prepared in the fame way as the penny-royal water. Both thefe ate ufeful ftomachic waters, and will fometimes relieve vomiting, efpe- cially when it proceeds from indigeftion, or cold vifcid phlegm. They are likewife ufeful in fome colicky complaints, the gout in the ftomaeh, &c. particularly thc pep» permint water. An infufion of the frefh plant is frequently found to have the fame effects as the diftilled water. Rofe Water. Take of rofes frefh gathered, fix pounds; water, two gallons. Diftil off one gallon. This water is principally valued on account of its fine flavour. Jamaica Pepper Water. Take of Jamaica pepper, half a pound; water, a gallon and a half. Diftil off one gallon. This isa very elegant diftilled water, and may, in moft cafes, fupply the place of the more coftly fpice waters. SPIRITUOUS DISTILLED WATERS. Spirituous Cinnamon Water. ' | TAKE of cinnamon bark, one pound; proof fpirit, and common water, of each X one ga.lon. Steep the cinnamon in the liquor for two days ; then diftil off our. gallon. Spirituous Jamaica Pepper Water. Take of Jamaica pepper, half a pound; proof fpirit, three gallons; water, two gallons. Diftil off three trai'ons. This is a fufficiently agreeable cordial, and may fupply the place of the Aroma* C 471 j WHEYS. Alum Whey. BOIL two drachms of powdered alum in a pint of milk till it is curdled ; then ftrain out the whey. . This whey is beneficial in an immoderate flow ofthe menfes, and in a diabetes, or ex- ceffive difcharge of urint. The dofe is two, three, or four ounces, according as the ftomach will bear it, three times a-day. If it fliould occafion vomiting, it may be diluted. Muftard Whey. Take milk and water, of each a pint; bruiftd muftard-feed, an ounce and a half- Boil them together till the curd is perfectly ftparated; afterwards ftrain the whey through a cloth. This is the moft elegant, and by no means the leaft efficacious method of exhibi- ting muftard. It warms and invigorates the habit, and promotefthe different fecre- tions. Hence, in the low ftate of nervous fevers, it will often fupply the place of wine Ir is alfo of ufe in the chronic rheumatifm, palfy, dropfy, &c, The addition ox" a little fugar will render ii more agreeable. The dofe is an ordinary tea-cupful four or five times a-day. Scorbutic Whey. This whey is made by boiling half a pint ofthe fcorbutic juices in a quart of cow'a milk. More benefit, however, is to be expected from eating the plants, than from their expreffed juices. The fcorbutic plants are, bitter oranges, brooklime, garden fcurvy-grafs, and vva- ter-creffes. A number of other wheys may be prepared nearly in the fame manner, as orange whey, cream of tartar whey, &c. Thefe are cooling, pleafant drinks in fevers, and may be rendered cordial, when neceffary, by the addition of wine. WINES. THE effects of wine are, to raife the pulfe, promote pfrfpiration, warm the habit, and exhilarate the fpirits. t he red wines, befides thefe effects, have an aftrin- gent quality, by which t'.ey ftrcngthen the tone of the ftomach and inteftines, and by this means prove lervieeable in reftraining immoderate fecretions. The thin fharp wines have a different tendency. They pafs off freely by the differ- ent emunctories, and gently open the body. 1 he effects of the full-bodied wines are, however, much more durable than thofe ofthe thinner. All fweet wines contain a glutinous fubftance, and do not pafs off free'y. Hence, they will heat the body more than an equal quantity of any other wine, though it fliould contain fully as miuh fpirit. Fror« the obvious qualities of wine, it muft appear to be an excellent coroial medi- cine. Indeed, it is worth all the reft put together. But to anfwer this character it muft be found, and good. No benefit is to be ex- pected from the common trafh that is often fold by the name of wine, without poffcl- iing one drop of the juice of the grape. Perhaps, no medicine is mere rarely ob- tained than genuine wine. _ Wine is m.t only ufed as a medicine, but is alfo employed as a menfruum lor ex true t- ino-the virtues of other medicinal fubftances ; for which it is not ill-adapted, being- H tomoound of water, inflammable fpirit, and acid ; by whi. h menus it is enabled to ad upon vegetable and animal fubftances, and alfo to dil.oivc fome bo.ue* ot thc metallic kind, fo as to impregnate itfelf with their virtues, as ftccl, antimony, /», then i.....;. ,.1 the v/me. 472 APPENDIX. As the ftomachs of perfons afflicted with worms are always debilitated, red wine alone will often prove ferviceable: it muft, however, have ftill better effects when joined with bitter and purgative ingredients, as in the above form. A glafs of this wine may be taken twice or thrice a-day. Antimonial Wine. Take a glafs of antimony, reduced to a fine powder, half an ounce; Lifbon wine, •ight ounces. Digeft, without heat, for three or four days, now and then ftiaking the bottle; afterwards filter the wine through paper. The dofe of this wine varies according to the intention. As an alterative and dia- phoretic, it may be taken from ten to fifty or fixty drops. In a larger dofe it generally proves cathartic, or excites vomiting. Bitter Wine. Take of gentian root, yellow rind of lemon-peel, frefh, each one ounce; long pep- per, two drachms ; mountain wine, two pints. Infufe without heat for a week, and ftrain out the wine f«r ufe. In complaints arifing from weaknefs of thp ftomach, or indigeftion, a glafs of this wine may be taken an hour before dinner and fupper. Ipecacuanha Wine. Take of ipecacuanha, in powder, one ounce ; mountain wine, a pint. Infufe for three or four days ; then filter the tincture. This is a fafe vomit, and anfwers extremely well for fuch perfons as cannot fwal- low the powder, or whofe ftomachs are too irritable to bear it. The dofe is from one ounce to an ounce and a half. Chalybeate, or Steel Wine. Take filings of iron, two ounces; cinnamon and mace, of each two drachms; Rhe- nifti wine, two pints. Infufe for three or four weeks, frequently fhaking the bottle; then pafs the wine through a filter. In obftructions ofthe menfes, this preparation of iron may be taken, in the dofe of half a wine-glafs twice or thrice a-day. The medicine would probably be as good if made with Lifbon wine, fharpened with half an ounce of the cream of tartar, or a fmall quantity ofthe vitriolic acid. Stomach Wine. Take of Peruvian bark, grofsly powdered, an ounce ; cardamom feeds, and orange peel, bruifed, of each two drachms. Infufe in a bottle of white port, or Lifbon wine, for five or fix days; then ftrain off the wine. This wine is not only of fervice in debility of the ftomach and inteftines, but may alfo be taken as a preventative, by perfons liable to the intermittent fever, or who re • fide in places where this difeafe prevails. It will be of ufe, likewife, to thofe who re- cover flowly after fevers of any kind, as it affifts digeftion, and helps to reftore the tone and vigour of the fyftem. A glafs of it may be taken two or three times a-day. A GLOSSARY. ALTHOUGH terms of art have been feduloiifly avoided in the com- pofitien of this treatife, it is impoffible entirely to banifh technical phrafes when writing on medicine, a fcience that has been lefs general- ly attended to by mankind, and continues, therefore, to be more infect- ed with the jargon of the fchools, than, perhaps, any other. Several perfons having exprelied their opinion, that a Glofiary would make this work more generally intelligible, the following concife explanation or the few terms of art that occur, has been added in compliance with their fentiments, and to fulfil the original intention of this treatife, by rendering it intelligible and ufeful to all ranks and claffes of mankind. ' Abdomsn. The belly. Abforbents. Veffels that convey the nourifhment from the inteftines, and the fecreted fluids from the various cavities into the mafs of blood. Acrimony. Corrofive fharpnefs. Acuti. A difeafe, the fymptoms of which are violent, and tend to a> fpeedy termination, is called acute. Adult. OF-mature age. Adult1. Drv, warm. Antifpafmodic. Whatever tends to prevent or remove fpafm. Apk'.a-c. Small whitifh ulcers appearing in the mouth. Afirhiion. A tightening or leffening. . „ Atrahilarian. An epithet commonly applied to people of a certain tem- perament, marked by a dark complexion, black hair, fpare diet &c. which the ancients fuppofed to arife from the atra bills, or tn© black bile. Mile, or Gall. A fluid which is fecreted by the liver into ithe■ S^blad; d.*r, and from thence paffes into the inteftines, in order to promotes digeftion. Cacockymie. An unhealthy ftate ofthe body. Caries. A rottennefs of the bone. . . . . Chyle. A milky fluid feparated from the aliment m the inteftine , and conveyed by the abforbentsinto the blood to fupply the wafte of tbe animal body. . r . „„„».- Chronic- A difrr.fe whofe progrefs is flow, in oppofition to acute. Urculation. The motion of the blood, which is driven by the heart through the arteries, and returns by the veins. Comatofe. Sleepy. Conglobate Gland. A fimple gland. Corplomerate. A compound gland. Co-Tiagioh. Infeflious matter. Cutis. The (kin. Ciuneous. Or or belonging to the fkin. Crifia A certain period in the progrefs~of a-difeafe, from whence a de- cided -.uteration either for the better or the worfe takes place. Critical' Deciiive or important, O 3 474 A GLOSSARY. Critical days. The fourth, fifth, feventh, ninth, eleventh, thirteenth, fourteenth, feventeenth, and twenty-firft, are, by fume authors, de- nominated critical days, becaufe febrile complaints have beeifob- ferved to take a decifive change at thefe periods. Debility. Weaknefs. Delirium\ A temporary, diforder ofthe meptal faculties. Diaphragm. A membrane feparating the cavity of the cheft from tnat of the belly. Diuretic. A medicine that promotes th© fecretion of urine. Draftic is applied to fuch purgative medicines as are violent or harlli in theft operation. Empyema., A collection of purulent matter in the cavity <>f the breaft. Endemic A difeafe pecu liar to a certain diftrict of country. Epidemic. A difeafe generally infectious. Exacerbation* The increafe of any difeafe. Fueces. Excrements. Foetid.. Emitting an offenfive fmell. Foetus* The child before birth, or whenborn before the proper period, is thus termed. Flatulent. Producing v/md. Fungus. Proud flefh. Gangrefie. Mortification. Gummata. ~> Tr , r Gmglia. $ Veneral exc.refcences. Gymnaftic. Exercife taken with a view to preferve or reftore health.— The ancient phyficians reckoned this an important branch of me- dicine. HeCtic Fever. A flow confuroing fever, generally attending a bad habit of body, or fome incurable and deep-rooted difeafe. Hanturrhotds. The piles. Hemorrhage,. Difcharge. of blood. Hypochondriadjm. Low fpirits. Hypochondriac vifcera. The liver, fpleen, &c. fo termed from their fitu- ation in the hypochondriac or upper and lateral parts of the belly. Ichor. Thin bad matter, Impofthume. A collection of purulent matter. Inflammation. A fnrcharge of blood, and an increafed action ofthe vef- fels, in any particular part ofthe body. Ligature. Bandage. Ltetmiiim. Ley.' • Miliary Eruption. Eruption of fmall puttuies refembling the.feeds «f millet. ; Morbific. Caufing difeafe, or difeafed. Mucus. The matter difcharged from the nofe, lungs, &c. Myfentery. A double membrane which connects the inteftines to the back bone. Nervous. Irritable. Naufea. An inclination to vomit. iVwfetfv£jUju-gerneift ofthe bone^produced by the venereal difeafe. A GLO.SSARY, 475 Peiloral. Medicines adapted to cure difeafes of the breaft. Pelvis. The bones fituated at the lower part ofthe trunk; thus named from their refembling, in fome meafure, a bafon. Peritonaeum. A. membrane, lining the cavity of the belly and covering: the inteftines. & Pericardium. Membrane containing the heart. Perfpiration. 1 he matter difcharged from the pores of the fkin in form of vapour or fweat. Phlogifton is here ufed to fignify fomewhat rendering the air unfit for the purpofes of refpiration. Phlegmatic. Watery, relaxed. Plethoric. Replete with blood. Polypus. A difeafed excrefcence, or a fubftance formed of coagulable lymph, frequently found in the large blood-veflels. Pus. Matter contained in a bile. Regimen. Regulation of diet. Reelum. The ftraight gut, in which the fceces are contained. Refpiration. The act of breathing. Saliva. The fluids fecreted by the glands of the mouth. Sanies. A thin bad matter, difcharged from an ill-conditioned fore. Schirrous. A ftate of difeafed hardnefs. Slough. A part feparated and thrown off by fuppuration. ■Spafm. A difeafed coHtra£lion. Spine. The back bone. Styptic. A medicine for ftopping the difcharge of blood. Syncope. A fainting-fic attended with a complete abolition of fenfation arid thought. Tabes. A fpecies of confumption. ■Temperament. A peculiar habit of body, of which there are, generally reckoned four, viz. the fc.iguine, the bilious, the melancholic, and the phlegmatic. ■Vertigo. Giddinefs. Ulcer. An ill-conditioned fore. Ureters. Two long and fmall canals, which convey the urine from the kidniesto the bladder. . Urethra- The canal which convey the urine from the bladder. INDEX, A ABLUTIONS, Jewifh and Mahometan, well calculated for the prefervation of health, page 84. Abortion, caufes and fymptoms of, 361. Means of prevention, ibid. Proper treatment in the cafe of, 362. Abfeeffes, how to be treated, 225. 389. Accidents. See' Cafualties. Acids, of peculiar fervice in confumptions, 134. In putrid fevers, 143. Not fuitable to the meafles, 184. Acidities, in the bowels of infants, the origin of, 371. Method of cure, 372. Ackivorth, foundling hofpital at, caufe of the children theic being afflicted with fcabbed heads, and fatal confequences of their ill treatment, 377, note. Addifon, his remark on the luxury of the table, 79. f/Ether, very ferviceable in removieg fits of the afthma, 288. & excellent for flatulencies, ? 11. Africans, their treatment of children, 29, mte. Agaric of the oak, its merit as a ityptic, 392. Method of gatlier- ing, preparing, and applying it, ibid. note. Agriculture, a healthful, conftant, and profitable employment, 52. Is two much neglected in favour of manufactures, ibid. Gar- dening, the mpft wholefome amufement for fedentary perfons, 54. Ague, a fpecies of fever no perfon can miftake, and the proper medicine for, generally known, 112. Caufes of, ibid. Symptoms, 113. Regimen for, ibid. Under a proper regimen will often go off, ibid. Medical treatment of, ibid. Often degenerates into ob- ftinate, chrpnical difeafes, if not radically cured, 116. Peruvian bark the only medicine to be relied on in, 117. Children how to be treated in. ibid. Preventive medicine for thofe who live in marfhy countries, 118. Air^ confined, poifonous to children, 41. A free open air will fometimes cure the moft obftinate diforders in chiMren, 42. Oc- cupations which injure the health by unwholefome air, 41. 52. The qualities of, a& more fenfibly on the body than is generally imagined, 67. The feveral noxious qualities of, fpecifisd, ibid. In large cities, polluted by various circumftances, 68. The air in churches, how rendered unwholefome, ibid. Hcufes ought to INDEX. 477 be ventilated daily, 69. The danger attending fmall apartments, ibid. Perfons whofe bufinefs confines them to town, ought to lie43 in the country, kid. High wails obftru£t the free current ''>. :r, 70. Trees fhould not be planted too near to houfes, ibid. Y:.'A\ air peculiarly neceffary for the fick, ibid. The fick in hof- p-i'u'o in moie danger from the want of frefh air, than from their ciforu rs, 71. Wholefomenefs of the morning :,-r, 73, The ch.er-^.^n.Taof, one great caufe of catching cold, 98. Thofe w.io keep mod within doors, the moft fsnfibLof thefe changes, 99. Of the night, tohe carefully guarded againft, 100. Frefn air often of more efficacy in difeefl's than medicine, 107. Its im- portance in fevers, 111. 120. States of, liable to produce putrid fevers. 141. Muft be kept cool and frefh in fick chambers under thefe diforders, 144. Change of, one of the moft effectual reme- dies for the hooping cough, 211. The qualities cf, a material ccnfederation for afthmatic patients, 287. The various "rays by which it may be rendered noxious, 413. Confined, how to try, and purify, 414. Method of recovering »:rfons poifoued by foul z.\v,ibid. Frefh, ofthe gre?teft importance in faimhig-fits, 419. y/r:"-:en, Mr. his treatife on the nature and cure of lrecdurcs, recom- mended, 402, ;;Ae. Alea'u, cauftic, recommended in the ftone, 238. How to prepare it, ibid. note. Aliment is capable of changing the whole conftitution of fhe body, 60. Will, in many cafes, anfwer every intention in the cure of difeefes, ibid. The calls of hunger and thirft, fufficient for regu- lating the due quantity cf, ibid. The quantity of, how injured, ibid. A due mixture cf vegetables neceffary with our Animal food, 62. To what the bad eifecls of tea are principally cu ing, Lid. Water, good and bad, diftinguifhed, 63. Inquiry into the qualities of fermented liquors, with inftruclions for the clue mrhing of them, 64. T*:e qualities of good bread, and why adulterated by bakers, ibid. General rules for the choice of food, 65. Ought not to be too uniform, ibid. Meals ought to be taken at regular times, 66. Long faiting injurious both to old and young, ibid. Breakfafts and fuppers, ibid. Changes of diet ought to be gradually made, 67. Amaurofis. See Gutta fere,ia. American Indians, their method of curing thc venereal difeafe, 3^0. Amufements, fedentary, improper for fedentary perfons, 53. Ought always to be of an active kind, 74. .Anafarca. See Drcpf. Anger, violent fits or, injurious to the conftituion, 89. Tranquility of mind effential to health, 90. Animal food, cautions in giving it to children, 33. Animals that die of themfelves, unfit for food, 61. Overdriven cattle render- ed unwholefome, ibid. The artifices of butchers expofed, ibid. Too great a quantity of, generates thc fcurvy, 62. Animals and piunts, the analogy in thc nourifhment of, ftateu. 79. 478 INDEX. •Anthony's fire, St. See Eryfipelas. Aphtha. See Trufh. Apoplexy, who moft liable to this diforder, 288. Caufes, ibid. Symp-* toms and method of cure, 289. Cautions to perfons of an apo- plectic make, 290. Apothecaries weights, a table of, 440. Apparel, See Clothing. Appetite^ want of, caufes an4 remedies for, 292. Arbuthnot, Dr. advice in the inflammation of the iungs, 127. His advice for perfons troubled with coftivenefs, 292, note. ■Arfenic, the effects of, on the ftomach, 329. Medical treatment when the fymptoms appear, 330. Arts. See Manufactures. Afcites. See Dropfy. Affes' milk, why it feldom does any good, 131- Inftru&ions for taking it, 132. Ajlhma, the different kinds of this diforder difiinguiftied, with its caufes, 286. Symptoms, ibid. Regimen, ibid. Medical treatment, 287. Remedies proper in the moift afthma, ibid. Atmofphere. See Air. B BalPs purging vermifuge powder, preparation of, 264. Balfams, how to prepare. Anodyne balfam,- 423. Locatelli's bal- fam, ibid. Vulnerary balfam, ibid. Bandages, tight, produce moft of the bad confequences attending fractured bones, 403. Bark, Peruvian, the beft antidote for failors againft diforders on a foreign coaft, 51. How to be adminiftered in the ague, 114. Diftin&ion between the red bark and quill bark, ibid. note. A deco&ion or infufion of, may be taken by thofe who cannot fwal- low it in fubftance, 115. Is often adulterated, #«/. note. Is the •only medicine to be tie p-ended on in agues, 117. How it may be rendered more palatable, ibid. May be adminiftered by clyfter, ibid. Cold water the beft menftruum for extra&mg the virtues of this drug, 135. How to be adminiftered in the putrid fever, ■ 145 ; and in the" eryfipelas, 190. In an inflammation of the eyes, 197. Its efficacy in a malignant quinfey, 204. In the hooping cough, 213. A good medicine in vomiting, "when it proceeds. from weaknefs of thc ftomach, 231. Its efficacy in a diabetes, and how lo take it, 234. Is good againft the piles, 243 ; and worms, 263. Its ufe dangerous for preventing a fit of the gout, 272:"* A good remedy in the king's evil, 282 ; and in the fiim albus,2$9' Barley water, how made, 123. Barrennefs in women, the general caufes of, 368. Courfe of relief, ibid. Dr. Cheyne's obfervation on, ibid. note. Bath waters, good in the gout, 247. 3a.il:, cold, the good efFe&s'of, on children, 40. Recommended to INDEX. 47* the ftudious, 60. Is peculiarly excellent for ftrengthening the nervous fyftem, 297. Therefore fhould never be omitted in gleets, 342. Is good for rickety children, 384. Cautions, concerning the improper ufe of, in adults, 426. 429. -Bath, warm, of great fervice in an inflammation of the ftomach, 2\4- ■Bathwg, a religious duty under the Judaic and Mahomitaivlaws, 84. Is conducive to health, ibid. Bears foot, recommended as a powerful remedy againft wotfms, 263. ■Beds, inftead-of being made up again as foon as perfons rife from them, ought to be turned down and expofed to the air, 69. Bad effects of too great indulgence in bed, 73. Damp, the danger of, io.q., Soft, are injurious to the kidnies, 233. 235?. Beer, the ill confequences of making it too weak, 64. Pernicious artifices of the dealers in, ibid. Bells, parifh, the toiling.them for the dead, a dangerous cuftom, 91. Biles, 3$$. Bilious cholic, fymptoms and treatment of, 219. Bilious fever. See Fever. Bke of a mad doer. See Do?. Bitters warm and aftringent, antidotes to agues, 115.. Are fervice- a,b,le in vomiting when it proceeds from weaknefs in the fto-~ mach, 23 1. i\ Bladder, inilammation of,, its general caufes, 223. Medical treaj- ment of, ibid. Bladder, ftone in. See Stone. Blafl. See Eryfipelas. . ■Bleeding, cautions for the operation of, in fevers, m. In the ague, 114. Its importance in the acute, continual fever, 121. In the pleurify, 123. When necefTary in an inflammation ofthe lungs, 127. Caution againft, in a nervous fever, 129. In the putrid fever, 144. In the miliary fever, 150. When neceflary ia the yellow fever, 160. When neceffary in the fmall-pox, 171, When ufeful in the meafles, 184. When neceflary in .the bilious fever, 188. Under what circumftances proper in the eryfipelas, 190. Mode of, proper in an inflammation of the brain, 194. Is always necefTary in ar\ inflammation ofthe eyes, 19&. When proper, and improper, in a cough, 298. When proper in the hooping-cougb, 211. Is almoft the enly thing to be depended on in an inflammation of; the ftomach, 214. And in an inflam- mation of the inteftinesj 215. Is necefTary in an inflammation, of the kidnies, 222. Its ufe in a fuppreffion of urine, 235. Is pror ner in an afthma, 287. Is dangerou.s in fainting-fits, without due caution, 310. Cautions proper in the puerperal fever, 366. " Is an operation generally performed by perfon? who do not underftand when it is proper, 387. In;w,hat cafes it oughtto be, had recourfe to,. 332, The quantity taken away, how tobe regu* 4°o IN D E X. » ■! ■ H latcd, 388. General rules for the operation, ibid. Objections fo bleeding by leeches, ibid. Prevailing prejudices relating to bleed- ing, ioid.. Tiie arm the moft commodious part to take blood from, 380. Bleeding at the nofe, fpontaneous, is of more fervice, where bleed- ing is neceiTary, than the operation witli the lancet, 240. Ought not to be flopped without due confideration, ibid. How to ftop it when necefTary, ibid. Cautions to prevent frequent returns of, 242. Blind perfons, when born fo, might be educated to employments fuited to .their capacity, 319, note. BlfJeas, peculiarly advantageous i:\ the nervous fever, 130. When only to be. applied in the putrid fever, 144. When proper in the miliary fever, 150. Seldom fail to remove the moft obftinate inila^niation of the eyes, 196. A good remedy in the quinfey, 200. P/op"1" for a violent hooping-cough, 212. Is one of the beft remedies in an irfnammation ofthe ftomach, 214. Are effica- cious in the tooth-ach, 257. Blood, involuntary difcharges of, often falutary, and ought not to be rafhly flopped, 238. The feveral kinds of thefe difcharges, with their ufual caufes, 239. Methods of cure, ibid. Blood, fpitting of, who moft fubjeet: to, and at what feafons, 244, Itn caufes, ibid. Symptoms, 245. Proper regimen in, ibid. Me- dical treatment, .746. Cautions for perfons fubjeel: to it, ibid. Blood, vomiting of, its caufes and fymptoms, 246. Medical treat- ment, 247. Blood-ihot eye, how to cure, 321. Bloody-flux. See Dfeiitery. Boerhaaze, his obfervation on drefs, 78, note. His mechanical ex- pedients t3 relieve an inflammation of the brain, 193. Bolufes, general rules for the ■ preparing of, 443. The aftringent bolus, 444'. Diaphoretic bolus, ibid. Mercurial bolus, ibid. Bo- lus of rhubarb and mercury, z£/V.-Pectoral bolus, ibid. Purging bolus, ibid. Bones, the exfoliation of, a very flow operation, 395 Bones broken, often fuccefsfully undertaken by ignorant operators, 401. Re- gimen to be adopted after the accident, 402. Hints of conduct if the patient is confined to his bed, ibid. Cleanlinefs to be re-- garded during this confinement, ibid. The limb not to be kept continually on the ftretch, ibid. Cautions to be obferved in fet- ting a bone, 403. Tight bandages condemned, ibid. How to keep the limb fteady by an eafy method, ibid. Fractures of the ribs, ibid. Bowels, inflammation of. See Stomach. Braidivood, Mr. his (kill in teaching the dumb to fpeak, 321, note. Brain, inflammation of, who moft liable to it, with its caufes and fymptoms, 192. Regimen, 193. Medical treatment, 194. Bread, proper food for children as foon as they can chew it, 33. INDEX. 48J A cruft of, the beft gum-ftick, ibid. The beft modes of prepar- ing it in food for children, 34. Good, the qualities of, and for what purpofe adulterated by the bakers, 64. Toafted, a decoc- tion of, good to check the vomiting in a cholera morbus, 227. Brimftone. See Sulphur. Broth, gelatinous, recommended in the dyfentery, how to make, 250. Bruifes, why of worfe confequence than wounds, 395. Propej treatment of, ibid. The exfoliation of injured bones a very How operation, ibid. How to cure fores occafioned by, ibid. Bubjes, diftinguifhed, with their proper treatment, 344. What ought to be done, ibid, note. Burdens, heavy, injurious to the lungs, 47. Burgundy pitch, a plaifter of,between the fhoulders, an excellent remedy in a cough, 209. In a hooping-cough, 212. And fqr children in teething, 381. Burials, the dangers attending their being allowed in the midft qf populous towns, 68. Burns, flight, how to cure, 393. Treatment of, when violent, ibid. Extraordinary cafe of, 394. Liniment for, 458. Batchers, their profeffional artifices explained, and condemned, 62. Butter ought to be very fparingly given to children, 35. c Camphor, why of little ufe in eye-waters, 446. Camphorated oil, preparation of, 459. Camphorated fpirit of wine, 467. Camps, the greateft neceffity of confulting cleanlinefs in, 84. Cancer, its different ftages defcribed, with the producing caufes, 325. Symptoms, ibid. Regimen and medical treatment, 326, Dr. Storck's method of treating this diforder, 327. Cautions for avoiding it, 328. Cancer fcroti. a diforder peculiar to chimney fweepers, owing ta want of cleanlinefs, 82, note. Carriages, the indulgence of, a facrifice of health to vanity, 72. Carrot, wild, recommended in the ftone, 238. Carrot poultice for cancers, how to prepare, 328. Cafualties, which apparently put an end to life, neceflary cautiong refpecting, 406, 411, 413, 4*7* 4*5- ---------fubftances flopped in the gullet, 407. - -■----drowning, 411. ______.---noxious vapours, 413. _________extremity of cold, 415. _________extreme heat, 416. _ ____-drinking cold water in warm weather, 417. Cataplafms, their general intentions, 444. Preparation of the diQ( cutient cataplafm, Vid. Ripening cataplafm, ibid. Cc'araft, the diforder and its proper treatment defcribed, 32a* P3 4*2 INDEX. Cattle, fhdl fed, are unwholefome food, 6\. Over-driven, ai id. Of farfaparilla, 449. Of fencka, ibid. White decoction, ibid. Deformity often occafioned by the injudicious manner of dreffing children, 28. Is feldom found amongfavage nations, 29. The ufual caufes of, explained, laid. Dews, night, dangerous to health, 100. Diabetes, who moft liable to this diforder, 213. Its caufes and fymptoms, Hid. Regimen and medical treatment, 214. Diftin- guifhed from incontinency of urine, 234. Diarrhoea. See Loofenefs. Diet will often anfwer all the indications of cure in difeafes, 107. Illuftrations, 98. See Aliment. Digftion, powers of, equally impaired by repletion or inanition, Difeafes, hereditary, cautions to perfons afflicted with, 28. Pecu- liar diforders attending particular occupations, 4 ;. Many of them infectious,' 86. The knowledge of, depends more upon expert ence and obfervation, than upon fcientifical principles, 105. Are to be diftinguifhed by the moft obvious and permanent fymptoms, ibid. The difference of fex, age, and conftitution, to be confider- ed, 106. Of the mind, to be diftinguifhed from thofe of the body, ibid. Climate, fituation, and occupation. to be attended to, ibid. Other collateral circumftanas, ibid. Many indications of cure, to be anfwered by diet alone, ibid. Cures often effected by frefli air, by exercife, or by cleanlinefs, 107. Nervous difeafes, of a complicated nature, and difficult to cure, 294. Diflocations fhould be reduced before the fwehing and inflamma- tion .come on, and hew, 397. Of the jaw, 398. Of the neck, 399. Of the rib?, ibid. C)i the fhoulder, 4cc. Of the elbow, ibid. Of the thigh, 401. Of the knees, ancle.1-, and toes, ibid. Diuretic irffion fa the Dropfy, how to prepare, 269. De.g, fymptoms of madnefs in, 331. Ought to be carefully pre- ferved after biting any perfon, to afcertain whether he is mad or not, 332. Is often reputed mad when he is not fo, ibid. Symp- toms of the bite of a mad dog, ibid. The poifon cannot lay ma- ny years dormant in the body, as is fuppofed, 333. Dr. Mead's receipt for ihe bite, ibid. The famous Eaft-Indui fpecific, 334. Other recipes, ibid. Vinegar of confiderable fervice in this dis- order, ibid. Medical courfe of treatment recommended, ibid. Regimen, ibid. Dipping in the fea not to be relied on, 335. Dr. 1 iffot's medical courfe for the cure of the hydrophobic, 336. INDEX. 487 Remarks on the Ormfkirk medicine, ibid, note. Dofes of medicine, the relative proportion of, for different ages, 440. Drams ought to be avoided by perfons affliaed with nervous dif- orders, 296. Draught is the proper form for fuch medicines as are intended for immediate operation, 449. How to prepare the anodyne draught, ibid. Diuretic draught, ibid. Purging draught, ibid. Sweating draught, 450. Vomiting draught, ibid. Drefs. See Clothing. Drinking, perfons who are feldom intoxicated may neverthelefs in- jure their conftitutions by, 81. The habit of drinking frequent- ly originates from misfortunes, ibid. Frequently deftroys the powers of the mind, ibid. Perfons often forced to it by miftaken hofpitaiity, ibid, note. Leads to other vices, 82. Dropfy, the feveral diftinctions of, with its caufes, 266. Symp- toms, 267. Regimen, ibid. Medical treatment, 268. Bleeding when proper and when improper, ibid, note. Tapping, a fafe and fimple operation, 270. Dropfy ofthe brain. See Water in the head. Drowned perfons ought not to be given up for dead, 411. Proper trials for the recovery of fuch, ibid. When electricity fliould be applied, and where moft effectually done, ibid, note. The ef- fects of a large flexible tube or cathetar for inflating the lungs, 412, note. A caution given in bleeding, purging, and clyfler- ing, ibid, note. Endeavours ought not to be fufpended upon the firft returns of life, 413. Succefs of the Amfterdam fociety for the recovery of, 42 v Drunkennefs. See Intoxication. Dumb perfons taught to read, write, and difcourfe, 321, note. Dyfentery, where and when moft prevalent, 248. Its caufes and fympioms, 249. Regimen, ibid. Fruit, one of the beft remedies for, 251. Proper drink for, ibid. Medical treatment for, ibid. Indications of cure, how more effectually anfwered, 252, note. Cautions to prevent a relapfe, ibid. E. EAR, the feveral injuries it is liable to, 321. Deafnefs, medicinal treatment of, according to its caufes, 322. Ought not to be tam- pered with, ibid. Good effects have been derived from wearing a conical plug in the ear, made of the ftalk of a green cabbage, ibid, note. Ear-ach, its caufes, and proper treatment for, 258. How to drive infects out of, ibid. Education of children fhould be begun at home by the parents, 383 note. That of girls hurtful to their conftitution, 29. Effluvia, putrid, will occafion the fpotted fever, 141. Eletlrieity beneficial in the palfy, 301. Electua'ics, general rules for making, 450. Preparations of leni- tive electuary, ibid. Electuary for the dyfentery, ibid. For the 4*3 I N D E K. epilepfy, ibid. For the gonorrhoea, 45 1. Of the bark, ibid. For the piles, ibid. For the palfy, ibid. For the rheumatifm ibid. Ebxir paregoric, how to prepare, 467. Sacred elixir, ibid. Sto- machic elixir, ibid. Acid elixir of vitriol, ibid. Bnuilfions, their ufes, 451. Preparation of the common emulfion, ibid. Arabic emulfion, 452. Camphorated emulfion, ibid. Emul- fion of gum ammoniac, ibid. Oily emulfion, ibid. Engleman, Dr. his account of the German method of recovering perfons from fainting-fits, 420. Entrails. See Inteftines. Epilepfy, the diforder defined, 304. Its caufes, ibid. Symptoms, 305. Due regimen, ibid. Medical treatment, ibid. Eruptions in children often free them from bad humours, but are miftaken and ill treated by nurfes, 44. Ought never to be Hop- ped without proper advice, ibid. In fevers, how to be treated, 140, 143, 148. In the fmall-pox, 169, 170. In children, the caufes of, 377. Hew to cure, ibid. Eryfipelas, a diforder incident to the laborious, 48. Its caufes ex- plained, and who moft fubjeet to it, 188. Its fymptoms, 189. Regimen, ibid. Medical treatment, 190. The fcorbutic eryfipe- las, 191. Inftructions for thofe fubjeet to this diforder, ibid. Evacuations of the human body, the principal, fpecified, 95. By ftool, ibid. Urine, 97. Perfpiration, 98. •Exercife, the importance of, to promote the growth and ftrength of children, 36. All young animals exert their organs of motion as foon as they are able, ibid. The utility of it proved from ana- tomical confiderations, 38, and from philofophical deductions, ibid. Benefits of dancing, 40. Is better for fedentary perfons un- der lownefs of fpirits than the tavern, 54. Gardening the beft -exercife for the fedentary, ibid. Violent, ought not to be taken immediately after a full meal, 59. Is as neceffary as food for the prefervation of health, 71. Our love of activity an evidence of its utility, ibid. Indolence relaxes the folids, ibid. The indul- gence of carriages as abfurd as pernicious, 72. Is almoft the on- ly cure for glandular obftructions, ibid. Will prevent and re- move thofe diforders that medicine cannot cure, ibid. Is the belt cure for complaints in the ftomach, 73. How to be taken with- in doors, when not to be done in the open air, ibid. Active fports better than fedentary amufements, 74. Exercife fhould not be extended to fatigue, ibid. Is as neceffary for the mind as for the body, 93. Is often of more efficacy than any medicine whatever, 107. The beft mode of taking it in a confumption, 130. Is of the greateft importance in a dropfy, 268. Mufcular, for the gout, 273. Is necefTary for the afthmatic, 287. Is fupe- rior to all medicine in nervous diforders, 296. And in the pal- fy, 302. Is proper for pregnant women, unlefs they are of a very delicate texture, 363. Want of, the occafion of Tickets in chil- dren, 382. INDEX. 4** Extrabls, general rules for making; but are more convenici.uy purehafed ready made, 452. Eyes, inflammation of the, its general caufes^ 194. Symptoms, 195. Medical treatment, 196. How to be treated when it proceeds from a fcrophulous habit, 197. Advice to thofe who are fubjeet to this complaint, ibid. Are fubjeet to many difeafes which are difficult to cure, 319. "The means by which they are frequently injured, ibid. General means of prevention, ibid. The fevere;! diforders of the, with their medical treatment, ibid. Good ef- fect of electuary when applied near the eyes, 320, note. Eye-waters,general remarks on, and their principal intentions, 446. Collyrium of alum, ibid. Vitriolic collyrium, ibid. Collyrium of lead, ibid. T? FAINTING-FHS, how to cure, 309, 414. Cautions to perfons fubjeet to them, 418. Falling-ficknefs. See Epilepfy. Fafting, long, injurious to thofe who labour hard, 49. Is hurtful both to old and young, 66. Fathers culpably inattentive to the management of their children, 25. Their irregular lives often injure the conftitution of their children, 27. Fear, the influence of, very great, in occafioning and aggravating difeafes, 90. Its various operations, ibid. Feet injured by wearing tight fhoes, 78. The wafhing of, an agree- able article of cleanlinefs, 84. Wet, the danger of, 99. Bathing them in warm water, a good remedy in a cold, 207. And in the hooping-cough, 212. Fermentation, the vapour of liquors in a ftate of, noxious* 414. Fevers, of a bad kind, often occafioned among labourers by poor living, 50. Frequently attack fedentary perfons after hard drink- ing, 54. Nervous, often the confequence of intenfe ftudy, 57. Putrid and malignant, often occafioned by want of cleanlinefs, 83. The moft general caufes of, enumerated, 108. The dif- tinguifhing fymptoms ot, 100. The feveral fpecies of, ibid. Is an effort of nature, which ought to be affifted, ibid. How this is to be done, ibid. Cordials and fweetmeats improper in, 110. Frefli air of great importance in, 111. The mind of the patient ought not to be alarmed with religious terrors, ibid. Cautions as to bleeding and fweating in, ibid. Longings, the calls of na» ture, and deferve attention, 112. Cautions to prevent a relapfe, ibid. Fever, acute continual, who moft liable to, 118. Ciufes, ibid. Symptoms, 119. Regimen, ibid. Medical treatment, 121. Symp- toms favourable and unfavourable, ibid. Regimen to be obLrv- ed during recovery, 122. Fever, bilious, general times of its appearance, 187. Tr^per treat* ment of, according to its fymptoms, lwS. 49^ INDEX. Fever, intermitting. See Acne. Fever, miliary, from w h-it the name derived, and its general appear- ances, 147. Who moft liable to it, ibid. Caufes, ibid. Symp- toms, I48. i-le^imen, ibid. Account of a miliary fever at Straf- burgh, 149, note. Proper medical treatment, ibid. Cautions for avoiding this diiorricr, 150. How to prevent, in childbed wo- men, 365. Fever, miik, how occafioned, ibid. How to prevent, 366. Fever, nervous, why more common now than formerly, and who molt it hie to it, 137. Its caufes, ibid. Symptoms and proper regimen, 138. Medical treatment, 139. Fever, puerperal, or childbed, the time of its attack, and fymptoms, 365. Medical treatment of, 366. Cautions for the prevention of this fever, 367. Fever, putrid, is of a peftilential nature, and who molt liable to it, 141. Its general caufes, ibid. Symptoms of, 142. Other fevers may be converted to this by improper treatment, ibid. Favoura- ble and unfavourable fymptoms of, 143. Regimen, ibid. Me- dical treatment, 144. Cautions for the prevention of this difor- der, 146. Fever, remitting, derivation of its name, 150. Its caufes and fymp- toms, ibid. Proper regimen, 151. Medical treatment, ibid. Cautions for avoiding this fever, 152. Fever, fcarlet, why fo named, and its ufual feafon of attack, 186. Proper treatment of, ibid. Is fometimes attended with putrid and malignant fymptoms, 187. Medicines adapted to this ftage of the malady, ibid. Bleeding neceffary, if the pulfe be full and hard, ibid, note. Hiftory of a fever of this kind at Edinburgh, ibid, note. 7-'ever, fecondary in the fmall-pox, proper treatment of, 173. Fever yellow, derivation of its name, and general appearance, 153. Its caufes, ibid. Symptoms, 154. Regimen, 160. Medicine, ib. Flatulencies in the ftomach, remedies againft, 259. The caufes of, 311. Medical treatment of, ibid. Flatulent colic, its caufes, and feat of the diforder, 217. Remedies fcr, 218. FLixecr-de-luce, the yellow water, the root of, recommended for the tooth-ach, 257. Fluor-albus defcribed, with its proper treatment, 359. Fomentations, how to make and apply, 452. General intentions of, ibid. Anodyne fomentation, ibid. Aromatic fomentation, 453. Common fomentation, ibid. Emollient fomentation, ibid. Strengthening fomentation, ibid. Food. See Aliment. Forgivenefs of injuries ought to be practifed from a regard t» our health, 90. Fractures. See Bones broken. Frozen limbs, how to recover, 41^, INDEX. . 49i &ruk, unripe,, very hurtful to children, 25. One of the beft medi- cines both for the prevention and cure of a dyfentery, 251. Funerals, the great number of vifitors attending them, dangerous to their health, 86. G GALLING, in infants, the caufe of, 372. Gangrene, proper treatment of, 389. Card-ning a wholefome amufement for fedentary pexfous, 54. Gargles fir the throat, how to make, 199, 203, 204- General in- tentions of, 453. Method of making thc attenuating gargle, ib, Common gargle, ibid. Detergent gargle, ibid. Emollient gargle, 454. For the mouth of infants in the thrufh, ibid. Garlic ointment, z North Britith remedy for the hooping-cough,, how to apply it, 212. Generals of armies, how they ought to confult the health of the men they command, 49. Gilders. See Miners. Ginger, fyrup of, how to prepare, 46$, Girls, the common mode of education prejudicial to their confti- tution, 39. Means of rectifying it recommended, ibid. Gleet, how occafioned, and its fymptoms, 2.42. Method of cure, ibid. Regimen, ibid. Obftinate gleets cured by mercurial in- unctions, ^43. Caution when fufp^cted to proceed from ulcers, ibid, note. Hov/ to apply bougies, 344. Glover, Mr. his courfe of treatment for the recovery of a hanged man, 423. Gonorrhoea, virulent, the nature of, and its fymptoms, 338. Regi- men, 339. Medical treatment, ibid. Is often cured by altrin,»ent injections, 340. Cooling purges al ways proper in, ijid. Mer- cury feldom necefTary in a gonorrhoea, 341. How to adminiiler it when needful, ibid. Goulard, M. preparation of his celebrated extract of Saturn, 468. His various applications of it, ibid. Gout, the general caufes of, $$- How t0 treat a loo^nef"s occafion- ed by repelling it from the extremities, 228. The fources of this diforder, and Tts fymptoms, 270. Regimen for, 271. Wool the beft external apolication in, 272. Why there are fo many nof- trums for, ibid. Proper medicines after the fit, 273. Proper regi- men in the intervals between fits to keep off their return, ibid. How to remove it from the nobler parts to the extremities, 274. General cautions to prevent danger by miftaken it for other diforders, ibhl. Gru-l, how formed in the bladder, 98. Hov/ diftinguifhed from the ftone, 236. Caufes aud fymptoms, ibid. Regimen, ibid. Medical treatment, 2374 Green ficknefs originates in indolence, 356. (Jrief, its effects permanent, and often fatal, 92. Danger of the riind dwelling long upon one fubjeet, efpecially if of a difagree- 49? INDEX. able nature, 93. The mind requires exercife as well as the body, ibid. Innocent amufements not to be neglected, ibid. Is pro- ductive ot nervous difeafes, 294. Gripes in infants, proper treatment of, 371. Gt'tnaci/m gum, a good remedy for the quinfey, 200 ; and rheu- m.itilm, 276. Gullet, how to remove fubftances detained in, 407. Caution for the ufe of crotchets with this intention, ibid. Other mechanical expedients, 408. Treatment if the obftruction cannot be moved, 410. Gums of children, applications to, during teething, and how to cut thtm, -82. Gutta ferena, proper treatment of, 320. H HjEMOPTOE, fpitting of blood. See Blood. Hcemort hages. See Blood. Harrowgate water, an excellent medicine for expelling worms, 263. And for the jaundice, 266. In the fcurvy, 280. Head ach, the fpecies of, diftinguifhed, 253. Caufes of, 254. Re- gimen, ibid. Medical treatment, 255. Health of the people in general, a proper object of attention for the maj. iterates, 11. Ought to be attended to in matrimonial con- tracts, 27. Is often laboured for after it is deflroyed, 59. Rules given by Celfus for the prefervation of, 104. Heart- am the nature of this diforder, with its caufes, and reme- dies for, 29^:. H-at, extreme, how to recover perfons overcome by, 416. flea'loek a good remedy in the king's evil, 283. Is recommended bv Dr. Storck for the cure of cancers, 327. Hemp-feed, a decoction of, good in the jaundice, and how to pre- pare it, 266. Hiccup, its caufes, and method of treatment, 306. Hives, defcribed, 378. Symptoms and medicine, 379. Hives, fpafmodic, 379. Symptoms and treatment, 380. Ho,man, his rules for guarding child-bed women againft the milir ary fever, 365. Hoi.ey, a wholefome article of food for children, 35. Is recom- mended in the ftone, 238. Hooping-cough. See Cough. Hofpitals, the want cf frefh air in, more dangerous to the patients ti in ! r.ir diforders, 72. Cleanlinefs peculiarly neceffary in, 85. Often fpread infection by being fituated i.i fhe middle of popu- lous towns, 87. How they might be rendered nroper receptacles for the fick, 88. Particularly in infectious diforders, 89. The fick v:. ought not to be crowding together, 169, note. Hurfi-rodfij, the chewing of, will reftore fenfibility to the organs of t die when injured, 324. Jfoufis, inftead of contrivances to make them clofe and warm, INDEX. 493 ought to be regularly ventilated, 6^. In marfhy fituations un- wholefome, 70. Ought to be built in a dry fituation, 101. Dan- ger of inhabiting new-built houfes before thoroughly dry, ibid. Are often rendered damp by unfeafon.ible cleanlinefs, ibid. Arc dangerous when kept too clofe and hot, 103. Hifbandmen, the peculiar diforders they are expofed to, from the viciffitudes of the weather, 47. JHuxham, Dr. recommends the ltudy of the dietetic part of medi- cine, 12. ' Hydrocephalus. See Dropfy. Hydrophobia, Dr. Tiffot's method of curing, 336. Hydrops pecloris. See Dropfy. Hypochondriac affections frequently produced by intenfe ftudy, 57. Their caufes, and who moft liable to them, 319. The general intentions of cure, ibid. Regimen, 3 17. Hyflerics, z diforder produced by the habitual ufe of tea, 62. Ge- neral caufes of, 313. Symptoms, 314. Proper treatment of, ibid. Regimen, 315. Medicines adapted to, ibid. Hyfteric cholic, fymptoms and treatment of, 219. I JAILS, why malignant fevers are often generated in them, 69. Often fpread infection by being fituated in the middle of popu- lous towns, 87. Ought to be removed, 83. Janin, M. his relation of the recovery of an overlaid infant, 423. And of a man who had hinged himfelf, ibid. Jaundice, the different flages of its appearance, with the caufes of this diforder, 264. Symptoms and regimen, 265. Medical treatment, ibid. Jefuits Barb. See Barh. Jews, the whole fyftem of their laws tending to promote cleanli- nefs, 87, 83. Iliac paffion, a particular kind of inflammation of the inteftines, 215. Impofihume in the breafi, in confumptions, how to make it break inwardly, when not to be difcharged by other means, 136. Im- pofthumes after the fmall-pox, proper treatment of, 174. Inconib-.ji.cy of urine, diftinguilhed from a diaoetes, 234. Expe- dient for relief, ibid. Indircflion is one confequence of intenfe ftudy, 57. General caufes, and remedies for, 291. Indolence, its bid effects on the conftitution, 71. Oecafions glan- dular obftructions, 72. Ill confequences of too much indulgence in bed, 73. Is toe parent of vice, 74. Is the general caufe "of mo:l nervous diforders, 318. Infancy, the foundation of a good or bad conftitution generally laid in this feafon of life, 23. Infants, nearly one-half of thofe born in Great-Britain, die under 494 INDEX. twelve years of age, 23. Perifh moftly by art, 2.;. Ought not to be fuckled by delicate women, ibid. Importance of their be- i ing nurfed by their mothers, ibid. Often lofe their lives, or be- J come deformed, by errors in clothing them, 23- How the art of J bandaging them became the province of the midwife, 29. How treated in Africa, ibid, note. Philofophical obfervations on their JM organical llructure, and on the caufes of deformity, ibid. Why J they fo frequently die of convulfions, 30. Why expofed to fe- m vers, 31. And colds, ibid. Rules for their dref-, ibid. Their food, 32. Reflections on the many evils they are expofed to, V 369. Why their firft diforders are in their bowels, ibid. How \\ to cleanfe their bowels, ibid. The meconium, 3.70. Thrufh, ibid. Acidities, 371. Gripes, ibid. Galling and excoriation, 372. I Stoppage of the nofe, 373. Vomiting, ibid. Loofenefs, 374. Vomiting and purging, 375. Eruptions, 377. Scabbed heads, ibid. Chilblains, 378. The hives, ibid. Spafmodic hive?, 3-79. Teething, 380. Rickets, 382. Convulfions, 384. Water in the head, 38 c How to recover infants feemingly dead, 419. Ought never to fleep in the fame bed with their mothers or nurfes, 422, note. Cafe of the recovery of an overlaid infant, 423. Cafe of an infant feemingly killed by a ftrong convulfion-fit, and re- covered, 424. See Children. IifieElion, the danger of, incurred by injudicious or unneceffary at- tendance on the fick, 86. And on funerals, ibid. Is often com- municated by clothes, ibid. Ii frequently imported, 87. Is fpread by hofpitals and jails being fituated in the middle of populous towns, ibid. How to prevent infection in fick cham- bers, 83. Phyficians liable to fpreed infection, ibid. note. In what refpect the fpreading of infection might be checked by the magiftrate, ibid. Bleeding and purging, increafe the danger of* by debilitating the body, 146. Small-pox, 167. Inflammations, how the laborious part of mankind expofe them- felves to, 48. Proper treatment of, 389. Inflammation of the bladder. See Bladder. ----------of the brain. See Brain. ----------of the eyes. See Eyes. .---------of the inteftines. See Inteftines. ■----------of the kidnies. See Kidnies. ----------of the liver. See Liver. ----------of the lungs. See Peripneumony. ----•-----of the ftomach. See Stomach. ----------of the throat, fee ^jdnfiey. ----------of the wcrob. See It/'cmb. I:f fions, advantages of, over decoctions, 454. How to obtain rich infufions from we tk vegetables, ibid. Preparation of the bitter infufion, ibid. Infufion of the bark, ibid. Infufion of carduus, ibid. Of linfeed, i id. Of rofes, 455. Of tamarinds and fcnna, ibid. Spaniili infuhcn, ibid. For the palfy, ibid. INDEX. 495 inns, the great danger of meeting with damp beds in them, ioc. The fheets in, how treated to fave wafhing, 101. Inoculation ofthe fmall-pox, more favourably received here than in neighbouring counties, 175. Cannot prove of general utility while kept in the hands of a few, ibid. No myflery in the pro- cefs, ibid. May fafely be performed by parents or nurfes, ibid. *•-- Various methods of doing it, 176. The clergy exhorted to re- W. move the prejudices againft the operation, 177. Arguments ci- ted from Dr. Mackenzie in favour of inoculation, ibid. note. Ought to be rendered univerfal, 178. Means of extending the practice of, 179. Two obftacles to the progrefs of, flated, ibid. Might be performed by clergymen, or by parents themfelves, 180. The proper feafons and age for performing it, 181. "Will often mend the habit of body, 182. Neceffary preparation and regimen for, ibid. Infects, when they creep into the-car, how to force them cut, z$%. Poifonous, the bites of, how to be treated, 337. Intemperance, one great caufe of the difeafes of feamen, 5c. The danger of, argued from the conftructions of the human body, 79. The analogy in the nourifhment of plants and animals, ibid. Is the abufe of natural paffions, ibid. In diet, ibid. In liquor and carnal pleafures, 80. The bad confequences of, involve whole families, ibid. Effects of drunkennefs on the conftitution, ibid. Perfons who feldom get drunk, may neverthelefs injure their conftitutions by drink, 8 r. The habit of drinking frequently ac- quired under misfortunes, ibid. Is peculiarly hurtful to young perfons, 82. Leads to all other vices, ibid. • Intermitting fever. See Ague. Inteftines, inflammation of, general caufes from whence it pro- ceeds, 215. The fymptoms, regimen, and medical treatment, ibid. Cautions to guard againft it, 217. Intoxication produces a fever, 80. fatal confequences of a daily repetition of this vice, ibid. Perfons who feldom get drunk, may . neverthelefs injure their conftitution by drinking, 81. Getting drunk, a hazardous remedy for a cold, 206. Often produces fatal effects, 421. Proper cautions for treating perfons in liquor, ibid. The fafeft drink after a debauch, ibid. Remarkable cafe, ibid. . Johnfon, Dr. extraordinary recovery of an infant i;ermngly kmed by a ftrong convulfion-fit, related by, 424. Iffues,hovr to make them take the beft effea, 300. ^ Itch, the nature and fymptoms of this difeafe defcribed, 283. Sul* phur, the beft remedy againft, 284. Great danger of the inju- dicious ufe of mercurial preparations for, 2S5. Cleanlinefs the beft prefervative againft, ibid. note. Juleps, the form of explained, 455. Preparation ofthe camphora- ted julep, ibid. Cordial julep, ibid. Expectorating julep, 4;6. Maflc julep, ibid. Saline julep, ibid. Vomkmg julep, ibii. 49-'> INDEX. K KERMJbiS miner ed, recommended by Dr. Duplanil for the hooping-cough, 212, note. Kidnies, inflammation of, its general caufes, 221. Its fymptoms and proper regimen, ibid. Medical treatment, 222. Where it proceeds from the ftone and gravel, ibid. Caution for thofe fub- jeet to this difrrder, 223. See Gravel. Kings evil. See Scrohhula. L LABORIOUS employments, the peculiar diforders incident to, 47. The fo'ly of men emulating each other in trials of ftrength, ioid. Dkhdvantages attending their diet, 50. How they expofe themfelves to inflammations, 48. Danger of fleeping in the fun, ibid. Long falling hurtful to them, 49. Injuries arifing from poor living, ibid. Many of the difeafes of labourers not only occr.foned, but aggravated by poverty, ibid. Labour iiiould not be impofed too early on children, 40. Lahjiir in child-bed, medical advice for, 363. Inconveniencies of collecting a number of women at, ibid, note. Laudanum, its efficacy in fits of an ague, 113, note. Its efficacy in giving to children, 117, note. How to be adminiftered in a cho- lera morbus, 228. In a loofenefs, 229. In a diabetes, 234. When proper for the head-ach, 255. How to apply, for the tooth-ach, '^7. Will eafe pain in the gout, 272. How to adminifter for the cramp in the ftomach, 307. Is good for flatulencies, 311. Effects of an over-dofe of, 33 1. Medical treatment in this cafe, ibid. Leading-firings, injurious to young children, 37. Letches may be' fucccfsfully applied to inflamed tefticles, 344, note. And to tiifptrfe buboes, 345, note. Are proper to apply to chil- dren where inflammations appear in teething, 381. Objections to bleeding with them, 388. Lemon t. See Granges. Leproiy, why lefs frequent in this country now than formerly, 281. Enquires the fame treatment as the fcurvy, ibid. J*' .'."■","proper treatment for, 25^. Li:";- may frequently be reftored, when the appearances of it are info-nded by ft.dden cafualties, 406. 409. 413.421;. Lirr.tn'ng, persons apparently kilied by, might poffibly be re- covered by the ufe of proper means, 425. Lime water recommended to prevent gravel in the kidnies from degenerating to the ftone in the bladder, 237. Is a good remedy for worms, 263." Happy effects of, in the cure oftobftinate ul- cers, 37. 4 ; : ^ Li..;.', Dr. hi: prefcription to abate fits of an ague/113, 7!:te- ^»3 directions for the treatment cf patients under putrid, i\;nrtdo t ■ fevers, 151, note. , . t N B E X. A91 Uritment for burns, preparation of, 458. White lin-mcr.-;, ibid. For the piles, 459. Volatile liniment, ibid. Liquors, ftrong, expofe children to inflammatory diforders, 35. Fermented, the qualities of, examined, 64. The bad confeoujn- ces of making them too weak, iuid. Why all families ought lO prepare their own liquors, ibid. Cold, the danger of drinking when a perfon is hot, 102. 417. Liver, fchirrus, produced by fedentary employments, 56. Liver, inflammation of, its caufes and fymptoms, 224- Regimen and medical treatment, 225. Abfcefs in, how to be treaied. ibid- Means to be ufed when the convex furface of liver does not ad- here to the peritonceum ofthe abdomen, iuid, note. The moft ju- dicious practice employed in the Eaft-Indies and China, ibid, ?tote. Cautions in the event of a fchirtus being formed, 226. Lobelia, an American plant ufed by the natives in the venereal dif- eafe, 350. Lochia, a fuppreffion of, how to be treated, 364. Loci:-Jaw. See Tetanus. Longings, in difeafes, are the calls of nature, and often point out what may be of real ufe, 11 o. Loofenefs, habitual, general directions for perfons fubjeet to, 96. Its general caufes, 228. A periodical loofenefs ought never to be flopped, 229. Medical treatment cf, according to its various caufes, ibid. Means of checking it when neceffary, 230. A long voyage to fea has entirely removed the complaint, after every aftringent and tonic medicine has failed in the chronic diarrhoea of warm climates, ib. note. In children, proper treatment of, 376. Love, why perhaps the ftrongeft of all the paffions, 94. Is not rapid in its progrefs, and may therefore be guarded againft at its com- mencement, ibid. To pretend fo it for amufement, cruelty to the object, ibid. Children often real martyrs between inclination and duty, ibid, note. Lues, confirmed, fymptoms of, 348. Mcvrury the only certain re- medy known in Europe for this difeafe, 349. Saline preparations of mercury more efficacious than the ointment, ibid. The beft method of introducing mercury into the fyftem to remedy this difeafe, explained, ibid, note. How to adminifter corrofive fub- limate, 350. This preparation is thought to be more efficacious than any other, ibid, note. American method of caring this dif- ■ eafe, ibid- lunvs injured by r.rtift;. working in bending pofturcs, $1. Studi- ous perfons liable to confumptions of, 56. l:r.:ury highly injurious to the organs cf taile and fmell, 323. M MACKENZIE, Dr. his arguments in favour of inoculating ia the fmall-pox, 177, note. f Mad dog. See Dog. R % 49» INDEX. Magnefia alba, a remedy for the heart-burn, 294. Is the beft me» dicine in cafes of acidity, 372. Magnets, artificial, their reputed virtue in the tooth-ach, 257. Malt liquors hurtful in the afthma, 286. See Beer. Man, why inferior to brutes in the management of his young, 23- Was never intended to be idle, 74. Manufactures^ the growth of, produced the rickets in children, 36, More favourable to riches than to health, 40. Some, injurious t«» health by confining artifts in unwholefome air, 46. Cautions t» the workmen, ibid. Compared with agriculture, 52. Are injuri- ous to health from artifts being crowded together, 53. And from their working in confined poflures, ibid. Cautions offered to fedentary artifts, ibid. Sedentary arts better fuited to women than to men, 73, note. Matrimony ought not to be contracted without a due attention to health and form, 27. Mead, Dr. his famous recipe for the bite of a mad dog, 333. Hi* character as a phyfician, ibid, note. Meals ought to be taken at regular times, 66. Reafons for this uniformity, ibid. Meafles have great affinity with the fmall-pox, 183. Caufe and fymptoms, ibid. Proper regimen and medicine, 184. Bleeding neceffary in the, 185, note. Inoculation of, might prove very fa- lutary, 186, note. Mechanics ought to employ their leifure hours in gardening, 5$. Meconium, the beft mode of expelling it, 32. 370. Medicine, the origin of the art of, 12. The operation of, doubtful at beft, ibid. Is made a myftery of, by its profeffors, 15. Thc ftudy of, neglected by gentlemen, ibid. This ignorance lays men open to pretenders, 16. Ought to be generally underftood, 17. A diffufion of the knowledge of, would deftroy quackery, 19. Objections to the cultivation of medical knowledge anfwered, 20. The theory of, cajh never fupply the want of experience and ob- fervation, 105. I Medicines have more virtue attributed to them than they deferve, 107. Ought not to be adminiftered by the ignorant, nor with- out caution, 108. Want of perfeverance in the ufe of, one rea- fon why chronic difeafes are fo feldom cured, 277. Many re- tained, which owe their reputation to credulity, 437. Are mul- tiplied and compounded in proportion to ignorance of the caufes ,md nature of difeafes, ibid. Difadvantages of compounded me- dicines, ibid. Are often adulterated for the fake of colour, ibid. The relative proportions of dofes of, for different ages, 439. A lift of fuch medical preparations as ought to be kept for private practice, 441. Melancholy, religious, its effects, 95. Leads to fuicide, ibid. De- fined, with its caufes, 298. Symptoms and regimen, ibid. Mt- dicinal treatment, 299. INDEX. 49^ Menflrudl difcharge in women, the commencement and decline cf, the moft critical periods of their lives, 356. Confinement injuri- ous to growing young women, ibid, and tight lacing for a fine fhape, 357. Symptoms ofthe firft appearance of this difcharge, ibid. Objects of attention in regimen at this time, 358. Ought to be reftored whenever unnaturally obftructed, and how, ibid. When an obltruction proceeds from another malady, the firft caufe is to be removed, ibid. Treatment under a redundancy of the difcharge, 359. Regimen and medicine proper at the final decline of the menfes, ibid. Mercury may be given in defperate cafes of an inflammation of thc inteftines, 217. Cautions for adminiftering it, ibid, note. Great caution neceflary in ufing mercurial preparations for the itch, 285. Is the only certain remedy known in Europe for the cure of a confirmed lues, 349. Saline preparations of, more ef- ficacious than the mercurial ointment, ibid. How to adminifter corrofive fublimate in venereal cafes, 350. Neceffiry cautions in the ufe of mercury, 351. Proper feafon.-* for entering on a courfe of, 352. Preparations for, ibid. Regimen under a courfe of, ibid. Mtzereon root, a powerful afliftant in venereal cafes, 359. Midwives, hiftorical view of the profeifion, 28. Flow they became intruftcd with the care of bandaging infants, with the ill effects of their attempts at dexterity in this office, ibid. Inftance of their rafhnefs and officious ignorance, 369, note. Miliary fever. See Fever. Milk, that of the mother, the moft natural food for an infant, 32. A good fubftitute for, 33. Cows milk, better unboiled than boil- ed, ibid. Is a good antidote againft the fcurvy, 62. Of more value in confumptions than the whole Materia Medica, 131. Its great efficacy in the fcurvy, 279. A milk diet proper both for men and women, in cafes of barrennefs, 368. Milk fever. See Fever. 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