li gy" ■ ii & *& ■IN. / „*. : -*-. "-" > . ! <*• r **.* • .. i' • ■4 fa '.V.1 l ■o V.,-* -■■ tJt >f A sj; K- ; ■.'■ ■«. > • ■i*T,;-; « >*?* ^>_>S-J ^ "T^sa^s^^-'" UNITED STATES OF AMERICA WASHINGTON, D.C. OPO 16—67244-1 M/W*4_ -CfeUlu.* ■£&. MEDICAL ADMONITIONS TO FAMILIES, RESPECTING THE PRESERVATION OF HEALTH, AND THE TREA TMENT OF THE SICK. AtSO, A TABLE OF SYMPTOMS, :■?:-. VIN'G TO POINT OUT THE BEGREE OF DANGER, AND", TO DIETINGViSS ONE DISEASE FROM ANOTHER : WITH OBSERVATIONS ON THE IMPROPER INDULGENCE OF CHILDREN, &C^ By JAMES PARKINSON, m. d. HOXTON. How best the fickle fabric to support Of mortal man ; in healthy body how A healthful mind the longest to maintain. ARMSTRONG. jFirtf't ametican, front tie jfourt?) (Engltefj €Uitton. PORTSMOUTH, Nsw.Ham*s*i*s : Printed tor CHARLES PEIRCE, bv N. S. &? W. PEIRCE, 1803. s*^?r •V*oXf>wfi:i^>w A ?>K- X / INTRODUCTION TO THE TABLE of SYMPTOMS. AN the moft trifling affairs, hardly any one will be found who will entruft another, with the per- formance of any bufinefs of the nature of which he js uninformed. Should any one be afked to truft another with the turning of a toothpick, out of fome fubftance which he valued, merely^ on the recommendation of his having an excellent fet of tools, and an effay on the art of turning, he would confider that fome practice would be necefTary to give him the art of turning the wheel, with due velocity and regu- larity, and of holding the tool, and of applying it in the moft proper manner. He would remark that repeated obfervation and experience were required, to give a knowledge of the grain of various fub- ftances, and in what diredion the grain of differ- ent % 4 MEDICAL ADMONITIONS. ent fubftanees mould be worked ; and that witta out this knowledge, he would be likely to fhiver to pieces the fubftance on which he operated, in- ftead of majcing it affume an iifeful and beautiful form. He would therefore fay, No, you muft ex- Ctife me, I muft apply to fome artift of more judg- ment and ability, for I will not have my toothpick fpoiled. But often when life itfelf is at ftake, much lefs circumfpe&ion is employed than in the turning of a toothpick—the treatment of fome dangerous difeafe is confided to any one who poffefles a medi- cine eheft and the fmall fhare of fkill which is de- rived from the perufal of fome treatife on domeftic medicine. To deftroy the ftrange infatuation on which fuch inconfiftency depends, would be a hopelefs endea- vour ; but humanity fuggefts, nay, commands, that every thing be done which may be Jikely to lefTen the evils refulting from it. If men will, in fpite of remonftrance, rufh into danger, they are not, therefore, to perifh unaided. Should any one obftinately put to fea without a compafs to fleer by, and without any knewledge refpecting the nav- igating of a fhip ; but what he picks up during his voyage; by reference to fome treatife on navi- gation, it would not be fufficient, merely to endea- vor to diffuade him from making the ralh attempt, But MEDICAL ADMONITIONS. 5 But if he perfift, every pofTible afliftance Ihould be yielded him : the perils he has to fhun mould be clearly pointed out, the different rocks and quick- fands he is to avoid, mould be marked ; and the different circumftances fhould be defcribed which may fhow his near approach to danger. With a fimilar intention, is the following table given ; it is by an attention to fymptoms, that the phyfician is enabled to fleer his courfe with conhV dence and fafety, and to difcover the dangers which threaten. By u reference to the following table, and by examining the fymptoms moft prominent at the commencement of difeafe, domeflic practi- tioners therefore, may more readily detecl: the dif- ' eafe which they wifh to remove ; and will be then better able to determine, as to the propriety of taking the tafk of curing it. on themfelves. If this be refolved on, a reference to the table may alfo ferve to fhow the degree of danger which is marked by any particular fymptom, which may arife in the progrefs of the diforder, and wjiich calls for very powerful affiftanceo TABLE OF SYMPTOMS. —o<@>©— ANXIETY. WHEN fever is accompanied by extreme anx- iety, the patient fuftaining, at the fame time, a confiderable lofs of fpirits and ftrength, the fever may be judged to be of a malignant kind, and to require the moft powerful aid. APHTHJE, fee Thrush. APPETITE, loss of, When accompanied by fqueamifhnefs, vomiting, diftention and pain of the ftomach, eruftations and heart-burn, weaknefs of the ftomach has taken place ; demanding a judicious regulation of the diet, and the ufe of corroborant remedies. Returning in fevers and other acute difeafes, a figr* of a fpeedy recovery. For 8 MEDICAL ADM0N1TI0>.5.. For things, feemingly improper, may often be in- dulged, in fever, not only without any ill confe- quence, but frequently with confiderable advan- tage. BELLY, pain of, in lying-in women. If within a few 4&ys after delivery, a confiderable degree of forenefs and pain is experienced in the belly, preceded by cold fhiverings ; the pulfe becoming quick and fmall, the fkin dry, the head and back painful, the breathing difficult, and the patient oppreffed with exceflive anxiety and dejection of fpirits ! there is great reafon to fup- pofe the Puerperal Fever, as it is termed, has come on : requiring the moft judicious and prompt exertions. Violent pain of, chiefly poffefling the parts about the navel, vomiting and obftinate coftivenefs, with fever, fhow the exiftence of inflam?natio?i of the bowels, a difeafe which in general terminates fatally in a very few days, if proper remedies are not early adopted. >» Griping pains of, chiefly about the naval, accom- panied by troublefome urgings, and generally preceding flimy or mucous flools, in which fmall ftreaks of blood are perceivable, fhow the difeafe to be Dyfentery or Bloody Flux. BLOOD, MEDICAL ADMONITIONS. 9 BLOOD', *aifcd by Coughing. In every cafe in which blood is raifed by coughing, it may be concluded that fome blood-veffel in the lungs is ruptured. This circumftance is gen- erally followed by Confumption, to mention this muft be fufficient to induce early attention. Raifed by vomiting. Blood thus difcharged, muft proceed from the ftomach ; and except in cafes of interrupted menftrual difcharge, is attended with no fmall degree of danger. Spitting of, without cough or vomiting. This always proceeds from the mouth only, and is therefore unaccompanied by danger. Difcharged ff om the Noftrils. This feldom occurs but in fuch a ftate of the fyftem as demands great care, that by a fparc regimen and a due employment of exercife, fuch a degree of fulnefs of the blood-veffels be prevented, as may produce Confumption in the young, or Apo- plexy in the aged. Flowing from the Fundament. This may in general be concluded to proceed from the Piles, if this be not the cafe, fome internal mifchief is to be feared. B BLOODY 10 MEDICAL ADMONITIONS. BLOODY STOOLS, y?f a very Serious 'tendency. :•' y:. ; FAINTING. When it occurs frequently, points out a very de- bilitated ftate of the fyftem.. n-, FEVER, Accompanying pain in any internal part, fhows in general, that inflammation is eftablifhing itfelf in that part ; and can only be removed by an im- mediate employment of jjowerful means. >u Increafing about noon and evening, with fweats during the%tter part of the night*; and the tr- rine depofit-ing'a braivlike Sediment, gives reaSon to Suppofe that Some change in the fyftem, full of danger, has taken place. FITS, Happening juft before the eruption of the Small- pox, are not always, though generally fucceeded by a favourable kind. GIDDINESS, With ficknels of the ftomach and lofs of appetite, fhows the Stomach to be foul. Ac- MEDICAL ADMONITIONS. TO. Accompanied with head-ach, finging in the ears, and impaired powers of recollection, threatens apoplectic or paralytic attacks. HANDS and FEET Swelling IN SMALL POX. As the Swelling of the head and face fubfides, is a favourable Symptom. HEAD - ACH. Continuing, with violence, through the courSe of fevers, fhews that a fatal termination of the fever is to be apprehended. With giddinefs, ficknefs, and loSs oS appetite, but without fever, accompanies foulnefs of the Stomach. With rednefs of the face and eyes, and fever, are fymptoms of inflammation of the brain. Accompanying Inflammation of the Eyes, is in gene- ral a mark of danger. With eructations, and lofs of appetite, points out Indigeftion. With -pain and tenfion at the pit of the ftomach, generally proceeds from wind pent in the ftom- ach. When accompanied by a ftricl ftate of the bowels, may be attributed to that circumftance. With 20 MEDICAL ADMONITIONS, \ With florid countenance, and a full, fluggifh pulfe, may arife from fullnefs of blood. With chillinefs,flight fhiverings,and great laflitude, generally diftinguifh the commencement of fever. HEAT At the pit of the ftomach and four rifings, consti- tute the Heart-burn, arifing from Weaknefs of the ftomach. Jfay not, in putrid fevers, arrive at fuch a degree as to excite a neceffary degree of alarm, in the friends of the patient, With pain in any external part, gives reafon to fufpect inflammation to be proceeding to fuppura* Hon, Internal, with cold limbs, in fevers, points out great danger, HICCUP, Succeeding to confiderable evacuations, Shows much danger. Occurring in the progrefs of internal Hjjbtnma- tion, gives reafon to fear the coming on imMor- tiftcation. y m Is an alarming Symptom in cafts of Aupprefion of Urine. "^^J *\ .*, Shows MEDICAL ADMONITIONS. 21 Shows great danger to exift in cafes of ftrangulated rupture. HOARSENESS, Generally found to accompany eruptive fever of meafles. LASSITUDE, And real debility, generally precede the other Symptoms of fever. And languor, in children, fhould always excite vi- gilance in parents and thoSe who have the care of children. LEGS, SWELLING OF, In a very flight degree, in perfons rather advanced in years, and ufing but little exercife, is not to be regarded as an alarming circumftance. In perfons beyond the middle ftage of ttfe, who are affected by difficulty of breathing, may be confidcred as entirely depending on the diford- ered ftate of the lungs ; and as pointing out the necefiity of exertions being made for their relief. With diminution of urine, and failure of ftrength, fhould be confidered as a warning that fome important change in the Syftem is taking place, perhaps tending to Dropfy. LIPS. 22 MEDICAL ADMONITIONS. A, . • LIPS. Eruptions on, fucceeded by fcabs, in fevers, is a fa- vourable fymptom. LOOSENESS, Occurring in cafes of hectic fever, with night fweats, fhows danger. MATTER, Discharged from the lungs, hectic fever being alfo prefent, a mark of confumption. Of a purulent appearance may be difcharged from the lungs, and if without hectic fever, confump- tion may not fucceed, if very powerful means are employed. MENSES, When SuppreffeoJ in consumption no benefit will be derived from endeavouring to procure their return ; their fuppreflion being a fymptom, not the caufe of confumption. MIND, Much dejected in the beginning of fevers, gene- rally points out a confiderable decree.of malig- nancy in their nature. PALN, Internal, with fever, requires particular attention ; it in general denoting inftammafyn of fome inter- nal part. Suddenly MEDICAL ADMONITIONS. 2,$ Suddenly ceafing, in cafes of internal inflammation, the countenance finking, the pulfe becoming very quick and fmall, with frequent cold fhiver- ings, gives caufe to fear the coming on of morti- fication. In cafes of internal inflammation, gradually dimin- ifhing, and a fenfation of weight in the part gradually arifing, with fome degree of anxiety, fhews that fitppufatioh is taking place. IN THE HEAD, With fever, rednefs of« the face and eyes, and ina- bility to bear noife and light, are fymptoms of inflammation of the brain or its membranes. ; » IN THE EAR, With feverifhnefs, fymptoms of inflammation in tin ear. IN THE CHEST, With a fenfe of oppreffion, and of heat lfilder the breaft bone, with a faltifh tafte in the mouth, generally precedes fpitting of blood. "... . ' ■, * In the cheft, with fever, difficulty and fhortnefs of breathing, are marks of inflammation of the Jungs. If the other fymptoms here enumerated are pre- fent, the difeafe may be concluded to exift, al- ' though the pain be not confiderable. 'ACROSS - 24 MEDICAL ADMONITIONS. ACROSS THE CHEST. Coming on fuddenly, during walking, and parti* cularly whilft going up flairs, or afcending a hill; a pain alfo being felt, at the fame time, about the middle of the arm, are fymptoms of the dif- eaSe termed Angina Pectoris. PAIN OF THE SIDE, IncreaSed by drawing in the breath, an4 particu- larly by coughing, with hard pulSe, and diffi- culty of laying on the pained fide, denotes Pleurify or Inflammation of the Pleura or membrane inveft- ing the infide of the cheft. IN THE LEFT SIDE OF THE CHEST, With fever, great anxiety, irregular pulfe, faint- ings and palpitations, are fymptoms of inflamma- tion of the heart. IN THE LEFT SIDE, Under the fhort ribs, with fulnefs and tenfion, dis- tinguishes the inflammation of the fpleen. ON EITHER SIDE OF THE CHEST, Not very acute, nor violently increafed during in- spiration, may occur in conSequence of an affec- tion of the mufcles of the cheft. IN THE RIGHT SIDE, Under the fhort ribs, extending to the fhoulder, with fever, points out inflammation of the liver. OVER MEDICAL ADMONITIONS. 2$ OVER THE WHOLE BELLY, Increafed by ftraitening the body, extreme forenefs and fever, mark inflammation of the peritoneum, or membrane lining the cavity of the belly. Very violent vomitings, obftinate coftivenefs and fever, diftinguifh inflammation of the bowels. ABOUT THE NAVEL, Very fevere, with coftivenefs and contraction of the belly, are fymptoms of Colic. With frequent flimy ftools, ftreaked with blood, point out Dyfentery or Bloody Flux. AT THE BOTTOM OF THE BELLY, With fulnefs and extreme tendernefs on preffure, and frequent painful attempts to pafs urine, which efcapes only in fmall quantities, fhows inflammation to have pofleffed the bladder. IN THE BACK, One of the firft fymptoms of fever, and generally occurs to a great degree in malignant and in erup- tive fevers. IN THE LOINS, Pafling forwards toward the bottom of the belly, fever, vomitings, numbnefs of the thigh, and drawing up or pain of the tefticles in the affected fide, accompany inflammation of the kidneys. D IN CL6 MEDICAL ADMONITIONS. IN THE LARGE MUSCLES, AND IN THE JOINTS, Without rednefs, Swelling, or fever, occurs in Chronic Rheumatifm. With Swelling, redneSs, and Sever, diftinguifh acute or Inflammatory Rheumatifm. IN THE SHIN BONES, Or in the head, Suffering a confiderable augmenta- tion in the evening, demands immediate atten- tion. IN THE JOINTS OF THE GREAT TOE, Inftep, or hand, generally preceded by Some affec- tion of the ftomach, and coming on moft com- monly in the night, characterizes the- attacks of Gout. IN THE LIMBS, Generally occurs at the commencement of fever. AT THE PIT OF THE STOMACH, With vomitings, may proceed from Gall-Stones. At the commencement of fever, is often followed by a difeafe of a confiderable degree of malignity. Alfo frequently precedes the eruption of the Small Pox or Meafles. And heat in the ftomach, increafed by the Swal- lowing of even fluids, with vomitings, extreme anxiety, and fever, with are fymptoms of infiam- mation of the flomach. AT MEDICAL ADMONITIONS. 27 AT THE BOTTOM OF THE BELLY, With heat, Swelling, and tenderneSs on preffure, Srequent vomitings and fever, are fymptoms of inflammation of the womb. Darting, in the region of the womb, generally accompanies a fchirrous *r a cancerous flate. PALPITATION OF THE HEART, May proceed from fome difeafe, originating in the heart itfelf j or may be Symptomatic of general debility. With quick and difficult breathing, after moderate exercife, and fallownefs of the complexion, marks of chlorofis. Irregular pulfe, extreme anxiety, and frequent fits of Suffocation, generally accompany Dropfy of the Pericardium. PAROXYSM, FEBRILE, Returning repeatedly, after twenty-four hours in- termiflion, diftinguifhes the Quotidian Ague. Returning after an intermiflion of forty-eight hours, the Tertian Ague ; And, after an intermiflion of feventy-two hours, the Quartan Ague. PULSE 28 MEDICAL ADMONITIONS, PULSE Quick, fucceeding to cold fhivering, and accompa- nied by heat, fhows the exiftence of fever. Quick, hard and ftrong, with preternatural heat, points out inflammatory fever. Similar to the foregoing accompanies particular in* flammation. Hard, fmall and quick, is generally found with inflammation oftheflomach or bowels. Quick, fmall and weak, with extreme debility in fevers, fhows the fever to be malignant, and great danger to exift. REDNESS OF THE SKIN. Diffufed, hot and but little fwelled, the fkin only elevated as with a little roughnefs, diftinguifhes the Eryflpelas, or St. Anthony's Fire. OF THE CHEEKS, Coming on with the hectic fever, marks Confump- tion. RESPIRATION QUICK AND SHORT. With fever, and tightnefs acrofs the cheft, indi- cates inflammation of the lungs. SHORT AND QUICK, Pains in the fide of the cheft and fever, diftinguifh Pleurify. DIFFICULT, MEDICAL ADMONITIONS. 2$ DIFFICULT, Recurring by fits, without fever generally marks Aflhma. Awaking the patient with confiderable alarm, with weight acrofs the cheft, and Swelling of the feet, points out water in the chefl. May alfo accompany Inflammation of the Liver, various affections of the heart and large veffels, diftenfion of the bowels by wind, and the pre- ternatural enlargement of any of the bowels. RESPIRATION. Snoring and long, with the appearance of deep fleep, diflinguifhes Apoplexy. DIFFICULT, A bad Symptom, in all Severs. RIGIDITY, At the fide oS the face, and back of the neck, and difficulty of Swallowing, are the firft fymptoms of a Locked Jaw. SHIVERING, Is the firft fymptom of every febrile or inflammatory difeafe. In fevers, not fucceeded by increafe of heat and fweat, an unfavourable fymptom. Occurring 3© MEDICAL ADMONITIONS. Occurring in the latter ftages of fever, the patient being very low and weak, is alfo an unfavoura- ble fign. With delirium, following intoxication, threatens a dangerous affection of the brain. After violent inflammation, fhows that fuppuration is taking place. •* In the fmall-pox, about the ninth day, the fkin ap- pearing fhrunk, and the puftules flattening, and becoming pale at their baSes, fhows danger. SICKNESS Occurring after having been in the chamber of a perfon in a fever, fometimes marks the firft im? preffion of infection, requiring the immediate employment of an emetic, Accompanied with pain at the ftomach, heartburn, and lofs of appetite, fhows the weaknefs of the ftomach. SIGHING Frequent, in fevers, a bad fymptom, SIGHT, EXTREMELY INDISTINCT, In fevers, the patient being much exhaufted, fhows muqh danger. INDISTINCT. MEDICAL ADMONITIONS. 32 INDISTINCT. The eyes becoming uneafy and hot, after reading, kc. the eye requiring to be removed farther for the examination of any minute object than* it has been wont, fhows the convexity of the cornea to have become morbidly difeafed, and that the ufe of convex glaffes is pofitively indi- cated *. Affefted by dark fpots and ftreaks-appearing on the objects viewed, fhows a ferious affection of the eyes, but this is not, as has been fuppofed, a Sign that blindneSs muft inevitably Sollow, Since this affection may fometimes be removed by pro- per meafures. SKIN, COLD, Whilft great thirft and internal heat are experi- enced, is a bad fymptom in a fever. PUNGENTLY * In a publication of this kind, it would be worfe than folly to facrifice utility to a fcrupulous adherence to order ; the above indication is therefore introduced, although rather out of place, from a conviction, that through inattention to this circura- ftance, the eyes are often confiderably injured. Obje&s require painful exertion to obferve them diftincfly; this being frequently done, the organs of vifion are (trained, and all the range of eye- waters employed, when the cure is onlv to be found in the ufe of a pa/r of Spectacle 33 MEDICAL ADMONITIONS. PUNGENTLY HOT, Leaving a fmarting fenfation of heat on the fingers of the examiner, fhows great malignancy in fever. OF A GREENISH YELLOW. Gives name to the Green Sicknefs. YELLOW, As well as the urine and the whites of the eyes, and the ftools white, diftinguifhes Jaundice. SLEEP Returning, with appetite for food, may be confid- ered as a moft favourable fymptom in every fever. Calm, after delirium, is a favourable event. SLEEPINESS Often precedes and accompanies the Eryfipelas of the face ; and if it increafes with the difeafe, it points out much danger. SNEEZING, Difcharge of a limpid fluid from the eyes and nofe, and frequent cough, fhow that Catarrh and Coryza, as it is termed, are forming. SPIRITS DEPRESSED IN THE BEGINNING OF FEVERS, Shows the fever to be of a low and malignant kind. DEPRESSED MEDICAL ADMONITIONS. 33 DEPRESSED WITHOUT CAUSE, Lofs of appetite, ficknefs, pain, and oppreffion in the ftomach, diftinguifh hypocondriacul affefiions. SPITTING, Difcoloured with blood, raifed by coughing, fliows fuch a ftate of the lungs as requires the greateft care and attention. SPOTS LIVID, Accompanied with putrid and bleeding gums, and great weaknefs, are the Signs of Scurvy. PURPLE, A fymptom marking great danger in malignant fever. STOMACH, Pain of, may proceed from ulcers or worms. VIOLENT PAIN OF, With vomiting and fever, are fymptoms of inflam- mation of the flomach. PAIN AT THE PIT OF, With ficknefs, recurring at uncertain periods, and fucceeded by flight yellowneSs of the fkin, accom- panies the palling of gall ftones. Painful diftention of, after even moderate eating, generally proceeds from weaknefs of the ftom- ach. y STOOLS 34 MEDICAL ADMONITIONS. STOOLS WHITE, Shew an obstruction of the gall through the ducts; hence alfo yellownefs of the fkin, or Jaundice. BLACK, With fudden relief from violent pain in inflamma- tion of the bowels, fhow great danger. SLIMY, Sometimes bloody, and griping pains, are fymp- toms of Dyfentery, or Bloody Flux. STUPOR, After wounds, or blows on*the head, requires par- ticular attention. SWALLOWING DIFFICULT, And acutely painful, with Swelling and redneSs of the back of the mouth or upper part of the throat with fever, marks inflammatory fore Throat. And not extremely painful, white crufts or floughs forming in the upper part of the throat,, and a low fever, point out, efpecially if a fcarlet erup- tion appears on the breaft, arms, &c. that the fore Throat is of the ulcerated malignant kind. Coming on gradually, and without pain or fever gives reafon to fear a contraction is taking place in MEDICAL ADMONITIONS. 35 in the gullet. Endeavours for it's cure are only to be made with a profpect of fuccefs during the commencement of the difeafe. Of liquids, inability of, and dread of water, confti- tute the difeafe termed Hydrophobia. m Of liquids, fometimes impeded in cafes that are plainly Hyflerical. SWEAT, GENERAL AND PROFUSE, Occurring in cafes of inflammation, a favourable fymptom. PROFUSE, Succeeding to hectic heat, with difficulty of breath- ing, cough, and Spitting of purulent matter, dif- tinguifh confumption. BREAKING OUT GRADUALLY, And continuing fome time, is, in general, a favour- able fymptom in fevers. Almoft always concludes the fit of Ague. COLD, Breaking out about the face and neck in fevers, fhows great weaknefs and danger. SWELLING OF THE HEAD AND FACE, Takes place, in fmall-pox, according to the number and confluency of the puftules. Ac- 3$ MEDICAL ADMONITIONS. Accompanies and fucceeds Eryfipelas, or St. Antho- ny's Fire in the face. OF THE HANDS AND FEET, In Small-Pox, fucceeds, to the fwelling of the head and face. ABOUT THE ANGLES OF THE JAW, With flight fever, diftinguifhes the Mumps. OF THE HEAD, Ift young children, who are heavy, drowfy, and even at times convulfed, gives reafon to fear Dropjy of the Brain. OF THE FORE PART OF THE HEAD, Large belly, the reft of the body thin, and the joints enlarged, are fymptoms of the Rickets. OF THE UPPER PART OF THE RIGHT SIDE OF THE BELLY, Gives reafon to apprehend Enlargement of the Liver. OF THE BELLY, Elaftic and fonorous, on being ftruck by the fin- gers, diftinguifhes the Tympany. The ftroke of the fingers producing a difcoverable nuftuation, diftinguifhes the Afcites, or the col- lection of water in the cavity of the Belly. AT MEDICAL ADMONITIONS. 37 AT THE BOTTOM OF THE BELLY, With Suppreffion of urine, or frequent inclination to void it, with pain, tendernefs, or preffure, characterize Inflammation of Urine. OF THE SCROTUM, Painful and hard, fhows inflammation of the part. Not painful, rather pellucid, and giving the idea of fluctuation on being gently ftruck with the fin- ger, diftinguifhes Hydrocele, or Dropfy of the Tef- tide. Gradually increafing downards, and enlarging upon Sneezing or coughing, fliows Hernia, or protrufion oS Some part of the bowels. OF THE FEET AND HANDS, In Small-Pox, generally takes place as the fwelling of the face fubfides. OF THE FEET, Where confiderable difcharge of blood has taken place, fhows that a dangerous degree of debility is brought on. Is, in general, a fymptom demanding particular attention. OF ANY PART, With heat, rednefs, tenfenefs and throbbing, fhows an Abfccfs to be forming in that part. Cold 3» MEDICAL ADMONITIONS. Cold, pallid, and retaining the impreflion of the fingers, diftinguifhes cedematous dwellings. IN THE BREAST, Solid, the edges rather hard and not very painful, is moft probably, fchirrous tumour, which, unlefs removed, will terminate in Cancer. OF THE GLANDS In the fides of the neck, with fwelling and chap- ping of the lip, and large belly, fhow a Scrophu- lous difpofition. TASTE, BITTER, SickneSs, want oS appetite, and pain at the ftomach, are Symptoms of indigeftion and weaknefs of the ftomach. ACID, With the foregoing fymptoms, alfo occurs in weak- nefs of the ftomach. TEETH, GRINDING OF, In fever, a fymptom of danger. In children, a fymptom of worms. ACHING OF, A fymptom of inflammation, or Caries. Covered MEDICAL ADMONITIONS. 39 Covered with dark, foul, vifcous matter, in fevers, generally marks malignancy. TENDONS. Twitching, at the wrift, in fevers, fhows danger. TESTICLES SWELLED, Occurs fometimes at the clofe of the difeafe called the Mumps. DRAWN UP, And affected with aching pain, with pain in the back, ftretching forwards and downwards, with ficknefs at the ftomach, are fymptoms of gravel in the kidneys, or ureters. THIRST Generally prefent in fever. Frequently occurs in fever ; but, when wanting, where the tongue is parched and foul, fhows danger. Is generally a troublefome Symptom in Dropfy. THROAT, SWELLED AND RED, Swallowing very painful, mark the inflammatory Sore Throat. OF 40 MEDICAL ADMONITIONS. OF A DEEP CRIMSON COLOUR, With whitifh fpecks, fpreading and deepening ; extreme debility, and the pulfe fmall and quick, diftinguifh the putrid ulcerated Sore Throat. THRUSH, OR APHTHA, Little ulcers, generally white, appearing on the tongue, infide of the lips, cheeks, &c. * When thefe occur to children, it may in general be concluded either that the food of the child is not Sufficiently nutritious, or that the child breathes an air too impure. Frequently appear in the latter ftage of confumption. Appearing in fever, not always to be considered as a Symptom of extreme danger, but fometimes as a mark of a critical, and even favourable change having taken place* TONGUE, TREMBLING AND BLACK, A fymptom of danger in fever. Parched, without thirft, in fevers, is a bad fymp- tom. ' HARD TUMOUR OF, Though fmall, demands immediate care. TOSSING ABOUT, A frequent fymptom in dangerous fever. TREMOR, MEDICAL ADMONITIONS. TREMOR, In fever, a fign of great debility. VOMITING, Frequently fymptomatic of inflammation of the kidney, and is generally excited by the paffing of gravel. Very frequent, extreme pain in the ftomach, fever, and fmall hard pulfe, diftinguifh Inflammation of the Stomach. With great pain in the bowels, fever, obftinate cof- tivenefs, and hard and fmall pulfe, point out in- flammation of the bowels and ftrangulated rupture. After blows or wounds on the head, gives reafon to fufpect very Serious injury. BILIOUS, With frequent bilious ftools and pains in the bow- els, are the fymptoms of the difeafe termed Cho- lera Morbus. URINE. DEPOSITING A BRANNY RED SEDIMENT, And the foles of the feet and palms of the hands frequently difagreeably hot, mow hectic fever to be prefent. F BLOODY, 42 MEDICAL ADMONITIONS. BLOODY, Shows a rupture, or morbid dilutation of fome blood veffel, in the kidneys, bladder, or urinary paffage. WITH A CREAM-COLOURED SEDIMENT, Blended with fmall light-colou»ed flakes, mark the existence oS an Ulcer in the bladder. HIGH-COLOURED, Generally accompanies inflammation, and inflamma- tory fever. HIGH-COLOURED, Depofiting a Sediment of a pink, or of a brick-duft colour, generally fhows difeafe of the liver. IN THE COLD STAGE OF AGUES, Generally limpid, in the hot ftage high-coloured and clear, and, during the abfence of the fever, depofiting a reddifh fediment. WITH AN OILY SKIN On the furface, points out a dangerous wafting. PASSING IN EXCESSIVE QUANTITY, Proceeds from Diabetes. COPIOUS AND VERY LIMPID, But of a natural colour and quantity at intervals, generally accompanies nervous affections. May MEDICAL ADMONITIONS. 43 SUPPRESSION OF, May occur as a fymptom of inflammation of the kidneys, ureters, bladder, or of the urethra, or urinary paffage ; it may alfo be occafioned by a paralytic affection of thefe parts and by ftrictures in the urethra. , Faffed without the patient's knowledge in fevers is a bad fymptom. WAKEFULNESS, Long continued, in fevers, with great eagernefs of attention, denotes the approach of Delirium. WEAKNESS, And indifpofition to motion, a Symptom of Cbloro- fits or Green Sicknefs. Extreme, at the beginning of fevers, generally marks malignity. YAWNING, Generally occurs at the commencement of the ague fit. i©*©**©*©* Medical Admonitions. tammmm^^m^^.^———————__ MY DEAR FRIEND, I COMPLY, with the utmoft willingnefs, with your requeft to Supply you with fuch information as may prevent you, on the one hand, from unne- ceffarily incurring the expence of medical attend- ance in the various trifling ails to which you and your family may be Subjected ; and, on the other, from facrificing a friend, or perhaps a beloved child, by delay or improper interference, in fome infi- dious difeafe. I undertake the work with additional pleafure, derived from the flattering confideration that I may, by its publication, render an effential fervice to thofe, who like yourfelf, being fur rounded with large families, are anxious to avoid unneceffary expence : but are, at the fame time, aware of the high degree of guilt which accompanies the omit- ting to obtain all that is in their power to mitigate the Sufferings, or to Save the liSe of a fellow-creature. I Shall not endeavour to furnifh you with in- structions for the cure of difeafes in general. This has indeed been induftrioufly attempted by feveral ingenious 46 MEDICAL ADMONITIONS. ingenious writers on Domeftic Medicine, but cer- tainly not with thoSe beneficial conSequences which I hope their authors intended. On the contrary, I fear that their difciples, not aware of the fhallow- nefs of the knowledge thus gained, immediately on the appearance of difeafe, fly with confidence to their oracles ; but, incapable of comprehending the various circumftances comprifed in the anfwers they receive, they frequently adopt the very means they fhould have avoided ; and thereby increafe the evils they were endeavouring to remove. , It is not a loofe and- vague affertion, that the direc- tions, given in fuch a work, are only intended for thofe cafes in which a phyfician cannot be eafily obtained, that will be Sufficient to deter a weak mind from obftinately confiding, even in the moft Serious cafes, in the knowledge derived Srom the peruSal oS a Specious, conciSe, and apparently com- prehenfive method of cure, Directions Sor the cure of difeafes Shall, in this work, be confined to thofe in which no rifque can be incurred, by trufting them to the management of a domeftic practitioner. Such difeafes will not only be accurately defcribed, but the fymptoms will be carefully marked out which diftinguifh them from thofe difeafes which differ from them in degree of danger, and in the mode of treatment they MEDICAL ADMONITIONS. 47 they require. The fymptoms of thofe difeafes in which the attendance of a phyfician or other medi- cal character, is required, will alfo be carefully marked ; the particular circumftances which ren- der fuch further aid neceffary, will be pointed out; and the mifchiefs, likely to arife from improper in- terference, particularifed. Since the degree of vio- lence, duration, and danger, as well as the confe- quent injuries the patient may experience, fre- quently depend upon the means employed in the firft moments of the attack in acute difeafes, and upon tli6 conduct adopted on the > occurrence of fudden and alarming circumftances in chronic dif- eafes ; the moft proper means to be employed on thefe occafions wijl be diftinctly laid down. The utility of thefe directions muft be Sufficiently evi- dent, as, particularly in the country, regular medi- cal afliftance often cannot be obtained, in thefe cafes of fudden emergency, with Sufficient fpeed ; and the diftrefs and confufion of thofe around the patient, will be likely to impede the due exercife of their judgment; and to prevent their exertions being made, with that promptnefs which the fitua- tion of the patient may demand. Another important tafk I Shall endeavour to per- form, is that of inftructing the attendants on the fick, how they may beft aid the effects of the means prefcribed 48 MEDICAL ADMONITIONS. prefcribed by the phyfician. In vain may the moft appropriate remedies be prefcribed, unlefs the di- rections with which they are accompanied be duly attended to. But unfortunately, it too often hap- pens, that the orders of the phyfician do not ex- actly coincide with the opinions of thofe about the patient; and whenever this happens, it is much to be feared, that either the directions are not com- plied with at all, or only to fuch an extent as by no means will accomplish tlifc purpoSe intended. When preSumptuous nurSes, or the timid friends of a patient, deviate from the directions of the phyfician, by omitting that which he has recom- mended, or by adopting that which has been fug- gefted by Some neighboring doareSs, the miSchiefs unfortunately do not flop here ; for, not chufing to have their folly known, they carefully conceal from the phyfician their departure from his direc- tions. Puzzled at finding the meafures, which he fuppofes to have been employed, have failed of ef- fecting thofe changes he expected ; and, unable to account for appearances, the eonfequences of means which have been ufed without his knowledge, the phyfician is himfelf prevented from forming an ac- curate judgment of the fituation of the patient. Of fuch importance is the information which is required under this head, that I fhall not only take every MEDICAL ADMONITIONS. 40 every opportunity to communicate particular di- rections ; but fhall trefpafs on your time, in this place, for the fake of offering to your confideration one or two general observations. Medical men have too frequently the opportunity of obferving, that whenever, Srom the urgency oS the caSe, mea- sures apparently Severe are recommended, the Sympathizing relatives, with more tenderneSs than judgment, delay punifhing, as they term him, the poor Sufferer, until Some trifling change ariSes, which may afford them the Shadow of an excufe for omitting them entirely ; and thus is the critical moment Suffered to flip, without employing thoSe remedies which alone could have Saved the patient. The tormenting reflections, which muft harraSs the minds of thofe, who become convinced oS hav- ing thus facrificed their friend or relation, muft exceed the powers of conception ; they not only Suffering regret for their loSs ; but, alSo experienc- ing the painful compunction, oS having robbed the object oS their affection of the only chance that exifted, of obtaining a refcue from the hands of death. One of the firft objects of enquiry, on the death of a beloved friend or relative, is, whether the utmoft that art could do has been performed ; the mind Seeking to obtain fome confolation, from the affurance that no meafures had been omitted, from which any advantage could have been de- G rived. $Q MEDICAL ADMONITIONS. rived. Frequently it happens, that this enquiry a inftituted, with too much feverity and unfairnefs, by the afflicted, felf-accufing furvivors. Fear left they fhould have imprudently occafioned the event they deplore, magnifies every SuSpicion ; and the recollection oS the moft trifling circumftances fixes the barbed fling in their mind. On this effential point, therefore, I fhall think it neceffary Srequently to dwell ; and to endeavour, by the arguments which each particular caSe may produce, to obtain that Strict compliance with or- ders, without which the beft adapted medicines may fail of their effects. In doing this another talk will arife ; that of re- futing thofe vulgar errors and prejudices which frequently occafion an injurious interference, as well as an equally pernicious neglect during the firft attack of the difeafe. By Shewing how unsup- ported Such opinions are by reaSon, and by pointing out the miSchiefs arifing from their influence, much benefit muft therefore arife. You will, I hope, be- lieve, that I entertain no wild expectation of con- quering the prejudices of doctreffes and of nurfes themfelves. No ! The object of endeavour under this head, is entirely to warn the friends of the fick, againft the delufive prophecies and counSels of thefe moft dangerous fibyls. By MEDICAL ADMONITIONS. 51 By expofing the evils refulting from the too fre- quent practice of domeftic quackery, it may be hoped too, that the benevolence of the rich may be directed into more ufeful channels. At prefent it too frequently happens, that perfons of influence and property are too much difpofed, with the help of a family medicine cheft, and a treatife on domeftic medicine, to become the difpenfers of phyfic to all k their poor neighbors ; and to believe, that they are thereby rendering more fervice to the community, than by contributing to the Support of thofe na- tional benefits, public hofpitals. Having made thefe prefatory obfervations, I fhall commence my promifed undertaking with a few, I truft ufeful, remarks on a difeafe, which, from the frequency with which it occurs, and from the danger with which it is accompanied, claims our firft attention. FEVER. Fevers begin with fome degree of cold Shiver- ing, to which increafed heat and quickened pulfe fucceed, with diminution of ftrength and interrup- tion and diforder of feveral functions. In the pro- grefs of every fever may be difcovered three dif- ferent States, which are termed the cold, the hot, and $1 MEDICAL ADMONITIONS. and the Sweating Stages or fits : thefe, fucceeding in the order here defcribed, constitute a paroxySm, When theSe paroxySms Succeed each other, with but little abatement of the fymptoms between them» Slight tranfitory chills take the place of a cold Shiv- ering, and are Soon Succeeded by the hot fit j this continues for feveral hours, and leffens as a flight t perfpiration comes on, but which is often very trifling, and fometimes, as well as the cold fit, is hardly perceptible. The increafe and abatement of the fymptoms, not being fo confiderable as dis- tinctly to mark the different Stages of each parox- Sym, the diSeaSe appears to be one continued hot fit, and is therefore termed a Continued Fever. When, between each paroxySm, there occurs an evident, but Short abatement, or remiflion of the violence of the fymptoms, the difeafe is called a Remittent Fever, When an interval of fome hours occurs between each paroxyfm, in which there is a complete intermiflion, the difeafe is termed an Intermittent Fever or Ague. Continued Fevers are divided, according to their duration, into Slow or Acute j they are again di- vided into Inflammatory or Nervous ; the latter fometimes acquiring the farther diftinction of Pu- trid or Malignant. Intermittent MEDICAL ADMONITIONS. 53 Intermittent Fevers are alSo divided, according io the length of the interval between each parox- ySm, into Quotidians, Tertians, and Quartans. There are other neceffary divifions of Fever, but thefe are the moft important, and Sufficient, I hope, to authorise me to make the Sollowing observation. In a diSeafe, which requires Such numerous divi- fions to mark the differences between its Severn Species, it muft be obvious, that much ftudy and experience muft be neceffary to enable any one to make a proper discrimination ; and, as thefe dis- tinctions are indifpenfably neceffary to be made, previous to the determining on the plan o !ure, you muft plainly fee that the cure ought only t: be attempted by thofe, who have caref,Ily Stud— the nature of the difeafe, and have diligent, v •■: ferved its feveral varieties. It muft L.'ieed r.t- al- lowed, that it is not difficult to perceive thefe dif- ferences, and point out thefe diftinctions, w,.sn the difeaSe has nearly paffed through its courSe. But, in almoft every caSe of fever, it is neceffary th-.c this diftinction fhould be made, in an early per. J of the difeafe ; for fhould any one, who attempt; the cure of fever, not be able, in its beginning, to make the neceffary difcrimination, there exifts the greateft probability, that the evils he Suffers to in- creafe, as well as thofe which he brings on by im- proper 54 MEDICAL ADMONITIONS. proper treatment, will be too great and too numer- ous to be fubdued, when the nature of the difeafe becomes known, and the moft proper means for its removal is adopted. It is very eafy to lay down nice and accurate distinctions between difeafes, in books, and the mind of the reader is often Satisfied of the eafe, with which he could make a practical application of them ; but every phyfician knows, that thefe difcriminations are not eafily made in the firft Stages of difeafes, but by thofe who poffefs that knowledge to obtain which, both Study and expe- rience are required. For the fake of exemplification, it is proper to remark, that .the firft fymptoms of an acute inflam- matory fever, and thofe of a flow nervous fever, are often fo fimilar as to point out, very equivo- cally, the difference between thefe difeafes ; fo that little chance can exift of any one, but an experien- ced obferver, afcertaining the fpecies of the fever, until the occurrence of fuch fymptoms, as Shall, not only Strongly mark its peculiar nature, but may alfo Jhew that the difeafe, aggravated by delay or injurious treatment, requires the utmoft exertions of even the moft Skilful phyfician, to prevent a fatal termination. Since MEDICAL ADMONITIONS. £^ Since thefe fevers are well known to arife from two different, nay, contrary flates of the fyftem, their indications of cure muft therefore be oppofite; it muft be obvious, that the adopting of the treat- ment adapted to the one, in the endeavour to re- move the other, muft be likely to be fucceeded by very injurious confequences ; and yet, from what has preceded, it is very evident, that this miftake is very liable to be made by thofe domeftic practi- tioners, who undertake the cure of fever, without a fufpicion of their own incapacity. The difference which takes place in fevers from the change of feafcyis, and the nature of the reign- ing epidemic, ought to be enquired into previoufly to inftituting a plan of cure : fince, from thefe circumftances, a confiderable difference may be oc- cafioned, in the nature oS the diSeaSe, and conse- quently in its mode of cure. But, from this infor- mation, the domeftic practitioner muft generally be precluded ; it being, of courfe, confined to thofe, whofe profeffion gives them the opportunity of remarking the progrefs of the difeafe, in many dif- ferent Subjects. The Small-pox, meafles, and other eruptive dif- eafes, as well as feveral diforders which differ very much in their respective natures, do yet agree in this particular, that their firft appearance very ex- adly 56 MEDICAL ADMONITIONS. actly refembles that of fimple fever ; and they of- ten, even for the firft two or three days, are with- out any particular fymptom, by which their pecu- liar nature can be afcertained, unlefs by thofe, who are informed of the nature of the prevailing epi# demic ; and are well acquainted with thofe parti- cular fymptoms, which are the threatening precur- sors of thefe feveral difeafes. The mifchievous ef- fects which muft arife from the interference of the ignorant, in thefe cafes, muft be fo obvious, as not to require to be here particularifed. INTERMITTENT FEVERS O R AGUES. Intermittent Fevers are compofed of feveral diftincl paroxyfms, in general, returning with a fhivering, having an evident intermiflion between each paroxyfm. The ague begins its attacks with inducing a con- fiderable degree of weaknefs and laffitude, with fre- quent ftretching and yawning ; foon after a fenfa- tion of cold is felt in the back and extremities, which foon pervades the whole body ; this increa- fes, until the limbs, as well as the trunk of the bo- dy, become agitated with frequent violent fhiver- ings. MEDICAL ADMONITIONS. Cf ings. This ftate continues Some time, during which a violent pain of the back and head, and a fenfation refembling a Stricture acrofs the ftomach, frequently diftrefs the patient j and the fenfe of coldnefs becomes fo great, that no endeavours to obtain warmth are of the leaft avail; the agitation of the whole frame being alfo, fometimes, fo vio- lent, that the patient is with difficulty held in his chair ; the pulfe becomes Small and Srequent ; the breathing, oppfeffed j and the urine, clear and al- moft colourleSs. TheSe are the principal Symptoms which diftinguifh the Cold Fit. Theie Symptoms fubfiding by degrees, give way to warm flufhings, which gradually increaSe, until rednefs and heat, much greater than natural, is ex^ tended over the whole body ; the patient, at length, burning with Such extreme heat as to be now, as Solicitous for the refrefliing fenfation of cold, as he was before anxious to mitigate its violence. His Sufferings become now increafed by an almoft in- fatiable thirft, and a pain of the head, Sometimes ending in delirium, and Sometimes bringing on a lethargic and almoft apoplectic ftate ; the pulSe becomes more hard and Sull; thereSpiration, freer; and the urine, high coloured, but without fedi- ment. Thefe are the -chief fymptoms obfervable la the Hot Fit. TT After 58 MEDICAL ADMONITIONS. After thefe complaints have exifted Some time, the heat gradually declines, the thirft leffens, and the fkin is relaxed, a Sweat gently breaks out on the head, and gradually diffufes itSelf over the whole body : this increafes, until it becomes pro- fufe, after which it abates, and by degrees entirely ceafes. During this ftage, which is termed the Sweating Fit, the pulfe becomes flower and Softer, and the breathing more free ; the urine, after the fweat has continued fome time, depofits a fediment, which is generally of a reddifh colour. The above flages of the difeaSe having been gone through, the patient enjoys an intermiflion of the fymptoms, which lafts according to the par- ticular type which the difeafe affumes. According to the length of time in which the paroxyfm returns, the ague obtains its name. If the paroxyfm returns every day it is termed a Quotidian, if every third day a Tertian,, if every fourth day a Quartan, &c. The remote caufes of agues are, firft, the effluvia which arife from marines or moift grounds acted on by heat j Secondly, cold, eSpecially when accom- panied by moifture. TheSe will neceffarily act with more certainty, if a predifpofition to the difeafe exifts. This predifpofition may be induced by too fpare MEDICAL ADMONITIONS. 59 fpare living, exceffive fatigue, watching, exceffive ftudy, indulgence in crude and watery food and in fpirituous liquors, and by preceding difeafes ; particularly fuch as have been attended with large evacuations, in a word, by every thing which tends to weaken the fyftem. Although the fymptoms, which have been defcri- bed, may appear to be Sufficiently characteristic, to prevent agues Srom being mistaken for any other difeafe, even by a domeftic practitioner -, yet fuch an error may be very likely to take place : for in- termittents are often accompanied by fuch irregu- lar fymptoms, as render it very difficult to afcer- tain the real nature of the difeafe. The Sagacious Sydenham obServes, that "It has "happened in every epidemical conftitution, that "in Some oS thoSe who had the Sever (the inter- "mittent Sever) the fit did not begin with chills "and Shivering, but the patient was attacked with "Symptoms reSembling true apoplexy. What need "(he Says) oS more words, Sor it affumes So many "Shapes as to imitate almoft all the diSeaSes to "which mankind is liable V Need there be any reServe then uSed, in point- ing out this diSeaSe as one oS thoSe, which does not come within the reach oS domeftic practice; Since, from pO MEDICAL ADMONITIONS. from the ambiguity of its firft appearances, fuch mistakes may take place as may prove dangerous jn their confequences ? Befides, fevers frequently Occur, which, at firft, appear in a continued form; but in which, after a little time, certain fymptoms appear, pointing out, to the difcerning obferver, a difpofition to affume the form of an intermittent. In fuch cafes, the greatest Skill is required ; for on the mode of treatment adopted, at this period, the length of the difeafe, and the life of the patient, may depend : Since, if due care be now taken, the difeafe may be brought to intermit, and foon after- wards be entirely removed ; but, if this opportu- nity be loft, its violence may be increafed, and its duration dangeroufly protracted. So much danger to a patient, and alarm to his attendants, will fometimes be produced, by an in- termittent Suddenly changing into a continued fever, as ought to deter family practitioners from attempting the cure of ague. Another cafe oS alarm and confufion, to which they will be expofed, is the irregularity with which the paroxyfm re- turns. The deviation is frequently fuch, as will prevent, even the moft intelligent, from directly determining, whether the fever is, or is not, an intermittent. After MEDICAL ADMONITIONS. bj After what has been already remarked, it cannot be expected that a full and regular plan of cure fhould be detailed here. Inftead of this, a general idea of the mode of cure fhall be given, with a few detached, but, it is hoped, ufeful obfervations on the regimen and conduct of the patient. The virtues of the Peruvian bark, in the cure of agues, are fo univerfally known, that it may have the appearance of an artful caution, to fuggeft, that any difficulty or danger can ariSe, Srom the endeavours to obtain the cure of ague by its means. But every medical man knows, that, with the ague, may exift certain Slates of the vifcera, which, if not corrected, previoufly to administering the bark, the ague may be, indeed, removed, but other difeafes, of a very ferious and alarming nature, may be in- duced. On the other hand, cafes occur very fre- quently, in which, although the bark be given very early, and in large quantities, the ague con- tinues to harrafs the constitution for a confiderable time ; and, at length, brings on Such an enfeebled ftate of the fyftem, as may terminate in dropfy, and even in death itfelf. Agreeable to your requefl, I Shall occasionally point out fome few paffages in your once favour- ite book (Buchan's Domeftic Medicine), as Seem to be likely to be more productive of harm than of good ; 62 MEDICAL ADMONITIONS. good ; accompanying them with fuch obfervations, as may, in my opinion, prevent you, and my other readers, from being lulled into the neglect arifing from a falfe fecurity; or from being excited to the adoption of raSh and dangerous meafures. The fol- lowing paffage is certainly not Sufficiently guarded,, to prevent its being productive of very ill confe- quences.—"Intermitting fevers, under a proper "regimen, will often go off without medicine; and "when the difeafe is mild, in an open, dry coun- "try, there is feldom any danger from allowing it "to take its courfe; but when the patient's flrength "feems to decline, or the paroxyfms are fo violent, that "his life is in danger, medicine ought immediately "to be administered." Domeftic Medicine, i \th edit. "p. 149. The injuries which the ftrongeft conftitution Suf- fers, from repeated attacks of agues, are often fo confiderable, as to produce the worft of confequen- • ces. Surely, therefore, much evil may be feared from a paffage like this, which is fo likely to add to that fupinenefs, with which many are difpofed to Suffer the ravages of difeafe. The doctor after- wards fays—"When the difeafe is very irregular, or "the fymptoms dangerous, the patient ought imme- diately to apply to a phyfician." But advice like this cannot but be prejudicial, both to the patient and MEDICAL ADMONITIONS. 63 and the phyfician ; for if a patient is not to apply to a phyfician, until the fymptoms are fo violent, that his life is brought into danger, the opportu- nity of obtaining his recovery may be paft by : and the fatal termination of the difeafe will often be imputed to the want of fkill, in the attending phy> fician ; when, its caufe is only to be found, in the having permitted the tampering with domeftic medicine to have produced fuch effects, as no exer- tions of art could remove. The empirical practice of thofe, who depend on amulets and charms for the cure of this difeafe, is not of very dangerous tendency ; any farther, than as it tends to place the patient in a ftate of imagi- nary fecurity ; which induces him to wafle that time, in which he might, by proper means, have gotten rid of the difeafe. There are, indeed, nu- merous inftances, in which we have reafon to fup- poSe, that the force of ftrong expectation has pro- duced fuch effects on the fyftem, as have put off the paroxyfm, and even cured the difeafe. There are alfo feveral hiftories of cafes related, in which the cure of ague has been produced by fudden and violent affections of the mind : by a fimilar opera- tion, perhaps, it is, that thofe remedies act, th« taking of which occafions a great degree of horror and difguft ; Such is the frequently mentioned remedy of fwallowing a large fpider, mafhed, and formed 64 MEDICAL ADMONITIONS. formed into a bolus, or involved in its web. Other* remedies recommended by thefe practitioners are not fo innocent, fuch as a large dofe of gin, with the addition of pepper, or the fudden application of cold water to the whole furface of the body.' A melancholy inftance of the ill effects of the lat- ter practice 1 once witneffed, in a young man, who had been for fome time afflicted with an autum- nal quartan : the good woman of the houfe, hav- ing purpofely procured his removal out of the bed, fuddenly threw over him a pail of cold water : the whole furface of the body directly had its florid hue changed for a livid purple, a confiderable oppref* fion of the cheft, with other alarming fymptoms, directly came on, and, notwithftanding the em- ployment of the moft powerful means to fave him, he expired in a few hours. The REGIMEN muft neceffarily be adapted to the feveral flages oS the diforder. In the cold fit, it is moft likely, the patient will not be inclined to take much ; a little barley-water, water gruel, or camomile-tea, for the fake of promoting ficknefs, will perhaps be all that is neceffary. During the hot fit, the drinks may be barley-water, mint-tea, or orgeat ; to which may be added, if the patient wifhes it, the juice of lemons or oranges, and a fmall quantity of the fyrup of capillaire : although the fweat is, in general, fuppofed to be fooner in. duced. Medical admonitions* 65 duced, by thefe drinks being given Slightly warm, yet it is not neceffary, that the patient Should be entirely debarred, from the luxury of a draught of cold toaft and water. When the Sweating begins, the drinks I have juft enumerated may have a little white wine added to them ; and, if the patient be able to take it, he may have a bafon of beef-tea, fago, falop, &c. During the time of intermiffion, the diet fhould be as nutritious, as the patient's appetite and digeilion may prompt him to adopt. Every thing which contributes to keep up the natural difcharge, by the pores of the fkin, and which gives ftrength and tone to the veffels, is ufe- ful in the cure of this difeafe ; hence exercife muft be peculiarly proper, fince nothing tends more to ' produce thefe beneficial effects. The exercife fhould be of that kind, to which the patient has been moft accuftomed ; and taken in the open air, unlefs wet weather, or damp fituation, forbids it. Care muft be likewife taken, that it be not ufed to fuch a degree, as to occafion much fatigue ; fince that, inftead of reftoring ftrength, muft induce debility. Prevention. ThoSe who are particularly liable to returns of this difeafe, Should endeavour to mend that peculiar ftate of the fyftem, which is known to produce a difpofition to it. This is to be accompliflied by avoiding, as much as poffible, I the 66 MEDICAL ADMONITIONS. the circumftances above enumerated, under the head of remote caufes, and carefully attending to the advice juft given, as to regimen and exercife. INFLAMMATORY FEVER. This fever is very rarely met with, efpecially in this climate, unleSs accompanied with the inflam- mation of fome particular part.* A confiderable degree of fhivering, and fevere pain in the fmall of the back, are the firft fymptoms of this fever. Thefe are fucceeded by an intenfe heat of the whole body; the countenance becomes of a deep crimfon colour, every veffel appearing turgid with blood ; the eyes are red, and Suffer much uneafineSs from the admiffion of light ; the arteries in the neck and temples throb violently ; the pulfe is ftrong, rapid, and full; the fkin, tongue, and all the infide of the mouth, are parched ; the urine of a very high red colour ; and the patient complains of the moft infatiable and diftreffing thirft. He likewiSe Suffers Srom difficulty of breath- ing, and a confiderable pain and confufion in his head ; and toffes about in the bed, Srom exceffive reftleffneSs. A delirious ftate Soon comes on ; and, if, * Dr. Blane obicrves, that the continued inflammatory fever is very uncommon in the Weft-Indies. MEDICAL ADMONITIONS. 6j if the diSeaSe be not oppofed by SucccSsful means, this Symptom becomes So violent, that the exertions of four or five perfons will be hardly fufficient to retain the patient in his bed. Soon after this, hic- cough, flarting of the tendons, involuntary dif- charges, and cold, clammy Sweats, fhew, that na- ture is nearly exhaufted, and the diSeaSe invincible. Fevers which, in the courSe of a few days, will Shew Strong marks of their being of the putrid kind, may commence with fymptoms fo nearly refem- bling thofe of the fever juft deScribed, as to render it very difficult to diftinguifh the one from the other. But thefe difeafes differ So much, in their real nature, and in the mode oS cure they require, that a miftake would, moft probably, be Succeeded by the moft dreadful confequences. The cure of this fever is to be obtained by timely bleedings, proportioned to the ftrength of the patient, and the violence of the difeafe ; antimo- nial medicines, given with a careful attention to their dofes, and the effects they produce ; the free adminiftration of opening medicines ; and the ufe of vegetable acids, neutral falts, fudorifics, &c. as the Symptoms may indicate. But fhould even the difficulty of afcertaining the difeafe be removed, and the malady be exactly known by the family practitioner, he certainly would not dare to attempt its 68 MEDICAL ADMONITIONS. Jts removal : when, from his inability, not only of making a proper felection of the means, but of de- termining alfo the extent to which they may be employed, the life of his patient might very likely be loft. Regimen. This difeafe depending on too great an action and fulnefs of the veffels, it is obvious, we fhould carefully avoid fuch things, as may be likely to increafe either of thefe circumftances, The room fhould be kept cool, by a conftant fuc- ceffion of frefh air ; the covering of the patient Should not be fuch, as to allow of the accumula^ tion of the heat of the body. The body Should be kept, as nearly as poffible, in a Slate of reft ; and, if the head appears to be difpofed to be deranged, the body Should be placed, as much as poffible, in an erect pofture. Animal food, of every kind, muft be ftrictly refrained from, even in the form of broths ; as well as all aromatic, fpirituous, and even the weakeft fermented liquors. Thirft may be allayed by drinking freely of watery liquors, made pleafantly acid with the juices of lemons, cit- rons, oranges, currants, &c. for this purpofe, bar- ley-water, mint and balm tea, anfwer very well ; and, for the fake of greater variety, orange-whey, tamarind drink, lemonade, orgeat, and capillaire, may be mentioned, as being well calculated for the fame purpofe. Oranges, currants, grapes, in fa&, every MEDICAL ADMONITIONS. 69 every fruit which the feafon affords, may be al- lowed ; and, when other fruit is not to be obtained, apples, roafted or boiled, may Supply their place. The clumber Should be kept as quiet as poffible, and Somewhat darkened. The patient fhould con- verfe no more than is absolutely neceffary ; and every circumftance, likely to intereft his mind, fhould carefully be kept from him. If the pro- moting of Sweating be intended, the hands and feet fhould be frequently bathed, or fomented with Warm water. The prefent opportunity muft not be paffed over, of remarking on the evil confequences arifing Srom the neglecting oS the phyfician's orders, with re- Spect to the conduct of the patient, as to his regi- men, &c. It is too frequent a practice, as has been before obferved, with nurSes, and other attendants on the fick, to make Such alterations, in this reSpect, as Tnay reduce the plan recommended, a little nearer to their own ideas ; and it generally hap- pens, that this liberty is taken, even in thoSe diSea- Ses, where an attention to theSe circumftances is moft neceffary : Sor there the reflections propoSed are Such, as are moft likely to meet with oppofi- tion from the ignorant. Thus, by a miftaken ten- dernefs, the diet above prefcribed, will often be va- ried, and the life of the patient brought into dan- ger, 7° MEDICAL ADMONITIONS. ger, by thofe who think, a patient muft foon be ftarved under fuch a regimen. But, with the hope of preventing this dangerous interference, it muft be here obferved, that, in this Slate, the patient will not only derive no more Support from the moft nourifhing diet, than from that which is here di- rected, but that he will be rendered, by it, more languid and uncomfortable : for the ftomach, par- ticipating in difeafe with the reft of the fyftem, performs its functions very imperfectly ; hence a very fmall part of this food is digefted, and con- verted into chyle, while the remainder occafions to the patient, the moft diflreffmg fenfations of anx- iety and oppreffion. SLOW NERVOUS FEVER. ' It is fuppofed, by fome phyficians, that the flow nervous fever, and the putrid malignant fever, are the fame fpecies of difeafe : and that the putrefcent ftate of the fluids, difcoverable in the latter, is an incidental circumftance ; and therefore, only ren- ders it a variety of the fpecies : whilft others have fuppofed them to be difeafes of entirely different fpecies. But fince, from the occurrence of fymp- toms denoting putridity, a confiderable difference is required in the treatment, it is thought proper, without entering into the merits of the queftion, to MEDICAL ADMONITIONS. Jl to treat of them feparately ; as the more appro- priate mode of treatment, in each cafe, may thereby be more clearly fliewn. The infidious manner in which this difeafe makes its attacks, is one reafon of its fo frequently termi- nating fatally. The firft departure from health is fo gradual, and the fymptoms fo ambiguous, that very frequently the patient will have Suffered the diSeaSe to have made a very confiderable progrefs, beSore he efteems it neceffary to apply for affiftance: and often will a difcerning phyfician, when firft called in this difeafe, difcover a patient to be in a very alarming condition, who is not fufpected, by himfelf or his attendants, to be in the leaft degree of danger. If this be duly confidered, it muft im- prefs the mind of every one, with a conviction of the neceffity of immediate application for regular medical help, at the firft appearance of thofe fymp- toms, which, in the following hiftory of the difeafe, mark its beginning. If this be done, there is the greateft probability, that the train of dreadful fymptoms, which is there defcribed as coming in fucceffion, will be checked in their approach. The History of the Disease. This difeafe, in general, begins with extreme liftlefsnefs, and un- willingnefs to move, with a fenfe of wearinefs; indifference to food, naufea, depreffion of fpirits ; and yi MEDICAL ADMONITION.'. and frequent flight and irregular chills, alternating' with tranfitory flufhes of heat. A dull and heavy pain, with a fenfe of coldnefs, poffefies the back part of the head, and is accompanied by a flight giddinefs ; the disinclination to motion increafes, the countenance is fhrunk and pale, bearing evi- dent marks of anxiety ; the breathing is perform- ed with Some little difficulty, the patient complain- ing oS an oppreffion on the cheft, and a tightneSs acroSs the pit of the ftomach ; frequently fighing, without knowing for what caufe. The fymptoms generally get worfe as evening comes on ; nature obtaining, at night, fome flight refreshment, from fhort flumbers, interrupted by diSagreeable dreams. The urine, in this firft ftage oS the diSeaSe, is moflly clear and colourleSs. TheSe Symptoms gradually increafe for a few days, when the pulfe becomes Smaller, and at the Same time quicker, than natural; the tongue gets lightly covered with a thin mu- cous coat, which Seems hardly to adhere to it. After the firft week is paft, the Symptoms will, in general, be found much increafed ; the fight of food, efpecially of an animal nature, excites difguft; the fhiverings are lefs, but the heat is in general more increafed, and the cheeks are frequently very much flufhed ; the anxiety and inquietude of the patient becomes more intolerable, the giddinefs and pain of the head more diftreffing, light and noiSe occafioning MEDICAL ADMONITIONS. ji occasioning much'uneafinefs ; the tongue becomes dry, red, and divided by large chaps : the urine, about this time, frequently depofits a bran-like Sed- iment. The patient obtains no refrefhment from his Slumbers, which are very much disturbed ; he frequently mutters vague and unconnected fenten* ces ; the hands tremble fo, as to prevent his guid- ing them to his mouth; the fingers are in con- stant motion ; the tendons agitated with frequent ftartings; the pulfations So Small and quick, as with difficulty to be counted ; the tongue trembles ; and is with difficulty put beyond the lips. A pro- fufe Sweating in Some, and a frequent purging in others, alfo occur, as the difeafe advances. If the remedies which have been had recourfe to, fail of producing the wifhed effects, fymptoms will foon appear, declaring the near approach of death : thefe are, a coldnefs of the extremities, which feem fhrunk, and of a pale, and almoft livid hue ; the nails appear almoft of a blue colour ; the eyes lofe their fenfibjlity and luftre, Swimming in tears, which now and then trickle down the cheeks ; the Stools and urine are voided without the patient's knowledge ; the brain becomes So affected, that all recolleftion and SenSe is loft. A conftant delirium accompanies this ftate, but without any efforts of violence; the deranged ftate of the mind, however, onng Sufficiently evident, from a conftant rnut- K ferino; 74 MEDICAL ADMONITIONS. tering of incoherent and fcarcely articulated founds. Convulfive motions affecting the whole frame, or an infenfible comatofe ftate generally clofing the Scene. But Sometimes, .even when the greateft part of the above Symptoms have come on, and death ap- pears, to a common obServer, as the inevitable con- sequence ; a Sudden amendment will take place, produced, either by the happy effects of medicine, or fome unexpected, favourable effort of nature. Inftances of fuch recoveries are by no means un- common ; and render the caution, contained in the following paragraph, abfolutely necefiary. When the greater part of the above defcribed appearances, are obferved in a patient, the defpair, and consequent inactivity, produced in his attend- ants, however they may be regretted, can by no means be wondered at : the Symptoms Seeming to- fhew, that death muft Soon put an end to the cal- amities of the unhappy Sufferer. So great a degree oS deSpair, indeed, poffeffes the by-ftanders, in theSe diftreffing caSes ; that frequently, when the medi- cal man fees confiderable ground of hope, they will, in the ftrongeft terms, condemn all attempts for his* recovery, as ufelefs and cruel : fince they imagine, that by thefe SuppoSed vain attempts, his torments, are increaSed, and their duration prolonged. To the MEDICAL ADMONITIONS. 75 the frequency with which this idea is adopted, may be attributed the death of numbers: for it feldom happens, when this opinion is entertained, that the ftrongeft remonftrances of the phyfician, can pro- duce the leaft exertions of the attendants, except, indeed, during the time he is prefent ; for imme- diately after his departure, all exertions ceafe. It is a circumftance that muft have occurred often, to every medical man, that having left a pa- tient, in this, or the putrid fever, with the moft earnefl entreaties to his attendants, to Supply him regularly with medicines, and almoft constantly with nourifhment, he fhall be told, at his next vifit, that they have not been able to procure the Swallowing of a drop of either : and Should he or- der the experiment rb be made before him, it will frequently happen, that the patient will take what is offered to him, not only with eafe, but with avidity. Such conduct cannot find a fufficient ex- cufe in mifapplied tendernefs ; fince the confe- quence, refulting from fo culpable an omiffion, may be the death of one, who otherwife might have been Saved : for, in all the long catalogue of difea- fes to which we are Subject, there are none, in which Symptoms of fo alarming an appearance are to be found, and where fo great a poffibility of recovery may exift, as in this, and the putrid malignant fe- ver, lnftances of recovery, from thefe difeafes, have 7& MEDICAL ADMONITIONS. have been fo really wonderful; that fo long as the patient breathes, his attendants fhould not devote themfelves to defpair ; but fhould perfift in their endeavours with unabated affiduity. » Having already given you reaSon to SuppoSe, that I would not Scruple to ftep out of my way, to give an ufeful admonition, I fhall not apologise for the digreffion, but point out one of the disadvantages refulting Srom intemperance. A phyfician, who is called to a patient afflicted with this or the putrid fever, will not fail to make enquiry refpecting his. former mode of living ; fince on the anfwer he ob- tains, his prognoftic of the event of the difeafe will confiderably depend : for, fhould the patient have unhappily devoted himSelf, to habits of debauchery, and intoxication, there will be*greater reafon to ap- prehend a fatal termination of the difeafe. To attempt to furnifh the domeftic practitioner, with information fufficient, to enable him to under^ take the cure of this fever, would be fruitlefs ; fince it would be certainly fafer, to omit medicine en- tirely ; than to entruft the management of the pa- tient, in fo dangerous a malady, to any but thofe, who are enabled, by their knowledge of the human frame, and of the difeafes to which it is fubject, to diftinguifh critical and falutary changes, from thofe which.are of a contrary tendency. So MEDICAL ADMONITIONS, 77 So general is an averfion to medicine, and fp great is its fway over weak minds ; that every circumltance, which tends to Support its tyranny, ought to be oppoSed : fince it is not to be doubted, that many have loft their lives, rather than mortify their tafte, or give up prejudices, which would ap- pear ridiculous even in a child. Dr. Buchan, whilft treating of the nervous fever, fays, "Though blift- " ering, and the ufe of cordial liquors, are the chief 'f things to be depended on, in this kind of fever ; yet,' "for thofe who may choofe to ufe them, we fhall mention " one or two of the forms of medicine, which are " commonly prefcribed in it." Now it is very reafonable to fuppofe, that many, who are guided by thofe ftrong averfions and prejudices, which I have juft mentioned ; if attacked with the*cLieafe we are treating of, would eagerly ca^h at t\\\?, au- thority, and refufe to make ufe of any tliir.g, but bliftcrs and cordial liquors ; they being, they would fay, the chief things to be depended on, in this khd of fiver • leaving other remedies for thofe who may choofe to ufe them. t The very great attention, which i> •:> been, of late years, paid to this fever, has rendered the practice of phyficians, of thefe days, exceed; r.dy fuccefsful ; So much So, that the cafe muft be at- tended by extraordinarily dangerous circumftan- ces, to prevent a cure being accompliflied ; even if the patient have but a fmall degree of ftrength.left. But, 78 MEDICAL ADMONITIONS. But, notwithstanding this, the beft informed phy- ficians know, that the various diftrefiing fymptoms which occur, oblige them to have recourfe to fev- eral powerful, and ufeful articles of the materia me- dica. The Regimen. After the ftomach and bowels have been cleared, the patient may be Supplied with food of a light and nutrient kind ; fuch as Sago, rice gruel, panada, and Salop, according as his in- clination may dictate. Good white wine may be added to theSe, as may be indicated by the ftate of the pulSe, and degree of languor ; and, for the fake of variety, he may be allowed to drink of red wine negus, bottled cyder, perry, and particularly, if the patient entertains a defire for it, porter. Animal food fhould be avoided ; unlefs the patient is anx- ious for it, when it will feldom do harm. But when the patient regains a defire for food, it will be beft to begin with puddings of various kinds, Shell fifh, &c. reSuming his uSual diet gradually, as he finds his health return. PUTRID MALIGNANT FEVER. The effluvia arifing from the human body, ac- cumulated, and long retained in the cloathing, &c. and the effluvia arifing from the bodies of thofe labouring MEDICAL ADMONITIONS. 79 labouring under this difeafe, are allowed to*be th<* moft ufual caufes of this fever. The Symptoms. This fever fometimes comes on with a great degree of rapidity ; but moft fre- quently it attacks in the fame flow and infidious manner, as was remarked to be the cafe, with the flow nervous fever, juft defcribed. The Shiverings; with which it in general commences, are, in Some caSes very flight and tranfitory ; in others, they are very violent. The fhivering is Succeeded by- febrile heat ; with pain in the head, loins, and, for the moft part, alfo in the limbs ; the dejection of fpirits, as well as the lofs of power in the whole nervous fyftem, is particularly obfervable. The pulfe is fmall, hard, and quick. Naufea and vomi- ting, are, alfo, among the fymptoms which appear at the commencement of this fever. The eyes foon have their luftre diminifhed ; their glaffy part ap- pearing dull, and that part which is termed the white of the eye, becoming of a yellow hue, blend- ed with red. The patient's breathing becomes la- borious ; and interrupted by frequent, deep, in- voluntary fighings : and the cheeks affume a deep crimfon, approaching to a purple. As the difeafe advances, the pulfe increafes in quicknefs, but lofes its hardnefs. The heat increafes ; fo as to give a very uneafy and lafting.fenfation of heat, to the fin- gers of any one, who applies them to the fkin of the 80 MEDICAL ADMONITIONS. the patient. Small red Spots appear on the fkiri^ reSembling thoSe remaining after the bites of fleas. The toi.^ue gets exceedingly dry, and is, in gene- ral, covered with a hard rough coat, of a dark brown colour ; the gums, and part of the teeth, are coated with a Similar covering. At length, if the remedies ufed, do not prove fufficient for the removiu of the difeafe, the pulfations of the arteries are reduced to indiftinct, tremulous vibrations; the Spots in the fkin increafe in number, and change their colour to a livid or dark purple. The patient conftantly employs his trembling fingers, as though engaged in picking flocks off the bed-clothes, or, as in purfuit of fome infect : this he continues, until a ftate oS fleepineSs Succeeds to that of deliri- um ; which foon terminates in fo lethargic a ftate, that the patient can hardly be rouSed, by the utmoft endeavours oS the attendants. Discharges oS blood Srom the noftrils, mouth, kidneys, &c. Sometimes happen juft before the death of the patient; which is generally preceded, alfo, by convulfive motions of the whole frame. The Urine, through the whole of the difeafe, differs much in its appearance. The Stools vary much, in different Subjects, as to their frequency : in general, there exifts a coftive ftate of the bowels, y in the firft days of the fever ; and a fatiguing and depreffing purging, towards the clofe. Sweating, which medical admonitions; 81 which, in general, is obtained with great difficulty, m the early part of the fever ; often comes on very profufely, after the firft eight or ten days ; When it is Sometimes critical, and denotes a favourable termination of the fever : but fometimes if is merely a confequence of the debilitated ftate oS the fyftem, which, in that cafe, it invariably increafes. When the fcene is contemplated, which has been juft defcrlbed ; the propriety of not offering, in a publication of this kind, to deliver a plan of cure, muft be fo obvious ; as to render it unneceffary to offer any other reafons, than thofe which were given, when treating of fevers in general. When doubt and alarm are excited, by fuch a variety of diftreffing Symptoms, the Sriends of the patient muft poffefs, more than ufual hardinefs, to venture to affume the office of the phyfician. But, unfortunately, there are many perfons, who, al- though they will not depend on their own judge- ment, in propofing a mode of cure, will fubmit, at the recommendation of fome ignorant," but well meaning friend, to ufe fuch remedies, with bold- nefs, which a perfon, properly informed, would ufe with the utmoft timidity. Thus, bleeding is often had recourfe to, immediately on the appear- ance of fever, it being the popular opinion, that bleeding is the moft effectual means of removing E that 82 MEDICAL ADMONITIONS; that difeafe ; whereas, the fact is, that there is riot one cafe of fever in a hundred, that will admit of this evacuation. Cafes of this, and of the preced- ing fever, in which it is proper, are very rare in- deed. The mifchiefs, which fucceed to its being improperly had recourfe to, in thefe fevers, are, in general, fo great; that no exertions, however fk.il- ful and vigorous, prove fufficient, afterwards, to Save the life of the patient. Dr. James's Powder and Emetic Tartar are med- icines, which are, almoft always, employed, by fam- ily practitioners, in their attempts to remove fevers. But the operations of thefe, and of other antimo- nial medicines, are, in general, fo violent, as to re- quire the utmoft caution in adminiftering them. Not only is it neceffary, that their dofes fhould be exactly adapted ; but alfo, that a Strict attention Should be paid, at the Same time, to various other circumftances, to Secure their beneficial effects. When, in addition to theSe confiderations, it is re- collected, that debility of the fyftem is that ftate, which moft certainly renders this difeafe fatal, the affertion muft obtain belief, that the ignorant em- ployment of remedies, fo powerfully debilitating, muft be accompanied with the great eft degree of danger. The celebrated Dr. Goldfmith loft his life, by the imprudent administration of Dr. James's Powder, as was clearly proved in the account of his MEDICAL ADMONITIONS. 83 his illnefs, publifhed by his worthy medical attend- ant, Dr. Hawes. Numerous other inftances might be adduced, of mifchiefs fucceeding the employ- ment of this, and fimilar medicines, by domeftic practitioners. • Another dangerous mode of treatment, which is frequently adopted in families, on the firft ap- pearance of fever, is ; that of confining the patient to his bed, under a great load of bed-clothes, in a clofe, heated chamber ; and plying him, profufely, with hot and fpirituous drinks, for the purpofe of forcing out perfpiration. But this effect feldom follows the ufe of thefe means ; but, on the con- trary, the confequences of thus increafing, that heat, which already exifts in a morbid degree, will be found to be ; the augmenting of the parched ftate of the Skin, and Still more rigidly doling its pores ; whilft the vigour of the fyftem, is, at the fame time exhaufted, by this accumulation of irri- tating circumftances. Regimen, and Management of the Pa- tient. Previously to delivering the advice which may be thought proper on this head, it is neceffary to obferve, that fo much depends on the care and vigilance of the attendants, that no ordinary nurfe ought to be trufted with this office ; unlefs the phyfician is exceedingly exact and decifive, in his orders 84 medical admonitions. orders ; and the friends of the patient equally care- ful in feeing, that his directions are literally obeyed." Whilft endeavouring to obtain the cure of this fever, the phyfician will be anxious to Support the ftrength of the patient, and to oppofe the tendency to putrefcency, which takes place in the fyftem. To affift in the accomplifhing of thefe intentions, is the office of the nurfe ; and of thofe, who take on themfelves the kind, and important tafk, of tending the fick : and is only to be executed, with advantage to the patient, by paying a Strict atten- tion to the following points : the due administra- tion of nourifhment and medicines ; the free admif- fion of frefh air ; the preventing of the accumula- tion of putrid effluvia ; and the careful ufe of fuch means, as may be directed, for the alleviation of particular fymptoms. With refpect to nourifhment ; it fhould not only be light and eaSy of digeftion, but it fhould alSo be of an antifeptic nature. It may, therefore, be compofed of fago, Salop, panada, &c. to which may be added, wine, in a quantity proportioned to the ftate of the patient. A glafs of pure wine, fuch as is moft agreeable to his palate, may be alfq frequently allowed ; in which may be dipped a piece of toaft or bifquit. Where it is thought proper to truft more to their antifeptic, than to their MEDICAL ADMONITIONS. 85 their cordial properties, wines made from fruit oi our own growth, are preferable ; fuch as wine made from currants, which contain a greater pro- portion of the vegetable acid, or, at leaft, in a lefs involved ftate, than is to be found in the foreign wines. Cyder and perry, especially if bottled, are exceedingly beneficial. But if, as is frequently the cafe, nature requires the free ufe of cordials ; none are fo falutary as claret, hock, or even the more generous wines, fuch as port, Sherry, or Madeira. Where the circumftances of the patient prevent his obtaining any of thefe, in the quantity required, bottled ale, or porter, will prove very ufeful fub- ftitutes. Nothing will be more Serviceable, in cor- recting the ftate of the fluids, than the free ufe of ripe and frefh-gathered fruits ; of thefe, the moft preferable arc currants, mulberries, oranges, ftraw- berries, grapes, and rafpberries. When thefe can- not be had, their place may be fupplied, by thofe fruits which may be in feafon ; or which allow of being preferved fome time, as apples, pears, &c. and if thefe cannot be obtained, recourfe muft be had to dried fruits and jellies, or marmalade, made by boiling the juices, or pulps of fruits with fugar. Jelly, made of ifinglafs or hartfhorn Shav- ings, is very ufeful ; being a very proper vehicle for the wine and acids ; and conveying nourifh- ment, at the fame time, into the fyftem. Beef-tea, or 86 MEDICAL ADMONITIONS. or broths, when ordered, Should be made Strong of the meat; but carefully cleared from every par- tide of fat. The drinks, which may confift of ap* pie-liquor, wine negus, barly-water, &c. Should be given cold, and impregnated with the juice of lemons, oranges, or citrons. Inftead of common water, Seltzer water Should be ufed, for all the drinks, which are prepared without heat. When the difeafe is nearly gone off, and the Stomach ap- pears to be regaining its powers, of digefting and affimilating the aliment it receives; beef-tea, and broths made of different animal fubftances, fhould be given more freely, and even folid animal food, may be permitted : efpecially if the patient anx- ioufly requeft it : fince it very feldom happens, that any ill confequence follows, from indulging the patient in thofe defires : befides, that the vex* ation and difappointment, confequent to the refu, fal, might not be without injurious effects, During the violence of the febrile heat, the par tient Should be allowed the indulgence of cold fpring water, for his drink ; and may frequently be refrefhed, by wiping his face, hands, and arms, with cloths dipped in cold water, to which a little vinegar has been added. This recommendation, of the application of cold water to the furface of the body, may not feem to accord with the cafe I related, MEDICAL ADMONITIONS. 87 related, when treating of ague, of a young man* who was killed by having a pailful of cold water thrown over him. But this poor fellow, worn down by a quartan ague, had been endeavouring, during the fhivering fit, to excite fome heat, by hovering over the fire ; and had juft retired to his bed, ftill fhivering, when the unfortunate affufion took place. But, in fever, Dr. Currie, phyfician to the Infirmary of Liverpool, has fhewn, that cold water may be poured over the naked body, not only without injury, but with confiderable benefit; but this muft be done, where circumftances are widely different, from thofe which exifted in this cafe :—the ftrength fhould not be greatly reduced ; the heat fhould be fleadily above the temperature of health ; and no fenfe of chillinefs fhould be pre- fent. The practice, fuccefsfully employed by Dr. Currie, is not, however, to be adopted, without due information : the rules juft mentioned, may, however, be oS Some advantage in directing the uSd of cold water, as a drink, &c. Before I conclude thefe inftructions, on the arti- cle of regimen, it is neceffary to add, with refpect to the uSe of wine, that, although it be abfolutely neceffary during the continuance of this fever ; and that, in fuch quantities, as to render it Surpri- sing how confiderable a portion may be taken, without producing any of thofe effects, which would 88 MEDICAL ADMONITIONS. would have proceeded from even a much lefs quan- tity, if taken by the fame perfon, when in health : yet, as foon as the fever has left the patient, much caution becomes neceffary in the ufe of it ; fince very difagreeable circumftances may follow, from too free ufe of it at this time. Several inftances have been feen, where patients juft recovered from this fever, during which they had Swallowed, with Salutary effects, confiderable quantities of wine, have, upon drinking only a few glaffes during their convalefcent ftate, experienced the return of a confiderable degree of febrile heat, and even of delirium : nor, have thefe cohfequences been either foon or eafily removed. For although, during the difordered ftate oS the Syftem, accompanying the fever, the patient be able to bear a much greater quantity of wine, than when in perfect health ; yet, when the fever entirely ceafes, the wine, not Only affects him as before ; but feems to have be- come capable of producing injurious confequencesi in proportion to the" degree of debility induced. For the fake of preventing the accumulation of putrid vapours about the patient, great attention Should be paid to the ventilation of the room, and to the frequent changing of the bed clothes. The patient fhould riot be confined to one room, but be removed from one to another: that which he has MEDICAL ADMONITIONS. 89 has left, having the windows and doors all thrown open, for the free paffage of the air ; the floors wiped with cloths, dipped in vinegar ; and fuch of the bed-clothes, as are not changed, expofed to the current of air; fince, by their known capacity for re- taining effluvia, they may become fo loaded with contagious and putrid matter, as to prove infectious to the attendants, and perhaps to impede the re- covery of the patient. The apartment may be frequently Sprinkled with rofe-water, or vinegar, and filled with the odours of ftrong fmelling plants. The fick perfon, in fome cafes, fhould be kept out of bed as much as poffible ;-and placed fo, as to face the current of air ; thd body being defended Sufficiently by the clothing, to prevent any incon- venience being experienced ; but not So much So, as to heat the patient. It muft be allowed, that this practice is not admiffible, in every caSe of put- rid fever.; fince circumftances may arife, which will render it highly improper : thefe circumftances, depending on various combinations, of the feafon of the year, weather, cojhftitution of the patient, Sec. will be difcovered and pointed out by the phy- fician. But there is much lefs reafon to fear, that this practice will be too frequently adopted ; than that it will be neglected, in thofe cafes in which it is recommended. For, too often, in this point, are the wifhes of the phyfician oppofed, and his M direction? oo Medical admonitions. directions difobeyed : the languor of the patient, and his unwillingnefs to be moved, with the pre- judices againft a practice So novel, forming, very often, almoft infuperable obftacles. Indeed, it is very difficult to perfuade thoSe, who have not wft- neffed the effects reSulting from this mode of prac- tice, that it is not neceffary, for* every perfon in a fever to be kept clofely confined, to his bed, under a load of bed-clothes, and Supplied with heating drinks. It frequently happens, therefore, that no fooner has a phyfician left the room ; than the patient is Supplied with warm liquors, the windows and curtains are clofed, and the bed-clothes, which had been removed, are replaced. Such oppofition to the directions of a)phyfician, viewed in the moft favourable light, is highly cenfurable : its being, in a great meafure, the effect of ignorance, is all that prevents it from being really criminal. Among the fymptoms which occur in this fever, no one requires more care and management, than the delirium, which, in general, accompanies the difeafe, almoft through to whole courfe. During this delirious ftate, the patient is agitated with vague and irregular exertions, both of body and mind ; which muft neceffarily, in proportion to their frequency, and length of continuance, exhauft the vital powers. To leffen theSe exertions, fhould be the talk of fome difcerning and intelligent at- tendant ; medical admonitions. 91 tendant ; who fhould gently reprefs the patient's efforts, and foothe his anxiety. Dr. Blane, in his obfervations on this fever, has fome remarks on delirium, which, from their ex- treme utility, and from their being only to be found in a publication, not likely to be read but by pro- feffional men, I fhall introduce here ; with the hope of more widely extending the comforts, which they were meant to procure, to the unfortunate victims of this difeafe. "Delirium," he fays, "feems chiefly to confift in a falfe reference of our "fenfations, whether external or internal : and "this is, in no fort of fever more evident, than in "this. When any painful imprcffion, for inftance, "is made by an external body, the patient, if in a "ftate of delirium, does not refer it juftly to the "part affected ; but the general agitation, and in- coherence of fentiments, will be aggravated for "the time. I have known a degree of heat applied "to the extremities, fufficient to blifter them ; yet "the part did not fhrink, though the raving and "general uneafinefs were increafed. In like man- "ner, with regard to internal fenfations, when an "irritation is excited, to expel the urine, or faces, "the mind does not recognife it as fuch, but from "a fenfe of uneafinefs, probably miftaken for fome- "thing elfe, an effort is made to relieve nature, which 92 medical admonitions. "which is done without a proper confcioufnefs, "and certain fymptoms are produced, which are "well known marks of danger in this fever. In "watching thofe, who have been under the in. "fluence of delirium, I have obferved it increafe, "when any particular want of nature urged ; and "this would continue for fome time, the patient "being incapable of procuring himfelf immediate "relief, on account of the falfe reference of fenfa- "tion, that has been mentioned ; but he would "become calm after voiding the urine or faces, or "after receiving fomething to drink, according to "the particular want that was prefent at the "time."*----"Delirium is one of the moft con- "ftant and alarming fymptoms in this difeafe, and "the removing of it depends much upon the attend- ants, as well as the phyfician.----1 have feen a "temporary Slop put to the patient's raving, by "making him drink, or upon his difcharging "his urine or faeces ; for he is then unconfcious "of thirft and other natural wants, is therefore "ignorant of the means of fatisfying them ; and "when he does fo, he fancies he is about fomething "elfe, which is the Subject of his delirious thoughts. "This obfervation leads to a material practical "purpofe; for it follows from it, that unremitting "attention Should be given to the patient's feel- ings, * Observations on the DifeaSes of Seamen, by Gilbert Blane, M. D. p. 374. medical admonitions. 93 "ings, and all his poffible wants, as thofe natural "notices, and inftinctive cravings, which occur in t;health, are now wanting, in conSequence of the "depraved ftate of fenfation."* It was remarked before, when treating of the flow nervous fever, that, on the appearance of thofe fymptoms, which are, in general, fuppofed to be the harbingers of death ; defpair takes fuch ftrong poffeffion of the minds of the attendants, that it is with the utmoft difficulty the phyfician obtains thofe exertions, which may poffibly fave the life of the patient ; and which, being omitted, he well knows, his death will be inevitable. The caution given there, is equally proper in this place ; fince it too often happens in this fever, as well as in the former, that patients are loft for want of being, almoft momentarily, Supplied, witJi cordial and nourifhing drinks : this omiffion proceeding from the attendants fuppofing theSe exertions to be uSe- leSs, and even cruel. Another reaSon, often given by thofe, who have neglected to make ufe of the neceffary means, is, the patient's incapability of fwallowing : when, perhaps, if the phyfician him- felf fhould make the trial, he would experience very little difficulty, in getting him to Swallow a confid- erable quantity. To afcertain the caufe of this difference * Observations on the Difeafes of Seamen, by Gilbert Blanc* M. D. p. 398. 94 MEDICAL ADMONITIONS. difference of fuccefs, in the different attempts of the nurfe and the phyfician ; and to point out the proper method to be ufed in thefe Situations, will be at leaft proper to attempt. In the advanced periods of thefe fevers, the brain, and whole nervous fyftem, are in fo deranged a ftate ; that a Slight Stimulous feldom excites the corresponding idea, which it was uSed to produce in health ; and, frequently occafions no impreffion at all. When a patient is in this ftate, the merely emptying a Spoonful of liquor into the mouth, is not fufficient to excite thofe mufcles into action, by which the act of fwallowing is performed ; the li- quid, therefore, remains in the mouth, until it efcapes out at the corner of the lips ; or elfe, from a drop infinuating itfelf into the windpipe, the whole quantity, from the violence and fuddennefs of the irritation, is thrown forcibly out at the mouth and noftrils. The appearances, in either of thefe cafes, feem, at firft fight, to warrant the conclufion which is generally drawn from them, that the pa- tient has totally loft the power of fwallowing: but, if the patient be fo much aroufed from this deli- rious, or comatofe ftate, as to be apprized of the nature and intention of the endeavours that are making, he will generally be found ready enough to affift them. After roufing him, by gently Shak- ing. MEDICAL ADMONITIONS. 95 ing, fpeaking to him, raifing him in the bed, &c. a fpoon, filled with the liquor, that is intended to be given him, fliould he put to his mouth; moving it about againft the tongue, lips, and fides of the mouth, until he is discovered to have Swallowed the Sew drops that have fallen from the fpoon. It now appearing, that the mufcles ferving to degluti- tion, are capable of performing their office, the whole quantity is to be poured into the mouth, and followed by as much more as may be thought ner ceffary ; Since, after having been thus roufed into action, it will be fome little time, before they re- lapfe into their previous ftate of infenfibility. Another circumftance alfo occurs, in the coma- tofe ftate of thefe fevers, from which the nurfes are too likely to form a prognostic, which muft neceffarily confirm them in their defpondency ; but this fymptom frequently is to be feen, without bearing that fatal import, which is commonly fup- pofed. Where death comes on flowly,. and the natural actions flop gradually, fome little time be- fore life ceaies, the mucus or phlegm collects in the back part of the fauces, from the infenfibility and lofs of power in thofe parts, which, in health, ferve to expel it ; and, by occafioning an interruption to the paffage of the air, in infpiration and expira- tion, a rattling noife is produced, which is termed, by g6 MEDICAL ADMONITIONS. by the nurfes, the rattles. Whenever, therefore, this accumulation oS phlegm, and conSequent rat- tling, takes place, in any caSe, where the diSeaSe has continued for a little time; the good women, ex- pecting; that, death will foon follow, refolutely op- pofe the making of any attempts for the recovery of the patient, or the fupport of his ftrength. But, in the advanced periods of thefe fevers, this fymp- tom may frequently appear, without being accom- panied by that degree of danger, which is in gen- eral fuppofed; for a confiderable quantity of mucus is fecreted, at this time, by the glands, which are placed about the back part of the fauces ; and is there gradually collected, in confequence of the patient, from the difordered ftate oS his brain, not experiencing any inconvenience t Srom it ; and, therefore, "employing no efforts for its removal. The mucus thus accumulated, and rendered ex- ceedingly tenaciousi, by the increafed evaporation^ from, the patient's breathing with his mouth openj. by obftructing, and almoft clqfing the paffage, pro-^ % duces the effect above mentioned. At the fama time, in confequence of this mode of breathing, the teeth, gums, and tongue become dry ; appear- ing as if covered with a dry, hard, and black varnifh, and feem to denote immediate diffolution. But it frequently happens, that if, inftead of aban- doning MEDICAL ADMONITIONS. 07 doning the patient in defpair ; the neceffary exer- tions are made, the patient is raifed and fupported in his bed, the mouth and throat conftantly moif- tened by nourifhing and cordial drinks, thefe fymp- toms will foon difappcar, and the patient probably recover. Prevention. The neceffity of conftantly ventilating the chamber of the fick, and of filling it with the fumes of vinegar, &c. to expedite the cure of the patient, has been already ftated. But, it is neceffary to be more particular on this head ; fince, by the proper management of fuch means, the fpreading of the infection to the attendants, the reft of the family, and even the neighbourhood, can alone be prevented. By the ingenious and affiduous enquiries of mod- ern phyficians, we have obtained confiderable in- formation, as to the nature of the contagion, which produces fever. They have even traced it to the fources, whence it arifes ; and have discovered it in the miafma, or vapour rifing from foul and ftag- nant waters, and from marfhy lands ; in the efflu- via from an healthy body, which has been fuffered to accumulate in foul clothing, and clofe apart- ments ; and the effluvia arifing from the body of one affected with fever. N It 98 MEDICAL ADMONITIONS. It has been afcertained, by a variety of experi- ments, I. That various fubftances may become imbued with theSe effluvia, and retain them for a confider- able time. II. That thefe effluvia, Suffered to remain long at reft, in Such Subftances; not only retain their noxious powers unimpaired, but Seem to poffeSs an higher degree of virulence, and more active pow* ers, than thofe which arife immediately from an human body. III. That the Sphere of action of thefe effluvia extends, but to a fmall diftance from the body, whence they arife; or from the fubftance, in which they are contained. IV. That their power of communicating infec- tion, is leffened, in proportion, as they are diffuSed through the atmoSphere. V. That the Space of time is very different, ac- cording to different circumftances, in which infec- tion manifefts its prefence, by any evident changes produced in the fyftem : thefe changes fometimes immediately following its introduction ; whilft, in other cafes, ten days or a fortnight will elapfe, be- fore its effects are difcoverable. ~VI. MEDICAL ADMONITIONS. 99 VI. That infection, like fome other poifons, does not affect thofe who are accuftomed to it ; especially, if it be gradually applied. Hence thofe about whom the poifon is generated, may be lefs fufceptible of injury from its influence : and phy- ficians and nurfes efcape, while the vifitors of the fick, become infected. VII. That cold, which, in general, has been thought to have produced different effects, con- tributes to the increafe of infection. I am convinced, that, when you confider the dangers, to which the juftly celebrated phyficians muft have expofed themfelves, who have eftab- lilhed thefe facts, by experiments, and accurate ob- fervations ; you will readily allow, that the world is highly indebted to them, for their enthufiaftic exertions in the caufe of humanity; and will, per- haps, feel, with me, a confiderable regret, that any motive Should induce an intelligent phyfician, to whom all this is known, to affert, in a popular work, that " very few of the valuable difcoyeries " in medicine, have been made by phyficians : they " have, in general, been the effect of chance, or "of neceffity, and have been ufually oppofed by the "faculty, 'till every one elfe was convinced of their " importance." Domeftic Medicine. Introdufl. p. xxii. Such £00 MEBICAL ADMONITIONS, Such an accufation as this, unfupported by a tittle of evidence, cannot require a defence to be fet up againft it ; however much, it may merit a fevere comment. But to return to that, which is of much more confequence.—We were remarking, that cold con- tributes to the increafe of infection. The import- ance of this obfervation to every family, and its contradicting the generally received opinion, de- mands, that the arguments advanced in its favour, by Dr. Blane, fhould appear in his own words.— " Cold is favourable to infection, by preventing " ventilation ; for people exclude the air, in order " to keep themfelves warm ; and the poor, in par- " ticular, do fo, on account of their bad clothing, " and their not being able to afford fuel, to make "good fires. Heat is the great deftroyer of infection, " and feems to act by evaporating, and thereby " diffipating it; and the effect of fires in apart- " ments, is to produce a conftant change of air ; " thereby preventing its flagnation and corruption, " and the accumulation of unwholefome effluvia."* To leffen the probability of the contagion being diffeminated, all unneceffary intercourse with the fick, fhould be avoided: and in addition to the means already propofed, for correcting the air of the * Observations on the Difeafes of Seamen, by Gilbert Blane, M. D. p. 250. MEDICAL ADMONITIONS. IOI the apartments, the mode recommended by Dr. James Carmichael Smyth, for obtaining the nitrous or marine acid, in a ftate of vapour, may be em- ployed. It confifts in decompofing nitre, or com- mon fait, by means of heated vitriolic acid, which may be done, as follows.—Put half an ounce of vitriolic acid, into a glafs, or china cup, or deep faucer ; warm it, by placing it in heated fand, add- ing to it, from time to time, fome common fait. By a fimilar procefs, as fuggefted by Mr. W. Bliz- ard, Surgeon of the London Hofpital, " the kali " acetatum (diuretic fait, of the Shops) being added " to the vitriolic acid, the acetous acid becomes " inftantly feparated from its alkaline balls, and " prefents itfelf, pungent, and refreshing, in a de- " gree even beyond the foflil acids." * The neceffity of an attention to thefe admoni- tions, may be rendered, perhaps, more evident, by confidering ; that the effluvia exhaled from one perfon, during the night, will, in general, be found to be very pungent and difgufting, to any other perfon, who may enter his bed-room ; whilft the perfon, from whom they may have arifen, will hardly be fenfible of any particular odour. The fame is to be obferved of clothing ; fince the fmell proceeding from foul clothing, is often extreme- iy * Suggeftions for the improvement of Hofpitals, and other charitable Inftitutions, p. 54. 102 MEDICAL ADMONITIONS. ly offenfive to others, whilft the wearer of them does not experience the leaft inconvenience. The organs of fmell, in the perfen who generates thefe effluvia, being as little fufceptible of imprefiion from their fenfible properties ; as his fyftem may be, from any peculiar virulence, they may poffefs. Hence, much mifchief may arife ; fince a perfon may thus carry about with him, a matter not only highly offenfive to others ; but, perhaps, pof- fefling properties very dangerous to any other perfon, who may come within the fphere of its action : whilft he is himfelf unconfcious of its pof- fefling either of thefe active powers. Another caution, not in general Sufficiently at- tended to ; is to properly ventilate, and fumigate, the clothes, which had been worn by the patient, in the early days of the difeafe ; and which, being moft probably the fame which were worn, at the time when he was expofed to the influence of the contagious matter, may Still retain a fufficient quantity of the poifon to communicate the difeafe. Great care is neceffary, in the management of the patient, even after the total removal of the fever. He will be now left in fuch a ftate of de- bility, that the flighteft exertions may prove too much for him : even the congratulations of his rejoicing friends muft be reftrained ; and great care MEDICAL ADMONITIONS. IO3 care be taken, that he be not exhaufted, by con- ventions with repeated vifitors. The food, which his returning appetite demands, perhaps with avidity, fliould be given in fmall quantities, and frequently : and the quanitity of his wine, as al- ready mentioned, Should be confiderably dimin- ished. ExerciSe Should be adopted, with the great- eft care ; left too much fatigue be induced. Some caution, alfo, muft be employed, as to the expo- sure to the air, in guarding againft the cold, by proper clothing; particularly, by the uSe oS flannel next the fkin. Removal into the country, is gen- erally recommended to the convaleScent ; but par- ticular care is neceffr.ry, that he be not imme- diately Sent to a Situation, in which the air is much colder, than that Srom which he is removed ; left an inflammation of the inteflines, or lungs, be in- duced. ^ * Should any one have reafon to fuppofe, he has received the infection of this fever, from the ap- pearance of thofe fymptoms, which mark its com- mencement ; and particularly, from a difagreeable fenfe of finking and uneafinefs at the pit of the ftomach ; it will be advifable, as foon as poffible, to cleanfe the ftomach by an emetic, and to gently open the bowqls ; immediately after which, Sweat- ing may be promoted, by freely drinking white wine 104 MEDICAL ADMONITIONS. wine whey. Should thefe means not prove fuffi- cient, a blifter may be applied to the nape of the neck ;—or rather, if thefe fail, immediate applica- tion fhould be made, for the advice of the intelli- gent and experienced phyfician. By the late difcoveries refpecting the constituent principles of atmofpheric air, phyficians have been enabled to eftablifh certain principles, on which they can proceed with greater confidence, in the treatment of this, and many other difeafes. A knowledge of thefe difcoveries, and of their appli- cation by the healing art, cannot but be a pleafing and interefting acquifition to any one ; but it is more,—it is a branch of fcience, which fhould be generally known. The friends of the fick, pof- Seffed of this knowledge, and confequently apprifed of the principles, on which the phyfician proceeds to obtain a cure, can then more powerfully aid his endeavours : nor is this all—they alfo gain a know- ledge of the principles, on which they ought to proceed, for the prefervation of their own health. The Medical Extracts of Dr. Thornton communi- cate this information, in a moft pleafing manner. Medical men wifh not for ignorance, either in their patient, or his friends : they know, that whilft ex- ercifing the duties of their profeffion, the know- ledge of the firft principles of medical fcience, will always MEDICAL ADMONITIONS. t05 -ilways yield them the Strongeft aid ; whilft igno- rance will%beft provide the prey of the rapacious empiric. I have given a flight fketch of the principles, on which airs of different purity are employed in dif- ferent difeafes, whilft treating of Confumption. I fliall therefore, here, only introduce the evidence of the ingenious Rev. Joseph Townsend, author of the Guide to Health, &c. as to the ufe of vital air in this difeafe. "In my putrid fever, when- ever the air of my chamber was artificially oxygen- ated, as my phyfician, Dr. Thornton, often witnef- fed, my refpiration was pleafant, my oppreffion at my cheft relieved, and I was enabled to breathe freely through the noftrils, without the affiftance of my mouth, which I could not do before the room was oxygenated. At the fame time, I am convinced that my appetite was greatly increafed, my occafional fleeps rendered found and undiflur- bed, and my digeflion confiderably quickened." On account of the comfort it muft yield to par- ents, to learn that infants are not lb liable to fevers as adults, I fliall clofe thefe remarks on this fever, with the opinion of Dr. Underwood on this Sub- ject- The Doctor has obferved, for many years, as well in the hofpital, as in private practice, that in- ° fants Io6 MEDICAL ADMONITIONS. fants do not readily take common fevers, though expofed, for a long time, to that contagion, which has appeared to affect adults around them. He alfo obferves, that every phyfician attending lying-in hofpitals, muft not only .have known many infants Suckled, without injury, through the whole ftage oS bad Severs, from which mothers have recovered; but alfo, in other inftances, Sucking greedily within an hour or two of their mother's death. REMITTING FEVER. Such fevers, as Suffer irregular abatements, or remiffions, oS their violence, are termed Remitting Fevers. Remitting fevers hold a middle place, be- tween continual and intermittent fevers. Con- tinued fevers, in changing to intermittents, in gen- eral, take on the appearance of a remittent, before they clearly intermit. Intermittents, alfo, which are becoming continued fevers, have irregular re- miffions, in the place of thofe clear intermiflions, which before characterised them. This, like other fevers, commences with a cold- nefs and Shivering ; accompanied by violent pains in the head, and back ; great dejection of fpirits, lofs of ftrength, and frequently a confiderable diffi- culty of breathing. Sicknefs at the ftomach, gid- dinefsj MEDICAL ADMONITIONS. 107 dinefs, and frequent hiccups, Shew that the firft paffages are charged with offenfive matters. The cold ftage is Succeeded by a confiderable degree of heat ; the pulfe, which in the cold fit was fmall and quick, becomes fuller, but abates not of its quicknefs. The pain of the head and back increafe; and the naufea is augmented, until it terminates in copious vomitings of bile ; difcharges of bile, by ftool, alfo often take place. Thefe fymptoms con- tinuing fome time, the fkin, which had hitherto been dry and hot, becomes moiftened with fweat; which fometimes flows very freely. Soon after this, the fymptoms abate, fome ceafing entirely, whilft others are much leffened ; the patient flat- tering himfelf with the hopes of health fpeedily returning ; but thefe pleafing illufions, are foon diffipated, by a return of the paroxyfm ; which comes on with increafed violence. The diforder proceeds thus, the paroxyfms alternating with the remiffions, until the remiffions, which leffen each time, are, at laft, entirely loft; the fever affuming a continued form. The difcharges now become very offenfive ; a conftant delirium and reftleflhefs takes place; and, if the fever be not oppofed by means Sufficiently powerful, ftartings of the ten- dons, profufe clammy fweats, and convulfions, come on ; which foon terminate in the death of the patient. In I08 MEDICAL ADMONITIONS. In the cure of this fever, one important indica- tion is, the removal of the accumulated bile ; but the Same motives, which have forbidden, the de- tailing of the mode of cure, in the other fpecies of fever, prevent its admiffion, in the prefent inftance. In this diSeaSe, the moft vigilant attention is re- quired ; nor will this be Sufficient, unleSs united to fkill and experience. Early, regular affiftance fhould be procured, in- deed, in every caSe of fever; but, in no cafe, is the watchful eye of the phyfician more neceffary, than in this : for if he be called early in the difeafe, and difcover the nature of the fever, which is, in gen- eral, Sufficiently apparent to the experienced ; he, by timely and well adapted evacuations, will re- move that accumulation of fordid matter, in the firft paffages ; which, in the courfe of the difeafe, would be likely to occafion much trouble and dan-. ger. As the difeafe proceeds, he will be enabled to afcertain the critical moment, when he may ven- ture on the free ufe of the bark ; the omiffion of which, might, moft probably, occafion the lofs of the patient: or, if ufed incautioufly, would render every fymptom more violent ; and the difeafe, of courfe, lefs likely to be removed. Should fuch circumftances occur, as may feem to forbid the ufe of this valuable medicine ; the intelligent phyfician will MEDICAL ADMONITIONS. 100. will often be enabled, by a due attention to the rules of his art, to effect thofe neceffary changes, which will rencler the employment of it fafe and beneficial. Languor, naufea, giddinefs, and difinclination to motion, often precede, for fome days, the fhiv- ering, which introduces this fever. At- this junc- ture, the administering of an emetic ; and fome gentle medicine, to produce a difcharge from the bowels, would probably prevent the coming on of the fever ; efpecially, if fucceeded by a proper ufe of the bark. By a regard to the rules, already laid down, the attendants on the fick, may derive fufficient in- structions Sor their conduct in the progreSs of this fever. HECTIC FEVER. In hectic fever, there are two evident exacerba- tions, in every twenty-four hours : one of thefe happens about noon, and continues the greater part of the afternoon, then Suffers a flight remif- fion ; as evening comes on, a Srefh exacerbation takes place, which continues until after midnight; another remiflion taking place about two or three o'clock in the moraing, about which time, or, in general, 110 MEDICAL ADMONITIONS. general, later, a profufe Sweating alfo frequently comes on. During the feverifh ftate, an exceffive heat is felt, in the palms of the hands, and the foles of the feet. The urine is, in general, of a high colour, and depofits a bran-like fediment ; but of a reddifh hue. This fever is generally fuppofed to exift only as a fymptom of fome other difeafe, and as a confequence of the injury of fome particular part. It moft frequently occurs, when a collection of matter has taken place. Since hectic fever is not a primary difeafe, I Should not have treated of it feparately, if I had preferred an attention to the rules of arrangement, to the important point of calling the attention par- ticularly, to that ftate I have juft deScribed ; which never exifts without danger ; and which is often to be found, where it has not excited the leaft alarm. Wherever this difeafe is met with, there may it be expected, that the fyftem is harraffed by Some local affection, of a dangerous tendency ; and if proper medical help has not been yet obtained, no time Should be loft, before application is made to Some one, to whom ftudy and practice have given acuteneSs, in discovering the difference of difeafes, as well as a knowledge of the moft judicious modes of treatment. INFLAMMATION. MEDICAL ADMONITIONS. Ill INFLAMMATION. INFLAMMATION, unlefs very trifling, is pre- ceded by a fenfe of coldnefs, and by fhivering : to thefe fucceed an increafe of the heat of the whole body, oppreffion, and thirft : the pulfe becoming full, hard, and quick ; and the urine high coloured. A fenfation of fulnefs and tenfion, with a preter- natural fenfibility, is experienced in the part, which is the Seat of the inflammation ; with a degree of heat, proportioned to the degree of the dif- i eafe ; and a pulfatile, or throbbing pain, which is more or lefs violent, in fome cafes, than in others: the difference depending, in a great meafure, on the ftructure of the affected part. The blood vef- fels, as far as the inflammation extends, are dif- tended with blood : and thofe veffels appear to be filled with red blood, which, in a natural ftate, do not appear to receive it at all. The blood, which is taken away in thefe difeafes, is, when immediately drawn, of a dark colour ; and in a more fluid ftate, than that which is taken away in health, or in thofe difeafes where inflam- mation does not exift ; whilft coagulating, its Sur- face is mottled with waves of a purpiifh hue ; but as foon as the coagulation has taken place, the fur- face of the coagulated part becomes covered with a 112 MEDICAL ADMONITIONS. a buff cruft : but this appearance is not conftant j fince, though it might otherwife Shew itfelf, it may- be prevented, by certain circumftances in the tak- ing it from the vein, in the receiving it in the veffel, &c. Inflammation may terminate either by difper- fion, Suppuration, or mortification. Refolution, or diSperfion, is Said to take place, when the cure is performed, while the texture of the part remains entire. This termination may be expected, when the difeafe is flight, and when proper means have been had recourfe to, in the early part of the difeafe. If the difeafe be violent, or Should it not be op- pofed by means, Sufficiently powerful ; the pulfa- tile or throbbing pain increafes, with the othef fymptoms, until fuppuration, or the formation of matter, takes place. This is known by the pain, heat, and rednefs abating : and, at length, by the difcovery of a fluctuation of a fluid, in the difeafed £art. But Should the difeafe have exifted a confiderable time ; and, inftead of yielding any of thofe appear- ances, from which we might conclude that fuppu- ration was about to take place; the pain, heat, and rednefs Should increaSe to a confiderable degree ; it MEDICAL ADMONITIONS. 11^ it may then be feared, that the difeafe will termi- nate in a gangrene or mortification. When this change is taking place, the colour of the part, from a bright fcarlet, becomes a dark crimfon ; blifters arife on the part ; the tumour fubfides, the part becoming Soft and flaccid ; and from being vio- lently pained, becomes nearly infenfible. The deep red colour is now exchanged for a livid purple : the part at length becomes quite black, and having loft all life, exhales a cadaverous fmell ; and, if health Should be reftored, is at laft thrown off by the action ©f the furrounding Jive parts, It cannot be neceffary to be more particular, as to the terminations of inflammation : the descrip- tion of the appearances which take place, on the feveral terminations juft mentioned, may be, how- ever, highly ufeful ; fince, by an attention to it, thofe who venture on the dangerous practice of domeftic quackery, may be enabled to difcover when danger is threatened, in confequence of their neglect, or improper interference. In every inflammation, there is an increafed ac- tion of the veffels of the part, and, indeed, of the heart itfelf, and of the whole fyftem of blood- veffels. F To 114 MEDICAL ADMONITION". To effect the cure of inflammation, therefore^ thofe means fhould be employed, which are known to be effectual, in restraining this inordinate action. Among the firft of thefe, may be reckoned bleed- ing. Blood, therefore, fhould be taken away, in the firft place----but, arrived at this point, how fliall I proceed ? Shall I attempt to furn^li the un- informed with particular rules, by which he fhall determine, as to the quantity of blood to be taken away, as to the mode in which it is to be drawn, &c. ? You muft plainly fee, that this ought not to be attempted ; and that I fhould rather fay, that every cafe of inflammation, which requires general bleeding, muft be a malady of fo ferious a nature, as to demand all that art and fcience can perform. I fliall, therefore, here only make fome general ob- fervations, on the* means of cure : Shewing the many difficult and important points, in* which an accurate decifion will be demanded; and leave it to you, and the reft of my readers, to judge of the! propriety of taking, without the beft advice, even this firft ftep, in the attempt to obtain a cure. In afcertaining the quantity of blood to be taken away, not only muft the Sex, age, and ftrength, be confidered ; but alSo the degree of violence of the difeafe, and the importance of the part affected, to the ceconomy of the fyftem. The quantity being determined on, it is next neceffary to afcertain, from MEDICAL ADMONITIONS. I I 5 from what part the blood fliall be taken. In fome cafes, where it is required, to produce a confidera- ble effea on the whole fyftem ; it may be taken from the moft convenient part, however diftant from the part affected : but where it is only necef- fary to leffen the quantity .of the blood, determined into the difeafed part ; topical bleedings Should be employed, as near as convenient to the inflam- mation. If topical bleeding be refolved on, the Situation of the difeaSed part, and other circum- ftances, muft point out the mode ; whether by opening a vein, near the part, or by the applica- tion of leeches, or by cupping. When it is deter- mined, as to the quantity, and the mode by which it is to be taken away ; it is neceffary to confider, in what Space oS time, the given quantity fhould be obtained. Jn moft caSes, the evacuation fhould be procured in as little time as poffible ; the more Speedily the diScharge being made, the more con- fiderable, in general, being the curative effects: but in other cafes, if the blood be not taken awray, with the utmoft flownefs and caution ; a fufficient quan- tity will not be obtained, to be productive of any real benefit. Nor is it a matter of trifling confe- quence, to afcertain whether a flight topical bleed- ing may be fufficient, for the removal of the difeafe; or whether a more large and gene'ral bleeding be neceffary ; for, on the one hand, if too fmall a quantity ^ Il6 MEDICAL ADMONITIONS. quantity be taken, the difeafe will not be removed , and, on the other, from too large a quantity being taken away, there is danger of inducing other dif- eafes, more difficult of removal than the original complaint. One of the moft powerful means, next to bleed- ing, of relieving the overloaded veffels, and of lef- fening the difeafe, is the proper adminiftration of purgative medicines : but no fmall degree of judge- ment is neceffary, in determining what kind of pur- gative fhould be employed ; fince, in. fome cafes, thofe only fhould be had recourfe to, as produce the leaft irritation ; fuch as manna, neutral Silts, &c. whilft, in other cafes, thofe of the ftrongeft kind, fuch as calomel, fcammOny, jallap, &c. muft be had recourfe to. This evacuation fhould not be perfifted in to the fame degree, in every cafe ; and there are caSes, where even greater relief will be experienced, by procuring an evacuation of a dif- ferent kind ; fuch as that by perfpiration, which will fometimes, indeed, be productive of more ad- vantage than even bleeding itfelf. In thofe cafes, where fudorifics are employed, purgative medi- cines, any Sarther than juft to obviate coftivenefs, are Sometimes, not only unneceffary, but even in- . compatible with the uSe oS Sudorifics ; fince, by the neceffary fhifting of pofture, occafioned by their operation, there is a probability of giving a check MEDICAL ADMONITIONS. H7 to the flow of perfpiration ; and thereby occafion- ing, an increafe of the original complaint. Neutral falts, vegetable acids, &c. are ufefVi j fince they appear to poffefs, a power of diminishing the increafed action of the blood-veffels, and, confe- quently, the impetus of the blood flowing into the difeafed part. The external applications, which may be ufefully employed, in the cure of inflammation, are nume- rous, and muft be varied, according to what is pointed out by the different indications. Hot wa- ter, plain, or impregnated with the virtue of med- icinal herbs, or in the form of Steam, will be ufeful in fome cafes ; whilft, in others, not only cold water, but ice itfelf, may be beneficially employed. Cataplafms alfo may be neceffary ; and thefe may be Sedative, or flimulating ; relaxing, or conftring- ing ; as the cafe may require. Sometimes, particu- larly where the inflammation is deeply feated, or poffeffes any of the internal parts, the ufe of blif- ters becomes adviSable, You may now expect me to proceed, in describ- ing the reSpective caSes, alluded to ; and in laying down particular rules to guide you, in the choice of the feveral applications, juft mentioned : but caft your eyes, once more, on the foregoing enumera- tion cf remedies; and then fay, whether the ufe of I I 8 MEDICAL ADMONITIONS. of fuch various, and even oppofite means, fhould b eafe, when in the hands of medical men, and as a proper MEDICAL ADMONITIONS. I93 proper regimen, is effential to the cure, and depends fo much on the patient himfelf, and his attendants, I Shall dwell more fully on this article. The diet Should be compoSed of fuch things as are Sufficiently nourishing ; and as are likely, by their mild and antiSeptic nature, to correct any prevailing acrimony, and diminish the diSpofition to inflammation. The loSs of flefh, and the extreme languor which generally takes place, too frequently induce the friends of the fick, with the hope of recruiting his impaired vigour, and wafted habit, to fupply him with food Of the moft highly nour- ifhing kind, with Wine, and even fpirituous liquors; and this, efpecially, when long indulged habits ren- der the demands oS the patient importunate. But as the caSes are very rare indeed, where theSe indul- gences will not aggravate every Symptom, and accelerate the fatal termination of the difeafe j they muft not be permitted on every weak and trifling argument, which the patient may adduce. This caution is the more neceffary, fince, where inclination is ftrong, reafons, light as air, are pro- duced as the oftenfible motives for a deviation from the rules laid down by the phyfician : but the friend, or the phyfician, who, through too much complai- fance, allows any weight to fuch arguments, by no means fulfils his duty. A A Dr. 194 MEDICAL ADMONITIONS* Dr. Buchan, when treating of the regimen in this difeafe, fays, " We do not, however, advife " thofe, who have been accuftomed to animal Sood " and ftrong liquors, to leave them off all at once." But I cannot help fufpecting, that this advice, in a work addreffed to patients themSelves, may fre- quently prove injurious, by allowing too great a latitude. For although the Doctor, aware of the ill confequences of neglecting a due attention to regimen ; and doubtlefsly with a view of prevent- ing the evils which improper indulgences may occa- fion, recommends, at firft, wine to be drank diluted with twice or thrice its quantity of water ; yet as wine generally turns four on the ftomach of thofe who are devoted to the pernicious cuftom of drink- ing fpiritiious liquors ; it is much to be feared, that fuch perfons will be likely to prefume On this advice, of not leaving them off all at once ; "and will Substitute, for the wine, a little of that to which they have hitherto been fo much accuftomed. There appears to roe two powerful reafons, why this change Should be undertaken, refolutely, at once. In the firft place, as the cure of the difeafe depends on a certain change being made in the constitution, the more expeditiously this change is brought about, the greater the probability muft exift of its effecting a cure. Since, during the time, occupied by the en- deavour to produce a gradual change, the chance of MEDICAL ADMONITIONS. 195 of recovery may be entirely loft, by the accumulated forces the difeafe may obtain. In the fecond place, there is little or no chance oS favourite habits being overcome in this gradual manner : the only mode of obtaining a victory, being by a refolute and firm refiftance ; every little indulgence allowed, like ground yielded to an enemy, tending, in general, to leffen the power of oppofing his attacks. Dr. Cad- ogan, when pointing out the neceffity of a fimilar abstinence, in gouty perSons, and the disadvantages of attempting to do it by degrees, very juftly ob- ferves, " But the danger of attempting it in this " manner is, that it will never be done ; and, like " a procraftinating firmer, he will for ever put off " his penitential refolution 'till to-morrow. If he did " it all at once, I would be hanged if he died of the " attempt ; he would be uneafy for three or four " days, that's all." The argument for good living, which in this cafe is commonly adopted by patients, and their friends, is induced from the weak ftate which accompanies the difeafe ; and from obferving the reftorative effects of highly nourifhing food, in thofe cafes of temporary defection of ftrength, produced by long falling, violent labour, or long continued exercife, of any kind ; thence they fuppofe, that no method is fo likely to remove the patient's extreme languor; as the fupplying him, freely, with thofe things, which; Ig5 MEDICAL ADMONITIONS. which in health appear to be the fource of ftrength and vigour. As it cannot be expected, that the directions of phyficians will be implicitly obeyed, when the opinion of the patient and his friends im- mediately militate againft thern ; the pointing out the fallacioufnefs oS thoSe opinions becomes necef- fary. This failure of ftrength, and wafting of the body, then, it muft be underftood, do not proceed from a deficiency of aliment, but are the neceffary confequences of a difeafed ftate of the fyftem ; and are only to be remedied by altering that peculiar ftate : until this be done, no advantage will refill* from any extraordinary Supply of food. The neceifity of thus regulatingthe patient's food, is rendered obvious, by the farther confideration, that foon after every meal, the hedic fever, the conftant attendant on this malady, is always, for a time, augmented ; the increafe being greater, when the food is highly nutritive and ftimulant, but lefs, when it is light and mild. The diet muft, therefore, almoft entirely, confift of milk and vegetables ; by blending which, an agreeable variety may be obtained. For breakfaft, the patient may have milk, freSh Srom the cow; or, if it Should prove offenfive to the ftomach in this ftate, it may be deprived of its cream. With the milk, may be eaten bifcuits, or toafted bread, either dry, or fpread with honey, or the jelly or marmal- ?de. of fruits. Dr< MEDICAL ADMONITIONS. 197 Dr. Buchan fays, " IS it (the milk) Should, not- " withstanding, prove heavy on the ftomach, a fmall " quantity of brandy, or rum, with a little fugar, " may be added, which will render it both more "light and nourishing." The late Dr.Fothergillvery juftly obServed, " There is one uSual addition made " to milk, which, I think, Should be either wholly " proScribed, or the moft expreSs directions given " concerning it, 1 mean the common addition of " brandy or rum to affes or cows milk."—Ardent Spirits, he obScrves, occafion the milk to diSagree, and augment the diSeaSe. Boiled bread and milk, water-gruel, and milk- pottage, are very proper ; and, if more agreeable, may be Substituted for what has been already recom- mended. For dinner, a tolerable extenfive range may be afforded the patient, in the various fruits, and other vegetable productions of the feafon. Apples drefled in different ways, turnips, afparagus, lettuces, dandelion, potatoes, parfnips, rice boiled into a pudding, either alone, or with the addition of an egg and milk, and puddings of various kinds, form a bill of fare, within the bounds of which, no one, furely, will refufe to confine himfelf, when it yields him almoft the only chance of a reftoration to health. For Supper the patient may have Salop, Sago, tapioca, panada, or any of thofe articles which have been recommended as proper for breakfaft. The 198 MEDICAL ADMONITIONS. The drinks through the day may be, butter-milk, fweetwort, affes milk, goats milk, barley-water, pec- toral drink, &c. I mean not to affert, that animal food is, in every caSe, to be ftrictly prohibited, or to deny that there may be caSes, in which its uSe may be adviSable. But theSe are Situations which are only to be pointed out by a thorough knowledge of the difeafe, and of the general ftate oS the Syftem. The kind oS exerciSe, and the degree to which it isuSed, at the commencement oSthis malady, muft depend on the manner in which the firft attacks were made. Thus, iS it has been preceded by Spit- ting of blood, or by confiderable inflammation of the lungs, the exercife employed muft be of the gen- tleft kind. But when the diSeaSe is produced by a long continued cough, or repeated catarrhs, exerciSe may be uSed to a greater extent. The neceffity of this difference exifts, however, only in the firft Stage oS the diSeaSe ; Sor after the difeafe is once formed, the fame rules for exercife will be proper in almoft every cafe. A general maxim for the regulation of exercife in this difeafe is, that it be never employed to fuch a degree, as that the heat of the body be much increafed by it, or that it induce much fatigue. As MEDICAL ADMONITIONS. 199 As the chief intention of exercife, in this difeafe, is to obtain the application of pure and frefh air to the lungs, it is evident, that the kind of exercife, moft likely to anfwer the intention, is that by which the patient is conveyed from one place to another, fuch as Walking, riding, failing, &c. Walking, in conSequence of its quickening the circulation of the blood, and fo foon inducing fa- tigue, is the kind of exercife leaft likely to prove beneficial in thefe cafes, and muft be had recourfe to with,great caution. Riding on horfeback, is an exercife, in many reSpects, much preferable to walking ; as the patient is, by this means Sooner conveyed into a more pure and Salubrious atmoSphere, and isj at the Same time, able, by regulating the pace of his horfe, to adapt his exercife to his ftrength, and to his ability of bearing it. But the exercife of riding, as well as that of walking, requires fome exertion on the part of the patient, and therefore is not admiffible, except with the greateft caution,in thoSe caSeswhere there exifts a SuSpicion oS inflammation, or impend- ing hemorrhage. In thoSe caSes where the expoSure to the open air is neceffary, but where weakneSs, or any other circumftance, renders it neceffary that this fhould be done with the leaft poffible exertion, recourSe muft be £00 MEDICAL ADMONITIONS. be had to the conveyance of a carriage; which may be more or lefs open, according to the mildnefs of inclemency of the weather. The mode of conveyance, which is to be preferred to all others, when no injury is likely to be induced by the violent exertions attendant on fea-ficknefs, is that of failing ; fince here the patient may enjoy the benefit of a fucceflion of frefh and Salubrious air, whilft the body is exerciSed in the moft regular and equable manner ; at the Same time, the patient may farther exercife himfelf, to the degree that his ftrength will admit, and his cafe require. Where the benefit of failing, or of a carriage^ cannot be obtained, and where the exercife of walk- ing or riding on horfeback, is not admiffible^ fwinging is a mode of exercife which may be emj ployed with the greateft fafety and advantage. It is not fufficient that the patient breaths aif that is frefh, and untainted with noxious vapours ; it is alfo neceffary j that the atmofphere, to which he is expofed, be temperately and uniformly warm* At the approach, therefore, of cold weather, the patient fhould remove to a warmer climate ; vary- ing the fituation, according as the viciffitudes oS the feafons may render it neceffary. The advanta- ges to be derived from a change of climate, in thefe cafes, are fo great, that, when joined with due reftrictions MEDICAL ADMONITIONS. 4ol reftriciions as to diet, it fometimes accomplishes a cure, in cafes where medicine alone would have been of no avail. It has been remarked, that the inhabitants of this ifland are particularly liable to this difeafe ; and this has been faid to be owing to the frequent and fudden changes in the weather, and the almoft conftant predominance of moifture in the atmof- phere. A removal to a more temperate climate, where the tranfitions of the weather are lefs confid- erable, and leSs Sudden, is therefore particularly neceffary, Sor Such as have reaSon to apprehend even a diSpofition to this diSeaSe. Air, extremely pure, is not, however, in this diSeaSe, always proportionally Salubrious ; on the contrary, it has been Sound, that, in Some caSes, advantage has been obtained Srom breathing an atmoSphere more impure than the common atmof- pheric air. Experiments fhew, that the atmofpheric air con- tains two different airs ; the one termed vital or oxygen air, which fupports refpiration and combuf- tion ; the other called azotic air, in which combuf- tion Soon ceaSes, and animals quickly die. An animal being confined under a glaSs, with a certain quantity of atmofpheric air, will foon die : B b and 202 MEDICAL ADMONITIONS. and the air remaining in the glafs being examined, it will appear, that the oxygen is confumed, and that the glaSs now contains azotic air, and fixed, or car- bonic acid air. Experiments alSo prove, that this change has been thus effected—the blood, which arrives at the lungs of a dark colour, parts with the carbon, or charcoal, it contains, which, uniting with one part of the oxygen, forms the carbonic acid air. Another part of the oxygen unites with the hydrogen or inflammable air, which is feparated from tie blood, and with it forms the humid vapour that iffues from the mouth. The other part of the oxygen is imbibed by the blood in the lungs, which it ren- ders of a bright red colour. Thus abforbed, the oxygen becomes a general ftimulus to the whole animal fyftem. Poffeffed of this knowledge, feveral intelligent phyficians have employed the two conftituents oS atmofpheric air, in various proportions, in differ- ent difeafes. By this they have difcovered, that by breathing an increafed proportion of oxygen, the infenfible perfpiration is increaSed, digeftion is quickened, the animal heat and the mufcular pow- ers are increaSed, and the reSpiration rendered eaSy; and that by breathing air in which azotic air pre- vails, febrile heat is moderated, and morbid action, efpecially in the finer veffels of the lungs, is re- ftrained. Oxygenated MEDICAL ADMONITIONS. 20'3 Oxygenated air has been fuccefsfully employed in putrid fever, afthma, dySpncea, chlorofis^dyfpepfia, ulcers of the leg, fcurvy, and other difeafes, by Drs. Beddoes, Thornton, Carmichael Smyth, Darwin, Ferriars, Pearfon, &c. Azotic air, and chiefly air termed the hydrocarbonate, has been Successfully ap- plied, by the fame gentlemen, in pleurify, croup, catarrh, Spitting oS blood, and even in confump- tion. Hence, then, it appears, that So far from a remo- val into the pure air of the country, being indicated in every cafe of confumption; that cafes muft often occur, (thofe where inflammation prevails,) in which the air, even of a crowded city, may be pre- ferable. Pulmonary confumption is a difeafe, to which thofe who are afflicted with a fcrophulous habit are particularly difpofed ; and is, undoubtedly, very frequently the confequence of fuch a difeafed habit, where, however, there may not be any other very obvious mark of its exiftence. The benefit arifing from the fea air, in fcropulous cafes, is well known, and points out another reafon for preferring failing to any other exerciSe, or mode of conveyance. Still, however, remembering, that if the patient be liable to very violent exertions from fea-ficknefs ; and cannot, by proper accommodation, obtain an entire 304 MEDICAL ADMONITIONS. entire exemption from the injurious effe cts of cold and rain, more injury than advantage may follow from a fea-voyage. In confequence of the application of cold and moifture to the Skin, the innumerable veffels difpo- fed on the furface of the body become conftricted, and the blood is driven back on the internal parts; inevitably occafioning additional injury to thoSe organs, which are already diSeaSed, and unable to bear an additional load. To prevent this from taking place, the utmoft care muft be taken in the choice of the patient's clothing, which Should be fa contrived, as to defend the Surface Srom the action of cold, and, at the fame time, fupport a free cir- culation through the extreme veffels. Flannel worn next the fkin, is of the utmoft fervice in thefe refpects, fince, by exciting a flight irritation on the Skin, it occafions an increaSed determination of blood and heat to the Surface ; by which the inter- nal parts are, of courfe, relieved. Befides this, it allows the accumulation of heat to take place more abundantly on the furface of the body, than would be the cafe,' if linen, or any other fubftance of a clofer texture, were worn. Nor is it liable, if ren- dered damp by perfpiration, to occafion cold chills, when re-applied to the Skin, after having been a little feparated from it ; a circumftance which can- not fail but take place, when linen clothing is worn next to the Skin. In MEDICAL ADMONITIONS. 205 In thofe cafes, where the irritation on the fur- face is not defirable, and where the perfpiration is confiderable, the fleecy hofiery will be found to be more pleafant and beneficial than the flannel. The clothing muft, in general, be light, but warm. The cheft, in particular, fhould be well defended from the cold, and the feet from the damp. By a ftrict attention to the above-mentioned di- rections, cafes, which otherwife might prove fatal, may frequently be brought to a favourable termi- nation. To expect fuccefs, however, it is neceffary that thefe regulations be adopted in the early ftages of the difeaSe, and perSevered in with the ftricteft conformity, for a confiderable time. INFLAMMATION OF THE STOMACH. In this d iftrefsful and dangerous malady, there is an acute burning pain in the region of the ftom- ach, vomiting, and fever. Exceflive thirft and reft- leffneSs alSo harraSs the patient. The pulSe is Small, hard, and quick, and the debility and languor ex- ceeds that which accompanies almoft any other caSe of inflammation. The breathing is performed with confiderable pain, and the region of the ftomach is extremely tender to the touch. If the difeafe is not fubdued, hiccup, delirium, and convulfions, foon 2o6 MEDICAL ADMONITIONS. foon come on, and with coldnefs of the extremi- ties, and clammy fweats, point out that death muft inevitably fucceed. Inflammation of the ftomach may be occafioned by acrid, or hard and indigestible Subftances, taken into the ftomach, and drinking extremely cold liquors whilft the body is in a heated ftate. It may be alSo produced by various internal cauSes, as well as thoSe general cauSes oS inflammation before re- cited. Among the moft powerful cauSes of this difeafe, may be confidered the fuddenly paffing from a cold atmofphere into warm rooms. Of the evils which may be thus produced, I have indeed already Spoken fully ; but the leffon cannot be too Strongly im- preffed, and the following opinion, from fo refpec- table an authority, ought not to be here omitted. Dr. Crichton, Speaking of the evils arifing from tranfitions from cold to heat, fays, "It may be re- marked, that almoft all the cafes of inflammation oS the lungs or ftomach, to which the common people of London are Subject, ariSe Srom fimilar cauSes. Either they have been riding in carts, or on the tops of coaches, in very cold weather, and after- wards have come into a warm room, probably an alehoufe ; or elfe they have been working for hours in drains, or in fimilar cold fituations. While they remain MEDICAL ADMONITIONS. 207 remain in the cold, no fymptoms of the diforder occur. It almoft always commences when they get home."* The Stomach may be affected with that Species of inflammation termed phlegmonic, or with that which is of an erifypelatous kind. The hiftory which has been juft given, deScr-ibes the progreSs of the former, which is an acute difeafe : the exift- ence of the latter, is generally made known by the appearance of the following fymptoms. In the beginning, a moderate degree of pain, and a fenfa- tion of heat, is experienced at the pit oS the ftom- ach. A naufea, and fometimes retchings, are pro- duced by the taking any fubftance into the Stomach; an increafe of the pain always being excited, in proportion to the degree of acrimony which the fubftance poffeffes. As the difeafe proceeds, the pain commonly increafes; feldom, however, becom* ing exceedingly acute, but fometimes teizing the patient for a confiderable time. Thirft, and a fre- quency of the pulfe, are in general alfo obfervable ; but oftentimes the general ftate of the fyftem will be very little affected. This kind of inflammation has been, frequently known to extend into the throat, and even to reach to the internal furface oS the mouth, and fometimes it has occupied Succef fively the whole tract of the interlines. The * Inquiry into the Nature and Origin of Mental Derange ment, vol. 1. p. 29 2o8 MEDICAL ADMONITIONS. The benevolent family practitioner will neceffa- rily perceive, that fuch an affection of fo important an organ as an acute inflammation of the ftomach, is too replete with danger to allow him to attempt to conduct the patient through the whole courSe oS this diSeaSe. A regular plan oS cure is therefore not intended to be here delivered, but only fuch obfervations* as may be likely to prove of benefit, and which cannot occafion any mifchievous error. A violent pain in the region of the ftomach, with fickneSs and Sever, fhould be always very Serioufly attended to ; and if regular medical advice cannot be directly obtained, the patient Should be copioufly bled from the arm, the bowels emptied by means of a clyfter of water-gruel or weak broth, and a blifter be applied immediately over the pained part. The patient fhould be immerfed in a tepid bath, all his drinks fhould be given lukewarm, and the tak- ing any thing poffefling the leaft acrimony care- fully avoided. Should the difeafe be confiderably mitigated by thefe means, yet the aid of the regular phyfician is abfolutely neceffary, as it will ftill require the ut- moft vigilance and care to prevent a relapfe. Great danger would follow, if the patient, milled by a deceitSul truce, Should, by omitting a due attention to thoSe things which may be beneficial or inju- rious MEDICAL ADMONITIONS. 209 rious, occafion a return of the difeafe ; fince the patient, weakened by the previous difeafe, and the remedies by which it had been removed, is but lit- tle able to Support thoSe evacuations which *again become neceffary. When the diSeafe is, to all appearance, entirely removed, the greateft care will be neceffary Sor a confiderable time aSterwards, left a relapSe Should be induced. For this reaSon, thoSe circumftances which were enumerated, when Speaking oS the cauSes of this inflammation, muft be Studioufly avoided ; particularly the paffing fuddenly into a much warmer or much colder temperature. A flannel waiftcoat worn next the Skin may prove highly ferviceable, by defending the convalefcent from thofe viciffitudes oS weather to which he muft neceffarily be expoSed. In the other Species oS this diSeaSe, which is evi- dently more oS a chronic kind, the length oS its duration will always allow oS application to the regular proSeffor oS the healing art; which, in this complaint, ought never to be precluded by the ex- periments of the ignorant. This diSeafe is always accompanied by extremely troublefome, and fre- quently by dangerous, fymptoms ; and which, fo far from decidedly pointing out the nature of the difeafe, are generally fo ambiguous, that much Skill Cc is 2IO MEDICAL ADMONITIONS. is required to detect it. Whenever, therefore, any1 one is attacked with complaints, fimilar to thofe laid down in the hiftory of this difeafe, Speedy ap- plication Should be made for medical affiftance. During the proceSs for the cure of this difeafe, and even for a confiderable time afterwards, the Same cautions are requifite, as were mentioned when fpeaking of the other fpecies* An affection of the ftomach, in which considera- ble pain is experienced, from the confinement of air in this bowel, will not be eafily distinguished, by a common obferver, from inflammation. This is a diftinction, which is, however, abfolutely necef- fary to be made ; fince the mode of cure required in the two cafes are widely different. • Should the patient, or his attendants, be milled, and have re- courfe to fpirituous and aromatic liquors, in in- flammation of the ftomach, fuppofing the difeafe to be occafioned by an accumulation of wind, a fatal termination of the difeafe will be moft rapidly produced. The naufea and urgings to vomit, may be fome- times the caufe of a miftake, pregnant. with the greateft danger ; for upon a Supposition that Some offenfive matter is contained in the Stomach, an emetic is frequently given, which muft neceffarily be productive of a considerable increafe of the in- flammation. INFLAMMATION MEDICAL ADMONITIONS, 211 INFLAMMATION OF THE BOWELS. An acute, fixed, burning pain, with a confidera- ble degree of tenfion of the belly, obftinate coftive- neSs, hard and Small pulSe, with Sever, are the Symptoms which characterise this dreadful malady, This diSeaSe commences, generally, with flight wandering pains in various parts of the belly ; but which generally become fixed, about the region of the navel. Soon after this, the pain becomes ex- ceffively violent, as though caufed by the applica- tion of fome burning fubftance to the bowels ; the belly becomes Swelled, tenSe, and extremely tender to the touch ; the tongue is parched, and of a dark brown colour, and the thirft unquenchable : fre- quent and violent urgings to vomit come 'on ; the urine is paffed but feldom ; and but feldom is any difcharge of faeces obtained, in fpite of the greateft efforts. The pulfe is hard, but fmall. The fever is, in general, acute ; in fome cafes, being obferva- ble before the coming on of the pain, and, in others, not until afterwards. If efficacious remedies are not had recourfe to, gangrene foon comes on. This is known to be the cafe, by a fudden ceffation of the pain ; from which the patient, and his at- tendants, are fometimes difpofed to derive flatter- ing expectations ; but the funk countenance, and fluttering pulfe, with convulfions, and coldnefs of the extremities, foon lhew what fatal termination has taken place. This 212 MEDICAL ADMONITIONS. This defcription would, perhaps, be fufficient to enable any one to diScover the nature of this dif- eafe, at its firft appearance ; but that it fometimes exifts, according to the greateft authorities, with- out being marked by thoSe Symptoms, which are, in general, its diftinguifhing criteria. Thus direc- tions have Shewn, that inflammation of the bowels has exifted, and terminated in gangrene, where neither fever nor pain had been perceived, but in a flight degree. Inflammation of the bowels may fometimes, at its commencement, be not immediately diftin- guifhed from that of the ftomach, or liver ; but this is not of much importance, fince the means of cure neceffary to be adopted, at the firft, in either of thefe cafes, would be beneficial in all. The moft dangerous error, with refpect to the treatment of this difeafe, is when it is mistaken Sor colicky pains ; to which Samily practitioners gene- rally reSer almoft every painSul affection of the belly. The remedies, which are almoft always had re- courfe to, on thefe occafions, are aromatic, fpiri- tuous, and heating liquors, under the delufive titles of colic elixirs, family cordials, &c. Thefe, it is evident, muft neceffarily accelerate the termination of this difeafe, in mortification. This difeafe may be occafioned by the fame cau- fes, MEDICAL ADMONITIONS. 2J3 fes which were recited, when treating of inflamma- tion of the ftomach. It may alfo be the fequel of other difeafes, as of hernise, coftivenefs, dyfentery, worms, &c. If the pain, before the difeafe has exifted long, changes its fituation, and becomes lefs violent ; if the vomitings leffen, and ftools are procured ; if the heat leffens, and the pulfation of the artery at the wrift feems to expand, it may be expected, that a refolution is taking place. But if the pam increa- fes, and keeps conftantly in one poin^and the belly becomes more tenfe and tender to the touch ; if no ftools are obtained, and the vomitings come on more frequently, and contain ftercoraceous matter, it is too evident that the difeafe is increafing; and fliould fudden ceffation of the pain, hiccups, clammy fweats, blacknefs of the tongue, fallen countenance, and coldnefs of the extremities, occur, thefe fymp- toms will evince that death is very near. No apology can be neceffary for declining to give a regular plan, for the treatment of this dread- ful difeafe ; fince no directions, however explicit, could Suffice to enable thoSe, who do not poffeSs real medical knowledge, to make the neceffary dis- criminations, in inveftigatirtg the nature of the malady, and in Selecting proper remedies for its re- jnoval- Every 214 MEDICAL ADMONITIONS. Every painful affection of the belly, however flight, fhould be immediately attended to. If the belly become fwelled, hard, and painful to the touch ; and the pulfe hard and contracted ; blood Should be taken freely from the arm, and the pa- tient put into the warm bath, about the fame tem- perature as the fkin ; or, if this cannot be conve- niently done, flannels wrung out of hot water fhould be applied to the belly, until a blifter can be procured ; which fliould be applied as Soon as pof- fible aSter the bleeding, Mild emollient clyfters, of barley-water, gruel, &c. may be given, until ftools are obtained ; and the patient be put to bed be- tween the blankets, and Supplied moderately with the moft bland diluting liquors, Such as barley-wa- ter, gruel, rice-gruel, &c, ' Dr. Buchan recommends, that "The clyfters may " be made of barley-water, or thin gruel, with fait." But Dr. Duplanil, the tranflator of Domeftic Med- icine, remarks, " Plus les douleurs Sont violentes, " plus l'inflammation eft confiderable, & plus les " remedes doivent etre adouciffants. Les lavements " avec le Sel ne doivent done etre donnes, qu'avec " circonSpection."—The more violent are the pains, the more confiderable is the inflammation, and the more appeafing ought the remedies to be. The clyfters with fait, ought therefore not to be given, but with circumfpection. During MEDICAL ADMONITIONS. 2lj » During the time that is employed, in the ufe of the above-mentioned means, proper advice may be obtained ; for which reafon, and as the utmoft caution is neceffary, in determining what internal remedies may be ventured on, they are not here enumerated. Dr. Buchan, whilft treating oS inflammation of the bowels, fays, "It has fometimes happened, after " all other means of procuring a Stool have been " tried to no purpoSe, that this was brought about " by immerfing the patient's lower extremities in " cold water, or making him walk upon a wet " pavement, and dafhing his legs and thighs with " the cold water. This method, when others Sail, " at leaft merits a trial. It is indeed attended with " Some danger ; but a doubtful remedy is better " than none." In cafes of obftinate coftivenefs, where there is no reafon to fuppofe that any in- flammation exifts, this experiment may be tried : but in this difeafe, no circumftance can warrant the adopting this practice ; fince there cannot be a doubt, that by this application of cold, the blood will be driven from the lower extremities, and be afterwards thrown, in an increafed quantity, into the veffels of the difeafed part, occafioning, not only an increafe of the inflammation, but, in all probability, a rapid termination of it in gangrene. Similar 210* MEDICAL ADMONITIONS. Similar cautions, with thofe which were recohl-" mended, at the clofe of the obfervations on the in- flammation of the ftomach, will be neceffary to be attended to, to prevent a return of this difeafe. INFLAMMATION OF THE LIVER. It has been afferted, by very great authorities* that the inflammation of the liver, was a difeafe, very rarely to be met with ; but diffections Shew, that this malady occurs more frequently than has been fuppofed, fcirrhous hardnefs, fuppuration, &c. being often difcovered in the liver after death, when inflammation has not been fufpected. Pain in the region of the liver, under the collar bone, and in the fhoulder of the right fide, with fever, ShortneSs of breath, a dry cough, vomiting, hiccup, and a difficulty in laying on the left fide, are the moft confpicuous fymptoms produced by an inflammation of this organ. In general, the difeafe commences with a rigour, or Shivering, which is fucceeded by febrile heat, lofs of ftrength, thirft, and general uneafinefs. The pain is fometimes dull, but at other times very acute- The pulfe is Stronger and quicker than na- „ tural: the urine high coloured, and Small in quan- tity. If MEDICAL ADMONITIONS. 217 If this inflammation be properly treated, in the firft days of the difeafe, a refolution may, in general be obtained. But Should the difeafe not yield to the means which are at firft employed, it is moft likely that it will terminate in fuppuration. When this takes place, the pulfe becomes fofter, frequent Shiverings pervade the whole fyftem, and the pain confiderably abates, and is accompanied by a fenfa- tion which is defcribed as refembling that which would be produced by a weighty fubftance added to the part affected. The patient becoming hectic, lofcs his ftrength, and waftes gradually, until colli- quative fweats and diarrhrea takes place, when his remaining ftrength is foon exhaufted. The con- tents of the abfcefs fometimes obtain a difcharge, either through the biliary ducts, or through fome of the adjoining parts, with which adhefions have been formed by the preceding inflammation. In fome cafes, where the difeafe has proceeded with great rapidity, it has been difcovered, that a gan- grene had taken place. This termination is marked by a ceffation from pain, proftration oS ftrength, fmall, and fometimes intermitting pulfe, coldnefs of the extremities, and convulfions. This difeafe may either poffefs the convex, or the concave part of the liver. From the variety this may occafion in the fymptoms, fome difficulty may occur in afcertaining the nature of the difeafe. D D pven 2l8 MEDICAL ADMONITIONS. even to the moft experienced. Nor is this the onk fource of error in this cafe ; for there are other dif- eafes, which, being accompanied by thofe fymptoms, which are always obfervable in inflammation of the liver, are liable to be confounded with it, by thofe who are not thoroughly verfed in the knowledge of difeafes. The difeafes here alluded to, are the pleurify, colic, and inflammation of the ftomach and bowels. Thofe who poffefs a fanguine temperament, and are of a middle age ; who live freely, indulging in the ufe of fpirituous liquors, and are frequently ex- pofed to the cold air, are particularly difpoSedto this diSeaSe. Violent exerciSe, expoSure of the heated body to the cold air, folid concretions, or collections of liquid matter in the liver, and drink- ing largely of fpirituous liquors, may be the excit- ing caufes of this malady. The cure, as in other internal inflammations, muft be attempted by the timely ufe of bleeding, a ftrict fpare diet, blifters, fomentations, cathartic medicines, &c. To deliver in a work of this kind a regular pro* cefs for the cure of this difeafe, would be to occupy the reader's time, without his being likely to derive any benefit from it ; fince, as has been before ob- ferved, the utmoft fkill is often requifite to dif- cover this difeafe, and diftinguifh it from thofe which MEDICAL ADMONITIONS. 2?9 which are accompanied with fimilar fymptoms. This difficulty has been acknowledged by fome, whofe knowledge in their profeffion has been fo eminent, that their precepts have been held in the higheft degree of eftimation by the reft of the med- ical world. If fuch men have found a more than ordinary exertion of their minds neceffary, in the inveftigation of this difeafe ; furely the informa- tion within the reach of a domeftic practitioner, can never be fufficient to allow him to undertake the cure of fo dangerous a malady. Should the difeafe, indeed, appear to be unequiv- ocally pointed out by the fymptoms defcribed in the foregoing hiftory of the difeafe, and regular medical affiftance be not directly obtainable, a large quantity of blood, that is to fay, fourteen or fixteen ounces, if the patient be an adult, fhould be directly taken away ; and a mild, but efficacious cathartic, be given. Flannels wrung out of warm formenta- tions, may be applied to the region of the liver ; after which a large blifter may be applied on the pained part, and, the patient being put to bed, a fweat may be excited by fuch means, as will not caufe any increafe of heat in the fyftem. Warm watery drinks, as barley-water, &c. may be ufed for this purpofe, taking care, that they are not Swallowed in Such large quantities, as too much to diftend the ftomach ; fince that will almoft always occafion an increaSe of the pain. Thofe 220 MEDICAL ADM0N|TI0NS. Thofe who have once Suffered Srom this difeafe, fhould be very careful in not expofing themSelves to cold, moift air, eSpecially when heated ; their bowels fhould be kept regular, and their diet fhould be compoSed of fubftances eaSy of digeftion, and void of acrimony. Pickles, all kinds of fpiceries, and Spirituous liquors, being carefully avoided. ThoSe who are So miSerable, as to have devoted themSelves to the deftructive habit of drinking to excefs, are particularly liable to difeafes of the liver. Tubercles, fcirrhous hardnefs, and chronic inflam- mations, are the changes which, in general, are pro- duced in this organ by this pernicious practice. In confequence of the fmall degree of fenfibility, with which the fubftance of this vifcus is endued, it fre- quently happens, that thefe alterations become very confiderable, before either pain, inconvenience, or any fymptoms arife, from which the patient can derive a fufpicion of his calamitous fituation. Too often is a man, boafting oS the ftrength and invul- nerableneSs oS his conftitution, which he SuppoSes repeated exceffes have no way impaired ; when Such changes have actually taken place, as prove the foundation of diftrefsful and incurable difeafes. Several inftances have occurred, where upon dif- fection, large tubercles and abceffes have been found in the liver, a fufpicion of the exiftence of which had never been entertained during the life- time of the patient. This MEDICAL ADMONITIONS. 221 This alarming ftatement of the evils refulting from the drinking fpirituous liquors, would not have been made, but with a faint hope of confirm- ing the refolution, of fome one of my readers, who may chance to be wavering between the gratifica- tion of his perverted tafte, and a wifh to free him- felf from a practice productive of fo much evil. Unfortunately, it too frequently happens, that, en thefe occafions, fear fuggefts, that the conftitution may be already too much injured to allow any hope of returning health ; and inclination prompts the conclufion, that to oppoSe the appetite will' be as uSeleSs as it will be mortifying. But I muft here remark, with the hope of ftrengthening the refolu- tion, in a conteft where fo much is at Stake ; that, not only will the animal Syftem Sometimes bear theSe attacks for a confiderable time, with fo little ferious injury, that on their being foreborne it will nearly admit of a reftoration; but that even when the conftitution has been fo harrafled by exceffes, that a morbid affection of the liver has taken place, the return to moderation, and the employment of well adapted medical means, will not unfrequently occafion the renovation of health. INFLAMMATION 222 MEDICAL ADMONITIONS. INFLAMMATION OF THE KIDNEY. Pain in the Small oS the back, paffing Sorwards toward the bottom of the belly, with fever, vomit- ings, and frequent voiding of the urine in fmall quantities ; fometimes very pale, and at other times of a high red colour ; are the Symptoms which, in general, characterise the inflammation of the kid- ney. When it is occafioned by the paffage of a calcu- lous concretion, that circumftance is Supposed to be pointed out by a numbneSs oS the thigh and leg, and a drawing up, or pain of the tefticle of the fame fide. The termination of inflammation of the kidneys may be either iq refolution, fuppuration, or gan- grene. The firft is known to have taken place, from the gradual ceffation of all the fymptoms. But when thefe have continued for fome days, without remiffiqn, the pain becoming throbbing and more acute, and frequent fhiverings take place, it may be known that matter is forming ; which is rendered more certain, by the pain afterwards abat- ing, and the fhiverings increafing. The matter thus Sormed, is, in general, discharged with the urine. It too Srequently happens, that after fup- puration has taken place, a hectic fucceeds, and the patient dies. But when the fymptoms Suffer no abatement MEDICAL ADMONITIONS. 223 abatement, from the means which are ufed, but the vomitings increafe, the pulfe becoming Smaller and quicker, the breathing difficult, the extremities cold, and the ftools are paffed without the patient's knowledge ; there is reaSon to Suppo'e, that the diSeaSe will terminate fatally by gangrene. Exceffive exertions, external injuries, hard rid- ing, violent ftrains* expoSure to cold when the body is heated, and to a confiderable degree of heat, when chilled, may be reckoned as exciting caufes of this difeafe. But the moft frequent caufe of this malady is, doubtlefsly, calcalous matter impacted in the kid- ney itfelf, or in the pelvis of the kidney at the com- mencement of the ureter. The nature of this difeafe, is not pointed out fo clearly by its fymptoms, as to be known by any but fuch as have had frequent opportunities of notic- ing it. The cure, therefore, ought never to be attempted, by any but thofe who poffefs a requifite degree of Skill. But where profeifional aid cannot be obtained at the firft attack of the difeafe, and the nature of the difeafe is rendered evident, a copious difcharge of blood may be obtained from the arm ; and ftools may be procured, by purgative medicines, and emollient clyfters. The external parts, immediately over 224 MEDICAL ADMONITIONS* over the pained part, may be fomented with hot and ftimulating fomentations ; and if it can be obtained, the patient may be immerfed in a warm bath, being immediately afterwards put into bed, between the blankets, and fupplied freely with cooling and demulcent drinks, as barley-water, with the addition of gum Arabac ; linfeed-tea, decoction of marfhmallows, apple-liquor, &c. with the hope of inducing copious perfpiration. A flannel, Sour folded, and wetted with Spirits, to which an eighth part of fpirits of hartfhorn is ad- ded, may be applied warm to the Small of the back, for the purpofe of exciting heat, and a flight degree of inflammation on the external parts. Over this flannel, a bladder filled with hot water, may be applied with great benefit. Dr. Buchan fays, " If the bladders be filled with " a decoction of mallow9 and camomile flowers, to " which a little faffron is added, and mixed with " about a third part of new milk, it will be ftill ,c more beneficial." But this opinion is undoubt- edly erroneous, fince none of the medical proper- ties of thefe ingredients can have any effect, through the bladder. Every purpofe will be therefore fully anfwered, by the bladder being filled, with hot water alone. Opiates are ferviceable, in fome cafes, when given after the inflammation is fomewhat abated, but MEDICAL ADMONITIONS. 225 but much judgment is required, to determine when they may be employed with fafety ; fince, if ufed at too early a period of the difeafe, the in- flammation muft neceffarily be thereby increafed. Of this, however, and of the other circumftances, in the fubfequent management of the patient, it is not neceffary to fpeak, fince thefe will be directed by the phyfician. But if medical aid fhould have been too long de- ferred, or, from the ambiguity of the fymptoms, the domeftic practitioner fhould have mistaken the caSe, and, oS conSequence, treated it improperly, a Suppuration will moft probably take place. Should this happen, and the matter be discharged with the urine, the greateft care muft be taken, by the pa- tient, that his food confift of the mildeft and moft mucilaginous fubftances ; avoiding every thing which is heating, or which is Salt and acrid: living chiefly on milk, puddings, broth, vegetables, Sruits, butter-milk, &c. Moderate exerciSe fliould be uSed, and that chiefly in the open air. INFLAMMATION OF THE BLADDER. The inflammation oS the bladder is known by an acute pain at the bottom of the belly, which is much increafed by preffure, and is accompanied by almoft conftant urgings to void the urine and ftools. Ee Of 226 MEDICAL ADMONITIONS. Of the former, there is fometimes a total retention, at other times it comes away frequently, but in fmall quantities at a time, and with much pain : the ftools are, in general, obftinately retained like- wise, and when discharged, it is with pain. This diSeaSe is accompanied with fever, in proportion to the degree of violence in which it exifts ; but as it feldom occurs as a primary difeafe, a confidera- ble variety muft be expected in this, and the other accompanying fymptoms. The caufes of this difeafe are, calculous concre- tions, fuppreffions of urine from obstructions in the urethra, cantharides taken internally, or applied to the fkin, wounds, bruifes, &c. Any admonition as to the admiffion of domeftic quackery in this difeafe, feems to be almoft unne- ceffary ; as the alarm and the diftrefs it excites is generally fufficient, to produce an application to thofe beft qualified to adminifter relief. It will be, however, proper to call the attention to the ill-con- fequences that arife, from delaying, too long, the neceffary oppofition to the difeafe. It fometimes happens, that, from the patient's having been un- happily too much accuftomed to pain, or from his not attributing the diftrefs he experiences to the true caufe, he neglects the obtaining of affiftance through the firft ftage of the difeafe. When this happens, there is much reafon to fear, that the moft Skilful MLDICAL ADMONITIONS. 227 Skilful furgeon, or phyfician, will be unable to pre- vent very difagrecable conSequences. Should the inflammation poffefs that part which is termed the neck of the bladder, or fhould the difeafe be chiefly feated in the proftrate gland which furrounds this part, there will be great danger of the patient's lofing the power of retaining his urine. If, therefore, no doubt remains, as to the nature of the difeafe, and regular medical aid cannot be foon obtained, blood may be taken away plentifully from the arm, ftools procured by fome active pur- gative, avoiding thofe of the faline clafs, and clyf- ters, of the decoction of poppy-heads, may be in- jected every two or three hours. Fomentations, alfo, of the fame decoction, may be kept conftantly applied, over the bottom of the belly ; and, if pof- fible, the patient Should be immerfed in the tepid bath, and in other refpects treated as has been juft recommended, in the inflammation of the kidneys; excepting that, where an entire retention of urine exifts, no more muft be drank than is abfolutely neceffary. Should the difeafe terminate by fuppuration, the conduct of the patient may, in that cafe alfo, be regulated, by the directions juft given, in the fup- pofed cafe of fuppuration in the kidneys. INFLAMMATION 228 MEDICAL ADMONITIONS, INFLAMMATION OF THE SPLEEN. This difeafe, which does not often occur, is to be difcovered by fever, with tenfion, heat, Swelling, and pain, oS the left hypochondrinna, the pain in- . creafing upon preffure. Inflammation of the fpleen requires nothing peculiar in its mode of treatment, nor yields any circumftance, from which I can de- duce any particularly ufeful obfervation. INFLAMMATION OF THE PERITONEUM. Inflammation Of the peritoneum may be fup- pofed to exift, when there is fever, with a confid- erable degree of pain of the belly, which is increafed during an erect pofture, and no fymptom charac- teristic of inflammation of any particular bowel. The treatment of this difeafe, and the manage- ment of the patient, fhould be directed by the rules laid down, when treating of inflammation of the bowels. Dr. Baillie, in his moft valuable work, The Mor- bid Anatomy, &c. of the Human Body, has this important remark on this moft ferious difeafe : " When the inflammation is flight, I have known the pain to be very inconfiderable, and the pulfe to be little increafed in its frequency, fo that inflam- mation medical admonitions. 229 mation of the peritoneum had not been fufpe&ed." A difeaSe thus infidious muft require all the cir- cumSpection and knowledge that ftudy can Supply, even to detect it. To the domeftic practitioner, nothing more Surely need be Said, to deter him from an improper interference, in cafes marked by fymptoms, fuch as have been juft defcribed. RHEUMATISM. Rheumatism may be very properly divided in- to two fpecies, the acute and the chronic. Each of thefe I fhall Speak of feparately, beginning with the acute. The acute rheumatifm generally begins with a fenfe of coldnefs pervading the whole body, fre- quently arifing to fuch a degree, as to occafion fhiv- ering. This is fucceeded. by feverifh heat, the pulfe becoming fuller and quicker, and the urine higher coloured, than in health. After thefe fymp- toms have exifted a day or two, the patient feels fharp wandering pains,in various parts of the body; fometimes thefe pains accompany the other fymp- toms, from their firft appearance, and fometimes the pain precedes the febrile fymptoms. The pain chiefly affects the joints of the ankles, wrifts, knees, and elbows, the patient being, in fome cafes, tor- jncnted with excruciating pains in feveral of thefe places, 210 MEDICAL ADMONITIONS. places, at the Same time ; in others, this painful affection is produced, in one joint, as it leffens in another ; and often diftreffes the unSortunate SuS- ferer with repeated attacks of the fame joint. Red- nefs and fwelling of the part generally accompany the pain. The pain, in general, is fo confiderable, as entirely to deprive the patient of reft ; and the night, in- stead of bringing Sleep, is generally the time, when the pain and reftleSsneSs are moft exceffive. Par- tial viScid Sweats Srequently come on, but without any accompanying relief. But fometimes general and copious perfpiration occuring, with a diminu- tion oS the pain, affords great reaSon to hope for a fpeedy and favourable termination of the difeafe. The duration of this difeafe is very uncertain ; but, in general, unlefs very efficacious means are ufed, it will continue, with very little amendment, for two or three weeks, and fometimes even longer. This difeafe is much more frequent in cold, than in warm climates ; and in thofe feafons in which the weather is variable, than even when it is con- ftantly cold : thus it is oftener met with in fpring and autumn, than in winter. Thofe are moft difpofed to acute rheumatifm, who are of a middle age, and of a fanguine tem- perament. MEDICAL ADMONITIONS. 23 I pcrament. -Thofe, alfo, who have once fuffered from this complaint, are more liable to its attacks than others. Thofe circumftances, which have already been Spoken of, as rendering the fyftem apt to take on an inflammatory ftate, will render the body more fufceptible of injury, from the changes in the ftate of the atmofphere, and thereby more liable to rheumatifm. This difeafe requires very great fkill and atten- tion in thofe who attempt its cure ; for although it is evidently of an inflammatory nature, it is alfo very certain, that it is, in many refpects, different Srom that kind of inflammation, of which we have hitherto treated ; and that it requires a very con- fiderable difference in the mode of cure. As in other inflammatory difeafes, fo in this, bleeding is often a very powerful remedy : this fhould be performed to fuch an extent, as its effects may direct, and the ftrength of the patient allow. In fome cafes, the taking away of blood may be highly injurious ; and in other cafes, where it is even adviiablc, much care muft be taken, left the blood be taken away in too large a quantity. Be- fides, it muft be obferved, that the difcharge by which moft relief is gained, in this difeafe, is that of perfpiration. this, if properly obtained, and the 232 MEDICAL ADMONITIONS. the patient properly managed, Seldom fails of re- moving the difeafe ; especially if it has not long exifted. During the ufe of fudorifics, the bowels fhould be kept regularly open, and the violence of pain moderated by anodyne applications to the part. As it is a point by no means eafy to afcertain how far the evacuation of blood may be allowed, fo does it require nicety of judgment to determine how far evacuations, of any kind, may be permit- ted ; fince, it is well known, that there is a period in this difeafe, after which, evacuations, of any kind, not only weaken the patient, but lengthen the difeafe ; and cordial medicines, a reftorative diet, and even the ufe of the bark are indicated. In the acute rheumatifm, the regimen muft be governed by the fame indications which direct the phyfician in his choice of remedies. In the chronic rheumatifm, the pains are lefs acute, and feldom accompanied with fever ; nor is any rednefs difcoverable on the parts affected. The larger joints, and the mufcles, are moft commonly the feat of this difeafe ; fuch as the hip and fhoulder joints, delloid mufcle, &c. The integuments above the pained part are always cold to the touch, it being difficult to excite in them either warmth or perfpiration. Sudden MEDICAL ADMONITIONS. 233 Sudden ftrains and exertions may be mentioned here, as a frequent caufe of chronic rheumatifm, in addition to what was faid of the caufes, when treat- ing of the acute kind. The remedies which may be ufed in this difeafe, are either internal or external. The internal rem- edies are chiefly fuch as act by determining the blood to the furface, and by producing an increafe of perfpiration. Such are, the falts of hartfhorn, the volatile tincture of guiacum, &c. the effects of which may be accelerated by drinking freely of white wine whey, or muftard whey, made by boil- ' ing the feeds of muftard in milk. The external applications are chiefly fuch ftimulating applica- tions as excite a redneSs in the fkin over the part affected : theSe may be, camphorated Spirits, oppo- deldoc ; or, if thefe prove not Sufficiently Stimu- lating, if ufed alone, they may be mixed with the volatile fpirits of hartfhorn, oil of amber, &c. Fric- tion with a flefh brufh renders theSe remedies ftill more effectual. Electricity has been SucceSsSuliy uSed in many caSes. The wearing a plaifter of Burgundy pitch over the part has alfo often proved Serviceable. ✓ To prevent the return of either ftate of this dif- eafe, the patient Should defend himfelf by warm, but light clothing, from the inclemencies of the F f weather. 234 MEDICAL ADMONITIONS, weather. Over the parts which are moft partictU larly the Seat of the difeafe, fliould be worn flannel, or rather clothing of fleecy hofiery. The paffing fuddenly out of one atmofphere into another, differing much in temperature from the former, is very likely to occafion this difeafe. Ex- pofure of the body to a ftream of cold air, is alfo likely to prove very injurious, efpecially if it be ap- plied to one particular part only, and that the body is in a heated ftate. Damp clothing Should be care- fully avoided, as well as the expofure to a moift atmofphere, the ill effects of cold being much in- creafed by the joint action of Tnoifture^ GOUT. The paroxyfms of this tormenting difeafe arc moft commonly preceded, by a general uneafinefs; the feet and legs are affected with numbnefs and coldnefs, and frequently alfo with a fenfe of prick- ling ; the veins on the furface are alfo faid to be- come unufually turgid, and the mufcles of the legs to be affected with the cramp. But the circum- stances which have been obferved, moft particularly to precede the attacks of this difeafe, are the changes which, for fome little time before, take place in the ftomach ; this organ generally Suffers a confid- erable derangement of its functions j the appetite being MEDICAL ADMONITIONS. 235 being much impaired, and the ftomach and bowels diftended with wind, the confequence of digeftion not being properly carried on ; the appetite becom- ing, however more eager before the attack. According to the obfervations of the attentive Sydenham, the paroxyfm generally begins about two o'clock in the morning. The patient, having gone to bed free from gain, is waked about that time with pain poffeffing commonly fome part of the foot. Soon after this, comes on a coldnefs and Shivering, which terminates in fever. The pain; increafing, fometimes refembles that which might be expected to be produced by the Stretching and tearing of the ligaments, or the gnawing of a dog; at others, the parts feem to Suffer the effects of a tight Stricture, or confiderable preffure, being fo feelingly alive, as not only, not to bear the weight of the bed-clothes, but not even the heavy tread of any one acrofs the room. In this miferable ftate the patient continues, tolling about the bed, in vain trying the effect of variety of pofture to leffen his Sufferings. At about the Same hour of the follow- ing morning, the patient, in general, experiences a fudden mitigation of the pain, which he com- monly attributes to the laft pofition in which the limb was placed. Soon after this, a moderate fweat coming on, he falls afleep, and, upon waking, finds that the jpain is confiderably diminished ; but that the 236 MEDICAL ADMONITIONS. the part which Suffers is affected with a red Shining fwelling. The pain fometimes continues two or three days, increafing at night, and becoming more mild towards morning. If, after the difeafe has thus completed its courfe in one foot, it disappears entirely, the patient re- gains the ufe of the foot, and experiences a moft grateful change-—ftrength and alacrity having taken the places of debility and languor. But it often happens, that after the violence of the firft attack has fubfided, a Second will be experienced in the other foot. In more inveterate cafes, both feet, fometimes, are affected at the fame time ; and repeated paroxyfms fometimes extend the Sufferings of the patient for fix weeks or two months, or even longer. After the firft attack of this difeafe, the patient is, in general, free from it for two or three years ; but the intervals becoming Shorter between every paroxyfm, it often happens, that, at laft, the difeafe Seldom quits the patient, except for two or three months in the fummer. As the ftrength of the patient becomes leffened, the paroxifms are accom- panied with lefs pain than before; ficknefs and de- bility Shewing, that the caufe of this confifts, not in a diminution of the gouty difpofition, but oS the powers of the fyftem. When the paroxyfms have recurred very often, the joints become ftifF, and the limbs ' MEDICAL ADMONITIONS. 237 limbs enfeebled, and, in many perfons, concretions, refembling chalk, form over the joints, and unite with the circumftances juft mentioned, in depriv- ing the patient of the ufe of the affected limbs. The above hiftory contains a defcription of this difeafe, in its moft common mode of appearance ; or in that form which is charadterifed as regular gout. But it fometimes happens, that inftead of the difeafe proceeding in this regular manner, a variety of anomalous fymptoms arife, unaccompa- nied by thofe affections of the joints, which were wont to appear. This ftate of the difeafe is termed the Irregular Gout. All the various fymptoms which occur in this ftate of .the difeafe, cannot well be here particularifed: thofe which have been moft frequently obferved,will, therefore,only be noticed. When the head is the feat of the difeafe, giddi- nefs, pain, lofs of memory, &c. are the fymptoms which occur,andwhich generally terminate in fome fatal affection of the brain. Palfy and apoplexy may indeed be, fometimes, the confequence of a fudden tranflation of the difeafe to the brain ; and may therefore happen, without the occurrence of any previous headach, or any other fymptom, from which the fatal termination might be fufpected. The lungs, as well as the heart, are alfo Subject to thefe anomalous attacks ; occafioning fhortnefs of 238 MEDICAL ADMONITIONS. of breathing, afthma, palpitations of the heart, faintings, and fudden death. When the ftomach and bowels are affe&ed by this diSeaSe, a variety of troublefome fymptoms arife ; fuch as lofs of appetite, ficknefs, flatulency, pains in the ftomach or bowels, acid erucations, &c. Frequently at the Same time, the unfortunate Suf- ferer experiences the moft diftreffing dejection of Spirits, his mind being poffefled with groundless apprehenfions and alarms. Men are more Subject to this diSeaSe than fe- males ; and thofe men are more efpecially liable to it, who are of a full and corpulent habit. A dif- pofition to it feems fometimes to be acquired, and at other times loft, by a difference in the mode of living. It feldom attacks thofe who live on a fpare diet, and who avoid wine and fpirituous liquors ; thofe, alfo, who ufe much exercife, are moftly ex- empt from it. Many fuppofe, that the attendance of a medical man, is, in this difeafe, entirely unneceffary; and that this muft certainly be one of thofe cafes, which may with propriety be committed to the care of the domeftic practitioner, whofe knowledge refpecting this diSeaSe is not likely, they fuppofe, to be much exceeded by that of phyficians themfelves. Phyficians, MEDICAL ADMONITIONS. 239 Phyficians* indeed, do not pretehd, either to an accurate knowledge of the nature of this malady, or to the poffeffion of a Specific, with which they are capable oS removing it, with' Safety. But, in conSequence of their knowledge of the laws by which the animal ceconomy is regulated, and by repeatedly obferving the progrefs of this difeafe, and the changes produced in it, by the various habits and constitutions in which it occurs, as well as the confequences refulting from the various means, by which its cure has been attempted ; they are often enabled both to palliate the prefent Suf- ferings of a patient, and to give him fuch direc- tions for his management, as may not only leffen the frequency, and the duration of future parox- yfms ; but may even, fometimes, entirely prevent their recurrence ; and, at the fame time, fecure the patient from experiencing any ill effects by the change thus induced. Thefe dire&ions muft ever be Varied according to the difference of temperaments; the morbid ftate of the constitution, which requires to be amended ; and thofe errors in the mode of living, which may have been the exciting caufe of the dif- eafe. Instructions Sor the conduct of patients, in every particular cafe of this malady, would of them- felves make a volume; it is not intended, therefore, to attempt more than to offer fome general obfer- vations, 240 MEDICAL ADMONITIONS. vations, by an attention' to which, the ravages of this painful diforder may be fometimes leffened. The treatment of the patient, during the parox- yfm, fhould be directed by the medical attendant; who will be beft able to judge and determine, ac- cording to the variety of circumftances, on the more proper plan. It may not, however, be araifs, to remark here, that the progrefs of the fit fhould be interrupted as little as poffible ; but Should the pain become exceffively^violent, recourfe may be had to proper anodynes, the body being at the fame time kept gently open, by fome mild laxative. The regimen, during the paroxyfm, fhould be of fuch a kind, as will fupport the ftrength, without increafing the heat: broths, puddings, jellies, light meats, &c. are therefore proper. But fpints or Wines muft be carefully avoided, as well as fait meats, and all highly feafoned food. When the fit is entirely gone off, the patient Should confider himfelf as entirely free from the difeafe, and fhould earneftly fet about preventing its return. This may be done, I am fatisfied, by med- icine alone ; but, unlefs a due attention is paid to the exercife and regimen, another difeafe, and ge- nerally a more fatal one, will be induced. But if due attention be paid to the following admonitions, there is the greateft reafon to believe, that the pa- roxyfms MEDICAL ADMONITIONS, 24! i'oxyfms may be rendered leSs violent, and leSs fre- quent ; and that fometimes their return may be even entirely prevented, and that without occa- sioning any other difeafe. It is alone by a Strict conformity to regimen, that this difeafe can be fafely checked. To obftruct the courfe of the dif- eafe, and prevent the return of the paroxyfms by medicine, whilft exceffes and irregularities are per- mitted, h to create a difeafed ftate of the fyftem, and at the Same time to hinder nature from infti- tuting that procefs, by which that difeafed ftate may be altered. But by carefully avoiding thofe injurious indulgencies, the difpofitiOn to the diSeaSe is itSelS removed, and its renewal prevented. The victims of this malady are generally thofe who have indulged their appetites with eating highly feafoned animal food, and drinking freely of fermented and fpirituous liquors, particularly of wine ; thofe who lead a fedantary life, who are diftreffed with anxious thoughts, or whofe minds are confiderably engaged in ftudy. The food of thofe who are Subject to this diSeaSe fhould be plain and light. At breakfaft they may take milk, raw or boiled ; and at dinner, puddings, vegetables, and animal food in moderate quanti- ties. Their Suppers Should be Small in quantity, and compoSed of fuch fubftances as are neither G o heating 24^ MEDICAL ADMONITIONS. heating nor difficult of digeftion. Pickles Should be entirely refrained from, and acids of every kind Should be ufed with great moderation. Spirituous liquors muft never be drank, except in the Smalleft quantities, and confiderably diluted. Wines, par- ticularly thoSe of foreign production, and even malt liquors, muft be avoided with equal care. Regular exercife is of the utmoft fervice, in mod- erating the violence of this difeafe. Such exer- cife Should be preferred, as being joined with amufe- ment, ferves at the fame time to exhilarate the Spirits ; Such are rural Sports, as hunting, Shooting, &c. or any mechanical employment, the execution of which requires fome little attention of the mind. Regularity in the hours of retiring to reft, and in rifing, muft be Strictly adhered to. Late hours being exceedingly prejudicial, muft be carefully avoided ; as well as too long continuance in bed, which, by the debility it induces, is in the higheft degree injurious. It is a common obfervation, that the affluent are, in general, the fubjects of this malady ; it feldom happening, that thofe of the inferior clafs of peo- ple are troubled with it, except they have received it as their reward for copying the follies and vices of their Superiors in fortune. ft MEDICAL ADMONITIONS. 243 It is however, by no means recommended, raShly to enter on any confiderable change of former hab- its, especially if a great degree of debility has been brought on by former exceffes, or by difeafes. In- deed no fuch changes ought to be attempted, with- out due advice, after a full confideration of every attendant circumftance. But Should it be deemed prudent thus to attempt the cure, the patient Should well confider the advantages likely to be gained by his SelS denial, and firmly refblve to give the plan a Sair trial. The neceffity oS a Strict attention to regimen, in thoSe who are Subject to this diSeaSe, is So well and So Sorcibly inculcated by Dr. Cadogan, that I can- not refill the impulSe oS recommending the peruSal of his treatife, to every one afflicted with this difeafe. Nor can I here refrain from noticing the obser- vations contained in a treatife on the Gout and gravel, by Mr. Murray Forbes ; who has moft in- . genioufly fhewn, by reaSonings upon eftabliShed chemical facts, and by Sair chemical deductions, that the gout is a diSeaSe proceeding from a redund- ancy of acid in the fyftem.—"That acids," he fays, "are greatly instrumental towards the pro- duction of gout, is an opinion which was founded upon obfervation, and has long been maintained. fhis difeafe, as well as gravel, has, in.many cafes, been 244 MEDICAL ADMONITIONS. been attributed to an exceffive ufe of acids. It hag likewife been regarded as intimately connected with that ftate of the ftomach, in which there is almoft a perpetual generation of acid. At the fame time, however, a variety of circumftances of a different kind have been enumerated as fources of it. If we examine with attention, the condition of many in whom gout makes its appearance, we fhall gene- rally find, that thofe other circumftances have ge- nerally been productive of it, when they have had the previous effect of impairing the digeftive facul- ties, and caufing a confequent tendency to the ge- neration of acid. Of this nature are infobriety, luxury, indolence, and voluptuoufnefs. The dif- eaSe frequently attends upon a habit of drinking, on account of the acids conveyed into the body by means of it. The tendency of different liquors to produce it, is not fo much in proportion* to their ftrength, as to the quantity of acid in their com- pofition. This affertion is warranted by the expe- rience of ages ; the liquor in which acid predomi- nates having been invariably confidered, by the beft authorities, as peculiarly predifpofing to gout. Shallow oS observation muft be the man, who, ac- cuftomed to endure the pains of gout, has not be- come acquainted with the injury of acids. By im- moderate indulgence in intoxicating compounds of any kind, by a life of luxury, by a ftate of indo- lence, and by an inordinate purfuit of pleafures, the MEDICAL ADMONITIONS. 245 the powers requifite for the procefs of digeftion are at laft brought into diforder, and the contents of the ftomach permitted to run into common fer- mentation. Thefe, and other circumftances, which tend to vitiate the action of the ftomach, and con- duce, by reaSon of derangement, to the formation of acid, may be looked upon as remote caufes of gout and of gravel." Dr. Wollafton, in the Philofophical TranfactionS for the year 1792, has discovered, by a Series oS in- genious experiments, that the gouty matter con- tains the peculiar (Uthic) acid which Mr. Forbes, in the foregoing paffage, fuppofed to be generated in the fyftem, and joined to the mineral alkali. SMALL POX. The Small pcx appears under two very different forms, which are termed the diftinct and the con- fluent. The mode of treatment of thefe being" re- quired to be as different as are their modes of ap- pearance, they will be each treated of feparately. The diftinct fmall pox is preceded, for a few days, by a fenfe of languor and wearinefs ; and im- mediately before the coming on of the febrile ftate, frequent cold Shiverings and tranfient glows of Jieat are perceived by the patient. The fever, which fucceeds 24°" MEDICAL ADMONITIONS. Succeeds to this ftate, is accompanied by violent pain of the head and loins, and frequently with a Severe oppreffive pain at the pit of the ftomach. Thefe fymptoms are much increafed on the fecond evening of the attack, when the patient generally becomes exceedingly reftlefs, and even delirious, through fome part of the night; the fkin burning with an uncommon degree of heat. f On the following day, the third day of the fever, the eruption is thrown out ; the fkin becoming lefs hot, and being moiftened with a general per- Spiration. The eruption which takes place on the face and limbs, generally precedes the eruption on the trunk, a few hours. The eruptions, at their firft appearance, are fmalj red points, which, upon being cloSely examined, and Selt by the fingers, will be found to form little eminences in the fkin, which are, from their firft appearance, feparate and diftinct from each other. The puftules gradually affume a conical form, and on the fifth or fixth day begin to turn white on their tops ; and by the eleventh day become entirely white, at which time the puftules acquire their greateft magnitude. Their bafes are red and inflamed during the whole courfe of the eruption ; but when the puftules are entirely filled,they affume a . t MEDICAL ADMONITIONS. 247 a brownifh hue, their bafes becoming, at the fame time, paler. The puftules now fhrivel, and are fucceeded by dark coloured crufts. Thefe in a few days fall off, leaving rednefs of the fkin, and fome- times a fmall pit in thofe parts which they poireffed. A tenfion of the fkin, fwelling of the face, and fome difficulty in Swallowing, generally accompany, even the mildeft Sort of this diforder, and fome- times occafion confiderable inconvenience, where the eruption is numerous ; thefe fymptoms being generally proportioned to the number of the puf- tules. The fever, where the eruption is trifling, generally ceafes when that is completed ; but where the eruption is confiderable, it continues during the procefs of fuppuration. The confluent fmall pox is preceded by a much greater degree of fever ; the frequency and fmaii- nefs of the pulfe Shewing, that the fever is of the low kind. The eruption appears alfo more early, is much fmaller, and in greater numbers, the whole face often having the appearance of being poffeffed by erifypelatous inflammation. The fpots affume a crimfon colour : they do not rife like the diftinct kind, but, remaining flat, and running into one another, they very much refemble the mealies, dur- ing the firft days of the eruption. As the eruption proceeds, little veficles form on the top of the pim- ples. A 248 MEDICAL ADMONITIONS. A fwelling of the face and neck takes place a* the commencement of the eruption, and becomes very confiderable ; but fubfides about the tenth or eleventh day. In the diftinct kind, the in fide of the mouth and throat fometimes become fwelled, in a flight degree ; but in the confluent kind, this affection is generally very confiderable, and is ac- companied, in children, with a diarrhae ; and hi adults, with a copious difcharge of faliva. This is frequently fo acrid, as to excoriate the mouth and throat ; and, as the difeafe advances, becomes fo vifcid,as to be difcharged with the utmoft difficulty. The puftules, inftead of being diftended with whit- ifh matter, as in the diftinct kind, feldom rife to any height above the fkin ; and contain only a fe- rious fluid, which in the more malignant cafes, is commonly of a purple colour. This colour is oc- cafioned by a mixture with the diffolved blood, which, in thefe cafes, efcapes at every outlet: from this caufe alfo arife difcharges of blood, by ftool and urine. In this malignant ftate of the difeafe, by the fame caufe are produced purple fpots, refem- bling flea bites, and bladders of dark coloured or limpid ferum. Thefe are the appearances diftin- guifhed by nurfes by the names of purple and white hives. When this fpecies of the difeafe terminates favourably, the puftules, filling firft on the face, and foon after on the reft of the body, begin to dry about the fixteenth day ; the contained flqid then exuding MEDICAL ADMONITIONS. 24O, exuding, and forming a dark coloured cruft, which remains for feveral days. Ulceration generally takes place between them, whence frequently re- fults confiderable lofs of fubftance, and difagreea- ble cicatrices. The fecondary fever, as it is called, which fre- quently comes on in this confluent kind, makes its appearance, in general, about the period of matura- tion ; and is commonly accompanied by fymptoms of a dangerous nature. In thofe cafes where the difeafe terminates fa- tally, the fever increafes, the. whole furface of the body becomes of a pallid hue, the puftules are flac- cid,, and the Swelling of the head fubfides, without that of the extremities fucceeding. The patient is harraffed with exceffive anxiety and reftlefsnefs, which is foon fucceeded by a delirious or a com- atofe ftate ; refpiration, at the fame time, being performed with the greateft difficulty. Suffoca- tion, or violent convulfions, at laft puts an end to the life and Sufferings of the patient. The Treatment. In the diftinct kind, where the eruptions are very few, and no particular fymp- toms appear, little more is required, than to regu- late the diet of the patient, and to allow him to re- ceive the benefit of free expofure to pure and cool air. The diet Should confift of vegetable fubftan- H h ces> \ 2^0 MEDICAL ABM0NITI0NS. ces, as Sago, panada, rice gruel, &c. milk, milk pot- tage, rice milk ; and, when the eruption is com. pleted, and Suppuration is taking place, a little broth and light puddings may be allowed. The drinks may be barley-water, toaft and water, and bread tea, rendered grateful to the tafte, by the addition of currant jelly, or the juice of lemons or oranges. Wines and fpirituous liquors, however diluted, muft be very carefully avoided; as well as all kinds of heating cardiac medicines, which are too fre- quently adminiftered by family doctreffes, with the intention, as they exprefs themfelves, ot throwing out the diforder. The treatment of the confluent kind requires much judgment in the phyfician, and even in the attendants. It will be unneceffary to treat, in a work of this kind, of the variety of medicines which will be indicated by the various fymptoms of this dreadful difeafe. Since no one, who does not poffefs real medical knowledge, ought to be encouraged in attempting the management of a malady fo full of danger. The exertions, indeed, of the moft intelligent phyfician, will be of little or no avail, unlefs the at- tendants are obedient and attentive to his orders. In no difeafe whatever, has ignorance and preju- dice fuch fway, as in that which is the Subject of the medical admonitions. 251 the prefent Section. In the firft ftage of this difeafe, it often happens, that the patient is put to bed, un- der a load of bed-clothes, in a room heated with a large fire, the frefh and pure air being, as much as poffible, excluded : and, left this fhould not prove Sufficiently efficacious, the febrile ftate of the patient is further increafed, by the heating cordials with which he is conftantly Supplied. Directed by Simi- lar ridiculous prejudices, the patient is not allowed a change, either of his body linen or bed clothes ; but is obliged to wear, to the end of the difeafe, the fame linen, which foon becomes uncomfortable* and even offenfive, from the quantity of putrid matter it has abforbed. Another injurious prac- tice, among practitioners of this defcription, is that of allowing their unfortunate patients to remain feveral days, without any difcharge from the bow- els ; many good women entertaining an idea, that the pock would fill better, if the patient could be prevented from having a Stool, even until the ma- turation was complete, or, in their language, until the pock was turned. It is much to be regretted, that thoSe who are under the neceffity of employing nurfes, do not confider that care, and exact fubmiffion to direc- tions, are requifites more effential in theSe female attendants, than the moft intimate knowledge of the various recipes of family quackery. Poffefling this 25* medical admonitions. this kind of information, felf-fufficiency and confi, dence take Such ftrong poffeffion of them, that, un- lefs they are fuperintended by fome anxious and vigilant friend of the patient, their own defultory and deftructive meaSures are Subftituted, for thofe which have been dictated by reafon and experience. Repeated observations have Shewn, that by aug- menting the febrile ftate, either by the application Of external heat, or by the adminiftration of inter- nal heating medicines and drinks, the number of the puftules may always be increafed. Apprifed of this circumftance, the celebrated inoculator Sut- ton, ufed to promife his patient a crop of puftules, numerous, or otherwife, according to their wifhes; well knowing, that, even ip good habits, a trifling deviation from the cooling plan he always purfued, was almoft Sure to be followed by an increafe in the number of puftules. How injurious, then, muft be that abfurd practice of increafing the heat of the patient, by every means which folly can fug- geft, when univerfal experience evinces, that the violence of the difeafe keeps pace, with the extent to which this pernicious mode is adopted. The advantages arifing from cleanlihefs of the perfon of the patient, and every thing around him; as well as from frequent ventilation of the bed- chamber, muft be fo obvious in every difeafe, ciif- tinguifhed by fymptoms pointing out a putrefcent tendency MEDICAL ADMONITIONS. 0 53 tendency in the fluids, that to enlarge on them is unneceffary ; efpecially as this Subject has been already difcuffed, when treating oS putrid Sever. Convulfive fits Srequently occur about the time pS 1 he eruption. The good women who pride themfelves on their medical Skill, always predict a favourable termination from the appearance of this fymptom ; and too frequently accompany their prognostic with advifing the friends of the patient, to rely on domeftic aid only, for the cure of a dif- eaSe, from which they expect no danger. But unfortunately the prognostic is often erroneous, and, confequently, the advice improper : for this fymptom being common to both kinds of the dif- eafe, is fometimes fucceeded by that ftate of the dif- eafe which calls for the utmoft care and Skill; but inftead of this being obtained, the life of the unfor- tunate patient is perhaps entrufted to Some opin- ionated and ignorant nurfe. An inconteftible proof of the impropriety of per- mitting the management of feverifh complaints to be entrufted to family practitioners, is derived from confidering, that the utmoft mifchief may be pro- duced by injurious interference, at the firft appear- ance of this, or of any of the eruptive fevers. Na- ture being difturbed in her procefs, the eruption is often either driven out with fuch violence ; or is fo improperly retarded, as to occafion the patient's death. There 254 ::EDICAL admonitions. There is one circumftance, which, as it may affift in carrying on the above delufion, dcf'erves to be pointed out» The eruption, even when of a very bad kind, will often, on the firft days, appear Suf- ficiently large and detached, as not to excite alarm, in any but thofe who poffefs real Skill and discern- ment. In confequence of which, proper afliftante is frequently not called for, until the life of the pa- tient is irretrievably forfeited. When the eruption makes its appearance in cluf- ters of a dark red colour, danger is to be appre- hended. This is more certainly the cafe, when, as the difeafe proceeds, the puftules remain flat, or even dented, inftead of becoming full and round, and the fkin between the puftules appears pale and flaccid. But when purple fpots, like flea bites, ap- pear between the puftules; or when the puftules themfelves are raifed like a blifter, and contain a pale or brownifh coloured fluid, the danger is then in the higheft degree imminent ; eSpecially if ac- companied by bloody urine or ftools. Shiverings happening after maturation is performed, and Sub- fidence of the fwelling of the head, without a tume- faftion of the hands and feet fucceeding, are alfo Signs of an alarming nature. The eyes are liable to Suffer confiderable injury, during the progrefs of.this difeafe ; it fometimes happening, that total blindnefs is difcovered to be the mpdical admonitions. ' 2-55 the unhappy lot of the patient, when the sye-lids open, on the fubfiding of the fwelling of the face. - The eyes foon manifeft, in this difeafe, much im- patience of the light ; but the fwelling of the eye- lids, which takes place, as the difeafe proceeds, ge- nerally clofes the eye-lids ; and, by excluding the light from the eyes, renders the patient, in this re* Spect, much more comfortable than before. In children,the relief thus afforded hardly ever efcapes obfervation ; and the parents and attendants be- come, therefore, lefs folicitous to prevent the adhe- fion of their eye-lids from taking place. From this omiffion, I very much fufpect, theSe injuries to the eyes Srequently proceed. The irritation of that membrane which lines the internal part of the eye- lids produces a copious fecretion, refembling matter, which Soon So cloSely agglutinates the edges of the eye-lids, that very little of this difcharge is allowed to efcapc. This morbid fecretion is, therefore, not only kept conftantly Suffufed over the eyes, but, be- ing thus detained, is applied to the external mem- branes of the eye, with fome degree of preffure, by which its injurious effects muft neceffarily be aug- mented. In theSe caSes, the mode of proceeding is tolera- bly clear, though but feldom adopted. The hard- ened cruft which unites the edges of the eye-lids, muft be foftened, by laying on it ftrips of lint, or of 250 medical admonitions. of fine folded linen, wetted with warm water i when fo much foftened, as to be able to be removed with eafe, this fliould be done ; and its future ac- cumulation muft be prevented, by frequently wafh- jng away the matter, as it exudes, with a piece of wet Sponge, or lint. By this treatment, the matter will be allowed to eScape, as faft as it is fecreted; ah opportunity may be obtained of afcertaining the real itate of the eyes ; and of employing fuch lo- tions,'as may be thought neceffary. . When the fmall pox has entirely completed its courfe, yet is the convalefcent, where the difeafe has exifted to a confiderable degree, far from being entirely exempt from danger : for frequently the habit of body becomes fo changed, and the consti- tution is, at the fame time, fo impaired ; that, to Obtain his perfect recovery, much nicety of manage- ment becomes neceffary. It alfo requires great Skill and difcernment, to afcertain the nature of the difeafed ftate which is induced, and the mode of treatment by which it may be removed. > Dr. Buchan obferves, "As the Secondary fever "is, in a great meafure, if not wholly, owing to the "abforption of the matter, it,would feem highly "conSonant to reafon, that the puftules, as foon as "they come to maturity, fhould be opened. This "is every day practiSed in other phlegmons which "tend to Suppuration ; and there Seems to be no cauSe MEDICAL ADMONITIONS. 257 ''caufe why it fhould be lefs proper here. - On the "contrary, we have reafon to believe, that the fe- "condary fever might always be leffened, and of- *'tcn wholly prevented." The Doctor Sarther ob- serves, that "Opening the puftules not only pre- sents the reSorption of matter into the blood, but "likewife takes off the tenfion of the Skin, and by "that means greatly relieves the patient. It like- "wife tends to prevent the pitting, which is a mat- ter of no fmall importance. Acrid matter, by "lodging long in the puftules, cannot fail to cor- "rode the tender Skin ; by which many a handfome "face becomes fo deformed, as hardly to bear a re- semblance to the human figure." Although the Doctor obferves, that, "it is only "neceffary when the patient has a great load of "Small pox, or when the matter which they contain "is of fo thin and acrid a nature, that there is rea- son to apprehend bad confequcnces from its being "too quickly reforbed ;" yet, in confequence of his afferting, that "this operation can never do harm" there is great reaSon to Sear, that the hope oS pre- venting deformity, may occafion its too frequent adoption by domeftic practitioners. To prevent this, I have introduced the opinion oS a gentleman'^ whoSe extenfive and SucceSsful practice muft of ne- ceffity give weight to his judgement, and render his obfervations truly valuable. He fays—"Allow I 1 * me 25*$ MEDICAL ADMONITIONS. "rae to remark on the practice of thofe, wno re- " commend the puftules on the face to be opened, "when at the height, that the contained matter "being thereby evacuated, the face may not retain "any difagreeable marks. In a favourable diftinct "pock, this caution Seems Superfluous, there being "little danger oS its leaving any deep impreffion ; "and in the confluent malignant kind, when I have "Seen it practised, it has always given Such intoler- able Smart, as muft wound any perSon not de* "prived of humanity itfelf."* Parents frequently deceive themfelves, With a confidence that their children are exempt from danger of infection, becaufe they have been in the fame room, or even in the fame bed, with thoSfi who have had the fmall pox upon them. But left too great a reliance fhould be placed on this cir- cumftance, and Should prevent the adoption of ne- ceffary meafures, it Should be generally known, that children, in early infancy, are not fo liable to receive this difeafe, as is commonly imagined; and that a child, who has been expofed to the influence of this difeafe, without receiving it, or who has even been inoculated without effect, may in a little time become highly fufceptible of infection. Purging * Observations en Epidemical Difeafes> &c. by James Sims, M. I>. MEDICAL ADMONITIONS. 259 Purging is, in general, neceffary after the fmall pox ; but when the patient has fuffered under the confluent kind, great care muft be taken, that the dofes are not fo confiderable, nor the intervals be- tween them fo Short, that exceflive debility be thereby produced. INOCULATION. Inoculation is generally performed by the ap- plication of a fmall quantity of matter, from a fmall-pox puftule, to a Slight wound in the Skin. The advantages derived from this practice are fo confiderable, as to render it deferving of being con. fidered as one of the moft important improvements in medicine. By inoculation, the Shocking rava- ges of this moft difgufting and alarming difeafe is prevented 5 and this, with fo much certainty, that it is almoft in the power of man to choofe, whether the difeafe Shall appear in its ufual difgufting and terrific form ; or whether it Shall be produced in fuch a decree, as need not to excite the leaft Shock or alarm. This beneficial practice is now become fo fre- quent, and the advantages derived from it are fo well known, that the greateft number of the ob- jections, which have been raifed againft it, have loft 2D<2> MEDICAL ADMONITIONS* loft their power ; at leaft on the minds of thofe who give themfelves the trouble to obtain any in- formation on this Subject. The poffibility of the difeafe being again produ- ced, in one who has already had the difeafe by in- oculation, is not now fufpected by any, except by thofe who obftinately reject the moft pofitive evi- dence, and even the dictates of common fenfe. The chief circumftance which prevents the prac- tice of inoculation from becoming univerfal, is the fufpicion, that as one difeafe may be thus transfer- red, other difeafes, which exift in the perfon from whom the matter is taken, may, at the fame time, be alfo introduced. This fufpicion is the confe- quence pi having remarked, that it fometimes hap- pens, that thofe who have been perfectly free from difeafe before, have, immediately after their recov- ery from the fmall pox, by inoculation, been af- fected with cutaneous diforders, and fcrophulous fwellings ; and fometimes to fuch a degree, as to have disfigured them, or even to have rendered them cripples, during the reft of their lives, That other difeafes may be inoculated, in the fame manner as the fmall pox ; and that fcrophu- lous affections have made their appearance after in? oculation, are circumftances which undoubtedly may occur. But all this being admitted, ftill it muft MEDICAL ADMONITIONS. 26l nvuft be denied, that fcrophula is ever inoculated with the fmall pox. The matter which is contained in the puftule of the fmall pox, confifts of that particular fpecies of morbific matter, only, which has been formed by tfiofe difeafed actions, which have been induced by the application of the matter of the fmall pox to the human body. This matter, thus fecreted, if again applied to the abforbent fyftem, of any one, who has never had this difeafe, or who has not been rendered infenfible to its influence, will again produce this difeafe, and no other. With refpect to Scrophulous tumours, inflamma- tion of the joints, abfceffes, &c. which are by fome fuppofed to be i\\c confequences of particular hu- mours introduced into the fyftem, with the variol- ous matter ; it muft be obferved, that phyficians have long known, even before the practice of in- oculation was introduced into Europe, that, in fome habits, very confiderable changes take place after the fmall pox. In fome cafes, difagreeable complaints, and thofe even of long continuance, have entirely ceafed, upon the coming on of this difeafe ; whilft in others,.it has been fucceeded by various affections of the glands and Skin, to which the patient had never before appeared to be Subject. Poth thefe effects fucceed much more frequently to the 262 MEDICAL ADMONITIONS. the fmall pox, which takes place in the natural way, as it is termed, than to that which is produced by inoculation. It has alfo been obferved to happen more commonly when the eruption has been nu- merous, than when it has been Scanty. Whence it may be concluded, that thefe circumftances are the reSult of the changes induced in certain habits, merely by the difeafed actions confequent to the application of the poifon of the fmall pox to the fyftem : and as thefe circumftances generally Seem to be proportioned to the quantity of eruption in the preceding difeafe ; fo the eruption of the inoc- ulated being much fewer, than that of the natural Small pox, the probability of thefe changes occur- ring, muft be much lefs likely in the former cafe, than in the latter. Inoculation, therefore, fo far from being avoided on this account, ought the more particularly to be had recourfe to ; fince the chance is much greater of obtaining, by it, an ex- emption from thefe difagreeable and alarming oc- currences. The benefits which would refult from the univer- sal practice of inoculation, are fo very confiderable; and the eafe with which the operation is performed is fuch, that Dr. Buchan, and other benevolent phyficians, have recommended to the nurfes and parents of children to perform the operation them- felves. But were this advice to be followed, I very much MEDICAL ADMONITIONS. 263 much fufpect that, Srom the operation being per- formed on improper fubjects ; from the neglect of due preparation ; from the want of proper man- agement, during the eruptive fever ; from the oc- currence of various anomalous fymptoms, which do fometimes happen to the moft Skilful inocula- tors, and which would excite confiderable alarm in the minds of the ignorant ; that the prejudices againft this practice, would be multiplied, and its adoption, perhaps, become even lefs general, than at prefent. There never would be wanting fome, who would be difpofed to place every thing difa- greeable, that might happen, to the account of an operation, which is feldom performed, without op- position from the prejudices of fome timid friend Or relation. Should the wound made by the incifion inflame, and only fome accidental pimple happen to appear on any part of the body ; the patient, fatisfied of having paffed through the difeafe, might neglect the neceffary cautions of avoiding the infection, and in confequence of the poifon not having before really entered the fyftem, he may now become a victim of the difeafe. Such an occurrence would doubtlefsly occafion many to adopt the opinion. that inoculation does not procure an exemption from this difeafe in future, Again, 264 MEDICAL ADMONITIONS. Again, it may be obServed, that caSes may hap- pen, where the contagious matter may be applied in Such a manner, as to eScape being taken up by the abSorbents of the part to which it is applied j but where, from the patient conftantly carrying the virus about him, which has been applied for the purpofe of inoculation, it may occafion the difeafe in the ordinary way. Should this happen, and the difeafe terminate fatally, the cafe would be cited as an inftance of the fatal confequences of inocula- tion. For inftance—Dr. Buchan, who Strongly recom- mends to parents to perform this operation them- Selves, deScribes to them the method he took with his own Son. "After giving him two gentle pur- "ges, I ordered the nurfe to take a bit of thread, "which had been previously wet with SreSh matter "from a pock, and to lay it upon- his arm, covering "it with a piece of Sticking plaifter. This remained "on until it was rubbed off by accident. At the "uSual time the Small pox made their appearance, "and were exceedingly favourable. Surely this," "the Doctor adds, "which is all that is generally "neceflary, maybe done without any fkill in medi- "cine."—But were fuch a mode of practice to be- come common, is it not very probable that a cafe would fometimes occur, in which, the abforbents of the arm not taking up the matter, the patient might MEDICAL ADMONITIONS. 16$ ■* might become infected in the natural way, from inhaling the poifon he carries about him ? And fhould the fucceeding difeafe prove fatal, there is little doubt but the animadverfions it would-occa- fion, would not a little tend to prevent the future adoption of inoculation. From a laudable zeal to promote the wide ex- tension of this bcnehpal practice, Dr. Buchan has endeavoured to render the procefs of inoculation as Simple and eafy as poffible. But I fhould much fear, that, from the little ftrefs the Doctor lays on the neceffity of preparation, thofe who are inclined to become inoculators may be milled ; and may bo induced to place too little reliance on this part of the procefs, on being told, "The fuccefs of in- "oculators does not depend on the preparation of "their patients, but on their management of them "while Under the difeafe." I have long been con- vinced, that from too little attention to prepara- tion, inoculation has produced more confiderable crops of puftules, than when it was the cuftom to attend more rigidly to this circumftance. On this point, the remarks of Mr. Daniel Sutton, the celebrated inoculator, are very decided. He fays, "I underftand it has been a practice of late, to give up preparation, medicinal and dietetic, en- tirely, and to rely on the power of medicines, and JCk; the 266 MEDICAL ADMONITIONS. the Skill of the operator, during the eruptive fever, to keep it in due Subjection. But with Submiffion to thoSe who chooSe to practiSe in this way, I con- ceive that one, at leaft, in eight or ten caSes, may give them more trouble than is either defirable or prudent.—I never yet could difcover any advan- tage from the mere act of inoculation, beyond that of afcertaining the time when the patient would fall ill." CHICKEN OR SWINE POX. In the chicken or fwine pox, an eruption, much refembling that of a very favourable fmall pox, ap- pears after a flight degree of fever. This eruption foon proceeds to fuppuration, in which ftate it re- mains but a little time, before the difeafe termi- nates, by the drying up of the puftules, which Sel- dom leave a cicatrix behind. The Similarity which exifb between this difeafe and the fmall pox, not only frequently occafions a difagreeable State of doubt and fufpence, in the minds of the patient and his friends, whether the difeafe he has paffed through was the fmall pox or not; but frequently in other inftances, it occafions an ill grounded hope, that the patient has paffed through the Small pox, in its milder kind. Hence fucceeds a confidence, which may be productive of conSequences MEDICAL ADMONITIONS. Z6y confequences of a ferious nature. The patient, be- ing affured of his future exemption from the ef- fects of the contagion of this dangerous difeafe, ho neither avoids thofe fituations in which he knows he may be within the fphere of its influence ; nor does he have recourfe to inoculation, which would either confirm the hopes he entertains, or infure his future fecurity, at the moment it convinced him of the danger of the fituation, in which he had before Stood. To prevent, however, an error of this kind, the following circumftances may be" attended to. ift. This difeafe feldom comes on with fo much fever, as, in general, accompanies a Similar quantity of variolous eruption. 2dly. The eruption, at its appearaace, generally differs from the fmall pox, in the pimples being, almoft from the firft, filled with a tranfparent liquor ; the veficle being almoft pel- lucid. 3dly» The eruption appears more early, and paffes through its different ftages more rapidly, than that of the Small pox : the puftules turning and becoming dry, fometimes in lefs than half the time than what is required in the mildeft kind of the fmall pox. An attention to thefe circumftan- ces will, in general, point out the difference ; but when the importance of afcertaining the real nature of the difeafe is confidered, there muft be very few who would not choofe to have the opinion of thofe whole judgement can be fully relied on. As 468 MEDICAL ADMONITIONS. As to the treatment of this difeaSe, medicine is Very Seldom neceffary, it being, in general, Suffi. cient, that the patient be kept, if the weather is cold, from the open air, and be fupplied with cool- ing drinks and light food. Sometimes, however, towards the conclufion of this difeafe, matter will form under the hardened fcabs, occafioning deep and troublefome fores, which frequently require, not only the affiftance of the furgeon, but the ufe of internal remedies alfo* The choice of thefe muft be directed by the pecu« liar habit of the patient, hi&-ag& Strength, &c. MEASLES. This difeafe depending upon contagion, children are moft generally the Sufferers from it ; fince few pafs their youth without being expofed to, and af. fected by, its influence. It moft commonly happens, that, for feveral days previous to the coming on of the difeafe, a child, who has been expofed to the contagion, will droop, lofe its appetite, and become pale and fretful. To thefe fucceeds a fhivering, which frequently in children, paffes without being obferved. This is directly followed by fever, accompanied with a maiclf refpiration -7 hoarfenefs; frequent, dry and MEDICAL ADMONITIONS. 269 tough cough ; rednefs of the eyes, fneezings, and a conftant wntery difcharge from the eyes and nof- trils. Commonly on the fourth day of the fever, the eruption appears in fmall red points, which are generally firft obfervable around the mouth, then in the other parts of the face, the ftomach, and, at length, on the whole body. The eruption feldom rifes much above the fkin ; fo that, except on the face, little or no prominence is difcoverable. After continuing three days, the eruption lofes its bright rednefs, and becomes of a brownifh red ; and, in a day or two entirely difappears, leaving the fkin rough, and as though it had been dufted with meal. The fever generally declining as the eruption goes off. The confideration of the following circumftance will Shew how dangerous it is to truft to domeftic practice, even in fo common and well known a difeafe. This difeafe is very likely, at its firft appearance, to be mistaken, by the unexperienced, for the fmall pox ; but this miftake is but of little confequence, when compared with an error to which family practitioners muft be very liable ;—that of mistak- ing the eruption peculiar to the putrid fore throat, for that of the mealies. This miftake is favoured *{>y the mealies iuclf being, fometimes, accompanied with 2JQ MEDICAL ADMONITIONS. with a forenefs of the throat; whilft in the difeafe, which, in this ftate it refembles, the SoreneSs of the throat does not always particularly call the atten- tion, until the eruption has taken place. Such an error, if not foon difcovered, can hardly fail to oc. cafion the death of the patient ; as the mode of treatment which Should be adopted in the one cafe, is directly oppofite to that which is required iu the other ; plainly evincing the danger of trufting, even in fo common a difeafe, to the precarious practice of domeftic medicine. Treatment. When this difeafe is very flight, the fever and cough being moderate, and the breathing eafy, and hardly quicker than natural, little more is neceffary, than to keepv the patient's body open, by the affiftance of tamarinds, manna, &c. ; at the fame time Supplying him, frequently, with cooling mucilaginous drinks, fuch as the pec- toral decoction, barley-water, or infufion of linfeed, Sweetened with honey. His apartment fhould be but moderately warm, and great care fhould be feken,that he is not expofed to a Stream of cold air. To leffen the inconvenience arifing from fre- quent coughing, the patient may frequently hold in his mouth, 3, mixture of two parts of oil of al- monds, and one of honey; fwallowing it as flowly as poffible. But fhould this not prove fufficient to moderate the cough5 it will not be right to tamper farther 5 MEDICAL ADMONITIONS. 2/1 farther ; but immediate medical advice Should be obtained, left ferious mifchief be concealed. The circumftance which generally occafions a fatal termination of this malady ; and to which, therefore, attention Should more particularly be excited, is an inflammation of the lungs. This dif- eafe, as was more fully demonstrated, when treat- ing cxprefsly of inflammation of the lungs, often comes on fo infidioufly, as to render it difficult of detection, even by the moft Skilful ; and parties larly in children. When it accompanies the meafles, the poffibility of its exifting without the knowledge of an ordinary obferver, is very great ; and the confequence of its continuance, uninterrupted by the early ufe of proper means, muft be moft proba-> bly the death of the patient. The likelihood of inflammation of the lungs con- tinuing without detection, when accompanying the mcafles, arifcs from this caufe. Quicknefs of breathing, the moft obvious and characteriftic fymptom of inflammation of the lungs, is generally prefent during the greater part of this difeafe ; and even in thofe cafes where the difeafe terminates in the moft favourable manner. Hence it too fre- quently happens, that fuch an affection of the breathing as calls for immediate recourfe to the moft vigorous meafures, is unnoticed, and the op- portunity of relief fuffered to efcape. To 2JZ MEDICAL ADMONITIONS. To prevent this, the breathing fliould be at ten- tively watched. If it becomes very quick, and is performed with a wheezing noife, the fever at the fame time being confiderable, and the cough fre- quent, and evidently occafioning pain to the pa- tient ; every thing is to be feared, and the beft and fpeedieft advice fliould be obtained. A fituation frequently occurs in this, and indeed in every other difeaSe accompanied by inflamma- tion, in which the friends of the patient are very liable to be mifled in the opinion they may form, of the judgment and abilities of the perfon, under whofe care the patient may have been placed. This arifes from the difference of treatment em- ployed whilft there are hopes of removing inflam- mation by refolution, from that which is adopted when fuppuration is taking place. In the former cafe, the furgeon or phyfician will in general have recourfe to free evacuations, and every other means which may have the effect of diminifhing the pow- ers by which the blood is propelled through the fyftem ; but in the latter cafe, it may be neceffary to employ a tolerably full diet, cordial medicines, and every thing which may prove reftorative and invigorating. Suppofe, then, a patient, afflicted with any difeafe, dependent on inflammation ; ir» whofe cafe the moft proper means have been em* ployed for its difperfion, by the medical gentleman firft MEDICAL ADMONITIONS. 273 firft employed, but unfortunately with fuch little fuccefs, as to have induced the patient, or his friends, to call in fome other perfon, of whofe char- acter they may have been led to form an higher degree of eftimation. The period in which there was a poffibility of removing the inflammation by difperfion, being now paft, that mode of treatment muft be adopted, which will beft accord with the intention of promoting fuppuration. This plan being of neceffity oppofite, almoft in every refpect, to that which has preceded, the comparison is too often made by the ignorant, to the prejudice of the perfon who had been firft confulted. "Here," Say they, "was the patient getting daily worSe and WorSe ; but now, directly that a different mode Of treatment is adopted, he immediately alters for the better. How fortunately we changed our phyfi- cian; he certainly has faved him—under the former, he as certainly would have loft his life." Thus the one is applauded, the other is feverely cenfured; whilft both have entertained the fame opinion ref. pecting" the difeafe, and both have been directed, by exactly the fame principles. When purple fpots, and other fymptoms peculiar to a diffolved ftate of the blood, accompany this difeafe, the greateft judgment and attention are required to bring the difeafe to a favourable termi- nation. L l An 274 MEDICAL ADMONITIONS. An obftinate cough will frequently be found to remain, after all the other fymptoms have fubfided. In this caSe, it would be extremely wrong to truft to the ordinary remedies for coughs, left the cough fhould be Symptomatic of more ferious and latent mifchief. To prevent thefe confequences, frequent purging is recommended at the conclufion of the difeafe ; and, in moft cafes, muft prove beneficial, being likely to diminifh the difpofition to inflammation, which is, in general, produced by this diSeaSe, and which occafions the above mentioned effects. But dependance is not always to be placed on purging alone ; fince, in almoft all theSe caSes, particular attention Should be paid to the regimen, which is required to be Spare and cooling ; and, in Some caSes, even repeated bleeding may be neceffary. I cannot quit this Subject without offering Some advice, which, if attended to, cannot but prove be- neficial. When one child in a family is attacked with this difeafe, let the greateft poffible care be ta- ken, left by expoSure to a cold and moift atmof- phere, the remaining children become affected by a catarrhal affection ; by which the danger of in- flammation of the lungs in the fubfequent difeafe is increafed. It is obvious, that this advice is equally applicable where the difeafe is even known to be in the neighbourhood. SCARLET MEDICAL ADMONITIONS. 2%S SCARLET FEVER. This fever comes on with cold Shivering, pains in the head and loins ; foon after, the throat be- comes uneafy, and the fwallowing difficult, the in- fide of the throat appearing tumid and red. About the third day, a fcarlet eruption takes place, mak- ing its appearance, at firft, in bright red fpots, on the face and neck, and afterwards on the reft of the body, and the extremities. From thefe Spots run- ning together, the whole Skin becomes of a bright Scarlet. Soon after the redneSs appears, white Specks or floughs are diScernable on the tonfils ; theSe enlarge, aSter a few days, fall off, and difcover an ulcerated furface underneath ; which, however, in general, foon heals. After continuing about three or four days, this eruption goes off, the fever generally fubfiding at the Same time. ASter this difeafe, the fkin almoft always peels off, and frequently in pretty large portions. It frequently happens, that an anafarcous fwelling of the whole body comes on within a few days after the difappearance of the eruption, and is fometimes difficult of removal. Although, in the above hiftory, I have mentioned the forenefs of the throat as one of the fymptoms of this difeafe, yet it muft be remarked, that fcar- let fever fometimes occurs without any affection of the throat. This 2y5 MEDICAL ADMONITIONS. This difeafe is fometimes to be met with, accom- panied with highly inflammatory fymptoms; and, at other times, with fymptoms marking a fimilar malignity, with the ulcerated fore throat, or putrid fever. To attempt to lay down a mode of cure to be adopted by family practitioners, in a difeafe which varies fo much in its mode of exiftence, as to re- quire, at different feafons, and in different fubjects, the ufe of means entirely of an oppofite nature, would be highly cenfurable, fince fatal mifchief might hereby be occafioned. Real benefit may, however, be derived from pointing out thofe dif- eafes with which fcarlet fever may be confounded, and the confequences that moft probably would fucceed to fuch a miftake. • At the firft appearance of the eruption, it is by no means unlikely, that a difficulty may be found, by fuch practitioners, in endeavouring to distin- guish between that which is characteristic oS this diSeaSe, and that which is peculiar to the mealies. In thoSe caSes of meafles, where the catarrhal Symp- toms are very Slight, it may very eafily be miftaken for Scarlet fever ; and in fcarlet fever, unaccompa- nied by fore throat, efpecially in young fubjects, the probability is great that it may be treated as the meafles. But MEDICAL ADMONITIONS. 277 But the moft to be feared is, left, on the one hand, a cafe of fcarlet fever, requiring a cooling treat- ment, and, perhaps, even bleeding, be fuppofed to be the putrid fore throat, and an attempt for its cure be made with heating cordials, wine, &c.; or, on the other hand, that a cafe of putrid fore throat be mistaken for fcarlet fever ; and, inftead of the free ufe of bark, nourishment, wine, &c. the con- trary mode of treatment be adopted. When this difeafe is fucceeded by anafarcous . fwelling, the greateft care is demanded; fince,Should it be neglected, an incurable dropfy may be the confequence. ERYSIPELAS, or ST. ANTHONY's FIRE. Erysipelas, according to the accurate defcrip- tion of Dr. Cullen, is an inflammatory affection of the fkin, with hardly any evident fwelling ; of a mixed, and not very bright red colour, readily dis- appearing upon preffure, but quickly returning again ; the rednefs of no regular circumfcription, but extending unequally ; and continuing, moft conftantly, to Spread upon the neighbouring parts, with a pain like to that Srom burning; producing blifters, Sometimes of a fmall, fometimes of a larger -Size ; always occafioning, as it goes off, a defquam- afion of the fcarf Skin, and fometimes urmir-ting in gangrene. "v.i^i 278 MEDICAL ADMONITIONS. When it attacks the face, the patient experien- ces, firft of all, a cold fhivering, fucceeded by a hot ftage, in which there is always more or lefs drowfi, nefs, with, fometimes, a confufion of the head, and, in fome cafes, even delirium. The affection of the fkin appears either on the firft, fecond, or third day of the fever ; frequently poffeffing, by degrees, the whole of the face ; fometimes the hairy fcalp, and even extending on to the neck. The whole face becomes much fwelled, and the eye lids fo much fo, that the patient is oftentimes not able to open them. The inflammation continues, in general, about eight or nine days, the fever not Suffering any abate- ment Srom the coming on of the affection of the fkin. In thofe cafes which have a favourable ter- mination, the fever and inflammation, generally, about this time, fubfide together. But in other caSes, the drowfineSs and delirium increaSe, as the inflammation proceeds ; and, the external affection being communicated to the brain, the patient is carried off about the Same period, Eryfipelas may be produced by the application of heat, or the fudden and partial application of cold, efpecially when the body is in an heated ftate. External injuries of various kinds, as wounds, punctures, and even the flighteft fcratches, are often fucceeded by this affection of the furrounding parts. The MEDICAL ADMONITIONS. 279 The application of poifons, more particularly thofe of the animal kingdom, often produces this difeafe. In fome cafes, it has been fuppofed to be the confe- quence of violent paffions of the mind. When eryfipelas exifts only in a trifling degree, and without any, or with but little, affection of the fyftem, or any other alarming fymptom, there may be no neceffity for calling in profeffional aid ; fince, by an attention to the following advice, the difeafe may be, in fuch flight cafes, carried off with the utmoft fafety. The body Should be kept in a laxative ftate, by the uSe of the gentleft aperitive medicines ; care- fully avoiding thofe medicines, which, from the irregularity with which they act, fometimes pro- duce effects far exceeding the intention with which they were given. Manna, lenitive electuary, faline purgatives, fuch as the Glauber and Rochelle falts, imperial drink, tamarind whey, &c. are remedies which may be ufed with the utmoft fafety. The patient, through the day, need not be con- fined to his bed ; it being fnfficient that he avoids expofing himfelf to a cold atmofphere. At bed time, the patient may take a few grains of Dover's Sudorific powder, or, a very Small doSe of James's powder ; drinking freely of weak wine whey, 28o MEDICAL ADMONITIONS. whey, or warm barley-water, with a fmall quantity of nitre, for the purpofe of procuring a gentle per* fpiration. Animal food Should not be indulged in ; pud- dings, fago, panada, &c being the moft proper ar- ticles of diet. But when eryfipelas exifts in a higher degree, or is accompanied by a confiderable affection of the whole fyftem, or by fuch fymptoms as we are about to defcribe ; it not only is of too ferious a nature to be entrufted to domeftic medicine, but even re- quires the greateft care oS the medical or chirurgi- cal perSon, whoSe attendance is obtained. For the diSeaSe not being uniform in its appearance, and the variety depending on widely different States of the fyftem, as well as of the part affected ; much Skill is required, in determining on the mode of treatment which ought to be adopted. When this difeafe exifts in the face to a consid- erable degree, there is great danger; of the commu- nication of the difeafe to the brain. The affected parts fometimes become gangrenous, the change* often taking place very fuddenly, without being fufpected but by thofe, who, by experience, have obtained an accurate knowledge of the difeafe; and ' who, by their acquaintance with the laws of the animal ceconomy, are enabled to detect the morbid ftate MEDICAL ADMONITIONS. 28l State of the fyftem. This difeafe'is very Subject to Sudden translations Srom one part to another ; Sre- quently from the external to the internal parts ; a circumftance which never occurs, without a great degree of danger. There is one circumftance, which alone ought to prevent family practitioners, from attempting the treatment of this difeafe, except in the flighteft cafes. It frequently, when properly conducted, proving a cure to maladies which have long and obftinately refifted every attempt made for their re- moval. When this difeaSe attacks with confidera- ble violence, the life of the patient may often de- pend on timely bleeding. But, of fo much confe- quence is the afcertaining the real ftate of the fyf- tem, that Should this evacuation be made improp- erly, inftead of faving the life of the patient, a fatal termination of the difeafe might be occafioned. As the particular ftate of the fyftem is neceffary to be afcertained, before it can be determined what remedies are moft proper ; fo is it impoffible to give here fuch general directions, for the diet and man- agement of the patient, as may be applicable in all cafes. Of the external applications it is not neceffary to fay much ; fince, when the difeafe exifts only in M m fuch 232 MEDICAL ADMONITIONS. fuch a degree, as to be a proper object of domeftic medicine, no particular application is neceffary : it being fufficient, that it is defended from the air by any fubftance, which is not allowed to adhere to the part affected. Befides, the felection of external applications, as well as of internal remedies, muft be directed by the ftate of the fyftem, and of the affected part. The following defultory cautions, are, therefore, all that can be introduced on this Subject; Greafy applications almoft always feem to aggra- vate the difeafe. Abforbent earths and farinaceous fubftances, which are frequently recommended, form hard and troublefome crufts, by mixing with the liquor which exudes Srom the part; the effufed fluid, confined by theSe crufts, irritating the parts beneath. Cooling and Sedative applications, Such as cold water, Goulard's vegito mineral water, &c. are very effectual in leffening the inflammation, and are, therefore, Srequently adopted by domeftic practitioners. But it is neceffary to remark, that theSe applications, which, at firft, Seem to produce very pleaSant and Salutary effects; do Sometimes produce, and Suddenly, the moft dangerous confe- quences : a gangrene oS the part being very likely to Succeed to the improper employment of them. They Should never therefore, be ufed in thefe cafes, but under the direction of the phyfician or furgeon. Eryfipelas MEDICAL ADMONITIONS. 283: Eryfipelas never appears in aged perfons, nor in thofe who have lived freely, without denoting fuch a ftate of the fyftem, as muft demand all the aid that can be obtained, from the conjoined powers of experience and judgement. Its occurrence in youth and middle age is feldom dangerous, except when accompanied with much fever, or when it extends over a confiderable fur- face. ERYSIPELAS OF CHILDREN, Very young children fometimes are attacked with eryfipelatous inflammation, to which it is ne- ceffary moft earneftly to call the attention of par- ents ; fince, from the feeming trifling and infigni- ficant appearances which take place on its firft oc- currence, there is too much probability, that it may be often allowed to attain a confiderable height, before application for affiftance is made. When- ever this does happen, the chance of recovery muft be very flight indeed; for even in thofe cafes where the utmoft exertions of art are early employed, this difeafe frequently carries off the little Sufferer with great rapidity. This difeafe begins in fmall red patches, with hardly any elevation, and by no means of fuch an appearance, 2§4 MEDICAL ADMONITTONS. appearance, as to be likely to excite any alarm ; ex- cept in the minds of thofe who are apprifed of the infidious and dangerous nature of this difeafe. Thefe patches, in fome cafes, make their firft ap- pearance on the extremities, and, in others, on the lower part of the belly. They extend themfelves confiderably over the limbs and trunk, becoming hard and more difcoloured, and, if not happily Stopped by the adoption of the moft appropriate meafures, the difeafe foon terminates fatally. To excite the attention of parents, fo that, on the firft appearance oS this diSeaSe, they may be ap- prised of the danger which threatens, and be thereby induced to apply for immediate affiftance, is all that can be attempted here, THE MILIARY FEVER. The eruption from which this fever derives its name, is formed by feveral little bladders, which rife on the fkin, of the fize and appearance of grains of millet. From this eruption having been feen to accom- pany various difeafes, it has been much doubted? whether it is an original and primarydifeafe ; or whether it is not merely a fymptomatic diforder, proceeding from the difeafe it accompanies, From the MEDICAL ADMONITIONS. 285 the circumftance of its having occurred as an epi- demic, having attacked many at the fame time, in the fame neighbourhood, there is hardly a doubt, but that it may exift as a primary difeafe. But it is not neceffary here to enter farther into this queftion ; fince the determination would not affect the precepts which will be here delivered, refpecting its treatment. This eruption generally makes its appearance when proSufe Sweatings have preceded ; but it has Sometimes been met with, where no Such previous Sweating has taken place. It attacks both Sexes, and thoSe of every age and conftitution ; but child- bed women appear to be moft frequently affected by it. When it occurs as a primary difeafe, it begins with a fhivering, which is Soon Succeeded by a con- siderable degree of heat, and pain in the head and loins, attended,with great anxiety and lownefs of fpirits, oppreffion on the breaft, and difficulty of breathing. Thefe latter fymptoms, with an itch- ing and prickling in the fkin, in general, imme- diately precede the eruption, which commonly ap- pears between the feventh and fourteenth day of the fever ; but it has not been remarked to make its appearance on any particular day. The erup- tion firft appears on the neck and cheft, then upon the 2%6 MEDICAL ADMONITIONS. the arms ; and at length is diffufed almoft over the whole body, but it is feldom to be difcovered on the face. The fkin has fometimes, but very rarely, continued dry through the whole of the difeafe ; but, in general, the Sweating is very profufe. The ftools are, for the moft part, loofe, and the urine pale, and of a particular lightiSh green caft. The tongue does not become very Soul, and the eyes acquire a more than common brightness. About the time of the eruption, there always arifes a pun- gent acid odour, peculiar to this difeafe. In ripen- ing, the eruption becomes of a yellowiSh hue ; and after continuing a few days, the length of time va- rying much in different cafes, it dies off, leaving the fkin covered with branny fcales. Sometimes the eruption is renewed feveral times in the courfe of the fame fever. Perfons fweating under febrile difeafes are efpe- cially liable to the miliary eruption, and particu- larly thofe who have been previoufly weakened by large evacuations, particularly of blood. This, Dr. Cullen thought, would explain why it happens to lying-in women more frequently than to any other perfons ; and has remarked it to happen to women not in child-bed, but who had been much Subject to a frequent and copious menftruatioh, and to an almoft conftant fluor albus. He alfo had occafion to obferve it to happen to men in fevers, after wounds, from which they had fuffered a great lofs of blood. Since MEDICAL ADMONITIONS. 287 Since the feveral varieties in the mode of treat- ing this fever, Should be the refult of a very nice and accurate inveftigation of all the concomitant circumftances; and as this talk requires, in the per- fon who undertakes it, a thorough knowledge of the laws of the animal ceconomy, and of the chan- ges induced by difeafe ; it would be very improper to lay down a plan of cure, to be attempted by any one who does not poffefs that neceffary informa- tion. The fame reafon that prevents the attempt of laying down a regular plan of cure, in a work of this nature, is equally forcible againft the endea- vour to eftablifh any fixed rules for the regimen and management of the patient ; thefe depending on the fame circumftances which have been alluded to, muft be regulated by the advice of the phyfi- cian. It may not be amifs to remark here, that this eruption fo genen&Ty fucceeds profufe fweating, that it has been fuppofed to be merely a confe- quence of this difcharge. In proportion as the fweating is encouraged or checked, fo may the eruption be augmented or diminifhed; but the pro priety of either practice cannot be determined, un- lefs it is firft afcertained how far the fweating and eruption is connected with a critical change in the difeafe. HEMORRHAGES 288 MEDICAL ADMONITIONS. HEMORRHAGES. Hemorrhage may depend on an increafed ac- tion of the blood veffels ; or it may originate in fuch a ftate of them, as is oppofite to that vigour. It may proceed from too great abundance of blood, where there is no error but in quantity ; or it may be the confequence of the blood having acquired fuch a morbid tenuity, as may enable it to pais through openings, by which, in an healthy ftate, it would have been detained. Thofe who lead fedentary lives, indulging much at the fame time, in highly nourishing and ftimu- lating food, can hardly poffible efcape fuch a pre- ternatural fulnefs of the fyftem, as is likely to be productive oS haemorrhage ; fince the evacuations not being proportioned to the quantity of nutri- tious matter taken in, a due equilibrium cannot be preferved, between the quantity of the circulating fluids, and the folids which contain them. The diminution or Suppreffion of accuftomed evacua- tions ; whether of thofe which are natural, Or of thofe which have been induced by art or previous difeafe, will alfo confiderably contribute to the for- mation of that difeafed ftate of the fyftem, in which haemorrhage is likely to occur. In this way much injury is often occafioned, by the frequent bleed- ings which are fometimes had recourfe to, when haemorrhage i MEDICAL ADMONITIONS; 289 haemorrhage has once occurred; and which actually promote that ftate of the fyftem they were in- tended to prevent. When the above defcribed State of the fyftem has been induced by the foregoing circumftance^, nothing more is required, than the action of one Or more exciting or occafional caufes, to produce the difeafe. The exciting caufes are, whatever al- ter the regular circulation of the blood ; as exter- nal heat, a confiderable and fudden diminution of the weight of the atmofphere, violent exercife, con- siderable efforts of the lungs, certain paffions of the mind, cold externally applied, and fuch poftures of the body and applications Of ligatures, as may oc- cafion a determination, or accumulation of the blood in particular parts of the body. Dr. Buchan, when treating of this Subject, very juftly obServes, that " Involuntary fluxes of blOod may proceed Srom very different, and oSten from quite oppofite caufes." Of thefe the Doctor enume* rates no lefs than thirteen; and then very properly obferves, that "The cure of a haemorrhage muft " be adapted to its caufe." An affertion to which all muft readily affent, and heartily regret that any one fhould ever be induced to attempt the manage- ment of a difeafe, dependant on fuch various cau- fes, with no other information than that which they may have derived from fome treatife: on do* meftic medicine. Nn If 29© MEDICAL ADMONITIONS, If the fyftem has once fuffered a lofs of blood, by accident, by art, or by a fpontaneous effufion ; that quantity is not only quickly reftored, but freSh t>lood is formed fo fait, that a preternatural fulnefs, or plethora, is very foon produced ; which is fre- quendy fucceeded by a return of the bleeding. This Is again, in like manner, followed by a rapid resto- ration of blood, fulnefs, and haemorrhage. Thefe alternations of evacuation and repletion, being thus repeated, a difpofition to haemorrhage is, agreeable to a certain law of the animal ceconomy, occafion* ed ; and the difeafe, of courfe, rendered more difficult of removal. Nor is this all, for, in pro- portion to the length of the continuance and fre- quency of recurrence of haemorrhage, will be the danger of its occafioning other difeafes, either by its continuance or Suppreffion. The pofitions here advanced, which are founded on the known laws of the animal ceconomy, and are proved by the daily obfervations of every at- tentive medical man j muft Shew clearly the dan- ger of permitting, through neglect, or an ill found- ed timidity, the continuance of haemorrhage : the probability of its inducing future difeafe, having been Shewn to be, in proportion to the quantity of blood which is permitted to flow* Every fcience, in an age of enquiry, is conftantly receiving fome improvement, by the aceeffion of fome MEDICAL ADMONITIONS. 291 fome new fad, or fome ingenious obfervation.— Thus has the art of healing derived confiderable light, from the obfervations and rcafoning of Dr. Cullen, on this point. He having clearly evinced the neceffity of preventing the occurrence of hae- morrhage ; and, in moft cafes, of moderating effu* fions of blood, when they have actually come on. The opinions on which the pradice of encourag- ing haemorrhage had been founded, were derived 1 from fome fallacious conjeftures, reflecting the influence of the foul on the body; the foul having been fuppofed to direct and occafion Such changes in the Syftem, as were neceffary to the prevention or removal of difeafe. It was alfo imagined, that the body was, in general, diSpoSed to a plethoric State; that the greater part of the difeafes to which the human body is Subject, Was produced by this caufe ; and that fpontaneous haemorrhage was, al- moft always, the confequence of the efforts of cer* tain powers in the fyftem, exerted for the removal of fome difpofition to diSeaSe, or of the difeafe itfelf, if already formed. On thefe principles the flow of blood was permitted, until, through the weak- nefs of the patient, it ceafed ; it being fuppofed, that when a fufficient quantity of blood had flowed* to effect the intended falutary change, it would then fpontaneoufly Stop. Nor was this the utmoft extent of this mifchievous doctrine, for the fame arguments, 2gj MEDICAL ADMONITIONS. arguments, which induced them thus to allow the ravages of the difeafe, in the firft inftance, occa- fioned them alfo to encourage its return. It may be eafily conceived, that thefe repeated loffes of the blood, on which the formation and nourishment of every part of the body depends, muft render that fluid thin and impoverished ; and occafion it to poffefs, after each effufion, lefs and lefs of thofe principles, which are more par- ticularly appropriated to the fupport of the fyftem; although, at the fame time, the circulating fluids may exceed their natural quantity. Thus, then, by permitting the repetitions of haemorrhage, may fuch a Sfcte cf the fyftem be produced, as will very probably occafion wafting the body, dropfy, or fome other difeafe, which, being founded on general debility, will be very difficult to be removed, Dr. Cullen's reafons for fuppofing that haemorr- hage Should, in general, be avoided, are, " lit. Bt- " cauSe it does not always happen in parts where «it is Safe. 2dly. Becaufe often, while it does re- *clieve a plethoric ftate, it may, at the fame time, 64 induce a very dangerous difeafe. 3dly. Becaufe << it may often go to excefs, and either endanger ««life, or induce a dangerous infirmity. And laftly, ? becaufe it has a tendency to increafe the pletho* ric MEDICAL ADMONITIONS. 293 Ci ric ftate it was meant to relieve ; to occafion its " own recurrence ; and thereby to induce a habit, " which, if left to the precarious and unequal ope- " ration of nature, may, from the frequent errors " of this, be attended with much danger." * Having recommended the prevention of plethora, rather than the allowing of the return of haemorr- hage, it is neceffary to defcribe the means by which this end may be accomplished. The innumerable fecretions made from the gene- ral mafs of blood, occafions a continual expence of that fluid; and exercife, as it promotes almoft every fecretion, fo muft it produce an increafe in the confumption of the blood. The quantity of blood thus expended, is reftored by the continual acceffion of new blood, formed from the chyle, which is immediately derived from the various fubftances taken as aliment. The quantity of blood muft, therefore, depend on the quantity of aliment from which it is produced, and the degree of ex- ercife, by which its expence is occafioned; in pro- portion as the one or the other of thefe prepon- derate, will a difpofition to plethora, or to the contrary ftate, take place. To prevent the quantity of blood from exceed- ing its due proportion, exercife, then, fhould be ufed Cullen's Firft Lines, vol. ii. p. 301. 294 MEDICAL ADMONITIONS. ufed freely, the quantity of food muft be diminifh- cd, and Should be compofed of fuch fubftances, as are nourishing, only in a moderate degree *, fuch as vegetables, milk, &c. Proper means muft, at the Same time, be employ- ed, for keeping the bowels in a laxative ftate ; and the circumftances which have been before defcrib- ed, as exciting caufes, muft carefully be avoided. When haemorrhage has actually come on, and it appears proper that it Should be moderated, the application of every thing heating and ftimulating riiuft be careSully avoided. The air of the cham- ber Should be cold, and no malt liquor, wine, or fpirits, permitted the patient. This caution is neceffary, fince it very frequently happens, that the patient is very freely fupplied with thefe pernicious liquors, with the intention of removing the fick- nefs and faintnefs, which accompany the difcharge. The patient Should be kept in Such a pofture, as may leaft favor the impetus of the blood towards the part from which it flows :—but this, as well as the other means of cure, will be more fully treated of, when fpeaking of haemorrhage from particular parts. Haemorrhages proceeding from a diffolved ftate of the blood, will always require the moft vigorous exertions for their Suppreffion ; fince, by their continuance, MEDICAL ADMONITIONS. 295 continuance, they neceffarily increafe that morbid ftate on which they depend. Upon the whole, when we confider how numer* ous the caufes of haemorrhage may be ; and how neceffary it is to afcertain the caufe on which each cafe depends, before a determination is made on fo nice a point, as whether the haemorrhage Shall be reftrained or fuffered to continue ; it muft be agreed, that no decisive ftep ought to be taken. Until competent advice has been obtained. Until then, little more fliould be done than removing any of the circumftances, which are above enume- rated, as likely to become exciting caufes; and em- ploying fuch means, as may moderate the difcharge, if it is violent, and the patient apparently finking. Skill is required in the treatment of few difeafes more than in thofe of this clafs ; the cafe being often fuch, as, from its urgency, to require an im- mediate decifion ; and the future health, and even the life of the patient, may depend on the judg- ment with which it is made. BLEEDING FROM THE NOSE. From the very confiderable number of blood- veffels with which the internal Surface of the nof- trils is furnifhed, and the delicate texture of their covering, we may account for the frequency with which this complaint occurs. This 200 MEDICAL ADMONITIONS. This complaint may be met with at every period of life ; but the changes which take place in the fyftem, juft before puberty, and after the age of forty and fifty, are fuch as to render it more likely, that, at thefe periods, the effufion fhould take place from this part, than any other. During the exiftence of febrile, or inflammatory complaints, in which the head is much affected, bleeding from the nofe fometimes happens; in ge- neral proving critical, and being followed by the removal of the prior difeafe. This difcharge alfo often occurs, in fevers which are accompanied by a languid ftate of the fyftem, and a diffolved State of the blood. It alfo frequently happens, when there is no reafon to fufpect it to depend on any particular State of the fyftem, but is only produced by fome incidental caufe ; Such as a violent effort made in Sneezing, &c.; or the application of fome hard fubftance to the internal furface of the nofe* Bleedings from the nofe in young people are fel- dom in any confiderable quantity ; generally ceaf- ing Spontaneously, aSter a moderate flow, or yield- ing to the application of cold water to the nofe and furrounding parts ; or to the application of any very cold fubftance, to any part Of the furface of the body : as may be obferved, in the common practice of putting a cold piece of metal, as a keyj down MEDICAL ADMONITIONS. 2(}f clown the back, next to the fkin, which induces a Shivering, foori after which the bleeding generally flops. The infrequency of this difcharge being directly followed by any evident ill conSequence, and the facility with which it is in generally reftrained, con^ tribute to miflead the patient and his friends, into an opinion, that no harm can be produced by a difeafe fo common, dnd apparently fo trivial. The patient is therefore, in general, configned to fome good woman, the bleeding ceafes, but no proper means are adopteel to alter the ftate on which the difeafe depends, and thereby to prevent its return. To Shew to thofe who are too much difpofed to truft to the vague and dangerous practice of do- meftic medicine, the neceffity Of obtaining the ad- vice of the Skilful and judicious, in thefe cafes, noth- ing more, Surely, can be neceffary, than to point out the ftate of the fyftem, at this time ; and the probable mifchiefs that may fucceed to improper management. From attentive obfervations, it appears, that in thofe young people who are Subject to bleedings from the nofe, there exifts not only a general ful- nefs of blood ; but alfo an increafed determination of the blood towards the head. This is a ftate which certainly demands the greateft care and at- O o tention 5 igB MEDICAL ADMONITIONS. tention; fince,fhould the haemorrhage be reftrained, without the adoption of due precautions, the blood might force an opening through fome other vef* fels, fituated, perhaps, in a part, where, as in the brain, it might occafion a fatal injury. And, on the other hand, if, by neglect of proper manage- ment, the bleeding Should be fuffered repeatedly to return, and become periodical; there will be rea* fon to fear, left, when the patient arrives at his full growth, a rupture of a blood-veffel in the lungs* terminating in a confumption, may take place. In confirmation of this opinion, I may here repeat a common observation; that thofe, who are moft lia- ble to a difcharge of blood from the lungs, have been Subject, when young, to bleeding at the noSe. When this diSeaSe happens to thoSe who are ad-i vanced in years, the niceft judgement is required^ in adopting the mode of treatment. As it certainly often prevents an attack of palfy, apoplexy, &c. there cannot exift a doubt of the impropriety of checking the difcharge, at its firft appearance : on the contrary, it is frequently neceffary to have re* courfe to bleeding, from the arms, and to other means calculated to diminifh the general fulneSs, and to take off the determination to the head. A careful attention to the foregoing indications ss neceffary, not only at the time when the haemorr- hage MEDICAL ADMONITIONS. 299 hage exifts, but Should be affiduoufly perfevered in, for a confiderable time after the haemorrhage has ceafed; and, in many of thefe cafes, a Strict regard muft be paid to rules, even during the remainder of life. The general principles, on which it is neceffary to proceed in thefe cafes, both with refpect to the treatment of the haemorrhage itfelf, and to prevent- ing its return, are laid down in the preceding chap- ter. But much caution is neceffary, in the appli- cation of thefe principles to particular cafes ; fince an error, on either fide, may be followed by conr fiderable mifchiefs: on the one fide, by occafioning a rupture of a blood-veffel in fome vital part; and, on the other, by laying tfie foundation for dropfy, or fome one, of the numerous clafs of difeafes, de- pendent on debility. Bleeding from the nofe, in febrile or inflamma- tory difeafes, efpecially when preceded by pain in the head, fluflied countenance, and redneSs of the eyes, will, in general, be found to be critical and falutary : and, confequently, muft not be checked, unlefs it becomes profufe, and is likely to exhauft the patient too much. Much caution and Skill is requifite, in forming a right judgement, in thefe cafes ; fince it often happens, that fevers, and va- rious febrile complaints, at their commencement, $nd during fome part of their courfe, are accompa- nied 30X3 MEDICAL ADMONITIONS. nied with ftrong marks of inflammation, to which, however, exceffive debility very Soon Succeeds. In fuch caSes, this difcharge, although happening at a critical period of the diSeaSe, will, if not very mod- erate, be likely irretrievably to fink the patient. When this haemorrhage happens in putrid fever, ulcerated fore throat, or any of thofe difeafes, which, from their firft appearance, are accompanied with great debility of the fyftem, the earlieft efforts muft be exerted to reftrain it; fince the loSs of even a fmall quantity of blood, may, in thefe cafes, be productive of fatal confequences. The occurrence of haemorrhage, in thefe cafes, is very rarely accomr panied with circumftances which render this ad- vice improper. Where there is nothing to forbid the fuppreA Sion oS the haemorrhage, the following means may be employed. Cloths dipped in cold water, vin- egar, or Spirits, may be Srequently applied to the noSe and face ; the body fhould be kept in an erect pofture, and expofed to the free accefs of cold air. If thefe fhould pot prove fufficient, a piece of lint, rolled up in the form of a cone, muft be introdu- ced into the noftrils ; no benefit can, however, bq expected from this, unlefs it is applied with fuffi- cient force to prefs on the orifice of the rapturec) yeffel. If this Should, not fucceed, the lint may? previous MEDICAL ADMONITIONS. ^ 30I previous to its introduction into the noftril, be en- veloped in flour ; and, if this fail, the lint may again be introduced, with the addition to the flour •of a fourth part of finely powdered allum. It is almoft unneceffary to add, that every thing likely to Stimulate the noftrils muft be carefully avoided. Dr. Buchan recommends, that "the garters may e'be tied a little tighter than ufual. Ligatures may *'be applied to the arms, about the place where they *care ufually made for bleeding, and with nearly *'the fame degree of tightnefs. Thefe muft be gra- dually flackened, as the blood begins to ftop; and *'removed entirely, as foon as it gives over." But this practice is not likely to produce the be- neficial effects, for which it is recommended. Dr. Chapman, in his ingeniousThefes on Haemorrhages, remarks, that ligatures are fometimes applied to comprefs the veins, and thereby to retard the re- turn of the blood from any part to the right ven- tricle of the heart, with the expectation of dimin- ifhing the action of the heart, and of leflening the Velocity and force, with which the blood circulates. But this practice, he obferves, was introduced before mankind had obtained a thorough know- ledge of the circulation of the blood ; and is man- ifeftly liable to objections, which cannot eafily be overturned. In 302 MEDICAL ADMONITIONS. In the firft place, it is difficult to apply the liga- ture fo as to compreSs the veins, without making a preffure on the arteries alSo ; So that it may hap* pen, that as much injury may be produced, by in* terrupting the paffage of the blood from the heart, as benefit can be expected by impeding its return. Secondly, fuppofe that the preffure is even confined to the veins alone, the beneficial effects which are thence expected cannot poffibly laft long ; Since fuch a degree of compreffion muft, in a little time, affect the arteries, to the fame degree, as though the ligatures had been applied to the arteries them- Selves. H^MORRHAGY FROM THE LUNGS,. or SPITTING OF BLOOD. KffiMORRHAGY from the lungs, or, as it is com* monly termed, fpitting of blood, is generally pre* ceded by a frequent cough, a fenfe of tightnefs, weight, and anxiety in the cheft ; and, fometimes, by a coldnefs of the limbs, or a general Shivering. A faltifh tafte of the Spittle, and a troubleSome tickling of the upper part of the windpipe, fre. quently occur, juft'before the difcharge comes on. The quantity of blood fpit, at the firft attack oS the difeafe, differs very much, in different cafes ; Some- times only appearing in ftreaks, mixed with the phlegm. Medical admonitions. 303 phlegm, and, in other cafes, proceeding in fuch con- fiderable quantities, as even to threaten iuffocation. Some judgement is neceffary to diftinguifh, from what part the blood proceeds, which is thrown out of the mouth ; fince it may not only be derived from the lungs, but alfo from the ftomach, the mouth, the back part of the noftrils, or the upper part of the throat. The treatment which thefe latter cafes require, differs fo much from that of an haemorrhage from the lungs, that confiderable injury may be produced by an attempt to perform the cure, unlefs the feat of the difeafe is previoufly afcertained. The difcharge fometimes comes on without any previous notice ; and is then, generally, the con- fequence of fome exceffive exertion o'f the lungs, as in a violent fit of coughing, &c. When this is^the cafe, and the habit of body is perfectly free from difeafe, the haemorrhage will fometimes foon ceafe. The fame happy termination may, for the 'moft part, be expected, when the difeaSe is even the re- fult of a plethoric ftate of the fyftem ; but if a dif- pofition to confumption previoufly exifted in the habit, there will be the greateft reafon to expect that difeafe may be fpeedily induced. But when the difeafe is preceded by the fymp- toms before mentioned, and the haemorrhage does not 304 • medical admonitions. not immediately ceafe, the difeafe will generally* proceed in the following manner. After the dif- charge of blood has taken place, the foregoing fymptoms are, in a great part, relieved ; the chcil becomes more free, the breathing is performed with lefs difficulty, and the cough is leSs Srequent. ASter a little time, more blood oozing Srom the ruptured veffel, occafions a degree oS weight and uneafineSs of the lungs, and the return of the irri- tation in the windpipe: to this the cough very foon Succeeds, by Which the extravaSated blood is again thrown off the lungs. It Srequently happens, that the patient is enabled to predict the return oSthe haemorrhage, by the in- creaSe of fome;of the foregoing fymptoms, which generally takes place after a little refpite. In thofe cafes, where the difeafe terminates fa- vourably, the quantity of blood becomes lefs and lefs, in every fpit, the breathing remains eafy, and the cough foon ceaSes. The Spit may remain tinged for a little time, but, at laft, reSumes its natural ap- pearance. But iS. ulceration of the lungs comes on, as the fpitting of blood disappears, a Spitting of thick yel- low matter comes on; the breathing continues dif- ficult, and the cough frequent. When this unhap- pily takes place, the wafting oS the patient, Srequent heat MEDICAL ADMONITIONS. 305 heat in the* palms of the hands, and flufhings on the cheeks, will foon point out too plainly the fatal ten- dency of the complaint. As this is a difeafe in which there is for the moft part a confiderable degree oS danger, and as there is no caSe in which it occurs, in which the greateft care is not neceffary, no one Should think of hazarding in any inftance of it, the pradice of domeftic quackery. In all thoSe cafes, however, where the diSeaSe comes on Suddenly, and the aid oS the judicious cannot be immediately obtained, it will be neceffary to have re- courSe to Such means as may prevent the return of the haemorrhage. With the hope of accomplishing this, blood Should be taken away from the arm, efpe- cially if the pulfe be full,'or there exifts any degree of fever: the apartment fhould be cool, and the patient kept entirely ftill; particularly avoiding any exertion oS the lungs, as in loud Speaking, &c. Animal food, and even broths, muft be Strictly avoided, the diet being allowed to confift only oS Such things as contain but very little nourifhment j and even theSe, only in Small quantities. Nothing fhould be drank warm : the beverage which may be barley-water or toaft and water, either aScidulated with the juice oS lemons, qr not according to the inclination oS the patient, muft be taken as cold as poffible ; and ftools may be pro- cured by the uSe oS Some mild purgative, as lenitive electuary, manna, &c. By an attention to theSe P p rules, 306 medical admonitions. rules, and what has been already Said, when treating oS haemorrhage in general, the difeaSe may common- ly be prevented Srom increafing, until proper affift- ance is obtained. To prevent the return of this difeaSe, the rules already laid down, muft be careSully attended to; and to thofe may be added, as particularly requiring attention, the injunction, that all exertions be care- Sully avoided, which detain, or which hurry, the blood, in its paffage through the lungs ; Such as ling- • ing, loud Speaking, running, coughing, lifting great weights, &c. HEMORRHOIDS, OR PILES. The piles are Small round prominent tumors, formed near the verge of the anus. When blood is difcharged from thefe tumors, they are termed the bleeding piles ; when this is not the cafe, they are faid to be the blind piles ; and when the difcharge, or the uneafinefs, proceeds from within the rectum, and no tumor appears externally, the difeafe is term- ed the inward piles. The piles fometimes come on without any previ- ous fymptoms; but, in general, they are preceded by fymptoms, which evidently Shew a plethoric ftate of <# medical admonitions. 30; oSthe Syftem; Such as giddineSs, pain and weight of the head, and pains in the back; and when the bleeding takes place, thefe fymptoms generally go off. The quantity of blood varies in different cafes j in fome, being very trifling, in others fo confiderable, as even to threaten the life of the patient. The difcharge frequently, as in other hemorrhages, becomes period- ical. In fome cafes, it Seems to conSift of pure blood; but much difference is obfervable in this refpect, fince the difcharge is, in other cafes, almoft colour- lefs. The piles fometimes come on, and continue fome time, with but little pain, or inconvenience, except- ing heat and itching about the fundament; but fometimes they are from the firft exeedingly painful, ■fwelled and inflamed. In theSe caSes, iS the means which are had recourSe to do not prove SucceSsSul, the pain and inflammation increaSe, until the whole Syftem becoming deranged, Sever at length enSues. IS the inflammation goes on to Suppuration, the patient un- dergoes the utmoft diftrefs, and moft excruciating pain j being often prevented Srom voiding either ftools or urine, until Supuration being completed, a diScharge oS the contained matter takes place, accompanied by an alleviating of almoft all the diftreffing fymptoms.' In particular habits of body, and in cafes where the inflammation has been very confiderable, they fome- times *08 MEDICAL ADMONITIONS^ times terminate, not in fuppuration, but in a gangrene, or mortification of the effected parts. This difeafe moft commonly happens to thoSe who are beyond the middle ftage of liSe, and are of a relaxed habit of body, and melancholic temperament. Thofe who have before fuffered repeated loffes of blood are, for the reafons before affigned, particularly liable to attacks of this difeafe; and, for the fame reafons, thofe who have been long Subject to other discharges, Such as Srom ulcers, iffues, &c. are Srequently troubled with this complaint, upon thoSe discharges ceafing. Want oS exerciSe, and exceffive indulgence in eating and drinking, particularly of highly feafoned foods, wines, and fpirituous liquors, are frequent caufes of this malady. But the moft frequent exciting caufe of this difeafe, is the paffing of indurated excrement, 01 the too free ufe of ftrong purging medicines, as aloes, jallap, &c, But whatever circumftances occafion a fulnefs of habit, and diminishes the freedom of the circulation in the interlines, and in the inferior part of the body, may produce this difeafe. In thofe cafes where but little pain or inconveni- ence is produced, no applications will be neceffary to the part, nor any internal medicine required, except- ing fome gentle laxative to be taken occafionally. The fymptoms, however flight, fhould ferve to ad- monish the patient of the neceffity of his adopting the MEMCAL ADMONITIONS. 309 the proper regulations in his diet, and mode of living 5 left the difeafe be augmented, or fome more danger- ous malady be induced. This is a moment which ought not heedlefsly to be paffed over, fince the dif- eafe being once permitted fully to form itSelf, a dispo- sition to future returns, Succeeds; and this difpofition is increaSed by each Srefh attack. On the other hand, fhould the progreSs of the Symptoms be checked, and the haemorrhage flopped, without due precautions, a foundation may be laid for fome more alarming and dangerous difeafe. Since there cannot exift a doubt, but that very confiderable mifchief is often the conSequence oS pa- tients themSelves,and of domeftic practitioners adopt- ing the opinion, that the hemorrhoidal dicharge is not only innocent, but Salutary, and even neceffary * it cannot but be beneficial to endeavour to mew how far this opinion is correct. A plethoric Slate of the fyftem, in general, accom- panies the firft, as well as every fubfequent attack 0$ the piles. If this is not otherwife reduced, a bleeding from the piles takes place, *.nd the equilibrium is thereby reftored. But iS the cauSes of this morbid ftate of the fyftem are not removed, the fulnefs re- turns j the parts affected with the piles having been weakened by the previous distention, more readily be- come again loaded with blood, and the hemorrhage again glG MEDICAL ADMONITIONS, again takes place. Thus, fuccefiive alternations of fulneSs and hemorrhage are produced, until, at laft, the returns of plethora become periodical, and even, in Some meaSure habitual. When this is the cafe, if the hemorrhage be prevented, without, the neceffary regulations being adopted, other difeafes, the confe- quence of plethora, may be induced ; and may be removed by the return of the hemorrhage. But here let it be remarked, that thefe diSeaSes are attri- butable to the permitting of the hemorrhoidal flux, at the firft, inftead of correcting thofe diSorders pSthe Syftem by which it was occafioned. When the piles are accompanied with much pain, it is to be feared that fuppuration may take place. Many applications are recommended for the piles, when they are become fwelled and painful 5 but to be able to point out which of thefe is preferable, it is neceffary firft to know the actual Slate of the parts, as the remedies which may be proper where inflammation has not taken place, may prove highly injurious where that ftate oS the parts exifts. Inftead of enumerating thefe, I fhall, therefore, call the attention to the confe- quences of neglecting to employ the moft proper means in Such a cafe. In moft cafes of painful piles, more or lefs of inflam- mation is prefent. And if this inflammation is not Suc- cessfully oppoSed, it will Soon extend itSelf to the ad- joining MEDICAL ADMONITIONS. ^11 joining parts, not only producing the moft excruciat- ing pains in the Sundament, but alSo in the neck of the bladder; occafioning almoft an entire Suppreffion of the urine. When this happens, the patient may be affured, that it will be with very great difficulty that a fuppuration in the adjoining parts will be prevent- ed. Should fuppuration take place, the patient Should confider, that he has now a much more dif- agreeable difeafe to combat with, than before, and that the free and fkilSul exerciSe oS the chirurgic art, alone can prevent him Srom Suffering the inconvenience and pain oS a fiftula. Where the inflammation is violent, and continues for fome time, without any appearance of fuppuration, an event may be reafonably feared, by which the life of the patient muft neceffarily be brought into the moft imminent danger. Hence it muft plainly ap- pear, that where the piles become inflamed, the moft judicious exertions are neceffary, to prevent the moft ferious evils from taking place. The regulations of diet, exercife, &c* neceffary for the prevention or removal of that ftate on which this difeaSe depends, may be learned Srom what has been aiready laid down in the immediately preceding chapters. IMMODERATE Qi2 MEDICAL ADMONITIONS. IMMODERATE FLOW OF TH£ MENSES. It is not every variation in the period or quan- tity of this difcharge that is to be confidered as a dif- eafe, fince every healthy female is not exactly alike in thefe refpects ■, the discharge recurring, in Some cafes at longer, and in others at fhorter, periods ; in fome cafes in larger, and in others in fmaller quanti- ties ; without the appearance of any circumftance that points out the variation to be unnatural, or un- equal to the neceflities of the constitution. Slight deviations in theSe reSpects may alSo occur in the fame perSon, without being accompanied by. any mark oS diSeaSe. But when the discharge is confiderably increafed beyond its accuftomed quantity; when its returns are at much fhorter periods than uSual ; eSpecially if preceded or accompanied by cold chills, Succeeded by heat and thirft, pain in the head and giddinefs, fhort- neSs oS breath, and pain in the loins, it may be conclu- ded, that it exceeds the natural and Salutary quanti- ty. IS the diSeaSe is not now checked, other Symp- toms, the conSequence of exceffive debility, Soon come on ; the face becomes pale, the Seet are with dif- ficulty kept warm, and become affected withan cede- matous Swelling ; a fluttering and extreme finking is felt in the infide j the ftomach, inftead of requiring food, MVMCAL ADMONITIONS. 313 food, is almoft conftantly affected with nauSea; the pulSe is Small and Srequent -, the Surface of the body is frequently covered with a cold Sweat, and extreme ag- itation or Sainting is occafioned, even by the flighteft alarm. When the diSeaSe has proceeded thus Sar, a trifling circumftance may produce an alarming change ; a Sudden and copious discharge may be al- moft immediately Succeeded by Sainting, and even death ; or the continuance of a discharge, not Suffi- cient to occafion immediate diffolution, may be pro- ductive oSdropfy, and other complaints Sounded on extreme debility. The increaSe, both in the Srequency and the quan- tity of the difcharge, may take place So gradually, and the miSchievous conSequences be induced in So in- sidious a manner, that Srequently the patient may be reduced to a dangerous ftate oS debility, beSore fhe is Sufficiently alarmed to Seek Sor affiftance ; or even beSore fhe is convinced of the exiftence oS any diS- eaSe. Females who lead a life of indulgence and inactiv- ity, and who have been weakened by frequent mif- carriages, difficult labours, and immoderate dischar- ges Srom other cauSes, are particularly liable to this complaint ; as well as thoSe who have Suffered the Suppreffion of fome long continued evacuation, or who have fubmitted to frequent bleedings. Diftrefs, and Q^q anxiety ,?!a MEDICAL ADMONITIONS. anxiety of mind, indulgence in wine, and fpirituous liquors, alfo difpoSe to this complaint. The exciting caufes oS this diSeaSe, may be the Same with.thofe al- ready enumerated, when treating oS the other he- morrhages ; to which may be added, as particularly likely to induce this Species of hemorrhage, fudden frights, violent fits of paffion, and the improper ufe of ftrong cathartic and forcing medicines ; particularly of the various pills, advertifed under different titles, but which are almoft wholly compoSed of aloes, fcam- mony, and other violent draftic purgatives ; which have the power alSo oS determining the blood into the uterine veffels. This hemorrhage is not always an original com- plaint, it Sometimes being a Symptom of fome other difeafe. Ulcers, polypous concretions, fcirrhous and cancerous affections of the womb, being frequently accompanied with this fpecies of hemorrhage. When the various modes in which this difeaSe makes its attacks are confidered ; being one while So violent, as to excite well Sounded Sears oS immediate diffolution 3 at others, So infidious as entirely to Sap the ftrength of the constitution, and bring on difeafes the moft difficult of cure, before the leaft alarm is en- tertained by the unfufpecting patient$ the neceffity of procuring early help muft be obvious to every one. And when the variety of caufes by which it may be produced MEDICAL ADMONITIONS. 315 jjroduced is alfo confidered, not a doubt can be enter- tained oS the imprudence and danger oStrufting the cure of fuch a difeafe, to the hazardous attempts of domeftic quackery; efpecially, fince the hemorrhage may, as has been juft obferved, be only the fymptom of fome other difeafe, which may be entirely overlook- ed and neglected j whilft the endeavours made Sor the removal oS the hemorrhage muft neceffarily prove ineffectual, the diSeafe on which it depends continuing unabated. IS an additional argument is neceffary to prove the danger oS Such interference, it may be derived from the confideration, that the neceffity of making that difficult and nice distinction between hemorr- hagy depending on increafed vigour, and that which arifes from the contrary ftate of the fyftem, is more fre- quently required in this than in any other fpecies of hemorrhage. And as the difeafe may depend on e ither of thefe two oppofite Slates of the fyftem, endeavours for a cure which are made without neceffary Skill', may not only prove ineffectual, but, by promoting that Slate oS the Syftem on which the diSeaSe depends, may increaSe every Symptom. Directions for the management of this difcharge, when it is not confiderable, as well as for preventing its return, are here unneceffary -, fince, in thefe caSes, there is no preffure oS hafte which ought to prevent application, gr6 MEDICAL ADMONITIONS. application, for the advice of the regular profeffor of the healing art. When the hemorrhage is fudden and profufe, the patient fhould, as foon as poffible,. be de-' prived of every part of her clothing, which may occa- fion the leaft interruption to the Sree circuktion of the blood, and be placed in an incumbent pofture, in a cool chamber, being covered but lightly with bed- clothes. Every thing which is drank Should be as cold as poffible, and cloths dipped in cold water fhould be frequently applied to the loins and neighbouring parts. VOMITING OF BLOOD. When blood is brought up manifestly by vomit- ing, there can be no doubt oS its proceeding Srom the Stomach. An uneafy ftate of the ftomach commonly, for Some time, precedes this discharge. Pain in the region of the ftomach, accompanied by anxiety, and a fenfe of oppreffion, is in general experienced, juft before the coming on of the hemorrhage. If this complaint is the confequence of a Suppreffion of the menftrual, or hemorrhoidal difcharge, and is in a Small quantity, there may not be reaSon to appre- hend much danger. But if the difcharge is very con- fiderable, and black grumous blood is difcharged, both by vomiting and by Stool, the diSeaSe is really alarm- ing, MEDICAL ADMONITIONS. 317 ing, and demands a careful enquiry as to its caufe, and the moft Skilful exertions to effect its cure. Not, a moment fhould be loft, but the beft affiftance fliould be obtained as Soon as poffible. In the mean while, the means recommended in hemorrhage Srom the lungs, may be employed. ThoSe who have Suffered Srom this diSorder, fhould, for Some time afterwards, be very careful to take nothing into the ftomach which may be likely to irritate it, or to produce vom- iting. The mode oS living Should, Sor Some time afterwards, be fimilar with that recommended aSter inflammation oS the ftomach. VOIDING OF BLOOD FROM THE URINARY PASSAGE. Blood discharged with the urine may proceed Srom the kidneys, the ureters, the bladder, or the urethra (the canal which conveys the urine Srom the bladder.) The part whence the diScharge oS the blood proceeds is to be discovered by attending to the Symptoms which preceded, and which accompany the difcharge. In general, it is a fymptomatic affection of fome dif- eaSe, and by the cure oS that only can be removed. CATARRH. 3i8 MEDICAL ADMONITIONS. CATARRH. At the commencement of this difeafe, the patient generally complains of wearinefs, and difincfination to move ; frequent thrills of cold, fucceeded by tranfient gleams of heat, run through the whole frame $ the head aches, and feems heavy, and the throat feels rough and dry. Soon after this, a Slight difficulty of breathing, hoarfenefs, and frequent dry cough, Super- venes. Oftentimes the difeafe is accompanied with a heat and forenefs of the eyes and noftrils ; a limpid, acrid liquid flowing conftantly, both from the nofe and eyes. As the difeafe proceeds, the Skin becomes hot and dry, the pulfe hard and full, and the urine high colour- ed ; the patient foon lofes all defire for animal food, is reftlefs and thirfty, and much harraffed with the cough. After a little time, a fmall difcharge of mucus is produced by the cough, which gradually increafes : the rough neSs and SoreneSs of the throat, the fever, cough, and other fymptoms, leflening, as this dif- charge thickens; foon after which, the difeafe, gene- rally, goes entirely off. The progrefs of the difeaSe, as here defcribed, is, however, only to be met with in thofe cafes where nature has been affifted by well adapted means; or, at MEDICAL ADMONITIONS. p§ at leaft, has not been interrupted by improper inter- ference. But where the difeafe, exifting to a con- siderable degree, has been neglected; or where trifling caSes have been exafperated by improper treatment; - a variety oS fymptoms may arife, by which the real nature oS the diSeaSe may be concealed Srom an unin- formed practitioner, and the danger, of neceffity, augmented. Thofe who have already fuffered from this difeafe, are particularly liable to future attacks ; thofe alfo, whom previous indifpofitions have rendered it necef- fary to confine themSelves to the houSe, for a time, are very likely to be affected with this diSeaSe, at their firlfc expoSure to the open air. This diSeaSe is Sometimes produced by a Specific contagion ; and when it thus occurs, it is obferved to Spread to a much greater extent than any other epi- demical diSeaSe. But the moft Srequent cauSe oS this malady is the too Sudden tranfition Srom one atmof- phere to another, much.higher or lower in its degree of temperature. When a perfon is affected with what he fuppofes to be a common cold, as it is termed, he generally either neglects it entirely, or attempts its removal by fpiritu- ous and heating drinks, hoping thereby to excite a fweat. In the one cafe, the parts affected become fo injured 320 MEDICAL ADMONITIONS.' injured and weakened, by the long continuance of the difeafe, as to be rendered particularly liable to future attacks ; in the other cafe, there is the greateft pro- bability that the difeafe will be immediately aggravat- ed, and perhaps additional diforders occafioned. Where the nature of the difeafe is obvious, and where the breathing is perfectly free, the feverifhnefs very flight, the appetite but little impaired, and the cough not very frequent, attempts may be made, by domeftic treatment, to carry off the diSeafe at its com- mencement. This may Srequently be done, by bathing the Seet and legs in lukewarm water, immedi- ately beSore going into bed, and drinking freely of fome warm diluting liquor, fuch as barley-water, weak whey, &c. thereby exciting a free perfpiration. The patient fhould carefully avoid every circum- ftance which may tend to quicken the circulation of the blood. Animal food, fpirituous liquors, wine, beer, &c. fhould be entirely omitted. The food fhould only confift of milk and vegetables, and their various preparations, fuch as rice-gruel, panada, falop, fago, &c. The drinks may be barley-water, pectoral decoction, infufion oS linfeed, bran-tea, &c. TheSe may be Sweetened with honey, and rendered pleaSantly acid by the addition oS the juice oS lemons or oranges. In thoSe cafes where the cough is very frequent, the fever confiderable, and the breathing interrupted by MEDICAL ADMONITIONS. 321 by tranfient pains, or tightnefs of the cheft, the management of the diSeafe will require the utmoft care and fkill : fince, iS a proper mode of treatment is not early adopted, inflammation oS the lungs will, very probably, Soon Succeed, which, if not Speedily detected and removed, will be too likely to terminate in a decline. In thoSe perSons who have previoufly Suffered Srom Spitting of blood, or who have been at all difpofed to confumption, it is abfolutely neceffary that the moft cautious and vigorous meafures be purSued, at the very onfet of the diSeaSe ; as there exifts not a doubt, but that, in Such Subjects, a common flight cold, as it is termed, Srequently proves the exciting caufe oS a consumption. The probability oS consumption immediately Suc- ceeding- to inflammation of the lungs, muft be readily conceived by any one, who has even the flighteft knowledge oS the functions of that organ. To fuch, then, it muft be fufficient to give them the informa- tion, that this difeafe, the danger of which is fo flightly estimated, is an inflammatory affection oS the mucous membrane which lines the windpipe, and even its ramifications in the lungs. If this be duly confidered, furely the probability of the inflammation extending itfelf to the fubftance of the lungs muft appear fuffi- ciently evident, as well as the neceffity of early adopt- Rr ing 32Z MEDICAL ADMONITIONS. ing the moft powerful means for the removal of th« difeaSe. Nor is it to the firft attacks of this diforder only, to which I would call particular attention. Many cafes may occur, in which the firft Symptoms of the difeafe may be very flight ; and the diSeaSe may proceed without being characterised by any marks, which may lead to a Sufpicion of danger ; but in which the cough may be tedioufly protracted. Frequently, when this is the caSe, the patient and his Sriends, deceived by the abSence oS Sever, and the Small inconvenience otherways experienced, allow the continuance of this injurious Symptom, until Such miSchief is produced, as no Subsequent care, or exertion, can remove. From inattention and improper management, at the commencement oSthis diSeaSe, originates that af- fection of the lungs, which has been deScribed as baftard peripneumony ; true inflammation of the lungs, and consumption, alfo Srequently proceed from the fame caufe. From its frequent recurrence pro- ceed conftant and troublefome accumulation of mucus, or phlegm, and afthma. The Srequency with which this diSeaSe occurs, in this part oSthe world, and the Slight degree oSintereft and alarm, which is, in general, excited by the ex- preflion, catching cold by which this diSeaSe is com- monly MEDICAL ADMONITIONS. 323 monly defcribed, to frequently occafion that neglect, by which the foregoing maladies are produced. Fully fatisfied that vaft numbers fall victims to the fuppofed infignificance of this infidious enemy, I have been anxious to difplay to your view the danger of not oppofing his attacks, however weak and trifling they may appear. It frequently happens, that catarrhal complaints, even when not exifting to an alarming degree, termi- nate, as has been already mentioned, in an affection of the lungs known by the name oS baftard peripneu- mony ; a diSeaSe which differs much Srom catarrh in its nature, and consequently requires a very different mode oS treatment. But this change may come on fo gradually, and in a manner So little likely to excite the attention of a common obferver, that much mif- chief may arife, from not timely adapting the mode of treatment to the irritation which has taken place. That truly dangerous malady, the croup, is very likely, efpecially in the firft ftage, to be mistaken Sor, and treated as, a Simple catarrh, by thoSe whoSe judg- ment has not been Sormed by obfervation and ex- perience. A miftake in this point cannot but prove highly injurious ; fince the ordinary remedies Sor catarrh, would prove oS no effect in checking the rapid progreSs of this dreadful difeafe. The 324 MEDICAL ADMONITIONS. The cough, which frequently is very troublefome, almoft entirely engroffes the attention oS domeftic practitioners, who, omitting the neceffary regulation of diet, as well as the uSe oS means likely to correct the febrile Slate oS their patients, frequently content them- felves with attempting to put a flop to the cough, by the exhibition of fome opiate, as the Paregoric Elixir -, which, in moft cafes, will not only prove inad- equate to the purpoSe Sor which it is given, but will Seldom Sail oS confiderably augmenting the diSeafe itfelf. Moft of the noftrums advertiSed as cough drops &c, are preparations oS opium, fimilar to the paregoric elixir of the Shops; but diSguiSed, and rendered more deleterious, by the addition oS aromatic and heating gums. The injury which may be occafioned by the indiscriminate employment oSSuch medicines, in this diSeaSe, may be very confiderable ; as is well known to every perSon poffeffing, even the Smalleft Share of medical knowledge, It would undoubtedly be rendering a great benefit to Society, iS Some medical man were to convince the ignorant, oS the pernicious conSequences oS their re- liance on advertifed noftrums : but, unSortunately, the fituation in which medical men Stand, is Such, that their beftintentioned, and moft difinterefted ex- ertions Sor this purpoSe, would not only be but little regarded, MEDICAL ADMONITIONS. 325 regarded, but Srequently would be even imputed to baSe and invidious motives. ThoSe to whom they have to addreSs their admonitions, are, unhappily, thoSe, on whom reaSon has leaft influence. " Prithee, Doctor," Said an old acquaintance to a celebrated empiric, who was Standing at his door, " how is it, that you, whoSe origin I So well know, fhould have been able to obtain more patients, than almoft all the regular bred phyficians ?"—" Pray," Says the quack, " how many perSons may have paffed us whilft you put your queftion ?"—" About twenty."—" And pray how many oS thoSe do you SuppoSe poffeffed a competent fhare of common SenSe ?"—" Perhaps one out of the twenty."—" Juft So," Says the Doctor, " and that one applies to the regular phyfician ; whilft I and my brethren pick up the other nineteen." Thofe who have Suffered Srom this diSeaSe, are, 1 have already remarked, very liable to its Suture at- tacks ; and Srom what has already been ftated, it cannot but be evident, that moft Serious mifchiefs may follow its Srequent recurrence. The ftricteft care, thereSore, fhould be taken, to avoid thofe cir- cumftances, which, a little confideration will (hew, may, iS not properly attended to, become powerful exciting cauSes oS this diSeaSe. The ill effects of too Suddenly paffing into an at- mofphere, confiderably higher or lower in its degree of temperature, 326 MEDICAL ADMONITIONS. of temperature, than that which has been juft quitted, have been already deScribed, when Speaking oS the prevention of inflammation in general. To the ad- monitions there given, I muft beg you to revert; with a confidence, that as this circumftance is one of the moft Srequent cauSes of catarrh, an attention to what is there delivered may be here of the utmoft importance. In guarding againft this diSeaSe, confiderable advan- tage is to be gained by a due regulation oS the cloth- ing. This fhould be neither too thin, nor So irregu- larly diSpoSed, as to leave one part oS the body naked, whilft the reft is even loaded by warm clothing. In children, and young folks, this error is too frequently obfervable. The former we generally fee, with their legs and arms uncovered ; and the necks and chefls oS the latter are often expoSed, unguarded, to the utmoft Severity oS the cold. " In every region, we may obServe external warmth to be nearly as neceffary as internal nourifhment, for the young of almoft every animal. Warm rooms and impure air may enervate the body, but warm clothing can never be injurious in cold weather. I am fo tho- roughly convinced, that pure air and a warm fkin are indifpenfibly neceffary for children, that I never be- hold them with naked breafts, legs, and arms, however hardy and robuft, that I do not anticipate the horrid conSequences MEDICAL ADMONITIONS. 327 confequences of angina of cropp, or of pectoral or in- teftinal inflammations." * The remarks of Dr. Beddoes on this point are par- ticularly interesting, as they are properly directed againft a moft filly, but prevailing notion. " In children, it is oS the utmoft conSequence to keep the body cool, but never to Suffer it to be cold. Thus, without being enervated, they may eScape the Satal confequences oS heat Succeeding quickly to cold ; for it is not true, as feems, in confequence of an analogy more or lefs distinctly conceived, to have been fre- quently imagined, that cold hardens children as k hardens Steel." -j* I never witneSs the cruel perSeverance in this pre- tended mode of hardening children, in which the weak and fickly hardly ever eScape, but it calls to my mind the practice of thofe nations, who, determined to fecure a hardy race, decree the decriped and infirm to be expofed to perifh, in the woods and deferts. The ufe of flannel, and of the fleecy hofiery, cannot be too much urged as a preventive of this difeafe ; but, unfortunately, thofe who think catarrhal affec- tions are of too little moment to call for much trouble in avoiding them, are generally too ready to evade * Medical Spectator, vol. i. p. 367. t Obfervations, &c. by Dr. Beddoes, p. 162. *2§ MEDICAL ADMONITION*. ejade the adoption of this meafure, on the mofV %trijfiingobjections.; the chief of which is, however, the uneafinefs arifing Srom the irritation, it occafions to the fkin. But rather than the important advan- tages to be gained by this mode of clothing fhould be loft, the flannel may be worn over the Shirt. In- deed, in thofe cafes where there has been much weaknefs produced by preceding diSeaSes, or where advantage is not expected to be derived from irritat- ing the Skin, this mode of wearing flannel is preferable to that of wearing it next the fkin. Remembering that it fhould be removed at night, with the other daily clothing ; and that the fame attention be paid to its cleanlinefs, and frequent renewal. Thofe who are liable to this difeafe, fhoula be alfo1 exceedingly cautious in their mode of living. Their diet fhould be light and fimple, confifting more of vegetable than of animal fubftances. Milk, in various forms, fhoqld constitute a confiderable part of their food. Spirituous liquors fhould be entirely avoided, and wine and beer Should only be taken in Small quantities; by children, thefe alfo Should be quite omitted. The neceffity oS avoiding the air rufhing in a Stream Srom the crevice, or the opening of a door or window, muft be So obvious, as not to require tp< be enlarged upon. Laying in damp beds, and Sitting in wetted rooms, I MEDICAL ADMONITIONS. 329 rooms, are fo well known to be productive of injurious effects, that it can hardly be neceffary to urge the$ ftricteft care in avoiding So open an enemy. s But there is one negligent, or cruel practice, which cannot be too Severely reprehended ; fince, Srom the frequent inftances of dangerous diSeaSes, which have been SuppoSed to have ariSen Srom this cauSe, there is too much reaSon to fear, that inattention, in this re- • Spect, is too frequent. Large rooms, which, being * reServed Sor the purpoSe of receiving company, arc ^ fhut up for many days, and even fometimes for weeks together, in damp and cold weather, are frequently ufed, with only the precaution of having a fire lighted in them an hour or two before the vifitors arrive. The fire not having yet Sufficiently warmed the room; and the furniture, particularly the curtains, carpeting, and chair-feats, being impregnatea with a confidera- ble quantity of moifture, which begins to evaporate as the^room becomes warm, the unfortunate objects of this ceremonious, and dangerous distinction, are expoSed to the joint action of cold and moifture. That confiderable injury may Sollow, there is little reaSon to doubt ; especially as the dreffes of the perSons who are thus expoSed to the influence of thefe circumftances, are, at thefe times, more light and airy than their ufual clothing j and are, confe- quently, but little calculated to defend them from fuch powerfully combined adversaries. S» CONVULSIVE > JO MEDICAL ADMONITION* CONVULSIVE ASTHMA. The ingenious Dr. Robert Bree,of Birmingham, was himfelf the object, he fays, of the attacks of this difeafe, and might poffibly, he thinks, have had a profpect of long complaining of its tyranny, if a de- f ermined refolution to deviate from the common path of .'practice had not occasionally yielded instruction, and*g^iven a bafis for further experiment. From the* year 1787,he examined the forms of affchmawith in- creafed induftry, and was fupplied with more numerous opportunities of trying the force of remedies in the paroxyfms (having made experiments in one hundred and thirty paroxyfms) than can generally occur in a practice of ten years, where the motives for enquiry are lefs perfonal to the phyfician. From- an attentive confideration of the Subject, he ^ifcovered, that afthma in general is the conSequence of irritation of the lungs* and that this may be pro- duced by acrid effluvia in the lungs, but is moft fre- quently occafioned by an effufion of ferum in the veficulse of the lungSw Other lefs frequent fpecies he alfo enumerates-; but thefe it is unneceffary to notice, fince all that is here intended to be done* is to enable you to form fuch an idea of the difeafe, and of the caufes on which it depends, as will enable you to fee the propriety of the directions for the conduct of the patient, MEDICAL ADMONITIONS. 33I patient, which I fhall prefume to extract, for the ad- vantage of afthmatics. It is Sar from my intention to attempt to furnilh instructions to practitioners of both fexes, for the cure of this difeafe, being fully con- vinced, with the author of this valuable treatife, that " No written rules will fupply the defect, which, in this diforder, as well as others, the fagacity and obser- vation of experience can alone remedy." Wherever indigeftion prevails, which may be known by want of appetite, flatulent distentions and pains of the ftomach, heart-burn, &c. there are we to expect that afthma alfo may occur. Indeed, So connecled are theSe difeafes, that afthma hardly ever takes place, but flatulence, and other Symptoms of indigeftion, are, at the Same time, discoverable. This circumftance, iS duly confidered, muft neceS- Sarily impreSs thoSe who Suffer the inconveniences of indigeftion with a ftrong conviction of the neceffity of early oppofing it with requifite remedies ; and oS Sub- mitting to thoSe regulations which may be pointed out, left the diftreffes arifing Srom afthma be Super- added. Again, Srom considering the dySpeptic con- dition of patients diftreffed with afthma, and the connection'which appears to exift between the two diSeaSes, the neceffity of correcting indigeftion, and of attending to a proper regimen, muft be very evi- dent to the afthmatic. Errors' I 3^2 MEDICAL ADMONITIONS. Errors in diet, Dr^Bree obferves, are a copious fource of inc&nveniettce to the afthmatkv Under this head he fpecifies, drinking too much Strong liquors, or diquors fullv of carbonic acid, or fixed ah*, with acefcent materials in the composition, fweet wines, and new beer. Profufe indulgence^ in the ufe of tea, and warm watery liquids of all kinds, are ex- citing caufes of afthma. Heavy Suppers, eating be- ' tween meals, and, generally, all food of difficult ,digeftion, may produce the fame effect ; fuch are, fmoked meats, paftry, fat pork or beef, water-fowl, raw vegetables, Sallads, and unripe fruits; alfo boiled cabbage and carrots, rich Soups, jellies, and Sauces.™ ->D b' ^il. U} iO T.ris> ,3r| TheSe alimentary Subftances are not readily govern*. ed by the Stomach of an afthmatic, but remain till a fermenting procefs takes place ; and, ,if purging or vomiting brings no relief, the paroxyfm may be ex- cited ; even when thefe evacuations occur, this confequence is not often prevented.^1 The afthmatic, he juftly obferves, muft rigidlylj believe, that his paroxyfms may be more frequent, or the intermiffidfis longer; according as the feductions of tlietable are too powerful for his prudence, or are refilled by his care. "Intoxication and furfeit are, fo confpicuous among the worft of his enemies, and can have fo little allurement where the habit is infirm, that an afthmatic ^is'not to be fufpected of Suffering Srom the excite- ment of thefe grofs errors, to &iKll 3-1* y&tit > v yisy # The MEDICAL jADMON ITIONS* 3J3 • The atmoSpbere produces effects on the fcftkpatic, by feterahchanges.. When the mercury in the baro« mefcet Stands as high as thirty inches, the denfity of the air is fufficient, cceteris paribus, to preferve the intermiflion of- his diforder ; and alterations Srom this Standard, to a lower, will be, according to circum- ftances, unSriendly. Befides a change Srom this degree oS denfity, the ftate of the air may be coldLor warm, cold and oaoift, or warm and moift ; and rain, fafm, or froft, florms and Sogs, may give additional impref- fion; but flight in comparison of the Slate (the diminished denfity oS the air) which occafions their appearances. When vapours hang tow, we have a certain index of the diminifhed denfity of the air, which' would otherwife carry them off; and that the caufe of their low fufpenfion is really a ftate of atmof- phere, producing, at the Same time, the disorder of the refpiration. .iSi on ?gn» ,.-,-/ ciril >bril *o 0l If to the lightnefs of the air, moifture is added, the operation of its influence may be more injurious; and has frequently been felt in various fituations, when the predifpofition to afthma was. not prefent. 73ullo| Gold and moifture check cutaneous perSpiratioh, and diminifh the heat oS the lungs ;*and is thereby hurtful to the afthmatic.in' -"* .IB') *" > >rft >11& -lift -str Q4d alone wig not ufually excite the paroxyfm, though there are States oS the atinoSphere, which we wt T very gj4 MEDICAL ADMONITIONS. very injurious, without the pofitive prefence of aqueous vapour, or moifture. The Eafl and North-Eaft zvinds, not only chill the lungs, and make their capillaries paffive, and incapa- ble of contracting on their contents ; but they check cutaneous perSpiration, inducing another caufe 01 afthma .in catarrh. Changes to rain or Jnow affect the afthmatic, be- caufe of the decreaSe oS weight in the air, which gives occafion to thefe alterations. Storms, of any kind, are ufually attended with Sudden rarity of atmofphere ; and according to the prevalence of exceflive heat or cold accompanying the change, the afthmatic will be more or lefs affected. Aclive motion in a warm air, with frequent refpirah tions, produces great increaSc oS exhalation Srom the Superficial capillaries, and Srom the lungs. The diffi- pation of heat, by this means, is productive of the moft Severe fits oS afthma. Heat may be carried away Srom the body, by other means, befides exhala- tion ; and this effect takes place in frofty weather, but not ufually with the fame confequences to the afth- matic. Profufe bleeding, fpontaneous or artificial, has brought on afthma, in Some instances ; and violent purging or vomiting may be an exciting cauSe oS the paroxySm. A MEDICAL ADMONITIONS. «$$ A critical attention is neceffary to the calls of the ftomach, and the power of that organ to perfomrdi- gcftion. The firft fhould never be neglected,.and the latter never oppreffed. If the ftomach is loaded, the fit will be more violent, than after the occafional caufe of farting. The want of food, or an abfurd neglect of regular meals, will as certainly excite the paroxySm in Some afthmatics, as a moderate and light Supper of tender animal food will alleviate the Symp- toms in others. Fafting is not only an exciting cauSe of afthma, but it will, according to its extent, increaSe the predifpo- fition to the diSeaSe, by lowering the heat of the body. A fudden increafe in the impulfe of the circulation, one caufe of which may be rapid or violent bodily motion, may excite the paroxyfm of afthma. The fitppreffion of the hemorrhoidal or me?iflrual fiux may occafion dyfpncea, or a paroxyfm of the afthma. Repelled eruptions or gout may, according to the habit in which the circumftance occurs, produce cither dySpnoea afthma, or peripneumony. Duft oS any kind, metallic Sumes and fetid Smells, and ftrong perSumes, Shew their effects on an afthmat- ic, by exciting a paroxySm. The fmoke of tobacco is, in moft caSes, offenfive to die 336 MEDICAL ADMONITIONS. the afthmatic ; and even when the habit o£ inhaling the Sume is purSued, and abSurdly thought to be a remedy Sor the difeaSe, by thoSe who miftake the great excretion of Saliva for a neceffary evacuation, the patient Strengthens the prediSpofition to this difeafe. It is affirmed, that Smokers are afthmatic; and Diemerbroeck found their lungs dark coloured, ap- proaching to black, and ulcerated. Sir J. Eloyej mentions a patient, who fmoked to cure a pain in the Stomach, and by this means acquired the afthma. The arial carbonic acid, or fixed air, is an exciting caufe recorded by Sir J. Floyer. I have known, Dr. Bree fays, the infpiring of the vapour of fermenting fubftances in brewing, to be followed immediately by the paroxyfm. \ The paffions of the mind may excite a paroxyfm, or Strengthen the predifpofition to it. Severe ftudy affects the digeftive powers, and therefore promoces predifpofition. v J .v It is not my intention, in a difeafe fo alarming*-to pretend to furnifh the domeftic practitioner with a regular plan of treatment, nor even to particularise the feveral remedies which may be demanded in its feveral periods. I fhall be Satisfied with making Some remarks on thoSe remedies which are particularly de- manded by the diftrefsful.State of 4he paroxyfm, and which aregenerally within the reach and management ot MEDICAL ADMONITIONS. 2$J of domeftic practice ; as well as on Some of thofe which alarm may prompt to the employment of, in defiance of the probability of dangerous misapplica- tion. Emetics are frequently employed with fucceSs in abating the violence of the paroxySm ; especially where the exiftence of indigefted matter irrthe ftomach is pointed out. But much judgment is neceffary to enable any one to determine the extent to which the operation is to be carried. In fome cafes, ftrong vomiting may be neceffary, and in others only nauSea, and flight urgings to reach. In Severe fits oS the Suffocative afthma, the patient will Srequently infift, in Spite of the ftrongeft remon- strances, that he may loSe blood, and Sometimes with Such a degree oS pertinacity as is impoffible to refill. But the afthmatic fhould confider this point, in the lefs hurried moments oS intermiffion ; he fhould then reafon with his medical attendant, and carefully at- tend to his arguments, that his mind may be So armed, as to prevent him Srom Soliciting Sor, and even infifting on, the performance of that which will have but little chance of rendering bim any fervice, but which will, moft likely, occafion an increafe of that debility which helped to constitute the prediSpofition to the diSeaSe. Dr. Bree, Speaking oS the effects of bleeding in the moft common Species of thfe difeafe, T t fays, 358 MEDICAL ADMONITIONS. fays, " I have repeatedly directed it, but have never " had reafon to think that the paroxyfm was fhor|cn- " ed an ljour by the lofs of blood ; and I have often "been convinced, that expectoration was delayed, and " more dySpnoea remained in the intermiffion," than "was common after former paroxyfms. In old " people, who have been ufed to the diforder, it is <**" certainly injurious." ' * The gum ammoniac and Squills, may be frequently employed with advantage. But the ordinary oily emulfions, and heavy clogging mixtures, are rarely of any ufe ; and indeed, by the interruption they, may occafion to the procefs of indigeftion, they muft, more commonly, rather promote than remove the diSeaSe. Blifters ought not to be employed, in this difeafe fo* indifcriminately as is generally the cafe. Their operation is not Sufficiently rapid to expect much ad- vantage Srom them, during the paroxySm ; and it fhould be remembered, that in every cafe where either theyfor iffues are employed to procure a continued discharge, if the caSe be not Such as to require evacua- tion, injurious weaknefs, in proportion to the dis- charge, will be produced. The experiments arid observations, of which I have fpoken when treating of confumption, fhew that con- fiderable advantage may be derived from breathing air MEDICAL ADMONITIONS. 3$9 air containing more than the ordinary propertion of oxygen. The acid of vinegar, diftilled vinegar, or, if that cannot be readily obtained, common vinegar, in a dofe of two table-Spoonfuls, with an equal quantity of cold water, is a remedy, Srom which relief may be frequently obtained in the paroxySm. Dr. Bree Says, that in afthma proceeding Srom the irritation of mucus, vinegar is the moft ufeSul medicine, in the paroxySm, which I have tried. Warm bathing, he remarks, is hurtful in every ff>ecieS of afthma : but, he afferts, upon numerous trials oS its efficacy, that there is no Single remedy of more value, in all Species oSthe complaint, during the jijbSence oS the paroxySm, than the cold bath. Having already pointed out the connection between afthma and a weakened ftate of the ftomach, the neceffity of having recourfe to, thoSe means which may give tone to this bowel, and thereby affift digef- tion, muft be obvious. But the afthmatic fhould alSo confider, that to accomplifh this end, a patient and reSolute perSeverance in the eourSe of medicines which may be preScribed for this purpoSe fhoukl be adopted. On nothing leSs can any hopes oS benefit be placed. With the hope oS preventing returns of the difeafe, the 34° MEDICAL ADMONITIONS. the-patient Should be very Sbictt in the diet he env> ploys. From the obfervations on the caufes of this difeafe, above mentioned, the afthmatic will learn what errors of diet Should be avoided : and to the rules he there obtains, he may add the following. His food Should not be generally fluid and poor- watery gruels and broths are therefore improper, the ftomach requiring Solids. Vinous drinks alfo fhould be avoided. Acidulated water, milk and water, with toafted bread or biScurt; rice boiled in broth until it is Soft, without fat, are Suited to the paroxySm. Hot liquors are always improper. Cold water is taken with great benefit ; and, if acidulated with vinegar, its good effects are often very confiderable. A Strong infufion of coffee was recommended by Sir J. Pringle, as a powerful medicine in the paroxyfm. It was alfo Successfully employed by Floyer. Dr. Per- cival alfo recommends its uSe. Dr. Bree alSo adviSes its employment medicinally. In juftice to Dr. Bree, I muft here obServe, that the leading points in this article are extracted Srom the Doctor's valuable observations. It may be confider- ed as very advantageous to thoSe who labour under any particular difeaSe, to have an intelligent phyfician a Sellow Sufferer. Independent of the nearer and Stronger.interest which muft neceffarily impel him to the earneft consideration oS the nature oS the diSeaSe, his Medical admonitions* 341 bis opportunities of inveftigation are infinitely ifiaperior to thoSe of others, whofe enquiries art-always likely to be productive of lefs information, on account, of the vague and incondufive descriptions contained in fhe anSwers-they receive. He is much betteT able to cbrr- nect caufe and effect; and to mark the confequences, beneficial or injurious,>wbich proceed from the feveial kinds of diet»>*the changes of the atmofphere, and various other circumftances. Having the means of experiment always in his power, he is able to employ, on the fpur of the moment, whatever judgment may Suggeft, or neceffity may demand. In a word, his experiments on the difeafe muft be numerous, and his observations conftant. .'laffo j zU Should a phyfician prefent to the world his obferva- tions, made under theSe circumftances, the benefits to his Sellow Sufferers muft be ineftimable : in his pub- lication they find a ufeSul itinerary, which points out to them the roads they fhould keep, as well as thoSe they fhould avoid. It calls their mind from the ufeleSs contemplation oS objects affording neither in- struction nor pleaSure, and directs" its attention to thoSe which are at once both important and uSeSuI. Such a publication is that Srom which I have So Sreely Vaken the chieSoSthe foregoing practical obfervations. mid lcx-|«a* yhuiltoo^n Jit' u ii.mi+1 hi TjrirvDTvV^ .1J1L* uiiJ 1 j viui&a udi to noi&isbiinoa -flames Sdi 34- MEDICAL ADMONITIONS. HOOPING COUGH. This inSectious diSeafe is Sufficiently known : a description oS it is therefore unneceffary. It may be, however, proper to remark, that it oSten commences with the Symptoms of a common catarrhal cough, or cold, and may exift Some little time before the charac- tereftic hoop is heard. There is, perhaps, hardly any diSeaSe, Sor which So many noftrums are recommended. Omitting the mention,oSthoSe which are So Sreely recommended by well meaning matrons, I fhall here only allude to thoSo advertiSed noftrums, which, with So many alluring promiSes oS SucceSs, are artfully foifted on the public. From the Srequent adoption of thefe, I am well affur- ed, the lives oS many children are loft ; but previous to advancing my reafons Sor this Suppofition, I will make a Sew remarks on one circumftance, which may occafion parents to place So much reliance on theSe dangerous means. This diSeaSe has no determined period for its termi? nation, it disappearing much fooncr in fome cafes than in others ; but Seldom, however, exceeding, three or Sour months in its duration. Frequently, a happy change will take place very Suddenly, and without any obvious cauSe : the fits becoming more and more flight, MEDICAL ADMONITIONS. $4% flight, every day, and the hoop as rapidly declining. A difeafe, thus uncertain in its termination, muft be very favourable to the character of any noftrum, em- ployed with the hope oS procuring its removal. Suppofe this pretended remedy to be taken by any given number oS children, and confider, that it muft be given either towards the beginning, the middle, or the end of the complaint. It muft be fair, then, tp conclude, that in one-third of thefe cafes, it will be given near to that period, when the difeaSe would of itfelf have gone off. Indeed the proportion might be fuppofed to be much greater than one-third, fince it moft commonly happens, that in the greater num- ber of cafes.where theSe noftrums are had recourSe to, the time employed in the trial of other various means has brought the difeafe near to the period of its con- clusion j and the very circumftance of having employ- ed fo many things before, without fuccefs, is employed to arrogate the more merit to the declared Specific. If no injury were the refult of thefe quackeries, they would here have efcaped mention. But during the continuance of this malady, there are feveral circum- ftances which require Such particular attention, that, iS neglected, they will moft probably occafion the death of the patient : and, UnSortunately, the parents relying entirely on the infallibility, which the decep- tive advertifement attributes to the mifchievous nof- trum ; 344 medical adMoNitions\ tram ; and complying exactly with the tferms de»- rhanded, that no other medicine be taken, neglect aH lefs notices of danger, until, feeing their child arrived almofbat the point of death* they, too late, apply for regular affiftance. . It Is true, that phyficians do not poffefs a Specific* which will directly remove this diSeaSe ; and the ac- knowledgment of this, is another inducement to the alarmed parent to fly to noftrums ; but they muft be informed, that Such a Specific will be Sought with as little SucceSs Srom the empiric, as Srom the phyfician. The latter is, however, enabled, by an attention to the different Symptoms which ariSe, in the progreSs of the difeafe, fo to conduct its courfe, by abating the violence of the fymptoms, that it fhall rarely prove fatal. The moft dangerous circumstance that ariSea in this diSeafe, is fhortneSs of the breath ; fince, when- ever, this occurs to any confiderable degree, there may be great reafon to Sufpect, that inflammation of the lungs has taken place. In this cafe, bleeding, blister- ing, and other appofite means, adapted to the age and ftrength of the patient, will generally afford Speedy relieS; but, on the contrary, fhould any noftrum be here relied on, it is moft probable the child woulc) Soon be loft. So alSo the Spaftnodic affection, which fo Strongly marks the diSeaSe, becomes Sometimes fo violent medical admonitions. 34$ violent as to threaten Suffocation, during each fit of coughing ; and here the greateft • benefit is derived from well adapted antiSpaSmodics. Thus alSo the ac- cumulation of phlegm, increafe of fever, &c. demand their appropriate remedies; and common fenfe muft be convinced, that all thefe neceffarily varying proper- ties, are not likely to be found in one boafted noftrum. Much reliance has been placed on removing children afflicted with this diSeaSe into a different air from that which they have been accuftomed to breathe : beneficial effects, it is Said, have proceeded from the change, when even the patient has been re- moved into air leSs pure than that he had left. TheSe Salutary effects, which the experience of parents and nurSes, unwarped by hypothefis, has So ftrongly marked, when contemplated by the aid of that light which the late difcoyeries in pneumatic chemiftry afford us, furnifh Strong evidence in favour oS the employment oSairs differing in purity, in Several of the difeafes incident to the human body. I have often been furprifed, that this circumftance has not been noticed by Dr. Beddoes, Thornton, and other gentlemen, who have made pneumatic medicine particularly their flutfyi It has, indeed, not merely excited my SurpriSe, it has occafioned my regret -? fince the practical deduction I fhall, perhaps, too feebly make, might have proceeded from their pens, U u with 346 MEDICAL ADMONITIONS. with fuch clearnefs and force* as might have been productive of much greater good. When treating of confumption, I endeavoured to Shew you, that the oxygen, or purer portion*of the air, is the beft and moft natural ftimulus to the lungs, and to the whole Syftem, in thoSe caSes, where there exifts difficult reSpiration, accompanied with a debilitated Slate of the,fyftem : and that the azotic, or more im- pure portion of the air, has been found to be highly beneficial in the contrary ftate of the fyftem.; w.here too much action, mantfetted by inflammation, catarrh, and Spitting oS blood, menance a termination in cqiv Sumption. In the hooping-cough, both thefe Slates arc, at different times, found to prevail j and Surely, it is not at all improbable, that theSe advantages have been the conSequence oS a fortunate coincidence ; and that, where fuccefs has followed the change of air, it has been when during an inflammatory ftate, the change has been for air lefs pure ; and in the contrary State, where the removal has been from the clofe air of town, to the purer air of the country. From the foregoing prernifes, we have certainly a right to conclude, that inftead of indifcriminate changes from one fituation to another, the air fhould be i chofen, according to the principles juft laid down— that in thoSe caSes where diSpofition to infiammation is MEDICAL ADMONITIONS. 347 is evident, the impure air oS a town Should be pre- ferred ; and that, in thofe cafes where a great degree of debility, and of difficulty of refpiration, threaten dropfy oS the cheft, &c. the purer air of the country Should be obtained. It can hardly be necefTaTy to rematk, that in thoSe caSes where the docility of the patient, and the facility of procuring the neceffary apparatus, and the required air, render the experiment eafy to be made, it will be advifable to try the effects of refpiring the hyperoxyge- nated air in the one caSe, and of the impure, hydro carbonate air in the other. That the advice of a phyfician would be defirable, to point out the proper plan to be adopted in thefe cafes, muft be very obvious ; and particularly fo, when it is confidered, that the medicinal effects of air, differing in purity from the common atmofpheric air, is but a late difcovery ; that phyficians are not yet determined, how much may be Sairly attributed to their employment ; and that Srom the induftry with which this part of the healing art is cultivated, daily information may be expected to be obtained. In the prefent imperfect ftate of pneumatic medicine, much real Scientific inSormation is neceffary in thofe who employ it. DYSENTERY, 348 MEDICAL ADMONITIONS* DYSENTERY, OR BLOODY FLUX.' This difeafe, in,general, commences with griping pains about the naval, accompanied with a frequent defire to void ftools^ Sometimes theft, complaints are precedecl by cold fhiverings, to which fever Suc- ceeds. The gripings and Stpols Soon become very frequent ; the functions of the ftomach become con- siderably impaired ; the appetite is loft; nauSea, fick- nefs, and Sometimes frequent vomitings, take place. The ftools are in Small quantities, and compoSed almoft entirely of mucus; at times mixed with blood; which in fome cafes appears in the mucus, in ftreaks ; and, in others, pure and unmixed. Small pieces of membranous films, and hardened excrement, are alfo obfervable in the ftools,, which are highly offenfive, and of a. fmell peculiar to this difeafe. In general, the difeafe is accompanied, through its whole courfe, by a fever of a malignant kind ; but Sometimes, the fever foon leffens, although the dyfenteric fymptoms con- tinue. • •< < ..., Children and aged perfons, and thpfe, who Jiaye ^een, weakened by former difeafes, are much endanger- ed by attacks of this diSeaie -, and, even thofe who are in MXDICAL ADMONITIONS. 549 in the prime of life, are frequently fo affected by it, as to give very jufbcauSe of alarm. If the gripings become more Severe, and the ftools more Srequent, whilft the quantity difcharged by them diminiflies ; efpecially if the fever increaSes, the dif- eafe may be concluded to be getting worSe. If the gripjngs ceaSe entirely, and the difcharge is of a dark fanious matter, the pulfe becoming exceedingly Small and quick, and the patient covered with a proSufe cold Sweat, a gangrene may be SuppoSed to have taken place, and a Speedy diffolution may be expected. A Savourable termination may be hoped for, when the gripings and ftools become lefs Srequent, and the discharge affumes a natural appearance. It however Srequently happens, that after the diT- eaSe has affumed a more Savourable appearance, and the patient is Satisfied that his recovery is almoft com- plete, the diSeaSe will continue without any Sarther amendment ; inducing a train of diSeaSes, which, unleSs well adapted means are employed, muft be productive of much ferious mifchief. It too frequently happens, that this difeafe is allow- ed to exift Sor Some time before the patient, who fuppoSes it a common looSeneSs, acquires a knowledge of the nature of his complaint ; in confequence of which it is permitted to run on until it becomes fo inveterate, 55O MEDICAL ADMONITIONS. inveterate, and the patient fo muc^i weakened, as to render the cure very difficult to accomplish. To conduct a patient fafely through this disagreea- ble and ahrming difeafe, demands much care and Sagacity on the part of the phyfician, and the ftricteft attention and moft implicit obedience Srom the at- tendants. The cure of this diSeaSe depends in a great meaSure, on the removal of the excrements which are morbidly retained in the bowels ; and, confequently, on the producing a fiecal difcharge of a natural ap- pearance. To effect this, purgative medicines, with occafional clyfters, fhould be employed. But this mode of practice is very little likely to be Sollowed by domeftic practitioners, who cannot be made to com- prehend the principle on which it is founded. To them it will appear, not only incompetent, but even fevere and injurious. They cannot conceive how a purging is to be removed by increafing,the difcharge; or how griping pains are to be leffened, but by the ufe of warm and aromatic remedies. They therefore often take the liberty, not only to fufpend the ad- ministering of the remedies prefcribed ; but to Substi- tute Sor them thoSe things which, in their opinion, will Sooner remove the Symptoms : endeavouring to Slop the purging by the moSt powerSul aftringents, and to leffen the gripings by aromatic and Spirituous drinks. « MEDICAL ADMONITIONS. 35I 1 So far is it Srom being Safe to truft the management oS this diSeaSe, to any one whoSe only knowledge refjpecting it is derived from Some treatiSe on domeftic medicine, that it is difficult to convey to Such, infor- mation Sufficiently explicit, on the article of diet alone, to enable them to adapt it to the different cafes of this difeafe. The age and ftrength oS the patient, the ftate of the Syftem, and the different ftages oS the diSeaSe, all require to be confidered, beSore a fit regi- men can be determined on. IS the difeafe be accompanied by inflammation, the food Should not only be confined to a liquid Sorm ; but fhould alSo confift of thoSe things which are fimple, and are of a cooling nature ; fuch as barley- Water, thin panada, or thin gruel, made from flour or rice, &c. &c. Where there are no marks of inflam- mation, the diet may be more nutritive ; but fliould ftill confift chiefly of liquids. To the articles above mentioned may be added broths of various kinds, calves feet jelly, &c. If the fever accompanying the difeafe is of a putrid nature, the patient fliould take freely of ripe fruits, the juice of ripe oranges, and currant jelly, may be added to the drinks. In gene- ral,, the diet may be more nourifhing, after the difeafe has exifted fome time ; and particularly fo, if the patient has been weakened by preceding difeafes, or is either of a tender or an advanced age. The »cz MEDICAL ADMONITIONS. The chamber fhould be frequently Supplied with - frefh air, and filled with the fumes of vinegar, &c. The clothing of the patient, as well as the bed-clothes, Should be frequently renewed ; and every thing pro- ductive of offenfive Smell fhould be removed as fpeedily as poffible. To prevent a return of the difeafe, to which the patient will be liable, moderate exercife may be em- ployed in the open air, in that degree, and in that mode, which his ftrength will permit. A tea-cupful of camomile tea, or of decoction of bark, may be taken three times a day. The diet Should not confift too much of animal food ; and fpirituous and fer- mented liquors Should be entirely avoided. The bowels Should be kept in a Slate oS regularity, and fhould be guarded Srom cold by additional clothing.' APOPLEXY. In this diSeaSe, the whole oS the SenSes, and of the voluntary motions, are in fome degree abolished, whilft the actions of the heart and lungs continue. The appearance of the patient is that of one in a deep fleep ; the breathing being moftly accompanied by a loud fnoring. The face is generally fwelled, and of a dark florid colour, every veffel about the head and neck MEDICAL ADMONITIONS. $$$ neck appearing to be diftended with blood* The eyes are bloodshot, watery, and prominent; and frequent- ly the head, and the whole body, is bedewed with a cold clammy Sweat; and a paralytic affection of one fide of the body is frequently found, at the Same time, to have taken place. Sometimes this diSeaSe comes on Suddenly; but moft Srequently it is preceded by theSe Symptoms. The Sace, Sor Some time before^ appears more than ufually florid, and the eyes Slightly bloodlhot. The head is giddy, and frequently affected with pain, par- ticularly in the back part of it. The extremities alfo are Srequently affected with numbnefs, and irregulari- ties, or inability oS motion ; and Sometimes a little faltering oS Speech may be discoverable. The patient is almoft conftantly drowSy, and generally Sleeps par- ticularly Sound ; but is Sometimes affected with fits oS the incubus, or night-mare. A troubleSomc ring- ing noiSe is Srequently perceived in the ears; tranfient irregularities, both in fight and hearing, are Srequent- ly discovered, and every SenSe appears, at times, to be Somewhat impaired. Recollection, reflection, and every other procefs of the mind, is performed, evident- ly with leffened power. The fubjects of this difeafe, are, generally, perfons in an advanced ftage oS life. ThoSe have been ob- ferved to be particularly diSpofed to it, who are of a W w corpulent 354 MEDICAL ADMONITIONS. corpulent habit, and have a large head and Short necfc. Indolence, and indulgence in the luxuries of the table, as well as the Suppreffion of any difcharge, which, by its length of continuance, has been Suffered to have become habitual to the constitution, contribute much to the forming of a predifpofition to this difeafe. Whatever interrupts the return of the blood from the head ; or, by impeding its circulation through the other parts, throws it in too great quantity upon the brain, may prove an exciting caufe of this difeafe ; fince the moft frequent immediate caufe of apoplexy, is the accumulation of blood in the blood-veffels of the brain, or an effufion of blood, or of fome other fluid, in different parts of the brain, or between it and the bones of the Skull. Every violent exertion, therefore, efpecially if accompanied by a full and long continued infpiration ; aconfiderable degree of fatigue, exceffive heat, or cold ; a violent fit of coughing; long continuance in a Slooping pofture, or with the neck in an oblique pofition ; any thing worn tight about the neck ; intoxication, exceffive diftenfion of the ftomach and bowels, and violent emotions of the mind, may occafion this difeaSe. It may alSo be pro- duced by various other changes, which may take place' within the cavity of the Skull ; the nature of which cannot be precifely aScertajned during liSe. \ In addition to the caufes of apoplexy here enume- ^ rated* MEDICAL ADMONITIONS. 355 rated, feveral others have been mentioned by different authors ; fuch as the receiving the exhalations from newly plaiftered walls, the mephitic air arifing Srom fermenting liquors, the fumes arifing Srom burning charcoal, brimflone, &c. Srom lead, arSenic, and Several other Subftances ; but the difeafes induced by theSe caufes being very different from apoplexy, and con- fequently requiring a different mode of treatment, will be fpoken of Separately. In a diSeafe, the caufes oS which are So various, and oftentimes So difficult to aScertain ; whofe mode oS attack is always So alarming, and whoSe termination is generally So fatal, the earlieft ufe of every effort, pointed out by ftudy and experience, muft be adopted. To attempt to Surnifh family practitioners, thereSore, with rules Sor the cure oS apoplexy, would be abfurd and dangerous : all that with propriety, therefore, can be attempted in a work of this kind, is to manifeft the neceffity oS obtaining the earlieft medical aid ; to recommend the Safeft mode oS treating the patient, until that is obtained ; and to point out the moft proper plan to be adopted, to prevent the return oS the diSeaSe. No time, then, muft be loft : the beft medical affiftance fliould be obtained, as Soon as poffible; fince, in every moment that is wafted, the difeaSe is, moft probably, more-firmly eftablifliing itfelf. In the interim, no rafh experiment, nor any violent 356 MEDICAL ADMONITIONS: violent endeavours, Should be employed. The appiiM cation of irritants to the noftrils, as volatile Salts, fnuff, he. with the hope of foufing him from his ftate of inSenfibility, muft be particularly forborne, as well as any attempts to force him to Swallow any ir- ritating liquors. The patient fhould immediately be raifed into an, elevated pofture, and his head, in particular, fhould be kept erect ; Since, otherwife, an angle being form- ed by the bending of the neck, the blood will be the more likely to be detained in the blood-veffels of the brain ; which, of neceffity, muft occafion an augmen- tation of the difeafe. The neckcloth, and whatever is likely to occafion a ftricture on any part of the body, muft be removed, fo that no interruption to the free circulation of the blood may exift. The am of the room fhould be moderately cold ; and the cloth- ing fo difpofed, as to allow the patient to breathe the cool air, at the fame time that the body itfelf may be Sufficiently defended from the action of the cold on its furface.. In removing the patient to his chamber or bed, great care fhould be taken, that he be Stirred no more than is absolutely Beceffary ; and that an erect pofition be preServed as much as poflible. Should the patient have befen Seizedfbon after eating a hearty meal, and fhould Srequent urgings point put a diSpofition to retch, the^^iScharge of the contents of the ftomach may ME-DICAL ADMONITIONS. 357 may be procured, by irritating the throat and ftuces with the end of a feather ; Supplying him, as Soon as he is able to Swallow, with camomile tea, Salt and water, warm water, &c. until the ftomach is quite emptied. This fhould, however, be performed with caution : if the eyes are very red, and the face exceed- ingly florid and turgid, it ought not to be attempted, until fomo blood has been taken away. From a confidence in its utility, in every cafe of this difeafe, bleeding is almoft always immediately pro- pofed, by thofe who happen to be prefent at the firft onfet ot the difeafe ; and is generally adopted, if any one can be found who can wield a lancet. And, in- deed, not only in this difeafe, but in every other, which menaces the Speedy1 extin&ion of life, is this operation too generally had recourfe to. To prevent the rafh and dangerous adoption of this practice, it may be fufficient to imprefs on the mind, that thefe alarming fituations may of tener depend on a depletion of the blood-veffels, and an exhauftion }of the vital powers, than on too great fulnefs, or on too powerful adion. Even in the difeafe, which is the Subject of the prefent Section, in which it muft be acknowledg- ed, that bleeding is more Srequently demanded than in any other diSeafe, which has Sor its characterift^c Symptoms the deprivation oS fe^fe and motion, the obfervations 35? MEDICAL ADMONITIONS. obfervations of the moft celebrated phyficians have proved, that bleeding is Sometimes highly injurious.* The beft advice," thereSore, that can be here given, with reSped to bleeding, as a rule of condud in thefe diftrefsful cafes, is, perhaps, to abftain from this operation, until the opinion of the intelligent can be obtained. This delay will be efpecially neceffary, if the coun- tenance appears to be funk and pallid, rather than tumid and florid ; if this attack has occurred at the dofe of long continued labours, either of the mind or body ; and in fubjeds who have not been devoted to indolent or luxurious indulgences, A fimilar caution is neceffary, with refped to the employment of blisters, which, Srom an opinion oS the Safety with which they may be uSed on all occafions, are often had recourSe to in theSe caSes. But, it muft be here remarked, that their employment is admiffible only in fome cafes ; in others, every alarming Symp- tom may be increafed by their application. It has been already remarked, that there is a certain peculiarity oS make, which very much diSpoSes to this diSeaSe ; * Heberden. Medical Tranfaftions, vol. i. p. 471. Fothergill. London ObS. & Inq. vol. vi. p. 680. Kirkland's Commentary on Apoplectic and Paralytic Affe&ions, p. 46. MEDICAL ADMONITIONS. ^50 difeafe ; this was faid to confift chiefly in a fhortnefs of the neck, and a largenefs of the head, accompanied by a full habit of body, and a florid countenance. I muft here digrefs, for the fake of leflening unnecef- fary uneafinefs and alarm, which may be excited, in thoSe who may conceive they poffefs, in Some degree, this peculiar form. This peculiarity, it muft be obServed, then, only gives a greater SuSceptibility oS this diSeafe ; and this by no means to the extent which has been generally SuppoSed. The difeafe itSelf, and even a difpofition towards it, muft be produced by a concurrence of various circumftances, the greater number of which may be removed, or prevented, by a little care and refolution. When it is recolleded, that a frequent caufe of apoplexy is a mechanical preffure on the brain, the confequence of the accumulation of • blood in the blood-veffels of the brain ; or of the extravafation of blood, or of fome other fluid, in or upon the brain ; it is obvious, that, to prevent fuch a fulnefs of blood arifing, as may deftroy the equilibrium between the blood-veffels and their contained fluid, fliould be the conftant endeavour of every one who has reafon to fear an attack of this diforder. To effed this, it will be neceffary that a due pro- portion g6© MEDICAL ADMONITIONS* portion be preferved, between the quantity of nourifh- ment which is taken, and the wafle which is occafioned by exercife. The patient fhould therefore be very fparing in his meals ; of which animal food fliould form but a very fmall part. Spirits, wine, and the Stronger kinds oS malt liquor, as porter and ale, fhould be Strictly avoided. The beverage fliould chiefly confift of lemonade, Sherbet, whey, butter-milk, &c. and, where Some indulgence to long eftabliShed habits is infifted on, weak negus, or a glaSs or two oS port, or oS the lighter French wines, may be allowed after dinner. The clothing fhould be light and looSe ; and par- ticular care fhould be taken, that nothing the leaft tight be worn about the neck. ExerciSe fhould be employed to a confiderable ex- tent, and no more Sleep indulged in, than is juft Suf- ficient to recruit the ftrength. Sleeping immediately after a full meal Should be carefully avoided : efpeci- ally Sleeping in a chair, which is particularly danger- ous ; fince, in confequence of the mufcles which fhould fupport the head lofing their power, during Sleep, the head falls on one fide, by which, the blood- vefieJs in the neck being compreffed, the return oSthe blood from the head may be impeded, and a rupture of fome of the veffels in the brain be thereby pro- duced. A MEDICAL ADMONITIONS. 361 A considerable number oS thoSe who Sail vidims to this difeaSe, are attacked during the night ; this may be accounted Sor, by confidering, that the hori- zontal pofition impedes the return of the blood through the jugular veins ; its motion being no longer aided by its gravity, which was the cafe whilft the bcdy was in an ered pofture. For this reaSon, the beds oS thoSe who have cauSe to Sear an attack oS this diSorder Should be considerably higher at the head than at the Sect. This riling of the bed fhould be gradual, Such as would be occafioned, by Shorten- ing the Supporting pofls at the foot of the bed ; fince if it be attempted only in the uSuai way, by three or Sour pillows, in addition to thoSe uSually employed to raiSe the head, the chin will be thrown Sorward on the cheft, and the neck bent at So acute an angle, as may be very likely, during the hours oS fleep, by interrupt- ing the paffage oS the venal blood, in the neck, to bring on thoSe very effeds which it was intended to prevent. The man of bufinefs, who Sor his cares and exer- tions has obtained the reward of eafe and competence, is particularly Subjed to this malady. In him we find the concurrence of many circumftances, which muft have a tendency to produce this difeafe. In the days of his induftry, when conftantly labouring, perhaps literally So, to obtain the gains oS his bufineSs or pro- X x Seffion, 362 MEDICAL ADMONITIONS. feffion, the neceffary exercife, both of body and mind, muft, Srom the great expence of the vital fluid, OC« cafion the demand of confiderable fupplies of nourifh- ment ; and we, in general, find, that men of the above defcription are favoured with organs of digeftion in a found and vigorous ftate, and are confequently well diSpofed towards the luxuries of the tabic. Such a man feldom quits the pleafing biaftle of a fuceefsSul bufinefs, until he difcovers, that he has So far paffed the acme of his life ; that his abilities are not what they were, and that his exertions are no longer produdive of that fuccefs which he has hither* to experienced. However difpofed he may be, at firft, to attribute this to other caufes, it will not be long before he difcovers the true caufe, in the diminifhed vigour, perhaps both of body and of mind. He retires, therefore,,, from the bufy world, with the intention, either oS freely indulging himfelf with. that reft, to which his purSuits, Sollowed with avidity, have hitherto rendered him a( Stranger ; or, at leaft, of exchanging his exercife and his employments, for fuch as may be more agreeable, and better fitted to his declining years and Strength. If we follow him in his retirement, we Shall moft probably find him indulging in almoft a ftate oS ab- solute indolence ; or, at leaft, in # ftate comparative- ly MEDICAL ADMONITIONS. 363 \j fo, if the adive fituation from which he has been removed, be recollected. Although he may, for his health's fake, being aware of the ill confequences of the omiffion, make a point of taking fome exercife; yet it is moft likely that this will not be,employed to that extent, which is neceffary to prevent the evils intended to be avoided. This may ariSe from his varying his modes of exercife, when he changes his fituation of life. Thus, whilft engaged in his Sormer purSuits, we may SuppoSe him to be almoft conftantly on Soot, hurrying to wherever he may be Summoned, by the various calls oS hie bufineS6 or profeffion. But after his retirement, he will moft probably adopt, for his amuSement, Such exerciSes as will confiderably differ Srom that to which he has hitherto, in Some meafure, been impelled* The culture of a flower garden, riding on horfe-back, or even the regular ringing of dumb bells, may be adopted ; but without anfwering thfc propoSed inten* tions. To understand the reaSon of this failure, I muft beg you to confider, that iS any Set oS mufcles are employed, in a different manner, and in a different combination, Srom that to which they have been ac- cuftomed, a Senfe oS wcarineSs and pain is Soon ex- perienced in them. Bend but the neck ftrongly to one fide, and retain it there a Sew minutes, this fad will be Soon.fufikiently evident. Thus, though the gardener 364 MEDICAL ADMONITION'S. gardener may delve f rom-morning tiM night* with little or no inconvenience ; and the veteran fportfman may follow the longeft and hardeft chace, with delight; he who has been unaccuftomed to thefe tteodes ©f exer- ciSe, would, by employing them, not only Soon become inexpreffibly wearied ; but would probably not get rid oS the painful affedion of the mufcles, for feveral days. In this way, an important deception may take place ; for reckoning his exercife by the quantity of fatigue he experiences, he may fuppofe it to be equal to that which ufed to be afforded, by fo much of his former amufements, as was produdive of a fimilar degree of wearinefs. Whereas, on the contrary, al- though his Satigue may be confiderable, his exercife may have been So trifling, as to have yielded no bene- ficial effed. But fhould he, after his retirement, even perfevere in a fimilar mode of exercife, with that to which he has been accuftomed (of walking for inftance,) it is very likely, that for want of an objed Sufficiently im- portant and interesting to engage his attention, he will too acutely feel the many little inconveniences and troubles, which continually arife, to teize a mind which is too little occupied. In confequence of which, he will foon yield to a fenfe of wearinefs ; and will endeavour to convince himfelf, that he has taken the full quantity of exercife, which had been allotted him. Were MEDICAL ADMONITIONS. $6$ . Were he to leffen the quantity of his fad? in the fame proportion as he diminishes his exerciSe, little or no evil might ariSe ; but, unfortunately it Sometimes happens, that the mere habit oS eating plentiful meals, may continue the cuftom ; even when the ap* petite itSelS does not demand them: and long, after the various modes of exercife have been given up, by which the neceffary balance fhould be preferved. In a word, then, perfons of the above defcription fhould change their modes of living gradually, and with the greateft circumfpedion : their minds fliould be almoft conftantly engaged, in fome purfuit or amufement, which may keep off the attacks of languor and liftleffnefs ; and the utmoft care fhould be taken, that a due proportion be preServed between the Sood they take, and the exerciSe they employ. But it is not the SucceSsSul and high Sed citizen alone, that is obnoxious to the attacks of this difeaSe. It frequently marks for its vidims,* objeds of a very different defcription—thofe who devote their hours to the moft Severe and obftrufe Studies ; and^particu- larly thoSe who may have long Struggled with adverfity and difappointment ; and whofe .mindsi yd i" f)i* 'i ; ^Palsy. confifts in a lofs of the power of motion, but affeding certain parts of the body only., The different forms in which this difeafe appears, are diftinguifhed by different names, according to the parts which are affeded : thus, if the lower part of the trunk, as well as the inferior extremities, are affeded, the, difeafe is termed paraplegia : if one fide of the body is affeded, with the lirnfos.on that fide, the dif- eafe is then named hemiplegia, ; ^lHil Such perfons as have been already defcribed, in the preceding chapter!"as predifpofed to attacks of apo- plexy, are alfo very liable fo paralytic affections. Thofe who lead fedentary and luxurious lives ; who have been much engaged in night Studies, and watch- ings ; and have fuffered much diftreSs and anxiety, are frequently the* vidims of this malady. It feldom comes on before the middle ftage of life is pall, and has been thought to happen more frequently to fe- males, than to men. Extreme coldnefs and dampneSs? of the atmofphere, appear to be favourable i to the produdion of this difeafe ; fince attacks ofr palfy, as well as apoplexy, are very frequent at the firft Setting in of winter. The immoderate ufe of fpiritu- ous liquors, tobacco, coffee, and tea, will be likely to *tow promote MEDICAL ADMONITIONS. $67 promote the produdion of this complaint. Similar effeds may be alfo produced by quick Silver, lead, ar- fenic, and other mineral fubftances; either by the unSkilful employment of them as medicines, or by the neceffary expoSore to their adion, in the various arts in which they are employed, Such as gilding, the fufing oS metals, painting, &c. Sudden and violent gulls of paffion, and other confiderable affedions of the mind, may alfo induce this difeafe. , . , The difeaSe Sometimes comes on without any pre- vious Symptoms, the'patient having appeared, but juft the minute beSore, as in perfed health ; but it more frequently happens, that, for fome time before, the patient has complained of pain, and of giddinefs and weight of the head ; and frequently of a general lan- guor and liftleffneSs ; the powers oS the mind alfo Seeming, in Some meaSure, to be impaired. , * . When the diSeaSe has taken place, the pulfe, as in the apoplexy, becomes, in general, hard and full,' and moderately quick ; fometimes it is flower than natu- ral, and fometimes very irregular, and even intermit- ting. The limb affeded drops ufelefs, and Peonies pale and cold ; and is almoft always, at the firft, in a clammy Sweat; Sometimes a painful prickling fenfa- tion is Selt, exadly refembling that which occurs when the.leg is Said to be afleep ; and in other cafes, the parts affected are deprived of the fenfe of SeclingJ as' >Jorno. well 368 MEDICAL ADMONITIONS. well as oS the power of motion. Apopledie Symp- toms frequently accompany the diieafe at the firft attack ; but thefe fometimes fubfkfe, and leave the patient affeded with the paralytic fymptoms only. When a fenfe of tingling is felt in the parts affed- ed,-and the parts regain" a fmall degree of motion, a hope may be reafonably entertained, that a confidera- ble change for the better may yet take place. This expedation may be the more indulged, if no giddi- nefs, head-ach, or preternatural Sleepinefs, remain; efpecially if the patient feems to be regaining the powers of recolledion, thought, &c. . ♦ The danger with which this difeafe is known always to be-accompanied, and the formidable manner in which its attacks are generally made, cannot fail but imprefs the mind of the patient, and his attendants, fo ftrongly, as to render it entirely unneceffary here, to ufe any arguments againft the folly of having recourfe to the futile, or dangerous attempts of domeftic medicine. On the firft onfet of the difeafe, and before proper medical aid can be obtained, the cautions laid down in the preceding fedion will be very proper to dired the management of the patient. As Soon as the difeaSe is Sufficiently leffened, to allow of the patient's making ufe of exercife, it fhould be MEDICAL ADMONITIONS. 369 be cautioufly and regularly employed ; but great care fhould be taken, that it be of that kind, which is beft adapted to his ftrength and former habits. Eledricity is almoft always had recourfe to, in this malady, and too often without fiifti-qbuining the neci iiary information, from thofe who alone are capa- ble of giving it, as to its propriety or impropriety. It j* too generally fuppofed, that, although £>edricjfy maty produce no beneficial effeds by its application, in cafes of difeafe, yet it cannot be produdive of any injury to the patient. But the contrary of this is the truth ; for eledricity, it is well known, is capable of producing very confiderable, and very different effeds on the animal fyftem ; for at the Same time that it is one of the moft powerful Stimulants that can be em- ployed, it is alSo poffeffed of the power of rapidly destroying the mobility of the nervous fyftem. In cafes, therefore, where the diSeafe depends on a Surcharge of the veffels of the brain, how dangerous muft be the rafh employment of So powerful a Stimu- lant ! Again, when its debilitating effeds are confider- ed, how evidently it appears, that in cafes of debility, it muft of neceffity occafion the farther diminution of the vital powers ; and thereby produce an increafe of the difeafe it was meant to remove, and perhaps the Speedy death oSthe patient. CaSes are not wanting, where the increaSe of pally has been maniSeftly the Y y conScquence 570 MtDICAt "ADMONltlOkt. torifequence Of employing eledricity, with tlife nop* oS its removal." ' ° " 10J * .»'PM ■.*:„;« ,yitoKiuobnri *iHi *ufl .tfoqisa yma ni -u " That the electric fluid ads as a ftia^ulw upon v the apical fyftem* muft, 1 belieye * be allowed ; but that its Stimulant effeds are more tranfient* and the Succeeding Slate of debility confequently more rapidfy produced, than what refults from the application of any other known ftimulus, muft, I think, be alfo allowed/'* *~ hi* ?Lo fd Qt\1 lo r rIuoud 3/ft ,'S\n$\ibpdi fel, nv Br. HaIeojter,,in the feme work, obferves****Ebb- tricity has often been recommended as a redradjrai* palfy, and much cried*'up by Some, feh*fe pretend to fecrets in the mode of administering this remedy. But the medical faculty have, I believe, nearly loft all faith in it, from experienced its general inefficacy to be of Service.'attd in Some inftaneesj of its mifchievous. effeds. 31 am more certain that a Strong eledric Shock poffeffes the power of caufing a palfy, than I am of its having any power to'cure it* "We have lately had two instances in the Bath hoVpital, of perfons who hail paralytic attacks after being ftruck with lightning*«j« -uoimq mo ,'iry> an- v -iij-c ''j .auon gt.igfin . v; piy Falconer alSo obferves, that it is a jjfcqwenfc ci£3wl!'., oliiloiq & djiw bo woo '{liniupyii pradke "'"* ftft Ac^unt of the Efects of lightning, by j?Paikia- foa, Hbitbnv Memoirs of the Medical" Society of Lbndofe, tol^ii'fi &frWs~rf sri* 8# ,i3w ?js tiiluq vni own ,■ *• «Mt Ibid. p. 201. MIDICAL ADMONITIONS. 3/1 A I practice to lap up paralytic limte in many folds of flannel, and to keep the perfon So affeded, very y$r$ in every reSped. But this is, undoubtedly, a very noxious practice, asf? ith generally induces % ten- Jdency.to fweat on the paralytic part, tyhicji afoiftjrs weakens it. >*l"b« .>*u- &> - - &lutaii\ itilJ \lbn{ei mo« ,i^D3lnoj yjilidabto s.j&n atubvrsjdi }o noil£->iiqqc 6di inoii *flr' sdw nad* .r^Dobor] ,-»k *j . J.uui I FAINTING. iW0Xi;< „dto y_ ~**^— " "Jjs/vOU* Jn this difeafe, the circulation of the blood, and * the idion of the lungs, become fo much weaker than >nat«al, as in fome cafes, to gfre^reafon to fo%ect ckhatthey are entirely fufpended.^ i'nuia oat t(ii^q When the difeafe does not come on fo Suddenly as to deprive the patient, at once, of his fenfes, he ex- periences a SenSe oS pain and oppreffion, about the region oS the heart; accompanied with exceflive ian- euor, and frequently with ficknefs. He Sees,very imperfedly the objeds which Surround him, which all ieem to be poffeffed with a rotatory motion, and at the fame time his ears are affeded, with a confufe4 ringing noife. Every part of the body, but particu- lafly the face and extremities, become cold and pale ; %nd are frequently covered with a profufe cold fweat. The powers of fenfe find motion are always impaired Ui1Soimei'd'eigreet.and jbmettcqes. entirely fufpended. for a time : the pulfe, as well as the breathjng, being* at !Oi: ■••» bidl the hjk MEDICAL ADMONITIONS* the Same time, "fcarcely, if at all, to be perceived. After the Symptoms have thus continued a few min- utes, they gradually difappear ;' a discharge of' the contents oS the ftomach Sometimes comes on, and Sometimes the fainting is Succeeded by convulfions. In moft caSes, if proper means are not had recourfe to, a recurrence of the difeafe may take place. Of the numerous caufes of fainting, the more fre- quent, need only be enumerated ; thefe are, fudden 'and profufe haemorrhages, irregular distributions of ttye blood, immoderate difcharges of various kinds, violent exertions, exceffive.pain, fudden or violent paffions or emotions of the mind, difgufting fights^, cjifagreea-. ble odours, long continuance in heated rooms, de- bauches, &c. A difpofition to this difeafe may take place when- ever debility exifts ; but when this difeaSe Srequently recurs, without any obvious caufe, a morbid Slate of the heart or brain themfelves is to be fufpeded. The treatment oS the patient reSpeds eijher, the Shortening of .the paroxyfm, or the preventing of its recurrence. ^iu^.j. ' The firft oS thefe intentions may, in general,'be'ac- eqmpliflicd, by adopting the following'meads.' The patient mould be placed in a reclined pofrute, and every part of the clothing, which, by its tightnefs, is likely MEDICAL ADMONITIONS. 373 likely to interrupt the free circulation of the-iltfo©^ fhould be immediately loofened.^rNo more! pesfcns fhould be allowed to be in the room, than are abfo- lutely neceffary, from the affiftance they may yields and thefe fhould &> diSpoie themSelves* as not to in- terrupt, the Sree acceSs of the air to the patient. The doors and windows of 'th«t room, efpeciaUy, if the weather be warm, fhould be kept open ; or, if the room be fo fituated, as not to allow of Sufficient air being thus obtained, the patient may then be removed into the open air. The face may be fprinhled with cold vinegar, or water. The fmoke of burnt linen cloth, vinegar, and any pungent vapour, particularly that of volatile Silts, may be applied to the noftrils ; but in doing this fome management is neceffary ; fince, without care, the intended effeds will not be pro* duced. Hi If the patient retains fenfe enough to experience any inconvenience from the application of pungent vapours to the noftrils, but not fufficient judgment to be aware of the neceffity of inhaling them, the ut- moft exertions will be made by him to inSpire-through the mouth only ; excluding the air thus impregnated, as much as poflible, from the noftrils. It is ulual to obferve patients, in this ftate, thus bear the applica- tion oifmeJhng bottles filled w ■iih the mof^ pungent and volatile remMfieSn.fora long time together, with- out *«7J. MEDICAL ADMONITIONS, °.'* *.* ;r. oi ,*. j< out feeming to be at all affeded by them. T# tjiefe cafes the mouth is to be clofely Slopped, by holding* handkerchief Sorcibly * againft it, but leaving the noftrils perfectly free. The patient being now undej the necemty of breathing through the noftrils, the effluvia which are employed, are impelled againft the membrane whkh lines the cavities of the noftrils, and on which are diSpofed the Sentient extremities of the olfa&ory nerves. Frequently it will be obferved, when recourSe is had to this mode, that theo patknt will Sor a" long time refrain Srom breathing at, all; but at laft, being under the neceffity pt mlpuing, and deeply, the pungent particles, imbibed in great quan- tity, and with confiderable/fbrce, will occafion fo con- fiderable a degree of irritation, as will Suddenly and moft eJ5e$dft%; aroufe the patient from his flat* of ^ctafibtityvj " dii^b oi *fr*Hlt>fIw ^a lL-i ~ i '.f« I3 * _)] yi *o tmifIs* «**--: To haften the termination oS the fit, as well as to i V i "■ v:* '' ' ' prevent its return, the occafional or exciting cauft fhould be afcertained and 'carefully removed. . But to prevent the recurrence of this difeafe, fomething more js required ; for toO frequently So ftrong a difpofition to Sainting fits exifts, that.the fhoft trifling circumftance may prove Sufficient tq occafion them. Whenever this is the caSe, there can; not be a doubt but that So confiderable a decree of ,T ^?f. •'■■.. »■ ' J * '& • , debility is induced, as will be likely .to termiiwtejn .. Some MtDICAL ADMONITION*. jf/ fome dangerous malady. ^ The caufes bf which this ftate of extreme debility may be produced, are fo numerous, and various, that to deted thein, and ap- propriate the fitteft modes of cure, is a talk only to be undertaken by the Skilful and experienced^ . hn*r t?lriiiOfl JP'i. ......'ti'P T w1' ' ■' ' ]-ff anndrnsnr •uMo «ftmrAFPARENT DEATH. 7* ri:>"Iw n0 ^brnfldo 3d Urn , *_ .wvwn fiofcaHo Reason and humanity demand, that a knowledge 6f the proper mode of treatment of perfons apparent- ly dead, from drowning;, &c. or brought to the brink of the grave by famine, or exceflive cold, fliould be as generally diffufed as poflible. , , , ' \ _ oni. ■»n.--iDul j ar **■ ^VP* £ aldinsbtl \< The leading principle of our conduct, in every cafe where a near approach to death is oc^ifiahearlsyr long falling, or expofure to extreme cold, is to yield as gradual 'a fupply as'poffible of that stimulus, from the deprivation of wide^ life appears to be about to ceafe. ^ Where life appears to be nearly extinguifhed by 2t*g[ expofure to extreme cold,, the greateft Caution is neceffary m reftorm^ the defective ftimulus* heat. Its amplication Ihould be aT firft in the loweft degree, and fhould be'gradually increaSed. T Imitating "the practice of the inhabitants oS the cold countries, who, Whert any part «S the body Wfrofi-birlen, immediateiy 3fil0> thaw 376 MEDICAL ADMOKITI0N9. thaw it, by rubbing it with fnow ; and very gradual- ly expoSe*it to the influence of a warmer temperature, well knowing, that by a fudden approach to the fire the frozen part would foon be. entirely deftroyed. When from long faft ing the vital powers feem to be nearly exhaufted, theiupply oSthe defective ftimulus, Poo-d, fhould alfo be made in the moft gradual and cautious manner. Weak broths fliould be firft given, barely warm, and in very Small quantities at a time ; and afterwards gruel, milk porridge, milk enriched by the addition of an egg, wine whey, &c. may confti- tute .the nourifhment with which the reftoration may, by the gentled gradations, be completed. The directions given by the Royal Humane Society are fo clear and explicit, as to put it in the power of any one, to employ the moft powerful means for the recovery of the apparent dead. As no opportunity fhould be omitted of promoting the diffufion of knowledge fo important to the deareft interefts of humanity, I have taken the liberty to introduce the procefs recommended by the fociety.* RESUSC1TATIVE *The Editor of the Reports of this Society eloquently remarks—" What an exalted tranfpoit muft it afford every compaffionate breaft, to be inftrumental in recalling our helpleis fellow-creatures from apparent death •,—to witnefs the heartfelt paffions of angtiifh and defpair, of hope, Sur- prise, MBDICAL ADMONITIONS. 377 RESUSCITATIVE PROCESS. What thou doeft, do quickly. THE DROWNED. 1. Convey carefully the body, with the head raif- ed, to the neareft receiving houSe. 2. Strip, dry the body -, clean the mouth and noftrils. 3. Young Children to be put between two perfbna in a warm bed. 4. An Adult—Lay the body on a bed, and in cold weather near the fire. In Summer, expoSe the body to the rays of the fun 5 and, in warm feafons, air fhould be freely admitted. Kf* 5. The body to be gently rubbed with flannel fprinkled with fpirits or flour oS muftard. The Z z proper prife, and joy, which alternately agitate the human frame ;— to mark the lively traits of gratitude, painted in the counte- nances of the mother, lifters, brothers, &c. of the reftored object !—What epicure could ever yet boaft fo refined, fo exquifite a luxury, as the benevolent deliverer from fuch a Scene—a fcene far beyond what any pen has yet been able lo dcScribc, or pencil to exprefs!" 4^8 MEDICAC ADMONITIONS, proper fubftances to be fprinkled on flannels, and a heated warming-pan, covered, may be lightly moved over the back and fpine--$ait never to be employed. 6. The breaft to be fomented with hot fpirits. Hot bricks or tiles, covered, &c. to be applied to the Soles of the feet and palms of the haads. If no Signs oS life appear, the body to be put into the warm bath. 7. To reftore breathing—Introduce the pipe of a bellows (when no apparatus is at hand) into one noftril ; the other, and the mouth, being clofed, inflate the lungs, till the breaft be a little raifed 5 the mouth and noftrils muft then be let free. Repeat this procefs till life appears. 8. Tobacco fmoke is to be thrown gently into the fondament, with a proper inftrument, or the bowl of a pipe covered, fo as to defend the mouth of the affiftant. 9. Electricity to be early employed, either by the medical affiftants, or other judicious practitioners. INTENSE COLD. Rub the body with fnow, ice, or cold water. Reftore warmth- by flow degrees j and after fome time, if there be no appearance of life, the refufcitative procefs for the drowned muft be employed. *v 5* BE M©N MEDICAI ADMONITIONS. 375 SUSPENSION BY THE CORD. 1. A few ounces of blood may be taken from the jugular vein ; cupping-glaffes applied to the head and neck ; leeches alfo to the temples, 2. The other methods of treatment the fame as recommended for the apparently drowned. SUFFOCATION EY NOXIOUS VAPOURS. Cold water to be repeatedly thrown upon the face, &c. drying the body by intervals. If the body feels cold, employ gradual warmth ; and the plans for reftoring the drowned. INTOXICATION. The body to be laid on a bed, with the head a little raifed : the neckcloth, &c. removed. Obtain immediately medical affiftance, as the modes oS treatment muft be varied according to the circum- ftances of the patient. GENERAL OBSERVATIONS. 1. On figns of returning life, a tea-SpoonSul of warm water may be given ; and, if Swallowing be re- turned, warm wine, or diluted brandy. The patients muft be put into a warm bed ; and, if difpofed to fleep, they will generally awake perfectly reftored. 2. The 38a MEDICAL ADMONITIONS. ■'*: The plans of refiftitation are to be uSed for three or Soar hours. It is an abjurd an4 vftfgar opinion, to* fuppofe f erfons irrecovjerabley becaufe Ufe does not foon make its .ap- pearance. 3. Bleeding never to'he employed, unltfe by the di- reclion of the medical aJflftantL CONVULSIONS. By convulfions are here meant thofe epileptic cpn- vulfive fits, to which children are Subject; and which from the fuddennefs with which they occur, and the Ihocking appearances they exhibit, are truly Subject* of alarm to a parent. To prove how much circumfpection and fkill is required in the treatment of this difeafe, it may be only necefiary to point Out the various caufes from which it may proceed. The difficulty which muft generally occur in ascertaining, on which of thefe caufes the convulfions may depend, muft be then Sufficiently obvious. Among the moft frequent caufes of convulfions may be enumerated painful dentition V the accefs of fmall pox, mealies, and other' 'eruptive fevers ; the irritation MEDICAfc ADMONITW*iiV ^. irritation from worms, in the intefYme* ;* exceffive diftenfion oS the ftomach, with even food propet in quality j the irritation Srom the employment of crude and indigeftible fubftances for food ; the retrocefuon of eruptions on the fkin ; the incaiitioufly "drying u£ of fome difcharge j the diftenfion of the ftomach or interlines with wind j Sudden and violent noife; acute pain ; and breathing too long a vitiated air. ^ Should it not be likely that medical advice can Soon be obtained, as ftrict an enquiry as poflible (hould be made, by thejparents of the child, to afcertain the exciting caufe ; fo that an appropriate method of treatment may be adopted. In the firft place, the ftate of the ftomach and belly fhould be enquired into. IS the region of the ftomach Seems diftended ; if the child has* either before the fits, or in the intervals between them, made exertions to vomit ; and efpecially if the child has been fed plentifully not long before, an emetic of the. tartarifated antimonial wine fhould be given as foon as it can be Swallowed, in a doSe proportioned to the age oS the child. If there be an evident diftenfion of the belly ; efpecially if the child have appeared tp Suffer pain in the bowels, the caufe of the,, rai^hief may juftly be fufpected to exift there. Infprmation muft. then be obtained, jSi MEDICAL ADMONITIONS. obtained, as to the previous ftate of the child's bowels, When coftivenefs has preceded, a clyfter fhould be exhibited, compofed of thin gruel, coarSe Sugar, and caftor oil ; a powder may be alfo given, with a grain or two of calomel, and fix or eight grains of jallap j repeating the clyfter every hour until ftools are ob- tained. But if the child have been reduced by a long continued loofenefs, the diftenfion of the bowels may be attributed to confined air ; and a clyfter, made by boiling carraway or annifeeds in thin gruel, fhould be directly given. A tea-Spoonful of fome carminative mixture, made by adding two tea-Spoon- fuls of feme aromatic cordial, fuch as annifeed, juniper, or carraway, with as many table-fpoonSuls of water, in which has beendiflblved a Small quantity of Sugar, may be occallonally given. The belly fhould be alfo rubbed with Such a degree oS preffure, as will be likely, without giving much pain to the child, to oc- cafion the diSperfion of the confined air. Both in this, and in the laft caSe, the belly may be fomented with flannels wrung out oS a ftrong decoction of camomile flowers. The camomile flowers themSelves, wetted with any Spirits, and made hot, may be alSo applied, in a flannel bag, to the belly. If the fymptoms which have previoufly occurred1 give reaSon to SuSpedt the preSehce of worms, a calo- mel purge may be given as Soon as the child can- .' Swallow; MEDICAL ADMONITIONS. 3^ Swallow ; and a clyfter may be thrown up, made by diflblving a Sew grains of aloes in water or milk, to which a Small portion oS oil may be added : the quantities, oS courSe, depending on the age of the patient. In thofe fits, where the exciting caufe cannot be afcertained, and in the above-mentioned caSes, where Such oS the Soregoing means as appeared moft appro- priate have not Succeeded, and regular afliftance can- not yet be obtained, the Sollowing meaSures may be adopted. IS the blood-veffels of the face be turgid, the eyes red, and the countenance of a crimfon hue, blood may be taken away from the arm, or, by leeches, from the temples. The Seet and legs may be bathed in warm water, and, where no confiderable determination to the head appears, Spirits oS hart fhorn, or Sal volatile, may be held to the noftrils, and rub- bed on the temples, &c. Should the remedies employed prove Succefsful, ftill confiderable attention will be required, in dis- covering on what cauSe the diSeafe depends, that the moft effectual means may be adopted to prevent a selapSe. Here I muft take notice of the abfurd opinion, that a phyfician is not required in the dif- eafes oS children—an opinion which, unfortunately for the little Sufferers, is too generally embraced. But Surely the occurrence oS circumftances So ambiguous, as 384 MEDICAL ADM0NI/TI0NS* as are perceived in the diSeaSes oS children, demand the cloSeft investigation, of even the moft intelligent phyfician. Often will, in other refpects, a confiderate parent Say, " the poor child is unable to deScribe its complaints—therefore a phyfician can be of no ufe." Inftead oS concluding, that in proportion as the caSe is involved in obScurity, are knowledge and the power oS discernment required. Dr. Underwood, in his TreatiSe on the DiSeaSes of Children, juftly remarks, " that although infants can give no account of their complaints, in the manner we receive information from adults, their difeafes are all plainly and fufficient- ly marked by the countenance, the age, the maniteft fymptoms, and the faithful account given by the parent, or an intelligent nurfe. This I am fo confi- dent of, that I never feel more at my eafe, in prefcrib- ing for any diforders, than thofe of infants; and never fucceed with more uniformity, or more agreeably to the opinion I may have adopted of the feat and the nature of the diSeafe. Every diftemper may be Said, in Some Senfe, to have a language of its own, and it is the bufinefs of a phyfician to be acquainted with it; nor do thofe of children fpeak lefs intelligibly1. Limited as is human knowledge in every department, there are yet certain principles and great outlines, as tvell in phyfic as in other fciences, with which men of experience are acquainted, that will generally lead them SaSely between th&dangfliou* extremes of doing too MEDICAL ADMONITIONS. 385 too little, or two much ; and will carry them fuccefs- fully, where perfons Who want thofe advantages cannot venture to follow them. Let me afk, then, is it ob* fervation and lorig experience, that can qualify a perfon for the fupcrintendance of infants, or the treat- ment of their complaints ? Surely all thefe fall eminently to the fhare of regular practitioners, to the Utter exclufion of nurfes and empirics." EPILEPSY, v""' OR FALLING SICKNESS. **'" In thefe fits, the perfqn falls, Suddenly deprived of fenfe and motion. During the fit, the limbs, the mufcles of the face, and every part of the body, are violently agitated by convulfive Struggles; a Srothy liquor iffues from the mouth, and, iS great care be not taken, the tongue is thruft out of the mouth between the teeth, and wounded by their convulfive clofing. During the fit, the greateft care fhould be taken that the patient does not injure himfelf by the violence of his ftruggles : he therefore fhould be directly placed on a bed. From neglect of this caution, it often happens, that the poor Sufferer fuflains very A a a confiderable 386 MEDICAL ADMONITIONS. confiderable injuries. The clothing fliould be every where loofened, and the head moderately elevated. As foon as poflible, fome fubftance fhould be intro* duced and held between the teeth to prevent their doling on the tongue ; and even when fenfe appears to be a little returned, no veffel of any fragile fub- ftance, as earthen-ware or glafs, fhould be ufed fos the purpoSe of offering drink • left, from the delirious ftate which occurs in the interval of the convulfion, or-from the convulfion itfelf Suddenly coming on, he fhould bite out a piece oS the edge of the cup, or glafs, and thereby get the fharp and broken Sragments within his mouth. Should it appear that the patient has been drinking too Sreely of Spirituous liquors, or has loaded his ftomach with indigeftible and offenfive matters, the firft opportunity fhould be feized oS getting a pretty ftrong emetic into the ftomach. In thefe cafes, it generally happens, that as Soon as the ftomach is cleared oS its injurious contents, the convulfions en- tirely Subfide. With reSpect to the other caufes oS this Shocking diSeaSe, they are So numerous, and, in general, So difficult of detection, that the aid of fome medical , man fhould be always, if poflible, obtained immedi- ately on the fits taking place. To prevent the return of the fit, the domeftic pharmacopeia teems with re- cipes 5 MEDICAL ADMONITIONS. 387 cipes ; but, previous to the adoption o£ any of thefe, I muft entreat you, and my other readers, to attend to this fact—That this difeafe may arife from caufes almoft innumerable 5 and many oS theSe not only much differing from* but even Sometimes directly oppofite to, each other. A due attention to this circumftance muft certainly, not only fhew that a medicine ought not to be thus fnatched at random^ but alSo that much patient inveftigation will be in- quired to be employed, even by the moft intelligent phyfician, before he can venture to determine on the means to be ufed for the cure. WORMS. As epileptic or convulfive fits arc very Srequently occafioned by the prefence of worms in the interlines, it may not be improper to Speak of them here. Palenefs, irregular appetite, and pains of the ftomach and bowels, are generally Suppofed to be marks, by which the exiftence oS worms in the ftomach or bowels may be known ; but theSe Symptoms are equivocal, fince they generally accompany a debili- tated ftate of the fyftem, proceeding from any caufe whatever. Indeed* it is by no means fo eafy, as is in general imagined, to determine whether worms do really $38 MEDICAL ADMQNITIOIW: , iAllyrrexift in the bowels, or not. *?. Ill would bejtafy to recite, in this place, the figns which are ufut% Said to denote the prefence of worms; maft^-or indeed all, of which accompany debility arifing from variotfc Other caufes : but the point is only to be determined, by a judicious and careful confideration of all the fymptoms that are prefent, as well as of foxmerulhielfl^ pn which fome of thefe fymptoms may depend. \3. fcnor /n ]< The neceffity of determining, with fome degree of accuracy, whether the complaints of a child depend on worms, or not, is much greater than may at firft P iv w " n ? . • . "J appear.. The fymptoms which are faid to mark their prefence, I have already obferved, are thofe which likewife accompany debility-i"ronr*any other caufe. If, therefore, this debility proceed not from worms, and the means generally recommended for their re- moval, particularly Smart mercurial and fcammoniate purges, be adopted, they will not only fail of produc- ing beneficial effects; but, by increafing the weaknefs of the^patient, occafion very dangerous confequences. - ^ iBl[i 3n"- 'rno• ■ D3 juorili v tAool bns r yiu-j-uq * 'lav *>'I2 .emiowyd The evils arifing from this difeafe,-are by nomems confined to the ftomadi 3 but generally extend over boviaviaq *he 390 MEDICAL ADMONITIONS. the whole fyftem. From the Sympathy which exifts between the brain and the ftomach, the patient is alfo affected with giddinefs, and pain of the head. In confequence of the functions of the ftomach not being duly performed, a fufficient quantity of aliment is not taken into the ftomach ; and what little is taken in, does not undergo a proper digeftion. The blood, therefore, becomes So impoverifhed, that the body no longer receives its due quantity of nourifh- ment ; hence ariSes a paleneSs and coldneSs of the whole Surface of the body, and particularly of the extremities ; the patient becoming, weak and emaci- ated, his lips white, his tongue foul, and his counte- nance bloated and unhealthy. • A confiderable degree of languor and dejection of fpirits alfo take place, his nights are disturbed with SrightSul dreams; and in the day time his mind is diftrefled with a variety of ill-grounded alarms, and apprehenfions. If the dif- eaSe is not timely oppoSed by proper means, the Seet and legs will be perceived to Swell; plainly fhewing that exceffive debility has taken place, and that a collection of water may be foon formed in fome of the larger cavities, by which death itfelf may be in- duced. Errors, and irregularities in the mode of living, are the moft frequent caufes of this malady. Thofe who indulge in the immoderate ufe of tea and coffee, are particularly MEDICAL ADMONITIONS. Jc}* particularly liable to it ; as well as thofe who are habituated to the conftant ufe oftobacco, and opium- Even bark and bitters, than which Sew things are naore Serviceable in curing this complaint, will fre- quently increafe it, or even produce it, if exhibited improperly. ThoSe who are much expoSed to cold and moift air, and thofe who lead Sedentary lives, and apply themSelves too cloSely to bufineSs, or to intenSei Study, as well as thoSe who Suffer from anxiety, audi diftreSs oS mind, are oSten victims to this difeafe. Distending the ftomach frequently, with exceflive quantities of either foiid or fluid aliment, is likewifc injurious. But the moft frequent caufe of weaknefs of the ftomach is, perhaps, the conftant uSe oS Spiritu- ous and ftrong fermented, liquors. Nor is it neceffary to the production of this difeafe, that thefe liquors fliould be taken in fuch quantities as will producq intoxication ; fince thefe effects fucceed to the fre- quent drinking of them, in fmall quantities, and even when highly diluted. There are few diSeaSes, if any, over which the pbyr fician has So little power ; unlefs aided by the refoluts efforts oS the patient, as in this. In vain may he , preScribe the beft adapted remedies, and in vain may (ihey be Swallowed, unleSs the Strictest attention be paid to thoSe rules, whicli every phvfician muft think Decenary to.dieiivcr to patients.in this difeafe. Thefe injunctions, 39I MfeDICAL ADMONITIONS.' injunctions, indeed, muft too frequently be of fuch a kind, as very few will be difpofed to fubmit to; fince they will enjoin, perhaps, the yielding up of habitSj which, in confequence of long indulgence, have taken fuch pofleflion of the will, as to require the moft fedulous, and unremitting endeavours to overcome them. They may perhaps require a courfe of life to be purfued, totally oppofite to that in which the patient has placed his greateft delight and enjoyment.' There exifts but little chance that a phyfician will be able to convince his patient, that any ill effects can be produced by the continuance of practices, in which he has So long perfevered ; and in which So many perfift, and, as he SuppoSes, Sor want of fuffici* ent enquiry, with entire impunity. Or fhould a phyfician prove fo SucceSsful, with the arguments he may adopt, as to convince his patient oS the perni- cious conSequences oS any Sarther indulgence j how little probability is there, that the neceffary restric- tions will be complied with. Rather will it happen, and, in fact, fb it daily does happen ; that the patient, Soured by the long continuance of his diSeaSe ; angry with the phyfician, Sor having pointed him out, as the cauSe oS his own Sufferings; and vexed with him- felf, for his weaknefs, and want of refolutiort ; will rail at the inefficacy of the art, and perhaps at the ignorance of its profefTors $ afferting, that the admo- nitions Medical admonitions. 393 Jfritions he has received, are Such Ieflbns of aufterity, as his monitor him Self, has neither the power, nor the inclination to follow; If a phyfician takes upon himfeli the honefl patt of (hewing to his patients, that the greateft number of difeaSes are the refult of indulgence in indolence and luxuries, he may expect* to a certainty, the fate of having his lectures but little attended to j and may even efteem himfelf Sortunate, iS he eScape both aWe and ridicule. " Who is this," the multitude cries, " who preSumes thus to preach ? *Tis Some " Satiated epicure, or fome rigid melancholic. If " health and life are only to be purchafed at the price " of all our enjoyments, they are not worth the price. " If our lives are thus to confift of a perpetual ftate " oS warfare and toil, hourly Struggling between the " dictates of our habits and inclinations, and the " denunciations of our phyficians, let us take our " chance—A fhort life and a merry one." Were phyficians to expect, that the preSent race of bon vi- vants would be reformed by their writings, and would immediately Set about to correct their irregularities, and abridge themSelves of their indulgences,' they might perhaps deServe to be told, that their plan was chimerical and abSurd. But thoSe who venture to inveigh againft idleneSs and intemperance, preSume not to hope for the accomplifhment of fuch wonders; B b b they 394 MEDICAL ADMONITION*. they cannot expect that their doctriae fliould often procure the facrifice of favourite, and long indulged habits : they will be amply rewarded, with the pledfr ing idea of having made fome converts^ to their opinions ; who, though they may not poffefs refolu- tion enough to quit the paths in which they have fo long trodden, will not be inclined to Suffer their children to be enflaved by habits, the ill effects of which they have themSelves So much experienced. This diSeaSe, however, as you will perceive by re- verting to the enumeration, of its caufes, is not ttye lot only oS the luxurious liver * Since it too often Sorms an addition to the diftreffes of the unfortunate; but never more certainly, than when he Seeks a reSpite Srom his miferies, in the temporary exhilara- tion arifing Srom the abuSe oS Spirituous liquors. The Symptoms accompanying this malady, mark it So distinctly, that there are very Sew who Suffer Srom it, but are enabled to judge of the nature of their complaint. The inconveniences they experience evidently pointing out a weakened ftate of tlie ftomach. When the fymptoms have become fb confiderable as to force the patient to feek for relief, he in general has recourfe to fome heating aromatksyor bitters fteeped in fpirits : the ftomach t>eiri£ ftitmalated by thefe MEDICAL ADMONITIONS. 305 thefe means, a trifling amendment will ijake place ; fome of the fymptoms becoming more moderate, whilft others are even fufpended. This truce will be, however, but of very fhort duration, unlefs more effectual means be employed. To procure an entire removal of the difeaSe, the Stomach muft be cfeanfed of the fordid and ill digefted matters with which it is loaded ; and proper regulations muft be adopted, both as to diet and medicine, to prevent their Suture accu- mulation. If theSe be carefully attended to, the Peruvian bark, bitters, preparations of fteel, &c. may be adminiftered with great probability of effential benefit. The infuSion oS camomile flowers is a medicine which is Srequently employed, with a confiderable degree of fuccefs, in this difeafe ; but owing to a miftake, fometimes made in the mode of administer- ing it, effects are produced, quite oppofite to thofe which were hoped for : the error confifts in the in- fufion of being drank warm, and in a iarge quantity ; by which naulea, and even vomiting, is produced; whereas if taken in the quantity of a tea-cupful, and quite cold, it leffens ficknefs, and increafes. the appetite. To furnilh a plan of regimen, adapted to every constitution and bal?it, is by no means an eafy talk ; fince fome variation will be always required, according to s S9§ * MEDICAL ADMONITIONS* to fhe age and ftrength, as well as the formerihabits bfrAhi patient. But, in general, by Strictly regarding ttotfoiiowmg rules, the cure of the difeafe will beiiafri cele*a^ed, and future attacks of it prevented, ni i 'b1 .3dJn ,, ,bW '5 > > The greateft attention fhould be exerted by the patient, in endeavouring to difcover what circum- ftances prove beneftciftH and what injurious; regulat- ing his mode oS living, in Suture, by the information he thus obtains. l/The circumftances which have been already enumerated, as productive of this difeafe, muft, of courfe, be carefully avoided."10* l 3H™ ,?bpTbIftiI to «n* t ah d^- ho o ir The food fhould be taken in fmall quantities at a time, but with frequency j carefully avoiding the dif- tending of the Stomach, especially with liquids. ^Fat of meat, butter, and all;foily fubftances,, fhould be taken very Sparingly; apd if at all rancid, abstained Srom entirely. Broths, &c. with all^liquid Sood, fhould be fully impregnated with nutritive matter ; and fhould be taken only lukewarm. Fruits,jand vegetables of all kinds, fliould not be ufed, until a confiderable progrefs is made in the cureV ^The vege- table acids, Such as vinegar, lemon-juice, &c. fhould ^be employed with a confiderable degree of caution. B Early rifing, and moderate exercife in the air, par^ ticularly riding on horSeback, will prove exceedingly Serviceable, giving ftrength and tone to the Stomach, m% well as'to the whole fyftem; • V™&m' * °* ,,iiuo But MEDICAL ADMONITIONS^. $97 •. But when it is confidered, that this diSeafe may, if jjot timely removed^ produce hygfochondriaqal, aod Other moft Serious and difixeffing complaints, no odd, furely, who has rt^a his c power, will hefitate, as to obtaining the advice oS the intelligent and Sriendly phyfician. HYPOCHONDRIAC AFFECTION, The hypochondriac is diftinguifhed, in the words of the celebrated Cullen, by—A languor, liftleflheSs, and want of reSolution and activity with reSpeet to all undertakings j a difpofition to ferioufnefs, fadnefs, and timidity ; as to all future events, an apprehenfion of the worft, or moft unhappy State of them; and therefore, often upon flight grounds, an apprehenfion of great evil. Such perfons are particularly attentive to the ftate of their own health, to every the Smallest change of feeling in their bodies; and from any un- ufual Seeling, perhaps oS the flighteft kind, they appreT hend great danger, and even death itfelf. Thofe who are unhappily afflicted by this malady, too frequently become the fubjects of raillery and reproof. The Strange capricioufneSs oS their com- plaints induce thofe around them to SuSpect them all to be, imaginary. This is, however, very far Srom |uri being 558 MEDICAL ADMONITIONS. being the cafe. It is true, indeed, that from the con- ftant attention they are difpofed to pay to every trifling change which arifes in their bodies, and from the apprehenfions with which they are tormented, their account of their feelings may be rather exagge- rated and hyperbolical. But allowing this to be the fact, and even that the moft ridiculous and chimerical diflreffes are imagined by them ; even in that cafe, their Sufferings are Such, that no confiderate perSon will regard them in any other point of view, than as demanding all the folace and relief that friendfhip, attention, and judgment, can beftovv. It muft be cohfeffed, indeed, that much depends on the patient himfelf, and that feveral circumftances imperioufly require of him a confiderable degree of exertion. A fondnefs for frequent and various medicines, he fhould carefully ftrive to reprefs; he fhould feek for a phyfician to whom he can entruft himfelf and his complaints, with Sriendly confidence, and to whofe advice he can pay implicit obedience ; guarding himfelf againft SuSpedting neglect, becauSe his medical friend honeftly avoids to load his Stomach with more drugs than are neceffary. But the grand point, on which all muft turn, is his ready acquieScence in thofe ^other meafures which may be dictated to him, as effential to his recovery. He muft aroufe himfelf from his diftreffing State of liftlefTnefs, and MEDICAL ADMONITION*. 399 and allow himfelf to be difpofed of as his friends may advife, for the purpofe of diverting his attention to other objects than his own feelings. His proper avocations fhould be attended to, fuch arrangements. being formed, as fhall prevent him frombeing/ expofed to too' much anxiety or fatigue. ^» His amufements fhould always be fuch as will af- ford a fufficient degree of intereft ; Such are games of fkill, as cards, draughts, backgammon, and even chefs ; for although the latter demands almoft pain- ful attention, yet it thereby p/events a much more injurious attention to certain other objects. Thefe fedentary amufements fhould not wholly engrofs his hours, but fhould be interrupted by various exercife* in the open air ; Such as bailing, riding on horSeback, driving a carriage, &c. I cannot quit this Subject without again noticing the folly, nay cruelty, of confidering this complaint as dependent on the will of the Sufferer ; and remark- ing, that So far from this being the cafe, this diSeafe particularly depends on the original temperament of body. As welli' therefore, may the peculiar make of the patient be afcribed to him as a crime, as the dif- treffing feelings he experiences be attributed to his caprice. COLIC. .,„Ji yinS 400 MEDICAL ADMONITIONS; COLIC; To the treatment of this malady, domeftic doctref* fes have ioag laid an exclufive claim : family pha»- macopaeias teeming with colic tinctures and elixirs* which, except when compoSed oStoo fiery ingredients* will Srequently produce a mitigation of the fymptoms, and fometimes a cure; To produce this defirable effect, however, thefe medicines muft be employed in pure colic ; and where no inflammation of the interline has taken placed But, unhappily, it is extremely difficult to determine, Whether inflammation be come on, or not: and there is very little doubt, that if this fhould be the cafe at the time of the adminiftration of thefe medicines, con- fiderable injury may be occafioned. Dr. Alexander Monro obferves, " The common practice of taking fpirituous liquors, or the warm carminatives, when people feel colic pains, is often unlucky, and public warning fhould be given againft it; for though relief is found from fuch things in the windy or fpafmodic colic, which is not a deadly diSeafe ; yet they hurry on the inflammatory difeafes fo faft, that they foon prove mortal." * Much * Obfervations, &c. by Dr. A. Monro. Medical and Literary Eflays, Vol. I. MEDICAL ADMONITIONS 401 Much mifchief may indeed be the confequence of tniftaking the fymptoon of pure inflammation of the bowels, or of ftrangulateerTupture, Sor thoSe oS colic. It is not to be wondered at, that domeftic practition- ers fhould be very liable to fail into this error -, fincft confiderabfe attention is required in the exercife of the judgment, in fimilar cafes, by thofe who are well lkUkd in the nature of thefe diSeaSes. This arifpa from the Similarity of the fymptoms belonging to thefe feveral diSeaSes, In colic, the chief fymptoms are, frequent vomit- ings, obftinate coftiveneSs, Severe griping pains over the whole oS the belly, but chiefly about the navel, accompanied by a painSul SenSation of djftenfion j the external part of the belly being, at the fame. time, drawn irregularly inwards. If thefe fymptoms be compared with thofe which were deScribed as the fymptoms of inflammation of tfie bowels, and wi{h thofe which belong to Strangulated rupture, treated of in the next article, the refemblance will be found to be fo great, as plainly to fhew the danger of 2X^ tempting even the alleviation of fuch. fymptoms, without judgment fufficient to difcover their true origin. In thoSe cafes where other affiftance cannot be ob- rained, and where, Srom the Sormer occurrence oS the Symptoms, or Srom other circumftances, thfi4ifef^**s C c c :"r. clearly.! 402 MEDICAL ADMONITIONS. clearly afcertained to be colic, a clyfter may be given, compofed of a pint of warm fat broth, to which may be added a table-fpoonfiil of common fait ; or the fame quantity of gruel with two tablei-fpoonfuls of caftor oil, and a tablerfpoonful of-Soft fugar, If ftools are not thereby obtained, a fpoonful or two of caftor oil may be taken. The belly fhould be fomented with flannels wrung out of hot watqr, and between the times of fomenting may be covered with one of the flannels wrung out as dry as poflible, over which may be laid a large oxes bladder, nearly filled with hot water. If thefe means fail, much circumfpe&ion is re- quired, before any determination is made, as to the next meafure to be adopted ; it being neceffary to alcertain, with as much precifion as poffible, whether inflammation has taken place or not. For fhould the complaint be merely colic, without inflammation, the cure may be accompliflied by fome carminative purging remedy, fuch as fena tea, warmed by the addition of a little fpirits of anniSeed ; but fliould inflammation have come on, not only will every thing irritating be productive of farther injury, but it will even be neceffary to employ bleeding, and that with a confiderable degree of freedom. RUPTUR.ES> MEDICAL ADMONITIONS. 403 RUPTURES, OR HERNLE. The term rupture was adopted when it was fup- pofed, that the difeafe was always the confequence of a rupture.of Some of the parts which form the cavity q£ the abdomen or belly. But anatomical examina- tion has fhewn, that this difeafe, as it moft commonly appears, takes place in confequence of the protrufion of fome of the contents of the abdomen, through openings which are natural to the human body ; and without any rupture, or violent feparation of parts. It will not be ncceflary to defcribe particularly, the Several kinds of ruptures which may occur. It will be Sufficient to obferve, that ruptures generally appear in the groin, in the upper and Sore part of the thigh, and at the navel : but they alfo may occur hi any point oS the Sore part of the belly. ThoSe wl>ich ap- pear, at firft, juft above the groin, will, in general, if neglected, ibon defcend into the fcrotum, in men, and into the labia pudet/diy of women. The turner, in this difeafe, is moft commonly formed by a part of the inteftinal canal, or of the omentum cr caul, or of both. In thofe ruptures which are capable of cafv re- duction, as foon as preffure is properly made, the protruded inteftine generally flips up, all at once, with a kind of guggling noife, and the tumour imme- diately 404 MEDICAL ADMONITIONS.* diately fubfides : where the tumour has chiefly been fbimed-by omentum, that paffes up more flowly, and without that particular noife which-accompanies the return of the interline, dot -:w ■liiv *n^ ''fr In thofe cafes of rupture, where Stricture has taken place on the protruded parts, and the reduction is thereby rendered difficult, the belly becomes tenfe and painful, the pain of the belly, as well as of the t tumour itfelf, being much increafed by theal leaft ex- ertion ; a total Stoppage of discharge by Stool takes place, and the patientjs diftreflfed by a ficknefs at the ftomach, which increaSes, until almoft conftanf: retch- ings add to his Sufferings, Having called your attention to thefe two States of ruptures, with or without Stricture, I will now point out that information refpecting them, of which I am convinced that every one ought to be poffeffed, In thofe ruptures which are eafily reduced, the mind of the patient fhould be imprefTed with the conviction, that, in general, and particularly where the difeaSe is recent, it will depend entirely on his own choice and reSolution, whether he ever Suffer from it any ferious inconvenience, or not. ,nHe ma/ atfiire himfelf, that from the moment the parts are reduced, he has it in his power constantly to retain them in their.natural> fituation j and that, if he neglects to do "y,l this MEDICAL ADMONITIONS.' 48 lie . But parents fhould be apprifed, that an ulceration juB of MEDICAL ADMONITION*. 413 cf this part, much more dangerous and iingwjemable, fometimes takes place, in children where a Confidera- ble degree of debility is manifeft. In thefe cafes, if the moft effectual means are not eariy employed, the child will moft probably be loft ; and, indeed, in many caSes witneffed by Dr. Underwood, in which, oS courSe, all that Science could Suggeft was adopted, the ulceration Spread over a great part of the belly, and even mortification enfued. CHOLERA. In the diSeaSe thus named, the patient is harraffed by almoft conflant vomiting and purging ; bile ap- pearing to exift in a confiderable proportion, in the matters thus discharged. In general, the patient is alfo diftreffed with Severe griping pains oS the bowels, SpaSmodic contractions of the muScles oS the belly, and extremely painful cramps in the muScles of the extremities, In thofe cafes where the diSeafe is only in a mode- rate degree, where the patient is ftrong, and oS a middle age, and no. very confiderable diminution oS his Strength takes place, there exifts little or no danger. The Sree ufe oS diluting drinks, as gruel, broths, &c. will, in general, prove Sufficient to procure the return of health. But 414 MEDICAL ADMONITIONS. But when the diSeafe comes on with great violence; occafioning faintings, cold fweats, coldnefs of the ex- tremities, and a fudden exhauftion of Strength, the patient ma\ be concluded to be in a moft perilous ftate : life depending on the immediate adoption of the moft vigorous meafures. Young" children, per^ Sons advanced in years, and thoSe who have been re- duced by preceding diSeaSes, muft be attended to with the uimoft care and vigilance; fince, in the courfe of two or three hours, the difeaSe, if unreftrain- ed, may fink them So low, as hardly to leave a poffi- bility of their recovery. When marks of leflening ftrength are evident, the moft ftrenuous exertions muft be made Sor their Support; by Sreely adminis- tering, in Small quantities at a time, ftrong beef, chicken, or mutton broths, deprived of their fat; gruel, made into white caudle, by the boiling in it ginger, allfpice, and whole pepper, and adding, to it a proper quantity of Spirits : and procuring that medi- cal aid which Symptoms So imminent muft require. DIARRHCEA, OR LOOSENESS. It may be Sufficient, for the purpofe of fhewing the impombihty of giving fuch directions, as may enable domsftic'practitioners to take on themfelves the cure of this difeafe, to point out the various cir- cumftances MEDICAL ADMONITIONS. 41$ cumftances on which it may depend. A diarrhoea may be occafioned by too great a quantity of aliment being taken into the ftomach ; by the peculiar nature of the food which has been taken ; by the digeftion ' of the food having been impeded in conlequence of the weaknefs of the ftomach and bowels ; by various paffions of the mind ; by difeafes of other parts, or of the general fyftem. Many other caufes might be enumerated, but thefe are furely lufncient to (hew the propriety of not attempting to lay down here, a plan of treatment applicable to every cafe. One caution is however neceffary, againft tlie too prompt and indiscriminate employment of purgative medicines, in the onfet of the difeafe. Believing it never to originate, but in the irritation occafioned by fome matter, which, they fuppofe, cannot be too rapidly removed, thofe who fuffer from this difeaSe, generally, have immediate recourfe to Some active purgative, to expedite the falutary procefs which they fuppofe nature to have instituted. But it will Srequently happen, that fo Sar Srom accelerating the cure oS this malady, Such medicines will, by their additional irritation, prove highly pernicious. Nutritive drinks fliould be taken freely, Such as broths, gruel, &c. : but beyond the employment of theSe the patient fhould not proceed ; unleSs he is able clearly to akcitain the cauSe on which his com- plaint depends. DIABETES. MEDICAL, ADMONITIONS* DIABETES. % The Symptoms of this diSeaSe are here enumerated merely to excite thofe who Suffer Srom it, to attend to it in its early ftages, when, of courSe, it muft be moft likely to be within the reach of medicine. In this difeale, the urine is voided in a quantity unufually large, the tongue is white and Soul, and the patient is tormented with exceffive thirft. The urine, when viewed in a certain direction, has a green- ilh hue ; and, on being evaporated, yields a, large proportion of faccharine extract. A powerful inducement to thofe who are Subject to this malady, to make early application for relief muft ariSe Srom the knowledge that an ingenious phyfician, who has particularly attended to the nature oS this diSeafe, which has hitherto been efleemed So difficult oS cure, concludes that it is now «fofar underftood, as to be fuccefsfully cured." * HYSTERICAL ■ m - * An Account of two Cafes of Diabetes Mtllitus. By John Rollo, M. D. MEDICAL ADMONITIONS. 417 HYSTERICAL AFFECTIONS. As theSe are, in general, fymptomatic oS Some other difeaSe ; and moft commonly, perhaps, oS Some particular affection of the uterine Syftem, the rules for their treatment can only be formed, upon a knowledge of thofe particular circumftances to which they owe their origin. .✓ The management of the patient during the ftrug- gles oSan hyfteric fit, or paroxySm, may be directed by the principles laid down when treating of epilep- tic convulfions. Suppreffion, or irregularity of the menftrual dif- charge, is very frequently the caufe of hyfterical affections. Indeed, So obvious is this cauSe, that a cure Sor theSe morbid affections is generally Sought for in fome noftrum, celebrated for its powerful ef- fects. But a few words on this practice cannot but be beneficial. That the moft injurious confequences may follow from the indifcriminate ufe of thefe violently forcing remedies, muft plainly appear, Srom ftating only one affumed cafe. A delicate female, from fome acciden- tal caufe, Suffers a Suppreffion oS the accuftomed dis- charge, the whole Syftem Soon becomes affected, E e e neither 4i8 medical Admonitions: neither digeftion oSthe Sooct, nor the uSuai converfion oS aliment into chyle and blood, takes place to the required degree ; and hence a State of extreme debili- ty enfues, plainly marked by a deadly paleneSs, dejec- tion of fpirits, and a conftant difincfination to motion; or rather, I Should Say, for the fake of leflening the too frequent, falfe imputations of indolence, in thefe cafes, almoft a deprivation oS the powers of motion. In fuch a cafe, what muft be the conSequence* fhould thefe medicines, by their violence, occafion a reftora- tion oS the menftrual difcharge, without, at the Same time, producing an augmentation oS ftrength ? Moft certainly an increaSe oS weakneSs and oS all its atten- dant evils. DROPSY. In Anafarca, a Serious fluid is collected in the cellular texture under the fkin. By Afcites, is meant dropSy of the lower belly. And by Hydrotho'rax, a preternatural collection of ferous fluid in the cheft. So numerous are the cauSes on which this diSeaSe may depend, and fo various are the diSeaSes Srom which it may originate, as to preclude a hope of ren- dering any Service by their enumeration, and to render the laying down a general plan of cure impoffible. A detached obfervation or two oh the noftrums generally MEDICAL ADMONITIONS. 419 generally employed in this-difeafe, is all that appears to be neceffary here. To cure the dropfy without tapping, is the promife of many pretenders, to whom the lives oS perSons afr flicted with this malady are Submitted. But, in general, So violent are the remedies they employ, and So ralh is their mode of administering them, that fliould they even make good their promife of remov- ing the dropfy, it is moft probable that So much weakneSs may be produced, that the patient will not long Survive. 1 very lately witneffed a caSe of confirmed dropfy of the belly, in which the patient was perfuaded, by a domeftic practitioner, to take a ftrong infufion of the fox-glove ; much Stronger than any phyfician would have dared to prefcribe. The dropSy was re- moved, Sor a time ; but the diSeafe oS the vifcus, from which the dropfy proceeded, Still remaining, the water again collected ; and inceffant vomitings and purgings, produced by the fox-glove, added confidera- bly to his Sufferings, and at length deftroyed him. HYDROCEPHALUS, or WATERY HEAD. No one, furely, can hefitate for a moment, in be- lieving that the treatment of this melancholy difeafe ought 4&P MEDICAL ADMONITIONS." OJIght only to be confided to the moft judicious and experienced'. I fhall, therefore, only mark out thofe fymptoms which ought to aroufe the attention of the parent, and occafion him immediately to call in the moft powerful aid, and point out Some circumftances, by an attention to which this malady may, perhaps, be Sometimes prevented ^ This difeafe generally occurs within the firft ten years of life. Sometimes the complaint comes on fuddenly, but in general it commences with a flow fever, and is indeed accompanied, in its beginning, by fuch fymptoms as to render it very likely to be mif- taken for an attack of the flow nervous fever. Soon, however, the difeafe is rendered more manifeft, by a difincfination to employ the mufcles on which volun- tary motion depends. The arms and legs arc moved with reluctance, and the fatigue of preferving the "body in an erect pofture is Such, that the patient is always defirous oS being laid down : the pain in the head is more conftant than in the low nervous fever ; and the heavinefs and dulneSs 'more evident : the t PulSe is aJSo uSually very flow and irregular. As the diSeafe proceeds, the pulfe becomes quicker ; the , chilcVs fenfes and faculties become evidently impaired, the fight particularly Sails hijri, objects appearing ex- ceedingly ipdiftinct, and the pupils. of the eyes are .conftantly dilated. Towards the^Me of this melan- MEDICAL"* ADMONITIONS.' ^Uk choly Scene, the urine and ftools are pan^d involunta- rily ; total blindneSs comes on, and a fatal'teftrrmafkfli takes place while the patient lays in a comatofg ftate, or whilft agitated with Severe convulfions. This diSeaSe may be the confequence of an original weak habit of body, of various other affections of thp brain, and of other difeafes which have induced a confiderable degree of debility of the whole fyftem. But one caufe, and that perhaps a very frequent one, more particularly demands here a few words. This caufe is a violent concuflion or jar of the head from blows or falls. When the numerous accidents, to which children are expofed, are confidered, to- gether with the delicate texture of the brain, it becomes really a Subject oS SurpriSe that this Ihocking calamity does not more Srequently occur. It however happens with Sufficient Srequency to warrant the moft zealous exertions Sor its prevention. On this head it will not be Sufficient to Say, that care fhould be taken that children fhould not be unneceffarily expoSed to injury.-----Parents moft ■• excuSe the Suggestion, as it is made with a hope that it may prove beneficial.-----The correction oS chil- dren, performed in the moment of paffion, is not rr always within thoSe bounds which the parent would the. moment before, or after the infliction oS the punilhment, 42i MEDICAL ADMONITIONS; punifhment, himfelf have defcribed. A box on the ear, as it is termed, or a fevere blow on the head with the open hand, is the moft ready punifhment, ■ and therefore moft generally adopted, when petulence or paffion impels to an immediate correction. But when I confider the tender Sabric of the brain, and alfo that a blow fufficient to give the intended degree of pain to the delinquent cannot be inflicted without giving a confiderable jar to the head, I muft SuSpect it to be a mode of correction highly improper, and which may poffibly occafion this dreadful malady. The observation I now fhall make, I am aware may appear to many to be bordering on Srivolity j but Satisfied of its real importance, I fhall, without apology, introduce it. To endue children with hardinefs and caution, it has been recommended, rather than fmooth the way for them, to render it more replete with obftacles ; and rather than Shield them from the little injuries they would Suffer Srom their trips and Stumbles, to let them Seel their con- Sequences ; that the difficulties they overcome, and the pain they Suffer, to-day, may Surnifh. them with courage and circumSpection to-morrow. The princi- ple is certainly good, therefore I propoSe not to com- bat with it, but with a practice which has arifen Srom its improper extenfion. I mean that of neg- lecting to guard the head Srom the injuries to which it MEDICAL ADMONITIONS. 4*3 it is Subject, Srom thoSe accidents to which children are So Srequently Subject. It was the -good practice oS parents, a Sew years back, to Surround the head with a circular quilted pad, covered with Silk, which, though not very ornamental, had no very forbidding appearance, and muft Srequently have Saved children from confiderable injuries of. the head. I am fo con- fident of this fact, that I cannot refift the impulfe of moft earnestly propofing their adoption to the affec- tionate parent. THE BITE OF AN HYDROPHOBIC ANIMAL. When the fhocking effects fometimes refulting from this injury are confidered, and the uncertainty of fuccefs arifing from the employment of fuch medicines as have hitherto been tried is alfo contem- plated ; the propriety of endeavouring, in this place, to excite every one to the prompt adoption of the only means of obtaining fecurity, will, I think, be manifeft. From the abSorption of the Saliva, conveyed by the teeth oS the animal into the wound he inflicts, is the' hydrophobia SuppoSed to proceed. The more fpeedy and the more complete its removal, the lefs chance is 424 MEDICAL ADMONITIONS. is there for abferption. Confequently, in every cafe of bite from an animal, in which there is reafon to fuppofe hydrophobia exifts, the piece fliould be im- mediately cut out ; So careSully including, even the parts immediately Surrounding the wound, both at the bottom and fides, that a probability fhall not exift of the kniSe's coming in contact with the wound made by the animal. For fhould this be the caSe, not only would the excifion be incomplete, but the knife itSelf, imbued with the poifon, would ferve to multi- ply the infection. The carefully wafhing the wound by repeated ab- lutions with warm and cold water, and the application of a cauftic to the part, have been recommended; but when our endeavour is to obtain an exemption' from fuch a terrific difeafe, no apprehenfion of mo- mentary Suffering fliould induce us to adopt thofe meaSures which obvioufly do not rank as firft, in the probability oS being Succefstul. SCALD HEAD Is a diSeafe in which little ulcers form in the fkin, at the roots of the hair, pouring out a difcharge, which generally dries on the part in a hard white cruft. Sometimes the difeafe fpreads over great part of tlie head, and jthe difcharge is fo confiderable as to keep MESCAL ADMONITIONS*. '" 425 keep'the diSeaSed parts in a moift State. When this is the cafe, the fcalp affnmes an honeycomb appear- ance. This diSeaSe is communicable by contact, and it is often the confluence of want of attention to clean- linefs. It is alfo fuppofed to be a fymptom of {cro- fula. The cure of this difeaSe fhould be attempted in this manner. The hair fhould be removed Sreely by (having j if the diSeaSe fhould be extenfive, the whole head fhould be fliaved ; but iS it is So flight that the removal of a part is Sufficient, the remainder fhould be carefully cleanSed by wafhing with ftrong Soap-Suds. The fbres themSelves may be rubbed with the unguen- tum hydrmrgyri nitrati of the (hops ; or with an oint- ment compoSed of one part of the powder of white hellebore, two parts of flour of fulphur, and as much tar as will make it into a due confiftence. When the hairs feem to be loofened, they fhould be pulled out; and this appears to be belt done by the application of fome adhefive plaifter, which, on its removal, will bring the hairs with it. A fubmiffion to this un- pleaSant and painSul proceSs is often neceffary to obtain a cure. Although I have here flightly fketched a mode of cure of this difagreeable malady, I muft yet remark, F f f that 426 MEDICAL ADMONITIONS. that it is a diSeafe So important in itfelf, and fo muc{* more fo in its confequences, as to render its early re- moval highly neceffary : regular chirurgical affiftance fhould thereSore, iS poflible, be obtained. I have already mentioned its being efleemed one of the Symptoms oS Scrofula ; but I fliall trouble you with one or two obfervations more on this point. When the unfortunate Sufferers under this malady have been Subjected to it Sor a little time, an enlarge- ment oS the glands on the fides of the neck generally ? takes place. This alfo being efleemed one of the Symptoms of fcrofula, it is in general fuppofed that the patient was originally fcrofulous, and that the Scald head was the firft manifestation oS the difeafe. But here I venture, with the utmoft deference to the authorities I oppofe, to fuggeft, that Scald head may not be a fymptom oS fcroSula ; and that, in many of thefe cafes, the enlargement of the cervical glands may be only the confequence of the irritation of the \ abforbents originating in the difeafed parts ; and that ScroSula may only Succeed where this irritation is ' long permitted, and where the Subject is unSortunate- ly predifpofed to this diSeafe. I fhould not have agitated this queftion, in fuch a work as this, a work pretending to no originality, but with a hope oS drawing Such a concjufion as may "prove of real ufe. From the foregoing obfervations, then, ■■.'. ' MEDICAL ADMONITIONS. 4*j? theti, it muft appear, that if the difeafe be removed at its firft appearance, the fwellings of the glands of the neck, the more ftrong characteristics oS Scrofula, may not appear ; that if thefe even" have appeared, they will difappear if the original difeafe be timely removed; and that, on the contrary,, where the original difeaSe has been allowed to exift long, the glands of the neck will become diSeaSed, and this Secondary affection may extend itfelS through the greater part oS the lymphatic Syftem : the fcald-head, in conSequence oS neglect, having become the cauSe, at leaft the exciting cauSe, of fcrofula. The importance of an early and judicious oppofi- tion to this difeaSe, muft, Srom the above considera- tions, be obvious. I have, therefore, only to repeat, that it is a contagious difeafe ; and to recommend, that, on its appearance, thofe whom it attacks fliould be carefully feparated from other children. THRUSH. Aphthous ulcers in the mouth Seldom happen to grown perSons, except Some confiderable diSorder of the fyftem exifts at the Same time, or has juft pre- ceded. In children they occur very frequently, and even at times when the child appears, in other re- Spects, 4iS MEDICAL ADMONITION*. ipects, perfectly well. Improper food h perhaps a principal canfe of their occurrence, finccthofe children who are robbed of their natural food, and crammed with mixtures of bread and water, &c. which are often given! jnuch too hot, feem much more difpofed to this complaint, than thofe children, whofe mothers have it in their power, and are difpofed, to fupply them with the food! which nature has appointed for them.* Breathing * The thrufh almoft always affects thofe children who are attempted to be dry-nnrfed. Gripings, conftant diarr- haca, rapid wade of ftrength and of flefh, are almoft the certain harbingers of Speedy death to the poor little victim, doomed to perifh Sor want* of that nutriment which nature had defigned and bounteoufly provided. " Connubial Fair ! whom no fond transport warms, To lull your infant in maternal arms ; Who, blefs'd in vain with tumid bofoms, hear His tender watlings with unfeeling ear ; .•' The foothing kifs and milky rill deny To the fweet pouting lip, and glift'ning eye !— Ah ! what avails the cradle's damafk roof, The eider bolfter, and embroider'd woof ! Oft hears the gilded couch unpitied plains, And many a tear the taflal'd cuftiion ftains ! No voice fo fweet attunes his caies tD reft, So foft no pillow as his mother's breaft !" Darwin. To fuch of my fair readers who arc difpofed to liften to the voice of admonition, on this important ftibjeft, I earneft- ' 1 j recommend the perufal of the charmiiig poeto of Tn* .Nvjtsf, by-Mr. Rofcoe. MEDICAL ADM0W1TI0S*. 4*9 3roath«pg the confined and impure air of th* bed and fccd-room, during the month, where dee attention to cJeanlinefs a&d ventilation is not attended to, may be another canfe -of rJiis difeafe. A difordered ftate of the ftomach and bowels may alfo be confidered as a caufe of the thrum- Unlefs the caufe of the difeafe can be afcertained, there will be very little probability of adopting a fuc- ceSsful mode of treatment. Enquiry, therefore, muft be made into the kind of food with which the child is fupported. In general, this will be found to be imFaPer» ^ not fufiiciently nutritious : this fault muft be therefore corrected ; the child muft be al- lowed to breathe a purer air, and particular regard muft be paid to the ftate of the bowels. As this dif- order may depend on So many different circumftances, it is not poffible to point out here the medicines which will be required. But I cannot allow this opportunity to paSs without calling the attention of parents to .the cruel practice, frequently adopted by nurfes, of cleanfing the mouths of children afflicted with the thrum, by rubbing the infide of their mouths roughly, with a piece of linen cloth wrapped round a piece of Slick, ancl dipped in a mixture of Armenian bole and honey. Whoever has wit netted this opera- tion, muft b&ve perceived that it has occafioned the little Sufferer yery con&lerable, pain ; and a very little ;;H .1 confideration 43° MEDICAL ADMONITIONS.' confideration will Serve to convince, that the pain thus inflicted is unnecefTary. The aphthous fores which conftitute the thrufh are filled by gangrenous floughs, thefe either adhere to the living parts, or are feparated from them. If the former be the caSe, there is very little likelihood that the floughs will be re- moved by friction, however Severely employed : if, on the other hand, a Separation have taken place, no Sorce is neceffary Sor their removal. In both caSes, it is entirely Sufficient, that whatever applications are reSolved on, fhould be of a tenacious confiftence, and be put into the child's mouth from the end of a tea- Spoon ; the action oS the child's tongue, which neceffarily follows, being quite Sufficient for the dif- fusion of the remedy, and Sor its application to the affected parts. SWALLOWING OF PINS, &c. Children, Srom their being playfully diSpoSed to put various Subftances in their mouths, are liable to have hard and fharp pointed Subftances paSs into the gullet, and even into the ftomach. By the Silly practice oS putting pins, &c. into their mouths, adults are alfo expofed to the fame mifchiefs. Pieces of bones, griftle, &c. Sometimes ftop in the gullet, and afford confiderable diftrefs ; but thefe may in general be MEDICAL ADMONITIONS* 43'L be Speedily, removed by a piece oS whalebone, to one end of which is affixed a button of Sponge. If a pin, or any other lharp-pointed Subftance, fliould ftick in the gullet, beyond the reach of the foreceps or nippers, it is indeed a cafe which calls for the utmoft exertions of patience from the unfortunate Sufferer, fince it will in general be Sound much better to wait the Spontaneous looSening of the fubftance, which may happen much fooner than could be ex- pected, than to rifque additional injury, by employing the means ufually recommended, which are the paffing of the fponged probe, and the adminiftering of a vomit. Unhappily the pofition of the pin, for in- stance, cannot be known, and it is not at all unlikely that the preffure of the fponge, or the urgings to vomit, may more deeply infix the point. Farther, it may be obferved, with refpect to an emetic, that fhould the patient unhappily, during the firft urgings to vomit, experience exceffive pain, from which it is concluded that the pin laying acrofs the throat, every exertion ferves to fix it deeper,"we are obliged to wit- nefs this addition to his Sufferings without affording relief, not having it in our power to ftop the vomit- ing, until the ftomach is cleared of the emetic. It is too prevalent: a practice, when any Subftance of this kind has paffed into the ftomach, to endeavour to haften its paffage through the bowels, by giving fome 452 MEDICAL ADMONITIONS. Some opening medicine. Juft the contrary conduft to this fliould be adopted. Milk, alone, or mixed with eggs unboiled, fliould be immediately taken, as by the coagulation which takes ptace» the fubftance may become So involved, as to prevent its doing injury to the ftomach.; and on the fame principle fhould opening medicines, which render the fasces thin, be avoided ; as, by allowing the fasces to obtain Some firmnefs, there will be the greater probability of the pointed parts of the Subftance being So ftieathcd, as to prevent them injuring the interlines. BOIL. A boil is a circumScribed hard tumour, exquifitely SenSible, Spreading below the SurSace, and rifing very little above the level oS the fkin. Its fize is in general about that of a pigeon's egg. After it has exifted a Sew days, a trifling discharge oS matter iffues Srom a Small opening in the moft prominent part of the tumour, a flough remaining at the bottom, which is, in general, a confiderable time before it is fepa* rated. Boils, unlefs they are very large, and happen in debilitated conftitutions, although productive of con- fiderable pain and inconvenience, are without danger, and MEDICAL ADMONITIONS.. 433 and will often do well without chirurgical aid ; but, in general, the cure will be accomplished much Sooner, and the patient Spared much inconvenience, by a Sree opening, and other affiftance, which cannot be well obtained but from the hands of a furgeon. In general they may be brought into a good ftate, by the application of warm fomentations, and emolli- ent cataplafms : when a tolerable opening is obtained, the ulcer may be drafted with any mild digeftive ointment; and in general the cure will be completed without much difficulty. Attention muft alSo be paid to the general ftate of the fyftem ; fince iS that particular ftate on which they depend is not changed, the patient may be harrafTed Sor a confiderable time, by their making their appearance in different parts of tlie body. With the hope of producing this change, domeftic practitioners, in general, adopt a practice which muft oSten prove very injurious : that oS put- ting the patient under a long courSe of draftic purga- tives. That this practice mult often be Succeeded by ill conSequences, muft be evident, when it is con- fidered, that the greateft benefit to be obtained in fuch caSes is Srom the uSe of tonic and Strengthening remedies, Such as the bark, Sea bathing, &c. G g g ANTHRAX, 434 MEDICAL ADMONITIONS. ANTHRAX, OR CARBUNCLE. At its commencement, anthrax has much the ap- pearance oS a common boil, but it foon puts on ap- pearances which point out the malignity of its nature: the redneSs and hardneSs extend themSelves very wide, although the tumour is raiSed but very little above the level of the fkin ; Small pufUes come out on the SurSace, which have the appearance oS being only Superficial, but the openings which they leave evident- ly reach to the large Sphacelated baSe which pofTefTes the place of the cellular membrane ; about the middle of the tumour the colour is of a deep crimfon, inclin- ing to purple, becoming paler and mottled toward the circumference ; the furrounding integuments are generally found by preffure to be in an ©edematous ftate. Several of thefe fometimes appear at the fame time ; but moft commonly a fingle one occurs, which Spreads to a great extent. The Cure of Anthrax. By the exertion of j a fkilful furgeon, and the moft fcrupulous exactnefs : jn purfuing his directions, this terrible difeafe is fome- times cured ; but the ftate of the body which exifts is fuch as muft always render the event highly to be , feared,. To treat, in this work, of the chirurgical treatment of this difeafe, would beprefumptuous and ufelefs -, MEDICAL ADMONITIONS. 435 ufelefs ; fince it is of too ferious a nature to admit of the friflings of family practice. A confiderable op- portunity, however, always offers itfelf for the friends of the patient to evince their zeal, and affift in the cure : Sor So much affiduity is required, in adminis- tering proper cordials and nourifhment, that it ought hardly ever to be entrufted to the care cnly oS an hired attendant. From their great Similitude at their firft appearance, there is much reaSon to Sear, that the carbuncle, at its commencement, is oSten miftaken Sor a common boil—a miftake which may be productive oS the moft dangerous conSequences, fince in carbuncle the ex- ertions Sor Saving the patient muft be very confidera- ble and unremitting : the treatment which is ordi- narily adopted Sor a common boil, would, thereSore, allow the diSeaSe to make Such a progreSs, that art might afterwards be of no avail in endeavouring to fave the patient. INFLAMMATION AND ABSCESS OF THE BREAST. Inflammation of the breaft may be judged to have taken place Srom heat, redneSs, and pain, poffeff- ing a part or the whole oS the breaft. When the diSeaSe 436 MEDICAL ADMONITIONS. difeafe is confiderable, it is ufually preceded by a fhiver- ing, and accompanied by fever. The milk continu- ing to be fometimes fecreted into the breaft, without any difcharge of it being obtained, the breaft neceffa- rily becomes tenfe and heavy. The inflammation of the breaft may happen without being able to aScertain any caufe. But, in general, it may be traced to one or the other oS theSe cauSes— expofure to cold, repreffing the diScharge oS the milk, or external violence, To remove this difeafe by reSolution, the means fhould be had recourfe to in the early part of the difeafe. When, if the difeaSe exifts in a very con- fiderable degree, blood may be taken Srom the arm, in a quantity proportionate ; but, in general, large bleedings are not required in the cure of this difeafe, the lofs of fmall quantities by topical bleedings generally proving fufficient for the intended effect. Gentle purgatives are proper, and a preference fhould be given to fuch as contain fome of the neutral falts in their compofition, fince thefe will alfo tend to increaSe the difcharge of urine. To leffen the fecretion of milk, no more aliment fhould be taken, than may be juft fufficient to Support the ftrength oS the patient. To promote the abSorption oS that which is Secreted, the breaft may be Srequently bathed with camphorat- ed oils, ufing, at the Same time, a moderate degree of preffure. MEDICAL ADMONITIONS. 437 preffure. To leffen the ill effeds refulting from its tenfion and weight, the milk may be drawn at proper intervals, and the breaft fufpended by means of proper bandages, and the increaSed action oS the inflamed part be leffened by the uSe of proper cooling appli- cations. If the inflammation does not fcem likely to be difperfed, but fuppuration appears to be advancing, recourfe muft be had to warm and emmollient fer- mentations and cataplafms. AbSceffes, in the breaft in general do very well, when allowed to break fpon- taneoufly -, but there are many caSes, where the affiftance oS the Surgeon prevents numberleSs incon- veniences, and very much accelerates the cure of the diSeaSe. The inflammation may be either outwardly, in the integuments, or it may poffeSs the centre of the breaft. Much need not be faid to make it believed, that the latter is much the worft caSe, and requires.the greateft exertions Sor its removal.' Frequently, however, in thofe cafes where the patient has been Satisfied with the affiftance of feme Samily practitioner, fhe will be under the necetlity, at the conclufion oS the diSeafe, to have recourfe: to a regular furgeon, for the removal of a difagrctfable hardnefs, which often continues for fome time after the 43$ MEDICAL ADMONITIONS. the inflammation has ceafed ; which, although it is not of the fame nature with Scirrhus and cancer, will often require the greateft fkill to afcertain its moft proper mode oS treatment. CHILBLAINS. A chilblain is an itching and painful Swelling, produced by the action of cold, fometimes terminat- ing in ulceration. Tumefaction, rednefs, and itching of the part, are the firft marks which denote the coming on of chil- blain, The Swelling aSterwards extends beyond the redneSs to the furrounding parts, which, upon preffure, will generally be found to be in an cedematous ftate ; the rednefs gets darker, until at laft it becomes of a deep crimfon* or even of a livid colour ; the itching increafes to fuch a degree, as to become almoft intole- rable, and is accompanied with aching pain. If the mode in which the complaint is treated does not prove equal to the removal of the difeaSe, it may con- tinue, nearly in the Same ftate, for a confiderable time, or may terminate in ulceration. Before this happens, the complaints increafe, and a blifter filled with bloody water arifes, after the breaking of which, a foul painful ulcer fucceeds, which, if not properly treated, will MEDICAL ADMONITIONS. 439 will extend itfelf, both in depth and width, affecting the tendons, and even the bones themfelves. Children, and young perfons who ufe but little exerciSe, are moft diSpoSed to this complaint, which generally comes on with the winter, and, iS powerful remedies are not had recourSe to, will continue until the return oS mild weather. ThoSe who have once Suffered Srom this diSeafe are obServed to be much diSpoSed to a return of the complaint in the fucceed- ing winter. When this difeafe is only in a trifling degree, there is no neceffity for application to a furgepn ; the reme- dies afforded by domeftic medicine are here frequently fufficient. To Strengthen the veffels of the part, So that by their action the blood, which Seemed to be ready tP Stagnate, may be propelled through them, is the chief principle which fhould regulate the mode oS treat- ment. With this view, the parts affected fhould be frequently rubbed with the naked hand, or with flannel; as much exerciSe fhould be uSed, as the ftate of the difeafed parts will allow ; and if there be no fore, ftimulating medicines, fuch as camphorated Spirits, Spirits of turpentine, warm fomentations, plaif- ters, &c. fhould be applied to the parts affected. Sudden and confiderable changes from cold to heat fhould 44° MEDICAL ADMONITIONS. fljoukl be avoided ; and, laftly, the parts fhould be defended. Srom the action of cold, by coverings of fucj^ fubftances as are known to have but little power in conducting heat, fuch as flightly woven woollen and cotton, wafh leather, which is loofe in its texture, and downy on each fide. When the chilblain becomes ulcerated, the ulcer muft be treated according as its appearances ma^ indicate, it being impoffible to lay down a mode of treatment which ought to be adopted in every cafe, fince the part affected is capable of putting on all the varieties of ulcers from other caufes, and confequent- ly may demand, in fome cafes, a different, or even an oppofite treatment, to what it may require in others. To prevent this difeafe, early recourfe may be had to the means above recited for its cure, efpecially fo far as refpects exercife, friction, and preventing the action of cold. WHITLOW. The Whitlow is an extremely painful inflammatory tumour, poffeffing the end of the finger. One .-fpecies of this complaint begins with a con- vertible burning pain ; but the fkin foon4 becomes elevated MEDICAL ADMONITIONS. 44* elevated around the nail, and the whole end of the finger, and becomes filled with a fanious liquor; the cuticle and contained fluid appearing almoft trans- parent. Another fpecies has its Situation much deeper than the former, the inflammation attacking the tendons and ligaments, and the intervening cellular membrane. The pain, at the commencement, and during the progreSs of this fpecies, is much more violent and throbbing than that of the former fpecies ; the pain being felt over the whole hand, and oftentimes even along the arm ; both the hand and arm, in fuch cafes, becoming confiderably fwelled. The fuppuration proceeds extremely flowly ; and when the matter is formed, it is So deep Seated as to be a confiderable time before it makes its way to the furface. By the violence of the pain, fever, delirium, and convulfions are fometimes produced j the whole nervous fyftem fuffering fuch a derangement, that instances are known where death itfelf has been occafioned by this malady. Abfceffcs frequently form along the courfe of the lymphatics, even as far as the arm-pit. The tendons Suffer Srequently So much, that the fingers become ftiff and immoveable ; the bone alSo Sometimes SuS- tain» So great a degree of injury, as to render the H h h amputation 442 MEDICAL ADMONITIONS.1 amputation of at leaft the laft joint of the finger, neceffary. Whitlows may be produced by external injuries, fuch as a puncture, bruife, or flight wound. There have been many inftances of the worft kind of this difeafe immediately fucceeding to the moft trifling and Superficial punctures ; but they happen moft fre- quently from fome internal caufe, or, at leaft, from caufes that cannot be afcertained. In the firft fpecies, no application is preferable to that of a bread and milk poultice : the tumour be- ing opened, when in a proper ftate, a continuance of the Same application will generally Soon complete the cure. In the other Species, as early an application as poffi- ble fhould be made to a Surgeon, fince this malady will require every poffible exertion to prevent the oc- curring of thofe evils above mentioned. Sometimes, indeed, when the difeaSe is Seated in thoSe parts which are in immediate contact with the bone, the injury is communicated to the bone itSelf, in So early a Stage oSthe diSeafe, that it may be impoffible tor the moft fkilful Surgeon to Save the diSeaSed bone. SCIRRHUS MEDICAL ADMONITIONS. 443 SCIRRHUS AND CANCER. The parts which are moft commonly affected by this diSeaSe are the breafts of women, the arm-pits, noftrils, tefticles, uterus, rectum, Scrotum, &c. A fcirrhus in the breaft commences with a very fmall, hard, and moveable kernel, which often re- mains a confiderable time, without pain, and without increaSe oS magnitude ; but, after Some time, it in- creafes, both in Senfibility and Size. A flight tingling alSo takes place in the part, and this gradually in- creaSes, until it terminates in a painSul SenSation, which at length becomes acute and lancinating. The tumour, as it increafes in magnitude, becomes more fixed, and more irregular in its figure. The veins which run juft under the fkin, are enlarged, and the fkin itSelS gets diScoloured in feveral parts ; a fluid is discoverable underneath thefe diScolourations, which exudes, when ulceration takes place. The ulcerations which Succeed are very irregular in their figure, and -----but why proceed in the description oS this dread- ful calamity ? Sufficient muft have been Said, to have furnifhed information to fecure its detection at its firft appearance ; and but little more, I hope, need be faid, to. fully prove the neceffity of a refolute fubmif- fion to its early removal. The 44$ MEDICAL ADMONITIONS. The hope of exciting in the unfortunate fuffere* the degree of cotrrage required to get rid, at firft, of an evil, which becomes dreadful by Sufferance, will induce me to employ the greater part of this article en that important object. 4 ' This difeaSe I have already deScribed as commen- cing with a very fmall kernel, ■■■If, upon a proper ex-; amination, which, immediately on its diScovery,fhould be Obtained, this fmall kernel be afcertained to be a true Scirrhus, the patient fhould confider, that nothing but its ■ fpeedy removal, by the kniSe, can be depended on, to prevent its termination in eancer. It fhould alfo be confidered, that during this State of the difeaSe, the operation is comparatively trivial, and requires but very little time Sor its performance; that the pain which accompanies it is very Sar fhort of that which is imagined ; and that the exemption Srorn future diSeafe is rendered, by it, almoft certain. It is worthy of remark, that the oppofition to this, and indeed to every operation, does not proceed .fimp- Jy,from the dread of pain ; but from an affociation pf the moft horrid ideas oSevery minutecirqumftanoe, rcfpectiug the operation, which can be fancied- The affemblage oS the Surgeons, the preparation of instru- ments, and many other circumftances, the enumera- tion of which would be oppofite to the prefent pur- poSe, are all reprefented in a colouring fb fombre, and with MEDICAL ADMONITIONI. 445 with touches fo mafterly and impreffive, that the mind is filled with the utmoft horror at the pifture the imagination has drawn, ReaSon has no longer power to exert its influence j and the unfortunate Sufferer, thus becoming the flave oS terror, attempt! not to argue and combat with the hoft oS terrific fpectres which fancy is conftantly placing beSore the eyes. When I confider how powerSully the dread of an operation affects the mind, I cannot indeed expect to effect much by argument. Some little good may however, perhaps, follow, from this analyfis of tlie ordinary procefs of the mind in this and fimilar cafes, Since it thus plainly appears, that the dreadful appre* henfion of the operation is formed, in a great meafure, by the mind's dwelling on objects entirely vifionary, and that the fear of Suffering pain has, perhaps fome^ times, the leaft influence in directing the oppofition to the operation recommended. Thus, we often See men who can bear pain with the greateft fortitude, declare, that although they well know the pain of the operation does not exceed that Occafioned by the fcratch of a pin, yet they can with difficulty bring themfelves to confent to Suffer the operation of— bleeding. Nor can it hardly be doubted, if the moft timid female, fufferingunder this difeafe, was affured, that if (he would permit the pain of the part to be augmented exactly to*the fame degree, and for the fame 446 MEDICAL ADMONITIONS^ fame period of time, as it would by any propofed operation, fhe fhould obtain an entire removal of the difeafe, and even indeed of the part itfelf, and this merely by an incantation, but that her confent would eafily be obtained. But, indeed, it is not neceffary to imagine a cafe, to Shew that the dread oS opera- tions does not depend merely on the Sear oS pain, as this is Sufficiently evident Srom the much more ready Submiffion to the application oS cauftics; even under the ftrongeft conviction oS their producing a much greater degree oS pain, and oS their affording a con-, fiderable leSs chance of a cure. The mode oS thinking which fhould therefore be adopted, by thofe to whom Such an operation has become neceffary, is to let the mind dwell only on the abSolute pain oS the operation, abstracted Srom all Soreign circumftances and vifionary terrors; and to confider, that a cure may be obtained by only a Sew minutes increaSed pain ; and this pain very Sar fhort indeed oS what is moft probably anticipated by ima- gination : but Suppofe it ever So violent, let it be remembered, that it is but Suffering, even Say ! the moft excrutiatiating pain, Sor a Sew minutes, to pro- cure an entire liberation Srom mifery and deSpondence. But, unhappily, there are many, whofe dread of chirurgical operation is fo great, that no argument or confideration can overcome. To theSe it is proper to MEDICAL ADMONITIONS. 447 to addreSs all the conSolatory language that truth will allow j and, therefore, to affure them, that this mala- dy, although perhaps incurable, and accompanied by moft diftreffing circumftances, is yet, in general, not attended with thofe excruciating pains which are Sup- poSed always to belong to this malady. If, indeed, the poor fufferer is induced, by the miftaken zeal of fome fympathifing friend, to place herfelf under the care oS Some oS thoSe impoftors who have acquired the character of cancer-curers, this may not be the caSe, but the pains may become cruelly aggravated, and the progreSs of the difeaSe rapidly accelerated. 1 am well aware, that many oS my readers will be ready to afk, But do not theSe, whom you have thus ftigmatiSed, Srequently effect cures, even in thofe cafes which have been deemed cancerous ? It is therefore neceffary to obferve, that tumours in the breaft fre- quently fucceed to the inflammation of the breaft, arifing Srom retention of the milk, which, although they are certainly not of a cancerous nature, do often poffeSs thoSe appearances which render it very diffi- cult to make the neceffary distinction, and will con- tinue under that Sorm Sor Several months, and at laft reSolve, perhaps, by the application of a bread and milk poultice. TheSe are the caSes which prove So favourable to the character oSthis claSs of practitioners. From their fize, hardneSs, and length of duration, they 44$ AjEDicAL ADMONITIONS. they commoniy gain from the patient tnd her friends the epithet cancerous j aod fhould any profeffional man, deceived by an imperfect hiftory-, drop a fufpicion of an unfavourable termination of the cafe, the ,foun» elation is laid, on which the reputation of fome igno< rant pretender may be raifed. When the furface of the fkin is attacked by cancer, it generally begins with a fmall excrefcerice of the warty kind, which becomes a cancerous ulcer on fuf- fering even a flight irritation : fuch are the cancers which appear in the face. The extirpation of thefe, at their firft appearance, may be accomplrffied by an operation by no means remarkable for its feverity. Cancer of the womb is commonly preceded by a very confiderable difcharge ; much pain is felt at the bottom of the belly, darting in different directions, but chiefly down the < thighs* M the complaint pro- >cced*, the pains become more pungent and forcing, and at length ulceration taking- place, a profufe dif- charge of varioufly coloured matter, very acrid and offenfive to the Smell, enfues \ the general ftate of the fyftem fympathinng with the lotal injury, hectic fever is induced. SCALDS KlEDICAL ADMONITIONS. SCALDS AND BURNS. Dr. Underwood obferves, that—A ftrong Solution of foap in water has long been in ufe with artificers, employed in any bufinefs expofing workmen to very bad fcalds j and is a very excellent remedy. But as the foap would take fome time in diffolving, and the Solution fome time in cooling, the doctor recommends a mixture of fix ounces of oil to ten of water, with two drachms of the ley of kali, or pot-afh. This quantity may be fufficient for a burn on the hand or foot, which is to be immerfed, and kept about half an hour in the liquor, which will remove the injury, if had recourfe to immediately ; but muft be repeat- ed, as the pain may require, if the fcald or burn be of fome Standing. Should a perfon be fcalded all over, and immediately put into a cold bath oS this kind, / and the head, at the Same time, be frequently im- merged, or well wafhed with the liquor, I believe, the Doctor Says, very little injury would enSue. The moft uSeful application, I think, with which families can be provided, againft the moment of emergency, is a ftrong brine, made by placing fliced potatoes and common fait in alternate layers m a pan, allowing them to remain until the whole of the fait is liquified ; which muft be then drained off, and kept in bottles, properly labelled, ready Sor immediate uSe. I i i Lin Seed 45,Q medxcal ADMONXTIOUS. Linfeed oih So Srequently recommended, Jhonld never be the firft application y fince it poffeffes little or no power in preventing the inflammations oS the parts, and by gteafing the fkin, defends it entirely from the action of thofe remedies which would prove beneficial, if applied immediately in contact with the feinV The ulcerations which fucceed to fcalds and burns demand fo much nicety in their management, as to require the care of a fkilful furgeon- Without this* the patient may be diftreffed by inconveniences fox the reft of his lifev which no fubfequent endeavour* may be able to remove : the moft unfufpec^e4 /- . . men, MEDICAL ADMONITION*. 453 men, miners, &c. it could not fail-of proving.highly beneficial:to mankind." * i^'rn?* Convinced, with the benevolent author of the pub- lication from which this and the fucceeding quotations are taken, of the advantages to be derived from the wide diffufion of Such knowledge, I have inSerted the following paragraphs: but at the Same time muft ex- preSs a wifh, that they may incite my readers to a peruSal oS the little work itSelS, as the leffons it teaches cannot be too plainly imprinted on the mind. " The veflels, or tubes, which proceed from the heart, to convey the blood to all parts of the body, are called Arteries. From the power with which the heart propels the blood through this fyftem of veffels, it happens, that, whenever they are wounded, the blood flows rapidly, and in jerks, from the wound- ed part. They divide, to be distributed to parts, Srom trunks, like the branches oS a tree Srom the body ; So that, on preffing together the fides oSany trunk, the flow oS blood into the branches beyond the compreffed part is prevented. " The veffels, which return the blood to the heart, are named Veins. In them the blood receives but little oS the impelling force of the heart, and, there- Sore, *'A Le'&ure on the Situation of the large B^ood- Veflels cf the Extremities, &c. &c. by Williarm Blizard, F. R. S. 4£4 MEDICAL ADMONITIONS. fore, moves not with a ftrong tide, or current, but glides evenly and gently on, like the ebbing water ; and, of confequence, wounds of thefe veffels are not of much importance ; a fmall degree of refiftance, by' a finger, or Some folded linen; applied to the wounded part, will generally ftop the bleeding. fl " -f' It is very plain? then, that, if a bandage or liga* ture be made fufficiently tight around any limb, the flow of blood into all the parts below muft be prer vented. But, to render this certain, the preffure muft be very great in the whole circumference of the limb j and, in fome cafes, from the fituation of arteries be* tween bones, the effect cannot be obtained. To perform this procefs, therefore, fuccefsfuliy, in cafes ©f wounds and operations, and, at the fame time, to prevent the confequences of an exceedingly ftrong general preffure', Surgeons have fixed on certain parts of the trunks of arteries, before their ramifications, for the application of a pad, or Compress. fl3C-7,- D.;o£<(dfat< h" „ "The Pul.se is the beating or diftending of an artery, from blood propelled into it by the heart. The Spaces of time between the pulfations are periods when the heart itfelf is filling with blood returned to it by the veins. ito "■ ^ ' v **» ." Now it is evident, that there can be no pulfa- tlon. when the flow of blood and pulfationo/an artery >t>&i are MEDICA1 ADMONXTI0W*. 4$$ are prevented. Where,•■then, a pulfe can be conve* niently felt, as in the wrh% the ceafing of it, frortt* preffure being made on the trunk above, will pror^ that the preffure is made effectually. To ill»ftrare> this by experiment—Let a Sriend Seel the pulSe in your wrift j then apply two or three fingers in the little pit immediately below the collar-bone, clofe to the fhoulder. PreSs ftrongly, and the pulfe will ceaSe, becauSe the artery that Supplies the upper extreniity paffes under the nllar-bone, ovet the firft and fecmi ribs, albng this pail, and will now be preffed againft one of theSe ribs. Remove the fingers, and ajgairF apply them, and the pulfe will be found to alternate with the preffure. " Suppofe, then, a wound to be received, an artery of confiderable fize to be cut or torn, and a copious bleeding, in conSequence, to happen, in any part of the arm below the place juft deScribed i it appears maniSeft, that, by. making a preffure with the fingers, in the manner deScribed, or affifted by a pad between the fingers and the party the bleeding would inflantly ceafe. " The arteries of the upper extremity, of arm, proceed from the trunk after this manner : the fi'tink paffes into the arm-pit, deeply fituated; it then pt oeeeds along, the fide of. the arm, next the body, ohliaiity to- wards the fore, part of the jmt or hud, and here di- vides 4$6 MEDICAL ADMONITION!* vides into three branches.. In this courfe to^its dtvifiott it lies «ear the bone, andrinay therefore be fuccofsful- Jy compreffed.aqa *" " The distribution of the'Veffels of the lower ex- tremity isin" this" way : the artery paffes from the cavity of the belly tO the Groin, where, iri thin perfons, the puliation of it may be felt. '« At this place, in cafe of wound and effufion of t>lood very high in the thigh, effectual comprefJion may be made, by fome fingers prefled very ftrongly, in the manner defcribed for compreflion below the collar-bone ; though it were better to have fome kind of ftrong pad, or firm body, Such as Will be-deScribed, interpofed between the fingers arid the part. From the groin, the artery proceeds in an oblique direction, downwards and inwards, and at about the middle of the infide of the thigh it lies clofe to the bone. This is the moft favourable part for making a preffure ■rjjjbh it,-becaufe of the refiftance of the thigh-bone behind. And, where there are Opportunities of choice, as in cafes of wounds, or operations below this part, this is the place which furgeons fix on for the appli- cation of the compreffing body ; it therefore deferves particular attention. M The courfe of the veffel. is then downwards and backwards to the Ham ; in the hollow of which* againft the lower flat md of tht tfegh'bpvey compreflion may L' ■ A 2 again MtniCX fr AWM otft fro**. 457 IgMfi be tery tafteftfaftly made^ in all csfeskrf%ound^ or operations below the knee joint. Btit tof J>f;i q&ainedkhi >< dxiw aiodw srii granrtnab ,rnia *rh b> V Another qualification necefTary to be pbfleMd^is,' that of being-able to ftop fhe flow of blood from £ vein thus opened. Obvious as are the means to be employed on fuoh-aa occafioftj J v^ill riik the affertion, that there is no medical.man who has witneffed a moderate fhare of practice, but who has met with an inftance,or two, where, if life itfelf has not been en- dangered,'confiderable injury has been occafioned by a wafte of blood, from the orifice opening afrefh, alter the departure of the Surgeon ; no one of the by- standers having prefence of mind and, intelligence fufficient to. prevent the farther effufion. But a little attention t°.a.-few words,will enable any one to pej:- ibrmthe office of furgeon in this cafe. UK) 01 «,k6Ir, The fimple principle, with .which the mind fhould be fully poffeffed, is, that the blood muff ceafe to -flow, if the orifice be clofed. To accomplifh this, let the thumb be Aid on to the orifice, fo as to bring its fides together,, and, to prefs it with a moderate force, j The flow of blood will be now Stopped, and the operatpr, now confident of the power ^epofleffes, with the other hand cle,anfes the arm, while, a.little .,°bo|fter of linen is Solded by .Some .by-gander, which , ,|ie artfully introduces ^between, £}# -orifice ,an/L his thicknefs srirflCA'I1' ADMOlffTlONSK 4$Q* tMcknefs fufficient to fill up the4iam^of^6%en#' of the arm, confining the whole with a ribband or tape paffed over the cooipreSs, and above and, below the elbow, in the, form of a figure of eight, finifhing with a knot over the comprefs. . . . . ... . .- .■ * r, boaaqu <;u;Jj ni37 no,."., >c e>rft itn M u I m 1 infirm 1 ifoqJi ao ba^olqma Ofi d?v/.' i^ro aari o , iq lo surii staisborn tI^ n-?.3d Jon <;i? ■*«-■• <* ^ v;j 7, f. Leeches may be employed in every, cafe where topical bleedings are thought neceffary, or where vensefeetion cannot be performed. . . r \ ■•■ ■ 'o aiuliixpn 3fit. 3j'As thefe little animals are-depended on for the re* moval of kvery dangerous difeafes, and as they often feenf capricioufly determined to refift the endeavours made to caufe them to adhere, I fhall give a few directions, by which their affiftance may, with more certainty, be obtained. . .^.-u .,, -> . c. . y ..'ci 1 _. 'rij .i*aiJ «j ie^Mt"-? yI'.'.'T ad • ^ This ufeful ally to the* phyfician, it may be remarla- ed, is as little fond of the fafte of phyfic as the phyfi- cian can be himfelf. The introducing ^aJ hand,-to ; Which* any ill flavoured medicine "adheres, into the water in which they are kept, will be often Sufficient to deprive them of life ; the ^pplicattOrf of a fmall quantity of any fallne~ matter to their Sump immedi- ately occafions the expulfion of the contents of their * Stomach-'•-' and, what is moft,to our preScnt ipw*pf>rri yh.- -^ • • ' w^--j-J distempered parts, either in an upright or fitting pofture, but let the patient be con- stantly kept in an incumbent pofture, on a bed or mattreSs. From want of attention*o this injunction, as every Surgeon knows, the Sailure of relief in thefe cafes, may frequently be attributed. h ; INFLAMMATION OF THE HIP AND V-Al'T-\ KNEE JOINT. , These dreadful calamities, known by the names of Hip Cafes and .White Swellings, might frequently be prevented, Jf parents were but aware that they may in general be traced back to fome painful affec- tion of the part whieh'may have occurred fome weeks before any lamenefe was perceived.* Painful affections ©f fhele parts, tberefbie,- ihouid be fdrioufly attended S™^ to, MEniCAi»;,AnMONiTie»% 4C3 to, avby &§ early and vigorous employment of appro-. priate. means, the difeafe- nify be jemoved in this, its fttft Stage, ^ir- snod jfo.H 10 oniq> { v .n But fhould thefe have been neglected, or have been uhfuccefsSully employed, Still a1 cure may be hoped for, but not unlefs,'as in the former cafe, the difeafed parts are kept conftantly refted. What expectation of cure'can be entertained, whilft the difeafed parti are forcibly grated together ? Who, to make ufe or- a homely comparison, would fet the wheels of a watch in motion, whilft in a State requiring the help oftheartift? " ' *** W • rdt. 'n .'fc, oi iqsA (bnaf* Vu[ni dV " ' ' . ' h ■ m .2f9f|ji:rfj FRACTURES OF THE LIMBS, AND IN- JURIES OF THE HEAD FROM £3bn EXTERNAL INJURIES. Presuming that the injurious interference of domeftic practitioners in thofe' cafes which belong to this Section, is not to be expected, I fhall here ^con- fine' my admonitions to thofe points which ate necef- fary to be attended to by fhe patient and his friends, during the'firft mdmcnts of the accident^1 « 3 i-A- lf> in confequence of a fall from Some high- place, torby any othe'tf accident, a confiderable degree #f injuryijgprltar.si.to have been received.;, the fufferer fit beInS 4&4 jftfitncAL ADiVromTiai** beang unable, in confequence 'df the deposition of his fenfes, to point cut the injured part ; Some con*- fideration and attention is neceffary, before any at* tempts are made, even to raife him Srom the ground. Should a fracture of one of the bones, either of the upper or lower extremity, have happened, and not be fufpected by his affiftants, their exertions to raife j him, and to place him on his feet, might force the ' fractured ends of the bone through the foft parts, and ! convert a mere Simple Sracture into a very dangerous , compound one. The limbs, therefore, with a view to this circumftance, fliould be carefully examined ;- but even if they Seem to have Suftained no material injury, • j yet mould the patient not be precipitately raiSed, until Something be provided, on which he may be placed : as thereby unneceffary, and perhaps injurious, exer- tions are avoided. As it will be Sair to conclude, *t from the deprivation of the fenfes, that the brain may have Suftained Some injury, great care fliould be I taken, that whiift he is conveying to his apartment, | and whilft laying in the bed the head be kept moder- J ately raiSed, and that on no Suggestion whatever, any \ fpiiituous drinks be given to him. The neceffity of the latter caution, from the di'fS- eulty it may occafion in forming an opinion of the nature of the injury, will be made evident by the following caje. A lad of twelve years of age fell from \ MEPICAL ADMONIJIONS*. 4^5 fo>m a hay-loft about twelve.fe^Jfrom the ground, and was brongltt to his parents a^out an hour after the accident, almoft infenSibie j it was with difficulty he was roufed to anfwer a queftion, and then immedi- ately relapfed into a SenSeleSs ftate ; after h&ving laid in this State about ten or twelve hours, the lurgeon firft Saw him : he then complained of extreme pain in his head, and SickneSs at his ftomach,. relapfmg be- tween whiles into a ftate approaching to infenhbiliry. Here appeared to be preSent fevera] of fhe moft characteristic Symptoms of ferious injury to the head,; 1 the,Surgeon, therefore, .had, begun to appriSe his v"< parents of Jus, apparent danger, when the boy threw a little matter qff his ftomach, which Smelt ftrongly of Spirits. He was immediately well drenched with warm water, until what he rejected no longer Smelt of fpirits. He then fell afleep; and awoke ^erfedly well in a few hours, the brain having fuftaihed an injury, not from the fall, but from a bumper of brandy, which had been given to him by one of the by-Stand* ers, as a Cordial,.when he was firft taj^en up. But fhould it be difcovered that a leg or thigh is broken, the aid and directions oS a Surgeon fhould, if poffible, be obtained, for his removal ; but if this Cannot be the cafe, the following rules fhould be >, Obferved. ^ . ; L 11 * T^t 4i66X MEDICAL AbMONiflONsJ" riVfThat he be not Stirred until a proper vehicle is ':''"vj procured, on which he can be placed. 2; This, if nothing more proper can be had, may be a door, a fhutter, or two or three flanks well Se- cured toother. i_ 3. To place him on this,-two perfons. 'may raiSe him, by means of a lheet flid under his, hips,, whilft one of two raiSe him by the fhoulders ; one perfon raifing the Sound leg, and one, the moft intelligent of ■' his friends, conducting the fractured limb. 4. In moving the.fractured limb, .the object which ■?} fhould, poffefs the mind, fhould be, that the divided pieces of the bonq be kept as, much as poflible in the fame line, left the fracturecl encls,. pierce through, the foft parts. • . f(. 5. If.a pillow qui. be obtained, tlie broken limb fhould be placed on it; and, if it appear to be pre- ferable, previous-to liis be^ng, raifed, "'iS.' When placed on" the litter, he mould be a little V^ inclined to the fame fide of the injured limb, which, '«/ if circumftances will admit, fhould alfo be laid on the nde, and With the knee a little bent. '•■■-* ..." ' ;"■ fill l ■-'..> .s : •' 7. The belt mode of conveyance i$ *H9doubtedly by two or four men, in the manner in which a fedan chair1 is carried. A cart, or even a coach, fhould never '♦** MEDICAL ADMONITIONS. 467 never be employed, where the mode juft recommend- ed can be adopted. (. 8, As, the patienf; will Jbe under the neceffity of k. laying fome time without getting up, a matrafs fhould ' " be laid on his feather-bed, or, if that cannot be hacl, two or three long and wide boards, joined together, maybe placed under thetfeather-ibed. If this can ^ be done before he is firft laid down, much Subsequent pain and exertion will be prevented. IS the arm be broken between the elbow and the t wrift, the arm fhould be bent at the elbow, raiSing the \ palm oS the hand to the breaft, with the fingers * moderately bent ; the thurnb being Superior, and the I ' little finger inSerior. In this ftate it may be retained by a fling or handkerchief, Supporting it from the elbow to the fingers ends. When the arm is fractured between the wrift and £• fhoulder, the fore arm may be placed in the fame * pofition as already defcribed ; but the fling, inftead * pS Supporting the..whole length oS the arm, fhould only fupport the;hand, which fhould be raiSed higher 1' than in the Sormer cafe, the elbow being allowed to fink ; its motion, however, being prevented, by a ; handkerchief paffed moderately tight round the trunk, including the fra&ured arm. I HERE M MEDICAL ADMONITIONS. I here conclude the talk allotted me, hoping thaf, notwithstanding its imperfections, this little work may prove of real utility. ..■■■■-, Your candour will,-1 truft, prevent you from in- ferring from my philippics againft domeftic quackecyj*- that it is my wifh to leffen the diffufion of ufeful • knowledge. Indeed, on the contrary, I am confident that the beft, and moft effectual mode of checking the career of empiricifm would be, by more Srequent ly admitting the ftudy of anatomy, phySiology, patho- logy, and chemiftry, as part oS a liberal education Poffeffed of fome knowledge of the Structure, of • M the ufes, and of the laws of action, of the various parts )• of the human body ; and apprifed of the confiderable difference between diSeaSes of fimilar appearance, few,* could be difpofed, except where error Seemed impof- fible, to prefcribe Sor themfelves, and JoSe the advan- tage oS that" aid which, they might expect Srom thoSe who had paffed their lives in the Study of the healing art. In farther recommendation of the Study oS theSe-' Sciences, I muft obServe, that, independent oS the a<&- vantages juft mentioned, anatomy and chemiftry would furnilh the inquifitivc mind with the moft curious artd'interesting facts ; and would prove a Source of rational and instructive entertainment. So obvious, indeed, is this, as to render it Surprifing that! '->■' gentlemetf, MEDICAL ADMONITIONS* 4^9 gentlemen, not of the 'profeffion, fhould not more ' frequently avail themSelves of the opportunities of acquiring this kind of knowledge, in the pleaSankand expeditious manner in .which it is offered them, by the public lectures on theSe various bfanc.fajsi.of Sci- ' ence. Nor is So much previous knowledge neceffary as is in general SuppoSed, the peruSal of Dh Gregory's CEconomy of Nature,-and of the Medical.Extracts, would Supply all the information neceffary to render the comprehenupp of the doctrines laid down in Such '* lectures perfectly, ^eafy. f» •- -To thoSe who may wifh to obtain more accurate knowledge respecting diet and regimen, the lectures, 1 publifhed on thefe Subjects, by Dr. A. fr JVI. \yillich will be Sound Ijighly ufeSul. And it is with plcafure I ftate, that very ample directions, to nurSes Sor the management oS tfce fick, in theSe reSpects,»may be expected Soon Srom Dr. Hamilton, Phyfician to the General DilpenSary. From a Sear left what I have Said againft indifcreet attempt to harden children, as it is termed, fhould not appear Sufficiently convincing, I cannot refrain from earnestly recommending, to parents the peruSal of Dr: Darwin's excellent Effay on the Education of J?emales. V • j r. ■' ■ AS 470 medical admonitions: JU the exemption from the fmall-pox by>the inocu- lation of the matter of the cow-pox, may ftill be con- sidered, as a Subject ojf experiment and inveftigation, it cannot with propriety be dwelt on in a work of this kind. The farther experiments of Dr. Jennerand Dr. Pearfbn, with thofe which, I truft, will enrich the fecond volume of Dr. Woodville's excellent Hiftory of Ipoculat'ionj will, I hope, clearly fliew howA much may be expected from this moft important difcovcry. lam, Tour's, J. P. -■■■•■ • f -r. ■ OBSERVATIQNS" ' «" ' ■ >' '" ON THE Exceflive Indulgence of Children y PARTICULARLY INTENDED TO SHOW its injurious Effects on their health, ■ i * AND THE DIFFICULTIES IT OCCASIONS IN THEIR TREATMENT DURING SICKNESS. Thcfc fhall the fury paffions tear. The vultures of the mind ; Difdainful anger, pallid fear, And fhamc that (kulks behind. GRAY. A , ♦ SLIGHT and tranfient view of the duties of parents to their children, during the flate of infancyy might favour the Opinion, that little more is required of them than that care for their prefervation which , the brute parent inftindtively bellows on its offspring. But when it is confidered that the human parent poflelTes reaSoning powers, and that the mental ener- gies of the child begin to be evolved in the early clays of infancy, it muft be obvious that the duties are much more numerous and much more important: Vbi.JI.' ;':i * of >' 47^' MBDICAL ADMONITIONS. of a degree of imp'ortance indeed proportioned to the elevated place a child pofTeffes m'the fcale of animated beings.' Nor is this observation Unneceffary ; no caftle is here erected merely for the purpofe of being levelled; fince there are too many inftances where the minds of children are no more* attended to, than rf they were really tlie offspring of brutes ; and where even the neceffary care for their health and exiftence is exceeded by almoft the whole of the brute creation. That children are born with various difpofitiojis is undoubtedly true ; but it is alfp true, that .by due management, thefe may be fo changed and meliorated' by the. attention of a parent, that not only little blem- J' ifhes may be fmoothed away ; but eyen thofe circum- ftances which may more offenfively diftinguifh the child, may, .by prpper management) J?efCQme the .■< chara&eriftic ornaments of" the man. But, alas! too often do we fee, from the want of this care, the charm-5 ing bloffoms oS virtue and happinefs blighted. ', On the treatment the child receives from his pzichis, during this ftage of his life, will, perhaps, depend much of the mifery or happinefs he may experience^ not only in his paffage through this, but: through the other ftages oS his exiftence. If, oh the one hand,V every little Sally of paffion and impatience is immedi- ately controlled ; if that which is 'admiffible is regu- larly permitted, and that which is improper as regu- larly M-BIHCAL APMONlTlQNf. 473 krly withheld, the wily little, creature will foon learn to diftinguifh that which is allowed of, Srom that whicli is prohibited. He will, indeed, urge his claim, for that to which he has been taught he has a right, with manly boldneSs j but will not haraSs himSelS and his attendants, with ceaSelcSs whinings or ravings, to ob-r tain that which uniform prohibition has placed beyond expeftance. But a melancholy reverfe appears, if, on the other hand, no confiftency is obServed in his management; if, at one time, the flighteft indulgence is refufed, and at another the moft extravagant, and even injurious cravings, are fatisfied, juft as the caprice of the parent may induce him to gratify his ill hu- mour, by thwarting another; or to amufe his moments of ennui, by playing with his child as a monkey, and exciting it to thofe acts of mifchief and audacity Sor which, in the next moment, it may Suffer a Severe cor- rection. Continually undergoing either difappoint- ment or punifhment ; or engaged in extorting grati- fications, which he oSten triumphs at having gained by an artSul diSplay oS paffion ; his time pafTes on, Until at laft the poor child manifefts ill nature Sufficient to render hun odious to all around him, and acquires .pride and meanneSs Sufficient to render him the little hated tyrant oS his playfellows and inferiors. Can the duties of a parent have been fulfilled in this cafe ? Can.the child owe any duty, in return for fuch con- duft ? Certainly not. What may be the natural Mmm obligations I 474 MEDICAL ADMONITIONS. obligations of a child to a parent is not intended to be here dwelt on, it is only meant to be affert ed, that they muft be. leffened by treatment fo abfurd and injurious. The mortifications which the parent muft repeated- ly endure, from perceiving his darling child render himfelf obnoxious to all around him, by the enormity of his conduct, muft awaken a fufpicion that fome error has been committed in his management ; and muft, at times, excite a tranfient inclination to adopt a! more firm and rational mode of conduct. But fup- pofe this child of humour and indulgence to be over- taken by ficknefs, then muft the unhappy parent find ; conviction flalh ftrong on his mind, and he becomes his own harfh, unforgiving accufer. When life itfelf depends on a peaceful ferenity, and an exact compli- ance with various regulations, he fees his froward darling fevered by the exertions of paffion -, and ex- haufted by petulant rejections of the means of relief, and by inceffant cravings for thofe things which, being noxious, are prohibited, and which, by the perverfenefs of temper, are thereby rendered more defirable. Generally does the poor little fufferer pay with his life the purchafe of his early indigencies ; or, at beft, efcapes with an enfeebled conftitution; prefenting a conftant memorial to hi? parent, that—the temper OF A CHILD IS FORMED IN THE EARLT DAYS OF INFANCY. ;nit/pi. Evefy MEDICAL ADMONITIONS." 475 Every one who has had opportunities of obfervation, muft have remarked howdiftreffingly the Sufferings^rf the child, the perplexity of the phyfician, and the diftrefs of the parents are augmented by frowardnefsof difpofition. To particularife the various injuries which the exceffive indulgence of the caprices of chil- dren may occafion to their health, and the feveral impediments it is productive of to their proper treat- ment, when oppreffed with difeafe, fhall be the en- deavour of the fucceeding pages. In making this attempt, it is eagerly hoped, that very powerful arguments will offer themfelves to the affectionate parent, in favour of a ftrict regulation of the difpofi- tions of children, even during their early infancy. The difeafes of children arc, in general, involved in fo confiderable a degree of obfeurity, as to demand the exercife of much ingenuity, and acutencSs of dis- crimination in the phyfician, whilft engaged in discov- ering the nature of the difeafe he is required to remove. But when his enquiries are impeded, by exceffive wailings j when the exprefiions of impatience magnify one particular fymptom, and conceal the reft ; the niceft inveftigation may prove infufficient to obtain the neceffary information. a Not only is the phyfician fometimes, thus prevented z Srom Soiming a juft opinion oSthe nature oS the diS- eaSe ; but even when, by dint oSearneft attention and enquiry, 47 6 Mtt$it&£ ab mon rrroNs* enquiry, he has Sarrsfied'his mind ; and is difpofed to employ thofe means whicn his judgment may dictate,. it too frequently happens that infuperable difficulties arife of another kind.' The*medicines he fhall pre- Scribe, he will, very likely, be told, muft not only not be ill-flavoured, but, if he expeds they fhall be gotten down his patient, they oiuft be abfolutely without any tafte. J'":' ■" ' ^ io Jn. thofe.cafes, in which bleeding by leeches, is re- quired, he will often be told that however neceffary their application may be, it is a remedy which muft be declined ; for fhould the child eveTfee them, he would be immediately thrown into convulfions ; and as to a blifter, although they, the parents, might be difpofed to fubmit to have their child expofed to the infliction of this torture ; they are fatisfied that as foon as he fhould experience pain from its action, be would directly tear it off. Placed under fuch limita- tions, it cannot be expected, however anxious the ; phyfician may be to procure relief to his patient, that much advantage can be obtained by his prefcriptions. He therefore, either declines his attendance ; or acting within the bounds to which he is limited, he does little more than alleviate fome of the more diftreffing fymptoms, whilft he has the mortification to witnefs . the almoft uninterrupted progrefs of the difeafe. , • *'• Thofe children Who a^e allowed to conduct them- ?«nr felves, MKPICAL ADMONITIONS. 473 &I*es, entiwly as their humour happens to prompt them i and who have unhapp'u'y beea taught, by their parents' imprudence, to. regard, their dictates as nugatory, are not only more expofed to the attacks of difeafe ; but have the cha/ice of its removal lefTen- cd. by not allowing the employment of the moft efficacious means. Frequently, alfo, their diforder is augmented, by the violent exertions conSequent to the irritation oS the mind, produced by the pain, and the various inconveniences, accompanying the ftate oS difeaSe.' IMPROPER INDULGENCES IN FOOD. Unlimited indulgence of children in the article oSSood, is a Source Srom which a multitude of diScafes arife. The child is placed at a table, wh«re variety of meats, and the ingenuity of the cook, tempt the ftomach to take food, beyond the calls of natural ap- petite. From extreme kindneSs,' lie is helped from almoft every difh, until the ftomach has received So much as to occafion an injurious diftenfion of its coats, in confequence of which, the performance of digeftion is confiderably impeded. This procefs being daily repeated, probably, the digeftive powers become So much impaired, that roSs of appetite, fqueamifhneSs, and even Srequent vomit- ings 47& MEDICAL ADMONITIONS.' ings Succeed. The child, inftead of acquiring ftrength, evidently becomes weaker, the eyes appear funk, the- complexion affumes a waxy palenefs, and fo great a degree of emaciation takes place, as plainly (hows1, that but little nourifhment is derived from the great quan- tity of food which is employed ; and that the kindly meant indulgences have produced effects, directly op- pofite to thofe which were intended. But fhould even thefe effects not take place, to the degree here defcribed, and the ftomach efcape this fpecies of injury ; an evil of another kind, of no fmall magnitude, will very probably occur. In confequence of thefe repeated diftenfions of the ftomach, its capa- city becomes actually enlarged, and the habit of taking large quantities of food is induced. Although the appetite becomes fo depraved as to demand the confumption of even an enormous quantity of food, the ftomach, however, not having its faculties increaf- ed, in the fame proportion as its capacity, the fyftem does not derive, even the fame quantity of nutriment, • as is afforded by the ordinary quantity of food, acted on by a ftomach in its natural ftate. Hence will it be often feen, that children who feed even rapacioufly, are thinner, and have a lefs healthful appearance than thofe, who feed with more regularity and moderation. from thefej inordinate gratifications, another diSa* greeable-circumftance Srequently ariSes,: as the child fuucji experiences MEDICAL ADMONITIONS. 479 experiences a loSs of appetite Sor proper Sood, he be- comes Subject to the moft unnatural cravings. The ftomach Satiated, and even Surfeited, with Sweets and delicacies, Solicits Sor Subftances which are, to others, the moft Sordid and difguflful. The foundation of all thefe evils is often laid in the firft months of the child's life, by repeatedly diftend- fng its ftomach with the various mixtures, cmplojed as fubftitutes for that food which nature has prepared for it, and, of which it never Suffers a deprivation, without danger oS the moft diftreSsful confequences enfuing. In early infancy, therefore, where unhappily the child is obliged to fubmit to this cruel deprivation, the food which is Subftituted fliould be fimple, and approaching as nearly as poffible to the nature of the mother's milk. Goats milk, affes milk, and cows milk are probably the beft fubftitutes , but thefe fhould be given frefhly drawn from the animal, flight- ly warm, unmixed with vegetable fubftances, md in Srequent, but moderate quantities. Too frequently is the paffive infant feen laying acrofs tie lap of its nurfe, who pours into its ftomach, one boatful after another, as warm as it can be fwallowed, a mixture of water thickened with bread, the acefcent fermenta- tion of which is promoted by the addition oS Sugar, this being oStcn allowed to begin to take place, in the Space 480 MEDICAL ADMONITIONS. {pace of time between its being mixed, and its being ^given to the infant. As the child advances in age, ftill muft it be remem- bered, that its health will depend on the fimplicity of its diet. The variety in its chief meal fliould never be extended beyond two difhes.; the one, confifting of vegetables, dreffed in the-moft fimple mode, or of fruits dreffed in the form of pudding or pie ;* and the Other, of animal food dreffed as plainly as poffible. Pickles and fpices fhould be entirely avoided. When this is done, and children are not teized with repeated urgings, to try to take a little bit more, they will be feldom found to eat inordinately ; or to reject capricioufly that food which is fitteft for them. In thofe cafes, where either of thefe circumftances oc- curs, it will, in general, be found to depend on injuri- ous habits, induced by thofe improper modes of feeding, during infancy, which have been juft par- ticukrifed. NERVOUS • This penniffion will to fome appear objectionable, as paftry has been repeatedly declared to be among thofe articles of food which are mod injurious to the ftomach. But aU though this may be true of thofe kinds of paftry which are made to contain a large quantity of butler, it does nor feem that pie-cruft of the plainer kinds can be fo htwtful as'to authorife its prohibition. MEDICAL AfcMONlTlONSr 48* NERVOUS AFFECTIONS, AND MADNfiS^ .■■-.-■ : ■ * K . Those parents will often find themfelves c°re* —— 51 ---->— Difficulty of making the neceffary Diftinftions of 53 Intermittent Fevers or Agues, Defcription of » •■ — 56 Ambiguity, from firft Appearance of 58 ---------from commencing in a continued form 59 ---------from fuddenly changing to a continued Fever 60 Obfervations on the Ufe of Peruvian Bark 61 Remarks on popular Remedies ■ ■■ 62 ----------Regimen and Prevention — 64 Inflammatory Fever, Defcription of ------ ■ 66 Danger of being mifled by the fit ft Symptoms 67 Neceffity of drift Attention to the Orders of the Phyfician 68 Slow Nervous Fever, Defcription of ...... ■ 70 Infidious Mode of Attack ---- ---- 71 Perfeverance in the Endeavours for a Cure enjoined, is long as Life remains 76 Obfervation of Dr. Buchan, Remarks on 77 Putrid Malignant Fever, Defcription of ---- —— 7^ Danger of Error in Domeftic Practitioners 80 Q^qj^ Mifchiefs 506 CONTENTS. Page Mifchiefs arifing from Bleeding, James's Powders, heat- ing Regimen, &c. ---- • 82 Regimen and Management of the Patient, 83 Cautions refpecting the Ufe of Wine ---- 87 Neceffity of ventilating the Bed-Room ---- 89 Directions for the Management of the Patient, whilft delirious ---- ---- 90 Quotation from Dr. Blane on this Subject 91 The Patient not to be abandoned, on the Appearance of thofe Symptoms ufually denoting fpeedy Death 93 Seeming Incapability of Swallowing accounted for, and the proper Mode of adminiftering Nourifhment pointed out —— ---- 94 Alarm unneceffarily excited by that which is termed The Rattler ---- ____ 95 Prevention ---- — 97 Obfervations on Effluvia ---- —__ 98 Remarks on a Quotation from Dr. Gregory, adopted by Dr. Buchan, —— ----99 Cold favourable to Infection ____ 100 Fumigation of Apartments 1 o 1 Mode of employing the nitrous, marine, and acetous Acid, as recommended by Dr. J. C. Smyth and Mr. W. Blizard ---- -----101 Danger of Infection from foul Clothing 102 Cautions neceffary on the Retuin of Appetite, and on the Expofure to cold Air---- ____i0* Mode to be adopted on the firft Appearances of In- fection ---- I09 Vital or Oxygenated Air, Benefit from 104 Study of Chemiftry recommended __ 104 Infants not fo liable to Fever as Adults 105 Remitting CONTENTS. 507 Remitting Fever, Defcription of ---- • Page 106 Neceffity of early attention to —— — - 108 Hectic Fever, Defcription of Importance and Neceffity of detecting its Caufe 109 no Inflammation, Defcription of III Care neceffary in felecting the Means of Cure, and in eftimating the Degree to which they fhould be em- ployed 113 Particularly in different Stages of the Difeafe, and whilft the Difeafe is gliding from one Stage to another 116 Prevention ---- 122 Avoiding the too fudden Tranfition to an Atmof- phere differing much in its Degree of Temperature, from that to which a Perfon has juft been expofed 124 Danger of ufing fpirituous and heating Drinks, ei- ther before, or after Expofure to extreme Cold 125 Proper Mode of Conduit fhewn -126 Maxim—In every cafe in which pain occurs with fever, to obtain immediately the beft advice 127 Inflammation of the Brain, Defcription of ---- . 129 Inflammation of the Eye, Defcription of —-*- ■ 1 * 1 Confequences of Neglect i«a Blindnefs may be produced in a few Hours, if proper Means are not adopted ----■ 133 Children, newly born, frequently blinded through im- proper Treatment or Inattention 136 Thi 508 CONTENTS. Page The Inflammatory Sore Throat, Defcription of---- ,---- 138 Only to be removed by proper Means, employed in the early Stages of the Difeafe ■■ - 130 Danger of Error in Domeftic Practitioners 140 Neceffity of frequently lubricating the Fauces 143 The PuTRrn or Malignant Ulcerated Sore Throat, Defcription of ---- ----r^j Danger of Interference with Domeftic Medicine 146 Regimen, and Rules for the Management of the Patient ---- ---- 147 Neceffity of Refolution and Perfeverance in the Treat- ment of Children —— ----148 The Croup, Defcription of ■ ------ 149 Abfolute Neceffity of immediate Aid ----152 Dr. Ferriar's Remarks on this Difeafe---- 153 Utility of anatomical Examinations of thofe who fall Victims to ambiguous Difeafes ------ 154 Remarks on the Objections to this Practice----155 Prevention of the Difeafe ■ 156 Expofure of Children to extreme Cold highly dan- gerous ---- ---- 157 Erroneous Calculations made on the Appearances of Cottage Children -*— ----159 Two cafes mentioned, where the Difeafe feemed to be caufed by violent fcreaming and holloing 160 The Mumps, Defcription of ------ ----,— 161 Fatal Termination of —— 162 Danger of Domeftic Practice, even in a Difeafe appar- ently trifling .---- •---- 162 Inflammation CONTENTS. 500 Page Inflammation of the Ear, Defcription and Treatment of ------ 162 Tooth Ach ------ -----■ 163 Errors in Domeftic Practice, from confidering Tooth-ach as a Term expreffive of one particular Difeafe 164 Tooth /Ich, the Symptom of various Difeafes of the Teeth, requiring different Modes of Treatment 165 Impropriety in the ordinary Domeftic Practice, and in the immediate Extraction of the Tooth — 166 More rational Mode propofed -----— 166 Teething ------•------ 167 Neceffary Cautions during Dentition ■ 167 Lancing the Gums, the Neceffity of pointed out 168 Tooth Necklaces a cruel Impofition ——— 170 Remarks on Dr. Buchan's Opinion of the Inutility of this Operation ..... - ■■ 171 Objections to the Modes of performing it recom- mended by Dr. Buchaa ---- ---- 172 Sorenefs behind the Ears, the Treatment of — 173 Inflammation of the Lungs ------■ 174 Symptoms of ---- ---- 175 111 Confequences arifing from an Oppofition to the Prefcriptions of the Phyfician —---- 179 Dr. Duplanil's Remarks on Dr. Buchan's Advice in this Difeafe ------ ------ 181 Infidious Nature of the Difeafe ; fometimes highly dan- gerous without caufing Alarm ---- 182 When the Breathing is altered in Quicknefs, a morbid State of the Lungs may be fufpected — 183 INFLAMMATION OF THE LuNGS IN CHILDREN, Defcribed ------ ------■ l84 The 5IO CONTENTS. Page The Attention of Parents called to this Difeafe 185 Alarming Symptoms, and the proper Mode of Con- duel pointed out ---- ---- 186 Directions for the Ufe of the Warm Bath — 186 Cautions refpecting the Mode of applying Blifters 187 III Confequences of deferring the Application to Med- ical Men until Evening ------ ------ 187 Pulmonary Consumption, Characteriftics defcribed ---- ----189 Regimen and Diet ■ ----ioi Remarks on Dr. Buchan's Advice as to leaving off Animal Food and ftrong Liquors 194 ----------Dr. Cadogan's Opinion on the fame Subject ■ ...... 195 Observations on the various Modes of Exercife 198 Atmofpheric Air, compofed of oxygen and azotie Air— their fuppofed medicinal Powers explained 201 Clothing, Remarks en —— ----204 Inflammation of the Stomach, Defcribed ---- ----205 Important Remark of Dr. Crichton ----206 Danger from the adoption of Domeftic Medicine 208 Regimen, Diet, and Prevention 208 Fatal Confequences of the Mifenaployment of fpirituous and aromatic Drinks ---- ----208 Frobability of Family Practitioners being mifled by the Vomiting ---- ---- 209 Inflammation of the Bowels, Defcribed ---- ---- 211 Danger of miftaking it for Colickry Pains — 212 Symptoms of Recovery and of Danger----213 Dr. Duplanil's Remarks on Dr. Buchan's Opinion 214 Inflammation CONTENTS. 511 Page Inflammation of the Liver, Symptoms of — — 216 Difficulty of detecting by a Domeftic Practitioner 219 Admonitions to the Intemperate «o Inflammation of the Kidney, defcribed 222 Inflammation of the Bladder ■ ttj Symptoms of --- --- 225 111 Confequences arifing from Delay ----. 226 Inflammation of thr Spleen • 128 Inflammation of thb Peritoneum ---- 228 May occur without exciting neceffary Alarm in Do- meftic Practitioners ---- ---- 228 Remark of Dr. Baillie ---- ---- 228 Rheumatism " --- 229 Gout, ■ --- 234 Advantages derivable from the Attendance of a Phy- fician in this Difeafe -— ---- 239 Obfervations on Regimen and Diet ......-— 240 Opinion of Mr. Forbes on the Nature of Gout — 243 Small Pox,--- --- —• Defcribed ---- --- 245 Neceffity of real medical Knowledge in treating this Difeafe ---- --- 250 Numerous tidiculous Prejudices noticed —- 251 Advantage of Attention to Regimen and Cleanlinefs 252 Symptoms of Danger ---- —— 254 Danger of Blindnefs—Conduct neceffary to be adopted 255 Opening the Puftules recommended by Dr. Buchan 256 Remarks on this Practice by Dr. Sims ---- 357 Ill-founded Confidence of Exemption from Danger of Infection .....— ---- 258 Inoculation CIS CONTENTS. Page Inoculation --- --- 259 Objections to it anfwered ---- -..... 259 Confequences of its being performed by Nurfes and Parents ---- ....... 262 Obfervations on the Mode recommended by Dr. Buchan ---- ---- 264 Remarks of Mr. Daniel Sutton ....... 265 Chicken or Swine Pox, Defcribed ---- ....... 266 Neceffity of afcertaining the real Nature of the Erup- tion ---- ....... 267 Marks by which it is diftinguiftiable from Small Pox 267 Measles ----- ----— 268 Precarious Practice of Domeflie Mtdicine not to be trufted to in this Difeafe ---- 269 Inflammation of the Lungs—Danger from it—Diffi- culty of Detection ---- ---- 271 IJndeferved Cenfure of Phyficians, whence arifing 272 Scarlet Fever, Defcribed ------ ------■ 275 Neceffity of a nice Difcrimination in determining the real Nature of the Difeafe------ 276 Erysipelas, Defcribed ------ ------ 277 Proper Treatment of flight Cafes ------■ 278 More ferious Cafes demand confiderable Judgement 280 Mifchiefs arifing from the Employment of Goulard's Vegito Mineral Water -------— 2%2 Erysipelas of Children The Attention of Parents called to the firft Appear- ances of this Difeafe ■ *83 Miliary contents. 513 Page Miliary Fever, Obfervations on ---- 284 Hemorrhages, From Internal Caufes -— 288 Dependent on numerous Caufes 289 Dr. Cullen's Reafons for preventing the Recurrence of Hemorrhage » 292 Bleedinc from the Nose 995 Danger, by permitting its frequent Recurrence, of pro- ducing Confumption - 297 The niceft Judgement neceffary in moft Cafes when it happens ------ — 298 Remarks on Dr. Buchan's Recommendation of Liga- tures ©n the Limbs ■ 301 Spitting of Blood --------302 Neceffity of diftinguifhing from what Part the Blood proceeds ■ ■ ------ 303 Degree of Danger pointed out 303 The Treatment of this Difeafe in no inftance to be trufted to Domeftic Quackery 305 Diet, Prevention, &c. ----— 305 Hamorrhoids, or Piles, Defcription of —-—— 306 Symptoms pointing out their probable Termination in Abfcefs and Fiftula 327 Neceffity of Regulation in the Mode of Living 308 111 Confequences of allowing their Progrefs, and of not preventing their Return 309 Erroneous Opinions reflecting their beneficial Effects on the Syftem ------ 3C9 Fiftula^ frequently produced by neglected Piles 311 Immoderate Flow of the Mknsrs 312 Immediate Danger and future ill Confequences fhewn 31 j Sometimes the Symptom of fome other Difeafe 315 R r r Vomiting 514 contents. Page Vomiting of Blood •----- 3l€> Voiding of Blood from tub Urinary Passages 317 Catarrh, Symptoms of - 318 Danger arifing from Neglect, or Improper Treatment 319 Proper Mode of Treatment pointed out 320 Danger of producing Inflammation of the Lungs and Confumption _— 321 A Common flight Cold, a frequent Caufe of Confumption 321 111 Confequences from attending to the Cough only 322 Cough Drops, Elixirs, and other Noftrums 324 Too fudden Changes of the Atmofphere 325 Clothing, in general too light, and irregularly difpofed 326 Folly of expofing Children too much to exceffive Cold 327 Flannel and Fleecy Hofiery, Directions refpecting 327 Rules for preventing Catarrh 328 111 Confequences of receiving Company in cold and damp Rooms ■ 329 nvulsive Asthma ■ 33° Excellent Remarks on by Dr. Bree 330 332 North- Effects of the Atmofphere, Cold, Eaft and Eaft Winds, Storms, &c. on the Afthmatic 333 Treatment neceffary during the Fit 335 Emetics and Bleedings, Obfervations on 337 Blifters and Warm Bathing ---- 338 Smoke of Tobacco, its Effects- ——• 339 Rules for the Prevention of this Difeafe 34i Hooping Cough — 342 Obfervations on the Noftrums recommended in this Diforder ---- — . ■ 34a Changs of Air, beneficial Effeds 345 Principles contents. 5*5 Page Principles fuggefted, on which this Change may be made ---- *4 Dysentery, or Bloody Flux -------■ 348 Symptoms of Recovery, or of Danger $49 Danger from permitting its too long Continuance 350 Mode of Cure contrary to common Opinion 351 Treatment of the Patient, ---- 352 Apoplexy ---• .---' 352 Conduct to be adopted in the firft Moments of Attack 355 Bleeding and Blifters, Obfervations on 357 Peculiarity of Make fuppofed to predifpofe to this Difeafe ■------ '------ 359 Mode of preventing the Difeafe 36° Sleeping after a full Meal, in a Chair, Remarks on 361 Apopledic Fits occur during Bed-time from horizon- tal Pofture ------ 363 Apoplexy too often the Lot of the retired Citizen 364 Deception as to the quantity of Exercife employed 365 Palsy ---- ---- 3«6 Symptoms and Caufes enumerated ---- 367 Eledricity, Obfervations on its Effeds 369 Fainting 37l Mode of Treatment ------ 372 Obfervations on the Mode of applying pungent O- dours to the Noftrils 373 Apparent Death, 375 From long Fafting, Treatment of 375 From Expofure to extreme Cold - 375 Refufeitative Procefs---- 377 In 5*6 contents. Page In Cafes of Sufpenfion by the Cord t-jq Suffocation by Noxious Vapours 370 379 380 380 ------— Intoxication Convulsions — Numerous Caufes of Condud to be adopted on the firft Attack 38! Convulfions in Children, Remarks on 382 Remarks on the Opinion of the Inutility of Phyficians in Difeafes of Children ---- 38, Epilefsy, or Falling Sigknes^ 385 Treatment during the Fit ,. 386! Worms, Symptoms of ...... 387 Ambiguity of the. Appearances fuppofed to denote their Prefence .---- 388 Mifchiefs arifing from Error 388 Danger of having recourfe to advertifed Noftrums 388 Weakness of the Stomach 389 Symptoms and Caufes of enumerated 390 Spirituous Liquors, injurious Effeds of 391 Remonftrances of Phyficians but too little attended to 391 Condud proper to be adopted 395 Hypochondriac Affection, Defcribed ■ 397 Attention required from the Frielids of the Patient 398 Confiderable Exertions demanded of the Patient himfelf 398 Cruelty of treating the Hypochondriac as a Subjed of Raillery and Reproof 395 Colic Colic Tindures and Elixirs, Remarks on 40a Danger of miftaking Symptoms of Strangulated Rup- ture and of Inflammation of the Bowels for thofe of Colic . 401 Difficulty contents. 517 Page Difficulty of making the neceffary Diftindion 402 Mode to be adopted when regular Aid is not to be obtained ------ —— 402 Ruptures, or Hernia Defcribed ------ 4°3 Their Increafe dependent on the Will and Refolution of the Patient ---- 4°4 May be conftantly retained 4°4 Truffes, Remarks on ■ 4°S Strangulated Rupture ---- 4°7 Life depends on immediate Redudion 407 Danger of Exertion improperly made, and of wafting a Moment in domeftic Quackery 4°8 Operation thereby rendered neceffary 4°9 The operation much lefs painful than is generally imagined, and in itfelf void of Danger 410 Duty of a Surgeon in this Cafe 4l° Rupture at the Navel------ 411 Neceffity of early and conftant Attention 411 Mode of treatment ■■■■ 413 Ulceration of the Navel in Children 4ir Demanding the utmoft Care 417 Cholera, Defcribed ---- —— 413 Treatment of flight Cafes ---- 4'3 Cautions refpeding violent Attacks in very young or old Perfons ------ 4T4 Diarrhoea, or Looseness General Mode of Treatment, Remarks on 4*4 Diabetes, Attention called to its firft Appearances 4l6 Succefsfully treated — 4l6 Hysterical 518 contents. Page Hysterical Affections Danger of having recourfe to violent forcing Nof- trums, as Deobftruents —— 417 Indolence often unjuftly imputed to the Subjeds of this Difeafe .... ■ 417 Dropsy Obfervations on the Employment of Noftrums in this Difeafe , ---- 418 Hydrocephalus, or Watery Head, Symptoms defcribed----- 419 Caufes enumerated ..... 421 Cautions refpeding the Corredion of Children 421 Danger from Blows on the Head -—— 422 Mode of Defence in Cafes of Falls fuggefted 423 The Bite of an Hydrophobic Akimal( Neceffity of immediate Excifion pointed out, and Diredions refpeding it —— 423 Scald Head, Defcribed ■ ---- 424 Early affiftance neceffary ■ 425 111 Confequences of Negled — -■ 426 Scrofulous Swellings in the Neck produced by it 427 Thrush, in Children, generally proceeding from impro- per Diet ------ 4*7 Dry-nurfing the moft frequent Caufe 428 Cautions refpeding the violent rubbing affeded Parts 429 Swallowing of piws, &c. Proper Mode of Condud to be adopted 43° Bcil, often improperly treated, and the Conftitution thereby injured —— ---- 434 Anthrax contents. 5x9 Page Anthrax, or Carbuncle, Defcribed ---- ---- 434 Danger of miftaking for a common Boil —— 434 Importance of the early Adoption of efficacious Means 434 Inflammation and Abscess of the Breast ---- 435 Cure may be much accelerated by furgical Aid — Hardnefs fometimes produced refembling Schirrhus 436 Chilblains, Treatment of propofed, Prevention, &c. — 438 Whitlow, Danger from ■ --- 44a Neceffity of immediate Application to the fkilful Sur- geon ---- ---- 44* Schirrhus and Cancer, Defcribed ------ ------ 443 Early Removal earneftly recommended ---- 444 Repugnance to the Operation not merely from the Fear of Pain ---- ---- 444 Confederations fuggefted as likely to diminifh the dread of the Operation ---- —— 444 Cancer Curers, pretended, Injuries they occafion — Remarks on the Cafes, on which their Fame is built 445 Scalds and Burns, Applications recommended to be kept in Readinefs 449 Linfeed Oil, improper —— ---- 450 Meafures fuggefted for Adoption, by Females, whofe Clothes have by Accident taken Fire ---- 450 Effusions of Blood from ruptured or wounded Vessels ------ ■ 452 Situation of the large Veffels, Sec. defcribed by Mr. Blizard ---- ---- 453 Meafures 5-0 CONTENTS. Page Meafures to V adopted in Cafes of Accidents of this Nature <•*' • - ------ 454 * '^ Bleeding ■ ---- 457 " Wafte of Blood from the Orifice opening afrefh 458 jfc Diredions for its Prevention ---- 458 Leeches $ Diredions for their Application and Management 459 -^ Curvature of the Spine Neceffity of abfolute Reft —— ----461 Inflammation of the Hip and Knee Joint Caution refpeding Attention to the earlieft Symptoms 461 Reft enjoined ■ .. 462 Fractures of the Limbs, and Injuries of the Head from External Injuries. 462 Treatment at the firft Moments of the Accident 463 Diredions refpeding the Removal of the Patient 464 Obfervations on the improper indulgence of Children 465 I'- * '\ :\ !• ★ * ARMY * * MEDICAL LIBRARY ^ Geoeland Branch M**l. Hid, MO' &*v (> *?tf8ajfcv'\