i.Vv, •«?■«*. r ig»: *ti ,/»:« ?*. *. £»^ UV> '("'''«' ■'. t *M •J Sqjnuel Hunt Titpper ARMY MEDICAL LIBRARY WASHINGTON Foxmrtori 18.16 fc; Section .l^jii.,. .£..sfc.^. -kv.L Number ^.S?.7.J...if..?....... • Fobm 113c, W. D., S. G. O. 3—10.143 (Revised June 13, 1936) &/ fv * .'* >, -' / i* 'if-- wz f9l2d . Omnes homines artem medicam nosse oportet. — Sapientiae cognitionem medicine sororem ac contubernalem esse puto. Hippocrates. Primoqne medeadi scientia, sapientiae pars habebatur. — Rationalem quidem puto medicinam esse debere. Celsus. Quemadmodum sanitas omnium rerum pretium excedit, omnisque felicitatis fundamen- tum est, ita scientia vitae ac sanitatis tuendae omnium nobilissima, omnibusque hominibus commendatissima esse debet. Hoffman. All men ought to be acquainted with the medical art. — I believe knowledge of medi- cine is the sister and companion of wisdom. In early times skill in healing was esteemed a part of wisdom. — I believe the practice of medicine should be agreeable to reason. As health is the most precious of all things, and is the foundation of all happiness, the science of protecting life and health is the noblest of all, and most worthy the at- tention of all mankind. r r r PREFACE. This New Edition of the Domestic Medicine, comes before the public with fresh claims upon their attention. It has undergone a thorough revision, with considerable additions and improvements. The little obsolete or irrelevant matter, scattered here and there in the preceding edition, has been expunged, and its place supplied with information of a more useful and more recent nature, which it was deemed essentially necessary not to omit, in order that a book so familiar to all ranks of society, might keep pace with the various improvements and opinions which have taken place of late years in medical science. In addition to the variety of new and interesting subjects above alluded to, numerous prescriptions, in English, with the Latin translation, selected from the practice of eminent medical practi- tioners, have been added, though in such a manner as riot to inter- fere with the text of the author, being appended at the bottom of the page, where they are referred to from the body of the work- It ought, however, to have been previously mentioned, that, with the introduction of the prescriptions, and some additional histories of disease, an important alteration has been made in the distribu- tion of the original matter, in order to give it more an appearance of method, conformable with modern nosological arrangement. To the diseases of children, which, instead of commencing the work, as in the older, and still in the spurious editions extant, stand towards the end, is added much valuable medical instruction. The diseases of women are treated of at large, as well as those which oc- cur during pregnancy ; to these is added the management of lying- in women, as well as the necessary treatment to be adopted during the process of a natural labour, than which a more useful feature, for various assignable and obvious reasons, could not possibly have been introduced into a work that professes to treat of Domestic Medicine in a simple and comprehensive manner. The dietetic, or that branch of medicine which has the regula- tion of diet for object, either in health or disease, as will readily be perceived, is placed at the commencement of the work; then fol- low the various diseases, nearly in the same succession as first laid down by the author. Another most important feature to those already mentioned, will be found in the toxicological, or that part which treats of the dif- ferent classes of poisons, (mineral, vegetable, aerial, and animal,) a subject every person ought, in some measure, to be acquainted with ; as these deleterious substances are not unfrequently taken by accident, as well as designedly; and their effects are often so pudden and violent, as not to admit of delay, or allow time to pro- cure the assistance of medical men. PREFACE. The suwical department of this popular work has also experi- enced several very useful additions and alterations. Undjf'the head of casualties will be found many useful direo tions'Tiow to proceed in all cases of suspended animation, with the treatment laid down by the Royal Humane Society, as well as that recommended by writers in every department of medical jurisprudence, for the restoration of life. The Appendix has also undergone some considerable improve- ment. To the list of drugs, with their lowest and greatest doses, has been added, the medicinal properties of each ; thus presenting to the reader, at one view, the respective article, its virtues, with the smallest and largest quantity of it that may be taken at one time. The prescriptions of the author have also been slightly touched, without, however, causing them to vary much from their original form. The additions, with the notes introduced in the preceding edi- tion of this work, by the late Dr. A. P. Buclian, (18J3) the highly respected and much lamented son of the Author, will be distin- guished from those of the present edition, by the initials of his name. And the reason given for these additions, cannot be better explained than in his (Dr. A. P. Buchan's) own words : " Of some complaints," says he, " hitherto omitted, I know it was my father's intention to have inserted an account in a future edition. From notes found among his papers, combined with the result of my own observations, I have drawn up a history of the symptoms, and most approved treatment of Chorea or St. Vitus's Dance, Fistu- la in Ano and a peculiar kind of epidemic sore throat, named the mumps, which occasionally makes its appearance in this country, at distant intervals of time. " Various affections of the lungs, comprised under the general denomination of consumption, too frequently prove fatal to the youth of this country, at an age when life is, for many reasons, peculiarly valuable. The remarks which I have ventured to intro- duce, on the means of detecting and counteracting the early ten- dencies to this complaint, originated in some apprehensions enter- tained concerning my own health at a former period of life, and they have since been matured by most extensive experience. " It is not unreasonable to suppose, that the extensive circula- tion of so popular a work, must have had some influence on the state of public opinion. This influence may, I think, be distinctly traced in the generally improved treatment of children, respecting their clothing and diet, and the consequent amelioration of their health. Nor let it be forgotten, that the utility of those noble, and now flourishing charities, the Humane Society, for the recovery of persons apparently drowned; an institution for teaching the Deaf and Dumb to read and speak; and a school for the Indigent Blind, was pointed out, and their establishment strongly recom- mended on the score of humanity, more than forty years ago, in the .early editions of the Domestic Medicine." The instances, if not without a parallel in the annals of litera- ture, are, at least, extremely rare, of a work on the science of med- icine having attained its twenty-second Edition of a series of large impressions. The Editor of the present Edition, by every possi- PREFACE. * ble means, has endeavoured to maintain the claim of this Work to a continuance of that general approbation with which, for upwards of fifty years, it has been so eminently distinguished. *w' J. S. F. London, May 1826. [*i J AUTHOR'S PREFACE When I first signified my intention of publishing the following sheets, I was told by my friends it would draw on me the resent- ment of the whole Faculty. As I never could entertain such an unfavourable idea, I was resolved to make the experiment, which indeed came out pretty much as might have been expected. Many whose learning and liberality of sentiments do honour to medi- cine, received the book in a manner which at once showed their in- dulgence, and the falsity of the opinion that every Physician wish- es to conceal his art; while the more selfish and narrow-minded, generally the most numerous in every profession, have not failed to persecute both the book and its author. The reception, however, which this work has met with from the Public, merits my most grateful acknowledgments. As the best way of expressing these, I have endeavoured to render it more generally useful, by enlarging the prophylaxis, or that part which treats of preventing diseases ; and by adding many articles which had been entirely omitted in the former impressions. It is needless to enumerate these additions ; I shall only say, that I hope they will be found real improvements. The observations relative to Nursing and the Management of Children were chiefly suggested by an extensive practice among in- fants, in a large branch of the Foundling Hospital, were I had an opportunity not only of treating the diseases incident to childhood, but likewise of trying different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and to be satisfied that they performed it, very few of them died ; but when, from distance of place, and other unavoidable cir- cumstances, the children were left to the sole care of mercenary nurses, without any person to instruct or superintend them, scarce- ly any of them lived. This was so apparent, as with me to amount to a proof of the following melancholy fact; that almost one half of the human spe- cies perhh in infancy, by improper management or neglect. This re- flection has made me often wish to be the happy instrument of alle- viating the miseries of those suffering innocents, or of rescuing them from an untimely grave. No one, who has not had an opportunity of observing them, can imagine what absurd and ridiculous prac- tices still prevail in the nursing and management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to ignorance, it is to be hoped, that when nurses are better informed, their conduct will be more proper. The application of medicine to the various occupations of life has been in general the result of observation. An extensive prac- PREFACE. *B tice for several years, in one of the largest manufacturing towns in England, afforded me sufficient opportunities of observing the injuries which those useful people sustain from their particular em- ployments, and likewise of trying various methods of obviating such injuries. The success which attended these trials was sufficient to encourage this attempt, which I hope will be of use to those who are under the necessity of earning their bread by such employ- ments as are unfavourable to health. I do not mean to intimidate men, far less to insinuate that even those arts, the practice of which is attended with some degree of danger, should not be carried on ; but to guard the less cautious and unwary against those dangers which they have it in their pow- er to avoid, and which they often, through mere ignorance, incur. As every occupation in life disposes those who follow it to some particular diseases more than to others, it is certainly of impor- tance to know these, in order that people may be upon their guard against them. It is always better to be warned of the approach of an enemy, than to be surprised by him, especially where there is a possibility of avoiding the danger. The observations concerning Diet, Air, Exercise, C. Instead of multiplying rules for preserving the health of the sedentary, we shall recommend them to the following general plan, viz. That every person who follows a sedentary employment should cultivate a piece of ground with his own hands. This he might dig, plant, sow, and weed at leisure hours, so as to make it both an exercise and amusement", while it produced many of the neces- saries of life. After working an hour in a garden, a man will re- turn with more keenness to his employment within doors, than if he had been all the while idle. Cultivating the ground is every way conducive to health. It nor only gives exercise to every part of the body, but the very smell of the earth and fresh herbs revives and cheers the spirits, whilst the perpetual prospect of something coming to maturity delights and entertains the mind. We are so formed as to be always pleased with somewhat in perspective, however distant or however trivial; hence the happiness that most men feel in planting, sow- ing, building, &c. These seem to have been the chief employ- ments of the more early ages ; and, when kings and conquerors cultivated the ground, there is reason to believe that they knew as well wherein true happiness consisted as we do. It may seem romantic to recommend gardening to manufactur- ers in great towns; but observation proves that the plan is very practicable. In the town of Sheffield, in Yorkshire, where the great iron manufacture is carried on, there is hardly a journeyman cutler who does not possess a piece of ground, which he cultivates as a garden. This practice has many salutary effects. It not only induces these people to take exercise without doors, but also to eat many greens, roots, &c, of their own growth, which they would never think of purchasing. There can be no reason why manufacturers in any other town in Great Britain should not fol- low the same plan. It is indeed to be regretted, that in such a place as London a plan of this kind is not practicable : yet, even there, sedentary artificers may find opportunities of taking air and exercise, if they choose to embrace them. Mechanics are too much inclined to crowd into great towns. The situation may have some advantages; but it has likewise ma- ny disadvantages. All mechanics who live in the country have it in their power to cultivate a piece of ground; which, indeed, most of them do. This not only gives them exercise, but enables them to live more comfortably. So far at least as my observation extends, mechanics who live in the country are far more happy than those in great towns. They enjoy better health, live in greater affluence, and seldom fail to rear a healthy and numerous offspring.* * Watchmakers, in consequence of their sedentary habits, are liable 1o a pecul- iar species of disease, to which I have witnessed many of them fall victims. Its commencement is indicated by deficient appetite and eructatious of wind from the stomach. There is also sallowness of complexion, and a muddy yellow appearance of the eyes. In the progress of the disease great quantities of black coagulated blood is discharged by stool, and occasionally by vomit. On dissection, the whole intestinal canal is found replete with blood either fluid or black and coagulated. The liver and the spleen appear soft, and as it were rotten. In its more early stages, this disease admits of being checked by active purgatives, exercise, and country air. .^•'■I'r'nTi'/i "i.J^-^ ^ ^jS* »l0IU1' "«»3^. 52"erru r c 1> 50 DISEASES PECULIAR TO In a word, exercise without doors, in one shape or another, is absolutely necessary to health. Those who neglect it, though they may for a while drag out life, can hardly be said to enjoy it. Weak and effeminate, they languish for a few years, and soon drop into an untimely grave. THE SEDENTARY STUDIOUS. Intense thinking is so destructive to health, that few instances can be produced of studious persons who are strong and healthy. Hard study always implies a sedentary life ; and when intense thinking is joined to the want of exercise, the consequences must be bad. We have frequently known even a few months of close appli- cation to study, ruin an excellent constitution, by inducing a train of nervous complaints which could never be removed. Man is evidently not formed for continual thought more than for per- petual action, and would be as soon worn out by the one as by the other. So great is the power of the mind over the body, that, by its influence, the whole vital motions may be accelerated or retarded to almost any degree. Thus, cheerfulness and mirth quicken the circulation, and promote all the secretions ; whereas sadness and profound thought never fail to retard them. Hence it would appear, that even a degree of thoughtlessness is necessary to health. In- deed the perpetual thinker seldom enjoys either health or spirits; while the person who can hardly be said to think at all, generally enjoys both. Perpetual thinkers, as they are called, seldom think long. In a few years they generally become quite stupid, and exhibit a mel- ancholy proof how readily the greatest blessings may be abused. Thinking, like every thing else, when carried to extreme, be- comes a vice ; nor can any thing afford a greater proof of wisdom, than for a man frequently and seasonably to unbend his mind. This may generally be done by mixing in cheerful company, active diversions, or the like. DISEASES TO WHICH STUDIOUS PEOPLE ARE MORE PECULIARLY LIABLE, &C. Studious persons are very subject to the gout. This painful dis- ease in a great measure proceeds from indigestion, and an obstruct- ed perspiration. It is impossible that the man who sits from morn- ing till night should either digest his food, or have any of the se- cretions in due quantity. But when that matter which should be thrown off by the skin, is retained in the body, and the humours are not duly prepared, diseases must ensue. Gravel.— The studious are likewise very liable to the stone and gravel. Exercise greatly promotes both the secretion and discharge of urine; consequently a sedentary life must have a contrary ef- fect. Any one may be satisfied of this by observing, that he pas- ses much more urine by day than in the night, and also when he walks or rides, than when he sits. The discharge of urine not only prevents the gravel and stone, but many other diseases. THE STUDIOUS, &c. 51 Hepatic complaints.—The circulation in the liver being slow, obstructions in that organ can hardly fail to be the consequence of inactivity. Hence sedentary people are frequently afflicted with schirrous livers. But the proper secretion and discharge of the bile is so necessary a part of the animal economy, that where these are not duly performed, the health must soon be impaired. Jaun- dice, indigestion, loss of appetite, and a wasting of the whole body, seldom fail to be the consequences of a vitiated state of the liver, or obstructions of the bile. Pulmonary consumption.—Few diseases prove more fatal to the studious than consumptions of the lungs* It has already been observed that this organ cannot be duly expanded in those who do not take proper exercise; and where that is the case, obstructions and adhesions will ensue. Not only want of exercise, but the pos- ture in which studious persons generally sit, is very hurtful to the lungs. Those who read or write much are ready to contract a habit of bending forwards, and often press with their breast upon a table or bench. This posture cannot fail to hurt the lungs. Adhesions, &c.—The functions of the heart may likewise by this means be injured. I remember to have seen a man opened, whose pericardium t adhered to the breast-bone in such a manner as to obstruct the motion of the heart, and occasion his death. The only probable cause that could be assigned for this singular symptom was, that the man, whose business was writing, used con- stantly to sit in a bending posture, with his breast upon the edge of a plain table. Weakness of the digestive organs, &c.—No person can enjoy health who does not properly digest his food. But intense thinking and inactivity never fail to weaken the powers of digestion. Hence the humours become crude and vitiated, the solids weak and relaxed, and the whole constitution goes to ruin. Head-ach, apoplexy, &c.—Long and intense thinking often occasions grievous head-achs, which bring on vertigoes, apoplexies, palsies, and other fatal disorders. The best way to prevent these is, never to study too long at one time, and to keep the body regu- lar, either by proper food, or taking frequently a little of some opening medicine. Inflammation of the eyes.— Those who read or write much are often afflicted with sore eyes. Studying by candle-light is peculiarly hurtful to the sight. This ought to be practised as seldom as pos- sible. When it is unavoidable, the eyes should be shaded, and the head should not be held too low. When the eyes are weak or painful, they should be bathed every night and morning in cold water, to which a little brandy may be added. Dropsy.—It has already been observed, that the excretions are * Since the lungs are the first and chief instrument in sanguification, or the formation of blood, the animal that has that organ faulty, can never be duly nourished, nor have the vital juices which are derived from the blood in a good state; and this is true, understanding the lunars only as an instrument of digestion, and abstracting from an acrid and purulent matter, that mixeth with the blood in suoh as have their lungs ulcer- ated. See Arbuthnot on Aliment, p. 26. t The membranous bag surrounding the heart. Its use is to secrete and contain the vapour of the pericardium, which lubricates the heart and prevents it from concreting or adhering to this membrane. 52 ADVICE TO THE STUDIOUS. very defective in the studious. The dropsy is often occasioned by the retention of those humours which ought to be carried off in this way. Any person may observe that sitting makes his legs swell, and that this goes off by exercise; which clearly points out the method of prevention. Fever.—Fevers, especially of the nervous kind, are often the effect of intense study; which in a manner unhinges the whole human frame, and not only hurts the vital motion, but disorders the mind itself. Hence delirium, melancholy, and even madness, are not unfrequently the effect of close application to study. In fine, there is no disease which can proceed either from a bad state of the hu- mours, a defect of the usual secretions, or a debility of the nervous system, which may not be induced by intense thinking. Hypochondriasm.—But the most afflicting of all the diseases which attack the studious is hypochondriasis.* This disease sel- dom fails to be the companion of deep thought. It may rather be called a complication of maladies than a single one. To what a wretched condition are the best of men often reduced by it! Their strength and appetite fail; a perpetual gloom hangs over their minds; they live in the constant dread of death, and are con- tinually in search of relief from medicine, where, alas ! it is not to be found. Those who labour under this disorder, though they are often made the subject of ridicule, justly claim our highest sympa- thy and compassion. Hardly any thing can be more preposterous than for a person to make study his sole business. A mere student is seldom an use- ful member of society. He orten neglects the most important du- ties of life, in order to pursue studies of a very trifling nature. advice to studious and intense thinkers, &c. Studious persons, and those who indulge long and frequently in intense thought, in order to relieve their minds, must not only discontinue to read and write, but engage in some employment or diversion that will so far occupy the thought as to make them forget the business of the closet. A solitary ride or walk are so far from relaxing the mind, that they rather encourage thought. Nothing can divert the mind when it gets into a train of serious thinking, but attention to subjects of a more trivial nature. These prove a kind of play to the mind, and consequently relieve it. As studious people are necessarily much within doors, they should make choice of a large and well-aired place for study. This would not only prevent the bad effects which attend confined * The state of mind peculiar to hypochondriacs is thus described by Cullen:—" A languor, listlessness, or want of resolution and activity, with respect to all undertar kings; a disposition to seriousness, sadness, and timidity, as to all future events, and apprehension of the worst or most unhappy state of them; and, therefore, often upon slight grounds, an apprehension of great evil. Such persons are particularly attentive as to the state of their own health, to every the smallest change of feeling in their bodies; and from any unusual sensation, perhaps of the slightest kind, they appre- hend great danger, and even death itself. In respect to these feelings and fears, there is commonly the most obstinate belief and persuasion." And it is only, he adds, when the state of mind just described is joined with indigestion, in either sex, somewhat advanced in years, of a melancholic temperament, and a firm and rigid habit, that the disease takes the names of hypochondriasm. ADVICE TO THE STUDIOUS. 53 air, but would cheer the spirits, and have a most happy influence both on the body and mind. It is said of Euripides the tragedian, that he used to retire to a dark cave to compose Ms tragedies; and of Demosthenes the Grecian orator, that he chose a place for study where nothing could be either heard or seen. With all def- erence to such venerable names, we cannot help condemning their taste. A man may surely think to as good purpose in an elegant apartment as in a cave ; and may have as happy conceptions where the all-cheering rays of the sun render the air wholesome, as in places where they never enter. DESK OCCUPATIONS, &*C. Those who read or write much should be very attentive to their posture. They ought to sit and stand by turns, always keeping as nearly in an erect posture as possible. Those who dictate, may do it walking. It has an excellent effect frequently to read or speak aloud. This not only exercises the lungs, but almost the whole body. Hence studious people are greatly benefitted by de- livering discourses in public. Public speakers, indeed, sometimes hurt themselves, by over-acting their part; but this is their own fault. The martyr to mere vociferation merits not our sympathy. MORNING BEST ADAPTED FOR STUDY AND EXERCISE, &C. The n;orning has, by all medical writers, been reckoned the best time for study. It is so. But it is also the most proper sea- son for exercise, while the stomach is empty, and the spirits re- freshed with sleep. Studious people should, therefore, sometimes spend the morning in walking, riding, or some manly diversions without doors. This would make them return to study with great- er alacrity, and would be of more service than twice the time after their spirits are worn out with fatigue. It is not sufficient to take diversion only when we can think no longer. Every studious person should make it part of his business, and should let nothing interrupt his hours of recreation more than those of study. EFFECTS OF MUSIC ON THE MIND, &C. Music has a very happy effect in relieving the mind when fatigu- ed with study. It would be well if every studious person were so far acquainted with that science as to amuse himself after severe thought by playing such airs as have a tendency to raise the spir- its, and inspire cheerfulness and good humour. It is a reproach to learning, that any of her votaries, to relieve the mind after study, should betake themselves to the use of strong liquors. This indeed is a remedy; but it is a desperate one, and always proves destructive. Would such persons, when their spir- its are low, get on horseback, and ride ten or a dozen miles, they would find it a more effectual remedy than any cordial medicine in the apothecary's shop, or all the strong liquors in the world. 54 DIET AND EXERCISE RECOMMENDED, &c< DR. BUCHAN's PLAN, &C. The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with study or other serious business, I mount my horse, and ride ten or twelve miles into the country, where I spend a day, and sometimes two, with a cheerful friend ; after which I never fail to return to town with new vigour, and to pursue my studies or business with fresh alacrity. It is much to be regretted, that learned men, while in health, pay so little regard to these things ! There is not any thing more common than to see a miserable object over-run with nervous dis- eases, bathing, walking, riding, and, in a word, doing every thing for health after it is gone; yet, if any one had recommended these things to him by way of prevention, the advice would, in all proba- bility, have been treated with contempt, or at least with neglect. Such is the weakness and folly of mankind, and such the want of foresight, even in those who ought to be wiser than others! DIET OF THE STUDIOUS, &C. With regard to the diet of the studious, we see no reason why they should abstain from any kind of food that is wholesome, pro- vided they use it in moderation. They ought, however, to be sparing in the use of every thing that is windy, rancid, or hard of digestion. Their suppers should always be light, or taken soon in the evening. Their drink may be water, fine malt liquor, not too strong, good cider, wine and water, or, if troubled with acidities, water mixed with a little brandy, rum, or any other gen- uine spirit. THE KIND OF EXERCISE RECOMMENDED TO PEOPLE OF STUDIOUS HABITS, &C. We shall only observe, with regard to those kinds of exercise which ar^ most proper for the studious, that they should not be too violent, nor ever carried to the degree of excessive fatigue. They ought likewise to be frequently varied, so as to give action to all the different parts of the body ; and should, as often as pos- sible, be taken in the open air. In general, riding on horseback, walking, working in a garden, or playing at some active diversions, are the best. We would likewise recommend the use of the cold bath to the studious. It will, in some measure, supply the place of exercise, and should not be neglected by persons of a relaxed habit, espe- cially in the warm season. No person ought either to take violent exercise, or to study im- mediately after a full meal. In the above remarks on the usual diseases of the studious, my chief object was to warn them of the evil consequences of painful and intense thinking. But I should be sorry to damp the ardour of their literary pursuits, which are injurious to health only when continued with incessant toil, at late hours, and without due inter- vals of rest, refreshment, relaxation, and exercise. It is not thought, says the medical poet, 'tis painful thinking, that corrodes OBSERVATIONS ON DIET, &c. our clay. I deem it necessary to be more explicit on this head, in consequence of having found that my former cautions to men of genius and science had been understood in too rigorous a sense, as discouraging the manly exertion of real talents. CHAP. III. NON-NATURALS. By the term non-naturals, ancient physicians comprehend air, MEAT and DRINK, SLEEP and WATCHING, MOTION and REST, the RE- TENTIONS and excretions, and the affections or passions of the mind ; or, in other words, those principal matters which do not enter into the composition of the body, but which at the same time are indispensable to its existence. OBSERVATIONS ON DIET, &C Unwholesome/oo^, and irregularities of diet, occasion many dis- eases. There is no doubt but the whole constitution of body may be changed by diet alone. The fluids may be thereby attenuated or condensed, rendered mild or acrimonious, coagulated or dilut- ed, to almost any degree. Nor are its effects upon the solids less considerable. They may be braced or relaxed, have their sensi- bility, motions, &c. greatly increased or diminished, by different kinds of aliment. A very small attention to these things will be sufficient to show, how much the preservation of health depends upon a proper regimen of the diet. Nor is an attention to diet necessary for the preservation of health only : it is likewise of importance in the cure of diseases. Every intention in the cure of many diseases, may be answered by diet alone. Its effects, indeed, are not always so quick as those of medicine, but they are generally more lasting: besides, it is neither so disagreeable to the patient, nor so dangerous as medi- cine, and is always more easily obtained. Our intention here is not to inquire minutely into the nature and properties of the various kinds of aliment in use among mankind; nor to show their effects upon the different constitutions of the hu- man body; but to mark some of the most pernicious errors which people are apt to fall into, with respect both to the quantity and quality of their food, and to point out their influence upon health. It is not, indeed, an easy matter to ascertain the exact quantity of food proper for every age, sex, and constitution : but a scrupu- lous nicety here is by no means necessary. The best rule is to avoid all extremes. Mankind were never intended to weigh and measure their food. Nature teaches every creature when it haa enough; and the calls of thirst and hunger are sufficient to inform them when more is necessary. Though moderation is the chief rule with regard to the quanti- 5(3 ANIMAL AND VEGETABLE DIET, &c. ty, yet the quality of food merits a farther consideration. There are many ways by which provisions may be rendered unwhole- some. Bad seasons may either prevent the ripening of grain, or damage it afterwards. These, indeed, are the acts of Providence, and we must submit to them; but surely no punishment can be too severe for those who suffer provisions to spoil by hoarding them, on purpose to raise the price, or who promote their own interest by adulterating the necessaries of life.* Animal as well as vegetable food may be rendered unwholesome, by being kept too long. All animal substances have a constant tendency to putrefaction; and when that has proceeded too far, they not only become offensive to the senses, "but hurtful to health. Dis- eased animals, and such as die of themselves, might never to be eaten. Animals which feed grossly, as tame ducks, hogs, fyc. are neither so easily digested, nor afford such wholesome nourishment as others. No animal can be wholesome which does not take sufficient exercise. Most of our stalled cattle are crammed with gross food, but not allowed exercise nor free air; by which means they indeed grow fat, but their juices, not being properly prepared or assimilated, remain crude, and occasion indigestions, gross humours, and op- pression of the spirits, in those who feed upon them. Animals are often rendered unwholesome by being over-heated. Excessive heat causes a fever, exalts the animal salts, and mixes the blood so intimately with the flesh, that it cannot be separated. For this reason, butchers should be severely punished who over- drive their cattle. No person would choose to eat the flesh of an aaimal which had died in a high fever; yet that is the case with all over-drove cattle; and the fever is often raised even to the degree of madness. But this is not the only way by which butchers render meat unwholesome. The abominable custom of filling the cellular membrane of animals with air, in order to make them appear fat, is every day practised. This not only spoils the meat, and renders it unfit for keeping, but is such a dirty trick, that the very idea of it is sufficient to disgust a person of any delicacy at every thing which comes from the shambles. Who can bear the thought of eating meat which has been blown up with air from the lungs of a dirty fellow, perhaps labouring under the very worst of diseases ? Salted animal food.—No people in the world eat such quanti- ties of salted animal food as the English, which is one reason why they are so generally tainted with the scurvy, and its numerous train of consequences, indigestion, low spirits, hypochondriacism, &c. Animal food was surely designed for man, and, with a proper mixture of vegetables, it will be found the most wholesome; but to gorge beef, mutton, pork, fish, and fowl, twice or thrice a-day, is certainly too much. All who value health ought to be contented with making one meal of animal food in twenty-four hours, and this ought to consist of one kind only. * The poor, Indeed, are generally the first who suffer by unsound provisions; but the lives of the labouring poor are of great importance to the state : besides, diseases occasioned by unwholesome food often prove infectious, by which means they reach people in every station. It is, therefore, the interest of all to take care that no snoilnd provisions of any kind be exoosed to VEGETABLE DIET, COOKERY, &c. 57 VEGETABLE diet. The most obstinate scurvy has often been cured by a vegetable diet; nay, milk alone will frequently do more in that disease than any medicine. Hence it is evident, that if vegetables and milk were more used in diet, we should have less scurvy, and likewise fewer putrid and inflammatory fevers. Fresh vegetables, indeed, come to be daily more used in diet; this laudable practice we hope will continue to gain ground. Aliments.—Our aliment ought neither to be too moist nor too dry. Moist aliment relaxes the solids, and renders the body fee- ble. Thus we see females, who live much on tea and other watery diet, generally become weak and unable to digest solid food : hence proceed hysterics, and all their dreadful consequences. On the other hand, food that is too dry, renders the solids in a man- ner rigid, and the humours viscid, which disposes the body to in- flammatory fevers, scurvies, and the like. Tea.—Much has been said on the ill-effects of tea in diet. They are, no doubt, numerous ; but they proceed rather from the imprudeut use of it, than from any bad qualities in the tea itself. Tea is now the universal breakfast in this part of the world ; but the morning is surely the most improper time of the day for drink- ing it. Most delicate persons, who, by the bye, are the greatest tea-drinkers, cannot eat any thing in the morning. If such per- sons, after fasting ten or twelve hours, drink four or five cups of green tea without eating almost any bread, it must hurt them. Good tea, taken in a moderate quantity, not too strong, nor too hot, nor drank upon an empty stomach, will seldom do harm; but if it be bad, which is often the case, or substituted in the room of solid food, it must have many ill effects. Cookery.— The arts of cookery render many things unwholesome, which are not so in their own nature. By jumbling together a num- ber of different ingredients, in order to make a poignant sauce, or rich soup, the composition proves almost a poison. All high sea- soning, pickles, &c. are only incentives to luxury, and never fail to hurt the stomach. It were well for mankind, if cookery, as an art, were entirely prohibited. Plain roasting or boiling is all that the stomach requires. These alone are sufficient for people in health, and the sick have still less need of a cook. The liquid part of our aliment likewise claims our attention. Water is not only the basis of most liquors, but also composes a great part of our solid food. Good water must, therefore, be of the greatest importance in diet. The best water is that which is most pure, and free from any mixture of foreign bodies. Water takes up parts of most bodies with which it comes into contact; by this means it is often impregnated with metals or minerals of a hurtful or poisonous nature. Hence the inhabitants of some hilly countries have peculiar diseases, which in all probability proceed from the water. Thus the people who live near the Alps in Swit- zerland, and the inhabitants of the Peak of Derby, in England, have large tumours or wens on their necks (bronchocele.) This disease is generally imputed to the snow-water; but there is mor* C3 58 WATER, FERMENTED LIQUORS, &c reason to believe it is owing to the minerals in the mountain* through which the waters pass.* Water, &c.—When water is impregnated with foreign bodies, it generally appears by its weight, colour, taste, smell, heat or some other sensible quality. Our business, therefore, is to choose such water, for common use, as is lightest, and without any particular colour, taste, or smell. In most places of Britain the inhabitants have it in their power to make choice of their water, and few things would contribute more to health than a due attention to this arti- cle. But mere indolence often induces people to make use of the water that is nearest to them, without considering its qualities. Before water is brought into great towns, the strictest attention ought to be paid to its qualifies, as many diseases may be occa- sioned or aggravated by bad water; and when once it has been procured at a great expense, people are unwilling to give it up. The common methods of rendering water clear by filtration ; or soft, by exposing it to the sun and air, therefore, a change becomes necessary, it ought always to be made gradually; a sudden tran- sition from a poor and low to a rich and luxurious diet, or the con- trary, might so disturb the functions of the body as to endanger health, or even to occasion death itself. When xvp i-r>r>nnr>in*»nrl rpmilarity in diet, We WOllld not be Under- 62 UNWHOLESOME AIR. stood as condemning every small deviation from it. It is next to impossible for people at all times to avoid some degree of excess, and living too much by rule might make even the smallest devia- tion dangerous. It may, therefore, be prudent to vary a little, sometimes taking more, sometimes less, than the usual quantity of meat and drink, provided always that a due regard be had to mod- eration. The details which some writers have entered into respecting the supposed qualities of every article of food and drink, as well as the proper quantities of each, appear to me just as trifling as the minute- ness of the physician who inserted in his prescription how many grains of salt should be eaten with an egg. Every man's experi- ence of what he has found to agree or disagree with him, is a much more unerring guide than whimsical calculations of the difference between the mucilage of a carrot and a parsnip, or between the jelly contained in a leg and a shoulder of mutton. But while I point out the folly of extreme solicitude in such matters, I am far from advising people to eat and drink, without any choice or re- straint, whatever falls in their way. This would be inconsistent with the rules I have already laid down. Rational enjoyment of the gifts of nature, is the happy medium between boundless indul- gence and frivolous or unnecessary self-denial. Such as have a faulty circulation through the lungs, the conse- quence of pulmonary or other complaints, ought to eat very little at a time, because the quantity of chyle being increased must obvi- ously render that circulation still more uneasy. The great secret then for consumptive and asthmatic patients in particular, and up- on which their cure principally depends, is to take their food in small quantities at a time. It happens, however, rather unfortun- ately for asthmatic patients, that their desire for food is consider- ably increased ; in consequence of which, sanguification is but im- perfectly performed, they become what is termed leucophlegmatic, that is, they acquire a dropsical tendency. The choice, therefore, as well as the quantity, of diet, is of great importance to those who have weak lungs, as well as to persons generally who are of deli- cate constitutions. CHAP. IV AIR. Unwholesome air is a very common cause of diseases. Few are aware of the danger arising from it. People generally pay some attention to what they eat or drink, but seldom regard what goes into the lungs, though the latter proves often more suddenly fatal than the former. Air, as well as water, takes up parts of most bodies with which it comes in contact, and is often so replenished with those of a noxious quality, as to occasion immediate death. But such vio* BURYING WITHIN CHURCHES. 63 lent effects seldom happen, as people are generally on their guard against them. The less perceptible influences of bad air prove more generally hurtful to mankind; we shall, therefore, endeav- our to point out some of these, and to show whence the danger chiefly arises. Airs may become noxious many ways. Whatever greatly alters its degrees of heat, cold, moisture, &c. renders it unwholesome : for example, that which is too hot dissipates the watery parts of the blood, exalts the bile, and renders the whole humours adust and thick. Hence proceed bilious and inflammatory fevers, cholera morbus, 64 STAGNATED AIR. might, in a great measure, be obviated by prohibiting ajl persons from burying within churches, by keeping them clean, and per- mitting a stream of fresh air to pass frequently through them, by opening opposite doors and windows.* Wherever air stagnates long, it becomes unwholesome. Hence the unhappy persons confined in jails not only contract malignant fe- vers themselves, but often communicate them to others. Nor are many of the holes, for we cannot call them houses, possessed by the poor in great towns, much better than jails. These low dirty habitations are the very lurking places of bad air and contagious diseases. Such as live in them seldom enjoy good health ; and their children commonly die young. In the choice of a house, those who have it in their power ought always to pay the greatest attention to open free air. The various methods which luxury has invented to make houses close and warm, contribute not a little to render them unwholesome. No house can be wholesome, unless the air has a free passage through it. For which reason, houses ought daily to be ventilated by opening opposite windows, and admitting a current of fresh air into every room. Beds, instead of being made up as soon as peo- ple rise out of them, ought to be turned down, and exposed to the fresh air from the open windows through the day. This would ex- pel any noxious vapour, and could not fail to promote the health of the inhabitants. In hospitals, jails, ships, f perspira- tion : these may, in some measure, be prevented by a suitable ad- dition to the clothing, or by wearing such as are better calculated for promoting the discharge from the skin, as clothes made of cot- ton, flannel, &c. The clothing ought likewise to be suited to the season of the year. Clothing may be warm enough for summer, which is by no means sufficient for winter. The greatest caution, however, is necessary in making these changes. We ought neither to put off our winter clothes too soon, nor to wear our summer ones too long. In this country, the winter often sets in very early with great rigour, and we have frequently cold weather even after the commencement of the summer months. It would likewise be prudent not to make the change all at once, but to do it gradually; and indeed the changes of apparel in this climate ought to he very inconsiderable, especially among those who have passed the meridian of life.* Clothes often become hurtful to the wearer by their being made sub- servient to the purposes of pride or vanity. Mankind in all ages seem to have considered clothes in this view ; accordingly their fashion and figure have been continually varying, with very little regard either to health, the climate, or conveniency: a farthingale, for example, may be very necessary in hot southern climates, but surely nothing can be more ridiculous in the cold regions of the north. Even the human shape is often attempted to be mended by dress, and those who know no better believe that mankind would be mon- sters without its assistance. All attempts of this nature are highly pernicious. The most destructive of them in this country is that of squeezing the stomach and bowels into as narrow a compass as possible, to procure what is falsely called, a fine shape.t By this practice, the action of the stomach and bowels, the motion of the heart and lungs, and almost all the vital functions, are obstructed. Hence proceed indigestions, syncopes or fainting fits, coughs, consumptions of the lungs, and other complaints so common among females. The feet likewise often suffer by pressure. How a small foot came to be reckoned genteel, I will not pretend to say ; but certain it is, that this notion has made many persons lame. Almost nine tenths of mankind are troubled with corns; a disease that is seldom or never occasioned but by strait shoes. Corns are not only very troublesome, but by rendering people unable to walk, they may likewise be considered as the remote cause of other diseases. J * That colds kill more than plagues is an old observation ; and, with regard to this country, it holds strictly true. Every person of discernment, however, will perceive, that most of the colds which prove so destructive to the inhabitants of Britain, are ow- ing to their imprudence in changing clothes. A few warm days in March or April in- duce them to throw off their winter garments, without considering that our most pene- trating colds, generally happen in the spring. t This madness seems to have pervaded the minds of mothers in every age and coun try. Terence, in his comedy of the Eunuch, ridicules the Roman -matrons for at' tempting to mend the shape of their daughters. X We often see persons, who are rendered quite lame by the nails of their toes har CLOTHING, 73 The size and figure of the shoe ought certainly to be adapted to the foot. In children the feet are as well shaped as the hands, and the motion of the toes as free and easy as that of the fingers ; yet few persons in the advanced period of life are able to make any use of their toes ; they are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether incapable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, bul; she will never walk well in this man- ner. It strains her joints, distorts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion; it is en- tirely owing to shoes with high heels and narrow toes, that not one female in ten can be said to walk well. Infixing on the clothes, due care should be taken to avoid all tight bandages. Garters, buckles, &.c. when drawn too tight, not only prevent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and oc- casions various diseases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood in its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases, are often occa- sioned. The perfection of dress is to be easy and clean. Nothing can. be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, and many such there are, would rather re- main as fixed as a statue from morning till night, than discompose a single hair, or alter the position of a pin. Were we to recom- mend any particular pattern for dress, it would be that which is worn by the people called quakers. They are always neat, clean, and often elegant, without any thing superfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt. We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and the pe- riod of life, but likewise to the temperature and constitution. Ro- bust persons are able to endure either cold or heat better than the delicate, consequently may be less attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm.* ing grown into the flesh, and frequently hear of mortifications proceeding from this cause. All these, and many other inconveniences attending the feet, must be impu- ted solely to the use of short and tight shoes. Though we hear frequently of plasters, salves, ointments, &c. for eradicating corns, yet they are never known to produce that effect. The only rational mode of proceed- ing is to soften the corn a little by immersion in warm water, and then to cut it care- fully, and to renew this operation every week, till the scarf skin is reduced to its origi- nal or natural thinness, after which it must be preserved from the irritating pressure of strait shoes, which had at first occasioned the painful callosity. * The celebrated Boerhaave used to say, that nobody suffered by cold, save fools »«d beggars ; the latter not being able to procure clothes, and the.former not having ■ease to wear them. Be this as it may, I can with the strictest truth declare, that in D 74 CLOTHING. Since the first publication of the preceding remarks, very im- portant changes have taken place in the dress of our fair country- women, which afford the strongest proofs of their good sense and taste. The shape is no longer distorted, nor is growth check- ed and the vital functions impeded by a whalebone press. Easy, safe, and graceful motion in a flat-heeled shoe has completely abol- ished the awkwardness and danger of former attempts to totter about, as it were upon stilts. In a word, a becoming regard to health, simplicity, and elegance, seems now to have more influence over female fashions than absurdity, caprice, or the desire of con- cealing any personal deformity. I wish I could pay my own sex the same compliment which the ladies have so well deserved. But an affectation of what is called military smartness seems to have converted their whole apparel into a system of bandages. The hat is as tight as if it was intend- ed for a helmet, and to defy the fury of a hurricane. Its form al- so being by no means suited to the natural shape of the head, it must be worn for a considerable time with very painful and une- qual pressure, before it can be made to fit its new block. The neck is4bolstered up and swathed with the most unnatural stiff- ness. Easy motion without, and free circulation within, are alike obstructed. Blotches and eruptions in the face, head-achs, apo- plexies, and sudden deaths, may be often traced to this cause ; and if we view its effects in another light, we shall not be surprised at any inconsistency in the language or conduct of persons who take so much pains to suspend all intercourse between the head and the heart. The close pressure of the other articles of dress is equally re- prehensible. Narrow sleeves are a great check upon the muscular exercise of the arms. The waistcoat in its present fashionable form, may be very properly termed a strait one ; and, no doubt, is in many instances an indication of some mental derangement. The wrists and knees, but more particularly the latter, are braced with ligatures, or tight buttoning ; and the legs, which require the utmost freedom of motion, are screwed into leathern cases, as if to convey an idea that the wearer is sometimes mounted on horse- back. To complete the whole, and in order that the feet may be kept in as tight a press as the head, when shoes are to be worn, the shape of the foot, and the easy expansion of the toes are never con- sulted, but fashion regulates the form of the shoe, sometimes square- toed, more frequently pointed, and always sure to produce cramp9 and corns, the keen, the sensible announcers of every change of the weather. I have so long employed serious argument upon these subjects in vain, that I am now accustomed to view them with pleasantry ; and when I meet with such figures, disguised, and rendered truly awkward both in their motions and appearance, I cannot help thinking with Shakspeare, " that some of Nature's journeymen had made them and not made them well; they imitate humanity so abominably !" many eases, where the powers of medicine had been tried in vain, I have cured the patient by recommending thick shoes, a flannel waistcoat and drawers, a pair of under* stockings, or a flannel petticoat, to be worn during the cold season at least. Where warmer clothing is wanted, I would recommend the fleecy hosiery to be worn next the skin. INTEMPERANCE. 75 CHAP. VIII. OF INTEMPERANCE. A modern author* observes, that temperance and exercise are ^ the two best physicians in the world. He might have added, that J if these were duly regarded, there would be little occasion for any other. Temperance may justly be called the parent of health ; ' yet numbers of mankind act as if they thought diseases and death too slow in their progress, and, by intemperance and debauch, seem as it were to solicit their approach. The danger of intemperance appears from the very construction of the human body. Health depends on that state of the solids and fluids which fits them for the due performance of the vital func- tions ; and while these go regularly on, we are sound and well; but whatever disturbs them necessarily impairs health, /fftitem- perance never fails to disorder the whole animal economy; 'it hurts the digestion, relaxes the nerves, and renders the different secre- tions irregular, vitiates the humours, and occasions numberless diseases. The analogy between the nourishment of plants and animals af- fords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation ; yet an over-quantity of either will entirely destroy it. The best things become hurtful, nay destructive, when carried to excess. Hence we learn, that the highest degree of human wisdom consists in regulating our ap- petites and passions so as to avoid all extremes. It is that chiefly which entitles us to the character of rational beings. The slave of appetite will ever be the disgrace of human nature. The author of nature hath endued us with various passions, for the propagation of the species, the preservation of the individual, &c. Intemperance is the abuse of these passions ; and modera- tion consists in the proper regulation of them. Men, not content- ed with satisfying the simple calls of Nature, create artificial wants, and are perpetually in search after something that may gratify them; but imaginary wants can never be gratified. Nature is content with little ; but luxury knows no bounds. Hence the ep- icure, the drunkard, and the debauchee, seldom stop in their ca- reer till their money or their constitution fails; then indeed they generally see their error when too late. It is impossible to lay down fixed rules with regard to diet, on account of the different constitutions of mankind. The most ig- norant person, however, certainly knows what is meant by excess : and it is in the power of every man, if he chooses, to avoid it. The great rule of diet is to study simplicity. Nature delights in the most plain and simple food, and every animal, except man, follows her dictates. Man alone riots at large, and ransacks the * Rousseau. 76 INTEMPERANCE. whole creation in quest of luxuries, to his own destruction. An el- egant writer* of the last age speaks thus of intemperance in diet: " For my part, when I behold a fashionable table set out in all its " magnificence, I fancy that I see* gouts and dropsies, fevers and " lethargies, with other innumerable distempers, lying in ambus- " cade among the dishes." Nor is intemperance in other things less destructive than in diet. How quickly does the immoderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best constitution ! In- deed these vices generally go hand in hand. Hence it is that we so often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and hastening with swift pace to an untimely grave. Did men reflect on the painful diseases and premature deaths which are daily oc- casioned by intemperance, it would be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures. Intemperance does not hurt its votaries alone; the innocent too of- ten feel the direful effects of it. How many wretched orphans are to be seen embracing dung-hills, whose parents, regardless of the future, spent in riot and debauch what might have served to bring up their offspring in a decent manner ! How often do we behold the miserable mother, with her helpless infants, pining in want, while the cruel father is indulging his insatiate appetites ! Families are not only reduced to misery, but even extirpated, by in- temperance. Nothing tends so much to prevent propagation, and to shorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down con- tented with his humble fare, can boast a numerous offspring, while his pampered lord, sunk in ease and luxury, often languishes with- out an heir to his ample fortunes. Even states and empires feel the influence of intemperance, and rise or fall as it prevails. Instead of mentioning the different kinds of intemperance, and pointing out their influence upon health, we shall only, by way of example, make a few observations on one particular species of that vice, viz. the abuse of intoxicating liquors. Every act of intoxication puts nature to the expense of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That constitution must be strong indeed which is able long to hold out under a daily fever ; but fevers occasioned by drinking do not al- . ways go off in a day ; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects. Though the drunkard should not fall by an acute disease, he seldom escapes those of a chronic kind. Intoxicating liquors, when used to excess, weaken the bowels and spoil the digestion ; they destroy the power of the nerves, and occasion paralytic and convulsive disorders ; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation and the nourish- ment of the body. Hence obstructions, atrophies, dropsies, and diseases of the lungs. These are the common ways in which * Addison. INTEMPERANCE. 77 drunkards make their exit. Disorders of this kind, when brought on by hard drinking, seldom admit of a cure. Many people injure their health by drinking, who seldom get drunk. The continual habit of soaking, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept constantly full and upon the stretch, the different digestions can neither be duly performed, nor the humours properly prepared. Hence most people of this character are afflicted with the gout, the gravel, ulcerous sores in the legs, &c. If these disorders do not appear, they are seized with low spirits, hypochondriacal affec- tions, and other symptoms of indigestion. Hard drinking is no doubt one of the causes to which we must im- pute the increase of consumptions. The great quantities of viscid malt liquor drank by the common people of England, cannot fail to render the blood sizy and unfit for circulation; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthisical: nor is that to be wondered at, considering the glutinous and almost indigestible nature of strong ale. Those who drink ardent spirits or strong wines run still greater hazard ; these liquors heat and inflame the blood, and tear the ten- der vessels of the lungs to pieces ; yet so great is the consump- tion of them in this country, that one would almost be induced to think that the inhabitants lived upon them. The habit of drinking proceeds frequently from misfortunes in life. The miserable fly to it for relief. It affords them, indeed, a temporary ease. But, alas ! this solace is short-lived; and when it is over, the spirits sink as much below their usual tone as they had before been raised above it. Hence a repetition of the dose becomes necessary, and every fresh dose makes way for another, till the unhappy wretch becomes a slave to the bottle, and at length falls a sacrifice to what at first perhaps was taken only as a med- icine. No man is so dejected as the drunkard when his debauch is gone off. Hence it is, that those who have the greatest flow of spirits while the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their own* miser- able existence in a fit of spleen or ill-humour. Drunkenness not only proves destructive to health, but likewise to the faculties of the mind. It is strange that creatures, who value themselves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so far below them. Were such as voluntarily deprive themselves of the use of reason to con- tinue ever after in that condition, it would seem but a just punish- ment. Though this be not the consequence of one act of intoxica- tion, it seldom fails to succeed a course of it. By a habit of drink- ing, the greatest genius is often reduced to a mere idiot.* * It is amazing that our improvements in arte, learning, and politeness, have not put the barbarous custom of drinking to excess out of fashion. It is indeed less common in South Britain than it was formerly ; but it still prevails very much in the North, where this relic of barbarity is mistaken for hospitality. There no man is supposed to entertain his guests well, who does not make them drunk. Forcing people to drink is certainly the greatest piece of rudeness that any man can be guilty of. Manliness, complaisance, or mere good-nature, may induce a man to take his glass, if urged to it 78 CLEANLINESS. Intoxication is peculiarly hurtful to young persons. It heats their blood, impairs their strength, and obstructs their growth; besides, the frequent use of strong liquors in the early part of life destroys any benefit that might arise from them afterwards. Those who make a practice of drinking generous liquors when young, cannot expect to reap any benefit from them as a cordial in the decline of life. Drunkenness is not only in itself a most abominable vice, but it is an inducement to many others. There is hardly any crime so horrid that.the drunkard will not perpetrate for the love of liquor. We have known mothers sell their children's clothes, the food that they should haVe eat, and afterwards even the infants themselves, in or- der to purchase the accursed draught. It is of the utmost importance to check the first propensities to glut- tony and intoxication, or they soon become uncontrollable. With re- spect to eating, the stomach, being often put upon the full stretch, feels uneasiness from the least vacuity, and acquires by degrees a sort of unnatural craving, the gratifications of which are sure to be attended with a stupor, debility, and disease. The same remark is applicable to drinking. After frequent indul- gence in excess, the smallest self-denial causes a faintness and de- pression of spirits, which nothing can remove but the favourite dram or pretended cordial. Nay more, the repetition of the last night's debauch is looked upon as the best remedy for the sickness of the ensuing day. Mild diluting liquors are rejected as insipid, and some hot stimulant is required for the palate and stomach, without considering, that by such means the action of the heart and arteries is stimulated also ; that the lungs are inflamed ; and the whole system is relaxed and enfeebled. CHAP. IX. CLEANLINESS. The want of cleanliness is a fault which admits of no excuse. Where water can be had for nothing, it is surely in the power of every person to be clean. The continual discharge from our bod- ies by perspiration, renders frequent change of apparel necessary. Changing apparel greatly promotes the secretion from the skin, so necessary for health. When that matter which ought to be carried off by perspiration is either retained in the body or re-absorbed from dirty clothes, it must occasion diseases. Diseases of the skin are chiefly owing to want of cleanliness.* They at a time when he might as well take poison. The custom of drinking to excess has long been out of fashion in France ; and, as it begins to lose ground among the polite part of the English, wo hope it will soon be banished from every part of this island. * Mr. Pott, in his surgical observations, was the first to notice a disease which he called the chimney-sweeper's cancer, now well known, as it is almost peculiar to that unhappy set of people, and of which be has left us a concise and accurate history, CLEANLINESS. 79 may, indeed, be caught by infection, or brought on by poor living, unwholesome food, &c.; but they will seldom continue long where cleanliness prevails. To the same cause must we impute the va- rious kinds of vermin which infest the human body, houses, &c. These may always be banished by cleanliness alone, and where- ever they abound, we have reason to believe it is neglected. One common cause of putrid and malignant fevers is the want of cleanliness. These fevers commonly begin among the inhabitants of close, dirty houses, who breathe unwholesome air, take little exercise, and wear dirty clothes. There the infection is general- ly hatched, which often spreads far and wide, to the destruction of many. Hence cleanliness may be considered as an object of pub- lic attention. It is not sufficient that 1 be clean myself, while the want of it in my neighbour affects my health as well as his. If dirty people cannot be removed as a common nuisance, they ought at least to be avoided as infectious. All who regard their health should keep at a distance even from their habitations. In places where great numbers of people are collected, cleanliness be- comes of the utmost importance. It is well known that infectious dis- eases are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excre- ments of the diseased. In many great towns the streets are little better than dung-hills, being frequently covered with ashes, dung, and nastiness of every kind. Even slaughter-houses, or killing-shambles, are often to be seen in the very centre of great towns. The putrid blood, excre- ments, &c. with which these places are generally covered, cannot fail to taint the air, and render it unwholesome. How easily might this be prevented by active magistrates, who have it always in their power to make proper laws relative to things of this na- ture, and to enforce the observance of them ? Whatever pretensions people may make to learning, politeness, or civilization, we will venture to affirm, that while they neglect cleanliness, they are in a state of barbarity.* The peasants in most countries seem to hold cleanliness in a sort of contempt. Were it not for the open situation of their houses, they This he attributes to neglect of cleanliness, and with great justice. I am convinced that if that part of the body which is the seat of this cruel disease were kept clean by frequent washing, it would never happen. The climbing-boys, as they are called, are certainly the most miserable wretches on the face of the earth ; yet, for cleaning chimneys, no such persons are necessary. According to the opinion of Mr. Earle, (see Medico Chirurgical Transactions, vol. xii.) it is invariably produced by the irritation of soot applied to the ruga? or folds of the skin. It is not a common disease, and rarely attacks under the age of thirty, which accounts for its comparative unfrequency. * In ancient Rome the greatest men did not think cleanliness an object unworthy of their attention. Pliny says, the Cloaca, or common sewers for the conveyance of filth and nastiness from the city, were the greatest of all the public works ; and be- stows higher encomiums upon Tarquinius, Agrippa, and others who made and improv- ed them, than those who achieved the greatest conquests. How truly great does the Emperor Trajan appear when giving directions to Pliny his proconsul, concerning the making of a common sewer for the health and conven- ience of a conquered city! 80 CLEANLINESS. would often feel the bad effects of this disposition. One seldom sees a farm-house without a dung-hill before the door, and fre- quently the cattle and their masters lodge under the same roof. Peasants are likewise extremely careless with respect to change of apparel, keeping their houses, &c. clean. This is merely the ef- fect of indolence and a dirty disposition. Habit may, indeed, ren- der rt less disagreeable to them, but no habit can ever make it sal- utary to wear dirty clothes, or breathe unwholesome air. As many articles of diet come through the hands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. This, for example, might be done, by giving a small premium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c, and by punishing severely those who bring it dirty. The same method should be taken with butchers, bakers, brewers, and all who are employed in preparing the necessaries of life. In camps the strictest regard should be paid to cleanliness. By neg- ligence in this matter, infectious diseases are often spread amongst a whole army ; and frequently more die of these than by the sword. The Jews, during their encampments in the wilderness, received particular instructions with respect to cleanliness.* The rules en- joined them ought to be observed by all in the like situation. In- deed the whole system of laws delivered to that people has a man- ifest tendency to promote cleanliness. Whoever considers the na- ture of their climate, the diseases to which they were liable, and their dirty disposition, will see the propriety of such laws. It is remarkable, that in the most eastern countries, cleanliness makes a great part of their religion. The Mahometan, as well as the Jewish religion, enjoins various bathings, washings, and purifi- cations. No doubt these might be designed to represent inward purity, but they were at the same time calculated for the preserva- tion of health. However whimsical these washings may appear to some, few things would tend more to prevent diseases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a dead body, or touching any thing that might convey infection, to wash before he went into company, or sat down to meat, he would run less hazard either of catching the infection himself, or of communicating it to others. NECESSITY OF FREQUENT ABLUTIONS, &C. Frequent washing not only removes the filth and sordes which adhere to the skin, but likewise promotes the perspiration, braces the body, and enlivens the spirits. How refreshed, how cheerful, and agreeable does one feel on being shaved, washed, and shifted, especially when these offices have been neglected longer than usual! The eastern custom of washing the feet, though less necessary in this country, is nevertheless a very agreeable piece of cleanli- ness, and contributes greatly to the preservation of health. The sweat and dirt with which these parts are frequently covered, can- not fail to obstruct the perspiration. This piece of cleanliness * See Deuteron. chap, xxii. ver. 12, 13. CLEANLINESS. 81 would often prevent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being exposed to cold or wet through the day, they would seldom expe- rience the ill effects which often proceed from these causes. A proper attention to cleanliness is no where more necessary than on shipboard. If epidemical distempers break out there, no one can be safe. The best way to prevent them is to take care that the whole company be cleanly in their clothes, bedding, &c. When infectious diseases do break out, cleanliness is the most likely means to prevent their spreading : it is likewise necessary to pre- vent their returning afterwards, or being conveyed to other places. For this purpose the clothes, bedding, &c. of the sick ought to be carefully washed, and fumigated with brimstone. Infection will lodge a long time in dirty clothes," and afterwards break out in the most terrible manner. In places where great numbers of sick people are collected to- gether, as jails, hospitals, &c. cleanliness ought to be most reli- giously observed. The very smell in such places is often sufficient to make one sick. It is easy to imagine what effect that is likely to have upon the diseased. In an hospital or infirmary where clean- liness is neglected, a person in perfect health has a greater chance to become sick than a sick person has to get well. Few things are more unaccountable than that neglect, or rather dread of cleanliness, which appears among those who have the care of the sick : they think it almost criminal to suffer any thing that is clean to come near a person in a fever, for example, and would rather allow him to wallow in all manner of filth than change the least bit of his linen. If cleanliness be necessary for persons in health, it is certainly more so for the sick. Many diseases may be cured by cleanliness alone ; most of them might be mitigated by it; and where it is neglected, the slightest disorders are often changed into the most malignant. The same mistaken care which prompted people to prevent the least admission of fresh air to the sick, seems to have induced them to keep them dirty. Both these destructive prejudices will, we hope, be soon entirely eradi- cated. Cleanliness is certainly agreeable to our nature. We cannot help approving it in others, even though we should not practise it our- selves. It sooner attracts our regard than even finery itself, and often gains esteem where that fails. It is an ornament to the high- est as well as the lowest station, and cannot be dispensed with in either. Few virtues are of more importance to society than gene- ral cleanliness. It ought to be carefully cultivated every where ; but in populous cities it should be almost revered.* * As it is impossible to be thoroughly clean without a sufficient quantity of water, we would earnestly recommend it to the magistrates of great towns to be particularly at- tentive to this article. Most great towns in Britain are so situated as to be easily sup- plied with water ; and those persons who will not make a proper use of it after it is brought to their hand, certainly deserve to be severely punished. The streets of great towns, where water can be had, ought to be washed every day. This is the only ef- fectual method of keeping them thoroughly clean : and, upon trial, we are persuaded it will be fourd the cheapest. Some of the most dreadful diseases incident to human nature might, in my opinion, be entirely eradicated by cleanliness. INFECTION AND CONTAGION. OHAF. X. INFECTION AND CONTAGION. Infection is designated a febrific agent, produced by the de- composition of animal and vegetable substances. It usually exists in the state of miasm or gas, and, in this form, occurs in filthy houses, ships, jails, hospitals, and cities ; and also in marshes, and fenny and low districts of country. Under the denominations of marsh, or paludal miasmata, exhalations of the soil, vegeto-animal ef- fluvium, malaria, human effluvia, febrile and putrid contagion, its va- rious specific effects are detailed in the works of practical writers, as having a decided influence on the human body* Contagion is a poison generated by morbid animal secretion, possessing the power of inducing a similar morbid action in healthy bodies, whereby it is reproduced, and indefinitely modified. This contagion can only be known by its effects, and can only be divi- ded into genera by classifying it with the diseases it produces : e.g. 1st, Contagion communicable exclusively by contact, the spe- cies of which are as follows : itch, syphilis, sibbens, loanda of Afri- ca, frambesia or yaws, elephantiasis, hydrophobia, ahd small-pox.i These diseases cannot be conveyed through the medium of the air, but require actual contact. Hence they are strictly contagious, in the etymological sense of the word. 2d, Contagion communica- ble both by contact and by the atmosphere. These are liable to become epidemic, in contradistinction to those of the first genera. In this the species are, small-pox, measles, chicken-pox, scarlet fever, hooping-cough, &.c. One of the laws which govern these contagions is, that they are communicable in every season, in the heat of summer as well as in the cold of winter, in a pure as well as an impure air. An- other, law is, general insusceptibility to future attacks of the same disease, but with exceptions. Many diseases are infectious. Every person ought, therefore, as far as he can, to avoid all communication with the diseased. The com- mon practice of visiting the sick, though often well meant, has many ill consequences. Far be it from me to discourage any act of charity or benevolence, especially towards those in distress ; but I cannot help blanking such as endanger their own or their neigh- bours' lives, by a mistaken friendship, or an impertinent curiosity. The houses of the sick, especially in the country, are generally crowded from morning till night with idle visiters. It is custom- ary in such places, for servants and young people to wait upon the * It has erroneously, we conceive, been denied that animal substances have any thing lo do in the production of febrific miasmata. An unequivocal proof, however, has lately been exhibited of the contrary opinion, or rather fact, produced by opening a grave in the island of Lenten. See Med. Chirurg. Review. t To these, Dr. Hossack, of New York, adds influenza, and cynancha maligna, or pu- trid sore throat, although Dr. Smith, whose modification of Dr. H.'s classification we have given, says, though without proof, that the former is evidently not contagious, and that the latter is either a modification of scarlatina, or an atmospheric disease. *■■'. INFECTION AND CONTAGION. 83 sick by turns, and even to sit up with them all night. It would be a miracle indeed should such always escape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and communicate them to others, till at length they become epidemic. It would be thought highly improper for one who had not had the small-pox, to wait upon a patient in that disease ; yet many other fevers are almost as infectious as the small-pox, and not less fatal. Some imagine that fevers prove more fatal in villages than in great towns, for want of proper medical assistance. This may sometimes be the case; but I am inclined to think it oftener pro- ceeds from the cause above-mentioned. Were a plan to be laid down for communicating infection, it could not be done more effectually than by the common method of visiting the sick. Such visiters not only endanger themselves and their connexions, but likewise hurt the sick. By crowding the house, they render the air unwholesome, and by their private whispers and dismal countenances, disturb the imagination of the patient, and depress his spirits. Persons who are ill, especially in fevers, ought to be kept as quiet as possible. The sight of strange faces, and every thing that disturbs the mind, hurts them. The common practice in country-places, of inviting great num- bers of people to funerals, and crowding them into the same apart- ment where the corpse lies, is another way of spreading infection. The infection does not always die with the patient. Every thing that comes into contact with his body while alive, receives the con- tagion, and some of them, as clothes, blankets, &c. will retain it for a long time. Persons who die of infectious disorders ought not to lie long unburied ; and people should keep as much as pos- sible at a distance from them. It would tend greatly to prevent the spreading of infectious dis- eases, if those in health were kept at a proper distance from the sick. The Jewish Legislator, among many other wise institutions for preserving health, has been peculiarly attentive to the means of preventing infection, or defilement, as it is called, either from a diseased person or a dead body. In many cases the diseased were to be separated from those in health ; and it was deemed a crime even to approach their habitations. If a person only touched a diseased or dead body, he was appointed to wash himself in water, and to keep for some time at a distance from society. Infectious diseases are often communicated by clothes. It is ex- tremely dangerous to wear apparel which has been worn by a per- son who died of an infectious disease, unless it has been well washed and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This shows the danger of buying at random the clothes which have been worn by other people. Infectious disorders are frequently imported. Commerce, togeth- er with the riches of foreign climes, brings us also their diseases. These do often more than counterbalance all the advantages of that trade by means of which they are introduced. It is to be re- gretted, that so little care is commonly bestowed, either to prevent the introduction or spreading of infectious maladies. Some atten- 9i INFECTION AND CONTAGION. tion indeed is generally paid to the plague ; but other diseases pass unregarded. Infection is often spread through cities, by jails, hospitals, Sfc. These are frequently situated in the very middle of populous towns ; and when infectious diseases break out in them, it is impossible for the inhabitants to escape. Did magistrates pay any regard to the health of the people, this evil might be easily remedied. Many are the causes which tend to diffuse infection through populous cities. The whole atmosphere of a large town is one contaminated mass, abounding with various kinds of infection, and must be pernicious to health. The best advice that we can give to such as are obliged to live in large cities, is to choose an open sit- uation ; to avoid narrow, dirty, crowded streets ; to keep their own house and offices clean ; and to be as much abroad in the open air as their time will permit. It would tend greatly to prevent the spreading of infectious dis- eases, were proper nurses every where employed to take care of the sick. This might often save a family, or even a whole town, from being infected by one person. We do not mean that people should abandon their friends or relations in distress, but only to put them on their guard against being too much in company with those who are afflicted with diseases of an infectious nature. Such as wait upon the sick in infectious diseases, run very great haz- ard. They should stuff their noses with, tobacco, or some other strong-smelling herb, as rue, tansy, or the like. They ought like- wise to keep the patient very clean, to sprinkle the room where he lies with vinegar or other strong acids, frequently to admit a stream of fresh air into it, and to avoid the smell of his breath as much as they can. They ought never to go into company without having changed their clothes and washed their hands ; otherwise, if the disease be infectious, they will in all probability carry the contagion along with them. However trifling it may appear to inconsiderate persons, we will venture to affirm, that a due attention to those things which tend to diffuse infection would be of great importance in preventing dis- eases. As most diseases are in some degree infectious, no one should continue long with the sick, except the necessary attend- ants. I mean not, however, by this caution to deter those whose duty or office leads them to wait upon the sick, from such a lauda- ble and necessary employment. As a disinfecting agent, either of the following simple and easily obtained fumigations, may be carried at least once a-day through the apartments of the sick ; or for the purpose of fumigating apart- ments where sick people have been lodged : Take nitrate of potash, (nitre,) four drachms. Sulphuric acid, (oil of vitriol,) two drachms. Place them in a saucer upon hot sand ; or, Take muriate of soda, (common salt,) three ounces. Black oxide of manganese, one ounce. AFFECTIONS OF THE MIND. Sulphuric acid, one ounce. Water, two ounces. Mix the three first ingredients, and pour in the water gradually, when visible streams of gas will be elicited, capable of destroying the contagious effluvia generated in the apartment, or about the furniture, bed-clothes, t. Life itself becomes a burden, and the unhappy wretch, persuaded that no evil can equal what he feels, often puts an end to his miserable existence. It is great pity that ever religion should be so far perverted, as to become the cause of those very evils which it was designed to cure. Nothing can be better calculated than True religion to raise and support the mind of its votaries under every affliction that can befal them. It teaches that even the sufferings of this life are pre- paratory to the happiness of the next; and that all who persist in a course of virtue shall at length arrive at complete felicity. Persons whose business it is to recommend religion to others, should THE F.ECAL EVACUATIONS. 91 beware of dwelling too much on gloomy subjects. That peace and tranquillity of mind, which true religion is calculated to inspire, is a more powerful argument in its favour, than all the terrors that can be uttered. Terror may indeed deter men from outward acts of wickedness, but can never inspire them with that love of God, and real goodness of heart, in which alone true religion consists. To conclude ; the best way to counteract the violence of any passion, is to keep the mind closely engaged in some useful pur- suit. I have often heard that the late Lord Raimes, when he saw any literary friend sinking under the pressure of melancholy, or some other corroding passion, always gave this advice in a few emphat- ical words, "Write a book ;" which he believed to be an infallible remedy. I also knew the author of a very beautiful elegy cured of his grief for a wife, whom he tenderly loved, by studying how to express the greatness of his loss, and the pungency of his sor- rows in the most plaintive and affecting strains. Indeed, the ear- nest direction of our thoughts to some important object is, as I be- fore hinted, the surest method of subduing passions which may stubbornly resist the control of reason. CHAP. XII. THE NATURAL EVACUATIONS. The principal evacuations from the human body are those by stool, urine, and insensible perspiration. None of thes^ can be long obstructed without impairing the health. When that which ought to be thrown out of the body is too long retained, it not only occa- sions a plethora, or too great fulness of the vessels, but acquires qualities which are hurtful to the health, as acrimony, putrescence, &c. THE f^cal evacuation, &c. Few things conduce more to health than keeping the body regu- lar. When the fceces lie too long in the bowels, they vitiate the humours ; and when they are too soon discharged, the body is not sufficiently nourished. A medium is therefore to be desired which can only be obtained by regularity in diet, sleep, and exercise. Whenever the body is not regular, there is reason to suspect a fault in one or other of these. Persons who eat and drink at irregular hours, and who eat va- rious kinds of food, and drink of several different liquors at every meal, have no reason to expect either that their digestion will be good, or discharges regular. Irregularity in eating and drinking disturbs every part of the animal economy, and never fails to oc- casion diseases. Either too much or too little food will have this effect. The former, indeed, generally occasions looseness, and the lutter costiveness ; but both have a tendency to hurt the health. 92 URINE. It would be difficult to ascertain the exact number of stools which may be consistent with health, as these differ in the different periods of life, in different constitutions, and even in the same con- stitution under a different regimen of diet, exercise, Sec. It is, however, generally allowed, that one stool a-day is sufficient for an>dult, and that more or less is hurtful. But this, like most gen- eral rules, admits of many exceptions. I have known persons in perfect health who did not go to stool above once a week.* Such a degree of costiveness, however, is not safe ; though the person who labours under it may for some time enjoy tolerable health, yet at length it may occasion diseases. One method of procuring a stool every day is to rise betimes, and go abroad in the open air. Not only the posture in bed is un- favourable to regular stools, but also the warmth. This, by pro- moting perspiration, lessens all the other discharges. The method recommended for this purpose, by Mr. Locke, is likewise very proper, viz. to solicit nature, by going regularly to stool every morning whether one has a call or not. II abits of this kind may be acquired, which will in time become natural. Persons who have frequent recourse to medicines for preventing costiveness seldom fail to ruin their constitution. Purging medi- cines frequently repeated weaken the bowels, hurt the digestion, and every dose makes way for another, till at length they become as necessary as daily bread. Those who are troubled with cos- tiveness ought rather, if possible, to remove it by diet than drugs. They should likewise go thinly clothed, and avoid every thing of an astringent or of an heating nature. The diet and other regi- men necessary in this case will be found under the article Costive- ness, where this state of the bowels is treated as a disease. Such persons as are troubled with an habitual looseness ought likewise to suit their diet to the nature of their complaint. They should use food which braces and strengthens the bowels, and which is rather of an astringent quality, as wheat-bread made of the finest flour, cheese, eggs, rice boiled in milk, Sec. Their drink should be red port, claret, brandy and water, in which toasted bread has been boiled, and such like. As an habitual looseness is often owing to an obstructed perspi- ration, persons affected with it ought to keep their feet warm, to wear flannel next their skin, and take every other method to promote the perspiration. Further directions with regard to the treatment of this complaint will be found under the article Looseness. URINE. So many things tend to change both the quantity and appear- ances of the urine, that it is very difficult to lay down any deter- mined rules for judging of either.t Dr. Cheyne says, the urine * Some persons have told me that they did not go to stool above once a month. > f It has long been an observation among physicians, that the appearances of the mine are very uncertain, and very little to be depended on. No one will be surprised at this, who considers how many ways it may be-affected, and, consequently, have its appearance altered. The passions, the state of the atmosphere, the quantity and quali- ty of the food, the exercise, the clothing, the state of the other evacuations, and num- URINE. 93 ought to be equal to three-fourths of the liquid part of our aliment. But suppose any one were to take the trouble of measuring both, he would find that every thing which altered the degree of perspi- ration would alter this proportion, and likewise that different kinds of aliment would afford very different quantities of urine. Though for these, and other reasons, no rule can be given forjudging the pre- cise quantity of urine which ought to be discharged, yet a person of common sense will seldom be at a loss to know when it is in either extreme. As a free discharge of urine not only prevents but actually cures many diseases, it ought by all means to be promoted; and every thing that may obstruct it should be carefully avoided. Both the secretion and discharge of urine are lessened by a sedentary life, sleeping on l>eds that are too soft and warm, food of a dry and heating quality, liquors which are astringent and heating, as red port, claret, and such like. Those who have reason to suspect that their urine is in too small quantity, or who have any symp- toms of the gravel, ought not only to avoid these things, but what- ever else they find has a tendency to lessen the quantity of their urine. When the urine is too long retained, it is not only resorbed, or taken up again into the mass of fluids, but by stagnating in the blad- der it becomes thicker, the more watery parts flying off first, and the more gross and earthy remaining behind. By the constant tendency which these have to concrete, the formation of stones and gravel in the bladder is promoted. Hence it comes to pass that indolent and sedentary people are much more liable to these diseases than persons of a more active life. Many persons have lost their lives, and others have brought on very tedious, and even incurable disorders, by retaining their urine too long, from a false delicacy. When the bladder has been over- distended, it often loses its power of action altogether, or becomes paralytic, by which means it is rendered unable either to retain the urine, or expel it properly. The calls of nature ought never to be postponed. Delicacy is dmibtless a virtue, but that can nev- er be reckoned true delicacy which induces any one to risk his health, or hazard his life. But the urine may be in too great, as well as too small a quan- tity. This may be occasioned by drinking large quantities of weak watery liquors, by the excessive use of alkaline salts, or any thing that stimulates the kidneys, dilutes the blood, &c. This disorder very soon weakens the body, and induces a consumption. It is difficult to cure, but may be mitigated by strengthening diet and astringent medicines, such as are recommended under the article Diabetes, or excessive discharge of urine. berless other causes, are sufficient to induce a change either in the quantity or appear- ance of the urine. Any one who attends to this will be astonished at the impudence of those daring quacks, who pretend to find out diseases, and prescribe to patients, from the bare inspection of their urine. These impostures, however, are very com- mon all over Britain, and, by the amazing credulity of the populace, many of them amass considerable fortunes. Of all the medical prejudices which prevail in this country, that in favour of urine doctors is the strongest. The common people have still an unlimited faith in their skill, although it has been demonstrated that no one of them is able to distinguish the urine of a horse, or «n;T other animal, from that of n man. 94 PERSPIRATION. THE PERSPIRATION. Insensible perspiration is generally reckoned the greatest of all the discharges from the human body.* It is of so great impor- tance to health, that few diseases attack us while it goes properly on ; but when it is obstructed, the whole frame is soon disordered. This discharge, however, being less perceptible than any of the rest, is, consequently, less attended to. Hence it is that acute fe- vers, rheumatisms, agues, Sec. often proceed from obstructed per- spiration, before we are aware of its having taken place. On examining patients, we find most of them impute their dis- eases either to violent colds which they had caught, or to slight ones which had been neglected. For this reason, instead of a crit- ical inquiry into the nature of the perspiration, its difference in dif- ferent seasons, climates, constitutions, &c. we shall endeavour to point out the causes which most commonly obstruct it, and to show how far they may be either avoided, or have their influence coun- teracted by timely care. The want of a due attention to these, costs Britain annually some thousands of useful lives. CAUSES OF OBSTRUCTED PERSPIRATION, SeC. One of the most common causes of obstructed perspiration,t or catching cold, in this country, is the changeableness of the weath- er, or state of the atmosphere. There is no place where such changes happen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the dif- ferent seasons of the year, but often change almost from one ex- treme to another in a few days, and sometimes even in the course of one day. That such changes must affect the state of the per- spiration is obvious to every one. The best method of fortifying the body against the changes of the weather is, to be abroad every day. Those who keep most within doors, are most liable to catch cold. Such persons gener- ally render themselves so delicate, as to feel even the slightest * Sanctorius, an Italian physician, was the first that directed the attention of the faculty to the cutaneous and pulmonary transpiration, which he proved to exceed the other secretions considerably in weight; and he maintained that this function must have a considerable influence on the system, and was deserving of great considera- tion in the treatment of diseases. There is, doubtless, much of truth in this general observation ; but in its application to practice, he appears to have gone to an extrava- gant length, and to have considerably contributed to prolong the humoral pathology, which referred all diseases to a vitiated state of the fluids, which is now well known to be the effect instead of the cause. Ed. f From the time of Sanctorius, colds, coughs, fevers, and other diseases, have been attributed, by many, to the suppression of perspiration, although there was no direct experiment to prove it. That this may sometimes act as a cause there can be little doubt, but not so frequently as has been imagined ; for we see people perspiring some- times a great deal, at other times not at all, and without any bad effect. A man, in fine, enjoys as good health in winter as in summer ; in cold as in hot countries; and, besides that perspiration is carried on to a great extent by the lungs, nature has also taken care to guard against obstructed perspiration, by making it a vicarious secretion with the urine ; for when the former is increased the latter is diminished, and vies versa. The matter of perspiration, nevertheless, appears to be useless to the human frame, and perhaps contains materials that might prove hurtful if retained; hence, when obstructed, it may produce some complaints and aggravate others ; although ma- ny of the diseases attributed to retained perspiration arise from mere torpor of the skin; and the effect is here taken for the cause. See Diaphoretics, Cold Bath, &c. Ed. WET CLOTHES.—WET FEET.—NIGHT AIR, See. 95 changes in the atmosphere, and by their pains, coughs, and oppres- sions of the breast, &c. they become a kind of living barometers. WET CLOTHES. Wet clothes not only by their coldness obstruct the perspira- tion, but their moisture, by being absorbed, or taken up into the body, greatly increases the danger. The most robust consti- tution is not proof against the danger arising from wet clothes; they daily occasion fevers, rheumatisms, and other fatal disorders, even in the young and healthy. It is impossible for people who go frequently abroad to avoid sometimes being wet. But the danger might generally be lessen- ed, if not wholly prevented, by changing their clothes soon ; when this cannot be done, they should keep in motion till they be dry. So far are many from taking this precaution, that they often sit or lie down in the fields with their clothes wet, and frequently sleep even whole nights in this condition. The frequent instances which we have of the fatal effects of this conduct, ought certainly to deter all from being guilty of it. WET FEET. Wet feet often occasion fatal diseases. The colic, inflam- mations of the breast and of the bowels, the iliac passion, cholera morbus, &c. are often occasioned by wet feet. Habit will, no doubt, render this less dangerous; but it ought as far as possible to be avoided. The delicate, and those who are not accustomed to have their clothes or feet wet, should be peculiarly careful in this re- spect. night air. The perspiration is often obstructed by night air ; even in sum- mer this ought to be avoided. The dews which fall plentifully after the hottest day, make the night more dangerous than when the weather is cool. Hence in warm countries, the evening dews are more hurtful than where the climate is more temperate. It is very agreeable after a warm day to be abroad in a cool eve- ning ; but this is a pleasure to be avoided by all who value their health. The effects of evening dews are gradual, indeed, and al- most imperceptible ; but they are not the less to be dreaded: we would therefore advise travellers, labourers, and all who are much heated by day, carefully to avoid them. When the perspiration has been great, these become dangerous in proportion. By not attending to this, in flat marshy countries, where the exhalations and dews are copious, labourers are often seized with intermitting fevers, quinseys, and other dangerous diseases. DAMP BEDS. Beds become damp, either from their not being used, standing in damp houses, or in rooms without fire, Or from the linen not be- ing dry when laid on the bed. Nothing is more to be dreaded by 96 DAMP HOUSES. traveUers than damp beds, which are very common in all places where fuel is scarce. When a traveller, cold and wet, arrives at an inn, he may, by means of a good fire, warm diluting liquor, and a dry bed, have the perspiration restored ; but if he be put into a cold room, and laid in a damp bed, it will be more obstructed, and the worst consequences will ensue. Travellers should avoid inns which are noted for damp beds, as they would a house infected with the plague, as no man, however robust, is proof against the danger arising from them. But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of strangers are often equally dangerous. All kinds of linen and bedding, when not frequently used, become damp. How then is it possible that beds which are not slept in above two or three times a-year, should be safe ? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reason is ob- vious : were they careful never to sleep in a bed but what was fre- quently used, they would seldom find any ill consequences from a change. Nothing is more to be dreaded by a delicate person when on a visit, than being laid in a bed which is kept on purpose for stran- gers. That ill-judged piece of complaisance becomes a real inju- ry. All the bad consequences from this quarter might easily be prevented in private families, by causing their servants to sleep in the spare beds, and resign them to strangers when they come. In inns, where the beds are used almost every night, nothing else is necessary than to keep the rooms well seasoned by frequent fires, and the linen dry. That baneful custom, said to be practised in many inns, of damping sheets, and pressing them, in order to save washing, and afterwards laying them on the beds, ought, when discovered, to be punished with the utmost severity. It is really a species of mur- der, and will often prove as fatal as poison or gun-shot. Indeed no linen, especially if it has been washed in winter, ought to be used till it has been exposed for some time to the fire ; nor is this operation less necessary for linen washed in summer, provided it has lain for any length of time. This caution is the more needful, as gentlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay no regard to a circumstance of much more importance.* DAMP HOUSES. Damp houses frequently produce the like ill consequences : for this reason those who build should be careful to choose a dry situa- tion. A house which stands on a damp marshy soil or deep clay, will never be thoroughly dry. All houses, unless where the ground is exceedingly dry, should have the first floor a little raised. Ser- vants and others, who are obliged to live in cellars and sunk sto- ries, seldom continue long in health : masters ought surely to pay •If a person suspect that his bed is damp, the simple precaution of taking off the sheets ana Wing in the blankets, with all, or most of his clothes on, will prevent all the danger I have practised this for many years, and never have been hurt by damp beds, though'no constitution, without care, is proof against their baneful influence. SUDDEJN TRANSITIONS, Sec. 97 some regard to the health of their servants, as well as to their own. Nothing is more common than for people, merely to avoid some trifling inconveniency, to hazard their lives by inhabiting a house almost as soon as the masons, plasterers, Sec. have done with it; such houses are not only dangerous from their dampness, but like- wise from the smell of lime, paint, &c. The asthmas, consump- tions, and other diseases of the lungs, so incident to people who work among these articles, are sufficient proofs of their being un- wholesome. Rooms are often rendered damp by an unseasonable piece of cleanliness ; I mean the pernicious custom of washing them imme- diately before company is put into them. Most people catch cold if they sit but a very short time in a room that has been lately washed ; the delicate ought carefully to avoid such a situation, and even the robust are not always proof against its influence.* SUDDEN TRANSITIONS FROM HEAT TO'COLD. The perspiration is commonly obstructed by sudden transi- tions from heat to cold. Colds are seldom caught, unless when people have been too much heated. Heat rarifies the blood, quick- ens the circulation, and increases the perspiration ; but when these are suddenly checked, the consequences must be bad. It is, in- deed, impossible for labourers not to be too hot upon some occa- sions ; but it is generally in their power to let themselves cool gradually, to put on their clothes when they leave off work, to make choice of a dry place to rest themselves in, and to avoid sleep- ing in the open fields. These easy rules, if observed, would often prevent fevers and other fatal disorders. It is very common for people, when hot, to drink freely of cold water, or small liquors. This conduct is extremely dangerous. Thirst, indeed, is hard to bear, and the inclination to gratify that appetite frequently gets the better of reason, and makes us do what our judgment disapproves. Every peasant, however, knows, if his horse be permitted to drink his belly-full of cold water after vio- lent exercise, and be immediately put into the stable, or suffered to remain at rest, that it will kill him. This they take the utmost care to prevent. It were well if they were equally attentive to their own safety. Thirst may be quenched many ways without swallowing large quan- tities of cold liquor. The fields afford variety of acid fruits and plants, the very chewing of which would abate thirst. Water kept in the mouth for some time, and spit out again, if frequently re- peated, will have the same effect. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirst more ef- fectually, and make the danger less. When a person is extremely hot, a mouthful of brandy, or other spirits, if it can be obtained, ought to be preferred to any thing else. But if any one has been "People imagine if a good fire is made in a room after it has been washed, that there is no danger from sitting in it; but they must give me leave to say that this in- creases the danger. The evaporation excited by the fire generates cold, and leaders .the damp more active. 98 SUDDEN TRANSITIONS, Sec. so foolish, when hot, as to drink freely of cold liquor, he ought to continue his exercise at least till what he drank be thoroughly warmed upon his stomach. It would be tedious to enumerate all the bad effects which flow from drinking cold liquors when the body is hot. Sometimes this has occasioned immediate death. Hoarseness, quinseys, and fevers of various kinds, are its common consequences. Neither is it safe when warm to eat freely of raw fruits, salads or the like. These, indeed, have not so sudden an effect upon the body as cold liquors, but they are notwithstanding dangerous, and ought to be avoided. Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is extremely dan- gerous. Colds, coughs, and inflammations of the breast, are the usual consequences of this conduct; yet nothing is more common than for people, after they have drunk warm liquors for several hours, to walk or ride a number of miles in the coldest night, or to ramble about in the streets.* People are very apt, when a room is hot, to throw open a win- dow, and to sit near it. This is a most dangerous practice. Any person had better sit without doors than in such a situation, as the current of air is directed against one particular part of the body. Inflammatory fevers, quinseys, and consumptions have often been occasioned by sitting or standing thinly clothed near an open win- dow. Nor is sleeping with open windows less to be dreaded. That ought never to be done, even in the hottest season, unless the window is at a distance. I have known mechanics frequently con- tract fatal diseases, by working stripped at an open window, and would advise all of them to beware of such a practicc.t Few things expose people more to catch cold than keeping their own houses too warm : such persons may be said to live in a sort of hot-houses ; they can hardly stir abroad to visit a neighbour but at the hazard of their lives. Were there no other reason for keep- ing houses moderately cool, that alone is sufficient; but no house that is too hot can be wholesome; heat destroys the spring and elasticity of the air, and renders it less fit for expanding the lungs, and the other purposes of respiration. Hence it is that consump- tions and other diseases of the lungs prove so fatal to people who work in forges, glass-houses, and the like. Some are even so fool-hardy as to plunge themselves, when hot, in cold water.| ^*ot only fevers, but madness itself, has frequent- * The tap-rooms in London and other great towns, where such numbers of people spend their evenings, are highly pernicious. The breath of a number of people crowd- ed into a low apartment, with the addition of fires, candles, the smoke of tobacco, and the fumes of hot liquor, &c. must not only render it hurtful to continue in such places, but dangerous to go out of them into a cold and chilly atmosphere. t Although this long uncontradicted opinion, which daily observation confirms, hai also been contradicted by Sir Arthur Clarke, the analogies are too wide to bear com- parison. It will, we believe, be universally admitted that a current of air pressing upon an overheated body, although it might not prove " inevitably fatal," is neither consist- ent with safety nor prudence, while that body is in a passive state ; and in an active one it is better to be removed some distance from a voluminous rush of air, which would be the means of keeping perspiration in check that was labouring to be set free, there- by counteracting the effects of exertion. $ A modern writer (Sir Arthur Clarke) entertains, we rather suspect, an untenable opinion on this particular subject; nor do we conceive in what manner sudden exter- nal transitions should be attended with less danger than such as are internally applied. SI'DDEN TRANSITIONS, Sec. 99 ly been the effect of this conduct. Indeed it looks too like the ac- tion of a madman to deserve a serious consideration. The result of all these observations is, that every one ought to avoid, with the utmost attention, all sudden transitions from heat to cold, and to keep the body in as uniform a temperature as pos- sible ; or where that cannot be done, to take care, when heated, to let it cool gradually. People may imagine that too strict an attention to these things would tend to render them delicate. So far, however, is this from being my design, that the very first rule proposed for preventing colds is, to harden the body, by inuring it daily to the open air. I shall put an end to what relates to this part of my subject, by giving an abstract of the justly celebrated advice of Celsus, with respect to the preservation of health: "A man," says he, " who is blessed with good health, should confine himself to no " particular rules either with respect to regimen or medicine. He "ought frequently to diversify his manner of living ; to be some- " times in town, sometimes in the country ; to hunt, sail, indulge " himself in rest, but more frequently to use exercise. He ought " to refuse no kind of food that is commonly used, but sometimes " to eat more and sometimes less ; sometimes to make one at an en- " tertainment, and sometimes to forbear it; to make rather two " meals a-day than one, and always to eat heartily, provided he " can digest it. He ought neither too eagerly to pursue, nor too " scrupulously to avoid intercourse with the fair sex : pleasures of " this kind, rarely indulged, render the body alert and active; but " when too frequently repeated, weak and languid. He should " be careful in time of health not to destroy, by excesses of any " kind, that vigour of constitution which should support him un- " der sickness." This plain, yet elegant and judicious summary of the most useful maxims of health, confirms the justness of my former remark, that enlightened Medicine breathes the true spirit of liberal indulgence, laying down no rules but such as a man of sense would cheerfully " It has been very commonly supposed," observes Sir Arthur, " even by medical men that immersion in the cold-bath, when the body was considerably heated with exercise' or other exertion, is a dangerous practice; and, accordingly, it is a general custom with bathers who find themselves overheated, to wait till they become cool, before they plunge into the bath. This opinion and practice has been ably controverted by the late Dr. Currie, who has shown, both from theory and experience, that the opinion is erroneous, and the practice injudicious. This is so true, that for some years he has directed infirm persons to use a degree of exercise before immersion, as may produce an increased action of the vascular, with some increase of heat, and thus secure a force of re-action under the shock, which otherwise might not always take place." We think Sir Arthur has brought Dr. Currie forward rather untimely ; for it is evident the latter alludes to infirm persons; convalescents, with whom almost invariably the beat of the body, accompanied with a sense of dullness, is below the natural standard: it is judicious, therefore, enough that such people should use a degree of exercise to enable them to resist the shock of the cold-bath, and to secure a re-action under it, which otherwise they could not withstand. This practice, however, applies equally to persons in health, whom we would caution never to use the cold-bath at a time when a cold sensation pervades the whole body, any more than to plunge Into U at a time when the body is overheated; although both of these conditions may admit of being considerably regulated by the feelings of the individual. " The popular opinion, therefore," says Sir Arthur Clarke, upon the preceding grounds, ''that it is safest to go perfectly cool into the water is an unfounded error productive of injurious conse- quences." Practice and experience, with all deference to such an opinion, have proved the reverse. Ed. 100 THE KNOWLEDGE, CURE, AND follow and forbidding nothing but what is incompatible with real hap- piness. Here the votaries of fashion and folly may learn to correct their own mistaken ideas of enjoyment; the epicure may acquire a relish for rational gratification ; and the man of pleasure may be taught the economy of love. PAftT II. CHAP. I. THE KNOWLEDGE AND CURE OF DISEASE . The cure of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often foresee the patient's fate sooner than many who have been bred to physic* We do not, however, mean to insinuate that a medical education is of no use : it is doubtless of the greatest importance, but it never can supply the place 6f observation and experience. Definition of diseases, &c.—Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead, therefore, of giving a classical arrangement of diseases, according to the sys- tematic method, it will be more suitable, in a performance of this nature, to give a full and accurate description of each particular disease as it occurs ; and, where any of the symptoms of one dis- ease have a near resemblance to those of another,t to take notice of that circumstance, and at the same time to point out the pecul- iar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine. A proper attention to the patient's age, sex, temper of mind, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases. In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin : whereas in old age the fibres are rigid, the nerves become almost insensible, and many of the vessels '" Physicians express this prescience by the term Prognosis, or the art of predicting 'the event of diseases from particular symptoms. f'Physicians express these symptomatic characters by the word Diagnosis; viae. the signs by which one disease may be distinguished from another disease. Hence, those symptoms which distinguish such affections are termed diagnostic signt. DEFINITION OF DISEASES, Sec. 101 imperviable. These and other peculiarities render the diseases of the young and aged very different, and of course they must re- quire a different method of treatment. See Diseases of Chil- dren. Females are liable to many diseases which do not afflict the other sex : besides, the nervous system being more irritable in them than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations; and all stimulating medicines ought to be administered to thein with a sparing hand. See Diseases of Females. Particular constitutions not only dispose persons to peculiar diseas- es, but likewise render it necessary to treat these diseases in a peculiar manner. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, .under any disease, precisely in the same manner as one who is hardy and robust, and one who is much exposed to the open air. The temper and mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When that is affected, the best medicine is to soothe the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible. See affections of the mind. Attention ought likewise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabitants of high countries. Those who breathe the im- pure air of cities have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and in- dulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, Sec. It has already been observed, that the different occupations and situations in life dispose men to peculiar diseases. (See p. 47.) It is therefore necessary to enquire into the patient's occupation, manner of life, &.c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary precisely in the same manner, even supposing them to labour un- der the same disease. It will likewise be proper to enquire, whether the disease be constitutional or accidental ; whether it has been of long or short duration ; whether it proceeds from any great and sudden altera- tion in the diet, manner of life, Sec. The state of the patient's body, and of the other evacuations, ought also to be enquired into ; and likewise whether he can with ease perform all the vital and animal functions, as breathing, digestion, &c. Lastly, it will be proper to enquire to what diseases the patient has formerly been liable, and what medicines were most beneficial to him; if he has a strong aversion to any particular drug, &c. As many of the indications of cure may be answered by diet alone, it is always the first thing to be attended to in the treat- ment of diseases. Those who know no better, imagine that every tkiikg which goes by the name of a medicine possesses some won- 102 DEFINITION OF DISEASES, &c. derful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences ; it makes people trust to drugs, and neglect their own endeavours; besides, it discourages all attempts to relieve the sick where medicines cannot be obtained. Medicines are no doubt useful in their places; and when admin- istered with prudence, may do much good; but when they are put in place of every thing else, or administered at random, which is not seldom the case, they must do mischief. We would, therefore, wish to call the attention of mankind from the pursuit of secret medicines, to such things as they are acquainted with. The prop- er regulation of these may often do much good, and there is little danger of their ever doing hurt. Every disease weakens the digestive powers. The diet ought, therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even absti- nence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking. In all fevers attended with inflammation, as pleurisies, peri- pneumonies, &c. thin gruels, wheys, watery infusions of mucilagi- nous plants, roots, &c. are not only proper for the patient's food, but they are likewise the best medicines that can be administered. In fevers of a slow, nervous, or putrid kind, where there are no symptoms of inflammation, and where the patient must be sup- ported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known. Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afflicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food, and generous liquors, than from all the cordial and carminative medicines which can be ad- ministered to them. The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet than to all the boasted antiscorbutic remedies of the shops. In consumptions, when the humours are vitiated, and the stom- ach so much weakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet con- sisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed. Nor is the attention to other things of less importance than diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other diseases, the patient will receive more benefit from having the fresh air pru- dently admitted into his chamber, than from all the medicines which can be given him. See Air, p. 65. Exercise may likewise in many cases be considered as a medicine: sailing, or riding on horseback, for example, will be of more ser- vice in the cure of consumptions, glandular obstructions, Sec. than DEFINITION OF DISEASES, Sec. 103 any medicines yet known. In diseases which proceed from a re- laxed state of the solids, the cold bath, and other parts of the gym- nastic regimen, will be found equally beneficial. See Exercise, P-66. Few things are of greater importance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the dan- ger. Many diseases may be cured by cleanliness alone ; most of them may be mitigated by it, and in all of them it is highly neces- sary both for the patient and those who attend him. See Clean- liness, p. 78. Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regi- men will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment of" diseases, we have always given the first place to regimen. Those who are ignorant of medicine may con- fine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These, however, are never to be administered but by people of better understanding ; nor even by them without the greatest precaution. The clearness and simplicity with which I took care to express myself on these points, would, I thought, have prevented the pos- sibility of any misrepresentation. Yet I find that a certain low class of self-appointed practitioners, who call themselves of the faculty, take no small pains to insinuate, that my observations on the prevention and cure of diseases serve only to encourage the fatal practice of domestic quackery. This is equally inconsistent with candour and truth. The obvious tendency of all my remarks is to enlighten the minds of the people on a subject of such imme- diate concern as their health, and thus to guard them against the bad effects of ignorance and rashness on their own part, and of impudence and deceit on the part of others. I should rather have expected to be blamed for teaching people to place very little reliance on the efficacy of any medicine; which was, indeed, one of the objects 1 had in view, for the express pur- pose of directing general attention to the far more assured means of preserving health, namely, air, cleanliness, diet, exercise, and the management of the passions. Upon these subjects I enlarged with peculiar earnestness, well knowing how much easier it is to prevent disorders before-hand than to cure them afterwards. Even in cases of actual infirmity and disease, I have intimated a wish, that those who are ignorant of physic would confine them- selves to regimen only, and leave the medical treatment of their complaints to persons of better information. The remedies which I have prescribed may be entrusted to such hands with perfect safety; and if the directions I give do not operate as a check upon rashness, I know of no words strong enough to produce that effect. 104 GENERAL OBSERVATIONS ON FEVERS, Sec. CHAP. II. GENERAL OBSERVATIONS ON FEVERS, Sec. Fevers, though the most common complaints, are those in which mankind, whether professional or laical, are those by which they are most apt to be misled. It has been well observed, that " in reality, no writer seems to have been fully satisfied with his own definition, and it is not extraordinary, therefore, that he should have seldom given satisfaction to others." This difficulty proceeds from the complexity of the symptoms that enter into the charac- ter of a fever; the contrariety of many of them to each other in different stages of it; and the occasional absence of some, thaf, in other instances, appear to constitute its leading features. There are also two other difficulties of no inconsiderable magnitude, which the nosologist has to contend with in laying down a clear and per- spicuous survey of fevers; namely, their division or collocation, and their generic names,—a province, on which, however, it is not our intention now to discuss. The remote cause of fever can frequently be traced ; but we are too little acquainted with the nature of several of them to be able to restrict them to a specific mode of action : of the proximate cause, but very little is at present known, and will probably be long before we know much more. The usual division of fevers is into intermittents, and continu- ed, on account of their taking up different times in their natural duration ; some being compounded of a number of paroxysms, fol- lowing each other in a regular succession, at some distance of time, as happens in intermittents or agues ; in others, a fresh paroxism comes in, immediately as the crisis of the former, so as hardly to leave the patient wholly free from fever, as occurs in remittents; and in others, there is such a quick succession of paroxysms, that the one comes on before there is any visible abatement of the fe- brile symptoms as in continued fevers. Causes of fevers, &c.—As more than one half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are, infection, er- rors in diet, unwholesome air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and ex- treme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shown, we shall not now resume the consideration of them, but shall only recom- mend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles. Fevers are not only the most frequent of all diseases, but they are likewise tie most complex. In the most simple species of fever there is always a combination of several different symptoms. The dis- tinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in erforming some of the vital or animal functions. The other symp- CAUSES OF FEVERS, Sec. 105 toms usually attendant on fevers, are nausea, thirst, anxiety, de- lirium, weariness, wasting of the flesh, want of sleep, or the sleep disturbed and not refreshing. When the fever comes on gradually, the patient generally com- plains first of languor or listlessness, soreness of the flesh or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth ; after some time come on excessive heat, violent thirst, restlessness, the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept in a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick person's chamber, so as to keep it moderately cool. Indeed, its degree of warmth ought never to be greater than is agreeable to one in perfect health. Nothing spoils the air of a sick person's chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such. air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manner poisonous to the sick. In fevers, when the patient's spirits are low and depressed, he is not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing hi& mind with the hopes and consolations of religion, frighten him with the views of hell and damnation. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct; it often hurts the body, and there is reason to believe seldom benefits the soul. Among common people, the very name of a fever generally sug- gests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature ; but true inflammatory fevers are now seldom to be met with. Sedentary occupations, and a different manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is ne- cessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, Sec. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be evident 6igns of inflammation. Bleeding is an excellent medicine when ne- cessary, but should never be wantonly performed. It is likewise a common, notion, that sweating is always, nec«K 108 SYMPTOMS OF FEVER. sary in the beginning of a fever. When the fever proceeds from „ an obstructed perspiration, this notion is not ill-founded. If the patient only lie in bed, bathe his feet and legs in warm water, and drink plentifully of warm water-gruel, or any other weak, diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever ; it will open the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c, which fire his blood, in- crease the spasms, and render the disease more dangerous. In all fevers, a proper attention should be paid to the patient's longings. These are the calls of Nature, and often point out what may be of real use. Patients are not indeed to be indulged in ev- ery thing that the sickly appetite may crave ; but it is generally right to let them have a little of what they eagerly desire, though it may not seem altogether proper. When a patient is recovering from a fever, great care is neces- sary to prevent relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and del- icate, it is necessary to guard against catching cold. Moderate exercise in the open air will be of use, but great fatigue is by all means to be avoided ; agreeable company will also have a good effect. The diet must be light, but nourishing. It should be tak- en frequently, but in small quantities. It is dangerous, at such a time, to eat as much as the stomach may crave. From the great variety of fevers that afflict the human body, it is impossible to find any medicine adapted to them all, or, in- deed, to all the symptoms of any one of them. Notwithstanding this, the people of England have, for half a century, been swal- lowing a powder said to possess wonderful virtues in the cure of fevers. Nor has the use of this powder been confined to England ; it has been carried to every part of the globe ; and great cures have been attributed to it, with what truth I will not pretend to say. I remember bleeding to have been as much in vogue in fe- vers, though now it is seldom prescribed, unless in local inflam- mations. But there is a fashion in physic, as well as in other things ; and it is always heresy to talk against the doctrine of the day. This fever-powder, like other quack medicines, is said to be good in a variety of complaints, and is used by some people in ev- ery disorder, real or imaginary. I knew a lady, who not only ad- ministered it to all the poor of the parish when ill, but likewise gave it to her dogs and horses ; and never failed to take it daily herself, till she destroyed her constitution. Many persons look upon it as panacea, or universal remedy, and keep it continually by them in case of emergencies. The fatal consequences of such credulity must be often irreparable. This, at least, was the situa- tion of an old General of my acquaintance, whom no argument eould dissuade from taking the powder, till he lost the use of all his extremities. INTERMITTENT FEVERS, Sec. 109 There is not a greater solecism in language, nor a greater ab- surdity in real practice, than to pretend that any one medicine is of certain efficacy in fevers. The most skilful physicians that ever existed have always found it necessary to watch attentively the progress of a fever ; and to adapt both the regimen and medicines to the different changes and symptoms as they occurred. CHAP. ZZZ. INTERMITTENT FEVERS, OR AGUES. The generic character of an intermittent fever consists of peri- ods or paroxysms, between each of which there is a perfect inter- val when no fever is present. They admit of several distinctions, as true, spurious, perfect, and imperfect. The true and perfect intermittents which occur are ; 1. The quotidian or daily—having an intermission of 24 hours. 2. Tertian, or third-day, 48 hours. 3. Quartan, or fourth-day, 72 hours. When the return of an intermittent exceeds the latest of these times, it is called erratic or wandering. The other distinctions are of no practical utility, the means of cure being the same. The paroxysm of an intermittent consists of three successive stages, viz. a hot, a cold, and a sweating stage. Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally known. The several kinds of intermittent fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c. It appears to be generally acknowledged, that marsh miasmata, or the effluvia arising from stagnant water, or marshy ground, when acted upon by heat, are the most frequent exciting cause of this fever. Exciting causes.—This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the fens of Cambridgeshire, the hundreds of Essex, &c, although we are not yet sufficiently acquainted with all the circumstances which are requisite to render marsh mias- mata productive of intermittents. In acknowledging, however, the lnfluen. c of marsh effluvia to produce intermittents, they must not, at the same time, be considered as their universal cause, since it is found that persons residing constantly in the most healthy 110 INTERMITTENT FEVERS, Sec. part of cities, and far remote from marshes, are not unfrequently attacked by them. Predisposing.—This disease may also be occasioned by debility, however induced, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions of the mind, &c. When the inhabitants of a high country remove to a low one, they are generally seized with intermittent fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circula- tion in the capillary or small vessels, disposes the body to agues. Symptoms of the cold stage.—An intermitting fever generally begins with pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and vio- lent shaking. Of the hot stage.—After a longer or shorter continuance of shivering, the heat of the body gradually returns ; irregularly at first, and by transient flushes, soon, however, succeeded by a steady, dry, and burning heat, considerably augmenting above the natural standard. The skin which before was pale and constricted, be- comes now swollen, tense, and red; and is remarkably sensible to the touch. The sensibility, diminished in the cold stages, is now preternaturally acute ; pains attack the head, and flying pains are felt over various parts of the body. The pulse is quick, strong, and hard; the tongue white, the thirst is great, and the urine is high coloured. Of the sweating stage.—A moisture is at length observed to break out upon the face and neck, which soon becomes universal and uniform. The heat falls to its ordinary standard; the pulse diminishes in frequency, and becomes full and free ; the urine de- posits a sediment; the bowels are no longer confined ; respiration is free and full; all the functions are restored to their natural or- der ; when, after a specific interval, the paroxysm returns, and performs the same successional evolutions. Between the paroxysms, the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch- He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bit- ter, has been infused. As the chief intentions of cure in an ague are to brace the sol- ids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such a* INTERMITTENT FEVERS, Sec. Ill his strength will permit. Nothing tends more to prolong an in- termitting fever, than indulging a lazy indolent disposition. Intermitting fevers, under a proper regimen, will frequently go off without medicine : and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course ; but when the patient's strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This, however, should never be done till the disease be properly formed, that is to say, till the pa- tient has had several fits of shaking and sweating. Medical treatment.—1. This consists during the cold stage, in endeavouring to bring on the hot, by means of artificial warmth ; putting the feet in warm water ; giving mild diluent liquids ; dia- phoretic cordials ;* opiates, &c. 2. During the hot stage, to promote perspiration, by means of cordial diaphoretics, with the means recommended in the cold stage. The principal object, therefore, in the treatment of intermittents, is to put a period to the stage which is present, by hastening that which naturally succeeds it. The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more effica- cious. In this disease the stomach is generally loaded with cold viscid phlegm, (sordes,) and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Emetics are, therefore, to be administered be- fore the patient takes any other medicine, which may be adminis- tered just before the accession of the cold fit. A dose of ipecacu- anha will generally answer this purpose very well. A scruple or half a drachm of the powder will be sufficient for an adult,t and for a younger person the dose must be less in proportion. After it begins to operate, the patient ought to drink plentifully of weak camomile-tea; and it may be repeated at the distance of two or three days. Emetics not only eleanse the stomach, but increase the perspiration, and all the other secretions, which render them of * Take Spirits of Nitric jEther, 2 drachma. Camphor mixture, 4 ounces. Liquor of acetated Ammonia, 1 ounce. Syrup of Roses, 3 drachms. Mix*: and take two table-spoonsful every fifteen minutes. t Take Powder of Ipecacuanha, 15 grains. Tartarised Antimony, 1 grain. Make an Emetic powder. or Powder of Ipecacuanha, 15 grains. Tartarized Antimony, 1 grain. Spearmuch water, l£ ounce. Syrup of Saffron, 1 ounce. Make an Emetic draught. or Take Peruvian Bark, 1 ounce. Divide into twelve equal parts, of which take one every hour, or every second or third hour, in a small cupful of new milk, during the absence of the fever. or Take Peruvian Bark, 1 ounce. Compound Cinnamon powder, £ drachm. Mix, and divide into twelve equal parts or Take Peruvian Bark, 1 ounce. Confection of Opium, 1 drachm. Mix, and divide into twelve equal parts. or Take Peruvian Bark, 1 ounce. Powdered Rhubarb, 2 scruples. Mix, and divide in twelve equal parts; to be taken as above. 112 INTERMITTENT FEVERS, Sex:. such importance, that they often cure intermitting fevers without the assistance of any other medicine. Purgative medicines are likewise useful and often necessary in intermitting fevers. Emetics, however, are more suitable in this disease, and render purging less necessary ; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bow- els by a dose or two of Epsom salts, jalap, or rhubarb, as may ap- pear best adapted to the constitution. Bleeding may sometimes be proper at the beginning of an in- termitting fever, when excessive heat, delirium, &c. give reason to suspect an inflammation or congestion of blood in the external ves- sels of the head; but as the blood is seldom in an inflammatory state in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease. After proper evacuations, the patient may safely use the Peruvi- an bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder. It may also, as required, be advantageously combined with other sub- stances, as, confection of opium, rhubarb, cinnamon also, in any form ; e. g. in powder, electuary, tincture, decoction, extract, Sec. Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses, as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient.* In an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method, the patient will be able to take five or six doses between each paroxysm. In a tertian, or third day, ague, it will be suffi- cient to take a dose every third hour, during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person, a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms.t The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to pa- tients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave * It has lately been observed, that the red bark is more powerful than that which has for some time been in common use. Its superior efficacy seems to arise from its be- ing of a more perfect growth than the quill-bark, and consequently more fully impreg- nated with the medical properties of the plant. f In intermitting fevers of an obstinate nature, I have found it necessary to throw in the bark much faster. Indeed, the benefits arising from this medicine depend chiefly upon a large quantity of it being administered in a short time. Several ounces of bark given in a°few days, will do more than as many pounds taken in the course of some weeks. When this medicine is intended either to stop a mortification, or cure an obstinate ague, it ought to be thrown in as fast as the stomach can possibly bear it. Inattention to this circumstance has hurl the reputation of one of the best medicines of which we are in possession. INTERMITTENT FEVERS, Sec. HU it off, and begin again at some distance of time : by which means the disease gathers strength, and often returns with as much violence as before. A relapse may always be prevented by the patient's continuing to take doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure. An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile flowers, and an handful of coiiander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this in- fusion drank three or four times a-day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a-day. If patients drink freely of the above, or any other proper infusion of bitters, •a smaller quantity of bark than is generally used will be sufficient to eure an intermittent. Those who cannot swallow the bark in substance may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pou* off the clear liquor. A wine-glass may be drank three or four times a-day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drachms of snake- root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, to an English pint. To the strained li- quor may be added an equal quantity of red wine, and a glass of it taken frequently. In obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than if taken alone. This I have had frequently occasion to observe in a coun- try where intermitting fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an in- flammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn or beginning of winter, warm and cordial medicines are absolutely necessary.* The sulphate and oxide of zinc have been successfully prescrib- ed : the former, in doses of a quarter or half a grain every four or six hours, is said to have proved very efficacious in cases of obstin- ate intermittents. As a tonic, the ammoniated copper has been given with considerable advantage. All these may be employed along with a decoction of cinchona, or any of the tonic bitters here recommended. * In obstinate agues, when the patient is old, the habit phlegmatic, the season rainy, the situation damp, or the like', it will be necessary to mix with two ounces of the bark, half an ounce of Virginian snake-root, and a quarter of an ounce of ginger, o* wme other warm aromatic ; but when the symptoms are of an inflammatory nature, half an ounce of salt of wormwood (subcarbonate of potash.) or salt of tartar, may be added to the above quantity of bark. 114 INTERMITTENT FEVERS, Sec. As autumnal and winter agues generally prove much more ob- stinate than those wliich attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an inter- mitting fever in the beginning of winter, ought frequently, if the season prove rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds. When agues are not properly cured, they often degenerate into obstinate chronical diseases, as the dropsy, jaundice, Sec. For this reason all possible care should be taken to have them radical- ly cured, before the constitution has been too much weakened. Though nothing is more rational than the method of treating intermitting fevers, yet, by some strange infatuation, more charms and whimsical remedies are daily used for removing this than any other disease. There is hardly an old woman who is not in pos- session of a nostrum for stopping an ague ; and it is amazing with what readiness their pretensions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of their disorder. Some, indeed, try bold, or rather fool-hardy experiments, to cure.agues, as drinking great quantities of strong liquors, jumping into a river, taking arsenic,* &c. These may sometimes have the desired effect, but must always be attended with danger.t When there is any degree of inflammation, or the least tendency to it, such experiments may prove fatal. The only patient whom I re- member to have lost in an intermitting fever, evidently killed him- self by drinking strong liquor, which some person had persuaded him would prove an infallible remedy. Many dirty things are extolled for the cure of intermitting fe- vers, as spiders, cobwebs,:}: snuffings of candles, Sec. Though * Take Liquor of Arsenic (Fowler's solu- Tincture of Cardamoms. tion,) 6 mins. or dps. Syrup of Ginger, of each, 1 drra. Cinnamon Water, 1A oz. Make a draught, to be taken every hour. t Vomitings, gripings, and swellings, and the loathing of food, are the troublesome symptoms now and then produced by an improper use of the arsenical solution. They generally, however, disappear on discontinuing the drops, or only require the exhi- bition of gentle opiates, some warm cathartic, or the tincture of rhubarb. It is said to cure intermittents in eight days. In Lincolnshire, which is a fenny country, where agues are very prevalent, it is universally used, and with most uniform success, and has been successfully administered by quacks under the appellation of the ague-drop. | It is a very old popular belief that the spider's web cures agues, but among medi- cal men, till within the last twenty years, little credit was given to this supposed pop- ular superstition. In Dr. Robert Jackson's late visit to Philadelphia, he mentioned the efficacy of this remedy as indisputably ascertained, and averred (what he after- wards published) that as an anodyne to allay pain or calm irritation, it proved vastly superior even to opiates. It has for some time past been pretty liberally prescribed by Drs. Physick, Chapman, and Dewers, in Philadelphia; and though they attach differ- ent degrees of value to the article, " they are all satisfied that the representation of its virtue is very little, if at all exaggerated. In doses of five grains, repeated every fourth or fifth hour, Dr. Chapman has cured some obstinate intermittents, suspended the par- oxysms of hectic, overcome morbid vigilance from excessive nervous mobility, and quieted irritation of the system from various causes. That used by Dr. Chapman was collected in cellars, and were probably the product of the common black spider. He has also satisfied himself that the web found in light exposed situations, the product INTERMITTENT FEVERS, Sec. 115 these may sometimes succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended up* on for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be used with safety; and I can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in. Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeble sharpness with diluted sulphuric acid. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, a proportionate dose of the saline mixture* may be given with advantage to children. Wine-whey is a very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit of hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourish- ing, and sometimes a little generous wine should be allowed. To children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm wa- ter, with the addition of half an ounce of sweet oil, and six or eight drops of laudanum, is the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of ex- tract and laudanum must be proportionably lessened. Children have been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it: by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirit, or with a mixture of equal parts of the tincture of opium and the soap liniment. To prevent agues, people must endeavour to avoid their causes. These have been already pointed out in the beginning of this sec- tion : we shall, therefore, only add one preventive medicine, which may be of use to such as are obliged to live in low marshy coun- tries, or who are liable to frequent attacks of this disease. Take an ounce of the best Peruvian bark; Virginian snake- root, and orange-peel, of each half an ounce ; bruise them all to- gether, and infuse for five or six days in a bottle of brandy, Hol- land gin, or any good spirit; afterwards pour off the clear liquor, and take a wine-glass of it twice or thrice a-day. This, indeed, is recommending a dram ; but the bitter ingredients in a great meas- ure take off the ill effects of the spirit. Those who do not choose of the grey spider, is inert, and so is the web of the other, when not recent, which may be known by its glutinous feel." See Elements of Therapeutics and Materia Medica. By N. Chapman, M. D. In two Vols. 8vo. Vol. ii. " Take Sulphate of Magnesia, 6 drachms. Syrup of Orange-peel, 1 drachm. Infusion of Senna, l£ ounce. Make a purging draught, I 116 INTERMITTENT FEVERS, Sec. it in brandy, may infuse it in wine ; and such as can bring them- selves to chew the bark, will find that method succeed very well. Gentian-root, or calamus aromaticus, may also be chewed by turns for the same purpose. All bitter tonics seem to be antidotes to agues, especially those that are warm and astringent.* Various other species of bark are found to be equally efficacious in the cure of intermittents ; e. g. salix fragile, or crack-willow bark, cascarilla, cusparia, Jamaica bark, oak bark, Sec. Two new vegetable alkalis have been procured from the Peru- vian bark ; one from the red, or cinchona oblongifolia, called cin- chonina : the other from the grey, or cinchona cordifolia, called quinine, though this is found in both the red and yellow bark. Quinine,t the most distinguished in the cures of agues, is white and intensely bitter. Its success in removing intermittents has been amply confirmed by Dr. Elliot, of St. Thomas's hospital, and others ; and it possesses many advantages over the Peruvian bark in any shape ; among which the smallness of the dose is not the least important, being from five to ten grains, either in the form of syrup, pills, tincture, wine, Sec. Intermittent fevers assume various types at different seasons, &c. which it is the province of the physician to attend to. Their character seems to depend much upon the age or peculiar habit of the body of the individual, and the temperament of the atmos- phere. It is also observed that variations are more common in the quotidian than in any other type, which, perhaps, may be at- tributed to its more frequent occurrence in early life, when .the frame is more irritable, and to the debility which the constitution suffers from this type above that of any other, in consequence of the greater length of its paroxysms, and the greater brevity of its intervals, by which means the prostrated strength of the sys- tem has no time to rally or recover itself. Diet.—While the fit continues, the patient ought to drink free- ly of water-gruel, orange-whey, weak comomile-tea ; or, if his spir- its be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that will assist in bringing on the sweat, and consequently shorten the paroxysm.J * Blessed thistle, gentian, wormwood, camomile, bitter wood, columba, St. Ignatiu bean, lesser centaury, German leopard's bane. or t Take Sulphate of Quinine, 12 grains. Take Sulphate of Quinine, 15 grs. Good Madeira wine, 2j pints. Extract of Camomile, 15 grs. Make a solution ; the dose of which may Beat up and divide into six pills; one to be from four to twenty four ounces in be taken every third hour. the course of the day. or or Take Sulphate of Quinine, 15 grs. Take Sulphate of Quinine, 6 grs. Simple Syrup, £ pint. Alcohol (specific gravity 847) 1 gr. Mix for a surup, and take three table Make a tincture j dose 2 to 6 drms. spoonsful three times a day. \ Dr. Lind says, that twenty or twenty-five drops of laudanum put into a cup of the patient's drink, and given about half an hour after the commencement of the hot fit, promotes the sweat, shortens the fit, relieves the head, and tends greatly to remove the REMITTENT FEVER. 117 CHAP. XV. REMITTENT FEVER. This fever takes its name from a remission of the symptoms, which happens sometimes sooner and sometimes later, but gener- ally before the eighth day. The remission is commonly preceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration: the nearer, however, that the fever approach- es to a regular intermittent, the danger is the less. Causes.—Remittent fevers prevail in low marshy countries abounding with wood and stagnating water ;* but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, Bengal, in the East Indies, Sec. where re- mitting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy seasons, great inundations, or the like. No age, sex, or con- stitution is exempted from the attack of this fever; but it chiefly seizes persons of a lax habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and use un- wholesome diet. Symptoms.—The first symptoms of this fever are generally yawn- ing, stretching, pain, languor, and giddiness in the head, with al- ternate fits of heat and cold. Sometimes the patient is affected with a delirium at the very first attack. There is a pain and some- times a swelling, about the region of the stomach, the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full; and the blood, when let, rarely shows any signs of inflammation. Some patients are exceedingly costive, and others are afflicted with a very troublesome looseness. It is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circum- stances too tedious to mention. Sometimes the bilious symptoms * Although originally produced by marsh miasma, and in its simple state not of an infectious nature, this fever under bad management, such as crowding too many sick together, neglecting proper cleanliness and a free ventilation, there cannot be a doubt that it may in its course engender a matter capable of occasioning a fever of a highly contagious nature ; and although remittent fever cannot be communicated at any great distance from the source of its exciting cause, however severely and epidemically it may prevail in certain situations and districts; and although the matter producing it be essentially the same, still we may conclude, " I think," says Dr. Thomas,(a) " that a more aggravated form of the disease is occasioned by a more concentrated state pf the person : hence the different degrees of severity of remittent fever at different pe- riods of the year, and in different climates." Ed. (a) Modern Practice of Physic. 118 REMITTENT FEVER.' predominate, sometimes the nervous, and at other times the pu- trid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person. Diet.—The regimen must be adapted to the prevailing symp- toms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms prevail, it will be necessary to support the pa- tient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must, however, be very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regi- men, and improper medicines. Whatever the symptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if possible, should be large, and frequently ventilated by letting in fresh air at the doors and win- dows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed clothes, &c. should be frequent- ly changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to imagine.* Medical treatment.—In order to cure this fever, we must en- deavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. But in all protracted cases, under every climate, where the pulse is weak, but where the head is still much affected, the application of cupping-glasses to the back part of the head, or of leeches to the temples, will be more advisable than venesection. As nausea usually prevails at the commencement of the disease, an emetic will seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well; but where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be re- peated once or twice at proper intervals, if the sickness or nausea continues. Cold affusion, where it can be practised with propriety, produ- ces the most agreeable effects with a tendency to sleep, fuller and more uniform pulse, moist skin, and now and then a distinct re- mission. To alter the type of the fever, it may be proper to give * The patient's shirt, bed-clothes, and bedding, ought frequently to be changed, and exposed to the air, and all his excrements immediately removed; the bed-chamber should be well ventilated, and frequently sprinkled with vinegar; in short,, every at- tention should be paid to the patient. I can affirm, that a physician who puts these in practice will much oftenersucceed, than one who is even more skilful, but hat not op- portunity of using these means. Da. Likd. REMITTENT FEVER. 119 antimonials,* in small and repeated doses. To allay vomiting, warm fomentation of camomiles, and bruised poppy-heads, clear the seat of the stomach. Saline draughts in a state of efferves- cence, to each of which may be added ten drops of the tincture of opium. The body ought to be kept open either by clysters or gentle lax- atives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like ; but all strong or drastic purgatives are to be carefully avoided. In this fever, as well as in that called the yellow fever {typhus vterocles,) the submuriate of mercury.t combined with rhubarb or jalap, may be regarded as a valuable remedy, where it is wished to carry off putrid feculent matter from the bowels, and there is at the same time any degree of nausea or vomiting present, as, from the smallness of the bulk, it may possibly be retained on the stom- ach when every other purgative might be rejected. In cold climates we may wait for a perfect and complete remis- sion before the bark is administered ; but in warm climates it ought to be given even in the most imperfect and shortest remis- sion ; and although it may not prove sufficiently efficacious to pre- vent a fresh attack at first, it will, nevertheless, mitigate the subse- quent return of the fever, and at last bring about regular and a per- fect remission. When this is omitted in warm^ climates, it is apt to assume a continued form. By this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case the Pe- ruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the hark, as we have already had occasion frequently to mention them. The most likely way to avoid this fever is to use a wholesome or nourishing diet, to pay the most scrupulous attention to cleanli- ness, to keep the body warm, to take sufficient exercise, and in hot countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which we can recommend is the Peruvian bark, which may either be chewed, or infused in brandy or wine, &c. Some recommend smoking tobacco as very beneficial in marshy coun- tries, both for prevention of this and intermitting fevers. And to guard against a relapse, the bark should be continued for some days after the attacks have ceased, and not, as is frequently the case, too hastily laid aside. A remittent fever is always attended with some hazard, particu- larly in warm climates, in which it usually goes through its course in the space of five or six days ; but in cold ones, its crisis is not usually affected until the twelfth or fourteenth. The shorter and * Take compound powder of ipecacuanha, 4 grains. Camphor, 3 grains. Confection of Roses, enough. Make a bolus, to be taken every third or fourth hour. t Take powdered Rhubarb, 10 to 20 grs. Submuriate of Mercury (Calomel,) 5 grains. Simple Syrup, enough to make up into four pills for a dose. or Take powdered Jalap, 15 grs. Submuriate of Mercury, 15 grs. Make a powder. 120 CONTINUED FEVERS. more obscure the remissions are the greater the danger, and each succeeding paroxysm is attended with more risk than the former one. On the contrary, the milder the attack, and the nearer the fever approaches to the intermittent form, the sooner will be the prospect of the patient's recovery. As disorders of this kind are more to be dreaded in a camp than the approach of an enemy, it is the duty of superior officers \ci-y earnestly to concur with their medical attendants in enforcing the proper means of prevention. The spirit of our soldiers betrays them into a contempt of disease, as well as of danger ; and they are too apt to forget, that no hardihood can of itself resist the warm, sickly moisture of autumn, and the damp air of the night to which they are often unavoidably exposed. Those brave, but thought- less men, should, therefore, be obliged to pay more attention to the simple preservatives from fevers above pointed out. I have too high an opinion of the talents of many eminent physicians and surgeons now in the army, to think any farther remarks on this subject necessary. I am persuaded that a hint will be suf- ficient to call forth the fullest exercise of their skill, their humani- ty, and their zeal also, for the honour and security of their coun- try, in saving their lives, and promoting the health and vigour of its gallant defenders. CHAP. V. CONTINUED FEVERS. Fevers of this type continue for several days, with nearly the same degree of violence, having evident exacerbations and remis- sions daily. SYNOCHUS, OR SIMPLE CONTINUED FEVER. A combination of synochal or inflammatory typhoid or putrid symptoms appear to constitute this species of fever ; the former being apt to preponderate at the commencement, the latter towardi the termination of the disease. It is contagious, and is of more frequent occurrence in this country. Remote Causes.—Every thing having a tendency to enervate the body, may be considered as a remote cause of fever ; and, ac- cordingly, we often find it resulting from great bodily fatigue, too great indulgence in sensual pleasures, violent exertions, intemper- ance in drinking, errors in diet, Sec.; and now and then from the suppression of long accustomed evacuations ; with all the causes enumerated under the general observations on fevers. See Fe- vers. It is the opinion of many physicians, that there is somethina in the nature of all acute diseases, except those of a putrid kind, CONTINUED FEVERS. 121 which usually determines them to be of a certain duration ; conse- quently, these terminations, when salutary, happen at certain peri- ods of the disease, rather than others, unless disturbed in their progress by improper treatment, or the occurrence of accidental causes. These periods, from the time of Hippocrates to the pres- ent day, have been pretty generally admitted, under the name of critical days. The days in wliich it is supposed the termination of continued fevers principally happens, are the third, fifth, seventh, ninth, eleventh, fourteenth, seventeenth, and twentieth. A simple continued fever terminates always by a regular crisis; and it is observable, with respect to diseases, the definite periods which take place in regular intermittents, as well those general as topical, in the course of true inflammation, which at the fourth, or furthest at the seventh day, is resolved, or after this period changes into abscess, scirrhus, or gangrene. In exanthematous eruptions, which, if they are favourable and regular, show themselves on a certain and definite day; for example, the small-pox about the fourth : in measles about the third and fourth. Symptoms.—An attack of simple continued fever is generally characterized by the patient's being seized with a considerable de- gree of languor or sense of debility, with sluggishness, an aversion to motion, frequent yawning and stretching; the face and extrem- ities at the same time becoming pale, the skin over the whole body becoming constricted ; a subsequent sensation of cold in the back, passing thence over the whole frame; and these continuing to in- crease, tremors in the limbs, and cold shiverings succeed. With these symptoms, there is loss of appetite, want of taste in the mouth, slight pains in the back, head, loins, and a small and frequent respiration. The sense of cold and its effects, after a little time become less violent, alternated with flushes ; and, at length, going off altogether, they are succeeded by great heat, diffused generally over the whole body ; the face appears flushed, the skin looks dry, as also the tongue ; uuiversal restlessness prevails, with violent pain of the head, oppression at the chest, sickness at the stomach, with inclination to vomit. There is likewise great thirst and cos- tiveness ; and the pulse is full and frequent, producing, perhaps, 90, 100, or 120 pulsations in a minute. When these symptoms run high, and there is considerable determination of blood to the head, delirium will ensue. There is, generally, in this fever, as in others of the continued kind, an increase of symptoms towards the evening. Unfavourable symptoms.—If the disease is likely to prove fatal, either in consequence of its long continuance, or the severity of the symptoms, there will be observed a starting of the tendons (subsultus tendinis,) the patient picking the bed-clothes ; involun- tary discharges by urine and stool; coldness of the extremities, and hiccups: but where no such appearances occur, the fever will run its course, and ultimately cease. Favourable symptoms.—The pulse becoming soft, moderate, and approaching its natural state: the tongue losing its furred ap- F 122 INFLAMMATORY FEVER. pearance, and becoming clean ; thirst nbating, the skin covered with a gentle and equable moisture, and feeling soft to the touch; the secretory organs performing their several functions, and the urine depositing flaky crystals of a dirty red colour, and becoming turbid on being allowed to stand. Medical treatment.—In fever, all bodily motion should be avoid- ed, especially that which calls any of the muscular powers into mo- tion ; the patient ought therefore to be confined to bed. The stom- ach and rest of the alimentary canal, in many cases of fever, be- ing manifestly affected in a higher degree than any other part of the body, emetics and purgatives, which are early adopted. The treatment, in short, will be nearly the same in this as in synocha or inflammatory at the commencement; the utmost caution, how- ever, must be employed in the use of those means which have a manifest tendency to reduce the tone of the system, especially blood-letting ; so that sufficient strength may be left to combat the succeeding stage, wliich is invariably one of great debility, and in which the treatment will be that proper for typhus or putrid fever. Diet.—In this fever, particularly at the commencement, the an- tiphlogistic regimen will be strictly necessary, as well as in some others of continued fevers. That kind of aliment which gives the least stimulus will be the most proper : it should consist of the most light, nutritive, and easiest digestible substances, c. g. preparations of barley, oatmeal, sago, vermicelli, tapioca, and the meal of Indi- an arrow, varying them now and then for panado, roasted apples, Sec. Animal broths increase the heat of the body, and, conse- quently, are improper, unless the patient be in a state of conva- lescence. The drink may be barley-water, linseed-tea, toast and water, milk whey, thin gruel, lemonade, &c. carefully abstaining from the use of spirituous or fermented liquors. CHAP. VI. INFLAMMATORY, ACUTE, OR ARDENT FEVER (synocha.) This fever is characterized with considerable increase of heat, a frequent, strong, and hard pulse, urine red, the animal functions but little disturbed, although at an advanced stage of it, the brain is apt to become much affected. It most commonly attacks the young, or persons about the prime and vigour of life, especially such as live high, abound in blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year; but is most frequent in the spring and beginning of summer. Causes.—Sudden transitions from heat to cold ; any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries, a full INFLAMMATORY FEVER. 123 diet, with little exercise, application of cold to the body when warm, &c. It may likewise be occasioned by whatever obstructs the perspiration, as lying on the damp ground, drinking cold li- quor when the body is hot, night-watching, repelled eruptions, sup- pressed evacuations, &c. Symptoms.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid counte- nance, pains in the back, loins, Sec. To these succeed difficulty of breathing, sickness, with an inclination to vomit. The patient complains of great thirst, has no appetite for solid food, is restless, and his tongue is of a scarlet colour at the sides, and furred with white in the centre. Unfavourable symptoms.—Delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons, hiccup, cold clammy sweats, and an involuntary discharge of urine, with those enumerated under this head in sim- ple continued fevers, &c. This disease usually goes through its course in about fourteen days, and terminates critically, either by a diaphoresis (gentle degrees of perspiration,) diarrhoea, hemorrhage from the nose, or the deposit of a copious sediment in the urine; a crisis which is usually preceded by some variation in the pulse. In some instances, however, it terminates fatally. Our judgment, therefore, of the disease, must be entirely regulated by the vio- lence of the attack, and the nature of the symptoms. As this disease is always attended with danger, the best medi- cal assistance ought to be procured as soon as possible. A physi- cian may be of use at the beginning, but his skill is often of no avail afterwards. Diet.—From the symptoms of this disease, it is evident, that the blood and other humours require to be attenuated; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity ; that the vessels are rigid, and the heat of the whole body too great: all these clearly point out the necessity of a regi- men calculated to dilute the blood, correct the acrimony of the hu- mours, allay the excessive heat, remove the spasmodic stricture of the vessels, and promote the secretions. These important purposes may be greatly promoted by drink- ing plentifully of diluting liquors, as water-gruel, or oatmeal-tea ; clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries, and such like : orange-whey is likewise an excellent cooling drink. It is made by boiling among milk and water a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonsful of vinegar will have the same effect. Two or three spoonsful of white wine may occasionally be added to the liquor when boiling. If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English pints of water to a quart. This makes a very pleas- ant drink, and may be used at discretion. The common pectoral 124 INFLAMMATORY FEVER. decoction is likewise a very proper drink in this disease. A tea- cupful of it may be taken every two hours, or oftener, if the pa- tient's heat and thirst be very great.* The above liquids must all be drank a little warm. They may be used in smaller quantities at the beginning of a fever, but more freely afterwards, in order to assist in carrying off the disease by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to choose those which are most agreeable, and that when tired of one, he may have recourse to another. The patient's diet must be very spare and light. All sorts of flesh meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, panado, or light bread boiled in water; to which may be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples, with a little sugar, toasted bread with jelly of currants, boiled prunes, &c. It will greatly relieve the patient, especially in a hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold. It is too common in fevers to load the patient with bed-clothes under the pretence of making him sweat, or defending him from the cold. This custom has many ill-effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the perspiration. Sitting upright in bed, if the patient be able to bear it, will often have a good effect. It relieves the head, by retarding the motion of the blood to the brain. But this posture ought never to be con-' tinued too long: and if the patient be inclined to sweat, it will be more safe to let him lie, only raising his head a little with pil- lows. Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-water, with a little nitre dissolved in it, will greatly re- fresh the patient. This ought to be done frequently, especially if the weather be hot. The patient's mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoction of figs in barley-water. His feet and hands ought likewise frequently to be bathed in lukewarm water ; especially if the head be affected. The patient should be kept as quiet and easy as possible. Com- pany, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that affects the senses, ought to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted ; even the promise of what he craves will often satisfy him as much as its reality. Medical treatment.—In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest import- * See Appendix, Pectoral Decoction. ii\*L,AMiviATORY FEVER. 125 aiice. This operation ought always to be performed as soon as the symptoms of an inflammatory fever appear; and one large bleed- ing at this period of the disease will have a much better effect than repeated small ones afterwards. The quantity of blood to be tak- en away from a large orifice, however, must be in proportion to the strength of the patient and the violence of the disease. If the patient be young and plethoric, twelve to twenty ounces of blood may be drawn off at once from a large orifice. If after the first bleeding the fever should increase, and the pulse become more fre- quent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth time, which may be done at the distance of twelve, eighteen, or twenty-four hours from each other, as the symptoms require. If the pulse continue soft, and the patient be tolerably easy after the first bleeding, it ought not to be repeated. If nausea prevail at the commencement of the disease, the stom- ach may be relieved by making the patient drink one or two cups- ful of the infusion of camomile flowers ; but should these simple means not be attended with the desired effect, he may take a table spoonful of an emetic solution, every quarter of an hour, until suf- ficiently eased. If the heat and fever be very great, forty or fifty drops of the dulcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf-sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours will be sufficient, using some diluent drink. If the body be bound, a clyster of milk and water, with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea- spoonful of magnesia alba, or cream of tartar, may be frequently a put into his drink, or some gentle aperient may be given.* He may likewise eat tamarinds, boiled prunes, roasted apples, and the like. If there be pain in the head with delirium, oppressed breathing, or determination to any organ, leeches should be applied to the temples, or other parts, blisters, fomentations, Sec. and the treat- ment laid down for the particular organ affected should be adopted. If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish sediment, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient's spir- its grow languid, his pulse sinks, and his breathing becomes diffi- * Take Pulp of Tamarinds, A ounce. Cream of Tartar, 2 drachms. Boiling Water, 5 ounces. Strain off the liquor and add, Cinnamon Water, 1 ounce. Tartarised Antimony, 1 grain. Four table spoonsful to be taken for a dose, to be repeated in three hours, should no motions in that time have been obtained. or Take Sulphate of Soda, 6 drachms. Infusion of Senna, 1 £ ounce. Syrup of Oranges, 1 drachm. Make a purging draught. or Take powdered Rhubarb, 25 grains. Cream of Tartar, 1 drachm. Make a powder, to be taken out of some appropriate vehicle. 126 INFLAMMATORY FEVER. cult, with a stupor, trembling of the nerves, starting of the ten- dons, &c. there is reason to fear that the consequences will be fa- tal. In this case blistering-plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion ; poul- tices of wheat-bread, mustard, and vinegar, may likewise be ap- plied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel, with wine in it, and such like, especially camphor and aether.* A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body be weak after a fever, yet the diet for some time ought to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the pa- tient should not attempt to pursue study, or any business that re- quires intense thinking. If the digestion be bad, or the patient be seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the re- mains of the fever. When the patient's strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a dram of senna may be boiled for a few minutes in an English pint of water, and an ounce of manna dissolved in the decoction; after- wards it may be strained, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening. Those who follow laborious employments ought not to return too soon to their labour after a fever, but should keep easy till their strength and spirits are sufficiently recruited. It requires very little argument to prove, that the body, as well as the mind, must require indulgence after the severity of such a disease. But I find it more difficult to prevent people from carry- ing this indulgence to excess in what relates to eating and drink- ing. The appetite is usually voracious upon recovering from most fevers, and to say, that its cravings are not to be satisfied, is cer- tainly an unpalatable doctrine. Yet self-command is necessary in such cases, as there will be great danger, not only of a relapse, but of other disagreeable consequences, such as biles, ulcers, and settled swellings in particular limbs. These may be obviated by a light and principally vegetable diet, not however totally exclud- ing animal food of easy digestion. Sudorifics do not appear to be advisable in this fever, from their aptitude to bring on profuse perspiration ; and it is not possible to keep the body warm without producing a considerable increase of heat. Epsom, or any of the other neutral salts, may be given in some simple form, every two or three hours, joined with small • Take camphor mixture, 6 ounces. each, 2& drachms. Spirits of compound ether. Mix, and give the patient two table spoons- Aromatic spirits of ammonia, of ful every hour. NERVOUS FEVER. 127 nauseating doses of tartarized antimony,* or the like, or so as to act on the bowels as occasion may require. A bath for the feet, at night, may assist the effect. In this fever, as in most others, sleep is much interrupted and from a want of it delirium often ensues. Opium here would be an uncertain remedy, for should it fail to procure rest, the deliri- um would be considerably increased by it. It should, therefore, only be given in cases of imminent danger, and even then in small doses, frequently repeated, paying strict attention to the state it produces. Throughout the whole disease the patient must be strictly en- joined to pay the greatest attention to the diet here laid down, and to abstain from solid food, and animal broths of any kind. Fresh air, exercise of a gentle kind, on horseback or in a car- riage, agreeable society, and a moderate use of wine, will greatly contribute to the recovery of convalescents. Should the digestive organs prove weak, which will be indicated by the appetite not readily returning, stomachic bitters, as advised under the head of indigestion, may be taken with advantage, &c. CHAP. VII. SLOW OR NERVOUS FEVER. (Typhus Mitior.) Nervous fevers have increased greatly of late years in this isl- and, owing doubtless to our different manner of living, and the in- crease of sedentary employments ; as they commonly attack per- sons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors. Causes.—Nervous fevers may be occasioned by whatever de- presses the spirits, or impoverishes the blood; as grief, fear, anxi- ety, want of sleep, intense thought, living on poor watery diet, as unripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fa- tal to those who live in low dirty houses, crowded streets, hospitals, jails, manufacturing or large towns, or such like places. It principally attacks those of weak lax fibres, and persons whose constitutions have been broken by excessive venery, frequent salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease. Keeping on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs the perspiration, or causes a spas- modic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so • Take Epsom Salts, 6 drachms. Syrup of Oranges, 1 drachm. Infusion of Senna, G ounces. Mix, and make a purgative draught, as Antimony Wine, 20 drops. occasion may require. 128 NERVOUS FEVER. much to preserve the body in a sound state as a regular diet ; nor can any thing (outii!,-:;te more to occasion fevers of the worst kind than its opposite. The most general cause of this fever is contagion,* communi- cated through the medium of an impure or heated atmosphere, by concentrated effluvia arising from the body of a person labouring under this specific disease ; but whatever debilitates the system or oppresses the mind may induce a state of pre-disposition more readily to be influenced by its operations ; and although in the origin and progress of typhus and such like fevers, it is undenia- ble that contagion is the most powerful agent in propagating the disease, still many of these fevers, though not contagious at their origin, become so in their progress and decline, and, in some in- stances, generate others of a much worse description than the ori- ginal one ; and this, in all probability, is the way in which epidem- ics appear and spread. In warm climates typhus sometimes occurs, and continued fe- vers of most kinds are apt to degenerate into fever of a typhus type. It is, however, most prevalent in temperate and cold cli- mates. In Great Britain typhus is favoured by a low temperature, being most prevalent in the cold months of winter, generally abat- ing or disappearing as the summer-heat advances, and often pre- vailing, in a considerable degree, in cool wet autumns. Symptoms.—Typhus Mitior generally sets in with remarkable mildness in its symptoms ; and although the patient experiences some trifling indisposition for several days, still he has no reason to suspect the approach of any severe disease. There is dejection of spirits; want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chilliness and flushings in turns, &.c. After some time the patient complains of a giddiness and pain of the head, has a nausea, with retchings and vomiting; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienation of the mind. If, towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moist- ure upon the skin ; or if a suppuration happen in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis. But if there be an excessive looseness or wasting sweats, with frequent fainting fits ; if the tongue when put out trembles ex- Dr. Haygarth, who devoted considerable attention to the consideration of the con- tagious nature of typhus fever, and the manner in which it ia propagated, has deduced therefrom a variety of important facts, of very great importance for the prevention of misery, and the preservation of human life; whence he concludes, that typhus mav be easily and certainly prevented by ventilation; (in large, airy, and clean rooms ) or by separation (into air hospitals, or into an adjoining room of the same house where practicable!; or especially by cleanliness, which entirely destroys the poison 'when- ever it can be completely accomplished. (See Dr. Haygarth's letter to Dr Percival NERVOUS FEVER. 129 cessively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there be a starting of the tendons, and almost total loss of sight and hearing, and an involuntary discharge of stool and urine, there is great reason to fear that death is ap- proaching. Diet.—It is very necessary, in this disease, to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient's imagination gloomy or frightful ideas. These of themselves but often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate them. The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or negus sharpened with the juice of or- ange or lemon, will be proper for his ordinary drink. Mustard- whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine.* Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from any of their bad qualities ; I say good wine ; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities. I have often seen patients in low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the ex- tremities, and almost every other mortal symptom, recover by us- ing, in whey, gruel, and negus, a bottle or two of strong wine eve- ry day. Good old sound claret is the best, and may be made into negus, or given by itself, as circumstances require.! In a word, the great aim in this disease is to support the pa- tient's strength, by giving him frequently small quantities of the above, or other drinks of a warm and cordial nature. He is not, however, to be overheated either with liquor or clothes ; and his food ought to be light, and given in small quantities. Medical treatment.—Where a nausea, load, and sickness at stomach, prevail at the beginning of the fever, it will be necessary * See Appendix, Mustard Whey. t Where wine cannot be procured, equally beneficial effects have been produced by drinking sound porter or ale with a lemon or orange sliced into it, and rendered agreeable to the palate of the patient by the addition of moist sugar. This beverage may be drunk at pleasure, will be found'to support strength as effectually as wine, and is in general much relished by the sick ; with the addition of one dram of muriatic acid to each quart of the liquor, it forms a remedy to which the cure of most of tha low fevers of this country may with safety be confided. Ed. F2 130 NERVOUS FEVER. to give the patient a gentle vomit.* This may be repeated any time before the third or fourth day, if the above symptoms contin- ue. Emetics not only clean the stomach, but, by the general shock wliich they give, promote the perspiration, and have many other excellent effects in slow fevers, where there are no signs of inflammation, and nature wants rousing. Such as dare not venture upon an emetic, may clear the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna, or sublimate of mercury.f In all fevers, the great point is to regulate the symptoms, so as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood dense, and the fibres too rigid, bleeding and other evacuations are necessary. But in nervous fevers, where nature flags, where the blood is vapid and poor, and the solids re- laxed, the lancet must be spared, and wine, with other cordials, plentifully administered. It is the more necessary to caution people against bleeding in this disease, as there is generally, at the beginning, an universal stricture upon the vessels, and sometimes an oppression and diffi- culty "of breathing, which suggest the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feelings in this respect, so far as to insist upon being bled, when it was evident, from the consequences, that the operation was improper. Though venesection is generally improper in this disease, yet topical bleeding from the temples, at the commencement, to re- lieve cerebral congestion, will be advisable, in persons of delicate constitutions ; although in full plethoric habits it may, be more proper to draw off six or eight ounces of blood from the arm, or jugular vein, on the first day of the attack. Cold affusions is one of the most powerful and efficacious means that can be resorted to in typhus fever ; but its effects will be more salutary in propor- tion as it is adopted early, or during the first stage of the disease. The affusion may be repeated four or five times in the course of the twenty-four hours, using spring water impregnated with com- mon salt, when sea water is not at hand. At the same time the patient's feet may be placed in a warm bath. This operation be- ing over, the feet dried, and the patient put to bed, some tepid bland fluid may be given to promote perspiration. In the more advanced stage a tepid affusion may be substituted for the cold, to which a small portion of ardent spirit may be added to the wa- ter, with the view of increasing the evaporative process. Vinegar ib usually substituted, although the former is preferable. Blister- ing is also highly necessary. Blistering plasters may be applied, at all times of the feve.-, with great advantage. If the patient be delirious, he ought to be blistered on the neck or head, and it will be the safest course, when the insensibility continues, as soon as * See Simple continued Fever. fTake Powdered Jalap, 10 grains. Submuriate of Mereury, 3 grains. Syrup of Buckthorn, enough to make the mass, which divide into three pills for a dose. NERVOUS FEVER. 131 the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger. I have been more sensible of the advantage of blistering in this, than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacua- tions, which seldom happen in this kind of fever. They are most proper, however, either towards the beginning, or after some de- gree of stupor has come on, in which last case it will always be proper to blister the head. If the patient be costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not op- erate. Should a violent looseness come on, it may be checked by hav- ing recourse to astringents;* but, in the progress of the disease, if a gentle diarrhoea occur, and seem likely to prove critical, it should by no means be checked. A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen ; but the patient should be sup- ported by gentle cordials, as wine-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too warm, yet a kindly-breathing sweat should by no means be checked. Though blistering and the use of cordial liquors are the chief" things to be depended on in this kind of fever ; yet for those who may choose to use them, we shall mention one or two of the forms' of medicine which are commonly prescribed in it. In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary ef- fects from large doses of musk, ether, camphor, ammonia, opium, frequently repeated. Musk is doubtless an antispasmodic, and may be given to the quantity of a scruple three or four times a-day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphor, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus, fifteen grains of musk, with three grains of camphor, and six grains * Take Chalk Mixture, 2 ounces. Tincture of Catechu, 2 drms. Tincture of Opium, 30 drops. Cinnamon Water. Make a mixture, of which give two table spoonsful every six hours. Take Virginian Snake-root. Contrayerva, of each 10 grains. Russian Castor, 5 grains. Syrup of Saffron, enough to make the mass into a bolus, to be taken every four or five hours. or Take powdered Valerian, 1 sple. Saffron. Russian Castor, of each, 4 grains. Make a powder, to be taken every thre«- or four hours, in a cup of wine-whey. 132 NERVOUS FEVER. of salt of hartshorn, may be made into a bolus with a little syrup, and given as above ; or in any of the subjoined forms.* If the fever should happen to intermit, which it frequently does towards the decline, or if the patient's strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stom- ach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in pow- der may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, and a glass of it tak- en frequently. The bark may likewise be very properly administered, along with other cordials, in the following manner —Take an ounce of Peruvian bark, orange-peel half an ounce, Virginian Snake-root two drachms, saffron one drachm. Let all of them be powdered, and infused in an English pint of the best brandy for three or four days. Afterwards the liquor may be strained, and two tea-spoon- fuls of it given three or four times a-day in a glass of small wine or negus. I now generally administer Huxham's tincture. Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observations may tend to establish this practice, we will not pretend to say; but we have reason to believe, that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers, where bleeding is not necessary, or where there are no symptoms of top- ical inflammation. There is no fever that requires to be watched with more care and attention than this. If the actions of the system are not kept up by stimulating applications, and the patient's strength support- ed by cordial medicines and nourishing diet, he will sink under the disease ; and it frequently happens, that, when the attendants think him better, he is actually dying. Mulled port wine, or pure port wine, or diluted brandy, should be frequently administered ; profuse perspirations may be restrain- ed by the use of some of the vegetable acids.t Should the extrem- ities become cold, direct senapisms \ to the feet, blisters to the in- side of the ancles, and give camphor and ether. I wish to inspire not only patients in this fever, but their physi- cians also, with unceasing, unabated hope till the very last extrem- * Take musk mixture, 6 oz. Compound Tincture of Cardamoms, 1 oz. Make a mixture, of which let two table spoonsful be taken every two hours. or Take Musk mixture, 7 oz. Compound Spirit of Ether, 2 drs. Syrup of Roses, 3 drs. Of which, make a mixture, and let the pa- tient take a table spoonful often. t Take of the strongest Camphor Mixture, 7 oz. Diluted Sulphuric Acid, i drm. Three table spoonsful to be taken often. or Take of infusion of Roses. Port Wine, of each equal parts ; mix for the ordinary drink. \ Take strongest Camphor mixture, 7 oz. Spirit of Compound Ether, 2 drs. Make a mixture—two table spoonsful eve- ry two hours. fUTKlD FEVER. 133 ity. The changes for the better are often as sudden, and unfore- seen, as those for the worse. The last gasp alone should induce us to give over the patient. I have left a patient twenty times and more, little expecting to see him alive next day. Yet I did not lose courage, but ordered a bottle, or perhaps two, of generous wine to be given in the course of twenty-four hours ; and that pa- tient, to my great satisfaction, recovered, and enjoyed health for many years after. CHAP. VIII. MALIGNANT AND PUTRID, OR SPOTTED FEVER, ( Typhus gravior.) This fever, which takes its name from the malignancy of its na- ture, and the symptoms of putrefaction observed towards its close, may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watching, hard labour, excessive venery, frequent salivations, &c. are most liable to it. Causes.—This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly venti- lated ; from putrid animal and vegetable effluvia, to ^ taken as above Tinct. of Orange-peel, 1 drachm. X Take Common Vinegar, 3 drachms. Cinnamon-water, 1 \ ounce. Infusion of Camomile, 5 ounces. Syrup of Saffron, 1 drachm. Mix for a clyster. Make a draught. To be taken every third or hour. Take Common Salt, £ ounce. or Vinegar, 2 ounces. Take Oxymuriatic Acid, 20 minims. Infusion of Camomile, 6 ounces. Decoction of Bark, 1A ounce, Make a clyster. 140 MILIARY FEVER. In typhus, whatever may be the mode of action of yeast, it ap- pears to be indisputable that fixed air takes off that extreme debil- ity of the stomach, so conspicuously marked in disorders of this nature ; and in proportion as that subsides, the pulse rises, becomes slower and fuller, the burning heat on the skin disappears, and a truce is gained for the reception of nutrition. CHAP. IX. MILIARY FEVER. This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together. The whole body is sometimes covered with pustules ; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption ; but when the skin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary disease ; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ar- dent, putrid, or nervous fever, Sec. In all these cases it is gener- ally the effect of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is like- wise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and live upon weak watery diet. Such females are ex- tremely liable to be seized with this disease in childbed, and often lose their lives by it. Causes.—The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety, thoughtfulness, ike. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy reasons, eating too freely of cold, crude, unripe fruit, as plums, cherries, cucumbers, melons, &c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stop- page of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women, nose. The vessels of that part readily heal, but an accident of the same kind taking place in the lungs, not unfrequently lays the foundation of consumption. This temporary fulness of blood should be counteracted, by strictly adhering to a diet of the farinacea and ripe fruits. Ani- mal food and fermented liquors ought to be rigidly prohibited. Even milk often proves too nutritious. Exercise should be regu- lar but gentle. Sudden and violent exertions are extremely haz- ardous. Riding on horseback is preferable to any other kind of exercise. Such efforts of the voice as are required in singing or playing on any wind-instrument of music, frequently produce dis- charges of blood from the lungs ; but the practice of reading or reciting for some time together in a moderate tone of voice, tends to strengthen these organs, and to diminish the danger of pulmo- nary hemorrhage from any sudden exertion. During the circulation of the blood through the lungs, a princi- ple necessary to the support of life is absorbed from the air; and various matters, the longer continuance of which in the body would be noxious, are also discharged in the form of vapour or gas. That there is, besides, no inconsiderable quantity of aqueous fluid se- creted and discharged from the lungs, every person must be con- vinced, who has attended to the deposition of watery particles that takes place from the breath in a frosty day. Of the whole quanti- ty of perspirable matter discharged from the surface of the body in any given portion of time, that exhaled from the surface of the 166 PREVENTION OF CONSUMPTION. lungs may be estimated as amounting to one-third. The skin and the lungs being both secreting surfaces, must also be considered as organs mutually compensating or balancing each other. If the skin be suddenly chilled, a larger share of perspirable matter will endeavour to escape by the lungs, as being an internal, and there- fore a warmer surface. It is not surprising that this effort should in a delicate organ be productive of derangement and disease, and accordingly we daily hear people dating their first attack of pul- monary complaints from sitting in a cold place after having been over-heated, from being thoroughly soaked with rain, or from cold- bathing in an improper state of the system. The purpose of these observations is to enforce the propriety of maintaining cutaneous perspiration, and endeavouring to ren- der the surface of the body less susceptible of atmospheric varia- tions. In persons of a phthisical habit the skin is in general either dry and scabrous, or clammy, both of which conditions betoken deficient perspiration. The most effectual means of removing this morbid state of the surface of the body is the sedulous use of cuta- neous friction. Why a practice, on which the ancient physicians placed so much dependence not only for the cure of many diseases, but in a pre-eminent manner for the preservation of health, should have in modern times fallen so completely into neglect, it is not perhaps easy to account; although at present nothing seems to be considered as medicine except what is taken into the stomach ; as if the due regulation of air and exercise did not furnish means of recovery, at least as efficacious as drugs. Cutaneous friction is most advantageously performed by means of a flesh-brush. To be of any essential use, this instrument ought to be of a much harder texture than those commonly offeredTor sale. The most favourable season for this practice is not immedi- ately on getting out of bed. There exists a sensibility of the skin at that time which renders the application of the brush painful and unpleasant. After the customary diurnal evacuation of the bowels has taken place, the person should strip, and applying this instru- ment to various parts of the body in succession, commencing with the chest, continue the friction until an universal redness and glow takes place over the whole surface of the body. The temporary exposure of the naked body to the air of the chamber during this operation, accustoms the skin to a certain variety of temperature, while any danger of taking cold is completely obviated by the ex- ercise, as a person ought always, if his strength permit, to rub himself. Though somewhat painful and irksome at first, this ope- ration, like all the rest of our active habits, gradually becomes pleasant, and at length necessary, so that a person accustomed to it feels himself uncomfortable if he has omitted for a day his usual exercise. From regularly persevering for some length of time in this prac- tice I have observed a very obvious alteration produced in the tex- ture of the skin. It appears to acquire thickness, and to become mellow and pliable, a condition very different from that of persons disposed to phthisis, whose skin is commonly thin and harsh. The muscles also seem to derive firmness from this practice. The brush will also be found daily to remove no small quantity of fur- PREVENTION OF CONSUMPTION. 167 furaceous matter, which, whether it be inspissated perspiration ad- hering to the surface, or particles of decaying cuticle, is certainly better away. This practice also removes every kind of roughness and asperity from the surface of the skin, which becomes beauti- fully smooth and polished, so that even as a cosmetic, having no tendency to impair health, cutaneous friction may be advantageous- ly employed. After exposure to wet, to strip and rub the surface of the body till it glows, is unquestionably the best means to pre- vent taking cold. I do not presume so strenuously to recommend friction of the skin as a means of supporting the healthy action of the external surface of the body, and of promoting cutaneous perspiration, without having witnessed remarkable changes for the better pro- duced in the constitution by adopting and persevering is this prac- tice. Indeed I am disposed to attribute much of the benefit deriv- ed from exercise on horseback, as well as the good effects of a sea- voyage towards a mild climate, to the increase of perspiration pro- duced by these modes of gestation. Every person suspicious of predisposition to pulmonary con- sumption ought at all times, but especially in cold weather, to wear a quantity of woollen clothing sufficient to obviate any ap- proach to the perception of dullness ; independently however of the actual presence of obstinate hoarseness or cough, I am dispos- ed to think that the requisite quantity of flannel is more advanta- geously worn over the usual shirt, than in immediate contact with (he skin. The possibility of communicating this disease by contagion is a point that has been much agitated. As a measure of precaution, the.delicate ought to decide this question for themselves in the af- firmative. Exhalation from the lungs is the mode by which infec- tious diseases are most generally propagated ; and from analogy we might infer that air impregnated with the effluvia of these organs in a state of ulceration, would have a tendency to excite diseased action of a similar kind if received into the lungs of a person pre- viously disposed to this complaint. I have seen more than one instance of a husband who appeared to have no previous disposi- tion to consumption, bemg affected with a distressing cough, which continued to harass him for months while his wife was lingering under that disease. On one melancholy occasion I witnessed the successive deaths of three young ladies, two of whom, in my opin- ion, decidedly caught the disease in consequence of their sedulous attention, during the progress of the indisposition, to her who was first affected, who evidently was of a phthisical habit, which was not apparent in either of the others. If the presence of the symptoms which have been already de- scribed as characterising this disease renders its existence no lon- ger equivocal, the person so affected ought without delay to mi- grate towards a warmer climate. Should circumstances render this expedient impracticable, the next best plan a phthisical per- son can adopt is to remove into a low and rather damp situa- tion. The fatal event of pulmonary consumption is uniformly ac- celerated by residing in an elevated region. There arc even in- stances on record of phthisis making its appearance in families, / tf$ (fl: j. SMALL-PQ*. previously unaffected by it, on changing their place of residence from a level to a hilly country. While on the contrary the inhab- itants of extensive districts in Lincolnshire and in Essex enjoy a complete immunity from this disease. In Holland, pulmonary consumption is a disease of comparatively rare occurrence. The same situations that predispose to ague are unfavourable to the attack of phthisis, as if these two states of the constitution were incompatible with each other. The physicians of ancient Rome were accustomed to send their consumptive patients to the low and marshy land of Egypt. Cicero, the celebrated orator, who, in his youth, was threatened with consumption, as the hollow temples and sharp features of his remaining busts abundantly testify, trav- elled into Egypt for the recovery of his health. In this country the choice of situation is not sufficiently attended to; although every practitioner of medicine must have remarked that even the soft breezes of Brompton and Chelsea have benefited invalids who were injured by the keener air of Highgate and Hampstead.* In the incipient stages of phthisis pulmonalis the dry vomit taken in a morning, fasting, I have known occasionally to be of use. Keeping up a copious discharge from the surface of the chest by the savin ointment subsequent to the application of a blistering- plaster, sometimes appears to arrest the progress of the disease. When symptoms of incipient phthisis have been accompanied by tumours commencing at the clavicle and extending upwards towards the ear, I have seen much benefit from the administration of calomel combined with steel. When recovery is despaired of, a diet consisting of buttermilk and the lighter farinacea, prolongs existence, and mitigates the distress of the cough more effectually than the use of opium. From a medicine, which of late years has been much extolled, as diminishing the frequency of the pulse, (digitalis) I am sorry to say, I have seen no permanent benefit produced in this disease; and notwithstanding the boast of empiricism, a remedy that will heal ulceration or resolve tubercles, I believe yet remains to be discovered. CHAP. XIV. SMALL POX, (Variola.) This disease, which originally came from Arabia, is, since the discovery of vaccination, not so general as heretofore; nor does it appear to be of so malignant a type. It is, nevertheless, a most contagious malady; and for many years proved the scourge of civ- ilized as well as uncivilized nations. It generally makes its ap- * In the islands of Guernsey and Jersey, where the climate is so loaded with moist- ure, that common salt deliquesces if exposed to the air, I am informed that coughs are very rare, and pulmonary consumptions almost unknown. Of course these islands must be an excellent situation for persona o'*a phthisical temperament. SMALL-POX. 169 pearance about the spring. It is very frequent in summer, less so in autumn, and still less in winter. Children are most liable to have it; and those whose food is unwholesome, who want proper exercise, and abound with gross humours, run the greatest hazard of catching it. The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the chrystalline, the bloody, &c. Causes.—The small-pox is commonly caught by infection. Since the disease was first brought into Europe, the infection hat? never been wholly extinguished, nor have any proper methoVls, as far as I know, been taken for that purpose; so that now it has become in a manner constitutional. Children who have overheat- ed themselves by running, wrestling, Sec or adults after a debauch, are most apt to be seized with the small-pox. Symptoms.—This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, seem listless and drowsy for a few days before the more vio- lent symptoms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, com- plain of weariness, and, upon taking exercise, are apt to perspire. These symptoms are succeeded by slight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vom- iting, &c. The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion-fits in very young chUdren. About the third or fourth day from the time of sickening, the small-pox generally begin to appear; sometimes, indeed, they appear sooner, but that is no favourable symptom. At first they very nearly resemble flea-bites, and are soonest discovered on the face, arms, and breast. The most favourable symptoms are a slow eruption, and an abatement of the fever as soon as the pustules appear. In a mild distinct kind of small-pox the pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules which are distinct, with a florid red basis, and which fill with thick purulent matter, first of a whitish, and afterwards of a yellowish colour, are the best. A livid brown colour of the pustules is an unfavourable symp- tom ; as also when they are small and flat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger. 'It is likewise a bad sign when they run into one another. It is a most unfavourable symptom when petechia?, or purple, brown, or black spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and show the danger H 170 SMALL-POX. to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an ap- proaching delirium or of convulsion-fits. When the face does not swell, or falls before the pox come to maturity, it is very unfavour- able. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well; but when these do not succeed each other, there is reason to apprehend danger. When the tongue is cover- ed with a brown crust, it is an unfavourable symptom. Cold shiv- ering fits coming on at the height of the disease, are likewise unfa- vourable. Grinding of the teeth, when it proceeds from an affec- tion of the nervous system, is a bad sign; but sometimes it is occa- sioned by worms, or a disordered stomach. Diet.—When the first symptoms of the small-pox appear, people are ready to be alarmed, and often fly to the use of medicines, to the great danger of the patient's life. I have known children, to appease the anxiety of their parents, bled,.blistered, and purged, during the fever which preceded the eruption of the small-pox, to such a degree, that Nature was not only disturbed in her opera- tion, but rendered unable to support the pustules after they were out; so that the patient, exhausted by mere evacuations, sunk under the disease. When convulsions appear, they give a dreadful alarm. Imme- diately some nostrum is applied, as if this were a primary disease; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit.* All that is, generally speaking, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, Sec. He should not be confined to bed, but should sit up as much as he is able, and should have his feet and legs frequently bathed in lukewarm water. His food ought to be very light, and he should be as little disturbed with company as possible. Much mischief is done at this period by confining the patient too soon to his bed, and plying him with warm cordials, or sudo- rific medicines. Every thing that heats and inflames the blood increases the fever, and pushes out the pustules prematurely. This has numberless ill effects. It not only increases the number of pustules, but likewise tends to make them run into one another; and when they have been pushed out with too great violence, they generally fall in before they come to maturity. * Convulsion-fits are, no doubt, very alarming, but their effects are often salutary. They seem to be one of the means made use of by Nature for breaking the force of a fever. I have always observed a fever abated, and sometimes quite removed, after one or more convulsion-fits. This readily accounts for convulsions being a favourable symptom in the fever which precedes the eruption of the small-pox, as every thing that mitigates this fever lessens the eruption. SMALL-POX. 171 The good women, as soon as they see the small-pox begin to ap- pear, commonly ply their tender charge with cordials, saffron, and marigold-teas, wine, punch, and even brandy itself. All these are given with a view, as they term it, to throw out the eruption from the heart. This, like most other popular mistakes, is the abuse of a very just observation, that when there is a moisture on the skin, the pox rise better, and the patient is easier, than when it continues dry and parched. But that is no reason for forcing the patient into a sweat. Sweating never relieves unless where it comes spontane- ously, or is the effect of drinking weak diluting liquors. The pa- tient ought to have no more covering in bed than is necessary to prevent his catching cold, and should be frequently taken up, to keep him cool, and prevent too great a flux of blood towards the head. Children are often so peevish, that they will not lie in bed with- out a nurse constantly by them. Indulging them in this, we have reason to believe, has many bad effects, both upon the nurse and the child. Even the natural heat of the nurse cannot fail to aug- ment the fever of the child; but if she too proves feverish, which is often the case, the danger must be increased. Laying several children who have the small-pox in the same bed, has many ill consequences. They ought, if possible, never to be in the same chamber, as the perspiration, the heat, smell, Sec. all tend to augment the fever, and to heighten the disease. It is com- mon among the poor to see two or three children lying in the same bed, with such a load of pustules that even their skins stick togeth- er. One can hardly view a scene of this kind without being sick- ened by the sight; but how must the effluvia affect the poor pa- tients, many of whom perish by this usage. This observation is Likewise applicable to hospitals, workhouses, &c, where numbers of children happen to have the small-pox at the same time. I have seen above forty children cooped up in one apartment, all the while they had this disease, without any of them being admitted to breathe the fresh air. No one can be at a loss to see the impropriety of such conduct. It ought to be a rule not only in hospitals for the small-pox, but likewise for other diseases, that no patient should be within sight or hearing of another. This is a matter to which too little regard is paid. In most hospitals and infirmaries, the sick, the dying, and the dead, are often to be seen in the same apart- ment. A very dirty custom prevails among the lower class of people, of allowing children in the small-pox to keep on the same linen, dur- ing the whole period of that loathsome disease. This is done lest they should catch cold; but it has many ill consequences. The linen becomes hard by the moisture, which it absorbs, and frets the tender skin. It likewise occasions a bad smell, which is very per- nicious both to the patient and those about him; besides, the filth and sordes which adhere to the linen being resorbed, or taken up again into the body, greatly augment the disease. A patient should not be suffered to be dirty in an internal dis- ease, far less in the small-pox. Cutaneous disorders are often oc- casioned by nastiness alone, and are always increased by it. "V\ ere the patient's linen to be changed every day, it would greatly refresh 172 SMALL-POX. him. Care, indeed, is to be taken that the linen be thoroughly dry. It ought likewise to be put on when the patient is most cool. So strong is the vulgar prejudice in this country, notwithstanding all that has been said against the hot regimen in the small-pox, that numbers still fall a sacrifice to that error. 1 have seen poor wom- en travelling in the depth of winter, and carrying their children along with them in the small-pox, and have frequently observed others begging by the way-side, with infants in their arms covered with the pustules; yet I could never learn that one of these chil- dren died by this sort of treatment. This is certainly a sufficient proof of the safety, at least, of exposing patients in the small-pox to the open air. There can be no reason, however, for exposing them to public view. It is now very common, in the environs of great towns, to meet patients in the small-pox on the public walks. This practice, however well it may suit the purposes of boasting inoculators, is dangerous to the citizens, and contrary to the laws of humanity and sound policy. The food in this disease ought to be very light, and of a cooling nature, as panado, or bread boiled with equal quantities of milk and water, good apples roasted, or boiled with milk, and sweeten- ed with a little sugar, or such like. The drink may be equal parts of milk and water, clear sweet- whey, barley-water, or thin gruel, &c. After the pox are full, but- termilk, being of an opening and cleansing nature, is a very proper drink. Medicine.—This disease is generally divided into four different periods, viz. the fever which precedes the eruption, the eruption itself, the suppuration or maturation of the pustules, and the sec- ondary fever. It has already been observed, that little more is necessary, dur- ing the primary fever, than to keep the patient cool and quiet, al- lowing him to drink diluting liquors, and bathing his feet frequent- ly in warm water. Though this be generally the safest course that can be taken with infants, yet adults of a strong constitution and plethoric habit sometimes require bleeding. When a full pulse, a dry skin, and other symptoms of inflammation, render this opera- tion necessary, it ought to be performed; but unless these symp- toms are urgent, it is safer to let it alone; if the body is bound, emollient clysters may be thrown in. If there is a great nausea, or inclination to vomit, weak camo- mile-tea, or lukewarm water, may be drunk, in order to cleanse the stomach. At the beginning of a fever, Nature generally at- tempts a discharge, either upwards or downwards, which, if pro- moted by gentle means, would tend greatly to abate the violence of the disease. Though every method is to be taken during the primary fever, by a cool regimen, &c. to prevent too great an eruption, yet, after the pustules have made their appearance, our business is to pro- mote the suppuration by diluting drink, light food, and, if Nature seems to flag, by generous cordials. When a low, creeping pulse, faintishness, and great loss of strength, render cordials necessary, we would recommend good wine, which may be made into negus SMALL-POX. 173 with an equal quantity of water, and sharpened with the juice of an orange, the jelly of currants, or the like. Wine-whey, sharp- ened as above, is likewise a proper drink in this case; great care, however, must be taken not to overheat the patient by any of these things. This, instead of promoting, would retard the eruption. The rising of the small-pox is often prevented by the violence of the fever ; in this case the coal regimen is strictly to be observed- The patient's chamber must not only be kept cool, but he ought likewise frequently to be taken cut of bed, and to' be lightly cover- ed with clothes while in it. Excessive restlessness often prevents the rising and filling of the small-pox. When this happens, gentle opiates are necessary. These, however, ought always to be administered with a sparing hand. To an infant, a tea-spoonful of the syrup of poppies may be given every five or six hours till it has the desired effect. An adult will require a table-spoonful in order to answer the same purpose. If the patient be troubled with a strangury, or suppression of urine, which often happens in the small-pox, he should be frequent- ly taken out of bed, and, if he be able, should walk across the room with his feet bare. When he cannot do this, he may be frequently set on his knees in bed, and should endeavour to pass his urine as often as he can. When these do not succeed, a teaspoonful of the sweet spirits of nitre may be occasionally mixed with his drink. Nothing more certainly relieves the patient, or is more beneficial in the small-pox, than a plentiful discharge of urine. If the mouth be foul, and the tongue dry and chapped, it ought frequently to be washed, and the throat gargled with water and honey, sharpened with a little vinegar or currant-jelly. During the rising of the small-pox, it frequently happens that the patient is eight or ten days.without a stool. This not only tends to heat and inflame the blood, but the fasces, by lodging so long in the body, become acrid, and even putrid, from whence bad conser quences must ensue. It will, therefore, be proper, when the body is bound, to throw in an emollient clyster every second or third day, through the whole course of the disease. This will greatly cool and relieve the patient. When petechia, purple, black, or livid spots appear among the small-pox, the Peruvian bark must immediately be administered, in as large doses as the patient's stomach can bear. For a child, two drachms of bark in powder may be mixed in three ounces of common water, one ounce of simple cinnamon water, and two ounces of the syrup of orange or lemon. This may be sharpened with the spirit of vitriol, and a table-spoonful of it given every hour. If it be given to an adult in the same form, he may take, at least, three or four spoonsftrt every hour. This medicine ought not to be trifled with, but must be administered as frequently as the stomach can bear it; in which case it will often produce very hap- py effects. I have frequently seen the petechia? disappear, and the small-pox, which had a very threatening aspect, rise and fill with laudable matter, by the use of the bark and acids. The patient's drink ought likewise, in this case, to be generous, as wine or strong negus, acidulated with spirits of vitriol, vinegar, the juice of lemon, jelly of currants, or such like. His food must 174 SMALL-POX. consist of apples, roasted or boiled, preserved cherries, plums, and other fruits of an acid nature. The bark and acids are not only necessary when the petechia?, or putrid symptoms, appear, but likewise in the lymphatic or crys- talline small-pox, where the matter is thin, and not duly prepared. The Peruvian bark seems to possess a singular power of assist- ing Nature in preparing laudable pus, or what is called good mat- ter ; consequently, it must be beneficial both in this and other dis- eases, where the crisis depends on a suppuration. I have often ob- served where the small-pox were flat, and the matter contained in them quite clear and transparent, and where at first they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and consistence of the matter, and produced the most happy effects. When the eruption subsides suddenly, or, as the good women term it, when the small-pox strike in, before they have arrived at maturity, the danger is very great. In this case blistering-plasters must be immediately applied to the wrists and ancles, and the pa- tient's spirits supported with cordials. Sometimes bleeding has a surprising effect in raising the pus- tules after they have subsided; but it requires skill to know when this is proper, or to what length the patient can bear it. Sharp cataplasms, however, may be applied to the feet and hands, as they tend to promote the swelling of these parts, and by that means to draw the humours towards the extremities. The most dangerous period of this disease is what we call the secondary fever. This generally comes on when the small-pox be- gin to blacken, or turn on the face; and most of those who die of the small-pox are carried off by this fever. Nature generally attempts, at the turn of the small-pox, to relieve the patient by loose stools. Her endeavours this way are by no means to be counteracted, but promoted, and the patient, at the same time, supported by food and drink of a nourishing and cor- dial nature. If, at the approach of the secondary fever, the pulse be very quick, hard, and strong, the heat intense, and the breathing labo- rious, with other symptoms of an inflammation of the breast, the patient must immediately be bled. The quantity of blood to be let must be regulated by the patient's strength, age, and the urgen- cy of the symptoms. But in the secondary fever, if the patient be faintish, the pus- tules become suddenly pale, and if there be great coldness of the extremities, blistering-plasters must be applied, and the patient must be supported with generous cordials. Wine, and even spir- its, have sometimes been given in such*cases with amazing suc- cess. As the secondary fever is, in great' measure, if not wholly, owing to the absorption of the matter, it would seem highly conso- nant to reason, that the pustules as soon as they come to maturity, should be opened. This is every day practised in other phlegmons which tend to suppuration ; and there seems to be no cause why it should be less proper here. On the contrary, we have reason to believe that by this means the secondary fever might always be lessened, and often wholly pr«vpnt«d. SMALL-POX. 175 The pustules should be opened when they begin to turn of a yellow colour. Very little art is necessary for this operation. They may either be opened with a lancet or a needle, and the matter absorbed by a little dry lint. As the pustules are generally first ripe on the face, it will be proper to begin with opening these, and the others of course as they become ripe. The pustules gen- erally fill again, a second, or even a third time, for which cause the operation must be repeated, or rather continued, as long as there is any considerable appearance of matter in the pustules. We have reason to believe that this operation, rational as it is, has been neglected from a piece of mistaken tenderness in parents. They believe that it must give great pain to the poor child, and, therefore, would rather see it die than have it thus tortured. This notion, however, is entirely without foundation. I have frequent- ly opened the pustules when the patient did not see me, without his being in the least sensible of it ; but suppose it were attended with a little pain, that is.nothing in comparison to the advantages which may arise from it. Opening the pustules not only prevents the resorption of the matter into the blood, but likewise takes off the tension of the skin, and by that means greatly relieves the patient. It likewise tends to prevent the pitting, which is a matter of no small import- ance. Acrid matter, by lodging long in the pustules, cannot fail to corrode the tender skin, by which many a handsome face be- comes so deformed as hardly to bear a resemblance to the human figure.* It is generally necessary, after the small-pox are gone off, to purge the patient. If, however, the body has been open through the whole course of the disease, or if buttermilk and other things of an opening nature have been drunk freely, after the height of the small-pox, purging becomes less necessary ; but it ought never wholly to be neglected. For very young children, an infusion of senna and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanc- ed must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grains of fine rhubarb, in powder, over-night, and the same quantity of jalap in powder next morning. This may be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further ad- vanced, and adults, the dose must be increased in proportion to the age and constitution.! When imposthumes happen after the small-pox, which is not seldom the case, they must be brought to suppuration as soon as possible, by means of ripening poultices ; and when they have * Though this great operation can never do harm, yet it is only necessary when the patient has a great load of small-pox, or when the matter which they contain is of so thin and acrid a nature that there is reason to apprehend bad consequences from its be- ing too quickly resorbed, or taken up again into the mass of circulating humours. T I have of late been accustomed, after the small-pox, to give one, two, three, four, or five grains of calomel, according to the age of the patient, over-night, and to work it of!* next morning with a suitable dose of jalap. Or the jalap and calomel may be mixed together, and given in the morning. 176 MEASLES. been opened, or have broke of their own accord, the patient must be purged. The Peruvian bark and a milk-diet will likewise be useful in this case. When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patient must be sent to a place where the air is good, and put upon a course of asses' milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions. CHAP. XV. MEASLE S. (Morbilli or Rubeola.) The measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than ohce. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but its consequences are often very troublesome. Causes.—This disease, like the small-pox, proceeds from in- fection, and is more or less dangerous according to the constitu- tion of the patient, the season of the year, the climate, &c. Symptoms.—The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes, indeed, the cough does not come before the eruption has appeared. There is an inflammation and beat in the eyes, accompanied with a defluction of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eyelids frequently swell so as to occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease. About the fourth day, small spots, resembling flea-bites, appear, first upon the face, then upon the breast, and afterwards on the extremities : these may be distinguished from the small-pox by • their scarcely rising above the skin. The fever, cough, and diffi- culty of breathing, instead of being removed by the eruption, as in the small-pox, are rather increased; but the vomiting generally ceases. About the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the body ; so that by the ninth day they entirely disappear. The fe- MEASLES. 177 ver, however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechia?, or purple spots, may likewise be occasioned by tfcis error. A violent looseness sometimes succeeds the measles ; in which case the patient's life is in imminent danger. Such as die of the measles generally expire about the ninth day* from the invasion, and are commonly carried off by a peripneumo- ny, or inflammation of the lungs. The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine. When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swal- lowing. Purple or black spots appearing among the measles, are very unfavourable. When a continual cough, with hoarseness, suc- ceeds the disease, there is reason to suspect an approaching con- sumption of the lungs. Our business in this disease is to assist Nature, by proper cor- dials, in throwing out the eruption, if her efforts be too languid ; but when they are too violent, they must be restrained by evacua- tions and cool diluting liquors, Sec. We ought likewise to endeav- our to appease the most urgent symptoms, as the cough, restless- ness, and difficulty of breathing. Regimen.—The cool regimen is necessary here as well as in the small-pox. The food, too, must be light, and the drink diluting. Acids, however, do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small-beer, likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh- mallow roots and sarsaparilla, infusions of linseed or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey; or, if that should disagree with the stomach, a little manna may occasionally be added to them. Medical treatment.—The measles being an inflammatory dis- ease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted.* Bathing the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption. * I do not know any disease wherein bleeding is more necessary than in the mea- Bles, especially when the fever runs high : in this case I have always found it relieve the patient. Practitioners, however, are at variance with respect to the time blood- letting may be employed with the most advantage. Dr. Morton thinks it requisite a*, soon as the eruption is completed. Sydenham recommends it after the eruption has disappeared : but practice, in this respect, should be regulated by the degree <)f th^ accompanying inflammation of the lungs, without attending to the particular period of the disorder or the state of the eruption : this is the generally approved practice at the present day. P 7' H2 178 MEASLES. The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking luke- warm water, or weak camomile-tea. When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the vapour into his lungs. He may likewise lick a little spermaceti and sugar-candy pound- ed together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it; which will soften the throat, and relieve the tickling cough; or the demulcent pectorals advised under the head of pleurisy, ticular ceremonies: the custom, however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief, or a piece of flannel, kept about it till the inflammation be removed. The jelly of black currants is a medicine very much in esteem for complaints of the throat; and, indeed, it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead. Gargles for the throat are very beneficial. They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of the pectoral decoction two or three spoonsful of honey, and the same quantity of currant jelly. This may be used three or four times a-day; and if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleans- ing, by adding to it a tea-spoonful of sal volatile, or any of the an- nexed forms:* There is no disease in which the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought, therefore, never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary. MEniciNE.—An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require. The body should-likewise be kept gently open. This may either be done by giving the patient for his ordinary drink a decoction of saline aperients, figs, and tamarinds, or small doses of rhubarb and nitre, as recommended in the erysipelas. These may be in- creased according to the age of the patient, and repeated till they have the desired effect. I have often known very good effects from a bit of salprunel, or purified nitre, held in the mouth and swallowed down as it melted. This promotes the discharge of saliva, by which'means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, Sec. At the commencement of inflammatory sore throat, and before the febrile symptoms have become any way violent, an early emetic is often, of great benefit, and not unfrequently checks its formation. * Take Confection of the Red Rose, 1 oz. Boiling Water, h pint. Diluted Sulphuric Acid, 1 drm. Mix for a gargle. or Take Barley-water, 6 ox. Honey of Roses, 1 ox. Diluted Sulphuric Acid, 1 drm. Make a gargle. 196 QUINSEY, Sec. The throat ought likewise to be rubbed twice or thrice a-day with a little of the volatile liniment. This seldom fails to produce some good effects. At the same time the neck ought to be care- fully covered with wool or flannel, to prevent the cold from pene- trating the skin, as this application renders it very tender. Many other external applications are recommended in this disease, as a swallow's nest, poultices made of the fungus called Jew's ears, album Graecum, &c.; but as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no further notice of them. When white sloughy specks appear in the throat, the gargles advised in putrid sore throat may be used. If a disposition to gangrene should manifest itself, those of an antiseptic nature should be immediately adopted, and the best are those composed of bark, myrrh,* port-wine, or of capsicum and vinegar. Some recommend the gum-guaiacum as a specific in this disease. Half a drachm of the gum in powder may be made into an electu- ary with the rob of elderberries, or the jelly of currants, for a dose, and repeated occasionally.! Blistering upon the neck, or behind the ears, in violent inflam- mations of the throat, is very beneficial; and in bad cases, it will be necessary to lay a blister quite across the throat, so as to reach from one ear to the other ear. After the plasters are taken off, the parts ought to be kept discharging by the application of issue ointment, till the inflammation is gone ; otherwise, upon their dry- ing up, the patient will be in danger of a relapse. When the patient has been treated as above, a suppuration sel- dom happens. This, however, is sometimes the case, in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a funnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig con- stantly in his mouth. It sometimes happens, before the tumour breaks, that the swel- ling is so great, as entirely to prevent any thing from getting down into the stomach. In this case, the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, &c. Patients have often been supported by these for several days, till the tumour has broke; and afterwards they have recovered. Not only the swallowing, but the breathing is often prevented by the tumour. In this case nothing can save the patient's life, but opening the trachea or windpipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be per- formed by a surgeon, it is not necessary here to give any directions about it. When a difficulty of swallowing is not attended with an acute * Take Infusion of Roses, 6 oz. Honey of Borax, $ drs, Tincture of Myrrh, £ oz. Mix for a gargle, k Dr. Home. MAJL.llii\AJNT QUINSEY, &c. 197 pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, Sec Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c.; all which practices are at best use- less, and often hurtful. Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not choose to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature. Violent exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought, therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circu- lation of the blood towards it, to take care to cool gradually, and to wrap some additional covering about their necks. I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a riband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There is danger indeed in leaving them off after persons have been accustomed to them ; but surely the inconveniency of using such things for life, is not to be com- pared with the danger which may attend the neglect of them. Sometimes, after an inflammation, the glands of the throat con- tinue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs, sharpened a little with diluted sulphuric acid. Malignant Quinsey, or Putrid Ulcerous Sore Tproat. (Cynanche Maligna.) This kind of sore throat is but little known in the northern parts of Britain, though for some time past it has been fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp or sultry weather. It is readily distinguished from the inflammatory quinsey by the soreness and white specks or aphthae covering ulcers which appear in the fauces, together with the great debility of the system, a 198 MALIGNANT QUINSEY, OR small fluttering pulse, and an eruption on the skin of the same nature with that of scarlet fever, which are to be observed in the former; whereas in the latter there is always considerable difliculty of breathing, a considerable degree of swelling, with a tendency in the parts to suppurate, and a hard pulse. Also in the seat of the disease, which in the former is principally in the nervous mem- brane of the mouth and throat, and the accompanying fever is of the typhoid kind; whereas, in the latter, it chiefly occupies the glandular parts, and the fever is of the inflammatory type. Causes.—This is evidently a contagious distemper, and is gene- rally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder; as by that means they endanger not only their own lives, but likewise those of their friends and connex- ions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, Sec. In some instances the symptoms of scarlet fever and putrid sore throat are so blended, that it is frequently difficult to pronounce of which the disease partakes most; this, however, is of little im- portance in a practical point of view, as both require the same mode of treatment. Symptoms.—It begins with alternate fits of shivering and heat The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient com- plains greatly of weakness and oppression of the breast; his spir- its are low, and he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude ; but, as the disease advances, it turns more of a yellow- ish colour. The tongue is white, and generally moist, which dis- tinguishes this from an inflammatory disease. Upon looking into the throat, it appears swelled, and of a florid red colour. Pale or ash-coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers. An efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting gener- ally cease. There is often a slight degree of delirium, and the face frequent- ly appears bloated, and the inside of the nostrils red and inflamed. The patient complains of a disagreeable putrid smell, and his breath is very offensive. The putrid, ulcerous sore throat may be distinguished from tne inflammatory, by the vomiting and looseness with which it is gen- erally ushered in ; the foul ulcers in the throat covered with a white or livid coat; and by the excessive weakness of the patient; with other symptoms of a nutrid fever. PUTRID ULCEROUS SORE THROAT. 199 Unfavourable symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, the danger is very great. If a gentle sweat break out about the third, or fourth day, and continue with a slow, firm, and equal pulse; if the sloughs cast off in a kindly manner, and appear clean and florid at the bottom ; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis. M Regimen.—The patient must be kept quiet, and for the most part in bed, as he will be apt to be faint when taken out of it. His food must be nourishing and restorative ; as sago-gruel with red- wine, jellies, strong broths, &c. His drink ought to be generous, and of an antiseptic quality ; as red-wine negus, white-wine whey, and such like.* Medicine.—The medicine in this kind of quinsey is entirely different from that which is proper in the inflammatory. All evac- uations, as bleeding, purging, &c. which weaken the patient, must be avoided. Cooling medicines, as nitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety ; and these ought never to be neglected. If at the beginning there is a great nausea, or inclination to vomit, the patient must drink an infusion of green tea, camomile flowers, or carduus benedictus, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit. If the disease be mild, the throat may be gargled with an infu- sion of sage and rose leaves, to a gill of which may be added a spoonful or two of honey, and as much vinegar as will make it agreeably acid ; but when the symptoms are urgent, the sloughs large and thick, and the breath very offensive, the following or similar* gargles may be used : To six or seven ounces of the pectoral decoction, when boiling, add half an ounce of contrayerva root; let it boil for some time, and afterwards strain the liquor ; to which add two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be used as a gargle, but a little of it should frequently be injected with a syringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly necessary for children, who cannot use a gar- gle. No degree of force, however, is to be used to effect a separa- tion of the sloughs ; and if, after a continuation of the gargles for some time, the sloughs should not begin to separate, all that can * Take Decoction of P. Bark, 6 ounces. Muriatic Acid, 1 drachm. Compound Tinct. of Cinnamon, £ ounce. Tincture of Myrrh, 1 ounce. Make a gargle; to be used as above. or Take Honey of Roses, 1 ounce. Barley Water, 10 ounces. Tincture of Myrrh, A ounce. Vinegar, I ounce. Mix, and make a gargle. 200 MALIGNANT QUINSEY, Sec. safely be done is to touch them with a little alum, or the muriatic acid mixed with honey, and applied by means of a piece of lint, or a hair pencil. It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, the steams of warm vine- gar, myrrh, and honey. But when the putrid symptoms run high, and the disease is at- tended with danger, the only medicine that can be depended upon is the Peruvian bark. It may be taken in substance, if the pa- tient's stomach will bear it. If not, an ounce of bark grossly pow- dered, with two drachms of Virginian snake-root, may be boiled in an English pint and a half of water to half a pint; to which a tea-spoonful of the diluted sulphuric acid may be added, and an ordinary teacupful of it taken every three or four hours. Blisters are very beneficial in this disease, especially when the patient's pulse and spirits are low. They may be applied to the throat, be- hind the ears, or upon the back part of the neck. . Should the vomiting prove troublesome, it will be proper to give the patient two table-spoonsful of the saline mixture in a state of effervescence by opiate joined with camphor, and cloths wetted in tincture of opium applied to the pit of the stomach. Mint tea and a little cinnamon will be very proper for the ordinary drink, especially if an equal quantity of red wine be mixed with it. If a diarrhoea should rise in the progress of the disease, power- ful astringents* must be immediately resorted to, to which may be added wine or brandy mulled up with spice. Every means must be adopted to put an immediate stop to it, as at all periods of this disease, diarrhoea is a very dangerous symptom. If bleeding from the nose occur, the steam of warm vinegar may be frequently inhaled up the nostrils, and the drink be sharpened with sulphuric acid, or tincture of roses. And as hemorrhage from the nose is not an uncommon occur- rence in putrid sore throats, as well as from the mouth and ears, and as it never proves critical, or is attended with any salutary effect, but, on the contrary, threatens the greatest danger, it ought to be immediately stopped by administering strong antiseptics in- ternally, as advised under the head of Malignant Fever; and by the external application of tents dipped in some powerful styptics, as a solution of the sulphate of copper.t In case of a strangury, the belly must be fomented with warm water, and emollient clysters given three or four times a-day. After the violence of the disease is over, the body should still be kept open with mild purgatives ; as manna, senna, rhubarb, or the like. If great weakness and dejection of spirits, or night-sweats, with other symptoms of a consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the * Take Aromatic Confection, 1 drachm. Chalk Mixture 2 ounces. Cinnamon Water, 1A ounce. Tincture of Opium, 20 to 30 dps. Tincture of Catechu, 1 drachm. Make a mixture j of which two table- spoonsful miy be given every four hours, t Take Sulphate of Cother, 1A drachm. Alum, | drachm. Water, 7 ounces. Rectified Spirit, 1 ounce. Make a styptic solution. MUMPS. 201 •lixir of vitriol, and to take frequently a glass of generous wine. The quantity of wine allowed ought to be in proportion to the age of the patient, the violence of the febrile symptoms, the degree of debility that exists, or the tendency there is to putrescency. These, together with a nourishing diet, and riding on horse-back, are the most likely means for recovering his strength. The quinsey, being a local disease, is generally caught by ex- posing the throat to a draught of cold ajju I know many people, who are sure to be troubled with this coijpdaint if they stand or sit near an open window, or continue fotany length of time in a room lately washed. There is not a readier or more certain way to catch a quinsey, than sitting near an open window in a carriage,. especially during the night, or when the weather is cold or damp. The inflammatory sore throat, though it sometimes comes to a sup- puration, generally yields to the method of treatment recommend- ed in this chapter. Cases, however, occur, where the power of swallowing is lost, and the patient perishes from the mere want of sustenance. I lately saw a very ingenious invention of a young surgeon, by which a man's life was saved in a case of this kind. He fastened a funnel to the skin of an eel, open at both ends; and, by means of a flexible probe, pushed one end down the gullet, till it entered the stomach. Afterwards, milk, broth, or whatever was deemed proper for nourishing the patient, was put into the funnel, and conveyed to the stomach. Though I mention this chiefly with a view of directing others in the like alarming situations, yet it may also serve to confirm an opinion, often avow- ed by the late John Hunter, and well illustrated in his own prac- tice, that presence of mind, and a readiness or fertility of mechan- ical contrivance, may sometimes prove more serviceable in a crit- ical moment, than all the resources of science. But the most dangerous kind of quinsey, as I before observed, is that attended with a putrid fever, commonly called the malig- nant quinsey, or putrid ulcerous sore throat. Whenever the symp- toms of this appear, I cannot too urgently advise the patient's friends to lose no time in procuring for him the best medical as- sistance they can obtain. The delay of an hour may be attend- ed with irreparable injury. Mumps. (Cynanche Parotidaa.) The Mumps is a swelling of the glands about the throat, which is occasionally observed to be epidemic in certain districts of this country. This disease generally makes its appearance in spring, and young persons of both sexes are much more liable to be at- tacked by it, than those farther advanced in life. It is preceded by heaviness, lassitude, and a general sensation of uneasiness, which continue for several days. Stiffness, pain, and difficulty of motion, is then perceived about the articulation of the lower jaw. A swelling of the glands situated under the jaws, and diffused over the neck, next takes place, which sometimes increases to so enor- mous a magnitude, as greatly to disfigure the countenance; There: is a good deal of fever, as indicated by the increased frequency of the pulse. About the fourth day from the commencement of th* 202 COLDS AND COUGHS. tumefaction, the disease is at the height. A gentle moisture then begins to exude from the surface of the swelling, accompanied with a general perspiration of the whole body, which, if it be en- couraged by keeping warm in bed, and drinking diluent fluids, appears to form the natural crisis of the disease, and the whole terminates favourably about the sixth day. But if, from exposure to cold, or improper management, this natural process of the disease be interrupted, a singular transla- tion of the morbid act^£ takes place. The turnouts About the throat suddenly subside, andjfere followed by swellings or the testi- cles in the male sex, and of the breasts in the female, accompani- ed with a fresh exacerbation of the fever.9 If the swellings of these parts be imprudently checked by exposure to cold, or if they sud- denly subside, the brain is apt to become affected, occasioning convulsions, delirium, and other dreadful symptoms, which finally terminate in death. In the treatment of this disease, evacuations of all kinds are not only improper, but dangerous. If the bowels are much con- stipated, they may occasionally be relieved by a clyster, but active purgatives, and blood-letting, must on no account be employed. The patient ought to keep warm in bed, and encourage perspi- ration, by drinking plentifully of diluting liquors, such as mint- whey, or balm-tea, with a few drops of spirit of hartshorn. The effort of nature to resolve the tumours by exudation, should be promoted by covering the parts with soft flannel. If the swellings show a disposition to subside too early, they should be covered with blistering plasters, or rubbed with the volatile liniment. Should the tumour, when seated in the testicles, suddenly sub- side, and any tendency to delirium manifest itself, the whole scro- tum ought, without delay, to be enveloped in a blistering cata- plasm, which is made by sprinkling a little of the powder of Span- ish flies over the surface of the common poultice. By this means the disease may be arrested in the part occupied by it, and the dangerous consequences of its falling on the brain prevented. It is not an uncommon sequel of this complaint to find some- times one and sometimes both testicles, after the inflammation has ceased, gradually shrink in size, and finally wither wholly away. The mumps, which in the northern parts of the country, is termed the branks, is decidedly an infectious disease, but there is rarely an instance of a person being attacked by it a second time. CHAP. XXI. COLDS AND COUGHS. (Catarrhal Affections.) Ix has already been observed, that colds are the effect of an ob- structed perspiration; the common causes of which we have like- wise endeavoured to point out, and shall not here repeat them. Neither shall we spend time in enumerating all the various symp- COLDS AND COUGHS. 20* toms of colds, as they are pretty generally known. It may not, however, be amiss to observe,, that almost every cold is a kind of fever, which only differs in degree from some of those that have already been treated of. No age, sex, or constitution, is exempted from this disease V- neither is it in the power of any medicine or regimen to prevent it.. The inhabitants of every climate are liable to catch coldf nor can even the greatest circumspection defend them at all times from its attacks. Indeed, if the human body could be kept constantly in an uniform degree of warmth, such a thing as catching cold would be impossible : but as that cannot be effected, by any means, the perspiration must be liable to many changes. Such changes, however, when small, do not affect the health; but when great, they must prove hurtful. When oppression of the breast, a stuffing of the nose, unusual weariness, pain of the head, &c. give ground to believe that the perspiration is obstructed, or in other words, that the person has- caught cold, he ought immediately to lessen his diet, at least the usual quantity of his solid food, and to abstain from all strong liquors. Instead of flesh, fish, eggs, milk, and other nourishing diet, he may eat light bread-pudding, veal or chicken broth, pan- ado, gruels, and such like. His drink may be water-gruel sweet- ened with a little honey; an infusion of balm or linseed sharpened with the juice of bitter orange or lemon ; a decoction of barley and liquorice with tamarinds, or any other cool, diluting, acid liquor. Above all, his supper should be light; as small posset, or water- gruel sweetened with honey, and a little toasted bread in it. If honey should disagree with the stomach, the gruel may be sweet- ened with treacle or coarse sugar, and sharpened with the jelly of currants. Those who have been accustomed to generous liquors may take wine-whey instead of gruel, which may be sweetened as above. The patient ought to lie longer than usual in bed, and to encour- age a gentle sweat, which is easily brought on towards morning by- drinking tea, or any Kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which in all prob- ability, had it been neglected, would have cost the patient his life, or have confined him for some months. Would people sacrifice a little time to ease and warmth, and practise a moderate degree of abstinence when the first symptoms appear, we have reason to believe that most of the bad effects which flow from an obstructed perspiration might be prevented. But, after the disease has gath- ered strength by delay, all attempts to remove it often prove vain. A pleurisy, a peripneumony, or a fatal consumption of the lungs, are the common effects of colds which have either been totally neg- lected, or treated improperly. Many attempt to cure a cold, by getting drunk: but this, to say no worse of it, is a very hazardous experiment. No doubt it may sometimes succeed, by suddenly restoring the perspiration ; but when there is anv degree of inflammation, which is frequently the- case, strong liquors, instead of removing the malady, will increase; it. By this means a common cold may be converted into an. inr- flammatory fever. 201 COLDS AND COUGHS. Y> hen those who labour for their daily bread have the misfortune to catch cold, they cannot afford to lose a day or two, in order to keep themselves warm, and take a little medicine; by which meana the disorder is often so aggravated as to confine them for a long time, or to render them ever after unable to sustain hard labour. But even such of the labouring poor as can afford to take care of themselves, are often too hardy to do it; they affect to despise colds, and as long as they can crawl about, scorn to be confined by what they call a common cold. Hence it is that colds destroy such numbers of mankind. Like an enemy despised, they gather strength from delay, till at length they become invincible. We often see this verified in travellers, who, rather than lose a day in the prosecution of their business, throw away their lives by pursu- ing their journey, even in the severest weather, with this disease upon them. It is certain, however, that colds may be too much indulged. When a person, for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion such a general relaxation of the solids as will not be easily remov- ed. It will, therefore, be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercise ; as walking, riding on horseback, Sec An obsti- nate cold, which no medicine can remove, will yield to gentle ex- ercise and a proper regimen of diet. Bathing the feet and legs in warm water has a great tendency to restore the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warmer than the blood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, aud drinking warm water-gruel, or other weak liquors, will sooner take off a spasm, and restore a perspiration, than all the hot sudo- rific medicines in the world. This is all that is necessary for removing a common cold ; and if this course be taken at the begin- ning, it will seldom fail. But when the symptoms do not yield to abstinence, warmth, and diluting liquors, there is reason to fear the approach of some other disease, as an inflammation of the breast, an ardent fever, or the like. If the pulse, therefore, be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be necessary to bleed, and to give the cooling powders recommended in the scarlet fever, every three or four hours, till they give a stool. It will likewise be proper to put a blistering-plaster on the back, to give two table-spoonsful of the saline mixture every two hours, and in short to treat the patient in all respects as for a slight fever. I have often seen this course, when observed at the beginning, re- move the complaint in two or three days, when the patient had all the symptoms of an approaching ardent fever, or an inflammation of the breast. The chief secret in preventing colds lies in avoiding, as far as possible, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treat- ed of under the article Obstructed Perspiration, that it is needless hpre to resume the consideration of them. COMMON COUGH. 205 Of a Common Cough. A cough is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obsti- nate, there is always reason to fear the consequences, as this shows a weak state of the lungs, and is often the forerunner of con- sumption. If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper; but in weak and re- laxed habits, bleeding rather prolongs the disease. When the patient spits freely, bleeding is unnecessary, and sometimes hurt- ful, as it tends to lessen that discharge. When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be ad- ministered ; as gum-ammoniac, squills, or whatever maladv n Z \°Z °rC,bly mt° the kidne^> »ay occasion this on the hJt Y , W1SC pr°Ceed from Iyi«g too soft, too rauch vessehi &c inVO,Uatary ^tractions, or spasms, in the urmarv K 218 INFLAMMATION OF THE KIDNEYS. Symptoms.—There is a sharp pain about the region of the kid- neys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and after- wards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright, lie lies with most ease 0:1 the affected side, and has generally a nausea or vomit- ing, resembling that which happens in the colic. This disease, however, may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine, with which it is constantly attended. Regimen.—Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drunk ; as clear whey, or balm-tea sweetened with honey, decoctions of marshmallow roots, with bar- ley and liquorice, &c. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other di- lutino- liquors. Nothing so safely and certainly abates the inflam- mation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain. Medicine.—Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet; and if the pain and inflammation continue, the op- eration may be repeated in twenty-four hours, especially if the pa- tient be of a full habit. Leeches may likewise be applied to the seat of pain, and to the hemorrhoidal veins, as a discharge from these will greatly relieve the patient. Cloths dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected and renewed u they grow cool. If the bladders be filled with a decoction of mal- lows and camomile flowers, to which a little saffron ui added,.and mixed with about a third part of new milk, it will be stm more beneficial. Oleaginous cathartics of castor oil,* manna 0r 01 0 almonds, with emollient clysters, ought frequently to be admim tered ; and if the latter do not open the body, a little salt and hon ey, or manna, may be added to them. . The same course is to be followed where gravel or a stoneu lodged in the kidney; but when the gravel or stjme w-epa■£ from the kidney, and lodges in the ureter,f it will be proper^ ^ * Take Castor Oil, 1 ounce. , ounce. Mucilage of Gum Arabic, Take Manna /drachma. Fennel Water, of each, A ounce. Tartrate of Potash, Tincture of Jalap % drachm. Warm Water , * ^ Make an opening draught. ^ '"™hi bysmal, ^eL^ t^l WlSg d/wn from the kidneys, and lodging ,n them. INFLAMMATION OF THE BLADDER. 219 sides the fomentations, to rub the small of the back* with sweet oil, and to give gentle diuretics ; as juniper-water sweetened with the syrup of marsh-mallows : a tea-spoonful of the sweet spirits of nitre, with a few drops of laudanum, may now and then be put in a cup of the patient's drink ; or a decoction of the dried leaves of the peach tree. He ought likewise to take exercise on horseback, or in a carriage, if he be able to bear it. When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chilliness, shivering, &c, there is reason to suspect that matter is forming in the kidney, and that an ab- scess will ensue. When matter in the urine shows that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions ; and to live chiefly upon mild mucilag- inous herbs and fruits, together with the broth of young animals, made with barley and common pot-herbs, &-c. His drink may be whey, and buttermilk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drunk for a considerable time. Chalybeate waters have likewise been found beneficial in this dis- ease. This medicine is easily obtained, as it is found in every part of Great Britain. It must likewise be used for a considera- ble time, in order to produce any salutary effect. Those who are liable to frequent returns of inflammation, or obstructions of the kidneys, must abstain from wines, especially such as abound with tartar ; and their food ought to be light find easy of digestion. They should use moderate exercise, not lie too hot, nor too much on their back, and avoid costiveness. Inflammation of the Bladder. (Cystitis.) The inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain and tension towards the bottom of the belly, and diffi- culty of passing urine, with some degree of fever, a constant in- clination to go to stool, and a perpetual desire to make water, ke Sure of^pium, ! oz. rubbed over the seat of the stomach. CHOLERA MORBUS, &c. 22.'» The bread should be toasted till it is of a brown colour, and af- terwards boiled in spring water. If oat-bread cannot be had, wheat-bread, or oat-meal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonsful of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases. The vomiting and purging, however, ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacu- ations, which may be known from the sinking of his pulse, >" primary P'-mptnms ■"•• ••"d, tpp irentlv in the stomac! is indicated by vom''.- 1 ppi«— ,.. i: .;.... and in the 2)G DIARRHCEA, OR LOOSENESS/ I have frequently had occasion to see this disease, and have sometimes felt it. Yet I never met with an instance, in my own practice, where it proved fatal, though we are told this often hap- pens. Whether so lamentable an issue be owing to improper treat- ment, or to the extreme weakness of the patient's bowels, I can- not pretend to say, without an exact knowledge of each particu- lar case ; but I am inclined to think, that when death is the con- sequence, the antidote, which is opium, has been too long delay-i ed. No time should be lost in administering it, upon the first seri- ous alarm, and before the powers of Nature are exhausted. What 1 generally prescribe is laudanum, to be taken in cinnamon or some other cordial water. Ten drops of laudanum may be added to two ounces of simple cinnamon water, and the draught repeated every two hours, or oftener if necessary. I have found opiates no less successful in diarrhoea, or loose- ness. Ten grains of the powder of bole compounded with opium, given in a glass of cordial water four or five times a-day, will sel- dom fail to check a recent diarrhoea, and if judiciously persisted in, will often cure the most obstinate. I would therefore advise, in such cases, a full reliance on its final efficacy, rather than a rash impatience to try other medicines far more uncertain, and perhaps dangerous. But as a looseness may arise from a great variety of causes, how to adapt the mode of medical treatment to each will be explained in the next section. DlARRHOZA OR LOOSENESS. Diarrhoea, in many cases is not to be considered as a disease, but rather as a salutary evacuation. It ought, therefore, never to be stopped, unless when it continues too long, or evidently weak- ens the patient. As this, however, sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment. When a looseness is occasioned by catching cold, or an obstruct- ed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in luketvarm water, to wear flannel next his skin, and to take every other method to restore the perspiration. In a looseness which proceeds from excess or repletion, an emetic is the proper medicine. Emetics not only cleanse the stomach, but promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder will answer this purpose very welk A day or two after the emetic, the same quantity of rhubarb may be tak- intestincs, as indicated by violent purging and painful contractions of the abdomen. Its effects are more uncertain where the affection of the stomach is obscure; where there is moderate but insidious purging; where there is great sense of heat in the epi- gastrium, and in every case where collapse has come on. In conjunction with other remedies of the antispasmodic and stimulant kind, blood-letting has latterly been esti- mated as an important measure in the treatment of this terrific malady; ai:d although brought forward in a late publication, was, we believe, first proposed by Dr. James Johnson, from observing its effects in one or two sporadic cases of cholera in the Isl- and of Cevlon, more than twenty years ago. Ki>. , Sec Report of the Kpidemic cholera, &c. by Willh'n Scott, surgeon, &c. 4to. Madras, 1824 DIARRHOEA, OR LOOSENESS. en, and repeated two or three times, if the looseness continues , castor oil, purging salts, or the subjoined draught.* The patient ought to live on light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water. A looseness occasioned by the obstruction of any customary evacuations generally requires bleeding. If that does not succeea, other evacuations may be substituted in the room of those which are obstructed. At the same time, every method is to be taken to restore the usual discharges, as not only the cure of the disease, but the patient's life, may depend on this. A periodical looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which it retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is, however, so far from being hurtful to them, that such children gen- erally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a teaspoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a lit- tle panada, or any other food, or the mixture advised below.t This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools. The chalk mixture in the annex- ed forms may be administered in doses of two or three spoonsful after each evacuation, to suspend the inordinate action of the in- testinal canal ;| or a tea-spoonful of fine powdered chalk may be mixed in a teacupful of water-gruel, and given occasionally. A diarrhoea, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper; nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and, other antispasmodic medicines, are most proper. Ten or twelve drops of liquid laudanum may be taken in a cup of valerian or penny-royal tea, every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquillity of mind are here of the greatest importance. * Take Carbonate of Magnesia, 1 scr. Tincture of Catechu, 1 oz. Aromatic Confection, J drm. Chalk Mixture, 6 oz. Powdered Rhubarb, 15 grs. Syrup of Ginger, \ oz. Syrup of Ginger, 1 drm. Tincture of Opium, 30 drps. Mint Water, 1J oz. Make a mixture; of which, let two table- Make anaperient antacid draught, spoonsful be taken after each liquid or stool, previously shaking the bottle- Take Magnesia, 2 scrs. or Powdered Rhubarb, 8 grs. Take Compound Powder of Chalk with Compound Powder of Cinnamon Opium, 1 scr. 10 grs. Extract of Catechu, 15 grs! Make a powder, to be taken morning and Make a powder; to be taken after each evening. liquid stool. or tTake Powdered Rhubarb, 15 grs. Take Compound Powder of Chalk, Carbonate of Magnesia, J drm. 6i'oz. Dill Water, 2 oz. Opium in Powder, 4 scrs. Aromatic Spirit of Ammonia, Dose, 1 to 2 scruples. 20 drps. or Tincture of Opium, 10 drps. Take Extract of Logwood, 1£ drm Make a mixture ; two or three tea-spoons- Chalk Mixture, 6 oz. ful, to be taken three times a-day, or Tincture of Cardamoms, 1 oz. oftener if occasion require. Make a mixture; and take three table- . _ , spoonsful after each liquid motion... I lake Aromatic Confection., 1 drm. 228 VOMITING. When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may likewise be taken to remove their irritation. • When the gout, repelled from the extremities, occasions a loose- ness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine-whey with spirits of hartshorn, or a few drops of liquid laudanum in it. When a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c, medicines must be given to kill and carry off these vermin, as the powder of tin, with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and pre- vent the new generation of worms. A looseness is often occasioned by drinking bad water. When this is the case, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or if that cannot be done, it may be corrected by mixing with it quick lime, chalk, or the like. In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this, is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white-wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret. From whatever cause a looseness proceeds, when it is found necessary to check it the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly, sago with red port, and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice-water, or weak broth made from lean veal, or with a sheep's head, as being more gelatinous than mutton, beef, or chicken-broth. Persons who, from a peculiar weakness, or too great an irrita- bility of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwhole- some foods, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspira- tion, and should wear flannel next the skin. All violent passions, as fear, anger, &c. are likewise carefully to be guarded against. Vomiting. Vomiting may proceed from various causes ; as excess in eating and drinking; foulness of the stomach; the acrimony of the ali- ments; a translation "f the .latter of ulcers, of «''e gout, VOMITING. 229 the erysipelas, or other diseases, to the stomach. It may likewise proceed from a looseness having been too suddenly stopped; from the stoppage of any customary evacuations, as the bleeding piles, the menses, Sec. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms, or from any kind of poison taken into the stomach: It is an usual symptom of injuries done to the brain ; as contusions, compressions, &c. It is likewise a symptom of wounds or inflammations of the dia- phragm, intestines, spleen, liver, kidneys, &c. Vomiting may be occasioned by unusual motions, as falling, being drawn back in a carriage, &c. It may likewise be excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vom- iting. Sometimes it proceeds from a regurgitation of the bile into the stomach: in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnane v. In this case it generally comes on about two weeks after the stoppage of the menses, and continues during the first three or four months. When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure of a disease. It ought, therefore, to be promoted, by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile tea. When the retrocession of the gout, or the obstruction of custom- ary evacuations occasion vomiting, all means must be used to restore these discharges; or, if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blis- ters, SiC. When vomiting is the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open. The bleeding, however, ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women are most apt to vomit in the morning immediately after getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach. It may generally be prevented, by taking a dish of coffee, tea, or some light breakfast, in bed. Pregnant women, who are afflicted with vomiting, ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor :>hould they eat much at once. Cold water is a very proper drink in this case ; if the stomach be weak, a little brandy inay be added to it. If the spirits be low, and the person apt to f;iint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken. If vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or bvnndv, with as much rhubarb as will keep the bodv gently open, !-• an excellent medicine in this case. Sulphuric acid is also a : -ulicine. 230 DIABETES, Sec. It may be taken in the dose of fifteen or twenty drops, twice or thrice a-day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet. A vomiting which proceeds from acidities in the stomach, is re- lieved by alkaline purges. The best medicine of this kind is the magnesia alba, a teaspoonful of which may be taken in a dish of tea, or a little milk, three or four times a-day, or oftener if neces- sary, to keep the body open, or any of the cretaceous mixtures recommended in diarrhoea. When vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added. When vomiting proceeds from spasmodic affections of the stom- ach, musk, castor, and other antispasmodic medicines are of use. Warm and aromatic plasters have likewise a good effect. Aro- matic medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with aether, or if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath. I have always found the saline draughts, taken in the act of ef- fervescence, of singular use in stopping a vomiting, from what- ever cause it proceeded. Tnese may be prepared by dissolving a drachm of the subcarbonate of potash, in an ounce and a half of fresh lemon-juice, and adding to it an ounce of peppermint-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach, after all other means had failed. As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of ac- tion. The diet must be so regulated as to sit easy upon the stom- ach, and nothing should be taken that is hard of digestion. We do not, however, mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids. CHAP. XXIV. DIABETES, AND OTHER DISORDERS OF THE URIN- ARY ORGANS. The diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people : but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth, DIABETES, Sec. „ 231 ' Causes.—A diabetes is often the consequence of acute diseases, as fevers, fluxes, Sec, where the patient has suffered by excessive evacuations ; it may also be occasioned by great fatigue, as riding long journies upon a hard-trotting horse, carrying heavy burdens, running, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drink- ing too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quan- tities, by^yvhich mistake it often happens that they occasion worse diseases tnan those they were intended to cure. In a word, this dis- ease may either proceed from too great a laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages. Symptoms.—In a diabetes, the urine generally exceeds in quan- tity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away till the patient is reduc- ed to skin and bone. There is a heat of the bowels ; and fre- quently the loins, testicles, and feet, are swelled. It has been remarked, that diabetes is often preceded or accom- panied with an affection of the lungs; and Dr. Bardsley informs us that he does not recollect an instance of the disease which was not attended with some affection of the chest. This disease may generally be cured at the beginning : but after it has continued long, the cure becomes very difficult. In drunk- ards, and very old people, a perfect cure is not to be expected. Regimen.—Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason, the patient should live chiefly on solid food. His thirst may be quench- ed with acids ; as sorrel, juice of lemon, or vinegar. The mucil- aginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be pre- ferred ; as oysters, crabs, &c. The Bristol Hot-well waters, when drank at the fountain head have long been celebrated for their good effects in this disease! VV hen that cannot be obtained, lime-water, in which a due propor- tion of oak-bark has been macerated, may be used. The patient ought daily to take exercise, but it should be so gen- tle as not to fatigue him. He should lie upon a hard bed or mat- tress. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh-brush, and every thing that pro- motes perspiration, is of service. For this reason, the patient ought to wear flannel next his skin. A large strengthening-plas- L'Ty ?%phcd l° the back ; or' what wil1 answer better, a great part of the body may be wrapped in plaster. *noiEi,,CINiE'~,('entle PurSes> if tfae patient be not too much weak- ened by the disease. hnv* » crn„A offect. They may congigt rf 232 DIABETES, &c. rhubarb, with cardamom-seeds, or any other spiceries, infused in wine, and may be taken in such quantities as to keep the body gen- tly open. The patient must next have recourse to astringents and corrobo- rants. Half a drachm of powder made of equal parts of alum and the inspissated juice, commonly called Terra Japonica, may be taken four times a-day, or oftener, if the stomach will bear it. The alum must first be melted in a crucible ; afterwards they may both be pounded together. Along with every dose of this powder, the patient may take a tea-cupful of the tincture of roses.* If the patient's stomach cannot bear the alum in substance whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The alum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of alum, till the curd separates. Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient's drink three or four times a-day. The best corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more effi- cacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance, may use the decoction, mixed with an equal quantity of red wine, and sharpened as above. There is a disease incident to labouring people in the decline of life, called an INCONTINENCYof Urine. But this is very differ- ent from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bladder, and is often the effect of a palsy. Some- times it proceeds from hurts, or injuries occasioned by blows, bruises, preternatural labours, &c. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diu- retics, or of stimulating medicines injected into the bladder. This disease may be mitigated by the use of astringent and corroborating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured.t * See Appendix, Tincture of Roses. t Dr Ferriar informs us that he has cured three confirmed cases of this disease by a combination of cinchona, uva ursi, and opium, taken three times a-day. in the propor- tion of a scruple of each of the former to half a grain of the latter; and that, Iroinwjo ereat success he had met with from this medicine, he found it unnecessary to try ui. Rollo's plan, which is said to have performed a cure under very unpromising circum- S The indications to be attended to, Dr. Rollo supposes to be, to destroy the saccha- rine process wing on in the stomach ; to promote a healthy assimilation ; to prevent a sunDOsed increased absorption by the surface; to diminish the increased action; ana to change the imagined derangement of the kidneys. To answer these indications r»r Rolfo -nioins a diet consisting wholly of animal food, rigid abstinence from every kind of v- • -able substance from which ni.iar may be produce,!. He likewise enjoiM heoaSe ' imonia, and the subenrbont. of ammoni t when .his r i •«• obtained, Sib skin • pointed with prepar. = ' H; exercise to be av„; SUPPRESSION OF URINE. 333 Inanincontinencyofurine, from whatever cause, a piece of Bponge ought to be worn, or a bladder applied in such a manner as to prevent the urine from galling and excoriating the parts. Suppression op Urine. It has already been observed, that a suppression of urine may proceed from various causes ; as an inflammation of the kidneys, or bladder ; small stones or gravel lodging in the urinary pass- ages, hard faces lying in the rectum, pregnancy, a spasm or con- traction of the neck of the bladder, clotted blood m the bladder itself, a swelling of the hsemorrhoidal veins, &c. Some of these cases require the catheter, both to remove the ob- structing matter, and to draw off the urine ; but as this instrument can only be managed with safety bv persons skilled in surgery, we shall say nothing further of its use. A bougee may be used by any cautious hand, and will often succeed better than the catheter. We would chiefly recommend, in all obstructions of urine, fo- mentations and evacuants. Bleeding, as far as the patient's strength will permit, is necessary, especially where there are symp- toms of topical inflammation. Bleeding in this case not only abates the fever, by lessening the force of the circulation, but, by relaxing the solids, it takes off the spasm or stricture upon the ves- sels, which occasioned the obstruction. After bleeding, fomentations must be used. These may either consist of warm water alone, or of decoctions of mild vegetables ; as mallows, camomile flowers, &c. Cloths dipped in these may either be applied to the part affected, or a large bladder filled with the decoction may be kept continually upon it. Some put the herbs themselves into a flannel bag, and apply them to the part, which is far from being a bad method. These continue longer warm than cloths dipped in the decoction, and at the same time keep the part equally moist. In all obstructions of urine the body ought to be kept open. This is not, however, to be attempted by strong purgatives, but by emollient clysters, or gentle infusions of senna and manna. Clys- ters in this case not only open the body, but answer the purpose of an internal fomentation, and greatly assist in removing the spasms of the bladder and parts adjacent. The food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mucilag- inous vegetables, as marsh-mallow roots, lime-tree buds, &c. A teaspoonful of the sweet spirits of nitre, or a drachm of Castile with opium to be taken at night; an ulceration of about the size of a half-crown to be kept open opposite each kidney ; and the bowels to be kept open by aloes and soap. At first Dr. Rollo was in the habit of using the sulphuret of potash ; for which, how- ever, he was induced to substitute the hepatized ammonia, under the supposition that the alkali of the former had an improper effect on the kidneys: e. g. Take Sulphuret of Potash, 10 grs. Take Sulphuret of Potash, 10 grs. Confection of Roses, q. s. Mint Water, 1} oz. To be made into a bolus, to be taken Syrup of Ginger, 1 drm. three times a-day. Make a draught to be taken three times or a-day. Ed. • k bottle nnda of the India rubber, and properly applied, answers this purpose best. 334 GRAVEL AND STONE. soap, may be frequently put into the patient's drink ; and, if there be no inflammation, he may drink small gin-punch. Persons subject to a suppression of urine ought to live very tem- perate. Their diet should be light, and their liquor diluting. They should avoid all acid and austere wines, should take sufficient ex- ercise, lie hard, and avoid study and sedentary occupations.* Gravel and Stone. (Lithiasis.) These diseases are the consequence of a peculiar disposition of the fluids, and more particularly the secretion of the kidneys to form a calculous matter, and have been supposed to be owing to the presence of an acid principle in them, called the uric acid; an opinion which seems to be confirmed by the benefit derived from a course of alkaline medicines. When small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the gravel. If one of these stones happen to make a lodgment in the bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. In this case the pa- tient is said to have the stone. Causes.—The stone and gravel may be occasioned by high liv- ing ; the use of astringent wines ; a sedentary life : lying too hot, soft, or too much on the back; the constant use of water impreg- nated with earthy or stony particles ; aliments of an astringent Or windy nature, Sec. It may likewise proceed from an heredita- ry disposition. Persons in the decline of life, and those who have been much afflicted with the gout or rheumatism, are most liable to it. Symptoms.—Small stones or gravel in the kidneys occasion fix- ed pain in the loins, sickness, vomiting, and sometimes bloody urine, and not unfrequently with a slight suppression of urine. When the stone descends into the ureter, and is too large to pass along with ease, all the above symptoms are increased; the pain extends towards the bladder ; the thigh and leg of the affected side are benumbed ; the testicles are drawn upwards, and the urine is obstructed. A stone in the bladder is known from the pain at the time, as well as before and after making water ; from the frequent inclina- tion to void the urine ; from the urine coming away by drops, or stopping suddenly when it was running in a full stream ; by a vio- lent pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road ; or from a white, thick, copious, stinking, mucous sediment in the urine ; from an itching at the top of the penis; from bloody urine; from an inclination to go to stool during the discharge of urine ; from the •Rubbing the abdomen and inside of the thighs with the volatile liniment, composed of equal parts of spirits of hartshorn and oil, will sometimes relieve a suppression 01 nrine • or ten drops of the tincture of the muriate of iron, given every ten minutes, in a wine-rfassfttl of water, will frequently produce the same effect, if the suppression Da » consequence of spasm of the neck of the bladder. Ed. GRAVEL AND STONE. 235 patient'8 passing his urine more easily when lying than in an erect posture ; from a kind of convulsive motion occasioned by the sharp pain in discharging the last drops of the urine ; and lastly, from sounding or searching with the sound, which is the only symptom to be depended upon. When gravel has once formed in the pelvis of the kidneys, or elsewhere, it continues to increase by receiving on its surface new layers of uric acid successively precipitated, of which any one may be convinced by cutting the concretions transversely, which ena- bles us to perceive that they are almost entirely composed of con- centric layers. Regimen.—Persons afflicted with the gravel or stone should avoid aliments of a windy or heating nature, as salt meats, sour fruits, &c. Their diet ought chiefly to consist of such things as tend to promote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, succory, purs- lane, turnips, potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and celery are, in this case, reckoned medicinal. The most proper drinks are whey, butter-milk, milk and water, barley-water ; decoctions or infusions of the roots of marsh-mal- lows, parsley, liquorice, or of other mild mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If the patient has been accustomed to generous liquors, he may drink gin and water not too strong. Gentle exercise is proper; but violent motion is apt to occasion bloody urine. We would, therefore, advise that it should be tak- en in moderation. Persons afflicted with the gravel often pass a great number of stones after riding on horseback, or in a carriage ; but those who have a stone in the bladder are seldom able to bear these kinds of exercise. Where there is a hereditary tendency to this disease, a sedentary life ought never to be indulged. Were people careful, upon the first symptoms of gravel, to observe a proper regimen of diet and to take sufficient exercise, it might often be carried off, or at least prevented from increasing ; but if the same course which occasioned the disease is persisted in, it must be aggravated. Medicine.—In what is called a fit of the gravel, which is com- monly occasioned by a stone sticking in the ureter, or some part of the urinary passages, the patient must be bled ; warm fomenta- tions should likewise be applied to the part affected, emollient clysters administered, and diluting mucilaginous liquors drank, &c. The treatment of this case has been fully pointed out under the articles Inflammation of the Kidneys and Bladder, to which we refer. When the preference is given to a palliative mode of treatment ot stone in the bladder, in males, instead of resorting to the opera- tion of lithotomy, hthontriptics, which retard or prevent the far- ther accumulation of calculous matter, may be had recourse to, for example, the fixed alkali, which is not only the most powerful, but 236 GRAVEL AND STONE. the one most generally employed, and which may be used both in its caustic* and mild state.t The aerated potash is a preparation somewhat similar in its nature to the aerated alkaline water, and is now used at St. Bar- tholomew's hospital, and given in the dose of two drachms dissolv. ed in a pint of distilled water, twice a-day. It consists of half an ounce of the subcarbonate of potash, five drachms of distilled water, and one drachm of subcarbonate of ammonia. The potash being dissolved in a water-bath, the ammonia is to be added; and when the effervescence is at an end, the mixture is set aside to chrystallize. Dr. Whyte advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morning, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes that though this quantity might be too small to have any sensible effect in dissolving a stone in the bladder, yet it may very probably prevent its growth. When a stone is formed in the bladder, the Doctor recommends Spanish soap,J and oyster or cockle-shell lime-water, to be taken in the following manner: the patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or Cockle-shell lime-water: the soap is to be divided into three doses; the largest to be taken fasting in the morning early, the second at noon, and the third at seven in the evening, drinking above each dose a large draught of the lime-water, the remainder of which he may take any time betwixt dinner and supper, instead of other liquors. The patient should begin with a smaller quantity of the lime- water and soap than that mentioned above; at first an English pint of the former, and three drachms of the latter, may be taken daily. This quantity, however, he may increase by degrees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his complaints, for several months ; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime- water in small quantities, but to take the second or third lime- water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first water, but if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells* Though the caustic alkali and soap-lees, and lime-water, are the most powerful medicines which have hitherto been discovered for the stone, yet there are some things of a more simple nature, which •Take Solution of Potash, 20 to 30 drops, Take Lime Water, 1 pint a-day, mixed three times a-day, in a tea-cupful of with milk. veal broth, gradually increasing the or dose Take Soda Water, £ pint, two or three times a-day. * T»k* Carbonate of Soda, from 1 scruple * T> half a £achm three times a-day. * Take Soap Pill, ten grains, for a do* of morning and night. GRAVEL AND STONE 237 in certain cases are found tp be beneficial, and therefore deserve a trial. An infusion of the seeds of daucus sylvestrts, or wild carrot, sweetened with honey, has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid lature. A decoction of raw coffee-berries taken morning and eve- ning, to the quantity of eight or ten ounces, with ten drops ot sweet spirit of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable. It is the opinion of Dr. Duncan that a solution of the subcarbon- ate of soda in pure water (in the proportion of a scruple to a pint) is preferable to the aerated soda water, on account of the carbonic acid gas not being disengaged on exposure to the atmosphere. On the addition of a small quantity of lemon-juice, or acid of tartar, a very agreeable effervescence is produced. The carbonate of soda, by being combined with an excess of carbonic acid gas in this pre- paration, is rendered not only more pleasant to the taste, but less liable to offend the stomach; and Dr. Duncan is of opinion that it is the only form in which the soda can be exhibited in sufficient doses, and for a length of time, so as to derive any benefit from its use. Muriatic add (particularly in what is called the phosphatic* diathesis) given in doses of twenty or thirty drops, three or four times a-day, diluted with water, has been found, in several cases where gravel was expelled from the bladder, to afford considerable benefit, and to appease the pain in micturition; and is found, moreover, to be a powerful lithontriptic. The only other medicine wliich we shall mention is the uva ursi. It has been greatly extolled of late, both for the gravel and stone. It seems, however, to be in all respects inferior to the soap and lime-water; but it is less disagreeable, and has frequently, to my knowledge, relieved gravelly complaints. It is generally taken in powder, from half a drachm to a whole drachm, two or three limes a-day. It may, however, be taken to the quantity of seven <>r eight drachms a-day, with great safety and good effect. The consistence of such stones varies so much, that there is rea- son to fear no medicine will ever be found sufficiently strong to lissolve the hardest of them, without destroying the bladder. Yet experiments on this subject ought not to be discontinued, as the object is great, and some hard substances are known to be soluble in seemingly mild ones. I have known several instances where stones, after gettino- into the urethra, were brought away by means of a bent probe, but how < > get them there is the difficulty. It can only happen while they are small, though 1 have seen flattish stones brought away in this •'»anner, winch measured two inches round. I have sometimes 2 , Vng °n a hard-tr°tting horse, or in a carriage on a "»gh road, might tend to bring down a small stone. . Most people troubled with the stone are guilty of one great re*a£on\nceCM)!Ht0!" fo"r *Pecie» of calculus noticed by Dr. Woll earson. ace Medical and Chirurgical Review, Vol. iv. p. 486. Vol. v ollaston and Dr. G. p. 306. Ed. 238 INVOLUNTARY DISCHARGES OF BLOOD. error; they put off the operation too long. When it is certaiuly known that there is a stone in the bladder, and that it is too large to get along the urethra, no time ought to be lost in having it cut out, before the patient's habit becomes too irritable, or the stone is so far increased in size, that it cannot be extracted without a laceration of the parts.* CHAP. XXV. INVOLUNTARY DISCHARGES OF BLOOD. (Hemorrhagic.) Spontaneous or involuntary discharges of blood often happen from various parts of the body. These, however, are so far from being always dangerous, that they often prove salutary. When such discharges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor, indeed, is it proper, at any time, to stop them, unless they be so great as to endanger the patient's life. Most people, afraid of the smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by which means an inflammation of the brain, or some other fatal disease, is occasioned, which, had the discharge been allowed to go on, might have been prevented. Periodical discharges of blood, from whatever part of the body they proceed, must not be stopped. They are always the efforts of Nature to relieve herself; and fatal diseases have often been the consequence of obstructing them. It may, indeed, be sometimes necessary to check the violence of such discharges ; but even this requires the greatest caution. Instances might be given where the stopping of a small periodical flux of blood from one of the fingers has proved fatal to the health. In the early period of life, bleeding at the nose is very common. Those who are farther advanced in years are more liable to life- moptoe, or discharge of blood from the lungs. After the middfe period of life, hemorrhoidal fluxes are most common, and, in (he decline of life, discharges of blood from the urinary passages. Involuntary fluxes of blood may proceed from very different, and often from quite opposite causes. Sometimes they are owing to a particular construction of the body, as a sanguine temperament, laxity of the vessels, plethoric habit, &c. At other times tney proceed from a determination of the blood towards one particular part, as the head, the hamiorrhoidal veins, Sec They may likewise proceed from an inflammatory disposition of the blood, in win case there is generally some degree of fever: this likewise happens when the flux is occasioned by an obstructed perspiration, or stricture upon the skin, the bowels, or any particular part ol «* ^BuTa dissolved state of the blood will likewise occasion hsmor- * A tea-sooonful of pure magnesia taken two or three times a-day has; of lattjbjj discovered^ be a most effectual preventive of the gravel and stone, and .. of «£ where alkals fail to relieve the increased secretion of uric acid, and to prevent wnere aiKans •* • , ----^o hnltpr wlth y,e Btomach. forming calculi in the kia BLEEDING AT THE NOSE. »» rhages. Thus, in putrid fevers, dysentery, scurvymaHgnant small-pox, Sec, there are often very great discharges of blood from rffeent parts of the body. They may likewise be brought on by Jh! oo liberal us of medicines which tend to dissolve the blood as cantharides, the volatile alkaline salt, Sec Food of an acrid r ,rritat,ng quality may likewise occasion haemorrhages , as also strong purges and vomits, or any thing that greatly stimulates the h° Vmlent passions or agitations of the mind will likewise have this effect. These often cause bleeding at the nose, and I have known them sometimes occasion an haemorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging the head very low, &c. The cure of hemorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to inflammation, bleeding, with gentle purges and other evacuations, will be necessa- ry. It will likewise be proper for the patient in this case to live chiefly upon a vegetable diet, to avoid all strong liquors and food that is of an acrid, hot, or stimulating quality. The body should be kept cool, and the mind easy. When an haemorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acrid fruits with milk, and vegetables of a nourishing nature, as sago, salop, &c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirits of vitriol. The best medicine in this case is the Peruvian bark, which may be taken according to the urgency of the symptoms. When a flux of blood is the effect of acrid food, or of strong stimulating medicines, the cure is to be effected by soft and mucil- aginous diet. The patient may likewise take frequently about the bulk of a nutmeg of Locatelli's balsam, or the same quantity of spermaceti. When obstructed perspiration, or a stricture upon any part of the system, is the cause ofan haemorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extremi- ties in warm water, &c. Bleeding at the Nose. (Epistazis.) Bleeding at the nose is commonly preceded by some degree of quickness of the pulse, flushing in the face, pulsation of the tem- poral arteries, heaviness in the head, dimness of the sio-ht, heat and itching of the nostrils, &c. To persons who abound with blood, this discharge is very saluta- ry. It often cures a vertigo, the head-ache, a phrenzy, and even M«!T. PS-V', ,nL f?VerS' Where there is a =reat determination of Wood towards the head, it is of the utmost service. It is likewise thelm V", am,Uati°nS °ft,,e liver and ^en, and often in ceo.Sv r»«*»»"»tism. In all diseases where bleeding is ne- inore?;rrtSPTan?Usdischar^e of b,ood from the nose is of much In »T'Cu than ,he samc quantity let with a lancet. a d.scharge of blood from the nose, the great point is to da- 840 BREEDING AT THE NOSE. termine whether it ought to be stopped or not. It is a common practice to stop the bleeding, without considering whether it be a disease, or the cure of a disease. This conduct proceeds from fear ; but it has often bad, and sometimes fatal consequences. When a discharge of blood from the nose happens in an inflam- matory disease, there is always reason to believe that it may prove salutary; and therefore it should be suffered to go on, at least as long as the patient is not weakened by it. When il naPPens to persons in perfect health, who are full of blood, it ought not to be suddenly stopped, especially if the symp- toms of plethora, mentioned above, have preceded it. In this case it cannot be stopped without risking the patient's life. In fine, whenever bleeding at the nose relieves any bad syrap. torn, and does not proceed so far as to endanger the patient's fife it ought not to be stopped. But when it returns frequently, or con- tinues till the pulse becomes low, the extremities begin to grow cold, the lips pale, or the patient complains of being sick or faint, it must immediately be stopped. For this purpose the patient should be set nearly upright, with his head reclining a little, and his legs immersed in water about the warmth of new milk. His hands ought likewise to be put in lukewarm water, and his garters may be tied a little tighter than usual. Ligatures may be applied to the arms, about the place where they are usually made for bleeding, and with nearly the same degree of tightness. These must be gradually slackened as the blood begins to stop, and removed entirely as soon as it gives over. Sometimes dry lint put up the nostrils will stop the bleeding. When this does not succeed, dossils of lint dipped in strong spirits of wine may be put up the nostrils, or if that cannot be had they may be dipped in brandy. When it arises in elderly peo- ple, or returns too frequently, or continues till the patient be- comes faint, it ought to be stopped as quick as possible : to effect this, the patient should be exposed freely to cool air, and placed nearly in the erect posture, with the head inclined somewhat back- ward ; drinking freely of cold liquor, and some saline medicine,' and living abstemiously. Besides these means, the patient nu[ immerse his head in a pailful of cold water impregnated with the muriate of ammonia, or common salt, and snuff vinegar diluted with cold water up the nose ; or some astringent washf may frequently be thrown up the nostril from which the hemorrhage proceeds, by means of a syringe. At the same time the body, if necessary, may be kept open, with cooling purgatives, in order to make some derivation from the blood-vessels of the head; the pa- tient carefully avoiding all those circumstances which might either determine the blood to the head, or prevent its free return from it • Take Acidulated Infusion of Roses, Make a draught, to be taken three or foot 6 oz. times a-day. Nitrate of Potash, 1 drm. t Take Powdered Alum, * «**■ Make a mixture; of which, take three Rose Water, 6 w. table-spoonsful every three hours. Distilled Vinegar, i 0%- Make an injection. Take Diluted Sulphuric Acid, 24 drps. or ,,,.«, Water H °z- Take Muriated Tincture of Iron, 1* otm■ Syrup of Roses, 2 drs. Distilled water, 6 <"• Tincture of Opium, 15 drps. Mix, and make an injection. BLEEDING AND BLIND PILES. 241 If the genitals be immersed for some time in cold water, it will generally stop a bleeding at the nose. I have not known this fail. Sometimes, when the bleeding is stopped outwardly, it contin- ues inwardly. This is very troublesome, and requires particular attention, as the patient is apt to be suffocated with the blood, es- pecially if he falls asleep, which he is very ready to do after losing a great quantity of blood. AY hen the patient is in danger of suffocation from the blood get- ting into his throat, the passages may be stopped by drawing threads up the nostrils, and bringing them out at the mouth, then fas- tening pieces of sponge, or small rolls of linen cloth to their ex- tremities ; afterwards drawing them back, and tying them on the outside with a sufficient degree of tightness. Vfter the bleeding is stopped, the patient ought to be kept as easy and quiet as possible. He should not pick his nose, nor take away the tentes or clotted blood till they fall off of their own ac- cord, and should not lie with his head low. Those who are affected with frequent bleeding at the nose, ought to bathe their feet often in warm water, and keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible, and never to view any object obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it. When bleeding at the nose occurs in adults of a full plethoric habit, a frequent use of cooling purgatives, and an antiphlogistic regimen, may probably prevent a return of the complaint. When occasioned by too great a determination of blood to the head, top- ical bleeding, by means of leeches applied to the temples, will be advisable'. When it is occasioned by the suppression of some ac- customed evacuation, such as the menstrual or hemorrhoidal flux, these are to be promoted, if possible, and should the attempt to restore them not succeed, some other discharge must be substitut- ed, either by means of an issue or seton, &.c. But when the disease proceeds from a thin dissolved state of the blood, the diet should be rich and nourishing ;' as strong broths and jellies, sago-gruel with wine and sugar, &c. Infusion of the Peruvian bark in wine ought likewise to be taken, and persisted in for a considerable time. Bleeding and Blind Piles, (Hamorrhois.) A discharge of blood from the hemorrhoidal vessels is called the bleeding piles. When the vessels only swell, and discharge no blood, but are exceedingly painful, the disease is called the blind piles. Persons of a loose spongy fibre, of a bulky size, who live high, and lead a sedentary, inactive life, are most subject to this disease. It is often owing to an hereditary disposition. Where this is the case, it attacks persons more early in life than when it is acciden- tal. Men are more liable to it than women, especially those of a sanguine, plethoric, or a scorbutic habit, or of a melancholy dis- position. L 242 BLEEDING AND BLIND PILES. The piles may be occasioned by an excess of blood, by strong aloetic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacua- tions, much riding, great costiveness, or any thing that occasion! hard and difficult stools. Anger, grief, or other violent passions, will likewise occasion the piles. 1 have often known them brought on by sitting on the damp ground. A pair of thin breeches will excite the disorder in a person who is subject to it, and sometime! even in those who never had it before. Pregnant women are often afflicted with the piles. A flux of blood from the anus is not always to be treated as a disease. It is even more salutary than bleeding at the nose, and often prevents or carries off diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondriacal complaints, and often proves critical in colics, and inflammatory fevers. In the treatment of piles due attention should be paid to the cause from which they have arisen; and as costiveness is one of the most frequent, the bowels ought to be kept open and regular by means of gentle laxative medicines;* and as a habit may be acquired, the patient will do well to observe stated times in the day for endeavouring to obtain motions, but without straining. Should none be procured by the aid of the laxative medicine,-the peristaltic motion may be excited by clysters of tepid water with soap and oil. In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which migbt be excessive and prove hurtful to one, may be very moderate, and even salutary to another. That only is to be esteemed dangerous, which continues too long, and is in such quantity as to waste the patient's strength, hurt the digestion, nutrition, and other functions necessary to life. When this is the case, the discharge must be checked by a proper regimen, and astringent medicines. The Diet must be cool but nourishing, consisting chiefly of bread, milk, cooling vegetables, and broths. The Drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and muci- laginous plants, as the tormentil root, bistort, the marsh-mallow roots cLr (* Old conserve of red roses is very good medicine in this case. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to pro- duce any effects; but when taken as here directed, and duly per- sisted in, I have known ir perform very extraordinary cures in violent haemorrhages, especially when assisted by the tincture ot roses; a tea-cupful of which may be taken about an hour alter every dose of the conserve. • Take Lenitive Electuary, 2 oz. or -.,„,-. Powdered Jalap, 2 drs. Take Castor Oil, 6 drs. to 1 <*. Nitrate of Potash, 1A drm. or Svruo of Buckthorn, enough to form an Take Powdered Jalap, I •«• electuarv. The bulk of a nutmeg to be Cream of Tartar, * •«•• taken occasionally. Make a powder for a dose. BLEEDING AND BLIND PILES. 243 The Peruvian bark is likewise proper in this case, both as a strengthener and astringent. Haifa drachm of it may be taken in a glass of red wine, sharpened with a few drops of the elixir of vit- riol, three or four times a-day. The bleeding piles are sometimes periodical, and return regular- ly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the hsemorrhoidal veins. In the blind piles, bleeding is generally of use. The diet must be light and thin, and the drink cool and diluting. It is likewise necessary that the body be kept gently open. This may be done by small doses of the flour of brimstone and cream of tartar.* These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftener if necessary." Or an ounce of the flour of brimstone and half an ounce of purified nitre, may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day. Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the anus, that they cannot be thrown up. In this case I have known a vomit have a very good effect. When the piles are exceedingly painful and swelled, but dis- charge nothing, the patient must sit over the steam of warm water. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possi- ble, or if they will fix upon the piles themselves, so much the bet- ter. When leeches will not fix, the piles may be opened with a lance. The operation is very easy, and is attended with no danger. Various ointments, and other external applications, are recom- mended in the piles ; but I do not remember to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, which may be done as well by a soft poultice, or an emollient cataplasm. When the pain, however, is very great, some anodyne liniment may be applied.t Perhaps no other cause of the piles is so frequent as the use of aloetic purgatives. It is to be observed that aloes forms a consid- erable share of almost all advertised purging pills. A costive habit is more effectually, and much more safely removed, by a spoonful of castor oil taken occasionally in an evening. When the piles are very painful, the best external application is a weak solution of sugar of lead with a little laudanum, or an oint- ment composed of similar ingredients.^ An ointment made of one- * Take Sublimed Sulphur, 1 oz. Lenitive Electuary, 2 oz. Cream of Tartar, 3 drs. Syrup of Roses : enough to make the whole into an electuary. Dose, the size of a nutmeg occasionally. t Take Spermaceti Ointment, 2 oz. Opium, fine powdered, 1 drm. Make an ointment. X Take Spermaceti Ointment, Cerate of Superacetate of Load, of each, 4, •*• Opium in Powder, J drm. Mix for an ointment. 244 SPITTING OF BLOOD. third finely powdered galls, and two-thirds hog's lard, is very useful. When the piles are seated high, relief may frequently be obtained from the injection of lime-water, or of an infusion of galls. . The pain of the piles is very often removed by an emetic, or by taking twice a-day thirty drops of balsam of copaiva on a little moist sugar. When a pile has a narrow neck, it is best extirpated by the knife. If the pile be large, or has a broad basis, a double ligature may be passed through it, and tied on each side. When piles are neglected, they are very apt to produce a fistula. This complaint is discovered by a stain of matter on the linen which, on examination, will be found to proceed from a small ori- fice in the neighbourhood of the anus. Various local remedies are recommended for this complaint. The utility of all of tliem de- pends on their power of stimulating the sides of the ulcer into more active inflammation, so as to make them cohere together. On this principle, I think I have seen advantage from taking a wine-o violent as to occasion great restlessness, anxiety, and even deliri- um. Sometimes epileptic fits, and other convulsive disorders, have been brought on by extreme pain in the ear. The ear-ach may proceed from any of the causes which pro- duce inflammation. It often proceeds from a sudden suppression of the perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the trans- lation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is gen- erally reckoned a favourable symptom. PAIN OF THE STOMACH, Sec. 259 When the ear-ach proceeds from insects, or any hard body Bticking in the ear, every method must be taken to remove them as noon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the pa- tient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be ex- tracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil. When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water ; or flannel bags filled with boiled mallows and camomile-flowers may be applied to it warm ; or bladders filled with warm milk and wa- ter. An exceedingly good method of fomenting the ear is to ap- ply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile-flowers. The patient's feet should be frequently bathed in lukewarm wa- ter, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter three times a- day. His drink may be whey, or decoction of barley and liquor- ice, with fisrs or raisins. The parts behind the ear ought frequent- ly to be rubbed with camphorated oil, or a little of the volatile lin- iment, and a few drops of the camphorated spirit of wine may be put into the ear with wool or cotton. A blister behind the ear, if applied earlv, will sometimes remove this complaint. When the" inflammation cannot be discussed, a poultice of bread and milk, or roasted onions may be applied to the ear, and fre- quently renewed, till the abscess breaks, or can be opened. Af- terwards the humours may be diverted from the part by gentle laxatives, blisters, or issues ; but the discharge must not be sud- denly dried up by any external application. Ear-neb someiimes continues for some time without any appar- ent inflammation, and is then frequently removed by filling the ear with cotton or wool, moistened with tincture of opium or ether, or even with warm oil or water. Pain in the ear is also sometimes the consequence of a diseased tooth, in which case the ether should be applied to the cheek over the suspected tooth, or a grain of opium with a little camphor, or half a grain of the ex- tract of belladonna may be applied to the tooth itself. Pain of the Stomach, Sic (Gastrodynia.) Tims may proceed from various causes, as indigestion, wind, the acrimony of the bile ; sharp, acrid, or poisonous substances taken into the stomach, Sic It may likewise be occasioned by worms ; the stoppage of customary evacuations ; or from a trans- lation of gouty matter to the stomach, the bowels, Sec. heart-burn, flatulency, and other dyspeptic symptoms. Women in the decline of life are very liable to pains of the stom- ach and bowels, especially such as are afflicted with hysteric com- plaints. It is likewise very common to hypochondriac men of a 260 PAIN OF THF STOMACH, Sec sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine. When the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change hie diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile-flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage. When a pain of the stomach proceeds from flatulency, the pa- tient is constantly belching up wind, and feels an uneasy disten- tion of the stomach after meals. This is a most deplorable dis- ease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, Sic This rule, however, admits of some exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched peas, though that grain is generally supposed to be of a windy nature.* This complaint may likewise be greatly relieved by labour, espe- cially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with, was in a person of a sedentary occupation, whom I advised, alter he had tried every kind of medicine in vain, to turn gardener ; which he did, and has ever since enjoyed good health. When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit : this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents. When a pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, Sec Some have drank a whole bottle of brandy or rum in this case in a few hours, without being in the least in- toxicated, or even feeling the stomach warmed by it. It is impos- sible to ascertain the quantity necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclin- ation to vomit, it may be promoted by drinking an infusion of cam- omile-flowers, or carduus benedictus. If a pain of the stomach proceed from the stoppage of custom- ary evacuations, bleeding will be necessary, especially in sunguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives ; as rhubarb or senna. When this disease affects women in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service. * These are prepared by steeping or soaking peas in water, and afterwards dry tag them in a pot or kiln till they burst. They may be used at pttasure. WORMS. 261 ' When the disease is occasioned by worms, they must be destroy- ed, or expelled, by such means as are recommended in the tollow- ,n^Vhen°tne stomach is greatly relaxed, and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be ot singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day. Persons afflicted with flatulency are generally unhappy unless they he taking some purgative medicines ; these, though they may give immediate ease., tend to weaken and relax the stomach and bowels, and consequently increase the disorder. The best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open. In heartburn, water-brash, Sec the oxide of bismuth is a remedy which has been employed in a variety of cases with considerable advantage. The proper dose is from three to ten grains, with about twenty-five grains of gum-tragacanth, repeated three times a-day. It will be safer, however, to commence with only about three grains, and increase it gradually. Pain of the stomach proceeds from such a variety of causes, that it is difficult to prescribe a medicine for- it. The treatment must of course be suited to the nature of the complaint. But I have for some years very generally recommended a plaster, which seldom fails to give relief. Its basis may be any kind of adhesive plaster spread upon leather, to which, while warm, a drachm and a half, or two drachms, of powdered opium may be added. It should be large enough to cover nearly the whole region of the stomach, and should be suffered to remain on as long as it will stick.* CHAP. XXVII. WORMS. (Vermes.) These are chiefly of three kinds, viz. the taenia, or tape-worm; the teres, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from simi- lar causes, have nearly the same symptoms, and require almost the same method of treatment as these already mentioned, we shall not spend time in enumerating them. The tape-worm is white, very long, and full of joints. It is gen- erally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or what is called the end gut, and occasion a disagree- able itching about the seat. The long round worms occasion squeamishness, vomiting, a dis- ..*;»P!? "l^* 8t?,m,ch1 is frequently relieved by drinking a cup or two of water as hot offoetuaT £D8WtUowed- Thls remedy i. always safe, and will frequently be found 302 WORMS. agreeable breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the intes- tines, and get into the cavity of the belly. The effects of the tape- worm are nearly the same with those of the long and round, but rather more violent. Andry says, the following symptoms particularly attend the soli- um, which is a species of the tape-worm, viz. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool. Causes.—Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally sub- ject to worms. There seems to be an hereditary disposition in some persons to this disease. I have often seen all the children of a family subject to worms of a particular kind. They seem like- wise frequently to be owing to the nurse. Children of the same family nursed by one woman have often worms, when those nursed by another have none. Symptoms.—The common symptoms of worms are, paleness of the countenance, and, at other times, an universal flushing of the face; itching of the nose (this, however, is doubtful, as children pick their noses in all diseases;) starting, and grinding of the teeth in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious ; looseness; a sour or stinking breath; a hard swelled belly; great thirst; the urine frothy, and sometimes of a whitish colour; griping, or colic pains; an involuntary dis- charge of saliva, especially when asleep; frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings, drowsiness, cold sweats, palsy, epileptic fits, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber- seeds are symptoms of the tape-worm. There is no certain symp- tom of worms but passing them. I lately saw some very surprising effects of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expired, and upon opening her body, a number of the teres, or long round worms, were found in her intestines, which were considerably inflamed; and what anatomists call an intus-sus- ceptio, or the involving of one part of the gut within another, had taken place in no less than four different parts of the intestinal canal.* * That worms exist in the human body there can bo no doubt, and that they must sometimes be considered aa a disease, is equally certain ; but this is not the ossc so often as people imagine. The idea that worms occasion many disuses, 151 vos an op- portunity to the professed worm-doctors of imposing on the credulity of mankind, sis) WORMS. 963 Medicine.—Though numberless medicines are extolled for ex- pelling and killing worms,* yet no disease more frequently baffles the physician's skill. In general, the most proper medicines foe their expulsion are strong purgatives, and, to prevent their breed- ing, stomachic bitters, and now and then a gla?i of good wine. The best purge for an adult is jalap and calomel. Five-and- twenty or thirty grains of the former, with six or seven of the lat- ter, mixed in syrup, may be taken early in the morning for a dose. It will he proper that the patient keep the house all day, and drink nothing cold. The dose may be repeated once or twice a-week, for a fortnight or three weeks. On the intermediate days the patient may take a drachm of the filings of tin, twice or thrice a-day, mixed with syrup, honey, or treacle. Those who do not choose to take calomel, may make use of the bitter purgatives; as aloes.t tincture of senna and rhubarb, &c. Oily medicines are sometimes found beneficial for expelling worms. An ounce of salad oil and a table-spoonful of common salt may be taken in a glass of red port wine thrice a day, or oftener if the stomach will bear it; but the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascarides,^ and likewise the teres. The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine in this case, which is found to be a fact. Many practi- tioners give flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or trea- cle, and taken in such quantity as to purge the patient. Where Harrowgate water cannot be obtained, sea-water may be used, which is far from being a contemptible medicine in this case. If sea-water cannot be had,*common salt dissolved in water may be drnnk. I have often seen this used by country-nurses with very good effect. Some flour of sulphur may be taken over-night, and the salt-water in the morning. But worms, though expelled, will soon breed again, if the stom- ach remain weak and relaxed; to prevent which, we would recom- mend the Peruvian bark. Haifa drachm of bark in powder may be taken in a glass of red port wine, three or friur times a-day, after the above medicines have been used. Lime-water is likewise good for this purpose, or a table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water tre- foil, camomile flowers, tops of wormwood, the lesser centaury, &c. doing much mischief. They find worms in everycase, and liberally throw in their an- Udotes, which generally consist of strong drastic purges. I have known these given "Jf1^6 constitutions, t0 the destruct'°n of the patient, where there was not the least symptom of worms. tTske Powder of Common Aloes, 1 drm. } Take Mixture of Asafatida, 3 ox. Water Groel, thin, 10 ot. M.lk. 5 „. Mate a clyster—to be given occasionally. Make a clyster. 264 WORMS. The above directions are intended for adults ; but for children the medicines must be more agreeable, and in smaller doses. Fur a child of four or five years old, six grains of rhubarb, live of jalap, and two of calomel, may be mixed in a spoonful of syrup or hon- ey, and given in the morning. The child should Keep the Ikiiim all day, and take nothing cold. This dose may be repeated twice a-week for three or four weeks. On the intermediate days, the child may take a scruple of powdered tin. and ten grains of irthi- ops mineral, in a spoonful of treacle, twice a-day. This dose musi be increased or diminished, according to the age of the patieut, or the form annexed below.* Bisset says, the great bastard black hellebore, or bear's foot, is a most powerful vermifuge for the long round worms, lie orders the decoction of about a drachm of the green leaves, or about fif- teen grains of the dried leaves in powder, for a dose to a child be- tween four and seven years of age. This dose is to he repeated two or three times. He adds, that the green leaves made into a syrup with coarse sugar is almost the only medicine he lias used for round worms for three years past. Before pressing out the juice, he moistens the bruised leaves with vinegar, which cor- rects the medicine. The dose is u tea-spoonful at bed-time, and one or two next morning. I have frequently known those big bellies, which in children are commonly reckoned a sign of worms, quite removed by giving them white soap in their pottage, or other food. Tansy, garlic, and rue, are all good against worms, and may be used various ways. We might here mention many other plants, both for exter- nal and internal use, as the cabbage-bark, Sec, but think the fil- ings of tin with a>thiops mineral, and the purges of rhubarb and calomel, are more to be depended on. Ball's purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, scammony, and calomel, with as much double-refined sugar as is equal to the weight of ull the other ingredients. These must be well mixed together, and reduc- ed to a fine powder. The dose for a child is from ten grains to twenty, once or twice a-week. An adult may tuke a druchm for a dose. A powder for the tape-worm, resembling this, called Madame Nouffer's powder (the name of the proprietor,)t was long kept a secret on the Continent: it was lately purchased by the French king. Parents who would preserve their children from worms ought to allow them plenty of exercise in the open air ; to take care that their food be wholesome and sufficiently solid ; and, as far as pos- sible, to prevent their eating raw herbs, roots, or green trashy fruits. It will not be amiss to allow a child who is subject to " Take Powdered Tin, 3 ounces. Mint Water, 4 ounces. Confection of Hips, 3 drachms. To be taken fasting in the morning, and Simple Syrup, enough to make an electu- two hours after, the following bolus: ary dose of the size of a nutmeg, in the Take Submuriate of Mercury, 5 or 6 grs. morning. Camboge, in Powder, 6 to 10 grs. Drinking often a cupful of the infusion ef t Take Male Fern Root, in Powder. green tea. 2 to 3 drms. JA1XDICE. 265 worms a glass of red wine after meals ; as every thing that braces and strengthens the stomach is good both for preventing and ex- pelling these vermin.* In order to prevent any mistake of what I have here said in fa- vour of solid food, it may be proper to observe, that I only made use of that word in opposition to slops of every kind ; not to ad- vise parents to cram their children with meat, two or three times a-day. This should only be allowed at dinner, and in moderate quantities, or it would create, instead of preventing worms ; for there is no substance in nature whidli generates so many worms as the flesh of animals, when in a slate of putrefaction. Meat, there- fore, nt the principal meal, should always be accompanied with plenty of good bread, and young, tender, and well-boiled vegeta- bles, especially in the spring, when these are poured forth from the bosom of the earth in such profusion. They promote the end in view, by keeping the body moderately open, without the aid of artificial physic. The ripe.fruits of autumn produce the same ef- fect ; and, from their cooling, antiputrescent qualities, are as wholesome as the unripe are pernicious. I also very earnestly conjure parents not to take the alarm at every imaginary symptom of worms, and directly run for drugs to the quack, or apothecary. They should first try the good effects of proper diet and regimen, and never have recourse to medicines till after unequivocal proofs of the nature of the complaint. The danger of advertised nostrums is sufficiently pointed out and exem- plified in the preceding note. CHAP. XXVIII. JAUNDICE. (Icterus.) This disease is first observable in the white of the eye, which appears yellow. Afterwards the whole skin puts on a yellow ap- pearance. The urine too is of a saffron hue, and dyes a white cloth, if put into it, of the same colour. There is likewise a spe- cies of this disease called the Black Jaundice. Causes.—The immediate cause of the jaundice is an obstruction of the bile, from biliary calculi in the gall-bladder and its ducts ; inspissated bile ; spasmodic constriction of the ducts themselves; pressing from adjacent tumours ; scirrhosity of the liver, &.c. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, A: e. ; the bilious or hysteric colic ; violent passions, as grief, an^er, «.V,c. Strong purges or vomits will like- wise occasion the jaundice. Sometimes it proceeds from obstin- * We think it necessary here to warn people of their danger who buy cakes, pow- ders, and other worm medicines, at random, from quacks, and give them to their chil- dren without proper care. The principal ingredients in most of these medicines is Mercury, whiek is never to be trifled with. I lately saw a shocking instance of the danger of this conduct. A girl who had taken a dose of worm-powder, bought of a travelling quack, went out, and perhaps was so imprudent as to drink cold water dur- ing its operation : she immediately swelled, and died on the following day, witb all Ike symptoms of having been poisoned. M 266 JAl'NDICE. ate agues, or from that disease being prematurely stopped by as- tringent medicines. In infants it is often occasioned by the mrro- nium not being sufficiently purged oft". Pregnant women are verv subject to it. It is likewise a symptom in several kinds of fever. Catching cold, or the stopping of customary evacuations, oh the menses, the bleeding piles, issues, Sec. will occasion the jaun- dice. Symptoms.—the patient at first complains of excessive weari- ness, languor, and inactivity, and bus great aversion to everv kind of motion. His skin is dry, and he generally feels a kind of itch- ing or pricking pain over the whole body." The stools are of a whitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load or oppression of the breast. Then1 is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness of the stomach, vomiting, flatulency, and other symptoms of indi- gestion. If the patient be young, and the di>ea>c complicated with no other malady, it is seldom dangerous ; but in old people, where it continues long, returns frequently, or is complicated with the drop- sy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. Regimen.—The diet should be cool, light, and diluting, consist- ing chiefly of ripe fruits and mild vegetables ; as apples boiled or roasted, stewed prunes, preserved plums, boiled splintage, Sic Veal or chicken-broth, with light bread, are likewise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be buttermilk, whey sweetened with honey, or decoctions of cool opening vegetables ; as marsh-mallow roots, with liquorice, &.c. The patient should take as much exercise as he can bear, either on horseback of in a carriage ; walking, running, and even jump- ing, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines have proved ineffectual. Amusements are likewise of great use in the jaundice. The disease is often occasioned by a sedentary life, joined to a dull mel- ancholy disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have good effect, a> dancing, laughing, singing, &c. Medicine.—The cure of jaundice, unpromising as at times it may appear, is nevertheless to be attempted, first, by restoring the interrupted passage of the bile through the duct; secondly, by carrying it off by the intestines; and, thirdly, by relieving the particular symptoms. Whether the passage of the bile be ob- structed by biliary concretions, or by spasmodic constriction of the ductus communis choledochus, the same plan nearly must be adopt- ed. If the patient be young, of a full sanguine habit, and complaint of pain in the right lide, about the region of the liver, bleeding will JAUNDICE. 267 be necessary. After this an emetic must be administered; and, if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than emetics, especially where it is not attended with inflammation. Half a drachm of ipecacuanha in powder will be a sufficient dose for an adult. It may he wrought off with weak camomile-tea, or luke- warm water. The body must likewise be kept open by taking a sufficient quantity of Castile soap, or the annexed pills.* Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand disease, and who, whenever it attacked him, mounted his horse, set out on a journey, and never returned till he was well. For my own part, I should place more reliance on the efficacy of such method, than on the whole catalogue of near a hundred specifics mentioned by the late Doctor Short of Sheffield, though I hart- known instances where one of them, the decoction of hemp->ced, a- already intimated, was found very beneficial. CHAP. XXIX. DROPSY. (Hydrops.) The dropsy is a preternatural swelling of the whole bodv, or some par"t of it, occasioned by a collection of watery humour. If is distinguished by different names, according to the part affected, as anasarca, or a collection of water under the cellular membrane; ascites, or a collection of water in the belly ; hydrops pectoris, or dropsy of the breast; hydrocephalus, or dropsy of the brain, Sic Causes.—The dropsy is often owing to an hereditary disposi- tion. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, thut great drinkers die of a dropsy. The want of exercise is also a very com- mon cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evac- uations, as frequent and copious bleedings, strong purges often re- peated, frequent salivations, &c. The sudden stoppage of cus- tomary or necessary evacuations, as the menses, the haemorrhoids, alvine fluxes, Sec. may likewise cause a dropsy. I have known the dropsy occasioned by drinking large quanti- ties of cold, weak watery liquor, when the body was heated by vi- olent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a long use of poor watery diet, or of viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrhus of the liver, a violent ague of long continuance, scarlet fever, diar- rhoea, dysentery, empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepared, may occasion a dropsy. Symptoms.—Anasarca generally begins with a swelling of the feet and ancles towards night, which for some time disappears in the morning. In the evening the parts, if pressed with the finger, DROPSY. 26U will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough. This last is generally a, fatal symptom, as it shows that the lungs are affected. In the (thrifts, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laving the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctuation. When the anasana and ascites are combined, the case is very dangerous. Kven a Minple ascites seldom admits of a radical cure. Almost all that can he done is, to let off the water by tapping, which seldom affords more than a temporary relief. When the disease conies suddenly on. and the patient is young and strong, there is reason to hope for a cure, especially if medi- cine be given early. But if the patient be old, has led an irregu- lar or a sedentary life, or if there be reason to suspect that the liv- er, lungs, or any of the viscera are unsound, there is great reason to fear that the consequences will prove fatal. Regimen.—The patient must abstain, as much as possible, from all drink, especially weak and watery liquors,* and must quench his thirst with mustard whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to he dry, of a stimulatin-' and diuretic quality, as tousled bread, the flesh of birds, or other wild animals, roasted ; pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, &cV He may also eat sea-biscuit dipped in wine or a little brandy ; this is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient must have drink, the Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best. Beer boiled with jumper-berries is much used as a diuretic drink by the German physicians. Kxercise is of the greatest importance in a dropsy. If the pa- tient be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he be not able to walk or la- bour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it His bed ought to be hard, and the air of his apartments warm and dry. It he live in a damp country, he ought to be removed into a * A tout abstinence from drink has long been considered as highly necessarv in all ta.es! cases; but n several cases this practice has been carriefJo far w Souany »cneht whatever It seems, however, to have fallen considerably into disrenute Z Urge quantities of watery liquors, are now.allowed, where diuretic? but more ffic^- kr BoVe rUZtT* ,h F^' "" ?'"■ ,J»d?ed' this mode of treat^drepYy ?. "vSh^ he formeVs %"• medicines can hardly be carried to the kid- irial the o?,. , ,e'n? ,ccon,Pan,erd w'lh » I««P Portion of water. When, upon a fair o«. fiW Z " Ur'n'' " lHA f°Und. l°> increa8Cd ^ drinking water or other aque- ous nuius, their ups may in that case be discontinued. M" 270 DROPSY. dry one, and, if possible, into a warm climate. In a word, everv method should be taken to promote the perspiration, and to hr.-ne the solids. For this purpose it will likewise be proper to rub the patient's body two or three times a-day with a hard cloth, or .1 flesh-brush; and he ought constantly to wear llanncl next his skin. In the treatment of drops), the attention should be primarily di- rected to ascertain whether the disease be idiopathic or symptom- atic ; that is, whether it be an original one, or whether it prevail as a symptom of some other ; as by removing the cause we shall often be enabled to remove the effect also, and thus perform a euro. For example, should dropsy have arisen as a consequence of in- temperance, a free use of spirituous liquors, exposure to a moist atmosphere, or having had recourse to large evacuations, particu- larly bleeding; or if it have proceeded from long continued inter- mittent fevers, obstructions in the abdominal or thoracic viscera, &c.; the removal of these will be the first indications of cure. The next will be to evacuate the serous fluid already collected ; and to restore the tone of the system, and strengthen the constitution generally. Medical Treatment.—If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong emetics, brisk purges, and such medicines us promote a discharge by perspiration and urine. For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses; or of the sulphate of copper as here advised, as having less tendency to exhaust than any other commonly used. The patient must not drink much after taking the vomit, otherwise he destroys its effects. A cup or two of camomile-tea will be suffi- cient to work it off. Between each vomit, on one of the intermediate days, the patient may take the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel, six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken- broth. The patient may likewise take every night at bed-time the fol- lowing bolus:—To four or five grains of camphor add one gram of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day:—Take juniper- berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom, half a pound; infuse them in a quart of Hheinsh wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, wliich is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broom in wine. DROPSY. 271 The above course will often cure an incidental dropsy, if the constitution be good; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the patient's strength by warm and nour- ishing cordials. The secretion of urine may be greatly promoted by nitre. Brookes savs, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scru- ple of nitre, nu.y ho given twice a-day in a glass of strong cinna- mon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual. 1 have sometimes seen good effects from cream of tartar in this disease.* It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even three ounces, if the stomach will bear it. This quantity is not, however, to be taken at once, but divided into three or four doses. To promote perspiration, the patient may use the decoction of seneka-root, as directed above; or he may tuke two table-spoons- ful of the solution of acetated ammonia (Mindererus's spirit) in a cup of wine-whey three or four times a-day. To promote a dis- charge of urine, the following infusion of the London hospitals will likewise he beneficial:— Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-hen ies bruised, of each a drachm ; cinnamon in powder, three drachms ; subcarbonate of potash, a drachm and a half; infuse in an English pint and a half of old hock wine, and when fit for use, filter the liquor. A wine-glass of it niav be taken three or four times a-day ; or, the subjoined bolus.t As an active diuretic, the foxglove has been recommended in dropsy: but should it not answer within the first fortnight, as is not unfrequently the case, that where one remedy of this class fails another succeeds, the best way will be to substitute some other for it. It may be given in infusion, saturated tincture, or combined in the form of powder with other diuretics, as squills, cream of tartar, Ac. in any of the eligible forms here advised.t Take Cream of Tartar 3 drachms. Antimonial Powder, 2 grains. Pn-'iTi v ?°Wder' = gra'"S Aromatic Confection, 10 grains. Make s„"t NUtmC8, Sn' *■ Make • bolus' t0 «* *ken at'bed-time. Make a powder. j Take of Purp|e Foxglove G drachras T.l.r»,m„fT f i j , Compound Tincture of PowZ. IrTv Tr J drachm Cardamoms, 2 drachms. Powder of \\ .1,1 Cucumber Spirit of Nitric Ether, 1 drm. r„m„„ . , lor S grains. Mix for a draught, to be taken twice Compound powder of Cinnamon, a-day. as- a. <• . * grains. or Mix them for a dose. Take Cream of Tartar, 2 drachms. ♦ t.Lo r-.__L Compound powder of Cinnamon, t lake Camphor, 5 grains. 5 ^^ 272 DROPSY. In the anasarca it is usual to scarify the feet and legs. By thi, means the water is often discharged; but the operator must b« cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spir- ituous fomentations and proper digestives, to prevent a gangrene.* In an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very simple and safe operation, and will often succeed, if it were performed in due time; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any perma- nent relief will be procured.t After the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol ; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. 1 lis diet ought to be dry uud nour- ishing, such as is recommended in the beginning of the chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel, or rather fleecy hosiery, next his skin, and make daily use of the flesh-brush. We have classical authority of two thousand years' standing to say that the dropsy is an obstinate di.sease; not that the incidental dropsy is incurable, for I have often been so happy as to succeed in the treatment of it; but when the dropsy is accompanied with a scirrhous liver, or a worn-out constitution, very little is to be ex- pected from medicine. I had lately a singular instance of the efficacy of nitre in a case of dropsy. A young man, a cornet of dragoons, was dropsical all over, even his face not excepted. After several things had been tried without success, I showed him my quotation from Dr. Brookes, in this chapter. He was desirous of making an experi- ment with nitre, and took a drachm of it in a cup of warm ale, for some time once, and afterwards twice a-day, till he was cured.f ---35---------------------------------------------------------■------------------ powder of Foxglove, 1 grain. Powder of Squills, 1 grain. Mix for a powder, to be taken twice or ------ of Foxglove, 4 to 1 grain. three times a-day. Make a powder, to be taken three times or a-day. Take Cream of Tartar, 2 drachms. * If it be desirable, as it generally is, to promote the discharge of the serous fluid, whether the skin be punctured or burst spontaneously, the best means of doing so, is by the application of a common cabbage-leaf, previously a little warmed. F.D. t The very name of an operation is dreadful to most people, and they wish to try every thing before they havr recourse to it. This is the reason why tapping so seldom succeeds to our wish. 1 hail a patient who was regularly lapped once a month for sev- eral years, and who used to eat her dinner .is well after the opernlion as if nothing had happened. She died at last rather worn out by age than by the disease. X I have repeatedly succeeded in carrying off the effusion of dropsy, by the use of the following pills:—Take of elaterium, six grains; of calomel, twelve grains; rub them carefully together, and with a sufficient quantity of extract of gentian, form into twelve pills. Of these, one may be taken every hour, commencing early in the morn- ing, till they begin to operate. I have known not only quarts but gallons of water evacuated by stool, after taking this medicine. During the operation, the patient's strength must be supported by strong beef-tea, with some wine in it. Bsl eves if suc- cessful in removing the watery accumulation by this means, a more difficult task ''till remains to the practitioner^ that of preventing its return. Ku. GOUT. 27S OHAP. ZZX. GOUT. Thf.rk is no disease which shows the imperfection of medicine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources whence it originally sprung, and all who would avoid it must be active and temperate. Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in those who are subject to it; as intense study ; excess of venery ; too free a use of acidulated liquors ; night-watching; grief or uneasi- ness of mind ; an obstruction or defect of any of the customary discharges, as tho menses, sweating of the feet, perspiration, Sic Symptoms.—A fit of the gout is generally preceded by indiges- tion, drowsiness, eructation, a slight head-ach, sickness, and some- times vomiting. The patient complains of weariness and dejec- tion of spirits, and has often a pain in the limbs, with a sensation us if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a slight pain in passing urine, and frequently an involuntary shedding of tears. Sometimes these symptoms are much more violent, es- pecially upon the approach of the fit ; and it has been observed, that as is the fever which ushers in the gout, so will the fit be ; if the fever be short and sharp, the fit will be so likewise ; if it be feeble, long and fingering, the fit will be such also. But this ob- servation can only hold with respect to very regular fits of the gout. The regular gout generally makes its attack in the spring orhmt- ginning of winter, in the following manner : About two or thre#in the morning, the patient is seized with a pain in his great toe, some- times in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured upon the part, which is succeeded by a shivering, with some degree of fever. Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the differ- ent kinds of torture, as if the part were stretched, burnt, squeez- ed, gnawed, or torn in pieces. The part at length becomes so ex- quisitely sensible, that the patient cannot bear to have it touched, or even suffer any person to walk across the room. The patient is generally in exquisite torture for twenty-four hours, from the time of the coming on of the fit : he then becomes easier, the part begins to swell, appears red, and is covered with a little moisture. Towards morning be drops asleep, and generally falls into a gentle breathing sweat. This terminates the first par- oxysm, a number of wliich constitutes a fit of the gout; wliich is- longer or shorter according to the patient's age, strength, the sea- son of the year, and the disposition of the body to this disease,. M.2. 874 GOUT. The patient is always worse towards night, and easier in the morning. The paroxysms, however, generally grow milder every day, till at length the disease is carried off by perspiration, urine, and the other evacuations. In some patients this happens in a few days ; in others, it requires weeks, and in some, months to finish the fit. Those whom age and frequent fits of the gout have great- ly debilitated, seldom get free from it before the approach of sum- mer, and sometimes not till it be pretty far advanced. Regimen.—As there are no medicines yet known that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit. In the fit, if the patient be young and strong, his diet ought to be thin and cooling, and his drink of a diluting nature; but where the constitution is weak, and the patient has been accustomed to live.high, this is not a proper lime to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiration without greatly heating the patient. It will answer this purpose better if a tea-spoonful of spirits of hartshorn be put into a cup of it twice a-day. It will likewise be proper to give nt bed-time a tea-spoonful of the volatile tincture of guaiacum, in a large draught of warm wine-whey. This will greatly promote perspiration through the night: equally with any of those advised below.* As the most safe and efficacious method of discharging the gouty matter is by perspiration, this ought to be kept up by all means, especially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fur, or wool. The last is most readily obtained, and seems to answer the purpose better than any thing else. The people of Lancashire look upon wool ns a kind of specific in the gout; they wrap a great quantity of it about the leg and foot affected, and cover it with a skin of soft dressed leather. This they suffer to continue for eight or ten days, and sometimes for a fortnight or three weeks, or longer, if the pain does not cease. I never knew any,external application answer so well in the gout. I have often seen it applied when the swelling und inflammation were very great, with violent pain, and have found all these symp- toms relieved by it in a few days. The wool which they use is generally greased, and carded or combed. They choose the soft- est which can be had, and seldom or never remove it till the fit be entirely gone off. The patient ought likewise to be kept quiet a^d easy during the fit. Every thing that affects the mind disturbs the paroxysm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They • Take Antimonial Powder, 2 grains. 3 !w&T Subcarbonate of Ammonia, 8 grs. Camphor Mixture, IS dricnms. Confection of Roses, enough to make a Solution of Tartanxed Antimony, bolus, to be taken every third or fourth , j ™,Km j^ur' Syrup of Orange-peel, 1 drachm or Make a draught. Take Solution of Acetated.Ammonia, GOUT. do not cure the disease, but remove it from a safer to a more dan-^ genius part of the body, where it often proves fatal. A fit of the gout is to be considered as Nature's method of removing something that might prove destructive to the body, and all that we can do with safety, is to promote her intentions, and to assist her in ex- pelling the enemy in her own way. Evacuations by bleeding, stool, dec. are likewise to be used with caution; they do not re- move the cause of the disease, and sometimes by weakening the patient prolong the fit; but where the constitution is able to bear it, it will be of use to keep the body gently open by dietr or very mild laxative medicines.* The wine of colchicum, or meadow saffron, given in the quanti- ty of a fluid drachm, twice a-day, in any convenient vehicle, has been found a valuable remedy, both in gout and rheumatism ; but to render this medicine more certain and efficacious, the bowels should be particularly attended to ; and all food of a flatulent na- ture should be avoided. Many things will indeed shorten a fit of the gout, and some will drive it off altogether ; but few have yet been found which will do this with safety to the patient. In pain we eagerly grasp at any- thing that promises immediate ease, and even hazard life itself for a temporary relief. This is the true reason why so many infalli- ble remedies have been proposed for the gout, and why such num- bers have lost their lives by the use of them. _ When the pain, however, is very great, and the patient is rest- less, thirty or forty drops of laudanum, more or less, according to the violence of the symptoms, may be taken at bed-time. This will ease the pain, procure rest, promote perspiration, and forward the crisis of the disease. After the fit is over, the patient ought to take a gentle dose or two of the bitter tincture of rhubarb, or some other warm stomachic purge. He should also drink a weak infusion of stomachic bit- ters in small wine or ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and orange-peel. The diet at this time should' be light, but nourishing, and gentle exercise ought to be taken on horseback, or in a carriage. Out of the fit, it is in the patient's power to do many things to- wards preventing a return of the disorder, or rendering the fit, if it should return, less severe. This, however, is not to be attempted by medicine. I have frequently known the gout kept off for sev- eral years by the Peruvian bark and other astringent medicines ; but in all the cases where I had occasion to see this tried, the per- sons died suddenly, and to all appearance for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to some constitutions, in the decline of life, is rath- er salutary than hurtful. Though it may be dangerous to stop a fit of the gout by medi- cine, yet if the constitution can be so changed by diet and exer- cise, as to lessen or totally prevent its return, there certainly can. * Tske Magnesis, 1 drachm. 5 grains Powder of Rhubarb, 8 grains. Make an aperient powder to be takasn Compound Powder of Cinnamon. occasionally.. 276 GOUT. be no danger in following such a course. It is well known, that the whole habit may be so altered by a proper regimen, as quite to eradicate this disease ; and those only who have sufficient reso- lution to persist in such a course have reason to expect a cure. The course which we would recommend for preventing the gout, is as follows :—In the first place, universal temperance. In the next place, sufficient exercise.* By this we do not mean saunter- ing about in an indolent manner, but labour, sweat, and toil. These only can render the humours wholesome, and keep them so. Going early to bed, and rising betimes, are also of great import- ance. It is likewise proper to avoid night studies, and intense thinking. The supper should be light and taken early. The use of milk, gradually increased, till it becomes the principal part of diet, is particularly recommended. All strong liquors, especial- ly generous wines and sour punch, are to be avoided. We would likewise recommend some doses of magnesia alba and rhubarb to be taken every spring and autumn; and afterwards a course of stomachic bitters,f as tanzy or water-trefoil tea, an infu- sion of gentian and camomile flowers, or a decoction of burdock- root, &c. Any of these, or an infusion of any wholesome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the internal parts, proper applications to recal and fix it become absolutely necessary. When the gout affects the head, the pain of the joint ceases, and the swelling disappears, while either severe head-ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing ensue. If it attacks the stomach, ex- treme sickness, vomiting, anxiety, pain in the epigastric region, and total loss of strength will succeed. When the gout attacks the head or lungs, every method must be taken to fix it in the feet. They must be frequently bathed in warm water, and acrid cataplasms applied to the soles. Blistering plasters ought likewise to be applied to the ancles or calves of the legs. Bleeding in the feet or angles is also necessary, and warm •Some make a secret of curing the gout by mus cular ex«cUi ™» ™rej£*- aver is as old as Celsus, who strongly recommends that mode of cure; andjhoeve will submit to it in the fullest extent, may expect to reap solid and pennaneo. sdv.n tages. spoonsful are to be tanen two or nutmeg may be taken twice .-day. times a-day. RHEUMATISM. «77 lOomaclne purges. The patient ought to keep in bed for the most purt, if there be any signs of inflammation, and should be very careful not to catch cold. If it attack the stomach, with a sense of cold, the most warm cordials are necessary; as strong wine boiled up with cinnamon or other spices, cinnamon-water, peppermint-water, and even brandy or rum.# The patient should keep his bed, and endeavour to pre- mofe a sweat by drinking warm liquors ; and if he should be troubled with a nausea, or inclination to vomit, he may drink cam- omile-tea, or any thing that will make him vomit freely. Opiate*,? joined with aromatics, or with camphor, musk, or ammonia, may be of service. W ben the gout attacks the kidneys, and imitates gravel-pains, the patient ought to drink freely of a decoction of marsb-mallowg, and to have the parts fomented with warm water. An emollient clyster ought likewise to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoction. Persons who have had the gout should be very attentive to any complaints that may happen to them about the time when they huve reason to expect a return of the fit. The gout imitates many other disorders, and by being mistaken for them, and treated improperly, is often diverted from its regular course, to the great danger of the patient's life. Those who never had the gout, but who, from their constitution or manner of living, have reason to expect it, ought likewise to be very circumspect with regard to its first approach. If the disease by wrong conduct or improper medicines, be diverted from its proper course, the miserable patient has a chance to be ever after tormented with head-achs, coughs, pains of the stomach and intes- tines; and to fall at last a victim to its attack upon some of the more noble parts. Rheumatism. This disease has often a resemblance to the gout. It generally attacks the joints with exquisite pain, and is sometimes°attended with inflammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually distinguished into acute and chronic: or the rheumatism with and without a fever. Causes.—The causes of a rheumatism are frequently the same as those of an inflammatory fever, viz. an obstructed perspiration, the immoderate use of strong liquors, and the like. Sudden changes of the weather, and all quick transitions from heat to cold, are very apt to occasion the rheumatism. The most extraor- • Ether is found to be an efficacious remedy in this case. t Tike Opium, 1 groin. Subcarbonate of Ammonia, 10 grs. Lsmphor, 6 grains. Tincture of Opium. 12 drops. Aromatic Confection, 6 grains. Spirit of Sulphuric Ether, 30 drops. Mass a bolus, to be taken occasionally. Make a draught, to be taken every three- unr«t Make a mixture. RHEUMATISM. 279 The chronic rheumatism is seldom attended with any conside- rable degree of fever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There is seldom any inflammation or swelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients, it often proves extremely obstinate and sometimes incurable. In this kind of rheumatism, the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chiefly of vegetable substances, as stewed prunes, coddled-apples, currants or gooseberries boiled in milk, is most proper. Arbuthnot says, "If there be a specific ,n aliment for the rheumatism,it is certainly whey;" and adds, " That he knew a person subject to this disease who could never be cured by any other method but a diet of whey and bread." He likewise says, "That cream of tartar in water gi, ,', ta!,r:n fo/ 8everal day8. will case rheumatic pains consider- ably. 1 his I have often experienced, but found it always more efficacious when joined with gum giiniacum, as already directed. In this case the patient may take the dose formerly mentioned twice a-day, and likewise a tea-spoonful of the volatile tincture of gum guaiacum at bed-time in wine-whey. This course may be continued for a week, or longer, if the ca«e proves obstinate, and the patient's strength will permit. It oiio-fit then to be omitted for a few days, and repeated again. At the same time leeches or a blistering plaster may be applied to the part affected. What I have generally found answer better than either of these, in obstinate fixed rheumatic pains, is the warm plaster. I have likewise known a plaster of Burgundy pitch worn tor some time on the part affected give great relief in rheumatic pains. My ingenious friend, Dr. Alexander of Edinburgh, says he has frequently cured very obstinate rheumatic pains,°by» rub- bing the part affected with tincture of cantharides. When the common tincture did not succeed, he used it of a double or treble strength. Cupping upon the part affected is likewise often very beneficial, and so is the application of leeches. . Blisters are sometimes employed in this complaint; but they ap^ pear to be most serviceable in those cases where the disease par- takes of the nature of acute rheumatism, or where the pain is fix- ed m any particular joint; and a repetition of fresh Ulisters will be preferable to keeping up a constant sore by stimulating-the part with savine or other ointments; and produce a greater effect upon the disease. l Though this disease may not seem to yield to medicines for some time, yet they ought still to be persisted in. Persons who are sub- ject to frequent returns of the rheumatism will often find their ac- count in using medicines, whether thev be immediately affected with the disease or not. The chronic rheumatism is similar to the gout 1.1 this respect, that the most proper time for usin»- medi- cines to extirpate it is when the patient is most free from the dis- order. " ^^rsmnho'r' « TT*- Tincture «*Cantharides. 1 drachm. »,...W3ft., %dnehmt- M.ke?iiS:fA—-' *-~ 290 RHEUMATISM. To those who can afford the expense, I would recomratad tlie warm baths of Buxton or Matlock in Derbyshire. These Uve often, to my knowledge, cured very obstinate rheumatisms, aud are always safe, either in or out of the fit. When the rlies- matism is complicated with scorbutic complaints, which is not sel- dom the case, the Harrowgate waters, and those of Moffat, a™ proper. They should both be drank and used as a warm bath. There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of water or small wine. The water trefoil is likewise of great use in this complaint, it may be infused in wine or ale, or drank in form of tea. The ground-ivy, camomile, and several other bitters, are also benefi- cial, and may be used in the same manner. No benefit, however, is to be expected from these, unless they be taken for a considera- ble time. Excellent medicines are often despised in this disease, because they do not perform an immediate cure: whereas nothing • would be more certain than their effect, were they duly persist- ed in. Want of perseverance in the use of medicines is one rea- son why chronic diseases are so seldom cured. The internal remedies most generally recommended in chronic rheumatism are sudorifics, and medicines of a stimulating nature, which abound in essential oils and resins; and therefore volatile alkaline salts, guaiacum, turpentine combined with Cinchona bark, and the like, may be given in any of the undermentioned forms.* Cold bathing, especially in salt water, often cures the rheuma- tism. We would also recommend exercise, and wearing flannel next the skin. Issues are likewise very proper, especially in chronic cases. If the pain affects the shoulders, an issue may he made in the arm ; but if it affects the loins, it should be put into the leg or thigh. Persons afflicted with the scurvy are very subject to rheumatic complaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or together, as the patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb, in powder, may be infused in a bottle of wine, and one, two, or three wine glasses of it taken daily, as shall be fiauwl necessary
: the part with warm vinegar and water, and by the ap- plication of emollient poultices and frictions ; sponginess of the gums, and looseness of the teeth, by washing the mouth frequent- ly with antiseptic and astringent gargles ;* and foul ulcers are to be cleansed and healed by washing them with lemon-juice, or a tincture consisting of equal parts of the tincture of myrrh, and then dressing them with some kind of ointment, or a sorrel poultice. In bud cases of ulceration the charcoal or effervescent poultice may probably be serviceable. It must indeed be owned, that many of them have it not in their power to make the provision we are speaking of; but in this case it is the duty of their employers to make it for them ; and no man ought to engage in a long voyage without having these articles se- cured.t * Take Infusion of Roses, Alum, in Powder, Honey, Mix them for a gargle. or t F.vcry body knows how much easier it is to prevent than to cure any disease; but this is particularly true with respect to the scurvy. I have therefore recommended the most assured means of preserving our seamen from its formidable attacks. Vege- table and mineral acids are certainly the best correctives of the acrimony occasioned by the long use of salted provisions. These are one of the chief causes of the scurvy not only at sen, but on land also, where salted and smoke dried meats are a favourite and very customary article of food. It appears from the reports of modern travellers, that the scurvy is almost unknown to the natives of Canada, though they live entirely on animal food, but not salted ; while the use of the latter never fails to produce the scimy. Would it not then be worth while to make various experiments for preserv- ing meat at sea without salt ? Surely the resources of human invention are not exhausted. The absorbent and antiputrcscent properties of sugar are well known; but it might be deemed too expensive s seasoning. I must leave trials of this sort to per- sons of more leisure. It is enough for me to suggest the bint. I wish it may lead to s discovery of so much importance. 4 ounces, Take Decoction of Bark, 6 ounces. 14 ounce. Tincture of Myrrh, 1A ounce. I drachm. Muriatic Acid, 12 to 20 drops. Make a gargle. 284 SCURVY. 1 have often seen very extraordinary effects in the land-scurvy from a milk diet. This preparation of Nature is a mixture of an- imal and vegetable properties, which of all others is the most fit for restoring a decayed constitution, and removing thut particular acrimony of the humours, which seems to constitute the very essence of the scurvy, and many other diseases. Hut people despise this wholesome and nourishing food, because it is cheap, and devour with greediness flesh and fermented liquors, while milk is only deemed fit for their hogs. The most proper drink in the scurvy is whey or buttermilk. When these cannot be had, sound cider, perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, and may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce-fir is likewise proper. It may be drank in the quantity of an English pint twice a-day. Tar-water may be used for the same purpose, or decoctions of any of the mild mucilaginous vegetables; as sarsa- parilla, marsh-mallow roots, &c. Infusions of the bitter plants, as ground ivy, the lesser centaury, marsh-trefoil, &c. are likewise beneficial. I have seen the peasants in some parts of Britain express the juice of the last-mentioned plant, and drink it with good effect in those foul scorbutic eruptions with which they arc often troubled in the spring season. Harrowgate-water is certainly an excellent medicine in tin: land-scurvy. I have often seen patients who had been reduced to the most deplorable condition by this disease, greatly relieved by drinking the sulphur-water, and bathing in it. The chalybeate- water may also be used with advantage, especially with a view to brace the stomach after drinking the sulphur-water, which, though it sharpens the appetite, never fails to weaken the powers of diges- A slight degree of scurvy may be carried off by frequently suck- ing a little of the juice of a bitter orange or a lemon. When the disease affects the gums only, this practice, if continued for some time, will generally carry it off. We would, however, recommend the bitter orange as greatly preferable to lemon; it seems to l» as good a medicine, and is not near so hurtful to the stomach. IVr- haps our own sorrel may be little inferior to either of them. All kinds of salad are good in the scurvy, and ought to be eaten very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, y lar SCROFULA, OR KING'S EVIL. 287 thice the specific effects of mercury to any extent. When given cautiously and in moderate doses, so as to act merely as an altera- tive* or gentle purgative, it agrees well in scrofulous complaints, and greatly contributes to discuss tumours and resolve indurations of this nuture ; or combined with antimony, or opium, where there is much irritation, or wliere there are deep-seated affections of the joints, \c The scrofula, at a certain period of life, often cures of itself; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature, who is really the physician. In the same way the insignificant nostrums of quacks and old women often gain applause when they deserve none. There is nothing more pernicious than the custom of plying children in the scrofula with strong purgative medicines. People imagine it proceeds from humours which must be purged off, with- out considering that these purgatives increase the debility and ag- gravate the disease. It has indeed been found, that keeping the body gently open for some time, especially with sea-water, has a good effect ; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day. Bathing in the salt-water has likewise a very good effect, espe- cially in the warm season. I have often known a course of bath- ing in salt-water, and drinking it in such quantities us to keep the body gently open, cure a scrofulu, ufter muny other medicines had been tried in vain. When salt-water cunnot be obtained, the pa- tient mny be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative. Next to cold bathing and drinking the suit-water, we would rec- ommend the Peruvian burk.t Burnt sponge is another remedy which has been much administered in this disease, and frequently with advantage. It may be given either in the form of bolus or draught.f A more active medicine, however, is the carbonate of soda in doses from ten to twenty grains to a drachm, twice or thrice a-day.<§ The cold bath may be used in summer, and the bark in winter. To an adult half a drachm of the bark in powder may be given in a glass of red wine four or five times a-day. Children, and such as cannot take it in substance, may use the decoction made in the following manner :— Boil un ounce of Peruvian bark and a drachm of winter's bark, both grossly powdered, in an English quart of water to a pint : * 'Take Prepared Chalk, I drachm. Submuriate of Mercury, ~ to -l grs Tartariied Antimony, 2 grains. Mn, and divide in 1- powders, of which 1st one be taken twice a-day. tTake Extract of Peruvian Bark, 2 drins. -----* of Hemlock, 1 drachm. Make 40 pills ; sad Ukc two or three three times a-day. t Take Burnt S|>ong«, SO to 30 grains. Rhubarb, 3 grains. Honey, enough to make a bolus, to be lakes twice a-dsy. $ Take Carbonate of Soda, 2 drachms. Infusion of Bark, 5 ounces. Compound Tincture of Cinnamon, * .A ounce. Syrup of Orange Peel, 2 drachms. Make a Mixture, two table-spoonsful of which arc to be taken three or four times a-day. or Take of Decoction of Bark, 10 drachms. C. Tincture of Cardamoms, l£ drachm. Carbonate of Soda, 15 grains. Make s draught, to be taken two or three times a iliv. 368 SCROFULA, OR KING'S EVIL towards the end, half an ounce of sliced liquorice-root and u I,,,.,! Jul of raisins may be added, which will both render ihe «l*r.H-ii»,i less disagreeable, and make it take up more of the bark The liquor must be strained, and two, three, or four tahlo-spoon^l according to the age of the patient, given three times a-dnv; bin' in place of this, I now use the compound tincture of bark. ' The Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrofula. Thev ought not however, to be drank in large quantities, but should be taken >.» n-i to keep the body gently open, and must be used for a considerable time. Hemlock may sometimes be used with advantage in the scrofu- la. Some lay it down as a general rule, that the sea-water is moot proper before there are any suppuration or symptoms of tabn. the Peruvian bark, when there are running sores, and a decree «.f hectic fever ; and the hemlock in old inveterate cases, approach- ing to the scirrhous or.cancerous state. Either the extract or the fresh juice of this plant may be used. The dose may be srhall at first, and increased gradually as far as the stomach is able to hear it. External applications are of little use. Before the tumour breaks, nothing ought to be applied to it, unless a piece of flaiinel, or something to keep it warm. After it breaks, the sore hihv he dress- ed with some digestive ointment. What I have alwuys found to an- swer best, was the yellow basilicon mixed with uhout a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed with this twice a-day ; and if it be very fungous, and does not digest well, a larger proportion of the precipitate may be added.* Scrofulous ulcers which had resisted many other remedies have healed under a weak solution of nitric acid in water (thirty drop* or less of the former to a pint of the latter.) In spreading and irritable sores, the application of an aqueous solution of opium, of of hemlock, and afterwards a solution of zinc, may be beneficial. Where the granulations rise above the surface, and are broad and flabby, and where pressure cannot be applied, the sorrel poulticet has proved useful. The topical application of bruised sorrel leaves has been recommended in very flattering terms as contributing essentially to the cicatrization of indolent scrofulous ulcers. In scrofulous sores of an ugly, gleeting, and ill-conditioned ap- pearance, much benefit has been obtained by the application of a poultice made with crumbs of bread moistened with a solution of about an ounce of the crystals of soda in a quart of water. The sub-borate of soda in the proportion of half a drachm to one drachm mixed with an ounce of spermaceti ointment, or Turin r'* cerate, has been found an efficacious application to scrofulous ul- cers ; and by such dressings they have been known to heal in a short space of time, when other applications have entirely failed. Medicines which mitigate this disease, though they do not cure • The application of the lunar caustic tend, very much topromote the, cur. of«£ nlons ulcere after they have broke, for they should never be opened, Hiey willi besr i^$S&ir%^m of this stimulos, not only witfTi-pumty, Ut^na- 'Tsorrel, a pound, to be beaten to a pulp, sod applied to the part, effected S( ROITLA, OR KING'S EVIL. 289 it, are not to be despised. If the patient can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get well ; but if he does not recover at this time, in all proba- bility he never will. There is no malady which parents are so apt to communicate to their offspring as the scrofula, for wliich reason people ought to beware of marrying into families affected with this disease. Obm.rvations.—One of the most effectual means of guarding against the scrofula, is a constant attention to keep the child dry nnd clean, by the immediate removal of all impurities, which not only taint the air and relax the skin, but vitiate the humours of the body, in consequence of the absorption of their most noxious particles through the pores. Washing children frequently, forms a necessary part of this plan. At first, lukewarm water is proper, as being best suited to the new-born infant, on account of the warm temperature to which he had been accustomed in the womb, and on account of the delicacy of habit which he may have inherited from his parents. But the warmth of the water should be gradually diminished as the infant gains strength, till it can be used quite cold with great safetv and benefit. The cold bath, so essential to the cure of the scrofula, operates with still greater certainty as a preventive. It braces and invigorates the frame, and thus directly counteracts one of the principal causes of the evil, wliich is relaxation. The whole body- ought to be washed every morning, and the lower half every night, after which the child is to be instantly wiped dry, and wrapped up in a warm blunket, to guard against the danger of sudden cold, and to .secure all the advantages of so salutary an operation. My former arguments, in favour of )iuht and loose clothing for children in general, acqmre double force when there is the least reason to dread the scrofula. It is little short of murder to keep an infant of a delicate habit smothered in clothes, and panting in a sort of vapour-bath caused by the noxious steams of its own body. The covering both by day and bv night should he as li<'ht asis consistent with due warmth. The linen next the skin, winch is always imbibing perspirable matter, must be changed often ; and the same dress ought never to be kept on for more than twelve' hours together. ^\ holesome unconfmed air, and frequent exercise, are grand preservatives from all diseases, but especiallv from the scrofula. It is not enough toselect the most spacious ami lofty apartment in the house for the nursery ; children should he taken out into the fields every day, particularly about noon, unless the heat be in- tense, as the most salutary exhalations from the earth then abound, and the air is impregnated with the balmv essence of the sweetest plants and flowers. Cold and wet weather being deemed one of the exciting causes of the scrofula, anv wanton exposure to it would be improper ; though even in this' respect, Jess caution is necessary, if the use of the cold bath be continued everv morning. This will brace the thinnest, finest skin, and harden it against the iMpressions of a damp, chilly atmosphere. Exercise, besides strengthening the whole habit, and powerfully 290 THE ITCH. assisting all the vital functions, has a direct tendency to prevent obstructions of every kind, and those of the glands in particuhu which constitute the earliest symptoms of ,|,e disease in question ' On the subject of diet, some little deviations must be made from my general plan, in rearing the child of scrofulous parents or on. that is marked with what may be called a pre-dispos.tion to this disease, a thin skin, and a general weakness and lla.culity of the habit. Extraordinary care should be taken to secure a very healthv nurse for such a child ; and, after it is weaned, the use of animal food, but light and easy of digestion, should be gradually introduc- ed, and freely allowed at dinner everyday. In case of nnyjn>t apprehensions of the scrofula, we must not trust to a mild rejn- men, to milk and vegetables, though in general so wholesome and nutritious. They cannot give that tone to the stomach, and that energy to the whole system, which they now stand in need of. A gross, full diet will certainly occasion humours and eruptions; hut these are very different from the scrofula, and far more easily cur- ed. A poverty of the blood, a relaxation of the fibres, those sure attendants, if not the principal causes of the evil, require the most strengthening articles both of food and drink. But I must reprobate, above all things, butter in every form, and other oily substances, which are so apt to turn rancid on the stom- ach, loading it with phlegm, relaxing and impeding its action, in- ducing a debility of the solids, and occasioning a great number of complaints, as well as glandular obstructions. One of the worst compositions, of which butter or fat always forms a part, is pastry. 1 really shudder whenever I see a delicate woman, or a weak child, greedily devouring those palatable poisons. Let it be understood, that I include in this censure gingerbread, plumcakes, and all trash of the like kind. Indeed, a child of a scrofulous habit should never eat any preparation of flour, except plain, well-made, and well-baked bread.* The Itch. (Psora.) Though this disease is commonly communicated by infection, yet it seldom prevails where due regard is paid to cleanliness, fresh air, and wholesome diet. It generally appears in for... of small watery pustules, first about the wrists, or between the fingers; afterwards it affects the arms, thighs, legs, Sec These pustules are attended with an intolerable itching, especially when the patient s warm in bed, or sits by the fire. Sometimes, indeed, the akin ». covered with large blotches or scabs, and at other times w.th a whTte scurf, or scaly eruption. This last is callld the Dry Itch, and is the most difficult to cure. The itch is seldom a dangerous disease unless.when,t. re - dered so by neglect or improper treatment. If it be «uBere° l" continue too long, it may vitiate the whole mass of humours; and, ff f be suddenTygd ove in, without proper evacuat.ons, it may oc- casion feverrinflamrnations of the viscera, or other interna, d,.- orders.____________________________------------------— ^De^chi^en are J^^***^^$\o^%£ n warm fluid eetness of tb. sweet or warm. Tr^ate children are V^^*^%^\A^£tf thin warm fluid, such"««*** hJg_ £_££?,_ be permittod to'drink ssy tb.sf ITCH. 291 The best medicine yet known for the itch is sulphur, which ought to be used both externally and internally. The parts most affect- ed may be rubbed with an ointment made of the flour of sulphur, two ounces; crude sal ammoniac finely powdered, two drachms; hog's lard, or butter, four ounces. If a scruple or half a drachm of the essence of lemon be added, it will entirely take away the disagreeable smell. About the bulk of a nutmeg of this may be rubbed upon the extremities at bed time, twice or thrice a-week. It is seldom necessary to rub the whole body ; but when it is, it ought not to be done ull at once, but by turns, as it is dangerous to stop too many pores at the same time. Before the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewise be proper, during the use of it, to take every night and morning as much of the flour of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catching cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment; and such clothes as have been worn while the patient was under the di.sease, are not to be used again, unless they have been fumigated with brimstone, and thoroughly cleansed, otherwise they will communi- cate the infection anew.* I never knew brimstone, when used as directed above, fail to cure the itch ; and 1 have reason to believe, that, if duly persisted in, it never will fail; but if it be only used once or twice, and clean- liness neglected, it is no wonder if the disorder returns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person; but, if any symptoms of the disease should appear again, the medicine must be repeated. It is both more safe and efficacious when persisted in for a considerable time, than when a large quantity is applied at once. As most people disliUe the smell of sulphur, they may use in its place the powder of white hellebore root made up into an ointment, in the same manner, which will seldom fail to cure the itch. People ought to be extremely cautious lest they take other eruptions for the itch; as the stoppage of these may be attended with fatal consequences. 51 any of the eruptive disorders to which children are liable, have a near resemblance; and I have often known infants killed by being rubbed with greasy ointments that make these eruptions strike suddenly in, which nature had thrown out to preserve the patient's life, or prevent some other malady. As the external use, however, of sulphur is frequently attended with much inconvenience from the dirtiness of the application, as well as its disagreeable smell; other remedies are frequently sub- stituted. The most efficacious of these are a solution of arsenic or oxymuriate of mercury,t different combinations of sulphuric * Sir John Pringle observes, that though this disease mav seem trifling, there is do one in the army that is more troublesome to cure, as the infection often lurks in clothes. Arc sad breaks out s second, or even a third time. The same inconveniency occurs in privste families, unless particular regard be paid to the changing or cleaning of their clothes, which last it by no menus sn easy operation. f Take Oxymanste of Mercury. 6 graius. Distilled Wster, IS ounces. ,__ Muriate of Ammonia, 10 grains. Make s lotion. 892 ASTHMA. acid;* white hellebore, and a strong decoction of digitalis". In some cases, an infusion of tobacco leaves, used as a lotion, has cur- ed the itch. Much mischief is likewise done by the use of mercury in this disease. Some persons are so fool-hardy as to wash the parts af- fected with a strong solution of the corrosive sublimate. Other* use the mercurial ointment, without taking the least care either to avoid cold, keep the body open, or observe a proper regimen. The consequences of such conduct may be easily guessed. I have known even the mercurial girdles produce bad effects, and would advise every person, as he values his health, to beware how he uses them. Mercury ought never to be used as a medicine without the greatest care. Ignorant people look upon the-e girdles as a kind of charm, without considering that the mercury enters the body. Those who would avoid this detestable disease, ought to beware of infected persons, to use wholesome food, and to study universal cleanliness.f Asthma. The asthma is a spasmodic^ disease of the lungs, coming on by paroxysms, which seldom admits of a cure. Persons in the de- cline of life are most liable to it. It is distinguished into the moist and dry, or humoral and nervous. 'The former is attended with expectoration or spitting ; but in the latter tin- patient seldom spits, Take Oxymuriate of Mercury, 12 grains. Take White Precipitate of Mercury, Muriate of Ammonia, 1 drachm. 2 drachm? Decoction of White Hellebore, Superncetate of Lead, 12 ounces. Subcarbonate of l'otash, Make a lotion. of each, 10 grains. Prepared Lard, 2 ounces. •Take Sulphuric Acid, \ drachm. Essential Oil of Bergamot, 26 drops. Prepared Lard, 1 ounce. Mako an ointment, to bo rubbed in every Make an ointment. night at bed-time. t The itch is now by cleanliness banished from every genteel family in Britain. It still, however, prevails among the poorer sorts of peasantry, and among the manufac- turers in England. These are not only sufficient to keep the seeds of the disease alive, but to spread the infection among others. It were to be wished that some effectual method could be devised for extirpating it altogether. Several country clergymen have told me, that by getting such as were infected cured, and strongly recommending an attention to cleanliness, they have banished the itch entirely out of their parishes Why might not others do the same 1 X Dr. Cullen, and most other writers, refer the proximate or immediate cause of asthma to a preternatural or spasmodic construction of the muscular fibres of the air- cells of the lungs, which not only prevents their being so dilated as to admit of a free and full inspiration, but also gives them a rigidity which interferes with a free and full expiration. This doctrine, however, has been disputed by Dr. Bree, who, ui a very ingenious treatise on this disease, gives it as his opinion that irritation Kitiiatcd within the bronchia or air-cavities, and arising cither from an effusion of s< rum, or from aerial acrimony, is the true proximate cause of convulsive asthma. The mucus, wlnoh is excreted in the course of the disease, and which has been looked upon by Dr. Cullen and others as only an effect, Dr. B. vie* as a prominent caune of the paroxysm ; or when it is absent, only yielding to a dirt", rent ciu*e equally irritating to the or^an, and exciting spasmodic contractions of the respiratory muscles. Dr. Darwin says, that whatever may be the remote causes of paroxysms of aBthma, the immediate cause e» the convulsive respiration, whether in the common asthma, or in what is termed the convulsive, which are perhaps only differ*nt degrees of the >»me disesae, must be owing to violent voluntary exertions to relieve pain, as in other convulsions; ssd the increase of irritability to external stimuli, or of sensibility during sleep, must occa- sion tbem to commence at this time. Ed. ASTHMA. 293 unless sometimes a little tough phlegm, by the mere force of coughing. It rarely appears before the age of puberty, and seems to attack men more frequently than women; particularly those of a full habit, in whom it seldom fails, by frequent repetition, to occasion some degree of emaciation. When the disease is attended with an accumulation and discharge of humours from the lungs, it is call- ed the humid asthma ; but when it is unaccompanied by any ex- pectoration, it is known by the name of the dry or spasmodic asth- mu. Cw ses.—The asthma is sometimes hereditary. It may like- wise proceed from a bad formation of the breast; the- fumes of metals or minerals taken into the lungs ; violent exercise, especial- ly running; the obstructions of customary evacuations, as the menses, hu-morrhoids, &c, sudden retrocession of the gout, or striking-in of eruptions, as the small-pox, measles, &c, violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that either impedes the cir- culation of the blood through the lungs, or prevents their being du- ly expanded by the air. Symptoms.—An asthma is known by a quick laborious breath- ing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of hreathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or con- tinued Jong in a damp place under ground, or has taken some food which the stomach could not digest, as pastries, toasted cheese, or the like. The paroxysm is commonly ushered-in with listlessness, want of sleep, hoarseness, a cough, belching of wind, a sense of heavi- ness about the breast, and difficulty of breathing. To these suc- ceed heat, fever, pain of the head, sickness and nausea, great op- pression of the breast, palpitation of the heart, a weak and some- times intermitting pulse, an involuntary flow of tears, bilious vom- itings, Sic All these symptoms grow worse towards night; the pat a-nt is easier when up than in bed, and is very desirous of cool air. After some nights passed away in this manner, the fits at length moderate, and suffer more considerable remissions, particularly when they are attended by a copious expectoration in the morn- ings, and when this continues from time to time, throughout the day; and, the disease going off at last, the patient enjoys his usu- al rest by night without further disturbance. The pulse, during the fit, is usually not much affected, but in a few cases there is a frequency of it, with some degree of thirst and other febrile symp- toms. J ^ imen—The food ought to be light and of easy digestion. meats are to be preferred to roasted, and the flesh of young 294 ASTHMA. animals to that of old. All windy food, and whatever is apt tn swell in the stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled or rousted, are proper. Strong liquors of all kinds, especially malt liquor, arc hurtful. The pa- tient should eat a very light supper, or ruther none at all, ami should never suffer himself to be long costive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service. But nothing is of so great importance in the asthma as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp keen at- mosphere of a bleak hilly country : a medium, therefore, between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far us not to be affected by the smoke. Some asthmatic patients indeed breathe easier in town than in the country ; but this is seldom the case, especially in towns where much coal is burnt. .Asthmatic persons who are obliged to be in town all day, ought ut least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Aluiiy asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it promotes the digestion, and greatly assists in the perspiration of the blood. The blood of asthmatic persons is seldom duly pre- pared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear. Medicine.—Almost all that can be done by medicine in this dis- ease, is to relieve the patient when seized with a violent fit. This indeed requires the greatest expedition, as the di.sease often proves suddenly fatal. During the paroxysm the body is generally bound, a purging clyster, with a solution of assafcetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times.* The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should for- bid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomentations or bladders filled with warm milk and water, may be applied to the part affected, and warm cata- plasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and saffron mixed together in a cup of valerian-tea, twice or thrice a day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This, however, will be more safe after other evacuations have been pre- mised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm. *Take Compound Decoction of Marsh- ~°[ein{ mallow, M. , Castor 0.1, Mixture of Assafcetida, Mix for % clyster, 5 ounces. £ ounce, ASTHMA. 295 In the moist asthma, such things as promote expectoration or spitting, ought to be used ; as the syrup of squills,* gum-ammoni- ac, and such like. A common spoonful of the syrup or oxymel of stpiills, mixed with an equal quantity of cinnamon-water, may be taken three or %ir times through the day, and four or five pills made of equal parts of assafotida and gum-ammoniac at bed time.t A combination of foxglove and opium has proved highly advan- tageous in spasmodic asthma, when given in the dose of half a grain of each e^ry four or five hours. In the petuitous asthma, squill and foxgloPrinight be more advisable.J On the authority of a modern writer, galvanism was found most efficacious in reliev- ing habitual asthma.^ For the convulsive or nervous asthma, antispasmodics and ton- ics arc the most proper medicines. The patient may take a tea- spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this case ; it may be taken in substance or infused in wine. Bitter infusions, chalybeate waters, and preparations of iron, particularly the subcarbonate and sul- phate, in short, every thing that braces the nerves or takes off spasm, may he of use in a nervous asthma. It is often relieved by the use of asses' milk: I have likewise known cows' milk drank warm in the morning have a very good effect in this case. In addition to other tonics, exercise either in swinging, sailing, riding in a carriage, or on horseback, but particularly the latter, together with a change of air, will be beneficial to asthmatics: they should try different situations to live in, where the disease is rendered less distressing, or is entirely removed. Their clothing should be warm. In the arthritic asthma, arising from the retrocession of gout, there are usually intermissions and other irregularities of the pulse, great anxiety of countenance, with a bluish tinge thereon. Large doses of opium, ether, camphor, and ammonia r.re the medicines most likely to afford relief. Sometimes it is necessary to bleed the patient, and often to apply a blister to the chest, assisted with placing the feet in warm water, «.Vc. In every species of asthma setons and issues have a good effect; they may either be set in the back or side, and should never be al- * Take Mixture of Ammoniacum, 4 oz. or Oxymel of Squills, 3 drs. Take Mixture of Ammoniacum, 1 oz. Solution of Antimony Wine, 40 drps. Solution of Acetated Ammonia, 2 drs. Distilled Vinegar, £ oz.-------Tartarized Antimony, Make a mixture ; of which two table- 15 drops. spoonsful are to be taken often, or when Syrup of Tolu, 1 drachm either the cough or shortness of breath Make a draught, to be taken every six is troublesome. hours. t After copious evacuations, large doses of ether have been found very efficacious in removing a fit of the asthma. I have likewise known the following mixture produce very happy effects: To four or five ounces of the solution or milk of gum ammoniac add two ounces of simple cinnamon water, the same quantity of balsamic syrup, and half an ounce of paregoric elixir. Of this two table-spoonsful may be token every three hours. \ Take Foxglove in Powder, 6 grains. Syrup of Tolu, enough to make the mass Compound Squill Pill, 2 scruples. into 12 pills, one to be taken three or four times a-day. v See Experimental Inquiry into the Laws of the Vital Functions, &c. by A. P. Wil- sod PhWip, M. D. p. 329. ' SJ96 ASTHMA. lowed to dry up. We shall here, once for nil, observe, that not only in the asthma, but in most chrome discuses, issues are ex- tremely proper. They are both a sate and efficacious remedy; aud though they do not always cure the disease, vet they will often prolong the patient's life. This disease, though so common with us, is little known in mild climates; and, on that account, it is always advisable to try the effect o£ a change of climate, which has generally been attended with great benefit. I have already iijfimated what little confidence I had in the power of any medicine to perform a radi- cal cure of the asthma; but there are many things that will give the patient ease, and, of course, tend to prolong his life. Much, also, may be done by regimen, when drugs are of little service; and I would therefore advise asthmatic patients to procure and keep by them rules for their management both in and out of the fit, adapted to their particular cases. By a proper attention to such rules a man may live many years, and enjoy tolerably good health. I had a patient some time ago, who was often carried home to his wife in an apparently dying state. She felt little alarm, well knowing what was necessary to be done ; and she always brought him about. This good woman did no more than may be done by any woman of common sense, if the doctor will deign to instruct her. (ieneral rules will not do ; they must, as before observed, be suited to the patient's case and constitution. For want of some such instructions, which a physician should take the earliest op- portunity to give, a patient may lose bis life before the doctor can be sent for, or any other medical advice or assistance procured.* Apoplexy. (Apolexia.) Apoplexy is a sudden loss of sense and motion, during which the patient is to all appearance dead ; the heart and lungs, how- ever, still continue to move. Though this disease proves often fatal, yet% may sometimes be removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in win- ter, especially in rainy seasons, and very low states of the barome- ter. Causes.—The immediate cause of an apoplexy is a compres- •Asthina is a disease more immediately alarming in appearance, than dangerous in reality. It is well to be aware that there is hardly an instance known of a person dying during the asthmatic paroxysm. The duration of life seems even rarely to be short- ened by this complaint. The celebrated Dr. Flover, who wrote on asthma, although he laboured under that disease during his whole life, died upwards of eighty yearn of age. He was of opinion that he shortened and lightened his fits by drinking sons* cups of very strong coffee without milk or sugar. I have known more than one asth- matic who never lay down in bed for a long series of years, and notwithsUudmg, during the intervals of the fits, enjoyed tolerable health. Much depends on sdhering to a dry diet, taking regular exercise, and on abstaining from those things which aro known by individual experience, to disorder the stomach. Considerable benefit is derived in the nervous asthma, from occasionally taking as much genuine assafoitid*, made into pills as is sufficient to keep the body regular. Smoking the herb Stramo- nium, shortens the duration of a fit, but does not permanently cure the disease, no* even diminish the number of paroxysms. See " New Domestic Medical Manual, DJ J. S. Forsyth. APOPLEXY. 297 sion of the brain, occasioned by an excess of blood, or a collec- tion of watery humours. The former is called a sanguine, and the latter a serous apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of the blood from the head : as intense study ; violent passions ; viewing objects for along time obliquely; wearing any thing too tight about the neck ; a rich and luxurious diet; suppression of urine ; suffering the body to cool suddenly after having been great- ly heated ; continuing long in a warm or cold bath ; the excessive us.c of spiceries, or high-seasoned food ; excess of venery ; the sudden striking in of any eruption ; suffering issues, setons, &c. sud- denly to dry up, or the stoppage of any customary evacuation ; a mercurial salivation pushed too far, or suddenly checked by cold ,~ wounds or bruises on the head; long exposure to excessive cold;' poisonous exhalations, &c. Symptoms, and method of cure.—The usual forerunners of an apoplexy are giddiness, pain and swimming of the head; loss of memory ; drowsiness; noise in the ears ; the nightmare ; a spon- taneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet, and opening medicines. In the sanguine apoplexy, if the patient does not die suddenly-, the countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and temples, are turgid; the pulse beats strong; the eyes are prominent and fixed, and the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting. In this species of apoplexy every method must be taken to res- sen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be rais- ed pretty high, and his feet suffered to hang down. His clothes. ought to be loosened, especially about the neck, and fr#h air ad- mitted into his chamber. His garters should be tied pretty tight,. by which means the motion of the blood from the lower extremi- ties will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours A laxative clyster.t with plenty of sweet oil or fresh butter, and a spoonful or two of common salt in it, may be administered every two- hours; and blistering plasters applied between the shoulders. and to the calves of the legs. Ab so"" as the symptoms are a little abated, and the patient is SkVaf firTt r„r„7.an,Sh0r 'Y Vi°le^ &% of •*,n?ep' WM 8eized with a ""*«««! apoplexy. -the exnre^ it inefw.Te Fm£ "' *dagee" W bten *"*th^ *«■*«A •LrSw^T Afterwards she became comatose, her pulse sunk very low and ^"r^f.trtaiJ? Whd"t bKStC;ing' a"d other evacuations, shTwarC* ..'.edolco^ ■ large quantity of estrava- t Tak. Compound Extract of Colocynth, Castor Oil, 1 ouoee WusionofSenna * Vl ounce?/ M^yr » c^^ »<» be injected imm*dfc- wx 298 APOPLEXY. able to swallow, he ought to drink freely of some diluting opening liquor; as a decoction of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar diss.dved in it. Or he may take any cooling purge, as Glauber's salts, manna dissolv- ed in an infusion of senna, tincture of rhubarb, or the like. All spirits and other strong liquors are to be avoided, liven volatile salts held to the nose do mischief. Vomits for the same reason, ought not to be given, or any thing that may increase the motion of the blood towards the head. In the serous apoplexy the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here as in the former case. It may, however, generally be performed once with safety and advantage, but should not be repeated. The pa- tient should be placed in the same posture as directed above, and should have blistering plasters applied, and receive opening clys- ters in the same manner. Purges are here likewise necessary, and the patient may drink strong balm tea. If he be inclined to sweat, it ought to be promoted by drinking small wine whey, or an infu- sion of carduus benedictus. A plentiful perspiration kept up for a considerable time has often carried off a serous apoplexy. Out of a fit of serous apoplexy the cephalic and nervous medicines recommended in palsy will be proper, taking occasionally some stomachic purgative. If the disease arise in consequence of a sup- pression of piles, leeches should be applied to the hemorrhoidal veins, fomentations must be employed, and the intestines stimulat- ed by means of aloetic purges. When apoplectic symptoms proceed from opium, or other nar- cotic substances taken into the stomach, vomits are necessary. The patient is generally relieved as soon as he has discharged the poison in this way. Persons of plethoric or apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong Jiquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, and to avoid the ex- tremes of heat and cold. The head should be shaved, and daily washed with cold water. The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected ; but it ought to be taken in moderation. Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons; great care, however, must be taken not to suffer them to dry up, without opening others in their stead. Apoplectic persons ought never to go to rest with a full stomach, or to lie with their heads low, or to wear any thing too tight about their necks. \\ lien an attack of apoplexy is immediately threatened, blood-letting is the remedv .oHo bellied on, and the blood should be drawn either from the jugular vein or temporal artery, determining the extent of blood to be taken away by the circumstances of the case, Sec When a lethargic disposition prevails, bleed.ni should also be adopted, particularly topical, from the temple., hj means of leech- eso from the nape of 'the neck by the scarificator and cupping; COSTIVENESS, Sec. ^ the frequent use of cathartics,* and a blister applied to the head or its immediate vicinity. , , The preceding cautions are of far greater importance than such persons may he aware of. The circulation which is slower dur- ing sleep than when awake, is farther clogged by a fulness of he stomach. The low posture of the head not only favours, but seems to invite stagnation ; and tight ligatures round the neck, impede the return of the blood from the vessels of the bram, so that an upoplexv, not only very naturally, but almost inevitably follow-. Instead of being astonished at the number of those who to to bed in apparent health, and are found dead in the morning, we should consider it as a matter of much more surprise for a per- son of a plethoric habit, after unchecked indulgence in the pleas- ures of the table, to go to rest without any regard to the inclina- tion of his head or the tightness of his collar, and ever to use again.t CosTlV K.NESS, AND OTHER AFFECTIONS OF THE STOMACH AND Bowels. Wi. do not here mean to treat of those astrictions of the bowels which are the symptoms of diseases, as of the cholic, the iliac pas- sion, Sec, but only to take notice of that infrequency of stools wliich sometimes happens, and which in some particular constitutions may occasion diseases. Costiveness may proeee'd from drinking rough red wines or oth- er astringent liquors ; too much exercise, especially on horseback. It may likewise proceed from a long use of cold insipid food, which does not sufficiently stimulate the intestines. Sometimes it is owing to the bile not descending to the intestines, as in. the jaun- dice ; and at other times it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumours, a cold dry state of the intestines, tVc. Excessive costiveness is apt to occasion pains of the headr vomiting eolics, and other complaints of the bowels. It is pecul- iarly hurtful to hypochondriac and hysteric persons, as it gener- ates wind and other grievous symptoms. Some people, however,. can bear costiveness to a great degree. I know persons who en- joy pretty good health, yet do not go to stool above once a-week, und others not above once a fortnight; indeed I have heard of some who do not go above once a-month. Persons who are generally costive should live upon a moisten- ing and laxative diet; as roasted or boiled apples, pears, stewed prunes, raisins, gruels with currants, butter, honey, sugar, and such like. Broths with spin age, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, or that wliich is made of a mix- ture of wheat and rye together, ought to be eaten. No person troubled with costiveness should eat white bread alone, especially "Take Submuriate of Mercury, 6 grains. or Compound Extract of Colocynth, Take Wine of Aloes, 2 ounces. 15 grains. Tincture of Jalap, 2 drachms.. Make \ pills for a dose. Infusion of Senna, 1 ounce. Make a cathartic draught. ♦ Persons inclined to apoplexy derive great benefit from cupping. This operotiaai should never be omitted once or twice a-year. I'u.. 300 WANT OF APPETITE. that which is made of fine flour. The best bread for keeping the body soluble is what in some parts of England they call mesh*. It is made of a mixture of wheat and rye, and is very agreeable to those who are accustomed to it. Costiveness is increased by keeping the body too warm, and by every thing that promotes the perspiration ; as wearing flannel, lying too long in bed, Sec. Intense thought and sedentary life are likewise hurtful. All the secretions and excretions nre promoted by moderate exercise without doors, and by a gay, cheerful, sprightly temper of mind. The drink should be of an opening quality. All nrdent spirits, austere and astringent wines, as port, claret. Sic ought to he avoided. Malt-liquor that is fine, and of a moderate strength, is very proper. Buttermilk, whey, and other watery liquors are proper, and may be drank in turns, as the patient's inclination directs. Those who are troubled with costiveness, ought, if possible, to remedy it by diet, as the constant use of medicines for that pur- pose is attended with many inconveniencies, and often with bad consequences.* I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time the custom becomes necessary, and generally ends in a total relaxation of the bowels, indigestion, loss of appetite, wasting of the strength, and death. When the body cannot be kept open without medicine, we would recommend gentle doses of rhubarb to be taken twice or thrice a- week. This is not so near injurious to the stomach as aloes, jal- ap, or the other drastic purgatives so much in use. Infusions of senna and manna may likewise be taken, or half an ounce of solu- ble tartar dissolved in water-gruel. About the size of a nutmeg of lenitive electuary taken twice or thrice a-day generally answers the purpose very well. See Diseases of Child-bed Women. Want of appetite. {Anorexia.) This may proceed from a foul stomach ; indigestion ; the want of free air and exercise ; grief, fear, anxiety, or any of the de- pressing passions ; excessive heat; the use of strong broths, fat meats, or any thing that palls the appetite, or is hard of digestion ; the immoderate use of strong liquors, tea, tobacco, opium, Sec The patient ought, if possible, to muke choice of an open dry air ; to take exercise daily on horseback or in a carriage ; to rise * The learned Dr. Arbuthnot advises those who are troubled with costiveness to use animal oils, as fresh butter, cream, marrow, fat broths, especially those made of the internal parts of animals, as the liver, heart, midriff, &c. He likewise recommends the expressed oils of mild vegetables, as olives, almonds, pistachios, and the fruits themselves} all oily and mild fruits, as figs> decoctions of mealy vegetables: these lubricate the intestines; some saponaceous substances which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined sugar, eec. The doctor observes, that such lenitive substances are proper for persons of dry atrabilarian constitutions, who are subject to astriction of the belly, and the piles, and will operate when stronger medicinal substances are sometimes ineffectual -, but that such lenitive diet hurts those whose bowels are woak and las. He likewise observes, that all watery substances are lenitive, and that even common water, whey, »our milk, and butter-milk, have that effect: that new milk, especially asses' milk, stimulstet still more when it sours on the stomach; and that whey turned sour will purge strongly. HEART-BURN. 301 betimes; and to avoid all intense thought. He should use a diet Of easy digestion ; and should avoid excessive heat and great fatigue. If want of appetite proceed from errors in diet, or any Other part of the pntient's regimen, it ought to be changed. If nausea and retellings show that the stomach is loaded with crudities, a vomit will be of service. After this a gentle purge or two of rhu- barb, or any of the bitter purging salts, may be taken. The pa- tient ought next to use some of the stomachic bitters infused in wine. Though gentle evacuations be necessary, yet strong purges and vomits are to he avoided, as they weaken the stomach, and hurt digestion. After proper evacuations, bitter elixirs and tinc- tures with aromatics may be used. Sulphuric acid is an excellent medicine in most cases of indiges- tion, weakness of the stomach, or want of appetite. From twenty to thirty drops of it may be taken twice or thrice a day in a glass of wine or water. It may likewise be mixed with the tincture of the bark, one drachm of the former to an ounce of the latter, and two tea-spoonsful of it taken in wine and water, as above. The chalybeate waters, if drank in moderation, are generally of considerable service in this case. The salt water has likewise flood effects ; but it must not be used too freely. The waters of Harrowgate, Scarborough, Moffat, and most other spas in Britain, may be used with advantage. We would advise all who are af- flicted with indigestion and want of appetite, to repair to those places of public rendezvous. The very change of air and the cheerful company, will be of service ; not to mention the exercise, dissipation, amusements, &c. A want of appetite and loathing of food is not usually an origin* al affection, but prevails as a symptom of some other disease, such as indigestion, and is therefore, to be obviated by aromatics, bit* ters, bark joined with chulybeates, sulphuric acid, &c. as under that head. In spontaneous anorexy or loss of appetite, where the stomach is loaded with bile, an emetic in the evening, with some kind of stomach purgative next morning, will seldom fail to effect a cure.—See Indigestion. Heart-Burn. (Cardialgia.) What is commonly called the heart-burn is not a disease of that organ, but an uneasy sensation of beat or acrimony about the pit of the stomach, which is sometimes attended with anxiety, nausea, and vomiting. It may proceed from debility of the stomach, indigestion, bile, the abounding of an acid in the stomach, Sec. Persons who are liable to this complaint ought to avoid stale liquors, acids, windy or greasy aliments, and should never use violent exercise soon af- ter a plentiful meal. I know many persons who never fail to have the heurt-burn if they ride soon after dinner, provided they have drank ale, wine, or any fermented liquor ; but are never troubled with it when they have drank rum or brandy and water without any sugar or flfcitl. When the neart-burn proceeds from a debility of the stomach* or indigestion, the patient ought to take a dose or two of rhubarb ; aAerwards he may use infusions of the Peruvian bark, or any oth-- 302 HEART-BURN. er of the stomachic bitters, in wine or brandy. Drinking a cup of camomile tea, with fifteen or twenty drops of elixir of vitriol in it, twice or thrice a day, will strengthen the stomach and promote di- gestion. Exercise in the open air will likewise be of use. When bilious humours occasion the heart-bum, a tea-spoonful of the sweet spirits of nitre in a glass of water, or a cup of tea, will generally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken. If acidity or sourness of the stomach occasions the heart-burn, absorbents are the proper medicines. In this case an ounce of powdered chalk, half an ounce of fine sugar, and a quarter of an ounce of gum arabic, may be mixed in an English quart of water, and a tea-cupful of it taken as often as is necessary. Such as do not choose chalk, may take a tea-spoonful of prepared oyster shells, or of the powder called crabs eyes, in a glass of cinnamon or pej>- permint water. But the safest and best absorbent is magnesia alba. This not only acts as an absorbent, but likewise as a purgutive ; whereas chalk, and other absorbents of that kind, are apt to lie in the intestines, and occasion obstructions. This powder is not dis- agreeable, and may be taken in a cup of tea, or a glass of mint water. A large tea-spoonful is the usual dose ; but it may be tak- en in a much greater quantity when there is occasion. These things are now generally made up into lozenges for the convenien- cy of being carried in the pocket, and taken at pleasure.* If wind be the cause of this complaint, the most proper medi- cines are those called carminatives; as aniseeds, juniper berries, ginger, canella alba, cardamom seeds, &c. These may either be chewed, or infused in wine, brandy, or other spirits ; but these ought never to be used, unless they are absolutely necessary, as they are only drams in a dry form, and very pernicious to the stomach. One of the safest medicines of this kind is the tincture made by infusing an ounce of rhubarb, and a quarter ofan ounce of the lesser cardamom seeds, in an English pint of brandy. After this has digested for two or three days, it ought to be strained, and four ounces of white sugar candy added to it. It must stand to digest a second time till the sugar be dissolved. A table-spoonful of it may be taken occasionally for a dose. I have frequently known the heart-burn cured, particularly in pregnant women, by chewing green tea. Two table-spoonsful of what is called the milk of gum ammoniac, taken once or twice a-day, will sometimes cure the heart-burn. See Diseases of Preg- nancy. As pregnant women are very subject to this unensy sensation, they should first consider, whether it proceeds from any of the causes already explained ; in which case the medicines prescribed under each head will probably remove it. But if the internal sense of heat be owing to the state of pregnancy itself; if it arises from the consent between the stomach and the womb, and is not accom- panied with much spitting or any acid eructations, the white ofan egg, mixed with a little sugar and water, will often afford the only relief that can be expected for some time. ^-af •The heart-hurn, if very troublesome, may be almost immediately removed, by taking fifteen or twenty drops of the pucjfied soap Ices, the aq'ii kali puri of the simps, in a cup of linseed tea, or of milk. A. P. E. NERVOUS DISEASES. 303 Nervous Diseases. (Neuroses.) Ok all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imitate almost every disease ; and are seldom alike in two different lierwons, or even the same person at different times. Proteus- like, they are continually changing shape : and upon every fresh attack, the patient thinks he feels symptoms which he never expe- rienced be lore. Nor do they only affect the body ; the mind like- wise suffers, and is often thereby rendered extremely weak and peevish. The low spirits, timorousness, malancholy, and fickle- ness of temper, which generally attend nervous disorders, induce many to believe that they are entirely diseases of the mind ; but this change of temper is rather a consequence, than the cause of nervous diseases. Causes.—Every thing that tends to relax or weaken the body- disposes it to nervous diseases, as indolence, excessive venery, drinking too much tea, or other weak watery liquors warm, fre- quent bleeding, purging, vomiting, &c. Whatever hurts the diges- tion, or prevents the proper assimilation of the food, has likewise this effect; as long fasting, excess in eating or drinking, the use of windy, crude, or unwholesome aliments, an unfavourable posture of the body, &,c. Nervous disorders often proceed from intense application to study. Indeed, few studious persons are entirely free from them. Nor is this at all to be wondered at; intense thinking not only preys upon the spirits, but prevents the person from taking proper exercise, by which means the digestion is impaired, the nourish- ment prevented, the solids relaxed, and the whole mass of hu- mours vitiated. Grief and disappointment likewise produce the same effects. I have known more nervous patients who dated the commencement of their disorders from the loss of a husband, a favourite child, or from some disappointment in life, than from any other cause. In a word, whatever weakens the body, or de- presses the spirits, may occasion nervous disorders; as unwhole- some air, want of sleep, great fatigue, disagreeable apprehensions, anxiety, vexation, &c. Symptoms.—We shall only mention some of the most general symptoms of these disorders, as it would be both a useless and impracticable task to enumerate the whole. They generally begin with windy inflations or distentions of the stomach and intestines; the appetite and digestion are usually bad ; yet sometimes there is an uncommon craving for food, and a quick digestion. The food often turns sour on the stomach; and the patient is troubled with tomitiiig of clear water, tough phlegm, or a blackish-coloured liquor resembling the grounds of coffee. Excruciating pains are often fell about the navel, attended with a rumbling or murmuring noise in the bowels. ight, siok- nese, &c. 310 PALSY. wine, mu.stard-whey, or brandy and water. Friction with the flesh brush, or a warm hand, is extremely proper, especially on the parts affected. Blistering plasters may likewise be applied to the affected parts with advantage. When this cannot be done, thev may be rubbed with the volatile liniment.* One of the best exter- nal applications is electricity. The shocks or other vibrations should be received on the part affected ; nnd they ought dailv t*. be repeated for several weeks. $ As a gentle stimulus to the parts, urticution may sometimes be used, warm bathing, the bath waters, electricity, galvanism, are all attended, in many cases, with much benefit, therefore ought not to be omitted. When the disease affects several different parts of the body, a> in hemiplegia and paraplegia, stimulants should be useil both inter- nally and externally. Those in most use arc mustard seed, horse- radish, and volatile alkaline salts or spirits, ami ether, as directed below.t Vomits are very beneficial in this kind of palsy, and ought fre- quently to be administered. Cephalic snuff, or any thing that makes the patient sneeze, is likewise of use. Some pretend to have found great benefit from rubbing the parts affected with net- tles; but this does not seem to be any way preferable to blistering. If the tongue be affected, the patient may gargle his mouth fre- quently with brandy and mustard; or he may hold a bit of sugar in his mouth, wet with the palsy drops, or compound spirits of luv- ender. The wild valerian root is a very proper medicine in this case. It may either be taken in an infusion with sage leaves, or half a drachm of it in powder may be given in a glass of wine three or four times a day. If the .patient cannot use the valerian, he may take of sal volatile oleosum, compound spirits of lavender, and tincture of castor, each half an ounce; mix these together, and take forty or fifty drops in a glass of wine three or four times a day. A table-spoonful of mustard seed taken frequently is a very good medicine. The patient ought likewise to chew cinna- mon, bark, ginger, or other warm spiceries. Although in every instance a dangerous disease, palsy, particu- larly at an advanced period of life, is sometimes removed by the occurrence of a diarrhoea or fever. A feeling of warmth, and a slight pricking pain, as if stung by ants in the parts affected, with returning sensation and motion, are favourable symptoms. Exercise is of the utmost importance in the palsy ; but the pa- tient must be aware of cold, damp, and moist air. He ought to wear flannel next his skin; and, if possible, should remove into a warmer climate. * Take Compound Camphor Liniment, 1 ounce. Oil of Turpentine, 3 drachms. Make a liniment. or Take Spirits of Camphor, 1 ounce. Tincture of Spanish Flies, 2 drachms. Solution of Subcarbonate of Ammonia, i ounce. t Take White Mustard Seed, Two tea-spoonsful in a tea-cupful of cold water. or Take White Mustard Seed bruised, Horse-radish, of each, X ounces. Orange Feel, Aouoce.' Pump Water, 2 pints. Make a decoction, and strain, of which i tea-cupful may be taken three timci a-day ; adding occasionally 20 drops ' f the Tincture of VaJeriun. EPILEPSY. 311 Op the Epilepsy, or Falling Sickness. The epilepsy is a sudden deprivation of all the senses wherein the patient falls suddenly down, and is affected with violent con- vulsive motions. Children, especially those who are delicately brought up, are most subject to it. It more frequently attacks men than women, and is very difficult to cure. When the epilepsy at- tacks children, there is reason to hope it may go off about the time of puberty. When it attacks any person after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expected. If the fit continues only for a short space, and re- turns seldom, there is reason to hope ; but if it continues long, and returns frequently, the prospect is bad. It is a very unfavourable symptom when the patient is seized with the fits in his sleep. The returns of epilepsy are periodical, and its paroxysms com- mence more frequently in the night than in the day, being some- what connected with sleep. It is one of those diseases that is fre- quently counterfeited by impostors to excite charity. It is occa- sionally combined with mania: and is properly distinguished into sympathic and idiopathic; being considered as sympathic when arit-ing as an affection of some other parts of the body, as acidity in the stomach, worms, teething, &c. and idiopathic, when it is a primary disease,* neither dependent on, nor proceeding from any other. Causes.—The epilepsy is sometimes hereditary. It may like- wise proceed from blows, bruises, or wounds on the head ; a col- lection of water, blood, or serous humours in the brain; a poly- pus; tumours or concretions within the skull ; excessive drinking; intense study; excess of venery ; worms; teething; suppression of customary evacuations ; too great emptiness or repletion ; vio- lent passions or affections of the mind, as fear, joy, &c.; hysteric affections ; contagion received into the body, as the infection of the small-pox, measles, Sic Symptoms.—An epileptic fit is generally preceded by unusual weariness ; pain of the head, dullness, giddiness, noise in the ears, dimness of the sight, palpitation of the heart, disturbed sleep, diffi- cult breathing, the bowels are inflated with wind, the urine is in great quantity, but thin ; the complexion is pale, the extremities are cold, and the patient often feels, as it were, a stream of cold air ascending towards his head. In the fit, the patient generally makes an unusual noise; his thumbs are drawn in towards the palms of his hands, his eyes are distorted, he starts, and foams at the mouth, his extremities are bent or twisted various ways, he often discharges his seed, urine, and faeces involuntary, and is quite destitute of all sejnse and rea- son. Alter the fit is over, his senses gradually return, and he com- plains of a kind of stupor, weariness, and pain of his head ; but *as no remembrance of what happened to him during the fit. ihlJwL^.l?0™'^ &' Dr- P*rry'in hi* Elements o«" Pathology and Therapeutic., MriT*!l?»; 2. «* *«P"m»ry cause of epilepsy, it usually depends immediately Mf" 0,,"ve ""Petus of blood in 4he vessels of the brain. Ed. 812 EPILEPSY. The fits are sometimes excited by violent affections of the mind, a debauch of liquor, excessive heat, cold, or the like. This disease, from the difficulty of investigating its causes, and its strange symptoms, was formerly attributed to the wrath of the gods, or the agency of evil spirits. In modem tunes, it has often, by the vulgar, been imputed to witchcraft and fascination. It de- pends, however, as much upon natural causes us any other imila- dy; and its cure may often be effected by persisting in the use of proper means. Regimen.—Epileptic patients ought, if possible, to breathe a pure and free air. Their diet should be light, but nourishing. They ought to drink nothing strong, to avoid swine's flesh, water- fowl, and likewise all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves cheerful, carefully gunrdnifr against all violent passions, as anger, fear, excessive joy, and the like. Exercise is likewise of great use ; but the patient must be careful to avoid all extremes either of heat or cold, all dangerous situations, as standing upon precipices, riding, deep waters, and such like. Medicine.—The intentions of cure must van according to the cause of the disease. If the patient be of a sanguine temperament, and there be reason to fear an obstruction in the brain, bleeding and other evacuations will be necessary. When the disease is oc- casioned by the stoppage of customary evacuations, these, .1 possi- ble, must be restored ; if this cannot be done, others may be sub- stituted in their place. Issues or setons in this case have often a very good effect. When there is reason to believe that the disease proceeds from worms, proper medicines must be used to kill, or carry off these vermin. When the disease proceeds from teeth- ing, the body should be kept open by emollient clysters, the feet frequently bathed in warm water, and, if the fits prove obstinate, a blistering-plaster may be put between the shoulders. The same method is to be followed, when epileptic fits precede the eruption of the small-pox or measles, Sec. When the disease is hereditary, or proceeds from a wrong for- mation of the brain, a cure is not to be expected. When it is ow- ing to a debility, or too great an irritability of the nervous system, such medicines as tend to brace and strengthen the nerves may be used, as the Peruvian bark, and steel, &c. As a tonic, the cinchona bark* has been much employed in the cure of this disease. It is best, however, adapted to those epilep- sies which recur at certain periods, and which are without pletho- ra ; in which cases, if given in a considerable quantity before the expected recurrence of the fit, it will most likely prove scrv u ca- ble ; and when taken for any length of time, it may be combined with valerian, gentian, Sec. as in some of the forms below. Metallic tonics have been found more powerful than the vegeta- ble ones, and are therefore more generally employed. Among •Take Decoction of Bark, 10 drachms. Tincture of Bark, 2 drachms. Tincture ,f Ammoniated Valerian, 4 'Irachm. Mil for a draught, to be taken three tiroes a-day. ST. VITUS'S DANCE. 313 these the oxyde of zinc* has of late been highly extolled for the cure of the epilepsy. Though this medicine will not be found to answer the expectations which have been raided concerning it, yet in obstinate epileptic cases it deserves a trial. The dose is from one to three or four grains, which may be taken either in pills or a bolus, as the patient inclines. The best method is to be- sriii with a single grain four or five times a-day, and gradually to increase the dose as far as the patient can bear it. I have often known this medicine, when duly persisted in, prove beneficial. Sulphate and carbonate of iron; the ammoniated iron ; ammonia- ted coppcrf of til.; Edinburgh pliarmacopoja (in small doses, in- creasing it gradually to as much as the stomach will bear.) The powder and other preparations of tin, have all been used in the cure of epilepsy, but their effects appear rather doubtful. Musk| has sometimes been found to succeed in epilepsy ; ten or twelve grains of which, with the same quantity of factitious cinna- bar, may be made up into a bolus, and taken every night and morning. The nitrate of silver,^ in the cure of epilepsy, has been found to be a valuable medicine, even where the disease has been of many years' standing, and had resisted the powers of others. It is ad- vised to begin with a quarter of a grain three times a-day (for an adult) gradually increasing it afterwards to one grain, or one and a half, in the form of a pill. The oil of turpentine has been used in some cases of epilepsy with manifest success, as well as in other spasmodic diseases. The dose should be considerable to produce any effect, e. g. an ounce for a delicate female; an ounce and a half for a robust female, or small man ; and about two ounces for a robust man. It is best exhibited in milk; and the fittest time for taking it will be early in the morning, upon an empty stomach. In some of the worst cases of epilepsy, in which the fits were long and violent; as well as frequent throughout the course of the day, and where the disease has been of long standing, electricity has been found to render them weaker, and to reduce their number very materially in a short space of time. When other means fail to produce the desired effect, galvanism may be tried. Convulsion fits proceed from the same causes, and must be treated in the same manner as the epilepsy. St. Vitus's Dance. (Chorta Sancti Viti.) * The disease termed Chorea, or St. Vitus's Dance, generally attacks young people from the eighth year of their age till the •Take Oxyde of Zinc. Compound Powder of Cin- namon, 15 grains. Bark in Powder, 1 drachm. Mis sad divide into IS papers, of which take one three times a-day. I Take Ammoniated Copper, 1 grain. Confection of Orange Peel, 10 grs. Make a bolus, to be taken twice a-dsy. t Take Musk. Castor of i>ach, 10 grains. Opium, £ grain. Confection of Roses, enough. Make a bolus, to be taken every 6 noure. GTake Nitrate of Silver, 3 grains. Dissolve it in a few drops of distilled water, then add crumbs of bread, a suffi- ciency to form the mass, to be divided into tO pills, of which one or two may be taken two or three times a-day. o 314 ST. VITUS'S DANCE. time of puberty ; though it has been sometimes found to occur at a more advanced period of life. Females are more liable to it than males. The first symptom of this disease is generally a slight lame- ness of one leg, which the patient drags a little, and seems to have lost the power of duly regulating its action. The arms next be- come affected, and are thrown into various contortions, which de- prive persons affected with this disease of the power of feeding themselves, and their awkward gesticulations in attempting to 'bring articles of food towards their mouth appear ridiculous. Out- side of the body is in general more affected than the other. The tongue participates of the general disease of the system, so as to render articulation nearly unintelligible. If the disease continue long, it materially injures the constitution, sleep becomes disturb- ed or is in great measure prevented, the mental faculties are im- paired, and revert to childishness ; pain is often felt in the stom- ach, the appetite for food is extremely irregular, being occasional- ly ravenous, the countenance appears pale and languid, and the body and limbs are much emaciated. The feebleness and debility caused by this disease seems to have influenced the routine of practice here pursued in the treatment of it. The remedies generally recommended are accordingly of the tonic class, such as Peruvian-bark, steel, bitters, preparations of zinc and copper, cold bathing, and electricity. Notwithstand- ing the administration of these remedies, chorea has generally proved a tedious and untractable disease, continuing to harass the patient for months and even years, not unfrequently occasion- ing permanent injury to the faculties of the mind as well as the powers of the body. Dr. James Hamilton of Edinburgh in his late valuable publica- tion on " Tfie utility and administration of purgative medicines," has promulgated so just a view of the nature and origin of the complaint now under consideration, accompanied with a mode of cure so judicious and successful, that it becomes a duty to diffuse a knowledge of his opinions and practice as extensively as possi- ble. Respecting the plan of treating this disease which has hitherto prevailed, the Doctor observes, " It is melancholy to reflect that months and years, the most valuable in respect of after-life, should glide on, while an effectual check is given to the improvement of the mind, the cultivation of useful learning, or the acquisition of necessary arts; with the hazard of permanent fatuity, to a certain extent, or of a grotesque appearance, from the unconquerable re- mains of irregular motions being imposed on the young sufferers for life. To these certain consequences of protracted chorea, 1 will add, the danger that attends it; I have no doubt, but it muit have, on some occasions, proved fatal." The remedies which that enlightened practitioner has found emi- nently successful in the cure of this disease, consist of active pur- gatives. From three to five grains of calomel combined with ten or fifteen of jalap; or a sufficient quantity of the aloetic pill, oc- casionally interposing a proper dose of the tartanzed infusion of 'enna, a7e so administered aSF to. produce full purging daily which is to be kept up till the progress of the-disease is found to be ar- rested. Hircrp. 315 The emaciation and apparent debility of the subjects of this dis- ease, and the unfounded alarms of their friends lest these symp- toms should be increased by evacuations, are apt to shake the reso- lution of the practitioner, and prevent him from following out this practice to a due extent. But the diminution of the involuntary motions, the general appearance of returning health visible in the countenance, and the regularity of the appetite for food, are the circuuiMances that should regulate his conduct; and their presence ought to encourage him to proceed notwithstanding the weakness of the patient. The quantity of faeces discharged during the ad- ministration of these medicines is sometimes so enormous as to exceed belief; and this circumstance affords grounds to suppose, either that their retention, or the torpor and inactivity of the bow- els, is a chief source of this complaint. The evacuations from the bowels ought to be daily and attentively inspected, and the return of their natural appearance and quantity will be found to indicate and keep pace with the renovation of health. Dr. II. adds, "Since 1 have employed purgatives in chorea, I have been disappointed in effecting a cure in one case only." To this statement I can add, my testimony of the complete success of this mode of treatment in three instances in which I have made trial of it. V\ hen the complaint is subdued, the complete restoration of health and vigour is best effected by the use of a light and nutri- tious diet, with moderate quantity of wine, due exercise in the open air, and bathing in the sea if convenient. A powder composed of five grains of the rust of iron, together with ten of rhubarb, and an equal quantity of fine sugar, may also be taken every morning for some weeks with advantage.' A. P. B. Some people, particularly pregnant women, are very subject to spasmodic contractions of the joints, coming on periodically, and attended with very violent pain ; for the removal of these, anodyne frictions appear to be the best remedy. The hiccup is a spasmodic or convulsive affection of the stom- ach and midriff, arising from any cause that irritates their nervous nbres. It may proceed from excess in eating or drinking; from a hurt in he stomach; poisons; wind; inflammations or scirrhous tu- mours of the stomach, intestines, bladder, midriff, or the rest of nftl" T* r Z&nZ™»es> acute and malignant fevers, a hiccup is often the forerunner of death. F When the hiccup proceeds from the use of aliment that is flatu- k*l or hard of digestion, a draught of generous wine, or a dram <>r any spirituous liquor will generally remove it. If poison be the ecmi^Sd Wb^^ ""J * dra"k' M has »-n formerly ZZTi \ he" ? Proceedsfrom an inflammation of the n r^u-h ,« I V^ daIn«ero^ In th" case the cooling regi- take W°,be TCtlI °b8erVed- The Patient must be Wed, and ofI , . Z Y aneW dr°pS °f the sweet "Pirits of nitre in a cup »i hiiu whey. HiS stomach should likewise be fomented with 316 CRAMP IN THE STOMACH. cloths dipped in warm water, or have bladders filled with wan milk and water applied to it. When the hiccup proceeds from a gangrene or mortification the Peruvian bark, with other antiseptics, are the only medicine which have a chance to succeed. When it is a primary disease and proceeds from afoul stomach, loaded either with a pituitous o a bilious humour, a gentle vomit and purge, if the patient be ahl to bear them, will be of service. If it arises from flatulencies, tin carminative medicines directed for the heartburn must be used. When the hiccup proves very obstinate, recourse must he ha. to the most powerful aromatic and antispasmodic medicines ; th< principal of these is musk; fifteen or twenty grains of which ninj be made into a bolus, and repeated occasionally. Opiutes ure like wise of service; but they must be used with caution. \ bit ..! sugar dipped in compound spirits of lavender, or the volatile aro- matic tincture, may be taken frequently. External application; are sometimes also beneficial; as the stomach plaster, or n cata- plasm of the Venice treacle of* the Edinburgh or London dispen- satory, applied to the region of the stomach. I lately attended a patient who had almost a constant hiccup foi above nine weeks. It was frequently stopped by the use of musk opium, wine, and other cordial and antispasmodic medicines, but always returned. Nothing, however, gave the patient so much ease as brisk small beer. By drinking freely of this the hiccup was often kept off for several days, which was more than could be done by the most powerful medicines. The patient was at length seized with a vomiting of blood, which soon put an end to his life. Upon opening the body a large scirrhous tumour was found near the pylorus, or right orifice of the stomach. The hiccup may be removed by taking vinegar; or by a few drops of sulphuric acid taken in water.* Cramp of the Stomach. This disease often seizes people suddenly, is very dangerous, and requires immediate assistance. It is most incident to persons in the decline of life, especially the nervous, gouty, hysteric, and hypochondriac. If the patient has any inclination to vomit he ought to take some draughts of warm water, or weak camomile tea, to cleanse his sttomach. After this, if he has been costive, a laxative clystei may be given. He ought then to take laudanum. The best way of administering it is in a clyster. Sixty or seventy drops of liquid laudanum may be given in a clyster of warm water. This is mucl more certain than laudanum given by the mouth, which is oiu.-i vomited, and in some cases increases the pain and spasms in tw stomach. If the pain and cramps return with great violence, after the ef fects of the anodyne clyster are over, another with an equal o larger quantity of opium, may be given: and every four or fiv * I have frequently seen a very troublesome hiccup put a stop to by swallowin quickly a glass of the strong soda water in a state of brisk effervescence.—The con mon hiccup may in general be removed by taking a pinch of snuff, or any thing th will cause sneezing. A. P. B. ^___' *"llngMto___________________ SARDONIC LAUGH.—NIGHT-MARE. S17 hours a bolus, with ten or twelve grains of musk, and half a-drachm of the Venice treacle. In the mean time the stomach ought to be fomented with cloths dipped in warm water, or bladders filled with warm milk and water should be constantly applied to it. I have often seen these produce the most happy effects. The ano- dyne bals;im may also be rubbed on the part affected ; and anti- hysteric plaster worn upon it for some time after the cramps are removed, to prevent their return. In verv violent and lasting pains of the stomach, some blood ought to he let, unless the weakness of the patient forbids it. When the pain or cramps proceed from the suppression of the menses, bleeding is of use. If they be owing to the gout, recourse must be had to spirits, or some of the warm cordial waters. Blistering plasters ought likewise, in this case, to be applied to the ancles. I have often seen violent cramps and pains of the stomach remov- ed by covering it with a large plaster of treacle of the London Dispensatory. Sardonic Laugh. (Risus Sardonicus.) This disease is principally characterised by a fit of laughter, arising without any evident cause, and often continuing in a vior lent degree for three or four nights, so far as to prevent the patient from sleeping. By its duration in this way great debility is pro- duced, accompanied with frequency of the pulse, and other febrile symptoms ; at which time it either proves fatal by its violence or ceases spontaneously. For the removal of this disease, opium in large doses, musk, castor, asafoetidu, camphor, ether, and other antispasmodics have usually been employed without effect; so that, indeed, we are bith-t erto unacquainted with any remedy that will prove effectual; the spontaneous cessation, therefore, of the fit is more to be trusted to than assistance from medicine. The Niuht-mare. (Incubus.) In this disease the patient, in time of sleep, imagines he feels an uncommon oppression of weight about his breast or stomach, which he can by no means shake off. He groans, and sometimes cries out, though oftener he attempts to speak in vain. Sometimes he imagines himself engaged with an enemy, and in danger of be- ing killed, attempts to run away, but finds he cannot. Sometimes he fancies himself in a house that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice-, and the dread of being dashed to pieces suddenly awakes him. This disorder has been supposed to proceed from too much blood ; from a stagnation of blood in the brain, lungs, &,c. But it is rather a nervous affection, and arises chiefly from indigestion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the night-m*m Nothing tends more to produce it than heavy suppers, especially when eaten late, or the patient goes to bed soon after. Wind is likewise a very frequent cause of this disease : for wliich reason, 318 SWOONING those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that oppresses the mind ought also to be avoided. Sailors are very liable to this disease; hypo- chondriacs and pregnant women are also its victims, but males more frequently than females. The night-mare is frequently occasioned by eating a full meal of animal food, and drinking freely of fermented liquor, after long fasting and bodily fatigue, by which the whole system is debilitat- ed, and the digestive faculties consequently impaired. When in this state, the safest thing a person can take is tea with bread and butter, which will be found to alleviate fatigue much more complete- ly than wine. As persons afflicted with the night-mare generally moan, or make some noise in the fit, they should be waked, or spoken to by such as hear them, as the uneasiness generally goes off as soon as the patient is awake. Dr. Whyte says, he generally found a drnm of brandy, taken at bed-time, prevent this disease. That, however, is a bad custom, and in time loses its effect. We would rather have the patient depend upon the use of food of easy digestion, cheerfulness, exercise through the day, and a light supper taken early, than to accustom himself to drams. A glass of peppermint water will often promote digestion as much as a glass of brandy, and is much safer. After a pefson of weak digestion, however, has eaten flatulent food, a dram may be necessary; in this case we would recommend it as the most proper medicine. When the nightmare goes off, as frequently is the case, without the patient awaking, strange aberrations of mind are occasionally produced, which give origin to reputed visions and supernatual vis- itations, even among people of superior intellectual cultivation. The degree of consciousness, during a paroxysm of nightmare, is so much greater than ever happens in a dream, that the person who has had a vision of this kind cannot easily bring himself to acknowledge the deceit unless he awakes, or is aroused from his paroxysm, and discovers some incongruity in respect to time or place, which proves the transaction to be an illusion. Persons who are young, and full of blood, if troubled with the night-mare, ought to take a purge frequently, use a Bpare diet, and exercise in the open air. The carbonate of soda, mixed with ale or porter, form an agreeable beverage for those liable to dyspeptic symptoms and incubus. Swooning. (Syncope.) People of weak nerves or delicate constitutions are liable to swoonings or fainting fits. These, indeed, are seldom dangerous when duly attended to; but when wholly neglected, or improperly treated, they often prove hurtful, and sometimes fatal. The general causes of swoonings are, sudden transitions from cold to heat; breathing air that is deprived of its proper spring or elasticity; great fatigue; excessive weakness; loss of blood; long fasting; fear, grief, and other violent passions or affections of the ""it is well known, that persons who have b«?n long exposed to SWOONING. 319 cold often faint, or fall into a swoon, upon coming into the house, especially if they drink hot liquor, or sit near a large fire. This might enmly be prevented by people taking care not to go into a warm room immediately after they have been exposed to the cold air, to approach the fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature. When any one, in consequence of neglecting these precautions, falU into a swoon, he ought immediately to be removed to a cooler apartment, to have ligatures applied above his knees and elbows, and to have his hands and face sprinkled with vinegar or cold wa- ter. He should likewise be made to smell to vinegar, and should have a spoonful or two of water, if he can swallow, with about a third pnrt of vinegar mixed with it, poured into his mouth. If these should not remove the complaint, it may be necessary to bleed the patient, and afterwards to give him a clyster. As air that is breathed frequently loses its elasticity or spring, it is no wonder if persons who respire in it often fall into a swoon or fainting-fit. They are in this case deprived of the very principle of life. Hence it is that fainting fits are so frequent in all crowd- ed assemblies, especially in hot seasons. Such fits, however, must be considered as a kind of temporary death; and, to the weak and delicate, they sometimes prove fatal. They ought therefore with the utmost care to be guarded against. The method of doing this is obvious. Let assembly-rooms, and all other places of public resort, be large and well ventilated; and let the weak and delicate avoid such places, particularly in warm seasons. A person who fuints in such a situation ought immediately to be carried into the open uir ; bis temples should be rubbed with strong vinegar or brandy, and volatile spirits or salts held to his nose. lie should be laid upon his back with his head low, and have a little wine, or some other cordial, as soon as he is able to swallow it, poured into his mouth. If the person has been subject to hys- teric fits, castor or asaf.etida should be applied to the nose, or burnt feathers, horn, or leather, Sic When fainting-fits proceed from mere weakness or exhaustion, which is often the case after great fatigue, long fasting, loss of blood, or the like, the patient must be supported with generous cordials, as jellies, wine, spirituous liquors, and such like. These, however, must be given at first in very small quantities, and increased gradually as the patient is able to bear thein. He ought to be allowed to lie quite still and easy upon his back, with his head low, and should have fresh air admitted into his chamber. His food should consist of nourishing broths, sago-gruel with wine, new milk, and other things of a light and cordial nature. These things are to be given out of the fit. All that can be done in the fit is, to let him smell to a bottle of Hungary-water, eau-de-luce, or spirits of hartshorn, and to rub his temples with warm brandy, or to lay a compress dipped in it to the pit of the stomach. In fainting-fits that proceed from fear, grief, or other violent passions or affections of the mind, the patient must be very cau- tiously managed. He should be suffered to remain at rest, and only mude to smell to tome vinegar. After he is come to himself. 330 FLATULENCIES, OR WIND. he may drink freely of warm lemonade, or balm-tta, with some orange or lemon peel in it. It will likewise be proper, if the faint- ing-fits have been long and severe, to cleanse the bowels by throw- ing in an emollient clyster. It is common in fainting-fits, from whatever cause they proceed, to bleed the patient. This practice may be very proper in strong persons of a full habit; but in those who are weak and delicate, or subject to nervous disorders, it is dangerous. The proper method with such people is, to expose them to the free air, and to use cor- dial and stimulating medicines, as volatile salts, Hungary-water, spirits of lavender, tincture of castor, and the like. Flatulencies, or Wind. (Flatulentia.) All nervous patients, without exception, are afflicted with wind and flatulencies in the stomach and bowels, which arise chiefly from the want of tone or vigour in these organs. Crude flatulent aliment, as green peas, beans, coleworts, cabbages, and sueh like may increase this complaint; but strong and healthy people are sel- dom troubled with Wmd, unless they either overload their sto- machs, or drink liquors that are in a fermenting state, and conse- quently full of elastic air. While therefore the matter of flatulence proceeds from our aliments, the cause which makes air separate from them in such quantity as to occasion complaints, is almost al- ways a fault of the bowels themselves, which are too weak either to prevent the production of elastic air, or to expel it after it is produced. To relieve this complaint, such medicines ought to be used as have a tendency to expel wind, and by strengthening the aliment- ary canal, to prevent its being produced there.* The list of medicines for expelling wind is very numerous; they often, however, disappoint the expectations of both the physician and his patient. The most celebrated among the class of carmi- natives are juniper-berries ; the roots of ginger and zedoary ; the seeds of anise, caraway, and coriander; gum asafoetida and opi- um ; the warm waters, tinctures, and spirits, as the aromatic water, the tincture of woodsoot, the volatile aromatic spirit, tether, Sec. Dr. Whyte says, he found no medicine more efficacious in expel- ling wind than rether and laudanum. He generally gave the laud- anum in a mixture with peppermint-water and tincture of castor, or sweet spirits of nitre. Sometimes, in place of this, he gave opi- um in pills with asafoetida. He observes that the good effects of opiates are equally conspicuous, whether the flatulence be contain- ed in the stomach or intestines; whereas those warm medicines, commonly called carminatives, do not often give immediate reliet, except when the wind is in the stomach. With regard to aether, the Doctor says, he has often seen very good effects from it in flatulent complaint.-,, where other medicines failed The dose is a tea-spoonful mixed with two table-spoonsful ♦Many nervous people fine.great ben efit ^^^^^^K ^Sd'recomfid IT^cZ^U* stomach, ans.ng from flatulence, ndigestion, &c. LOWr SPIRITS. 321 of water.* In gouty cases, he observes that «ther, a glass of French brandy, or of the aromatic water, or ginger, either taken in substance or infused in boiling water, are among the best medi- cines for expelling wind. When the case of flatulent patients is such as makes it improper to give them warm medicines inwardly, the Doctor recommends external applications, which are sometimes of advantage. Equal parte of the anti-hysteric and stomach-plaster may be spread upon a piece of soft leather, of such size as to cover the greater part of the belly. This should he kept on for a considerable time, provid- ed the patient he able to bear it; if it should give great uneasiness, it may be taken off, and the following liniment used in its stead :— Take of Bate's anodyne balsam an ounce ; of the expressed oil of mace half an ounce ; oil of mint two drachms. Let these in- gredients be mixed together, and about a table-spoonful well rub- bed on the parts at bed-time. For strengthening the stomach and bowels, and consequently fitfr lessening the production of flatulence, the Doctor recommends the Peruvian bark, bitters, < halybeates, and exe^ise. In flatulent ca- ses, be thinks some nutmeg or ginger should be added to the tinct- ure of the bark and bitters, and that the aromatic powder should be joined with the filings of iron. When windy complaints are attended with costiveness, which is often the case, few things will be found to answer better than four or five of the following pills taken every night at bedtime :— Take of asafcetida two drachms; succotrine aloes, salt of iron, and powdered ginger, of each one drachm ; and as much of the eUxir proprietatis as will be sufficient to form them into pills. On the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm, or two scruples of the Jap- onic confection, given every other evening, will have very good effect. In those flatulent complaints which come on about the time the menses cease, repeated small bleedings often give more relief than any other remedy. With regard to diet, the Doctor observes, that tea, and likewise all flatulent aliments, are to be avoided ; and that for drink, water with a little brandy or rum is not only preferable to malt liquor, but in most cases also to wine. As Dr. \>'byte has paid great attention to this subject, and as his sentiments upon it in a great measure agree with mine, I have taken the liberty to adopt them ; and shall only add to his observa- tions, that exercise is in my opinion superior to all medicines, both for preventing the production, and likewise for expelling of flatu- lencies. These effects, however, are not to be expected from saun- tering about, or lolling in a carriage ; but from labour, or such ac- tive amusements as give exercise to every part of the body. Low Spirits. (Hypochondriasis.) This disease, known also by the name of the vapours, is a cer- * Though the patient may begin with this quantity, it will be necessary to increase- the dose gradually m the stomach cm brar it. ./Ether is now given in considerably greater dotea than it was in Dr. Whyte's time. 822 HYSTERIC AFFECTIONS tain state of the mind accompanied with dyspepsy, in which the greatest evils are apprehended upon the slightest grounds, and the worst consequences imagined from any unusual feeling even of n trifling kind; and as regards these apprehensions and feelings. there is always the most obstinate belief and persuasion. All who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise, and amuse- ments, are the most likely means to remove this complaint. It is greatly increased by solitude and indulging gloomy ideas, but may often be relieved by cheerful company and sprightly amusements. When low spirits are owing to a weak relaxed state of the stomach and bowels, an infusion of the Peruvian hark with eimm- mon or nutmeg will be proper. Steel joined with aromatics may likewise in this case be used with advantage; but riding, and a proper diet, are most to be depended on.—When they arise from a foulness of the stomach and intestines, or obstructions in the hypochondriac viscera, aloetic purges will be proper. I have sometimes known the Harrowgate or Tunbridge water of service in these cases.—When the disease proceeds from a suppression of the menstrual or of the hemorrhoidal flux, these evacuations mnv either be restored, or some other substituted in their place, as is- sues, setons, or the like. Dr. Whyte observes, that nothing has such sudden good effects in this case as bleeding.—When it has been brought on by long-continued grief, anxiety, or other distress of mind, agreeable company, variety of amusements, and change of place, especially travelling into foreign countries, will afford the most certain relief. Persons afflicted with low spirits should avoid all kinds of ex- cess, especially of venery and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful ; but when taken to excess, they weaken the stomach, vitiate the humours, and depress the spirits. This caution is the more necessary, as the unfortunate and melancholy often fly to strong liquors for re- lief, by which means they never fail to precipitate their own de- struction. Besides the usual symptoms attendant on this disease, hypo- chondriacs are apt to be troubled with pain in the head and stom- ach ; to relieve which it may be proper to give such medicines as aether, musk,* and opium, either separately or conjointly. Hysteric Affections. These likewise belong to the numerous tribe of nervous diseases, which may justly be reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons an hysteric lit, as it is call- • Take Musk mixture, *h ounce. Spirit of Sulphuric Ether, 1 drachm. Spirit of Sulphuric Ether, 30 drps. 1'mcture of Opium, Make a draught to be taken three times------- of I.av. nder, ____ a-dav of each, 3U drops. '" or Make a mixture ; two table-spoon *ul Take Spirit of Caraway, i ounce. three or four times a-day. Camphor Mixture, 6 ounces HYSTERIC AFFECTIONS. 32:5 ed, may be brought on by an irritation of the nerves of the stom- ach or intestines, by wind, acrid humour, or the like. A sudden suppression of the menses often gives rise to hysteric fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments.—It appears- under such various shapes, imitates so many other diseases, and is attended with such a variety of symptoms, that it is difficult to give a just character or definition of it; and it is only by taking the aggregate of its appearances that a proper idea can be convey- ed of it to others. Sometimes the hysteric fit resembles a swoon or fainting fit, during which the patient lies as in a sleep, only the breathing is so low ns scarcely to be perceived. At other times the patient is af- fected with cat. lungs and strong convulsions. The symptoms which precede hysteric fits are likewise various in different per- sons. Sometimes the fits come on with coldness of the extremi- ties, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting; afterwards it rises into the throat, and occasions a degree of suffocation, to which quick breath- ing, palpitation of the heart, giddiness of the head, dimness of the Bight, loss of hearing, with convulsive motions of the extremities and other parts of the body, succeed. The hysteric paroxysm is often introduced by an immoderate fit of laughter, and sometimes it goes off by crying. Indeed there is not much difference between the laughing and crying of an hysteric lady. Our uim in the treatment of this disease must be to shorten the fit or paroxysm when present, and to prevent its return. The longer fits continue, and the more frequently they return, the dis- ease becomes the more obstinate. Their strength is increased by- habit, and they induce so great a relaxation of the system, that it is with difficulty removed. It is customary, during the hysteric fit or paroxysm, to bleed the patient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper; but in weak and delicate consti- tutions, or where the disease has been of long standing, or arises- from inanition, it is not safe. The best course in such cases is to rouse the patient by strong smells, as burnt feathers, asafoetida, or spirits of hartshorn, held to the nose. Hot bricks may also be ap- plied to the soles of the feet, and the legs, arms, and belly, mav be strongly rubbed with a warm cloth. But the best application is to put the feet and legs into warm water. This is peculiarly proper when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafoetida will be proper : anr% as soon as the patient can swallow, two table-spoonsful of a solu- tion of asafoetida, or of some cordial julep, may be given fre- quently.* * When hysteric fits are occasioned by sympathy, they may be cured by exciting an* opposite passion. This is said to have been the case of a whole school of young ladiev in Holland, who were all cured bv beinj told, that the first who was-seizod.BhouH.be> burned to death. But this method of cure,'» my. knowledge,,wjtl uotaijrsvj ruocsmJI 324 HYSTERIC AFFECTIONS. The radical cure of this disorder will be best attempted m a tine when the patient is most free from the fits. It will be greatly pro- moted by a proper attention to diet. A milk and vegrtnhlr diet, when duly persisted in, will often perform a cure. If, however! the patient has been accustomed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most proper drink is water with a small quantity of spirits. A cool dry air is the best. Cold bathing, and every thing that braces the nerves, and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the great- est importance to have the mind kept constantly ensy and cheerful, and, if possible, to have it always engaged in some agreeable and interesting pursuit. The proper medicines are those which strengthen the alimentary canal and the whole nervous system, as the preparations of iron, the Peruvian bark and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a-day. The bark and iron may likewise be taken in sub- stance, provided the stomach can bear them ; but they arc gener- ally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder. If the stomach is loaded with phlegm, vomits will be of use ; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there is a tendency to costiveness, it must be removed either by diet, or by taking an open- ing pill as often as it shall be found necessary. To lessen the irritability of the system, antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opi- um, and castor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is often suc- cessful in removing those periodical head-achs to which hysteric and hypochondriac patients are subject. Castor has in some cases been found to procure sleep where opium failed ; for which reason Dr. Whyte advises, that they should be joined together. He like- wise recommends the anti-hysteric plaster to be applied to the ab- domen* Hysteric women are often afflicted with cramps in various parts of the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In pat'ents whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphor, and the warm bath. Cramps are often prevented or cured by compression. Thus by means of tonic and corroborating medicines. HYPOCHONDRIAC AFFECTIONS. 325 cramps in the legs are prevented, and sometimes removed, by tight bandages ; and when convulsions arise from a flatulent distention of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong compression up- on the abdomen by means of a broad belt. A roll of brimstone held in the hand is frequently used as a remedy for cramps. Though this seems to owe its effect chiefly to imagination, yet, as it sometimes succeeds, it merits a trial.* When spasms or convul- sive motions arise from sharp humours in the stomach or intes- tines, no lasting relief can be procured till these are either cor- rected or expelled. The Peruvian bark has sometimes cured pe- riodic convulsions after other medicines had failed. Hypochondriac Affections. (Hypochondriasis.) This disease generally attacks the indolent, the luxurious, the unfortunate, and the studious. It becomes daily more common in this country, owing, no doubt, to the increase of luxury and sed- entary employments. It has so near a resemblance to the imme- diately preceding, that many authors consider them as the same disease, and treat them accordingly. They require, however, a very different regimen; and the symptoms of the latter, though less violent, are more permanent than those of the former. Men of melancholy temperament, whose minds are capable of great attention, and whose passions are not easily moved, are, in the advanced periods of life, most liable to this disease. It is usu- ally brought on by long and serious attention to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous eruptions, long continued evacuations, obstructions in some of the viscera, as the liver, spleen, Sic Hypochondriac persons ought never to fast long, and their food should be solid and nourishing. All acescent and windy vegeta- bles are to be avoided. Flesh-meats agree best with them, and their drink should be old claret or good madeira. Should these disagree with the stomach, water with a little brandy or rum in it may be drank. Cheerfulness and serenity of mind are by all means to be cul- tivated. Exercise of every kind is useful. The cold bath is like- wise beneficial; and, where it does not agree with the patient, fric- tions with the flesh-brush or a coarse cloth may be tried. If the patient has it in his power, he ought to travel either by sea or land. A voyage or a long journey, especially towards a warmer climate, will be of more service than any medicine. The general intentions of cure in this disease, are to strengthen the alimentary canal, and to promote the secretions. These in- tentions will be best answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations, may be taken in the sume manner as directed in the preceding disease. If the patient be costive, it will be necessary to make use of some gentle opening medicine, as pills composed of equal parts of aloes, rhubarb, and asafo-tida, with as much of the elixir propri- * Some persons afflicted with cramps pretend to reap great benefit from small bun- dles of rosemary lied all night about their feet, ancles, and knees. 326 HYPOCHONDRIAC AFFECTIONS. etatis as is necessary to form the ingredients into pills. Two ?"?f ?♦ T ?T ,mAy be taken M ofte» a« i* -hill he found needful to keep the body gently open. Such as cannot bear he asafoetida may substitute Spanish soap in its place Though a cheerful glass may have good effects in this d.sease Sta?pmanneMf excess is hurtfuL Intei,se ^ »»d «% that depresses the spirits, are likewise pernicious. ' g 1 hough the general symptoms and treatment of nervous disor- ders were pointed out in the beginning of this chapter, yet, for the benent of the unhappy persons afflicted with those obstinate nii.l complicated maladies, I have treated several of their capital sv.np- toms under distinct or separate heads. These, however, are not to be considered as different diseases, but as various modifications of the same disease. They all arise from the same general caus- es, and require nearly the same method of treatment. There are many other symptoms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I shall therefore omit them altogether, and conclude this chapter with a few general remarks on the most obvious means of prevent- ing or avoiding nervous disorders. In all persons afflicted with nervous disorders, there is a great delicacy and sensibility of the whole system, and an uncommon degree of weakness of the organs of digestion. These may be ei- ther natural or acquired. When owing to a defect in the consti- tution, they are hardly to be removed; but may be mitigated by proper care. When induced by diseases, as long or repeated fe- vers, profuse haemorrhages, or the like, they prove also very ob- stinate, and will yield only to a course of regimen calculated to restore and invigorate the habit. But nervous affections arise more frequently from causes, which it is in a great measure in our own power to avoid, than from dis- eases, or an original fault in the constitution, Sec Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases. It has been already observed, that grief indulged destroys the appetite and digestion, depresses the spirits, and induces an uni- versal relaxation and debility of the whole system. Instances of this are daily to be seen. The loss of a near relation, or any other misfortune in life, is often sufficient to occasion the most compli- cated series of nervous symptoms. Such misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and prop- er exertion of the mind, might be rendered less hurtful. For di- rections in this matter we must refer the reader to the article Grief, in the chapter on the Passions. The effects of intense study are pretty similar to those occasion- ed bv erief. It preys upon the animal spirits, and destroys the a|>- petite and digestion. To prevent these effects, studious Jpernms ought, according to the Poet, to toy wxth their books* They should neve study toS long at a time; nor attend long to one parti* Tr subieci especially if it be of a serious nature They ought ^^Sb^t^vlto their p^stur^and shou.cUake^fre- Armstiona on Health. HYPOCHONDRIAC AFFECTIONS. quently to unbend their minds by music, diversions, or going into agreeable company. With regard to diet, I shall only observe, that nervous diseases may he induced either by excess or inanition. Both of these ex- tremes hurt the digestion, and vitiate the humours. When nature is oppressed with fresh loads of food, before she has had time to digest and assimilate the former meal, her powers are weakened, and the vessels are filled with crude humours. On the other hand, when the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with wind, and the humours, for want of regular fresh supplies of wholesome chyle, are vitiated. These ex- tremes are, therefore, with equal care to be avoided. They both tend to induce a relaxation and debility of.the nervous system, with all its dreadful train of consequences. But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is, that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labour or suffer diseases, surely no individual has any right to ex- pect an exemption from the general rule. Those, however, who are willing to take exercise, but whose oc- cupations confine them to the house, and perhaps to an unfavoura- ble posture, really deserve our pity. We have in a former part of the book endeavoured to lay down rules for their conduct; and shall only add, that where these cannot be complied with, their place may, in some measure, be supplied by the use of bracing and strengthening medicines, as the Peruvian bark, with other bitters; the preparation of steel; the elixir of vitriol, and such like. Among many remarkable cases of the nervous kind, which I have often met with, one very lately attracted my notice in a pe- culiar manner. It was written by the patient himself, a gentle- man of fortune and of liberal education ; and it might be justly called a picture from nature, drawn with uncommon sensibility and force. The whole account being too long for insertion, the follow- ing extract may serve as a specimen of the writer's sufferings and descriptive talents:—" It is in vain," he says, "that I attempt to impress the Faculty with the real state of my sufferings. The symptoms of the disorders are not to be described, from their unu- sual pressure upon the mind ; nor can they be conceived, I believe, by any but those who have suffered under them. They may be said to constitute a phenomenon in the science of diseases. Since I know of no terms to express them in, or language to describe them by, I am obliged to content myself with denominating the disorder :md its effects together a mental agony, whose influence creates a real tedium nttr. It attacks me sometimes when sitting, some- times when walking; and if I were not to throw myself on a bed during the violence of the paroxysm, I should certainly dash my- seii to pieces. This iS accompanied with a lassitude, restlessness, Him total incapacity of attending to any concerns in life." lhe same spirit animated every part of the affecting descrip- tion; and the case was accompanied with a list of eleven eminent MS HYPOCHONDRIAC AFFECTIONS physicians, whom the patient had consulted at different times, but whose names I suppress, as their prescriptions did him no good, and did them no honour. When the primary seat of the disenw is in the mind.it is stooping to the low tricks of quackery to amuse a patient with false hopes of the efficacy of any medicine. The disappointment that follows aggravates every painful symptom, and makes the unhappy sufferer look forward to death as the only re- source. All I prescribe for him is travelling. I should also have willingly inserted here an account of some other nervous affections of an extraordinary nature, had not their length exceeded the limits I prescribed to myself in these supple- mentary observations. ' For this very prevalent and distressing class of complaints, there is not any remedy so much to be relied on ns the habit of early rising, which necessarily implies that of retiring also at an early hour to rest. The energies of the nervous system become exhausted and worn out, by the impressions of external objects on the senses, as well as by the mental exertions which are perpetu- ally going on while we are awake. Sleep is the means appointed by Nature for the renovation of these wasted energies. On waking from a state of sound sleep, we find ourselves, in the proper sense of the word, refreshed. Such refreshment, however, is chiefly to be expected from that sleep which takes place before midnight. After a certain hour of the evening, even the most healthy persons experience an increased quickness of the pulse. In feeble consti- tutions this nocturnal access of fever is still more strongly mark- ed ; and the repetition of it is the true cause of that worn, bagged appearance, by which the votaries, or rather the victims, of fashion may, in general, be distinguished. It is by no means advisable to curtail the natural time of sleep. The great Lord Mansfield, himself an early riser, and whose long-protracted life gives impor- tance to his opinion on any subject connected with the preservation of health, used to counsel his friends, as one of the best means of obtaining that blessing, "to cultivate bleep." But it must be the sound repose of temperance, which can only be found during the early hours of night, not the perturbed slumbers of the noon- day couch. Nothing, indeed, tends more to debilitate the consti- tution, and in an especial manner to aggravate every species of nervous complaint, than remaining in bed till a late hour of the mCou"d'"the still small voice of reason" expect to be heard in opposition to the imperious mandates of fashion, the prese: it cus- tom of taking the principal meal at so very late an horn of day might also be denounced as contributing not a httlo produce diseases of the nerves. After the system has been x.medy long fasting, the stomach is suddenly ™?]?™^J™*l£uZ of rich food and stimulating liquors, which the empJ » els £ sorb with an eagerness far beyond their powers to a .nd.ue. tM this, the immediate consequence is drowsiness but ,1 i\ na ginj fpUts be roused by thepresence. o^^l^^M EYE. 329 be compensated by an equivalent depression during some other period of the natural day. Sleep is disturbed and interrupted, in consequence of the blood-vessels of the brain being irritated by the sudden influx of fresh chyle, by which they are distended; and rendered, more particularly in the supine posture, liable to rupture. May we not venture, without being accused of entering too far into theoretical speculations, to attribute, in part at least, to these causes, the augmented frequency of apoplexy, and its melancholy sequel, palsy 1 The palpable increase of which complaints in this country of late years is a subject of serious alarm.' A. P. B. CHAP. XXXII. DISORDER OF THE SENSES. Wk do not mean to treat of the nature of our sensations, or to give a minute description of the various organs by which they are performed ; but to point out some of the diseases to which these organs are more liable, and to show how they may be prevented or remedied. Of the Eye. No organ of the body is subject to more diseases than the eye; nor is there any one of which the diseases are more difficult te cure. Though more ignorant persons pretend to cure these, than any other class of diseases, yet a very superficial acquaintance with the structure of the eye, and the nature of vision, will be sufficient to convince any one of the danger of trusting to them. These dis- eases often exceed the skill of the most learned physician; hence we may easily infer the dangerlpf trusting them to ignorant quaeks, who, without all peradventure, put out more eyes than they cure. But, though the diseases of the eye can seldom be cured, they might often, by due care, be prevented ; and, even where the sight is totally lost, innnv things might be done, which are generally neg>- lected, to render the unhappy person both more useful to himself and to society.* The eyes are hurt by viewing bright or luminous objects ; keep- ing the head too long in a hanging posture; violent head-achs; excessive venery; the long use of bitters; the effluvia from acrid or volatile substances ; various diseases, as the smallpox, measles, Sec.; but, above all, from night-watching, and candlelight-studies. Long fasting is likewise hurtful to the eyes, and frequent heats and colds are no les- pernicious. The eyes are often hurt by the stop- page of customary evacuations ; as morning sweats; sweating of the feet; the menses in women ; and the bleediug piles in men. •There are many employ ments of which blind persons are very capable, ss knitting, carding, turning s wheel, teaching languages, - ing a poultice of fresh hemlock constantly upon the eye, and a perpetual blister on the neck.* Myopia, or short-sightedness; and the Presbyopia, or seeing only at too great a distance, are disorders which depend on the original * In both these cases electricity merits a trial, EYE. 331 •tructure or figure of the eye, therefore admit of no cure. The inconveniences arising from them may however be in some meas- ure remedied by the help of proper glasses. The former requires the aid of a concave, and the latter of a convex glass. Strabismus, or squinting, depends upon an irregular contraction of the muscles of the eye from a spasm, palsy, epilepsy, or an ill ^ habit. Children often contract this disorder by having their eyes' unequally exposed to the light. They may likewise acquire it by imitation from a squinting nurse, or playfellow, Sec. As this dis- order can hardly be cured, parents ought to be careful to prevent it. Almost the only thing which can be done for it is to contrive a mask for the child to wear, which will only permit him to see in a straight direction. In most cases of squinting we shall be enabled to afford essen- tial relief, by the simple process of binding up the sound eye eve- ry day, for two or three hours, so as to oblige the patient to make use of the debilitated organ, and according as it is more or less in- disposed, to keep the other more or less veiled, and continuing these means until the diseased eye is enabled fully and properly to perform its functions. Spots or Specks on the eyes are generally the effect of inflam- mation, and often appear after the small-pox, the measles, or vio- lent ophthalmias. They are very difficult to cure, and often occa- sion total blindness. If the specks are soft and thin, they may sometimes be taken off by gentle caustics and discutients ; as vit- riol, the juice of celandine, &c. When these do not succeed, a surgical operation may be tried : the success of this, however, is always very doubtful. The Blooo-shot Eye may be occasioned by a stroke, a fall, retching, vomiting, violent coughing, &c. I have frequently known it happen to children in the hooping-cough. It appears at first like a bit of scarlet, and is afterwards of a livid or blackish colour. This disorder generally goes off without medicine. Should it prove obstinate, tne patient may be bled, and have his eyes foment- ed with a decoction of comphry roots and elder flowers. A soft poultice may be applied to the eyes; and the body should be kept open by gentle purgatives. The Watery or Weeping Eye is generally occasioned by a re- laxation or weakness of the glandular parts of that organ. These may be braced and strengthened by bathing the eye with brandy and water, Hungary water, rose water, with white vitriol dissolv- ed in it, Sec. Medicines which make a revulsion are likewise proper ; ns mild purgatives, perpetual blisters on the neck, bath- ing the feet frequently in lukewarm water, &c. >\ hen this disease proceeds from an obstruction of the lachrymal duct, or natural passage of the tears, it is called a fistula lachryma- ls, and can only be cured by a surgical operation.* * A weeping or watery eye is often the mark of a scrofulous habit. 80S EAR. There are many diseases to which the eye is liable, requirm. the best surgical treatment, which it would serve to little purpose to introduce into a work of family medicine, several of them de- manding different means of treatment, as the affection may be in the acute or chronic stage. See Inflammation of the eyes. The Ear. The functions of the ear may be injured by wounds, ulcers, or any thing that hurt* its fabric. The hearing may likewise be hurt by excessive noise ; violent colds in the head ; fevers; hard wax, or other substances sticking in the cavity of the ear ; too great a degree of moisture or dryness in the ear. Deafness is very often the effect of old age, and is incident to most people in the decline of life. Sometimes it is owing to an original fault in the structure or formation of the ear itself. When this is the case, it admits of no cure : and the unhappy person not only continues deaf, but generally likewise dumb for life.* "When deafness is the effect of wounds or ulcers of the ear, or of old age, it is not easily removed. When it proceeds from cold of the head, the patient must be careful to keep his head warm, especially in the night; he should likewise take some gentle pur- ges, and keep his feet warm, and bathe them frequently in luke- warm water at bed-time. When deafness is the effect of a fever, it generally goes off after the patient recovers. If it proceeds from dry wax sticking in the ears, it may be softened by dropping oil into them; afterwards they must be syringed with warm milk and water. If deafness proceed from dryness of the ears, which may be known by looking into them, half an ounce of the oil of sweet al- monds, and the same quantity of opodeldoc, or tincture of asafoet- ida, may be mixed together, and a few drops of it put into the ear every night at bed-time, stopping them afterwards with a little wool or cotton. Some, instead of oil, put a small slice of the fat of bacon into each ear, which is said to answer the purpose very well. When the ears abound with moisture, it may be drained off by an issue or s*ton, which should be made as near the affected parts as possible. __________________________________ •Tfcoacfc thooe who have the misfortune to be born deaf are generally suffered to eoavtiune dumb, and consequently are in a great measure lost to society,yet nothing i. more certain than that such persons may be taught not only to resd and write, but aboto speak, and to understand what others say tg them. Teach.ng.be dumb to .Beak, will appear paradoxical to those who do not consider that the formation of soamou is uswrfv ineehanicnl, and may be taught without the assistance of the ear. TrWU not only capable of demoustraUon, bat is actually reduced to practice by the ^^^oooLsBraidwood of Edinburgh This gentleman hasbytbe mere foEeof genius and applicatiou, brought the teach.ng of dumb person, to such a degree r.17. Erin.i A.. kMacaolxrs areaoueralW more forward in their educauon, than iTrflne*s£e a£ whV«ior*»^eU 'faculties. They not only read and write ^ST£ ^^«JT»J« but likewise mtak, and are capable of holding conversation with the utmost ^'■"^JJJSTu^TS 0f the human specie, should remain in with anyperson in ">e M*- J»{*| ^£ "^ndered as useful and intelligent as oth- tateXaTSa\st"tatiee toImt. Braidwood. whose success has ftr exceeded a^l be DOW «u. oa\ mau '■ j-= ,_j..j -, rrM.A. imagination itae f so far, that no per- former attempts this way; and indeed it exceed*"■"£■££ n . , c,p,bl« of. so. who has not seen and examined h» ^:.^J3.Tf. "and as the fair greater As tl»je.U«a., k<^, pel- licles, warts, &c. covering the tongue. It may be depraved by a fault of the saliva, which, being discharged into the mouth, gives the same sensations as if the food which the person takes had re- ally a bad taste ; or it may be entirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurtful either to the sense of tasting or smelling, than obstinate colds, especially those which affect the head. When the taste is diminished by filth, mucus, Sec the tongue ought to be scraped, and frequently washed with a mixture of wa- ter, vinegar, and honey, or some other detergent. When the sali- va is vitiated, which seldom happens, unless in fevers or other dis- eases, the curing of the disorder is the cure of this symptom. To relieve it, however, in the mean time, the following things may be of use : If there be a bitter taste, it may be taken away by vomits, •The most efficacious sternutatory, and which will frequently be found nscfulin obstinate head-schs and in complaints of the eyes, ss well as in dryness of the nose, anSeficiency tf smell, is composed of equal part, of the v.tr.o ated -""cury •« wear and powder of liquorice root. Theso are to be well m.xed together. A p.noh offfi's composition drawn forcibly up the affected nostril a short t.me orev.ou. to going £ bed, generally produces a copious discharge of watery mucus during the night, without sneezing. Ed. THE TOUCH. 335 purges, and other things which evacuate bile. What is called a nidorous taste, arising from putrid humours, is corrected by the juice of citrons, oranges, and other acids. A salt taste is cured by a plentiful dilution with watery liquors. An acid taste is destroy- ed by absorbents, and alkaline salts, as powder of oyster-shells, ■alt of wormwood, Sec. When the sensibility of the nerves, which supply the organs of taste, is diminished, the chewing of horse-radish, or other stimulat- ing substances, will help to recover it. Of the Touch. The sense of touching may be hurt by any thing that obstructs the nervous influence, or prevents its being regularly conveyed to the organs of touching; as pressure, extreme cold, &c. It may likewise be hurt by too great a degree of sensibility, when the nerve is not sufficiently covered by the cuticle or scarf-skin, or where there is too great a tension of it, or it is too delicate. Whatever disorders the functions of the brain and nerves, hurts the sense of touching. Hence it appears to proceed from the same general causes as palsy and apoplexy, and requires nearly the same mode of treatment. In a stupor, or defect of touching, which arises from an obstruc- tion of the cutaneous nerves, the patient must first be purged ; afterwards such medicines as excite the action of the nerves, or stimulate the system, may be used. For this purpose the spirit of hartshorn, sal volatile oleosum, horse-radish, &c. may be taken in- wardly ; the disordered parts, at the same time, may be frequently rubbed with fresh nettles, or spirit of sal ammoniac. Blistering- plasters and sinapisms applied to the parts will likewise be of use, as also warm bathing, especially in the natural hot baths. In a work like this wliich is wholly designed for popular in- struction, it would have been a useless display of anatomical skill to mention such disorders of the senses as admit of no remedy, be- cause they are owing to a defect in the organization or structure of the brain, whence the nerves, those fine organs of sensation, take their rise. But it may be proper to make a few remarks on one or two general causes of nervous weakness, and of consequent debility or imperfection of the senses, which proceed wholly from our own misconduct. Nothing so much relaxes the nervous system, so much blunts the acuteuess of every sense, and destroys its energy, as intemper- ance. To say of a man when drunk, tlmt he has lost his senses, is literally true in the most comprehensive meaning of the word. He can neither see, hear, taste, smell, nor feel, with exactness ; and though he may flatter himself that with the return of sobriety, he recovers his senses also, yet they become more and more im- paired by every debauch, till frequrnt repetitions of the frantic in- dulgence consign him to blindness, to deafness, and to the grave. Excess in eating produces similar effects, and, like the touch of the torpedo, benumbs every faculty. It particularly vitiates the taste and smell, and thus defeats the chief purposes for which these senses were given, to inform us of the wholesome or noxious prop- erties of every thing we eat and drink. 336 SCIRRHUS AND CANCER. Uncleanhness is also highly injurious to the organs of -eruation Perhaps the benignity of Nature is not displayed in any thinir mnr,; strongly than m the warnings she gives of this evil, and in her own endeavours to avert it. She has left us so little to do, that we de- serve no pity for the severest punishment of our neglect. See |J0W kindly she has guarded the extremities of the nerves all over tin body, the interior parts of the nose, the mouth, the ear, the f»i^ against external annoyance ! Observe with what efforts, rrmrflr independent of our will, she strives to relieve those delicate Ar«;nn> from all impurities! The uneasiness we feel upon such occasion.. ought to rouse our immediate attention. Shall we suffer dirt tn gather upon the skin, to dull the sense of feeling, to obstruct tin: pores, and to drive back into the system the noxious particles win. h Nature endeavours to throw off, when the use of a little soap ami water would prevent every inconvenience ? Is it too much trouble to wash the ears; to dip the face with the eyes open in a bason of clean water four or five times every morning, to rinse the nose and mouth; and to keep the tongue clean, not by scraping it, but by attending to the state of the stomach, of which the tongue is an index ? Some people seem to be as much afraid of water as if they had been bitten by a mad dog; and if they remain obstinate in that antipathy, I can only say, they deserve a far worse end than that of such unfortunate incurables, to be suffocated in their own filth. CHAP. XXXIII. OF A SCIRRHUS AND CANCER. A Scirrhus is a hard indolent tumour, usually seated in some of the glands; as the breast, the arm-pits, Sec If the tumour be- comes large, unequal, of a livid, blackish, or leaden colour, and is •attended with violent pain, it gets the name of un occult cancer. When the skin is broken, and a sanies or ichorous matter, of an abominably foetid smell, is discharged from the sore, it is called an open or ulcerated cancer. Persons after the age of forty-five, par- ticularly women, and those who lead an indolent sedentary life, are most subject to this disease. It is most commonly confined to glands, and particularly the testes and mamma;, but is now and tJien, nevertheless, to be met with in the uterus, as likewise in the face and other parts that are thinly covered with flesh, and which at the same time are a good deal exposed to external irritation, such as the lower lip, the angles of the eyes, the organs of vision, the wings of the nose, tongue, and penis. A cancer is an ulcer of the very worst kind, with an uneven surface, and ragged and panful ed^s, which spreads in a very rapid manner, discharges a thin acrimonious matter, that excoriates the neighbouring integument*. and haT a very fetid smell, and which is usua ly preceded by . hard or scirrhous swelling of the part, if glandular. CAUSE8.-This disease is often owing to suppressed eraeurion-; henceTproves so frequently fatal to women of a gross hab.t, SCIRRHUS AND CANCER. 337 particularly old maids and widows, about the time when the men- strual flux ceases. It may likewise be occasioned by excessive fear, grief, anger, religious melancholy, or any of the depressing pas- sions. Hence the unfortunate, the choleric, and those persons who devote themselves to a religious life in convents or monasteries, are often afflicted with it. It may also be occasioned by the long con- tinued use of food that is too hard of digestion, or of an acrid na- ture ; by barrenness, celibacy, indolence, cold, external injuries, friction, pressure, or the like. Women often suffer from the last of these by means of their stays, which squeeze and compress their breasts so as to occasion great mischief. Sometimes the dis- ease is owing to an hereditary disposition. Svmi-toms.—This disorder seems often very trifling at the begin- ning. A hard tumour, about the size of a hazle-nut, or perhaps smaller, is generally the first symptom. This will often continue for a long time without seeming to increase, or giving the patient great uneasiness; but if the constitution be hurt, or the tumour irritated by pressure or improper treatment of any kind, it begins to extend itself towards the neighbouring parts, by pushing out a kind of roots or limbs. It then gets the name of cancer, from r fancied resemblance between these limbs and the claws of a crab. The colour of the skin begins to change, which is first red, after- wards purple, then bluish, livid, and at last black. The patient complains of heat, with a burning, gnawing, shotting pain. The tumour is very hard, rough, and unequal, with a protuberance, or rising, in the middle : its si/.e increases daily, and the neighbour- ing veins become (hick, knotty, and of a blackish colour. The skin at length gives \\av, and a thin ©harp ichor begins to flow, which corrodes the neighbouring parts till it forms a large unsightly ulcer. More occult cancers arise, and communicate with the neighbouring glunds. The pain and stench become intolera- ble ; the appetite fails; the strength is exhausted by a continual hectic fever; at last, a violent lueinorrhage, or discharge of blood, from some part of the body, with faintings or convulsion fits, gen- erally put an end to the miserable patient's life. Regimen.—The diet ought to be light, but nourishing. All strong liquors, and high-seasoned or salted provisions, are to be avoided. The patient may take as much exercise as he can easily bear; and should use every method to divert thong'.t and amuse his fancy. All kinds of external injury are carefully to be guard- ed against, particularly of the alfected part, wliich ought to be de- fended from all pressure, and even from the external air, by cover- ing it with fur or soft flannel. y Mkoicim:.—This is one of those diseases for winch no certain remedy is vet known. Its progress, however, may sometimes be retarded, and some of its most disagreeable symptoms mitigated, by proper applications. • One misfortune attending the disease is, that the unhappy patient often conceals it too long. Were proper means used in due tune, a cancer might often be prevented; but after the disorder has arrived at a certain height, it generally pets all medicine at defiance. V 338 SCIRRHUS AND CANCER. When a scirrhous tumour is first discovered, the patient ought to observe a proper regimen, and to take twice or thrite a-week t dose of the common purging mercurial pill. Some blood may al- so be let, and the part affected may be gently rubbed twice a-day, with a little of the mercurial ointment, and kept warm with fur or flannel. The food must be light, and an English pint of the de- coction of woods or sarsaparilla may be drank daily. I have sometimes discussed hard tumours, wliich had the appearance of beginning cancers, by a course of this kind. To allay pain and irritation, and, probably, thereby retard the progress of the disease, opium may be given internally, and like- wise applied externally, mixed with the different preparations of lead used as sedatives and discutients ;* and much may be done in all incipient scirrhous tumours by repeatedly blistering the part, having first had recourse to the frequent applications of leeches, occasional purgatives, and a cooling diet. Should the tumour, however, not yield to this treatment, but, on the contrary, become larger and harder, it will be proper to extir- pate it either by the knife or caustic. Indeed, whenever this can be done with safety the sooner it is done the better. It can an- swer no purpose to extirpate a cancer after the constitution is ruined, or the whole mass of humours corrupted by it. This, how- ever, is the common way, which makes the operation so seldom succeed. Scirrhous tumours are often removed with perfect safe- ty, and thereby prevented from degenerating into true cancer, when extirpation is not delayed too long; but after a tumour of this description has ulcerated, thereby assuming the cancerous character, and has afforded an opportunity for an absorption of the matter into the system, there is every reason to suppose that a complete cure seldom, if ever, be effected. Few people will sub- mit to the extirpation till death stares them in the face, whereas, if it were done early the patient's life would not be endangered by the operation, and it would generally prove a radical cure. When the cancer is so situated that it cannot be cut off, or if the patient will not submit to the operation, such medicines as will mitigate or relieve the most urgent symptoms may be used. Dr. Home says, that half a grain of the corrosive sublimate of mercu- ry, dissolved in a proper quantity of brandy, and taken night and morning, will often be of service in cancers of the face and nose. He likewise recommends an infusion of the solanum, or night-^ shade, in cancers of the breasts. But the medicine most in repute at present for this disease is hemlock. Dr. Stork, physician at Vienna, has of late recommend- ed the extract of this plant as very efficacious in cancers of every kind. The Doctor says, he has given some hundred weight* of it without ever hurting any body, and often with manifest advantage. • Take Cerate of Superacetate of Lead, °r Ammnn;. r 1 ounce. Take Solution of Acetate of Ammonia, *rt"i Make a lotion. SCIRRHUS AND CANCER. 339 He advises the patient, however, to begin with very small doses, as two or three grains, and to increase the dose gradually till some food effect be perceived, and there to resUvithout further increase. 'rom two or three grains at first, the Doctor says he has increased the dose to two, three, or four drachms a-day, and finds that such doses may be continued for several weeks without any bad conse- quences. The regimen which the Doctor recommends during the use of the medicine, is to avoid farinaceous substances not fermented, and too acrid aromatics. He says good wine will not be hurtful to those who are accustomed to it, nor a moderate use of acids ; and adds, that the patient should live in a pure free air, and keep his mind as quiet and cheerful as possible. The Doctor does not pretend to fix the time in which a cancer may be resolved by the use of hemlock, but says he has given it for above two years in large doses without any apparent benefit; nevertheless the patient has been cured by persisting in the use of it for half a year longer. This is at least encouragement to give it a fair trial. Though we are far from thinking the hemlock mer- its those extravagant encomia which the Doctor has bestowed up- on it, yet in a disease which has so long baffled the boasted pow- ers of medicine, we think it ought always to be tried, at least, dur- ing the occult or scirrhous state. Deadly nightshade and henbane are medicines of the same class with hemlock, and the timely use of them has sometimes proved advantageous in glandular tu- mours and indurations that are likely to become cancerous. These have also been employed, with others of the narcotic class, in ex- ternal applications, as well as the hemlock. When used in this way the leaves may be boiled in milk, so as to form a decoction sufficiently strong, with wliich the part is to be frequently fomented. The powder of hemlock is by some preferred to the extract. They are both made of the fresh leaves, and may be Used nearly in the same manner. Dr. Nicholson of Berwick says, he gradually increased the dose of the powder from a few grains to half a drachm, and gave near four drachms of it in a day with remarka- bly good effects. The hemlock may also be used externally either as a poultice or fomentation. The sore may likewise be kept clean by injecting daily a strong decoction of the tops of leaves into it. Few things contribute more to the healing of foul sordid ulcers of any kind than keeping them thoroughly clean. This ought nev- er to be neglected. The best application for this purpose seems to be the carrot poultice. The root of the common carrot may be grated, and moistened with as much water as will brin* it to the consistence of a poultice or cataplasm. This must be applied to the sore, and renewed twice a-day. It generally cleans the sore, eases the pain, and takes away the disagreeable smell, which are objects of no small importance in such a dreadful disorder.* In every species of open cancer, the air should be excluded as much us possible ; a double covering of oil-silk may therefore be applied over tho dressings. * London Medical Estays. 340 SCIRRHUS AND CANCER. Wort, or an infusion of malt, has been recommended, not only as a proper drink, but as a powerful medicine in this disease, ft must be frequently mafle fresh, and the patient may take it at pleasure. Two, three, or even four English pints of it may lie drank every day for a considerable time. No benefit can be ex- pected from any medicine in this disease, unless it be persisted in for a long time. !t is of too obstinate a nature to he soon remov- ed ; and, when it admits of a cure at all, it must be brought about by inducing an almost total change of the habit, which must al- ways be a work of time. Setons or issues in the neighbourhood of the cancer have sometimes good effects.* A cancerous ulcer of the tongue has been cured by nitric acidf and opium, which had resisted various remedies. An opiate was given at night; and the acid, to prevent it from corroding the teeth, was directed to be sucked through a tube. In fourteen days after the exhibition of this medicine, healthy granulations were seen to shoot out from the bottom of the ulcer, which gradually healed from this time; and in the course of three months, although half the tongue had been in a state of ulceration, was perfectly healed. Nothing was applied to the diseased part but a lotion composed of the extract of hem- lock, rectified spirit and water, to which little or no cflicucy was ascribed. Applications of a caustic nature have been much used in the ul- cerated stage of cancer, and they have been employed under a va- riety of forms ; but their principal ingredients have been well known to be either arsenic or corrosive sublimate. The most noted are the Arundel powder, Guy's powder, and I'lunket's pow- der: which last is a composition of crow's-foot, dog's-fennel, and arsenic. None of these have ever produced the smallest benefit; on the contrary, they all occasion infinitely more pain than the more certain method of cure, when taken in due time, by the operation of cutting out the cancerous core; but, unfortunately, by such em- pirical, mercenary, and fallacious means as the above, the unhap- py patient has been but too frequently beirmled beyond the period when the operation might have been attended with success. As a topical application in external cancer, such as of the lip, breast, &c, lint dipped in a solution of the subborate of soda.f and applied to the ulcerated surface, removing it as often as it be- comes dry, has been frequently attended with a good effect. . » In a cancer which had set all medicines, and even sur-ery, at defiance, I.lately saw remarkable effects from an obstinate perseverance in a course of an .aeptkM. ordered the deep ulcers to be washed to the bottom by means of * «yrmg.., twicn « Ued with the same powder. When the patient began this course her-«ui^« «»j evidently did almost to a miracle. tTake Diluted Nitric Acid, lounce. * Take Solution of Subborate of Sodj^ o0ne&,., *rintte"' Ejtract of Henbane, i drachm.. Pure Water, z p . V. Distilled Water made warm, 8 01 SCIRRHUS AND CANCER. 341 When all other medicines fail, recourse must be had to opium, as a kind of solace. This will not, indeed, cure the disease, but it will case the patient's agony, and render life more tolerable while it continues. To avoid this dreadful disorder, people ought to use wholesome food ; to take sufficient exercise in the open air; to be as easy and cheerful as possible; and carefully to guard against all blows, bruises, and every kind of pressure upon the breasts, or other glandular parts.* In the long catalogue of human affections, there is scarcely one to be more dreaded than the cancer. It is no less painful than loathsome ; it kills by inches ; is seldom cured except by the knife ; and even that does not always succeed. I have frequently seen small tumours in the breast, which might perhaps have ended in cancers, yield to the camphorated mercurial ointment, applied twice a-day; but after the scirrhus had broke and become a can- cer, I do not remember having ever seen it cured ; nor do I believe that the whole materia medica can afford a remedy for it. Net there are plenty of people in London who cure cancers; and no one, who has a sufficient share of faith, can be at a loss for a cancer-doctor. One may see even the fronts of houses inscribed with the words, " Cancers cured here,'''' in large characters. 1 late- ly had a patient, who once fancied that hex breast was a little can- cerous, ami, under that impression, was kept for two years in the hands of a female cancer-curer, though the lady in reality had not the least symptom of a cancer about her.t But credulity is a disease of the mind still more incurable than cancers. I hud occasion, a few years ago, to make several visits at the house of one of the richest merchants in London, whose sister was afflicted at the time with a cancer; and though she lived in the same house, 1 was never desired to look at her. Blind cre- dulity prevailed over reason. Her cure was entrusted to an Amer- ican quack, who knew just as much as my lady's lap-dog, of the nature and proper treatment of cancers. He only helped to Jull her. wliich the disease might ultimately have done: yet surely she ought to have bad better advice. * As hemlock i* tic principal medicine recommended in this disease, we would have u'ivi u hoiuc directions for the gathering and preparing of that plant; but as its different preparations are now kept in the shops, wc think it much safer for peoplo to get them there, Willi proper directions for using them. t In a work UteU published on cancer by a Air. Carmichael, a number of cases are adduced in fafour of the utility of iron as a remedy in this disease. Tbo preparation of this metal, to which he gives the preference, is the carbonate, that is, th$ precipi- tate formed b> saturating a solution of the salt of steel (feniim vitriolatum)iv. 1^1 Xhe tixeil alkali. Its properties are nearly the same as those of the rust of iron," when properly prepared. (if this the patient may take to the extent of a drachm per day, formed into pills, with the addition of any aromatic, to make it sit more easily on the klomach. The same preparation, finely levigated, may also be advantageously sprin- kled on the surface of the sore; or a wash, made by diluting the muriated tincture of alee! with water, may be used. This answers well also as an injection, when the uterus is the seat of llie complaint. On the authority of this gentleman, whose practice appears to be founded on experience, and is detailed with candour, in so de- plorable a dne*M\ the remedy proposed by him certainly merits a trial. V. P.'ft.-' 342 POISONS. CHAP. XXXIV. POISONS. Every person ought, in some measure, to be acquainted with the nature and treatment of poisons. They are not unfrequently taken unawares, and their effects are often so sudden and violent, as not to admit of delay, or allow time to procure the assistance of medi- cal men. There are four kinds of poisons; viz. mineral, vegetable, aerial, and animal. Mineral poisons are distinguished from vegetable ones by their action. The former corrode, stimulate, and inflame; the latter generally stupify, without leaving any marks of inflammation. None of the mineral poisons prove fatal, till after a most excru- ciating operation of at least two or three hours; whereas some of the vegetable ones terminate life in a few minutes. From the ani- mal poisons the distinction is as remarkable. The aerial poisons operate still more quickly than any other classes, and their action on respiration is of so peculiar and immediate influence, that it cun seldom be mistaken. Poison seldom remains long in the stomach before it occasions sickness, with an inclination to vomit. This shows plainly what ought to be done. Indeed, common sense dictates to every one, that if any thing has been taken into the stomach which endangers life, it ought immediately to be discharged. Were this duly regarded, the danger arising from poisons might often be avoided. MINERAL POISONS. These consist of corrosive metallic salts; e. g. Arsenic and its preparations; Corrosive Sublimate, Sec Symptoms.—When a medical poison has been swallowed,* the symptoms are an austere taste, fetid breath, constriction of the pharynx and gullet; hiccup; nausea and vomiting of brown or bloody matter; anxiety and faintings; heat with violent pain at the pit of the stomach; black and offensive stools; small pulse; frequent and irregular palpitations; great thirst and burning heat; breathing difficult; urine scanty, red and bloody; delirium; convulsions of an epileptic type, and death. Treatment.—Vomiting to be immediately excited ; and encour- aged bv large and long-continued draughts of sugared water, lin- ked tea, or other emollient fluids. If arsenic has been taken ,n solution, lime-water, or chalk and water, may be drank freely. Inflammatory symptoms are to be combated; biding from the arm!Td leeches to the region of the stomach; fomentations, fre- quent emollient clysters, as symptoms may require. ftSZSSSS^i SSSrfi ^ecu hv the latter than & former mode Ed. POISONS. 343 For arsenic no specific antidote is yet known. Fat, oil, vinegar, charcoal powder, lime of sulphur, and vegetable decoctions, which have been recommended, are not to be relied on. Tests.—To ascertain when arsenic is present in any fluid, a solu- tion of the ammoniacal sulphate of copper added to it, produces, generally, a beautiful grass green precipitate ; but if added to wine, the precipitate would be a dark-coloured blue. Sulphureted hydro- gen precipitates arsenic from tea of a beautiful yellow colour, and changes a solution of arsenic in water of a yellow colour, with- out any precipitate. From albumen, gelatine and bile, contain- ing arsenic in solution, nitrate of silver produces a white pre- cipitate. The annnoniaco-nitrate of silver produces a yellow pre- cipitate, soluble in nitric acid and ammonia ; but the presence of muriates or phosphates, or their acids, renders this a fallacious test. Make with the suspected fluid a broad streak on writing paper, then draw a piece of lunar caustic several times over the moisten- ed part, which will become yellow if arsenic or alkaline phosphate be present. If it be arsenic, the streak will be rough, curdy, and floeculent, as if done with a crayon ; if a phosphate, homogeneous and uniform. In a few minutes the phosphoric yellow fades into a dull green, becomes darker, and ultimately black. The arsen- ical yellow remains permanent, or nearly so, for some time, when it becomes brown. These distinctions are to be viewed by reflect- ed, not transmitted light, the test being made in the shade. The most certain test to detect the presence of arsenic, is to re- duce it to its metallic state, by calcining the dried suspected mat- ter in a glass tube, with equal parts of charcoal and potash ; when, if arsenic be present, in however minute a quantity, it will be sub- limed and stick to the inside of the tube, in the form of a shining metallic coating, consisting of cubic crystals. Antimony, and its Preparations. Emetic Tartar, Sic—When an excess of emetic tartar, or any other of the preparations of antimony have been taken, we may remark the following Symptoms, viz. Those occasioned by acids, with copious and obstinate vomitings, abundant stools, constrictions of the throat, cramps, symptoms of intoxication, and prostration of strength. Treatment.—Emetic tartar genernlly defeats itself by the vomit- ing it soon occasions after it is taken ; but when this does not take place, it should be excited by tickling the throat with a feather or the finger ; and encouraged by copious draughts of mild fluids ; or when too severe, to be allayed by opium according to the effects previously produced by the poison. The best antidotes are, decoction of astringent vegetables, such as oak or willow bark, gall nuts, strong green tea, &c, which should be given freely for the purpose of diluting and decomposing the poison. Tests.—Sulphureted hydrogen, and the hydrosulphurets, precip- itate tnrtarized antimony from its solution of an orange or deep brownish red colour ; white, by sulphuric acid> alkalies, barytes or 344 POISONS. lime water. Alkaline and earthy neutral salts do not affect it • but salts with excess of acid do. Infusion of gall, occasions a copnoi whitish-yellow precipitate. The muriate of antimony is a dark heavy fluid, to which, if water be added, a white precipitate i. formed. The oxide is soluble in muriatic acid, by which the muri- ate is formed. *#* AH the preparations of antimony are readily reduced to the metallic state by calcination with charcoal and potash. Copper, and its Preparations. (Sulphate of copper', or blue vit- riol; subacetate of copper, or verdigrise. Food cooked in foul copper vessels, and pickles made green by copper.) Symptoms.—Acrid and coppery taste ; tongue parched and dry ; constriction of the throat and coppery eructations ; severe vomit- ings, or fruitless efforts to vomit; dragging at the stomach ; dread- ful colic; frequent black bloody stools with tenesmus : abdomen distended; pulse small, hard, and quick ; syncope; great thirst and anxiety; cold sweats, scanty urine ; pain in the heud, vertigo, cramps, convulsions, and death. Treatment.—Large draughts of milk and water to encourage vomiting. Whites of eggs stirred up with water, and taken freely. Inflammation to be attacked as a generul principle, and the ner- vous symptoms by anodynes and antispasmodics. Sugar, as first promulgated by Orfila, is not a specific, bin it may be given ad- vantageously with coffee. Tests.—The salts of copper are mostly of a bright green or blue colour, and are easily reduced to their metallic state by means of charcoal, at an elevated temperature. The sulphate of copper is partly decomposed by alkalies and alkaline earths. Potash pre- cipitates a subsulphate of a green colour from it. If the salts of copper be dissolved in coffee, port wine, or mah liquors, which partly decompose them, they may be detected by adding a spirituous tincture of guaiacum, which will throw down a precipitate varying in shade from a greenish indigo to that of a pale green. Ammonia added to a solution of any cupreous salt, gives a blue or greenish precipitate, according to the quantity; but, if added in excess, it re-dissolves the precipitate, and forms a deep blue transparent solution. Lead and its Preparations ; or fluids adulterated with lead. Symptoms.—When lead has been taken in large quantity, a su- o-arv astringent metallic taste is felt in the mouth ; constriction of the throat; pain in the region of the stomach; obstinate, painful, and often bloody vomiting hiccup ; convulsions and death. When taken in small long-continued doses, it produces Devon- shire colic (colica pictonum,) and paralytic symptoms. Treatment.-See Alkaline Earths.-ln addition to which if symp- toms suggest it, bleeding must be used; in conjunction with castor oTwR without opium, assisted by frequent emollient clysters to clean out the bowels. The warm bath, Sec. tSs.-AII the preparations of lead are easily reduced to the.r metallic state by calcination with charcoal. POISONS. 345 , The superacetate of lead (sugar of lead) dissolved in water is precipitated white by means of sulphuric acid ; of a canary colour by chromate of potash and chromic acid ; both of which are easily reduced by calcination. The alkaline sulphurets precipitate the superacetate of lead of a blackish colour. Mkiktry, and its Preparations; e. g. Oxymuriate of mercury, or corrosive sublimate; nitric oxide of mercury, or red precipitate; sulphuret of mercury, or vermilion. Symptoms.—Acrid metallic taste, thirst, fulness and burning at the throat ; anxiety, teasing pains of the stomach and bowels; nausea and vomiting of various coloured fluid, sometimes bloody; diarrhoea and dysuria, or difficulty of making water. Pulse quick, small, and hard: faintings, great debility, difficult breathing, cramp, cold sweats, insensibility, death. Treatment.—Whites of eggs decompose corrosive sublimate. One mixed with water may be given every two or three minutes to promote vomiting, aud to lessen the virulence of the poison ; milk in large quantities, gum-water, or linseed-tea, sugar and wa- ter, or water itself at about 80°. Gluten, as it exists in wheat- flour, also decomposes sublimate, and should be given mixed with water. Inflammation to be anticipated, and treated by the usual remedies. Ttsts.—Mercurial preparations heated to redness in a glass tube with potash, are decomposed; the quicksilver being volatilized. The oxymuriate or sublimate is precipitated white by ammonia ; yellow by potash ; and ofan orange .colour by lime-water. By ni- trate of tin, u copious dark brown precipitate is formed; and by albumen mixed with cold water, a flocculent one. The red and nitric oxides may be dissolved in muriatic acid and converted into sublimate. » Vermilion is insoluble in water or muriatic acid ; but is entirely volatilized by heat. Silver, Nitrate of. (Lunarcaustic.) Symptoms similar to those occasioned by other corrosive poisons. Treatment.—A table-spoonful of the muriate of soda (common salt) dissolved in a pint of water, and a wine-glassful to be taken every two minutes, to decompose the poison; after which mucila- ginous drenches or purgatives may be administered. Tests.— Nitrate of silver is precipitated white by muriate of soda; yellow by phosphate and chromate of soda. If placed on burning coals, it animates them, leaving a coating of silver; cal- cined with charcoal and potash, the silver is reduced to its metal- lic state. Zinc. St lphate or Oxyd of. Symptoms.—A sour taste, sense of choking, nausea, vomiting, pain in the stomach, frequent stools, difficult breathing, quickened pulse, face pale, cold extremities, but seldom death from the emetic qualities of the poison. P2 346 POISONS. Treatment.—Vomiting is rendered easy by copious draughts of warm water, and particular symptoms to be opposed by appropri- ate remedies. Tests.—Pure sulphate of zinc is precipitated white by potash and ammonia; yellowish white, by the alkaline hydrosulphurets; and of an orange colour by the chromate of lead!!—The oxide is readily reduced by calcination with charcoal and nitre. ACIDS: e. g. Sulphuric acid, or oil of vitriol. Xitrir acid, or aquafortis. Muriatic acid, or spirit of sedt. Oxalic acid, or acid of sugar. Phosphoric, Fluoric, Tartaric, Prussic. General symptoms.—Acid burning taste in the mouth, acute pain in the throat, stomach, and bowels, frequent vomiting of bloody fluid, which effervesces with chalk, or alkaline carbonates, and reddens litmus paper ; hiccup ; copious stools, more or less bloody; tenderness of the abdomen ; difficult breathing; irregular pulse; excessive thirst; drink increasing the pain, and seldom staying down; frequent but vain efforts to make water; cold sweats; al- tered countenance ; convulsions ; death. Treatment.—Mix an ounce of calcined magnesia with a quart of water, and give a wine-glassful every two minutes. Soup-suds or chalk and water may be used till magnesia be procured. Vom- iting to be excited by tickling the throat with a feather. Diluents to betaken after the poison is neutralized or ejected. Inflamma- tions and other consequences to be treated in the ordinary way. If the sulphuric acid, vulgarly called the oil of vitriol, has been swallowed, water alone should not be given, nor should calcined magnesia with water be given : but the common carbonate of mag- nesia maybe given freely when mixed with water. If these pre- cautions be not observed there is too much heat generated in the stomach. . If oxalic acid has been taken, chalk and water is preferable to magnesia. . . , If Prussic acid* has been taken, emetics are to be administered with as little delay as possible, and after their operation, oil of tur- pentine, ammonia, brandy, and other stimulants capable of rousing the system, should be perseveringly employed, with warmth, fric- tion, and blisters. . »„„i„ Tests.—Sulphuric acid is known by its great weight, by its evolv- ing heat when mixed with water; by emitting no fumes If bu- ry tes be added to it, a sulphate is formed, (sulphate of barytes,) which is insoluble in water or nitric acid. Nitric acid emits orange-coloured fumes »P°" ^dmg coppe o it bv which it is changed blue. If potash be added to i , a n.tra e i formed (nitrate of potash) which deflagrates when thrown on L„nin. S54 BLEEDING. while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body : besides it may often be occasioned or prevented by the manner in which the operation is performed. Children are generally bled with leeches. This, though some- times necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches ; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practise bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine. Certain vulgar prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts whence they are sup- posed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will per- form wonders. This belief makes them often postpone the oper- ation when necessary, in order to reserve it for some more impor- tant occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain stated periods or seasons has likewise bad effects. It is a common notion that bleeding in the feet draws the hu- mours downwards, and consequently cures diseases of the head and other superior parts ; but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let. All the apparatus essential for blood-letting, on the part of the patient, is a bandage or fillet, two or more small pieces of folded linen for compresses, a bason to receive the blood, and a little clean water and a towel. The bandage ought to be about a yard in length, and near two inches broad, a common riband or garter being frequently employed. The compresses are made by doub- ling a bit of linen rag about two inches square. On the part ot the surgeon, it is necessary for him to have a good lancet, of prop- er shape ; for if the shoulders of the lancet be too broad, it will not readily enter the vein, and when it does enter, it '"variably makes a large opening, which is not always desirable If"the Ian- cet be too spear-pointed, an incautious operator would often.run a risk of transfixing the vein, and wounding the artery beneath it. More however, depends on the mode of introducing the lancet thrSh^ down, or stand up each of w«^sitions.nay e cnosen,^ «, INFLAMMATION AND ABSCESSES, &c' 355 surgical purpose, it is best to bleed him in a recumbent posture. But when the person is strong and vigorous, there is little occasion for this precaution, and a sitting posture is to be preferred, as the most convenient, both for the surgeon and patient. At the bend of the arm, there are several veins in which a punc- ture may be made, viz. the basilic, cephalic, median basilic, and median cephalic. The median basilic vein being usually the larg- est and most conspicuous, is that in which the operation is mostly performed ; but it should never be forgotten, that it is under this vessel that the brachial artery runs, with the mere intervention of the thin aponeurotic sheath, sent off by the biceps muscle. In Ve- ry thin persons, indeed, the medial basilic vein lies almost close lo the artery, and nothing is then more easy than to transfix the first of these vessels and wound the last. In fat subjects, the large veins at the bend of the arm are some- times totally imperceptible, notwithstanding the fillet is tightly ap- plied, the limb is put in warm water, and every thing done to make those vessels as turgid as possible. Under these circumstances, if the surgeon has not had much experience in the practice of vene- section, he will do well to be content with opening one of the veins of the back of the hand, after putting the member for sometime in warm water, and applying a ligature round the wrist. In children, a sufficient quantity of blood cannot always be ob- tained by venesection, and, in this event, the free application of leeches, and, occasionally, the puncture of the temporal artery, are the only effectual methods. One of the most common ill consequences of bleeding in the arm is a thrombus, or ecchymosis, that is, a small tumour around the orifice, and occasioned by the blood insinuating itself into the ad- joining cellular substance, at the time this fluid is escaping from the vein. Changing the posture of the arm will frequently hinder the thrombus from increasing in size, so as to obstruct the evacua- tion of blood. The best applications for promoting the absorption of these tumours, are those containing spirit, vinegar, or muriate of ammonia. Compresses wetted with any lotion of this sort, may be advantageously put on the swelling, and confined there with a slack bandage. The integuments and subjacent cellular substance, the absorb- ents, the vein, «.\r. are all liable to inflammation, in consequence of bleeding, a nerve also may be wounded, all requiring proper surgical treatment. Topical Blood-letting. This is performed either by means of a scarificator and cupping- glass, or leeches, or by dividing the visibly distended vessels with a lancet, as is frequently done in cases of inflammation of the eye. Inflammations and Abscksses. From whatever cause inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is im- possible to foretel with certainty in which of these ways any par- ticular inflammation will terminate, yet a probable conjecture may 856 INFLAMMATION AND ABSCESSES. be formed with regard to the event, from a knowledge of the r* Uent s age and constitution. Inflammations happening in a sliSt degree upon colds, and without any previous indisposition, will most probably be dispersed ; those which follow close upon a fever or happen to persons of a gross habit of body, will generally mp- purate; and those which attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene. If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best pro- moted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax-plaster. If, notwithstanding these applications, the symptomatic fever in- creases, and the tumour becomes larger, with violent pain and pul- sation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renew- ed twice a-day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon.the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, fluctuation of matter, which may be felt under the finger, and, gen- erally speaking, an abatement of the pain, it may be opened either with a lancet, or by means of caustic. The last way in which an inflammation terminates, is in a gan- grene or mortification, the approach of which may be known by the following symptoms:—The inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish com- plexion becomes black; a quick low pulse, with cold clammy sweats, are the immediate forerunners of death. When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified, and afterwards dressed with basilicum softened with oil of turpen- tine. All the dressings must be applied warm. NVith regard to internal medicines, the patient must be supported with generous cardials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound will become a common ulcer; and must be treated accord- This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, trrpost- humes, whitloes* Sec. They are all abscesses in consequence ot u * A whitloe is a very painful complaint. It is generally cauaed by a .mall wnXAy Wrth a lancet. ine»Kin ■nouiuai frpauentiv thrown out from a wb.tloe, and compression of the fungous flesh that .i trequntiy tnrwnt ^ WOUNDS. 367 previous inflammation, which, if possible, ought to be discussed; but, when this cannot be done, the suppuration should be promot- ed, and the matter discharged by an incision, if necessary; after- wards, the sore may be dressed with yellow basilicum, or some other digestive ointment. Wotmos. No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters, are possessed of wonderful healing pow- ers, and imagine that no one can be cured without the application of them. It is, however, a fact, that no external application what- ever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the ex- ternal air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them. The same observation holds with respect to internal applications., These only promote the cure of wounds as far as they tend to pre- vent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is .Nature alone that cures wounds. All that art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature's efforts. With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to fa- cilitate their cure. The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, if it can be conveniently done, ought to be extracted, and the wound cleaned before any dressings be applied. When that cannot be effected with safety, on account of the patient's weak- ness or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breast, the bowels, «.Vc, or where any considerable blood- vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the dis- cbarge of blood is so great, that if it be not stopped, the patient may die, even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present, lithe wound be in any of the limbs, the bleeding may genernllv be stopped by applying a tight ligature or bandage round the member, a little above the wound. The best method of doing this is to put a stionsr brond gaiter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart- rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much niiirht occasion an inllauimution of the parts, and endan- ger a gangrene. In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of 358 WOUNDS. styptics, astringents, Sec. Cloths dipped in a solution of blue vit- riol in water, or the styptic water of the dispensatories, may be »p. plied to the wound. When these cannot be obtained, strong spir- its of wine maybe used. Some recommend the agaric* of the oak as preferable to any of the other styptics ; and indeed it de- serves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firm- ly on. Thougb spirits, tinctures, and hot balsams, may be used, in or- der to stop the bleeding from small vessels when it is excessive, they are improper at other times. They do not promote, but re- tard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouth of the vessels; but, by rendering the parts callous, they obstruct the cure. In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking- plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When n wound penetrates deep, the edges of it, if a clean incised wound, ought to be brought in contact, and retained in that position by means of slips of adhesive plaster, when, in all probability, it will become glued together by what surgeons term the adhesive inflammation. If a deep irregular wound, from blunted instru- ments, it is not safe to keep the lips quite close ; this keeps i'n the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It, however, must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax-plaster or poultice; and the whole must be kept on by a proper bandage, as circumstances may point out. The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be remov- ed with ease or safety to the patient, it may be allowed to contin- ue, and fresh lint dipped in sweet oil laid over it. 1 hi. will soften it so as to make it come off easily at next dressing. Afterwards, the wound may be dressed twice a-day in the same^manner till it "^^nT^ preparing, and apply.ng the V"^—"^ J" J?K7u nans or excre.ccnc, ...uiag Weather lasts, the agaric of the oak, which »?W*™S%H"h prc.en. themaolvM from the wood of that tree. It consuls at first of fou P*™'.*"^"J" 2. The p^rt successively: 1. The outward rind or sk.n wh.ch my be hrown .w,^ ^ ^ ^ immediately under this rind, which ,8.q\e.be8Vni8, the only prep.irat.on it reau.rej, hammer, till it becomes soft and very pl«M»- ™"''V"0"lyt|Pc bursting open blood- and a slice of it of a proper sue u' » *'ft£^X "£ liie bleeding, and gene- «ssels. It constringes and brings them close gg-'J^Xriiig to the second, ma, ESS&S °^^^^»^ the aame manner, * baa nearly the same effects. BURNS. 359 be quite healed. Those who are fond of salves or ointments may, after the wound is become very superficial, dress it with the yellow basilicum ; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum, or red precipitate of mercury ; or it may be kept down by a compress. When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should ♦ic changed twice a-day. If the wound be large, and there is reason to fear an inflamma- tion, the patient should be kept on a very low diet. He must ab- stain from animal food, strong liquors, and everything that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled ; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient's strength by excessive evacuations. Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind, or moves the passions, as love, anger, fear, excessive joy, &c. are very hurtful. They ought, above all things, to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegeta- ble diet, as roasted apples, stewed prunes, boiled spinagc, and such like. Burns. In slight burns, which do not break the skin, it is customary to hold the part near the fire for a competent time, to rub it with salt, or to lay a compress* upon it, dipped in spirits of wine or brandy. It is, however, a preferable practice to plunge immediately the burnt or scalded part into cold water, and keeping it for some time im- mersed. Strong brandy or alcohol is particularly praised. At first the pain is increased by this remedy, but an agreeable sooth- ing sensation soon follows. The parts should be immersed in the spirit, and, when this cannot be done, soft old linen, soakeil in the application, should he constantly kept on the part. A strong solution of alum and water is also useful. The way Te deceives himself, and converts into an incurable malady what mighthave been removed by only keeping the part easy for a few ^Country-people generally immerse a strained limb in cold water. RUPTURES. 377 This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in «old water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one. Wrapping a garter, or some other bandage, pretty tight "about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from in- creasing the disease. It should not, however, be applied too tight, I have frequently known bleeding near the affected part have a very good effect; but what we would recommend above all, is ease. It is more to be depended on than any medicine, and sel- dom fails to remove the complaint.* Ruptures. Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease. A rupture sometimes proves fatal before it is discovered. When- ever sickness, voriiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where rup- tures usually happen ought carefully to be examined. The protru- sion of a very small part of the gut will occasion all these symp- toms ; and, if not returned in due time, will prove fatal. On the first appearance of a rupture in an infant, it ought to be laid upon its back with its head very low. While in this posture, if the gut does not neturn of itself it may easily be put up by gentle pres- sure. After it is returned, a piece of sticking-plaster may be appli- ed over the part, and a proper truss or bandage must be constantly Worn for a considerable time. The method of making and apply- ing rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite cured. In adults, when the gut has been forced down with great vio- lence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite im- practicable without an operation ; a description of which is for- eign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without hav- ing recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue. After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. * A great many external applications are recommended for strains, some of which do good, and others hurt. The following are such as may be used with the greatest safety, vix. poultices made of stale beer or vinegar and oatmeal, onmphorated spires of wine, Mihdererun's spirit, volatile liniment, volatile aromatic apirit diluted with n double quantity of water, and the common fomentation, with the addition of brandy or spirit of wine, 378 CASUALTIES. In this situation flannel-cloths wrung out of a decoction of mallowi and camomile-flowers, or, if these are not at hand, warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter, and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary ; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hands, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove inef- fectual, clysters of the smoke of tobacco may be tried. These hare been often known to succeed where every other method failed. There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Operating for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declar- ed the reduction of the gut impracticable without an operation.* An adult, after the gut has been returned, must wear a proper truss. It is needless to describe this, as it may always be had ready-made from the artists. Such bandages are generally uneasy to tne wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man's estate should ever be without one of these bandages. Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold. CHAP. V. CASUALTIES. It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects. No person ought to be looked upon as dead from any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The functions of these organs may be so far impaired, as even to be for some time imperceptible when life is by no means extinct. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even fhough the solids should recover their power The/vtt^^ attendance, SUBSTANCES STOPPED, Sec. 379 of acting. Thus, when the motion of the lungs has been stopped by unwholesome vapour; the action of the heart by a stroke on the breast; or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but,* the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored. It is a horrid custom immediately to consign over to death every person who has-the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to a church or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no farther notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in a house that is inhabited. What the ground of this superstition may be, we shall not pretend to enquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense. When a person seems to be suddenly deprived of life, our first business is to enquire into the cause. We ought carefully to ob- serve whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like. I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy suf- ferers ; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content my- self with collecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice. OF SfUSTANCES STOPPED BETWEEN THE MoUTH AND STOMACH. Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Chil- dren should be taught to chew their food well, and to put nothing into their mouths'which it would be dangerous for them to swal- low. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This con- 380 SUBSTANCES STOPPED BETWEEN duct is exceedingly injudicious, as a fit of coughing, or twenty oth- er accidents, may force over the substance before the person i. aware.' When any substance is detained in the gullet there are two way. TbeTflT *} m-either. ^extracting it dr pushing it down The safest and most certain way » to extract it; but this is not always the easiest: it may, therefore, be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature that there is no danger from its reception into the stom- ach. 1 he substances, which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like. AH indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought, if possible, to be extracted, especially if these bodies be sharp-pointed, as pins, needles, fish-bones, bits of glass, Sec When such substances have not passed in too deep, we should endeavour to extract them with our fingers; which method often succeeds. When they are lower we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet. If the fingers and pincers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be jnade at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way; and, for the better conducting it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it; which has this farther use, that it may be secured by a string tied to it; a circum- stance not to be omitted in any instrument employed on such occa- sions, to avoid such ill-accidents as have sometimes ensued from these instruments slipping out of the operator's hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient when a substance somewhat flex- ible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them. When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straighten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whalebone, or any kind of flexible wood, and by this means introduced, in order to surround * A woman in one of the hospitals of this city lately discharged a great number of pins, which she had swallowed in the course of her business through an ulcer in h.r side. THE MOUTH AND STOMACH. 381 the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the' more certain- ly to lay hold of the obstructing body, whioh may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twisted, as to be moved every way, which must in many cases be a considerable advantage. Another material employed on these unhappy occasions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopped in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopped, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation ; and, indeed, the enlargement of it may be forwarded by making the patient swallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fastened ; and as it is now too large to return through the small cavity by which it was conveyed inf.it draws out the obstruct- ing body along with it. -"' The compressibility of sponge is another foundation of its useful- ness in such cases. A pretty large piece of sponge may be com- pressed or squeezed into a small size, by winding a string of tape closely about it, wliich may be easily unwound and withdrawn, after the sponge has been introduced. A bit of sponge may like- wise be compressed by a piece of whalebone split at one end; but this can hardly be introduced in such a manner as not to hurt the patient. I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing sponge, and will often answer the purpose equally well. When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when siich obstructing bodies are simply en- gaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion farther mischief. If the patient can swallow, vomiting may be excited by taking half a drach.n or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling a drachm of tobacco in twelve ounces of water. This has often been found to succeed, when other attempts to ex- cite vomiting had failed. When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible ; or a piece of whalebone, wire, or flexible wood, with a sponge fastened to one end. Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least 388 SUBSTANCES STOPPED, Sec. of two evils, and rather run the hazard of pushing them down, than suffer the patient to perish in a few minutes ; and we ought to scruple the resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder. Whenever it is manifest that all endeavours either to extract or push down the substance must prove ineffectual, they should be discontinued: because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed. While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection, through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and soothe the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments. When, after all our endeavours, we are obliged to leave the ob- structing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed. A proper degree of agitation has sometimes loosened the inher- ing body more effectually than instruments. Thus a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the windpipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage. When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and »f"tatfn« things, as wine, punch, pepper, and such like; and his drink should be milk aud water, barley-water, or whey. When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like. When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored, the operation of bronchotomy, or opening of the windpipe, must be directly perform- ed As this operation is neither difficult to an expert surgeon, nor very painful Jthe patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by surgeons skilled in anatomy. DROWNED PERSONS. 883 Suspended Animation and Resuscitation. Drowned Persons.—When a person has remained above a quar- ter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances may happen to have continued life, in such an unfortunate "situation, beyond the ordin- ary term, we should never too soon resign the unhappy object to bis fate, but try every method for his relief, as there are many well-attested proofs of the recovery of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life. The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture, with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men's shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms. In attempting to recover persons apparently drowned, the prin- cipal intention to be pursued is, to restore, by gradual means, the natural warmth, upon which all the vital functions depend, and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c. A high degree of heat will not be necessary ; a moderate de- gree will be sufficient. If the weather be under the freezing point, and the body, when stripped, feel cold, and nearly in the same condition with the water that is frozen, it will be necessary at first to rub it well with snow, or wash it with cold water ; the sudden ap- plication of heat in such cases having been found very pernicious. In n short time, however, warmth must be gradually applied. Though cold was by no means the cause of the person's death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as war... as they can be made ; and as soon as a well-heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm clothes ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm wa- ter, to the soles of his feet, and to the palms of his hands. After the restoration of heat, volatile spirits should be frequent- ly applied to the nose ; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought also to be chafed with volatile spirits ; and stimulat- ing powders, as that of tobacco or marjoram, may be blown up the nostrils. To renew the breathing, in the absence of a better apparatus, a strong person may blow his own breath into the patient's mouth with all the force he can, holding bis nostrils at the same time. When it can be perceived by the ri>mg of the chest or belly that the lungs arc filled with air, the person ouffht to desist from blow- ing, and should press the breast and belly so as to expel the air 884 DROWNED PERSONS. IK?5- ^^ tM8 °Pjration mar be repeated for some time, alter IS^^"' PreSSmg thC 1Ung8' 8° as t0 imitate «5 If. the lungs cannot be inflated in this manner, it may be attemnt. ed by blowing through one of the nostrils, and a The same hm. keeping the other close. Dr. Monro, for this purpose reco"me ,d other for iT "m" ^ °nC t"d f°r fi,,iB* th« no'st^d; and a h other for being blown into by a person's mouth, or for receiv ,« ?»KL£ ^ °f beH°WS' l° * *"**« ">' ** ^ S! it Z^h ^ 0annOt bC f°r?ed int° the chest °V the mouth or nose, l"Ibe n~eBBary to make an opening into the windpipe for this purpose. It is need ess, however, to spend time in describing (his operation, as it should not be attempted unless by persons skilled in surgery. r It was the practice, some time ago, to employ the smoke of tobacco; but this, instead of answering any good purpose, has proved injurious, by further depressing the vital principle. Instead ot this, therefore, a clyster is recommended, consisting of a pint or more of water, moderately warmed, to which may' be added a little volatile spirit, essence of peppermint, or rectified spirit. While these things are doing, some of the attendants outfit to be preparing a warm-bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no con- veniences for using the warm-bath, the body may be covered with warm sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet upon her head, and a stocking round her neck, stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out, I freeze, /freeze: a little cher- ry brandy was given her, and she remained buried, as it were, under the ashes for eight hours: afterwards she was taken out, without any other complaint, except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.* When there is reason to suppose that the skin has, in some de- gree, recovered its sensibility, the wrists, ancles, temples, and parts over the stomach and heart may be rubbed with a little volatile liniment, which will evaporate but slowly, and produce no cold on being rubbed in. In cases of suspended animation, it has likewise been usual to stimulate the stomach and intestines; the former by means of some moderately warm liquor, such as negus highly spiced, introduced into the organ through a flexible tube, and the latter by means of injections. *From some late experiments made by Professor Aldini, of the university of Bologna, on the body of a malefactor, it would appear that galvanism, as an auxiliary, promise! great advantages to the interests of humanity, in cases of drowning and other instnncei of suspended animation. With this view, also, electricity is sometimes resorted to; anless, however, employed by insulation alone, it will be more likely to do harm than good. Ed. NOXIOUS VAPOURS. 386 Till the patient show some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather, dipped in warm brandy or other strong spirits ; and, as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be ad- ministered. Some recommend a vomit after the patient is a little reanimated ; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot, in this case, recommends the oxymel of squills, a table-spoonful of which, diluted with wa- ter, may be given every quarter of an hour, till the patient has taken five or six doses. Wliere that medicine is not at hand, a strong infusion of sage, camomile-flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics, in this situation are not expedient. We are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be adminis- tered. Lastly, though the person should be manifestly reanimat- ed, there sometimes remains an oppression, a cough, and feverish- ness, which effectually constitute a disease. In this case, it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully of barley-water, elder-flower tea, or any other soft pectoral infusion. Such persons as have the misfortune to be deprived of the ap- pearance of life by a fall, a blow, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarce- ly exhibited any signs of life ; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Es- says, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These and other instances of a similar nature, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly per- sisted in. Ok \oxtots Vapours. (Atrial Poisons.) Air may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle be- ing destroyed, or from subtle exhalations with which it is impreg- R 386 NOXIOUS VAPOURS. nated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the dan. ger of sleeping in close chambers with coal fires. Some indeed suppose the danger here proceeds from the sulphureous oil con! tamed m the coal, which is set at liberty and diffused all over the chamber ; while others imagine it is owing tp the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suffocated by sleeping in an apartment where a small fire of coal had been left burning. The vapour which exhales from wine, cider, beer, or other li- quors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instan- ces of persons struck dead on entering such places, and of others who have with difficulty escaped. When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emp- tied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no per- son ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in ; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire. The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. There have, however, been instances of people killed by the fumes of lamps which had been extinguished in a close chamber; and persons of weak, delicate breasts, generally find themselves quickly oppressed in apartments illuminated with many candles. Such as are sensible of their danger in these situations, and re- treat seasonably from it, aie generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a lit- tle water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling, and understanding, the following means must be used for their re- covery :— . , The patient should be exposed to a very pure, ^sh, and open air ; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or, if that does not suc- ceed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallow, some lemonade, or wa- ter and vinegar, with the addition of a little nitre, may be given hl Nor are sharp clysters by any means to be neglected ; these may EFFECTS OF EXTREME COLD. 387 be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces ; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonsful of com- mon salt may be put into the clyster. The same means, if neces- sary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c. Mr. Tossach, surgeon, at Alloa, relates the case of a man suffo- cated by the steam of burning coal, whom he recovered by blowing his breath into the patient's mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stupified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed. The practice of plunging persons suffocated by noxious vapours in cold water would seem to be supported by the common experi- ment of suffocating dogs in the Grotto del Cani, and afterwards recovering them by throwing them into the neighbouring lake. When a person dies from suffocation, the symptoms are nearly tho same in apoplexy. Effects of Extreme Cold. When cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain ; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble bis efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some allevia- tion of his sufferings, would, if indulged, prove his last. Such violent effects of cold are happily not very common in this country : it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mor- tification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation show, that this is a most dangerous and imprudent practice. Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed by rottenness, or a kind of mortification ; and that the only way to recover them, is to immerse them for some time in »ery cold water. The same observation holds with regard to ani- mals in this condition. When the hands or feet are greatly benumbed witb cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which, the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder-flowers sweet- ened with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way 388 EFFECTS OF EXTREME HEAT. to warm them was by washing them in cold water, and continuing to rub them well for some time. When, therefore, the hands, feet, or nose, or any other part ef the body have been exposed to violent cold, so as to be frost-bitten, they ought at first either to be well rubbed with snow, or be put into cold water, and afterwards be subjected to warmth in the most gentle and gradual manner. When a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest wa- ter. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for sev- eral hours, have nevertheless been revived. If the power of swallowing be restored, some warm and gently stimulating drink should be given, such as thin broth, with a little brandy in it, or water with some wine, administered by a spoonful at a time. While the body is cold, and the circulation and respi- ration are languid, blood-letting might be improper. If, however, after these functions, and the natural temperature are restored, the patient should remain any time in a comatose state, with a strong full pulse, the propriety and necessity of venesection can hardly be doubted. I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been expos- ed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above. Effects of extreme Heat. The effects of extreme heat, though not so common in this coun- try, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cor- dial can be poured into the mouth, it ought to be done If this cannot be effected, thev may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating nature, may be applied to the skin, which should be well rubbed wv u coarse cloths whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons appar- ently dead, by beating them with rods. gead-achi are often occasioned by exposure to^intense h a , and in warm climates, where people are very liable to what they ^11 couvs de soldi-, or strokes of the sun, it is a common custom to f^ S cths, several times doubled, on the head, and to keep FAINTING FITS. 389 them moistened with very cold water for half an hour, or till the stupor is diminished. This they term drawing the fire out of the head. Of Fainting Fits. (Syncope.) Strong and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like. In such cases the patient ought to be made to smell to some vinegar. His temples, forehead, and wrists, ought at the same time to be bathed with vinegar mixed with an equal quantity of warn, water ; and two or three spoonsful of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth. If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half-hour a cup or two ofan infusion of any mild vegetable, with the addition of a little sugar and vinegar. When swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, consisting chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should sleep but moderately, and take much exercise. But fainting fits proceed much oftener from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these, an almost directly opposite course to that mentioned above must be pursued. The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary-water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy ; and, if he can swallow, some hot wine mixed with sugar and cin- namon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to his feet. As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot- spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nour- ishment, as panada made with soup instead of water, newlaid eggs lightlv poached, chocolate, light roast meats, jellies, and such like. Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminat- ing as toon as the patient is laid upon the bed; indeed, persons subject to this kind should always be bled lying, in order to prevent it. Should the fainting, however, continue longer than usual, vol- 390 FAINTING FITS. atile spirits may be held to the nose, and rubbed on the temple,, When fainting is the effect of too strong or acrid purges or vom- its, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of m.lk warm water, and oil, barley-water, or such like ; emollient clyster^m reeled bPr°Per' ^ the Pat,em'S St'enSth sho»,d a^rwanls be recruited, by giving him generous cordials, and anodyne medicine h aintings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former or these is the cause, the cure will be best performed by vomiting which may be promoted by causing the patient to drink a weak infusion of camomile flowers, carduus benedictus, or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, &.c.; after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, ns it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines. Even disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already ta- ken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head. Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases, they generally denote an oppression at the stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accom- panied with great evacuations must be treated like those wliich are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermit- ting fever, or at that of each exacerbation of a continue! fever, the patient must be supported by small draughts of wine and water. Delicate and hysteric women are very liable to swooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained^ They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman "in " childbed, who, after being happily delivered, suddenly fainted, " and lay upwards of a quarter of an hour apparently dead. A " physician was sent for; her own maid, in the meanwhile, being "out of patience at his delay, attempted to assist her herself, " and extending herself upon her mistress, applied her mouth to " hers, blew in as much breath as she possibly could, and in a very " short time the exhausted woman awaked as out of a profound INTOXICATION. 391 " aleep ; when, proper things being given her, Bhe soon recovered. " The maid being asked how she came to think of this expedi- ent, said, she had seen it practised at Altenburgh, by midwives, "upon children, with the happiest effect." We mention this case chiefly that other midwives may be induc- ed to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, beyond all doubt, by proper care, have been restored to life. From whatever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeav- ouring to save them. Alarmed at the patient's situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very com- mon among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons oui,rlit ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air. Persons subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequen- ces are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagula- tions and obstructions are fora»ed, and, if the motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers ; yet even these ought, as soon as possible, to be removed. 1 have before remarked, but I deem it of importance to repeat the observation, that it is only when the fainting fit evidently arises from a fulness of the habit, and is accompanied with a total aboli- tion of feeliii" and understanding, thut bleeding is advisable. The use of the lancet might otherwise have the most deadly effect. Many persons, even of robust constitutions, are very apt to faint upon having a vein opened and losing a little blood. How danger- ous, then, must the operation he, when a patient has already faint- ed, and most probably from extreme weakness and a defect of blood ! I have no doubt but many a murder has been rashly com- mitted in such cases. Of Intoxication. The effects of intoxication are often fatal. No kind of poison kills more certainly than an overdose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors 892 INTOXICATION. may prove fatal when taken to excess, as well as ardent spiriti • but they may generally be discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor. More of those unhappy persons who die intoxicated, lose their lives from an inability to conduct themselves, than from the de- structive quality of the liquor. Unable to walk, they tumble down, and he in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No person, when drunk, should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most fa- vourable for continuing the vital motions and discharging the con- tents of the stomach. The best posture for discharging the con- tents of the stomach is to lay the person upon his belly; when asleep, he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twist- ed, or have any thing too tight about it. The excessive degree of thirst occasioned by drinking strong li- quors often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a debauch of wine or sour punch ; these acid liquors, togeth- er with the heat of the stomach, having coagulated the milk in such a manner that it could never be digested. The safest drink after a debauch is water with a toast, tea, infusions of balm, sage, barley-water and such like. If the person wants to vomit, he may drink a weak infusion of camomile flowers or hike-warm water and oil; but in this condition, vomiting may generally be excited by only tickling the throat with the finger or a feather. Instead of giving a detail of all the different symptoms of intoxi- cation which indicate danger, and proposing a general plan of treat- ment for persons in this situation, I shall briefly relate the history of a case which lately fell under my own observation, wherein most of those symptoms usually reckoned dangerous concurred, and where the treatment was successful. A young man, about fifteen years of age, had, for a hire, drank ten glasses of strong brandy. He soon after fell fast asleep, and continued in that situation for several hours, till at length his unea- sy manner of breathing, the coldness of the extremities, and other threatening symptoms, alarmed his friends, and made them send forme. I found him still sleeping, his countenance ghastly, and his skin covered with a cold clammy sweat. Almost the only signs of life remaining were, a deep laborious breathing, and a convulsive motion or agitation of his bowels. I tried to rouse him, but in vain, by pinching, shaking, applying volatile spirits, and other stimulating things to his nose, Sec. A few ounces of blood were likewise taken from his arm, and a mix- ture of vinegar and water was poured into his mouth ; but as he could not swallow, very little of this got into the stomach. None of these things having the least effect, and the danger seeming to increase, t ordered his legs to be put into warm water, and a sharp clvster to be immediately administered. This gave him a stool, and was the first thing that relieved him. It was afterwardsire- „eLd with the same happy effect, and seemed to be the chief Jau0f his recovery. He then began to show some signs of life, SUFFOCATION AND STRANGLING. *m took drink when it was offered him, and came gradually to his senses. He continued, however, for several days weak and fever- ish, and complained much of a soreness in his bowels, which grad- ually went off, by means of a slender diet, and cool mucilaginous liquors. This young man would probably have been suffered to die, with- out any assistance being called, had not a neighbour, a few days before, who had been advised to drink a bottle of spirits to cure him ofan ague, expired under very similar circumstances.* Of Suffocation and Strangling, from Hanging, Drowning, and othkr causes. In cases where life is suspended from hanging, the same means as recommended for drowned people are to be adopted, with the addition of opening the jugular veins, or applying cupping-glasses to the neck, which will tend considerably to facilitate the restora- tion of life, by lessening the quantity of blood contained in the ves- sels of the bead, and thereby taking off the pressure from the brain. Except in persons of a full plethoric habit, the quantity drawn off need seldom exceed an ordinary tea-cupful, which in general will be sufficient to unload the vessels of the head, without weakening the powers of life. Suffocation may sometimes proceed from an infarction of the lungs, produced by viscid clammy humours, or a spasmodic affec- tion of the nerves of that organ. Persons who feed grossly, and abound in rich blood, are very liable to suffocating fits from the former of these causes. Such ought, as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently u cup of diluting liquor with a little nitre in it. They should like- wise receive the steams of hot vinegar into their lungs by breath- ing. Nervous and asthmatic persons are most subject to spasmodic affection of the lungs. In this case the patient's legs should be immersed in warm water, and the steams of vinegar applied as nbove. Warm diluting liquors should likewise be drunk ; to a cup of which a tea-spoonful of the paregoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the pa- tient's nose, and fresh air should be freely admitted to him. Infants are often suffocated by the carelessness or inattention of their nurses.t An infant when in bed should always be laid so, that it cannot tumble down with its bead under the bed clothes; and when in a cradle, its face ought never to be covered. A small decree of attention to these two si nple rules would save the lives * I have seen repeated instinces of persons being restored to perfect sobriety, and the complete use of their senses, from a state of most alarming intoxication, by taking away eight or ten ounces of blood from the nape of the neck, as ne.tr the head as pos- sible, bv means of cupping-glisses. The same efTect is produced by taking blond from the arm, but the practice is not perhaps quite so safe ; cupping certainly Reserves the preference. A. P. B. t These arridenls are not always tho effects of carelessness. I have known an infant overlaid by its mother being seised in the night with a hysteric fit. This ought to serve as a caulum against employing hysteric women as nurses; and should likewise teach such women neror to lay an infant in the same bed with themselves, but in j small adjacent one. Hi - ft fRM SIFFOCATION AND STRANGLING. of many infants, and prevent others from being rendered weak and sickly all their days by the injuries done to their lungs. Instead of laying down a plan for the recovery of infants who are suffocated, or overlaid, as it is termed by their nurses, I shall give the history of a cast related by Monsieur .lanin, of the Royal College of Surgery at Paris, as it was uttended with success, and contains almost every thing that can be done on such occasions. A nurse havinir had the misfortune to overlay a child, he was called in, and found the infant without any signs of life ; no puls- ation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of snivel, the mouth gaping, in short it was almost cold. Whilst some linen clothes and a parcel of ashes were wanning, he had the boy unswathed, and laid him in a warm bed, and on the right side. He then was rubbed all over with fine linen, for fear of fretting his tender and delicate skin. As soon as the ashes hud received their due degree of heat, Mr. Janiu buried him in them, exc. pt the face, placed him on the side opposite to that on which he had been at first laid, and covered him with a blanket. lie hud a bottle of eau de luce in his pocket, which he presented to his nose from time to time ; and between whiles some puffs of tobacco were blown up his nostrils ; to these succeeded the blowing into his mouth, and squeezing tight his nose. Animal heat began thus to be excited gradually: the pulsations of the temporal artery were soon felt, the breathing be- came more frequent and free, and the eyes closed and opened alternately. At length the child fetched some cries expressive of his want of the breast, which being applied to his mouth, he cutch- ed it with avidity, and sucked as if nothing had happened to him. Though the pulsations of the arteries were by this time very well re-established, and it was hot weather, yet Mr. Junin thought it advisable to leave his little patient three quarters of an hour longer under the ashes. He was afterwards tal;en out, cleaned and dressed as usuul ; to which a gentle sleep succeeded, and he continued perfectly well. Mr. Janin mentions likewise an example of a young man, who had hanged himself through despair, to whom he administered help as effectually as in the preceding case. Mr. (.lover, surgeon in Doctors' Commons, London, relates the case of a person who was restored to life after twenty-nine min- utes hanging, and continued in good health for many years after. The principal means used to restore this man to life were, opening the temporal artery and the external jugular ; rubbing the back, mouth, and neck, with a quantity of volatile spirits and oil ; administering the tobacco-clyster by means of lighted pipes, and strong frictions of the legs and arms. This course hud been con- tinued for about four hours, when an incision was made into the windpi; e, and air blown strongly through a eanula into the lungs. About twenty minutes after this, the blood at the artery began'to run down the face, and a slow pul.-e was just perceptible at the wrist. The frictions were continued for sometime longer ; his pulse became more frequent, and his mouth and nose being irritat- ed with spirit of sal ammoniac, he opened his eyes. Warm cor- dials were then administered to him, and in two days he was so well as to be able to walk eight miles. CONVULSION-FITS. 39f> These cases are sufficient to show what may be done for the re- covery of those unhappy persons who strangle themselves in a tit of despair. Of Persons who expire in Convulsion-Fits. (onvii.sion-fits often constitute the last scene of acute or chronic disorders. When this is the case, there can remain but small hopes of the patient's recovery after expiring in a fit. But when a person who appears to be in perfect health is suddenly seized with a convulsion-fit, and seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often carried off very suddenly by one or more fits about the time of teething. There are many well-au- thenticated accounts of infants having been restored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance mentioned by Dr. Johnson, in his pamphlet On the Practicability of recovering Persons visibly dead. In the parish of St. Clements in Colchester, a child of six months old, lying upon its mother's lap, having had the breast, was seized with a strong convulsion-fit, which lasted so long, and ended with so total a privation of motion in the body, lungs, and pulse, that it was deemed absolutely dead. It was accordingly stripped, laid out, the passing bell ordered to be tolled, and a coffin to be made; but a neighbouring gentlewoman, who used to admire the child, hearing of its sudden death, hastened to the house, and upon ex- amining the child, found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with the breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour she felt the heart begin to beat°faintly ; she then put a little of the mother's milk into its mouth, continued to rub its palms and soles, found the child begin to move, and the milk was swallowed; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive. These means, which are certainly in the power of every person were sufficient to restore to life an infant to all appearance dead^ and who, in all probability, but for the use of these simple endeav- ours, would have remained so. There are, however, many other things which might be done in case the above should not succeed • as rubbing the body with strong spirits, covering it with warm ashes or salt, blowing air into the lungs, throwing up warm stimu- lating enters or the smoke of tobacco into the intestines, and such like. When children are dead-born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in circumstances similar to those mentioned above. hJmT? d,rect,°"S my ,,kt!wise be extended*) adults, attention being always paid to the age and other circumstances of the pa- The foregoing cases and observations afford sufficient proof of ;fc* CASES OF .SUDDEN DEATH. the success which may attend the endeavours of persons totally ignorant of medicine, in assisting those who are suddenly deprived of life by an accident or disease. Many facts of a similar nature might be adduced, were it ncce.-sary : but these, it is hoped, will he sufficient to call up the attention of the public, nnd to excite the humane and benevolent to exert their utmost endeavours for the preservation of their fellow-men. The Society for the Recovery of drowned Ftrsons, instituted at Amsterdam in the year 17(57, had the satisfaction to find that no fewer than 150 persons, in the space of four years, had been saved by the means pointed out by them, many of whom owed their pre- servation to peasants and people of no medical knowledge. But the means used with so much efficacy in recovering drowned per- sons are, with equal success, applicable to a number of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this con- sideration, many persons have been committed to the grave in whom the principles of life might have been revived.* The cases wherein such endeavours are most likely to be attend- ed with success are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, and many other disorders wherein persons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations from the sulphureous damps of mines, coal-pits, Sec.; the unwholesome air of long-unopened wells or caverns; the noxious vapours arising from fermenting liquors ; the steams of burning charcoal; sulphu- reous mineral acids; arsenical effluvia, &c. The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, iVc. likewise furnish oppor- tunities of trying such endeavours. Those, perhaps, who, to ap- pearance, are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strongly into the lungs, &-c. The means to be used for the recovery of persons suddenly de- prived of life are nearly the same in all cases; they are practicable by every one who happens to be present at the accident, and re- quire no great expence, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters, and generous cordials. These must be varied aceerding to circumstances. Common sense, and the situa- tion of the patient, will surest the proper manner of conducting them. Above all, we would recommend perseverance. People ought never to despair on account of discouraging eireumstnnces, or to leave off their endeavours as long as there is the leust hope of success. Where much good and no hurt can be done, no one ought to grudge his labour. • The Royal Humane Society for the recorcrv of drowned persons, in London, is now equal, if not superior to any similnr institu.ion in Kurope; and the laudable en- deavours, persevering efTortg, and encouragement given by its members to promote its •ttlity, are at least upon the same scale, as far as tie means are adapted to the ends. Ed. DISEASES OF WOMEN. 897 OHAF. VX. DISEASES OF WOMEN. Women, in all civilized nations, have the management of domes- tic affairs, and it is very proper they should, as nature has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far ; and fe- males, instead of being benefitted by it, are greatly injured, from the want of exercise and free air. To be satisfied of this, one need only compure the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though nature has made an evident distinction between the male and the female with regard to bodily strength and vigour, yet she certuinly never meant, either that the one should be al- ways without, or the other always within doors. The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disor- ders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting, the former is rarely to be found. I have always observed, that women who were chiefly employed without doors, in the different branches of husbandry, garden- ing, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shown, we shall proceed to point out those circum- stances in the structure and design of females, which subject them to peculiar diseases, the chief of which are, their monthly evacua- tions, pregnancy, and child-bearing. These, indeed, cannot prop- erly be called diseases ; but, from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities. The Menstrual Discharge. (Catamcnia.) Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this dis- charge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and hap- piness of the female depend in a great measure upon her conduct at this period.* * It is the duty of mothers, and those who nre intrusted with the education x>f girls, to instruct them early in the conduct and management of themselves at this 'critical period of their lives. False modesty, inattention, and ignorance of what is beneficial Of hurtful at .his time, nre ihe sources of manv diseases and misfortunes in life, which a few sensible lessons from an experienced matron might have prevented. Nor is care less necessary in the subsequent return of this discharge. Taking improper food, vio- lent afTccti.ini of the mind, or catching '••>' t at this period, is often sufficient to ruia the healtii. r l • rcuder the female e\< ' r incapable of procreation. 398 THE MENSTRUAL DISCHARGE. If a girl about this time of life be confined to the house, kept constantly sitting, and neither allowed to romp nbout, nor employ- ed in any active business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan ; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the state of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are at this critical period, denied the benefit of exercise and free air. A lazy, indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstruc- tions amongst the more active and industrious part of the sex; whereas the indolent and lazy nre seldom free from them. These are in a manner eaten up by the chlorosis, or green-sickness, and other diseases of this nature. We would, therefore, recom- mend it to all who wish to escape these calamities, to avoid indo- lence and inactivity as their greatest enemies, and to be as much abroad in the open air as possible. Another thing which proves very hurtful to girls about this peri- od of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours nre quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. \ccordingly we find that such girls as lead an indolent life, and cat great quantities of trash, are not only subject to obstructions of the menses, but like- wise to glandular obstructions ; as the scrofula, or king's evil, Sec A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature proves the very prey of vapours und hysterics. Youth is the .season for mirth and cheerfulness; let it therefore be indulged; it is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp with serious gloom the season destined to mirth and innocent festivity. Another thing very hurtful to females about this period of life, is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hen. v, by squeezing the stomach and bowels, they hurt the diges- tion, and occ.i.-ion many incurable maladies. This error is not indeed so common as it lias been, but, as ft.-I.ions change, it may come about again; we therefore think it not improper to mention it. I know many females who, to this duy, feel the dreadful effects of that wretched custom which prevailed some vears ago, of squeezing every girl into as small a size in the middle us po-sible. Human invention could not possibly have devi>ed a practice more destructive to health. • After a female has arrived at that period of life when the mense* usually begin to flow, and they do not appear, but, on tin; contrary, her health and spirits begin to decline, we would advise, instead of '**** THE MENSTRUAL DISCHARGE. 399 ■hutting the poor girl up in the house, and dosing her with steel, asafoetida, and other nauseous drugs, to place her in a situation where she can enjoy the benefit of free air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side. This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretell its approach; as a sense of heat, weight, and dull pain in the loins ; distention and hardness of the breasts ; head- ache, loss of appetite, lassitude, paleness of the countenance, and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation, and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c. After the menses have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceedingly cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to sour on the stomach, ought to be avoided ; as fruit, butter- milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the sex date their diseases from colds caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not in the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution. The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable. As far as my observation goes, there are no women in the world so inattentive to this discharge as the English ; and they suffer acconlingly, as a very great number of them are obstructed, and many prove barren in consequence. From whatever cnuse this flux is obstructed, except in the state of pregnuncy, proper means should he used to restore it. For this purpose we would recommend sufficient exercise in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine. When obstruction.- proceed from a weak relaxed state of the solids, such medicines as tend t > promote digestion, to brace the 400 THE MENSTRUAL DISCHARGE. •ohds, and assist the body in preparing good blood, ought to be used. For this purpose, 1 have of late made use of pills compos- ed of prepared steel, powdered myrrh,* and the best aloes, equal parts. These must be formed into pills of the common size, and two or three of them given every night at bed-time. The principal medicines, however, are iron, and the Peruvian bark, with other bitters and astringents. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks, it may be filtered, and about half a wine- glass of it taken twice a-day ; or prepared steel may la- taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the pa- tient. Previous, however, to the use of these medicines, it may be advisable to give a gentle emetic, for the purpose of cleansing the stomach, and freeing it from acidities and inactive fluids. When obstructions proceed from a viscid state of the blood, or for women of a gross or full habit, evacuations, and such medicines as attenutite the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise. A tcaspoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water. When obstructions proceed from affections of the mind, as grief, fear, anger, Sec every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often u very happy influ- ence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situution is also of the last importance. An obstruction of the menses is often the effect of other maladies. When this is the ease, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient's health and strength. When that is effected, the other will return of course. Immoderate Flow ok tin. Menses. The flow of the menses is to be considered as immoderate, when it either returns more frequently than what is natural, continues longer than ordinary, or is more abundant than is umiuI with the • Take Myrrh, £ drachm. two table-spoonsful of ihe following subcarbonate of Soda, 15 grains, mixture: * £ Sulphate of Iron. 1 icruple. Take Compound Infusion of Gentian, Extract of Hark, lirruple. G ounces. Syrup of Ginger, enough to form the Tincture of Bark, tmmm; to be divided in 21 pills, two of------of Cardamoms, of each, which are tu be nken twice or three l ounce times a-day , washing tbem douuwith Make a mixture. THE MENSTRUAL DISCHARGE. 401 same person than at other times; usually accompanied with pains in the back and belly, somewhat like those of childbirth. But the menstrual discharge may be too great as well as too small. When this happens, the patient becomesTveak, the colour pale, the appetite and digestion are bad, to which cedematous swel- lings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life ; a full diet, consisting chiefly of salted, high seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c. The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient's regi- men, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flow, and counteract the morbid affections of the sys- tem whence it proceeds. To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of net- tle-roots, or the greater comfrey, cooling aperients,* and refrige- rants, as small and frequent doses of nitre ;t cool acidulated liquors, as lemonade ; light covering, and lying on a mattress instead of a bed. If these be not sufficient to stop the flux, stronger astrin- gents! may be used, as Japan earth, alum, elixir of vitriol, the Peruvian bark, &c: e. g. two drachms of alum and one of Japan earth may be pounded together, and divided into eight or nine doses, one of which may be taken three times a-day. Persons whose stomachs cannot bear the alum, may take two table-spoonsful of the tincture of roses three or four times a-day, to each dose of which ten drops of laudanum may be added. If these should fail, half a drachm of the Peruvian bark, in powder, with ten drops of the elixir of vitriol, may be taken, in a glass of red wine, four times a-day, or any of the forms prescribed below. Fluor Albus. The uterine discharge may offend in quality as well as in quan- tity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale yellow, green, or of a blackish colour: sometimes it is sharp and ■ Take Epsom Salts, 2 ounces. Warm Water, 6 ounces. Compound Tincture of Senna, A ounce. Syrup of Roses, z drachms. Mix; and tare two table-spoonsful for a dose. t Take Infusion of Roses, lj ounce. Nitre, 10 grains. Occasionally adding, if necessary, Tincture of Opium, 15 drops. Make a draught, to be repeated every third hour. t Take Gum Kino, 8 grains. Alum, in Powder, IS grains. Confection of Roses, enough. Make a bolus, to be taken every third or fourth hour. or Take Turified Alum, 10 grains. Extract of Bark, 12 grains. Confection of Rosea, enough. Make a bolus to be taken a* above. 402 THE MENSTRUAL DISCHARGE. corrosive, sometimes foul and foetid, Sec. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet, frequent chihlbear- ing, &c. To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion ; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths'have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long in bed. Independent of this regimen, tfie proper indications of cure to be observed appear to be, to increase the action of the absorbents of the uterus and vagina, by restoring the tone of the system; to correct the acrimony of the discharge; diminish its quantity; to alleviate other urgent and distressing symptoms; and to strengthen the system, when the disease is complicated with general debihtv and relaxation. With this view, the first of these intentions is to be effected by astringents, administered by the mouth; and like- wise thrown up into the vagina and uterus in the form of injec- tions.* Alum, sulphate of zinc (white vitriol,) gum kino, and cat- echu, are the astringents most employed as internal remedies; and these may be given either separately or combined with some tonic, as the bark, bitters, chalybeates, and the sulphuric acid as advised below,t with partial cold bathing, or spunging the loins and thighs with cold water. In addition to astringents, it has been usual to employ in fluor albus such stimulating medicines as most commonly determine to the urinary passages, which, from their vicinity to the uterus, have often been found to afford considerable relief. On this occasion, turpentine and other balsams have been used.J Gentle emetics are also supposed to be of singular benefit in this complaint. When there are excoriations externally or internally, the solution of the acetate of lead, sufficiently diluted with water, may be em- ployed as a wash. r^ecoction of Oak B^j^Take Powdered Alum. 2 drachms. Alum, 1 draenm._______Catechu, 1 drachm. Make an injecUon. ________Peruvian Bark, k ox. or Syrup of Ginger, a sufficiency to form an or The Yolk of an Egg. Make an injection. Clari6ed Honey, k ounce- m „ Tincture of Spanish Fly, 1 drm. Take Strong Infusion of Green 1 ea, ^ Jwo aeMert.ipoonaful thr.o Make an injection. f ^y DISEASES OF PREGNANCY. ' 408 Dipficult Menstruation. (Dymenorrheea.) Besides the other deviations from the usual course of nature, al- luded to under this head, a third sometimes occurs, wherein men- struation, although not entirely suppressed, is nevertheless some- what difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is supposed to be ow- iiijr to a weak action of the vessels of the uterus, or spasm of its extreme vessels ; and is to be removed by cbalybeates, warm bath- ing, both topical and general, with the use of opiates, which should be employed as soon as the symptoms that denote its approach are apparent. The extract of stramonium, in half grain doses, will often prove serviceable when other anodynes fail. Cessation of the Menses. (Commonly called the " Turn of Life") That period of life at which the menses cease to flow is likewise very critical to the sex. The stoppage of any customary evacua- tion, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women cither fall into chronic disorders, or die about this time. Such of the,m, however, as survive it, without contracting any chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age. If the menses cease all of a sudden, which is seldom the case, in women of a full habit, they ought to abate somewhat of their usu- al quantity of food, especially of the more nourishing kind, as flesh, eggs, «.Vc They ought likewise to take sufficient exercise, and to keep the body open. This may be done by taking, once or twice a week, a little rhubarb, or an infusion of hiera picra in wine or brandy. ^ Should any scirrhous or cancerous affection of the uterus take place on a stoppage of the menstrual flux, as sometimes happens, all that can be done in such eases is to have recourse to pallia- tives, such as opium, henbane, and hemlock, in the manner point- ed out in the diseases wherein these medicines are indicated. It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ankles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open or have artificial drains substituted in their stead. Women who will have such Bores dried up are often soon after carried off by acute diseases, or fall into those of a chronic nature. OHAP. VII. DISEASES OF PREGNANCY. Though pregnancy is not a disease, yet it is a state often at- tended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some wo- men, indeed, are more healthy dnring their pregnancy than at any 404 DISEASES OF PREGNANCY. other time ; but this is by no means generally the case; most of them being frequently indisposed during the whole or greater part of the time of their gestation. Few fatal diseases, however, hap. pen, during this period ; and hardly any except abortion that can be called dangerous. During a state of pregnancy, three different stnges evidently ei- ist, each of which has a distinct set of symptoms ; nor need we be surprised, when we come to consider the alteration the constitu- tion suffers as a consequence of impregnation, at the many com- plaints and irregularities which then arise. The first state of pregnancy is usually attended with a suppression of the menses, accompanied with frequent nausea and vomiting, particularly in the morning, heartburn, indigestion, peculiar longing, head-ache, gid- diness, tooth-ache, and sometimes a slight cough: the breasts be- come enlarged, shooting pains extend through them, and the cir- cle round the nipple alters to a dark brown colour. A feverish tendency, with debility, emaciation, irritability, and peevishness-of temper, and a total alteration of the countenance, every feature of which becomes much sharpened, also frequently occur. Daring the whole or greater part of the second stage of gestation, as well as the first, the vomiting will continue with some women; this, however, does not usually happen. Partial suppressions of urine, with a frequent inclination to void it; itching about the external parts of generation, costiveness, inclination without ability to go to stool, and the piles, are what pregnant women are chiefly incommoded by during the second stage. Quickening.—Most women quicken about the sixteenth week after conception, at which time the mother becomes sensible of the slightest efforts of the child; and besides the complaints just enumerated, she will then be liable to sudden faintings, and slight hysteric affections.* During the last three months, or third stage of pregnancy, general uneasiness, restlessness (particularly by night,) costiveness, puffy swellings of the feet, ancles, and private parts, cramps in the legs and thighs, difficulty of retaining the urine for any length of time, varicose swellings of the veins of the belly and lower extremities, and the piles, are the affections which usually prove most troublesome. In delicate and weak women, of an irritable habit, convulsive fits sometimes arise, which are ever to be regarded in a dangerous point of view. Nausea and Vomiting.—These symptoms most frequently arise immediately on first getting out of bed in the morning; under such circumstances, therefore, it is advisable for the patient never to rise until she has taken a dish of tea or coffee, or whatever else she may have been accustomed to substitute for her breakfast. • According! to the opinion most commonly received, quickening, thus termed, has been Generally understood to commence at the time when particular wnsat.ons are Deceived| by the mother, supposed to be occasioned by the first mot.on of the child foe mo* usual time of feelinf anv such symptoms is about the latter end of the fourth orbeXing of the fifth month of pregnancy, at th.s period the uterus filling up tba wlvif ahi out and rises above tba rim; and from that .uddea Irans.i.on women of a d^Ucate wn^tuUoo aad irritable 6bre arotfbt to faint, more particularly .0 ,f .a a. erect position. Ed. DISEASES OF FRBGNANCY. 40ft Should the vomiting at any time become so severe as to threaten abortion from the violence of the straining, it may then be advisa- ble to direct two or three table-spoonsful of the ealine medicine to be taken every now and then in such a manner as the effervescence shall ensue after it is swallowed. The patient also should keep the body open with some gentle laxative. Should these means not succeed, about six ounces of blood may be drawn from the arm, and, if necessary, repeated in a week's time. The sickness in such cases depends on irritation, and is only to be removed with cer- tainty by bleeding. To abate excessive vomiting local applications have been recom- mended. For example, a piece of folded linen cloth, moistened with the tincture of opium, may be kept constantly applied to the stomach; to which, probably, the addition of a small portion of ether might increase its effect. It sometimes happens that vomit- ing continues incessantly for many days, accompanied with great prostration of strength, and constant thirst, with, at the same time, an utter impossibility of retaining any thing on the stomach. Under these circumstances the application of leeches to the pit offctte stomach, and a constant attention to swallow nothing that canirri- tute, allowing the patient asses' milk, and that by a single spoonful nt a time, have afforded relief. If much nausea should prevail without the possibility of throwing up, fourteen or fifteen grains of the powder of ipecacuanha may then be given, experience hav- ing proved that gentle emetics may be safely administered to preg- nunt women. IIkautiumin.—When a pregnant woman is incommoded by heartburn, (which commonly arises from acidity in the stomach,) half a drachm of magnesia may be taken morning and evening; and, if this fail to obviate it, the absorbent mixture advised below* mav he used, which Dr. Sims says he has found the most effica- cious of till remedies for the removal of this distressing complaint. Hkmj-ache with Plethora.—When either drowsiness, a sense of fulness of the vessels of the head, or head-ache, prove trouble- some to pregnant women, taking away a few ounces of blood from the arm in robust women will most likely prove serviceable. In women of a weak irritable habit the application of a leech or two to each temple will be more advisable than bleeding from the arm, where the head-ache proves obstinate, and resists the other means employed. Costivim ss, Pilks, \ c.—Costiveness, partial suppressions of urine, and the piles, which attend on the second stage of preg- nane v, are occasioned by the great pressure of the uterus on the rectum and bladder. 'The fir>t and last of these symptoms are to be obviated by a daily use of some gentle laxative; >uch as a solution of manna, or the subjoined electuary.t Pills eoin- " Take Ms.'ucsia, 1 drachm. table-spoonsful may be taken occasion- I'un- Water, 5 ounces. ally. Spirit of Cinnamon, 3 drachma. Solution of Ammonia. I drachm. t Take Confection of Senna, U ounce. Make • mixture, of which two or three ♦ Cream of Tartar, Jounce. Tho sixe of a nutmeg to be taken occa- sionally. 400 DISEASES OF PREGNANCY. posed of aloes are highly improper, as being of a nature too stim- ulating, and very apt to occasion hemorrhages, and bring on the piles. When the piles are troublesome, the best applications, when they can be applied, are leeches and cold saturnine lotions, as a solution of the superacetate of lead. To allay the irritation, ten grains of the superacetate of lead, dissolved in four ounces of rose-water, to which, if necessary, a little of the vinous tincture of opium may be added, form a good lotion. Tooth-ache.—To relieve the tooth-ache a few drops of the oil of cloves, cajeput, juniper, or any other essential oil, applied to the affected tooth, will often remove it for the time. Longings.—It is always desirable to gratify the peculiar longings of pregnant women, otherwise they are apt to miscarry from the anxiety these occasion, when not indulged in them. Hut that the child in the womb can be marked by any depraved appetite of the mother, or be mutilated by any disagreeable sight that may be presented to her, cannot readily be admitted. Hysterics.—Should sudden fainting, or any other hysterical affection, arise, little more will be necessary than to expose the pa- tient to a free open air, to place her in a horizontal position, and to give her a glass of cold water, with a few drops of hartshorn, or a little wine sufficiently diluted. Diarrhcea.—Diarrhoea during pregnancy should be treated just as at any other time; and after the stomach and intestines are cleared astringents may be used, if there be no great degree of fever present; but should there be fever, that must be atteuded to and first removed. Suppression op Urine.—To relieve the suppression of urine that frequently takes place in the advanced state of pregnancy, be- sides making use of emollient fomentations, clysters, and gentle purgatives, such as castor-oil, Sec, the patient, at the same tune, drinking plentifully of diluent liquors, surgical aid will be necessa- ry to draw it off morning and evening by means of a catheter. Troublesome Itchings.—When these sensations arise about the parts of generation during the pregnant state, it will be proper to keep the body perfectly free with some cooling laxative, and to wash the parts three or four times a day with a solution of lead, or the diluted solution of the acetate of lead. If much irritation ac- company this itching, leeches may be applied to the place. Puffy Swellings of the feet, ankles, and private parts, which are apt to arise towards the end of pregnancy, are occasioned by the pressure of the womb on the returning vessels, which prevents the blood being carried back to the heart. Gravid women are usu- ally free from these complaints in the morning, but towards night they frequently suffer much from^them. Slight scarifications from the edge of a lancet, to discharge the stagnated fluid, with the af- DISEASES OF PREGNANCY. 407 ter-application of flannels wrung out in a warm effusion of emolli- ent herbs, have been employed in cases of great distention. In general, however, it will only be necessary that the patient does not keep her feet in a pendent position for any length of time. Cramps of the Leos and Thighs are to be relieved by rubbing the purts with cold vinegar; camphor dissolved in oil, or other liniments, the |>erson wearing stockings in bed. At an advanced period of pregnancy they are only to be relieved by labour remov- ing the cause. Proper doses of ether and tincture of opium, with the menus advised in hysterical affections, will afford the greatest benefit where the stomach is affected with spasms. In such cases the patient will do well to avoid all kinds of food that are apt to prove flatulent and hard of digestion, and keep the body perfectly open. Restlessness and Want of Sleep prove troublesome complaints towards the latter end of pregnancy, obliging the patient to rise frequently throughout the course of the night, in order to expose herself to the influence of cool air. In cases of this nature noth- ing affords relief so effectually as small bleedings, with the occa- sional use of some cooling laxative medicine. Opiates, in such conditions, are ne\er attended with any advantage. Varicose Veins.—Considerable enlargement and distention of the veins of the legs, thighs, and abdomen often take place to an alarming extent in the lust state of pregnancy. But, as no bad consequences have been observed to attend this state, the only thing necessary to be done is to empty the vascular system by moderate bleeding, gentle purging, and a spare diet. Should, how- ever, the vein of any particular part become so distended as to prove troublesome, it may be advisable to apply a bandage of a moderate tightness, so as to give the necessary support to it. Jaundice.—Pregnant women, in some instances, are afflicted with a pain in the side, evcessive sickness at the stomach, and retchings, the skin assuming a deep yellow tint; under which cir- cumstances alone the complaint proves distressing ; and it is usual- ly occasioned by the formation of one or more gall-stones, and the obstructions they oppose to the usual and regular passage of the bile. The most efficient means to relieve the patient from this de- gree of the complaint are, bleeding, fomentations of the painful part, and large doses of opium, with such laxatives as shall coun- teract the constipating effects of the latter. When jaundice or any other bilious effects prevail during pregnancy, in consequence of the pressure kept up by the womb on the gall-bladder or ducts, it is to be obviated by keeping the body open with some gentle lax- atives, as pills composed of jalap and rhubarb. Incontinent* of 1:rine is to be removed only by delivery, but muy admit of being partially relieved by the horizontal posture. The bad effects of this very disagreeable complaint, may be pre- vented by a scrupulous attention to cleanliness, and the use of a 406 CONVULSIONS. the^Tm^nf0'™ SKIN-Pe *■» of the abdomen, i. Sl^tt PreP>??cy, wdl sometimes become cracked Sf r?«™ ■?? ^.^hing is more effectual than the frequent £d l^?t h7 ^V t0 ^hlch a Utt,e «»!*»' "»7 ^ ad- ded to rre it somewhat of a medicated appearance. Fi^i Paws, resembling those attendant on actual labour, are apt to come on at a late period of pregnancy, often occasioning un- if^^n rf™" Confinement in a horizontal position ; bleeding tfft: afiill hamt: laxative medicines if costive, and giving small awi frequent doses of some opiate until the patient finds ease, will, m sjeh cases, be necessary. CHAP. VIZI. CONVULSIONS. Coxttlsions may take place either during pregnancy or labour. These are of different kinds, requiring opposite treatment. One species i? a consequence of great exhaustion from a tedious labour, excessive fatigue, and profuse hemorrhage; which makes its at- tack without much previ u< warning, and generally alternates witk fainungs, or great •':; re-M i of strength, and debility: the mr s*le* about the face and chest are chiefly affected, and the pulse i? s.v._.. frequent, and compressible, the face pale, the eyes sunk, t!.e extremities cold. The fits succeed each other rapidly, and ve- ry -on terminate in a fatal syncope.* In all cases of this nature, the first object should be directed towards restraining the liemor- rhajr if j-reseat, or preventing any kind of exertion, thus husband- ly the remaining strenffth, or recruiting it by cordials. In con- junction with ether and camphor, opiates will be of considerable service. Delivery is usually necessary. The other spec its of convulsions, which are those of an hysteri- cal nature, are more common during gestation than during partu- rition. In th;? case it may only be necessary to add to what has been already s.-id relative to hysterics (p. 390.), that if they do not speedilv yield to antispasmodics, bleeding had better be reported to : should this fail, the woman, if possible, should be delivered. Puerperal e: :.\ uV, ..n- k'dom happen before the sixth month, hut may occur at any time between this period and the completion of labour. Thev may arise is the first symptom of labour, or after delivery. This <:"**"»■• * Tak° OpC * ■»* TakC Confect. of Roses, \ senile. % P «„, ^ ««. W *g °KPir to be take/ev r, fourth .hou.d it be reared*, u.t.l ... pd- - Make a bolna^to be tawn eye j gi-ren. hour. MANAGEMENT OF CHILD-BED WOMEN. 411 a« the hemorrhage has stopped, give a dose of castor-oil in order to prevent any bad effects from the action of these remedies on the coats of the stomach and intestines. The application of cloths dipped in cold water to the back and external parts will have a much better effect than internal astringents, consequently ought never to be neglected. The introduction of a piece of smooth ice into the vagina has often a very speedy effect in arresting the he- morrhage. A snow-ball wrapt in a bit of soft linen will have the same effect ; but neither of these should be continued so long as to cause pain. The most effectual means, then, to be resorted to for relieving the hemorrhage attendant on abortions are : if the pulse be full, hard, and frequent, bleeding is to be resorted to; if not, the fox- glove is to be trustc.l^o, either in the form of pill, tincture, or infusion: the application of cold to the thighs and pubes; admit- ting a free circulation of cool air in the patient's bed-chamber ; keeping the heat of the body at a low temperature; absolute rest in a horizontal position, and which must be continued during the whole process, however long it maybe; cold acidulated liquors for ordinary drink ; light food taken in small quantities at a time ; carefully abstaining from every thing stimulant, and plugging up the . agina, & c. Sic Sometimes the hemorrhage is kept up by some portion of the ovum remaining partly within and partly without the uterus; wl.cn, should circumstances demand it, this should be removed un- careful manual interference with a pair of armed forceps. For some days after abortion the patient should be confined to bed, as getting up too soon is apt to produce a debilitating dis- charge. Women disposed to abort should the more sedulously avoid the exciting causes of abortion at those dates of utero-gesta- tion when it is most apt to take place. OHAP. X. MANAGEMENT OF CHILDBED-WOMEN. Many diseases proceed from the want of due care in child-bed ; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case with young wives. They think, when the labour-pains are ended, the danger is over; but in truth it may only then be said to be begun. .Nature, if left to herself, will seldom fail to expel the fort us; but proper care and management are certainly necessary for the recovery of the mother. No doubt, mischief may be done by too much as well as by too little care. Hence females who have the greatest number of attendants in child-bed generally recover worst. But this is not peculiar to the >tate of child-bed. Exces- sive care always defeat* its own intention, and is generally more dangerous than none at all.* • Though the management ofwomrn in child-bod has been practised as an employ- ment since the earliest accounts of time, yet it is «nll io roost countries on a very bad 412 MANAGEMENT OF CHILD-BED WOMEIX During actual labour, nothing of a heating nature ought to he given. The woman may now nnd then take a little pauado, and her drink ought to be toast and water, or thin groat-gruel. Spirits, wines, coidial-watcrs, and other things which are given with a view to strengthen the mother, and promote the birth, for the most part tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, nsthey occasion violent and mortal hemorrhages, or dispose her to erup- tive and other fevers. Parturition. Is that natural process which, at the expiration of forty weeks from conception, is matured, and by which the womb detaches and expels its contents, and returns nearly to the same condition in which it was previous to its impregnation. Classification ok Laboihs, &<•. The division of labours, originally made bv Hippocrates into natural and preternatural, is sufficiently comprehensive, whilst it forcibly recommends itself by its simplicity and perspicuity. Natural labour, of wliich we shall only treat here, supposes four things: 1. That the vertex presents. '2. That there be sufficient room in the pelvis to admit of the ready descent of the child in that direction which permits the occiput or back part of the head to emerge under the arch of the pubis. If. That there be parturi- ent energy adequate to the expulsion of the contents of the uterus, without manual interference; and without danger, either to the mother or child : and, 4. That the process of parturition be com- pleted within a moderate time. Stages of Labour. Certain occurrences take place during the progress of parturi- tion which may be managed under three divisions or stages; the Hrst comprehends all that may occur before the complete dilatation of the os uteri; the second includes all thut takes place between the developement of the os uteri and the expulsion of the child; the third embraces every thing connected with the detachment and extension of the placenta and its adherent membranes. Symptoms preceding Labour. For several days before the actual existence of labour arrives, footing. Few women think of following this employment till they are reduced to the necessity of doing it for bread. Hence not one in a hundred of them have any edu- cation, or proper Knowledge of their business. It is true, that nature, if left to her- self, will generally eipel the fatus ; but it is equally true, that nioit women, in child- bed, require to be managed with skill and attention, and that they are often hurt by the auperatitious prejudices of ignorant and officious inidwive*. The mischief done ia this way is much greater than is generally imagined; most of which might be pre tent- ed by allowing no women to practi-<- midwifery but »uch as arc properly qualified. Were due attention paid to this, it would not only be t)>e means of saving many lirea, but weald prevent the necessity of employing men In this indelicate ami dttayreeaula branch ef medic.'ae, which is, on many account*, more proper for the other sex. MANAGEMENT OF CHILD-BED WOMEN. 41 f there are often certain premonitory symptoms, which, by women who have borne children, are viewed as precursors of that eventful hour which many of them so much dread. Among these are: I. Restlessness, particularly at night, very frequently precedes parturition for duys and weeks, and is rarely to be considered as bearing unfavourably in labour. 'J. Sulisidenri of the womb and abdomen is not an unusual monitor of the approach of suffering. It may be viewed in a favourable light, inasmuch as it indicates room in the pelvis. 3. (Hairy mucuous secretion from the os uteri and vagina, popu- larly termed shew, .sometimes occurs for days before the more active symptoms of lubour. It is often streaked with blood, and tends to lubricate the parts concerned in parturition. 4. Irritability of the bladder and n c.tum, demanding their frequent relief, is another occasional precursor of labour. Symptoms accompanying Labour. Owing to the resistance which the womb encounters during its contractile efforts, pain follows every such contraction ; but the pain attendant on parturition differs very materially in its nature, and in its influence in the uterus. These paroxysms of ptiin are either intestinal or uterine. I'aroxyMii* of intestinal pain, or such as are termed false or spu- rious, may be distinguished from genuine labour-pains by being unconnected with uterine contraction ; by attacking different parts of the abdomen; and by recurring irregularly. These pains usually originate in some source of intestinal irritation, and may almost always be removed by emptying the bowels, and subsequently exhibiting uu opiate. IK the observant practitioner, should one be present, they cannot he confounded with pain in the bowels. The true or uterine pains are either dilating or expulsi\e. Diluting Pains, or, as they are popularly termed, grinding pains, result from contraction of the womb. They are principally con- fined io the back, and occur in the earliest stage of labour, and are often peculiarly distressing to the patient, who expresses her- self by restlessness, despondency, and moaning They often con- tinue a long time without the intermissions being free from uneasi- ness, and appear almost exclusively to dilate the mouth of the womb, having little influence o\or the fundus of the uteriis. It is during the existence of these dilating pains that cold shivenngs most com- monly come on, and may be relieved by avoiding spiced or fer- mented fluid, and by administering any simple warm diluents. When the mouth of the womb is considerably dilated, expulsive pains, sometimes termed forcing or bearing down pains, commence iu the loins, and gradunlh proceed round the abdomen, till they meet at the region of the puhes, and dart down the labia pudendi % and thighs. If the accoucheur's hand be placed on the flaccid sides of the abdomen, previous to the accession of a paroxysm of expulsive pain, befomithc 'vfbman is aware of it. the womb ma\ be fisvlt contracting to ^Hiard. tense, incompressible tumour. These pains observe regular iutenf»ls of ei.se. which become shorter, whilst the pains, in»*u» WUttt ratio, increase in their duration anil 414 MANAGEMENT OF CHILD-BED WOMEN. severity ; and now it is that the abdominal muscles and diaphragm afford their assistance. During each propulsive effort a larger portion of the membrane*, distended with the liquor of the amnion, is forced through the mouth of the womb, performing to it, and all the parts through which the child is to pass, the office ofan easy but powerful wedge. With these pains there is often a frequent disposition to empty the rectum; and sometimes this inclination is so harassing as to justi- fy the administration of a small clyster, with half a drachm of the tincture of opium. Vomiting is a common attendant on uterine pain, and is benefi- cial by rejecting food, which, from its quality or quantity, may be a source of irritation to the stomach. It principally occurs during the dilating pains, and unquestionably assists in the relaxation and dilatation of the mouth of the womb. In a protracted labour, when vomiting continues or returns, after the mouth of the womb is fully dilated, with abdominal tension and pain, without uterine contractions, and with ejection from the stomach of fluid like dark coffee-grounds, with foul tongue, and rapid and hard pulse, it generally must be taken as indicative of inflammatory action, and as requiring immediate and most efficient interference. Besides these attendants on parturition, the pulse usually becomes quickened and full; the countenance florid; the whole surface of the body covered with profuse perspiration ; and the lower extremities cramped. The Process of Natural Labour. The process of natural labour, to use the words of a modern writer, is at once so simple and beautiful, that it cannot fail to ex- cite the admiration of those who look beneath the surface of the operations of nature. Without repeating what has already l>een advanced respecting the precursory and accompanying symptoms of delivery, we shall merely recall to the mind those utatements, as constituting a part of the history of this process. The symp- toms which announce the commencement of natural labour have continued for an indefinite time; pains iu the loins, darting through the pelvis, with an appearance of shew, indicate the ap- proach of unequivocal evidences of this stage of parturition. From time to time these pains are of the dilating kind and on an examination per vaginam, will be found to be diminishing the thickness of the cervix uteri more than to be opening the mouth of the womb. When the neck of the womb becomes reduced to the thickness of the other parts of that organ, it begins to open, and as soon as it can admit the extention of any part of the membranes distended with the liquor of the amnion, the pains rather assume the expulsive character, and there will be a sensible bearing down of the whole uterine tumour. Successive paroxysms of pain dilate the mouth of the womb more and more, whilst the protruded mem- branes, distended like a tense bladder, fill up the owning, and perform the office of an inimitable wedge, till the womb and the entrance to it form one continuous passage. Soon after this the membranes generally burst during a strong pain, having previously MANAGEMENT OF CHILD-BED WOMEN.' 41."i contributed to the dilatation of the vagina; and with the escape of the waters, or liquor of the amnion, there is sometimes a tem- porary suspension of pain, and the head of the child falls into the superior aperture or brim of the pelvis, or descends into the cavi- ty ; but more frequently this advance is not made until several pains have followed this occurrence. The contractions of the womb recurring with augmented fre- quency and force, gradually propel the f.etus along the passages until the I.cud presses on the perinu-um or fork, which is put on the full stretch : and also against the soft parts which it protrudes. These by degrees dilate, and permit the back part of the head to emerge under (he arch of the pubes, and with the complete extru- sion of the head, the other parts of the body are expelled, some- times by the same pain, but more frequently by one which speedily follows. The same paroxysm of pain that expels the child now and then detaches and expels the placenta, or after-burden, commonly so called ; but more frequently the womb remains at rest for about a quarter of an hour, when it resumes its contractions, and throw- it off with the adherent membranes. This constitutes the interest- ing process of natural labour, in which the uterus requires no offi- cious interference, but which, when forced to submit to any, she often resents, by harassing the busy meddler with some untoward occurrence. All that it becomes necessary for the accoucheur to do during this interesting process of natural labour, is to support the peri- nieum bv his hand, covered smoothly with a soft napkin, and so applied as to give equable support, without in the slightest degree resisting the exit of* the head. No other interference, in natural labour, is justifiable, and too strong terms cannot be employed to reprobate the practice of hastening the birth of the body, dragging it forcibly by the head into the world. It should be left to be ex- pelled by the unaided contraction of the uterus. As soon as the child is thus brought into the world, and manifests unequivocal signs of life, the funis or navel-string must be tied, by passing a ligature, consisting of a few threads, or a thin piece of tupe, round it, ut alniut the distance of two inches from the navel, and a second at the distance of three inches from the first. The funis mav then be divided by a round-pointed pair of scissors, at a Wioint equidistant from each liguture, taking care to cut nothing Hit the funis. All this should be don- in the most delicate manner under the bed-clothes, without exposing either the mother or child. The navel-string being thus secured, and the child separated from the mother, it is to he transferred to the nurse, whilst the bandage, previously passed round the body of the mother, should be moderately tightened, or the womb supported by gentle pressure made by an assistant, which will be found very materially to aid it* efforts to detach and expel the placenta. Management of the Jftrr-burden. The management of the placenta constitutes a very important part of natural labour; and if the womb l>e not permitted to 4?»» MANAGEMENT OF t IULD-BED WOMEN. empty itself gradually, some untoward and alarming circumstance may occur in this stage of parturition. Generally from twenty to thirty milvutes elapse between the birth and the expulsion of the placenta. The woman then complains of a slight pain in her back or abdomen, and this secondary contraction of the uterus de- taches the placenta, although it but rarely expels it from the pass- ages ; whence, however, it may usually be easily removed by coil- ing the funis round two of the fingers of the right hand, whilst guided by the cord, the thumb and index finger of the left hand should be passed up to its insertion into the placenta, which, if it can be felt, is a pretty certain indication of the detachment of the whole mass from the sides of the womb. By this means, also, the navel-string is prevented from breaking off, and a firmer hold of the placenta is obtained. To prevent the possibility of inverting the womb, or from its oc- currence without knowing it, the placenta should be permitted to slip by the fingers of the left hand into the vagina; and the with- drawing of the placental mass should always be in the axis of the brim, cavity, and outlet of the pelvis, as it passes those parts. The hand of the accoucheur should afterwards be laid on the abdomen, to ascertain that the uterus is well contracted : and the pulse •should be felt, lest internal hemorrhage redistending the uterus may be going on to the endangering of the patient's life. It is of great importance that a bandage be passed over the re- gion of the womb : this being done, and a well-aired napkin ap- plied to the labia pudendi, or external parts, some mild and cool nourishment may be given to the woman, who, after having been suffered to remain quiet for about half an hour, should have her soiled linen withdrawn, and, without being raised from her hori- zontal posture on any pretence, may be drawn up to the head of the bed ; whilst she herself remains perfectly passive, without tak- ing any part in this operation, lest hemorrhage or prolapsus of the ■voinb should follow. Tedious Labours.—When the labour proves tedious and diffi- cult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered, and the patient should sit over the steams of warm water. The pas- sage ought to be gently rubbed with a little soft pomatum, or fresh butter, and cloths wrung out of warm water applied over the belly^ If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours ; and in all preternatural cases, a skilful surgeon, or man-midwife, ought to be called as soon as possible. Treatment after Delivery.—After delivery, the woman ought to be kept as quiet and easy as possible.* Her food should be * Wc cannot help taking notice of that ridiculous custom which still prevails in some parts of the country, of collecting a number of women together upon such occa- sions. These, instead of being useful, serve only to crowd the house, and obstruct the necessary attendants. Besides, they hurt the patient with their noise; and often, by their untimely and impertinent advice, do much mischief. MANAGEMENT OF CHILD-BED WOMEN. 411 light and thin, as gruel, panado, &c. and her drink weak and di- lating. To this rule, however, there are many exceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors ; to such, a glass of wine and a bit of chicken must be allowed. Sometimes an excessive hemorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flow of the menses. If the flooding prove violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thigh : these must be changed as they grow dry, and may- be discontinued as soon as the flooding abates. In a violent flooding after delivery, I have seen very good effects from the following mixture :—Take of penny-royal water, simple cinnamon-water, and syrup of poppies, each two ounces, elixir of vitriol, a drachm. Mix, and take two table-spoonsful every two hours, or oftener if necessary. After-Pains.—If there be violent pains after delivery, the pa- tient ought to drink plentifully of warm diluting liquors, as groat- gruel, or tea with a little saffron in it; and to take small broths,. with caraway-seeds, or a bit of orange-peel in them; an ounce of the oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink.* If she be hot or feverish, one of the follow- ing powders may be taken in a cup of her usual drink every five or six hours. Take of crabs' claws prepared, half an ounce, purified nitre two drachms, saffron powdered, half a drachm ; rub them together in a mortar, and divide the whole into eight or nine doses. And if she be low-spirited, or troubled with hysterical complaints, she ought to take frequently twelve or fifteen drops of the tincture of asafoetida in a cup of penny-royal tea. Costiveness.—Costiveness is apt to prevail after delivery, and should always be removed by a laxative clyster, or some gentle .purgative, such as neutral salt and manna, or about an ounce of castor oil. Inflammation of the Womb.—An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increas- ed upon touching; by the tension or tightness of the parts; great weakness ; change of countenance, a constant fever, with a weak and hard pulse ; a slight delirium, or raving ; sometimes incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp water from the wound ; an inclination to go frequently to stool; a heat,. and sometimes total suppression of urine. * Take Cinnamon Watrr, I ounce. Tincture of Opium, 50 to 40 drop?. Tincture of Castor, A drachm, Svrup of Violets, 2 drachms. Make a draught, to be taken at becUtirae 418 MANAGEMENT OF CHILD-BED WOMEN. This must be treated like other inflammatory disorders, by bleed- ing and plentiful dilution. The drink may be thin gruel or bar- ley-water ; in a cup of which half a drachm of nitre may be dis- solved and taken three or four times a-day. Clysters of warm milk and water must be frequently administered: and the belly should be fomented by cloths wrung out of warm water, or by ap- plying bladders filled with warm milk and water to it. Suppression of the Lochia.—A suppression of the lochia or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacu- ations, and fomentations of the parts affected. In the milk-fever, the breasts may be embrocated with a little warm linseed-oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person. Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child. Every mother who has milk in her breasts ought either to suckle her own child or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases wliich prove fatal to women in child-bed. Inflammation of the Breast.—When an inflammation happens in the breast, attended with redness, hardness, and other symp- toms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to sup- puration. The use of repellents, in-this case, is very dangerous; they often occasion fevers, and sometimes cancers; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects. Fretted or Chapped Nipples.—When the nipples are fretted or chapped, they may be anointed with a mixture of oil and bees' wax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary-water applied to the nipples have a very good* effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it. Miliary Fever.—The miliary fever is a disease incident to wo- men in child-bed; but as it has been treated of already, we shall take no farther notice of it. The celebrated Hoffman observes, that this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar ; not forgetting to bleed in the first months, and to avoid all sharp air. When the labour is coming on it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions pro- MANAGEMENT OF CHILD-BED WOMEN. 419 ceed regularly; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered. Puerperal Fever.—The most fatal disorder consequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Some- times, indeed, it comes on sooner, and at other times, though rare- ly, it does not appear before the fifth or sixth day. It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at the stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb ; a sudden change in the quan- tity or quality of the lochia also takes place ; and the patient is fre- quently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease ac- quires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature', comes on, and accompanies the disease through all its future progress. There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought, however, to be used with caution, and not to be repeated, unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb. During the rigour, or cold fit, proper means should be used to abate its violence and shorten its duration. For this purpose, the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of wine-whey; warm applications to the extremities, as heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage. Emollient clysters of milk and water, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial, by promoting a discharge from the intes- tines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care, however, is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time. To evacuate the offending bile from the stomach, a vomit is gen- erally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, and to procure a free discharge of the bile.* Midwives ought to be very cautious in administering vomits or purges to women child-bed. 1 have known a woman who was recovering extremely well, thrown in, the most imminent danger by a strong purge which was given her by an offioiou* 420 MANAGEMENT OF CHILD-BED WOMEN. The medicine which I have always found to succeed best in this disease, is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added. If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or the powder of bole combined with opium. Though in general the food ought to be light, and the drink diluting, yet, when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to sup- port her with nourishing diet, and generous cordials. It was observed, that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents ; or a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary. When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef-tea or chicken-broth. To avoid this fever, every woman in child-bed ought to be kept perfectly easy; her food should be light and simple, and her bed- chamber cool and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness. Milk Fever.—To prevent the milk fever, the breasts ought to be frequently drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to pre- vent the milk from becoming acrid, and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet. We shall conclude our observations on child-bed women, by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold of which they never recover. It is a pity the poor are not better taken care of in this situation. But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to everv one. The BARRENNESS. 421 superstitious custom of obliging women to keep the house till they Jo to church is likewise a very common cause of catching cold. Jl churches are damp, and most of them cold; consequently they are the very worst places to which a woman can go to make her first visit, after having been confined in a warm room for a month, CHAP. ZZ. OF BARRENNESS. Barrenness may be very properly reckoned among the diseases of females, as few married women, who have not children, enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, &c. ; but it is chiefly owing to an obstruction or irregularity of the menstrual flux. It is very certain that high living vitiates the humours, and pre- vents fecundity. We seldom find a barren woman among the la- bouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in propor- tion to their poverty ; and it would be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and de- pendants the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their ex- tensive domains. Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids ; a state highly un- favourable to procreation. To remove this, we would recommend the following course :—First, sufficient exercise in the open air ; secondly, a diet consisting chiefly of milk and vegetables*; thirdly, the use of astringent medicines, as steel, alum, dragon's blood, elixir of vitriol, the Spa or Tunbridge waters, Peruvian bark, &c; and, lastly, above all, the cold bath. Barrenness is often the consequence of grief, sudden fear, anxi- ety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as pos- sible ; all disagreeable objects are to be avoided, and every meth- od taken to amuse and entertain the fancy. I believe I have never written, and I hope I never shall write, any thing offensive to real modesty. Yet I have not suppressed, from motives of false delicacy, what I thought might be of import- * D>- Cheyne avers, that want of children is oftener the fault of the male than of the female ; in this the Doctor and I do not agree ; and strondy recommends a milk and vegetable diet to the former as well as the latter; adding,"that his friend Dr. Taylor, whom he called the Milk-doctor of Croyden, had brought sundry opulent families in his neighbourhood, who had continued some years after marriage without progeny, to have several fine children, by keeping both parents, for a considerable time, to a milk and vegetable diet. 422 DISEASES OF INFANTS. ance on a subject so closely connected with conjugal happiness The remarks here made, though few and apparently simple, con- tain all that is really known, in medical practice, of the causes and remedies of barrenness. I therefore wish to put married ladies on their guard against the fallacy of private suggestions, and of public advertisements on this head. The things commonly advis- ed by silly nurses, as well as the grand restoratives of quack im- postors, are all of them dangerous stimulants, that provoke desire, but enfeeble, instead of strengthening, the powers of nature, and render a weakness, which proper treatment might have removed, absolutely incurable. CHAP. XII. DISEASES OF INFANTS. Miserable indeed is the lot of man in the state of infancy! He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his pa- rents : but, alas ! this care is not always bestowed upon him ; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.* It must be obvious to every attentive person, that the first dis- eases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with in- digestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be con- sidered as a poison ; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death. As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to re- move it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonsful of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates ; or, what will more certainly answer the purpose, a grain of emetic tar- tar, may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are unwilling to use * Of the officious and ill-judged care of midwives, we shall adduce only one instance, viz. the common practice of torturing infants, by squeezing their breasts, to draw off the milk, as they call it. Though a small quantity of moisture is generally found in the breasts of infants, yet, as they are certainly not intended to give suck, this ought never to be drawn off. I have seen this cruel operation brini; on hardness, inflamma- tion, and suppuration of the breasts; but never knew any ill consequencea from its being omitted. When the breasts are hard, the only application that we would re- commend is a soft poultice, or a little of the diachylon plaster, spread thin upon a bit of soft leather, about the size of half a crown, and applied over each nipple. These may be suffered to continue till the hardness disappears. DISEASES OF INFANTS. 423 the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred. These medicines will not only cleanse the stomach, but will gen- erally likewise open the body. Should this, however, not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved in boiling water, and given in small quantities till it operates ; or, what will answer rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and con- tinued till it has the desired effect. If these medicines be properly administered, and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suf- fer so much. These general directions include most of what can be done for relieving the internal disorders of infants. They will likewise go a considerable way in alleviating those which appear externally, as the rash, gum, or fellon, Sec. These, as was formerly observed, are principally owing to too hot a regimen, and consequently will be most effectually relieved by gentle evacuations. Indeed, evac- uations of one kind or other constitute a principal part of the med- icine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief. Of the Meconium. The stomach and bowels of a new-born infant are filled with a blackish-coloured matter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of nature ; in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not sufficiently carried off, a little manna, or magnesia alba, may be given, as mentioned above ; or, if these should not be at hand, a common spoonful of whey, sweetened with a little honey, or moist sugar, will answer the purpose. The most proper medicine for expelling the meconium is the mother's milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they show an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats. The Aphtha, or Thrush. The aphthte are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant's life. If the a"liiim; are of a pale colour, pellucid, few in number, soft, superficial :mi<1 fall easily off, they -arc not dangerous; but if opake, yel'ow, brown, black, thick, or running together, they otfght 424 » DISEASES OF INFANTS. It is generally thought that the aphtha? owe their origin to acrid humours ; we have reason, however, to believe, they are more fre« quently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion in- flammatory disorders, even in adults; is it any wonder then that they should heat and inflame the tender bodies of infants, and set, as it were, the whole constitution on a blaze ? The most proper medicines for the aphthae are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb, and half a drachm of magnesia alba, may be rubbed together, and divided into six doses, one of which may he given to the infant every four or five hours till they operate. These powders may either be given in the child's food, or a little of the syrup of pale roses, and may be repeated as often as is found ne- cessary to keep the body open. It is common in this case to ad- minister calomel; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution. Many things have been recommended for gargling the mouth and throat in this disease ; but it is not easy to apply these in very young children; we would therefore recommend it to the nurse to rub the child's mouth frequently with a little borax and honey; or with the following mixture :—Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose-water two drachms ; mix them together. A very proper application in this case is a solution of ten or twelve grains of white vitriol in eight ounces of barley- water. These may be applied with the finger, or by means of a bit of soft rag tied to the end of a probe. Hiccups. Some infants are much incommoded by hiccups, arising proba- bly, either from acidity in the stomach, or from some nervous irri- tation. In the former case, a powder composed of a little prepar- ed chalk and rhubarb (about eight grains of the former with two or three of the latter) may prove beneficial. In the latter, it may be proper to give a few drops of the aromatic spirit of ammonia, or the compound tincture of camphor (paregoric.) In some cases, a little plain vinegar has proved an effectual remedy. Where the complaint is severe, or returns frequently, it may be advisable to rub the stomach with soap liniment, to which a little tincture of opium has been added. Of Acidities. The food of children being for the most part of an acescent na- ture, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of children are ac- companied with evident signs of acidity, as green stools, gripes. Sec These appearances have induced many to believe, that all the diseases of children were owing to an acid aboundiug in the stomach and bowels ; but whoever considers the matter attentive- ly, will find that these symptoms of acidity are oftener the effect than the cause of their disea DISEASES OF INFANTS. 425 Nature evidently intended that the food of children should be acescent; and unless the body be disordered, or the digestion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, how- ever, is often a symptom of disorders in children ; and, as it is sometimes a troublesome one, we shall point out the method of re- lieving it. When green stools, gripes, purgings, sour smells, Sec, show that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient exer- cise, in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs' eyes, and other tes- taceous powders. These, indeed, by "their absorbent quality, may correct the acidity ; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines ; as rhubarb, manna, or such like. The best medicine which we know, in all cases of acidity, is that fine insipid powder, called magnesia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Ap- pendix.* When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things ; but should have its body opened with an emollient clyster, or the medicine mentioned above ; and, at the same time, a -little brandy may be rubbed on its belly with a warm hand before the fire. I have sel- dom seen this fail to ease the gripes of infants. If it shquld hap- pen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoon- ful of it given frequently, till the infant be easier. Sometimes a little peppermint-water will answer this purpose as well.t Galling and Excoriation. These are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine. As these complaints are, in a great measure, owing to want of cleanliness, the most effectual means of preventing them are, to wash the parts frequently with cold water, to change the linen of- ten, and, in a word, to keep the child in all respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders ; as burnt hartshorn, tutty, chalk, crabs' claws prepared, and the like. When the parts * See Appendix, Laxative absorbent Mixture. t Twenty drops of the spirits of hartshorn given in a little linseed-tea immediately relieves children affected by that acidity of the bowels which frequently attends teeth- ing. Much of the acidity of the stomachs of children arises, from the too free uae of fermented bread. 426 DISEASES OF INFANTS. affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders ; or to anoint the place with the camphorated ointment. If the parts be washed with spring-water, in which a little white vitriol has been dissolved it will dry and heal them very powerfully. One of the best appli- cations for this purpose is to dissolve some fuller's earth in a suffi- cient quantity of hot water ; and after it has stood till it is cold, to rub it gently upon the galled parts once or twice a-day. Or' to wash them gently now and then with a mixture of equal parts of rose-water and spirits of wine. Stoppage of the Nose. The nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, and likewise renders it diffi- cult for them to suck or swallow. Some in this case order, after a suitable purge, two or three grains of white vitriol, dissolved in half an ounce of marjoram wa- ter, and filtered, to be applied now and then to the nostrils with a linen-rag. Wedellus says, if two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjo- ram-water, and applied to the nose, as above directed, that it brings away the mucus without sneezing. In obstinate cases these medicines may be tried ; but I have nev- er found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free.* Of Vomiting. From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood than in the more advanced periods of life. They are seldom, however, dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient. Vomiting may be excited by an over-quantity of food ; by food that is of such a nature as to irritate the nerves of the stomach too much; or by the sensibility of the nerves being so much increased as to render them unable to bear the stimulus of even the mildest aliment. When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food ofan acrid or irritating quality, the diet ought to be chang- ed, and aliment of a milder nature substituted in its stead. When vomiting proceeds from an increased degree of sensibility, * Some nurses remove this complaint by sucking the child's nose. This is by no means a cleanly operation; but when nurses have the resolution to do it, I am flu from discouraging the practice. DISEASES OF INFANTS. 427 or. too great an irritability of the nerves of the stomach, such med- icines as have a tendency to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may occasionally be added. In obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations made with wine, applied warm to the pit of the stomach ; or the use of the stomach-plaster, with the addition of a little theriaca. Looseness. (Diarrhoia.) A looseness may generally be reckoned salutary, when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappear- ed. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours which would otherwise tend to relax the habit. Diarrhoea may be injurious in different ways. The increased peristaltic motion of so great a tract of sensible muscular substance as the intestinal canal must, like other muscular exertion, weaken the bowels ; and thus the whole body sympathises with it. Great debility is often rapidly excited by affections of the intestinal fibres, though there have been few evacuations. Diarrhoea likewise in- jures the system by the irritation and great secretion which often accompanies it, whether in children or adults; add to this the di- minution of the powers of digestion, and the obstacle afforded to the absorption of the due quantity of chyle, together with the de- rangement which other parts of the system may suffer, and the dis- eases thus excited, such as convulsions, anasarca, &c. As the principal intention in the cure of a looseness is to evacu- ate the offending matter, it is customary to give the patient a gen- tle vomit of ipecacuanha, and afterwards to exhibit small and fre- quent doses of rhubarb ; interposing absorbent medicines to miti- gate the acrimony of the humours. The best purge, however, in this case, is magnesia alba. It is at the same time absorbent and laxative, and operates without exciting gripes. The antimonial wine, which acts both as an emetic and purge, i- also an excellent medicine in this case. By being diluted with water, it may be proportioned to the weakest constitution ; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the dis- ease, and pave the way for the use of absorbents. If, however, the patient's strength will permit, the medicine ought to be repeat- ed every six or eight hours, till the stools begin to assume a more natural appearance ; afterwards a longer space may be allowed to intervene between the doses, When it is necessary to repeat the 438 DISEASES OF INFANTS. medicine frequently, the dose ought always to be a little increased as its efficacy is generally diminished by use. Some, upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be ad% ministered before the offending humours are discharged, though the disease may appear to be mitigated for a little time, it soon af- terwards breaks forth with greater violence, and often proves fatal After proper evacuations, however, these medicines may be admin- istered with considerable advantage. Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of pop- pies may be given in a little simple cinnamon-water three or four times a-day, till these symptoms have ceased. Cutaneous Eruptions. Children, while on the breast, are seldom free from eruptions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hurtful humours, which, if retained, might produce fatal disorders. The eruptions of children are chiefly owing to improper food and neglect of cleanliness. If a child be stuffed at all hours with food that its stomach is not able to digest, such food, not being properly assimilated, instead of nourishing the body, fills it with groes humours. These must either break out in form of eruptions upon the skin, or remain in the body, and occasion fevers and other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to swarm with vermin, and are generally covered with the scab, itch, and other eruptions. When eruptions are the effect of improper food, or want of cleanliness, a proper attention to these alone will generally be suf- ficient to remove them. If this should not be the case, some dry- ing medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cokl is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sulphur, provided it be prudently used. A little of the flowers of sulphur may be mixed with fresh butter, oil, or hog's lard, and the parts affected frequently touched with it. The most obstinate of all the eruptions incident to children are, the tinea capitis, or scabbed head,1 and chilblains. The scabbed head is often exceedingly difficult to cure, and sometimes, indeed, the cure proves worse than the disease. I have frequently known children seized with,internal disorders, of which they died soon af- ter their scabbed heads had been healed by the application of dry- ing medicines.* The cure ought always first to be attempted by * I some time ago saw a very striking instance of the danger of substituting drying medicines in the place of cleanliness and wholesome food, in the Foundling Hospital at Ackworth, where the children were grievously afflicted with scabbed heads, and other cutaneous disorders. Upon inquiry it was found, that very little attention was paid either to the propriety or soundness of their provisions, and that cleanlineas was totally neglected; accordingly it was advised that they should have more wholesome DISEASES OF IIYFANTS. 409 keeping the head very clean, cutting off the hair, combing and brushing away the scabs, &c. If this is not sufficient, let the head be shaved once a-week, washed daily with yellow soap, and gently anointed with a liniment made of train-oil eight ounces, red precip- itate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, or sprinkled with a lit- tle burnt alum. M'hile these things are doing, the patient must be confined to a regular light diet, the body should be kept gently open ; and cold, as far as possible, ought to be avoided. To pre- vent any bad consequences from stopping this discharge, it will be proper, especially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient becomes more strong, and the constitution be somewhat mended. Chilblains commonly attack children in cold weather. They are generally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, and an infarction of the vessels ; which being often repeated, the vessels are at last over-distended, and forced to give way. To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rub- bed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes between cloths to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner's cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are, indeed, troublesome, but seldom dangerous. They generally heal as soon as the warm weather sets in. Of the Croup. Children are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east coast of Scotland, it is called the croup. On the west they call it the chock or stuff- ing. In some parts of England, where I have observed it, the good women call it the rising of the lights. It seems to be a spe- cies of asthma, attended with very acute and violent catarrhal symptoms. This disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet food, and be kept thoroughly clean. This advice, however, was not followed. It waj too troublesome to the servants and supt rintendents. The business was to be done by medicine ; which was accordingly attempted, but had nearly proved fatal to the whole house. Fevers and other internal disorders, immediately appeared, and at length a putrid dysentery, which proved fo infectious, that it carried off a great many of the children and spread over a considerable part of the neighbouring country. 430 DISEASES OF INFANTS. clothes, or any thing that obstructs the perspiration, may occasion the croup. It is attended with a frequent pulse, quick and laborious breath- ing, wliich is performed with a peculiar kind of croaking noise, that may be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though some- times it is of a livid colour. When a child is seized with the above symptoms, his feet should immediately be put into warm water. He ought likewise to be bled,* and to have a laxative clyster administered as soon as pos- sible. He should be made to breathe over the steams of warm water and vinegar ; or an emollient decoction, and emollient cata- plasms or fomentations may be applied round his neck. If the symptoms do not abate, a blistering plaster must be applied round the neck, or between the shoulders, and the child may take fre- quently a table-spoonful of the following julep :—Take penny-royal water, three ounces, syrup of althea and of poppies, each one ounce ; mix them together. Assafcetidat is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of assafcetida may be dissolved in one ounce of Minderer- us's spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftener, if the patient's stomach be able to bear it.j; If the child cannot be brought to take this medicine, two drachms of the assafcetida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates.§ Emetics|| have been strongly recommended in croup, whilst oth- ers have little faith in their utility. Much benefit may be derived, nevertheless, from their early use. Even in the advanced stage of the disease, emetics do much service, appearing mechanically to remove the lymphatic membrane. Decoctions of senega and pre- parations of squills have been used to assist the expectoration of the membrane ; but, for this purpose, they do not equal emetics. Calomel would appear to be a powerful remedy in croup, and, * In this disease bleeding is not always proper ; but in very full habits it must cer- tainly be of use. f Antispasmodics have been trusted to almost exclusively by many; but their exhibition, it would appear, ought to be confined to a different disease, namely, den- tition. t We find this formula copied into other works, under the name of Dr. Miller's for- mula, though we verily believe it to belong originally to this work ! Eo. § I was lately favoured with a letter from Dr. William Turnbull, in London, a phy- sician of great experience, and who, from his former situation on the north-east coast of England, had many opportunities of observing the symptoms and progress of thii dangerous disease. The Doctor's sentiments differ very little from my own: he ob- serves, that he never found blistering of any service ; and recommends cataplasms of garlic, camphor, and Venice treacle to be applied both to the throat and soles of the feet. He likewise recommends boluses of camphor, castor, valerian-root, salt of hartshorn, and musk, adapted to the age, strength, &c. of the patient; after which he advises two spoonsful of the following decoction :—Take of garlic and distilled vinegar each an ounce, hyssop-water eight ounces ; beat up the ingredients together, gradually mixing the water, and adding three ounces of honey. Let the whole be sim- mered over a gentle fire, and afterwards strained for use. H Take Tartarized Antimony, 2 grains, Mix them together, and give two tea- Pure Water, 2 ounces, spoonsful from time to time until vow- Oxymel of Squill, Jounce. it ing is promoted. DISEASES OF INFANTS. 431 if given early, it will frequently save the child. The early detrac- tion of blood, followed by an emetic, and the subsequent use of calomel,* will afford the greatest hope of removing the disease. To an infant of six months, a grain and a half of calomel may be giv- en every hour, until it purge freely; to a child a year old two grains ; and to one of two years old, sometimes even four grains are given every hour, until the bowels are acted on, and the child purges freely, or vomits repeatedly. The stools are generally green in colour, and their discharge is usually accompanied with an alleviation of the symptoms. When this is observed, the dose must be repeated less frequently, perhaps only once in two hours for some time, then still seldomer, and finally abandoned. Should the child be greatly weakened, either by the disease or the medi- cine, the strength must be afterwards carefully supported by nour- ishment and cordials. Notwithstanding the great quantity of cal- omel given in this way, salivation is not produced in children. Dr. James Hamilton, junior, to whom we are chiefly indebted for the introduction of the use of calomel in croup in this country, from the practice of Dr. Rush, is extremely unwilling to bleed children freely in this disease, from its subsequent debilitating ef- fects ; and in croup, begins at once with the calomel, after having used the warm bath. Some children are subject to slight wheezing, continuing for a day or two, with intermissions, and accompanied with a hoarse- ness, but without fever. Emetics, laxatives, and a large Burgun- dy-pitch plaster applied to the back, remove the disease. To prevent a return of the disorder, all those things which occa- sion it must be carefully avoided; as wet feet, cold, damp, easterly winds, Sec. Children who have had frequent returns of this dis- ease, or whose constitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of di- gestion, and all crude, raw, trashy fruits are to be avoided. They ought likewise to have a drain constantly kept open in some part of their body, by means of a seton or issue. I have sometimes known a Burgundy-pitch plaster, worn continually between the shoulders for several years, have a very happy effect in preventing the return of this dreadful disorder. Of Teething. Dr. Arbuthnot observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the ten- der nervous parts of the jaws, occasioning inflammations, fevers, convulsions, gangrenes, Sec These symptoms are in a great measure owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children who are delicately brought up always suffer most in teething, and often fall by convulsive disorders. About the sixth or seventh month the teeth generally begin to make their appearance; first, the incisores, or fore-teeth; next, the canini, or dog-teeth; and, lastly, the molares, or grinders. About 'Take Rhubarb in Powder, 6 grains, Calomel, 2 grains. Make a powder. rf&J DISEASES OF INFANT*. the seventh year there conies a new set; and about the twentieth the two inner grinders, called denies sapienlia, the teeth of wi* dom. ~ Children about the time of cutting their teeth, slaver much, and have generally a looseness. When the toething is difficult/espe- cially when the dog-teeth begin to make their way through the gums the child has starlings a, hi. sleep, tumours of thTgums watchings, gripes, green stools, the thrush, fever, difficult breathing and convulsions. «""ing, Difficult teething requires nearly the same treatment as an in- flammatory disease. If the body be bound, it must be opened either ?AGmu unt, ClyStGTS °r gentle Pure&tives ; as manna, magnesia alba, rhubarb, senna, or the like. The food should be light and in small quantity; the drink plentiful, but weak and diluting as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may he added. If the fever be high, bleeding will be necessary; but this in very young children ought always to be sparingly performed. It is an evacuation which they bear the worst of any. Purging vomiting or sweating, agree much better with them, and are generally more beneficial. Harris, however, observes, that when an inflammation appears, the physician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with convulsion-fits, a blistering plaster may be applied between the shoulders, or one behind each ear. Sydenham says, that in fevers occasioned by teething he never found any remedy so effectual as two, three, or four drops of spir- its of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. The number of doses may be four, five, or six. I have often prescribed this medicine with suc- cess, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, according to the age of the child, and when costiveness does not forbid it, three or four drops of laudanum may be added to each dose. In Scotland, it is very common, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoul- ders. This generally eases the tickling cough which attends teeth- ing, and is by no means a useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed at least once a fortnight. Several things have been recommended for rubbing the gums, as oils, mucilages, &c. ; but from these much is not to be expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three* or four times a-day. Children are generally at this time disposed to chew whatever they get into their hands. For this reason they ought never to be without somewhat that will yield a little to the pressure of their gums, as a crust of bread, a wax-candle, a bit of liquorice-root, or such like. With regard to cutting the gums, we have seldom known it o( any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger-Bail, the edge of a six- DISEASES OF INFANTS. 433 penny piece* that is worn thin, or any sharp body which can be with safety introduced into the mouth ; but the lancet, in a skilful hand, is certainly the most proper. In order to render the teething less difficult, parents ought to take care that their children's food be light and wholesome, and that their nerves be braced by sufficient exercise without doors, the use of the cold bath, Sic Were these things duly regarded, they would have a much better effect than teething (anodyne) neck- laces, or other nonsensical relics of superstition, worn for that purpose. Infants, during dentition, are subject to sudden attacks of spasm about the wind-pipe, producing a temporary feeling of suffocation, with a crowing sound ; but there is no hoarse cough. It is apt to take place suddenly at night, or when crying. It is cured by giv- ing a combination of tincture of assafcetida, and of hyoscyamus (henbane,) and using laxatives. The tepid bath is also useful. The gum should be cut ; and if there be any tendency to a return, particularly if the child be hot, and the pulse quick, the eye heavy, and the face unusually pale, or flushed, leeches should be applied, and then a blister to the back of the head. Of the Rickets. This disease generally attacks children between the age of nine months and two years. It appeared first in England about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise themselves, or to give it to their children. Causes.—One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them after they are brought forth. Accordingly we find that the children of such women gen- erally die of the rickets, the scrofula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often afflicted with the venereal disease in their youth, are likewise very liable to the rickets. Any disorder that weakens the constitution or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it. But nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough milk to nourish the child, it • Whatever exception may have bren taken by Dr. Underwood at the edge of a six- penny piece, (see his Treatise on the Diseases of children, vol. i. p. 328.) or others who have-quoted him, in performing this operation, it could never be understood that the regular surgeon would have recourse to it instead of his lancet; then, what could be better adapted, in an unskilful hand, than one of the old thin sixpences, or attended «Hh lew danger. A lancet, certainly, would accomplish the object better could it be trusted in the hands of every one j this, however, is not the case. Ed. T 434 DISEASES OF INFANTS. cannot thrive. But children suffer oftener by want of care in nurses than want of food. Allowing an infant to lie or sit too much, or not keeping it thoroughly clean in its clothes, has the most pernicious effects. The want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep ; if it be suf- fered to lie or sit, instead of being tossed and dandled about, it will not thrive. Symptoms.—At the beginning of this disease the child's flesh grows soft and flabby ; its strength is diminished ; it loses its wont- ed cheerfulness, looks more grave and composed than is natural for its age, and does not choose to be moved. The head and belly become too large in proportion to the other parts; the face ap- pears full, and the complexion florid. Afterwards the bones begin to be affected, especially in the more soft and spungy parts. Hence ihe wrists and ankles become thicker than usual; the spine or back- bone puts on an unnatural shape; the breast is likewise often de- formed, and the bones of the arms and legs grow crooked. All these symptoms vary according to the violence of the disease. The pulse is generally quick, but feeble; the appetite and diges- tion for the most part bad ; the teeth come slowly and with diffi- culty, and they often rot and fall out afterwards. Ricketty chil- dren generally have great acuteness of mind, and an understand- ing above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatu- ral enlargement of the brain, is not material. Regimen.—As t'.iis disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be5to brace and strengthen the solids, and to promote digestion and the due preparation of the fluids. These important ends will be best answered by wholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If the child has a bad nurse, who either neglects her duty, or does not understand it, she should be changed. If the season be cold, the child ought to be kept warm ; and when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the same effect. The limbs should be rubbed frequently with a warm hand, and the child kept as cheer- ful as possible. The diet ought to be dry and nourishing, as good bread, roast- ed flesh, Sec Biscuit is generally reckoned the best bread ; and pigeons, pullets, veal, rabbits, or mutton roasted or minced, are the most proper meat. If the child be too young for animal food, he may have rice, millet, or pearl-barley, boiled with raisins, to which may be added a little wine or spice. His drink may be good claret mixed with an equal quantity of water. Those who cannot af- ford claret, may give the child now and then a wine-glass of mild ale, or good porter. DISEASES OF INFANTS. 435 Medicine.—Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may sometimes be of use, but they will seldom carry off the disease ; that must depend chiefly upon such things as brace and strengthen the system ; for which purpose, besides the regimen mentioned above, we would recommend the cold bath, especially in the warm season. It must, however, be used with prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be well rub- bed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath it must be discon- tinued. Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would he of service, were it possible to bring children to take it. We might here mention many other medicines which have been recom- mended for the rickets ; but as there is far more danger in trusting to these than in neglecting them altogether, we choose rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on. Of Convulsions. Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves may occasion convulsions. Hence infants, whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal; likewise by teething, strait clothes, the approach of the small-pox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure; where- fore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be re- peated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed with the powder of crabs' claws. Convulsions which precede the eruption of the small-pox or measles generally go off upon these making their appearance. The principal danger in this case arises from the fear and apprehension of those who have the care of the patient. Convulsions are very alarming, and something must be done to appease the affrighted parents, nurses, Sec. Hence the unhappy infant often undergoes bleeding, blistering, and several 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 clyster, would have set all to rights. When convulsion-fits arise from the cutting of teeth, besides geu- tle evacuations we would recommend blistering, and the use of an- tispasmodic medicines, as the tincture of soot, assafcetida, or ca«- 436 DISEASES OF INFANTS. tor. A few drops of any of these may be mixed in a cupof white- wine whey, and given occasionally. When convulsions proceed from any external cause, as the pres- sure occasioned by strait clothes or bandages, Sec these ought im- mediately to be removed; though in this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover as long as the cause wliich first gave rise to the disorder continues to act. When a child is seized with convulsions without having any com- plaint in the bowels, or symptoms of teething, or any rash or other discharge which has been suddenly dried up, we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhap- py patient. When a disease proceeds from an original fault in the formation or structure of the brain itself we cannot expect that it should yield to medicine. But as this is not always the cause even of convulsions which proceed immediately from the brain, some at- tempts should be made to remove them. The chief intention to be pursued for this purpose is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders. Of Water in the Head. Though water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly lia- ble to it, we thought it would be most proper to place it among the diseases of infants. Causes.—A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like; it may likewise pro- ceed from an original laxity or weakness of the brain; from scir- rhous tumours or excrescences within the skull; a thin watery state of the blood; a diminished secretion of urine; a sudden check-of the perspiration ; and, lastly, from tedious and lingering diseases, which waste and consume the patient. Symptoms.—This disease has at first the appearance of a slow fever ; the patient complains of a pain in the crown of his head, or over his eyes ; he shuns the light, is sick, and sometimes vomits ; his pulse is irregular and generally low ; though he seems heavy and dull, yet he does not sleep; he is sometimes delirious, and fre- quently sees objects double ; towards the end of this commonly fa- tal disease the pulse becomes more frequent, the pupils are gener- ally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.* Medicine.—No medicine has hitherto been found sufficient to carry off a dropsy of the brain. It is laudable, however, to make • I have lately lost a patient in this disease where a curious metastasis seemed.to take okce The water at first appeared to be in the abdomen, afterwards in the Sit and last of all it mounted up to the brain, where it soon proved fatal. diseases ur tNFANTS. 437 some attempts, as time or chance may bring many things to light of which at present we have no idea. The medicines generally us- ed are, purges of rhubarb or jalap, with calomel, and blistering- plasters applied to the neck .or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white helle- bore, or the like.* Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any in- stance of a cure being performed in a confirmed dropsy of the brain ; but in so desperate a malady every thing deserves a trial. t To look over the long catalogue of infantile diseases in some medical books, one would be inclined to think that the real design of the authors, though concealed under the show of precision, was to spread alarm through every family. I have had a very dif- ferent object in view, to quiet the fears of parents, to direct their attention to the proper treatment of their children, and thus to ren- der the use of any medicines almost unnecessary. I have shown the folly of having recourse to physic to bring away the black, vis- cid, syrup-like substance contained in the intestines of a new-born infant, when the purgative quality of its mother's milk is so admi- rably suited to that very purpose. The new milk is thin and wa- terish, but acquires every day greater consistence, and thus affords a more solid aliment to the child, as he becomes more capable of digesting it. If the mother does not vitiate by her own improper diet the pure fountains of nourishment and health which nature has kindly given her, the child will neither be troubled with cos- tiveness nor gripes. He will escape those complaints of the sto- mach which are occasioned by swallowing crude, inflammatory trash, or still more pernicious drugs. The daily use of the cold bath and frequent exercise in the open air will not only preserve him from colds and defluxions, but from all the disorders which are the consequences of relaxation and of nervous irritability. A child brought up in the manner I have recommended will have lit- tle to fear even from external contagion. The firm texture of his skin, like a shield, will almost resist its approach, and the purity of his habit will correct its malignity. The small-pox is the only infectious disease for which I would have him prepare by any particular process, because that process * When the presence of this disease can be ascertained at a sufficiently early peri- od, I believe much benefit may be derived by taking away blood pretty freely by means of leeches applied near the temples. I lately saw an instance where a child was at- tacked with every symptom of this disease, by which its parents had previously lost children. Leeches were applied. The puncture made by one of them continued to discharge blood during the whole night; on discovering this accident next morning the parents were much alarmed for the consequences. From that period, however, the child began to recover, and is at present in good health. A. P. B. t One reason why this disease is seldom or never cured may be, that it is seldom known till too far advanced to admit of remedy. Did parents watch the first symptoms, and call a physician in due time, I am inclined to think that something might be done. But these symptoms are not yet sufficiently known, and are often mistaken even by physicians themselves. Of this I lately saw a striking instance in a patient at- tended by an eminent practitioner of this city, who had all along mistaken the disease for teething. 438 PHYSICAL MANAGEMENT is so easy and certain, besides affording a perfect command both of lime and circumstances. (Hooping Cough.* See p. 207.) CHAP. XI. OBSERVATIONS ON THE MORAL AND PHYSICAL MANAGEMENT OF CHILDREN, DISEASES, &c. It is during infancy that the foundation of a good or bad constitu- tion is generally laid; it is therefore of importance that parents should be weil acquainted with the various causes which may in- jure the health of their offspring. It appears from the annual registers of the dead, that almost one half of the children born in Great Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but on due examination it will be found to be one of our own cre- ating. Were the death pf infants a natural evil, other animals would be as liable to die young as man ; but this we find is by no means the case. It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the manage- ment of his young; but our surprise will soon cease, if we consid- er that brutes, guided by instinct, never err in this respect; while man, trusting solely to art, is seldom right. Were a catalogue of those infants who perish annually by art alone exhibited to public view, it would astonish most people. If parents are above taking care of their children, others must be employed for that purpose; these will always endeavour to re- commend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and de- structive articles have been introduced into the diet, clothing, &.c. of infants, that it is no wonder so many of them perish. Nothing can be more preposterous than a mother who thinks it below her to take care of her own child, or who is so ignorant as not to know what is proper to be done for it. If we search nature throughout, we cannot find a parallel to this. Every other animal is the nurse of its own offspring, and they thrive accor- dingly. Were the brutes to bring up their young by proxy they would share the same fate with those of the human species. We mean not, however, to impose it as a task upon every moth- er to suckle her own child. This, whatever speculative writers may allege, is in some cases impracticable, and would inevitably prove destructive both to the mother and child. Women of deli- cate constitutions, subject to hysteric fits, or other nervous affec- tions, make very bad nurses ;t and these complaints are now so common, that it is rare to find a woman of fashion free from them; such women, therefore, supposing them willing, are often unable to suckle their own children. * Smali.-pox, Measles, Worms, &c. in the body of the work. 11 have known an hysteric woman kill her child by being seized with a fit in the night. OF CHILDREN. 439 Almost every mother would be in a condition to give suck, did mankind live agreeably to nature ; but whoever considers how far many mothers deviate from her dictates, will not be surprised to find some of them unable to perform that necessary office. Moth- ers who do not eat a sufficient quantity of solid food, nor enjoy the benefit of free air and exercise, can neither have wholesome juices themselves, nor afford proper nourishment to an infant. Hence children who are suckled by delicate women either die young, or continue weak and sickly all their lives. When we say that mothers are not always in a condition to suckle their own children, we would not be understood as discour- aging that practice. Every mother who can, ought certainly to perform so tender and agreeable an office.* But suppose it to be out of her power, she may, nevertheless, be of great service to her child. The business of nursing is by no means confined to giving suck. To a woman who abounds with milk, this is the easiest part of it. Numberless other offices are necessary for a child, which the mother ought at least to see done. A mother who abandons the fruit of her womb as soon as it is born to the sole care ofan hireling hardly deserves that name. A child, by being brought up under the mother's eye, not only secures her affection, but may reap all the advantages of a parent's care though it be suckled by another. How can a mother be better em- ployed than in superintending the nursery ? This is at once the most delightful and important office ; yet the most trivial business or insipid amusements are often preferred to it! A strong proof both of the bad taste and wrong education of modern females. It is indeed to be regretted that more care is not bestowed in teaching the proper management* of children to those whom nature has designed for mothers. This, instead of being made the princi- pal, is seldom considered as any part of female education. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to that char- acter ? However strange it may appear, it is certainly true, that many mothers, and those of fashion too, are as ignorant, when they have brought a child into the world, of what is to be done for it, as the infant itself. Indeed the most ignorant of the sex are generally reckoned most knowing in the business of nursing. Hence, sensible people become the dupes of ignorance and super- stition ; and the nursing of children, instead of being conducted by reason, is the result of whim and caprice.t * Many advantages would arise to society, as well as to individuals, from mothers suckling their own children. It would prevent the temptation which poor women are laid under of abandoning their children to 6uckle those of the rich for-the sake of gain ; by which means society loses many of its most useful members, and mothers become in some sense the murderers of their own offspring. 1 am sure I speak within the truth when I say, that not one in twenty of those children live who are thus abandon- ed by their mothers. For this reason no mother should be allowed to suckle anoth- er's child till her own is either dead or fit to be weaned. A regulation of this kind would save many lives among the poorer sort, and could do no hurt to the rich, as most women who make good nurses are able to suckle two children in succession upon the same milk. t 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 6ays, that informer times the greatest women in Rome used to account it their chief glory to keep the house and attend their children; but that now the young infant was com- 440 PHYSICAL MANAGEMENT Were the tune that is generally spent by females in the acquisi tion of trifling accomplishments employed in learning how toTbiim, up their children ; how to dress them so as not to hurt, cramn or confine their motions ; how to feed them with wholesome and nourishing food; how to exercise their tender bodies, so as best to promote their growth and strength: were these made the objects of female instruction, mankind would derive the greatest advVn tagc. from it But while the education of females implies little more than what relates to dress and public show, we have nothing to expect from them but ignorance even in the most import!!? concerns. »'l'"iuiiu Did mothers reflect on their own importance and lay it to heart they would embrace every opportunity of informing themselves of the duties which they owe to their infant offspring;! It is their province, not only to form the body, but also to give the'mind its most early bias. They have it very much in their power to make men healthy or valetudinary, useful in life or the pests of society. r But the mother is not the only person concerned in the manage- ment of children. The father has an equal interest in their wel- fare, and ought to assist in e\cry thing that respects either the improvement of the body or mind. It is a pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments as recommend them to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the af- fairs of the nursery, that many would reckon it an affront were they supposed to know any thing'of them. Not so, however, with the kennel or the stables ! A gentleman of the first rank is not ashamed to give directions concerning the management of his dogs or horses, yet would blush were he surprised in performing the same office for that being who derived its existence from himself, who is the heir of his fortunes, and the future hope of his country ! Nor have physicians themselves been sufficiently attentive to the management of children. This has been generally considered as the sole province of old women, while men of the first character in physic have refused to visit infants even when sick. Such con- duct in the faculty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous dis- eases. The consequence is, that a physician is seldom called till the good women have exhausted all their skill; when his attend- ance can only serve to divide the blame, and appease the discon- solate parents. Nurses should do all in their power to prevent diseases ; but when a child is taken ill, some person of skill ought immediately to be consulted. The diseases of children are generally acute, and the least delay is dangerous. Were physicians more attentive to the diseases of infants, they mitted to the sole care of some poor Grecian wench, or other menial servant.—We are afraid, wherever luxury and effeminacy prevail, there will be too much ground far this complaint. OF CHILDREN. 441 would not only be better qualified to treat them properly when Bick, but likewise to give useful directions for their management when well. The diseases of children are by no means so difficult to be understood as many imagine. It is true, children cannot tell their complaints ; but the causes of them may be pretty certainly discovered by observing the symptoms, and putting proper ques- tions to the nurses. Besides, the diseases of infants, being less complicated, are easier cured than those of adults.* It is really astonishing that so little attention should in general be paid to the preservation of infants. What labour and expense are daily bestowed to prop an old tottering carcase for a few years, while thousands of those who might be useful in life perish without being regarded ! Mankind are too apt to value things according to their present, not their future usefulness. Though this is of all others the most erroneous method of estimation, yet upon no other principle is it possible to account for the general indifference with respect to the death of infants. Of Diseased Parents. Onk great source of the diseases of children is the unhealthi- ness of parents. It would be as reasonable to expect a rich crop from a barren soil, as that strong and healthy children should be horn of parents whose constitutions have been worn out with in- temperance or disease. An ingenious writert observes, that on the constitution of moth- ers depends originally that of their offspring. No one who be- lieves this will be surprised, on a view of the female world, to find diseases and death so frequent among children. A delicate female, brought up within doors, an utter stranger to exercise and open nir, who lives on tea and other slops, may bring a child into the world, but it will hardly be fit to live. The first blast of disease will nip the tender plant in the bud ; or should it struggle through a few years' existence, its feeble frame, shaken with convulsions from every trivial cause, will be unable to perform the common functions of life, and prove a burden to society. If to the delicacy of mothers we add the irregular lives of fathers, we shall see farther cause to believe that children are often hurt by the constitution of their parents. A sickly frame may be origin- ally induced by hardships or intemperance, but chiefly by the lat- ter. It is impossible that a course of vice shall not spoil the best constitution ; and, did the evil terminate here, it would be a just punishment for the folly of the sufferer : but when once a disease is contracted and riveted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the king's evil, to transmit to our offspring ! How happy had it been for the heir of many a great estate had he been born a beggar, rather than * The common opinion, that the diseases of infants are hard to discover and diffi- cult to cure, has deterred many physicians, from paying that attention to them which they deserve. I ran, however, from experience declare, that this opinion is without foundation ; and that the diseases of infants are neither so difficult to discover nor M ill to cure as those of adults. t Rousseau. T2 442 PHYSICAL MANAGEMENT to inherit his father's fortunes at the expense of inheriting his dig- eases ! A person labouring under any incurable malady ought not to marry. He thereby not only shortens his own life but transmits misery to others; but when both parties are deeply tainted with the scrofula, the scurvy, or the like, the effects must be still worse. If such have any issue they must be miserable indeed. Want of attention to these things in forming connections for life has root- ed out more families than plague, famine, or the sword ; and ai long as these connections are formed from mercenary views the evil will be continued.* In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know that the generous courser cannot be bred out of the foundered jade, nor the sagacious spaniel out of the snarling cur. This is settled upon immutable laws. The man who marries a woman of a sickly con- stitution, and descended of unhealthy parents, whatever his views may be, cannot be said to act a prudent part. A diseased woman may prove fertile; should this be the case, the family must become an infirmary : what prospect of happiness the father of such a fam- ily has, we shall leave any one to judge.t Such children as have the misfortune to be born of diseased pa- rents will require to be nursed with greater care than others. This is the only way to make amends for the defects of constitution; and it will often go a great length. A healthy nurse, wholesome air, and sufficient exercise, will do wonders. But when these are neglected, little is to be expected from any other quarter. The defects of constitution cannot be supplied by medicine. Those who inherit any family-disease ought to be very circum- spect in their manner of living. They should consider well the nature of such disease, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one generation ; and there is reason to believe, that, by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family-constitutions are as capable of improvement as family-estates; and the libertine who impairs the one does greater injury to his posterity than the prodigal who squanders the other. Clothing of Children. The clothing of an infant is so simple a matter, that it is sur- prising how any person should err in it; yet many children lose fheir lives, and others are deformed by inattention to this article. Nature knows of no use of clothes to an infant, but to keep it warm. All that is necessary for this purpose is to wrap it in a merce with the d.seased; and to *w aU w«e *e£' ™, bee8n forbid ,0 marry. Thi. ?ard- .a y:^^^?^**™**'aod a p°utical mi8chief; M therefore requires a public cons.deration. OF CHILDREN. 443 soft loose covering. Were a mother left to the dictates of nature alone, she would certainly pursue this course. But the business of dressing an infant has long been out of the hands of mothers, and has at last become a secret which none but adepts pretend to un- derstand. From the most early ages it has been thought necessary, that a woman in labour should have some person to attend her. This in time became a business; and, as in all others, those who were em- ployed in it strove to outdo one another in the different branches of their profession. The dressing of a child came of course to be considered as the midwife's province ; who, no doubt, imagined, that the more dexterity she could show in this article the more her skill should be admired. Her attempts were seconded by the van- ity of parents, who, too often desirous of making a show of the in- fant as soon as it was born, were ambitious to have as much finery heaped upon it as possible. Thus it came to be thought as neces- sary for a midwife to excel in bracing and dressing an infant as for a surgeon to be expert in applying bandages to a broken limb; and the poor child, as soon as it came into the world, had as many rol- lers and wrappers applied to its body as if every bone had been fractured in the birth ; while these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary to life. In most parts of Britain, the practice of rolling children with so many bandages is now, in some measure, laid aside ; but it would still be a difficult task to persuade the generality of mankind that the shape ofan infant does not entirely depend on the care of the midwife. So far, however, are all her endeavours to mend the shape from being successful, that they constantly operate the con- trary way, and mankind become deformed in proportion to the means used to prevent it. How little deformity of body is to be found among uncivilized nations ! So little, indeed, that it is vul- garly believed they put all their deformed children to death. The truth is, they hardly know such a thing as a deformed child. Nei- ther should we, if we. followed their example. Savage nations nev- er think of managing their children. They allow them the full use of every organ, carry them abroad in the open air, wash their bod- ies daily in cold water, &c. Uy this management their children become so strong and hardy, that by the time our puny infants get out of the nurse's arms, theirs are able to shift for themselves.* Among brute animals, no art is necessary to procure a fine shape. Though many of them are extremely delicate when thev come into the world, yet we never find them grow crooked for want of swaddling-bands. Is nature less generous to the human kind ? i\o : but we take the business out of nature's hands. Not only the analogy of other animals, but the very feelings of infants tell us, they ought to be kept easy and free from pressure. They cannot, indeed, tell their complaints, but they can show signs of pain ; and this they never fail to do by crying when hurt by * A friend of mine, who was several years on the coast of Africa, tells me, that the natives neither put any clothes upon their children, nor apply to their bodies bandages of any kind, but lay them on a pallet, and suffer them to tumble about at pleasure ) Tet they are all straight, and seldom have *ny disease. 444 PHYSICAL MANAGEMENT their clothes. No sooner are they freed from their bracings than they seem pleased and happy; yet, strange infatuation! the moment they hold their peace they are again committed to their chains. If we consider the body of an infant as a bundle of soft pipes, replenished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of the children, has formed their bodies soft and flexible; and lest they should receive any injury from pressure in the womb, has surrounded the foetus everywhere with fluids. This shows the care which nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing that might in the least cramp or confine their motions. Even the bones of an infant are so soft and cartilaginous that they readily yield to the slightest pressure, and easily assume a bad shape, which can never after be remedied. Hence it is that so many people appear with high shoulders, crooked spines, and flat breasts, who were as well-proportioned at their births as others, but who had the misfortune to be squeezed out of shape by the ap- plication of stays and bandages. Pressure, by obstructing the circulation, likewise prevents the equal distribution of nourishment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, while another remains too small; and thus in time the whole frame becomes disproportioned and misshapen. To this we must add, that when a child is cramped in its clothes it naturally shrinks from the part that is hurt; and by putting its body into unnatural postures, it becomes deformed by habit. Deformity of body may, indeed, proceed from weakness or dis- ease ; but, in general, it is the effect of improper clothing. Nine- tenths, at least, of the deformity among mankind must be imputed to this cause. A deformed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impaired. Hence few people re- markably misshapen are strong or healthy. The new motions which commence at the birth, as the circula- tion of the whole mass of blood through the lungs, respiration, the peristaltic motion, &c. afford another strong argument for keeping die body of an infant free from all pressure. These organs, not having been accustomed to move, are easily stopped ; but when this happens, death must ensue. Hardly any method could be de- vised more effectually to stop these motions than bracing the body too tight with rollers* and bandages. Were these to be applied in the same manner to the body of an adult for an equal length of time, they would hardly fail to hurt the digestion and make him sick. How much more hurtful they must prove to the tender bod- ies of infants, we shall leave any one to judge. Whoever considers these things will not be surprised that so many children die of convulsions soon after the birth, lnesei «■ are generally attributed to some inward cause ; but in fact tney "•Thisiabvno means inveighing against a thing that does not happen. In nan paJJf Britoin atThis day, a Atotdfrt or ten feet in length, is applied t.ghtly rourf the child's body as soon as it is born. OF CHILDREN. 446 oftener proceed from our own imprudent conduct. I have known a child seized with convulsion-fits soon after the midwife had done swaddling it, who, upon taking off the rollers and bandages, was immediately relieved, and never had the disease afterwards. Nu- merous examples of this might be given were they necessary. It would be safer to fasten the clothes of an infant with strings than pins, as they often gall and irritate their tender skins, and occasion disorders. Pins have been found sticking above half an inch into the body of a child after it had died of convulsion-fits, which in all probability proceeded from that cause. Children are not only hurt by the tightness of their clothes, but also by the quantity. Every child has some degree of fever after the birth ; and if it be loaded with too many clothes the fever must be increased. But this is not all ; the child is generally laid in bed with the mother, who is often likewise feverish; to which we may add the heat of the bed-chamber, the wines and other heating things too frequently given to children immediately after birth. When all these are combined, which does not seldom happen, they must increase the fever to such a degree as will endanger the life of the infant. The danger of keeping infants too hot will further appear, if we consider that, after they have been for some time in the situation mentioned above, they are often sent into the country to be nursed in a cold house. Is it any wonder if a child, from such a transi- tion, catches a mortal cold, or contracts some other fatal disease ? When an infant is kept too hot, its lungs, not being sufficiently expanded, are apt to remain weak and flaccid for life; hence pro- ceed coughs, consumptions, and other diseases of the breast. It would answer little purpose to specify the particular species of dress proper for an infant. These will always vary in different countries, according to custom and the humour of parents. The great rule to be observed is, That a child have no more clothes than are necessary to keep it warm, and that they be quite easy for its body. Stays are the very bane of infants. A volume would not suffice to point out all the bad effects of this ridiculous piece of dress, both on children and adults. The madness in favour of stays, seems, however, to be somewhat abated ; and it is to be hoped the world will, in time, become wise enough to know, that the human shape does not solely depend upon whalebone and bend leather.* I shall only, add with respect to the clothes of children, that they ought to be kept thoroughly clean. Children perspire more than ndults, and if their clothes be not frequently changed, they become very hurtful. Dirty clothes not only gall and fret the tender skins of infants, but likewise occasion ill smells, and, what is worse, tend to produce vermin and cutaneous diseases. Cleanliness is not only agreeable to the eye, but tends greatly to * Stays, made of bend leather, are worn by all the women of lower station in many parts of England. ... , . * , »v„;. I am sorry to understand, that there are still mothers mad enough tolace their daughters very ti«»ht in order to improve their shape. As reasoning would be totally lost upon such people, I shall beg leave just to ask them, Why there are ten deformed women for one man 1 and likewise to recommend to their perusal a short moral pre- cept, which forbids us to deform the human body. 446 PHYSICAL MANAGEMENT preserve the health of children. It promotes the perspiration, and, by that means, frees the body from superfluous humours, which, if retained, could not fail to occasion diseases. No mother or nurse can have any excuse for allowing a child to be dirty. Poverty may oblige her to give it coarse clothes; but if she does not keep them clean, it must be her own fault. Of the Food of Children. Nature not only points out the food proper for an infant, but ac- tually prepares it. This, however, is not sufficient to prevent some who think themselves wiser than nature from attempting to bring up their children without her provision. Nothing can show the disposition which mankind have to depart from nature more than their endeavouring to bring up children without the breast. The mother's milk, or that of a healthy nurse, is unquestionably the best food for an infant. Neither art nor nature ca'n afford a proper substitute for it. Children may seem to thrive for a few months without the breast; but when teething, the small-pox, and other diseases incident to childhood come on, they generally perish. A child, soon after the birth, shows an inclination to suck; and there is no reason why it should not be gratified. It is true, the mother's milk does not always come immediately after the birth ; but this is the way to bring it; besides, the first milk that the child can squeeze out of the breast answers the purpose of cleansing bet- ter than all the drugs in the apothecary's shop, and at the same time prevents inflammations of the breast, fevers, and other dis- eases incident to mothers. It is strange how people came to think that the first thing given to a child should be drugs. This is beginning with medicine be- times, and no wonder if they generally end with it. It sometimes happens, indeed, that a child does not discharge the meconium so soon as could be wished; this has induced physicians, in such cases, to give something of an opening nature to cleanse the first passages. Midwives have improved upon this hint, and.never fail to give syrups, oils, Sec. whether they be necessary or not. Cram- ming an infant with such indigestible stuff as soon as it is born can hardly fail to make it sick, and is more likely to occasion dis- eases than to prevent them. Children are seldom long after the birth without having passage both by stool and urine ; though these evacuations may be wanting for some time without any danger. But if children must have something before they be allowed the breast, let it be a little thin water pap, to which may be added an equal quantity of new milk, or rather water alone, with the addi- tion of a little moist sugar. If this be given without any wine or spiceries it will neither heat the blood, load the stomach, nor occa- sion gripes. , . , Upon the first sight of an infant, almost every person is struck with the idea of its being weak, feeble, and wanting support. 1 his naturally suggests the need of cordials. Accordingly wines are universally mixed with the first food of children. Nothing can be more fallacious than this way of reasoning, or more hurtful to in- fants than the conduct founded upon it. Children require very lit* OF CHILDREN. 447 tie food for some time after the birth, and what they receive should be thin, weak, light, and of a cooling quality. ^||very small quan- tity of wine is sufficient to heat and inflame the Wood of an infant; but every person conversant in these matters must know, that most of the diseases of infants proceed from the heat of their hu- mours. If the mother or nurse has enough of milk, the child will need little or no other food for the third or fourth month. It will then be proper to give it, once or twice a-day, a little of some food that is easy of digestion, as water-pap, milk-pottage, weak broth with bread in it, and such like. This will ease the mother, will accus- tom the child by degrees to take food, and will render the weaning both less difficult and less dangerous. All great and sudden tran- sitions are to be avoided in nursing. For this purpose the food of children ought not only to be simple, but to resemble, as nearly as possible, the properties of milk. Indeed, milk itself should make a principal part of their food, not only before they are weaned but for some time after. Next to milk, we would recommend good light bread. Bread may be given to a child as soon as it shows an inclination to chew; and it may at all times be allowed as much plain bread as it will eat. The very chewing of bread will promote the cutting of the teeth, and the discharge of saliva, while, by mixing with the nurse's milk in the stomach, it will afford an excellent nourishment. Chil- dren discover an early inclination to chew whatever is put into their hands. Parents observe the inclination but generally mis- take the object. Instead of giving the child something which may at once exercise its gums and afford it nourishment, they common- ly put into its hands a piece of hard metal, or impenetrable coral. A crust of bread is the best gum-stick. It not only answers the purpose better than any thing else, but has the additional proper- ties of nourishing the child, and carrying the saliva down into the stomach, wliich is too valuable a liquor to be lost. Bread, besides being used dry, may be many ways prepared in- to food for children. One of the best methods is to boil it in water, afterwards pouring the water off, and mixing with the bread a proper quantity of new milk unboiled. Milk is both more whole- some and nourishing this way than boiled, and is less apt to occa- sion costiveness. For a child farther advanced, bread may be mix- ed in veal or chicken broth, made into puddings, or the like. Bread is a proper food for children at all times, provided it be plain, made of wholesome grain, and well fermented ; but when enriched with fruits, sugars, or such things, it becomes very un- wholesome, i i It is soon enough to allow children animal food when they have got teeth to eat it. They should never taste it till after they are weaned, and even then they ought to use it sparingly. Indeed, when children live wholly on vegetable food, it is apt to sour on their stomachs ; but, on the other hand, too much flesh heats the body, and occasions fevers and other inflammatory diseases, lhis plainly points out a due mixture of animal and vegetable food us most proper for children. Few things prove more hurtful to infants than the common. 448 PHYSICAL MANAGEMENT method of sweetening their food. It entices them to take more than they ought 4Nlo, which makes them grow fat and bloated. It is pretty certahvif the food of children were quite plain, that they would never take more than enough. Their excesses are entirely owing to nurses. If a child be gorged with food at all hours, and enticed to take it, by making it sweet and agreeable to the palate, is it any wonder that such a child should in time be in- duced to crave more food than it ought to have 1 Children may be hurt by too little as well as by too much food. After a child is weaned it ought to be fed four or five times a-day; but should never be accustomed Jo eat in the night; neither should it have too much at a time. Children thrive best with small quan- tities of food frequently given. This neither overloads the stomach nor hurts the digestion, and is certainly most agreeable to nature. Writers on nursing have inveighed with such vehemence against giving children too much food, that many parents, by endeavour- ing to shun that error, have run into the opposite 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 herself when overcharged; but a child who is pinched with hunger will never become a strong or a healthy man. That errors are frequently committed on both sides we are ready to acknowledge; but where one child is hurt by the quantity of its food, ten suffer from the quality. This is the prin- cipal evil, and claims our strictest attention. Many people imagine, that the food which they themselves love cannot be bad for their children ; but this notion is very absurd. In the more advanced periods of life we often acquire an inclina- tion for food which when children we could not endure. Besides, there are many things that by habit may agree very well with the stomach of a grown person, which would be hurtful to a child; as high-seasoned, salted, and smoke-dried provisions, &c. It would also be improper to feed children with fat meat, strong broths, rich soups, or the like. All strong liquors are hurtful to children. Some parents teach their children to guzzle ale, and other fermented liquors, at every meal. Such a practice cannot fail to do mischief. These children seldom escape the violence of the small-pox, measles, hooping- cough, or some inflammatory disorder. Milk, water, butter-milk, or whey, are the most proper for children to drink. If they have any thing stronger, it may be fine small beer, or a little wine mix- ed with water. The stomachs of children can digest well enough without the assistance of warm stimulants ; besides, being natu- rally hot, they are easily hurt by every thing of a heating quality. Few things are more hurtful to children than unr.pe fruits. They weaken the powers of digestion, and sour and relax the stomach, by which means it becomes a proper nest for insects. Children, indeed, show a great inclination for fruit and 1 am ap to believe that if good ripe fruit were allowed them in prope quant tyt would hive no bad effects. We never find a natural Sttion wrong if properly regulated. Fruils are generally of a cooHngnaturefand"correct the heat and acr.m,nr »: the hu- This is what most children require; only care should be mours. OF CHILDREN. 449 taken lest they exceed. Indeed the best way to prevent children from going to excess in the use of fruit, or eatinjLjhat which is bad, is to allow thein a proper quantity of what is j0|Ril!* Roots which contain a crude viscid juice fjibuld be sparingly given to children. They fill the body with gross humours, and tend to produce eruptive diseases ; this caution is peculiarly neces- sary for the poor. Glad to obtain, at a small price, what will fill the bellies of their children, they stuff them too or three times a day with crude vegetables. Children had better eat a smaller quantity of food which yields a wholesome nourishment, than be crammed with what their digestive powers are unable properly to assimilate. Butter ought likewise to be sparingly given to children. It both relaxes the stomach, and produces gross humours. Indeed, most things that are fat or oily have this effect. Butter when salted be- comes still more hurtful. Instead of butter, so liberally given to children in most parts of Britain, we would recommend honey. Children who eat honey are seldom troubled with worms ; they are also less subject to cutaneous diseases, as itch, scabbed head, Sic Many people err in thinking that the diet of children ought to be altogether moist. When children live entirely upon slops, it relaxes their solids, renders them weak, and disposes them to the rickets, the scrofula, and other glandular disorders. Relaxation is one of the most general causes of the diseases of children. Ev- ery thing, therefore, which tends to unbrace their solids ought to be carefully avoided. We would not be understood by these observations as confining children to any particular kind of food. Their diet may be fre- quently varied, provided always that sufficient regard be had to simplicity. Exercise of Children. Of all the causes which conspire to render the life of man short and miserable, none has greater influence than the want of proper Exercise : healthy parents, wholesome food, and proper clothing, will avail little, where exercise is neglected. Sufficient exercise will make up for several defects in nursing: but nothing can sup- ply the want of it. It is absolutely necessary to the health, the growth, and the strength of children. The desire of exercise is coeval with life itself. Were this princi- ple attended to, many diseases might be prevented. But, while in- dolence and sedentary employments prevent two-thirds of mankind from either taking sufficient exercise themselves, or giving it to their children, what have we to expect but diseases and deformity among their offspring? The rickets, so destructive to children, * Children are always sickly in the fruit season, which may be thus accounted for :-- Two-thirds of the fruit which comes to market in this country is really unripe ; and children, not being in a condition to judge for themselves, eat whatever they can lay their hands upon, which often proves litUe better than a poison to their tender bowel*. Servanto, and others who have the care of children, should be strictly forbidden to give them any fruit without the knowledge of their parents. 450 PHYSICAL MANAGEMENT never appeared in Britain till manufactures began to flourish, ami people, attract^! by the love of gain, left the country to follow sedentary employments in great towns. It is amongst these peo- ple that this disealfc chiefly prevails, and not only deforms but kills many of their offspring. The conduct of other young animals shows the propriety of giv- ing exercise to children. Every other animal makes use of its or- gans of motion as soon as it can; and many of them, even when under no necessity of moving in quest of food, cannot be restrain- ed without force. This is evidently the case with the calf, the lamb, and most other young animals. If these creatures were not permitted to frisk about and take exercise, they would soon die or become diseased. The same inclination appears very early in the human species; but as they are not able to take exercise them- selves, it is the business of their parents and nurses to assist them. Children may be exercised various ways. The best method, while they are light, is to carry them about in the nurse's arms.* This gives the nurse an opportunity of talking to the child, and of pointing out every thing that may please and delight its fancy. Besides, it is much safer than swinging an infant in a machine, or leaving it to the care of such as are not fit to take care of them- selves. Nothing can be more absurd than to set one child to keep another; this conduct has proved fatal to many infants, and has rendered others miserable for life. When children begin to walk, the safest and best method of leading them about is by the hands. The common way, of swing- ing them in leading-strings fixed to their backs, has several bad consequences. It makes them throw their bodies forward, and press with their whole weight upon their stomach and breast; by this means the breathing is obstructed, the breast flattened, and the bowels compressed; which must hurt the digestion, and occasion consumptions of the lungs, and other diseases. It is a common notion, that if children are set upon their feet too soon their legs will become crooked. There is reason to believe that the very reverse of this is true. Every member acquires strength in proportion as it is exercised. The limbs of children are weak indeed, but their bodies are proportionably light; and had thev skill to direct themselves, they would soon be able to support their own weight. Who ever heard of any other animal that be- came crooked by using its legs too soon ? ndeed, if a child be not permitted to make any use of its legs till a considerableMime after its birth, and be then set upon them with its whole we gh at once, there may be some danger; but this proceeds entirely from the child's not having been accustomed to use its legs from ^Mo&Tofthe poorer sort think they are great gainers by mak- ing their children lie or sit while they themselves work. In this hfv are greatly mistaken. By neglecting to give their children exerctse,Uiey a7re obliged to keep them a long time before they nurse Sying it constantly on one arm. OF CHILDREN. 451 can do any thing for themselves, and to spend more on medicine than would have paid for proper care. ^m^ To take care of their children is the m^^Rful business in which even the poor can be employed: but,"J^T! it is not always in their power. Poverty often obliges them 1o neglect their off- spring in order to procure the necessaries of life. When this is the case, it becomes the interest as well as the duty of the public to assist them. Ten thousand times more benefit would accrue to the state by enabling the poor to bring up their own children, than from all the hospitals* that ever can be erected for that purpose. Whoever considers the structure of the human body will soon be convinced of the necessity of exercise for the health of children. The body is composed ofan infinite number of tubes, whose fluids cannot be pushed on without the action and pressure of the mus- cles. But, if the fluids remain inactive, obstructions must happen, and the humours will of course be vitiated, which cannot faH to occasion diseases. Nature has furnished both the vessels which carry the blood and.lymph with numerous valves, in order that the action of every muscle might push forward their contents ; but without action, this admirable contrivance can have no effect. This part of the animal economy proves to a demonstration the neces- sity of exercise fo^the preservation of health. Arguments to show the importance of exercise might be drawn from every part of the animal economy; without exercise the cir- culation of the blood cannot be properly carried on, nor the differ- ent secretions duly performed ; without exercise, the fluids cannot be properly prepared, nor the solids rendered strong or firm. The action of the heart, the motion of the lungs, and all the vital func- tions, are greatly assisted by exercise. But to point out the man- ner in which these effects are produced would lead us farther into the economy of the human body than most of those for whom this treatise is intended would be able to follow. We shall therefore only add, that when exercise is neglected, none of the animal func- tions can be duly performed ; and when this is the case, the whole constitution must go to wreck. A good constitution ought certainly to be our first object in the management of children. It lays a foundation for their being use- ful and happy in life ; and whoever neglects it, not only fails in his duty to his offspring, but to society. One very common error of parents, by which they hurt the con- stitutions of their children, is the sending them too young to school. This is often done solely to prevent trouble. When the child is ut school, he needs no keeper. Thus the school-master is made the nurse ; and the poor child is fixed to a seat seven or eight hours a-day, which time ought to be spent in exercise and diver- sions. Sitting so long cannot fail to produce the worst effects up- * If it were made the interest of the poor to keep their children alive, we should lose very few of them. A small premium given annually to each poor family, for eve- ry child they have alive at the year's end, would save more infant lives than if the whole revenue of the crown were expended on hospitals for this purpose. This would make the poor esteem fertility a blessing; whereas many of them thjnk it the great- est curse that can befall the.ii; and in place of wishing their children to live, so tar does poverty get the better of natural affection, that they are often very happy when they die. m PHYSICAL MANAGEMENT on the .body;.nor is the mind less injured. Early application weakens the faejues, and often fixes in the mind an aversion Z books which corl^iueii for life.* But suppose thisippre the way to make children scholars, it cer- tainly ought not toTe done at the expense of their constitution! Our ancestors who seldom went to school very young, were 2 Jess learned than we. But we imagine the bnj'I educaUon w H^ quite marred unless he be carried to school in his nurse's a Is No wonder that such hot-bed plants seldom become either scholar, Not only the confinement of children in public schools, but their number often proves hurtful. Children are much injured by bein. kept m crowds within doors ; their breathing not only renders the place unwholesome, but if any one of them happen to be diseased, the rest catch the infection. A single child has been often known to communicate the bloody flux, the hooping-cough, the itch, or other diseases, to almost every individual in a numerous school. But, if fashion must prevail, and infants are to be sent to school, we would recommend it to teachers, as they value the interests of society, not to confine them too long at a time, but allow them to run about and play at such active diversions as may promote their growth, and strengthen their constitutions. Were boys, instead of being whipped for stealing an hour to run, ride, swim, or the like, encouraged to employ a proper part of their time in these munly and useful exercises, it would have many excellent effects. It would be of great service to boys, if, at a proper age, they were' taught the military exercise. This would increase their strength, inspire them with courage, and when their country called for their assistance, would enable them to act in her defence, with- out being obliged to undergo a tedious and troublesome course of instructions, at a time when they are less fit to Jearn new motions, gestures, Secf An effeminate education will infallibly spoil the best natural con- stitution ; and if boys are brought up in a more delicate manner than even girls ought to be, they will never be men. Nor is the common education of girls less hurtful to the constitu- tion than that of boys. Miss is set down to her frame before she can put on her own clothes ; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general es- teem. It is unnecessary here to insist upon the dangerous conse- quences of obliging girls to sit too much. They are pretty well known, and are too often felt at a certain time of life. But suppos- ing this critical period to be got over, greater dangers still wait * It is undoubtedly the duty of parents to instruct their children, at least till they are ofan age proper to take some care of themselves. This would tend much to con- firm the ties of paternal tenderness and filial affection, of the want of which there are at present so many deplorable instances. Though few fathers have time to instruct their children, yet most mothers have; and surely they cannot be better employed. 11 am happy to find that the masters of academies now begin to put in practice this advice. Each of them ought to keep a drill-serjeant for teaching the boys the milita- ry exercise. This, besides contributing to their health and vigour of body, would hare many other happy effects. [Gymnastic exercises are becoming justly popular, and their superiority over the warlike needs not to be told to Americans. Am. Ed.] OF CHILDREN. 453 them when they come to be mothers. Women who have been ear- ly accustomed to a sedentary life, generally rMkgreat hazard in child-bed ; while those who have been used tororrlp about, and take sufficient exercise, are seldom in any dangen^- One hardly meets with a girl who can at the same time boast of early performances by the needle, and a good constitution. Close and early confinement generally occasions indigestions, head- aches, pale complexions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and deformity of body. The last of these, indeed, is not to be wondered at, considering the awk- ward postures in which girls sit at many kinds of needlework, and the delicate flexible state of their bodies in the early periods of life. Would mothers, instead of having their daughters instructed in many trifling accomplishments, employ them in plain work and housewifery, arid allow them sufficient exercise in the open air, they would both make them more healthy mothers, arid more use- ful members of society, f am no enemy to genteel accomplish- ments, but would have them only considered as secondary, and al- ways disregarded when they impair health. Manv people imagine it a great advantage for children to be early taught to earn their bread. This opinion is certainly right, provided they wefjfcfso employed as not to hurt their health or growth; but, when these suffer, society, instead of being benefited, is a real loser by their labour. There are few employments, ex- cept sedentary ones, by which children can earn a livelihood ; and if they be set to these too soon, it ruins their constitutions. Thus, by gaining a few years from childhood, we generally lose twice as many in the latter period of life, and even render the person less useful while he does live. In on!er to be satisfied of the truth of this observation, we need only look into the great manufacturing towns, where we shall find a punv degenerate race of people, weak and sickly all their lives, seldom exceeding the middle period of life; or if they do, being unfit for business, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a coun- iry. are by no means favourable to the health of its inhabitants. od policy would therefore require, that such people as labour during life should not be set too early to work. Every person conversant in the breed of horses, or other working animals, knows, that if thev be set to hard labour too soon, they will never turn out to advantage. This is equally true with respect to the human species. There are, nevertheless, various ways of employing young peo- ple, without hurting their health. The easier parts of gardening, husbandry, or any business carried on without doors, are most proper. These are employments which most young people are fond of, and some parts of them may be always adapted to their age, taste, and strength.* Such parents, however, as are under the necessity of employing their children within doors, ought to allow them sufficient time for • I have been told that in China, where the police is the best in the world, all the children are employed m the easier part of gardening and husbandry) as weeding gathering stones off the land, and such like. 454 PHYSICAL MANAGEMENT active diversions without. This would both encourage them to .In more work, andfcvent their constitutions from being hurt Some imagim»j^exercise within doors is sufficient; but thev are generally muoK One hour spent ,n running, or any other exercise without doors, is worth ten within. When children can ^FJ^^^J"™. b.G "^ « home. The £ method of doing this is to make them run about in a lam or dance. This last kind of exercise, if „ot carried to eCii of excellent service to young people. It cheers the -. _ j~~..& i'<-»i"c- it ciieers tne spirits, nm- motes perspiration strengthens the limbs, &c. I knew an cm ■ em physician who used to say, that he made his children dance,,"!"c"d exaSTg P ySlC' ^ W6re We" lf m01C pe°pIe folloued '* ♦u Tu eJC°?d Lbath ,may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretions promoted, and were it conducted with prudence, many diseases, as rickets, scrofula,&c. might thereby be prevented. The ancients who took every method to render children hardy and robust, were no strangers to the use of the cold bath ; and, if we may credit re- port, the practice of immersing children daily in cold water mutt have been very common among our ancestors. The greatest objection to the use of the coldjbpth arises from the superstitious prejudices of nurses. These are often so strong, that it is impossible to bring them to make a proper use of it. I have known some of them who would not dry a child's skin after bath- ing it, lest it should destroy the effect of the water. Others will even put cloths dipt in the water upon the child, and either put it to bed, or suffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular saint; while others place their confidence in a certain number of dips, as three, seven, nine, or the like; and the world could not persuade them, if these do not succeed, to try it a little longer. Thus by the whims of nurses, children Jose the benefit of the cold bath, and the hopes of the physician from that remedy are often frustrated. We ought not, however, entirely to set aside the cold bath, be- cause some nurses make a wrong use of it. Every child, when in health, should at least have its extremities daily washed in cold water. This is a partial use of the cold bath, and is better than none. In winter this may suffice; but in the warm season, if a child be relaxed, or seem to have a tendency to the rickets or scro- fula, its whole body ought to be frequently immersed in cold water. Care, however, must be taken not to do this when the body is hot, or the stomach full. The child should be dipped only once at a time, should be taken out immediately, and have its skin well rub- bed with a dry cloth. The bad Effects of unwholesome Air upon Children. Few things prove more destructive to children than confined or unwholesome air. This is one reason why so few of those infanta who are put into hospitals, or parish-workhouses, live. The.se places are generally crowded with old, sickly, and infirm people; OF CHILDREN. 455 by which means the air is rendered so extremely pernicious, that it becomes a poison to infants. Want of wholesome air is likewise destructive'to many of the children born in great towns. There the poorer sort of inhabit- ants live in low, dirty, confined houses, to which the fresh air has scarcely any access. Though grown people, who are hardy and robust, may live in such situations, yet they generally prove fatal to their offspring, few of whom arrive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad into the open air, we must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mother goes along with them. Servants are often negligent in these matters, and allow a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as well as her children ; and how can she be better employed than in at- tending them 1 A very bad custom prevails, of making children sleep in small apartments, or crowding two or three beds into one chamber. In- stead of this, the nursery ought always to be the largest and best aired room in the house. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, renders them delicate, and disposes them to colds and many other disorders. Nor is the custom of wrapping them too close in cradles less pernicious. One would think that nurses were afraid lest children should suffer by breathing free air, as many of them actually cover the child's face while asleep, m and others wrap a covering over the whole cradle, by which means the child is forced to breathe the same air over and over all the time it sleeps. Cradles, indeed, are on many accounts hurtful to children, and it would be better if the use of them were totally laid aside.* A child is generally laid to sleep with all its clothes on ; and if a number of others are heaped above them it must be overheated: by which means it cannot fail to catch cold on being taken out of the cradle, and exposed to the open air with only its usual cloth- ing, which is too frequently the case. Children who are kept within doors all day, and sleep all night in warm close apartments, may, with great propriety, be compar- ed to plants nursed in a hot-house, instead of the open air. Though such plants may by this means be kept alive for some time, they will never arrive at that degree of strength, vigour, and magnitude, * It is amazing how children escape suffocation, considering the manner in which they arc often rolled up in flannels, &c. I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I begged for a little free air to the poor babe ; but though this indulgence was granted during my stay, I found it always on my return in the same situation. Death, as might be expected, soon freed the infant from all its miseries : but it was not in my power to free the minds of its parents from those prejudices which proved fatal to their child. ... I was very lately called to tec an infant which was said to be expiring in convulsion 6U. I desired the mothur to strip the child, and wrap it in a loose covering. It had do more convulsion fits. 456 PHYSICAL MANAGEMENT which th«y would have acquired in the open air, nor would they be able to bear it afterwards should they be exposed to it. Children brought up in the country, who have been accustomed to open air, should not be too early sent to great towns, where it is confined and unwholesome. This is frequently done with a view to forward their education, but proves very hurtful to their health. All schools and seminaries of learning ought, if possible, to be so situated as to have fresh, dry, wholesome air, and should never be too much crowded. Without entering into a detail of the particular advantages of wholesome air to children, or of the bad consequences wliich pro- ceed from the want of it, I shall only observe that of several thou- sands of children which have been under my care, I do not re- member one instance of a single child who continued healthy in a close confined situation ; but have often known the most obstin- ate diseases cured by removing them from such a situation to an open free air. Of Nurses. It is not here intended to lay down rules for the choice of nurses. This would be wasting time. Common sense will direct every one to choose a woman who is healthy, and has plenty of milk.* If she be at the same time cleanly, careful, and good-natured, she can hardly fail to make a proper nurse. After all, however, the only certain proof of a good nurse, is a healthy child upon her breast. But, as the misconduct of nurses often proves fatal to children, it will be of importance to point out a few of their most baneful errors, in order to rouse the attention of parents, and to • make them look more strictly into the conduct of those to whom they commit the care of their infant offspring. Though it admits of some exceptions, yet we may lay it down as a general rule, That every woman who nurses for hire should be carefully looked after, otherwise she will not do her duty. For this reason parents ought always to have their children nursed under their own eye, if possible ; and where this cannot be done, they should be extremely circumspect in the choice of those persons to whom they intrust "them. It is folly to imagine that any woman who abandons her own child to suckle another for the sake of pin. Luld feel all the affections of a parent towards her nurding y so necessary are these affections in a nurse, that but for them the human race would soon be extinct. One of the most common faults of those who nurse for hire dosinff children with stupefactives, or such things as lull their. asleep An indolent nurse, who does not give a child sufficentex- e S in the open air to make it sleep, and does not choose to. be Sirtnrhed bv it in the night, will seldom fail to procure for it a d2oeiaudyanum, diacooium, saffron, or what answer, the«J purpose, a dose of spiritsor other strong liquors. TJie^hough "TThTve often known people so imposed upon, as to give an infant to a nurse ft. .uckled who had not one drop of milk in her breast. OF CHILDREN. 457 they be certain poison to infants, are every day administered by many who bear the character of very good nurses.* A nurse who has not milk enough is apt to imagine that this de- fect may be supplied by giving the child wines, cordial waters, or other strong liquors. This is an egregious mistake. The only thing that has any chance to supply the place of the nurse's milk, must be somewhat nearly of the same quality, as cow's milk, ass's milk, or beef tea, with a little bread. It never can be done by the use of strong'liquors. These, instead of nourishing an infant, nev- er fail to produce the contrary effect. Children are often hurt by nurses suffering them to cry long and vehemently. This strains their tender bodies, and frequently oc- casions ruptures, inflammations of the throat, lungs, Sic A child never continues to cry long without some cause, which might al- ways>be discovered by proper attention ; and the nurse who can hear an infant cry till it has almost spent itself, without endeav- ouring to please it, must be cruel indeed, and is unworthy to be in- trusted with the care of a human creature. Nurses who deal much in medicine are always to be suspected. They trust to it and neglect their duty. I never knew a good nurse who had her Godfrey's Cordial, Daffey's Elixir, Dalby's Carminative, &c. at hand.t Such nurses generally imagine that a dose of medicine will make up for all defects in food, air, exer- cise and cleanliness. By errors of this kind, I will venture to say, that one half the children who die annually in London lose their lives. Allowing children to continue long wet, is another very perni- cious custom of indolent nurses. This is not only disagreeable, but it galls and frets the infant, and, by relaxing the solids, occa- sions scrophula, rickets, and other diseases. A dirty nurse is al- ways to be suspected. Nature often attempts to free the bodies of children from bad humours, by throwing them upon the skin ; by this means fevers and other diseases are prevented. Nurses are apt to mistake such critical eruptions for an itch, or some other infectious disorder. Accordingly they take every method to drive them in. In this way many children lose their lives ; and no wonder, as Nature is op- posed in the very method she takes to relieve them. It ought to be a rule, wliich every nurse should observe, never to stop any eruption without proper advice, or being well assured that it is not of a critical nature. At any rate, it is never to be done without previous evacuations. Loose stools is another method by which Nature often prevents or carries off the diseases of infants. If these proceed too far, no doubt they ought to be checked ; 'tut this is never to be done with- out the greatest caution. Numv, upon the first appearance of loose stools, frequently fly to the use of astringents, or such things as bind the body. Hence inflammatory fevers, and other fatal dis- eases, are occasioned. A dose of rhubarb, a gentle vomit, or some * If a mother on visiting her c!allies of wit or specious arguments in physic for observations and experience! By these superior excellence of the cold-bath in placed beyond the possibility of a doubt. Its tonic powers are found to be peculiarly proper for the lax fibres of young people, rendering them firm and elastic, and enabling the vital organs to perform their respective functions with ease and regularity. In other parts of this work I had occasion to describe, with greater minuteness than is now necessary, the many good effects of washing children; and I gave a few directions as to the man- ner of employing this very salutary operation, from the moment uf their birth. I showed how the use of the cold bath might he grad- ually brought about with the utmost safety; and I am persuaded that those who give it a fair trial will readily comply with my far- ther advice to continue it ever after, except in such cases of indis- position or infirmity as 1 shall presently notice. Nothing contrib- utes more to the growth, vigour, and firmness of youth, or to the activity and permanent health of manhood, than daily immersion in cold water. It steels the frame against changes of weather, against the impressions of cold or moisture, and many other exter- nal injuries. It is of course the best preventive of all those diseas- es which arise from a relaxed skin, obstructed or profuse perspira- tion, and nervous weakness. When the cold bath is used merely as a means of preserving health, in which point of view I am now considering it, a single plunge or dip of the whole body will be sufficient, though active swimmers may continue their favourite amusement for five or six minutes without injury. Any longer stay might prove dangerous, by not only occasioning a strong determination of blood to the head, but chilling the vital fluid, cramping the muscles, relaxing the nerves, and wholly defeating the intention of bathing. For want of a due regard to these circumstances, young men have of- ten endangered, and sometimes lost their lives. In all cases, it is hip-hly necessary to be rubbed dry at the instant of coming out of the water, and to take exercise for at least half an hour after. A little exercise is also advisable before bathing, so as to excite a gentle glow or temperate degree of warmth, and thus guard against the bad consequences of a too sudden shock, when the body is either chilly or overheated. The like caution should be given against plunging into cold water after dinner, or after much fatigue. For these and many other reason?, the morning is very properly recommended to per- sons in health as the best time for bathing. It is the least likely to interfere with their other pursuits or concerns : it washes away any particles of the perspirable matter that may have remained on the surface of the skin, before they can be re-absorbed ; it affords fresh supplies of vigour and alacrity, to enter upon the duties ot he day and, as I have already hinted, it fortifies the body agatnet any changes of weather to which it may be afterwaUds exposed in 8 t S ofTeSt health, it may be further observed, that pet, COLD-BATHl.Mi. 461 pie need not give themselves much trouble to enjoy the advantages of sea-bathing in preference to river-water, as the grand effect of both is nearly the same, though some considerations of less mo- ment may concur to render the former more inviting. Among these we must reckon the usual resort of gay company to different parts of the coast in summer, the refreshing coolness of the sea-air in that season, and the agreeable stimulus which many persons expe- rience from the action of saline particles, not only in the water, but when they are floating in the atmosphere. Tt should also be considered, that the temperature of the sea is more uniform than that of rivers, never rising so high, or sinking so low, in any change of weather. But such points of difference are chiefly interesting to valetudinarians. What I have said of the cold-bath, when used as the means of preventing disease, will throw some light on the propriety of occa- sionally resorting to it as an important remedy. In cases of pe- culiar delicacy and danger, it is an instrument which can only be entrusted to the most skilful hands ; but in many other less critical situations, a few plain rules may be of considerable service. The first object to be attended to in the use of the cold-bath, as a remedy, is, whether the patient is not too much enfeebled to bear the shock. This cannot always be determined by appearances ; but a single experiment will remove all doubt. If the immersion be followed by a pleasant glow, and a sense of increasing alacrity, it is the best proof of its agreeing with the constitution, and of Its being likely to have a happy influence on the whole frame. Hence the cold-bath is found to be an excellent bracer and restorative in cases of languor, of habitual lassitude, and of muscular or nervous weakness, when arising from much confinement, a sedentary life, intense study, or any of the usual causes of relaxation. But it is always understood, that, in every instance of this sort, a sufficient strength of original stamina still remains to produce a proper re- action of the" heart and arteries, upon which all the salutary effects of bathing depend. The great efficacy of the cold bath, and particularly of sea- bathing, has often been experienced in scrofulous complaints, which are alwnys attended with a relaxation of the fibres, and a strong disposition to languor and indolence. In such cases, sea-bathing is not only recommended as a tonic, or bracer, but as a powerful detergent and purifier also, especially if the sea-water be used inter- nally at the same time. No difference of opinion prevails on this head, as far as it relates to the scrofula, but it has been alleged, that sea-bathing, though a good preventive of the scrofula, could not remove the local effects of the disease when once formed. My own practice in the treatment of scrofulous affections has not been extensive enough to enable me to speak to this point with a tone of confidence ; but the contrary doctrine appears to me supported by the fairest reasoning, and, what is more, by indisputable facts. In the first place, a weak flaccid habit, and a thin skin, very sus- ceptible of impressions from cold moist air, are the principal, if not the .only predisposing causes of the scrofula. Now the cold-bath is the best remedy for both, as it renders the texture of the skin firm, and invigorates the system. By being therefore so well adapted 462 COLD-BATHING. to obviate causes, it must, according to one of the surest maxim of medical practice, be very fit to remove effects. The justness of such an inference has been placed beyond doubt, by the reports of men of professional eminence and veracitv under whose direction, and immediate inspection also, sea-bathing has been known to resolve swellings of the glands, as well -lS t„ correct the discharge of scrofulous ulcers, and to dispose the,,, to heal. I am therefore very willing to believe, that a regular course of sea-bathing, and the internal use of sea-water, with the aid of good air, proper exercise, and a light, yet nourishing diet, are the best means hitherto discovered for checking the progress of the evil, or counteracting its morbid effects. But, in order to prevent any possible misconception' of my mean- ing, it may be necessary to add, that my opinion of the efficacy of sea-water in scrofulous complaints, is confined to its probable removal of the outward symptoms of the malady, before these hare arrived at a certain pitch, or have reduced the patient to a state of extreme debility; in which case, as well as in all internal affections of the scrofula, when it has once fastened upon the lungs, or any other vital part, bathing in the sea, or drinking its waters, would be not only useless, but extremely injurious. It would also imply too great a confidence in the salutary virtues of sea-bathing, to prescribe it as a remedy for cutaneous disorders in general. To many of them the warm-bath is much better adapted ; and the proper choice of the one or the other can only be determined by a skilful physician, after a due consideration of the patient's ease. Some eruptions, if imprudently repelled by the action of cold on the skin, may carry back into the habit the seeds of disease, to be deposited, perhaps, on some vital part, in spite of Nature's kind efforts to throw them off. But a medical man will not prescribe sea-bathing in any case where pimples or blotches appear on the surface, without recommending the internal use of the sea-water at the same time, to determine regularly and mode- rately to the bowels, so as to carry off all impurities, without the least injury to the general health, spirits, or appetite. I shall have occasion to repeat this caution, when I come to speak of some mineral waters, which are frequently resorted to for the cure of similar complaints. Though, as before observed, there may be very little difference between the effects of sea-water and of river-water of the same temperature, when applied to a sound skin and healthy body, yet the gently stimulant, detergent, and healing properties of the saline impregnation of the former must give it a decisive superiority in many diseases of the surface and habit. It cleanses sores, and for- wards the progress of granulation. It often disperses tumours that have resisted the most powerful discutient medicines. Even deeply-seated ulcers, though beyond the reach of other appli- cations, sometimes yield to the penetrating action of sea-water. We must not forget, however, that its internal use is a necessary auxiliary in all these cases, and others of a similar nature. About half a pint of it, which contains somewhat more than a quarter of an ounce of salts, taken in the morning, immediately on coming put of the sea, and the like dose in half an hour after, will com- COLD-BATHING. 463 monly answer the purpose of a mild purgative. The quantity may be augmented, or the dose repeated, if requisite, with perfect safe- ty, and little inconvenience. It excites thirst, but seldom nausea, unless the stomach is very irritable, or the patient very squeamish. In chronic diseases, where a cure cannot be expected but from the long-continued use of any remedy, it is a great recommenda- tion of the sea-water, that it may be persevered in for a considera- ble time, without weakening the stomach, the intestines, or the con- stitution in general. Instances frequently occur of persons who keep the body moderately open by its daily use for months together, and yet enjoy during the whole time a good appetite, and excellent powers of digestion, with increased vigour both of body and mind. It is always most advisable to make use of the sea-water externally and internally, in the manner here directed, only twice or fhree times a-week, till the patient is encouraged by degrees to employ the salutary process every day. It should also be gradually discon- tinued in the same manner, after the desired end is obtained. There are several disorders, besides those already mentioned, particularly ardent fevers, and various cases of local inflammation and muscular rigidity, in which the external application of cold water may produce good effects. But many of them require great accuracy of distinction, as well as the utmost judgment and caution in the use of a remedy, which a small mistake, or a small change of circumstances, may render hazardous. In a work like this, de- signed for popular instruction, it would be improper to encourage rash experiments, by pointing out such niceties in medical practice as are safe only when under the guidance of medical skill. I do not know any thing in its own nature so salutary, and yet so liable to be abused, as the cold-bath. I shall therefore proceed to touch upon the cases, where the inconsiderate or improper application of such a remedy may prove injurious, and sometimes fatal. It is not merely in the critical cases just alluded to, but in many slighter indispositions, that injudicious immersion in cold water may be attended with very serious consequences. Fevers are much oftener produced than cured by cold-bathing, if rashly re- sorted to. Disorders of the intellectual functions, palsies, apoplex- ies, and death, may be, and are frequently occasioned by a single dip, in cases either of extreme nervous debility or of extreme fulness. When I reflect on the frantic precipitancy with which I have seen many persons of very weak, and others of very plethoric habit, after a rapid journey from London to some watering-place, plunge instantly into the sea, without the least preparation, so far from being surprised at the numbers who suffer, 1 am rather astonished that any should escape. In order to prevent the ignorant and the thoughtless from falling victims to their indiscretion, and to guard persons afflicted with particular complaints against the use ofan improper medicine, I shall point out the principal indisposi- tions, in which the cold-bath would be likely to aggravate the symp- toms, and even to endanger the life of the patient. Effects of Cold-Bathing, &;c. When a person in the ordinary state of health is immersed iu a 464 COLD-BATHING. cold-bath, he first experiences a general sensation of cold, whirl is almost immediately succeeded by a general sensation of warmtb the latter rapidly increasing, so as to cause the surrounding wattr to feel ofan agreeable temperature. If the immersion has ben sudden and momentary, and the body be immediately dried and covered from the air, the agreeable sensation of warmth continues the whole body feels refreshed and invigorated, and, under favour- able circumstances, the natural perspiration is increased. If, how- ever, the immersion be continued for a considerable time, and the water be not at the highest range of the temperature assigned to the cold-bath, the sensation of warmth goes off, and is followed by numbness and shivering, the skin becomes pale and contracted, the vessels near the surface of the body are evidently diminished in diameter, and the blood which flows through them is drawn to- wards the internal parts ; the person feels drowsy and inactive, his joints become rigid and inflexible, his limbs are affected with pain and cramps, his respiration becomes quick and irregular, his pulse low and small, and his perspiration suppressed. If the im- mersion be still continued, or if the water be very cold, the pulse gradually ceases, the action of the heart becomes weak and lan- guid, a sensation of faintness and coldness of the stomach is expe- rienced, followed by a rapid diminution of the whole animal heat; the vital energy at length becomes exhausted, and death ultimately ensues. In the preceding description, it is supposed that the body has been suddenly plunged into the water; if, as it often happens with weak or timid people, the bather enters the bath slowly, or if the water is much below sixty degrees, the sensation of cold is more striking, a shivering is produced, and as the person advances so as to make the water rise towards the belly and chest, a shuddering and convulsive sobbing takes place, sometimes attended with sick- ness and head-ache. Cautions to be Observed, Sfc. When, therefore, cold-bathing occasions dullness, loss of appe- tite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head-achs, it ought to be discontinued. These unpleasant sensations are the surest proofs, that the actual state of the patient's habit is unfit to bear the shock ; and that either the re-action of the heart and arteries is too weak to overcome the cold pressure on-the surface, or that the determination to the head, or to some other vital part, is too rapidly increased. Lvery body's feelings, after immersion in cold water, are the best crite- rion by which we can decide on the probability of its good or its bad effects. We might otherwise be deceived by appearances, and be induced to recommend the cold-bath in all cases that might seem to require a tonic and stimulant plan of cure. But it may sometimes be dangerous, or at least very detriment- al to make even a single experiment. In particular affections ol the stomach and bowels, as well as in diseases of the lungs or of he brain, and all obstinate obstructions, the effect may be fatal. The late Dr. Smoixkt, indeed, said, that if he were persuaded he COLD-BATHING. 465 hud an ulcer in the lungs, be would jump into the cold bath. In doing so, however, the Doctor would certainly show more courage than discretion ; and that he was more a man of wit than a physi- oian, every one will allow. A nervous asthma, or an atrophy, may be mistaken for a pulmonary consumption : yet, in the two for- mer, the cold bath proves often beneficial, though I never knew it so in the latter. Indeed, all the phthisical patients I ever saw, who had tried the cold bath, were evidently hurt by it. Persons of very full habits, as I have already hinted, run a great risk of bursting a blood vessel, or of causing an inflammation of some important organ, by rushing into the cold bath, without due preparation. People of this description ought by no means to bathe, unless the body has been previously prepared by suitable evacuations. They will then derive the utmost benefit from what might be otherwise attended with irreparable injury to many of them. Though I recommend the cold-bath in cases of nervous weak- ness, yet the degree of that weakness should be considered, lest the shock might prove too powerful for extreme debility. Not only women of very weakly and delicate habits, but men also in the same predicament, as well as puny children, should begin with the warm-bath, at the same degree nearly as that of animal heat, about 96° of Fahrenheit's thermometer ; and reduce it gradually in pro- portion to the increase of the patient's strength and internal pow- ers of re-action. The cold-bath is often very necessary to com- plete a cure, though not always advisable to begin with. This re- quires particular illustration. In hysteric and hypochondriac cases, cold-bathing at first has done the greatest mischief, though it may be finally resorted to with good effect, after a preparatory and long continued use of the tepid or lukewarm bath. Its warmth must be diminished very slowly, and almost imperceptibly. Nature revolts against all great transitions ; and those who do violence to her dictates, have often cause to repent of their temerity. The like gradual diminution of the temperature of the water is no less proper in rheumatic complaints, and in those muscular con- tractions and convulsive motions which are called St. Vitus'* Dance. Indeed, it may be laid down as a pretty general rule in that branch of nervous disorders which includes spasms, convulsions, epilepsies, and similar consequences of the debility or irritability of the system, that we should always begin with the warm-bath, and proceed to the cold by the most pleasing and gentle grada- tions. The chief exceptions to this rule occur in the treatment of spas- modic affections of the intestines, hooping coughs, and convulsive asthmas, in which, though classed under the general head of spasms, the cold-bath would at any time be extremely improper. But this prohibition is also implied in my remark on complaints of the bowels and chest in general, the latter including coughs of ev- ery description. When-these are the mere consequences of slight irritation, or cold, bathing the lower extremities in warm water af- fords great relief; but immersing the whole body in either the 466 COLD-BATHING. warm or the cold bath, would only aggravate the symptoms, when the breathing is difficult. As palsies are often occasioned by the inconsiderate use of the cold-bath, it cannot be too strictly prohibited, where any paralytic symptoms are discoverable. There is no complaint that bears aad requires a greater degree of external heat than the palsy, and there is none in which the shock of cold water is more directly opposite to every curative indication. The hot-baths, therefore, whether natural or artificial, and particularly if impregnated with salt, which increases their stimulus, are employed as a sovereign reme- dy for paralytic affections. Friction, which should never be neg- lected after bathing, is in these cases of eminent service. In affections of the nervous coat of the stomach, and in cases of indigestion, especially when occasioned by intemperance, cold- bathing is as improper as in complaints of the bowels, before taken notice of. But it is the excess of folly, after immoderate drinking, to use the cold-bath with a view of alleviating its painful effects next day. It must increase the disorder of the stomach, the vio- lence of the head-ach, and the derangement of the circulation. It may be productive of still worse consequences. The cooling op- eration may prove far more powerful and more lasting than was expected, and may extinguish forever the remains of animal heat; or, should nature, by extraordinary efforts, be able to resist the shock, it would probably be attended with symptoms of fever, or with very troublesome eruptions. Many painful affections of the head, as well as those which arise from intoxication, are, indeed, often relieved by what is called the shower-bath, or by the affusion of cold water on the part affected, but never by the rash experi- ment of swimming, or of total immersion. I must take this opportunity to add, that the shower-bath is in many other respects a valuable contrivance. It may be easily pro- cured : its actions can be regulated at pleasure ; and as the water descends like rain, it gently impels the blood towards the lower extremities, and prevents the danger which would arise from its sudden or too rapid determination to the lungs and head in some of the cases already mentioned. In uterine hemorrhages, and other fluxes of blood, when so con- iderable as to endanger the patient's life or constitution, cold wa- ff or drinking cnaiyneaie waici* ... .,..~ .»—--- - struation. But when the discharge of blood is critical,^.in some affections h»rh woufdII nfcrr^aUnLm^ions, those of the gout, for■ instance m which •struation. .nut wnen me uiseimigc «. ».~— — ----- - • »i,„ Sons of ,he brain, lungs, &c. o, I. become habitual, - m£ Te ,o ch ek so sa .ar7»n evacuation bv .he use of .he CO.* K «ulo be the heigh, of madness This » no ess,**, rf - „» critical inflammations, those of the gout for instance, in whel n?,f_'...', .„. Mher renellent would evidently counteract the °°,d w:rofo„rreotd ■^W*- "Z c=Vo» from some mismanagement of this sort, as we iu P ^ COLD-BATHING. 467 in the absence of the symptoms, when no indisposition is felt in either the head or stomach, when the extremities are not threat- ened with pain; and then only in concurrence with the best medi- cal advice. Bathing the lower extremities in warm water is generally and very properly recommended both in the retention and suppression of the menses, to excite the action of the uterine vessels, and, in the latter case, to remove any stricture of those vessels which may be induced by cold or fear. A skilful physician, however, will some- times meet with cases of a retention of the menses after the usual age, in which the cold-bath, if seasonably used at the beginning of the disease, may contribute to restore the tone of the system. The delicacy and general irritability of the habit in a state of pregnancy, as well as the danger of too great a determination of the blood to the womb, clearly forbid the use of the cold-bath, un- less it should be rendered advisable by some circumstances of a pe- culiar nature, of which a medical man of skill and experience is the only proper judge. It is a great and often a fatal mistake to rely on the tonic pow- ers of the cold-bath as the best means of repairing the injury done to the constitution by the relaxing influence of hot climates. Peo- ple, on their return to England, after having resided in the East or West Indies, would find the warm-bath not only safer, but far more conducive to the recovery of their former strength. 1 would not have them venture into a bath of a temperature under 90° for a considerable time, after which they may gradually diminish its warmth, as before recommended in cases of extreme debility. I might here go into farther details, and show how much more salutary the warm-bath is than the cold in diseases of the liver and kidneys, and in numerous other cases of internal derangement; but the principles, which I have laid down, may be easily extended to them all; and I hope that the cautions I have given will operate as some check on the abuse of the most powerful means of preserving and restoring health, with which we are acquainted. Some years ago a foreign quack made a great deal of noise in this country with his medicated baths, but, like other follies of the day, they are now almost sunk into oblivion. A few writers have also been very lavish of their panegyrics on the wonderful effects of vapour-baths as used in Russia: but I do not think that the in- habitants of these milder regions will ever have occasion to envy the rigid fibres of the north the enjoyment of such fanciful luxuries. The strength of steam is, perhaps, better known and more usefully employed in England than in any quarter of the globe ; but we meet with very few cases, where its intense action on the surface of the human body can he deemed essentially necessary either for the prevention or the cure of diseases. Surely the skin ofan Eng- lishman may be rendered perspirable by a much gentler stimulus, and without the aid of so troublesome and suffocating a process. 468 MINERAL WATERS. CHAP. XIII. OF MINERAL WATERS. Waters holding minerals in solution are called mineral waters. But as all water, in a mineral state, is, either more or less impreg- nated with some mineral substances, the name mineral waters should be confined to those that are sufficiently impregnated with mineral matter to produce some sensible effects on the animal econ- omy, and either to cure or prevent some of the diseases to which the human body is liable. On which account, these waters with much more propriety might be called medicinal waters, were not the name by which they are commonly known too firmly establish- ed by long use. The mineral waters most esteemed, consequently those most fre- quently resorted to for the cure of diseases, are those of Aix, in Provence, Harrowgate, Spa, Barege, Hartfell, Sedlitz, Bath, Holywell, Sea-water, Bristol, Leamington, Seltzer, Buxton, Malvern, Tunbridge, Borset, Matlock, Vechy, and others Cheltenham, Moffat, of less note. Carlsbad, Pyrmont, Epsom, Scarborough, It is scarcely possible to read without a smile the numberless books, essays, and pamphlets, which have been written on this subject. It seems to be the favourite region for the exercise of fic- tion and fancy. The traditionary tales of ancient miracles, said to be wrought by holy wells and consecrated springs, do not much surpass in extravagance the modern cures ascribed to those favour- ite haunts of valetudinarians by fraud, ignorance, and credulity. In printed Guides, as they are called, or Pocket Companions, to any of those fountains of health, it may be excusable to amuse us with a little romance ; but we are sorry to find the same spirit per- vading many medical treatises which should be distinguished by the most sacred regard for truth, and a just contempt of puerile 'ISSwoce indeed should be made for the influence of local prejudices, and for the strong bias of interest and ambition on the mind of a professional man, who, residing near one of those springs, has perhaps, no other means of acquiring popularity and reputa- Sn, but by an encomium on its virtues, and a description, quite in he noetical style, of the beauties of the surrounding scenery. The a«ePris indeed, a harmless puff; it seldom deceives anybody; buTs vtewed in the same light as an auctioneer's advertisement of ... o> where frightful chasms are often described as curious a" nra'fewfurSushes as a shrubbery laid out by the finger S Nature a^dafallows as a hanging-wood. There is anot er ^JX'in which those highly-coloured landscapes that form the MINERAL WATERS. 469 introductory part of almost every treatise on a medicinal spring, may defeat the proposed end, and that is, by exciting a reasonable sus- picion that those waters are chiefly indebted for the high reputation of their efficacy to local circumstances, to the pleasant walks and rides, or the delightful prospects round them. A display of all the attractions of the favourite spot is commonly followed by very minute details of chemical analysis, which are just of as httle use to the generality of readers as the description of the scenery. A knowledge of the contents of any mineral water by no means implies a knowledge of its medical properties. These are to be learned by repeated experiments; Were it not for the evidence of facts, the late discoveries in chemistry, as far as they respect the analysis of mineral waters, would only tend to lessen their credit, by showing the little difference between them and any common water of the same purity and temperature. For instance, if we confined ourselves to mere speculation on the subject, how could we suppose that a quarter of a grain of the oxyd of iron sus- pended by a little fixed air in a whole quart of Tunbridge water, the largest quantity usually taken in the course of a day, could produce any remarkable or peculiar effects ? The same thing might be said of the most celebrated springs in the kingdom ; and many physicians of great professional eminence, arguing from this principle, have not hesitated to assert, that the cures performed by those springs were not owing to the ingredients with which they were impregnated, but to the simple elementary part, or what may be called pure water. It would not be easy therefore to determine, whether chemical analysis has furnished more arguments in favour of, or against, the boasted superiority of mineral waters. Dr. Falconer, the author of one of the very few books relative to this subject, that contain something more than the gratification of idle curiosity, candidly confesses, that " chemical analysis, as far as it bus been hitherto prosecuted, seems to give us a very imper- fect view of the methods by which these effects (i. e. the medicinal effects of the Bath-waters) have been produced ; and this circum- stance has induced several persons to deny the truth of the facts altogether, or to represent them as highly exaggerated, and that such advantages (if any) as might be in truth received, were owing to collateral circumstances of uncertain and indeterminate efficacy, as change of air, diet, manner of life, and the like." It is not therefore to the landscape-painter, or to the chemist, that we must look for any useful information on those points, but to the modest and judicious practitioner, who, like the author now quoted, watches with care, and reports with fidelity, the bad as well as the good effects of the waters he describes, the instances of their failure, as well as of their success, in various disorders. I am sorry to add, that the fund of such truly valuable materials is as yet very scanty, and that I must confine myself to general re- marks on the most frequented of our medical springs, so as to di- rect invalids to the fountain, from the use of which they may form some reasonable hopes of relief. As more particular instructions will often be necessary when they get to the spot, I feel it my duty to caution them against choosing for their medical guide any man, however high his reputation may be, who has distinguished himself 470 MINERAL WATERS. as the loudest or most eloquent trumpeter in the indiscriminate praise of the waters near which he resides. The like caution may prove still more serviceable to such of our countrymen as resort to foreign springs for medicinal purposes. A popular advocate for the use of any remedy is seldom to be relied on as a good physician ; and we have always strong reason to sus- pect the skill or the integrity of a man, who speaks in a tone of confidence of the infallible efficacy of the waters which he pre- scribes. Some of those foreign waters being also frequently im- ported into this kingdom, and used here medicinally, I shall give a short account of a few of them, which are found to possess virtuei superior to any of our own in the cure of certain disorders. Classification of Mineral Waters. t Mineral waters are usually classed according to their sensible qualities, as perceived by the touch, sight, taste and smell, or ac- cording to some well-known ingredient, which may predominate in this or that particular spring. The most obvious division is into cold and hot fountains ; but both these, being too comprehensive, are again subdivided into chalybeate, saline, sulphureous, and calca- reous, from their being impregnated with iron, salts, sulphur, or lime. There are many still minuter distinctions, wliere two or more of those ingredients may be found united in the same spring, or combined with different sorts of air, which must-have a very powerful effect in the internal use of the waters. The first class of mineral waters, which I shall notice, are those called chalybeates, from a Greek word that signifies iron, the taste of which is very perceptible in them when fresh from the spring, though they lose it on being exposed for some time to the atmos- phere. The reason is, that the small quantity of iron which they contain, being kept in solution by fixed air, when this evaporates, the iron sinks to the bottom, forming the fine ochre that lines the channel or water-course. As iron abounds in almost every part of the earth, it is no wonder that so many springs should be im- pregnated with it, in a greater or less degree, according to the quantity of fixed air they contain, by which the iron is held m a state of solution. Some of those waters have, in conjunction with the iron and fixed air, a pretty strong mixture of purgative salt, and are very different from the others in their effects as well as their taste. In order to distinguish each by a specific name, the former may be called simple chalybeates, and the latter saline or purging chalybeates. Tunbridge-Wells standing in point of repu- tation, or of fashionable resort, at the head of the one, and Chel- tenham at the head of the other; they may be very properly chosen as examples or illustrations of the various medicinal effects of tins numerous class of waters. Tunbridge-Wells. Medicinal Properties, Sec. It has been already intimated, that the water of Tunbridge- Wells is found, upon being analyzed, to differ from that of com- mon springs only by containing in every gallon a gram of iron sua- MINERAL WATERS. 471 pended by about three table-spoonsful in bulk of fixed air.* Yet its medicinal effects are very considerable. It gives a gentle stim- ulus to the relaxed nerves, and contributes to restore their proper tone. It affords great relief in many complaints of the stomach, in flatulencies, bilious vomitings, irregular or imperfect digestion, and other consequences of either debility or intemperance. It pro- motes the circulation of the blood, and the various secretions; but more particularly that of urine : and this latter circumstance is one of the best proofs of its agreeing with the habit of the patient. In short, its natural tendency in the cases to which its stimulant and tonic powers are adapted, is to raise the spirits, and increase the general vigour of all the functions. The Tunbridge-waters are eminently serviceable in what may be called the sexual disorders of females, arising from a great weak- ness or derangement of the uterine system ; such as an immode- rate flow of the menses, green sickness, fluor albus, and other simi- lar indispositions, which are not only relaxing and painful in them- selves, but are often the cause of abortion, or of sterility. If the profuse flow of the menses should be accompanied, as it often is, by feverish symptoms, by pain in the back, and local irritation, the stimulus of the waters might then prove injurious. Indeed, they are improper in all inflammatory cases, except the feverish irrita- tion which attends the green sickness, and which is more frequently- abated than increased by the use of chalybeates. In all obstructions of the urinary passages, and other complaints of that region, those waters are found of singular efficacy; for though, ns before observed, they in some degree promote every se- cretion, yet their chief and most regular determination is to the kidneys ; and experience has fully proved the good effects of their gently stimulant and diuretic properties. We may proceed still farther in our recommendation of the Tun- bridge-waters, and prescribe them with great probability of success in such chronic disorders as arise from slow beginnings, and are attended with great laxity and weakness of the solids, but without much organic disease. It is necessary to attend to this material exception ; because a general weakness may be often brought on by morbid affections of the mesentery, of the lungs, or of some other important organ, to the cure or relief of which they would be very inadequate. Even in complaints where they have commonly proved efficacious, cases must often occur that require the exercise of the nicest judgment and discrimination. * A recent analysis of the Tunbridge-Wells says : " A single dose of half a pint will contain, according to the analysis which has been given, and the statement made agreeable to Dr. Mtirrav's views, of solid ingredients, about 14-I00ths of a grain of ox- ide of iron ; 9-IOOtlis of muriate of lime ; 8-100lhs of a grain of muriate of magnesia ; 9-IOOths ofa grain of the sulphate of soda; --lOOths of a grain of carbonate of lime, and a minute portion of manganese ; and of gaseous ingredients, half a cubic inch (or a .1 oz. in bulk) of carbonic acid ; ll-100ths of a cubic inch of azote, and about the l.une quantity of atmospherical air." These minutia?, be they ever so correct, are of no use in practice ; and we merely give this as a specimen of that species of chymical ear-wigging wliich the author of the •• Domestic Medicine" so justly and so humour- ously disclaims, while he goes at once into the more solid utility to be derived from frequenting mineral springs for the cure of disease and the improvement of the general health. Dr. Scudninore's book has neither index nor table of contents, consequently it was never intended to be referred to. (For a general survey, analysis, properties, ftc. of the mineral waters, soo ' Natural and M eoical D.ktkticon, Sec") Ed. , An MINERAL WATERS. But it is not enough to consider well the propriety of having re- course to those waters in any particular instance ; some caution ii also necessary in using them. Persons of a full habit should not begin to drink them, without losing a little blood, or without some other evacuation. When the stomach is foul, a purgative is com- monly preferable to emetics. What the immediate effect of the waters may be, can only be known by trial. They often purge very briskly at first, but this effect soon ceases ; and as their con- tinued use has some tendency to occasion costiveness, gently-open- ing medicines from time to time are necessary. The water itself may be easily converted into a purging chalybeate, by the addition of a little magnesia or Glauber's salts, when necessary. In the removal of other obstructions, those more especially to which fe- males are subject, the occasional use of the warm-bath will be found an excellent auxiliary. Directions and Cautions to be observed in the Use of these I Voters. In entering upon a course of the Tunbridge-waters, it is always best to begin with a small dose, not exceeding a quarter of a pint, about half an hour before breakfast, to be repeated, at regular in- tervals, once or twice in the forenoon, according to the pleasant- ness of the sensations it excites. The quantity may be soon aug- mented to half a pint or even more at each dose, if agreeable, or necessary, as the waters lose much of their medicinal effect by continued use, the stimulus wearing off in about six or eight weeks, and making no peculiar impression on the stomach or habit. The usual hours for the three doses are eight o'clock, ten o'clock, and twelve. A light breakfast at nine will not impede the proper ac- tion of the waters ; and as one of their effects is to improve the appetite, its indulgence should be under the control of moderation. But I have elsewhere enlarged so fully on the advantages of tem- perance, as well as of early hours and exercise, that I need not stop here to point out their importance in promoting the salutary ope- ration of any course of medicines either natural or artibcial. As some persons may be too soon prejudiced against the use of chalybeates by any unpleasant or unexpected sensations at first, it is proper to inform them, that giddiness and sometimes a^ heavi- ness of the head, nausea, vomiting, a slight pain about the heart, Td a sense of fulness over the whole body, though by no mean uncommon symptoms on beginning a course of these waters W1ll disaooear after a little use. It is only when they stubbornly con- finue that they should be regarded as a proof that the waters are nT ui*d to tL nature of the complaint or to th.p-n.nf. const. tution. The nausea or sickness being often occasioned by the oldness of the fresh-drawn water acting on an emptv-ra very weak and irritable stomach, it is advisable, in the first instance, Tot to d ink the waters fasting, till the stoma h becomes graditall -iaA t« tl,pm • and in case of extreme irritability, it is « MINERAL WATERS. 473 man Spa, or still more in those of Pyrmont, it need not be preser- ved with so much caution ; but a sufficient quantity of boiling water may be added to that which is taken from the spring, to bring the whole to a moderate temperature. Remarks.—Then; are many springs of simple chalybeate water in different parts of Great Britain, and even in the neighbourhood of London, which probably are little inferior in medicinal virtue or intrinsic strength to Tunbridge-Wells, though these have acquired a higher reputation. Pure air, temperate living, regular and early hours, active diversions, agreeable company, and a total exemption from all concern, except a rational desire to promote health, are the only circumstances that cause any real difference in the use of waters so similar iu quality. This difference, however, is consid- erable ; and the want of some of those co-operating circumstances will always prevent the springs of Islington or Hampstead from being set in competition with those of Tunbridge, for the certainty of their effects. The remarks, which I have made on the proper method of drinking the latter, as well as on the disorders and par- ticular habits of body to wliich they are adapted, are equally appli- cable to all waters of the same description in our island. But there are a few chalybeates on the continent, particularly those of the German Spa and of Pyrmont, which, being more active and pow- erful in their operation, require to be used with greater caution and delicacy. Pyrmont ano German Spa, Slc, compared with the Tunbridge Waters, Sfc. On drinking a glass of the Spa water, the taste immediately perceives a strong infusion of iron blended with an agreeable acid- ity. The latter is owing to the abundance of fixed air, which amounts to near half the bulk of the water, and holds in solution more than four times as much iron as we find in the like quantity of Tunbridge water. The effects are not less perceptible than the taste. A full draught of the Spa water, especially in hot weather, or upon an empty stomach, will produce a swimming in the head, and a sort of intoxication, which sometimes continues for half an hour, and is very like that which arises from spirituous liquors, though it does not leave the same debility after going off. A patient, therefore, should not drink more than a gill at first about an hour after breakfast, and another gill after an interval of two hours more. In three or four days the quantity may be in- creased, and the dose more frequently repeated ; but in these par- ticulars every body's experience will be the best guide. I before suggested the propriety of mixing as much boiling water with the chalybeate as will bring it to a degree of tepid warmth, and there- by prevent any unpleasant sensations, which its natural coldness might excite in a very weak or a very irritable stomach. If some evacuation was recommended to persons of a plethoric habit, before drinking the Tunbridge water, how much more neces- sary must it be to prepare in the same manner for the use of a far stronger stimulant ? This very active property of the Spa waters must also render them still more improper than those of Tunbridge in inflammatory complaints, attended with determination to the 474 MINERAL WATERS. head, flushing of the face, or any other strong indications of ferehih heat. But if the febrile symptoms are very slight, the Spa waters, used cautiously and moderately, may prove beneficial. They quench thirst more than common water ; and they have been frequently known to afford relief in ulcerated sore throats. What has been said of the efficacy of our own simple chaly- beates in cases of nervous relaxation, or of general weakness, ma- ny affections of the stomach and bowels, in disorders of the kid- neys and bladder, or obstructions in the urinary passages, and in various complaints peculiarly incident to females, may be asserted with still greater confidence of the waters of the German Spa, be- cause of their superior strength. Yet they do not equal the activ- ity of the Pyrmont waters, which contain as much iron and twice as much fixed air as those of the Spa, besides a larger proportion of earthy salts. The directions already given, will apply to them both, under similar circumstances. Where the stimulus is evidently stronger, more caution is at first necessary ; but every patient must learn'from experience what quantity of either of those chaly- beates the stomach or general habit will conveniently bear; and this quantity, when ascertained, whatever it may be, whether one, two, or three pints in the course of a day, must be continued with- out farther increase. It may be thought worthy of remark, that the waters of Pyr- mont and Spa, though in their own nature somewhat intoxicating, afford the most refreshing and wholesome draught, to relieve in the morning a weakness of the stomach occasioned by the too free use of the bowl or the bottle the night before. The only peculiarity in the virtues or medicinal effects of the Pyrmont waters is, that, when diluted with new milk, they are found very serviceable in gouty cases, and may therefore be safely prescribed in this form, during the intervals of the fits and the ab- sence of inflammatory symptoms. It is fortunate for a patient who cannot go to drink either of those waters at the fountain head, that they may be conveyed to any distance, and will retain their medicinal properties, with little or no diminution, for two years, if they are inclosed in bottles well corked and covered with cement. They contain so much fixed air that it is usual, after filling the bottles, to leave them uncorked for a while, in order to let the excess of the fixed air escape, as its expansion might burst the bottles, if they were to be instantly corked and removed to a warm place. The other species of this class of waters, which come next to be noticed, are the saline ox purging chalybeates, so called part y from their contents, and partly from their mode of operation. Be«de> ron and fixed air, which they have in common with the simple cha- lybeates, they hold in solution such a quantity of purgative salt as |ves them a regular and strongly marked determination to the bowels Any chalybeate, whether of the milder sort, as the Tun- Se-waferf or of the rougher, as those of the German Spa and of pfrinWwill often purge briskly at first; but this is not their SnorConstant effect. It seems to ^pend on the previous S or the actual state of the patient's stomach and bowels. It alt goes off very soon, and is followed by a tendency to costive- MINERAL WATERS. 475 ness. But the purging chalybeates commonly operate in the same regular, constant, and uniform manner, as long as they are con- tinued. The chief springs of this description in England are those of Cheltenham and Scarborough, upon the medical properties of which I shall now make a few remarks. Cheltenham Waters. The Cheltenham-waters require no preparation ; but the quan- tity sufficient to produce the desired effect on the bowels, can only be known by experience. Half a pint is as much as any patient can well drink at a time, and this may be repeated three or four times, at proper intervals, in the course of the day, according to its operation, or to the intention with which it is taken. Four doses of half a pint each contain about a quarter of an ounce of purging salts, with somewhat more than a grain of iron held in so- lution by four ounces in bulk of fixed air. Ars purgatives act very differently in different habits, the quantity here mentioned will op- erate briskly upon some patients, but so weakly upon others, as to render the occasional addition to the crystallized salts necessary, when a powerful and speedy effect is desired. On the other hand, the quantity of the water, or the number of doses, may be lessened, when it is used merely as an alterative. But even persons of very delicate habits may divest themselves of their usual prejudices against cathartics, as those saline chalybeates do not occasion griping or languor. The only unpleasant sensation, which they sometimes excite on first drinking them, is a sort of giddiness, or slight head-ach, wliich soon goes off; but their agreeable and salu- tary effects are not so transient. They improve the appetite. strengthen the stomach, and promote general alertness, while they correct and carry off the impurities of the whole system. Hence it is that they may be persevered in for a considerable length of time, and the body kept moderately open by their uninterrupted use, without the least debility or inconvenience. These remarks, however, admit of some exceptions, particularly when the consti- tution is either naturally very weak, or much enfeebled by disease, without any marks of obstruction, or of acrimony in the fluids. A constant operation on the bowels would in such cases prove very injurious. Cheltenham-water has often been found of the greatest service in glandular and visceral obstructions, in a variety of bilious and scrofulous complaints, in the first symptoms of a dropsical disposi- tion, and in many of the most distressing scorbutic eruptions and ulcerations on tlie skin. But the obstiuacy of some of these can only be overcome by perseverance. In our endeavours to obtain a cure of any disease of the chronic kind, we should not forget that complaints, slow in their progress, go off also very slowly; and that, a-cording to the judicious remark of Celsus, time is necessa- ry to remove the deep-rooted evils which time has occasioned. The proper season for drinking the waters of Cheltenham is the summer; and as the warm-bath may also be advisable in some of the cases to which the waters are suited, the town is well sup- plied with accommodations for that purpose. 476 MINERAL WATERS, Scarborough Waters. The saline chalybeate at Scarborough does not contain above a third part of the purging salts which are found in a like quantity of the Cheltenham-water. Of course, it cannot be supposed to operate with the same force and activity, unless larger doses ars taken than most stomachs will bear, or unless the powers of the water are increased by the addition of some opening salts of the like kind as those which it already holds in solution. In its natural state, it is chiefly employed as an alterative, but may, by the arti- ficial means just mentioned, be adapted to all the complaints in which the Cheltenham-water is found efficacious. Neither of them will keep well even in close bottles, or bear to be carried to any great distance, as the iron is deposited in a few days, though the saline impregnation continues. By evaporating the water the purgative salts are procured, for the purpose of being again dis- solved in some more water from the same spring, to increase its operation on the bowels. The inferiority, in point of strength, of the Scarborough-water, is more than counterbalanced by other advantages which Chelten- ham does not possess. In the first place, near the saline chalybeate spring there is another spring of simple chalybeate water, like that of Tunbridge-Wells, which is very convenient for patients in ca- ses where a determination to the kidneys may be desirable. But the situation of Scarborough on the coast is an object of still great- er importance, as it affords an opportunity of bathing in the sea, so conducive to the cure of many of the disorders for which those springs are resorted to. The elevation of the ground, and the un- common purity of the air,, deserve also peculiar notice in a medi- cal survey of the local advantages of Scarborough. It is remarkable, that all the saline chalybeates in our island arc cold, while many of those on the continent are hot, and are used as baths, as well as internally, in a number of diseases very difficult of cure. I shall therefore reserve my account of one or two of the most celebrated of them, till I come to describe our own hot baths, though the foreign ones, on account of their principal ingredients, may be said more strictly to belong to the class of waters which I have just been considering. The details before entered into respecting the external and inter- nal use of the sea-water, and its admirable effects not only as a grand preservative of health, but as an efficacious restorative of that blessing in various complaints, preclude the necessity of sav- in* much of the second class of mineral waters, denominated the simply saline, and differing from common water only in being im- pregnated with some purging salts. We have several of these Lings near the metropolis; but they are little used, as . ,s so easy to procure the sea-water, which is much superior to all others of this description, in the strength of its sal.ne ingredients and the certainty of its effects. Epsom-water, though one of the first of the salt springs that was brought into use vs now se dom or never prescribed. Bagnigge-Wells, those at the Dog and Duck in St. George's Fields,* ai well as at Rilburn andActon, have ^Iso had T^he waters of the "Dog and Duck" have long ago been disturbed by the lew MINERAL WATERS. 477 their day of medicinal reputation ; but even recommendatory es- says and pamphlets can no longer prop up their fame. The por- tion of salts which they contain is not sufficient to act with certain- ty on the bowels, unless they are taken in such large quantities as delicate stomachs cannot bear, and as very few people can swallow without difficulty and disgust. Two or three pints must be taken one after the other, in a short space of time, to ensure the full pur- gative effect. On this account, when they were in vogue, it was a common practice to administer more convenient doses, smaller in quantity, but strengthened by an additional solution of some of the same suit as that which they already contained. But this differs so little from an artificial dose of physic, as almost to destroy the idea of a remedy prepared by nature. Besides, the facility which our insular situation affords, of procuring salt-water of the greatest efficacy from its grand reservoir, must lessen the value of those substitutes. Local convenience has certainly contributed its share to the high repute of a spring of the like kind at Sedlitz, a village in Bohemia, wliich, being much more strongly impregnated with bitter purging salt than the Epsom-water, can be more relied upon for its medicinal effects, and is therefore very justly esteemed in a part of the continent far removed from the sea. Skltzer Water. BYt there is another saline spring in Germany, a more particu- lar account of which must be interesting to the English reader, not only from the peculiarity of its nature and virtues, but because large quantities of it are imported into this country for medicinal purposes. Few mineral waters have acquired a greater degree of celebrity than those which are brought from Seltzer, and which may be said to form a peculiar species, being saline and slightly alkaline, with a strong impregnation of fixed air. This quickly evaporates on being exposed to the Atmosphere, so that the water designed for exportation must be instantly bottled, and kept close- ly corked, with the mouths of the bottles well covered with cement, or it will soon become not only vapid but putrescent. If well pre- served, when poured into a glass, it is perfectly clear and spark- ling, and has a gentle saline, and somewhat pungent or acidulous taste : but if the fixed air be suffered to escape, through the least neglect, the water appears turbid, is offensive to the smell, and en- tirely loses its pungency. The stone-bottles, in which it is brought to England, contain about three pints each, a sufficient quantity for a day, to be taken in half-pint glasses at convenient intervals. lis natural flavour is rather agreeable, and its effects on the spirits are in general exhilarating. Persons of very irritable stomachs may dilute it with milk; in which mixed state it is particularly re- commended in cases of hectic fever with expectoration. It corrects and diminishes the discharge from the lungs, checks the violence of the sweats, and contributes very much to the patient's repose. The Seltzer-water is also used with considerable benefit in ner- vous affections of the stomach and bowels, in cases of indigestion, medicinal but more inebriating and destructive substitution of those of Uod^.^j ;nd Barclay, Perkins, ice.; a public-house having been erected on the spot. Ed. 478 MINERAL WATERS. foulness, bilious vomiting, acidity, heart-burn, spasmodic pains in the alimentary canal, and various diseases of the urinary organs. Its rapid determination to the kidneys, the action of its stimulus and perhaps some considerable power as a solvent, may concur to produce the very agreeable effects that are experienced from it in the latter complaints especially. In any of the former, it is advis- able to take some gently-opening medicine every two or three dnvs • and the easiest method of doing this is to add to the dose of Seltzc'r- water such a quantity of vitriolated magnesia as will keep the bowels in a regular state. Though this water cannot be prescribed with so much confi. dence, it may be very safely tried in miliary pustules, and the like sudden eruptions on the skin, attended with general irritation. I consider it merely as a good diet-drink in these disorders ; for the relief of which, greater reliance is justly placed on regimen than on medicine. Harrowgate Waters. In a few of the waters already described, we can discover a slight impregnation of sulphur; but where this principle abounds or predominates, the waters are distinguished by the name of sul- phureous, from their chief ingredient. The springs of Harrowgate take the lead in this class, and are certainly deserving of the repu- tation they have acquired, though they are also very frequently used with great indiscretion : and as the same error is very com- mon in drinking the other strong purgative mineral waters, I shall take this opportunity of enlarging upon it. A very hurtful prejudice prevails in this country, that all diseases must be cured by medicines taken into the stomach, and that the more violently these medicines operate, they are the more likely to have the desired effect. This opinion has proved fatal to thou»- sands, and will, in all probability, destroy many more, before it can be wholly eradicated. Purging is often useful in acute diseas- es, and in chronical cases may pave the way for the operation of other medicines : but it will seldom perform a cure; and, by ex- hausting the strength of the patient, will often leave him inaworae condition than it found him. That this is frequently the case with regard to the more active mineral waters, every person conversant in these matters will readily allow. Strong stimulants applied to the stomach and bowels for a length of time must tend to weaken and destroy their energy ; and what stimulants are more active than salt and sulphur, especially when these substances are intimately combined, and carried through the system by the penetrating medium of water ? Those bowels must be strong indeed which can withstand the daily operation of Mich active principles for months together, and not be injured. This, however, is the plan too generally pursued by those who drink the purging mineral waters, and whose circumstances permit them to continue long enough at Harrowgate, and the like places of fash- ionable resort. Many people imagine that every thing depends on the quantity of water taken, and that the more they drink, they will the sooner MINERAL WATERS. 479 get well. This is an egregious error ; for, while the unhappy pa- tient thinks he is by this means eradicating his disorder, he is of- ten, in fact, undermining the powers of life, and ruining his consti- tution. Indeed, nothing can do this so effectually as weakening the powers of digestion by the improper application of strong stim- ulants. The very essence of health depends on the digestive organs performing their due functions, and the most tedious maladies are all connected with indigestion. Drinking the water in too great quantity not only injures the bowels, and occasions indigestion, but generally defeats the inten- tion for which it is taken. The diseases, for the cure of which mineral waters are chiefly celebrated, are mostly of the chronic kind ; and it is well known that such diseases can only be cured by the slow operation of alteratives, or such medicines as act by inducing a gradual change in the habit. This requires length of time, and can never be effected by medicines which run off by stool, and operate chiefly on the first passages. Those who wish for the cure of any obstinate malady from the Harrowgate-waters, or others of the sulphureous or saline class, ought to take them in such a manner as hardly to produce any effect whatever on the bowels. With this view, a half-pint glass may be drank at bed-time,* and the same quantity an hour before breakfast, dinner, and supper. The dose, however, must vary ac- cording to circumstances. Even the quantity mentioned above will purge some persons while others will drink twice as much without being in the least moved by it. Its operation on the bow- els is the only standard for using the water as an alterative. No more ought to be taken than barely to move the body ; nor is it always necessary to carry it even this length, provided the water goes off by the other emunctories, and does not occasion a ehilness or flatulency in the stomach or bowels. When the water is intend- ed to purge, in cases where the nature of the patient's complaint requires a strong determination to the bowels, it may be necessary to drink a pint or two before breakfast. I would not only caution patients who drink those waters over- night, to avoid hearty suppers, but also against eating heavy meals at nny time. The stimulus of water, impregnated with sulphur and salts, seems to create a false appetite. I have seen a delicate per- son, after drinking the Harrowgate-waters of a morning, eat a breakfast sufficient to have served two ploughmen, devour a plen- tiful dinner of flesh and fish, and, to crown all, eat such a supper as might have satisfied a hun»rv porter. All this, indeed, the stomach seemed to crave ; but this craving had better remain not quite satisfied, thnn that the stomach should be loaded with what exceeds its powers. To starve patients was never my plan; but I am clearly of opinion, that, in the use of all the stromrly purging mineral waters, a light aud rather diluting diet is the most proper; * When I speak of drinking a glass of the water over-night, I must beg leave to cau- tion those who follow this pUn against eating hearty suppers. The late Dr. 1) v. . t rv of York, who was the nVt that broueht the Harrow-ate-waters into repute, used to, ad- v.se bit patients to drink a glass before they wont to bed ; the eun"e^c"ccv°*" ™"? wu, that having eat a meat-supper, and Uie water opcratum in the night, til. y were 01 ten tormented with, gnpos, and obliged to call for medical assistance. 48© MINERAL WATERS. and that no person, during such a course, ought to eat to the folj extent of what his appetite craves. Exercise is not less conducive to the salutary end in view than temperance. It promotes the operation of the waters, and carries them through the system. It may be taken in anv manner tint it most agreeable to the patient; but he ought never to carry it to excess. I scarcely need repeat a remark often made in other parts of this work, that the best kinds of exercise are those connected with amusement. Every thing that tends to exhilarate the spirit. not only increases the efficacy of the waters, hut acts as a medi^ cine. All those who repair to the fountains of health nu*ht there- fore to leave every care behind, to mix with the company, and to make themselves as cheerful and happy as possible. From tin.. conduct, assisted by the free and wholesome air of those fashion- able places of resort, and also the regular and early hours which are usually kept, the patient often receives more benefit than from using the waters. During my residence at Harrowgate, I met with many instances of the most mischievous effects produced by drinking the waters in cases where they were absolutely improper, and adverse to the nature of the disease. When people hear of a wonderful cure having been performed by some mineral water, they immediately conclude that it will cure every thing, and accordingly swallow it down, when they might as well take poison. Before patients he- gin to drink the more active kinds of mineral waters, they ought to be well informed of the propriety of the course, and should never persist in using them, when they are found to aggravate the disorder. On the other hand, I often witnessed the happy issue of experi- ment made with judgment and caution at Harrowgate, when the greatest benefit was derived from the proper use of the waters in various eruptions on the skin, of the most distressing nature; in rheumatism complicated with scorbutic complaints; in obstructions of the glandular and lymphatic system ; and in diseases'of the first passages, accompanied with, or proceeding from, inactivity of the stomach and bowels, acidity, indigestion, vitiated bile, worms, pu- trid sores, the piles, and jaundice. They answer two very impor- tant purposes ; first, when .taken in small quantities, acting as an alterative, and inducing, by their mild operation, a gradual change in the habit; and, secondly, when employed in larger doses where purging is indicated, fulfilling that intention in the most desirable manner, without irritating the nerves, or weakening the patient so much as other purgatives. After a little use, almost every body can drink them without any great disgust, though they are at first no less nauseous to the taste, than offensive to the smell. I shall only add, that the external use of the Harrowgate-waten being justly deemed a very powerful auxiliary in many of the dis- orders for which they are resorted to, particularly those of the cu- taneous class, there are proper baths for this purpose, to the supply of which three springs out of four are devoted, that which is re- served for drinking being more strongly impregnated with salt and sulphur than the rest. MINERAL WATERS. 481 Moffat Waters. The sulphureous and saline waters of Moffat in North Britain are almost as much resorted to as those of Harrowgate. The im- pregnation of the former, indeed, is not so strong as that of the latter, and their effects are of course somewhat different. Two or three quarts of the Moffat water may be drank in a morning, with- out any sensible effect but that of increasing the flow of urine. It now and then purges ; but this is so far from being its constant or regular mode of operation, that opening medicines are almost al- ways necessary during a course of it. Its evident determination to the kidneys renders it of essential service to persons afflicted with the stone and gravel, particularly the latter. It has likewise afforded great relief in many bilious complaints, and in the early symptoms of a scrofulous habit. But its chief point of celebrity, and that in which it may be said to rival the springs of Harrow- gate, is the cure of cutaneous eruptions of every kind. In these cases, the external application of the water, warmed to a consider- able temperature, is very judiciously made a material part of the plan of treatment. One disadvantage, however, attends this pro- cess both at Moffat and Harrowgate. The waters, while heating, unavoidably lose in vapour some of their sulphureous impregna- tion, on which part of their efficacy, even when externally applied, must depend. So far, therefore, a preference is justly due to the natural hot sulphureous springs of Aix-la-Chapelle and Bareges, of which I shall take some farther notice, after I describe the thermal springs in our own island, which constitute the next and last class in my arrangement of mineral waters. In the introductory part of this section, the waters which now remain to be considered are specifically distinguished by the title of calcareous, because they contain more lime or calcareous salts than they do of any other solid substance. I adopted this title, however, in compliance with custom, and merely as a nominal dis- tinction, rather than from considering it as an important charac- teristic, or by any means expressive of the grand cause of the effi- cacy of such waters. It is not to chemical analysis, but to expe- rience that we are indebted for a knowledge of their virtues ; and, instead of giving them a name taken from a part of their contents, which conveys no useful information, we had better simply call them hot springs, as every body will then have a clear idea of the most perceptible difference between them and all the other mineral waters in our island. Bath Hot Springs. In this part of our description, the hot springs of Bath have the most indisputable claims to precedency. The fame of their medi- cal virtues is more widely diffused and more firmly established than that of any other springs in the known world. It is no wonder, therefore, that the pen of industry, of genius, or of ambition, should huve been often exercised upon so popular a topic. Amidst such a multitude of books, Dr. Falconer's " Practical Dissertation on the Medicinal Effects of the Bath Waters," is acknowledged to be W 482 MINERAL WATERS. the best account which has yet appeared of whut he justly calls a " powerful, but (in many instances) nice remedy." His situation as physician to the Bath Hospital must have afforded him the best opportunities of observing the effects of those waters ; and he has given the most satisfactory proofs of his being well qualified to profit by those opportunities. One of his remarks is really of more consequence than a whole volume of chymical investigations, which have thrown just as little light upon the efficacy of the wa- ters as the fables concerning Bladud, or the frequently-discovered fragments of Roman antiquities. Chemistry, indeed, makes us ac- quainted with the component parts of those waters, and tells us they contain a good deal of calcareous salts, but little, if any, neu- tral alkaline salts; and that they are impregnated with about asix- tieth part in bulk of fixed air, which holds in solution so very small a quantity of iron as to be scarcely appreciable, though it gives n slight chalybeate taste to the water when hot from the spring. But what inference could we deduce from these and the like amusing details, in the treatment of any particular disease ? It is, then, to the enlightened practitioner, as I said before, that we must look for useful information ; and, in this view of the subject, we cannot wish for more respectable authority than that of Dr. Falconer. According to this writer, the Bath-water, when drank fresh from the spring, has in most persons the effect of raising and rather ac- celerating the pulse, increasing the heat, and exciting the secre- tions. The action on the nervous system is felt at the same time, so that the stimulating properties of the water must be very diffu- sive ; and, what is farther remarkable, though these symptoms come on suddenly, yet they often continue much longer than we can sup- pose them to be excited by the actual presence of the water in the body. Medicinal Properties.—The Bath-waters not only promote urine and perspiration, but also increase the salivary discharge; and quench thirst better than other fluid, in cases where there is no tendency to fever. If any disposition of this kind should appear, a hot stimulant would be evidently improper. It has been generally imagined, that those waters were some- what astringent, on account of the costiveness which frequently accompanies the use of them. But this effect is more reasonably ascribed to their heating qualities, and to their power of exciting the other secretions. As a proof of this, when perspiration is checked in cold weather, they sometimes prove slightly purgative. The relief which the Bath-waters afford in the colic, in convul- sive retchings which often attend the gout in the stomach, and in many other similar affections, is a sufficient evidence of their anti- spasmodic powers. This account of the primary and immediate effects of the water used internally will enable any patient to judge, from his own leel- ings, whether it agrees with his constitution or not. If it excitei, on being first taken, a pleasing glow in the stomach, followed by an increase of spirits, and of appetite, particularly for breakfast, and above all, a rapid determination to the kidneys, there is-tM o-reatest probability of its proving serviceable. But if it occasions head-ach, thirst, and dryness of the tongue ;-if it sits heavy on the MINERAL WATERS. 483 stomach, or produces sickness, and does not pass off by urine or perspiration;—it may be fairly concluded, that its continuance would do injury, unless these symptoms can be removed. If we come next to consider the external application of those waters, we shall find, in the first place, that they unite all the me- dicinal advantages of warm-baths, from about a hundred and six degrees of heat to any inferior degree that may be desired. The extent also of the baths, wliich affords room to move about in them freely, and the permanence and uniformity of their warmth, are not unimportant recommendations. But Dr. Falconer is of opinion, that the Bath-waters possess some farther powers or specific qual- ities superior to those of common water of the same temperature. He thinks that their action on the nervous system is more stimu- lating than a common warm-bath ;—that they raise the pulse and heat of the body to a higher degree, yet are much less apt to pro- duce a violent perspiration ;—that they remarkably increase the urinary discharge ;—and that, so far from causing any relaxation or weakness, the bathers are observed to be in general more alert and vigorous, and to have a better appetite on the days of bathing than in the interval. As far as my own opportunities of observa- tion extended during a few short visits at Bath, they are in per- fect concurrence with the Doctor's opinion. The diseases, in which this eminent practitioner very accurately describes the good effects of the Bath-waters, are the green sick- ness, particularly before any considerable affection of the stomach takes place, or any feverish symptoms appear ; visceral obstruc- tions, when the consequences of intermittent fever, or of long res- idence iu hot climates, if the disorder in these cases has not ad- vanced too far ; the palsy, from a great variety of causes ; the gout, in that stage of the complaint, when the inflammatory symp- toms, if any have preceded, have in a good measure abated, and a degree of weakness and want of tone in the system begins to take place ; the chronic rheumatism, and the acute also, provided the feverish disposition be previously allayed by proper evacuations ; white swellings on the knee ; hip cases ; weakness of the organs of digestion ; the colic, accompanied with hysteric symptoms, or produced by the poison of lead ; the jaundice, when arising from simple obstruction of the biliary ducts ; hypochondriac and hyster- ical complaints; St. Vitus's Dance; spasmodic affections of the womb and painful menstruation ; and, lastly, in many cutaneous, but more especially leprous eruptions. I have confined myself here to a bare outline, which may be suf- ficient for the general direction of valetudinarians, who must avail themselves of more particular advice at the fountain-head. Almost every case will require a peculiar mode of treatment; and great caution will be found necessary to prevent fatal mistakes. I can- not too often repeat, that the more powerful any remedy is, the more liable it is to abuse ; and though the efficacy of the Bath- waters has been fully established in a variety of the most stubborn and afflicting disorders, yet their misapplication has also been often attended with very serious consequences. Even when the use of the Bath-waters may be deemed safe or proper, consideration must be had, as Dr. Falconer justly ob- 484 MINERAL WATERS. serves, to the quantity taken in, when they are drank ; and to th« time of stay in the bath, heat of the water, Sec. wben they are ex- ternally used. The safest method is to begin with drinking n glass, containing about a quarter of a pint, before breakfast; and to judge from iu effects how often it may be repeated, or the quantity enlarged. If it feel easy, warm, and cordial, to the stomach and spirits, and ex- cites no pain or sense of fulness in the head or eyes, a second glass of the same size may be taken the same day at noon, and this quantity gradually increased to a pint in the day, taken at two or three times, as convenience may suit. This is deemed a proper medium for the generality of people, though in some cases, where the habit is not very irritable, the daily allowance may be augment- ed to a pint and a half, with safety and benefit. The Cross Bath- water, the temperature of which, when fresh from the spring, ia 112°, is usually recommended at the commencement of a course, especially when there is any affection of the head, or when any tendency to plethora appears in the system. After some time, the more powerful water of the King's or the Hot Bath, which is four degrees higher in temperature, may be used; and this change will prevent, in some measure, the disgust wliich is apt to come on after a long trial of the Bath-waters. No less regard should be paid to the proper use of the Bath. A short stay of five or six minutes is most advisable at first; and if this trial produces no symptoms that are disagreeable, but, on the contrary, seems to improve the health, spirits, and strength, a longer stay may be gradually indulged, till it comes to half an hour, but never to cause lassitude, faintness, or disgust. The choice of the baths is often a matter of importance, as there is a still greater variation in the temperature of the waters when in the baths than at the pumps, the waters in the King's, or the Hot Bath, being from eight to twelve degrees warmer than those of the Cross Bath. There are also private baths of any temperature to suit the pecul- iarities of every patient's habit or complaint. The best time in general for bathing is the morning ; and it may be repeated twice, or at most thrice a-week. As the public baths are emptied soon after nine o'clock, a much earlier hour is usually chosen for bath- ing ; but the private baths may be prepared at any hour of the day. Where a greater stimulus than mere immersion is thought neces- sary, or where a partial application of the water is deemed prefer- able to a general one, the part may be pumped upon, so as to in- crease the forcible action of the water on that part, and yet prove less heating to the system at large. Bcxton Waters, &.c. There are no springs in our island besides those at Bath, which can be strictly called hot, though a few others have got the name, and are referred to this class of thermal waters, from being, inva- riably in every season, and independently of the state of the aU mosphere, warmer than the general average of the heat of common springs. The temperature of Buxton-waters is only 82°, yet ap- proaches nearest to that of the hot springs at Bath, which, in their coolest state, are never lower than 90°. In other sensible proper- MINERAL WATERS. 485 ties the Buxton-water differs very little from common pump-water. The medicinal effects of the Buxton-waters, however, are far from being inconsiderable. Taken internally in small doses at dif- ferent intervals, amounting to near a pint before breakfast, and the like quantity before dinner, they afford very great relief in heart- burn, flatulency, sickness at the stomach, and other distressing symptoms of defective digestion and derangement of the alimenta- ry organs, the sure attendants of indolence and luxury. In such cases, the body must be kept regularly open by means of medicine during the use of the waters, if these do not, as they sometimes will, produce a laxative effect which is always salutary.* They are no less serviceable in alleviating painful affections of the kid- neys tind bladder ; and here also the external use of the waters is often found to promote their internal operation. But the employment of the Buxton-waters as a bath is not con- fined to the relief of gravelly complaints. They contribute far more effectually to restore the healthy action of particular limbs, that may have lost their moving powers in consequence of long or violent inflammation, occasioned either by external injury, or pre- ceding acute rheumatism. But if the rigidity, weakness, or im- paired functions of the parts affected be the consequence of a par- alytic stroke or of gouty inflammation, more benefit will be experi- enced from the warmer temperature of the Bath waters. In general, the Buxton bath is well suited to such a languid, en- feebled, or very irritable state of the habit, as cannot bear abso- lutely cold water, but may be excited to easy and salutary re-action by a milder stimulus. The slight shock, which people feel at the instant of immersion in the Buxton waters, is almost immediately followed by a pleasant glow all over the body; and this is precisely the effect aimed at. But I have expressed myself so fully on. the nature of the particular infirmities to which the lukewarm bath is adapted, as to render any farther observations on this head unne- cessary. Matlock, &c. The tepid springs at Matlock approach still nearer to cold water than those at Buxton, being sixteen degrees lower in point of tem- perature. The shock, which they give on immersion, is conse- quently stronger, and requires greater powers of re-action in the habit; but they form a good intermediate bath between Buxton and the sea. They are, therefore, very properly employed in pre- paring invalids for the latter, when this is necessary to complete a cure, as is often the case in the chronic rheumatism. They are used internally as a pure diluting drink, but are not known to pos- sess any other remarkable medicinal properties. Bristol Hot Well, &c. The Hot-well, as it is improperly called, near Bristol, is not, • A dose or two of some aperient medicine is advised to be taken preliminary to the use of these waters ; and gouty patients, to whom also they are recommended, ought not to begin a course unless they are well prepared, and rendered free from every discoverable sign ofan acute state of the disposition to an attack of their complaint 4*6 MINERAL WATERS. indeed, so cold as the springs at Matlock, but does not rise to tl.a temperature of those at Buxton, being only 74", or twenty-two degrees below the ordinary warmth of the blood in a state of health. The Hot-well water is not made use of to bathe in ; but, taken internally, it has acquired very high reputation for curing the incipient symptoms of consumption, and affording considera- ble relief in the more advanced stages of this disease. As the ef- fects it produces are very gradual, its agreeableness to the palate is a fortunate circumstance for a class of patients, who can only hope, by long and steady perseverance, to check the progress of one of the most insidious destroyers of the human species. There is no doubt but they are also indebted for a part of the relief they experience to the mild, sheltered, yet sufficiently ventilated situ- ation of the Hot-wells, and to. the judicious plan of diet, exercise, and amusement pursued there. The other complaints, in which the purity and temperature of the Hot-well water render it very grateful and of no small efficacy, are relaxations of the stomach and bowels, brought on by long res- idence in hot climates ; bilious diarrhoea ; slight dysentery; and a disorder still more difficult of cure than any of these, I mean the diabetes. I do not know any natural remedy better adapted to re- lieve its various symptoms ; such as the constant thirst, the imped- ed perspiration, the dryness and frequent desquamation of the skin, the feverish quickness of the pulse, and the preternatural discharge of urine. A regular course of the Hot-well water has been found to moderate this almost unquenchable thirst; to keep the skin moist and perspirable; to allay the fever; and to render the urinary or- gans fitter to receive benefit from the medicines usually prescribed to remove their debility and that of the system in general. It may be farther necessary to observe, that, as this water contains but a very small quantity of purgative salts, which are also counteracted by a larger solution of calcareous salts, it must have a stronger de- termination to the kidneys than to the bowels, so that the use of a gentle aperient medicine becomes in several cases advisable. Particular habits and complaints require variations in the quan- tity to be taken of this, as well as of any other mineral water. The full dose is half a pint, to be drank early in the morning, and repeated before breakfast, at the interval of at least half an hour spent in gentle exercise. Two more doses of the like quantity, and with the like interposition of active amusement, are to be taken between breakfast and dinner, at the longest distance from each of those meals. As this water is also used at table and for domes- tic purposes, every invalid unavoidably takes more than the above quantity every day ; but in consequence of its altered temperature and of the loss of the fixed air it contained, it cannot be in so lug" a slate of medicinal perfection as when drank fresh from the spring. The same remark must of course apply to the immense quantities that are bottled for exportation, though the almost proverbial purity and softness of the water, as well as its excellent property of keeping untainted for a great length of time in hot climates, must render it a very valuable water for long voyages. MINERAL WATERS. . 487 Continbntal Hot Sprinos, &.c. I shall subjoin to these observations on the medicinal virtues of our own thermal waters, a short account of the most celebrated hot springs on the continent. There is none of the foreign watering places more resorted to than the German Spa, of which I already took notice among the cold chalybeates, and Aix-la-Chapelle, about twenty-four miles dis- tant from the former, and equally famous for waters of a very different quality and temperature. Their celebrity is traced back even to the days of Charlemaonk, who resided for a long time at Aix, and took so much delight in the use of the waters, as fre- quently to bold his levee in the bath, with all his attendants. The exact degree of the heat of these waters is given differently by different observers; but, taking the average of their accounts, it may be reckoned in the well of the hottest bath at 140°, and at the fountain where it is drank, about l"J()o. It requires to stand several hours in the large baths, before it is sufficiently cooled for tepid bathing, without the addition of cold water. It contains an uncom- mon quantity of sulphur, and emits a smell like that of Harrowgate water, but far more penetrating. From its heat, and its stronger impregnation of the sulphureous principle, it js also more powerful in all the diseases of the skin, for wliich Harrowgate is resorted to. The baths at Aix-la-Chapelle are looked upon as a cure for almost every cutaneous eruption ; but the water should be used internally at the same time, to carry off impurities, and keep up the full per- spiration promoted by the bathing. These baths are equally ser- viceable in stiffness of the joints and ligaments, which is left by the inflammation of gout and rheumatism, and in the debility of palsy, where the highest degree of heat which the skin can bear is required. In obstinate cases, the vapour-bath, formed by the steam of those very hot waters, is recommended by the German physicians. Numberless instances serve to establish the efficacy of the waters of Aix as an internal medicine in painful affections of the kidneys and bladder, as well as in disorders of the stomach and biliary organs occasioned by luxurious indulgence and intemperance. The common dose is half a pint, to be repeated more or less often, according to its sensible effects, and to the intention with which it is prescribed, either as a purgative or a diuretic. It is a striking proof of the power of habit, that the palate and stomach are soon reconciled to the use of such waters, though at first extremely dis- gusting and nauseous. The hot sulphureous springs at Bareges, two little hamlets on the French side of the Pvrenean mountains, are, indeed, inferior in the degrees of heat and strength of impregnation to the waters of Aix-la-Chapelle, yet are found very beneficial in the like com- plaints. Their highly detergent powers, owing perhaps to a small portion of oilv or bituminous matter, added to the other medicinal properties which they possess iu common with those of Aix. render them peculiarly efficacious in deep-seated ulcers, and those morbid affections of the womb, which French ladies call, though not with medical correctness, depots de lait. In such cases the waters are 488 MINERAL WATERS. injected. They are also very frequently used in the form of doutkt or by way of pumping on the part affected, as well as for general bathing. In the interior parts of France, particularly in the central pro?- inces of Auvergne and the Bourbonnois, now included in the De- partment of the Loire, there are several hot springs, but of the saline chalybeate class, the efficacy of which, as an internal medi- cine, is greatly increased by their higher degree of temperature, in the disorders for which Cheltenham is resorted to in our own country. Those French springs derive another very important advantage from their heat, that of being used as a bath in all cases which may require that salutary stimulus on the surface. In many of these, the internal and external use of the waters co-operate with wonderful effect; and particularly in the sexual com plaints of women, arising from any defect or irregularity in the functions of the uterine organs. Catherine de Medicis, the mother of several French princes, is said to have been much indebted for her fertility to the waters of Bourbon Lancy, not far from the town of Moulins, a place consigned to immortal fame by Sterne's affecting story of "Maria." There is a village on the confines of Bohemia, where the wafers may be said, in the strictest sense of the word, to boil up with ve- hemence from the spring, and are often used for scalding hogs and fowls, to loosen the hair and feathers, the heat being quite sufficient for these purposes. The temperature of the Prudel, or furious fountain, as it first issues forth, is as high at 165°, and keeps in- variably to the same point. Of course it requires to be very much cooled before it can be used as a bath, or even drank. Those wa- ters are said to have been resorted to, and first brought into con- siderable notice, by the Emperor Charles IV. in 1370; to which circumstance the village owes its name of Carlsbad, or Charles's bath. The natural history of its waters would afford a great vari- ety of curious and interesting particulars; but the limits of my present plan confine me to a short medical notice of their extraor- ainary virtues in all the diseases for the cure of which saline chaly- beates are internally or externally employed. Malvern Water. Malvern, in Worcestershire, has for many years been celebrat- ed for a spring of such remarkable purity, that it has acquired the name of the Holy Well, from the reputed sanctity of its waters, and the real extensive benefit long derived in various cases from its US6« The great benefit arising from the use of Malvern water as an external remedy in diseases of the skin and surface of the body, has led to its employment in some internal disorders, and often with considerable advantage. Of these the most important are painful affections of the kidneys and bladder, attended with the discharge of bloody, purulent, or fetid urine ; the hectic fever produced by scrofulous ulceration of the lungs, or very extensive and irritating sores of the surface of the body, and also fistula? of long standing that have been neglected, and have become constant and trouble- MINERAL WATERS. 489 some sores. Though unquestionably of benefit in many of these cases, it is in general a safe application, and may be used with the utmost freedom, both as an external dressing for sores, and as a common drink ; and this is particularly the case with common people that resort to this spring for diseases of the skin or other sores, who are in the constant habit of dipping their linen into the water, dressing with it quite wet, and renewing this application as often as it dries. The perfect safety of this practice .mi a preter- naturally irritated surface, has been ascertained by long experience. and is in itself an important circumstance in illustrating the effect of moisture on the surface of the body. The internal use of Malvern water is sometimes, on first begin- ning to use it, attended with a slight nausea ; for the first day or two it occasions some degree of drowsiness, vertigo, or slight pain of the bead, which comes on a few minutes after drinking it. These symptoms, however, subside spontaneously in a few days, or may readily be removed by some mild purgative medicine. The effects of the Malvern water on the bowels are not at all constant ; it frequently purges briskly for a few days, nor is it at all uncommon for the body to be rendered costive by its use, es- pecially with those accustomed to malt liquors. In all cases it de- cidedly increases the flow of urine, and the general health of the patient ; his appetite and spirits almost invariably improve during a course of the water, if it agree in the first instance. In addition to the benefits to be derived from the use of the Mal- vern water, the pure mountain air, added to the romantic beauty of the situation, which solicit the invalid to active exercise, con- tribute greatly to the convalescent state ; and the temperance gen- erally observed by patients of every rank in these places, assists materially in securing the advantage which has been gained from the use of this mineral spring. A course of Malvern water must vary very considerably in du- ration, on account of the different kinds of disease for which tin* spring is resorted to. Cases of obstinate scrofulous sores, espe- cially with caries in any bone, are always long in healing, and re- quire a residence here for a considerable time. The same may be said of very obstinate herpetic eruptions ; but where the cutaneous affection is mild, or where a tendency to it comes on at stated times, which is sometimes the case, this habit may be checked by a short use of this water ; and hence some persons who are liable to this disorder, make an annual visit to this salubrious spring. Ai.r.MiNotrs Chalybeate Spring in the Isle of Wight. This spring, discovered by a Mr. Waterworth, is situated on the south-west coast of the Isle of Wight, about two miles to the west- ward of Nitron, in one of those romantic spots for which that coast is so remarkable. From a tabular view of the diseases which preceded a course of this mineral spring, furnished by Dr. Lempriere, who had the op- portunity of witnessing the effects of this water upon an extensive scale, it appears that many patients, labouring under continued fever, agues, pulmonic diseases, chronic dysentery, chronic rbeu- W2 490 VEGETABLE POISONS. matism with emaciation, diseases of the abdominal viscera, dropiy Sec were benefited. " In giving this water," observes Dr. Leinpriere, " I was very forcibly struck with the rapid effect it produced on the appetite and spirits, and the confidence it inspired in the mind of the patient." The improvement of the appetite was soon succeeded by an in- crease of strength, and a return of the natural complexion. The water did not appear to produce any effect upon the pulse or skin, nor did it act particularly on the kidneys; its tendency to increase the appetite and raise the spirits was the only evident effect to he observed during the early course; and a return of strength, and general appearance of improved health, marked its later progress. In administering the water, it was a rule previously to devote one day to clearing the bowels by some suitable aperient; and Epsom salts were the medicine generally preferred. Under this prepara- tive, the water seldom produced any disagreeable effect on the stomach or bowels, or rendered it necessary, during the course, to take laxative medicines ; an advantage which does not attach to other chalybeate waters, unless they hold in solution a considera- ble portion of some aperient salt. It is advisable to begin the use of these waters in very small pro- portions, using it in a diluted state when, from peculiarity of consti- tution, it appears to excite nausea, increasing it gradually when this may be done with safety, combining with its use a nutritive diet, without excess, paying strict attention to the state of the bow- els, so as to avoid costiveness, early hours, particularly early ris- ing, exercise in the open air, more especially on horseback, and sea-bathing, when not otherwise prohibited. CHAP. XIV. VEGETABLE POISONS. All vegetable poisons act upon the nervous system. Those of an irritating nature are Monkshood, Meadow Saffron, Mezere- on, Bear's Foot, Hemlock Dropwort, Water Hemlock, Wall- Pepper, Sec. The general symptoms they produce when taken are an acrid pungent taste, with more or less bitterness, excessive heat great dryness of the mouth and throat, accompanied with a sense of tightness there ; violent vomiting, and the efforts continu- ed even after the stomach is emptied ; purging, with great pain in the stomach and bowels; pulse strong, frequent, and regular; breathing often quick and difficult; appearance of intoxication; the pupil of the eye frequently dilated; insensibility, resembling death ; the pulse becomes slow and loses its force, until death clos- ^Ext^n^Uy applied, many of the vegetable poisons produce vio- lent inflammation of the skin, with vessications, or pustulary erup- tions. Treatment.—If vomiting has been occasioned by the poison, pad the efforts are still continued, they may be rendered easier by NARCOTIC POISONS. 491 swallowing copious draughts of warm water, or thin gruel; but should insensibility have come on without vomiting, it ought imme- diately to be excited by some powerful emetic, as the sulphate of zinc, (twenty grains dissolved in half a tea-cupful of water) or sul- phate of copper, from ten to fifteen grains; after the operation of which, a brisk purgative should be given, and emollient or stim- ulating clysters administered, as the urgency of the case may re- quire. A preferable and more expeditious mode, provided it can readily be procured, of dislodging the poison, mineral or vegetable, is the stomach-pump ; as this, however, requires some anatomical knowl- edge, a medical practitioner, having one of these valuable machines in "his possession, should be instantly sent for, in the meantime either of the preceding, or other emetics, being given. After as much as possible of the poison is dislodged, either by emetics or other means, a very strong infusion of coffee, or vinegar diluted with water, may be then given with advantage* Camphor- mixture with ether (two ounces of the former to half a drachm of the latter,) may be taken frequently; and should the insensibility increase, warmth, friction, and blisters may be employed. If in- flammation, or other dangerous consequences have arisen, these must be treated accordingly. NARCOTIC POISONS.—Among the narcotic poisons are enumerated the following: Deadly Nightshade, Hemlock, Fox- glove, Henbane, Touacco, Opium, Woody Nightshade^ Sl.c Sic The general symptoms of these, when taken into the stomach, or applied to a wound, produce the following effects : viz. stupor, numbness, heaviness in the head, desire to vomit, at first slight, but afterwards insupportable ; a sort of intoxication, stupid air, the pupil of the eye dilated, furious or lively delirium, sometimes pain, convulsions of different parts of the body, or palsy of the limbs. The pulse is variable, but at first generally strong and full ; the breathing is quick, and there is great anxiety and dejection, which, if not speedily relieved, soon terminates in death. Treatment.—In the treatment of persons labouring under the influence of narcotic poison, the principal attention should be di- rected to rouse the sensibility of the system, so as to render the stomach susceptible to the irritation of emetics, and the action of other stimulants. Late experience has proved that the best mode of etlectin" this is by repeatedly dashing cold water over the head and neck ."whilst the other parts of the body are kept warm and dry. \pplying the solution of ammonia to the nostrils by means of a feather, introducing a drop or two of the spirit of hartshorn into each eye, sprinkling cowhage over the neck, breast, and hands, and applying a mustard-plaster over the seat of the stomach, have been attended with good effects. The best form of an emetic, in • The fruit of the Fewillea cordifolia has latterly been recommended as a powerful " nnt.dole agni..*t vegetable poisons; and .8 directed to be used in as recent a state as possible. El>. r 1 All plants whose flowers have five stamens, one pistil, one l»*$>*n*™*°fij™l i.of the berrv kind, may at once be pronounced " P°»o»««- » ^"S,, ™ plant, which arow in teufir, are mostly poisonous ; and such as have the corolla pur pie and yellow, m.iy be suspected of being so. Ed, 192 POISONOUS fi>:ii. these cases, is the subjoined draught.* Should this, however, fail, four or five grains of tartar emetic, or from ten to twenty of the sulphate of zinc, should be introduced into the stomach every quar- ter of an hour, and vomiting excited and assisted by irritating the fauces with the finger, or the end of a feather. Large and strong clysters of soap, dissolved in water, or of thin gruel, into wliich a table-spoonful of salt may be put, should be speedily administered, to clear the bowels, and to assist in getting the poison dislodged, giving active purgatives after the poison has ceased ; after which the strong coffee and diluted vinegar and water may be given, as above directed. If by these means the stupor and drowsiness, which is sometimes extreme, and the insensibility bordering on apoplexy, be not remedied, blood may be taken from the jugular vein, blisters applied to the neck and legs, and the sensibility rous- ed by every possible means. If the heat of the body decline, warmth and friction must be perseveringly used to restore it. Veg- etable acids are on no account to be given before the poison is ex- pelled ; and it is even desirable that as little fluid as possible, of any description, should be given. The stomach-pump, if it can be procured and adapted without loss of time, should precede these means, as the most effective in dislodging the poison. POISONOUS MUSHROOMS.—Among these are the Pepper Agaric, Deadly Agaric, Champignon, which are frequently mis- taken for the edible mushroom.t The symptoms they produce are nausea, heat and pain in the stomach and bowels, with vomit- ing and purging; thirst, convulsions, and faintings; small and frequent pulse; delirium, dilated pupil, stupor, cold sweats, and often death. Treatment.—In the first place, when any of the above symp- toms arise, after eating mushrooms, an emetic of tartarized antimo- ny, followed by frequent doses of Glauber or Epsom salts, and large stimulating clysters, are to be speedily administered. After the contents of the stomach are thoroughly evacuated, ether may be given in small quantities of brandy and water; but should in- flammatory symptoms supervene, these and other stimuli must be laid aside, and means accordingly adopted to combat them, bee Mineral Poisons, &c. p. 342. CHAP. XV. POISONOUS FISH, &c. Of this class are the Yellow-billed Sprat, Sea Lobster, Tincture of Capsicum, 2 drs. ateiy. 10 "*'' SHSS/SS •!>«m1« ..«.««• ill, are "ter, ».-» op.» «l PJ VACCINATION. 493 Land Crab, Conger Eel, Muscle, Rock Fish, Sec. In an hear or two after eating stale fish, or often in much less time, a sense of weight at the stomach comes on, with slight vertigo and head- ach, heat about the head and eyes, and considerable thirst; often an eruption of the skin similar to what is called the nettle rash; and, in some instances, death has been the consequence. Treatment.—An emetic should be taken as soon as any of the preceding symptoms, after eating any of the above fish, begin to manifest themselves ; and where it cannot readily be procured, vomiting may be excited by tickling the throat with the finger, and taking large draughts of warm water. After full vomiting an ac- tive purgative should be given to remove any of the noxious mat- ter that may have found its way into the intestines. Vinegar and water may be drank after the operation of these remedies, with which also the body may be sponged. Water made very sweet with sugar, to which some ether may be added, may be drank freely as a corrective ; and a very weak solution of alkali may be given to obviate the effects produced by the poison. If spasms come on after the evacuations, large doses of the tincture of opium are necessary. If inflammation arise, the usual means of remov- ing it must be employed.—See Animal Poison, p. 112, Sic* CHAP. XVI. VACCINATION. As a preventive of the small-pox, the vaccine inoculation is now universally practised. This generally produces a very mild and safe disease, consisting of a single vesicle forming on the place where the inoculation was performed. On the third day, the scratch where the vaccine matter was introduced is slightly red, and, if pressed with the finger, feels hard. Next day, the red point is a little increased, and somewhat radiated. On the fifth day, a small vesicle appears, but it is more easily seen on the sixth. This gradually increases, until it acquires the size of a split pea. The colour of the vesicle is dull white, like a pearl. Its shape is circular, or slightly oval when the inoculation has been made with a lengthened scratch, acquiring about the tenth day a diameter equal to about the third or fourth part of an inch. Till the end of the eighth day, the surface is uneven, being depressed in the cen- tre, but on the ninth day it becomes flat, or sometimes higher at the middle than at the edges. The margins are tinged and round- ed, projecting a little over the base of the vesicle. The vesicle is not simple, but cellular, and contains a clear limpid fluid, like the purest water. On the eighth or ninth day, the vesicle is surrounded with an areola or circle of intense red colour, wliich is hard and tumid. About this time an erythematic efflorescence sometimes takes • See \rw London Medical Pocket Rook, p. 234-, to p. 849, for an excellent hit- lory of mineral, vegetable, animal, and aerial poisons, &c. 494 SEA-SICKNESS. place near the areola, and spreads gradually to a considerable part of the body. It consists of patches, slightly elevated, nnd is at- tended with symptoms of fever. On the eleventh or twelfth day, as the areola decreases, the surface of the vesicle becomes brown at the centre, and is not so clean at the margin ; the cuticle gives way, and there is found a glassy hard scab, of a reddish brown colour, which is not detached, in general, till the twentieth day. When it falls off, a scar about half an inch in diameter is seen, and having as many pits as there were cells in the vesicles. During the progress of the vesicle, there is often some disorder of the constitution ; and occasionally a papulous eruption, like scrophulus, appears next the vesicle. As security against the small- pox is not secured by spurious vaccine vesicles, it becomes necessa- ry to study carefully the character of the genuine disease, which is here briefly described. CHAP. XVII. SEA-SICKNESS. The cause of this distressing affection is the well-known motion of a vessel on the surface of the water. Some thousands are an- nually, nay daily, prevented from going to sea, either upon busi- ness, health or pleasure, in consequence of the terror of the waves. The most alarming, nay even fatal, consequences have been known to result from the violent retching and vomiting produced by the motion of the vessel, without it being in the power of any one to stop it; for, if it be true that sea-sickness is only to be cur- ed by habit,* what hope can be held out to the afflicted that they will acquire this habit, without inconvenience, and without risk; such as the bursting of a blood vessel, apoplexy, idiotcy, blindness, abortion, Sec, which have been known to result from excessive straining and vomiting 1 . People of delicate constitutions are known to derive considera- ble benefit from sailing on the sea; though frequcai.y t.;6 good they have received has been more than counterbalanced by the in- * With the exception of Dr. Stevenson's Imperial Marine Tincture which,Jfor the »nd freauen lvsince It possesses also the no less singular quality of completely ar- Btmmmmmm been attempted, but without success, SEA-SICKNESS. 495 jurious effects that have been caused by the violent sickness there- by occasioned. Those who intend to travel by sea, and are apprehensive of sick- ness, should previously use gentle aperients ; and afterwards, to alleviate the nausea and vomiting, drink soda-water in a state of effervescence ; live sparingly; take up their station as near the mid- dle of the ship as possible; sleep in a hammock or cot, in prefer- ence to a cabin, with their head towards the stern of the vessel; and while they are upon deck to look always in the direction the ship is sailing. Persons of a plethoric constitution should purge, and lose a little blood from the arm. The Imperial Marine Tincture, in doses of one, two, or three tea-spoonsful every quarter of an hour, has the remarkable effect, in the course of a few doses, of completely removing all the symp- toms ; indeed, this is so valuable a medicine, of the nostrum-kind, for this and other affections, that whether by land or sea, in hot, or cold, or temperate climates, it must always prove a safe and most useful medicine to resort to on emergencies. Many persons, on the least motion of a vessel, are instantly ta- ken with nausea and vomiting. Whenever the latter occurs, it should be encouraged, until the contents of the stomach are eject- ed, by copious drafts of tepid water ; after which, a tea-spoonful or two of the Imperial Marine Tincture effectually prevents any recurrence of these unpleasant symptoms. The many flattering encomia that have been lavished upon this valuable preparation in sea-sickness and nervous affections in gen- rral, render it, from the smallness of the dose, and the safety with which it may be taken, an object of some consideration, where such a medicine of the kind may be required. TABLES OF WEIGHTS AND MEASURES USED IN WEIGHING MEDICINE, Sec There are two kinds of weights received in use in England, by one of which gold and silver, and by the other, nearly all kinds of merchandize are estimated. In medi- cine, the former (Troy weight) is adopted, by which the pound is divided as follows — The Pound \ e twelve Ounces. °anc* \ contains \ f^ Drachms. Drachm ( J tD*ee Scruples. Scruple / 1 twenty Grains. The liquid measure also differs, one being proper for ale, the other for wine; th«- latter of which is adopted. The wine gallon is defined [by the laws of the kingdom, which is thus divided lw medicinal purposes:— The Gallon. C. \ Pint { Fluid Ounce I Fluid Drachm J contains eight Pints. sixteen Fluid Ounces. eight Fluid Drachms. sixty Minims.* V Acid, alkaline, earthy, and metalic preparations, and salts of all kinds, should be kept in glass-stopped bottles. The degree of heat is measured by Fahrenheit's thermometer, and when a boiling heat is prescribed, it is that which is marked by the 212th degree. A gentle heat ii between the ninetieth and hundredth A TABLE OF PROPORTIONATE DOSES, REGULATED FOR ALL AGES. Ages. Suppose the common dose 1 Drachm. Proportionate Dose. Weeks 7 1-15 4 grains. Months 7 14 28 1-12 1-8 1-6 5 grains. 8 grains. 12 grains. Years 3J 5 7 14 21 63 77 100 1-4 1-3 1-2 2-3 *i 5-6 4-5 25 grains. 1 scruple. A drachm. 2 scruples. 1 drachm. 55 grains. 2A, scruples. 2 scruples. UTENSILS NECESSARY FOR THE FAMILY MEDICINE CHEST. 1. A two or three ounce graduated measure. 2. A large and small spatula for spreading ointments, plasters, &c. 3. Weights and scales; —a larger set to weigh ounces; —a smaller for grains,sera pies, and drachms. 4. A clyster syringe. 5. A pint marble mortar and pestle. 6. A naif pint glass do. 7. A slab of marble, or of Wedgewood's composition, for sundry purposes. 8. A mfnim glass, &c. &c. * A minim glass is used for measuring the smallest portions of liquids, marked at regular nter»»b Reckoning by drops is sometime deeefving, according to the neck of Ike vehicle whence the, fall, aTwell as uncertain; w just twice as many drops of any tincture is required for filling the .»■»■ measure as water. APPENDIX: CONTAINING ^UsiVSi dZIT and °f ,0Ch Medicinal PreP«ation. a, are commonly need in Practice, with B>.Ti^?.hSL,ifpr-.Pu''!,uD,rAa^ .comP°"n«ing such Medicines as are recommended in the former Part of the Book, with the Addition of several others of a similar Nature. ». Remarks on the Dotes, Uses, and Manner of applying the different Preparations. Thk design of the following pagee is, to exhibit such a list of drugs and medicines as may be necessary for private practice. They are considerably more numerous indeed than those recommended in the former part of the book, but are still greatly within the number contained in the most reformed d.spensatories. The same medicine is seldom exhibited under different fcrms ; and where different medicines answer nearly the same intention, there ,s commonly no more than one of them retained. Multiplying forms of medicine lor the same intention tends rather to bewilder than assist the youni practitioner, and the experienced physician can never be at a loss to vary his prescrip- tions as occasion requires. The chemical and other difficult preparations are for the moot part Omitted. All of them that are used by any private practitioner are not worth preparing. He will buy them much cheaper than he can make them. Great care COWever, is necessary to obtain them genuine. They are often adulterated, and ought never to be purchased unless from persons of known veracity. Such of them as are in common use are inserted in the lists of drugs and medicines. Their proper doses and manner of application are mentioned in the practical part of the book, wherever they are prescribed. Such articles of medicines as are to bo found in the house or garden of almost every peasant, as barley, eggs, onions, &e. are likewise for the most part omitted. It is needless to swell a list of medicines with such things as can be obtained whenever they are wanted, and which spoil by being kept. The preparations made and sold by distillers and confectioners are also generally left out. These people, by operating upon a larger plan, generally make things bet- ter, while it is in their power to afford them much cheaper than they can be pre- pared by any private liana.—The quantity ordered of every medicine is as small as could well be prepared, both to prevent unnecessary expense, and that the medicine might not spoil by keeping. Almost every medicine suffers by being kept, and should be used aa soon after it has beon prepared us possible. Even simple drugs are apt to spoil, and should therefore be laid in in small quantities; they either rot, are consumed by insects, or evaporate so as to lose their peculiar taste or flavour, and often become quite insignificant. In several compositions, the ingredient on which the efficacy of the medicine prin- cipally depends is increased, while the auxiliaries, which are generally ordered in such trifling quantities as to be of no importance, are left out, or only such of them retained as are necessary to give the medicine a proper consistence, or the like. The colouring ingredients are likewise for the most part omitted. They increase the bulk and price of the medicine ; without adding any thing to its value. It would be well if they were never used at all. Medicines are often adulterated for the sake of a colour. Acrid and even poisonous substances are, for this purpose, sometimes in- troduced into those medicines which ought to be most bland and emollient. Oint- ment of elder, for example, is often mixed with verdegrise to give it a fine green col- our, which entirely frustrates the intention of that mild ointment. Those who wish to obtain genuine medicines should pay no regard to their colour. Some regard is likewise paid to expense. Such ingredients as greatly increase the price of any composition, without adding considerably to iu virtue, are generally cither omitted, or somewhat less expensive substituted in their place. Medicines are by no meane powerful in proportion to their price. The cheapest are oflen the best; besides, they are the leas, apt to be adulterated, and are always most readily obtained. With regard to the method of compounding medicine*, I have generally followed Ihu. which seemed to be the most simple and natural, mentioning the different steps APPENDIX. of the process in the same order in which they ought to be taken, without paying ta implicit regard to the method of other dispensatories. I have followed the alphabetical order, both with regard to the simples and preptu. tions. A more scientific method would have been agreeable to some personi, but leu useful to the generality of readers. The different classes of medicine have no great dependence upon one another, and, where they have, it is hard to say which should stand first or last; no doubt the simple preparations ought to precede the more com- pound. But all the advantages arising from this method of arrangement do not ap- pear equal to that single one, of being able,"on the first opening o? the book, to find out any article, which, by the alphabetical order, is rendered quite easy. The dose of every medicine is mentioned, whenever it appeared necessary. When this is omitted, it is to be understood that the medicine may be used at discretion. The dose mentioned is always for an adult, unless when the contrary is expressed. It is not an easy matter to proportion the doses of medicine exactly to the dill'erentiget, constitutions, &c. of patients ; but, happily for mankind, mathematical exactness here is by no means necessary. Several attempts have been made to ascertain the proportional doses for the differ- ent ages and constitutions of patients ; but, after all that can be said upon this subject, a great deal must be left to the judgment and skill of the person who administers the medicine. The following general proportions may be observed ; but they art by no means intended for exact rules. A patient between twenty and fourteen may lake two-thirds of the dose ordered for an adult; from fourteen to nine, one-half; from nine to six, one-third ; from six to four, one-fourth ; from four to two, one-sixth ; from two to one, a tenth ; and below one, a twelfth. To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the order of the English alphabet, and the smallest and largest dose placed opposite to the operation of each article. The dosr-i indeed refer to adults, but may be adapted to different ages by attending to the rules laid down in the opposite page. Short cautions are occasionally inserted under such articles as require to be used with care. , • . Though a greater variety of medicines is contained in this than in any former edition of the Domestic medicine, yet the Author would advise those who peruse it, as far as possible, to adhere to simplicity in practice. Diseases are not cured by multiplicity of medicines, but by their proper application. A few simples judi- ciously administered, and accompanied with a proper regimen, will do more good than a farrago of medicines employed at random. [ iii ] A LIST OF THK MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PARTICULAR VIRTUES AND PROPER DOSES. *»• Explanation of the Abbreviations used in the following DoseB: scr. scruple, scrs. scruples, dr. diachm, drs. drachms, oz. ounce, drps. drops, gr. grain, grs. grains, grad. gradually. Names. ACACIA, the expressed ) juice, from ) Acid, the acetous , muriatic - ----, nitrous, diluted , vitriolic, diluted /Ether, vitriolic /Ethiop's mineral Properties. Demulcent. Refrigerant, &c. Antiseptic, &.c. Tonic, febrifuge, &c. Tonic, Antiseptic. Anodyne. Alterative. Doses. 1 scr. to 1 dr. Agaric, used externally as a styptic, to staunch blood Aloes Alum .... ----, burned Amber, prepared Ammoniac, gum ■■ milk of Angelica, the root powdered An.se, the seeds Antimony, crude ------—, calcined , cinnabar of ------——, glass of ----------, tartarized Asafoetida, ----------, milk of - Asarum, - - - - Balsam of capivi - Canadian -------of Peru _. of Tolu Emenagogue, &c Astringent. Escharotic, &.c. Antispasmodic. Expectorant. Expectorant. Stimulant, &c. Carminative. Febrifuge, &c. Febrifuge. Diaphoretic. Emetic, never used. Emetic. Emenagogue, Expecto- rant, and Antispas- modic. Antispasmodic, «fec. Emetic and Errhine. Diuretic, &c. Diuretic, &c. Expectorant, Stimulant. Stimulant, Expectorant. Tonic, &.C Tonic. Bark, cascarilla ____, Peruvian, powder of Rear'* foot oowder of the leaves Narcotic. — „.-- D. genzo.n re,^n of, not employed internally, and principally for obtaining Benzoic acid. 1 scr. 10 drps. 15 drps. 15 drps. 30 drps. 10 grs. 5 grs. 6 grs. 3 grs. 4 dr. 6 grs. A oz. \ dr. 10 grs. 10 grs. 1 scr. 10 grs. f gr. J gr- grs. h oz. 3 grs. 20 drps. } scr. 15 grs. 10 grs. 1 scr. 10 grs. 1 dr. 40 drps. 40 drps. 40 drps. 2 drs. 30 grs. 30 grs. 20 grs. '?r 30 grs. 1 oz. U dr. 1 dr. 1 dr. 1 dr. 1 scr. 2 grs. 4 grs. 4 dr. 1 oz. 6 grs. 60 drps. 4 dr. 2 scrs. 1 dr. 2 drs. 20 grs. Bistort, powder of the root Blessed Tliistle ______________-, expressed, ; juice of - - ' Bole, Armenian ----, French Borax, rarely used internally Broom, ashes of* the tops - Burdock, powder of the root Astringent. Tonic, Emetic. The same. Astringent. The same. Detergent. Diuretic. Sudorific, &c. 1 scr. 10 grs. 2 drs. 10 grs. 10 grs. 1 scr. 10 grs. 1 dr. 1 dr. 2 oz. 2 drs. 40 Calamine stone, levigated, used externally in Turners cerate. S Alterative. ' %*■ Purgative. 3 g™' 1 dx. 3 grs. 12 grs IV MEDICINES U9ED IN PRACTICE, Names. Camphor - Canella alba, powder of Cantharides Cardamoms Caraway seeds Carrot, seed of the wild Cascarilla bark Cassia, the pulp Castor Caustic, lunar; used externally as to grs. ij. in epilepsy. Catechu..... Camomile, in powder Centaury, the lesser Chalk..... Cinnamon .... Colocynth..... Columbo..... Confection, aromatic ----------, opiate Crab's claws, prepared Conserve of roses Contrayerva - Coriander seed Properties. Narcotic, Diaphoretic Tonic, Carminative. Stimulant, Diuretic. Carminative. Carminative. Carminative. Tonic. Laxative. Antispasmodic Doses. * gr»- to A,. I kt. I scr. to 2 an. i «t. - 4 grs. o grs. 10 grs. 1 scr. 10 grs. 2 drs. 8 grs 20 grs. 40 grs. lur. lot. 1 dr. r---------; «# gin. - i nr, an escharotic; internally, gr. A, cautiously increa Cowhage, Cummin seed Dandelion, expressed juice of Decoction of hartshorn > of broom tops -of Peruvian bark - of the inner bark of the elm ————— of sarsaparilla Decoction of sarsaparilla, > compound - - ) ———— of guaiacum Deadly night shade - Dragon's blood Earth, fuller's, use external ) in excoriations ) Electuary of cassia - ——.— of scammony - ---------lenitive, or of senna - Elixir of vitriol Elecampane, powder of the root Extract of broom-tops —- Peruvian bark ------- cascarilla - . camomile .-------colocynth comp. - Extract of gentian -------hemlock ------• liquorice - logwood - _______black hellebore - -------jalap - - - - .------guaiacum .______white poppies _______rue - _______savin - _______ senna - _______wormwood - Fern, powder of the root Astringent. Tonic. Tonic. Absorbent. Carminative. Violently Cathartic. Tonic. Cordial. Anodyne. Absorbent, Astringent. Febrifuge. Carminative. Vermifuge. Stimulant. 15 grs. 20 grs. 1 scr. 20 grs. 5 grs. 2 grs. 10 grs. 10 grs. 10 grs. 10 grs. l3r. 10 grs. 30 grs. 1 3r. 1 dr. "' scrs. 1 dr. 10 grs. 2 sera. 2 sen. I dr. 1 oz. 2 sen. dr. 15 grs. I dr. C The spiculae of one pod s mixed with honey or C molasses. 1 scr. I dr. Diuretic. 1 oz. 3 oz. Demulcent. \ Hal^ * Pint' rePeated M ( often as necessary. C 1 oz. to a pint of water; Diuretic. < to be taken by teacups- C fill. Tonic. 1 oz. 4 oz, Diuretic. 4 oz. - 10 oz. daily. Alterative & diaphoretic. 4 ox. - 16 oz. daily. Alterative & diaphoretic. 4 oz. - 16 oz. daily. „. . (3 drachms to a pint of Diaphoretic. J wgter A pint'daily. Narcotic, gr. £ to grs. ij. of the powdered leaves. Astringent. " 10 grs. - 2 scrs. Astringent. Aperient. Purgative. Purgative. Tonic. Stimulant. Diuretic. Tonic. Tonic. Tonic. Cathartic. Stomachic, Alterative. Demulcent. Astringent. Emenagogue. Purgative. Diaphoretic. Anodyne. Emenagogue. The same. Aperient. Tonic. Vermifuge. 1 dr. 20 grs. 30 grs. 15 drps. 20 gri A dr. 10 grs 10 grs. 10 grs, 5 grs 10 grs 2 grs l3r. 10 grs 3 grs 5 grs 10 grs 1 gr. 10 grs 10 grs 10 grs 10 grs 4 dr. I oz. 2 drs. 6 drs. 130 drps 1 dr. 1 dr. dr. ift 25 grs. A3r. 10 gri. dr. *"■ 20 grs. 20 grs. 5 grs. 20 grs. 30 grs. 30 grs. 30 grs. Ao, MEDICINES USED IN PRACTICE, Names. Fennel seed Foxglove, powder of the leaves Properties. Aromatic. Diuretic. > Ad libitum. Dose*. 20 grs. to 1 dr. A. gr. - 3 grs. or a drachm infused in a i pint of boiling water, 5- 1 oz. of which a dose is > (Administered with caution.) Frankincense.........10 grs. - 30 grs. Flowers of camomile, powder of Tonic. 10 grs. - 1 dr. - elder .... Cathartic, &c. -------rosemary ... Emenagogue. -------damask roses, rarely ~i employed unless to make > Laxative. rose-w:it«!r. j -------red ditto, in infusion - Astringent. Fruit*. Almonds - - - Demulcent. ------ Figs, dried - - - Aperient. ——— French prunes - - Aperient. ------ Tamarinds Aperient. (ialbanum .... Deobstruent. Cnlls ..... Astringent. (.arlic, cloves of - - - Expectorant. lientian.....Tonic, Germander ... - Tonic. lunger.....Carminative. Ginseng ..... Guaiacum, wood of - - • Diaphoretic. ---------? gum-resin - - The same. Gum-arabic .... Demulcent. -----gamboge .... Hydragogue. Hartshorn, prepared - - Emollient. ---------, spirits of Hellebore, black - - - Emenagogue. ________( white ..- Emetic, etc. Hemlock.....Narcotic. Hiera picra ... Honey of squills ------of roses Hoffman's anodyne liquor Infusion of gentian, compound ------- roses -------senna - - - Ipecacuanha Iris, florentine - Iron, rust of ----, ammoniated ----, tartarized Jalap, powder of Juniper, powder of the berries Kino, gum Lead, white ... —, sugar of - Lichen, ash-coloured, ground -------Icelandic, a strong de- coction of Lime-water Lixivium of tartar Linseed Liquorice, root of Purgative. Diuretic. Astringent. Anodyne, &c. Tonic. Astringent. Aperient. L Emetic, and expecto [ rant, gr. i. to iij. Tonic. Tonic. The same. Tonic. Purgative. Diuretic. Astringent. Astringent. Demulcent. The same. Refrigerant. Lethontriptic. Demulcent. Demulcent I 10 grs. idr- 10 grs. - 20 grs. No. 1. - No. 6. 10 grs. 40 grs. 15 grs. 1 dr. 5 grs. 20 grs. 20 grs. 30 grs. 10 grs. - 30 grs. 15 grs. 1 dr. 2 grs. - 12 grs. 20 grs. 10 drps. - 1 dr. 40 drps. 5 grs. - 10 grs. 1 gr. - 5 grs. r Should always be begun with very small doses, as one grain or less, and gradually increased as the constitution will bear. See extract of. 10 grs. • 20 grs. 10 grs. -I dr. 40 grs. 2 drs. 20 drps. - 60 drps. 1 oz. 3 oz. 2 oz. 8 oz. A. oz. 2 oz. 10 grs. - 30 grs. 1 scr. 1 dr. 5 grs. 20 grs. 2 grs. - 10 grs. 2 grs. - 10 grs. 10 grs. -20 grs. 40 jfrs. 1 Sr. 10 grs. 30 grs. J Br- - 2 grs. 10 grs. - 40 grs. 1 oz. 4 oz. 4 oz. 8 oz. 15 drps. - 40 drps. C An infusion of 1 ounce to < a quart of water, may be { used at pleasure. J dr. - 1 dr. vi Nrnntt. Madder powder Mace Magnesia --------, calcined Manna - Marsh-mallows, root and leaves of .... ?vlastich, gum, - - - Mercury, crude -------, calcined • -------, with chalk -------, corrosive sublimate ■ -------, cinnabar of -------, red precipitate of ) -------, white ditto - > -, yellow emetic - MEDICINES USED IN PRACTICE, Properties. - Stomachic. • Antacid. - The same. Aperient. Demulcent Carminative. Mezereon Millipedes Musk Mustard seed Myrrh, gum Nitre, purified - Nutmeg Oil of Almonds ----amber, rectified ----anniseed - ----castor ----cinnamon ----juniper ----lemon peel ----linseed ----olive ----palm ----peppermint — turpenne Onion, expressed juice of Opium Opoponax Oyster-shells, prepared Oxymel of colchicum ------of squills Pennyroyal Peppermint Petroleum Pills, aloetic ----, of the gums ----, mercurial Titch, Burgundy - Pomegranate, powder ot Poppy heads Powder, antimonial Alterative. Alterative, Antisyphilitic The same. Alterative, &c. Use chiefly external. Sternutatory. Sialogogue in Decoct. Expectorant. Antispasmodic. Stimulant. Emetic. Expectorant. Diuretic. Stomachic. Demulcent. Antispasmodic Carminative, Stimulant. Diuretic. Demulcent. Demulcent, Laxative. Use external. Stimulant, &c. ( Diuretic. Externally,) ( stimulant. ) A powerful diuretic. Narcotic. Emenagogue. Absorbent. Expectorant. Diuretic. Emenagogue. Stimulant. Antispasmodic. Purgative. Diuretic. Antisyphilitic. 10 grs. 4 dr. 4 oz. 4 dr. 10 grs. igr. 10 grs. i gr- 10 grs. Doses. I veet mercury, and precipitated sulphur of V, e a pJ-r o-Tthi* 'subject in the Edinburgh Physical and Literary E„ays, b, the ingenious ~*u soups JJruises - - - Buchan, Dr. his plan of ex- ercise - Buckwheat, highly nutritious Burns ... -----, Cleghorn, Mr. his plan of treating -----, Kentish, Mr. his plan -----, Earle, Sir James, his plan ... Burying within churches, the practice condemned ------, its practice among the Jews, Romans, &c. Butter, considered as food Buxton waters 436 185 21 22 23 id. 61 418 485 34 36 37 362 54 27 359 361 360 361 63 id. 27 484 Cancer Candied orange peel ------, lemon ditto Carrots to be eaten young Casualties Catamenia. See Discharge, Menstrual. Cataplasms ---------, discutient, ripening Cataract Celsus, his justly celebrated advice - Cheltenham waters Child-bed women, manage- ment of - - Children,' moral and physic- al management of --------, diseases of - --------, mothers; advice to, concerning --------, seldom well un- less their bodies are kept gently open Chimney sweeper's cancer -------, Pott, Mr. quoted on 336 xii id. 33 378 x id. id. 330 99 475 411 438 id. 439 26 78 id. , Earl, Mr. quoted on "79 Chin-cough. See Cough, Hooping. Choking ... 379 Choke-damp explained 41 Cholera morbus - 1223 Clarke, Sir Arthur, hypoth- esis, faulty, relative to im- mersion in cold water 98-99 Cleanliness 78 Clothing, how to be regula- ted - - - - 71 -------, to be suited to cli- id. 72 id. 73 442 445 x xi id. mate —, to the season of the year how hurtful -------, tight bandages to be avoided in - - --------of children -------, necessary regula- tions and observations on Clysters ... Clyster, emollient ------, laxative INDEX. xli Clyster, carminative - xi ------, oily - - - id. ------, starch - - id. ------, turpentine - - id. -----r, vinegar - - id. Cold, the effects of extreme 387 Colds, more destructive than plagues 72 -----Boerhaave, quoted on 74 Colds and coughs - - 202 Colic 214 Collyria xi Collyrium of alum - id. --------vitriolic - - id. --------of lead - id. Confection, japonic - - xii ---------of catechu - id. Conserves ... id. Conserve of red roses - - id. --------of sloe - - id. Consumption, pulmonary - 152 ----------on the means of preventing - - 161 Convulsions, during preg- nancy or labour - 408 Convulsion fits, persons who expire in 395 Convulsions of infants - 435 Copper and its preparations. See Mineral Poisons. Corn, Indian, when boiled 26 Corrosive sublimate. See Mi- neral Poisons. Costiveness ... 299 ---------, after delivery 417 Cough, hooping - - 207 Cramp, of the stomach - 316 Cramps of the legs & thighs of pregnant women - 407 Croup ... 429 -----Turnbull, Dr. Will- iam, quoted on - 430 Customs, reprehensible ones 87 D. Deadly nightshade. See Poi- sons Narcotic. Decoctions ... --------of mallows - --------common - logwood xii xiii id. id. id. — bark ------compound of id. — sarsaparilla - id. — seneka - - id. — white - id. 416 Delivery, treatment after Dentition. See Teething. Desk occupations - Diabetes - ------Doctors Farrier and 53 230 232 55 57 19 Rollo, quoted on Diet, observations on ----vegetable and animal ----, observations on, «fec. ----, plain rules for the se- lection of - - - 59 ----, general observations on CO ---, sudden changes in - 61 Diarrhoea - - - 226 ---:----of pregnant women 406 Discharge, menstrual - 401 Diseases of the extremities, how often caused - 43 ------, knowledge and cure 100 ------, females liable to some which do not affect the opposite sex -, particular constitu- tions disposed to Dislocations ---------of the jaw -------------- neck - --------------ribs --------------shoulder --------------elbow --------------clavicle or collar bone kneepan Daffey's Elixir, a dangerous nostrum in the nursery 457 Dalby's carminative, a dan- Draughts ... Draught, anodyne -------diuretic - gerous nostrum in the nursery ... id. Damp beds - - - 95 •----houses 96 -------purging -------sweating -------vomiting Dress, the perfection of, in patella or thigh 101 id. 369 370 id. 371 372 id. id. 373 id. xiii xiv id. id. id. id. Y2 xiii INDEX. what consists - - 73 Dress, military smartness in, condemned - - 74 Drinking, how health injur- ed by it - - 77 -------, to excess, the bar- barous custom of - id. --------, hard, increase of consumption imputed to id. Dropsy - - - 268 ------of the extremities, or anasarca - 272 ------of the abdomen, or ascites - id. Drowned persons - - 382 Drugs necessary for private practice - iii Dysentery - - - 249 ---------putrid - 251 E. Ear-ach - - - 258 Ear, disorder of - - 332 Electuaries - - xiv Electuary, lenitive - - id. --------for dysentery - id. --------for epilepsy - id. --------for obstructed menses ------of bark ------for piles ----— palsy ------rheumatism Elixir, paregoric -----, sacred -----, stomachic -----, acid of vitriol Employments, various servations on Emulsions --------, common --------, arabic -, camphorated xv - id. id. - id. id. xxvii id. - id. ■ xxviii ob- - 42 xv id. id. id. Exercise, as necessary as food ... -------, to be taken in the open air ... -, glandular obstruc- --------sajjof gum ammoniac id. ---------, oily - - id. Epilepsy. See Falling Sick- ness. Eresipelas, or St. Anthony's fire - - - - 181 Eruptions, cutaneous of chil- dren ... 428 Excoriation. See Galling. tions removed by Exercise of children -------, the kind of, recom- mended for studious habits Extracts Evacuations, the natural Eye, disorders of - - ----, spots or specks on ----, blood-shot ----, watery or weeping Eye-waters. Sec Collyria. Eyes, inflammation of 66 68 66 449 54 xv 91 329 331 id. id. 189 Falling sickness - - 311 Fasting, long, its conse- quences 60 Fear - 86 ----, its effects on child-bed women - id. Feet, they suffer by pressure 72 Fever, intermittent - 109 -----, remittent, &c. - 117 -----, putrid remitting, of Bengal, Dr. Lind quoted on - - - - 118 -----, continued - 120 -----, inflammatory, acute, or ardent - 122 -----, slow or nervous 127 -----, malignant and pu- trid, or spotted fevers 133 -----, miliary - 140, 418 -----, bilious - 143 -----, scarlet - - 179 ---, puerperal - - 418 420 104 106 —, milk Fevers, general observations on - ------, beverage, in inflam- matory - -, exciting causes of, &c. ----, treatment, Sec ----, Hoffman and Cul- len on ----, hypothesis of Stahl 109 110 100 id. INDEX. xliu Fewillea cordifolia, the fruit of, an antidote, Sec Fish, poisonous - , - Fistula in ano -, lachrymalis Flatulencies Fits, fainting Fluor albus Flux, bloody. See Dysentery. 491 492 367 331 320 389 401 Fomentations ----------, anodyne ■----------, aromatic ---, emollient , strengthening xvi id. id. id. id. 446 448 39 Food of children ----, how to be regulated ----considered in a medi- cal point of view Foxglove. See Poison Nar- cotic. Fruits and roots, substitutes for bread 29 Fumigations, disinfecting 84 G. Galling - - - 425 Gargles - xvi Gargle, attenuating - id. ------, common - - id. ------, detergent - id. ------, emollient - - xvii Gluttony, Sec ought to be checked - 78 Godfrey's cordial, a danger- ous nostrum in the nurse- ry - 457 Gout - 273 Grain, boiled 24 Gravel and stone - 234 Grief, the most destructive of all passions - - 88 Ground, cultivation of, con- ducive to health - 49 Gutta serena - - 330 H. Hanging. See Suffocation. Harrowgate water - 4/8 Head-ach, with plethora of pregnant women - 405 Head-ach ... 254 Heart-burn - - 301 Heart-burn of pregnant wo- men - 40-j Heat, the effects of extreme .;8>"< Hernia. See Ruptures. Henbane. See Poisons nar- cotic. Hiccup ... 315 Hiccups, of infants - - 424 Hiera picra. See Tincture sacred and sacred elixir. Hossack, Dr. of New York, quoted - - - 82 Hot-springs, continental 4s? Humane Society, Royal - 396 Hydrophobia - - 348 Hypochondriac affections 325 Hypochondriacs, Cullen's description of - - 52 Hypochondriasis. See Low Spirits. Hysteria. See Hysteric af- fections. Hysteric* affections - 322 Hysterics of pregnant women 406 I. Ideas, a change of, necessa- ry to health 89 Inactive, the, always com- plaining, of what - 67 Indolence, its consequences 69 Infants, diseases of - 422 arise chief- ly from the bowels Infection and contagion -------observations and opinions on ------, diseases, many caused by - - - -------, cautions against Inflammations, &c. Inflammation of the bladder. See Bladder. A - , --------— of the nraih. id. 82 id. id. 84 355 See Brain. of the eyes. See Eyes. —'-------of the intes- tines. Sec Intestines. ---------of the kidneys.. See Kidnevs. xlir INDEX. Inflammation of the liver. See Liver. ------------of the lungs. See Lungs. ------------of the stom- ach. See Stomach. ------------of the throat. See Quinsey. ------------of the womb. See Womb. Infusions - xvii Infusion, bitter - id. --------of the bark - id. --------Carduus Benedic- tus, or blessed thistle - id. --------linseed - - id. --------of roses - - id. --------tamarinds and senna id. --------Spanish - - xviii --------for the palsy - id. .-------antiscorbutic - id. Intemperance - - ?5 ------------, the danger of id. ----, a striking King's evil 285 Laborious occupations, Sec remarks on - - 40 Labours, classification of 412 Labour, stages of - id. ------, symptoms preceding id. symptoms accompa- 413 414 416 id. 317 proof of afforded, by what id. ----r-------, families affect- ed by it - - - 76 Intestines, inflammation of the - - - 211 Intoxication, consequences of - - - " 76 -----------hurtful to young persons _ - - 78 -----------effects of, often fatal --- 391 Itch - - - - 290 Itchings, troublesome, of pregnant women - 406 J. Jaundice - 265 -------of pregnant wo- men - 407 Juleps - xvni Julep, caWphorated - id. ----, cordial - - - id. ----, expectorating - id. ----, musk - - - id. ----, saline - - id. ----, vomiting - id- K. Kidneys, inflammation of 217 nying -, process of, natural ------, tedious ------, treatment after Laugh, sardonic Lead and its preparations. See Mineral Poisons. Leeks - 34 Lichen, islandicus, prepara- tions of - - - xxxi Lime. See Alkaline Earths. Liniment for burns --------, volatile ------—, white —, for piles Liquors, fermented -------, observations on hot, in warm rooms, the danger of drinking Liver, inflammation of Lochia, suppression of Longings of pregnant wo- men - Looseness of infants Love, perhaps the strongest of all passions Low spirits Lungs, inflammation of M. xx id. id. id. 58 59 98 220 418 406 427 90 321 150 Malvern water - - 488 Marine tincture, imperial, for sea-sickness and ner- vous disorders - 495 Matlock waters - - 485 Measles ... 176 Mechanics, advice to - 49 Meconium - - - 423 Medicines used in private practice - - iii-viii ---------, names of - id. ------—■, properties - id. INDEX. xlv Medicines, doses - iii—viii Melancholy - - 306 ----------, religious - 90 Menses, immoderate flow of 401 —----, cessation of - 403 Menstruation, difficult id. Mercury and its prepara- tions. See Mineral Poi- sons. Midwives, their ill-judged care of infants - 422 Mind, the temper of in dis- eases, how to be attended to - - - - 101 -----, affections of - 85 Mindererus's spirit - xxviii Mineral waters - - 468 -------------, classifica- tion of 470 Mixtures - xviii Mixture, astringent - xix -------, diuretic - id. -------, laxative, absorbent id. -------, saline - - id. -------, squill - - id. Moffat waters - - 481 Mouth and nose, substances stopped between - 379 Mumps - - - 201 Mushrooms, poisonous 492 Music, its effects on the mind - 53 Myopia - - - 331 N. Nausea and vomiting of pregnant woman - 404 Nerves, weak, the compan- ion of inactivity - 67 Nervous diseases - 303 Night-air - 95 Night-mare ' - - 317 Nipples, fretted or chapped 418 Nitre 348 Non-naturals - - 55 Nose, bleeding at - 239 ----, stoppage of, in chil- dren - - - 426 Nurses, the duty of - 456 O. Oatmeal frequently made into bread - - 25 Oil, camphorated Ointments Ointment, yellow basilicum --------, of calamine - --------, emollient --------, eye -----—, issue --------, lead --------, mercurial --------, sulphur ■, for diseases of the skin -, white - Opium. See Poisons, Nar- cotic. Onions how dressed Pain after - Pains false Palsy Paraphrenitis Parents, diseased, the effect upon children - Parturition Peas and beans considered as food - Perspiration. See Evacua- tions. -----------, causes of, ob- XXI xix id. id. id. id. xx id. id. id. id. id. 34 417 408 309 149 441 412 25 structed - 94 Pills - - - - xxi Pill, composing - - id. ---, deobstruent - - id. ---, foetid --- id. ---, hemlock - - id. ---, mercurial - - id. —•■, mercurial sublimate id. ---, plummer's - - id. ---, purging - - xxii ---, purgative - - id. ---, for the bile - - id. ----------jaundice - id. ---, stomachic y - id. ---, squill - id. ---, strengthening - id. Piles, blind and bleeding 241 Placenta. See After Burden. Plants, poisonous - 351 Plasters - - - xxii Plaster, common - xxiii ------, adhesive - id. ------, blistering - id. ft xlvi INDEX. id. id. Plaster, gum - - id. ------, mercurial - id. ------, stomach id. ------, warm ------, wax Pleurisy - - - 144 ------, bastard - - 149 Poisons, mineral - - 342 ------, vegetable 342, 490 ------, animal - - 342 ------, aerial. See Noxious Vapours. narcotic - 491 Poor living after the course of fever among labourers 44 Posture, injurious effect of, long inclined - - 47 ------, figure of body, how hurt by - - - id. Potatoes considered as a substitute for bread 30 Potash. See Alkalies. Poultices - - - xxiv Powders - id. Powder, astringent - id. ------, of bole - - id. ------, carminative - id. —-----, diuretic - id. ------, aromatic opening, id. ------, saline laxative xxv ------, steel - - id. ------, sudorific - id. ------, worm - - id. ------, purging - - id. ------, for tape-worm id. Pregnancy, diseases of 403 ---------, during, three stages exist - - 404 Preserves. See Conserves. Prognosis, what - - 100 Q. Quickenings - - 404 ■----------, opinion rela- tive to id. Quinsey. See Sore Throat, inflammatory. -------, malignant - 197 R. Rattlesnake, bite of - 351 Resurrection. See Animation suspended. Rheumatism - - 277 Rickets - - - 433 Rising, early, a consequence of what - - - 71 Ruptures ... 377 S. Sailors and soldiers, conse- quences of their calling 44 Saint Anthony's fire, a dis- ease incident to labouring people - - - 43 -------——----, iliac pas- sion, colic, and other com- plaints of the bowels often occasioned by the same cause as - - - id. Saint Vitus's dance - 313 Salsafy, skirrets, and sever- al kinds of beets, observa- tions on 33 Sanctorius, an Italian phy- sician quoted on pulmona- ry and cutaneous transpi- ration ... 94 Scarborough waters - 476 Scald head - - - 428 Scenes, the variety of, why designed - 89 Scirrhus ... 33(5 Scrofula. See King's Evil. Scurvy - - - 281 Sea-sickness - - 494 ----------, imperial ma- rine tincture for - 495 Sedentary, studious, and la- borious occupations, re- marks on - - 40 --------, sedentary studi- ous - 50 --------, advice to - id. ----■----, diseases of - id. Seltzer water - - 477 Senses, disorders of - 329 Shortsightedness. See My- opia. Silver, nitrate of, See Min- eral Poisons. Simples, a list of. See Ap- pendix. Simplicity, the great rule of diet ... 75 Sinapisms. See Cataplasms. INDEX. xlvn Skin, over distention of, in pregnant women - 408 Smell and taste - - 333 Shoe, the size and figure how regulated - 73—74 Sleep, want of, and restless- ness of pregnant women 407 ---, its benefits - - 69 -, like diet ought to be duly regulated ---, to procure refreshing ---, light suppers procure -, refreshing, when id. 70 id. 71 168 Small-pox Soda. Sec Alkalies. Soldiers and sailors, the con- sequences of their employ- ment - - - Sore throat, inflammatory Spirit of wine, camphorat- ed - xxviii Spring-chalybeate in the Isle of Wight - Squinting. See Strabismus. Stale bread, its effects upon the humours Stone and gravel - Stomach, cramp of -, pain of 44 193 489 —, inflammation of 45 234 316 259 210 -------, and bowels, affec- tions of. See Costiveness. Studious and intense think- ers, advice to - -------, diet of - Studious occupations, re- marks on - Strabismus - - - Strains - Strangling. See Suffocation. Study and exercise, the best time for - - - Subjects, gloomy ones, not to be inculcated Suffocation from various causes - ---------: of infants Suppers and breakfasts con- trasted - Surgery - Swellings, puffy, of the feet, of pregnant women - Swooning * 52 54 40 331 377 53 91 393 id. 61 352 406 318 24 431 Syncope. See Fits, Fainting. See Swooning. Syrups - xxv T. Tap-rooms, highly pernicious 98 Taste and smell - - 333 Tea, the mischief of, when substituted for solid food Teething - Tests. See Poisons. Thrush. See Aphthae. Tinea, capitis. See Scald Head. Tinctures - xxvi Tincture, imperial marine, against sea-sickness, &c. 495 -------, how taken in nerv- ous and other disorders. id. -------, aromatic - xxvi -------, compound, of the bark - - -. id. -------, volatile, foetid id. ---------------, of guiacum id. -------, of black hellebore, id. -------, astringent - id. -------, of myrrh and aloes id. -------, of opium - xxvii -------, sacred, or hiera picra - id. ---, compound of senna id. id. id. id. id. 256 406 335 97 470 id. balsam of tolu -------, Spanish flies - ., -------,rhubarb -------, tonic Tooth-ach - ---------, of pregnant wo- men - - Touch, disorders of V Transitions, sudden, Sec Tunbridge-wells - -----------—, medicinal properties --------------, Pyrmont, and German spa, compar- ed with - Turner's cerate. See Oint- ment of Calamine. Turnips, how considered as food. - 473 33 U. Ulcers 362 xlviii INDEX. Ulcers, cure of by roller and compresses, Sec. on Mr. Whately's plan - 363 -----, Baynton, his plan of curing old - - 365 -----, Home, Sir Everard, on - - - - 367 -----, Dr. White, on - id. Urinary organs, diseases of. See Diabetes. Urine, suppression of - 233 -----, bloody - - 248 -----, suppression of, in pregnant women - 406 -----, incontinency of, in pregnant women - 407 V. Vaccination - - 493 Vapours, noxious - - 385 Vegetable and animal food, difference between - 39 --------, observations on 56 Vinegars - xxviii Vinegar of litharge - id. --------, roses• - xxix --------, squills - id. Vomiting of infants 228 —, when from other affections - 229—230 W. Waters by infusion - xxix Water, lime - - id. *-----, compound - id. •-----, sublimate - id. ------, styptic - - id. Water, tar - - - id. ------, simple distilled id. ------, cinnamon - xxx ------, peppermint - id. ------, spearmint - id. -----, rose - - id. ------, spirituous distilled id. -----, Jamaica pepper id. ------, spirituous cinnamon id. ------, necessary to clean liness - 81 Wet clothes - - 95 ----feet ... id. Wheys ... xxx Whey, alum - - id. -----, mustard - - id. ----—, scorbutic - id. Whites. See Fluor Albus. Wind. See Flatulencies. Wines, ... xxxi Wine, anthelmintic - id. ----, bitter - - id ----, ipecacuanha - id. ----, chalybeate or steel id. ----, stomach - id. Womb, inflammation of 417 Women, diseases of - 397 Woody nightshade. See Poisons, Narcotic. Worms - - - 261 Wounds - - - 357 A Zinc, sulphate of, &c. ----, oxyd of. See Mineral Poisons. S ;,/. j, .'.^.yyU^i I, / r. 'A 't y^ \ * * V;f;'v) •*'.■ m^ >*, **:"*/ tft^if &A