UNITED STATES OF AMERICA *■ * . FOUNDED 1836 WASHINGTON, D. C. GPO 16—67244-1 \T ----iff. & ;ff v , \ Bost MEokiAL Library Association, ig BoYLSTch^ PLACE, ^ ♦ \ Received........................ / By Gift of........................... J\ Y\0 (Wt 'vTW'S-a. 4.--X-.V.■■ .yrysA mas ID r vw to? ,'^'i »■ \ ^: :\^ ..^ ^.~*. / /T\ y^#w :\^.b0 h y^hcrtiaJ iW^/fwnctn / SO (a h^ i> ^ 0 - s V ^*Ti 1.. ..'•• ■. > > DOMESTIC MEDICINE: OR, A TREATISE -^ ON THE PREVENTION AND CURE OF DISEASES, BY REGIMEN AND SIMPLE MEDICINES. ,WITH AN APPENDIX, CONTAINING A DISPENSATORY FOR THE USE OF PRIVATE PRACTITIONERS. TO WHICH ARE ADDED, OBSERVATIONS ON DIET; RECOMMENDING A METHOD OF LIVING LESS EXPENSIVE, AND MORE CONDL'SIVE TO HEALTH, THAN THE PRESENT. BY W. BUCHAN, M. D. ENLARGED FROM THE AUTH^R'S^LAsf ijfaj'Igift.^ "^ ■■$ | SJhGr.;>Ti JEUcfUuS OFFICE NEW-YORK^l HAW* PUBLISHED BY RICHARD SCOTT, NO. 276 PEARL-STREET. —ewmo 1812 ........ cuu.., -STREET. _ k _ 4 Priutcd by D. gc O. BKUCE, No. 20 Slote Lmc. ADVERTISEMENT. THE present edition of the "Domestic Medicine," claims no otiier pre-eminence over former impressions, than that it is a eopy of the Author's last revisal. From an examination of the several revised editions of this work, which have been published in the United States, it appears, a particular defer- ence has been shewn to the Author's opinion, and the improvements to be chiefly in addition. From this consideration, which no doubt originated, not only from the correctness of the Author's principles and practice, but from the deservedly high estimation in which the public hold the original work, the Publisher of the present impression was in- duced not to admit of any alterations.—The articles which have been added to this edition, from the sources whence they havq been derived, whether original or selected, win" no doubt enhance its value. The new matter in the body of the Work, is marked with a Section, and that of the Notes will readily be distinguished by the letters, a. v. ADVERTISEMENT BY DR. BUCHAN. THE Anthor, having been in constant practice since the first ap- pearance of this Book, has taken occasion in the later Editions through which it has passed, to improve many articles which were inserted with less accuracy in the more early impressions. To the preceding Edition was added a Chapter on Diet, recommending a method of living less expensive, and mose conducive to health, than the present. Several other improvements have been also made in the form of notes to illus- trate the text, or put people on their guard in dangerous situations, and prevent fatal mistakes in the practice of medicine, which, it is to be re- gretted, are but too common. Although the Domestic Medicine was never intended to supersede the use of a Physician, but to supply his place in situations where medi- cal assistance could not easily be obtained; the Author is sorry to ob- serve, that the jealousies and fears of some of the Faculty have prompted them to treat the Work in a manner very unbecoming the Professors of a liberal science: notwithstanding this injurious treatment, convinced of the utility of his plan, he shall spare no pains to make it more useful; determined that neither interest uor prejudice shall ever deter him from exerting his best endeavours to render the Medital Art more extensively beneficial to Mankind. New-Store Street, Bedford Square, \ June *, 179$. J PREFACE. WHEN I first signified my intention of publishing the following sheets, I was told by my friends it would draw on me the resentment of t he Faculty As I never could entertain such an unfavourable idea, I was resolved to make the experiment, which indeed came out pret- ty much as might have been expected. Many whose learning and libe- rality of sentiments do honour to medicine, received the book in a manner which at once shewed their indulgence, and the fa «ty of the opinion tluxt every physician wishes to conceal his art; while the more selfish and narrow-minded, generally themost numerous in every pro- fession, have not failed to persecute both the book and its authoi. The reception, however, which this work has met with from the Public, merits my most grateful acknowledgments. As the belt way of expressing these, I have endeavoured to render it more generally useful, by enlarging the protasis, or that part which.treats of pre- venting diseases; and by adding many articles which had been en- tirely omitted in the former impressions. It is needless to enumerate these additions; I shall only say, that I hope they will be found real ^Th^observations relative to Nursing and the Management of chil- dren, were chiefly suggested by an extensive practice among infants, in a large branch of the Foundling Hospital, where I hadan oppor- tunity not only of treating the diseases incident to childhood, but like- wise of trying different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and to be sa- tibfied that they performed it, very few of them died ; but, when from distance of place, and other unavoidable circumstances, the children were left to the sole care of mercenary nurses, without any person to instruct andsuperintend them, scarce any of them lived. This was so apparent, as with me to amount to a proot ot the fol- lowing melancholy fact: Tliat almost one half of the human specus perish, in infancy, by improper management or neglect: This reflection has made me often wish to be the happy instrument of alleviating the miseries of those suffering innocents, or of rescuing them from an un- timely grave. No one, who has not had an opportunity of observing them, can imagine what absurd and ridiculous practices still prevail in the musing aud management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to iguorance, it is to be hoped, that when nurses are better informed, their conduct will be more proper. The application of medicine to the various occupations ot lite has been in general the result of observation. An extensive practice for several years, in one of the largest manufacturing towns in England, afforded me sufficient opportunities of observing the injuries which those useful people sustain from their particular employments, and A2 vi PREFACE. likewise of trying various methods of obviating such injuries. The success which attended these trials was sufficient to encourage this attempt, which I hope will be of use to those who are under the ne. cessity of eating their bread by such employments as are unfavourable to health. I do not mean to intimidate men, far less to insinuate that even those arts, the practice of which is attended with some degree of danger, should not be carried on ; but to guard the less cautious and unwary against those dangers which they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occupation in life disposes those who follow it to some parti- cular diseases more than to others, it is certainly of importance to know these, in order that people may be upon their guard against them. It is always better to be warned of the approach of an enemy, than to be surprised by him, especially when there is a possibility of avoiding the danger. The observations concerning Diet, Air, Exercise, &c. are of a more general nature, and have not Escaped the attention of physi- cians in any age. They are subjects of too great importance, how- ever, to be passed over in an attempt of this kind, and can never be sufficiently recommended. The man who pays a proper attention to these, will seldom need the physician ; and he who does not, will seldom enjoy health, let him employ as many physicians as he pleases. Though we have endeavoured to point out the causes of diseases, and to put people npon their guard against them, yet it must be ac- knowledged that they are often of such a nature as to admit of being removed only by the diligence and activity of the public magistrate. We are sorry, indeed, to observe, that the power of the* magistrate is seldom exerted in this country for the preservation of health. The importance of a proper medical police is either not understood, or lit- tle regarded. Many things highly injurious to the public health are daily practised with impunity, while others absolutely necessary for its perservation, are entirely neglected. Some of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widening the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, ike. ; but they are passed over in a very curso- ry manner. A proper attention to these would have swelled this vol- ume to too large a size; I have therefore reserved them for the subject of a future publication. In the treatment of diseases, I have been pecnliarly attentive to regimen. The generality of people lay too much stress upon Medi- cine, and trust too little to their own endeavours. 11 is always in the power of the patient, or of those about him, to do as much towards his recovery as can be effected by the physician. By not attending to this, the designs of medicine are often frustrated ; and the patient, by pursuing a wrong plan of regimen, not only defeats the Doctor's en- favours, but renders them dangerous. I have often known patients killed by an error in regimen, when they were using very proper me- dicines. It will be said, the physician always orders the regimen when lie prescribes a medicine. I wish it were so, both for the honour of the faculty and the safety of their patients : but physicians, as well as other people, are too little attentive to this matter. PREFACE. vii Though many reckon It doubtful whether physic is beneficial or hurtful to mankind, yet all allow the necessity and importance, of a pro- per regimen in diseases. Indeed the very appetites of the sick prove its propriety. No man in his senses, ever imagined that a person in a fever for example, could eat, drink, or conduct himself in the same manner as one in perfect health. This part of medicine, therefore, is evidently founded in Nature, and is every way consistent with reason and common sense. Had men been more attentive to it, and less soli- citous in hunting after secret remedies, Medicine had never become an object of ridicule. This seems to have been the first idea of Medicine. The ancient physicians ,:c'cd chiefly in the capacity of nurses. They went very little beyond aliment in their prescriptions ; and even this they general- ly administered themselves, attending the sick for that purpose through the whole course of the disease ; which gave them an opportunity not only of marking the changes of diseases with great accuracy, but like- wise of observing the effects of their different applications, and adapting them to the symptoms. The learned Dr. Aibuthnot asserts, that by a proper attention to those things which are almost within the reach of every body, more good and less mischief will be done in acute diseases, than by medi- cines improperly and unseasonably administered ; and that great cures may be effected in chronic distempers, by a proper regimen of the diet only. So entirely do the Doctor's sentiments and mine agree, that I would advise every person, ignorant of physic, to confine his practice solely to diet, and the other parts of regimen ; by which means he may often do much good, and can seldom do any hurt. This seems also to have been the opinion of the ingenious Doctor Huxam, who observes, that we often seek from Art what all-bounti- ful Nature most readily, and as effectually, offers us, had we diligence and sagacity enough to observe and make use of them j that the dietetic part of Medicine is not so much studied as it ought to be ; and that though less pompous, yet it is the most natural method of curing diseases. To render this book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have in most dis- eases, besides regimen, recommended some of the most simple and approved forms of medicine, and added such cautions and directions as seemed necessary for their safe administration. It would no doubt have been more acceptable to many, had it abounded with pompons prescriptions, and promised great cures in consequence of their use ; but this was not my plan: I think the administration of medicines always doubtful, ana often dangerous, and would much rather teach men how to avoid the necessity of using them, than how they should be used. Several medicines, and those of considerable efficacy, may be ad- ministered with great freedom and safety. Physicians generally tri- fle a long time with medicines before they learn their proper use. Many peasants at present know better how to use some of the most important articles in the materia medica, than physicians did a centu- ry ago ; and doubtless the same observations will hold with regard to others some time hence. Wherever I was convinced that medicine might be used with safety, 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 necessary, it is omitted. viii PREFACE. I have not troubled the reader with an useless parade of quotations from different authors, but have in general adopted their observations where my own were cither defective, or totally wanting. Those to whom I am most obliged are, Ramizini, Arbuthnot, and Tissot ; the last of which, in his Avis du peuple, comes the nearest to my views of any author which I have seeu. Had the Doctor's plan be«n as complete as the execution is masterly, we should have had no occasion for any new treatise of this kind soon ; but by confining himself to the acute diseases, he has in my opinion omitted the most useful part of his subject. People in acute diseases may sometimes be their own physicians; but in chronic case;, the cure must ever depend chief- ly upon the patient's own endeavours. The Doctor has also passed over the Prophylaxis, or preventive part of medicine very slightly, though it is certainly of the greatest importance in such a work. He had no doubt his reasons for so doing ; and I am so far from finding fanlt with him, that I think his performance does great honour both to his head and his heart. Several other foreign physicians of eminence have written on near- ly the same plan with Tissot, as the Baron Van Swienten, physician to their Imperial Majesties, M. Rosen, first physician of the king. dom of Sweden, &c.; but these gentlemen's productions have never come to my hand. I cannot help wishing, however, that some of our distinguished countrymen would follow their example. There still remains much to be done on this subject, and it does not appear to me how any man could better employ his time or talents, than in era- dicating hurtful prejudices, and diffusing useful knowledge among the people. I know some of the faculty disapprove of every attempt of this na- ture, imagining that it must totally destroy their influence. Bnt this notion appears to me to be as absurd as it is illiberal. People in dis- tress will always apply for relief to men of superior abilities, when they have it in their power ; and they will do this with far greater confidence and readiness when they believe that medicine is a rational science, than wlien they take it to be only a matter of mere conjecture. Though I have endeavoured to render this Treatise plain and useful, yet I found it impossible to avoid some terms of art, but those are in general either explained, or are such as most people understand. In short, I have endeavoured to conform my style to the capacities of mankind in general ; and, if my readers do not flatter either them- selves or me, with some degree of success. On a medical subject, this is not so easy a matter as some may imagine. To make a shew of learning is easier than to write plain sense, especially in a science which has been kept at such a distance from common observation. It would however be no difficult matter to prove, that every thing valuable in the practical part of medicine is within the reach of com- mon abilities. It would he ungenerous not to express my warmest acknowledg- ments to thote gentlemen who have endeavoured to extend the useful- ness of this performance, by translating it into the language of their respective countries. Most of them have not only given elegant trans- lations of the book, but have also enriched it with many useful obser- vations, by which it is rendered more complete, and better adapted to the climate and the constitutions of their countrymen. To the learned Dr. Duplaml of Paris, physician to the Count d'Artois, I lie under par-' ticular obligations; as this gentleman has not only considerably enlarg- PREFACE. ed my treatise, but, by his very ingenious and useful notes, has rendered it so popular on the Continent, as to occasion its being translated into all the languages of modern Europe. I have only to add, that the book has not more exceeded my expec- tations in its success, than in the effects it has produced. Some of the most pernicious practices, with regard to the treatment of the sick, have already given place to a more rational conduct; and many of the most hurtful prejudice?, which seemed to be quite insurmountable, have in a great measure yielded to better information. Of this a stronger instance cannot be given than the inoculation of the small pox. Few mothers, some years ago, would submit to have their children inoculated even by the hand of a physician ; yet nothing is more certain, than that of late many of them have performed this operation with their own hands ; and as their success has been equal to that of the most dignified inocu- lators, there is little reason to doubt that the practice will become gene- ral. Whenever this shall be the case, more lives will be saved by inoc- ulation alone, than are at present by all the endeavours of the Faculty. INTRODUCTION. J. HE improvements in Medicine, since the revival of learning, have by no means kept pace with those of the other arts. The reason is ob- vious. Medicine has been studied by few, except those who intended to live by it as a business. Such either from a mistaken zeal for the honour of Medicine, or to raise their own importance, have endeavour- ed to disguise and conceal the art. Medical authors have generally written in a foreign language ■, and those who were unequal to this task, have even valued themselves upon couching, at least, their pre- scriptions, in terms and characters umntellible to the rest of mankind. The contentions of the clergy, which soon happened after the resto- ration of learning,' engaged the attention of mankind, and paved the way for that freedom of thought and enquiry, which has since prevail- ed in most parts of Europe with regard to religious matters. Every man took a side in those bloody disputes ; and every gentleman, that he might distinguish himself on one side or other, was instructed in Divinity. This taught people to think and reason for themselves in matters of religion, and at last totally destroyed that complete and absolute dominion which the clergy had obtained over the minds of men. The study of Law has likewise, in most civilized nations, been just- ly deemed a necessary part of the education of a gentleman. Every gentleman ought certainly to know at least the laws of his own country; and, if he were also acquainted with those of others, it might be more than barely an ornament to him. The different branches of Philosophy have also of late been very universally studied by all who pretended to a liberal education. The advantages of this are manifest. It frees the mind from prejudice and superstition, fits it for the investigation of truth ; induces habits of reasoning and judging properly ; opens an inexhaustable source of enter- tainment ; paves the way to the improvement of aits and agriculture; and qualities men for acting with propriety in the most important sta- tions of life. Natural History is likewise become an object of general attention; and it well deserves to be so. It leads to discoveries of the greatest importance. Indeed agriculture, the most useful of all arts, is only a branch of Natural History, and can never arrive at a high degree of improvement where the study of that science is neglected. Medicine however, has not, as far as I know, in any country, been reckoned a necessary par! of the education of a gentleman. But surely no sufficient reason can bo assigned for this omission. No science lays open a more extensive field of useful knowledge, or affords more ample entertainment to an inquisitive mind. Anatomy, Botany, Chemistry, and the Materia Medica, are all branches of Natural History, and arc fraught with such amusement and utility, that the man who entire- ly neglects them has but a sorry claim either to taste or learning. If a gentleman has a turn for observation, says an excellent aud sensible INTRODUCTION. writer,* sure'y tbe natural Idstory of his own species is a more interes- ting subject, and presents a more ample field for the exertion of genius, than the natural history of spiders and cockle-shells. We do not mean that every man should become a physician. This would be an attempt as ridiculous as it is impossible. All we plead for is, that men of sense and learning should be so far acquainted with the general principles of Medicine, as to be in a condition to derive from it some of those advantages with which it is fraught; and at the same time to guard themselves against the destructive influences of ignorance, superstition and quackery. # As matters stand at present, it is easier to cheat a man out of his life than of a shilling, and almost impossible either to detect or punish the offender. Notwithstanding this, people still shut their eyes, and take every thing upon trust that is administered by any Pretender to medicine, without daring to ask him a reason for any part of his conduct. Implicit faith, every where else the object of ridicule, is still sacred here. Many of the faculty are no doubt worthy of all the confidence thai can be reposed in them ; but as this can never be the character of every individual in any profession, it would certainly be for the safety, as well as the honour of mankind, to have some check npon the conduct of those to whom they entrust so valuable a treasure as health. The veil of mystery, which still hangs over Medicine, renders it not only a conjectural, but even a suspicious art. This has been long ago removed from the other sciences, which induces many to believe that medicine is a mere trick, and that it will not bear a fair and candid ex- amination. Medicine, however, needs only to be better known, in or- der to secure the general esteem of mankind. Its precepts are such as every wise man would chuse to observe, and it forbids nothing but what is incompatible with true happiness. Disguising Medicine not only retards its improvement as a science, but exposes the profession to ridicule, and is injurious to the true inter- ests of society. An art founded on observation never can arrive at any high degree of improvement, while it is confined to a few who make u trade of it. The united observations of all the ingenious and sensible part of mankind, would do more in a few years towards the improve- ment of Medicine, than those of the Faculty alone in a great many. Any man can tell when a medicine gives him ease as well as a physician; and if he only knows the name and dose of the medicine, and the name of the disease, it is sufficient to perpetuate the fact. Yet the man who adds one single fact to the stock of medical observations, does more real service to the art, than he who writes a volume in support of some favourite hypothesis. Very few of the valuable discoveries in medicine have been made by physicians. They have in general either been the effect of chance or of necessity, and have been usually opposed by the Faculty; till every one else was convinced of their importance. An implicit faith in the opinions of teachers, an attachment to systems and established forms, and the dread of reflections, will always operate upon those who follow medicine as a trade. Few improvements are to be expected from a man who might ruin his character and family by the smallest deviation from an established rule. Observations on tie Duties and Offices of a Pbj-sicira. xii INTRODUCTION. If men of letters, %ays the author of the performance quoted above, were to claim their right of inquiry into a matter that so nearly concerns them, the good effects on medicine would soon appear. Such men would haverno separate interest from that of the art. They would de- tect and expose assuming Ignorance under the mask of Gravity and Importance, and would be the judges and patrons of modest merit Not having their understandings perverted in their youth by false the- ories, unawed by authority, and unbiassed by interest, they would can- vass with freedom the most universally received principles in medicine, and expose the uncertainty of many of those doctrines, of which a phy- sician dares not so much as seem to doubt. No argument, continues he, can be brought against laying open medi- cine, which does not apply with equal, if not greater force to religion; yet experience has shewn, that since the laity have asserted their right of inquiry into these subjects, Theology, considered as a science, has been improved, the interests of real religion have been promoted, and the clergy have become a more learned, a more useful, and a more respectable body of men, than they ever were in the days of their greatest power and splendour. Had other medical writer* been as honest as this gentleman, the art had been upon a very different footing at this day. Most of them extol the merit of those men who brought Philosophy out of the schools, and subjected it to the rules of common sense. But they never consider that medicine, at present, is in nearly the same situation as philosophy was at that time, and that it might be as much improved by being treated in the same manner. Indeed no science can either be rendered_ rational or useful, wi-thout being submitted to the common sense and' reason of mankind. These alone stamp a value upon science; and what will not bear the test of these ought to be rejected. I know it will be said, that diffusing medical knowledge among the people might induce them to tamper with medicine, and to trust to their own skill instead of calling a physician. The reverse of this however is true. Persons who have the most knowledge in these metters, are commonly most ready both to ask and to follow advice, when it is ne- cessary. The ignorant are always most apt to tamper with medicine, and have the least confidence in physicians. Instances of this are daily to be met with among the ignorant peasants, who, while tliey absolute- ly refuse to take a medicine which has been prescribed by a physician, will swallow with greediness any thing that is recommended to them by their credulous neighbours. Where men will act even without knowledge, it iscertainly more rational to afford them all the light we can, than to leave them entirely in tho dark. It may also be alleged, that laying medicine more open to mankind would lc'sen ilieir faith in it. This would indeed be the case with re- gard to Lome; but it would have a quite contrary effect upon others. I know many people who have the utmost dread and horror of every thing prescribed by a physician, but who will nevertheless very readily take a medicine which they know, and whose qualities they are in some uieasure acquainted wi'h. Hence it is evident, that the dread arises from the doctor, not from the drug. Nothing ever can or will inspire mankind with an absolute confidence in physicians, but an open, frank, and undisguised behaviour. While the least shadow of mystery remains in the conduct of the Faculty, doubts, jealousies and suspicions, will arise in the minds of men. No doubt cases will sometimes occur, where a prndent physician INTRODUCTION". xiii may tind it expedient to disguise a medicine. The whims and hu- mours of men must be regarded by those who mean to do them ser- vice ; but this can never affect the general argument 111 favour of can- dour and openness. A man might as we'l allege, because there are knaves and fools in the world, that he ought to take every one he meets for such, and to treat him accordingly. A sensible physician will al- ways know where disguise is necessary ; but it ought never to appear On the face of bis general conduct. The appearance of mjstery in the conduct of^ physicians not only renders their art suspicious, but lays the foundations of Quackery, winch is the disgrace of Medicine. No two characters can be more different than that of the honest physician and the quack yet they have generally been very much confounded. The line between them is not sufficiently apparent; at least is too fine for the general eye. Few person^ are able to distinguish sufficiently be'ween the conduct of that man who administers a secret medicine, and him who writes a pre- scription in mystical characters and an unknown tongue. Thus the conduct ot the honest physician, which needs no disguise, gives a sanc- tion to that of the villain, whose sole consequence depends upon secrecy. No laws will ever be able to prevent qnackery, while people believe that the quack is as honest a man, and as well qualified, as the physician. A very small degree of i edical knowledge,however, would be sufficient to break this spell; and nothing else can effee ually undeceive them. It is the ignorance anil cieduii'.y of the tiimtiitide, wi h regard to medi- cine, which renders them such an ea:y prey to every one who has tlie hardiness to a* tack them on tins qturter. Nor can the evil be remedi- ed by any other means but by mat ing them wiser. The mosl effectual way to d. str y quackery in any art or science, is to diffise the knowledge of it amou.; mankind. Did phvsician.s write their prescriptions in the commo language of he country, and explain their intentions to the patient, as far a- he could undt island (In >., it would enable him io know whin the medicine had the desired effect; would inspire him with absolute confluence m tuc physician ; and wou'd make him dread and detest every man who pretended (o cram a secret medicine down his throat. Men in the different states of society, have very different views of the same object Sone time ago it was tht practice of tins country for every person to say his prayers in Latin, whether he knew any thing of that language or not. This conduct, though sacred in the eyes of our ancestors, appears ridiculous euoiii h to ns; and doubtless some parts of ouis will seem as strange to poverity. Among these we may reckon the present mode of medical prescription, wind., we venture to affirm, wdl some time hence appear to have been complete- ly ridiculous, and a very high burlesque upon the common stu.se of mankind. But this practice is not only ridiculous, it is likewise dangerous. However capable physicians may be of writing La-tin, I am certain apothecar esarc not always in a cundi'ion to read it, and that danger- ous misiakts, in consequence of this, of in happen. But suppose the apothecary ever so able to read the physician's pre.cr>p ion, he is genen ly otherwise employed, and he business of making up prescrip- tions is let1 entirely to the apprentice. By thi. means ? he greatest man in tli«' kingdom, even when h< et: ploy- a first ra'.e physician, in vea'.ty trusts bis uic m the hands of an idle boy, who has not only the chance Niv INTRODUCTION. of being very ignorant, but likewise giddy and careless. Mistakes will sometimes happen in spite of the greatest care; but, where human lives arc concerned, all possible methods ought certainly to be taken to pre- vent them For this reason, the prescriptions of physicians, instead of being couched in mystical characters, and a dead language, ought, in my humble opinion, to be conceived in the most plain and obvious terms imaginable. Diffusing medical knowledge among the people would not only fend to improve the art and to banish quackery, but likewise to render Medi- cine more universally useful, by extending its benefits to society. However long Medicine may have been known as a science, we will venture to say, that many of its most important purposes to society have either been overlooked, or very little attended to. The cure of diseases is doubtless a matter of great importance , but the preservation of health is of still greater This is the concern of every man, and sure- ly what relates to it ought to be rendered as p'ain and obvious to all as possible. It is not to be supposed, that men can be sufficiently upon their guard against diseases, who are totally ignorant of their causes. Neither can the Legislature, in whose power it is to do much more for preserving the public health than can ever be done by the Faculty, ex- ert that power with propriety, and to the greatest advantage, without some degree of medical knowledge. Men of every occupation and condition in life might avail themselves of a degree of medical knowledge; as it would teach them to avoid the dangers peculiar to their respective stations ; which is always easier than *o remove their effects. Medical knowledge, instead of being a check upon the enjoyments of life, only teaches men how to make the most of them. It has indited been said, that to live medically, is to live miserably: but it might with equal propriety be said, that to live ration- ally is to live miserably. If physicians obtrude their own ridiculous whims upon mankind, or lay down rules inconsistent with reason or common sense, no doubt they wall be dtspised. But this is not tire fault of medicine. It proposes no rules that I know, but such as are perfect- ly consistent with the truejenjoyment of life, and every way conducive to the realhappinesi of mankind. We are sorry indeed to observe, that medicine has hitherto hardly been considered as a popular science, but as a branch of knowledge solely confined to a particular set of men, while all the rest have been ta lit not only to neglect, but even to dread and despise it. It will however appear, upon a more strict examination, that no science better de>erves the attention, or is more capable of being rendered generally useful. People are told, that if they dip the least into medical knowledge,,it will render them fanciful, and make them believe they have every disease of which they read. This I am satisfied will seldom be the case with sensible people; and suppose it were, they must soon be undeceiv- ed. A short time will shew them their error, and a little more reading will infallibly correct it, A single instance will shew the absurdity of this notion. A sensible lady, rather than read a medical performance, which would instruct her in the management of her children, generally leaves them entirely to the care and conduct of the most ignorant, .cred- ulous, and supeistitious part of the human species. No part of medicine is of more general importance than that which relates to the nursing and management of children. Yet few parents nay a proper attention to it. They leave the sole care of their tender INTRODUCTION. XV offspring, at the very time when care and attention are most necessary, to hirelings, who are either too negligent to do their duty or too igno- rant to know it. We will venture to affirm, that more human lives are lost by the carelessness and ina tention of parents and nurses, than are saved by the Faculty ; and that the joint and well-conducted endeavours, both of private persons and the public, for the preservation of infant lives, would be of more advantage to society than the whole art of medicine, upon its present footing. The benefits of medicine, as a trade, will ever be confined to those who arc abie to pay for them ; and of course, the far greater part of mankind will be every where deprived of them. Physicians, like other people, must live by their employment, and the poor must either want advice altogether, or take up with that which is worse than none. There are not however any where wanting well-di?posed people, cf bet- ter sense, who are willing to supply the defect of medical advice to the poor, did not their fear of doing ill often suppress their inclination to do good. Such people are often deterred from the most noble and praise-worthy actions, by the foolish alarms sounded in their ears by a 'ttofmen who, to raise their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the sick which is not conducted by the precise rules of medicine. These gentlemen must however excuse me for say- ing, that I have often known such well-disposed persous do much good ; and that their practice, which is generally the result of good sense and observation, assisted by a little medical reading, is frequently more ra- tional than that of the ignorant retainer of physic, who despises both reason and observation, f hat he may be wrong by rule ; and who while he is dosing his patient with medicines, often neglects other things of far greater importance. Many things are. necessary for the sick besides medicine. Nor is the person who takes care to procure these for them, of less importance than a physician. The poor oftener perish in diseases for want of proper nursing than of medicine. They are frequently in want of even the necessaries of life, and still more so of what is proper for a sick-bed. No one can imagine, who has not been a witness of these situations, liow much good a well-disposed person may do, by only taking care to have snch wants supplied. There certainly cannot be a mere necessa- ry, a more noble, or a more godlike action, than to administer to the wants of our fellow-creatures in distress. While virtue or religion are known among mankind, this conduct Mill be approved; and while Hea- ven is just it must be rewarded! Persons who do not choose to administer medicine to the sick, mav nevertheless direct their regimen. An eminent medical author has said, That by diet alone all the intentions of medicine may be answer- ed.* No doubt a great many of them may; but there are other things besides diet, which ought by no means to be neglected. Many hurtful and destructive prejudices, with regard to the treatment of the sick, still prevail among the people, which persons of better sense and learn- ing alone can eradicate. To guard the poor against the influence of these prejudices, and to instil into their minds some just ideas of the importance of proper food, fresh air, cleanliness, and other pieces of regimen necessary in diseases, would be a work of great merit, and productive of many happy consequences. A proper regimen, iu most • Arbuthuot. xvi INTRODUCTION. diseases, is at least equal to medicine, and in many of them it is greatly superior. To assist the well-meant endeavours of the humane and benevolent in relieving distress; to eradicate dangerous and hurtful prejudices; to guard the ignorant and credulous against the frauds and impositions of quacks and imposters ; and to shew men what is in their own power, both with regard to the prevention and cure of diseases, are certainly objects worthy of the physician's attention—These were the leading views in composing and publishing the following sheets. They were suggested by an attention to the conduct of mankind with regard to medicine, in the course of a pretty long practice m different parts of this island, during which the author has often had occasion to wish that his patients, or those about them, had been possessed of some such plain directory for regulating their conduct. How far he has suc- ceeded in his endeavours to supply this deficiency, musi be left to oth- ers to determine: but if they be found to contribute in any measure to- wards alleviating the calamities of mankind, he will think his labour , very well bestowed. §" Before we enter upon the prevention or cure of diseases, it may not be improper to take a cursory view of the human body, respecting the functions immediately connected with life. So wonderful is the structure of our frame, as displayed by anatomy, that atheistical per- sons, obdurate to every other evidence of the existence of a God, who created the universe, have, on witnessing a dissection, been instantly convinced of their mistake, and have acknowledged with equal aston- ishment and shame, that nothing less than a Being of infinite wisdom and power could have contrived and executed such a wonderful piece of mechanism as that of the human body. " The primary agent in the circulation of the blood is the heart, a large muscle situated in the left side of the breast (thorax, or chest) and endowed with great irritability. In the first rudiments of animal life, even before the brain is formed, the punctum salitns, as it is call- ed, points oht the embryo heart in miniature, and marks its prima;vj irritability as a sure presage of its future importance in supporting the vital motions. As this singular organ exhibits irritability the first, so it never relinquishes it till the last; whence u ha; been called the pri- mum mobile, and ultimum moriens, that is, " the first part that moves, aud the last that dies," of the animal machine. It is observable, that the motion of the heart not only survives that of the organs of voluntary moiion, but continues a .considerable time, even after it is separated from the body of many animals. Hence, m drowning, or suf- focation, though the puhe be imperceptible, and apparently extinguish- ed, yet the heart still preserves this latent power or susceptibility of motion, and wants only to be gently excited by suitable means to renew its action. This organ is surrounded by the pericardium, or heart-purse, an ex- ceeding strong membrane, which covers the heart, even to its basis. Its uses are to keep the heart from having any frictiou with the lungs, and to contain a fluid to lubiicate or moisten its surface. " From the right ventricle or cavity of the heart, the irritability of which is excited into action by the circulating fluid, the blood is pro- pelled through the lungs, which are situated on the right ami left side of the heart, from which they differ in appearing to be void of irritability. They are divided into two lobes, and these into more divisions, three on INTRODUCTION. xvii the i ight side, and two on the left. The trachae, or wind-pipe,descends into the lungs, and forms innumerable cells, which have a communica- tion with each other, and give the whole the appearance of a honey- comb or sponge. " The blood, after passing through the lungs, arrives again at the heart, and from the left ventricle is expelled into the aorta, or great ar- tery ; which dividing into two branches, one upwards, and the other downwards, distributes the blood through the whole body; from the extremities of which it returns, by various veins, through the ascending and descendingcava,* and is transmitted again to the heart. " The heart is the grand organ which actuates the vital functions; and to this purpose it is admirably fitted by its own irritability; but it is necessarily supported in its action by the powerful influence of the nerves, which are the ultimate instruments both of motion and sensa- tion, and have their origin in the brain. " The diaphragm or midriff is a large broad muscle, which divides the thorax from the abdomenr or belly. In its natural state, it is con- cave or vaulted towards the abdomen, and convex towards the thorax J Hallcr calls it " the most noble bowel next to the heart;" and, like the latter, it is in constant action. At the time of inspiration it approaches towards a plane. Besides being a muscle of inspiration, it assists in vomiting, and the expulsion of the faeces.|| From the exertion of this muscle likewise proceed sighing,yawning, coughing, and laughing. It is affected by spasms, as in the hick up, &c. It is both a muscle of vol- untary and involuntary action. We may observe in this muscle strong characters of admirable contrivance. It separates posteriorly into two slips, between which the descending aorta passes. A little above this, and towards the left side, in the most fleshy part of the midriff, there is a direct opening for the passage of the cesophagus or gullet. There is also on the right side a large triangular hole for the passage of the ascendingca'-a. " Thegullet is composed both of longitudinal and circular fibres, but chiefly circular, much more so than the intestines ; because this has no foreign power to assist it, and because it is neceseary that the food should make a shorter stay in the throat than in the bowels. The inner surface is a smooth membrane, well supplied with mucil- age, to sheath the organ, and render the passage of the aliment or food easy. " The stomach lies across the upper part of the abdomen, and is covered by the liver; when distended it presses on the spleen. It nearly resembles in figure the pouch of a bag pipe, its upper side being concave, and the lower convex. Its let*, end is the most capacious. On the left side is the entrance from the gullet; on the right is the open- ing, called pylorus, by which the chyle passes, into the intestines. Here is a circular valve, or sphincter-muscle, which prevents a regurgitation of the aliment. The stomach has circular and longitudinal fibres, and its inner membrane is covered with a strong viscid mucus. " The liver, the largest gland in the. body, is situated immediately un- der the vaulted cavity of the midriff, chiefly on the right side, and somewhat on the left over the stomach. Exteriorly, or anteriorly, it is * Cava is the large vein wbidi conveys the refluent blood to the heart. t Abdomen, from abdo to hide, as its contents lie hidden. % Derived from the Greek,signifying the breast. || This word with chemists is used to express the jmgredknts and settling after di> tjllatjou and infusion; hue it means excreim >.t. B 2 xviii INTRODUCTION. convex, inwardly it is concave ; very thick in its superior part, and thin in its inferior. The upper side adheres to the midriff; and it is fixed to this, and the sternum, or breast-bone, by a broad ligament It is also tied to the navel by a ligamentous band, which is the umbilical vein of the unborn infant, degenerated into a ligament. Both those bands serve to suspend it, while lying on the back, from bearing too much on the subjacent cava; otherwise it might press on tins important U-turning vessel, stop the circulation, and put a period to life. Dogs and cats, and other animals who are designed for leaping, have their liver divided into many distinct lobule-, to prevent too great a concus- sion of the organ. The liver is the viscus or bowel which performs the secretion of the bile. " The gall-bladder is situated under the great lobe of tlu? liver, a little to the right. In a standing posture, it lies forwards and down- wards. Its bottom is raised by a fulness, and depressed by the empty- ing of the stomach. The use of the gall-bladder is to serve as a recep- tacle for the bile. " The intestines are destined to receive the food from the stomach, and after exposing the useful part of it to the lacteal s, a set of extreme- ly small vessels, to convey the remainder oat of the body. The intes- tinal canal is usually five times the length of the individual: it is curi- ously convoluted in the abdomen, and is extremely irritab'e. Anato- mists have divided this canal, although one continued pipe, into six portions, three of which are termed the sm*U intestines,* and the three last, the great In the small intestines there are numerous plaits to de- tain the food, and allow a larger surface for its absorption. These are larger, and far more numerous near the stomach, where the food is thinner, than they are towards the other extremity. At the entrance of the ilium into theco/an, there are two very large valves, which prevent the regress of the fae.C"s into the ilium. The caxum and colon, two of the intestines towards the lower extremity, besides having stronger muscular coats than the small intestines, are furnished with three liga- mentous bands, running lengthwise on their outside, dividing their surfaces into three portions nearly equal. Though appearing external- ly like ligaments, they are composed, in their inner structure, of true muscular fibres. The ligament-tike bands, which in the caecum and colon are collected into three portions, are spread equally over the sur- face of the rectum, or lower extremity oi' the intestines. This is a wise precaution of Nature, that no part of it may be weaker than another, lest i' should give way in the efforts for expelling the faces. The plaits are considerably fewer in the great intestines. They have all an inner membrane, covered with an infinite number of arteries or glands, which discharge a lubricating fluid. They are famished with muscular fibres, both circular and longitudinal. u The spleen, or milt, is situated immediately under the edge;of the midriff, above the left kidney, and between the stomach and ribs. In figure, it re«embles a depressed oval, near twice as long as broad, and almost twice as broad as thick. Cheselden informs us, that it has been taken from dogs without any observable inconvenience to them. Its use is still problematical. » The tlire.- smaller are, the duodenum, ffrom its hngth being about that of the breadth of twelve flnseTsO/yiiniwi and i//i«», from the Greek signifying to turnabout, b* cause it mikes many con volutions. Th 'ti-e larger *r>-. th.»< iseum, or blind gut (so called from its being perforated at obi-end only 0 the cfon, signifying hollow, a word from the Greek; aiidtaercrrwH,or straight gut. INTRODUCTION. XIX " The pancreas, or sweet bread, is situated travers#ly under toe stomach. Its shape resembles a tlog's tongue. Along the whole length of it there is a duct, which terminates in the upper part of the in* testines near the stomach. The pancreatic juiee resembles the sa- liva, but is less viscid or slimy, and contains a larger proportion of the salts of the blood. It is probably intended fo* the solution of our aliment. The kidneys are two oval bodies, situated in the loins, contiguous to the two last short ribs ; the right under the liver, and the left under the spleen. The structure of the kidney* is curiously fitted for securing the urine, which is carried from each of them by canals termed tho ureters, into the bladder, the reservoir of that flwd, situated in the lower part of the belly. They enter the bladder near its neck, running for tlie space of an inch obliqaely between its coats, and forming, as it were, to themselves, two valves -, so that, upon the contraction of the bladder, the urine » directed along the urethra, which is, its proper pas» sage oui of the body. Over the upper part of tbe abdomen is spread the omentum, or caul* consisting of two broad, thin, and transparent membranes, joined to* gether by cellular texture, in the cells of which a quantity of fat is do* posited. Tlie uses of it are to interpose between the peritvnaumf ox lining, the intestines, and the stomach, to keep all these parts nioisb, warm, slippery, and to prevent their adhesion. Last of all comes tbe peritoDteum, a strong membrane, which, con* fines, as an inclosure, the intestines and contents of the abdomen- Such, in a general view, are the contents of the cavities of the breast aud belly, which perform, respectively, the vital motions, and tliose natural functions that are subservient to the support of our frame. But there remains to be mentioned another essentia,!, cavity, with its dependent system, to the primary influence of which all the otfoet parts of the body are indebted for their action and energy. The ca» vitv to which I allude is the skull, the receptacle of the brain. The brain is divided into two portions , namely, the certkrum and ctrebeL lu,iu ;t the. former situated in the upper part of the skull, and the lat- ter under it, in the hind part. The brain is a soft pulpy substance, surrounded by two membranes; one called dura, and the other piuy matter. It has also a third, called amchnoid, from its fineness, as be. ing similar to a spider's web. It contains some swtttse*, which are no- thing more than large veins or receptacles for blood, and four cavities called ventricles, moistened, in a healthful state, with a fine vapour, which encreasing gives ri.-e So diseases. Like other parts of the body, it has a variety of arterial branches from tbe heart, which diffuses through its substance, and on the membranes. The brain is the great clabo-.-atory, where the annual spirits, or nervous influences which ac- tuate our frame, are supposed to receive their existence. The nature of this fluid, if really a fluid, has not yet been sufficiently investigated. It is certain, however, that from this source the nerves derive their origin These are white, firm, solid cords, which arise from the brain and spinal marrow, which is ouly an elongation of the brain, and are spread over every part of the body endowed with sensibility, by in- numerable filaments. Ten pair of nerves issue from the brain itself, * Signifying near to,stretching round, or about, as paroostt>um,/>£ricarpiuro, near U> the bom, ht;>i't. &c t Cerrbetlum,ihe little brain as it were; both arc often called thus, v.hca the brain is spoken of in small animal i. INTRODUCTION. and thirty from the spinal marrow. Those that go to the Organs of sense are considerably larger than the rest, and are in part divested of their outer covering. Whether an immaterial and invisible Being can positively be said to exist in any place, it might appear presumptuous to determine; but it is a prevailing opinion in physiology, that the brain is the seat of the soul; aud the pineal gland, in the penetralia of the brain, has been as- signed as the sacred mansion of this immortal inhabitant. Human vision can discover no signs to confirm this opinion ; but the man would be blind, and utterly void of understanding, who could not trace through the whole of the animal system the most evident marks of Divine Intelligence and wisdom ; of intelligence which excites ad- miration, and of wisdom beyond conception. The wonderful contrivance exhibited in the human frame is, if pos- sible, still more manifest from the curious formation of the eye and ear ; of which only a very imperfect idea could be conveyed by verbal description. I shall therefore not attempt to delineate those admirable organs : nor need I mention the construction of the limbs ; of the arms and tegs; of the hands and feet; so nicely united with joints, and so happily supplied with muscles and tendons, with ligaments and nerves, that they are adapted to all the various purposes of convenience and utility in motion. I shall conclude this imperfect sketch of the human body with a brief account of digestion, that important process in the animalcconomy, by means of which the continual and unavoidable waste of the consti- tution is regularly supplied. The aliment being received into the mouth, the first operation it tin- dergoes is to be masticated by the action of the teeth and several mus- cles. This mastication is of greater moment than is generally imagin- ed ; and the good effects of it are further promoted by mixing with the food a quantity of saliva, discharged from the glands of the mouth, and which is greatly conducive, to digestion. When the food is carried down the gullet into the stomach, it there meets with an additional sup- ply of juices, called the gastric juices, of a nature yet more efficacious than the former, besides a small portion of bile. During its continu- ance in the stomach, it experiences the effects of heat and muscular action, from the coats of that organ, and the motion and warmth of the surrounding parts. It thence passes out gradually by the right ori- fice of the stomach, and there meets with an additional quantity of bile from the gall bladder and liver, besides the pancreatic juice, or that of the sweet-bread, of a nature similar to the saliva, but rather more thick, and the fluids separated by the intestines. It now receives tbe action of the bowels, or the peristaltic motion, by which tbey churn, as it were, tbe whole mass, minutely mixing together the food, and the dif- ferent juices, collected in the> passage from the mouth. A fluid is now produced called chyle, which is separated from the grosser materials, and taken up by a set of extremely small absorbent vessels called lac- teals. These have their origin in the inner coat of the intestines, and, passing thence, discharge themselves into a duct named the receptacle of the chyle, whence this fluid proceeds along the thoracic* duct, which terminates in the left subclaviant vein. In the passage from the intes- tines to the receptacle, there is a number of glands, which separate a watery liquid, for the purpose of giving the chyle a thinner consistence. * From thorax the breast. f A term applied to any thing under the arm-pit or :Ueul4er. INTRODUCTION. xxi To prevent the chyle from faPing back in its progress through the lac- teals, the construction of these vessels is atlmu-ably contrived. They are furnished with a number of vahe% which open only forwards, and are shut by any fluid pressing backwards. From the subclavian vein, Hie chyle is poured into the blood, and thence immediately thrown in- to tlui right auricle and ventricle} of the heart ; from winch, now mis.ed with tbe blood, it passes into the lungs. It nndergoes in that 01 sail« considerable chanue from Ihe act of respiration. From the hntis it proceeds through the pulmonary vein to, the left auricle of tlie heart, and then into the left ventricle ■* whence, at last endowed with, all the qualities of blood, it passes into the aorta, and is diffused universal- ly through the frame ; the wants of which it is fitted to supp'y by the addition of nourishing pai tides. Is it possible to contemplate this ad- mirable mechanism without breaking forth in the exclamation of the Psalmist, that" we are wonderfully made r" I may justly add, that con- sidering the great variety of waysin which the human body n-av be af- fected, both from without and within, wi h the necessity for the per- petual motion of the vital powers, and the millions of vessels, invisible to the naked eye, through which the fluids oneht to pass, it is u matter of real astonishment that we should subsist a single day '^od doubt- less it would be impossible, were noi the machine constantly sustained fcy tlie same Almighty and Beneficent Being who formed it. t Two muscu.hu bags, one on each side^are termed a»rw&p,.&om,ih$ Laiia signify* IPS ear?. MEDICINES USED IN PRACTICE. iVl \NY who peruse the Domestic Medicine, have expressed a wish that the catalogue of medicines contained in that book should be more extensive, and likewise that the do e of each article should be ascertain- ed, as they are often at a loss to know how to administer even those medicines, the names of which they meet with in almost every medical author. To obviate this objection, and furnish a greater scope to those who may wish to employ more articles than are contained in the Dispen«atory annexed to the above work, the following List of Simples and Compounds, taken from the most improved Dispensatories, is now inserted. To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the order of the English alphabet, and the smallest and largest dose placed oppo- site to each article. The doses indeed refer to adults, but may be adapt- ed to different ages by attending to the rules laid down in the Intro- duction to the Appendix. Short cautions are occasionally inserted un- der such articles as require to be used with care. Though a greater variety of medicines is contained in this than in any former edition of the Domestic Medicine, yet the Author would ad- vise those who peruse it, as far as possible, to adhere to, simplicity in practice. Diseases are not cured by the multiplicity of medicines, but by their proper application. A few simples, judiciously administered, and accompanied with a pVoper regimen, will do more good, than a ferrago of medicines employed at random. A LIST OF THE MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PROPER DOSES. Acacia, the expressed juice, Acid, the acetous ----, muriatic ----, nitrons, diluted ----, vitriolic diluted ^Ether, vitriolic iEthiops mineral Aloes ... Alum - ■----, burned Amber prepared • Ammoniac, g,tim ---------, milk of Angelica, the root powdered Anise, the seeds Antimony ---------, calcined --------, glass of Asafoetida --------, milk of Asarum, to provoke sneezing Balsam of capivi from 1 scruple • 1 scruple 10 drops -15 drops 15 drops SO drops ' 10 grains 5 grains - 6 grains 3 grains \ drahin b grains i oz. 5 'drahm 10 grains 10 grains 1 scruple £ grain 6 grains i oz. 3 grains 20 drops to 1 drachm 1 drachm 40 drops 40 drops 40 dropi 2drachmi 30 grains 30 grains 20 grains 12 grains 1 drachm 30 grains 1 ounce \\ drachm 1 drachm 1 drachm 1 drachm G grains f adra. 1 ounce 5 grains CO drops MEDICINES USED IN PRACTICE. sxii. Balsam, Canadian - from —----, of Pern ... -----,ofTolu Bark, Peruvian, powder - . Bears foot powder Benzoin, resin of - « - Benzoin, flowers of - . • . • Bistort, powder of the root • B'es3ed thistle -------------, expressed juice of Bole, Armenian - - - ----French Borax - Broom, ashes of the tops Burdock, powder of the root - Calomel - - « J Camphor - - - Can? I hi alba, powder of - Cautharides - Cardamoms Caraway seed ... Cascarilla bark Cassia, the pulp ... Castor ... Catechu - • Camomile, in powder Chalk .... Cinnamon - - Colocynth - - Coluinbo - Confection, aromatic -----------, opiate Crabs claws, prepared Conserve of roses -------—, of squills --------, of arum Contrayerva ... Coriander seed - Cowhage, the spicula? of one pod mixed with honey or molasses. Dandelion, expressedjuice Decoction of heartshorn, halfa pin t repeated as often as necessary. --------, of broom, 1 oz. to a pint of water, to be taken by tea-cnpsful. -------—, of Peruvian bark --------, of the inner bark of the elm --------., of sarsaparilla ---------------------compound ------— of guaiaeum, 3 drachms to a pint of water. A pint daily. Electuary of cassia - . ofscauwnony to -»-lenitive, or of senna, 2 scruples 10 grans 4 grains 10. grains I scruple, 10 grains 2 drachms 10 grams tO grains 1 scruple 10 grains 1 grain to 3 3 do. to 12 2 grains to 1 scruple 5 gram 5 grains 10 grains 10 grains 3 d racisms 8 grains 15 grains 20 grains 30 grams 5 grains 10 grains 10 grains 10 grains 10 grains 10 grains 1 dra. 50 grams 20 grains 20 grains 15 grains 1 oz. 1 oz. 4 oz. 4oz. 1 dra. 20 grains 30 grains 2 drachms 20 grains 20 grains SO stains 1 drachm 1 drachm 2 ounces 2 diacumS. 40 grains 1 drachm 1 drachm gra. alterative do. purgative halfa drachm 2 drachms 4 grains 20 grains 40 grains 40 grains I oz. 1 drachm 30 grains 1 drachm 2 scruples 1 drachm 1 drachm 1 drachm 2 scrnple.3 2 scruples 1 drachm 1 oz. 30 grains 1 drachm 2 scruples 1 drachm 3 oz. 4 oz. 16 oz. daily 16 oz. daily 1 oz. 1 drachm 6 drachms Jtxiv MEDICINES USED IN PRACTICE, Elixir of vitriol - from E'ecmipane, powder of the root ExtTact of broom ops ----- of Peruvian bark _—£—- cascanlla - • .—---camomile ... .—<-^~ colocynth ... -*----gentian ... —»■ ■ ■ liquorice • • *-!—— logwood • . • •*■ —— black hellebore —— -jalap ... >' guaiacum ... —----white poppies . rue - ------savin .... ■**-----senna » Fern, powder of ilie root « . Fennel seed - Fox glove, powder of the leaves Or a drachm infused in a pint of boiling tvater, of which a dose is Should be administered with caution. Galbaiwm - - Galls Gar'ic, cloves of • Gentian - • Germander * • Ginger • - - - Ginseng - - - Guaiacum, gum-resin - - Gum arahic - ----gamboge » • Har'shorn, prepared ,spirits of , caustic in some mucilaginous vehicle «~----, salt of ... Hellpbore, white ... - , black - Hen lock should always be begun in very small doses, of one grainor less, and gradually increasedas the cons itution wilt bear. Hiera picra - Honey of squills ... —----of roses .... Heffrnan's anodyne liquor Ijalap.-powder ... Infusion of Gentian powder -----of roses ... •-----of senna ... Ipecacuanha - - Iron, rust of - iron ammoiiiated - . . 15 drops to 20 grains i dia. 10 grains 16 grains 20 grains 5 grams 10 grains 1 dra. 10 grains 3 trams 10 grains 10 grains 1 grain 10 grains 10 grams 10 grains |dra. 20 grains \ grain 1 oz. 10 grains 10 grains No. l. 10 grains 15 grains 5 trains 20 grains 10 grains 15 grains 2 grains 20 grains 10 drops f 5 drops 2 grains 1 grain 5 grains 10 grains 10 grains 1 drachm 2<) drops 10 grains 1 ounce 2 ounces \ ounce 10 >• rains 5 grains 2 grams 50 drop* 1 drachm 1 dracinn § drachm \ dracbfli l drachm 25 grams 4 drachm * oz. \ drachm 10 grains 20 grains HO grains 5 grains 20 grams 30 grains 30 grains i oz. 1 dracinh 3 grains 30 grain9 2o grains No. 6. 40 grains 1 drachm 20 grains 30 grains 30 grains 1 draehm 12 grains I diaclrih 40 drops 25 drops 12 gram 5 grains 10 grains 20 grains 40 urams 2 drachm! 60 drops 40 grains S on. ees 8 ouncei 2 0|I1:(C3 30 ^r«ins 20 -.rains 40 grains MEDICINES USED IN PRACTICE. Iron tartarized - - from ----salt of - - Juniper, powder of the berries Kino, gum Kermes, juice of Lichen, ash-coloured ------, Icelandic, a strong decoctioh of Lime-water - - - Lixivium, of tartar Linseed, an infusion of one ounce to a quart of water, may be used at pleasure- Madder powder - - Mace - - Magnesia - - ------calcined Manna, • Mastich, gum Mercury, crude - - - ------calcined ------with chalk - - " ■ ------. corrosive sublimate ■ . cinnabar of .------yellow emetic, as a stermitory Mezereon, decoct, to a pint of water Millepedes - - Musk - - ... Mustard seed - ... Myrrh, gum - - Nitre, purified - - - Nutmeg - - ... Oil of almonds - " * . " ----Linseed - - ----- Castor - - - - Olibanum - ... Onion, expressed juice of, a ^ powerful diuretic J Opium .... Opopanax Oxymelofcolchicltm - ------of squills Petoleum - Pills, aloe tic ... .---- of the gums ... ----mercurial ... Pomegranate, powder of Powder antimonial - May be taken according to the directions for James's powder, with which it nearly coincides. Powder, of Contrayerva, compound .------ of Chalk compound ------of Chalk compound, with opium ■ of Ipecacuanha, com- ) C 2 grains f grain 20 grains 10 grains 1 drachm 3 grains I ounce 4 ounces 15 drops to | drachm 10 grains & drachm £ ounce 10 grains \ ounce \ grain 10 grains i grain 10 grains 1 grain 20 grains 5 grains 1 drachm 10 grains 10 grains 6 grains i ounce pound, or Dover's powder 2 drachms 5 grains | ounce \ grain 10 grains £ drachm i drachm 10 drops 10 grains 10 grains 10 grains 20 grains 3 grains IS grains 20 grains 10 grains 10 grains 10 grains 5' grains 1 drachm 30 grains 3 dtachms 40 grains 4 ounces 8 ounces 40 drops 1 drachm SO grains 2 drachms 2 o'nnces 30 grains 4 ounces 2 grains 30 grains i graii} 30 grains .^ 3. grains. 2 drachms 2 drachms 40 grains 1 ounce 1 drachm 30 grains \ drachm 1 ounce i ounce 30 grains 2 ounces .2 grains 30 grains 1 ounce 2 drachms ,30 di ops' 30 grams 30 grains 20 grians 1 drachm 6 grains 30 grains 40 grains 40 grains SO grains Jtxvi MEDICINES USED IN PRACTICE. Quassia Two drachms to a pint of water for a decoction. Quince seeds, mucilage of, at plea- sure, to obtund acrimony. Rhubarb, powder Resin, yellow Rne powder St. Jolin's-wort Saffron Sagapenum Sal ammoniac Salt, Epsom —— Glauber ----Polychrest ----of Tartar Sarsaparilla, powder of Scammony Seneca Senna Soap ----lees Scurvy-grass, expressed juice Snake foot Sorrel, juice of, depurated Spirit of Mindererus ----sweet, of vitriol -------- of nitre ---■ of sal ammoniac ■-------compound -----~ foetid Spirits, distilled Spermaceti Sponge, burned Sulphur,flowers of -------precipitated, of antimony Squill,, dried powder ----fresh Syrufp of poppies .---■— of buckthorn -----of ginger Syritps in general Tar water, a pint daily Tartar, cream of ■ regenerated ■-----soluble -----emetic, alterative - ■-----■------as emetic Terra japonica Tobacco, an infusion of 1 drachm to a pint of water ; should be adminis- tered by table spoonsful: strongly diuretic. Tin, powder of Turmeric from 5 grains to 30 grains 10 grains 3 grains 20 grains 20 grains 5 grains 10 grains 10 grains 2 drachms 4 drachms 20 grains 10 grains 20 grains 5 grains 20 grains 20 grains 20 grains 10 drops 1 ounce 20 grains 4 ounces 1 drachm 15 drops 15 drops 15 drops •I drachm 20 grams 20 grains 20 grains 1 grain 1 grain 5 grains \ drachm 1 drachm 1 drachm 1 drachm 2 drachms 20 grains 2 drachms I grain 1 grain 20 grains 20 grains 20 grains 40 grains 90 grains 40 grains 1 drachm 20 grains 30 grains 30 grains 1| ounce i ounces \ ounce 30 grains 40 grains 10 grains 40 grains 40 grains \ ounce 30 drops 4 ounces 40 grains 8 ounces 1 ounce 40 drops 40 drops 40 drops \ ounce 1 drachm 1 drachm 1 drachm 4 grains 3 grains 15 grains \ ounce 2 drachms \ ounce 2 drachms 1 ounce 1 drachm I ounce \ grain 3 grains 40 grains 1 drachm 1 drachm MEDICINES USED IN PRACTICE. xxvii Turpentine, spirits of Tincture of aloes ■--------------compound ----ofasafcetida »----Benzoin, compound ----of cantharides ----of cardamoms ----of castor ----of catechu ----■ of Peruvian bark ----of iron muriated ----of Colombo ----of Gentian, compound ----guaiacum volatile ----of blackjielleboi e ----of jalap ----of lavender, compound ----of myrrh ----of opium from camphorated, or paregoric elixir 1 drachm of rhubarb of senna of snake-root ■ of valerian volatile Tormentil, powder of Valerian, power of Vinegar, distilled ------of squills --------------as emetic Verdegris, violent emetic Vitriol, white, as a tonic ------------as a quickly ) operating emetic $ ------blue emetic Uva urai, in powder Water-cress, expressed juice of Water, the simple distilled, } may generally be given $ Worm wood, expressed juice White lead Wine, aloetic ----antimonial ----ipecacuanha ----rhubarb 10 drops to | ounce £ drachm \ drachm 10 drops 10 drops 1 drachm 1 drachm 1 drachm 1 drachm 10 drops 1 drachm 1 drachm 1 drachm 1 scruple 1 drachm 20 drops 1 scruple 10 drops % ounce 2 drachms 1 drachm 1 drachm 1 drachm 10 grains 20 grains 2 drachms 10 drops \ ounce 1 grain 2 grains 20 grains 1 grain 20 grains \ ounce \ ounce * ounce 1 grain | ounce 20 drops l drachm \ ounce 30 drops 1 ounce 2 drachms 2 drachms 40 drops 40 drops I ounce l| drachms 2 drachms \ ounce 60 drops 3 drachms 3 drachms 3 drachms 1 drachm | ounce 2 drachms 1 drachm 40 drops 3 drachms 2 ounces 1 ounce 2 drachms 3 drachms 2 drachms 1 drachm 2 drachms 1 ounce 50 drops 1 ounce 2 grains 5 grains 1 drachm 3 grains 1 drachm 2 ounces 3 or 4 oz. 2 ounces 3 grains 1 ounce 2 drachms 1-| ounce V ounces i * !..|l,l >..b-'i;-> \ s^ *-..ib :u N4 « 2N$ .^ N v^ :nj s^oih .i-»fcib ■o i: >:-?l <$ i; ^ PART I. OF THE GENERAL CAUSES OF DISEASES. CHAPTER I. OF CHILDREN. THE better to trace diseases from their original causes, we shall take a view of the common treatment of mankind in the state of infancy. In this period of our lives, the foundations of a good or bad constitu- tion are laid ; it is therefore of importance, that parents be well ac- quainted with the various causes which may injure the health of their offspring. It appears from the annual registers of the doad, that almost one half of the children born in Great-Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but on due examination, it will be found to be one of our own creating. Were the death of infants a natural evil, other animals would be as liable to die young as man ; but this we find is by no means the case. It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the management of his young: But our surprise will soon cease, if we consider that brutes, guided by instinct, never err in this respect; while, man, trusting sole- ly to art, is seldom right. Were a catalogue of those infants who per- ish annually by art alone exhibited to public view, it would astonish most people. ✓ If parents arc above taking care of their children, others must be employed for that purpose: these will always endeavour to recommend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and destructive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder so many of them perish Nothing can be more preposterous than a mother who thinks it be- low her to take care of her own child, or who is so ignorant as not to know what is proper to be done for it. If we search Nature through- out, we cannot find a parallel to this. Every other animal is the nurse of its own offspring, and they thrive accordingly : Were the brutes to bring up their young by proxy, they would share the same fate with those of the human species. We mean not, however, to impose it as a task upon every mother to suckle her own child. This, whatever speculative writers may al- lege, is in some cases impracticable, and would inevitably prove de- structive both to the mother and child. Women of delicate constitu- tions, subject to hysteric fits, or other nervous affections, make very bad nurses :* and these complaints are now so common, that it is rare to find a woman of fashion free from them-, such women therefore, snp. posing them willing, are often unable to suckle their own children. * I have known an hysteric woman kill her child, by being seized with a £{ j„ the night. 2C SO OF CHILDREN. Almost every mother would be in a condition to give suck, did man- kind live agreeably to Nature ; but whoever considers how far many mothers deviate from her dictates, will not be surprised to find some of them unable to perform that necessary office. Mothers who do not eat a sufficient quantity of solid food, nor enjoy the benefit of fresh air and exercise, can neither have wholesome juices themselves, nor af- ford proper nourishment to an infant. Hence children who are suckled by delicate women, either die young, or continue weak and sickly all their lives. When we say that mothers are not always in a condition to suckle their own children, we would not be understood as discouraging that practice. Every mother who can, ought certainly to perform so tender and agreeable an office.* But suppose it to be out of her power, she may nevertheless, be of great service to her child. The busiuess of nurs- ing is by no means confined to giving suck. To a woman who abounds with milk this is the easiest part ot it. Numberless other offices are necessary for a child, which the mother ought at least to see done. A mother who abandons the fruit of her womb, as soon as it is born, to the sole care of a hireling, hardly deserves that name. A child by being brought up under the mother's eye, not only secures her affec- tion ; bnt may reap all the advantages of a parent's care, though it be suckled by another. How can a mother be better employed than in superintending the nursery ? This is at once the most delightful and important office; yet the most trivial business or insipid amusements are often preferred to it! A strong poof both of the bad^taste and wrong education of modern females. It is indeed to be regretted, that more care is not bestowed in teach- ing the proper management of children to those whom Nature has de- signed for mothers. This, instead of being made the principal, h seldom considered as any part of female education. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of tlie duties belonging to that character ? However strange it may appear, it is certainly true, that many mothers, and those of fashion too, are as ignorant, when they have brought a child into the world, of what i* to be flone for it, as the infant itself. Indeed, the most ignorant of the sex are generally reckoned moc.t knowing in the business of nursing. Hence sensible people become the dopes of ignorance and superstition-, and the nursing of children, instead of be- ing conducted by reason, is the result of whim and caprice.f Were the time that is generally spent by females in the acquisition of trifling accompli iimcuts, employed in learning how to bring up * Many advantages would arise to society, as well as to individuals, from mothers suckling their own children. It would prevent the temptation which poor women are laid under of abandoning their children to suckle those of the rich for the sake of gain; by which means society loses many of its most useful members, and mothers becoina in some sense the murderers of their own offspring. lam sure I speak within the truth when I say, that not one in twenty of those children live, who are thus aban- doned by their mothers. For this reason no mother should be allowed to suckle an- other's child, till her own is either dead or fit to be weaned. A regulation of this kind would save many lives among the poort r sort, and could do no hurt to the rich, as most women who make good nurses are able to suckle two children in suc- cession upon the same milk. t Tacitus, the celebrated Roman historian complains greatly of tlie degeneracy of the Koman ladies in his time, with regard to the care of their offspring. He aays that, in former times, the greatest women in Rome used to account it their chief glory to keep the house and attend their children ; but that now the young infant was commuted to the sole care of some poor Grecian wench, or other Bt- nial servant.—We are afraid, wherever luxury and effeminacy prevail there will be too much ground for this complaint. OF CHILDREN. 31 their children; how to dress them so as not to hurt, cramp, or confine their motions; how to feed them with wholesome and nourishing food ; how to exercise their tender bodies, so as best to promote their growth and strength ; were these made the objects of female instruction, man- kind would derive the greatest advantages from it. But while the edu- cation of females implies little more than what relates to dress and pnb- lic shew, we have nothing to expect from them but ignorance even in the most important concerns. Did mothers reflect on their own importance, and lay it to heart, they would embrace every opportunity of informing themselves of the duties which they owe to their infant offspring. It is their province, not only to form the body, but also to give the mind its most early bias. They have it very much in their power to make men healthy or valetu- dinary, useful in life, or the pests of society. But the mother is not the only person concerned in the management of children. The father has an equal interest in their welfare, and ought to assist in every thing that respects either the improvement of the body or mind. It is pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments as recommend them to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the affairs of the nursery, that ma- ny would reckon it an affront, were they supposed to know any thing of them. Not so, however, with the kennel or the stable: a gentleman of the first rank is not ashamed to give directions concerning the management ofhisdogsor horses, yet would blush were he surprised in performing the same office for that being who derived its existence from himself, who is the heir of his fortunes, and the future hope of his country. Nor have physicians themselves been sufficiently attentive to the management of children: this has been generally considered as the sole province of old women, while men of the first character In physic, have refused to visitinfants even when sick. Such conduct in the facul- ty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous diseases. The consequence is that a physician is seldom called till tlie good women have exhausted all their skill; when his attendance can only serve to divide the blame, and ap- pease the disconsolate parents. Nurses should do all in their power to prevent diseases; but when a child is taken ill, some person of skill ought immediately to be consul- ted. The diseases of children are generally acute, and the least delay is dangerous. Were physicians more attentive to the diseases of infants, they would uot only be better qualified to treat them properly when sick, but like- wise to give useful directions for their management when well. Tlie diseases of children are by no means so difficult to be understood as . many imagine. It is true, children cannot tell their complaints; but the causes of them may be pretty certainly discovered by observing the symptoms, and putting proper questions to the nurses. Besides the diseases of infants being less complicated, are easier cured than those of adults.* * The common opinion, that the diseases of infants are hard to discover and difficult to cure, has deterred many physicians from paving that attention to tlicm which they 32 OF CHILDREN. It is really astonishing, that so little attention should in general be paid to the preservation of infants. What labor and expense are daily bestowed to prop an old tottering carcase for a few years, while thou- sands of those who might be useful in life, perish without being re- garded ! Mankind are too apt to value things according to their present, not their future usefulness. Though this is of all others the most er- roneous method of estimation ; yet upon no other principle is it possi- ble, to account for the general indifference with respect to the death of infants. OF DISEASED PARENTS. One great source of the diseases of children is, the unhealthiness of parents. It would be as reasonable to expect a rich crop from a barren soil, as that strong and healthy children should be born of parents whose constitutions have been worn out with intemperance aud disease. An ingenious writer* observes, that on the constitution of mothers depends originally that of their off-pring. No one who believes this, will be surprised, on a view of the female world, to find diseases and death so frequent among children. A delicate female, brought up with- in doors, an utter stranger to exercise and open air, who lives on tea and other slops, may bring a child into the world, but it will hardly be fit to live. The first blast of disease will nip the tender plant iu the bud: or should it struggle through a few years existence, i'.sfeeble frame shaken with convulsions from every trivial cause, will be unable to perform the common functions of life, and prove a burden to society. If to the delicacy of mothers, we add the irregular lives of fathers, we shall see further cause to believe that children are often hurt by the constitution of their parents. A sickly frame may be originally indu- ced by hardships and intemperance, but chiefly by the latter. It is im- possible that a course of vice should not spoil the best constitution : and, did the evil terminate here, it would be a just punishment for the folly of the sufferers; but when once a disease is contracted and riveted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the king's evil, to transmit to our offspring! bow happy had it been for the heir of many a great estate, had he been born a beggar rather than to inherit his father's fortunes at the expense of inheriting his diseases! A person laboring under any incurable malady, ought not to marry. He thereby not only shortens his own life, but transmits misery to oth- ers ; but when both parties are deeply tainted with the scrophula, the scurvy, or the like, the effects must be still worse. If such have any issue, they must be miserable indeed. Want of attention to these things in forming connections for life, has rooted out more fai ilies than plague, famine, or the sword; and as long as these conuections are for- med from mercenary views, the evil will be continued.t In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know that the gene- ions courser cannot be bred out of the foundered jade, nor the saga- cious spaniel out of the snarling cur. This is settled upon immutable deserve. I can however, from experience, declare, that this opinion is without founda- tion; and that the diseases of infants aie neither so difficult to discover nor so ill to care, as those of adults. * Rousseau. t The Lacedemonians condemned their king Archidamus for having married a weak, puny woman; because, said they, instead of propagating a rac« 0f heroes,} ou will till the throne with a progeny of changelings. OF CHILDREN. 33 laws. The man who marries a woman of a sickly constitution, and de- scended of unhealthy parents, whatever his views may be, cannot be said to act a prudent part. A diseased woman may prove fertile; should this be the case, the family must become an infirmary ; what-prospect of happiness the father of such a family has, we shall leave any one to judge.* Such children as have the misfortune to be born of diseased parents, will require to be nursed with greater care than others. This is the on- ly way to make amends for the defects of constitution; and it will often go a great length. A healthy uurse, wholesome air, and sufficient exer- cise, will do wonders. But when these are neglected, little is to be expected from any other quarter. The defects of constitution cannot be supplied by medicine. Those who inherit any family disease ought to be very circumspect in their maimer of living. They should consider well the nature of such diseases, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one gene- ration ; and there is reason to believe, that by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family constitutions are as capable of improvement as family estates; and the libertine who impairs the one, does greater injury to his, posterity, than the .prodigal who squanders away the other. OF THE CLOTHING OF CHILDREN. The clothing of an infant is so simple if matter, that it is surprising how any person should err in it; yet many children lose their lives, and oth- ers are deformed, by inattention to this article. Nature knows no use of clothes to an infant, but to keep it warm. AH that is necessary for this purpose, is to wrap it in a soft loose covering. Were a mother left to tlie dictates of Nature alone, she would certainly pursue this course. But tlie business of dressing an infant has long been out of the hands of mothers, and has at last become a secret which none hut adepts pretend to understand. From the most early ages it has been thought necessary, that a wo- man in labor should have some person to attend her. This in time be- came a business; and, as in all others, those who were employed in it strove to outdo one another in the different branches of their profession. The dressing of a child came of course to be considered as the mid- wife's province,, who no doubt imagined, that the more dexterity she could shew iu this article, the more her skill would he admired. Her attempts were seconded by the vanity of parents, who, too often desi- ruiis of making a shew of the infant as soon as it was born, were ambi- tious to iiave as much finery heaped upon it as possible. Thus it came to be thought as necessary for a midwife to excel in bracing and dressing an infant, as for a surgeon to be expert in applying bandages to a bro- ken limb ; and the poor child, as soon as it came into the world, had as many rollers and wrappers applied to its body, as if every bone had been fractured in the birth; whi'e these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary for life. * The Jews, by their laws, were, iu certain cases, forbid to have any manner of com- merce with the diseased; and indeed to this all wise legislators ought to have a special regard. In some couutriet, diseased pcisons have actually been forbid to marry. This is an evil of a complicated kind, a natural deformity, and political mischief; and there- fore requires a public consideration. 34 OF CHILDREN In most parts of Britain, the practice of rolling children with so many bandages is now, in some measure, laid aside ; but it would still be a difficult task to persuade the generality of mankind, that the shape of an infant does not entirely depend on the care of the midwife. So far however, are all her endeavors to mend the shape from being success- ful, that they constantly operate the contrary way, and mankind become deformed in proportion to the means used to prevent it. How little de- formity of body i3 to be found among uncivilized nations ! So little in- deed, that it is vulgarly believed they put all their deformed children to death. The truth is, they hardly know such a thingas a deformed child. Neither should we if we followed their example. Savage nations ne- ver think of manacling their children. They allow them the full use of every organ, carry them abroad in the open air, wash their bodies daily hi cold water, &c. By this management, their children become so strong and hardy, that by the time our puny infants get out of the nurse's arms, theirs are able to shift for themselves.* Among brute animals, no art is necessary to procure a tine shape. Though many of them are extremely delicate when they come into the world, yet we never find them grow crooked for want of swaddling bands. Is Nature less generous to the human kind ? No : but we take the business ont of Nature's hands. Not only tlie analogy of other animals, but the very feelings of infants tell us, they ought to be kept easy and free from all pressure. They cannot indeed tell their complaints ; but they can shew signs of pain : and this they never fail to do, by crying when hurt by their clothes. No sooner are they freed from their bracings, than they seem pleased and happy : yet, strange infatnat ion! the moment they hold their peace, they are again committed to their chains. If we consider the body of an infant as a bundle of soft pipes, re- plenished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of children, has formed their bodies soft andf flexible ; and lest they should receive any injury from pressure in the womb, has sur- rounded the fat us every where with fluids. This shews the care which Nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing that might in the least cramp or confine their motions. Even the bones of an infant are so soft and cartilaginous, that they readily yield to the slightest pressure, and easily assume a bad shape,, which can never after be remedied. Hence it is, that so many people appear with high shoulders, crooked spines, and flat breasts, who were as well proportioned at their births as others, but had the misfortune to be squeezed out of shape by the application of stays and bandages. Pressure, by obstructing the circulation, likewise prevents the equal distribution of nourishment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, while another remains too small ; and thus in time the whole frame becomes disproportionate and misshapen. To this we must add, that when a child is; cramped in its clothes, it naturally shrinks from the part that is hurt; and by putting its body in unnatural postures, it becomes deformed by habit. • A friend of mine, who was several years on the coast of Africa, tells me, that tlie natives neither put any clothes upon their children, nor apply to their bodies bandages of any kind, but lay then- on a pallet, and suffer them to tumble about at pleasure; yet they are all straight, and seldtun have any disease. OF CHILDREN Deformity of body may indeed proceed from weakness or disease ; rmt in general, it is the effect of improper clothing. Nine-tenths, at least, of the deformity among mankind, must be imputed to this cause. A deformed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impaired. Hence few people remarkably misshappen are strong or healthy. The new motions which commence at the birth, as the circulation of the whole mass of blood through the lungs, respiration, the peris- taltic motion, &c. afford another strong argument for keeping the body of an infant free from all pressure. These organs not having been accustomed to move, are easily stopped ; but when this happens, death must ensue. Hardly any method could be devised more effectually to stop these motions, than bracing the body toe tight with rollers* and bandages. Were these to be applied in the same manner to the body of an adult for an equal length of time they would hardly fail to hurt the digestion and make him sick. How much more hurtful they must prove to the tender bodies of infants, we shall leave any one to judge. Whoever considers these things will not be surprised, that so many childrci-. die of convulsion ^ soon after their birth. These, fits are gene- rally ai •.'touted to some inward cause ; but in fact they oftener proceed from our owr imprudent conduct. I nave known a child seized with convulsion tit* soon after the midwife had done swaddling it, who, upon taken off tin rollers and bandages, was immediately relieved and ne- ver had the disease afterwards. Numerous examples of this might be given, were they necessary. If would be safer to fasten the clothes of an infant with strings than pins, as those often gall and irritate their tender skins, and occasion disorders. Pins have been found sticking above half an inch in the body of a child, after it had died of convulsion fits whicSi in all pro- bability proceeded from that cause. Children are not only hurt by the tightness of their clothes, but also by the quantity. Every child has some degree of fever after the birth; and if it be loaded with too many clothes, the fever must be increased. But this is not all ; the child is generally laid in bed with the mother ; who is often likewise feverish ; to which we may add the heat of the bed-chamber, the wines, and other heating things, too fre- quently givtn lo children immediately after the birth. When all these are combined, which does not seldom happen, they must increase the fever to such a degree as will endanger the life of the infant. The danger of keeping infants too hot will further appear, if we consider that, after they have been for some time iu the situation men- tioned above, they are often sent into the country to be nursed in a cold house. Is it any wonder, if a child, from such a transition, catches a mortal cold, or contracts some other fatal disease ? When an infant is kept too hot, its lungs not being sufficiently expanded, are apt to remain weak and flaccid for life; hence proceed coughs, consumptions, and otiier diseases of the breast. It would answer little purpose to specify the particular species of dress proper for an infant. These will always vary in different coun- tries, according to custom and the humour of parents. The. great rule to be observed is That a child huvc no more clothes than are ne- cessaryfto keep it warm, and that they be quite easy for its body. • This is by no means inveighing against a thing Uiat does not happen. In many parts of Britain at this day, a roller eight or ten feet in length is applied tightlr round (he Child's body as soon as it is bora. 36 OF CHILDREN. Stays are the very baue of infants. A volume would not suffice to point out the bad effects of this ridiculous piece of dress both on child- ren and adults. The madness in favour of <-tav s seems, however, to be somewhat abated ; and it is to be hoped the world will, in time, become wise enough to know, that the human shape does not solely depend up- on whale bone and bend leather.* I shall only add with respect to the clothes of children, that they ought to be kept thoroughly clean. Children perspire more than adults ; and if their clothes be not frequently changed, they become very hurtful. Dirty clothes not only gall and fret the tender skins of infants, but likewise occasion ill smells; and what is worse, tend to pro- duce vermin and cutaneous diseases. Cleanliness is not only agreeable to the eye, but tends greatly to pre- serve the health of children. It promotes the perspiration, and, bj that means, frees the body from superfluous humours, which, if retained, could not fail to occasion diseases. No mother or nurse can have any excuse for allowing a child to be dirty Poverty may oblige her to give it coarse clothes ; but if she does not keep them clean, it must be her own fault. OF THE FOOD OF CHILDREN. Nature not only points out the food proper for an infant, but actual- ly prepares it. This however is not sufficient to prevent some who think themselves wiser than nature, from attempting to bring up their children without her provision. Nothing can shew the disposition which mankind have to depart from nature more than their endeavour- ing to bring up children without the breast The mother's milk, or that of a healthy nurse, is unquestionably the best food for an infant. Nei- ther art nor nature can afford a proper substitute for it. Children may seem to thrive for a few months without the breast; but when teething, the small-pox, and other diseases incident to childhood, come on, they generally perish. A child, soon after the birth, shews an inclination to suck, and there is no reason why it should not be gratified. It is true, the mother's milk does not always come immediately after the birth ; but this is the way to bring it: besides, the first milk that the child can squeeze out of the breast answers the purpose of cleansing better than all the drugs in the apothecary's shop, and at the same time prevents inflammations of the breast, fevers, and other diseases incident to mothers. It is strange how people came to think that the first thing given to a child should be drugs. This is beginning with medicine by times, and no wonder if they generally end with it. It sometimes happens, in- deed, that a child does not discharge the meconium as soon a.< could be wished ; this has induced pliy ic^ns, in such cases, to gi ve something of an opening nature to elea se the first passages. Midwives have impro- ved upon this hint, and never fait to give syrups, oils, &rc. whether they be necessary or not. Cramming an infant with such indigestible stuff as soon as it is born, can hardly fail to make it sick, and is more likely to occasion diseases than to prevent them. Children are seldom !ong after the birth without having a passage both by stool and urine; though * Stays made of bend leather are worn by all the women in lower station in many' parts of England. Jam sorry to understand, that there are still mothers mad enough to lace their daugh- ters very tight in onlrr to improve their shape. As reatorii-.g-wouM be totallx lost up- on such people. 1 siiill beg leave juit to ask them, Whj ther. are I'-n deformed women for one man ? and likewise to recommend to their perusal a short moral precevt. Whicn forbids us to DKFOltM THE HUMAK BODY. OF CHILDREN. S7 these evacuations may be wanting for some time without any danger. But if children mtisthave something before they be allowed the breast, let it be a little thin water pap, to which may be added an equal quan- tity of new milk ; 01 rather water alone, with the adcitit n of alitrle raw sugar. If this be given without any wines or spiceries, it will nei- ther heat the hlood,load the stomach, nor occasion gripes. Upon the first sight of an infant, almost every person is struck with the idea of its beinn weak, feeble, and wanting support This natu- rally suggests the need of cordials. Accordingly wines are universally mixed with the first food of children. Nothing can be more fallacious than this way of reasoning, or more hurtful to infants than the conduct futn.ded upon it. Children require Very little food for some tune after the birth ; aud what they receive should he thin, weak, light, and of a cooling quality. A very small quantity of wine is sufficient to nea and inflame tlie blood of an infant ; but every person conversant in these matiers must know, that most of the diseases of infants proceed trom the heat of their humours. If the mother or nurse has enough of milk, the child will need little or no food before the third or fourth month. It will then be proper to give it, once or twice a day, a little of some food that is easy of diges- tion, as water-pap, milk-pottage, weak broth with bread in it, and such like. This will ease the mother, will accustom the child by degrees to take food, and will render the weaning both less difficult and less dan- gerous. All great and sudden transitions are to be avoided in nursing. For this purpose, the food of children ought not only to be simple, but to resemble, as nearly a? possible, the properties of milk. Indeed milk itself should make a principal part of their food, not only before they are weaned, but for some time after. Next to milk, we would recommend gcod light bread. Bread may be given to a child as soon as it shews an inclination to chew; and it may at all times bcallowid as much plain bread as it will eat. The very chew ing of bread will promote the cutting of the teeth, and the discharge of saliva, whi.e by mixing with the nurse's milk in tiie stom- ach, it will afford an excellent nourishment. Children discover an early inclination to chew whatever is put into their hands. Parents observe the inclin.i ion, but generally mistake thf object. Instead of tivine the child something which may at once exercise its gums, and afford it nourishment, they commonly put into its hands a piece ot hard n.eta , or impenetrable coral A crust of bread is the best gum stick Ii not only answers the purpose better than any thing else, but has the addi- tional properties of nourishing the child and carrying the saliva down to the stomach, which is too valuable a liquor to be lost. Bread, be-ides being used dry, may be many ways prepared into food for children. One of the be»t methods is to boi! U in water, after- w.tids pouring the water off, and mixing with the bread a proper quan- tity of new n.ilk unboiled. Milk is both more wholesome and nour- ishing this May than boiled, and is less apt to occasion eostivciuss For a child farther advanced, biead may be mixed in veal or ehic.en broth, made into puddings or the like. Bieadis a proper food for chil- dren at all ti'uCt, provided it be plain, made of wholesome gram, and well fermented , but when enriched with fruits, sugars, or such things, it becones vciy unwholesome. I is soon enough to allow children animal food when they have got teeth, oeat it Tuey should never taste it till aftei they are w« aw-J, and even then they ought to use it sparingly. Indeed, when children live S OF CHILDREN. wholly on vegetable food, it is apt (o .-our on their stomachs ; but, on the other h.iud, too much flesh heats the ho Iy, and occasions fevers and other nitl.iinmatoi'y diseases. Tins plainly poinis out a due mixture of animal an.l vegitable food as most proper for cliilffren. Few things prove more hurtful to infants ban he common method of sweetening their food. It entices them to take more ihan they ought to do, winch makes them grow fat and bloated. It is pretty cer- taji, if the food of chi'dren were quite plain, that they would never take more than enough. Their excesses are entirely owing to nurses. If a child be gorged with food at all hours, and enticed to take it, by making it sweet and agreeable to the palate, is it any wonder that such a child should in time be induced to crave more food than it ought to have. ? Children may be hurt by too little as well as too much food. After a child is weaned, it ought to be fed four five times a day ; but should never be accustomed to eat in the night; neither should it have too much at a time. Children thrive best with small quantities of food fre- quently given. Tins neither overloads the stomach, nor hurts the di- gestion, aud is certainly most agreeable to nature. Wntei> on nursing have inveighed with such vehemence against giving children too much food, that many parents, by endeavouring to s-hun thai error, have run into the opposite extreme, and ruined the con- strn ions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Nature has many ways of relieving hcr«e'f when overcharged ; but a child, who is pinched w.th hunger, will never become a strong or healthy man. That errors are frequently committed on both sides, we are ready to acknowledge; but where one child is hurt by the quantity of i food, ten suffer from the quality. This is the principal evil and claims our suiciest atten- tion. Many people imagine, that the food which they themselves love, can* not be bad for their children : but this notion is very ab;urd. In the more advanced periods of life we often acquire an incln atmn for food, which when children we could not endure. Besides, there are many thn:;s that by habit may agree very we I with the stomach of a grown person, which would be hurtful to a child : as high-sea-oned, salt,and smoke-dried provisions, &c. It would also be improper to feed child- ren with fat meat, strong broths, rich soups, or the like. All stioug liquors are hurtful to chi dren. Some parents teach ilieir children o guzzle ale, and other fermented .iquors, at every meal. Such a practice cannot fail to do u.ischief. These children seldom ecape t.'ie violeive of the small-pox, neasles, hooping-cough, or some inflammatory di-order. Milk, water, biittt-r-milk, or whey, are the most proper for children to drink. If they have any thing stiongei. it may be tine so a 1 beer, or a little wine mixed wilh water. The stom- ach of cinl iren can digest well enough without the a- istance of warm siiiiulan : hesi lis, being naturally hot, they are easily hurt byevtiy tin ig of a heati ig quality. F^w thing are mort hurtful To rhildren than unripe frui s. They weaken the powers of digestion, and sour and relax the itomach, by which means it ^eomes a proper nest for insects. Children indeed shew a ur* at inclination for fruit, and I am apt to believe, thai if L'ooJ n»e fuut were allowi d 'hem in proper quantity, it would have no bid effect- >Ve never find a natural inclination wrong, if pioperly 1 iij n ta- red. Fruits a.e generally of a cooling nature, and correct the heat OF CHILDREN. SO and acrimony of thehurronrs This is what most children require ; on- ly can should he taken lest they exceed. Indetu the best way to prc- v« i,i children from going to excess in the me of fruit, or eating that winch is bad, is to allow them a pioper quantity of what is good.* Boots which contain a crude viscul juice flionld be spa-intlv given to children. They fill the body with grms humouis, and tend "to pio- duce eruptive diseases. This caution is peculiarly i:ectss:ny fu\ the poor; glad to obtain at a small (nice what will fi i the bellies of their children, they stiff them two or three times a day «ith crn.te vegf-ta- bles. Children had better eat a spialler quantity ot food which v uids a wholesome iioinishmcnt, than he crammed wi:h what their digestive powers arc unable pi opt rly to ass-imitate. Butter ought likewise to bespaimtly given to children. It both re- laxes ihe stomach, and produces gross humours. Indeed, mos«- things that are fat or oily have tins effect. Bu ter when salted beeon.es still more hurtful Ins.cat! of bu .ter. so liberally Liven to children in most parts of Britain, wc would recommend hmev Iloncv is not only wholesome, but cooling, ckausmg, and tends to .sweetenthe hu- mours. Children who eat honey are seldom troubled with worms: th< y are also less subject to cutaneous diseases, as itch, scabbed head, Sic. Many persons err in thinking that the d:et of children out to be alto- gether moist. When children live entirely upon slops, it relaxes their solids, ren iers them weak, and disposes them to the tickets, scro- phiila, ami other glandular disorders. Kelaxalion is one of the mo t general causes of the dieaes of children. Everv thing therefore Which tends to unbrace their solids, ought to he carefully avoided. We wond no be understood by these observations as confi:.i::v chil- dren to any particular kind of food. Their diet may be frequently ya- rn ■■;, provided always that sufficient regard be had to simplicity Or 771 fi EXERCISE OF CJIILDRES Of all the causes which conspire to r. trier the life of man short and mis( rablc, none have greater influence than the want of proper rxHi- cisi: : heal hy parents, wholesome food, and proper do hmg. will i;v..il little, where, exercise is •egiccted. Sufficient exerci e will make i ,. for -evera! defects in nursing ; but nothing can supply the want of i> It is absolutely neccssaiy to-the health, the growth, and ihe strength of children. , The desire of exercise is coeval with life i'seif. Were this pnn- ip!e attended to, many diseases nu-i.t be prevented. But while indoVnce aii'l s(.,(u,tary employments prevent two thm.s of mankind from'crhtr taking s'utficient ixeicise themselves, or giving it to tin ir children wiii have wc to. expect but diseases and defo.mitv am on;; their olf- ?pri:ig? The rickets, sodestn clive to clitldren, never ai'iicared in I'ri- tain rill manufactures began to flourish, and people, utira« ted I,v the. love of gain, left the country to follow seden ary emp ey. cuts in «'r< '\t towns. It is amongst ti:e-.e people that th s disease chutiv prevails and not only deforms but k:lls many of their offspring. The conduct of other young animals" hews the propriety of givir" exerci-e to children. livery other animal makes use of its or:, an- of • Children ire always sfcklj- in the fruit seison, which inav be thus nccnuntf-.i Tor- Two thirds of tin* fruit which conies lo murker i:, this counrr\ is mhIIv ui-r:i t • ami children no; u-iniri a condition to juiljjefor 'h tin. I\i%, m whato. . rtlu \ e u lax 'their hii.nl. ii|> hi. w'ii.-!i often pro. little hetier than poi.t.n to tl • :>• t d,-ruou'eh. Servants and oilurs who hax • u.- cgre o. children, should be strictly lorbid to tive them any fruit without tlie knowledge of their parents. * 4G OF CHILDREN. motion as soon as it can, and many of them, even when under no ne- cessity of moving in quest of food, cannot be restrained without force. This is evidently the case with the calf, the lamb, aud most other vonng animals. If these creatures were not permitted :o frisk about and take exercise, tficy would soon die or become diseased. The same inclina- tion appears very early in the human -pecies; but as they are no able to take exercise themselves, it is the business of their parents and nurses to assist them Children may be exercised various ways. The best method, while they are light, is to carry them about in the nurse's arms.* This gives the nurse an opportunity of talking to the child, and of pointing out every thing that may please and delight its fancy. Besides, it is much safer than swinging an infant in a machine, or leaving*it to the care of such as are not fit to take care of themselves. Nothing can he more absurd than to set one child to keep another ; this conduct has proved fa al to many infants, and has rendered others miserable for life. When children begin to walk, the safest and best method of leading them about is by the hands. The common way, of swinging them in leading trings, fixed to their backs, has several bad consequences. It make.- them throw their bodies forward, and press with their whole weight upon the stomach and breast; by this means the breathing it ebstrnctcd, the breast flattened, and the bowels compressed, which must hurt the digestion, aud occasion consumptions of the. lungs, and other diseases. It is a common notion, that if children are set upon their feet too soon, their legs will become crooked. There is reason to believe, (hat the very reverse of this is true. Every member acquires strength in proportion as it is exercised. The limbs of children are weak indeed, but their bodies arc proportionately light; and had they skill to direct themselves, they would soon be able to support their own weight. Wlig ever heard of any other animal that became crooked by using its legs too soon ? Indeed, if a child is not permitted to make any use of its legs till a considerable time after the. birth, and be then set upon them with its whole weight at once, there may be some danger ; but this proceeds en- tirely from the child's not having been accustomed to use its legs from the beginning. Mothers of the poorer sort think they are great gainers by making their children lie or sit while they themselves work. In this they are greatly mistaken. I3y ucglectiiK- to give their children exercise, they are obliged to keep them a long time before they can do any;thing tor themselves, and to spend more on medicine than would hav. ,>aicl for proper care. To take care of their children, is the most useful business in which even the poor can be employed : but alas! it is not always in their pow- er. Poverty often obliges them to neglect their offspring in order to procure the necessaries of life. When this is the case, it becomes the interest as well as the duty of the public to assist them. Ten thousand times more benefit would accrue to the state, by enabling the poor to bring up their own children, than from all the hospitalsf that ever can be erected for that purpose. • The mine ought to he careful to keep the child in a proper position; as deformity s often the consequence of iiiiilf-ntion to this circuipstaiic.. Its situation ought also to be frequently changi-d. I have* kuown a child's leg bent all on one side, by the nunc '•amins it constantly on out arm. t It it were made the intt rest of the poor to keep their children alive, wc should lose tv.'y few of them. A small premium given annually to each poor family, for exery OF CHILDREN'. 41 Whoever considers the struc lire of the human body will soon be convinced of the necessity of exercise for the health of children. The body is composed of an infinite number of tubes, whose fluids cannot be pushed on without the action and pressure of the muscles. But, if the fluids remain inactive, obstructions must happen, and the humours will of course be vitiated, which cannot fail to occasion disea-c. Nature has furnished both the vessels which carry the blood and lymph with numerous valves, in order that the action of every muscle might push forward their contents; but without action, this admirable contrivance can have no effect. This part of the animal economy proves to a demon- stration the necessity of exercise for the preservation of health Arguments to shew the importance of exercise might be drawn from every part of the animal economy; without exercise, the circulation of the blood cannot be properly carried on, nor the different reactions duly performed ; without exercise, the fluids cannot be properly prepa- red, nor the solids rendered strong or firm. The action of the heart, the motion of the lungs, and all the vital functions are greatly assisted by exercise. But to point out the manner in which these effects are produced, would lead us further into the economy of the human body, than most of those for whom this treatise, is intended would be able to follow. We shall therefore only add, that, when exercise is neglected, none of the animal functions can be duly performed; and when that is the case, the whole constitution must eo to wreck. A good consti ution ought certainly to be our first object in the man- agement of children. It lays a foundation for their being useful and happy iit.Jifc : and whoever neglects it, not only fails in his duty to his offspring, but to society t One very common error of parents, by which they hurt the constitu- tions of their children, is the sending them too young -to school. This is often done iolely to prevent trouble. When the child is at school, he needs no keeper. Thus the schoolmaster is made the nurse ; and the poor child \- fixed to a seat seven or eight hours a-day, which time ought to be spent in exercise and diversions. Sitting so long cannot fail to produce the worst effects upon the body; nor is the mind less injured. Kirly application weakens the faculties, and often fixes in the mind an aversion to books, which continues for life.* But suppose this were the way to make children scholars, it certainly ought not to be done at the. expense of their constitutions. Our ances- tors, who seldom went to school very young, were not less learned than we. But we imagine the boy's education wi be quite marred, unlers he be carried to school in his nurse's arms. No wonder if such hot-bed plants seldom become, either scholars or men! Not only the confinement of children in public schools, but their number, often proves hurtful. Children are much injured by being kept iu crowds withindoors ; their breathing not only renders the place unwholesome, but if any one of them happens to be diseased, the rest catch the infection. A single child has been often known to communi- child thry had alive at the year's end, would save more infant lives than if the whole revenue of the nation were . xpended o;i hospitals for this puruos-.'. This would make the poor esteem fertility a blessing; whereas many of them think it li.e greatest curse thai 1.1 n bifal them ; and in place of wishing t'l.ir children to live, solar does poverty pet theb tterofimuiul alT.ction.that they are often very-happy whin they di . * It is undoubtedly the dut\ of parents to iiMruct their children, at least till tlwy are of an age proper to take some care of themselves. This would tend murh to confirm the tii s of pareu'al tenderness and filial affection, of the want of which then.-aren't present so many d [■lorablc instances. Though few fathers have time to instruct their ihildren. yet most i:iethers have ; and surely they cannot be better cmplo) od. 42 OF CHILDREN. cate the bloody flux, the hooping cough, the itch, or other disease, to almost every individual in a numerous school. But, if fashion must prevail, aud infants are to be seut to school, wc would recommend it to teachers, as they value the interc-ts of society, not to confine them too long at a time, but allow them to run about and play at such active diversions as may promote their growth, and strengthen their constitutions. Were boys, instead of beiug whipped for stealing an hour to run, ride, swim, or the like, encouraged to em- ploy a proper part of their time in these manly and useful exercises, it would have many excellent effects. It would be of great service to boys, if, at a proper age, they were taught the military exercise. This would increase their strength, in- spire them with courage, and when their country called for their assis- tance, would enable them to act in her defence, without being obliged to undergo a tedious and troublesome course ot instructions, at a time when they are less fit to learn new motions, gestures, &c* An effeminate education will infallibly spoil the best natural constitu- tion ; and if boys are brought up in a more delicate manner than even girls ought to be, they will never be men. Nor is the common education of girls less hurtful to the constitution than that of boys. Miss is set down to her frame before she can put on her clothes; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general esteem. It is unnecessary here to insist upon the dangerous consequences of obliging girls to sit too much. They are pretty well known, and are too often felt at a certain time of life. But supposing this critical period to be^got over, greater dangers still await them when they come to be mothers. Women who have been early accustomed to a sedentary life, generally run great hazard in child-bed ; while those who have been used to romp about, and take sufficient exercise,are seldom in any danger. One hardly meet* with a girl who can at the same time boast of ear- ly performances by the needle, and a good constitution. Close and ear- ly confinement generally occasions indigestions, head aehs, pale com- plexions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and deformity of body. The last of these indeed is not to be wondered at, considering the awkward postures in which girls sit at many kinds of needle-work, and the delicate flexible state of their bodies in the early periods of life. Would mothers, instead of having their daughters instructed in many trifling accomplishments, employ them in plain work an I housewife- ry, and ailuw them sufficient exercise in the open air, they w onld both make them more healthy mothers, and more useful membeis of* society. I am no enemy to genteel accomplishment, hut would have them only considered as secondary, and always disregarded when they inipau the 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 wereso employed as not to hurt their health or grow th ; but, when these suffer, society, instead of being benefited, is a real loser by their labor. There are few employments, except sedentary one«, by which children can earn a livelihood ; and if they be set to these too soon, it * I am happy to find that the masters of academies now begin to put in practice this advice. Each of them ought to keep a drill sergeant for teaching the boys tlie military exercise- This, besides, contributing to their health aud vigour of body, v. aukl have i uany other happy efiicts. OF CHILDREN*. 43 ruins their constitutions. Thus, by gaining a few years from childhood, we generally lose twice a3 many in the latter period of life, and even render the person less useful while he does live. In order to be satisfied of the truth of this observation, we need only look into the great manufacturing towns, where we shall find a puny degenerate race of people, weak and sickly ail their lives, seldom ex- ceeding the middle period of life ; or if they do, being unfit for business, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a country, are by no means favourable to the health of its inhabitants. Good policy would therefore require, that such people as labour during life, should not be set too early to work. Every person conversant in tbe breed of horses, or other working aniu "als, knows, that if they be set to hard labour too soon, they never will turn out to advantage. This is equally true with respect to the human species. Weakly children should always be put apprentices to trades which require their being mostly out of doors. There are nevertheless various ways of employing young people, without hurting their health. The easier parts of gardening, husband- ry, or any business carried on without doors, are most proper. These are employments which most young people are fond of, aud some parts of them may always be adapted to their age, taste, and strength.* Such parents, however, as are under the necessity of employing their children within doors, ought to allow them sufficient time for active di- versions without. This would both encourage them to do more work, and prevent their constitutions from being hurt. Some imagine, that exercise within doors is sufficient; but they are greatly mistaken. One hour spent in running, or any other exercise without doors, is worth ten within. When children cannot go abroad, they may indeed be exercised at home. The best method of doing this, is to make them run about in a large room, or dance. This last kind of exercise, ifnot carried to excess, is of excellent service to young people. It cheers the spirits, promotes perspiration, strengthens the limbs, &c. I know an eminent physician who used to say, that he made his children dance, instead of giving them physic. It were well if more people fol- lowed his example. The cold bath may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretions promo- ted, and, were it conducted with prudence, many diseases, as the rick- ets, scrophula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and robust, were no stran- gers to the use of the cold bath; and, if we may credit report, tlie prac- tice of immersing children daily in cold water must have been very common among our ancestors. The greatest objection to the use of the cold bath arises from the su- perstitious prejudices ofnur.es. These are often so strong, that it is impossible to bring them to make a proper use of it. I have known some of them who would not dry a child's skin after bathing it, lest it should de.vroy the f fleets of the water. Others will even put clothes dipt in water upon the child, and either put it to bed, or suffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a paititular saint; while others place their confidence in a certaiu number of dips, as three, • I have been told that in China, where the police is tlie best in the world, all the children arc employed in th« easier part of gardening aud husbandry; as weeding, gathering Jtoues off the laud, and ju.ch like. OF CHILDREN. seven, nine, or'the like; and the world could not persuade them, if these do not succeed, to try it a little longer. Thus, by the whims of nurses, children lose tlie benefit of the cold bath, and the hopes of the physi- cian from that medicine are often frustrated. We. ought not, however, entirely to set aside the cold bath, because some nurses make a wrong use of it. Every child when in health, should at least have its extremities daily washed in cold water. This is a partial use of the cold bath, and is better than none. In winter this may suffice ; but in the warm season, if a child be relaxed, or seem to have a tendency to the rickets or scrophula, its whole body ought to be frequently immersed in cold water. Care however must be taken not to do this when the body is hot or the stomach full. The child should be dipped only once at a time . should be taken out immediately, and have its skin well rubbed with a dry cloth. THE BAD EFFECTS OF UNWHOLESOME AIR UPON CHILDREN. Few things prove more distructive to children than confined or un- wholesome air. This is one reason why so few of those infants, who are put into hospitals, or parish workhouses, live. These places are generally crowded with old, sickly, and infirm people ; by which means the air is rendered so extremely pernicious, that it becomes a poison to infants. Want of wholesome air, is likewise destructive to many of the chil- dren born iu great towns. There the poorer sort of inhabitants live in low, dirty, confined houses, to which the fresh air has hardly any ac- cess. Though grown people, whcare hardy and robust, may live in such situations, yet they generally prove fatal tt their offspring, few of whom arrive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad in the open air, we must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily . arried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mother goes along with them Servants are often negligent in these matters and allow a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as well as her children, and how can she be better employed than in attending them ? A very bad custom prevails, of making children sleep in small apart- ments, or crowding two or three beds in one chamber. Instead of thi.-, tlie nursery ought always to be the largest and best aired room in the house. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, ren- ders tliem delicate, and disposes them to colds and many other disor- ders. Nor is the custom of wrapping them up too close in cradles less pernicious. One would think that nurses were afraid lest children should suffer by breathing free air. as many of them actually cover the child's face while asleep, and others wrap a covering over the whole cradle, by which means the child is forced to breathe the same air over and over all the time it sleeps. Cradles indeed are on many ac- counts hurtful to children, and it would be better if the use of them were totally laid aside.* * it is amazing how children escape suffocation, considering the mnnntrin which tttcy a-e ottn rolled up in flannels, See I lately attended an infant, whom 1 found ruutUd up ov^t bead aud car. iu many folds of flannel, though it was iu the, middle oi OF CHILDREN. 45 A child is generally laid to sleep with all its clothes on; and if a num- ber of others are heaped above them, it must be over heated . by winch means it cannot fail to catch cold on being taken out of the cra- dle, and exposed to the open air with only its usual clothing, which is too freqnent'y the ca*e. Children who are kept within doors all day, and sleep all night in warm, close apartments, may «vith great propriety, be compared to plants, nursed in a hot hone, instead of the open air. Though such plants may by this means be k«'pt alive for some lime, they will never arrive to that degree of strength, vigour, and magnitude, which they would have acquired in the open air, nor would Ihey be able to bear it afterwards, should they be exposed to it Children brought up iu the country, who have been accustomed to open air, should not be too early sent to great towns, where it is con- fined and unwholesome. This is frequently done wi'h a view to for- ward their education, but proves very hurtful to their health. All Bchools and seminaries of learning ought, if possible, to be so situated as to have fresh, dry, wholesome air, and should never be too much crowded Without entering into a detail of the particular advantages of whole. some air to children or of the bad consequences which proceed from the want of it, I shall only observe, that of several thousands of chil- dren which have been under my care, I do not remember one instance of a -inglfc child who continued healthy in a close confined situation; hut have often known the most obstinate diseases cured by removing them from such a situation to an open free air. OF NURSES. It is not here intended to lay down rules for the choice of nurses, This would be wasting tin.e. Common sense will direct every one to chuse. a woman who is healthy and has plenty of milk.* If she be at the same tune c'eanly, careful, and good-natured, she can hardly fail to make a proper nurse.t After all, however, the only certain proof of a iood nurse, is a healthy child upon her breast. But, as the mis- conduct of nurses often proves fa'al to children, it will be of importance to point out a few of their most baneful errors in order to rouse the at ention of parents, and to make them look more s> rictly into the con- duct of those to whom they commit the care of their infant offspring. Though it admits of some exceptions, yet we may lay it down as a general ride, That every woman who nurses for hire should be carefully looked afttr, otherwise she will not do her duty. For this reason parents oughtalways to have their children nursed under their own eye, if pos- sible ; and where this cannot be done, they should be extremely cir- June. I begged for a little free air to the poor babe ; but though this indulgence was granted during iuj stay, I found it always on my return in the same situation. Death, as might be expected, soon freed the intant from all its miseries : but it was not in my power to free the minds of its parents from those prejudice winch proved fatal to their child. 1 was very lately called to sse an infant which was said to be expiring in convulsion tits. 1 desin d the mother to strip the child, and wrap it in a loose covering. It bad no more convulsi in fits. » * 1 have often known people so imposed upon, as to give an infant to a nurse to be suckled who had not one drop of milk in her breast. t Nevt of importance to a healthy, cleanly, and good natnred nurse, is her diet- On this subject, after a clot-and lengthy investigation, Dr. Cullen, concludes, '• I al- lege it to be a matter of experience, that nurses living ntirely, or for the most part, upon vegetable aliment, afford a greater quantity of milk, and of a mor;- proper quality, than nurses living upon much animal food. This. I venture to assert, from the obser- vation of fifty years j during which time, I have known innumerable instances of the healthiest children reared upon the milk of nurses living entirely upon vegetable a1.- 45 OF CHILDREN*. cnmspect in the choice of those persons to whom they intrust Ihem. It is fo Iy to imagine that any woman, who abandons hci own child to suckie another for the sake of gam, should feel all the affections of a paw-tit towards her nursling; yet so necessary are tire affections in a nurse, that, but for them, the human race would oon be extinct. One of tue most common fauits of those who nurse for hire, is do- sing child en with stupetactivcs, or such Hunts as lull them a-lrep. An indolent nurse, who does not me a child sufficient exercise m the open air to make it sleep, anil does r.ot choose to he disturbed hy it in the night will seldom fm to procure for it a dose of laudanum, diacodmni, saffron, or what answers the same purpose, a dose of spires, or o her strong liquors. These, tliomh they be certain poison to intuits, are every day admnus ered by ma;:y who bear the chaiacter of very good nurses.* A nurse who has not milk enough is apt to imagine tint this defect may be supplied by giving the cln'd wnu s, cordial wattrs, or other strong liquors This is an emeuioi.s mistake The only thing that has any chance to supply the place of the nurse's milk, must be some- what nearly of the sa. e quality, as cow's milk, a-s's nu.k or beef-tea) with a little breath It never can be done by the help of strong liquors. These, instead of nourishing an infant,never fail to produce the contra- ry effect. Children are often hurt by muses suffering them to cry longaml ve- hemently. This strains their tender bodies, and frequently occa-ioiis ruptures, inflammations of the throat, lungs, &c. A child never ton- tinues to cry long without some cause, which mi^ht always be discover- ed by proper attention; and the nurse who can hear an infant cry till it has almost spmt' itself, wi hont endeavouring to please it. must be cruel indeed, and is unworthy to be intrusted with the care of a human creature. Nurses who deal much in medicine are always to be suspected. They trust to it, and neglect theirduty. I never knew a good nnr.-t who hail her Godfrey's cordial, DatSy's enx;r», Dalby's carminative, ..vc. at hand. Such generally in a-u:e, that a dose of medicine will make up for ail de- fects in food, air, exercise, and cleanliness. By erron of this kind, I wil venture to say, that one half ot the children who die annually in London lose their lives. Allowing children to continue long wet, is ano'her very pernicious custom of indolent nur-es. This is not only du agreeable, but ;.al!s and frets the infant, and, by relaxing the solids, occasions scrot hulas, tick- ets, and other diseases. A dirty nur e is always to be suspected. Nature often attempts to tite the bodies of children fiom had hu- mours, by throwing them upon the skiu ; by this means fevers and other diseases are prevented. Nurses are apt to mistake such critical eruptions for an itch, or some other infectious disorder. Accordingly they take every method to drive them in. In this way many children lose their lives : and no wonder, as nature is opposed in the very meth- od she takes to relieve them. It ought to be a rule, which every nurse should observe, never to stop any eruption without proper advice, or ment; and Ihave known many instances of children becoming diseased by their be- ing fell by the milk of nurses who had changeil their diet from eiiirely vegetable, to their taki g in a quantity of animal food. Nay, I have known instances ol children's betomiiie disordered from a nurse's making a single meal of an unusually larei not lion of mutual food.' A. E. /si * It a mother on visiting hi r child at nurse, finds it always asleep, I would advise her to remove it immediately ; otherwise it will soon sleep its last. OF THE LABORIOUS, &c. A? being well assured that it is not of a critical nature. At any rate, it is never tu be done without p.evious evacuations. Loo»e stools is another method by which nature often prevents or carr.es off the diseases of infants. If these proceed too far, no doubt they ought to be checked ; but this is never to be don" without the greatest caution. Nurses, upon the first a ipearance of loose stools, frequently fly to the use of as.r.ngent-, or such things as bind the body. Hence inflammatory fevers, and other fatal diseases, art- occasioned. A dose of rhubarb a gentle vomit, or some other evacuations, should always precede tlielise of astringents medic ties. One of the greatest faults of nm ses is, concealing the diseases of chil- dren from heir parents. Tin* they are extremely ready to ao, espe- cially when the disease is the efte. t of their own negligence. Many instances might be given of persons who have been rendered lame for life by a fa I from the nurse's arms, which she, turough fear, concealed till the misfortune was past cure. Every parent who intrusts a nurse with the care of a clmd, oueht to give her the strictest charge not to conceal the most trifling disorder or in ^fortune that may befal it Wc can see no reason why a nurse who conceals any mi-fortune which happens to a child under her care, till it loses its life or limbs, should not ue punished. A few examples of tins would save the ives of many infants ; but as there is little reason to expect that it ever will be the case, we would earnestly recommend it to all parents to look carefully after their children anil not to trust so valuable a treasure en- tirely in the hands of an hireling. No person ought to imagine these things unworthy of his attention. On the proper management of children depend not only their health ami usefulness in life, but likewise the safety and pr> s.ieriiy of the state to which they belong. F.ffemiiiacy ever will prove he rum of any state where it prevails ; and, when it- foundations are laid in infancy, it can never afterwards be wholly eradicated. Parents who love their off- spring, and, wish we'l to. their country, ought therefore, in the man- agement of their children, to avoid every thing that may have a tenden- cy to make them weak or effeminate, and to take every method in their power to render their constitutions strong and hardy. " By arts like these " Laconia nurs'd of old her hardy sons; u And Uo-i.e's unconnuer'd 1 gion- urg'd their way, u Unhurt, througii every toil ii every clime." Armstrong} CHAPTER II. OF THE LABORIOUS TH SEDENTARY, AND THE STUDIOUS 1 II \T men are exposed to particular diseases from the occupations which they fol'ow, is a fact well known; but to remedy this evil is a matter of some difficulty Most people are under the necessity of fol- lowing those employments to which the\ have been bred, whether they be favourable to health or not. F ions which are hurtful 'o Ikm'th we sha'l endeavour to point out he circum- stances in each of them from which the danger chiefly arises, and to pro- ■pose the most rational methods of preventing it. 48 OF THE LABORIOUS, THE SEDENTARY, Chemists, founders, formers, glass-makers, and several other artists, are hurt by the unwholesome air which they are obliged to breathe. This air is not only loaded with the 110x10m exhalations aiisn.g from metals and minerals, but is so charged with phlogiston »> to be render- ed until for expanding the lungs sufficiently, and answering the other important purposes of respiration Hence proceed asihiuas, coi-jJis, and consumptions of the lungs, so incident to poisons who follow these employments. To prevent such consequences, as far as possible, the places where these occupations of south latitude, of one hundred and eighteen men composing the ship's company, he lost only one, who died of a Phthisis Putrnonalit. The principal means he used were, to preserve a strict attention to cleanliiie-s, to procure abundance of vegetable and fresh'provisions,especially good water, and to allow his people sufficient time for rest. + A regulation on board the United States' Navy, requiring every individual, of least onreaveek to wash their feet dean, is worthy of general attention, as a means of preser- ving health. A. E. AND THE STUDIOUS. 55 this medicine is taken. It may either be infused in water, wine, or spirits, as recommended above, or made into an electuary with syrups of lemons, oranges, or the like. THE SEDENTARY. Though nothing can be more contrary to the nature of man than a sedentary life, yet this class comprehends by far the greater part of the species. Almost the whole female world,.and in manufacturing countries, the major part of the males, may be reckoned sedentary.* Agriculture, the first and most healthful of all employments, is now followed by few who are able to carry on any other business. But those who imagine that the culture of the earth is not sufficient 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 immense increase of inhabitants Britain might admit of, and all of them live by the culture of die ground. Agriculture is the great source of domestic riches. Where it is ne- glected, whatever wealth may be imported from abroad, poverty aud misery will abound at home. Such is, and ever will be, the fluctuating s-tate of trade and manufactures, that thousands of people may be in full employmentto-day and in beggary tomorrow. This can never hap- pen to those who cultivate the ground. They can eat the fruit of their labor, and always by industry obtain, at least, the necessaries of life. Though sedentary employments are necessary, yet there si cms to be no reason why any person sliould be confined for life to these alone. Were such employments intermixed with the most active and laborious, they would never do hurt. It is constant confinement that ruins the health. A man may not be hnrt by sitting five or six hours a-day; but if he is obliged to sit ten or twelve, he will soon become diseased. But it is not want of exercise alone which hurts sedentary people; they likewise suffer from the confined air which they breathe. It is very common to see ten or a dozen taylors,f or ftay-makers, for ex- ample, crowded into one. small apartment, where there is hardly room for one person to breathe freely. In this situation they generally con- tinue for many hours at a time, often with the addition of several can- dles, which tend likewise to waste the air, and render it less fit tor respiration. Air that is breathed repeatedly becomes unfit for expan- ding the lungs. This is "one cause of the phthisical coughs, and other complaints of the breast so incident to sedentary artificers. Even the perspiration from a great number of persons pent up to- gether, renders the aiv unwholesome. The dang«r from this quarter will be greatly increased, if any one of them happens to have bad lungs, or to be otherwise diseased. Those who set near him, being forced to breathe the same air, can iiardiv fail to be infected. It would be a rare thing, however, to find a dozen of sedentary people all in good health. The danger of crowding them together must therefore be evi- dent to every one. • The appellation ofsedefltary" has generally been given only to die studious; we can see no reason, however, for restricting it to them alone. Many artificers may, with as much propriety, be denominated sedentary at the studious, w ith this particular disad- vantage, that they are often obliged to sit in very awkward postures, which the studious need not do, unless they plw.e. t A |>crson of observation in that line of life told me, that most Uylors die of con- sumptions; which he attributed chiefly to tbe unt'avouable postures in which they sic and the unwhoLsomeness of those places where their business is carried on. If more, atttntinn was nut paid to profit than to the per.crvation of human lives, this evil might be easily remedied; but while masters only mind their own interest, notnittg w ill be done tor the safety of their servants. E 3 54 OF THE LABORIOUS, THE SEDENTARY, Many of those who follow sedentary employments are constantly in a bending posture, as shoemakers, taylors, cutlers, &c. Such a situa- tion is extremely hurtful. A bending posture obstructs all the vital motions, and of course must destroy the health. Accordingly we find such artificers generally complaining of indigestions, flatulencies, head- aches, pains of* the breast, &c. The aliment in sedentary people, instead of being pushed forwards by an erect posture, and the action of the muscles, is in a manner con- fined in the bowels. Hence indigestion, costiveness, wind, and other hypochondrical affections, the constant companions of the sedentary. Indeed none of the excretions can be duly performed where exercise is wanting; and when the matter which ought to be discharged in this way is retained too long in the body, it must have bad effects as it is again taken up into the mass of the humours. A bending posture is likewise hurtful to the lungs. When this orpan is compressed, the air cannot have free access in all its parts, so as to expand them properly. Hence tubercles, adhesions, &c. are formed, which often end in consumptions. Besides, the proper action of the lungs being absolutely necessary for making good blood, when the or- gan fails, the humours soon become universally depraved, and the whole constitution goes to wreck. Sedentary artificers are not only hurt by pressure on tbe bowels, but also on the inferior extremities, which obstructs the circulation in these parts, and renders them weak and feeble. Thus taylors, shoe- makers, &c. frequently lose the nse of their legs all together : besides, the blood and humours are, by stagnation, vitiated, and the perspira- tion is obstructed ; from whence proceed the scab, ulcerous sores, foul blotches, and other custanoons diseases so common among seden- tary artificers. A bad figure of body is a very common consequence of close appli- cation to sedentary employments. The spine, for example, by being continually bent puts on a crooked sha^ie, and generally remains so ever after. But a bad figure of body has already been observed to be hurt- ful to health, as the vital functions are thereby impeded. A sedentary life seldom fails to occasion an universal relaxation of the solids. This is the great source from whence most of the diseases ef sedentary people flow. The scropluila, consumption, hysterics, and nervous diseases, now so common, were very little known in this coun- try before sedentary artificers became so numerous ; and they are very tittle known still among such of our people as follow active employ- ments without doors, though in great towns at least two thirds of the inhabitants are afflicted with them. It is very difficult to remedy those evils, because many who have been accustomed tb a sedentary life, like ricketty children, lose all in- clination for exercise; we shall, however, throw out a few hints with res- pect to the most likely means for preserving the health of this useful set of people, which some of them, we hope, will be wise enough to take. It has been already observed that sedentary artificers are often hurt by their bending posture. They ought therefore to stand or sit as erect as the nature of their employments will permit. They should likewise change their posture frequently, and should never sit too long at a time, but leave off work, and walk, ride, run, or do any thing that will pro- mote the vital functions. Sedentary artificers are generally allowed too little time forexercise; yet short as it is, they seldom employ it properly. A journeyman tay« AND THE STUDIOUS. 55 lor or weaver, for example, instead of walking abroad for exercise and fresh air, at his hours of leasure, chooses often to spend them iu a pub- lic-houre, or in playing at some sedentary game, by which he generally loses both his time and his money. The awkward postures in which many sedentary artificers work, seem rather to be the effect of custom than necessity. For example, a table might surely be contrived for ten or a dozen taylors to sit round with liberty for their legs either to hang down, or rest upon a foot-board as they should choose. A place might likewise be cut out for each person in snch a manner that he might sit as conveniently for working as in the present mode of sitting cross-legged. All sedentary artificers ought to pay the most religions regard to clean- liness. Both their situation and occupations render this highly neces- fary. Nothing would contribute more to preserve their health, tlian a strict attention to it: and such of them as neglect it, not only run the hazard of losing health, but of becoming a nuisance to their neighbours. Sedentary people ought to avoid food that is windy or hard of diges- tion, and should pay the strictest regard to sotriety. A person who works hard without doors will soon throw of a debauch; but one who sits has by no means an equal chance. Hence it often happens, that se- dentary people are seized with fevers after hard drinking- When such persons feel their Fpirits low, instead of running to the tavern for relief; they should ride or walk in the field. This would remove the com- plaint more effectually than strong liquor and would never hurt the constitution. Instead of multiplying rules for perserving the health of the sedenta- ry, we shall recommend to them the following general plan, viz. That every person who follows a sedentary employment, should cultivate a piece of ground with his own hands. This he might dig, plant, sow, and weed at leisure hours, so as to make it both ati exercise and amusement while it produced many of the neces-ai i?- pi" life. After working an hour in a garden, a man will return vvivli raofe kpeuness to his employment within doors, than if he had been all the while idle. Laboring the ground is every way conducive to health. It not only wives exercise to every part of the body, but the very ; meil of the earth and fresh herbs revives and cheers the spirits, whilst the perpetual pros- pect of something coining to maturity, delights and entertains the mind. We are so formed as to be always pleased with somewhat in prospect, however distant or however trivial. Hence the happiness that most men feel in planting, sowing, bnildiurr, <\-c. These seem to have been the chief employments ot the more early ages; and, when kings and conquerors cultivated the ground, there is reason to believe that they knew as well wherein true happiness consisted as we do. It may seem romantic to recommend gardening to manufacturers in great towns; hut observation proves that the plan is very practica- ble. In the town of Sheffield, in Yorkshire, where the great iron manufacture is carried on, there is haidiy a journey man cutler who does not possess a piece of ground which he cultivates as a garden. This practice has many salutary effects. It not only induces these people to take exercise without doors, but also to eat many preens, roots, &c. of their own growth, which they would uever thiuk of purchasing. There can be no reason why manufacturers in any other town in Great- Britain should not follow tlie same plan. It is indeed to be regretted, that in such a place as London a plan of this kind is not practicable: yet even there, sedentary artificers may find opportunities of taking air and exercise if they choose to embrace them. 56 OF THE LABORIOUS, THE SEDENTARY, Mechanics are too much inclined to crowd into great towns. The situation may have some advantages; but it has likewise many disad- vantages. All mechanics who live in the country have k in their power to cultivate a piece of ground; which indeed most of them do. This not only gives them exercise but enables them to live more comfort- ably. So far at least as my observation extends, mechanics who live in the country are far more happy than those in great towns. They enjoy better health, live in greater affluence, and seldom fail to rear a healthy and numerous offspring. In a word, exercise without doors in one shape or another, is abso- lutely necessary to health. Those who neglect it, though they may for a while drag out life, can hardly be said to enjoy it. Weak and effemi- nate, they languish for a few years, aud soon drop into an untimely grave. THE STUDIOUS. Intense thinking is so di?tructive to health that few instances can be produced of studious persons who are strong and healthy. Hard stu- dy always implies a vedentary life, and when intense thinking is join- ed to the want of exercise, the consequences must be bad. We have frequently known even a few months of close application to study, ruin an excellent constitution, by inducing a train of nervous complaints, which could never be removed. Man is evidently not formed for con- tinual thought more than for perpetual action, and would be as soon worn out by the one as the other. So great is the power of the mind over the body, that, by its inflo- ence, the whole vital motions may be accelerated or retarded, to al- most any degree. Thus cheerfulness and mirth quicken the circula- tion, and promote all the secretions; whereas sadness and profound thought never fail to retard tiiem. Hence it would appear, that even a degree of thoughtlessness is necessary to health. Indeed the perpetu- al thinker seldom enjoys either health or spirits; while the person, who can hardly be said to think at all generally enjoys both. Perpetual thinkers, as they are called, seldom think long. In a few years they generally become quite stupid, and exhibit a melancholy proof how readily the greatest blessings may be abused. Thinking, like every thing else, when carried to extremes, becomes a vice; nor can any thing afford a greater proof of wisdom, than for a man frequently, and seasonably to unbend his mind. This may generally be done by mixing in cheerful company, active diversions or the like. Instead of attempting to investigate the nature of that connection which subsists between the mind and body, or to inquire into the man- ner in which they mutually affect each other, we shall only mention those diseases t% which the learued are more peculiarly liable, and en- deavour to point out the means of avoiding them. Studious persons are very subject to the gout. This painful disease in a great measure proceeds from indigestion, and an obstructed per spiration. It it is impossible that the man who sits from morning till night should either digest his food, or have any of the secretions in due quantity. But when that matter which should be thrown oft by the skin, is retained in the body, and the humours are not duly prepared, diseases must ensue. Tlie studious are likewise very liable to the stone and gravel. Ex- ercise git. tly promotes both tlie secretion and discharge of urine; con- sequently a sedentary life must have the contrary effect. Any one may be satisfied of tlits, by observing that he passe* much more urine AND THE STUDIOUS. $7 by day than in the night, and also when he waiks or rides, than when he sits. The circulation in the liver being slow, obstructions in that organ can hardly fail to be the consequence of inactivity. Hence sedentary people are frequently afflicted with schirrous livers. But the proper secretion and discharge of the bile is so necessary a part of the animal economy, that where these are not duly performed, the health must soon be impaired. Jaundice, indigestion, loss of appetite and a wasting of the whole body, seldom fail to be the consequences of a vitiated state of the liver or obstructions of the bile. Few diseases prove more fatal to the studious than consumptions of the lungs. It has already been observed, that this organ cannot be duly expanded in those who do not take proper exercise ; and where this is the case, obstructions and adhesions will ensue. Not only want of exercise, but the posture in which studious persons generally sit, is very hurtful to the lungs. Those who read or write much are ready to contract a habit of bending forwards, and often press with their breast upon a table or bench. This posture cannot fail to hurt the lungs. The functions of the heart may likewise by this means be injured. I remember to have seen a man opened, whose pericardium adhered to the breast-bone, in such a manner as to obstruct the motion of the heart, and occasion his death. The only probable cause that could be assigned for this singular symptom was, that the man, whose business was writing, used constantly to sit in a bending posture, with his breast pressing upon the edge of a plain table. No person can enjoy health who does not properly digest his food. But intense thinking, and inactivity never fail to weaken the powers of digestion. Hence the humours become crude and vitiated, the solids weak and relaxed, and the whole constitution goes to ruin. Long and intense thinking often occasions grievous head-achs, which bring on vertigoes, apoplexies, palsies, and other fatal disorders. The best way to prevent these is, never to study too long at one time, and to keep the body regular, either by properfood, or taking frequently a little of some opening medicine. Those who read or write much are often afflicted with sore eyes. Studying by candle-light is peculiarly hurtful to the sight. This ought to be practised as seldom as possible. When it is unavoidable, the eyes should be shaded, and the head should not be held too low. When the eyes are weak or painful, they should be bathed every night and morning in cool water, to which a little brandy may be added. It has already been observed, that the excretions are very defective in the studious. The dropsy is often occasioned by the retention of those humours which ought to be carried off in this way. Any person may observe that sitting makes his legs swell and that this goes off by exercise ; which clearly points out the method of prevention. levers, especially of the nervous kind, are often the effect of study. Nothing affects the nerves so much as iutense thought. It in a manner unhinges the whole human frame, and not only hurts the vital motions, but disorders the mind itself. Hence a delirium, melancholy, and even - madness, are often the effect of close application to study. In fine, there is no diseases which can proceed either from a bad state of the humours, a defect of the usual secretions, or a debility of the nervous system, which may not be induced by intense thinking. 58 OF THE LABORIOUS, THE SEDENTARY, But the most afflicting of all the. diseases which attack the studious is the hypochoudriac. This disease seldom fails to be the companion of deep thought. It may rather be called a complication of maladies than a single one. To what a wretched condition are the best of men often reduced by it! Their strength and appetite fail ; a perpetual gloom hangs over their minds; they ii ve in the constant dread of death, and are continually in search of relief from medicine ; where, alas! it is not to be found. Those who labour under this disorder, though they are often made the subject of ridicule, justly claim our highest sympa- thy and compassion. Hardly any thing can be moro prepostcrons than for a person to make study his sole business. A mere student is seldom an useful member of society. He often neglects the most important duties of life, in order to pursue studies of a very trifling nature. Indeed it rarely happens, that any useful invention is the effect of mere study. The farther men dive into profound researches, they generally deviate the more from common sense, and too often lose sight of it altogether. Profound speculations, instead of making men wiser or better, gene- rally render them absolute sceptics, and overwhelm them with doubt and uncertainty. All that is necessary for a man to know, in order to be happy, is easily obtained ; and the rest, like the forbidden fruit, serves only to increase his misery. Studious persons in order to relieve their minds, must not only dis- continue to read and write, but engage in some employment or di« version that will so far occupy the thought as to make them forget the business of the closet. A solitary ride or walk are so far from re* taxing the mind, that they rather encourage thought. Nothing can di- vert the mind when it gets into a train.of serious thinking, but atten- tion to subjects of a more trivial nature. These prove a kind of play to the mind, and consequently relieve it. Learned men often contract a contempt for what they call trifling company. They are ashamed to be seen with any but philosophers. This however is no proof of their being philosophers themselves. Nf man deserves that name who is ashamed to unbend bis mind, by associ- ating with the cheerful and gay. Even the society of children will re- lieve the mind, and expel the gloom which application to study is too apt to occasion. As studious people are necessarily much within doors, they should make choice of a large and \vt II aired place for study. This would not only prevent the bad effects which attend confined air, but would cheer the spirits, and have a most happy influence both on the body and mind. It is said of Euripides the tragedian, that he used to retire to a dark cave to compose his tragedies, and of Demosthenes (he Grecian or- ator, that he chose a place for study where nothing could be. either heard or seen. With all deference to such venerable names, we cannot help condemning their taste. A man may surely think to as good pur- pose in an elegant apartment as in a cave; and may have as happy conceptions were the all-cheering rays of the sun render the air whole- some, as in places where they never enter. Those who read or write much should be very attentive to their pos» tore. They ought to sit and study by turns, always keeping asneaily in an erect posture as possible. Those who dictate may do it walking. It has an excellent effect frequently to read or speak aloud. This not only exercises the lungs, but almost the whole body. Hence studious people are generally benefited by delivering discourses in public. Pub- AND THE STUDIOUS. 59 tic speakers indeed, sometimes hurt themselves, by over-acting their part; but this is their own fault. The martyr to mere vociferation merit): not oui sympathy. The morning has, by ail medical writers, been reckoned the best time for study. It is so. But it is also the most proper season for ex- ercise, while the stomach is empty, and the spirits refreshed with sleep. Studious people should therefore sometimes spend the morning in walking, riding, or some manly diversions without doors. This would make them return to study with greater alacrity, and would be of more service than twice the time after their spirits are worn out with fatigue. It is not sufficient to take diversion only when we can think no longer. Every studious person should make it a part of his business, and should let nothing interrupt his hours of recrea- tion more than those of study. Music has a very happy effect in relieving the mind when fatigued with study. It would be well if every studious person were so far ac- quainted with that science as to amuse him.relf after severe thought by , playing such airs as have a tendency to raise the spirits, and inspire Cheerfulness and good humour. It is a reproach to learning, that any of her votaries, to relieve the mind after study, should betake themselves to the use of strong liquors* This indeed is a remedy ; but it is a desperate one, and always proves destructive. Would such persons, when their spirits are low, get on horseback, and ride ten or a dozen miles, they would find it a more ef- fectual remedy than any cordial medicine in the apothecary's shop, or all the strong liquors in the world. The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with study, or other serious busi* ness, I mount my horse, and ride ten or twelve miles into the country, where I spend a day, and sometimes two, with a cheerful friend ; after which I never fail to return to town with new vigour, and to pursue my studies or business with fresh alacrity. It is much to be regretted, that learned men, while in health, pay so little regard to these things! There is not any thing more common than to see a miserable object over-run with nervous diseases, bathing, walk- ing, riding, and, in a word, doing every thing for health after it is gone ; yet, if any offe had recommended these things to him by way of pra- vention, the advice would, in all probability, have been treated with contempt, or at least with neglect. Such is the weakness and folly of mankind, and such the want of foresight, even in those who ought to be wiser than others! With regard to the diet of the studious, we see no reason why they should abstain from any kind of food that is wholesome, provided they use it iu moderation. They ought, however, to be sparing in the use of every thing that is windy, rancid, or hard of digestion. Their sup- pers should always be light or taken soon in the evening. Their drink may be water, fine malt liquor, not too strong, good cider, wine and water, or if troubled with acidities, water mixed with a little brandy, r:im,or any other genuine spirit. • « To such persons," says Dr. Rush, " it may be a discovery to know, that tea is a much better remedy for that purpose. By its grateful and gende stimulus, it removes fatigue, restores the excitement of the mind, and invigorates the whole system. I am no advocate for the excessive use of tea. When taken too strong, it is hurtful especial- ly to the female constitution ; but when taken of a moderate degree of strength, and in moderate quantities, with sugar and cream.or milk, 1 believe it ft in general, innox- ious, and, at all times, to be preferred to ardent spirits, as a cordial for studious men." ^ ^ SO OF ALIMENT. We shall only observe, with regard to those kinds of exercise which are most proper for the studious.; that they should not be too violent, nor ever carried to the degree of excessive fatigue. They ought like- wise to be frequently varied so as to give action to all the different parts of the body ; and should, as often as possible, be taken in the open air. In general, riding on horseback, walking, working in a garden, or playing at some active diversions, are the best. We would likewise recommend the use of the cold bath to the stu- dious. It will, in some measure, supply the place of exercise, and should not be neglected by persons of a relaxed habit, especially in the warm season. No person ought either to take violent exercise or to study immedi- ately after a full meal. CHAPTER III. OF ALIMENT. IjNWHOLESOME food, and irregularities of diet, occasion many diseases. There is no doubt but the whole constitution of body may be changed by diet alone. The fluids may be thereby attenuated or con- densed, rendered mild or acrimonious, coagulated or diluted, to almost any degree. Nor are its effects upon the solids less considerable. They may be braced or relaxed, have their sensibility, motions, &c. greatly increased or diminished, by different kinds of aliment. A very small attention to these things will be sufficient to shew how much the preservation of health depends upon a proper regimen of the diet. Nor is an attention to diet necessary for the preservation of health only : it is likewise of importance in the cure of diseases. Every in- tention in the cure of many diseases, nay be answered by diet alone. Its effects, indeed, are not always so quick as those of medicine, but they are generally more lasting : besides, it is neither so disagreeable to the patient, nor so dangerous as medicine, and is always more easily obtained. Our intention here is not to inquire minutely into the nature and properties of the various kinds of aliment in use among mankind ; nor to shew their effects upon the different constitutions of the human bo- dy; but to mark some of the most pernicious errors which people are apt to fall into, with respect both to the quantity and quality of their food, and to point out their influence upon health. It is not indeed an easy matter to ascertain the exact quantity of food proper for every age, sex, and constitution: but a scrupulous nicety here is by no means necessary. The best rule is to avoid all extremes. Mankind were never intended to weigh and measure their food. Nature teaches every creature when it has enough ; and the calls of thirst and hunger are sufficient to inform them when more » necessary. Though moderation is the chief rule with regard to the quantity, yet the quality of food merits a farther consideration. There are many ways by which provisions may be rendered unwholesome. Bad sea- sons may either prevent the ripening of grain, or damage it after- wards. These, indeed, are acts of Providence, and we must submit to them; but surely no punishment can be too severe for those who suffer provisions to spoil by hoarding them, on purpose to raise the price, OF ALIMENT. 61 or who promote tlieir own interest by adulterating the necessaries of life.* Animal, as well as vegetable food may be rendered unwholesome, by being kept too long. Ail animal substances have a constant ten- dency to putrefaction; and, when that has proceeded too far, they not only become offensive to the senses, but hurtful to health. Dis- eased animals, and such as die of themselves, ought never to be eaten. It is a common practice, however, in some grazing countries, for ser- vants and poor people to eat such animals as die of any disease, or are killed by accident, poverty indeed, may oblige people to do this; but they had better eat a smaller quantity of what is sound and whole- some : it would both afford a better nourishment, and be attended with lew danger. The injunction given to the Jews, not to eat any creature which died of itself, seemed to have a strict regard to health ; and ought to be ob- seived by Christians as well as Jews. Animals never die themselves without some previous disease; bit. how a diseased animal should he wholesome food, is inconceivable: even those which die hy accident must be hurtful, as their blood is mixed with the flesh, and soon turns putrid. Animals which feed grossly, as tame ducks, hogs, ell for mankind, if cookery, as an art, were entirely prohibited. Plain roasting or boiling is all that the stomach requires. These aionc are sufficient for people in health, and the sick have s.ill less "dd of acook. The liquid part of our aliment likewise claims our attention. Water is not only the basis of most liquors, but also composes a great part of our solid food. Good water must therefore he of ihe gre..ust is por- tance in diet. The best water is that which is most pure, am! free fi oiu any mixture of foreign bodies. Water takes up parts of most bodies will which if comes into contact; by tins m ins jt i.- off en impregnated with metalsor mineral-of a hurtful or poisonous nature. Hence the in- OF ALIMENT. 63 habitants of some hilly countries have peculiar diseases, which in all probability proceed from the water. Thus the people who live near the Alps in Switzerland, and the inhabitants of the Peak of Derby in England, have large tumours or wens on their necks. This disease is generally imputed to the snow water; but there is more reason to believe it is owing to the minerals in the mountains through which the waters pass. When water is impregnated with foreign bodies it generally appears by its wciylit, colour, taste, smell, heat, or some other sensible quality. Our business therefore is to chuse such water, for common use, as is lightest, and without any particular colour, taste, or smell. In most places of Britain the inhabitants have it in their power to make choice of their water; and few things would contribute more to health than a due attention to this article. But mere indolence often induce peo- ple to make use of the water that is nearest to them, without considering its qualities. Before water is brought into great towns, the strictest attention ought to be paid to its qualities, as many diseases may be occasioned or axgravated by bad water; and when once it has been procured at a great expense, people are unwilling to give it up. The common methods of rendering water clear by filtration, or soft by exposing it to the sun and air, Ate. are so generally known, that it is unnecessary to spend time in explaining them. We shall only, in gen- eral, advise all to'avoid waters which stagnate long in small lakes, pouds or the like, as such waters often become putrid, by the corruption of animal and vegetable bodies with which they abound. Even cattle frequently suffer by drinking, in dry seasons, water which has stood long in small reservoirs, without being supplied by springs, or freshened with chowers. All wells ought to be kept clean, and to have a free communication with the air. As fermented liquors, notwithstanding tliey have been exclaimed against by many writers, still continue to be the common di ink of al- most every person who can aff-rd them ; we shall rather endeavour to assist people in the choice of these liquors, than pretend lo condemn what cut-torn has so firmly established. It is not the moderate use of sound fermented liquors which hurts mankind : it is exces», and using such as are ill prepared or vitiated. Fermented liquors, which are too strong, hurt digestion: and the body is so far from being strengthened by them, that it is weakened and re- laxed. Many imagine that hard labour could not be supported witliout drinking Strom: liquors; this is a very erroneous notion. INren who never taste strong liquors are Hot only able to endure more fatigue, but also live much longer than those who use them daily. But suppose strong liquors did enable a man to do more work, they muslneveitlule a •wa-te the powers of life, and occasion premature old age. They keep up a constant fever, which exhausts the spirits, inflames the blood, and dispones the body to numberless diseases. But fermented liquors may be too weak as well as too strong: when that is the case, they must either be drank new, or they become sour and dead: when such liquors are drank new, the fernn ntaion not being over, they generate air in the bowels, and oci-a ion flituleucies ; and when kept till stale, they turn sour on the stomach, am! hurt digestion. Fortius reason all malt liquor, cyder, ivc. ouglii to be of Mich strem. h as to keep till they be ripe, and then they should be used. When such 64 OF ALIMENT. liquors are kept too long, though they should not become sour, yet they generally contract a hardness which renders them unwholesome. All families, who can, ought to prepare their own liquors. Since preparing and vending of liquors became one of the most general branch- es of business, every method has been tried to adulterate them. The great object both to the makers and venders of liquor is to render it in- toxicating, and give it the appearance of age. But it is well known that this may be done by other ingredients, than those which ought to be used for making it strong. It would be imprudent even to name thoie thing's which are daily made use of to render liquors heady. •Snitice it to say that the practice is very common, and that all the in- gredients used for this purpose are of a narcotic or stupefactive quality. But as all opiates are poisonous it is easy to see what must he the consequence of their general use. Though they do not kill sudden- ly, yet they hurt the nerves, relax and weaken the stomach, and spoil tbe digestion. Were fermented liqnors faithfully prepared, kept to a proper age, and used in moderation, they would prove real blessings to mankind. But, while they are ill prepared, in various ways adulterated, and taken to excess, they must have many pernicious effects. We would recommend it to families, not only to prepare their own liquors, but likewise their bread. Bread is so necessary a part of diet that too much care cannot be bestowed in order to have it sound and wholesome. For this purpose, it is not only necessary that it be made of good grain, but likewise properly prepared, and kept free from all unwholesome ingredients. This however, we have reason to believe is not always the case with bread prepared by those who make a bade of vending it. Their object is rather to please the eye, than to consult tlie health. The best bread is that which is neither too coarse nor too fine; well fermented, and made of wheat flower, or rather of wheat and rye mixed together. To specify the different kinds of aliment, to explain their nature and properties, and to point out their effects in different constitutions, would far exceed the limits of our design. Instead of a detail of this kind, which would not be generally understood, and of course little attended to, we shall only mention the following easy rules with respect to the choice of aliment. Persons whose solids are weak and relaxed, ought to avoid a!) visrid food, or snch things as are hard of digestion. Their diet, however, ought to be nourishing; and they should take sufficient exercise in the open air. Such as abound with blood should be sparing in the use of every thing that is highly nourishing, as fat meat, rich wines, strong ale, and such like. Their food should consist chiefly of breed and otliei vegetable substances; and their drink ought to be water, whey, or small beer. Fat people should not eat freely of oily nourishing diet. They ought frequently to use horse-radish, garlics, spices, or such things as ure heating anti promote perspiration and urine. Their drink sliould be water, coffee, tea, or the like ; and they ought to take much exercise and little sleep. Those who are too lean must follow an opposite course. Such as are troubled with acidities, or whose food is apt to sour on the stomach, sliould live much on animal food ; and those who are afflic- ted with hoi bilious eructation', ought to use a diet consisting chiefly of acid vegetables. OF ALIMENT. 65 People who are afflicted with thegont,low spirits, hypochondriac or hysteric disorders, ought to avoid all flatulent food ; every thing that is viscid or hard of digestion, all salted or smoke-dried provisions, and whatever is austere, acid.or apt to turn sour on the stomach. 1 lieu food sliould be light, spare, cool, and of an opening nature. The diet ought not only to be suited to the age and constitution, but also to the manner of life: a sedentary or studious person should live more sparingly than one who labours hard without doors. Many kinds. of food will nourish a peasant very well which would be almost indi- gestible to a citizen ; and the latter will live upon a diet on which the former would starve. . Diet-ought not to be too uniform. The constant me of one kind ot food might have some bad effects. Nature teaches us this, by the ureat variety of aliment which she has provided for man, andlikewi?e by giv- ing him an appetite for different kinds of food. Those who labour under any particular disease, ought to avoid such aliments as have a tendency to increase it: for example, a gouty person should not indulge in rich wines, strong soups, or gravies, and should avoid all acids- One who is troubled with the gravel ought to shun all austere and astringent aliments ; and those who are scorbutic should he sparing in the use of salted provisions, &c. In the first period of life, our food ougiit to be light, but nourishing, and frequently taken. Food that is solid, with a sufficient degree of tenacity, is most proper for the state of manhood. The diet suited to the last period of life, when nature is upon the decline, approaches nearly to that of the. first. It should be lighter and more succulent than that of vigorous age, and likewise more frequently taken. It is not only necessary for health that our diet be wholesome, but also that it be taken at regular periods. Some imagine long fasting «ill atone for excess; but this, instead of mending the matter, general- ly makes it worse. When the stomach and intestines, are over distend? ed with food, they lose their proper tone, and, by long fasting, they he- come weak, and inflated with wind. Thus either gluttony or fasting dcstioys the powers of digestion. The frequent repetition of aliment is not only necessary for repair- ing the continual waste of our bodies, but likewise to keep the fluids sound aud sweet. Our humours, even in the most healthy state, have a constant tendency to putrefaction, which can only be prevented by t>< '|u< nt supplies of fresh nourishment: when that is v.anting too long, the putrefaction often proceeds so far as to occasion very danger- ous fevers. From hence we may learn the necessity of regular meals. No person can enjoy a good state of health, whose vessels arc either frequently overcharged, or the humours long deprived of fresh supplies of chyle. Long fatting is extremely hurtful to young people; it not only vi- tiates their humours, but prevents their growth. Nor is it less injuri- ous to the aged. Most persons, in the decline of life, are atfiictcd with wind : this complaint is not only increased, but even rendered danger- ous, and often fatal, by long fasting. Old people, when their stomachs are empty, are frequently seized with giddiness, heud-achs, and fuint- ncss. These complaints may generally be removed by a piece of bread and a jjass of wine, or taking any other solid food; which plainly points out the method of preventing them. It is more (huu probable,'that many of the sudden deaths, which happen in th? advanced periods of lif^ are occasioned by fasting tp0 F 2 ii« OF ALIMENT. long, as it exhausts the spirits, and fills the bowels with wind; we would therefore advise people in the decline of life, never to allow their stomachs to be too long empty. 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 said to fast almost three-fourths of their time. This can hardly fail to ruin the appetite, vitiate the hu- mours, and fill the bowels with wind; all which might be prevented by a solid breakfast. It is a very common practice to eat a light breakfast and a heavy supper. This custom ought to be reversed. When people sup late, their supper should be very, light; but the breakfast ought always to be solid. If any one eats a light supper, goes soon to bed, and rises be- times in the morning, he will be sure to find an appetite for his break- fast, and he may freely indulge it. The strong and healthy do not indeed suffer so much from fasting as the weak and delicate ; but they run great hazard from its opposite, viz. repletion. Many diseases, especially fevers, are the eflectofa plethora, or too great fulness of the vessels. Strong.people, in high health, have generally a great quantity of blood and other humours. When these are suddenly increased, by an overcharge of rich and nour- ishing diet, the vessels become too much distended,and obstructions and inflammations ensue. Hence so many people are seized with inflamma- tory and eruptive fevers, apoplexies, &c. after a feast or debauch. All great and ludden changes in diet, are dangerous. What the sto- mach has been long accustomed to digest, though less wholesome, will ngree better with it than food of a more salutary nature to which it has not been used. When therefore a change becomes necessary, it ought always to be made gradually; a sudden transition from a poor and low, to a rich and luxurious diet, or the contrary, might so disturb the func- tions of the body as to endanger health, or even to occasion death itself. When tve recommend regularity in diet, we would not be understood as condemning every small deviation from it. It is next to impossible for people at all times to avoid some degree of excess, and living too much by rule might make even the smallest deviation dangerous. It may therefore be prudent to vary a little, sometimes taking more, sometimes less, than the usual quantity of meat and drink, provided always that a due regard be had to moderation. § Notwithstanding our author's omission of a particular account of the qualities of the different kinds of animal and vegetable food most commonly used in diet, we think the following not unworthy atten- tion. " Beef. When this is the flesh of a bullock of middle age it affords good and strong nourishment, and is peculiarly well adapted to those who labour or take much exercise. It will often sit easy upon sto- machs that can digest no other kind of food ; and its fat is almost at easily digested as that of veal. " Veal it ^ proper food for persons recovering from an indisposition and may eveu be given to febrile patients in a very weak state, but it affords Jess nourishment than therfesh of the same animal in a state of maturity. The fat of it is lighter than that of any other animal, and shows the least disposition to putrescency. Veal is a very suitable food in costive ha- bits; hut of all meat it is the least calculated for removing an acid rcui the stomach. OF ALIMENT. &7 " Mutton, from the age of four to six years, and fed on dry pasture, is an excellent meat. It is of a middle kind been tbe firmness of beef and the tenderness of veal. The lean part of mutton, however, is tbe most nourishing, and conducive to health ; the fat being liard of diges- tion. Tlie head of the sheep, especially when divested of the skin, is very tender; and the feet, on account of the jelly they contain, highly nutritive. " Lamb is not so nourishing as mutton; but it is light, and extreme- ly suitable to delicate stomachs. " House-lamb; though much esteemed by many, possesses tbe bad qualities common to the flesh of all animals reared in an unnatural way. " Pork affords rich and substantial nourishment; and its juices are wholesome when properly fed, and when tlie animal enjoys pure air and exercise. But tlie flesh of hogs reared in towns is both hard of di- gestion and unwholesome. Pork is particularly improper for those who are liable to any foulness of the skin. It is almost proverbial, that a dram is good for promoting its digestion: but this an erroneous notion : for though a dram may give a momentary stimulus to the coats of the stomach, it tends to harden the flesh, and of course, to make it more indigestible. " Smoked-hams are a strong kind of meat, and rather fit for a relish than for diet. It is the quality of all salted meat that the fibres become rigid, and therefore more difficult of digestion; and .when to this is add- ed smoking, the heat of the chimney occasions the salt to concen - Irate, and the fat between the muscles to become rancid. " Bacon is also of an indigestible quality, and is apt to turn rancid on weak stomachs. " The flesh of goals is hard and indigestible ; but that of kids is ten- der, as well as delicious, and affords good nourishment. " Venison, or the flesh-of deer, and that of liares, is of a nourishing Juality but is liable to one inconvenience ; which is that though much isposed to putrescency of itself, it must be kept for a little time be- fore it becomes tender. " The blood of animals is used as aliment by the common people: but they could not long subsist upon it unless mixed with oat-meal, &c. for it is not soluble alone by the digestive powers of the human stomach, and therefore cannot be nourishing. " Milk is of very different consistence in different animals; but that of cows being the kind used in diet, is at present the object of our at- tention. Milk, where it agrees with the stomach, affords excellent nourishment for those who are weak, and cannot digest other aliments. Though an animal production, it does not readily become putrid, as being possessed of the properties of vegitable aliment; but it is apt to become sour on the stomach, and thence to produce flatulence, the heart-burn, or gripes, and in some constitutions, a looseness. The best milk is from a cow at three or four years of age, about two months af- ter producing a calf. - It is lighter, but more watery, than the milk of sheep and goats; while, on the other hand it is more thick and heavy than the milk of asses and mares, which are the next in consistence to human milk. »« Ou account of the acid which is generated after digestion, milk coagulates in all stomachs ; but the caseous or cheesy part is again dissolved by the digestive juices, and rendered fit for the purpose of nutrition. It is however, improper to eat acid substances with milk, as these would tend to prevent the due digestion of it. S9 OF ALIMENT. " Cream is very nourishing, but on account of its fatness is difficult to be digested in weak stomachs. Violent exercise, after eating it, will in a little time convert it into butter. '• Some writers inveigh against the use of Butter as universally per- nicious ; but they might with equal reason condemn all vegetable oils, which form a considerable part of diet in the southern climates, and seem to have been beneficially intended, by nature for that purpose.. Butter, like every other oily substance, has doubtless a relaxing quality, and, if long retained in the stomach, is liable to become rancid ; but, if eaten in moderation, it will not produce those effects in any hurtful de- gree. It is, however, improper in bilious constitutions. The worst consequence produced by butter, when eaten with bread, is, that its obstructs the discharge of the saliva in the act of mastication or chewing ; by which means the food is not so readily digested. To obviate this effect, it would be a commendable practice at breakfast, first to eat some dry bread, and chew it well, till the salivary glands were exhausted, and afterwards to eat it with butter. By these means such a quantity of saliva might be carried into the stomach as would be sufficient for the purpose of digestion. " Cheese is likewise reprobated by many as extremely unwholesome. It is doubtless not easy of digestion ; and, when eaten in a great quan- ity, may load the stomach ; but, if taken sparingly, its tenacity maybe dissolved by the digestive juices, aud it may yield a wholesome, though not a very nourishing chyle. Toasted cheese is agreeable to most pa- lates, but is rendered more indigestible by that process. " The flesh of Birds differs in quality according to the food on which they live. Such as feed upon grain and berries afford, in general, good nourishment if we except geese and ducks, which are hard of digestion. A young hen or chicken is tender and delicate food, and extremely well adapted when the digestive powers are weak. But of all tame fowls the capon is the most nutritious. " Turkies, as well as Guinea or India fowls, afford a substantial ali- ment, but are not so easy of digestion as the common domestic fowl-. In#ill birds those parts are tlie most firm which arc most exercised: in the small birds, therefore, the wings, and in the larger kinds, the legs are commonly the most difficult of digestion. " The flesh of wild birds in general, though more easily digested, is less nourishing than that of quadrupeds, as being more dry, on account of their almost constant exercise. Those birds are not wholesome which subsist upon worms, insects, and fishes.^ "Eggs. In the last class of terrestrial animal food we may rank the Cggs of birds, which are a simple and wholesome aliment. Those of the -turkey are superior in all the qualifications of food. The white of Vggs is dissolved in a warm temperature, but by much heat it is ren- dered tough and hard. The yolk contains much oil, and is highly nour- ishing, but has a strong tendency to putrefaction ; on which account eggs are improper for people, of weak stomachs, especially when they aie not quite fresh. Eggs hard boiled or ft ied are difficult of digestion, and are rendered still more indigestible by the addition of butter. All eggs require a sufficient quantity of salt, to promote their solution in the stomach. " Fish, though some of them be light, and easy of digestion, afford less nourishment than vegetables or the flesh of quadrupeds, and are of all animal tribes the most disposed to putrefaction. Salt-water fish tire, in general, tbe besti but when tailed, though less disposed to pe: OF ALIMENT. 69 tresccncj', they become more difficult of digestion. Whitings and floun- deis are the most ca«ily .hir«i»ted Acid sauces and pckles, by resist- ing putrefaction, are a proper addition to fish, both as they retard pit- iresceney, and correct, the relaxing tendency of butter, so generally used with this kind of aliment. *• Ousters are eaten both raw and dressed ; but in the former state they are preferable : because heat dissipates considerably their untri- tious parts,as well as the salt-water, which promotes their digestion iu the stomach; if not eaten very sparingly, they generally prove laxative. " Muscles are far inferior to oysters, both in point of digestion and nutriment. Sea muscles are by some supposeil to be of a poisonous nature, but though this opinion is not niuob countenanced" by experi- ence, the safest way is to eat them with vinegar, or some other vegeta- ble acid. "Bread. At the head of the vegetable class stands bread, that article of diet, which, from general use, has received the name of the stuff of life Wheat is the grain chiefly used for the purpose in this country, and is among the most nutritive of all the farinaceous kinds, as it con- tains a tjreat deal of mwcilage. Bread is very properly eaten with ani- mal food, to correct the disposition to putrcscency ; but is most expe- dient with sucb articles in diet as contain much nouiishmcnt in a small bulk, because it then serves to give the stomach a proper degree of ex- pansion. But as it produces a slimy chyle, and disposes to cosriveness, it ought not to be eaten in a larec quantity. To render bread easy of digestion it ought to be well fermented and baked; and it never should be used till it has stood twenty-four hours after being taken out of the oven otherwise it is apt to occasion various complaints in those tvIki have weak bowels; sucb as flatulence, the heart born, watchful- ness, and the like. The cus'oin of eating butter with bread hot from the oven is compatible only with strong digestive powers. " PMstry, especially when hot, has all the disadvantages of hot bread and butter; and even buttered toast, though the bread is stale, is scarcely inferior in its effects on a weak stomach. Dry toast without butter is by far the wholesomest breakfast. t> " Bread made of Rye is apt to sour on the stomach, and to excite. heartburn in certain constitutions,—is of a laxative nature, and, there- fore, better silted to costive habits, either alone, or mixed with wheat: But on account of its disposition to acescency, fermentation, and fla- tulency, may not be so well adapted for persons of choleric tempera- ments and those afflicted with dyspeptic, hypochondriac, and hysteric symptoms: yet, it is the best to prevent or cure the scurvy. £' That made of Indian corn appears to agree well with most peoplo who like it; and when mixed with Wheat or Rye or both.it make»- theni palatable, and keeps moist a considerable time. " Buckwheat being somewhat liable to an acescent fermentaion in the stomach, does not agree well with all constitutions. The grain should, previous to being ground, be freed from dust and -flit, it is stip|>osed that its use occasions itchings and cutaneous eruptions—and constantly used, is not thought so wholesome as other bread. ' Oats, when deprived of the husk, and particularly barley, wlien pro- perly prepared, are each of them softening, and afford wholesome an J cooling nourishment. Rice likewise contains a nutritious mucilage, and is less used in thi? country than it deserves, both on account of its wholcsomeness and economical utility. The notion of its being hurt- ful to the sight is a vulgar error. In some constitutions it tends to w OF ALIMENT. make them costive; but this seems to be owing chiefly to flatulence, and may be corrected by the addition of some spice, such as caraway, anise seed, and the like. " Potatoes are an agreeable and wholesome food, and yield as much nourishment as any of the roots used in diet The farinaceous or mealy kind ik in general the most easy of digestion; and they are much im- proved by being roasted. " Green pease and Turkey beans, boiled in their fresh state, are both agreeable to the taste, and wholesome. being neither near so flatulent,. nor difficult of digestion, as in their ripe state ; in which they resemble the other leguminous vegetables. French beans possess much the same qualities, but yield a more watery juice, and have a greater disposition to produce flatulence. The leguminous vegetables in general ought to be eaten with some spice " Sallads being eaten raw, require good digestive powers, especial- ly those of the cooling kind; and the addition of oil and vinegar, tjtough qualified with mustard, hardly renders the tree use of them con- sistant with the weak stomach " Spinage affords a soft lubricating aliment, but contains little nour- ishment. In weak stomachs it is apt to produce acidity, and frequent- ly a looseness. To obviate these effect", it ought always to be well beaten, and but little butter mixed with it. " Asparagus is a nourishing article in diet, and promotes urine ; bnt, in common with the vegetable clasp, disposes a little to flatulence. " Artichokes resemble asparagus in their qualities, but seem to be more nutritive and less diuretic. *' White cabbage is one of the most conspicuous plants in the garden. It does not afford much nourishment, but is an agreeable addition to an- imal food, and not quite so flatulent as the common greens. It is like- wise diuretic, and somewhat laxative. Cabbage has a stronger tenden- cy to putrefaction than most other vegetable substances; and, dnring their putrefying state, sends forth an offensive smell, much resembling that of putrefying animal bodies. So far, however, from promoting a pujpid disposition in the human body, it is, on the contrary, a wholesome aliment in the true putrid scurvy. " Turnips are a nutritious article of vegetable food, but not very easy of digestion, and are flatulent. Thi- effect is, in a great ni|asure, obvia- ted by pressing the water out of them before they are eaten. " Carrots contain a cons.derable quantity of nutritious juice, but are amoDij the most flatulent of vegetable productions. " Parsnips are more nourishing and less flatulent than carrots, which they also exceed in the sweetness of their mucilage By boiling them in two different waters, they are rendered less flatulent, but their other qualities are thereby diminished in proportion. " Parsley is of a stimulating and aromatic nature, well calculated to make agreeable sauces. It is also a gentle diuretic, but preferable in all its qualities when boiled. " Celery affords a root both wholesome and fragrant, but is diffi- cult of digestion in its raw state. It gives an agreeable taste to soups, as well as renders tbem diuretic " Onions, garlic, and shallots, are all of a stimulating nature, by which they assist digestion, dissolve slimy humours, and expel flatulency. They are, however, most suitable to persousof a cold and phlegmatic constitution. OF ALIMENT. « " Radishes of all kinds, particularly the horse-radish, agree with tbe three preceding articles iu powerfully dissolving slimy humours. They excite tne discharge of air lodged in the intestines; but this proceeds from the expulsion of the air contained in themselves. " Apples are a wholesome vegetable aliment, and in many cases medi- cinal, particularly in diseases of'.he reast and complaints arising from phlegm. But, in general, they agree best wrh the stomach when eaten cither roasted or boiled. The more aromatic kinds of apples are the fittest for eating ra-.v. " Pears resemble .nuch in their effects the sweet kind of apples, but have more of a laxative quality, and a greater tendency to flatulence. " Cherries are, in general, a wholesome fruit, when they agree with the stomach, and they -are beneficial in many diseases, especially those of the putrid kind. " Plums are nourishing, and have besides an attenuating, as well as a laxative qr.ahty; bin are apt to produce flatulence. If eaten fresh, and before they are quite ripe, especially in large quantities, they occasion cohes and other complaints of the bowels. " Peaches are not of a very nourishing quality, but they abound in juice, and are serviceable in bilious complaints. " Apricots are more pulpy than peaches, but are apt to ferment and produce acidities iu weak stoma< lis. Where they do not disagree they are cooling, and tend likewise to correct a disposition to pntrescency. " Govsebemes, as well as currants, when ripe, are similar in their qualities to diaries, and, when used in a green state, they are agreeably cooling. " Stratolierries, are an agreeable, cooling aliment, and are accounted good aga.nst the gravel. " ( ucumbers are cooling, and agreeable to the palate in hot weather ; but to prevent them from proving hurtful to the stomach, the juice ought to be squeezed out after they are sliced, and vinegar, pepper, and salt, afterwards added. " Tea. By some the use of this exotic is condemned in terms the most vehement and unqualified, while others have cither asserted its«^- nocence, or gone so far as to ascribe to it salubrious and even extraordi- nary virtues. The truth seems to lie between these extremes: there is however an essential difference in the effects of green tea and of black, or bohea; the former of which is much more apt to affect the nerves of tlie stomach than the latter, especially when drunk without cream and likewise without bread and butter. That when taken in a large quanti- ty, or at a later hour than usual, it often produces watchfulness, is a point winch cannot be denied ; but if used in moderation, and accompanied with tbcadditcn ju.'t now mentioned, it does not sensibly discover any hurtful effects, but greatly relieves an oppression of the somach, and abates a pain of the head. It ought always to be made of a moderate degree of strength: for if too weak it certainly relaxes the stomach. As it has auastrmgent taste, which seems not very consistent with a re- laxing power, there is ground for ascribing this'effect not so much to the herb u.-elf,as to the hot water, winch not being impregnated with a sufficient quantity of tea to correct its own emohent tendency, produ- ces a relaxation unjus'ly imputed to some noxious quality of tlie plant. Bu* tea, like every other commodity, is liable to damage, and when this happens, it may produce eftects not necessarily connected with its origma! qualities. '• Coffee. It is allowed that coffee promotes digestion, and exhilarates rs OF AIR. the animal spirits ; besides which, various other qualities are ascribed to it, such as hi petting flatulency,removing dizziness of the head, at ten* Dating viscid humours, increasing the circulation oftnc blood, anil con- sequently perspiration; but if drank too strong it affects the nerves, oc- casions watchfulness, and tremor of the hands ; though in some plilegmat- ie constitutions it is apt to produce sleep. Indeed it is to persons of that habit that coffee is well accommodated : tor to people of a thin and dry habit of body it seems to be injurious. Turkey coflee is great- ly preferable in Havoni to that of the West-Indie?. Drunk only m the quantity of-one dish after dinner to promote digestion, it answers best without either sugar or milk : but if taken at other times it should have both, or in place of the latter rather cream, wlncu not only improves the beverage, but tends to mitigate the effect of coSVe upon the nerves. «* Chocolate is a nutritive and wholesome composition if taken in small quantity, and no1, repeated too often ; but is generally hurtful to the stomach of those with whom a vegetable diet disagrees. By the addi- tion of vanilla and other ingredients it is made too heating, and so much affects particular constitutions as to excite nervous symptoms, especially complaints of the head." CHAPTER IV. OF AIR. UNWHOLESOME air is a very common canse of diseases. Few are aware of the danger arising from it. People generally pay some atten- tion to what they eat or drink, but seldom regard what goes into the lungs, though the latter proves often more suddenly fatal than the former. Air. as well as water, takes up parts of most bodies with which it conies in contact, and is often so replenished with those of a noxious qualitv, as to occasion immediate death. But such violent eftects sel- dom happen, as people are generally on their guard against them. The less perceptible influences of bad air prove more generally hurtful to mankind ; we shall therefore endeavour to point out some of these and to shew whence the danger chiefly arises. Air may become noxious many ways. Whatever greatly alters its degree of heat, cold, moisture, &c. renders it unwholesome: for exam- ple, that which is too hot dissipates the watery paits of the blood, ex- alts the bile, av.d renders the whole humours adust and thick. Hence proteed bilious and inflammatory fevers, cholera morbus, &c. Very cold air obstructs the perspiration, constringes the solids, and conden- ses the fluids. It occasions rheumatisms, coughs, and catarrhs, with other diseases of the throat and breast. Air that is too moist destroys the elasticity or spring of the solids, induces phlegmatic or lax consti- tutions, and disposes the body to agues, or intermitting fevers, dropsies, ike. Wherever greatnnmbers of people are crowded into one place, if the air has not a free circulation, it suou becomes unwholesome. Hence it is that delicate persons are so apt to turn sick or feint in crowded churches, assemblies, or any place where the air is iuj^ml by breathing, tires, candles, or the like. In great cities so many things tend to contaminate the air, that it is no wouder it proves so fatal to the inhabitants. The air in cities is not on- ly breathed repeatedly over, but is likewise loaded with sulphur, smoke, OF AIR. and other exhalations, besides the vapors continually arising from initu merable putrid substances, as dunghills, slaughter-houses, &c. All pos- sible care should be taken to keep the streets of large towns open and wide, that the air may have a free current through them. They ought likewise to be kept very clean. Nothing tends more to pollute aHd contaminate the air of a city than dirty streets. It is very common in this country to have church-yards in the middle of populous cities. Whether this be the effect of ancient superstition, or owing to the increase of such towns, is a matter of no consequence. Whatever gave rise to the custom, it is a bad one. It is habit alone which reconciles us to these things ; by means of which the most ridicu- lous, nay pernicious customs, often become sacred. Certain it is, that thousands pf putrid carcases, so near the surface of the earth, in a place where the air is confined, cannot fail to taint it; and that such air, when breathed into-the lungs, must occasion diseases.* Burying within churches is a practice still more detestable. The air in churches is seldom good, and the effluvia from putrid carcases must render it still worse. Churches are commonly old buildings with arched roofs. They are seldom open above, once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occasions that damp, musty, unwholesome smell which one feels upon entering a church, and renders it a very unsafe, place for the'weak and valetudinary. These inconveniences might, in a great measure, be obviated, by pro- hibiting all persons from burying within churches, by keeping them dean, and permitting a stream of fresh air to pass frequently through them by opening opposite doors and windows, t Wherever air stagnates long, it becomes unwholesome. Hence the unhappy persons confined in jails not only contract malignant fevers themselves but often communicate them to others. Nor are many of the holes, for we cannot call them houses, possessed by the poor in great towns, much better than jails. These low duty habitations are the very lurking places of bad air and contagious diseases. Such as live in them seldom enjoy good health ; and their children commonly die young. In the choice of a house, those who have it in their power ought always to pay the greatest attention to open free air. The various methods which luxury has invented to make houses close and warm, contribute not a little to render them unwholesome. No house can be wholesome unless the air has a free passage through it. For which reason, houses ought daily to be ventilated bv openin* oppo- site windows, and admitting a current of fresh^ir into every room. Beds, instead of being made up as soon as people rise out of them' onght to be turned down, and exposed to the fresh air from the open windows through the day. This would expel any noxious vapour, and could not tail to promote the health of the inhabitants. In hospitals, jails, ships, &c. where that cannot be conveniently done ventilators should be used. The method of expelling foul, and introdu- cing fresh air, by means of ventilators, is a most salutary invention and is indeed the most useful ofall our modern medical improvements It is capable of universal application, and is fraught with numerous ad- vantages, both to those in health and sickness. In all places, where • In most eastern countries it was customary to bury the dead at some distant fiv,™ any town. As th,s practice obtained among the Jews, tie Greeks and also the Ronf^i? ™?EX£? •I"1*""1** *°M not lave folto^ved their Sle'in a ^omTo fcdi^uitecMU?" U,r0UBh " 1Wffe ChUrC'1« catfcodr»l,«vwi in summer, withe-- G 4 OF AIR. numbers of people are crowded together, ventilation becomei absolutely necessary. Air which stagnates in mines, wells, cellars, &c. is extremely nox- ious. That kind of air is to be avoided as the most deadly poison. It often kills almost as quickly as lightning. For this reason, people should be very cautious in opening cellars that have been long shut, or going down into deep wells or pits, especially if they have been kept close covered* Many people who have splendid houses, chuse to sleep in small apart- ments. 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 thut. If a fire be kept in it, the danger from a small room becomes still greater. Numbers have been stifled when asleep by a fire in a small apartment, which is always hurtful. Those who are obliged, on account of business, to spend the day in close towns, ought if possible, to sleep in the country. Breathing free air in the night will, in some measure, make up for the want of it through the day. This practice would have a greater effect in preserving the health of citizens than is commonly imagined. Delicate persons ought, as much as possible, to avoid the air of great towns. It is peculiarly hurtful to the asthmatic and consumptive. Such persons should avoid Cities as they would the plague. The hypochon- driac are likewise much hurt by it. I have often seen persons -o much afflicted with this malady while in town, that it seemed impossible tor them to live, who, upon being removed to the country, were immedi- ately relieved. Tbe same observation holds with regard to nervous and hysteric women. Many people, indeed, have it not iu their power to change their situation in quest of better air. All we can say to such persons is, that they should go as often abroad into the open air ai they can, that they should admit fresh air frequently into their ho uses, and take care to keep them very clean. It was necessary, in former times, for safety, to surround cities, col- leges, and even single houses, with high walls. These by obstructing t^efree current of air, never fail to render such places damp and un- wholesome. As such walls are now, in most parts of this country, lie- come useless, they ought to be pulled down, and every method takeu to admit a free passage of the air. Proper attention to air and clean- linkss would tend more to preserve the health of mankind, than all the prescriptions of the faculty. Surrounding houses : oo cloiely with planting or thick woods, like- wise tends to render the air unwholesome. Wood not only obstructs the free current of the air, but sends forth great quantities of moist exhalations, which render it constantly damp. Wood is very agreeable at a proper distance from a house, but should never be planted too near it, especially in a flat country. Many of the gentlemen's seats in Eng- land are rendered very unwholesome from the great quantity of wood which surrounds them. Houses situated in low marshy countries, or near large lakes of stag- Rating water are likewise unwholesome. Waters, which stagnate not only render the air damp, but load it with putred exhalations, which produce the most dangerous and fatal diseases. Those who arc obliged • Weliave daily accounts of persons who lose their lives by going down into deep wells and other places where the air stagnates ; all these accidents might bit prevented by only letting down a lighted candle before them, and stopping when they perceive it fj» out; yet this precaution, simple as it is,is seldom used OF EXERCISE. 75 to inhabit marshy countries, ought to make choice of the dryest situa- tions that they can find, to live generously, and to pay the strictest re- gard to cleanliness. If frc*.h air be necessary for those in health, it is still more so for the sick, who often lose their lives for want of it. The notion that sick people must be kept very hot, is so common, that one can hardly enter a chamber where a patient lies, without being ready to faint, by reason of the hot suffocating smell. How this must affect the sick any one may judge. No medicine is so beneficial to the sick as fresh air. It is the most reviving of all cordials, if it be administered with prudence. We are not, however, to throw open doors and windows at random upon the sick. Fresh air is to be let into the chamber gra- dually, and, if possible by opening the windows of some other apart- ment. The air of a sick person's chamber may be greatly freshened, and the patient much revived, by sprinkling the flooi, bed, &c. frequently with vinegar, juice of lemon, or any other strong vegetable acid. In places where numbers of sick are crowded into the same house, or winch is often the case, into the same apartment, the frequent ad- mission of fresh air becomes absolutely necessary. Infirmaries, hospi- tals, &c. are often rendered so noxious, for want of proper ventilation, that the sick run more hazard from them than from the disease. This is particularly the case when putrid fevers, dysentaries, and other infec- tious diseases prevail. Physicians, surgeons, and others who attend hospitals, ought, for their own safety, to take care that they be properly ventilated. Such persons as are obliged to spend the most of their time amongst the sick, run great hazard of being themselves infected when the air is bad. All hospitals, and places of reception for the sick, ought to have an open situation, at some distance from any great town, and such patients as labour under any infectious disease ought never to be suffered to come near the rest.* chapter v. OF EXERCISE. JVlAN V people look upon the necessity man is under of earning his bread by labour, as a curse. Be this as it may,it is evident from the structure of the body, that exercise is not less necessary than food for the preservation of health : those whom poverty obliges to labour for daily bread, are not only the most healthy, but generally the most hap- py part of mankind. Industry seldom fails to place them above want and activity serves them instead of physic. This is peculiarly the case with those who live by the culture of the ground. The great increase of inhabi\ants in itifant colonies, and the longevity of such as follow ag- riculture, every where evidently prove it to be the most healthy a= well as the most useful employment. The love of activity shews itself very early in man. So strong is this principle, that a healthy youth cannot be restrained from exercise ever by the fear of punishment. Our love of motion is surely a strong proof of its utility. Nature implaints no disposition in vain. It seems to • A year seldom passu, that we do not hear of some hospital physician or suiwon having lost his lire by an hospital, fever, caught Iron, hi, patients.Vor Ms thlv fare themselves alone to blame. Their patients are either in an imprope. Situation or thev are too careless with regard to their own conduct. F "tuauon.or tne> OF EXERCISE. be a catholic law throughout the. whole animal creation, that no crea- ture, without exercise, should enjoy health, or be able to find subsist- ence. Every creature, except man, takes as much of it as is necessary. He alone, and such animals as are under his direction, deviate from this original law, and they suffer accordingly. > Inactivity never fails to induce an universal relaxation of tlie solids, which disposes the body to innumerable diseases. When tlie solid* are relaxed, neither the digestion nor any of the secretions cau be duly performed. In this case, the worst consequences must ensue. How can persons who loll all day in easy chairs, and sleep all night on beds of down, fail to be relaxed ? Nor do such greatly mend tlie matter, who never stir abroad but in a coach, sedan, or such like. These ele- gant pieces of luxury are become so common, that the inhabitants of ;;reat towns seem to be in some danger of losing the use of their limbi altogether. It is now below any one to walk, who can afford to be car- ried. How ridiculous would it seem to a person unacquainted with modern luxury, to behold the young and healthy swinging along on the •'loulders of their fellow creatures ! or to see a fat carcase, over-run with diseases occasioned by inactivity, dragged through the streets by half a dozen h«rse3.* Glandular obstructions, now so common, generally proceed from in- activity. Those are the most obstinate maladies. So long as the liver, kidnies, and other glands, duly perform their functions, health is seldom impaired ; but when they fail, nothing can restore it. Exercise is al- most the only cure we know for glandular obstructions; indeed it doei not always succeed as a remedy: but there is reason to believe that it would seldom fail to prevent these complaints, were it used in due time. One thing is certain, that amongst those who take sufficient ex- ercise, glandular diseases are very little known ; whereas the indolent and inactive are seldom free from them. Weak nerves are the constant companions of inactivity. Nothing but exercise and open air can brace and strengthen the nerves, or pre- vent the endless train of diseases which proceed from a relaxed state of these organs. We seldom bear the active or laborious complain of nervous diseases ; these are reserved for the sons of ease and affluence. Many have been completely cured of these disorders, by being redu- ced, from a* state of opulence, to labour for their daily bread. This plainly points out the sources from whence nervous diseases flow, and the means by which they may be prevented. It is absolutely impossible to enjoy health where the perspiration is not duly carried on : but that can uever be the case where exercise is neglected. When the matter which ought to be thrown off by per- spiration is retained in the body, it vitiates the humours, and occasions the gout, fevers, rhumatism, 6cc Exercise alone would prevent many of those diseases which cannot be cured, and would remove otlieri where medicine proves ineffectual. A late author,t in his excellent treatise on health, says that the weak and valetudinary ought to make exercise a part of their religion. We would recommend this, not only to the weak and valetudinary, but to * It is not necessity, bat fashion which makes tbe ute of carriages so common. There are many people who have not tintise enough to keep theiv humours whale' some, who yet dare not vei ture to make a visit to their in xi neighbours, but in a coach or «dan,test the}' stioaid be looked down upon. Strange, that men should be such fools •' to be laughed out of the use of their limbs, or to throw nway thpir health, iu order to gra- tify a pieeeof vanity, or to comply with a ridiculous fashion I + Cheyne. OF EXERCISE. 77 all whom business docs not oblige to take sufficient exercise, as se- dentary artificers,* shop-keepers, studious perons, &c. Such ought to use exercise as regularly as they take food. This might generally be done without any interruption to business or real loss of time. No piece of indolence hurts the health more than the modern custom oflyinga-bed too long in the morning. This is the general practice in great towns. The inhabitants of cities seldom rise before eight or nine o'clock ; but the morning is undoubtedly the best time for exercise, while the Ftomach is empty and the body refreshed with sleep. Besides the morning air braces and strengthens the nerves, and in some meas- ure, answers the purpose of a cold bath. Let any one who has been- accustomed to lie a-bed till eight or nine o'clock, rise by six or seven, spend a couple of hours in walking, riding, or any active diversion without doors, and he will find his spirits cheerful and serenethrough the day, his appetite keen, and his body braced and strengthened. Cus: torn soon renders early rising agreeable, and nothing contributes more to the preservation of health. The inactive are continually complaining of pains of the stomach, flatulencies, indigestions, seldom or never occa- sioned but by strait shoes. Corns are not only very troublesome, but * That colds kill more than plagues, is an old observation; and. with regard to this country, it holds strictly true. Every person of discernment, however, will perceive, that most of thi colds uhich prove sp destructive to the inhabitants of Ilritain,areo» isig to their imprudence in changing clothes. A few warm days in March or April induce them to throw off their winter garments, without considering that our most penetrating colds generally happen in the.spring.. f Thi« madness ser ms to have pervaded the minds of mothers in every age and coun- try. Terence, in his Comedy of the Eunuch, ridicules the Roman matrons for attempt- ing to mend the shape of their daughters. OF INTEMPERANCE. 81 by rendering people unable to walk, they may likewise be considered as the remote cause of other diseases.* The size and figure of the shoe ought certainly to be adapted to the foot. In children the feet are as well shaped as the hands, and the mo- tion of tlie toes as free and easy as that of the fingers ; yet few persons in the advanced period of life are able to make any use of their toes. They are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether in- capable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, but she will never walk well in this manner. It strains her joints, distoi ts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion: it is entirely owing to shoes with high heels and narrow toes, that not one female in ten can be said to walk well. In fixing on the clothes, due care should be taken to avoid all tight bandages. Garters, -buckles, &c. when drawn too tight, not only pre- vent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and occasions various diseases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood iu its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases are often occasioned. The perfection of dress is to be easy and clean. Nothing can be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, and many such there are, would rather remain as fixtas a statue from morning till night, than discompose a single hair or alter the position of a pin. Were we to recommend any particu- lar pattern for dress, it would be that which is worn by the people cal- led Quakers. They are always heat, clean, and often elegant, without any thing superfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt. We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and tlie period of life; but likewise to the temperature and constitution. Robust persons are able to endure either cold or heat better than the delicate; consequent- ly may be Jess attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm.| CHAPTKR VII. OF INTEMPERANCE. A MODERN author^ observes, that temperance aud exercise are * We often see persons, who are rendered quite lame by the nails of their toes having grown into the H sh, and frequently hear of mortifications proceeding from this cause- All these, and many oiln r inconveniences attending the feet must be imputed solely to the use of short and mait shoes. t The celebrated Rocrltuave used to say, that nobody suffered by cold save fools and beggars ; the Litter not being able to procure clothes, and the former not having sense to we.ir theiu. lie this as it may, 1 can with th- strictest truth declare, (hat in many ca- ses where the powers of medicine had been tried in vain, 1 have cured the patient by recmn, lending thick shoes, n flannel waistcoat and drawers, a pair of under stockings, or u (liiinelp-ttieo.it to be womduring the cold season at least. Where warmer clothing is wanted, I would recommend the fleecy hosiery to be worn ncxtthe akin. X Rousseau. 80 OF INTEMPERANCE. the two best physicians in the world. He might have added, that if these were duly regarded, there would be little occasion for any other. Temperance may justly be called the parent of health; yet numbers of mankind act as if they thought diseases and death too slow in their progress and by intemperance and debauch seem as it were to solicit their approach. The danger of intemperance appears from the very construction of the human body. Health depends ou that state of the solids and fluids which fits them for the due performance of the vital functions; and while these go regularly on, we are sound and well; but whatever dis- turbs tlicm necessarily impairs health. Intemperance never fails to disorder the whole animal ecoiiomy; it hurts the digestion, relaxes the nerves, renders the different secretions irregular, vitiates the humours, and occasions numberless diseases. The analogy between the nourishment of plants and animals affords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation -, yet an over-quantity of either will entire- ly de^roy it. The best things become hurtful, and destructive, when carried to excess. Hence we learn, that the highest degree of human wisdom consists in regulating our appetites and passions so as to avoid all extremes. It is that chiefly which entitles us to the character of rational beings. The slave of appetite will ever be. the disgrace of human nature. The Author of Nature hath endned us with various passions ;. for tbe propagation of the species*, the preservation of the individual, tic. Intemperance is the abuse of these passions; and moderation consists in the proper regulation of them. Men, not contented with satisfying the simple calls of Nature, create artificial wants, and are perpetually in search after something that may gratify them; but imaginary wants can never be gratified. Nature is content with little-, but luxu- ry knows no bounds. Hence the epicure, the drunkard, and the de- bauchee, seldom stop in their career till their money or tlieir consti- tution fails: then indeed they generally see their error when too late; It is impossible to lay down fixed rules with regard to diet, on ac- count of the. different constitutions of mankind. Tlie most iguorant person, however, certainly knows what is meant by excess; and it is in the power of every man, if he chooses to avoid it. The great rule of diet is to study simplicity. Nature deli "Its in the most plain and simple food, and every animal, except man, follows her dictates. Man alone riots at large, and ransacks the v hole creation in quest of luxuries, to his own destruction. An elegant writer,* of tlie last age, speaks thus of intemperance in diet: " For my part, when I behold a fashonab'e table set out in all its magnificence, I fancy that I see gouts and dropsie?, fevers and lethargies, with other innumera- ble distempers.lying in ambuscade among the dishes." Nor is intemperance in other things less destructive than in diet. How quickly does the immoderate pursuit of carnal pleasure*, or the abuse of intoxicating liquors, ruin the best constitution! Indeed these vices generally go hand in hand. Hence it is that we so often behold the voteries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and liastening with swift pace to an untimely grave. Did men reflect on the painful diseases and pre- mature deaths, which are daily occasioned by intemperance, it would * Addison. OF INTEMPERANCE. U be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures. Intemperance does not hurt its votaries alone ; the innocent too of- ten feel the direful effects of it. How many wretched orphans are to be seen embracing dung-hills, whose parents, regardless of the future, spent in riot and debauch what might have served to bring up their offspring in a decent manner ! How often do we behold the miserable mother, with her helpless infants, pining in want, while the cruel father is indulging his insatiate appetites ! Families are not only reduced to misery, but even extirpated, by intemperance. Nothing tends so much to prevent propagation, and 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 boast a numerous offspring, while his pampered lord, sunk in ease aud luxury, often languishes without an heir to his ample fortunes. Even states and empires feel the influence of intem- perance, and rise or fall as it prevails. Instead of mentioning the different kinds of intemperance, and point- ing out their influence upon health, we shall only, by way of example, make a few observations on one particular species of that vice, viz. the abuse, of intoxicating liquors. Every act of intoxication puts nature to the expense of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That con- stitution must be strong, indeed, which is able long to hold out under a daily fever .' but lovers occasioned by drinking do not always go off in atlay; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects. Though the drunkard should not fall by an acute disease, he seldom escapes those of a chronic kind. Intoxicating liquors when used to excess, weaken the bowels, and spoil the digestion ; they destroy the power of the nerves, and occasion paralytic and convulsive disorders; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation, and the nourishment of the body. Hence obstruction-, atrophies, dropsies, and consumptions of the lungs. These are the common ways in which drunkards make their exit. Diseases of this kind, when brought on by hard drinking, seldom admit of a cure. Many people injure their health by drinking, who seldom get drunk. The continual habit of soaking, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept constant- ly full and upon the stretch, the different digestions can neither be duly performed, nor the humours properly prepared. Hence most people of this wharacter are afflicted with the gout, the gravel, ulcerous sores iu the legs, dec If these disorders do not appear, they are seized with low spirits, hypochondriacal affections, and other symptoms of indiges- tion. Consumptions are now so common, that it is thought one-tenth of the inhabitants of great towns die of that disease. Hard drinking is no doubt one of the causes to which wc must impute the increase of con- sumptions. The great quantities of vicid malt liquor drank by the common people of England, cannot fail to render'the blood sizy and unfit for circulation; from whence proceed obstructions and inflamma- tions of'tlie lungs. There are few great ale drinkers who arc rot phthia- 5 s OF INTEMPERANCE. ical: nor is that to be wondered at, considering the glutinous and al- most indigestible nature of strong ale. Those who drink ardent spirits or strong wines, run still greater haz- ard ; these liquors heat and inflame the blood, and tear the tender ves- sels of the lungs to pieces ; yet so great is the consumption of them in this country, that one would almost be induced to think that the inhab- itants lived upon them.* The habit of drinking proceeds frequently from misfortunes in life. The miserable fly to it for relief. It afford:, them indeed a temporary ease. But, alas! this solace is short-lived; and when it is over,tbe spirits sink as much below their usual tone as they had before been raised above it. Hence a repetition of the dose becomes necessary, and every fresh do-,e makes way for another, till the unhappy wretch becomes a slave to the bottle, and at length falls a sacrifice to what at first, perhaps, was taken only as a medicine No man is so dejected at the drunkard when his debauch is goiit- off. Hence it is, that those who have the greatest flow of spirits while the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their own miserable existence in a fit of spleen or ill humour. Drunkenness not only proves destructive to health, but likewise to the faculties of the mind. It is strange that creatures who value them- selves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so fir below them. Were such as vo- luntarily deprive themselves of the use of reason, to continue ever after in that condition, it would seem but a just punishment. Though this be not the consequence of one act of intoxication, it seldom fails to succeed a course of it. By a habit of drinking, the greatest genius is often reduced to a mere idiot.t Intoxication is peculiarly hurtful to young persons. It heats their blood, impairs their strength, and obstiucts their growth; besides, the frequent use of strong liquors in the early part of life destroys any bene- fit that might arise from them afterwards. Those who make a practice of drinking generous liquors when young, cannot expect to rcapanj benefit from them as a cordial in the decline of life. Drunkenness is not only in itself a most abominable vice, but is an inducement to many others. There is hardly any crime so horrid that the drunkard will not perpetrate for the love of liquor. We have known mothers sell their children's clothes, the food that they should have eat, aud afterwards even the infants themselves, iu order to pur- chase the accursed draught. * We may form some notion of the immense quantity of ardent spirits consumed ia •reat-Britain from this circumstance, that in the city of Edinburgh and its environs, besides the great quantity ot loreign spirits dul) entered, and the still greater calamity which is supposed to be smuggled, it is computtd that above two thousand private itilli are constantly employed in preparing a poisonous liquor called Molasses. TV common people have got so universally into the habit of drinking this base spirit, that when n porter or labourer is seen reeling along the streets, they say that, He has get molassed. t it is amazing that our improvements in arts, h arning and politeness, have not put the barbarous cusioui of drinking to excess out ofiashion. It is indeed less common in South Britain than it was formerly; but it still prevails very much in the North, where this relic of barbarity is mistaken for hospitality. Tin re no man is supposed to entertain his guests well, who does not make them drunk. Forcing people todrinl; is certainly the greatest piece of rudeness that any mmi can be guilty of. Manliness, complaisance, or mere good nature, may induce a imui to take his glass if urged toil. at a time when he might as well take poison. The custom oi drinking to excess hm long been out of fashion in France; and, :is it begins to lose ground anionc the politer part of the English, we hope it will soon be banished from every part of this island OF CLEANLINESS, 83 CHAPTER VIII. OF CLEANLINESS. XrlE want of cleanliness is a fault which admits of no excuse. Where water can he had for nothing, it ig surely in the power of every person to lie clean. The continual discharge from our bodies by perspiration; renders freqnent change of apparel necessary. Changing apparel great- ly promotes the secretion of the skin, so necessary for health. When that matter which ought tD be carried off by perspiration is either re- tained in the body, or re-absorbed from dirty clothes, it mnst occasion diseases. Diseases of the skin are chiefly owing to want of cleanliness.* They may indeed be caught by infection, or brought on by poor living, unwholesome food, &c. but they will seldom continue long where cleanliness prevails. To the Rame cause must we impute the various kinds of vermin which infest the human body, houses, Arc. These may always be banished by cleanliness alone, and wherever they abound, we have reason to believe it is ne?'ected. One common cause of putrid and malignant fevers is the want of cleanliness. These fevers commonly begin among the inhabitants of close, dirty houses, who breathe unwholesome air. take little exercise, ami wear dirty clothes There the infection is generally hatched, which often spreads far and wide, to the destruction of many. Hence clean- liness may be considered as an object of public attention. It is not suf- ficient that I be clean myself, while the want of it in my neighbour af- fects my health as well ns his. If dirty people cannot be removed as a common nuisance, they ought, at least to be avoided as infections. All who regard their health should keep at a distance even from tlieir habitations. In places where great numbers of people are collected, cleanliness becomes of the utmost importance. It is well known that infections di-cases are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care, to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excrements of the diseased. In many great towns the streets are little better than dunghills, be- ing frequently covered with ashes, dung, and nastiness of every kind. Even slaughter-houses, or killing shamble0, are often to be seen in the very centre of great towns. The putrid blood, excrements, &c. with winch these places are generally covered, cannot fail to taint the air, and render it unwholesome. How easily might this be prevented by active magistrates, who have it always in their power to make proper law- relative to things of this nature, and to enforce the observance Of them ! We are sorry to say, that tlie importance of general cleanliness does not seem to be sufficiently understood by the magistrates of most great towns in Britain ; though health, pleasure, and delicacy, all conspire to * Mr. Pot, in his surgical observations, mention* a disease which he calls the chim- ■ey-sweeper's cancer, as it is almost peculiar to that unhappy set of people. Thi-- he attributes to lieglcct of cleanliness and with great .justness. I am convinced, that il that purt of the body which is thy seat of this cruel disease was kept clean by frequent washnie:. it would never' app.n. the climbing boys, as they are called, aive rtainly the niHt miserable ur, ictus on the face of the earth j yet, for cleaning chunsiesso such persons are necessary. 86 OF CLEANLINESS. recommend an attention to it. Nothing can be more agreeable to the senses, more to the honour of the inhabitants, or more conducive to their health, than a clean town; nor can any thing impress a stranger with a more disrespectful idea of any people than its opposite. What- ever pretensions people may make to learning, politeness, or civilization, we will venture to affirm, that while they neglect cleanliness, they are in a state of barbarity.* The peasants in most countries seem to hold cleanliness in a sort of contempt. Were it not for the open situation of their bouses, they would often feel the bad effects of this disposition. One seldom sees a farm-house without a dunghill before the door, and frequently the cattle and their masters lodge under the same roof. Peasants are like- wise extremely careless with respect to change of apparel, keeping tlieir houses, &c. clean. This is merely the effect of indolence and a dirty disposition. Habit may indeed render it less disagreeable to them, but no habit can ever make it salutary to wear dirty clothes or breathe unwholesome air. As many articles of diet come through the bands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. Thisj for example, might be done by giving a unall premium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c. and by punishing severely those who bring it dirty. The same method should be taken with butchers, bakers, brewers, and all who are employed in preparing the. necessaries of life. In camps the strictest regard should be paid to cleanliness. By neg- ligence in this matter, infectious diseases are often spread amongst a whole army; and frequently more die of these than by the sword. The Jews, during their encampments in the wilderness, received particular instructions with respect to cleanliness.t The rules enjoined them ought to be observed by all in the like situation. Indeed the whole system of laws delivered to that people has a manifest tendency to pro. mote cleanliness. Whoever considers the nature of their climate, the diseases to which they were liable, and their dirty disposition, will see tlie propriety of such laws. It is remarkable that, in most eastern countries, cleanliness makes a great part of their religion. The Mahometan, as well as the Jewish re- ligion, enjoins various bathings, washings, and purifications—No doubl these might be designed to represent inward purity ; but they w ere at the same time calculated for the preservation of health. However whimsical these washings may appear to some, few thiags would tent) more to prevent diseases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a deai| body, or touching any thing that might convey infection, to wash be fore he went into company, or sat down to meat, he would run Uss * In ancient Home the greatest men did not think cleanliness an object unworthy of their attention. Pliny says, the Cloaca, or common sewers for the conveyance of £Jtli and Hastiness from the city, were the greatest of all the public works; and bestows higher encomiums upon Tarquinius, Agrippa, and others who made aud improved them, than on those who achieved the greatest conquests. How truly great does the emperor Trajan appear, when giving directions to Pliny his proconsul, concerning the making of a common sewer For tbe health and conve- i.ience of a conquered city I . f Thou shaft have a place also without the camp, whither thou shalt go forth abroad; and thno shalt have a paddle upon thy weapon : and it shall be when thou shalt ease thyself abroad, thou shalt dig therewith, and shall turn back', and cover that which caaeth from thee, (Sec. Detite*. chap. k\h- rer. 12,13. OF CLEANLINESS. 8* hazard either of catching the infection himself, or of communicating it to others. Frequent washing not only removes the filth and sores which adhere to the skin, but likewise promotes the perspiration, braces the body, and enlivens the spirits. How refreshed, how cheerful, and agreeable does one feel on being shaved, washed, and shifted ; especially when these offices have been neglected longer than usual! The eastern custom of washing the feet, though less necessary in this countvv, is nevertheless a very agreeable piece of cleanliness, and con- tributes greatly to the preservation of health. The sweat and dirt with which these parts are frequently covered, cannot fail to obstruct the perspiration. This piece of cleanliness would often prevent colds and fevers. Were people careful to bathe tlieir feet and legs in lnke-warm water at night, after being exposed to cold or wet through the day, they would seldom experience the ill effects which often proceed from these causes. A proper attention to cleanliness is nowhere more necessary than on ship board. If epidemical distempers break out there, no one can be safe. The best way to prevent them, is to take care that the whole company be cleanly in their clothes, bedding, &c. When infections diseases do break out, cleanliness is the most likely means to prevent their spreading: it is likewise necessary to prevent their returning af- terwards, or being conveyed to other places. For this purpose tbe clothes, bedding, &c. of the sick ought to be carefully washed, and fumi- gated with brimstone. Infection will lodge a long time in dirty clothes, and afterwards break out in the most terrible manner. In places where great numbers of sick people are collected together, cleanliness ought to be most religiously observed. The very smell in such places is often sufficient to make one sick. It is easy to imagine what effect that is likely to have upon the diseased. In an hospital or infirmary, where clcauliness is neglected, a person in perfect health has a greater chance to become sick, than a sick person has to get well. Few things are more unaccountable than that neglect, or rather dread of cleanliness, which appears among those who have the care of the sick ; they think it almost criminal to suffer any thing that is clean to come near a person in a fever, for example ; they would rather allow him to wallow in all manner of filth, than change the least bit ofhis linen. If cleanliness be necessary for persons in health, it is certainly more so for the sick. Many diseases may be cured by cleanliness alone; most of them might be mitigated by it; and, where it is neglected, the slightest disorders are often changed into the most malignant. The same mistaken care which prompted people to prevent the least ad- mission of fresh air to the sick, seems to have induced them to keep the-'i dirty. Both these destructive prejudices will, we hope, be soon •radicated. Cleanliness is certainly agreeable to our nature. We cannot help ap- proving it iu others, even though we should not practice it ourselves. It sooner attracts our regard than even finery itself, and often gains esteem where that rails. It is an ornament to the highest as well as to the lowest station, and cannot be dispensed with in either. Few virtues are of more importance to society than general cleanliness. It ought to be carefully cultivated every where ; but in populous cities it should be almost revered * * As it is impossible to be thoroughly clean without a sufficient quantity of water, we would earnestly recommend it to the magistrates of great towns to be particularly M OF INFECTION. CHAPTER IX. OF INFECTION. MANY diseases are infectious. Every person ought therefore, as far as he can, to avoid all-communication with the diseased. The common practice of visiting the sick, though often well meant, has many ill consequences. Far be it from me to discourage any act of charity or benevolence, especially towards those in distress -, but I cannot help blaming such as endanger their own or their neighbours'livo^, by amis- taken friendship or an impertinent curiosity. The houses of the sick, especially in the country, are generally crowded from morning till night with idle visitors. It is customary in such places, for servants and young people to wait upon tbe sick by turns, and even to sit up with them all night. It would be a miracle indeed should such always escape. Experience teaches us the danger of this conduct. People often catch fevers in this' way, and communi- cate them to others, till at length they become epidemic. It would be thought highly improper for one who had not bad the small-pox, to wait upon a patient in that disease; yet many other fe- vers ai e almost as infections as the small-pox, and not less fatal. Some imagine that fevers prove more fatal in villages than in great towns, for want of proper medical assistance. This may sometimes be the case; but I am inclined to think it oftener proceeds from the came above-mentioned. Were a plan to be laid down for communicating infection, it could not be done more effectually than by the common method of visiting the sick. Such visitors not only endanger themselves and their con- nections, bat likewise hurt the sick. By crowding the house they ren- der the air unwholesome, and by their private whispers and dismal countenances disturb the imagination of the patient, and depress his spirits. Persons who are ill, especially in fevers, ought to be kept as quiet as possible. The sight of strange faces, and every thing that disturbs the mind, hurts them. The common practice in country places of inviting great numbers of people to funerals, and crowding them into the same apartment where the corpse lies, is another way of spreading infection. The infection does not always die with the patient. Every thing that comes into con- tact with his body while alive, receives the contagion, and some of them, as clothes, blankets, &c. will retain it for a long time. Persons who die of infectious disorders ought not to lie long unburied ; and peo- ple should keep as much as possible at a distance from them. It would tend greatly to prevent the spreading of infectious diseases, if those in health were kept at a proper distance from the sick. The Jewish Legislator, among many other wise institutions for preserving health, has been peculiarly attentive to the means of preventing infec- tion , or defilement as it is called, either from a diseased person or a dead body. In many cases the diseased were to be separated from attentive to this article. Most great towns in Britain are so situated as to be easily sup- plied with water; and those persons who will not make a proper useotit, after itn brought to their hand, certainly deserve to be severely punished. Tlie streets of great towns, wliere water can be had, ought to be washed every day. This ii the only 3ft* tual method for keeping them thoroughly clean; and, upon trial, we are persuaded it will be found the cheapest. So me of the most dreadful diseases incident to human nature, might in my opinion, I* entirely eradicated by cleanliness. OF INFECTION M those in health; and it was deemed a crime even to approach then habitations. If a person only touched a diseased or dead body, he was appointed to wash himself in water, and to keep for some tune at a distance from society. Infectious diseases are often communicated by clothes, it is ex- tremely dangerous to wear apparel which has been worn by the diseas- ed, unless it has been well washed and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This shews the danger of buying at random the clothes which have been worn by other people. Infectious disorders are frequently imported. Commerce, together with the riches of foreign climes, bring us also their diseases. These do often more than counterbalance all the advantages of that trade by means of which they are introduced. It is to be regretted, that so little care is commonly bestowed, either to prevent the introduction or spreading of infectious maladies. Some attention indeed is generally paid to the plague; but other diseases pass unregarded.* Infection is often spread through cities, by jails, hospitals, &c. These are frequently situated in the very middle of populous towns ; and when infectious diseases break out in them, it is impossible for the inhabitants to escape. Did magistrates pay any regard to the health of the people, this evil might be easily remedied. Many are the causes which tend to diffuse infection through popu- lous cities. The whole atmosphere of a large town is one contaminated mass, abounding with various kinds of infection, and must be perni- cious to health. The best advice that we can give to such as are obliged to live in large cities, is to chase an open situation ; to avoid narrow, dirty, crowded streets; to keep their own house and offices clean ; and to be as much abroad in the open air as their time will permit. It would tend greatly to present the spreading of infectious diseases, were proper nurses every where employed to take care of the sick. This might often save a family, or even a whole town from being infect- ed by one person. We do not mean that people should abandon their friends or relations in distress, but only to put them on their guard against being too much in company with those who are afflicted with diseases of an infections nature. Such as wait upon the sick in infectious diseases run very great haz- ard. They should stuff their noses with tobacco, or some other strong smelling herb, as rue, tansy, or the like. They ought likewise to keep tbe patient very clean, to sprinkle the room where he lies with vinegar, or other stroug acids, frequently to admit a stream of fresh air into it, and to avoid the smell of his breath as much as they can. They ought never to go into company without having changed their clothes and • Were the tenth part of the care taken to prevent tbe importation of diseases, that there is to prevent smuggling, it would be attended with many happy consequences. This might easily be done by appointing a physician at every considerable sea-port, to inspect the ship's company, passengers, Sec. before they came ashore, and, if any fevtr be either destroyed, or thoroughly cleansed by fumigation, &c. before any of it were sent ashore. A scheme of this kind, if properly conducted, would prevent many fevers and other infectious diseases, from being brought by sailor: into sta-port towns, and by tlus means diffused all oyer the coinitry. ' H2 iO OF INFECTION. washed their hands; otherwise, if the disease be infectious, they will in all probability carry the contagion along with them.* However trifling it may appear to inconsiderate persons, we will venture to affirm, that a due attention to those things which tend to diffuse infection would be of great importance in preventing diseases. As most diseases are in some degree infections, no one should continae long with the sick, except the necessary attendants. I mean not, how- ever, by this caution, to deter those whose duty or office leads then to wait upon the nek, from such a laudable and necessary employ- ment. Many things are in the power of the magistrate which would tend to prevent the spreading of infection ; as the promoting of public clean- liness ; removing jails, hospitals, burying-groimds, and other places where infection may be generated at a proper distance from great towns ;t widening the streets; pulling down useless walls and taking all methods to promote a free circulation of air through every part of the town, <&c. Public hospitals, or proper places of reception for the sick, provided they were kept clean, well ventilated, and placed in an open situation, would likewise tend to prevent the spreading of infection. Such places of reception would prevent the poor, when sick, from be* ing visited by their idle or officious neighbours. They would likewise render it unnecessary for sick servants tobe kept iu their master's houses. Masters had better pay for having tlieir servants taken care of in an hospital, than run the hazard of having an infectious disease dif- fused among a numerous family. Sick servants and poor people, when placed in hospitals, are not only less apt to diffuse infection among their neighbours, but have likewise the advantage of being well attended. We are not, however, to learn that hospitals, instead of preventing infection, may become the means of diffusing it. When they are placed in the middle of great towns; vvhen numbers of patients arc crowded together in small apartments ; when there is a constant com- munication kept up between the citizens and the patients; and when cleanliness and ventilation are neglected, they become nests for batch- ing diseases, and every one who goes into them not only runs a risk of receiving infection himself, but likewise of communicating it to others. This however is not the fault of the hospitals, but of those wb« have the management of them. It were to be wished, that they were both more numerous, and upon a more respectable footing, as that would induce people to go into them with less reluctance. This is tbe more to be desired, because most of the putrid fevers and other infec- tious disorders break out among the poor, and are by them communi- cated to the more cleanly, and the wealthy. Were proper attention paid to the first appearances of such disorders, and the patients early conveyed to an hospital, we should seldom see a putrid fever, which is almost as infections as the plague, become epidemic. * There is reason to believe that infection is often conveyed from one place to ano- ther by the carelessness of the faculty themselves. Many physicians affect a familiar way of sitting upon the patient's bed-side, and holding his arm for a considerable time. If the patient has the small-pox, or any other infectious disease, there is no doubt bat the doctor's hands,slothes, &c. will carry away some of the infection; and if he goes di- rectly to visit another patient without washing his hands, changing his clothes, or being exposed to tbe open air, which is not seldom the case, is it any wonder that he should car- ry the disease along with him? Physicians not only endanger Others, but also thern- sthes, by this practice. And indeed they sometimes suffer fbrtheir want of care. t The ancients would not suffer even tire temples of their gods, where the lick re- sorted, to be built within the walls of a city. OF THE PASSIONS. 19 CHAPTER X. OF THE PASSIONS. THE passions have a great influence both in the cause and cure of dis- eases. How the mind affects tbe body, will m all probability ever re- main a secret. It is sufficient for us to know, that there is established a reciprocal influence between the mental and corporeal parts, and that whatever injures the one disorders the other. OF ANGER. The passion of anger ruffles the mind, distorts the countenance, hur- ries on tlie circulation of the blood, and disorders the whole vital and animal functions. It often occasions fevers, and other acute diseases; aud sometimes even sudden death. This passion is peculiarly hurtful to the delicate, and those of weak nerves. I have known such per- sons frequently lose their lives by a violent fit of anger, and would ad- vise them to guard against the excess of this passion with the utmost care. It is not indeed always in our power to prevent being angry ; but we may surely avoid harbouring resentment in our breast. Resentment preys upon the mind, and occasions the most obstinate chronical disor- ders, which gradually waste the constitution. Nothing shews true greatness of mind more than to forgive injuries; it promotes the peace of society, and greatly conduces to our own ease, health, and felicity. Such as value health should avoid violent gusts of anger, as they would the most deadly poison. Neither ought they to indulge resent- ment, but to endeavour at all times to keep their minds calm and se- rene. Nothing tends so much to the health of the body as a constant tranquillity of mind. OF FEAR. The influence of fear, both in occasioning and aggravating disease? is very great. No man ought to be blamed for a decent concern about life ; but too great a desire to preserve it is often tlie cause of losing it. Fear and anxiety, by depressing the spirits, not only dispose us to diseases, but often render tho^e diseases fatal which an undaunted mind would overcome. Sudden fear has generally violent effects. Epileptic fits, and other convulsive disorders are often occasioned by it. Hence the danger of that practice, so common among young people of frightening one another. Many have lost their lives, and others have been rendered miserable by frolics of this kind. It is dangerous to tamper with the human passions. The mind may easily be thrown into such disorder as never again to act with regularity. But the gradual effects of fear prove most hurtful. The constant dread of «ome future evil, by dwelling upon the mind, often occasions the very evil itself. Hence it comes to pass, that so many die of those very diseases of which they long had a dread, or which had been impress* ed on their minds by some accident or foolish prediction. This, for ex- ample, is often the case with women in childbed. Many of those who die in that situation are impressed with a notion of their death a long time before it happens; and there is reason to believe that this impres- sion in often the cause of it. Tbe methods.taken to impress the minds of women with the appro* hension of tbe great pain and peril of child-birth, are very hurtful. 02 OF THE PASSIONS. Few.women die in labour, though many lose their lives after it; which may be thus accounted for. A womau after delivery, finding herself weak and exhausted, immediately apprehends she is in danger; but this fear seldom fails to obstruct the necessary evacuations, upon which her recovery depends. Thus the sex often fall a sacrifice to their own imaginations, when there would be no danger, did they apprehend none. It seldom happens that two or three women in a great town die in child-bed, but their death is followed by many others. Every woman of their acquaintance who is with child dreads the same fate, and the disease becomes epidemical by the mere force of imagination. This should induct; pregnant women to dispise fear, and by all means to avoid thos-e tattling gossips who are continually buzzing in their ears the misfortunes of others. Every thing that may in the least alarm a pregnant or child-bed woman, ought with the greatest care to be guard- ed against. Many women have lost their lives in child-bed by the old supersti- tious custom, still kept up in most parts of Britain, of tolling the pa- rish hell for every person who dies. People who think themselves in danger are very inquisitive ; and if they come to know that the bell toils for one who died in the same situation with themselves, what must be the consequence ? At any rate they are apt to suppose that this is the case, and it will often be found a very difficult matter to persuade them ©f the contrary. But this custom is not pernicious to child-bed women only. It is hurtful to many other cares. When low fevers, in which it is difficult to support the patient's spirits, prevail, what must be the effect of a funeral peal sounding five or six times a day in his cars : No doubt his imagination, will suggest that others died of the same disease under which he labours. This apprehension will have a greater tendency to depress his spirits, than all the cordials of which medicine can boast, will have to raise them. If this useless piece of ceremony cannot be abolished, we ought to keep the sick as much from hearing it as possible, 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 business to visit the sick, on purpose to wisper dismal stories in their ears. Such may pass for sympathizing friends, but they ought rather to be considered as en- emies. All who wish well to the sick ought to keep such persons at the greatest distance from them. A custom has long prevailed among physicians of prognosticating, as they call it, the patient's fate, or foretelling the issue of the disease. Vanity, no doubt introduced this practice, and still supports it, in spite of common sense and the safety of mankind. I have known a physi- cian barbarous enough to boast, that he pronounced more sentences than all his majesty's judges. Would to God that such sentences were not often equally fatal! It may indeed be alleged, that the doctor does not declare his opiniou before the patient. So much the worse. A sensible patient had better hear what the doctor says, than leani it, from the disconsolate looks, the watery eyes, and the broken whis- pers of those about him. It seldom happens, when the doctor gives 1 an unfavourable opinion, that it can be concealed from the patient. The very embarrassment which the friends and attendants shew in disguising what he has said, is generally eufficient to discover tbe troth. OF THE PASSIONS. 93 Kind heaven has, for the wisest ends, concealed from mortals their fate ; and we do not see what right any man has to announce the death of another, especially if such a declaration has a chance to kill him. Mankind are indeed very fond of prying into future events, and seiuom fail to solicit the physician for his opinion. A doubtful answer, how- ever, or one that may tend rather to encourage the hopes of the sick, is surely the most proper. This conduct could neither hurt the pa- tient nor the physiciau. Nothing tends more to destroy the credit of physic than those bold prognosticators, who by the bye, are generally the most ignorant of the faculty. The mistakes which daily happen in this way are so many standing proofs of human vanity, and the weak- ness of science. We readily admit, that there are cases where the physician ought to give intimation of the patient's danger to some of his near connections; though even this ought always to be done with the greatest caution: but it never can be necessary in any case that the whole town and country Should know, immediately after the doctor has made his first visit, that he has no hopes of his patient's recovery. Persons whose impertinent curiosity leads them to question the physician, with regard to the fate of his patient, certainly deserves no other than an evasive answer. The vanity of forteilmg the fate of the sick is not peculiar to the faculty. Others follow their example, and those who think themselves wiser than their neighbours, often do much hurt in this way—Human- ity surely calls upon every one to comfort the sick, and not to add to tlieir affliction by alarming their fears. A friend or even a physician, may often do more good by a mild and sympathizing behaviour than by a medicine, aud should never neglect to administer that greatest of all cordials, Hope. OF GRIEF. . Grief is the most destructive of all the passions. Its effects arc per* mauent; and when it sinks deep into the mind, it generally proves fatal. Anger and fear being of a more violent nature, seldom last long; but grief often changes into a fixed melancholy, which preys upon the spi- rits, and wastes the constitution. This passion ought not to be indulged. It may generally be conquered at the Beginning; but when it has gain* ed strength, all attempts to remove it are vain. No person can preveut misfortunes in life; but it shews true great- ness of mind to bear them with serenity. Many persons make a merit of indulging grief, and when misfortunes happen they obstinately re- fuse all consolation, till tlie mind, overwhelmed with melaucholy, sinks under the load. Such conduct is not only destructive to health, but hv- consistant with reason, religion, and common sense. Change of ideas is as necessary for health as change of posture. When the mind dwells long upon one subject, especially of a disagree- able nature, it hurts the whole functions of the body. Hence grief in- dulged spoils the digestion and destroys the appetite; by which means the spirits are depressed, the nerves relaxed, the bowels inflated with wind, and tbe humours, for want of fresh supplies of chyle, vitiated. Thus many an excellent constitution has been ruined by a family mis- fortune, or any thing that occasions excessive grief. It is utterly impossible that any person of a dejected mind should en- joy health. Life indeed may be dragged out for a few years; but who- ever would live to a good old age, must be good humoured and cheer- ful. This indeeti is not altogether in our own power; yet our temper of mind, as well as onr actions, depend greatly upon oureelves. We can 94 OP THE PASSIONS. either associate with cheerful or melancholy companions, mingle in the amusements and offices in life, or sit still and brood over our calamities as w e choose. These, and many such things, are certainly in our power, and from these the mind generally takes its cast. The variety of scenes which present themselves to the senses, were certainly designed to prevent our attention from being too long fixed tipou any one object. Nature abounds with variety, and tbe mind, un- less fixed down by habit, delights in contemplating new objects. This at once -points out tbe method of relieving the mind in distress. Turn the attention frequently to new objects. Examine them for some time. Wheu the mind begins to recoil, shift the scene. By this means a con- stant succession of new ideas may be kept up, till the disagreeable ones entirely disappear. Thus travelling, the study of any art or sience, read- ing, or writing on such subjects as deeply engage the attention, will sooner expel grief than the most sprightly amusements. It has already been observed, that the body cannot be healthy unless it be exercised; neither can the mind. Indolence nourishes grief. When the mind has nothing else to think of but calamities, no wonder that it dwells there. Few people who pursue business with attention are. hurt by grief. Instead therefore of abstracting ourselves from the world or business when misfortunes happen, we ought to ingage in it with more than usual attention, to discharge with double diligence the functions of our station, and to mix with friends of a cheerful and social temper. Innocent amusements are by no means to be neglected. These, by leading the mind insensibly to tbe contemplation of agreeable objects, help to dispel the gloom which misfortunes cast over it. They make time seem less tedious, and have many other happy effects. Some persons, when overwhelmed with grief, betake themselves to drinking. This is making the cure worse than the disease. It seldom fails to end in tbe ruin of fortune, character, and constitution. OF LOVE. Love is perhaps the strongest of all the passions ; at least, when it becomes violent, it is less subject to the contiol eithei of the under- siauuing or will, than any of the rest. Fear, anger, aud several other passions, are necessary for the preservation of the individual, but love is necessary for the continuation of the species itself: it was therefore proper that this passion should be deeply rooted in the human breast. Though love be a strong passion, it is seldom so rapid in its progress as several of the others. Few persons fall desperately in love all at once- We would therefore advise every one, before he tampers with this passion, to consider well the probability of his being able to ob- tain the object of his wishes. When that is not likely, he should avoid every occasion of increasing it. He ought immediately to flee the company of the beloved object; to apply his mind attentively to bu- siness or study; to take every kind of amusement; aiid above all, to endeavour if possible, to find another object widen may engage his af- fections, and which it may be in his power to obtain. There is no passion with winch people are so ready to tamper as love, although none is more dangerous. Some men make love for amuse- ment, others for mere vanity, or on purpose to shew their consequence with the fair. Tics is perhaps the greatest piece of cruelty which any one can b° guilty of. What we eagerly wish for we easily credit. Hence the too credulous fur are often detrayed into a situation winch is truly deplorable, before they are able to discover that the pretended OF THE COMMON EVACUATIONS. 95 lover was only in jest. But there is no jesting with this passion. When love has got to a certain height, it admits of no other cure but the pos- session of its object, which in this case ought always if possible to be obtained.* OP RELIGIOUS MELANCHOLY. Many persons of a religions turn of mind behave as if they thought it a crime to be cheerful. They imagine the whole of religion consists in certain mortifications, or denying themselves the smallest indulgence, even of the most innocent amusements. A perpetual gloom hangs over their countenances, while the deepest melancholy preys upon their minds. At length the fairest prospects vanish, every thing puts on a dismal appearance, and those very objects which ought to give delight, afford nothing put disgust. Life itself becomes a burden, and tlie un- happy wretch, persuaded that no evil can equal what he feels, often puts an end to his miserable existence. It is great pity that ever religion should be so far perverted, as to become the cause of those very evils which it was designed to cure. Nothing can be better calculated than True Religion, to raise and sup* port the mind of its votaries under every affliction that can befal them. It teaches men that even the sufferings of this life are preparatory to the happiness of the next; and that all who persist in a course of virtue shall at length arrive at complete felicity. Person whose business it is to recommend religion to others, should beware of dwelling too much on gloomy subjects. That peace and tranquillity of mind, which true religion is calculated to inspire, is a more powerful argument in its favour, than all the terrors that, can be uttered. Terror may indeed deter men from outward acts of wicked- ne;^, but can never inspire them with that love of God, and real good- ness of h< rt, in which alone true religion consists. To coo lude; the best way to counteract the violence of any passion, is to keep tlie mind closely engaged in some useful pursuit. CHAPTER XI. OF THE COMMON EVACUATIONS. THE principal evacuations from the human body are those by stool, urine, and .•sensibleperspiration. N one of these can be long obstructed without in.pairing the health. When that which ought to be thrown off the body is long retained, it not only occasions a plethora, Or too fulness of the vessels, but acquires qualities which are hurtful to the health, as acrimony, putrescence, &c. OF THI-: EVACUATION BY STOOL. Few things conduce more to health than keeping the body regular. When the/aces lie too long in the bowels, they v itiate the humours, and when they are too soon discharged, the body is not sufficiently nour- ished. A medium is therefore to be desired, which can only be obtain- ed by regularity in diet, sleep and exercise. Whenever the body is not regular, there is reason to suspect a fault in one or other of these. * Tbe conduct of parents with regard to the disposal of their children U marriage is often very blamable. An advantageous match is the constant aim of parents; whQe. their children often sufrr a rial martyrdom betwixt their inclinations and duty. The first thing which parents ought to consult in disposing their children in mania*.' is cer- tainly their indioatioiu. Were due regard always paid to these, there would be fewer unhappy couples, and parents would nut have so often cause to repent the severity of their conduct, after a ruined constitution,a lost character, or a distracted uind, b»i shown them their mistake. 96 OF THE COMMON EVACUATIONS. Persons who eat and drink at irregular hours, and who eat various kinds of food, and drink of several different liquors at every meal, have no reason to expect either that their digestion will be good, or their discharges regular. Irregularity in eating and drinking disturbs cveiy part of the animal economy, and never fails to occasion dise ises. Either too much or too little food will have this effect. The former indeed generally occasions looseness, and the latter costiveness; but both have a tendency to hurt the health. It would be difficult to ascertain the exact number of stools which may be consistent with health, as these differ-in the different periods of life, in different constitutions, and even in the same constitution under a different regimen of diet, exercise, &c. It is however, gene- rally allowed, that one stool a day is sufficient for an adult, and that less is hurtful. But this, like most general rules, admits of many exceptions. I have known persons in perfect health who did not go to stool above once a-week* Snch a degree of costiveness however is not safe; though the person who labours under it may for sometime enjoy toler- able health, yet at length it may occasion diseases. One method of procuring a stool every day is to rise betimes, and go abroad in the open air. Not only the posture in bed is unfavourable to regular stools, but also the warmth. This, by promoting the per- spiration, lessens all the other discharges. The method recommended for this purpose by Mr. Locke is likewise very proper, viz. to solicit nature, by going regularly to stool every mor- ning, whether one has a call or not. Habits of this kind may be acquired, which will in time become natural. Persons who have a frequent recourse to medicines for preventing costiveness, seldom fail to ruin their constitution. Purging medicines frequently repeated weaken the bowels, hurt the digestion, and every .dose makes way for another, till at length they become as necessary as daily bread.- Those who are troubled with costiveness ought rather,if possible, to remove it by diet than drugs. They should likewise go thiuly clothed, and avoid every thing of an astringent or of an heating nature. The diet and other regimen necessary in. this case will be found underthe'article Costiveness, where this state of the bowels is treated as a disease. Such persons as are troubled with an habitual looseness ought like- wise to suit their diet to the nature of their complaint. Theyshonld use food which braces and strengthens the bowels, and which is rather of an astringent quality, as wheat bread made of the finest flour, cheese, eggs, rice boiled in milk, &c. Their drink should be red port, claret, brandy and water, in which toasted bread has been boiled, and sack like. As an habitual looseness is often owing to an obstmcted perspira- tion, persons affected with it ought to keep their feet warm, to west flannel next their skin, and take every other method to promote the perspiration. Further directions with regard to the treatment of this complaint will be found under the article Looseness. 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.t Dr. Cheyne says, tbe uriue ought to be equal to * Some persons have told me that they did not go to stool above once a month. t It has long been an observation among |ihysicians, that the app* aranc* i of the v is* are very uncertain, and very little to be depended on. Mo one will be surprised at tab OF THE COMMON EVACUATIONS. §7 three-fourths of the liquid part of our aliment. But suppose any one were to take the trouble of measuring both, he would find that every thing which altered the degree of perspiration, would alter this propor- tion, and likewise that different kinds of aliment would afford very dif- ferent quantities of urine. Though for these, and other reasons, no rule can be given forjudging of the precise quantity of urine which ought to be discharged, yet a person of common sense will seldom be at a loss to know when it is in either extreme. As a free discharge of urine not only prevents but actually cures many diseases, it ought by all means to be promoted; and every thing that may obstruct it should be carefully avoided. Both the secretion and discharge of urine are lessened by a sedentary life, sleeping on beds that are too soft and warm, food of a dry and heating quality, liquors which are astringent and heating, as red port, claret, and such like. Those who have reason to suspect that their urine is in too small quantity, or who have any symptoms of the gravel, ought not only to avoid these things, but whatever else they find has a tendency to lessen the quantity of their urine. When the urine is too longretained, it is notonly re-absorbed, or ta- ken up again into the mass of fluids, but by stagnating in the bladder it becomes thicker, the more watery parts flying off first, and the more gross and earthy remaining behind. By the constant tendency which these have to coucrete, the formation of stones and gravel in the bladder is promoted. Hence it comes to pass that indolent and seden- tary people are much more liable to these diseases, than persons of a more active life. Many persons have lost their lives, and others have bronght on very tedious, and even incurable disorders by retaining their urine too long, from a false delicacy. When the bladder has been over-distended, it often loses its power of action altogether, or becomes paralytic, by which means it is rendered unable either to retain the urine, or expel it properly. The calls of nature ought never to be postponed. Delica- cy is doubtless a virtue, but that can never be reckoned true delicacy, which induces any one to risk his health or hazard his life. But the urine may be in too great as well as too small a quantity. This may be occasioned by drinking large quantities of weak watery li- quors, by the excessive use of alkaline salts, or any thing that stimulates the kidneys, dilutes the blood, &c. This disorder very soon weakens the body, and induces a consumption. It is difficult to cure, but may be mitigated by strengthening diet and astringent medicines, such as are recommended under the article Diabetes, or excessive discharge of urine. OF THE PERSPIRATION. Insensible perspiration is generally reckoned the greatest of all the discharges from the hnuian body. It is of so great importance to health, who considers how many ways it may be affected, and consequently have its appearance altered. The passions, the state of the atmosphere, the quantity and quality of the food, the exercise, the clothing, the state of the other evacuations, and numberless other cau- ses, a iv sufficient to induce a change either in the quantity or appearance of the urine. Any one who attends to this will be astonished at the impudence of those daring quacks, who pretend to find out diseases, and prescribe to patients, from the bare inspection of their urine. These impostors, however, are very common all over Britain, and by the amazing credulity of the populace, many of them amass considerable fortunes. Of all the medical prejudices which prevail in this country, that in favour ot'urinc doctors is tbe strongest. The common people have still an unlimited faith in their skill,although k has been demonstrated that no one of them is able to distinguish, the urine of a horse or aDy other animal, troui that of a man. 98 OF THE COMMON EVACUATIONS. that few diseases attack us while it goes properly on ; but when it is obstructed, the whole frame is soon disordered. This discharge how- ever, being less perceptible than any of the rest, is consequently less attended to. Hence it is, that acute fevers, rheumatisms, agues, Arc. often proceed from obstructed perspiration before we are aware of its having taken place. On examining patients, we find most of them impute their diseases either to violent colds which they had caught, or to slight ones which had been neglected. For this reason, instead of a critical inquiry into the nature of the perspiration, its difference in different seasons, cli- mates, constitutions, &c. we shall endeavour to point out the causes which most commonly obstruct it, and to shew how far they may either be avoided, or have tlieir influence counteracted by timely care. The want of a due attention to these, costs Britain annually some thousands of useful lives. CHANGES IN THE ATMOSPHERE. One of the most common causes of obstructed perspiration, or catch- ing cold, in this country, is the changeableness of the weather, or state of the atmosphere. There is no place where such changes happen more frequently than in Great-Britain: With us the degrees of beat and cold are not only very different in the different seasons of the year, but often change almost from one extreme to another in a few days, and sometimes even in the course of one day. That such chauges must affect the state of the perspiration is obvious to every one.* The best method of fortifying the body against the changes of the weather, is to be abroad every day. Those who keep most within doors are most liable to catch colds. Such persons generally render them- selves so delicate as to feel even the slightest changes in the atmosphere, and by their pains, coughs, and oppressions of the breast, &c. tbey become a kind of living, barometers. WET CLOTHES. Wet clothes not only by their coldness obstruct the perspiration, hut their moisture by being absorbed, or taken up into the body, greatly in- creases the danger. The most robust constitution is not proof against the danger arising from wet clothes; they daily occasion fevers, rheu- matisms, and other fatal disorders, even in the young and healthy. It is impossible for people who frequently go abroad to avoid some- times being wet. But the danger might generally be lessened, if not wholly prevented, by changing their clothes soon; when this cannot be done, they should keep in motion till they dry. So far are many from taking this precaution, that they often sit or lie down in the fields witk their clothes wet, and frequently sleep even whole nights in this condi- tion. The frequent instances which we have of the fatal effects of this conduct, ought certainly to deter all from being guilty of it. WET FEET. Even wet feet often occasion fatal diseases. The- cholic, inflamma- tions of the breast and of the bowels, the iliac passion, cholera morbus, &c, are often occasioned by wet feet. Habit will, no doubt, render this less dangerous; but it ought, as far as possible, to be avoided. The * I never knew a more remarkable instance of the uncertainty of the weather in this eountry, than happened when I - ague, it ought to be thrown, in as fast as the stomach eaa possibly bear it. Inat- tention to this circumstance- has hurt there putatiou of one of the best medicines of which v>e are in possession. Vi2 OF INTERMITTING FEVERS. ters, a smaller quantity of bark than is geucrally used will be sufficient to cure an ague.* Those who cannot swallow the bark in substance, may take it in tie- coction or infusion. An ounce of bark in powder may be infused in a bottle of white wine, for four or five days, frequently shaking the bottle, afterwards let the powder snb-idc, and*pour off the clear I'quor. A' wine glass may be drank three or four times a day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of ihe bark, and two drams of snake-root bruised, with an equal quantity of salt of v. ormwood, may be boiled in a quart of water, to an English pint. To tlie strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently. In obstinate a«ues, the bark will be found much more efficacions when assisted by brandy, or other warm cordpb, than taken alone. This I have had frequently occasion to observe in a country where in- termitting fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aro- matic. When the fits are frequent and violent, in which case the fever ifcen approaches towards an inflammatory nature, it will be safer to .: ccp out the aromatic?, and to add salt of tartar iu their stead. Bnt in m obstinate tertian or quartan, in the end of autumn or beginning of winter,' warm and cordial medicines are absolutely necossary.t As autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be ne- cessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting'fever in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, tilf the return of the warm season. He ought like- wise to take care not to be much abroad in wet weather, erpccially in oohl easterly winds. \Vrhen agues arc not properly cured, they often degenerate into ob- : tinntc chror.ical disease*, as the dropsy, jaundice, &c. For this reason iiLI possible care should he taken to have them radically cured, before the cors.itution has been too much weakened. Tliornti nothing ir. more rational than tlie metliod of treating inter- mitting fevers, yet by some strange infatuation, more charms and whim' sical remedies are daily used for removing this than any other disease; There is hardly an old woman who is not in possession of a nostrum for stopping an ague ; and it is amazing with what readiness their preten- sions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of the disorder. * Thess is ieason to believe, that sundry of our own plants or barks, which are very bitter and astringent, would s^ice-d in the cure of intermitting fevers, especially when assisted by aromaties. But as the Peruvian bark has been long approved in tbe cure oi'this disease, and is now to be obtained at a rery reasonable rate, it is of less impor- tance to search after new medicines. We cannot however omit taking notice, that the Peruvian bark is very often adulterated, and that it requires considerable skill to distin- guish between the genuine and the false. This ought to make people very cautious of whom they purchase it. t In obstinate agues, when the patient is old, the habit phlegmatic, the season rainy, the situation damp, or the like, it will be necessary to mix with tw u ounces of the bark, hair an ounce of Virginian snake-root, and a quarter of an ounce of giiiger,or some other warm aromatic; but when the symptoms are of an inflammatory natuiv, hi'll'an ounce ut salt of wormwood or salt of tartar may be added to the above quantity of bark. OF INTERMITTING FEVERS. 113 Some indeed try bold, or rather fool-hardy experiments to cure agues, as drinking great quantities of strong liquors, jumping into a river, taking arsenic, &c. These may sometimes have the desired effect, but must always be attended with danger.* When there is any degree of inflammation, or tlie least tendency to it, such experiments may prove fatal. The only patient whom I remember to have lost in an intermitting fever, evidently killed himself by drinking strong liquor, which some person had persuaded him would prove an infallible remedy. Many dirty things are extolled for the cure of intermitting fevers, as spiders, cobwebs, snuffings of candles, cvc. Though these may some- times succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended upon for thoroughly curing an in- termitting fever, is the Peruvian bark. It may always be used with safety ; and I can honestly declare, that in all my practice I never knew it faii, when combined with the medicines mentioned above, aud duly persisted in. Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeable sharpness with the elixir or spirit of vitriol. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, the saline mixture may be given with advantage to children.? Wine-whey is a very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit of harts- horn. Exercise is likewise of considerable service; aud when the disease proves too obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourishing, aud sometimes a little generous wine should be allowed. To children, and such as cannot swallow the bark, or when the sto- mach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm water, with the addi- tion of half an ounce of sweet oil, and six or eight drops of laudanum, is the form recommended by Dr. Lind for an adult, and this to be re- peated every fourth hour, or oftener, as the occasion shall require. For children the quantity of extract and laudanum must be proportionably lessened. Children have been cHred of agues by making them wear a waistcoat with powdered bark quilted between the folds of it; by bathing them frequently in a strong decoction of the bark, and by rub- bing the spine with strong spirits, or with a mixture of equal parts of laudanum and the saponaceous liniment. We have been the more full upon this disease, becartse it is very com- mon, and because few patients in an ague apply to physicians unless in extremities. There are, however, many cases iu which the disease is very irregular, being complicated with other diseases, or attended with symptoms which are both very dangerous and very difficult to under- stand. All these we have purposely pa«sed over, as they would only bewilder the generality of readers. When the disease is very irregular, * Arsenic bas of late been recommended as an infallible remedy in the ague j huJ ( < cu!d ad ris; that i( should be used only under the eye of a physician, t See Appendix, Saline Mixture, K2 Hi OF AN ACUTE CONTINUAL FEVEK or the symptoms dangerous, the patient ought immediately to apply t<. a physician, aud strictly to follow his advice. To prevent agues people must endeavour to avoid their causes.—- These have been already pointed out in the begiuniiig of this section. we shall therefore only add one preventive medicine, which may be t.t'use to such as are obliged to live in low marshy countries, or who are liable to frequent attacks of this disease. Take an ounce of the best Peruvian bark; Virginian snake-root, and orange-peel, of each half an onnce; bruise them all together, and in- fuse for five or six days in a bottle of brandy, Holland gin, or any good spirit; afterwards pour of the clear liquor, and take a wine glass of it twice or thrice a day. This indeed is recommending a dram ; but the bitter ingredients in a great measure take off the ill effects of tlie spirit. Those who do not chuse it in brandy, may infuse it in wine; and such as can bring themselves to chew the bark, will find that me- thod succeed very well. Gentian root or calamus aromaticus, may also be chewed by turns for the purpose. All bitters seem to be antidotes to agues, especially those that are warm and astringent CHAPTER XV. OF AN ACUTE CONTINUAL FEVER. X HIS fever is denominated acute, ardent, or inflammatory. It mo.-t commonly attacks the young, or persons about the prime and vigour of life, especially such as live high, abound with blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year; but is most frequent in the spring and beginning of summer. CAUSES.—An ardent fever may be occasioned by any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries; a full diet, with little exercise, &c. It may likewise, be occasioned by whatever ob- structs the perspiration, as lying on the damp ground, drinking cold li- quor when the body is hot, night watching, or the like. SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid countenance, pains in the back, roins,&c. To these succeed difficulty of breathing, sick- ness, with an inclination to vomit. The patient complains of great thirst, has no appetite for solid food, is restless, and bis tongue generally appears black and rough. A delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons,hickup, cold, clam- my sweats, an involuntary discbarge of urine, are very dangerous symp- toms. As this disease 13 always attended with danger, the best medical a^istance ought to be procured as soon as possible. A physician rosy he of use at the beginning, but his skill is often of no avail afterwards. Nothing can be more unaccountable than the conduct of those who i.ave it in their power, at the beginning of a fever, to procure the best medical assistance, yet put it off till things come to an extremity.' When the disease, by delay, or wrong treatment, has become incura- ble, and has exhausted the strength of the patient, it is vain to hope for rehef from medicine. Physicians may indeed assist Nature; but their attempts must ever prove fruitless, when she is no longer able to co- operate with their endeavours' OF AN ACUTE CONTINUAL FEVER. 115 KEGIMEN.—From the symptoms of this disease, it is evident, that the blood and other humours require to be attenuated ; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity; that the vessels are rigid, and the heat-of the whole body too great: all these clearly point out the necessity of a regimen calculated ta dilute the blood, correct the acrimony of the humours, allay the exces- sive heat, remove the spasmodic structure of the vessels, and promote the secretions. These important purposes may be greatly promoted by drinking plentifully of diluting liquors; as water-gruel, oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries,and such like: orange- whey i3 likewise an excellent cooling drink. It is made by boiling among milk and water, a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonsful of vinegar, will have the same effect. Two or three spoons- ful of white wine may occasionally be added to the liquor when boil- ing. If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English piuts of water to a quart. This makes a very pleasant drink, and may be used at discretion. The common pectoral decoction is likewise a very proper drink in this disease. A tea-cup full of it may be taken every two hours, or oftener,if the patient's heat and thirst be very great.* The above liquids must all be drank a little warm. They may be. used in smaller quantities at the beginning of a fever, but more freely -afterwards, in order to assist in carrying off the disease by promoting the different excretions. We have mentioned a variety of drinks that tlie patient may have it in his power to chuse those which are' most agreeable, and that, when tired of one, he may have recourse to another. The patient's diet must be very spare and light. All sorts of flesh- meats, and even chicken-broths, are to be avoided. He may be allow- ed groat-gruel, panado, or light bread boiled in water; to which may- be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples with a little su- gar, toasted bread with jelly of currants, boiled prunes, &c. It will greatly relieve the patient, especially in a hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold. ■ It is too common in fevers to load the patient with bed clothes un- der the pretence of making him sweat, or defending him from' the cold. This custom has many ill effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the per- spiration. r 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 posture ought never to be continued too long: and if the patient is inclined to sweat, it will be more safe to let him lie, only raising his head a little with pillows. Sprinkling the chamber with vinegar, juice of lemon, or vinegar and roee-tM«tu-, with a little nitre dissolved in it, will greatly refresh * SwAppendiXj/ecrjraiifecwio/i, lift OF AN ACUTE CONTINUAL FEVER. the patient. This ought to be done frequently, especially if the wea- ther is hot. The patient's mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoc- tion of figs in barley-water. His feet and hands ought likewise fre- quently to be bathed in lukewarm water; especially if the head is af- fected. The patient should be kept as quiet and easy as possible. Company, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that effects the senses, ought to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted ; even the promise of what he craves will often satisfy him as much as its reality. MEDICINE.—In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest importance. This ope- ration ought always to be performed as soon as the symptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, must be in proportion to the strength of the patient and the violence of the disease. If after the first bleeding the fever should increase, and the pulse become more frequent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth time, which may be done at the distance of twelve, eighteen, or twen- ty-four hours from each other, as the symptoms require. If the pulse continues soft, and the patient continues easy after the first bleed- ing, it ought not to be"repeated. If the heat and fever be very great, forty or fifty drops of the dulcifi- ed or sweet 6pirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of sim- ple syrup, or a bit of loaf-sugar. This draught may be given to the pa- tient every three or four hours while the fever is violent; afterwards once in five or six honrs will be sufficient. If the patient be afflicted with reaching, or an inclination to vomit, it will be right to assist nature's attempts, by giving him weak camomile- tea, or luke-warm water to drink. If the body is bound, a clyster of milk and water, with a little salt, and a spoonful of sweet-oil or fresh butter in it, ought daily to be ad- ministered. Should this not have the desired effect, a tea-spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink. He may likewise cat tamarinds, boiled prunes, roasted apples, and the like, If about tbe tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moistcr, and the uriue begins to let fall a reddish sedi- ment, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient's spirits grow languid, his pulse sinks, and his breathing becomes difficult, with a stupor, trem- bling of the nerves, startling of the tendons, &c. there is reason to fear that the consequences will be fatal. In this case blistering plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion; poultices of wheat-bread, mustard and vinegar, may likewise be applied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel, with wine in it, and such like. A proper regimen is not only necessary during the fever, but like- wise after the patient begins to recover. By neglecting lbi-. ma?" OP THE PLEURISY. H7 relapse, or fall into other diseases and continue valetuniuary for life. Though the hotly is weak after a fever, yet the diet for some time ©tight to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, tVc. are carefully to be avoided. The mind ought likewise to be kept easy, and the patient should uot attempt to pursue study, or any business that requires intense thinking. If the digestion is bad, or the patient is seized at times with fever* ish heats, an infu«ion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the remains of the fever. When the patieut's strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a drain of sena may be boiled for a few minutes in an English -pint of water, and an- ounce of manna dissolved in the decoction ; afterwards it may be strain- ed, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening. Those who follow laborious employments ought not to return too soon to their labon rafter a fever, but should keep easy till their strength and spirits are sufficiently recruited. i CHAPTER xiv. OF THE PLEURISY. THE true plenrisy is an inflammation of that membrane called the. • Pleura, which lines the inside of the breast. It is distinguished into j the moist and dry. In the former, the patient spits freely; in the lat- ter, little or none at all. There is likewise a species of this disease, which is called the spurious, or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the libs. The pleurisy prevails ambng labouring people, especially such as work, without doors and are of a sanguine constitution. It is most frequent in the spring season. CAUSES.—The pleurisy may be occasioned by whatever obstructs - i the j;c:„-iir^tion; as cold m,. }!.*■ Iy winds; drinking cold liquors when the body is hot; sleeping without doors on the damp ground -, wet clothes ; plunging the body into cold water, or exposing it to the cold air, when covered with sweat, Arc. It may likewise be occasioned by drinking strong liquors ; by the stoppage of the usual evacuations ; as old ulcers, issues, sweating of the feet or hands, 6lc. The sudden stri- king in of an eruption, as the itch, the measles, or the small-pox. Those who have been accustomed to bleed at a certain season of the year are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm, by means of lire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as ruuning, wrestling, leaping, or by supporting great weight, blows on the breast, milk, &oe. tlie drink, butter-milk or whey, sweetened with honey. This is likewise a proper time for using the Peruvian bark, which may be taken as directed above. If the vomica or ireporthume should discharge itself into the cavity Of? the breast, between the pleura and die lungs, there is. no way of get- ting the matter out but by an incision-, as has already been observed; As this operation must always be performed by a. surgeon, it is nut necet> sary here to describe it. We shall only add, that it is nut so dreadful as B£opJtra«eap* to imagine, audi that)itciff the only chance the patient in this case has for his lii'e» OF THE NERVOUS FEVER. 129 A NERVOUS CONSUMPTION is a wasting or decay of the whole body, without any considerable degree of fever, cough, or diffi- culty of breathing. It is attended with indigestion, weakness, and want of appetite, &c. Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease. We would chiefly recommend, for the cure of a nervous consump- tion, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach ; as the Peruvian bark, gentian root, camomile, horehonnd, &c. These may be infused in water or wine, and a glass of it drank frequently. It will greatly assist the digestion, and promotethe cure of this dis- ease, to take twice a-day twenty or thirty drops of the elixir of vitriol in a glass of wine or water. The chalybeate wine is likewise an excel- lent medicine in this case. It strengthens the solids, and powerfully assists Nature in the preparation of good blood.* Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recommend a long journey of pleasure, as the most likely means to restore his health. What is called a symptomatic consumption, cannot be cured without first removing the disease by which it is occasioned. Thus, when a con- sumption proceeds from the scrophula, or king's evil, from the scurvy, the asthma, the venereal disease, <&c. a due attention must be paid to the malady from whence it arises, and the regimen and medicine direct- ed accordingly. When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient's strength must be restored by gentle exercise, nourishing diet, and generous cordials. Young and delicate mothers often fall into consumptions by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, other- wise they cannot expect a cure. Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptious, to take as much exercise, without doors, as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of hot punch or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and 6poil the appetite, but heat and inflame the blood, and set the whole constitution on fire. CHAPTER xix. OF THE SLOW OR NERVOUS FEVER. JlERVOUS fevers have increased of late years in this island, owing doubtless to our different manner of living, and the increase of sedentary employments ; as they commonly attack persons of a weak relaxed ha- bit/.who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors. CAUSKS.—Nervous fevers may be occasioned by whatever de- presses the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, unripe fruits. See Appendix, Chalybtntc wine. 1 JO OF THE NERVOUS FEVER. cucumbers, melons, mushrooms, Sec. They may likewise be occa- sioned by damp, confined or unwholesome air. Hence they are very common in rainy seasons, and prove most fatal to those who live in dirty low houses, crowded streets, hospitals, jails), or such like places. Persons whose constitutions have been broken by excessive venery, frequent salvations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease. Keeping on wet clothes, lying on the damp ground, excessive fa- tigue, and whatever obstructs the perspiration, or causes a spasmodic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so much to preserve the body in a sound state as a regular diet; nor can any thing contribute more to occasion fevers of the worst kind than its opposite. SYMPTOMS.—Low spirits, want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue, without any considerable thirst, chilli- ness and flushing m turns, &c. After some time the patient complains of a giddiness and pain of the head, has a nausea, with retchings and vomiting; tlie pulse is quick, and sometimes intermitting ; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienations of the mind. If towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin ; or if a suppuration happens in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favour- able crisis. But if there is an excessive looseness or wasting sweats, with fre- quent fainting fits ; if the tongue, when put out, trembles excessively, and tbe extremities feel cold, with a fluttering or slow creeping pulse; if there is a startling of the tendons, an almost total loss of sight anrl hearing, and an involuntary discharge by stool and urine, there is great reason to fear that death is approaching. REGIMEN.—It is very necessary in this disease, to keep the pa- tient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not on- ly to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient's imagination gloomy or frightful ideas. These of themselves often occasion nervous fevers, aud it is not to bfl doubted but they will likewise aggravate them. The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panada, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or small negus sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mustard-whey ii likewise a very proper drink in this fever, and may be rendered au excellent cordial medicine by the addition of a proper quantity of *4nM wine.* * Sets Appendix, awWrtf-wAey. OF THE NERVOUS FEVER. 131 Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of tlie cordial medicines, while it is free from many of then- bad qualities. I say good wine ; for however common this article of luxury is now become, it is rarefy to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities. I have often seen patients ia low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the extsemities, and almost every other mortal symptom, recover by using in whey, gruel, and negus, a bottle or two oi? strong wine every day. Good old sound claret is tbe- best, and may be made into negus, or given by it- self, as circumstances may require. In a word, the great aim in this, disease is to support the patient's strength, by giving him frequently small quantities of the above, or other drinks of a worm and cordial nature. He is not, however to be overheated either with liquor or clothes; aud his food ought to be light, and given in small quantities. MEDICINE.—.When a nausea, load* and sickness of the stomach, prevail at the beginning of a fever, it wild be necessary to give tjie- patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few spoonsful of the vomiting julep,* will generally answer this purpose very well. This may be repeated any time before the thud or fourth day, if tlie above symptoms continue. Vomits not only clean the stomach, but by the general shock which they give, pro* mote the perspiration, and have many ether excellent effects in slow fevers, where there are no signs of inflammation, and natuse wanti rousing. Such as dare not venture upon a vomit may clean the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna. In all fevers, the ^reat point is to regulate the symptoms, so as to prevent them from going to either extreme. Trnit^ in fevei» of tbe inflammatory kind, where the force of the circulation is too great, or the. blood dense, and the fibres too rigid, bleeding aud other eva- cuations are necessary. But in nervous fevers, where nature wags, where the blood is vapid and poor, and tbe solids relaxed, the lancet must be spared, and wine, with other cordials, plentifully administered. It is the more necessary to caution people against Weeding in this disease, as. there is generally at the beginning an universal stricture upon the vessels, and sometimes an oppression and difficulty of breath- ing, which suggests the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feeliqgs in this respect, so far as to insist upon being bled, when it was evident from the consequences that the operation was improper. Though bleeding is generally improper in this disease, yet blistering is highly necessary. BJistering-plasters 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 safest course, when the insensibility continues, as soon as the discharge occasioned by uiic blisteriug-pUviter abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of daugor- I have been more sensible of the advantage of blistering in this, thau in any other disease. Blistering-plasters not only stimulate the • See Appendix, Vomiting Julep. 132 OF THE NERVOUS FEVER. solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacuations, which seldom happens in this kind of fever. They are most proper, however, either towards the beginning, or after some degree of stupor has come on, in which last case it will always be proper to blister the head. If the patient is costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoon- ful of common salt, if the above does not operate. Should a violent looseness come on, it may be checked by small quantities of Venice treacle, or giving the patient for his ordinary drink the white decoction.* A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature's operation in this particular. The eruption ought nei- ther to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen ; but the patient should be supported by gentle cor- dials, as wine-whey, small negus, sago-gruel, with a little wine in it, and such like. He ought not to be kept too warm; yet a kindly breathing sweat should by no means be checked. Though blistering and the use of cordial liquors are the chief things lo be depended on in this kind of fever ; yet for those who may chnse to use them, wc shall mention one or two of the forms of medicine which are commonly prescribed in it.t In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary effects from doses of musk frequently repeated. Musk is doubtless an antispas- modic, and may be given to the quantity of a scruple three or tour times a day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphire, and salt of hartshorn, as these tend to promote perspiration and the discharge of uriue. Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above. If the fever should happen to intermit, which it frequently does to- wards the decline, or if the patient's strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Haifa drachm, or a whole drachm, if the stomach will bear it, of the bark in fine powder, may be given four or five times a-day iua glass of red port or claret. Sliould the bark in substance not sit easy on the stomach, an ounce of it in powder may be infused in a bottle of Lisbon or Rhenish Wine for two or three days, afterwards it may be strained, and a glass of it taken frequently.': * See Appendix, WlAte decoction. t When the patient is low, ten grains of Virginian snake-root, and tbe same quanti- ty of contrayerva-root, with five grains of Russian castor, all in fine powder, may be made into a bolus with a little of tbe cordial confection of syrup or saffron. Oat of these may be taken every four or five hours. The following powder may he used with the same intention : Take wild Velerian root in powder one scruple, saffron and castor each four grains. Mix these by rubbing tbem together in a mortar, and give one in a cup of wine-whey, three or four times • day- .. . . I The bark may likewise be very properly administered, along with other cordials,in the following manner: Take an ounce ot Peruvian bark, orange-peel half an ounce, Virtpnian snake-root two drachms, saffron one drachm. Let all of them be powderedi and iafused in a pint of die best brandy for three or four days. Afterwards the liquor may be strained, and two tta-spoonsful of it given three or four times a-day in a glasi d small wise or negus. OF PUTRID OR SPOTTED FEVER. 1$3 Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observation may tend to establish this practice, w <> will not pretend to say ; bnt we have reason to believe that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers where bleeding is not necessary, or where there are no symptoms of topical inflamma- tion. CHAPTER XX. OF THE MALIGNANT, PUTRID OR SPOTTED FEVER. THIS may be called the pestilential fever of Europe, as in many of •ts symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been waisted by long fasting, watching, hard labour, excessive venery, frequent salivations, &c. are most liable to it. CAUSES.—This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly ventilated: from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hospitals, and infirmaries especially where such places, are too much crowded, and cleanliness is neglected. A close constitution of the air, with long rainy or foggy weather, like- wise occasions putrid fevers. They often succeed great inundations in low and marshy countries, especially when these are preceded or followed by a hot and sultry season. Living too much upon animal food, without a proper mixture of vecetables, or eating fish or flesh that has been kept too long, are like- wise apt to occasion this kind of fever. Hence sailors on long voyages, and the inhabitants of besieged cities, are very often visited with putrid fevers. ' Corn that has been greatly damaged by rainy seasons, or long keep- in?, and water which has become putrid by stagnation, &c. may like- wise occasion this fever. Dead carcases tainting the air, especially in hot seasons, arc very apt to occasion putrid diseases. Hence this kind of fever often prevails in countries which are the scenes of war and bloodshed. This shews the propriety of removing burying-grounds, slaughter-houses, &c. at a proper distance from great towns. Want of cleanlines is a very general cause of putrid fevers. Hence they prevail amongst the poor inhabitants of large towns, who breathe a confined unwholesome air, and neglect cleanliness. Such mechanics a^ carry on dirty employments, and are constantly confined within doors, are likewise very liable to this disease. We shall only add, that putrid, malignant, or spotted fevers, are highly infectious, and are therefore often communicated by conta- gion. For which reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance is absolutely necessary. SYMPTOMS.—The malignant fever is generally preceded by a re- markable weakness or loss of strength, without any apparent cause. This is sometimes so great, that the patient can scarce walk, or even sit upright, without being in danger of fainting away. His mind too is generally dejected; he sighs, and is full of dreadful apprehensions. There is a nausea, and sometimes a vomiting of bile; a violent pain 134 PUTRID OR SPOTTED FEVER. of the head, with a strong pulsation or throbbing of the temporal arte- ries ; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh; complaints of a pain about the re- gion of the stomach, and in the back and loins; the tongue u> at first white, but afterwards it appears black and chaped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and downwards, is affected with tremors or shaking, and often becomes delirious. If blood is let, it appears dissolved, or with a very small degree of cohesion, and soon becomes putrid; the stools smell extremely faeted, and are sometimes of a greeisb, black, or reddish cast. Spots of a pale purple, dun, or black colour, often appear upon the skin, and some- times there are violent haemrorhages or discharges of blood from tlie mouth, eyes, nose, &c. Putrid fevers may be distinguished from the inflammatory by the smallness of the pulse, the great dejection of mind, the dissolved sta.tc of the blood, the petechias, or purple spots, and the putrid smell of the excrements. They may likewise be distinguished from the low or nervous fever, by the heat and thirst being greater, the urine of a high- cr colour, and the loss of strength, dejection of mind, and all the other symptoms more violent. It sometimes happens, however, that the inflammatory, nervous, and putrid symptoms are so blended together, as to render it very difficult to determine to which class the fever belongs. In this case the great- est caution and skill are requisite. Attention must be paid to those symptoms which are most prevalent, and both the regimen and medi- cines adapted to them. Inflammatory and nervous fevers maybe converted into malignant and putrid; by too hot a regimen or improper medicines. The duration of putrid fevers is extremely uncertain; sometimes they terminate between the seventh and fourteenth day, and at other times they are prolonged for five or six weeks. Their duration de- pends greatly upon the constitution of the patient, and the manner of treating the disease. The most favourable symptoms are, a gentle looseness after the fourth or fifth day, with a warm mild sweat. These, when continned for a considerable time, often carry off the fever, and should never be imprudently stopped. Small miliary pustules appearing between the petechia or purple spots, are likewise favourable, as also hot scab- by eruptions about the mouth and nose. It is a good sign when the pulse rises upon the use of wine, or other cordials, and the nervous symptoms abate; deafness coming on towards the decline of the fever, is likewise often a favourable symptom,* as are abscesses in the groin or parotid glands. Among the unfavourable symptoms may be reckoned an excessive looseness, with a hard swelled belly; large black or livid blotches ' breaking out iipon the skin ; aphthx in the mouth; cold clammy sweats; blindness; change of the voice ; a wild starting of the eyes; difficulty of swallowing; inability to put out the tongue; and a constant incli- nation to uncover tbe breast. When the sweat and saliva are tinged with blood, and the urine is black, or deposits a black sooty sediment, the patient is in great danger. Starting of the tendons, and foetid, * Deafness is not always a favourable symptom in this difeaie. Perhaps it U OtOj » when occasioned by abscesses formed within the ears. PUTRID OR SPOTTED FEVER. 13i ichorous, involuntary stools, attended with coldness of the extremities, are generally the forerunners of death. REGIMEN.—In the treatment of this disease we ought to endea- vour as far as possible to counteract the putrid tendency of the htl- mours; to support the patient's strength and spirits ; and to assist na- ture in expelling the cause of this disease, hy gently promoting perspi- ration and the otiier evacuations. It has been observed, that pntrid fevers are often occasioned by unwholesome air, and of course they must be aggravated by it. Care sliould therefore be taken to prevent the air from stagnating in the pa- tient's chamber, to keep it cool, and renew it frequently, by opening the doors or windows of some adjacent apartment. The breath and perspiration of persons in perfect health soon render the air of a small apartment noxious; but this will sooner happen from the perspiration and breath of a person whose whole mass of humours arc in a putrid htate. Besides the frequent admission of fresh air, we would recommend the use of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be most readily obtained. These ought frequently to be sprinkled on the floor, the bed, and every part of the room. They may also be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons or oranges ought likewise to .be laid in different parts of the room, and they should be frequently held to tbe patient's nose. The use of acids in this manner would not oidy prove very refreshing to the patient, but would likewise tend to prevent the infection from spreading among those who attend him. Strong scented herbs, as rue, tansy, rosemary, wormwood, Ac. may likewise be laid in different parts of the bouse, and smelled to by those who go near the patient. The patient must not only be kept cool, but likewise quiet and easy. The least noise will affect his head, and the smallest fatigue will be apt to make him faint. Few tilings are of greater importance in this disease than acids, which ought to be mixed with all the patient's food as well as drink. Orange, lemon, or vinegar-whey, are all very proper, and may be drank by turns, according to the patient's inclination. They may be rendered cordial by the addition of wine in such quantity as the pa- tient's strength seems to require. When he is very low, he may drink negus, with only one half water,and sharpened with the juice of orange or lemon. In some cases a glass of wine may now and then be allowed. The most proper wine i~ Rhenish, or Madeira; but if the body be open, red port or claret is to be preferred. When the body is bound, a tea-spoonful of the cream of tartar may be put into a cup of the patient's drink, as there is occasion ; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool. If camomile-tea will sit upon his stomach, it is a very proper drink in this disease. It may be sharpened by adding to every cup of the tea ten or fifteen drops of the elixir of vitriol. The food must be light, as panado, or groat-gruel, to which a little wine may be added, if the patient be weak and low ; and they ought all o be sharpened with the juice of orange, the jelly of currants, or the like. The patient ought likewise to eat freely of ripe fruits as roast- ed apples, currant or gooseberry tart*, preserved cherries, or plums, Ac. 136 PUTRID OR SPOTTED FEVER. Taking a little food or drink frequently, not only supports the spirit^ but counteracts the putrid tendency of the humour*; for which rea- son the patient ought frequently to be sipping small quantities of some of the acid liquors mentioned above, oe any that may be more agreea- ble to his palate, or more readily obtained. If he is delirious, his feet and hands ought to be frequently fomented with a strong infusion of camomile flowers. This or an infusion of the bark; to such as can afford it, cannot fail to have a good effect. Fo- mentations of this kind uot only relieve the head, by relaxing the ves- sel in the extremities, but as tlieir contents are absorbed, aud taken into the system, they may assist in preventing the putresceney of the humours. MEDICINE.—If a vomit be given at the beginning of this fever, it will hardly fail to have a good effect; but if the fever has gone on fo* some days, aud the symptoms are violent, vomits are not quite so safe. The body, however, is always to be kept gently open by clysters, ox mild laxative medicines. Bleeding is seldom necessary in putrid fevers. If there be signs of an inflammation, it may sometimes to be permitted at the first ouset; but the repetition of it generally proves hurtful. Blistering-plasters are never to be used unless in the greatest extre- mities. If the petechia; or spots should suddenly disappear, tlie pa- tient's pulse sink remarkably, and a delirium, with other bad symptoms, come on, blistering may be permitted. Iu this case the blistering-plat- ters are to be applied to tlie head, and inside of the legs or thighs. But as they are sometimes apt to occasion a gangrene, we would rattier recommend warm cataplasms or poultices of mustard and vinegar to be applied to the feet, having recourse to blisters only in the utmost extremities. It is common in the beginning of this fever to give the emetic tar- tar in small doses, repeated every second or third hour, till it shall either vomit, purge, or throw the patient into a sweat. This prac- tice is very proper, provided it be not pushed so far as to weaken the patient. A very rcdiculous notion has long prevailed of expelling the poison- ous matter of malignant diseases by trifling doses of cordial or alexi- pharmic medicines. In consequence of this notion, tlie contrayerva- root, the cordial confection, the inithridate, &c. have been extolled as infallible remedies. There is reason, however, to believe, that these seldom do much good. Where cordials are necessary, wc know none that is superior to good wine ; and therefore again recommend it both as the safest at: I the best. Wine, with acids and antiseptics, arc the on- ly things to be relied on in the cure of malignant fevers. In the most dangerous species of this disease, when it is attended with purple, livid, or black spots, the Peruvian bark must be' adminis- tered. I have seen it, when joined with acids, prove successful even in cases where the petechias had die most threatening aspect. But to an- swer this purpose it must not only be given in large doses, but duly per- sisted in. The best method of administering the bark is certainly in substance. An ounce of it in powder may be mixed with half a pint of water, and the same quantity of red wine, aud sharpened with the elixir Or the spirit of vitriol, which will both make it sit easu ;• on the stomach, and tender it more beneficial. Two or three ounces of the syrup of lemon may be added, and r--.'o table spoonsful of the mixture taken every two PUTRID OR SPOTTED FEVER. IS, hours, or oftener, if the stomach is able to bear it. Those who cannot take the bark in substance may infuse it in wine, as recommended in the preceding disease. If there be a violent looseness, the bark must be boiled in red wine with a little cinnamon, and sharpened with the elixir of vitriol, as above. Nothing can be more beneficial in this kind of looseness than plenty of acids, and such things as promote a gentle perspiration. If the patient be troubled with vomiting, a dram of the salt of worm- wood, dissolved in an ouncaand a half of fresh lemon juice, and made into a draught with an ounce of simple cinnamon-water, and a bit of su- gar may be given and repeated as often as it is necessary. If swellings of the glands appear, their suppuration is to be promoted by the application of poultices, ripening cataplasms, &c. And as soon as there is any appearance of matter in them, they ought to be laid open and the poultices continued. I have known large ulcerous sores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a most putrid cadaverous smell. These gradually healed, and the patient recovered by the plentiful use of Peruvian bark and wine, sharpened with the spirits of vitriol. For preventing putrid fevers we would recommend a strict regard to cleanliness; a dry situation ; sufficient exercise in the open air; whole- some food, and a moderate use of generous liquors. Infection ought above all things to be avoided. No constitution is proof agaiust it. I have known persons seized with a putrid fever, by only making a single visit to a patient in it; others have caught it by lodging for one night in a to wu where it prevailed; and some bv attending the funeral of such as died of it.* When a putrid fever seizes any person in a family, the greatest atten- tion is necessary to prevent the disease from spreading. The sick ought to be placed in a large apartment, as remote from the rest of the fami- y as possible; he ought likewise to be kept extremely clean, and should L? YLltsh air f r<,<.uent,y,et into «« chamber; whatever comes from bin. •should be immediately removed, his linen should be frequently changed and those in health ought to avoid all unnecessary communication with Any one who is apprehensive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile-tea. This may be repeated in a day or two, if the appre- hensions still continue, or any unfavourable symptoms appear. The person ought likewise to take an infusion of the bark and camo- mile flowers for his ordinary drink ; and before he goes to bed, he may drink a pint of pretty strong negus, or a few glasses of generous wine. i have been frequently obliged to follow this course when malignant levers prevailed, and have likewise recommended it to others with con- stant success. People generally fly to bleeding and purging as antidotes against in- • The late Sir John Pringle expressed a concern lest these cautions should prevent people trom attending their friends or relations when afflicted with putrid fevers r - told hmi I meant only to discourage unnecessary attendance, and mentioned a number of instances where were putrid fevers had proved fetal to persons, who were rather huVt- ,M than ben. Ucial to the «,ck. This sagacious physician agreed with me, in thinkm* that a good doctor and a careful nurse were the only necessafy attendants; and that a»l eMifatntth k!?an5erwl *•*"***»>but generally, by their solicitude atd i!!-direCi«l M2 13S OF THE MILIARY FEVER. lection ; but these are so far from securing them, that they often, by debilitating the body, increase the danger. Those who wait upon the sick in putrid fevers, ought always to have a piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to smell to while near the patient. They ought likewise to wash their bunds, and, if possible, to change tlieir clothes, before they go into com- pany. CHAPTER XXI. OF THE MILIARY FEVER. 1 HIS fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either ted or white, and sometimes both are mixed together. The whole body is sometimes covered with pustules; but they arc generally more numerous where tbe sweat is most abundant, as ou the breast the back, &c. A gentle sweat, or moisture on the skin, great- ly promotes the eruption ; but when the skin is dry, tlie eruption is both more painful and dangerous. Sometimes this is a primary disease ; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of two hot a regimen or medicines. The miliary fever chiefly attacks tbe idle and phlegmatic, or per- sons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is also more incident to women than men, especially the delicate and the indolent, who, neglect- ing exercise, keep continually within doors, and live upon weak and watery diet. Such females are extremely liable to be seized with this disease in child-bed, and often lose their lives by it. CAUSES.—The miliary fever is sometimes occasioned by violent passions or affections of the mind; an excessive grief, anxiety, thought- fulness? &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too fre- quently of cold, crude, unripe fruits, as plums, cherries, cucumbers, melous, &c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stoppage of any enstomany eva- cuation, as issues, setons, ulcers, tbe bleeding piles iu men, or the mens- trual flux in women, &c. This disease in child-bed women is sometimes the effect of great costiveness during pregnancy; it may likewise be occasioned by (heir excessive use of green trash, and other unwholesome things, in which pregnant women are too apt to indulge. But its most general cause is indolence. Such women as lead a sedentary life, especially during pregnancy, and at the same time live grossly, can hardly escape this disease in child-bed. Hence it proves extremely fatal to women of fashion, and likewise to those women in manufacturing towns, who, in order to assist their husbands, sit close within doors for almost tbe whole of their time. But among women who are active and laborious, who live in the country, and take sufficient exercise without doors, this disease is very little known. SYMPTOMS.—When this is a primary disease, it makes its at* 1Rck, like most other eruptive fevers, with a slight shivering, which OF THE MILIARY FEVER. is succeeded by heat, loss of strength, faiutishness, sighing, a low quick, pulse, difficulty of breathing, with great anxiety and oppression of the breast. The patient is restless, and sometimes delirious; the tongue appears white, and the hands shake, with often a burning heat in the palms ; and in child-bed women the milk generally goes away, and the other discharges stop. The patient feels an itching or pricking pain under the skin, after which innumerable small pustules of a red or white colour begin to ap- pear. Upon this the symptoms generally abate, the pulse becomes more full and soft, the skin grows moister, and the sweat, as the dis- ease advances, begins to have a peculiar foetid smell; the great load on the breast, and oppression of the spirits, generally go off, and the customary evacuations gradually return. About the sixth or seventh day from the eruption, tne pustules begin to dry, and fall off, which occasions a very disagreeable itching in the skin. It is impossible to ascertain the exact time when the pustules will either appear or go off. They generally come out ou the third or or fourth day, when the eruption is critical; but, when symptomatica], they may appear at any time of the disease. Sometimes the pustules appear and vanish by turns. When that is the case, there is always danger ; but when they go in all of a sudden, aud do not appear again, the danger is very great. In child-bed woman the pustules are commonly at first filled with clear water, afterwards they grow yellowish Sometimes they are in- terspersed with pustules of red colour. When these only appear the diseases noes by the name of a rash. REGIMEN.—In all eruptive fevers of whatever kind, the chief point is to prevent the sudden disappearing of the pustules, and to promote their maturation. For this purpose the patient must be kept in such temperature, as neither to push out the eruption too fast, nor to cause it to retreat prematurely. The diet and drink ought there- fore to be in a moderate degree nourishing and cordial; but neither strong nor heating. The patient's chamber ought neither to be kept too hot nor too cold : and he should not be too much covered with clothes. Above all, tlie mind is to be kept easy and cheerful. Nothing so cer- tainly makes an eruption go in as fear. - The food must be weak chicken broth with bread, panado, sago, or groat-gruel, Sec. to a gill of which may be added a spoonful or two of wine, as the patient's strength requires, with a few grains of salt and a little sugar. Good apples roasted or boiled, with other ripe fruits of an opening cooling nature may be eaten. The drink may be suited to the state of the patient's strength and spirits. If these be pretty high, the drink ought to be weak; as wa- ter-gruel, balm-tea, or the decoction mentioned below.* When the patient's spirits are low, and the eruption dees not rise sufficiently, his drink must be a little more generous ; as wine-whey, or small negus, sharpened with the juice of orange or lemon and made stronger or weaker as circumstances may require, Sometimes the miliary fever approaches toward a putrid nature, in which case the patient's strength must be supported with generous cordials, joined with acids; and, if the degree of putrescence be great, * Take two ounces of tbe shavings of hartshorn, and the same quantity of sarsapa- tilla, bail them in two English quarts of water. To the strained decoction add » little white sugar, and lot the patient take it for bis ordinary drink. 140 OF THE MILIARY FEVER. the Peruvian bark, must be administered. If the head be much af- fected, the body must be kept optn by emolient clysters.* MEDICINE.—If the food and drink bepropeily regulated, there will be 11 tie occasion for medicine in this disease. Should the erup- tion however not rise, or the spirits flag, it will not only be necessary to support the patient with cordials, but likewise to apply blistering plasters. The most proper cordial, in this case, is good wine, which may either be taken in the patient's food or drink ; and if there be sigi.s of putrescence, the bark and acids may be mixed with wine, as directed in the putrid fever. Some recommend blistering through the whole course of this dis- ease; and where Nature flags, and the eruption comes and goes, it may be necessary to keep up a stimulus, by a continual succession of small blistering plasters , but we would not recommend above one at a time. If however the pulse should sink remarkably, the pustules fall •in, and the head be affected, it will be necessary to apply several blis- tering plasters to the most sensible parts, as the inside of the legs-and thighs, &c. Bleeding is seldom necessary in this disease, and sometimes it does much hurt, as it weakens the patient, and depresses his spirits. It is therefore never to be attempted unless by tbe advice of a physician. "We mention this, because it has been customary to treat this disease in child-bed women, by plentiful bleeding, aud other evacuations, as if it were highly inflammatory. But this practice is generally very unsafe. Patients in this situation bear evacuations very ill. And in- deed the disease seems to be more of a putrid than of an inflammatory nature. , Though this fever is often occasioned in child-bed women by too hot a regimen, yet it would be dangerous to leave that off all of a sudden, and have recourse to a very cool regimen, and large evacuations. We have reason to believe, that supporting the patient's spirits, and pro- moting the natural evacuations, is here much safer than to have recourse to artificial ones, as these, by sinking the spirits, seldom fail to increase the danger. If the disease proves tedious, or the recovery slow, we would recom- mend the Peruvian bark, which may cither be taken in substance or infused in wine or water, as the patient inclines. ■ The miliary fever, like other eruptive diseases, requires gentle purg- ing, wliich sliould not be neglected, as soon as the fever is gone oft, and the patient's strength wdl permit. To preventthis disease, a pure dry air, sufficient exercise, and whole- •In the Commereium Literarium for tbe year 1735. we have the history of an epidemie- Tttl miliary fever, which raged at Strasburg in the months of November, December, and January ; front which we learn the necessity of a temperate regimen in this mala- jriy, and likewise that physicians are not always the first who discover the proper treat- ment of diseases, " This fever made terrible bavock even among men of robust con- stitutions, and all medicine proved in vain. They were seized in an instant with shiv- ering, yawning, stretching, and pains in tbe baek, succeeded by a most intense heat; at the same time there was a great loss of strength and appi tite. On the seventh or ninth day the miliary eruptions appeared, or spots like IKa-bites, with great anxiety, a delirium, restlessness and tossing in bed. Hleeding was fatal. While matters were in this unhappy situation, a midwife, of her own accord, gave to a patient, in the height of UV disease, a clyster of rain-watt r and butter without salt, and for his oidinary 'drinka quart of spring water, halfa pint of generous wine, the juice of a lemon, and nix ounces of the vhite.it sugar, gently hoiled til) a scum arose, and this with meat success; for the belly was soon loosened, the grievous symptoms vanished, aid the pa- tient was restored to his senses and snatchtdffrom the jaws of death. This practice nas imitated by others with the like happy effect. OF THE REMITTING FEVER. 141 some food, are necessary. Pregnant women should guard against cos- tiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things; and when in child-bed, they ought 6trictly to observe a cool regimen. CHAPTER XXtl. OF THE REMITTING FEVER. THIS fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometinies later, but generally before the eighth day. The remission is commonly preceded by a gentle sweat after which the patieut seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometinies of longer, sometimes of shorter duration; the nearer however that tbe fever approaches to a regular intermittent the danger is the less. CAUSES.—Remitting fevers prevail in low marshy countries, a- bounding with wood and stagnating waters; but they prove most fatal in places where great beat and moistcr are combined, as in some parts of Africa, the province ef Bengal in the East-Indies, &c. where remit- ting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy season?, great inundations, or the like. No age, sex, or constitution is exempt- ed from the attack of this fever; but it chiefly seizes persons of a re- laxed habit, who live in low dirty habitations, breathe an impure stag- nating air, take little exercise, and use unwholesome diet. SYMPTOMS.—The first symptoms of this fever are generally yawn- ing, stretching, pain, and giddiness in the head, with alternate fits of heat and cold. Sometimes the patieut is affected with a delirium at the first attack. There is a pain, and sometimes a swelling, about tlie regiomof the stomach, the tongue is white, the eyes and skin frequent- ly appeal yellow, and the patient is often afflicted with bilious vomit- ings. The pulse is sometimes a little hard, but seldom full, and the blood, when let, rarely shews any signs of inflammation. Some pa- tients are exceedingly costive, and others are afflicted with a very troublesome looseness. It is impossible to describe all the symptoms of this disease as they vary according to the situation, the season of the year and the consti- tution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances too tedious to mention. Sometime,- the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession ofeach of these, or even a complication of them at the same time, in the same person. REGIMEN.—The regimen must be adapted to the prevailing symp- toms. When there are any signs of inflammation, the diet must be slender, and tbe drink weak and diluting. But when any nervous or putrid symptoms prevail, it will be necessary to support the patient with food and liquors of a more generous nature such as are recom- mended in the immediately preceding fevers. We must however he very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regimen, and improper medicines. Whatever the symptoms are, the patientonght to be keep cool, qniet, and clean. His apartment, if possible, should be large and frequently H2 OP THE YELLOW FEVER* ventilated by letting in fresh air at the doors and windows. Is oorlrt likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes, &c. should be frequently changed, and all his ex- crements immediately removed. Though these things have been re- commended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to im- agine.* MEDICINE.—In order to cure this fever, we must endeavour to bring it to a regular intermission This intention may be promoted by bleeding, if there be any signs of inflammation ; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. A vomit however will seldom be improper, and is generally of great service. Twenty or thir- ty grains of ipecacuanha will answer this purpose very well; hut, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice. at proper intervals, if the sickness or nausea continues. The body ought to be kept open either by clysters or gentle laxa- tives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like; but all strong or drastic purgatives are to be carefully avoided. By this course the fever iu a few days may generally be brought to a pretty regular or distinct intermission, in which case the Peruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them. Tlie most likely way to avoid this fever is to use a wholesome and nourishing diet, to pay the most scrupulous attention to cleanliness, to keep the body warm, to take sufficient exercise, and in hot countries to .avoid damp situations, night air, evening dews, aud the like. In coun- tries where it is endemical, the best preventative medicine which we can recommend is the best Peruvian bark, which may either be chew- ed, or infused in brandy or wine, &c. Some recommend smoking to- bacco as very beneficial in marshy countries both for the prevention of this and intermitting fevers. CHlPTER XXIII.§ OF THE YELLOW FEVER. To enter into a minute investigation of the dispntcd Origin of this disease, (and whether it be imported and contagious, or Domestic and Epidemic,) under existing circumstances, would be to assume 8 province, unwarrantable as it regards the present work. * The ingenious Dr. Lind, of Windsor, in his inaugural dissertation concerning the putrid remitting fever of Bengal, has the following observation: "liidusia,lodicts, ac straguta. saepius sunt mutanda, ac aeri exptnenda; la-ces sordtsque quain primum removeiida: oporiet etiam ut loca quibus tegri decumbent sint salubria et ncetocon- spersa; denique ut aigris cura quanta maxima prospieiatur. Conpertum ego babeo, medic urn ha;c scdulo observantem, quique ea exequi potest mullo nibgis segris profa- turum, quain intdicum peritioreni hisse commodis,destitutum." " l'he patient's shirt, bed-clothe* and bedding, ought fn quently to be changed and exposed to tlie air, and all his excrements immediately be removed ; the bed-chamber should be well ventilated, and frequently sprinkled with venegar, in short, every at- tention should be paid to the patient. I can affirm, that a physician who pats the*: in practice will much ofteuer succeed than one who is even mqre skilful, hut has nut opportunity of using these means. OF THE YELLOW FEVER. 145 So early as the year 1699, we learn the existence of Yellow Fever in Charleston. At that,and for some time subsequent it was considered an infectious distemper, and in 1748, Dr. Lining pronounced it an imported disease and contagious.—The most learned of the Faculty agree," That as most all fivers are generally Epidemic, it is probable that some mat- ter floating in tbe atmosphere, and applied to the bodies of men,onght to be considered as the remote cause of fevers : And these matters pre- sent in the atmosphere, and thus acting upon men, may be considered either as contagions, (that Is, effluvia arising directly or originally from the body of a man under a particular disease, and exciting the same kind of disease in the body to whom they are applied,) or mias- mata, that is effluvia arising from other substances than tbe bodies of men, producing a disease in the person to whom they are applied."-— Hence we may infer, that this lat'er term embraces what is meant by Epidemic when applied to divers places, or Endemic when we speak of any onep'ace. It is however evident, that the terms Epidemic and Contagious are so connected, as not to be capable of an entire disjunction : The efflu- via arising from other substances than the body of man, contaminating the air, and producing disease in persons predisposed,—what is the consequence? By the accumulation of disease, a combination of Causes proceeding from miasmata, combined with the effluvia arising from the bodies of the diseased—or in other words, Animal and Vegetable effluvia uniting—must of necessity produce a species of contagion or at least a variety. Dr. Cullen admits the probability of a variety in contagions. Yet observes, that though they have now been observed and distinguished for many ages, and in many different parts of the world, they have been always found to retain the same general character, and to differ only in circumstances, that may be imputed to season, climate, and other external causes, or to the peculiar constitutions of the several persons effected. He rather inclines to admit the probability, that in each of these species the contagion is of one Specific nature, which we apprehend consists in the union of the two effluvias already mentioned. Hence, whenever it can be proved, that any disease has been commu- nicated from a combination of these, we may pronounce it contagion j, and vice versa. Then with respect to the Contagious or Non-Contagions nature of tbe Yellow Fever, as it occurred in Charleston, we need only demand, has it in any known instance been communicated from one person to anoth- er? The learned and experienced Dr. Ramsay of Charleston, in a letter to Dr. Miller of New-York, says " There is but one opinion among tbe Physicians aud inhabitants, and that is, that the disease was neither Imported, nor Contagious. This was the unanimous sentiment of the Medical Society, who in pursuance of it, gave their opinion to the government last summer" (i.e. the summer of 1800) " that the rigid en- forcement of the quarantine laws was by no means necessary on account of the Yellow Fever." The doctor concludes by observing " my pri- vate opinion is, that our Yellow Fever is a local disease originating in the air of Charleston." Correspondent to this is the opinion of Dr. Tucker Harris, communicated te Dr. Currie: " with respect to the contagious nature of Yellow Fever, so far as it has occurred in this city, there is no instance, which can be cited to induce the smallest suspicion thereof. It appears, that not only Europeans aud strangers from differ. ettjetiitc?, who visit oar city, take the disease and die, without cocinro- 144 OF THE YELLOW FEVER. njcatingit to the physicians, nurses, or attendants, but that people from the country, strangers to our atmosphere, on coming to town, often sicken on their way home, and die in houses on the road ; yet in no one instance, hath the disorder been transferred to any of the individuals of the family who received them in. This in my opinion, is an undeniable and convincing proof of the non-enntmgious nature of Yellow Fever. Indeed I strongly doubt whether any disease, originating from vegeta- ble or marsh miasma, can be contagious, for as yet it has never been demonstrated : while, on the other hand I am inclined to believe, that animal, perhaps it would be more correct to say Human effluvia, under certain modifications, prove the source of all such diseases as are of a contagious kind . and the operation of this contagion is not, as happens in the case of Yellow Fever, confined to the autumnal months, but will exist at any season. This may perhaps, serve in some measure, to dis- criminate between Epidemic and contagious disorders.'Wc. These facts corroborated by such high and undoubted testimonies, will esiabhsh what I have already advanced with regard to the locality of this disease, and proceed to give the Definition.—The Yellow Fever derives its appellation from the yellow Suffusion, which commonly appears in the eyes and on the skin, how- ever, as this appearance is not universal and frequently happening in many other cases, the term may not be strictly proper. It was during the Revolution, termed Camp-Ftver. It appears to be a fever of tlie Typhus kind, and by Dr. Cullen is very properly called Typhus ictero- des. The term Yellow Fever is most generally applied to it, and as such we presume it will continue to be handed down to the latest posterity. C VTJSE.—Authors appear to be divided as to the cause of Yellow Fever, which may be collected from what has been already said. It is however beiicved that a particular idiosyncrasy, i- e. constitution or de- rangement of the atmosphere, probably effected by the strong light and intense heat of the sun, depriving that portion nearest the earth of its proper quantity of vital air, leaving the Mephitic or heavier part near to the surface of the earth, forms one not among the least of causes. The loss of a small portion of.vitul air renders this lower stratum very imfit for respiration, consequently very unwholesome; when this circum- stance takes place, and the atmosphere seems vitiated slowly ai£ by degrees, tlie effect of Yellow Fever or indeed any other, is not so con- siderable, in proportion to tiie suddenness and degree of this idiosyncra- sy and vitiated state of the atmosphere so is tbe violence of its appear- ance. Marsh miasma, as has been already observed is productive of Epidemics, and none deny that contagious disorders are produced by tbe exhalations from putrifying animal and vegetable substances. It may also be remarked, that most climates experience an unhealthy and pestilential atmosphere, soon or immediately after the exhalations from the putrifying collections of vegetable and animal matter begin to rise, which diffusing themselves in the air, bring on diseases of different for- ces of malignity according to the contaminated state of the atmosphere, in conjunction with other predisposing circumstances, and that these exhalations are principally produced by heat combined with some pecu- liar state of the atmosphere, is an opinion backed by good authority. Dr. Harris, whose opinion I have before taken the liberty to introduce, observes, afer having objected to the generally assigned" causes," I am iiowever decidedly of opinion, that heat combining with some unknown modification of the atmosphere of onr city, has, in ten out of the last thirteen years, given existence to this dreadful disease." OF THE YELLOW FEVER. 14J SYMPTOMS.—There is little or no difference among authors of the p^e^ent day with regard to these, I have consulted eight or ten of the greatest celebrity, and observe an almost unique of opinion—Be- fore the fever forms itself, the most usual sign of its approach is a sud- den and universal pain of the head generally above one or both eyes, wh:ch in some remit with short intervals, causine a giddiness or vertigo, rather than sharp pain, attended with an nnusnal feebleness and languor of the body. Dr. Rush states among other premonitory symptoms, a sudden drying up, or breaking out of an old sore, fresh eruptions in different parts of tlie body ; a cessation of a chronic disease or a con- version ofa periodical into a continual disease—a peculiar saltowness of the complexion—a head-ach, a decay or increase of appetite, costive- ness ; a diminished or increased secretion of urine, a hot and offensive breath, constant sweats, and sometimes of afoetid nature, or a dry skin ; wakefulness, or a disposition to early or protracted sleep, a preternatur- ally frequent pulse; unusual vivacity, or depression ot spirits, fatigue or sweats from light exertions ; the hands when rubbed, emitting a smell like hepar (li\ er) of sulphur, and lastly a sense of burning in the mouth. The fever is commonly ushered in with alternate slight chills and heats, nausea, pains of the head, back, loins, and at the pit of the stomach. These syinp'.oms are often followed, in less than 24 hours with violent retchings and vomiting ofa green or yellow bile, the smell of wineh is very offensive. The learned Dr. Mitchill very ingeniously arranges the pathognomic, (peculiar or always attendant) symptoms of this disease into the six fol- lowing particulars. I. A very jjreat and sudden debility without any manifest cause. 2. A feverish anxiety, generally very grievous. 3. A Bhort quick and difficult orthopnaic respiration, (i. e. the patient cannot draw his breath with ease unless in an upright postnre) after the fever is formed. 4. A contracted deep pulse ; the artery feels tense, but the pulse is compressible, to which succeeds a depressed, or soft and low pulse, after the state of the disease, or after the yellow effusion appears. 5. -V pain of the scorbicnlus cordis, (pit of the stomach) eithermuch com- plained of or to be felt on squeezing that part; and more or less severe according to the severity of the disease. 6. A yellowness in the eyes, or all over the body at the height of the disease ; unless prevented by colliquative or critical discharges, to which may be. added, a violent and unusual kind of pain of the head, unless it isdrowned as it were in the more grievous complaint about the pracordiu, (the vitals or particular- ly the heart.) The three latter are symptoms most peculiar to this fe- ver. At other times the patient is attacked with very great anxiety, sickness aud pain of the stomach, attended with an excessive convul- sive vomiting, which no medicine seems likely to relieve.—After the first day the surface of the body is generally either cold, or dry and parched, the head-ach and stupor often ending in a delirium which proves suddenly fatal in many cases. It is to be observed that ihe vomi- ting sometimes occurs as early as the first or second day, but more commonly on the third, when it brings on bicknp, inflammation of the stomach and viscera, with a large discharge by vomit of a black atra- bilious matter, (anciently denominated black choler) like coffee grounds, mixed with a bloody lymph, or coagulated blood. The atrabilious hu- mour is often highly acrid; sometimes vi>cid, in which la'ter case it is difficultly tjec'ed, and hence by its great acrimony it renders this symptom violent and often fatal. We have been thus prolix in describing the symptoms, because tve 1*4 OF THE YELLOW FEVER. think much depends thereon, and indeed much more might be said did we not presume, a due attention to these, would discover to any careful observer the premonitory as well as concomitant advances thereof— with regard to Prognostics, we decline advancing any observations, and proceed to the REGIMEN.—It may not be amiss to describe under this particular, what are considered as preventives of fever,—these are severally pointed out by that eminent physician, Dr. Rush. He advises first, where it is practicable, the flight of persons exposed to its attack, but where this is impracticable, safety sliould be sought for in such means as reduce the preternatural tone and fuiness induced in the blood ves- sels by the stimulus of the miasmata and the suppression of customary secretions. These are, 1. A diet accommodated to the greater or less exposure of the body to the action of the miasmata and to the greater or less degree of labour or exercise, which are taken. In cases of great exposure to an infected atmosphere, with but little exercise, the diet should be simple in its quality and small in its quantity Fresh meats and wines should be avoided. A little salted meat and Cayenne pep- per with vegetables, prevent an undue IangHor of the stomach, from tlie want of its usual cordial aliments. But where a great deal of exercise is taken, broths, a little wine or malt liquors may be used with the fruits and garden vegetables of the season with safety and advantage. The change from a full to a low diet should be made gradually. When made suddenly it predisposes to an attack of the disease. 2- Laxative medicines—3. A plentiful perspiration kept up by means of warm clothing and bed-clothes. The excretion which takes place by the pores is of the first necessity ; as is a particular attention to clean linen or flannel; and 4. Blood-letting. All these depleting remedies, whether used separately or together, induce such an artificial debility in the system, as disposes it to vibrate more readily under tlie impression of the miasmata. A second class of preventives, arc such as obviate tbe internal action of miasmata, by exciting a general or partial determination to the ex- ternal surface of the body. These are—1. The warm bath ; it serves file treble purposes of keeping the skin clean, the pores open, and of defending what are called the vital organs from disease, by inviting its remote cause to the external surface of the body. This cannot be too highly recommended. 2. The cold bath. 3. Washing the body morn- ing and evening with salt water. 4. Anointing the body with oil or fresh butter. 5. Issues, setons, and blisters. A third class of preventives are such as excite a general action, more powerful than that which the miasmata are disposed to create in tbe system, or an action ofa contrary nature. These are—1. Onions and garlick. The liberal use of these condiments in food hath exempted all those who used them in 1793, from yellow fever. 2. Calomel takea in such small doses as gently to affect the gums. Several other contro- verted or at least doubtful particulars are enumerated, which we pass over in order to point out the necessity of avoiding all its exciting cau- ses. These are—1. Heat and cold : While the former has excited the yellow fever in thousands, the latter has excited it in ten thousands. It is not iu middle latitudes only, that cold awakens this disease in the body. 2. Tlie early morning and evening air, even in warm weather. 3, Fatigue from amusements; such as fishing, gunning, dancing, and from unusual labour or exercise. 4. Intemperance iu eating and drinking. 6. Partaking of new aliments and drinks. 6. Violent cote- 0$ THE YELLOW FEVER. i±7 films or passions of the mind. 7. The entire cessation of moderate la- bour. 8. The cantinuance of hard labour. These are the principal means of preven tion which have been enumerated as necessary. The Regimen to be observed after an attack, consists in the following: The patient should abstain from animal food; the diet should consist of gru- el, panado, sago, chicken-broth, and other spoon-meats ; he should use cool diluting drinks, such as barley-water, toast and water, lemonade, apple-tea, tamarind-water, hop-tea, and also small quantities of ripe fruits, which tend to keep the bowels soluble. The chamber of the sick should be spacious and airy, and frequently ventilated through the day: vinegar, sprinkled on hot bricks, should be introduced into the apart- ment frequently, and impregnated with aromatic herbs repeatedly sprinkled over the floor, bed-clothes, &c. The passions of the mind ought also to be regularly attended to, and the excrements should not be suffered to remain a moment in the apartment. These circumstan- ces are of infinite importance, as well to the sick, as to those who frequent them. ' MKDICINE.—Here a particular necessity compels us to be minute in our observations.—This publication was originally, and is now in- tended, as an assistant and guide to Families, and to such as are out of the reach of Physicians. Happily for mankind, where this disease pre- vails, there are generally a sufficient number of eminent physicians. Need we observe the importance of an early application to an honest and skilful practitioner ?—Where however this highly prudent plan it- neglected, or impracticable, we would recommend the following mode of treatment. In this fever the first, indication is to subdue it by the most speedy means in our power. The second is to prevent the putres- cent state that follows so rapidly after the febrile stage, or to oppose its progress when begun, and at the same time to support the strength of the patient. The first intention is best accomplished by bleeding and purgatives; bleeding is best performed within the first twenty-four boors from an attack, or at most within thirty-six. Some practitioners have pointed out the exact quantity of blood to be drawn, but as an implicit attention to that rule may subject us to error, we decline the insertion. In general, when the use of the lancet is indicated, one or more bleedings may be admitted, with a view to alleviate the violent pains of the bead, eyes, &c. provided it be performed within the time prescribed. In order to moderate the violent determination to the head, the feet should be bathed in warm water, and an opening clyster administered immediately. As obstinate costiveness generally prevails, and the stomach is seldom long capable to retain the common purga- tives, we ought to improve the time to advantage. It may be here ob- served that if perspiration can be promoted soon after the attack, it may be a means to subdue the fever: with this view, if there be no in- clination to vomit, and the skin is dry and parched, the following may he administered to advantage, during the first twenty-four hours, fake an imomal powder, and calomel, of each one scruple, syrup enough to make a mass, of which eight pill.- may be made. Four of these may be taken immediately, aud two more repeated every second or third hour after, tiii they either procure a due discharge, or free perspiration Should however the first dose occasion a retching or vomiting, wc. should immediately desist and report to the other means hereafter raid dow u. If the prescription operates pentifully by sweat and stool, tlie patient will in ail probability-recover, as by this means the fever is of- ten prevented from forming itself. Should toe stomach not retain the 148 OF THE YELLOW FEVER. foregoing, forty grains of jalap and twenty of calomel, or twenty of calomel with the like quantity of Crabs-eyes or magnesia, may be rub- bed together, and divided into ten powders ; one of these may be given every two hours, in a little cold tea, or they may be formed into ten pills, oue of which to be taken at the same periods, and continued during the whole of the febrile stage, or nntii the gums are affected. When this fortunate circumstance takes place, the medicine must be suspended, and nourishment with a little wine given. 2. As bark in substance will rarely remain on the stomach, decoctions are to be pre- ferred, and as in this stage it is necessary to exert every effort to re- sist a tendency to putrefaction, four table-spoonsful of the decoction of bark may be given every two hours. If the stomach sliould reject it, or whether it does or not, we ought not to neglect repeated clysters of it, acidulated with vinegar or iime-juice, at least every two hours, nor would it be amiss to rub the body with vinegar or lime-juice, as often as practicable. Some have recommended olive or sweet oil for this purpose also. Sometimes the strained juice of wood-sorrel given internally and by way of clyster, has been attended with good effects in restraining the putrid tendency, and in one instance has been known to check the black vomit. Hops, being possessed of great antiseptic properties, an infusion of them may be taken in moderate draughts, at proper intervals. In case of vomiting, a blister applied totheepigas- tric region, particularly the pit of the stomach, is almost alone to be re- lied on. In this fever, an inflammation of the stomach and-viscera are almost always present, and the tendency to putrescence is so great, as to exclude the remedies usually applied in other cases attended with vomiting. Here it is essentially and absolutely necessary to avoid all heating medicine. Wherefore, if the gums are not already affected, frictions of strong mercurial ointment, particularly over the hypoc hon- driac and epigastric regions, may be used ; and if by this means the gums can be affected, a cure may be looked for. From what has been said, we may collect, that the general plan of treat- ment for this Hydra-disease, consists of such remedies, as tend to subdue the inflammatory diathesis already pointed out.—Bleeding warm ba- thing, and purgatives, appear to be the most approved, to which may be added blistering and the mercurial friction. Among the purgatives, calomel appears to claim the preference, and when timely and prudent- ly administered, seldom fails to prove successful. Hence we are again induced, earnestly to advise timely application to a Professional Cha- racter. We shall now conclude with some remarks on the treatment of convalescents. They should avoid every thing which may tend to bring on a relapse; among these may be reckoned a too early expo- sure to improper exercise, food, and drink. They should eat but little at a time, and that little should be easy of digestion. Their exercise should be gentle, and introduction to the air gradual; morning and niuht air should be avoided at all events. If wine had been used in the tever, it must be now used more sparingly. Bark in subRtance or decoction, should be continued in moderate doses, until the debilitated sys-i ■ Miv'.torated, the digestive faculty repaired and strengthened, sand tlie patient returns to his usual mode of living. OF THE SMALL-POX. 149 CHAPTER XXIV. OF THE SMALL POX. XHIS disease, which originally came from Arabia, is now become so giueral, that very few escape it at one time of life or another. It is a most contagious malady ; and has for many years proved the scourge of Europe. The small pox generally appears towards the spring. They are very frequent in summer, less so in autumn, and least of all in wiuter. Chil- dren are most liable to this disease ; and those whose food is unwhole- some, who want proper exercise, and abound with gross humours, run the greatest hazard from it. The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are like- wise other distinctions of the small-pox: as the crystalline, the bloody, cVC. CAUSES.—The small-pox is commonly caught by infection.—Since the disease was first brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpose ; so that now it has become in a manner constitutional. Children who have over-heated themselves by running, wrestling, (Sec. or adults after a debauch, are most apt to be seized with the smah-pox. . SYMPTOMS.—This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, seem listless and drowsy for a few days before the more violent symp- toms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, complain of weari- ness, and, upon taking exercise, are apt to sweat. These are succeeded by slight fits of cold and heat iu turns, which as the time of the erup- tion approaches, become more violent, and are accompanied with pains of the head and loins, vomiting7&c The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion-fits in very young children. About the third or fourth day from the time of sickening, the small- pox generally begin to appear ; sometimes indeed they appear sooner, but that is no favourable symptom. At first they very nearly resem^ bleflea-bites, and are soonest discovered on the face, arms, and breast. The most favourable symptoms are a slow eruption, and an abate- ment of the fever as soon as the pustules appear. In a mild distinct kiud of small-pox, pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules.which are distinct, with a florid red basis, and which fill with thick purulent matter, first cf a whi'.isb, and afterwards of a yellowish colour, are the best. A livid brown colour of the pustules is an unfavourable symptom ; as also when they are small and flat, with black specks in the middle! Pustules which contain a thin watery ichor are very bad. A great num- ber of pox on the face is always attended with danger. It is likewise a very bad sign when they run into one another. It is a most unfavourable symptom when petechia?, or purple, brown, fir black spots are interspersed among the pustules. These are signs of N 2 150 OF THE SMALL-POX. a putrid dissolution of the blood, and shew the danger to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an approaching delirium, or of convul- sion-fits. When the face does not swell, or falls before the pox come to matnrity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day,and at the same time the hands and feet begin t nets from its being tl»« quickly rcsorbed, ur tswV.n up again into the mass of circulating humours. ©P THE SMALL-POX. i& It is generally necessary, after the small pox are gone off, to purge tlie patient. If however the body has been open through the whole course of the disease, or if buttermilk and other things of an opening nature have been drank freely after the height of the small pox, purging becomes less necessary; but it ought never wholly to be neglected. For very young children, an infusion of sesma and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanced must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grams of fine rhubarb in powder over-night, and the same quantity of jalap in powder next morning. This may-be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further advanced, and adults, the dose must be in- creased in proportion to the age and constitution.* When imposthumes happen after the small-pox, which is not seldom the care, they must be brought to suppuration as soon as possible, by means of ripening poultices ; and when they have been opened, or have broke of their own accord, the patient must be purged. The Peruvi- an bark and a milk diet will likewise be useful in this case. When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patieut must be sent to a place where the air is good, and put upon a course of asses' milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions. OF INOCULATION. Though no disease, after it is formed, baffles the power of medicine more effectually than the small-pox,yet more may be done before-hand to render this disease favourable than any one we know, as almost all the danger from it may be prevented by inoculation. This salutary invention has been known in Europe above half a century ; but, like most other useful discoveries, it has till of late made but slow progress. It must however be acknowledged, to the honour of this country, that inoculation has met with a more favourable reception here, than among any of our neighbours. It is still however far from being general, which we have reason to fear will be the case, as long as the practice continues in the hands of the faculty. No discovery can be of general utility, while the practice of it is kept in the hands of a few. Had the inoculation of tbe small-pox be n introduced as a fashion, and not as a medical discovery, or had it been practised by the same kind of operators here, as it is in those countries from whence we learned it, it had long ago been universal. The fears, the jealousies, the prejudices, and the opposite interests of the faculty, are, and ever will be, the most effectual obstacles to the progress of any salutary discovery. Hence it is that the practice of inoculation never became in any measure general, even in England, till taken up by men not bred to physic. These have not only rendered the practice more extensive, but likewise more safe, and by acting under less re- straint than the regular practitioners, have taught them that the pa- tient's gieatest danger arose, not from the want of care, but from the excess of it. • Ihave of late beea aecastomed, after tie small-pox, to give one, two, three, fooij, OX five grains of calomel, according to the age of the patient, ovtv night, to work it oft next morning with a suitable dose of jalap. Or the jalap sutd caJoau J, ma? be moed Wjejlyr*. smtf given fn the momi nfr- 156 OF THE SMALL-POX. They know very little of the matter, who impute the success ot modern iuoculators to any superior skill, either in preparing the pa- tient or communicating the disease. Some of them indeed, from a sordid desire of engrossing the whole practice to theinstlves, pretend to have extraordinary secrets or nostrums for preparing persons for inoculation, which never fail of success. But this, is only a pretence calculated to blind the ignorant and inattentive- Common sense and prudence alone are sufficient both in the choice of the subject and management of the operation. Whoever is possessed of these may perform this office for his children whenever he finds it convenient, provided they be in a good state of health. This sentiment is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inocula- tion in all its different forms, so little appears to me to depend on those, generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, ore. that for several years past I have persuaded the parents or nurses to eiform the whole themselves, and have found that method followed with equal success, while it is free from any inconveniences that attend the other.* The small-pox may be communicated in a great variety of ways with nearly the same degree of safety and success. In Turkey,from whence we learned the practice, the women communicate the disease to children, by opening a bit of the skin with a needle, and putting into the wound a little matter taken from a ripe pustule. On the coast of Barbary they pass a thread wet with the matter tnrough the skin be- tween the thumb and fore-finger ; and in some of the states of Barbary, inoculation is performed by rubbing in the variolous matter between the thumb and fore-finger, or on other parts of the body. The practice of communicating the small-pox, by rubbing the variolous matter upon the skin, has been long known in many parts of Asia and Em ope as well as in Barbary, and has generally gone, by the name of buying the small-pox. The present method of inoculating in Britain is to make two or three slanting incisions in the arm, so superficial as not to piei ce quite through the skin, with a lancet wet with fresh matter taken from a ripe pustule j afterwards the wounds are closed up, and left without any dressing. Some make use ofa lancet covered with dry matter ; but this is le i certain, and ought never to be used unless where fresh matter cannot be obtained : when this is tbe case, the matter ought to be moistened by holding the lancet for some time in the steam of warm water, t * A critical situation, too often to be met with, first put me upon trying this method. A gentleman who bad lost all his children except one son by the natural suialt-pox, was determined to have him inoculated. He told me his intention, and desired I would persuade the niotfier and grandmother, 8tc of its propriety. But that was impossible. They were not to be persuaded, and either could not get the better of their tears, or were determined against conviction. It was always a point with me ot to perform the opera- tion without the consent ol the parties concerned. I therefore advised the father, aftrf giving his son a dose or two of rhubarb, to go to a patient who bad the small-pox ol a good kind, to open two or three of the pustules, taking up the matti r with a little cotton, and as soon as tie came home to take lus son apart, and give his arm a slight scratch with a pin,afterwards to rub the place well with tbe cotton, and take no farther notice of it. All this he punctually performed : and at the usual period the small-pox made their appearance, which were of an exceeding good kind, and so mild as not to confine the boy an hour to his bt d. None of the other relations knew but the disease had come in the natural way, till the boy was well. f Mr.Tronchin communicates this disease by a Kttle bit of thread dipt in tbe matter, which he covers' with a small blistering-plaster. This method may no doubt be used with advantage in those easus where the patient is very much alarmed at the sight ol any cutting iastrunxnt. OF THE SMALL-POX. 1ST- Indeed if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter, be immediately applied to the arm, mid- way between the shoulder and the elbow, and covered with a piece of the common sticking plaster, aud kept on for eight or ten days. This will seldom fail to communicate the disease. We mention .this method, because many people are afraid of a wound; and doubtless the more easily the operation can be performed, it has the greater chance to be- come general. Some people imagine, that the discharge from a wound lessens the emotion -, but there is no great stress to be laid upon this notion ; besides, deep wounds often ulcerate, and become trouble- some. We do not find that inoculation is at all considered a? a medical ope- ration in those countries from whence we learned it. In Turkey it is pj^formed by the women, and in the East-Indies by the Brachmins or priests. In this country the custom is still in its infancy ; we make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, thanat present they do of giving them a purge. No set of men have it so much in their power to render the practice Of inoculation general as the clergy, the greatest opposition to it, still arising from some scruplefof conscience, which they alone can remove. I would recommend it to them, not only to endeavour to remove the religious objections which weak minds may have to this salutary prac- tice, but to enjoin it as a duty, and to point out the danger of r.eg;ecting to make use ofa mean which Providence has put into our power, for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children's lives, are as guilty as those who put lhem to death. I wish this matter were duly weighed. No one is more ready to make allowance for human weakness and religious prejudices; yet I cannot help recommending it, in the warm- est manner, to parents, to consider how great an injury they do their childrc.i, by neglecting to give them this disease in the early period of lift. The numerous advantages arising from the inoculation of the small- pox have been pretty fully pointed out by the learned Dr. M'Kinzie^ iu his History of Health.* To those mentioned by the Doctor we shall * u Many and groat,'' says this humane author, " are the dangers attending the na- tural infection, from all which the inoculation is quite secure. The natural infection may invade weak or distempered bodie9, by no means disposed for its kindly reception. It may attack them at a season of the year either violently hot or intensely cold. It Trjy be communicated from a sort of small-pox impregnated with the utmost virulence. It may lay hold upon people unexpectedly, when a dangerous sort is imprudent- ly imported into a maritime place. It may surprise us soon after excesses com- ' "ttritteu in luxury, intemperance, or lewdness. It may likewise seize on the innocent after indispensable watchings, hard labour, or necessary jouvnits. And is it a trivial advantage, that all these unhappy circumstances can be prevented by inoculation ? By inoculation numbers are saved from deformity as well as from death. In the na- tural small-pox, how often are the finest features, and the most beautiful complexions, loiserahly disfigured 1 whereas inoculation rarely leaves any ugly marks or scars, even where the number of pustules on the face has been very considerable, and the symp- toms by no means favourable. And many other grievous complaints that are fre- quently subsequent to the natural sort, seldom follow the artificial. Does not inocula- tion also prevent those inexpressible terror* that perpetually harass persons who never had this tusease,insomuch that when the small-pox is epidemical,entire villages are de- populated, markets ruined, and the face of distress spread Over the whole country? From this terror it arises, that justice is frequently postponed, or discouraged, at sessions or assizes where the small-pox rages. Witnesses and juries dare not appear ; and by te«jsoa Of the necessary absence of some gentlemen, our honourable and useful judgti 158 OP THE SMALL-POX. only add, that such as have not had the small pox in the early period of file, are not only rendered unhappy, but likewise in a great measure unfit fur sustaining many of the most useful and important offices. Few people would chuse even to hire a servant who had not had the small-pox, far less to purchase a slave, who had the chance of dying of this disease. How could a phyrician or a surgeon, who had never had the small-pox himself, attend others under that malady ? How deplo- rable is the.situation of females, who arrive at mature age without hav- ing had the smallpox I A woman with child seldom survives this disease : and if an infant happens to be seized with the small-pox upon tlie mother's breast, who has not had the disease herself, the scene must be distressing ! If she continue to suckle the child, it is at (he peril of Ler own life ; and if she wean it, in all probability it will perish. How often is the affectionate mother forced to leave her house, and abandon her children at the very time when her care is most necessary I Vet, should parental affection get the better of her fears, the consequences would often prove fa'al. 1 have known the tender mother and her suck- ing inf'ant laid in the same grave, both untimely victims to this^ dread- ful malady. But these are scenes too shocking even to mention. Let parent- who run away with their children to avoid the small-pox, or who refuse to inoculate them in infancy, consider to what deplorable situa- tions they may be reduced by this mistaken tenderness'. As the small pox is now become an epidemical disease in most parts of the known world, no other choice remain-but to render the ma'aily as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of communicating the di-ease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small consequence, whether a disease be entirely ex irpated, or render- ed so mild as neither to destroy life nor hurt the constitution ; but that this may be done by inoculation does not now adn.it of a doubt. The numbers who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies ; but by inocula- tion not one of a tliOH-and. Nay, some can boast of having inoculated ten thousand without the loss of a single patient. I have often wished to see some plan established for rendering this salutary praetice universal; but am afraid I shall never be so happy. The difficulties indeed are many; yet the thing is by no means im- practicable. The aim is great : no ot* not inoculation, iu like manner, prevent our brave sailors from being si izi d wilh this distemp i on ship-board, where they mu.-.t quickly spread the infection among such or the crew who never had it before, and where they have scarce any chance to escape, bTine half stifled with the closeness of their cabins, and but very indifferently nursed. LrsiIv with regard to the soldiery, the miseries attending these poor cr. atures when stttacl-ed by the small-pox on a march, are inconceivable, without attendance, withou*. lodgings without any accommodation ; so that one of three commonly perishes." OF THE SMALLPOX. >3, dren of the poor gratis. It is hard that so useful a part of mankind should, by their poverty, be excluded from such a benefit. Should this fail, it is surely in the power of any state to render the practice general, at least as far as their dominion extends. We do not mean that it ought to be enforced by a law. The best way to promote it would be to employ a sufficient number of operators at the public expense to inoculate the children of the poor. This would only be necessary till the practice became general : afterwards custom, tlie strongest of all law*, would oblige every ind vidnal to inoculate his children to prevent reflections. It may be objected to this scheme, that the poor would refuse to em- ploy the inoculators; this difficulty is easily removed. A small pre- mium to enable mothers to a.teud their children while under the dis- ease, would be a sufficient inducement; besides, the success attending the operation would soon banish all objections to it. Even considera- tions of profit would induce the poor to embrace this plan. They often bring up their children to the age often or twelve, and when they come to be useful, they are snatched away by this malady, to the great loss of their parents, and detriment of the public. The British legislature has of late years shewn great attention to the preservation of infant-lives, by supporting the foundling hospital, &c. But we will venture to say, if one tenth-part of tlie sums laid out in supporting that institution, had been bestowed towards promoting the practice of inoculation of the small-pox among the poor, that not only more useful lives had been saved, but the practice, ere now, rendered quite universal in this island. It is not to be imagined what effect ex- ample and a little money will have upon the poor; yet, if left to themselves, 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-spirited. Should such a scheme be approved, a proper plan might easily be laid down for the execution of it. But as public plans are very difficult to bring about, and often, by tlie selfish views and misconduct of those entrusted with the execution of them, fail of answering the nobble purpose for wliich they were de- signed; we shall therefore point out some other method by which the benefits of inoculation may be extended to the poor. There is no doubt but inoculators will daily become more numerous. We would therefore have every parish in Britain to allow one of them a small annual salary for inoculating all the children of the parish at a proper age. This might be done at a very trifling expense, and it would euable every one to enjoy the benefit of this i-alutary invention. Two tilings chiefly operate to prevent the progress »f inoculation. The one is a wish to put the evil day as far off as possible. This is a principle in our nature; and as inoculation seems rather to be antici- pating a future evil, it is no wonder mankind are so averse to it. But this objection is sufficiently answered by the success. Who in his senses would not prefer a lesser evil to-day to a greater to-morrow, pro- vided they were equally certain? The other obstacle is the fear of reflections. This has a 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 dif- ficulty ; and, till that be removed, inoculation will make but small progress. Nothing however can remove it but custom. Make the practice fashionable, and all objections will soon vanish. It is fashion alone that has led the multitude since the beginning of the world, and 160 OF THE SMALL-POX. will lead them to the end. We must therefore call upon the more en. lightened part ot mankind to set a pattern to the rest. Their exam- ple, though it may for some time meet with opposition, will at length prevail. I am aware of an objection to this practice from the expense with which it may be attended: this is easily obviated. We do not mean that every parish ought to employ a Sutton or a Dimsdale as inocula- tors. These have by their success already recommended themselves to crowned heads, and are beyond the vulgar reach; but have not others an equal chance to succeed? They certainly have. Let them make the same trial, and the difficulties will soon vanish. There is not a parish, and hardly a village in Britain, destitute of some who can bleed. But this is a far more difficult operation, and requires both more skill aud dexterity than inoculation. The persons to whom we would chiefly recommend the perform- ance of this operation are the clergy. Most of them know something of medicine. Almost all of them bleed, and can order a purge, whicii are all the qualifications necessary for the practice of inoculation. The priests among the less enlightened Indians perform this office, and. why should a Christian teacher think himself above it? Surely the bodies of men, as well as their souls, merit a part of the pastor's care; at least the greatest Teacher who ever appeared among men, seems to have thought so. Should ail other methods fail, we would recommend it to parents to perform the operation themselves. Let them take any method of com. municating the disease they please; provided the subjects be healthy, and ofa proper age, they will seldom fail to succeed to their wish. I have known many instances even of mothers performing the operation, and never so much as heard of one bad consequence. A planter in one of the West India islands is said to have inoculated, with his own hand, in one year, three hundred of his slaves, who, notwithstanding the warmth of tbe climate, and other unfavourable circumstances, all did well. Common mechanics have often, to my knowledge, per- formed the operation with as good success as physicians. We do not however mean to discourage-those who have it in tlieir power, from employing people of skill to inoculate their children, and attend then* while tinder the disease; but only to shew, that where such cannot be bad, the operation ought not upon that account to be neglected. Instead of multiplying arguments to recommend this practice, I shall just beg leave to mention themethod which I took with my own son, then an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rubbed off by accident. At the usual time the small-pox made their appearance, and were exceedingly favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine. . We have been the more full on this subject because the benefits ot inoculatiou cannot be extended to society by any other means than making the practice general. While it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread, and is communicated to many who might otherwise never have had *,he disease. Accordingly it is found that nearly the same number te of the small-pox now as before inoculation was introduced ;and this important discovery, by which alone more lives might be saved than by OF THE SMALL-POX. 161 all the endeavours of the Faculty, is in a great measure lost by its henefits not being extended to the whole community.* The spring and autumn have been usually reckoned the most proper seasons for inoculation, on account of the weather being then most temperate; but it ought to be considered that these are generally the most unhealthy seasons of the whole year. Undoubtedly the best pre- paration for the disease is a previous good state of health. I have al- ways observed that children in particular are more sickly towards the end of spring and autumn, than at any other time of the year. On this account, as well as for the advantage of cool air, I would propose winter as the most proper season for inoculation; though on every other consideration, the spring would seem to be preferable. The most proper age for inoculation is between three and five. Many approve of inoculation on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more liable to convulsions at this time than afterwards ; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the milk. Children who have constitutional diseases, must nevertheless be hi- oculated. It will often mend the habit of body; but ought to be per- formed at a time when they are most healthy. Accidental diseases' should always be removed before inoculation. It is generally thought necessary to regulate the diet for some time before the disease be communicated. In children, however, great alteration in diet is seldom necessary, their food being commonly of the most simple and wholesome kind, as milk, water-pap, weak broths, bread, light pudding, mild roots, and white meats. But children who have been accustomed to a richer diet, who are of a gross habit, or abound with bad humours, ought to be put upona spare diet before they are inoculated. Their food should be of a light cooling nature, aud their drink whey, butter-milk, and such like. We would recommend no other medicinal preparation but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the; preparation of their patients, but on their management of them while tinder the disease. Their constant care is to keep them cool, and their bodies gentiy open, by which means the fever is kept low, and the eruption greatly lessened. The danger is seldom great when the pustules are few ; and their number is- generally in proportion to the fever wliich precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods mentioned above. The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be light, and his drink weak and diluting, ckc. Sliould any bad symp- toms appear, which is seldom the case, they must be treated in the same way as directed in the natural small-pox. Purging is not less necessa- ry after the small-pox by inoculation than in the natural way, and ought by no means to be neglected. • By a well-laid plan for extending inoculation, more lives might be saved at a small expense than are at present preserved by all the hospitals in England, which cost ik^pubhcsuchanajnazinssum. 163 OF THE COW-POX CHAPTER XXV.§ OF THE COW-POX, AND ITS INOCULATION. IN the preceding Chapter, the method of inoculating for the small-pox has been retained, as having hitherto been successfully practised dur- ing a number of years; but, by a fortunate discovery it is now found, that the infection may be introduced in a manner equally successful, and the disease rendered still less considerable than by the former kind of inoculation. This is done by inoculating with matter either taken from a cow affected with the disease, or from some person who had re- ceived the infection originally derived from that animal. It may be proper here to give a general account of the manner in which so surpri- sing a discovery has been made. In several parts of England, where cows are kept for the purposes of the dairy, a peculiar eruptive disease has been occasionally observed among the herd, and which affects in particular the udders and teats of those animals. It has, therefore, pretty generally obtained the name of the Cow-pox, (vaccinia, or vacciola.) Till within these last two years, the. knowledge of this distemper has been chiefly confined to the people employed in the dairies, and to far- riers and cow-doctors in the neighbourhood ; but, by the latter, it ap- pears to have been observed with particular accuracy, and they have even employed means for its removal. It farther appears, that wherever the existence of this disease was" known, tlie fact was likewise ascertained, that the disorder is commu- nicated by the touch to the milkers who handle the teats of the dis- eased cows, and from them again is often spread through a numerous herd : that, when affecting the human species, it is not merely con- fined to the local disease of the hands and arms, but also occasions a general indisposition, often severe, but never fatal, which inns a regular course ; and that the person who has once undergone the disease so communicated is ever after secure against the infection of the small-pox, either in the natural way by contagion, or by inocu- lation. All these circumstances, however, though known, as we are told, from time immemorial in certain parts of the kingdom, still remained in obscurity till within these three years, when Dr. Jenner, of Berkley, in Gloucestershire, conceived the important idea of employing the cow- pox to annihilate the small-pox, aud published several interesting par- ticulars concerning this disease, which works have now made it known to the public in general. It appears, from observations made by those who are most conver- sant with cows, that several causes may produce sores upon the udder and teats of this animal, especially such as excite any irritation in those parts, during the season when the cows abound most in milk. The stinging of flies-, or rough handling while milking, and other such exter- nal irritations, will often occasion small white blisters on the parts; which, however, never extend more than skin-deep, and are generally easy of cure. Another, and more serious disorder in those parts, is said to be some- times produced by suffering a'cOw, while in full milking, to remain for a day-or two unmilked ; in order to distend the udder when naturally small. This, it appears, is a common artifice practised at fairs and cat- tle-markets, with the view of increasing tbe price of the cow, a large AND ITS INOCULATION. 163 adder being reckoned an important circumstance in the value of that animal. By this cruel and unwarrantable artifice, the vessels that sup- ply the udder are kept for an unusual length of time in a state of great distension, which terminates frequently in a violent inflammation of those parts, succeeded by large eruptions upon the teats and udder that sometimes leave deep and troublesome sores. The matter discharged fiom these ulcers will communicate a disorder, like tbe other, into the bands of the milkers, when the skin is broken in any part; and often produces foul and extensive ulcers, which sometimes occasion pustules ou the arms and shoulders, aud prove tedious and difficult of cure. The. genuine cow-pox, however, is a distinct disease from those which have been just mentioned. It generally makes its appearance in the spring, and shews itself in irregular pustules on the teats or nip- ples of the udder. They are at first of a palish blue, or rather a livid colour, and contain a thin, watery, and sharp fluid. The turrounding parts are inflamed and hardened. These pustules, it seems are very apt to degenerate into deep corroding ulcers, which, as the cow-doc- tors term it, eat into the fiesh, and constantly discharge a matter, which commonly increase in thickness, and hardens at last into a scab. Now and then the cow becomes evidently indisposed, looses herappetite, and gives less milk than usual; but it often happens, that the disorder, though severe, is entirely local. It appears that tlie cow-pox never proves fatal to cows, nor is it in- fectious in the usual manner of contagious distempers, but can only be 'communicated to them or to the human species by actually touching the matter which proceeds from the sores. Hence, the cows which are not in milk escape the disease entirely, though constantly in the same field with those that are highly infected ; and it seems to be only from the circumstance of the milker handling the teats of the sound cows, after touching the diseased, that the cow-pox ever spreads among the herd. We are informed that the cow-pox is familiar to the inhabitants of the hundred of Berkley in Gloucestershire. It has likewise been discov- ered in various parts of the counties of Wilts, Somerset, Buckingham, Devon, and Hants; in a few places of Suffolk and Norfolk, whereitis sometinies called the pappox; and in Leicestershire and Staffordshire. Nor is it unfreqnent in the very large milk-farms contiguous to the me- tropolis on the Middlesex side. It is here observed generally to at- tack first some cow newly introduced to the herd, and is supposed to originate in a sudden change from a poor to a very rich and partly un« natural diet which it is the practice to use, in order to bring the yield ofmilk to its highest point. According to Dr. Jenner, the origin of the cow-po»>is ascribed to a derivation from the horse. The horse is well known to be subject to an inflammation and swelling in the heel, called the grease, from which is discharged a very sharp matter, capable of producing irritation and ulcers in any other animal to the surface of which it is applied. It is supposed that this matter is conveyed to the cow by the men-servants of the farm, who, in several of the dairy counties, assist in milking. One of tliese, having dressed the horse, goes immediately to his occu- pation of milking; and having upon his hand some particles of the dis- charge from the grease, he, of course, applies it to the udder of the cow, where, if the animal be ma state for receiving the infection, it produ- ces that specific change in those parts which gives rise to the disease of the cow-pox.. 164 OF THE COW-POX, The origin here ascribed to this disorder is principally founded on the circumstance, that wherever the cow-pox appears, the grease is gen- erally found to have preceded it; and the opinion of the propagation of the disease from the horse to the cow is likewise current in some of the dairy counties where the disease is known. But this opiuion re- quires to be ascertained by further observations. This conjecture, respecting the origin of the cow-pox, was no sooner started by Dr. Jenner, than attempts were made repeatedly, but with- out success, to introduce the disease in the nipple of the cow hy di- rect inoculation of the recent matter of the grease from the horse's heel. The consequence of this experiment, when it took any effect, was a slight inflammation, and the production of a small pustule or pimple, but which disappeared in a few days, without exciting the specific di- sease of the pox. But the failure of these experiments by no means overthrows the opinion for the ascertainment of which they were matle; since it is admitted that a certain predisposition in the constitution of the cow to receive the disease is also requisite for its production. It is remarked, that the matter discharged from the sores in the horse's heel is likewise found to occaMon, at times, very troublesome ulcers on the hand?> of the men that dress them, attended with a very considerable degree of indisposition; both of which appear to be full us severe as in the genuine cow-pox, and in many points to resemble this latter disorder. But the person who has been infected by the horse is not rendered thereby entirely secure from afterwards receiving the small-pox. * The pustular sores on the udder and teats of the cow, that constitute the genuine cow-pox, whatever be the way in which they are produ- ced, are found by experience to possess the power of infecting the hu- man species, when any part of the body, where the skin is broken, or naturally thin, comes into actual contact with the matter which they discharge. Hence it is, that with the milkers, the bauds are the parts that acquire this disorder accidentally, and it there exhibits the follow. ing appearances: Inflamed spots begin to appear on the hands, wnsls, and especially the joints and tips of the fingers; and these spots at first resemble the small blisters of « burn, but quickly proceed to suppu- ration. The pustule is quite circular, depressed in the middle, and of a blueish colour, and is surrounded with a considerable redness. The blue colour which the pustule almost invariably assumes, when the dis- order is communicated directly from the cow, is one of the most char- acteristic marks by which the cow-pox may be distinguished from oth- er diseases which the milkers are likewise liable to receive from the cow. The matter of the pustule i» at first thin and colourless; but, as the disorder advances, it becomes yellower and more purulent. In a few days from the first eruption, a tenderness and swelling of the glands in the arm-pit come on, and soon after tlie whole constitution becomes disordered, the pulse is increased in quickness, shivering suc- ceeds, with a sense of weariness, and pains about the loins, vomiting, head-ach, and sometimes a slight degree of delirium. These symptoms continue with more or less violence from one day to three or four, and, when they abate, they leave sores about the hands, which heal very slowly ; resembling, in this respect, the ulcers on the nipple of the cow, from which they derive their origin. It is to be observed, that the cow-pox eruption, though very severe on the hands, and occasioning much general illness, never produces a crop of pustules over distant parts of the body, arising spontaneously, AND ITS INOCULATION. 165 as n the small-pox. It often happens, however, that pustules are formed in various parts which accidentally come in contact with the diseased hands, as on the nostrils, lips, and other parts of tbe face where the skin is thin ; or sometimes on the forehead, when the milker leans with that part upon the udder of an infected cow. From this account it appears, that the cow-pox as it affects the milkers, or what may be termed the casual cow-pox in the human species, is often a severe dis- order, sometime* confining the patient to his bed during the period of fever, and generally leaving troublesome sores, but it has never been known to prove fatal ; nor are these sores, if properly attended to, fol- lowed with any lasting injury of the affected parts, though they some- times leave scars for life. In consequence of the close investigation which this disorder has late- ly undergone, the following facts may be considered as fully ascertained by the fairest experiments aud most accurate observations : First.—The cow-pox, in its natural state, or when propagated imme- diately from an infected cow, to the hands of the milkers, is capable of affecting the human species from one to another repeatedly to an indefi- nite number of times; but after the first attack, it is generally much milder in its symptoms, and in particular it is much less liable to pro-. duce the fever and general indisposition which always attend the first infection. There are instances, however, where the second and even third attack have been as severe in every respect as the first; but these* are very rare. Secondly.—The small-pox in a considerable degree secures a person. from the infection of the cow-pox ; and in this respect appears to act in a manner very similar to a previous attack of the latter disease ; that is, to confine its operation to the forming of local pustules, but unatten- ded with general fever. Hence it is, that where all the servants of the dairy take the infection from the cows, those of them who have previ- ously undergone the small-pox are often the only persons among them able to go through the usual work. Thirdly.—The cow-pox, in its genuine state, when it has been accom- panied with general fever, and has run its regular course, ever after. preserves the person who has been infected with it from receiving the infection of the small-pox. This assertion is, however, to be taken with exactly the same limitations as that of re-infection with the small- pox preventing a second attack of the same disease. No previous in- fection willentirely counteract the local effect on the arm, produced by the insertion of variolous matter iu common inoculation: this may in a few cases go so fir as to induce a degree of general fever, slight in- deed, but perhaps equal to that of the mildest indisposition caused by a first infection with this disorder. By the inoculation of either disease, however, the small-pox is equally and completely disarmed of its viru- lence against any subsequent attack, which is the circumstance that so much distinguishes and sostrongly recommends this operation. Fourthly.—A comparison of the two diseases in respect of the mild- ness of their symptoms, and the hazard to life v. hich they may occasion, will show a very great advantage in favour of the cow-pox. Compared with the natural smallpox, the natural or casual cow-pox is both milder and infinitely more safe; no instance having ever been known ofa fatal event in the cow-pox, so far as it affects the people employed in the dairies. When both diseases are introduced by artificial inoculation, thev are each rendered much less severe ; and here too the superiority •f the cow-pox as a sater aud milder disease is extremely evident. 16-3 OF THE COW-POX, &c. Fifthly.—The cow-pox, even in its most virulent state, is not com-; mumcable by the air, nor by any other of the ordinary means of con- tagion, but can only be propagated, by the actual contact of matter of a pustule from the cow-pox with some part of the body of the person who receives it. It is not yet ascertained, whether in all cases an in- sertion of specific infections matter under the skin be necessary; but in its most active state, as it is when formed in the cow's udder, the skin which covers the lips andiiotrils readily receives the infection without bein« broken. In this respect the contagion of the cow-pox seems to equal that of the small-pox in activity ; but the striking differ- ence between the two diseases in the cow pox not being communicated by the air, &c. is a circumstance fully and satisfactorily ascertained. In the dairy-farms, infected servants sleep with the uninfected : infants at the breast have remained with their mothers whiht only one of the two have had the disorder upon them . and in no instance has the disease of one been communicated by contagion to the other. It is this circum- stance which gives the cow-pox its decided superiority; since, by adopting this disease instead of the small-pox, all the dread and all the mischief occasioned by the contagion of the latter are entirely removed. The inoculated cow-pox appears to have almost as great a superi- ority m point of mildness and security over the ordinary inoculation of the small-pox, as this has over the natural small-pox; so that the same precautions which would be highly requisite in communicating the lat- ter becomes less so where the disorder is to be introduced by inocula- tion ; and still less where the cow-pox is substituted in the room of the other. With reaard to the method of performing Inoculation in the Cow-pox, Dr. Woodville, whose industry, judgment, and accuracy, appear to great advantage in his observations on this subject, advises " that the lancet should be held nearly at a right angle with the skin, in order that the infectious fluid may gravitate to the point of the instrument, which, in this direction, should be made to scratch the cuticle repeatedly, until it reach the true skin and become tinged with blood." The act of inoculation having been performed, the first proof of its success is a small inflamed spot at the part where the puncture has been made, which is very distinguishable about the third day. This continues to increase in size, becomes hard, and a small circular tumour is formed, rising a little above the skin. About the sixth day the centre of the tumour shows a discoloured speck, owing to the formation ofa small quantity of fluid; and this continues to increase, and the pustule or pim- ple to fill, till about the tenth day. After the eighth day, when the pustule is fully formed, the effects on the constitution begin to show themselves; the general indisposition being commonly preceded by pain at the pustule and in the arm pit, followed by head-ach, some shivering, loss of appetite, pain iu the limbs, and a feverish increase of the pulse. These continue, with more or less violence, for one or two days, and always abate of their own accord, without leaving any unpleasant consequence behind them. During, or a little after, the general indisposition, the pustule in the arm, which had been advancing in a regular manner, becomes sur- rounded with a broad circular inflamed margin, and this is a sign that the body in general is affected. After this period, the fluid in the pustule gradually dries up, the surrounding redness becomes fainter, nud in a day or two vnuULes imperceptibly ; whilst the pustule no OF THE MEASLES. 107 longer increases in extent, but on its surface a hard thick scab of a brown colour is formed, which, if not pulled off, remains for nearly a fortnight ; Ull at length it falls off, leaving the skin beneath perfectly sound and uninjured. It is a circumstance of great importance in favour of this method ot inoculation, that though some attention in choosing the matter for in- oculation, aud performing this slight operation in such a manner as to insure success, be requisite, very little medical treatment is necessary m order to conduct the patient through it with perfect safety. In most cases it is attended with so little fever as scarcely to be detected by an attentive observer. To conclude this account of the cow-pox with a repetition of tbe circumstances wliich gives it a decided superiority over the small-pox, Dr. Woodville affirms (and his authority is unquestionable) that of all the patients whom he inoculated with the variolous matter, after they had parsed through ; lie cow-pox, amounting to upwards of four hun- dred, not one was affected with the small-pox, though purposely and repeatedly exposed to the infection of the disease ; and what is not less extraordinary, nearly a fourth part of this number were so slightly af- fected with the cow-pox, that it neither produced any perceptible indis- position, nor pustules. From the beginning of the world, the cow has, iu all countries, been esteemed a valuable animal Besides cultivating the ground, which her species performs, she. applies us with an aliment of her own pre- paring, the most wholesome a- well as nourishing in nature ; but never before was it known, except, as appears, in some particular districts in England, that, even from a disease to which she is liable, she can likewise befuriher useful, in preserving us from one of the most fatal calamities that ever infested human kind. CHAPTER XXVI. OF THE MEASLES. THE measles appeared in Europe about the same time with the small- pox, and have a great affinity to that disease. They both came from the :ame quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in tlie sprinu season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but it consequences are often very troublesome. CAUSE.—This disease, like the small-pox, proceeds from infection, and is more or less dangerous according to the constitution of the pa- tient, the season of the year, the climate, a:c. SYMPTOMS__The measles, like other fevers, are preceded by al- ternate fits of heat and cold, with sickness aud loss of appetite. The tongue is white, but generally moist. There is a shorl cough, heavi- ness of the head and eyes, drowsiness, and a running a the nose. Sometimes indeed the cough does not come before the eruption lias appeared. There is an inflammation and heat iu the eyes, accom- panied with a defluxion of sharp rh-um, an'' great acuteness of sen- sation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. Ti;j patient generally complains of his throat, and a vomiting or looseness often precedes tlie eruption. The stools in cltiidren are commonly greenish; they complain of an itching of the skin, aud are remarkably peevish. Bleed- 168 OF THE MEASLES. ing at the nose is common, both before and in the progress of the disease. About the fourth day, small spots resembling flea-bites, appear, first upon the face, then upon the breas^ and afterwards on the extremi- ties: these may be distinguished from the small-pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small-pox, are rather increased ; but the vomiting generally ceases. And the sixth or seventh day from the time of sickening, the mea- sles begin to turn -pale on (the face, and afterwards upon the body ; so that by the ninth day they entirely disappear. The fever, however, and difficulty of breathing, often continue and especially if the patient has been kept upon too hot a regimen. Petechia;, or purple spots, may likewise be occasioned by this error. A violent looseness sometimes succeeds the measles, in which case the-patient's life is in imminent danger. 4ftch as die of the measles, generally expire about the ninth day from rftc irJi/afflun, and are commonly carried off by a peripneumony, or in- flammation of the lungs. team of warm water, aud thaw the steam into his lungs. He may likewise lick a little spermaceti and sugar candy pounded together; or take now and then a spoonful of the oil of sweet al- monds, with sugar candy dissolved in it. These will soften the throat, and relieve the tickling cough. If at the turn of the disease the fever assumes new vigour, and there appears urcat danger of suffocation, the patient must be bled accord- ing to his strength, and blistering plasters applied, with a view to pre- vent the load from being thrown on the lungs, where if an inflammation should fix itself, tbe patient's life will be in imminent danger. In case the measles should suddenly disappear, it will be necessary to pursue the same method wliich we have recommended when the small-pox recede. The patient must be supported with wine and cor- dials Blistering plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may like- wise be applied to the feet and palms of the hands. When purple or black spots appear, the patient's drink should be sharpened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in tlie same manner as directed in the small-pox- Opiates are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is suf- ficient. A tea-spoonful ortwo may be occasionally given according to the patient's age, or the. violence of the symptoms. After thu measles arc gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small- pox. If a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night ; but if these do not remove it, bleeding will seldom fail to have that effect. Pati uis recovering after the measles should be careful what they eat or drink. Their food for some time ought to be light, and in small .quantities, and their driuk diluting, and rather of an opening nature, as butter-milk, whey, and such like. They ought also to beware of ex- posing themselves too soon to the cold air, least a suffocating catarrh, an asthma, or a consumption of the lungs, shonld ensue. Should a cough, with difficulty of breathing, and other symptoms ofa consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as tne patient's strength and con- stitution will permit. He ought likewi.se to drink as.ses-milk, to re- move to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables ; and lastly, if these do not succeed, let him remove to a warmer climate*. • Attempts have been mada to communicate the mcasU-i, as well as tie small-poii by inoculation, ami we make no doubt but in time the practic.- may succeed. Dr. Home of Ediuburgh, says, he coftimunicaud the di* ase by the blood. Others have tried this method, and have not found it succeed, borne think the disease would be more certainty communicated by rubbing- the skin of the patient who has tlie measles with cotton, aud afteruarn. applying the cotton to a wound as iu the small-pox ; while otbxrs recommend a bit ot ttajuu,-!, which bad been applied to t*e patient's stao,aJl the CO OF THE BILIOUS FEVER. OF THE SCARLET FEVER. THE scarlet fever is so called from the colour of the patient's skin, which appears as if it werie tinged with red wine It happens at any season of the year, but is most common towards the end of summer; at which time it often seizes whole families; children and young per- sons are most subject to it. It begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spois, which are broader, more florid, and less uniform than the measles. They con- tinue two or three days, and then disappear ; after which the cuticle, ot scarf-skin, falls off. There is seldom any occasion for medicine in this disease. The pa- tient ought however to keep within doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool and diluting liquors. If the fever runs high, the body must be kep' gently open by emollient '.lysters, orsmall doses of nitre and rhubarb. A scruple of the former, with five grains of the latter, may be taken thrice a day, or ofteuer, if accessary. Children and young persons are sometimes seized at the beginning of this disease with a kind of stupor aud epileptic tits. In this case the feet and legs should be bathed in warm water, a large blistering-plaster aop'ied to the neck, and a dose of the syrup of poppies given every night till the patient recovers*. The scarlet fever however is not always of so mild a nature. It is Fomelimes attended with putrid or malignant symptoms, in wliich case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness an.i shivering, but with languor, sick- ness, and great oppression ; to these succeed excessive heat, nausea, and vomiting, with a soreness of the throat; the pulse is extremely ■quick, but small and depressed ; the breathing frequent and laborious; the skin hot, but not quite dry ; the tongue moist, and covered with a -whitish mucus ; the tonsils inflamed and ulcerated. Wheu the erup- tion appears, it brings no relief: on the contrary, the symptoms gene- rally grow worse, and fresh ones come on, as purging, delirium, Sec. When this disease is mistaken for a simple inflammation, and treated ■with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this «ase, are cordials and antiseptics, as the Peruvian bark, wine, snake- root and the like. The treatment must be in general ritnilar to that of slan!? 'htir tonRUt in tlie »ame manner. t As must people ar lbnd of using eye-watt r, and ointments in this and other diseases of tin .yes wt iia»v inserted some of the most approved torras of these u.tdicines in the AW'eadi** Sec Appendix. F.^tl'ccv and Lyc-Mve. 160 ©F THE QUINSEY, OR lady. It is likewise frequently occasioned by continning long in a raoisf place, sitting nestr an open window, sleeping in a damp bed, sitting in a room that has been newly plastered, &c. I know people who never fail to have a sore throat, if they sit even but a short time in a room that has been lately washed. Acrid or irritating food may likewise inflame the throat, and occasion a quinsey. It may also proceed from bones, pins, or other sharp sub- stances sticking in the throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, Sec. taken in by the breath. This disease is sometimes epidemic and infectious. SYMPTOMS.—The inflammation of the throat is evident fiom in. spection, the parts appearing red and swelled; besides, the patient complains of pain in swallowing. His pulse is quick and hard, with other symptoms ofa fever. If blood be let, it is generally covered with a tough coat of a whitish colour, and the patient spits a tough phlegm. As the swelling and inflammation increase, the breathing and swallowing become more difficult; tbe pain affects the cars ; the eyes generally appear red ; and the face swells. The patient is often obli- ged to keep himself in an erect posture, being in danger of suffocation; there is a constant nausea, or inclination to vomit, and the drink, instead of passing into the stomach, is often returned by the nose. The patient is sometimes starved at last,'merely from an inability to swallow any kind of food. When the breathing is laborious, with straitness of the breast, and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy, there is not so much dan- ger. An external swelling is no unfavourable symptom ; but if it sud- denly falls, and the disease affects the breast, the danger is very great. When a quinsey is the consequence of some other disease, which has already weakened the patient, his situation is dangerous. A frothing at the mouth, with a swelled tongue, a pale, ghastly countenance, ana coldness of ihe extremities, are fatal symptoms. REGIMEN.—The regimen in thi> disease is in all respects the same as in the pleurisy, or peripneumony. The food must he light, and in small quantity, and the drink plentiful, freak, and diluting, mixed with acids. It is highly necessary that the patient be kept easy and quiet. Vio- lent affections of the mind, or great efforts of the body, may prove fatal. He should not even attempt to speak but in a low voice. Such a degree of warmth as to promote a constant gentle sweat, is proper. When the patient is in bed, his head ought to be raised a little higher than usual. It is peculiarly necessary that the neck be kept warm; for which purpose several folds of soft flannel may be wrap* round it. Thatalone wiil often remove aslight complaint of tlie throat, especially if applied in due time. We cannot here omit observing the propriety of a cus- tom which prevails among the peasants of Scotland. Wnen they feel any uneasiness of the throat, they wrap a stocking about it all night. So effectual is this remedy, that in many places it passes for ,Sf charm, and the stocking is applied with particular ceremonies: the custom however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief or a piece of flannel kept about it till tlie inflammation be removed. INFLAMMATION OF THE THROAft ihi The jelly of black currants is a medicine very much in esteem for complaints of the throat; and indeed it is of soincjAe. It should be almost constantly kept in the mouth, and svi^ioviSfd down leisurely. It may likewise be mixed in the patient's drink, dr taken any other way. When it cannot be obtained, tli',-jelly of fed currants, or of mulberries, may be used in its stead. Gargles for the throat are very beneficial. Tlicy may be made of sage-tea, with a little vinegar and honey, or by adding to half a pint of the pectoral decoction, two or three spqorisf.il of honey, and the same quantity of currant-jelly. This .may be used three or four times a-day ; and if the patient be troubled with a tough viscid phlegm, the gargle may be rendered more sharp and cleansing, by adding to it a tea-spoonful of the spirit of sal ammoniac Some recommend gargles made of a decoction of the leaves or bark of the black currant-bush ; but where the jelly can be had these are unnecessary. There is no disease wherein the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought therefore never to be neglected. If people were eareful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger ; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary. MEDICINE.—An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as tlie symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require. The body should likewise be kept gently open. This may either be done by giving the patient for his ordinary drink a decoction of figs and tamarinds, or small doses of rhubarb and nitre, as recommended in the erysipelas. These may be increased according to the age of the patient, and repeated till they have the desired effect. I have, often kuowu very good effects from a bit of salprunel, or puri- fied nitre, held in the mouth, and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, Sec. The throat ought likewise to be rubbed twice or thrice a-day with a little of the volatile liniment- Tins seldom fails to produce some good effects. At the same time the neck ought to be carefully covered with wool or flannel, to prevent tbe cold from penetrating the skin, as this application render* it very tender. Many other external applications are recommended in this disease^as a swallow's nest, poultices made of tlie fungus called Jew's ears, album Graecum, Sec. But as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no farther notice of them. Some recommend the gum-gnaiacum as a specific in this disease. Haifa drachm of the gum m pdwdcr may be made into an electuary with the rob of elder-berries, or the jelly of currants for u dose, and re» seated occasionally* Blisteringflup^n the neck or behind the ears in violent inflammations 'vjii tL"OatiSTcry beueficial; and iu bud .:^u it will be uccsssary to • Dr. Hrrarf Q 18-2 OF THE QUINSEY, &c. lay a blistering-plaster quite across the throat, so as to r*ach from ear to ear. After thetohisters are taken off, the parts ought to*be kept run- ning by the application of issue ointment, till the inflammation is gone; otherwise, upon their drying up, the patient will be in danger of a relapse. When the patient has been treated as above, a suppuration seldom happens. This however is sometimes the case, in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a tunnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig constantly in bis mouth. It sometimes happens, before the tumour breaks, that the swelling 3s so great, as entirely to prevent any thing from getting down into the stomach. In this case the patient must inevitably perish unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, Sec. Patients have often been supported by these for several days,, till the tumour has broke; and af- terwards they have recovered. Not only the swallowing, but the breathing, is often prevented by the tumour. In this case nothing can save the patient's life, but open- ing the trachea or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any directions about it. When a difficulty of swallowing is not attended with an acute pain op inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gar- gle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the ■pap of the throat, the falling down of the almonds of the ears, Sec. Ac- cordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c. all which practices are at best useless, and often hurtful. Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not choose to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought like- wise to beware of catching cold, and should abstain from aliment or medicines of an astringent or stimulating nature. Violent exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circulation of the blood towards it, to take care to cool gradually, and to wrap some additional covering about their necks. I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a ribband, or bit of flannel, constantly round their necks, or by wearing thicker -hoe«, a 'flannel waistcoat or the like. These may seem trifling, but they have OF THE MALIGNANT QUINSEY, &c 183 gTeat effect. There is danger indeed in leaving them off after persona have been accustomed to them; but surely the inconveniency of using such things for life, is not to be compared with the danger which may attend the neglect of them. Sometimes, after an inflammation, the glands of the throat continue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered daugerous by the too frequent applica- tion of strong stimulating and styptic medicines. The best method b to keep it warm, and to gargle it twice a-day with a decoction of figs, sharpened a little with the elixir or spirit of vitriol. OF THE MALIGNANT QUINSEY, OR PUTRID ULCEROUS SORE THROAT. THIS kind of quinsey is but little known in the northern parts of Britain, though, for some time past, it has been fatal in the more south- ern countries. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It pre- vails chiefly in autumn, and is most frequent after a long course of damp or sultry weather. j CAUSES.—This is evidently a contagious distemper, and is generally communicated by infection. Whole, families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder-, as by that means they endanger not ouly their own lives, but likewise those of tlieir friends and connexions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, &c. SYMPTOMS.—It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient complains great- ly of weakness and oppression of the breast; his spirit.- are low, aud he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, aud the face swells. The urine is at first pale and crude ; but, as the disease advances, it turns more ofa yellowish colour. The tongue is white, and generally moist, which distinguishes this from an inflammatory disease. Upon looking into the throat, it appears swelled, and ofa florid red colour. Pale or ash-coloured spots however are here and there interspersed, and some- times one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers. An efflorescence, or eruption upon the neck, arms,breast, and fingers, about the second or third day, is a common symptom*of this disease. When it appears, the purging and vomiting generally cease. There is often a slight degree of delirium, and the face frequently ap- pears bloated, and the inside of the nostrils red and inflamed.—The pa- tient complains of a disagreeable putrid smell, and his breath is very offensive. The putrid ulcerous sore throat may be distinguished from the inflam- matory, by the vomiting and looseness with which it is generally usher- ed in; the foul ulcers in the throat covered with a white or livid coat ; and by the excessive weakness of the patient; with other symptoms of a putrid fever. Unfavourable symptoms, are, an obstinate purging, extreme weak- 18i OF THE MALIGNANT OUINSEV, S.£ ness, dimness of the sight; a livid or black colour of the ?pota, and frequent shivenngs, with a weak fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour with a discharge of blood from the nose or mouth, the danger is very great. If a gentle sweat break out about the third or fourth day, and con*. tinue with a slow, firm, and equal pulse ; if the sloughs cast off in a fcindly manner, and appear clean and florid at the bottom ; and it' the breaming is soft and free, with a lively colour of the eyes, there is rea- son to hope for a salutary crisis. REGIMEN.—The patient must be kept quiet, and for the most part in bed, as he will be apt to faint when taken out of it.—His food must be nourishing and restorative ; as sago gruel with red wine, jellies, strong broths, Sec. His drink onght to be generous, and of an anti- septic quality : as red wine negus, white-wine whey, and such like. MEDICINE.—The medicine in this kind of quinsey is entirely dif- ferent from that wliich is proper in the inflammatory. All evacuations,, as bleeding, purging,&c. which weaken the patient, must be avoided. Cooling medicines, as uitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety ; and these ought never to be neglected. If at the beginning, there is a great nausea, or inclination to vomit, the patient must take an infusion of green tea, camomile flowers, or carduus benedictus, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit. If the disease is mild, the throat may be gargled with an infusion of sa<*e and rose leaves, to a gill of which may be added a spoonful or two of honey ; and as much vinegar as will make it agreeably acid ; but when the symptoms are urgent, the sloughs large and thick, and the breath very offensive, the following gargle may be used : To six,or seven ounces of the pectoral decoction, when boiling, add ha'.!'an ounce of contrayerva-root; let it boil for some lime, and alter. ward; strain the liquor ; to which add two ounces of white wine vine- gar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not onlv 'o be used as a gargle, but a little of it should fie- qucntly be injected with a syringe to clean the throat, before the pa- tient takes any meat or drink This method is peculiarly necessary for children who cannot use a gargle. It will be of u'icat benefit if the patient frequently receives into his mouth, through an iu.eited funnel, the steams of warm vinegar, inyrrb, and honey. But when the putri 1 symptoms run high, and the disease is attended with danger, the. only medicine that can be depended upon is the Peru- vianbark. It may be taken in substance, if the patient'- stomach will bear it. If not, an ounce of bark grossly powdered, with twodrachms of Virginian snake root, may be boiled in an English pint and a half of water to halfa pint; to which a tea-spoonful of the elixir of vitriol may be added, and an ordinary tea cupful of it taken every three or four hours. Blistering-plasters are very beneficial in this disease, especially when the patient's pulse and spirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck. Sliould the vomiting prove trouble-ome, it will be proper to give the patient two table-spoonsful of the saline jultp every hour. Tea made OP COLDS AND COUGH*. M of mint and a little cinnamon will be very proper for his ordinary drink, especially if an equal quantity of red wine be muted with it. In case of a violent looseness, the size of a nutmeg of diascordium, or the japonic confection, may be taken two or three times a day, or oftener if necessary. If a discharge of blood from the nose happens, the steams of warm vinegar may be received up the nostrils frequently ; and the.drink must be sharpened with spirits of vitriol, or tincture of roses. In case of a strangury, the body must be fomented with warm water, and emollient clysters given three or four times a-day. After the violence of the disease is over, the body should still be kept open with mild purgatives; as manna, senna, rhubarb, or the like. If great weakness and dejection of spirits, or night-sweats, with other symptoms ofa consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the elixir of vitriol, and to take frequently a glass of generous wine. These, togeth- er with a milk diet, and riding on horseback, are the most likely meads, for recovering his strength. CHAPTER XXXI. OF COLDS AND COUGHS. IT has already been observed, that colds are the effect of an obstructed perspiration j the common causes of which we have likewise endeavour- ed to point out, and shall not here repeat them. Neither shall we spend time in enumerating all the various symptoms of colds, as they are pretty generally known. It may not however be amiss to observe, that almost every cold is a kind of fever, which only differs in degree from some of those that have already been treated of. No age, sex, or constitution, is exempted from this disease; nepi ther is it in the power of any medicine or regimen to prevent it. The inhabitants of every climate are liable to catch cold, nor can even the greatest circum petition defend them at all times from its attacks. Indeed, if the human body could be kept constantly in an uniform degree of warmth, such i thing as catching cold would be impossi- ble ; but as that cannot be effected by any means, the perspiration must be liable to many changes. Such changes, however, when small, du not affect the health ; but, when great, they must prove hurt- ful. When oppression of the breast, a stuffing of the nose, unusual weari- ness, pain of the head, &c. give ground to believe that the perspiration is ob.- tructed, or, m other words that the person has caught cold, he ought immediately to les.-eu his diet, at least the usual quantity of his solid food, and to abstain from all strong liquors. Instead of flesh, fi-bjCiigs, milk, and other nourishing diet, he may eat light bread pud- ding, veal or chicken broth, panado, gruels, and such like. His drink may be water gruel sweetened with a little honey; an infusion of balm or linseed, sharpened with the juice oforange or lemon ; a decoc- tion of barley and liquorice, with tamarinds, orany other cool, diluting, acid liquor. Above all, his supper should be light; as small posset, or water-gruel sweetened with honey, and a little toasted bread hut. If honey should disagree vrith the stomach,the gruel nay be sweetened with treacle ot coarse sugar, and sharpened with t»ie jel'y of currants. Those who |S6 OF COLDS AND COUGHS have been accustomed to generous liquors may take wine-whcy in- stead of gruel, which may be sweetened as above. The patient ought to lie longer than usual a-bed, and to encourage a gentle sweat, which is easily brought on towards morning, !<; drinking tea, or any kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which, in all probability, had it bneit neglected, would have cost the patient his life, or have confined him for some months. Would people sacrifice a little time to ease and warmth, and practise a moderate degree of abstinence when the first symptoms ofa cold appear, we have reason to believe that most of the bad effects which flow from an obstructed perspiration might be pre- vented. But, after the disease has gathered strength by delay, all at- tempts to remove it often prove vain. A pleurisy, a peripneumo- ny, or a fatal consumption of the lungs, are the common effects of colds which have either been totally neglected, or treated improperly. Many attempt to cure a cold, by getting drunk. But this, to sav no worse of it, is a very hazardous experiment. No doubt it may sometimes succeed, by suddenly restoring the perspiration; but when there is any degree of inflammation, which is frequently the cafe, strong liquors, instead of removing the malady, will increase it. ru- tins means a common cold may be converted into an inflammatory fever. When those who labour for their daily bread have the misfortune to catch cold, they cannot afford to lose a day or two, in order to keep them- selves warm, and take a little medicine ; by which means the disorder is often so aggravated as to coufine them for a long time, or even to render them ever after unable to sustain hard labour. But even snch of the labouring poor as can afford to take care of themselves, are often too hardy to do it; they affect to despise colds, and as long as thry can crawl about, scorn to be confined by what they call a common cold. Hence it is, that cojds destroy such numbers of mankind. Like an enemy despised, they gather strengh from delay, till at length they become invincible. We often see this verified in travellers, who, ra- ther than lose a day in the prosecution of their business, throwanay their lives by pursuing their journey, even in the severest weather, with this disease upon them. It is certain however, that colds may be too much indulged.— When a person for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion snch a general relaxation of the solids as will not be easily removed. It will therefore be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercise; as walking, riding on horseback, or in a carriage, Sec. An obstinate cold which no medicine can remove, will yield to gentle exercise, and a proper regimen of the diet. Bathing the feet and legs in warm water has a great tendency to re- store the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warm- er than the btood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will sooner take off a spasm, and restore the perspiration, than all the hot sudorific medicines hi tlie world. This is all that is necessary for removing a common cold; anil if this course be taken at the beginning, it will seldom tail. OF A COMMON COUGH. 1ST But when the symptoms do not yield to abstinence, warmth, and di- luting liquors, there is reason to fear the approach of some other dis- ease, as an inflammation of the breast, an ardent fever or the like. If the pulse therefore be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be. necessary to bleed, i-.nd to give the cooling powders recommended in the scarlet fever eve- ry three or four hours, till they give a stool. It v. ill likewise be proper to put a blistering-plaster on the back, to give two table-spoonsful of the saline mixture every two hour:-, and iu short, to treat the patient hi all respects, as for a slight fever. I have often seen this course, when observed at the beginning, remove the complaints in two or three days, when the patient had all the symp- toms of an approaching ardent fever, or an inflammation of the breast. The chief secret of preventing colds, lies in avoiding, as far as possi- ble, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treated of under the arti- cle Ohstructed Perspiration, that it is needless here to resume the consi- deration of them. OF A COMMON COUGH. A COUGH is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obstinate, there is always reason to fear the consequences, as this shews a weak state of the lungs, and is often the forerunner of a consumption. If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper; but in weak and relaxed habits, bleeding rather prolongs the disease. When the patient spits free- ly, bleeding is unnecessary, aud sometimes hurtful, as it tends to lessen tiiat discharge. When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be adminis- tered, as gum ammoniac, squills, &c. Two table-spoonsful of the su- lution of gum ammoniac may be taken three or four times a-day, more or less, according to the age and constitution of the patient.—Squills may be given various ways ; two ounces of the vinegar, the oxymel, or the syrup, may be mixed with the same quantity of simple cinnamon water, to winch may be added an ounce of common water and an ounce of balsamic syrup. Two table-spoonfuls of this mixture may be taken three or four times a-day. A i-vrupmade of equal parts of lemon-juice, honey, and sugar-candy, is likewise very proper iu this kind of cough. A table-spoonful of it may be taken at pleasure. But when the defluxion is sharp and thin, these medicines rather do hurt. In this case gentle opiates, oils, and mucilages are more proper. A cup of an infusion of wild poppy leaves, aud marsh-mallow roots or the flowers of colts-foot, may be taken frequently ; or a tea-spoonful of the paregoric elixir may be put into the patient's drink twice a-day. Fuller's Spanish infusion is also a very proper medicine in this case, and may be taken in the quantity ofa tea-cupful three or four times When a cou"h is occasioned by acrid humours tickling the throat and fauces the patfent should keep some soft pectoral lozenges, almost con- stantly in his mouth; as the Pontrefact liquorice cakes, barley-sugar, * See Appendix, Spanish Infwiov. 1*8 OF A COMMON COUGH. the common bal-amic lozenges, Spanish juice, &r. These blunt the acrimony of the humours, and by taking of their stimulating quality, help to appease tlie cough.* In obstinate coughs, proceeding from a flux of humours upon the lungs, it will often be necessary, besides expectorating medicines, to have recourse to issues, setons, or some other drain. In this case I have of- ten observed the most happy effects from a Burgundy-pitch plaster. applied between the shoulders. I have ordered this simple remedy in the most obstinute coughs, in a great number of cases, and in many. different constitutions, without ever knowing it fail to give relief, unless where there were evident signs of an ulcer in the lungs. About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a piece of soft leather, about the size of the hand, and laid between the shoulder-blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap anil simple medicine, and consequently apt to be despised ; but we will venture toafhrm, that the whole materia medi. ca does not afford an application more efficacious in almost every kind of cough. It has not indeed always an immediate effect; but, if kept on for some time, it w ill succeed where most other medi'-ines fail. The only inconveniency attending this plaster is the itching which it occasions ; but surely this may be dispensed with considering the ad- vantage wliich the palien' may expect to reap from the application; besides, when the itching becomes very uneasy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed with a little warm milk and water. Some caution indeed is necessary in discontinuing tbe use of such a plaster; this however may be safely done by making it smaller by degrees, and at length quitting it al together in a warm season.t But coughs proceed from many other causes besides defluxions upon the lungs. In these cases the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from a foulness and debility of the stomach, syrups, oils, mucilages, and all kinds of balsamic medicines do hurt. Tlie stomach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient courIis t whenever he inspires, or draws in his breath fully ; but in the former 1 that does not happen. * 'ihe cure of this cough depends chiefly upon cleansing and strength- ening the stomach ; for which purpoi-e gentle vomits and bitter purga- tives are most proper. Thus, after a vomit or two, the sacred tincture* as it is called, may be taken for a considerable time in the dose of one or two table-spoonsful twice a-day, or as often as itisfotindnere^ui'y, to keep the body gent'y open. People may make this tincture them- selves, by infusing an ounce of hierapicrai m ah English pint of white * wine, letting it stand a few days, and then straining it. • In a former editian of this book 1 recommended, for an obstinate tickling cor ?h, an oily emulsion, made with the paregoric elixir of the Edinburgh dispi nsatcry. injh.au ol the common alk. line spirit. I have since been told by several pnictitioiiers, that they found it to !k an excellent m< dicine in this disord r, and rvery v»a\ deserving of the rharactrr which I had given it. Where this elixir is not kept, its place may be supplied by adding to the common oily emulsion, an adequate proportion of tlie TheJiat timtuie,or liquid laudai.um. t Some complain that tht pitch-plaster adheres too fast, while others find difficulty ' in keeping it on. This proceeds fioni the different kinds ofpiich n ade use of, unu i tiki wise from the maimer of making it. I g.ntvall) find it answers best whm niiittd with a little btes-v ax, and spread as cool as possible the clear, hard, iraiisomtat sitch answi rs tin- purpos test. % See Appendix, Hkra i'i'.ra. OP TflE HOOPING COUGrt. i& tn couchs which proceed from a debility of the stomach, the Peruvr- an bark is likewise of considerable service. It may either be chewed, taken in powder, or made itito a tincture along with other stomachic bitters. A nervous cough can only be removed by change of air and proper exercise ; to wliich may be added the use of gentle opiates.—Instead ■A' the saponaceous pill, the paregoric elixir, Sec. which are only opium disguised, ten, fifteen, twenty, or twenty-five drops of liquid lauda- num, more or less, as circumstances require, may be taken at bed- time, or when the cough is most troublesome. Immersing the feet and hands in warm water will often appease the violence ofa nervons cough. When a cough is only the symptom of some other malady, it is nt vain to attempt to remove it without first curing the disease from wliich it proceeds. Thus when a couuti is occasioned by teething, keeping the body open, scarifying tiie gums, or whatever facilitates ihe cutting of the teeth, likewise appeases the cough. In like manner, when worms occasion a cough, such medicines as remove these vermin will generally cure the cough; as bitter purgatives, oily clysters, and such like. Women, during the last months of pregnancy, are often greatly afflicted with a cough, wliich is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose easy dress. A cough is not only m symptom, but is often likewise the forerunner of diseases. Thus, tlie gout is frequently ushered in by a very trouble- some cough, which affects the patient for some days before-the coming on of ihe fit. This cough is generally removed by a paroxysm of the £0111, which should therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in Inke-warm water. OF THE HOOPING-COUGH, OR CIIIN-COl'GH. This cough seldom affects adults but proves often fatal to chil- dren. Such children as live upon thin watery diet, who breathe un- wholesome air, and have too little exercise, are most liable to this disease, and generally suffer most from it. The chin-cough i»so well known, even to nurses, that a description of it is unnecessary. Whatever hurts the digestion, obstructs the pers- piration, or relaxes the soids. disposes to this disease; consequently its cue must depend upon clean-sing ami strengthening the sto- mach, bracing the solid-, and at the same time promoting perspiration, and the different secretions. The diet must be light and of easy digestion; for children, good bread made into pap or pudding*, chicken-broth, with other light spoon- meats, are proper; but those who are farther advanced, may be allow- ed sago-gnu-1, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyssop, or penny-royal tea, sweetened with honey or sugar-candy, small wine-whey, or if the pa- tient be weak, lie may sometimes be allowed a little negus. One of the most effectual remedies in the chin-cough is change of air. Tins oficn removes the malady, even when the change seems to be from a purer to a less wholesome an. This may in some measure depend on the patient's being removed from the place, wnere the infection prevails. Most of the diseases of children are infectious; nor is it at all uncom- mon to find the chin-cough prevailing in one town or ullage, when an- XatV * OF THE HOOPING COUGH. other, at a very small distance, is quite free from it. But whatever be the cause, we are sure of tlie fact. No time ought therefore te be lost in removing the patient at some distance from the place where he caught the disease, and, if possible, into a more pure and warm air.* When the disease proves violent, and the patient is in danger of be- ing suffocated by the cough, he ought to be bled, especially if there be a fever with a hard full pulse. But as the chief intention of bleeding is to prevent an inflammation of the lungs, and te render it more safe to give vomits, it will seldom be necessary to repeat the operation; yet if there are symptoms of an inflammation of the lungs, a second or even a third bleeding may be requisite. It is generally reckoned a favourable symptom when a fit of cough- ing makes the patient vomit. This cleanses the stomach, and greatly relieves the cough. It will therefore be proper to promote this dis- charge, either by small doses of ipecacuanha, or the vomiting julep re- commended in the Appendix.t It is very difficult to make children drink after a vomit. I have of- ten seen them happily deceived, by infusing a scruple or half a drachm of the powder of ipecacuanha in a tea pot, with half a pint of boiling water. If this be disguised with a few drops of milk and a little su- gar, they will imagine it tea, and drink it very greedily. A small tea- cupful of this may be given every quarter of an hour, or rather every ten minutes, till it operates. When the child begins to puke, there will be no occasion for drinking any more, as the water already on the stomach will be suffi- cient. Vomits not only cleanse the stomach, which in this disease is gene- rally loaded with viscid phlegm, but they likewise promote the perspi- ration and other secretions, and ought therefore to be repeated ac- cording to the obstinacy of the disease. They should not however be strong; and gentle vomits frequently repeated are both less dangerous, and more beneficial than strong ones. The body ought to be kept gently open. The best medicines for this purpose are rhubarb and its preparations, as the syrup, tincture, cvc. Of these a tea-spoonful or two may be given to an infant twice or tlince a-day, as there is occasion To such as are farther advanced, the dose must be proportionally increased, aud repeated till it has the desired effect. Those who cannot be brought to take the bitter tincture, may have aninfusiOii of senna and prunes, sweetened with manna, coarse su- gar, or honey or a few grains of rhubarb mixed with a tea-spoonful or two of syrup, or currant jelly, so as to disguise the taste. Mostehil- dren are fond of syrups and jellies, and seldom refuse even a disagreea- ble medicine when mixed with them. Many people believe that oily, pectoral, and balsamic medicines pos- sess wonderful virtues for the cure of the chin-cough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that every thing of this nature must load the sto- mach, hurt the digestion, and of course aggravate the disorder. J * Some think the air ought not to be changed till the disease is on the decline; but there stems to be no sufficu ut reason for this opinion, as patients have bi en known to reap benefit from a change of air at all periods of the disease. It is not sufficient to take the patient out daily in a carriage. This seldom answers any good purpose; but ofttn dots hurt, by giving him cold. t See Appendix, Vomiting Julep. t Dr. Duplunil says, he has seen many good pfftctsfrom t ;? kermes mineral in this pomnlai.it, the cough being frequently alleviated cyeu by tK: first dose. Theda»« INFLAMMATION OP THE STOMACH, &c. lgi Tlie millepedes, or wood-lice, are greatly recommended for the cure of a chin-cough. Those who chuse to make use of these insects, may infuse two ounces of them bruised in a pint of small white-wine for one night. Afterwards the liquor may be strained through a cloth, and a table-spoonful of it given to the patient three or four times a-day. Opiates are sometimes necessary to allay the violence of the cough. For this purpose a little of the syrup of poppies, or five, six, or seven drops of laudanum, according to the age of the patient, may be taken in a cup of hyssop or penny-royal tea, and repeated occasionally.* The garlic ointment is a well-known remedy in North Britain for the chin-cough. It is made, by beating in a mortar, garlic, with an equal quantity of hog's lard. With this the soles of the feet may be rubbed twice or three a day ; but the best method is to spread it upon a rag, and apply it in the form of plaster. It should be renewed every night and morning at least, as the garlic soon loses its virtue. This is an ex- ceeding good medicine both in the chin-cough,t and in most other coughs of an obstinate nature. It ought not however to be used when the patient is very hot or feverish, lest itshould increase these symptoms. The feet should be bathed once every two or three days in lukewarm water; and a Burgundy-pitch plaster kept constantly between the shoulders. But when the disease proves very violent, it will be neces- sary, instead of it, to apply a blistering-plaster, aud to keep the part open for some time with issue-ointment. When the disease is prolonged, and the patient is free from a fever, the Peruvian bark, and other bitters, are the most proper medicines. The bark may either be taken in substance, or iu a decoction or infu- sion, as is most agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a- day. For an adult, half a drachm or two scruples will be proper. Some give the extract of the bark with cantharides; but to manage this requires considerable attention. It is more sate to give a few grains of castor along with the bark. A child of six or seven years of age may take seven or eight grains of castor, with fifteen grains of powdered bark, for a dose. This may be made into a mixture with two or three ounces of any simple distilled water, and a little syrup, and taken three or four times a-day. CHAPTER XXXII. INFLAMMATION OF THE STOMACH, AND OTHER VISCERA. ALL inflammations of the bowels are dangerous, and require the most speedy assistance ; as they frequently end in a suppuration, and some- times in a mortification, which is certain death. CAUSES.—An inflammation of the stomach may proceed from any of the causes which produce an inflammatory fever; as cold liquor for a child of one year old, is a quarter of a grain dissolved in a cup of any liquid, re* pcatul two or three times a-day. For a child of two ytars the dose is half a grain; and tlie quantity must be thus increased in proportion to the age of the patient. * Some recommend the i xtract of hemlock as an extraordinary remedy in the hooping- roiigh ; butio far a* I hare been able to obserre, it is no way superior to opium, which, when properly admiuistertd, will often reliev someof the most troublesome symptoms Of tli is disorder. t As this disi as is e< identlj spasmodic, I am inclined to think, that tonic medicinei wiUin time bo found the most proper tor iu cure. K» INFLAMMATION OF THE STOMACH, 6eC drank while the body is warm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimo- ny of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and suchlike. When the gout has been repelled from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach. Hard or indigestible substances taken into the stomach, as bones, the stones of fruit, &c. may likewise have that effect. SYMPTOMS.—It is attended with a fixed pain and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or, at least, a nausea and sickness; excessive thirst; ooldness of the extremities; difficulty of breathing; cold clammy sweats; and sometimes convulsions and faintingfits. The stomach is swelled, and often feels hard to the touch. One of tbe most certain eigns of this disease, is tlie sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or top cold. When the patient vomits every thing he eats or drinks, is extremely restless, has a luckup, with an intermitting pulse, and frequent fainting fits, the danger is very great. REGIMEN.—All acrimonious, heating and irritating food and drink, are carefully to be avoided. The weakness of the patient may deceive the bystanders, and induce thein to give wines, spirits, or other cordials; but these never fail to increase the di-easi, and often occasion sudden death. The inclination to vomit may like- wise impose on the attendants, andmake them think a vomit necessary; l>ut that too is almost certain death. The food must be light, thin, cool, and easy of digestion. It mu^ be given in small quantities, and should neither be quite cold, not) too hot. Thus gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are the most proper. The drink should be clear whey, barley-water, water in which toasted bread has been boiled, or decoctions of emollient vegetables, as liquorice and marsh-mallow roots, sarsaparilla, or the like. MEDICINE.—Bleeding in this disease is absolutely necessary, and is almost the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times, nor must the low state of the pulse deter us from doing so. Tlie pulse indeed generally rises upon bleeding, and as long as that is the case, the operation is safe. Frequent fomentations with lukewarm water, or a decoction of emol« silent vegetables, are likewise beneficial. Flannel cloths dipped in these must be applied to the region of the stomach, and removed as they grow cool. They must neither be applied too warm, nor be suffered to continue till ihey become quite cold, as either of these extremes vvould aggravate the disease. The feet and leys ought likewise to be frequently bathed in luke« Warm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used will be of great service. In this and all otiier inflammations of the bowels, an epispastie; or blistering-plaster, applied over the part affected, is one of the best rem- edies I know. I have often used it, and do not recollect one instance vrhereiu it did not give relief to the patient. TLe oul> internal medic.hies which we shall venture to recommend INFLAMMATION OF THE INTESTINES I9,V in this disease, are mild clysters. These may be made of warm water, or thin water gruel; and if the patient is costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food upon his stomach. For these reasons they must not be neglec- ted, as the patient's life may depend on them. INFLAMMATION OF THE INTPSTINES. This is one of the most painful and dangerous diseases that mankind is liable to. It generally proceeds from the same cause as the inflamma- tion of the stomach ; to which may be added costiveness, worms,eating unripe fruits ; or great quantities of nuts, drinking hard windy malt li- quors, as stale bottled beer or ale, sour wine, cyder, Sec. It may like- wise be occasioned by a rupture, by schirrous tumours of tbe intestine?. or by their opposite sides growing together. The inflammation of the intestines is denominated Iliac passion, Em- teritis, Wc. according to the name of the parts affected. The treat- ment however is nearly the same whatever part of the intestinal canal be the seat of the disease ; we shall therefore omit these distinctions, lest they should perplex tlie reader. The symptoms here are nearly the same as in the foregoing disease, only the pain, if possible, is not so acute, and is situated lower. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters, are discharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine. While the pain shifts, and the vomiting only returns at certain inter- vals, and while the clysters pass downwards, there is ground for hope; but when the clysters and faces are vomited, and the patieut is ex- ceeding weak, with a low fluttering pulse, a pale countenance, and a disagreeable or stinking breath, there is great reason to fear that the consequences will prove fa'al. Clammy sweat, black ftetid stools, with a small intermitting pulse, and a total cessation of pain, are signs ofa mortification already begun, and of an approaching death. RIXJIMEN.-—The regimen in this disease is in general the same aa in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities; his drink weak and dilu- ting ; as clear whey, barley-water, and such like. MEDICINE.—Bleeding in this, as well as in the inflammation of the stomach, is of the greatest impoi tance. It should be performed as soon as the symptoms appear, and must be repeated according to the strength of the patient, and the violence of the disease. A blistering plaster is here likewise to be applied immediately over the part where the most violent pain is. f his not only relieves the pain of the bowels; but even clysters and purgative medicines, which before had no effect, will operate when the blister begins to rise. Fomentations aud laxative clysters are by no means to be omitted. The patient's feet and legs sliould frequently be bathed in warm water; and cloths dipped into it applied to his belly. Bladders filled with warm water may likewise be applied to tiie region of the naval, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of barley-water or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered eVery two or three hours, or oftener, if the patient continues costive 194 INFLAMMATION OF THE INTESTINES. If the disease does not yield to clysters and fomentations, recourse must be had to pretty strong purg.itives: but as these, by in itaring the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary to join them with opiates, which by allaying the pain, and relaxing the spasmodic .contractions of the guts, greatly assist the operation of purgatives in this case. VVhat answers the purpose of opening the body very well, is a solu- tion of the bitter purging salts. Two ounces of these may be dissolved in an English pint of warm water, or thin gruel, and a tea-spoonful of it taken every half hour till it operates. At the same time fifteen, twen- ty, or twenty-five drops of laudanum may be given in a glass of pepper- mint or simple cinnamon-water, to appease the irritation, and prevent the vomiting, Sec. Acids have often a very happy effect in staying the vomiting, and ap- peasing the other violent symptoms of this disease. It will therefore be of use to sharpen the patient's drink with cream of tartar, juice of lemon ; or, when these cannot be obtained, with vinegar. But it often happens that no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well: Take jalap in powder, and vitriolated tartar, of each halfa drachm, opium one gram, Castile feoap as much as will make the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated. If a stool cannot be procured by any of the above means, it will be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immersion has not the desired effect, it may be repeated as soon as the patient's strength and spirits are recruited. It is more safe for him to go frequently into the bath, than to continue too long at a time, and it is often necessary to repeat it several times before it has the desired effect. It has sometimes happened, after all other means of procuring a stool had been tried to no purpose, that this was brought about by im- mersing the patient's lower extremities in cold water, or making him walk on a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is indeed atteuded with some danger; but a doubtful remedy is better than none. In desperate cases it is common to give quicksilver. This may be given to tbe quantity of several ounces, or even a pound, but should not exceed that.* When there is reason to suspect a mortification of the guts, this medicine ought not to be tried. Iu that case it cannot cure the patient, and will only hasten his death. But when the ob- struction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can he ad- ministered, as it is the fittest body we know for making its way through the intestinal canal. If the disease proceeds from a rupture, the patient must belaid with his head very low, and the intestines returned by gentle pressure with * When quicksilver is given in too large quantities, it defeats its a*m intention, as itdrags down the bottom of the stomach, which prevents its getting ovir the Pylorus. In this cast- the patient should be hung up by the heels, iu order that tlie quicksilver may be discharged by his mouth. *? OF THE COLIC. 1J35 the hand. If this, with fomentations and clysters, sliould not succeed, recourse might be had to a surgical operation, which may give the patient relief. J b Such as would avoid this excruciating and dangerous disease, must take care never to be too long without a stool. Some who have died of it have had several pounds of hard dry faxes taken out of their guts. They should likewise beware of eating too freely of sour or unripe fruiis, or drinking stale windy liquors, &c. I have known it brought on by living too much on baked fruits, which are seldom good. It like- wise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet. OF THE COLIC. THE colic has a great resemblance to the two preceding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and acute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c. Colics are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, Sec. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for tlieir relief. The flatulent, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meatsof hard digestion, windy vegetables, fermen- ting liquors, and such like. It may likewise proceed from an obstruct- ed perspiration, or catching cold. Delicate people, whose digestive powers are weak, are most liable to this kind of colic. The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his guts, and is generally relieved by a discharge of wind, either upwards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another till it finds a vent. When the disease proceeds from windy liquor, green fruit, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels. This is the only colic wherein ardent spirits, spiceries, or any thing ofa hot nature may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflamma- tion appear. We have reason to believe, that a colic occasioned by wind or flatulent food might always be cured by spirits, and warm li- quors, if they were taken immediately upon perceiving the first un- easiness ; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines. Sever.il kinds of food, as honey, eggs, Sec. occasion colics in some particular constitutions. I have generally found the best method of cure for these, was to drink plentifully of small diluting liquors, as wa- ter-gruel, small posset, water with toasted bread soaked in it, <&c. Colics which proceed from excess and indigestion generally cure themselves by occasional vomiting or purging. These discharges are by no means to be stopped butpromoted by drinking plentifully of warm OF THE COLIC. water, or weak posset. When their violence is over, the patient may fake a dose of rhubarb, e; any other gentle purge, to cany off the dregs of his debauch. • \ilics which are occasioned by wet feet, or catching cold, may gen- : rally be removed at the beginning, by bathing the feet and legs m warm water, and drinking such diluting liquors as will promote the perspiration, as wcali-wlie;-, or water-gruel, with a small quantity of pirits iu it. These flatulent colics, which prevail so much among country peo- ple, might generally be prevented were they careful to change their clothes when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram drinking, but in this cuie ardcut spirits prove a real medicine, and indeed the best that can be administered. A gla.-s of irood peppermint-water will have nearly the same effect as a glass of brandy, and in some cases is father to be preferred. The bilious colic i3 attended with very acute pains about the region of the naval. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow coloured bile-, which being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propen- sity to vomit sometimes increases so as to become almost continual, and the proper motion of the intestines is so far perverted, that there are all the symptoms of impending iliac passion. If the patient be young and strong, and the pulse full and frequent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream ot tartar, must be drank freely. Small chicken broth, with a little man- na dissolved in it, or a slight decoction of tamarinds, are likewise rery proper, or any other thai, acid, opening liquor. Besides bleeding and plentiful dilution, it will be necessary to fo- ment the belry with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water. In the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice treacie may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered. The hysteric colic bears a great resemblance to the bilious. It is attended with acute pain- about the region of the stomach, vomiting, &c. What the patient vomits in this case is commonly ofa greenish colour. There is a great sinking of the spirits, with dejection of mind and difficulty of breathing, which are the characteristic symp- toms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days. In this colic all evacuations, as bleeding, purging, vomiting, Sec. do hurt. Every thing that weakens tiie patient, or sinks the spirits, is to be avoided. If however the vomiting should prove violent, luke- warm water, or small posset, may be drank to cleanse the stomach. OF THE COLIC 197 Afterwards the patient may take fifteen, twenty, or twenty-five drops ot liquid laudanum in a glass of cinnamon-water. This may be repeat- ed every ten or twelve hours till the symptoms abate. The patient may likewise take four or five of the foetid pills every six hours, and drink a cup of penny-royal tea after them. f asafce- tida should prove disagreeable, which is sometimes the case, a tea- spoonful of the tincture of castor in a cup of penny-royal tea, or thir- ty or forty drops of the balsam of Peru dropped upon a bit of loaf-su- gar, may be taken in its stead. The anti-hysteric plaster may also be used, which has often a good effect.* The nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, cvc. It is very common in the cyder counties of Eng'and, and is supposed to be occasioned by the leaden vessels used in preparing that liquor. It is likewise a frequent disease in the. West-Indies, where it is termed the dry belly-ache. No disease of the bowels is attended with more excruciating pain than this. Nor is it soon at an end. I have known it contiuue eight or ten days with very little intermission, the body all the while contin- uing bound in spite of medicine, yet at length yield, and the patient recover.t It generally however, leaves the patient weak, and often ends in a palsy. The general treatment of this disease is so nearly the same with that of the ilhac passion, or inflammation of the guts, that we shall not in- sist upon it. The body is to be opened by mild purgatives given in small doses, and frequently repeated, and then operation must be as- sisted by soft oily clysters, fomentations, tic. The castor-oil is reck- oned peculiarly proper in this disease. It may both be mixed with the clysters and given by the mouth.:): The Barbadoes tar is said to be an efficacious medicine in this com- plaint. It may be taken to the quantity of two drachms three times a-day, or ofteuer if the stomach will bear it. This tar, mixed with an equal quanti'.y of strong rum, is likewise proper for rubbing the spine in case any tingling or other symptoms of the palsy, are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits or a Uttle oil of nutmegs, or of rosemary. If the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peruvian bark in wine. When the disease ends in a pahy, the Bath-waters are found to be extremely proper. To avoid this kind of colic, people must shun all sour fruits, acids, and austere liquors, Sec. Thore who work in lead ought never to go to their business fasting, and their food should be oily or fat. They may take a glass of salad oil, with a little brandy or rum, every morning, but should never take spirits alone. Liquid aliment is best for them • as fat broths. Sec. but low living is bad. They should frequently go' a little out of the tainted air; and should never suffer themselves to be costive. In tlie West-Indies and on the coast of Guinea, it has been found of great \ise for preventing this colic, to wear a piece of flan- nel round the waist, and to drink an infusion of ginger by way of tea. • See appendix, Anti-Hysteric Plaster. t As the smoke of tobacco throw n into the bowels will often procure a stool when all other means have failed, an apparat us for this purpose ought to be kept by every sur- teon. It may be purchased at a small expense, and will be of service in several "other cases, as the recover) of drowm-d persons, &c. t The dose is from one table-spoonful to two or three, if nect ssary to open the hody. R2 105 INFLAMMATION OP THE KIDNEYS. Sundry other kinds of this disease might be mentioned, but too many 1 distinctions would tend only to perplex the reader. Those already mentioned are the most material, and should indeed be attended to, as their treatment is very different. But even persons who are not in a condition to distinguish very accurately in these matters, may never- theless be of great service to patients in colics of every kind, by only observing the following general rules, viz. To bathe the feet and legs in warm water ; to apply bladders filled with warm water, or cloths wrung out of it, to the stomach and bowels ; to make the patient drink freely of diluting mucilaginous liquors; and to give him an emol- lient clyster every two or three hours. Should these not succeed, tbe patient ought to be immersed in warm water. INFLAMMATION OF THE KIDNEYS CAUSES.—This disease may proceed from many of those causes which produce an inflammatory fever. It may likewise be occasioned by wounds or bruises of the kidneys ; small stones or gravel lodging within them ; by strong diuretic medicines, as spirits of turpentine, tincture of cantharides, &c. Violent motion, as hard riding or walk- ing, especially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occasion the malady. It may likewise proceed from lying too soft, too much on the back, involuntary con- tractions, or spasms in the urinary vessels, &c. SYMPTOMS.—There is a sharp pain about the region of the kidneys, vvith tome degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards ofa red- dish colour ; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most case on the affected side, and has generally a nausea or vomiting, resembling that which happens in the colic. This disease however may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine with which it is constantly attended. REGIMEN.—Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank ; as clear whey, or balm-tea sweetened with honey, decoction of inarsh-mallovv roots : with barley and liquorice, Sec. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the ob- structing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain. MEDICINE.—Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet, and if the pain and inflammation continue, the operation may 1 e repeated in twenty-four hours, especially if the patient he of a full habit. Leeches may likewise be applied to the hemorrhoidal veins, as a discharge from these will greatly relieve the patient. "' ^ Cloths dipped in warm water, or bladders filled with-it, must be ap- plied as pear as possible to the part affected, and renewed as they grow cool. If tbe bladders be filled with a decoction of mallows and cam- rf INFLAMMATION OF THE BLADDER. VJ) omile flowers, to wliich n little saffron is added, and mixed with about a third part of new milk, it will be still more beneficial. Emollient clysters ought frequently to be administered; and if these do not open the body, a little salt and honey or manna may be. added to them. The same course is to be followed where gravel or stone is lodged in the kidney, but when the gravel or stone is separated from the kidney, and lodges in the Ureter,* it will be proper, besides the fomentations, to rub the small of the back with sweet oil, aud to give gentle diu- retics ; as juniper-water, sweetened with the syrup of marsh-mallows : a tea-spoonful of the sweet spirits of nitre, with a few drops of lauda- num, may now and then be put in a cup of the patient's drink. He ought likewise to take exercise on horse-back, or in a carriage, if he be able to bear it. When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of dullness, shivering, &c. there is reason to sus- pect that matter is forming in the kidney, and that an abscess will ensue. When matter in the urine shews that an ulcer is already fornjed in the kidney, the patient must be careful to abstain from all acrid^isour and salted provisions, and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley, and common pot-herbs, Sec. His drink may be whey, and butter milk that is not sour. The latter is by some reckoned a specific reme- dy in ulcers of the kidneys. To answer this character however, it must be drank for a considerable time. Chalybeate waters have like- wise been found beneficial in this disease. This medicine is easily obtained, as it is found in every part of Great-Britain. It must like- wise be used for a considerable time, in order to produce any salutary effects. Those who are liable to frequent returns of inflammation, or ob- structions of the kidneys, must abstain from wines, especially such as abound with tarter ; and their food ought to be light, and of easy diges- tion. They should use. moderate exercise, and should not lie too hot, nor too much on their back. INFLAMMATION OF THE BLADDER. The inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a per- petual desire to make water. This disease must be treated on the same principles as the one im- mediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very pfoper at the beginning, and in robust constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented with warm water, or a de- coction of mild vegetables; and emollient clysters ought frequently to be administered, e, as well as in all other topical inflammations, ought to drink nothing that is colder than the blood. If the stools should »e loose, and even streaked with blood, no menus must be used to stop them, unless they be so frequent as to weaken the patient. Loose stools often prove critical, and carry off the disease. I fan abscess or imposthume is formed in tbe liver, all methods should be tried to make it break and discharge itself outwardly, as fo- mentations, the application of poultices, ripening cataplasms, &c —« So'ne:imes indeed the matter of an abscess conies away in tbe urine, and sometimes it is discharged by stool, but these are efforts of nature which no means can promote. When the abscess bursts into the cavity of the abdomen at large, death must ensue, nor will the. event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the peritonaum, so as to form a bag for the matter, and prevent it from falling into the cavity of the ubdomen; in which case opening the abscess by a sufficiently large incision will pro- bably save the patient's life.* If the disorder, in spite of all endeavours to the contrary, should end iu a scirrhus, the patient must be careful to regulate his diet, Sec. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly seasoned er salted provisions; but should, tor the most part, live on mild vegetables; as fruits and roots; taking gentle exercise, and drinking whey, barley-water, or but- ter-milk. If he takes any thing stronger, it should be fine, mild ale, which is less heating than wines or spirits. We shall take no notice of inflammations of the other viscera.—They must in general be treated upon the same principles, as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thing that is strong, or of a heating nature, to apply warm fomentations to the parts affected, and to cause the patient tt. drink a sufficient quantity of warm diluting liquors. * I know a gentleman who bad several abscesses of the liver opened, and is now a. strong and healthy man, though above eighty years of ac;e. 202 OF THE CHOLERA MORBUS, Ac CHAPTER XXXIII. OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH AND BOWELS. IHE cliolera morbus is a violent purging and vomiting, attended with gripes, sickness, and a constant desire to go to stool It conies on sud- denly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used iu due time for removing it. CAUSES.—It is occasioned by a redundancy and putrid acrimony of the bile ; cold; food that easily turns rancid or sour on the stomach ; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold fuiits.* It is sometimes the effect of strong acrid purges or vo- mits, or of poisonous substances taken into the stomach. It may like- wise proceed from violent passions or affections of the mind; as fear, anger, &c. SYMPTOMS.—It is generally preceded by a eardialgia, or heart- burn, sour-belcliings, and flatulencies, with pain of the stomach and in- testines. To these succeed excessive vomiting and purging of green, yellow, or blackish coloured bile, with a distension of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks so low as to become quite imperceptible, the extremities grow cold or cramp- ed, and are often covered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, .fainting, and convulsions, are the signs of approaching death. MEDICINE.—At the beginning of this disease, the efforts of na- ture to expel the offending cause, should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink free- ly of diluting liquors; as whey, butter milk, warm water, thin water- gruel, small posset, or, what is perhaps preferable to any of them, very weak chicken-broth. This sliould not only be drank plentifully to pro- mote the vomiting, but a clyster of it given every hour in order to pro- mote the purging. After these evacuations have been continued for some time, a decoc- tion of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a brown colour, and afterwards boiled in spring-water. If oat-bread cannot be had, wheat-bread, or oat meal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonsful of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases. . The vomiting and purging however ought never to be stopped too soon. As long as these discharges do not weaken the patient they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the sinking of his pulse, Sec. recourse must immediately be had to opiates, as recommended above; to which may be added strong wines, with spirituous cinnamon waters, and other generous cordials. Warm negus, or strong wine-whey, will likewise be necessary to support the patient's spirits, aud promote tbe perspiration. His legs should be * I have been twice brought to the gates of death by this disease, and both tunes it was occasioned by eating rancid bacon. ©F A D1ARRH02A, OR LOOSENESS. 203 bathed in warm water, and afterwards rubbed with flannel cloths, or wrapped in warm blankets, and warm bricks applied to the soles of his feet Flannels wrung out of warm spirituous fomentations should like- vise be applied to the region of the stomach. When the violence of the disease is over, to prevent a relapse, it will be net-essary for some time to continue the use of small doses of lauda- num. Ten or twelve drops may be taken in a glass of wine, at least twice a-day, for eight or ten days. The patient's food ought to be nourish- ing, but taken in small quantities, and he sliould use moderate exercise- As the stomach and intestines are generally much weakened, an infu- sion of the bark, or other bitters, in small wine, sharpened with the elixir of vitriol, may be drank for some time. Though physicians are seldom called in due time in this disease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saw a very striking proof in an old man and his son, who had been both seized with it about the middle of the night I did not see them till next morning, when they had much more the appearance of dead than of li.ing men. No pulse could be felt; the extremities were cold and rigid, the countenance was ghast- ly, and the strength almost qui.e exhausted. Yet from this deplorable condition they were both recovered by the use of opiates and cordial medicines. OF A DIARRHOEA, OR LOOSENESS. A looseness, in many cases, is not to be considered as a disease, but rather as a sanitary evacuation. It ought therefore never to be stop- ped, unless when it continues too long, or evidently weakens the patient. As this however sometimes happens, we shall point out the most com- mon causes ofa looseness, with the proper method of treatment. When a looseness is occasioned by catching cold, or an obstructed perspiration, the pa'ient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs, frequently in luke-wai m water, to wear flannel next his skin, and to take every other method to restore the perspiration. In a looseness which proceeds from excess or repletion, a vomit is the proper medicine. Vomits not only cleanse the stomach, but pro- mote all the secretions, which renders them of great importance in carrying off a debauch- Haifa drachm of ipecacuanha in powder will answ er this purpose very well. A day or two after the vomit; the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness continues. The patient ought to live upon light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water. A looseness occasioned by the obstruction of any customary evacu- ation, generally requires bleeding. If that does not succeed, other ' evacuations may be substituted in the room of those which are obstruc- ted. At the same time, every method is to be takeu to restore the usual discharges, as not only the cure of the disease, but the patient's life, may depend on this*. A periodical looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which, if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is however so far from being hurtful to them, that such children generally set their teeth with least trouble. If tlicse loose stools should at any ui>e pit %e som or griping, a tea-spoonful of magnesia alba, with four or five grains of rhu- Jul OF A DIARRHO \, OR LOOSENESS barb, may be given to the child in a little panado, or any other fou:, This, if repeated three or four times, will generally correct the acidily, and carry off the griping stools. A diarrhoea, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper. Nor are purges safe, unlets they be very mild, and given in small quantities. Opiates and other antispasmodic medicines, are most proper. Ten or twelve drops of Uquid laudanum may be taken in a cup of valerian or penny-royal tea every eight or ten hours, till the symptoms abate. Ease, cheertufnes--, and tranquillity of mind arc here of the greatest importance. When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting li- quors, with oil or fat broths, to promote vomiting and purging. After- wards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may likewise be taken to remove their irritation. When the gout, repelled from the extremities, occasions a looseness, it ought to be promoted by gentle doses of rhubarb, or other mild pur- gatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine whey with spirits of hartshorn, or a few drops of liquid laudanum, in it. When a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c. medicines must be given to kill and carry off these vermin, as the pow- der of tin with purges of rhubarb and calomel. Afterwards lime- water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and prevent the new generation of worms. A looseness is often occasioned by drinking bad water. When this is the ca-e, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quick lime, chalk, or the like. In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this is obvi- ous, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret. From whatever cause a looseness proceeds, when it is found necessary to check it, the diet ought to consist of rice boiled with milk, and fla- voured with cinnamon ; rice-jelly, sago with red port; and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice- water, or weak broth made from lean veal, or with a sheep's head, as being more gelatinous than mutton, beef, or chicken-broth. Persons who, from a peculiar weakness, or too great an irritability of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwholesome foods, and meats of hard digestion. They ought likewise to beware of cold mois- ture or whatever may obstruct tbe perspiration, and should wear flan- OF VOMITING. 205 nel next the skin. All violent passions, as fear, anger, Sic. are likewise carefully to be guarded against. OF VOMITING. Vomiting may proceed from various causes ; as excess in eating and drinking ; foulness of the stomach , the acrimony of the aliment; a translation of the morbific matter of ulcers, of the gout, the erysipelas, or other diseases, to the stomach. It may likewise proceed from a looseness having been too suddenly stopped ; from the stoppage of any customary evacuation, as the bleeding piles, the menses, Sec. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms ; or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain ; as contusions, compressions, Sec. It is likewise a symptom of wounds or inflamma- tions of the diaphragm, intestines, spleen, liver, kidneys, &c. Vomiting may be occasioned by unusual motions, as sailing, being drawn backwards in a carriage, Sec. It may likewise be excited by vi- olent passions, or by the idea, of nauseous or disagreeable objects, espe- cially of such things as have formerly produced vomiting.— Sometimes it proceeds from a regurgitation of the bile into the stomach : in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Person' who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomi- ting is a common symptom of pregnancy.—In this case it generally comes on about two weeks after the stoppage of the menses, and contin- ues during the first three or four months. When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure ofa disease. It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile-tea. When the retrocession of the gout, or the obstruction of customary evacuations, occasion vomiting, all means must be used to restore these discharges : or, if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, sctons, perpetual blisters, «S:c. When vomiting is the effect of pregnancy, it may generally be miti- gated by bleeding, and keeping the body gently open. The bleeding however ought to be in small qu-.uitities at a time, and the purgatives shonl I be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women arc most apt to vomit in the morning immediately af- ter getting out of bed, which is owing part'y to the change of posture, but more to the emptiness of the stomach.—It may generally be pre- vented by taking a dish of coffee, tea, or some light breakfast in bed. Pregnant women who are afflicted with vomiting, ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor should they eat much at once. Cold water is a very proper drink in this case; if the stomach be weak, a little biandy may be added to it. If the spirits are low, and the person apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken. If vomiting proceed from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or brandy, with as much rhubarb as will keep th^ body gently open, is an excellent medicine in tun-case. The elixir of vitriol i- als^agood :< edicine.—It may be ta- ken in the dose of fifteen or twenty drops, twice or thrice a-day, in a 206 OF THE DIABETES, Ac. glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet. A vomiting which proceed* from acidities in the stomach, is relieved by alkaline purges. The best medicine of this kind is the magnesi alba, a tea-spoonful of which may be taken in a dish of tea or a little milk, three or four times a-day, or oftener if necessary, to keep the body open. When vomiting proceeds from violent passions, or affections of the mind, all evacuations must be carefully avoided, especially vomits.— These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added. When vomiting proceeds from spasmodic affections of the stomach, musk, castor, and other antispasmodic medicines are of use. Warm and aromatic plasters have likewise a good effect. The stomach-plaster of the London or Edinburgh dispensatory may be applied to the pit of the stomach, or a plaster of theriaca, which will answer rather better. Aromatic medicines may likewise be taken inwardly, as cinnamon or mint tea, wine with spiceries boiled in it, cvc. The region of the stomach may be rubbed with aether, or it that cannot be had, with strong bran- dy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath. I have always found the saline draughts taken in the act of efferves- cence, of singular use in stopping of vomiting, from whatever cause it proceeded. These may be prepared by dissolving a drachm of the salt of tartar in an ounce and a half of fresh lemon juice, and adding to it an ounce of pepper-mi t water, the same quantity of simple cinnamon water, and a little whi.j sugar. This draught must be swallowed be- fore the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent* A violent vomiting lias sometimes been stopped by cupping on the region of the stomach, after all other means had failed. As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of action. The diet must be so regulated as to sit easy upon the stomach, and nothing should be taken that is hard of digestion. We do not however mean that the patient should live entirely upon slops. Solid food, iu this case, often sits easier on the stomach than liquids. CHAPTER XXXIV. OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER. THE diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people ; but often attack.' persons in the decline of life, especially those who follow the more violent em- ployments, or have been hard drinkers in their youth. CAUSES.—A diabetes is often the consequence of acute diseases, as fevers, fluxes, Sec. where the patient has suffered by excessive evacua- tions; it may also be occasioned by great fatigue, as riding long jour- niesupou a hard trotting horse, carrying heavy burdens, Sec. It may- be brought on by hard drinking, or the use of strong stimulating, diure- tic medicines, as tincture of cantbarides spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral OF THE DIABETES, Sec. 207 waters. Many imagine that these will do them no service unless they be drank in great quantities, by wliich mistake it often happens that they occasion worse diseases than those they were intended to cure. In a word, this disease may either proceed from too great al ivity of the organs, which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages. SYMPTOMS.—In a diabetes, the urine generally exceeds in quan- tity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continu- ed thirst, with some degree of fever; his mouth is dry, and bespits frequently a frothy spittle. The strength fails, the appetite decays, ami the flesh wastes away till the patient is reduced to skin and bone. There is a heat of the bowels, and frequently the loins and feet are swelled. This disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected. REGIMEN.—Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason the patient should live chiefly on solid food. His thirst may be quenched with acids ; as sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of -animal substances, shell fish are to be preferred ; as oysters, crabs, Sec. The drink may be Bristol-water. When that cannot be obtained, lime-water, in which a due proportion of oak-bark has been macerated, may be used. The white decoction,* with isinglass dissolved in it, is likewise a very proper drink. The patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or matrass. Nothing hurts the kidneys more than lying too soft. A warm, dry air, the use of the flesh-brush, and every thing that promotes perspiration, is of service For this reason the patient ought to wear flannel next his skin. A large, strengthening plaster may be applied to the back ; or, what will answer better, a great part of the body may be wrapped iu plaster. MEDICINES.—Gentle purges, if the patient be not too much weakened by the disease, have a good effect. They may consist of rhubarb, with cardamum seeds, or any other spiceries, infused in wine, and may be taken in such quantities as to keep the body gently open. The patient must next have recourse to astringents and corrobo rants. Half a drachm of powder, made of equal parts of alum and tln> inspissated juice commonly called Terra Japonica, may be taken four times a-day, or oftener, if the stomach will bear it. The alum must first be melted in a crucible, afterwards they may both be pounded to- gether. Along with every dose of this powder the patient may take a tea cupful of the tincture of roses.t If the patient's stomach cannot bear the alum in substance, whey may be made of it, and taken in the dose ofa tea-cupful three or four times a-day. The alum whey is prepared by boiling two English • See Appendix, White Decoction. t See Appendix, Tincture of Ro&co. 208 OF A SUPPRESSION OF URINE. quarts ofroilk over a slow fire, with three drachms of alum, till the curd separates. Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time Its- sen the force of the circulation. Ten or twelve drops of liquid lau- danum may be taken in a cup of the patient's drink three or four times a-day. The best corroborants which we know, are the Peruvian bark, and wine. A drachm of bark may be taken ina glass of red port or claret three times a-day. The medicine wiltbe both more efficacious and less dis- agreeable, if fifteen or twenty drops of the acid elixir of vitriol be add- ed to each dose. Such as cannot take the bark in substance may use the decoction, mixed with an equal quantity of red wine, and sharpen- ed as above. ,-.,,. ? .« There is a disease incident to labouring people in the decline of life, called incontinency of crine. But this is very different from a dia- betes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bladder, and is often the effect of a palsy. Sometimes it proceeds from hurts or injuries oc- casioned by blows, bruises, preternatural labours, Sec. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diuretics, or of stimulating medicines injected into the bladder. This disease may be mitigated by the use of astringent and corrobor. ating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured. Iu an incontinency of urine, from whatever cause, a piece of sponge ought to be worn, or a bladder applied in such a manner as to prevent the urine from galling and excoriating the parts* OF A SUPPRESSION OF URINE. IT has already been observed, that a suppression of urine, may pro- ceed from various causes; as an inflammation of the kidneys, or blad- der; small stones or gravel lodging in the urinary passages, hard/<*<*« King in the rectum, pregnancy, a spasm or contraction of the neck of The bladder, clotted blood in the bladder itself, a swelling of the he- morrhoidal veins, &c. Some of these cases require the catheter, both to remove the on- stuictir." matter, and to draw of the urine ; but as this instrument can only be"managed with safety by persons skilled in surgery, we shall e.s are found to be beneficial, and therefore deserve a trial. An infusion of the seeds of duueus sylvestris, or wild carrot, sweeteneoflfath honey, has been found to give considerable ease in cases where"thenomacli could not bear any thing of an acrid nature. A decoction of raw coffee-ber- ries, taken morning and evening, to the qantity of eight or ten ounces, with ten drops of sweet spiri s of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruei, or in any other form that is more agreeable. The only other medicine wliich we shall mention is the ura ursi. It has been greatly extolled of late both for the gravel and stone. It seems however to be in all respects inferior to the soap and lime water; but it is less disagreeable, and has frequently to my knowledge, reliev- ed gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a day. It may how- ever be taken to the quantity of seven or eight drachms a-day, with great safety and good effect. CHAPTER XXXV. OF INVOLUNTARY DISCHARGES OF BLOOD. SPONTANEOUS or involuntary discharges of blood often happen from various parts of the body. These, however, are so far fronv being always dangerous, that they often prove salutary. When such dis- charges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor indeed is it proper at any time to stop them, unless they be so great as to endanger the patient's life. Most people, afraid of the. smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by which means an inflammation of the brain, or some other fatal disease, is occa- sioned, which, had the discharge been allowed to go on, might have been prevented. Periodical discharges of blood, from whatever part of the body they proceed, must not be stopped. They are always the efforts of Nature to relieve herself; and fatal diseases have of en been the consequence of obstructing them. It may indeed be sometimes necessary to check the violence of such discharges ; but even this requires the greatest can ion. Instances might be given where the stopping of * Tin- caustic alkali snay be prepared by raixingtwo parts of quick-lime with one of pot-ashi-v. and suffering tliein to stand till the lixivium lx- formed, which must Ik- care- fully tjluMteil before it W used. lithe solution does not happen readily, a small quali- ty of water may be added to the mixture. 2U OF BLEEDING AT THE NOSE. a small periodical flux of blood, from one of the fingers, has proved fatal to the health. In the eaily period of life, bleeding at the nose is very common. Those who are farther advanced in years are more liable to haemoptoe, or discharge of blood from the lungs. After the middle period of life, hemorrhoidal fluxes are most common ; and in the decline of life, dis- charges of blood from the urinary passages. Involuntary fluxes of blood may proceed from very different, and often quite opposite causes. Sometimes they are owing to a particular construction of the body, as a sanguine temperament, a laxity of the. vessels, a plethoric habit, &c. At other times they proceed from a determination of the blood, towards one particular part, as the head, the hemorrhoidal veins, &c. They may likewise proceed from an in- flammatory disposition of the blood, in which case there is generally some degree oLfjfer.: this likewise happens when the flux is occa- sioned by an obstructed perspiration, or a structure upon the skin, the bowels, or any particular part of the system. But a dissolved state of the blood will likewise occasion haemorrha- ges. Tim-, in putrid fevers, the dysentery, the scurvy, the malignant small pox, sec. there are often very great discharges of blood from dif- ferent parts of the body. They may likewise be brought on by too liberal an use of medicine, which tend to di solve the blood, as can- thai ide», the volatile alkaline salts, Sec. Foot! of an acrid or irritating quality may likewise occasion haemorrhages; as also strong purges and vomits, or any thi!>gthat greatly stimulates the bowels. Violent passions or agitations of the mind will likewise have this ef- feet. These often cause bleeding at the nose, and I have known them sometimes occasion an haemorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging tlie head very low, Sec. Tlie cure of an haemorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to inflammation, bleeding with gentle purges and other evacuations, will be necessary. It will like wise be proper for the patient in this case to live chiefly upon a vegetable diet, to avoid all strong liquors, and food that is of an acrid, hot, or stimulating quality. The body should be kept cool and the mind easy. When an haemorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acid fruits with milk, and vegetables of a nourishing nature, as sago, salop, and vinegar.* If the genitals be immersed for some time in cold water, it will gene- rally sto,) a bleeding at the nose. I have not known this fail Sometimes when the bleeding is stopped outwardly, it continues in- wardly. This is very troublesome, antl requires particular attention, as the patient is apt to be suffocated with the blood, especially if he falls asleep, which he is very ready to do after losing a great quantity of blood. When the patient is in danger of suffocation from the blood getting into his throat, the passages may be stopped by drawing threads up the nostrils, and bringing them out at the mouth, then fastening pieces of sponge, or small rolls of linen cloth to their extremities; afterwards drawi ig them back, and tying them outside with a sufficient degree of tightness. After the bleeding is stopped, the patient ought to be kept as easy and quiet as possible. He should not pick bis nose, nor take away the tents or clotted blood, till they fall off of their own accord, and sliould not lie with his head low. Those who are affected with freqnent bleeding at the nose, ought to bathe their feet often in warm water, and to keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible, and never to view any object obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it. But when the disease proceeds from a thin dissolved state of the blood, the diet should be rich and nourishing; as strong broths and jellies, sago gruel, with wine and sugar, Sec. Infusions of the Peruvian bark in wine ought likewise to be taken and persisted in for a consid- erable time. OF THE BLEEDING AND BLIND PILES. A discharge ot blood from the hantnorrhoidal ves els is called tbe bleeding piles When the vessels only swell, and discharge no blood, but are exceeding painful, the disease is called the blind piles. Persons ofa loose spungy fibre, ofa bulky size, who live high, and lead a sedentary, inactive life, are most subject to this disease. It a often owing to an hereditary disposition. Where this is the case, it at- tacks persons more early in life than when it is accidental Men arc more liable to it than-women, especially those of a sanguine plethoricj or scorbutic habit, or ofa melancholy disposition. The piles may be occasioned by an excess of blood, by strong aloclic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacuations, much riding, great costiveness, as any thing that occasions hard or difficult stools. Anger, grief, or other violent passions, will likewise occasion the piles. I have often known them bronght on by sitting on the damp ground. A pair of thin breeches will excite the disorder in a person who is subject to it, and sometimes even in those who never had it before. Pregnant women are often afflicted with the piles. A flux of blood from the anus, is not always to be treated as a disease. It is even mere salutary than bleeding at the nose, and often prevents or carries off diseases. It is peculiarly beneficial in the gout, rheuma- * From ten to twenty drops of the oil of turpentine in a little water given freguehtly, eldom fails to stop a bleeding at the nose, orfrorajany other part. OF THE BLEEDING AND BLIND PILES. 215 tism, as'hma, and hypochondncal complaints, and often proves critial in colics, and inflammatory fevers. In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which might be excessive and prove hurtful to one, may be very moderate, and even -alutary to another. That only is to be esteemed dangerous, which continues too long, and is in such quantity as to waste the pa- tient's strength, hurt the digestion, nutrition, and other functions necessary to life. When this is the case, the discharge must be checked by a proper re- gimen, and astringent medicines. The DIET must be cool but nour- ishing, consisting chiefly of bread, milk,cooling vegetables, and broths. The drink may be chalybeate water, orange-whey, decoctions or infu- sions of the astringent and mucilaginous plants, as the tormentil root, bistort, the marshniallow-roots, Sec. Old conserve of roses is a very good medicine in this case. It may be mixed in new milk, and may be taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to produce any effects ; but when taken as here directed, and duly persisted in, I have known it perform very extraordinary cures in violent haemorrhages, especially when assisted by the tincture of roses ; a tea-spoonful of which may be taken about an hour after every dose of the conserve. The Peruvian bark is likewise proper in this case, both as a strength- cner and astringent. Hnlf a drachm of it may be taken in a glass of red wine, sharpened with a few drops of the elixir of vitriol, three or four times a-day. The bleedingpiles are sometimes periodical,and return regularly once a month, or once 111 three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical dis- cbarge of blood from the haemorrhoidal veins. In the blind piles bleeding is generally of use. The diet must be light and ttiin, and the drink cool and diluting. It is likewise necessa- ry that the body be kept gently open. This may be done by small do- ses of the flour of brimstone and cream of tartar. These maybe mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftener if necessary. Or an ounce of the flour of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day. Emollient clysters are here likewise beneficial; but there is some- times such an astnction of the anus, that they cannot be thrown up. In this case I have known a vomit have a very good effect. Wh n the piles are exceeding painful and swelled, but discharge nothing, the patient must sit over the steams of warm water.. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possible, or, if they will fix upon the piles themselves, so much the better. When leeches will not fix, the piles may be opeued with a lancet. The operation is very easy, and is attended with no danger. Various ointments, and other external applications, are recommended in the piles; but I do not re- Hie^nbert0 Ui*ve setn a°y effec& il0m luese wortn mentioning. Their 210 SPITTING OF BLOOD. principal use is to keep the part moist, wliich may be done as well by a soft poultice, or an emollient cataplasm. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied. SPITTING OF BLOOD. WE mean here to treat of that discharge of blood from the lungs only which is called an hamoptoe or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and straight breasts are most liable to this disease. It is most common in the spring, and general- ly attacks people before they are at the prime or middle period of life. It is a common observation that those who have been subject to bleeding at the nose when young, are afterwards most liable to an haemoptoe. CAUSES.—An haemoptoe may proceed from excess of blood,from a peculiar weakness of the lungs,"or a bad conformation of the breast. It is often occasioned by excessive drinking, running, wrestling, sing- ing, or spgaking aloud. Such as have weak lungs ought to avoid all vio- lent exertions of that organ, as they value life. They -hould likewise guard against violent passions, excessive drinking, and every thing that occasions a rapid circulation of the blood. This disease may likewise proceed from wounds of the lungs.— The-e may either be received from without, or they may be occasion- ed by hard bodies getting into the wind pipe, and so falling down upon the lungs, and hurting that tender organ. The obstruction of any ' customary evacuation may occasion a spitting of blood; as neglec- of bleeding or pinging at the u*uai seasons, the stoppage of the bleeding piles in men, or the menses in women, Sec It may likewise proceed from a polypus, scirrhous concretions, or any thing that obstructs the circulation of the blood in the lungs. It is often the effect of a long and violent cough ; jn which case it is generally the forerunner of a consumption. A vidlent degree of cold suddenly applied to the exter- nal parts of the body will occasion an haemoptoe. It nia> likewise be occasioned by breathing air which is too much rarified to be able pro- perly to expand the lungs. This is often tlie case with those who work in hot places, as furnaces, glass-houses, or the like. It is likewise said to happen to snch as ascend to the top of very high mountains, as the Peak of Teneriffe, See. Spitting of blood is not always to be considered as a primarv disease. It is often only a symptom, and in some diseases not an unfavourable one. This is the case in pleurisies, peripnenmonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shews that the lungs are ulcerated. SYMPTOMS___Spitting of blood is generally preceded by a sense of weight, and oppression of the breast, a dry tickling cough, hoarse- ness, and a difficulty of breathing. Sometimes it is ushered in with shivering,'coldness of the extremities, costiveness, great lassitude, fla- tulence, pain of the back and loins, Sec As these shew a general stric- ture upon the vessels,' and a tendency of the blood to inflammation, they are commonly the forerunners ofa very copious discharge. 'I be above symptoms do not attend a discharge of blood from the gums or fauces, by which means these may always be distinguished from an haemoptoe. Sometimes the blood that is spit up is thin, and ofa florid red colour; and at other times it i* thick, and ofa dark or black- J ish colour j nothing however can be inferred from this circum- SPITTING OF BLOOD. 217 stance, but that the blood has lain a longer or shorter time in the breast before it was discharged. Spitting of blood, in a strong healthy person, of a sound constitution, is not very dangerous ; but when it attacks the tender and delicate, or persons ofa weak lax fibre, it is with difficulty removed.—When it pro- ceeds from a scirrhous or poly pus of the lungs, it is bad. The dan- ger is greater when the discharge proceeds from the rupture of a large vessel than a small one. When the extravasated blood is not spit up, but lodges'in the breast, it corrupts, and greatly increases the dan- ger. When the blood proceeds from an ulcer in the lungs it is gene- rally fatal. REGIMEN.—The patient ought to be kept cool and easy.. Every thing that heats the body or quickens the circulation, increases the danger. The mind ought likewise lobe soothed, and every occasion of exciting the passions avoided. The diet should be soft, cooling, and slender ; as rice boiled with milk, small broths, barley-gruels, panado, &c. The diet, in this case, can scarce be too low. Even water-gruel is sufficient to support the patient for some days. All strong liquors must be avoided. The patient may drink milk and water, bai ley-wa- ter, whey, butter-milk, and such like. Every thing however should be drank cold, and in small quantities at a time. He should observe the strictest silence, or at least speak with a very low voice. MEDICINE.—This, like the other involuntary discharges of blood, Ought not to be suddenly stopped by astringent medicines.—More mischief is often done by these than if it were suffered to go oh. It may however proceed so far as to weaken the patient, and even endanger his life; in which case proper means must be used for res- training it. The body sliould be kept gently open by laxative diet; as roasted apples, stewed prunes, and such like. If these should not have the de- sired effect, a tea-spoonful of the lenitive electuary may be takeu twice or thrice a-day, as is found necessary. If the bleeding proves violent, ligatures may be applied to the extremities, as directed for a bleeding at the nose. If the patient be hot or feverish, bleeding, and small doses of nitre will be of use ; a scruple or halfa drachm of nitre ; may be taken in a cup of his ordinary drink twice or thrice a-day. Hi; drink may likewise be sharpened with acids, as juice of lemon, or a few drops of the spirits of vitriol ,- or he may take frequently a cup of the tincture of roses. Bathing the feet and legs in lukewarm water has likewise a very good effect in this disease. Opiates too are sometimes beneficial; but these must be administered with caution. Ten or twelve drops of lau- danum may be given in a cup of barley-water twice a-day,and continu- ed for some time, provided they be found beneficial. The conserve of roses is likewise a very good medicine in this case; provided it be takefl in sufficient quantity, and long enough persisted in. It may be taken to the quantity of three or font* ounces a-day; and, if the patient be troubled with a cough, it should be made into an electuary with balsamic syrup, and a little of the syrup of poppies. If stronger astringents be necessary, fifteen or twenty drops of the elixir of vitriol may be given in a glass of water three or four times a- day. Those who are subject to frequent returns of this disease should avoid all excess. Their diet should be light aud cool, consisting chief- T 218 VOMITING OF BLOOD. Iy of milk, and vegetables. Above all, let them beware of vigorous efforts of the body, and violent agitations of the mind. VOMITING OF BLOOD. THIS is not so common as the other discharges of blood which have already been mentioned; but it is very dangerous, and requires par- ticular attention. Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea ; and is accompanied with great anxiety, and fre- quent fainting fits. This disease is sometimes periodical; in which case it is less danger- ous. It often proceeds from an obstruction of the menses in wo- men ; and sometimes from the stoppage of the haemorrhoidal flux in men. It may be occasioned by any thing that greatly stimulates or wounds the stomach, as strong vomits or purges, aerid poison, sharp or hard substances taken into the stomach, &c. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external violence, as blows, bruises, or from any o" the causes which produced inflammation. In hysteric women, vomiting of blood is a very common, but by no means a dan- gerous symptom. A great part of the danger in this disease arise from the extravasa- Jled blood lodging in the bowels, and becoming putrid, by which means a dysentery or putrid fever may be occasioned. Tbe best way of pre- venting this, is to keep the body gently open, by frequently exhibiting emollient clysters. Purges must not be given till the discharge is stopt, otherwise they will irritate the stomach, and increase the disorder. All the food aud drink must be of a mild cooling nature, and taken in small quantities. Even drinking cold water has sometimes proved a remedy, but it will succeed the better when sharpened with the weak spirits of vitriol. When there are signs of an inflammation, bleeding may be necessary; but the patient's weakness will seldom permit it. Opiates may be of use; but they must be given in very small doses, as four or five drops of liquid laudanum twice or thricea- day. After the discharge is over, as the patient is generally troubled with gripes occasioned by the acrimony of the blood lodged in the intes- tines, gentle purges will be necessary. OF BLOODY URINE. - THIS is a discharge of blood from the vessels of the kidneys or bladder, occasioned by their being either enlarged, broken, or erod- ed. It is more or less dangerous according to the different circum- stances wliich attend it. When pure blood is voided suddenly without interruption and without pain, it proceeds fYo-n the kidneys; but if the blood be in small quantity, of a dark colour, and emitted with heat and pain about the bottom of the bcliy, it proceeds from the bladder. When bloody urine is occasioned by a rough stone descending from the kidneys to the bladder, which wounds the ureters, it is attended with a sharp pain in the back, and difficulty of making water. If the coats of the bladder are hurl by a stone, and the bloody urine follows, it is attended with the most acute pain, and a previous stop- page of urine B'oody urine may likewise be era lutied by falls, blows, the hftin» or carrying of heavy burdens, hard riding, or any violent motion. It OF THE DYSENTERY, &c. 21* may also proceed from ulcers of the bladder, from a stone lodged in the kidneys, or from violent purges, or sharp diuretic medicines, especial- ly cautharides. Bloody urine is always attended with some degree of danger : but it is peculiarly so when mixed with purulent matter, as this shews au ulcer somewhere in the urinary passages. Sometimes this discharge proceeds from excess of blood, in wliich case it is rather to be consid- ered as a salutary evacuation than a disease. If the discharge however be very great, it may waste the patient's strength, and occasion an ill habit ol'bodv, a dropsy or a consumption. The treatment of this disorder must be varied according to the different causes from which it proceeds. Wlien it is owing to a stone in the bladder, the cure depends upon an operation, a description of which would be foreign to our purpose. If it be attended with a plethora, and symptoms of inflammation, bleeding will be necessary. The body must likewise be kept open by emollient clysters, or cooling purgative medicines ; as cream of tartar, rhubarb, manua ; or small doses of lenitive electuary. When bloody urine proceeds from a dissolved state of the blood, it is commonly the symptom of some malignant disease ; as the small-pox, a putrid fever, or the like. In this case the patient's life depends on the liberal use of the Peruvian bark and acids, a= has already been shewn. When there is reason to suspect an ulcer in the kidneys or bladder, the patient's diet must be cool, and his drink ofa soft healing, balsamm quality, as decoctions of inarsli-niallow roots with liquorice, solutions of gum-arabic, &c Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in two English quarts of water to one ; two ounces gum-arabic, and half an ounce of purified nitre may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day. The early use of astringents in this disease has often bad conse- quences. When the flux is stopped too soon, the grumous blood, by being confined in the vessels, may produce inflammations, abscess, and ulcers. If however the case be urgent, or the patient seems to suffer from the loss of blood, gentle astringents may be necessary. In this case the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a- day. OF THE DYSENTERY, OR BLOODY FLUX. THIS disease prevails in the spring and autumn. It is most common in marshy countries, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much expos- ed to the night air, or who live in places where the an is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places. CAUSES.—The dysentery may be occasioned by any thing that ob- structs the perspiration, or renders the humours putrid; as damp beds, wet, clothes, unwholesome diet, b id air, exc. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labour under the disease. Even the smell of the patient's excrements has been known to counnunicat* the infection. SCO OF THE DYSENTERY, SYMPTOMS.—It is known by a flux of the belly, attended by vio- lent pains of the bowels, a constant inclination to go to stool, and gen- erally more or less blood in the stools. It begins like other fevers, with chilliness, loss of strength, a quick pulse, great thirst, and an in. clination to vomit. The stools are at first greasy and frothy, after- wards they are streaked with blood, and at last have frequently the ap- pearance of pure blood, mixed with small filaments resembling bits of .skin. Worms are sometimes passed both upwards and downwards through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of tbe iutestine is actually protruded, which proves exceeding troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the di- sease. This disease may be distinguished from a diarrhoea or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera morbus by its not being attended with such violent and frequent fits of vomiting, &c. When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering diseases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they shew an inflammation of the stomach. When the stools are green, black, or have an exceeding disagreeable cadaverous smell, the dan- ger is very great, as it shews the disease to be of the putrid kind. It is an unfavourable symptom when the clysters are immediately return- ed ; but still more so when the passage is so obstinately shut, that they tannot be injected, a feeble pulse, coldness of the extremities, with difficulty of swallowing, and convulsions, are signs of approaching death. REGIMEN.— Nothing is of. more importance in this disease, than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases ihe danger is increased, and the infection spread, by the neglect of cleanliness ; but in no one more than this. Ever thing about the pa- tient should be frequently changed. The excrements should never be *uffered to continue in his chamber, but removed immediately and bu- ried under ground. A constant stream of fresh air should be admitted into the ch^nber; and it ought frequently to be sprinkled with vine- gar, juice of lemon, or some other strong acid. The patient must not be discouraged, but his spirits kept up in hopes •fa cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is in- creased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst eftects. A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes tbe perspiration without over heating the hotly. Great caution however is necessary in leaving it off. I have often known a dysentery brought on by imprudently throwing off a flannel waistcoat before the season was sufficiently warm. For what- ever purpose this piece of dress is worn, it should never be left off but in a warm season. In this disease the greatest attention must be paid to the patient's diet. Flesh, fish, and every thing that has a tendency to turn putrid or rancid on the stomach, must be abstained from. Apples boiled in milk, water pap; and plain li^ht pudding, with broth made of the gda- OR BLOODY FLUX. 231 tinous parts of animals, may constitute the principal pirt of the pa- tient's food. Gelatinous broth not only answers the pnrpco of food, but likewise of medicine. I have often known dysenteries, which were not ofa putrid nature, cured by it, after pompous medicates had proved ineffectual.* Another kind of food very proper in the dysentery, which may be us- ed by such as cannot take the broth mentioned above, is made by boil- ing a few handsful of fine flour, tied in a cloth, for six or seven hours, till it becomes as hard as starch. Two or three table-spocmful of this may be grated down, and boiled in such a quantily of new milk and water, as to be of the thickness of pap. This maybe sweetened to the patient's taste, and taken for his ordinary food.t In a putrid dysentery the patient may be allowed to eat freely of most kinds of*good ripe fruit; as apples, grapes, goo. cherries, cm i ant- berries, straw-berries, &c. These may either be eaten raw or boiled, with or without milk, as the patieut chooses. The prejudice against fruit in this disease is so great, that many believe it to he the common cause of dysenteries. This however is an egregious mistake. Both reason and experience shew, that good fruit is one of the best medi- cines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefac- tion, from whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore to be allowed to eat as much fruit as he pleases, provided it be ripe.} The most proper drink iu this disorder is whey. The dysentery has often been cured by the use of clear whey alone. It may be takea both for drink and in form ofa clyster. When whey cannot be had, barley water sharpened with cream of tartar may be drank, or a decoc- tion of barley and tamarinds ; two ounces of the former and one of the * The manner of making this broth is, to take a sheep's head and feet with the skin upon them, and to burn the wool off with a hot iron ; afterwards to boil thein till the broth is quite a jelly. A little cinnamon or mace may be added, to give the broth au agreeable flavour, and the patient may take a little of it warm with toastid bread three or four times a-day. A clyster of it nut) likewise be given twice a-day. Such as can- not use the broth made in this way, may hnve the head and tett skinned ; but we have reason to believe that this injures the medicine. It is not our business here to reason upon the nature and qualities of medicine, otherwise this might be shewn to possess virtues every way suited to the cure ofa dysentery which does not proceed from a pu- trid state of the humours One thing we know which is preferable to all reasoning, that whole families have ofti n been cured by it, after they had used many other medi- cines in vain. It will, however, be proper that the patimt takea vomit, and a dose or two of rhubarb, before he begins to use the broth. It will likewise be necessary to c tinue the use of it fur a considerable time, and to make it the principal food. t The learned and humane Dr. Rutherford, late professor of medicine iu the uni- versity of Edinburgh, used to mention this food in his public lectur. s with great en- comiums. He directed it to be made by tying a pound or two of the finest flour, as tight as possible, in a linen rag, afterwards to dip it irequently in water, and to drialge th> outside with Hour, till a cake or trust was formed around it, which prevents the waterfroiii soaking into it while boiling. It is thi n to be boiled till it becomes a hard dry mas* as directed above. This, when mixed with milk and water, will not only an- swer the purpose of food, but may likewise be given in clysters. $ I lately saw a young man who had beensei/.id with a dysentery in North America. Many things had been tried for his relief, but to no purpost. • At length tired out w ills disanpointim nts from medicine, and nduc d to skin m.d lione, he came over tojb.ituin, rattier w ith a view to die among lus relation., than withal.) hopes ofa cure. After ta- king sundry medicines lure with no bt tter *hcC' ss than abroad. I ailvistd him to leave eft'th use of drugs, and trust entirely to udiet ot milk an liuiis, with gentle exercise. Sstrawberii s were th. on I v fruit he could procure at that season. These he ate with milk twice and sonu times thrice a-day. The consequence was. tl at in a short tiin. his stools were reduced from upwards of twenty in a day, to tlu\t or four, and sometimes not so man). fie us. d the other fruits as they came in,and w.rs in a f. w weeks so wejl ac »o leave thai part »f the country where l was with a view to rvturu to America. T2 *22 OF THE DYSENTERY. latter may be boiled in two English quarts of water to one. Warm water, water-gruel, or water wherein hot iron lias been frequently quenched, are all very proper, and may be drank in turns. Cainomile- tea, if the stomach will bear it, is an exceeding proper drink. It both strengthens the stomach, anil by its antiseptic quality, tend3 to prevent a mortification of the bowels. MEDICINE.—At the beginning of this disease it is always necessa- ry to cleanse the first passages. For this purpose a vomit of ipecacuan- ha must be given, and wrought off with weak camomile-tea. Strong vomits are seldom necess.iry here. A scruple, or at most halfa drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very few grains will suffice. The day after the vomit, half a drachm, or two scruples of rhubarb, must be taken; or what will answer the pur- pose rather better, an ounce or an ounce and an half of Epsom salt. This dose may be repeated every other day for two or three times. Af- terwards small doses of ipecacuanha may be taken for some time. Two or three grains of the powder may be mixed in a table spoonful of the syrup of poppies, and taken three times a-day. These evacuations, and the. regimen prescribed above, will often be sufficient to effect a cure. Should it however happen otherwise, the following astringent medicines may be used : A clyster of starch or fat mutton broth, with thirty or forty drops of liquid laudanum in it may be administered twice a-day. At the same time an ounce of gum-arabic, and half an ounce of gtnn-tragacanth, may be dissolved in an English pint of barley-water, over a slow fire, and a table-spoonful of it taken every hour. If these have not the desired effect, the patieut may take, four times a-day, about ihe bulk of a nutmeg of the Japonic Confection, drinking after it a tea-spoonful of the decoction of logwood.* Persons who have, b en cured of this disease are very liable to suffer a relapse; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fermented liquors, ex- cept now and then a glass of good wine; but he must drink no kind of malt liquor. He should likewise abstain from animal food, as fish and flefh, and live principally on milk and vegetables. Gentle exercise and wholesome air are likewise of importance.—The patient sliould go to the country as s-oon as his strength will permit, and should take exercise daily on horseback, or in a carriage. He may like- wise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with aw equal quantity of new milk. When dysenteries prevail, we would recommend a strict attention to cleanliness, a spue use of animal food, and the free use of sound rips fruits, and otlm vegetables. The night air is to be. carefully avoided, and all communication with the sick. Bad smells are likewise to bu shunned, especinl'y those which arise from putrid animal substances. The necessaries where the sick go are carefully to be avoided. When the first symptoms of'he dysentery appear, the pal it nt ought immediately to take a vomit, to go to bed, and drink plentifully of we\k warm liquor, to promote a t w -at. This with a dose or two ot rhubarb at the beginning, would otien carry off the disease. Ju countries where dysenteries prevail, we would advise such as are liabl« to them, to take either a vomit or a purge every spring or autumn, as a preventive. * Se« Kvpmifc, Qtcostiw of L'wwd. OP THE HEAD-ACH. 2*8 There are sundry other fluxes of the belly, as the LiEXTERYand ccb- Live passion, which though less dangerous ilian the dysentery, yet merit consideration. These diseases generally proceed from ;i relaxed state of the stomach and intestines, wlueli is sometimes so great, that the food passes through them with hardly any sensible alteration ; and the patient dies merely from the want of nourishment. When thelientery orcreliac passion succeeds to a dysentery, the ease is bad. They are always dangerous in old aj;e, especially when the constitution has been broken by excess or acute diseases. If the stools be very frequent, and quite crude, the thirst great, with little urine, the mouth ulcerated, and the face marked with spots of different colours the danger is very great. The treatment of the patient is in general the same as in (he dysente- ry. In all obtinate fluxes of the belly, the cure must be attempted, by first cleansing the stomach and bowels with gentle vomits and pur- ges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent medicines, will generally com- plctc the cure. The same observation holds with respect to a tenesmus, or frequent desire of going to stool. This disease resembles the dysentery so much, both in its symptoms and method of cure, that we think it need- less to insist upon it. CHAPTER XXXVr. OF THE HEAD-ACH. ACHES and pains proceed from very different causes and may af- fect any part of the body, but we shall point out those only which occur most frequently, and are attended with the greatest danger. When the head-ache is slight, and affects a particularpart of the head only, it is called cephalalgia; when the whole head is affected, ccphulcea ; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hystericus. There are also other distinctions. Sometinies the pain is internal, sometinies external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbiug, with a considerable heal of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, aud has a sense of coldness in the part. This kind of head-ach is sometimes attended with a de« gree of stupidity or folly. Whatever obstructs the free circulation of the blood through the ves- sels of the head, may occasion a head-ach. In persons ofa full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at tha nose, sweating of the feet, Sec. It may likewise proceed from any cause that determii.es a great flux of blood towards the head ; as cold- ness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will likewise occasion a head-ach ; a* looking long obliquely at any object, weaung any thing tight about the neck, a new hat or the like. When a head-ach proceeds from a stoppage ofa running at the nose, there is a heavy, obtuse, pressing pain in the fore part of the head, in which there seems to be such a weight, that the patient can scarce 2W OF THE HEAD-ACH. hold it up. When it is occasioned by the caustic matter of the vcnere il disease, it generally affects the skull, and often produces a caries of the bones. Sometimes the head-ach proceeds from the repulsion or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other erup- tive diseases. What is called a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness, will often also occa- sion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food. There is likewise a most violent, fixed, constant, and almost intole- rable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a vertigo, dimness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c. The head-ach is often symptomatic in continual and intermitting fe- vers, especially quartans. It is likewise a very common symptom in hysteric and hypocondriac complaints. When a head-ach attends an acute fever, with pale urine, it is an unfavourably symptom. In excessive head-achs, coldness of the ex- tremities is a bad sign. When the disease continues long, and is very violent, it often termi- nates in blindness, an apoplexy, deafness, a vertigo, the palsy, or the epilepsy. In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will correct the acrimony of the humours, and keep the body open ; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-water, infusions of mild mucilaginous vegetables, decoctions of the sodorific woods, Sec. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water ; the head should be shaved, and bathed with water and vinegar. The patient ought as much as possible to keep in an erect posture, and not to lie with his head too low. When the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled iu the jugular vein, and the operation repeated if there be occasion. ^Cup- ping also, or the application of leeches to the temples, ana behind the ears, will be of service. Afterwards a blistering plaster may be applied to the neck behind the cars, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The body ought likewise to be kept open by gentle laxatives. But when the head-ach proceeds from a copious vitiated serum stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are rnces.sary, as pills made of aloes, resin of jalap, or the like. It will also be necessa- ry pi this case to blister the whole head, and to keep the back part of the neck open for a considerable tune by a perpetual b.ister. When the head ach is occasioned by the stoppage of a tunning at the nose, the patient should frequently smell to a bottle of volatile salts j he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb muitich, ground ivy, sec. OF THE TOOTH-ACH. 225 A hemicrania, especially a periodical one, is generally owiug to a foulness of the stomach, for which gentle vomits must be adminis- tered, as also purges of rhubarb. After the bowels have been'sufficient- ly cleared, chalybeate waters, and such bitters as strengthen the stom- ach, will be necessary. A periodical head-ach has been cured by wear- ing a piece of flannel over the forehead during the night. When, the head-ach aiises from a vitiated state of the humours, as in tlie scurvy and venereal diseases, the patient, after proper evacua- tions, must drink freely of the deboction of woods, or the decoction of ttirsaparilla, with raisins and liquorice.* These if duly pershted in, will produce very happy effects. When a collection of matter is felt under (he skin, it must be discharged by an incision,otherwise it will render the bone carious. When the head-ach is so intolerable as to endanger the patient's life, or is attended with continual watching and delirium, recourse must be had to opiates. These, after proper evacuations by clysters or mild pur- gatives, may be applied both externally aud internally.—The affected part may be rubbed with Bate's anodyne balsam, or a cloth dipped in i it may be applied to the part. The patient may, at the same time, i take twenty drops of laudanum, in a cup of valerian or penny-royal ■ tea, twice or thrice a-day. This is only to be done in case of extreme A pain. Proper evacuations ought always to accompany and follow the \ use of opiatcs.t When the patient cannot bear therloss of blood, his feet ought fre- (. qucntly to be bathed in lukewarm water, and well rubbed with a ^ lolent, and does not yield to small rinses of laudanum, the , quantity may be increased. I have known a patieut in extreme pain, take thre« hundred drops in tw«uty-four hours; butsueh dosittought only to be administered07* person of skilk , 226 OF THE TOOTH-ACH. gums. In this case the teeth are sometimes wasted, and fall out with- out any considerable degree of pain. The more immediate cause of the tooth ach is a rotten or carious tooth. In order to relieve the tooth-ach, we must first endeavour to lessen the flux of humours to the part affected. This may be done by mild purgatives, scarrifyiug the gums, or applying leeches to them, and bathing the feet frequently with warm water. The perspiration ought likewise to be promoted, by drinking freely of weak wine-wlicy, or other diluting liquors, with small doses of nitre. Vomits too have of- ten an exceeding good effect in the tooth ach.- It is seldom safe to administer opiates, or any kind of heating medicines, or even to draw a tooth, till proper evacuations have been premised ; and these alone will often effect the cure. If this fails, and the pain and inflammation still increase, a suppu- ration may be expected ; to promote wliich a toasted fig should be held between the gum and the check ; bags filled with boiled camo- mile-flowers, flowers of elder, or the like, may be applied near the pait affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth ofa porringer filled with warm wa- ter, &c. Such things as promote the discharge of saliva, or cause the pa- tient to spit, are generally of serviae. For this purpose, bitter, hot, or pungent vegetables may be chewed; as gentian, calamus aroinaticus, or pellitory of Spain. Allen recommends the root of yellow water flowir- de-luce in this case. This root may cithai be rubbed upon the tooth, or a little of it chewed. Brookes says he hardly ever knew it tail to ease the tooth-ach. It ought however to be used with caution. Many other herbs, roots, and seeds are recommended for curing the tooth-ach ; as the leaves or roots of millefoil or yarrow chewed, tobacco 3moaked or chewed, staves-acre, or the seeds of mustard chew- ed, &c. These bitter, hot, and pungent things, by occasioning a great- er flow of saliva, frequently give ease in the tooth ach. Opiates often relieve the tooth-ach. For this pin pose a little cotton wet with laudanum may be held between the teeth ; or a piece of stick- ing-plaster, about tlie bigness of a shilling, with a bit of opium in the middle of it, of a size not to prevent the sticking of the other, may be laid on the temporal artery, where the pulsation is most sensible. De la Motte affirms, that there are few cases wherein this will not give relief. If there he a hollow tooth, a small pill made of equal parts of camphire and opium, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with t;inn masticb, wax, lead, or auy substance that will stick in it, and keep out the external air. Few applications give more relief in the tooth-ach than blistering- plasters.'" These may be applied between the shoulders ; bi.t they have the best effect when put behind the ears, and made so large as to cover a great part of the lower jaw. ' After all, when a tooth is carious, it is often impossible to remove the pain without extracting it; and, as a spoilt tooth never becomei sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much practised by mechanics, as well as persons of the medical profession. The operation ho w«ver is uot OF THE EAR-ACH. 227 ■without danger, and ought always to be performed with care. A per- son unacquainted with the structure of the parts v.i t be in danger of hurting the jaw-bone, or of drawing a sound tooth instead of a rotten one.* ** When the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by tne bark. Some pretend to have found great benefit in the tooth-ach, from the application of an artificial magnet to the affected tooth. We shall not attempt to account for its mode of operation ; but, if it be found to an- swer, though only in particular cases, it certainly deserves a trial, as it is attended with no ex.i^nse, and cannot do any harm. Electricity has likewise been recommended, and particular instruments have been in- vented for sending a shock through the affected tooth. Persons who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times. Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The best method of doing this is to wash tliem daily with salt and water, a decoction of the bark, or with cold water alone. All brushing and scraping of the teeth is dangerous, and, unless it be per- formed with great care, does mischief. OF THE EAR-ACH. This disorder chiefly affects the membrane which lines the inner cavi- , ty of the ear, called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even delirium. Sometimes I. epileptic fits,and other convulsive disorders, have been brought on by \. extreme pain in the ear. k' The ear-ach may proceed from any of the causes which produce in- flammation. It often proceeds from a sudden suppression of perspira- tion, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the car. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is generally reckoned a favourable symptom. When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The rnembranes may be relaxed, by dropping into the ear, oil of sweet almonds, or olive oil. Afterwards the patient should be mide to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen in- ' sects, which had got into the ear, come out of their own accord upon pouring in oil. When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and i opening medicines. Bleeding at the beginning, either in the arm or I*" jugular vein, or cupping in the neck, will be proper. The ear may iiko- wise be fomented with steams of warm water; or flannel bags filled with boiled mallows and camo 'die-flowers may be applied to it warm ; or bladders filled with warm miljt and water. An exceeding good method of fomenting the ear, is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile-flowers. Tlie patient's feet should be frequently bathed in lukewarm water, j * This may always he prevented by the operator striking- nponthe teeth withanf piece ot' mi tal, as this never fltils to excite the pain in the carious tooth. 435 PAIN OF THE STOMACH, &c and he ought to take small doses of nitre and rhubarb, viz. a scruple of , the former, and ten grains of the latter, three times a-day.—His drink J may be whey, or a decoction of barley and liquorice, with figs or rai- sins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment. When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to toe ear, and frequently re- newed, till the abscess breaks, or can be opened. Afterwards the hu- mours ;,ipy be diverted from the part by gentle laxatives, blisters, or issues; but the discharge must uot be suddenly dried up by any exter- nal application. PAIN OP THE STOMACH, &c. This may proceed fro.n various cuises, as indigestion; wind; the ac- rimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise be occa ioned by worms ; the stoppage of customary evacuations; a translation of gouty matter to the stomach, the bowels, &c. Women in the decline of life are very liable to pains of the stomach aud bowels, especially .such as are afflicted with hysteric complaints. It is likewise very common to hypochondriac men of a sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine. When the pain or' the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault, either in the diges- tion or the food. In this ease the patient ought to change his diet, till he duds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet docs not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some otiier stomachic bitter, cither in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage. When a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy distention of the sto- mach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy di- et, and every thing that sours on the stomach, as greens, roots, &c. This rule however admits of some exceptions. There are many instan- ces of persons very much troubled with wind, who have received great benefit from eating parched pease, though that grain is generally sup. posed to be ofa windy nature.* This complaint may likewise be greatly relieved by labour, especial- ly digging, reaping, mowing, or any kind of active employment hy which the bowels are alternately compressed and dilated. The most obj|uiate case of this kind I ever met with, was in a person ofa scden- tary%tpupation, whom I advised, after he had tried every kind of medicine, to turn gardener; which he did, and has ever since enjoyed good health. When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be dicharged by vomit; thi* may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents. • These are prepared by sleeping or soaking pease in water, and afterwards dryiflf .Oiem in a pot or kiltt.tiU they bo quite hard. They may bu used at uleasure. OF WORMS. 229 Whetiapaio of the stomach proceeds from a translation of gouty matter, warm cordials are neces-ary, as generous wines, French bran- dy, Sec. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feel- ing the stomach warmed by it. It is impossible to a-certain tbe quan- tity necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however, is not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile-flowers, or carduus benedictus. If a pain of the stomach proceed from the stoppage, of customary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives ; as rhubarb or senna. When this disease af- fects women in the decline of life, after the stoppage of the menses, ma- king an issue in the leg or arm will be of peculiar service. When the disease is occasioned by worms, they must be destroyed, or expelled by such means as are recommended in the following sec- tion. When the stomach is greatly relaxed and the digestion bad, which of- ten occasions flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day. Persons afflicted with flatulency are generally unhappy unless they be taken some purgative medicine*; these, though they may give im- mediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. Their best method is to mix pur- gatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open. CHAPTER XXXVIt. OF WORMS. 1 HESE are chiefly of three kinds, viz. the tania, or tape-worm ; the teni, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human bo- dy ; but as they proceed, in a great measure, from similar causes, have nearly the same symptoms, and require almost the same method of treatment as the?e already mentioned, we shall not spend time in enu- merating them. The tape-worm is white, very long, and full ofjoints. It is generally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms, commonly lodge in the rectum, or what is called the end gut, and occasion a disagreeable itching about tbe seat. The long round worms occasion squeamishness, vomiting, a disa- greeable breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, nndat other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privatiou of speech. These worms have been known to perforate the intestines, and get into the cavity of the belly. The effects of the tape-worm are nearly the same with those of the iong and round, but rather more violent. Andry aays, the following symptoms particularly attend the solium, * I' 230 OF WORMft. which is a specie of the tape-worm, riz. swooning*, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the aims, cause swoouings, and tenesmus, or an inclina- tion to go to stool. CAUSE.—Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the diges- tion is bad. Sedentary persons are more liable to them than the ac- tive and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally subject to worms. There seems to be an hereditary disposition in some persons to this di- sease. I have often seen all the children of a family subject to worms of a particular kind. They seem likewise frequently to be owing to the nnrse. Children of the same family, nursed by one woman, have often worms, when those nursed by another have none. SYMPTOMS.—The common symptoms of worms are paleness of the countenance, and at other times, an universal flushing of the face ; itching of the nose : this however is doubtful, as children pick their noses in all diseases; starting, and grinding of the teeth in sleep; swell- ing of the upper lip; the appetite sometimes bad, at other times unite voracious; looseness; a sour or stinking breath; a hard swelled belly ; great thirst; the urine frothy, and sometimes ofa whiti'h colour; grip- ing, or colic pains; an involuntary discharge of saliva, especially when asleep, frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings; cold sweats; palsy; epileptic tit^, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber seed are symptoms of the tape-worm. I lately saw some very surprising effects of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expiretl, and upon opening lit r body a number of the teres or long round worms, were found in her guts, which were considerably inflam- ed ; aud what anatomists call an intus susceplio, or involving of one part of the gut within another, had taken place in no less than four differ- ent parts of the intestinal canal.* MEDICINE.—Though numberless medicines are extolled for ex- pelling and killing worins,f yet no disease more frequently baffles the physician's skill. In general, the most proper medicines for their ex- pulsion are strong purgatives; and to prevent their breeding, stomach bitters, with now and then a glass of good wine. The best purge for an adult is jalap and calomel. Five and twenty or thirty grains of the former with six or seven of the latter, mixed in syrup, may be taken early in the morning, for a dose. It will be pro- per.that the patient keep the house ad day, and drink nothing cold. The dose may be repeated once or twice, a week for a fortnight or threo weeks. On the intermediate days the patient may take a drachm of * That worms exist in the human body there can be no doubt; and that they mu,t sometimes be considered as u disease, is equally certain; but this is not the case so of- ten as people imnepne. The idea that worms occasion many diseases, give an oppor- tunity to th* professed worm doctors of imposing on the credulity of mankind, Mid do- ing much mischief. They find worms in every case, and liberally throw in their anti- dotes, which generally consist of strong drastic pnrpis. Ihave known tlicse given in delicate cotistitutior.s to the destruction ofthe patient, where there whs not the least symptom of worms. " t A medical writer of the present aye has enumerated upwards of fifty British plants, all selebratt^l for killing and expellinj; worms. OF WORMS. £3t the powder of tin, twice or thrice a-day, mixed with syrup, honey, or treacle. Those who do not chuse to take calomel, may make use of the bitter purgatives; as aloes, hiera picra, the tincture of senna, and rhubarb, Are. Oily medicines are sometimes found beneficial for expelling worms. An ounce of salad oil and a table-spoonful of common salt may be ta- ken in a glass of red port wine-thrice a-day, or oftener, if the stomach will bear it. But the more common form of using oil is in clysters. Oily civ sters, sweetened with sugar or honey, are very efficacious in bringing away the short round v\ onus called ascarides,and likewise the teres. The Harrow-gate water is an excellent medicine f>r expelling worms, especially the uscarides. As i!ii» water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine iu this case ; which is found to be a fact. Many practitioners ■j-ive flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or treacle, and taken in such quantity as to purge the patient. Where Harrowga'e water cannot be obtained, sea-water maybe used, which is far from being a contemptible medicine in this case. If sea-water cannot be had, common salt dissolved in water may be drank. I have often seen this used by country nurses with very good < fleet. Some flour of sulphur may be taken over night, and the salt water in the morning. But worms though expelled, will soon breed again, if the stomach re- mains weak and relaxed; to prevent which, we would recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glass of red port wine, three or four times a-day, after the above medi- cines have been used. Lime-water is likewise good for this purpose, or a table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank ; as the infusion of tansy, water trefoil, camomile-flowers, tops of worm-wood, the lesser centaury, &c. For a child of four or five years old, six grains of rhubarb, five of ja-' lap, and two of calomel, may be mixed ill a spoonful of syrup or ho- ney, and filven in the morniug. The child should keep the house all day, and take nothing cold. This dose may be repeated twice a- week for three or four weeks. On the intermediate days the child may takea scruple of powdered tin and ten grains of isthiops mineral in a spoonful of treacle twice a-day. This dose must be increased ov diminished according to the age of the patient. Bisset says, the great bastard black hellebore, or bear's foot, is a most powerful vermifuge for the loug round worms. He orders the decoction of about a drachm of the green leaves, or about fiftecu (irains of the dried leaves in powder for a dose to a child between four and seven years of age. This dose is to be repeated two or three times. He adds, that the green leaves made into a syrup with coarse su«ar is almost the only medicine he has used for round worms for three years past. Before'pressiog out the juice he moisteus the bruis- ed leaves v ith vinegar, which corrects the medicine. The dose is a tea- spoonful at bed time, and one or two next morning. I have frequently known those big bellies, which in children are com- monly reckoned a sign of worms, quite removed by giving them white soap iu their pottage, or other food. Tansy, garlic, aud rue, are all *32 OF THE JAUNDICE. good against worms^and may be used various ways. We might here mention many other plants, both for external and internal uh,as the cabbage bark, Sec. but think the powder of tin, with vthiops miner.. 1, and^lie purges of the rhubarb and calomel, arc more to be depend- ed on. Ball's purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, scamnieny, and calomel, with as much double refined sugar as is equal to the weight of all the other ingredients. These must be v\ell mixed together, and re- duced to a fine powder. The do?e for a. child is from ten graiiis to twenty, onve or twice a-w eek. An adult may take a drachm for a dose.* Parents who would preserve their children from worms ought to allow them plenty of exercise in the open air ; to take care that tlieir food be wholesome and sufficiently solid; and as far as possi- ble, to prevent their eating raw herbs, roots, or green trashy fruits. It will not he amiss to aiiowa child who is subject to worms, aglass of red wine after meals; as every thing that braces and strengthens tfee ttomach is good both for preventing aud expelling these vermin.t CHAPTER XXXVlIt. OF THE JAUNDICE. 1 HIS disease is first observable in the white of the eve, which ap- pears yellow. Afterwards the whole skin puts on a yellow appearance. The urine too is ofa saffron hue, and dyes a white cloth of the same colour. There is likewise a species of this disease called the Black Jaundice. CAUSES—The immediate cause of the jaundice is an obstruction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, \c. the bilious or hysteric colic ; vio- lent passions, as grief, anger, Sec. Strong purges or vomit- will like- wise occasion the jaundice. Sometimes it proceeds from obstinate agues, or from that disease being prematurely slopped by astringent medicines. In infants it is often occasioned by the meconium not being sufficiently purged off". Pregnant women are very subject to it. It is likewise a symptom in several kinds of fever. Catching cold, or the stoppage of customary evacuations, as the menses, the bleeding piles, issues, Sec. will occasion the jaundice. SYMPTOMS.—The patient at first complains of excessive weari- ness, and has great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The stools are of a whitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load'or oppression on his breast. There is a heat in his nostrils, a bitter taste in thi; mouth, loathing of food, sick- * A powder for the tape-worm resembling this, was long kept a secret on the Conti- nent ; it was lately purchased by the French king, and will be found under the article Powder in the Appendix. t We think it nect ssary hereto warn people of tlieir danger who buy cakes, powders, and •ther worm mediciiies,'at random. Ironi quacks, and give them to their children without proper care. The principal ingredients in most of these medicines is mercury, which is iicvw to be trifled with. I lutely saw a shocking instance of the danger of this con- duct. A girl who had taken a dose of wtirin powder, bought of a tr„ veiling quack, went out. and perhaps was so imprudent as to drink cold water during the operation.. She immt diately swelled, and died on the following; day with all the symptoms wfh <, in? been poisoned. OF THE JAUNDICE. 28S Bess of the stomach, vomiting, flatulency, and other symptoms of indigestion. If the patient be young, and the disease complicated with no other malady, it is seldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropsy or hypochon- driac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. REGIMEN.—The diet should be cool, light, and diluting, consisting chiefly of ripe fruits and mild vegetables , as apples boiled or roasted, stewed prunes, preserved plums, boiled spinnage, &c. Veal or chicken broth, with light bread, are likewise, very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be butter-milk, whey sweetened with honey, or decoctions of cool opening vegetables; or marsh-mallow roots, with liquorice, &c. The patient should take as much exercise as he can bear, either on horseback, or in a carriage; walking, running, and even jumping, are likewise proper, provided he can bear them witliout pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines had proved ineffectual. Amusements are likewise of great use in the jaundice The disease is often occasioned by a sedentary life, joined to a dull melancholy disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have a good effect; as dancing, laughing, singing, Sec. MEDICINE.—If the patient be young, of a full sanguine habit, and complains of pain in the right side about the region of the liver, bleeding will be necessary. After this a vomit must be administered, and if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than vomits, especially where it is not attended with inflammation. Haifa drachm of ipecacu- anha in powder, will be a sufficient dose for an adult. It may be wrought off with weak camomile-tea, or lukewarm water. The body must likewise be kept open by a sufficient quantity of castilc soap, or the pills for the jaundice recommended in the Appendix. Fomenting the parts about the region of the stomach and liver, and nibbing them with a warm hand or flesh brush, are likewise beneficial, but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue in it as long as his strength will permit. Many dirty things are recommended for the cure of the jaundice ; as lice, millepedes, Sec. But these do more harm than good, as people trust to them, and neglect more valuable medicines; besides they are feltloni taken in sufficient quantity to produce any eli'ects. People al- ways expect that such things should act as charms, and consequently seldom persist in the use of them. Vomits, purges, fomen'ations, and exercise, will seldom fail to cure the jaundice when it is a simple disease ; and when complicated with the dropsy, a scirrhous liver, or other chronic complaints, it is hardly to be cured by any means. Numberless British herbs are extolled for the cure of this disease. The author of the Medicina Britannica mentions near a hundred, all famous for curing the jaundice. The fact is, the disease often goes oil"of its own accord ; ip wliich case the last niedicme is always said *to have, performed the cure. Ihave sometimes, however, seen con- siderable benefit, in a very obstinate jaundice, from a decoction of *S4 Ol THi: DR01JSV. si heinpseed. Four ounces of the seed maybe boile.l in two Eii»li u quarts of ale, and sweetened with coarse sugar. The dose is h-.ilf an English pint every morning. It may be continued for eight or nine days. I have likewise known Harrowgate sulphur water cure a jaundice of Very long standing. It should be used for some weeks, and the patient must both driint and bathe. The soluble tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning In a cup of tea or water-gruel. If it does not open the body, the dose may be increns-cd. Persons subject to the jaundice ought to take as much exercise as possible, and to avoid all heating and astringent aliments. CHAPTER XXXIX. OF THE DROPSY. I HE dropsy is a preternatural swelling of the whole body, or some part of it occasioned by a collection of watery humour. It is distin- guished by different names, according to the part affected, as the anas- area, or collection of water under the skin; the ascites, or collection of water in the billy ; the hydrops pectoris, or dropsy of the.breast; the hildrtierpL.-tii:-", or dropsy of the brain, &C. i CAUSES.—The dropsy is often owing to an hereditary disposition. It usi'.y likewise proceed from drinkiug ardent spirits, or other strong liquors, it is true almost to a proverb, that great drinkers die of the dropsy. The van; of exercise is also a very common cause of the drop- sy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evacuations, as frequent and copious Idcediug, strong purges often repeated, frequent salivations, cvc. Tiic sudden stoppage of customary or necessary evacuations, a3 t:ii? menses, the Liunionhoi-Js, fluxes of the belly, &c. may likewise cause a dropsy. 1 have known the dropsy occasioned by drinking large quantities cf cold, weak, watery liquor, when the body was heated by violent ex- ercis'j. A iow,damp, or marshy sit-.tiitiou is likewise a frequent cause ot" it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a long use of poor watery diet, or of vi>cons aliment that is hard of digestion. It is often the effect of ot'ier disease?, as the jaundice a scirrhus^ of the liver, 1 violent t> airue of Ions cot.tiunaiics, a distrrkuu, dysentery, an empyema, or a • consumption of tbe lings. Iu >l>ort, whatever obstructs the perspira- tion, or pre. ents the blood fioia being duly prepared, may occasion a dropsy.- .*.. S Y Al iJ. O '. 3.—The anasarca generally begins with a swelling of the feot and anc'ps towards night, wlm-h for some time disappears in the morning. I'i •he, evening tin? parts, it' pressed with the finger, will pit. The swePins'gradually ascends, and occupies the trunk of the body, the iirip.»,a*.id the head. Afterwards the breathing becomes dif- ficult, the mine is in small quantity, and the thirst great; the hotly u . bound, and the per >,nation is p;reatiy obstructed. To these succeed torpor, heaviness, i-low waiting fe\;.-r, and a troublesome cocjdi. This last is fcenual'v u fata! svuptoui, as it chews that the lung' >re • ..r-Vci.''.. OF THE DROPSY. 233 Iu an ascites, besides tlie above symptoms, there is a swelling of the belly,mid often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swell- ing, as well as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits ofa radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief. When the disease comes suddenly on, and the patient is young and strong, there is reason, however, to hope for a cure, especially if medi- cine bi^given early. But if the patient be old, has led an irregular or a sedentary life, or if there be reason to suspect that the liver, lungs, or any of the viscera are. unsound, there is great reason to fear that the consequences will prove fatal. REGIMEN.—The patient must abstain as much as possible from all drink, especially weak and watery liquors, and most quench his thirst with mustard-whey, or acids, as juice of lemons, oranges, sorrel, or suchlike. His aliment ought to be dry, ofa stimulating and diu- retic quality, as toasted bread, the flesh of birds, or other wild animals roasted; pungent aud aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, Sec. He may also eat sea- biscuit dipt in wine or a little brandy. This is not only nourishing, but ; tends to quench thirst. Some have been actually cured of a dropsy ', by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient must have drink, the i Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best. Exercise is of the greatest importance in a dropsy. If the patient be able to walk,dig, or the iike, he ought to continue these exercises as loug as he can. If he is notable to walk or labour, he must ride on horse- 's back, or in a carriage, and the more violent the motion so much the ' In tier, 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 possible, into a warmer i-limate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient's body two or three limes a-day, with a hard cloth, or the flesh-brush; and he ought constantly to wear flannel next his skin. MEDICINE.—If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by f strong vomils, brisk purges, and such medicines as promote a discharge > by sweat and urine. For an adult, half a drachm of ipecacuanha in powder, and half an oui:ce of oxymel of squills, will he a proper vomit. This may be repeated as often as is uete s.uy, three or four days inter- vening between the doses. The patient must not drink much after ukii;g lilt' vomit, otherwise he destroys its effect. A cup or two of camomile tea will be sufficient to work it off. Between each vomit, on one. of the intermediate days, the patient may lake the following purge : Jalap in powder halfa drachm, cream of tartar two drachms, calomel six grains. These may be made into a •% bolus with a little syrup of pale roses, and taken early in the morning. The less thepatientdrinks after it the better. If he be much griped, he may now and then take a cup of chicken broth. S36 OF THE DROPSY. Thepatientmay likewise take every night at bed-time the following bolus: To four or five grains of camphor add one grain of opium, and as much syrup of orange-peal as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encoura- ged by drinking now and then a small cup of wine whey, with a tea- spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day. Take juniper berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom half a pound; infuse them in a quart of Rhenish wine or stong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broom in wine. The above course will often cure an incidental dropsy, if the con- stitution be good ; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case, the safer course is to palliate the symptoms by the use of such medicines as promote the secre- tions, and to support the patient's strength by warm and nourishing cor- dials. The secretion of urine may be greatly promoted by nitre. Brookes says, he knew a young woman who was cured ofa dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a gaod diuretic. Six or eight grains of it, with a scruple of nitre, may be given twice a-day in a glass of strong cinnamon water. Ball says, a large spoonful of unbruired mustard-seed taken every night and mor- ning, and drinking half an English pint of the decoction of the tops of jjreen broom after it, has performed a cure after other powerful medi- cines had proved ineffectual. I have sometimes seen good effects from cream of tartar in this di- sease. It promotes the discharges by stool aud urine, and will at least palliate, if it does not perform a cure. The patient may begin by tak- ing an ounce every second or third day, and may increase the quanti- ty to-two or even to three ounces, if the stomach will bear it. This quantity is not however to be taken at once, but divided into three or four doses. To promote perspiration, the patient may use the decoction of sene- ka-root, as directed above; or he may take two table-spoonsful of Miudererus'spirit in a cup of wine-whey three or four times a-day. To ■^ promote a discharge of urine, the following infusion of the London hos- pitals will likewise be beneficial: Take of zedoary-root two drachms ; dried squills, rhubarb, and ju- niper-berries bruised, of each a drachm; cinnamon in powder, three drachms; salt of worm-wood, a drachm and a half; infuse in an Eng- lish pint and a half of old hock wine, and when tit for use, filter the li- quor. A wine-glass of it may be taken three or four times a-day. In the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged ; but the operator must becautioHs not to make the incisions too deep; tbfyouglit barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and propei digestives, to prevent a gangrene. In an acites, when the disease docs not evidently and speedily givo OF THE GOUT. *.)7 way to purgative and diuretic medicmcs, the water ought to be let off by tapping. This is a very simple and safe operation, and would of- ten succeed, if it were performed in due time ; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any permanent relief will be pro- cured.* After the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. His diet ought to be dry and nourishing such as is recommended in the beginning of the Chapter; and he should take as much exercise as he can bear without fatigu". He should wear flan- nel next his skin, and make daily use of the flesh-brush. CHAPTER XL. OF THE GOUT. THERE is no disease wliich shews the imperfection of medicine or sets tlm advantages of temperance and exercise in a stronger light, than the goat. Excess and idleness are the true sources from whence it originally sprung, and all who would avoid it must be active and tem- perate. Though idleness and intemperance are the principal causes of the gout, yet many otiier things may contribute to brin;.' on the disorder in those who are not, and to induce a paroxysm in those who are sub- ject to it; as intense study; too free an use of acidulated liquors ; night- ' watching; grief or uneasiness of mind ; an obs'ruction or defect of any of the customary discharges, as the menses, sweating of the feet, pers- piration, &c. . SYMPTOMS.—A fit of the gout is generally preceded by mdigcs- tion, drowsiness, belching of wind, a slight head-ach, sickness, and sometinies vomiting. The patient complains of weariness and dejec- tion of spirits,-and has often a pain in the limbs, with a sensation as if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, aud there is a slight pain in passing urine, and frequently an involuntary shedding of tears. Sometimes these symptoms are much more violent especially upon the near approach of the fit; and it has been observed, that as is the fever which ushers in the gout, so will the fit be; if the fever be short and sharp, the fit will be so likewise; if it be feeble, long, and lingering, the fit will be such also. But this observation can only hold with re- spect to very regular fits of the gout. . The regular gout generally makes its attack in the spring or begin- ning of winter, in the following manner: About two or three in the morning the patient is seized with a pain in his great toe, sometimes in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured upon the part which is succeeded by a shivering, with some degree of fe- ver Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the different kinds of torture, as it the * The rcry name of an operation is dreadful to aost people, and they wi-h to try srei-v thine before they have recourse to it. This is the reason why tapping so seldom Jucieeditoour wish. 7I have had a patient who was regular v tapped once- a month rbr several vears, aud who used to eat her dinner as wtIIafter the operation a. it r**h- £g had kapneacd. She died at lMt rather worn eut by age than by the dunase. 33S OF THE GOUT. part were stretched, burnt, squeezed, gnawed, or torn to pieces. The part at length becomes so exquisitely sensible, that the patient can- not bear to have it touched, or even suffer airy perron to walk across the room. The patient is generally in exquisite torture for twenty-four hours, from the time of the coming on of the fit; he then becomes easier, the part begins to swell, appear red, and is covered with a little moisture. Towards morning he drops asleep, and generally falls into a gentle breathing sweat. This terminates the-first paroxysm, a number of which constitutes a fit of the gout; which is longer or shorter, accord- ing to the patienl's age, strength, the season of the year, and the dis- position of the body to this disease. The patient is always worse towards night, and easier in the morn- ing. The paroxysms however generally grow milder every day, till at length the disease is carried off by perspiration, urine and tlie other evacuations. In some patients this happens in a few day6; in other:' it requires weeks, and in some, months, to finish the fit.—Those whom age and frequent fits of the gout have greatly debilitated, seldom get free from it before tbe approach of summer, and sometimes not till it be pretty far advanced. REGIMEN.—As there are no medicines yet known, that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit. In the fit, if the patient be young and strong, his diet ought to be thin and cooling, and his drink ofa diluting nature; but when the constitu- tion is weak, and the patient has been accustomed to live high, this is not a proper time to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiration without greatly heating the patient. It will answer this purpose better if a tea-spoonful of sal volatile oleosum, or spirits of hartshorn, be putin'o a cup of it twice a-day. It will like- wise be proper to give at bed-time a tea spoonful of the volatile tincture of guaiacum in a large: draught of warm wine-whey. This will greatly promote perspiration through the night. As the most safe anil efficacious method of discharging the gouty matter, is by perspiration, this ought to be kept up by all means, cs- pecially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fiur, or wool. The. last is most readily obtain- , ed, and seems to answer the purpose better than any thiir.' else. The ,;'r.\ people of Lancashire look upon wool as a kind of specific in the gout. They wrap a great quantity of it about the leg and foot affected, and I cover it with a skin of soft dressed leather. This they suffer to contin- ue for eight or ten days, and sometimes for a fortnight or three weeks, or longer, if the pain does not cease. I never knew any external appli- cation answer so w ell in the gout. I have often seen it applied when the swelling and inflammation were very great, with violent pain, and have found all these symptoms relieved by it in a few days. The wool which they use is generally greased, and carded or combed. They choose the softest which can be had, and seldom or never remove it till the fit be entirely gone off. The patient ought likewise to be kept quiet and easy during the fit. j Every thing that affects the mind disturbs the paroxysm, nnd tends to L throw the gout upon the uobler parts. All external applications that Ife repel th» matter are to be avoided as death. They do not cure tht OF THE GOUT. S3§ disease, but remove it from a safer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is to be considered as Nature's method of removing something that might prove destruc- tive to the body,and all that we can do, with safety, is to promote her intentions, and to assist her in expelling the enemy in her own way. Evacuation by bleeding, stool, Sec. are likewise to be used with caution, they do not remove the cause of the disease, and sometimes by weaken- ing the patient, prolong the fit; but where the constitution is able to bear it, it will be of use to keep the body gently open by diet, or very mild laxative medicines. Many things will indeed shorten a fit of the gout, and some will drive it off altogether : but nothing has yet been found which will do this with safety to the patient. In pain we eagerly grasp at any thing that prom- i-es immediate ease, and even hazard life itself for a temporary relief. This is the true reason why so many infallible remedies have been pro- posed for the gout, and why such numbers have lost tlieir lives by the use of them. It would be as prudent to stop the small-pox from rising, and to drive them into the blood, as to attempt to repel the gouty mat- ter afterit has been thrown upon the extremities. The latter is as much an effort of Nature to free herself from an offending cause as the former, and ought equally to be promoted. When the pain however is very great, and the patient is restless, thir- ty or forty drops of laudanum, more or less, according to the violence of the symptoms, may be taken at bed-time. This will ease the pain, procure rest, promote perspiration, and forward the crisis of the disease. After the fit is over the patient ought to take a gentle dose or two of ,- the bitter tincture of rhubarb, or some other worm stomachic purge. He should also drink a weak infusion of stomachic bitters in small wine er ale, as the Peruvian bark, with cinnamon, Virginia snake-root, and oraoj e-p :el. The diet at this time should be light but nourishing, and gentle exercise ought to be taken on horseback, or in a carriage. Out of tne lit, it is in the parent's power to do many things towards preventing a return of the disorder, or rendering the fit, if it should re- turn, less severe. This, however, is not to be attempted by medicine. I have frequently known the gout kept off for several years, by the Peruvian bark and other astringent medicines; but in all the cases where I had occasion to see this tried, the persons died suddenly, and, to all appearance, for want ofa regular fit of tlie gout. One would be • apt, from hence, to conclude, that a fit of the gout to some constitu- r tions, iu the decline of life, i:> rather salutary than hurtful. Though it may be dangerous to stop a fit of the gout by medicine, yet if the constitution can be so changed by diet and exercise, as to lessen or totally prevent its return, there certainly can be no danger in following such a course. It is well known that the whole habit may be so altered by a proper regimen, as quits to eradicate this disease; and those only who have sufficient resolution to persist in such a course have reason to t\f>ect a cure. The course which we would recommend for preventing the gout, is as follows: In the first place, universal temperance. In the next place sufficient exercise.* By~tbis we do not meau sauntering about in aa indolent manner, but labour, sw-ut, aud toil. These only can render I • Some mike a sreret of curing the gout by muscular exercise. This secret, how- i ever, is as "Id as CYlsus, who strongly retommtnds that mode of cure; and whoever will .vibn.ii tu a, in the fullest extest, may expect t« reap sow aud perwant-nt sr'vantag-i-s. , i*Q OF THE GOUT. the humours wholesome, and keep them so. Going early to bed, aud rising betimes, are also of great importance. It is likewise proper to avoid night studies, and e ofa rheuma- tism that I ever saw, where almost everyjoint of the body was distorted, was a man who used to work one part of the day by fire, and the other part of it in water. Very obstinate rheumatisms have likewise been brought on by persons not accustomed to it, allowing tlieir feet to continue long wet. The same effects are often produced by wet clothes, damp-beds, sitting or lying on the damp ground, travelling in the night, &c. The rheumatism may likewise be occasioned by excessive evacua- tions, or the stoppage of customary discharges. It is often the effect of chronic diseases, which vitiate the humours ; as the scurvy, the lue$ veneroa, obstinate autumnal agues, &c. The rheumatism prevails in cold, damp, marshy countries. It is most common among the poorer sort of peasants, who are ill clothed, live in low damp houses, and eat coarse and unwholesome food, which con- tains but little nourishment, and is not easily digested. SYMPTOMS.—The acute rheumatism commonly begins with wea- riness, shivering, a quick pulse, restlessness, thirst aod other symp- toms of fever. Afterwards the patient complains of flying pains, which are increased by the least motion. These at length fix in the joints, which are often affected with swelling and inflammation. If blood be let in this disease, it has generally the same appearance as m the P Tn'this kind of rheumatism the treatment of the patient is nearly thesame as in an acute or inflammatory fever. If he be young and strong, bleeding is necessary, which may be repeated according to the exigencies of the case. The body ought likewise to be kept open by emollient clysters, 01 cool opening liquors ; as .lecoctiousot tamarinds, cream of tartar, whey, seuna-tea, and the like. The diet -Houltl b* • A late French writer (M- Cadet de Vaux) <.!' some c. lebrity, for tfce eure of this_di»- e«.o nres^ibeTtortv-e Sht gl. uies of warm water in tw ive hours, a glass every u.n.,rter, ^J^^V^^h^^^S^^- This*™*" » ah-eady^emraUy adopted in Frauce. ut OF THE RHEUMATISM. Mindereri, Sec. He may likewise take, for a few nights, at bed-time, ia a cup of wine-whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder. Warm bathing, after proper evacuations, has often an exceeding good effect. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affected. Great care must be taken that he do not catch cold after bathing. The chronic rheumatism is seldom attended with any considerable degree of fever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There is seldom any inflammation or swelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients it often proves extremely obstinate and sometimes incurable. In this kind of rheumatism the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chiefly of vegetable substances, as stewed prunes, coddled apples, currants or gooseberries boiled in milk, is most proper. Arbuthnot says, " If there be a specific in aliment for the rheumatism, it is certainly whey ;" and adds, " That he kuew a person subject to this disease, who could never be cured by any other method but a diet of whey and bread." He likewise says, " That cream of tartar in watcr-gruel, taken for several days, will ease rheumatic pains considerably." This I have often experien- ced, but found it always more efficacious when joined with gum guaiacum, as already directed.—In this case the patient may take the dose formerly mentioned, twice a-day, and likewise a tea- spoonful of the volatile tincture of gum guaiacum, at bed-time, in wine-whey. This course may be continued for a week, or longer, if the case proves obstinate, and the patient's strength will permit. It ought then to be omitted for a few days, and repeated again. At the same time leeches, or a blistering-plaster may be applied to the part affect- ed. What I have generally found answer better than either of these, in obstinate fixed rheumatic pains, is the warm-plaster* I have like- wise known a plaster of Burgundy pitch worn for some time on the part affected, give great relief in rheumatic pains. My ingenious friend, Dr. Alexander, of Edinburgh, says, he has frequently cured very obstinate rheumatic pains, by rubbing the part affected, with tincture of cantharides. When the common tincture did not suc- ceed, he used it of a double or treble strength. Cupping upon the part affected, is likewise often very beneficial, and so is the application of leeches. Though this disease may not seem to yield to medicines for some time, yet they ought still to be persisted in. Persons who are subject to frequent returns of the rheumatism, will often find their account in using medicines, whether they be immediately affected with the dis- ease or not. The chronic rheumatism is similar to the gout in this res- pect, tha' the. most proper time for using medicines to extirpate it,is when the patient is most free from the disorder. To those who can afford the expense, I would recommend the warm baths of Buxton or Matlock in Derbyshire. These have, often, to my knowledge, cured very obstinate rheumatisms, and are always safe either in or out of the fit. When the rheumatism is complicated with scorbutic complaints, which is not seldom the case, the Harrowgata • See Appendix, IVarm Plaster, OF THE SCURVY. 243 waters, and those of Moffat, are proper. They should both be drank and used as a warm bath. There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of water, or small wine. The water-trefoil is like- wise of great use in this complaint. It may be infused in wine or ale, or drank in form of tea. The ground-ivy, camomile, and seve- ral other bitters, are also beneficial, and may be used in the same manner. No benefit however is to be expected from these un- less they be taken for a considerable time. Excellent medicines arc often despised iu this disease, because they do not perform an im- mediate cure ; whereas nothing would be more certain than tlieir effect, were they duly persisted in. Want of perseverance in the use of medicines, is one reason why chronic diseases are so seldom cured. Cold bathing, especially in salt water, often cures Ihe rheumatism. We would also recommend riding on horseback, and wearing flannel next the skin. Issues are likewise very proper, especially in chro- nic cases. If the pain affects the shoulders, an issue may be made in the arm -, but if it affects the loins, it should he put into the leg or thigh. Persons afflicted with the scurvy are very subject to rheumatic com- plaints. The best medicines iu this case are bitters aud mild purga- tives. These may either be taken separately or together, as the pfrient inclines. An ounce of Peruvian bark, and half an ounce of rluuiarb in powder, may be infused in a bottle of wine ; and one, two, or three wine-glasses of it taken daily, as shall be found necessary for ". keeping the body gently open. In cases where the bark itself proves sufficiently purgative, the rhubarb may be omitted. Such as are subject to frequent attacks of the rheumatism, ought to make choice of a dry, warm situation, to avoid the night-air, wet clothes, and wet feet, as much as possible. Their clothing should be warm, and they should wear flannel next tlieir skin, and make frequent use of the flesh-brush. CHAPTER XLI. OF THE SCURVY. J: HIS disease prevails chiefly in cold northern countries, especially in ' low damp situations, near large marshes, or great quantities of stagna- ** ting water. Sedentary people, of a dull melancholy disposition, are ' most subject to it. It proves often fatal to sailors on long voyages, particularly in ships that are not properly ventilated, have many people on board, or where cleanliness is neglected. It is not necessary to mention the different species into which this disease has been divided, as they differ from one another chiefly in degree. What is called the land scurvy, however, is seldom attended with those highly putrid symptoms which appear iu patients who ' have been long at sea, and which we presume, are rather owing to confined air, want of exerci-e, and the unwholesome food eaten by sailois on long voyages, than to any specific difference in the disease. CAUSES.—The scurvy is occasioned by cold moist air; by the long use of salted or smoke dried provisions, or any kind of food that 2« OF THE SCURVY. is hard of digestion, and affords little nourishment. It may also pro- ceed from the suppression of customary evacuations ; as the menses, haemorrhoidal flux, &c. It is sometimes owing to an hereditary taint, in which case a veiy small cause will excite the latent dis- order. Grief, fear, and other depressing passions, have a great tendency both to excite and aggravate this disease. The same ob- servation holds with regard to neglect of cleanliness ; bad cloth- ing ; the want of proper exercise ; confined air ; unwholesome food ; or any disease which greatly weakens the body, or vitiates the hu- mours. SYMPTOMS.—This disease may be known by unusual weariness, heaviness; and difficulty of breathing, especially after motion; rot- tenness of the gums, which are apt to bleed on the slightest tonch; a stinking breath; frequent bleeding at the nose ; crackling of the joints; difficulty of walking; sometimes a swelling and sometimes a falling away of the legs, on which there are livid, yellow, or violet coloured spots; the face is generally ofa pale or leaden colour. As the disease advances, other symptoms come on; as rottenness of the teeth, haemorrhages or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, especially about the breast, dry scaly eruptions all over the body, Sec. At last a wasting or hectic fever comes on, and the miserable patientis often carried off by a dysentery, a diarrhoea, a dropsy, the palsy, fainting fits, or a mor- tification of some of the bowels. CURE.—-We know no way of curing this disease but by pursuing a plan directly opposite to that which brings it on. It proceeds from a vitiated 3tate of the humours, occasioned by errors in diet, air, or exer- cise ; and this cannot be removed but by a proper attention to these im- portant articles. If the patient ha3 been obliged to breathe a cold, damp, or confined air, he should be removed, as soon as possible to a dry, open, and mod- erately warm one. If there is reason to believe that the disease pro- ceeds from a sedentary life, or depressing passions, as grief, fear, Set. the patient must take daily as much exercise in the open air, as he can bear, and his mind should be diverted by cheerful company and other amusements. Nothing has a greater tendency either to prevent or remove this disease, than constant cheerfulness and good humour. But this, alas! is seldom the lot of pei sons afflicted with the scurvy; they are generally surly, peevish, and morose. When the scurvy has been brought on by a long use of salted provi- sions, the proper medicine is a diet consisting chiefly of fresh vegeta- bles ; as oranges, apples, lemons, limes, tamarinds, water-cresses, tcnr- vy-grass, brook-lime, Sec. The use of these, with milk, pot-herbs, new bread, and fresh beer or cyder, will seldom fail to remove a scurvy of this kind, if taken before it be too far advanced, but to have this ef- fect they must be persisted in a considerable time. When fresh vege- tables cannot be obtained, pickled or pre-erved ones may be used; and wherethe.se are wanting recourse must be had to the chymical acids. All the patieut's food and drink should in this case be sharpened with cream of tartar, elixir of vitriol, vinegar, or the spirit of sea-salt. These things however will more certainly prevent than cure the scur- vy, for which reason sea-faring people, especially on long voyages, ought to lay in plenty of them. Cabbages, onions, goose-berries, and many other vegetables, may be kept a long time by pickling, preser- ving, Sec. aud when these fail the chymical acids, recommended a- OF THE SCURVY. 2« bove, which will keep for any length of time, may be used. We have reason to believe, if ships were well ventilated, had got stores of fruits, greens, cyder, &c. laid in, and if proper regard were paid to clean- liness and warmth, that sailors would be the most healthy people in the world, aud would seldom suffer either from the scurvy or putrid fevers, which are so fatal to that useful set of men ; but it is too much the tem- per of such people to despise all precaution ; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow. It must indeed be owned, that many of them have it not in their pow- er to make the provision we are speaking of; but in this case it is the duty of their employer to make it for them ; and no man ought to en- gage in a long voyage without having these articles secured. I have often seen very extraordinary eftects in the land scurvy from a milk diet. This preparation of nature is a mixture of animal and ve- getable properties, which of all others is the most fit for restoring a decayed constitution, and removing that particular acrimony of the humours, which seem to constitute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourish- ing food, because it is cheap, and devour with greediness, flesh and fer- * mented liquors, while milk is only deemed fit for tlieir hogs. The most proper drink in the scurvy, is whey or butter-milk__When these cannot be had, sound cyder, .perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, and , may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce fir is likewise proper. It may be drank in the quantity of an English pint twice a day. Tar-water may ^ be used for the same purpose, or decoctions of any of the mild muci- lagenous vegetables: as sarsaparilla, map-h-mallow roots, Sec. Infu- sions of the bitter plants, as ground-ivy, the lesser centaury, marsh- trefoil, Sec. are likewise beneficial. I have seen peasants in some parts of Britain express the juice of the. last mentioned plant, and drink it with good effect in those foul scorbutic eruptions, with which they are often troubled in the spring season. Harrowgate water is certainly an excellent medicine in the land scur- vy. I have often seen patients who had been reduced to the most de- plorable condition by this disease, greatly relieved by drinking the sul- phur-water, and bathing in it. The chalybeate water, may also be us- ed with advantage, especially with a view to brace the stomach after * drinking the sulphur-water, which though it sharpens the appetite, ne- ver fails to weaken the powers of digestion. A slight degree of scurvy may be carried off by frequently suckin» a little of the juice ofa bitter orange or lemon. When the disease affects the gums only, this practice, if continued for some time, will generally carry it off. We would however recommend the bitter or- ' ange as greatly preferable to lemon, it seems to be as good a medicine aud is not near so hurtful to the stomach. Perhaps our own sorrel may be little inferior to either of them. All kinds of salad are good in the scurvy, and ought to be eaten very plentifully, as spinuage, lettuce, parsley, celery, endive, radish, dan- delion, Sec. It is amazing to see how soon fre h vegetables in the spring, cure the brute animals of any scab or foulness which is upon tlieir skins. It is reasonable to suppose that their effects would be as great n-.on the human species, were they used in proper quantities for a sufficient length of time. I have seen good effects in scorbutic complaints of very long stand. X2 2i6 OF THE SCROPHULA, ing, from the use of a decoction of the roots of water dock. It is ^usually made by boiling a pound of the fresh root in six English pints of water, till about one third of it be consumed. The dose is from half a pint to a whole pint of the decoction every day. But in all the cases where I have seen it prove beneficial, it was made much stronger, and drank in larger quantities. The safest way, however, is for the patient to begin with small doses, and increase "them both in strength and quantity as he finds his stomach will bear it. It must be used for a considerable time. I have known some take it for many months, and have been told of others who had used it for several years, before they were sensible of any benefit, but who nevertheless were cured by it at length. The leprosy, which was so common in the country long ago, seems to have been near a-kin to the scurvy. Perhaps its appearing so seldom now, may be owing to the inhabitants of Britain eating more vegetable food than formerly, living more upon tea and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, &c. For the cure of this disease we would recommend the same course of diet and medicine as in the scurvy. OF THE SCROPHULA, OR KING'S EVIL. • This disease chiefly affects the glands, especially those of the neck. Children and young persons of a sedentary life are very subject to it. It is one of those diseases which may be removed by proper regimen, but seldom yields to medicine. The inhabitants of cold, damp, marshy countries, are most liable to the scrophula. CAUSES.—This disease may proceed from an hereditary taint, from a scrophulous nurse, &c. Children who have the misfortune to be born of Sickly parents, whose constitutions have been greatly in- jured by the pox, or other chronic diseases, are apt to be affected with the scrophula. It may likewise proceed from such diseases as weaken the habit or vitiate the humours, as the small-pox, measles, Sec. External injuries, as blows, bruises, and the like, sometimes produce scrophulous ulcers; but we have reason to believe, when this happens, that there has been a predisposition in the habit to this disease. In short, whatever tends to vitiate the humours or relax the solids, paves the way to the scrophula; as tbe want of proper exercise, too much heat or cold, confined air, unwholesome food, bad water, the long use of poor, weak, watery aliments, the neglect of cleanliness, Sec. Nothing tends more to produce this disease in children, than allowing them to continue long wet.* SYMPTOMS.—At first small knots appear under the chin, or be- hind the ears, which gradually increase in number and size, till they form one large hard tumour. This often continues for a long time without breaking, and when it does break, it only discharges a thin sanies, or watery humour. Other parts of the body are likewise liable to its attack, as the arm-pits, groins, feet, hands, eyes, breasts, Sec. Nor are the internal parts exempt from it. It often affects the lungs, liver, or spleen; and I have frequently seen the glands of the mysentery greatly enlarged by it. Those obstinate ulcers which break out upon the feet and hands with swelling, and little or no redness, are of the scrophulous kind. They seldom discharge good matter, and are exceedingly difficult to cure. The white swellings of the joints seem likewise to be of thif kind. They are with difficulty brought to a suppuration, and when opened, they on- - • The scrophula, as well as the rickets, is found to prevail in large ounufacturiDg towns, where people live gross, and lead sedentary livea. OR KINGS EVIL. 247 Iy discharge a thin ichor. There is not a more general symptom of the scrophula than a swelling of the upper lip and nose. REGIMEN.—As this disease proceeds, in a great measure, from re- laxation, the diet ought to be generous and nourishing, but at the same time light and of easy digestion; as well fermented bread, made of sound grain, the flesh and broth of young animals, with now and then a glass of generous wine, or good ale. The air ought to be open, dry and not too cold, and the patient should take as much exercise as he can bear. This is of the utmost importance. Children who have sufficient exer- cise, are seldom troubled with the scrophula. MEDICINE.—The vulgar are remarkably credulous with regard to the cure of the scrophula; many of them believing in the virtue of the royal touch, that of the seventh son, &c. The truth is, we know but little either of the nature or cure of this disease, and where reason or medicines fail, superstition always comes in their place. Hence it is, that in diseases which are the most difficult to understand, we general- ly hear of the greatest number of miraculous cures being performed. Here, however, the deception is easily accounted for. The scrophula, at a certain period of life, often cures of itself; and if the patient hap- pens to be touched about this time, the cure is imputed to the touch, and not to nature, who is really the physician. In the same way the insignificant nostrums of quacks and old women, often gain applause when they deserve none. There is nothing more pernicious than the custom of plying children in the scrophula with strong purgative medicines. People imagine it proceeds from humours which must be purged off, without considering that these purgatives increase the debility, and aggravate the disease. It has indeed been found, that keeping the body gently open for some time, especially with sea-water, has a good effect; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day. Bathing in the salt-water has likewise a very good effect, especially in tbe warm season. I have often known a course of bathing in salt- water, and drinking it in such quantities as to keep the body gently open, cure a scrophula, after many other medicines had been tried in vain. When salt water cannot be. obtained, the patient may be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative. Next to cold bathing, and drinking the salt water, we would recom- mend the Peruvian bark- The cold bath may be used in summer and the bark in winter. To an adult halfa drachm of the bark in powder may be given in a glass of red wine, four or five times a-day. Children, and such as cannot take it in substance, may use the decoction, made in the following manner: Boil an ounce of Peruvian bark, and a drachm of Winter's bark, both grossly powdered, in an English quart of water to a pint: towards the end, half an ounce, of sliced liquorice-root, and a handful of raisins may be added, which will both render the decoction less disagreeable, and make it take up more of tlie bark. The liquor must be strained, and two, three, or four table-spoonsful, according to the age of the patient, given three times a-day. The Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrophula. They ought not, however, to be drank in large quantities, but should be taken so as 248 OF THE ITCH. to keep the body gently open, and must be used for a considerable time. The hemlock may sometimes be used with advantage in the scro- phula. Some lay it down as a general rule, that the sea-water is most proper before there are any suppuration or symptoms of faces; the Peruvian bark, when there are running sores, and a degree of hectic fever; and the hemlock in old inveterate cases, approach- ing to the scirrhous or cancerous state. Either the extract, or the fresh juice of this plant may be used. The dose must be small at first, and increased gradually as far as the stomach is able to bear it. External applications are of little use. Before the tumour breaks nothing ought to be applied to it, unless a piece of flannel, or some- thing to keep it warm. After it breaks, the sore may be dressed with some digestive ointment. What I have always found to answer best, was the yellow basilicon mixed with about a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed with this twice a-day; and if it be very fungous, and does not digest well, a larger proportion of the precipitate may be added. Medicines which mitigate this disease, though they do not cure it, are not to be despised. If the patient can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get well; but if he does not recover at this time, in all probability he never will. There is no malady which parents are so apt to communicate to their offspring, as the scrophula, for which reason people ought to beware of marrying into families affected with this disease. For the means of preventing the scrophula we must refer the reader to the observations on nursing at the beginning of the book. OF THE ITCH. Though this disease is commonly communicated by infection, yet it seldom prevails where due regard is paid to cleanliness, fresh air aud wholesome diet. It generally appears in form of small watery pus- tules, first about the wrists or betweeu the fingers ; afterwards it af- fects the arms, legs, thighs, &c. These pustules are attended with an intolerable itching, especially when the patient is warm in bed, or sits by the fire. Sometimes indeed the skin is covered with large blotches or scabs, and at other times with a white scurf, or scaly eruption. This last is called the dry itch, and is the most difficult to cure. The itch is seldom a dangerous disease, unless when it is rendered so by neglect or improper treatment. If it be suffered to continue too long, it may vitiate the whole mass of humours; and if it be suddenly drove in, without proper evacuations, it may occasion fevers, inflam- mations of the viscera, orotherinternal disorders. The best medicine yet known for the itch is sulphur, which ought to be used both externally, and internally. The parts most affected may be rubbed with an ointment made of the flour of sulphur, two ounces; crude sal ammouiac finely powdered, two drachms ; hog's lard, or but- ter, four ounces. If a scruple or halfa drachm of the essence of lemon be added, it will entirely takeaway the disagreeable smell. About the bulk of a nutmeg of this may tie rubbed upon the extremi- ties at bed time twice or thrice a week. It is seldom necessary to rub the whole body ; but when it is, it ought not to be done all OF THE ITCH. 549 at once, but by tarns, as it is dangerous to stop too many pores at the same time. Before the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge, or two. It will likewise be pro- per, during the use of it, to take every night and morning, as much of the fli.'tr of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catch- ing cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment ; and such clothes as have been worn while the patient was under the disease, are not to be used again, unless they have been fumigated with brimstone, and tho- roughly cleansed, otherwise they will communicate the iufection anew.* • I never knew brimstone, when used as directed above, fail to cure the itch ; and I have reason to believe, that if duly persisted in, it never will fail; but if it be only used once or twice, and cleanliness neglected, it is no wonder if the disorder returns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person ; but if any symptoms of the disease should appear again, the medicine must be repeated. It is both more safe and efficacious when persisted in for a considerable time than when a large quantity is applied at once. As most people dislike the smell of sulphur, they may use in its place the powder of white hellebore root made up into an ointment, in the same manner, which w:!l seldom fail to cure the itch. People ought to be extremely cautious lest they take other eruptions for tbe itch; as the stoppage of these may be attended with fatal con- sequences. Many of the eruptive disorders to which children are lia- ble, have a near resemblance to this disease ; aud I have often known infants killed by being rubbed with greasy ointments that make these eruptions strike suddenly in, which nature had thrown out to preserve the patient's life, or prevent some other malady. Much mischief is likewise done by the use of mercury in this disease. Some persons are so fool-hardy as to wash the parts affected with a strong solution of the corrosive sublimate. Others use the mercurial ointment, without taking the least care either to avoid cold, keep the body open, or observe a proper regimen. The. consequences of such conduct may be easily guessed. I have known even the mercurial gir- dles produce bad effects, and would advise every person, as he values his health, to beware, how he uses them. Mercury ought never to be used as a medicine without the greatest care. Ignorant people look upon these girdles as a kind of charm, without considering that the mercury enters the body. It is not to be told what mischief is done by using mercurial oint- ment for curing the itch and killing vermin ; yet it is unnecessary for either : the former may he always more certainly cured by sulphur, and the latter will never be found where due regard is paid to cleanliness. Those who would avoid this detestable disease ought to beware of • Sir John Pringle observes, that though this disease may seem trifling, there is no one in the array that is more troublesome to cure, as the infection often lurks in clothes. &c. and breaks out a second, or even a third time. The same ineonveniency occurs in private families, unless particular regard is paid to the changing or dealing of their clothes, which hut is by no means an easy operation. 250 OF THE ASTHMA. infected persons, to use wholesome food, and to study universal cleanliness.* CHAPTER XLII. OF THE ASTHMA. 1 HE asthma is a disease of the lungs, which seldom admits of a cure. Persons iu the decline of life are most liable to it. It is distinguished into the moist and dry, or humoura! and nervous. The former is attended with expectoration or spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing. CAUSES.—The asthma is sometimes hereditary. It may likewise proceed from a bad formation of the breast; the fumes of metals or minerals taken into the lungs; violent exercise, especially running; the obstruction of customary evacuations, as the menses, hemorrhoids, &c. the sudden retrocession of the gout, or striking in of eruptions, as the small pox, measles, &c. violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that cither impedes the circulation of the blood, through the lungs, or pre- vents their being duly expanded by the air. SYMPTOMS.—An asthma is known by a quick laborious breathing, which is generally performed with a kind of wheezing noise. Some- times the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffoca- ted. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place under ground, or has taken some food which the stomach could not digest, at pastries, toasted cheese, or the like. The paroxysm is commonly ushered in with listlessness, want of sleep, hoarseness, a cough, belching of wind, a sense of heaviness about the breast, and difficulty of breathing. To these succeed heat, fever, pain of the head, sickness and nausea, great oppression of the breast, palpitation of the heart, a weak, and sometimes intermitting pulse, an involuntary flow of tears, bilious vomitings, &c. All the symptom! grow worse towards night; the patient is easier when up than in bed, and is very desirous of cool air. REGIMEN.—The food ought to be light, and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young nni- mals to that of old. All windy food, and whatever is apt to swell in th« stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled, or roasted are proper. Strong liquors of all kinds, especially malt-liquor, are hurtful. The patient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting* the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service. * The itch is now. by cleanliness banished from every genteel family in Britain. It still however prevails among tbe poorer sorts of peasants in Scotland, and among the manufacturers in Kngland. These are not only sufficient to keep th» seeds of the dis- ease alive, but to spread the infection among others. It were to be wished that some ef- fectual method could be devised tor extirpating it altogether. Several country clergy- men have told me, that by getting such as were infected cured, and strongly recommen- ding an attention to cleanliness, they have banished the itch entirely out of their parish* es. Why might not others do the tame. OF THE ASTHMA. 261 But nothing is of so great importance in the asthma, as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air ofa large town, or the sharp, keen atmosphere of a bleak hilly country; a medium therefore, between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed, breathe easier in town than in the country; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asth- matic persons who cannot live in Britain, enjoy very good health in the. south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it promotes the digestion, preparation of the blood, &c. The blood of asthmatic persons is seldom duly prepared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear. MEDICINE.—Almostall that can be done by medicine in this dis- ease, is to relieve the patient when seized with a violent fit. This in- deed requires the greatest expedition, as the disease often proves sud- denly fata'. In the paroxysm or fit, the body is generally bound ; a purging clyster, with a solution of asafoetida, ought therefore to be ad- ministered, and if there be occasion, it may be repeated two or three times. The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand or dry cloth. Bleeding, unless extreme weakness or old age sliould forbid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomenta- tions, or bladders filled with warm milk and water, may be applied to the part affected; and warm cataplasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoon- ful of the tincture of castor and of saffron mixed together, in a cup of valerian tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This however will be more safe after other evacuations have been pre- mised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm. In the moist asthma, such things as promote expectoration or spit- ting, ought to be used ; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup or oxymel of squills, mix- ed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of asafoetida and gum ammoniac, at bed time.* For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patieut may take a tea-spoonful of the paregoric elixir twice a day. The Peruvian bark is sometimes found to be of use in this case. It may be taken in substance, or infus- ed in wine. In short, every thing that braces the nerves, or takes off „spasm, may be of use iu a nervous asthma. It is often relieved by the * After copious evacuations, large doses of tether have been found very efficacious in removing a fit of the asthma. I h;>.ve likewise known the following mixture pro- duce very happy effects: To four or five ounces of the solution of gum-a nmoniac,add two ounces of simple cinnamon-water, the same quantity of balsamic syrup, and half an ounce of parogorio elixir. Of this, two table-spoousful may be taken every llnee hours. 252 OF THE APOPLEXY. use of asses'milk; I have likewise known cow's milk drank warm in the morning, have a very good effect in this case. In every species of asthma, sctons and issues have a good effect; they may either be set in the back or side, aud should never be allow- ed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient's life. CHAPTER XMII. OF THE APOPLEXY. IHE apoplexy is the sudden los« of sense and motion, during which the patient is to all appearance dead; the heart and lungs however still continue to move. Though this disease proves often fatal, ye^ it may be sometimes removed by proper care. It chiefly attacks sedentary persons ofa gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in winter, especially in rainy seasons, and very low states of the barometer. CAUSES.—The immediate cause of an apoplexy is a compression of the brain, occasioned by an excess of blood, or a collection of wa- tery humours. The former is called a sanguine, and the latter a se. tons apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of tbe blood from the head ; as intense study ; violent passions,* viewing objects for a long time obliquely ; wearing any thing too tight about the neck ; a rich and luxurious diet; suppression of urine ; suffering the body to cool suddenly after having been greatly heated; continuing long in a warm or cold bath; the excessive use of spiceries, or high seasoned food ; excess of venery ; the sudden striking in of any eruption ; suf- fering issues, setons, &c. suddenly to dry up, or the stoppage of any customary evacuation ; a mercurial salivation pushed too far, or sud- denly checked by cold -. wounds or bruises on the head ; long exposure to excessive cold ; poisonous exhalations, &c. SYMPTOMS, and method of cure.—The usual forerunners of an apoplexy are giddiness, pain and swimming of the head ; loss of memo- ry ; drowsiness, noise in the ears, the night-mare, a spontaneous flnx of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit. and should endeavour to prevent it by bleeding, a slender diet and opening medicines. In the sanguine apoplexy, if the patient does not die suddenly, tlie countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and temples, are turgid ; the breathing is difficult, and performed with a snorting noise. The excre- ments and urine are often voided spontaneously, and the patient is sometimes seized with vomiting. In this species of apoplexy every method must be taken to lessen the force of the circulation towards the head. The patient should be kept * I knew a woman, who in a violent fit of anger was seized with a sanguine apo- nlexy. She at first eon plained ofextremepauv'as if daggers had been thrust through her hivd " as she express* d it. Afterwards she became comatose, her pulse sunk very low and'w;-s exceeding slow. By bleeding, blistering, and other evacuations, she »a# kept alive for about a fortnight. When her head wasopened, a large quantity ofe*U* vacated blood wai found in the left veutriele. of the biain. OF COSTIVENESS, &c. 25* perfectly easy and cool. His head sliould be'raised pretty high, and his feet suffered to hang down. His clothes ought to be loosened es. pecially about the neck, and fresh air admitted into bis chamber. His garters sliould be tied pretty tight, by which means the motion of the blood from the lower extremities will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours. A laxative clyster, with plenty of sweet oil, or fresh butter, and a spoonful or two of common salt in it, may be ad- ministered every two hours ; and blistering-plasters applied between the shouldeis, and to the calves of the legs. As soon as the symptoms are a little abated, and the patieut is able to swallow, he ought to drink freely of some diluting opening liquor, as a decoction of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glauber's salts, manna dissolved in an infusion of senna, or the like. All spirits and other strong liquors are to be avoided. Even volatile salts held to the nose do mischief. Vomits, for the same rea- son, ought not to be given, or any thing that may increase the motion of the blood towards the head. In the serous apoplexy, the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here as in the former case. It may, however, generally be performed once with safety and advan- tage, but sliould not be repeated. The patient should be placed in the same posture as directed above, and should have blistering-plasters ap- plied, and receive opening clysters in the same manner. Purges here are likewise necessary, and the patient may drink strong balm-tea. If ! he be inclined to sweat, it ought to be promoted by drinking small wine-whey, or an infusion ofcarduns benedictus. A plentiful sweat kept up for a considerable time, has often carried off a serous apoplexy. When the apoplectic symptoms proceed from opium, or other nar- > cotic substances taken into the stomach, vomits are necessary. The 1 patient is generally relieved as soon as he has discharged the poison iu this way. Persons of an apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high seasoned food. They ought likewise to guard against all violent passions, and to avoid the extremes of heat and cold. The head should be shaved, and daily washed with cold water. ' The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected; but it ought to be taken in moderation.* Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons ; great care however, must be taken not to surfer them to dry i up, without opening others in their stead.—Apoplectic persons ought never to go to rest with a full stomach, or to he with their heads low, or to wear any thing too tight about their necks. CIIAPTFK XI.IV. OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS. We do not here mean to treat of those astrictions of the bowel1-. Y >j4 OF COSTIVENESS, &c. which are the symptoms of disease, as of the colic, the iliac passion, Sec. but only to take notice of that infrequcncy of stools wliich some- times happens, and which in some particular constitutions may occasion diseases. Costiveness may proceed from drinking rough red wines, or other astringent liquors; too much exercise, especially on horseback. It may likewise proceed from a long use of cold insipid food, which doea not sufficiently stimulate the intestines. Sometinies it is owing to the bile not descending to the intestines, as in the jaundice; and at other rimes it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumours, a cold dry state of the intestines, Sec. Excessive costiveness is apt to occasion pains of the head, vomiting, colics, and other complaints of the bowels. It is peculiarly hurtful to hypochondriac and hysteric persons, as it generates wind and other grievous symptoms. Some people however, can bear costiveness to a great degree. I know persons who enjoy pretty good health, yet do not go to stool above once a week, and others not above once a fortnight. Indeed I have heard of some who do not go above once a month. Persons who are generally costive, should live upon a moistening and laxative diet, as roasted or boiled apples, pears, stewed prunes, rai- sins, gruels with currants, butter, honey, sugar, and such like. Broths with spinnage, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, or that which is made ofa mixture of wheat and rye togeth- er, ought to be eaten. No person troubled with costiveness, should f^at white bread alone, especially that which is made of fine flour. The best bread for keeping the body soluble, is what in some parts of England they call meslin. It is made of a mixture of wheat and Tye, and is very agreeable to those who are accustomed to it. Costiveness is increased by keeping the body too warm, and by every thing that promotes the perspiration; as wearing flannel, lying too long a-bed, Sec. Intense thought, and a sedentary life, are like- wise hurtful. All the secretions and excretions are prompted by mode- rate exercise without doors, and by a gay, cheerful, sprightly temper of mind. The drink should be of an opening quality. All ardent spirits, aus- tere and astringent wines, as port, claret, Sec. ought to be avoided. .Halt liquor that is fine, and ofa moderate strength, is very proper. Butter-milk, whey, and other watery liquors, are likewise proper, and may be drank in turns, as the patient's inclination directs. Those who are troubled with costiveness, ought if possible to reme- dy it by diet, as the constant use of medicines for that purpose is at- tended with many inconveniences, and often with bad consequences.* * The learned Dr. Arbutbnot advises those who are troubled with costiveness to use animal oils, as fresh butter, cream, marrow, fat broths, especially those rnadu of the in- ternal parts of animals, as tbe liver, heart, midriff, &c. He like« ise recommends the expressed oils of mild vegetables, as olives, almonds, pastaches, and the fruits them- selves ; all oily and mild fruits, as figs; decoctions of mealy vegetables; these lubricate tlie intestine*; some saponaceous substances which stimulate gently, as honey, hydro- mel, or boiled honey and water, unrefined sugar, &c. The Doctor observes, that such lenitivo substances are proper for persons of dry atrabilarian constitutions, who are subject to astrit-tion of the belly, and the piles, and will operate when stronger medicinal substances are sometimes ineffectual ;.Jjut that •_uch lenitive diet, hurts those whose bowels are weak and lax. He like wise observes, that all watery substances are lenitive, and that even common water, wfcey, soar milk, and butter-milk have ttiak effect: that new milk, especially asses milk, stimulates still more when it sours on the stomach; and that whey turned sour, will purge stiangly :— That Most garden fruits arc likewise laxative; and that some ofthern, as gru pes, will In-ow such as take them immoderately into a cholera morbus, or incurable tfiarrhtta* WANT Or^APPETITE—THE HEART-BURN. 255 I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time the custom becomes necessary, and generally ends in a total relaxation of the. bowels, indi- gestion, loss of appetite, wasting of the strength, and death. When the body cannot be kept open without medicine, we would recommend gentle doses of rhubarb to be taken twice or thrice a-week. This is not near so injurious to the stomach as aloes, jalap, or the other drastic purgatives so much in use. Infusions of senna and man- na may likewise be taken, or half an ounce of soluble tartar dissolved in water-gruel. About the size of a. nutmeg of lenitive electuary, taken twice or thrice a-day, generally answers the purpose very well. WANT OF APPETITE. THIS may proceed from a foul stomach ; indigestion ; the want of free air and exercise ; grief; fear ; anxiety ; or any o^the depressing passions ; excessive heat ; the use of strong broths, fat meats, or any thing that palls the appetite, or is hard of digestion ; the immoderate use ot strong liquors, tea, tobacco, opium, &c. i The patient ought, if possible, to make choice of an open dry air ; to take exercise daily on horseback or in a carriage; to rise betimes ; and to avoid all intense thought. He should_use a diet of easy diges- tion ; and should avoid excessive heat and great fatigue. If want of appetite proceeds from errors in diet, or any other part of the patient's regimen, it ought to be changed. If nausea and retch- ings shew that the stomach is loaded with crudities, a vomit will bo of service. After this a gentle purge or two of rhubarb, or any of the bit- ter purging salts, may be taken. The patient ought next to use some of the stomachic bitters infused in wine. Though gentle evacuations be necessary, yet strong purges and vomits are to be avoided, as they weaken the stomach and hurt digestion. Elixir of vitriol is an excellent medicine inmost cases of indigestion, weakness of the stomach, or want of appetite. From twenty to thirty drops of it may be taken twice or thrice a-day in a glass of wine or wa- ter. It may likewise be mixed with the tincture of the bark, one drachm ofithe former to an ounce of the latter, and two tea-spoonsful of it taken in wine and water, as above. The chalybeate waters, if drank in moderation, are generally of con- siderable service in this case. The salt water has likewise good effects ; but it must not be used too freely. The waters of Harrowgate, Scar- borough, Moffat, and most other spas in Britain, may be used wi,th ad- vantage. We would advise all who are afflicted with indigestion and want of appetite, to repair to these places of public rendezvous. The very change of air, and the cheerful company, will be of service, not to mention the exercise, amusements, &c. OF THE HEART-BURN. WHAT is commonly called the heart-burn, is not a disease of that organ, but an uneasy sensation of heat or acrimony, about the pit of the stomach, which is sometimes attended with anxiety, and vomit- ing- It may proceed from debility of thestomach, indigestion,bile.the abounding of an acid in the stomach,'Sec. Persons who are liable to this complaint, ought to avoid stale liquors, acids, windy or greasy aliments, and should never use violent exercise soon after a hearty meal. I know many persons who never fail to have the heart-burn if thev ride soon after dinner, provided they have drank ale, wine, or 256 OF NERVOUS DISEASESr# zni' Jfcroented liquor; but are never troubled with it when they have drank rum, or brandy and water, without any sugar or acid. When the heart-burn proceeds from debility of the stomach or indi- gestion, the patient ought to take a dose or two of rhubarb ; after- wards he may use infusions of the Peruvian bark ; or any other of the stomachic bitters, in wine or brandy. Exercise in the open air will likewise be of use, aud every thing that promotes digestion. When bilious humours occasion the heart-burn, a tea-spoonful of the sweet spirit of nitre, in a glass of water, or a cup of tea, will gene- rally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken. If acidity or sourness of the stomach occasions the heart-burn, ab- sorbents are the proper medicines. In this case an ounce of pow- dered chalk, half an ounce of fine sugar, and a quarter of an ounce of gum-arabic, may be. mixed in a quart of water, and a tea-cupful of it taken as often a3 is necessary. Such "as do not chuse chalk may take a tea-cupful of prepared oyster-shells, or of the powder called crabs-eyes, iu a glass of cinnamon or peppermint-water. But the safest and best absorbent is magnesia alba. This not only acts as an absorbent, but likewise as a purgative ; whereas chalk and other ab-" sorbents of that kind, are apt to lie in the intestines, and occasion obstructions. This powder is not disagreeable, and may be taken in a cup of tea, or a glass of mint-water. A large tea-spoonful is the utual dose ; but it may be taken in a much greater quantity when there is occasion. These things are now generally made up into lozenges for the conveniency of being carried in the pocket, and taken at pleasure. If wind be the cause of this complaint, the most proper medicines are those called carminatives; as aniseeds, juniper berries, ginger, ca- nelia alba, cardamom seeds, Sec. These may either be chewed, or infused in wine, brandy, or other spirits. One of the safest medicines of this kind, is the tincture made by infusing an ounce of rhubarb, and a quarter of an ounce of the lesser cardamom seeds into an Eng- lish pint of brandy. After this has digested for two or three days, it ought to be strained, and four ounces of white sugar-candy added to it. It must stand to digest a second time till the sugar be dissolved. A table-spoonful of it may be taken occasionally for a dose. Ihave frequently known the.heart-burn cured, particularly in preg- nant women, by chewing green tea. Two table-spoonsful of what is called the milk of gum ammoniac, taken once or twice a-day will some- times cure the heart-burn. CHAPTER XLV. OF NERVOUS DISEASES. Of all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be suffi- cient to point out their various appearances. They imitate almost ev- ery disease ; and are seldom alike in two different persons, or even the same person at different times. Proteus like, they arecontinually chang- ing shape; and upon every fresh at tack the patient thinks he feels symp- toms which he never experienced before.—Nor do they only affect the body ; the mind likewise suffers, and is thereby r< ndered weak and peevish. The low spirits, tiu.orcusiiess, melancholy, and fickleness of temper, which generally attend nervous disortlei .>, induce many to ^QF NERVOUS DISEASES. 257 believe that they are entirely diseases of the mind; bat this change of temper is rather a consequence, than the cause of nervous dis- eases. CAUSES.—Every thing that tends to relax or weaken the body, disposes it to nervous diseases, as indolence,excessive venery, drink- ing too much tea, or other weak watery liquors warm, frequent bleeding, purging, vomiting, &c. whatever hurts the digestion, or prevents the proper assimilation of the food, has likewise this ef- fect ; as long fasting, excess in eating or drinking, the use of win- dy, crude or unwholesome aliments, an unfavourable posture of the body, &c. Nervous disorders often proceed from intense application to study. Indeed few studious persons are entirely free from them. Nor is this at all to be wondered at; intense thinking not only preys upon the spirits, but prevents the person from taking proper exercise, by which means the digestion is impaired, the nourishment prevented, solids relaxed, and the whole mass of humours vitiated. Grief and disappointment likewise produce the same effects. I hava known more nervous patients who dated the commencement of their disorders from the loss ofa husband, a favourite child, or from some disappoint- ment in life, than from any other cause. In a word, whatever weakens the body, or depresses the spirits, may occasion nervous disorders, , as unwholesome air, want of sleep, great fatigue, disagreeable apprehen- sions, anxiety, vexation, Sec. SYMPTOMS.—We shall only mention some of the most general ,_ symptoms of these disorders, as it would be both an nselessand an end- less task to enumerate the whole. They generally begin with windy inflations or distentions of the stomach and intestines; the appetite [ and digestion are usually bad ; yet sometimes there is an uncommon craving for food, and a quick digestion. The food often turns sour on ''. the stomach, and the patient is troubled with vomiting of clear water, tough phlegm, or a blackish coloured liquor resembling the grounds of , coffee. Excruciating pains are often felt about the naval, attended with a rumbling or mui muring noise in the bowels. The body is some- times loose, but more commonly bound, which occasions a retention of wind aud great uneasiness. — The urine is sometimes in small quantity, at other times very copious and quite clear. There is a great straitness of the breast, with difficul- ty of breathing ; violent palpitations of the heart; sudden flushings of heat in various parts of the body; at other times a sense of cold, as if water were poured on them; flying pains in tlie arms and * limbs, pains in the back and belly, resembling those occasioned by the gravel; the pulse very variable, sometimes uncommonly slow, aud at other times very quick ; yawning, the hiccup, frequent sighing, I and a sense of suffocation, as if from a ball or lump in tlie throat; al- ternate fits of crying and convulsive laughing ; the sleep is unsound, and seldom refreshing; and the patient is often troubled with the uight-mare. As the disease increases, the patient is molested with hcud-achs, cramps, aud fixed pains in various parts of the body; the eyes are clouded, and often affected with pain and dryness ; there is a noise io I the ears, and often a dulness of hearing; in short the whole animal functions are impaired. The mind is disturbed on the most trivial occasions, and is hurried into the most perverse commotions, inqui, etude, terror, sadness, anger, diffidence, &c. The patient is apt to -»8 OF NERVOUS DIS1 \SKSi*1 especially of the lower extremities, will foice the blood into the brain entertain wild imaginations, and extravagant fancies; the memory be comes weak and the judgment fails. Nothing is more characteristic of this disease than a constant dread of death. This renders those unhappy persons who labour under it peevish, fickle, impatient, and apt to run from one physician to ano- tner; which is one reason why they seldom reap any benefit from me- dicine, as they have not sufficient resolution to persist in any one course till it has time to produce its proper effects. They are like- wise apt to imagine that they labour under diseases from which they are quite free ; and are very angry if any one attempt's to set them right, or laugh them out of their ridiculous notions. REGIMEN.—Persons afflicted with nervous diseases ought neve^r to fast long. Their food should be solid and nourishing, but of easy digestion. Fat meats and heavy sauces are hurtful. AH excess should be carefully avoided. They ought never to eat more at a time than they can easily digest; but if they feel themselves weak and faint be- tween meals, they ought to eat a bit of bread, and drink a glass of wine. Heavy suppers are to be avoided. Though wine in excess en- feebles the body, and impairs the faculties of the mind, yet taken in moderation it strengthens the stomach, and promotes digestion. Wine and water is a very proper drink at meals; but if wine sours on the stomach, or the patient is much troubled with wind, brandy and wa- ter will answer better. Every thing that is windy or hard of digestion must be avoided. All weak and warm liquors are hurtful, as tea, cof- fee, puuch, Sec. People may find a temporary relief in the use of these, but they always increase the malady as they weaken the stomach, and hurt digestion. Above all things, drams are to be avoided. Whatever immediate ease the patient may feel from the use of ardent spirits, they are sure to aggravate the malady, and prove certain poisons at last. These cautions are the more necessary ; as most nervous people are peculiarly fond of tea and .ardent spirits, to the use of which many of them fall victims. Exercise in nervous disorders is superior to all medicines. Riding on horseback is generally esteemed the best, as it gives motion to the whole body without fatiguing it. I have known some patients, how- pver, with whom walking agreed better, and others who were most ben- efited by riding in a carriage. Every one ought to use that which he finds most beneficial. Long sea-voyages have an excellent effect; and to those who have sufficient resolution, we would by all means recom- mend this course. Even change of place, and the sight of new objects, by diverting the mind, have a great tendency to remove these com- plaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journies near home. A cool and dry air is proper, as it braces and invigorates the whole body. Few things tend more to relax and enervate than hot air, es- pecially that which is rendered so by great fires, or stoves in small apartments. But when the stomach or bowels are weak, the body ought to be well guarded against cold, especially in winter, by wear- ing a thin flannel waistcoat next the skin. This will keep up an equal perspiration, and defend the alimentary canal from many im- pressions to which it would otherwise be subject, upon every sudden change from warm to cold weather. Rubbing the body frequently with a fk'sh-brnsb, or a coarse linen cloth, is likewise beneficial, as :l promotes the circulation, perspiration, Sec. Persons who have weak nerves ought to rise early, and take exercise before breakfast, « OF MELANCHOLY. 255 method of cm ing melancholy among the Jews, as we learn from the story as lying too long a-bed cannot fail to relax the solids. They ought likewise to be diverted and to be kept as easy and cheerful as possible. There is not any thing which hurts the nervous system, or weakens the digestive powers more than fear, grief or anxiety. t MEDICINES.—Though nervous diseases are seldom radically cur- ed, yet the symptoms may sometimes be alleviated, and the patient's life rendered at least more comfortable by proper medicines. When the patient is costive, he ought to take a little rhubarb, or some other mild purgative, and should never suffer his body to be long bound. All strong and violent purgatives are however to be avoided, as aloes, jalap, &c. I have generally seen an infusion of senna and rhubarb m brandy, answer very well. This may be made of any strength, and taken in such quantity as the patient finds necessary. When digestion is bad, or the stomach relaxed and weak, the following infusion of Peruvian bark and other bitters may be used with advantage: Take of Peruvian bark an ounce, gentian-root, orange-peel, and co- riander seed, of each half an ounce; h)t these ingredients be all bruis- ed in a morter, and infused in a bottle of brandy or rum, for the space of five or six days. A table-spoonful of the strained liquor may be tak- en in halfa glass of water, an hour before breakfast, dinner, and supper. Few things tend more to strengthen the nervous system than cold bathing. This practice, if duly persisted in, will produce very extra- ordinary effects; but when the liver or other viscera are obstructed, or otherwise unsound, the cold bath is improper. It is therefore to be used with very great caution. The most proper seasons for it are sum- mer and autumn. It will be sufficient, especially for persons ofa spare habit, to go into the cold bath three or four times a-week. If the pa- tient be weakened by it, or feels chilly for a long time after coming out, it is improper. In patient's afflicted with wind, I have always observed the greatest benefit from the elixir of vitriol It may be taken in the quantity of fifteen, twenty or thirty drops, twice or thrice a-day, in a glass of wa- ter. This both expels wind, strengthens the stomach, and promotes digestion. Opiates are generally extolled in these maladies; but as they only palliate the symptoms and generally afterwards increase the disease, we would advise people to be extremely sparing in the use of them, lest habit render them at last absolutely necessary. It would be an easy matter to enumerate many medicines which have been extolled for relieving nervous disorders; but whoever wishes for a thorough cure, must expect it from regimen alone ; we shall therefore omit mentioning more medicines, and again recommend the strictest attention to diet, air, exercise, and amusement. OF MELANCHOLY. MELANCHOLY is that state of alienation or weakness of mind, which renders people incapable of enjoying the pleasures or perform- ing the duties of life. It is a degree of insanity, and often terminates in absolute madness. CAUSES.—It may proceed from an hereditary disposition; intense thinking, especially where the mind is long occupied by one object; violent passions or affections of the mind, as love, fear, joy, grief, pride, and such like. It may also be occasioned by excessive venery, narcotic or stupefactive poisons ; a sedentary life; solitude ; the sup- pression of customary evacuations ; acute fevers or other diseases. Vio- lent anger will change melancholy into madness; aud excessive cold, 260 OF MELANCHOLY. and produce all the symptoms of madness. It may likewise proceed from the use of aliment that is hard of digestion, or which cannot be easily assimilated, from a callous state of the integuments of the brain or a dryness of the brain itself. To all wliich we may add gloomy and mistaken notions of religion. SYMPTOMS.—When persons begin to be melancholy they are tim- orous; watchful; fond of solitude; fretful; fickle ; captious and inquis- itive ; solicitous about trifles; sometimes niggardly, and at otiier times prodigal. The body is generally bound, the urine thin, and in small quantity ; the stomach and bowels inflated with wind; the complexion pale; the pulse slow and weak. The functions of the mind are also greatly perverted, insomuch that the patient often imagines himself dead ; or changed into some other animal. Some have imagined 'their bodies were, made of glass, or other brittle substances, and were afraid to move, least they should be broken to pieces. The unhappy patient, in this case, unless carefully watched, is apt to put an end to his own miserable life. When the disease is owing to an obstruction of customary evacua- tions, or any bodily disorder, it is easier cured than when it proceeds from affections of the mind, or an hereditary taint. A discharge of blood from tbe nose, looseness, scabby eruptions, the bleeding piles, 1 or the menses, sometimes carry off this disease. - _ REGIMEN.—The diet should consist chiefly of vegetables ofa. cool- ' ing and opening quality. Animal food, especially salted or smoke-dried fish or flesh, ought to be avoided. All kinds of shell-fish are bad. Ali- ments prepared with onions, garlic, or auy thing that generates thick M blood, are likewise improper. All kinds of fruits that arc wholesome may be eaten with advantage. Boerhaave gives an instance of a patient who, by a long use of whey, water, and garden-fruit, recovered, after .1 having evacuated a great quantity of black coloured matter. r Strong liquors of every kind ought to be avoided as poison. The most proper drink is water, whey or very small beer. Tea and coffee i are improper. If honey agrees with the patient, it maybe eaten free- ly or his drink may be sweetened with it. Inthsions of balm-leaves, • , penny-royal, the roots of wild valerian, or the flowers of the lime-tree, may be drank freely, either by themselves, or sweetened with honey, I as the patient shall chusc. The patient ought to take as much exercise as he can bear. This , helps to dissolve the viscid humours, it removes the obstructions, pro- motes the perspiration, and all the other secretions. Every kind of madness is attended with a diminished perspiration; all means ought therefore to be used to promote that necessary and salutary discharge. Nothing can have a more direct tendency to increase the disease than confiuing the patient to a close apartment. Were he forced to ride or j walk a certain numbei of miles everyday, it would tend greatly to al- leviate his disorder; hut it would have still a better effect, if he were { obliged to labour a piece of ground. By digging, hoeing, planting, sowing, &c. both the body and mind would be exercised. A long jour- ney, or a voyage, especially towards a warmer climate, with agreeable companions, have often very happy effects. A plan of this kind, with a strictattention to diet is a much more rational method of cure, than confining the patient withindoors and plying him with medicines.- MEDICINE—In the cure of this disease particular attention must j be paid to the mind. When the patient is in a low state, his mind ought to be soothed and diverted with variety of amusemen' s, as en- tcrtaining stories, pastimes, music, oVcs This seems to cave been the OF THE PALSY. 261 i»f King Saul; and indeed it is a very rational one. Nothing can re- move diseases of the mind so effectually as applications to the mind it- self, the most efficacious of which is music. The patient's company ought likewise to consist of such persons as are agreeable to him. Peo- ple in this state are apt to conceive unaccountable aversions against par- ticular persons ; aud the very sight of such persons is sufficient to dis- tract their minds, and throw them into the utmost perturbation. When the patient's strength is high, or the pulse admits of it, evacua- tions are necessary. In this case he must be bled, and have his' body kept open by purging medicines, as manna, rhubard, cream of tartar, or the soluble tartar. I have seen the last have very happy rffrcti. It may be taken in the dose of half an ounce, dissolved in water-gruel, every day, for several weeks, or even for months, if necessary. More or less may be given according as it operates. Vomits have likewise a good effect; but they must be pretty strong, otherwise they will not operate. Whatever increases the evacuation of urine or promotes perspira- tion, has a tendency to remove this disease. Both these secretions may be promoted by the use of nitre and vinegar. H.'it a drachm of purified nitre maybe given three or four times a-day, in any manner that is most agreeable to the patient; and an ounce and an half of distilled vinegar may be daily mixed with his drink. Dr. Locker seems'to think vinegar the best medicine that can be given in this disease. Camphire and musk have likewise been used in this case with advan- tage. Ten or twelve grains of camphire may be rubbed in a mortar, with halfa drachm of nitre, and taken twice a-day, or oftener, if the stomach will bear it. If it Will not sit upon the stomach in this form, it may be made into pills with gum asafoetida and Russian castor, and taken in the quantity above directed. If musk is to be administered, a scruple or twenty-five grains of it may be made into a bolus with a little honey or common syrup, and raken twice or thrice a-day. We do not mean that all these medicines should be administered at onco ; but which ever of them is given, must be duly persisted in, and where one fails another may be tried. As it is very difficult to induce patients in this disease to take me- dicines, we shall mention a few outward applications which somcumes do good; the principal of these are issues, setons, and warm bathing. Issues may be made in any part of the body, but they generally havs the best effect near the spine. The discharge from these may be greatly promoted by dressing them with the mild blistering ointment, and keeping what are commonly called the orrice pease in them. Tbe most proper place for a seton is between the shoulder-blades; andat ought to be placed upwards and downwards, or in the direction of the spine. OF THE PALSY. THE palsy is a lo-s or diminution of sense or motion, or of both iu one or more parts of the body. Of all the affections called nervous, this is the most suddenly fa like- wist evident from its preventing sleep, occasioning giddiness, dim mess of the ;1*1.1, sickness, &c> OF THE EPILEPSY, ic. 263 When it attacks any person after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expected. If tho fit continues only for a small space, ami returns seldom, there is reason to hope ; but if it continues leiig, and returns frequently, the prospect is bad. It is a very unfavourable symptom when the patient is seized with the fits :n his sleep. CAUSES.--The epilepsy is sometimes hereditary. It may likewise proceed from blows, bruises, or wounds on the head; a collection of water, blood, or serous humours in the brain; a polypus; tumours or concretions within the skull; excessive drinking ; intense study ; ex- cess of venery; worms; teething; suppression of customary evacua- tions ; too great emptiness or repletion ; violent passions or affections of the mind, as fear, joy, &c. hysteric affections; contagion received into the body, as the infection of the small-pox, measles, &c. , SYMPTOMS.—An epileptic fit is generally preceded by .unusual wearine.-s; pain of the head; dulness; giddiness; noise in the ears; dimness of sight; palpitation of the heart; disturbed sleep; difficult breathing; the bowels are inflated with wind ; the urine is iu great quantity, but thin ; the complexion is pale; the extremities are cold; and the patient often feels, as it were, a stream of cold air ascending towards his head. In the fit, the patient generally makes an unusual noise ; his thumbs are drawn in towards the palms of the hands; his eyes are distorted ; he stirts, and foams at the mouth ; his extremities are bent or twisted various ways ; he often discharges his seed, urine, and faeces involunta- rily; and is quite destitute of all sense and reason. After the fit is over, his senses gradually return, and he complains of a kind of stupor, weariness, and pain of his head; but has no remembrance of what hap- pened to him during the fit. The fits are sometimes excited by violent affections of the mind, a debauch of liquor, excessive heat, cold, or the like. This disease, from the difficulty of investigating its causes, and its strange symptoms, was formerly attributed to the wrath of the gods, or the agency of evil spirits. In modern limes it has often, by the vulgar, been imputed to witchcraft or fascination. It depends, however, as much upon natural causes as any other malady ; and its, cure may often be effected by persisting in the use of proper means. REGIMEN.—Epileptic patients ought,if possible, to breathe a pure and free air. Tlieir diet should be light but nourishing. They ought to drink nothing strong, to avoid swine's flesh, water fowl, and likewise all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves cheerful, carefully guarding against all violent passions, as anger, fear, excessive joy, and the like. Exercise is likewise of great use; but the patient must be careful to avoid all extremes either of heat or cold, all dangerous situations, as standing upon precipices, riding, deep waters, and such like MEDICINE.—The intentions of cure must vary according to the cause of the disease. If the patieut be of a sanguine temperament, and there be reason to fear an obstruction in the brain, bleeding and other evacuations will be necessary. When the disease is occasioned by the stoppage of customary evacuations, these, if possible, must be restored; if this cannot be done, others may be substituted in their place. Issues or setons in this care have often a very good effect. When there is reason to believe that the disease proceedsfrom worms, proper medicines must be used to kill, or carry off these vermin. When tbe OF THE HICCUP. disease proceeds from teething, the body should be kept open by emollient clysters, the feel frequentlv bathed in warm water, and if the fits prove ob-tinate, a blistering-plaster may be put between the shoul- ders. The same method is to be followed, when epileptic fits precede the eruption of the small-pox, or measles, Sec. When the disease ishereditary, or proceeds from a wrong formation of the brain, a cure is not to be expected. When it is owing to a debili- ty, or too great an irritability of the nervous system, such medicines as tend to brace and strengthen the nerves may be used, as the Peruvian bark,and steel; or the anti-epileptic electuaries, recommended by Fuller and Mead.* The flowers of zinc have of late been highly extolled for the cure of the epilepsy. Though this medicine will not be found to answer the expectations which have been raised concerning it, yet in obstinate epi- leptic cases it deserves a trial. The dose is from one to three or four grains, wliich may be taken either in pills or a bolus, as the patient in- clines. The best method is to begin with a single grain four or five times a-day, and gradually to increase the dose as far as the patient can bear it. I have known this medicine, when duly persisted in, prove beneficial. Musk has sometimes been found to^succeed in the epilepsy. Ten or twelve grains of it, with the same quantity of factitious cin- nabar, may be made up into a bolus, and taken every night and morning. Sometimes the epilepsy has been cured by electricity. Convulsion fits proceed from the same cause, and must be treated in the same manuer as the epilepsy. There is one particular species of convulsion fits which commonly goes by the names of St. Vitus's dance, wherein the patient is agi- tated with strange notions and gesticulations, wliich by the com- mon people are generally believed to be the effects of witchcraft. This disease may be cured by repeated bleedings and purges; and afterwards using the medicines, prescribed above for the epilepsy, viz. the Peruvian bark and snake-root, &c. Chalybeate-waters are found to be beneficial in this case. The cold bath is likewise of sin- gular service, and ought never to be neglected when the patient can bear it. OF THE HICCUP. The hiccup is a spasmodic or convulsive affection of the stom- ach and midriff, arising from any cause that irritates their nervous fibres. It may proceed from excess in eating or drinking ; from a hurt of the stomach ; poisons; inflammations or scirrhous tumours of the sto- mach, intestines, bladder, midriff, or the rest of the viscera. In gan- grenes, acute and malignant fevers, a hiccup is often the forerunner of death. When the hiccup proceeds from the use of aliment that is flatulent, or hard of digestion, a draught of generous w'ne, or a dram of any spi- " ritotis liquor, will generally remove it. If poison be the cause, plen- "' ty of milk and oil must be drank, a- lias been formerly recommended. When it proceeds from an inflammation of the stomach, &c. it is very dangerous. In his case the cooling regimen ought to be strictly eb- served. The patient must be bl«*d, ami *ake frcqueirly a few drops of * See Appeutlix, &cctuaryfQr the Epilepsy. CRAMP OF THE STOMACH. 265 the spirits of nitre in a cup of wine. His stomach should likewise be fomented with cloths dipped in warm water, or have bladders filled with warm milk and water applied to it. When the hiccup proceeds from a gangrene or mortification, the Pe- ruvian bark, with other antiseptics, are the only medicines which have a chance to succeed. When it is a primary disease, and proceeds from afoul stomach, loaded either with a pituitous or a bilious humour, a gentle vomit and purge, if the patient be able to bear them, will be of service. If it arises from flatulencies, the carminative medicines direct- ed for the heart-burn must be used. When the hiccup proves very obstinate, recourse must be had to the most powerful aromatic and antispasmodic medicines. The principal of these is musk ; fifteen or twenty grains of which may be made into a bolus, and repeated occasionally. Opiates are likewise of service; but they must be used with caution. A bit of sugar dipped in com- pound spirits of lavender, or the volatile aromatic tincture, may he taken frequently. External applications are sometinies also benefi- cial ; as the stomach plaster, or a cataplasm of the Venice treacle of the Edinburgh or London dispensatory, applied to the region of the stomach. I latt Iy attended a patient who had almost a constant hiccup for above nine weeks. It was frequently stopped by the use of musk, opium, wine, and other cordial and antispasmodic medicines, but al- ways returned. Nothing however gave the patient so much ease as brisk small beer. By drinking freely of this, the hiccup was often kept off for several day«, winch was more than could be done by the most powerful medicines The patient was at length seized with a vomiting of blood, which soon put an end to his life. Upon opening the body, a large sclnri ous tumour was found near the pylorus, or right orifice of the stomach. The hiccup may be removed by taking vinegar; or by a few drops of the oil of vitriol taken in wa'er. CRAMP OF THE STOMACH. THIS disease often seizes people suddenly, is very dangerous, and requires immediate assistance. It is most incident to persons in the decline of life, especially the nervous, gouty, hysteric, and hypochon- driac. If the patient has any inclination to vomit, he ought to take 60iue draughts of warm water, or weak camomile tea, to cleanse his stomach. After thi-, if he has been costive, a laxative clyster may be given. He ought then to take laudanum. The best way of administering it is in a clyster. Sixty or seventy drops of liquid laudanum may be given in a clyster of warm water. This is much more certain than laudanum given by the mouth, which is often vomited, and in some cases increases the pain and spasms in the stomach. If the pains and cramps return with great violence, after the effects of the. anodyne clyster are over, another with an equal or larger quan- tity of opium, may be given; and every four or five hours a bolus, with ten or iwelve grains of musk, and half a drachm of the Venice treacle. Iu the mean time the stomach ought to be fomented with cloths dip- ped in warm water, or bladders filled with warm milk and water sliould be applied to it. I have often seen these produce the most hap- py effects. The anodyne balsam may also be rubbed ou tbe part af- Z 966 OF THE NIGHT-MARE. fected; and an anti-hysteric plaster worn upon it for some time after the cramps are removed, to prevent their return. Iu very violent and lasting pains of the stomach, some blood ought to be let, unless the weakness of tbe patient forbuls it. When the pains or cramps proceed from a suppression of the menses, bleeding is of use. If they be owing to the gout, recourse must be had to spirits, or some of the warm cordial waters. Blistering-plasters ought likewise in this case to be applied to the ancles. 1 have often seen violent cramps and pains of the stomach removed by covering it with a large plaster of Venice treacle. OF THE NIGHT-MARE. IN this disease the patient, in time of sleep, imagines he feels an un- common oppression or weight about his breast or stomach, which he can by no means shake off. He groans, and sometimes cries out, though oftener he attempts to speak in vain. Sometimes he imagines himself engaged with an enemy, and in danger of being killed, attempts to run away, bat he finds he cannot. Sometimes he fancies h mse f iu a house that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dashed to pieces suddenly awakes him. This disorder has been supposed to proceed from two much blood ; from a stagnation of blood in the brain, lun.s, Sec. But it is rather a nervous affection, and arises chiefly from indite tion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the night-mare. Nothing tends more to produce, it than heavy suppers, especially when eaten late, or the patient goes to bed soon after. Wind is likewise a very frequent cause of this disease ; for which reason those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that oppresses the mind, ought also to be avoided. As persons afflicted with the night-mare genera'ly moan, or make some noise in the fit, they -hould be waked, or spoken to by such us hear them, as the uneasiness generally goes off as soon as the patient is awake. Dr. Whytt says, he generally found a dram of brandy, taken at bed-time, prevent this disease. That however is a bad custom, and in time loses its effects. We would ralher have the patient depend upon the use of food of easy digestion, cheerfulness, exercise through the day, and a light supper taken eaily, than to accustom himself to drams. A glass of peppermint water will often promote digestion as much as a glass of brandy, and is much safer. After a person of weak di- gestion, however, has eaten fla-ulent food, a dram may be necessary. Persons who are young and full of blood, if troubled with the night- mare, ought to take a puree frequently, and use a spare diet. OF SWOONINGS. PEOPLE of weak nerves or delicate constitutions are liable to swooningsor fainting-fits. These indeed are seldom dangerous when duly attended to ; but when wholly neglected, or improperly Heated, they often prove hurtful, and sometimes fatal. The general causes of swoonings are, sudden transition from cold to heat; breathing air that is deprived of its proper spring or elasticity; great fatigue ; excessive weakness ; loss of blood; long fasting; fear, grief, and other violent passions or affections of the mind. It is well known, that peisons who have been long exposed to cold often faint or fall into a swoon, upon coming into tbe bouse, especially if they drink hot liquor, or sit near a large lire. This might easily be OF FLATULENCIES, OR WIND. c267 prevented by people taking care not to go into a warm room immedi- ately after they have been exposed to the cold air, to approach tlie fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature. When any one, in cousequence of neglecting these precautions, falls into a swoon, he ought immediately to be removed to a cooler apart- ment, to have ligatures applied above his knees and elbows, and to have his hands and face sprinkled with vinegar or cold water. He should likewise be made to smell to vinegar, and should have a spoon- ful or two of water, if he can swallow, with about a third part of vine- gar mixed with it, poured into his month. If these should not remove the complaint, it will be necessary to bleed the patient, and afterwards to give him a clyster. As air that is breathed frequently loses its elasticity or spring, it is no wonder if persons who respite in it often fall into a swoon or fainting fit. They are in this case deprived of the very principle of life. Hence it is that fainting tits are so frequent in all crowded assemblies, especi- ally in hot seasons. Such fits, however, must be considered as a kind of temporary death ; and to the weak and delicate, they sometimes prove fatal. They ought therefore with the utmost care be guarded against. The method of doing this is obvious. Let assembly rooms, and all other places of public resort, be large and well ven triated ; and let the weak and delicate avoid such places, particularly in warm sea- sons. A person who fainte, in such a situation, ought immediately to be car- ried into the open air ; his temples should be rubbed with strong vine- gar or brandy, and volatile spirits of salts held to his nose. He should be laid upon his back with his head low, and have a little wine, or some other cordial, as soon as he is able to swallow it, poured into his mouth. If the person has been subject to hysteric fits, castor or asafoetida should be applied to the nose, or burnt feathers, horn, or leather, &c. When fainting fits proceed from mere weakness or exhaustion, which is often the case after great fatigue, long fasting, loss of blood or the like, the patient must be supported with generous cordials, as jel- lies, wines, spirituous liquors,&c. These however must be given at first in very small quantities, and increased gradually as the patient is able to bear them. He ought to be allowed to lie quite still and easy upon his back, with his head low, and should have fresh air admitted into his chamber. His food should consist of nourishing broths, sago-grnel, with wine, new milk, and other things of a light and cordial nature. These things are to be given out of the fit. All that can be done in the fit, is to let him smell to a bottle of Hungary-water, eau de luce, or spir- its of hartshorn, and to rub his temples with warm brandy, or to lay a compress dipped in it to the pit of the stomach. In fainting fits that proceed from fear, grief, or other violent passious or affectious of the mind, the patient must be very cautiously managed. He should be suffered to remain at rest, and ouly made to smell some vinegar. After he is come to himself he may drink freely of warm le- monade, or balm-tea, with some orange or lemon-peel in it. It will likewise be proper, if the fainting fits have been long and severe, to clean the bowels by throwing in an emollient clyster. It is common in fainting fits,from whatever cause they proceed, to bleed the patient. This practice may be very proper in strong persons, of a full habit; but in those who are weak and delicate, or subject to ner- vous disorders, it is dangerous. Tbe proper method with such people 268 OF FLATULENCIES, OR WIND. is, to expose them to the free air, and to use cordial and stimulating medicines, as volatile salts, Hungary-water, spirits of lavender, tincture of castor, and the like. OF FLATULENCIES, OR WIND. ALL nervous patients, without exception, are afflicted with wind or flatulencies in the stomach and bowels, which arise chiefly from the want ef tone or vigour in these organs. Crude flatulent aliment, as green peas, beans, coleworts, cabbages, and such like, may increase this com- plaint; but strong and healthy people are seldom troubled with wind, unless they either overload their stomachs, or drink liquors that are in a fermenting state, and consequently full of elastic air. While therefore the matter of flatulence proceeds from our aliments, the cause wliich makes air separate from them in such quantity as to occasion com- plaints, is almost always a fault of the bowels themselves, which are too weak either to prevent the production of elastic air, or to expel it after it is produced. To relieve this complaint, such medicines ought to be used as have a tendency to expel wind, and by strengthening the alimentary canal, to prevent its being produced there.* The list of medicines for expelling wind is very numerous; they often however disappoint the expectations of both the physician and his pa- tient. The most celebrated among the class of carminatives are juni- per berries; the root of ginger and zedoary ; the seeds of anise, cara- way, and coriander; gum asafoetida and opium; the warm waters, tinc- tures, and spirits, as the aromatic water, the tinctures of woodsoot, the volatile aromatic spirit, aether, &c. Dr. Whytt says, he found no medicines more efficacious in expelling wind than aether and laudanum. He generally gave the laudanum in a mixture with peppermint-water and tincture of castor, or sweet spirits of nitre. Sometimes in place of this, he gave opium in pills with asafoetida. He observes that the good effects of opiates are equal- ly conspicuous, whether the flatulence be contained in the stomach or intestines; whereas those warm medicines, commonly called carmina- tives, do not often give immediate relief, except when the wind is in the stomach. With regard to aether, the Doctor says, he has often seen very good effects from it in flatulent complaints, where other medicines failed. The dose is a tea-spoonful, mixed with two table-spoonsful of water.t In gouty cases he observes, that aether, a glass of French brandy, or of the aromatic water, or ginger, either taken in substance or infused in boiling water, are among the best medicines for expelling wind. When the case of flatulent patients is such as makes it improper to give them warm medicines inwardly, the Doctor recommends external ap- plications, which are sometimes of advantage. Equal parts of the anti- hysteric and stomach plaster may bespread upon a piece of soft leather, of such size as to cover the greater part of the belly. This should be kept on for a considerable time, provided the patient be able to bear it; if it should give great uneasiness it may be taken off, and the following liniment used in its stead: * Many nervous people find great benefit from eating a dry biscuit, especially when the stomach is empty. I look upon this as one of the best carminative niedicin s: and would recommend it in all complaints of the stomach, arising from flatulence, indigestion, &c. T Though the patient may begin with this quantity, it will be necessary to increase the dose gradually as the stomach can bear it. jEther is now given in considerably greater doses than it was in Dr. Whytt'» time. OF LOW SPIRITS. <°9 Take of Bate's anodyne balsam, an ounce ; of the expressed oil of mace, haifau ounce ; oil of mint, two drachms. Let these ingredients be mixed together, and about a table-spoonful welf rubbed on tlie parts at bed-time. For strengthening the stomach and bowels, and consequently for lessening the production of flatulence, the Doctor recommends the Pe- ruvian bark, bitters, chalybeatcs, and exercise. In flatulent cases, he thinks some nutmeg or ginger should be added to the tincture of the bark and bitters, and that the aromatic powder should be joined with the filings of iron. When windy complaints are attended with costiveness, which is often the case, few things will be found to answer better than four or five of the following pills taken every ni-ht at bedtime : Take of asafoetida two drachms ; succotrine aloes, salt of iron, and powdered ginger, of each, one drachm ; as much of the elixir proprietatis as will be sufficient to form them into pills. On the other hand, wheu the body is too open, twelve or fifteen grains • of rhubarb, with halfa drachm or two scruples of the Japonic confec- tion, given every other evening, will have very good effects. In those flat-.lent complaints which come on about the time the men- sea cease, repeated small bleedings often give more relief than any other rt-ii'u'dy. With regard to diet the Doctor observes, that tea, and likewise all flatulent aliments, are to be avoided ; and that for drink, water with a little brandy or rum, is not only preferable to malt liquor, but in most cuses also to wine. As Dr Why tt has paid great attention to this subject, and as bis sen- timents uponit in a great measure agree with mine, I have taken the lilKT-y to adopt them; and shall only add to his observations, that ex- ercise is in my opinion superior to ail medicine, both forpreventing the production, and likewise for expelling of flatulencies. These effects however are not to be expected from sauntering about, or lolling in a carriage; but from labour or such active amusements as give exercise to every part of the body. OF LOW SPIRITS. All who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise, and amusements, are the most likely means to remove this complaint. It is greatly in- creased by solitude and indulging gloomy ideas, but may often be re- lieved by cheerful company and sprightly amusements. When low spirits are owing to a weak relaxed state of the stomach and bowels, an infusion of the Peruvian bark with cinnamon or nut- meg will be proper. Steel joined with aromatics may likewise in this case be used with advantage; but riding and a proper diet are most to be depended on. When they arise from foulness of the stomach and intestine?., or ob- structions in the hypochondriac viscera, aloetic purges w ill be proper. I have sometimes known the Harrowgate sulphur-water of service in this case. When low spirits proceed from a suppression of the menstrual or of the haemorrhoidal flux, these evacuations may either be restored, or some other substituted in their place, as issues, setons or tli" like, Dr. Whytt observes, that nothing has such sudden good effects in this case as bleeding. When low spit its have been brought on by long continued gridf, anx- Z2 270 OF HYSTERIC AFFECTIO\.i. lety, or other distress of mind, agreeable company, variety of am ail- ments, and change of place, especially travelling into foreign countries, will afford the most certain relief. Persons afflicted with low spirits should avoid all kinds of excess, es- pecially of venery and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful; but when taken to excess they we.iken the stomach, vitiate the humours, and depress the spirits. ri.is caution is the more reressary, as the unfortunate ai.d melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction. OF HYSTERIC AFFECTIONS. THESE likewise belong to the numerous tribe of nervous diseases, wliich may be justly reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons an hysteric fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid humour, or the like. A sudden suppression of the menses often give rise to histeric fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments. Sometimes the hysteric fit resembles a swoon or faintingfit, dur- ing which the patient lies as in a sleep, only the breathing is so low as scarce to.be perceived. At other times the patient is affected with catchings and strong convulsions. The symptoms which precede hys- teric fits, are likewise various in different persons. Sometimes the fits come on with coldness of the extremities, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the ap- proach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting ; after- wards it rises into the gullet, and occasions a degree of suffocation, to which quick breathing, palpitation of the heart, giddiness of the head, dimness of the sight, loss of hearing, with convulsive motions of the ex- tremities and other parts of the body, succeed. The histeric paroxysm is often introduced by an immoderate fit of laughter, and somtimesit goes off by crying, indeed there is not much difference between the ianghing and crying of an highly hysteric lady. Our aim ig the treatment of this disease must be to shorten the fit or pavoxysm when present, and to prevent its return. The longer the hf« continue, and the more frequently they return, the disease becomes ii.'riiiore obstinate. Tlieir strength is increased by habit, and thfy induce so great a relaxation of the system, that it is with difficulty re- moved. It i> customary during the hysteric fit or paroxysm, to bleed the pa- ■ fiei-t. In strong persons ofa plethoric habit, and where the pulse is full, this may be proper; but in weak and delicate constitutions, or where the disease has been of long standing, or arises from inanition, it is not safe. The best course in surh ?ase is to rouse the patient by strong smells, as I.urnt feathers, asatVetida?' or spirits of hartshorn, iield to the nose. Hot bricks may also be applied to the soks of the f.-et, and the legs, arms and belly may be strongly rubbed with a warm cloth. But the best application is to put the. feet and legs into warm water. This is peculiai Iy proper when the fits precede the flow of the menses. In case cf tott.veness, a laxative clyster with asafoetida will OF HYSTERIC AFFECTIONS. 2W be proper; and as soon as the patient can swallow, two table-spoonsful of a solution of asafoetida, or of some cordial julep, may be given.* The radical cure of this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly promo- ted by a proper attention to diet. A n.ilk and vegetable diet, when duly persisted in will often perform a cure. If however the patient has been accustomed to a more generous diet, it will not be safe to leave it oft' all at once, but b> degrees. The most proper drink is water with a small quantity of spirits. A cool dry air is the best. Cold bathiug, and every thirg that braces the nerves and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the greatest importance to have the mind kept con- stantly easy and cheerful, and, if possible, to have it always engaged in so ne agreeable and interesting per u t. The proper medicines are those which strengthen the alimentary canal and the whole nervous system, as the preparations of iron, the Peruvian bark and other bitters. Twenty dropsof the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a-day. The bark and iron may likew ise be taken ir. substance, provided the stomach can bear them; but they are generally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder. If the stomach is loaded with phlegm, vomits will be of use; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there be a tendency to costiveness, it must be removed either by diet, or by taking an opening pill as often as it shall be found necessary. To lessen the irritability of the system antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opium, and castor. When opium disagrees with the stomach, it may either be ap- plied externallv, or given in clysters. It is often successful in remov- ing those periodical head-achs to which hysteric and hypochondriac patients are subject. Ca3tor has in some cases been found to procure sleep where opium failed; for which reason, Dr. Whytt advises, that they should be joined together. He likewise recommends the anti- hysteric plaster to be applied to the abdomen^ Hysteric women are often afflicted with cramps, in various parts of the body, wliich are most apt to seize them in bed, or when asleep. The most afficacions medicines in this case are opium blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very vioient, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blis- terin<«-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphire, and the warm bath. • When hysteric fits are occasioned by sympathy, they may be cured hy exciting an opposite passion. This is said to hare been the case of * whole school of young ladir* in Holland, v. ho wen- all cured by being fcld, that the first who was seized should be burnt to death. Hut this method ot'eure, to my knowledge, will not always succeed. I would therefore advise, that youm* ladies who are subject to hysteric fits should not be sentto boarding-schools, as the disease may be caught by imitation. I have known mad- iips« ilscli'bwiught on by sympathy. . . t Thoueh antispasmodics and anodynes are universally recommended in this disease vet nil the extraordinary cures that I «-ve from sharp humours in the stomach or intestines, no lasting relief can be pro- cured till these are either corrected or expelled. The Peruvian bark ha» sometimes cured periodical convulsions afer other medicines had failed. OF HYPOCHONDRIAC AFFECTIONS. THIS ditease generally attacks the indolent, the luxurious, the un- fortunate, and the studious. It becomes daily more common in thin country, owing no doubt to the increase of luxury and sedentary em- ployments. It has so near a resemblance to the immediately preceding, that many authors consider them as the same disease, and treat them accordingly. They require, however, a very different regimen ; and the symptoms of the latter, though less violent, are more permanent than those of the former. Men ofa melancholy temperament, whose minds are capable of great attention, and whose passions are. not easily moved, are in the advanced periods cf life, most liable to this disease. It is usually brought on by long and serious atteution to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous eruptions, long continued evacuations, obstruction in some of the visce- ra, as the liver, spleen, Sec. Hypochondriac persons ought never to fast long, and tlieir food should be solid and nourishing. All ascescent and windy vegetables are to be avoided. Flesh meats agree best wi'h them, and their drink should be old claret, or good Madeira. Should these disagree with the stomach, water with a little brandy or rum in it may be drank. Cheerfulness and serenity of mind are by all means to be cultivated. Exercise of every kind is useful. The cold bath is likewise beneficial: and where it does not agree with the patient, frictions with the flesh- brush or a coarse cloth may be tried. If the patient has it in Ins power, he ought to travel either by sea or land. A voyage or a long j«grrley, especially towards a warmer climate, will be of" more service tiifu any medicine. m~ > The general intentions of cure in this disease, are to strengtl|0h tfw alimentary canal, and to promote the secretions. These infections wi.i treat of the nature of onr sensations, or to give a minute description of the various organs by which tu y are perform- ed ; but to point out some of the diseases to which these organs are most liable, and to shew how thev may be prevented or remedied. OF THE EVE. No organ of the body is snbject to more diseases than the eye ; nor is there any one of which the diseases are more difficult to cure.— Though more ignorant persons pretend to cure these than any other class of diseases ; yet a very superficial acquaintance with the struc- ture of the eye, and the nature of vision, will be sufficient to convince any one ot the danger of trusting to them. These diseases often ex- ceed the skill of the most learned physician ; hence we may easily in- fer the danger of trusting them to ignorant quacks, who, without doubt, put out more eyes than they cure. But, though the diseases of the eye can seldom be cured, they might often, by due care, be prevented ; and, even where the sight is totally lost, many things might be done, which are generally neglected, to render the unhappy person both more use- ful to himself and to society.* The eyes are hurt by viewing bright or luminous objects ; keeping tlie head too long in a hanging posture ; violent head-achs ; excessive venery ; the long use of bitters; the effluvia from acrid or volatile sub- stances ; various diseases ; as the small-pox, measles, Sec. but above all from night-watching, and candle-light studies. Long fasting is likewise hurtful to the eyes,and frequent heats and colds are no less pernicious. The eyes are often hurt by the stoppage of customary evacuations; as morning sweats; sweating of the feet, the menses in women ; and the bleeding piles in men. All kind of excess are likewise hurtful to the right, particularly the immoderate use of ardent spirits, and other Bt ong liquors. In all diseases of the eyes, especially those attended with inflamma- tion, the cool regimen ought to be observed. The patient must abstain from all spirituous liquors. The smqke of tobacco, smoky rooms, the vapours of onions and garlic, and all vivid lights and glaring co- lours, are carefully to be avoided, The drink may be water, whey, or small-beer; and the aliment must be light and of easy digestion. For preventing disorders of the eyes, issues and setons are of prime use. Every person whose eyes are tender, ought to have one or more * It is pity those who have the misfortune to be born blind, or who lose their sight when young, should be sutf red to remain in ignorance, or to beg. 1 his is both cruelly and want of economy, there are many employments of which blind persons are very capable, as knitting, carding, turning a wheel, teaching languages, &c. Norare instan- ces wanting of person* w ho have arrived at the highest pitch of learning, without having tbe least idea of light. Witness the late famous Nicholas Sanderson of Cambriilge.min r-y worthy friend Dr. Thomas Blaeklock of Edinburgh. The former wai one of tbe first mathematicians of the age, and the latter, besides being a good pint and philoso- pher, is master of all the learned language*, and a very considerable adept in the liberal *rt*. OF THE EYE. *.V of these in some part of the body. It will likewise be of use to keep the body gently open, and either to bleed or purge every spring and fall. All excess and night studies are to be avoided. Such asdo nor choose a seton or an issue, will reap benefit from wearing a small Bur- gundy-pitch plaster beween the shoulders. A gutta serena or amaurosis is an abolition of the sight without any apparent cause or fault in the eyes. When it is owing to a decay or wasting of the optic nerve, it does not admit of a cure ; but when it proceeds from a compression of the nerves by aedundant humours these may in some measure be drained off, and the patieut relieved. For this purpose the body must be kept open with the laxative mercu- rial pills. If the patient be young and ofa sanguine habit he may be bled. Cupping, with scarifications on the back part of the head, will likewise be of use. A running at the nose may be promoted by volatile salts, stimulating powders, &c. But the most likely means for reliev- ing the patient are issues or blisters kept open for a long time on the back part of the head, behind the ears, or on the neck. I have known these restore sight, even after it had been for a considerable time lost. Should these fail, recourse must be had to mercurial salivations; or what will perhaps answer the purpose better, twelve grains of corro- sive sublimate of mercury may be dissolved in an English pint and a half of brandy, and a table-spoonful of it taken twice a-day, drinking halfa pint of the decoction of sarsaparilla after it. A cataract is an obstruction of the pupil by the interposition of some opaque, substance which either diminishes or totally extinguishes the sight. It is generally an opacity of chrystalline humour. In a recent or beginning cataract, the 3ame medicines are to be used as in the gutta serena ; and they will sometimes succeed. But when this does not happen, and the cataract becomes firm, it must be couched, or rather extracted. I have resolved a recent cataract by giving the patient frequent purges with calomel, keeping a poultice of fresh hemlock constantly upon the eye, and a perpalual blister on th« neck.* The myopia or short sightedness, and the presbyopia or seeing only at too great a distance, are disorders which depend on the original struc- ture or figure of the eye, therefore admit of no cure. Tlie inconven- iencies arising from them may however, be, in some measure remedied, by the help of proper glasses. The former requires the aid ofa cl- eave, and the latter of a convex glass. A strabismus, or squinting, depends upon an irregular contraction of the muscles of the eye from a spasm, palsy, epilepsy, or an ill habit.— Children often contract this disorder by having their eyes unequally ex- posed to the light. They may likewise acquire it by imitation ficma squinting nurse or play-fellow, &c. As tliis disorder can hardly be cured, parents ought to be careful to prevent it. Almost the only thing wliich can be done for it is to contrive a mask for the child tj wear, which will only permit him to see in a straight direction. Spots or Specks on the eyes are generally the effect of inflammation, and often appear after the. small-pox, the measles, or violent ophthal- mia*. They are very difficult to cure, and ofteu occasion total blind- ne.ss. If the specks are soft and thin, they may sometimes be taken oH' by gentle caustics and discutieuts ; as vitriol, the juice of celandine, * In both these cases,electricity merits a trial. A a 1/8 OF THE EAR. .\c. When these do not succeed, a surgical operation may be tried : the success of this however is always very doubtful. The blood-shot eye may be occasioned by a stroke, a fall, retching, vomiting, violent coughing, &c. I have frequently known it happen to children in the hooping cough. It appears at first like a bit of scarlet, and is afterwards ofa livid or blackish colour. This disorder general- iy goes off without medicine. Should it prove obstinate, the patient may be bled, and have his eyes fomented with a decoction of cumphry roots and elder flowers. A soft poultice may be applied to the eyes ; iiudthe body should be kept open by gentle purgatives. The watery or weeping eye is generally occasioned by a relaxation or weakness of the glandular parts of that organ. These may be braced and strengthened by bathing the eye with brandy and water, Hunga- ry-water, rose water, with white vitriol dissolved in it, &c. Medicines wliich make a revulsion are likewise proper ; as mild purgatives, per- petual blisters on the neck, bathing the feet frequently in lukewarm water, &c. When thi* disease proceeds from an obstrnction of the lachrymal duct, or natural passage of the tears, it is called a fistula lachrymalis} andean only be cured by a surgical operation.* OF THE EAR. THE functions of the ear may be injured by wounds, ulcers, or any t'.ing that hurts its fabric. The hearing may likewise be hurt by excessive noise ; violent colds in the head ; fevers ; hard wax, or other substan- ces sticking in the cavity of the ear ; too great a degree of moisture or dryness of the car. Deafness is very often the effect of old age, and is incident to people iu the decline of life. Sometimes it is owing to an original fault in the structure or formation of the ear itself. When this is the case, it admits of no cure -, and the unhappy person not only con- tinues deaf, but generally likewise dumb, for life.t When deafness is the effect of wounds or ulcers of the ear, or of old age, it is not easily removed. When it proceeds from cold of the head, the patient must be careful to keep his head warm, especially in the night ; he should likewise take some gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bed time.— When deafness is the effect ofa fever, it generally goes off after the pa- tient recovers. If it proceeds from dry wax sticking in the ears, it may * A weeping or watery eye is often the mark ef a scrophulous habit. t Though those who have the misfo rtune to be born deaf are generally suffered ta continue dumb, and consequently are in a great measure lost to society, yet nothing m more certain than that such persons may be taught not only to read and write, but also to speak and to understand what others say to them. Teaching the dumb to speak will appear paradoxical to those who do not consider that the formation of sounds is merely mechanical, and may be taught without the assistance of the ear. This is not only capable of demonstration, but is actually reduced to practice by the ingenious Mr. Thomas Braiilwood ol Edinburgh. This gentleman has, by the mere force of geriuJ and application, brought the teaching of dumb persons to such a degree of perfection, that his scholars are generally more forward in their education than those of the same age who enjoy all their faculties. Tbey not only read and write with the utmost read- iness, but likewise speak, and are capable of holding conversation with any person in the light. What a pity any of tbe human specii s should remain in a state of idiotism, who are capable of being rendered as useful and intelligent as others! We mention this not only from humanity to those who have the misfortune to be born deaf, but also injustice to Mr. Braidwood, whose success has far exceeded all former attempts this way; and indeed it exceeds imagination itself so far, that no person who has not seen and ex- amined his punjls, can believe what they are capable of.—As this gentleman, however willing, is only-Able to teach a few, and as the far greater part of those who are born deaf cannot afford to attend him, it would be an act of great humanity, as well at of public utility to erect an acadamy for their benefit. OF THE TASTE AND SMELL. ITv be softened by dropping oil into them ; afterwards they must be syringed with warm milk and water. If deafness proceeds from dryness of the ears, which may be known by looking into them, half an ounce of the oil of sweet almonds, and the same quantity of liquid opodeldoch, or tincture of asafoetida, may be mixed together, and a few drops of it put into the ear every night at bed-time, stopping them afterwards with a little wool or cotton. Some instead of oil, put a small slice of the fat of bacon into each ear, which is said to answer the purpose very well. When the ears abound with moisture, it may be drained off by an issue or seton, which should be made as near the affected parts as possible. Some, for the cure of deafness, recommend the gall of an eel, mixed with spirit of wine, to be dropped into the ear ; others equal parts of Hungary-water, and spirit of lavender. Etmuller extols amber and musk ; and Brookes says, he kas often known hardness of hearing cur- ed, by putting a grain or two of musk into the ear with cotton-wool.— But these and other applications must be varied according to the cause of the disorder.* Though such applications may sometimes be of service, yet they much ofter.er fail, aud frequently they do hurt. Neither the eyes nor ears ought to be tampered with ; they are tender organs, and require a very delicate touch. For this reason, what we would chiefly recommend in deafness, is, to keep the head warm. From whatever cause the disor- der proceeds, this is always proper; and Ihave known more benefit from it alone, in the most obstinate cases of deafness, than from all the medicines I ever used.t OF THE TASTE AND SMELL. THOUGH these senses are not of so great importance to man in a state of society, as the sight and hearing ; yet, as the loss of them is at- tended with some inconveniency, they deserve our notice.— They are , seldom to be restored when lost; which ought to make us very atten- £._ tive to their preservation, by carefully avoiding whatever may in the * least prove, injurious. As there is a very great affinity between the ngans of tasting and smelling, whatever hurts the one, generally affects the o:her. Luxury is highly injurious to these organs. When the nose and pa- late are frequently stimulated by fragrant and poignant dishes, they soon lose the power of distinguishing tastes and odours with any degree of nicety. Man, in a state of nature, may perhaps have these faculties as acute as any other animal. The sense of smelling may be diminished or destroyed by diseases ; as,-the moisture, dryness, inflammation or suppuration of that mem- brane which lines the inside of the nose, commonly called the olfacto- ry membrane ; the compression of the nerves which supply this mem- brane, or some fault in the brain itself at their origin. A defect or too great a degree of solidity, of the small spungy bones of the upper-jaw, the caverns of the forehead, Sec. may likewise impair the sense of smelling. It may also be injured by a collection of foetid matter in those caverns, which keeps constantly exhaling from them. Few • A gentleman on whose veracity I can depend, told me, that after using many things to no purpose for an obstinate deafness, he was at last advised to put a few drops of his own uriue warm int» his ears every night and morning, from which he received great benefit. It is probable that a solution of sal ammoniac, in water, would produce the tain* effect. t An obstinate deafness h^s bee« cured by electricity. -'SO OF THE TOUCH. things are more hurtful to the sense of smelling, than taking great quaiir titles of smiff. When the nose abounds with moisture,after gentle evacuations, such things ;.s tend to take off irritation, and coagulate the thin sharp so- rum may be applied ; as the oil of anise mixed with fine flour ; cam- phire dissolved in oil of almonds, Sec. The vapours of amber, frank- iucense, gum-mastic, and benjamin, may likewise be received iuto the nose and mouth. For moistening the mucus when it is too dry. some recommend snuff made of the leaves of marjoram, mixed with the oil of amber, marjoram and aniseed; or a sternutatory of calcined white vitriol; twelve grains of which may be mixed with two ounces of marjoram- water, and filtrated. The steam or vapour of vinegar upon hot iron received up the nostril is likewise of use tor softening the mucus, open- ing obstructions, \-c. If there is an ulcer in the nose, it ought to be dressed with some emollient ointment, to which, if the pain be very great, a little lauda- num may be added. If it be a venereal ulcer, it is not to be cure** without mercury. In that case, the solution of the corrosive sublimate "* in brandy may be taken, as directed in the gutta serena. The ulcer ought likewise to be washed with it; and the fumes of cinnabar may be received up the nostrils. If there be reason to suspect that the nerves which supply the organs of smelling are inert, or want stimulating, volatile salts, strong snuffs, and other things which occasion sneezing, may be applied to the nose. The forehead may likewise be anointed with balsam of Peru, to which may be added a little of the oil of amber. The taste may be diminished by crusts, filth, mucus, aphthae, pelli- cles, warts, &c. covering the tongue ; it may be depraved by a fault of the saliva, which being discharged into the mouth, gives the same sensations as if the food which the person takes had really a bad taste; or it may be entirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurtful either to the sense of tasting or smelling than obstinate colds, especially those which affect the head. When the taste is diminished by filth, mucus, &c. the tongue ought to be scraped and frequently washed with a mixture of water, vinegar, and honey, or some o'her detergent. When the saliva is vitiated, which seldom happens unless in fevers or other diseases, the curing of the disorder is the cure of this symptom. To relieve it however in the mean time, the following things may be of use; if there be a bitter taste, it may be taken away by vomits, purges, and otiier things which evacuate bile. AVUat is called auidorous taste, arising from putrid hu- mours, is corrected by the juice of citrons, oranges, and other acids. A salt taste is cured by plentiful dilution with watery liquors. An acid taste is destroyed by absorbents, and alkaline salts, as powder of oyster- shells, salt of wormwood, Sec. When the sensibility of the nerves which supply the organs of taste is diminished, the chewing of horse-radish, or other stimulating sub- stance, will help to recover it. OF THE TOUCH. * THE sense of touching may be hurt by any thing that obstructs Ihe nervous influence, or prevents its being regularly conveyed to the or- gans of touching ; as pressure, extreme cola, &c. It may likewise be hurt bv too great a degree of sensibility, when the nerve is not suffi- OF A SCIRRHUS AND CANCER. ^ox ciently covered by the cuticle or scarf-skin, or where there is too great a tension of it, or it is too delicate. Whatever disorders the functions of the brain and nerves, hurts the sense of touching. Hence it appears to proceed from the same general causes as palsy and apoplexy, and requires nearly the same method of treatment. In a stupor, or defect of touching, which arises from an obstruction of the cutaneous nerves, the patient must first be purged ; afterwards ~ such medicines as excite the action of the nerves, or stimulate the sys- tem may be used. For this purpose, the spirit of hartshorn, sal vola- tile oleosum, horse-radish, Sec. may be taken inwardly ; the disordered parts, at the same time, be frequently rubbed with fresh nettles or spi- rit of sal ammoniac. Blistering-plasters and sinapisms applied to the partsjwill likewise be of use, as also warm bathing, especially in the natural hot baths. CHAPTER XLVII. OF A SCIRRHUS AND CANCER. A SCIRRHUS is a hard indolent tumour usually seated in some of the glands ; as the breasts, the arm-pits, Sec. If the tumour becomes large, unequal, of a livid, blackish, or leaden colour, and is attended with violent paiu, it gets the name of an occult cancer. When the skin is broken and a sanies or ichorous matter of an abominable foetid smell is dischargeoi from the sore, it is called an open or ulcerated cancer. Persons after the age of forty-five, particularly woipen, and those who lead au indolent sedentary life, are most subject to this disease. CAUSES.—This disease is often owing to suppressed evacuations ; hence it proves so frequently fatal to women ofa gross habit, particu- larly old maids and widows, about the time when the menstrual flux ceases. It may likewise be occasioned by excessive fear, gnef, anger, religious melancholy, or any of the depressing passions. Hence thr unfortunate, the choleric, and those persons who devote tnemselves to a religious life in convents or monasteries, are often afflicted with it. It may also beoccasioued by the long continued use of food that is too hard of digestion, or of an acrid nature ; by barrenness ; indolence ; celibacy ; cold ; blows; friction ; pressure ; or the like. Women often suffer from the last of these by means of their stays, which squeeze and compress their breast so as to occasion great mischief. Sometimes the disease is owiag to an hereditary disposition. SYMPTOMS.—This disorder seems often very trifling at the begin- ning. A hard tumour about the size of a hazle-nnt, or perhaps smaller, is generally the first symptom. This will often continue for a long time without seeming to increase or giving the patient great uneasiness; but if the constitution be hurt, or the tumour irritated by pressure or improper treatment of any kind, it begins to extend itself towards the neighbouring parts by pushing out a kind of roots or limbs. It then gets the name of cancer, from a fancied resemblance between these limbs and the claws ofa crab. The colour of the skin begins to change, which is first red, afterwards purple, then bluish, livid, ami at last black. The patient complains of heat, with a burning, gnawing, shooting pain. The tumour is very hard, rough, and unequal, with ;i protuberance or rising in the middle ; its size increases daily, and the neighbouring veins become thick, knotty, and ofa blackish colour. The skin at length gives way, and a thin sharp ichor begins to f1"" Aa2 OF A SCIRRHUS AND CANCER. which corrodes the neighbouring parts till it forms a large unsightly ulcer. More occult cancers arise, and communicate with the neigh- bouring glands. The pain and stench becomes intolerable ; the ap- petite fails ; the strength is exhausted by a continual hectic fever ; at last a violent haemorrhage, or discharge of blood, from some part of the body, with faintings, or convulsiou fits, generally put an end to the .ii:serable patient's life. REGIMEN.—The diet ought to be light, but nourishing. All strong liquors, and high seasoned or salted provisions, are to be avoided. The patient may take as much exercise as he can easily bear; and should use every method to divert thought, and amuse his fancy. All kinds of external injury are carefully to be guarded against, particularly of the affected part, which ought to be defended from all pressure, and even from the external air, by covering it with fur or soft flannel. MEDICINE.—This is one of those diseases for which no certain remedy is yet known. Its progress however may sometimes be re- tarded, and some of its most disagreeable symptoms mitigated, by proper applications. One misfortune attending the disease is, that the unhappy patient often conceals it too loug. Were proper means used in due time, a cancer might often be cured ; but after the disor- der has arrived at a certain height, it generally sets all medicine at defiance. vVhen a scirrhus tumour is first discovered, the patient'ought to ob- serve a proper regimen, and to take twice or thrice a-week a dose of the common purging mercurial pill. Some blood may also be let, aud the part affected may be gently rubbed twice a day with a little of the mercurial ointment, and kept warm with fur or flannel. The food must he light, and a pint of the decoction of woods or sarsaparilla may be drank daily. I have sometimes discussed hard tumours, which had the appearance of beginning cancers, by a course of this kind. Should tbe tumour however not yield to this treatment, hut, on the contrary, become larger and harder, it will be proper 10 extirpate it, either by the knife or caustic. Indeed, whenever this can be done with safety, the sooner it is done the better. It can answer no purpose to extirpate a cancer after the constitution is ruined, or the whole mass of humours corrupted by it. This, however, is the common way, which makes the operation so seldom succeed. Few people wib submit to tbe extirpation till death stares them in the face; whereas, if it were done early, the patient's life would not be endangered by the operation, and it would generally prove a radical cure. When the cancer is so situated that it cannot be cut off, or if the patient will not submit to the operation, such medicines as will mitigate or re- lieve the most urgent symptoms may be used. Dr. Home says, that halfa grain of the corrosive sublimate of mercury, dissolved in a proper quantity of brandy, and taken night and morning, will often be of ser- vice in cancers of the face and nose. He likewise recommends an infu- sion of the solanum or night-shade, in cancers of thebreasts. But the medicine most in repute at present for this disease is hem- lock. Dr. Stork, physician at Vienna, has of late recommended the extract of this plant as very efficacious in cancers of every kind. The Doctor says, he has given some hundred weights of it without ever hurting any body, and often with manifest advantage. He advises the patient however to begin with very small doses, as two or three uraius, and to increase the dose gradually till some good effect be perceived, OF A SCIRRHUS AND CANCER. 23E and there to rest without further increase. From two or three grains at first, the Doctor says he has increased the dose to two, three, or four1 drachms a-day, and finds that such doses may be continued for several weeks without any bad consequences. The regimen wliich the Doctor recommends during the use of the medicine, is to avoid farinaceous substances not fermented, and too acrid aromatics. He says, good wine will not be hurtful to those who are accustomeel to it, nor a moderate use of acids; and adds, that the patient should live in a pure free air, and keep his mind as quiet and cheerful as possible. Tbe doctor does not pretend to fix the time in which a cancer may be resolved by the use of hemlock, but says he has given it for above two years in large doses without any apparent benefit; nevertheless the patient has been cured by persisting in the use of it for halfa year longer. This is at least encouragement to give it a fair trial. Though we are far from thinking the hemlock merits those extravagant inco- miums which the doctor has bestowed upon it, yet, in a disease which has so long baffled the boasted powers of medicine, we think it ought always to be tried. The powder of hemlock is by some preferred to the extract. They are both made of the fresh leaves, and may be used nearly in the same manner. Dr. Nicholson of Berwick, says, he gradually increased the dose of the powder from a few grains to halfa drachm, and gave near four drachms of it in the day with remarkably good effects. The hem- lock may also be used externally either as a poultice or fomentation. The sore may likewise be kept cleau by injecting daily a strong de- coction of the tops and leaves into it. Few things contribute more to the healing of foul sordid ulcers of any kind than keeping them thoroughly clean. This ought never to be neglected. The best application for this purpose seems to be the carrot poultice. The root of the common carrot may be grated, and moistened with as much water as will bring it to the consistence ofa poultice or cataplasm. This must be applied to the sore, and renew- ed twice a-day. It generally cleans the sore, eases the pain, and takes away the disagreeable smell, which are objects of no small importance in such a dreadful disorder.* Wort, or an infusion of malt, has been recommended not only as a proper drink, but as a powerful medicine in this disease. It must be frequently made fresh, and the patient may take it at pleasure. Two three, or even four English pints of it may be diauk every day for a considerable time. No benefit can be expected from any medicine in this disease, unless it be persisted in for a long time. It is of too ob- stinate a nature to be soon removed ; and, when it admits of a cure at all, it must be brought about by inducing au almost total change of the habit, which must always be a work of time. Setons or issues in the neighbourhood of the cancer have sometimes good tffects.t • London Medical Essays. . , t In a cancer which had set all medicines, and even surgery, at defiance, I lately saw remarkable elfectsfrom an obstinate perseverance in a course ol anu*. ptics. I ordered the deep ulcers to b* washed to the bottom hy means of a syringe, twice or thrice a-day, eitherwithan infu.ion of the bark, or a decoction ot carrot, and that the p tieut siould * take four or five times a-day, a glass of good wine, with halfa drachm of the best pow- dered bark in it- The sores, after bring washed, Men- likew ist- spruihl d « Uh the same powder. When the patient began this course. herd- an Mas daily expected. She con. tinued it for above two years with manifest advantage; but being told t* an eminent rargeon, that the bark would not cure a eancer, and that the sores ought not to be 284 OF POISONS. When all other medicines fail, recourse may be had to opium, as a kind of solace, litis will not indeed cure the disease, but it will ease tbe patient's agony, and render life more tolerable while it continues. To avoid this dreadful disorder, people ought to use wholesome food; to take sufficient exercise in the open air; to be as easy and cheerful as possible; and carefully to guard against all blows ; bruises and every kind of pressure upon the breast, or othtr glandular parts.* CHAPTER XLVIII. OF POISONS. EVERY person ought, in some measure, to be acquainted with the nature and cure of poisons. They are generally taken unawares, and their effects are often so sudden and violent, as not to admit of delay, or allow time to procure the assistance of physicians. Happily indeed no great degree of medical knowledge is here necessary; the remedies for most poisons being generally at hand, or easily obtained, and nothing but common prudence needful in the application of them. The vulgar notion that every poison is cured by some counter poi- son, as a specific, has done much hurt. People believe they can do nothing for the patient, unless they know the particular antidote to that kind of poison which he has taken. Whereas the cure of all poi- sons taken into the stomach, without exception, depends chiefly on dis- charging them as soon as possible. There is no case wherein the indications of cure are more obvious. Poison is seldom long in the stomach before it occasions sickness, with an inclination to vomit. This shews plainly what ought to be done. Indeed common sense dictates to every one, that, if any thing has been taken into the stomach which endangers life, it ought immediately to be discharged. Were this duly regarded, the danger arising from poi- son might generally be avoided. The method of prevention is obvious, and the means are in the hands of every one. We shall not take up the leader's time with a detail of the ridiculous notions which have prevailed among ignorant people in differeut ages with regard to poisons; neither shall we mention the boasted antidotes, wliich have been recommended either for preventing or obviating their effects; but shall content ourselves with pointing out the poisons most common in this country, and the means of (avoiding their dangerons consequences. Poisons either belong to the mineral, the vegetable, or the animal kingdom. Mineral poisons are commonly of an acrid or corrosive quality; as arsenic, cobalt, the corrosive sublimate of mercury, &c. Those of the vegetable kind are generally of ft narcotic or stupefac- tive quality ; as poppy, hemlock, henbane, berries of the deadly night- shade, Sec. Poisonous animals communicate their infection either by the bite or sting. This poison is very different from the former, and only produ- ces its effects when received into the body by a wound. washed, ihe discontinued the practice, and died in a few weeks. This course was not expected to cure the cauctr, but to prolong thi patient's lilt, which it ev idently did al- most to a miracle. ....... * As hemlock isthe principal rmdicioe recommended in this disease, we would have given some directions for tlie path, ring and pr< paring of that plant; but as its diflt rent preparations aiv no* kept in the shops, we ttuak H ipneb. safer tor people to get then) Tbyre with proper directions tor wing them. OP POISON?. 285 MINERAL POISONS.—Arsenic is the most common of this class ; and, as the whole of them are pretty similar both in their effects and method of cure, what is said with respect to it wiff be applicable to every other species of corrosive poison. When a person has been taking tfrsenic, he soon perceives a burning heat, and a violent pricking pain in his stomach and bowels, with an intolerable thirst, and an inclination to vomit. The tongue and throat feel rough and dry; and if proper means be not soon administered, the patient is seized with great anxiety, hiccnpping, faintings, and coldness of the extremities. To these succeed b.ack vomits, foetid stools, with a mortification of the stomach and intestines, which are the immediate forerunners of death. On the first appearance of these symptoms the'patient should drink large quantities of new-iu.!k and salad oil till he vomits ; or he may drink warm water mixed with oil. Fat broths are likewise proper, provided they can be got ready in time. Where no oil is to be had, fresh butter may be melted and mixed with the milk or water. These things are to be drank as long as the inclination to vomit continues. Some have drank eight or ten English quarts before the vomiting ceas- ed ; and it is never safe to leave off drinking while one particle of the poison remains in the stomach. These oily or fat substances not only provoke vomiting, but likewise blunt the acrimonv of the poison, and prevent its wounding the bow- els ; but if they should not make the person vomit, halfa drachm or two scruples of the powder of ipecacnanha must be given, or a few spoonsful of the oxymel, or viuogar of squills may be mixed with the water which he drinks. Vomiting may likewise be excited by tickling the inside of the throat with a feather. Should these methods how- ever fail, half a drachm of white vitriol, or five or six grain* of emetic tartar, must be administered. If tormenting paiii3 are felt in the lower belly, and there is reason to fear that the poison has got down to ihe intestines, clysters of milk and oil must be very frequently thrown up; and the patient must drink emollient decoctions of barley, oat-meal, marsh-mallows, and such like. He must likewise take an infusion of senna and manna, a solu- tion of Glauber's salts, or some other purgative. After the poison has been evacuated, the patient ought for some time to live upon such things as are of a healing and cooling quality ; to abstain from flesh and all strong-liquors,and to live upon milk, broth, gruel, light puddings, and other spoon meats of easy digestion. His drink should be barley-water, linseed-tea, or infusions of any of the wild mucilaginous vegetables. VEGETABLE POISONS,—besides heat and pain of the sto- mach, commonly occasion some degree of giddiness, and often a kind of stupidity or folly. Persons who have taken these poisons must be treated in the same manner as for the mineral or corrosive. ThoiHi the vegetable poisons, when allowed to remain in the sto- mach, often proves fatal ; yet the danger is generally over as soon as thev are discharged. Not being of such a caustic or corrosive nature, tin V are less apt to wound or inflame the bowels than the mineral substances: no time, however, ought to be lost in having them dis- charged. , . , ;. . , Opium, being frequently taken by mistake, merits particular atten- tion. It is used as a medicine both in a solid and liquid form, which latter commonly goes bv the name of laudanum. It is indeed a valu- 288 BITES OF POISONOUS ANIMALS. able medicine when taken in proper quantity; but as an over-dose proves a strong poison, we shall point out its common effects, together with the method of cure. An over-dose of opium generally occasions great drowsiness, with stupor and other apoplectic symptoms. Sometimes the person has so great an inclination to sleep, that it is almost impossible to keep him awake. Every method must however be tried for this purpose. He should be tossed, shaked and moved about. Sharp biistering-plasten should be applied to his legs or arras, and stimulating medicines, as salts of hartshorn, &c. held under his nose. It will also be proper to let blood. At the same time every method must be taken to make him discharge the poison. This may be done in the manner directed above, viz. by the use of strong vomits, drinking plenty of warm water with oil, &c. Mead, besides vomits, in this case, recommends acid medicines * with lixivial salts. He says, that he has often given salt of worm- wood mixed with juice of lemon in repeated doses with great suc- cess. If the body should remain weak and languid after the poison has been extracted, nourishing diet and cordials will be proper; but when there is reason to fear that the stomach or bowels are inflamed, the greatest circumspection is necessary both with regard to food and medicine. OF THE BITES OF POISONOUS ANIMALS. We shalljbegin with the bite of a mad dog, as it is both the most common and ddiign'otrs antmtrl poison in this country. The creatures naturally liable to contract this disease 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-madness. It so seldom happens that any person is bit by the, two first,-that they scarce deserve to be taken notice of. If such a thing should happen, the method of treatment is precisely the same as for the bite of a mad-dog. The symptoms of madness in a dog are as follow : At first he looks dull, shews an aversion to food and company; be does not bark as usual, but seems to murmur, is peevish and apt to bite strangers: his ears and tail droop more than usual, and he appears drowsy. After- wards he begins to loll out his tongue, and froth at the mouth, his eye seeming heavy and watery. He now, if not confined, takes off", runs panting along with a kind of dejected air, arid endeavours to bite every one he meets. Other dogs are said to fly from him. Some think this a certain sign of madness, supposing that they know him by the smell, but it is not to be depended on. If he escapes being killed, he seldom runs above two or three days till he dies exhausted with heat, hunger and fatigue. . This disease is most frequent after long, dry, hot seasons; and such dogs as live upon putrid stinking carrion, without having enough of fresh water, are most liable to it. When any person has been bit by a dog, the strictest inquiry ought to be made whether the animal was really mad. Many disagreeable consequences arise from neglecting to ascertain this point. Some peo- ple have lived in continual anxiety for many years, because they had been bit by a dog which they believed to be nirfd ; but, as he had been killed on the spot, it was impossible to ascertain the fact. This should induce us, instead of killing a dog the moment he has bit any person, to do all in our power to keen him alive, at least till we be certain whether he be mad or not BITES OF POISONOUS ANIMALS. 28? Mauy circumstances may contribute to make people imagine a dog mad. He loses his master, runs about in quest of him, is set upon by other dogs, and perhaps by men. The creature, thus frightened, beat and abused, looks v. lid, antl lolls out his tongue as he runs along. Immediately a crowd is after him ; while he, finding himself closely pin sued, aud taking every one he meets for an enemy, naturally at- tempts to bite in self-defence. He soon gets knocked on the head, and it passes currently that he was mad, as it is then impossible to prove the contrary. This being the true history of, by far, the greater part of those dogs which pass for mad, is it any wonder that numberless whimsical medi- cines have been extolled for preventing the effectsof their bite? This readily accounts for the great variety of infallible remedies for the bite of a mad dog, which are to be met with in almost every famity. Though not one in a thousand has any claim to merit, yet they are all . supported by numberless vouchers. No wonder that imaginary diseases should be cured by imaginary remedies. In this way, credu- lous people first impose upon themselves, and then deceive, others. The same medicines which was supposed to prevent the effects of the bite, when the dog was not mad, is recommended to a person who has had tlie misfortune to be bit by a dog that was really mad. He takes it, trusts to it, and is undone. To these mistakes we must impute the frequent ill success of the medicines used for preventing the effects of the bite of a mad dog. It is not owing so much to a defect in medicine, as to wrong applications. I am persuaded, if proper medicines were administered immediately after the bite is received, and continued for a sufficient length of time, we should not lose one in a thousand of those who have the misfortune to be bit by a mad dog. This poison is generally communicated by a wound, which neverthe- less heals as soon as a common wound: but afterwards it begins to feel painful, and as the pain spreads towards the neighbouring parts, the person becomes heavy and listless. His sleep is unquiet with frightful dreams; he sighs, looks dull, and loves solitude. These are the fore- runners, or rather the first symptoms of that dreadful disease occasion- ed by the bite ofa mad dog. But as we do not propose to treat fully •f the disease itself, but to point out the method of preventing it, we shall not take up time in shewing its progress from the first invasion to its commonly fatal end. The common notion, that this poison may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridiculous. It must render such persons as have had the misfortune to be bit very unhappy, and can have no good effects. If the person takes proper medicines for forty days after the time of his being bit, and feels no symptom of the disease, there is reason to believe him out of danger. The medicines recommended for preventing the effects of the bite of a mad dog, are chiefly such as" promote the different secretions, aud antispasmodics. Dr. Mead recommends a preventive medicine, which hWsays he never knew fail, though in the space of thirty years he had used it a thousand times. The Doctor's prescription is as follows : " Take ash-coloured ground liver-wort, cleaied, dried, and powder- ed, half an ounce; of black pepper powdered, a quarter of an ounce. Mix these well together, and divide the powder into four doses; oue of 288 BITES OF POISONOUS ANIMALS. which must be taken every morning fasting, for four mornings succes- sively, in halfa pint of cows milk warm. *' After these four doses are taken, the patient must go into the cold bath, or a cold spring or river, every morning fasting, for a month ; he must be dipped all over, but not stay in (with his head above water) louder than half a minute, if the water be very cold. After this he must go in three times a-week for a fortnight longer. " The person must be bled before he begins to use the medicine."* We shall next mention the famous East-India specific as it is called. This medicine is composed of cinnabar and mnsk. It is esteemed a great antispasmodic; and, by many, extolled as an infallible remedy for preventing the effects of the bite ofa mad dog. " Take native and factitious cinnabar, of each twenty-four grains, mnsk sixteen grains. Let these be made into a fine powder, and taken in a glass of arrack or brandy." This single dose is said to secure the person for thirty days, at the end of which it must be repeated; but if he has any symptoms of the disease, it must be repeated in three hours. The following is likewise reckoned a good antispasmodic medicine : " Take of Virginian snake-root in powder, halfa drachm, gum asafoe- tida twelve grains, gum camphire seven grains; make these into a bolus with a little syrup of saffron." Camphire may also be given in the following manner: " Take purified nitre half an ounce, Virginian snake-root in powder two drachms, camphire one drachm; rub them together in a mortar. and divide the whole into ten doses." Mercury is likewise recommended as of great efficacy, both in the prevention and cure of this kind of madness. When used as a preven- tive, it will be sufficient to rub daily a drachm of the ointment into the parts about the wound. Vinegar is likewise of considerable service, and should be taken freely, either in the patient's food or drink. These are the principal medicines recommended for preventing the effects of the bite ofa mad dog. We would not however advise people to trust to any one of them; but from a proper combination of their different powers, there is the greatest reason to hope for success. The great error in the use of these medicines, lies in not taking them for a sufficient length of time. They are used more like charms, than medicines intended to produce any change in the body. To this, and not to the insufficiency of the medicines, we must impute their frequent want of success. Dr. Me*-d says, that the virtue of his medicine consists in promo- ting urine. But how a poison should be expelled by urine, with only three or.fourdores of any medicine, however powerful, it is not easy to conceive. More time is certainly necessary, even though the medicine were more powerful than that which the Doctor pre- scribes. The East-India specific is stjjl more exceptionable on this ac- count. ». As these and most other medicines, taken singly, have frequently been found to fail, we shall recommend the following couise: * Though wejgive this prescription on the credit of Dr. Mead, yet we would aot ad- vise any person, Who has reason to believe that he has been bit by a dog which was real- ly mad, to trust to it alone. Mead was an able physician, but he seems to have been no great philosopher, and was sometimes the dupe of his own ea-dulit j. BITES OF POISONOUS ANIMALS. 889 If a person is bit in a fleshy part, where there is no hazard of hurt- ing any large blood-vessel, the parts adjacent to the wound may be cut away. But if this be not done soon after the bite has been received, it will be better to omit it. The wound may be dressed with salt and water, or a pickle made of vinegar and salt, and afterwards dressed twice a-day with yellow ba- silicon, mixed with red precipitate of mercury. The patient should begin to use either Dr. Mead's medicine, or some of the others mentioned above. If he takes Mead's medicine, he may use it as the Doctor directs for four days successively. Let him then omit it for two or three days, and again repeat the same number of doses as before. During this course, he must rub into the parts about the wound, dai- ly, one drachm of the mercurial ointment. This may be done for ten or twelve days at least. When this course is over, he may take a purge or two, and wait a few days till the effect of the mercury be gone off. He must then be- gin to use the told bath, into which he may go every morning for five orsix weeks. If he should feel cold and chilly for a long time after com- ing outof the cold bath, it will be better to use a tepid one, or to have the water a little warmed. In the mean time we would advise him not to leave off all internal medicines, but to take either one of the bolusses of snake-root, asafoe- tida, and camphire ; or one of the powders of uitre, camphire, and snake-root, twice a day. These may be. used during the whole time he is bathing. During the use of the mercurial ointment, the patient must keep within doors, and take nothing cold. A proper regimen must be observed throughout the whole course. The patient should abstain from flesh, and all salted and high-seasoned provisions. He must avoid strong liquors, and live mostly upon a light and rather spare diet. His mind should be kept as easy and cheerful as possible, and all excessive heat and violent passions avoided with the utmost care. I have never seen this course of medicine, with proper regimen, fail to prevent the hydrophobia, and cannot help again observing, that the want ot success must generally be owing either to the application of improper medicines, or not using proper ones for a sufficient length of time. Mankind are extremely fond of every thing that promises a sudden or miraculous cure. By trusting to these they often lose their lives, when a regular course of medicine would have rendered them abso- lutely safe. This holds remarkably in the present case. Numbers of people, for example, believe, if they or their cattle were once dipped in the sea it is sufficient; as if the salt water were a charm against the effects of the bite. This, and such like whims, have proved fatal to n.any. It is a common notion, if a person be bit by a dog which is not mad, that, if he should go mad afterwards, the person would be affected with the disorder at the same, time ; but this notion is too ridiculous to deserve a serious consideration. It is a good rule, however, to avoid dogs as much as possible, as the disease is rften upon them for some time before its violent symptoms appear. The hydrophobia has been occasioned by the bite ofa dog which shewed no other symptoms of ti e disease but listlefsncss and a sullen disposition. Bb S90 BITES OF POISONOUS ANIMALS. Though we do not mean to treat fully of the cure of the hydropho- bia, yet we are far from reckoning it incurable. The notion that this disease could not be cured, has been productive of the most horrid con- sequences. It was usual either to abandon the unhappy persons as «oon as they were seized with the disease, to their fate, to bleed them to death, or to suffocate them between mattresses or feather-beds, &c. This conduct certainly deserved the severest punishment! We hope, for the honour of human nature, it will never again be heard of. I have never had an opportunity of treating this disease, and there- fore can say nothing of it from my own experience ; but the learned Dr. Tissot 'ays, it may be cured in the following manner : 1. The patient must be bled to a considerable quantity, and this may be repeated twice, or thrice, or even a fourth time, if circumstances require it. 2. The patient should be put, if possible, into a warm bath ; and this should be used twice a-day. 3. He should every day receive two, or even three emollient clys- ters. 4. The wound, and the parts adjoining to it, sliould be rubbed with the mercurial ointment twice a-day. 5. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in an oily flannel. 6. Every three hours a dose of Cobb's powder should be taken in a cup of the infusion of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of na- tive and factitious cinnabar, each twenty-four grains; of musk, sixteen grains.* 7 The following bolus is to be pven every night, and to be repeated 'ii the morning, if the patient is not easy, washing it down with the in- fusion mentioned above : Take one drachm of Virginian snake-root in powder ; of camphire and asafoetida, ten grains each ; of opium, one grain; and with a sufficient quantity of conserve, or rob of elder, make a bolus. 8. If there be a great nausea at the stomach, with a bitterness in the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be taken for a vomit. 9. The patient's food, if he takes any, must be light; as panada, soups made of farinaceous or mealy vegetables, &c. 10. If the patient should long continue weak, and subject to terrors, he may take halfa drachm of the Peruvian bark thrice a-day. The next poisonous animal which we shall mention is the VIl'ER. The grease of this animal rubbed into the wound, is said to cure the bite. Though that is all the viper-catchers generally do when bit, we should not think it sufficient for the bite of an enraged viper. It would surely be more safe to have the wound well sucked,t aud after- * The Ormskirk medicine, as it is called, seems to me to consist chiefly of cinnabar. Though it is said to be infallible, as a preventive; yet I would not advise any one to trust to it uloiie. Indeed it is ordered to be taken in a manner which gives it moi-e the appearance of n charm than ofa medicine. Surely if a medicine is to produce any chance in the body, it must lie takeu for some considerable time, and in sufficient quantity. t 'i'lte pr.ictic«ofsuekjiigout poisnns is very ancient; and iutleeJ nothing can b« more rational. When the bite cannot be cut out, this is tlio most iiki-1) way Ibreitraet- ing the poison. Theiv con be no danger in performing this office, as the poison does no harm unless it tv ta!st-n into the body by a wound, the person who sucLs thi wound,ought hnwsver to wash his mouth freuuently with »«lad-oil, which will sctaie BITES OF POISONOUS ANIMALS. £91 wards rubbed with warm salad oil.t A poultice, of bread and milk,sof- tened with salad-oil, should likewise be applied to the wound; and the patient ought to drink freely of vinegar-whey, or water-gruel with vin- egar in it, to make him sweat. Vinegar i* one of the best medicines which can be used in any kind of poison, and ought to be taken very liberally. If the patient be sick he may take a vomit. Thi3Course will be sufficient to cure the bite of any of the poisonous animals of this country. With regard to poifonous insects, as the the bee, the wasp, the hornet, &c. theirstings are seldom attended with danger, unless when a person happens to be s:uny condition of such persons will certainly plead oir excuse, if any excuse be necessary, for endeavouring to point out the syLolcms and cure of this tuo common disease. * ^ To enumerate all its different symptoms, however, and to trac-> the diceaic minutely throtu'i i:s various stages, would require a mud. EbS 29i OF THE VIRULENT GONORRHOEA. larger space than falls to this part of my subject; I shall therefore con- fine my observations chiefly to circumstances of importance, omitting such as are either trifling, or which occur but seldom. I shall likewise pass over the history of the disease, with the different methods of treatment which it has undergone since it was first introduced into Eu- rope, and many other circumstances of a similar nature; all of which though they might tend to amuse the reader, yet could afford him little or no useful knowledge. OF THE VIRULENT GONORRHOEA. THE virulent Gonorrhoea is an involuntary discharge of infectious matter from the parts of generation in either sex. It generally makes its appearance within eight or ten days after the infection has been receiv- ed; some times indeed itappcars in two or three days, and at other times not before the end offourorfive weeks. Previous to the discharge the patient feels an itching, with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary pas- sage, which stains the linen, and occasions a small degree of titillation, particularly at the time of making water; this gradually increasing, arises at length to a degree of heat and pain, which are chiefly perceiv- ed about the extremity of the urinary passage, where a slight degree of redness and inflammation likewise begin to appear. As the disorder advances, the pain, heat of urine, and running, in- crease, while fresh symptoms daily ensue. In men, the erections be- come painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is warm iu bed. The pain which was at first only perceived towards the extremity, now begins to reach all up the urinary passage, aud is most intense just after the patient has done making water. The running gradually recedes from the colour of seed, grows yellow, and at length puts on the appearance of mucus. When the disorder has arrived at its height, all the symptoms are more intense; the heat of the urine is so great, that the patient dieadi the making water ; and though tie feels a constant inclination this way yet it is rendered with the greatest difficulty, and often only by drops: the involuntary erections now become extremely painful and frequent; there is also a pain, heat, and seuse of fulness about the seat, and the ru ruling is plentiful and sharp, ofa brown, greenish and sometinies of a bloody colour. By a proper treatment the violence of the symptoms grcuhilly a- bates; the heat of urine goes off; the involuntary and painful erec- tions, and the heat and pain about the seat become easier; the running idso gradually decreases, grows whiter aud thicker, till at last it entirely disappear-. By attending to these symptoms the gonorrhoea may be generally alistiuguished from any other disease. There are however some "few disorders for which it may be mistaken, as an ulcer in the kidnies or bladder, the fluor alb us, or whites in women, Sec. But in tbe former of these, the matter comes away only with the urine, or when the sphincter of the bladder is open; whereas in the gonorrhoea the dis- charge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects, as pain, communicating the in- lection, Sec. REG i -i V.S.—When a person has reason to expect that he has caught the venereal infection, he ought most strictly to observe a cooling re- gimen, to avoid every thing of u heating nature, as wines, spirituous K- OF THE VIRULENT GONORRHOEA. 295 quors, rich sauces, spices, salted, high seasoned and smoke-dried pro- visions, Sec. also all aromatic and stimulating vegetables, as onions, garlic, shallot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panada, gruels, &c. His drink may be barley-water, milk aud water, decoctions of marsh-mallows and liquorice, linseed-tea, or clear whey. Of these he ought to drink plentifully. Violent exer- cise of all kinds, especially riding on horse-back, and venereal pleas- ures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed. MEDICINE.— \ virulent gonorrhoea cannot always be cured speed- ily and effectually at the same time. The patient ought therefore not to expect, nor the physician to premise it. It will often continue for two or three weeks, and sometimes for five or six, even where the treat- ment has been very proper. Sometimes indeed a slight infection may be carried off in a few days, by bathiiii; the parts in warm milk and water, and injecting frequently up the urethra'a little sweet oil or linseed tea, about the warmth ofnew milk. Should these not succeed in carrying off the infection, they will at least have a tendency to lessen its virulence. To effect a cure, however, astringent injections will be found neces- sary. These may be various ways prepared, but I think those made with the white vitriol are both more safe and efficacious. They can be made stronger or weaker as circumstances may require; but it is best to begin with the more gentle and increase their power if neces- sary. I generally order a drachm of white vitriol to be dissolved in eight or nine ounces of common or rose water, and an ordinary syr- inge 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 dose iu- creased.* Whether injections be used or not, cooling purges are always pro- per in a gonorrhoea. They ought not, however, to be of the stron» or dractic kind. Whatever raises a violent commotion in the body increases the danger, and tends to drive the disease deeper into the habit. Procuring two or thee stools every second or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the running, and to change its colour and con- sistence. It gradually becomes more white and ropy as the virulence abates.t • Although it is now very common to cure the gonorrhoea hy astringent injections, there are still many practitioners who do not approve this mode of practice. 1 can, however, from much experience, assert that it is both the most easy, elegant, anil effi- cacious method of cure; and that any bad consequences arising from it must be ow- ing to tbe ignorance or misconduct of tbe prastitioner himself, and not to the reme- dy. Many, for example, use strong preparations of lead, all of which are dangerous when appliidto the iuteiiral surlaces of the body; others use esch.irotics. which in- fl»me and injure the parts. 1 have known a gonorrha a actually cured by an injection made of green-tea, and would always recommend gentle methods where they will su». teed. t Ifthe patient can swallow a solution of salts and manna, he may take six drachms, W, if his constitution reriuirrs it, an ounce of the former with half an ounce of the lat- ter. 1 Ik-si- may be dissolved in an Knglish pint of boiling water, whey, or thin water- gruel, anil :aken early in tlie morning. If au infusion of senna and tamarinds be more agreeable two drachms of the former and an ounce ofthe latter, may be infused all niijht in an Fnplish pint of boiling water. flu; infusiim may be strained next morr.ing.and halfan ounce of Glauber's salts ilissolr. »d In it. A wa-vupfulof Uusinfusion n>ay be takfiicTery half tuitiv till itopi rar.s. 29o OF THE VIRULENT GONORRHOEA. When the inflammatory symptoms run high, bleeding is always ne- cessary at the beginning. This operation as in other topical inflam- mations, must be repeated according to the strength and constitution of the patient, and the vehemence and urgency of the symptoms. Medicines which promote the secretion of urine are likew ise proper in this stage of the disorder. For this purpose an ounce of nitre and two ounces of gum arabic, pounded together, may be divided iuto twen- ty-four doses, one of which may be taken frequently in a cup of the patient's drink. If these sliould make him pass his urine so often as to become troublesome to him, he may either take them less frequently, or leave out the nitre altogether, and take equal parts of gum arabic and cream of tartar. These may be pounded together, and a tea- spoonful taken in a cup of the patient's drink four or five times a-day. I have generally found this answer extremely well, both as a diuretic and for keeping the body gently open. When the pain and inflammation are seated high, towards the neck of the bladder, it will be proper frequently to throw up an emollient clyster, which, besides the benefit of procuring stools will serve as a fomentation to the inflamed parts. Soft poultices, when they can conveniently be applied to the parts, are of great service. They may be made of the flour of linseed, or of wheat-bread and milk, softened with fresh butter, or sweet oil. When poultices cannot be conveniently used, cloths wrung out of warm water, or bladders filled with warm milk and water, may be applied. I have known most excruciating pains, during the inflammatory state of the gonorrhoea, relieved by one or other of these applications. Few things tend more to keep off inflammation in the spermatic ves- sels than a proper truss for the scrotum. It ought to be so contrived as to support the testicles, and should be worn from the first appearance of the disease till it has ceased some weeks. The above treatment will sometimes remove the gonorrhoea so quick- ly, that the person w ill be in doubt whether he really laboured under that disease. This however is too favourable a turn to be often expected. It more frequently happens, that we are only able to procure an abate- ment or remission of the inflammatory symptoms, so far as to make it *afe to have recourse to the great antidote mercury. . Many people, on the first appearance ofa gonorrhoea, fly to the use of mercury. This is a bad plan. Mercury is often not at all uecessary in ;« gonorrhoea; and when taken too early it does mischief. It may be necessary to complete the cure, but can never be proper at the commencement of it. When bleeding, purging, fomentations, and the other things recom- mended as above, have eased the pain, softened the pulse, relieved the heat of urine, and render the involuntary erections less frequent, the patient may begin to use mercury in any form that is least disagreeable to him. If he takes the common mercurial pill, two at night and one in the morning will be a mifficicnt dose at first. Should they affect the mouth Should the patient prefer an electuary, the following will be found to answer very well Take of the lenitive electuary four ounces, cream of tartar two ounce*, jalap in uowder, two ilrachms, iliubarb, one drachm, and as much of the syrup of pair rases as will serve to mnU» up the whol» into a soft electuary. Two or three tea-spoonsful ot this may be taken over night, and about the same «;uantity next morning, everyday ih-t the patient chust-s to tnke a purge. The do't-i of the above medicines may be increased or diminished according as the patient finds it necessary. AV« have ordered the salts to lie disjoint! in a large tiuauU* ,y olv.ntei) because it rendu: their operation icore mild. OF THE VIRULENT GONORRHOEA. 297 too much, the dose must be lessened ; if not at all, it may be gradnally increased to five or six pills in the day. If calomel be thought prefera- ble, two or three grains of it, formed into a bolus with a little of the conserve of hips, may be taken at bed-time, and the dose gradually increased to eight or ten grains. One of the most common preparations of mercury now in use is the corrosive sublimate. This may be taken in the manner afterwards recommended under the confirmed lues or pox. I have always found it one of the most safe and efficacious medi- cines when properly used. The above medicines may either be taken every day or every other day, as the patient is able to bear them. They ought never to be taken in such quantity as to raise a salivation, unless in a very slight degree. The disease may be more safely, and as certainly cured without a saliva- tion as with it. When the mercury runs off by the mouth, it is not so successful in carrying off the disease, as when it continues longer in the body, and is discharged gradually. Should the patient be purged or griped in the night by the mercury, he must take an infusion of senna, or some other purgative, and drink freely of water-gruel, to prevent bloody stools, which are very apt to happen should the patient catch cold,or if the mercury has not been du- ly prepared. When the bowels are weak and the mercury is apt to gripe or purge, these disagreeable consequences maybe prevented by taking, with the. above pills or bolus, halfa drachm or two scruples of diascordi- tur>, or of the Japonic confection. To prevent the disagreeable circumstance of the mercury's affecting tho mouth too much, or bringing on a salivation, it may be combined with purgatives. With this view tho- laxative mercurial pill has been contrived, the usual dose of which is half a drachm, or three pills, night and morning, to be repeated every other day, but the safer way for the patient to begin with two, or even with one pill, gradually increasing the dose. To such pcisons as can neither swallow a bolus nor a pill, mercury may be given in a liquid form, as it can be suspended even in a watery vehicle, by means of gum-arabic -, which, not only serves this purpose, but likewise prevents the mercury from affecting the mouth, and renders it in many respects a better medicine.* It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application ofit will answer equally well, and in some re-pects better. It must be acknowledged, that mer- cury, taken inwardly for any length of time, greatly weakens and disor- ders the bowels; for which reason, when a plentiful use ofit becomes necessary, wc would prefer rubbing to the mercurial pills. The com- mon mercurial or blue oiivnicnt will answer very well. Of that which is made by rubbing together equal quantities of hog's lard and quicksil- ver, about a drachm may be used at a time. The best time for rubbing it ou is at night, anil the most proper place the inner side of the thighs. The patient should stand before the fire when he rubs, and should wear flanuel drawers next his skin at the time he is using the ointment. If • Take quicksilver one drachm, gum-arabic reduced to a mucilage two drachms; let the quicksilver be rubbed with the mucilage, in a marble mortar, until the globule. of mercury entirely disappear; afterwards add gradually, still continuing thetutura- lion, half an ounce of balsamic syrup, and eight ounces of simple cinnamon-water. Two table-spoonsrul of this solution may be taken night and morning. Some reckon this the best form in which quicksilver nan be wdnbited for the cure ofa g»uorrh*a. 2y» OF GLEETS. ointment ofa weaker or stronger kind be used, the quantity must be increased or diminished in proportion. If during the use of the ointment, tlie inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath become of- fensive, a dose or two of Glauber's salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As Kion however as the signs of spitting are gone off, if the virulcncy be not quite corrected, the ointment must he repeated, but in smaller quanti- ties, and at longer intervals than before. Whatever way mercury is administered, its use may be persisted in as long as any viiulency is sus- pected to remain. During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammato- ry state, yet intemperance of every kind must be avoided. 'Ihe food must be light, plain, and of easy digestion ; and the gieatest indulgence that may be allowed with respect to drink is, a little wine diluted with a sufficient quantity of water. Spirituous liquors are to he avoided iu eve.-y shape. I have often known the inflammatory symptoms renew- ed and heightened, the running increased, and the cure rendered ex- tremely difficult and tedious, by one fit of excessive drinking. When the above treatment has removed the boat of urine, and the soreness of the genital parts ; when the quantity of running is considera- bly lessened, without any pain or swelling in tbe groin or testicle su. pervening ; when the patient is free from involuntary erections ; and lastly, when the running becwes pale, whitish, thick, void of ill smell, and tenacious or ropy ; *lien~ajl or most of these symptoms appear, the gonorrhoea is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringentyand agglutinating mediciues. OF GLEETS. A Gonorrhoea frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from a relaxation, or from some remains of the disease. It is however of the greatest importance in the cure of the gleet, to know from which of these causes it proceeds.— When the discharge proves very obstinate, and receiveslittleorno check from astringent remedies, there is ground to suspect that it is owing to to the latter; but if the chcain is inconstant, and is chiefly observable when the patientis stimulated by lascivious ideas, or upon straining to goto stool, we may reasonably conclude that it is chiefly owing to the former. In the cure of a gleet proceeding from relaxation, the principal de- sign is to brace, and restorea proper degree of tension to the debili- tated and relaxed vessels, ^ror this purpose, besides the medicines recommended in the gonorrhoea, the patient may have recourse to stronger and more powerful astringents, as the Peruvian bark,* alum, vitriol, galls, tormentil, bistort, baldustiues, tincture of gum kino, Sec. The injections may be rendered more astringent by the addition ofa few grains of alum, or increasing the quantity of vitriol as far as the parts are able to bear it. The last remedy which we shall mention in this case is the cold bath, * The Peruvian bark may be combined with other astringents, and prepared in- tbe following manner: Take of Peruvian bark bruised six drachms, of fresh gall < bruised two drachms; boil them in a pound and an half of water to a pound : to tlie strained liquor add three ouuci-s of the simple tincture of the bark. A small ti a-cipful of this any be taken three times a-day, adding to each qup fifteen or twenty cV.p, of th#acifl clear of vitriol. OF THE SWELLED TESTICLE. S9« than which there is not perhaps a more powerful bracer in the Whole compass of medicine. It ought never to be omitted in this'species of gleet, unless there be something iu the constitution of the patient which renders the use of it unsafe. The chief objections to the use of the cold bath are a full habit and an unsound state of the viscera. The dan- ger from the former may always be lessened, if not removed, by purg- ing and bleeding ; but the latter is an insurmountable obstacle, as the pressure of the water, and the sudden contraction of the external ves- vessels, by throwing the blood with too much force upon the internal parts, are apt to occasion ruptures of the vessels, or a flux of humours up- on the diseased organs. But where no objection of this kind prevails, the patient ought to plunge over head in water every morning, fasting for three or four weeks together. He should not however stay long in the water, and should take care to have his skin dried as soon as he comes out. The regimen proper in this case is the same as was mentioned in the last stage of the gonorrhoea : the diet must be drying and astringent, and the drink, Spa, Pyrmont, or Bristol waters, with which a little cla- ret or red wine may sometimes by mixed. Any person may now afford to drink these waters, as they can be every where prepared at almost no expense, by a mixture of common chalk and oil of vitriol. When the gleet does not in the smallest degree yield to these medi- cines, there is reason to suspect that it proceeds from ulcers. In this case recourse must be had to mercury, and such medicines as teird to correct any predominant acrimony with which the juices may be affect- ed, as the decoction of China, sarsaparilla, sassafras, or the like. Mr. Fordyce says, he has seen many obstinate gleets, of two, three or four years standing, effectually cured by a mercurial inunction, when almost every other medicine has been tried in vaiu. Dr. Chapman seems to be of the same opinion ; but says, he has always found the mercury succeed best in this case when joined with terebinthinate and other agglutinating medicines. For which reason the Doctoi re- commends pills made of calomel and Venice turpentine *lra\vd desires that their use may be accompanied with the decoction of guaiacum or sarsaparilla. The last kind of remedy wliich we shall mention forthe cure of ul- cers in the urinary passage, are the suppurating camMe, or bougies • as these are prepared various ways, and are generajly to "'be bought ready made, it is needless to spent! time in enumerating the different ingredients of which they are composed, or teaching tlie manner of preparing them Before a bougie be introduced into the urethra, however, it should be smeared all over with sweet oil, to prevent it from stimulating too suddenly ; it may be suffered to continue in from one to seven ot eight hours, according as the patient can bear it. Ob- stinate ulcers are not only often healed, but tumours and excrescences in the urinary passages taken away, and an obstruction of urine re- moved by means of bougies. Obstinate gleets may be removed by the use of bougies. _ OF THE SWELLED TESTICLE. THE swelled testicle may either proceed from infection lately con- »00 OF BUBOES. traded, or from the venereal poison lurking in the body : the latter iu deed is not very common, but the former frequently happens both in the first and second stages ofa gonorrhoea; particularly when the running is unseasonably checked by cold, haul drinking, strong dras- tic purges, violent exercise, the too early use of astringent medicines, or the like. In the inflammatory stage, bleeding is necessary, wliich must be re- peated according to the urgency of the symptoms.' The food must be light, antl the drink diluting. High-seasoned food, flesh, wines, and everything ofa heating nature are to be avoided. Fomentations are of singular service. Poultices of bread and milk, softened with fresh butter or oil, are likewise very proper, and ought constantly to be applied when the patient is in bed, when he is up the testicles should be kept warm, and supported by a bag or truss, which may easily he contrived in such a manner as to prevent the weight of the testicle from having any effect. If it should be fount! impracticable to clear the testicle by the cool- ing regimen now pointed out, and extended according to circumstances, it will be necessary to lead the patient through such a complete anti-ve- nereal course as shall ensure him against any future uneasiness. For this < purpose, besides rubbing the mercurial ointment on the part, if free from pain, or on the thighs, as directed in the gonorrhoea, the patient must be confined to bed, if necessary, for five or six w eeks, suspending thetesticleallthe while with a bag or truss, and plying him inwardly with strong decoctions of sarsaparilla. When these means do not succeed, and there is reason to suspect a scrophulous or cancerous habit, either of which may support a scirrhus induration after the venereal poison is corrected, the parts should be fomented daily with a decoction of hemlock, the bruised leaves of which may likewise be added to the poultice, and the extract at the same tinn taken inwardly.t This practice is strongly recommended by Dr. Stork in scirrhus and cancerous cases : and Mr. Fordyce assures us, that by this-method he has cured diseased testicles of two or three years standing, even when ulcerated, and when the scirrhus had be- gun to be affected with pricking and lancing pains. OF BUBOES. VENEREAL buboes are hard tumours seated in the groin, occa- sioned by ,the "H^ereal poison lodged in this part. They are of two kinds, viz. sucb-as proceed from a recent infection, and such as accom- pany a confirmed lues. The cure ot recent buboes, that is, such as appear so soon after impure coition, may be first attempted by dispersion, and if that should not succeed, by suppuration. To promote the dispersion of a bubo, the same regimen must be observed as was directed iq the first sta;e ofa gonorrhoea. The patient must likewise be bled, and take some cool- ing purges, as the decoction of tamarinds and senna, Glauber's salts, and the like. If, by this course, the swelling and other inflammatory fymptoms abate, we may safely proceed to Hie use of mercury, which must be continued till the venereal virus is subdued.} -i • I have lieen accustomed for some time past to apply leeches to inflamed testicles, which practice has alwaj s been followed hy the most happy eftects t The extract of hemlock may be made into pills, and taken in tlie manner directed under the article Cancer. % For the dispersion of n bubo, a number of leeches applied to the part nfl'extcd will be fo*wl equally efiicaciout as in the inflamed testicle. OF CHANCRES. 101 But if the bubo should, from the beginning, be attended with great heat, pain, and pulsation, it will be properto promote its suppuration. For this purpose the patient may be allowed to use his ordinary diet and to take now and then a glass of wine. Emollient cataplasms, con- sisting of bread and milk softened with oil or fresh butter, may be ap- plied to the part; and in cold constitutions, where the tumour advan- ces slowly, white lily-roots boiled, or sliced onions raw, and a suffi- cient quantity of yellow basilicon, may be added to the poultice. When the tumour is ripe, which may be known by its conical figure, the softness of the skin, and a fluctuation of matter plainly to be felt under the finger, it may be opened either by a caustic or a lancet, and afterwards dressed with digestive ointment. It sometimes however happens, that buboes can neither be dispersed nor brought to a suppuration, but remain hard, indolent tumours. Inthis case the indurated glands must be consumed by caustic; if they should become scirrhus, they must be dissolved by the application of hemlock, both externally, and internally as directed in the scirrhus testicles. OF CHANCRES. CHANCRES are superficial, callous, eating ulcers ; which may hap- pen either with or without a gonorrhoea. They are commonly seated about the glands, and make tlieir appearance in the following manner: First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish'matter inclining to yellow. This pimple is hot, and itches generally before it breaks : afterwards it degenerates into an obstinate ulcer, the bottom of wliich is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle ; which, however, if the cause be venereal, soon becomes a true chancre. A chancre is sometimes a primary affection, but it is much .oftener symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in pails covered with a thin cuticle, as the lips, the nipples of women, the glanspenis of nu-n,&c* When a chancre appears soon after impure coition, its'treatment is nearly similar to that of the virulent gonorrhoea. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed, or rather soaked, in warm milk and water, and, if the inflam- mation be great, au emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the in- flammation, and prepare the patient for the use of mercury. Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scurvy eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of"the parts mentioned above, tiity con-monly appear upon the private parts, or the inside of the thigh. I hey are also less painful, but frequently much larger aud harder than primary chancres. As their cure must depend upon that of the pox, of which ihey are only • When venereal ulcers are seated in the lips, the infection may be communicated by kissiue 1 have s- en v. ty obstinate venereal ulcers in tin lips, which I have all the MasonTin thi world to beli ve were commn. icat.din this manner. Niims ouirhl to beware of suckling infected ihildn-n, or having th> ir breasts draw« by pit-sous tainted with ihe «men .'I disease. This caution is verj necessary l»r uursee »ho reside ii» the neighbourhood of great towns. C c 30* OF CHANCRES. a symptom, wc shall take no further notice of them, till we come to treat ofa confirmed lues.* Thus we have related most of the symptoms which accompany or suc- ceed a violent gonorrhoea, and have also given a short view of their pro- per treatment; there are, however, several others which sometimes at- tend this disease, as a strangury, or obstruction of urine, a phymosis, paraphimosis, lie. A strangury may either be occasioned by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the blad- der. In the former case, the patient begins to void his urine with tolerable ease ; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, sometimes by drops only. When the strangury is owing to an inflammation about tbe neck t»f the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool. When the strangury is owing to spasms, snch medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions sweet- ened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding and emollient fomentations, will be neces- sary. When the complaint is evidently owing to an inflammation about the neck of tlie bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum iu them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which, six ounces of the syrup of marshmallows, four ounces of tbe oilofsweetalmonds, and half an ounce of nitre, may be added. If these remedies should not relieve tbe complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm batb up to the middle. It will be proper in this case to dis- continue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, wc would rather recommend the use of mild bougies. These often lubricate the pas- sage, and greatly facilitate the discharge of urine. Whenever they be- gin to stimulate or give any uneasiness, they may be withdrawn. The phymosis is such a constriction of the prepuce over the glands, as hinders it from being drawn backwards ; the paraphymosis, on the con- trary, is such a constriction of the prepuce behind the glands, as hinders it from being brought forward. The treatment of these symptoms is so nearly the same with that of the virulent gonorrhoea, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations are sufficient. Should these however fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and may be worked off with warm water or thin gruel. * I have found it answer extremely wall to sprinkle chancres twice a-day with calomel. This will often perform a cure without any other application whatever. If the chanare are upon theglands, they may be washed with milk and water a little warm, and after wards the calomel may be applied as above. A CONFIRMED LUES. 303 It sometimes happens, that, in spite of all endeavours to the contra- ry, the inflammation goes on, and the symptoms ofa beginning morti- fication appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, iu order to prevent a strangu- lation, and set the imprisoned glands at liberty. We shall not des- cribe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary besides performing the above operations, to foment the parts frequently with cloths wrung out of a strong 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 priapism, chordee, and other distortions of the pe- nis, their treatment is no way different from that of the gonori-Loa. When they prove very troublesome, the patieut may take a few drops of laudanum at night, especially aftev the operation of a purgative through the day. OF A CONFIRMED LUES WE have hitherto treated of those affections in which the venereal poison is supposed to be confined chiefly to the particular part by which it was received, and shall next take a view of the lues in its con- firmed state ; that is, when the poison is actually received into the blood, and circulating with it through every part of the body, mixes with the several secretions, and renders the whole habit tainted. The symptoms of a confirmed lues are, buboes iu the groin, pain of the head and joints, which are peculiarly troublesome in the night, or when the patient is warm in bed ; scabs and sends in various parts of the body, "especially on the head, of a yellowish colour, resembling a honey-comb ; corroding ulcers in various parts of the body, which gen- erally begin abont the throat, from whence they creep gradually, by the palate, towards the cartilage of the nose, which they destroy ; ex- crescences or exostoses arise in the middle of the bones, and their spon- gy ends become brittle, and break upon the least accident; at other times they are soft, and bend like wax; the conglobate glands become hard and callous, and form in the neck, armpits, groin, and mesentery, hard moveable tumours, like the king's evil; tumours of different kinds are likewise formed in the lymphatic vessels, tendons, liga- ments, and nerves, as the gummatu, ganglia, nodes, tophs, Sec.; tbe eyes are affected with itching, pain, redness, and sometimes with total blindness, and the ears with a singing noise, pain, and deafness, whilst their internal substance is ulcerated and rendered carious ; at length all the animal, vital, and natural functions are depraved ; the face be- comes pale and livid ; the body emaciated and unfit for motion, and the miserable patient falls into an atrophy or wasting consumption. Women have symptoms peculiar to the sex; as cancers of the breast; a suppression or overflowing of the menses; the whites; hysteric af- fections ; an inflammation, abscess, scirrhus, gangrene, cancer, or ul- cer of the womb, they are generally either barren or subject to abor- tion ; or, if they bring children into the world, they have an universal erysipelas, are half rotten, and covered with ulcers Snch is the catalogue of symptoms attending this dreadful disease in its confirmed state. Indeed they are seldom all to be met with in the same person, or at the same time; so many of them, however, are gen- erally present as are sufficient to alarm the patient; and if he has rea- -on to suspect the infection U lurking in his body, he ought immediate- 3«* A CONFIRMID LUES Iy to set about the expulsion ofit, otherwise the most tragical conse- quences will ensue. The only certain remedy hitherto known in Europe, for the cure of this disease, is mercury, which may be used in a great variety of forms, with nearly the same success.* Some time ago it was reckoned im- possible to cure a confirmed lues without a salivation. This method -s now however pretty generally laid aside, and mercury is found to he as efficacious, or rather more so, in expelling the venereal poison, when administered in such a manner as not to run off by the salivary klands. Though many are of opinion, that the mercurial ointment is as effi- cacious as any other preparation of that mineral; yet experience has taught me to think otherwise. I have often seen the most obstinate venereal cases, where great quantities of mercurial ointment had been used in vain, yield to the saline preparations of mercury. Nor am I singular in this opinion. My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures me, that for some time past he has employ- ed, in venereal cases, a saline preparation of mercury with most happy success. This preparation rubbed with a sufficient quantity of any mild powder, he applies, in small portions to the tongue, where, with a gentle degree of friction, it is immediately absorbed, and pro- duces its full effect upon the system, without doing the least injury to ihe stomach or bowels; a matter of the greatest importance in the ap- plication of this most active and powerful remedy. It is impossible to ascertain either the exact quantity of medicines that must be taken, or the time they ought to be continued, in order lo perform a cure. These will ever vary according to the constitution of the patient, the season of the year, the degree of infection, the time it has lodged in the body, &c. But though it is difficult, as Astruc ob- serves, to determine a prioii, what quantity of mercury will, iu the whole, be necessary to cure this distemper completely; yet it may be judged of a posteriori, from the abatement and ceasing of the symptoms. The same author adds, that commonly not less than two ounces of tha strong mercurial ointment is sufficient, and not more than three or four ounces necessary. The only chemical preparation of mercury which we shall take no- tice of, is the corrosive sublimate. This was some time ago brought in- to use for the venereal disease, in Germany, by the illustrious Barou Van Swieten; and was soon after introduced into Britain by the learn- ed Sir John Pringle, at that time physician to the army. The method of giving it is as follows: One grain of corrosive sublimate is dissolved in two ounces of French brandy or malt spirits; and of this solution, an ordinary table-spoonful, or the quantity of half an ounce, is to be ta- ken twice a-day, and to be continued as long as any symptoms of the disorder remain. To those whose stomach cannot bear the solution, the sublimate may be given inform ofa pill.t Several roots, woods, and bark«, have been recommended for cur- ing the venereal disease; but none of them have been found, upon ex- * The preparation* which I now chiefly use, in the confirmed lues,are oalomel and talcim d mercury. t Tlie sublimate may be given in distilled water, or any other liquid that the patient chooses. I commonly order ten grains to be dissolved in an ounce of the spirit of win'. fortheconTeniencyofcarriage,andlet the patient take twem.j or thirty drops ofit night and morning in huilf a glass of brandy or other spirits. Mr. Debra, au ingenious chemist of this place, informs me, tbat he prepares a salt of mercury mueh more mild and yen'.l- in it) operation than the sublimate, th»ugh equally efficacious. A CONFIRMED LUES. 305 perience, to answer the high encomiums wliich had been bestowed upon them. Though no one of these is to be depended upon alone, yet, when joined with mercury, some of them have been found to be very beneficial in promoting a cure. One of the best we know yet, is sarsaparilla, which may be prepared and taken according to the direc- tions in the appendix * The mezereon-root is likewise found to be a powerful assistant to the sublimate or any other mercurial. It may either be used along with sarsaparilla, as directed in the. Appendix, or by itself. Those who choose to use the mezereon by itself, may boil an ounce of the fresh bark, taken from the root, in twelve English pints of water to eight, adding towards the end an ounce of liquorice. The dose of this is the same as of the decoction of sarsaparilla. We have been told that the natives of America cure the venereal disease, in every stage, by a decoction of the root ofa plant called Lo- belia. »It is used either fresh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it as those of the ranunculous, the caenothus, Sec. but whether these are designed to distinguish or assist it, is doubtful. The patient takes a large draught of tbe decoction early in the morning, and continues to use it for his ordinary drink through the day.t Many other roots and woods might be mentioned, which have been extolled for curing the venereal disease, as the china-root, the roots ot soap wort, burdock, eve. as also the wood of guaiacum and sassafras; but as none of these have been found to possess virtues superior to those already mentioned, we shall, for the sake of brevity, pass them over, and shall conclude our observations on this disease, with a few general remarks concerning the proper management of the patient, and the nature of the infection. GENERAL OBSERVATIONS. The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury, to a person labour- ine under any violent acute disease, as a putrid fever, pleurisy, perm- neumony, or the like. It would likewise be dangerous in some chronic cases • as a slow hectic fever, or the last stage of a consumption. Some- times however, these diseases proceed from a confirmed lues; in which case i't will be necessary to give mercury. In chronic diseases ofa less dangerous nature, as the asthma, the gravel, and snch like, mercury, if necessary, may be safely administered. If the patient's strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored. Mercury ought not to be administered to women during the men- thi, disease-among the natives of America, yet t is generally affirmed that they do cure it withlueed. safety and success, and that without the ImisI knowledge of mercury. Hene ifbtcoms an object of considerable importance to discover their method ot cure. ThU ntelVtsu ely be done by making trials ot' the various plants which ore round in those tituVs and particularly of meh as the natives are known to make use of. All peo- ple in a rude sli tX tlieir medicine, chi. fly rron. th, vegetable k,nSdo,„, a..u are St . nossessed of valuable secrets with r. gard to the virtues of nlants, of vv h.cb more oumi posse sseuui "'"*.' indeed we make no doubt but some plants ot our enughtrned ««»»■"* W£Vakcnacdiscov™ them, would be found £ fficaciou. own growth, ^"P"^.^™''those in America. It must however be mm. abt red, E.tUr&*rill«^ «uauy, willuotalway, be found to hare equal suweis hi another. ^ g si06 *. CONFIRMED LUES strual flux, or when tbe period is near at hand. Neither should il be given in the last stage of pregnancy. If, however, the woman be not near the time of delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual: with these precautions, both the mother and child may be cured -at the same time ; if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sum- < iently recovered, when a more effectual method may be pursued, «hich, if she suckles her child, will in all probability be sufficient for the cure of both. Mercury ought always to be administered to infants with the great- est caution. Their tender conditiou unfits them for supporting a sali- vation, ar.1 makes it necessary to administer even the mildest prepara- tions of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation ; but this, as was formerly observed, is never necessary; besides, we have generally found, that mercury had much less effect upon very old per- sons, than on those who were younger. Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhoea or dysentery, or to frequent and violent attacks of the epilepsy, or who are afflicted with the scrophula, or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails, it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered iu smaller doses, and at longer intervals than usual. The most proper seasons for entering upon a course of mercury, are Ihe spring and autumn, when the air is ofa moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury ; taking care at the same time to keep the patient's chamber warmer or cooler, according as the season of the year requires. The next thing to be considered is the preparation necessary to be Observed before we proceed to administer a course of mercury. Some lay great stress upon this circumstance, observing, that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in tbe blood, not only the mercury will be disposed to act more kindly, but many other inconveniences will be prevented. We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be con- veniently done, the patient ought to bathe once" or twice a-day, for a few days, in lukewarm water. His diet in the mean time must be light, moist, and cooling. Wine, and all heating liquors, also violent bodily exercise, and all great exertions of the mind, is carefully to be avoided. A proper regimen is likewise to be observed by such as are under a course, of mercury. Inattention to this not only endangers the patient's life, but often also disappoints him of a cure A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot A CONFIRMED LUES. •04 •ndure to put the smallest restraint upon his appetites; indeed it but rarely happens that such are thoroughly cured. There is hardly any thing of more importance, either for preventing or removing venereal infection, than cleanliness. By an tarly attention to this, the infection might often be prevented from entering the body; and, where it has already taken place, its effects may be greatly mitiga- ted. The moment any person has reason to suspect that he has recei- ved tlie infection, he ought to wash the parts with water and spirits, sweet-oil, or milk and water; a small quantity of the last may likewise be injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness, is hard to say; but wherever that prevails, the infection is found in its greatest degree of virulence, which gives ground to believe, that a strict attention to clean- liness, would go far towards extirpating it altogether.* When the venereal disease has been neglected, or improperly treat- ed, it often becomes a disorder of the habit. In this care the cure must be attempted by restoratives, as a milk diet, the decoction of sar- saparilla, and such like, to which mercury may be occasionally added. It is a common practice in North-Britain to send such 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 case, and the patient trusts to the whey for finishing bis cure, he will often be disappointed. 1 have frequently known the disease return with all its virulence atter a course of goat whey, even when that course bad been thought quite sufficient for completing the cure. Oue of the most unfortunate circumstances attending patients in this disease, is the necessity they are often laid under of hurrying the cure. This induces them to take medicine too fast, and to leave it off too soon. A few grains more of medicine, or a few days longer confine- ment, would often be sufficient to perfect the cure ; whereas, by neg- lect of these, a small degree of virulence is still left in the humours, which gradually vitiates, and at length contaminates tbe whole mass. To avoid this, we would advise, that the patient should never leave off taking medicine immediately upon the disappearing of the symptoms, but continue it for some time after, gradually lessening the quantity, till there is sufficient ground to believe that the disease is entirely erad- icated. It is not only difficult, but absolutely impossible to ascertain the exact degree of virulence that may attend the disease; for wliich reason it will • I have not only seen a recent infection carried off in a few days by means of clean- liness, viz. bathing, fomentations, injections, 8cc but have likewise lound it of the great- est advantage in the more advanced stages of the disease. Of this I had lately a very remarkable instance, in a man whose penis was almost wholly consumed by venereal ulcers ■ the matter had been allowed to continue on the sores, without an> care having been taken to clean them, till, notwithstanding the use of mercury and other medicines, it had produced the effects above mentioned. I ordered warm milk and water to be in- jected three or four times a-day, into all the sinuous ulc. rs in order to wash out all the rrntter • after which they were stuffed with dry lint to absorb the ir.-sh matter us it was Eene-rated. The patient at the same time took every iiaj. Haifa gran, of tlie corrosive iubli.nate of mercury, dissolved in an ounce of brandy, anddiankan Knglish quart of the de coction of safsaparilla. By this treatment in about »ii « eeks. he was uerfectly cure-d -. and what was very remarkable, a partol the perns was actually r ^.lerated. Doctor Gilchrist has given an account ofa s,.eciesol the lues vet.-re**. Inc.. prevails iu the West of Scotland, to whieh the nat.M s give the name ol Sihbins »r Siwms. The DocrorobserVes, that the spreading of this .ifsease is chiefly owing to the neglect or detuUim-^ml Sms to think, that by due attention to that virtue, u might be e«jr- nated The lVeV.trae.it ol this disease is similar to that ofa continued lues or ..ox. The £nt?,a disease How very common both iu America and the Wot-lndu islands, may also be cured iu the same maimer. SOS DISEASES OF WOMEN. always be a much safer rule to continue the use of medicine too lon», than to leave it off too soon. This seems to be the leading maxim of a modem practitioiierof some note for the venereal disease, who always orders his patient to perform a quarantine of at least forty days, du- ring which time he takes forty bottles of, I suppose, a strong decoction of sarsaparilla, or some other anti-venereal simple. Whoever takes this method, and adds a sufficient quantity of corrosive sublimate, or some other active preparation of mercury to the decoction, will seldom fail tocure a confirmed lues. It is peculiarly unfortunate for the cure of this disease, that not one in ten of those who contract it, are either able or willing to submit to a proper plan of regimen. The patient is willing to take medicine; but he must follow his business, and to prevent suspicions, must cat and drink like the rest of the family. This is the true source of nine tenths of all the mischief arising from the venereal disease. I never knew the cure attended with any great difficulty or danger where the patient strictly followed the physician's advice ; but a volume would not he sufficient to point out the dreadful consequences which proceed from an opposite conduct. Scirrhus testicles, ulcerous sore throats, mad- ness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source. There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution con- tracts a slight degree of the disorder. He gets well without taking any .great care, or using much medicine, and hence concludes that this will always be the case. The next time the disease occurs ; though ten times more virulent, he pursues the same course, hnd his constitution is ruined. Indeed, the different degrees of virulence in the small-pox are not greater than in this disease, though as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ignorant old woman cannot kill the patient in that dis- order. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal contagion, after it has got into the habit. In this case a proper course of medicine is always indispensibly necessary. Although it is impossible, on account of the different degrees of virn- lence &c. to lay down fixed and certain rules for the cure of this dis- ease vet the following general plan will always be found safe, and often successful, viz. to bleed and administer gentle purges with diuretics during the inflammatory state,and as soon as the symptoms of inflam- mation are abated, to administer mercury, in any form that maybe most agreeable to the patient. The same medicine, assisted by the de- coction of saisaparilla, and a proper regimen, will not only secure the constitution against any further progress ofa confirmed pox, but will generally perform a complete cure. CHAPTER L. DISEASES OF WOMEN. WOMEN in all civihzed nations, have the management of domestic affairs, and it \- very proper they should, as Name has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far ; and feinaii s instead of being bene- fited by it, are greatly injured from the waut of exercise and free air. OF THE MENSTRUAL DISCHARGE. 30J To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though Nature has made an evident dis- tinction between tbe male and female with regard to bodily strength and vigour, yet she certainly never meant,either that the one should be always without, or the other always within doors. The confinement of females, besides hurting their figure and complex- ion, relaxes their solids, weakens their minds, and disorders all the func- tions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical aud ridiculous. A sound mini depends so much upon a healthy body that where the latter is wanting, the former is rarely to be found. I have always observed that women who were chiefly employed without doors in the different branches of husbandry, gardening, and the like, were almost as hardy as their husbands, and that their chil- dren were likewise healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shewn, we shall pro- ceed to point out those circumstances in the structure and design of females, which subject them to peculiar diseases ; the chief of which are their monthly evacuations, pregnancy, and child-bearing. These in- deed cannot properly be called diseases, but from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities. OF THE MENSTRUAL DISCHARGE. FEMALES generally begin to menstruate about the age of fifteea, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this discharge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and happiness of the female de- pends in a great measure upon her conduct at this period.* If a girl about this time of life be confined to the house, kept con- stantly sitting, and neither allowed to romp about, nor employed in ■ny active business, which gives exercise to the whole body,she be- comes weak, relaxed, and puny ; her blood not being duly prepared, she looks pale and wan ; her health, spirits and vigour decline, and she sinks iuto a valetudinarian for life. Such is the fate of numbers of those unhappy females, who either from too much indulgence, or their own narrow circumstances, are, at this critical period, denied the bene- fit of exercise and free air. A lazy indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstructions among the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eateu up by the chlorosis, or ^reen sickness, and other diseases of this nature. We would therefore recommend it to all who wish to escape • It is the duty of mothers, and those who are entrusted with the education of girls, to instruct them early in the conduct and management of themselves at this critical period of their lives. False modesty, inattention and ignorance of what is beneficial or hurtful at this time, are the sources of many diseases and misfortune! in life, which a few si nsilile lessons from an e\p< rienced matron might have prevented. Nor is care less necessary in the- subsequent returns of this discharge. Taking imprope-r food, violent affections of the mind.orcathi.igcoldat this |>,-riod, is often sufficient to ruin the health, or to render the female ever afte r incapable of procreation. 319 OF THE MENSTRUAL DISCHARGE. these calamilities, to avoid indolence and inactivity, as their greatest enemies, and to be as much abroad in tbe open air as possible. Another thing which proves very hurtful to girls about this period of life, is unwholesome food. Fond of all manner of trash, they often in- dulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. Accordingly we find ; that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the menses, but likewise to glandular obstructions ; as the scrophula, or king's evil, &c. A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature, proves the very prey of va- pours and hysterics. Youth is the season for mirlh and cheerfulness. Let it therefore be indulged. It is au absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age.—While, therefore, wise Nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp, with serious gloom, the (season destined to mirth and innoeent fes- tivity. Another thing very hurtful to females about this period of life, is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeez- ing the stomach and bowels, they hurt tbe digestion, and occasion many incurable maladies. This error is not indeed so common as it has been; but, as fashions 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 direful effects of that wretched custom which prevail- ed some years ago, of squeezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to health. After a female has arrived at that period of life when the menses usu- ally begin to flow, and they do not appear, but on the contrary, her health and spirits begin to deline, we would advise, instead of shutting the poor girl up in the bouse, and dosing her with steel, asafretida, anil other nauseous drugs, to place her in a situation where she can enjoy the benefit of fresh air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner ; and we have little reason to fear, but nature, thus assisted, will do her proper work.1" Indeed the seldom fails, unless where the fault is on our side. This discharge in the beginning is seldom so instantaneous as to sur- prise females unawares. It is generally preceded by symptoms which foretel its approach ; as a sense of heat, weight, and dull pain iu the loins ; distension and hardness of the breasts ; head-ach; loss of appe- tite; lassitude; paleness of the countenance; and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoid- ed which may obstnict that necessary and salutary evacuation , and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c. After the menses have once begun to flow, the greatest care should he taken to avoid every thing that may tend to obstruct them. Fe- OF THE MENSTRUAL DISCHARGE. 3lt wales 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 sour on the stomach ought to be avoided; as fruit, butter milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disa- gree with individuals at this time, we would recommend it to every fe- male to be very attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the sex date their diseases from colds, caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not in the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution. The greatest attention. ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable. From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this purpose we would recommend sufficient exercise, in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine. When obstructions proceed from a weak relaxed state of the solids, inch medicines as tend to promote digestion, to brace the solids, and assist tbe body in preparing good blood, ought to be used. The princi- pal of these arc ii ou and the Peruvian bark, with other bitter and as- tringent medicines. Filings of iron may be infused'in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks it may be filtered, and about half a wine glass ofit taken twice a-day: or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a- day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the patient. When obstructions proceed from a viscid state of the blood; or from women ofa gross or full habit, evacuations, and such medicines as at- tenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink sliould be whey, water, or small beer ; and she ought to take sufficient exercise. A tea-spoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water. When obstructions proceed from affections of tbe mind, as grief, tear, anger, Sec. every method should be taken to amuse and divert the pa- tient. And .hat she may the more readily forget the cause of her afflic- tion, she ought, if possible, to be removed from the place where it hap- pened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females m this situation, is also of the last importance. An obstruction of the menses is often the effect of other maladies. «12 OF THE MENSTRUAL DISCHARGE. When this is the case, instead of giving medicines to force that dis- charge, which might be dangerous, we ought by all means to endeavour to restore the patient's health and strength. When that is effected, the other will return of course. But the menstrual flux may be too great as well as too small. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, and cedematous swellings of the feet, dropsies and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted, high seasoned, or acrid food; the use of spirituous liquors ; ex- cessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, Sec. The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient's regimen, an oppo- site course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flux, and coun- teract the morbid affections of the system from whence it proceeds. To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed, with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of nettle-roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astringents may be used, as Japan earth, alum, elixir of vitriol, tbe Peruvian bark, &c* The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale, yellow, green, or of a blackish colour; sometimes it is sharp and corrosive, sometimes foul and foetid, Sec. It is attended with a pale complexion, pain iu thi back, loss of appetite, swelling of the feet, aud other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet. To remove this disease, the patient must/ take as much exercise at she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret mixed with Pyrmont, Bristol, or lime-water. Tea and coflee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is necessary, we know none preferable to the Peruvian bark, which in this case ought always to be taken in substance. Iu warm weather the cold bath will be of considerable service. Tl it period of life at which the menses cease to flow, is likewise very eritica to the sex. The stoppage of any customary evacuation, how- ever small, is sufficient to di order the whole frame, and often to de- stroy life itself. Hence it comes to pass, that so many women either fall * Two drachms of alum and on.- of Japan earth may be pounded together, and di\ ided into eight or nine doses, one of which nay b taken three times a-day. Person* whose stomachs cannot beat the alum miy take ' .\o table-spoonsful of the tinctun of roses three or four times a-day, to each tUi>u of whie-h ten drops of laudanum da. • e aud d li tnese should I'uil. half a drichmo."tlie Peruvian bark, in pou der, \. ith tea drops of the elixir of vitriol may be t*h.t.n in a glass of red w ine, four units a-day. OF PREGNANC\. j\3 j into chronic disorders, or die about this time. Such of them, however, as survive it, witliout contracting any chronic disease^ often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age. I If the menses cease all ofa sudden in women of a full habit, they ought "I to abate somewhat of their usual quantity of food, especially of the jj more nourishing kind, as flesh, eggs, &c. Tl;«y ought likewise to take j sufficient exercise, and to keep the body open. This may be done hy 1 taking once or twice a weok, a little rhubarb, or an infusion of hiera picra in wine or brandy. i It often happens that women ofa gross habit, at this period of life Imve ulcerous sores break out about their ancles, or in other parts of the body. Such ulcers ought to be considered as critical, and should .. *"' either be suffered to continue open, or have artificial drains substituted in tlieir stead. Women who will have snch sores dried up, are often j toon after carried off by acute diseases, or fall into those ofa chronic nature. OF PREGNANCY. j THOUGH pregnancy is not a disease, yet that state is often attend- ed with a variety of complaints which merit attention, and which some- times require tlie assistance of medicine. Some women indeed are more healthy during their pregn&ncy than at any other time ; but this ' is by no means the general case: most of them breed in sorroiv, and are frequently indisposed during the whole time of pregnancy. Few fatal diseases, however, happen during that period ; and hardly any, except abortion, that can be called dangerous. We shall therefore pay par- ticular attention to it, as it proves generally fatal to the child, and '' sometinies to the mother. Pregnant women are ofteii afflicted with the heart-burn. The meth- od of treating this complaint has been already pointed out. They are likewise, in the more early periods of pregnancy, often harassed with sickness and vomiting, especially in the morning. Tlie method of re- lieving these complaints has also been shewn. Both the head-ach and tooth-ach are very troublesome symptoms of pregnancy. The former may generally be removed by keeping the hotly gently open, by the use of prunes, figs, roasted apples, and such like. V. lien the pain is very violent, bleeding may be necessary. For the treatment of the latter, we must refer to that article. Several other complaints inci- dent to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and' incontinency of urine, Sec. ;sbut as all of these have been taken notice of before, it is needless to repeat them. Every pregnant women is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weak- ens the constitution, but renders the woman liable to the same misfor- tune afterwards.* Abortion may happen at any period of pregnancy, but it is most common in the second or third month. Sometinies, however, it happens in the fourth or fifth. If it happens within the first month it is usuallv called a false conception ; if after the seventh month, the child may often be kept alive by proper care. • Everv mother who procures an abortion does it at the haaard other life; yet there are not a few who run this risk merely to prevent the trouble of bearing and bringing up children. It is surely a most unnatural crime, and cannot, even in the most aban- doned be viewed without horror; but in the decent matron, it is still more unpardona- ble.—Those wretches who daily advertise their assistance to women in this business,de- serve, in my opinion, the most severe of all human punishments. D d 314 OF CHILD-BIRTH. The common causes of abortion are, the death of the child ; weak- ness or relaxation of the mother; great evacuation*; violent exercise; raising great weights; reaching too high ; jumping or stepping from an eminence; vomiting; coughing-, convulsion fits; blows on the belly; falls; fevers; disagreeable smells; excess of blood; indolence; high living, or the contrary ; violent passions or affections of the mind, as fear, grief, ..Vc. The signs of approaching abortion are, pain in the loins, or about the bottom of the belly ; a dull heavy paiu iu the insitle of the thigh; a slight degree of coldness, or shivering; sickness, palpitation of the heart; the breasts become flat and soft; the belly falls; and there is a discharge of blood or watery humours from the womb. To prevent abortion, we would advise women ofa weak or relaxed , habit to use solid food, avoiding great quantities of tea, and other weak and watery liquors; to rise early and go soon to bed; to shun damp houses ; to take frequent exercise in the open air, but to avoid fatigue; and never to go abroad in damp foggy weather, if they can ilmn it. Women ofa full habit ought to use a spare diet, avoiding strong li- qours, and every thing that may tend to heat the body, or iucrcase the quantity of blood. Their diet should be of an opening nature, consist- mg principally of vegetable substances. Every woman with child ought to be kept cheerful and easy in her mind. Her appetites,even though •kpraved, ought to be indulged as far as prudence will permit. When any signs of abortion appear, the woman ought to be laid in hed tn a mattress, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oat-meal, and the like, all of wliich •ught to be taken cold. If she be able to bear it, she should lore at least half a pound of blood from the arm. Her drink ought to be barley-water sharpened with juice of lemon ; or she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the woman be reized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected with vomiting, let her take frequently two table-spoonsful of the saline mixture. In gen- eral, opiates are of service; but they should always be given with caution. Sanguine robust women, who are liable to miscarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape.that misfortune. , Though we recommend duo care for preventing abortion, wc would not be understood as restraining pregnant women from tlieir usual exer- cises. This would generally operate a quite contrary way. Want of exercise not -,6nly relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of a- bortion. There are, however, some women of so delicate a texture, that it is necessary for them to avoid almost every kind of exercise during the whole period of pregnancy. OF CHILD-BIRTH. MANY diseases proceed from the want of due care in child-bed ; and the more hardy part of the sex arc most apt to despise the necessary precautions in this state. This is peculiarly the cast with young wives OF CHILDBIRTH. S15 They think, when the labour-pains are ended, the danger is over ; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fcetua ; but proper care and management are certainly necessary for the recovery of the mother. No doubt mis- chief may be done by too much as we; 1 as by too little care. Hence females who have the greatest number of attendants in child-bed ™t ne- rally recover worst. But this is not peculiar to the state of child-bed. Excessive care always defeats its own intention, and is geuerally nioi't. dangerous than none at all.* Duringactual labour, nothing ofa heating nature ought to bo given. The woman may now and then take a little panada, and her drink ought to be toast and water, or thin groat gruel. Spirits, wines, cordial-wa- ters, and other things which are given with a view to strengthen the mo- ther, and promote the birth, f». the most part, tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endan- ger tlie woman afterwards, as they often occasion violmt and mortal haemorrhages, or dispose her to eruptive ami other fevers. When tiie labour proves tedious and difficult, to prevent inflamma- tions, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered ; and the patient sliould sit over tlis steams of warm water. The passage ought to be gently rubbed with a little soft pomatum or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is great- ly exhausted with fatigue, a draft of generous wine, or some other cor- dial, may be given, but not otherwise. These directions are sufficient in natural labours ; and in all preternatural cases, a skilful surgeon or man-midwife, ought to he called as soon as possible. After delivery, the woman ought to be kept as quiet and easy as pos- sible.t Her food should be light and thin,as gruel, panada, &c. and her drink weak and diluting. To this rule, however, there are many ex- ceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors ; to such, a glass of wine and a bit of chicken must be allowed. Sometimes an excessive haemorrhage or flooding happens after' dcliv- eiy. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flux of the menses it"the flooding proves violent, linen cloths, which have been wrung out ofa mixture of equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thighs: these must be changes as they grow dry ; aud may be discontinued as soon as the flooding abates.} • Though the manage ment of women in cliild-brd has been practised as as ernploy- ment since the earliest V.ccounts of time; yet it is still in most countries on a very bad footing. Few women think of following this employment till they are reduced to the necessity ol doing it for bread. Hence not one in an hundred of them have any educa- tion, or proper knowledge of their business. It i« true, that Nature, if left to herself, will re-ni railI v expe 1 the feet us ; but it is equally true, that most women in child-bed require lo be- managed with skill andattention.and tliat they are often hurt by the superstitious prejudices of ignorant and officious midwives. The mischief done in this way is much rreater than is eeiie-rnlly imagined; most of which might be prevented by allowing no , to practise midwife.v but such as are properly qualified. Were due attention this.it would not only be the means of saving many lives.but would prevent the woman I Darts or the euuntrv, of collecting a numocrui vuiukml^^ukx w... »«". «,s.s...---- Thes, inst-uil oi'belli* useful,serve only to crowd the IfcWse, and obstruct tbe necessar, attend.'-1' He-side they luat the patient with their noue: UndoAeD, by their uuUme- sic - OF CHILD BIRTH. If there be violent pains after delivery, the patient ought to drink plentifully of warm diluting liquors, as gruel, or tea with a little saffron in it; and to take small Lroths, with carraway-seeds, or a bit of an orange-peel in them ; an ounce'of the oil of sweet almonds may like- wise be frequently taken in a cup of any of the above liquors ; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink. If she be hot or feverish, one of thefollowing powders may be taken m a cup of her usual drink every five or six hours.* An inflammation of the womb is a dangerous and not unfreqnent dis- ease after delivery. It is known by pains in the lower part of the bel- ly, which are greatly increased upon touching; by the tension or tight- ness cf the parts; treat weakness ; change of countenance ; a constant •ever, with a weak and hard pulse-, a slight delirium or ravin? ; some- iiines incessant vomiting ; a hiccup; a discharge of reddish, stink- ing, sharp water from the womb ; an inclination to go frequently to .stool: a heat,ar.dsometimes total suppression ol'urine. This must be treated like other inflammatory disorders, by bleeding find plentiful dilution. The drink may be thin gruel or barlty water; in a cup of wliich halfa drachm of nitre may be dissolved, and taken rhreeor four limes a-day. Clysters of warm milk and watt r must be frequently administered ; and the belly should be fomented by cloths .vrnng out of warm water, or by applying bladdersfilled w ith warm milk and water to it. A suppression of the lochia, or usual discharges after delivery, and ihe milk-fever, must be treated nearly in the same manner as an inflam- mation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacuations, and fomentations of the.parts affected. In the milk-fever, the breasts may be embrocated with a little warm lin« eed-oil, or the leaves of red cabbage maybe applied to them. The child should be often put to the breast, or it should be drawn by some other person. • Nothing would tend more to prevent the milk-fever than putting Jgf'e child early to the breast. The custom of not allowing children to •uck for the first two or three days, is contrary to nature, and common ense, and is very hurtful both to the mother and child. Every mother who has milk In her breasts, ought either to suckle her own child, or to have her breasts frequently draw n, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed. When an inflammation happens in the breast, attended with redness, hardness, and other symptoms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to suppuration. The use of repellents, in this case, is very dangerous; they often occasion fevers, and sometimes cancers ; where- Mixture: Take of penny-royal watev,simple cinnamon-water, and syru p of poppies, each two ounces, elixir of vitriol a drachm. Mix, and take two table spoonsful every two hours, or oftener, if necessary. * Takeof crabs' claws prepared ha If an ounce, purified nitre two drachms, saffron powdered halfa drachm; rub them together in a mortar, and divide the whole into eight or nine doses. When the patient is low spirited,or troubled with hysterical complaints, she ought votakefrequenth twelve or fifteen drops of the tiuaturc ofixafcet'da io ■> cup ot'pos- T-royal tea. Or CHILD-BIKTH. SI 7 as a suppuration is seldom attended with any danger, and has often tht most salutary effects. When the nipples are fretted or chapt, they may be anointed with a mixture of oil and bees-wax, or a little powdered eum-arabic may be sprinkled on them. I have seen Hungary-water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cool- ing purge may be given, which generally removes it. The mili try fever is a disease incident to women in child-bed ; but ks it has been treated of already, we shall take no further notice of it. The celebrated Hoffman observes, that this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar $ not forget- ting to bleed in the first months, and to avoid all sharp air. When tht labour is coming on, it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken after the birth, that the natural excretions proceed regularly ; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be admin- istered. The most fatal disorder consequent upon delivery is the peurperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Sometimes indeed it comes on sooner, and at other times, though rarely, it does not appfear before the fifth or sixth day. It begins like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at the sto- mach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips and region of the womb ; a sudden change in the quantity or quality of the lochia also takes place ; and the patient is frequently troubled with a tenesmus, or con- stant inclination to go to stool. The urine, which is very high colour- ed, is discharged in small quantity, and generally with pain. The bel- ly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the te.er has continued for a few days, the symptoms of inflammation usually subside, and the dis- ease acquires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future pro- gress. There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric con-tiu;- tions, bleeding will generally be proper at the beginning; it ought, however to he used with caution, and not to be repeated unless where the signs of inflammation rise high ; in which case it will also be ne- cessary to apply a blistering-plaster to the region of the womb. During tlie rigour, or cold fit, proper means should be used to abate its violence, and shorten its duration. For this purpose the patieut may drink freely of warm diluting liquors, and, if low, may take now and tiKT.acup of wine vhey ; warm applications to the extremities, as heated mcks, bottles or bladders filled with warm water, and such like, may also be used with advantage. Dd2 3; 8 OFCHILD-BlRTli Emollient clysters of milk and water, or of chicken water, ou^m t» be frequently administered through the course of the disease. These prove beneficial by promoting a discharge from the intestines, and al- *o by acting as a kindly fomentation to the womb and parts adjacent. Great care however is requisite in giving them, on account of the ten- derness of the parts in the pelvis at this time. To evacuate the offending bile from the stomach, a vomit is general- ly given. But as this is apt to increase the irritability of the stom- ach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, and to pro- cure a free discharge of the bile* The medicine which I have always found to succeed best in this disease, is the saline draught. This, if frequently repeated, will of- ten put a stop to the vomiting, and at the same time lessen the vio- lence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally lie added. If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require ; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these tail, recourse must be had to Coluin- bo-root, or some other strong astringent. Though in general the food ought to be light, and the drink diluting, yet when the disease has been long protracted, and the patient is great- ly spent by evacuations, it will be necessary to support her with nour- ishing diet, and generous cordials. It was observed that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in de- coction or infusion mixed with the tincture of roses, or other gentle astringents; or a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every se- cond, third, or fourth hour, as shall be found necessary. When the stomach will not bear any kind of nourishment, the pa- tient may be supported for some time by clysters of beef-tea, or ehicken-water. To avoid this fever, every woman in child-bed ought to be kept per- fectly easy; her food should be light and simple, and her bed chamber cool, and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have, her body bound too tight, nor to rise too soon from bed after de- livery ; catching cold is also to be avoided; and a proper attention sho'.id be paid to cleanliness. To prevent the milk-fever, the breasts ought frequently to be drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to prevent the nu.k from becoi.-ing acrid and its being absorbed in this state Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet. ' « Midwives ought to be very cautious in a.lministering vomits or purges to women kxchild-bed. 1 have known a woman who was recovering extremely well, thrown into the most imminent danger, by a strong purge whick was given her by aa officious ■Mdwifr. 4 OF BARRENNESS. 319 We shall conclude our observations on child-bed women by recom- mending it to, them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often con- tract diseases from cold, of wliich they never recover. It is a pity the poor are not better taken care of in this situation. But the better sort of women run the greatest hazard from too much lirat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to sec company. The danger of this conduct must be obvious to every one. The superstitious custom of obliging women to keep the house till they go to church, is likewise a very common cause of catching cold. All churches are damp, and most of them cold ; consequently they are the very worst places to which a woman can go to make her first visit, after having been confined in a warm room for a month. OF BARRENNESS. Barrenness may be very properly reckoned among the diseases of females, asfew married women who have not children enjoy a good state of health. It may proceed from various causes, as high living, grief, re- laxation, Sec. but it is chiefly owing to an obstruction or irregularity of the meustrual flux. It is very certain that high living vitiates the humours, and prevents fecundity. We seldom find a barren woman among the labouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in proportion to their poverty ; and it would be an easy matter to adduce many instances of women, who, by being reduced lo live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food aud exercise as the better sort of peasants, they would seldom have cause to envy their poor vas-als and dependants, the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their extensive domains. Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids ; a state highly unfavour- able to procreation. To remove this, we would recommend the fol- lowing course; First, sufficient exercise in the open air; secondly, a diet consisting chiefly of milk and vegetables * thirdly, the use of astringent medicines, as steel, alum, dragon's blood, elixir of vitriol, the Spaw or Tunbridge waters, Peruvian bark, Sec.; and lastly, above all, the cold bath. „•*-...<• Barrenness u often the consequence of grief, sudden tear, anxiety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of tin mind the person ought to be kept as easy and cheerful as possible; all disa- greeable objects are to be avoided, and every method taken to amuse and entertain the fancy. • Dr. Chevne avers, that want of children is oftener the fault of the male than or the female' and strongly recomn.. nds a milk and v^- .ablediet i, the tonne,- a, «e 1 as the r ' j r . .i.«f l,ii fpii-nd Dr. lavlor, whinn !!• culls tin MiIk-J. et-r ■! Cro..lon, ^l^t^no^^H,^ Ms neighbourhood, who ban continued ,oi£ tl„telmlvk*&MMinogcuy,to have s veral hue chi*r.u, u, iwep.-S both parent., for aconsiderable time, to a milk aud vegetable diet. 520 DISEASES OF CHILDREN. CHAPTER M. D1SFASES OF CHILDREN. MISERABLE indeed is the lot of man in the state of infancy ! FI« comes into the world more, helpless than any other animal, and stands much longer iu need of the protection and care of his parents; but, alas ! this care is not always bestowed upon him ; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.* It must be obvious to every attentive person, that the first din-as. s of children arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are iu a manner poisoned with indigestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be considered as a poison ; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death. As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to expel it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may he mixed in two table-spoonsfu^of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates ; or, w hat will more certainly aiia« er the purpose, a grain of emetic tartar may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are willing to use the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Smali doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred. These medicines will not only cleanse the stomach, but will gene- rally likew ise open the body. Should this however not happen, and if the child be costive, some gentle purge will be necessary; for this purpose, some manna and pulp of cas.aa may be dissolvedin boiling wa- ter, and given in small quantities till it operates ; or, what will ai.svver rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and continued till it has the desired effect. If these medicines be properly administered, and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bow- els from which infants suffer so much. These general directions include most of what can he done for re- lieving the internal disorders of infants. They will like wise go a con- * Of the officious and ill-judged care of midwives, we shall adduce only one instance, viz. the Cu*iimwi practice ol uriuringinftuits by squeezing then breasts, to draw off tlie milk as they eall it. Though a small quantity of moisture is generally found in the breasts of infarts, yet as they are certainly not i.nendi d to giic- suck, this ought never to be drawn <> .'. Ihave seen this cruel op.-ration bring on hardti.-s>, ii.flan mation, and iuppuratio'i i'the breasts ; but never knew i.ny ill consequences from its :*-iiig n...ilted. When the iii-easti an-hard, the only application that we womd re-commend, i> a soft puulu.e, or a little ofth.-diachylon plaster, spit ail thin upon a bit of sot) leather, nbout tbe siteoi'hah a ■ .-own, ami applied over each nipple. The*c may be suffered to om- aiyxc tiU the hankies disappears. THE APHTH/E. 321* sitleiable way in alleviating those which appear externally, as the rash, gum, or fellon, Sec. These, as was formerly observed, are princi- pally owing to too hot a regimen, and consequently will be most effect- ually relieved by gentle evacuations. Indeed evacuations of one kind or other, constitute a principal part of the medicine of infants, and will seldom, if administered with prudence, in any of tlieir distav. 3, fail to give relief. OF THE MECONIUM. The stomach and bowels ofa new-born infant are filled with a black- ish coloured matter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of nature ; in which case it is not necessary to give the iufan* any kind of medicine. But if it should be retained, or not sufficiently carried off, a little manna or magnesia alba may be given as mentioned above ; or, if these sliould not be at hand, a common spoonful of whey, sweetened with a little honey, or raw sugar, will answer tlfc purpose. The most proper medicine for expelling the meconium is the mo- ther's milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they shew an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium: but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats. OF THE APHTHA:, OR THRUSH. THE aphthae are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and 3tomach of infant;. Sometimes they reach through the whole intestinal canal ; in which case they arc very dangerous, and often put an end to the infant's life. If the aphthae are of a pale colour, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous ; butifopake, yellow, brown, black, thick, or running together, they ought to be dreaded. It is generally thought that the aphtha? owe tlieir origin to acid hu- mours ; we have reason however to believe, that they are more fre- quently owing to too hot a regimen both of the mother and cfilld. It is a rare thing to find a child who is not dosed with wine, punch, cin- 1 namon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion inflammatory . disorders even in adults : is it any wonder then that they should heat and inflame the tender bodies of infants, and set as it where the whole constitution in a blavc * The most proper medicines for the aphtha? are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhu- barb and half a drachm of magnesia alba may be rubbed together, and divided into six doses, one of which may be given to the infant every feiurorfive hours till thev operate. These powders may either be given in the child's food, or a little of the syrup of pale roses, and may be repeated as often as is found necessary to keep the body open. It is common in this case to administer calomel ; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution. . . - .. .. j Manv things have been recommended for gargling the mouth and throat in this disease ; but it is not easy to apply these in very young childeu • we would therefore recommend it to the nurse to rub the 322 OP GALLING AND EXCORIATION. child's mouth frequently with a little borax and honey ; or with the following mixture: Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose water two drachms; mix them together. A very proper application in this case, is the solution of ten or twelve grains of white vitriol in eight ounces of barley-water. Tlicse may be applied with the finger, or by means ofa bit of soft rag tied to the end ofa probe. OF ACIDITIES. THE food of children being for the mo.-t part of an acescent nature, it readily turns sour upon the stomach, t specially if the body be any way disordered. Hence most diseases of chil.lien are accompanied with evident signs of acidity, as green stools, gripes, &c. Tlicse ap- pearances have induced many to believe, that all the diseases of chil- dren were owing to an acid abounding in the stomach and bowels ; but whoever considers the matter attentively, will find that these symp- toms of acidity are oftener the effect than the cause of their dis- eases. Nature evidently intended that the food of children should be aces- cent ; and unless the body be disordered, or the digestion hurt, from some, other cau«c, we will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, however, is often a symptom of disorders in children, and, as it is sometimes a troublesome one, we shall point out the method of relieving it. When green stools, gripes, purging, sour smells, &c. shew that the bowels abound with an acid, let the child have a little small broth, with liuht white bread in it; and it should have sufficient exercise in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs' eyes, and other testaceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, wliich may prove very hurtful to the infant. For this reason they should never be given un- less mixed with purgative medicines: as rhubarb, manna, and such like. The best medicine which we know in all cases of acidity, is that fine insipid powder called masmsia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may b?. given in any kind of food, or in a mixture, as recommended in the Appendix.* When an infant is troubled with gripes, it ought not at first to bo dosed with brandy, spiceries, and other hot things; but should have its body opened with an emollient clyster, or the medicine mentioned above ; and at the same time a little brandy may be rubbed on its bel- ly with a warm hand before the fire. I have seldom seen this fail to ease the gripes of infants. If it should happen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoonful ofit given frequently till the infant be easier. Sometimes a little peppermint water will answer this pur- pose very well. • GALLING AND EXCORIATION. THESE are very troublesome to children, 'flay happen chiefly a bout the groin and wrinkles of the neck, under the arms, behind the cars, and in other parts that are moistened by the sweat or urine. As these complain'.s are, in a great measure, owing to want of e'eas- • S»e Appendix, Laxative p\orbtnt Mixture, OF VOMITING. iU finess, the most effectual means of preventing them, are, to wash the parts frequently with cold water, to change the linen often, aud, in a word, to keep the child in all respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with ab- sorbent or drying powders; as burnt hartshorn, tutty, chalk, crabs' claws prepared, and the like. When the parts affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders; or to anoint the place with the camphorated oint- ment. If the parts be washed with spring-water, in which a little white vitriol has been dissolved, it will dry and heal them very pow- erfully. One of the best applications for this purpose, is to dissolve some fuller's earth in a sufficient quantity of hot water; and after it has stood till it is cold, to rub it gently upon the galled parts, once or twice a-day. . STOPPAGE OF THE NOSE. THE nostrils of infants are often plugged up with a gross mucus, wliich prevents their breathing freely, and likewise renders it difficult for them to suck or swallow. Some in this case order, after a suitable purge, two or three grains of white vitriol dissolved in half an ounce of marjoram-water, and filtered, to be applied now and then to the nostrils with a linen rag. Wedclins says, If two grains of white vitriol, and the same quantity of elalerium, be dissolved in half an ounce of marjoram-water, and appli- ed to the nose, as above directed, that it brings away the mucus without sneezing. In obstinate cases these medicines may be tried; but I have never found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free.* OF VJOMITING. FROM the delicate state of children, and the great sensibility of their organs, a vomiting or looseuess may be induced by any thing that irri- tates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood, than m the more advanced peri- ods of life. Thev are seldom however, dangerous, and ought never to be considered as'diseases, unless when they are violent, or continue Sto long as to exhaust the strength of the patient. „,,.-,. Vomiting may be excited by an over-quantity of food ; by food that is of such a nature as to irritate the nerves of the stomach too niuoh; or by the sensibility of the nerves being so much increased as to reuder them unable to bare the stimulus of even the mildest element. When vomiting is occasioned by too much food, it ought to be pro- moted, as the cure will depend upon cleansing the stomach. Tins may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it « owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a milder nature substituted in its stead. When vomiting proceeds from an increased degree ef sensibility, or too great an irritability of the nerves of the stomach, snch medicines as have a tendcucy to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answer- m^clZ^^^ ucouraginc the practice 3«i OF ERUPTIONS. ed by a slight infusion of the Peruvian bark, with the addition of a little - rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may be occasionly added. In obstinate vomitings the operation of internal medicines may be as- sisted by aromatic fomentations made with wine, applied wann to the pit of the stomach; or the use of the stomach-plaster, with the addition of a little Theriaca. OF A LOOS EN ESS. A LOOSENESS may generally be reckoned salutary when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and waters-^ ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappeared. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours, which would otherwise tend to relax the habit. As the principal intention of the cure of a looseness is to evacuate the offending matter, it is customary to give the patient a gentle vomit of ipecacuanha, and afterwards to-exhibit small and frequent doses of rhubarb ; interposing absorbent medicines, to mitigate the acrimony of the humours. The best purge, however, in this case, is magnesia alba. It is'at the same time absorbent and laxative, and operates without ex- citing gripes. The antimonial wine, which acts both as an emetic and purge, is also an excellent medicine in this case. By being diluted with water, it : may be proportioned to the weakest constitution ; and, not being dis- agreeable to the palate, it may be repeated as often as occasion re- '., quires. Even one dose will frequently mitigate the disease, and pave the way for the use of absorbents. If, however, the patient's strength will permit, the medicine ought to be repeated every six or eight ; hours, till the stools begin to assume a more natural appearance ; af- terwards a longer space may be allowed to intervene between the dos- es. When it is necessary to repeat the medicine frequently the dose ought always to be a little increased, as its efficacy is generally dimin- ished by use. Some upon the first appearance ofa looseness, fly immediately to the use of absorbent medicines and astringents. If these be administered before the offending humours are discharged, though the disease may appear to be mitigated for a little time, it soon afterwards breaks forth with greater violence, and ofttn proves fatal. After proper evacua- tions, however, these medicines may be administered with considerable advantage. Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of poppies may be given in a little simple cinnamon-water, three or four times a-day, till these symptoms have ceased. OF ERUPTIONS. CHILDREN, while on the breast, are seldom free from eruptions of onekiud or other. These, however, are not often dangerous, and ' ought never to be dried up* but with the greatest caution. They tend to free the bodies of infants from hurtful, humours, which, if retained, might produce fatal disorders. The eruptions of children are chiefly owing to improper food and neglect of cleanliness. If a child be stuffed at all hours with food that OF ERUPTIONS. 323 » its stomach is not alrle to digest, such food, not being properly a simi- laled, instead of nourishing the body, fills it with gross humours. These must cither break out in form of eruptions upon the skin, or re- main in the body, and occasion fevers and other internal disorders That neglect of cleanliness is a very general cause of eruptive disor- ders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to 'warm with vermin, and arc generally covered with tlie scab, itch, and other erup- tions. When eruptions are the effect of improper food, or want of cleanli- ness, a proper attention to these alpne will generally be sufficient to re- move them. If this should not be the ease, some drying medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cold' is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sul- phur, provided it be prudently used. A little of the flour of sulphur may be mixed with fresh butter, oil, or hog's lard, and the parts affected frequently touched with it.* The most obstinate ofall the eruptions incident to children, are the tinea capitis, or scabbed head, and chilblains. The scabbed head is of- ten exceeding difficult to cure, aud sometimes indeed the cure proves worse than the disease. I have frequently known children seized w i tli internal disorders, of which they died soon after their scabbed heads had been healed by the application of drying medicines.t The cure ought always first to be attempted by keeping the head very clean, c lifting off the hair, combing and brushing away the scabs, Sec. If this is not sufficient, let the head be shaved once a week, washed daily with soap snds, aud gently anointed with a liniment made of train oil i ight ounces, red precipitate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, or sprinkled with a little burnt alum. While these things are doing, tbe patient must be confined to a regular light diet, the body should he * The following method for drying and curing cutaneous eruptions, is deemed not unworthv attention—It is an extract of a letter (taken from a Calcutta paper,) from a Gentleman of the Faculty, at Fort St. George, to the Doctor of the Bengal Establish- ment :— " Sir Paul Joddivl, from his skill in botany, has made a discovery which is likely to prove of importance to the health and ease of the Europeans in India; and will tend to the extirpation of that cruel malady, the ri'n^-n-olfaj and the remedy is as simple as it is efficacious. It consists in nothing more than a frequent embrocation, or friction ef the parts where the eruption prevails, withcemmon mushroom ketchup. Thisrtuie- ily. simple as it appears, has never been known to fail in removing the ring-worm, itch, or any othtr cutaneous eruptiou. after every nostrum has failed. " Sir Paul accounts for this efficacy of the vegetable curative, in the known noxious property of the mushroom to all animalcula. The solution or essence of this fungus is proved,hy this discovery, to bear such enmity to the minute insect which is the occult name of this disorder, that it immediately perforates the cuticle-, and totally extermi- nates tbe infection. 'I he experiment is easy, and atrial is recommended to those af- flicted u ith ring-worms, tetters, or eruptions of any kind." A. F-. ^^ some time ago saw a very striking instanceof the danger of substituting dry- * i^Hnedicines in the place of cleanliness and wholesome food, in the Foundling Hosp'i- •-.tarat Ackworth, where the children were grievously afflicted wiUi scabbed bends .and other cutaneous disorders. Upon inquiry it was found, that very little attention was paid either to the propriety or soundness of tlieir provisions, ami that cleanliness was totally neglected; accordingly it was advised, that tk^r should have more wholesome; food and be kept thoroughly clean. Ibis advice, however, was not followed. It mi too troublesome to the servants, superintendar.ls, &c. The business was to be done by mi it'.cine ; which wns accordingly attempted, but had nearly proved ititiil to the whole house. Fevers, end other internal disorders immediately appeared,and ut length!-, pu- trid dysentery, which proved so infectious, that it cam. d ofi a great ir.any of the; chil- dren, and spread over a considerable part of the neighbouring country. E e tr -»: OF THE CROUP, OR HIVES. kept gently open ; and cold, as far as possible, ought to be avoided. To prevent any bad consequences from stopping this discharge, it will be proper, especially in children ofa gross habit, to make.an issue in the neck or arm, wliich may be kept open till the patient becomes more strong, and the constitution be somewhat mended. Chilblains commonly attack children in cold weather. They arc generally occasioned by the feet of hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, anil an infraction of the vessels ; which being often repeated, the vessels are at last over- distended, and forced to give way. To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rubbed with mustard and brandy, or something ofa warming nature. They ought likewi.-c to be covered with flannel, and kept warm and dry. Some apply warm ashes between cloths, to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner's cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are indeed troublesome, but ist-ldom dangerous. They generally heal as soon as the warm weather sets in. OF THE CROUP, OR HIVES. CHILDREN are often seized very suddenly with this disease, which, it not quickly relieved, proves mortal. It is known by various names in different parts of Britain. Ou the east coast of Scotland it is called the croup. On the west they call it the chock or stuffing. In some parts of England, where I have observed it, the good women call it the ri- sing- of the lights, and in America, the hives. It seems to be a species i.f asthma attended with very acute and violent catarrhal symptoms. This disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the. night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet clothes, or any thing that ob- structs the perspiration, mav occasion the croup. It is attended with a freqnent pulse, quick and laborious breathing, which is performed with a peculiar kind of croaking noise, that must be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is ofa livid colour. ^ When a child is seized with the above symptoms, his feet should be immediately put into warm water. He ought likev, i.-e to be bled,* and te have a laxative clyster administered us soon as possible. He should be made to breathe over the steams cf warm water and vinegar ^i an emollient decoction, and emollient cataplasm* or fomentations iBy be applied round his neck. If the symptoms do not abate, a blister- ing-plaster must be applied round the neck, or between the shoulders, and the child may take freqsJently a table-spoonful of the following ju- lep : Take, penny-royal water three ounces, syrup of althea and of pop- pies, each oue ounce, mix them together. * In this disease bleeding is not always proper; but in rery full babiu it certain]) mast be of use. i* OF TEETHING. 3«r Asafoetida is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two dracjmis of asafoetida may be dissolved in one ounce of Mindcrerus's spirit, and three ounces of penny-roya! water. A table-spoonful of this mix- ture may be given every hour, or oftener, if the patient's stomach bo able to bear it. If ihe child cannot be brought to take thi-- medicine, two drachms of the asafoetida may be dissolved in a common clystei, and admini: tered cvety six or eight hours, till the violence of the disease abate.* To prevent a return of the disorder, all those thirc* wliich occasion it must carefully be avoided ; as wet feet, cold, damp, easterly winds, ■S.C. Children who have had frequent returns of this disease, or whose constitutions seem to dispose them to it, ought to have their diet pro- perly regulated; all food that is viscid or hard of digestion, and all crude, raw, trashy fruits are to be avoided. They ought likewiss to have a drain constantly kept open in some part of their body, by means of a seton or issue. I have sometimes known a llurgnndy-pitch plaster, worn continually between the shoulders for several vents, have a very happy effect in preventing the return of thi*dreadful disorder. OF TEETHING. Dr. Arbuthnot observes, that above a tdith part of infants die in teething, by symptoms proceeding from the irritation of the tender nervous parts of the jaws, occasioning inflammations, fevers, convul- sions, gangrenes, Sec. These symptoms are iu a great measure owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, wliich is too often iuciea-ed by an effeminate educa- tion. Hence it comes to pa. ast. j an. » . > this misfortune is the less to be re- t^^flS^ri&ol^toShe never found blistering eT»y jcrvtecj grettea. i in "0""r" f ,„ -amphor and Venice treacle, to be applied both #► S--S OF THE RICRETS. 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 necessary; but this in very young children ought always to he sparingly performed. It is an evacuation which they bear the worst of any. Purging, vomiting, or sweating, agree much better with them, arid are generally more beneficial. Harris, however, observes, that when an inflammation appears, the physician will labour in vain, if the cure be not be^un with applying a leech under each ear. If the child be seized with con- valsion-fits, a blistering-plaster may be applied between the shoulder-, or one behind each ear. Sydenham says, that in fevers occarioncd by teething, he never found any remedy so effectual as two, three, or four drops of spirits of hartshorn in a spoonful of simple water, or other convenient vehicle, sriven every four hours. The number of doses may be four, five, or si\. 1 have often prescribed this medicine with success, but always found a larger dose necessary. It may be given from five drops to fifteen or tweaty, according to the age of the child, and when costiveness does not forbid it, three or four drops of laudanum may be added to each dose. In Scotland, it is very common, when children are cutting tlieir teeth, to put a small Burgundy-pitch plaster between their shoulders. Tliis generally eases the tickling cough which attends teething, and is by no means an useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, aud ought to be renewed at least ence a fortnight. Several things have been recommended for rubbing the gum.", as eils, mucilages, &c. but from these, much is not to be. expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a- day. * Children are generally at this time disposed to chew whatever tiiey get into their hands. For this reason they ought never to be without somewhat that will yield a little to Ihe pressure of tlidr gums, as a crust of bread, a wax candle, a bit of liquorice-root, or such like. With regard to cutting the gums, we have seldom known it of any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger nail, the edge of a six-penny piece that is worn thin, or any sharp body which can be with safety intro- duced into the mouth; but a lancet, in a skilful hand, is certainly the most proper. In order to render the teething less difficult, parents ought to talce care that their children's food be light and wholesome, ami that their nerves be braced by sufficient exercise witliout doors, the i^e of the cold bath, &c. Were these things duly regarded, they would have a much better effect than teething necklaces, or other nonsensical amukMfe worn for that purpose. OF THE RICKETS. THIS disease generally attacks children between the age of nine months and two years. It appeared first in England, about the lime when manufactures began to flourish, and still pie vails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise tla.ii selves, or to „:.e it to their children. OF THE RICKETS. 329 CAUSES.—One cause of the rickets is diseased parents. Mothers •f a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them after they are brought forth. Accordingly we find, that the children of such women gene- rally die of the rickets, the scrophula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often afflicted with the venereal disease, in their youth are likewise very liable to the rickets. Any disorder that weakens the constitution, or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, &c. disposes them to this disease. It may likewise be occasioned by im- proper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it. Bad nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough of milk to nourish the child, it can- not thrive. But children suffer oftener by want of care in nurses thai want of food. Allowing an infant to lie or sit too much, or not keeping it thoroughly clean in its clothes, has the most pernicious effects. The want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep ; if it be suffered to lie or sit, instead of being tossed and dandled about, it will not thrive. SYMPTOMS.—At the beginning of this disease the child's flesh grows soft and flabby ; its strength is diminished; it loses its wonted cheerfulness, looks more grave and composed than is natural for its age, and does not chuse 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, espe- cially in the more soft and spungy parts. Hence the wi ists and ancles become thicker than usual; the spine or back-bone puts on an unnatu- ral shape ; the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All these symptoms vary accordmg to the violence of the disease. The pulse is generally quick, but feeble ; the appetite and digestion for the most part bad ; the teeth come slow- ly aud with difficulty, and they often rot and fall out afterwards. Ricketty children generally have great acuteness of mind, and an un- derstanding above their years. Whether this is owing to tlieir being more ill the company of adults than other children, or to the preter- natural enlargement of the brain, is not material. REGIMEN—As this tlisease is always attended with evident signs «nf weakness and relaxation, our chief aim in the cure must be to bracts and strengthen the solids, and to promote digestion and the due pre- paration of the fluids. These important ends will be best answered by a wholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If the eliild has a bad nur-ewho cither neglects her duty, or does not understand it, she Should be changed. If the s» ason be cold, the child ought to be kept warm • anil when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the »0 OF CONVULSIONS. «ame effect. The limbs should be rubbed frequently with a warns hand, and the child kept as cheerful as possible. , The diet ought to be dry and nourishing, as good bread, roasted flesh, i &c. Biscuit is generally reckoned the best bread; and pigeons, pul- lets, veal, rabbits, or mutton roasted or minced, are the most proper flesh. If the child be too young for flesh-meats, he may have rice, mil- let, or pearl-barley boiled with raisins, to which may be added a little wine and spice. His drink may be good claret mixed with an equal quantity of water. Those who cannot afford claret, may give tlicrhild :iow and then a wine-glass of mild ale, or good porter. MEDICINE.—Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children if a gross habit, gentle vomits and repeated purges of iliubarb may •sometimes be of use, but they will seldom carry off the disease ; that must depend chiefly upon such things as brace and strengthen the sys- tem : for which purpose, besides the regimen mentioned above, we ' would recommend the cold bath especially in the warm season. It must however be used with prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be well rubbed with a dry cloth immediately after he comes out ofit. If the child should be weakened by the cold bath, it must be discontinued. Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would be of service, were it possible to bring them to take it. We might here mention many other medicines which have been recommended for the rickets; but as there is far more danger in trusting to these than in ueglecting them al- together, we chuse rather to pass them over, and to recommend a pro- ! ■ per regimen as the thing chiefly to be depended on. '[ OF CONVULSIONS. i THOUGH move children are said to die of convulsions than of any other dir ease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves, may occasion convulsions. Hence infants whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimen- tary canal; likewise by teething; strait clothes; the approach of the small-pox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bow- els, whatever clears them of their act id contents, or renders these mild and inoffensive^ will senerally perform a cure: wherefore, if the child H be costive, tgBDest way will be to begin with a clyster and afterward* to give a gemfe vomit, which may be repeated occasionally, and the bo- | dy in the meantime kept open by gentle doses of magnesia alba, or small f|, quantities of rhubarb mixed with the powder of crabs'claws. ' Convulsions which precede the eruption of the small-pox or mcasler generally go oft upon these making their appearance. The principal danger in this case arises from the fears and apprehensions of those who '< have the care of the patient. Convulsions are very alarming, and • something must be done to appease the affrighted parents, nurses, Sec. 'jj Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great danger ot its life, when a little time, bathing the feet in warm water, and throwing in a mild clyster, would have set all to rights. OF WATER IN THE HEAD. 331 When convulsion-fits arise from the cutting of eeth, besides gentle evacuations, we would recommend blistering, and the use of antispas- modic medicines, as the tincture of soot, asafoetida, or castor. A few drops of any of these maybe mixed in a cup of white-wine whey and given occasionally. When convulsions proceed from any external cause, as the pressure occasioned by strait clothes or bandages, &c. theie ought immediate- ly to be removed; though in this case taking away the cause will not al- ways remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the cause which first gave rise to the disorder continues to act. When a child is seized with convulsions without having any complaint in the bowels, or symptoms of teething, or any rash or other discharge which has been suddenly dried up; we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhappy patient. When a disease proceeds from an original fault in the formation or structure of the brain itself, we cannot expect that it should yield to medicine. But as this is not always the cause, even of convulsions which proceed im- mediately from the brain, some attempts should be made to remove them. The chief intention to be pursued for this purpose, is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders. OF WATER IN THE HEAD. THOUGH water in the head, or a dropsy of the brain, may affect a- dults as well as children, yet, as the latter are more peculiarly liable to it, we thought that it would be most proper to place it among thn diseases of infants. ... CAUSES.—A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like ; it may also proceed from an original laxity or weakness of the brain ; from scirrhus tumours or excrescences within the skull; a thin watery state of the blood , a diminished secretion of urine ; a sudden check of the perspiration; and lastly,'from tedious and lingering diseases, which waste and con- sume the patient. SYMPTOMS.—This disease has at first the appearance ot a slow fever • the patient complains of a pain in the crown of his head or over his eyes ; he. shuns the"light; is sick, and sometimes vomits ; hii pulse is irregular and generally low : thougii he seems heavy and dull, vet he does not sleep : he is sometimes delirious, and frequently sees objects double ; towards the. end of this commonly fatal disease the pulse becomes more frequent, the pupils are generally dilated, the cheeks flushed, Uie patient becomes comatose, and convulsions en- ""mfDICINE — No medicine has hitherto been found sufficient to carVoff a dropsy of the bram. It is landable, however, to make some aVtempts, as time or chance mayJmng many things to light of which at present we have no idea. The medicines generally used arcT,purgedI of ihubarb or jalap, with calomel or blistering pl-stersap- • i .. ..t;™! ;n this disease, where aaeitrious metastasis seetncl totok; . I very tatrfy'""g™,, "^ toTuYttie afJo^n.afterw.nlsintheba-mst.an* 332 OF SURGERY. plied to tbe neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secre- tion of urine, such as are recommended in the common dropsy. A dis- charge from the nose ought likewise to be promoted by causing tbe patient to snuff the powder of asarum, white hellebore or the like. Some practitioners have of late pretended to cure this disease by tlie use of mercury. I have not been so happy as to sec any instances •fa cure being performed in a confirmed dropsy of the brain ; but ii ■o desperate a malady every thing deserves a trial.* CHAPTER Ml. OF SURGERV.t XO describe all the operations of surgery, and to point out the differ- ent diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it: we must therefore confine our observations to such cases as most generally occur, and in wliich proper assistance is either not asked, or not always to be obtained. Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert surgeon ; yet many things may be done to save the lives of their fellow-men, in emergencies, by those who are no adepts in anatomy. It is amazing with what facility the peasants daily perform operations upon brute ani- mals, wliich are not of a less difficult nature than many of those per- formed on the human species ; yet they seldom fail of success. Indeed every man is in some measure a surgeon whether he will or not. He feels an inclination to assist his fellow-men in distress, and ac- cidents happen every hour which give occasion to exercise this feeling. The feelings of the. heart, however, when not directed by the judg. ment, are apt to mislead. Thus one, by a ra-ii attempt to save hii friend may sometimes destroy him ; while another, for fear of doing amiss, stands still and sees his bosom friend expire witliout so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to know what ought to be done upon such emergencies. OF BLEEDING. NO operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practi- sed by midwives, gardeners, blacksmiths, &c. we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular ser- vice to those in distress. * One reason why this disease is seldom or never cured, may be, that ft is seldom known till too far advanced to admit of a remedy. Did parents watch the first symp- toms, and call a physician in due time, I am inclined to think that something might be done. But these symptoms are not yet sufficiently known, and are often mistaken even by physicians themselves. Of this I lately saw a striking instance in a patient, attended by an eminent practitioner of this city, who had all along mistaken the disease for teething. f Latepracticehasfully proven, that all Surgical Instruments, except the lancet for 'j | vaccination, dipped in oil at the instant of using, lessens the.pain.—It is salutary also to have all instruments at Woo* beat. X. U. OF BLEEDING. Ml Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonics,&c. Itis likewise proper in all topical in- flammations, as those of the intestine', womb, bladder, stomach, kiduies, throat, eyes, etc. as also in the asthma, sciatic pains Coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody-flux. After falls, blows, bruises, orany violent hurt received either externally or internal- ly, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal or the like. In a word, whenever the vital motions have been suddenly stopt from any cause wflatever, except in swoon- ings occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, Sec. bleeding is improper. Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lan- cet, itis to be preferred to any other method ; but where a vein can- not be found, recourse must be had to leeches or cupping. The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances re- lating to the patient. It would be ridiculous to suppose that a child could bean to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man. From whatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as seon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and an half, from the place where the wound is intended to bt^ made. Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whip cord under the finger. It was formerly a rule, even among those who had the character ot being regular practitioners, to bleed their patients in certaiu diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight ofa lancet, while another will lose almost the whole blood of his body before he faints. Swoon- ing depends more upon the state of the mind than of the body : be- sides, it may often be occasioned or prevented by the manner m which the operation is performed. . Children are generally bled with leeches. Tin?, though sometimss necessary is a very troublesome and uncertain practice. It is impos- sible to know what quantity of blood is taken away by leeches ; be- sides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practise bleeding u.ke a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine. Certain hurtful prejudices with regard to bleeding still prevail among the count.v-ueople. They talk, for instance, ot head-veins, hea.t- veL ™rea tS'-vc. and believe that bleeding in these will certain- l„ nni-P • 11 dLeases of the parts from whence they are supposed t« c'ome wlouT^nshlellng^hat all the. blood vessels arise^firom.the heal t, m.a ..tut u to it again} for which reason, unlc* u. topical mflam- S.H OF INFLAMMATIONS AND AUSCESSES. mations, it signifies very little from what part of the body the blood ii taken. But this, though a foolish prejudice, is not near so hurtful is the vulgar notion that the first bleeding will perform wonders. 'I uis belief makes them often postpone the operation when necessary, in or- der to reserve it for some more important occasion, anil, when they think themselves in extreme danger, they fly to it for relief whether it be proper or not. Bleeding at certain stated periods or seasons has likewise bad effects. It i3 a common notion that bleeding in the feot draws the hiimonis downwards, and consequently cures diseases of the head and other su- . perior parts; but we have already observed that, iu all topical affec- tions, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be im- mersed in warm water, and kept there till a sufficient quantity of blood be let. We shall not spend time in describing the manner of performing this operation : that will be better learned by example than precept, i Twenty pages of description would not convey so just an idea of tbe j operation as seeing it once performed by an expert hand. Neither is it necessary to point out the different parts of the body from whence J blood may be taken, as the arm, foot, forehead, temples, neck, &c. These will readily occur to every intelligent person, and the forego- j iog observations will be sufficient for determining wliich of them is i most proper upon any particular occasion. In all cases where the in- tention is merely to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be per- formed. ^ OF I NFL A MM A TIO NS AND A BSC ESSES. * FROM whatever cause an inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is impossible ttrforetell with certainty in which of these ways any particular inflam- mation will terminate, yet a probable conjecture may be formed with regard to the event,from a knowledge of the patient's ageand constitu- tion. Inflammations happening in a slight degree upon colds, and with- out any previous indisposition, will most probably be dispersed ; those which follow close upon a fever, or happen to persons ofa gross habit of body, will generally suppurate ; and thofee which attack very old people, or persons ofa dropsical habit, will have a strong tendency to gangrene. If the inflammation be slight, and the constitution sound, the disper- sion ought always tobe attempted. This will be best promoted by a . slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be em- brocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax-plaster. Ifj notwithstanding these applications the symptomatic fever in- creases, and the tumour becomes larger, with violent pain and pulsation, it will be proper to promote the suppuration. The best amplication for this purpose is a soft poultice, which may be renewed twice a-day. 11 the suppuration proceeds but slowly, a raw onion cut small or bruised , may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it; a fluctuation of matter which may be,felt '" under the finger, and, generally speaking, an abatement of the pain, it may be opened either with a lancet or by means of caustic. OF WOUNDS. 535 The last way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following symptoms: the inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby ; little blad- ders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish complexion becomes black ; a quick low pulse, with cold clammy sweats, are the immediate foreruuneis of death. When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified and afterwards dressed with basilicum softened with oil of turpentine. All the dress- ings must be applied warm. With ie:;ard to internal medicines, the patient must be supported with generous cordials, and the Peruvian bark exhibited iu as large doses as the stomach wiil bear it. If the mortified parts sliould separate, the wound will become a common ul- cer, and must be treated accordingly. This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, imposthumes, M'hitloes, Sec. They are all abscesses in consequence ofa previous in- flammation, which, if possible, ought to be discussed; but when this cannot be done, the suppuration should be promoted, and the matter disciplined by an incision, if necessary; afterwards the sore may be dressed with yellow basilicum, orsome other digestive ointment. OF WOUNDS. NO part of medicine has been more mistaken than the treatment or cure of w ounds. Mankiud in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a fact, that no external application whatever contributes towards the cure ofa wound, any other way than by keep- in; tlie parts soft, clean, and defending them from the external air, which may be as effectually done by dry lint, as by the most pompouu applications, while it is exempt from many of the bad consequences attending them. The same observation holds with respect to internal applications. Tlicse only promote the cure of wounds as tar as they tend to prevent a fever, or to remove any cause that might obstruct or impede the ope- rations of Nature. It is Nature alone that cures wounds ! All that art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature's efforts. With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to facilitate their cure. The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of doth or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient's weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the hie ist, the bowels, Sec. or where any considerable blood-vessel is cut, a *kilful .surgeon ought immediately "to be called, otherwise the patient may lose his life. But soaietimt i the discharge of blood is so great, 336 OF WOUNDS. that if not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this ca: e, something must be done by those who are present. If the wound be in any of the limbs, bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the woniid. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cartrope to secure his load- ing, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endanger a gangrene. In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped in a solution of" blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric* of the oak as prefer- able to any of the other styptics; and indeed it deserves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above wliich a bandage may be applied so tight as to keep it firmly on. Though spirits, tinctures, and hot balsams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote, but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, a>id seem, as it were, to solder up the wound, that they there- fore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouths of the vessels; but, by rendering tlie parts callous they obstruct the cure. Inflight wounds, which do not penetrate, much deeper than tbe skin, the "best application is a bit of the common black sticking-plaster. This keeps the sides of the wound together, aud prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, it is not safe to keep its lips quite close : this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fiil the wound with soft lint, commonly called caddis. It however must not be stuffed in too hard, otherwise it will do huit. The lint may be covered with a cloth dipped in oil, or spread with the common wax- plaster ; t and the whole must be kept on by a proper bandage. We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common * Dr. Tissot, in his " Advice to the people," gives the fallowing directions for gath- ering, preparing, and applying the agatie.—" Gather in autumn," says ha," while tlie Gue weather lasts, the agaric of (he oak, wliich is a kind of fungus or excrescence issu- ing from tbe wood of that tree. It consists at hist of four parts, which present them- selves successively :—l. The outward rind, or skin, which may be thrown aw ay. 2. The part immediately under this rind, which is the best of all. '1 his is to be beat well with a hammer, till it becomes soft and pliable. This is the only preparation it requires,and a slice of it of a proper size is to be applied directly over the bursting openblood-vuseli It constringes and brings them close together, stops the bleeding, and generally falls off at the end of two days. 3. The third part adhering to the second may serve to stop the bleeding from the smaller vessels; and the fourth and last part in ay be reduced to pow- der as conducing to the same purpose."— Where the agaric cannot be had, sponge may be used in its stead. It must be applied in the same manner, and has nearly the tame etltc.i. '<• See AppemdU, fVax-Plaster. OF BURNS AND SCALDS. - 5^7 sense will generally suggest the most commodious method of applying a bandage; besides, descriptions of this kind are not easily understood or remembered. The first dressing ought to continue on for at least two days; after wliich it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be removed with ease or safety to the patient, it may be allowed to continue, and fresh lint dip- ped in sweet oil laid over it. This will soften it, so as to make it come off easily at the next dressing. Afterwards the wound may be dit«- sed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it with the yellow basilicum;* and if fungus, or what is called proud-flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum or red precipitate of mercury. When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be chang- ed twice a-day. If the wound be large, and there is reason to fear an inflammation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and every thing that is ofa heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled ; and, if the symptoms be urgent, the operation may be repeat- ed. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleetl him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient's strength by excessive evacuations. Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind or moves the passions, as love, anger, fear, uxce-sive joy,&c. are very hurtful. They ought aboveall things to ab- stain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegetable diet, as roasted apples, stewed prunes, boiled spiimage,and such like. BURNS AND SCALDS.§ VARIOUS remedies are recommended for the treatment of these accidents ; and it happens fortunately for the pressure of such an emer- gency, that some of the most common things are also the most useful on the occasion. The pain of burns and scalds may be instantly aba- led by immersing the part affected in cold water, or indeed in any cold liuid, or inspirits of wine. An excellent application likewise is vine- gar with or without powdered chalk in it. If the injury be on the fin- gers or hands, the application may be made by immersion ; but if in any part where this would be inconvenient, the vinegar may be appli- ed by means of linen rags dipped in it. In slight injuries, the vinegar, if early and assiduously applied, will of itself soon effect a cure; but should any degree of pain return, the immersion or fomentation must be repeated. In recent burns or scalds, attended with large blisters, excoriations, orlossofsiihstanee, the vinegar ought to be applied till the pain nearly ceases, which generally happens within eight hours. Many practition- ers recommend spirits of turpentine instead of vinegar; or lime-water • See Appendix, 1 cilow Basilicum. 1' f 5-iS OF BURNS AND SCALDS. and linseed-oil. The vinegar need not be employed louger than twelve hours, except on the outside of the sores, which, while they continue to be swelled or inflamed, should be fomented Cora minute or two before they are dressed. For dressing the sores wliich arise, from burns or scalds, one of the best applications, is a poultice of bread, water, and sweet oil. This should be removed in six hours, when the sores arc to be covered with chalk finely powdered, till it has absorbed the matter, and appears quite dry. A fresh poultice must be laid over the whole, which, with the sprinkling of the chalk, is to be repeated morning and evening till the sores are healed. After the second or third day, if the sores be on a part of the body where it is difficult to keep the poultice from shifting, a plaster of cerate thickly spread, may he used as a substitute in the day-time. When there are large blisters upon the part they should be opened with a lancet before the application of the vinegar ; and the water they contain be pressed out with a linen cloth, that the vinegar may act more closely upon the burnt flesh, which in this case it does efficaciously. In severe cases, and in cold weather, the vinegar should be nearly blood- warm. If the patient will not suffer the vinegar to be applied immediately to rhe. surface, on account of the pain it excites, a linen rag soaked in sweet oil may be previously laid on the part, covering the whole with cloths dipped in vinegar ; and these applications are to be occasionally repeated till the pain and inflammation be entirely removed ; after which the parts should be dressed, or, if the burning be very deep, with a mixture of that and yellow basilicum. When the burn or scald is violent, or has produced a high degree of inflammation, so that there is reason to be apprehensive of a gangrene, the same method of cure becomes necessary as in other violent inflam- mations. The patient, in this case, must be put upon a low diet, and drink plentifully of weak diluting liquors. He must likewise be bled, and his body be kept open. But if the burnt parts should become liv- id or black, with other symptoms of mortification, it will be necessary to apply to them camphorated spirits of wine, tincture of myrrh, and other antiseptics or correctors of putrefaction, mixed with a decoction of the Peruvian bark. In this case, the bark must likewise be taken in- ternally ; the patient at the same time using a more gcneious diet, with wine, spiceries, &c. When burns are occasioned by the explosion" of gun powder, someof the grains of the powder are apt to be forced into the skin. At first they produce much irritation ; and, if they be not removed, they com- monly leave marks which remain during life. They should therefore be picked out as soon as possible after the accident; and to prevent inflammation, as well as to dissolve any powder which may remain, the parts affected, should be covered for a day or two with emollient poultices. A strong solution of soap in water has long been in use with artificers employed in any business exposing workmen to very bad scalds. This is allowed to be an excellent remedy. But, as the soap would take some time in dissolving, and the solution some time in cooling, Dr. Un- derwood recommends a mixture of six ounces of oil to ten of water, with two drachms of the ley of kali, or pot-ash. This quantity may be sufficient for a burn on the hand or foot, which is to be immersed, and kept about half an hour in the liquor, which will remove the injury, if OF BRUISE*. 33'J recourse to it immediately be had ; but must be repeated, as the pain may require, if the scald or burn be of some standing. As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occurred in my prac- tice. A middle-aged man, ofa good constitution, fell into a lar;*j ves- mI full of boiling water, and miserably scalded about one half of his body. As his clothes were on, the burning in some parts wa3 very deep before they could be got off. For the first two days the scalded pai ts hat! been frequently anointed with a mixture of lime-water and oil. which is a very proper application for recent burnings. On the third day, when 1 first saw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyster administered. Poul- tices of bread and milk, softened with fresh butter, were likewise ap- plied to the affected parts, to abate the heat and inflammation. His lever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture with small doses 01 nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a diges- tive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, aud touched with tlie tincture or myrrh, and to prevent their spreading, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend bis business. The most useful application, we are told, with which families c"an be provided against any emergency of this kind, is a strong brine, made by placing sliced potatoes and common salt in alternate layers in a pan, allowing thein to remain until the whole of the salt is liquified ; which must be then drained off, and kept in bottles, properly labelled, ready for immediate use. OF BRUISES. BRUISES are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is needless to give any definition of a disease so universally known 5 we shall there- fore proceed to point out? the method of treating it. In slight bruises it will be sufficient to bathe the part with warm vine- gar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ar- dent spirits, which are commonly used in such cases. * •> In some parts of the country the peasants apply toiiv, recent bruise a cataplasm of fresh cow-dung. I have often seen this cataplasm ap- plied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect. When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food should be light and cool, and his drink weak and of an opening nature; as whey sweetened with honey, decoctions el tamarinds, barley, cream-tartar whey,and such like. The bruised part must be bathed with vinegar and water, as directed above ; and a poultice made by boiling crumbs of bread, elder-1loweisS 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 bruise. It may be i. newed two or three times a-titiy. MO- OF ULCEUS As the structure of the vessels is totallv tics'.royed by a violent bruise, there often ensues a great loss of substance, w hich produces an ulcerous sore very difficult to cure. If the bone he affected, the sore will not heal before an exfoliation take.' place ; that is, before the diseased part of the bone separates, andconiCMnit through the wound. 'I his is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are fre- quently mistaken for the kind's evil, and treated as such, though in fact they proceed solely from the injury which the solitl parts received fiom tiie blow. Patients in thissituation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best method of managing such sores is, to take care that the patient's constitution does not sutler by confinement or improper medicine, and to apply nothing to them be- s.des simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile-flowers, or the like, may be put to nourish the part, and keep it soft and warm. Nature, thus assisted, j will generally in time operate a cure, by tin owing off the diseased parts of the bone, after which the sore soon heals. OF ULCERS. ULCERS may be the consequences of wounds, bruises, or impos- , thumes improperly treated; they may likewise proceed from an ill state of the humours,or what may be called a bad habit of body. In the latter case they ought not to be hastily dried up, otherwise it may prove fata! to the patient. Ulcers happen most commonly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to them. They might often be prevented by retrenching some part of the solid food, or by opening artificial drains, as issues, se- \ tons, or the like. An ulcer may be distinguished from a wound by its discharging a thin watery humour, which is often so acrid as to inflame and corrode j the skin; by the hardness and perpendicular situation of its sides or edges; by the time of its duration, ike. It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In geneial, all ulcers which proceed from i a bad habit of body, should be suffered to continue open,at ieast till tlie constitution has been so far changed by proper regimen, or the use of medicine,that they seem disposed to heal of their own accord. Ulcers | which are the effect of malignant fevers or other acute diseases, may generally be'healed with safety after the health has been restored for Jj some time. The cure ought not however to be attempted too soon, not at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either accompany chronic diseases, or come in their stead, they must be cautiously healed. If an ulcer conduces to the patient's health, from whatever cause it proceeds, it ought not to be healed ; but if, on the contrary, it wastes the strength, and con sumes the patient by a slow fever, it should be healed as soo.i as pos- sible. ' We would earnestly recommend a strict attention to these particu- j Jars to all who have the misfortune to labour under this disorder, par. ,'"| licularlv those in the decline of life; as we have frequently known pco. j OF DISLOCATIONS. 341 I pie throw away their lives by the want ofit, while they w-re extolling 1 and ncnerously rewarding those whom they ought to have looked upon as tlieir executioners. The most proper regimen for promoting the cure of ulcers, is to avoid all spices, salted and high seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxative vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, and should take as much exer- cise as he can easily bear. When the bottom and sides of an ulcer seem hard and callous, :j they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the yellow basilicum ointment. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet. Lime-water has frequently been known to have happy effects in the cure of obstinate ulcers. It may be used in the same manner as direc- ted for the stone and gravel. ' My late learned and ingenious friend Dr. Why tt strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill-conditioned ulcers. I have frequently found this medicine, when given according to the Doctor's directions, prove very successful. The dose is a table spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a let- ter which I had from the Doctor a little before his death, he informed me, " That he observed washing the sore thrice a-day with the solution ofa triple strength was very beneficial."* A fistulous ulcer can seldom be cured without an operation. It must either be laid open so as to have its callous parts destroyed by some corrosive application, or they must be entirely cut away by the knife; but as this operation requires the hand of an expert surgeon, there is no occasion to describe it. Ulcers about the anus are most apt to become fistulous, and are very difficult to cure. Some indeed pretend to have found Ward's fistula paste very successful in this complaint. It is not a dangerous medicine, and being easily procured, it may deserve a trial; but as these ulcers generally proceed from an ill habit of body, they will seldom yield to any thing except a long course of regimen, assisted by medicines which are calculated to correct that particular habit, and to induce an almost total change in th" coustitution. CHAPTER LIII. OF DISLOCATIONS. WHEN a bone is moved out of its place or articulation, so as to im- pede its proper functions, it is said to be. luxated or dislocated. As this often happens to persons iu situations where no medical assistance can be obtained, by winch means limbs, and even lives,are frequently lost, we shall endeavour to point out the method of reducing the most com- mon luxations, and those which require immediate assistance. Any person of common sense and resolution, who is present when a disloca- tion happens, may often be of more service to the patient, than the • In ulcers of the lower limbs great benefit is often received from tight rollers, or wearing a laced stacking, as this prevents the fluv ol humours to ihe sores, and disposes ihciu to heal. 812 DISLOCATION OF THE NECK most expert surgeon can after the swelling and inflammation have com? on. When these are present, itis difficult to know the state of the joint, and dangerous to attempt a reduction, and by waiting till they are gone off, the muscles become so relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place. A recent dislocation may generally be reduced by exten-ion alone, which must always be greater or less according to the strength of the muscles which move the joint,, the age, robustness, and other cir- cumstances of the patient. When the bone has been outfits place for a considerable time, and a swelling or inflammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduc- tion is attempted. All that is necessary after the reduction, is to apply cloths dipt in vinegar or camphorated spirits of wine to the part, and to keep it per- fectly easy. Many bad consequences proceed from the neglect of this rule. A dislocation seldom happens without the tendons and ligaments of the joint being stretched and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well; hut if the injury be increased by too frequent an exertion of the parts, no wonder if they be found weak and diseased ever after. DISLOCATION OF THE JAW. THE lower jaw may be luxated by yawning, blows, falls, chewing hard substances, or the like. It is easily known from the patient's j being unable to shut his mouth, or to eat any thing, as the tcelh of the under jaw do not correspond with those of the upper ; besides, the chin either hangs down, or is thrown toward one side, and the pa- tient is neither able to speak distinctly, nor to swallow without con- r •iderable difficulty. ,r The usual method of reducing a dislocated jaw is to set the pafient \ upon a low stool, so as an assistant may hold the head firm by pres- sing it against his breast. The operator is then to thrust his two thumbs, being first wrapped tip with linen cloths that they may not slip, as far back into the patient's mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards by wliich means > the elapsed heads of the jaw may be easily pushed into their forme* ji cavities. The peasants in some parts of the country have a peculiar way of performing:, this operation. One of them puts a handkerchief under • the patient's chin, then turning his back to that of the patient, pulls him np by the chin so as to suspend him from the ground. This method I often succeeds, but we think it a dangerous one, and therefore recom- mend the former. DISLOCATION OF THE NECK. THE neck may be dislocated by falls, violent blows, or the like. / In this case, if the patient receives no assistance, he soon dies, wbichj| makes people imagine the neck was broken ; it is however, for the most .' part only partially dislocated, and may be reduced by almost any per- son who has resolntion enough to attempt it. A complete dislocation^ of the neck is instantaneous death. ' When the neck is dislocated, the patient is immediately deprived of all sense and motion ; his neck swells, his countenance appears bloated!' his chin lies upon his breast, and his face is generally .turned towarcfr one side. * DISLOCATION OF THE SHOULDER. til To reduce this dislocation, the unhappy person sliould immediately be laid upon his back on the ground, and, the operator mm t place him- self behind him so as to be able to lay hold of his head with both hands, while he makes a resistance, by placing his knees against the patient's shoulders. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives that the joint is replaced, which may be known from the noise which the bones generally make when going in, the pa- tient's beginning to breathe, and the head continuing in its natural posture. This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily performed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for sonic days, till the parts recover their proper tone. DISLOCATION OF THE RIBS. AS the articulation of the ribs with the back-bone is very strong, they are not often dislocated. It does however sometimes happen, which is a sufficient reason for our taking notice ofit. When a rib is dislo- cated either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, and the operator must endea- vour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and, while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into tlieir former situation. Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient upon his belly over a cask, or some gibbous body, and to move the fore part of the rib inward towards the back, some- times shaking it; by this means the heads of the luxated ribs may slip into their former place. DISLOCATION OF THE SHOULDER. THEhtimerusor upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but very seldom directly upwards. From the nature of its articulation, as well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression of cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm pit; but when itis backwards, there appears a protuberance behind the shoulder, and the arm is thrown forwards towards the breast. The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while another lays hold of the arm a little above the elbow, and gradually extends it. The op- erator then puts a napkin under the patient's arm, and causes it to be tied behind Ins own neck ; by this, while a sufficient extension is made, he lifts up the head of tlie bone, and with his hands direct: it into its proper'placc. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, 1 have generally found it a very easy mat- 3*4 OF BROKEN BONKS, Ac. ter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making tht*/ \ttn- sion, the arm ought always to be a little bent. DISLOCATION OF THE ELBOW. THE bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the pa- tient's inability to bend his arm, a dislocation of this joint may easily be known. Two assistants are generally necessary for reducing a dislocation of the elbow ; one of them must lay hold of the arm above, and the otlid below the joint, and make a pretty stronj; extension, while the opera- tor returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck. Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow ; viz. by making an extension in different directions, and thrusting the head of the bone into its place. DISLOCATION OF THE THIGH. WHEN the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other ; but when it is displaced backward, it is usually pushed upwards at the same time, by which means the limb is shortened, and the foot is turned in- wards. When the thigh bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back and made fast by bandages, or held by assistants, while by others an extension is made by means cf slinks fixed about the bottom of the thigh a little above the knee. While the extension is made, the operator must push the head of the bone outward, till it gets into the socket. If the dislocation be outward, the patii nt must be laid upon his face, and, during the ex- tension, the head of the bone must be pushed inward. Dislocations of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an exten- sion in opposite directions, while the operator replaces the bones. In manycases, however, the extension alone is sufficient and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocations. Skill and address will often succeed better thai: force. I nave known a dislocation of the thigh reduced by one man, alter all the force that could be used by six had proved ineffectual. CHAPTER LIV. OF BROKEN BONES, Ire. THERE is, in most villages, some person who pretends to the art of reducing fractures. Though in general snch persons are very igno- rant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had ; but when that is impractica- ble, they must be employed : we shall therefore recommend the fol- lowing hints to their consideration : When a large bone is broken, the patient's diet ought in all re#pects OF BROKEN BONES, &c. 3i0 to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clvsters; or, if these cannot be conveniently administered, by food that is of an opening qual- ity; as stewed prunes, apples boiled in milk, boiled spinnage, and the like. It ought however to be here remarked, that persons who have been accustomed to live high, are not all ofa sudden to be reduced to a verv low diet. This might have fatal eftects. There is often a necessi- ty for indulging even bad habit?, in some measure, where the nature of the disease might require a different treatment. , It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, ofa full habit, or has at the same time received any bruise or contusion. This operation should not only be performed soon after theaccident happens, but if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly necessary. If any of the large bones which support the body are broken, tIn- patient must keep his bed for several weeks. It is by no means neces- sary, however that he should lie all that lime, as is customary, upon his back. This situation sinks the spirits, galls and frets the patient's skin, and renders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up and laying him down, that he make no ex- ertions himself, otherwise the action of the muscles may pull the bone out of its place.* It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoria- ted, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had been kept straight for above a fort- night, displaced by this means,and continue bent for life, in spite of all that could be done. It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure The best situation is to keep the limb a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles arc upon the stretch. It is easily effected, by either laying the patient upon his ride, or making the bed so as to favour this position of the limb. Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will some- times be necessary to have the limb immediately taken oft", otherwise a gafjRrene or mortification may ensue. The horror which attends the very idea of an amputation, often occasions its being delayed in such cases till too late. I have known thi-- principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, * Various pieces of machinery have been contrived for counteracting the force of the muscles, and retaining the fragments of broken bones ; but as descriptions of these with- out drawings would be of little use, I shall refer the reader taa cheap and useful per- ibrmai.ee " on the nature and cure of fractures," lately published by my ingenious friend Mr. Aiken, surgeon in Edinburgh; wherein that gentleman has not only given an ac- count of the machines recommended in fractures by former authors, but has likewise added several improvements of his own, which are peculiarly useful in compound fractures,and in cases where patients with broken bones are oWiged to be transporu-u from one place to another. 316 OK >TRAINS. when the gangrene had proceeded so far as to render the operation us*. When a fracture is accompanied with a wound, it must be dressed in all respects as a common wound. All that art can do towards the cure ofa broken bone, is to lay it perfectly strai Jit, and to keep it quite easy. All ti^ht bandacei do hurt. They had much better be wantingaltogcther. A ;;i eat many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one.of the ways in which excess of art, or rather tbe abuse of it, does more mischief than would be occa-ioned by the want ofit. Some of the most sudden cures of broken bone- which were ever known, happened where no bandages were applied at all. Some method however must be taken to keep the membt i steady ; but this may be done many ways without bracing it with a tight bandage. The best method of retention is by two or more splints made of leather or pasteboard. These if moistened before they be applied, soon assume the shape of the included member, and aie sufficient, by the assistance ofa very slight bandage, for all the purposes of retention. The bandage wliich we would recommend, is that made with twelve or eighteen taih. It ig much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The splints should always be as long as the limb, with holes cut for the ancle when the fracture is in the leg. In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occa- sion sneezing, laughing, coughing, or the like. He ought to keep hit body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors. The most proper external application for a fracture is oxycralt or a mixture of vinegar and water. The bandages should be wet with this at every dressing. OF STRAINS. Strains are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member eas\, be- cause he cannot make use ofit; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, au! converts into an incurable malady what might have been removed by only keeping the part easy for a few days. Country people generally immerse a strained limb in cold water. This is very proper provided it be done immediately, aud not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one. Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tore of the vessels and prevents the action of the parts from increasing the disease. It should not however be applied too tight. 1 have frequent- I; known bleeding near the affected part have a very good crfpct ■, but OF RUPTURES. 317 what we would recommend above all is ease. It is more to be depended on than auy medicine, and seldom fails to remove the complaint.* OF RUPTURES. CHILDREN and old people are most liable to this disease. In the former it is generally occasioned by exce-stve crying, coughing, vom- iting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, a« leaping, carrying great weights, &c. In both a relaxed habit, indolence, and on oily or very moist diet, dis- pose the body to this disease. A rapture sometimes proves fatal before it is discovered. Whenever Bickness, vomiting, ami obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually hap- pen ought carefully to be examined. The protrusion ofa very small part of the gut will occasion all these symptoms, and if not returned in due lime, w ill prove fatal. On the first appearance ofa rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking plaster may be applied over the part, aud a proper truss or bandage must be constantly worn for a con- rideiable time. -The method of making and applying these rupture bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed. In adults, when the gut has been forced down with great violence, or happens from any c msc to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable without au operation; a description of wliich is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, witliout having recourse to any other means than what uro in the power of every man, 1 shall briefly mention the method which I generally pursue. After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and cam- omile flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a lame spoonful of butter and an ounce or two of salt, may be afterward-Tthrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be uecessary : but itis not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hands, must with bis'fingers artfully conduct the gut in by the same aperture through wliich it came out. The manner of doiii" this can be much easier conceived than described. Sliould these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed. ' . . There is reason to believe that, by persisting m the use of these, and such other means as the circumstances of the .case may suggest, * A «n-at mnnv external applications are recommended for strains, some of which do sW andffi hurt. The following are such as may be used with the gr. atest ^K vizXuUice' niade of stale beer or vinegar and oat-meal, camphorat.-d sprnt, of |#W Mmd£™u7'» spirit, volatile liniment, volatile aromatic spirit diluted wuia double ,"auu^ of water, and the common fomentation, with the addition of brandy or spirit ol wine. , 348 OF CASUALTIES. most hernias might be reduced without au operation. Cutting for the hernia is a nice and difficult matter. I would therefore ailvise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my en- deavours, after eminent surgeons had declared the reduction of the gut impracticable without an operation.* An adult, after the gut he been returned, must wear a steel band- age. It is needless to describe this, as it may always be had ready made from the artists. Such bandages arc'generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man's estate should ever be witliout one of those bandages. Persons who have a rupture ought carefully to avoid all violent ex- . ercise, carrying great weights, leaping, running, anil the like. They should likewise avoid windy aliment and strong liquors: and should carefully guard against catching cold. CHAPTER LV. OF CASUALTIES. IT is certain that life, when to all appearance lost, may oft^n, by tiat care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects. No person ought to be looked upon as killed by any accident unless ' Where the structure of the heart, brain, or some organ necc-.-ary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Tims, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow ou the head, if the person be suffered to grow cold, he will in all probability continue so ; but if the body be kept warm, as soon as the injured part has recovered its power of acting, the i fluids will again begin to move, and all the vital functions will be res- tored. It is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be de- prived of the appearance of life. The unhappy person instead of be- ing carried into a warm house, and laid by the lire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where after a fruitless attempt has been made to bleed him, perhaps by one w ho knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to * be the result of ignorance, supported by an ancient superstitious notion, wliich forbids the body of any person killed by accident to be laid in a house that is inhabited. W hat the ground of this - uperstitioii may be, we shall not pretend to inquire; but surely the contii ct founded upon * I would here beg leave to recommend it to every practitioner, when Iii. palieat If complains of pain in the belly wilh obstinate costiveness, to examine the groins and ■■ every place where a rapture may happen, in order that it may be in-mcdiali-ly .edueethJ ' ' Byneglecting this, many perish who weie not suspected to have had ruptim s till afttjfl they were dead. I hare known this happen where halfa dozen of the faculty were ufl , attendance. ♦> OF CASUALTIES. 549 it iscontraty to all the principles of reason, humanity, and common sense. When a peison seems to be suddenly deprived of life, our first busi- ness is to inquire into the cause. We ought carefully to observe whe- ther any substance be lodged in ihe windpipe or gullet; and if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought 'immediately to be removed out ofit. If the circulation be suddenly stopped, from any cause whatever, exc-pt mere weakness, the patient sliould be bleu. If the blood does not How, he may be immersed in warm water, or rubbed with warm cloths, Sec. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hoi cloths, or salt, and cover- iiii; his body with warm sand, ashes, or the like. I should now proceed to treat more fully of those accidents, which without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers ; but as I have been happily anticipated inthis part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my ow n as have occurred in the course 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 effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp pointed substauces in (heir mouths upon every occasion, and some wiio even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may fiu-ce over tho sub- stance before the person is aware* When any substance is retained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is not alwiys the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such .< »iatn e, that there is no danger from its reception into : lie stomach. Tiie substan- ces which may be pushed down without danger an-, :dl common nour- ishing ones, as bread, flesh, fruits, ai>d i... i:ke. Ah indige.-lible ho lies, as cork, wood, bones, pieces of metal, and suchlike, ou^h* if possible to be extracted, especially if these boilies be sharp pointed, as puis, needles, fish-bones, bits of glass, &c. When such substances have not passed in too d.t-p. we shoe1 J en- deavour to extract them with our fingeis, which n".i!.ou often *.»• feeds. When they are lower, we must make ue of n.ppei.-, or a small pair of forceps, such as, suigeous use. R.it this aitei.ip. to extract rarely succeeds, if the sullstance be of a rlev.hk a iture, and has- de- sceuded f..rinfo the tju'let. If ill.* finger- and nippers fdA. or cannot be dn'v app'ied, crotchet*, a kind of hooks, must be employed. Tuese ■ .7 ue 11a >• at -nee, by • A voman in .me of tin 1 npitals of this city ii-tcly 'i*ch-eid a ^re»t nam- l>erv)fpiiis,vfhichs|iehads«.i!I.)wedir.UiLCour*eoi'htrL viiuss, thriiugu r.:t uieerin her side. Gg 350 SUBSTANCES STOPT BETWEEN bending a piece of pretty strong iron wire at one end, it must be intro- duced in the flat way; and for the better conducting it, there should likew ise be a curve or bending at the edd it is hel 1 by, to serve as a kind of handle to it; which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument pmployed on such occasions, to avoid such ill accidents as have some- times ensued from these instruments slipping out of the operator's hand. After the crotchet has passed below the substance that obstructs (he passage,it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flex- ible, as a pin or fish-bone, sticks across the gullet, the hook, in such cas- es, seizing them about their middle part, crooks and thus disengages them ; or, if they are very brittle substances, serves to break them. When the obstructing bodies are small, and only 6top up a part of the passage, and which may either easily elude the hook, or straighten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle about the middle, of about an inch diameter, and the long uu- bent sides brought parallel, and near each other : these are to beheld in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about die obstructing body, and so to extract it. More flexible riugs may hematic of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consis-j tence. One of these is to be tied fast to a handle of iron wire, whale- bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Sev- eral of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is,that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twisted, as to be moved every way, which must in many cases be a considerable advantage. Another material employed on these unhappy occasions, is the sponge. Its property of swelling considerably on being wet is tlie principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist sit- uation ; and indeed the enlargement ofit may be forwarded by making the patient swallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fastened ; and as it is now too large to return through the small cavity by which it was conveyed in,it ! draws out the obstructing body along with it. I The compressibility of sponge i1- another foundation of its usefulness in sneh cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after Ihe sponge lias been introduce I. A bit of sporarc may likewise be compressed by a , piece of whalebone split at one end ; but th.s can hardly be introdu- ' ced in such a n.taner as not to hurt the patient. I hi. kJ often known pins and oth°r sharp bodies, which had j.tnek in . the throat, breiigi.tup by causing the persoi to swallow a oil f .o.udii meat tied to a thread, and lirawiu: it »;uic!.ly up a^ain. Tim s safer™ than swallowing sponge, and will often auV.ver the puposc equally wellr THE MOUTH AND STOMACH. 3jt When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in* this case vomit- ing might sometimes occasion further mischief. If the patient can swallow, vomiting may be excited by taking halfa drachm or two scru- ples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather ; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of to- bacco in a sufficient quantity of water ; this has often been found to succeed, when other attempts to excite vomiting had failed. When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means ofa wax-candle oiled, and a little heated, so as to make it flexible ; or a I piece of w hale-bone, wire, or flexible wood, with a sponge fastened lo one end. J Should it he impossible to extract even those bodies wliich it is dan- i gcrous to admit into the stomach, we must then prefer the least of | two eyils, aud rather run the hazard of pushing them down than suffer fi the patient to perish in a few minutes ; and we ought to scruple this I resolution the less, as a great many instances have happened, where j the swallowing of such hurtful and indigestible substances have been {■ followed by no disorder. * Whenever it is manifest that all endeavours, either to extract or push down the substance, must prove ineffectual, they should be discontin- ! ued, because the inflammation occasioned by persisting in them might ^ be as dangerous as the obstruction itself. Some have died in conse- t- quence of the inflammation, even after the body which caused the ob- ^ struction had been entirely removed. While the means recommended above are making use of, the patient \ should often swallow, or, if he cannot, he should frequently receive by injection through a crooked tube or pipe that may reach down to tlu: gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown inwithfo.ee, are often more successful in loosening the obstruction than all attempt.?: with in» struments. When, after all our endeavours, we are obliged to leave the obstruct- f ing body in the part, the patient must be treated as if he had an inflam- matory disease. He should be bled, kept upon a low diet, and have fl his whole neck surrounded with emollient poultices. The like treat- p ment must also be used, if there be any reason to suspect an inflamma- tion of the passages, though tlie obstructing body be removed. i= A proper degree of agitation has sometimes loosened the inhering t) body more effectually than instruments. Thus a blow on the back has k often forced up a substance which stuck in the gullet, but this is still L more proper and efficacious when the substance geta-into the wind- Bj pipe. Iu this case vomiting and sneezing are likewisvto be excited. f] Pins which stuck in the gullet have been frequently discharged by ri- L ding on horse-back, or in a carriage. *' When any indigestible substance has been forced down into tlie ' stomach, the patient should use. a very mild and smooth diet, consisting ■ ' chiefly of fruits and farinaceous substances, as puddings, pottage, and I soups. He should avoid all heating and irritating things, as wine, I 358 OF DROWNED PERSONS. punch, pepper, and such like; and his drink should be milk and water, barley water, or whey. When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters ot soup, jelly, and the like. When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death .-ecus at hand, if respiration be not restored ; the operation of broncholmny, or open- ing of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled in surgery. OF DROWNED PERSONS. WHEN a person has remained above a quarter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances may happen to have continued life, in such an unfortunate situation, beyond the ordinary term, we should never too Foon resign the unhappy object to his fate, but try every method for his relief, as there are many well attested proofs of the recovery of persons to life and health who had been taken out of the water appa- rently dead, and who remained a considerable time without exhibiting any signs of life. The first thingto be done, after the body is taken out of tire water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. Iu doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw with the head a little raised, and carried on a cart or men's shoulders,and kept in as natural and ea3y a position as possible. A small body may be carried in the arms. In attempting to recover persons apparently drowned, the principal intention to be pursued is, to restore the natural warmth, upon wbicj all the vital functions depend; and to excite these functions by the appli- cation of stimulants, not only to the skin, but likewise to the lungs, intestines, &c. Though cold was by no means the cause of the person's death, yet it will prove an effectual obstacle to his recovery. For this reason, stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and, as soon as n well heated bed can be got ready, he may be laid into it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm-water, to the soles of his feet, and to the palms of his hands. Strong volatile spirits should be frequently applied to the nose; and ihe spine of Die*'bick and pit of tbe stomach may be rubbed with warm brandy or spirit of wine. The temples ought also to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjo- ram, may be blown up the nostril". To renew the breathing a strong person may blow his own breath in- to the patient's mouth with all the force he can, holding his nostril at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desi3t from * OF DROWNED PERSONS. 353 blowing, and should press the breast and belly so as to expel the air again ; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate natural respiration. If the lungs cannot be inflated in this manner, it may be attempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a wooden pipe fitted at one end for tilling the nostril, and at the other for being blown into by a person's mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary. When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the wind-pipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery. To stimulate the intestines, the fume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose which may beusedwhen at hand; but where these cannot be obtained, the business may be done by a common tobacco pipe. The bowl of the pipe must be filled with tobacco well kindled, aud, af- ter the small tube has been introduced into the fundament, the smoke may be forced up by blowing through a piece of paper full of holes wrapped round the mouth of the pipe, or by blowing through aji empty pipe, the mouth of which is applied close to that of the other. This may also be done in the following manner. A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the bowl of wliich tobacco is to be kiudled, and tbe smoke blown up as directed above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the ad- dition ofa little salt and some wine or spirits, may be frequently ad- ministered. This may be done by a common clyster-bag and pipe; but, as it ought to be thrown well up, a pretty large syringe will answer the purpose better. While these things are doing, some of the attendants ought to be preparing a warm bath, into wliich the person should be put, if the above endeavours prove ineffectual. Where there are no conveniences for using the warm bath, the body may be covered with warm salt, sand, ashes, giains, or such like. Tissot mentions au instance ofa girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her v. itli others equally hot, putting a bonnet round her head, and a stocking round her neck, stuficd with the same, and heaving coverings over all. After she had remained ha.t an hour in this situation, lur pulse returned, she recovered speech, and cried out, I freeze; I freeze; a little cherry-brandy was given her and she remained buried as it were under the ashes for eight hours; afterwards she was taken out, without any other complaint except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had re- mained ft* hours under water, by the heat of a dunghill. Till the patieut shews some signs of life, and i. able to swallow, it woukl be useless and even dangerous to pour liquors into his mouth. Ftps however, and tongue, may be frequently wet with a feaiber it in warm brandv cr other strong spinu ; and, a* soon a* he has i s ' 354 OF NOXIOUS VAPOURS. recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be administered. Some recommend a vomit alter the patient is a little re-animated ; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will notinjure the parts. Tissot in this case recommends the oxymel of squills, a table-spoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camo- mile-flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition ofa little salt, may, he says, supply its place. The doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are not expedient. We are by no means to discontinue our assistance as soon as the j patients discover some tokens of life, since they sometimes expire / after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cor- dial, liquor ought frequently to be administered. Lastly, though the ) person should be manifestly re-animated, there sometimes remains an oppression, a cough, and feverishness, which effectually constitute a 1 I disease. In this case it will be necessary to bleed the patient in the f arm and to cause him to drink plentifully of barley-water, elder-flower- if tea, or any other soft pectoral infusions. f Such persons as have the misfortune to be deprived of the appearan- • ■ ccs of life, by a fall, a blow, suffocation, or the like, must be treated f nearly in the same maimer as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. ' Alexander gives an instance to the same purpose in the Edinburgh Physical and Literary Essays, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These, and other instances of a similar na- ture, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly persist- ed in. j OF NOXIOUS VAPOURS. AIR may be many ways rendered noxrous, or even destructive to animals. This may either happen from its vivifying principles being destroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of sup- porting fire nor the life of animals. Hence the danger of sleeping iu close chambers with coal fires. Some indeed suppose the danger here proceeds from the sulphureous oil contained in the coal, which is set at liberty and diffused all over the chamber; while others imagine it is owing to the air of the room being charged with phlogistonA-srBe this as it may, it is a situation carefully to he avoided. Indeed it is danger- i ous to sleep in a small apartment with a fire of any kind. I latelWMttL four persons who had been suffocated by sleeping in an apartfl ^L where a small fire of coal had been left burning. «^ % OF NOXIOUS VAPOURS. 355 The vapour which exhales from wine, eyder, beer, or other liquors in the state of fermentation, contains somethiug poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger iu going into cellars where a large quantity of these liquors, is in a state of fermentation, especially if they have been close shut up for some time. There have been many instances of persons struck dead on entering such places, and of others who have with difficulty escaped. When subterraneous caves, that have been very long shut, are open- ed, or when deep wells are cleaned, which have not been emptied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason no person ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified by burning gun-pow- der in ir. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in ; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire. The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. Tliere have however been instances of people killed by the fumes of lamps which had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly oppressed in apartments illuminated with many can- dles. Such as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into tlie open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned as to have lost their feeling and understanding, the following means must be used for tlieir recovery. The patient should be exposed to a very pure, fresh, and open air ; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or if that does not succeed, in the neck. His legs ought to be put into warm water, and well rub- bed. As soon as he can swallow, some lemonade, or water, and vine- gar with the addition ofa little nitre, may be given him. Nor are sharp clysters by any means to be neglected ; these may be made, by adding to the common clyster, syrup of buckthorn and tinc- ture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonsful of common salt may be put into the clyster. The same means, if necessary, which were recom- mended in the former part of this chapter, may be used to restore the, circulation, warmth, &c. TT Mr. Tossach, surgeon at Alloa, relates the case ofa man suffocattfl by the steam oPburning coal, whom he recovered by blowing his breath intojhe patient's mouth, bleeding him in thearm and causing him to be well nibbed and tossed about. And Dr. Frewen, of Sussex, mentions **te f}B a young man wbo was stupified by the smoke of sea-coal, fts recovered by being plunged into cold water, and afterwards u a warm bed. * 35C r.i'rr,iyia or cviKbivic K,ytL.u. The practice of plunging persons suffocated by noxious vapours iu cold water, would seem to be supported by the common experiment of suffocating dogs iu the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake. EFFECTS OF EXTREME COLD. WHEN cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circula- tion in the extremities, and forcing too great a proportion of blood towards the brain ; so that the patient dies ofa kind of apoplexy, pre- ceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some alleviation of his sufferings, would, if indul- ged, prove his last. t Such violent effects of cold are happily not very common in this i country; it frequently happens, however, that the hands or feet of tra- vellers are so benumbed or frozen, as to be in danger ofa mortification, if proper means are uot used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very com- mon, when the hands or feet are pinched v. itli cold, to hold them to the , fire ; yet reason and observation shew that this is a most dangerous j and imprudent practice. Every peasant knows, if frozen meat, fruits, or roots of any kind be I brought near the fire, or put into warm water, they will be destroyed, by rottenness or a kind of mortification; and that the only way to re- B cover them, is to immerse them for some time in very cold water. The ' same observation holds with regard to animals in this condition. When the hands or feet are greatly benumbed with cold, they ought > either to be immersed in cold water, or rubbed with snow, till they re- j cover their natural warmth and sensibility ; after w hich the person may I be removed into an apartment a little wanner, and may drink some cups of tea, or an infusion of elder flowers sweetened with honey. Every person must have observod, when his hands were even but slightly af- fected with cold, that the best wa\ to v>