l^'.'NS'M I'Af; mk C — /• V $ V .,-v ^i:)750t:0C47DCl^,OC!00'QrCO0.Q,C^Q7>.Qrl'^ Surgeon General's Office W i&QOQOGOOO O7: '00'QOOGOOQO-GO*'M7r^ ^ c ,4tA/*> ■*< > Domejiic Mddicine: OR, A TREATISE ON THE PREVENTION AND CURE OF DISEASES, BY REGIMEN AND SIMPLE MEDICINES. WITH An APPENDIX, containing a dispensatory for the use of private Practitioners. I By WILLIAM BUCHAN, m. d. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, EDINBURGH : ,J • - CO REVISED AND ADAPTED TO THE* ^ *••' ' O Difeafes and Climate of the United States of America, By SAMUEL POWEL GRIFFITTS, m. d. PROFESSOR OF MATERIA MEDICA IN THE UNIVERSITY OF PENNSYLVANIA. PHILADELPHIA, PRINTED BY THOMAS DOBSON, AT THE STONE HOUSE N° 41, SOUTH SECOND-STREET. 1795- Preface of the American Editor. XT is not neceflary to enter into a de- tail of my reafons for the prefent publication. Doctor Buchan's Domejiic Medicine has long fmce had a place in moft families; but, al- though it is one of the moft fenfible and judi- cious performances of the kind that has hither- to appeared, yet it is evidently not fufficiently adapted to the climate and difeafes of the Uni- ted States of America. I thought this defici- ency might be remedied, and accordingly un- dertook the taik ; and although the alterations and additions in the prefent edition have been confiderable, yet I can truly fay, none have been made with any other view than that of render- ing the book more ferviceable. As to medical reputation, I am well aware this is not the way to obtain it; but if I have fucceeded in making this valuable and popular work more intelligible, and confequently more ufeful, to my fellow-citizens, I mail be fufficiently re- warded. SAMUEL POWEL GRIFFI1TS. Philadelphia, \ May, i8/£, 1795. 1 c PREFACE, (Br Dr. BUCHAN.) VV HEN I firft fignified my intention of publiming the following fheets, I was told by my friends it would draw on me the refentment of the whole Faculty. As I never could entertain fuch an unfavourable idea, I was refolved to make the ex- periment, which indeed came out pretty much as might have been expected. Many whofe learning and liberality of fentiments do honour to medicine, received the book in a manner which at once Ihewed their indulgence, and the falfity of the opinion that every phyfician wifhes to conceal his art; while the more felfifh and narrow-minded, generally the moft numerous in every profeffion, have not failed to per- fecute both the book and its author. The reception, however, which this work has met with from the Public merits my mod grateful acknowledgments. As the bed way of expreffing thefe, I have endeavoured to render it more gene- rally ufeful, by enlarging the prophylaxis, or that part which treats of preventing difeafes; and by adding many articles which had been entirely omit- ted in the former impreflions. It is needlefs to enu- merate thefe additions; I (hall only fay, that I hope they will be found real improvements. a 3 The i v PREFACE. The obfervations relative to Nurfmg and the Ma- nagement of Children, were chiefly fuggefted by an extenfive practice among infants, in a large branch of the Foundling Hofpital, where I had an oppor- tunity not only of treating the difeafes incident to childhood, but likewife of trying different plans of nurfmg, and obferving their effects. Whenever I had it in my power to place the children under the care of proper nurfes, to inftruit thefe nurfes in their duty, and to be fatisfied that .they performed it, very few of them died ; but when, from diftancer of place, and other unavoidable circumftances, the children were left to the fole care of mercenary nurfes, without any perfon to inftruit or fuperintend them, fcarce any of them lived. This was fo apparent, as with me to amount to a proof of the following melancholy fail:: That al- mofk one half of the human fpecies perifo in infancy, by improper management or neglecl. This refleilion has made me often wifh to be the happy inftrument of alleviating the miferies of thofe fuffering innocents, or of refcuing them from an untimely grave. No one, who has not had an opportunity of obferving ihem, can imagine what abfurd and ridiculous practices ftill prevail in the nurfmg and manage- ment of ir.faiit?, and what numbers of lives are by that means loft to fociety. As thefe practices are chiefly owing to ignorance, it is to be hoped, that when nurfes are better informed, their conduit will be more proper. The application of medicine to the various occu- pations of life has been in general the refult of ob- fervation. An extenfive practice for feveral years, in one of the large!!: manufacturing towns in Eng- land, afforded me fnificient opportunities of ob- k-rving the injuries which thofe ufeful people fuftain from their particular employments, and likewife of trying PREFACE. vU trying various methods of obviating fuch injuries. The fuccefs which attended thefe trials was fuffi- cient to encourage this attempt, which I hope will be of ufe to thofe who are under the neceffity of earning their bread by fuch employments as are unfavourable to health. I do noj: mean to intimidate men, far lefs to in- finuate* that even thofe arts, the practice of which is attended with fome degree of danger, fhould not be carried on; but to guard the lefs cautious and unwary againft thofe dangers which they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occupation in life difpofes thofe who follow it to fome particular dif- eafes more than to others, it is certainly of import- ance to know thefe, in order that people may be upon their guard againft them. It is always better to be warned of the approach of an enemy, than to be furprifed by him, efpecially where there is a poffi- bility of avoiding the danger. The obfervations concerning Diet, Air, Exercife, &c. are of a more general nature, and have not efcaped the attention of phyficians in any age. They are fubjeits of too great importance, however, to be palTed over in an attempt of this kind, and can never be fufficiently recommended. The man who pays,a proper attention to thefe, will feldom need the phy- fician ; and he who does not, will feldom enjoy health, let him employ as many phyficians as he pleafes. Though we have endeavoured to point out the caufes of difeafes, and to put people upon their guard againft them, yet it muft be acknowledged, that they are often of fuch a nature as to admit of being removed only by the diligence and activity of the public magistrate. We are forry, indeed, to obferve, that the power of the magiftrate is fel- a 4 dom viii PREFACE. dom exerted in this country for the prefervation of health. The importance of a proper medical po- lice is either not understood, or little regarded. Many things highly injurious to the public health are daily practifed with impunity, while others, ab- folutely neceffary for its prefervation, are entirely neglected. Some of the public means of preferving health are mentioned in the general prophylaxis, as the infpeition of provifions, widening the ftreets of great towns, keeping them clean, fupplying the inhabitants with wholefome water, &c.; but they are paffed over in a very curfory manner. A pro- per attention to thefe would have fwelled this vo- lume to too large a fize ; 1 have therefore referved them for the fubjeit of a future publication. In the treatment of difeafes, I have been peculiarly attentive to regimen. The generality of people lay too much ftrefs upon Medicine, and truft too little to their own endeavours. It is always in the power of the patient, or of thofe about him, to do as much towards his recovery as can be effected by the phy- fician. By not attending to this, the defigns of Me- dicine are often fruftrated ; and the patient, by pur- fuing a wrong plan of regimen, ndt only defeats the Doctor's endeavours, but renders them dangerous. I have often known patients killed by an error in regimen, when they were ufing very proper medi- cines. It will be faid, the phyfician always orders the regimen when he prefcribes a medicine. I wifh it were fo, both for the honour of the Faculty and the Mety of their patients : but phyficians, as well as other people, are too little attentive to this mat- ter. , Though many reckon it doubtful whether phy- fic is more beneilcial-br hurtful to mankind, yet all allow the neceflity and importance of a proper regi- men PREFACE. ix men in difeafes. Indeed the very appetites of the iick prove its propriety. No man in his fenfes ever imagined that a perfon in a fever, for example, could eat, drink, or conduit himfelf in the fame manner as one in perfect health. This part of medicine, there- fore, is evidently founded in Nature, and is every way confiftent with reafon and common fenfe. Had men been more attentive to ir, and lefs folicitous in hunting after fecret remedies, Medicine had never become an object of ridicule. This feems to haye been the firft idea of Me- dicine. The ancient phyficians acted chiefly in the capacity of nurfes. They went very little beyond aliment in their prefcriptions; and even this they generally adminiftered themfelves, attending the fick for that purpofe through the whole courfe of the difeafe; which gave them an opportunity not only of marking the changes 'of difeafes with great accuracy, but likewife of obferving the effects of their different applications, and adapting them to the fymptoms. The learned Dr. Arbuthnot afferts, that by a pro- per attention to thofe things which are almoft within the reach of every body, more good and lefs mif- chief will be done in acute difeafes, than by medi- cines improperly and unfeafonably adminiftered ; and that great cur^s may be effected in chronic diftem- peis, by a proper regimen of the diet only. So en- tirely do the Doctor's fentiments and mine agree, that I would advife every perfon, ignorant of phyfic, to confine his practice folely to diet, and the othcr parts of regimen ; by whicii means he may often do much good, and can feldom do any hurt. This feems alfo toliave been the opinion of the ingenious Dr. Huxham, who obferves, that we often feek from Art v hat all-bountiful Nature moft rea- dily, and as eff cora'ly, ofiers us, had wc diligence and X PREFACE. and fagacity enough to obferve and make ufe of it; that the dietetic part of Medicine is not fo much ftudied as it ought to be; and that, though lefs pompous, yet it is the moft natural method of curing difeafes. To render the book more generally ufeful, how- ever, as well as more acceptable to the intelligent part of mankind, I have in moft difeafes, befides regimen, recommended fome of the moft Ample and approved forms of medicine, and added fuch cautions and directions as feemed neceffary for their fafe administration. It would no doubt have been more acceptable to many, had it abounded with pompous prefcriptions, and promifed great cures in conftquence of their ufe ; but this was not my plan ; I think the adminiftration of medicines al- ways doubtful, and often dangerous, and would much rather teach men how to avoid the neceflity of ufing them, than how they fhould be ufcd. Several medicines, and thofe of confiderable ef- ficacy, may be adminiftered with great freedom and fafety. Phyficians generally trifle a long time with medicines before they learn their proper ufe. Many peafants at prefent .know better how to ufe fome of the moft important articles in the materia medica, than phyficians did a century ago ; and doubtlefs the fame obfervation will hold with regard to others fome time hence. Wherever I was con- vinced that medicine might be ufed with fafety, or where the cure depended chiefly upon it, I have taken care to recommend it ; but where it was either highly dangerous, or not very neceffary, it is omitted. » I have not troubled the-reader with an ufelefs parade of quotations from different authors, but have in general adopted their obfervations where my own were either defective, or totally warning, Thofe. PREFACE. x» Thofe to whom I am moft obliged are, Ramazini, Arbuthnot, and Tiffot; the laft of which, in his Avis au Peuple, comes the neareft to my views of any author that I have feen. Had the Doctor's plan been as complete as the execution is mafterly, we mould have had no occafion for any new trea- tife of this kind foon ; but by confining himfelf to the acute difeafes, he has in my opinion omitted the moflf ufeful part of his fubjeit. People in acute difeafes may fometimes be their own phyficians ; but in the chronic, the cure mult ever depend chiefly upon the patient's own endeavours. The Doctor has alfo paffed over the Prophylaxis, or pre- ventative part of Medicine, very flightly, though it is certainly of the greateft importance in fuch a work. He had no doubt his reafons for fo doing, and I am fo far from finding fault with him, that I think his performance does great honour both to his head and to his heart. Several other foreign phyficians of eminence have written on nearly the fame plan with Tiffot, as the Baron Van Swieten, phyfician to their Imperial Ma- jefties, M. Rofen, firft phyfician of the kingdom of Sweden, &c.; but thefe gentlemen's productions have never come to my hand. I cannot help wifh- ing, however, that fome of our diftinguifhed coun- trymen would follow their example. There ftill re- mains much to be done on this fubjeit, and it does not appear to me how any man could better employ his time or talents, than in eradicating hurtful pre- judices, and diffufing ufeful knowledge among the people. I know fome of the Faculty difapprove of every attempt of this nature, imagining that it mult totally deftroy their influence. But this notion appears to me to be as abfurd as it is illiberal. People in dif- trefs will always apply for relief to men of fupe- nor xii PREFACE. rior abilities, when they have it in their power; and they will do this with far greater confidence and readinefs when they believe that Medicine is a ra- tional fcience, than when they take it to be only a matter of mere conjecture. Though I have endeavoured to render this Trea- tife plain and ufeful, yet I found it impoflible to avoid fome terms of art; but thofe are in general either explained, or are fuch as moft people under- stand. In Short, I have endeavoured to conform my Style to the capacities of mankind in general; and, if my readers do not flatter either themfelves or me, with fome degree of fuccefs. On a medical fubjeit, this is not fo eafy a matter as fome may imagine. To make a Shew of learning is eafier than to write plain fenfe, efpecially in a fcience which has been kept at fuch a diftance from common obfervation. It would h<3wever be no difficult matter to prove, that every thing valuable in the practical part of Me- dicine is within the reach of common abilities. It would be ungenerous not to exprefs my warm- eft acknowledgments to thofe gentlemen who have endeavoured to extend the ufefulnefs of this Per- formance, by tranflating it into the language of their refpeitive countries. Moft of them have not only given elegant translations of the Book, but have alfo enriched it with many ufeful obfervations ; by which it is rendered more complete, and better adapted to the climate and the constitutions of their countrymen. To the learned Dr. Duplanil of Paris, phyfician to the Count d'Artois, I lie under particu- lar obligations; as this gentleman has not only con- fiderably enlarged my Treatife, but, by his very in- genious and ufeful notes, has rendered it fo popular on the Continent, as to occafion its being tranflated into all the languages of modern Europe. Ijjiave PREFACE. xm I have only to add, that the book has not more exceeded my expectations in its fuccefs, than in the effects it has produced. Some of the moft pernici- ous practices, with regard to the treatment of the fick, have already given place to a more rational conduit; and many of the moft hurtful prejudices, which feemed to be quite infurmountable, have in a great meafure yielded to better information. Of this a ftronger inftance cannot be given than in the inoculation of the fmall-pox. Few mothers, fome years ago, would fubrnit to have their children ino- culated, even by the hand of a phyfician ; yet no- thing is more certain, than that of late many of them have performed this operation with their own hands; and as their fuccefs has been equal to that of the moft dignified inoculators, there is little reafon to doubt that the practice will become general. When- ever this Shall be the cafe, more lives will be faved by inoculation alone, than are at prefent by all the endeavours of the Faculty. » I I NTRODUCTION. 1 HE improvements in Medicine, fince the revival of learning, have by no means kept pace with thofe of the other arts. The reafon is ob- vious. Medicine has been ftudied by few, except thofe who intended to live by it as a trade. Such, either from a miftaken zeal for the honour of Medi- cine, or to raife their own importance, have endeav- oured to difguife and conceal the art. Medical authors have too generally written in a foreign language ; and thofe who were unequal to this talk, have even valued themfelves upon couching, at leaft, their prefcriptions, in terms and characters unintelligible to the reft of mankind. The contentions of the clergy, which happened foon after the restoration of learning, engaged the attention of mankind, and paved the way for that freedom of thought and inquiry, which has fince ; prevailed in moft,parts of Europe with regard to religious matters. Every man took a fide in thofe difputes; and every gentleman, that he might dif- tinguifh himfelf on one fide or other, was inftruc- ted in Divinity. This taught people to think and reafon for themfelves in matters of religion, and at laft, in a degree, deftroyed that complete and abfo- lute dominion which the clergy had obtained over the minds of men. The Study of Law has likewife, in moft civilized nations, been juftly deemed a neceffary part cf edu- cation. Every man ought certainly to know at leaft the laws of his own country ; and, if he were alfo xvi INTRODUCTION. alfo acquainted with thofe of others, it might be more than barely an ornament to him. The different branches of Philofophy have alfo of late been very univerfally Studied by all who pretended to a liberal education. The advantages of this are manifeft. It frees the mind from preju- dice and fuperftition ; fits it for the inveftigation of truth ; induces habits of reafoning and judging pro- perly ; opens an inexhauftible fource of entertain- ment; paves the way to the/improvement of arts and agriculture; and qualifies men for acting with propriety in the moft important ftations of life. Natural Hiftory is likewife become an object of general attention ; and it well deferves to be fo. It leads to difcoveries of the greateft importance. In- deed agriculture, the moft ufeful of all arts, is only a • branch of Natural Hiftory, and can never arrive at a high degree of improvement where the ftudy of that fcience is neglected. Medicine however has not, as far as I know, in any country, been reckoned a neceffary part of education. But furely no Sufficient reafon can be affigned for this omiffion. No fcience lays open a j.' more extenfive field of ufeful knowledge, or affords * more ample entertainment to an inquifitive mind. f Anatomy, Botany, Chemiftry, and the Materia Medica, are all branches of Natural Hiftory, and are fraught with fuch amufement and utility, that' the man who entirely neglects them has but a forry claim either to tafte or learning. If a man has a turn for obfervauoii? fays an excellent and fenfible writer*, furely the naturaj hiftory of his own fpecies is a more interesting fubjeit, and prefents a more ample field for the exertion of. genius, than the natural hiftory of fpiders and cockle-fhells. * Obfervations on the Duties and Offices of a Phyfician. 2 We INTRODUCTION. xvii We do not mean that every man Should become a phyfician. This would be an attempt as ridicu- lous as it is impoffible. All we plead for is, that men of fenfe and learning Should be fo far acquainted with the general principles of Medicine, as to be in a condition to derive from it fome of thofe advan- tages with which it is fraught; and at the fame time to guard themfelves againft the destructive influences of Ignorance, Superftition, and Quackery. As matters Stand at prefent, it is eafier to cheat a man out of his life than of a Shilling, and almoft impoSfible either to detect or punifh the offender. Notwithstanding this, people Still Shut their eyes, and take every thing upon truft that is adminiftered by any Pretender to Medicine, without daring to afk him a reafon for any part of his conduct. Implicit faith, every where elfe the object of ridicule, is Still facred here. Many of the faculty are no doubt worthy of all the confidence that can be repofed in them ; but as this can never be the character of every individual in any profeffion, it would certainly be for the fafety, as well as the honor of mankind, to have fome check upon the conduct of thofe to whom they entruft fo valuable a treafure as health. Medicine, however, needs only to be better known, in order to fecure the general efteem of mankind. Its precepts are fuch as every wife man would chufe to obferve, and it forbids nothing but what is incompatible with true happinefs. Difguifing Medicine not only retards its improve- ment as a fcience, but expofes the profeffion to ridi- cule, and is injurious to the true interefts of fociety. An art founded on obfervation never can arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united ob- fervations of all the ingenious and fenfible part of mankind, would do more in a few years towards the b improve- xviii INTRODUCTION, improvement of Medicine, than thofe of the Faculty alcne in a great many. Any man can tell when a medicine gives him e^k as well as a phyfician ; and if he only knows the name and dofe of the medicine, and the name of the difeafe, it is Sufficient to perpe- tuate the fact. Yet the man who acids one fingle fait to the Stock of medical obfervations, does more real fervice to the art, than he who writes a volume in fnpport of fome favourite hypothefis. Very few of the valuable difcoveries in Medicine have been made by phyficians. They have in gene- ral either been the cffeit of chance or of neceffity, and have been often oppofed by the Faculty, till every one elfe was convinced of their importance. An implicit faith in the opinions of teachers, an attachment to fyftems and eftablifhed forms, and the dread of refleitions, will always operate upon thofe who follow Medicine as a trade. Few improvements are to be expected from a man who might ruin his character and family by even the fmalieft deviation from an eftablifhed rule. If men of letters, fays the author of the perform- ance quoted above, were to claim their right of inquiry into a matter that fo nearly concerns them, the good effects on Medicine would foon appear. Such men would have no Separate intereft from that of the art. They would detect and expofe affuming Ignorance under the malk of Gravity and Import- ance, and would be the judges and patrons of mo- deft merit. Not having their understandings per- verted in their youth by faife theories, unawed by authority, and unbiaffed by intereft, they would canvafs with freedom the moft univerfally received principles in Medicine, and expofe the uncertainty of many of thofe doctrines, of which a phyfician dares not fo much as fecra to doubt. No INTRODUCTION. xi.\ No argument, continues he, can be brought againft laying open Medicine, which does not apply with equal, if not greater, force to religion ; yet experience has fhown, that fince the laity have afferted their right of inquiry into thefe fubjeits, Theology, considered as a fcience, has been im- proved, the interefts of real religion have been promoted, and the clergy have become a more learned, a more ufeful, and a more refpeitable body of men than they ever were in the days of their greateft power and fplendor. Had other medical writers been as honefl as this gentleman, the art had been upon a very different footing at this day. Moft 6f them extol the merit of thofe men who brought Philofophy out of the fchools, and fubjeited it to the rules of common fenfe. But they never confider that Medicine, at prefent, is in nearly the fame fituation as Philofophy was at that time, and that it might be as much improved by being treated in the fame manner. Indeed, no fcience can be rendered either rational or ufeful, without being fubmitted to the common fenfe and reafon of mankind. Thefe alone ftamp a value upon fcience •> and what will not bear the teft: of thefe ought to be rejected. I know it will be laid, that diffufing medical knowledge among the people might induce them to tamper with Medicine, and to truft to their ovoi Skill inftead of calling in a phyfician. The reverfe of this however is true. Perfons who have moft knowledge in thefe matters, are commonly moft ready both to afk and to follow advice, when it is neceffary. The ignorant are always moft apt to tamper with Medicine, and have the leaft confidence in phyficians. Inftances of this are daily to be met with among the ignorant, who, while they they ab- solutely refufe to take a medicine which has been b 2 prefcribed XX INTRODUCTION. prefcribed by a phyfician, will fwallow with greedL- nefs any thing that is recommended to them by their credulous neighbours. Where men will ait even without knowledge, it is certainly more rational to afford them all the light we can, than to leave them entirely in the dark. It may alfo be alleged, that laying Medicine more open to mankind would leffen their faith in it. This would indeed be the cafe with regard to fome ; but it would have a quite contrary effect upon others. I know many people who have the utmoft dread and horror of every thing prefcribed by a phyfician, but who will neverthelefs very readily take a medicine which they know, and whofe qualities they are in fome meafure acquainted with. Hence it is evident, that the dread arifes from the doctor not from the drug. Nothing ever can or will infpire mankind with an abfolute confidence in phyficians, but an open, frank, and undifguifed behaviour. While the leaft Shadow of myftery remains in the conduit of the Faculty, doubts, jealoufies, and fufpicions, will arife in the minds of men. No doubt cafes will fometimes occur, where a prudent phyfician may find it expedient to difguife a medicine. The whims and humors of men mult be regarded by thofe who mean to do them fervice ; but this can never affect the general argument in favour of candour and opennefs. A man might as well allege, becaufe there are knaves and fools in the world, that he ought to take every one he meets for fuch, and to treat him accordingly. A fenfible phyfician will always know where difguife is necef- fary ; but it ought never to appear on the face of his general conduct. The appearance of myftery in the conduit of phyficians not only renders their art fufpicious, but lays the foundations of Quackery, which is the dif- i grace INTRODUCTION. xxi grace of Medicine. No two characters can be more different than that of the honeft phyfician and the quack ; yet they have generally been very much confounded. No laws will ever be able to prevent quackery, while people believe that the quack is as honeft a man, and as well qualified, as the phyfician. A very fmall degree of medical knowledge, however, would be fufficient to break this fpell ; and nothing elfe can effectually undeceive them. It is the igno- rance and credulity of the multitude, with regard to medicine, which renders them fuch an eafy prey to every one who has the hardinefs to attack them in this quarter. Nor can the evil be remedied by any other means but by making them wifer. The moft effectual way to deftroy quackery in any art or fcience, is to diffufe the knowledge of thefe among mankind. Diffufing medical knowledge among the people would not only tend to improve the arr, and to banifh quackery, but likewife to render Medicine more univerfally ufeful, by extending its benefits to fociety. However long Medicine may have been known as a fcience, we will venture to fay, that many of its moft important purpofes to fociety have either been over- looked, or very little attended to. The cure of difeafes is doubtlefs a matter of great importance; but the prefervation of health is of ftill greater. This is the concern of every man, and furely what relates to it ought to be rendered as plain and obvious to all as poffible. It is not to be fuppofed, that men can be Sufficiently upon their guard againft difeafes, who are totally ignorant of their caufes. Neither can the legislature, in whofe power it is to do much more for prcf-rvin^ the public health than can ever be done by the Faculty, .exert that pow.n none. There are not, however, any where wanting well-difpoled people, of better fenfe, who are willing to fupply the defeit of medical advice to the poor, did not their fear of doing ill often fupprefs their inclination to do good. Such people are often deterred from the moft noble and praife-worthy actions, by the foolifh alarms founded in their ears by a fet of men who, to raife their own importance, magnify the b 4 difficulties xxir INTRODUCTION. difficulties of doing good, find fault with what is tiuly commendable, and fleer at every attempt to relieve the fick, which is not conducted by the pre- cife rules of Medicine. Thefe gentlemen muft, how- ever excufe me for faying, that I have often known fuch well difpofed perfons do much good; and that their practice, which is generally the refult of good fenfe and obfervation, affifted by a little medical read- ing, is frequently more rational than that of the ig- norant retainer to phyfic, who defpifes both reafon and obfervation, that he may go wrong by rule : and who, while he is dofing his patient with medicines, often neglects other things of far greater importance. Many things are neceffary for the fick befides me- dicine. Nor is the perfon who takes care to procure thofe for them, of lefs importance than a phyfician. The poor oftener perifh in difeafes for want of pro- per nurfmg than of medicine. They are frequently in want of even the neceffaries of life, and ftill more fo of what is proper for a fick-bed. No one can imagine, who has not been a witnefs of thefe fitua- tions, how much good a well-difpofed perfon may do, by only taking care to have fuch wants fupplied. There certainly cannot be a more neceffary, a more noble, or a more god-like action, than to adminifter to the wants of our fellow-creatures in diftrefs. While virtue or religion are known among mankind, this conduit will be approved; and while Heaven is juft, it muft be rewarded ! Perfons who do not chufe to adminifter medi- cine to the fick, may neverthelefs direct their regi- men. An eminent medical author has faid, That by diet alone all the intentions of Medicine may be an- fwered *. No doubt a great many of them may ; but there are other things befide diet, which ought Arbuthnot. by INTRODUCTION. XXV by no means to be neglected. Many hurtful and de- ftruitive prejudices, with regard to the treatment of the fick, ftill prevail among the people, which per- fons of better fenfe and learning only can eradicate. To guard the poor againft the influence of thefe pre- judices, and to inftil into their minds fome juft ideas of the importance of proper food, frefh air, cleanli- nefs, and other pieces of regimen neceffary in dif- eafes, would be a work of great merit, and produc- tive of many happy confequences. A proper regi- men, in moft difeafes, is at leaft equal to medicine, and in many of them it is greatly fuperior. To affift the well-meant endeavours of the hu- mane and benevolent in relieving diftrefs; to era- dicate dangerous and hurtful prejudices; to guard the ignorant and credulous againft the frauds and impositions of quacks and impoftors ; and to fhew men what is in their own power, both with regard to the prevention and cure of difeafes, are certainly objects worthy of the phyfician's attention. Thefe were the leading views in compofing and publifhing the following fheets. They were fuggefted by an attention to the conduit of mankind, with regard to Medicine, in the courfe of a pretty long practice, in different parts of this ifland, during which the author has often had occafion to wifh that his patients, or thofe about them, had been poffeffed of fome fuch plain directory for regulating their conduct. How far he has fucceeded in his endeavours to fupply this deficiency, muft be left for others to determine ; but if they be found to contribute in any meafure to- wards alleviating the calamities of mankind, he wii! think his labour very well beftowed. CONTENTS., PART I. Of the general Caufes of Difeafes. CHAP. 1. Page. OF Children i — Difeafed Parents 7 —Clothing of Children 10 —Food of ditto 16 —Exercife of ditto 22 —Bad Effects of unwholefome Air upon ditto 32 —Nurfes . . 34 chap. 11. Of the Laborious, &c. 39 —the Sedentary . 48 —the Studious . 55 chap. III. Of Aliment . 63 chap. IV. Of Air . . 76 CHAP. V. Of Exercife . 82 CHAP. VI. Of Sleep . . 89 —Clothing . ibid. CHAP. VII. ** Of Intemperance . 96 • CHAF. VIII. Of Cleanlinsfs - 102 " CHAP. IX. Page. Of Infedion . 108 CHAP. X. Of the Paflions . 114 —Anger . . ibid. —Fear . . 115 —Grief . . 119 —Love . . 121 —Religious Melancholy 122 CHAP. XI. Of the common Evacuations 124 —Stool . . ibid. —Urine . . 126 —Perfpiration . 128 —being affected by changes in the atmofphere 129 —Wet Clothes . 130 —Wet feet . . ib. —Night Air . 131 —Damp Beds . ibid. —Damp Houfes 133 —Sudden Tranfitions from Heat to Cold . 134 PART II. Of Difeafes. CHAP. XII. Of the Knowledge and Cure cf Difeafes . 139 xxviii CONTENTS. CHAP. XIII. Page. Fevers in general 145 CHAP. XIV. Of Intermitting Fevers or Agues . . 152 CHAP. XV. Of an Acute Continual Fever 162 CH>P. xvi. Of the Pleurify . 168 ------Baftard ditto 173 ------Paraphrenitis 174 CHAP. XVII. Inflammationof the Lungs 175 CHAP. XVIII. Of Confumptions 178 CHAP XIX. Of the Slow or Nervous Fever 192 CHAP. XX. Malignant, Putrid, or Spotted Fever . . 199 CHAP. XXI. Miliary Fever . 209 CHAP. XXII. Remitting Fever 214 CHAP. XXIII. Yellow Fever . 218 CHAP. XXIV. The Small-pox . 225 Inoculation . 237 CHAP. xxv. The Mealies . 249 —Scarlet Fever . 254 —Biiiuus Fever . 255 CHAP. XXVI. St. Anthony's Fire 257 CHAP. XXVII. inflammation of the Brain 262 CHAP. XXVIII. 1 nfUmmation of the Eyes 266 CHAP. XXIX. The Quinfey . 272 —Ma'.i^nant ditto 279 CHAP. XXX. Page. Colds and Coughs 283 A Common Cough 287 Whooping-Cou^h 291 CHAP. XXXI. Inflammation of the Stomach 296 -----------of the Inteftines 298 Of the Colic . 302 Inflammation of the Kidnies 3°9 -----------of the Bladder -----------of the Liver 313 CHAP. XXXII. Of the Cholera Morbus, and other exceffive Difcharges from the Stomach and Bowels . . 316 — the refult of whim and ca- price*. Were the time that is generally fpent by females in the acquisition of trifling accomplishments, em- ployed in. learning how to bring up their children ; * Tacitus, the celebrated Roman Hiftorian, complains greatly of the degeneracy of the Roman ladies in his time, with regard to the care of their offspring. He fays that, in former times, the greateft women in Rome ufed to account it their chief glory to keep the houfe and attend their children; but that now the young infant was committed to the fole care of fome poor Grecian wench, or other menial fervant—We are afraid, wherever luxury and effeminacy prevail, there will be too much ground for this complaint. how OF CHILDREN. 5 how to drefs them (r as not to hurt, cramp, or con- fine their motions; how to feed them with whole- fome and nourishing food; how to exercife their tender bodies, fo as beft to promote their growth and Strength : were thefe made the objects of female inlhu&ion, mankind would derive the greateft ad- vantages from it. But while the education of fe- males implies little more than what relates to drefs and public Shew, we have nothing to expect from them but ignorance, even in the moft important concerns. Did mothers reflect on their own importance, and lay it to heart, they would embrace every opportu- nity of informing themfelves of the duties which they owe to their infant offspring. It is their province, not only to form the body, but alfo to give the mind its moft early biajs. They have it very much in their power to make men healthy or valetudinary, ufeful in life, or the pelts of fociety. But the mother is not the only perfon concerned in the management of children. The father has an equal intereft in their welfare, and ought to affift in every thin- that refpects either the improvement of the body or mind. It is a pity that the men Should be fo inattentive to this matter. Their negligence is one reafon why females know fo little of it. Women will ever be defirous to excel in fuch accomplishments as recom- mend them to the other fex. But men generally keep at fuch a diftance from even the fmalleft ac- quaintance with the affairs of the nurfery, that many would reckon it an affront, were they fuppofed to know any thing of them. Not fo, however, with the kennel or the Stables: a gentleman of the firft rank is not afhamed to give directions concerning the ma- nagement of his dogs or horfes, yet would blufh were he furprifed in performing the fame office for B 3 that 6 OF CHILDREN. that being who derived its existence from himfelf, who is the heir of his fortunes, and the fmuir hope of his country. Nor have phyficians themfelves been fufficiently . attentive to the management of children : this has been generally considered as the fole province of old women. Such conduct has not only caufed this branch of medicine to be neglected, but has alfo en- couraged the other fex to affume an abfolute title to prefcribe for children in the moft dangerous difeafes. The confequeiice is, that a phyfician is too feldom called till the good women have exhaufted all their ikill; when his attendance can only ferve to divide the blame, and appeafe the difconfolate parents. Nurfes fhould do all in their power to prevent difeafes ; but when a child is taken ill, fome perfon of Skill ought immediately to be confulted. The difeafes of children are generally acute, and the leaft delay is dangerous. Were phyficians more attentive to the difeafes of infants, they would not only be better qualified to treat them properly when fick, but likewife to give ufeful directions for oieir management when well. The difeafes of children are by no means fo diffi- cult to be underftcod as many imagine. It is true, children cannot tell their complaints; but the caufes of them may be pretty certainly difcovered by ob- ferving the fymptoms, and putting proper queftions to the nurfes. Befides, the difeafes of infants be- ing lefs complicated, are eafier cured than thofe of adults*. * The common opinion that the difeafes of infants are hard to difcover and difficult to cure, has deterred m.my phyficians from paying that attention to them which 'hey dOerve. I can, however, trom experience declare, tnat this opinion is without foundation ; and that the difeafes of infants are neither fo diffi- cult to difcover, nor fo ill to cure, as thofe of adults. It OF CHILDREN. 7 It is really aftoniShing, that fo little attention Should in general be paid to the prefervation of in- fants. What labour and expence are daily bellowed, to prop an old tottering carcafe for a few years, while thoufands of thofe who might be ufeful in life, perifh without being regarded ! Mankind are too apt to value things according to their prefent, not their future, ufefulnefs. Though this is, of all others, the moft erroneous method of estimation ; yet, upon no other principle, is it poffible to account for the general indifference, with refpect to the death of infants. Of Difeafed Parents. One great fource of the difeafes of children is, the unhealthiness of Parf.nts. It w >uld be as reafonable to expect a rich crop from a barren foil, as that Strong and healthy children Should be born of parents whofe constitutions have bee^| worn out with intemperance or difeafe. An ingenious writer* obferves, that on the con- stitution of mothers depends originally that of their offspring. No one, who believes this, will be fur- prifed, on a view of the female world, to find difeafes and death fo frequent among children. A delicate female, brought up within doors, an utter Stranger to exercife and open air, who lives on tea and other flops, may bring a child into the world, but it will hardly be fit to live. The firft blaft of difeafe will nip the tender plant in the bud : or, Should it Strug- gle through a few years existence, its feeble frame, Shaken with convulsions from every trivial caufe, will be unable to perform the common functions of life, and prove a burden to fociety. * Rouffeau. B 4 If 3 OF CHILDREN. If to the delicacy of mothers, we add the irregular lives of fathers, we Shall fee farther caufe to believe, that children are often hurt by the conftitutions of their parents. A fickly frame may be originally induced by hardships or intemperance, but chiefly by the latter. It is impoffible that a courfe of vice fhould not fpoil the belt constitution : and, did the evil terminate here, it would be a juft punifhment for the folly of the Sufferer. What a dreadful inhe- ritance is the gout, the fcurvy, or the king's evil, to tranfmit to our offspring ! how happy had it been for the heir of many a great eftate, had he been born a beggar, rather than to inherit his father's fortunes, at the expence of inheriting his difeafes! A perfon labouring under any incurable malady, ought not to marry. He thereby not only Shortens his own life, but tranfmits mifery to others : but, when both parties are deeply tainted with the fcro- phula, the fcurvy, or the like, the .effects muft be rniferaHle indeed. Want of attention to thefe things, in forming connections for life, has rooted out more families than plague, famine, or the fword ; and, as long as thefe connections are formed from mercenary views, the evil will be continued *. In our matrimonial contracts, it is amazing fo little regard is had to the health and form of the object. Our fportfmen know, that the generous courfer cannot be bred out of the foundered jade, nor the fagacious fpaniel out of the fnariing cur. This is fettled upon immutable laws. The man who marries a woman of a fickly constitution, and de- * The Lacedemonians condemned their king Archidamus, for having married a weak, puny woman : becaufe, faid they, inftead of propagating a race of heroes, you will fill the throne with a progeny of changelings. fcended OF CHILDREN. 9 fcended of unhealthy parents, whatever his views may be, cannot be faid to act a prudent part. A difeafed woman may prove fertile ; Should this be the cafe, the family muft become an infirmary: what profpect of happinefs the father of fuch a family has, we Shall leave any one to judge*. Such children as have the misfortune to be born of difeafed parents, will require to be nurfed with greater care than others. This is the only way to make amends for the defects of constitution ; and i: will often go a great length. An healthy nurfe, whole- fome air, and fufficient exercife, will do wonders. But when thefe are neglected, little is to be expe£ted from any other quarter. The defeats of constitution cannot be fupplied by medicine. Thofe who inherit any family difeafe, ought to be very cirrurafpect. in their manner of living. They Should confider well the nature of fuch difeafe, and guard againft it by a proper regimen. It is certain, that family difeafes have often, by proper care, been kept off for one generation ; and there is reafon to believe, that, by perfifting in the fame courfe, fuch difeafes might at length be wholly eradicated. This is a fubjetl: very little regarded, though of the greateft importance. Family constitutions are as capable of improvement as family eftates; and the libertine, who impairs the one, does greater injury to his pofterity, than the prodigal, who fquanders away the other. * The Jews, by their laws, were, in certain cafes, forbid to have any manner of commerce with the difeafed; and indeed to this all wife legillators ought to have a fpecial regard. In fome countries, difeafed perfons have actually been forbid to marry. This is an evil of a complicated kind, a natural de- formity, and political mifchief; and therefore requires a public confideration. of 19 OF CHILDREN. Of the Clothing of Children. r'Tie clothing of an infant is (o fimple a matter, th.. ;t is Surprising how any perfon fhould err in it; yet man/children lofe their lives, and others are deformed, by inattention to this article. Nature knows no ufe of clothes to an infant, but to keep it \vrni. All that is neceffary for this pur- pofe, h to wrap it in a foft ioofe covering. Were a mother left to the dictates of Nature alone, {lie would certainly purfue this courfe. But the bufinefs of dreffmg sin infant, Las long been out of the hands of mothers, and has at laft become a fecret which none but adepts pretend to underftand. From the moft early ages, it has been thought neceffary, that a woman in labour Should have fome perfon to attend her. This in time became a bufi- nefs ; and, as in all others, thofe who were employed in it, Strove to outdo one another in the different branches of their profeffion. The dreffmg of a child came of courfe to be conlidered as the midwife's province, who no doubt imagined, that the more dexterity Site could Shew, in this article, tlte more her Skill wouid be admired. Her attempts were feconded by the vanity of parents, who, too often defirous of making a Show of the infant as foon as it was born, were ambitious to have as much finery heaped upon it as poffible. thus it came to be thought as Eecef- fary for a midwife to excel in bracing and dreffmg an infant, as for a furgeon to be expert in applying bandages to a broken limb; and the poor child, as loon as it came into the- world, had as many rollers and wrappers applied to its body, as if every Ijpne had been fractured in the birth; while thefe were often fo tight, as not only to gall and wound its tender OF CHILDREN. u tender frame, but even to obstruct the motion of the hf-^.rt, lungs, and other organs neceffary for life. in it parts of Britain, the practice of rolling children with fo many bondages is now, in f me mea- fure, laid afide; but it would ftill be a difficult rafk to perfuade the generality of mankind, that the Shape of an i,r t does not entirely depend on the care of the midwife. So far, however, are all her endea- vours tv mend the Shape from being fuccefsful, that they constantly operate the contrary way, and man- kind become deformed in proportion to the me ins ufed to prevent it. How little deformity of body is to be found among uncivilized nations ? So little, indeed, that it is vulgarly believed they put all their deformed children to death. The truth is, they hardly know fuch a thing as a deformed child. Neither Should we, if we followed their example. S/.vage nations never think of manacling their chil- dren. They allow them the full ufe of every organ, carry them abroad in the open air, waSh their bodies daily in cold water, &c. By this management, their children become fo Strong and hardy, that, by the time our puny infants get out of the nurfe's arms, theirs are able to Shift for themfelves*. Among brute animals, no art is neceffary to pro- cure a fine Shape. Though many of them are ex- tremely delicate, when they come into the world, yet we never find them grow crooked for want of Swaddling bauds. Is nature lefs generous to the * A friend of mine, who was feveral years on the coaft of Africa, tells me, that the natives neither put any clothes upon their children, nor apply to their bodies bandages of aay kind, but lay them on a pallet, and fuffer them to tumble about at pleafure; yet they are all ftrait, and feldom have any difeafe. An American need go no further, for examples of the truth of this afTertion, than in our own country. The fhapes of the In- dians are proverbial. human 12 OF CHILDREN. human kind ? No: but we take the bufinefs out of Nature's hands. Not only the analogy of other animals, but the very feelings of infants tell us, they ought t>> be kc-pt eafy and free from all preiTure. They cannot indeed tell their complaints ; but they can Shew figns of pain ; snd this they never fail to do, by crying when hurt by their clothes. No fooner are they freed from their bracings, than they (eem pleafed and happy; yet, Strange infatuation ! the moment they hold their peace, they are again committed to their chains. If we confider the body of an infant as a bundle of foft pipes, replenished with- fluids, in continual motion, the danger of preiTure will appear in the Strongeft light. Nature, in order to make way for the growth of children, has formed their bodies foft and flexible ; and, left they mould receive any injury from preffure in the womb, has furrounded the foetus every where with fluids. This fhews the care which Nature takes to prevent all unequal preffure on the bodies of infants, and to defend them againft every thing that might in the leaft cramp or confine their motion;,. Even the bones of an infant are fo foft and car- tilaginous, that they teadily yield to the flighted preffure, and eafily affume a bad Shape, which can never after be remedied. Hence it is, that fo many people appear with high Shoulders, crooked fpines, and flat breafts, who were as well proportioned at their birth as others, but had the misfortune to be fqueezed out of Shape, by the application of ftays and bandages. Preffure, by obftru&ing the circulation, likewife prevents the equal diftribution of nouriSliment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, OF CHILDREN. ig large, while another remains too fmall; and thus, in time, tlv_ whole frame becomes difproportioned and misfhapen. To this we muft add, that when a child is cramped in its clothes, it naturally Shrinks from the nart that is hart; and, by putting its body into uivAtural poftures, k becomes deformed by habit. Deformity of body may indeed proceed from weaknefs or difeafe ; but, ifi general, it is the effect. of improper clothing. Nine tenths, at leaft, of the deformity among mankind, muft be imputed to this caufe. A deformed body is not only difagreeable to the eye, but, by a bad figure, both the animal and vita! functions muft be impeded, and, of courfe, health impaired. Hence, fe*v people remarkably misfhapen are Strong or healthy. The new motions which commence at the birth, as the circulation of the whole mafs of blood through the Itsn^s, refpiration, the periftalric motion, &c. afford another Strong argument for keeping the body of an infant free from all preffure. Thefe organs, not having been acciiftomed to move arc eafily (lopped ; but when th;s happens, death muft enfue. Hardly any method could be deviled more effectually to Stop thefe motions, than bracin.; the body too tight with rollers* and bandages. Were thefe to be applied in the fame manner to the body of an adult, for an equal length of time, they would hardly fail to hurt the digeftion and make him fick. How much more hurtful they muft prove to the tender bodies of infants, we Shall leave any one ro judge. Whoever confiders thefe things, will not be fur- prifed, that fo many children die of convulfions foon * This is by no means inveighing againft a thing that does not happen. In many parts of Britain, and in France, at this day, a roller, eight or ten feet in length, is applied tightly round the child's body, as foon as it is ban?.. *rc« 14 OF CHILDREN. after the birth. Thefe fits are generally attributed to fome inward caufe ; but in fact, they oftener proceed from our own imprudent conduct. I have known a child feized with convulsion fits, foon after the mid-wife had done fwaddling it, who, upon taking off the rollers and bandages, was immediately relieved, and never had the difeafe afterwards. Nu- merous examples of this might be given, were they neceffary. It would be far fafer to faften the clothes of an infant with firings than pins, as thefe often gall and irritate their tender Skins, and occafion diforders. Pins have been found Sticking above half an inch into the body of a child, after it had died of convul- sion fits, which, in all probability, proceeded from that caufe. Children are not only hurt by the tightnefs of their clothes, but alfo by the quantity. Every child has fome degree of fever after the birth ; and if it be loaded with too many clothes, the fever muft be in- creafed. But this is not all; the child is generally laid in bed with the mother, who is often likewife feverifh ; to which we,-may add the heat of the bed- chamber, the wines, and other heating things, too frequently given to children immediately after the birth. When all thefe are combined, which does not feldom happen, they muft encreafe the fever to fuch a degree as will endanger the life of the infant. The danger of keeping infants too hot will further appear, if we confider that, after they have been for fome time in the iituaiion mentioned above, they are often fent into the country to be nurSed in a cold hcufe. Is it any wonder, if a child, from fuch a traniition, catches a mortal cold, or contracts fome other fatal difeafe ? When an infant is kept too hot, its lungs, not being fufficiently expanded, are apt to remain weak and flaccid for life; hence pro- ceed OF CHILDREN. 15 ceed coughs, confumpuons, and other difeafes of the breat. It would anfwer little purpofe, to fpecify the par- ticular fpecies of drefs proper for an infant. Thefe will always vary in different countries, according to cuftom and the humour of parents. The great rule to be obferved is, That a child have no more clothes than are neceffary to keep it warm, and that they be quite eafy for its body. Stays are the very bane of infants. A volume would not fuffice to point out all the bad effects of this ridiculous piece of drefs both on children and adults. The madnefs in favour of ftays feems, how- ever, to be fomewhat abated ; and it is to be hoped the world will, in time, become wife enough to know, that the human Shape does not folely depend upon whale-bone and bend-learhcr*. I Shall only add, with refpect to the clothes of children, that they ought to be kept thoroughly clean. Children perfpire more than adults; and if their clothes be not frequently changed, they be- come very hurtful. Dirty clothes not only'gall and fret the tender fkins of infants, but likewife occafion ill fmells; and, what is worfe, tend to produce ver- min and cutaneous difeafes. Cleanlinefs is not only agreeable to the eye, bin tends greatly to preferve the healrli of children. It promotes the prefpiraticn, and, by that means, frees * Stays made of bend-leather, are worn by all the women of lower ftation, in many parts of England. I am forsy to underftand, that there are ftill mothers mad enough to lace their daughters very tight, in order to improve their fhape. As reasoning would be totally loft upon fuch people, 1 fhall beg leave juft to afk them, why there are tea deformed women for one man? and likewife to recommend to their perufal a fhort moral pre:-pt, which forbids as to deform the human body. the i6 OF CHILDREN. the body from fuperfluous humours, which, if re- tained could not fail to occafion dlfe.ifes. No mo- ther or nurfe can have any excufe for allowing a child to be dirty. Poverty may oblige her to give it coarfe clothes; but if She does not keep them clean, it muft be her own fault. Of the Food of Children. Nature not only points out the food proper for an infant, but actually prepares it. This, however, is not fufEcient to prevent fome who think themfelves wifer than Nature, from attempting to bring up their children without her provision. Nothing can Shew the difpofition which mankind have to depart from Nature more, than their endeavouring to bring up children without the breaft. The mother's milk, or that of an healthy nurfe, is unqueftionably the beft food for an infant. Neither art nor nature can afford a proper fubltitute for it. Children may feem to thrive for a few months without the breaft ; but, when teething, the fmall-pox, and other difeafe9 in- cident to childhood, come on, they generally perifli. A child, foon after the birth, Shews an inclination to fuck; and there is no reafon 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: befides, the firft milk that the child can fqueeze out of the breaft anfwers the pur- pofe of cleanfing, better than all the drugs in the apothecary's lhop, and at the fame time prevents in^ flammations of the breaft, fevers, and other difeafes incident to mothers. It is Strange how people came to think that the firft thing given to a child Should be drugs. This is beginning with medicine betimes, and no wonder if they generally ended with it. It fometimes happens, 2 irndeed. OF CHILDREN. if indeed, that a child does not difcharge the meconium fo foon as could be wiShed; this has induced phy- ficians, in fuch cafes, to give fomething of an open- ing nature to cleanfe the firft paffages. Midwives have improved upon this Lint, and never fail to give fyrups, oils, &c. whether they be neceffary or not. Cramming an infant \vi:h fuch indigestible Stuff as foon as it is born, can hardly fail to make it fick, and is more likely to occafion difeafis than to pre- vent them. Children are f.ldom long after the birtn without having paffage both by Stool and urine; though thefe evacuations may be wanting for fome time without any danger. But if children muft have fomething before they be allowed the breaft, let it be a little thin water-pap, to which may be added an equal quantity of new milk; or rather water alone, with the addition of a little raw fugar. If this be given without any wines or fpiceries, it will neither heat the blood, load the Stomach, nor occafion gripes. Upon the firft fight of an infant, almoft every perfon is Struck with the idea of its being weak, feeble, and wanting fupport. This naturally fuggefts the idea of cordials. Accordingly wines are univer- fally mixed with the firft food of children. Nothing can be more fallacious than this way c f reafoning, or more hurtful to infants than the conduct founded upon it. Children require very little food for fome time after the birth ; and what they receive Should be thin, weak, light, and of a cooling quality. A very fmall quantity of wine is fuflicient to heat and inflame the blood of an infant; but every perfon converfant in thefe matters muft know, that moft of the difeafes of infants proceed from the heat of their humours. If the mother or nurfe has enough of milk, the child will need little or no other food before the third or fourth month. It will then be proper to give it, once or twice a day, a little cf feme tood C that i3 OF CHILDREN. that is eafy of digeftion, as water-pap, milk-pottage, weak broth with bread in it, and fuch like. This will eafe the mother, will accuftom the child by de- grees to take food, and will render the weaning both lefs difficult and lefs dangerous. All great and hid- den tranfitions are to be avoided in nurfmg. For this purpofe, the food of children ought not only to be fimple, but to referable, as nearly as poffible, the properties of milk. Indeed milk itfelf mould make a principal part of their food, not only before they are weaned, but for fome time after *. Next to milk we Should recommend good light bread. Bread may be given to a child as foon as it fhews 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 difcharge of faliva, while, by mixing with the nurfe's milk in the Stomach, it will afford an excellent nourishment. Children difcover an early inclination to chew whatever is put into their hands. Parents obferve the inclination, but generally miftake the object. Inftead of giving the child fomething which may at once exercife its gums and afford it nourishment, they commonly put into its hands a piece of hard metal, or impenetrable coral. A cruft of bread is the beft gum-Stick. It not only anfwers the purpofe better than any thing elfe, but has the additional properties of nourishing the child and carrying the faliva down to the Stomach, which is too valuable a liquor to be loft. * I do not wifh to differ from the judicious author, but t am well perfuaded, that it is in general beft to learn children to feed a little when very young, and I believe there is no food fo proper for them as the hard water bifcuit pounded and boiled in water, and afterwards adding milk and fugar. A. E. Bread, OF CHILDREN. 19 Bread, befides being ufed dry, may be many ways prepared into food for children. One of the beft methods is to boil it in water, afterwards pouring the water off, and mixing with the bread a proper quantity of new milk unboiled. Milk is both more wholefome and nourishing this way than boiled, and is lefs apt to occafion coftivenefs. For a child farther advanced, bread may be mixed in veal or chicken broth, made into puddings or the like. Bread is a proper food for children at all times, provided it be plain, made of wholefome grain, and well ferment- ed; but when enriched with fruits, fugars, or fuch things, it becomes very unwholefome. It is foon enough to allow children animal food when they have got teeth to eat it. They fhould never talte it till after they are weaned, and even then they ought to ufe it Sparingly. Indeed, when children live wholly on vegetable food, it is apt to four on their Stomachs ; but, on the other hand, too much flcfh heats the body, and occafions fevers and other inflammatory difeafes. This plainly points out a due mixture of animal and vegetable food as moft proper for children. Few things prove more hurtful to infants, than the common method of fweetening their food. It entices them to take more than they ought to do, which makes them grow fat and bloated. It is pretty certain, if the food of children were quite plain, that they would never take more than enough. Their exceffes are entirely owing to nurfes. If a child be gorged with food at all hours, and enticed to take it by making it fweet and agreeable to the pa- late, is it any wonder that fuch a child Should in time be induced to crave more food than it ought to have ? Children may be hurt by too little as well as too much food. After a child is weaned, it ought to be C 2 fed 20 OF CHILDREN. fed four or five times a day; but fhould never be accuftomed to eat in the night; neither Should ir. have too much at a time. Children thrive beft with fmall quantities of food frequently given. This nei- ther overloads the Stomach nor hurts the digeftion, and is certainly moft agreeable to nature. Writers on nurfmg have inveighed with fuch ve- hemence againft giving children too much food, that many parents, by endeavouring to Shun that error, have run into the oppofite extreme, and ruined the conftitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Nature has many ways of re- lieving herfelf when overcharged ; but a child who is pinched with hunger will never become a Strong or healthy man. That errors are frequently com- mitted on both fides, we are ready to acknowledge; but where one child is hurt by the quantity of its food, ten fuffer from the quality. This is the prin- cipal evil, and claims cur Strictefl attention. Many people imagine that the food which they themfelves love cannot be bad for their children: but this notion is very abfurd. In the more advan- ced period of life we often acquire an inclination for food, which when children we could not endure. Befides, there are many things that by habit may agree very well with the Stomach of a grown perfon, which would be hurtful to a child ; as high-feafoned, falted, and fmoke-dried provifions, &c. It would alfo be improper to feed children with fat meat, Strong broths, rich foups, 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 mifchief. Thefe children feldom efcape the violence of the fmall-pox, meafles, hoop- ing cough, or fome inflammatory diforder. Milk, water, OF CHILDREN. 2! water, butter-milk, or whey, are the moft proper for children to drink. If they have any thing Stronger, it may be fine fmall beer, or a little wine mixed with water. The Stomachs of children can digeft well enough without the affiftance of warm Stimulants: befides, being naturally hot, they are eafily hurt by every thing of a heating quality. Few things are more hurtful to children than un- ripe fruits. They weaken the powers of digeftion, and four and relax the Stomach, by which means it becomes a proper r.eft for infects. Children indeed Shew a great inclination for fruit, and I am apt to believe, that if good ripe fruit were allowed them in proper quantity, it would have no bad effects. We never find a natural inclination wrong, if properly regulated. Fruits are generally of a cooling nature, and correct the heat and acrimony of the humours. This is what moft children require; only care fhould be taken left they exceed. Indeed the beft way to prevent children from going to excefs in the ufe of fruit, or eating that which is bad, is to allow them a proper quantity of what is good *. Roots which contain a crude vifcid juice fhould be fparingly given to children. They fill the body with grofs humours, and tend to produce eruptive difeafes. This C3mion is peculiarly neceffary for the poor; glad to obtain at a fmall price what will fill the bellies of their children, they Stuft them two or three times a day with crude vegetables. Children * Children are always fick!y in the fruit feafon, which may be thus accounted for: Two thirds of the fruit which comes to market in this country is really unrip?; and children not being in a condition to judge for themfelves, eat whatever they can lay their hands upon, which often proves \iv\s better than a poif .n to their tender bowels. Servants, and others who have the care of children uVtuII be ftriitly forbid to give them any fruit without the knowledge of their parents. C 3 had 22 OF CHILDREN. had better eat a fmaller quantity of food which yields a wholefome nouriSliment, than be crammed with what their digeftive powers are unable properly to affimilate. Butter ought likewife to be fparingly given to children. It both relaxes the Stomach, and produces grofs humours. Indeed, moft things that are fat or oily, have this effect. Butter, when falted, be- comes ftill more hurtful. Inftead of butter, fo libe- rally given to children in moft parts of Brit in, we would recommend -honey. FL ney is not only wholefome, but cooling, cleanfing, and tends to fweeten the humours. Children who rat honey are feldom troubled with worms : they are alfo Ids Sub- ject to cutaneous difeafes, as itch, fcabbed ; ead, &c. Many people err in thinking that the dirt of chil- dren ought to be altogether moift. When children live entirely upon flops, it relaxes their folids, ren- ders them weak, and difpofes them to the rickets, the fcrophula, and other glandular diforders. Re- laxation is one of the moft general caufes of the dif- eafes of children. Every thing therefore which tends to unbrace their folids, ought to be carefully avoided. We would not be understood by thefe obfervations as confining children to any particular kind of food. Their diet may be frequently varied, provided always that fuflicient regard be had to fimplicity. Of the Exercife of Children. Of all the caufes which confpire to render the life of man fhort and miferable, none has greater influ- ence than the want of proper exercise : healthy parents, wholefome food, and proper clothing, will avail little, where cxercife is neglected. Sufficient cxercife will make up for feveral defects in nurfmg; bin OF CHILDREN. 23 but nothing can fupply the want of it. It is abfo- lutely neceffary to the health, the growth, and the Strength of children. The defire of exercife is coeval with life itfelf. Were this principle attended to, many difeafes might be prevented. But, while indolence and fedentary employments prevent two-thirds of mankind from either taking fufficient exercife themfelves, or giving it to their children, what have we to expect but dif- eafes and deformity among their offspring ? The rickets, fo destructive to children, never appeared in Britain till manufactures began to flourish, and people, attracted by the love of gain, left the coun- try to follow fedentary employments in great towns. It is amongft thefe people that this difeafe chiefly prevails, and not only deforms, but kills many of their offspring. The conduct of other young animals fhews the propriety of giving exercife to children. Every other animal makes ufe of its organs of motion as foon as it can, and many of them, even when under no neceffity of moving in queft of food, cannot be restrained without force. This is evidently the cafe with the calf, the lamb, and moft other young animals. If thefe creatures were not permitted to frifk about and take exercife, they would foon die or become difeafed. The fame inclination appears very early in the human fpecies ; but as they are not able to take exercife themfelves, it is the bufi- nefs of their parents and nurfes to affift them. Children may be exercifed various ways. The beft method, while they are light, is to carry them about in the nurfe's arms*. This gives the nurfe 1 * The nurfe ought to be careful ts keep the child in a proper pofition ; as deformity is often the confequonce of inattention to this circumitance. Its fituation ought alfo to be frequently C 4 aa M OF CHILDREN. an opportunity of talking to the child, and of point- ing out every thing that may pleafe and delight its fancy. Befides, it is much Safer than fwinging an infant in a machine, or leaving it to the care of fuch as are not fit to take care of themfelves. No-hing can be more abfurd than to fet one chiid to keep another: this conduct has proved fatal to many in- fants, and has rendered others miferable for life. When children begin to walk, the fafeft and beft method of leading them about, is by the hands. The common way, of fwinging them in leading Strings fixed to their backs, has feveral bad confequences., It makes them throw their bodies forward, and prefs with their whole weight upon the Stomach and breaft; by this means the breathing is obstructed, the breaft flattened, and the bowels compreffed ; which muft hurt the digeftion, and occafion confumptions of the lungs, and other difeafes.. It is a common notion, that if children are fet upon their feet too foon, their legs will become crooked. There is reafon to believe, that the very revcrfe of this is true. Every member acquires Strength in proportion as it is exercifed. The limbs of children are weak indeed, but their bodies are proportionably light; and had they Skill to direct themfelves, they would foon be able to fupport their own weight. Who ever heard of any other animal that hecame crooked by ufing its legs too foon ? Indeed, if a child is not permitted to make any ufe of its legs till a confiderable time after the birth, and be then fet upon them with its whole weight at once, there may be fome danger ; but this proceeds entirely from the child's not having been accuftomed to ufe its legs from the beginning. changed. I have known a child's leg bent all en one fide, by the nurfe carrying it conftantly on one arm. Mothers OF CHILDREN. 25 Mothers of the poorer fort think they are great gainers by making their children lie or fit while they themfelves work. In this they are greatly miftaken. By neglecting to give their children exercife, they are obliged to keep them a long time before they can do any thing for themfelves, and to fpend more on medicine than would have paid for proper care. To take care of their children, is the moft ufe- ful bufinefs in which even the poor can be em- ployed : but alas! it is not always in their po'wer. Poverty often obliges them to neglect their offspring, in order to procure the neceffaries of life. When this is the cafe, it becomes the intereft as well as the duty of the public to affift them. Ten thoufand times more benefit would accrue to the State, by enabling the poor to bring up their own children, than from all the hofpitals* that ever can be erected for that purpofe. Whoever confiders the Structure of the human body will foon he convinced of the neceffity of exer- cife for the health of children. The body is com- pofed of an infinite number of tubes, whofe fluids cannot be pufhed on without the action and preffure of the mufcles. But, if the fluids remain inactive, obftrucYions muft happen, and the humours will of courfe be vitiated, which cannot fail to occafion difeafes. Nature has furnifhed both the veffels * If it were made the intereft of the poor to keep their chil- dren alive, we fhould lofe very few of them, A fmall premium given annually to each poor family, for every child they haves alive at the year's end, would fave more infant lives than if the whole revenue were expended on hofpitals for this purpofe. This would make the poor elteem fertility a bkffing; whereas many of them think it the greateft curfe that can befal them; and in place of wifhing their children to live, fo far does po- verty get the better of natural affcflicn, that they are ofteq very happy when they die. which 26 OFCHILDREN. which carry the blood and the lymph with nume- rous valves, in order that the action of every mufcle might pufh forward their contents; but without action, this admirable contrivance can have no ef- fect. This part of the animal ceconomy proves to a demonstration the neceffity of exercife for the pre- fervation of health. Arguments to fhew the importance of exercife might be drawn from every part of the animal ceco- nomy ; without exercife, the circulation of the blood cannot be properly carried on, nor the different fe- cretions duly performed ; without exercife, the fluids cannot be properly prepared, nor the folids rendered Strong or firm. The action of the heart, the motion of the lungs, and all the vital functions, are greatly affifted by exercife. But to point out the manner in which thefe effects are produced, would lead us farther into the oeconomy of the human body, than moft of thofe for whom this treatife is intend- ed would be able to follow. We Shall therefore only add, that, where exercife is neglected, none of the animal functions can be duly performed; and when that is the cafe, the whole constitution muft go to wreck. A good constitution ought certainly to be our firft object in the management of children. It lays a foundation for their being ufeful and happy in life; and whoever neglects it, not only fails in his duty to his offspring, but to fociety. One very common error of parents, by which they hurt the conftitutions of their children, is the fending them too young to fchool. This is often done folely to prevent trouble. When the child is at fchool, he needs no keeper. Thus the fchool- mafter is made the nurfe ; and the poor child is fixed to a feat feven or eight hours a day, which time ought to be fpent in exercife and diverfions. Sitting OF CHILDREN. 27 Sitting fo long cannot fail to produce the worft ef- fects upon the body; nor is the mind lefs injured. Early application weakens the faculties, and often fixes in the mind an averfion to books, which conti- nues for life *. But fuppofe this were the way to make children fcholars, it certainly ought not to be done at the expence of their conftitutions. Our anceftors, who feldom went to fchool very young, were not lefs learned than we. But we imagine the boy's edu- cation will be quite marred, unlefs he be carried to fchool in his nurfe's arms. No wonder if fuch hot- bed plants feldom become either fcholars or men ! Not only the confinement of children in public fchools, but their number, often proves hurtful. Children are much injured by being kept in crowds within doors ; their breathing not only renders the place unwholefome, but if any one of them happens to be difeafed, the reft catch the infection. A fin- gle child has been often known to communicate the bloody flux, the hooping-cough, the itch, or other difeafes, to almoft every individual in a numerous fchool. But, if fafhion muft prevail, and infants are to be fent to fchool, we would recommend it to teachers, as they value the interefts of fociety, not to con- fine them too long at a time, but allow them to run about and play at fuch active diverfions as m :y promote their growth, and Strengthen their conftitu- tions. Were boys, inftead of being prevented from * It is undoubtedly the duty of parents to inftruct their chil- dren, at leaft tit they are of an age proper to take fome care of themfelves. This would tend much to confirm the ties of pa- rental tendernefs and filial affection, of the want of which the;e are at prefent fo many deplorable inftances. Though few fa- thers have time to inftiuct their children, yet moft mothers have j an J. furely they cannot, be belter employed. running, 23 OF CHILDREN. running, riding, fwimming, or the like, encouraged to employ a proper part of their time in thefe manly and ufeful exercifes, it would have many excellent effects. An effeminate education will infallibly fpoil the beft natural conftitution ; and if boys are brought up in a more delicate manner than even girls ought to be, they never will be men. Nor is the common education of girls lefs hurt- ful to the conftitution than that of boys. Mifs is fet down to her frame before She can put on her clothes ; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general efteem. It is unneceffary here to infill upon the dangerous confequences of obliging girls to fit too much. They are pretty well known, and are too often felt at a certain time of life. But fup- pofing this critical period to be got over, greater dangers Still await them when they come to be mo- thers. Women who have been early accuftomed to a fedentary life, generally run great hazards in child- bed ; while thofe who have been ufed to take fufli- cient exercife, are feldom in any danger. One hardly meets with a girl who can at the fame time boaft of early performances by the needle, and a good conftitution. Clofe and early confinement generally occafions indigeftions, head-achs, pale com- plexions, pain of the Stomach, lofs of appetite, coughs, confumptions of the lungs, and deformity of body. The laft of thefe indeed is not to be won- dered at, confidering the awkward pofturcs in which girls fit at many kinds of needle-work, and the de- licate flexible State of their bodies in the early pe- riods of life. Would mothers, inftead of having their daugh- ters instructed in many trifling accomplishments, employ them in plain work and houfewifery, and al- low OF CHILDREN. ty low them fufficient exercife >n the open air, they would both make them more healthy mothers, and more ufeful members of fociety. 1 am no enemy to genteel accomplishments, but would have them only considered as fecondary, and always difregarded when they impair health. Many people imagine it a great advantage for children to be early taught to earn their bread. This opinion is certainly right, provided they were fo employed as not to hurt their health or growth ; but, when thefe fuffer, fociety, inftead of being be- nefited, is a real lofer by their labour.' There are few employments, except fedentary ones, by which children can earn a livelihood; and if they be fet to thefe too foon, it ruins their conftitutions. Thus, by gaining a few years from childhood, we gene- rally lofe twice as many in the latter period of life, and even render the perfon lefs ufeful while he does live. In order to be fatisfied of the truth of this obferva- tion, we need only look into the great manufactur- ing towns, where we Shall find a puny degenerate race of people, weak and fickly all their lives, feldom exceeding the middle period of life ; or if they do, being unfit for bufinefs, they become a burden to fociety. Thus arts and manufactures, though they may increafe the riches of a country, are by no means favourable to the health of its in- habitants. Good*, policy would therefore require, that fuch people" as labour during life, fliould not be fet too early to work. Every perfon converfant in the breed of horfes, or other working animals, knows, that if they be fet to hard laboui too foon, they never will turn out to advantage. This is equally true with refpect to the human fpecies.— Weakly children fhould always bs put apprentice to trade: which require their being muftly cut of doors> 3« OF CHILDREN. ■doors; the contrary practice is, however, too com- mon. There are neverthelefs various ways of employ- ing young people without hurting their health. The eafier parts of gardening, husbandry, or any bufinefs carried on without doors, are moft proper. Thefe are employments which moft young people are fond of, and fome parts of them may always be adapted to their age, talte, and Strength *. Such parents, however, as are under the necef- fity of employing their children within doors, ought to allow them fuflicient time for active diverfions without. This would both encourage them to do more work, and prevent their conftitutions from being hurt. Some imagine, that exercife within doors is Suf- ficient ; but they are greatly mistaken. One hour fpent in running, or any other exercife without doors, is worth ten within. When children cannot go abroad, they may indeed be exercifed at home. The beft method of doing this, is to make them run about in a long room, or dance. This laft kind of exercife, if not carried to excefs, is of ex- cellent fervice to young people. It cheers the fpi- rits, promotes perfpiration, Strengthens the limbs, &c. I know an eminent phyfician who ufed to fay, that he made his children dance, inftead of giving them phyfic. It were well if more people followed his example. The cold bath may be confidered as an aid to exercife. By it the body is braced and Strengthen- ed, the circulation and fecretions promoted, and, * I have been told that in China, where the police is the beft in the world, all the children are employed in the eafier part of gardening and hufbandry ; as weeding, gathering ftones off die land, and fuch like. were OF CHILDREN. 31 were it conducted with prudence, many difeafes, as the rickets, fcrophula, &c. might thereby be pre- vented. The ancients, who took every method to render children hardy and robuft, were no Strangers to the ufe of the cold bath ; and, if we may credit report, the practice of immerfing children daily in cold water muft have been very common among our ancestors. The greateft objection to the ufe of the cold bath arifes from the fuperftitious prejudices of nurfes. Thefe are often fo Strong, that it is impoffible to bring them to make a proper ufe of it. I have known fome of them who would not dry a child's Skin after bathing it, left it Should deftroy the effect of the water. Others will even put cloths dipt in the water upon the child, and either put it to bed, or fuffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular faint: while others place their confidence in a certain number of dips, as three, 'feven, nine, or the like ; and the world could not perfuade them, if thefe do not fucceed, to try it a little longer. Thus, by the whims of nurfes, children lofe the benefit of the cold bath, and the hopes of the phyfician from that medicine are often frustrated. We ought not, however, entirely to fet afide the cold bath, becaufc fome nurfes make a wrong ufe of it. Every child, when in health, Should at leaft have its head and extremities daily wafhed in cold water. This is a partial ufe of the cold bath, and is better than none. In winter this may fuffice ; but, in the warm feafon, if a child be relaxed, or feem to have a tendency to the rickets or fcrophula, its whole body ought to be frequently immerfi d in cold wa- ter. Care, however, muft be taken not to do this when the bodv is hot, or the Stomach full. The child 32 OF CHILDREN. child Should be dipt only once at a time, fliould be taken out immediately, and have its Skin well rubbed With a dry cloth. The bad Ejfecls of unwh:lefome Air upon Children. Few things prove more destructive to children than confined or unwholefome air. This is one reafon why fo few of thofe infants, who are put into hofpital*, or parilh workhoufes, live. Thefe places are generally crowded with old, fickly, and infirm people ; by which means the air is rendered fo extremely pernicious, that it becomes a poifoft to infants. Want of wholefome air is likewife destructive to many of the children born in great towns. There the poorer fort of inhabitants live in low, dirty, confined houfes, to which the freSh air has hardly any accefs. Though grown people, who are hardy and robuft, may live in fuch Situations, yet they generally prove fatal to' their offspring, few of whom arrive at maturity, and thofe who do are weak and deformed. As fuch people are not in a condition to carry their children abroad into the open air, we muft lay our account with lofing the greater part of them. But the rich have not this excufe. It is their bufinefs to fee that their chil- dren be daily carried abroad, and that they be kept in the open air for a fuflicient time. This- will al- ways fucceed better if the mother goes along with them. Servants are often negligent in thefe mat- ters, and allow a child to fit or lie on the damp ground, inftead of leading or carrying it about. The mother furely needs air as well as her chil- dren ; and how can She be better employed than in attending them ? Lr A very OF CHILDREN. 33 A very bad cuftom prevails, of making children fleep in fmall apartments, or crowding two or three beds into one chamber. Inftead of this, the nurfery ought always to be the largeft and beft aired room in the houfe. When children are confined in fmall apartments, the air not only becomes unwholefome, but the heat relaxes their folids, renders them de- licate, and difpofes them to colds and many other diforders. Nor is the cuftom of wrapping them up too clofe in cradles lefs pernicious. One would think that nurfes were afraid left children Should fuffer by breathing free air, as many of them ac- tually cover the child's face while afleep, and others wrap a covering over the whole cradle, by which means the child is forced to breathe the fame air over and over all the time it Sleeps. Cradles indeed are on many accounts hurtful to children, and it would be better if the ufe of them were totally laid afide *. A child is generally laid to fleep with all its clothes on ; and if a number of others are heaped above them, it muft be overheated ; by which means it can- not fail to catch cold on being taken out of the * It is amazing how children efcape fuffocation, confidering the manner in which they are often rolled up in flannels, &c. I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I begged for a little free air to the poor babe ; but though this indulgence was granted during my ftay, I found it always on my return in the fame fituation. Death, as might be expected, foon freed $\e infant from all its miferies ; but it was not in my power to free the minds of its parents from thofe prejudices which proved fatal to their child. I was very lately called to fee an infant which was faid to be expiring in convulfion fits. I defired the mother to ftrip the child, and wrap it in a loofe covering. It had no more con- vulfion fits. D cradle, 34 OF CHILDREN. cradle, and expofed in the open air with only its ufual clothing, which is too frequently the cafe. Children who are kept within doors all day, and Sleep all night in warm clofe apartments, may, with great propriety, be compared to plants, nurfed in a hot-houfe, inftead of the open air. Though fuch plants may, by this means, be kept alive for fome time, they will never arrive at that degree of Strength, vi- gour, and magnitude, which they would have ac- quired in the open air, nor would they be able to bear it afterwards, fhould they be expofed to it. Children brought up in the country, who have been accuftomed to open air, Should not be too early fent to great towns, where it is confined and unwholefome. This is frequently done with a view to forward their education, but proves very hurtful to their health. All fchools and feminaries of learn- ing ought, if poffible, to be fo fituated as to have frefh, dry, wholefome air, and fhould never be too much crowded. Without entering into a detail of the particular advantages of wholefome air to children, or of the bad confequences which proceed from the want of it, I fhall only obferve, that, of feveral thoufands of children which have been under my care, I do not remember one inftance of a fingle child who continued healthy in a clofe confined fituation; but have often known the moft obftinate difeafes cured by removing them from fuch a fituation to an open free air. Of Nurfes. It is not here intended to lay down rules for the choice of nurfes. This would be wafting time. Common fenfe will direft every one to chufe a wo- man OF CHILDREN. 3£ man who is healthy, and has plenty of milk *. If (he be at the fame time cleanly, careful, and good- natured, flie can hardly fail to make a proper nurfe. After all, however, the only certain proof of a good nurfe is an healthy child upon her breaft. But, as the mifconduct of nurfes often proves fatal to children, it will be of importance to point out a few of their moft baneful errors, in order to roufe the attention of parents, and to make them look more Strictly into the conduct of thofe to whom they commit the care of their infant offspring. Though it admits of fome exceptions* yet we may lay it down as a general rule, that every woman who nurfes for hire Jhould be carefully looked after, otherwife fhe will not do her duty. For this reafon parents ought always to have their children nurfed under their own eye, if poffible; and where this cannot be done, they fhould +>e extremely circum- fpect in the choice of thofe perfons to whom they intruft them. It is folly to imagine that any wo- man, who abandons her own child to fuckle an- other for the fake of gain, fliould feel all the affec- tions of a parent towards her nurlling ; yet fo necef- fary are thofe affections in a nurfe, that, but for them, the human race would foon be extinct. One of the moft common faults of thofe who nurfe for hire, is to dofe children with flupefac- tives, or fuch things as lull them afleep. An in- dolent nurfe, who does not give a child fufficient exercife in the open air to make it fleep, and does not chufe to be difturbed by it in the night, will feldom fail to procure for it a dofe of laudanum, diacodium, faffron, or what anfwers the fame pur- * I have often known people fo impofed upon, as to give an infant to a nurfe to- be fuckled, who had not one drop of milk in her breaft. D 2 pofe, 36 OF CHILDREN. pofe, a dofe of fpirits, or other Strong liquors. Thefe, though they be certain poifon to infants, are every day adminiftered by many who bear the cha- racter of very good nurfes *. A nurfe who has not milk enough is apt to ima- gine that this defect may be fupplied by giving the child wines, cordial waters, or other flrong liquors. This is an egregious miftake. The only thing that has any chance to fupply the piace of the nurfe's milk, muft be fomewhat nearly of the fame quality, as cow's milk, afs's milk, or beef tea, with good bread. It never can be done by the help of flrong liquors. Thefe inftead of nourishing an infant, never fail to produce the contrary effect. Children are often hurt by nurfes fuffering them to cry long and vehemently. This Strains their tender bodies, and frequently occafions ruptures, inflammations of the*throat, lungs, &c. A child never continues to cry long without fome caufe, which might always be difcovered by proper atten- tion ; and the nurfe who can hear an infant cry till it has almoft fpent itfelf, without endeavouring to pleafe it, muft be cruel indeed, and is unworthy to be intruded with the care of an human creature. Nurfes who deal much in medicine are always to be fufpected. They truft to it, and neglect their duty. I never knew a good nurfe who had her Godfrey's cordials, Daffy's elixirs, &c. at hand. Such generally imagine, that a dofe of medicine will make up for ail defects in food, air, exercife, and cleanlinefs. By errors of this kind, I will venture to fay, that one half of the children who die annu- ally in London, lofe their lives. * If a mother, on vifiting her child at nurfe, find it always sfleep, I would advife her to remove it immediately ; otherwife it will foon fleep its laft. Allowing OF CHILDREN. 37 Allowing children to continue long wet, is another very pernicious cuftom of indolent nurfes. This is not only difagreeable, but it galls and frets the in- fant, and, by relaxing the folids, occafions fcrophu- las, rickets, and other difeafes. A dirty nurfe is always to be fufpeqted. Nature often attempts to free the bodies of chib dren from bad humours, by throwing them upon the Skin: by this means fevers and other difeafes are prevented. Nurfes are apt to miftake fuch cri- tical eruptions for an itch, or fome other infectious diforder. Accordingly they take every method to drive them in. In this way many children lofe their lives; and no wonder, as Nature is oppofed in the very method fhe takes to relieve them. It ought to be a rule, which every nurfe Should obferve, never to flop any eruption without proper advice, or being well affured that it is not of a critical nature. At any rate, it is never to be done without previous evacuations. Loofe Stools is another method by which Nature often prevents or carries off the difeafes of infants. If thefe proceed too far, no doubt they ought to be checked; but this is never to be done without the greateft caution. Nurfes, upon the firft appearance •f loofe Stools, frequently fly to the ufe of aftrin- gents, or fuch things as bind the body. Hence in- flammatory fevers, and other fatal difeafes, are oc- casioned. A dofe of rhubarb, a gentle vomit, or fome other evacuation, fhould generally precede the ufe of aftringent medicines. One of the greateft faults of nurfes is, concealing the difeafes of children from their parents. This they are extremely ready to do, efpecially when the difeafe is the effect of their own negligence. Many inftances might be given of perfons who have been rendered lame for life by a fall from their nurfe's D 3 arms, 38 OF CHILDREN. arms, which She, through fear, concealed till the misfortune was paft cure. Every parent who in- trufts a nurfe with the care of a child, ought to give her the ftricteft charge not to conceal the moft trifling diforder or misfortune that may befal it. We can fee no reafon why a nurfe, who conceals any misfortune which happens to a child under her care, till it lofes its life or limbs, Should not be puniShed. A few examples of this would fave the lives of many infants; but as there is little reafon to expect that it ever will be the cafe, we would earnestly recommend it to all parents to look care- fully after their children, and not to trull fo valu- able a treafure entirely in the hands of an hireling. No perfon ought to imagine thefe things unwor- thy of his attention. On the proper management of children depend not only their health and ufeful- nefs in life, but likewife the fafety and profperity of the ftate to which they belong. Effeminacy ever will prove the ruin of any ftate where it prevails; and, when its foundations are laid in infancy, it can never afterwards be wholly eradicated. Parents who love their offspring, and wifh well to their country, ought therefore, in the management of their chil- dren, to avoid every thing that may have a tendency to make them weak or effeminate, and to take every method in their power to render their conftitutions ftrong.and hardy. -------By arts like thefe Laconia nurs'd of old her hardy fons ; And Rome's unconquer'd legions urg'd their way, Unhurt, thro' every toil in every clime*. * Armftrong. CHAP, I 39 J CHAP. II.' Of the Laborious, the Sedentary, and the Studious. 1 HAT men are expofed to particular difeafes from the occupations which they follow, is a fact well known ; but to remedy this evil is a mat- ter of fome difficulty. Moft people are under the neceffity of following thofe employments to which they have been bred, whether they be favourable to health or not. For this reafon, inftead of in- veighing, in a general way, as fome authors have done, againft thofe occupations which are hurtful to health, we Shall endeavour to point out the cir- cumstances in each of them from which the danger chiefly arifes, and to propofe the moft rational me- thods of preventing it. Chymifts, founders, forgers, glafs-makers, and feveral other artifts, are hurt by the unwholefome air which they are obliged to breathe. This air is not only loaded with the noxious exhalations arifing from metals and minerals, but is fo charged with phlogifton as to be rendered unfit for expanding the lungs fufficiently, and anfwering the other im- portant purpofes of refpiration. Hence proceed afthmas, coughs and confumptions of the lungs, fo incident to perfons who follow thefe employments. To prevent fuch confequences, as far as poffible, the places where thefe occupations are carried on, ought to be constructed in fuch a manner as to dif- charge the fmoke and other exhalations, and admit a free current of frefh air. Such artifts ought never D 4 to 40 OF THE LABORIOUS, THE SEDENTARY, to continue too long at work ; and when they give over, they fhould fuffer themfelves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quantities of cold, weak, or watery liquors, while their bodies are hot, nor to indulge in raw fruits, fallads, or any thing that is cold on the Stomach*. Miners, and all who work under ground, are like- wife hurt by unwholefome air. The air, by its Stag- nation in deep mines, not only lofes its proper fpring and other qualities neceffary for refpiration, but is often loaded with fuch noxious exhalations as to be- come a moft deadly poifon. The two kinds of air which prove moft destructive to miners, are what they call the fire damp, and the choke damp. In both cafes the air becomes a poifon, The danger from the former may be obviated by making it explode before it accumulates in too great quantities; and the latter may be generally carried off by promoting a free circulation of air in the mine. Miners are not only hurt by unwholefome air, but likewife by the particles of metal which adhere to their Skin, clothes, &c. Thefe are abforbed, or taken up into the body, and occafion palfies, verti- goes, and other nervous affections, which often prove fatal. Fallopius obferves, that thofe who work in mines of mercury feldom live above three or four years. Lead, and feveral other metals, are likewife very pernicious to the health. Miners ought never to go to work faffing, nor to continue too long at work. Their food ought to be nourishing, and their liquor generous: no- thing more certainly hurts them than living too low. * When perfons heated with labour have drank cold liquor, they ought to continue at work for fome time after. They AND THE STUDIOUS. 4I They fliould by all means avoid coftivenefs. This may cither be done by chewing a little rhubarb, or taking a fufficient quantity of fallad oil. Oil not only opens the body, but fheaths and defends the inteftines from the ill effects of the metals. All who work in mines or metals ought to wafh carefully, and to change their clothes as foon as they give over working. Nothing would tend more to preferve the health of fuch people than a Strict, and almoft reli- gious regard to cleanlinefs. Plumbers, painters, gilders, fmelters, makers of white lead, and many others who work in metals, are liable to the fame difeafes as miners, and ought to obferve the fame directions for avoiding them. Tallow-chandlers, boilers of oil, and all who work in putrid animal fubftances, are likewife liable to fuffer from the unwholefome fmells or effluvia of thefe bodies. They ought to pay the fame regard to cleanlinefs as miners; and when they are affected with naufea, ficknefs, or indigeftion, we would ad- vife them to take a vomit or a gentle purge. Such fubftances ought always to be manufactured as foon as poffible. When long kept, they not only become unwholefome to thofe who manufacture them, but likewife to people who live in the neighbourhood. It would greatly exceed the limits of this part of our fubject, to fpecify the difeafes peculiar to perfons of every occupation; we Shall therefore confider mankind under the general claffes of Laborious, Se- dentary, and Studious. * THE LABORIOUS. Though thofe who follow laborious employments are in general the moft healthy of mankind, yet the * mature of their occupations, and the places where they 42 OF THE LABORIOUS, THE SEDENTARY. they are carried on, expofe them more particularly to fome difeafes. HuSbandmen, for example, are expofed to all the viciffitudes of the weather, which, in this country, are often very great and fudden, and occafion colds, coughs, quinfies, rheumatifms, fevers, and other acute diforders. They are likewife forced to work hard, and often to carry burdens above their Strength, which, by overftraining the veffels, occafion afthmas, ruptures, pleurifies, &c. Thofe who labour without doors are often afflict- ed with intermitting fevers or agues, occafioned by the frequent viciffitudes of heat and cold, poor living, bad water, fitting or lying- on the damp ground, evening dews, night air, &c. to which they are fre- quently expofed. Such as bear heavy burdens, as porters, labourers, &c. are obliged to draw in the air with much greater force, and alfo to keep their lungs diftended with more violence than is neceffary for common refpira- tion: by this means the tender veffels of the lungs are overftrctched, and often burlt, infomuch that a Spitting of blood or fever enfues. Hippocrates men- tions an inftance to this purpofe, of a man, who, upon a wager, carried an afs ; but was foon after fcized with a fever, a vomiting of blood, and a rupture. Carrying heavy burdens is generally the effect of mere lazinefs, which prompts people to do at once what fliould be done at twice. Sometimes it proceeds from vanity or emulation. Hence it is, that the ftrongeft men are moft commonly hurt by heavy burdens, hard labour, or feats of activity. It is rare to find one who boafts of his Strength without a rupture, a fpitting of blood, or fome other difeafe, which he reaps as the fruit of his folly. One would imagine, the daily inftances we have, of the fatal effe&s AND THE STUDIOUS. 43 effects of carrying great weights, running, wreft- ling, and the like, would be fufficient to prevent fuch practices. There are indeed fome employments which ne- ceffarily require a great exertion of Strength, as por- ters, blackfmiths, carpenters, &c. They fhould never exert their ftrength to the utmoft, nor work too long. When the mufcles are violently Strained, frequent reft is neceffary, in order that they may recover their tone; without this, the Strength and conftitution will foon be worn out, and a premature old age be induced. The eryfipelas, or St. Anthony's fire, is a difeafe very incident to the laborious. It is occafioned by whatever gives a hidden check to the perfpiration, as drinking cold water when the body is warm, wet feet, keeping on wet clothes, fitting or lying on the damp ground, &c. It is impoffible for thofe who labour without doors always to guard againft thefe inconveniences; but it is known from expe- rience, that their ill confequences might often be prevented by proper care. The iliac paffion, the cholic, and other complaints of the bowels, are often occafioned by the fame caufes as the eryfipelas; but they may likewife proceed from flatulent and indigeftible food. Labourers generally eat unfermented bread, made of peas, beans, rye and other windy ingredients. They alfo devour great quantities of unripe fruits, baked, ftewed or raw, with various kinds of roots and herbs, upon which they often drink four milk, Stale fmall beer, or the like. Such a mixture cannot fail to fill the bowels with wind, and occafion difeafes of thofe parts. Inflammations, whitloes, and other difeafes of the extremities, are likewife common among thofe who labour without doors. Thefe difeafes are often at- tributed to venom, or fome kind of poifon; but thay gene- 44 OF THE LABORIOUS, THE SEDENTARY, generally proceed either from fudden heat after cold, or the contrary. When labourers, milk-maids, &c. come from the field, cold or wet, they run to the fire, and often plunge their hands in warm water, by which means the blood and other humours in thofe parts are fuddenly expanded, and, the veffels not yielding fo quickly, a ftrangulation happens, and an inflammation or a mortification enfues. When fuch perfons come home cold, they ought to keep at a distance from the fire for fome time, to wafh their hands in cold water, and to rub them well with a dry cloth. It fometimes happens, that people are fo benumbed with cold, as to be quite deprived of the ufe of their limbs. In this cafe, the only re- medy is to rub the parts affected with fnow, or where it cannot be had, with cold water. If they be held near the fire, or plunged into warm water, a morti- fication will generally enfue. Labourers in the hot feafon are apt to lie down and fleep in the fun. This practice is fo dangerous, that they often wake in a burning fever. Thefe ar- dent fevers, which prove fo fatal about the end of fummcr and beginning of autumn, are frequently occafioned by this means. When labourers leave off work, which they ought always to do during the heat of the day, they Should go home, or, at leaft, get under fome cover, where they may repofe them- felves in fafety. Many people follow their employments in the fields from morning till night, without eating any thing. This cannot fail to hurt their health. How- ever homely their fare be, they ought to have it at regular times; and the harder they work, the more frequently they fhould eat. If the humors be not frequently replenished with freSh nourishment, they foon become putrid, and produce fevers of the very worft kind. Many AND THE STUDIOUS. 45 Many peafants are extremely carelefs with refpect to what they eat or drink, and often, through mere indolence, ufe unwholefome food, when they might for the fame expence have that which is wholefome. In fome parts of Britain, the peafants are too care- lefs even to take the trouble of dreffmg their own victuals. Such people would live upon one meal a-day in indolence, rather than labour, though it were to procure them the greateft affluence. Fevers of a very bad kind are often occafioned among labourers by poor living. When the body is not fufficiently nourished the humours become vi- tiated, and the folids weak; from whence the moft fatal confequences enfue. Poor living is likewife productive of many of thofe cutaneous difeafes fo frequent among the lower clafs of people. It is re- markable that cattle, when pinched in their food, are generally affected with difeafes of the Skin, which feldom fail to difappear, when they are put upon a good pafture. This Shews how much a good ftate of the humours depends upon a fufficient quantity of proper nourishment. Poverty not only occafions, but aggravates, many of the difeafes of the laborious. Few of them have much forefight; and, if they had, it is feldom in their power to fave any thing. They are glad to make a fhift to live from day to day; and, when any difeafe overtakes them, they are miferable indeed. Here the god-like virtue of charity ought always to exert itfelf. To relieve the induftrious poor in dif- trefs, is furely the moft exalted act of religion and humanity. They alone, who are witneffes of thofe fcenes of calamity, can form an idea of what num- bers periSh in difeafes, for want of proper affiftancc, and even for want of the neceffaries of life. Labourers are often hurt by a foolifh emulation, which prompts them to vie with one another, till they 46 OF THE LABORIOUS, THE SEDENTARY, they overheat themfelves to fuch a degree as o oc- cafion a fever, or even to drop down dead. SuO, as wantonly throw away their lives in this manner, de- ferve to be looked upon in no better light than felf- murderers. Sailors may alfo be numbered among the laborious. They undergo great hardships from change of cli- mate, the violence of weather, hard labour, bad pro- vifions, &c. Sailors are of fo'great importance, that too much pains can never be bellowed in pointing out the means of preferving their lives. One great fource of the difeafes of fea-faring peo- ple is excefs. When they get on Shore, after hav- ing been long at fea, without regard to the climate, or their own conftitutions, they plunge headlong in- to all manner of riot, and often perfift till a fever puts an end to their lives. Thus intemperance, and not the climate, is often the caufe why fo many of our brave failors die on foreign coafts. Such peo- ple ought not to live too low; but they will find moderation the beft defence againft fevers, and many other maladies. Sailors, when on duty, cannot avoid fometimes getting wet. When this happens they Should change their clothes as foon as they are relieved, and take every method to reftore the perfpiration. They Should not, in this cafe, make too/ree with fpirits or other ftrong liquors, but fhould rather drink them diluted with warm water, and go immediately to bed, where a found fleep and a gentle fweat would fet all to rights. But the health of failors fuffers moft from un- wholefome food. The conftant ufe of falted provi- fions vitiates their humours, and occafions the fcurvy, and other obftinate maladies. It is no eafy matter to prevent this difeafe in long voyages; yet much might be done towards effecting fo defirable an end, were AND THE STUDIOUS. 47 were due pains beftowed for that purpofe. For ex- ample, various roots, greens, and fruits might be kept a long time at fea, as onions, potatoes, cabba- ges, lemons, oranges, tamarinds, apples, &e. When fruits cannot be kept, the juices of them, either frefh or fermented, may. With thefe all the drink, and even the food of the Ship's company, ought to be acidulated in long voyages. Stale bread and beer likewife contribute to vitiate the humours. Flour will keep for a long time on board, of which freSh bread might frequently b-z made. Malt too might be kept and infufed with boiling water at any time. This liquor, when drank even in form of wort, is very wholefome, and is found to be an antidote againft the fcurvy. Small wines and cyder might likewife be plentifully laid in; and fhould they turn four, they would ftill be ufeful as viuegar. Vinegar is a great antidote againft difeafes, and fliould be ufed by all travellers, efpeci- ally at fea. It may either be mixed with the water they drink, or taken in their food. Such animals as can be kept alive, ought likewife to be carried on board, as hens, ducks, pigs, &c. FreSh broths made of portable foup, and puddings made of peas, or other vegetables ought to be ufed plentifully. Many other things will readily occur to people converfant in thefe matters, which would tend to preferve the health of that brave and ufeful fet of men *. * The celebrated Captain Cook, has fhewn how far, by proper care and attention, the difeafes formerly fo fatal to fea- men may be prevented. In a voyage of three years and eigh- teen days, during which he was expofed to every climate, from the 5 2° north to the 710 of fouth latitude, of one hundred and eighteen men compoling the fhip's company, he loft only one, who died of a phthifis pulmonalis. The principal means he ufed -vere, to preferve a ftrict attention to cbanlineiV, to procure at.'unda..i.vi 48 OF THE LABORIOUS, THE SEDENTARY, We have reafon to believe, if due attention were paid to the diet, air, clothing, and above all things to the cleanlinefs of fea-faring people, they would be the moft healthy fet of men in the world; but when thefe are neglected, the very reverfe will happen. The beft medical antidote that we can recommend to failors or foldiers, on foreign coafts, efpecially where dampnefs prevails, is the Peruvian bark. This will often prevent fevers, and other fatal dif- eafes. About a drachm of it may be chewed every day; or if this Should prove difagreeable, an ounce of bark, with half an ounce of orange peel, and two drachms of fnake-root coarfely powdered, may be infufed for two or three days in an Englffh quart of brandy, and half a wine glafs of it taken twice or thrice a-day, when the Stomach is empty. This has been found to be an excellent antidote againft fluxes, putrid, intermitting, and other fevers, in unhealthy climates/ It is not material in what form this medi- cine is taken. It may either be infufed in water, wine, or fpirits, as recommended above, or made into an electuary with fyrup of lemons, oranges, or the like. THE SEDENTARY. Though nothing can be more contrary to the na- ture of man than a fedentary life, yet this clafs com- prehends by far the greater part of the fpecies. Al- moft the whole female world, and in manufacturing countries, the major part of the males, may be rec- koned fedentary*. abundance of vegetables and frefh provifions, efpecially good water, and to allow his people fufficient time for reft. * The appellation of fedentary has generally been given only to the ftudious; we can fee no reafon, however, for reftricting it to them alone. Many artificers may, with as much propriety, 2 be AND THE STUDIOUS. 49 Agriculture, the firft and moft healthful of all employments, is now followed by few who are able to carry on any other bufinefs. But thofe who ima- gine, that the culture of the earth is not fufficient to employ all its inhabitants, are greatly mistaken. An ancient Roman, we are told, could maintain his family from the produce of one acre of ground. So might a modern Briton, if he would be contented to live like a Roman. This Shews what an immenfe increafe of inhabitants Britain might admit of, and all of them live by the culture of the ground. '"0 Agriculture is the great fource of domeftic riches. Wiiere it is neglected, whatever wealth may be im- pprtcd from abroad, poverty and mifery will abound at home. Such is, and ever will be, the fluctuating State of trade and manufactures, that thoufands of people may be in full employment to-day, and in begoary to-morrow. This can never happen to thofe ,\ho cultivate the ground. They can eat the fruit of their labour, and can always, by induftry obtain, at leaft, the neceffaries of life. Though fedentary employments are neceffary, yet there feems to be no reafon why any perfon fhould be confined for life to thefe alone. Were fuch employments intermixed with the more active and laborious, they would never do hurt. It is conftant confinement that ruins the health. A man may not be hurt by fitting five or fix hours a-day; but if he is obliged to fit ten or twelve, he will foon become difeafed. But it is not want of exercife alone, which hurts fedentary people; they likewife fuffer from the con- fined air which they breathe. It is very common to be denominated fedentary as the ftudious,' with this particular difadvantage, that they are often obliged to fit in very awkward poftures, which the ftudious need not do, unlefs they pleafe. E fee So OF THE LABORIOUS, THE SEDENTARY, fee ten or a dozen taylors*, or Haymakers, for example, crowded into one fmall apartment, where there is hardly room for one perfon to breathe freely. In this fituation they generally continue for many hours at a time, often with the addition of feveral candle's, which tend likewife to wafte the air, an3 render it lefs fit for refpiration. Air that is breathed repeatedly, becomes unfit for expanding the lungs. This is one caufe of the phthifical coughs, and other complaints Of the breaft, fo incident to fedentary artificers. Even the perfpiration from a great number of perfons pent up together, renders the air unwhole- fome. The danger from this quarter Will be greatly increafed, if ^any one of them happens to have bad lungs, or to be otherwife difeafed. Thofe who fit near him, being forced to breathe the fame air, can hardly fail to be infected. It would be a rare thing, however, to find a dozen of fedentary people all in good health. The danger of crowding them toge- ther, muft therefore be evident to every one. Many of thofe who follow fedentary employments are constantly in a bending pofture, as Shoemakers^' taylors, cutlers, Sec. Such a fituation is extremely hurtful. A bending pofture obftnicts all the vital motions, and of courfe molt deftroy the health. Ac- cordingly we find fuch artificers generally complain- ing of indigeftions, flatulencies, head-achs, pains of the breaft, &c. * A perfon of obfervation in that line of life'told me, that moft taylors die of confumptions; which'he attributed chittV tothe'unfavourable poftures in which they fit, and theTin^ho»\ fomenefs of thofe places, where their bufinefs is carried on. If more attention was not paid to profit, than to the prefervation of human lives, this evil might be eafily remedied; but, while matters mind only their own intereft, nothing will be done for Hie fafety of their fervants. The AND THE STUDIOUS. si The aliment in fedentary people, inftead of being pufhed forwards, by an erect pofture, and the action of the mufcles, is in a manner confined in the bowels. Hence indigetions, coftivenefs, wind, and other hypochondriacal affections, the conftant companions of the fedentary. Indeed, none of the excretions can be duly performed, where exercife is wanting; and when the matter, which ought to be difcharged in this way, is retained too long in the body, it muft have bad effects, as it is again taken up into the mafs of humors. A bending pofture is likewife hurtful to the lungs. When this organ is compr.ffed, the air cannot have free accefs into all its parts, fo as to expand them properly. Hence tubercles, adhefions, &e. are formed, which often end in confumptions. Befides, the proper action of the lungs being abfolutely necef- fary for making good blood, when that organ fails, the humors foon become univerfally depraved, and the whole conftitution goes to wreck. Sedentary artificers are not only hurt by preffure on the bowels, but alfo on the inferior extremities, which obftmcts the circulation in thefe parts, and renders them weak and feeble. Thus taylors, Shoe- makers, &c. frequently lofe the ufe of their legs altogether : befides, the blood and huisours are, by Stagnation, vitiated, and the perfpiration is obstructed: from whence proceed the fcab, ulcerous fores, foul blotches, and other cutaneous difeafes, fo common among fedentary artificers. A bad figure of body is a very common confe- quence of clofe application to fedentary employments. The fpine, for example, by being continually bent, puts on a crooked fhape, and generally remains fo ever after'. But a bad figure of body, has already been obferved to be hurtful to health, as the vital functions are thereby impeded. % % A feden- i 2 OF THE LABORIOUS, THE SEDENTARY. A fedentary life feldom fails to occafion an uni- verfal relaxation of the folids. This is the great fource from whence moft of the difeafes of fedentary people flow. The fcrophula, confumption, hyfterics, and nervous difeafes, now fo common, were very little known in Great Britain, before fedentary arti- ficers became fo numerous : and they are very little known ftill among fuch of our people as follow active employments without doors, though in great towns, at leaft two thirds of the inhabitants are afflicted with them. It is very difficult to remedy thofe evils, becaufe many who have been accuftomed to a fedentary life, like ricketty children, lofe all inclination for exer^ cife; we Shall, however, throw out a few hints, with refpect to the moft likely means for preferving th© health of this ufeful fet of people, which fome of them, we hope, will be wife enough to take. It has been already obferved, that fedentary arti- ficers are often hurt by their bending pofture. They ought, therefore, to ftand or fit as erect as the nature of their employments will permit. They fhould like-, wife change their pofture frequently, and fliould never fit too long at a time, but leave off work, and walk, ride, run, or do any thing that will promote the exercife of the vital functions. Sedentary artificers are generally allowed too little time for exercife; yet, fhort as it is, they feldom em- ploy it properly. A journeyman taylor or weaver, for example, inftead of walking abroad for exerciSo and frefli air, at his hours of leifure, chufes often to fpend them in a public houfe, or in playing at fome fedentary game, by which he generally lofes both his time and his money. The awkward poftures in which many fedentary artificers work, feem rather to be the effect of cuf— torn than neceffity. For example, a table might furely i AND THE STUDIOUS. 53 furely be contrived for ten or a dozen taylors to fit round, with liberty for their legs either to hang down, or reft upon a foot-board, as thty Should chufe. A place might likewife be cur out for each perfon, in fuch a manner, that he might fit as conveniently for working as in the prefent mode of fitting crofs-lcg- ged' All fedentary artificers ought to pay the moft reli- gious regard to cleanlinefs. Both their fituation arid occupations, render this highly neceffary. Nothing would contribute more to preferve their health, than a ftrict attention to it; and fuch of them as neglect it, not only run the hazard of lofing health, but cf becoming a nuifance to their neighbours. Sedentary people ought to avoid food that is windy, or ha*d of digeftion, and fliould pay the ftricteft regard to fobriety. A perfon who works hard without doors, will fooner throw off a debauch ; but one who fits, has by no means an equal chance. Hence it often happens, that fedentary people are feized with fevers after hard drinking. When fuch perfons feel their fpirits low, inftead of running to the tavern for relief, they fhould ride or walk in the fields. This would remove the complaint more effectually than ftrong liquor, and would never hurt the conftitution. Inftead of multiplying rules for preferving the health of the fedentary, we Shall recommend to them the following general plan, viz. That every perfon who follows a fedentary employment fhould culti- vate a piece of ground with his own hands. This he might dig, plant, fow, and weed, at leifure hours., fo as to make it both an exercife and amufement, while it produced many of the neceffaries of life. After v/orking an hour in a garden, a man will re- turn with more kecnnefs to his employment within .doors, than if he had been all the while idle. E 3 Labouring 54 OF THE LABORIOUS, THE SEDENTARY, Labouring the ground is every way conducive to J health. It not only gives exercife to every part of 1 the body, but the very fmell of the earth and freftt j herbs revives and cheers the fpirits, whilft the per* t petual profpect of fomething coming to maturity, delights and entertains the mind. We are fo formed as to be always pleafed with fomewhat in profpcft, "™ however diltant, or however trivial. Hence the ■ happinefs that moft men feel in planting, fowing, m building, &c. Thefe feem to have been the chief ] employments of the more early ages: and, whe* W kings and conquerors cultivated the ground, there I is reafon to believe, that they knew as well wherein true happinefs confifted as we do. J It may feem romantic to recommend gardening '] to manufacturers in great towns; but obfervatioa \ proves that the plan is very practicable. In the I town of Sheffield, in Yorkshire, where the great 1 iron manufactury is carried on, there is hardly a 1 journeyman cutler, who does not poflefs a piece of j ground, which he cultivates as a garden. This 1 practice has many falutary effects. It not only in- duces thefe people to take exercife without doors, ; but alfo to eat many greens, roots, &c. of their town growth, which they would never think of par- ' chafing. There can be no reafon why manufac- turers in any other town in Great Britain, fhouid not itollow the fame plan. It is indeed to be regretted, ■ that in fuch a place as London, a plan of this kind is not practicable; yet, even there, fedentary artifi- cers may find opportunities of taking air and exer- cife, if rhey chufe to embrace them. Mechanics are too much inclined to crowd into great towns. The fituation may have fome advan- | tages ; but it has likewife many difadvantages. All mechanics who live in the country, have it in their power to cultivate a piece of ground; which mdee4 ; AND THE STUDIOUS. 5.5 moft of tjiem do. This not qnly gives them exer- cife, but enables them to live more comfortably. So far, at leaft, as my obfervation extends, mechanics who live in the country are far more happy than thofe in great towns. T^ey enjoy better health, live in greater affluence, and feldom fail to rear a healthy and numerous offspring. In a word, exercife without doors, in one fhape or another, is abfolutely neceffary to health. Thofe Who neglect it, though they may for a while drag out life, can hardly be faid to enjoy it. Weak and effeminate, they languifh for a few years, and foon drop into an untimely grave. •* THE STUDIOUS. Intenff thinking is fo destructive to healtji, that few inftances can be produced of ftudious perfons who are ftrong and healthy. Hard Study always implies a fedentary life; and when intenfe thinking is joined to the want of exercife, the confequences muft be bad. We have frequently known even a few months of clofe application to ftudy, ruin an excellent conftitution, by inducing a train of nervous complaints, which could never be removed. Mae is evidently not formed for continual thought, more than for perpetual action, and would be as foon worn out by the one as by the other. So great is the power of the mind over the body, that, by its influence, the whole vital morions may be accelerated or retarded, to almoft any degree. Thus cheerfulnefs and mirth quicken the circula- tion, and promote all the fecretions; whereas fad- nefs and profound thought, never fail to retard them. Hence it would appear, that even a degree of thoughtlcffncfs is neceffary to health. Indeed, the perpetual thinker feldom enjoys either health or E 4 fpirits ^ $6 OF THE LABORIOUS, THE SEDENTARY, fpirits; while the perfon, who can hardly be faid to think at all, generally enjoys both. Perpetual thinkers, as they are called, feldom think long. In a few years they generally become quite Stupid, and exhibit a melancholy p o! how readily the greateft bleffings may be abufed. Tl ink-. ing, like every thing elfe, when carried to extreme* becomes a vice : nor can any thing afford a greater proof of wifdom, than for a man frequently airtt feafonably to unbend his mind. This may generally , be done by mixing in cheerful company, active dt- I verfions, or the like. Inftead of attempting to investigate the nature oi that connection which fubfifts between the mind and body, or to enquire into the manner in which they mutually affect each other, we fliall only mention thofe difeafes to which the learned are more pecu- liarly liable, and endeavour to point out the means of avoiding them. Studious perfons are very Subject to the gout, This painful difeafe in a great meafure proceeds from indigeftion, and an obstructed perfpiration. It is impoffible that the man who fits from morning till night Should either digeft his food, or have any of the fecretions in due quantity. But when that mat- ter, which fliould te thrown off by the Skin, is re- tained in the body, and the humors are not duly prepared, difeafes muft enfue. The ftudious are likewife very liable to the Stone and gravel. Exercife greatly promotes both the fe- cretion and difcharge of urine ; confequently a fe- dentary life muft have the contrary effect. Any one may be fatisfied of this by obferving, that he paffes much more urine by day than in the night, and alfo whea he walks or rides, than when he fits. The circulation in the liver being flow, obstructions yn that organ can hardly h.il to be the confequence oi AND THE STUDIOUS. S7 of inactivity. Hence fedentary people are frequently afflicted with fchirrous livers. But the proper fe- cretion and difcharge of the bile is fo neceffary a part of the animal oeconomy, that where thefe are not duly performed, the health muft foon be im- paired. Jaundice, indigeftion, lofs of appetite, and a wafting of the whole body, feldom fail to be the confequences of a vitiated ftate of the liver, or ob- structions of the bile. Few difeafes prove more fatal to the ftudious than confumptions of the lungs. It has already been ob- ferved, that this organ cannot be duly expanded in thofe who do not take proper exercife; and where that is the cafe, obstructions and adhefions will en- fue. Not only want of exercife, but the pofture in which ftudious perfons generally fir, is very hurtful to the lungs. Thofe who read or write much are ready to contract a habit of bending forwards, and often prefs with their breaft upon a table or bench. This pofture cannot fail to hurt the lungs. The functions of the heart may likewife by this means be injured. I remember to have feen a man opened, whofe pericardium adhered to the breaft- bone in fuch a manner as to obftruct the motion of the heart, and occafion his dea'h. The only pro- bable caufe that could be affigned for this Angular Symptom was, that the man, whofe bufinefs was writing, ufed constantly to fit in a bending pofture, with his breaft preSfing upon the edge of a plain table. No perfon can enjoy health who does not pro- perly digeft his food. But intenfe thinking and inactivity never fail to wTeaken the powrers of digef- tion. Hence the humors become crude and vitiated, the folids weak and relaxed, and the whole consti- tution goes to ruin. 5 8 OF THE LABORIOUS, THE SEDENTARY, Long and intenfe thinking often occafions griev- ous head-achs, which bring on vertigoes, apo- plexies, palfies, and other fatal diforders. The beft way to prevent thefe is, aever to ftudy too long at one time, and to keep the body regular, either by proper food, or taking frequently a little of fome opening medicine. Thofe who read or write much are often afiticted with fore eyes. Studying by candle-light is pecu- liarly hurtful to the fight. This ought to be prac- tifed as feldom as poffible. When it is unavoidable, the eyes fhould be Shaded, and the head Should not be held too low. When the eyes are weak or painful, they fhould be bathed every night and morning in cold water, to which a little brandy may be added. It has ajready been obferved, that the excretions are very defective in the ftudious. The dropfy is often occafioned by the retention of thofe humors which ought to be carried off in this way. iVny perfon may obferve, that fitting makes his legs fwell, and that this goes ©ff by exercife; which clearly points out the method of prevention. Fevers, efpecially of the nervous kind, are often the effect of ftudy. Nothing affects the nerves fo much as intenfe thought. It in a manner unhinges t.he whole human frame, and not only hurts the vital motions, but diforders the mind itfelf. Hence a delirium, melancholy, and even madnefs, are of- ten the effects of clofe application to Study. In fine, there is no difeafe which can proceed either from a bad ftate of the humors, a defect of the ufual fecre- tions, or a debility of the nervous fyitem, which may not be induced by intenfe thinking. £ut the moft afflicting of all the difeafes which attack the Studious is the hypochondriac. This dif- eafe feldom fails to be the companion of deep thought. " It AND THE STUDIOUS. 59 It may rather be called a complication of maladies than a fmgle one. To what a wrretched condition are the beft of men often reduced by it! Their ftrength and appetite fail; a perpetual gloom hangs over their minds; they live in the conftant dread of death, and are continually in fearch of relief from medicine, where, alas i it is not to be found. Thofe who labour under this diforder, though they are often made the fubject of ridicule, juftly claim our higheft fympathy and companion. Hardly any thing can be more prepofterous than for a perfon to make Study his fole bufinefs. A mere Student is feldom an ufeful member of fociety. He often neglects the moft important duties of life, in order to purfue Studies of a very trifling nature. Indeed it rarely happens, than any ufeful invention is the effect of mere ftudy. The farther men dive into profound researches, they generally deviate the more from common fenfe, and too often lofe fight of it altogether. Profound fpeculations, inftead of making men wifer or better, often render them ab- folute fceptics, and overwhelm them with doubt and uncertainty. All that is neceffary for a man to know, in order to be happy, is eafily obtained ; and the reft, like the forbidden fruit, ferves only to in- creafe his mifery. Studious perfons, in order to relieve their minds, muft not only discontinue to read and write, but -engage in fome employment or diversion, that will fo far occupy the thoughts as to make them forget the bufinefs of the clofet. A folitary ride or walk are fo fsr from relaxing the mind, that they rather encourage thought. Nothing can divert the mind, when it gees into a train of ferious thinking, but at- tention to fubje&s of a more trivial nature. Thefe prove a kind of play to :he mind, and .confequently relieve it. Learned Go OF THE LABORIOUS, THE SEDENTARY, Learned men often contract a contempt for what they call trifling company. They are nfliamed to be Seen with any but philofophers. This however is no proof of their being philofophers themfelves." No man deferves that name who is afhamed to un- bend his mind, by affociating with the cheerful and gay. Even the fociery of children will relieve the mind, and expel the gloom which application to Study is too apt to occafion. As ftudious people are neceffarily much within doors, they fhould make choice of a large and well-aired place for ftudy. This would not only prevent the bad effects which attend confined air, but would cheer the fpirits, and have a moft happy influence both on the body and mind. It is faid of Euripides the tragedian, that he ufed to retire to a dark cave to compofe his tragedies, and of De- mofthenes the Grecian orator, that he chofe a place for ftudy where nothing could be either heard or feen. With all deference to fuch venerable names, we cannot help condemning their tafte. A man may furely think to as good purpofe in an elegant apartment as in a cave; and may have as happy conceptions where the all-cheering rays of the fun render the air wholefome, as in places where they never enter. Thofe who read or write much Should be very attentive to their pofture. They ought to fit and Stand by turns, always keeping as nearly in an erect' pofture as poffible. Thefe who dictate, may -do it walking. It has an excellent effect frequently to read or fpeak aloud. Th's not only exercifes the lungs, but almoft the whole body. Hence ftudious people are greatly benefited by delivering difcourfes in public. Public fpeakers, indeed, fometimes hurt themfelves by overacting their part; but this is their' own fault. The msrtyr to mere vociferation merits not our fympathy. The AND THE STUDIOUS. 61 The morning has, by all medical writers been reckoned the beft time for ftudy. It is fo. But in is alfo the moft proper feafou for exercife, while the Stomach is empty, and the fpirits refreshed with fleep. Studious people Should therefore fometimes fpend the morning in walking, riding, or fome manly diverfions without doors. This would make them return to Study with greater alacrity, and would be of more fervice than twice the time after their fpirits are worn out with fatigue. It is not fuflicient to take diverfion only when we can think no longer. Every Studious perfon Should make it a part of his bufinefs, and Should let nothing in- terrupt his hours of recreation more than thofe of ftudy. Mufic has a very happy effect in relieving the mind when fatigued with Study. It would be well f every ftudious perfon were fo far acquainted with that fcience as to amufe himfelf after fevere thought, by playing fuch airs as have a tendency to raifc the fpirits, and infpire cheerfulnefs and good humour. It is a reproach to Learning, that any of her vo- taries, to relieve the mind after ftudy, fliould betake themfelves to the ufe of ftrong liquors. This, indeed, is a remedy; but it is a defperate one, and always proves deftruclive. Would fuch perfons, when their fpirits are low, get on horfeback, and ride ten or a dozen miles, they would find it a more effectual remedy than any cordial medicine in the apotheca- ry's ihop, or all the ftrong liquors in the world. The following is my plan, and I cannot recom- mend a better to others. When my mind is fa- tigued with ftudy, or other ferious bufinefs,. 1 mount my horfe, and ride ten or twelve miles into the coun- try, where I fpend a day, and fometimes two, with a cheerful 6% OF THE LABORIOUS, fcrV. cheerful friend; after which I never fail to return to town with new vigour, and to purfue my fludies or bufinefs with frefh alacrity. It is much to be regretted, that learned men, while in health, pay fo little regard to thefe things! There is not any thing more common than to fee a refera- ble object over-run with nervous difeafes, bathing, Walking, riding, and, in a word, doing every thing for health after it is gone; yet, if any one had re- commended thefe things to him by way of preven- tion, the advice would, in all probability, have been treated with contempt, or, at leaft, with neglect. Such is the weaknefs and folly of mankind, and fuch the want of forefight, even in thofe who ought to be wifer than others ! With regard to the diet of the ftudious, we fee . no reafon why they fhould abftain from any kind of food that is wholefome, provided they ufe it in mo- deration. They ought, however, to be fparing in the ufe of every thing that is windy, rancid, or hard of digeftion. Their fuppers Should always be light, or taken fbon in the evening. Their drink may be water, fine malt liquor, not too ftrong, good cyder, and wine and water. We fhall only obferve, with regard to thofe kinds of exercife which are moft proper for the Studious, that they fhould not be too violent, nor ever carried to the degree of exceffive fatigue. They ought likewife to be frequently varied fo as to give action to all the different parts of the body; and fhould, as often as poffible, be taken in the open air. In general, riding on horfeback, walking, working in a garden, or playing at fome active diverfions, are the beft. We would likewife recommend the ufe of the cold bath to the ftudious. It will, in fome meafure, fupply . . OF ALIMENT. 63 fupply the place of exercife, and fhould not be ne* glected by perfons of a relaxed habit, efjpecially in the warm feafon. No perfon ought either to take violent exercife, or to ftudy immediately after a full meal. C H A P. m. Of Aliment. Unwholesome food, and h-regu- Cities In diet, occafion many difeafes. There is nO doubt out the whole conftitution of body may be changed by diet alone. Nor are its effects upon the folids lefs confiderable. They may be braced or re- laxed, have their fenfibility, motions, &c. greatly incfeafed or diminished, by different kinds of aliment. A very fmall attention to thefe things will be fufli- cient to Shew, how much the prefervation of health depends upon a proper regimen of the diet. Nor is an attention to diet neceffary for the pre- fervation of health only o it is likewife of impor- tance in the cure of difeafes. Every intention in the cure of many difeafes, may be anfweredby diet alone. Its'effects, indeed, are not always fo quick as thofe of medicine, but they are generally more lafting: befides, it is neither fo difagreeable to the patient, nor fo dangerous as medicine, and is always more eafily obtained. Our intention here is not to enquire minutely into the nature and properties of the various kinds of aliment in ufe among mankind; nor to Shew their effects 64 OF ALIMENT. effects upon the different conftitutions of the human body ; but to mark fome of the moft pernicious er- rors which people are apt to fall into, with refpect both to the quantity and qualities of their food, and to point out their influence upon health. It is not indeed an eafy matter to afcertain the exact quantity of food proper for every age, fex, and conftitution : but a fcrupulous nicety here is by no means neceffary. The beft rule is to avoid all ex- tremes. Mankind were never intended to weigh and meafure their food. Nature teaches every crea- ture when it has enough ; and the calls of thirft and hunger are fufficient to inform them when more is neceffary. Though moderation is the chief rule with regard to the quantity, yet the quality of food merits a far- ther consideration. There are many ways by which provifions may be rendered unwholefome. Bad fea- fons may either prevent the ripening of grain, or damage it afterwards. Thefe, indeed, are acts of Providence, and we muft fubmit to them ; but fure- ly no pnnifliment can be too fevere for thofe who fuffer provifions to fpoil by hoarding them, on pur- pofe to raife the price, or who promote their own fuppofed intereft by adulterating the neceilaries of life*. Animal, as well as vegetable food, may be render- ed unwholefome, by being kept too long. All ani- mal fubftances have a conftant tendency to putre- faction ; and, when that has proceeded too far, they * The poor, indeed, are generally the firft who fuffer by unfound provifions; but the lives of the labouring poor are of great importance to the ftate: befides, difeafes occafioned by unwholefome food often prove infe&ious, by which means they reach people in every riation. It is therefore the intereft of all to take care that no fpoilt provifions of any kind be ex* pofed to file. A. na OF ALIMENT. 65 not only become offenfive to the fenfes, but hurtful to health. Difeafed animals, and fuch as die of themfelves, ought never to be eaten. It is a com- mon practice, however, in fome grazing countries, for fervants and poor people to eat fuch animals as die of any difeafe, or are killed by accident. Pover- ty, indeed, may oblige people to do this ; but they had better eat a fmaller quantity of what is found and wholefome: it would both afford a better noui ifh- menr, and be attended with lefs danger. The injunctions given to the Jews, not to eat any creature which died of itfclf, feemed to have a Strict regard to health ; and ought to be obferved by » Chriftians as well as Jews. Even thofe which die by accident muft be hurtful, as their blood is mixed with the flefli, and foon turns putrid. Animals which feed grofsly, as tame ducks, hogs, &c. are neither fo eafily digefted, nor afford fuch wholefome nouriSliment as others. No animal can be vrholefome which does not take fuflicient exercife. Moft of our flailed cattle are crammed with grofi food, but not allowed exercife nor free air; by which means they indeed grow fat, but their juices not being properly prepared or affimilated, remain crude, and occafion indigeftions, grofs humours, and oppreffion of the fpirits, in thofe who feed upon them. Animals are often rendered umvholefome by being over-heated. Exceffive heat caufes a fever, exalts the animal falts, and mixes the blood fo intimately with the fleih that it cannot be feparated. For this reafon, butchers fliould be feverely puniShed uho over-drive tlieir cattle. No perfon wouloV chufe to eat the flefli of an animal which had died in a high fever ; yet that is the cafe with all over-drove cattle; and the fever is often raifed to the decree of rnad- ncfs. F But 66 OF ALIMENT. But this is not the only way by which butchers render meat unwholefome. The abominable cuf- tom of filling the cellular membrane of animals with air, in order to make them appear fat, is every day practifed. This not only fpoils the meat, and ren- ders it unfit for keeping, bur is fuch a dirty trick, that the very idea of it is fufficient to difguft a perfon of any delicacy at every thing which comes from the Shambles. W'ho can bear the thought of eat- ing meat which has been blown up with air from the hngs of a dirty fellow, perhaps labouring under the very worft of difeales ? Butchers have likewife a method of filling the celiular membranes of animals with blood. Thi*. makes the meat feem fatter, and likewife weigh more, but is notwithstanding a very pernicious cuf. torn, qs it both renders the meat unwholefome and unfit for keeping. I feldom fee a piece of meat from the Shambles, where the blood is not diffufed through the cellular texture. I Shall not fay that this is always the effect of defign ; but 1 am certain it is not the cafe with animals that are killed for domeftic ufe, and properly blooded. Veal feems to be mod frequently fpoilt in this way. Perhaps that may in fome meafme be owing to the practice of carrying calves from a great distance to market, by which means their tender flefh is bruifed, and many of their veffels burft. No people in the world eat fuch quantities of ani- mal food as the EngliSh, which is one reafon why they are fo generally tainted with the fcurvy and its numerous train of confequences, indigeftion, low fpirits, hypochondriacifm, &c. Animal food was furely defigned for man, and, with a proper mixture of vegetables, it will be found the moft wholefome; but to gorge beef, mutton, pork, fifh, and fowl, twice or thrice a day, is certainly too much. All who 6F ALIMENT. 67 who value health ought to be contented with making one meal of flefh in the twenty-four hours, and this ought to confift of one kind only. The moft obftinate fcurvy has often been cured by a vegetable diet'; nay, milk alone will frequently do more in that difeafe than any medicine. Hence it is evident, that if vegetables and milk were mere ufed in diet, we fhould have lefs fcurvy, and like- wife fewer putrid and inflammatory fevers. ' FreSh vegetables, indeed, come to be daily more ufed in diet; this laudable practice we hope will continue to gain ground. Our aliment ought neither to be too moift nor too dry. Moift aliment relaxes the folids, and ren- ders the body feeble. Thus we fee females, who live much on tea and other watery diet, generally become weak, and unable to digeft folid food : hence proceed hyfterics, and all their dreadful con- fequences. On the other hand, food that is too dry, renders the folids in a manner rigid, and the hu- mors vifcid, which difpofes the body to inflamma- tory fevers, fcurvies, and the like. Much has been faid on the ill effects of tea in diet. They are, no doubt, numerous; but they proceed rather from the imprudent ufe of it, than from any bad qualities in the tea itfelf. Tea is now the uni- verfal breakfaft in Great Britain; but the morning is furely the moft improper time of the day for drink- ing it. Moft delicate perfons, who, by the bye, are the greateft tea-drinkers, cannot eat any thing in the morning. If fuch perfons, after fafting ten or twelve hours, drink four or five cups of tea with- out eating almoft any bread, it muft hurt them. Good tea, taken in moderate quantity, not too ftrong, nor too hot, nor drank upon an empty Sto- mach, will feldom do harm ; but it it be bad, which F 2 is 63 OF ALIMENT. is often the cafe, or fubflituted in the room of folic! bod, it muft have many ill effects. The arts of cookery render many things unwhole- fome, which are not fo in thejr own nature. By jumbling together a number of different ingredients, in order to make a poignant fauce, or rich foup, the compofition proves almoft a poifon. All high feafoning, pickles, &c. are only incentives to lux- ury, and never fail to hurt the Stomach. It were well for mankind, if cookery, as an art, were en- tirely prohibited. Plain roafting or boiling is all that the Stomach requires. Thefe alone are fulfil cient for people in health, and the fick have ftill lefs need of a cook. The liquid part of our aliment likewife claims our attention. Water is not only the bafis of moft li- quors, but alfo compofes a great part of our folid food. Good water muft therefore be of the greateft importance in diet. The beft water is that which is moft pure, and free from any mixture of foreign bodies. Water takes up parts of moft bodies with which it comes into contact; by this means it is often impregnated with metals or minerals of a hurtful or poifonous nature. Hence the inhabitants of fome hilly countries have peculiar difeafes, which, in all probability, proceed from the water, thus the people who live near the Alps in Switzerland, and the inhabitants of the Peak of Derby in Eng- land, have large tumors or wens on their necks. This difeafe is generally imputed ro the fnow water; but there is more reafon to believe it is owing to the minerals in the mountains through which the waters pafs. When water is impregnated with foreign bodies, k generally appears by its weight, colour, tafte, fmell, heat, or feme other fenfible quality. Onr bufinefe OF ALIMENT. 6q bufinefs therefore is to chufe fuch water, for com- mon ufe, as is lighteft, and without any particular colour, tafte, or fmell. In mpft places of Britain the inhabitants have it in their power to make choice of their water; and few things would contribute more to health than a due attention to this article. But mere indolence often induces people to make ufe ©f the water that is neareft to them, without confidering its qualities. Before water is brought into great towns, the ftricteft attention ought to be paid to its qualities, as many difeafes may be occafioned or aggravated by bad water; and when once it has been procured at a great expence, people are unwilling to give it up. The common methods of rendering water clear by filtration, or foft, by expofing it to the fun and air, &c. are fo generally known, that it is unnecef- fary to fpend time in explaining them. We Shall only, in general, advife all to avoid waters which Stagnate long in fmall lakes, ponds, or the like, as fuch waters often become putrid, by the corruption of animal and vegetable bodies with which they abound. Even cattle frequently fuffer by drinking, in dry feafons, water which has Stood long in fmall refervoirs, without being fupplied by fprings, or frefliened with fliowers. All wells ought to be kept clean, and to have a free communication with the air. As fermented liquors, notwithstanding they have been exclaimed againft by many w7riters, Still con- tinue to be the common drink of almoft every per- fon who can afford them ; we Shall rather endea- vour to aflift people in the choice of thefe liquors, than to pretend to condemn what cuftom has fo firmly eftablifhed. It is not the moderate ufe of found fermented liquors which hurts mankind : it is excefc, and ufing fuctoas are ill prepared or vitiated. F 3 • fermented 70 OF ALIMENT. Fermented liquors, which are too ftrong, hurt digeftion ; and the body is fo far from being Strength- ened by them, that it is weakened and relaxed. Many imagine that hard labour could not be fup. ported without drinking ftrong liquors : this is a very erroneous notion. Men who never tafte ftrong liquors are not only able to endure more fatiguft, but alfo live much longer, than thofe who ufe thett daily. But, fuppofe Strong liquors did enable a man to do more work, they muft neverthelefs wafte the powers of life, and occafion premature old age, they keep,up a conftant fever, which exhaufts the fpirits, inflames the blood, and difpofes the body to numberlefs difeafes. But fermented liquors may be too weak as well as too ftrong : when that is the cafe, they muft ei- ther be drank new, or they become foiir and dead: when fuch liquors are drank new, the fermentation not being over, they generate air in the bowels, and occafion flatulencies; and, when kept till ftale, they turn four on the Stomach, and hurt digeftidrJ. For this reafon, all malt liquors, cider, Sec. ought to be of fuch ftrength as to keep till they be ripe, and then they fliould be ufed. When fuch liquors are kept too long, though they fhould not become four, yet they generally contract a hardnefs, which renders them unwholefome. All families, who can, ought to prepare their own liquors. Since preparing and vending of li- quors became one of the moft general branches of bufinefs, every method has been tried to adulter- ate them. The great object both to the makers and venders of liquor is, to render it intoxicating, and give it the appearance of age. But it is well known that this may be done by other ingredients than thofe which ought to be ufed for making it Strong. It would be imprudent even to name thofe things which are OF ALIMENT. 7i are daily made ufe of to render liquors heady. Suf- fice it to fay, that the practice is very common, and that all the ingredients ufed for this purpofe are of a narcoticbr Stupefactive quality. But as all thefe drugs are poifonous, it is eafy to fee what muft be the con- fequence of their general ufe. Though they do not kill fuddenly, yet they hurt the nerves, relax and weaken the Stomach, and fpoil the digeftion. Were fermented liquors faithfully prepared, kept to a proper age, and ufed in moderation, they would prove real bleffings to mankind. But, while they are ill prepared, various ways adulterated, and taken to excef;, they muft have mauy pernicious ef- fects. We would recommend it to families, not only to prepare their own liquors, but likewife their bread. Bread is fo neceffary a part of diet, that too much care cannot be beft owed in order to have it found and wholefome. For this purpofe, it is not only neceffary that it be made of good grain, but like- wife properly prepared, and kept free from all un- wholefome ingredients. This, however, we have reafon to believe is not always the cafe with bread prepared by thofe who make a trade of vending it. Their-objcct is rather to pleafe the eye, than to con- fult the health. The beft bread is that which is nei- ther too coarfe nor too fine; w7ell fermented, and made of wheat flour, or rather of wheat and rye mixed together. Notwithftanding the general idea of the fuperiority of fermented bread, it is certain that unfetmented bread is more wholefome ; witncfs, the oaL«|fckes of the Scotch, the rice of the Eaft In- dians, tjfe indian meal of the Indians of America, the hard bifcuit of wheaten flour. To fpecify the different kinds of aliment, to ex- plain their nature and properties, and to point out iheir effects in different constitutions, would far ex- F 4 ceed 72 OF ALIMENT. ceed the limits of our defign. Inftead of a detail of this kind, which would not be generally understood, and of courfe li:tie attended to, we Shall only men- tion the following eafy rules with refpect to the choice of aliment. Perfons, whofe folids are weak and relaxed, ought to avoid all vif id food, or fuch things as are hard of digeftion. Their diet, however, ought to be nou- rishing ; and they fliould take fufficient exercife in the open air. Such as abound with blood fliould be fparing in the ufe of every thing that is highly nourishing, as fat meat, rich wines, ftrong ale, and fuch like. Their food fliould confift chiefly of bread and other vege- table fubftances ; and their drink ought to be water," whey, or fmall beer. Fat people fliould not eat freely of oily nourish- ing diet. They ought frequently to ufe horfe-radifh, garlic, and fuch things as promote perfpiration and urine. I heir drink fhould be water, coffee, tea, or the like ; and they ought to take much exercife and little fleep. Thofe who are too lean muft follow an oppofite courfe. •• Such as are troubled with acidities, or whofe food is apt to four on the Stomach, fliould live much on animal food ; and thofe who are afflicted with hot bilious eructations, ought to ufe a diet confuting chiefly of acid vegetables. People who are affected with the gout, low fpirits, hypochondriac or hyfteiic diforders, ought to avoid all flatulent food, every thing that is vifcid, or hard of digeftion, all falted or fmoke-dried provifions, and whatever is auftere, acid, or apt to turn four on the Stomach. Their food Should be light, fpare, cool, i-.nd of an opening nature. The OF ALIMENT. 73 The diet ought not only to be fuited to the age and conftitution, but alfo to the manner of life : a fedentary or ftudious perfon fliould live more fpa- ringly than one who labours hard without doors. Many kinds of food will nourifh a peafant very well which would be almoft indigeftible to a citizen ; and the latter would live upon a diet on which the for- mer would Starve. Diet ought not to be too uniform. The conftant ufe of one kind ol food might have fome bad effects. Nature teaches us this by the great variety of ali- ment which flie has provided for man, and likewife by giving him an appetite for different kinds of food. Thofe who labour under any particular difeafe, ought to avoid fuch aliments as have a tendency to increafe it: for example, a gouty perfon fliould not indulge in rich wines, ftrong foups, or gravies, and fliould avoid all acids. And thofe who are fcorbu- tic, fhould be foaring in the ufe of falted provifions, &c. In the firft period of life, our food ought to be light, but nourifliing, and frequently taken. Food that is folid, with a fufficient degree of tenacity, is moft proper for the ftate of manhood. The diet fuited to the laft period of life, when nature is upon the decline, approaches nearly to that of the firft. It fliould be lighter and more fucculent than that of vigorous age, and likewife more frequently taken. The beft general rule in the choice of diet is to eat fuch food as is agreeable to the tafte, and is found by experience to be eafy to the ftomach. No one who is honeft to himfelf need ever be deceived in this particular. It is not only neceffary for health that our diet be wholefome, but alfo that it be taken at regular pe- riods. Some imagine long fading will atone for ex- cefs; 74 OF ALIMENT. cefs ; but this, inftead of mending the matter, gene- rally makes it worfe. When the Stomach and in- teftines are over-diftended with food, they lofe their proper tone ; and, by long failing, they become weak, and inflated with wind. Thus, either glut- tony or fafting deftroys the powers of digeftion. The frequent repetition of aliment is not only ne- ceffary for repairing the continual wafte of our bo- dies, but likewife to keep the fluids found and fweet. Our humors, even in the moft healthy ftate, have a conftant tendency to putrefaction, which can only be prevented by frequent fupplies of frefli nouriSli- ment : when that is wanting too long, the putrefac- tion often proceeds fo far as to occafion very danger- ous fevers. From hence we may learn the neceffity of regular meals. No perfon can enjoy a good State of health, wtiofe veffels are either frequently over- charged, or the humors long deprived of frefh fup- plies of chyle. Long fafting is extremely hurtful to young peo- ple; it not only vitiates their humors, but prevents their growth. Nor is it lefs injurious to the aged. Many perlons, in the decline of life, are afH cted with wind: this complaint is not only increafed, but even rendered dangerous, and often fatal, by long fafting. Old people, when their ftomachs are empty, are fre- quently feized with giddinefs, head-achs, and fainti- nefs. Thefe complaints may generally be removed by a piece of bread and a glafs of wine, or by taking any other folid food ; which plainly points out the method of preventing them. It is more than probable, that many of the hid- den deaths, which happen in the advanced periods of life, are occafioned by fafting too long, as it ex- haufts the fpirits, and fills the bowels with wind ; we would therefore advife perfons, in the decline of life, never to allow their ftomachs to be too long empty. Many ■M OF ALIMENT. 7| Many people take nothing but a few cups of tea and a little bread, from nine o'clock at night till two or three next afternoon. Such may be faid to faft al- moft three fourths of their time. This can hardly fail to ruin the appetite, vitiate the humors, and fill the bowels with wind ; all which might be prevented by a folid breakfaft. It is a very common practice to eat a light break- faft and a heavy fupper. This cuftom ought to be reverfed. When people fup late, their fupper fliould be very light ; but the breakfaft ought always to be folid. If any one eats a light fupper, goes foon to bed, and rifes betimes in the morning, he will befure to find an appetite for his breakfaft, and he may freely indulge it. The ftrong and healthy do not indeed fuffer fo much from fafting as the weak and delicate ; but they run great hazard from its oppofite, viz. reple- tion. Many difeafes, efpecially fevers, are the effect of a plethora, or too great fulnefs of the veffels. Strong people, in high health, have generally a great quantity of blood and other humours. When thefe are fuddenly increafed, by an over-charge of rich and nourishing diet, the veffels become too much diftended, and obstructions and inflammations enfue. Hence fo many people are Seized with inflammatory and eruptive fevers after a feaft or a debauch. All great and hidden changes in diet are danger- ous. What the Stomach has been long accuftomed to digeft, though lefs wholefome, will agree better with it than food of a more Salutary nature which it has not been ufed to. When therefore a change becomes neceffary, it ought always to be made gra- dually; a hidden tranfition from a poor and low, to a rich and luxurious diet, or the contrary, might fo difturb the functions of the body, as to endanger health, or even to occafion death itfelf. When 16 OF AIR. When we recommend regularity in diet, we would not be understood as condemning every fmall devia- tion from it. It is next to impofSble for people at all times to avoid fome degree of excefs, and living too much by rule might make even the fmalleft devi- ation dangerous. It may therefore be prudent to vary a little, fometimes taking more, fometimes lefs, than the ufual quantity of meat and drink, provided always that a due regard be had to moderation. CHAP. IV. Of Air. Ui NWHOLESOME air is a very com- mon caufe of difeafes. Few perfons are aware of the danger arifing from it. People generally pay fome attention to what they eat and drink, but fel- dom regard what goes into the lungs, though the latter proves often more fuddenly fatal than the for- mer. Air, as well as water, takes up parts of moft bo- dies with which it comes in contact, and is often fo replenished with thofe of a noxious quality, as to oc- cafion immediate death. But fuch violent effects feldom happen, as people are generally on their guard againft them. The lefs perceptible influences of bad air prove more generally hurtful to mankind ; we Shall therefore endeavour to point out fome of thefe, and to Shew from whence the danger chiefly arifes. Wherever OF AIR. 77 Wherever great numbers of people are crowded into one place, if the air has not a free circulation, it foon becomes unwholefome. Hence it is that delicate perfons are fo apt to turn fick or faint in crowded churches, affemblies, or any place where the air is injured by breathing, fires, candles, or the like. In great cities fo many things tend to contami- nate the air, that it is no wonder it proves fo fatal to the inhabitants. The air in cities is not only breathed repeatedly over, but is likewife loaded with fulphur, fmoke, and other exhalations, befides the vapours continually arifing from innumerable putrid fubftances, as dunghills, flaughter-houfes, &c. All poffible care Should be taken to keep the ftreets of large towns open and wide, that the air may have a free current through them. They likewife ought to be kept very clean. Nothing tends mere to pol- lute and contaminate the air of a city than dirty ftreets. It is very common, in this country, to have church- yards in the middle of populous cities. Whether this be the effect of ancient fuperftition, or owing to the increafe of fuch towns, is a matter of. no confe- quence. Whatever gave rife to the cuftom, it is a bad one. It is habit alone, which reconciles us to thefe things ; by means of which the moft ridiculous, nay, pernicious cuftoms, often become facred *. Burying within churches, is a practice ftill more deteftable. the air in churches is feldom good, and the effluvia from putrid carcafes muft render it Still worfe. Churches are commonly old buildings * In mod eaftern countries, it was cuftomary to bury the dead at fome diftance from any town. As this practice ob. tained among the Jews, the Greeks, and alfo the Romans, it is ftrange that the weftern parts of Europe, fhould not have followed their example in a cuftcm fo truly laudable. with 78 OF AIR. with arched roofs. They are feldom open above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occafions that damp, mufty, unwholefome fmell which one feels upon entering a church, and renders it a very unfafe place for the weak and valetudinary. Thefe incon- veniences might, in a great meafure, be obviated, by prohibiting all perfons from burying within churches, by keeping them clean, and permitting a Stream of freSh air to pafs frequently through them, by opening oppofite doors and windows*. Wherever air Stagnates long, it becomes unwhole- fome. Hence the unhappy perfons confined in jails, not only contract malignant fevers themfelves, but often communicate them to others. Nor are many of the holes, for we cannot call them houfes, pof- feffed by the poor in great towns, much better than jails. Thefe low, dirty habitations, are the very lurking-places of bad air and contagious difeafes, Such as live in them feldom enjoy good health ; and their children commonly die young. In the choice of a houfe, thofe who have it in their power ought always to pay the greateft attention to open free air. The various methods, which luxury has invented to make houfes clofe and warm, contribute not a little to render them unwholefome. No houfe can be wholefome, unlefs the air has a free paffagc through it. For which reafon, houfes ought daily to be ventilated, by opening oppofite windows, and admitting a current of freSh air into every room. Beds, inftead of being made up as foon as people rife out of them, ought to be turned down, and expofed to the frcfli air, from the open windows, through the day. This would expel any noxious * One cannot pafs through a large church or cathedral, even in fummer, without feeling quite chilly. vapour O F A I R. 79 vapour, and could not fail to promote the health of the inhabitants. In hofpitals, jails, Ships, &c. where that cannot be conveniently done, ventilators fhould be ufed. The method of expelling foul, and introducing frefli air, by means of ventilators, is a moft falutary invention, and is indeed the moft ufeful of all our modern me- dical improvements. It is capable of univerfal appli- cation, and is fraught with numerous advantages, both to thofe in health and ficknefs. In all places, where numbers of people are crowded together, ventilation becomes abfolutely neceffary. Air which Stagnates in mines, wells, cellars, &c. is extremely noxious. That kind of air is to be avoided, as the moft deadly poifon. It often kills, ahnoft as quickly as lightning. For this reafon, people fliould be very cautious in opening cellars that have been long Shut, or going down into deep wells or pits, efpecially if they have heen kept clofe covered*. Many people, who have fplendid houfes, choofe to fleep in fmall apartments. This conduct is very imprudent. A bed-chamber ought always to be well aired; as it is generally occupied in the night only, when all doors and windows are fhut. If a fire be kept in it, the danger from a fmall room be- comes ftill greater. Numbers have been ftifled when afleep by a fire in a fmall apartment, which is always hurtful. Thofe who are obliged, on account of bufinefs, to fpend the day in clofe towns, ought, if poffible, to * We have daily accounts of perfons who lofe their lives, by going down into deep wells, and other places where the air ftagnates; all thefe accidents might be prevented, by only letting down a lighted candle before them, and flopping when they perceive it go out; yet this precaution, Ample as it is, is too feldom ufed. Sleep 80 O F A I R. Sleep in the country. Breathing free air inthe night, Will, in fome meafure, make up for the want of it through the day. This practice would have a greater. effect in preferving the health of citizens than is com- monly imagined. Delicate perfons ought, as much as poffible, to avoid the air of great towns. It is peculiarly hurtful} to the afthmatic and confumptive. Such perfons. Should avoid cities as they would the plague. The* hypochondriac are likewife much hurt by it. I havci often feen perfons fo much afflicted with this malady, while in town, that it feemed impoffible for them to live, whp, upon being removed to the country, were immediately relieved. The fame obfervation^ holds with regard to nervous and hyfteric women *. Many people, indeed, haVe it not in their power to change their fituation in queft of better air. All we; can fay to fuch perfons is, that they Should go as often abroad into the open air as they can, that they fhould admit freSh air frequently into their houfes, and take care to keep them very clean. It was neceffary in former times, for fafety, to furround cities, colleges, and even fingle houfes,' with high walls. Thefe, by obstructing the free, current of air, never fail to render fuch places damp and unwholefome. As fuch walls are now become ufelefs, they ought to be pulled down, and every method taken to admit a free paffage to the air.. Proper attention to Air and Cleanliness, woulpyj tend more to preferve the health of mankind, than. all the endeavours of the faculty. * And yet we often find thefe difeafes to prevail in the country, where a retired life gives rife to them. The beft rule in thefe cafes is, to ufe exercife, whether in town or country; and to exchange the one for the other, according to circum- ftances. Surrounding OF AIR. 81 Surrounding houfes too clofely with planting, or thick woods, likewife tends to render the air un- wholefome. Wood not only obftru&s the free cur- rent of the air, but fends forth great quantities of moift exhalations, which render it constantly damp. Wood is veiy agreeable at a proper distance from a haufe, but fhould never be planted too near it, efpe- cially in a flat country. Many of the gentlemen's feats in England are rendered very unwholefome, from the great quantity of wood which furrounds. them. Houfes fituated in low marShy countries, or near large lakes of ftagnating water, are likewife unwhole- fome. Waters which Stagnate, not only render the air damp, but load it with putrid exhalations, Which produce the moft dangerous and fatal difeafes. Thofe who are obliged to inhabit marfhy countries, ought to make choice of the drieft Situations they can find, and to the windward, as the failors fay, of any pond or marfh, to live generoufty, and to pay the ftricteft regard to cleanlinefs. If freSh air be neceffary for thofe in health, it is ftill more fo for the fick, who often lofe their lives for want of it. The notion that fick people muft be kept very hot, is fo common, that one can hardly enter the chamber where a patient lies without being ready to faint, by reafon of the hot fuffocating fmell. How this may affect the fick any one may judge. No medicine is fo beneficial to them as frefh air. It is the moft reviving of all cordials, if it be admi- niftered with prudence. We are not, however, to throw open doors and windows at random upon the fick. FreSh air is to be let into the chamber gradu- ally, and, if poffible, by opening the windows of fome other apartment. The air of a fick perfon's chamber may be greatly , freShened, and the patient much revived by fprink- G ling *e OF EXERCISE. ling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other ftrong vegetable acid. In places where numbers of fick are crowded into the fame houfe, or, which is often the cafe, into the fame apartment, the frequent admiffion of frefh air becomes abfolutcly neceffary. Infirmaries, hofpitals, &c. are often rendered fo noxious, for want of pro* per ventilation, that the fick run more hazard from them than from the difeafe. This is particularly the cafe when fevers, dyfenteries, and other infectious difeafes prevail. Phyficians, furgeons, and others who attend hof- pitals, ought, for their own fafety, to take care that they be properly ventilated. Such perfons as are obliged to fpend moft of their time amongft the fick, run a hazard of being themfelves infected when the air is bad. All hofpitals, and places of recep- tion for the fick, ought to have an open fituation, at fome dillance from any great town, and fuch patients as labour under any infectious difeafe ought never to be fuffered to come near the reft. CHAP. V. Of Exercife. lvlANY people look upon the neceflity man is under of earning his bread by labour, as a curfe. Be this as it may, it is evident from the Structure of the body, that exercife is not lefs necef- fary than food for the prefervation of health: thofe whom poverty obliges to labour for daily bread, are not only the moft healthy, but generally the moft happy OF EXERCISE. 33 happy part of mankind. Induftry feldom fails to place them above want, and activity ferves them in- stead of phytic. This is peculiarly the cafe with thofe who live by the culture of the ground. The great increafe of inhabitants i:i infant colonics, and the longevity of fuch as follow agriculture every where, evidently prove it to be the mcft healthful as well as the moft ufeful employment. The love of activity Shows itfelf very early in man. So ftrong is this principle, that an healthy youth can- not be reftrained from exercife, even by the fear of punifhment. Our love of motion is furely a ftrong proof of its utility- Nature implants no difpofition in vain. It feems to be a general law throughout the" whole animal creation, that no creature, without exercife, fliould enjoy health, or be able to find fub- fiftence. Every creature, except man, takes as much of it as is neceffary. He alone, and fuch animals as are under his direction, deviate from this original law, and they fuffer accordingly. Inactivity feldom fails to induce an univerfal relax- ation of the folids, which difpofes the body to innu- merable difeafes. When the folids are relaxed, nei- ther the digeftion, nor any cf the fecretions, can be duly performed. In this cafe the worft confequences muft enfue. How can perfons, who loll all day in eafy chairs, and fleep all night on beds of down, fail to be relaxed? Nor do fuch greatly mend the matter, who never Stir abroad but in a coach, fedan, or fuch like. Thefe elegant pieces of luxury are become fo common, that the inhabitants of great towns feem to be in fome danger of lofing the ufe of their limbs alto- gether. It is now below any one to walk, who can af- ford to be carried. How ridiculous would it feem, to a perfon unacquainted with modern luxury, to behold the young and healthy fwinging along en the Shoul- ders of their fellow-creatures! or to fee a fat car- \ &+ OF EXERCISE. cafe, over-run with difeafes. occafioned by inacti- vity, dragged throygh the Streets by half a dozeo j horSes *! Glandular obstructions, now fo common, gene- rally proceed from inactivity. Thefe are the moft Gbftinate of maladies. So long as the liver, kid- neys, and other glands, duly perform their func- tions, health is Seldom impaired; but, when they. ■ fail, nothing can reftore it. Exercife is almoft the only cure we know for glandular obstructions; in- deed, it does not always fucceed as a remedy ; but there is reafon to believe that it would feldom foil to prevent thefe complai.nts, were it ufed in due time. One thing is certain, that, amongft thofQ who take fufficient exercife, glandular difeafes iyrq very little known ; whereas the indolent and inactive are feldom free from thern. Weak nerves are the conftant companions of in- activity. Nothing but exercife and open air. can brace and Strengthen the nerves, or prevent the end- lefs train of difeafes which proceed from, a relaxed ftate of thefe organs. We feldom hear the active or laborious complain of nervous difeafes ! thefe are referved for the fons of eafe and affluence. Mafty have been completely cured of thefe diforders by being reduced, from a ftate of opulence, to. JabQMF ; for th,eir daily bread. This plainly points, out the fources from whence nervous difeafes flow9 and the means by which they may be prevented. ^ it is not neceffity, but fafhion, which makes the ufe of carriages fo common. There are many people who haye not exercife enough to keep their humors whplef me, who yet dare not venture to make a'vifit to their next neighbours, but in a coach or fedan, left they fhould be looked down upon. Strange i hat men fhould be fuch fools as to be laughed out of the ufe (f their limbs, or to threw away their health, in order to gra- tify a iHete cf vanity, or to comply with a ridiculous fafhion) it OF EXERCISE. fcc tt is abfolutely impoffible to enjoy health, where the perforation is not duly Carried on ; but that can never be the cafe where exercife is neglected. When the matter which ought to be thrown off by perfpi- ration is retained in the body, it vitiates the hu ■ mor?, and occafions the gout, fevers, rheumatifrti, &c. Exercife alone would prevent many of thofe difeafes Which cannot be cured, and would remove others Where medicine proves ineffectual. A late author*, in his excellent treatife on health, fays, that the weak and valetudinary ought to make exercife a part of their religion. We would recom- mend this, not only to the weak and valetudinary, but to all whofe bufinefs does not oblige them to take fufficient exercife, as fedentary artificers-}-, Shop- keepers, ftudious perfons, &c. Such ought to ufe exercife as regularly as they take food. This might generally be done without any interruption to bufi- nefs or real lofs of time. No piece of indolence hurts the health more than the modern cuftom of lying a-bed too lcrtg in a morning. This is the general practice in great * Cheyne. f Sedentary occupations ought chiefly to be followed by women. They bear confinement better than men, and are fitter for every kind of bufinefs which does not require much ftrength. It is ridiculous enough to fee a lufty fellow making funs, needles, or watch wheels, while many of the laborious parts of hufbandry are carried on by the other fex. The fail is, we want men for laborious f mployments, while one half of the other fex are tendered ufelefs for want of occupations fuited to their ftrength, &c. Were girls bred to mechanical em- ploymentsi. we fhould not fes filch numbers of them prollitute themfelves for bread, nor find fuch a want of men for the im- portant purpofes of navigation, agriculture, &c. An eminent (ilk manufacturer told rnc, that he found women anfwer better for that bufinefs, than men; and that he had lately taken a great many girls apprentices as filk-weavers. I hope his ex- ample will be followed by many others. G 3 towns- 86 OF EXERCISE. towns. The inhabitants cf cities feldom rife before eight or nine o'clock ; but the morning is undoubt- j ediy the beft time for exercife, while the Stomach is empty, and the body refreftud with fleep. Befides, the morning air braces and Strengthens the nerves, and, in fome meafure, anfwers the purpofe of a cold bath. Let any one who has been accuftomed to lie a-bed till eight or nine o'clock, rife by fix or feven, fpend a couple of hours in walking riding, or any active diverfion without doors, and he will find his fpirits cheerful and ferene through the day, his appetite keen, and his body braced and Strengthened. Cuftom foon renders early rifing agreeable, and nothing contributes more to the prefervation of health *. The inactive are continually complaining of pains of the Stomach, flatulencies, indigeftions, &c. Thefe complaints, which pave the way to many others, are not to be removed by medicines. They can only be cured by a vigorous courfe of exercife, to which in- deed they feldom fail to yield. Exercife, if poffible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercifing the body within doors, as the dumb bell, dancing, fencing, &:c. It is not neceffary to adhere Strictly to any par- ticular kind of exercife. The beft way is to take them by turns, and to ufe that longeft which is moft fuitable to the Strength and conftitution. Thofe kinds of exercife which give action to moft of the bodily organs, are always to be preferred,* as walking, run- ning, riding, digging, fwimming, and fuch like. * Thofe who live in the country, however, in the neigh- bourhood of marfhy places, efpecially, ought never to be out of doors, before fun-rife nor after fun-fet- It OF EXERCISE. 87 It is much to be regretted, that active and manly diveifions are now fo liilje practifed. Diverfions make people take more exercife than they otherwife would do, and are of the greateft fcrvice to fuch as are not under the neceffity of labouring for their bread. As active diverfions lofe ground, thofe of a fedentary kind feem to prevail. Sedentary diverfions are of no other ufe but to confume time. Inftead of relieving the mind, they often require more thought than either ftudy or bufinef. Every thing that induces people to fit Still, unltfs it be fome ne- ceffary employment, ought to be avoided. The diverfions which afford the beft exercife are, hunting, Shooting, playing at cricket, hand-ball, golff*, &c. Thefe exercife the limbs, promote per- fpiration, and the other fecretions. They likewife ftrengthen the lungs, and give firmnefs and agility to the whole body. Such as can, ought to fpend twTo or three hours a-day on horfeback; thofe who cannot ride, fhould employ the fame time in walking. Exercife fliould never be continued too long. Over-fatigue prevents the benefit of exercife, and, inftead of Strengthening the body, tends to weaken it. Every man Should lay himfelf under fome fort of neceffity to take exercife. Indolence, like other vices when indulged, gains ground, and at length becomes agreeable. Hence many who were fond of exercife in the early part of life, become quite averfe to it afterwards. This is the cafe of moft hypochondriac and gouty people, which renders their difeafes, in a great meafure, incurable. * Golff is a diverfion very common in North Britain. It is well calculated for exeicihng the body, and may always be taken in fuch moderation, as neither to over-heat ncr fatigue. It has greatly the preference over ciicket, tennis, or any of thofe games which cannot be played without violence. G 4 In 88 OF EXERCISE. In fome countries, laws have been made, dbliging tfvery man, of whatever rank, to learn fome mecha- nical' employment. Whether fuch laws were defign- ed for the prefervation of health, or the encourage- ment of manufacture, is a queftion of no importance. Certain it is, that if gentlemen were frequently to amufe and exercife themfelves in this way, it might have many good effects. They would at leaft derive as much honour from a few mafterly fpecimens of their own workmanlhip, as from the character of having ruined moft of their companions by gaming or drinking. Befides, men of lelfure, by applying themfelves to the mechanical arts, might improve-; them to the great benefit of fociety. Indolence not only occafions difeafed, and renders men nfelefs to fociety, but promote* all manner of vice. To fay a man is idle, is little better than to call him vicious. The mind, if not engaged in fome ufeful purfuit, is conftantly in queft of ideal pleafures, or impreffed with the apprehenfton of fome imaginary evil. From thefe fources proceed moft of the miferies of mankind. Certainly mari was never intended to be idle. Inactivity frustrates the very defign of his creation; Whereas an active life is the beft guardian of virtue* and the greateft prefervative of health. CHAP. OF SLEEP AND CLOTHING. 89 CHAP. VI. Of Sleep and Clothing. »3LEEP, as well as diet, ought to be du- ly regulated. Too little fleep weakens the nerves, exhaufts the fpirits, and occafions difeafes; and too much renders the mind dull, the body grofs, and dif- pofes to apoplexies, lethargies, and other complaints of a fimilar nature, A medium ought therefore to be dbferved; but this is not eafy to fix. Children require more fleep than grown perfons, the labori- ous than the idle, and fuch as eat and drink freely, than thofe who live abftemioufly. Befides, the real quantity of fleep cannot be meafured by time; as one perfon will be more refrefhed by five or fix hours fleep, than another by eight or ten. Children may always be allowed to take as much fleep as they pleafe, but, for adults, fix or feven hours is certainly fufficient, and no one ought to exceed eight. Thofe who lie a bed more than eight hours may flumber, but thejr can hardly be faid to fleep; fuch generally tofs and dream aWay the fore- part of the night, fink to reft towards morning, and dofe till noon. The beft way to make fleep found and refrefhing is to rife betimes. The cuftom of ly- ing a-bed for nine or ten hour*, not only makes the fleep lefs refrefhing, but relaxes the folids, and gteatly weakens the conftitution. Nature points out night as the proper feafon for fleep. Nothing more certainly destroys the consti- tution than night-Watching. It is great pity that a practice f© deftructivfe to health Should be fo much in fafhion. 9 a OF SLEEP AND CLOTHING. fafhion. How quickly the want of reft in due feafon will blaft the moft blooming complexion, or ruin the beft conftitution, is evident from the ghaftly coun- tenances of thofe who, as the phrafe is, turn day into night and night into day. To make fleep refrefhing the following things are requisite: Firft, to take fufficient exercife in the open air, to avoid ftrong tea or coffee; next, to eat a light fupper; and laftly, to lie down with a mind as cheerful and ferene as poffible. It is certain that too much exercife will prevent fleep as well as too little. We feldom however hear the active and laborious complain of reftlefs nights.1 It is the indolent and flothful who generally have thefe complaints. Is it any wonder that a bed of down fliould not be refrefhing to a perfon who fits all day in an eafy chair? A great part of the pleafure cf life confifts in alternate reft and motion; but they who neglect the latter can never relifli the former. The labourer enjoys more true luxury in plain food and found fleep, than is to be found in Sumptuous tables and downy pillows, where exercife is want- ing.^ That light fuppers caufe found fleep is true even to a proverb. Many perfons, if they exceed the leaft at that meal, are Sure to have uneafy nights; and, if they fall afleep, the load and oppreffion on their llomach and fpirits occafion frightful dreams, broken and dilturbed rcpofe, the night-mare, &c. Were the fame perfons to go to bed with a light fupper, or fit up till that meal was pretty well di- geftcd, they would enjoy found fleep, and rife re- freshed and cheerful. There are indeed fome peor pie who cannot fleep unltfs they have eat fome folid food at night, but this does not imply the neceffity of an heavy fupper; befides, thefe are generally per- fons who have accuftomed themfelves to this method, and OF SLEEP AND CLOTHING. 91 and who do not,take a fufficient quantity of folid food and exercife. Nothing more certainly difturbs our repofe than anxiety. When the mind is not at eafe, one feldom enjoys found fleep. The greateft of human bleffings flies the wretched, and vifits the happy, the chearful, and the gay. This is a fufficient reafon why every man fhould endeavour to be as eafy in his mind as poffible when he goes to reft. Many, by indulging grief and anxious thought, have baniShed found Sleep fo long, that they could never afterwards enjoy it. Sleep, when taken in the fore-part of the night is generally reckoned moft refrefhing. Whether this be the effect of habit or not, is hard to fay; but as moft people are accuftomed to go early to bed when young, it may be prefumed that fleep, at this feafon, will prove moft refrefhing to them ever after. Whether the fore part of the night be beft for fleep or not, furely the fore-part of the day is fitteft both for bufinefs and amufement. I hardly ever knew an early rifer who did not enjoy a good ftate of hearth*. Of Clothing. The clothing ought to be fuited to the climate. Cuftom has, no doubt, a very great influence on this article; but no cuftom can ever change the nature * Men of every occupation, and in every fituation cf life, have lived to a good old age; nay fome have enjoyed this blef- fmg whofe plan of living was by no means regular: but it con- fifts with obfervation, that all very old men have been early rifers. This is the only circumftance attending longevity to which I never knew an exception. It may be an unpopular idea, but I believe i: to be a juft one, tbat fleeping on feather beds is very prejudicial to the health—a good matrafs would be fufficiently foft for the moft delicate, and is indifpenfably neceffary in cenftmption, gravel, and many other difeafes. of 9$ OF SLEEP AND CLOTHING. of tliiiigS fo far, as to render the fame clothing fir for an inhabitant of Nova Zembia and the iflarid of jartlaica. It is not iiideCd neceffary to obferve an exact proportion betWeefi the quantity of clothes We Wear, and the degree of latitude which we inhabit; but, at the fame time, proper attention ought to be j?aid to it, as Well as to the opennefs of the country, the frequency and violence of florins, &c. hi ybiith, While the blood is hot and the peflpU fati6ri free!, it is lefs neceffary to cover the body With a'great quantity of clothes; but, in the decline of life, when, the ffeiri becomes rigid and the humors hidrfc cool, the clothing Should be iricreafcd. Many difeafes ih the latter period Of life proceed from a defect of perfpiteitibri: thefe may, in fome meafure, be prevented by a fuitable addition to the clothing, Or by Wearing fuch as are better calculated for pro- moting the difcharge from the flan, as clothes made ofcottbtl, flannel, &c. * The clothirig ought likewife to he fuited to the feafon Of the year. Clothirig may be Warm enough for fummer, which is by no means fuflicient for win- ter. The greateft caution* hoWever, is neceffary in making thefe changes. We ought neither to put off \ our winter clbthes tOo foon, ribr to Wear our ftim- irier ones too long. In this cburitry, the winter often fets ih verjr early with great rigdtir, arid We have frequently cold weather even after the com- mencement of the fiimmer months. It Would like- wife be prudent t\6t to make the change all at brice, but to do it gradually ; and indeed the changes of apparel in this climate ought to be very inconfider- * The ufe 6f flannel fhif ts has become very general in Ame- rica: They fliould be changed once or twice a-week—itfo one heed be afraid of becoming too delicate from the ufe of them. —They have" cjuite a contrary effect. able, OF SLEEP AND CLOTHING. ^ able, efpecially among thofe who have paffed the meridian of life*. Clothes often become hurtful by their being made fubfervient to the purpofes of pride or vanity. Man- kind, in all ages, feem to have considered clothes in this view, accordingly .their fafhion and figure have been continually varying, with very little regard ei- ther to health, the climate, or conveniency: a far- thingale, for example, may be very neceffary in hot fouthern climates, but furely nothing can be more ridiculous ia the cold regions of the north. Even the human lhape is often attempted to be mended by drefs, and thofe, who know no better, be- lieve that mankind would be monfters without its af- fiftance. All attempts of this nature are highly per- nicious. The moft destructive of them in this coun* try is that of Squeezing the ftomach and bowels into as narrow a compafs as poffible, to procure, what is falfely called, a fine fhape. By this practice the action of the ftomach and bowels, the motion of the heart and lungs, and almoft all the vital functions, are obstructed. Hence proceed indigeftions, fyn- copes, or fainting fits, coughs, confumptions of the lungs, and other complaints fo. common among fe- males. The feet likewife often fuffer by preffure. How a fmall foot came to be reckoned genteel, I will nor * That colds kill more than plages, is an old obfervation; and, with regard to this country, it-hoWs ftrict-ly t^ue. Every perfon of difcemment, however, will perceive, that moft of the colds wjiich prove fo deftru&ive t;o the inhabitants of Britain, and we* may add in North America, arc owing to their imprudence in changing clothes. A few warm days in March ox April indu.ce them to throw off! their winter garments, without confidering that our moft penetrating colds generally happen in the fpring. It is often neceffary to change our clothing feveraltunes in r^he day. pretend 94 OF SLEEP AND CLOTHING pretend to fay ; but certain it is, that this notion has rendered many perfons lame. Almoft nine-tenths of mankind are troubled with corns : a difeafe that is feldom or never occafioned but by ftrait Shoes. Corns are not only very troublefome, but by reudering people unable to walk, they may likewife be conti. dered as the remote caufe of other difeafes *. The fize and figure of the fhoe 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 eafy as that of the fingers; yet few per- fons in the advanced periods of life are able to make any ufe of their toes. They are generally, by nar- row Shoes, fqueezed all of a heap, and often laid over one another in fuch a manner as to be rendered al- together incapable of motion. Nor is the high heel lefs hurtful than the narrow toe. A lady may feem taller for walking on her tiptoes, but fhe will never walk well in this manner. It Strains her joints, dis- torts her limbs, makes her Stoop, and utterly deftroys all her eafe and gracefulnefs of motion : it is entirely owing to fhoes with high heels and narrow toes, that not one female in ten can be faid to walk well. In fixing on the clothes, due care fhould be taken to avoid all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free mo- tion and ufe of the parts about which they are bound, but likewife obftruet the circulation of the blood, which prevents the equal nourishment and growth of thefe parts, and occafions various difeafes. Tight bandages about the neck, as Stocks, cravats, necklaces, &c. are extremely dangerous. They ob- * We often fee perfons who are rendered quite lame by the nails of their toe-s having grown into the flefh, and frequently hear of mortifications proceeding from this caufe. All thefe and many other inconveniencies attending the feet, muft be imputed folely to the uf; of Short and ftrait fhoei. Struct OF SLEEP AND CLOTHING. j- Struct the blood in its courfe from the brain, by which means headachs, vertigoes, apoplexies, and other fatal difeafes are often occafioned. The perfection of drefs is to be eafy and clean. Nothing can be more ridiculous, than for any one to make himfelf a Have to fine clothes. Such an one, and many fuch there are, would rather remain as fixt as a Statue from morning till night, than difcom- pofe a fingle hair, or alter the pofition of a pin. Were we to recommend any particular pattern for drefs, it would be that which is worn by the people called Quakers. They are always neat, clean, and often elegant, without any thing fuperfiuous. What others lay out upon tawdry laces, ruffles, snd rib- bands, they beftow uponfuperior cleanlinefs. Finery is only the affectation of drefs, and very often covers a great deal of dirt. We Shall only add, with regard to clothing, that it ought, not only to be fuited to the climate, the feafon of the year, and the period of life, but like- wife to the temperature and conftitution. Robuft perfons are able to endure either cold or heat better than the delicate ; confequently may be lefs atten- tive lo their clothing. But the precife quantity of clothes neceffary for any perfon cannot be deter- mined by reafoning. It is entirely a matter cf expe- rience, and every man is the beft judge for himfelf what quantity of clothes is neceffary to keep him warm *. * The celebrated Boerhaave ufed to fay, that no body fuf- fered by cold fave fools and beggars ; the latter not being able to procure clothes, and the former not having fenfe to wear them} Be this as it may, I can with the ftricled truth declare, that in many cafes where the powers of medicine had been tried in vain, I have cured the patient by recommending thick fhces,, a flannel waiftcoat and drawers, a pair of under flockings, or a flannel petticoat, to be worn during the cold feafon at leait. I have known feveral inftances cf f. re throat from thin fhoes. CHAP. 9* OF INTEMPERANCE. CHAP. VII. Of Intemperance* A MODERN author * obferves, that; temperance and exercife are the two beft phyficiaw in the world. Temperance may juftly be called the parent of health ; yet numbers of mankind act as if they thought difeafes and death too flow in their progrefs, and, by intemperance arid debauch, feem, as it were, to folicit their approach. The danger of intemperance appears from the very construction of the human body. Health de- pends on that ftate of the folids and fluids which fits them for the due performance of the vital functions; and, while thefe go, regularly on, we are found ancj well; but whatever difturbs them, neceffarily npanys health. Intemperance never fails to difordeif the whole animal ceconomy ; it hurts the digeft ion, re- laxes the nerves, renders the different fecietions, irre* gular, vitiates the humours, and occafions numberlefs; difeafes. The analogy between the nourishment of plants and animals affords a Striking proof of the danger of intemperance. Moifture and manure greatly pro- mote vegetation ; yet an over quantity of either will entirely deftroy it. The beft things become hurt- ful, nay definitive, when carried to excefs. Hence, we barn, that the high.eft degree of human wifdom confifts in regulating our appetites and pafjfions fo as to avoid all extremes. It is that chiefly which en- RoufTeau.. 2 titles OF INTEMPERANCE. tf titles us to the character of rational beings. The flave of appetite will ever be the difgrace of human nature. The Author of Nature hath endued us with vari- ous paffions, for the propagation of the fpecies, the prefervation of the individual, &c. Intemperance is the abufe of thefe paffions ; and moderation confifts in the proper regulation of them. Men, not con- tented- with fatisfying the fimple calls cf Nature, create artificial wants, and are perpetually in fearch of fomething that may gratify them ; but imaginary wants can never.be gratified. Nature is content with little ; but luxury knows no bounds. Hence the epicure, the-drunkard, and the debauchee, fel- dom Stop in their career, till their money or their conftitution fails: then, indeed, :they generally fee their error, when too hue. It is impoflible to lay down fixt rules with regard to diet, on account, of the different constitutions of mankind. The moft ignorant perfon, however, cer- tainly knows what is meant by excefs; and it, is in the pqwer of every man, if he choofes, to avoid it. The great rule of diet is to ftudy. fimplicity. Na- ture delights in the moft plain and fimple food, and every animal, except -man, follows her dictates. Man, alone, riots at large, and ranfacks the whole creation in queft of luxuries, to his own definition. An elegant, writer * of the,laft age fpeaks thus of in- temperance in diet: " For my part, when I behold " a fafhionable table fet out in all its magnificence, " I fancy that I fee gouts and dropfies, fevers and " lethargies, with other innumerable diftempers, " lying in ambufcade among the dilhes." Nor is intemperance in other things lefs destruc- tive than in diet. How quickly does the immode- * Addifon. H rate 9B OF INTEMPERANCE. * rate purfuit of carnal pleafures, or the abufe of in- toxicating liquors, ruin the beft conftitution ! Indeed thefe vices generally go hand and hand. Hence it is that we fo often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with difeafes, and baftening with fwift pace to an untimely grave. Did men reflect on the painful difeafes and premature deaths, which are daily occafioned by intemperance, it would be fuf- ficient to make them Shrink back with horror from the indulgence even of their darling pleafures. Intemperance does not hurt its votaries alone ; the innocent too often feel the direful effects of it. How many wretched orphans are to be feen embra- cing dunghills, whofe parents, regardlefs of the fu- ture, fpent in riot and debauch what might have ferved to bring up their offspring in a decent man- ner ? How often do we behold the miferable mother, wTith. her helplefs infants, pining in want, while the cruel father is indulging his infatiate appetites? Families are not only reduced to mifery, but even extirpated, by intemperance. Nothing tends fo much to prevent propagation, and to Shorten the lives of children, as the intemperance of parents. The poor man who labours all day, .and at night lies down contented with his humble fare, can boaft a numerous offspring, while his pampered lord, funk in eafe and luxury, often languifhes without an heir to his ample fortunes. Even States and empires feel the influence of intemperance, and rife or fall as it prevails. Inftead of mentioning the different kinds of in- temperance, and pointing out their influence upon health, we fhall only, by way of example, make a few obfervations on one particular fpecies of that vice, viz. the abufe of intoxicating liquors. Every OF INTEMPERANCE. 99k Every act of intoxication puts Nature to the ex- pence of a fever, in order to difcharge the poifonous draught. When this is repeated almoft every day, it is eafy to forefee the confequences. That confti- tution muft be ftrong indeed, which is able long to hold out under a daily fever! but fevers occafioned by drinking do not always go off in a day ; they fre- quently end in an inflammation of the breaft, liver, or brain, and produce fatal effects. Though the drunkard fhould not fall by an acute difeafe, he feldom efcapes thofe of a chronic kind. Intoxicating liquors, when ufed to excefs, weaken the bowels, and fpoil the digeftion ; they deftroy the power of the nerves, and occafion paralytic and con- vulfive diforders; they likewife heat and inflame the blood, deftroy its balfamic quality, render it unfit for circulation, and the nourifhment of the body. Hence obstructions, atrophies, dropfies, and con- fumptions of the lungs. Thefe are the common ways in which drunkards make their exit. Difeafes of this kind, when brought on by hard drinking, fel- dom admit of a cure *. Many people injure their health by drinking, who feldom get drunk. The continual habit of foaking, as it is called, though its effects be not fo violent, is not lefs pernicious. When the veffels are kept con- stantly full and upon the ftretch, the different digef- tions can neither be duly performed, nor the hu- mors properly prepared. Hence moft people of this character are afflicted with the gout, the gravel, fores in the legs, &c. If thefe diforders do not ap- pear, they are feized with low fpirits, hypochondri- acal affections, and other fymptoms of indigeftion. * It is much to be feared, that phyficians have too often tn- cautioufly made drunkards of their patients, by prefcribing fpirits, or brandy and water, for their drink; which, however, are never neceffary. H 2 Confump- too OF INTEMPERANCE. Confumptions are now fo common* that it is thought one-tenth of the inhabitants of great towns die of that difeafe. Hard drinkingjs no doubt one of the caufes to which we muft impute the increafe of confumptions. The great quantities of ftrong vif- cid malt liquor drank by the common people of Eng- land, cannot fail to render the bloocVfizy and unfit for circulation ; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthifical : nor is that to be wondered at, confidering the glutinous and al- moft indigeftible nature of ftrong ale. Thofe who drink ardent fpirits or ftrong wines run ftill greater hazard ; thefe liquors heat and inflame the blood, and tear the tender veffels of the lungs to pieces; yet fo great is the confumption of them in this country, that one would almoft be induced to think that the inhabitants lived upon them *. The habit of drinking proceeds frequently from misfortunes in life. The miferable fly to it for re- lief. It affords them indeed a temporary eafe. But, alas! this folace is fhort-lived ; and when it is over, the fpirits fink as much below their ufual tone as they had before been raifed above it. Hence a re- petition of the dofe becomes neceffary, and every frefh dofe makes way for another, till the unhappy wretch becomes a flave to the bottle, and at length falls a facrifice to what at firft perhaps was taken only as a medicine. No man is fo dejected as the * We may form feme notion of the immenfe quantity of ar- dent fpirits confumed in Great Britain from this circumftance, that in the city of Edinburgh and its environs, befides the great quantity of foreign fpirits duly entered, and the ftill greater quantity which is fuppofed to be fmuggled, it is computed that above two thoufand private ftiils are conftantly employed in preparing a poifonous liquor called Molaffes. The common people have got fo univerfally into the habit of drinking this bafe fpirit, that when a porter or labourer is feen reeling along tke ftreets, they fay, he has got molajfed. drunkard OF INTEMPERANCE. 10! clrankard when his debauch is gone off. Hence it is, that thofe who have the greateft flow of fpirits while the gtafs circulates freely, are of all others the moft melancholy when fober, and often put an end to their own miferable existence in a fit of fpleen or ill humor. Drunkenness not only proves deftructive to health, but likewife to the faculties of the mind, *t is ftrange that creatures who value themfelves on account of a fuperior degree of reafon to that of brutes, fliould take pleafure in finking fo far below them. Were fuch as voluntarily deprive themfelves of the ufe of reafon, to continue ever after in that condition, it would feem but a juft punifhment. Though this be not the confequence of one act of intoxication, it feldom fails to fucceed a courfe of it. By a habit of drinking, the greateft genius is often reduced to a mere idiot *. Intoxication is peculiarly hurtful to young perfons. It heats their blood, impairs their ftrength, and ob-. ftructs their growth; befides, the frequent ufe of ftrong liquors in the early part of life deftroys any benefit that might arife from them afterwards. Thofe 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. * It is amazing that our improvements in arts, learning, and politenefs, have not put the barbarous cuftom of drinking to excefs out of fafhion. It is indeed lefs common in South Bri- tain than it was formerly ; but it ftill prevails very much in the North, where this relic of barbarity is miftaken for hofpitality. Th.rre no man is fuppofed to entertain his guefts well, who does not make them drunk. Forcing people to drink, is certainly the greateft piece of uidenefs that any man can be guilty of. Suppofed manlinefs, complaifance, or meer good nature, may induce a man to take his glafs, if urged to it, at a time when he might as well take poifon. The cultom of drinking to excefs has long been out of fafhion in France ; and, as it begins to lofe ground among the politer part of the Englifb, we hope it will foon be banifhed from every part of this ifland. H 3 Drunk- to* OF CLEANLINESS. Drunkennefs is not only in itfelf a moft abomina- ble vice, but is an inducement to many others. There is hardly any crime fo horrid that the drunk- ard will not perpetrate for the love of liquor. We have known mothers fell their children's clothes, the food that they would have eat, and afterwards even the infants themfelves, in order to purchafe the ac- curfed draught. A Very abfurd argument in favour of fpirits has been ufed, from obferving, that fome perfons who made a very free ufe of them have lived to old age: we fometimes fee an old foldier, and an old failor ; but no one will fuppofe that a military, or a fea-faring life, are favourable to longevity. CHAP. VIII. Of Cleanlinefs. -I HE want of cleanlinefs is a fault which admits of no excufe. Where water can be had for nothing, it is furely in the power of every perfon to be clean. The continual difcharge from our bodies by perfpiration, renders frequent change of apparel neceffary. Changing apparel greatly promotes the fecretion from the Skin, fo neceffary for health. When that matter, which ought to be carried off by perfpiration, is either retained in the body, or re- forbed from dirty clothes, it muft occafion difeafes. Difeafes of the fkin are, in a great meafure, owing to want of cleanlinefs. They may indeed be caught by infection, or brought on by poor living, unwhole- some food, &c. but they will feldom continue long where OF CLEANLINESS. 103 where cleanlinefs prevails. To the fame caufe muft we impute the various kinds of vermin which infeft the human body, houfes, &c. Thefe may always be banifhed by cleanlinefs alone, and wherever they abound, we have reafon to believe it is neglected. One common caufe of malignant fevers, is the want of cleanlinefs. Thefe fevers commonly begin among the inhabitants of clofe dirty houfes, who breathe unwholefome air, take little exercife, and wear dirty clothes. There the infection is gene- rally hatched, which often fpreads far and wide, to the destruction of many. Hence cleanlinefs may be confidered as an object of public attention. It is not fufficient that I be clean myfelf, while the want of it in my neighbour affects my health as well as his own. If dirty people cannot be removed as a common nuifance, they ought at leaft 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 col- lected, cleanlinefs becomes of the utmoft importance. It is well known that infectious difeafes are commu- nicated by tainted air. Every thing, therefore, which tends to pollute the air, or Spread the infec- tion, ought with the utmoft care to be guarded againft. For this reafon, in great towns, no filth of any kind, fliould be permitted to lie upon the ftreets. In many great towns the Streets are little better than dunghills, being frequently covered with allies, dung, and naftinefs of every kind. Even flaughter- houfes, or killing fhambles, are often to be feen in the very centre of great towns, The putrid blood, excrements, &c. with which thefe places are gene- rally covered, cannot fail to taint the air, and render it unwholefome. How eafily might this be prevented by active magistrates, who have it always in their power 104 OF CLEANLINESS. power to make proper laws relative to things of this nature, and to enforce the obfervance of them ! We are forry to fay, that the importance of gene- ral cleanlinefs does not feem to be fufficiently under- stood by the magistrates of moft great towns in Britain ; though health, pleafure, and delicacy, all confpire to recommend an attention to it. Nothing can be more agreeable to the fenfes, more to the honour of the inhabitants, or more conducive to their health, than a clean town ; nor can any thing imprefs a ftranger with a more difrefpectful idea of any people than its oppofite. Whatever pretenfions people may make to learning, politenefs, or civiliza- tion, we will venture to affirm, that while they ne- glect cleanlinefs, they are in a State of barbarity *. The peafants in moft countries feem to hold clean- linefs in a fort of contempt. Were it not for the open fituation of their houfes, they would often feel the bad effects of this difpofition. One feldom fees a farm-houfe without a dunghill before the door, and frequently the cattle and their matters lodge under the fame roof. Peafants are likewife extremely care- lefs with refpect to change of apparel, keeping their houfes, &c. clean. This is merely the effect of in- dolence and a dirty difpofition. Habit may indeed render it lefs difagreeable to them, but no habit can * In aneient Rome the greateft men did not think cleanlinefs an objeel unworthy of their attention. Pliny fays, the Cloaca, or common fewers for the conveyance of filth and raftinefs from the city, were the greateft of all the public works; and bellows higher encomiums upon Tarquinus, Agrippa, and others who made and improved them, than on thofe who atchieved the greateft conqutfts. How truly great dees the emperor Trajan appear, when giving directions to Pliny his procor.ful, concerning the making cf a cemmen fewer for the health and ccnvenier.ee of a con- quered city ? ever OF CLEANLINESS. 105 ever make it falutary to wear dirty clothes or breathe unwholefome air. As many articles of diet come through the hands of peafants, every method Should be taken to encou- rage and promote habits of cleanlinefs among them. This, for example, might be done by giving a fmall premium to the perfon who brings the cleaneft and beft article of any kind to market, as butter, cheefe, &c. and by punifhing feverely thofe who bring it dirty. The fame method fhould be taken with butchers, bakers, brewers, and all who are employed in preparing the neceffaries of life. In camps the ftricteft regard Should be paid to cleanlinefs. By negligence in this matter, infectious difeafes are often fpread amongft a whole army ; ajid frequently more die of thefe than by the fword. The Jews during their encampments in the wildernefs, received particular instructions with refpect to clean- linefs *. The rules enjoined them ought to be ob- ferved by all in the like fituation. Indeed the whole fyftem of laws delivered to that people has a manifeft tendency to promote cleanlinefs. Whoever considers the nature of their climate, the difeafes to which they were liable, and their dirty difpofition, will fee the propriety of fuch laws. It is remarkable, that in moft eaftern countries, cleanlinefs makes a great part of their religion. The Mahometan, as well as the Jewifli religion, en- joins various bathings, wafliings, and purifications. No doubt thefe might be defigned to reprefent in- ward purity; but they were at the fame time cal- culated for the prefervation cf health. However * Thru fhalt have a place alfo without the camp, whither thou fhalt go forth abroad ; and thou fnalt have a paddle upon thy weapon : and it fliall be when thou fhalt eafe thyfelf abroad, thou fiialt dig therewith, and fhalt turn back, and cover thai which qcmeth fr:m thee. &c. Deuter. chap. x.\ii. ver. 12, 13, whimfic;.! ioo" OF CLEANLINESS. whimfical thefe wafliings may appear to fome, few things would tend more to prevent difeafes than a proper attention to many of them. Were every per- fon, for example, after vifiting the fick, handling a dead body, or touching any thing that might convey infection, to walh before he went into company, or fat down to meat, he would run lefs hazard either of catching the infection himfelf, or of communicating it to others *. Frequent wafhing not only removes the filth and fordes which adhere to the fkin, but likewife pro- mores the perfpiration, braces the body, and enlivens the fpirits. How refreflied, how cheerful, and agree- able does one feel on being Shaved, wafhed, and Shifted ; efpecially when thefe offices have been ne- glected longer than ufual. The eaftern cuftom of wafhing the feet, though lefs neceffary in this country, is nevenhelcfs a very agreeable piece of cleanlinefs, and contributes great- ly to the prefervation of health. The fweat and dirt with which thefe parts are frequently covered, can- not fail to obftruct the perfpiration. This piece of cleanlinefs would often prevent colds and fevers, Were people careful to bathe their feet and legs in lukewarm water at night, after being expofed to cold or wet through the day, they would feldom experi- ence the ill effects which often proceed from thefe caufes. A proper attention to cleanlinefs is no where more neceffary than on Shipboard. If epidemical diftem- pers break out there, no one can be fafe. The beft way to prevent them, is to take care that the whole company be cleanly in their clothes, bedding, Sec. When infectious difeafes do break out, cleanlinefs is * I know a phyfician, who from habit, feldom or never en- ters his houfe widiout wafhing his hands. the OF CLEANLINESS. to7 the moft likely means to prevent their Spreading : it is likewife neceffary to prevent their returning after- wards, or being conveyed to other places. For this purpofe, the clothes, bedding, Sec. of the fick ought to be carefully wafhed, and fumigated with brim- ftone. Infection will lodge a long time in dirty clothes, and afterwards break out in the moft terrible manner *. In places where great numbers of fick people are collected together, cleanlinefs ought to be moft reli- gioufly obferved. The very fm.ell in fuch places is often fufficient to make one fick. It is eafy to ima- gine what effect that is likely to have upon the dif- eafed. In an hofpital or infirmary, where cleanlinefs is neglected, a perfon in perfect health has a greater chance to become fick, than a fick perfon has to get well. Few things are more unaccountable than that neglect, or rather dread of cleanlinefs, which appears among thofe who have the care of the fick ; they think it almoft criminal to fuffer any thing that is clean to come near a perfon in a fever, for example, and would rather allow him to wallow in all manner of filth, than change the leaft bit of his linen. If cleanlinefs be neceffary for perfons in health, it is certainly more fo for the fick. Many difeafes may be cured by cleanlinefs alone; moft of them might be mitigated by it; and, where it is neglected, the flighteft diforders are often changed into the moft malignant. The fame miftaken care which prompted people to prevent the leaft admiffion of frefh air to the fick, feems to have induced them to keep them * The beft mode of purifying a bed is to expofe it to an heavy rain, then dry it; this docs not in the leaft injure the ted. dirty. io& OF INFECTION. dirty. Both thefe destructive prejudices will, we hope, be in time entirely eradicated. Cleanlinefs is certainly agreeable to our nature. We cannot help approving it in others, even though we fhould not practife it ourfelves. It fooner attracts our regard than even finery itfelf, and often gains efteem where that fails. It is an ornament to the higheft as well as the loweft Station, and cannot be difpenfed with in either. Few virtues arc of more importance to fociety than general cleanlinefs. It ought to be carefully cultivated every where ; but in populous cities it fliould be almoft revered *. CHAP. IX. Of Infeclion. IVlANY difeafes are infectious. Every perfon ought, therefore, as far as he can, to avoid all communication with the difeafed. The common practice of vifiting the fick, though often well meant, has many ill confequences. Far be it from us to dif- courageany act of charity or benevolence, efpecially towards thofe in diftrefs ; but we cannot help blaming fuch as endanger their own or their neighbours lives by a miftaken friendship or an impertinent curiofity. * The ftreets of great towns, where water can be had, ought to be wafhed every day. This is the only effectual me- thod for keeping them thoroughly clean ; and, upon trial, we are perfuaded it will be found the cheapelt. Some, of the moft dreadful difeafes incident to human nature might, in my opinion, be entirely eradicated by cleanlinefs. The OF INFECTION. 109 The houfes of the fick, efpecially in the country, are generally crowded from morning 'till night with idle vifitors. It is cuftomary, in fuch places, for fervants and young people to wait upon the fick by turns, and even to .fit up with them all night. It would be a miracle indeed fhould fuch always efcape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and commu- nicate them to others, till at length they become epidemic. It would be thought highly improper, for one who had not had the fmall-pox, to wait upon a pa- tient in that difeafe ; yet many other fevers are al- moft as infectious as the fmall-pox, and not lefs fatal. Some imagine, that fevers prove more fatal in vil- lages than in great towns, for want of proper me- dical affiftance. This may fometimes be the cafe; but we are inclined to think it oftener proceeds from the caufe above mentioned. Were a plan to be laid down for communicating infection, it could not be done more effectually than by the common method of vifiting the fick. Such vifitors, not only endanger themfelves and their con- nections, but likewife hurt the fick. By crowding the houfe, they render the air unwholefome, and by their private whifpers and difmal countenances, difturb the imagination cf the patient, and deprefs his fpirits. Perfons who are ill, efpecially in fevers, ought to be kept as quiet as poffible. The fight of Strange faces, and every thing that disturbs the mind, hurts them. The common practice in country-places of in- viting great numbers of people to funerals, and crowding them into the fame apartment where the corpfe lies, is another way of fpreading infection. The infection dees not ahvays die with the patient. Every no OF INFECTION. Every thing that comes into contact with his body while alive, receives the contagion, and fome of thefe things, as clothes, blankets, &c. will retain it for a long time. Perfons who die of infectious dif. orders, ought not to lie long unburied ; and people fhould keep as much as poffible at a distance from them. It would tend greatly to prevent the fpreading of infectious difeafes, if thofe in health were kept at a proper diftance from the fick. The Jewifli Le« giflator, among many other wife inftitutions for pre- ferving health, has been peculiarly attentive to the means of preventing infection, or defilement as it is called, either from a difeafed perform or a dead body. In many cafes, the difeafed were to be feparated from thofe in health; and it was deemed a crime, even to approach their habitations. If a perfon only touched a difeafed or dead body, he was appointed to wafli himfelf in water, and to keep for fome time at a diftance from fociety. Infectious difeafes are often communicated by clothes. It is extremely dangerous to wear apparel which has been worn by the difeafed, unlefs it has been well waflied and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This fhews the danger of buying at random, the clothes which have been worn by other people. Infectious diforders are frequently imported. Com- merce, together with the riches of foreign climes, brings us alfo their difeafes. Thefe do often more than counterbalance all the advantages of that trade, by means of which thjy are introduced. It is to be regretted, that fo little care is commonly bellowed, either to prevent the introduction or fprcading of infectious maladies. Some attention, indeed, is ge- nerally OF INFECTION. in uerally paid to the plague; but other difeafes pafs unregarded*. p Infection is often fpread through cities, by jails, hofpitals, &c. Thefe are frequently fituated in. the very middle of populous towns ; and when infectious difeafes break out in them, it is impoflible for the inhabitants to efcape. Did magiftrates pay any regard to the health of the people, this evil might be eafily remedied. Many are the caufes which tend to diffufe infection through populous cities. The beft advice that we can give to fuch as are obliged to live in large cities is, to choofe an open fituation ; to avoid narrow, dirty, crowded ftreets; to keep their own houfe and offices clean ; and to be as much abroad in the open air as their time will permit. It would tend greatly to prevent the.fpreading of infectious difeafes, were proper nurfes every where employed to take care of the fick. This might often fave a family, or even a whole town, from being infected by one perfon. We do not mean that people fhould abandon their friends or rela- tions in diftrefs, but only to put them on their * Were the tenth part of the care taken to prevent the importation of difeafes, that there is to prevent fmuggling, it would be attended with many happy confequences. This might eafily be done, by appointing a phyfician at every con- fiderable fea-port, to infpeCt the fhip's company, paffengers, &c. before they came afhore, and, if any fever or other in- fectious diforder prevaiLd, to order the fhip to perform a fhcrt quarantine, and to fend the fick to fome hofpital or proper place to be cured. He mOht likewife order all the clothes, bedding, &c. which bad been ufed by the fick during the voyage, to be eidier deftroyed, or thoroughly cleanfed by fumigation, &c. before any of it were fent afhore. A fcheme of this kind, if properly conducted, would prevent many fe- vers, and other infectious dif afes, from being brought by failors into fea-port towns, and, by this means diffufed all «v«r the country. guard ii2 O? INFECTION. guard againft being too much in company with ! thofe who are afflicted with difeafes of an infectious nature. Such as wait upon the fick in infectious difeafes, fliould fluff their nofes with tobacco, or fome other ftrong fmtlling herb, as rue, tanfy, or the like. They ought likewife to keep the patient very clean, j to fprinkle the room where he lies with vinegar, or other ftrong acids, frequently to admit a ftream of frefh air into it, and to avoid the fmell of his breath ] as much as they can. They ought never to go into company without having changed their clothes and wafhed their hands ; otherwife, if the difeafe be in- fectious, they will in all probability carry the conta- gion along with them. However trifling it may appear to inconfiderate perfons, we will venture to affirm, that a due atten- tion to thofe things which tend to diffufe infection, would be of great importance in preventing difeafes. As moft difeafes are in fome degree infectious, no one fliould continue long with the fick, except the neceffary attendants. I mean not, however, by this caution, to deter thofe whofe duty or office leads them to wait upon the fick, from fuch a laudable and neceffary employment. Many things are in the power of the magistrate, which would tend to prevent the fpreading of, infec- tion ; as the promoting of public cleanlinefs; re- moving jails, hofpitals, burying-grounds, and other places where infection may be generated, at a proper diftance from great towns*; widening the ftreets; pulling down ufelefs walls, and taking all methods to promote a free circulation of air, through every part "* The ancients would not fuffer even the temples of tlieir gods, where the fick reforted, to he built within the walls of a city. 4 of OF INFECTION. 113 of the town, &c. Public hofpitals, or proper places of reception for the fickj provided they were kept clean, well ventilated, and placed in an open fixa- tion, would likewife tend to prevent the fpreading of infection. Such places of reception would pre- vent the poor, when fick, from being vifited by their idle or officious neighbours. We are not, however, to learn, that hofpitals, in- ftead of preventing infection, may become the means of diffufing it. When they are placed in the mid- dle of great towns; when numbers of patients are crowded together in fmall apartments; when there is a conftant communication kept up between the citizens and the patients ; and when cleanlinefs and ventilation are neglected, they become nefts for hatching difeafes., and every one who goes into them, not only runs a rilk of receiving infection himfelf, but likewife of communicating it to others. This, however, is not the fault of the hofpitals, but of thofe who have the management of them. It were to be wifhed, that they were both more numerous, .and upon a m^re refpectable footing, as that would induce people to go into them with lefs reluctance. This is the more to be defired, becaufe moft of the putrid fevers, fo called, and other infectious difor- ders break out among the poor, and are by them communicated to thofe in better circumftances. Were proper attention paid to the firft appearances of fuch diforders, and the patients early conveyed to an hof- pital, we fhould feldom fee a putrid fever, which is almoft as infectious as the plague, become epidemic. I CHAP. [ "4 3 CHAP. X. Of the' PaJJions. A HE paffions have great influence, both in the caufe and cure of difeafes. How the mind affects the body, will, in all probability, ever'remain a fecret. It is fufficient for us to know, that there is eflabliflied a reciprocal influence between the mental and corporeal parts, and that whatever in- jures the one, diforders the other. Of Anger. The paffion of anger ruffles the mind, diftorts the countenance, hurries on the circulation of the blood, and diforders the whole vital and animal functions. It often occafions fevers, and other acute difeafes; and fometimes even fudden death. This paffion is peculiarly hurtful to the delicate, and thofe of weak nerves. I have known fuch perfons frequently lofe their lives by a violent fit of anger, and would ad- vife them to guard againft the excefs of this paffion, with the utmoft care. It is ngt indeed always in our power to prevent being angry ; but we may furely avoid harbouring refentment in our breaft. Refentment preys upon the mind, and occafions the moft obftinate chronical, diforders, which gradually walte the conftitution. Nothing fhews true greatnefs of mind, more than to forgive injuries; it promotes the peace of fociety, and greatly conduces to our own eafe, health, and felicity. Such OF THE PASSIONS. 115 Such as value health, fliould avoid violent gufts of anger, as they would the moft deadly poifon. Neither ought they to indulge refentment, but to endeavour at ail times to keep their minds calm and ferene. Nothing tends fo much to the health of the body, as a conftant tranquillity of the mind. Of Fear. The influence of fear, both in occafioning and aggravating difeafes, is very great. No man ought to be blamed for a decent concern about life ; but too great a defire to preferve it, is often the caufe of lofing it. Fear and anxiety, by depreffing the fpirits, not only difpofe us to difeafes, but often render thofe difeafes fatal, which an undaunted mind would over- come*. Sudden fear has generally violent effects. Epi- leptic fits, and other convulfive diforders, are often occafioned by it. Hence the danger of that practice, fo common among young people, of frightening one another. Many have loft their lives, and others have been rendered miferable by frolics of this kind. It is dangerous to tamper with the human paffions. The mind may eafily be thrown into fuch diforder, as never again to act with regularity. But the gradual effects of fear prove moft hurtful. The conftant dread of fome future evil, by dwelling upon the mind, often occafions the very evil itfelf. Hence it comes to pafs, that fo many die cf thofe very difeafes, of which they long had a dread, or wtf!< h had been impreffed on their minds by fome accident or fooiifh prediction. This, for example, is * It were to be wiflied, that epidemics might alarm without caufing terror. And great advantages would refult, from accuftoming young perfons to a fick room : thus every family would afford nurfes. I 2 often 116 OF THE PASSIONS. often the cafe with women in childbed. Many of thofe who die in that fituation, are impreffed with the notion of their death, a long time before it hap- pens ; and there is reafon to believe, that this im- preffion is often the caufe of it. The methods taken to imprefs the minds of wo- men with the apprchenfions of the great pain and peril of child-birth, are very hurtful. Very few women die in labour, though many lofe their lives after it; which may be thus accounted for. A wo- man, after delivery, finding herfelf weak and ex- hausted, immediately apprehends the is in danger; but this fear feldom fails to obftruct the neceffary evacuations, upon which her recovery depends. Thus the fex frequently fall a facrifice to their own imagi- nations, when there would be no danger, did they apprehend none. It feldom happens, that two or three women in a great town die in child-bed, but their death is fol- lowed by many others. Every woman of their ac- quaintance who is with child, dreads the fame fate, and the difeafe becomes epidemical by the mere force of imagination. This fliould induce pregnant women to dtfpife fear, and by all means, to avoid thofe tattling goffips, who are continually buzzing in their ears the misfortunes of others. Every thing that may in the leaft alarm a pregnant or child-bed woman, ought with the greateft care to be guarded againft. Many women have loft their lives in child-bed, by the old fuperftitious cuftom, ftill kept up in moft parts of Britain, and far too much in America, of tolling the parifli bell for every perfon who dies. People who think themfelves in danger, are very inquiiitive ; and if they come to know, that the bell tolls for one who died in the fame fituation with themfelves, what muft be the confequence ? At any rate, OF THE PASSIONS. 117 rate they are apt to fuppofe that this is the cafe, and it will often be found a very difficult matter to per- fuade them of the contrary. But this cuftom is not pernicious to child-bed women only. It is hurtful in many other cafes. When low fev rs, in which it is difficult to fupport the patient's fpirits, prevail, wnat muft be the effect of a funeral peal founding five or fix times a-day in his ears ? No doubt his imagination will fuggeft that others died of the fame difeafe under which he la- bours. This apprehenfion will have a greater ten- dency to deprcfs his fpirits, than all the cordials of which medicine can boaft will have to raife them. If this ufelefs piece of ceremony cannot be abo- lifhed, we ought to keep the fick as much from hearing it as poffible, and from every other thing that may tend to alarm them. So far, however, is. this from being generally attended to, that many make it their bufinefs 10 vifit the fick, on purpofe to whifper d f rial Stories in their ears. Such may pafs for fy 1 pathizing friends, but they outfit rather to be confidered as enemies. All who wifh well to the fick ought to keep fuch perfons at the greateft diftance from them. A cuftom has long prevailed among phyficians, of prognosticating, as they call it, the patient's fate, or foretelling the iffue of the difeafe. Vanity no doubt introduced this practice, and ftill fupports it, in fpite of common fenfe anJ the fafety of mankind. It may indeed be alleged, that the doctor does not declare his opinion before the patient. So much the worfe. A fenfible patient had better hear what the doctor fays than learn it from the difconfolate looks, the watery eyes, and the broken whifpers of thofe about him. It feldom happens, when, the doctor gives an unfavourable opinion, that it can be con- cealed, from the patient. The very embarraffmen; I 3 which nS OF THE PASSIONS. which the friends and attendants fhew in difiuifmg what he has faid, is generally fufficient to difcover the truth. Kind Heaven has, for the wifeft ends, concealed from mortals their fate; and we do not fee what right any man has to announce the death of another, efpecially if fuch a declaration has a chance to kill him. Mankind are indeed very fond of prying into future events, and fttdom fail to folicit the phyfician for his opinion. A doubtful anfwer, however, or one that may tend rather to encourage the hopes of the fick, is furely the moft fafe. This conduct cculd neither hurt the patient nor the phyfician. Nothing tends more to deftroy the credit of phytic than thofe bold prognofticators, who, by the bye, are gene- rally the moft ignorant of the faculty. The mistakes which daily happen in this way are fo many Standing proofs of human vanity, and the weaknefs of fcience. We readily admit that there are cafes where the phyfician ought to give intimation of the patients danger to fome of his near connections ; though even this ought always to be done with the greateft caution: but it never can be neceffary in any cafe that the whole town and country fhould know, im- mediately after the doctor has made his firft vifit, that he has no hopes of his patient*s recovery. Perfons whofe impertinent curiofity leads them to queftion the phyfician with regard to the fate of his patient, certainly deferve no other than an evafive anfwer. The vanity of foretelling the fate of the fick is not peculiar to the faculty. Others follow their example, and thofe who think themfelves wifer than their neighbours often do much hurt in this way. Humanity furely calls upon every one to comfort the fick, and not to add to their affliction by alarming their fears. A friend, or even a- phyfician, may often do more good by a mild and fympathizing be- haviour OF THE PASSIONS. u9 haviour than by medicine, and Should never neglect to adminifter that greateft of all cordials, Hope, when he can do it with confiftency. Of Grief. Grief is the moft deftructive of all the paffions. Its effects are permanent, and when it finks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature feldom laft long; but grief often changes into a fixed melancholy, which preys upon the fpirits, and waftes the confti- tution. This paffion ought not to be indulged. It may generally be conquered at the beginning; but when it has gained ftrength, all attempts to remove it are vain. No man can prevent misfortunes in life; but it fhews true greatnefs of mind to bear them with fe- renity. Many perfons make a merit of indulging grief, and when misfortunes happen, they obftinately refufe all confolation, 'till the mind, overwhelmed with melancholy, finks under the load. Such con- duct is not only deftructive to. health, but utterly inconfiftent with reafon, religion, and common fenfe. Change of ideas is as neceffary for health as change of pofture. When the mind dwells long upon one fubject, efpecially of a difagreeable nature, it hurts the whole functions of the body. Hence grief indulged fpoils the digeftion and deftroys ths: appetite; by which means the fpirits are depreffed, the nerves relaxed, the bowels inflated with wind, and the humors, for want of frefh fupplies of chyle, vitiated. Thus many an excellent conftitution has been ruined by a family misfortune, or any thing which occafions exceffive grief. I 4 It 120 OF THE PASSIONS. It is not probable, that any perfon of a dejected mind fhould enjoy health. Life may indeed be draeeed out for a few years; but whoever would live to a good old a^e, muft be good-humored and cheer- ful. This indeed is not altogether in our own power; yet our temper of mind, as well as our ac- tions, depend greatly U'>on ourfelves. We can cither affociate with cheerful or melancholy companions, mingle in the amufements* and offices of life, or fit ftill and brood over our calamities as we chufe. Thefe, and many fuch things, are certainly in our power, and from thefe the mind generally takes its caft. The variety of fcenes which prefent themfelves to the fenfes, were certainly defigned to prevent our attention from being too long fixed upon any one object. Nature abounds with variety, and the mind, unlefs fixed down by habit, delights in contemplating new o' jt£te. This at once points out the method of relieving the mind in diltrefs. Turn the attention frequently to new objects. Examine them for fome time. When the mind begins to recoil, fhift the f cene. By this means a conftanf fucceffion of new ideas may be kept up, till the difagreeable ones en- irely difappear. Thus, travelling, the ftudy of any art or fcience, reading or writing on fuch fubjects us deeply engage the attention, will fooner expel grief than the moft fprightly amufements. It has already been obferved, that the body can- not be healthy unlefs it be exercifed; neither can the mind. Indolence nourifhes grief. When the mind has nothing elfe to think of but calamities, no won- der that it dwells there. Few people who purfue bufinefs with attention, are hurt by grief. Inftead therefore of abstracting ourfelves from the world or bufinefs, when misfortunes happen, we ought to engage in it with more than ufual attention, to dif- charge OF THE PASSIONS. 121 charge with double diligence the functions of our Station, and to mix with friends of a cheerful and focial temper. Innocent amufements are by no means to be ne- glected. Thefe, by leading the mind infenli \y to the contemplation of agreeable objects, help to dif- pel the gloom which misfortunes call over it. They make time feem lefs tedious, and have many other happy effects *. Some perfons, when overwhelmed with grief, be- take themfelves to drinking. This is making the cure muTi worfe than the difeafe. It feldom fails to end in the ruin of fortune, character, and conftitution. Of Love. Love is perhaps, the ftrongeft of all the paffions ; at leaft, when it becomes violent, it is lefs fubject to the control either of the underitanding or will, than any of the reft. Fear, anger, and feveral other paf- fions, are neceffary for the prefervation of the indi- vidual, but love is neceffary for the continuation of the fpecies itfeif: it was therefore proper that this paffion fhould be deeply rooted in the human breaft. Though love be a ftrong paffion, it is feldom fo rapid in its progrefs as feveral of the others. Few perfons fall defperatcly in love all at once. We would therefore adviie every one, before he tam- pers with this paffion, to confider well the probabi- lity and propriety of his being able to obtain the ob- ject of his love. When that is not likely, he fhould avoid every occafion of increasing it. He ought im- mediately to fly the company of the beloved object; * After all that has- been faid, there is nothing which can relieve the mind from grief with fo much certainty as a calm and humble refignaticn to the Divine Will. to 122 OF THE PASSIONS. to apply his mind attentively to bufinefs or ftudy; to take amufement; and above all, to endeavour, if poffible, to find another object which may engage his affections, and which it may be in his power to obtain. There is no paffion with.which people are fo ready to tamper as love, although none is more dangerous. Some men make love for amufement, others from mere vanity, or on purpofe to fliew their confequence with the fair. This is perhaps the greateft piece of cruelty which any one can be guilty of. What we eagerly wifii for we eafijy credit. Hence the too credulous fair are often betrayed into a firuation which is truly deplorable, before they are able to difcover that the pretended lover was only in jeft. But there is no jefting with this paffion. When love has got to a certain height, it admits of no other cure but the poffeffion of its object, which in this cafe ought always if poffible and proper to be obtained *. Of Religious Melancholy. Many perfons of a religious turn of mind behave as if they thought it a crime to be cheerful. They imagine the whole of religion confifts in certain mor- tifications, or denying themfelves the fmalleft indul- gence, even of the moft innocent amufements. A * The conduct of parents with regard to the difpofal of their children in marriage, is often very blameable. An advantage- ous match is the too constant aim of parents ; while their chil- dren often fuffer a real martyi dom betwixt their inclinations and duty. The firft thing which parents ought to confult in dif- rx.iing their children in marriage, is certainly their inclinations. Were due regard always paid to thefe, there would be fewer unhappy couples, and parents would not have fo often caufe to repent the feverity of their conduct, after a ruined conftitution, aloft charafter, or a diffracted mind, has fhewn them their mif- Uke. perpetual OF THE PASSIONS. 123 perpetual gloom hangs over their countenances, while the deepeft Melancholy preys upon their minds. At length the faireft profpects vanifli, every thing puts on a difmal appearance, and thofe very objects which ought to give delight afford nothing but difguft. Life itfelf becomes a burden, and the unhappy wretch, perfuaded that no evil can- equal what he feels, often puts an end to his own miferable exiftence. It is a great pity that even religion fhould be fo far perverted, as to become the caufe of thofe very evils which it was defigned to cure. Nothing can be better calculated than True Religion, to raife and fupport the mind of its votaries under every afflic- tion that can befal them. It teaches them that even the fufferings of this life are preparatory to the hap- pinefs of the next; and that all who perfift in a courfe of virtue fliall at length arrive at complete felicity. Perfons whofe bufinefs it is to recommend reli- gion to others, fhould beware of dwelling too much on gloomy fubjedts. That peace and tranquillity of mind, which true religion is calculated to infpire, is a more powerful argument in its favour than all the ter- rors that can be uttered. Terror may indeed deter men from outward a£ts of wickednefs, but can never infpire them with that love of God, and real good- neSs of heart, in which alone true religion confifts. To conclude ; the belt way to counteract the vio- lence of any paffion, is to keep the mind clofely en- gaged in fome ufeful purfuit. CHAP. C 124 3 CHAP. XI. Of the Common Evacuations. J. HE principal evacuations from the hu- man body are thofe hyflool, urine, and infenfible per- fpiration. None of thefe can be long obftructed without impairing the health. When that which ought to be thrown out of the body is too long re- tained, it not only occafions a plethora, or too great fulnefs of the veffels, but acquires many qualities which are hurtful to the health. Of the Evacuation by Stool. Few things conduce more to health than keep- ing the body regular. When the faces lie too long in the bowels, they vitiate the humors ; and when they are too foon difcharged, the body is not fuffi- ciently nourished. A medium is therefore to be de- fired, which can only be obtained by regularity in diet, fleep, and exercife. Whenever the body is not regular, there is reafon to fufpect a fault in one or other of thefe. Perfons who eat and drink at irregular hours,, and who eat various kinds of food, and drink of feveral different liquors at every meal, have no reafon to ex- pea cither that their digeftion will be good, or their difcharges regular. Irregularity in eating and drink- ing difturbs every part of the animal oeconomy, and never fails to occafion difeafes. Either too much or too little food will have this effect. The former in- deed generally occafions loofenefs, and the latter coftivenefs; OF THE EVACUATIONS. 125 coftivenefs ; but both have a tendency to hurt the health. It would be difficult to afcertain the exact num- ber of Stools which may be confiftent with health, as thefe differ in the different periods of life, in dif- ferent conftitntions, and even in the fame conftitu- tion under a different regimen of diet, exercife, &c. It is however generally allowed, that one ftool a-day is fufficient for an adult, and that lefs is hurtful. But this, like moft general rules, admits of many ex- ceptions. I have known perfons in perfect health who did not go to ftool above once a-wcek. Such a degree of coftivenefs however is not fafe ; though the perfon who labours under it may for fome time enjoy tolerable health, yet at length it may occafion difeafes. One method of procuring a ftool every day is to life betimes, and go abroad in the open air. Not only the pofture in bed is unfavourable to regular Stools, but alfo the warmth. This, by promoting the perfpiration, leffens all the other difcharges. The method recommended for this purpofe by Mr. Locke is likewife very proper, viz. to folicit na- ture, by going regularly to ftool every morning whether one has a call or not. Habits of this kind may be ac- quired, which will in time become natural. Perfons who have frequent recourfe to medicines for preventing coftivenefs feldom fail to ruin their conftitution. Purging medicines frequently repeated weaken the bowels, hurt the digeftion, and every dofe makes way for another, till at length they be- come as neceffary as daily bread. Thofe who are troubled with coftivenefs ought rather, if poffible, to remove it by diet than drugs. They Should likewife go more thinly clothed, and avoid every thing of an aftringent or of an heating nature. The diet and other regimen neceffary in this cafe will be found under 126 OF THE EVACUATIONS. under the article Coftivenefs, where this ftate of the bowels is treated of as a difeafe. Such perfons as are troubled with an habitual loofe- nefs ought likewife to fuit their diet to the nature of their complaint. They fhould ufe food which braces and ftrengthens the bowels, and which is rather of an aftringent quality, as wheat-bread made of the fineft flour, cheefe, eggs, rice boiled in milk, &c. Their drink fhould be red port, or claret, and water, in which toafted bread has been boiled, and fuch like. As an habitual loofenefs is often owing to an ob- ftructed perfpiration, perfons affected with it ought to keep their feet warm, to wear flannel next their fkin, and take every other method to promote the perfpiration. Further directions with regard to the treatment of this complaint will be found under the article Loofenefs. Of Urine. So many things tend to change both the quantity and appearances of the urine, that it is very difficult to lay down any determined rules for judging of either *. Dr. Cheyne fays, the urine ought to be * It has long been an obfervation among phyficians, thattta appearances* of the urine are very uncertain, and very little to be depended on. No one will be furprifed at this who confi- ders how many ways it may be affected, and confequently have its appearance altered. The paffions, the ftate of the atmo- fphere, the quantity and quality of food, the exercife, the clothing, the ftate of the other evacuations, and nemberlefs other caufes, are fufficient to induce a change either in the quan- tity or appearance of the urine. Any one who attends to this, will be aftonifhed at the impudence of thofe daring quacks, who pretend to find out di'eafe?, and prefcribe to patients from the bare infpection of their urine. Thefe impoftors, however, are very common all over Britain, and by the amazing credulity of OF THE EVACUATIONS. 127 equal to three-fourths of the liquid part of our ali- ment. But fuppofe any one were to take the trouble of meafuring both, he would find that every thing which altered the degree of perfpimtion, would alter this proportion, and likewife that different kinds of aliment would afford very different quantities of urine. Though for thefe, and other reafons, no rule can be given for judging of the precife quantity of urine which ought to be difcharged, yet a perfon of common fenfe will feldom be at a lofs to know when it is in either extreme. As a free difcharge of urine not only prevents but actually cures many difeafes, it ought by all means to be promoted ; and every thing that may obstruct it Should be carefully avoided. Both the fecretion and difcharge of urine are leffened by a fedentary life, fleeping on beds that are too foft and warm, food of a dry and heating quality, liquors which are aftringent and heating, as red port, claret, and fuch like. Thofe who have reafon to fufpect that their urine is in too fmall quantity, or who have any fymptcms of the gravel, ought not only to avoid thefe things, but whatever elfe they find'has a ten- dency to leffen the quantity of their urine. When the urine is too long retained, it is not only reforbed, or taken up again into the mafs of fluids, but by ftagnating in the bladder, it becomes thicker, the more watery parrs flying off firft, and the more grofs and earthy remaining behind. By the conftant tendency which thefe have to concrete, the formation of ftones and gravel in the bladder is the populace, many of them amafs confiderable fortunes. Of all the medical prejudices which prevail in this country, that in favour of urine do8ors is the ftrongell. The common people have ftill an unlimited faith in their fkill, although it has been demonftrated that no one of them is able to diftinguifh the urine of an hoife, cr any other animal, from that of a man. promoted. n8 OF. THE EVACUATIONS. promoted. Hence it comes- to pafs, that indolent.. and fedentary people are much more liable to thefe difeafes, than perfons of a more active life. ' Many perfons have loft their lives and others have brought on very tedious, and even incurable diforders, by retaining their urine too long, fro u a falfe delicacy. When the bladder has been over- diftended, it often lofes its power of action altog*, J ther, or becomes paralytic, by which means it u rendered unable either to retain the urine, or expel ] it properly. .-The calls.of nature ought never to he poftpoued. Delicacy is doubtlefs a virtue,, but that j can never be reckoned true delicacy, which induces i any one to riik his health or hazard his life. But the urine may be in too great as well as too fmall ax|uantity. This may be occafioned by drink- i ing large quantities of weak watery liquors, by the exceffive .ufe of alkaline falts, or any thing that Sli- raulates the kidnies, dilutes.the blood, Sec. this diforder very foon weakens the body, and induces a confumption. It is difficult to cure, but may be mitigated by Strengthening, diet and aftringent medi- cines, fuch as are recommended under the article Diabetes, or exceffive difcharge. of urine. Of the Perfpinatiotii • Infenfible perfpiration is generally reckoned the greateft of'all the difcharges from the'-human body. It is of fo great importance to health, that few dif- eafes attaik us while it goes properly on ; but v/hen it is obftrueted, the whole frame is foon difordered. This difcharge, however, being lefs perceptible than any of the reft, is confcquehtly lefs attended to. Hcnce.it is, that acute fevers, rheumatifms, agues, &c. often proceed from obftructed perfpiration be- fore we are aware of its having taken place. OF THE EVACUATIONS. On examining patients, we find moft of theih impute their difeafes either to violent colds which they had caught, or to flight ones which had been neglected. For this reafon, inftead of a critical in- quiry into the nature of the perfpiration, its differ- ence in different feafons, climates, conftitutions, &c. we fhall endeavour to point out the caufes which moft commonly obftruct it, and to fhew how far they may be either avoided, or have their influence counteracted by timely care. The want of a due attention to thefe, cofts annually fome thoufands of ufeful lives. Changes in the Atmofphere. One of the moft common caufes of obftructed per- fpiration, or catching cold, in this country, is the changeablenefs of the weather, or ftate of the atmo- fphere. There is no place where fuch changes hap- pen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the different feafons of the year, but of- ten change almoft from one extreme to another in a few days, and fometimes even in the courfe of one day. That fuch changes muft affect the ftate of the perfpiration is obvious to every one *. * I never knew a more remarkable inftance of the uncertainty of the weather in this country, than happened whPe I was wri- ting thefe notes. This morning, Auguft 14, 1783, the ther- mometer in the fhade was down at fifty-three degrees, and a very few days ago it flood above eighty. No one who refkclfe on fuch great and fudden changes in the atmofphere, will be furprifed to find colds, coughs, rheums, with other affections of the breaft and bowels, fo common in this country^—-----One would almoft fuppofe that this, and many other remarks of the fame kind, had ieen written in America. K The 133 OF THE EVACUATIONS. The beft method of fortifying the body againft- the changes of the weather, is to be abroad every day. Thofe who keep moft within doors are moft liable to catch cold. Such perfons generally render themfelves fo delicate as to feel even the flighteft changes in the atmofphere, and by their pains, coughs, oppreffions of the breaft, Sec. they become a kind of living barometers. Wet Clothes. Wet clothes, not only by their coldnefs, obftruft the perfpiration, but their moifture, by being ah- forbed, or taken up into the body, greatly increafes the danger. The moft robuft constitution is not proof againft the danger arifing from wet clothes; they daily occafion fevers, rheumatifms, and other , fatal diforders, even in the young and healthy. . It is impoffible for people who go frequently abroad, to avoid fometimes being wet. But the danger might generally be leffened, if not wholly : prevented, by changing their clothes foon ; when this cannot be done, they fhould keep in motion till they be dry. So far are many from taking this pre- caution, that they often fit or lie down in the fields with their clothes wet,, and frequently fleep even whole nights in this condition. The frequent in- ftances which we have of the fetal effects of this conduct, ought certainly to deter others from being guilty of it. Wet Feet. Even Wet feet often occafion fatal difeafes. The colic, inflammations of the breaft and of the bowels, the iliac paffion, cholera morbus, fore threat, &c. arc often occafioned by wet feet. Habit v. ill, no doubt, , render OF THE EVACUATIONS. 131 render this lefs dangerous; but it ought, as far as poffible, to be avoided. The delicate, and thofe who are not accuftomed to have their clothes or feet wet, fhould be peculiarly careful in this refpedt. ■Night Air. The perfpiration is often obftructed by night air ; even in fummer, this ought to be avoided. The dews which fall plentifully after the hotteft day, make the night more dangerous than when the weather is cool. Hence, in warm countries, the evening dews are more hurtful than where the cli- mate is more temperate. It is very agreeable after a warm day to be abroad in the cool evening; but this is a pleafure to be avoided by all who value their health. The effects of evening dews are gradual indeed, and al- moft imperceptible; but they are not the lefs to be dreaded: we would therefore advife travellers, la- bourers, and all who are much heated by day, carefully to avoid them. When the perfpiration has been great, thefe become dangerous in propor- tion. By not attending to this, in flat marlhy countries, where the exhalations and dews are co- pious, labourers are often feized with intermitting fevers, quinfeys, and other dangerous difeafes. Damp Beds. Beds become damp, either from their not being ufed, Standing in damp houfes, or in rooms without fire. Nothing is more to be dreaded by travellers. than damp beds, which are very common in all places where fuel is fcarce. When a traveller, coldi and wet, arrives at an inn, he may, by means of a good fire, warm diluting liquor, and a. dry bed, K 2 have :j2 OF THE EVACUATIONS. have the perfpiration reftorcd ; but if he be put into a cold room, and laid on a damp bed, it will be more obftructed, and the worft conf quences will enfue. Travellers fhduld avoid inns which are noted for damp beds, as they Would a houfe infected with the plague, as no man, however robuft, is proof againft the danger arifing from them. But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of ftrangers ..are often equally dan- gerous. All kinds of linen anct bedding, when not frequently ufed become damp. How then is it pof- fible, that beds, which are not flept in above two or three times a-year, fliould be fafe? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reafon is obvious : were they careful never to fleep in a bed but what was frequently ufed, they would feldom find any ill confequences from a change. Nothing is more to be dreaded by a delicate per« fon when on a vifit, than being laid in a bed whielj is kept on purpofe for ftrangers. That ill-judged piece of complaifance becomes a real injury. All the bad confequences from this quarter might eafily be prevented in private families, by caufmg their fervants to fleep in the fpare beds, and refign them to ftrangers when they come. In inns where the beds are ufed almoft every night, nothing elfe is neceffary than to keep the rooms well feafoned by frequent fires, and the linen dry.: That baneful cuftom faid to be practifed in many inns, of damping Sheets, and preffing them in order to fave wafhing, and afterwards laying them on the beds, ought, when difcovered, to be puniShed with the utmoft feverity. It is really a fpecies of murder, and will often prove as fatal as poifon or gun-Shot. Indeed, no linen, efpecially if it has been wafhed in OF THE EVACUATIONS. 133 in winter, ought to be ufed till it has been expofed for fome time to the fire; nor is this operation lefs neceffary for linen wafhed in fummer, provided it has lain by for any length of time. This caution is the more needful, as gentlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay no regard to a circumftance of much more inv. portance *. Damp Houfes. Damp Houfes frequently produce the like ill con- fequences; for this reafon thofe who build fhould be careful to chufe a dry fituation. A houfe which itands on a damp marfhy foil or deep clay, will never be thoroughly dry. All houfes, unlefs where the ground is exceedingly dry, fliould have the firft floor a little raifed. Servants and others, who are obliged to live in cellars and funk Stories, feldom continue long in health: matters ought furely to- pay fome regard to the health of their fervants, as well as to their own. Nothing is more common than for people, merely to avoid fome trifling imconveniency, to hazard their lives, by inhabiting aihfcufe almoft as foon as the mafons, 'plafterers, &cw have done with it: fuch houfes are not only dangerous from their dampnefs, but likewife from ithrrfmell of lime, paint, &c. The afthmas^xonfurnptions, and other difeafe^ of the lungs, fo incident to people who work in thefe arti- * If a perfon fufipctts that his bed Is damp, the Ample pre- caution of taking off the fheets, and lying in the blankets, with all or moft of his clothes on, will prevent all the danger. I have praclafed this for many years, and never have been hurt by damo-beds, though no conftitution, witkwjt care, is proof :ig.inft tlieir baneful influence. K 3 4es.j 134 OF THE EVACUATIONS. cles, arc fufficient proofs of their being unwhofo fome. Rooms are often rendered damp by an unfeafon* able piece of cleanlinefs; I mean the pernicioui cuftom of wafhing them immediately before com* pany is put into them. Moft people catch cold, if ■they fit but a very fhort time in a room that has been lately wafhed; the delicate ought carefully to avoid fuch a fituation, and even the robuft are not always proof againft its influence*. Sudden Tranfitions from Heat to Cold. The perfpiration is commonly obftructed by sud» den transitions from heat to cold. Colds are feldom caught, unlefs when people have been too much heated. Heat rarifies the blood, quickens the circulation, and increafes the perfpiration; but when thefe are fuddenly checked, the confequenctt 1 muft be bad. It is indeed impoflible for labourers not to be too hot upon fome occafions; but it is generally in their power to let themfelves cool grar dually, to put on their clothes when they leave off work, to make choice of a dry place to reft them- felves in, and to avoid Sleeping in the open fields. Thefe eafy rules, if obferved, would often prevent fevers and other fatal diforders. It is very common for people, when hot, to drink freely of cold water, or fmall liquors. This con- duct is extremely dangerous. Thirft indeed is hard to bear, and the inclination to gratify that appetite •r * People imagine if a good fire is made in a room after it has been wafhed, that there is no dang'er from fitting in it; but they muft give me leave to fay that this increafes the danger. The evaporation excited by the fire generates cold, and renders *he damp more active. , frequently OF THE EVACUATIONS. 135 frequently gets the better of reafon, and makes us do what our judgment difapproves. Every peafant, however, knows, if his horfe be permitted to drink his bellyful of cold water after violent exercife, and be immediately put into the Stable, or Suffered to remain at reft, that it will kill him. This they take the utmoft care to prevent. It were well if they were equally attentive to their own fafety. Thirft may be quenched many ways without fwah lowing large quantities of cold liquor. The fields afford variety of acid fruits and plants, the very chewing of which would abate thirft. Water kept in the mouth for fome time, and fpit out again, if frequently repeated, would have the fame effect. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirft more effectually, and make the danger lefs. When a perfon is extremely hot, a mouthful of wine and water, if it can be obtained, ought to be preferred to any thing elfe. But if any one has been fo foolifh, when hot, as to drink freely of cold liquor, he ought to continue his exercife at leaft till what he drank be thoroughly warmed upon his ftomach. It would be tedious to enumerate all the bad ef- fects which flow from drinking cold liquors when the body is hot. Sometimes this has occafioned immediate death. Hoarfenefs, quinfeys, and fevers of various kinds, are its common confequences. .Neither is it fafe when warm to eat freely of raw fruits, fallads, or the like. Thefe indeed have not fo fudden an effect on the body as cold liquors, but they are notwithftanding dangerous, and ought to be avoided. Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is extremely dangerous. Colds, coughs, and inflammations of the breaft, are the K 4 ufual i$6 OF THE EVACUATIONS. ufual effect of this -conduct: yet nothing is mare common than for perfons Who have drank warm li- quors for- feveral houfsy to walk or ride a number of miles in the coldeft night, or to ramble about ifl the ftreets*. -,*.. - ' . People are very apt, when a room is hot, to throw open a window, and to fit near it. This is a moft dangerous practice. Any perfon had better fit with- out doors than in fuch a fituation, as the current of air is directed againft one particular part of .the body. Inflammatory fevers and confumptions have often' been occafioned by fitting pr ftandiflg thinly clothed near an open window. Nor is fleeping with open windows lefs to be dreaded. That ought never to be done, even in the hotteft feafon, unlefs the win. dow is at a diftance- I have known mechanics fre- quently contract fatal difeafes, by working ftript at an open window, and would advife all of them to beware of fuch a practice. Few things expofe people more to catch cold than keeping their own houfes too warm ; fuch per- fons may be faid to live in a fort of hot-houfes; they can hardly Stir abroad to vifit a neighbour, but at the hazard of their lives. Were there no other reafon for keeping houfes moderately cool, that alone is fufficient: but no houfe that is too hot can be wholefome; heat deftroys the fpring and elasticity of the air, and renders it lefs fit for expanding the lungs, and for the other purpofes of refpiration. Hence it is, that confumptions and other difeafeirof * .Tre bfr. ho^s ™ greaf towns, where fuch numbers of people fpend their evenings are highlv pernicious. The breath of a number of people crowded into a low apartment, with the addition of fires, candles, the fmoke of tobacco, and- the- iumes of hot liquor, &c. muftrnot only render it hurtful to continue in fuch places, but dangerous to go out of them into a cold and chilly atmofphere. ;■; the OF THE EVACUATIONS. i37. the lungs prove fo fatal to thofe who work in forges, glafs-houfes, and the like. Some are even fo fool-hardy, as to plunge them- felves when hot into cold water. Not only fevers, but madnefs itfelf has frequently been the effect of this conduct. Indeed it looks to6 like the action of a madman to deferve a ferious confideratibn. The refult of all thefe obfervations is, that "every one ought to avoid, with the utmoft attention, all hidden tranfitions from heat to cold, and to keep the body in as uniform a temperature as poffible; or where that cannot be done, to take care to let it cool gradually. People may imagine that too ftrict an attention to thefe things would tend to render them delicate. So far, however, is this from being my defign, that the very firft rule propofed for preventing colds, is to harden the body, by inuring it daily to the open air. I fhall put an* end to what relates to this part of my fubject, by giving an abftract of the juftly cele- brated advice of Celfus, with refpect to the prefer- vation of health. " A man," fays he, " who is " bleffed with good health, fliould confine himfelf " to no particular rules, either with refpect to regi- " men or medicine. He ought frequently to diver- " fify his manner of living; to be fometimes in "town, fometimes in the country; to hunt, fail, " indulge himfelf in reft, but more frequently to " ufe exercife. He ought to refufe no kind of food " that is commonly ufed; fometimes to make one at " an entertainment, and fometimes to forbear it; to " make rather two meals a-day than one, and always " to eat heartily, provided he can digeft it. He " Should be careful in time of health not to deftroy, " by exceffes of any kind, that vigour of conftitution " which fliould fupport him under ficknefs." PART PART II. OF DISEASES. CHAPTER XII. Of the Knowledge and Cure of Difeafes. I- HE knowledge of difeafes does not depend fo much upon fcientific principles as many imagine. It is chiefly the refult of experience and obfervation. By attending the fick, and carefully obferving the various occurrences in difeafes, a great degree of accuracy may be acquired, both in diftin- guifhing their fymptoms, and in the application of medicines. Hence fenfible nurfes, and other perfons who wait upon the fick, often difcover a difeafe fooner than thofe who have been bred to phyfic. We do not, however, mean to infinuate, that a me- dical education is of no ufe: it is doubtlefs of the greateft importance ; but it never can fupply the place of obfervation and experience. Every difeafe may be confidered as an affem- blage of fymptoms, and muft be diftinguifhed by thofe which are moft obvious and permanent. In- ftead, therefore, of giving a claffical arrangement of difeafes, i4© OF THE KNOWLEDGE difeafes, according to the fyftematic method, it will j be more fuitable, in a performance of this nature, to give a full and accurate defcription of each particular difeafe as it occurs ; and, where any of the fymptoms of one difeafe have a near refemblance to thofe of another, to take notice of that circumftance, and, at the fame time, to point out the peculiar or charac- teristic fymptoms by which it may be diftinguifhed. By a due attention to thefe, the inveftigation of dif- eafes will be found to be a lefs difficult matter than moft people would at firft be ready to imagine. i A proper attention to the patient's age, fex, tern- j per of mind, conftitution, and manner of life, will likewife greatly affift, both in the inveftigation and treatment of difeafes. In childhood the fibres are lax and foft, the nerves extremely irritable, and the fluids thin ; whereas in old age the fibres are rigid, the nerves become al- moft infenfible, and many of the veffels imperviablc. 1 Thefe, and other peculiarities, render the difeafes of J the young and aged very different, and of courfe they muft require a different method of treatment. Females are liable to many difeafes which do not afflict the other fex; befides, the nervous fyftem be- ing more irritable in them than in men, their difeafes require to be treated with greater caution. They are often lefs able to bear large evacuations; and aH Stimulating medicines ought to be administered'to them with a fparing hand. Particular conftitutions not only difpofe perfons to peculiar difeafes, but likewife render it neceffary to treat thefe difeafes in a peculiar manner. A delicate perfon, for example, with weak nerves, who lives moftly within doors, muft not oe treated, under any difeafe, precifely in the fame manner as one whofe hardy and robuft, and who is much'expofed to the open air. The AND CURE OF DISEASES. i4i The temper of raiod ought to be carefully attended to in difeafes. Fear,,anxiety, and a fretful temper, both occafion and aggravate difeafes. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When this is af- fected, the beft medicine is to footh the paffions, to divert the mind from anxious thought, and to keep the patient as eafy and cheerful as poflible. Attention ought likewife to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marfhy fituations are fubject to many difeafes which are unknown to the inhabitants of high countries. Thofe who breathe the impure air of cities, have many maladies to which the more happy ruftics are entire ftrangers. Perfons who feed grofsly, and indulge in ftrong li- quors, are liable to difeafes which do not affect the temperate and abftemious. . It has already been obferved, that the different occupations and fituations in life difpofe men to pecu- liar difeafes. It is therefore neceffary to inquire into the patient's occupation, manner of life, Sec This will not only affift us in finding out the difeafe, but will likewife direct us in the treatment of it. It would be very imprudent to treat the laborious and the fedentary precifely in the fame manner, even fup- pofmg them to labour under the fame difeafe. It will likewife be proper to inquire, whether the difeafe be conftitutional or accidental; whether it has been oftong or Short duration ; whether it pro- ceeds from any great and hidden alteration in the diet, manner of life, &c* . The ftate of the patient's body, and of the evacuations, ought alfo to be inquired into; and likewife whether he can with eafe perform all the vital and animal functions, as breath- i°g> digeftion, &o. LafHy 14* OF THE KNOWLEDGE Laftly, it will be proper to inquire what difeafes the patient has formerly been liable to, and what me- dicines were moft beneficial to him; if he has a ftrong avqrfion to any particular drug, &c. *. As many of the indications of cure may-be an- fwered by diet alone, it is always the firft thing; to be attended to in the treatment of difeafes. Thofe who know no better, imagine that every thing which goes by the name of a medicine poffeues fome won- derful power or fecret charm, and think, if the pa- tient fwallows enough of drugs, that he muft do well. This miftake has many ill confequences; it makes people truft to drugs, and neglect their own endeavours; befides, it difcourages all attempts to relieve the fick where medicines cannot be obtained. Medicines are no doubt ufeful in their placej i and, when adminiftered with prudence, they may do much good ; but, when they are put in place of every thing elfe, or adminiftered at random-, which is not feldom the cafe, they muft do mifchief. We would therefore wifti to call the attention of man- kind from the purfuit of fecret medicines, to fnch things as they are acquainted with. The proper re- gulation of thefe may often do much good, and there is little danger of their ever doing hurt. >• ' Every difeafe weakens the digeftive powers. The diet ought therefore, in all difeafes, to be light and of eafy digeition. It would be as prudent for a per- fon with a broken leg to attempt to walk, as for one in a fever to eat the fame kind of food, and in the fame quantity, as when he was in perfect health. Even abftinence alone will often cure a fever, efpe- cially when it has been occafioned by excefsiin eating or drinking. .. ■•. * It is, however, no uncommon cafe for a patient to fup- pofe that fome particular medicines difagree with him. la AND CURE OF DISEASES. 143 In all fevers attended with inflammation, as pleu- rifies, peripneumonies, &c. thin gruels, wheys, wa- tery infufions of mucilaginous plants, roots, &c. are not only proper for the patient's food, but they are likewife fome of the beft medicines which can be adminiftered. In fevers of a flow, nervous, or putrid kind, where there are no fymptoms of inflammation, and where the patient muft be fupported with cordials, that in- tention can always be more effectually anfwered by nourifhing diet, and generous wines, than by any medicines yet known. Nor is a proper attention to diet of lefs import- ance in chronic than in acute difeafes. Perfons af- flicted with low fpirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the ufe of folid food and gene- rous liquors, than from all the cordial and car- minative medicines which can be adminiftered to them. The fcurvy, that moft obftinate malady, will fooner yield to a proper vegetable diet, than to all the boafted antifcorbutic remedies of the Shops. In confumptions, when the humors are vitiated, and the ftomach fo much weakened as to be unable to digeft the folid jfibres of animals, or even to affi- milate the juices of vegetables, a diet confuting chiefly of milk will not only fupport the patient, but will often cure the difeafe after every other medicine has failed. Nor is an attention toother things of lefs import- ance than to diet. The ftrange infatuation which has long induced people to Shut up the fick from all communication with the external air, has done great mifchief. Not only in fevers, but in many other dif- eafes, the patient will receive more benefit from having the frefh air prudently admitted into his cham- ber, M4 OF THE KNOWLEDGE, fcrV. ber, than from all the medicines which can be given him. Exercife may likewife in many cafes be confi- dered as a medicine. Sailing, or riding on horfe, back, for example, will be of more fervice in the cure of confumptions, glandular obftructions, difeafes of the ftomach and bowels, Sec. than any medicine yet known. In difeafes which proceed from a re- laxed ftate of the folids, the cold bath, and other parts of the gymnaftic regimen, will be found equally beneficial. Few things are of greater importance in the cure of difeafes than cleanlinefs. When a patient is fuf- fered to lie in dirty clothes, whatever perfpires from his body is again reforbed, or taken up into it, which ferves to nourifh the difeafe, and increafe the danger. Many difeafes may be cured by cleanlinefs alone; moft of them may be mitigated by it, and in all of them it is highly neceffary both for the patient and thofe who attend him. Many other obfervations, were it neceffary, might be adduced to prove the importance of a proper re- gimen in difeafes. Regimen will often cure difeafa without medicine, but medicine will feldom fucceed where a proper regimen is neglected. For this rea- fon, in the treatment of difeafes, we have always given the firft place to regimen. Thofe who arc ignorant of medicine may confine themfelves to it only. For others who have more knowledge, we have recommended fome of the moft fimple, but ap- proved forms of racdkine in every diieafe. Thefe, however, are never to be adminiftered but by people of better underftanding; nor even by them without the greateft precaution. 4 CHAP. t H5 ] CHAP. Xlli. Of Fevers in general. As more than one half of mankind is faid to perifh by fevers, it is of importance to be acquainted with thtir caufes. The moft genera! caufes of fevers are, i'nfedion, errors in diet, un- wholefome air, violent emotions of the mind, excefs or fuppreffim of ufual evacuations, external or internal injuries, and extreme degrees of heat or cold. As moft of thefe have already been treated of at confiderable length, and their effects lhewn, we fhaft not now refume the confideration of them, but fhall only recommend it to all, as they would wifh to avoid fevers, and other fatal difeafes, to pay the moft punc- tual attention to thefe articles. Fevers are not only the moft frequent of all dif- eafes, but they are likewife the moft complex. In the moft fimple fpecies of fever, there is always a combination of feveral different fymptoms* The distinguishing fymptoiKs of:fever are, increafed heap, frequency 'of pulfe, lofs'of: appetite, general debility, pain in -the head, and' a difficulty in performing fonue ef the vital or animal functions: The: Other fymp- toms ufually attendant on fevers are, nalafea, thirft, anxiety, delirium, wearinefs; waftirrg ofothe-flefh, want of fleep, or the Sleep difturbed and not re- • frefhing. • •. When the fever comes on gradually, the patient generally complains firft of languor or liftleffnefs, forenefs of the fleih, or the bones, as the country people exprefs it, heavinefs of the head, lofs of L appetite, 146 OF FEVERS IN GENERAL. appetite, ficknefs, with clamminefs of the mouth; after fome time, come on exceffive heat, violent thirft, reftleffnefs, &c. When the fever attacks fuddenly, it always be- gins with an uneafy fenfation of exceffive cold, ac- companied with debility and lofs of appetite ; fre- quently the cold is attended with Shivering, oppref- fion about the heart, and ficknefs at ftomach, or vomiting. Fevers are divided into continual, remitting, in- termitting, and fuch as are attended with cutaneous eruption or topical inflammation, as the fmall pox, eryfipelas, Sec. By a continual fever is meant, that which never leaves the patient during the whole courfe of the difeafe, or which fhews no remarkable increafe or abatement in the fymptoms. This kind of fever is likewife divided into acute, flow, and malignant. The fever is called acute, when its pro- grefs is quick, and the fymptoms violent; but when thefe are more gentle, it is generally denominated ftow. When livid or petechial fpots fhew a putrid fta;e of the humours, the fever is called malignant^ ■ putrid, or petechial. 1 A remitting fever differs from a continual only in a degree. It has frequent increafes and decreafes, i or exacerbations and remiffions, but never wholly leaves the patient during the courfe of the difeafe. Intermitting fevers or agues are thofe which, during the time that the patient may be faid to be ill, have evident intervals or remiffions of the fymptoms. As a fever is only an effort of Nature to free her- felf from an offending caufe, it is the bufinefs of thofe who have the care of the fick, to obferve with • diligence which way Nature points, and to endea- vour to aflift her operations. Our bodies are fo framed, as to have a conftant tendency to expel or throw off whatever is injurious to health. This is generally j OF FEVERS IN GENERAL. 147 generally done by urine, fweat, ftool, expectoration, vomit, or fome other evacuation. There is reafon to believe, if the efforts of Na- ture, at the beginning of a fever, were duly attended to and promoted, it would feldom continue long; but when her attempts are either neglected or coun- teracted, it is no wonder if the difeafe proves fatal. There are daily inftances of perfons who, after catching cold, have all the fymptoms of a beginning fever; but by keeping warm, drinking diluting li- quors, bathing their feet in warm water, Sec. the fymptoms in a few hours difappear, and the danger is prevented. When fevers of a putrid kind threaten, the beft method of obviating their effecls is by one or two vomits. Our defign is not to enter into a critical enquiry into the nature and immediate caufes of fevers, but to mark their moft obvious fymptoms, and to point out the proper treatment of the patient with refpect to his diet, drink, air, &c. in the different ftages of the difeafe. In thefe articles the inclinations of the patient, will, in a great meafure, direct our conduct. Almoft every perfon in a fever complains of great thirft, and calls out for drink, efpecially of a cooling nature. This at once points out the ufe of water, and other cooling liquors. What is fo likely to abate the heat, attenuate the humors, remove fpafms and obstructions, promote perfpiration, increafe the quantity of urine, and, in Short, produce every falu- tary effect in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is 'the bufis ? The neceflity of diluting liquors, is pointed out by the dry tongue, the parched Skin, and the burning heat, as well as the unquenchable thirft of the patient. Many cooling liquors, which are extremely grate- ful to patients in a fever, may be prepared from L 2 fruits, 148 OF FEVERS IN GENERAL. fruits, as decoctions of tamarinds, apple-tea, orange- whey, and the like. Mucilaginous liquors might j alfo be prepared from marfhmallow roots, flax-feed, ] lime-tree buds, barley, and other mild vegetables. Thefe liquors, efpecially when* acidulated, are highly agreeable to the patient, and fhould never be denied him. At the beginning of a fever, the patient generally complains of great laflitude or wearinefs, and has no inclination to move. This evidently Shews the propriety of keeping him eafy, and if poffible in bed. Lying in bed relaxes the fpafms, abates the violence of the circulation, and gives Nature an opportunity of exerting all her force to overcome the difeafe. The bed alone would often remove a fever at the beginning ; but when the patient Strug- gles with the difeafe, inftead of driving it off, he only fixes it the deeper, and renders it more dan- gerous, this obfervation is too often verified in travellers, who happen, when on a journey, to he feized with a fever. Their anxiety to get home, induces them to travel with the fever upon them, which conduct often renders it fatal. In fevers, the mind, as well as the body, fhould be kept eafy. Company is feldom agreeable to the fick. Indeed, every thing that disturbs the imagina- tion, increafes the difeafe ; for which reafon, every ! perfon in a fever ought to be kept perfectly quiet, and neither allowed to fee nor hear any thing that may in the leaft affect or difcompofe his mind. Though the patient^ in a fever, has the greateft inclination for drink, yet he feldom has any appetite for folid food ; hence the impropriety of urging him to take victuals is evident. Much folid food, in a fever, is every way hurtful. It' oppreffes nature, i and, inftead of nourifhing the patient, ferves only to feed the difeafe. What food the patient takes, fhould j OF FEVERS IN GENERAL. i49 mould be in fmall quantity, light, and of eafy di- geftion. It ought to be chiefly of the vegetable kind, as panada, roafted apples, gruels, and fuch like. Poor people, when any of their family are taken ill, run directly to their rich neighbours for cordials, and pour wine, fpirits, &c. into the patient, who, perhaps, never had been accuftomed to tafte fuch liquors when in health. If there be any degree of fever, this conduct muft increafe it, and if there be none, this is the ready way to raife one. Stuffing the patient with fweatmeats, and other delicacies, h likewife very pernicious. Thefe are always harder to digeft than common food, and cannot fail to hurt the Stomach. Nothing is more defired by a patient in a fever than frefh air. It not only removes his anxiety, but cools the blood, revives the fpirits, and proves every way beneficial. Many patients are in a manner ftifled to death in fevers, for want of frefh air; yet, fuch is the unaccountable infatuation of moft people, that the moment they think a perfon in a fever, they imagine he fhould be kept in a clofe chamber, into which not one particle of frefli air muft be admitted. Inftead of this, there ought to be a conftant Stream of frefli air into a fick perfon's chamber, fo 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 fpoils the air of a fick perfon's chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humors in a' putrid ftate, air that has been breathed repeatedly, will greatly increafe the difeafe. Such air, not only lofes its fpring, and becomes iinfit for the purpofe of refpiration, but acquires a L 3 noxious 150 OF FEVERS IN GENERAL. noxious quality, which renders it, in a manner poi- fonous to the fick. The body linen, as well as the fheets, fhould be often changed : there is no cjfe where this is dangerous, if the linen is dry and warm, unlefs when the patient is too weak to bear it. In fevers, when the patients fpirits are low and depreffed, he is not only to be fupported with cor- dials, but every method fliould be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a perfon in danger, inftead of folacing his mind with the hopes and confolations of religion, fright him with the views of hell and dam- nation. It would be unfuitable here, to dwell upon the impropriety and dangerous confequences of this conduct; it often hurts the body, and there is rea- fon to believe feldom benefits the foul. Among common people, the very name of a fever generally fuggefts the neceffity of bleeding. This notion feems to have taken its rife from moft fevers in this country having been formerly of an inflam- matory nature; but true inflammatory fevers are now feldom to be met with. Sedentary occupations, and a different manner of living, have fo changed the ftate of difeafes in Britain, that there is now hardly one fever in ten, where the lancet is neceffary. In moft low, nervous, and putrid fevers, which are now fo common, bleeding is really hurtful, as it weakens the patient, finks his fpirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unlefs there be evident Signs of inflammation. Bleeding is an excellent me- dicine when neceffiiry, but fliould never be wantonly performed*. * See hereafter, the chapter on the yellow fever. It OF FEVERS IN GENERAL. iyi It is likewife a common notion, that fweating is always neceffary in the beginning of a fever. When the fever proceeds from an obftructed perfpiration, this notion is not ill founded. If the patient only lies in bed, bathes his feet and legs in warm water, and drjnks freely of water-gruel, or any other weak diluting liquor, he will feldom fail to perfpire freely. The warmth of the bed, and the diluting drink, will relax the univerfal fpafm, which'generally affects the fkin at the beginning of a fever; it will open the pores, and promote the perfpiration, by means of which the fever may often be carried off. But, in- ftead of this, the common practice is, to heap clothes upon the patient, and to give him things of a hot nature, as fpirits, fpiceries, Sec. which fire his blood, increafe the fpafms, and render the difeafe more dangerous. In all fevers, a proper attention fliould be paid to the patient's longings. Thefe are the calls of Na- ture, and often point out what may be of real ufe. Patients are not, indeed, to be indulged in every thing that the fickly appetite may crave; but, it is generally right to let them have a little of what they eagerly defire, though it may not feem altogether proper. What the patient longs for, his ftomach will generally digeft ; and, fuch things have fome- times a very happy effect. We fhould, however, be careful to diftinguifh between a longing for any thing, and the incoherent wifhes of perfons in a delirium. When a patient is recovering from a fever, great care is neceffary to prevent a relapfe. Many per- fons, by too foon imagining themfelves well, have loft their lives, or contracted other difeafes of an obftinate nature. As the body, after a fever, is weak and delicate, it is neceffary to guard againft catching cold. Moderate exercife in the open air L 4 will 152 OF INTERMITTING FEVERS, &c. will be of ufe, but great fatigue is, by all means, to be avoided ; agreeable company will alfo have a. good effect. The diet muft be light, but nourifhing. It fliould be taken frequently, but in fmall quantities. It is dangerous, at fuch a time, to eat as much as the ftomach may crave. CHAP. XIV. Of Intermitting Fevers, or Agues. Intermitting fevers afford the belt opportunity, both of obferving the nature of a fever, and alfo the effects of a medicine. No perfon can be at a lofs to diftinguilh an intermitting fever from any other, and the proper medicine for it, is now almoft univerfaliy known. The feveral kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c. CAUSES.—Agues are occafioned by effluvia from putrid ftagnating water. This is evident from their abounding in rainy feafons, and being moft frequent in countries where the foil is marfliy, as in Holland, the fens of Cambridgeshire, the Hundreds of Effex, &e. This difeafe may alfo be occafioned by eating too much fruit, by a poor watery diet, by drinking cold liquors, damp houfes, expofure to the fun, evening dews, lying upon the damp ground, watching, fatigue, depreffing paffions, and the like. When the inhabitants of a high country remove to ft. low one, they are generally feized with intermitting fevers, OF INTERMITTING FEVERS. 153 fevers, and. to fuch the difeafe is moft apt to prove fatal. In a word, whatever relaxes the folids, di- minishes the perfpiration, or obstructs the circulation in the capillary or fmall veffels, difpofes the body to agues. SYMPTOMS.—An intermitting fever generally begins with a pain of the head and loins, wearinefs of the limbs, coldnefs of the extremities, ftretching, yawning, with fometimes great ficknefs and vomiting; to which fucceed fliivcring and violent making; this is followed by confiderable heat, and a quick, full, hard pulfe, which lafts from half an hour to one, two or three hours. Afterwards the fkin becomes moift, and a profufe fweat breaks out, which generally ter- minates the fit or paroxyfm. Sometimes indeed the difeafe comes on fuddenly, when the perfon thinks himfelf in perfect health; but it is more commonly preceded by liftleffnefs, lofs of appetite, and the fymptoms mentioned above. REGIMEN.—While the fit continues the patient ought to drink freely of water-gruel, lemonade, weak camomile tea; or, if his fpirits be low, fmall wine- whey, fliarpened with the juice of lemon. All his drink fhould be warm, as that will affift in bringing on the fweat, and confequently fhorten the par roxyfm *. * Dr, Lind fays, that twenty or twenty-five drops of lauda- num, put into a cup of the patient's drink, and given about half an hour after the commencement of the hot fit, promotes the fweat, fhortens the fit, relieves the head, and tends greatly to remove the difeafe. There is no doubt that this remedy will often effectually re- move it—and from one to two grains of opium given an hour before the cold fit is expected, will alfo flop the fit, and often cure the difeafe. Between iS4 OF INTERMITTING FEVERS. Between the paroxyfms the patient muft be fup. ported with food that is nourifliing, but light and eafy of digeftion, as veal or chicken broths, fago, gruel with a little wine, light puddings, and fuch like. He may drink infufions of bitter herbs, as camomile, worm-wood, or centaury, and may now and then take a glafs of fmall wine, in which gen- tian root, centaury, or fome other bitter, has been infufed. As the chief intentions of cure in an ague are to brace the folids, and promote perfpiration, the pa- tient ought to take as much exercife between the fits as he can bear. If he be able to go abroad, riding on horfeback, or in a carriage, will be of great fer- vice. But if he cannot bear rhat kind of exercife, he ought to take fuch as his ftrength will permit. Nothing tends more to prolong an intermitting fever, than indulging a lazy indolent difpofition. MEDICINE.—The firft thing to be done in the cure of an intermitting fever, is to cleanfe the Sto- mach and bowels. This not only renders the appli- cation of other medicines more fafc, but likewife more efficacious. In this difeafe, the ftomach is generally loaded with cold vifcid phlegm, and fre- quently great quantities of bile are difcharged by vomit; which plainly points out the neceffity of fuch evacuations. Vomits are therefore to be adminiftered before the patient takes any other medicine. A dofe of ipecacuanha will generally anfwer this purpofe very well. Fifteen grains or a feruple of the pow- der will be fufficient for an adult, and for a younger perfon the dofe muft be lefs in proportion. After the vomit begins to operate,*the patient ought to drink plentifully of weak camomile-tea. The vomit fhould be taken two or three hours before the return of the fit. Vomits not only cleanfe the ftomach, but increafe the perfpiration, and all the other fecretions, which OF INTERMITTING FEVERS. jc5 which render them of fnch importance, that they often cure intermittent fevers without the affiftance of any other medicine. Purging medicines are likewife ufeful and often neceffary in intermitting fevers. A fmart purge has been known to cure an obftinate ague, after the Peruvian bark and other medicines had been ufed in vain. Vomits however are more fuitable in this dif- eafe, and render purging lefs neceffary; but if the patient be afraid to take a vomit, he ought in this cafe to cleanfe the bowels by a dofe or two of jalap, or rhubarb. Bleeding may fometimes be proper at the begin- ning of an intermitting fever, when exceffive heat, a delirium, &c. give reafon to fufpect an inflamma- tion; but as the blood is feldom in an inflammatory ftate in intermitting fevers, this operation is rarely neceffary. When frequently repeated, it tends to prolong the difeafe. After proper evacuations the patient may fafely ufe the Peruvian bark, which may be taken in any way that is moft agreeable to him. No preparation of the bark feems to anfwer better than the moft fimple form in which it can be given, viz. in powder. Two ounces of the beft Peruvian bark, finely powdered, may be divided into twenty-four dofes. Thefe may either be made into boluffes as they are ufed, with a little fyrup of lemon, or mixed in a glafs of red wine, a cup of camomile-tea, water- gruel, or any other drink that is more agreeable to the patient*. The Peruvian bark frequently occa- fions a ficknefs at ftomach; this may often be pre- * It has lately been obferved, that the red bark is more pow- erful than that which has for fome time been in common ufe. vented r$6 OF INTERMITTING FEVERS. vented by eating nothing but clear broth. If it pur. ges, add three or four drops of laudanum to each dofe—If it renders the body coftive, add five or fix grains of rhubarb to every dofe till it purges. In an ague which returns every day, one of the above dofes may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or fix dofes between each paroxyfm. In a tertian or third day ague it will be fufficient to take a dofe every third hour during the 'interval, and in a quartan every fourth. If the pa- tient cannot take fo large a dofe of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young perfon a fmailer quantity cf this medicine will be fuflicient, and the dofe muft be adapted to the age, conftitution, and vio- lence of the fymptoms *. The above quantity of bark will frequently cure * an ague; the patient, however, ought not to leave off taking the medicine as foon as the paroxyfms are Stopped, but fhould continue to ufe it till there is j reafon to believe the difeafe is entirely overcome. J Moft of the failures in the cure of this difeafe arc j owing to patients not continuing to ufe the medicine long enough. They are generally directed to take' it till the fits are Stopped, then to leave it off, and \ *' In intermitting fevers of an obftinate nature, I have found it neceffary to throw in the bark much fafter. Indeed the be- nefits arifmg from this medicine depend chiefly upon a large quantity of it being adminiftered in a fhort time. Several ounces of bark given in a few days will do more than as many pounds taken in the courfe of fome weeks. When this medicine is intended either to flop a mortification, or cure an obftinate ague, it ought to be thrown in as faft as the ftomach can pof- fibly bear it. Inattention to this circumftance has hurt the re- putation of one of the beft medicines of which we are in pof- feflion. begin OF INTERMITTING FEVERS. itf begin again at fome diftance of time; by which means the difeafe gathers ftrength, and often returns With as much violence as before. A relapfe may always be prevented by the patient's continuing to take fmall dofes of the medicine for fome time after the fymptoms difappear. This is both the moft fafe and effectual method of cure. An dunce of gentian root, calamus aromaticus, and orange peel, of each half an ounce, with three or four hanclfuls of camomile-flowers, and an hand- ful of coriander-feed, all bruifed together in a mor- tar, may be ufed in form of infufion or tea. About half an handful of thefe ingredients may be put into a tea-pot, and a pint of boiling water poured on them. A cup of this infufion drank three or four times a-day will greatly promote the cure. Such patients as cannot drink the watery infufion, may put two handfuls of the fame ingredients into a bottle of white wine, and take a glafs of it twice or thrice a-day. If patients drink freely of the above, or any other proper infufion of bitters, a fmaller quantity of bark than is generally ufed, will be fufficient to cure an ague*. Thofe who cannot fwallow the bark in fubftance, may take it in decoction or infufion. An ounce of bark in powder may be infufed in a bottle of white wine for four or five days, frequently fhaking the * There is reafon to believe, that fundry of our own plants or barks, whicn are very bitter and aftringent, would fucceed in the cure of intermittent fevers, efpecially when affifted by aromatics. But as the Peruvian bark has been long approved in the cure of this difeafe, and is now to be obtained at a very reafonable rate, it is of lefs importance to fearch after new me- dicines. We cannot, however, omit taking notice, that the Peruvian bark is very often adulterated, and that it requires confiderable fkill to diftinguifh between the genuine and the falfe. This ought to make people very cautious of whom they purchafe it. bottle, 158 OF INTERMITTING FEVERS. bottle, afterwards let the powder fubfide, and pour off the clear liquor. A wine glafs may be drank three or four times a day, or oftener, as there is oc- cafion. If a decoction he more agreeable, an ounce of the bark, and two drams of Shake root bruifed, with an equal quantity of fait of worm-wood, may be boiled in a quart of water, into an Englifli pint. To the ftrained liquor may be added an equal quan- tity of red wine, and a glafs of it taken frequently. In an obftinate tertian or quartan, in the end of autumn, or beginning of winter, warm and cordial medicines are abfolutely neceffary *. Obftinate autumnal agues are cured by blifters to the wrifts; winter agues, by bleeding, if the pulfe will bear it: after thefe the bark to be given, as in common cafes of ague. As autumnal and winter agues generally prove much more obftinate than thofe which attack the , patient in fpring or fummer, it will be neceffary to continue the ufe of medicines longer in the former j than in the latter. A perfon who is feized with an intermitting fever in the beginning of winter, ought frequently, if the feafon proves rainy, to take a little medicine, although the difeafe may feem to be cured, to prevent a relapfe, till the return of the warm feafon. He ought likewife to take care not to be much abroad in wet weather, efpecially in cold eafterly winds. When agues are not properly cured, they often degenerate into obftinate chronical difeafes, as the * In obftinate agues, when the patient is old, the habit phlegmatic, the feafon rainy, the fituation damp, or the like, it will be neceffary to mix with two ounces of the bark, half an ounce of Virginia fnake-root, and a quarter of an ounce of gin- ger, or fome other warm aromatic ; but when the fymptoms are of an inflammatory nature, half an ounce of fat of wormwond or fait of tartar may be added to the above quantity of barb cropfy, OF INTERMITTING FEVERS. 159 dropfy, jaundice, &c. For this reafon, all poffible care fhould be taken to have them radically cured, before the conftitution has been too much weakened. Though nothing is more rational than the method of treating intermitting fevers, yet, by fome ftrange infatuation, more charms and whimfical remedies are daily ufed for removing this, than any other difeafe. there is hardly an old woman who is not in poffeffion of a noftrum for Stopping an ague ; and it is amazing with what readinefs their preten- fions are believed. Thofe in diftrefs eagerly grafp at any thing that promifes fudden relief; but the fhorteft way is not always the beft in the treatment of difeafes. The only method to obtain a fafe and lafting cure, is gradually to affift Nature in removing the caufe of the diforder. Some indeed try bold, or rather fool-hardy expe- riments to cure agues, as drinking great quantities of ftrong liquors, jumping into a river, &c. Thefe may fometimes have the defired effect, but muft al- ways be atrended with danger *. When there is any degree of inflammation, or the leaft tendency to it, fuch experiments may prove fatal. The only patient whom I remember to have loft in an intermittent fe- ver, evidently killed himfelf by drinking ftrong li- quor, which fome perfon had perfuaded him would prove an infallible remedy. Half an ounce of the flowers of fulphur taken in milk an hour before the cold fit, will often cure an ague : So will a ftrong in- fufion of gentian—flannel fhirt—change of air ; thefe are fafe and rational remedies. Many dirty things are extolled for the cure of in- termitting fevers, as fpiders, cobwebs, fnuffings of * Arfenic has of late been recommended as an infallible re- medy in the ague ; but I would advife that it fhould be ufed •nly under the eye of a phyfician. candles, l6o OF INTERMITTING FEVERS. candles, Sec. Though thefe may fometimes fucceed, yet their very naftinefs is fufficient to fet them afide, efpecially when cleanly medicines will anfwer the purpofe better. The only medicine that can be de. pended Upon, for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be ufed with fafety: and I can honeftly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly perfifted in. Where agues are endemical, even children are often afflicted with that difeafe. Such patients are very difficult to cure, as they can feldom be prevailed upon to take the bark, or any other difagreeabfe medicine. One method of rendering this medicine more palatable, is to make it into a mixture with diftilled waters and fyrup, and afterwards to give it an agreeable Sharpnefs with the elixir or fpirit of vi- triol. This both improves the medicine, and takes off the naufeous tafte. In cafes where the bark can- not be adminiftered, the faline mixture may begivenO ■ with advantage to children #. , 1 Wine-whey is a very proper drink for a child in the cold fit of an ague ; to half a pint of which may ' be put a teafpoonful of the fpirit of hartfhorn. Ex- ercife is likewife of confiderable fervice; and when the difeafe proves obftinate, the child ought, if pof* ! ffible, to be removed to a warm dry air. The food ought to be nourishing, and fometimes a little gene- rous wine Should be allowed. To children, and fuch as cannot fwallow the bark, or when the ftomach will not bear it, may be given by clyfter, Half an ounce of the extract of bark, ciffolved in four ounces of warm water, with fix or eight drops of laudanum, in the form recommended by Dr. Lind for an adult, and this to be repeated '* See Appendix, Saline mixture. i every i OF INTERMITTING FEVERS. x6i every fourth hour, or oftener, as the occafion fhall require. For children, the quantity of extract and laudanum muft be proportionably leffened. Children have been cured of agues, by making them wear a waiftcoat with powdered bark quilted between the folds of it; by bathing them frequently in a ftrong decoction of the bark, and by rubbing the fpine with ftrong fpirits, or with a mixture of equal parts of laudanum and the faponaceous liniment. We have been the more full upon this fubject, be- cairfe it is very common, and becaufe few patients in an ague apply to phyficians, unlefs in extremities. There are, however, many cafes in which the difeafe is very irregular, being complicated with other dif- eafes, or attended with fymptoms which are both very dangerous and very difficult to underftand. All thefe we have purpofely paffed over, as they would only bewilder the generality of readers. When the difeafe is very irregular, or the fymptoms dangerous, the patient ought immediately to apply to a phyfi- cian, and Strictly to follow his advice. To prevent agues, people muft endeavour to avoid their caufes. Thefe have been already pointed out in the beginning of this fection ; we fliall therefore only add one preventative medicine, which may be of ufe to fuch as are obliged to live in low marfhy countries, or who are liable to frequent attacks o. this difeafe. Take a tea-fpoonful of good Peruvian bark three times a-day, in a little water, or wine and water. M CHAP. C 162 ] CHAP. XV. i Of an Acute Continual Fever. -I HIS fever is denominated acute, ar. dent, or inflammatory. It moft commonly attacks the yoilng, or perfons about the prime or vigour of life, efpecially fuch as live high, abound with blood, and whofe fibres are ftrong and elaftic. It feizes people at all feafons of the year ; but is moft frequent ; in the fpring. CAUSES.—An ardent fever may be occafioned by any thing that overheats the body, or produces plethora, as violent exercife, fleeping in the fun, drinking ftrong liquors, eating fpiceries, a full diet, with little exercife, &c. It may likewife be occa- fioned by whatever obftructs the perfpiration, as lying on the damp ground, drinking cold liquor when the body is hot, night-watching, or the like. SYMPTOMS.—A rigour or chillinefs generally ufliers in this fever, which is foon fucceeded by great heat, a frequent and full pulfe, pain of the head, dry fkin, rednefs of the eyes, a florid coun- tenance, pains in the back, loins, &c. To thefe fuc- ceed difficulty of breathing, ficknefs, with an incli- nation to vomit. The patient complains of great thirft, has no appetite for folid food, is reftlefs, and his tongue generally appears black and rough. A delirium, exceffive reftleffnefs, great oppreflion of the breaft, with laborious refpiration, ftarting of ! the tendons, hiccup, cold clammy fweats, and an involuntary difcharge of urine, are very dangerofla 1 fymptoms. As OF AN ACUTE CONTINUAL FEVER. 163 As this difeafe is always attended with danger, the beft medical afiftance ought to be procured as foon as poffible. Nothing can be more unaccountable than the conduct of thofe who have it in their pow- er, at the beginning of a fever, to procure the beft medical affiftance, yet put it off till things come to an extremity. When the difeafe, by delay or wrong treatment, has become incurable, and has exhausted the ftrength of the patient, it is in vain to hope for relief from medicine. Phyficians may indeed affift Nature ; but their attempts will ever prove fruitlefs, when fhe is no longer able to co-operate with their endeavours. REGIMEN.—From the fymptoms of this dif- eafe, it is evident that the blood and other humors require to be diluted ; that the perfpiration, urine, faliva, and all the other fecretions, are in too fmail quantity; that the veffels are rigid, and the heat of the whole body too great : all thofe clearly point out the neceffity of a regimen calculated to dilute the blood, correct the acrimony of the humors, allay the exceffive heat, remove the fpafmodic ftricture of the veffels, and promote the fecretions. Thefe important purpofes may be greatly pro- moted by drinking plentifully of diluting liquors ; as water-gruel, or oatmeal tea, clear whey, barley- water, balm-tea, apple-tea, &c. Thefe may be fharp- ened with juice of orange, jelly of currants, rafp- berries, and fuch like: orange-whey is likewife an excellent cooling drink. It is made by boiling'among milk and water a bitter orange fliced, till the curd feparates. If no orange can be had, a lemon, a little cream of tartar, or a few fpoonfuls of vinegar, will have the fame effect. Two or three table fpoonfuls of white wine may occafionally be added to the liquor when boiling. M 2 If i64 OF AN ACUTE CONTINUAL FEVER. If the patient be coftive, an ounce of tamarinds, with two ounces of ftoned raifins of the fun, and a couple of figs, may be boiled in three pints of water to a quart. This makes a very pleafant drink, and may be ufed ar difcretion. The common pectoral infufion is likewife a very proper drink in this difeafe. A tea-cupful of it may be taken every two hours, or oftener, if the patient's heat and thirft be very great *. The above liquids muft all be drank a little warm. They may be ufed in fmaller quantities at the begin- ning of a fever, but more freely afterwards, in order to affift in carrying off the difeafe by promoting the different excretions." We have mentioned a variety of drinks, that the patient may have it in his power J to chufe thofe which are moft agreeable ; and that, when tired of one, he may have recourfe to another. The patient's diet muft be very fpare and light. All forts of flefh-meats, and even chicken-broths, are to be avoided. He may be allowed panada, or light bread boiled in water ; to which may be added, a few grains of common fair, and a little fugar, which will render it more palatable. He may eat roafted apples with a little fugar, toafted bread with jelly of currants, boiled prunes, &c. It will greatly relieve the patient, efpecially in an hot feafon, to have frefh air frequently let into his chamber. This, however, muft always be done in fuch a manner as not to endanger his catching cold. It is too common in fevers to load the patient with.bed clothes, under the pretence of making him fweat, or defending him from the cold. This cuftom is always wron^, and has many ill effects. It increafes the heat of the body, fatigues the patient, and re- tards, inftead of promoting, the perfpiration. * See. Appendix, Peroral infufion. Sitting OF AN ACUTE CONTINUAL FEVER. 165 Sitting upright in bed, if the patient is able to ' bear it, will often have a good effect. It relieves the head{ by retarding the motion of the blood to the brain. But this pofture ought never to be con- tinued too long: and if the patient is inclined to fweat, it will be morr fafe to let him lie, only raifing his head a little with pillows. The judicious Syden- ham has advifed, with great propriety, to let the pa- tient lie on the bed with his clothes on, unlefs where we Willi to promote a fweat. Sprinkling the chamber with vinegar will greatly refrefli the patient. This ought to be done frequently, efpecially-if the weather is hot. The patient's mouth fhould be often wafhed with a mixture of wr.ter and honey, to which a little vine- gar may be added, or with a decoction of figs, in barley-water. His feet ought likewife frequently to be bathed at bed-time, in lukewarm water j efpecially if the head is affected. The patient fliould be kept as quiet and eafy as poffible. Company, noife, and every thing that difturbs the mind, is hurtful, Even roo much light, or any thing that affects the fenfes, ought to be avoided. His attendants fliould be as few as pof- fible, and they ought not to be too often changed. His inclinations ought rather to be foothed than con- tradicted ; even the promife of what he craves will often fatisfy him as much as its reality. MEDICINE.—In this and ail other fevers, at- tended with a hard, full; quick pulfe, bleeding is of the greateft importance. This operation ought al- ways to be performed as foon as the fymptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, muft be in proportion to the ftrength of the patient and the violence of the difeafe. If, after the firft bleeding, the fever fhould increafe, and the pu'fe become more frequent and M 3 hard, 166 OF AN ACUTE CONTINUAL FEVER. hard, there will be a neceffity for repeating it a fecond, and perhaps a third, or even a fourth time; which may be done at the diftance of twelve, eighteen, or twenty-four hours from each other, as the fymptoms require. If the pulfe continues foft, and the pa* tient is tolerably eafy after the firft bleeding, it ought not to be repeated. If the heat and fever be very great, forty or fifty drops of the dulcified or fweet fpirit of nitre may be made into a draught, with three ounces of common water, and half an ounce of fimple fyrup, or a bit of loaf-fugar. This draught may be given to the pa- tient every three or four hours while the fever is violent; afterwards once in five or fix hours will be fufficient. If the patient be afflicted with retching, or an in- clination to vomit, it will be right to affift Nature's attempts, by giving him weak camomile tea, or luke- warm water to ci j ink. If the body is bound, an ounce of Glauber falts fliould be given, after which a clylter of milk and water with a little fait, and a fpoonful of fweet oil or frefli butter in it, ought daily to be administered. Should this not have the defired effect, a tea-fpoon- ful of magnefia alba, or cream of tartar may be fre- quently put into his drink. He may likewife eat tamarinds, boiled prunes, roafted apples, and the like. After this, if the fever continues, give the ni- trous powders. See Appendix. If about the tenth, eleventh, or twelfth day, the pulfe becomes more foft, the tongue moiftcr, and the urine begins to let fail a reddifli fediment, there is reafon to expect a favourable iffue to the difeafe. But if, inftead of thefe fymptoms, the patient's fpi- rits grow languid, his pulfe finks, and his breathing becomes difficult; with a ftupor, trembling of the utrves, ftarting of the tendons, &c. there is reafon to OF AN ACUTE CONTINUAL FEVER. / 167 to fear that the confequences will be fatal. In this cafe bliftering plafters muft be applied to the head, ancles, infide of the legs or thighs, as there may be occafion; poultices of wheat bread, muftard, and vinegar, may likewife be applied to the foles of the feet, and the patient muft be fupported with cordials, as ftrong wine-whey, negus, fago-gruel with wine in it, and fuch like. A proper regimen is not only neceffary during the fever, but likewife after the patient begins to reco- ver. Though the bodv is weak after a fever, yet the diet for fome time ought to be rather light than of too nourishing a nature. Too much food, drink, exercife, company, &c. are carefully to be avoided. The mind ought likewife to be kept eafy, and the patient fliould not attempt to purfue Study, or any bufinefs that requires intenfe thinking. If the digeftion is bad, or the patient is feized at times with feverifh heats, an infufion of Peruvian bark in cold water will be of ufe. It will Strengthen the ftomach, and help to fubduc the remains of the fever. Thofe who follow laborious employments ought not to return too foon to their labour after a fever, but fhould keep eafy till their ftrength and fpirits are fufficiently recruited *. * The pure acute continual fever is feldom met with; how- ever, as it generally accompanies local inflammations, fuch as pleurify, rheumatifm, &c. I have retained this chapter ; more *fpecia|y as the remarks contained in it are very judicious. M 4 CHAP. C 168 ] CHAP. XVI. t m J Of the Pleurify. 1 HE true pleurify is an inflammation of that membrane called the pleura* which lines the ia- fide of the breaft. There is likewife a fpecies of this difeafe, which is cailed the fpurious or baftari tilcurify, in which the pain is more external, and chiefly affects the mufcles between the ribs. This is, Strictly fpeaking, a rheumatifm. It is moft frequent i in the fpring feafon. GAUSES.—The pleurify may be occafioned by whatever obstructs the perfpiration; as cold winds; drinking cold liquors when the body is hot; fleeping without doors on the damp ground; wet clothes; plunging the body into cold water, or by expofing it to the cold air, when covered with fweat, Sec. It may likewife be occafioned by drinking ftrong li- quors ; by the Stoppage of ufual evacuations; as old ulcers, iffues, fweating of the feet or hands, &c. the fudden ftriking in of any eruption, as the itch, the meafles, or the fmall-pox, or by a mifplaced gout, or by worms. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this difeafe. A pleurify may likewife be occafioned by violent exercife, as running, wreftling, leaping or by fupporting great weight, blows on the breaft, &c. A bad conformation of the body renders perfons more liable to this difeafe, as a narrow cheft, a ftraknefs of the arteries of the pleura, Sec. SYMP- OF THE PLEURISY. ict? SYMPTOMS.—This, like moft other fevers, ge- nerally begins with chillinefs and ihivering, which are followed by heat, thirft, and reftleffnefs. To thefe fucceeds a violent p'ricking pain in one of the fides among the ribs. Sometimes the pain extends towards the back-bone, fometimes towards the fore- part of the breaft, and at other times towards the fhoulder blades. The pain is generally moft violent when the patient draws his breath. A diftreffing cough ufually attends this difeafe. The pulfe, in this difeafe, is commonly quick and hard, the urine high-coloured; and if blood be let, it is covered with a tough cruft, or buffy coat. The patient's fpittle is at firft thin, but afterwards it be- comes groffer, and is often Streaked with blood. REGIMEN.—-Nature often endeavours to carry off this difeafe bv a critical difcharge of blood from J O fome part of the body, or by expectoration, fweat, loofe Stools, thick urine, or the like. We ought, therefore, to fecond her intentions by leffening the force of the circulation, relaxing the veffels, diluting the humors, and promoting expectoration. For thefe purpofes the diet, as in the former dif- eafe, ought to be cool, Slender, and diluting. The patient muft avoid all food that is vifcid, hard of di- geStion, or that affords much nourifhment; as flefh, butter, cheefe, eggs, milk, and alfo every thing that is of an heating nature. His drink may be whey, or an infufion of pectoral and balfamic vegetables*. Barley-water, with a little honey or jelly of cur- rants mixed with it, or merely fweetened with fugar, is likewife a very proper drink in this difeafe. It is made by boiling an ounce of barley in three pints of water to two, which muft afterwards be Strained. The decoction of figs, raifins, barley, recommended * See Appendix, Peroralinfufion. in 170 OF THE PLEURISY. in the preceding difeafe, is here likewife very pro- per. Thefe and other diluting liquors are not to be drank in large quantities at a time, but the patient ought to keep continually' fipping them, fo as to render his mouth and throat always moift. All his food and drink fliould be taken juft warm. The patient fliould be kept quiet, cool, and every way eafy, as directed under the foregoing difeafed His feet ought daily to be bathed in lukewarm water; and he may fometimes fit up in bed for a Short fpace, in.order to relieve his he«d. MEDICINE.—Aimoft every perfon knows, when a fever is attended with a violent pain of the fide, and a quick hard pulfe, that bleeding is neceffary. When thefe fymptoms come on, the fooner this ope. ration is performed the better; and the quantity at firft muft be pretty large, provided the patient is able to bear it. A large quantity of blood let at once, in the beginning of a pleurify, has a much better effect than repeated fmall bleedings. A man may loofe twelve oh fourteen ounces of blood as foon as it is certainly known that he is feized with a pleurify. For a younger perfon, or one of a delicate constitu- tion, the quantity muft be lefs. A blifter may be applied on the painful part, five or fix hours after the bleeding, if the pain continues, and the pulfe does not require another bleeding. If, after the firft bleeding and blistering, the Stitch, with the other violent fymptoms, fliould ftiil conti- nue, it will be neceffary, at the diftance of twelve or eighteen hours, to let eight or nine ounces more. If the fymptoms do not then abate, and the blood fhews a ftrong buffy coat, a third or even a fourth bleeding may be requifite. If the pain of the fide abates, the pulfe becomes fofter, or the patient he- gins to fpit freely, bleeding ought not to be repeated, This operation is feldom neceffary after the third cr fourth OF THE PLEURISY. i?1 fourth day of the fever, and ought not then to be performed, unlefs in urgent circumftances. The blood may be many ways attenuated without bleeding. There are likewife many things that may be done to eafe the pain of the fide without this ope- ration, as fomenting, &c. Fomentations may be made by boiling an handful of the flowers of elder, camomile, and common mallow's, or any other foft vegetables, in a proper quantity of water. The herbs may be either put into a flannel bag, and ap- plied warm to the fide, or flannels may be dipped in the decoction, afterwards wrung out, and applied to the part affected, with as much warmth as the pa- tient can eafily bear. As the cloths grow cool, they muft be changed, and great care taken that the pa- tient do not catch cold. A bladder may be filled with warm milk and water, and applied to the fide, if the above method of fomenting be found inconve- nient. Fomentations not only eafe the pain, but relax the veffels, and prevent the Stagnation of the blood and other humors. The fide may likewife be frequently rubbed with a little of the volatile lini- ment*. Topical bleeding has often a very good effect in this difeafe. It may either be performed by apply- ing a number of leeches to the part affected, or by cupping, which is both a more certain and expedi- tious method than the other. Leaves of various plants might likewife be applied to the patient's fide with advantage. I have often feen great benefit from young cabbage-leaves applied warm to the fide in a pleurify. Thefe not only relax the parts, but likewife draw off a little moifture. To prevent a ftranguary when the bliftering-piafter is on, the patient may drink freely of barley-water. * See Appendix, Volatile liniment. If 172 OF THE PLEURISY. If the patient is coftive, a purge of glaubcr fairs, or a clyfter of thin water-gruel, or of barley-water, in which a handful of mallows, or any other emol- lient vegetable has been boiled, may be daily admi- niftered. This will not only empty the bowels, but have the effect of a warm fomentation applied to the inferior vifcera, which will help to make a derivation from the breaft. The expectoration, or fpitting may be promoted by fharp medicines, or by drinking plentifully of ' barley-water, flaxfeed-tea, or bran-tea. If medicines are neceffary, when the patient is not much reduced, give one of the nitrous powders every two or three hours ; if the pulfe is low, one of the volatile bolufes in the fame time. We fhall only mention one medicine more, which fome reckon almoft a fpecific in the pleurify, viz. the decoction of the feneka rattle-fnake root *. After bleeding and other evacuations have been premifed, the patient may take two, three, or four tabie-fpoon- fuls of this decoction, according as his ftomach will bear it, three or four times a-day. If it fliould oc- cafion vomiting, two or three ounces of fimple cin- namon-water may be mixed with the quantity of de- coction here directed, or it may be taken in fmailer dofes. As/this medicine piomotes perfpiration and urine, and likewife keeps the body eafy, it may,be of fome fervice in a pleurify, or any other inflammation of the breaft. No one will imagine that th^fe medicines are all , to be ufed at the fame time. We have mentioned different things, on purpofe that people may have it in their power to chufe ; and likewife, that when one cannot be obtained, they may make ufe of an- other. Different medicines are no doubt neceffary in the different periods of a diforder ; and where one * See Appendix, DeccCllon offncha root. fails OF THE PLEURISY. 173 fails of fuccefs, or difagrees with the patient, it will be proper to try another. What is called the crifis, or heigtu of the fever, is fometimes attended with very alarming fymptoms, as difficulty of breathing, an irregular pulfe, convul- five motions, &c. Thefe are apt to frighten the at- tendants, and induce them to do improper things, as bleeding the patient, giving him ftrong Stimu- lating medicines, or the like. But they are only the Struggles of Nature to overcome the difeafe, in which fhe ought to be affifted by plenty of diluting drink, which is then peculiarly neceffary. If the patient's ftrength, however, be much exhaufted by the difeafe, it will be neceflary at this time to fupport him with frequent fmall draughts of wine-whey, negus, or the like. When the pain and fever are gone, it will be pro- per, after the patient has recovered fufficient ftrength, to give him fome gentle purges, as thofe directed towards the end of the acute continual fever. He ought likewife to ufe a light diet, of eafy digeStion, and his drink fhould be butter-milk, whey, and other things of a cleanfing nature. OF THE BASTARD PLEURISY. That fpecies of pleurify which is called the baftard or fpurious, generally goes off by keeping warm for a few days, drinking plenty of diluting liquors, and obferving a cool regimen. It is known J)y a dry cough, a quick pulfe, and a difficulty of lying on the affected fide, which laft does not often happen in the true pleurify. Sometimes indeed this difeafe proves obftinate, and requires bleeding, with cupping, and fcarifications of the part affected, thefe, together with the ufe of nitrous and ether cooling medicines,feldom fail to effect a cure. OF [ 174 ] OF THE PARAPHRENIAS. THE paraphrenitis, or inflammation of the dia« phragrh, is fo nearly connected with the pleurify, and refembles it fo much in the manner of treatment, that it is fcarcely neceffary to confider it as a feparate difeafe. It is attended with a very acute fever, and an ex- treme pain in the part affected, which is generally augmented by coughing, fneezing, drawing in the breath, taking food, going to ftool, making water, &c. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm; is reftlefs, anxious, has a dry cough, an hiccup, and often a delirium. A convulsive laugh, or rather a kind of involuntary grin, is no uncommon fymptom of this difeafe. Every method muft be taken to prevent a fuppu- ration. The regimen and medicine are in all re- flects the fame as in the pleurify. We fhall only add, that in this difeafe emollient clyfters are peculiarly ufeful, as they relax the bowels, and by that means make a derivation from the part affected. CHAP C *75 3 . CHAP. XVII. % Of a Peripneumony, or Inflammation of the Lungs* x\S this difeafe affects an organ which is abfolutely neceffary to life, it muft always be at- tended with danger. Perfons whofe fibres are tenfe and rigid, who feed upon grofs aliment, and drink ftrong vifcid liquors, are moft liable to a peripneu- mony. It is moft fatal to thofe who have a flat breaft, or narrow cheft, and to fuch as are afflicted with an afthma, efpecially in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole of the organ is affected ; in which cafe the difeafe can hardly fail to prove fatal. When the difeafe proceeds from a vifcid pituitous matter obstructing the veffels of the lungs, it is called 2.fpurious or baftard peripneumony. When it arifes from a thin acrid deflnction on the lungs, it is deno- minated a catarrhal peripneumony, Sec. CAUSES.----An inflammation of the lungs is fometimes a primary difeafe, and fometimes it is the confequence of other difeafes, as a quinfcy, a pleu- rify, &o. It proceeds from the fame caufes as the pleurify, viz. an obftructed perfpiration from cold, wet clothes, Sec. or from an increafed circulation of the blood by violent exercife, the ufe of fpiceries, ardent fpirits, and fuch like. The pleurify and pe- ripneumony are often complicated ; in which cafe the difeafe is called a pleuro-peripneumony *. * The fact is, that it is difficult to diftinguifh between a pleurify and peripneumony; and the fame treatment is proper for both. SYMP- 176* OF A PERIPNEUMONY. SYMPTOMS.—Moft of the fymptoms of a pleu- rify likewife attend an inflammation of the lungs; only in the latter the pulfe is more foft, and the pain lefs acuje; but the difficulty of breathing, and op. preffion of the breaft, are generally greater. REGIMEN.—As the regimen and medicine are in all refpects the fame in the true peripneumony as in the pleurify, we fliall not here repeat them, but refer the reader to the treatment of that difeafe. It may not, however, be improper to add, that the ali- ment ought to be more flender and thin in this than in any other inflammatory difeafe. The learned Dr. Arbuthnot afferts, that even common whey is fuffi- cient to fupport the patient, and that decoctions of barley, and infufions of fennel roots in warm water, with milk, are the moft proper both for drink and nourishment. He likewife recommends the Steam of warm water taken in by the breath, which fervea as a kind of internal fomentation, and helps to atte- nuate the impacted humors. ' If the patient has loofe ftools, but is not weakened by them, they are not to be flopped, but rather promoted by the ufe of emol- lient clyfters. .It has already been obferved, that the fpurious or baftard peripneumony is occafioned by a vifcid pitui- tous matter obstructing the veffels of the lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and wet feafons. The patient at the beginning is cold and hot by turns, has a fmall quick pulfe, feels a fenfe of weight upon his breaft, breathes with difficulty, and fome- times complains of a pain and giddinefs of his head. His urine is ufually pale, and his colour very little changed. The diet in this, as well as in the true peripneu- mony, muft be very flender, as weak broths, Sharp- ened with the juice of orange or iemon, and fuch i like. OF A PERIPNEUMONY. 177 like. His drink may be thin water-gruel, fweetened With honey, or a decoction of the roots of fen neland liquorice. An ounce of each of thefe may be boiled in three pints of water to a quart, and fharperjjd with a little currant-jelly, or the like. Bleeding and purging, are generally proper at the beginning of this difeafe ; but if the patient's fpittle is pretty thick or well concocted, neither of them is neceffary. It will be fufficient to affift the expec- toration, by fome of the fiiarp medicines recom- mended for that purpofe in the pleurify, as the folu- tion of gum ammoniac with oxymel of fquills, Sec. Blistering plafters, have generally a good effect, and ought to be applied pretty early. If the patient does not fpit, he muft be bled according as his ftrength will permit, and have a gentle purge adminiftered. Afterwards his body may be kept open by clyfters, and the expectoration promoted, by taking every four hours two table- fpoonfuls of the folution mentioned above. When an inflammation of the breaft does not yield to bleeding, blistering, and other evacuations, it commonly ends in a fuppuration, which is more or lefs dangerous, according to the part where it is fituatei. When this happens in the pleura, it fome- times breaks outwardly, and the matter is difcharged by the wound. When the fuppuration happens within the Sub- stance or body of the lungs, the m :tter may be dif- charged by expectoration ; but if the matter floats in the cavity of the breaft, between the pleura and the lungs, it can only be difcharged by an incifion made betwixt the ribs. If the patient's ftrength does not return, after the inflammation is, to all appearance, removed ; if his pulfe continues quick, though fofc, his breathing difficult and oppreffed ; if he has cold fhiverings at N times 178 OF CONSUMPTIONS. times, his cheeks fluSlied, his lips dry; and if he complains of thirft, and want of appetite, there it reafon to fear a fuppuration, and that a phthifis, or confumption of the lungs will enfue. We fliall, therefore, next proceed to confider the proper treat- ment of that difeafe. CHAP. XVIII. Of Confumptions. A CONSUMPTION is a wafting or J decay of the whole body, from an ulcer, tubercles, 1 or concretions of the lungs, or an empyema. <1 Dr. Arbuthnot obferves that, in his time, con- 1 fnmptions made up above one-tenth part of the bills of mortality, in and about London. There is reafon to believe they have rather increafed fince; and we know from experience, that they are not lefs fatal in fome other towns of England, than in London. Young perfons, between the age of fifteen and thirty, of a flender make, long neck, high fhoulders, 1 and flat breafts, are moft liable to this difeafe. Confumptions prevail more in England than in any other part of the world, owing, perhaps, to the great ufe of animal food, and the general application to fedentary employments. To which we may add, the perpetual changes in the atmofphere, or varia- blenefs of the weather. CAUSES.—It has already been obferved, that an inflammation of the brealt often ends in an im- polthume'. OF CONSUMPTIONS. 179 pofthume: confequently, whatever difpofes to this difeafe, muft likewife be considered as a caufe of confumpiion. Other difeafes, by vitiating the habit, may like- wife occafion confumptions ; as the fcurvy, the fcro- phula, or king's evil, the venereal difeafe, the afthma, fmall-pox, meafles, &c. As this difeafe is too feldom cured, we fliall en- deavour the more particularly to point out its caufes, in order that people may be enabled to avoid it. Thefe are: -----Confined or unwholefome air. When this fluid is impregnated with the fumes of metals, or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender veffels of that necef- fary organ. -----Violent paffiens, exertions or affections of the mind ; as grief, difappointmenr, anxiety, or clofe application to the ftudy of abftrufe arts or fciences. -----Great evacuations ; as fweating, diarrhoeas, diabetes, exceffive venery, the fluor alous, an over- difcharge of the menftrual flux,' giving fuck too long, Sec. -----The fudden Stoppage of cuftomary evacua- tions ; as the bleeding piles, fweating of the feet, bleeding at the nofe, the menfes, iffucs, ulcers, or eruptions of any kind. -----Injuries done to the lungs, calculi, Sec. I lately faw the fymptoms of a phthifis occafioned by a fmall bone Sticking in the bronchia. It was after- wards vomited along with a confiderable quantity of purulent matter, and the patient, by a proper regi- men, and the ufe of the Peruvian bark, recovered. -----Making a fudden tranfition from an hot to a very cold climate, change of apparel, or whatever greatly leffens the perfpiration. N 2 •Fre- i8o OF CONSUMPTIONS. -----Frequent and exceffive debaucheries. Late watcning, and drinking ftrong liquors, which gene- rally go together, can hardly fail to deftroy the lungs, Hence the bon compagnon generally falls a facrifice to this dife;«.fe. -----Infection. Confumptions are likewife caught by ffeeping with the difeafed ; for which reafon, this fliould be carefully avoided. It cannot be of great benefit to the fick, and muft hurt thofe in health. -----Occupations in life. Thofe artificers who fit much, and are constantly leaning forward, orpref- fing upon the Stomach and breaft, as cutlers, taylors, Shoe-makers, feamftrcffcs, &c. often die of confump- tions. They likewife prove fatal to fingers, and all who have occafion to make frequent. and violent exertions of the lungs*. -----Cold. More confumptive patients date the beginning of their diforders from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all ether caufes. Sharp, faline, and aromatic aliments, which heat and inflame the blood, are likewife frequently the caufe of confumptions. We fliall only add, that this difeafe is often owing to an hereditary taint, or a fcrophulous habit; in which cafe it is too generally incurable. SYMPTOMS.— this difeafe generally begins with a dry cough, which often continues for fome months. If a difpofition to vomit after eating be excited by it, there is ftill greater reafon to fear an approaching confumption. The patient complain9 of a more than ufual degree of hear, a pain and op- * An eminent phyfician of our country (Dr. Rufli) is, however, of a different opinion, and recommends finging as a euie for this difeu:e. See his Medical Inquiries and Obferva- tions. preffion OF CONSUMPTIONS. 181 preffion of the breaft, efpecially after motion ; his fpittle is of a faltifti tafte, and fometimes mixed with blood. He is apt to be fad ; his appetite is bad, and his thirft great. Theie is generally a quick, foft, fmall pulfe; though fometimes the pulfe is pretty full, and rather hard, thefe arc the common fymptoms of a beginning confumption. Afterwards, the cough encreafes, the' patient begins to fpit a greenifli, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative fweats, which mutually fucceed one an- other, viz. the one towards night, and the other in the morning. A loofenefs, and an exceffive difcharge of urine, are often troublefome fymptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flufhes after eating ; the finders become remarkably fmall, the nails are bent inwards, and the hairs fall off. At laft a diarrhoea, the fwelling of the feet and Jegs, the total lofs of ftrength, the finking of the eyes, the difficulty of fwallowing, and the coldnefs of the extremities, fhew the immediate approach of' death, which, however, the patient feldom believes to be fo near. Such is the ufual p.ogrefs of this fatal difeafe, which, if not early checked, commonly fets all medicine at defiance. REGIMEN.—On the firft appearance of a con- fumption, if the patient lives in a large town, or any place where the air is confined, lie ought immediately ■to quit it, and to make choice of a fituation in the country, where the air is pure and free. Here he muft not remain inactive, but take every day as much exercife as he can bear. The beft method of taking exercife is to ride on horfeback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear N 3 this iSz OF CONSUMPTIONS. this kind of exercife, muft make ufe of a carriage. A long journey, as it amufes the mind by a continual change of objects, is greatly preferable to riding the fame ground over and over. Care, however, muft be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought alwavs to finifh his ride in the morning, or at leaft befortf dinner ; otherwife it will oftener do harm than good. It is a pity that thofe who attend the fick feldom recommend riding in this difeafe, till the patient i* cither unable to bear it, or the malady has become incurable. Patients are likewife apt to trifle with every thing that is in their own power. They can- not fee how one of the common actions of life Should prove a remedy in an obftinate difeafe, and therefore they reject it, while they greedily hunt after relief from medicine, merely becaufe they do not under- itand it. Thofe who have ftrength and courage to under- take a pretty long voyage, may expect great advan- tage from it. This, to my knowledge, has fre- quently cured a confumption after the patient was, to all appearance, far advanced in that difeafe, and where medicine had proved ineffectual. Hence it is reafonable to conclude, that if a voyage were under- taken in due time, it would feldom fail to perform a cuie*. Such as try this method of cure, ought to carry as much frefh provifions along with them as will fervc * Two things chiefly operate to prevent the benefits which would arife from failing. The one is, that phyficians feldom order it 'till the difeafe is too far advanced ; and the other is, tlr.it they fel Jom order a voyage of fufficient length. A patient may receive no benefit by croffing the channel, who, fhould he crofs the Atlantic, might be completely cured. Indeed, we have reafon to believe, that a voyage of this kind, if taken in due time, would Olicm fail to cure a confumption. for OF CONSUMPTIONS. 183 for the whole time they are at fea. As milk is not eafily obtained in this fituation, they ought to live upon fruits, and the broth of chickens or other young animals which can be kept alive on board. It is fcarcely neceffary to add, that fuch voyages Should be under- taken, if poffible, in tlie mildeft feafon, and that they ought to be towards a warmer climate*. Thofe who have not courage for a long voyage, may travel into a more fouthern climate, as the fouth of France, Spain, or Portugal; and if they find the air of thefe countries agree with them, they fhould continue there, at leaft till their health be confirmed f. Next to proper air and exercife, we would re- commend a due attention to diet. The patent fhould eat nothing that is either heating or hard of digeftion, and his drink muft be of a foft and cool- ing nature. All the diet ought to be calculated to leffeu the inflammatory ftate of the fyftem, and to nourifli and fupport the patient. For this purpofe he muft keep chiefly to the ufe of vegetables and milk. Milk alone is of more value in this difeafe, than the whole materia medica. Affes milk is commonly reckoned preferable to any other; but it cannot always be obtained ; be- fides, it is generally taken in a very fmall quantity; whereas, to produce any effects, it ought to make a confiderable part of the patient's diet. It is hardly to be expected, that a gill or two of affes milk, drank * Though I did not remember to have feen one inflance of. a genuine confumption of the lungs cured by medicine, yet I have known a Weil India voyage work wonders in that dread- ful diforder. + For Americans, we may recommend the fame voyage, if practicable. If not, they may go to the fouthern dates in win- ter, and to the eaftern ftates in fummer. If a journey by land is preferred, the back parts of our country are the belt. N 4 in 184 OF CONSUMPTIONS. in the fpace of twenty-four hours, fliould be able to produce any confiderable change in an adult; and when people do not perceive its effects foon, they lofe hope, and fo leave it off. Hence it happens, that this remedy, however valuable, very feldom per- forms a cure. The reafon is obvious; it is com- monly ufed too late, is taken in too fmall quantities, and is not duly perfifted in. i have known extraordinary effects from affes milk in obftinate coughs, which threatened a con- fumption of the lungs; and do verily believe, if ufed at this period, that it would feldom fail; but if it be delayed till an ulcer is formed, which is generally the cafe, how can it be expected to fucceed ? Affes milk ought to be drank, if poffible, in its na- tural warmth, and, by a grown perfon, in the quan- tity of half a pint at a time. Inftead of taking this quantity night and morning only, the patient ought to take it four times, or at leaft thrice a-day, and to eat a little light bread along with it, fo as to make it a kind of meal. If the milk fliould happen to purge, it may be mixed with old conferve of rofes. When that can- not be obtained, the powder of crabs claws may be ufed in its ftcad. Affes milk is ufually ordered to be drank warm in bed ; but as it generally throws the patient in a fweat when taken in this way, it would perhaps be better to give it after he rifes. Some extraordinary cures in confumptive cafes have been performed by women's milk. Could this be obtained in fufficient quantity, we would recom- mend it in preference to any other. It is better if the patient can fuck it from the breaft, than to drink it afterwards. I knew a man who was reduced to fuch a degree of weaknefs in a confumption, as not to be able to turn himfelf in bed. Hi-? wife was at that time giving fuok, and the child happening to OF CONSUMPTIONS. r85 die, he fucked her breafts, not with a view to reap any advantage from the milk, but to make her eafy. Finding himfelf, however, greatly benefited by it, he continued to fuck her till he became perfectly well, and is at prefent a ftrong and healthy man. Some prefer butter-milk to any other, and it is in- deed a very valuable medicine, if the ftomach be able to bear it. It does not agree with every perfon at firft ; and is therefore often laid afide without a fuffi- cient trial. It fhould at firft be taken fparingly, and the quantity gradually increafed, until it comes to be almoft the fole food. I never knew it fucceed un- lefs where the patient lived almoft upon it. Cows milk is moft readily obtained of any, and though it be not fo eafily digefted as that of affes or mares, it may be rendered lighter by adding to it an equal quantity of water, or allowing it to ftand for fome hours, and afterwards taking oft the cream. If it fliould, notwithftanding, prove heavy on the ftomach, a fmall quantity of brandy, with a little fugar, may be added, which will render it both more light and nourishing. Il is not to be wondered at, that milk fliould for fome time difagree with a ftomach that has not been accuftomed to digeft any thing but flefli and ftrong liquors, which is the cafe with many of thofe who fall into confumptions. We do not, however, advife thofe who have been accuftomed to animal food and ftrong liquors, to leave them off all at once. This might bedangerous. It will be neceffary for fuch to eat a little once a day of the flefli of fome young animal, or rather to ufe the broth made of chickens, veal, lamb, or fuch like. They ought likewife to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether. Thefe i85 OF CONSUMPTIONS. Thefe muft be ufed only as preparatives to a diet confifting chiefly of milk and vegetables, which the fooner the patient can be brought to bear, the better. Rice and milk, or barley and milk, boiled with a little fugar, is very proper food. Pipe fruits roafted, baked, or boiled, are likewife proper, as goofeberry or currant tarts, apples roafted, or boiled in milk, &c. The jellies, conferves and preferves, &c. of ripe fubacid fruits, ought to be eaten plentifully, as the jelly of currants, conferve of rofes, pr lids, and powerfully aififts nature in the preparation of good blood*. . Agreeable amufements, cheerful company, and riding about, are, however, preferable to all medi- cines in this difeafe. For which reafon, when the patient can afford it, we would recommend a long jotirney of pleafure, as the moft likely means to re- store his health. , What is called a fymptomatic confumption cannot be cured without firft removing the difeafe by which it is occafioned. Thus, when a confumption pro- ceeds from the fcrophula or king's evil, from the fcurvy, the afthma, the venereal difeafe, &c. a due attention muft be paid to the malady from whence it arifes, and the regimen and medicines directed ac- cordingly. When exceffive evacuations of any kind occafion a confumption, they muft not only be reftrained, but the patient's Strength muft be rcftored by gentle ex- ercife, nourifhing diet, and generous cordials. Young and delicate mothers often fall into confumptions by giving fuck too long. As foon as they perceive their ftrength and appetite begin to fail, and are troubled * Scj Appendix, Chalybeate v.'ir.s. with 192 OF THE NERVOUS FEVER. with chills and fevers, or a pain or weaknefs of the breaft, they ought immediately to wean the child, or provide another nurfe, otherwife they cannot expect a cure. Before we quit this fubject, we would earneftly recommend it to all, as they with to avoid confump- tions, to take as much exercife without doors as they can, to avoid unwholefome air, and to ftudy fo. briety. Confumptions owe their prefent increafe not a little to the fafhion of fitting up late, eating hot fuppers, and fpending every evening over a bowl of hot punch or other ftrong liquors. Thefe liquors, when too freely ufed, not only hurt the digeftion, and fpoil the appetite, but heat and inflame the blood, and fet the whole conftitution on fire. CHAP. XIX. Of the Slow or Nervous Fever* IN ERVOUS fevers have increafed great- . ly of late years amongft us, owing doubtlefs to our different manner of living, and the increafe of feden- tary employments; as they commonly attack perfons of a weak relaxed habit, who neglect exercife, eat little folid food, ftudy hard, or indulge in fpirituous liquors. CAUSES,—Nervous fevers may be occafioned by whatever deprcffes the fpirits, or impoverifhes the blood; as grief, fear, anxiety, want of fleep, in- tenfe thought, living on poor watery diet, unripe i fruits, OF THE NERVOUS FEVER. i93 fruits, cucumbers, melons, &c. They may likewife be occafioned by damp, confined, or unwholefome air. Hence they prove moft fatal to thofe who live in dirty low houfes, crowded ftreets, hofpitals, jails, or fuch-like places. Perfons whofe conftitutions have been broken by exceffive venery, frequent falivations, too free an ufe of purgative medicines, or by any other exceffive evacuations, are moft liable to this difeafe. Keeping on wet clothes, lying on the damp ground, expofure to the night air, exceffive fatigue, and whatever obftructs the perfpiration, may likewife occafion nervous fevers. We fhall only add, fre- quent and great irregularities in diet. Too great abftinence as well as excefs, is hurtful. Nothing tends fo much to preferve the body in a found ftate as a regular diet; nor can any thing contribute more to occafion fevers of the worft kind than its oppo- fite. SYMPTOMS.—Low fpirits, want of appetite, weaknefs, wearinefs after motion, watchfulnefs, deep fighing, and dejection of mind, are generally the forerunners of this difeafe. Thefe are fucceeded by a quick low pulfe, a dry tongue without any consi- derable thirft, chillinefs, and flufhing in turns, &c. After fome time the patient complains, of a giddi- nefs and pain of the head, has a naufea, with retch- ings and vomiting; the pulfe is quick, and fometimes intermitting; the urine pale, refembling dead fmall beer, and the breathing is difficult, with oppreffion of the breaft, and flight alienations of mind. If towards the ninth, tenth, or twelfth day, the tongue becomes more moift, with a plentiful fpitting, a gentle purging, or a moifture upon the fkin; or if a fuppuration happens in one or both ears, or large puftules break out about the lips and nofe, there is reafon to hope for a favourable crifis. O But 194 OF THE NERVOUS FEVER. But if there is an exceffive loofenefs, or wafting fweats, with frequent fainting fits; if the tongue, when put out trembles exceffively, and the extre- mities feel cold, with a fluttering or flow creeping pulfe; if there is a ftarting of the tendons, an almoft total lofs of fight and hearing, and an involuntary ■; difcharge by ftool and urine, there is reafon to ap- prehend confiderable danger. REGIMEN.—It is very neceffary in this difeafe to keep the patient cool and quiet. The leaft mo- tion would fatigue him, and will be apt to occafion wearinefs, and even faintings. His mind ought not only to be kept eafy, but foothed and comforted, j Nothing is more hurtful in low fevers of this kind J than prefenting to the patient's imagination gloomy or frightful ideas. Thefe of themfelves often occa- fion nervous fevers, and it is not to be doubted but they will likewife aggravate them. The patient muft not be kept too low. His Strength and fpirits ought to be fupported by nourishing diet, and generous cordials. For this purpofe his gruel, panada, or whatever food he takes, muft be mixed with wine according as the fymptoms may require. Pretty ftrong wine-whey, or fmall negus, Sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Muftard-whey is likewife 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 difeafe, when genuine, is often al- moft the only medicine that is neceffary. Good wine poffeffes all the virtues of the cordial medicines, while it is free from many of their bad qualities. I fay good wine, for however common this article of luxury is now become, it is too feldom to be ob- * §ee Appendiv, Muflard-whey. tained < OF THE NERVOUS FEVER. 195 tained genuine, efpecially by the poor, who are ob- liged to purchafe it in fmall quantities. I have often feen patients in low nervous fevers where the pulfe could hardly be felt, with a conftant delirium, coldnefs of the extremities, and almoft every other mortal fymptom, recover by ufing in whey, gruel, and negus, a bottle or two of ftrong wine every day. Good old found Madeira, or , Sherry, are the beft, and may be made into negusj or given alone, as circumftances require. In a word, the great aim in this difeafe is to fup- port the patients ftrength, by giving him frequently fmall quantities of the above, or other drinks of a warm and cordial nature. He is not, however, to be over-heated, either with liquor or clothes; and his food ought to be light, and given in fmall quantities. MEDICINE.—Where a naufea, load, and fick- nefs at ftomach, prevail at the beginning of the fever, it will be neceffary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine pow- der, or a few fpoonfuls of the vomiting julep *, will ■ ■generally anfwer this purpofe very well. This may be repeated any time before the third or fourth day, if the above fymptoms continue.. Vomits not only clean the ftomach, but, by the general fhock which they give, promote the perfpiration, and have many other excellent effects in flow fevers, where there are no figns of inflammation. Such as dare not venture upon a vomit, may clean - the bowels by a fmall dofe of Turkey rhubarb, or an infufion of fenna and manna. In all fevers, the great point is to regulate the fymptoms, fo as to prevent them from going to ei- ther extreme. Thus, in fevers of the inflammatory * See Appendix, Vomiting Julep. O 2 kind, 196 OF THE NERVOUS FEVER. kind, where the force of the circulation is too great, and the fibres too rigid, bleeding and other evacua- tions are neceflary. But in nervous fevers, where nature flags, where the folids are relaxed, the lancet muft be fpared, and wine, with other cordials, plenti- fully adminiftered. It is the more neceffary to caution people againft bleeding in this difeafe, as there is generally at the beginning an univerfal Stricture upon the veffels; and fometimes an oppreffion and difficulty of breath. ing, which fuggeft the idea of a plethora, or too great a quantity of blood. I have known even fome of the faculty deceived by their own feelings in this refpect, fo far as to infift upon being bled, when it was evident from the confequences that the ope- ration was improper. Though bleeding is generally improper in this difeafe, yet bliftering is highly neceffary. Blifter- ing-plafters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be blistered on the neck or head, and it will be the fafeft courfe, when the infenfibility continues, as foon as the difcharge occafioned by one bliftering-plafter abates, to apply another to fome other part of the body, and by that means keep up a continual fucceffion of theni, till he be out of danger. I have been more fenfible of the advantage of bliftering in this than in any other difeafe. Blifter- ing-plafters not only Stimulate the folids to action, but likewife occafion a continual difcharge, which may, in fome meafure, fupply the want of critical evacuations, which feldom happen in this kind of fever. They are moft proper, however, either to- wards the beginning, or after fome degree of ftupor has come on, in which laft cafe it will always be proper to blifter the head. If OF THE NERVOUS FEVER. 197 If the patient is coftive through the courfe of the difeafe, it will be neceffary to procure a ftool, by giving him every other day a clyfter of milk and water, with a little fugar ; to which may be added, a fpoonful of common fait, if the above does not operate. Should a violent loofenefs come on, it may be checked by fmall quantities of laudanum, or giving the patient for his ordinary drink the white decoc- tion *. A miliary eruption fometimes breaks out about the ninth or tenth day. As eruptions are often cri- tical, great care fhould be taken not to retard Na- ture's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pufhed out by a hot regimen ; but the patient fhould be fupporred by gentle cordials, as wine-whey, fmall negus, fago-gruel with a little wine in it, and fuch like. He ought not to be kept too warm ; yet a kindly breathing fweat fhould by no means be checked. Though bliftering and the ufe of cordial liquors are the chief things to be depended on in this kind of fever; yet, for thofe who may chufe to ufe them, we fhall mention one or two of the forms of medi- cine which are commonly prefcribed in it; centaury and fnake-root tea, volatile boluffes. In defperate cafes, where the hiccup and ftarting of the * tendons have already come on, we have fometimes feen extraordinary effects from large dofes of mufk frequently repeated. Mufk is doubt- lefs an antifpafmodic, and may be given to the quantity of a feruple three or four limes a-day, or oftener, if neceffary. Sometimes it may be proper to add to the mufk a few grains of camphire, and * See Appendix, White decoclion. O 3 fait 198 OF THE NERVOUS FEVER. fait'of hartfhorn, as thefe tend to promote perfpi- ration and the difchaige of urine. thus ffteen grams of mufk, with three grains of camphire, and fix grains of fait of hartfhorn, may be made into a bolus with a little fyrup, and given as above. If the fever fhould happen to intermit, which it frequently does towards the decline, or if the pa- tient's ftrength fhould be wafted with colliquative fweats, Sec. it will be neceffary to give him the Pe- ruvian bark. Half a drachm, or a whole drachm, if the ftomach will bear it, of 'the bark in fine powder, may be given four or five times a-day in a glafs of red port or claret. Should the bark in fubftance not fit eafily on the ftomach, an ounce of it in powder may be infufed in a bottle of Lifbon or Rhenifh wine for two or three days, afterwards it may be ftrained, and a glafs of it taken frequently *. Some give the bark in this and other fevers, where there are no fymptoms of inflammation, without any regard to the remiffion or intermiffion of the fever. How far future obfervations may tend to eftablifh this practice, we will not pretend to fay; but we have reafon to believe that the bark is a very univerfal febrifuge, and that it may be adminiftered with advantage in moft fevers where bleeding is not neceffary, or where there are no fymptoms of topical inflammation. * The bark may likewife be very properly adminiftered, along with other cordials, in the following manner : Take an ounce of Peruvian bark, orange-peel half an ounce, Virginian fnake-root two drachms. Let all of them be powdered, and infufed in a pint of the beft brandy for three or four days. Afterwards the liquor may be (trained, and two tea-fpoonfuls of it given three or four times a-day in a glafs of a fmall wine Or negus, CHAP. [ *99 J CHAP. XX. Of the Malignant, Putrid, or Spotted Fever. J. HIS may be called the peftilental fever of Europe, as in many of its fymptoms it bears a great refemblance to that dreadful difeafe, the plague. Perfons of a lax habit, a melancholy difpofition, and thofe whofe vigour has been wafted by long fafting, watching, hard labour, exceffive venery, frequent falivations, &c. are moft liable to it. CAUSES.—This fever is occafioned by foul air, from a number of people being confined in a narrow place, not properly ventilated; from putrid animal and vegetable effluvia, Sec. Hence it prevails in camps, jails, hofpitals, and infirmaries, efpecially where fuch places are too much crowded, and clean- linefs is neglected. Thefe fevers often fucceed great inundations in low and marfhy countries, efpecially when thefe are pre- ceded or followed by a hot and fultry feafon. Living too much upon animal food, without a proper mixture of vegetables, or eating fifh or flefh that has been kept too long, are likewife apt to oc- cafion this kind of fever. Hence failors on long voyages, and the inhabitants of befieged cities, are very often vifited with putrid fevers. Corn that has been greatly damaged by rainy fea- fons, or long keeping, and water which has become putrid by Stagnation, &c. may likewife occafion this fever. O 4 Dead 200 PUTRID OR SPOTTED FEVER. Dead carcafes tainting the air, efpecially in hot feafons, are very apt to occafion putrid difeafes Hence this kind of fever often prevails in countries which are the fcenes of war and bloodfhed. This fhews the propriety of removing burying-grounds, flaughter-houfes, Sec. to a proper diftance from great towns. Want of cleanlinefs is a very general caufe of pu- trid fevers. Hence they prevail amongft the poor inhabitants of large towns, who breathe a confined unwholefome air, and neglect cleanlinefs. Such mechanics as carry on dirty employments, and are conftantly confined within doors, are likewife very liable to this difeafe. We fliall only add, that putrid, malignant, or fpotted fevers, are highly infectious, and are there- fore often communicated by contagion. SYMPTOMS.—The malignant fever is generally j preceded by a remarkable weaknefs, or lofs of j ftrength, without any apparent caufe. This is fome- times fo great, that the patient can fcarcely walk, or even fit upright, without being in danger of fainting away. His mind too is greatly dejected; he Sighs, and is full of dreadful apprehenfions. ^ There is a naufea, and fometimes a vomiting of bile ; a violent pain of the head, with a ftrong pul- fation or throbbing of the temporal arteries; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noife in the ears, the breathing is laborious, and often interrupted with a figh ; the patient complains of a pain about the region of the ftomach, and in his back and loins; his tongue is at firft white, but afterwards it appears black and chapped ; and his teeth are covered with a black cruft. He fometimes paffes worms both upwards and downwards, is affected with tremors or Shaking, and often becomes delirious. PUTRID OR SPOTTED FEVER. If blood is let, it appears diffolved, or with a very fmall degree of cohefion, and foon becomes putrid ; the Stools fmell extremely foetid, and are fometimes of a greenifh, black, or reddifh caft. Spots of a pale purple, duo, or black colour, often appear upon the fkin, and fometimes there are violent haemorrhages, or difcharges of blood from the mouth, eyes, nofe, &c. Putrid fevers may be diftinguifhed from the in- flammatory, by the fmallnefs of the pulfe, the great dejection of mind, the diffolved State of the blood, the petechia, or purple fpots, and the putrid fmell of the excrements. They may likewife be diftin- guifhed from the low or nervous fever, by the heat and thirft being greater, the urine of a higher co- lour, and the lofs of ftrength, dejection of mind, and all the other fymptoms more violent. It fometimes happens, however, that the inflam- matory, nervous, and putrid fymptoms are fo blended together, as to render it very difficult to determine to which clafs the fever belongs. In this cafe the greateft caution and Skill are requisite. Attention muft be paid to thofe fymptoms which are moft pre- valent, and both the regimen and medicines muft be adapted to them *. Inflammatory and nervous fevers may be converted into malignant and putrid, by too hot a regimen, or improper medicines. The duration of putrid fevers is extremely uncer- tain ; fometimes they terminate between the feventh and fourteenth day, and at other times they are pro- longed for five or fix weeks. Their duration de- pends greatly upon the conftitution of the patient, and the manner of treating the difeafe. * After all that has been faid upon this fubject, it is not at all probable, that any fever can with propriety be called pu- trid. They are always inflammatory at firft. The 2c2 TUTRID OR SPOTIED FE\ ER. The moft favourable fymptoms are, a gentle loofe- nefs after the fourth or fifth day, with a warm mild fweat. Thefe, when continued for a confiderable time, often carry off the fever, and fliould never be imprudently flopped. Small miliary puftules ap. pearing between the petechias, or purple fpots, are likewife favourable, as alfo hot fcabby eruptions about the mouth and nofe. It is a good fign when the pulfe rifes upon the ufe of wine, or other cor- dials, and the nervous fymptoms abate; deafnefs coming on towards the decline of the fever, is likewife often a favourable fymptom *, as are ab- fceffes in the groin or parotid glands. Among the unfavourable fymptoms may be reck- oned an exceffive loofenefs, with a hard fwejled belly ; large black or livid blotches breaking out upon the fkin ; aphthae in the mouth ; cold clammy fweats ; blindnefs; change of the voice ; a wild Star- ing of the eyes ; difficulty of fwallowing; inability to put out the tongue ; and a conftant inclination to uncover the breaft. When the fweat and faliva are tinged with blood, and the urine is black, or clcpofites a black footy fediment, the patient is in great danger. Starting of the tendons, and foetid, ichorous, involuntary Stools, attended with coldneSs of the extremities, are moft generally the forerun- ners of death |. REGIMEN.—In the treatment of this difeafe, we ought to endeavour, as far as poffible, to coun- teract the putrid tendency of the humors ; to fup- port the patient's ftrength and fpirits ; and to affift * Deafnefs is not always a favourable fymptom in this dif- eafe. Perhaps it is only fo when occafioned by abfceffes formed within the ears. f It is worth remarking here, that although much is faid by medical writers of a putridity of the humors, yet fuch a ftate cf them feldcm or never exifts, unlefs indeed in the excietions.. Nature PUTRID OR SPOTTED FEVER. 203 Nature in expelling the caufe of this difeafe, by gently promoting perfpiration and the other evacu- ations. It has been obferved, that putrid fevers are often occafioned "by unwholefome air, and of courfe they muft be aggravated by it. Care Should therefore be taken to prevent the air from Stagnating in the pa- tient's chamber, to keep it cool, and renew it fre- quently, by opening the doors or windows of fome adjacent apartment. The breath and perfpiration of perfons in perfect health, foon render the air of a fmall apartment noxious; but this will fooner happen from the perfpiration and breath of a perfon whofe whole mafs of humors are in a putrid State*. Befides the frequent admiffion of frefh air, we would recommend the ufe of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be moft readily obtained. Thefe ought frequently to be fprinkled upon the floor, the bed, and every part of the room. They may alfo be evaporated by pouring them on an hot iron, or by boiling, &c. The frefh fkins of lemons or oranges, ought likewife to be laid in different parts of the room, and they fhould be frequently held to the patient's nofe. The ufe of acids in this manner, would not only prove very refrefhing to the patient, but would likewife tend to prevent the infection from fpreading among thofe who attend him. Strong fccnted herbs, as rue, tanfy, rofemary, wormwood, &c. may likewife be laid in different parts of the houfe, and fmelled to by thofe who go near the patient. * It is of the utmoft importance to change the patient's linen, bed-clothes, and bed daily, and, when practicable, to remove him into another room. A matrafs is far preferable to a bed. The 204 PUTRID OR SPOTTED FEVER. The patient muft not only be kept cool, but like. wife quiet and eafy. The leaft noife will affect his head, and the fmalleft fatigue will be apt to make him faint. Few things are of greater importance in this dif. eafe than acids, which ought to be mixed with all the patient's food as well as drink. Orange, lemoa, or vinegar-whey, are all very proper, and may be drank by turns, according to the patient's inclina- tion. They may be rendered cordial, by the addi. tion of wine in fuch quantity as the patient's ftrength feems to require. When he is very low, he may drink negus, with only one half water, and Sharp- ened with the juice of orange or lemon. In fome cafes, a glafs of wine may now and then be allowed. The moft proper wine is good Madeira, or Sherry; but if the body be open, red port or claret is to be preferred. When the body is bound, a tea-fpoonful of the cream of tartar may be put into a cup of the patient's drink, as there is occafion ; or he may drink a decoction of tamarinds, which will both quench his thirft, and promote a difcharge by ftool. If camomile-tea will fit upon his Stomach, it is a very proper drink in this difeafe. It may be Sharp- ened by adding to every cup of the tea ten or fifteen drops of the elixir of vitriol. The food muft be light, as panacra or oatmeal gruel, to which wine may be added, if the patient be weak and low; and they ought all to be Sharp- ened with the juice of orange, the jelly of currants, or the like. The patient ought likewife to eat freely of ripe fruits, as roafted apples, currant or goofe- berry tarts, preferved cherries, or plums, Sec. Taking a little food or drink frequently, not only fupports the fpirits, but counteracts the putrid ten- dency of the humors; for which reafon, the patient ought PUTRID OR SPOTTED FEVER. 205 ought. frequently to be fipping fmall quantities of fome of the acid liquors mentioned above, or any that may be more agreeable to his palate, or more readily obtained. If he is delirious, his feet and hands ought to be frequently fomented with a ftrong infufion of camo- mile flowers. This, or an infufion of the bark, to fuch as can afford it, cannot fail to have a good effect. Fomentations of this kind not only relieve the head, by relaxing the veffels in the extremities, but as their contents are abforbed, and taken into the fyftem, they may affift in preventing the pu- trefcency of the humors. MEDICINE.—If a vomit be given at the begin- ning of this fever, it will hardly fail to have a good effect; but if the fever has gone ou for fome days, and the fymptoms are violent, vomits are not quite fo fafe. The body, however, is always to be kept open by clyfters, or laxative medicines. Bleeding is feldom neceffary in putrid fevers. If there be Signs of an inflammation, it may be per- mitted at the firft onfet. Bliftering plafters are never to be ufed, unlefs in the greateft extremities. If the petechia? or fpots Should fuddenly difappear, the patient's pulfe fink remarkably, and a delirium, with other bad fymp- toms come on, bliftering may be permitted. In this cafe, the bliftering plafters are to be applied to the head, and infide of the legs or thighs. ^ It is common, in the beginning of this fever, to give the emetic tartar in fmall dofes, repeated every fecond or third hour, till it fhall either vomit, purge, or throw the patient into a fweat. This practice is very proper, provided it be not pufhed fo far as to weaken the patient. A very ridiculous notion has long prevailed, of expelling the poifonous matter of malignant difeafes, by 206 PUTRID OR SPOTTED FEVER. by trifling dofes of cordial or alexipharmic medicines, In confequence of this notion, the contrayerva-root, the cordial confection, the mithridate, Sec. have been extolled as infallible remedies. There is reafon, however, to believe that thefe feldom do much good. Where cordials are neceffary, we know none that is fuperior to good wine, and therefore again recommend I it, both as the fafeft and beft. Wine, with acids and antifeptics, are the only cordials to be relied on, in the cure of malignant fevers. In the moft dangerous fpecies of this difeafe, when it is attended with purple, livid, or black fpots, the Peruvian bark muft be adminiftered. I have feen it, when joined with acids, prove fuccefsful, even in cafes where the petechias had the moft threatening I afpect. But, to anfwer this purpofe, it muft not only be given in large dofes, but duly perfifted in. The beft method of administering the bark is cer- tainly in fubftance. An ounce of it in powder, may be mixed with half a pint of water, and the fame quantity of-red wine, and fharpened with the elixir or the fpirit of vitriol, which will both make it fit eafier on the ftomach, and render it more beneficial.' Two or three ounces of the fyrup of lemons may be added, and two table-fjpoonfuls of the mixture taken every two hours, or oftener, if the ftomach is able to bear it. Thofe who cannot take the bark in fubftance, may infufe it in wine, as recommended in the pieceding 1 difeafe. If there be a violent loofenefs, the bark muft be boiled in red wine with a little cinnamon, and Sharp- ened with the elixir of vitriol, as above. Nothing j can be more beneficial, in this kind of loofenefs, ' than plenty of acids, and fuch things as promote a gentle perfpiration. If PUTRID OR SPOTTED FEVER. 207 If the patient be troubled with vomiting, a dram of the fait of wormwood, diffolved in an ounce and a half of frefh lemon juice, and made into a draught with an ounce of fimple cinnamon water, and a bit of fugar, may be given and repeated as often as it is neceffary. A table-fpoonful of milk every half hour will often flop the vomiting. If fwellings of the glands appear, their fuppura- tion is to be promoted by the application of poulti- ces, ripening cataplafms, Sec. And as foon as there is any appearance of matter in them, theyvought to be opened, and the poultices continued. I have known large ulcerous forts break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a moft putrid cadaverous fmell. Thefe gradually healed,. and the patient recovered, by the plentiful ufe of Peruvian bark and wine, Sharpened with the fpirits of vitriol. For preventing putrid fevers we would recommend a Strict regard to cleanlinefs; a dry fituation; fufficient exercife in the open air; wholefome food, and a mo- derate ufe of generous liquors. Infection ought above all things to be avoided. No constitution is proof againft it. I have known perfons feized with a putrid fever, by only making a fingle visit to a pa- tient in it; others have caught it by lodging for one night in a town where it prevailed ; and fome by attending the funerals- of fuch as died of it *» *_The late Sir John Pungle exprefTed a concern left thefe cautions lhould prevent people from attending their friends or relations when afflicted with putrid fevers. I told him I m.ant only to difcourage unneceffary, attendance^ and mentioned a n»mber of inftances where putrid fevers had proved fatal to. perfon?, who were rather hurtful than beneficial to the fick. This fagacious phyfician agreed with me, in thinking that a good doctor and a careful nurfe were the oi.ly n-*ce.'L; v attend- ing; 208 PUTRID OR SPOTTED FEVER. When a putrid fever feizes any perfon fn a family, the greateft attention is neceffary to prevent the dif. eafe from fpreading. The fick ought to be placed in a large apartment, as remote from the reft of the family as poffible ; he ought likewife to be kept ex- tremely clean, and fhould have frefh air frequetrrfjrk j let into his chamber; whatever comes from him fhould be immediately removed, his linen fhould be frequently changed, and thofe in health ought to avoid all unneceffary communication with him. Any one who is apprehejifive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of chamo- mile tea. This may be repeated in a day or two, if the apprehenfions ftill continue, or any unfavourable fymptoms appear. The perfon ought likewife to take an infufion of the bark and chamomile flowers for his ordinaryflrink; and before he goes to bed, he may drink a pint of pretty ftrong negus, or a few glaffes of generous | wine. I have been frequently obliged tofoHow this courfe, when malignant fevers prevailed, and have likewife recommended it to others with conftant • fuccefs. People generally fly to bleeding and pirr^mj as , antidotes againft?infection; but thefe are fo far'from ! fecuring them, that by debilitating the body they increafe the danger*. ants j and that all others, by tlieir folicitude and ill-directed. care, hurt the fick. If perfons attendant on the fick would pay fufficient atten- tion to cleanlinefs, and not fit ntfar.the patient unneeeflarily, they would feldom be infected. . * This may be true in many cafes, but where fymptoms of inflammation occur, bleeding and purging are conftantly the phief and only remedies. 2 Thofe OF THE MILIARY FEVER. 200 Thofe who v*ait upon the fick in. putrid fevers, ought always to have a piece of fpunge or a hand- kerchief dipt in vinegar, or juice of lemon, to fmell to while near the patient. They ought likewife to wafh their hands, and, if poffible, to change their clothes, before they go into company. CHAJ\ XXI. Of the Miliary Fever, J. HIS fever takes its name from the fmall puftules or bladders which appear on the fkin, refembling, in fhape and fize, the feeds of millet. The puftules are either red or white, and fometimes both arc mixed together. The whole body is fometimes covered with puf- tules ; but they are generally nioi e numerous where the fweat is moft abundant, as on the breaft, the back, &c. A gentle fweat or moiSture on the ikin, greatly promotes the eruption; but, when the ikin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary difeafe; but it is much oftener only a fymptom of fome other malady, as the fmall-pox, meaflcs, ardent, or nervous fever, Sec. la all thefe cafes it is generally the effect of too hot a regimen or medicines. the young and the aged are more liable to it than thofe in the vigour and prime of life. It is likewife more incident to women than men, efpecially the de- licate and the indolent, who, neglecting exercife, keep continually within doors, and live upon weak P watery 210 OF THE MILIARY FEVER. watery diet. Such females are ex»remely liable to be feized with this difeafe in child-bed. C1AUSES.— The miliary fever is fometimes occa- fioned by violent paffions or affections of the mind; as cxaffive grief, anxiety, thoughtfulnefs, &c. It may likewife be occafioned by exceffive watching, great evacuations, a weak watery diet, eating too freely of cold, crude, unripe fruits, as plumbs, cher- ries, cucumbers, melons, &c. Impure waters, or provifions which have been fpoiled by rainy feafons, long keeping, Sec. may likewife caufe miliary fevers. This difeafe in child bed-women is fometimes the effect of great coftivenefs during pregnancy; it may likewife be occafioned by their exceffive ufe of green traih, and other unwholefome things, in which preg- nant women are too apt to indulge. But its moft general caufe is indolence. Such women as lead a fedentary life, efpecially during pregnancy, and at the fame time live groSsly, can hardly efcape this difeafe in childbed. Hence it proves extremely fatal, to women of fafhion, and likewife to thofe women in manufacturing towns, who, in order to afiift their hufbands, fit clofe within doors for almoft the whole of their time. But amongft women who are active and laborious, who live in. the country, and take fufficient exercife without doors, this difeafe is very Jit tie known. SYMPTOMS.—When this is a primary difeafe, it makes irs attack, like moft other eruptive fevcrsj with a flight Shivering, which is fucceeded by, heat, lofs of ftrength, faintnefs, fighing, a low quick pulfir, difficulty of breathing, with great anxiety and op- preffion of the breaft. The patient is reftlefs, and fometimes delirious; the tongue appears white, and the hands Shake, v.ith often a burning heat in the palms; and in childbed women the milk generally goes away, and the other difcharges Stop. The OF THE MILIARY FEVER. 2rt The patient feels an itching or pricking pain un- der the fkin, after which innumerable fmall puftules of a red or white colour begin to appear. Upon this the fymptoms generally abate, the pulfe becomes more full and foft, the fkin grows moilter, and the fweat, as the difeafe advances, begins to have a pe- culiar foetid fmell; the great load on the breaft and oppreffion of the fpirits, generally go off, and the cuftomary evacuations gradually return. About the fixth or feventh day from the eruption, the puf- tules begin to dry and fall off, which occafions a very difagreeable itching in the ikin. It is impoffible to ascertain the exact time when the puftules will either appear or go off. They ge- nerally come out on the third or fourth day, when the eruption is critical; but, when fymptomatical, they may appear at any time of the difeafe. Sometimes the puftules appearand vanifh by turns. When that is the cafe, there i> always danger ; but when they go in all of a hidden, and do not appear again, the danger is great. * In child-bed women the puftules are commonly at firft filled with clear water, afterwards they "grow yellowish. Sometimes they are interfperfed with puftules of a red colour. When thefe My appear the difeafe goes by the name of a rajh. REGIMEN.—In all eruptive fevers, of whatever kind, the chief point'is io prevent the hidden difap- pearing of the puftules, and to promote their matu- ration. For this purpofe, the patient muft be kept in fuch a temperature, as neither to pufh out the eruption too faft, nor to caufe it to retreat prema- turely. The diet and drink ought therefore to be in a moderate degree nourishing and cordial; but neither ftrong nor heating. The patient's chamber ought neither to be kept too hot nor too cold ; and he fhould not be too much covered with clothes. P 2 Above 212 OF THE MILIARY FEVER. Above all, the mind is to be kept eafy and cheerful. Nothing fo certainly makes an eruption go in as fear, or the apprehenfion of denger. The food muft be weak chicken-broth with bread* panada, fago, or oatmeal-gruel, ,&c. to a gill off which may be added a fpoonful or two of wine, as the patient's ftrength requires, with a few grains of fait and a little fugar. Good apples roafted or boiled, with other ripe fruits of an opening cooling nature, may be eaten. The drink may be fuited to the ftate of the patient's ftrength and fpirits. If thefe be pretty high, the) drink ought to be weak ; as water-gruel, or balm tea. When the patient's fpirits are low, and the erup- tion does not rife fufficiently, his drink muft be a little more generous ; as wine-whey, or fmall negus, Sharpened with the juice of orange or lemon, and made Stronger or weaker as circumftances may re- quire, t Sometimes the miliary fever approaches towards* putrid nature, in which cafe the patient's Strength muft »be fupported with generous cordials, joined with acids ; and, if the degree of putrefcence be great, the Peruvian bark muft be adminiftered. If the head be much affected, the body muft be kept open by emollient clyfters. MEDICINE.—If the food and drink.be properly regulated, there will be little occafion for medicine in this difeafe. Should the eruption, however, not rife, or the fpirits flag, it will not only be neceffary to Support the patient with cordials, but likewife to apply bliftering--plafters. The moft proper cordial, in this cafe, is good wine, which may either be taken in the patient's food or drink ; and if there be figns of putrefcency, the bark and acids may be mixed with wine, as directed in the putrid fever. Some OF THE MILIARY FEVER. ^213 Some recommend bliftering through the whole courfe of this difeafe ; and where Nature flags, and the eruption comes and goes, it may be neceffary to keep up a ftimulus, by a continual fucceffion of fmall bliftering-plafters; but we would n t recom- mend above one at a time. If, however, the pulfe Should fink remarkably, the puftules fall in, and the head be affected, it will be neceffary to apply feveral bliftering-plafters to the moft fenfible parts, as the infide of the legs and thighs, &c. Bleeding is feldom neceffary in this difeafe, and fometimes it does much hurt, as it weakens the pa- tient, and depreffes his fpirits. It is therefore never to be attempted, unlefs by the advice of a phyfician. We mention this, becaufe it has been cuftomary to treat this difeafe in childbed-women by plentiful bleeding, and other evacuations, as if it were highly inflammatory* . If the difeafe proves tedious, or the recovery flow, we would recommend the Peruvian bark, which may either be taken in fubftance, or infufed in wine or water, as the patient inclines. The miliary fever, like other eruptive difeafes, re- quires gentle purging when the fever is gone off, and the patient's ftrength will permit. To prevent this difeafe, a pure dry air, fufficient exercife, and wholefome food, are neceffary. Preg- nant women fhould guard againft coftivenefs, and take daily as much exercife as they can bear, avoid- ing all green fruits, and other unwholefome things; and when in childbed, they ought Strictly to obferve a cool regimen. * The only rule to go by here is the ftate of the pulfe and violence of the fymptoms. If thefe require bleeding, it cannot be improper. O CHAP. I "4 3 CHAP. XXII. Of the Remitting Fever. 1 HIS fever takes its name from a re. miffion of the fymptoms, which happens fometimes fooner, and fometimes later. The remiffion is com- monly preceded by a gentle fweat, after which the patient feems greatly relieved, but in a few hours the fever returns. Thefe remiffions return at very irregular periods, and are fometimes of longer, fome- times of fhorter duration : the nearer, however, that the fever approaches to a regular intermittent, the danger is the lefs. CAUSES.——-Remitting fevers prevail in low marfhy countries, abounding with wood and ftagnat- ing water ; but they prove moft fatal in places where great heat and moifture are combined, as in fome parts of Africa, the province of Bengal in the Eaft Indies, &c. where remitting fevers are generally very fatal. They are moft frequent in clofe calm wea- ther, efpecially after rainy feafons, great inundations, or the like *. No age, fex, or conftitution, is ex- empted from the attack of this fever; but it chiefly feizes perfons of a relaxed habit, who live in low dirty habitations, breathe an impure ftagnating air, take little exercife, and ufe unwholefome diet. SYMPTOMS.r—The firft fymptoms of this fever are generally yawning, ftretching, pain and giddinefs of the head, with alternate fits of heat and cold. * In America, they are moft generally prevalent after dry fummei$. Some- OF THE REMITTING FEVER. 215 Sometimes the patient is affected with a delirium at the very firft attack. There is a pain, and fometimes a Swelling, about the region of the ftomach, the tongue is white, the eyes and fkin frequently appear yellow, and the patient is often afflicted with bi!:ous vomitings. The pulfe is fometimes a little hard, but feldom full, and the blood, when let, rarely Shews any figns of inflammation. Some patients are ex- ceedingly coftive, and others are afflicted with a very troublefome loofenefs. ' It is impoffible to defcribe all the fymptoms of this difeafe, as they vary according to the fituation, the feafon of the year, and the conftitution of the patient. They may likewife be gneatly changed by the method of treatment, and by many other cir- cumstances too tedious to mention. Sometimes the bilious fymptoms predominate, fometimes the ner- vous, and at other times the putrid. Nor is it at all uncommon to find a fucceffion of each of thefe, or even a complication of them at the fame time, in the fame perfon. This fever in its common appearance, approaches neareft to an intermittent with protracted parovyfins. REGIMEN.—The regimen muft be adapted to the prevailing fymptoms. When there are any figns of inflammation, the diet muft be flender, and the drink weak and diluting. But when nervous fymp- toms occur, it will be neceffary to fupport the patient with food and liquors of a more generous natur-, fuch as are recommended in the immediately pre- ceding fevers. We muft, however, be very cautious in the ufe of things of a heating quality, as this fever is frequently changed into a continual one by an hot regimen, and improper medicines. Whatever the fymptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if poffible, fliould be large, and frequently ventilated, P 4 by atS OF THE REMITTING FEVER. by letting in frefh air at the doors or windows. It ought likewife to be fprinkled with vinegar, juice of lemon, or the like. His linen, bed clothes, &c. fhould be frequently changed, and all his excrements immediately removed, though thefe things have been recommended before, we think neceffary to repeat them here, as they are of more importance to the fick than practitioners are apt to imagine*. MEDICINE.—In order to cure this fever, we muft endeavour to bring it to a regular intermiflion. This intention may be promoted by bleeding, if there be figns of inflammation ; but, when that is not the cafe, bleeding ought by no means to bo attempted, as it will weaken the patient, and pro- long the difeafe. A vomit, however, will feldom bo improper, and is generally of great fervice. Fifteen or twenty grains of ipecacuanha will anfwer this purpofe very well; but, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or fix grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice, at proper intervals, if the ficknefs or naufea continues. The body ought to be kept open either by clyfters or laxatives, as weak infufions of fenna and manna, fmall dofes of cream of tartar, tamarinds, ftewed prunes, or the like. * The ingenious Dr. Lind, of Edinburgh, in his inaugural differtation concerning the putrid remitting fever of Bengal, has the following obfervation: " The patient's fhirt, bed- ■«* clothes, and bedding, ought frequently to be changed, and " expofed to the air, and all his excrements immediately " removed ; the bedchamber fhould be made pure and whole« " fome, and frequently fprinkled with vinegar ; in fhort every " attention fhould be paid to the patient. I can affirm, that a " phyfician who puts thefe in practice, will much oftener fuc- " ceed than one who is even more fkillful, but has not oppor- " tunity o$ ufing thefe means." By OF THE REMITTING FEVER. 217 By this courfe the fever, in a few days, may gene- rally be brought to a pretty regular or diftinct inter- miffion ; and if the intermiffion is not complete, the faline julep, and blifters to the wrifts, will moft com- monly produce one ; in which cafe the Peruvian bark may be adminiftered, and, if the ftomach will bear it, it will feldom fail to perfect the cure. It is need- lefs here to repeat the methods of giving the bark, as we have already had occafion frequently to men- tion them*. The moft likely way to avoid this fever, is to ufe a wholefome and nourishing diet, to pay the moft fcrupulous attention to cleanlinefs, to keep the body warm, to take fufficient exercife, and, in hot coun- tries, to avoid damp fituations, night air, evening dews, and the like. In countries where it is ende- mical, the beft preventative medicine which we can recommend, is the Peruvian bark, wrfich may either be chewed, or infufed in wine. Some recommend fmoking tobacco, as very beneficial in marfhy coun- tries, both for the prevention of this and intermit- ting fevers. * It often happens that the ftomach will not bear the bark, or perhaps the Inteimiffion is not fufficiently evident to give it. In fuch cafes, a ftrong tea, made of three fourths centaury and one fourth Virginia Inake root, may be drank cold, a tea-cup full every hour. QHAP, [ -2i8 ] CHAP. XXIII. Of the Tellow Fever. -T EVERS have already been divided and fubdivided into too many fpecies; and, it is by no means from a wifh to add to the number, that I in- fert this chapter on, what is commonly called, the Yellow Fever. But, as there are fome particulars in it, which feem to diftinguifh it from other fevers, although the discriminating fhades between fevers are difficult to mark, and as the practice does cer- tainly vary from that which is proper in others, to which it has arconfiderable refemhlance, I thought it might be ufeful to give a general acccount of it; more efpecially, as there are but few, even of the phyficians in the United States, who have had an opportunity of feeing this difeafe. To thefe 1 would particularly recommend a careful perufil of Dr. RufiVs book on the fubject. I need hardly remark, that a more full account, than that which is here given, would be improper in the prefent work. This fever is fo called from a yellownefs of the whole furface, which takes place, generally, from the fecond and third to the fixth and feventh days: it does not, however, occur in every inftance. It would feem, from the defcriptions given by various authors, that this difeafe appears in different forms: fome tell us of its appearance with fuch fymptoms as indicate great debility ; others place it among the moft violent inflammatory fevers; and it is certain, that this laft was the form it generally affumed at Philadelphia, in the Summer and autumn 0¥ THE YELLOW FEVER. , 219 of 1793; although it fuffered all the varieties pro- duced by age, constitution;, the ftate of the atmo- fphere, feafon of the year, together with a number of other caufes, fuch as fear, grief, and defpondency, which powerfully operated on the mind. The young and plethoric were moft fubject to this difeafe, efpecially at the beginning ; but, during its progrefs, no age nor conftitution were exempt from its attacks. The danger was, in general, to be estimated by the violence of the attack, and age of the patient. It ofteneft proved mortal from the third to the feventh day: a yellownefs on the Sixth day, was not an un- favourable fymptom. CAUSES —It remains a matter of difpute, whe- ther this difeafe is always imported, or whether it ever originates in this country. But, as it is agreed that it may be imported, the ftricteft vigilance fliould be exercifed at every port of the United States during, at leaft, the months of July, Auguft, and September, when this difeafe is known to prevail in the Weft Indies and South America, and more efpecially in a time of war there. Perhaps it would not be too Strict to fubject every veffel, coming from a fickly or fufpected place, to a delay of at leaft thirty days, in fome port, at a convenient diftance from any town. Though it may not be an eafy matter to determine the queftion concerning the origin of the difeafe, it is by no means difficult to trace the caufes of its Spreading, when once amongft us. Thefe are, dry, or moift and hot weather, dirty ftreets or houfes, want of cleanlinefs in general, fearcity of good ripe fruit, intemperance, expofure to the fun or night air, fatigue, and fear. And,"as thofe who fuppofe the difeafe to be always Imported, regard the caufes juft mentioned to be the Tflofi; 220 OF THE YELLOW FEVER. moft probable ones of fpreading the difeafe, and thofe who fuppofe it to be an original diforder, be- lieve thefe to be the caufes of the difeafe; it is, in either cafe, ftrictly incumbent on the magiftrates and citizens of every city to have the ftreets kept per- fectly clean, as well as to have them properly watered in dry feafons. SYMPTOMS.—Thefe are various; generally, however, after a previous laffitude, the fever attacks with a chill more or lefs violent, followed by heat, fevere pains in the head, back, and hips, opprefiion at the breaft, naufea and vomiting, delirium and watchfulnefs. The eyes are muddy, fometimes fparkling, fometimes dull, the pupil dilated, rhe tongue is moift, the fkin dry, the bowels generally very coftive, the pulfe fometimes oppreffed and fmall, generally hard, the fever has irregular exacerbations, but moftly one in the evening or during the night; thefe are not followed by fweat as in the remittent fever. The urine is in fmall quantity and high colour- ed; eruptions fometimes appear, particularly about the breaft. In the moft fatal cafes thefe fymptoms continue with violence till the third or fourth day, when the pulfe fails, the fkin turns yellow, hasmorr- hagies from different parts come on, the vomiting increafes, and, inftead of bile and the contents of the ftomach, a dark coloured liquor is thrown up, ex- actly refembling coffee grounds diffolved in water; this vomiting is often accompanied with a diftreffmg noife and exceffive rcitleffnefs, the extremities be- come ceddj the debility increafes, and the patient is foon relieved by death from all his agonies. When the difeafe terminates favourably, the fymp- toms of attack are much the fame at fir St, and of dif- ferent degrees of violence; by proper remedies they often abate on the firft or fecond day, and when they continue longer, the exacerbations are lefs violent, OF THE YELLOW FEVER. 221 violent, there is lefs vomiting, pain, &c. If the patient lives over the eighth or ninth day, there is more reafon to hope a favourable iffue. REGIMEN.—The fame regimen is proper here as in moft fevers; but we muft be particularly care- ful to place the fick in as large and airy a room as poffible, to change his linen and bed clothes every- day, and to carry the cooling plan to its greateft ex- tent; the bed-clothes Should be very light, the win- dows and doors Should be kept open conftantly, linen cloths dipt in cold water Should be applied often to the forehead and hands, efpecially where the pain in the head is violent. Every attention fhould be paid to leffen the exertions of the fick; the faeces fhould be removed immediately, and fugar and fata petre burnt in the chamber on coals—the floor may be often fprinkled with vinegar. The diet muft be very light, and confiding chiefijr of vegetables, indeed moftly of drinks, fuch as thin fago-gruei, lemonade, toaft and water, tamarind- water, molaffes and water: a fmall quantity of thefe muft be taken at a time to prevent vomiting. This is a moft troublefome and dangerous fymptom, and will often yield to a few table-fpoonfulls of milk every hour, or a table-fpoonfull of good dive oil occafionally. The fick perfon fhould drink very freely of any. of the mild diluents abovementioned if his ftomach will bear it, and the drink muft be offered to him. MEDICINES —The chief remedies in this dif- eafe are bleeding and purging: and were thefe timely adminiftered and repeated in fufficient quantity, with proper nurfmg and accomodations there is no cafe of [ever that would become lefs fatal than this terrible one. The bleeding fhould be performed on the firft at-. tack, and repeated two, three, or four times a day, according 222 OF THE YELLOW FEVER, according to the violence of the fymptoms, in the* quantity of from eight and ten to fourteen and twenty ounces, until the fymptoms are fubdued, or in com- mon language, until the fever is broken. Every new exacerbation of fever calls for another bleeding, and this may be repeated commonly until the feventh and eighth day if neceffary, or longer if there is any local determination to the head, breaft, or bowels. The pulfe will direct us greatly here; we are not always to look for the ftrong, hard pulfe, it is often a fmalf, tenfe, or, as it may be ftiled, chorded pulfe, which requires bleeding; where there is fuch a pulfe we are not to be reftrained by haemorrhagies from the ufe of the iancet. The blood drawn firft appears of a fcariet colour, without much feparation; it will afterwards generally put on the appearance of blood in other inflammatory diforders, or what is com- monly called buffy blood. Purging is alfo abfolurely neceffary. As the cof- tivenefs is obftinate wre are obliged to ufe fuch cathartics as will overcome it. Nothing has been found more effectual for this purpofe than calo- mel, and as it is flow, though fure in its effects', we add feme jalap or rhubarb to quicken its opera- tion. From eight to-twelve grains of calomel with the fame, or rather a larger, quantity of jalap or rhubarb may be given every four or fix hours uniil they operate. It is, however, often neceffary alfo eo give feveral purgative glyfters before the bowels can be opened. aiw After fix or eight large dark coloured or black ftools have been procured, we may give, perhaps, a fingle dofe of this medicine daily, and when the fymptoms abate, any other purgative may be ufed, as caftor-oil, Glauber fahs, &c. and fometimes it is neceffary, efpecially after the difeafe has continued for fome days, and the coftivenefs remains obftinate, to OF THE YELLOW FEVER. 223 to combine the calomel with aloes or gamboge, in the form of pills, two of which, containing equal parts of each, may be given every three or four hours until they operate. Confiderable advantages arife from giving a few grains of calomel daily until the difeafe is fubdued. It will often vomit as well as pur *e when firft admi- niftered. It will bring on perfpiration, and it feems to increafe the fecretion and excretion of the bile, which appears to be deficient in this difeafe. -The fears which fome entertain refpectlng the rough and inflammatory nature of this mercurial purg^ are totally groundlefs. Indeed, when we con- fider that it is the cathartic almoft univerfally em- ployed in the difeafes of children, we furely cannot fuppofe it to be too heating in thofe of adults. The difeafe has fometimes been fuddenly refolved by a general perfpiration. It will not, however, be fafe to lofe time by attempting to procure this eva- cuation, more efpecially as the means made ufe of to bring it on, would encreafe the inflammatory ftate of the fyftem, if they failed of producing their defired effect. Having faid thus much of bleeding and purging, little need be added concerning any other remedies, as the whole cure depends on the ufe of,thefe and of a proper regimen. It fometimes happens-, in the ad- vanced Stage of this difeafe, when bleeding is no longer proper, that pain of any particular part, coma, vomiting, or a continuance of fever, require the ap- plication of blifters. In this ftate only, laudanum may be of fervice, efpecially if there is any delirium. Sinapifms to the ancles may be ufed if there is much ftupor, as well as wine and other cordials; but thefe are only admiffible in that ftage of the difeafe when the pulfe is too weak to bear bleeding, and there ii no appearance of fever. The ^24 OF THE YELLOW FEVER. The efficacy of the above remedies depends upon their being early applied. To prevent infection, the bowels fhould be kept open by gentle laxatives; a temperate diet, confifting of broths, milk, vegetables, and ripe fruits of all kinds fhould be ufed, and the exciting caufes of un- ufual heat, cold, and fatigue, fliould be carefully avoided. During the convalefcence, light food, ripe fruit, beer and water, wine and water, the elixir of vitriol, and ceritaury-tea, may be ufed ; and, when able, the patient fhould ufe exercife in a carriage. But there is great danger of a relapfe, and much caution is neceffary not to be expofed to fatigue, the rays of the fun, or night air. It does not appear that this difeafe is communicable in the country, and we are told by Dr. Lining of Charleston, where it has often prevailed, that no perfon can have it twice, though this is doubted. The black people, and perfons from the Weft Indies, are lefs fubject to it than others. The treatment above recommended applies to the yellow fever as it appeared here in 1793 anc* I794* If it Should hereafter appear in a different form, a different mode of practice may be requifite. This, however, can eafily by afcertained by the fymptoms- If they are inflammatory, they will undoubtedly res quire the fame treatment, and at any rate catharrici cannot be improper. 1 CHAP. [ *25 J CHAP. XXIV. Of the SmalUPo*. J- HIS difeafe, which originally came from Arabia, is now become fo general, that very few efcape it at one time of life or another. It is a moft contagious malady; and has for many years proved the fcourge of Europe and America. The fmall-pox generally appear towards the fpring. They are very frequent in fummer, lefs fo in autumn, and leaft of all in winter. Children are moft liable to this difeafe ; and thofe whofe food is unwholefome, who want proper exercife, or who ufe too much exercife, or drink diftilled fpirits, run the greateft hazard from it. The difeafe is diftinguifhed into the dictindt and confluent kind ; the latter of which is always at- tended with danger. There are likewife other dif- tinctions of the fmall-pox; as the cryftalline, the bloody, Sec. CAUSES.—The fmall-pox is commonly caught by infection. Since the difeafe was firft brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpofe; fo that now it has become in a manner constitutional. Children who have over-headed themfelves by running, wreft- ling, &c. or adults after a debauch, are moft apt to be feized with the fmall-pox. SYMPTOMS.----This difeafe is fo generally known, that a minute defcription of it is unnecef- fary. Children commonly look a little dull, feem liftkfs and drowfy for a few days before the more O violent zi6 OF THE SMALL-POX. violent fymptoms of the fmall-pox appear. They are likewife more inclined to drink than ufual, have little appetite for folid food, complain of wearinefs, and, upon taking exercife, are apt to fweat. Thefe are Succeeded by flight fits of cold and heat in turns, which, as the time cf the eruption approaches, be- co -oe more violent, and arc accompanied with pains of the head and loins, vomiting, Sec. The pulfe is quick, with a great heat of the ikin, and reftleffnefs. When the patient drops afleep, he wakes, in a kind of hon-or, with a hidden ftart, which is a very com- mon fymptom of the approaching eruption ; as are alfo convulfion-fits in young children. We ,may remark, however, that all the feverifh fymptoms of fmall-pox are greatly relieved by walking about in the cool air. About the third or fourth day from the time of fickening, the fmall-pox 'generally begin to appear; fometimes indeed they appear fooner. At firft they very nearly refemble flea-bites, and are fooneft dis- covered on the face, arms, and breaft. The moft favourable fymptoms are a flow erup-, tion, and an abatement of the fever as foon as the puftules appear. in a mild diftinct kind of fmall- pox the rulhiles feldom appear before the third or fourth day from the time of fickening, and they generally keep coming out gradually for feveral days after. Puftules which are diftinct, with a florid reef bafi°., and which fill with thick purulent matter, .are the {;cSt. A livid brown colour of the puftules is an unfa- vourable fymptom ; as alfo when they are fmall and flat, with black fpecks in the middle. Puftules which contain a thin watery ichor are very bad. A great number of pock on the face is always attended with danger. It is likewife a bad iign when they run into one another. i It OF THE SMALL-POX. 227 It is a moft unfavourable fymptom when petechias, or purple, brown, or black fpots are interfperfed among the puftules *. Bloody Stools or urine, with a fwelled belly, are bad fymptoms; as is alfo a cou- tinual Strangury. Pale urine, and a violent throb- bing of the arteries of the neck, are Signs of an ap- proaching delirium, or of convulfion-fit?. When the face does not fweii, or falls before the pock come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at the fame time the hands and feet beyin to fwell, the patient generally does well ; but when thefe do not fucceed to each other, there is reafon to appre- hend danger. A continued fpitting is now very fa- vourable. When the tongue is covered with a brown cruft, it is an unfavourable fymptom. Grind- ing of the teeth, when it proceeds from an affection of the nervous fyftem, is a bad Sign ; but fometimes it is occafioned by worms, or a difordered ftomach. REGIMEN.—When convulfions appear, they give a dreadful alarm ; immediately fome noftrum is applied, as if this were a primary difeafe ; whereas it is only a fymptom, and far from being an unfa- vourable one, of the approaching eruption. As the fits generally go off before the actuil appearance of the fmall-pox, it is attributed to the medicine, which, ■by this means, acquires a reputation without any merit *. * And yet we often fee a few purple pock fcattered amongft a very good dillinct kind ; here there is no daqger. f Convulfion-fits .% e no doubt v^ry alarming, but their effects are often fakr.ary. They feem to be one of the means made ufe of by Nature for breaking the force of a fever. I have al- ways obferved the fever abated, and fometimes quite removed, after one or more convulfion-hts. This readily accounts for convulfions being a favourable fymptom in the fever which pic- cedes the euiption of the fmall-pox, as ;.v..-ry thing that miti- gates this fever lelibr.s the eruption. O 2 I have* 228 OF THE SMALL-POX. All that is, generally fpeaking, neceffary during the eruptive fever, is to keep the patient cool and eafy, allowing him to drink freely of fome weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He fliould not be confined to bed, but fhould fit up, and go into the cool air. as much as he is able. His food ought to be very light; and he fhould be as little difturbed with company as poffible. Much mifchief is done at this period by confining the patient too foon to his bed, and plying him with warm cordials or fudorific medicines. Every thing that heats and inflames the blood, increafes the fe- ver, and pufhes out the puftules prematurely. This has numberlefs ill effects. It not only increafes the number of puftules, but likewife tends to makcthera run into one another; and when they have been puflied out with too great violence, they generally fall in before they come to maturity. The good women, as foon as they fee the fmall- pox begin to appear, commonly ply their tender charge with cordials, faffron and marigold-teas, wine, punch, and even brandy itfelf. All thefe are given with a view, as they term it, to throw out the eruption from the heart. This, like moft other po- pular mistakes, is the abufe of a very juft obferva- tion, that when there is a ?noifture on the fkin, the pock rife better, and the patient is eafter, than when it continues dry and parched. But that is no reafon for forcing the patient into a fweat. Sweating never relieves unlefs where it comes on fpontaneoufly, or is the effect of drinking weak diluting liquors. I have never feen a cafe in which convulfions, preceding the eruption, were fatal. If the fever is high, expofure to cool air; if the feet are very cold, the warm bath; if the pulfe requires it, bleeding ; alfo emetics and anodynes are amongft the moft ufeful remedies. Children OF THE SMALL-POX. 229 Children are often fo peevifh, that they will not lie a-bed without a nurfe conftantly by them. In- dulging them in this, we have reafon to believe, has many bad effects, both upon the nurfe and child. Even the natural heat of the nurfe cannot fail to aug- ment the fever of the child; but if She alfo proves feverifh, which is often the cafe, the danger muft be increafed. Laying feveral children who have the fmall-pox in the fame bed has many ill confequences. They ought, if poffible, never to be in the fame chamber, as the perfpiration, the heat, the fmell, &c. all tend to augment the fever, and to heighten the difeafe. It is common among the poor to fee two or three children lying in the fame bed, with fuch a load of puftules that even their fkins Stick together. One can hardly view a fcene of this kind without being Sickened by the fight. But how muft the effluvia affect the poor patients, many of whom perifli by this ufage *. A very dirty cuftom prevails among the lower clafs of people, of allowing children in the fmall-pox to keep on the fame linen during the whole period of that loathfome difeafe. This is done left they fhould catch cold ; but it has many ill confequences. The linen becomes hard by the moifture which it abforbs, and frets the tender fkin. It likewife occa- * This obfervation is likewife applicable to hofpitals, work- houfes, &c. where numbers of children happen to have the fmall- pox at the fame time. I have feen above forty children cooped up in one apartment all the while they had this difeafe, without any of them being admitted to breathe the frefh air. No one can be at a lofe to fee the impropriety of fuch conduct. It ought to be a rule, not only in hofpitals for the fmall-pox, but likewife for other difeafes, that no patient fhould be within fight or hear- ing of another. This is a matter to which too little regard is paid. (^3 fions 253 OT 'IKE SMALL-POX. fions a bad fmell, which is very pernicious, both to the pat ism and to thofe about him ; befides, the filih which adheres to the linen being reforbed, or taken up again into the body, greatly augments the difeafe. A pa:ient Should not be fuft'ered to be dirty in an internal difeafe, far lefs in the fmall-pox. Cutaneous diforders are often occafioned by naftinefs alone, and are always increafed by it. Were the patient's linen to be changed every day, it would greatly refrefh him. Care indeed is to be taken that the linen be thoroughly dry. It ought likewife to be put on when the patient is moft cool, and fhould be old and foft, without any Starch in it. So ftrong is the vulgar prejudice in this country, r.Gtv.'itlillanding all that has been faid againft the hot regimen in the fmall-pox, that numbers ftill fall a facrifice to that error. I have feen poor women tra- velling in the depth of winter, and carrying their children along with them in the fmall-pox, and have frequently observed others begging by the way-fide, with infants in their arras covered with the puftules; yet I could never learn that one of thefe children d'ed by this fen cf treatment. This is certainly a fufficient proof of the fafety at leaft, of expoiing pa- tients in the fmail-pox to the open air. There can he no reafon however for expofing them to public view. It is now very common in the environs of urrat towns to inert patients in the fmall-pox on the public walks. This practice, however well it may fuit the purpofes cf boafting inoculators, fs danger- ous to the citizens, and contrary to the laws of hu- manity and found policy. The food in this difeafe ought to he very light, and of a cooling nature, as panada, or bread boiled v.ith equal quantities of milk and water, good apples roafted or boiled with milk, and fweetened with a little fagar. or fuch like. The OF THE SMALL-POX. 231 The drink may be toaft and water, clear fweet whey, barky-water, or thin gruel, &c. After the pock is full, butter-milk, being of an opening and cleanfing nature, is a very proper drink, or wine- whey if the patient is low. MEDICINE.—This difeafe is generally divided into four different periods, viz. the fever which precedes the eruption, the eruption itfelf, the fup- puration, or maturation of the puftules, and the Secondary fever. ' It has already been obferved, that little more is neceffary during the primary fever than to keep the patient cool and quiet, and allowing him to drink diluting liquors. Though this be generally the fafeft courfe that can be taken with infants, yet adults of a ftrong conftitution and plethoric habit generally require bleeding. When a full pulfe, a dry ikin, and other fymptoms of inflammation render this operation neceffary, it ought to be performed; but, unlefs thefe fymptoms are urgent, it is fafer to let it alone; if the body is bound, emollient clyiters may be thrown in. Many have fuppofed that the contagion of the fmall-pox could be entirely destroyed by mercury. Though this is not proved, yet much ^ood will arife from a free ufe of the mercurial pow- der, (fee Appendix,) when a patient is fuppofed either to have received or to be liable to the contagion. If there is a great naufea or inclination to vomit, weak camomile-tea or lukewarm water may be drank, or fifteen grains of ipecacuanha may be given, in order to clean the ftomach. Though every method is to be taken dining the primary fever, by a cool regimen, &c. to prevent too great an eruption; vet after the puftules have made their appearance, our bufinefs is to promote the fuppuration, bv diluting drink, light food, and if Fuif.rre feems to flag, by generous cordials. When Qji a low, 831 OF THE SMALL-POX. a low, creeping pulfe, faintnefs, and great lofs of ftrength, render cordials neceffary, we would recom- mend good wine, which may be made into negus, with an equal quantity of water, and fharpened with the juice of orange, the jelly of currants, or the like. Wine-whey, fharpened as above, is likewife a proper drink in this cafe; great care however muft be taken not to overheat the patient by any of thefe things. This, inftead of promoting, would retard the eruption. The riling of the fmall-pox is often prevented by the violence of the fever; in this cafe the cool regi- men is ftrictly to be obferved. The patient's cham- ber muft not only be kept cool, but he ought like- wife frequently to be taken out of bed, and to be lightly covered with clothes while in it. Exceffive reftleffnefs often prevents the rifing and filling of the fmall-pox. When this happens, gentle opiates are neceffary. Thefe, however, ought always to be adminiftered with a fparing hand. To an in- fant, a tea-fpoonful of the anodyne mixture* maybe given every five or fix hours till it has the defired effect. An adult will require a table-fpoonful in or- der to anfwer the fame purpofe. If the patient be troubled with a ftrangury, or fuppreffion of the urine, which often happens in the fmall-pox, he Should be frequently taken out of bed, and, if he be able, fhould walk acrofs the room with his feet bare. When he cannot do this, he may be frequently fet on his knees in bed, and fhould en- deavour to pafs his urine as often as he can. When thefe do not fucceed, a tea-fpoonful of the fweet fpirits of nitre may be occafionally mixed with his drink. Nothing more certainly relieves the patient, or is more heneficial in the fmall-pox, than a plenti- ful difcharge of urine. * See Appendix, Anodyne Mixture. If OF THE SMALL-POX. 233 If the mouth be foul, and the tongue dry and chapped, it ought to be frequently wafhed, and the throat gargled with water and honey, fharpened with a little vinegar or currant jelly. During the rifing of the fmall-pox, it frequently happens that the patient is feveral days without a ftool. This not only tends to heat and inflame the blood, but the feces, by lodging fo long in the body, become acrid, and even putrid; from whence bad confequences muft enfue. It will therefore be pro- per, when the body is bound, to throw in an emol- lient clyfter every day, through the whole courfe of the difeafe. This will greatly cool and relieve the patient. When petechise, or purple, black, or livid fpots appear among the fmall-pox, the Peruvian bark muft immediately be adminiftered in as large dofes as the patient's ftomach can bear. For a child, two drachms of the bark in powder may be mixed in three ounces of common water, and one ounce of fimple cinnamon water. This may be fharpened with the fpirits of vitriol, and a table-fpoonful of it given every hour. If it be given to an adult in the fame form, he may take at leaft three or four table-fpoons full every hour. This medicine ought not to be trifled with, but muft be adminiftered as frequently as the fto- mach can bear it; in which cafe it will often produce very happy effects. I have frequently feen the pe- techias difappear, and the fmall-pox, which had a very threatening afpect, rife and fill with laudable matter, by the ufe of the bark and acids. The patient's drink ought likewife in this cafe to be generous, as wine or ftrong negus acidulated with fpirits of vitriol, vinegar, the juice of lemons, jelly of currants, or fuch like. His food muft confift of roafted apples, preferved cherries, plums, and other fruits of an acid nature. The ■34 OF THE SMALL-POX. The bark and acids are not only neceffary when the petechias or putrid fymptoms appear, but likewife in the lymphatic or cryftalline fmall-pox, where the matter is thin, and not duly prepared. The Peru- vian bark feems to poffefs a lingular power of affiSting Nature in preparing laudable pus, or what is called good matter; consequently it niuft be beneficial both in this and other difeafes, where the crifis depends on a fuppuration. I have often obferved where the fmall-pox were fiat, and the matter contained in them quite clear and tranfparent, and where at firft they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and confiftence of the matter, and pro- duced the moft happy effects. When the eruption fubiides fuddenly, or as it is termed, when the fmall-pox ftrike in, before they have arrived at maturity, the danger is very great. in this cafe bliftering-plafters muft be immediately applied to the wrifts and ancles, and the patient Supported with cordials. Sometimes bleeding has a furpriflng effect in raifing the puftules after they have fubfided; but it requires ikill to know when this is proper, or to what length ihe patient can bear it*. Sharp cataplafms however if tlie'pulfe is weak may be applied to the feet and hands, as they tend to promote the fwelling of thefe ' parts. The moft dangerous period of this difeafe is what we call the Secondary fever. This generally comes on when the fmall-pox begin to blacken, or turn on the face; ami moft of thofe who die of the fmall-pox are carried off bv this fzxer. * It is proper when the pulfe is tenfe, whether high or low, but never when the puhc is weak or foft. Nature OF THE SMALL-POX. 235 Nature fometimes attempts, at the turn of the fmall-pox, to relieve the patient by loofe ftools, ef- pecially in children. Her endeavours this way are by no means to be counteracted, but promoted, and the patient at the'fame time fupported by food and drink- of a nourishing and cordial nature. If, at the approach of the fecondary fever, the pulfe be very quick, hard, and ftrong, the heat intenfe, and the breathing laborious, with other fymptoms of an inflammation of the breaft,. the pa- tient muft immediately be bled. The quantity of blood to be let muft be regulated by the patient's Strength, age, and the urgency of the fymptoms. But, in the fecondary fever, if the patient be faintifli, the puftules become fuddenly pale, and if there be great coldnefs of the extremities, bliftering plafters muft be applied, and the patient muft be fupported with generous cordials. Wine is often given, in fuch cafes, with amazing fuccefs. As the fecondary fever is in great meafure, if not wholly, owing to the puftules, it would feem highly confonant to reafon that thefe, as foon as they come to maturity, fliould be opened. This is every day practifed in other phlegmons, which tend to fuppu- ration ; and there feems to be no caufe why it Should be lefs proper here. On the contrary, we have reafon to believe, that by this means the-fecondary fever might always be leffened, and often wholly prevented. The puftules fliould be opened when they begin to turn of a yellow colour. Very little art is neceffary for this operation. They may either be opened with a lancet or a needle, and the matter abforbed by ;.i little dry lint. As the puftules are generally firft ripe on the face, it will be proper to begin with opening thefe, and the others in courfe as they ! ecome ripe. . The puftules generally fill again, a fecond 236 OF THE SMALL-POX. fecond or even a third time; for which caufe, the operation muft be repeated, or rather continued, as long as there is any confiderable appearance of mat- ter in the puftules. We have reafon to believe that this operation, rational as it is, has been neglected from a piece of mistaken tendernefs in parents. They believe that it muft give great pain to the poor child ; and, there- fore, would rather fee it die, than have it thus tor- tured. This notion, however, is entirely without foundation. I have frequently opened the puftules when the patient did not fee me, without his being in the leaft fenfible of it; but, fuppofe it were at- tended with a litrle pain, that is nothing in compa- rifon to the advantages which arife from it. Opening the puftules not only prevents the re- forption of the matter into the blood, but likewife takes off the tenfion of the ikin, and by that means greatly relieves the patient. It likewife tends to prevent the pitting which is a matter of no fmall importance. Acrid matter, by lodging long in the puftules, cannot fail to corrode the tender fkin; by which many an handfome face becomes fo deformed, as hardly to bear a refemblance to the human figure*. It is generally neceffary, after the fmall-pox are gone off, to purge the patient. If, however, the body has been open through the whole courfe of the difeafe, or if butter-milk, and other things of an opening nature, have been drank freely after the height of the fmall-pox, purging becomes lefs necef- fary ; but it ought never wholly to be neglected. * Though this operation can never do harm, yet it is only neceffary when the patient has a great load of fmall-pox, or when the matter which they contain is of fo thin and acrid a nature, that there is reafon to apprehend bad confequences from its being too quickly reforbed, or taken up again into the mafs of circulating humors. For OF THE SMALL-POX. 237 For very young children, an infufion of fenna and prunes, with a little rhubarb, may be fweetened with coarfe fugar, and given in fmall quantities 'till it operates. Thofe who are farther advanced muft take medicines of a Sharper nature. For example, a child of five or fix years of age, may take eight or ten grains of fine rhubarb in powder, or the fame quantity of jalap in powder. This may be wrought off with frefh broth or water gruel. For children further advanced, and adults, the dofe muft be in- creafed in proportion to the age and conftitution. When impofthumes happen after the fmall-pox, which is not feldom the cafe, they muft be brought to fuppuration as foon as poffible, by means of ripen- ing poultices, and opened, if they have not broke of their own accord. The Peruvian bark and a milk diet, will likewife be ufeful in this cafe. When a cough, a difficulty of breathing, or other fymptoms of a confumption, fucceed to the fmall- pox, the patient muft be fent to a place where the air is good, and put upon a courfe of affes or cow's milk, with fuch exercife as he can bear. For fur- ther directions in this cafe, fee the article Confump- tions. OF INOCULATION. Though, perhaps, no difeafe, after it is formed, baffles the powers of medicine more effectually than the fmall-pox* yet more may be done before-hand, to render this difeafe favourable, than any one wc know, as almoft all the danger from it may be pre- vented by inoculation. This falutary invention has been known in Europe above half a century; but, like moft other ufeful difcoveries, it has, 'till of late, made but flow progrefs. It muft, however, be ac- knowledged, to the honour of this country, that inoculation 23 3 OF THE SMALL-POX. inoculation has met with a more favourable recep- tion than among any of our neighbours. It is {fill, however, far from being general, which we have reafon to fear will be the cafe, as long as the practice continues in the hands of the faculty. No difcovery can be of general utility, while the practice of it is kept in the hands of a few. Had the inoculation of the fmall pox been introduced as a fafhion, and not as a medical difcovery, or had it been practifed by the fame kind of operators here, as it is in thofe countries from whence we learned it, it had long ago been univerfal. Hence it is, that the practice of inoculation never became in any mea- fure general, 'till taken up by men not bred to phy- fic. Thefe have not only rendered the practice more extenfive, but likewife more fafe, and by acting un- der lefs reftraint than the regular practitioners, have taught them that the patient's greateft danger arofe, not from the want of care, but from the excefs of it. They know very little of the matter, who impute the fuccefs of modern inoculators to any fuperior fkill, either in preparing the patient or communi- cating the difeafe. Some of them, indeed, from a fordid define of engroffihg the whole practice to themfelves^* pretend to have extraordinary fecrets or noftrums for preparing perfons for inoculation, which never fail of fuccefs. But this is only a pretence calculated to blind the ignorant and inattentive. Common fenfe and prudence alone are fufficient, both in the choice of the fubject and management of the operation. Whoever is poffeffed of thefe* may perform this office for his children whenever he finds it convenient, provided they be in a good ftate of health. This fentiment is not the refult of theory, but of obfervation. Though few phyficians have had more opportunities OF THE SMALL-POX. 230 opportunities of trying inoculation in all its different forms, fo little appears to me to depend on thofe, generally reckoned important circumftances 0/ pre- paring the body, communicating the infection by this or the other method, ccc. that for feveral years paft, I have perfuaded the parents or nurfes to per- form the whole themfelves, and have found that method followed with equal fuccefs, while it is free from many inconveniences that attend the other* The fmall-pox may be communicated in a great variety of ways, with nearly the fame degree of fafety and fuccefs. In Turkey, from whence we learned the practice, the women communicate the difeafe to children, by opening a bit of the fkin with a needle, and putting into the wound a lii-ilc matter taken from a ripe puitule. On the coait of Barbary they pafs a thread, wet with the matter, through the fkin between the thumb and fore-finger : and in fome of the ftates of Barbary, inoculation is performed by * A critical fituation, too often to be met with, firfi: put mc upon trying this method. A gentleman who had lou ail his children, except one fo,n, by the natural (mall-pox, was deter- mined to have him inoculated. He told me his intention, and defired I would perfuade the mother and grand-mother, &c. of its propriety. But that was impoflible. They were not to be perfuaded, and either could not get the better of their fears, or were determined againft conviction. It was always a p< int with me not to perform the operation without the confent of the parties concerned. I therefore advifcu the father, after giving his fon a doii or two < f lhubarb, to go to a patient who lud the frqall-pox of a good kind, to open two or three of the puftules, taking up the matter with a little cotton, and as foon as he came home, to take his fon apart, and give his arm a flight fcratch with a pin, afterwards to rub the place well with the cotton, and take no further notice of it. All this he punftuallv performed; and, at the ufual pe:iod, the fmall-pox made tlieir appearance, which were of an exceeding good kind, and fo mild as not to confine the boy an hour to his bed. None of the other relations knew but the difeafe h?.d come in the natural way, 'till the boy was well. ru'r.'in^ 240 OF THE SMALL-POX. rubbing in the variolous matter between the thumb and fore-finger, or on other parts of the body. The practise of communicating the fmall-pox, by rubbing the variolous matter upon the fkin, has been long known in many parts of Afia and Europe, as well as m Barbary, and has generally gone by the name of buying the fmall-pox. The prefent method of inoculating in Britain is, to make two or three flaming incifions in the arm, fo fuperficial as not to pierce quite through the fkin, with a lancet wet with frefli matter taken from a ripe puftule ; afterwards the wounds are clofed up, and left without any dreffing*. We do not find that inoculation is at all confidered as a medical operation in thofe countries from whence we learned it. In Turkey it is performed by the women, and in the Eaft Indies by the Brachmins or priefts. In this country, the cuftom is ftill too much in its infancy ; we make no doubt, however, but it will foon become fo familiar, that parents will think no more of inoculating their children, than at pre- fent they do of giving them a purge. No fet of men have it fo much in their power to render the practice of inoculation general as the clergy, the greateft oppofition to it ftill arifing from fome feruples of confidence. I would recommend it to them not only to endeavour to remove the religi- ous objections which weak minds may have to this falutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make ufe of a mean which Providence has put in our power for * The American method is, to open the ripe puftules with a lancet, put the mattter on a bit of glafs or ivory, and when it is to be ufed, render it moift with a little cold water, wet the point of a lancet with it, and introduce it under the fkin, fo as juft to fee the blood: one puncture is as certain as a dozen. % ■ faving OF THE SMALL-POX. 241 laving the lives of our offspring. Surely fuch parents as wilfully neglect the means of faving their children's lives, are as guilty as thofe who put them to death. I wifh this matter were duly weighed. No one is more ready to make allowance for human weaknefs and religious prejudices, yet I cannot help recom- mending it, in the warmeft manner, to parents, to confider how great an injury they do their children, by neglecting to give them this difeafe in the early period of life. The numerous advantages arifing from the inocu- lation of the fmall-pox have been pretty fully pointed out by the learned Dr. M'Kenzie, in his Hiftory of Health *. To thofe mentioned by the Doctor we * " Many and great," fays this humane author, " are the " dangers attending the natural infection, from all which the " inoculation is quite fecure. The natural infection may in- " vade weak or diftempered bodies, by no means difpofed " for its kindly reception. It may attack them at a feafon " of the year cither violently hot, or intently cold. It may " lay hold upon people, unexpectedly. It may furprife lis " foon aftir exceffes committed in luxury, intemperance, or " lewdnefs. It may likewife feize on the innocent after in- " difpenfable watchings, hard labour, or neceflary journies. " And is it a trivial advantage, that all thefe unhappy cir- " cumftances can be prevented by inoculation ? By inocula- " tion numbers are faved from deformity, as well as from " death. In the natural fmall-pox, how often are the fineft " features, and the moft beautiful complexions, miferably dif- " figured? Whereas inoculation rarely leaves any ugly marks " of fears, even where the number of puftules on the face has " been very confiderable, and the fympt: ms by no means fa- " vourable. And many other grievous complaints, that are " frequently fubfequent to the natural fort, feldom follow the " artificial. Does not inoculation alfo prevent thofe inexpref- " fible terrors that perpetually harafs perfons who never had " this difeafe, infomuch that when the fmall-pox is epidemical, 41 entire villages are depopulated, markets ruined, and the face " of dillrels is fpread over the whole country ? From this terror " it arifes, that juftice is frequently poftponed, or difcouraged, •* at fefhons cr aflizes where the fmall-pox rages. Witneffes R " and 242 OF THE SMALL-POX. fhall only add, that fuch as have not had the fmall- pox in the early period of life, are not only rendered uvhap'.-y, but likewife in a great meafure unfit for fuftainuig many of the moft ufeful and important oiiics. Few people would chufe even to hire a fer- vant who had not had the fmall-pox. How could a phyfician or a furgeon, who had never had the fmall- pox himfelf, attend others under that malady? How deplorable is the fituation of females, who arrive at mature age without having had the fmall-pox ! If an infant happen to be feized with the fmall-pox upon the mother's breaft, who has not had the difeafe her- felf, he feene muft be diftrcffing ! If fhe continue to fuckle the child, it is at the peril of her own life; and if fhe wean it, in all probability it will perifh. How often is the affectionate mother forced to leave her houfe, and abandon her children, at the very time when her care is moft neceffary ? Yet fhould maternal affection get the better of her fears, the confequences would often prove fatal. I have known the tender mother and her fucking infant laid in the fame grave, both untimely victims to this dreadful malady. But thefe are fcenes too fliocking even to mention. Let parents who run away with their children to avoid the fmall-pox, or who refule to inoculate them in infancy, confider to " and juries dare not appear. Does not inoculation, in like " manner, prevent our failors from being feized with this " diftemper on fhipboard, where they muft quickly fpread " the infection among fuch of the crew who never had it " before, and where they have fcarce any chance to efcape, " being half ftifled with the clofenefs of their cabins, and " but very indifferently nurfed ? Laftly, with regard to the " foldiery, the miferies attending thefe poor creatures when " attacked by the fmall-pox on a march, are inconceivable, " without attendance, without lodgings, without any accom- «« modation; fo that one of three commonly perifhes." what OF THE SMALL-POX. 243 what deplorable fituations they may be reduced by this mistaken tendernefs ! As the fmall-pox has now become an epidemical difeafe in moft parts of the known world, no other choice remains but to render the malady as mild as poffible. This is the only manner of extirpation now left in our power ; the artificial method of com- municating the difeafe, could it be rendered univer- fal, would amount to nearly the fame thing as root- ing it out. It is a matter of fmall confequence, whe- ther a difeafe be entirely extirpated, or rendered fo mild as neither to deftroy life nor hurt the conftitu- tion ; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deferve to be named. In the natural way, one in four or five generally dies ; but by inoculation not one of a thoufand. Nay, fome can boaft of having inoculated ten thoufand without the lofs of a fingle patient. I have often wifhed to fee fome plan eftablifhed for rendering this falutary practice univerfal ; but am afraid I fliall never be fo happy. The difficulties indeed are many ; yet the thing is by no means im- practicable. The aim is great; no lefs than laving the lives of one-fourth part of mankind. What ought not to be attempted in order to accomplifh fo defirable an end ? The firft ftep towards rendering the practice uni- verfal, muft be to remove the religious prejudices againft it. This, as already obferved, can be done by the clergy. They muft not only recommend it as a duty to others, but likewife practife it on their own children. Example will ever have more influ- ence than precept. The next thing requifite is to put it in the power of all. For this purpofe we would recommend it to the Faculty to inoculate the children of the poor R 2 gratis. 244 OF THE SMALL-POX. gratis. It is hard that fo ufeful a part of mankind fhould by their poverty be excluded from fuch a be- nefit. Should this fail, it is furely in the power of any State to render the practice general, at leaft as far as their dominion extends. We do not mean that it ought to be enforced by a law. The beft way to promote it would be to employ a fufficient number of operators at the public expence to inoculate the children of the poor. This would only be ne- ceflary till the practice became general ; afterwards cuftom, the itrongeft of all laws, would oblige every individual to inoculate his children to prevent reflec- tions. It may be objected to this fcheme, that the poor would refufe to employ the inoculators ; this diffi- culty is eafily removed. A fmall premium to en- able mothers to attend their children while under the difeafe, would be a fufficient inducement; be- fides, the fuccefs attending the operation would foon banifli all objections to it. Even confederations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten cr twe've, and when they come to be ufeful, they are fnatcved away by this malady, to the great lofs of their parents, and detriment of the public. The Britifh legislature has of late years fhewn great attention to the prefervation of infant-lives, by fupporting the foundling hofpital, &e. But we will venture to fay, if one-tenth part of_the fums laid out in fupporting that inftitution, had been beftowed towards promoting the practice of inocu- lation of the fmall-pox among the poor, that not only more ufeful lives had been faved, but the prac- tice ere now rendered quite univerfal in this ifland. It is not to be imagined what effect example and a little money will have upon the poor; yet, if left to themfelves, OF THE SMALL-POX. 245 themfelves, they would go on for ever in the old way, without thinking of any improvement. We only mean this as a hint to the humane and public-fpirited. Should fuch a fcheme be approved, a proper plan might eafily be laid down for the execution of it. But as public plans are very difficult to bring about, and often, by the felfilh views and mifcon- q*uct of thofe intrufted with the execution of them, fail of anfwering the noble purpofes for which they were defigned ; we Shall therefore point out feme Other method by which the benefits of inoculation may be extended to the poor. There is no doubt but inoculators will daily be- come more numerous. We would therefore have every parifli in Britain to allow them a fmall annual falary for inoculating all the children of the parifli at a propsr age. This might be done at a very trifling expencc, and it would enable every one to enjoy the benefit of this falutary invention. Two tilings chiefly operate to prevent the progrefs of inoculation. The one is a wiSli to.put the evil day as far off as poffible. This is a principle in our nature ; and as inoculation feems rather to be anti- cipating a future evil, mankind are therefore fo averfe to it. But this objection is fufficiently an- fyvered by the fuccefs. Who in hisfenfes would not prefer a. leffer evil to-day to a greater to-morrow, provided they were equally certain ? The other obstacle is the fear of reflections. This. has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty ; and till that be removed, inoculation will make but fmall progrefs. Nothing, however, can remove it but cuftom. Make the practice fashion- able, and all objections will foon vanish. It is fafhion that has, in a great degree, led the multitude fince R 3 the t 246" OF THE SMALL-POX. the beginning of the world, and will lead them to the end. We muft therefore call upon the more enlightened part of mankind to fet a pattern to the reft. Their example, though it may for fome time meet with oppofition, will at length prevail. I am aware of the objection to this practice from the expence with which it may be attended : this is eafily obviated. We do not mean that every parifh ought to employ a Sutton or a Dimfdale as inocu- lators. Thefe h^ve, by their fuccefs, already recom. ■ mended themfelves, and are beyond the vulgar reach ; but have not others an equal chance to fuc- ceed ? They certainly have. Let them make the fame trial, and the difficulties will foon vanifh. There is not a parifh, and hardly a village in Britain, deftitute of fome perfon who can bleed. But this is a far more difficult operation, and requires both more fkill and dexterity than inoculation. The perfons to whom we would chiefly recom. mend the performance of this operation, arc the clergy. Melt of them know fomething of medicine. Almoft all of them bleed, and can order a purge, which are all the qualifications neceffary for the practice of inoculation. The priefts among the lefs enlightened Indians perform this office, and why fliould a Christian teacher think himfelf above it? Surely the bodies of men, as well as their fouls, me- rit a part of the paftor's care; at leaft the greateft Teacher who ever appeared among men thought fo. Should all other methods fail, we would recom- mend it to parents to perform the operation them- felves. Let them take any method of communi- cating the difeafe they pleafe ; provided the fubjects be healthy, and of a proper age, they will feldom fail to fucceed to their wifh. I have known many inftances even of mothers performing the operation, and never fo much as heard of one bad confequence. A planter OF THE SMALL-POX. 247 A planter in one of the Weft-India iflands is faid to have inoculated, with his own hand, in one year, three hundred of his flavcs, who, notwithstanding the warmth of the climate, and other unfavourable circumftances, all did well. Common mechanics have often, to my knowledge, performed the opera- tion with as good fuccefs as phyficians. We do not, however, mean to difcourage thofe who have it in their power, from employing people of fkill to inocu- late their children, and attend them while und.r the difeafe, but only to Shew, that where fuch cannot be had, the operation ought not, upon that account, to be neglected. We have been the more full upon this fubject be- caufe the benefits of inoculation cannot be extended to^fociety by any other means than by making the practice general. While it is confined to a few, it muft prove hurtful to the whole. By means of it the contagion is fpread, and is communicated to many who might otherwife never have had the dif- eafe. Accordingly it is found that more die of the fmall-pox now than before inoculation was intro- duced ; and this important difcovery, by which alone more lives might be faved than by all the endeavours of the Faculty, is in great meafure loft by its benefits not being extended to the whole community *. The fpring and autumn are ufually reckoned the moft proper feafons for inoculation, on account of the weather being then moft temperate. The moft proper age for inoculation is between two and five. Many approve of inoculating on the breaft, and where no circumftances forbid this prac- tice, I have no objection to it. Children, however, * By a well-laid plan for extending inoculation, more lives might be faved at a fmall expence, than are at prefent preferved by all the hofpitals in England, which coft the public fuch an amazing fum. R 4 are 248. OF THE SMALL-POX. are more liable to convulfions at this time than after- wards ; befides, the anxiety of the mother or nurfe, fliould the child be in danger, would not fail to heighten it by fpoiling the milk. Children who have constitutional difeafes muft, nbverthelefs be inoculated. It will often mend the habit of body ; but ought to be performed at a time, when they are moft healthy. Accidental difeafes. fhould always, if poffible, be removed before inocu- lation. It is generally thought neceffary to regulate, the, diet for fome time before the difeafe be communi- cated. In children, however, great alteration in diet is feldom neceffary, their food being commonly of the moft fimple and wholefome kind, as milk, water- pap, weak broths, bread, light pudding, mild roots, and white meats. But children who have been accuftomed to a hotter diet, who are of a grofs habit, or, abound, with bad humors, ought to be put upon a fpare diet when they are inoculated. Their food fliould be of a.light cooimg nature, and their drink whey, butter- milk, and fuch like. We would recommend no other medicinal pre-, paration but two or three mjld purges, which ought to be fuited to the age and ftrength of the patient *. The fuccefs of inoculators does not depend on the preparation of their patients, but on their manage- ment of them while under the difeafe. Their con- ftant care is to keep them cool, and tjieir bodies gently open, by which means the fever is kept low* and the eruption greatly leffened. The danger, is feldom or never great when the puftules are few,; and their number is generally in proportion to the * Many phyficians, however, are in the practice of giving one of the mercurial powders every morning after the inoculation, until the eruption. fever OF THE MEASLES, 249 fever which precedes and attends the eruption. Hence the chief fecret of inoculation confifts in re- gulating the eruptive fever, which generally may be kept fufficiently low by the methods mentioned' above. The regimen during the difeafe is in all refpects the fame as under the natural fmall-pox. The pa-^ tient muft be kept cool, his diet fhould be light j and his drink weak and diluting, &c. Should any bad fymptoms appear, which is feldom the cafe, they muft be treated in the fame way as directed in the natural fmall-pox. CHAP. XXV. Of the Meaflles. i. HE meafles appeared;ip Europe about the fame time with the fmall-pox, and have a great affinity to that difeafe. They both came from the fame quarter of the world, are both infectious, and: feldom attack the fame perfon more than once. The meafles are moft common in the fpring feafon, and generally difappear in fummer. The. difeafe itfelf, when properly managed, feldom proves fatal; but its confequences are often very troublefome. CAUSE.—This difeafe, like the fmall-pox, pro- ceeds from infection, and is more or. lefs dangerous according to the conftitution of the patient, the fea- fon of the year, the climate, Sec. SYMPTOMS.—The meafles, like other feverifh complaints, are preceded by alternate fits of heat and cold, with ficknefs, and lofs of appetite. The tongue, k 250 OF THE MEASLES. is white, but generally moift. There is a fhort cough, a heavinefs of the head and eyes, drowfinefs, and a running at the nofe. Sometimes indeed the cough does not come before the eruption has ap- peared. There is an inflammation and heat in the eyes,* accompanied with a defluxion of Sharp rheum, and great acutpiefs of fenfation, fo that they cannot bear the light without pain. The eye-lids frequently fwell fo as to occafion blindnefs. The patient gene- rally complains of his throat; and a vomiting or loofenefs often precedes the eruption. The ftools in children are commonly greenifh; they complain of an itching of tl>e fkin, and are remaikabfy peevifh. Bleeding at the nofe is common, both before and in the progrefs of the difeafe. About the fourth day, fmall fpots, refembling flea-bites, appear, firft upon the face, then upon the breaft, and afterwards on the extremities: thefe may be diftinguifhed from the fmall-pox by their fcarcely rifing above the fkin. The fever, cough, and difficulty of breathing, inftead of being removed by the eruption as in the fmall-pox, are rather in- creafed; but the vomiting generally ceafes. About the fixth or feventh day from the time of fickening, the meafles begin to turn pale on the face, and afterwards upon the body; fo that by the ninth day they entirely difappear, leaving furfuraceous or bianny appearances of the fkin. The fever, how- ever, and difficulty of breathing, often continue, efpecially if the patient has been kept upon too hot a regimen. Petechias, or purple fpots, may likewife be occafioned by this error. A violent loofenefs fometimes fucceeds the meafles; in which cafe the patient's life is in immi- nent danger. Such as die of the meafles generally expire about the ninth day from the invafion, and are commonly carried OF THE MEASLES. 251 carried off by the peripneumony, or inflammation of the lungs. The moft favourable fymptoms are a moderate loofenefs, a moift fkin, and a plentiful difcharge of urine. When the eruption fuddenly ftrikes in, and the patient is feized with a delirium, he it in the greateft danger. If the meafles turn too foon of a pale co- lour, it is an unfavourable fymptom, as are alfo great weaknefs, vomiting, reftleffnefs, and difficulty of fwallowing. Purple- or black fpots appearing among the meafles are very unfavourable. When a continual cough, with hoarfenefs, fucceeds the dif- eafe, there is reafon to fufpedt an approaching con- fumption of the lungs. Our bufinefs in this difeafe is to affift Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid; this, however, is feldom the cafe: but when they are too violent they muft be reftrained by evacuations, and cool diluting liquors, &c. We ought likewife to endeavour to appeafe the moft urgent fymptoms, as the cough, reftleffnefs, and difficulty of breathing. REGIMEN.—The cool regimen is neceffary here as well as in the fmall-pox. The food too muft be light, and the drink diluting. Small-beer likewife, though a good drink in the fmall-pox, is here impro- per. The moft fuitable liquors are decoctions of liquorice with marfhmallow roots and farfaparilla, infufions pf flax-feed, or the flowers of elder, balm- tea, whey, barley-water, bran-tea, and fuch like. Thefe, if the patient be coftive, may be fweetened with honey; or, if that fhould difagree with the ftomach, a little brown-fugar may occafionally be added to them. MEDICINE.—The meafles being an inflammatory difeafe, without any critical difcharge of matter, as in the fmall-pox, bleeding is commonly neceffary? efpecially 252 OF THE- MEASLES. qfpecifdly when the fever runs high, with difficulty of breathing, and great oppreffion of the breaft. But if the difeafe be of a mild kind, bleeding may Jpe omitted. The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak ca- momile-tea. When the cough is very troublefome, with dry- nefs of the throat, and difficulty of breathing, the patient may hold l)is head over the fteam of warm water, and draw the fteam into his lungs. He may likewife lick a little fpermaccti and fugar- candy pounded together; or take now and then a, fpoonful of the oil of fweet almonds, with fugar- candy diffolved in it. Thefe will foften the throat, and relieve the tickling cough. If at the turn of the difeafe the fever affumes new vigour, and there appears great danger of fuffoca- tion, the patient muft be bled according-to his pulfe, and bliftering-plafters applied, with a view, to prevent tfie load from being thrown on the lungs, where if an inflammation fhould fix itfelf, the patients life wjll be in danger. In cafe the meafles fliould fuddenly difappear, it will be neceffary to purfue the fame method which we have recommended when the fmall-pox recede. rl he patient muft be fupported with wine and cordials, Bliftering-plafters muft be applied to the legs and arms, and the body rubbed all over With warm flannels. Warm'poultices may be likewife* %applied; tp the feet and palms of the hands. When purple or black fpots appear, the patient's drink fhould be fharpened with fpirits of vitriol; and if thefe fymptoms increafe, the Peruvian bark muft be. adminiftered in the fame manner as directed in the fmall-pox. Opiates OF THE MEASLES. 253 Opiates are fometimes neceffary, but fhould never be given except in cafes of extreme reftleiTnefs, a violent loofenefs, or when the cough is very trouble- fome. For children, a tea-fpoonful of afthmatic elixir may be occafionally given, according to the patient's age, or the violence of the fymptoms. Whenever opiates are given in this difeafe, antimonial wine fliould be addfd. After the meafles are gone off, the patient ought to be purged. This may be conducted in the fame manner as directed in the fmall-pox. If a violent loofenefs fucceeds the meafles, it may be checked by taking for feme days a gentle dofe of rhubarb in the morning, and an opiate over night; but if thefe do not remove it, and the pulfe is hard, bleeding will feldom fail to have that effect. Patients recovering after the meafles fhduld be careful what they eat or driuk. Their food for fome time ought to be light, and in fmall quantities, and their drink diluting, and rather of an opening nature, as butter-milk, whey, and fuch "like. They ought alfo to beware of expofing themfelves too foon to the cold air, leaft a fuffocating catarrh, an afthma, or a confumption of the lungs, fhould enfue. Should a cough, with difficulty of breathing, and other fymptoms of a confumption, remain after the meafles, fmall quantities of blood may be frequently let at proper intervals, as the patient's ftrength and conftitution will permit. He ought likewife to drink milk, to remove to a free air, if in a large town, and to *rfde daily on horfeback. He muft keep clofe to a diet confifting of milk and vegetables; and laftly, if thefe do not fucceed, let him remove to a warmer climate*. * Attempts have been made to communicate the meafhw, as well as the fmall-pox, by inoculation, and we make no doubt bilt in time the practice may fucceed. Dr. Home of Edin- burgh [ 254 ] OF THE SCARLET FEVER. The fcarlet fever is fo called from the colour of the patient's fkin, which appears, as if it were, tinged with red wine. It happens at any feafon of the year, but is moft common towards the end of fummer ; at which time it often feizes whole families; children and young perfons are moft fubject to it. It begins, like other fevers, with coldnefs and Ihivering, without any violent ficknefs. Afterwards the fkin is covered with red fpots, which are broader, more florid, and lefs uniform than the meafles. They continue two or three days, and then difappear; after which the cuticle or fearf-fkin, falls off. There is feldom any occafion for medicine in this difeafe. The patient ought, however, to keep with- in doors, to abftain from flefh, ftrong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body muft be kept gently open by emollient clyfters, or fmall dofes of flowers of fulphur and cream of tartar. burgh fays, he communicated the difeafe by the blood. Others have tried this method, and have not found it fucceed. Some think the difeafe would be more certainly communicated, by rubbing the fkin of a patient who has the meafles with cotton, and afterwards applying the cotton to a wound, as in the fmall- pox ; while others recommend a bit of flannel, which had been applied to the patient's fkin all the time of the difeafe, to be afterwards laid upon the arm or leg cf the perfon, to whom the infection is to be communicated. There is no doubt but this difeafe, as well as the fmall-pox, may be communicated various ways; the moft probable, however, is either from cotton rubbed upon the fkin, as mentioned above, or by intro- duping a little of the fharp humor, which diftils from the eyes of the patient into the blood. It is agreed on all hands, that fuch patients as have been inoculated had the difeafe very mildly; we therefore wifh the praSice were more general, as the meafles are often fatal. Children OF THE BILIOUS FEVER. 255 Children and young perfons are fometimes feized at the beginning of this difeafe, with a kind of ftu- por and epileptic fits. In this cafe, the feet and legs fhould be bathed in warm water, a large bliftering- plafter applied to tbjfcneck, and the patient bled, if the pulfe is ftrong ana hard. The fearlet fever, however, is not always of fo mild a nature. It is fometimes attended with putrid or malignant fymptoms, in which cafe it is always dangerous. In the malignant fearlet fever, the pa- tient is not only affected with coldnefs and Shivering, but with languor, ficknefs, and great oppreffion ; to thefe fucceed exceffive heat, naufea and vomiting, with a forenefs of the throat; the pulfe is extremely quick, but fmall and depreffed ; the breathing fre- quent and laborious; the fkin hot, but not quite dry; the tongue moift, and covered with a whitifh mucus; the tonfils inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the fymptoms generally grow worfe, and frefh ones come on, as purging, delirium, &c. * OF THE BILIOUS FEVER. When a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacua- tion of bile, either by vomit or ftool, the fever is denominated bilious. The bilious fever generally makes its appearance about the end of fummer, and ceafes towards the approach of winter. It is moft frequent and fatal in warm countries, efpecially where the foil is marfhy, and when great rains are fucceeded by fultry heats. Perfons who work without doors, * For the treatment of this malignant fearlet fever, as it is here called, fee putrid ulcerous fore-throat, as there is every reafon to believe they are the fame difeafes, differing only in the evidence of the fymptoms, lie 256 OF THE BILIOUS FEVER. lie in camps, or who are expofed to the night air$ are moft liable to this kind of fever. If there are fymptoms of" inflammation at the beginning ot this fever, it will be.neceffary to bleed, and to put the patient upon the cool diluting regimen recommended in the inflammatory fever. The fa- line draught may likewife be frequently adminiftered, and the patient's body kept open#by clyfters or mild purgatives. But if the fever Should remit or inter- mit, bleeding will feldom be neceffary. In^this cafe, a vomit maybe adminiftered, and, if the body be bound, a gentle purge ; after which the Peruvian bark will generally complete the cure. In cafe of a violent loofenefs, the patient muft be fupported with chicken broth, jellies of hartShorn, and the like ; and he may ufe the white decoclion for his ordinary drink*. If a bloody flux fhould accom- pany this fever, it muft be treated in the manner recommended under the article Dyfeniery. , When there is a burning heat, and the patient does not fweat, that evacuation may be promoted by giving him, three or four times a-day, a table- fpoonful of Mindererus's fpirit -j-, mixed in a cup of his ordinary drink. If the biiious fever be attended with the nervous, malignant, or putrid fymptoms, which is fometimes the cafe, the patient muft be treated in the fame manner as directed under thefe difeafes. After this fever, proper care is neceffary to pre- ' vent a relapfe. iFor this purpofe, the patient, efpe- cially towards the end of autumn, ought to continue the ufe of the Peruvian-bark, for fome time after he is well. He fliould likewife abftain from all tralhy fruits, new liquors, and every kind of. flatulent aliment. * See Appendix, White DecoSion. f See Appendix, Spirit of Mindererus. i CHAP. « CHAP. XXVI. 0 Of the Eryfipelas*, or St. Anthony's Fire. ■ 0 1 filS difeafe, which in fome parts of Britain is caljed the rdje, attacks perfons at any period of life, but is moft common between the age of thirty*and forty. Perfons of a fanguine or ple- thoric habit are moft liable to it. It often attacks young people, and pregnant women; and fuch as have once been afflicted with it are very liable to have it again. Sometimes it is a primary difeafe, and at other times only a fymptom of fome other malady. Every part of the body is liable to be at- tacked by an eryfipelas, but it moft frequently feizes the legs or face, efpecially the latter. It is moft common in autumn, or when hot weather is fucceeded by cold and wet. CAUSES,-—The eryfipelas maybe occafioned by violent paffions or affections of the mind ; as fear, anger, &c. When the body has been heated to a great degree, and is immediately expofed to the cold air, fo that the perfpiration is fuddenly checked, an eryfipelas will often enfue *. It may alfo be oc- cafioned by drinking to excefs, by continuing too long in a warm bath, or by any thing that overheats * The country people in many parts of Britain call this dif- eafe a blajl, and imagine it proceeds from foul air, or ill wind, as they term it. The truth is, they often lie down to reft them, when warm and fatigued, upon the dump ground, where they fall afleep, and lie fo long as to catch cold, which occafions th« eryfipelas. This difeafe may indeed proceed from other caufes, but we may venture to fay, that nine times out of ten it is occa- fioned by cold caught after the body has been greatly heated or fatigued. S the 25 3 OF THE ERYSIPELAS, the blood. If any of.the natural evacuations be ob- ^ftructed, or in too fmall quantity, it may caufe an eryfipelas. The fame effect will follow from the floppage of artificial evacuations ; as iffues, fetons, or the like. SYMPTOMS.—The eryfipelas attacks with Shi- vering, thirft, lofs of ftrength, pain in the head and back, heat, reftleffnefs, and a quick pulfe ; to which may be added vomiting, aad fometimes a delirium. On the fecond, third, or fourth day, the part fwells, becomes r6d, and fmall puftules appear; at which time the fever generally abates. When the eryfipelas feizes the foot, the parts contiguous fwell, the fkin fliines ; and, if the pain be violent, it will afcend to the leg, and will not bear to be touched. When it attacks the face, it fwells, appears red, and the Skin is often covered with fmall puftules filled with clear water. One or both eyes are generally clofed with the fwelling ; and there is a difficulty of breathing. If the eryfipelas affects, the breaft, it fwells and becomes exceedingly hard, with great pain, and may fuppurate. There is fometimes a violent paiii in the arm-pit on the fide affected, where an abfeefs is often formed. If in a day or two the fwelling fubfides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in fcales, the dan- ger is over. When the eryfipelas is large, deep, and affects a very fenfible part of the body, the danger is great. If the red colour changes into a livid or black, it may end in a mortification. Sometimes the inflam- mation cannot be difcuffed, but comes to a fuppu- ration ; in which cafe, fiftulas, a gangrene, or mor- tification, often enfue. Such OR ST. ANTHONY'? FIRE. 259 Such as die of this difeafe are commonly carried off by the fever, which is attended with difficulty of breathing, and fometimes with a delirium and great drowfinefs. They.generally die about the fe- venth or eighth day. REGIMEN.—In the eryfipelas the patient muft neither be kept too hot nor too cold, ,as either of thefe extremes will tend to make it retreat, which is always to be guarded againft. When the difeafe is mild, it will be fufficient to keep the patient within doors, without confining him to his bed, and to pro- mote the perfpiration by diluting liquors, Sec. The diet ought to be Slender, aud of a moderately cooling and moiftening quality, as oatmeal-gruel, pa- nada, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flefh, fifh, ftrong drink, fpices, pickles, and all other things that may heat and inflame the blood ; the drink may be barley- water, an infufion of elder flowers, common whey, and fuch like. But if the pulfe be low, and the fpirits funk, the patient muft be fupported with negus, and other tilings of a cordial nature. His food may be fago gruel with a little wine, and nourishing broths taken in fmall quantities, and often repeated. Great care however muft betaken not to overheat him. MEDICINE.—In this difeafe much mifchief is often done by medicine, efpecially by external ap- plications. People, when they fee an inflamma- tion, immediately think that fomething ought to be applied to it. This indeed is neceffary in large phlegmons ; but in an eryfipelas the fafer courfe is to apply nothing. All ointments, falves, and plafters, being of a greafy nature, tend rather to obstruct and repel, than promote any difcharge from the part. At the beginning of this difeafe it is neither hfc to promote a fuppuration, nor to repel the matter too S 2 quickly ado OF THE ERYSIPELAS, quickly. The eryfipelas in many refpects refembles the gout, and is to be treated with the greateft caution. The inflamed parts fhould be kept con- ftantly powdered with rye-meal. It is common to bleed in the eryfipelas; but this likewife requires caution. If, however, the fever be high, the pulfe hard and ftrong, and the patient vigorous, it will be proper to bleed ; but the quan- tity muft be regulated by thefe circumftances, and the operations repeated as the fymptoms may require. If the patient has been accuftomed to ftrong liquors, and the difeafe attacks his head, bleeding is abfo- lutely neceffary. Bathing the feet and legs frequently in lukewarm water, when the difeafe attacks the face or brain, has an excellent effect. It tends to make a deriva- tion from the head, and feldom fails to relieve the patient. When bathing proves ineffectual, poul- tices, or fharp finapifms, may be applied to the foles of the feet, for the fame purpofe. In cafes where bleeding is requifite, it is likewife neceffary to keep the body open. This may be ef- fected by emollient clyfters, or fmall dofes of nitre and rhubarb. Some indeed recommend very large dofes of nitre in the eryfipelas; but nitre feldom fits eafy on the ftomach when tak en in large "dofes. It is, however, one of the beft medicines when the fever and inflammation run high. Half a drachm of it, with four or five g$3His of rhubarb, may be taken in the patient's oriJfeary drink four times a-day. When the eryfipelas leaves the extremities, and feizes the head, fo as to occafion a delirium or ftupor, it is abfolutely neceffary to open the body. If clyfters and mild purgatives fail to have this effect, ftronger ones muft be given. Bliftering plafters muft likewife be applied to the neck, or behind the ears, and fiiarp eataplafms laid on the foles of the feet. When OR ST. ANTHONY'S FIRE. 26i When the inflammation cannot be difcuffed, and the part has a tendency to ulcerate, it will then be proper to promote fuppuration. When the black, livid, or blue colour of the part (hews a tendency to mortification, the Peruvian bark muft be adminiftered. It may be taken along with acids, as recommended in the fmall-pox, or in any other form more agreeable to the patient. It muft not, however, be trifled with, as the patient's life is at ftake. A drachm may be given every two hours, if the fymptoms be threatening, and cloths dipped in warm camphorated fpirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewife be proper in this cafe to apply poultices of the bark, or to foment the part affected with a ftrong decoction of it. In what is commonly called the fcorbuiic eryfipelas, which continues for a confiderable time, it will only be neceffary to give gentle laxatives, and fuch things as purify the blood, and promote the perfpiration. Thus, after the inflammation has been checked by opening medicines, the decoction of farfapariiia * may be drank; after which a courfe of bitters would be proper. Such as are liable to frequent attacks of the ery- fipelas ought carefully to guard againft all violent paffions; to abftain from ftrong liquors, and all fat, vifcid, and highly nourishing food. They fliould likewife take fuflicient exercife, carefully avoiding the extremes of heat or cold. Their food fhould confift chiefly of milk, and fuch fruits, herbs, and roots, as are of a cooling quality, and their drink ought to be fmall-beer, whey, butter-milk, and fuch like. They fliould never fuffer themfelves to be * See Appendix, DecoSion of Sarfaparilla. S 3 long 262 OF THE PHRENITIS, OR long coftive. If that cannot be prevented by fuit- able diet, it will be proper to take frequently a gentle dofe of rhubarb, cream of tartar, the lenitive elec- tuary, or fome other mild purgative. CHAP. XXVII. Of the Phrenitis, or Inflammation of the Brain. 1 HIS is fometimes a primary difeafe, but oftener only a fymptom of fome other malady ; as the inflammatory, eruptive, or fpotted fever, &c. It is very common, however, as a primary difeafe in warm climates, and is moft incident to perfons about the prime or vigour of life. The paffionate, the ftudious, and thofe whofe nervous fyftem is irri- table in a high degree, are moft liable to it. CAUSES.—This difeafe is often occafioned by night-watching, efpecially when joined with hard ftudy : it may likewife proceed from hard drinking, anger, grief, or anxiety. It is often occafioned by the Stoppage of ufual evacuations ; as the bleeding piles in men, the cuftomary difcharges of women, Sec. Such as imprudently expofe themfelves to the heat cf the fun, efpecially by Sleeping without doors in a hot feafon with their heads uncovered, are oiten fuddenly feized with an inflammation of the brain, fo as to awake quite delirious. When repellents are imprudently ufed in an eryfipelas, an inflamma- tion of the brain is fometimes the confequence. It may likewife be occafioned by external injuries, as blows or bruifes upon the head, Sec. SYMP- INFLAMMATION OF THE BRAIN. 263 SYMPTOMS.---i-The fymptoms which ufually precede a true inflammation of the brain, are, pain of the head, rednefs of the eyes, a dilated pupil, a violent flufliing of the face, difturbed fleep, or a total want of it, great drynefs of the fkin, coftivenefs, a retention of urine, fometimes a fmall dropping of blood ftom the nofe, finding of the ears, and ex- treme fenfibility of the nervous fyftem. When the inflammation is formed, the fymptoms in general are fimilar to thofe of the inflammatory fever. The pulfe indeed is- often weak, irregular, and trembling; but fometimes it is hard and con- tracted. When the brain itfelf is inflamed, the pulfe is always low; but when the inflammation only affects the integuments of the brain, viz. the dura and pia matter, it is hard. A remarkable quicknefs of hearing is a common fymptom of this difeafe; but that feldom continues long. Another ufual fymptom is a great throbbing or, pulfation in the arteries of the neck and temples. The patient feldom complains of thirft, and even refufes drink. The mind chiefly runs upon fuch objects as have before made a deep impref- fion on it; and fometimes, from a fullen filence, the patient becomes all of a fudden quite outrageous. A conftant trembling and Starting of the tendons is an unfavourable fymptom, as are alfo a fuppreffion of urine; a total want of fleep; a conftant fpitting and a grinding of the teeth. When a phrenitis fuc- ceeds an inflammation of the lungs, of the inteftines, or of the throat, Sec. it is owing to a tranfiation of the difeafe from thefe parts to the brain, and often proves fatal. This fliews the neceffity of proper evacuations, and the danger of repellents in all in- flammatory difeafes. - The favourable fymptoms are, a free perfpiration, a copious difcharge of blood from the nofe, the bleeding piles, a plentiful thfchnrge of urine, which S 4 lets i6a, OF THE PHRENITIS, OR lets fall a copious fcdiment. Sometimes the difeafe is carried off by a loofenefs, and in women by an exceffive flow of the menfes. As this difeafe often proves fatal in a few days, h requires the moft fpeedy applications. When it is prolonged, or improperly treated, it fometimes ends in madnefs, or a kind of ftupidity, which may conti- nue for life. In the cure, two things are chiefly to be attended to, viz. to leffen the quantity of blood in the brain, and to retard the circulation towards the head. REGIMEN.—The patient ought to be kept very quiet. Company, noife, and every thing that affects the fenfes, or disturbs the imagination, increafes the difeafe. Even too much light is hurtful; for which reafon the patient's chamber ought to be a little darkened, and he fhould neither be kept too hot nor too cold. It is not however neceffary to exclude the company of an agreeable friend, as this has a ten- dency to footh and quiet the mind. Neither ought the patient to be kept too much in the dark, left it jShould occafion a gloomy melancholy, which is too often the confequence of this difeafe. The patient muft, as far as poffible, be foothed and humoured in every tiling. Contradiction will ruffle his mind, and increafe his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be pofitively denied them, but rather put off with the proniife of having them as foon as they can be obtained, or by fome other excufe. A little of any thing that the mind is fet upon, though not quite proper, will hurt the patient lefs than a pofitive refufal. In a word, whatever he was fond cf, or ufed to be delighted with when in health, may here be tried, as pleafing ftories, foft mufic, or whatever has a tendency to fcothe the paffions and compofe the mind, Boerhaave propofes INFLAMMATION OF THE BRAIN. 265 propofes feveral mechanical experiments for this purpofe; as the foft noife of water diftilhng by drops into a bafon, and the patient trying to reckon them, Sec. Any uniform found, if low and continued, has a tendency to procure fleep, and confequently may be of fervice. The aliment ought to be light, confifting chiefly of farinaceous fubftances; as panada, and water- gruel fharpened with jelly of currants, or juice of lemons, ripe fruits roafted or boiled, jellies, pre- ferves, &c. The drink fmall, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not »nly render the liquor more palatable, but likewife more beneficial, as they are of an opening nature. MEDICINE.—In an inflammation of the brain, nothing more certainly relieves the patient than a free difcharge of blood from the nofe. When this comes of its own accord, it is by no means to be ftopped, but rather promoted, by applying cloths dipped in warm water to the part. The chief re- medy is frequent and copious bleeding. Bleeding in the temporal arteries alfo greatly re- lieves the head: but as this operation cannot always be performed, we would* recommend in its ftead bleeding in the jugular veins. When the patient's pulfe and fpirits are fo low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. Thefe not only draw off the blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief. A difcharge of blood from the hasmorrhoidal veins is likewife of great fervice, and ought by all means to be promoted. If the patient has been fub- ject to the bleeding piles, and that difcharge has been ftopped, every method muft be tried to reftorc it; as the application of leeches to the parts,-fitting over 266 OF THE OPHTHALMIA, OR over the fteams of warm water, fliarp clyfters, or fuppofitories made of honey, aloes, and rock-falt. If the inflammation of the brain be occafioned by the ftoppage of evacuations either natural or artifi- cial, as the menfes, iffues, fetons, or fuch like, all means muft be ufed to reftore them as foon as poffi- ble, or to fubftitute others in their Stead. [ he patient's body muft be kept open by Stimu- lating clyfters or fmart purges; and fmall quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the cafe be dan- gerous, may be ufed in the fpace of twenty-four hours. The head fhould be fhaved and cloths dipped in cold water frequently applied to it. If the difeafe proves obftinate, and does not yield to thefe medicines, it will be neceffary to apply a bliftering-plafter to the whole head. 0:.r>j CHAP. XXVIII. r,i>wi| n Of the Ophthalmia, or Inflammation of the Eyes. 1 HIS difeafe may be occafioned by ex- ternal injuries; as blows, burns, bruifes, and the like. It may likewife proceed from duft, quick-lime, or other fubftances, getting into the eyes. It is often caufed by the ftoppage of cuftomary evacua- tions; as the healing of old fores, drying up of iffues, the fuppreffing of gentle morning fweats, or of the fweating of the feet, Sec. Long expofure to the night air, efpecially in cold northerly winds, or whatever INFLAMMATION OF THE EYES. 267 whatever fuddenly checks the perfpiration, efpecially after the body has been much heated, is very apt to c; ufe :;n inflammation of the* eyes. Viewing fnow or orber white bodies for a long time, or looking ftedfativ at the fun, a clear fire, or any bright ob- ject will likewife occafion this malady. A fudden tr.-uifition from darknefs to very bright light will often hav." the fame effect. Nothing more certainly occafions an inflammation of the eyes than night-watching, efpecially reading or writing by candle-light. Drinking fpirituous' liquors, -and excefs of venery, are likewife very hurtful to the eyes. The acrid fumes of metals', ant of feveral kinds of fuel, are alfo pernicious. Sometimes an inflammation of the" eyes proceeds from a venereal taint, and Often from a ferophulous or gouty habit. It may likewife be occafioned by hairs in the eye-lids turning inwards, and hurting the eyes. Sometimes the difeafe is epidemic, efpecially after wet feafons, and often in dry feafons ; and I have frequently known it to prove infectious, parti- cularly to thofe who lived in the fame houfe with the patient. It may be occafioned by moift air, or living in low damp houfes, efpecially in perfons who are not accuftomed to fuch fituations. In children it often proceeds from imprudently drying up of fcabbed heads, a running behind the ears, or any other difcharge of that/ kind. Inflammations of the eyes often fucceed the fmall-pox or mealies, efpe- cially in children of a ferophulous habit. SYMPTOMS.—An inflammation of the eyes is attended with acute pain, heat, rednefs, and fwel- ling. The patient is not able to bear the light, and fometimes he feels a pricking pain, as if his eyes were pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he fees flies dancing before him. The eyes are filled with a fea'dino- 268 OF THE OPHTHALMIA, OR fcalding rheum, which rufties forth in great quantities, whenever the patient attempts to look up. The pulfe is generally quick and hard, with fome degree of fever. When the difeafe is violent, the neigh- bouring parts fwell, and there is a throbbing or pul- fation in the temporal arteries, &c. A flight inflammation of the eyes, efpecially from an external caufe, is eafily cured.; but when the dif- eafe is violent, and continues long, it often leaves fpecks upon the eyes, or dimnefs of fight, and fome- limes total blindnefs. If the patient be feized with a loofenefs, it has a good effect; and when the inflammation paffes from one eye to another, as it were by infection, it is no unfavourable fymptom. But when the difeafe is accompanied with a violent pain of the head, and continues long, the patient is tn danger of lofing his fight. REGIMEN.----The diet, unlefs in ferophulous cafes, can hardly be too fpare, efpecially at the be- ginning. The patient muft abftain from every thing .of a heating nature. His food fliould confift chtefly of mild vegetables, weak broths, and gruels. His drink may he barley-water, balm-tea, common whey, and fuch like. The patient's chamber muft be darkened, or his eyes fhaded by a cover, fo as to exclude the light, but not to prefs upon the eyes. He fhould not look at a candle, the fire, or any luminous object; and and ought to avoid all fmoke, as the fumes of to- bacco, or any thing that may caufe coughing, fneez- ing, or vomiting. He fhould be kfept quiet, avoidipg all violent efforts, either of body or mind, and en- couraging fleep as much as poffible. MEDICINE.-----This is one of thofe difeafes wherein great hurt is often done by external appli- cations. Almoft every perfon pretends to bepdf-' feffed INFLAMMATION OF THE EYES. 269 feffed of a remedy for the cure of fore eyes. Thefe remedies generally confift of eye-waters $nd oint- ments, with other external applications, which do mifehief twenty times for once they do good. People ought therefore to be very cautious how they ufe fuch things, as even the preffure upon the eyes often increafes the malady. Bleeding, in a violent inflammation of the eyes, is always neceffary. This fhould be performed as near the part affected as poffible. An adult may lofe ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the fymptoms. If it fhould not be convenient to bleed in the neck, the fame quantity may be let from the arm, or any other part of thr body, efpecially from the temples and behind the ears by cupping. Leeches are often applied to the temples, or un- der the eyes, with good effect. The wounds muft be fuffered to bleed for fome hours, and if the bleeding flop foon, it may be promoted by the ap- plication of cloths dipt in warm water. In obftinate cafes, it will be neceffary to repeat this operation feveral times. Opening and diluting medicines are, by no means, to be neglected. The patient may take a fmall dofe of Glauber's fahs, and cream of tartar, every fecond or third day, or a decoction of tamarinds with fenna. If thefe be not agreeable, gentle dofes of rhubarb and nitre, a little lenitive electuary, or any other mild purgative, will anfwer the fame end. The pa- tient, at the fame time, muft drink freely of water- gruel, tea, whey, or any other weak diluting liquor. If the inflammation does not yield to thefe eva- cuations, bliftering-plafters muft be applied to the temples, behind the ears, or upon the neri OR CHIN-COUGH. 295 The garlic-ointment is a well known remedy in North-Britain for the chin-cough. It is made by be.ting in a mortar garlic with an equal quantity of hoi>s lard. With this the foles of the feet may be rubbed twice or thrice a-day ; but the beft method is to fpread it upon a rag, and apply it in the form of plafter. It fliould be renewed every night and morning at leaft, as the garlic foon lofes its virtue. This is an exceeding good medicine, both in the chin-cough, and in moft other coughs of an obftinate nature. It ought not, however, to be ufed when the patient is very hot or feverifli, left it fliould in- creafe thefe fymptoms. The feet fhould b6 bathed once every two or three days in lukewarm water ; and a Burgundy- pitch plafter kept conftantly between the Shoulders. But when the difeafe proves very violent, it will be lieccffiry, inftead of it, to apply a bliftering-plafter, and to keep the part open for fome time with iffue- ointment. When the difeafe is prolonged, and the patient is free from a fever, the Peruvian bark, and other bitters, are the moft proper medicines. The bark may either be taken in fubfta.ice, or in a decoction or infufion, as is moft agreeabe. For a child, ten fifteen, or twenty grains, according to the age of the patient, may he given three or four times a-day. For an adult, half a drachm or two feruples will be proper. Some give the extract of the bark with cantharides; but to manage this requires a con- fiderable attention. It is more fife to give a few grains of caftor along with the bark. A child of fix or feven years of age may take feven or eight grains of caftor, with fifteen grains of powdered bark, for a dofe. This may be made into a mix- ture, with two or three ounces of a fimple diftilled water, and a little fyrup, and taken three or four times a-day. U 4 CHAP. i 296 ] CHAP. XXXI. Inflammation of the Stomach, and other Vifcera. —>ri' ALL inflammations of the bowels are dangerous, and require the moft fpeedy affiftance; as they frequently end in a fuppuration, and fome- times in a mortification, which is certain death. CAUbES.—An inflammation of the ftomach may proceed from any of the caufes which produce an inflammatory fever; as cold liquor drank while,the. body is warm, obftructed perfpiration, or the fudden ftriking in of any eruption. It may likewife proceed from the acrimony of the bile, or from acrid and ftimulating fubftances taken into the fiomach; as ftrong vomits or purges, corrofive poifons, and fuch like. When the gout has been repelled from the extremities, eit/er by cold or improper applications, it often occasions an inflammation of the ftomach. Hard or indigeftible fubftances taken into the* Ho- rn tch, as bones, the ftones of fruit, &c, may likewife ha/e that effect. SYMPTOMS.—It is attended with a fixed pain and burning heat in the ftomach ; great reftleffnefs and anxiety ; a fmall, quick, and hard pulfe: vomit- ing, or, at leaft, a naufea and ficknefs ; exceffive thirft; coldnefs of the extremities; difficulty of breathing ; cold clammy fweats; and fometimes con- vulfions and fainting fits. The ftomach is fwelled, and often feels hard to the touch. One of the moft certain figns of this difeafe is the fenfe of pain, which the patient feels upon taking any kind of food or drink, efpecially if it be either too hot or too cold, When INFLAMMATION OF THE STOMACH, csV. 297 When the patient vomits every thing he eats or drinks, is extremely reftlefs, has a hiccup, with an intermitting pulfe, and frequent fainting fits, the danger is very great. REGIMEN.—All acrimonious, heating, and irri- tating food and drink are carefully to be avoided. The weaknefs of the patient may deceive the by- ftanders, and induce them to give him wines, fpi- rits, or other cordials; but thefe never fail to in- creafe the difeafe, and often occafion fudden death. The inclination to vomit may likewife impofe on the attendants, and make.thrm think a vomit necef- fary ; but that too is almoft certain death. The food muft be light, thin, cool, and eafy of digeftion. It muft be given in fmall quantities, and fhould neither be quite cold nor too hot, Thin gruel- made of barley or oatmeal, light toafted bread diffolved in boiling water, or very weak chicken broth, are the moft proper. The drink fliould be clear whey, barley-water, water in which toafted bread has been boiled, or decoctions of emollient vegetables; as tiquorice and marfh-mal- low roots, &c. MEDICINE.—Bleeding in this difeafe is abfo- lutely neceffary, and Js almoft the only thing that can be depended on. When the difeafe proves ob- ftinate, it will often be proper to repeat this ope- ration feveral times, nor muft the low ftate of the pulfe deter us from doing fo. The pulfe indeed generally rifes upon bleeding, and as long as that is the cafe, the operation is fafe. Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, are likewife beneficial. Flannel cloths dipped in thefe muft be applied to the region of the ftomach, and removed as they grow cool. They muft neither be applied too warm, nor be fuffered to continue till they be- come 298 INFL AMMATION OF THE INTESTINES. come quite cold, as either of thefe extremities would aggravate the difeafe. The feet and legs ought likewife to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the foles of the feet. The warm bath, if it can be conveniently ufed, will be of great fervice. In this, and all other inflammations of the bowelsj an epifpaftic, or bliftering-plafter, ronlied over the part affected, is one of the beft r< medics I know. I have often ufed it, and do not recollect one inltancc wherein it did not give relief to the patient. The only internal medicines which We fhall ven> ture to recommend in this difeafe, are mild clyfters. Thefe may be made of warm water, or thin water- gruel; and if the patient is coftive, a little fweet oil, honey, or manna, may be added. Clyfters anfwer the purpofe of an internal fomentation, while they keep the body open, and at the fame time nourifh the patient, who is often in this difeafe unable to retain any food upon his ftomach. For thefe rea- fons they muft not be neglected, as the patient's life may depend on them. INFLAMMATION OF THE INTESTINES. This is one of the moft painful and dangerous difeafes that mankind is liable to. It generally pro- ceeds from the fame caufes as the inflammation of the ftomach; to which may be added coftivenefs, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as ftale bottled beer or ale, four wine, cyder, &c. It may likewife be occafioned by a rupture, by fchirrous tumors of the inteftines, or by their oppofite fides growing together. The INFLAMMATION OF THE INTESTINES. 299 The inflammation of the inteftines is denominated Iliac paffion, Enteritis, &c. according to the names of the parts affected. The treatment, however, is nearly the fame whatever part of the inteftinal canal be the feat of the difeafe; we fhall therefore omit thefe distinctions left they fhould .perplex the reader. The fymptoms here are nearly the fame as in the foregoing difeafe; only the pain, if poffible, is more acute* and is fituated lower. The vomiting is like- wife more violent, and fometimes even the excre- ments, together with the clyfters, are difcharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine. While the pain Shifts, and the vomiting only re- turns at certain intervals, and while the clyfters pafs downwards, there is ground for hope; but when the clyfters and faces are vomited, and the patient is exceeding weak* with a low fluttering pulfe, a pale countenance, and a •difagreeable or ftinking breath, there is great reafon to fear that the. confe- quences will prove fatal. Clammy fweats, black foetid ftools, with a fmall intermitting pulfe, and a total ceffation of pain, are figns of a mortification already begun, and of approaching death. REGIMEN.—The regimen in this difeafe is in general the fame as in an inflammation of the ftomach. The patient muft be kept quiet, avoiding cold, and all violent paffions of the mind. His food ought to be very light, and given in fmall quantities; his drink weak and diluting; as clear whey, barley-wa- ter, and fuch like. . MEDICINE.—Bleeding in this, as well as in the inflammation of the ftomach, is of the greateft im- portance. It fhould be performed as foon as the fymptoms appear, and muft be repeated according to the Strength of the patient, and the violence of r.he difeafe. A blif- 3©o INFLAMMATION OF THE INTESTINES. A bliftering plafter is here likewife to be applied immediately over the part where the moft violent pain is. This not only relieves the pain of the bowels, but even clyfters and purgative medicines, which before had no effect, will operate when the blifter begins to rife. Fomentations and laxative clyfters are by no means to be omitted. The patient's feet and legs fhould frequently be bathed in warm water; and cloths dipped in it applied to his belly. Bladders filled with warm water may hkewife be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the foles of the feet. The clyfters may be made of barley-water or thin gruel with fait, and foftened with fweet oil or frefh butter. Thefe may be adminiftered every two or three hours, or oftener, if the patient continues eoftive. If the difeafe does notyield to clyfters and fomen- tations, recourfe rnuft be had to pretty ftrong pur- gatives; but as thefe, by irritating the bowels, often increafe their contraction, and by that means fraftrate their own intention, it will be neceffary to join them with opiates, which, by allaying the pain, and re- laxing the fpafmodic contractions of the guts, greatly affift the operation of purgatives in this cafe. What anfwers the purpofe of opening the body very well, is a folution of the bitter purging falts. Two ounces of thefe may be diffolved m a pint of warm water, or thin gruel, and a tea-cupful of it taken every half hour till it operates. At the fame time fifteen, twenty, or twenty-five drops of lauda- num may be given in a glafs of peppermint or fimple cinnamon-water, to appeafe the irritation, and pre- vent the vomiting, &c. Acids have often a very happy effect in flaying the vomiting, and appeafing the other violent fymp- toms INFLAMMATION OF THE INTESTINES. 301 toms of this difeafe. It will therefore be of ufe to fliarpen the patient's drink with cream of tartar, juice of lemon; or, when thefe cannot be obtained, with vinegar. But it often happens that no liquid whatever wiii flay on the ftomacn. In this cafe the patient muft take purging pilis. I have gener illy found the fol- lowing anfwer very well: Take jalap in powder, and vitriolated tartar, of each half a drachm, opium one grain, Caftile foap as much as will make the nr-ifs fit for pills. Thefe muft be taken at one dofe, and if they do not operate in a few hours, the dole may be repeated. If a ftool cannot be procured by any of the above means, it will be neceffary to immerfe the patient in Warm water up to the breaft. I have often feen this fucceed when other means had been tried in vain. The patient muft continue in the water as long as he can eafily bear it without fainting, and if one immerfion has not the defired effect, it may be repeated as foon as the patient's ftrength and fpirits are recruited. It is more fafe for him to go fre- quently into the bath, than to continue too long at a time, and it is often neceffary to repeat it feveral times before it has the defired effect. It has fometimes happened, after all other means of procuring a ftool had been tried to no purpofe, that this was brought about by immerfing the pa- tient's lower extremities in cold water, or making him walk upon a wet pavement, and dafhing his legs, thighs, and body, with the cold water. This method, when Others fail, at leaft merits a trial. If the difeafe proceed from a rupture, the patient muft be laid with his head very low, and the intef- lines returned by gentle preffure with the hand. If this, with fomentations and clyfters, fhould not fuc- ceed, 302 OF THE COLIC. ceed, recourfe muft be had to a furgical operation, ^?hich may give the patient relief. Such as would avoid this excruciating and danger rous difeafe, muft take care never to be too long without a ftool. Some who have died of it have had feveral pounds of hard dry faces taken out of their guts. They fliould likewife beware of eating too freely of four or unripe fruits, or drinking ftale windy liquors, &c. It likewife proceeds frequently from cold caught by wet clothes, &c. but efpecially from wet feet. OF THE COLIC. The colic has a great refemblance to the two pre- ceding difeafes, both in its fymptoms and method of cure. It is generally attended with coftivenefs and acute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c. Colics are varioufly denominated according to their caufes, as the flatulent, the bilious, the hyfleric, the nervous, Sec. As each of thefe requires a par- ticular method of treatment, we fhall point out their moft general fymptoms, and the means to be ufed for their relief. The flatulent, or wind-colic, is generally occa- fioned by the indifcreet ufe of unripe fruits; meats of hard digeftion, windy vegetables, fermenting liquors, and fuch like. It may likewife proceed from an obftructed perfpiration, or catching cold. Delicate people, whofe digeftive powers are weak, are moft liable to this kind of colic. The flatulent colic may either affect the ftomach or inteftines. It is attended with a painful ftretch- ing of the affected part. The patient feels a rum- bling in his guts, and is generally relieved by a dif- charge- OF THE COLIC. 303 charge of wind, either upwards or downwards. The pain is feldom confined to any particular part, as the vapour wanders from one divifion of the bowels to another till it finds a vent. When the difeafe proceeds from windy liquor, green fruit, four herbs, or the like, the beft medi- cine on the firft appearance of the fymptoms is a dram of brandy, gin, or any good fpirits. The pa- tient fhould likewife fit with his feet upon a warm hearth-ftone, or apply warm bricks to them; and warm cloths may be applied to his ftomach and bowels. This is the only colic wherein ardent fpirits, fpi- ceries, or any thing of a hot nature, may be ven- tured upon*. Nor indeed are they to be ufed here unlefs at the very beginning, before any fymptoms of inflammation appear. We have reafon to believe, that a colic occafioned by wind or flatulent food might always be cured by fpirits and warm liquors, if they were taken immediately upon perceiving the firft uneafinefs; but when the pain has continued for a confiderable time, and there is reafon to fear an inflammation of the bowels is already begun, all hoc things are to be avoided as poifon, and the patient is to be treated in the fame manner as for the inflam- mation of the inteftines. Several kinds of food, as honey, eggs, Sec. occa- fion colics in fome panicular conttitutions. I have generally found the beft method of cure for thefe was to drink, plentifully of fmall diluting liquors, as water-gruel, fmall poffet, water witn toafted bread foaked in it, &c. * I believe there is never a neceffity of uGng fpirits in this cafe—A glafs of mint water, or mint, ginger, or penny-royal tea, would always anfwer the purpofe. Colics $c4 OF THE COLIC. Colics which proceed from excefs and indigeftion generally cur themfelves by occafioning vomiting or purging. Thefe difcharges are by no means to be ftopped, but promoted by drinking plentifully of warm water, or weak poffet. When their violence is over, the patient may take a dofe of rhubarb, or any other gentle purge, to carry off the dregs of his debauch. Colics which are occafioned by wet feet, or catch- ing cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking fuch warm diluting liquors as will promote the perfpiration, as weak wine-whey, or water-gruel, with a fmall quantity of wine in it. Thofe flatulent colics, which prevail fo much among country people, might generally be prevented were they careful to change their clothes when they get wet. They ought likewife to take a dram, or to drink fome warm liquor after eating any kind of green trafli. We do not mean to recommend the practice of dram-drinking, but in this cafe ardent fpirits prove a real medicine, and indeed the beft that can be administered. A glafs of good pepper- mint water will have nearly *the fame effect as a glafs of brandy, and in fome cafes is rather to be pre- ferred. The bilious colic is attended with very acute pains about the region of the navel. The patient com- plains of great thirft, and is generally coftive. He vomits a hot, bitter, yellow-coloured bile, which being difcharged, feems to afford fome relief, but is quickly followed by the fame violent pain as before. As the diftemper advances, the propenfity to vomit fometimes increafes fo as to become almoft continual, and the proper motion of the inteftines is fo far per- verted j that there are all the fymptoms of an im- pending iliac paffion. 4 If OF THE COLIC. 3o$ If "the patient be young and ftrong, and the pulfe full and frequent, it will be proper to bleed, after which clyfters may be adminiftered. Clear whey or gruel, fharpened with the juice of lemon, or cream of tartar, muft be drank freely. Small chicken-broth, with a little manna diffolved in it, or a flight decoc- tion of tamarinds, are likewife very proper, or any other thin, acid, opening liquor. Befides bleeding and plentiful dilution, it will be neceffary to foment the belly with cloths dipped in warm water, and if this fhould not fucceed, the pa- tient muft be immerfed up to the' breaft in warm water. In the bilious colic the vomiting is often very dif- ficult to reftrain. When this happens the patient may drink a decoction of toafted bread, or toafted oats, or an infufion of mint in boiling water. Should thefe not have the defired effect, the faline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the fymp- toms. A fmall quantity of Venice treacle may be fpread in form of a cataplafm, and applied to the pit of the ftomach. Clyfters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewife be frequently adminiftered. Such as are liable to frequent returns of the bi- lious colic fhould ufe flefh fparingly, and live chiefly upon a light vegetable diet. They fhould likewife take frequently a dofe of cream of tartar with tama- rinds, or any other cool acid purge. The kyfteric colic bears a great rcfetnblancc to the bilious. It is attended with acute pains about the region of the ftomach, vomiting, &c. But what the patient vomits in this cafe is commonly of a greenifh colour. There is a great finking of the fpirits, with dejection of mind and difficulty of breathing, which are the characteristic fymptens of X this 3o6 OF THE COLIC. this diforder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own ac- cord in a few days. In this colic all. evacuations, as bleeding, purging, vomiting, &c. do hurt. Every thing that weakens the patient, or finks the fpirits, is to be avoided. If, however, the vomiting fliould prove violent, lukewarm water, or fmall poffet, may be drank to cleanfe the ftomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glafs of cinnamon-water. This may be repeated every ten or twelve hours till the fymp- toms abate. The patient may likewife take four or five of the foetid pills every fix hours, and drink a cup of pen- ny-royal tea after them. If afafcetida fliould prove difagreeable, which is fometimes the cafe, a tea- fpoonful of the tincture of caftor in a cup of penny- royal tea, or thirty or forty drops of the balfam of Peru dropped upon a bit of loaf-fugar, may be taken in its ftead. The anti-hyfteric plafter may alfo be ufed, which has often a good effect*. The nervous colic prevails among miners, fmelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is fuppofed to be occafioned by the leaden veffels ufed in preparing that liquor. It is likewife a frequent difeafe in the Weft Indies, where it is termed the dry belly-ache. No difeafe of the bowels is attended with more excruciating pain than this. Nor is it foon at an end. I have known it continue eight or ten days with very little intermiffion, the body all the while continuing bound in Jpite of medicine, yet at length * See Appendix, Anti-hyfleric, «r Jlomach-plafler. yield, OF THE COLIC. - 30? yield, and the patient, recover*. It generally however leaves the patient weak, and often ends in a palfy. The general treatment of this difeafe is fo nearly the fame with that of the iliac paffion, or inflamma- tion of the guts, that we fhall not infill upon ir. The body is to be opened by mild purgatives given in fmall dofes, and frequently repeated, and their operation muft be affiited by foft oily clyfters, fo- mentations, &c. ' The caftor oil is reckoned pecu- liarly proper in this difeafe. It may both be mixed with the clyfters and given by the mouth. The warm bath geuerally gives great relief. The Barbadoes tar is faid to be an efficacious me- dicine in this complaint. It may be taken to the quantity of two drachms three times a day, or oftener if the ftomach will bear it. This tar, mixed with an equal quantity of ftrong rum, is likewife proper for rubbing the fpine, in cafe any tingling, or other fymptoms of a palfy, are felt. When the tar cannot be obtained, the back may be rubbed with ftrong fpirits, or a little oil of nutmegs or of rofemary. If the patient remains weak and languid after this difeafe, he muft take exercife on horfeback, and ufe an infufion of the Peruvian bark in wine. When the difeafe ends in a palfy, the warm-fprings are found to be extremely proper. To avoid this kind of colic, people muft fhun all four fruits, acids, and auftere liquors, &c. Thofe . * As the fmoke of tobacco thrown into the bowels will often procure a ftool when all other means have failed, an apparatus for this purpofe ought to be kept by every furgeon. It may be purchafed at a fmall expence, and will be of fervice in feve- ral other caOi, as the recovery of Drowned perfons, &c.----A table-fpoonful of muftard-feed a little bruifed and given eveiy two or three hours, will fomeumes open the bowels when every thing erfe has failed. X 2 who 3o8 OF THE COLIC. who work in lead ought never to go to their bufinefs fafting, and their food fhould be oily or fat. They may take a glafs of fallad oil every morning. Liquid aliment is beft for them; as fat broths, &c. but low living is bad. They fliould frequently go a little out of the tainted air; and fhould never fuffer them- felves to be coftive. In the Weft Indies, and on the coaft of Guinea, it has been found of great ufe, for preventing this colic, to wear a piece of flannel round the waift, and to drink an infufion of ginger by way of tea. Sundry other kinds of this difeafe might be men- tioned, but too many diftinctions would tend only to perplex the reader. Thofe already mentioned arc the moft material, and lhould indeed be attended to, as their treatment is very different. But even per- fons who are not in a condition to diftinguifli very accurately in thefe matters, may neverthelefs be of great fervice to patients in colics of every kind, by only obferving the following general rules, viz. To bathe the feet and legs in warm water; to apply bladders filled with warm water, or cloths dipped in it, to the ftomach and bowels: to make the patient drink freely of diluting mucilaginous liquors; and to give him an emollient clyfter every two or three hours. Should thefe not fucceed, the patient ought to be immerfed in warm water; and in almoft every cafe of colic, except where inflammation is prefent, the chief remedy, in the firft inftance, where the pain is violent, is laudanum—from twenty to twenty- five drops may be given every hour in a little fugar and water, until the pain abates—when we fufpect inflammation the laudanum in dofes of ten drops in the camphor mixture *—and when there are fymptoms * See Appendix, Camphor Jllixtvre, of INFLAMMATION OF THE KIDNEYS. 309 of hylteria, the fame quantity in a tea-fpoonful of fetid tincture. INFLAMMATION OF THE KIDNEYS. CAUSES.---This difeafe may proceed from any of thofe caufes which produce an inflammatory fever. It may likewife be occafioned by wounds or bruifes of the kidneys; fmall ftones or gravel lodging within them; by ftrong diuretic medicines; as fpirits of turpentine, tincture of cantharides, &e. Violent motion, as hard riding or walking, efpecially in hot Weather, or whatever drives the blood too forcibly into the kidneys, may occafion this malady. It may likewife proceed from lying too foft, too 'much on the back, involuntary contractions, or fpafms, in the urinary veffels, Sec. alfo from the mifplaced gout. SYMPTOMS.—There is a fharp pain about the region of the kidneys, with fome degree of fever, and a ftupor or dull pain in the thigh of the affected fide. The urine is at firft clear, and afterwards of a reddifh colour; but in the worft kind of the difeafe it generally continues pale, is paffed with difficulty, and commonly in fmall quantities at a time. The patient feels great uneafinefs when he endeavours to walk or fit upright. lie lies with moft eafe on the affected fide, and has generally a nmfea or vomiting, refembling that which happens in the colic. This difeafe, however,, may be diftinguifhed from the colic by the pain being feated farther back, and by the difficulty of paffing urine with which it is conftantly attended. REGIMEN.—Every thing cf a heating or ftimu- lating nature is to be avoided. The food muft be thin and light; as panada, fmall broths, with mild vegetables and the like. Emollient and thin liquors X 3 muft 310 INFLAMMATION OF THE KIDNEYS. muft be plentifully drank ; as clear whey, or balm- tea fweetened with honey, decoctions of marfh-mal- low roots, with barley and liquorice, &c. The pa- tient, notwithstanding the vomiting, muft conftantly keep fipping fmall quantities of thefe or other dilut- ing liquors. Nothing fo fafely and certainly abates the inflammation, and expels the obstructing caufe, as copious dilution. The patient muft be kept eafy, quiet, and free from cold, as long as any fymptoms of inflammation remain. MEDICINE.—Bleeding is generally neceffary, efpecially at the beginning. Ten or twelve ounces may betet from the arm or foot with a lancet, and if the pain and inflammation continue, the operation may be repeated in twenty-four hours, or fooner, efpecially if the patient be of a full habit. Indeed there are few cafes which require more copious bleeding. Leeches may likewife be applied to the hemorrhoidal veins, as a difcharge from thefe will greatly refieve the patient. Cloths dipped in warm water, or bladders filled with it, muft be applied as near as poffible to the part affected, and renewed as they grow cool. Emollient clyfters ought frequently to be admi- niftered ; and if thefe do not open the body, a little fait and honey, or manna, may be added to them. The fame courfe is to be followed where gravel or a Stone is lodged in the kidney, but when the gravel or ftone is feparated from the kidney, and lodges in the Ureter *, it will be proper, befides the fomenta- tions, to rub the fmall of the back with fweet oil, and to give gentle diuretics; a tea-fpoonful of the fweet fpirits of nitre, with a few drops of laudanum, * The Ureters are two long and fmall canals, one on each fide^ which carry the urine from the bafon of the kidneys to the bladder. They are fometimes obflrucled by fmall ftones of gravel failing down frcm the kidneys, and lodging in them. may INFLAMMATION .OF THE BLADDER. 31 z may now and then be put into a cup of the patient's drink : the warm bath* and opium are here of great fervice. When the difeafe is protracted beyond the feyenth or eighth day, and the patient complains of a ftupor and heavinefs of the part, has frequent returns of chillinefs, fliivering, Sec. there is reafon to fufpect that matter is forming in the kidney, and that an abfeefs will enfue. When matter in the urine fhews that an ulcer is already formed in the kidney, the patient muft be careful to abftain from all acrid, four, and falted pro- vifions, and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth cf animals, made with barley and common pot herbs, &c. His drink may be whey, and butter-milk that is not four. The latter is by feme-reckoned a fpecific remedy in ulcers of the kidneys. To anfwer this character, however, it muft be drank for a confiderable time. Chalybeate waters have likewife been found bene- ficial in this difeafe. They muft likewife be ufed for a confiderable time, in order to produce any falutary effects. Thofe who are liable to frequent returns of inflam- mation, or obstructions of the kidneys, muft abftain from wines, and their food ought to be light, and of eafy digeftion. They Should ufe moderate exer- cife, and Should not lie too hot, nor too much oa their back. INFLAMMATION OF THE BLADDER. The inflammation of the bladder proceeds, in a great meafure, from the fame caufes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of paffing urine, with fome degree of fever, a conftant in- X 4 clination 3i2 INFLAMMATION OF THE BLADDER. clination to go to ftool, and a perpetual defire ta make water. This difeafe muft be treated on the fame princi- ples as the one immediately preceding. The diet muft be light and thin, and the drink of a cooling nature. Bleeding is very proper at the beginning, and in robuft conftitutions it will often be neceflary to repeat it. The lower part of the belly fhould be fomented with warm water, or a decoction of mild vegetables; and emollient clyfters ought frequently to be adminiftered, &c. The patient fliould abftain from every thing that is of a hot, acrid, and ftimulating quality, and fliould live entirely upon fmall broths, gruels, or mild vegetables. A ftoppage of urine may proceed from other caufes befides an inflammation of the bladder; as a fwelling of the hasmorrlioidal veins, hard faces lodged in the reclum ; a ftone in the bladder; excrc- fcences in the urinary paffages, a palfy of the blad- der, hyfteric affections, Sec. Each of thefe requires a particular treatment, which does not fall under our prefent confideration. We fhall only obfervej that in all of them mild and gentle applications are the fafeft, as ftrong diuretic medicines, or things of an irritating nature, generally increafe the danger. I have known fome perfons kill themfelves by in- troducing probes into the urinary paffages, to re- move, as they thought, fomewhat that obstructed the difcharge of urine, and others bring on a violent inflammation of the bladder, by ufing ftrong diure- tics, as oil of turpentine, &c. for that purpofe. INFLAM- [ 3'3 3 INFLAMMATION OF THE LIVER. The liver is lefs fubject to inflammation than moft of the other vifcera, as in it thecirculation is flower ; but when an inflammation does happen, it is with difficulty removed, and often ends in a fuppuration or fchirrus. CAUSES—Befides the common caufes of in- flammation, we may here reckon the following, viz. exceffive fatnefs, a fcirrhus of the liver itfelf, vio- lent fhocks from ftrong vomits when the liver was before unfound, any thing that fuddenly cools the liver after it has been greatly heated, ftones obftruct- ing the courfe of the bile, drinking ftrong wines and fpirituous liquors, ufing hot fpicy aliment, obftinate hypochondriacal affections, &c. SYMPTOMS.—This difeafe is known by a pain- ful tenfion of the right fide under the falfe ribs, at- tended with more or lefs fever, a fenfe of weight, or fulnefs of the part, difficulty of breathing, loathing of food, great thirft, with a pale or yellowifh colour of the fkin and eyes. The fymptoms here are various, according to the degree of inflammation, and likewife according to the particular part of the liver where the inflamma- tion happens. Sometimes the pain is fo inconfider- able, that an inflammation is not fo much as fuf- pected ; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulfe quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the flioulder, with difficulty of lying on the left fide, Sec. This difeafe may be diftinguifhed from the pleu- rify by the pain being lefs violent, feated under the falfe ribs, and by the difficulty of lying on the left fide. It may be distinguished from the hyfteric and hypochon? 3i4 INFLAMMATION OF THE LIVER. hypochondriac diforders by the degree of fever with which it is always attended. This difeafe, if properly treated, is feldom mor- tal. A conftant hiccuping, violent fever, and ex- ceffive thirft, are ban1' fymptoms. If it ends in a fuppuration, and the matter cannot be difcharged outwardly, the danger is gieat. When the fcirrhus of the liver enfues, the patient, if he obferves a proper regimen, may neverthelefs live a number of years tolerably eafy; but if he indulge in animal food and ftrong liquors, or take medicines of an acrid or irritating nature, the fchirrus will be con- verted into a cancer, which muft infallibly prove fatal. REGIMEN.—The fame regimen is to be ob- Terved in this as in other inflammatory diforders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley-water, &c. drank freely. The food muft be light and thin, and the body, as well as the mind, kept eafy and quiet. MEDICINE.—Bleeding is proper at the begin- ning of this difeafe, and it will be neceffary, if the pulfe fliould feel hard, to repeat ir. All violent pur- gatives are to be avoided ; the body, however, muft be kept gently open. A decoction of tamarinds, with a little honey or manna, will anfwer this pur- pofe very well. The fide affected muft be fomented in the manner directed in the foregoing difeafes. Mild laxative clyfters fliould be frequently adminif- tered ; and, if the pain fhould, notwithftanding, con- tinue violent, a bliftering-plafter may be applied over the part affected. When there is an inclination to fweat, it ought to be promoted, but not by warm fudurifics. The only thing to be ufed for that purpofe is plenty cf diluting liquors drank about the warmth of the hu- man blood. Indeed the patient in ibis cafe, jas well as INFLAMMATION OF THE LIVER. 315 as in all other topical inflammations, ought to drink nothing that is colder than the blood *. If the ftools fhould be loofe, and even ftreaked with blood, no means muft be ufed to flop them, unlefs they be fo frequent as to weaken the patient. Loofe ftools often prove critical, and carry off the difeafe. If an abfcefs or impofthume is formed in the liver, all methods fliould be tried to make it break and difcharge itfelf outwardly, as fomentations, the ap- plication of poultices, ripening cataplafms, Sec. Sometimes indeed the matter of an abfcefs comes away in the urine, and fometimes it is difcharged by ftool; but thefe are efforts of Nature which no means can promote. When the abfcefs burfts into the cavity of the abdomen at lar^e, death muft enfne ; nor will the event be more favourable when the ab- fcefs is opened by an incifion, unlefs in cafes where the liver adheres to the peritonaum, fo as to form a bag for the .matter, and prevent it from falling into the cavity of the abdomen ; in which cafe opening the abfcefs by a fufficiently large incifion will pro- bably fave the patient's life f. If the diforder, in fpite of all endeavours to the contrary, fhould end in a fehirrus, the patient muft be careful to regulate his diet, &c. in fuch a manner as not to aggravate the difeafe. He muft not in- * The American practice is, after bleeding and purging, to give two or three grains of calomel twice a-day, until the dif- eafe is fubdued; if this purges much, a quarter of a grain of powdered opium may be added to each dofe ; if the fymptoms are violent, from half a drachm to a drachm of mercurial oint- ment fliould be rubbed into the fide twice a-day. There are few cafes that will not yield to this treatment. f I know a gentleman who has had feveral abfceffes of the liver opened, and is now a firong and healthy man, though above eighty years of age. dulge 3i6 OF THE CHOLERA MORBUS, Ufe. dulge in flefh, fifh, ftrong liquors, or any bigily feafoned or fatted provifions ; but fhould, for the moft part, live on mild vegetables, as fnaits and roots; taking gentle exercife, and drinking whey, barley-water, or butter-milk. If he takes any thing ftronger, it fhould be fine mild ale, which is lefs heating than wines or fpirits. We fhall take no notice of inflammations of the other vifcera. They muft in general be treated upon the fame principles as thofe already mentioned. The chief rule with refpect to all of them, is to let blood, to avoid every thing that is ftrong, or of a hearing nature, to apply warm fomentations to the part affected, and to caufe the patient to diink * fufficient quantity of warm diluting liquors. CHAP. XXXII. Of the Cholera Morbus, and other exceffive difchar^s from the Stomach and Bowels. A HE cholera morbus is a violent purging and vomiting, attended with gripes, ficknefs, and a conftant defire to go to ftool. It comes on fuddenly, and is moft common in fummer and autumn. CAUSES*—It is occafioned by a redundancy and acrimony of the bile ; cold; food that eafily turns rancid or four on the ftomach ; as butter, bacon, fweetmeats, cucumbers, melons, cherries, and other cold fruits*. It is fometimes the effect of ftrong * I have been twice brought to the gates of death by this difeafe, and both times it was occafioned by eatirg rancid bacon. acrid OF THE CHOLERA MORBUS, tfV. 317 tcrid purges or vomits, or of poifonous fubftances taken into the ftomach. It may likewife proceed From violent paffions or affections of the mind; as fear, anger, &c. SYMPTOMS.—It is generally preceded by a eardialgia, or heart-burn, four belchings, and fla- tulencies, with pain of the ftomach and inteftiues* To thefe fucceed exceffive vomiting, and purging of green, yellow, or blackifh coloured bile, with a diftenfion of the ftomach, and violent griping pains- There is likewife a great thirft, with a very quick unequal pulfe, and often a fixed acute pain about the region of the navel. As the difeafe advances, the pulfe often finks fo low as to become quite im- perceptible, the extremities grow cold, or cramped, and are often covered with a clammy fweat, the urine is obftructed, and there is a palpitation of the heart. Violent hiccupping, fainting, and convul- fions, are the figns of approaching death, MEDICINE.—At the beginning of this difeafe the efforts of Nature to expel the offending caufe Ihould be affifted, by promoting the purging and vomiting. For this purpofe the patient muft drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, fmall poffet, or, what is perhaps preferable to any of them, very weak chicken broth. After thefe evacuations have been continued for fome time, a decoction of toafted oats may be drank to flop the vomiting. The oats fhould be toafted 'till of a brown colour, and afterwards made into a tea. If oats cannot be had, wheat bread, or oat- meal well toafted, may be ufed in their flead. If this does not put a Stop to the vomiting, two table- fpoonfuls of the feline julep, made without lemon- juice, with ten drops of laudanum, may be taken every half-hour, 'till it ceafes. The 3i 8 OF THE CHOLERA MORBUS, &e. The vomiting and purging, however, ought never to be ftopped too foon. As long as thefe difcharges do not weaken the patient, they are falutary, and may be allowed to. go on, or rather, ought to be promoted. But, when the patient is weakened by the evacuations, which may be known from the finking of his pulfe, &c. rccourfe muft immediately be had to opiates, as recommended above; to which may be added ftrong wines, with fpirituous cinnamon- waters, and other generous cordials. Warm negus, or ftrong. wine-whey, will likewife be neceffary to fupport the patient's fpirits and promote the perfpi- ration. His legs fliould be bathed in warm water, and afterwards rubbed with flannel cloths, or wrap- ped in warm blankets, and warm bricks applied to the foles of his feet. Flannels, wrung out of warm fpirituous fomentations, fhould likewife be applied to the region of the ftomach. The patient's food ought to be nourifhing, but taken in fmall quantities, and he fhould ufe mode- rate exercife. As the ftomach and inteftines are generally much weakened, an infufion of the bark, or other bitters, in fmall wine, fliarpened with the elixir of vitriol, may be drank for fome time. Though phyficians are fometimes not called in due time in this difeafe, they ought not to defpair of relieving the patient even in the moft defperate circumftances. Of this I lately faw a moft ftriking proof in an old man and his fon, who had been both feized with it about the middle of the night. I did not fee them till next morning, when they had much more the appearance of dead than of living men. No pulfe could be felt; the extremities- were cold and rigid ; the countenance was ghaftly, and the ftrength almoft quite exhaufted. Yet from this de- plorable condition they were both recovered by the ufe of opiates and cordial medicines. Indeed, opium feems here to be a fovereign remedy. OF • t 3*9 1 OF A DIARRHOEA, or LOOSENESS. A loofenefs, in many cafes^ is not to be confl- dered as a difeafe, but rather as a falutary evacua- tion. It ought, therefore, never to be ftopped, un- lefs when it continues too long, or evidently weakens the patient. As this, however, fometimes happens, we fhall point out the moft common caufes of a loofenefs, with the proper method of treatment. When a loofnefs is occafioned by catching cold, or an obftructed perfpiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in luke-warra water, to wear flannel next his fkin, and to take every other method to reftore the perfpiration. In a loofenefs which proceeds from excefs or re- pletion, a, vomit is the proper medicine. Vomits not only cleanfe the ftomach but promote all the fecretions, which renders them of great importance in carrying off a debauch. Fifteen grains of ipeca- cuanha in powder, will anfwer this purpofe very well. A day or two after the vomit, the fame quan- tity of rhubarb may be taken, and repeated two or three times, if the loofenefs continues. The patient ought to live upon light vegetable food of eafy di- geftion, and to drink whey, thin gruel, or barley- water. A loofenefs, occafioned by the obftruction of any cuftomary evacuation, generally requires bleeding. If that does not fucceed, other evacuations ma£ be fubftituted in the room of thofe which are obftructed. At the fame time, every method is to be taken to reftore the ufual difcharges, as not only the cure of the difeafe, but the patient's life may depend on this. A peri- 3*o OF A DIARRHCEA, OR LOOSENESS. A periodical loofenefs ought never to be flopped. It is always an effort of Nature to carry off fome offending matter, which, if retained in the body might have fatal effects. Children are very liable to this kind of loofenefs, efpecially while teething. It is, however, fo far from being hurtful to them, that fuch children generally get their teeth with leaft trouble. If thefe loofe ftools fhould at any time prove four or griping, a tea-fpoonful of mag- nefia alba, with four or five grains of rhubarb, may be given to the child. This, if repeated three or four times, will generally correct the acidity, and carry off the griping ftools. A diarrhoea, or loofenefs, which proceeds from violent paffions or affections of the mind, muft be treated with the greateft caution. Vomits, in this cafe, are highly improper. Nor are purges fafe, unlefs they be very mild, and given in fmall quan- tities. Opiates, and other antifpafmodic medicines, are moft proper. Ten or twelve drops of liquid laudanum, may be taken in a cup of valerian or penny-royal tea every eight or ten hours, till the fymptoms abate. Eafe, cheerfulnefs, and tranquillity of mind, are here of the greateft importance. When a loofenefs proceeds from acrid or poi- fonous fubftances taken into the ftomach, the patient muft drink large quantities of diluting liquors, with oil or fat broths to promote vomiting and purging. Afterwards, if there be reafon to fufpect that the bowels are inflamed, bleeding will be neceflary. Small dofes of laudanum may likewife be taken to remove their irritation. When the gout, repelled from the extremities, occafions a loofenefs, it ought to be promoted by gentle dofes of rhubarb, or other mild purgatives. The gouty matter is likewife to be folicited towards the extremities by warm fomentations, cataplafms, 4 &c. OF A DIARRHOEA, OR LOOSENESS. 321 &c. The perfpiration ought, at the fame time, to be promoted by warm diluting liquors; as wine- whey, with fpirits of hartfhorn, or a few drops of liquid laudanum, in it. When a loofenefs proceeds from worms, which may be known from the fliminefs of the ftools, mixed with pieces of decayed worms, Sec. medicines muft be given to kill and carry off thefe vermin, as the green vitriol, with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a fmall quantity of rhubarb infufed, will be proper to ftrengthen the bowers, and prevent the new genera- tion of worms. A loofenefs is often occafioned by drinking bad water. When this is the cafe, the difeafe generally proves cndemical. When there is reafon to be- lieve that this, or any other difeafe, proceeds from the ufe of unwholefome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quick-lime, chalk, or the like. In people whofe ftomachs are weak, violent exer- cife immediately after eating will occafion a loofe- nefs. Though the cure of this is obvious, yet it will be proper, befides avoiding violent exercife, to ufe fuch medicines as tend to brace and ftrengthen the ftomach, as infufions of the bark with other bitter and aftringent ingredients, in white-wine. Such perfons ought likewife to take frequently a glafs or two of old red port, or good claret. From whatever Caufe a loofenefs proceeds, when it is found neceffary to check it, the diet ought to confift of rice boiled with milk, and flavoured with cinnamon ; rice-jelly ; fago, with red port ; and the lighter forts of flefh-meat. The drink may be thin water-gruel, rice-water, beef, or chicken- broth. 3?2 OF VOMITING. Perfons who, from a peculiar weaknefs, or tot* great an irritability of the bowels, are liable to fre- quent returns of this difeafe, fliould live temperately, avoiding crude fummer fruits, all unwholefome food, and meats of hard digeftion. they ought likewife to beware of cold, moifture, or whatever may ob- struct the perfpirarion, and fhould wear flannel next their fkin. All violent paffions, as fear, anger, &c. are likewife carefully to be guarded againft. OF VOMITING. Vomiting may proceed from various caufes, as excefs in earing and drinking; foulnefs of the fto- mach ; the acrimony of the aliment; a tranfiation of the morbific matter of ulcers, of the gout, the eryfi- pelas, or other difeafes, to the ftomach. It may hkewife proceed from a loofenefs having been too '[';.%»-;■. 'fuddenly ftopped; from the ftoppage of any cuf- '-$± :>"ri£f ternary evacuation, as the bleeding piles, xhemenfes, ! ■',,-- y\ , &c.f?om a weaknefs of the ftomach, the colic, the '*<£&-■**- ^'uc Pa^lon» a rupture, a fit of the gravel, worms; • $3wT or from any kind of poifon taken into the ftomach. It is an ufual fymptom of injuries done to the brain ; as contr.fions, compreffions, Sec. It is likewife a fymptom of wounds or inflammations of the dia- phragm, inteftines, fpleen, liver, kidneys, &c. Vomiting may be occafioned by unufual motions;. as failing, being drawn backwards in a cart or coach, Sec. it may likewife be excited by violent paffions, or by the idea of naufeous or difagreeable objects* efpecially of fuch things as have formerly produced vomitin?. Sometimes it proceeds from a regurgita- tion of the bile in;o ihe ftomach : in this cafe, what the patient vomits ;s generally of a yellow or greenifh colour, and has a bitter tafte. Perfons who are fubject to nervous affections are often fuddenly feized with v.io-ent fits of vomiting. Laltlv, vomiting is a *,,. common OF VOMITING. 323 common fymptom of pregnancy. In this cafe, it generally comes on about two weeks after the ftop- page of the menfes, and continues during the firft three or four months. When vomiting proceeds from a foul ftomach or indigeftion, it is not to be confidered as a difeafe, but as the cure of a difeafe. It ought, therefore, to be promoted by drinking lukewarm water, or thin gruel. If this does not put a flop to the vomiting, a dofe of ipecacuanha may be taken, and worked oft with weak camomile-tea. When the retroceffion of the gout, or the ob- ftruction of cuftomary evacuations, occafion vo- miting, all means muft be ufed to reftore thefe dif- charges ; or, if that cannot be effected, their place muft be fupplied by others, as bleeding, purging, bathing the extremities in warm water, opening iffues, fetons, perpetual blifters, Sec. 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 fmall quantities at a time, and the purgatives fhould be of the mildeft kind, as figs, ftewed prunes, manna, or fenna. Pregnant women are moft apt to vomit in the morning, immediately after getting out of bed, which is owing partly to the change of pofture, but more to the emptinefs of the ftomach. It may generally be prevented by taking a diSli of coffee, tea, or fome light breakfaft in bed. Pregnant women who are affhcted with vomitting, ought to be kept eafy, both in body and mind. They fhould neither allow their ftomachs to be quite empty, nor fliould they eat much at once. If the fpi- rits are low, and the perfon apt to faint, a fpobnfuj of cinnamon water, with a little marmalade of quinces or oranges, may be taken. Vomiting, in this cafe, fo often proceeds from irritability, that a few drops Y * qfr 3^4 OF VOMITING. of laudanum in mint water, after bleeding, will ge- nerally flop it. If vomiting proceeds from weaknefs of the fto- mach, bitters will be of fervice. Peruvian bark in- fufed in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent me- dicine in this cafe. The elixir of vitriol is alfo a good medicine. It may be taken in the dofe of fif- teen or twenty drops, twice or thrice a-day, in a glafs of wine or water. Habitual vomitings are fometimes alleviated by making oyfters a principal part of diet. , A vomiting, which proceeds from acidities in the ftomach, is relieved by alkaline purges. The beft medicine of this kind is the magnefia alba, a tea- fpoonful of which may be taken in a difh of tea or a little milk, three or four times a day, or oftener if neceffary, to keep the body open. When vomiting proceeds from violent paffions, or affections of the mind, all evacuants muff be carefully avoided, efpecially vomits. Thefe are ex- ceedingly dangerous. The patient in this cafe ought to be kept perfectly eafy and quiet, to have the mind foothed, and to take fome gentle cordial, as negus, to which a few drops of laudanum may occa- fionally be added. When vomiting proceeds from fpafmodic affec- tions of the ftomach, mufic, caftor, and other anti- /pafmodic medicines, are of ufe. Warm and aro- matic plafters have likewife a good effect. The ftomach-plafter of the London or Edinburgh dif- penfatory may be applied to the pit of the ftomach, or a plafter of theriaca, which will anfwer rather better. Aromatic medicines may likewife be taken inwardly, as cinnamon or mint-tea, wine with fpice- ries boiled in it, &c. The region of the ftomach may be rubbed with rcther, or, if that cannot be had, OF THE VOMITING, &c. 325 had, with ftrong brandy, or other fpirits. The belly fhould be fomented with warm water, or the patient immerfed up to the breaft in a warm bath. I have always found the faline draughts taken in the act of effervefcence, of fingular ufe in flopping a vomiting, from whatever caufe it proceeded. Thefe may be prepared by diffolving a drachm of the fait of tartar in an ounce and a half of frefli lemon juice, and adding to it an ounce of peppermint-water, the fame quantity of fimple cinnamon-water, and a little white fugar. This draught muft be fwallowed before the effervefcence is quite over, and may be repeated every two hours, or oftener, if the vomit- ing be violent. A violent vomiting has fometimes been ftopped by cupping on the region of the fto- mach after all other means had failed. As the leaft motion will often bring on the vomit- ing again, even after it has been ftopped, the patient muft avoid all manner of action. The diet muft be fo regulated as to fit eafy upon the ftomach, and nothing fhould be taken that is hard of digeftion. We do not howevqr mean that-the patient fhould live entirely upon flops. Solid food, in this cafe, often fits eafier on the ftomach than liquids. OF THE VOMITING AND PURGING OF CHILDREN. This fatal difeafe feems peculiar to our cities *. It occurs, moft commonly, in the months of June, July, and Auguft, and is always moft frequent and moft violent in the hotteft weather, and in children under two years of age. It feldom occurs violently after this age, or in the cool feafons; although den- tition, worms or any thing which irritates the fto- mach and inteftines may bring it on at any time. * In the United States of America.—This fedfion, as well as the chapter on the yellow fever, being added by the Ame- rican editor. Y 3 The Sz6 OF THE VOMITING AND The patient is either feized with a violent or more moderate cholera, which is to be treated as the cho- lera in grown people. When the violence of it abates, diarrhoea, with an almoft conftant tendency to vomit, enfues; a fever, in many refpects refembling the remittent, comes on; the patient becomes ema- ciated. The fymptoms are often very flattering, but the appetite fails, the emaciation encreafes, the food often paffes unchanged, great thirft enfues, the belly fwells and grows hard, the feet are ccdema- tous, the child becomes very drowfy, a fore mouth comes on, petechias often appear, and death, fooncr or later, clofes the feene. This difeafe is often much encreafed by the whooping-cough. It is very often attributed to teethiug and to worms, and there is no doubt that thefe greatly aggravate it. To prevent, or at leaft to lighten, this deftructive diforder, experience teaches, us to remove children at this age into the country during the fummer months. If they are about cutting their teeth, which is generally the cafe, to give the proper medicines, efpecially to have their gums lanced; if worms are fufpected, to ufe the remedies recommended for them, particularly calomel and fleel; to avoid all the caufes which produce remittents, or tend to de- bilitate the ftomach, as expofure to the fun or night air, unripe fruit, Sec. to ufe the cold bath daily, and, in weakly children, a flannel fhirt—the feet fliould be kept warm. When the difeafe exifls, the firft thing to be given is a fmall dofe of rhubarb, or rhubarb and calomel, then give the anodyne laxative mixture (fee Appendix). If this docs not anfwer, ufe the infufion of Colombo, with a little tincture of cinna- mon and laudanum; or, if the diarrhoea is violent, a fmall .quantity of alum with laudanum may be given, or of the tincture or infufion of kino in the fame manner, PURGING OF CHILDREN. 327 manner. It is fuppofed that a plafter made of Venice treacle, and a few drops of the oil of mint, applied directly to the region of the ftomach, is of great fervice. The Peruvian bark given in the form of mixture, decoction, or infufion, is often a very ufe- ful medicine, when the ftomach will bear it. For diet, ufe thin fago-gruel, wine-whey, clear- broth, rice-water, and fait meat, fait fifli, and good cheefe, when the patient will take them. Baths of warm wine and brandy have been often found to be very beneficial when the patient was much reduced. When the child drinks ic fwallows greedily, and of courfe foon throws it up : this might be prevented by reftricting it to a fmall quantity at a time. Cold water is generally craved, but it fliould always have a toaft in it. At night children will drink any thing though they will not in the day. If lime or lemon juice is mixed with a little boiling water, and more water is added, and the whole fweetened with loaf-fugar, a moft agreeable and nfeful drink is made. Port wine or claret and water are alfo very proper. The abfurd practice of giving brandy or rum and water is as improper here as in all other cafes. But the chief remedy is yet to be mentioned—this is a change of air; and, were children removed into the country, in any reafonable time after the attack, we may almoft venture to affert, that this difeafe would feldom prove fatal. It is almoft impoffible to fay when it is too late to remove them ; it would be better to lay it down as a rule, that it is never too late to attempt it. Thofe who cannot be moved into the country fliould be taken out a riding once or twice a-day, and eveu when in the country this exercife is very neceffary. Thofe who cannot take their children a riding, fhould carry them oat of town daily in the Y 4 . afternoon. 328 OF A DIABETES, fcfc. afternoon. A compliance with thefe directions is fo abfolutely neceffary, that without it medicines are feldom of any fervice. CHAP. XXXIII. Of the Diabetes, and other diforders of the Kidneys and Bladder. A HE diabetes is a frequent and exceffive difcharge of urine. It is feldom to be met with among young people; but often attacks perfons in the decline of life, efpecially thofe who follow the * more violent employments, or have been hard drinkers in their youth. CAUSES.—A diabetes is often the confequence of acute difeafes, as fevers, fluxes, &c. where the patient has fuffered by exceffive evacuations; it may alfo be occafioned by great fatigue, as riding long journies upon a hard-trotting horfe, carrying heavy burden-, running, &c. It may be brought on by hard drinking, or the ufe of ftrong ftimulating diu- retic medicines, as tincture of cantharides, fpirits of turpentine, and fuch like. It is fometimes brought on by long expofure to cold and damp. It is often the effect of drinking too great quantities of mineral waters. Many imagine that thefe will do them no fervice unlefs they be drank in great quantities, by which miftake it often happens that they occafion worfe difeafes than thofe they were intended to cure. fn a word, this difeafe may either proceed from too great a laxity of the organs which fecrete the urine, from fomething that ftimulates the kidneys too much, or OF A DIABETES, fcrV. 529 or from a thin diffolved ftate of the blood, which makes too great a quantity of it run off by the uri- nary paffages. SYMPTOMS.----In a diabetes, the urine gene- rally exceeds in quantity all the liquid food which the patient takes. It is thin and pale, moft com- monly of a fweetifh tafte, and an agreeable fmell. The patient has a continual thirft, with fome degree of fever; his mouth is dry, and he fpits frequently a frothy fpittle. The ftrength fails, the appetite decays, and the flefh waftes away till the patient is reduced to fkin and bone. There is a heat of the bowels; and frequently the loins, tefticles, and feet are fwelled. This difeafe may generally be cured at the begin- ning ; but after it has continued long, the cure be- comes very difficult. In drunkards, and very old people, a perfect cure is hardly to be expected. REGIMEN.----Every thing that ftimulates the urinary paffages, or tends to relax the habit, muft be avoided. For this reafon the patient fliould live chiefly on folid food. His thirft may be quenched with acids; as forrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, fago, tapioca, and falep, with milk, are the moft proper food. Of animal fubftances, fhell-fifh are to be preferred; as oyfters, crabs, &c. The drink may be Briftol-water. When that cannot be obtained, lime-water, in which a due proportion of oak-bark has been macerated, may be ufed. The white decoction*, with ifinglafs diffolved in it, is likewife a very proper drink. The patient ought daily to take exercife, but it fhould be fo gentle as not to fatigue him. He fhould lie upon a hard bed or mattrafs. Nothing hurts the * See Appendix, White Deeoilion. kidneys 330 OF A DIABETES, &rV. kidneys more than lyin-> too foft. A warm dry air, the ufe of the fleih-brufh, and every thing that pro- motes perfpiration, is of fervice. For this reafon the patient ought to wear flannel next his fkin. A large ftrengthening plafter may be applied to the back. • MEDICINE.—Gentle purges, if the patient be not too much weakened by the difeafe, have a good effect. They may confift of rhubarb, with cardamom feeds, or any other fpiceries, infufed in wine, and may be taken in fuch quantities as to keep the body gently open. The patient muft next have recourfe to aftringents and corroborants. One feruple of powder of allum may be taken four times a-day, or oftner, if the fto- mach will bear it. If the patient's ftomach cannot bear the allum in fubftance, whey may be made of it, and taken in the dofe of a tea-cupful three or four times a-day. The allum-whey is prepared by boiling two quarts of milk over a flow fire, with three drachms of allum, till the curd feparates. Opiites are of fervice in this difeafe, even though the patient refts well. They take off fpaftn and irri- tation, and at the fame time leffen 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 beft corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glafs of red port or claret three times a-day. The medicine will be both more efficacious and lefs difagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dofe. Such as cannot take the bark in fubftance may ufe the de- coction, mixed with an equal quantity of red wine, and fliarpened as above. There OF A SUPPRESSION OF URINE. 331 There is a difeafe incident to many people in the decline of life, called an INCONTINENCT of urine. But this is very different from a diabetes, as tne water paffes off involuntarily by drops, and does not exceed the ufual quantity. This difeafe is rather troublefome than dangerous, it is owing to a relaxation of the fphincter of the bladder, and is often rhe effect of a palfy. Sometimes it proceeds from hurts, or injuries occafioned by blows, bruifes, preternatural labours, Sec. Sometimes it is the effect of a fever. It may likewife be occafioned by a lon^ ufe of ftrong diuretics.. This difeafe may be mitigated by the ufe of aftrin- gent and corroborating medicines, fuch as have been mentioned above, and by a blifter to the loweft part of the back bone. In an incotitinency of urine, from whatever caufe, a piece of fponge ought to be worn, or a bladder applied in fuch a manner as to prevent the urine from galling and excoriating the parts. OF A SUPPRESSION OF URINE. It has already been obferved, that a fuppreffion of urine may proceed from various caufes; as an in- flammation of the kidneys, or bladder; fmall ftones or gravel lodging in the urinary paffages, hard faces lying in the reclum, pregnancy, a fpafm or contraction of the neck of the bladder, clotted blood in the bladder itfelf, a fwelling of the hsemorrhoidal veins, &c. Some of thefe cafes require the catheter, both to remove the obftructing matter, and to draw off the urine; but as this inftrument can only be managed with fafety by perfons fkilled in furgery, we fhall fay nothing further of its ufe. A bougie may be ufed by any cautious hand, and will often fucceed better than the catheter. We 332 OF A SUPPRESSION OF URINE. We would chiefly recommend, in all obstructions of urine, fomentations and evacuations. Bleeding, as far as the patient's ftrength will permit, is necef- fary, efpecially where there are fymptoms of topi- cal inflammation. Bleeding in this cafe not only abates the fever, by leffening the force of the cir- culation, but, by relaxing the folids, it takes off the fpafm or Stricture upon the veffels which occa- fioned the obstruction. Opiates fliould be ufed if there is any pain. After bleeding, fomentations muft be ufed. Thefe may either confut of warm water alone, or of decoctions of mild vegetables ; as mallows, camo- mile flowers, &c. Cloths dipped in thefe may ei- ther be applied to the part affected, or a large blad- der filled with the decoction, may be kept conti- nually upon it. Some put the herbs themfelves into a flannel-bag, and apply them to the part, which is far from being a bad method. Thefe continue longer warm than cloths dipped in the de- coction, and at the fame time keep the part equally moift. In all obstructions of urine, the body ought to be kept open. This is not, however, to be attempted by ftrong purgatives, but by emollient clyfters, or gentle infufions of fenna and manna. Clyfters in this cafe not only open the body, but anfwer the purpofe of an internal fomentation, and greatly af- fift in removing the fpafms of the bladder and parts adjacent. The food muft be light, and taken in fmall quan- tities. The drink may be weak broth, or decoc- tions and infufions of mucilaginous vegetables, as marfh-mallow roots, lime-tree buds, &c. A tea- fpoonful of the fweet fpirits of nitre, or a drachm of Caftile foap, may be frequently put into the pa- tient's drink. Perfons OF THE GRAVEL AND STONE. 333 Perfons fubject to a fuppreffion of urine ought to live very temperately. Their diet fhould be light, and their liquor diluting. They fhould avoid all acids and auStere wines, fhould take fufficient exer- cife, lie hard, and avoid ftudy and fedentary occu- pations. OF THE GRAVEL AND STONE. When fmall ftones are lodged in the kidneys, or difcharged along with the urine, the patient is faid to be afflicted with the gravel. If one of thefe ftones happens to make a lodgment in the bladder for fome time, it accumulates frefh matter, and at length becomes too large to pafs off with the urine. In this cafe the patient is faid to have the ftone. CAUSES.—The ftone and gravel may be occa- fioned by high living ; the ufe of ftrong aftringent wines ; a fedentary life ; lying too hot, foft, or too much on the back; the conftant ufe of water im- pregnated with earthy or ftony particles : aliments of an aftringent or windy nature, Sec. It may like- wife proceed from an hereditary difpofition. Per- fons in the decline of life, and thofe who have been much afflicted with the gout or rheumatifm, are moft liable to it. SYMPTOMS.—Small ftones or gravel in the kidneys occafion pain in the loins; ficknefs; vo- miting, and fometimes bloody urine. When the ftone defcends into the ureter, and is too large to pafs along with cafe, all the above fymptoms are increafed; the pain extends towards the bladder; the thigh and leg of the affected fide are benumbed ;. the tefticles are drawn upwards, and the urine is ob- structed. A ftone in the bladder is known from a pain ae the time, as well as before and after making water; frorn, 334 OF THE GRAVEL AND STONE. from the urine coming away by drops, or flopping fuddenly when it was running in a full ftream ; by a violent pain in the neck of the bladJer upon mo- tion, efpecially on horfeback, or in a carriage on a rough road ; from a white, thick, copi-nis. Sink- ing, mucous fcdiment in the urhie j fro.r, an tell- ing in the top of the penis; from bloody urine ; from an inclination to go to lfooi during :he dif- charge of urine; from the patient's paffirg his un'ne more eafily when lying than in an the profeffed worm doctors of impofing on the jdnlity v\ mankind, and doing much mifchief. They rms in every cafe, and liberally throw in their antidotes, * --- - gen, rally con'ill of ltrong, draftic purges. I have known thef. ;>iven, in delicate conftitutions, to the detraction of the patie-i, where 7 ere was net the leaft fymptom of worms. f V me ixal w, iter of the prefent age, has enumerated up- ward of fifty Britifh plants, all celebrated for killing and ex- ptiir.g wciViS, drachm OF WORMS. 37c drachm of the powder of tin, twice or thrice a-day, mixed with fyrup, honey or molaffes. Thofe who do not chufe to take calomel, may make ufe of the bitter purgatives; as aloes, hiera picra, tincture of fenna, rhubarb, Sec. Oily medicines are fometimes found beneficial for expelling worms. An ounce of fallad oil, and a table- fpoonful of common fait may be taken in a glafs of red port wine thrice a-day, or oftener, if the ftomach will bear it. But the more common form of ufing oil is in clyfters. Oily clyfters, fweetened with fugar or honey, are very efficacious in bringing away the Short round worms called afcarides, and likewife the teres. The Uarrowgate water is an excellent medicine for expelling worms, efpecially the afcarides. As this water is impregnated with fulphur, we may hence infer, that fulphur alone muft be a good medicine in this cafe; which is found to be a fact. Many practitioners give flour of fulphur in very large dofes, and with great fuccefs. It fhould be made into an electuary with honey or molaffes, and taken in fuch quantity as to purge the patient. Where Harrowgate water cannot be obtained, fea-water may be ufed, which is far from being a contemptible medicine in this cafe. If fea-water cannot be had, common fait diffolved. in water may be.drank. I have often feen this ufed by country nurfes, with very good effect. Some flour of fulphur may be taken over night, and the falt-water in the morning. But worms, though expelled, will foon breed again, if the ftomach remains weak and relaxed ; to prevent which, we would recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glafs of red port wine three or four times a-day, after the above medicines have been ufed. Lime-water is likewife good for this purpofe, or a- Bb 4 table- 376 OF WORMS. table-fpoonful of the chalybeate wine taken twice or thrice a-day. Infufions or decoctions of bitter he'bs, may likewife be drank; as the infufion of tanfy, water trefoil, camomile flowers, tops of wormwood* centaury, &c. For a child of four or five years old, fix grains of rhubarb, five of jalap, and fix of calomel, may be mixed in a fpoonful of fyrup or honey, and given in the morning. The child fhould keep the houfe all day, and take nothing cold. This dofe may be repeated twice a-week for three or four weeks. On the intermediate days the child may take a fcruple of powdered tin and ten grains of aethiops mineral in a fpoonful of molaffes twice a-day. This dofe muft be increafed or diminished according to the age of the patient. Biffet fays, the great baftard black hellebore, or bear's foot, is a moft powerful vermifuge for the long round worms. He orders the decoction of about a drachm of the green leaves, or about fifteen grains of the dried leaves in powder for a dofe to a child between four and feven years of age. This dofe is to be repeated two or three times. He adds, that the green leaves made into-a fyrup'with coarfe fugar, is almoft the only medicine he has ufed for round worms for three years paft. Before preffing out the juice, he moiftens the bruifed leaves with vinegar, which corrects the medicine. The dofe is a tea-fpoonful at bed time, and one or two next morning. I have frequently known thofe big bellies, which in children are commonly reckoned a fign of worms, quite removed by giving them white foap in their pottage, or other food. Tanfy, garlic, and rue, are all good againft worms, and may be ufed various ways. We might here mention many other plants, both for external and internal ufe, as the cabbage- fcark, Sec. but think the powder of tin with aethiops* mineral, OF WORMS. 377 mineral, and the purges of rhubarb and calomel, are more to be depended on. Perhaps there is no me- dicine more powerful, in thefe cafes, and at the fame time more fafe, than from two to eight grains of fal martis, with five grains of iron filings, twice a-day, for feveral days, in a little fyrup or molaffes. Ball's purging vermifuge powder is a very power- ful medicine. It is made of equal parts of rhubarb, feammony, and calomel, with as much double re- fined fugar as is equal to the weight of all the other ingredients. Thefe muft be well mixed together, and reduced to a fine powder. The dofe for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dofe*. Parents who would preferve their children from worms, ought to allow them plenty of exercife in the open air ; to take care that their food be wholefome and fufficiently folid ; and, as far as poffible, to pre- vent their eating raw herbs, roots, or green trafliy fruits. It will not be amifs to allow a child who is fubject to worms, a glafs of red wine after meals; as every thing that braces and ftrengthens the fto- mach is good both for preventing and expelling thefe verminf. * A powder for the tape-worm, was long kept a fecret on the Continent; it was lately purchafed by the French king, and will be found under the article Powder, in the Appendix. f We think it neceffary here to warn people of their danger who buy cakes, powdeTs, and other worm medicines, at ran- dom from quacks, and give them to their children without proper care. The principal ingredients in moft of thefe medi- cines is mercury, which is never to be trifled with. I lately faw a fhocking inftance of the danger of this conduct. A girl who had taken a dofe of worm powder, bought of a travelling quack, went out, and perhaps was fo imprudent as to drink cold water during its operation. She immediately fwelled, and died on the following day, with all the fymptoms of having been poifoned. CHAP. t "" [ 378 ] CHAP. XXXVII. Of the Jaundice. 1 I1IS difeafe is firft obfervable in the white of the eye, which appears yellow. Afterwards the whole fkin puts on a yellow appearance. The urine, too, is of a faffron hue, and dies a white cloth of the fame colour. There is likewife a fpecies of this difeafe called the Black Jaundice. CAUSES.—The immediate caufe of the jaundice is an obstruction of the bile. The remote or occa- fional caufes are, the bites of poifonous animals, as the viper, mad dog, Sec. the bilious or hyfteric colic ; violent paffions, as grief, anger, Sec. Strong purges or vomits will likewife occafion the jaundice. Sometimes it proceeds from obftinate agues, or from that difeafe being prematurely ftopped by aftringent medicines. In infants it is often occafioned by the meconium not being fufficiently purged off. Preg- nant women are very fubject to it. It is likewife a fymptom in feveral kinds of fever. Catching cold, or the ftoppage of cuftomary evacuations, as the menfes, the bleeding piles, iffues, &c. will occafion the jaundice. SYMPTOMS.—The patient at firft complains of exceffive wearinefs, and has great averfion to every kind of motion. His fkin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The Stools are of a whitifli or clay colour, and the urine, 'as was obferved above, is yellow. The breathing is difficult, and the patient complains of an unufual load or oppreffion on his breaft, often attended with great defpondency. There OF THE JAUNDICE. 379 is a heat in the noftrils, a bitter tafte in the mouth, loathing of food", ficknefs at the ftomach, vomiting, flatulency, and other fymptoms of indigeftion. If the patient be young, and the difeafe compli- cated with no other malady, it is feldom dangerous ; but in old people, where it continues long, returns frequently, or is complicated with the dropfy or hypochondriac fymptoms, it often proves fatal. The black jaundice, or vomiting of a dark coloured fluid, is more dangerous than the yellow. REGIMEN.—The diet fhould be cool, light, and diluting, confifting chiefly of ripe fruits and mild vegetables; as apples boiled or roafted, ftewed prunes, preferved plums, boiled fpinage, &c. Veal or chicken-broth, with light bread, are likewife very proper. Many have been cured by living almoft wholly for fome days on raw eggs, the drink fhould be butter-milk, whey fweetened with honey, or de- coctions of cool opening vegetables; or marfh-mal- low roots, with liquorice, Sec. The patient fliould take as much exercife as he can bear, either on horfeback or in a carriage ; walk- ing, running, and even jumping, are likewife proper, provided he can bear them without pain, and there be no fymptoms of inflammation. Patients have been often cured of this difeafe by a long journey, after medicines had proved ineffectual. Amulements are likewife of great ufe in the jaun- dice. The difeafe is often occafioned by a fedentary life, joined to a dull melancholy difpofition. What- ever therefore tends to promote the circulation, and to cheer the fpirits, muft have a good effect; as dancing, laughing, finging, &c. MEDICINE.—If the'patient be young, of a full Sanguine habit, and complains of pain in the right fide about the region of the liver, bleeding will be neceffary. If bleeding does not relieve, a blifter fliould 3go OF THE JAUNDICE. fhould be applied directly to the painful part. The body muft likewife be kept open by taking a fufB. cient quantity of Caftile foap, or the pills for the jaundice recommended in the Appendix. Fomenting the parts about the region of the fto- mach and liver, and rubbing them with a warm hand or flefli-brufh, are likewife beneficial; but it is ftill more fo for the patient to fit in a bath of warm water up to the breaft. He ought to do this fre- quently, and fhould continue in it as long as his ftrength will permit; but if the pain continues vio- lent, it will be neceffary to have recourfe to the liquid laudanum. Many dirty things are recommended for the cure of the jaundice; as lice, millepedes, &c. But thefe do more harm than good, as people truft to them, and neglect more valuable medicines ; befides, they' are feldom taken in fufficient quantity to produce any effects. People always expect that fuch things fhould act as charms, and consequently feldom per- fift in the ufe of them. Bleeding, purges, fomen- tations, and exercife, will feldom fail to cure the jaundice when it is a fimple difeafe, and when com- plicated with the dropfy, a fchirrous liver, or other ehronic complaints, it requires a more particular treatment. Numbcrlefs British herbs are extolled for the cure of this difeafe. The author of the Medicina Britan- nica mentions near an hundred, all famous1 for cur- ing the jaundice. The fact is, the difeafe often goes off of its own accord; in which cafe the laft medicine is always faid to have performed the cure. I have fometimes however feen confiderable benefit, in a very obftinate jaundice, from a decoction of hempfeed. Four ounces of the feed may be boiled in two Englifh quarts of ale, and fweetened with coarfe fugar. The dofe is half an Englifh pint every OF THE DROPSY. 3g, every morning. It may be continued for eight or nine days. I have likewife known Harrowgate fulphur-water cure a jaundice of very long Handing. It fliould be ufed for fome weeks, and the patient muft both drink and bathe. The foluble tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning in a cup of tea or water-gruel. If it does not open the body, the dofe may be in- creafed. Perfons fubject to the jaundice ought to take as much exercife as poffible, and to avoid all heating and aftringent aliments. CHAP. XXXVIII. Of the Dropfy. i- HE dropfy is a preternatural fwelling of the whole body, or fome part of it, occafioned by a collection of watery humor. It .is diftinguifhed by different names, according to the part affected, as the anafarca, or a collection of water under the fkin ; the a/cites, or a collection of water in the belly ; the hydrops pecloris, or dropfy of the breaft ; the hydro- cephalus, or dropfy of the brain, &c. CAUSES—The dropfy is often owing to an he- reditary difpofition. It may likewife proceed from drinking ardent fpirits, or other ftrong liquors. It is true almoft to a proverb, that great drinkers die of a dropfy. The want of exercife is alfo a very common caufe of the dropfy. Hence it is juftly reckoned 332 OF THE DROPSY. reckoned among the difeafes of the fedentary. It fometimes proceeds from exceffive evacuations, as frequent and copious bleedings, ftrong purges often repeated, frequent falivations, &c. The fudden ftop- page of cuftomary or neceffary evacuations, as the menfes, the haemorrhoids, fluxes of the belly, &c. may likewife caufe a dropfy. I have known the dropfy occafioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by violent exercife. A low, damp, or marfhy fituation is likewife a frequent caufe of it. Hence it is a common difeafe in moift, flat, fenny countries. It may alfo be brought on by a long ufe of poor watery diet, or of vifcous aliment that is hard of digeftion. It is very often the effect of other difeafes, as the jaundice, a fchirrus of the liver, a violent ague of long continuance, a diarrhoea, a dy- fentery, an empyema, or a confumption of the lungs. In fhort, whatever obstructs the perfpiration, or pre- vents the blood from being duly prepared, may occa- fion a dropfy. SYMPTOMS.—The anafarca generally begins with a fwelling of the feet and ancles towards night, which for fome time difappears in the morning. In the evening the parts, if preffed with the finger, will pit. The fwelling gradually afcends, and occu- pies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in fmall quantity, and the thirft great; the body is bound, and the perfpiration is greatly obftructed. To thefe fucceed torpor, heavinefs, a flow wafting fever, and a troublefome cough. This laft is gene- rally a bad fymptom, as it fliows that the lungs|j|re affected. * In an afcites, befides the above fymptoms, there is a fwelling of the belly, and often a fluctuation, which may be perceived by (hiking the belly on one OF THE DROrSY. 383 one fide, and laying the palm of the hand on the oppofite. This may be diftinguifhed from a tympany by the weight of the fwelling, as well as by the fluctuation. When the anafarca and afcites are com- bined, the cafe is more dangerous. Even a fimple afcites too feldom admits of a radical cure. When the difeafe comes fuddenly on, and the pa- tient is young and ftrong, there is reafon, however, to hope for a cure, efpecially if medicine be given early. But if the patient be old, has led an irregular or a fedentary life, or if there be reafon to fufpect that the liver, lungs, or any of the vifeera are un- found, there is great reafon to fear that the confe- quences will prove fatal. REGIMEN.—The patient muft abftain as much as poffible from all drink, efpecially weak and watery liquors, and muft quench his thirft with muftard- whey, or acids, as juice of lemons, oranges, forrel, or fuch hke. His aliment ought to be dry, of a ftimulating and diuretic quality, as toafted bread, the flefh of birds, or other wild animals, roafted ; pungent and aromatic vegetables, as garlic, muftard, onions, creffes, horfe-radifh, rocambole, fhalot, Sec. He may alfo eat fea-bifcuit, dipt in wine. This is not only nounihing, but tends to quencht hirft. Some have been actually cured of a dropfy from a total abilinence from all liquids, and living entirely upon fuch tilings as are mentioned above. If the patient: muft have drink, the Spa-water, or Rhenifh wine, with diuretic medicines inft.fed in it, are the beSt. There are, however, many diuretic medicines which require a large quantity cf drink to make them ope- rate. Exercife is of the greateft importance in a dropfy. If the patient be able to walk, dig, or the like, ho ought to continue thefe exercifes as long as he can. If he is not able to walk or labour, he muft ride on or.,o.iCK.a 384 OF THE DROPSY. horfeback, or in a carriage; and the more violent the motion fo much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one and, if poffible, into a warmer climate. In a word every method fliould be taken to promote the per- fpiration, and to brace the folids. For this purpofe it will likewife be proper to rub the patient's body, two or three times a-day, with a hard cloth, or the flefh-brufh ; and he ought conftantly to wear flannel next his fkin. Thefe obfervations apply to the cure of dropfy, attended with the common fymptoms of weaknefs. For there are many cafes of dropfy in which the pulfe evidently indicates bleeding and the remedies proper for inflammatory difeafes. MEDICINE.—If the patient be young, his confti- tution good, and the difeafe has come on fuddenly, it may generally be removed by bleeding, brifk purges, and fuch medicines as promote a difcharge by fweat and urine. The patient may take the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel fix grains. Thefe may be made into a bolus with a little fyrup of pale rofes, and taken early in the morning.* The patient may likewife take every night at bed- time the following bolus: To four or five grains of camphor add one grain of opium, and as much fyrup of orange-peel as is fufficient to make them into a bolus. This will generally promote a gentle fweat, which fhould be encouraged by drinking now and then a fmall cup of wine whey, with a tea-fpoonful of the fpirits of hartfhorn in it. A tea-cupful of the following diuretic infufion may likewife be taken every four or five hours through the day: Take / OF THE DROPSY. 385 Take juniper berries, muftard-feed, and horfe. radifli, of each half an ounce, allies of broom half a pound ; infufe them in a quart of Rhenilh wine or ftrong ale, for a few days, and afterwards ftrain off the liquor. Such as cannot take this infufion, may ufe the decoction of feneka-root, which is both diu- retic and fudorific. I have known an obftinate anafarca cured by an infufion of the aflies of broom in wine. The above courfe will often cure an incidental dropfy, if the conftitution be good ; but when the difeafe proceeds from a bad habit, or an unfound ftate of the vifcera, ftrong purges are not to be ven- tured upon. In this cafe, the fafer courfe is to pal- liate the fymptoms, by the ufe of fuch medicines as promote the fecretions, and to fupport the patient's ftrength by warm and nourishing cordials. The fecretion of urine may be greatly promoted by nitre. Brookes fays, he knew a young woman who was cured of a dropfy by taking a drachm of nitre every morning in a draught of ale, after fhe had been given over as incurable. The powder of fquifis is likewife a good diuretic. Six or eight grains of it, with a feruple of nitre, may be given twice a-day in a glafs of ftrong cinnamon-water. Ball fays, a large fpoonful of unbruifed multard- feed taken every night and morning, and drinking half a pint of the decoction of the tops of grten broom after it, has performed a cure after other powerful medicines had proved ineffectual. I have often feen good effects from cream of tartar in this difeafe. It promotes the difcharges by ftool and urine, it will at leaft palliate, and often perform a cure. The patient may begin by taking an ounce every fecond or third day, and may in- creafe the quantity to two, or even to three ounces, if the ftomach will bear it. This quantity is not, however, to be taken at once, but divided into three C c or 386 OF THE DROPSY. or four dofes. The fox-glove, taken in dofes of two or three grains, night and morning, for five or fix days, will prove more diuretic than moft other remedies. It will be neceffary to diink very freely of chamomilc-tea, weak'wine and water, or any other drink of this kind, to promote its operation. Indeed, this is neceffary, when we ufe any kind of diuretics. If the fox-glove either does not prove diuretic in a few days, or if it produces a flownefs in the pulfe, its ufe muft be difeontinued. In pure afcites diuretics do no good. To promote perfpiration, the patient may ufe the decoction of fencka-root, as directed above; or he may take two table-fpoonfuls of Mindererus's fpirit, in a cup of wine-whey, three or four times a-day. To promote a difcharge of urine, the following infu- fion of the London hofpitals will likewife be beneficial: Take of zedoary root two drachms; dried fquills, rhubarb, and juniper-berries- bruifed, of each a drachm; cinnamon in powder, three drachms; fait of wormwood, a drachm and a half; infufe in a pint and a half of old hock wine, and when fit for ufe, filter the liquor. A wine-glafs of it may be taken three or four times a-day. In an.afcites, when the difeafe does not evidently and fpeedily give way to purgative and diuretic medi- cines, the water ought to be let off by tapping. This is a very fimple and feft* operation, and would often Succeed, if it were performed in due time ; but if it be delayed till the humours are vitiated, or the bowels fpoiled, by long foaking in water, it can hardly be expected that any permanent relief will be procured 0 Afcites is often relieved, and fometimes cured, by rubbing the belly with fwcet-oil. * The very name of an operation is dreadful to moft peo- ple, and they wifli to try every thing before they have recourfe to it. This is the reafcn why tapping feldcm fuccceds to our wifh.. OF THE GOUT. 387 After the evacuation of the water, the patient is to be put on a courfe of ftrengthening medicines; as the Peruvian bark ; the elixir of vitriol; preparations of iron ; warm aromatics, with a due proportion of rhubarb, infufed in wine, and fuch like. His diet ought to be dry and nourishing, fuch as is recom- mended in the beginning of the Chapter ; and he fhould take as much exercife as he can bear with- out fatig-ue. He fliould wear flannel next his fkin, and make daily ufe of the flefh-brufli. CHAP. XXXIX. Of the Gout. 1 HERE is no difeafe which fets the advantages of temperance and exercife in a Stronger light, than the gout. Excefs and idlenefs are the true fources from whence it originally fprung, and all who would avoid it muft be active and temperate* Though idlenefs and intemperance are the princi- pal caufes of the gout, yet many other things may contribute to bring on the diforder in thofe who are not, and to induce a paroxyfm in thofe who are fub- ject to it; as intenfe Study; too free an ufe of acidu- lated liquors ; night-watching ; grief or uneafinefs of the mind ; an obstruction or defect of any of the cuftomary difcharges, as the menfes, fweating of the feet, perfpiration, Sec. wifh. I have had a patient who was regularly tapped, once a month, for feveral years, and who ufed to eat her dinner as well after the operation, as if nothing had happened. She died at laft, rather wwn out by age than by the difeafe. C c 2 SYMP- 388 OF THE GOUT. SYMPTOMS.—-A fit of the gout is generally preceded by indigeftion, drowfinefs, belching of wind, a flight head-ach, ficknefs, and fometimes vo- miting, i he patient complains of wearinefs and dejection of fpirits, and has often a pain in the limbs, with a fenfation as if wind or cold water were paffing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a flight pain in paffing urine, and fometimes an involuntary-fhedding of tears. Sometimes thefe fymptoms are much more violent, efpecially upon the near approach of the fit; and fome obferve, that as is the fever which ufliers in the gout, fo will the fit be; if the fever be fhort and fliarp, the fit will be fo likewife ; if it be feeble, long, and lin- gering, the fit will be fuch alfo. But this obfervation can only hold with refpect to very regular fits of the gout. The regular gout generally makes its attack in the fpring, or beginning of winter, in the follow- ing manner: About two or three in the morning, the patient is feized with a pain in his great toe, fometimes in the heel, and at other times in the an- cle or calf of the leg. This pain is accompanied with a fenfation as if cold water were poured upon the part, which is fucceeded by a fhivering, with fome degree of fever. Afterwards the pain in- creafes, and fixing among the fmall bones of the loot, the patient feels all the different kinds of torture, as if the part were Stretched, burnt, fqueezed, gnaw- ed, or torn in pieces, &c. The part at length be- comes fo exquisitely fenfible, that the patient cannot bear to have it touched, or even fuffer any perfon to walk acrofs the room. The patient is generally in exquifite torture for twenty-four hours, from the time of the coming on of the fit: he then becomes eafier, the part begins to OF THE GOUT 3S9 to fwell, appears red, and is covered with a litrle moifture. Towards morning he drops afleep, and generally falls into a gentle breathing fweat. This terminates the firft paroxyfin, a number of which constitute a fit of the gout; which is longer or fhorter according to the patient's age, ftrength, the feafon of the year, and the difpofition of the body to this difeafe. The patient is always worfe towards night, and eafier in the morning. The paroxyfms however ge- nerally grow milder every day, till at length the dif- eafe is carried off by perfpiration, urine, and the other evacuations. In feme patients this happens in a few days ; in others, it requires weeks, and in fome, months, to finifli the fit. Thofe whom age and frequent fits of the gout have greatly debili- tated, feldom get free from it before the approach of fummer, and fometimes not till it be pretty far ad- vanced. REGIMEN.—As there are no medicines yet known that will cure the gout, we fhall confine our obfervations chiefly to regimen, both in and out of the fit. In the fit, if the patient be young and ftrong, his diet ought to be thin and cooling, and his drink of a diluting nature; but where the constitution is weak, and the patient has been accuftomed to live high, this is not a proper time to retrench. In this cafe he muft keep nearly to his ufual diet, and fhould take frequently a cup of ftrong negus, or a glafs of generous wine. Wine-whey is a very proper drink in this cafe, as it promotes the per- fpiration without greatly heating the p.uienr. It will anfwer this purpofe better if a tea-fpoonful-of fal volatile oleofum, or fpirits of hartfhorn, be put into a cup of it twice a-day. It will likewife be proper to give at bed-time two or three tea-fpoonfuis Cc3 of 3qo OF THE GOUT. of the volatile tincture of guaiacum in a large draught of warm wine-whey. This will greatly promote perfpiration through the night. As the moft fafe and efficacious method of dif- charging the gouty matter is by perfpiration, th'ii ought to be kept up by all means, efpecially in the affected part. For this purpofe the leg and foot fhould be wrapt in foft flannel, fur, or wool. The laft is moft readily obtained, and feems to anfwer the purpofe better than any thing elfe. The peo- ple of Lancashire look upon wool as a kind of fpecific in the gout. They wrap a great quantity of it about the leg and foot affected, and cover it with a Ikin of foft dieffed leather. This they fuffer to continue for eight or ten days, and fometimes for a fortnight or three weeks, or longer, if the pain does not ceafe. I never knew any external applica- tion anfwer fo well in the gout. I have often feen it applied when the fwelling and inflammation were very great, with violent pain, and have found all thefe fymptoms relieved by it in a few days. The wool which they ufe is generally greafed, and carded or combed. They chufe the fofteft which can be had, and feldom or never remove it till the fit be en- tirely gene off. It is, however, neceffary to obferve, that too much heat is always hurtful. When flannel or wool produce perfpiration and give eafe they are ufeful; but when they have not this effect, and in- creafe the heat, they are improper. The patient ought likewife to be kept quiet and eafy during the fit. Every thing that affects the mind diftrubs the paroxyfm, and tends to throw the gout upon the nobler parts. All external applica- tions that repel the matter, are to be avoided as death. They do not cure the difeafe, but remove it from a fafer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is to he OF THE GOUT. 39i be confidered as Nature's method of removing fome- thing that might prove deftructive to the body, and all that we can do, with fafety, is to promote her intentions, and to affift her in expelling the enemy in her own way. Evacuations by bleeding, ftool, &c. are likewife to be ufed with caution ; they do not remove the caufe of the difeafe., and fometimes by weakening the parent, prolong the fit: but where the conftitution is able to bear it, it will be of ufe to keep the body gently open by diet, or very mild lax- ative medicines. It may, however, be laid down as a general rule, thar, where the pulfe is ftrong or tenfe, bleeding is abfolutely neceffary, as well as purging, in thofe cafes where the gout affumss the form of apoplexy, pleurify, ftrangury, &c. Many things will indeed fliorten a fit of the gout, and fome will drive it off altogether: but nothing has yet been found which will do this with fafety to the patient. In pain we eagerly grafp at any thing that promifes immediate eafe, and even hazard life itfelf for a temporary relief. This is the true rea- fon why fo many infallible remedies have been pro- pofed'for the gout, and why fuch numbers have loft their lives by the ufe of them. It would be as prudent to Stop the fmall-pox from rifing,. and to drive them into the blood, as to attempt to re- pel the gouty m itter after it has been thrown upon the extremities. The latter is as much an effort of Nature to free herfelf from an offending caufe, as the former, and ought equally to be promoted. When the pain, however, is very great, and the patient is reftlefs, thirty or forty drops of laudanum, more or lefs, according to the violence of the fymp- toms, may be taken at bed-time. This will eafe the pain, procure reft, promote perfpiration, and forward the crifis of the difeafe. After the fit is over, the patient, if he is in a weak ftate, ought to take a gentle dofe or two of the bitter C c 4 tincture 3Q2 OF THE GOUT. tincture of rhubarb, or fome other warm ftomachie purge, lie fliould alfo drink a weak infufion of fto- machic bitters in fmall wine or ale, as the Peruvian bark, with cinnamon, Virginian fnake-root, and orange-peel. The diet at this time fhould be light, but nourifhing, and gentle exercife ought to be taken on horfeback, or in a carriage. Out of the fit, it is in the patient's power to do many things towards preventing a return of the dif- order, or rendering the fit, if it Should return, lefs fevere. This, however, is not to be attempted by medicine. I have frequently known the gout kept off for feveral years by the Peruvian bark and other aftringent medicines ; but in all the cafes where 1 had occafion to fee this tried, the perfons died fuddenly, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to fome constitu- tions, in the decline of life, is rather falutary than hurtful. Though it may be dangerous to flop a fit of the gout by medicine, yet if the conftitution can be fo changed by diet and exercife, as to leffen or totally prevent its return, there certainly can be no danger in following fuch a courfe. It is well known that the whole habit may be fo altered by a proper regimen, as quite to eradicate this difeafe; and thofe only who have fuffi- cient rcfolution to ferflft in fuch a courfe, have reafon to expect a cure. The courfe which we would recommend for pre- venting the gout, is as follows : In the firft place, univerfal temperance. In the next place fuflicient ex- ercife *. By this we do not mean fauntering about * Some make a fecret of curing the gout by mufcular exer- df. this fecret, however, is as old as Cclfus, who ftrongly recommended that mode of cure ; and whoever will fubmit to it, in th? fu'lefl extent, may expect to reap folid and permanent advantages. in OF THE GOUT. 393 in an indolent manner, but labour, fweat, and toil. Thefe only can render the humors wholefome, and keep them fo. Going early to bed, and rifing be- times, are alfo of great importance. It is likewife proper to avoid night ftudies, and all intenfe thought. The fupper fhould be light, and taken early. All ftrong liquors, efpecially generous wines and four pu:ich, are to be avoided. We would likewife recommend fome dofes of mag- nefia alba and rhubarb to be taken every fpring and autumn; and afterwards, if the ftomach is weak, a courfe of ftomachie bitters, as tanfey or water-tre- foil tea, an infufion of gentian and camomile flowers, or a decoction of burdock root, &c. Any of thefe, or an infufion of any wholefome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An iffue or perpetual blifter has a great tendency to prevent the gout. If thefe were more generally ufed in the decline of life, they would not only often prevent the gout, but alfo other chronic mala- dies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digeltion, and invigorates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extre- mities and fails on fome of the internal parts, proper applications to recall and fix it, become abfolutely neceffary. When the gout affects the head, the pain of the joints ceafes, and the fwelling difappears, while either fevere head-ach, drowfinefs, trembling, gid- dinefs, convulfions, or delirium come on. When it feizes the lungs, great oppreffion, with cough and difficulty of breathing, enfue. If it attacks the fto- mach, extreme ficknefs, vomiting, anxiety, pain in the epigaftric region, and total lofs of ftrength, will fucceed. When 294 OF THE GOUT. When the gout attacks the head or lungs, every method muft be taken to fix it in the feet. They muft be frequently bathed in warm water, and acrid cataplafms applied to the foles. Bliftering-plafters ought likewife to be applied to the ancles or calves of the legs. Bleeding is alfo neceffary, and purges. The patient ought to keep in bed for the moft part, if there be any figns of inflammation, and fliould be very careful not to catch cold. If it attacks the ftomach with a fenfe of cold, the moft warm cordials are neceffary; as ftrong wine boiled up with cinnamon or other fpices; cinnamon- water; peppermint-water, or a tea-fpoonful of ether every hour in a little water, with the addition of fif- teen or twenty drops of laudanum to every dofe if there is much pain. The patient fliould keep his bed, and endeavour to promote a fweat by drinking warm liquors. When the gout attacks the kidneys, and imitates gravel pains, the patient ought to drink freely of a decoction of marfh-mallows, and to have the parrs fomented with warm water. An emollient clyfter ought likewife to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoc- tion. Perfons who have had the gout fhould be very attentive to any complaints that may happen to them about the time when they have reafon to expect a return of the fit. The gout imitates many other diforders, and by being mistaken for them, and treated improperly, is often diverted from its regular courfe, to the great danger of the patient's life. Thofe who never had the gout, but who, from their conftitution or manner of living, have reafon to expect it, ought likewife to be very circumfpect with regard to its firft approach. If the difeafe, by wrong OF THE RHEUMATISM. 395 wrong conduct or improper medicines, be diverted from its proper courfe, the miferable patient has a chance to be ever after tormented with head-achs, coughs, pains of the ftomach and inteftines; and to fall at laft a victim to its attack upon fome of the more noble parts. When the gout attacks any part befides the feet, without fymptoms of inflammation, unlefs indeed it is in the ftomach, the tincture of guaiacum will be found of great fervice. OF THE RHEUMATISM. This difeafe has often a refemblance to the gout. It generally attacks the mufcles and large joints with exquifite pain, and is fometimes attended with inflam- mation and fwelling. It is moft common in the fpring, and towards the end of autumn. It is ufually distin- guished into acute and chronic; or the rheumatifm with and without a fever. CAUSES.—The caufes of a rheumatifm are fre- quently the fame as thofe of an inflammatory fever, viz. an obftructed perfpiration, the immoderate ufe of ftrong liquors, and the like. Sudden changes of the weather, and all quick tranfitions from heat to cold, are very apt to occafion the rheumatifm. The moft extraordinary cafe of a rheumatifin that I ever faw, where almoft every joint of the body was dis- torted, was a man who ufed to work one part of the day by the fire, and the other part of it in the water. Very obftinate rheumatifms have likewife been brought on by perfons not accuftomed to it, allowing their feet to continue long wet. The fame effects are often produced by wet clothes, damp beds, fit- ting or lying on the damp ground, travelling in the pight, &c. , The rheumatifin may likewife be occafioned by exceffive evacuations, or the ftoppage of cuftomary difcharges. 396 OF THE RHEUMATISM. difcharges. It is often the effect of chronic difeafes, which vitiate the humors; as the fcurvy, the lues venerea, obftinate autumnal agues, &c. The rheumatifm prevails in cold, damp, marfhy countries. It is moft common among the poorer fort of peafants, who are ill clothed, live in low damp houfes, and eat coarfe unwholefome food, which contains but little nourifhment, and is not eafily di- gefled. SYMPTOMS.—The acute rheumatifm commonly begins with wearinefs, fliivering, a quick pulfe, reft- leffnefs, thirft, and other fymptoms of fever. After- wards the patient complains of flying pains, which are increafed by the leaft motion. Thefe at length fix in the joints, which are often affected with fwel- ling and inflammation. If blood be let in this difeafe, it has generally the fame appearance as in the pleu- rify. In this kind of rheumatifm the treatment of the patient is nearly the fame as in an acute or inflam- matory fever. If he be young and ftrong, bleeding is neceffary, which may be repeated according to the exigencies of the cafe. The body ought likewife to be kept open by emollient clyfters, or cool opening liquors; as decoctions of tamarinds, cream of tartar whey, fenna-tea, and the like. The diet fhould be light and in fmall quantity, confifting chiefly of roafted apples, oatmeal-gruel, or weak chicken-broth. After the feverifh fymptoms have abated, if the pain ftill continues the patient muft keep his bed, and take fuch things as promote perfpiration; as wine-whey with fpiritus Mindereri, Sec. He may likewife take, for a few nights, at bed-time, in a cup of wine- whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder*. * Smart purging in rheumatifm is generally of very effen- tial fervice. Warm OF THE RHEUMATISM. 397 Warm bathing, after proper evacuations, has often an exceeding good effect. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to tut ;wts affected. Great care muft be taken that he do not catch cold after bathing. The chronic rheumatifm is feldom attended with any confiderable degree of fever, and is generally confined to fome particular part of the body, as the fhoulders, the back, or the loins. There is feldom any inflammation or fwelling in this cafe. Perfons in the decline of life are moft fubject to the chronic rheumatifm. In fuch patients it often proves ex- tremely obftinate. In this kind of rheumatifm the regimen fliould be nearly the fame as in the acute. Cool and diluting diet, confifting chiefly of vegetable fubftances, as ftewed prunes, coddled apples, currants or goofe- berries boiled in milk, is moft proper. Arbuthnot fays, " If there be a fpecific in aliment for the rheu- matifm, it is certainly whey;" and adds, " That he knew a perfon fubject to this difeafe, who could never be cured by any other method but a diet of whey and bread." He likewife fays, " That cream of tartar in water-gruel, taken for feveral days, will eafe rheumatic pains confiderably." This I have often experienced, but found it always more effica- cious when joined with gum guaiacum, as already directed. In this cafe the patient may take the dofe formerly mentioned twice a-day, and likewife two tea-fpoons full of the volatile tincture of gum guaia- cum, at bed-time, in wine-whey. This courfe may be continued for a week, or longer, if the cafe proves obftinate, and the patient's ftrength will permit. It ought then to be omitted for a few days, and repeated again. At the fame time leeches or a bliftering-plafter may be applied to the 308 OF THE RHEUMATISM. the part affected. What I have generally found an- fwer better than either of thefe, in obftinate fixed rheumatic pains, is the warm plafter*. I have like- wife known a plafter of Buroundy pitch worn for fome time on the part affected give great relief in rheumatic pains. My ingenious friend, Dr Alexan- der of Edinburgh, fays, he has frequently cured very obftinate rheumatic pains by rubbing the part affected with tincture of cantharides. When the common tincture did not fucceed, he ufed it of a double or treble ftrength. Cupping upon the part affected, is likewife often very beneficial, and is greatly preferable to the application of leeches. Though this difeafe may not feem to yield to me- dicines for fome time, yet they ought ftill to be per- fifted in. Perfons who are fubject to frequent re- turns of the rheumatifm, will often find their account in ufing medicines, whether they be immediately affected with the difeafe or not. The chronic rheu- matifm is fimilar to the gout in this refpect, that the moft proper time for ufing medicines to extirpate it, is when the patient is moft free from the diforder. To thofe who can afford the expence, I would recommend the warm baths of Buxton or Matlock in Derbyfhire. Thefe have often, to my knowledge, cured very obftinate rheumatifms, and are always fafe either in or out of the fit. When the rheuma- tifm is complicated with feorbutic complaints, which is not feldom the cafe, the Harrowgate waters, and thofe of Moffat, are proper. They fliould both be drank and ufed as a warm bath. There are feveral of our own domeftic plants which may be ufed with advantage in the rheumatifm. One of the beft is the white muftard. A table- fpoonful of the feed of this plant may be taken twice * See Appendix, Warm Plafler. or OF THE RHEUMATISM. 3go Or thrice a-day, in a glafs of water or fmall wine. .The water trefoil is likewife of great ufe in this com- plaint. It may be infufed in wine or ^le, or drank in form of tea. The ground-ivy, camomile, and feve- ral other bitters, are alfo beneficial, and may be ufed in the fame manner. No benefit however is to be expected from thefe unlefs they be taken for a confiderable time. Excellent medicines are often defpifed in this difeafe, becaufe they do not perform an immediate cure; whereas nothing would be more certain than their effect, were they duly perfifted in. Want of perfeverance in the ufe of medicines is one reafon why chronic difeafes are fo feldom cured. Cold bathing, efpecially in fait water, often cures the rheumatifm. We would alfo recommend riding on horfeback, and wearing flannel next the fkin. Iffues are likewife very proper, efpecially in chronic cafes. If the pain affects the fhoulders, an iffue may be made in the arm; but if it affects the loins, it fhould be put into the leg or thigh. Perfons afflicted with the fcurvy are very fubject to rheumatic complaints. The beft medicines in this cafe are bitters and mild purgatives. Thefe may either be taken feparately or together, as the patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb in powder, may be infufed in a bottle of wine; and one, two, or three wine glaffes of it taken daily, as fhall be found neceffary, for keeping the body gently open. In cafes where the bark itfelf proves fufficiently purgative, the rhubarb may be omitted. Such as are fubject to frequent attacks of the rheu- matifm ought to make choice of a dry, warm fitua- tion, to avoid the night-air, wet clothes, and wet feet, as much as poffible. Their clothing fliould be warm, and they fhould wear flannel next their fkin, and make frequent ufe of the flefh brufh. Chronic 400 OF THE SCURVY. Chronic rheumatic affections often appear in the form of fpafms of different parts, with violent pain. This kind is moft certainly relieved by the balfani of Peru, balfiim capivi, or fpirits of turpentine, from thirty to fixty drops for a dofe, twice or three times a-day. CHAP. XL. Of the Scurvy. X HIS difeafe prevails chiefly in cold northern countries, efpecially in low damp fituations, near large marflies, or great quantities of ftagnating water. Sedentary people of a dull melancholy dif- pofition, are moft fubject to it. It proves often fatal to failors on long voyages, particularly in fhips that are not properly ventilated, have many people on board, or where cleanlinefs is neglected. It is not neceffary to mention the different fpecies into which this difeafe has been divided, as they differ from one another chiefly in degree. What is called the land fcurvy, however, is feldom attended with thofe highly putrid fymptoms which appear in patients who have been long at fea, and which, we prefume, are rather owing to confined air, want of exercife, and the unwholefome food eaten by failors on long voyages, than to any fpecific difference in the difeafe. CAUSES.—The fcurvy is occafioned by cold moift air ; by the long ufe of falted or fmoke-dried provifions, or any kind of food that is hard of di- i geftion, OF THE SCURVY. 4ox geftion, and affords little nourifhment. It may alfo proceed from the fuppreffion of cuftomary evacua- tions ; as the menfes, the hasmorrhoidal flux, Sec. It is fometimes owing to an hereditary taint, in which cafe a very fmall caufe will excite the latent diforder. Grief, fear, and other depreffing paffions, have a great tendency both to excite and aggravate this difeafe. The fame obfervation holds, with re- gu-d to neglect of cleanlinefs ; bad clothing; the want of proper exerc'fe; confined air; unwhole- fome food; or any difeafe which greatly weakens the body, or vitiates the humors. SYMPTOMS.—This difeafe may be known by unufual wearinefs, heavinefs, and difficulty of breath- ing, efpecially after motion ; rottennefs of the gums, which are apt to bleed on the flighteft touch ; a (linking breath; frequent bleeding at the nofe; crackling of the joints; difficulty of walking ; fome- times a fwelling and fometimes a falling away of the legs, on which there are livid, yellow, or violet- coloured fpots ; the face is generally of a pale or leaden colour. A' the difeafe advances, other fymp- toms come on ; as rottennefs of the teeth, hemor- rhages, or difcharges of blood from different parts of the body, foul obftinate ulcers, pains in various parts, efpecially about the breaft, dry fealy erup- tions all over the body, Sec. At laft a wafting or hectic fever comes on, and the miferable patient is often carried off by a dyfentery, a diarrhoea, a dropfy, the palfy, fainting fits, or a mortification of fome of the bowels. CURE.—We know no way of curing this difeafe, but by purfuing a plan directly oppofite to that which brings it on. It proceeds from a vitiated State of the humors occafioned by errors in diet, air, or exercife; and this cannot be removed, but by a proper atten- tion to thefe important articles. D d If 402 OF THE SCURVY. If the patient has been obliged to breathe a cold, damp, or confined air, he fliould be removed, as foon as poffible, to a dry, open, and moderately warm one. If there is reafon to believe that the difeafe proceeds from a fedentary life, or depreffing paffions, as grief, fear, &c. the patient muft take daily as much exercife in the open air as he can bear, and his mind fhould be diverted by cheerful company and other amufements. Nothing has a greater tendency, either to prevent or remove this difeafe, than conftant cheerfulnefs and good humor. But this, alas ! is feldom the lot of perfons afflicted with the fcurvy ; they are generally furly, peevifti, and morofe. When the fcurvy has been brought on by a long nfe of falted provifions, the proper medicine is a diet confifting chiefly of frefli vegetables ; as oranges, apples, lemons, limes, tamarinds, water-creffes, fcur- vy-grafs, brook-lime, &c. The ufe of thefe, with milk, pot-herbs, new bread, and frefh beer or cyder, will feldom fail to remove a fcurvy of this kind, if taken before it be too far advanced ; but to have this effect, they muft be perfifted in for a confider- able time. When frefh vegetables cannot be ob- tained, pickled or preferved ones may be ufed ; and where thefe are wanting, recourfe muft be had to the chymical acids. All the patient's food and drink fhould, in this cafe, be fliarpened with cream of tar- tar, elixir of vitriol, vinegar, or the fpirit of fea-falt. Thefe things, however, will more certainly pre- vent, than cure the fcurvy; for which reafon, fea- faring people, efpecially on long voyages, ought to lay in plenty of them. Cabbages, onions, goofe- berries, and many other vegetables, may be kept a long time by pickling, preferving, Sec. and when thefe fail, the chymical acids, recommended above, which will keep tor any length of time, mav be ufed. We OF THE SCURVY. 403 We have reafon to believe, if Ships were well venti- lated, had good flore of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanlinefs and warmth, that failors would be the moft healthy people in the world, and would feldom fuffer eh her from the fcurvy or putrid fevers, which are fo fatal to that ufeful fet of men ; but it is too much the temper of fuch people to defpife all precaution ; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow. It muft, indeed, be owned, that many of them have it not in their power to make the provifion we are fpeaking of; but, in this cafe, it is the duty of their employers to do it for them ; and no man ought to engage in a long voyage, without having thefe arti- cles fecured. I have often feen very extraordinary effects in the land-fcurvy from a milk diet. This preparation of Nature, is a mixture of animal and vegetable proper- ties, which, of all others, is the moft fit for reftoring a decayed conftitution. But, people defpife this wholefome and nourifhing food, becaufe it is cheap, and devour with greedinefs, flefli, and fermented liquors, while milk is only deemed fit for their hogs. The moft proper drink in the fcurvy is whey, or butter-milk. When thefe cannot be had, found cyder, perry, or fpruce-beer, may be ufed. Wort has likewife been found to be a proper drink in the fcurvy, and may be ufed at fea, as malt will keep during the longeft voyage. A decoction of the tops of the fpruce fir, is likewife proper. It may be drank in the quantity of a pint, twice a-day. Tar-water may be ufed for the lame purpofe, or decoctions of any of the mild mucilaginous vegetables ; as farfapa- rilla, marfh-mallow roots, Sec. Infufions of the bitter plants, as ground-ivy, the leffer centaury, marfh-trefoil, &c. are likewife beneficial. I have D d 2 feen 4o4 OF THE SCURVY. feen the peafants, in fome parts of Britain, exprefs the juice of the laft-mentioned plant, and drink if with good effect in thofe foul feorbutic eruptions with which they are often troubled in the fpring feafon. Harrowgate-water is certainly an excellent rnedi- cine in the land-feurvy. 1 have often feen patients who had been reduced to the moft deplorable con* dition by this difeafe, greatly relieved by drinking the fulphur-water, and bathing in it. The chaly- beate-water may alfo be ufed with advantage, efpe- cially with a view to brace the ftomach after drinking the fulphur-water, which, though it fharpens the appetite, never fails to weaken the powers of di- geftion. A flight degree of fcurvy may be carried off, by frequently fucking a little of t,he juice of a bitter prauge, or a lemon. When the difeafe affects the gums only, this practice, if continued for fome time, vyill generally carry it off. We would, however, re- commend the bitter orange as greatly preferable to lemon; it feems to he as good a medicine, and is not near fo hurtful to the ftomach. Perhaps our own forrel may be little inferior to either of them. All kinds of fallad are good in the fcurvy, and ought to be eaten very plentifully, as fpinnage, let- tuce, parfley, celery, endive, radifli, dandelion, Sec. It is amazing to fee how foon frefh vegetables in the Cpring, cure the brute animals of any fcab or foul- nefs which is upon thqir fkins. It is reafonable to fuppofe, that their effects would be as great upon the human fpecies, were they ufed in proper quan- tity, for a fufficient length of time. I have fometimes feen good effects in feorbutic complaints of very long Standing, from the ufe of a decoction of the roots of water dock. It is ufually aaade by boiling a pound of the frefli root in fix pints OF THE SCROPHULA, &V. 4$5 pints of water, 'till about one-third of it be confumed. The dofe is from half a pint to a. whole pint of the decoction evfry day. But in all the cafes where I have feen it prove beneficial, it Was" made riiuch ftronger, and drank in larger quantities. The fafeft way> however, is for the patient to begin With fmall dofes* and increafe them both in Strength and quan- tity as he finds his ftomach will bear it. It muft be ufed for a confiderable time. I have known feme take it for many months, and have been told ot others who had ufed it for feveral years, before they were fcnfiblc of any benefit, but who neverthelefs were cured by it at length. The leproly, which was fo common in this coun- try long ago, feems to have been near a-kin to the fcurvy. Perhaps its appearing fo feldom now, may be owing to the inhabitants of Britain eating more vege* table food than formerly, living more upon tea and other diluting diet, ufing lefs falted meat, being more cleanly, better lodged and clothed, &c.—For tho cure of this difeafe we would recommend the fame courfe of diet and medicine as in the fcurvy. OF THE SCROPHULA, OR KING's EVIL. This difeafe chiefly affects the glands, efpecially thofe of the neck. Children and young perfons of a fedentary life are very fubject to it. It is one of thofe difeafes which may be removed by proper regi- men, but too feldom yields to medicine. The inhabi- tants of cold, damp, marfhy countries are moll liable co the fcrophula. CAUSES.—This difeafe may proceed from an hereditary taint. Children who have the misfortune to be born of fickly parents, whofe conftitutions have been greatly injured by the pox, or other chronic djfeafes, are apt to be affected with the fcrophula. P d 3 k 406 OF THE SCROPHULA, It may likewife proceed from fuch difeafes as weaken the habit or vitiate the humors, as the fmall-pox, meafles, &c. External injuries, as blows, bruifes, and the like, fometimes produce ferophulous ulcers; but we have reafon to believe, when this happens, that there has been a predifpofition in the habit to this difeafe. In fhort, whatever tends to vitiate the humors or relax the folids, paves the way to the fcrophula ; as the want of proper exercife, too much heat or cold, confined air, unwholef me food, bad water, the long ufe of poor, weak, watery aliments, the neglect of cleanlinefs. Sec, Nothing tends more to induce this difeafe in children, than allowing them to continue long wet*. SYMPTOMS.—At firft fmall knots appear under the chin or behind the ears, which gradually increafe in number and fize, till they form one large hard tumor. This often continues for a long time without breaking, and when it does break, it only difcharges a thin fanies, or watery humor. Other parts of the body are likewife liable to its attack, as the arm-pits, groins, feet, hands, eyes, breafts, Sec. Nor are the internal parts exempt from it. it often affects the lungs, liver, or fpleen ; and I have frequently feen the qlands of the myfentery greatly enlarged by it. Ttnfe obftinate ulcers which break out upon the feet and hands with fwelling and little or no rednefs, are of the ferophulous kind. They feldom difcharge good matter, and are exceedingly difficult to cure. The white fwellings of the joints feem likewife to be of this kind. They are with difficulty brought to a fuppuration, and when opened they only difcharge a thin ichor. There is not a more general fymptom * The fcrophula, as well as the rickets, is found to prevail in large manufacturing towns, where people live grofs, and lead fedentary lives. of OR KING'S EVIL. 4o7 of the fcrophula, than a fwelling of the upper lip and nofe, and, often, adilated pupil. REGIMEN.—As this difeafe proceeds, in a great meafure, from relaxation, the diet ought to be gene- rous and nourishing, but, at the fame time, light and of eafy digeftion ; as well fermented bread, made of found grain, the flefli and broth of young animals, with now and then a glafs of generous wine, or good ale. The air ought to be open, dry, and not too cold, and the patient fhould take as much exercife as he can bear. This is of the utmoft importance. Children who have fufficient exercife are feldom troubled with the fcrophula. MEDICINE.—The vulgar are remarkably cre- dulous with regard to the cure of the fcrophula; many of them believing in the virtue of the royal touch, that of the feventh fon, &c. The truth is, where reafon or medicines fail, fuperftition always comes in their place. Hence it is, that in difeafes which are the moft difficult to understand, we gene^ rally hear of the greateft number of miraculous cures being performed. Here, however, the deception is eafily accounted for. The fcrophula, at a certain period of life, is often cured of itfelf; 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 phyfician. In the fame way the infignificant noftrums of quacks and old women often gain applaufe when they deferve none. There is nothing more pernicious than the cuftom of plying children in the fcrophula with Strong pur- gative medicines. People imagine it proceeds from humors which muft be purged off, without confi- dering that thefe purgatives increafe the debility and aggravate the difeafe. It has, indeed, been found., that keeping the body gently open for fome time, efpecially with fea-water, has a good effect ; but D d 4 this 4o8 OF THE SCROPHULA, this fhould only be given in grofs habits, and in fuch quantity as to procure one, or at moft two ftools every day. Bathing in the fait water has likewife a very good effect, efpecially in the warm feafon. I have often known a courfe of bathing in fait water, and drink- ing it in fuch quantities as to keep the body gently open, cure a fer^phula, after many other medicines had been tried in vain. When fait-water cannot be obtained, the patient may be bathed in frefh water, and his body kept open by fmall quantities of fait and water, or fome other mild purgative. Next to cold bathing, and drinking the falt-water, we would recommend the Peruvian bark. The cold bath may be ufed in fummer, and the bark in winter. To an adult half a drachm of the bark in powder may be given in a glafs of red wine four or five times a-day. Children and fuch as cannot take it in f jbftance, may ufe the decoction made in the follow- ing manner: Boil an ounce of Peruvian bark and a drachm of Winter's bark, both grofsly powdered, in a quart of water to a pint.: towards the end half an ounce of fliced liquorice-root, and a handful of raifins may be added, which .will both render the decoction iefs difagreeable, and make it take up more of the bark. The liquor muft be ftrained, and two, three, or four table-fpoonfuls, according to the age of the patient, given three times a-day. The Moffat and ftarrowgate waters, efpecially the latter, are likewife very proper medicines in the fcrophula. They ought not, however, to be drank in large quantities, but fhould be taken fo as to keep the body gently open, and muft be ufed for a con- fiderable time. The hemlock may fometimes be ufed with advan- tage in the fcrophula. Some lay it down as a gene- ral OR KING'S EVIL. 4op ral rule, that the fea-water is moft proper before there are any fuppuration or fymptoms of tabes; the Peruvian bark, when there are running fores and a degree of hectic fever; and the hemlock in old inveterate cafes, approaching to the fchirrous or cancerous ftate. Either the extract or the frefh juice of this plant may be ufed. The dofe muft be fmall at firft,. and increafed gradually as far as the ftomach is able to bear it*. External applications are of little ufe. Before the tumour breaks, nothing ought to be applied to it, nnlefs a piece of flannel, or fomething to keep it warm. After it breaks, the fore may be dreffed with fome digeftive ointment. What 1 have always found to anfwer beft, was the yellow bafilicon mixed with about a fixth or eighth part of its weight of red precipitate of mercury. The fore may be dreffed with this twice a-day; and if it be very fungous, and does not digeft well, a larger proportion of the pre- cipitate may be added. Medicines which mitigate this difeafe, though they do not cure it, are not to be defpifed. If the patient can be kept aliveby 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 fo apt to communicate to their offspring as the fcrophula, for which reafon people ought to beware of marrying into families affected with this difeafe. * We often find fcrophula, efpecially when it firft appears, attended with a confiderable degree of fever: Here repeated fmall bleedings, gentle purging, and low diet, will do moft good; after tins fmall dofes of corrofive fublimate and bark, with wort for drink, will be found of the greateft fervice. For 4io OF THE ITCH. For the means of preventing the fcrophula, we muft refer the reader to the obfervations on nurfing, at the beginning of the book. OF THE ITCH. Though this difeafe is commonly cotrimunicated by infection, yet it feldom prevails where due regard is paid to cleanlinefs, frefh air, and wholefome diet. It generally appears in form of fmall watery puftules, firft about the wrifts or between the fingers; after- wards it affects the arms, legs, thighs, &c. Thefe puftules are attended with an intolerable itching, efpecially when the patient is warm a-bed, or fits by the fire. Sometimes indeed the ikin is covered with large blotches or feabs, and at other times with a white feurf, or fealy eruption. This laft is called the dry itch, and is the moft difficult to cure. The itch is feldom a dangerous difeafe, unlefs when it is rendered fo by neglect, or improper treat- ment. If it be ftiffered to continue too long, it may vitiate the whole mafs of humors; and, if it be fud- denly drove in, without proper evacuations, it may occafion fevers, inflammations of the vifcera, or other internal diforders. The beft medicine yet known for the itch is ful- phur, which ought to be ufed both externally and internally. The parts moft affected may be rubbed with an ointment made of the flower of fulphur, two ounces; crude fal ammoniac, finely powdered, two drachms; hog's lard, or butter, four ounces. If a fcruple or half a drachm of the effence of lemon be added it will entirely take away the difagreeable fmell. About the bulk of a nutmeg of this may be rubbed upon the extremities every night at bed time. It is fel- dom neceffary to rub the whole body; but when it is, it ought not to be done all at once, but by turns, as OF THE ITCH. 4u it is dangerous to ftop too many pores at the fame time. Before the patient begins to ufe the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewife be proper, during the ufe of it, to take every night and morning as much of the flower of brimftone and cream of tanar, in a little molaffes or new milk, as will keep the body gently open. He fliould beware of catching cold, Should wear more clothes than ufual, and take every thing warm. It will alfo be proper daily to wafh off the ointment with warm water and a litrle Caftile foap, fome hours before anointing afrefh. The fame clothes, the linen excepted, ought to be w m all.the time of ufing the ointment; and fuch clothes as have been worn while the patient was under the difeafe, are not to be ufed again, unlefs they have been fumigated with brimftone, aud tho- roughly cleaned, otherwife they will communicate the infection anew*. I never knew brimftone, when ufed as directed above, fail to cure the itch ; and I have reafon to believe, that, if duly perfifted in, it never will fail; but if it be only ufed once or twice, and cleanlinefs neglected, it is no wonder if the diforder returns. The quantity of ointment mentioned above will generally be fufficient for the cure of one perfon; but, if any fymptoms of the difeafe fhould appear again, the medicine may be repeated. It is both i * Sir John Pringle obferves, that though this difeafe may feem trifling, there is no one in the army that is more trouble- fome to cure, as the infection often lurks in clothes, &c. and breaks out a fecond, or even a third time. The fame inconve- niency occurs in private families, unlefs particular regard is paid to the changing or cleaning of their clothes, which laft is by no means an eafy operation. more 41 z OF THE ITCH. more fafe and efficacious when perfifted in for a con- fiderable time, than when a large quantity is applied at once. As moft people diflike the fmell of fal. phur, they may ufe in its place the powder of white hellebore root made up into an ointment in the fame manner, which will feldom fail to cure ! the itch. People ought to be extremely cautious left they take other eruptions for the itch; as the ftoppage of '■ thefe may be attended with fatal confequences. Many of the eruptive diforders to which children. are liable, have a near refemblance to this difeafe; ' and I have often known infants killed by being rub- \ bed with greafy ointments that made thefe eruptions Strike fuddenly in, which Nature had thrown out to preferve the patient's life, *or prevent fome other malady. Much mifchief is likewife done by the ufe of mer- cury in this difeafe. Some perfons are fo fool-hardy j as to wafh the parts affected with a ftrong folution of the corrofive fublimate. Others ufe the mercu- rial ointment, without taking the leaft care either to avoid cold, keep the body open, or obferve a pro- per regimen. The confequences of fuch condoct may be eafily gueffed. I have known even the mer- curial girdles produce bad effects, and would advife every perfon, as he values his health, to beware how he ufes them. Mercury ought never to be ufed as a medicine without the greateft care. Ignorant people look upon fhefe girdles as a kind of charm, without confidering that the mercury enters the body. It is not to be told what mifchief is done by ufing mercurial ointment for curing the itch and killing vermin; yet it is unneceffary for either: the former may be always more certainly cured by fulphur, and the OF THE ASTHMA. 413 the latter will never be found where due regard is (paid to cleanlinefs*. Thofe who would avoid this deteftable difeafe ought to beware of infected perfons, to ufe whole- fome food, and to ftudy univerfal cleanlinefsf. CHAP. XLI. Of the AJihma. \ 1 HE afthma is a difeafe of the lungs, which rarely admits of «. perfect cure. Perfons in i the decline of life are moft liable to ir. It is diftin- J. guifhed into the moift and dry, or the humoral and nervous. The former is attended with expectoration or fpitting; but in the latter the patient feldom fpits, unlefs fometimes a little tough phlegm by the mere force of coughing. * If Mercury is ufed, the ungucntum citrinurn is the moft powerful form of it. The moft inveterate itches are cured by an ointment made by mixing from fifty to one hundred drops of fpirits of vitriol with an ounce of hog's lard. f The itch is now, by cleanlinefs, banifhed from every .genteel family in Britain. It ftill, however,prevails among the poorer - fort of peafants in Scotland, and among the manufacturers in England. Thefe are not only fufficient ^fckeep the feeds of the difeafe alive, but to fpread the infection among others. It were to be wifhed that fome effectual method could be devifed for extirpating it altogether. Several country clergymen have told me, that by getting fuch as were infected cured, and ftrongly recommending an attention to cleanlinefs, they have banifhed the itjch entirely out of their parifhes. Why .might $©t others do the fame? CAUSES- 4M OF THE ASTHMA. CAUSES.—The afthma is fometimes hereditary. It may likewife proceed from a bad formation of the breaft; the fumes of metals or minerals taken into theluugs; violent exercife, efpecially running; the obstruction of cuftomary evacuations, as the menfes, j haemorrhoids, Sec. the fudden retroceffion of the a gout, and Striking in of eruptions, as the fmall pox, 1 meafles, Sec. violent paffions of the mind, as fud.len 1 fear or fnrprife. In a word, the difeafe may proceed ■ from any caufe that either impedes the circulation of the blood through the lungs, or prevents their } being duly expanded by the air. < SYMPTOMS.—An afthma is known by a quick j laborious breathing, which is generally performed with a kind of wheezing noife. Sometimes the diffi- [ culty of breathing is fo great, that the patient is ob- liged to keep in an erect pofture, otherwife he is in danger of being fuffocated. A fit or paroxyfm of 'i' the afthma generally happens after a perfon has been expofed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or continued ' long in a damp place, or has taken food which the ftomach could not digeft, as paftries, toafted cheefe, or the like. * The paroxyfm is commonly uShered in with lilt- leffnefs, want of fleep, hoarfenefs, a cough, belch- ing of wind, a fenfe of heavinefs about the breaft, and difficulty of breathing. To thefe fucceed heat, fever, pain of the head, ficknefs and naufea, great oppreffion of the breaft, palpitation of the heart, a weak, and fometfSes intermitting pulfe, an involun- tary flow of tears, bilious vomitings, &c. All the fymptoms grow worfe towards night; the patient is eafier when up than in bed, and is very defirous of cool air. REGIMEN.----The food ought to be light, and of eafy digeftion. Boiled meats are to be preferred to OF THE ASTHMA. 415 '. to roafted, and the flefli of animals come to their full growth to that of old. Ail windy food, and what- 1 ever is apt to fwell in the ftomach, is to be avoided. I ■ Light puddings, broths, and ripe fruits baked, boiled, or roafted, are proper. Strong liquors of all kinds, | efpecially malt-liquors, are hurtful. The patient ;*. fhould eat a very light fupper, or rather none at all, and fliould never fuffer himfelf to be long coftive. His clothing fhould be warm, efpecially in the win- [ ter-feafon. As all diforders of the breaft are much j' relieved by keeping the feet warm, and promoting 4 the perfpiration, a flannel fhirt or waiftcoat, and thick fhoes will be of finoular fervice. But nothing is of fo great importance in the afth- ma as pure and moderately warm air. Afthmatic | people can feldom bear either the clofe heavy air of \ a large town, or the fharp, keen atmofphere of a ; bleak hilly country; a medium therefore between thefe is to be chofen. The air near a large to vn is often better than at a diftance, provided the patient be $ removed fo far as not be affected by the fmoke. Some afthmatic patients indeed breathe eafier in town than in the country; but this is feldom the cafe, efpecially in towns where much coal is burnt. | Afthmatic perfons who are obliged to be in town all day, ought at leaft to fleep out of it. Even this will ; often prove of great fervice. Thofe who can afford it ought to travel into a warmer climate. Many afthmatic perfons who cannot live in Britain, enjoy very good health in the fouth of France, Portugal, Spain, or Italy. J± Exercife is likewife of very great importance in the afthma, as it promotes the digeftion, preparation pf the blood, &c. The blood of afthmatic perfons is feldom duly prepared, owing to the proper action of the lungs being impeded. For this reafon fuch people ought daily to take as much exercife, either on Ai6 OF THE ASTHMA. on foot, horfeback, or in a carriage, as they can bear. MEDICINE.-----Almoft all that can be done by medicine in this difeafe, is to relieve the patient when feized with a violent fit. This indeed requires the greateft expedition, as the difeafe often proves fuddenly fatal. In the paroxyfm or fit, the body is generally bound; a purging clyfter, with a folution of afafcetida, ought therefore to be adminiftered, and if there be occafion, it may be repeated two or three times. The patient's feet and legs ought to be immerfed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unlefs ' weaknefs or old age fliould forbid it, is highly pro- ,j per. If there be a violent fpafm about the breaft or ftomach, warm fomentations, or bladders filled with , warm milk and water, may be applied to the part affected, and warm cataplafms to the foles of the feet. The patient muft drink freely of diluting j liquors, and may take a tea-fpoonful of the tincture of caftor, in a cup of valerian-tea, twice or thrice ] a-day. Sometimes a vomit has a very gocd effect, and fnatches the patient, as it were, from the jaws | of death. This however will be more fafe after other j evacuations have been premifed. A very ftrong in- fufion of roafted coffee is faid to give eafe in an afthmatic paroxyfm. . In the moift afthma, fuch things as promote expec- < toration or fpitting ought to be ufed; as the fyrup ■; of fquills, gum ammoniac, and fuch like. A com- j mon fpoonful o^ihe fyrup, or oxymel of fquills, J mixed with an equal quautity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of afafcetida and gum-ammoniac, at bed-time*. * After copious evacuations, large dofes of aether have been , found very efficacious in removing a fit of the. or fmall beer. Tea and coffee are improper. If honey agrees with the patient, it may be eaten freely, or his clrink may be fweetened wkh it. Infufions of balm-leaves, penny-royal, the roots of wild valerian, or the flowers of the lime-tree, may be drank freely, either by themfelves, or fweetened with honey, as the patient fhall chufe. The patient ought to take as much exercife in the open air as he can bear. This is a very important remedy. It is, indeed, more fo than any other that has ever been thought of. It helps to remove ob- ftructions, promote the perfpiration, and all other fecretions. Every kind of madnefs is attended with a diminished perfpiration ; all means ought therefore to be ufed to promote that neceffary and falutary difcharge. Nothing can have a more direct tendency to increafe the difeafe than confining the patient to a clofe apartment. Were he forced to ride or walk a certain number of miles every day, it would tend greatly to alleviate his diforder ; but it would have ftill a better effect, if he were obliged to labour a piece of ground. By digging, hoeing, planting, fowing, Sec. both the body and mind would be exercifed. A long journey, or a voyage, efpecially 436 OF MELANCHOLY. towards a warmer climate, with agreeable compa- nions, has often very happy effects. A plan of this kind, with a ftrict attention to diet, is a much more rational method of cure, than confining the patient within doors and plying him with medicines. MEDICINE.—In the cure of this difeafe, parti- cular attention muft be paid to the mind. When the patient is in a low ftate, his mind ought to be foothed and diverted with variety of amufements, as entertaining ftories, paltimes, mufic, &c. This feems to have been the method of curing melancholy among the Jews, as wc learn from the flory of king Saul ; and, indeed, it is a very rational one. Nothing can remove difeafes of the mind fo effectually as applica- tions to the mind itfelf, the moft efficacious of which is mufic. The patient's company ought, likewife, to confift of fuch perfons as are agreeable him. People in this ftate are apt to conceive unaccount- able averfions againft particular perfons; and the very fight of fuch perfons is fufficient to diffract their minds, and throw them into the utmoft perturbation. When the patient's ftrength is high, evacuations are neceffary. In this cafe, he muft be bled, and have his body kept open by purging medicines, as manna, rhubarb, cream of tartar, or the foluble tar- tar. I have feen the laft have very happy effects. It may be taken in the dofe of half an ounce, diffolved in water-gruel, every day, for fundry weeks, or even for months, if neceffary. More or lefs may be given according as it operates. Vomits have likewife a good effect; but they muft be pretty ftrong, other- wife they will not operate. Whatever increafes the evacuation of urine or promotes perfpiration, has a tendency to remove this difeafe. Both thefe fecretions may be promoted by the ufe of nitre and vinegar. Half a drachm of pu- rified nitre may be given three or four times a-day, OF MELANCHOLY. 43 7 in any manner that is moft agreeable to the patient; and an ounce and a half of diftilled vinegar may be daily mixed with his drink. Dr. Locker feems to think vinegar the beft medicine that can be given in this difeafe. Camphire and mufk have likewife been ufed in this cafe with advantage. Fifteen or twenty grains of camphire may be rubbed in a mortar with half a drachm of nitre, and taken twice a-day, or oftener, if the ftomach will bear it. If it will not fit upon the ftomach in this form, it may be made into pills with gum afafoetida and Ruffian caftor, and taken in the quantity above directed. If mufk is to be adminif- tered, a fcruple or twenty-five grains of it may be made into a bolus with a little honey or common fyrup, and taken twice or thrice a-day. We do not mean, that all thefe medicines fhould be adminif- tered at once ; but which ever of them is given, muft be duly perfifted in, and where one fajls another may be tried. As it is very difficult to induce patients in this difeafe to take medicines, we fhall mention a few outward applications, which fometimes do good; the principal of thefe are iffues, fetons, and warm bathing. Iffues may be made in any part of the body, but they generally have the beft effect near the fpine. The difcharge from thefe may be greatly promoted by dreffing them with the mild bliftering ointment, and keeping what are commonly called the orrice peafe in them. The moft proper place for a feton is between the fhoulder-blades; and it ought 10 be placed upwards and downwards, or in the direction of the fpine *. * There are two cafes of melancholy in which the fymp- toms are very diftreffing, and in which, however, we may proniife our patients a recovery, from time, exercife, and change of air and objects. I mean thofe cafes which occur after fevers, F f 3 and [ 438 ] OF THE PALSY. The palfy is a lofs or diminution of fenfe or mo- tion, or of both, in one or more parts of the body. Of all the affections called nervous, this is the moSt fuddenly fatal. It is more- or left dangerous ac- cording to the importance of the part affected. A palfy of the heart, lungs, or any part neceffary to life, is generally mortal. When it affects the ftomach, the inteftines, or the bladder, it is highly dangerous. If the face be affected, the cafe is bad, as ir Shews that the difeafe proceeds from the brain. When the part affected feels cold, is infenfible, or waftes away, or when the judgment or memory begin to fail, there is leaft hope of cure. CAUSES.—The immediate caufe of the palfy is, any thing that prevents the regular exertion of the nervous power, upon any particular mufcle or part of the body. The occafional and predifpofmg caufes are various, as drunkennefs ; wounds of the brain, or fpinal marrow ; preffure upon the brain or nerves; very cold or damp air ; the fuppreffion of cuftomary evacuations ; fudden fear ; want of exercife ; or what- ever greatly relaxes the fyftem, as drinkiug much tea*, or coffee, Sec. The palfy may likewife pro- and to women after lying in. In thefe, it is the duty of the phyfician conftantly to endeavour to infpire his patients with hope, as there are few or no cafes of the kind, which do not terminate favourably. * Many people imagine, that tea has no tendency to hurt the nerves, and that drinking the fame quantity of warm wa- ter wculd be equally pernicious, This, however, feems to be n. miftake. Many perfons drink three or four cups of warm milk and water daily, without feeling any bad confequences; yet the fame quantity of tea will make their hands fhake for twenty-four hours. That tea affects the nerves, is likewife evident from its preventing fleep, occafioning giddinefs, dim- nefs of the fight, ficknefs, &c. ceed OF THE PALSY. 43^. ceed from wounds of the nerves themfelves, from the poifonous fumes of metals or minerals, as mer-j cury, lead, arfenic. In young perfons of a full habit the palfy muft be treated in the fame manner as the fanguine apoplexy. The patient muft be bled, bliitered, and have his body opened by fharp clyfters or purgative medicines. But, in old age, or when the difeafe proceeds from relaxation, or debility, which is generally the cafe, a quite contrary courfe mud be purfued*. The diet muft De warm and invigorating, feafoned with fpicy and aromatic vegetables, as muftard, horfe-radifli, &c. The drink may be generous wine or muftard- whey. Friction with the flefli-brufh, or a warm hand, is extremely proper, efpecially on the parts affe&cd. Bliftering-plafters may likewife be applied to the affected parts with advantage, and particularly to the head in cafes of coma or delirium. When this cannot be done, they may be rubbed with the volatile liniment, or the nerve ointment of the Edin- burgh difpenfatory. One of the beft external ap- plications is electricity. The fhocks, or rather vibra- tions, fliould be received on the part affected ; and they ought daily to be repeated for feveral weeks. Cephalic fnuff, or any thing that makes the pati- ent ihecze, is likewife of ufe. Some pretend to have found great benefit from rubbing the parts affected with nettles ; but this does not feem to be any way preferable to bliftering. If the tongue is affected, the patient may gargle his mouth frequently with brandy and muftard ; or he may hold a bit of fugar in his mouth wet with the compound fpirits of la- vender. The wild valerian root is a very proper * It often happens, however, tha* the fame tr3atment di- rected for the young is neceffary in old perfons, at leaft in a degree, if the pulfe is vigorous, and there are fymptoms of ful- nefjs. . F f 4 medicine 440 OF THE EPILEPSY, medicine in this cafe. It may either be taken in an infufion with fage-leaves, or half a drachm of it in powder may be given in a glafs of wine three times a-day. If the patient cannot ufe the valerian, he may take offal volatile oleofutn, compound fpirits of lavender, and tincture of caftor, each half an ounce ; mix thefe together, and take forty or fifty drops in a glafs of wine three or four times a-day. A table- fpoonful of muftard-feed taken daily about eleven o'clock, is a very good medicine. The patient ought likewife to chew cinnamon bark, ginger, or other warm fpiceries. Exercife is of the utmoft importance in the palfy; but the patient muft beware of cold, damp, and moift air. He ought to wear flannel next his fkin ; and, if poffible, fhould remove into a warmer climate. OF THE EPILEPSY, OR FALLING SICKNESS. The epilepfy is a fudden deprivation of all the fenfes, wherein the patient falls fuddenly down, and is affected with violent convulfive motions. Chil- dren, efpecially thofe who are delicately brought up, are moft fubject to it. It more frequently attacks men than women, and is often very difficult to cure. When the epilepfy attacks children, there is reafon to hope it may go off about the time of puberty. When it attacks any perfon after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expected. If the fit continues only for a fhort fpace, and returns feldom, there is reafon to hope ; but if it continues long, and returns frequently, the profpect is bad. It is a very unfa- vourable fymptom when the patient is feized with the fits in his fleep. CAUSES.—The epilepfy is fometimes hereditary. It may likewife proceed from blows, bruifes, or wounds OR FALLING SICKNESS. 441 wounds on the head; a collection of water, blood, or ferous humors in the brain ; a polypus; tumors or concretions within the fkull; exceffive drinking ; intenfe ftudy ; much bodily fatigue ; excefs of ve- nery ; worms; teething; fuppreffion of cuftomary evacuations ; too great emptinefs or repletion ; vio- lent paffions or affections of the mind, as fear, joy, &c.; hyfteric affections ; contagion received into the body, as the infection of the fmall-pox, meafles, &c. SYMPTOMS.—An epileptic fit is generally pre- ceded by unufual wearinefs ; pain of the head ; dui- nefs ; giddinefs ; noife in the ears ; dimnefs of fight; palpitation of the heart; difturbed fleep; difficult breathing ; the bowels are inflated with wind ; the urine is in great quantity, but thin ; the complexion is- pale; the extremities are cold; and the patient often feels, as it were, a ftream of cold air afcending towards his head, and it often comes on fuddenly without any previous notice. In the fit, the patient generally makes an unufual noife ; his thumbs are drawn in towards the palms of his hands ; his eyes are distorted ; he ftarts, and foams at the mouth; his extremities are bent or twilled various ways ; he often difcharges his urine and faeces involuntarily ; and is quite deftitute of all fenfe and reafon. After the fit is over, his fenfes gradually return, and he complains of a kind of ftupor, wearinefs, and pain of his head ; but has no remembrance of what happened to him during the fit. The fits are fometimes excited by violent affections of the mind, a debauch of liquor, exceffive heat, cold, or the like. This difeafe, from the difficulty of inveftigating its caufes, and its ftrange fymptoms, was formerly attributed to the wrath of the gods, or the agency of evil fpirits. In modern times it has often, by the 442 OF THE EPILEPSY, the vulgar, been imputed to witchcraft or fafcina. tion. It depends, however, as much upon natural caufes as any other malady ; and its cure may of- ten be effected by perfifting in the ufe of proper means. REGIMEN.—Epileptic patients ought, if poffi- ble, to breathe a pure and free air. Their diet fhould be light but nourishing. They ought to drink nothing ftrong, to avoid fwine's flefli, water- fowl, and likewife all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep them- felves cheerful, carefully guarding againft all vio- lent paffions, as anger, fear, exceffive joy, and the like. Exercife is likewife of great ufe; but the patient muft be careful to avoid all extremes either of heat or cold, all dangerous fituations, as Standing upon pre- cipices, riding through deep waters, and fuch like. MEDICINE.—t he intentions of cure muft vary according to the caufe of the difeafe. If the patient be of a fanguine temperament, and there be reafon to fear an obstruction in the brain, bleeding and other evacuations will be neceffary. When the dif- eafe is occafioned by the ftoppage of cuftomary eva- luations, thefe, if poffible, muft be restored ; if this cannot be done, others may be fubftituted in their place. Iffues or fetons in this cafe have often a very good effect. When there is reafon to believe that the difeafe proceeds from worms, proper medi- cines muft be ufed to kill, or carry off thefe vermin. When the difeafe proceeds from teething, the body fhould be kept open by emollient clyfters, the feet frequently bathed in warm water, and, if the fits prove obftinate, a bliftering-plaSter may be put be- tween the fhoulders. When epileptic fits precede the eruption of the fmall-pox or meafles, the method pointed out in the chapter on the fmall-pox is to be followed. When OR FALLING SICKNESS. 443 When the difeafe is hereditary, or proceeds from a wrong formation cf the.brain, a cure is not to be expected. When it is owing to a debility, or too great an irritability of the nervous fyftem, fuch me- dicines as tend to' brace and ftrengthen the nerves miy be ufed, as the Peruvian bark, and Steel. The flowers of zinc have been highly extolled for the cure of the epilepfy. Though this medicine will not be found to anfwer the expectations which have been raifed concerning it, yet in obftinate epileptic cafes it deferves a trial. The dofe is from one to three or four grains, which may be taken either in pilh or a bolus, as the patient inclines. The beft method is to begin with a fingle grain four or five times a-day, and gradually to increafe the dofe as far as the patient can bear it. I have known this medi- cine, when duly perfifted in, prove beneficial. The cuprum ammoniacum in the form of pills, two grains two or three times a-day, and the blue vitriol in the fame form, in a dofe of one fourth of a grain twice a day, are 6f great fervice in thofe cafes of epilepfy which are evidently connected with hyfteria, and it is in thefe cafes the zinc does good. Mufk has fometimes been found to fucceed in the epilepfy. Ten or twelve grains of it, with the fame quantity of factitious.cinnabar, may be made up into a bolus, and taken evry night and morning. Sometimes the epilepfy has been cured by electri- city. Change of air will often produce the moft happy effects. Many kind of convulfion-fits proceed from the fame caufes, and muft be treated in the fame manner as the epilepfy. There is one particular fpecies of convulfion-fits which commonly goes by the name of St Vitus's dance, wherein the patient is agitated with ftrange motions and gesticulations, which by the common people 444 OF THE HICCUP. people are generally believed to be the effects of wit'.':icraft. This difeafe may be cured by repeated b* jdin -- a; d purges; and afterwards ufing the me- ucires prescribed above for the epilepfy, viz. the Peruvian bark, cuprum ammoniacum, aud blue vi- ' vi. Chalybeate waters are found to be beneficial i7 this cafe. The cold bath is likewife of lingular fervice, and ought never to be neglected when the patient can bear it. Change of climate and fea voy- ages are remedies of the utmoft importance in this difeafe, OF THE HiCCUP. The hiccup is a fpafmodic or convulfive affection of the ftomach and midriff, arifing from any caufe that irritates their nervous fibres. It may proceed from excels in eating or drinking ; from a hurt of the ftomach ; poifons ; inflammations or fchirrous tumors of the ftomach, inteftines, blad- der, midriff", or the reft of the vifcera. In gangrenes, acute and malignant fevers, a hiccup is often the forerunner of death. When the. hiccup proceeds from the ufe of ali- ment that is flatulent, or hard of digeftion, a draught of generous wine, or a tea-cupfull of mint-water will generally remove it. If poifon be 'the caufe, plenty of milk and oil muft be drank, as has been formerly recommended. When it proceeds from an inflammation of the ftomach, Sec. it is very danger- ous. In this cafe the cooling regimen ought to be Strictly obferved. The patient muft be bled, and a blifter applied to the region of the Stomach. When the hiccup proceeds from a gangrene or mortification, the Peruvian bark, with other anti- fceptics, are the only medicines which have a chance to fucceed. When it is a primary difeafe, and pro- ceeds OF THE HICCUP. 445 ceeds from a foul ftomach, loaded either with a pi- tuitous or a bilious humor, a gentle vomit and purge, if the patient be able to bear them, will be of fervice. If it arifes from flatulencies, the carmi- native medicines muft be ufed. When the hiccup proves very obftinate, recourfe muft be had to the moft powerful aromatic and an- tifpafmodic medicines. The principal of thefe is mufk; fifteen or twenty grains of which may be made into a bolus, and repeated occafionally. Opi- ates are likewife of fervice. A bit of fugar dipped in compound fpirits of lavender, or the volatile aro- matic tincture, may be taken frequently. External applications are fometimes alfo beneficial ; as the ftomach plafter, or a cataplafm of the Venice treacle of the Edinburgh or London difpenfatory, applied to the region of the ftomach. I lately attended a patient who had almoft a con- ftant hiccup for above nine weeks. It was fre- quently ftopped by the ufe of mufk, opium, wine, and other cordial and antifpafmodic medicines, but always returned. Nothing, however, gave the pa- tient fo much eafe as brifk fmall-beer. By drink- ing freely of this, the hiccup was often kept off for feveral davs, which was more'than could be done by the moft powerful medicines. The pati- ent was at length feized with a vomiting of blood, which foon put an end to his life. Upon opening the body, a large fchirrous tumor was found near the pylorus or right orifice of the ftomach. t he hiccup may be removed by taking vinegar, or a few drops of the oil of vitriol taken in water. We know the hiccup may fometimes be removed by fright, and by holding the mouth full of water; fluffing the mouth with brown fugar h::s lucu-vdei in very bad cafes. CRAMP C 446 ] CRAMP OF THE STOMACH. This difeafe often feizes people fuddenly, is very dangerous, and requires immediate affiftance. It is moft incident to perfons in the decline oi life, efeeci- ally the nervous, gouty, hyft; rio, and hypochondriac. If the patient has great inclination to vomit, he ought to take fome draughts of warm water, or weak camomile-tea, to cleanfe his Stomach. After this, if he has been coftive, a laxative clyfter may be given. He ought then to take laudanum. The beft way of administering it is in a clyfter. Sixty or fe- venty drops of liquid laudanum may be given in a clyfter of warm water. This is much more certain than laudanum given by the mouth, which is often vomited, and in fome cafes, though rarely, increafes the pain and fpafms in the ftomach. If the pain and cramps return with great violence, after the effects of the anodyne clyfter are over, an- other, with an equal or a larger quantity of opium, may be given ; and every four or five hours a bolus, with ten or twelve grains of mufk, and half a drachm of the Venice treacle. In the mean time, the ftomach ought to be fo- mented with cloths dipped in warm water, or blad- ders filled with warm milk and water fliould be conftantly applied to it. I have often feen thefe pro- duce the moft happy effects. The anodyne bal- fam may alfo be rubbed on the part affected ; and an anti-hyfteric plafter worn upon it for fome time after the cramps are removed, to prevent their return. In very violent and lading pains of the ftomach, fome blood ought to be let, unlefs the weaknefs of the patient forbids it. When the pain or cramps * If, however, the ftomach, laudanum muft always be given internally, either alone, or mixed with ether, mufk, Sec. proceed OF THE NIGHT-MARE. 447 proceed from a fuppreffion of the menfes, with ple- thora, bleeding is of ufe. If they be owing to the gout, recourfe muft be had to ether, or fome of the warm cordial waters. Bliftering-plafters ought like- wife in this cafe to be applied to the ancles. I have often feen violent cramps and pains of the ftomach removed by covering it with a large plafter of Ve- nice treacle. OF THE NIGHT-MARE. In this difeafe the patient, in time of Sleep, imagines he feels an uncommon oppreffion or weight about his breaft or Stomach, which he can by no means Shake off. Me groans, and fometimes cries out, though oftner he attempts to fpeak in vain. Sometimes he imagines himfelf engaged with an enemy, and in danger of being killed, attempts to run away, but finds he cannot. Sometimes he fancies himfelf in a houfe that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dafhed to pieces fuddenly awakes him. This diforder has been fuppofed to proceed from too much blood; from a ftagnation of blood in the brain, lungs, &c. But it is rather a nervous af- fection, and arifes chiefly from indigeftion. Hence we find that perfons of weak nerves, who lead a fe- dentary life, and live full, are moft commonly af- flicted with the night-mare. Nothing tends more to produce it than heavy fuppers, efpecially when eaten late, or the patient goes to bed foon after. Wind is likewife a very frequent caufe of this dif- eafe ; for which reafon thofe who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that opprtffes the mind, ought alfo to be avoided. A3 448 OF SWOONINGS. As perfons afflicted with the night-mare generally moan, or make fome noife in the fit, they fhould be waked, or fpoken to by fuch as hear them, as the un- eafinefs generally goes off as foon as the patient is awake. Dr Whytt fays, he generally found a dram of brandy, taken at bed-time, prevent this difeafe. That however is a bad cuftom, and in time lofes its effect. We would rather have the patient depend upon the ufe of food of eafy digeftion, cheerfulnefs, exercife through the day, and a ligftt fupper taken early, than to accufto'm himfelf to drams. A glafs of peppermint-water will promote digeftion much better than brandy, and is much fafer. Perfons who are young, and full of blood, if trou- bled with the night-mare, ought to take a purge fre- quently, and ufe a fpare diet. OF SWOONINGS. People of weak nerves or delicate conftitutions are liable to fwoonings or fainting-fits. Thefe indeed are feldom dangerous when duly attended to ; but when wholly neglected, or improperly treated, they often prove hurtful, and fometimes fatal. The general caufes of fwoonings are, fudden tran- fition from cold to heat; breathing air that is de- prived of its proper fpring or elasticity; great fa- tigue ; exceffive weaknefs ; lofs of blood ; long faft- ing ; fear, grief, and other violent paffions or affec- tions of the mind. It is well known, that perfons who have been long expofed to cold, often faint or fall into a fwoon, upon coming into the houfe, efpecially if they drink hot liquor, or fit near a large fire. This might eafily be prevented by taking care not to go into a warm room immediately after having been expofed to the cold air, to approach the fire gradu- 2 ally. OF SWOONINGS, 449 ally, and not to eat or drink any thing hot, till the body has been gradually brought into a warm tem- perature. When any one, in confequence of neglecting thefe precautions, falls in:o a fwoon, he ought immediately to be removed to a cooler apartment, to have liga- tures applied abuve his kn^es and elbows, and to have his hands and face fprinkled with vinegar or cold water. He fhould likewife be mad'3 to fmell to vinegar, and fhould have a fpoonful or two of water, if he can fwallow, with about a third part of vinegar mixed with it, poured into his mouth. If rhefe fhould not remove the complaint, it will be neceffary to bleed the patient if the pulfe will bear it, and af- terwards to give him a clyfter. As air that is breathed frequently lofes its elaf- ticity or fpring, it is no wonder if perfons who refpire in it often fall into a fwoon or fainting fit. They are in this cafe deprived of the very prin- ciple of life. Hence it is that fainting firs are fo frequent in aH crowded affemblies, efpecially in hot feafons. Such fits, however, muft be confidered as a kind of temporary death ; and, to the weak and delicate, they fometimes prove fatal. They ought, therefore, with the utmoft care to be guard- ed againft. The method of doing this is obvious. Let affembly-rooms, and all other places of public refort, be large and well ventilated ; and let the weak and delicate avoid fuch places, particularly in warm feafons. A perfon who faints, in fuch a fituation, ought immediately to be carried into the open air; hia temples fhould be rubbed with ftrong vinegar or brandy, and volatile fpirits or falts held to his nofe* He fhould be laid upon his back, with his head low, arid have a little wine or fome other cor- dial, as foon as he is able to fwallow it, poured G g into 4Sa Q? 3WO0KINGS. into his mouth. If the perfon, has been fubject to hyfteric fits, caftor or afafcetida fliould be ap« plied to the nofe^ or burnt feathers, horn, or lea. ther, Sec. When faintiug fits proceed from mere weaknefs or exhauftion, which is often the cafe after great fa- tigue, long fafting, lofa of Wood, or the like, the patient muft be fupported with generous cordials, as jellies, wines, &c. Thefe, however,, muft be given at firft m very fmall quantities, and increafed gra- dually as the patient is able to bear them. He ought to be allowed to lie quite ftill and eafy upon bis back, with his head low, and fhouW haye feeih air admitted into his chamber. His food fhould con- fift of nourifhing broths, fago-gruel with wine, new milk, and other things of a ligh* and cordiali nature. Thefe things are to be given out of the fit. All that can be done in the fit is, to let him faaelj to a bot- tle of Hungary water, ean de luce, or fpijrits of harts- horn, and to rub his temples- with warm brandy, or to lay a cornprefs dipped in it to nhe pit of the ftomach. In fainting fits that proceed from feay, grief, or Other violent paffions or affections of the mind, the patient muft be very cautioufly managed. He fhould be fuffi&red to remain at reft,, and only made to fmell to fome vinegar. After he is come to himfelf, he may drink freely of warm lemonade, or balm-tea, with fome orange or lemon-peel in it, It will likewife be proper, if the fainting fits have been long and fe- vere, to cleanfe the bowels by throwing ia an emol- lient clyfter. It is common in fainting fits, from whatever caufe they proceed, to bleed the patient* This practice may be very proper in ftrong- perfons of a full habit; but in thofe who are weak and delicate, or fubject to nervous diforders^ it is dangerous. The proper OF FLATULENCIES, OR WIND. 4 the lachrymal duct, or natural paffage of the tears, it 1 is called zfiftula lachrymalis, and can only be cured ; by a furgical operation ; though it may be greatly ' relieved by continued blifters or iffues, and avoiding the caufes cf irritation and inflammation. OF THE EAR. < The functions of the ear may be injured by wounds, ulcers, or any thing that hurts its fabric. The hearing may likewife be'hurt by exceffive noife ; violent colds in the head ; fevers; hard wax, or powder daily, for fome -vecks, or months, difcontinuing it if A the mouth fhould become fore; blifters muft at the fame tinYe "< be kept to the back of the neck, to the arms, or behind the ears ; and the Peruvian bark ufed in the latter part of the treatment. J The idea of cutting off or deftroying the fpeck is a very dan- gerous one. j other j OF THE EAR. 469 other fubftances flicking in the cavity of the ear; too great a degree of moifture or drynefs of the ear. Deafnefs is very often the effect of old age, and is incident to moft people in the decline of life. Some- times it is owing to an original fault in the ftructure or formation of the ear itfelf. When this is the cafe, it admits of no cure; and the unhappy perfon not only continues deaf, but generally likewife dumb, for life *. When deafnefs is the effect of wounds or ulcers of the ears, or of old age, it is not eafily removed. When it proceeds from cold of the head, the pa- * Though thofe who have the misfortune to be born deaf are generally fuffered to continue dumb, and confequently are in a great meafure loft to fociety, yet nothing is more certain than that fuch perfons may be taught not only to read and write, but alfo to fpeak and to underftsnd what others fay to them. Teaching the dumb to fpeak will appear paradoxical to thofe who do not confider that the format On of founds is merely mechanical, and may be taught without the affiftanee of the ear. This is not only capable cf demonftration, but is actually reduced to practice by the ingenious Mr Thomas Braidwood of Edinburgh. This gentleman has, by the mere force of genius and application, brought the teaching of dumb perfons to fuch a degree of perfection, that his fcholars are generally more for- ward in their education than thofe of the fame age who enjoy all their faculties. They not only read and write with the ut- moft read inefs, but likewife fpeak, and are capable of holding converfation with any perfon in the light. What a piry that any of the human fpecies fhould remain in a ftate of idiotifm, who are capable of being rendered as ufeful and intelligent as others ! We mention this not only from humanity to thofe who h;ive the misfortune to be born deaf, but alfo in juftice to Mr Kraidwood, whofe fuccefs has far exceeded all former attempts in this way; and indeed it exceeds imagination itfelf fo far, that no perfon who has not feen and examined his pupils, can believe what they are capable of. As this gentleman, however willing, is c nly able to teach a few, and as the far greater part of thofe who are born deaf cannot afford to attend him, it would be an act of great humanity, as well as of public utility, to-erect an academy for their benefit. H h 3 tient 47° OF THE EAR. tient muft be careful to keep his head warm, efpe- cially in the night; he fhould likewife take fome gentle purges and keep his feet warm, and bathe them frequently in lukewarm water at bed-time. When deafnefs is the effect of a fever, it generally goes off after the patient recovers. If it proceeds from dry wax flicking in the ears, it may be foftened by dropping oil into them; afterwards they muft be fyringed with warm milk and water. If deafnefs proceeds from drynefs of the ears, which may be known by looking into them, half an ounce of the oil of fweet almonds, and the fame quantity of liquid opodeldoch, or tincture of afafce- tida, may be mixed together, and a few drops of it put into the ear every night at bed-time, flopping them afterwards with a little wool or cotton. Some, inftead of oil, put a fmall flice of the fat of bacon into each ear, which is faid to anfwer the purpofe very well. When the ears abound with moifture, it may be drained off by an iffue or feton, which fhould be made as near the affected parts as poffible. Some, for the cure of deafnefs, recommend to be dropped into the ear equal parts of Hungary-water and fpirit of lavender. Etmuller extols amber and mufk; and Brookes fays, he has often known hard- nefs of hearing cured by putting a grain or two of mufk into the ear with cotton-wool. But thefe and other applications muft be varied according to the caufe of the diforder. Though fuch applications may fometimes be of fervice, yet they much oftner fail, and frequently they do hurt. Neither the eyes nor ears ought to be tampered with; they are tender organs, and re- quire a very delicate touch. For this reafon, what we would chiefly recommend in deafnefs, is, to keep the head warm. From whatever caufe the diforder proceeds, this is always proper; and 1 have known more OF THE TASTE AND SMELL. 47, more benefit from it alone, in the moft obftinate cafes of deafnefs, than from all the medicines I ever ufed. OF THE TASTE AND SMELL. Though thefe fenfes are not of fo great importance to man in a ftate of fociety, as the fight and hearing; yet, as the lofs of them is attended with inconveni- ency, they deferve our notice. They are feldom to be restored when loft ; which ought to make us very attentive to their prefervation, by carefully avoiding whatever may in the leaft prove injurious to them. As there is a very great affinity between the organs of tailing and fmelling, whatever hurts the one ge- nerally affects the other. Luxury is highly injurious to thefe organs. When the nofe and palate are frequently flimulated by fragrant and poignant difhes, they foon lofe the power of distinguishing taftes and odours with any degree of nicety. Man, in a ftate of nature, may perhaps have thefe faculties as acute as any other animal. The fenfe of fmelling may be diminished or de- stroyed by difeafes ; as, the moifture, drynefs, in- flammation or fuppuration of that membrane which lines the infide of the nofe, commonly called the ol- factory membrane; the comprdfion of the nerves which fupply this membrane, or fome fault in the brain itfelf at their origin. A defect or too great a degree of folidity, of the fmall fpungy bones of the upper jaw, the caverns of the forehead, &c. may likewife impair the fenfe of fmelling. It may alfo be injured by a collection of foetid matter in thofe ca- verns, which keeps conftantly exhaling from them. Few things are more hurtful to the fenfe of fmelling than taking great quantities of fnuff. H h 4 When 472 OF THE TASTE AND SMELL. When the nofe abounds with moifture, after gentle evacuations, fuch things as tend to take off irritation, and coagulate the thin fharp ferura, may be applied; as the oil of anife mixed with fine flour; camphire diffolved in oil of almonds, &c. The vapors of am- ber, frankincenfe, gum-maftic, and benjamin, may likewife be received into the nofe and mouth. For moiftening the mucus when it is too dry, fome recommend fnuff made of the leaves of marjoram, mixed with the oil of amber, marjoram and annifeed; or a fternutatory of calcined white vitriol; twelve grains of which may be mixed with two ounces of marjoram-water, and filtrated. The fteam or vapor of vinegar upon hot iron received up the noflrils is likewife of ufe for foftening the mucus, opening ob- flructions, &c. If there is an ulcer in the nofe, it ought to be dreffed with fome emollient ointment, to which, if the pain be very great, a little laudanum may be added. If it be a venereal ulcer, it is not to be cured without mercury. In that cafe the folution of the corrofive fublimate in water may be taken. The ulcer ought likewife to be wafhed with it; and the fumes of cinnabar may be received up the noftrils. If there be reafon to fufpect that the nerves which fupply the organs of fmelling are inert, or want Sti- mulating, volatile falts, ftrong fnuffs, and other things which occafion fneezing, may be applied to the nofe. The forehead may likewife be anointed with balfam of Peru, to which may be added a little of the oil of amber. The tafte may be diminifhed by crufts, filth, mu- cus, aphtha?, pellicles, warts, &c. covering the tongue : it may be depraved by a fault of the faliva, which, being difcharged into the mouth, gives the fame fenfation as if the food which the perfon takes had really a bad tafte; or it may be entirely deftroy ed by OF THE TOUCH. 473 by injuries done to the nerves of the tongue and pa- late. Few things prove more hurtful either to the fenfe of tafting or fmelling than obftinate colds, efpe- cially thofe which affect the head. When the tafte is diminifhed by filth, mucus, &c. the tongue ought to be fcraped and frequently wafhed with a mixture of water, vinegar, and honey, or fome other detergent. When the faliva is vitiated, which feldom happens unlefs in fevers or other difeafes, the curing of the diforder is the cure of this fymptom. To relieve it however in the mean time, the following things may be of ufe ; if there be a bitter tafte, it may be taken away by vomits, purges, and other things which evacuate bile. What is called a nidorous tafte, arifing from putrid humors, is corrected by the juice of citrons, oranges, and other acids. A fait tafte is cured by plentiful dilution with watery liquors. An acid tafte is deftroyed by abforbents, and alkaline falts, as powder of oySter-Shells, fait of wormwood, &c. When the fenfibility of the nerves which fupply the organs of tafte is diminifhed, the chewing of horfe-radifh, or other ftimulating fubftances, will help to recover it. OF THE TOUCH. The fenfe of touching may be hurt by any thing that obstructs the nervous influence, or prevents its being regularly conveyed to the" organs of touching ; as preffure, extreme cold, &c. It may likewife be hurt by too great a degree of fenfibility, when the nerve is not fufficiently covered by the cuticle or fearf-fkin, or where there is too great a tenfion of it or it is too delicate. What ever diforders the func- tions of the brain and nerves, hurts the fenfe of touching. Hence it appears to proceed from the fame general caufes as palfy and apoplexy, and re, quires nearly the fame method of treatment. In 474 OF A SCHIRRUS AND CANCER. In a ftupor, or defect of touching, which arifes from an obstruction of the cutaneous nerves, the pa- tient muft firft be purged; afterwards fuch medi- cines as excite the action of the nerves, or ftimulate the fyftem, may be ufed. For this purpofe, the fpirit of hartfhorn, horfe-radifh, Sec. may be taken in- wardly ; the difordered parts, at the fame time, may be frequently rubbed with frefh nettles, or fpirit of fal ammoniac. Bliftering-plafters and finapifms ap- plied to the parts will likewife be of ufe, as alfo warm bathing, efpecially in the natural hot baths. CHAP. XLVI. Of a Schirrus and Cancer. A SCHIRRUS is an hard indolent tu- mor feated in fome of the glands ; as the breafts, the arm-pits, &c. If the tumor becomes large, unequal, of a livid, blackifh, or leaden colour, and is attended with violent pain, it gets the name cf an occult cancer. When the fkin is broken, and a fanies or ichorous matter of an abominable foetid fmell is difcharged from the fore, it is called an open or ulcerated cancer. Perfons after the age of forty-five, particularly women, and thofe who lead an indolent fedentary life, are moft fubject to this dif- eafe. CAUSES.—This difeafe is often owing to fup- preffed evacuations ; hence it proves fo frequently fatal to women of a grofs habit, about the time when the menftrual flux ceafes. It may likewife be occa- fioned by exceffive fear, grief, anger, religious me- lancholy, OF A SCHIRRUS AND CANCER. 4-5 lancholy, or any of the depreffing paffions. Hence the unfortunate, the choleric, and thofe perfons who devote themfelves to a religious life in convents or monasteries, are often afflicted with it. It may alfo be occafioned by the long-continued ufe of food that is too hard of digeftion, or of an acrid nature ; indo- lence ; cold ; blows ; friction ; preffure ; or the like. Women often fuffer from the laft of thefe by means of their Stays, which fqueeze and comprefs their breaft fo as to occafion great mifchief. Sometimes the difeafe is owing to an hereditary difpofition. SYMPTOMS.—This diforder feems often very trifling at the beginning. A hard tumor about the fize of a hazle-nut, or perhaps fmaller, is generally the firft fymptom. This will often continue for a long time without feeming to increafe, or giving the patient great uneafinefs; but if the conftitution be hurt, or the tumor irritated by preffure, or improper treatment of any kind, it begins to extend itfelf to- wards the neighbouring parts by pufhing out a kind of roots or limbs. It then gets the name of cancer, from a fancied refemblance between thefe limbs and the claws of a crab. The colour of the fkin begins to change, which is firft red, afterwards purple, then bluifh, livid, and at laft black. The patient com- plains of heat, with a burning, gnawing, fliooting pain. The tumor is very hard, rough, and unequal, with a protuberance, or rifing in the middle; its fize increafes daily, and the neighbouring veins become thick, knotty, and of a blackifh colour. The fkin at length gives way, and a thin fharp ichor begins to flow, which corrodes the neighbour- ing parts till it forms a large unfightly ulcer. More occult cancers arife, and communicate with the neighbouring glands. The pain and Stench become intolerable; the appetite fails; the ftrength is ex- hausted by a continual hectic fever ; at laft, a vio- 476 OF A SCHIRRUS AND CANCER. lent haemorrhage, or difcharge of blood, from fome part of the body, with faintings, or convulfion fits, generally put an end to the miferable patient's life. REGIMEN.—The diet ought to be light, but ! nourishing. All ftrong liquors, and high-feafoned I or falted provifions, are to be avoided. The patient j may take as much exercife as he can eafily bear. All kinds of external injury are carefully to be ^ guarded againft, particularly of the affected part, ! which ought to be defended from all preffure, and \ even from the external air, by covering it with fur, i or foft flannel. ' MEDICINE.—This is one of thofe difeafes for which no certain remedy is yet known. Its progrefs however may fometimes be retarded, and fome of its moft difagreeable fymptoms mitigated, by proper ap- plications. One misfortune attending the difeafe is, that the unhappy patient often conceals it too long. Were proper means ufed in due time, a cancer might often be cured ; but after the diforder has arrived j at a certain height, it generally fets all medicine at defiance. When a fchirrous tumor is firft difcovered, the patient ought to obferve a proper regimen, and to take twice or thrice a-week a dofe of the common purging mercurial pill. Some blood may alfo be , let, and leeches daily applied to the part for one or j two weeks ; and the part affected may be kept warm with fur or flannel. The food muft be light, and a pint of the decoction of woods or farfaparilla may be drank daily. Should the tumor, however, not yield to this treat- ment, but, on the contrary, become larger and harder, it will be proper to extirpate it, either by the knife or cauftic. Indeed, whenever this can be done with fafety, the fooner it is done the better. It OF A SCHIRRUS AND CANCER. 477 It can anfwer no purpofe to extirpate a cancer after the conftitution is ruined, or the whole mafs of hu- mors corrupted by it; This, however, is the com- mon way, which makes the operation fo feldom fuc- ceed. Few people will fubmit to the extirpation till death flares them in the face; whereas, if it were done early, the patient's life would not be endan- gered by the operation, and it would generally prove a radical cure. When the cancer is fo fituated that it cannot be cut off, or if the patient will not fubmit to the ope- ration, fuch medicines as will mitigate or relieve the moft urgent fymptoms may be ufed. The medicine moft in repute at prefent for this difeafe is hemlock. Dr Stork, phyfician at Vienna, has of late recommended the extract of this plant as very efficacious in cancers of every kind. The Doc tor fays, he has given fome hundred weights of it without ever hurting any body, and often with ma- nifeft advantage. He advifes the patient, however, to begin with very fmall dofes, as two or three grains, and to increafe the dofe gradually till fome good effect be perceived, and there to reft without further increafe. From two or three grains at firft, the Doctor fays he has increafed the dofe to two, three, or four drachms a-day, and finds that fuch dofes may be continued for feveral weeks without any bad confequences. The regimen which the Doctor recommends during the ufe of the medicine, is to avoid farinaceous fub- ftances not fermented, and too acrid aromatics. He fays, good wine will not be hurtful to thofe who are accultomed to it, nor a moderate ufe of acids ; and adds, that the patient fliould live in a pure free air, and keep his mind as quiet and cheerful as poffible. The Doctor does not pretend to fix the time in which a cancer may be rcfolved by the ufe of hem- lock, but fays he has given it for above two years ir, 473 OF A SCHIRRUS AND CANCER. in large dofes without any apparent benefit; never- thelefs the patient has been cured by perfifting in the ufe of it for half a year longer. This is at leaft en- couragement to give it a fair trial. Though we are far from thinking the hemlock merits thofe extrava- gant encomiums which the Doit or has beftowed upon it, yet, in a difeafe which has fo long baffled the boafted powers of medicine, we think it ought always to be tried. The powder of hemlock is by fome preferred to the extract. They are both made of the frefli leaves, and may be ufed nearly in the fame manner. Dr. Nicholfon of Berwick fays, he gradually increafed the dofe of the powder from a few grains to half a drachm, and gave near four drachms of it in the day with remarkably good effects. The hemlock may alfo be ufed externally either as a poultice or fomentation. The fore may likewife be kept clean by injecting daily a ftrong decoction of the tops and leaves into it. Few things contribute more to the healing of foul fordid ulcers of any kind, than keeping them tho- roughly clean. This ought never to be neglected. The beft application for this purpofe, feems to be the carrot poultice. The root of the common carrot may be grated, and moiltened with as much water as will bring it to the confiftence of a poultice or cata- plafm. This muft be applied to the fore, and renewed twice a-day. It generally cleans the fore, eafes the pain, and takes away the difagreeable Smell, which are objects of no fmall importance in fuch a dreadful diforder*. Wort, or an infufion of malt, has been recom- mended not only as a proper drink, but as a power- ful medicine in this difeafe. It muft be frequently made frefli, and the patient may take it at pleafure. *• London Medical EiTays. Two OF A SCHIRRUS AND CANCER. 475 Two, three, or even four pints of it may be drank every day for a confiderable time. No benefit can he expected from any medicine in this difeafe, unlefs it be perfifted in for a long time. It is of too obfti- nate a nature to be foon removed ; and, when 'it admits of a cure at all, it muft be brought about by inducing an almoft total change of the habit, which muft always be a work of time. Setons or iffues, applied near the cancer, have fometimes good ef- fects*. When all other medicines fail, recourfe muft be had to opium, as a kind ot folace. This will not, indeed, cure the difeafe, but it will eafe the patient's agony, and render life more tolerable while it con- tinues. To avoid this dreadful diforder, people ought to ufe wholefome food ; to take fufficient exercife in the open air; to be as eafy and cheerful as poffible; and carefully to guard againft all blows, bruifes, and every kind of preffure upon the breafts or other glandular parts-)-. * In a cancer which had fet all medicines, and even furgery, at defiance, I lately faw remarkable effects from an obftinate perfeverance in a courfe of antifeptics. I ordered the deep ulcers to be wafhed to the bottom bymea-is of a fyringe, twice or thrice a-day, either with an infufion of the bark, or a de- coction of carrot, and that the patient fhould take four or five limes a-day, a glafs cf good wine, with half a drachm of the beft pr.wdered bark in it. The fores, after being wafhed, were likewife fprinkled with the fame powder. When the patient began this courfe, her death was daily expected. She conti- nued it for above two years, with m anife ft advantage; but, being told by an eminei t furgeon, that the bark would not cure a cancer, and that the fores' ought not to be wafhed, flie dif- continued the practice, and died in a few weeks. This ccurfe was not expected to cure the cancer, but to prolong the patient's life, which it evidently did almoft to a miracle. f As hemlock is the pi incipal medicine recommended in this difeafe, we would have given fome directions for the gathering anil preparing of that plast; Uit a. its different preparations and [ 48o ] CHAP. XLVII. ■ Of Poifons. Hi VERY perfon ought, in fome meafure, \ to be acquainted with the nature and cure of poifons. They are generally taken unawares, and their effects are often fo fudden and violent, as not to admit of delay, or allow time to procure the affiftance of phy- ficians. Happily, indeed, no great degree of medical knowledge is here neceffary ; the remedies for moft poifons being generally at hand, or eafily obtained, and nothing but common prudence needful in the ! application of them. The vulgar notion, that every poifon is cured by fome counter-poifon, as a fpecific, has done much hurt. People believe they can do nothing for the patient, unlefs they know the particular antidote to ') that kind of poifon which he has taken. Whereas, the cure of all poifons taken into the ftomach, with- out exception, depends chiefly on difcharging them as foon as poffible. There is no cafe, wherein the indications of cure are more obvious. Poifon is feldom long in the ftomach before it occafions ficknefs, with an incli- nation to vomit, this fliews plainly what ought to i be done. Indeed, common fenfe dictates to every .< one, that, if any thing has been taken into the fto- mach which endangers life, it ought immediately to be difcharged, if poffible. Were this duly regarded, \ the danger arifing from poilons might generally be are now kept in fliops, we think it much fafer for people to get them there, wich proper directions Tor ufing them. 2 avoided. OF POtSONS. 481 avoided. The method 01 prevention is obvious, and the means are in the hands of every -ne. We fliall not take up the reader's time with a detailof the ridiculous notions which have prevailed among ignorant people, in different ages, with regard to poifons ; neither Shall we mention the boafted antidotes, which have been recommended either for preventing or obviating their effects ; but fhall con- tent ourfelves with pointing out the poifons moft Common in this country, and the means of avoiding their dangerous confequences. Poifons either belong to the mineral, the vegeta- ble, or the animal kingdom. Mineral poifons are commonly of an acrid or cor- rofive quality ; as arfenic, cobalt, the corrofive fub- limate of mercury, &c. Thofe of the vegetable kind, are generally of a narcotic or ftupefactive quality ; as poppy, hemlock, hen-bane, berries of the deadly night-fhade, ftramo- nium, palma chrifti, Sec Poifonous animals communicate their infection either by the bite or Sting. This poifon is very dif- ferent from the former, and only produces its effects When received into the body by a wound." MINERAL POISONS.----Arfenic is the moft common of this clafs; and, as the whole of them are pretty fimilar, both in their effects and method of cure, what is faid with refpect to it will be applica- ble to every other fpecies of corrofive poifon. When a perfen has taken arfenic, he foon per- ceives a burning heat, and a violent pricking pain in his ftomach and bowels, with an intolerable thirft, and an inclination to vomit. The tongue and throat feel rough and dry ; and, if proper means be not foon administered, the patient is feized with great anxiety, hiccupping, faintings, and coldnels of the extremities. To thefe fucceed black vomitings, foetid ftools, with a mortification of the ftomach and intef. I l tiurs 482 OF POISONS. tines, which are the immediate forerunners of death. If corrofive fublimate or fugar of lead have been taken, the patient fhould drink frequently of a folu- tion of fait of tartar in water. On the firft appearance of thefe fymptoms, the patient Should drink large quantities of new milk and fallad oil, till he vomits ; or, he may drink warm water mixed with oil. Fat broths are likewife pro- per, provided they can be got ready in time. Where no oil is to be hold, frefli butter may be melted and mixed with the milk or water. Thefe things are to be drank as long as the inclination to vomit conti- nues. Some have drank eight or ten quarts before the vomiting ceafed ; and it is never fafe to leave off drinking, while one particle of the poifon remains in the ftomach. Thefe oily or fat fubftances not only provoke vomiting, but likewife blunt the acrimony of the poifon, and prevent its wounding the bowels; but if they fliould not make the perfon vomit, half a drachm or two feruples of the powder of ipecacu- anha muft be given, or a few fpoonfuls of the oxy- iixl or vinegar of fquills, may be mixed with the water which he drinks. Vomiting may likewife be excited by tickling the infide of the throat with a feather. Should thefe methods, however, fail, half a drachm of white vitriol, or five or fix grains of emetic tartar, or two feruples of powdered ipecacu- anha, muft be admin;ncred. If tormenting p.mis are felt in the lower belly, and there is reafon to fear that the poifon has got down to the inteftines, clyfters of milk and oil muft be very frequently thrown up ; and the patient muft drink emollient decoctions of barley, oat-meal, marfh- mallows, and fuch like. He muft likewife take an infufion of fenna and manna, a Solution of Glauber's * falts, or tome other purgative. After OF POISONS. 483 After the poifon has been evacuated, the patient ought, for fome time, to live upon fuch things as are of a healing and cooling quality ; to abftain front flefli and all ftrong liquors, and to live upon milk, broth, gruel, light puddings, and other fpoon meats of eafy digeftion. His drink fhould be barley-water, flax-feed-tea, or infufions of any of the mild mucila- ginous vegetables. VEGETABLE POISONS, befides heat and pain of the Stomach, commonly occafion fome degree of giddinefs, and often a kind of Stupidity or folly* Perfons who have taken thefe poifons muft be treated in the fame manner as for the mineral or corrofive. Though the vegetable poifons'f when allowed to remain in the ftomach, often prove fatal ; yet the danger is generally over as foon as they are dif* charged. Not being of fuch a Cauftic or corrofive . nature, they are lefs apt to wound or inflame the bowels than mineral fubftances: no time, however, ought to be loft in having them difcharged. Opium, being frequently taken by miftake, merits particular attention. It is ufed as a medicine, both in a folid and liquid form, v. hich latter commonly goes by the name of laudanum. It is, indeed, a valuable medicine, when taken in proper quantity; but, as an over-dofe proves a ftrong poifon, we fliall point out its common effects, together with the me* thod of cure. An over-dofe of opium generally occafions great drowfinefs, with ftupor and other apoplectic fymp- toms. Sometimes the perfon has fo great an incli- nation to fleep, that it is aim oil impoffible to keep him awake. Every method muft, however, be tried for this purpofe. He fhould be toffed, fhaked, and moved about. Sharp bliftering-plaftcs Should be applied to his legs or arms, and ftimulating medi- cines, as falts of hartfhorn, Sec. held under his I i 2 nofe. 484 BITES OF POISONOUS ANIMALS. nofe. It will alfo be proper to let blood if the pulfe requires it. At the fame time every method muft be taken to make him difcharge the poifon. This may be done in the manner directed above, viz. by the ufe of ftrong vomits, drinking plenty of warm water with oil, large draughts of vinegar, or lime juice and water. Mead, befides vomits, in this cafe, recommends acid medicines with lixivial falts. He fays, that he has often given fait of wormwood mixed with juice of lemon in repeated dofes with great fuccefs. if the body fliould remain weak and languid after the poifon has been difcharged, nourishing diet and cordials will be proper ; but when there is reafon to fear that the ftomach or bowels are inflamed, the greateft circumfpection is neceffary, both with re- gard to food and medicine. OF THE BITES OF POISONOUS ANIMALS. We fliall begin with the bite of a mad dog, as it is both the moft common and dangerous animal-poi- fon in this country. The creatures naturally liable to contract this dif- eafe are, as far as we yet know, all of the dog kind, viz. foxes, wolves, and dogs. Hence it is called the rabies canina, or dog madnefs. It fo feldom happens that any perfon is bit by the two firft, that they fcarce dtferve to be taken notice of. If fuch a thing fliould happen, the method of treatment is precifely the fame as for the bite of a mad dog. t he fymptoms of madnefs in a dog are as fol- low : At firft he looks dull, Shews an averfion to food and company ; he does not bark as ufual, but feems to murmur, is peeviih, and apt to bite ftrangers : his ears and tail droop more than ufual, and he ap- pears drowiy : afterwards he begins to loll out his tongue, and froth at the mouth, his eyes feeming heavy BITES OF POISONOUS ANIMALS. 485 heavy and watery: he now, if not confined, takes off, runs panting along with a kind of dejected air, and endeavours to bite every one he meets. Other dogs are faid to fly from him. Some think this a certain fign of madnefs, fuppofing that they know him by the fmell; but it is not to be depended on. If he efcapes being killed, he feldom runs above two or three days, till he dies exhaufted with hear, hun- ger, and fatigue. This difeafe is moft frequent after long, dry, ho$ feafons ; and fuch dogs as live upon putrid,.ftinking carrion, without having enough of frefli water, are moft liable to ir. When any perfon has been bit by. a dog, the Strict- eft inquiry ought to be made whether the animal was really mad. Many, difagreeable confequences arife from neglecting to afcertain this point. Some people have lived in continual anxiety for many years, be- caufe they had been bit by a dog which they believed to be mad ; but, as he had been killed on the fpot, it was impoffible to afcertain the fact. This fliould induce us, inftead of killing a dog the moment he has bit any perfon, to do all in our power to keep him aiive, at leaft till we can be certain whether he be mad or not. Many circumftances may contribute to make peo- ple imagine a dog mad. He lofes his mailer, runs about in queft of him, is fet upon by other dogs, and perhaps by men. The creature, thus frighr- ened, beat, and abufed, looks wild, and lolls out his tongue as he runs along. Immediately a croud is after him ; while he, finding himfelf clofely pur- fued, and taking every one he meets for an enemy, naturally attempts to bite in felf-defence. He foon gets knocked on the head, and it paffes currently that he was mad, as it is then impoffible to prove the contrary. I i 3 This 486 BITES OF POISONOUS ANIMALS. This being the true hiftory of, by far, the greater part of thofe dogs which pafs for mad, is it any wonder that numberlefs whimfical medicines have been extolled for preventing the effects of their bite ? This readily accounts for the great variety of infallible remedies for the bite of a mad dog, which are to be met with in almoft every family. Though not one in a thoufand has any claim to merit, yet they are all fupported by numberlefs voucher*. No wonder that imaginary difeafes fhould be cured by imaginary remedies. In this way, credulous peo- ple firft impofe upon themfelves, and then deceive others. The fame medicine which was.fuppofed to prevent the effects of the bite, when the dog was not mad, is recommended to a perfon who has had the misfortune to be bit by a dog that was really mad. He takes it, trufts to it, and is undone. To thefe miftakes we muft impute the frequent ill fuccefs of the medicines ufed for preventing the effects of the bite of a mad dog. It is not owing fo much to a defect in medicine, as to wrong ap- plications. I am perfuaded, if proper medicines were adminiftered immediately after the bite is re- ceived, and continued for a fufficient length of time, we fliould not lofe one in a thoufand of thofe who have the misfortune to be bit by a mad dog. This poifon is generally communicated by a wound, which, neverthelefs, heals as foon as a common wound : -but afterwards it begins to feel painful, and as the pain fpreads towards the neighbouring parts, the perfon becomes heavy and liftlefs. His fleep is unquiet, with frightful dreams; he fighs, looks dull, and loves folitude. Thefe are the fore- runners, or rather the firft fvmptoms of that dread- ful difeafe occafioned by the bite of a mad dog. But as we do not propofe to treat fully of the difeafe itfelf, but to point out the method of pre- venting BITES OF POISONOUS ANIMALS. 487 venting it, we fhall not take up time in fliewing its progrefs from the firft invafion to its commonly fatal end. The common notion, that this poifon may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridiculous. It muft render fuch perfons as have had tlie misfortune to be bit very unhappy, and can have no good effects. If the per- fon takes proper medicines for forty days after the time of bis being bit, and feels no fymptoms of the difeafe, there is reafon to believe him out of danger. The medicines recommended for preventing the effects of the bite of a mad dog, are chiefly fuch as promote the different fecretions, and antifpafm'odics. Dr Mead recommends a preventative medicine, which,'he fays, he never knew fail, though in the fpace of thirty years he had ufed it a thoufand times. The Doctor's prescription is as follows: "Take afti-colourcd ground liver-wort, cleaned, dried, and powdered, half an ounce ; of black pep- per powdered, a quarter of an ounce. Mix thefe well together, and divide the powder into four dofes; one of which muft be taken every morning, fafting, for four mornings fucceffively, in half a pint of cows -milk voirm. " After thefe four dofes are taken, the patient muft go into the cold bath, or a cold fpring or river, every morning fafting, for a month ; he muft be dip- ped all over, but not ftay in (with his head above water) longer than half a minute, if the water be very cold. After this he muft go in three times a- week for a fortnight longer. " The perfon muft be bled before he begins to ufe the medicine *." * Though we give this prefcription on the credit of Dr. Mead, yet we would not advife any peribn, who has reafon lo -beliere that he has been bit by a dog which was really I i 4 mad, 488 BITES OF POISONOUS ANIMALS. We fii•■ til u.xt mention the famous Eaft India fpe- cific, as it is called. This medicine is compoOd of cinnabar and mufk:. It is elteemed a great an- tifpafmodic ; and, by many, extolled as an infalifele remedy for preventing the effects of the bite of a mad dog. " Take native and factitious cinnabar, of each twenty-four grains, mufic fixteen grains. Let thefe be made into a fine powder, and taken inli glafs of arrack or brandy." This fingle dofe is faid to fecure the perfon for thirty days, at the end of which it muft be repeated ; but if he has any fymptoms of the difeafe, it muft be repeated in three hours. The following is likewife reckoned a good anti- fpafmodic medicine: " Take of Virginian fnake-root in powder, half a drachm, gum afafcetida twelve grains, gum camphire feven grains ; make thefe into a bolus with a little fyrup of faffron." Camphire may alfo be given in the following man- ner: " Take purified nitre half an ounce, Virginian fnake-root in powder two drachms, camphire one drachm ; rub them together in a mortar, and divide the whole into ten dofes." Mercury is likewife recommended as of great effi- cacy, both in the prevention and cure of this kind of madnefs. When ufed as a preventative, it will be fuf- ficient to rub daily a drachm of the ointment into the parts about the wound. Vinegar is like wile of confiderable fervice, and fhould be taken freely, either in the patient's food or drink. mad, to truft to it a'one. Mead was an ab'e phyfician, but he feems to have been no great philofopher, and was fome- »7 nes the dupe of his own credulity. Thefe BITES OF POISONOUS ANIMALS. 489 Thefe are the principal medicines recommended for preventing the effects of the bite of a mad dog. We would not, however, advife people to truft to any one of them ; but from a proper combination of their different powers, there is the greateft reafon to hope for fuccefs. The great error in the ufe of thefe medicines lies in not taking them for a fufficient length of time. They are ufed more like charms, than medicines in- tended to produce any change in the body. To this, and not to the infufficiency of the medicines, we muft impute their frequent want of fuccefs. Dr Mead fays, that the virtue of his medicine con- fifts in promoting urine. But how a poifon Should be expelled by urine, with only three or four dofes of any medicine, however powerful, it is not eafy to conceive. More time is certainly neceffary, even though the medicine were more powerful than that which the Doctor prefcribes. The Eaft India fpecific is ftill more exceptionable on this account. As thefe and moft other medicines, taken fingly, have frequently been found to fail, we fhall recom- mend the following courfe: If a perfon be bit on a flefliy part, where there is no hazard of hurting any large blood-vcffel, the parts adjacent to the wound may be cut away, or apply a cauftic directly on the part. The wound may be dreffed with fait and water, or a pickle made of vinegar and fait, and afterwards dreffed twice a-day with red precipitate of mercury *. The patient fhould begin to ufe either Dr Mead's medicine, or fome of the others mentioned above. If he takes Mead's medicine, he may ufe it as the * In everv cafe of wound from the bite of a dog, there is no application equal to red precipitate, in order to pro- duce good matter. Doctor 49P BITES OF POISONOUS ANIMALS. Doctor directs, for four days fucceffiyely. Let him then omit it for two or three days, and again repeat the fame number of dofes as before. During this courfe, he muft rub into the parts ^b.ont the wound, daily, one drachm of the mercu- rial ointment. This may be done for ten or twelva days at leaft. When this courfe is over, he may take a purge or two, and wait a few days till the effect of tl)e mer.cu^y he gone off. He muft then begin to ufe Hie cold bath, into which he may go every morn- ing for five or fix weeks. If he Should feel cold and chilly for a long time after coming out of the: cold bath, it will be better to ufe a tepid one, or to have the water a little warmed. In tfee mean time, we would advife him not to leave o^f aj.1 internal medicines, but to rake either one of the bO|hnres of fnake-root, afafcetida, and cam- phire ; or one of the powders of nitre, camphire, and fnake-root, twice a-day. Thefe may be ufed during the whole time he is bathing. J3uring the ufe of the mercurial ointment, the patient muft keep within doors, and take npthing cold. A proper regimen muft be obferved throughout the whole courfe. The patient Should abftain from flefli, and all falted and high-feafoned provifions. He muft avoid ftrong liquors, and live moStly upon a light and rather fpare diet. His mind fhquld be kept as eafy and cheerful as poffible, and.all exceffive heat and violent paffions avoided with the utmoft care. I have never feen this courfe of medicine, with proper regimen, fail to prevent the hydrophobia, and cannot help again obferving, that the want of fuccefs muft generally be owing either to the appli- cation of improper medicines, or not ufing proper ones for a fufficient length of time. Mankind BITES OF POISONOUS ANIMALS. 49? Mankind are extremely fonc) of every thing that promifes a fudden or miraculous cure. By trufljng to thefe they often lofe jtheijr live5;, when a regular courfe of tnedicjne woujd have rendered thern abfo- lutely fafe. This holds remarkably in the prefent Cafe. Numbers of people, for example, believe if fhey or their cattle were once dipped in t'le fea, it is fufficient; as if the fait water were a charm againft fhe effects of tfye bite. This, and fuph like whims, have proved fatal to many. It h a common notion, if a perfon be bit by a dog which is not mad, that, if he fliould go mac) af- (terwards, the perfon would be affe&ed with the dif- order at the fame time ; but this notion is too ridi- culous to deferve a ferious confider at ion. It is a good rule, however, to avoid dogs as much as pof- fible. Though we do pot mean to treat fully of the cure of the hydrophobia, yet we are far from reckoning it incurable. The notion that this difeafe could not pe cured, has been productiye of the moft horrid confequences. It was ufual either to abandon tl>e unhappy peitfbns, as foon as they were feized with the difeafe, to their fate, to bleed tliem to death, or to fuffocate them between matraffes or feather beds, Sec This conduct certainly deferved the fevereft pnnifliment! We hope, for the honor of human na- ture, it will never again be heard of. I have never had an opportunity of treating this difeafe, and therefore can fay nothing of it from my own experience ; but the learned Dr. Tiffot fays, it jnay be cured in rhe following manner : i. The patient muft be bled to a confiderable quantity; and this may be repeated twice, or thrice, or even a fourth time, if circumftances require it. 2. The patient Should be put, if poffible, into a warm bath ; and this fhould be ufed twice a-day. 3- He 492 BITES OF POISONOUS ANIMALS. 3. He fhould every day receive two, or even three emollient clyfters. 4. The wound, and the parts adjoining to it, fhould be rubbed with the mercurial ointment twice a-day. 5. The whole limb which contains the wound fhould be rubbed with oil, and be wrapped up in an oily flannel. 6. Every three hours a dofe of Cob's powder fhould be taken in a cup of the infufion of lime tree and elder flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of native and factitious cinnabar, each twenty-four grains; of mufk, fixteen grains *. 7. The following bolus is to be given every night, and to be repeated in the morning, if the patient is not eafy, wafhing it down with the infufion mention- ed above: Take one drachm of Virginian fnake- root in powder; of camphire and afafcetida, ten grains each ; of opium, one grain ; and with a fuf- ficient quantity of conferve, or rob of elder, make a bolus. 8. If there be a great naufea at the ftomach, with a bitternefs in the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be jtalcen for a vo- mit. 9. The patient's food, if he takes any, muft be light; as panad-a, foups made of farinaceous or mealy vegetables, Sec. * The Ormfkirk medicine, as it is called, feems to me/lr> confift chiefly of cinnabar. Though it is faid to be infallible, as a preventative; yet I would not advife any one to trufl to it alone* Indeed it is ordered to be taken in a manner which gives it more the appearance of a charm than of a medicine. Suiely if a medicine is to produce any change in the body, it mull be takep for fome confiderable time and in fufficient quantity, 10. If BITES OF POISONOUS ANIMALS. 49, to. If the patient fliould long continue weak, and fubject to terrors, he may take half a drachm of the Peruvian bark thrice a-day *. The next poifonous animal which we fhall mention is the VIPER. The greafe of this animal rubbed into the wound is faid to cure the bite. Though that is all the viper-catchers generally do when bit, we fliould not think it fufficient for the bite of an enraged viper. It would furely be more fafe to have the wound well fucked-}-, and afterwards rubbed with warm falad oil. A poultice of bread and milk, foftened with falad-oil, fhould likewife be applied to the wound; and the patient ought to drink freely of vinegar-whey, or water-gruel with vinegar in it, to make him fweat. Vinegar is one of the beft medi- cines which can be ufed in any kind of poifon, and ought to be taken very liberally. If the patient be fick, he may take a vomit. This courfe will be fuf- ficient to cure the bite of any of the poifonous ani- mals of this country. With regard to poifonous infects, as the bee, the wafp, the hornet, &c. their flings are feldom at- tended with danger, unlefs when a perfon happens * It is to be lamented that the cure of this difeafe is fo little underftood. The ufe of the cauflic at the beginning is of the greateft importance, afterwards we fliould treat it as we do other difeafes according to the general habit, either by evacu- ations or tonics. f The practice of fucking out poifons is very ancient. There can be no danger in performing this office, as the poifon does no harm unlefs it be taken into the body by a wound. The per- fon who fucks the wound ought, however, to wafh his mouth frequently with falad-oil, which will fecwre him from even the leaft inconveniency. Tne Pfylli in Africa, and the Marft in Italy, were famed for curing the bites of poifonous animals by fucking the wound; and we are told, that the Indians in North America practife the fame at this day. to 494 ®$ VEGETABLE POISONS. to be SlUflg by a great number of them at the fame time ; in witch cafe fo ncthing fhould be done to abate the inflammation and fwelling. Some, for this purpofe, apply honey, others lay pounded parfley to ihe part. A rhixture 6f vinegar and Venice treacle is likewife recommended: but 1 have always found ' rubbing the plan with Warm falad oil fucceed very well. Indeed when the flings are fo numerous as to endanger the f>itient's life, which is fometimes the cafe, he muft bt bled, and take fome cooling medi- cines, as nitre or cream of tartar, and fhould drink plentifully of diluting liquors. It is the happinefs of Great Britain to have Very few poifonous animals, and thofe which we have are by no means of the moft virulent kind. Nlne'tenths of the effects attributed to poifon oi- venom iri this country, are really other difeafes, and proceed from cjUite different caufes; OF VEGETABLE POISONS. Wb cannot, however, make the fame obfervation with regard to pbifbnoUs vegetables. Thefe abound every where, and prove of eh fatal to the ignorant and unwary. This, indeed, is chiefly owing to care- Itffnefs. Children ought early to be cautioned againft eating any kind of fruit, roots, or berries which they do not know, and all poifonous plants to which they can have arcefs, ought, as far as poffible, to be destroyed. This would not be fo difficult a talk a$ fome people imagine. Poifonous plants have no doubt their ufe, and they Ought to be propagated in proper places; but. as they prove often deftructive to cattle, they Should be rooted out of all pafture-grounds. They ought hkewife, for the fafety of the human fpecies, to bfc destroyed in the neighbourhood of aft towns and vil- lages ) Ot VEGETABLE POlSdNS. 495 Iages; which, by the bye, are the places where they moft commonly abound. I have feen the poifonous hemlock, henbane, wolfsbane, and deadfly night- shade, all growing within the environs of a fmall . town, where, though feveral perfons within the me- mory of thofe living in it, had loft their lives by one or other of thefe plants; yet ho method, that I could hear of, had ever been taken to foot them out; though this might be done at a very trifling expence. Seldom a year paffes but we have accounts of fe- veral perfons poifoned by eating hemlock-roots in- ftead of parfnips, or fome kind or fungus which they had gathered for mufhrooms. Thefe examples ought to put people upon their guard with refpect to the former, and to put the latter entirely out of ufe. MuShrooms may be a delicate difh, but they are a , dangerous one, as they are generally gathered by perfons who do not know one kind of fungus from another, and take every thing for a mufhroom which has that appearance. We might here mention many other plants and animals of a poifonous nature which are found in foreign countries; but, as our obfervations are chiefly intended for Great Britain, we fhall pafs thefe over. It may not however be amifs to obferve, for the benefit of fuch of our countrymen as go to Ame- rica, that an effectual remedy is now faid to be found for the bite of the rattle-fnake. The prefcription is as follows: Take of the roots of plantain and hore- hound, in fummer, roots and branches together, a fufficient quantity; bruife them in a mortar, and fqueeze out the juice, of which give, as foon as pof- fible, one large fpoonful; if the patient be fwelled yon muft force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another fpoonful, which never fails.—- If the roots are dried, they muft be moiftened with a little 496* OF THE VENEREAL DISEASE. a little water. To the wound may be applied a leaf ' of good tobacco moiftened with rum. We give this upon the faith of Dr Brookes, who fays it was the invention of a negro ; for the difco- very of which he had his freedom purchafed, and a hundred pouuds per annum fettled upon him during life, by the General Affembly of Carolina. It is poffible there may be in nature fpccinc reme- f. dies for every kind of poifon; but as we have very little faith in any of thofe which have yet been pre- tended to be difcovered, we fhall again recommend \ the moft ftrict attention to the following rules, viz. That when any poifonous fubftance has been taken I into the ftomach it ought, as foon as poffible, to be *j difcharged by vomits, clyfters, and purges; and, when poifon has been received into the body by a wound, that it be expelled by medicines which pro- mote the different fecretions, efpecially thofe of • fweat, urine, and infenfible perfpiration; to which may be joined antifpafmodics, or fuch medicines as take off tenfion and irritation ; the chief of which , are opium, mufk, camphire, and afafcetida. CHAP. XLVIII. Of the Venereal Difeafe. ^N the firft edition of this book the vene- real difeafe was omitted. The reafons, however, which at that time induced me to leave it out, have upon more mature confideration vanished. Bad con- fequences, no doubt, may arife from ignorant perfons i tampering OF THE VENEREAL DISEASE. 49l tampering with medicine in this diforder; but the dan yer from that quarter feems to be more than ba- lanced by the great and folid advantages, which muft arife to the patient from an early knowledge of his cafe, and an attention to a plan of regimen, which, if it does not cure the difeafe, will be fure to render it more mild, and lefs hurtful to the conftitution. It is peculiarly unfortunate for the unhappy per- fons who contract this difeafe, that it lies under a fort of difgrace. This renders difguife neceffary, and makes the patient either conceal his diforder al- together, or apply to thofe who promife a fudden and fecret cure ; but who in fact only remove the fymp- toms for a time, while they fix the difeafe deeper in the habit. By this means a flight infection, which might have been eafily removed, is often converted into an obftinate, and fometimes incurable malady. Another unfavourable circumftance attending this difeafe is, that it affumes a variety of different fhapes, and may with more propriety be called an affemblage of difeafes, than a fingle one. No two difeafes can require a more different method of treatment than this does in its different ftages. Hence the folly and danger of trufting to any particular noftrum for the cure of it. Such noftrums are however generally adminiftered in the fame manner to all who apply for them, without the leaft regard to the ftate of the difeafe, the conftitution of the patient, the degree of infection, and a thoufand other circumftances of the utmoft importance. Though the venereal difeafe is generally the fruit of unlawful embraces, yet it may be communicated to the innocent as well as the guilty. Infants, nur- fes, mid wives, and married women, whofe hufbands lead diffolute lives, are often affected with it, and frequently lofe their lives by not being aware of their danger in due time. The unhappy condition Kk o£ 498 OF..THE VIRULENT GONORRHOEA. of fuch perfons will certainly plead our excufe, if any excufe be neceffary, for endeavouring to point out the fymptoms and cure of this too common dif- eafe. To enumerate all its different fymptoms, however, and to trace the difeafe minutely through its various ftages, would require a much larger fpace than falls to this part of my fubject; 1 fhall therefore confine my obfervations chiefly to circumftances of import- ance, omitting fuch as are either trifling, or which occur but feldom. I fliall likewife pafs over the hif- tory of the difeafe, with the different methods of treatment which it has undergone fince it was firft introduced into Europe, and many other circumftan- ces of a fimilar nature; all of which, though they might tend to amufe the reader, yet could afford him little or no ufeful knowledge. OF THE VIRULENT GONORRHOEA. The virulent gonorrhoea is an involuntary dif- charge of infectious matter from the parts of ge- neration in either fex. It generally makes its ap- pearance within eight or ten days after the infec- * tion has been received : fometimes indeed it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the dif- charge, the patient feels an itching with a fmall de- gree of pain in the genitals. Afterwards a thin glai- ry matter begins to diftil from the urinary paffage, which Stains the linen, and occafions a fmall degree of titillation, particularly in the time of making wa- ter ; this gradually ihcreafing, arifis at length to a degree of heat and pain, which are chiefly perceiv- ed about the extremity of the urinary paffage, where a flight degree of rednefs and inflammation likewife begin to appear. As OF THE VIRULENT GONORRHOEA. 499 As the diforder advances, the pain, heat of urine, and running, increafe, while frefh fymptoms daily enfue. In men the erections become painful and involuntary, and are more frequent and lafting than when natural. This fymptom is moft troublefome when the patient is warm in bed. The pain which was at firft only perceived towards the exiremity, now begins to reach all up the urinary paffage, and is moft intenfe juft after the patient has done making water. The running gradually grows yellow, and at length puts on the appearance of matter. When the diforder has arrived at its height, all the fymptoms are more intenfe ; the heat of urine is fo great, that the patient dreads the making wa- ter ; and though he feels a conftant inclination this way, yet it is rendered with the greateft difficulty, and often only by drops: the involuntary erections now become extremely painful and frequent; there is alfo a pain, heat, and fenfe of fulnefs about the feat, and the running is plentiful and fliarp, of a brown, greenifh, and fometimes of a bloody co- lour. By a proper treatment the violence of the fymp- toms gradually abates; the heat of urine goes off; the involuntary and painful erections, and the heat and pain about the feat, become eafier ; the running alfo gradually decreafesj grows whiter and thicker, till at laft it entirely difappears. By attending to thefe fymptoms, the gonorrhoea may be generally diftinguifhed from any other dif- eafe. There are however fome few diforders for which it may be miftaken, as an Ulcer in the kid- nies or bladder, the fluor albus or whites in women, &c. But in the former of thefe, the matter comes away only with the urine, or when the fphincter of the bladder is open; whereas in a gonorrhoea, the difcharge is conftant. The latter is more difficult K k 2 to fee OF THE VIRULENT GONORRHOEA. to diftinguifh, and muft be known chiefly from Its effects, as pain, communicating the infection, &c. REGIMEN.----When a perfon has reafon to fufpect that he has caught the venereal infection, he ought moft flrictly to obferve a cooling regimen, to avoid every thing of an heating nature, as wines, fpirituous liquors, rich fauces, fpiced, falted, high- feafoned and fmoke-dried provifions, &c. as alfo all aromatic and ftimulating vegetables, as onions, garlic, Shallot, nutmeg, muftard, cinnamon, mace, ginger, and fuch like. His food ought chiefly to confift of mild vegetables, milk, broths, light pud- dings, panada, gruels, &c. His drink may be barley-water, milk and water, decoctions of marfh- mallows and liquorice, flaxfeed-tea, or clear whey. Of thefe he ought to drink plentifully. Violent exercife of all kinds, efpecially riding on horfeback, and venereal pleafures, are to be avoided. The patient muft beware of cold, and when the inflam- mation is violent, he ought to keep his bed. MEDICINE.-----A virulent gonorrhoea cannot always be cured fpeedily and effectually at the fame time. The patient ought therefore not to expect, nor the phyfician to promife it. It will often con- tinue for two or three weeks, and fometimes for five or fix, even where the treatment has been very proper. Sometimes indeed a flight infection may be car- ried off in a few days, by bathing the parts in warm milk and water, and injecting frequently up the ure- thra a little fweet oil or linfeed-tea about the warmth of new milk. Should thefe not fucceed in carrying off the infection, they will at leaft have a tendency to leffen its virulence. To effect a cure, however, aftringent injections will generally be found neceflary. Thefe may be various ways prepared, but I think thofe made with the OF THE VIRULENT GONORRHOEA. 501 the white vitriol are both moft fafe and efficacious. They can be made Stronger or weaker as circum- ftances may require; but it is beft to begin with the more gentle, and increafe their power if neceffary. I generally order ^a drachm of white vitriol to be diffolved in eight or nine ounces of common or rofe- water, and an ordinary fyringe full of it to be thrown up three or four times a-day. If this quan- tity does not perform a cure, it may be repeated, and the dofe increafed*. Whether injections be ufed or not, cooling purges are always proper in the gonorrhoea. They ought not however to be of the ftrong or draftic kind. Whatever raifes a violent commotion in the body increafes the danger, and tends to drive the difeafe deeper into the habit. Procuring two or three ftools every fecond or third day for the firft fort- night, and the fame number every fourth or fifth day for the fecond, will generally be fuflicient to re- move the inflammatory fymptoms, to diminifh the running, and to change its colour and confiftence. It gradually becomes more white and ropy as the virulence abates f. * Although it is now very common to cure the gonorrhoea by aftringent injeclions, there are ftill many practitioners who do not approve this mode of practice. I can, however, from much experience, afTert, that it is both the moft eafy, elegant, and efficacious method of cure ; and that any bad confeqnences arifing from it muft be owing to the ignorance or mifconduft of the practitioner himfelf, and not to the remedy. Many, for example, ufe ftrong preparations of lead, all of which are dangerous when applied to the internal furfaces of the body ; others ufe efcharotics, which inflame and injure the parts. I have known a gonorrhoea actually cured by an injection made of green-tea, and would always recommend gende methods where they will fucceed. f If the patient can fwallow a folution of falts and mannn, he may take fix drachms, or, if his conftitution requires it, an ounce of the former, with half an ounce of the latter. Thefe K k 3 may $*2 OF THE VIRULENT GONORRHOEA. When the inflammatory fymptoms run high, bleeding is always neceffary at the beginning. This operation, as in other topical inflammations, muft be repeated according to the ftrength and coniza- tion of the patient, and the vehemence and urgency of the fymptoms. Medicines which promote the fecretion of urir.e, are likewife proper in this flage of the diforder. For this purpofe, an ounce of nitre and two ounces of gum-arabic, pounded together, may be divided into twenty-four dofes, one of which may be taken frequently in a cup of the patient's drink. If thefe fhould make him pafs his urine fo often as to be- come troublefome to him, he may either take them lefs frequently, or leave out the nitre altogether, and take equal parts of gum-arabic and cream of tartar. Thefe mr.y be pounded together, and a tea-fpoonful taken in a cup of the patient's drink may be diffolved in an Englifh pint of boiling water, whey, or thin water-gruel, and taken early in the morning. If an infufion of fenna and tamarinds be more agreeable, two drachms of the former, and an ounce of the latter, may be infufed all night in an Englifh pint of boiling water. The infufion may be ftrained next morning, and half an ounce of Glauber's falts diffolved in it. A tea-cupful of this infufion may be taken every half hour till it operates. Should the patient prefer an elecluary, the following will be* found to anfwer very well. Take of the lenitive elecf uary four ounces, cream of tartar two ounces, jalap in powder two drachm-, rhubarb one drachm, and as much of the fyrup of pale rofes as will ferve to make up the whole into a foft elec- tuary. Two or three tea fpoonfuls of this may be taken over- night, and about the fame quantity next morning, every day that the patient chufes to take a purge. The dofes of the above medicines may be increafed or dimi- nifhed according as the patient finds it neceffary. We have ordered the falts to be diffolved in a large quantity of water, becaufe it renders their operation more mild. four OF THE VIRULENT GONORRHOEA. 503 four or five times a-day. I have generally found this anfwer extremely well, both as a diuretic, and for keeping the body gently open. When the pain and inflammation are feated high towards the neck of the bladder, it will be proper frequently to throw up an emollient clyfter, which, befides the benefit of procuring ftools, will ferve as a fomentation to the inflamed parts. Soft poultices, when they can conveniently be applied to the parts, are of great fervice. They may be made of the flour of liufeed, or of wheat- bread and milk, foftened with frefli butter or fweet oil. When poultices cannot be conveniently ufed, cloths wrung out of warm water, or bladders filled with warm milk and water, may be applied. I have often known the moft excruciating pains, during the inflammatory ftate of the gonorrhoea, relieved by one or other of thefe applications. Few things tend more to keep off inflammation in the fpermatic veffels, than a proper trufs for the ferotum. It ought to be fo contrived as to fupport the tefticles, and Should be worn from the firft appearance of the difeafe till it has ceafed fome weeks. The above treatment will fometimes remove the gonorrhoea fo quickly, th:.t the perfon will be in doubt whether he really laboured under that difeafe. This, however, is too favourable a turn to be often expected. When the above treatment has removed the heat of urine, and forenefs of the genital parts ; when the quantity of running is confider.ibly leffened, without any pain or fwelling in the groin or teftiele fupervening ; when the patient is free from involun- tary erections; and laftly, when the running becomes pale, whitifli, thick, void pf ill fmell, and tenacious or ropy ; when all or moft of chefe fymptoms appear, K k 4 the 504 OF GLEETS. the gonorrhoea is arrived at its laft ftage, and we may gradually proceed to treat it as a gleet, with aftrin- gent and agglutinating medicines. OF GLEETS. A gonorrhoea frequently repeated, or improperly treated, often ends in a gleet, which may either pro- ceed from relaxation, or from fome remains of the difeafe. It is, however, of the greateft importance, in the cure of the gleet, to know from which of thefe caufes it proceeds. When the difcharge proves very obftinate, and receives little or no check from aftrin- gent remedies, there is ground to fufpect that it is owing to the latter ; but, if the drain is inconftant, ancl is chiefly obfervable when the patient is ftimulated by lafcivious ideas, or upon ftraining to go to ftool, we may reafonably conclude, that it is chiefly owing to the former. In the cure of a gleet proceeding from relaxation, the principal defign is to brace, and reftore a proper degree of tenfion to the debilitated and relaxed veffels. For this purpofe, befides the medicines recommended in the gonorrhoea, the patient may have recourfe to flronger and more powerful aftringents, as the Peru- vian bark*, alum, vitriol, galls, tincture of gum kino, Sec. The injections may be rendered more aftringent by the addition of a few grains of alum, or increafing the quantity of vitriol as far as the parts are able to * The Peruvian bark may be combined with other aftrhv gents, and prepared in the following manner: Take of Peruvian bark bruifed fix drachms, of frefli galls bruifed two drachms; boil them in a pound and a half of water to a pc und : to the ftrained liquor add three ounces of the fimple tincture of the bark. A fmall tea-cupful of this may be taken three times a-day, adding to each cup fifteen or twenty drops of the acid elixir of vitriol. bear OF GLEETS. 505 bear it. From twenty to fixty drops of the balfam capivi, or oil of turpentine, taken two or three times a-day, in a little fugar and water, will be found to be one of the moft powerful medicines in thefe cafes. The laft remedy which we fhall mention in this cafe is the cold bath, than which there is not per- haps a more powerful bracer in the whole compafs of medicine. It ought never to be omitted in this fpecies of gleet, unlefs there be fomething in the conftitution of the patient which renders the ufe of it unfafe. The chief objections to the ufe cf the cold bath are, a full habit, and an unfound ftate of the vifcera. The danger from the former may always be leffened, if not removed, by purging and bleeding ; but the latter is an unfathomable obftacle, as the preffure of the water, and the fudden con- traction of the external veffels, by throwing the blood with too much force upon the internal parts, are apt to occafion ruptures of the veffels, or a flux of humors upon the difeafed organs. But where no objection of this kind prevails, the patient ought to plunge over head in water every morning fafting, for three or four weeks together. He fhould not, however, ftay long in the water, and fhould take care to have his fkin dried as foon as he comes out. The regimen proper in this cafe, is the fame as was mentioned in the laft ftage of the gonorrhoea: the diet muft be drying and aftringent, and the drink Spa, Pyrmont, or Briftol waters, with which a little claret or red wine may fometimes be mixed. Any perfon may now afford to drink thefe waters, as they can be every where prepared at almoft no expence, by a mixture of common chalk and oil of vitriol. When the gleet does not in the fmalleft degree yield to thefe niediciues, there is reafon to fufpect that it proceeds from ulcers. In this cafe, recourfe muft 506 OF GLEETS. muft be had to mercury, and the decoction of China, farfaparilla, faffafras, or the like. Mr. Fordyce fays, he has feen many obftinate gleeta of two, three, or four years Handing, effectually cured by a mercurial inunction, when almoll every other medicine has been tried in vain. Dr. Chapman feems to be of the fame opinion ; but fays, he has always found the mercury fucceed bell, in this cafe, when joined with terebinthinate and other agglutu nating medicines. For which reafon, the Doctor recommends pills made of calomel and Venice tur- pentine* ; and defires that their ufe may be accom- panied with a decoction of guaiacum or farfaparilla. The laft kind of remedy which we fhall mention for the cure of ulcers in the urinary paffage, are the fuppurating candles or bougies: as thefe are pre* pared various ways, and are generally to be bought ready made, it is needlefs to fpend time in enume- rating the different ingredients of which they are compofed, or teaching the manner of preparing them,, Before a bougie be introduced into the urethra, however, it fhould be fmeared all over with fweet oil, to prevent it from ftimulating too fuddenly; it may be fuffered to continue in from one to feven or eight hours, according as the patient can bear it. Obftinate ulcers are not only often healed, but tu> mors and excrcfeences in the urinary paffages taken away, and an obftructi n of urine removed, by means of bougies. Obftinate gleets may be removed by the ufe of bougies. * Take Venice turpentine, boiled to a fufficient degree'of hardnefs, half an ounce, calomel half a drachm. Let thefe be mixed into fixty pits, cf which five or fix may be taken nighr and morning. If, daring the uie ol thefe pills, the month fhould grow fore, or the breath become olfenfive, they muft be difcontinued till thefe fymptoms disappear. OF C S°7 1 OF THE SWELLED TESTICLE. The fwelled tefticle may either proceed from in- fection lately contracted, or from the venereal poifon lurking in the blood : the latter, indeed, is not very common, but the former frequently happens, both in the firft and fecond ftages of a gonorrhoea; par- ticularly when the running is unfeafonably checked, by cold, hard drinking, flrong draftic purges, vio- lent exercife, the too early ufe of aftringent medi- cines, or the like. In the inflammatory ftage bleeding is neceffary, which muft be repeated according to the urgency of the fymptoms *. The food muft be light, and the drink diluting. High feafoned food, flefh, wines, and every thing of an heating nature, are to be avoid- ed. Fomentations are of fingular fervice. Poul- tices of bread and milk, foftened with frefli butter or oil are likewife very proper, and ought to be ap- plied when the patient is in bed, where he ought to be conftantly: when he gets up, the tefticles Should be kept warm, and fupported by a bag or trufs. If it fliould be found impracticable to cure the tefticle by the cooling regimen now pointed out, and extended according to circumftances, it will be neceffary to lead the patient through fuch a com- plete anti-venereal courfe as fhall enfure him againft any future uneafinefs. For this purpofe, befides rubbing the mercurial ointment on the part, if free from pain, or on the thighs, the patient muft be confineJ to bed, if neceflary, for five or fix weeks, "* I have been accuftomed, for fume time paft, to npply leeches to inflamed tefticles, which practice, has always been followed with the moft happy effecls. fufpending 508 OF BUBOES. fufpending the tefticle all the while with a bag or trufs, and plying him inwardly with ftrong decoc- tions of farfaparilla. When thefe means do not fucceed, and there is reafon to fufpect a ferophulous or cancerous habit, either of which may fupport a fchirrous induration, after the venereal poifon is corrected, the parts fhould be fomented daily with a decoction of hem- lock, the bruifed leaves of which may likewife be added to the poultice, and the extract at the fame ' time taken inwardly *. This practice is ftrongly re- commended by Dr. Stork in fchirrous and cancerous cafes; and Mr. Fordyce affures us, that by this me- thod he has cured difeafed tefticles of two or three years Standing, even when ulcerated, and when the fchirrus had begun to be affected with pricking and lancing pains. OF BUBOES. Venereal buboes are hard tumors feated in the groin, occafioned by the venereal poifon lodged in this part. The cure of recent buboes, that is, fuch as appear foon after impure coition, may be firft attempted by difperfion, and, if that fhould not fucceed, by fuppu- ration. To promote the difperfion of a bubo, the fame regimen muft be obferved as was directed in the firft ftage of a gonorrhoea. The patient muft likewife be bled, and take fome cooling purges, as the decoction of tamarinds and fenna, Glauber's falts, and the like. If, by this courfe, the fwelling and other inflammatory fymptoms abate, we may * The extract of hemlock may be made into pills, and taken in the manner directed under the article Cancer. fufely (OF CHANCRES. 5o9 fafely proceed to the ufe of mercury, which muft be continued till the venereal virus is quite fubdued *. But if the bubo fliould, from the beginning, be r attended with great heat, pain, and pulfation, and it 'ir cannot be difperfed, it will be proper to promote its K fuppuration. For this purpofe the patient may be allowed to ufe emollient cataplafms, confilting of J bread and milk, foftened with oil or frefh butter, I Applied to the part; and, in cold conftitutions, where VA the tumor advances flowly, while lily-roots boiled, I or fliced onions raw, and a fufficient quantity of ; yellow bafilicon, may be added to the poultice. When the tumor is ripe, which may be known by its conical figure, the foftnefs of the ikin, and a fluctuation of matter plainly to be felt under the finger, it may be opened either by a cauftic or a lancet, and afterwards dreffed with digeftive oint- ment f. It fometimes however happens, that buboes can neither be difperfed nor brought to a fuppuration, but remain hard, indolent tumors. In this cafe, the indurated glands muft be confumed by cauftic; if they fhould become fchirrous, they muft be dif- folved by the application of hemlock, both exter- \ nally and internally, as directed in the fchirrous tefticle. OF CHANCRES. Chancres are fuperficial, callous, eating ulcers; which may happen either with or without a gonor- rhoea. They are commonly feated about the glans, * For the difperfion of a bubo, a number of leeches ap- plied to the part affected will be found equally efficacious as in the inflamed tefticle. f The cauftic is preferable to the lancet, but it is better if they will open of themfelves. and 510 OF CHANCRES. and make their appearance in the following manner Firft a little red pimple arifes, which foon becomes pointed at top, and is filled with a whitifli matter in- clining to yellow. This pimple is hot, and itches generally before it breaks: afterwards it degenerates into an obftinate ulcer, the bottom of which is ufually covered with a vifcid mucus, whofe edges gradually become hard and callous. Sometimes the firft appearance refembles a fimple excoriation of the cuticle ; which, however, if the caufe be venereal, foon becomes a true chancre. A chancre is fometimes a primary affection, but it is much oftener fymptomatic, and is the mark of a confirmed lues. Primary chancres difcover them- felves foon after impure coition, and are generally feated in parts covered with a thin cuticle, as the lips, the nipples of women, the glans penis of men, &c. * When a chancre appears foon after impure coi- tion, its treatment is nearly fimilar to that of the virulent gonorrhoea, if there is much inflammation. The patient muft obferve the cooling regimen, lofe a little blood, and take fome gentle dofes of falts and manna. The parts affected ought frequently to be bathed, or rather foaked, in warm milk and water, and, if the inflammation be great, an emollient poul- tice or cataplafm may be applied f to them. This courfe will, in moft cafes, be fufficient to abate the inflammatiunj and prepare the patient for the ufe of mercury. * When venereal ulcers are feated in the lips, the infection may be communicated by kiffing. I have feen very obftinate venereal ulcers in the lips, which I had all the reafon in the world to believe were communicated in this manner. Nurfes ought to beware of fuckling infected children, or having their brealts drawn by perfons tainted with the venereal difeafe. This caution is peculiarly neceffary for nurfes who refide in the neighbourhood of great towns. Symp- OF CHANCRES. 511 Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, feurfy erup- tions about the roots of the hair, and other fymp- toms of a confirmed lues. Though they may be ' feated in any of the parts mentioned above, they commonly appear upon the private parts, or the infide of the thigh. They are alfo lefs painful, but fre- quently much larger and harder than primary chancres. As their cure mult depend upon that of > the pox, of which they are only a fymptom, we fhall take no further notice of them, till we come to treat of a confirmed lues *. Thus we have related moft of the fymptoms which accompany or fucceed a virulent gonorrhoea, or lues, and have alfo given a Short view of their proper treatment; there are, however, feveral others which \ fometimes attend this difeafe, as a ftrangury, or ob- y ftruction of urine, a phymofis, paraphymofts, Sec A ftrangury may be occasioned either by a fpaf- f. modic conftriction, or an inflammation of the ure- * thra and parts about the neck of the bladder. In 1 the former cafe, the patient begins to void his urine with tolerable eafe ; but, as foon as it touches the galled or inflamed urethra, a fudden conftriction takes place, and the urine is voided by fpurts, and fometimes by drops only. When the ftrangury is ;, owing to an inflammation about the neck of the bladder, there is a conftant heat and uneafinefs of the part, a perpetual defire to make water, while the patient can only render a few drops, and a * I have found it anfwer extremely well to fprinkle chancres twice a-day with calomel. This will often perform a cure with- out any other application whatever. If the chancres are upon the j glans, they may be wafhed with milk and water, a little warm, and afterwards the calomel may be applied as above, or they may be touched with the lunar cauftic for two or three davs, and then dreffed with red precipitate finely powdered. trouble Si* OF CHANCRES. troublefome tenefmus, or conftant inclination to go to ftool. When the ftrangury is owing to fpafm, fuch me- dicines as tend to dilute and blunt the falts of the urine will be proper. For this purpofe, befides the common diluting liquors, foft and cooling emul- fions, fweetened with the fyrup of poppies, may be ufed. Should thefe not have the defired effect, bleeding, and emollient fomentations, will be ne- ceffary. When the complaint is evidently owing to an inflammation about the neck of the bladder, bleed- ing muft be more liberally performed, and repeated according to the urgency of the fymptoms. After bleeding, if the ftrangury ftill continues, foft clyf- ters, with a proper quantity of laudanum in them, may be adminiftered, and emollient fomentations ap- plied to the region of the bladder. At the fame time, the patient may take, every four hours, a tea- cupfull of barley-water, to a pint of which half an ounce of nitre may be added. If thefe remedies fhould not relieve the complaint, and a total fup- preffion of urine Should come on, bleeding muft be repeated, and the patient fet in a warm bath up to the middle. It will be proper in this cafe to dif- eontinue the diuretics, and to. draw off the water with the catheter; but as the patient is feldom able to bear its being introduced, we would rather recom- mend the ufe of mild bougies. Thefe often lubricate the paffage, and greatly facilitate the difcharge of urine. Whenever they begin to ftimulate or give any uneafinefs, they may be withdrawn. The phymofls is fuch a conftriction of the prepuce over the glans, as hinders it from being drawn back- wards ; the paraphymofis, on the contrary, is fuch a conftriction of the prepuce behind the glans, as hinders it from being brought forward. a The OF A CONFIRMED LUES'. 513 The treatment of thefe fymptoms is fo nearly the fame with that of the virulent gonorrhoea, that we have no occafion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomen- tations are fufficient. Cold water dropt on the part has fometimes relieved the moft violent cafes, efpe- cially if it be applied for a confiderable time. It fometimes happens, that, in fpite of all endea- • vours to the contrary, the inflammation goes on, and fymptoms of a beginning mortification appear. When this is the cafe, the prepuce muft be fearified with a lancet, and, if neceffary, divided, in order to prevent a ftrangnl.ition, and fet the imprifoned glans at liberty. We fliall not defcribe the manner of performing this operation, as it ought always to be done by a furgeon. When a mortification has actually taken place, it will be neceffary, befides performing the above operations, to foment the parts frequently with cloths wrung out of a ftrong decoction of camomile-flowers and bark, and to give the patient a drachm of the bark in powder every two or three hours. With regard to the priapifm, chordee, and other diflortions of the penis, their treatment is no way different from that of the gonorrhoea. When they prove very troublefome, the patient may take a dofe of laudanum at night, efpecially after the ope- ration of a purgative through the day. OF A CONFIRMED LUES. We have hitherto treated of thofe affections in which the venereal poifon is fuppofed to be confined chiefly to the particular part by which it was rer ceived, and fliall next take a view of the lues in its confirmed ftate ; that is, when the poifon is actually received into the blood, and, circulating with ir, L 1 through 514 OF A CONFIRMED LUES. through every part of the body, niixes with the feveral fecretions, and fenders the whole habit tainted. The fymptoms of confirmed lues are, chancres, buboes in the groin, pains of the head and joints, 'which are peculiarly troublefome in the night, or when the patient is warm in bed; fcahs and fcurfs in various parts of the body, efpecially oh the head, of a yellowifh colour, fefembling a honey-comb; corroding ulcers in various parts of the body, which generally begin about the throat, from whence they , creep gradually, by the palate, towards the carti- lage of the uofe, which they deftroy; eruptions in different parts, excrefcences or exoftofes arife ih the middle of the bones, and their fpongy ends become brittle ; and break upon the leaft accident; at other times they are foft, and bend like wax; the conglo- bate glands becohle hard and callous, and form, in the neck, armpits, groin, and mefentery, hard moveable tumours, like the king's evil; tumours of different kinds are likewife formed in the lymphatic veffels, tendons, ligaments, and nerVes, as the gum- mata, ganglia, nodes, tdphs, &c; the eyes are af- fected with itching, pain, rednefs, and fometimes with total blindnefs, and the ears with a finging noife, pain, and deafnefs, whilft their internal fub- ftance is exuleerated and rendered carious; at length all the animal, vital, and natural functions are de- praved ; the face becomes pale and livid ; the body emaciated and unfit for motion, and the miferable patient falls into an atrophy or wafting confumption. Women have fymptoms peculiar to the fex; as cancers of the breaft^ a fuppreffion or overflowing of the menfes; the whites ; hyfteric affections ; an inflammation, abfcefs, fchirrhus, gangrene, cancer, or ulcer of the womb; they are generally either barren or fubject to abortion; or, if they bring children OF A CONFIRMED LUES. Si$ children into the world, they have an univerfal ery- fipelas, are half rotten, and covered with ulcers. Such is the catalogue of fymptoms attending this dreadful difeafe in its confirmed ftate. Indeed they are feldom all to be met with in the fame perfon, or at the fame time; fo many of them, however, are generally prefent as are fufficient to alarm the patient; and if he has reafon to fufpect the infection " is lurking in his body, he ought immediately to fet about the expulfion of it, otherwife the moft tragi- cal confequences may enfue. The only certain remedy hitherto known for the cure of this difeafe, is mercury, which may be ufed in a great variety of forms, with nearly the fame fuccefs. Some time ago it was reckoned impoffible to cure a confirmed lues without a falivation. This method is now however pretty generally laid afide, and mercury is found to be by far moft efficacious • in expelling the venereal poifon, when adminiftered in fuch a manner as not to run off by the falivary glands. The moft certain mode of curing this difeafe is to introduce mercury into the fyftem until we obferve the fymptoms to give way, then continue its ufe * until the fymptoms entirely difappear and for fome time afterwards. If we ufe the mercurial ointment half a drachm may be rubbed into the infide of the thighs, or legs, or arms, twice a-day, taking care, daily to wafh thefe parts with warm water and Caftile foap. If we ufe mercury internally, the mercurial pill, fee Appendix, may be given in common cafes, from one to three every day. If the fymptoms are violent or the ikin affected, t>fce folution-%r pill of fublimate, fee Appendix. This laft in fmall dofes agrees beft with children. The main point is to charge the body with mercury, and this may be effected, by not letting it run off by the bowels, L 1 z which 516 OF A CONFIRMED LUES. which a little opium will prevent; and not getting cold, which would bring on a falivation. It is impoffible to afcertain either the exact quan- tity of medicines that muft be taken, or the time they ought to be continued, in order to perform a cure. Thefe will ever vary according to the confti- tution of the patient, the feafon of the year, the degree of infection, the time it has lodged in the bo- dy, &c. But though it is difficult, as Aftruc ob- ferves, to determine a priori, what quantity of mer- cury will, in the whole, be neceffary to cure this diftemper completely ; yet it may be judged of el pofteriori, from the abatement and ceafing of the fymptoms. The fame author adds, that commonly not lefs than two ounces of the ftrong mercurial ointment is fufficient, and not more than three or four ounces neceffary. Several roots, woods, and barks, have been re- commended for curing the venereal difeafe; but, none of them have been found, upon experience, to anfwer the high eucomiums, which had been be- llowed upon them. Though no one of thefe is to be depended upon alone, yet, when joined with mercury, fome of them are fund to be very bene-* ficial in promoting a cure. One of the beft we know yet is farfaparilla, which may be prepared and taken according to the directions in the Appen- dix *. The mezereon-root is likewife found to be a pow- erful afliitant to the fublimate, or any other mercu- rial. It may either be ufed along with the farfapa- rilla, as directed in the appendix or by itfelf. Thofe who chufe to ufe the inezerecn by itfelf, may boil an ounce of the frefli bark, taken from the root, in twelve pints of water to eight, adding towards the * See Appendix, D.eotl. of Sarrapwil/a end OF A CONFIRMED LUES. 517 tnd an ounce of liquorice. The dofe of this is the fame as of the decoction of farfaparilla. , We have been told that the natives of America cure the venereal difeafe, in every ftage, by a decoc- tion of the root of a plant called the Lobelia. It is ufed either frefh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as thofe of the ranun- culus, the ceanothus, &c; but whether thefe are defigned to difguife or aflift it, is doubtful. The pa- tient takes a large draught of the decoction early in the morning, and continues to ufe it for his ordinary * drink through the day *. It has of late years been I afferted that opium alone, in large dofes, would entire- ly cure this difeafe. It is certain that opium is of great fervice by leffening the irritability of the bow- i els, and by the relief it gives in thofe cafes of violent pain which fo often accompany this difeafe, and there * Though we are ftill very much in the dark with regard to the method of curing this difeafe among the natives of Ame- rica, yet it is generally affirmed, that they do cure it with fpeed, fafety, and fuccefs, and that without the leaft knowledge of mercury. Hence it becomes an object of confiderable import- ance to difcover their method of cure. This might furely be done by making trials of the various plants which are found in thofe parts, and particularly of fuch as the natives are known to make ufe of. All people in a rude ftate take their medicines chiefly from the vegetable kingdom, and are often poffeifed of valuable fecrets with regard to the virtues of plants, of which more enlightened nations are ignorant. . Indeed we make no doubt but fome plants of our own growth, were proper pains taken to difcover them, would be found as efficacious in curing the venereal difeafe as thofe of America. It muft, however, be remembered, that what will cure the venereal difeafe in one country, will not always be found to have equal fuccefs in ano- ther; and it is moft probable that no medicine but mercury wdl cure this difeafe; and although many dilirefllng fymptoms, fuch as ulcers, nodes, &c. remain after the proper ufe of mercury, yet thefe are not venereal, and are to be cured by fome of the many remedies here recommended. LI 3 is *»« OF A CONFIRMED LUES. is no doubt that many fores, originally of this nature, have been cured by it, but it does not certainly ap- pear that opium will do any thing more. Many other roots and foods might be mentioned which have beefi extolled for curing the venereal difeafe, as the china-root, the roots of foap-wort, burdock, &c. as alfo the wood of guaiacum and faf- fafras; but as none of thefe have been found to pof- fefs virtues fuperior to thofe already mentioned, we fliall, for the fake of brevity, pafs them over, and fliall conclude our .obfervations on this difeafe with a few general remarks concerning the proper manage- ment of the patient, and the nature of the infection. GENERAL OBSERVATIONS. The condition of the patient ought always to be confidered previoully to his entering upon a courfe of mercury in any form. It would be equally rafh and dangerous to adminifter mercury to a perfon labour- ing under any violent acute difeafe, as a fever, pleu- rify, peripneumony, or the like. It would likewife be dangerous in fome chronic cafes; as a flow hectic fever, or the laft ftage of a confumption. Sometimes, however, thefe difeafes proceed from a confirmed lues; in which cafe it will be neceffary to give mer- cury. In chronic difeafes of a lefs dangerous na- ture, as the afthma, the gravel, and fuch like, mer- cury, if neceffary, may be fafely adminiftered. If the patient's ftrength has been greatly exhaufted by ficknefs, labour, abftinence, or any other caufe, the ufe of mercury muft be poftponed, till by time, reft, and a nourishing diet, it can be fufficiently reftored. If in pregnancy circumftances render it neceffary, mercury may be given, but in fmaller dofes, and at greater intervals than ufual; with thefe precautions, both the mother and child may be cured at the fame time; OF A CONFIRMED LUES. 510 time ; if not, the diforder will at leaft be kept from, growing worfe, till the woman be brought to bed and fufficiently recovered, when a. more effectual method may be purfued, which, if fhe feckles her child, will in all probability be fufficient for the cure of both. Mercury ought always to be adminiftered to in- fants with caution. A fimilar conduct is recom- mended in* the treatment of old perfons, who have the misfortune to labour under a confirmed lues. Hyfteric perfons, and fuch as are fubject to an ha- bitual diarrhoea, or who are afflicted with the fcurvy, ought to be cautious in the ufe of mercury. Where. any one of thefe diforders prevails, it ought, if poflib'e, to be cured, or at leaft palliated, before the patient enters upon a courfe of mercury. When this.cannot be done, the mercury muft be adminif- tered in finalfer dofes, and at longer intervals than ufual. The moft proper feafons for entering upon a courfe of mercury, are the fpring, fummer, and autumn, when the air is of a moderate warmth. If the cir- cumflanees of the cafe, however, will not admit of delay, wc muft not defer the cure on account of the feafon, but muft adminifter the mercury; taking care at the fame time to keep the patient's chamber warmer or cooler according as the feafon of the yeaj requires. The next thing to be confidered is the preparation neceffary to be obferved before we proceed to ad- minifter a courfe of mercury. Some lay great ftrefs upon this circumftance, obferving, that by previoufly relaxing the veffels, and correcting any diforder which may happen to prevail in the blood, not only the mercury will be difppfed to act more kindly, but many other ineonveniencies will be prevented. We have already recommended bleeding and gentle purges, previoufly to the administration of L 1 4 mercury, £20 OF A CONFIRMED LUES. mercury, and fliall only now add, that thefe are al- ways to be repeated according to the age, ftrength, conftitution, and other circumftances of the patient. Afterwards, if it can be conveniently done, the pa- tient ought to bathe once or twice a-day, for a few days, in lukewarm water. His diet in the mean time muft be light, moift, and cooling. Wine, and all heating liquors, alfo violent bodily exercife, and all great exertions of the mind, are carefully to be avoided. A proper regimen is likewife to be obferved by fuch as are under a courfe of mercury. Inattention to this not only endangers the patient's life, but of- ten alfo difappoints him of a cure. A much fmaller quantity of mercury will be fufficient for the cure of a perfon who lives low, keeps warm, and avoids all manner of excefs, than of one who cannot endure to put the fmalleft reflraint upon his appetites: in- deed it but rarely happens that fuch are thoroughly cured. If, for want of proper attention to thefe cautions, the mouth fhould become fore, and faliva- tion come on, the patient may firft of all be bled, if the pulfe and conftitution require it. He muft keep in his chamber, take a tea-fpoonful of the flowers of fulphur twice a-day, in a little milk or molaffes, wafh his mouth with an aftringent gargle, and dif- continue the mercury ; this will generally fet all to rights in a few days. There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanlinefs. By an early attention to this, the infection might often be prevented from entering the body; and, where it has already taken place, iis effects may be greatly mitigated. The moment any perfon has reafon to fufpect that he has received the infection, he ought to wafh the parts with water and fpirits, fweet oil, or milk and water; a fmall quantity OF A CONFIRMED LUES. C2i of the laft may likewife be injected up the urethra, if it can be conveniently done. Whether this difeafe at firft took its rife from dirtinefs is hard to fay; but wherever that prevails, the infection is found in its greateft degree of virulence, which gives ground to believe that a ftrict attention to cleanlinefs would go far towards extirpating it altogether*. When the venereal difeafe has been neglected or improperly treated, it often becomes a diforder of the habir. In this cafe the cure muft be attempted by reftoratives, as a milk diet, the decoction of far- faparilla, and fuch like, to which mercury may be occafionally added. It is a common practice in North * I have not only feen a recent infection carried off in a few days by means of cleanlinefs, viz. bathing, fomentations, injec- tions, Oc. but have likewif • found it of the greareft advantage in the more advanced ftages of the difeafe. Of this I had lately a very remarkable inftance in a man whole penis was almoft wholly confumed by venereal ulcers; the matter had been al- lowed to continue on the Ores, without any care having been taken to clean tnem, till, notwithftanding the ufe of mercury and other medicines, it had produced the effects above men- tioned. I ordered warm milk and water to be injected three or four times a-day into all the finuous ulcers, in order to wafh out the matter; after which they were fluffed with dry lint to abforb the frefh matter-as it was generated. The patient at the fame time took every day half a grain cf the corrofive fubli- mate of mercury, dilfolved in an ounce of brandy, and drank a quart of the decoilion of farfaparilla. By this treatment, in about fix weeks, he was perfectl/cured; and, what was very remarkable, a part of the penis was actually regenerated. Doctor Gilchrift has given an account of a fpecies of the lues venerea which prevails in the weft of Scotland, to which the natives give the name of Sibbins or Sivvins. The Doctor ob- ferves, that the fpreading of this difeafe is chiefly owing to a neglect of cleanlinefs, and feems to think, that by a due atten- tion to that virtue, it might be extirpated. The treatment of this difeafe is fimilar to that of a confirmed lues or pox. The yaws, a difeafe which is now very common both in America and the Weft India iflands, may alfo be cured in the fame manner. Britain 522 OF A CONFIRMED LUES. Britain to fend fuch patients to drink goat-whey. This is a very proper plan, provided the infection has been totally eradicated before-hand ; but when that is not the cafe, and the patient trulls to the whey for finifhing his cure, he will often be difappointed. I have frequently known the difeafe return with all its virulence after a courfe of goat-whey, even when that courfe had been thought quite fufficient for com- pleting the cure. One of the moft unfortunate circumftances attend- ing patients in this difeafe, is the neceffity they are often laid under of being foot} weft. TJiis induces them to take medicine too fall, and to leave it off too foon. A few grains more of medicine, or a few days longer confinement, would often be fufficient to perfect the cure; whereas, by neglect of thefe, a fmall degree of virulence is ftill left in the humors, which gradually vitiates, and at length contami- nates the whole mafs. To avoid this, wc wou,ld advife, that the patient fhould never leave off taking medicine immediately upon the difappearing of the fymptoms, but continue it for fome time after, gra- dually leffening the quantity, till there is fufficient ground to believe that the difeafe is entirely eradi- cated. It is not ouly difficult, but abfolutely impoffible, to afcertain the exact degree o,f virulence that may attend the difeafe ; for which reafon it will always, be a much fafer rule to continue the ufe of medicine too long, than to leave it off too foon. This feems to be the leading maxim of a modern practitioner of feme note for the venerea] difeafe, who always orcfers, his patient to perform a quarantine of at leaft forty, days, during which time he takes forty bottles of, I fuppofe, a ftrong decoction of farfaparilla, or fome other anti-venereal fimple. Whoever takes this me- thod, and adds a fufficient quantity of corrofive fublimate, OF A CONFIRMED LUES. 523 fublimate, or fome other active preparation of mer- cury to the decoction, will generally cure a con- firmed lues. It is peculiarly unfortunate for the cur$ of this difeafe, that not one in ten of thofe who contract it, are either able or willing to fubmit to a pamper plan of regimen. The patient is willing to take medi- cine ; but he muft follow his bufinefs, and, to prevent fufpicions, muft eat and drink like the reft of the fa- mily. This is the true fource of nine-tenths of all the mifchief arifing from the venereal difeafe. I ne- ver knew the cure attended with any great difficulty or danger where the patient ftrictly followed the phy- fician's advice : but a volume would not be fufficient to point out the dreadful confequences which proceed from an oppofite conduct. Schirrous tefticles, ul- cerous fore throats, madnefs, confumptions, carious bones, and a rotten progeny, are a few of the blef- fings derived from this fource. There is a fpecies of falfe reafoning, with regard to this difeafe, which proves fatal to many. A per- fon of a found conftitution contracts a flight degree of the diforder. He gets well without taking any great care, or ufing much medicine, and hence concludes, that this will always be the cafe. The next time the difeafe occurs, though ten times more virulent, he purfues the fame courfe, and his conftitution is ruined. Indeed, the different degrees of virulence in the fmall- pox are not greater than in this difeafe, though, as the learned Sydenham obferves, in feme cafes the moft fkilful phyficians cannot cure, and in others the moft ignorant old woman cannot kill the patient in that diforder. Though a good conftitution is always in favour of the patient, yet too great ftrefs may be laid upon it. It does not appear from obfervation, that the rood robuft conftitution is able to over- come the virulence of the venereal contagion, after it 5 24 DISEASES OF WOMEN. it has got into the habit. In this cafe a proper courfe of medicine is always indifpenfably neceffary. Although it is impoffible, on account of the dif- . ferent degrees of virulence, Sec to lay down fixed and certain rules for the cure of this difeafe, yet the following general plan will always be found fafe, and often fuccefsful, viz. to bleed and adminifter gentle purges with diuretics during the inflammatory ftate, and as foon as the fymptoms of inflammation are abated, td adminifter mercury in the form that is beft fuited to the fymptoms. The fame medicine, affifted by the decoction of farfaparilla, and a proper regimen, will not only fecure the constitution againft the further .progrefs of a confirmed pox, but will generally perform a complete cure; and if the pa- tient is weakened by the courfe, or by the difeafe, the bark, reftorative diet, and above all, country air, will be neceffary to reftore his health. CHAP. XLIX. Difeafes cf Women. WOMEN, in all civilized nations, have the management of domeftic affairs, and it is very proper they fhould, as Nature has made them lefs fit for the more active and laborious employments. This indulgence, however, is generally carried too far ; and females, inftead of being benefited by it, are greatly injured, from the want of exercife and free air. To be fatisfied of this, one need only compare the frefli and ruddy looks of a milk-maid, with the pale complexion of thofe females whofe whole OF THE MENSTRUAL DISCHARGE. 525 whole time is fpent within doors. Though Nature has made an evident distinction between the male and female with regard to bodily ftrength and vi- gour, yet fhe certainly never meant, either that the one fhould be always without, or the other always within doors. The confinement of females, befides hurting their figure and complexion, relaxes their folids, weakens their minds, and diforders all the functions of the body. Hence proceed obstructions, indigeftions, fla- tulencies, abortions, and the whole train of nervous diforders. Thefe not only unfit women for being mothers and nurfes, but often render them whimfi- cal and ridiculous. A found mind depends fo much upon a healthy body, that where the latter is want- ing, the former is rarely to be found. I have always obferved, that women who were chiefly employed without doors, in the different branches of hufbandry, gardening, and the like, were almoft as hardy as their hufbands, and that their children were likewife ftrong and healthy. But as the bad effects of confinement and inactivity upon both fexes have been already fhewn, we fhall proceed to point out thofe circumftances in the Structure and de- sign of females, which fubject them to peculiar dii- eafes ; the. chief of which are, their monthly evacua- tions, pregnancy, and child-bearing. Thefe indeed cannot properly be called difeafes, but from the de- licacy of the fex, and their being often improperly managed in fuch fituations, they become the fource of numerous calamities. OF THE MENSTRUAL DISCHARGE. Females generally begin to menftruate about the age of fifteen, and leave it off about fifty, whicii renders thefe two periods the meft critical of their lives. S2o* OF THE MENSTRUAL DISCHARGE. lives *. Abotrt the firft appearance of this difcharge, the conftitution undergoes a very confiderable change, generally indeed for the better, though fometimes for the worfe. The greateft care is now neceffary, as the future health and happinefs of the female depends in a great meafure upon her conduct at this period \. If a girl about this time of life be confined to the houfe, kept constantly fitting, and neither allowed to run about, nor employed in any active bufinefs, which gives exercife to the whole body, fhe becomes weak, relaxed, and puny ; her blood not being duly prepared, She looks pale and wan ; her health, fpi- rits, and vigor decline, and fhe finks into a valetu- dinarian for life. 5iuch is the fate of numbers of thofe unhappy females, Who, either from too much indulgence, or their own narrow circumftances', are, at this critical period, denied the benefit of exercife and free air. A lazy indolent difpofition proves likewife very hurtful to girls at this period. One feldom meets with complaints from obstructions amongft the more active and induftrious part of the fex; whereas the indolent and lazy are feldom free from them. Thefe are in a manner eaten up by the chlorofis, or green- * This period, however, varies in different countries. It occurs earlieft in fouthern climates. f It is the duty of mothers, and thofe who are entrufted with the education of girls, to inftruct them early in the conduct and management of themfelves at this critical period of their lives. Falfe modefty, inattention, and ignorance of what is beneficial or hurtful at this time, are the fources of many difeafes and misfortunes in life, which a few fenfible leffons fiom an experi- enced matron might have prevented. Nor is care lefs neceffary in the fubfequent returns of this difcharge. „Tak''ng ;mproper food, violent affections of the mind, or catching cold at this pe- riod, is often fufficient to ruin the health, or to render the fe- male ever after incapable of procreation. ficknefs. OF THE MENSTRUAL DISCHARGE. 527 ficknefs, and other difeafes of this nature. We would therefore recommend it to all who wifh to efcape thefe calamities, to avoid indolence and inactivity, as their greateft enemies, and to be as much abroad in the open air as poffible. Another thing which proves very hurtful to girls ahout this period of life, is unwholefome food. Fond of all manner of traih, they often indulge in it, till their whole humors are quite vitiated. Hence enfue indigeftions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impoffible that the fecretions fhould go pro- perly on. Accordingly We find, that fuch girls as lead an indolent life, and eat great quantities of trafh, are not only fubject to obftructions of the menfes, but likewife to glandular obftructions; as the fcrophula or king's evil, &c. A dull difpofition is alfo very hurtful to girls at this period. It is a rare thing to fee a fprightly girl Who does not enjoy good health, while the moping, melancholy creature, proves the very prey of vapours and hyfterics. Youth is the feafon for mirth and cheerfulnefs. Let it therefore be indulged. It is an abfolute duty. To lay in a flock of health in lime of youth, is as neceffary a piece of prudence, as to make provifion againft the decays of old age. While, therefore, wife Nature prompts the happy youth to join in fprightly amufements, let not the fevere dictates of hoary age forbid the ufeful impulfe, nor damp, with ferious gloom, the feafon deftined to mirth and innocent feftivity. Another thing very hurtful to females about this period of life is ftrait clothes. They are fond of a fine fhape, and foolifhly imagine that this can be acquired by "lacing themfelves tight. Hence, by fqueezing the ftomach and bowels, they hurt the digeftion, and occafion many incurable maladies. This 528 OF THE MENSTRUAL DISCHARGE. This error is not indeed fo common as it has been • but, as fafhions change, it may come about again : we therefore think it not improper to mention it. I know many females who, to this day, feel the dire- ful effects of that wretched cuftom which prevailed ] fome years ago, of fqueezing every girl into as fmall | a fize in the middle as poffible. Human invention could not pcffibly have devifed a practice more de- .1 ftructive to health. After a female has arrived at that period of life j when the menfes ufually begin to flow, and they do | not appear, but, on the contrary, her health and fpirits begin to decline, we would advife, inftead of Shutting the poor girl up in the houfe, and dofing ! her with Steel, afafcetida, and other naufeous drugs, to place her in a fituation where flie can erfjoy the benefit of free air and agreeable company. There let her eat wholefome food, take fufficient exer- cife, and amufe herfelf in the moft agreeable man- % ner; and we have little reafon to fear, but Na- ture, thus affifted, will do her proper work. In- ! deed fhe feldom fails, unlefs where the fault is on our fide *. T The difcharge in the beginning is feldom fo in- i ftantaneous as to furprife females unawares. It is generally preceded by fymptoms -which foretel its ap- I proach ; as a fenfe of heat, weight, and dull pain ' in the loins ; distention and hardnefs of the breafts ; head-ach ; lofs of appetite ; laffitude; palenefs of the countenance, and fometimes a flight degree of fever. When thefe fymptoms appear about the age ,, at which the me'nflrual flux ufually begins, every ; * * This advice is well worth attending to. Inftead of truft- ing to medicine, we fhould attend to the general health, which is beft procured by country air, exercife, and the cold bath. When this is eftablifhed, we may ufe the preparations of ileel , with the greateft advantage. 2 . thing OF THE MENSTRUAL DISCHARGE. 529 - thing fliould be carefully avoided which may obstruct that neceffary and falutary evacuation *. After the menfes have once begun to flow, the greateft care fhould be taken to avoid every thing that may tend to obstruct them. Females ought to be exceeding cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to four on the ftomach, ought to be avoided ; as fruit, butter-milk, and fuch like. Fifh, and all kinds of food that are hard of digeftion, are alfo to be avoided. As it is impoffible to mention every thing that may difagree with individuals at this time, we would recommend it to every female to be very attentive to what difagrees with herfelf, and carefully to avoid it. Cold is extremely hurtful at this particular pe- riod. More of the fex date their diforders from colds, caught while they are out of order, than from all other caufes. This ought furely to put them upon their guard, and to make them very circum- fpect in their conduct at fuch times. A degree of cold that will not at the leaft hurt them at another time, will at this period be fufficient entirely to ruin their health and conftitution. The greateft attention ought likewife to be paid to the mind, wjiich fliould be kept as eafy and cheerful as poffible. Every part of the animal ©eco- nomy is influenced by the paffions, but none more fo than this. Anger, fear, grief, and other affec- tions of the mind, often occafion obstructions of the menftrual flux, which prove abfolutely incura- ble. * Complaints of the breaft, coftivenefs, and violent pain in different parts, now alfo occur. Thefe are to Be treated accord- ingly. For die pain, nothing anfwers better than the camphor mixture with fome laudanum. See Appendix. M m From * 53o OF THE MENSTRUAL DISCHARGE. From whatever caufe this flux is obftructed, ex- cept in the ftate of pregnancy, proper means fhould be.ufed to reftore it. For this purpofe we would recommend fufficient exercife, in a dry, open, and rather cool air; wholefome diet, and, if the body be weak and languid, generous liquors ; alfo cheer- ful company and proper active amufements. If thefe fail, recourfe mult be had to medicine. When obftructions proceed from a weak relaxed ftate of the folids, fuch medicines as tend to pro- mote digeftion, to brace the folids, and affift the body in preparing good blood, ought to be ufed. The principal of thefe are iron and the Peruvian bark, with other bitter and aftringent medicines. Prepared fteel may be taken in the dofe of half a drachm, mixed with a little honey or treacle; three or four times a-day. Or what is much betrer, and by far more powerful, from four to eight grains of the fait of fteel or green vitriol, made into a powder with twenty or thirty grains of prepared fteel twice a-day. The bark and other bitters may either be taken in fubftance or infufion, as is moft agreeable to the patient. When obftructions proceed from an inflammatory ftate of the fyftem ; or for women of a grofs or full habit, evacuations, and fuch medicines as attenuate the humours, are neceffary. The patient in this cafe ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a fpare thin diet. Her drink fliould be whey, water, or fmall beer, and fhe ought to take fufficient exercife. A tea-fpoonful of die tincture of black hellebore may alfo be taken twice a-day in a cup of warm water. When obftructions proceed from affections of the mind, as grief, fear, anger, &c. every method Ihould be taken to amufe and divert the patient. And OF THE MENSTRUAL DISCHARGE. 531 And that fhe may the more readily forget the caufe of her affliction, fhe ought, if poffible, to be re- moved from the place where it happened. A change of place, by prefenting the mind with a variety of hew objects, has often a very happy influence in re- lieving it from the deepeft diftrefs. A foothing, kind, and affable behaviour to females in this fitua- tion is alfo of the laft importance. An obstruction of the menfes is often the effect of other maladies. When this is the cafe, inftead of giving medicines to force that difcharge, which might be dangerous, we ought by all means to en- deavour to reftore the patient's health and Strength. When that is effected, the other will return of courfe. But the nienftriial flux may be too great as well as too final!. When this happens, the patient be- comes weak, the colour pale, the appetite and di- geftion are bad, and cedematous fwelling^ of the feet, dropfies, and confumptions often enfue. this frequently happens to women about the age of forty- five or fifty j arid is very difficult to cure. It may proceed from a fedentary life ; a full diet, confifting chiefly of falted, high-feafoned, or acrid food ; the ufe of fpirituous tqiors; exceffive fetfeue; relax- ation ; a ftate of debility; violent paffions of the mind, &c. The treatment cf this difeafe muft be varied accord- ing to its caufe. When it is occafioned by any error in the patient's regimen, an oppofite courfe to that which induced the diforder muft be purfued, and fuch medicines taken as have a tendency to reftrain the flux, and counteract the morbid affections of the fyftem from whence it proceeds. To reftrain the flux, the patient flmuld be kept quiei and eafy both in body and mind. If it be very violent, and the pulfe will bear it fhe muft be M iii 2 bled, 532 OF THE MENSTRUAL DISCHARGE. bled, and ought to lie in bed with her head low; to live upon a cool and flender diet, as veal or chicken broths with bread ; and to drink decoctions of nettle- roots, or the greater comfrey. If thefe be not fuf- ficient to ftop the flux, Stronger aftringents may be ufed, as Japan earth, Gum kino, alum, elixir of vitriol, the Peruvian bark*, &c. The uterine flux may offend in quality as well as in quantity. What is ufually called the fluor albus, or whites, is a very common difeafe, and proves ex- tremely hurtful to delicate women. This difcharge, however, is not always white, but fometimes pale, vellow, green, or of a blackifh colour; fometimes it is fliarp and corrofive, fometimes foul and foetid, &rc. It is attended with a pale complexion, pain in the back, lofs of appetite, fwelling of the feet, and other figns of debility. It proceeds from a relaxed ftate of the body, arifing from indolence, the exceffive ufe of tea, coffee, or other weak and watery diet, and a variety of other caufes. To remove this difeafe, the patient muft take as much exercife as flie can bear without fatigue. Her food fhould be folid and nourifhing, but of eafy digeftion ; and her drink rather generous, as red port or claret, mixed with Pyrmont, Briftol, or lime-water. Tea and coffee are to be avoided. 1 have often known ftrong broths have an exceeding good effect, * Two drachms of alum and one of Japan earth may be pnnnded together, and divided into eight or nine dofes, one i-f which may be taken thiee times a-day. Perfons whofe ftomachs cannot bear the alum, may take two table-fpoonfuls of the tincture of rofes three or four times a-day, to each dofe cf which ten drops of laudanum may be added. If thefe fhould fs.il, half a drachm of the Peruvian baik, in powder, wi'h ten drops of ibe elixir of vitriol, may be taken, in a glafs of red wine, four times a-dar. and OF THE MENSTRUAL DISCHARGE. 533 and fometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is neceffary, we know none preferable to the Peruvian bark, which in this cafe ought always to be taken in fubftance. In warm weather, the cold bath will be of confiderable fervice. This is a very dif- treffing complaint, and is owing to a variety of caufes, which muft feverally be attended to. Where it is owing to mere debility, the preparations of iron and balfam capivi are the beft medicines. That period of life at which the menfes eeafe to flow, is likewife very critical to the fex. The ftop- page of any cuftomary evacuation, however fmall, is fufficient to diforder the whole frame, and often to deftroy life itfelf. Hence it comes to pafs, that fo many women fall into chronic diforders, about this time. Such of them, however, as furvive it, without contracting any chronic difeafe, often be- come more healthy and hardy than they were before, and enjoy ftrength and vigour to a very great age. If the menfes ceafe all of a fudden, in women of a full habit, they ought to abate fomewhat of their ufual quantity of food, efpecially of the more nou- rishing kind, as flefli, eggs, Sec. They ought like- wife to take fufficient exercife, and to keep the body open. This may be done by taking, once or twice a-week, a little rhubarb, or tincture of aloes; and fmall but repeated bleedings are of great fervice. It often happens that women of a grofs habit, at this period of life, have ulcerous fores break out about their ancles, or in other parts of the body. Such ulcers ought to be confidered as critical, and fhould either be fuffered to continue open, or have artificial drains fubftituted in their ftead. Women who will have fuch fores dried up, are often foon after carried off by acute difeafes, or fa.ll into thofe of a chronic nature. M m 3 OF C 534 ] OF PREGNANCY. Though pregnancy is not a difeafe, yet that flats is often attended with a variety of complaints which merit attention, and which fometimes require the af- fiftance of medicine. Some women indeed are more healthy during their pregnancy than at any other time ; but this is by no means the general cafe: moft of them breed in forrow, and are frequently jndifpo. fed during the whole time of pregnancy. Few fatal difeafes, however, happen during that period; and hardly any, except abortion, that can be called dan- gerous. We fhall therefore pay particular attention to them, as it proves generally fatal to the child, and fometime? fo to the mother. Pregnant women are often afflicted with the heart-burn. The method of treating this complaint has been already pointed out. they are likewife, in the more early periods of pregnancy, often haraff- ed with ficknefs and vomiting, efpedally in the morn- ing. The method of relieving thefe complaints has alfo been fliewn. Both the head-ach and tooth-ach are very troublefome fymptoms of pregnancy. The former may generally be removed by keeping the bo- dy gently open, by the ufe of prunes, figs, roafted apples, and fuch like. When the pain is very vio- lent, bleeding may be neceffary. For the treatment of the latter, we muft refer to that article. Several other complaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, fuppreffion and incontinency of urine, Sec.; but as all of thefe have been taken notice of before, it is needlefs to repeat them. Every pregnant womau is more or lefs in danger of abortion. This fliould be guarded againft with the greateft care, as it not only weakens the conftitution, but OF PREGNANCY. 535 but renders the woman liable to the fame misfortune afterwards*. Abortion may happen at any period of pregnancy, but it is molt common in the fecond or third month. Sometimes, however, it happens in the fourth or fifth. If it happens within the firft month, it is ufually called a falfe conception; if after the feventh month, the child may often be kept alive by proper care. The common caufes of abortion are, the death of the child ; weaknefs or relaxation of the mother; great evacuations ; violent exercife ; raising great weights ; reaching too high ; jumping, or Stepping from an eminence; vomiting; coughing; convul- ' fion fits ; blows on the belly; falls; fevers; difa- greeable fmells ; excefs of blood; indolence ; high living, or the contrary ; violent paffions or affections of the mind, as fear, grief, Sec The figns of approaching abortion are, pain in the loins, or about the bottom of the belly ; a dull heavy pain in the infide of the thighs; a flight degree of coldnefs, or fhivering; ficknefs, palpitation of the heart; the breafts become flat and foft; the belly falls; and there is a difcharge of blood or watery hu- mours from the womb. To prevent abortion, we would advife women of a weak or relaxed habit to ufe felid food, avoid- ing great quantities of tea, and other weak and watery liquors; to rife early and go foon to bed j * Every mother who procures an abortion docs it at the hazard of her life ; yet there are not a few v.i.o run this rifk merely to prevent th; trouble of b.aring and bringing up chil- dren. It is furely a moft unnatural crime, and cannot, even in the moft abandoned, be viewed without horror; but in the decent matron, it is ftill more unpardonable.—Thofe wretches who daily advertife their affiftance to women in this bufinefs, deferve, in my opinion, the moft fevere cf all human punifh- ments. M m 4 to Sl6 OF PREGNANCY. to fhun damp houfes; to take frequent exercife in the open air, but to avoid fatigue ; and never to go abroad in damp foggy weather, if they can fhun it. Women of a full habit ought to ufe a fpare diet, avoiding Strong liquors, and every thing that may tend to heat the body, or increafe the quantity of blood. Their diet fhould be of an opening nature, confifting principally of vegetable fubftances. Eve- ry woman with child ought to be kept cheerful and eafy in her mind. Her appetites, even though de^ praved, ought to be indulged as far as prudence will permit. Wi en any figns of abortion appear, the woman ought to be laid in bed on a mattraft, with her head low. She fliould be kept quiet, and her mind footh- ed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food fliould confift of broths, rice and milk, jellies, gruels made of oat-meal, and the like, all of which ought to be taken cold. If file be able to bear it, fhe fliould lofe at leaft half a pound of blood from the arm. Her drink ought to be barley warer fliarpened with juice of lemon ; or fhe may take half a drachm of powdered nitre, in a cup of water-gruel, every five or fix hour;. If the woman be feized with a violent loofenefs, fhe ought to drink the decoction of calcined hartfliorn prepared. If fhe be affected with vomiting, let her take frequently two table-fpoonfuls of the feline mixture. In general, opiates are of fervice; but they fliould always be given with caution. Sanguine robuft women, who are liable to mifcarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and obferving the regimen above prefcribed, ihey might often efcape that misfortune. Though OF CHILD-BIRTH. 537 Though we recommend due care for preventing abortion, we would not be underftood as reftraining pregnant women from their ufual exercifes. This would generally operate the quite contrary way. Want of exercife not only relaxes the body, but in- duces a plethora, or too great a fulnefs of the veffels, which are the two principal caufes of abortion. There are, however, fome women of fo delicate a texture, that it is neceffary for them to avoid almoft every kind of exercife during the whole period of pregnancy. OF CHILD-BIRTH. Many difeafes proceed from the want of due care in child-bed ; and the more hardy part of the fex are moft apt to defpife the neceffary precautions in this ftate. This is peculiarly the cafe with young wives. They think, when the labour-pains are ended, the danger is over ; but in truth it may only then be faid to be begun. Nature, if left to herfelf, will feldom fail to expel the fatus; but pro- per care and management are certainly neceffary for the recovery of the mother. No doubt mifchief may be done by too much as well as by too little care. Hence, females who have the greateft number cf attendants in child-bed, generally recover worft. But this is not peculiar to the ftate of child-bed. Excef- five care always defeats its own intention, and is generally more dangerous than none at all*. * Though the management of women in child-bed has been practifed as an employment fince the earlieft accounts of time; yet it is ftill, in moft countries, on a very bad footing. Few women think of following this employment till they are reduced fo the neceffity of doing it for bread. Hence, not one in a hun- dred of them have any education, or proper knowledge of their bufinefs. It is true, that Nature, if left to herfelf, will gene- 538 OF CHILD-BIRTH. During actual labour, nothing of a heating nature ought to be given, the woman may now and then take a little panada, and her drink ought to be toaft and water, or thin oatmeal-giuel. Spirits, wines, cor- dial-waters, and other things which are given with a view to ftrengthen the mother, and promote the birrh, for the moft part, tend only to increafe the fever, inflame the womb, and retard the labour. ijkfides, they endanger the woman afterwards, as they often occafion violent and mortal haemorrhages, or difpofe her to eruptive and other fevers. When the labour proves tedious and difficult, to prevent inflammations, it will be proper to bleed. An emollient clyfter ought likewife to be adminif- tered. The paffage ought to be gently rubbed with a little foft pomatum or frefh butter. Thefe directions are fufficient in natural labours; and in all preterna- tural cafes, a fkilful furgeon, or man-midwife, ought to be called as foon as poffible. After delivery, the woman ought to be kept as quiet and eafy as poffible*. Her food fliould be rally expel the fatus; but it is equally true, that moft women in child-bed require to be managed with fkill and atteii,On, and that they are often hurt by the fuperftitious prejudices of igno- rant and officious midwives. The mifchief doi:e in this way is much greater than is generally imagined ; moft of which might be prevented, by allowing no women to praclice midwifery but fuch as are properly qualified. Were due attention paid to this, it would not only be the means of fiving many lives, but would prevent the neceffity of employing men in this indelicate and difagreeable branch of medicine, which is, on many accounts, mere proper for the other fex. * We cannot help taking notice of that ridiculous cuftom whicii ftill prevails, in fome parts of the country, cf collecting a number of women together upon fuch occafions. Thefe, in- fttad of being ufeful, ferve only to crowd the houfe, and ob- ftruct the neceffary attendants. Befides, tliey hurl the patient wich their noife; and.often, by their untimely and impertinent advice, do much mifchief. light OF CHILD-BIRTH. 53p light and thin, as gruel, panada, &c. and her drink weak and diluting. To this rule, however, there may be exceptions, Sometimes an exceffive hemorrhage or flooding happens after delivery. In this cafe the patient fliould be laid with her head low, kept cool, and be in all refpects treated as for an exceffive flux of the menfes. If the flooding proves violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, Should be applied to the belly, the loins, and the thighs: thefe muft be changed as they grow dry; and may be difr continued as foon as the flooding abates*, If there be violent pains after delivery, the patient ought to take one or two opium pills-}-. An inflammation of the womb is a dangerous dif- eafe, after delivery. It is known by pains in the lower part of the belly, which are greatly increafed upon touching; by the tenfion or tightnefs of the parts; great weaknefs; change of countenance; a conftant fever, with a weak and hard pulfe; a flight delirium or raving; fometimes inceffant vomiting ; a hiccup ; a difcharge of reddifli, ftinking, fliarp water from the womb; an inclination to go frequently to ftool; a heat, and fometimes total fuppreffion of urine. This muft be treated like other inflammatory dif. orders, by bleeding and plentiful dilution. The drink * In a violent flooding after delivery, I have feen very good effects from the following mixture : Take of penny-royal water, fimple cinnamon-water, and fyrup of poppies, etch two ounces, elixir of vitriol a drachm. Mix, and take two tablefpoonfuls every two hours, or oftener, if neceffary. When the patient is low-fpirited, or troubled with hyfterical complaints, fhe ought to take frequently twelve or fifteen drops pf the tincture of afafcetida, in a cup of penny-royal tea. t See Appendix, Opium Pills. may 540 OF CHILD-BIRTH. may be thin gruel or barley-water; in a cup of which ha'f a drachm of nitre may be diffolved, and taken three or four times a-day. Clyfters of warm milk and water muft be frequently adminiftered; and the belly fhould be fomented by cloths wrung out of warm water, or apply bladders filled with milk and water to it. A fuppreffion of the lochia, or ufual difcharges after delivery, and the milk-fever, muft be treated nearly in the fame manner as an inflammation of the womb. In all thefe cafes, the fafeft courfe is plenti- ful dilution, gentle evacuations, and fomentations of the parts affected. In the milk-fever, the breafts may be embrocated with a little warm linfeed-oil, or the leaves of cabbage may be applied to them. The child fliould be often put to the breaft, or it fliould be drawn by fome other perfon. Nothing would tend more to prevent the milk-fe- ver than putting the child early to the breaft. The cuftom of not allowing children to fuck for the firft two or three days, is contrary to Nature and common fenfe, and is very hurtful both to the mother and child *. Every mother who has milk in her breafts, ought either to fuckle her own child, or to have her breafts frequently drawn, at leaft for the firft month. This would prevent many of the difeafes which prove fatal to women in child-bed. When an inflammation happens in the breaft, at- tended with rednefs, hardnefs, and other fymptoms of fuppuration, the fafeft application is a poultice of bread and milk, foftened with oil or frefli butter. This may be renewed twice a-day. till the tumor be either difcuffed or brought to fuppuration. The ufe * The child fhould be put to the breaft within twenty-four tours after delivery. of OF CHILD-BIRTH. 54i of repellents, in this cafe, is very dangerous; they often occafion fevers, and fometimes cancers *. When the nipples are fretted and chapt, they may be anointed with a mixture of oil and bees-wax, or a little powdered gum-arabic may be fprinkled on them. I have feen Hungary water applied to the nipples have a very good effect. Should the com- plaint prove obftinate, a cooling purge may be given, which generally removes it |. The miliary fever is a difeafe incident to women in child-bed ; but as it has been treated of already, we fhall take no further notice of it. The celebrated Hoffmann obferves, That this fever of child-bed wo- men might generally be prevented, if they, during their pregnancy, were regular in their diet, ufed mo- derate exercife, took now and then a gentle laxative of manna, rhubarb, or cream of tartar ; not forget- ting to bleed in the firft months, and avoid all fharp air. When the labour is coming on, it is not to be haftened with forcing medicines, which inflame the blood and humors, or put them into unnatural com- motions. Care fliould be taken, , after the* birth, that the natural excretions proceed regularly* and if the pulfe be quick, a little nitrous powder, or fome other cooling medicines, fhould be administered. The moft fatal diforder confequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the fecond or third day after delivery. Sometimes indeed it comes on fooner, and at other times, though rarely, it does not appear ber fore the fifth or fixth day. * As it is better to prevent than to cure a difeafe, much good may be done by bleeding in thefe cafes when the pulfe will bear it. f To prevent fore nipples, they Should be wafhed twice a-day with brandy for a month or fix weeks, previous to the lying- It S42 OF CHILD-BIRTH. ft begins* like moft other fevers, with a cold or fhivering fir, which is fucceeded by reftleffnefs, pairi ' of the head, great ficknefs at ftomach, and bilious ■ vomiting. 'I'he pulfe is generally quick, the tongue dry, a'nd there is a remarkable detpreffidn of fpirits 5 and lofe of ftrength. A great pain is ufually felt iri the back, hips, and region of the wdmb; a fudden change in the quantity or quality of the lochia i\fo takes place ; and the patient is frequently troubled with a tenefmus, or conftant inclination to go to ftool. The urine, which is very high colonred, i- difchar- ged in finall quantity, and generally with pain. The belly fometimes fwells to a confiderable bulk, and becomes fufceptible of pain from the flighteft touch. When the fever has continued for a few days, the fymptoms of inflammation ufually fubfide, and the1 difeafe acquires a more putrid form. At this period; if not fooner, a -bilious or putrid loofenefs, of an ob-i flinate and dangerous nature, comes on, and accom- panies the difeafe through all its future progrefs; There is not any difeafe that requires to be treated with niire fkin and attention than this; confequently the beft affiftance ought always to be obtained as1 foon as poffible. In women of plethoric cortftitutiorisj bleeding will generally be proper at the beginning ; it ought however to be ufed with cautidrf, and not to be repeated unlefs where the figns of inflamma- tion rife high ; in which cafe it will alfo be neceflary to apply a bliftering plafter to the region of the womb. During the rigor, or cold fit, proper means fliould be ufed to abate its violence, and fhorten its duration. For this purpofe the patient may drink \ freely of warm diluting liquors, and if low, may take now and then a cup of wine-whey ; warm applica- tions to the extremities, as heated bricks, bottles or ' bladders filled with warm water, may alfo be ufed with advantage. Emollient OF fcHlLB-BIRTH. w Emollient clyfters of milk and water, or of chicken tyntf-r, ought to be frequently adminiftered through tl.'e t ou' fe of the difeafe. Thefe prove beneficial by promoting a difcharge from the inteftines,. and alio by acting as a fomentation to the womb and parts ad- jacent. Great care, however, \< reqtifite in giving thtm; on account of the tendernefs of the parts in the pelvis at thi* nine. To evacuate the offending bile from the ftomach, a vomit is generally given. The medicine Which I have always found to1 fuc- ceed belt in this difeafe is the faline draught. This, if frequently repeated, will often put a ftop to the vomiting, and at the fame time leffen the violence of the feVer. If it runs off by.ftoolyor if the patient be reftlefs* a few drops of laudanum may occafionally be added. m: If the ftools fliould prove fo frequent as to weaken find exhauft the patient, a Starch clyfter, with thirty or fdrty drdps of laudanum in it, may be administered as occafion fhall require; and the drink may be ricei Water, In every pint of which half an ounceMtenm- atabic has been diffolved. Should thefe fai', r^rourfe hiuft be had to Columbo-root, or fome other ftrong aftringent. Though in general the food ought to be lights and the drink diluting, -yet when the difeafe has been long protracted, and the patient is greatly fpent by evacuations, it will be neceffary to fupport her With nourishing diet and generous cordials. It was obferved that this fever, after continuing for fome time, often acquires a putrid form. In this cafe the Peruvian bark muft be given, either by itfelfj or joined with cordials, as circumftances may require. As the bark in fubftance will be apt to purge, it may fee given in decoction or infufion mixed with the 4. tincture f 544 OF CHILD-BIRTH. tincture of rofes, or other gentle aftringentsj of, a fcruple of the extract of bark with half an ounce of fpirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every fecond, third, or fourth hour, as fliall be found neceffary. When the ftomach will not bear any kind of nou- rishment, the patient may be fupported for fome time by clyfters of beef-tea, or chicken-water. * To avoid this fever, every woman in child-bed ought to be kept perfectly eafy; her food fhould be light and fimple, and her bed-chamber cool, and pro- perly ventilated. There is not any thing more hurt- ful to a woman in this fituation than being kept too warm. She ought not to have her body bound too tight, nor to rife too foon from bed, after delivery; catching cold is alfo to be avoided ; and a proper at- tention fhould be paid to cleanlinefs. To prevent the milk fever, the breafts ought to be frequently drawn ; and if they are filled previous to the onfet of a fever, they fhould, upon its firft appe^pice, be drawn, to prevent the milk from be- coming acrid, and its being abforbed in this ftate. Coftivenefs is likewife to be avoided. This will be beft effected by the ufe of mild clyfters and a laxative diet. We fhall conclude our obfervations on child-bed women by recommending it to them above all things to beware of cold. Poor women, whofe circumftan- ces oblige them to quit their bed too foon, often con- tract difeafes from cold, of which they never recover. It is a pity the poor are not better taken care-of in this fituation. But women in more affluent circumftances run the greateft hazard from too much heat. They are ge- nerally kept in a fort of bath for the firft eight or i ten OF BARRENNESS. 54S ten days and then dreffed out to fee company. The danger of this conduct muft be obvious to every one *. The fuperftitious cuftom of obliging women to keep the houfe till they go to church, is likewife a very common caufe of catching cold. All churches are damp and moft of them cold ; confequently they are the very worft places to which a woman can go to make her firft vifit, after having been confined in a warm room for a month. OF BARRENNESS. Barrennefs may be very properly reckoned among the difeafes of females, as few married women who have not children enjoy a good ftate of health. It may proceed from various caufes, as high living, grief, relaxation, &c. but it is chiefly owing to an obstruction or irregularity of the menftrual flux. It is very certain that high living vitiates the hu- mors and prevents fecundity. We feldom find a barren woman among the labouring poorowhile nothing is more common-arnong the rich anc^Buent. The inhabitants of every country are prolific^n pro- portion to their poverty; and it would be an eafy matter to adduce many inftances of women-, who, by being reduced to live entirely upon a milk and vege- table diet, have conceived and brought forth chil- dren, though they never had any before. Would the rich ufe the fame fort of food and exercife as the better fort of peafants, they would feldom have caufe to envy the poor the bleffmg of a numerous and healthy offspring, while they pine in forrow for v/ant of even a fingle heir to their extenfive domains. * And it were much to be wifhed that this cuftom was en- tirely fet afide. N n Affluence 546 DISEASES OF CHILDREN. Affluence begets indolence, which not only vi- tiates the humours, but induces a general relaxa- ation of the folids; a ftate highly unfavourable to fruirfulnefs. To remove this, we would recom- mend the following courfe: Firft, fufficient exer- cife in the open air; fecondly, a diet confifting chiefly of milk and vegetables; thirdly, the ufe of aftringent medicines, as fteel, alum, elixir of vi- triol, the Chalybeate waters, Peruvian bark, Sec.; and laftly, above all, the cold bath. Barrennefs is often the confequence of grief, fud- den fear, anxiety, or any of the paffions which tend to obstruct the menftrual flux. When barrennefs is fufpected to proceed from affections of the mind, the perfon ought to be kept as eafy and cheerful as poffible. CHAP. XLIX. (P» Difeafes of Children. MISERABLE indeed is the lot of man in the ftate of infancy! He comes into the world more helplefs than any other animal, and Stands much longer in need of the protection and care of his pa- rents ; but, alas! this care is not always bellowed upon him ; and when it is, he often fuffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurfes, and midwives, becomes one of the moft fruit- ful fources of the diforders of infants*. * Of the officious and ill judged care of midwives, we fhall adduce only one inftance, viz. the common practice of tortu- ring DISEASES OF CHILDREN. $47 It muft be obvious to every attentive perfon, that the firft difeafes of infants arife chiefly from their bowels. Nor is this in the leaft to be Won- dered at, as they are in a manner poifoned with indigeftible drugs and improper diet as foon as they come into the world. Every thing that the fto- mach cannot digeft may be conficLred as a poifon ; t and unlefs it can be thrown up, or voided by ftool, it muft occafion ficknefs, gripes, fpafmodic affections of the bowels, or what the good women call inward fits, and at laft convulfions and death. As thefe fymptoms evidently arife from fomewhat that irritates the inreftines, doubtlefs the proper I method of cure muft be to expel it as foon as poffi- ble. The moft fafe and effectual method of doing this, if the child be coftive, is by a gentle purge; for ! this purpofe, fome manna and pulp of caffia may be diffolved in boiling water, and given in fmall quantities till it operates; or, what will anfwer ra* ther better, a few grains of magnefia alba and rhu- barb may be mixed in any kind of food that is given to the child, and continued till it has the feiired effect. If thefe medicines be properly adminiftered, and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will feldom , * ring infants by fqueezing their breafts, to draw off the milk, as they call it. Though a fmall quantity of moifture is gene- [ rally found in the breafts of infants, yet, as they are certainly not intended to give fuck, this ought never to be drawn off. »I have feen this cruel operation bring onhardnefs, ;nftammation, and fuppuration of the breafts ; but never knew any ill confe- quences from its being omitted. When the breafts are hard, the only application that we would recommend is a foft poul- tice, or a little of the diachylon plafter, fpread thin upon a bit *! of foft leather, about the fize of half a crown, and applied over each nipple. Thefe may be fuffered to continue till the hard* nefs difappears. N n 3 fall 548 OF THE MECONIUM. fail to relieve thofe affections of the ftomach and bowels from which infants fuffer fo much. Thefe general directions include moft of what can be done for relieving the internal diforders of infants. They will likewife go a confiderable way in alleviating thofe whicii appear externally, as the rafh, gum, Sec Thefe, as was formerly obferved, are principally owing to too. hot a regimen, and confequently will be moft effectually relieved by gen- tle evacuations. Indeed, evacuations of one kind or other conftitute a principal part of the medicine of in- fants, and will feldom, if adminiftered with prudence, in any of their difeafes, fail to give relief. OF THE MECONIUM. The ftomach and bowels of a new-born infant are filled with a blackifh-coloured matter of the confiitence of fyrup, commonly called the meconium. This is generally paffed foon after the birth, by the mere effort of Nature ; in which cafe it is not necef- fary t|give the infant any kind of medicine. But if it fhould be retained, or not fufficiently carried off, a little manna, magnefia alba or rhubarb may be given, as mentioned above; or, if thefe fhould not be at hand, a common fpoonful of whey, fweet- ened with a little honey, or brown fugar, will anfwer the purpofe. The moft proper medicine for expelling the meco- nium is the mother's milk, whicii is always at firft of a purgative quality. Were children allowed to fuck as foon as they fhew an inclination for the breaft, they would feldom have occafion for medicines to dif- charge the meconium ; but even where this is not al- lowed, they ought never to have fyrup, oils, and other indigeftible fluff, crammed down their throats. the [ 549 J THE APHTHA OR THRUSH. The aphtha? are little whitifli ulcers affecting the whole infide of the mouth, tongue, throat, and ftomach of infants. Sometimes they reach through the whole inteftinal canal; in which cafe they are very dangerous. If the aphthae are of a pale colour, pellucid, few in number, foft, fuperficial, and fall eafily off, they are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ought to be dreaded. It is generally thought that the aphthae owe their origin to acid humors ; we have reafon however to believe, they are more frequently owing to too hot a regimen both of the mother and child. We too often find the child dofed with wine, punch, cinna- mon-waters, or fome other hot and inflaming liquors, almoft as foon as it is born. It is well known that thefe will occafion inflammatory diforders even in adults ; is it any wonder then they fhould lieat and inflame the tender bodies of infants, and fet as it were the whole conftitution on a blaze ? The moft proper medicines for the aphthse are vomits, fuch as have been already recommended, and gentle laxatives. Five grains of rhubarb and half a drachm of magnefia-alba may be rubbed toge- ther, and divided into fix dofes, one of which may be given to the infant every four or five hours till they operate. Thefe powders may either be given in the child's food, or a little of the fyrup of pale rofes, and may be repeated as often as is found ne- ceffary to keep the body open. It is common in this cafe to administer calomel, which is more effec- tual than any other medicine. N n 3 Many 55o OF ACIDITIES. Many things have been recommended for gargling the mouth and throat in this difeafe ; but it is not eafy to apply thefe in very young infants ; we would therefore recommend it to the nurfe 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, rofe-water two drachms ; mix them together. A very proper application in this cafe, is a folution of ten or twelve grains of white vitriol in eight ounces of barley water. Thefe may be applied with the fin- ger, or by means of a bit of foft rag wrapped round the finger. OF ACIDITIES. The food of children being for the moft part of an acefcent nature, it readily turns four upon the fto- mach, efpecially if the body be any way disordered. Hence moft difeafes of children are accompanied with evident figns of acidity, as greeu ftools, gripes, Sec. Thefe appearances have induced many to be- lieve, that all the difeafes of children were owing to an acid abounding in the ftomach and bowels; but whoever confiders the matter attentively, will find that thefe fymptoms of acidity are oftener the effect than the caufe of their difeafes. Nature evidently intended, that the food of chil- dren fliould be acefcent; and unlefs the body be difordered, or the digeftion hurt, from fome other caufe, we will venture to fay, that the acefcent quality of their food is feldom injurious to them. Acidity, however, is often a fymptom of diforders in children, and, as it is fometimes a troublefome one, we fhall point out the method of relieving it. When GALLING AND EXCORIATION. 5Si When green ftools, gripes, purgings, four fmells, &c. fhew that the bowels abound with an acid, the child fhould have a little clear broth, with light white bread in it; and fhould have fufficient exer- cife in order to promote the digeftion. It has been cuftomary in this cafe to give the pearl-julep, chalk, crabs eyes, and other teftaceous powders. Thefe, indeed, by their abforbent quality, may correct the acidity; but they are attended with this inconveni- ence, that they are apt to lodge in the bowels, and occafion coftivenefs, which may prove hurtful to the infant. For this reafon they lhould never be given unlefs mixed with purgative medicines; as rhubarb, manna, or fuch like. The beft medicine which we know, in all cafes of acidity, is that fine infipid powder called magnefia alba. It purges, and at the fame time corrects the acidity: by which means it not only removes the difeafe, but carries off its caufe. It may be given in any kind of food, or in a mixture, as recommended in the Appendix *. When an infant is troubled with gripes, it ought never to be dofed with brandy, fpiceries, and other hot things, but fliould have its body opened with an emollient clyfter, or the medicine mentioned above ; and at the fame time a little brandy may be rubbed on its belly with a warm hand before the fire. I have feldom feen this fail to eafe the gripes of in- fants. Strong fennel-feed tea, fweetened with mc- laffes, is a very ufeful medicine here. GALLING AND EXCORIATION. Thefe are very troublefome to children. They happen chiefly about the groin and wrinkles of the "* See Appendix, Laxative abforbent Mixture. N n 4 neck. 55 2 STOPPAGE OF THE NOSE. neck, under the arms, behind the ears, and in other parts that are moiftened by the fweat or urine. As thefe complaints are, in a great meafure, ow- ing to want of cleanlinefs, the moft effectual means of preventing them are, to wafh the parts frequently with cold water, to change the linen often, and, in a word, to keep the child in all refpects thoroughly clean. When this is not fufficient, the excoriated parts may be fprinkled with abforbent or drying powders ; as prepared chalk, flarch-po'wder, and the like. When the parts affected are very fore, and tend to a real ulceration, it will be proper to anoint the place with Goulard's cerate. If the parts be wafhed with fpring-water, in whicii a little white vi- triol has been diffolved, it will dry and heal them very powerfully. One of the beft applications for this purpofe, is tp diffolve fome fuller's earth in a fufficient quantity of hot water; and after it has flood 'till it is cold, to rub it gently upon the galled parts once or twice a-day. STOPPAGE OF THE NOSE. The noftrils of infants are often plugged'up with a grofs mucus, which prevents their breathing freely, and likewife renders it difficult for them to fuck or fwallow. Some in this cafe order, after a fuitable purge, two or three grains of white vitriol diffolved in half an ounce of water, and filtered, to be applied now and then to the noftrils with a linen rag. Wedelius fays, if two grains of white vitriol, and the fame quantity of elaterium, be diffolved in half an ounce of marjoram-water, and applied to the nofe, as above directed, that it brings away the mucus without fncczing. OF VOMITING. 553 In obftinate cafes thefe medicines may be tried ; but I have never found any thing neceffary, befides rubbing and introducing into the nofe at bed-time a little fweet-oil, or frefli butter. This refolves the filth, and renders the breathing more free. OF VOMITING. From the delicate ftate of children, and the great fenfibility of their organs, a vomiting or loofenefs may be induced by any thing that irritates the nerves of the ftomach or inteftines. Hence thefe diforders are much more common in childhood than in the more advanced periods of life. They are feldom, however, dangerous, and ought never to be confidered as difeafes, unlefs when they are violent, or continue fo long as to exhauft the ftrength of the patient. Vomiting may be excited by an over-quantity of food ; by food that is of fuch a nature as to irritate the nerves of the ftomach too much ; or by the fen- fibility of the nerves being fo much increafed as to render them unable to bear the Stimulus of even the mildeft element. When vomiting is occafioned by too much food, it ought to be promoted, as the cure will depend upon cleanfing the ftomach. This may be done ei- ther by a few grains of ipecacuanha, or a weak fo- lution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a mil- der nature fubftituted in its flead. When vomiting proceeds from an increafed degree of fenfibility, or too great an irritability of the nerves of the ftomach,.fuch medicines as have a ten- dency to brace and ftrengthen that organ, and to abate its fenfibility, muft be ufed. The firft of thefe intentions 554 OF A LOOSENESS. intentions may be anfwered by a flight infufion of the Peruvian bark, with the addition of a fettle rhu- barb and orange-peel; and the fecond by the faline draughts, to which a few drops of liquid laudanum may be occafionally added. In obftinate vomiting the operation of internal me- dicines may be affifted by aromatic fomentations made with wine, applied warm to the pit of the fto- mach ; or the ufe of the ftomach-plafter, with the addition of a little Theriaca. OF A LOOSENESS. A loofenefs may generally be reckoned falutary when the ftools are four, flimy, green, or crundled. It is not the difcharge, but the caufe of luch ftools, which ought to be. remedied. Even where the purging is thin and watery, it ought not to be checked too fuddenly, as it often proves critical, efpecially when the child has caught coid, or an eruption on the fkin has difappearcd. Sometimes an evacuation of this kind fucceeds an humid Slate of the atmofphere, in whicii cafe it may a'fo prove of advantage, by carrying off a quantity of watery humors which would otherwife tend to relax the habit. As the principal intention of the cure of a loofe- nefs is to evacuate the offending matter, it is cuf- tomary to give the patient a gentle vomit of ipe- cacuanha, and afterwards to exhibit fmall and fre- quent dofes of rhubarb; interpofing abforbent me- dicines to mitigate the acrimony of the humors. The beft purge, however, in this cafe, is magnefia alba. It is at the fame time abforbent and laxative, and operates without exciting .gripes. The antimonial wine, which acts both as an eme- tic and purge, is alfo an excellent medicine in this cafe, OF ERUPTIONS. 55s cafe. By being diluted with water, it may be pro- portioned to the weakeft conftitution ; and, not be- ing difagreeable to the palate, it may be repeated as often as occafion requires. Even one dofe will fre- quently mitigate the difeafe, and pave the way for .the ufe of abforbents. If, however, the patient's ftrength will permit, the medicine ought to be re- peated every fix or eight hours, 'till the ftools begin to affume a more natural appearance; afterwards a longer fpace may be allowed to intervene between the dofes. When it is neceflary to repeat the me- dicine frequently, the dofe ought always to be a little increafed, as its efficacy is generally diminifhed by ufe. Some, upon the firft appearance of a loofenefs, fly immediately to the ufe of abforbent mediches and aftringents. If thefe be adminiftered before the offending humors are difcharged, though the difeafe may appear to be mitigated for a little time, it foon afterwards breaks forth with greater violence, and often proves fatal. After proper evacuations, however, thefe medicines may be adminiftered with confiderable advantage. Should any gripings or reftleffnefs remain after the ftomach and bowels have been cleanfed, a tea- fpoonful of the fyrup of poppies may be given in a little fimple cinnamon-water, three or four times a- day till thefe fymptoms have ceafed. OF ERUPTIONS. Children, while on the breaft, are feldom free from eruptions of one kind or other. Thefe, how- ever, are not cften dangerous, and ought never to be dried up but with the greateft caution. They tend to free the bodies of infants from hurtful hu. mors, $$6 OF ERUPTIONS. mors, which, if retained, might produce fatal dif- orders. The eruptions of children are chiefly owing to improper food and neglect of cleanlinefs. If a child be fluffed at all hours with food that its flo- I mach is not able to digeft, fuch food, not being properly affimilated, inftead of nourishing the body, ' fills it with grofs humors. Thefe muft either break out in form of eruptions upon the fkin, or remain in the body, and occafion fevers and other internal \ diforders. That neglect of cleanlinefs is a very ge- « neral caufe of eruptive diforders, muft be obvious "i to every one. The children of the poor, and of all who defpife cleanlinefs, are almoft conftantly I found to fwarm with vermin, and are generally co- vered with the fcab, itch, and other eruptions. When eruptions are the effect of improper food, or want of cleanlinefs, a proper attention to thefe alone will generally be fufficient to remove them. If this fhould not be the cafe, fome drying medi- cines will be neceffary. When they are applied, the body ought at the fame time to be kept open, , and cold is carefully to be avoided. We know no j medicine that is more fafe for drying up cutaneous * eruptions than fulphur, provided it be prudently ufed. A little of the flour of fulphur may be mixed ' with frefli butter, oil, or hog's lard, and the parts af- fected frequently touched with it. The moft obftinate of all the eruptions incident to children are, the tinea capitis, or feabbed head, and chilblains. The feabbed head is often exceedingly difficult to cure, and fometimes indeed the cure proves worfe than the difeafe. I have frequently jj known children feized with internal diforders, of which they died foon after their feabbed heads had been healed by the application of drying medi- cines. OF ERUPTIONS. 557 cines*. The cure ought always firft to be attempted by keeping the head very clean, cutting off the hair, combing and brufhing away the feabs, &c. If this is not fufficient, let the head be fhaved once a-week, wafhed daily with foap-fuds, and gently anointed with the citrine ointment f. While thefe things are doing, the patient muft be confined to a regular light diet, the body fhould be kept gently open ; and cold, as far as poffible, ought to be avoided. To prevent any bad confequences from flopping this difcharge, it will be proper, efpecially in children of a grofs habit, to make an iffue in the neck or arm, which may be kept open till the patient becomes more ftrong, and the conftitution be fomewhac mended. Chilblains commonly attack children in cold wea- ther. They are generally occafioned by the feet or hands being kept long wet or cold, and afterwards fuddenly heated. When children are cold, inftead of taking exercife to warm themfelves gradually, they run to the fire. * I fome time ago faw a very Striking inftance of the danger of fubftituting drying medicines in the place of cleanlinefs and wholefome food, in the Foundling Hofpital at Ackworth, where the children were grievoufly afflicted with feabbed heads and other cutaneous diforders. Upon inquiry it was found, that very little attention was paid either to the propriety or foiand- nefs of their provifions, and that cleanlinefs was totally neglec- ted; accordingly it was advif.d that they fhould have more wholefome food, and be kept thoroughly clean. This advice, however, was not followed. It was too troublefome to the fer- vants, fuperintendants, &c. The bufinefs was to be done by medicine; which was accordingly attempted, but had nearly proved fatal to the whole houfe. Fevers and other internal diforders immediately appeared, and at length a putrid dyfen- tery, which proved fo infectious, that it carried off a great many of the children, and fpread over a confiderable part of the neighbouring country. f See Appendix, Citrine Ointment. To 558 OF THE CROUP OR HIVES. To prevent it, violent cold and fudden heat muft be equally avoided. When the parts begin to look red and fwell, the patient ought to be purged, and to have the affected parts frequently rubbed with muftard and brandy, or fomething of a warming na- ture. They ought likewife to be covered with flan- nel, and kept warm and dry. Some apply warm afhes between cloths to the fwelled parts, which frequently help to reduce them. When there is a fore, it muft be dreffed with Goulard's cerate, Tur- ner's cerate, the ointment of tutty, or feme other drying ointment. Thefe fores are indeed trouble- fome, but feldom dangerous. They generally heal as foon as the warm weather fets in. OF THE CROUP OR HIVES. This difeafe is called the Croup in fome parts of Scotland, and it is thus (tiled by moft of the Bri- tish medical writers. In America it is moft generally known by the name of the Hives, although feveral eruptive difeafes, particularly the nettle rafh are im- properly fo called ; moreover, fo great is the dread of this difeafe, that almoft every catarrh in young children has been fufpected for it. As it is of great confequence to be able to diftinguifh this complaint, we fhall be more full in our account of it. The difeafe more ftrictly called the hives or croup generally attacks children under fix years of age, but it may occur at any time of life. The child is firft drooping for a few days, neither fick nor well, per- haps fome flight fymptoms of a cold, when the dif- eafe fuddenly encreafes, the voice particularly, and" breathing are changed. This laft becomes quick, and during refpiration the air paffes through the wind-pipe in fuch a manner as to make an indescriba- ble noife faid to refemble the crowing of a cock, but OF THE CROUP OR HIVES. 5e9 with more propriety it may be likened to the noife produced by air forced through a narrow tube whofe fides are very hard; this noife continues to the laft : fometi nes the phlegm will appear to rattle, as if loofe ; the face is generally flufhed, the countenance diftrcffed, the noftrils expanded, the head thrown back: indeed the patient cannot lie down, and is very reftlefs; continually feeking for eafe from a change of pofture. More or lefs cough, and fever attend ; the pulfe varying, but generally quick ; the bowels moftly coftive; the face and hands now be- come livid ; the fkin often moift, from the agony the patient is in. Thefe fymptoms continue to the laft, when the patient appears to fink under fuffocation and debdity. A little momentary eafe, however, will often produce fuch an alleviation of the fymptoms, as to give rife to the moft flattering hopes ; but thefe fliould never in- duce us to remit our exertions, for it is fo common to be called to this difeafe, after it has made a confi- derable progrefs, that there is not a moment to be loft. Some other difeafes appear to terminate fatally in this, more efpecially the rheumatifm, pleurify, fmall- pox, meafles, and fearlet fever. This I would denominate the true hives. But there is another difeafe highly dangerous, which has generally been called by the fame name—its fymp- toms are as follows : It attacks children of the fame age as before-men- tioned, more efpecially fuch as are of a grofs, plump habit of body, after expofure to cold or wet, the ftriking in of eruptions, eating indigeftible food, &e. They are generally feized when in the higheft health, moftly in the night; it begins with very la- borious refpiration, flulhed face, and fomething of a croaking noife, but more refembling a fit of the 4 afthma 560 OF THE CROUP OR HIVES. afthma than the true hives; a confiderable degree of fever comes on: If neglected, or not checked, thefe fymptoms will encreafe until the patient dies, fuffo- cated, as in the other cafe. This fpafmodic afthma, as it has been called, is often produced by worms and teething. The treatment of thefe two difeafes is in fome re- flects fimilar. In the true hives, the firft thing to be done, if called early in the difeafe, is to bleed, if the pulfe is hard, or inflammatory difeafes prevail. Directly af- terwards, to give from fix to twelve or fifteen grains of ipecacuanha, or repeated dofes of the vomiting julep, until the child is well puked; then give from four to twenty grains of calomel, at firft, with eight or ten grains of jalap to open the bowels, and then continue the calomel with a few grains of magnefia two or three times a-day, fo as to keep the bowels conftantly loofe. This is peculiarly to be attended to, as it is the chief remedy, and no time muft be loft; and even if the fymptoms appear to be alle- viated we muft not defift untill the patient is fairly out of danger. A blifter fhould be applied to the throat and breaft if the fymptoms are violent; bath- ing the feet in warm water may be tried. It is almoft incredible, to thofe who have not feen this difeafe, how much calomel very young children will bear, and how difficult it is to move their bowels. In the fpafmodic afthma, a moft important remedy is the warm-bath, efpecially if ufed at the firft attack. If the fymptoms do not yield to this, bleeding will be neceffary, and fhould be repeated according to their violence. An emetic will often do good; ipe- cacuanha, tartar emetic, or vinegar of fquills may be ufed; the bowels fhould be kept thoroughly opened by pretty large dofes of jalap and calomel, as moft of the difeafes of children require a drain in the bowels, 1 and OF TEETHING. 56i and there is no medicine that promotes this fo well as calomel. A burgundy-pitch plafter fhould be put between the Shoulders, or if the violence of the fymptoms demand it, a blifter fhould be applied there. If worms or teething occafion the diforder, the medicines recommended in thefe cafes are to be ufed. Many children are troubled with this complaint for a few years, and then feem to outgrow it. What- ever ftrengthens the body will prevent, or at leaft leffen the violence of the attack; fuch as light food, a flannel fhirt, cold bath, country air, and gentle exercife. It often happens that children who are troubled with this difeafe, are much relieved by a tea fpoonful or two of the juice of a raw onion. This may be tried, but if it does not foon give relief, recourfe muft be had to the other more powerful remedies. OF TEETHING. Di- Arbuthnot obferves, that above a tenth part of infants die in teething, by fymptoms proceeding from the irritation of the tender nervous parts of die jaws, occafioning inflammations, fevers, convul- fions, gangrenes, &c. Thefe fymptoms are in a great meafure owing to the great delicacy and ex- quifite fenfibility of the nervous fyftem at this time of life, whicii is too often increafed by an effemi- nate education. Hence it comes to pafs, that chil- dren who are delicately brought up, always fuffer moft in teething, and often fall by convulfive difor- ders. About the fixth or feventh month the teeth gene- rally begin to make their appearance ; firft, the inci- forcs, or fore-teeth ; next, the canini, or dog-teeth ; O o and, 562 OF TEETHING. and, laftly, the molares, or grinders. About the feventh year, there comes a new fet; and about the twentieth, the two inner grinders, called dentes fapi- cntiee, the teeth of wifdom. Children, about the time of cutting their teeth, flaver much, and have generally a loofenefs. When the teething is difficult, efpecially when the dog- teeth begin to make their way through the gums, many children have ftartings in their fleep, tumors of the gums, watchings, gripes, green ftools, the thrufh, fever, difficult breathing, and convulfions. Difficult teething requires nearly the fame treat- ment as an inflammatory difeafe. If the body be bound, it muft be opened either by emollient clyfters or gentle purgatives ; as manna, magnefia alba, rhu- barb, fenna, or the like. The food fhould be light, and in fmall quantity; the drink plentiful, but weak and diluting, as infufions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added. If the fever be high, bleeding will be neceffary; but this, in very young children, ought always to be fparingly performed. It is an evacuation which they bear the worft of any. Purging, vomiting, or fweating, agree much better with them, and are ge- nerally more beneficial. After fufficient purging, if the pulfe be fufficiently reduced, a tea-fpoonfull of the anodyne mixture (fee Appendix) every two hours will be of great fervice. Harris, however, obferves, that when an inflammation appears, the phyfician will labour in vain, if the cure be not be- gun with applying a leech under each ear. If the child be feized with convulfion-fits, a bliftering-plaf- ter may be applied between the flioulders, or one behind each ear, or the warm bath may be ufed and frequently repeated. Sydenham OF TEETHING. 563 Sydenham fays, that in fevers occafioned by teeth- ing, he never found any remedy fo effectual as two, three, or four drops of fpirits of h.rtfhorn in a fpoon- full of fimple water, or other convenient vehicle, given every four hours. The number of dofes may be four, five, or Six. I have often preferibed this medw ine with fuccefs, but always found a larger dofe ' neceffary. It may be given from five drops to fifteen or twenty, according to the age of the chil !, and, when coftivenefs does not for'oid it, three or four drops of laudanum may be added to each dofe. In Scotland it is very common, when children are cutting their teeth, to put a fmall Burgundy-pitch- plaffer between their fhnuldcrs. This generally eafes the tickling cough which attends teething, and is by no means an ufelefs application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occa- fion requires, and ought to be renewed at leaft once a fortnight. Several things have been recommended for rub- bing the gums, as oils, mucilages, &c. ; but from thefe much is not to be expected. If any thing of this kind is to be ufed, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generally at this time difpofed to chew whatever they get in their hands. For this reafon they ought never to be with- out fomewhat that will yield a little to the preffure of their gums, as a cruft of bread, a wax-candle, a bit of liquorice-root, or fuch like. Cutting or lancing the gums may be performed by the finger-nail, the edge of a fixpenny piece that is worn thin, or any fharp body, which can be with fafety introduced into the mouth ; but the lancet in a fkil- fwl hand is certainly the moft proper. O o 2 In 564 OF THE RICKETS. In order to render the teething lefs difficult, pa- rents ought to take care that their children's food be light and wholefome, and that their nerves be braced by fufficient exercife without doors, the ufe of the cold bath, &c. Were thefe things duly re- garded, they would have a much better effect than teething necklaces, or ether nonfenfical amulets worn for that purpofe. OF THE RICKETS. This difeafe generally attacks children between the age of nine months and two years. It appeared firft in England about the time when manufactures began to flourifh, and ftill prevails moft in towns where the inhabitants follow fedentary employments ; by which means they neglect either to take proper exercife themfelves, or to give it to tlieir children. CAUSES.—One caufe of the rickets is difeafed parents. Mothers of a weak relaxed habit, who ne- glect exercife, and live upon weak diet, can neither be expected to bring forth ftrong and healthy chil- dren, or to be able to nurfe them, after they are brought forth. Accordingly we find, that the chil- dren of fuch women generally die of the rickets, the fcrophula, confumptions, or fuch like difeafes. Chil- dren begotten by men in the decline of life, who are fubject to the gout, the gravel, or other chronic dif- eafes, or who have been often affected with the ve- nereal difeafe in their youth, are likewife very liable to the rickets. Any diforder that weakens the conftitution, or re- laxes the habit of children, as the fmall-pox, meafles, teething, the hooping-cough, Sec. difpofes them to this difeafe. It may likewife be occafioned by im- proper diet, as food that is either too weak and wa- tery, or fo vifcid that the ftomach cannot digeft it. Bad OF THE RICKETS. 565 Bad nurfmg is the chief caufe of this difeafe. When the nurfe is either difeafed, or has not enough of milk to nourifh the child, it cannot thrive. But children fuffer oftner by want of care in nurfes than want of food. Allowing an infant to lie or fit too much, or not keeping ir thoroughly clean in its clothes, has the moft pernicious effects. The want of free air is likewife very hurtful to children in this refpect. When a nurfe lives in a clofe fmall houfe, where the air is damp and con- fined, and is too indolent to carry her child abroad into the open air, it will hardly eicape this difeafe. A healthy child fliould always be in motion, unlefs when afleep ; if it be fuffered to lie, or fit, inftead of being toffed and dandled about, it will not thrive. SYMPTOMS.—-At the beginning of this difeafe the child's flelh grows foft and flabby ; its ftrength is diminished ; it lofes its wonted cheerfulnefs, looks more grave and compofed than is natural for its age, and does not chufe to be moved. The head and belly become too large in proportion to the other parts ; the face appears full, and the complexion florid. Afterwards the bones begin to be affected, efpecially in the more foft and fpongy parts. Hence the wrifts and ancles become thicker than ufual; the fpine or back-bone puts on an unnatural fliape; the breaft ii likewife often deformed ; and the bones of the arms and legs grow crooked. All thefe fymp- toms vary according to the violence of the difeafe. The pulfe is generally quick, but feeble ; the appe- tite and digeftion for the moft part bad ; the teeth come Slowly and with difficulty ; and they often rot and fall out afterwards. Rickety children generally have great acutenefs of mind, and an understanding above their years. Whether this is owing to their being mors in the company of adults than other chil- O o 3 dren, 566 OF THE RICKETS. dren, or to the preternatural enlargement of the br-iin, is not material. REGIMEN.—As this difeafe is always attended with evident figns of weaknefs and relaxation, our chief aim in the cure muft be to brace and Strength- en the folids, and to promote digeftion and the due preparation of the fluids. Thefe important ends will be beft anfwered by wholefome nourithing diet, fuited to the age and ftrength of the patient, open dry air, and fufficient exercife. If the child has a bad nurfe, who either neglects her duty, or does not understand it, fhe fhould be changed. If the fearon be cold, the child ought to be kept warm ; and when the weather is hot, it ought to be kept cool; as fweating is apt to weaken it, and too great a degree of cold has the fame effect. A flannel fhirt fhould be worn conftantly. The limbs fhould be rubbed frequently with a warm hand, and the child kept as cheerful as poffible. The diet ought to be dry and nourishing, as good bread, roafted flefh, &c. Bifcuit is generally reck- oned the beft bread ; and pigeons, pullots, beef, rab- bits, or mutton roafted or minced, are the moft pro- per flefli. If the child be too young for flefh-meats, he may have rice, millet, or pearl-barley boiled with raifins, to which may be added a little wine and fpice. His drink may be good claret, mixed with an equal quantity of water. Thofe who cannot afford claret, may give the child now and then a wine-glafs of good porter. MEDICINE.—Medicines are here of little avail. The difeafe may often be cured by the nurfe, but feldom by the phyfician. In children of a grofs ha- bit, gentle vomits and repeated purges of rhubarb may fometimes be of ufe, but they will feldom carry off ihe difeafe ; that muft depend chiefly upon fuch things as brace and ftrengthen the fyftem : for which purpofe, OF CONVULSIONS. 567 purpofe, befides the regimen mentioned above, we would recommend the cold bath, efpecially in the warm feafon. It muft, however, be ufed with pru- dence, as fome rickety children cannot bear it. The beft time for ufing the cold bath is in the morning, and the child Should be well rubbed with a dry cloth immediately after he comes out of it. If the child Should be weakened by the cold bath, it muft be dif- continued. Sometimes iffues have been found beneficial in this difeafe. They are peculiarly neceffary for chil- dren who abound with grofs humors. An infufion of the Peruvian bark in wine would be of fervice. We might here mention many other medicines which have been recommended for the rickets ; but as there is far more danger in trufting to thefe than in ne- glecting them altogether, we choofe rather to pafs them over, and to recommend a proper regimen as the thing chiefly to be depended on. OF CONVULSIONS. Though more children are faid to die of convul- fions than of any other difeafe, yet they are for the moft part only a fymptom of fome other malady. Whatever greatly irritates or ftimulates the nerves, may occafion convulfions. Hence infants, whofe nerves are eafily affected, are often thrown into convulfions by any thing that irritates the alimen- tary canal ; likewife by teething ; ftrait clothes ; the approach of the fmall-pox, meafles, or other eruptive difeafes. When convulfions proceed from an irritation of the ftomach or bowels, whatever clears them of their acrid contents, or renders thefe mild and in- offenfive, will generally perform a cure : wherefore, if the child be coftive, the beft way will be to begin O o 4 with 568 OF CONVULSIONS. with a clyfter, and afterwards to give a gentle vomit, which may be repeated occafionally, and the body in the mean time kept open by gentle dofes of mag- nefia alba alone, or mixed with fmall quantities of rhubarb. Convulfions which precede the eruption of the fmall pox or meafles generally go off upon thefe making their appearance. The principal danger in this cafe arifes from the fears and apprehenfions of thofe who have the care of the patient. Con- vulfions are very alarming, and fomething muft be done to appeafe the affrighted parents, nurfes, &c. Hence the unhappy infant often undergoes bleed- ing, bliftering, and feveral other operations, when a little time, bathing the feet in warm water, and throwing in a mild clyfter, would have fet all to rights. When convulfion fits arife from the cutting of teeth, befides gentle evacuations, we would recom- mend bliftering, and the ufe of a few drops of lau- danum, mixed in a cup of white-wine whey, and given occafionally. Wrhen convulfions proceed from any external caufe, as the preffure occafioned by ftrait clothes or bandages, &c. thefe ought immediately to be removed ; though in this cafe taking away the caufe will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the caufe which firft gave rife to the diforder continues to act. When a child is feized with convulfions, without having any complaint in the bowels, or fymptoms of teething ; or any rafli or other difcharge which has been fuddenly dried up; we have reafon to con- clude that it is a primary difeafe, and proceeds im- mediately from the brain. Cafes of this kind, however, happen but feldom, which is very for- tunate, OF WATER IN THE HEAD, cjrV. 569 tunate, as it is difficult to relieve the unhappy patient. When a difeafe proceeds from an origi- nal fault in the formation or Structure of the brain itfelf, we cannot expect that it fhould yield to me- dicine. But as this is not always the caufe, even of convulfions which proceed immediately from the brain, fome attempts fliould be made to remove them. The chief intention to be purfued for this purpofe, is by bleeding, or to make fome derivation from the head, by bliftering, purging, and the like. Should thefe fail, iffues or fetons may be put in the neck, or between the flioulders. Bathing the feet in warm water is proper in almoft every cafe of con- vulfions in children. OF WATER IN THE HEAD, OR, DROPSY OF THE BRAIN. Though water in the head, or a dropfy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly liable to it, we thought it would be moft proper to place it among the dif- eafes of infants. CAUSES.----A dropfy of the brain may pro- ceed fr@m injuries done to the brain itfelf by falls, blows, or the like; it may likewife proceed from an original laxity or weaknefs of the brain ; from fchirrous tumors or excrefcences within the fkull. It often occurs in the latter ftage of fevers and fe- verifh difeafes, by a determination of fluids to the brain and congeftion and confequent inflammation there. SYMPTOMS.----This difeafe has at firft the appearance of a flow fever; the patient complains heavily of a pain in the head, where he moftly places his hands, or over his eyes: he fliuns the light, is fick, 570 OF WATER IN THE HEAD, ferV. fick, and fometimes vomits ; his pulfe is irregular, fometimes full, fometimes low, often preternaturally flow, and generally hard ; the pupils are dilated; the body very coftive ; urine in fmall quantities. This difeafe is often attributed to worms,and, indeed, before it was well underftood, was generally called the Worm-Fever. Though the patient fetms heavy and dull, yet he does not fleep : he is fometimes de- lirious, and frequently fees objects double; towards the end of the difeafe, the pulfe becomes more fre- quenr, the pupils continue dilated, a fquinting comes on, the cheeks are flulhed, the patient becomes co- matofe, and a palfy or convulfions clofe the fcene. MEDICINE.----The cure of this difeafe is, by repeated bleedings, as long as the hard pulfe, fever, pain and dilated pupils continue. No time muft be loft in ufing this neceffary evacuation ; and were it ufed foon enough and in fuiife ient quantity, this hi- therto formidable difeafe would yield as foon as moft others. It is, in fact, an inflammation of the brain, ending in effufion or dropfy; and by curing the in- flammation, we prevent the dropfy. For this pur- pofe, along with the Heeding, the cooling regimen fhould be ufed in its utmoft extent, as in other in- flammatory difeafes, particularly cold applications to the head. The bowels Should be kept conftantly loofe with calomel mixed with jalap, rhubarb or nitre; blifters fhould be kept running at the back of the neck or behind the ears ; the diet fhould be light. If there is reafon to fuppofe the effufion has taken place, which is known by the continuance of the difeafe and the fymptoms above-mentioned, we muft bleed if the pulfe will bear it; ufe the purga- tives and blifters very freely; and endeavour to ex- cite a falivation, by rubbing in mercurial ointment on the throat and neck. Towards the clofe of the difeafe, if the patient is weak, ftrengthening med - cines OF SURGERY. S?I cines and regimen, particularly exercife are proper. The chief caution to be attended to in the cure of this difeafe, is to apply our remedies fpeedily and freely*. CHAP. LI. Of Surgery. 1 O deferibe all the operations of fur- gery, and to point out the different difeafes in which thefe operations are neceffary, would extend this article far beyond the limits allotted to it: we muft therefore confine our obfervations to fuch cafes as moft generally occur, and in which proper affift- ance is cither not afked, or not always to be ob- tained. Though an acquaintance with the Structure of the human body is indifpenfibly neceflary to qua- lify a man for being an expert Surgeon; yet many things may be done to fave the lives of their fellow- men in emergencies by thofe who are no adepts in anatomy. It is amazing with what facility the peafants daily perform operations upon brute ani- mals, which are not of a lefs difficult nature than many of thofe performed on the human fpecies; yet they feldom fail of fuccefs. Indeed every man is in fome meafure a furgeon whether he will or not. He feels an inclination to * Large and continued dofes of calomel have been much recommended for the cure of this difeafe. They may f )metimes fucceed beiore the effufion takes place, and are certainly of great fervice afterwards; but the more active praclice above recommended is chiefly to be muted to. affift 57* OF BLEEDING. affift his fellow-men in diftrefs, and accidents hap- pen every hour which give occafion to exercife this feeling. The feelings of the heart, however, when not directed by the judgment, are apt to mislead. Thus one, by a rafh attempt to fave his friend, may fometimes deftroy him; while another, for fear of doing amifs, ftands ftill and fees his bofom- friend expire without fo much as attempting to re- lieve him, even when the means are in his power. As every good man would wifh to fleer a courfe different from either of thefe, it will no doubt be agreeable to him to know what ought to be done upon fuch emergencies. OF BLEEDING. No operation of furgery is fo frequently necef- fary as bleeding ; it ought therefore to be very ge- nerally underftood. But though practifed by mid- wives, gardeners, blackfmiths, Sec we have reafon to believe that very few know when it is proper. It is however an operation of great importance, and muft, when feafonably and properly performed, be of fingular fervice to thofe in diftrefs. Bleeding is proper at the beginning of all in- flammatory fevers, as pleurifies, peripneumonies, &e. It is likewife proper in all topical inflamma- tions, as thofe of the inteftines, womb, bladder, ftomach, kidnies, throat, eyes, Sec. as alfc in the afthma, feiatic pains, coughs, head-achs, rheu- matifms, the apoplexy, epilepfy, and bloody flux. After falls, blows, bruifes, or any violent hurt re- ceived either externally or internally, bleeding is neceffary. But in all diforders proceeding from a relaxation of the folids, and an impoverished ftate of the blood, as fome kind of dropfies, cacochymies, &c. bleeding is improper. Bleeding, OF BLEEDING. 573 Bleeding, for topical inflammations, ought always to be performed as near the part affected as poffible. When this can be done with a lancet, it is to be pre- ferred to any other method ; but where a vein can- not be found, recourfe muft be had to leeches or cupping. The quantity of blood to be let muft always be regulated by the ftrength, age, conftitution, manner of life, and other circumftances relating to the patient. From whatever part of the body blood is to be let, a bandage muft be applied between that part and the heart. As it is often neceffary, in order to raife the vein, to make the bandage pretty tight, it will be proper, in fuch cafes, as foon as the blood begins to flow, to Slacken it a little. The bandage ought to be applied at leaft an inch, or an inch and a half from the place where the wound is intended to be made. Perfons not fkilled in anatomy, ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may eafily be known from its pulfation or beating, and the latter from its feeling hard or tight, like a whipcord, under the finger. It was formerly a rule, even among thofe who had the character of being regular practitioners, to ■bleed their patients, in certain difeafes, till they fainted. Surely a more ridiculous rule could not be propofed. One perfon will faint at the fight of a lancet, while another will lofe almoft the whole blood of his body before he faints. Swooning depends more upon the flare of the mind, than of the body* befides, it may often be occafioned or prevented, by the manner in which the operation is performed. Though children are generally bled with difficulty, vet would thofe who practice bleeding take a-little more pains, and accuftom themfelves to bleed chil- dren, 574 OF BLEEDING. dren, they would not find it fuch a difficult opera- tion as they imagine. Certain hurtful prejudices, with regard to bleeding, ftill prevail. There is a talk, for inftance, of head- veins, heart-veins, breaft-veins, &c. and it is be- lieved that bleeding in thefe, will certainly cure all difeafes of the parts from whence they are fuppofed to come, without confidering that all the blood- veffels arife from the heart, and return to it again; for which reafon, unlefs in topical inflammations, it fignifies very little from what part of the body blood is taken. But this, though a foolifh prejudice, is not near fo hurtful as the vulgar notion, that the firft bleeding will perform wonders. This belief makes them often poll pone the operation, when neceffary, in order to referve it for fome more important occa- fion, and, when they think themfelves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain ftated periods or feafons, has likewife often bad effects. It is a common notion, that bleeding in the feet draws the humors downwards, and confequently cures difeafes of the head and other fuperior parts: but we have already obferved, that, in all topical affections, the blood ought to be drawn as near the part as poffible. When it is neceffary, however, to bleed in the foot or hand, as the veins are fmall, and the bleeding is apt to ftop too foon, the part ought to be immerfed in warm water, and kept there till a fufficient quantity of blood be let. We Shall not fpend time in defcribing the manner of performing this operation : that will be better learned by example than precept. Twenty pages of defcription would not convey fo juft an idea of the operation, as feeing it once performed by an expert hand. Neither is it neceffary to point out the dif- ferent parts of the body from whence blood may be a taken OF INFLAMMATIONS AND ABSCESSES. 575 ! taken, as the arm, foot, forehead, temples, neck, I &c. Thefe will readily occur to every intelligent perfon, and the foregoing obfervations will be fuf- ficient for determining which of them is moil pro- per upon any particular occafion. In all cafes, unlefs where topical bleeding is neceffary, the arm is the moft commodious part of the body, in which the operation can be performed. fc OF INFLAMMATIONS AND ABSCESSES. From whatever caufe an inflammation proceeds, it muft terminate either by difperfion, fuppuration, ; or gangrene. Though it is impoffible to foretel, with certainty, in which of thefe ways any particular I inflammation will terminate, yet a probable conjec- ture may be formed, with regard to the event, from a knowledge of the patient's age and conftitution. Inflammations happening in a flight degree upon ( colds, and without any previous indifpofition, will moft probably be difperfed ; thofe which follow clofe upon a fever, or happen to perfons of a grofs habit of body, will generally fuppurate; and thofe which attack very old people, or perfons of a dropfical habit, \ will have a ftrong tendency to gangrene. If the inflammation be flight, and the conftitution found, the difperfion ought always to be attempted. This will be beft promoted by a Slender diluting diet, plentiful bleeding, and repeated purges. The part '; itfelf muft be fomented, and, if the fkin be very !. tenfe, it may be embrocated with a mixture of three- '■ fourths of fweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax-plafter. - If, notwithftanding thefe applications, the fymp- tomatic fever increafes, and the tumor becomes ' larger, with violent pain and pulfation, it will be \ proper to promote the fuppuration. The beft appli- cation 57<5 OF INFAMMATIONS AND ABSCESSES. cation for this purpofe, is a foft poultice of bread and milk, which fliould always be renewed fix or feven times a-day. If the fuppuration proceeds but Slowly, a raw onion, cue fmall or bruifed, may be fpread upon the poultice. When the abfcefs is ripe or fit for opening, which may eafily be known from the thinuefs of the fkin in the moft prominent part of it, a fluctuation of matter which may be felt undei the finger, and, generally fpeaking, an abatement of the pain, it may be opened either with a lancet or by means of cauftic*. The laft way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following fymptoms: the inflammation lofes its rednefs, and becomes dufkifli or livid ; the tenfion of the ikin goes off, and it feels flabby; little bladders filled with ichor of different colours fpread all over it; the tumor fub- fides, and from a clufkifh complexion becomes black; a quick low pulfe with cold clammy fweats, are the immediate forerunners of death. When thefe fymptoms firft appear, the part ought to be dreffed with a cataplafm made of lye and bran. Should the fymptoms become worfe, the part muft be fearified and afterwards dreffed with bafilicum foftened with oil cf turpentine. All the dreffings muft be applied warn. With regard to internal medicines, the patient muft be fupported with gene- rous cordials, and the Peruvian bark exhibited in as large dofes as the ftomach will bear it. If the mor- tified parts fliould feparate, the vvound will become a common ulcer, and muft be treated accordingly. This article includes the treatment of all thofe dif- eafes, which in different parts of the country, go * It fometimes happens that, from the fituation of an in- flammation, we do not wiih it to fuppurate. In this cafe it may be reiblved by fcarifying. 2 by OF WOtlNDS. $tf by the names of biles, impofthumes, whitloes, &c. * They are all abfceffes in confequence of a previous inflammation, which, if poffible, ought to be difcuf- fed; but when this cannot be done, the fuppuration fhould be promoted, and the matter difcharged by an incifion, if neceffary; afterwards the fore may be dreffed with yellow bafilicum, or fome other digef- tive ointment. OF WOUNDS. No part of medicine has been more miftaken than the treatment or cure of wounds. Mankind in ge- neral believe that certain herbs, ointments* and plafters are poffeffed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a well eftab- lifhed fact, that no external application whatever contributes towards the cure of a wound, any other way than by keeping the parts foft, clean, and de- fending them from the external air, which may be as effectually done by dry lint, as by the moft pom- pous applications, while it is exempt from many of r the bad confequences attending them*. The fame obfervation holds with refpect to inter- nal applications. Thefe only promote the cure of wounds as far as they tend to prevent a fever, or to remove any caufe that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that Art can do is to remove obstacles, * The paronychia or whitlow is moft certainly cured by thrufling a lancet into the moft painful part, fo as to feel the bone. * It may be faid that frefh wounds are healed by the appli- cation of Turlington's balfam, and fimilar medicines. The truth is, that thefe fubftances do good only by excluding the external air, which dry lint would do much better. P p and 57* OF WOUNDS. and to put the parts in fuch a condition as is the moft favourable to Nature's efforts. With this fimple view we fliall confider the treat- ment of wounds, and endeavour to point out fuch iteps as ought to be taken to facilitate their cure. The firft thing to be done when a perfon has re- ceived a wound, is to examine whether any foreign body be lodged in it, as wood, ftone, iron, lead, glafs, dirt, bits of cloth, or the like. Thefe, if poffible, ought to be extracted, and the wound cleaned before any dreffings be applied. When that cannot be effected with fafety, on account of the patient's weaknefs, or lofs of blood, they muft be fuffered to remain in the wound, and afterwards ex- tracted when he is more able to bear it*. When a wound penetrates into any of the cavities of the body, as the breaft, the bowels, &c. or where any confiderable blood-veffel is cut, a fkilful furgeon ought immediately to be called, otherwife the patient may lofe his life. But fometimes the difcharge of blood is fo great, that if it be not ftopt, the patient may die even before a furgeon, though at no great diftance, can arrive. In this cafe fomething muft be done by thofe who are prefent. If the wound be in any of the limbs, the bleeding may generally be ftopt by applying a tight ligature or bandage round the member a little above the wound. The beft method of doing this is to put a ftrong broad garter round the part, with a comprefs of linen di- rectly on.it, but fo flack as eafily to admit a fmall piece of ftick to be put under it, which muft be twitted, in the fame manner as a countryman does a cart-rope to fecure his loading, till the bleeding flops. Whenever this is the cafe, he muft take care f The lips of a wound fliould always be brought together either by bandage, flicking plafter, or future. to OF WOUNDS. 579 to twift it no longer, as Straining it too much might \ ' occafion an inflammation of the parts, and endanger a gangrene. In parts where this bandage cannot be applied, various other methods m^y be tried to ftop the bleeding, as the application of flyptics, aftringents, &c. Cloths dipped in a folution of blue vitriol in water, or the ftyptic water of the Difpenfatories, may be applied to ihe wound. When thefe cannot be obtained ftrong fpirits of wine may be ufed. Some recommend the agaric* of the oak as prefer- able to any of the other flyptics; and indeed it de- L ferves confiderable encomiums. It is eafily obtained, ' and ought to be kept in every family, in cafe of ac- ! cidents. A piece of it muft be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied fo tight as to keep it firmly onf. Though fpirits, tinftures, and hot balfams may be ufed, in order to ftop the bleeding when it is excef- * Dr. TifTot, in his Advice to the People, gives the following direftions for gathering, preparing, and applying the agaric : " Gather in autumn," fays he, " while the fine weather lafts, the agaric of the oak, which is a kind of fungus or excrefcence iffuing from the wood of that tree. It confifts at firft of four parts, which prefent themfelves fucceflively: 1. The outward : rind or fkin, which may be thrown away. 2. The part irr- l mediately under this rind, which is the beft of all. This is to be beat well with a hammer, till it becomes foft and very plia- ;' ble. This is the only preparation it requires, and a Slice of it of a proper fize is to be applied directly over the open blood-vef- fels. It conftringes and brings them clofe together, ftops the bleeding, and generally falls off at the end of two days. 3. The third part adhering to the fecond may ferve to ftop the bleeding • from the fmaller veffels; and the fourth and laft part may be reduced to powder as conducing to the fame purpofe." Where- agaric cannot be had, fponge may be ufed in its flead. It muft be applied in the fame manner, and has ne.irly the fame effects. j f Lint alone, or lint dipped in flour, will often ftop a bleed- in jj fo will fcraped hat and cob-webs. P p 2 five, OF WOUNDS. five, they are improper at other times. They do not promote but retard the cure, and often change ■ a fimple wound, into an ulcer. People imagine be- caufe hot balfams congeal the blood, and feem, as it were, to folder up the wound, that they thertfore heal it; but this is only a deception. They may indeed ftop the flowing blood, by fearing the mouths of the veffels; but, by rendering the part callous, they obstruct the cure. In flight wounds, which do not penetrate much deeper than the fkin, the beft application is a bit of the common black fticking-plafter. This keeps the fides of the wound together, and prevents the air from hurting it, which is all that is neceffary. When a wound penetrates deep, its lips fliould be drawn together by futures. We fhall not fpend time in defcribing the different bandages that may be proper for wounds in different parts of the body ; common fenfe will generally fug- geft the moft commodious method of applying a bandage; befides, defcriptions of this kind are not eafily underftood or remembered. The firft dreffing ought to continue on for at leaft two days; after which it may be removed, and frefli lint applied as before. If any part of the firft dref- fmg flicks fo clofe as not to be removed with eafe Or fafety to the patient, it may be allowed to con- tinue, and frefh lint dipped in fweet oil laid over it. This will foften it, fo as to make it come off eafily at the next dreffing. Afterwards the wound may be dreffed twice a-day in the fame manner till it be quite healed. Thofe who are fond of falves or ointments, may, after the wound is become very fuperficial, drefs it with the yellow bafilicum*; and if fungous, or what is called proud flefh, fhould rife in the * * See Appendix, Yellow laflicum. wound OF BURNS. 581 t wound, it may be checked by fprinkling on it . a little burnt alum or red precipitate of mercury. When a wound is greatly inflamed, the moft pro- Iper application is a poultice of bread and milk, foftened with a little fweet oil, frefh butter or lard. This muft be applied inftead of a plafter, and fhould be changed feveral times a-day. If the wound be large, and there is reafon to fear an inflammation, the patient fhould be kept on a very low diet. He muft abftain from flefli, ftrong J liquors, and every thing that is of a heating nature. If he be of a full habit, and has not loft much blood from the wound, he muft be bled ; and, if the fymp- toms be urgent, the operation muft be repeated. But when the patient has been greatly weakened by lofs of blood from the wound, it will be needlefs to ["• bleed him, unlefs a fever fhould enfue. Nature fhould never be too far exhausted. It is more fafe to allow her to ftruggle with the difeafe in her own way, than to fiuk the patient's ftrength by exceffive evacuations. Wounded perfons ought to be kept perfectly quiet and eafy. FIvery thing that ruffles the mind or moves the paffions, as love, anger, fear, exceffive joy, &c. are very hurtful. They ought above all l things to abftain from venery. The body fhould be kept gently open, cither by laxative clyfters, or by a cool vegetable diet, as roafted apples, ftewed | prunes, boiled fpinage, and fuch like. OF BURNS. In flight burns which do not break the fkin, it is Cuftomary to hold the part near the fire for a com- petent time, to rub it with fait, or to lay a comprefs upon it dipped in fpirits of wine or brandy. But P p 3 the 582 OF BURNS. the proper way of treating burns is to apply linen cloths dipped in cold water, conftantly to the part, until the pain is relieved. This is the moft effectual remedy to prevent pain, inflammation and ulceration. But when the bum has penetrated fo deep as to blifter or break the fkin, it muft be dreffed with fome of the liniment for burns mentioned in the Appendix, or with the ointment, commonly called •Goulard's cerate*. This may be mixed with an equal quantity of Turners cerate^, and fpread upon a foft rag, and applied to the part affected, if the part is very irritable. If it is not, the Goulard's cerate alone is the beft application. When this ointment cannot be had, an egg may be beat up with about an equal quantity of the fweeteft felad oil. This will ferve very well till a proper ointment can be prepared. When the burning is very deep, after the firft two or three days, it fhould be dreffed with equal parts of Goulard's and Turner's cerate mixed together. When the burn is violent, or has occafioned a high degree of inflammation, and there is reafon to fear a gangrene or mortification, the fame means muft be ufed to prevent it as are recommended in other violent inflammations. The patient, in this cafe, muft live low, and drink freely of weak di- luting liquors. He muft likewife be bled, and have his body kept open. But if the burnt parts ihould become livid or black, with other fymp- toms of mortification, it will be neceffary to bathe them frequently with warm camphorated fpirits of wine, tincture of myrrh, or other antifeptics, mixed with a decoction of the bark. In this cafe the bark * See Appendix, Goulard's cerate. f See Appendix, Turner's cerate. muft OF BURNS. 583 muft likewife be taken internally, and the patient's diet muft be more generous*. As example teaches better than precept, I fhall relate the treatment of the moft dreaofui cafe of this kind that has occurred in my practice. A middle-aged man, of a good conftitution, fell into a large veffel full of boiling water, and miferably fcalded about one half of his body. As his clothes were on, the burning in fome parts was very deep before they could be got off. For the firft two days the fcalded parts had been frequently anointed with a.mixture of lime-water and oil, which is a , very proper application for recent burns. On the third day, when I firft faw him, his fever was high, and his body coftive, for which he was bled, and had an emollient clyfter adminiftered. Poultices of bread and milk, foftened with frefh butter, were likewife applied to the affected parts, to abate the heat and inflammation. His fever ftill continuing high, he was bled a fecond time, was kept ftrictly on the cooling regimen, took the faline mixture with fmall dofes of nitre, and had an emollient clyf- ter adminiftered once a-day. When the inflamma- tion began to abate, the parts were dreffed with a digeftive compofed of brown cerate and yellow bafi- licum. Where any black fpots appeared, they were Slightly fearified, and touched with the tinc- ture of myrrh ; and, to prevent their fpreading, the Peruvian bark was adminiftered. By this courfe, the man was fo well in three weeks as to be able to attend to his bufinefs. * The fore remaining after a burn is generally filled with fungous, or as it is commonly called, proud flefli; this fhouLd be kept down by the daily application cf the lunar cauftic, ■bine vitiiol or burnt alum. Pp 4 OF [ 5«4 ] OF BRUISES. Bruifes are generally productive of worfe confe- quences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is need- lefs to give any definition of a difeafe fo univerfally known; we fhall therefore proceed to point out the method of treating it. In flight bruifes it will be fufficient to bathe the part with warm vinegar, to which a little brandy or rum may occafionally be added, and to keep cloths wet with this mixture conftantly applied to it. This is more proper than rubbing it with brandy, fpirits of wine, or other ardent fpirits, which are commonly ufed in fuch cafes*. When a bruife is very violent, the patient ought immediately to be bled, and put upon a proper re- gimen. His food fhould be light and cool, and his drink weak, and of an opening nature; as whey fweetened with honey, decoctions of tamarinds, bar- ley, cream of tartar-whey, and fuch like. The bruifed part muft be bathed with vinegar, as di- rected above ; and a poultice made by boiling crumb of bread, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruife. It may be renewed two or three times a-day. As the ftructure of the veffels is totally deftroyed by a violent bruife, there often enfues a great lofs of * In every cafe of recent bruife, if the fkin is not broke, and the part is immediately immerfed in cold vinegar or cold water, and kept there for fome time, moft of the difagreeable confequences may be prevented. fubftance. OF ULCERS.. 585 fubftance, which produces an ulcerous fore difficult to cure. If the bone be affected, the fore will not heal I efore an exfoliation takes place; that is, be- fore the difeafed part of the bone feparates, and comes out through the wound, this is often a very flow operation, and may even require feveral years to be completed. Hence it happens, that thefe fores are frequently miftaken for the king's evil, and treated as.fuch, though in fact they pro- ceed folely from the injury which the folid parts received from the blow. Patients in this fituation are peftered with dif- ferent advices. Every one who fees them propofes a new remedy, till the fore is fo much irritated with various and oppofite applications, that it is often at length rendered abfolutely incurable. The beft method of managing fuch fores is, to take care that the patient's conftitution does not fuffer by confinement, or improper medicine, and to apply nothing to them befides fimple ointment fpread upon foft lint, over which a poultice of bread and milk, with boiled camomile-flowers, or the like, may be put, to nourifh the part, and keep it foft and warm. Nature, thus affifted, will generally in time operate a cure, by throwing off the dif- eafed parts of the bone, after which the fore foon heals. OF ULCERS. Ulcers may be the confequence of wounds, bruifes, or impofthumes improperly treated ; they may likewife proceed from an ill ftate of the hu- mors, or what is called a bad habit of body. In the latter cafe, they ought not to be haftily dried up, otherwife it may prove fatal to the pa- tient. Ulcers happen moft commonly in the de- cline S86 OF ULCERS. cline of life; and perfons who neglect exercife, and live grofsly, are moft liable to them. They might often be prevented by retrenching fome part of the folid food, or by opening artificial drains, as iffues, fetons, or the like. An ulcer may be diftinguifhed from a wound by its difcharging a thin watery humour, which is often fo acrid as to inflame and corrode the fkin ; by the hardnefs and perpendicular fituation of its fides or edges, by the time of its duration, &c. It requires confiderable fkill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad ha- bit of body, fhould be fuffered to continue open, at leaft till the conftitution has been fo far changed by proper regimen, or the ufe of medicine, that they feem difpofed to heal of their own accord. Ulcers which are the effect of malignant fevers, or other acute difeafes, may generally be healed with fafety after the health has been reftored for fome time. The cure ought not however to be attempt- ed too foon, nor at any time without the ufe of purging medicines and a proper regimen. When wounds or bruifes have, by wrong treatment, de- generated into ulcers, if the conftitution be good, they may generally be healed with fafety. When ulcers either accompany chronic difeafes, or come in their flead, they muft be cautioufly healed. If an ulcer conduces to the patient's health, from whatever caufe it proceeds, it ought not to be healed; but if, on the contrary, it waftes the ftrength, and confumes the patient by a flow fever, it fhould be healed as foon as poffible. We would earneftly recommend a ftrict attention to thefe particulars, to all who have the misfortune to labour under this diforder, particularly perfons in the decline of life; as we have frequently known people OF ULCERS. S87 people throw away their lives by the want of it, while they were extolling and generoufly reward- ing thofe whom they ought to have looked upon as their executioners. The moft proper regimen for promoting the cure of ulcers, is to avoid all fpices, falted and high- feafoned food, all ftrong liquors, and to leffen the ufual quantity of flefh meat. The body ought to be kept gently open by a diet confifting chiefly of cooling laxative vegetables, and by drinking but- ter-milk, whey fweetened with honey, or the like. The patient ought to be kept cheerful, and fliould take as much exercife as he can eafily bear. When the bottom and fides of an ulcer feem hard and callous, they may be fprinkled twice a-day with a little red precipitate of mercury, and afterwards dreffed with the yellow bafilicum ointment. Some- times it will be neceffary to have the edges of the ulcer fcarified with the lancet. Lime-water has frequently been known to have very happy effects in the cure of obftinate ulcers. It may be ufed, made in the fame manner as directed for the ftone and gravel. My late learned and ingenious friend, Dr. Whytt, ftrongly recommends the ufe of the folution of cor- rofive fublimate of mercury in brandy, for the cure of obftinate ill-conditioned ulcers. I have frequent- ly found this medicine, when given according to the Doctor's directions, prove very fuccefsful. The dofe is a table-fpoonful night and morning ; at the fame time wafliing the fore twice or thrice a-day with it. In a letter which I had from the Doctor a little before his death, he informed me, 6 That he 4 obferved wafhing the fore thrice a-day with the 4 folution of a triple ftrength was very beneficial*.' * In ulcers of the lower limbs great benefit is often re- ceived from tight rollers, or wearing a laced flocking, as this prevents 588 OF ULCERS. A fiftulous ulcer can feldom be cured without an operation. It muft either be laid open fo as to have its callous ..parts deftroyed by fome corrofive applica- tion, or they muft be entirely cut away by the knife: but as this operation requires the hand of an expert furgeon, there is no occafion to defcribe it. Ulcers about the anus are moft apt to become fiftulous, and are very difficult to cure. Some indeed pretend to have found Ward's Fiftula pafte very fuccefeful in this complaint. It is not a dangerous medicine, and being eafily procured, it may deferve a trial; but as thefe ulcers generally proceed from an ill habit of body, they will feldom yield to any thing except a long courfe of regimen, affifted by medicines, which are calculated to correct that particular habit, and to induce an almoft total change in the conftitu- tion. The beft general rule, for the cure of ulcers, is to reduce the callous edges, procure good pus, and ftrengthen the part affected ; and to do this we muft treat our patients as in other cafes. If the fymptoms of inflammation prevail, ufe fuch remedies as will leffen it; bleeding, purging, and a vegetable diet. Half a drachm of nitre twice or three times a-day fhould be given. If debility prevails in the fyftem give bark, wine, and generous diet. In either cafe abfolute reft is neceffary. To relieve violent pain we ufe opium internally, and the lead water to the part; to reduce the edges, lunar cauftic or the knife* If thefe do not produce good pus, we fill the fore with red precipitate, or arfenic powder, fee Appendix, or powdered columbo root, or rhubarb, according to the nature of it. If the fore fmells bad, the carrot poultice or lime juice. If thefe do not produce good prevents the flux cf humours to the fores, and difpofes them to heal. pus, OF DISLOCATIONS. 589 pus, one of the calomel pills night and morning until it change the nature of the difcharge. In all old ulcers, an iffue fliould be made; and when the fore has become healthy, the tight roller of coarfe muffin will be found of the greateft fervice. CHAP. LIL Of Diftocations. W HEN a bone is moved out of its place or articulation, fo as to impede its proper func- tions, it is faid to be luxated or difllocated. As this often happens to perfons in fituations where no me- dical affiftance can be obtained, by which means limbs, and even lives, are frequently loft, we fhall endeavour to point out the method of reducing the moft common luxations, and thofe which re- quire immediate affiftance. - Any perfon of com- mon fenfe and refolution, who is prefent when a# diflocation happens, may often be of more fervice to the patient, than the moft expert furgeon can after the fweliing and inflammation have come on. When thefe are prefent, it is difficult to know the ftate of the joint, and dangerous to attempt a re- duction ; and by waiting till they are gone off, the mufcles may become fo relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place. A recent diflocation may generally be reduced by extenfion alone, which mull always be greater or lefs according to the ftrength of the mufcles which 590 DISLOCATION OF THE JAW. which move the joint, the age, robuftnefs, and other circumftances of the patient. When the bone has been out of its place for any confiderable time, and a fwelling or inflammation has come on, it will be neceffary to bleed the patient, and, after fomenting the part, to apply foft poultices with vinegar to it for fome time before the reduction is attempted. All that is neceffary after the reduction, is to apply cloths dipt in vinegar or camphorated fpirits of wine to the part, and to keep it perfectly eafy. Many bad confequences proceed from the neglect of this rule. A diflocation feldom happens with- out the tendons and ligaments of the joints being ftretched and fometimes torn. When thefe are kept eafy till they recover their ftrength and tone, all goes on very well; but if the injury be increafed by too frequent an exertion of the parts, no wonder if they be found weak and difeafed ever after. DISLOCATION OF THE JAW. The lower jaw may be luxated by yawning, blows, falls, chewing hard fubftances, or the like. .It is eafily known from the patient's being unable to fliut his mouth, or to eat any thing, as the teeth of the under jaw do not correfpond with thofe of the upper; befides, the chin either hangs down, or is thrown toward one fide, and the patient is neither able to fpeak distinctly, nor to fwallow without confi- derable difficulty. The ufual method of reducing a diflocated jaw, is to fet the patient upon a low ftool, fo as an af- fiftant may hold the head firm by preffmg it againft his breaft. The operator is then to thruft his two thumbs, being firft wrapped up with linen cloths that they may not flip, as far back into the pa- tient's DISLOCATION OF THE NECK. 59i tient's mouth as he can, while his finders are ap- plied to the jaw externally. After he has got firm hold of the jaw, he is to prefs it Strongly down- wards and backwards, by which means the elapfed heads of the jaw may be eafily pufhed into their former cavities. The peafants in fome parts ©f the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient's chin, then turning his back to that of the patient, pulls him up by the chin fo as to fufpend him from the ground. This method often fucceeds, but we think it a dangerous one, and therefore recommend the former. DISLOCATION OF THE NECK. The neck may be diflocated by falls, violent blows^ or the like. In this cafe, if the patient receives no affiftance, he foon dies, which makes people imagine the neck was broken ; it is, however, for the moft part only partially diflocated, and may be reduced by almoft any perfon who has refolution enough to at- tempt it. A complete diflocation of the neck is in- stantaneous death. When the neck is diflocated, the patient is im- mediately deprived of all fenfe and motion; his neck fwells, his countenance appears bloated; hi$ chin lies upon his breaft, and his face is generally turned towards one fide. To reduce this diflocation, the unhappy perfon fliould immediately be laid upon his back on the ground, and the operator muft place himfelf behind him, fo as to be able to lay hold of his head with both hands, while he makes a refiftance by placing his knees againft the patient's fhoulders. In thfs pofture he muft pull the head with confiderable 4 force. 592 DISLOCATION OF THE RIBS. force, gently twilling it at the fame time, if the face be turned to one fide, till he perceives that the joint is replaced, which may be known from the noife which the bones generally make when going in, the patient's beginning to breathe, and the head conti- nuing in its natural pofture. This is one of thofe operations which it is mere eafy to perform than defcribe. I have known in- ftances of its being happily performed even by women, and often by men of no medical educa- tion. After the neck is reduced, the patient ought to be bled, and fhould be fuffered to reft for fome days, till the parts recover their proper tone. DISLOCATION OF THE RIBS. As the articulation of the ribs with the back- bone is very ftrong, they are not often diflocated. It does however fometimes happen, which is a fuf- ficient reafon for our taking notice of it. When a rib is diflocated either upwards or downwards, in order to replace it, the patient fhould be laid upon his belly on a table, and the operator muft endeavour to pufh the head of the bone into its proper place. Should this method not fucceed, the arm of the dis- ordered fide may be fufpended over a gate or ladder, and, while the ribs are thus ftretched afunder, the heads of fuch as are out of place may be thruft into their former fituation. Thofe diflocations wherein the heads of the ribs are forced inwards, are both more dangerous and the moft difficult to reduce, as neither the hand nor any inftrument can be applied internally to di- rect the luxated heads of the ribs. Almoft the only thing that can be done is, to lay the patient upon his belly over a cafk, or fome gibbous body, and to move the fore-part of the rib inward towards the 2 back, DISLOCATION OF THE SHOULDER. 5g3 back, fometimes fhaking it; by this means the heads of the luxated ribs may flip into their former place. DISLOCATION OF THE SHOULDER. The humerus or upper bone of the arm may be diflocated in various directions : it happens, how- ever, moft frequently downwards, but very feldom directly upwards. From the nature of its articu- lation, as well as from its expofure to external in- juries, this bone is the moft fubject to diflocation of any in the body. A diflocation of the humerus may be known by a depreffion or cavity on the top of the fhoulder, and an inability to move the arm. When the diflocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the Shoulder, and the arm is thrown forwards towards the breaft. The ufual method of reducing dislocations of the Shoulder is to feat the patient upon a low ftool, and to caufe an affiftant to hold his body fo that it may not give way to the extenfion, while another lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient's arm, and caufes it to be tied behind his own neck : by this, while a fufficient extenfion is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert furgeon is always more fafe. In young and delicate patients, I have generally found it a very eafy matter to reduce the Shoulder, by extending the arm with one hand, and thrufting in the head of the bone with the other. In making the extenfion, the arm ought always to be a little bent. Qj] DIS- C 594 ] DISLOCATION OF THE ELBOW. The bones of the fore-arm may be diflocated in any direction. When this is the cafe, a protu- berance may be obferved on that fide of the arm towards which the bone is puflied, from which, and the patient's inability to bend his arm, a difloca- tion of this joint may eafily be known. Two affiftants are generally neceffary for redu- cing a diflocation of the elbow ; one of them muft lay hold of the arm above, and the other below the joint, and make a pretty ftrong extenfion, while the operator returns the bones into their proper place. Afterwards the arm muft be bent, and fufpendedfor fome time with a fling about the neck. Luxations of the wrift and fingers are to be re- moved in the fame manner as thofe of the elbow, viz. by making an extenfion in different directions, and thrufting the head of the bone into its place. DISLOCATION OF THE THIGH. When the thigh-bone is diflocated forward and downward, the knee and foot are turned out, and the leg is longer than the other ; but when it is difplaced backward, it is ufually puflied upward at the fame time, by which means the limb is fhort- ened, and the foot is turned inwards. When the thigh-bone is difplaced forward and downward, the patient, in order to have it re- duced, muft be laid upon his back, and made faft by bandages, or held by affiftants, while by others an extenfion is made by means of flings fixed about the bottom of the thigh a little above the knee. While the extenfion is made, the operator muft puih the head of the bone outward, till it gets into the focke?. OF BROKEN BONES, &rV. j95 focket. If the diflocation be outward, the patient muft be laid upon his face, and, during the extenfion, the head of the bone muft be pufhed inward. Diflocations of the knees, ancles, and toes, are reduced much in the fame manner as thofe of the upper extremities, viz. by making an extenfion in oppofite directions, while the operator replaces the bones. In many cafes* however, the extenfion alone is fufficient, and the bone will flip into its place merely by pulling the limb with fufficient force. It is not hereby meant, that force alone is fufficient for the reduction of diflocations. Skill and addrefg will often fucceed better than force. I have known a diflocation of the thigh reduced by one man, after all the force that could be ufed by fix had proved ineffectual. CHAP. LIII. Of Broken Bones, life. A HERE is, in moft country villages, Tome perfon who pretends to the art of reducing fractures. Though in general fuch perfons are very ignorant, yet fome of them are very fuccefsful; which evidently proves, that a fmall degree of learning, with a fufficient fhare of common fenfe and a mechanical head, will enable a man to be ufeful in this way. We would, however, advife people never to employ fuch operators, when an expert and fkilful furgeon can be had, but when that is impracticable, they muft be employed: we Shall therefore recom- mend the following hints to their confideration : f^q 2 When 5<;6 OF BROKEN BONES, &c. When a large bone is broken, the patient's diet ought in all refpects to be the fame as in an inflam- matory fever. He fhould likewife be kept quiet and cool, and his body open by emollient clyfters; or, if thefe cannot be conveniently adminiftered, by food that is of an opening quality ; as ftewed prunes, apples boiled in milk, boiled fpinage, and the like. It ought however to be here remarked, that perfons who have been accuftomed to live high, are not all of a fudden to be reduced to a very low diet. This might have fatal effects. There is often a neceffity for indulging even fuch habits, in fome meafure, where the nature of the difeafe might require a dif- ferent treatment. It will generally be neceffary to bleed the patient immediately after a fracture, efpecially if he be young, of a full habit, or has at the fame time re- ceived any bruife or contufion. This operation Should not only be performed foon after the acci- dent happens, but if the patient be very feverifh, it may be repeated next day. When feveral of the ribs are broken, bleeding is peculiarly neceffary. If any of the large bones which fupport the body are broken, the patient muft keep his bed for feve- ral weeks. It is by no means neceffary, however, that he fliould lie all that time, as is cuftomary, upon his back. This fituation finks the fpirits, galls and frets the patient's fkin, and renders him very uneafy. After the fecond week he may be gently raifed up, and may fit feveral hours, fupported by a bed-chair, or the like, whicii will greatly relieve him. Great care, however, muft be taken in raifing him up, and laying him down, that he make no exertions himfelf, otherwife the action of the mufcles may pull the bone out of its place*. * Various pieces of machinery have been contrived for ^uttracting the force of the mufcles, and retaining the frag- ments OF BROKEN BONES, &c. 597 It is of great importance to keep the patient dry and clean while in this fituation. By .neglecting this, he is often fo galled and excoriated, that he is forced to keep fhifting places for eafe. I have known a fractured thigh-bone, after it had been kept Straight for above a fortnight, difplaced by this means, and continue bent for life, in fpite of all that could be done. It has been cuftomary when a bone was broken, to keep the limb for five or fix weeks continually upon the Stretch. But this is a bad pofture. It 'u both uneafy to the patient, and unfavourable to the 'cure. The beft fituation is to keep the limb a little. bent. This is the pofture into which every animal puts its limbs when it goes to reft, and in which feweft mufcles are upon the ftretch. It is eafily effected, by either laying the patient upon his Side, or making the bed fo as to favour this pofition of the limb. Bone-fetters ought carefully to examine whether the bone be not fhattered or broken into feveral pieces. In this cafe it may fometimes be neceffary to have the limb immediately taken off, otherwife a gangrene or mortification may enfue. But it is un- neceffary to give further directions on this head, as fuch an operation will never be attempted without the advice of a lkilful furgeon. ments of broken bones; but as defcriptions of thefe without drawings would be of little ufe, I fliall refer the reader to a cheap and ufeful performance on the nature and cure of'fratlures, lately publifhed by my ingenious friend Mr. Akken, furgeon i:i Edinburgh; wherein that gentleman has not only given an ac- count of the machines recommended in frrutures by former authors, but has likewife added feveral improvements of his own, which are peculiarly ufeful in compound fraftures, and in cafes where patients with broken bones are obliged to be trans- ported from one place to another. Q^q 3 When 598 OF BROKEN BONES, tf«. When a fracture is accompanied with a wound, it muft be dreffed in all refpects as a common wound. All that art can do towards the cure of a broken bone, is to lay it perfectly Straight, and to keep it quite eafy. All tight bandages do hurt. They had much better be wanting altogether. A great many of the bad confequences which fucceed to fractured bones are owing to tight bandages. This is one of the ways in which the excefs of art, or rather the abufe of it, does more mifchief than would be occa- fioned by the want of it. Some of the moft fudden cures of broken bones which were ever known, happened where no bandages were applied at all. Some method however muft be taken to keep the member fteady; but this may be done many ways without bracing it with a tight bandage. The beft method of retention is by two or more fplints made of leatlier or pafteboard. Thefe, if moiftened before they be applied, foon affume the fliape of the included member, and are'fufficient by the affiftance of a very flight bandage, for all the purpofes of retention. The bandage which we would recommend is that made with feveral diftinct pieces of broad tape or ferret. It is much eafier applied and taken off than rollers, and anfwers all the pur- pofes of retention equally well. The fplints fliould always be as long as the limb, with holes cut for the ancles when the fracture is in the leg. In fractures of the ribs, where a bandage cannot be properly ufed, an adhefive plafter may be applied over the part. The patient in this cafe ought to keep himfelf quite eafy, avoiding every thing that may occafion freezing, laughing, coughing, or the like. He ought to keep his body in a ftraight pof- ture, and fliould take care that his ftomach be con- ftantly diftended, by taking frequently fome light food, and drink freely of weak watery liquors. The OF STRAINS. 599 The moft proper external application for a frac- ture is oxycrate, or a mixture of vinegar and water. The bandages fhould be wet with this at every dref- fing. OF STRAINS. Strains are often attended with worfe confequences than broken bones. The reafon is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member eafy, be- caufe he cannot make ufe of it; but when a joint n «nly ftrained, the perfon, finding he can ftill make a . fliift to move it, is forry to lofe his time for fo trifling an ailment. In this way he deceives himfelf, and converts into an incurable malady, what might have been removed by only keeping the part eafy for a few days. Country people generally immerfe a ftrained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long. Wrapping a garter, or fome other bandage, pretty tight about ihe ftrained part, is likewife cf ufe. It helps to reftore the proper tone of the veffels, and prevents the action of the parts from increasing the difeafe. It fhould not, however, be applied too tight. 1 have frequently known bleeding near the affected part have a very good effect: but what we would recommend a-bove all is eafe. It is more to be de- pended upon than any medicine, and feldom fails to remove the complaint. The parts affected generally remain weak after dislocations, fractures and ftrains. There is no application equal to cold water, poured once o«f twice a day on the part from a tea-pot, and . afterwairds rubbing fmartiy with flannel or the flefh- brufli*. * A great many external applications are recommended for ftrainsj fome of" winch do good, and others hurt. The follow- ing are fuch as may be ufed'with the greateff! fafety, viz. poul- Q,_q 4 tices [ 600 J OF RUPTURES. Children and old people are moft liable to this difeafe. In the former, it is generally oceafioned by exceffive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the ftrength, as leaping, carrying great weights, &c. In both, a relaxed habit, indo- lence, and very moift diet, difpofe the body to ihis difeafe. A rupture fometimes proves fatal before it is dif- covered. Whenever ficknefs, vomiting, and obfti- nate coftivenefs, give reafon tofufpect an obstruction of the bowels, all thofe places where ruptures ufualiy happen ought carefully to be examined. The pro- trusion of a very fmall part of the gut will occafion all thefe fymptoms ; and, if not returned in due time, may prove mortal. On the firft appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this pofture, if the gut does not return of itfelf, it may eafily be put up by gentle preffure. ' After it is returned, a piece of iticking- plafter may be applied over the part, and a proper trufs or bandage muft be conftantly worn for a con- fiderable time. The method of making and ap- plying thefe rupture-bandages for children is pretty well known. The child muft, as far as poffible, be* kept from crying, and from all violent exertions, till the rupture is quite healed*. tices made of ftale beer or vinegar and oat meal, camphorated fpirits ct wine, Mir.dererus's fpirit, volatile l:i iment, volatile, aromatic fpirit, diluted with a lOuble quantity ri water, and fhe common fomentation, with the addition of brandy or fpirit v.t v.ine. * 1 he cold bath, ufed daily, and for a confiderable time, : 5 a capital remedy for this complaint in children. In OF RUPTURES. 601 In adults, when the gut has been forced down with great violence, or happens from any caufe to be inflamed, there is often great difficulty in re- turning it, and fometimes the thing is quite imprac- ticable without an operation ; a defcription of which is foreign to our purpofe. As I have been fortunate enough, however, always to fucceed in my attempts to return the gut, without having recourfe to any other means than what are in the power of every man, I fliall briefly mention the method which I generally purfue. After the patient has been bled, he muft be laid upon his back, with his head very lew, and his. breech raifed high with pillows. In this fituation flannel-cloths wrung out of a decoction of mallows and camomile-flowers, or, if thefe are not at hand, of warm water, muft be applied for a con- fiderable time. A clyfter made of this decoction, with a large fpoonful of butter and an ounce or two of fait, may be afterwards thrown up. If thefe fliould not prove fuccefsful, recourfe muft be had to preffure. If the tumor be very hard, this muft be continued for a confiderable time, for it is not force which fucceeds here. The operator, at the fame time that he makes a preffure with the palms of his hand, muft with his fingers artfully conduct the gut in by the fame aperture through which it came out. The manner%of doing this can be much eafier con- ceived than defcribed. Should thefe endeavours prove ineffectual, clyfters of the fmoke of tobacco may be tried. Thefe have been often known to fucceed where every other method failed. There is reafon to believe that, by perfifting in the ufe of thefe, and fuch other means as the cir- cumftances of the cafe may fuggeft, moft hernias might be reduced without an operation. Cutting for the hernia is a nice and diificult matter. I would therefore 602 OF RUPTURES. therefore advife furgeons to try every method of returning the gut before they have recourfe to the knife. 1 have once and again fucceeded by perfe- vering in my endeavours, after eminent furgeons had declared the reduction of the gut impracticable without an operation*. An adult, after the gut has been returned, muft wear a fteel bandage. It is needlefs to defcribe this, as it may always be had ready-made from the artifts. Such bandages are generally uneafy to the wearer for fome time, bat by cuftom they become quite eafy. No perfon who has had a rupture after he arrived at man's eftate fhould ever be without one of thefe bandages. Perfons who have a rupture ought carefully to avoid all violent exercife, carrying great weights, leaping, running, and the like. They fhould like- wife avoid windy aliment and ftrong liquors; and fliould carefully guard againft catching cold. * I would here beg leave to recommend it to every practi- tioner, when his patient complains of pain in the belly with obr ftinate coftivenefs, to examine the groins and every place where a rupture may happen, in order that it may be immediately re- duced. By neglecting this, many perifh who were not fufpetfed to have had ruptures till after they were dead. I have known this happen where half a dozen of the faculty were in attend- ance. # CHAP. [ 6o3 ] CHAP. LIV. Of Cafualties. IT is eertain that life, when to all ap- pearance loft, may often, by due care, be reftored. Accidents frequently prove fatal, merely becaufe proper means are not ufed to counteract their effects. No perfon ought to be looked upon as killed by any accident, unlefs where the Structure of the heart, brain, or fome organ neceffary to life, is evidently deftroyed. The action of thefe organs m?y be fo far impaired as even to be for fome time imperceptible, when life is by no means gone. In this cafe, however, if the fluids be fuffered to grow cold, it may be impoffible to put them again in motion, even though the folids fhould recover their power of acting. Thus, when the motion of the lungs has been ftopt by unwholefome vapour, the action of the heart by a Stroke on the breaft, or the functions of the brain by a blow on the head, if the perfon be fuffered to grow cold, he will in all probability continue fo; but, if the body be kept warm, as foon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be reftored. It is a horrid cuftom immediately to confign over to death every perfon who has the misfortune, by a; fall, a blow, or the like, to be deprived of the ap- pearance of life. The unhappy perfon, inftead of being carried into a w<»rm houfe, and laid by the fire, or put to a warm bed, is generally hurried away to fome damp houfe, where, after a fruitlefs attempt has been made to bleed him, perhaps by one who knew 604 SUBSTANCES STOPT BETWEEN knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct feems to be the refult of ignorance, fup- ported by an ancient fuperftitious notion, which for- bids the body of any perfon killed by accident to be laid in an houfe that is inhabited. What the ground of this fuperftition may be, we fhall not pretend to inquire; but furely the conduct founded upon it is contrary to all the principles of reafon, humanity, and common fenfe. When a perfon feems to be fuddenly deprived of life, our firft bufinefs is to inquire into the caufe. We ought carefully to obferve whether any fub- ftance be lodged in the wind-pipe or gullet; and, if that is the cafe, attempts muft be made to remove it. When unwholefome air is the caufe, the patient ought immediately to be removed out of it. When the catife cannot be fuddenly removed, our great aim muft be to keep up the vital warmth by rubbing the patient with hot cloths, or fait, and covering his body with warm fand, afhe's, or the like. I fhould now proceed to treat more fully of thofe accidents, which without immediate affiftance, would often prove fatal, and to point out the moft likely means for relieving the unhappy fufferers; but as I have been happily anticipated in this part of my fubject by the learned and humane Dr. Tiffot, I fhall content myfelf with felecting fuch of his obfer- fervations as feem to be the moft important, and adding fuch of my own as have occurred in the courfe of practice. OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH. Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effea THE MOUTH AND STOMACH. 60$ effect of careleffnefs. Children fhould be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to fwallow. But children are not the only perfons guilty of this piece of imprudence. 1 know many adults who put pins, nails, and other fliarp-pointed fubftances in their mouths upon every occafion, and fome who even fleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the fubftance before the perfon is aware*. When any fubftance is detained in the gullet, there are two ways of removing it, viz. either by extracting it, or pufhing it down. The fafeft and moft certain way is to extract it; but this is not always the eafieft; it may therefore be more eli- gible fometimes to thruft it down, efpecially when the obftrucling body is of fuch a nature, that there is no danger from its reception into the ftomach. The fubftances whicii may be puflied down without danger are, all common nourishing ones, as bread, flefli, fruits, and the like. All indigeftible bodies, as cork, wood, bones, pieces of metal, and fuch like, ought if poffible to be extracted, efpecially if thefe bodies be fharp pointed, as pins, needles, fifli-bones, bits of glafs, &c. W7hen fuch fubftances have not paffed in too deep, we fhould endeavour to extract them with our fingers, which method often fucceeds. When they are lower, we muft make ufe of nippers, or a fmall pair of forceps, fuch as furgeons ufe. But this attempt to extract rarely fucceeds, if the fub- ftance be of a flexible nature, and has defcended far into the gullet. * A woman in one of the hofpitals of this city lately dif- charged a great number of pins, which fhe had fwallowed in the courfe of her bufinefs, through an ulcer i/i her fide. If 606 SUBSTANCES STOPT BETWEEN If the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, muft be em- ployed. Thefe may be made at once, by bending a piece of pretty ftrong iron wire at one end. It muft be introduced in the flat way; and for the better conducting it, there fliould likewife be a curve or bending at the end it is held by, to ferve as a kind of handle to it; which has this further ufe, that it may be fecured by a firing tied to it, a circumftance not to be omitted in any instrument employed on fuch occafions, to avoid fuch ill acci- dents as have fometimes enfued from thefe instru- ments flipping out of the operator's hand. After the crotchet has paffed below the fubftance that ob- structs the paffage, it is drawn up again, and hooks up the body along with it. The crotchet is alfo very convenient, when a fubftance fomewhat flexible, as a pin or fifh-bone, flicks acrofs the gullet, the hook, in fuch cafes, feizing them about their middle part, crooks and thus difengages them; or, if they are very brittle fubftances, ferves to break them. When the obftructing bodies are fmall, and only ftop up a part of the paffage, and which may either eafily elude the hook, or flraiten it by their refift- ance, a kind of rings, made either of wire, wool, or filk, may be ufed. A piece of fine wire of a proper length may be bent isto a circle, about the middle, of about an inch diameter, and the long unbent fides brought parallel, and near each other: thefe are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obftructing body, and fo to extract it. More flexible rings may be made of wool, thread, filk, or fmall packthread, which may be waxed for their greater ftrength and confif- tence. One of thefe is to be tied faSt to a handle of iron wire, whale-bcne, or any kind of flexible wood, THE MOUTH AND STOMACH. 607 wood, and by this means introduced, in order to furround the obftructing fubftance, and to draw it out. Several of thefe rings paffed through one another may be ufed, the more certainly to lay hold of the obftructing body, which may be involved by one, if another fhould mifs it. Thefe ring9 have one advantage, which is, that when the fub- ftance to be extracted is once laid hold of, it may then, by turning the handle, be retained fo Strongly in the ring thus twilled, as to be moved every way, which muft in many cafes be a confiderable advantage. Another material employed on thefe unhappy oc- cafions is the fponge. Its property of fwelling con- fiderably on being wet is the principal foundation of its ufefulnefs here. If any fubftance is ftopt in the gullet, but without filling up the whole paffage, a bit of fponge may be introduced into that part which is unftopt, and beyond the fubftance. The fponge foon dilates, and grows larger in this moift fituation ; and indeed the enlargement of it may be forwarded by making the patient fwallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fattened; and as it is now too large to return through the fmall cavity by which it was conveyed in, it draws out the obftruc- ting body along with it. The compreffibility of fponge is another founda- tion of its ufefulnefs in fuch cafes. A pretty large piece of fponge may be compreffed or fqueezed into a fmall fize, by winding a firing of tape clofcly about it, which may be eafily unwound, and with- drawn, after the fponge has been introduced. A bit of fponge may likewife be compreffed by a piece of whale-bone fplit at one end ; but this can hardly be introduced in fuch a manner as not to hurt the patient. I have 6o8 SUBSTANCES STOPT BETWEEN I have often known pins and other fharp bodies, which had fluck in the throat, brought up by caufing the perfon to fwallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is fafer than fwallowing fponge, and will often anfwer the purpofe equally well. Wheu all thefe methods prove unfuccefsful, there remains one more, which is, to make the patient vomit: but this can fiooce'y be of any fervice, un- lefs when fuch obftructing bodies are fimply engaged in, and not hooked or fluck into the fides of the gullet, as in this cafe vomiting might fometimes occafion further mifchief. If the patient can fwal- low, vomiting may be excited by taking half a drachm or two feruples of ipecacuanha in powder made into a draught. If he is not able to fwallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that fhould not fucceed, a clyfter of tobacco may be ad- miniftered. It is made by boiling an ounce of to- bacco in a fufficient quantity of water : this has of- ten been found to fucceed, when other attempts to excite vomiting had failed. When the obftructing body is of fuch a nature that it may with fafety be puflied downwards, this may be attempted by means of a fmall wax-candle oiled, and a little heated, fo as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a fponge fattened to one end. Should it be impoffible to extract even thofe bo- odes which it is dangerous to admit into the fto- mach, we muft then prefer the leaft of two evils, and rather run the hazard of pufhing them down than fuffer the patient to perifh in a few minutes; and we ought to fcruple this refolution the lefs, as a great many inftances have happened, where the fwallowing of fuch hurtful and indigeftible fub- ftances has been followed by no diforder. I Whenever THE MOUTH AND STOMACH. 609 Whenever it is manifeft that all endeavours ei- ther to extract or pufh down the fubftance muft prove ineffectual, they fliould be difcontinued ; be- caufe the inflammation occafioned by perfifting in them might be as dangerous as the obstruction itfelf. Some have died in confequence of the in- flammation, even after the body which caufed the obftruction had been entirely removed, While the means recommended above are making ufe of, the patient fhould often fwallow, or, if he cannot, he fliould frequently receive by injection through a crooked tube or pipe that may reach down to the gullet, fome emollient liquor, as warm milk and water, barley-water, or a decbction of mallows. Injections of this kind not only foften and Toothe the irritated parts, but, when thrown in with force, are often more fuccefsful in loofening the ob- ftruction than all attempts with inftruments. When, after all our endeavours, we are obliged to leave the obftructing body in the part, the pa- tient muft be treated as if he had an inflammatory difeafe. He fliould be bled, kept upon a low diet, and have his whole neck furrounded with emollient 'poultices. The like treatment muft alfo be ufed, if "there be any occafion to expect an inflammation of the paffages, though the obftructing body be re- moved. A proper degree of agitation has fometimes loof- ened the inhering body more effectually than inftru- ments. Thus, a blow on the back has often forced up a fubftance which ftuck in the gullet; but this is ftill more proper and efficacious when the fubftance gets into the wind-pipe. In this cafe, vomiting and fneezing are likewife to be excited. Pins, which ftuck in the gullet, have been frequently difcharged by riding on horfeback, or in a carriage. R r When 6io OF DROWNED PERSONS. When any indigeftible fubftance has been forced down into the Stomach, the patient fliould ufe a very mild and fmooth diet, confifting chiefly of fruits and farinaceous fubftances, as puddings, pottage, and foups. He fhould avoid all heating and irritating things, as wine, punch, pepper, and fuch like; and his drink fhould be milk and water, barley-water, or whey. When the gullet is fo Strongly and fully clofed, that the patient can receive no food by the mouth, he muft be nourifhed by clyfters of foup, jelly, and the like. When the patient is in danger of being imme- diately fuffocated, and all hope of freeing the paffage is vanifhed, fo that death feems at hand, if refpira- tion be not reftored ; the operation of bronchotomy,. or opening of the wind-pipe, muft be directly per- formed. As this operation is neither difficult to an expert furgeon, nor very painful to the patient, and is often the only method which can be taken to pre- ferve life in thefe emergencies, we thought proper to mention it, though it fliould only be attempted by perfons fkilled in forgery. OF DROWNED PERSONS. When a perfon has remained above a quarter of an hour under water, there can be no coufiderable hopes of his recovery. But as feveral circumftances may happen to have continued life, in fuch an unfor- tunate Situation, beyond the ordinary term, we fliould never too foon reSign the unhappy object to his fate, but try every method for his relief, as there are many well atteited proofs of the recovery of perfons to life and health who had been taken out of the water apparently dead, and who remained a confiderable time without exhibiting ;.ny figns of life.. The OF DROWNED PERSONS. 611 The firft thing to be done, after the body is taken out of the water, is to convey it as foon as poffible to fome convenient place, where the neceffary ope- rations for its recovery may be performed. In do- ing this, care muft be taken not to bruife or injure the body by carrying it in any unnatural pofture, with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on ftraw, with the head a little raifed, and carried on a cart or on men's fhoulders, and kept in as natural and eafy a pofition as poffible. A fmall body may be carried in the arms. In attempting to recover perfons apparently drowned, the principal intention to be purfued is, to reftore the natural warmth, upon which all the vital functions depend ; and to excite thefe func- tions by the application of Stimulants, not only to the fkin, but likewife to the lungs, inteftines, &c. Though cold was by no means the caufe of the perfon's death, yet it will prove an effectual ob- flacle to his recovery. For this reafon, after Strip- ping him of his wet clothes, his body muft be ftrongly rubbed for a confiderable time with coarfe linen cloths, as warm as they can be made ; and, as foon as a well-heated bed can be got ready, he may be laid into it, and the rubbing fhould be con- tinued. Warm cloths ought likewife to be fre- quently applied to the ftomach and bowels, and hot bricks, or bottles of warm water, to the foles of his feet, and to the palms of his hands. Strong volatile fpirits fhould be frequently ap- plied to the nofe; and the fpine of the back and pit of the ftomach may be rubbed with 'warm brandy or fpirit of wine. The temples ought al- fo to be chafed with volatile fpirits ; and ftimu- lating powders may be blown up the noftrils. R r 2 To 612 OF DROWNED PERSONS. To renew the breathing, the lungs may be in- flated by blowing through one of the noftrils, and at the fame time keeping the other clofe. Dr. Monro for this purpofe recommends a wooden pipe, fitted at one end for filling the noftril, and at the other for receiving the pipe of a pair of bellows, to be employed for the fame purpofe, if neceffary. When air cannot be forced into the cheft by the mouth or nofe, it may be neceffary to make an opening into the wind-pipe for this purpofe. It is needlefs, however, to fpend time in deferibing this operation, as it fhould not be attempted unlefs by perfons fkilled in forgery. While thefe things are doing, fome of the at- tendants ought to be preparing a warm bath, into which the perfon fhould be put, if the above en- deavours prove ineffectual. Where there are no conveniences for ufing the warm bath, the body may be covered with warm fait, fand, aflies, grains, or fuch like. Tiffot mentions an inftance of a girl who was reftored to life, after fhe had been taken out of the water, fwelled, bloated, and to all ap- pearance dead, by laying her naked body upon hot allies, covering her with others equally hot, put- ting a bonnet round her head, and a Slocking round her neck Stuffed with the fame, and heaping co- verings over all. After fhe had remained half an hour in this fituation, her pulfe returned, She re- covered fpeech, and cried out, 1 freeze, I freeze; a little cherry-brandy was given her, and She re- mained buried as it were ..under the afhes for eight hours ; afterwards fhe was taken out, without any other complaint except that of laffitude or weari- nefs, which went off in a few days. The Doctor mentions likewife an inftar.ee of a man who was re- ftored to life after he had remained fix hours under water, by the heat of a dunghill. Till OF DROWNED PERSONS. 013 Till the patient fliews fome figns of life, and is able to fwallow, it would be ufelels and even dan- gerous to pour liquors into his mouth. His lips however, and tongue, may be frequently wet with a feather dipt in warm brandy or other ftrong fpirits; and, as foon as he has recovered the power of fwal- lowing, a little warm wine, or fome other cordial, ought every now and then to be adminiftered. We are by no means to difeontinue our aSfiftance as foon as the patients difcover feme tokens of life, fince they fometimes expire after thefe firft appearances of recovering. The warm and ftimu- lating applications are ftill to be continued, and fmall quantities of fome cordial liquor ought fre- quently to be adminiftered. Laftly, though the perfon Should be manifestly re-animated, there fome- times remain an oppreffion, a cough, and feverifh- nefs, which effectually constitute a difeafe. In this cafe it will be neceffary to bleed the patient in the arm, and to caufe him to drink plentifully of barley- water, elder flower-tea, or any other foft pectoral in- fufions. Such perfons as have the misfortune to be de- prived of the appearances of life, by a fall, a blow, fuffocation, or the like, muft be treated nearly in the fame manner as thofe who have been for fome time under water. 1 once attended a patient who was fo flunned by a fall from a horfe, that for above fix hours he fcarcely exhibited any figns of life ; yet this man, by being bled, and proper methods taken to keep up the vital warmth, lecovered, and in a few days was perfectly well. Dr. Alexander gives an inftance to the fame purpofe, in the Edinburgh Phyfical and Literary Effays, of a man who was to all appearance killed by a blow on the breaft, but recovered upon being immerfed for fome time in warm water. Thefe, and other inftances of a fimi- 11 r 3 lar 614 OF NOXIOUS VAPOURS. lar nature, which might be adduced, amount to a full proof of this fact, that many of thofe unhappy perfons who lofe their lives by falls, blows, and other accidents, might be faved by the ufe of proper means duly perfifted in. OF NOXIOUS VAPOURS. Air may be many ways rendered noxious, or even deftructive to animals. This may either happen from its vivifying principle being deftroyed, or from fubtle exhalations with which it is impregnated. Thus air that has paffed through burning fuel is neither capable of fupporting fire nor the life of ani- mals. Hence the danger of fleeping in clofe cham- bers with charcoal fires. Some indeed fuppofe the danger here proceeds from the fulphureous oil con- tained in the charcoal, which is fet at liberty and diffufed all over the chamber ; while others imagine it is owing to the air of the room being charged with phlogifton. Be this as it may, it is a fituation care- fully to be avoided. Indeed, it is dangerous to fleep in a fmall apartment, with a fire of any kind. I lately faw four perfons who had been fuffocated by fleeping in an apartment where a fmall fire of coal had been left burning. The vapour which exhales from wine, cyder, beer, or other liquors, in the ftate of fermentation, contains fomething poifonous, which kills in the fame manner as the vapour of coal. Hence there is always danger in going into cellars v/here a large quantity of thefe liquors is in a State of fermenta- tion, efpecially if they have been clofe fhut up for fome time. There have been many inftances of per- fons Struck dead on entering fuch places, and of others who have with difficulty efcaped. When OF NOXIOUS VAPOURS. 615 When fubterranecus caves, that have been very long fhut, are opened, or when deep wells are cleaned, which have not been emptied for feveral years, the vapours arifing from them produce the fame effects as thofe mentioned above. For this reafon, no perfon ought to venture into a well, pit, cellar, or any place that is damp, and has been long fhut up, till the air has been fufficiently pu- rified, by burning gun-powder in it. It is eafy to know, as has been obferved in a former part of this work, when the air of fuch places is unwhole- fome, by letting down a lighted candle, throwing in burning fuel, or the like. If thefe continue to burn, people may fafely venture in ; but where they are fuddenly extinguifhed, no one ought to enter till the air has been firft purified by fire. The offenfive fmell of lamps and of candles, efpe- cially when their flames are extinguished, operate like other vapours, though with lefs violence, and lefs fuddenly. There have, however, been inftances of people killed by the fumes of lamps which had been extinguished in a clofe chamber, and perfons of weak delicate breafts generally find themfelves quickly oppreffed in apartments illuminated with many candle?. Such as are fenfible of their danger in thefe fitua- tions, and retreat feafenably from it, are generally relieved as foon as they get into the open air, or, if they have any remaining uneafinefs, a little water and vinegar, or lemonade, drank hot, affords them re- lief. But when they are fo far poifoned, as to have loft their feeling and underftanding, the following means muft be ufed for their recovery: The patient fliould be expofed to a very pure, frefli, and open air ; and volatile falts, or other fti- mulating fubftances, held to his nofe. His legs ought to be put into warm water, and well rubbed. R r 4 As 6i0 EFFECTS OF EXTREME COLD. As foon as he can fwallow, fome lemonade, or water and vinegar, with the addition of a little nitre, may be given him. Nor are fharp clyfters by any means to be ne- glected ; thefe may be made, by adding to the common clyfter, fyrup of buckthorn and tincture of fenna, of each two ounces; or, in their Stead, half an ounce of Venice turpentine diffolved in the yolk of an egg. Should thefe things not be at hand, two or three large fpoonfulls of common fait may be put into the clyfter. The fame means, if neceffary, which were recommended in the former part .of this chapter, may be ufed to reftore the circulation, Warmth, &c. Dr. Frewen, of Suffex, mentions the cafe of a young man who was Stupefied by the fmoke of fea- coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed. The practice of plunging perfons fuffocated by noxious vapours in cold water, would feem to be fupported by the common experiment of fuffocating dogs in the grotto del cani, and afterwards recover- ing them, by throwing them into the neighbouring lake. EFFECTS OF EXTREME COLD. When cold is extremely fevere, and a perfon is expofed to it for a long time, it proves mortal, in confequence of its flopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain ; fo that the patient dies of a kind of apoplexy, preceded by great fleepi- nefs. The traveller, in this fituation, who finds himfeif begin to grow drowfy, fhould redouble his efforts to extricate himfelf from the imminent dan- ger he is expofed to. This fleep, which he might confider EFFECTS OF EXTREME COLD. 617 confider as fome alleviation of his fufferings, would, if indulged, prove his laft. 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 fo benumbed or frozen, as to be in danger of a mor- tification, if proper means are not ufed to prevent it. The chief danger in this fituation arifes from the fudden application of heat. It is very com- mon, when the hands or feet are pinched with cold, to hold them to the fire; yet reafon and obfervation fhew that this is a moft dangerous and imprudent practice. Every peafant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be deftroyed, by rotten- nefs or a kind of mortification ; and that the only way to recover them, is to immerfe them for fome time in very cold water. The fame obfervation holds with regard to animals in this condition. When the hands or feet are greatly benumbed with cold, they ought either to be immerfed in cold water, or rubbed with fnow, till they recover their natural warmth and fenfibility ; after which the perfon may be removed into an apartment a little warmer, and may drink fome cups of tea, or an infufion of elder-flowers, fweetened with honey. Every perfon muft have obferved, when his hands were even but Slightly affected with cold, that the beft way to warm them was by wafliing them in cold water, and continuing to rub them well for fome time. When a perfon has been fo long expofed to the cold, that all appearances of life are gone, it will be neceffary to rub him all over wirh fnow or cold water; or, what will anfwer better, if it can be obtained, to immerfe him in a bath of the very coldeft 618 EFFECTS OF EXTREME HEAT. coldeft water. There is the greateft encouragement to perfift in the ufe of thefe means, as we are affured that perfons who had remained in the fnow, or had been expofed to the freezing air during five or fix fucceffive days, and who had difcovered no marks of life for feveral hours, have neverthelefs been re- vived. I have always thought, that the whitloes, kibes, chilblains, and other infl.immations of the extremi- ties, which are fo common among the peafants in the cold feafon, were chiefly occasioned by their fud- den transitions from cold to heat. After they have been expofed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occafion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation feldom fails to enfue. Moft of the ill confequences from this quarter might be eafily avoided, by only obferving the precautions mentioned above. EFFECTS OF EXTREME HEAT. The effects of extreme heat, though not fo com- mon in this country, are no lefs fatal, and much more fudden than thofe of cold. In hot countries people frequently drop down dead in the ftreets, ex- hausted with heat and fatigue. In this cafe, if any warm cordial can be poured into the mouth, it ought to be done. If this cannot be effected, they may be thrown up in form of a clyfter. Volatile fpirits, and other things cf a ftimulating nature, may be applied to the ikin, which fliould he well rubbed with coarfe cloths, or other ftimulating things. CHAP. [ 6i9 ] CHAP. LV. Of Faintingfits, and other Cafes which require immediate affiftance. OTRONG and healthy perfons, who abound with blood, are often feized with fudden faintingfits, after violent exercife, drinking freely of warm or ftrong liquors, expofure to great hear, in- tenfe application to Study, or the like. In fuch cafes the patient fhould be made to fmell to fome vinegar. Flis temples, forehead, and wrifls ought at the fame time to be bathed with vinegar mixed with an equal quantity of warm water; and two or three fpoonfulls of vinegar, with four or five times as much water, may, if he can fwallow, be poured into his mouth. If the fainting proves obftinate, or degenerates into a fyncope, that is, an abolition of feeling and understanding, the patient muft be bled. After the bleeding, a clyfter will be proper, and then he fhould be kept eafy and quiet, only giving him every half hour a cup or two of an infufion of any mild vegetable, with the addition of a little fugar and vi- negar. When fwoonings, whicii arife from this caufe, occur frequently in the fame perfon, he fhould, in order to efcape them, confine himfelf to a light diet, confifting chiefly of bread, fruits, and other vegeta- bles. His drink ought to be water or fmall-becr, and he fliould fleep but moderately, and take much exercife. \ But fainting fits proceed much oftener from a defect than an excefs of blood. Hence they are very 620 FAINTING FITS, &V. WHICH REQUIRE very ready to happen after great evacuations of any kind, obilinate watching, want of appetite, or fuch like. In thefe an almoft directly oppofite courfe^to that mentioned above muft be purfued. The patient fliould be laid in bed, with bis head low, and being covered, fliould have his legs, thighs, arms, and his whole body rubbed ffrongly with hot flannels. Hungary water, volatile falts, or ftrong-fmelling herbs, as rue, mint, or rofemary, may be held to his nofe. Flis mouth may be wet with a little hartfhorn in water; and, if he can fwal- low, fome hot wine, mixed with fugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A comprefs of flannel, dipt in hot wine or brandy, muft be applied to the pit of the ftomach, and warm bricks, or bottles filled with hot water, laid to the feet. As foon as the patient is recovered a little, he fhould take fome ftrong foup or broth, or a little bread or bifcuit feaked in hot-fpiced wine. To prevent the return of the fits, he ought to take often, but in fmall quantities, fome light, yet ftrengthening, nourishment, as panada made with foup inffead of water, new laid eggs lightly poached, chocolate, light roaft meats, jellies, and fuch like. Thofe fainting fits, which are the effect of bleed- ing, or of the violent operation of purges, belong to this clafs. Such as happen after artificial bleed- ing are feldom dangerous, generally terminating as foon as the patient is laid upon the bed ; indeed, perfons fubject to this kind fhould always he bled, lying, in order to prevent it. Should the fainting, however, continue longer than ufual, volatile fpirits may he held to the nofe, and rubbed on the temples, &c. When fainting is the effect of too ftrong or acrid purges or vomits, the patient muft be treated in all refpects IMMEDIATE ASSISTANCE. 621 refpects as if he had taken poifon. He fhould be made to drink plentifully of milk, warm water, and oil, barley-water, or fuch like ; emollient clyfters will likewife be proper, and the patient's ftrength Should afterwards be recruited, by giving him generous cor- dials, and anodyne medicines. Faintings are often occafioned by indigeftion. This may either proceed from the quantity or qua- lity of the food. When the former of thefe is the caufe, the cure will be beft performed by vomiting, which may be promoted by caufing the patient to drink a weak infufion of camomile-flowers, carduus benediclus, or the like. When the diforder proceeds from rhe nature of the food, the patient, as in the cafe of weaknefs, muft be revived by ftrong fmells, Sec after wtiich he fliould be made to fwallow a large quantity of light warm fluid, which may ferve to drown, as it were, the offending matter, to foften its acrimony, and either to affect a difcharge of it by vomiting, ur force it down into the inteftines. Even difagreeable fmells will fometimes occafion fwoonings, efpecially in people of weak nerves. When this happens, the patient fliould be carried into the open air, have ftimulating things held to his nofe, and thofe fubftances which are difagree- able to him ought immediately to be removed. But we have already taken notice of fwoonings which arife from nervous diforders, and fhall there- fore fay no more upon that head. Fainting fits often happen in the progrefs of difeafes. In the beginning of putrid difeafes they generally denote an oppreffion at ftomach, or a mafs of corrupted humors, and they ceafe after evacua- ations either by vomit or ftool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of thefe cafes, vinegar ufed both externally and internally is the beft remedy d»- 622 FAINTIG FITS, fcrV. WHICH REQUIRE ring the paroxyfm, and plenty of lemon-juice and water after it. Swoonings which happen in difeafes accompanied with great evacuations, mull be treated like thofe which are owing to weaknefs, and the evacuations ought to be reftrained. When they happen towards the end of a violent fit of an inter- mitting fever, or at that of each exacerbation of a continual fever, the patient muft be ltipported by fmall draughts of wine and water*. Delicate and hyfteric women are very liable to fwooning or fainting fits after delivery. Thefe might be often prevented by generous cordials, and the admiffion of frefli air. When they are occafi- oned by exceffive flooding, it ought by all -means to be reftrained. They are generally the effect of meie weaknefs or exhauftion. Dr. Engleman re- lates the cafe of a woman " in childbed, who, after " being happily delivered, fuddenly fainted, and "lay upwards of a quarter of an hour apparently " dead. A phyfician was fent for; her own maid, " in the mean while, being out of patience at his t: delay, attempted to affift her herfelf, and extend- ec ing herfelf upon her mi ftrefs, applied her mouth " to her's, blew in as much breath as She pcfiibly tc could, and in a very fhort time the exhaufted " woman awaked as out of a profound fleep ; when " proper things being given her, fhe foon reco- " vered. cs The maid being aiked how fhe came to think " of this expedient, faid flic had feen it practifed " at Altenburgh, by midwives, uoon children with " the happieft effect." * It fometimes happens that this weaknefs occurs in the exacerbation of fevers from too much fullnefs and oppreffion. In this cafe bleeding is the remedy. It may be known by the pulfe. We IMMEDIATE ASSISTANCE. 623 We mention this cafe chiefly that other mid- wives may be induced to follow fo laudable an ex- ample. Many children are born without any figns of life, and others expire foon after the birth, who might, without all doubt, by proper care, be re- ftored to life. From whatever caufe fainting fits proceed, frefli air is always of the greateft importance to the pa- tient. By not attending to this circumftance, peo- ple often kill their friends while they are endea- vouring to fave them. Alarmed at the patient's Situation, they call in a crowd of people to his af- fiftance, or perhaps to witnefs hi3 exit, whofe breathing exhaufts the air, and increafes the dan- ger. There is not the leaft doubt but this prac- tice, which is very common among the lower fort of people, often proves fatal, efpecially to the de- licate, and fuch perfons as fall into fainting fits from mere exhauftion, or the violence of fome dif- eafe. No more perfons ought ever to be admitted into the room where a patient lies in a fwoon than are abfolutely neceflary for his affiftance, and the windows of the apartment fhould always be opened, at leaft as far as to admit a ftream of frefli air. Perfons fubject to frequent fwoonings. or faint- ing fits, fhould neglect no means to remove the caufe of them, as their confequences are always injurious to the conftitution. Every fainting fit leaves the perfon in dejection and weaknefs; the fecretions are thereby fufpencfed, the humours dif- pofed to ftagnation, coagulations and obftructions are formed, and, if the motion of the blood be to- tally intercepted, or very confiderably checked, po- lypufcs are fometimes formed in the heart or larger veffels. The only kind of fwoonings not to be dreaded are thofe which fometimes mark the crifis 024 OF INTOXICATION. ?n fevers ; yet even thefe ought, as foon as poffible, to be removed. OF INTOXICATION. The effects of intoxication are often fatal. No kind of poifon kills more certainly than an over- dofe of ardent fpirits. Sometimes, by deftroying the nervous energy, they put an end to life at once; but in general their effects are more flow, and in many refpects fimilar to thofe of opium. Other kinds of intoxicating liquors may prove fatal when taken to excefs, as well as ardent fpirits; but they may generally be difcharged by vomiting, which ought always to be excited when the ftomach is over- charged with liquor. More of thofe unhappy perfons, who die intoxi- cated, lofe their lives from an inability to conduct themfelves than from the deftructive quality of the liquor. Unable to walk, they tumble down, and lie in fome awkward pofture, which obftructs,. the circulation or breathing, and often continue in this fituation tili they die. No drunken perfon fhould be left by himfelf, till his clothes have been loofened, and his body laid in fuch a pofture as is moft fa- vourable for continuing the vital motions, difcharg- ing the contents of the ftomach, &o The beft pofture for difcharging the contents of the ftomach, is to lay the perfon upon his belly; when afleep he may be laid on his fide, with his head a little raifed, and particular care muft be taken that his neck be no way bent, twifted, or have any thing too tight about it. The exceffive degree of thirft occafioned by drinking ftrong liquors, often induces people to quench it by taking what is hurtful. I have known 2 fatal OF INTOXICATION. 6ii fatal confequences even from drinking freely of milk after a debauch of wine or four punch ; thefe acid liquors, together with the heat of the ftomach, having coagulated the milk in fuch a manner that it could never be digested. The fafeft drink after a debauch is water with a toaft, tea, infufions of balm, fage, barley-water, and fuch like. If the perfon wants to vomit, he may drink a weak infu- fion of camomile-flowers, or lukewarm water and oil; but in this condition vomiting may generally be excited by only tickling the throat with the fin- ger or a feather. Inftead of giving a detail of all the different fymp- toms of intoxication which indicate danger, and propofing a general plan of treatment for perfons in this fituation, I fhall briefly relate the hiftory of a cafe which lately fell under my own obfervation, wherein moft of thofe fymptoms ufually reckoned dangerous occurred, and where the treatment was fuccefsful. A young man, about fifteen years of age, had, for a hire, drank ten glaffes of ftrong brandy. He foon after fell fall afleep, and continued in that fitu- ation for near twelve hours, till at length his uneafy manner of breathing, the coldnefs of the extremities, and other threatening fymptoms alarmed his friends, and made them fend for me. I found him ftill fleep- ing, his countenance ghaftly, and his fkin covered with a cold clammy fweat. Almoft the only figns of life remaining were, a deep laborious breathing, and a convulfive motion or agitation of his bowels. I tried to roufe him, but in vain, by pinching, fhaking, applying volatile fpirits, and other ftimulat- ing things to his nofe, Sec. A few ounces of blood were likewife taken from his arm, and a mixture of vinegar and water was poured into his mouth; but, as he could not fwallow, very little of this got 626 SUFFOCATION AND STRANGLING. into the ftomach. None of thefe things having the leaft effect, and the danger feeming to increafe, I ordered his legs to be put into warm water, and a fliarp clyfter to be immmediately adminiftered. This gave him a ftool, and was the firft thing that relieved hirn. It was afterwards repeated with the fame happy effect, and feemed to be the chief caufe of his recovery. He then began to fhow fome figns of life, took drink when it was offered him, and came gra- dually to his fenfes. He continued, however, for feveral days weak and feverifh, and complained much of a forenefs in his bowels, which gradually went off, by means of a flender diet, and cool mucilagi- nous liquois. This young man would probably have been fuf- fered to die, without any affiftance being called, had not a neighbour, a few days before, who had been advifed to drink a bottle of fpirits to cure him of an ague, expired under very fimilar circum- ftances. OF SUFFOCATION AND STRANGLING. Thefe may fometimes proceed from an infarction of the lungs, produced by vifcid clammy humors, or a fpafmodic affection of the nerves of that organ. Perfons who feed grofsly and abound in rich blood, are very liable to fuffocating fits from the former of thefe caufes. Such ought, as foon as they, are attacked, to be bled, to receive an emollient clyfterr. and to take frequently a cup of diluting liquor with a little nitre in ir. They fhould likewife receive the fleams of hot vinegar into their lungs by breathing. Nervous and afthmatic perfons are moft fubject to fpafmodic affections of the lungs. In this cafe the patient's legs fliould be immerfed in warm water, and the fteams of vinegar applijd as above. Warm diluting SUFFOCATION AND STRANGLING. 627 diluting liquors fliould likewife be drank ; to a cup of which a tea-fpoonful of the paregoric elixir may occafionally be added. Burnt paper, feathers, or leather, may be held to the patients nofe, and frefh air fhould be freely admitted to him. Infants are often fuffocared by the careleffnefs or inattention of their nurfes*. An infant when in bed fhould always be laid fo, that it cannot tumble down with its head under the bed-clothes; and when in a cradle, its face ought never to be covered. A fmall degree of attention to thefe two fimple rules would fave the lives of many infants, and prevent others from being rendered weak and fickly all their days by the injuries done to their lungs. Inftead of laying down a plan for the recovery of infants who are fuffocated, or over-laid, as it is termed by their nurfes, I fliall give the hiftory of a cafe related by Monfieur Janin, of the Royal Col- lege of Surgery at Paris, as it was attended with fuccefs, and contains almoft every thing that can be done on fuch occafions* A nurfe having had the misfortune to over-lay a child, he was called in, and found the infant with- out any figns of life; no pulfation in the arteries^ no refpiration, the face livid, the eyes open, dull, and tarniflied, the nofe full of fnivei, the mouth gaping ; in fhort it was almoft cold. Whilft fome linen clothes and a parcel of afhes were warming, he had the boy unfwathed, and laid him in a warm bed, and on the right fide. He then was rubbed all over with fine linen, for fear of fretting his ten- * Thefe accidents are not always the effects of careleffncfr. I have known an infant over-laid by its mother being feized in the night with an hyfteric fit. This ought to fcrve as a caution againft employing hyfteric women as nurfes; and Ihould like- wife teach fuch women never to lay an infmt in thetame bed with themfelves, but in a fmall adjacent one. S f 2 4er 628 SUFFOCATION AND STRANGLING. der and delicate fkin. As foon as the aflies had re- ceived their due degree of heat, Mr fanin buried him in them except the face, placed him on the fide oppofite to that on which he had been at firft laid, and covered him with a blanket. He had a bottle of eau de luce in his pocket, which he prefented to his nofe from time to time; and between whiles fome puffs of tobaccq were blown up his noftrils : to thefe fucceeded the blowing into his mouth, and fqueezing tight his nofe. Animal heat began thus to be excited gradually; the pulfations of the tem- poral artery were foon felt, the breathiug became more frequent and free, and the eyes clofed and opened alternately. At length the child fetched fome cries expreffive of his want of the breaft, which being applied to his mouth, he catched at it with avidity, and fucked as if nothing had happened to him. Though the pulfations of the arteries were by this time very well re-eftablifhed, and it was hot weather, yet Mr. fanin thought it advifeable to leave his little patient three quarters of an hour longer under the afhes. He was afterwards taken out, cleaned and dreffed as ufual; to which a gentle fleep fucceeded, and he continued perfectly well. Mr. Janin mentions likewife an example of a young man who had hanged himfelf through defpair, to whom he adminiftered help as effectually as in the preceding cafe. Mr. Glover, furgeon in Doctors Commons, Lon- don, relates the cafe of a perfon who was reftored to life after twenty-nine minutes hanging, and eon- tmued in good health for many years after. The principal means ufed to reftore this man to fife were, .opening the temporal artery and the ex- ternal jugular; rubbing the back, mouth, and neck, with a quantity of volatile fpirits and oil; adminif- iciing the tobacco clyfter by means of lighted pipes, and PERSONS WHO EXPIRE, cjrV. 629 and ftrong frictions of the legs and arms. This courfe had been continued for about four hours, when an incifion was made into the wind-pipe, and air blown ftrongly through a canula into the lungs. About twenty minutes after this, the blood at the artery began to run down the face, and a flow pulfe was juft perceptible at the wrift. The frictions were continued for fome time longer; his puife became more frequent, and his mouth and nofe being irri- tated with fpirit of fid ammoniac, he opened his eyes. Wrarm cordials were then administered to him, and in two days he was fo well as to be able to walk eight miles. Thefe cafes are fufficient to fhew what may be done for the recovery of thofe unhappy perfons who ftrangle themfelves in a fit of defpair. OF PERSONS WHO EXPIRE IN CONVUL- SION FITS. Convulfion fits often constitute the laft feene of acute or chronic diforders. When this is the cafe, there can remain but fmall hopes of the patient's recovery after expiring in a fit. But when a per- fon, who appears to be in perfect health, is fuddenly feized with a convulfion fir, and feems to expire, fome attempts ought always to be made to reftore him to life. Infants are moft liable to convulfions, and are often carried off very fuddenly by one or more fits about the time of teething. There are mauy well-authenticated accounts of iuf ints having been reftored to life, after they had, to all appear- ance, expired in convulfions ; but we fhall only re- late the following inftance mentioned by Dr. John- fon in his pamphlet on the praciicability of recovering perfons vifibly dead. Sf3 In / 630 PERSONS WHO EXPIRE In the parifh of St. Clemens in Colchefter, a child of fix months old, lying upon its mother's lap, having had the breaft, was feized with a ftrong convulfion fir, which lafted fo long, and ended with fo total a privation of motion in the body, lungs, and pulfe, that it was deemed abfolutely dead. It was accordingly Stripped, laid out, the paffing-bcll or- dered to be tolled, and a coffin to be made; but a neighbouring gentlewoman who ufed to admire the child, hearing of its fudden death, haftened to the houfe, and upon examining the child found it not cold, its joints limber, and fancied that a glafs fhe held to its mouth and nofe was a little damped with the breath ; upon which fhe took the child in her lap, fat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour fhe felt the heart begin to beat faintly ; fhe then put a little of the mother's milk into its mouth, continued to rub its palms and foles, found the child begin to move, and the milk was fwallowed ; and in another quarter of an hour fhe had the fatisfaction of re- ftoring, to its difconfolate mother, the babe quite recovered, eager to lay hold of the breaft, and able to fuck again. The child throve, had no more fits, is grown up, and at prefent alive. Thefe means, which are certainly in the power of every perfon, were fufficient to reftore to life an in- fant to all appearance dead, and who, in all proba- bility, but for the ufe of thefe fimple endeavours, would have remained fo. There are, however, ma- ny other things which might be done in cafe the above fliould not fucceed ; as rubbing the body wiih ftrong fpirits, covering it with warm aflies or fait, putting it up to the neck in pretty hot water, blow- ing air into the lungs, throwing up warm ftimulating clyfters, or the fmoke of tobacco, into the inteftines, >ad fuch like. When IN CONVULSION FITS. 631 When children are dead born, or expire foon after the birth, the fame means ought to be ufed for their recovery, as if they had expired in circum- ftances fimilar to thofe mentioned above. Thefe directions may likewife be extended to adults, attention being always paid to the age and other circumftances of the patient. The foregoing cafes and obfervations afford fuf- ficient proof of the fuccefs which may attend the endeavours of perfons totally ignorant of-medicine, in affifting thofe who are fuddenly deprived of life by any accident 01 difeafe. Many facts of a fimilar nature might be adduced, were it neceffary ; but thefe, it is hoped, will be fufficient to call up the at- tention of the public, and to excite the humane ant benevolent to exert their utmoft endeavours for the prefervation of their fellow-men. The fociety for the recovery of drowned perfons, in- . ftituted at Amfterdam in the year 1767, had the fatisfaction to find that not fewer than 150 perfonp, in the fpace of four years, had been faved by the means pointed out by them, many of whom owed their prefervation to peafants and people of no me- dical knowledge. But the means ufed with fo much efficacy in recovering drowned perfons are, with equal fuccefs, applicable to a number of cafes where the powers of life feem in reality to be only fuf- pended, 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 confidera- tion many perfons have been committed to the grave, in whom the principles of life might have been re- vived. The cafes wherein fuch endeavours are moft likely to be attended with fuccefs, are all thofe called fudden deaths from an invifible caufe, as apoplexies, Jiyfterics, faintings. and many other diforders where- S f 4 >R 63 2 PERSONS WHO EXPIRE in perfons in a moment fink down and expire. The various cafualities in whicii they may be tried are, fuffocations from the fulphureousr damps of mines, coal-pits, &c. ; the unwholefome air of long un- opened wells or caverns; the noxious vapours ari- fing from fermenting liquors; the fteams of burning charcoal; fulphureous mineral acids; arfenical efflu- via, &c. The various accidents of drowning, ftrangling, and apparent deaths, by blows, falls, hunger, cold, Sec likewife furnifh opportunities of trying fuch endeavours. Thofe perhaps who to appearance are killed by lightning, or by any violent agitation of the paffions, a3 fear, joy, furprife, and fuch like, might alfo be frequently recovered by the ufe of proper means, as blowing itrongly into their lungs, * &c. The means to be ufed for the recovery of perfons fuddenly deprived of life are nearly the fame in all cafes; they are practicable by every one who hap- pens to be prefent at the accident, and require no great expence, and lefs fkill. The great aim is to reftore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clyfters and generous cordials. Thefe muft be varied according to circumftances. Common fenfe, and the fituation of the patient, will fuggeft the proper manner of conducting them. Above all we would recommend perfevcrance. People ought never to defpair on account of difeouraging circumftances, or to leave off their endeavours as long as there is the leaft hope of fuccefs. Where much good and no hurt can be done, no one ought to grudge his la- bour. It were greatly to be wiflied, that an inftitution, fimilar to that of Amfterdam, v/as eftablifhed, upon a more IN CONVULSION FITS! * 6^3 a more extenfive plan, in Great Britain ; and that a reward was allowed to every one who fhould be in- strumental in rcftoring to life a perfon feemingly dead *. Men will do much for fame, but ftill more for money. Should no profit, however, be annexed to thofe benevolent offices, the heart-felt pleafure which a good man muft enjoy, on reflecting that he has been the happy inftrument of faving one of his fellow-creatures from an untimely grave, is itfelf a fuflicient reward. The many focieties formed in different parts of Europe and America for the recovery of perfons apparently dead from drowning, Sec. 8ec have clearly proved the benefits of fuch inftitutions. The fol- lowing directions published fome years fince by the Humane Society of Philadelphia are fo intelligible as well as comprehenfive, that we have fubjoined them here in order to give a general view of the fubject. The fociety, in order to render them more exten- fively ufeful, have had them printed in large charac- ters, and hung up in moft of the public places and compting houfes of this city; more particularly in the neighbourhood of the river, and of purnps which are much frequented in hot weather. * The Author is happy to obforve, that fince the firft pub- lication of this work, feveral focieties have been militated in Britain with the fame benevolent intention as that cf Amfter- dam, and that their endeavours have proved no lefs fuccefsful. He is likewifb happy to obferve, that premiums have been awarded to thofe v ho have been active in their endeavours to reftore to life perfons who had been drowned, or fuddenly de- prived of life by any accident. How much is this fuperior to the fuperftitious inltitution, which allows any man a premium who brings a dead perfon out of the water, fo that he may receive Chrift;an burial; but allows nothing to the perfon who brings him out alive, or who recovers him af.er he has bee& fo all appearance dead. Di reel ions, 634 PERSONS SUPPOSED DEAD Direclions, for Recovering Perfons, who are fuppofed to be Dead from drowning. I. As foon as the body is taken out of the water, it muft be conveyed to a houfe, or any other place, where it can be laid dry and warm, avoiding the ufual deftructive methods of hanging it by the heels, rolling it on a barrel, or placing it acrofs a log en its belly. II. The clothes muft be immediately Stripped off, and the body wrapped up in blankets, well warmed. It fhould be laid on its back, with the head a little raifed. If the weather be cold, it fhould be placed near a fire ; but if the weather fhould be warm, it will be fufficient to place it between two blankets well heated ; taking care to prevent the room from being crouded, with any perfons who are not necef- farily employed about the body. III. As foon as it can poffibly be done, a bellow! fhould be applied to one noftril, while the other noftril and the mouth are kept clofed, and the lower end of the prominent part of the wind-pipe (or that pare which is called by the anatomifts, Pomum Ada- mi) is preffed backward. The bellows is to be worked in this fituation ; and when the breaft is fwelled by it, the bellows fhould ftop, and an aflif- tant fhould prefs the belly upwards, to force the air out. The bellows fhould then be applied as before, and the belly fliould again be preffed ; and this pro- cefs fhould be repeated from twenty to thirty times in a minute, fo as to imitate natural breathing as nearly as poffible. Some volatile fpirits, heated, fhould be held under the valve of the bellows, while it works. If a bellows cannot be procured, fome perfon Should blow into one of the noftrils, through a pipe FROM DROWNING, ferV. fcfc. 635 a pipe or quill, while the other noftril and mouth are clofed as before ; or if a pipe or quill be not at hand, he fhould blow into the mouth, while both noftrils are clofed ; but whenever a bellows can be procured, it fhould be preferred, as air forced in by this means, will be much more ferviceable than air which has already been breathed. IV. At the fame time, the whole body fhould be rubbed with the hand, or with hot woollen cloths. The rubbing Should be moderate, but continued with induftry a long time, and particularly about the breaft. V. During this time, a large quantity of aflies, or fait, or fand, fhould be heated ; and as foon as it is milk-warm, the body fliould be placed in it; the blowing and rubbing are then to be continued as before ; and when the afhes, or fait, are cooled, fome warmer muft be added, fo that the whole may be kept milk-warm. Thefe methods fhould be continued three or four hours, as in feveral inftances they have proved fuc- eefsful, although no figns of life appeared until that time. When the patient is able to fwallow, he fhould take fome wine, or rum and water; bleed- ing or purging ought not to be ufed, without con- fulting a phyfician, who fhould be called in as foon as poffible, To prevent the fatal cffecls of drinking cold Water, or cold Liquors of any kind in warm Weather. 1 ft, Avoid drinking while you are wTarm, or, 2d, Drink only a fmall quantity at once, and let it remain a fhort time in your mouth before you fwallow it; or, "d 636 PERSONS SUPPOSED DEAD 3d, Wafh your hands and face, and rinfe your mouth with cold water before you drink. If thefe precautions have been neglected, and the diforder incident to drinking cold water hath been produced, the firft, and in moft inftances, the only remedy to be adminiftered, is fixty drops of liquid laud.mum in fpirit and water, or warm drink of any kind. If this fliould fail of giving relief, the fame quan- tity may be given twenty minutes afterwards. When laudanum cannot be obtained, rum and water, or warm water fhould be given. Vomits and bleeding fhould not be ufed without confuhing' a phyfician. The dangerous Effecls of noxious Vapours, from Wells, Cellars, fermenting Liquors, &c. may be prevented, By procuring a free circulation of air, either by ventilators, or opening the doors or windows, where it is confined, or by changing the air, by keeping fires in the infected place, or by throwing in water, in which flone-lime has been diffolved. Thefe precautions fliould be taken, before enter- ing into fuch fufpected places, or a lighted candle fhould be firft introduced, which will go out, if the air is bad. When a perfon is let down into a well, he fhould be carefully watched, and drawn up again on the leaft change. But when a perfon is appa- rently dead, from the above-mentioned caufe, the firft thing to be done is to remove the body to a cool place in a wholefome air; then let the body be Stripped, and let cold water be thrown from buckets over it for fome time. This is particularly ufeful in cafes of apparent death from drunkennefs. ■—Let the treatment now be the fame as that for drowned FROM DROWNING, cjrv. &r>. 637 drowned perfons. The head fhould be raifed a lit- tle ; and continued frictions, with blowing into the noftril with a bellows, fhould be practifed for feveral hours. In Cafes of Suffocation, from the Fumes of Burning Charcoal. The general treatment recommended for curing the diforders brought on by noxious vapours, is to be applied ; but the dangerous effects of this may be prevented, by taking care not to fit near it when burning ; to burn it in a chimney ; and where there is no chimney, to keep the door open, and to place a large tub of water in the room. In all thefe, as well as in cafes of drowned per- fons, moderate purges and bleeding are only to be ufed, with the advice of a phyfician. To prevent the fatal Eflfecls of Lightning. Let your houfe be provided with an iron conduc- tor ; but when this cannot be had, avoid fitting, or Handing, near the window, door, or walls of an houfe, during the time of a thunder guft. Tfie nearer you are placed to the middle of a room, the better. When you are not in an houfe, avoid fly- ing to the cover of the woods, or a folitary tree, for fafety. When a perfon is ftruck by lightning, let conti- nued frictions and inflations of the lungs be practifed'. Let gentle fhocks of electricity be made to pafo through the cheft, when a Skilful perfon can be pro- cured to apply it; and let blifters be applied to the breaft. To 638 PERSONS SUPPOSED DEAD To prevent Danger from Expofure to the Exceffive Heat of the Sun. Diforders from this caufe, or fas they are vul- garly termed) ftrokes of the fun, may be expected, when a perfon who is expofed to his rays, is affec- ted with a violent hesd-ach, attended with throb- bing or with giddinefs; where the diforder takes place, thefe fymptoms are followed by faintinefs and great infenfibility, with violent heat and drynefs of the Ikin, rednefs and drynefs of the eyes, difficulty of breathing, and, according as the difeafe is more or lefs violent, with a difficulty, or entire inability of fpeaking or moving. To guard againft thefe dangerous effects of heat, it will be proper, lft, To avoid labour, or violent exercife, or ex- pofing yourfelf to the rays of the fun, immediately after eating a hearty meal: 2d, To avoid drinking fpirits of any kind, when you are thus expofed. Thefe add an internal fire to the heat of the fun, and are particularly hurtful in harveft. Vinegar and water, fweetened with molaffes or brown fugar, butter-milk and water, fmall beer, whey, or milk and water, are the moft proper drinks for people who are expofed to excef- five heat. But the lefs a perfon drinks of liquors of any kind in the forenoon, the better will he en- dure the heat of a warm day. It will alfo be proper, 3d, To wear a white hat, or to cover a black one with white paper, when you are neceffarily ex- pofed to the hot fun, and to avoid ftanding Still when in fuch a fituation. 4th, To retire into the Shade as foon as you begin to be affected with pain or throbbing in the head, with giddinefs or with faintinefs. if FROM DROWNING, isfe. fcrV. 639 If thefe precautions have been neglected, and the fymptoms above defcribed have come on, it will be proper. ifl, To remove the perfon fo affected into a cool, dry place, and to loofen all his garments, particu- larly thofe around his neck and breaft. 2d, To examine whether the pulfe at the wrift or temples beats forcibly, and if it does, to bleed im- mediately ; but if the pulfe be weak, or cannot be perceived, bleeding muft not be performed. 3d4 To place his feet and legs (or if it can be done) the lower half of his body, in warm water. But if this remedy fails, 4th, Dr. Tiffot advifes to apply linen cloths wet with cold water, or with cold water and vinegar, to the temples and all over the head. 5th, To adminifter plentiful draughts of vinegar and water fweetened. In all cafes of this kind, a phyfician fhould be fent for, unlefs the patient recovers fpeedily. To prevent the Effects of exceffive Cold. Perfons are in danger of being deftroyed by it, when they become very drowfy, or are affected with general numbnefs or infenfibility of the body. As the cold which proves fatal, generally affects the feet firft, great care fliould be taken to keep them as warm as poffible. 1 ft, By protecting them when you are expofed to cold with wool, or woollen focks within the fhoes or boots, or with large woollen ftockings drawn over them, or when you ride, with hay or ftraw wrapped round them. 2d, By keeping up a brifk circulation in the blood veffels of the feet, by moving them conftantly; or 040 PERSONS SUPPOSED DEAD, &c. or when this is impracticable, from a confined fitu- ation, and two or more perfons are expofed toge- ther. 3d, By placing their feet, without Jhoes, againft each other's breafts. . If notwithstanding thefe precautions, a perfon Should be rendered fleepy or infenfible by cold, he muft exert himfelf and move about quickly, for if he fliould fleep in the cold, he will inevitably perifh. W7hen a perfon who is travelling in company, begins to be affected in this manner, his companions fhould force him to walk brifkly or to run. When cold has produced apparent death, the body fhould be placed in a room without fire, and rubbed Steadily with fnow, or cloths wet with cold water, at the fame time that the bellows is applied to the nofe, and ufed as in the cafe of drowning. This treatment Should be continued a long time, al- though no figns of life appear, for fome perfons have recovered, who were to appearance lifelefs for feveral hours. When the limbs only are affected by cold, they fhould be rubbed gently with fnow, or bathed in cold water with ice in it, until their feeling and power of motion returns; after which, the bathing or rubbing with fnow is to be repeated once every hour, and continued a longer or Shorter time, as the pains are more or lefs violent. t he perfon thus affected fhould be kept from the fire, for warmth and acrid applications of every kind are very injurious. CHAP. t 641 3 CHAP. LVI. Cautions concerning Ctld Bathing, and drinking the Mineral Waters. A S it is now fafhionable for perfons of all ranks to plunge into the fea, and drink the mi- neral waters, I was defirous of rendering this work ftill more extenfively ufeful, by the addition of fome practical remarks on thefe active and ufeful reme- dies. Finding it impoffible to bring thefe obferva- tions within fo narrow a compafs as not tp fwell the book, already too large, into an enormous fize* I refolved to confine myfelf to a few hints or cau- tious ; which may be of fervice to perfons who bathe, or drink the mineral waters, without being able to put themfelves under the care of a phyfician* v No part of the practice of medicine is of greater importance, or merits more the attention of the phyfician, as many lives are loft, and numbers ruin their health, by cold bathing, and an imprudent ufe of the mineral waters. On fome future occafion I may probably refume this fubject, as I know not any work that contains a fuflicient number of prac- tical obfervations to regulate the patient's conduct in the ufe of thefe active and important remedies. We have indeed many books on the mineral waters, and fome of them are written with much ingenuity; but they are chiefly employed in afeer- taining the contents of the waters by chymical ana- lyfis. This, no doubt, has its ufe, but it is by no means of fuch importance as fome may imagine. A man may know the chymical analyfis of all ths 642 ON COLD BATHING, AND articles in the"materia medica, without being.able properly to apply any one of them in the cure of difeafes. One page of practical obfervations is worth a whole volume of chymical analyfis. But where are fuch obfervations to be met with ? Few phyficians are in a fituation to make them, and fewer ftill are qualified for fuch a talk. It can only be accomplifhed by practitioners who refide at the fountains, and who, poffeffing minds fuperior to local prejudices, are capable of diftinguifhing difeafes with accuracy, and of forming a found judgment refpecting the genuine effects of medicines. Without a proper difcrimination with regard to the difeafe and the conftitution of the patient, the moft powerful medicine is more likely to do harm than good. Every one knows that the fame phy- fician who, by cold bathing, cured Auguftus, by an imprudent ufe of the fame medicine, killed his heir. This induced the Roman fenate to make laws for regulating the baths, and preventing the numerous evils which arofe from an imprudent and promifcu- ous ufe of thofe elegant and fafhionable pieces of luxury. But as no fuch laws exift in this country, every one does that which is right in his own eyes, and of courfe many muft do wrong. People are apt to imagine that the fimple element of water can do no hurt, and that they may plunge , into it at any time with impunity. In this, however, they are much miftaken. I have known apoplexies occafioned by going into the cold bath, fevers ex- cited by flaying too long in it, and other maladies fo much aggravated by Its continued ufe, that they could never be wholly eradicated. Nor are exam- ples wanting, either in ancient or modern times, of the baneful confequences which have arifen alfo from an injudicious application of the warm bath ; but as warm baths are not fo common in this coun- try, DRINKING MINERAL WATERS. 643 try, and are feldom ufed but under the direction o^ a phyfician, I fhall not enlarge on that part of the fubjea. Im nerfion in cold Water is a cuftom which lays claim to the moft remote antiquity: indeed it muft have been coeval with man himfelf. The neceffity of water for the purpofe of cleanlinefs, and the pleafure arifing from its application to the body in hot countries, muft very early have recommended it to the human fpecies. Even the example of other animals was fufficient to give the hint to man. By inftinct many of them are led to apply cold water in this manner; and f )me, when de- prived of its ufe, have been known to languish, and even die. But whether the practice of cold bathing arofe from neceffity, reafoning, or imita- tion, is an inquiry of no importance ; our bufinefs is to point out the advantages which may be de- rived from it, and to guard people againft an im- proper ufe of it. The cold bath recommends itfelf in a variety of cafes, and is peculiarly beneficial to the inhabitants of populous cities, who indulge in idlenefs, and lead fedentary lives. In perfons of this defcrip- tion the action of the folids is always too weak, which induces a languid circulation, a crude indi- gested mafs of humors, and obftructions in the capillary veffels and glandular fyftem. Cold water, from its gravity as well as its tonic power, is well calculated either to obviate or remove thefe fymp- toms. It accelerates the motion of the blood, pro- motes the different fecretions, and gives permanent vigour to the folids. But all thefe important pur- pofes will be more effentially anfwered by the ap- plication of fait water. This ought not only to be preferred on account of its fuperior gravity, but like- wife for its greater power of ftimulating the fkin, T t 2 which 644 ON COLD BATHING, AND which promotes the perfpiration, and prevents the patient from catching cold. It is neceffary, however, to obferve, that cold bathing is more likely to prevent, than to remove obftructions of the glandular or lymphatic fyftem. In this cafe the cold bath will only aggravate the fymptoms, and hurry the unhappy patient into an untimely grave. It is therefore of the utmoft im- portance, previous to the patient's entering upon the ufe of the cold bath, to determine whether or not he labours under any obftinate obftructions of the lungs or other vifcera; and where this is the cafe, cold bathing ought ftrictly to be prohibited *. In what is called a plethoric ftate, or too great a fulnefs of the body, it is likewife dangerous to ufe the cold bath, without due preparation. In this cafe there is great danger of burfting a blood-veffel, or occafioning an inflammation of the brain, or fome of the vifcera. This precaution is the more neceffary to citizens, as moft of them live full, and are of a grofs habit. Yet, what is very remarkable, thefe people refort in crowds every feafon to the fea-fide, and plunge in the water without the leaft confidera- tion. No doubt they often efeape with impunity, but does this give a fanction to the practice ? Per- fons of this defcription ought by no means to bathe, unlefs the body has been previoufly prepared by fuitable evacuations. * The celebrated Dr. Smollet has indeed faid, that if he were perfuaded he had an ulcer in the lungs, he would, jump into the cold bath : but here the' Doctor evidently fhews more courage than difcretion; and that he was more a man of wit than a phyfician, every one will allow. A nervous afthma, or an atrophy, may be miftaken for a pulmonary confumption; yet, in the two former, the cold bath proves often beneficial, though I never knew it fo in the latter. Indeed, all the phthi- fieal patients I ever faw, who had tried the cold bath, were evidently hurt by it. Another DRINKING MINERAL WATERS. 645 Another clafs of patients, who ftand peculiarly in need of the bracing qualities of cold water, is the nervous. This includes a great number of the male, and almoft all the female inhabitants of great cities. Yet even thofe perfons ought to be cautious in ufing the cold bath. Nervous people have often weak bowels, and may, as well as others, be fubject to congeftions and obftructions of the vifcera; aud in this cafe they will not be able to bear the effects of the cold water. For them, therefore, and indeed for all delicate people, the beft plan would be to accuftom themfelves to it by the moft pleafing and gentle degrees. They ought to begin with the tem- perate bath, and gradually ufe it cooler, till at length the coldeft proves quite agreeable. Nature revolts againft all great tranfitions ; and thofe who do violence to her dictates, have often caufe to re- pent of their temerity. Wherever cold bathing is practifed, there ought likewife to be tepid baths for the purpofe mentioned above. Indeed it is the practice of fome countries to throw cold water over the patient as foon as he comes out of the warm bath; but though this may not injure a Ruffian pealant, we dare not recommend it to the inhabitants of this country. The ancient Greeks and Romans, we are told, when covered with fweat and duft, ufed to plunge into rivers, without receiving the fmalleft injury. Though they might often efcape danger from this imprudent con- duct, yet it was certainly contrary to found reafon. I have known many robuft men throw away their lives by fuch an attempt. We would not, however, advife patients to go into the cold water when the body is chilly ; as much exercife, at leaft, ought to be taken, as may excite a gentle glow all over the body, but by no means fo as to overheat it. Tt 3 To 646 ON COLD BATHING AND To young people, and particularly to children, cold bathing is of the laft importance. Their lax fibres render its tonic powers peculiarly proper. It promotes their growth, increafes their ftrength*, and prevents a variety of difeafes incident to child- hood. Were infants early accuftomed to the cc.4 bath, it would feldom difagree with them; and we fhould fee fewer inftances of the fcrophula, rickets, and other difeafes, which prove tatal to many, and make others miferable for life. Sometimes, indeed, thefe diforders render infants incapable of bearing the fhock of cold water; but this is owing to their not having been early and regularly accuftomed to it. There is no practice equal to cold-bathing for fortifying the body againft the heats of fumiv er. It is however neceffary here to caution young men againft too frequent bathing; as 1 have known many fatal confequences refult from the daily practice of plunging into rivers, and continuing there too long. It is feldom that fwimming can be regarded as a re- medy. It is right for every boy to learn to fwim ; and it is a cleanly practice; but much mifchief is done by going into the water at improper times of the day, and flaying in too long. The moft proper time of the day for ufing the cold bath is, no doubt, the morning, or at leaft be- fore dinner; and the beft mode, that of quick im- merfion. As cold bathing has a conftant tendency to propel the blood and other humors towards the head, it ought to be a rule always to wet that part as foon as poffible. By due attention to this eircum- * The celebrated Galen fays, that immerfion in cold water is fit only for the young of lions and bears; and recommends warm bathing as conducive to the growth and ftrength of in- fants How egregioufly do the greateft men err whenever they lofe fight of fatfs, and fubftitute reafoning in phyfic in place of obfervation and experience! ftance, DRINKING MINERAL WATERS. 647 fiance, there is reafon to believe, that violent head- achs, and other complaints, which frequently proceed from cold bathing, might be often prevented. The cold bath, when too long continued in, not only occafions an exceffive flux of humors towards the head, but chills the blood, cramps the mufcles, relaxes the nerves, and wholly defeats the intention of bathing. Hence, by not adverting to this cir- cumftance, expert fwimmers are often injured, and fometimes even lofe their lives. All the beneficial purpofes of cold bathing are anfwered by one, two, or three immerfions at a time ; and the patient ought to be rubbed dry the moment he comes out of the water, and fhould continue to take exercife for fome time after. When the cold bathing is fucceeded by a glow, it is ufeful. When this does not follow the patient fhould be well rubbed, and put between blankets. When cold bathing occafions chillinefs, lofs of ap- petite, liftleffnefs, pain of the breaft or bowels, a proftration of ftrength, or violent head-achs, it ought to be difcontinued. Though thefe hints are by no means intended to point out all the cafes where cold bathing may be hurtful, nor to illustrate its extenfive utility as a medicine; yet it is hoped they may ferve to guard people againft fome of thofe errors into which, from mere inattention, they are apt to fall, and thereby not only endanger their own lives, but bring an ex- cellent medicine into difrepute. OF DRINKING THE MINERAL WATERS. The internal ufe of water, as a medicine, is no lefs an object of the phyfician's attention than the external. Pure elementary water is indeed the moft inoffenfive of all liquors, and conftitutes a princi- T t 4 pal 6-48 ON COLD BATHING AND pal part of the food of every animal. But this ele ment is often impregnated with fubftances of a very active and penetrating nature; and of fuch an infidious quality, that, while ttiey promote certain fecretions, and even alleviate fome difagreeable fymptoms, they weaken the powers of life, undermine the conftitu- tion, and lay the foundation of worfe difeafes than thofe which they were employed to remove. Of this every practitioner muft have feen inftances ; and phyficians of eminence have more than one declared that they have known more difeafes occafioned than removed by the ufe of mineral waters. This doubt- lefs has proceeded from the abufe of thefe powerful medicines, -which evinces the neceffity of ufing them with caution. By examining the contents of the mineral waters which are moft ufed in this country, we fhall be enabled to form an idea of the danger which may arife from an improper application of them either (externally or internally, though it is to the latter of thefe that the prefent obfervations are chiefly confined. The waters moft in ufe for medical purpofes in Britain, are thofe impregnated with falts, fulphur, iron, and mephitic air, either feparately, or varioufly combined. Of thefe the moft powerful is the feline fulphureous water of Harrowgate, of which I have had more occafion to obferve the pernicious confe- quences, when improperly ufed, than of any other. To this, therefore, the following remarks will more immediately relate, though they will be found appli- cable to all the purging waters in the kingdom which are ftrong enough to merit attention*. * The greateft clafs of mineral waters in this country is the chalybeate. In many parts of Britain thefe are to be found in almoft every field; but thofe chiefly in ufe, for medical pur- pofes, are the purging chalybeates, as the waters of Scarbo- rough, Cheltenham, Thorp Arch, Nevil Holt, &c. Of thofe which DRINKING MINERAL WATERS. 649 The errors which fo often defeat the intention of drinking the purgative mineral waters, and whicii fo frequently prove injurious to the patient, proceed from the manner of ufing them, the quantity taken, the regimen purfued, or ufing them in cafes where they are not proper. A very hurtful prejudice ftill prevails in this country, that all difeafes muft be cured by medicines taken into the ftomach, and that the more violently thefe medicines operate, they are the more likely to h;:ve the defired effect. This opinion has proved fatal to thousands, and will, in all probability, de- ftroy many more before it can be wholly eradicated. Purging is often ufeful in acute difeafes, and in chronical cafes may pave the way for the operation of other medicines; but it will feldom perform a cure ; and by exhaufting the Strength of the patient, will often leave him in a worfe condition than it found him. That this is frequently the cafe with regard to the more active mineral waters, every per- fon eonverfant in thefe matters will readily allow. Strong ftimulants applied to the ftomach and bowels for a length of time, muft tend to weaken and deftroy their energy; and what ftimulants are more active than fait and fulphur, efpecially when thefe fubftances are intimately combined, and carried through the fyftem by the penetrating medium of water ? Thofe bowels muft be ftrong indeed, which can withftand the daily operation of fuch active prin- ciples for months together, and not be injured. This however is the plan purfued by moft of thofe which do not purge, the waters of Tunbridge ftand in the higheft repute. The faline purging waters, as thofe of Adon, Epfom, Kilburn, &c. are alfo in very general efteem; but the fountains moft frequented by the fick in this country, are thofe to which the minerals impart a certain degree of heat, as Bath, Briftol, Buxton, &c. 650 ON COLD BATHING AND who drink the purging mineral waters, and whofe circumftances will permit them to continue long enough at thofe fafhionable places of refort. Many people imagine that every thing depends on the quantity of water taken, and that the more they drink they will the fooner get well. This is an egregious error; for, while the unhappy patient thinks he is by this means eradicating his diforder, he is often, in fact, undermining the powers of life, and ruining his conftitution. Indeed nothing can do this fo effectually as weakening the powers of digef- tion by the improper application of flrong ftimulants. The very effence of health depends on the digeftive organs performing their due functions, and the moft tedious maladies are all connected with indigeftion. Drinking the water in too great quantity, not only injures the bowels and occafions indigeftion, but generally defeats the intention for which it is taken. The difeafes for the cure of which mineral waters are chiefly celebrated, are moftly of the chronic kind; and it is well known that fuch difeafes can only be cured by the flow operation of alteratives, or fuch medicines as act by inducing a gradual change in the habit. This requires length of time, and never can be effected by medicines which run off by ftool, and operate chiefly on the firft paffages. Thofe who wifh for the cure of any obftinate ma- lady from the mineral waters, ought to take them in fuch a manner as hardly to produce any effect whatever on the bowels. With this view a half- pint glafs may be drank at bed-time*, and the fame quantity an hour before breakfaft, dinner, and fup- per. The dofe, however, muft vary according to * When T fpeak of drinking a glafs of the water over-night, I muft beg leave to caution thofe who follow this plan againft eating heavy fupper s. circumftances DRINKING MINERAL WATERS. 651 circumftances. Even the quantity mentioned above will purge fome perfons, while others will drink twice as much without being in the leaft moved by it. Its op ration on the bowels is the only Standard for ufing the water as an alterative. No more ought to be taken than barely to move the body ; nor is it always neceffary to carry it this length, provided the water goes off by the other emunctories, and does not occafion a chillinefs, or flatulency in the ftomach or bowels. When the water is intended to purge, the quantity mentioned above may be all taken be- fore breakfaft. I would not only caution patients who drink the purging mineral waters over night to avoid heavy fuppers, but alfo from eating heavy meals at any time. The ftimulus of water impregnated with falts, feems to create a falfe appetite. I have feen a deli- cate perfon, after drinking the Harrowgate waters of a morning, eat a breakfaft fufficient to have ferved two ploughmen, devour a plentiful dinner of flefli and fifli, and, to crown all, eat fuch a fupper as might have fatisfied a hungry porter. All this, indeed, the ftomach feemed to crave; but this craving had better remain not quite fatisfied, than that the ftomach fhould be loaded with what exceeds its powers. To flarve patients was never my plan; but I am clearly of opinion, that, in the ufe of all the purging mineral waters, a light and rather diluting diet is the moft proper; and that no perfon, during fuch a courfe, ought to eat to the full extent of what his appetite craves. To promote the operation of mineral waters, and to carrry them through the fyftem, exercife is indif- penfably neceffary. This may be taken in any man- ner that is moft agreable to the patient; but he ought never to carry it to excefs. The beft kinds of exer- cife are thofe connected with amufement. Every thing 652 ON COLD BATHING, AND thing that tends to exhilarate the fpirits, not only promotes the operation of the waters, but acts as a medicine. All who refort to the mineral waters ought therefore to leave every care behind, to mix wTith the company, and to make themfelves as cheer- ful and happy as poffible. From this conduct, af- fifted by the free and wholefome air of thofe fafhion- able places of refort, and alfo the regular and early hours which are ufually kept, the patient often re- ceives more benefit than from ufing the waters. But the greateft errors in drinking the purging mineral waters arife from their being ufed in cafes where they are abfolutely improper, and adverfe to the nature of the difeafe. When people hear of a wonderful cure having been performed by fome mineral water, they immediately conclude that it will cure every thing, and accordingly fwallow it down, when they might as well take poifon. Pa- tients ought to be well informed, before they be- gin to drink the more active kinds of mineral wa- ters, of the propriety of the courfe, and fhould never perfift in ufing them when they are found to aggravate the diforder. In all'cafes where purging is indicated, the faline mineral waters will be found to fulfil this intention better than any other medicine. Their operation, if taken in proper quantity, is generally mild ; and they are neither found to irritate the nerves, nor debilitate the patient fo much as the other purgatives. As a purgative, thefe waters are chiefly recom- mended in difeafes of the firft paffages, accompanied with, or proceeding from, inactivity of the ftomach and bowels, acidity, indigeftion, vitiated bile, worms, putrid fordes, the piles, and jaundice. In moft cafes of this kind they are the beft medicines that can be adminiftered. But when ufed with this view, it is fuflicient to take them twice, or at moft three times a-week, DRINKING MINERAL WATERS. 053 a-week, fo as to move the body three or four times ; and it will be proper to continue this courfe for fome weeks. But the operation of the more active mineral wa- ters is not confined to the bowels. They often pro- mote the difcharge of urine, and not unfrequently increafe the perfpiration. This (hews that they are capable of penetrating into every part of the body, and of ftimulating the whole fyftem. Hence arifes their efficacy in removing the moft obftinate of all diforders, obftruclions of the glandular and lymphatic fyftem. Under this clafs is comprehended the fcro- phula or king's evil, indolent tumors, obftructions of the liver, fpleen, kidneys, and mefenteric glands. When thefe great purpofes are to be effected, the waters muft be ufed in the gradual manner mentioned above, and perfifted in for a length of time. It will be proper, however, now and then to difeontinue their ufe for a few days. The next great clafs of difeafes where mineral waters are found to be beneficial, are thofe of the fkin, as the itch, fcab, tetters, ringworms, fealy erup- tions, leprofies, blotches, foul ulcers, &c. Though thefe may feem fuperficialj yet they are often the moft obftinate which the phyfician has to encounter, and not unfrequently fet his fkill at defiance: but they will fometimes yield to the application of mine- ral waters for a fufficient length of time, and in moft cafes of this kind thefe waters deferve a trial. The faline fulphureous waters, fuch as thofe of Moffat in Scotland, and Harrowgate in England, are the moft likely to fucceed in difeafes of the lit in ; but for this purpofe it will be neceffary not only to drink the waters, but likewife to ufe them externally. To enumerate more particularly the qualities of the different mineral waters, to fpecify thofe dif- eafes in which they are refpectively indicated, and to 6s4 ON COLD BATHING, tffc. to point out their proper modes of application, would be an ufeful, and by no means a difagree- able employment; but as the limits prefcribed to thefe remarks will not allow me to treat the fubject at more length, I fhall conclude by obferving, that whenever the mineral waters are found to exhauft the ftrength, deprefs the fpirits, take away the ap- petite, excite fevers, diftend the bowels, or occafion a cough, they ought to be difcontinued. *#* Thefe Cautions having been printed and fold feparately for the accommodation of thofe who had purchafed the former editions of this book, has inductd fome perfons to confider them as a Treatife on fea-bathin? and drinking the mineral waters ; whereas the author'.^ fole intention was to furnifh a few general hints to perfons who frequent thofe faftiionabie places of refort, without putting themfelves under the care of a phyfician. As he looks upon this fubject, however, to be of the greateft import- ance to the fick, he pledges himfelf to treat it at more length on a future occafion. APPENDIX; CONTAINING A Lift of Simples and of fuch Medicinal Pre^- parations as ought to be kept in readinefs for private Practice: The Method of preparing and compounding fuch Medicines as are recommended in the former Part of the Book, with the Addition of feveral others of a fimilar Nature: Remarks on the Dofes, Ufes, and Manner of applying the different Preparations. -•—=--——■----——-*---- ' m n ■■■■ .jii.. t ,.f,i',.^> INTRODUCTION. IGNORANCE and fuperftition have attributed extraordinary medical virtues to almoft every production of nature. That fuch virtues were often imaginary, lime and experience have fufficiently fhewn. Phyficians, however, from a veneration for antiquity, ftill retain in their lifts of medicine many things which owe their reputation entirely to the fuper- ftition and credulity of our anceftors. The inftrumerits of medicine will always be multiplied, in proportion to men's ignorance of the nature and caufe of difeafes j when thefe are fufficiently underftood, the method of cure will be fimple and obvious. Ignorance of the real nature and permanent properties of thofe fubftances employed in the cure of difeafes, is another reafon why they have been fo greatly multiplied. Phyficiarff thought they could effect by a number of ingredients, what could not be done by any one of them. Hence arofe thofe amazing farragos which have fo long difgraced the medical art, and which were efteemed powerful in proportion to the number of fimples that entered tlieir composition. The great variety of forms into which almoft every article of medicine has been manufactured, affords another proof of the imperfection of the medical art. A drug which is perhaps moft efficacious in the fimpleft form in which it can be admi- niftered, has been neverthelefs ferved up in fo many different fhapes, that one would be induced to think the whole art of phytic lay in exhibiting medicine under as many different modes as poffible. Different forms of medicine, no doubt, have their ufe ; but they ought never to be wantonly increafed. They are by no means fo neceffary as is generally imagined. A few grains nf powdered rhubarb, jalap, or ipecacuanha, will actually perform all that can be done by the different preparations of U u thefe f)58 APPENDIX. thefe roots, and may alfo be exhibited in as fafe and agreeable a manner. The fame obfervation holds with regard to the Peruvian bark, and many other fimples, of which the prepa- rations are very numerous. Multiplying the ingredients of a medicine, not only renders it more expenfive, but alfo lefs certain, both in its dofe and operation. Nor is this all. The compound, when kept, is apt to fpoil, or acquire qualities of a different nature. When a medicine is rendered more fafe, efficacious, or agreeable, by the addition of another, they ought, no doubt, to be join- ed ; in all other cafes, they are better kept afunder. The combination of medicines embarraffes the phyfician, and re- tards the progrefs of medical knowledge. It is impoffible to afcertain the precife effect of any one medicine, as long as it is combined with others, either of a fimilar or diffimilar nature. In the exhibition of medicine, regard fhould not only be had to iimplicity, but likewife to elegance. Patients feldom reap much benefit from things that are highly difagreeable to their fenfes. To tafte or fmell like a drug, is become a proverb; and to fay truth, there is too much ground for it. Indeed no art can take away the difagreeable tafte and flavour of fome drugs, without eHtirely deftroying their efficacy: it is poffible, however, to render many medicines lefs difguftful, and others even agreeable; an object highly deferving the at- tention of all who adminifter medicine. The defign of the following pages is, to exhibit fuch a lift of drugs and medicines as may be neceffary for private prac- tice. They are confiderably more numerous indeed than thofe recommended in the former part of the Book, but are ftill greatly within the number contained in the moft re- formed difpenfatories. The fame medicine is feldom exhi- bited under different forms; and where different medicines anfwer nearly the fame intention, there is commonly no more than one of them retained. Multiplying forms of medicine for the fame intention tends rather to bewilder than aflift the young practitioner, and the experienced phyfician can never be at a lofs to vary his prefcriptions as occafion re- quires. The chemical and other difficult preparations are for the moft part emitted. All of them that are ufed by any private practitioner are not worth preparing. He will buy them much cheaper than he can make them. Great care however L neceffary to obtain them genuine. They are often adul- terated, and ought'never to be pin chafed unlefs from perfons of APPENDIX. - 6c9 of known veracity. Such of them as are in common ufe, are inferted in the lift of drugs and medicines. Their proper dofes and manner of application, are mentioned in the practical part of the Book, wherever they are prefcribed. Such articles of medicine as are to be found in the houfe or garden of almoft every peafant, as barley, eggs, onions, &c. are likewife, for the moft part, omitted. It is needlefs to fwell a lift of medicines with.fueh things as can be obtained when- ever they are wanted, and which fpoil by being kept. The preparations made and fold by difttiers and confec- tioners are alfo generally left out. Thefe people, by ope- rating upon a larger plan, generally nuke things better, while it is in their power to afford them much cheaper, than they can be prepared by any private hand. The quantity ordered of every medicine is as fmall as could well be prepared, both to prevent unneceffary expence," and that the medicine might not fpoil by keeping. Almoft every medicine fuffers by being kept, and fhould be ufed as foon after it has been prepared as poffible. Even fimple drugs are apt to fpoil, and fhould therefore be laid in in fmaU quantities; they either rot, are confumed by infects, or eva- porate fo as to lofe their peculiar tafte or flavour, and often become quite infignificant. In the preparation of medicine, I have generally followed the moft improved difpenfatories; but have taken the liberty to differ from them wherever my own obfervations, or thofe of other pra&ical writers, on whofe judgment I could de- pend, fuggefted an improvement. In feveral compofitions, the ingredient on which the effi- cacy of the medicine principally depends is increafed, while the auxiliaries, which are generally ordered in fuch trifling quantities as to be of no importance, are left out, or only fuch of them retained as are neccifury to give the medicine a proper confidence, or the like. The colouring ingredients are likewife for the moft part omitted. They increafe the bulk and price of the medicine, without adding any thing to its value. It would be well if they were never ufed at all. Medicines are often adulterated for the fake of a colour. Acrid, and even poif >nous fub- ftances are, for this purpofe, fometimes introduced into thofe medicines which ought to be moft bland and emollient. Ointment of elder, for example, is often mixed with verde- grife to give it a fine green colour, which entirely fruftrates the intention of that mild ointment, Thofe who wifti to obtain feemiine medicines fliould pay :r> rr^.rJ :>-, their colour. 66t> APPENDIX, Some regard is likewife paid to expence. Such ingredi- ents as greatly increafe the price of any competition, with. out adding confiderably to its virtue, are generally either omitted, or fomewhat lels expenfive fubftituted in their place. Medicines are by no means powerful in proportion to their price. The cheapeft are often the beft; befides, they are the leaft apt to be adulterated, and are always moft readily obtained. With regard to the method of compounding medicines, I have generally followed that which feemed to be the moft fimple and natural, mentioning the different fteps of the pro- cefs in the fame order in which they ought to be taken, with- out paying an implicit regard to the method of other dif- penfatories. For many of the remarks concerning the preparation, &c, of medicines, I have been obliged to the author of the New Difpenfatory. The other obfervations are either fuch as. have occurred to myfelf in practice, or have been fuggefte4 in the courfe cf reading, by authors whofe names I am not able diftirctly to recollect. I have followed the alphabetical order, both with regard to the fimples and preparations. A more fcientific method would have been agreeable to fome perfons, but lefs ufeful to the generality of readers. The different clafies of me- dicine have no great dependence upon one another; and, where they have, it is hard to fay which fhould Hand firft or laft; no doubt the fimple p eparations ought to precede the more compound. But all the advantages arifing from this method of arrangement do not appear equal to that fingle on?, of being able, on the firft opening of the book, to find out any article, which, by the alphabetical order, is rendered quite eafy. OThe dofe of every medicine is mentioned whenever it ap- peared neceflary. When this is omitted, it is to be under- ftood that the medicine may be ufed at difcrction. The dofe mentioned is alivays for an adultt unlefs ivhen the contrary is ex- preffed. It is not an eafy matter to proportion the dofes of me- dicine exactly to the different ages, conftitutions, &c. of pa- tients ; but, happily for mankind, mathematical exactnefs here is by no means neceffary. Several attempts have been made to afcertain the proporti- onal defes for the different ages and conftitutions of patients ; but, after all that can be faid upon this fubject, a great deal muft be left to the judgment and fkill of the perfon who admi- mfters the medicine. The following general proportions may he APPENDIX. 66$ be obferved; but tbey are by no means intended for exact rules. A patient between twenty and fourteen may take two-thirds of the dofe ordered for an adult; from fourteen to nine, one half; from nine to fix, one-third; from fix to four, one-fourth ; from four to two, one fixth j from two to one, a tenth; and below one, a twelfth. h> NB. The Apothecary's weights, and the Englifh wine mea. fures, are ufed throughout the whole book,* the different deno- minations of which will appear from the following Table : A pouad contains twelve ounces. An ounce - - eight drachms. A drachm - - three feruples. A fcruple - - twenty grains. A gallon contains eight pints. A pint - - - fixteen ounces. An ounce - - eight drachms. A table-fpoorrfull is the meafure of half an ounce. A tea-fpoonfull w one-fourth of a table-fpoonfull. Sixty drops make one tea-fpoonfull. A LIST of SIMPLES, and of fuch MEDICINAL PREPARATIONS, as ought to be kept in readinefs for private Pra&ice. AGARIC Earth, Armenian bole Alum Extracts of Gentian Antimony, crude •-----. of Hellebore, black Arfenic, white ---:--- of hemlock Balfam of CapivL -------• of liquorice ------- of Peru ------- of Peruvian bark Bark, caffia Flowers of camomile ■ cinnamon ----:— colt's foot ----Mezerion «------elder ■»■ ■ Peruvian ■ red rofes Borax Fox-glove Calamine ftone, levi- Fruits, caffia fiftularrs gated ---- Curaffao orange* Caftor, Ruffian ----- figs, dried Cauftic, common ----- French prunes ------- lunar ----- Jamaica pepper Chalk prepared -----juniper berries Earth, Japan ----- nutmegs U u a Fruit?, 662 APPENDIX. Fruits, tamarinds Galls Gums, aloes ---- ammoniac ---- arabic ---- afafcetida - camphor .---- galbanum ---- gamboge ---- guaiacum ----. kino ---- myrrh ---- opium Herbs, leffer centaury ■ peppermint .------- pemiy-royal ------- favin ------- trefoil —----- uva urfi .------ w.rmwood Lead, Litharge ---- extract of ---- fugar of Lemon-peel Mace Magnefia alba Manna Mercury, crude ---------calcined ---------calomel ■ — corrofive fublimate ---------red precipitate ---------white ditto Mufk Oil, effential, of amber -----------of anife ——------- of cinnamon -----------of lemon-peel -----------of peppermint —- exprefled, of linfeed Oil of olive:, or Florence oil caftor oil — of turpentine Orange-peel Refins, benzoin ■-------flowers of Refins, Burgundy pitch -------white, or rofin -------fcammony Roots, calamus aromaticus ---- Carolina pink ---- col umbo ---- garlic ---- gentian ---- ginger ---- hellebore, black, white ---- jafep ---- ipecacuanha ---- lily, white ---- liquorice ---- marfhmallow -----mezerion ---- rhubarb ---- farfaparilla ---- feneka ----• fquills ---- tormentil ---- Virginian fnake ---- wild valerian ---- zedoary Saffron Sal ammoniac, crude -------------volatile Salt, Epfom ---- of Glauber ---- nitre, purified ---- Rochelle ■---- foda, phofphorata ---- of tartar Seeds, anife ■----carraway ----cardamom ----coriander ----cummin ----muftard ---- fweet fennel Senna Spanifh flies Sperma ceti Spirits, aetherial, or aether ------- of hartfhorn ■ ■ of lavender, compound Spirits, APPENDIX. Spirits, of nitre ■------- ditto dulcified of fal ammoniac 663 — of fea fait — of vinegar of vitriol ------- of wine rectified ------- volatile aromatic Steel, filings of ----■ ruft of, prepared Sulphur ------- flowers of Tar ---Barbadoes Tartar, cream of -------> emetic Tartar, foluble -------vitriolated Tin prepared Tutty, levigated Turpentine, Venice Verdegrife Vitriol, green ■------ blue ■------- white Wax, White ----- yellow Wbode, guaiacum -------logwood -------faffafras- ------- faunders, red Zinc, flowers of MEDI- C 664 J MEDICINAL PREPARATIONS. BALSAMS. ry^HE fubject of this fe&ion is not the natural balferas, but J_ certain compofitions, which, from their being fuppofed to poffefs balfamie qualities, generally go by that name. This clafs of medicines- was formerly very numerous, and held in great efteem: modern practice, however, has juftly reduced it to a very narrow compafs. Anodyne Balfam. Take of white Spanifh foap, one ounce; opium, unpreparedi two drachms; brandy, nine ounces. Digeft them together in a gentle heat for three days; then ftrain off the liquor, and add to it three drachms of camphor. This balfam, as its title exprefTes, is intended to eafe pain. It is of fervice in violent ftrains and rheumatic complaints, when not attended with inflammation. It muft be rubbed with a warm hand on the part affected; or a linen rag moif- tened with it may be applied to the part, and renewed every third or fourth hour, till the pain abates. If the opium is left out, this will be the faponaceeous balfam. BOLUSES. AS bolufes are intended for immediate ufe, volatile falts and other ingredients improper for being kept, are admitted into their compofition. They are generally compofed of pow- ders, with a proper quanty of fyrup, conferve, or mucilage. The lighter powders are commonly made up with fyrup, and the more ponderous, as mercury, &c. with conferve; but thofe of the lighter kind would be more conveniently made up with mucilage, as it increafes thesr bulk lefs than the other addi- tions, and likewife occafions the medicine to pafs down more eafily. Aftringent Bolus. Take of alum in powder, five grains j fyrup, a fufficient quantity to make a bolus. 1 la B O L U S S E S. 66$ In an exceffive flow of the menfes, and other violent dif- charges of blood, proceeding from relaxation, this bolus may be given every four or five hours till the difcharge abates. Diaphoretic Bolus. Take of gum guaiacum, in powder, ten grains; flowers of fulphur and cream of tartar, of each one fcruple; fimple fyrup, a fufficient quantity. In rheumatic complaints, and diforders of the fkin, this bolus may be taken twice a-day. Mercurial Bolus. Take of calomel, fix grains; conferve of rofes, half a drachm. M.les and other earthy fubftances, as they do pot diffolve in water, are likewife unfit for this purpofe. CoPyrium CONFECTIONS. 669 Collyrium of Alum. Take of alum, half a drachm ; agitate it well together with the white »f one egg. T'ns is the Collyrium of Riverius. It is ufed in inflamma- tion of the eyes, to allay heat, and reftrain the flux of hu- mors. Ir muft be put in a fine linen bag, and applied to the eyes at bed-time. Vitriolic Collyrium. Take of white vitriol, half a drachm; rofe-water, fix ounces. Diffolve the vitriol in the water, and filter the liquor. This, though fimple, is perhaps equal in virtue to moft of the celebrated collyri i. It is an ufeful application in weak, watery, and inflamed eyes. Th-'Ugh the flighter inflamma- tions will generally yield to it, yet in thofe of a imre obfti- nate nature, the affiftance of bleeding and bliftering will often be recelfary. When a ftrong aftringent is judged proper, a double or triple quantity of the vitriol may be ufed. I have feen a fo. lu.ion of f ur times the ftrength of the above ufed with ma- nifeft advantage. Collyrium of Lead. Take fugar of lead, and crude fal ammoniac, of each four grains. Diffolve them in eight ounces of common water. Forty or fifty drops of laudanum may be occafionally added to this collyrium. Tuofe who choofe may fubftitute inftead of this the colly- rium of lead recommended by Goulrrd ; which is made by putting twenty-five drops of his Ext rail of L:ad to eight ounces of water, and adding a tea-fpoonful of brandy. Indeed, common waUr and brandy, without any other ad- dition, will in many cafes anfwer very well as a collyrium. An ounce of the latter may be added to five or fix ounces of the former; and the eyes, if weak, bathed with it night and morning. CONFECTIONS. CONFECTIONS containing above fixty ingredients are ftill to be found in fome of the moft reformed difpenfatories. As moft of their intentions, however, may be more certainly, and as effrflually anfwered by a few glaffes of wine or grains 670 APPENDIX. of opium, we fhall pafs over this clafs of medicines very flightly. Japonic Confeclion. Take cf Japan earth, three ounces; tormentil root, nut meg, olibanum, of each two ounces; opium diffolved in a fufficient quantity of Lifbon wine, a drachm and a half; fim- ple fyrup and conferve cf rofes, of each fourteen ounces. ' Mix and make them into an electuary. This fupplies the place of the Diafcordium. The dofe of this electuary is from a fcruple to a drachm. CONSERVES AND PRESERVES. EVERY Apothecary's fhop was formerly fo full of thefe preparations, that it might have paffed for a confectioner's wareboufe. They pofLfs very few medicinal properties, and may rather be claffed among fweetmeats than medicines. They are fometimes, however, of ufe, for reducing into bo- lufes or pills fome of the'more ponderous powders, as the pre- parations of iron, mercury, and tin. Conferves are compofitions of frefh vegetables and fugar, beaten together into an uniform mafs. In making thefe pre- parations, the leaves of vegetables muft be freed from their ftalks, the flowers from their cups, and the yellow part of orange peel taken off with a rafp. They are then to be pound- ed in a marble mortar, with a wooden peftle, into a fmooth mafs; after which, thrice their weight of fine fugar is com- monly added by degrees, and the beating continued till they are uniformly mixed; but the conferve will be better if only twice its weight of fugar be added. Thofe who prepare large quantities of conferve generally reduce the vegetables to a pulp by the means of a mill, and afterwards beat them up with the fugar. Conferve of Red Rofes. Take a pound of red rofe buds, cleared of their heels; beat them well in a mortar, and, adding by degrees two pounds of double refined fugar, in powder, make a conferve. After the fame manner are prepared the conferves of orange peel, roiemary flowers, fea wormwood, of the leaves of wood-forrel, &c The conferve of rofes is one of the moft agreeable and ufe- ful preparations belonging to this clafs. A drachm or two of DECOCTIONS. 6ji of it, diffolved in warm milk, is ordered to be given as a gen- tle reftringent in weaknefs of the ftomach, and likewife in phthi- fical coughs, and fpitting of blood. To have any confiderable effects, however, it muft be taken in larger quantities. Conferve of Sloes. This may be made by boiling the floes gently in water, be- ing careful to take them out before they burft ; afterwards ex- prefling thejuice, and beating it up with three times its weight of fine fugar. In relaxations of the uvula and glands of the throat, this makes an excellent gargle, and may be ufed at difcretion. Preferves are made by fleeping or boiling frefh. vegetables firft in water, and afterwards in fyrup, or a folution of fugar. The fubject is either preferved moift in the fyrup, or taken eut and dried, that the fugar may candy upon it. The laft is the moft ufeful method. Candied Orange-Peel. Soak Seville orange-peel in feveral waters, till it lofes its bitternefs; then boil it in a folution of double-refined fugar in water, till it becomes tender and tranfparent. Candied lemon-peel is prepared in the fame manner. It is needlefs to add more of thefe preparations, as they belong rather to the art of the confectioner than that of the apothecary. DECOCTIONS. WATER readily extracts the gummy and faline parts of vegetables; and though its action is chiefly confined to thefe, yet the refinous and oily being intimately blended with the gummy and faline, are in great part taken up along with them « Hence watery decoctions and infufions of vegetables, conftitute a large, and not unufeful, clafe of medicines. Although mcft vegetables yield their virtues to water, as well by infufion as decoction, yet the latter is often neceffary, as it fives time, and does in a few minutes what the other would require hours, and fometimes days, to effect. The medicines of this clafs are all intended for immediate ufe. Decoclion of Althaea. Take of the roots of marfh-mallows, moderately dried/ three ounces; raifins of the fun, one ounce ; water, three pints. Bcil 6-7? APPENDIX. Boil the ingredients in the water till one-third of it is con- firmed ; afterwards ftrain the decoction, and let it ftand for fome time to fettle. If the roots be thoroughly dried, they muft be boiled till one half the water be combined. In coughs, and fharp defluctions upon the lungs, this decoc- tion may be ufed for ordinary drink. The Common Decoclion. Take of camomile flowers, one ounce; elder flowers, and fweet fennel feeds, of each half an ounce ; water, two quarts. Boil them a little while, and then ftrain the decoction. A medicine equally good may be prepared by infufing the ingredients for fome hours in boiling water. This decoction is chiefly intended as the bafis of clyfters, to which other ingredients may be occafionally added. It will likewife ferve as a common fomentation, fpirit of wme or other things being added in fuch quantity as the cafe may require. Decoclion of Logwood. Boil three ounces of the fhavings, or chips, of logwood, in four pints of water, till one half of the liquor is wafted. Two or three ounces of fimple cinnamon-water may be added to this decoction. In fluxes of the belly, where the ftronger aftringents are improper, a tea-cupfull of this decoction may be taken with advantage three or four times a-day. Decoclion of the Bark. Boil two ounces of the Peruvian bark, grofsly powdered,.in a pint and and a half of water to one pint; then ftrain the de- coction. If a tea-fpoonfull of the weak fpirit of vitriol be ad- ded to this medicine, it will render it both more agreeable and efficacious. Compound Decoclion of the Bark. Take of Peruvian bark and Virginian fnake-root, grofsly powdered, each three drachms. Boil them in a pint of wa- ter to one half. This is a proper medicine towards the decline of malig- nant fevers, when the pulfe is low, the voice weak, and .the head affected with ftupor, but with little delirium. The dofe is fjur table- fpoonfulls every fecond or third hour. 4 DetoSiort DECOCTIONS. *n Decoclion of Sarfaparilla. Take of frefh farfaparilla root, fliced and bruifed, two ounces ; fhavings of guaiacum wood, one ounce. Boil over a flow fire, in three quarts of water, to one ; adding towards the end half an ounce of liquorice-root. Strain the decoction. This may either be employed as an affiftant to a courfe of mercurial alteratives, or taken after the mercury has been ufed for fome time. It ftrengthens the ftomach, and reftores flefh and vigour to habits emaciated by the venereal difeafe. It may alfo be taken in the rheumatifm, and cutaneous difor- ders proceeding from foulnefs of the blood and juices. This decoction may be taken, from a pint and a half, to two quarts in the day. The following decoction is faid to be fimilar to that ufed by Kennedy, in the cure of the venereal difeafe, and may fupply the place of Lifbon diet drink: Take of farfaparilla, three ounces; liquorice and mezereon root, of each half an ounce ; fhavings of guaiacum and faffa- fras wood, of each one ounce; crude antimony, powdered, an ounce and a half. Infufe thefe ingredients in eight pints of boiling water for twenty-four hours, then boil them till one half of the water is confumed; afterwards ftrain the de- coction. . This decoction may be ufed in the fame manner as the pre- ceding. Decoclion of Seneka. Take of feneka rattle-fnake root, one ounce; water, a pint and a half. Boil to one pint, and ftrain. This decoclion is recommended in the pleurify, dropfy, rheu- matifm, and fome obftinate diforders of the fkin. The dofe is two ounces, three or four times a-day, or oftener, if the fto- mach will bear it. White Decoclion. Take of the pureft chalk, in powder, two ounces; gum, arabic, half an ounce ; water, three pints. Boil to one quart, and ftraiivthe decoction. # This is a proper drink in acute difeafes, attended with, or inclining to, a loofenefs, and where acidities abound in the ftomach or bowels. It is peculiarly proper for children when afflicted with fournefs of the ftomach, and for perfons who are fubject to the heartburn. It may have two or three ounces ot fimple cinnamon-water added to it. d74 APPENDIX. An ounce of powdered chalk, mixed with two pints of water, will occafionally fupply the place of this decoction, and alfo of the chalk julep. DRAUGHTS. THIS is a proper form for exhibiting fuch medicines as are intended to operate immadiately, and which do not need to be frequently repeated; as purges, vomits, and a few others, which are to be taken at one dofe. Where a medicine requires to be ufed for any length of time, it is better to make up a larger quantity of it at once, which faves both trouble and ex- pence. Anodyne Draught. Take of liquid laudanum, twenty-five drops; mint-water, an ounce. Mix them with a little fugar. In exceffive pain, where bleeding is not neceffary, and irt great reftleffnefs, this compofing draught may be taken and repeated occafionally. Diuretic Draught. Take of nitre, half a drachm ; common water, an ounce. This draught is of fervice in an obftruction or deficiency of urine. Purging Draughts. Take of manna, an ounce; fduble tartar, or Rochel fait, from three to four drachms. Diffolve in three ounces of boil- ing water; to which add peppermint-water, half an ounce. As manna fometimes will not fit upon the ftomach, an ounce or ten drachms of the bitter purging falts, diffolved in four ounces of water, may be taken inftead of the above. To mO.o Glauber or Epfcm falts agreeable, we add cream of tartar or lime juice, and fweetenwith fugar. Thofe who cannot take falts, may ufe the following draught: Tike of jalap in powder, a fcruple; common water, an ounce; mint water, fix drachms. Rub the jalap with twice its weight of fugar, and add to it the other ingredients. Sweating Draught. Take fjMnt of Mindererus, two ounces ; liquid laudanum, antimonial wine, each twenty-five drops ; mint-water, half an ounce. Make them into a draught. In ELECTUARIES. 675 In recent colds and rheumatic complaints, this draught is of fervice. To promote its effect*, however, the patient ought to drink freely of warm water-gruel, or of fome other weak dilut- ing liquor. Vomiting Draughts. Take of ipecacuanha, in powder, a fcruple ; water, an ounce ; fugar, a drachm. Mix them. Perfons who repuire a ftronger vomit, may add to the above half a grain, or a grain, of emetic tartar. Thofe who do not choofe the powder, may take ten drachms of the ipecacuanha wine ; or half an ounce of the wine, and an equal quantity of the fyrup of fquills. ELECTUARIES. Electuaries are generally comprfed of the lighter pow- ders, mixed with fyrup, honey, conferve, or mucilage, into fuch a confiftence, that the powders may neither feparate by keep- ing, nor the mafs prove too ftiff for fwallowing. They receive chiefly the milder alterative medicines, and fuch as are not un- grateful to the palate. Aftringent electuaries, and fuch as have pulps of fruit in them, fhould be prepared only in fmall quantities ; as aftrin- gent medicines lofe their virtues by being kept in this fi>rm, and the pulps of fruits are apt to ferment. For the extraction of pulps it will be neceffary to boil un- ripe fruits, and ripe ones if they are dried, in a fmall quantity of water till they become foft. The pulp is then to be preffed out through a ftrong hair fieve, or thin cloth, and afterwards boiled to a due conlifience, in an earthen veffel, over a gentle fire, taking care to prevent the matter from burning by conti- nually ftirring it. The pulps of fruits that are both ripe and frefh, may be preffed out without any previous boiling. Lenitive Electuary. Take of fenna, in fine powder, eight ounces; coriander feeds> alfo in powder, four ounces; pulp of tamaunds and of F^nch prunes, each a pound. Mix th; pulps and powders together, and with a fufficient quantity of fimple fyrup, reduce the whole into an electuary. A tea-fpoonfull of this electuary, taken two or three times a-day, generally proves an agreeable laxative. It likewife ferves as a convenient vehicle for exhibiting more active medi- cines, as jalap, fcammony, and fuch like. This may fupply the place of the electuary of Caffia. Y y 2 Electuary 6*76 APPENDIX. Elecluary of the Bark. Take of Peruvian bark, in powder, three ounces; cafcarilla, half an ounce; fyrup of ginger, enough to make an electuary. In the cure of obftinate intermitting fevers, the bark is af- fifted by the cafcarilla. In hectic habits, however, it will be better to leave out the cafcarilla, and put three drachms of crude fal ammoniac in its ftead. Elecluary for the Piles. Take flowers of fulphur, cream of tartar powdered, each one ounce; molaffes a fufficient quantity to form an electuary, A tea-fpoonfull of this may be taken three or four times a-day. Elecluary for the Palfy. Take of powdered muftard-feed, and conferve cfj^>fes, each an ounce; fyrup of ginger, enough to make an electuary. A tea-fpoonfull of this may be taken three or four times a-day. Elecluary for the Rheumatifm. Take of conferve of rofes, two ounces; gum guaiacum, in powder, an ounce; fyrup of ginger, a fufficient quantity to make an electuary. In obftinate rheumatifms, which are not accompanied with a fever, a tea-fpoonfull of this electuary may be taken twice a-day with confiderable advantage. EMULSIONS. Emulsions, befide their ufe as medicines, are alfo proper vehicles for certain fubftances, which could not otherwife be conveniently taken in a liquid form. Thus camphor, tritur- ated with almonds readily unites with water into an emulfion. Pure oils, balfams, refins, and other fimilar fubftances, are likewife rendered mifcible with water by the intervention of mucilages. Common JLmulfion. Take of fweet almonds, an ounce; water, two pints. Let the almonds be blanched, and beat up in a marble mor- tar; adding the water by little and little, fo as to make an emulfion; afterwards let it be ftrained. Arabic EXTRACTS. 677 Arabic Emulfion. This is made in the fame manner as the above, adding to the almonds, while beating, two ounces and a half of the mucilage of gum arabic. Where foft cooling liquors are neceffary, thefe emulfions may be ufed as ordinary drink. Camphorated Emulfion. Take of camphor, half a drachm; fweet almonds, half a dozen; white fugar, half an ounce; mint water, eight ounces. Grind the camphor and almonds well together in a ftone mor- tar, and add by degrees the mint-water; then ftrain the liquor, and diffolve in it the fugar. In fevers, and other diforders which require the ufe of cam- phor, a table-fpoonfull of this emulfion may be taken every two or th«ee hours. Emulfion of Gum Ammoniac. Take of gum ammoniac, two drachms; water, eight ounces. Grind the gum with the water poured upon it by little and little, till it is diffolved. This emulfion is ufed for attenuating tough, vifcid phlegm, and promoting expectoration. In obftinate coughs, two ounces of the fyrup of poppies may be added to ic. The dofe is two table-fpoonfuls three or four times a-day. Oily Emulfion. Take of foft water, Gx ounces; volatile fpirit, two drachms; fweet oil, an ounce; fhake them well together, and add, of fimple fyrup, half an ounce. In recent colds and coughs, this emulfion is generally cf fervice ; but if the cough proves obftinate, it will fucceed bet- ter when made with the paregoric elixir, inftead of the volatile fpirit. A table fpoonfull of it may be taken every two or three hours. EXTRACTS.. Extracts are prepared by boiling the fubject in water, and evaporating the ftrained decoction to a due confiftence. By this procefs fome of the more aflive parts of plants are freed from the ufelefs, ip.diffoluble earthy matter, which makes the larger fhare of their bulk. Water, however, is not the only menftruum ufed in the preparation of extracts; fometimes it is joined 67S APPENDIX. joined with fpirits, and at other times rectified fpirits alone is employed for that purpofe. Extracts are prepared from a variety of different drugs, as the bark, gentian, jalap, &c.; but as they require a trouble- fome and tedious operation, it will be more convenient for a private practitioner to purchafe what he needs of them from a profeffed druggift, than to prepare them himfelf. Such of them as are generally ufed are inferted in our lift of fuch drugs and medicines as are to be kept for private practice. FOMENTATIONS. Fomentations are generally intended either to eafe pa'n, by taking off tenfion and fpafm; or to brace and reftore the tone and vigor of thofe parts to which they are applied. The firft of thefe intentions may generally be anfwered by warm water, and the fecond by cold. Certain fubftances,"^however, are ufually added to water, with a view to heighten its effects, as anodynes, aromatics, aftringents, &c. We fhall therefore fubjoin a few of the moft ufeful medicated fomentations, that people may have it in their power to make ufe of them if they choofe. Anodyne Fomentation. Take of white poppy heads, two ounces; elder flowers, half an ounce; water, three pints. Boil till one pint is evaporated, and ftrain out the liquor. This fomentation, as its title expreffes, is ufed for relieving acute pain. ^ Aromatic Fomentation. Take of Jamaica pepper, half an ounee ; red wine, a pint. Boil them a little, and then ftrain the liqurr. This is intended, not only as a topical application for exter- nal complaints, but alfo for relieving the internal parts. Pains of the bowels, which accompany dyfenteries and diarrhoeas, flatulent colics, uneafinefs of the ftomach, and retchings to vomit, are frequently abated by fomenting the abdomen and region of the ftomach with the warm liquor. Common Bitter Fomentation. Take tops of wormwood and camomile flowers, dried, of each two ounces, water, two quarts. After a flight boiling, pour off the liquor. , Brandy GARGLES. 679 Brandy or fpirit of wine may be added to this fomentation, in fuch quantity as the particular circumftances of the cafe fhall require; but thefe are not always neceffary. Emollient Fomentation. This is the fame as the common decoction. Strengthening Fomentation. Take of oak bark, one ounce ; alum, two drachms ; water, three pints. Boil the water with the bark to the confumption of one third ; then ftrain the remaining decodion, and diffolve the alum in it. This aftringent liquor is employed as an external fomenta- tion to weak parts; it may alfo be ufed internally. GARGLES. HOWEVER trifling this clafs of medicines may appear, they are by no means without their ufe. They feldom indeed cure difeafes, but they often alleviate very difagreeable fymp- toms; as parchednefs of the mouth, foulnefs of the tongue * and fauces, &c. they are peculiarly ufeful in fevers and fore throats. In the latter, a gargle will fometimes remove the diforder ; and in the former, few things are more refrefhing or agreeable to the patient, than to have his mouth frequently wafhed with fome foft detergent gargle. One advantage of thefe medicines is, that they are eafily prepared. A little barley-water or fage tea and honey may be had any where ; and if to thefe be added as much vinegar or alum as wiH give them an agreeable fharpnefs, they will make a very ufeful gargle for foitening and cleanfing the mouth. Gargles have the beft effect when injected with a fyringe. Attenuating Gargle. Take of water, fix ounces; honey, one ounce; nitre, a drachm and a half. Mix them. This cooling gargle may be ufed either in the inflamma- tory quinfey, or in fevers, for cleanfing the tongue and fauces. Common Gargle. Tike of water, fix ounces; fugar half an ounce; fpirit of vitriol, a fufficient quantity to give it an agreeable fharpnefs. Mix them. ^,. This 680 APPENDIX. This gargle, befides cleanfing the tongue and fauces, acts as a gentle repellent, and will fometimes remove a flight quinfey. A very good gargle may be made by pouring boil- ing water on Sumach berries. Detergent Gargle. Take of the emollient gargle, a pint; tincture of myrrh) an ounce; honey, two ounces. Mix them. When exulcerations require to be cleanfed, or the excre- tion of tough vifcid faliva promoted, this gargle will be of fervice. Emollient Gargle. Take an ounce cf marfjhmallow roots, and two or threa figs; boil them in a quart of water till near one half of it be confumed; then ftiain out the liquor. If an ounce of honey, and half an ounce of fpirit of fal- ammoniac, be added to the above, it will then be a good atte- nuating gargle. This gargle is beneficial in fevers, where the tongue and fauces are rough and parched, to foften thefe parts, and pro- mote the difcharge of faliva. The learned and accurate Sir John Pringle obferves, that in the inflammatory quinfey, or ftrangulation of the fauces, little benefit arifes from the commen gargles; that fuch as are of an acid nature do more harm than good, by contract- ing the emunctofies of the faliva and mucus, and thickening thofe humours; that a decoction of figs in milk and water has a contrary effect, efpecially if fome fal-ammoniac be added; by which the faliva is made thinner, and the glands brought to fecrete more freely; a circumftance always con- ducive to the cure. INFUSIONS. VEGETABLES yield nearly the fame properties to water by infufion as by decoction; and though they may require a longer time to give out their virtues in this way, yet it has feveral advantages over the other ; fince. boiling is found to diffipate the .finer parts of many bitter and aromatic fubftances, without more fully extracting their medicinal principles. The author of the New Difpenfatory obferves, that even from thofe vegetables which are weak in virtue, rich infu». fions may be obtained, by returning the liquor upon frefh quantities of the fubject, the water leading itfelf more and I more INFUSIONS. fj>3i more with the active parts; and that thefe loaded infufions are applicable to valuable purpofes in medicine, as they con- tain in a fmall compafs the finer, more fubtile, and active principles of vegetables, in a form readily mifcible with the fluids of the human body. A very good and expeditious mode of making infufions, is to reduce the fubftance to a fine powder, add the water gradually to it in a mortar, rubbing them well together. Then let it ftand to fettle; in a fev/ hours it will be fit for ufe. Bitter Infufion. Take tops of centaury and camomile flowers, cf each half an ounce; orange peel, carefully freed from the inner white part, two drachms. Cut them in fmall pieces, and infufe them in a quart of boiling water. For indigeftion, weaknefs of the ftomach, or want of appe- tite, a tea-cupfull of this infufion may be taken twice or thrice a day. Infufion of the Bark. To an ounce ef the bark, in powder, add one or two table- fpoonful s of brandy, and a pint of boiling .water. Let them infufe for two or three days. This is a good preparation of the bark for weak ftomachs. In diforders where the corroborating virtues of that medicine dVe required, a tea-cupfull of it may be taken two Or three times a-day. Infufion of Carduus. Infufe an ounce of the dried leaves of carduus benedictu?, or bleffed thiftle, in a pint of common water, for fix hours, without heat; then filter the liquor through payer. This light infufion may be given, with gre.it benefit, in weaknefs of the ftomach, where the common bitters do not agree. It may be flavoured at pieafure with cinnamon, or other aromatic materials. Infufion of Flaxfeed. Take of flaxfeed, two fpoonfuls; liquorice root, fliced, half an ounce; boiling water, three pints. Let them ft in J to infufe by the fire for fome hours, and then ftrain off the . liquor. If an ounce of the leaves of colt's font be added to thefe ingredients, it will then be the pel^ral infufion. B"-th thefe are emollient mucilaginous liquors, and may be- taken with Z t advantiije 682 APPENDIX. advantage as ordinary drink in difficulty of making water; and in coughs and other complaints of the breaft. Infufion of Rofes. Take of red rofes, dried, half an ounce; boiling water, a quart; vitriolic acid, commonly called oil of vitriol, half a drachm ; loaf fugar, an ounce. Infufe the rofes in the water for four hours, in an unglazed earthen veffel; afterwards pour in the acid, and having ftiained the liquor, add to rt the fugar. In an exceffive flow of the menfes, vomiting of blood, and other haemorrhages, a tea-cupfull of this gently aftringent infufion may be taken every three or four hours. It likewife makes an exceeding g<*>d gaEgle. :. As the quantity of rofes ufed here can have little or no eff.ct, an equally valuable medicine may be prepared by mix- ing the acid and water without infufion. Infufion of Tamarinds and Senna. Take rf tamarinds, one ounce; fenna, and cryftals of tar- tar, each two drachms. Let thefe ingredients be infufed four or five hours in a pint of boiling water; afterwards let the liquor be ftrained, and an ounce or two of the aromatic tincture added to it. Perfons who are eafily purged may leave out either the tamarinds or the cryftals of tartar. This is arPagreeable cooling purge. A tea-cupfull may be given every half hour till it operates. This fupplies the place of ths decoSion of tamarinds and fcma. Infufion for the Palfy. Take of horfe-radifli root fliaved, muftard feed bruifed, each four ounces. Infufe them in two quaxts cf boiling water, in a clofe veffel, for twenty-four hours. In paralytic complaints, a tea-cupful cf this warm ftimu- lating medicine may be taken three or four times a-day. It excites the action of the folids, proves diuretic, and, if the patient be kept waim, promotes perfpiration. If two or three ounces of the dried leaves of marfh-trefoil be ufed inftead cf the muftard, it will make the dnfrfctrbutic Vif'JlilU JULEPS. r. 683 ] JULEPS. ■ '' THE bafis of juleps is generally common water, or fome fimple diftilled water, with one-third or one-fourth its quantity of diftilled fpirituous water, and as much fugar or fyrup as is fufficient to render the mixture agreeable. This is fharpened 'with vegetable or mineral acids, or impregnated with other medicines fuitable to the intention. ■ - • ■>!;>•,;■ Expeilorating Julep, Take of the emulfion of gum ammoniac, fix ounces $ fyrup of fquills, two ounces. Mix them. : In< coughs, afthmas, and obftructions of the breaft, two table-fpoonfulls of this julep -ttatj be taken every three or four hours. Mucilaginous Vitriolic Julep. Take of powdered gum arabic, two ounces; water, eight ounces ; elisir.pf vitriol and fugar, each half an ounce. Mx them together. A fable-fpoonfull may be taken for a dofe four or five times a-day, in catarrh and cough, with much expecto- rafion. Mufk Jukp. Rub half a drachm of mufk well together, with half an ounce of fugar and gum arabic ; and add to it, gradually, of GrBple cinnamon or-peppermint-water, four ounres. In the low ftate of nervous fevers, hiccupping, gout in the ftomach, convulfions, and other fpafmodic affections, two ta- ble-fpoonfulls of this julep may be taken every two or three hours. SaTtne Julep. Diffolve.'twodrachms of fait of tartar in three ounces of frefh lemon-juice, ftrained ; when .the effervefcence is over, add, of mint-water, and common water, each two ounces. This remover, ficknefs at the ftomach, relieves vomiting, promotes perfpiration, and may be of fome fervice in fevers, efpecially in thofe of the inflammatory kind. Vomiting Julep. ' y Diffolve four grains' of emetic tartar in eight ounces of wit- ter. - • Z z 2 In 684 APPENDIX. In the beginning of fevers, where there is no topical in- flammation, this julep may be given in the dofe of one table- ipoonfull every quarter of an hour till it operates. Antimonial vomits ferve not only to evacuate the contents of the ftomach, but likewife to promote the different excretions. Hence they are found in fevers to have nearly the fame effects as Dr, James's Powder. MIXTURES. A mixture differs from a julep in. this refpect, that it re- ceives into its compofition not only falts, extracts, and other fubftances diffoluble in water, but alfo earths, powders, and fuch fubftances as cannot be diffolved. A mixture is feldom either an elegant or agreeable medicine. It is nevertlielefs ne- ceffary. Many perfons can take a mixture, who are not able to fwallow a bolus or an electuary : befides, there are medicines w hich act better in this than in any other form. Anodyne Mixture. Take of liquid laudanum, thirty drops ; water, one ounce; fugar, half a drachm. Mix them togeiher. Aftringent Mixture. Take fimple cinnamon-water and common water, of each three ounces ; Japonic confection, half an ounce. Mix them. In dyfenteries which are not of long ftanding, after the neceffary evacuations, a fpoonfull or "two of this mixture may be taken"every four hours, interpofing every fecond or third day a dofe of rhubarb. Camphor Mixture. Take of camphor reduced to a powder by rubbing with a few drops of brandy, one drachm j powdered myrrh, ten grains; rub them well together, and add gradually four ounces of water. The dofe is a table-fpoonfull, to be repeated every two hours in cafes of delirium in fever, or violent colics. Diuretic Mixture. Take of mint-water, five ounces; vinegar of fquills, fix drachms ; fweet fpirit of nitre, half an ounce. Mix them. In obftructions of the urinary paffages, two fpoonfulls of this n.Lture may be taken twice or thrice a-day. Guaiacum MIXTURES. 6i$ Guaiacum Mixture. Take of gum guaiacum, finely powdered, two drachms; gum arabic, loaf fugar, powdered, each two drachms ; pow- dered liqtiorice-bal], half a drachm. Mix them well together, and add gradually four ounces of water. The dofe is a table-fpoonfull two or three times a-day, in thofe cafes of rheumatifm where moft inflammation prevails. Laxative Abforbent Mixture. Rub one drachm of magnefia alba in a mortar with ten or twelve gr£ins of the beft Turkey rhubarb, and add to them three ounces of common water; fimple mint-water, one ounce ; fugar, two drachms. As moft difeafes of infants are accompanied with acidities, this mixture may either be given with a view to correct thefe, or to open the body. A table-fpoonfull may be taken for a dofe, and repeated three times a-day. Where the pain is very fevere, from twenty to thirty drops of laudanum may be added to the mixture. To a very young child, half a fpoOn- full will be fufficient. When the mixture is intended to purge, the dofe may either be increafed, or the quantity of rhubarb doubled. This is one of the moft generally ufeful medicines for chil- dren with which I am acquainted. Paregoric Mixture. Take of paregoric elixir, one ounce; antimonial wine, half an ounce ; mucilage of gum arabic, liquorice-ball, each half an ounce ; water, eight ounce;. Mix them together. The dofe is a table-fpoonfull, to be repeated every three or four hours if neceffary, in cafes of catarrh and pleurify, where the cough is troublefome. Saline Mixture. Diffolve a drachm of the fait of tartar in four ounces of boiling water ; and, when cold, drop into it fpirit of vitriol till the eflFervefcence ceafes ; then add, of peppermint-water, two ounces, fimple fyrup, one oui.ce. Where frefh lemons cannot be had, this mixture may occafi- onally ftipply the place of the faline julep. Squill Mixture. Take of fimple cinnamon-water, five ounces; vinegar of fquills, one ounce; fyrup of roarfhmaHews, an ounce and a half. Mix them. This 6%6 APPENDIX^ This mixture, by promoting expectoration, and the fecretion cf urine, proves ferviceable in afthmatic and dropfical habits. A table-fpoonfull of it may be taken frequently. OINTMENTS, LINIMENTS, AND CERATES. Notwithstanding the extravagant encomiums which have been beftowed on different preparations of this kind, with re- gard to their efficacy in the cure of wounds, fores, Sic. it is be- yond a doubt, that the moft proper application to a frefh wound is dry lint. But though ointments, do not heal wounds and fores, yet they fervt. to defend them from the external air, and to retain fuch fubftances as may be neceffary for drying, de- terging, deftroying proud flefh, and fuch like. For thefe pur- pofes, however, it will be fufficient to infert only a few of the moft fimple forms, as ingredients of a more active nature can occafionally be added to them. Yellow Bafilicum Ointment. Take of yellow wax, four ounces; white refin, ten ounces; melt them together over a gentle fire'-; then add, of hog*s Jard, prepared, one pound. Strain the ointment while warm. This ointment is employed for cleanfing and healing wounds and ulcers. Ointment of Calamine. Take of olive oil, a pint and a half; white wax, and cala- mine fto-r»e, levigated, of each half a pound. Let the calamine ftone, reduced into a fine powder, be rubbed with fome part of the oil, and afterwards added to the reft of the oil and wax, previoufly melted together, continually ftirring them till quite cold. This ointment, which is commonly known by the name of Tun r-s Cerate, h an exceeding good application in burns and excoriations from whatever caufe. Ciirine Ointment. Take of purified quickfilver, one ounce ; fpirit of nitre, two ounces'} hog's lard, one pound. Diffolve the quickfilver in the acid, in a gentle heat, and while it is warm, ftir into it,-gra- dually, the hogls lard which has been melted, and cooled fo much as juft-. to be growing thick. Eye Ointment. Take of hog's lard', prepaTed,Tour ounces ; white wax, two drachms; tatty* prepared, one ounce; melt the wax with the OINTMENTS, &c. ^87 the lard over a gentle fire, and then fprinkle in the tutty, continually ftirring them till the ointment is cold. This ointment will be more efficacious, and cf a better confidence, if two or three drachms of camphor be rubbed up with a little oil, arid intimately mixed with it. Another. Take of camphor, and calamine ftone, levigated, each fix drachms ; verdegrife well prepared, two drachms; bog's lard, and muttcn fuet, prepared, of each two ounces. Rub the cam- phor well with the powder; a' terwards mix in the lard and fuet, continuing the^triture till they be perfectly united. This ointment has been long in efteem for difeafes of the eyes. It ought, however, tq be ufed with caution, when the eyes are much inflamed or very tender. 8rIt Is indeed, as well as the preceding one, more proper to anoint the edges of the eye-lids with when they are fore. ljfue Ointment. ■..,•-• Mix half an ounce of Spanifh flic, finely powdered, in fix ounces of yellow bafilicum ointment. . This ointment is ehiefly intended for dreffing blifters, in order to keep them open duriag pleafure. Ointment of Lead. Take of olive oil, half a pint; white wax, two ounces 5 fugar of iead, three drachms. Let the fugar of lead, re- duced into a fine powder, be rubbed up with fome part of the oil, and afterwards added to the other ingredients, pre- .vioufly melted together, continually ftirring them till quite cold. ^ This cooling and gently aftringent cintmes&tr-irrra-y be ufed in all cafes* where the intention is to dry and fkin over t!$e part, as in fcalding, &c. at*. Goulard's- Ointment or Cerate. Take of, yellow wax, four ounces; olive' oil, one pound. Melt them together, and when cooling, gradually mix, by beating with a wooden fpatula, four ounces of extract of feturn diffolved in half a pint of rain water. This cerate is very ufeful for burns, cr any kind of ul- cers attended with much heat and pain. Meratrial Ointment. Take of quickfilver, two ounces ; -hog*s lard, three ounces; autton fuet, cne ounce. Rub the quickfilver with an ounce of 68 o APPENDIX. of the hog's lard in a warm mortar, till the.globules be per- fectly extinguifhed; then rub it up with the reft of the lard and fuet, previoufly melted together. The principal intention of this ointment is to convey mer- cury into the body by being rubbed upon the fkin. Ointment of Sulphur. Take of hog's lard, prepared, four ounces ; flowers of ful- phur, an ounce and a half; crude fal ammoniac, two drachms ; eflcnce of lemon, ten or twelve drops. Make them into an ointment. This ointment, rubbed upon the parts affected, will gene- rally cure the itch. It is both the fafeft and beft application for that purpofe, and, when made in this way, has no dif- agreeable fmell. White Ointment. Take of olive oil, one pint, white wax and fpermaceti, of each three ounces. Melt them with a gentle heat, and keep them conftantly and brifky ftirring together, till quite cold. If two drachms of camphor, previoufly rubbed with a fmall quantity of oil, be added to the above, it will make the White Camphorated Oinlment.. Liniment for Burns. Take equal parts of Florence oil, or frefh drawji linfeed oil, and lime-water; Pnake them well together in a wide mouthed bottle, fo as to form a liniment. This is found to be a very proper application for recent fcalds or burns. It may either be fpread upon a cloth, or the parts affected may be anointed with it twice or thrice a-day. White Liniment. This is made in the fame manner as the white ointment, two thirds of the wax beirg left out. This liniment may be applied in cafes of excoriation, where, on account of the largenefs of the furface, the oint- ments with lead or calamine might be improper. Liniment for the Piles. Take of-white ointment, two ounces; liquid laudanum, half an ounce. Mix thefe ingredients with the yolk of an egg, and work them w„>U together. i IWatilc PILLS. 6Bg Volatile Liniment. Take of olive oil, an ounce; fpirit of hartfhorn, half an ounce. Shake them together. This liniment, made with equal parts of the fpirit and oil, will be more efficacious, where the patient's fkin is able to bear it. Sir John Pringle obferves, that in the inflammatory quinfey, a piece of flannel, moiftened with this liniment, and applied to the throat, to be renewed every four or five hours, is one of the moft efficacious remedies; and that it feldom fails, after bleed- ing, either to leffen or carry off the complaint. The truth of this obfervation I have often experienced. Camphorated Oil. Rub an ounce of camphor, with two ounces of olive oil, in a mortar, till the camphor be entirely diffolved. This antiipafmodic liniment may be ufed in obftinate rheu- matifms, and in fome other cafes accompanied with extreme pain and tenfion of the parts. PILLS. MEDICINES which operate in a fmall dofe, and whofe difagreeable tafte, or fmell, makes it neceffary that they fhould be concealed from the palate, are moft commodioufty exhibited in this form. No medicine, however, that is intended to ope- rate very quickly, ought to be made into pills, as they often lie for a confiderable time on the ftomach before they are dif- folved, fo as to produce any effect. As the ingredients which enter the compofition of pills are generally fo contrived, that one pill of an ordinary fize may contain1 about five grains of the compound, in mentioning the dofe we fhall only fpecify the number of pills to be taken; as one, two, three, &c. Compofing Pill. Take of purified opium, ten grains; Caftile foap, half a drachm. Beat them together, and form the whole into twenty pills. When a quieting draught will not fit upon the ftomach, one, two, or three of thefe pills may be taken, as occafion re- quires. , 3 A Foetid APPENDIX. 65)0 Foetid Pill. Take of afafcetida, an ounce; Caftile foap, half an ounce; add as much water as is neceffary to form it into pills. In hyfteric complaints, four or five pills, of an ordinary fize, may be taken twice or thrice a-day. They are likewife often cf fervice to perfons afllidled with the afthma. When it is neceffary to keep the bedy open, a proper quan- tity of rhubarb, aloes, or jalap, may occafionally be added to the above mafs. Hemlock Pill. Take any quantity of the extract of hemlock, and adding to it about a fifth part its weight of the powder of the dried leaves, form it into pills of the ordinary fize. The extract ot hemlock may be taken from one grain to Oweral dr.ichms in the day. The beft method, however, of ufing thefe pills, is to begin with one or two, and to increafe the dofe gradually, as far as the patient can bear them, with- out any remarkable degree of ftupor or giddinefs. Mercurial Pill. Take of purified quickfilver and honey, each half an ounce. Rub them together in a mortar, till the globules of mercury are perfectly extingOfhed; then add, of Caftile foap, two drachms; powdered liquorice or crumb of bread, a fufficient quantity to give the mafs a proper confiftence for pills. When ftronger mercurial pills are wanted, the quantity of quickfilver may be doubled. The dofe of thefe pills is different, according to the inten- tion with which they are given. As an alterant, two or three may be taken daily. To raife a falivation, four or five will be neceffary. Equal parts of the above pill and powdered rhubarb" made into a' mafs, with a fufficient quantity of fimple fyrup, will make a Mercurial purring Pill. Mercurial Sublimate Pill. Diffolve fifteen grains of the corrofive fublimate of mercury in two drachms of the faturated folution of crude fal ammo- niac, and make it into a pafte, in a glafs mortar, with a fuffi- cient quantity of the crumb of bread. This mafs muft be formed into one hundred and twenty pills. This pill, which is the moft agreeable form of exhibiting the fublimate, has been fo und efficacious, not only in curing the PILLS. 691 the venereal difeafe, but alfo in killing and expelling worms, after other powerful medicines had failed*. For the venereal difeafe, four of thefe pills may be taken twice a-day, as an alterant three, and for worms two. _^ Opium Pill. Take of opium, Caftile foap, each one fcruple; beat them together in an iron mortar, and make them into twenty pills. Plummer's Pill. Take of calomel, or fweet mercury, and precipitated ful- phur of antimony, each three drachms; extract of liquorice, two drachms. Rub the fulphur and mercury well together; afterwards add the extract, and, with a fufficient quantity of the mucilage of gum arabic, make them into pills. This pill has been found a powerful, yet fafe, alterative in obftinate cutaneous diforders; and has completed a cure after falivation had failed. In venereal cafes it has likewife produced excellent effects. Two or three pills of an ordinary fize may be taken night and morning, the patient keeping moderately warm, and drinking after each dofe a draught of decoction of the woods, or of farfaparilla. Calomel Pill. Take of calomel, one drachm; powdered opium fix grains ; Caftile foap, two feruples; add a fufficient quantity of waur to make fixty pills. The dofe is one pill night and morning. Purging Pills. Take of focotorine aloes, and Caftile foap, each two drachms; of fimple fyrup, a fufficient quantity to make them into pills. Four or five of thefe pills will generally prove a fufficient purgfe. For keeping the body gently open, one may be taken night and morning. They are reckoned both deobftruent and ftomachie, and will be found to anfwer ail the purpofes of Dr. Anderfon's pills, the principal ingredient of whicii is aloes. Where aloetic purges are improper, the following pills may be ufed: Take extract of jalap, and vitriolated tartar, of each two drachms; fyrup of ginger, as much as will m.ik2 them of a proper confiftence fur pills. * See a paper on this fubject ia the EcliOurgli PO-fical and Lirenry EJTiyg, by the ingenious t)r John Gardener. 3 A 2 Tiefe 6p2 APPENDIX. Thefe pills may be taken in the fame quantity as the above. Pill for the Jaundice. Take of Caftile foap, focotorine aloes, and rhubarb, of each one drachm. Make them into pills with a fufficient quan- tity of fyrup or mucilage. Thefe pills, as their title expreffes, are chiefly intended for the jaundice, which, with the affiftance of proper diet, they ieill often cure. Five or fix of them may be taken twice a-day, more or lefs, as is neceffary to keep the body open. Stomachic Pill. Take extract of gentian, two drachms; powdered rhubarb and vitriolated tartar, of each one drachm; oil of mint, thirty drops ; fimple fyrup, a fufficient quantity. Three or four of thefe pills may be taken twice a-day, for invigorating the ftomach, and keeping the body gently open. Squill Pills. Take powder of dried fquills, a drachm and a half; gum ammoniac, and cardamom feeds, in powder, of each three drachms; fimple fyrup, a fufficient quantity. In dropficaland afthmatic complaints, two or three of thefe pills may be taken twice a-day, or oftener, if the ftomach will bear them. Strengthening Pill. Take foft extraft of the bark, and fait of fteel, each a drachm. Make into pills. In diforders arifing from exceffive debility, or relaxation of the folids, as the chlorofs, or green ficknefs, two of thefe pills may be taken three times a-day. PLASTERS. Plasters ought to be of a different confiftence, according to the purpofes for which they are intended. Such as are to be applied to the breaft or ftomach ought to be foft and yield- ing; while thofe defigned for the limbs fhould be firm and ad- hefive. Jt has been fuppofed, that plafters might be impregnated with the virtues of different vegetables, by boiling the recent vegetable with the oil employed for the compofition of the plafter; but this treatment does not communicate to the oils any valuable qualities. The PLASTERS. 693 The calces of lead boiled with oils unite with them into a plafter of a proper confiftence, which make the bafis of feveral other plafters. In boiling thefe compofitions, a quantity of hot water muft be added from time to time to prevent the plafter from burning or growing black. This, however, fhould be done with care, left it caufe the matter to explode. Common Plafter. Take of common olive oil, fix pints; litharge reduced to a fine powder, two pounds and a half. Boil the litharge and oil together over a gentle fire, continually ftirring them, and keeping always about half a gallon of water in the veffel: after they have boiled about three hours, a little of the plafter may be taken out and put into cold water, to try if it be of a proper confiftence: when that is the cafe, the whole may be fuffered to cool, and the water well preffed out of it with the hands. This plafter is generally applied in flight wounds and excoriations of the fkin. It keeps the part foft and warm, and defends it from the air, which is all that is neceffary in fuch cafes. Its principal ufe, however, is to ferve as a bafis for other plafters. Adhefive Plafter. Take of common plafter, half a pound; of Burgundy pitch, a quarter of. a pound. Melt them together. This plafter is principally ufed for keeping on other dreffings. Anodyne Plafter. Melt an ounce of adhefive plafter, and, when it is cooling, mix with it a drachm of powdered opium, and the fame quantity of camphor, previoufly rubbed up with a little oil. This plafter generally gives eafe in acute pains, efpecially of the nervous kind.' Bliftering Plafter. Take of Venice turpentine, fix ounces; yellow wax, two ounces; Spanifti flies in fine powder, three ounces; powdered muftard, one ounce. Melt the wax, and while it is warm, add to it the turpentine, taking care not to evaporate it by too much heat. After the turpentine and wax are fufficiently incorporated, fprinkle in the powders, continually ftirring the mafs till it be cold. Though G94 APPENDIX. Though this plafter is made in a variety of ways, one fel- dom meets with it of a proper confiftence. When compound- ed with oils and other greafy fubftances, its effects are blunted, and it is apt to run; while pitch and refin render it too hard and very inconvenient. When the bliftering plafter is not at hand, its place may be fupplied by mixing with any foft ointment a fufficient quantity of powdered flies; or by forming them into a pafte with flour and vinegar, or what is- ftill better by firft fpread- ing yellow balilicon ointment on leather, and then covering it entirely with Spanifh flies, finely powdered. Gum Plafter. Take of the common plafter, four pounds; gum ammo- niac and galbanum, ftrained, of each half a pound. Melt them together, and add, of Venice turpentine, fix ounces. This plafter is ufed as a digeftive, and likewife for difcuf- fing indolent tumours. Mercurial Plafter. Take of common plafter, one pound; of gum ammoniac, ftrained, half a pound. Melt them together, and, when cooling, add eight ounces of quickfilver, previoufly extin- guifhed by triture, with three ounces of hog's lard. This plafter is recommended in pains of the limbs arifing from a venereal caufe. Indurations of the glands, and other violent tumours, are likewife found fometimes to yield to it. Stomach Plafter. Take of gum plafter, half a pound; camphorated oil, an ounce and a half; black pepper, or capficum, where it can be had, one ounce. Melt the plafter, and mix with it the oil; then fprinkle in the pepper, previoufly reduced to a fine powder. An ounce or two of this plafter, fpread upon foft leather, and applied to the region of the ftomach, will be of fervice in flatulencies arifing from hyfteric and hypochondriac affec- tions. A little of the expreffed oil of mace, or a few drops of the effential oil of mint, may be rubbed upon it before it is applied. This may fupply the place of the Antihyjleric Plajler. Warm Plafter. Take of gum plafter, one ounce; bliftering plafter, two drachms. Melt them together over a gentle fire. This POWDERS. 60s This plafter is ufeful in the fciatica and other fixed pains of the rheumatic kind: it ought, however, to be worn for fome time, and to be renewed, at leaft, once a-week. If this is found to blifter the part, which is fometimes the cafe, it muft be made with a fmaller proportion of the bliftering plafter. Wax Plafter. Take of yellow wax, one pound; white refin, half a pound; mutton fuet, three quarters of a pound. Melt them together. This is generally ufed inftead of the Melilot Plafter. It is a proper application after blifters, and in other cafes where a gentle digeftive is neceffary. POWDERS. THIS is one of the moft fimple forms in which medicine can be adminiftered. Many medicinal fubftances, however, cannot be reduced into powder, and others are too difagree- able to be taken in this form. The lighter powders may be mixed in any agreeable thin liquor, as tea or water gruel. The heavier ones will require a more confiftent vehicle, as fyrup, conferve, jelly, or honey. Gums, and other fubftances which are difficult to powder, fhould be pounded along with the drier ones; but thofe which are too dry, efpecially aromatics, ought to be fprinkled during their pulverization with a few drops of any proper water. Aromatic powders are to be prepared only in fmall quan- tities at a time, and kept in glafs veffels clofely ftopped. In- deed, no powders ought to be expofed to the air or kept too long, otherwife their virtues will be in great meafure de- ftroyed. Arfenic Powder. Take of white arfenic powdered, five grains ; Peruvian bark, powdered, one drachm and an half. Mix them well toge- ther. Aftringent Powder. ..^ Take of alum and Japan earth, each two drachms. Pound them together, and divide the whole into ten or twelve dofes. In 696 APPENDIX. In an immoderate flow of the menfes, and other haemor- rhages, one of thefe powders may be taken every hour, or every half-hour, if the difcharge be violent. Powder of Bole. Take of armenian bole, or French bole, two ounces; cin- namon, one ounce; tormentil root and gum arabic, of each fix drachms; long pepper, one drachm. Let all thefe in- gredients be reduced into a powder. This warm, glutinous aftringent powder, is given in fluxes, and other diforders where mfedicines of that clafs are necef- fary, in the dofe of a fcruple, or half a drachm. If a drachm of opium be added, it will make the Powder of Bole with Opium, which is a medicine of confiderable efficacy. It may be taken in the fame quantity as the former, but not above twice or thrice a-day. Carminative Powder. Take of coriander-feed, half an ounce; ginger, one drachm ; nutmegs, half a drachm; fine fugar, a drachm and a half. Reduce them into powder for twelve dofes. This powder is employed for expelling flatulencies arifing from indigeftion, particularly thofe to which hyfteric and hy- pochondriac perfons are fo liable. It may likewife be given in fmall quantities to children in their food, when troubled with gripes. Diuretic Powder. Take of gum arabic, four ounces; purified nitre, one ounce. Pound them together, and divide the whole into twenty-four dofes. ' During the firft ftage of the virulent gonorrhoea, one of thefe cooling powders may be taken three times a-day, with confiderable advantage. Aromatic Opening Powder. Take of the beft Turkey rhubarb, cinnamon, and fine fugar, each two drachms. Let the ingredients be pounded, and afterwards mixed well together. Where flatulency is accompanied with coftivenefs, a tea- fpoonfull of this powder may be taken once or twice a-day, according to circumftances. 1 Mercurial POWDERS. 697 Mercurial Powder. Take of magnefia alba, one fcruple ; calomel eight grains ; powdered ipecacuanha, fix grains. - Make them into eight powders. To take a powder every morning, in inoculation for the fmall-pox, eruptions, and fore eyes. Nitrous Powders. Take of nitre, one fcruple; emetic tartar, one fixth of a grain. Make a powder. To be ufed in moft feverifh complaints. Saline Laxative Powder. Take of foluble tartar, and cream of tartar, each one drachm; purified nitre, half a drachm. Make them into a powder. In fevers, and other inflammatory diforders, where it is neceffary to keep the body gently open, one of thefe cooling •Jaxative powders may be taken in a little gruel, and repeated occafionally. Steel Powder. ' Take filings of fteel, and loaf fugar, of each two ounces; ginger, two drachms. Pound them together. In obftructions of the menfes, and other cafes where fteel is proper, a tea-fpoonful of this powder may be taken twice a-day, and wafhed down with a little wine or water. Sudorific Powder. Take purified nitre and vitriolated tartar, of each half an ounce; opium and ipecacuanha, of each one drachm. Mix the ingredients, and reduce them to a fine powder. This is generally known by the name of Dover's Powder. lt%. a powerful fudorific. In obftinate rheumatifms, and other cafes where it is neceffary to excite a copious fweat, this powder may be adminiftered in the dofe of a fcruple or half a drachm. Some patients will require two feruples. It ought to be accompanied with the plentiful ufe of fome warm dilu- ting liquor. Worm Powders. Take of fait of fteel reduced into a fine powder, half a drachm ; prepared fteel, two drachms. Mix them well toge- ther, and divide the whole into fix dofes. 3 B One-*, 608 A P P E N D I X. One of thefe powders may be taken in a little fyrup, ho- ney, or treacle, twice a-day After they have been all ufed, the following anthelmintic purge may be proper. Purging Worm-Powder. Take of powdered rhubarb, a fcruple; fcammony and ca- lomel, of each five grains. Rub them together in a mortar for one dofe. For children the above dofes muft be leffened according to their age. Powder for the Tape-Worm. Early in the morning the patient is to take in any liquid, two or three drachms, according to his age and conftitution, of the root of the male fern reduced into a fine powder. About two hours afterwards, he is to take of calomel and refin of fcammony, each ten grains; gum gamboge, fix grains. Thefe ingredients muft be finely powdered and given in a little fyrup, honey, treacle, or any thing that is moft agreeable to the patient. He is then to walk gently about, now and then drinking a difh of weak green tea, till the worm is paffed. If the powder of the fern produces naufea, or ficknefs, it may be removed by fucking the juice of an orange or lemon. This medicine, which had been long kept a fecret abroad for the cure of the tape-worm, was fome time ago purchafed by the French King, and made public for the benefit of man- kind. Not having had an opportunity of trying it, I can fay nothing from experience concerning its efficacy. It feems, however, from its ingredients, to be an active medicine, and ought to be taken with care. The dofe here prefcribed is fufficient for the ftrongeft patient; it muft, therefore, be re- duced according to the age and conftitution. SYRUPS.' SYRUPS were fome time ago looked upon as medicines of confiderable value. They are at prefent, however, regard- ed chiefly as vehicles for medicines of greater efficacy, and are ufed for fweetening draughts, juleps, or mixtures; and for reducing the lighter powders into bolufes, pills, and elec- tuaries. As all thefe purpofes may be anfwered by the fimple fjrup alone, there is little occafion for any other; efpecially as TINCTURES, ELIXIRS, fcrV. 699 as they are feldom found but in a ftate of fermentation ; and as the dofe of any medicine given in this form is very uncer- tain. Perfons who ferve the public muft keep whatever their cuftomers call for; but to the private practitioner nine-tenths of the fyrups ufually kept in the lhops are unneceffary. Simple Syrup. Is made by diffolving in water, either with or without heat, about double its weight of fine fugar. If twenty-five drops of laudanum be added to an ounce of the fimple fyrup, it will fupply the place of diacodium, or the fyrup of poppies, and will be found a more fafe and cer- tain medicine. The lubricating virtues of the fyrup of marfhmallows may likewife be fupplied, by adding to the common fyrup a fuffi- cient quantity of mucilage of gum arabic. Thofe who choofe to preferve the juice of lemons in form of fyrup, may diffolve in it, by the heat of a warm bath, nearly double its weight of fine fugar. The juice ought to be previoufly ftrained, and fuffered to ftand till it fettles. The fyrup of ginger is fometimes of ufe as a warm vehicle for giving medicines to perfons afflicted with flatulency. It may be ufed by infufing two ounces of bruifed ginger in two pints of boiling water for twenty-four hours. After the li- quor has been ftrained, and has flood to fettle for fome time, it may be poured off, and a little more than double its weight of fine powdered fugar diffolved in It. TINCTURES, ELIXIRS, &c. RECTIFIED fpirit is the direft menftruum of the refins and effential oils of vegetables, and totally extracts thefe active principles from fundry fubftances, which yield them to water, either not at all, or only in part. It diffolves likewife thofe parts of animal fubftances in which their peculiar fmells and taftes refide. Hence the tinctures prepared with rectified fpirits form an ufeful and elegant clafs of medicines, poffeffing many of the moft ef- fential virtues of fimples, without being clogged with their inert or ufelefs parts. Water, however, being the proper menftruum of the gummy, faline, and faccharine parts of medicinal fubftances, it will be neceffary, in the preparation of feveral tinctures, to 3 B 2 make 7oe APPENDIX.11 make ufe of a weak fpirit, or a compofition of rectified fpirit and water, and, of courfe, good brandy will be found fufficiently ftrong for every purpofe. Aromatic Tinclure. Infufe two ounces of Jamaica pepper in two pints of brandy for a few days.; then ftrain off the tincture. This fimple tincture will fufficiently anfwer all the inten- tions of the more coftly preparations of this kind. It is ra. ther too hot to be taken by itfelf; but it is very proper for mixing with fuch medicines as might otherwife prove too cold for the ftomach. Tinclure of the Bark. Take of Peruvian bark, two ounces. Let the bark be grofsly powdered, and infufed in a pint of brandy, for eight or ten days, in a clofe veffel; afterwards ftrain off the tincture. This tincture is not only beneficial in intermitting fevers, but alfo in the flow, nervous, and putrid kinds, efpecially towards their decline. The dofe is from one drachm to three or four, every fifth or fixth hour. It may be given in any fuitable liquor, and occafionally fharpened with a few drops of the fpirit of vitriol, Tinclure of Cinnamon. Take of cinnamon or caffia bark grofsly powdered, two ounces; brandy, one pint. Digeft for eight or ten days. This is an elegant tincture, and very proper to mix with ftomachie medicines. Foetid Tinclure. Infufe two ounces of afafcetida in one pint of brandy, for eight days, in a clofe bottle, frequently, making it; then ftrain the tincture. This medicine is beneficial in hyfteric diforders, efpecially when attended with lownefs of fpirits, and faintings. A tea- fpoonfull of it may be taken in a glafs of water every two or three hours. Tinclure of Gum Guaiacum. Take of gum guaiacum, two ounces; brandy, a pint. In- fufe in a veffel well ftopped, for eight or ten days; then ftrain off the tincture. In TINCTURES. 701 In rheumatic complaints, two tea-fpoonfulls of this tincture may be taken in a cup of water twice or thrice a-day. It may be made volatile, by adding four ounces of volatile fpirit. Tinclure of Black Hellebore. Infufe two ounces of the roots of black hellebore, bruifed, in a pint of brandy, for feven or eight days; then filter the tincture through paper. A fcruple of cochineal may be infufed along with the roots, to give the tincture a color. In obftrucrions of the menfes, a tea-fpoonfull of this tincture may be taken in a cup of camomile or penny-royal tea twice a-day. Aftringent Tinclure. Digeft two ounces of gum' kino, in a pint and a half of brandy, for eight days; afterwards ftrain it for ufe. This tincture is a good aftringent medicine. With this view two tea-fpoonfulls, or more of it may be taken three or four times a-day. Tinclure of Myrrh and Aloes. Take of gum myrrh, an ounce and a half; hepatic aloes, one ounce. Let them be reduced to a powder, and infufed in two pints of brandy, for fix days, in a gentle heat; then ftrain the tincture. This is principally ufed by furgeons for cleanfing foul ulcers, and reftraining the progrefs of gangrenes. It is alfo, by fome, though improperly, recommended as a proper application to frefh wounds. Tinclure of Opium, or Liquid Laudanum. Take of crude opium, two ounces; brandy, a pint. Dif- folve the opium fliced, in the brandy, with a gentle heat, fre- quently fhaking it; and ftrain off the tincture. The common dofe may be from twenty to thirty drops. Tinclure of Aloes. Take of focotorine aloes in powder, one ounce; Virginian fnake-root and ginger, of each two drachms. Infufe in a pint of brandy, for a week, frequently fhaking the bottle, then ftrain off the tincture. This is a fafe and ufeful purge for perfons of a languid and phlegmatic habit; but is thought to have better effects, taken in fmall dofes as a laxative. The 7oa APPENDIX. The dofe, as a purge, is from two drachms to half an ounce. Compound Tinclure of Senna. Take of fenna, one ounce; jalap, coriander feeds, and cream of tartar, of each half an ounce. Infufe them in a pint and a half of French brandy for a week; then ftrain the tincture, and add to it four ounces of fine fugar. This is an agreeable purge, and anfwers all the purpofes of the Elixir falutis, and of Enfy's Elixir. The dofe is from one t: two or three ounces. Tincture of Spanifh Flies. Take of Spanifh flies, reduced to a fine powder, two ounces; brandy, one pint. Infufe for two or three days; then ftrain off the tincture. This is intended as an acrid ftimulant for external ufe. Parts affefted with the palfy or chronic rheumatifm may be fre- quently rubbed with it. Tinclure of Rhubarb. Take of rhubarb, two ounces and a half; leffer cardamom feeds, half an ounce; brandy, two pints. Digeft for a week, and ftrain the tincture. Thofe who chufe to have a vinous tincture of rhubarb, may infufe the above ingredients in a bottle of Lifbon wine, adding to it about two ounces of brandy. If half an ounce of gentian root, and a drachm of Virgi- nian fnake-root be added to the above ingredients, it will make the bitter tincture of rhubarb. All thefe tinctures are defigned as ftomachics and corrobo- rants as well as purgatives. In weaknefs of the ftomach, in- digeftion, laxity of the inteftines, fluxes, colicky and fuch like complaints, they are frequently of great fervice. The dofe is from half a table-fpoonfull to three or four table fpoonfulls or more, according to the circumftances of the patient, and the purpofes it is intended to anfwer. Paregoric Elixir. Take of flowers of benzoin, half an ounce; camphor and opium, each two drachms. Infufe in one pint of brandy, for eight or ten days, frequently fhaking the bottle; afterwards ftrain the elixir. This is an agreeable and fafe way of adminiftering opium. It eafcs pain, allays tickling coughs, relieves difficult breath- ing TINCTURES,^. 7o3 ing, and is ufeful in many diforders of children, particularly the whooping cough. The dofe to an adult is from fifty to a hundred drops. Sacred Elixir. Take of rhubarb cut fmall, ten drachms; focotorine aloes, in powder, fix drachms; leffer cardamom feeds, half an ounce; French brandy, two pints. Infufe for two or three days, and then ftrain the elixir. This'ufeful ftomachie purge may be taken from one ounce to an ounce and a half. Stomachic Elixir. Take of gentian root, two ounces; Curaffao oranges, one ounce; Virginian fnake-root, half an ounce. Let the ingre- dients be bruifed, and infufed for three or four days in two pints of French brandy ; afterwards ftrain out the elixir. This is an elegant ftomachie bitter. In flatulencies, indi- geftion, want of appetite, and fuch like complaints, a fmall glafs of it may be taken twice a-day. It likewife relieves the gout in the ftomach, when taken in a large dofe. Acid Elixir of Vitriol. Take of brandy, one pint; oil of vitriol, three ounces. Mix them gradually, and after the faeces have fubfided, filter the elixir through paper, in a glafs funnel. This is one of the beft medicines which I know for hyfteric and hypochondriac patients, afflicted with flatulencies arifing from relaxation or debility of the ftomach and inteftines. It will fucceed where the moft celebrated ftomachie bitters have no effect. The dofe is from ten to forty drops, in a glafs of water, fweetened with a little fugar fo as to make it palatable, twice or thrice a-day. It fhouid be taken when the ftomach is moft empty. Camphorated Spirit of Wine. Diffolve an ounce of camphor in a pint of fpirits or brandy. This folution is chiefly employed as an embrocation in bruifes, palfies, the chronic rheumatifm, and for preventing gangrenes. The above quantity of camphor, diffolved in half a pound of the volatile aromatic fpirit, makes Ward's Effence. Spirit of Mindererus. Take of volatile fal ammoniac, any quantity. Pour on it gradually ftrong vinegar, till the effervefcence ceafes. This 7o4 APPENDIX. This medicine is ufeful in promoting a difcharge both by the fkin and urinary paffages. It is alfo a good external appli- cation in ftrains and bruifes. When intended to raife a fweat, half an ounce of it in a cup of warm gruel, may be given to the patient in bed every hour till it has the defired effect. VINEGARS. VINEGAR is an acid produced from vinous liquors by a fecond fermentation. It is an ufeful medicine both in inflam- matory and putrid diforders. Its effects are, to cool the blood, quench thirft, counteract a tendency to putrefaction, and allay inordinate motions of the fyftem. It likewife promotes the natural fecretions, and in fome cafes excites a copious fweat, where the warm medicines, called alexipharmic, tend rather to prevent that falutary evacuation. Weaknefs, faintings, vomitings, and other hyfteric affec- tions, are often relieved by vinegar applied to the mouth and nofe, or received into the ftomach. It is of excellent ufe alfo in correcting many poifonous fubftances, when taken into the ftomach; and in promoting their expulfion, by the different emunctories, when received into the blood. Vinegar is not only an ufeful medicine, but ferves likewife to extract, in tolerable perfection, the virtues of feveral other medicinal fubftances. Moft of the odoriferous flowers impart to it their fragrance, together with a beautiful purplifh or red colour. It alfo affifts or coincides with the intention of fquills, garlic, gum ammoniac, and feveral other valuable mqdicines, Thefe effects, however, are not to be expected from every thing that is fold under the name of vinegar, but from fuch as is found and well prepared. The beft vinegars are thofe prepared from French wines. It is neceffary for fome purpofes that the vinegar be diftilled; but as this operation requires a particular chemical apparatus, we fhall not infert it. Vinegar of Litharge. Take of litharge, half a pound; ftrong vinegar, two pints. Infufe them together in a moderate heat for three days, fre-» quently fhaking the veffel; then filter the liquor for ufe. This medicine i3 little ufed, fiom a general notion of its being dangerous. There is no doubt, however, that the pre- parations of lead with vinegar are poffeffed of valuable proper- ties, and that they may be ufed in many cafes with fafety and fuccefs. i A pre- WATERS BY INFUSION, fcrV. 705 A preparation of a fimilar nature with the above has cf late been extolled by Goulard, a French furgeon, as a fafe and extenfively ufeful medicine, which he calls the ExtraS of Sa- turn, and orders to be made in the following manner : Take of litharge, one pound ; ftrong vinegar, two pints. Put them together into a glazed earthen pipkin, and let them boil, or rather fimmer, for an hour, or an hour and a quarter, taking care to ftir them all the while with a wooden fpatula. After the whole has flood to fettle, pour off the liquor which is upon the top into bottles for ufe. With this extract Goulard makes his vegeto-mineral water*, which he recommends in a great variety of external diforders, as inflammations, burns, bruifes, fprains, ulcers, &c. He likewife prepares with it a number of other forms of medicine, as poultices, plafters, ointments, powders, &c. Vinegar of Squills. Take of dried fquills, two ounces; diftilled vinegar, two pints. Infufe for ten days or a fortnight in a gentle degree of heat; afterwards ftrain off the liquor, and add to it about a twelfth part its quantity of proof fpirits. This medicine has good effects in diforders of the breaft, Occafioned by a load of vifcid phlegm. It is alfo of ufe in hydropic cafes for promoting a difcharge of urine. The dofe is from two drachms to two ounces, according to the intention for which it is given. When intended to act as a vomit, the dofe ought to be large. In other cafes, it muft not only be exhibited in fmall dofes, but alfo mixed with cinnamon-water, or fome other agreeable aromatic liquor, to prevent the naufea it might otherwife occafion. WATERS BY INFUSION, &c. Lime Water. POUR two gallons of water gradually upon a pound of frefh burnt quicklime; and when the ebullition ceafes, ftir them well together; then fuffer the whole to ftand at reft, that the lime may fettle, and afterwards decant the liquor which is to be kept in veffels clofely ftopt. The lime-water from calcined oyfter-fhells, is prepared in the fame manner. • See Collyrium of Lead- 3 C Lime- 706 APPENDIX. Lime-water is principally ufed for the gravel; in which cafe, from a pint to two or more of it may be drank daily. Externally it is ufed for wafhing foul ulcers, and removing the itch, and other difeafes of the fkin. Sublimate Water, or Solution. Diffolve eight grains of the corrofive fublimate, and half a drachm of crude fal ammoniac, in a pint of water. If a ftronger folution is wanted, a double or triple quantity of fublimate may be ufed. The weaker folution is ufed in the dofe of a table fpoonfull, morning and evening in lues, for adults; and from twenty to thirty, or forty drops in a little water for children. The ftronger folution is ufed for a wafh in fome obftinate eruptions and ulcers. Styptic Water. Take of blue vitriol and alum, each an ounce and a half; water, one pint. Boil them until the falts are diffolved, then filter the liquor, and add to it a drachm of the oil of vitriol. This water is ufed for flopping a bleeding at the nofe, and other haemorrhages; for which purpofe cloths or doffils dipt in it muft be applied to the part. Tar Water. Pour a gallon of water on two pounds of tar, and ftir them ftrongly together with a wooden rod: after they have ftood to fettle for two days, pour off the water for ufe. Though tar-water falls greatly fhort of the character which has been given of it, yet it poffeffes fome medicinal virtues. It fenfibly raifes the pulfe, increafes the fecretions, and fome- times opens the body, or occafions vomiting. A pint of it may be drank daily, or more, if the ftomach can bear it. It is generally ordered to be taken on an empty ftomach, viz. four ounces morning and evening, and the fame quantity about two hours after breakfaft and dinner. SIMPLE DISTILLED WATERS. A great number of diftilled waters were formerly kept in the fhops, and are ftill retained in fome Difpenfatories. But we confider them chiefly in the light of grateful diluents, fuit- able vehicles for medicines of greater efficacy, or for render- ing SIMPLE DISTILLED WATERS. 707 ing difguftful ones more agreeable to the palate and ftomach. We fhall therefore infert only a few of thofe which are beft adapted to thefe intentions. The management of a ftill being now generally underftood, it is needlefs to fpend time in giving directions for that pur- pofe. All thefe waters may be imitated fufficiently well by dif- folving the effential oils in a little rectified fpirits; then adding a fmall quantity of loaf fugar, and a larger or imaller pro- portion of water, according to the ftrength we wifh the pre- paration to be. Cinnamon Water. Steep one pound of cinnamon bark, bruifed, in a gallon and a half of water, and one pint of brandy, for two days; and then diftil off one gallon. This is an agreeable aromatic water, poffeffing in a high de- gree the fragrance and cordial virtues of the fpice. Pennyroyal Water. Take of pennyroyal leaves, dried, a pound and a half; water, from a gallon and a half to two gallons, praw off by diftillation one gallon. This water poffefTes, in a confiderable degree, the fmell, tafte, and virtues of the plant. It is given in mixtures and juleps to hyfteric patients. An infufion of the herb in boiling water anfwers nearly the fame purpofes. Peppermint Water. This is made in the fame manner as the preceding. Spearmint Water. This may alfo be prepared in the fame way as the penny- royal water. Both thefe are ufeful ftomachie waters, and will fometimes relieve vomiting, efpecially when it proceeds from indigeftion, or cold vifcid phlegm. They are likewife ufeful in fome co- licky complaints, the gout in the ftomach, &c. particularly the peppermint water. An infufion of tiie frefh plant is frequently found to have the fimc effects as the diftilled water. 3 C 2 Rofe 7oS APPENDIX. Rofe Water. Take of rofes frefh gathered, fix pounds; water, two gal- lons. Diftil off one gallon. This water is principally valued on account of its fine fla- vour. Jamaica Pepper Water. Take of Jamaica pepper, half a pound; water, a gallon and a half. D'ftil off one gallon. This is a Very elegant diftilled water, and may in mod cafes . fupply the place of the more coftly fpice wateis. SPIRITUOUS DISTILLED WATERS. Spirituous Cinnamon Water. TAKE of cinnamon bark, one pound; proof fpirit, and common water, of each one gallon. Steep the cinnamon in the liquor for two days; then diftil off one gallon. Spirituous Jamaica Pepper Water. Take of Jamaica pepper, half a pound ; proof fpirit, three gallons ; water, two gallons. Diftil off three gallons. This is a fufficiently agreeable cordial, and may fupply the place of the Aromatic Water. WHEYS. Alum Whey. BOIL two drachms of powdered alum in a pint of milk tiH it is curdled ; then ftrain out the whey. This whey is beneficial in an immoderate flow of the tnenfes, and in a diabetes, or exceffive difcharge of urine. The dr fe is two, three, or four ounces, according as the ftomach will bear it, three times a-day. If it fliould occafion vomiting, it may be diluted. Muftard Whey. Take milk and water, of each a pint; bruifed muftard- feed, an ounce and a half. Boil them together till the curd is peifediy feparated; afterwards ftrain the whey through a cloth. This WINES. 7o9 This is the moft elegant, and by no means the leaft effica- cious method of exhibiting muftard. It warms and invigo- rates the habit, and promotes the different fecretions. Hence, in a low ftate of nervous fevers, it will often fupply the place of wine. It is alfo of ufe in the chronic rheumatifm, palfy, dropfy, &c. The addition of a little fugar will render it more agreeable. The dofe is an ordinary tea-cupfull four or five times a-day. Scorbutic Whey. This whey is made by boiling half a pint of the feorbutic juices in a quart of cow's milk. More benefit, however, is to be expected from eating the plants, than from their ex- preffed juices. The feorbutic plants are, bitter oranges, brooklime, garden fcurvy-grafs, and water-creffes. A number of other wheys may be prepared nearly in the fame manner, as orange whey, cream of tartar whey, &c. Thefe are cooling pleafant drinks in fevers, and may be ren- dered cordial, when neceffary, by the addition of wine. WINES. THE effects of wine are, to raife the pulfe, promote per- fpiration, warm the habit, and exhilarate the fpirits. The red wines, befides thefe effects, have an aftringent quality, by which they ftrengthen the tone of the ftomach and inteftines, and by this means prove ferviceable in reftraining immode- rate fecretions. The thin fharp wines have a different tendency. , They pafs off freely by the different emunctories, and gently open the body. The effects of the full bodied wines are, however, much more durable than thofe of the thinner. All fweet wines contain a glutinous fubftance, and do not pafs off freely. Hence they will heat the body more than an equal quantity of any other wine, though it fhould contain fully as much fpirit. From the obvious qualities of wine, it muft appear to be an excellent cordial medicine. Indeed, to fay the truth, it is worth all the reft put together. But to anfwer thi> character, it muft be found and good. No benefit is to be expected from the common trafh that is often fold by the name of wine, without poffeffing one drop of the juice of the grape. Perhaps no medicine is more rarely obtained genuine than wine. Wine 7io APPENDIX. Wine is not only ufed as a medicine, but is alfo employed as a menftruum for extracting the virtues of other medicinal fubftances ; for which it is not ill adapted, being a compound of water, inflammable fpirit, and acid; by which means it is enabled to act upon vegetable and animal fubftances, and alfo to diffolve fome bodies of the metallic kind, fo as to impregnate itfelf with their virtues, as fteel, antimony, &c. Antimonial Wine. Take glafs of antimony, reduced to a fine powder, half an ounce; Lifbon wine, fixteen ounces. Digeft, without heat, for three or four days, now and then fhaking the bottle; af- terwards filter the wine through paper. The dofe of this wine varies according to the intention. As an alterative and diaphoretic, it may be taken from ten to fifty or fixty drops. In a larger dofe it generally proves ca- thartic, or excites vomiting. Bitter Wine. Take of gentian root, yellow rind of lemon-peel, frefh, each one ounce; long pepper, two drachms ; Lifbon or Sher- ry wine, two pints, Infufe without heat for a week, and ftrain out the wine for ufe. In complaints arifing from weaknefs of the ftomach, or indigeftion, a glafs of this wine may be taken an hour before dinner and fupper. Ipecacuanha Wine. Take of ipecacuanha, in powder, one ounce; Lifbon wine, a pint. Infufe for three or four days ; then filter the tincture. This is a fafe vomit, and anfwers extremely well for fuch perfons as cannot fwallow the powder, or whofe ftomachs are too irritable to bear it. The dofe is from one ounce to an ounce and a half. Chalybeate or Steel Wine. Take filings of iron, two ounces; cinnamon two drachms ; Lifbon wine, two pint?. Infufe for three or four weeks, fre- quently fhaking the bottle; then pafs the wine through a filter. In WINES. 711 In obftructions of the menfes, this preparation of iroa may be taken, in the dofe of half a wine-glafs twice or thrice a-day. The medicine would probably be better if fharpened with half an ounce of the cream of tartar, or a fmall quantity of the vitriolic acid. Stomach Wine. Take of Peruvian bark, grofsly powdered, an ounce; car- damom feeds, and orange peel, bruifed, of each two drachms. Infufe in a bottle of Sherry or Lifbon wine for five or fix days; then ftrain off the wine. This wine is not only of fervice in debility of the ftomach and inteftines, but may alfo be taken as a preventative, by perfons liable to the intermittent fever, or who refide in places where this difeafe prevails. It will be of ufe likewife to thofe who recover flowly after fevers of any kind, as it affifts di- geftion, and helps to reftore the tone and vigour of the fyftem. A glafs of it may be taken two or three times a-day. A GLOS- C 7*2 3 A GLOSSARY. ALTHOUGH terms of art have been fedu- loufly avoided in the compofition of this treatife, it is impoffible entirely to banifh technical phrafes when writing on medicine, a fcience that has been lefs generally attended to by mankind, and continues therefore to be more infected with the jargon of the fchools, than perhaps any other. Several perfons have expreffed their opinion that a Gloffary would make this work more generally intelligible, the following concife explanation of the few terms of art that occur, has been added in compli- ance with their fentiments, and to fulfil the original intention of this treatife, by rendering it intelligible and ufeful to all ranks and claffes of mankind. A. Abdomen. The belly. Abforbents. Veffels that convey the nourifbment from the inteftines, and the fecreted fluids from -the various cavi- ties into the mafs of blood. Acrimony. Corrofive fharpnefs. Acute. A difeafe, the fymptoms of which are violent, and tend to a fpeedy termination, is called acute. Adult. Of mature age. Adufl. Dry, warm. Antifpafmodic. Whatever tends to prevent or remove fpafm. Aphtha. Small whitifh ulcers appearing in the mouth. Aftriaion. A tightening or leffening. Atrabilarian. An epithet commonly applied to people of a certain temperament, marked by a dark complexion, black hair, fpare habit, &c. which the ancients fuppofed to arife from the atra bills, or the black bile. i B. A GLOSSARY. B Bile, or Gall. A fluid which is fecreted by the liver into the gall-bladder, and from thence paffes into the inteftines, in order to promote digeftion. C Cacochymia. An unhealthy ftate of the body. Caries. A rottennefs of a bone. Chyle. A milky fluid feparated from the aliment in the in- teftines, and conveyed by the abforbents into the blood to fupply the wafte of the animal body. Chronic. A difeafe whofe progrefs is flow, in oppofition to acute. Circulation. The motion of the blood, which is driven by the heart through the arteries, and returns by the veins. Comatofe. Sleepy. Conglobate Gland. A fimple gland. Conglomerate. A compound gland. Contagion. Infectious matter. Cutis. The fkin. Cutaneous. Of or belonging to the fkin. Crifis. A certain period in the prcgrefs of a difeafe, from whence a decided alteration either for the better or the worfe takes place. Critical. Decifive or important. Critical Days. The fourth, fifth, feventh, ninth, eleventh, thirteenth, fourteenth, feventeenth, and' twenty-firft, are by fome authors denominated critical days, becaufe febrile complaints have been obferved to take a decifive change at thefe periods. D Debility. Weaknefs. Delirium. A temporary diforder of the mental faculties. Diaphragm. A membrane feparating the cavity of the cheft from that of the belly. Diuretic. A medicine that promotes the fecretion of urine. Draftic. Is applied to fuch purgative medicines as are violent or harfh in their operation. E Empyema. A collection of purulent matter in the cavity of the breaft. 3 D Endtmie. 7r4 A GLOSSARY. Endemic. A difeafe peculiar to a certain diftrict of country. Epidemic. A difeafe generally infectious. Exacerbation' The increafe of any difeafe, or rather the coming on of the paroxyfm or fit, as in an intermittent. F Faeces. Excrements. Foetid. Emitting an offenfive fmell. Fcetm. The child before birth, or when born before the proper period, is thus termed. Flatulent. Producing wind. Fungus. Proud flefh. G Gangrene. Mortification. Gummata. Ganglia. Gymnqflie. Exercife taken with a view to preferve or reftore health.—The ancient phyficians reckoned this an impor- tant branch of medicine. [■ Venereal excrefcences. H Heffic Fever. A flow confuming fever, generally attending a bad habit of body, or fome incurable and deep rooted difeafe. Haemorrhoids. The piles. Hemorrhage. Difcharge of blood. Hypochondriacifm. Low fpirits. Hypochondriac vifcera. The liver, fpleen, &c. fo termed from their fituation in the hypochondriac or upper and lateral parts of the belly. I Ichor. Thin bad matter. Impojlhume. A collection of purulent matter. Inflammation. A furcharge of blood, and an increafed action of the veffels, in any particular part of the body. L Ligature. Bandage. Lixivium. Ley. M Mefentery. A double membrane which connects the inteftines to the back bone. Miliary A GLOSSARY. 715 Miliary Eruption. Eruption of fmall puftules refembling the feeds of millet. Morbific. Caufing difeafe, or difeafed. Mucus. The matter difcharged from the nofe, lungs, &c. ... "V N. Nervous. Irritable. Naufea. At inclination to vomit. Nodes. Enlargements of the bones produced by the venereal difeafe. P. PeeJoral. Medicines adapted to cure difeafes of the breaft. Pelvis. The bones fituated at the lower part of the trunk; thus named from their refembling in fome meafure a bafon. Peritoneum. A membrane lining the cavity of the belly and covering the inteftines. Pericardium. Membrane containing the heart. Perfpiration. The matter difcharged from the pores of the fkin in form of vapor or fweat. Phlogifton. Is here ufed to fignify fomewhat rendering the air unfit for the purpofes of refpiration. Phlegmatic. Watery, relaxed. Plethoric. Replete with blood. Polypus. A difeafed excrefcence, or a fubftance formed of coagulable lymph, frequently found in the large blood veffels. Pus. Matter contained in a boil. R. Regimen. Regulation of diet. RecJum. The ftraight gut, in which the feces are contained- Refpiration The act of breathing. S. Saliva. The fluid fecreted by the glands of the mouth. Sanies. A thin bad matter, difcharged from an ill-conditioned fore. Schirrous. A ftate of difeafed hardnefs. Slough. A part feparated and thrown off by fuppuration. Spafm. A difeafed contraction. Spine. The back bone. Styptic. A medicine for flopping the difcharge of blood. 3 D 2 Syncope. yi6 A GLOSSARY. Syncope. A fainting fit attended with a complete abolition of fenfation and thought. T. Tabes. A fpecies of confumption. Temperament. A peculiar habit of body, of which there are generally reckoned four, viz. the fanguine, the bilious, the melancholic, and the phlegmatic. U. Vertigo. Giddinefs. Ulcer. An ill conditioned fore. Ureters. Two long and fmall canals which convey the urine from the kidneys to the bladder. Urethra. The canal which conveys the urine from the blad- der out of the body. INDEX. A ABLUTIONS, Jewifh, and Mahometan, well calculated for the prefervation of health, 105. Abortion, caufes and fymptoms of, 534. Means of prevention, 535. Proper treatment in the cafe of, 536. AbfefJ'es, how to be treated, $15. 575. Accidents. See Cafualities. Acids, of peculiar fervice in confumptions, 187. In putrid fevers, 204. Acidities in the bowels of infants, the origin of, 550. Method of cure, 551. Achivorth, Foundling Hofpital at, caufe of the children there being afflicted with feabbed heads, and fatal confequences of their ill-treatment, 557, note. Addifon, his remark on the luxury of the table, 97. JEther, very ferviceable in gout in the ftomach, 371, 394. In removing fits of the afthma, 416, note. Is excellent for fla- tulencies, 452. 'JEthiops, mineral, ftrongly recommended by Dr. Cheyne in in- flammations of the eyes, 271. Africans, their treatment of children, 11, note. Agaric of the oak, its merit as a ftyptic, 579. Method of gathering, preparing, and applying it, ibid. note. Agriculture, a healthful, conftant, and profitable employment, 49. Is too much neglected in favour of manufactures, Hid. Gardening the moft wholefi me amufemer.t for fedentary perfons, 54. 'fue, a fpecies of fever no perfon can miftake, and the proper medicine for, generally kn.)wn, 152. Caufes of, ibid. Symptoms, 153. Regimen for, ibid. Medical treatment of, 154. Often degenerates into obftinate chronical difeafes, if not radically cured, 159. Peru.ian baik the only medi- cine 7t8 INDEX. cine to be relied on in, 160. Children how to be treated in, ibid. Preventative medicine for thofe who live in marfhy countries, 161. Air, confined, poifonous to children, 32. A free open air will fometimes cure the moft obftinate diforders in children, 34. Occupations which injure the health by unwholefome air, 39, 50. The qualities of, act more fenfibly on the body, than is generally imagined, 76. The feveral noxious qualities of, fpecified, ibid. In large cities, polluted by various cir- cumftances, 77. The air in churches, how rendered un- wholefome, ibid. Houfes ought to be ventilated daily, 79. The danger attending fmall apartments, ibid. Perfons whofe bufinefs confines them to town ought to fleep in the country, ibid. High walls obftruct the free current of air, 80. Trees fhould not be planted too near to houfes, 81. Frefh air pe- culiarly neceffary for the fick, ibid. The fick in hofpitals in more danger from the want of frefh air, than from their diforders, 82. Wholefomenefs of the morning air, 86. The changeablenefs of, one great caufe of catching cold, 129. Thofe who keep moft within doors, the moft fenfible of thefe changes, 130. Of the night, to be carefully guarded againft, 131. Frefh air often of more efficacy in difeafes than medicine, 143. Its importance in fevers, 149, 164. Muft be kept cool and frefli in fick chambers under thefe diforders, 203. Change of, one of the moft effec- tual remedies for the whooping-cough, 292. The qualities of, a material confederation for afthmatic patients, 415. The various ways by which it may be rendered noxious, 614. Confined, how to try, and purify, 615. Method of recover- ing perfons poifoned by foul air, ibid. Frefh, of the greateft importance in fainting fits, 623. Aitken, Mr. his treatife on the nature and cure of fractures, recommended, 597, note. Alkali, cauftic, recommended in the ftone, 336. How to pre- pare it, ibid. note. Aliment is capable of changing the whole conftitution of the body, 63. Will in many cafes anfwer every intention in. the cure of difeafes, ibid. The calls of hunger and thirft, fuf- ficient for regulating the due quantity of, 64. The quality cf, how injured, ibid. A due mixture of vegetables neceffary with our animal food, 66. Te what the find effects of tea are principally owing, 67. Water, good and bad, diftin- guifhed, 68. Inquiry into the qualities of fermented liquors, with inftructions for the due making of them, 70. The qualities of good bread, and why adulterated by bakers, 71. Unfer- Index. ?I9 Unfermented bread not fo unwholefome as is generally imagined, ibid. General rules for the choice of food, 72. Ought not to be too uniform, 73. Meals ought to be taken at regular times, 74. Long fafting injurious both to old. and young, ibid. Breakfafts and fuppers, 75. Changes of diet ought to be gradually made, ibid. Amaurosis. See Gutta ferena. American Indians, their method of curing the venereal difeafe, 517- Amufements, fedentary, improper for fedentary perfons, 52. Ought always to be of an active kind, 87. Anafarca. See Dropfy. Anger, violent fits of, injurious to the conftitution, j 14. Tran- quility of mind effential to health, 115. Animal food, cautions in giving it to children, 19. Animals that die of themfelves, unfit for food, 65. Overdriven cattle rendered unwholefome, ibid. The artifices of butchers ex- pofed, 66. Too great a quantity of animal food, generates the fcurvy, ibid. Animals and plants, the analogy in the nourifhrnent of, ftated, 96. Anthony's fire, St. See Eryfipelas. Aphtha. See Thrufb. Apoplexy, who moft liable to this diforder, 418. Caufes, ibid. Symptoms and method of cure, 419. Cautions to perfons of an apoplectic make, 421. Apothecaries weights, a table of, 661, Apparel. See Clothing. Appetite, want of, caufes and remedies for, 424. Arbuthnot, Dr. his advice in the inflammation of the lungs, 176. His advice for perfons troubled with coftivenefs, 423, note. Arfenic, the effects of, on the ftomach, 481. Medical treat- ment when the fymptoms appear, 482. Arts. See Manufactures. Afcites. See Dropfy. Affes milk, why it feldom does any good, 183. Inftructions for taking it,' 184. AJlhma, the different kinds of this diforder diftinguifhed, with its caufes, 413. Symptoms, 414. Regimen, ibid. Medical treatment, 416. Remedies proper in the moift afthma, ibid. Atmofphere. See Air. Ball's 7$o INDEX. B Bad purging vermifuge powder, preparation of, 377. Bdfams, how to prepare. Anodyne balfani, 664. Balfam capivi, in rl.-;imatifm, 4C0. In Gleets, 504. Bandages, tight, produce moft of the bad confequences at- tending fracfured bones, 598. Bark, Peruvian, the beft antidote for failors againft diforders on a foreign coaft, 48. How to be adminiftered in the ague, 155. Diftinction between the red and pale bark, ibid. note. A decoction or infufion of, may be taken by thofe who cannot fwallow it in fubftance, 157. Is often adulterated, ibid. note. Is the only medicine to be depended on in agues, 160. How it may be rendered more palatable, ibid. May be adminiftered by clyfter, ibid. May be infufed in cold water, 189. How to be adminiftered in the putrid fever, 206; and in the eryfipelas, 261. In an inflammation of the eyes, 271. Its efficacy in a malignant quinfey, 282. In the whooping-cough, 295. A good medicine in vomiting, when it proceeds from weaknefs of the ftomach, 324. Its efficacy in a diabetes, and how to take it, 330. Is good againft the piles, 344; and worms, 375. Its ufe dangerous for preventing a fit of the gout, 392. A-good remedy in the King's evil, 408; and in thejluor albus, 533. Barley -water, how made, 169. Barrennefs in women, the general caufes of, 545. Courfe of relief, 546. Bath waters, good in the gout, 393. Bath, cold, the good effects of, on children, 31. Recrmmended to the ftudious, 62. Is peculiarly excellent for ftrengthen- ing the nervous fyftem, 432. Should never be omitted in gleets, 505. Is good for rickety children, 567. Cautions concerning the improper ufe of in adults, 641. 647. Bath, warm, of great fervice in an inflammation of the ftomach* 298. Bathing, a religious duty under the Judaic and Mahometan laws, 105. Is conducive to health, 106. Bears foot, recommended as a powerful remedy againft worms, 376: Beds, inftead of being made up again as foon as perfons rife from them, ought to be turned down and expofed to the air, 78. Bad effects cf to© great indulgence in bed, 85. Damp, the danger of, 131. Soft, are injurious to the kid- neys, 329. 330. 4 Beer INDEX. 721 Beer, the ill confequences of making it two weak, 7o. Per- nicious artifices of the dealers in, ibid. Bells, parifh, the tolling of them for the dead a dangerous cuftom, 116. Biles, 577. Bilious colic, fymptoms and treatment of, 305. Bilious fever. See Fever. Bite of a mad dog. See Dog. Bitters, warm and aftringent, antidotes to agues, 157. Arre ferviceable in vomiting when it proceeds from weaknefs in the ftomach, 324. Bladder, inflammation of, its general caufes, 312. Medical treatment of, ibid. Bladder, ftone in, See Stone. Blajl. See Eryfipelas. Bleeding, cautions for the operation of, in fevers, 150. In the ague, 155. Its importance in the acute continual fever, 165. In the pleurify, 170. When neceffary in an inflam- mation of the lungs, 177. Caution againft, in a nervous fever, 196. In the putrid fever, 205. In the miliary fever, 213. When neceffary in the fmall-pox, 231. When ufeful in the meafles, 252. When neceffary in the bilious fever, 255. Under what circumftances proper in the eryfipelas, 260. Mode of, proper in an inflammation of the brain, 265. Is always neceffary in an inflammation of the eyes, 269. When proper, and improper, in a cough, 287. V/hen proper in the whooping-cough, 293. Is almoft the only thing to be depended on in an inflammation of the ftomach, 297. And in an inflammation of the- inteftines, 299. Is neceffary in an inflammation of the kidneys, 310. Its ufe in a fuppreffion of urine, 332. In dropfy, 384. Is proper in an afthma, 416. Is dangerous in fainting fits, without due caution, 450 Cautions proper in the puerperal fever, 542. Is an operation generally performed by perfons who do not underftand when it is proper, 572. In what cafes it ought to be had recourfe to, 572. The quantity taken away, how to be regulated, 573. General rules for the operation, ibid. Prevailing prejudices relating to bleeding, 574. The arm the moft commodious part to take blood from, 575. Bleeding at the nofe, fpontaneous, is of more fervice, whers bleeding is neceffary, than the operation with the lancet, 340. Ought not to be ftopped without due consideration, ibid. How to ftop it when neceffary, 341. Cautions to prevent frequent returns of, 342. v 4 3 E Blind 722 INDEX. Blind perfons, when born fo, might be educated to employ- ments fuited to their capacity, 464, note. BH/lers, peculiarly advantageous in the nervous fever, 196. When only to be applied in the putrid fever, 205. When proper in the miliary fever, 213. Seldom fail to remove the moft obftinate inflammation of the eyes, 269. A good remedy in the quinfey, 276. Proper for a violent whoop- ing-cough, 295. The beft remedies for an inflammation ef the ftomach, 298. Are efficacious in the tooth-ach, 366. Blood, involuntary difcharges of, often falutary, and ought not to be ralhly ftopped, 338. The feveral kinds of thefe dif- charges, with their ufual caufes, ibid. Methods of cure, 339. Blood, fpitting of, who moft fubject to, and and at what feafons, 346. Its caufes, ibid. Symptoms, 347. Proper regimen in, 348. Medical treatment, ibid. Cautions to perfons fub- ject to it, 349. Blood, vomiting of, its caufes and fymptoms, 350. Medical treatment, ibid. Bloodfhot eye, how to cure, 468. Bloody-flux. See Dyfintery. Boerhaave, his'obfervation on diefs, 95, note. His mechanical expedients to relieve an inflammation of the brain, 264. Bolufes, general rules for the preparing of, 664. The aftringent bolus, ibid. Diaphoretic bolus, 665. Mercurial bolus, ibid. Bolus of rhubarb and mercury, ibid. Pectoral bolus, ibid. Purging bolus, ibid. Volatile bolus, 666. Bones, the exfoliation of, a very flow operation, 585. Bones, broken, oftenfuccefsfully undertaken by ignorant operators, 595. Regimen to be adopted after the accident, 5 96. Hints of conduct if the patient be confined to his bed, ibid. Clean- linefs to be regarded during this confinement, 597. The limb not to be kept continually on the ftretch, ibid. Cautions to be obferved in fetting a bone, ibid. Tight bandages con- demned, 598. How to keep the limb fteady by an eafy method, ibid. Fractures of the ribs, ibid. Boivels, inflammation of. See Stomach. Braidwood, Mr. his fkill in teaching the dumb to fpeak, 469, note. Brain, inflammation of, who moft liable to it, with its caufes and fymptoms, 262. Regimen, 264. Medical treatment, 265. Bread, proper food for children, as foon as they can chew it, 18. A cruft of, the beft gum-ftick, ibid. The beft modes of preparing it in food for children, 19. Good, the qualities of, INDEX. 723 of, and for what purpofe adulterated by the bakers, 7jJ Toafted, a decoction of, good to check the vomiting in a cholera morbus, 317. Brimftone. See Sulphur. Bruifes, why of worfe confequence than wounds, 584. Proper treatment of, ibid. The exfoliation of injured bones a very flow operation, $$5. How to cure fores occafioned by, ibid. Buboes, diftinguifhed, with their proper treatment, 508. Burdens, heavy, injurious to the lungs, 42. Burgundy pitch, a plafter of, between the flioulders, an excellent remedy in a cough, 289. In a whooping-cough, 295. And for children in teething, 563. Burials, the dangers attending their being allowed in the midft of populous towns, 77. Burns, flight, how to cure, 582. Proper treatment of recent ones, ibid. Treatment of, when violent, ibid. Extraordinary cafe of, 583. Liniment for, 688. Butchers, their profeffional artifices explained, and condemned, 66. Butter ought to be very fparingly given to children, 22. C Cabbage leaves, topical application of, in a pleurify, 171. Camphor, why of little ufe in eye-waters, 668. Camphorated oil, preparation of, 689. x Camphorated fpirit of wine, 703. Camps, the greateft neceffity of confulting cleanlinefs in, 105. Cancer, its different ftages defcribed, with the producing caufes, 474. Symptoms, 475. Regimen, and medical treatment, 476, Dr. Storck's method of treating this diforder, 477. Cautions for avoiding it, 479. Carriages, the indulgence of, a facrifice of health to vanity, 83. Carrot, wild, recommended in the ftone, 336. Carrot poultice for cancers, how to prepare, 478.. Cafualties, which apparently put an end to life, neceffary cau- tions refpecting, 603. 610. 614. 632. ---------fubftances ftopped in the gullet, 634. ---------drowning, 610. ---------noxious vapours, 614- .---------extremity of cold, 616. ---------extreme heat, 618. \ Cataplafms, their general intentions, 666. Cataratl, the diforder and its proper treatment defcribed, 466. Cattle, flail fed, are unwholefome food, 65. Over driven are killed in a high fever, ibid. The artifices of butchers ex- pofed, 66. 3 E 2 Ctllart 724 INDEX. Cellars, long fhut, ought to be cautioufly opened, 79. And funk ftories of houfes unhealthy to live in, 133. Of liquors in a ftate of fermentation, dangerous to enter, 614. How to purify the air in, 615. Celfus, his rules for the prefervation of health, 137. Chancres, defcribed, 510. Primary, how to treat, ibid. Symp- tomatic, 511. Charcoal fire, the danger of fleeping in the fume of, 614. Charity, the proper exercife of, 45. Cheyne, Dr. his perfuafive to the ufe of exercife, 8c. His judgment of the due quantity of urine, not to be relied on, 126. Strongly recommends ^Ethiops mineral in inflamma- tions of the eyes, 271. Chilblains, caufe of, 557. How to cure, 558. Child-bed women, how to be treated under a miliary fever, 213. Child-bed fever. See Fever. Child-birth, the feafon of, requires due care after the labour pains are over, 537. Medical advice to women in labour, 538. Ill effects of collecting a number of women on fuch occafions, ibid. note. How to guard againft the miliary fever, 541. Symptoms of the puerperal fever, ibid. Proper treatment of this fever, 542. General cautions for women at this feafon, 544. 545. Ghildren, their difeafes generally acute, and delay dangerous, 6. Their diforders lefs complicated, and eafier cured, than thofe of adults, Hid. Are often the heirs of the difeafes of their parents, 7. Thofe born of difeafed parents require peculiar care in the nurfmg, 9. Are often killed or deformed by in- judicious clothing, 10. How treated in Africa and America, 11, note. The ufual caufes of deformity in, explained, ibid. Their clothes ought to be faftened on with firings, 14. Ge- neral rules for clothing them, 15. Cleanlinefs an import- ant article in their drefs, ibid. The milk of the mother the moft natural food for, 16. Abfurdity of giving them drugs as their firft food, ibid. The beft method of expelling the meconium, 17. How they ought to be weaned from the breaft, 18. A cruft of bread the beft gum-ftick for them, ibid. How to prepare bread in their food, 19. Cautions as to giving them animal food, ibid. Cautions as to the quan- tity of their food, ibid. Errors in the quality of their food more frequent than in the quantity, 20. The food of adults improper for children, ibid Strong liquors expofe them to inflammatory diforders, ibid. Ill effects of unripe fruit, 2r. Butter, 22. Honey, a wholefome article of food for them, ibid. The importance of exercife to promote their growth aad INDEX. 72C and ftrength, ibid. Rules for their exercife, 24. Poverty of parents occafions their neglect of children, 25. The uti- lity of exercife demonftrated from the organical ftructure of children, ibid. Philofophical arguments fliewing the neceffity of exercife, ibid. Ought nut to be fent to fchool too foon, 26. Nor be put too foon to labour, 2,9. Weakly children fhould be employed out of doors, ibid. Dancing an excel- lent exercife for them, 30. The cold bath, 31. Want of wholefome air deftructive to children, 32. To wrap them up clofe in cradles, pernicious, 33. Are treated like plants in a hot-houfe, 34. The ufual faulty conduct of nurfes pointed out, 35. Are crammed with cordials by indolent nurfes, 36. Eruptions ignorantly treated by nurfes, 37. Loofe ftools, the proper treatment of, ibid. Every method ought to be taken to make them ftrong and hardy, 38. In- dications of the fmall-pox in, 225. Vomiting and purging of, 325. Chincough. See Cough. Cholera morbus, the diforder defined, with its caufes and fymp- toms, 316. Medical treatment, 317. Churches, the feveral circumftances that render the air in, un- - wholefome, 77. Churching of women after lying-in, a dangerous cuftom, 545. Church-yards, the bad confequences of having them in large towns, 77. Cities, large, the air in, contaminated by various means, 77. The bad effects of burying the dead in, ibid. Houfes ought to be ventilated daily, 78. The danger attending fmall apartments, 79. All who can ought to fleep in the country, ibid. Diforders that large towns are peculiarly hurtful to, 80. Cleanlinefs nqt fufficiently attended to in, 103. Should be fupplied with plenty of water, 108, note. The beft means to guard againft infection in, 111. Cleanlinefs, an important article of attention in the drefs of children, 15; and to fedentary artifts, 53. Is neceffary to health, 102. Diforders originating from the want of, ibid. Is not fufficiently attended to in large towns, 103. Nor by country peafants, 104. Great attention paid to, by the ancient Romans, ibid. note. Neceffity of confulting cleanli- nefs in camps, 105. Was the principal object of the whole fyftem of the Jewifh laws, ibid. Is a great part of the reli- gion of the Eaftern countries, ibid. Bathing and wafhing greatly conducive to health, 106. Cl-anlinefs peculiarly neceffary on board of fhips, ibid. And to the fick, 107. General remarks on, 108. Many diforders may be cured by 726 INDEX. by cleanlinefs alone, 144. The want of, a very general caufe of putrid fevers, 200. Is a great prefervative againft venereal infection, 520; and againft galling in infants, 552. Clergy, exhorted to remove popular prejudices againft inocula- tion, 240. Might do great good by undertaking the prac- tice of it themfelves, 246. Clothing, the only natural ufe of, 10. That of children, has be- come a fecret art, ibid. Ought to be faftened on infants with firings inftead of pins, 14. Pernicious confequences of ftays, 15. The due quantity of, dictated by the climate, 91. Should be increafed in the decline of life, 92. and adap- ted to the feafons, ibid. Is often hurtful by being made fub- fervient to the purpofes of vanity, 93. Pernicious confe- quences of attempting to mend the fliape by drefs, ibid. Stays, ibid. Shoes, ibid. Garters, buckles, and other bandages, 94. The perfection of, to be eafy and clean, 95. General re- marks on, ibid. Wet, the danger of, and how to guard againft it, 130. Clyfters, a proper form of, for an inflammation of the ftomach, 298. And for an inflammation of the inteftines, 300. Of tobacco fmoke, its efficacy in procuring a ftool, 307, note. Their ufe in a fuppreffion of urine, 332. Ought to be fre- quently adminiftered in the puerperal fever, 543. Of tobacco to excite vomiting, 608. The general intention of, 666. Preparation cf the emollient clyfter, 667. Laxative clyfter, ibid. Carminative clyfter, Hid. Oily clyfter, ibid. Starch clyfter, 668. Turpentine clyfter, ibid. Vinegar clyfter, ibid. Ceeliacpaffion, proper treatment for, 359. Coffee berries recommended in the ftone, 336. Cold, extreme, its effects on the human frrame, 616. The fud- den application of heat dangerous in fuch cafes, 617. How to recover frozen or benumbed limbs, ibid. Cold Bath. See Bath. Colds, frequently occafioned by imprudent changes of clothes at the firft approaches of fummer, 93, note. Various caufes of, fpecified, 129. Their general caufes, 284. Proper re- gimen on the fymptoms of, appearing, Hid. Danger of ne- glecting the diforder, 285. The chief fecret for avoiding, 287. Colic, different fpecies of, 302. Medical treatment of, accord- ing to their fpecies an i caufes, 304. Bilious colic, ibid. Hyfteric colic, 305. Nervous colic, 306. Cautions necef- fary to guard againft the nervous colic, 307. General ad- vice in colics, 508. Collyria. INDEX. 727 Collyria. See Eye-waters. Commerce often imports infectious diforders, no. Means fug- gefted to guard againft this danger, in, note. Confeclions often very needlefsly compounded, 669. Prepara- tion of the Japonic confection, 670. Conferves and prcferves, general remarks on, and their compo- fition, 670. Of red rofes, ibid. Of floes, 671. Candied orange-peel, ibid. Conjlituiion, good or bad, the foundation of, generally laid dur- ing infancy, r. Confumptions, the increafe of this diforder, may be attributed to hard drinking, 100. Who moft liable to, and the caufes, 178. Symptoms, 180. Regimen, 181. Riding, ibid. Much benefit to be expected from going a long voyage, 182. Tra- velling, 183. Diet, ibid. Great efficacy of milk, ibid. Me- dical treatment, 187. -----------Nervous, defined, and the perfons moft liable to, 190. Proper treatment of, 191. -----------Symptomatic, the treatment of, muft be directed to the producing caufe, [91. Convulfions, why new-born infants are fo liable to, 13. Thofe preceding the eruption in the fmall-pox favourable fymptoms, 227. The general caufes of, 567. Proper treatment of, 568. Extraordinary recovery of an infant feemingly killed by, 629. Further inftructions in like cafes, 630. Cook, Captain, the circumnavigator, his means of preferving the health of his men, 47, note. Cookery, the arts of, render many things unwholefome that are not naturally fo, 68. Cordials, ought not to be given to infants, 17. Are the com- mon refuge of nurfes who neglect their duty to children, 36. Are often fatal in an inflammation of the ftomach, 297. When good in the colic, 303. Ought not to be given to a pregnant woman during labour, 538. Corn, damaged, will produce the putrid fever, 199. Corns in the feet are occafioned by wearing tight fhoes, 94. Cort.x. See Bark. Coftivenefs, a frequent recourfe to medicines for the prevention of, injurious to the conftitution, 125. Is rather to be re- moved by diet than by drugs, 126. Its general caufes and ill effects, 422. Regimen, ibid. Remedies for, 424. Cough, the proper remedies for, 287. A plafter of Burgundy pitch laid between the fhoulders an excellent remedy for, 289. The ftomach-cough, and cough of the lun^s, diftinguilhed, 290. Tivaimcnt for the nervous cough, ibid. Cough, 728 INDEX. Cough, whooping, who moft liable to, with its difpofing cau- ies, 291. Remedies, 292. Is infectious, ibid. Vomits, their ufe, and how to adminifter them to children, 293. Garlic ointment a good remedy for, 295. Cough, phthifical, incident to fedentary artificers, from their breathing confined air, 50. Cradles, on many accounts hurtful to children, 33. Cramp, proper remedies for, 459. Cramp of thejlomach, who moft fubject to, 446. Medical treat- ment of, ibid. Crotchets, how to ufe for extracting fubftances detained in the .gullet, 606. Croup or hives in children, defcribed, 558. Its fymptoms and proper treatment, ibid. Cuprum ammoniacum, its ufe in epilepfy, 443. Cyder, the ill confequences of making it too weak, 70. D Dancing, an excellent kind of exercife for young perfons, 30. Daucus fylveftris. See Carrot. Deafnefs, when a favourable fymptom in the putrid fever, 202. note. Methods of cure according to its caufes, 469. Death, the evidences of, fometimes fallacious and ought not to be too foon credited, 603. 610. 612. 632. The means to be ufed for the recovery of perfons from, nearly the fame in all cafes, 632. Decoclions, general remarks on, 671. Preparation of the de- coction of althaea, ibid. Common decoction, 672. Of log- wood, ibid. Of bark, ibid. Compound decoction of bark, ibid. Of farfaparilla, 673. Of feneka, ibid. White de- coclion, ibid. Deformity, often occafioned by the injudicious method of dref- fing children, 10. Is feldom found among favage nations, II. The ufual caufes of, explained, ibid. Dews, night, dangerous to health, 131. Diabetes, who moft liable to this diforder, 328. Its caufes and fymptoms, ibid. Regimen and medical treatment, 329. Diftinguifhed from incontinency of urine, 331. Diarrhoea. See Loofenefs. Diet, will often anfwer moft of the indications of cure in dif- eafes, 142. Illuftrations, 143. See Aliment. Digeftion, the powers of, equally impaired by repletion or ina- nition, 74. Difeafes, hereditary, cautions to perfons afflicted with, 8. Pe- culiar diforders attending particular occupations, 39. Many 2 of INDEX. 729 of them infectious, 108. The knowledge of, depends more upon experience and obfervation f.han upon fcientifical prin- ciples, 139. Are to be diftinguifhed by the moft obvious and permanent fymptoms, ibid. The differences of fex, age, and conftitution, to be confidered, 140. Of the mind, to be diftinguifhed from thofe of the body, 141. Climate, fituation, and occupation to be attended to, ibid. Other collateral circumftances, ibid. Many indications of cure, to be anfwered by diet alone, 142. Cures often effected by frefh air, by exercife, or by cleanlinefs, 144. Nervous dif- eafes, of a complicated nature, and difficult to cure, 427. Diflocations, fliould be reduced before the fwelling and inflam- mation come on, and how, 589. Of the jaw, 590. Of the neck, 591. Of the ribs, 592. Of the fhoulder, 593. Of the elbow, 594. Of the thigh, ibid. Of the knees, ancles, and toes, 595. Diuretic infufion for the Dropfy, how to prepare, 384. 385. Dog, fymptoms of madnefs in, 484. Ought to be carefully preferved after biting any perfon, to afcertain whether he is mad or not, 485. Is often reputed mad when he is not fo, ibid. Symptoms of the bite of a mad dog, 486. The poi- fon cannot lie many years dormant in the body, as is fup- pofed, 487. Dr. Mead's receipt for the bite, ibid. The famous Eaft India fpecific for, 488. Other recipes, ibid. Vinegar of confiderable fervice in this diforder, ibid. Medi- cal courfe of treatment recommended, ibid. Regimen, 490. Dipping in the fea not to be relied on, 491. Dr. Tiffot's medical courfe for the cure of the hydrophobia, ibid. Re- marks on the Ormfkirk medicine, 492, note. Dofes of medicines, the relative proportions of, for different ages, 660. Drams ought to be avoided by perfons afflicted with nervous diforders, 431. Draught, is the proper form for fuch medicines as are intended for immediate operation, 674. How to prepare the anodyne draught, ibid. Diuretic draught, ibid. Purging draught, ibid. Sweating draught, ibid. Vomiting draught, 675. Drefs. See Clothing. Drinking, perfons who are feldom intoxicated may neverthelefs injure their conftitutions by, 99. The habit of drinking, fre- quently originates from misfortunes, 100. Frequently de- ftroys the powers of the mind, 101. Perfons often forced to it by miftaken hofpitality, ibid. note. Leads to other vices, 102. 3 F Dropfy, 73o INDEX. Dropfy, the feveral diftinctions of, with its caufes, 381. Symp- toms, 382. Regimen, 383. Medical treatment, 384. Tap- ping, a fafe and fimple operation, 386. Dropfy of the brain. See Water in the head. Drownedperfojis, ought net to be rafhly given up for dead, 610. Proper trials for the recovery of, 611. Endeavours ought not to be fufpended upon the firft returns of life, 613. Suc- cefs of the Amfterdam fociety for the recovery of, 631. Drunkennefs. See Intoxication. Dumb perfons may be taught to read, write, and difcourfe, 469. note. Dyfentery, where and when moft prevalent, 353. Its caufes and fymptoms, ibid. Regimen, 354. Fruit, one of the beft remedies for, 356. Proper drink for, 357. Medical treat- ment, ibid. Cautions to prevent a relapie, 358. E. Ear, the feveral injuries it is liable to, 468. Deafnefs, medical treatment of, according to its caufes, 469. Ought not to be tampered with, 470. Ear-ach, its caufes, and proper treatment for, 36S. How to drive infects out of, ibid. Education of children, fhould be begun at home by the parents, 27, note. That of girls hurtful to the conftitution, 28. Effluvia, putrid, will occafion the fpotted fever, 199. Eleclrieity beneficial in the palfy, 439. In gutta ferena, 466. Electuaries, general rules for making, 675. Preparation of lenitive electuary, ibid. Of the bark, 676. For the piles, ibid. For the palfy, ibid. For the rheumatifm, ibid. Elixir, paregoric ,how to prepare, 702. Sacred elixir, 703. Stomachic elixir, ibid. Acid elixir of vitriol, ibid. Emulfwns, their ufes, 676. Preparation of the common emul- fion, ibid. Arabic emulfion, 677. Camphorated emulfion, ibid. Emulfion of gum ammoniac, ibidi. Oily emulfion, ibid. Engleman, Dr. his account of the German method of recover- ing perfons from fainting fits, 622. Entrails. See Inteftines. Epilepfy, the diforder defined, 440. Its caufes, ibid. Symp- toms, 441. Due regimen, 442. Medical treatment, ibid. Eruptions in children often free them from bad humors, but are miftaken and ill treated by nurfes, 37. Ought never to be ftopped without proper advice, ibid. In fevers, how to be treated, 197. 205. 211. 212. In the fmall-pox, 227. 231. In children, the caufes of, 556. How to cure, ibid. Eryfipelas, INDEX. 73i Eryfipelas, a diforder incident to the laborious, 43. Its caufes explained, and who moft fubject to it, 257. Its fymptoms, 258. Regimen, 259. Medical treatment, ibid. The feor- butic eryfipelas, 261. Inflructions for thofe who are fub- ject to this diforder, ibid. Evacuations of the human body, the principal, fpecified, 124. By ftool, ibid. Urine, 126. Perfpiration, 128. Exercife, the importance of, to promote the growth and ftrength of children, 23. All young animals exert their organs of motion as foon as they are able, ibid. The utility of, proved from anatomical confederations, 25. And from philofophi- cal deductions, 26. Benefits of dancing, 30. Is better for fedentary perfons under lownefs of fpirits thari the tavern, 53. Gardening the beft exercife for the fedentary, ibid. Violent, ought not to be taken immediately after a full meal, 63. Is as neceffary as food for the prefervation of health, 82. Our love of activity an evidence of its utility, 83. Indolence relaxes the folids, ibid. The indulgence of carriages as ab- furd as pernicious, ibid. Is almoft the only cure for glandu- lar obftructions, 84. Will prevent and remove thofe dif- ders that medicine cannot cure, 85. Is the beft cure for complaints in the ftomach, 86. How to be taken within doors, when not to be done in the open air, ibid. Active fports better than fedentary amufements, 87. The golf a better exercife than cricker, ibid. note. Exercife fhould not be extended to fatigue, ibid. Is as neceffary for the mind as for the body, 120. Is often of more efficacy than any medicine whatever, 144. The beft mode of taking it in a confumption, 181. Is of the greateft importance in a dropfy, 383. Mufcular, for the gout, 392. Is neceffary for the afthmatic, 415. Is fuperior to all medicine in ner- vous diforders, 431. And in the palfy, 440. Is proper for pregnant women, unlefs they are of a very delicate texture, 537. Want of, the occafion of rickets in children, 565. Extracts, general rules for making; but are more conveniently purchafed ready made, 677. 678. Eyes, inflammation of, its general caufes, 266. Symptoms, 267. Regiii.cn, 268. Medical treatment, ibid. How to be treated when it proceeds from a ferophulous habit, 271. Advice to thofe who are fubject to this complaint, 272. Are fubject to many difeafes which are difficult to cure, 464. The means by which they are frequently injured, 465. General means of prevention, ibid. The feveral dif- orders o;', with their medical treatment, 466. 3 F 2 Eye 732 INDEX. Eye-waters, general remarks on, and their principal intentions 668. Collyrium of alum, 669. Vitriolic collyrium, ibid. Collyrium of lead, ibid. F. Fainting fits, how to cure, 449. 619. Cautions to perfons fub- ject to them, 623. Falling ficknefs. See Epilepfy. Fafting, long, injurious to thofe who labour hard, 44. Is hurt- ful both to old and young, "74. Fathers, culpably inattentive to the management of their chil- dren, 5. Their irregular lives often injure the conftitution of their children, 8. Fear, the influence of, very great, in occafioning and aggra- vating difeafes, 115. Its various operations, ibid. Feet, injured by wearing tight fhoes, 93. The wafhing of, an agreeable article of cleanlinefs, 106. Wet, the danger of, 130. Bathing them in warm water, a good remedy in a cold, 286. And in the whooping-cough, 295. Fermentation, the vapour of liquors in a ftate of,noxious, 614. Fevers, of a bad kind, often occafioned among labourers by poor living, 45. Frequently attack fedentary perfons after hard drinking, 53. Nervous, often the confequence of in- tenfe ftudy, 58. Malignant, often occafioned by want of cleanlinefs, 103. The moft general caufes of, numerated, 14c. The diftinguifhing fymptoms of, ibid. The feveral fpecies of, 146. Is an effort of nature, which ought to be affifted, ibid. How this is to be done, 147. Cordials and fweetmeats improper in, 149, Frefh air of great importance in, ibid. The mind of the patient ought not to be alarmed with religious terrors, 150. Cautions as to bleeding, ibid, and fweating in, 151. Longings, the calls of nature, and de- ferve attenrion, ibid. Cautions to prevent a relapfe, ibid. Fever acute continual, who moft liable to, 162. Caufes, ibid. Symptoms, ibid. Regimen, 163. Medical treatment, 165. Symptoms favourable and unfavourable, 166. Regimen to be obferved during recovery, 167. Fever, bilious, general time of its appearance 255. Proper treatment of, according to its. fymptoms, 256. Fever, intermitting. See Ague. Fever, miliary, from what the name derived, and its general appearances, 209. Who moft liable to it, ibid. Caufes, 210. Symptoms, ibid, kegimea, 211. Proper medical treat- ment, 212. Cautions for avoiding this diforder, 213. How to prevent, in childbed-women, 541. Fever, INDEX. 733 Fever, milk, how to prevent, 540. Fever, nervous, why more common now than formerly, and who moft liable to it, 192. Its caufes, ibid. Symptoms, 193. Regimen, 194. Medical treatment of, 19 c. Fever, puerperal, or child-bed, the time of its attack, 541. and fymptoms, 542. Medical treatment of, 543. Cautions for the prevention of this fever, 544. Fever, putrid, is of a peftilential nature, and who moft liable to it, 199. Its general caufes, ibid. Symptoms of, 200. Other fevers may be converted to this, by improper treatment, 201. Favourable and unfavourable fymptoms of, 202. Re- gimen, ibid. Medical treatment, 205. Cautions for the pre- vention of this diforder, 207. Fever, remitting, derivation of its name, 214. Its caufes and fymptoms, ibid. Proper regimen, 215. Medical treatment, 216. Cautions for avoiding this fever, 217. Fever, fearlet, why fo named, and its ufual feafon of attack, 254. Proper treatment of, ibid. Is fometimes attended with putrid and malignant fymptoms, 2^5. Fever, fecondary in the fmall-pox, proper treatment of, 234. Fever, yellow, why fo called, 218. Its caufes, 219. Symptoms, 220. Regimen neceffary, 221. Medical treatmant, ibid. Flatulencies in the ftomach, remedies againft, 370. The feve- ral caufes of, 451. Medical treatment of, ibid. Flatulent colic, its caufes, and feat of the diforder, 302. Reme- dies, for, 303. Fluor albus defcribed, with its proper treatment, 532. Fomentations, how to make and apply, 678. General intentions of, ibid.. Anodyne fomentation, ibid. Aromatic fomenta- tion, ibid. Common bitter fomentation, ibid. Emollient fomentation, 679. Strengthening fomentation, ibid. Food. See Aliment. Forgivenefs of injuries, ought to be praclifed from a regard to our own health, 114. Fox-glove, its ufe in dropfy, 386. FraClures. See B:ms, broken. Frozen limbs, how to recover, 617. Fruit, unripe, very hurtful to children, 21. One of the beft medicines both for the prevention and cure of a dyfentery, 556* Funerals, the great number of vifitors attending them, dange- rous to their health, 109. Galling, 734 INDEX. G. Galling, in infants, the caufe and cure of, 551. Gangrene, proper treatment of, 576. Gardening, a wholefome amufement for fedentary perfon?, 55. Gargles for the throat, how to make, 275. 277. General in- tentions of, 679. Method of making the attenuating gargle, ibid. Common gargle, ibid. Detergent gargle, 680. Emol- lient gargle, ibid. For the mouth of infants in the thrufh, 55°' Garlic ointment, a North Britifh remedy for the whooping-cough, how to apply it, 295. Gilders. See Miners. Ginger, fyrup of, how to prepare, 699. Girls, the common mode of education prejudicial to their con- ftitution, 28. Means of rectifying it recommended, ibid. Gleet, how occafioned, and its fymptoms, 504. Method of cure, ibid. Regimen, 505. Obftinate gleets cured by mer- curial unctions, 506. How to apply bougies, ibid. Glover, Mr. his courfe of treatment for the recovery of a hanged man, 628. Gonorrhoea, virulent, the nature of, and its fymptoms, 498. Regimen, 500. Medical treatment, ibid. Is often cured by aftringent injections, ibid. Cooling purges always proper in, 501. Goulard, M. preparation of his celebrated extract of Saturn, 705. His various applications of it, ibid. Cerate, 687. Gout, the general caufes of, 56. How to treat a loofenefs oc- cafioned by the repelling it from the extremities, 320. The fomxes of this diforder, and its fymptoms, 387. 388. Re- gimen for, 389. Wool the beft external application in, 390. Why there are fo many noftrums for, 391. Proper medi- cines after the fit, 392! Proper regimen in the intervals between fits to keep off their return, ibid. How to remove it from the.nobler parts to the extremities, 393. General cautions to prevent danger by miftaking it for other difor- ders, 394. Gravel, how formed in the bladder, 127. How diftinguifhed from the ftone, 333. Caufes and fymptoms, ibid. Regimen, 334. Medical treatment, 335. Green ficknefs originates in indolence, 527. Grief, its effects permanent, and often fatal, 119. Danger of the mind dwelling long^upon one fubject, efpecially if of a difagreeable nature, ibid. The mind requires exercife as well as INDEX. 735 as the body, 120. Innocent amufements not to be neglected, 121. Is productive of nervous difeafes, 428. Gripes in infants, proper treatment of, 551. Guaiacum, gum, a good remedy for the rheumatifm, 397. Gullet, how to remove fubftances detained in, 605. Cautions for the ufe of crotchets with this intention, 606. Other me- chanical expedients, ibid. Treatment if the obftruction can- not be removed, 609. Gums of children, applications to, during teething, and how to cut them, 56$. Gutta ferena, proper treatment of, 466. H. Hamoptoe, fpitting of blood. See Blood. Hemorrhages. See Blood. Harrowgate water, an excellent medicine for expelling worms, 375. And for the jaundice, 381. In the fcurvy, 398. Headach, the fpecies of, diftinguifhed, 360. Caufes of, 361, Regimen, 362. Medical treatment, ibid. Health of the people in general, a proper object of attention for the magiftrates, vii. Ought to be attended to in matrimo- nial contracts, 8. Is often laboured for after it is deftroyed, 62. Rules given by Celfus for the prefervation of, 137. Heart burn, the nature of this diforder, with its caufes, and re- medies for, 425. Heat, extreme, how to recover perfons overcome by, 618. Hemlock, a good remedy in the king's evil, 408. Is recom- mended by Dr. Storck for the cure of cancers, 477. Hempfeed, a decoction of, good in the jaundice, and how to prepare it, 380. Hiccup, its caufes, and method of treatment, 444. Hives. See Croup. Hoffman, his rults for guarding child-bed women againft the miliary fever, 541. Honey, a wholefome article of food for children, 22. Is recom- mended in the ftone, 337. Hofpitals, the want of frefh air in, more dangerous to the pa- tients than their diforders, 82. Cleanlinefs peculiarly ne- ceffary in 107. Often fpread infection by being fituated in the middle of populous towns, in. How they might be rendered proper receptacles for the fick, ibid. Particularly in infectious diforders, 113. The fick in, ought not to be crowded together, 229, note. Horfc radifli, the chewing of, will reftore fenfibility to the or- gans of ufte when injured, 473. Houfes, 736 INDEX. Houfes, inftead of contrivances to make them clofe and warm, ought to be regularly ventilated, 78. In marfhy fituations unwholefome, 81. Ought to be built in a dry fituation, 133. Danger of inhabiting new-built houfes before thoroughly dry, ibid. Are often rendered damp by unfeafonable cleanlinefs, 134. Are dangerous when kept too clofe and hot, 136. Hufbandmen, the peculiar diforders they are expofed to, from the viciffitudes of the weather, 42. Huxham, Dr. recommends the ftudy of the dietetic part of me- dicine, ix. Hydrocephalus. See Dropfy. Hydrophobia, Dr. Tiffot's method of curing, 491. Hydrops pectoris. See Dropfj. Hypochondriac affeclions, frequently produced by intenfe ftudy, 58. Their caufes, and who moft fubject to them, 459. The general intentions of cure, 460. Regimen, 462. Hyfterics, a diforder produced by the habitual ufe of tea, 67. General caufes of, 455. Symptoms, ibid. Proper treatment of, 456. Regimen, 457. Medicines adapted to, ibid. Hyfteric colic, fymptoms and treatment of, 305. I. Jails, why malignant fevers are often generated in them, 78. Often fpread infection by being fituated in the middle of po- pulous towns, 111. Ought to be removed, ibid. Janin, M. his relation of the recovery of an overlaid infant, 627. And of a man who had hanged himfelf, 628. Jaundice, the different ftages of its appearance, with the caufes of this diforder, 378. 379. Symptoms and regimen, ibid. Medical treatment, ibid. Jefuits Bark. See Bark. Jews, the whole fyftem of their laws tending to promote clean- linefs, 105. 110. Iliac paffion, a particular kind of inflammation of the inteftines, 299. Impoflhume in the breaft, in confumptions, how to be treated, 189. Impofthumes after the fmall-pox, proper treatment of, 237. Incontinency of urine, diftinguiflied from a diabetes, 331. Expe- dient for relief, ibid. Indigeftion, is one confequence of intenfe ftudy, 57. General caufes, and remedies for, 423. Indolence, its bad effects on the conftitution, 83. Occafions glan- dular obftructions, 84. Ill confequences of too much indul- gence in bed, 85. Is the parent of vice, 88. Is the general caufe of moft nervous diforder-, 463. 2 Infancy, INDEX. 737 infancy, the foundation of a good or bad conftitution, generally laid in this feafon of life, i. Infants, nearly one half of thofe born in Great Britain die un- der twelve years of age, i. Perifh moftly by art, 2. Ought not to be fuckled by delicate women, 3. Importance of their being nurfed by their mothers, 5. Often lofe their ^ives, or become deformed, by errors in clothing them, io* How the art of bandaging them became the province of the midwife, ibid. How treated in Africa, 11, note. Philofo- phical obfervations on their organical ftructure, and on the caufes of deformity, 12. Why they fo frequently die of convulfions, 13. Why expofed to fevers, 14. And colds, ibid. Rules for their drefs, 15. Their food, 16. Reflectiors on the many evils they are expofed to, 546. Why their firft diforders are in their bowels, 547. How to cleanfe their bowels, ibid. The meconium, 548. Thrufh, 549. Acidities 550. Gripes, 551. Galling and excoriation» ibid. Stoppage of the nofe, 552. Vomiting, 553. Loofe" nefs, 554. Eruptions, 555. Scabbed heads, 556. Chil- blains, 557. The croup, 558. Teething, 561. Rickets, 564. Convulfions, 567. Water in the head, 569. How to recover infants feemingly dead, 623. Ought never to fleep in the fame bed with their mothers or nurfes 627, note. Cafe of the recovery of an overlaid infant, 627. Cafe of an infant feemingly killed by a ftrong convulfion fit, and recovered, 630. See Children. Infection, the danger of, incurred by injudicious or unneceffary attendance on the fick, 108. And on funerals, 109. Is often communicated by clorhes, no. Is frequently import- ed, ibid. Is fpread by hofpitals and jails being fituated in the middle of populous towns, in. How to prevent in- fection in fick chambers, 112. In what refpects the fpread- ing of infection might be checked by the magiftrate, 112. Smallpox, 225. Inflammations, how the laborious part of mankind expofe them- felves to, 44. Preper treatment of, 575. Inflammation of the bladder. See Bladder. --------■---of the brain. See Brain. .------.-----of the eyes. See Eyes. -----------of the inteftines. See Inteftines.. -----------of the kidneys. See Kidneys. ----------- of the liver. See Liver. _----------of the lungs. See Peripneumony. ,-----------of the ftomach. See Stomach. ------------of the throat. See Quinfey. ^______ of the womb. See Womb* 30 Infufions 73? INDEX. Infufians, advantages of, over decoctions, 680. Expeditiouj mode of preparing them, 681. How to obtain rich infu- fions from weak vegetables, ibid. Preparation of the bitter infufion, ibid. Infufion of the bark, ibid. Infufion of car- duus, ibid. Of flaxfeed, ibid. Of rofes 682. Of tamarinds and fenna, ibid. For the palfy, ibid. Inns. The great danger of meeting with damp beds in them, 131. The fheets in, how treated to fave wafhing, 132. Inoculation of the fmall-pox, more favourably received here than in neighbouring countries, 238. Cannot prove of ge- neral utility while kept in the hands of a few, ibid. No my- ftery in the procefs, ibid. May fafely be performed by pa- rents or nurfes, 239. Various methods of doing it, ibid. The clergy exhorted to remove the prejudices againft the operation, 240. Moft fimple method of performing the ope- ration, 240, note. Arguments cited from Dr. Mackenzie in favour of inoculation, 241. note. Ought to be rendered univerfal, 243. Means of extending the.practice of, ibid. Two obftacles to the progrefs of, ftated, 245. Might be performed by clergymen, or by parents themfelves, 246. The proper feafons and age for performing it, 247. Will often mend the habit of body, 24.8. Neceffary preparation and regimen for, ibid. Infefls, when they creep into the ear, how to force them out, 368. Poifonous, the bites of, how to be treated, 493. Intemperance, one great caufe of the difeafes of feamen, 46. The danger of, argued from the conftruction of the human bo. dy, 96. The analogy in the nourifhment of plants and ani- mals, ibid. Is the abufe of natural paffions, ibid. In diet, 97. In liquor and carnal pleafures, 98. The bad confe-; cpiences cf, involve whole families, ibid. Effects of drunk- ennefs upon the conftitution, 99. Perfons who feldom get drunk, may neverthelefs injure their conftitutions by drink, ibid. The habit of drinking, frequently acquired under mif- fortunes, 100. Is peculiarly hurtful to young perfons, 101. Leads to all other vices, 102. Intermitting fever. See Ague. Inteftines, inflammation of, general caufes from whence it pro- ceeds, 298. The fymptoms, regimen, and medical treat- ment, 299. Cautions to guard againft it, 302. Intoxication produces a fever, 99. Fatal confequences of a daily repetition of this vice, ibid. Perfons who feldom get drunk, may neverthelefs injure their conftitution by drinking, ibid. Getting drunk, a hazardous remedy for a cold, 285. Often produces fatal effects, 624. Proper cautions for treating perfons in liquor, ibid. The fafeft drink after a debauch, #25. Remarkable cafe, ibid. INDEX, 73* Johnfon, Dr. extraordinary recovery of an infant feemingly killed by a ftrong convulfion fit, related by, 629. Iffues, how to make them take the beft effect, 437. Itch, the nature and fymptoms of this difeafe defcribed, 41c. Sulphur, the beft remedy againft, ibid. Great danger of the injudicious ufe of mercurial preparations for, 412. Clean- linefs the beft prefervative againft, 4I3. note. Juleps, the form of, explained, 683. Preparation of the expectorating julep, ibid. Mucilaginous vitriolic julep, ibid. Mufk julep, ibid. Saline julep, ibid. Vomiting julep, ibid. K. Kermes mineral, recommended by Dr. Duplanil for the whoop- ing cough, 294. note. Kidneys, inflammation of, its general caufes, 301. Its fymp- toms and proper regimen, 309. Medical treatment, 312. Where it proceeds from the ftone and gravel, ibid. Cau- tions for thofe*fubject to this diforder, ibid. See GraveL King's Evil. See Scrophula. L Laborious employments, the peculiar diforders incident to, 42 * The folly of men emulating each other in trials of ftrength, ibid. Difadvantages attending their diet. 43. How they expofe themfelves to inflammations, 44. Danger of fleep- ing in the fun, ibid. Long fafting hurtful to them, ibid. Injuries arifing from poor living, 45. Many of the dif- eafes of labourers, not only occafioned, but aggravated, by poverty, ibid. Labour fhould not be impofed too early on children, 29. # Labour in child-bed, medical advice for, 538. Inconveni- ences of collecting a number of women at, ibid. note. Laudanum, its efficacy in fits of an ague, 153. note. In a loofenefs, 320* In a diabetes, 330. When proper for the head-ach, 356. How to apply for the .tooth-ach, 363. Will eafe pain in the gout, 391. How to adminifter for the cramp in the ftomach, 446. Is good for flatulencies, 45J. Effects of an over-dofe of, 477. Medical treatment in this cafe, 483. Leading ft rings t injurious to young children, 24. Leeches may be fuccefsfully applied to inflamed teftloes, 507. note. And to difperfe buboes, 509. note. Are proper to apply to children where inflammations appear in teething, 562. Lcmtns, See Oranges. X G 4 Lrpnfyt 74<3 INDEX. Leprf, why lefs frequent in this country now than for- merly, 405; Requires the fame treatment as the fcurvy, ibid. Lientcry, proper treatment for, 359. Life may frequently be reftored, when the appearances of it are fufpended by fudden cafualties, 6c 1, 610, 614, 631. Lightning, perfons apparently killed by, might poffibly be recovered by the ufe of proper means, 632. Lime-water recommended to prevent gravel in the kidneys from degenerating to the ftone in the bladder, 33c. Is a good remedy for worms, 375. Happy effects of, in the cure of obftinate ulcers, 587. Lind, Dr. his prefcription to abate fits of an ague, 153. note. His directions for the treatment of patients under putrid remitting fevers, 216, note. Liniment for burns, preparation of, 688. White liniment, ibid. For the piles, ibid. Volatile liniment, 689. Liquors, ftrong, expofe children to inflammatory diforders, 20. Fermented, the qualities of, examined, 69. The bad confequences of making them too weak, 70. Why all families ought to prepare their own liquors, ibid. Cold, the danger of drinking, when a perfon is hot, 134. Liver, fchinous, produced by fedentary employments, 57. Liver, inflammation of, its caufes and fymptoms, 313. Re- gimen and medical treatment 314. Abfcefs in, how to be treated, 315. Cautions in the event of a fchirrus be- ing formed, ibid. Lobelia, an American plant, ufed by the natives in the venereal diOafe, 517. Lochia, a fuppreffion of, how to be treated, 40 Longings in difeafes, are the calls of nature, and often point out what may be of real ufe, 151. Loofenefs, habitual, general directions for perfons fubject tor 125.. Its general caufes, 319. A periodical loofenefs ought never to be ftopped, 320. Medical treatment of, according to its various caufes, Hid. Means cf checking it when neceffary, 321. In children, proper treatment of, 554. Love, why perhaps the ftrongeft of all the paffions, 121. Is not rapid in its progrefs, and may therefore be guarded againft at its commencement, ibid. To pvetend to it for amufement, cruelty to the object, ibid. Children often real martyrs between inclination and duty, 122, note. Lues,.confirmed, fymptoms of, 513. Mercury the only cer- tain remedy known in Europe for this difeafe, 515. Ame- rican method of curing this difeafe, 517. Lungs, INDEX. ?4r Lungs, injured by artifts working in bending poftures, 51. Stu- dious perfons liable to confumptions of, 57. Luxury, highly injurious to the organs of tafte and fmell, 471, M Mackenzie, Dr. his arguments in favour of inoculating in the fmall-pox, 241, note. Mad dog. See D:g. Magnefia alba, a remedy for the heart-burn, 426. Is the beft medicine in a'1 cafes of acidity, 551. Magnets, artificial, their repu^d virtue in the tooth-ach, 367. Malt liquors 1 urttLv in the afthma, 415. See Beer. Man, why inferior to brutes in the management of his young, 1. Was ne . ei intended to be idle, 88. Manufactures, the growth of, produce the rickets in children, 23. More favourable to riches than to health, 29. Some, injurious to health, by confining artifts in unwholefome air, 39. Cautions to the workmen, ibid. Compared with agri- culture, 49. Aie injurious to health from artifts being crowded together, 50. And from their working in confined, poftures, ibid. Cautions offered to fedentary artifts, 52. Sedentary arts better fuited to women than to men, 85, note. Matrimony ought not to be contracted without a due attention to health and form, 9. Meed, Dr. his famous recipe for the bite of a mad dog, 487. His character as a phyfician, ibid. note. Meals ought to be taken at regular times, 74. Reafons for this uniformity, ibid. Meafles, have great affinity to the fmall-pox, 249. Caufe and fymptoms, ibid. Proper regimen and medicine, 251. Ino- culation of, might prove very falutary, 253, note. Mechanics ought to employ their leifure hours in gardening, 54. Meconium, the beft mode of expelling it, 17. 548. Medicine, the origin of the art of, :x. The operation of, doubt- ful at beft x. Is made a myftery of, by its profeffors, xvii. The ftudy of, negle#ed by gentlemen, xviii. This ignorance lays men open to pretenders, xx. Ought to be generally underftood, xxi. A diffuffion of the knowledge of, would deftroy quackery, ibid. Objections to the cultivation of me- dical knowledge anfwered, ibid. The theory of, can never fupply the want of experience and obfervation, 139. Medicines have more virtue attributed to them than they defcrve, 142. Ought not to be adminiftered by toe ignorant, nor without catnion, 144. %Want of perfeveraac; in the ufe of, 74<5 I N D E X. cines, 689. Preparation of the compofing pill, ibid* Foetid pill, 690. Hemlock pill, ibid. Mercurial pill, ibid. Mer- curial fublimate pills, ibid. Opium pills, 691. Calomel pill, ibid. Plummer's pill, ibid. Purging pill, 691. Pill for the jaundice, 692. Stomachic pill, ibid. Squill pills, tbid. Strengthening pills, ibid. Pins ought never to be ufed in the dreffing of children, 14. Swallowed, difcharged from an ulcer in the fide, 605, note. Plafters, the general intentions of, and their ufual bafis, 692. Preparation of the common plafter, 693. Adhefive plafter, ibid. Anodyne plafter, ibid. Bliftering plafter, ibid. Gum plafter, 694. Mercurial plafter, ibid. Stomach plafter, ibid. Warm plafter, ibid. Wax plafter, 695. Pleurify, the nature of the diforder explained, with its caufes, 168. Symptoms, 169. Regimen, ibid. Medical treatment, 170. A decoction of Seneka reckoned a fpecific in, 172. Baftard pleurify, 173. Plumbers. See Miners. Poifons, the nature and cure of, a general concern, and eafily acquired, 480. Minerajl poifons, 481. Vegetable poifons, 483. Bites of poifonous animals, 484. Bite of a mad dog, 486. Bite of a viper, 493. The practice of fucking the poifon out of wounds recommended, ibid. note. Poifonous plants ought to be deftroyed in the neighbourhood of towns, 494. Negro remedy to cure the bite of a rattle-fnake, 495. General rules for fecurity againft poifons, 496. Poor living, the dangers of, 45. Porters fubject to diforders of the lungs, 42. Poftures, confined, injurious to'the health of fedentary artifts, 51- Poverty occafions parents to neglect giving their children proper exercife, 25. Deftroys parental affection, ibid..note. Not only occafions, but aggravates, many of the difeafes of la- bourers, 45. The poor great fufferers by the fale of bad provifions, 64. And by bad air in large cities, 78. Poultices proper for inflamed wounds, 581. Powders, general inftructions for making and adminiftering, 659. Arfenic powder, ibid. Aftringent powder, ibid. Powder of bole, 696. Carminative powder, ibid. Diuretic powder, ibid. Aromatic purging powder, ibid. Mercurial powder, 697. Nitrous powder, ibid. Saline laxative pow- der, ibid. Steel powder, ibid. Sudorific powder, ibid. Worm powder, ibid. Purging worm powder, 698. Pow- der for the tapeworm, ibid. Pox, INDEX. 747 LPwc, fmajl, who moft liable to, and at what feafons,, 225. Its caufes and fymptoms, ibid. Favourable and unfavourable fymptoms in, 226. 227. Regimen, ibid. How the patient ought to be treated during the eruptive fever, 221. Chil- dren in this diforder ought not to lie together in the fame bed, 229. Should be allowed clean linen, ibid. Patients under this diforder ought not to appear in public view, 230. Medical treatment, 231. The fecondary fever, 234. When and how to open the puftules, 235. Of inoculation, 237. Pregnancy, how to treat vomiting when the effect of, 3 2^. Rules of conduct for women under the diforders incident to, 534. Caufes and fymptoms of abortion, 535. How to guard againft abortion, 536. Treatment in cafes of abortion, ibid. Childbirth, 537. Provifions, unfound, the fale of, a public injury, 64. Puerperal fever. See Fever. Purges, the frequent taking of them renders the habitual ufe of them neceffary, 125. Their efficacy in agues, 155. Pro- per form for an inflammation of the inteftines, 300. Ufe- ful in rheumatifm, 396, note. Form of a gentle purge for infants difordered in the bowels, 547. For the Thrufh, 549. Puftules in the fmall pox, favourable and unfavourable appear- ances of, 225. 226. The fuppuration of, to be promoted/ 232. When and how to open, 23 c. Putrid fever. See Fever. i <^ Quacks put out more eyes than they cure, 464. Quackery, how to deftroy, xxi. Quakers, their mode of dreffing recommended, 95. Quinfey, a common and dangerous diforder, and to whom moft fatal, 272. Its caufes, ibid. Symptoms, 273. Regimen, 274. Medical applications, 275. How to promote fuppu- ration, 277. How to nourifh the patient when he cannot fwallow, ibid. Advice to perfons fubject to this diforder, 278. -, malignant, who moft fubject to, and its caufes, 279. Its fymptoms, ibid. Regimen and medical treatment, 281. R. Rattlefnake, Negro remedy for the cure of its bite, 495. Regimen ought to co-operate with medicine to accomplifh the cure of difeafes, ix. Will often cure difeafes without medi- cine, 144. See Aliment. 3 H2 Religionf 74« INDEX Religion, true, calculated to fupport the mind under every aifliction, 123- The inftructors in, ought not to dwell too much on gloomy fubjects, ibid. Remitting fever. See Fever. Repletion, impairs the digeftive power, 74. Difeafes occafioned by, 75. How to treat a loofenefs produced by, 319. Refentment, the indulgence of, injurious to the conftitution, 114. Riefins, and effential oils, the proper menftruum for, 699. Refpiration, how to reftore in a drowned perfon, 611. Rheumatifm, acute and chronic diftinguifhed, 395. Caufes, ibid. Symptoms, 396. Medical treatment, ibid. Cautions to perfons fubject to this diforder, 398. Rickets, the appearance of, in Britain, dated from the growth of manufactures and fedentary employments, 23- The caufes of, 564, Symptoms, 565. Regimen, and medical treatment, 566. Rollers, pernicious tendency of applying them round the bodies of infants, 13. Romans, ancient, their great attention to the cleanlinefs of their townc, 104, note. Rofes, conferve of, its great virtue againft haemorrhages, 344. 349- Rofemary, the external application of, a popular remedy for the cramp, 459, note. Ruptures, are chiefly incident to children and very old perfons, 600. The caufes reflectively, ibid. Method of treatment, ibid. Cutting fhould be avoided if poffible, 602. Cautions for perfons afflicted with a rupture, ibid. Often prove fiital before difcovered, ibid. note. Rutherford, Dr. his preparation for the cure of a dyfentery, 356. note. S. Sailors, their health injured by change of climate, hard weather, and bad provifions, 46. Many of their difeafes fpring from intemperance, ibid. Ought to guard againft wet clothes, ibid. How the ill effects of fait provifions might be corrected, ibid. Peruvian bark the beft antidote to failors on a foreign coaft, 48. Cleanlinefs greatly conducive to their health, 106. Sal prunella, its good effects in a quinfey, 276. Saline draughts, of good ufe for flopping a vomiting, 325. Preparation of, for this purpofe, ibid. Peculiarly good in the puerperal fever, 543. Salivation not neceffary in the cure of the venereal difeafe, 515, Salt and Sugar, their ufe in fpitting of blood, 348. Sarfaparilla, INDEX. 740 Sarfaparilla, a powerful affiftant in venereal cafles, 516. Scabbed heaa in children, difficult to cure, 556. Medical treat, ment, 557. Scarlet fever. See Fever. School, fending children there too young, its bad confequences, 26, Ought to be feated in a dry air, and not to be too much crowded, 34. i Schirrus in the liver, proper regimen is the cafe of, 315. See Cancer. Scrophula, nature of this difeafe, and its caufes, 405. Symp- toms, and regimen, 406. Medical treatment, 407. Scurvy, why prevalent among the Englifh, 66. Where moft prevalent, and the tvvodiftinctionsof, 400. Caufes of, ibid. Symptoms and cure, 401. Inftruytjons to fea-faring men 492. Extraordinary effects of milk, 403. Proper liquors, ibid. Sedentary life, includes the greater part of the human fpecies, 48. Few perfons follow agriculture who are capable of other bufinefs, 49. Sedentary and a£Hve employments ought to be intermixed, for the fake of health, ibid. Artifts fuffer from unwholefome air, by being crowded together, ibid. The poftures artifts are confined to injurious to health, 50. Dif- orders produced by, ibid. Cautions, offered to the fedentary, 53, Sedentary amufements improper for fedentary perfons, ibid. Hints relating to improper food, ibid. Exercife a furer relief for low fpirits than drinking, ibid. Gardening a whole- fome amufement for the fedentary, ibid. Diforders occa- fioned by intenfe ftudy, $6, Dietetical advice to the feden- tary, 73. Sedentary occupations better adapted to women than men, 85, nste. | Sea water a good remedy in the king's evil, 407. Senfes, diforders of, 464. Seton, fometimes has extraordinary effects in an inflammation of the eyes, 270. Is of fervice for preventing apoplexies, 421. The beft method of making it, 437. Shoe, tight, the bad confequences refulting from, 93. The high heels of women's fhoes, 94. Sibbins, a venereal diforder fo termed in the weft of Scotland* how to cure, 521, note. Sick, the mutual danger incurred by unneceffary vifitors to, 109. Perfons in health to be kept at a diftance from the fick, 110. Proper nurfes ought to be employed about them, 111. Jnftructions for avoiding infection, 112. Tolling of bells for the dead very dangerous to, l \6. Their fears ought not to be alarmed, \\$. 750 INDEX. Sight injured by ftudying by candle-light, 58. Simples, a lift of thofe proper to be kept for private practice, 661, Sinapifms, the general intentions of, 666. Directions for making of, ibid. Sleep, the due proportion of, not eafy to fix, 89. How to make it refrefhing, 90. Complaints of the want of, chiefly made by the indolent, ibid. Heavy fuppers caufe uneafy nights, ibid. Anxiety deftructive of fleep, 91. That in the fore- part of the night moft refrefhing, ibid. Early rifers the longeft livers, ibid. note. Sleeping in the fun, the danger of, 44. Smallpox. See Pox. Smell, injuries to which the fenfe of, is liable, with the reme- dies applicable to, 471. Soap, Alicant, recommended in the ftone, 335. Soap lees, how to take, 336. Solanum. See Nightfhade. Specks in the eye, how cured, 467. Spine often bent by artifts working in unfavourable poftures, 51. Spirit, rectified, the direct menftruum for refins and effential oils of vegetable, 699. Of wine, camphorated, how to prepare, 703. Spirit of Mindererus, ibid. Spirits, lownefs of, the general forerunner of a nervous fever, 193. The proper remedies for, 454. Cautions to perfons under this complaint, 455. Spirituous liquors, when good in the colic, 303. And for gouty complaints in the ftomach, 371. Should be avoided by all perfons afflicted with nervous diforders, 431. The ufe of, often fatal, 624. .Spitting.of blood. See Blood. Sponge, may be ufed to fupply the want of agaric as a ftyptic, 5 79, note. Its ufe in extracting fubftances ftopped in the gul- let, 607. Sports, active, far more wholefome than fedentary amufements, 87. Golf, a better exercife than cricket, ibid. note. ' Spots in the eye how to treat, 467. Squinting, how to correct the habit of, 467. Stays, a ridiculous and pernicious article of female drefs, 15, 93. The wearing of, tends to produce cancers in the breafts, 475. Strenutatories, preparations of, recommended for reftoring loft fmell, 472. Sticking Plafter is the beft application for flight wounds, 580. Stomach, exercife the beft cure for diforders of, 85. Inflamma- tion of, a diforder that calls for fp«edy affiftance, 296. Its caufes, I N D E X. 15t caufes, ibid. Symptoms, ibid. Regimen, 297. Medical treatment, ibid. Pain in, its caufes, 369. "Remedies for, 370. lnftructions for perfons fubject to, 372. Stone, the formation of, in the bladder, explained, 127. This dif >rder how diftinguifhed from the gravel, 333. Caufes and fymptoms, ibid. Regimen, 334. Medical treatment, 335. Alicant foap and lime-water, how to take for this diforder, ibid. The uva urfi, a remedy in prefent requeft for, 337. Stool, loofe, the benefit of, to children, 37. Proper treatment of, when exceffive, ibid. The difcharge by, cannot be regu- lar, if the mode of living be irregular, 124. One in a day generally fufficient for an adult, 125. How to produce a regularity of, ibid. Frequent recourfe to medicines for cof- tivenefs, injurious to the conftitution, ibid. Stork, Dr. his method of treating cancers, 477. Strabifinus. See Squinting. Strains, proper method of treating, 599. The fafeft external applications, ibid, note. Strangury, from a bliftering plafter, how to guard againft, 171. In the fmall-pox, how to relieve, 232. From a venereal caufe, defcribed, with its proper treatment, 511. Strangulation, courfe of treatment for the recovery of perfons from, 628. Strength, the folly of trials of, from emulation, 40, 44. Study, intenfe injurious to health, 55. The diforders occafioned by 56. Character of a mere ftudent, 59. Hints of advice to ftudious perfons, 60. Danger of their having recourfe to cordials, 61. Health often neglected while in poffeffion, and laboured for after it is deftroyed, 62. No perfon ought to ftu- dy immediately after a full meal, 63. Dietetical advice to the ftudious, 73. The general effects of, on the conftitu- tion, 428. Suffocation, by the fumes of charcoal, liable to happen in clofe chambers, 614. General caufes of fuffocation, 626. Over- laying of infants, 627. Sugar, an improper article in the food of children, 19. Sulphur, a good remedy for expelling worms, 376. And for the itch, 410. Suppers, ought not to deftroy the appetite for breakfaft, 75. Heavy fuppers fure to occafion uneafy nights, 90. Surgery, many of the operations of, fuccefsfully performed by perfons unfkilled in anatomy, 571. Humanity induces every one more or lefs to be a furgeon, ibid. Sweating, 7$2 INDEX. Sweating, generally excited in an improper maimer, in fevers, 151. 164. Snvoonings, die feveral caufes of, defcribed, 440. Proper treat- ment of this diforder, 441. 618. Cautions to perfotis fubject to them, 623. Sydenham, Dr. his method of treating fevers in children from teething, 563. Symptoms, difeafes better diftinguifhed by, than by the fyftemati- cal arrangement of, 139. The differences of fex, age, and conftitution, to be considered, 140. Difeafes of the mind to be diftinguifhed from thofe of the body, 141. Syncope, proper treatment in, 619. Syrups, the general intention of, 699. How to make fimple fyrup, and to modify it for particular purpofes, ibid. T. Tacitus, his remark on the degeneracy of the Roman ladies* 4, note. Tallow chandlers, and others working on putrid animal fubftan- ces, cautions to, 41. Tapping for the dropfy, a fafe and fimple operation, 386. Tar, Barbadoes, its efficacy in the nervous colic, 307. Tartar, foluble, a good remedy for the jaundice, 381. Cream of, a good remedy in a dropfy, 385. And rheumatifm, 397- Tafte, how to reftore the fenfe of, when injured, 473. Tailors, are expofed to injuries from breathing confined air, 50. Are fubject to confumptions, ibid. note. Often lofe the ufe of their legs, 51. Hints of inftruction offered to them in re- gard to their health, $2. Tea, the cuftomary ufe of, injurious to female conftitutions. 7. Deftroys their digeftive powers, and produces hyfterics, 67. The bad qualities of, principally owing to imprudence in the ufe of it, ibid. Green, chewing of, a remedy for the heart- burn, 427. Has a powerful effect upon the nerves, 438, note. Is bad for perfons troubled with flatulencies, 453. Teething, the diforders attending, 561. Regimen, and medi- cal treatment in, 562. Applications to the gums, and how tocutthem,*563. Tmperance, the parent of health, 96. Tejlkles, fwelled, the caufe of, 507. Regimen and medicine m, ibid. Treatment under a cancerous or ferophulous ha- bit, 508. Thirft, how it maybe quenched when a perfon is hot, without danger, 135. 1 Thought, INDEX. 753 Thought, intenfe, deftructive of health, 55. Thrujh in infants, the diforder and its caufes defcribad, 549. Medical treatment of, ibid. Tinclures and elixirs, the proper medicines to exhibit in the form of, 699. Preparations of the aromatic tincture, 700. Tinc- ture of the bark, ibid. Tincture of cinnamon, ibid. ' Foetid tincture, ibid. Tincture of gum guaiacum, ibid. Tincture of black hellebore, 701. Aftringent tincture, ibid. Tincture of myrrh and aloes, ibid. Tincture of opium, or liquid lauda- num, ibid. Tincture of aloes, ibid. Compound tincture of fenna, 702. Tincture of Spanifh flies, ibid. Tincture of rhu- barb, ibid. Tiffot, Dr. character of his Avis au Peuple, xi. His medical courfe for the cure of the hydrophobia, 491. His directions for gathering, preparing, and applying agaric of the oak as a ftyptic, 579, note. Inftances from, of the recovery of drowned , perfons, 612. Tobacco, a clyfter of a decoaion of, ufeful to excite vomiting, 608. A clyfter of the fumes of, will ftimulate the inteftines, and produce a ftool, 307. Toes, the free motion of, deftroyed by wearing tight flioes, 94. Tooth-ach, the general caufes of, 364. Medical treatment of, 365. When recourfe muft be had to extraction, 366. Di- rections for cleaning the teeth, 367. Touch, injuries to which the fenfe of, is liable, with the reme- dies applicable to, 473. Towns, great, the air of, deftructive to the children of the poor, 32. Children bred in the country ought not to be fent too early into towns, 34. Cleanlinefs not fufficiently attended to in, 103. Ought to be fupplied with plenty of water for wafhing the ftreets, 108, note. The beft means to guard againft infection in, 112. Trades, fome injurious to health by making artifts breathe un- wholefome air, 39. 52. Tranfitions, fudden, from heat to cold, the ill effects of, to the conftitution, 134. Travellers, the ufe of vinegar recommended to, 47. Ought to be very careful not to fleep in damp beds, 131. Fevers why often fatal to, 148. Trees fhould not be planted too near to houfes, 81. Trefoil water, a good remedy in the rheumatifm, 399. Tumours, proper treatment of, 576. Turner's cerate, preparation of, 686 » I Vaptur 7*4 INDEX. V. Vapour oi fermenting liquors, noxious nature of, 614. Vegetables, wholefome correctors of the bad qualities of animal food, 66. Their extraordinary effects in the fcurvy, 404. Venereal difeafe, why omitted in the firft edition of this work, 487. Unfavourable circumftances attending this diforder, ibid. The virulent gonorrhoea, 498. Gleets, 504. Swell- ed tefticles, 507. Buboes, 508. Chancres, 510. Stran- gury, 511. Phymofis, 512. A confirmed lues, 513. American method of curing this difeafe, 517. General ob- fervations. 518. Cleanlinefs a great preiervative againft, 520. The ufe of medicines ought not to be haftily dropped, 522. Is often too much difregarded, 523, Ventilators, the moft ufeful of all modern medical improve- ments, 79. Vertigo often produced by intenfe ftudy, 58. Vinegar, a great antidote againft difeaies, and ought to be ufed by all travellers, 47. Should be fprinkled in fick cham- bers, 112. 165. 203. Is of confiderable fervice in the bite of a mad dog, 488; and in any kind of poifon, 493. Its medical properties, 704. Is of ufe to extract the virtues of feveral medical fubftances, ibid. How to prepare vinegar of litharge, ibid. Vinegar of Squills, 705. Viper, the bite of, the fufficiency of the greafe for the cure of, doubted, 493. Method of treatment recommended, ibid. Vitriol blue, its ufe in epilepfy, 443. Vitriol, elixir of, an excellent medicine in weakneffes of the fto- mach, 425. Spirit of, in gravel, 337. And for windy complaints, 433. Vitus, St. his dance, method of cure of, 44.3. Vomiting and p irging, of children. Caufes, fymptoms, re- gimen, and method of cure, 325. Vomits, their ufe in agues, 154; and in the nervous fever, 195. C.iuiion for adminifteriog in the putrid fever, 205. Ought by no mea^s to be adminiftered in an inflammation of the ft mach, 297. Are ufeful in cafes of repletion, 319. Are the firft object to be purfued when poifon has been received into the ftomach, 481. Their ufe in whooping cough, and how to adminifter ihem to children, 293. Form of a gentle one for infants difordered in the b