f» . ,v w : \ W >, fe I * •jjll t: / &( \9 CONSISTING OF 1896 VOLS. % , Bequeathed by the late £> BENJAMIN DE MILT, g TO THE » GENERAL SOCIETY P OF MECHANICS' AND TRADESMEN, g?< [ And arranged in the |p jf } NEW YORK APPRENTICES' LIBRARY. , ■:i jvo. fr&£f • Dr. BUCHAN's FAMILY MEDICAL WORKS: CONTAINING THE DOMESTIC MEDICINE, ENLARGED : £ () I () 5 AND THE ADVICE TO MOTHERS, ON THE SUBJECT OF THEIR OWN HEALTH; AND ON THE MEANS OF PROMOTING THE HEALTH, STRENGTH, AND BEAUTY OF THEIR OFFSPRING. \\ \ DOMESTIC MEDICINE, ^ryysf y/j* A TREATISE ON THE PREVENTION AND CURE OF DISEASES BY REGIMEN AND SIMPLE MEDICINES. ~-±-f WITH 9 AN APPENDIX, 3 0 1 C> 8 '•if $ C7 6» CONTAINING -jd* DISPENSATORY FOR THE TJST ^F PRIVATE PRACTITIONERS. TO WHICH ARE ADDED, OBSERVATIONS ON DIET; RECOMMENDING L METHOD OF LIVING LESS EXPENSIVE AND MORE CONDU- CIVE TO HEALTH THAN THE PRESENT. BY WILLIAM BUCHAN, M.T). ^ ./y FELLOW OF THE ROYAL COLLEGE OF THYSICliNS, EDINBURGH, - " ) NEW-YORK; PUBLISHED BY SAMUEL A. BURTUS, No. 19 PETK-SLtP, CORNER OF WATER-STREET Largin & Thompson, Printers. 1813, I ft3 k t. \ s\ ADVERTISEMENT. THE present edition of the *' Domestic Medicine," claims no other pre-eminence over former impressions, than that it is a copy of the Author's last revisal. ■ From an examination of the several revised editions of this Work, which have been published in the Union, it appears, a particular defer- rence has been shewn to the Author's opinion, and the improvements to be chiefly in addition—From this consideration, which no doubt origi- nated, not only from the correctness of the Author's principles and prac- tice, but from the deservedly high estimation the public entertain for the original Work, the publisher of the present Impression, was induced not to admit of any alterations.—The articles which have been added to this edition, from the sources whence they have been derived, whether original or selected, will no doubt enhance its value. The new matter in the body of the Work, is marked with a Section, and that of the Notes will readily be distinguished by the letters, a. e, New-Yokk, 1812. ^ ^ ^ S: ADVERTISEMENT BY DR. BUCHAN. THE Author, having been in constant practice since the first appear- ance of this Book, has taken occasion in the later Editions through which it has passed, to improve many articles which were inserted with less accuracy in the more early impressions. To the preceding Edition wras added a Chapter on Diet, recommending a method of living Jess expendve, and more conducive to health, than the present. Several other improvements have been also made in the form of notes to illus- trate the text, or put people on their guard in dangerous situations, and prevent fatal mistakes in the practice of medicine, which, it is to be re- gretted, are but too common. Although the Domestic Medicine was never intended to supersede the use of a Physician, but to supply his place in situations where me- dical assistance could not easily be obtained; the Author is sorry to ob- serve, that the jealousies and fears of some of the Faculty have prompt- ed them to treat the Work in a manner very unbecoming the Professors of a liberal science: notwithstanding this injurious treatment, convinced of the utility of his plan, he shall spare no pains to make it more useful; determined that neither interest nor prejudice shall ever deter him from exerting his best endeavours to render the Medical Art more exten- sively beneficial to Mankind* New-Store Street, Bedford Square, ) June 4, 1798. $ 3oj^y CONTENTS. PART I. Of the general causes of diseases. chap. i. Of Children - - - Page 33 — Diseased Parents - - - 36 — Clothing of Children - - 37 — Food of ditto - --- 40 — Exercise of ditto - - - 44 — Bad effects of unwholesome Air upon ditto - - - - 49 — Nurses ------ 50 chap II. Of the laborious &c. - - - 52 — the Sedentary - - - - 58 — the Studious.....61 CHAP III. Of Aliment......66 CHAP IV. Of Air......- 78 CHAP V. Of Exercise - - - - 82 CHAP VI. Of Sleep.......85 — Clothing - , ... 86 CHAP. VII. Of Intemperance - - - - 89 CHAP. VIII. Of Cleanliness.....92 CHAP IX. Of Infection......95 CHAP x. Of the Passions - - - - 98 — Anger ......ib. — Fear.......99 — Grief......101 — Love......102 — Religious Melancholy - 103 CHAP. XI. Of the Common Evacuations ib. — Stool.......ib. — Urine ------ 105 — Perspiration - - - - 106 — being affected by Changes in the Atmosphere - - - ib. — Wet Clothes - - - - 107 — Wet feet ----- ib. Of Night Air - - - Page 101 — Damp Beds - - - - ib. — Damp Houses - - - - 108 — Sudden Transitions from Heat to Cold - - - - 109 PART II. Of Diseases. CHAP. XII. Of the Knowledge and Cure of Diseases - ---. -in CHAP. XIII. Fevers in general - - - - 114 CHAP. XIV. Of intermitting Fevers or Agues 117 CHAP. XV. Of an acute continual fever 123 CHAP. XVI. Of the Pleurisy ----126 ------Bastard ditto - - 129 ------ Paraphrenias - - ib. CHAP. XVII. Inflammation of the Lungs 130 CHAP. XVIII. Of Consumptions - - - 132 CHAP. XIX, Of the Slow or Nervous Fever 139 CHAP xx. Malignant, Putrid or Spotted Fever ------ 143 CHAP. XXI. Miliary Fever - - - - 148 CHAP. XXII. Remitting Fever - - - - 151 chap. xxm. Of the Yellow Fever - - 153 chap. xxiv. The Small Pox - - - - 159 Inoculation.....166 chap xxv. Of the Cow-pox, and its Inocu- lation .......173 chap xxvi. The Measles.....179 ----Scarlet Fever - - - 182 CONTENTS. The Bilious Fever - Page 183 chap, xxvii. St. Anthony's Fire - - - 183 chap, xxviii. Inflammation of the Brain - 186 CHAP. xxix. Inflammation of the Eyes - 189 CHAP. XXX. TheQuinsey.....192 ----Malignant ditto - - 196 CHAP. XXXI. Colds and Coughs - - - 198 A Common Cough - - - 20n Hooping Cough - - - - 202 CHAP. XXXII. Inflammation of the Stomach 205 -----------of the Intestines 206 Of the Colic.....209 Inflammation of the Kidnies 212 ------------of the Bladder 213 ------------of the Liver 214 CHAP. XXXIII. Of the Cholera Morbus and other excessive discharges from the Stomach and Bow- els ........216 — a Diarrhoea, or Loosenees 217 — Vomiting.....219 CHAP XXXIV. Disorders of the kidnies and Bladder......221 Of the Diabetes, or excessive Discharge of Urine - - ib — Suppression of ditto - - 223 — tiie Gravel and Stone - 224 CHAP. XXXV. Involuntary Discharges of Blood 226 Bleeding at the Nose Bleeding and Blind Piles Spitting of Blood - - Vomiting of ditto - - Bloody Urine - - - ------Flux - - - - \ . .chVi11* XXXIX. Of theVDropsy - - -* \ CHAP. XL. Of the Gout - - - ------Rheumatism - CHAP XLI. Of the Scurvy - - Scrophula Page 250 — Itch Cceliac Passion - - - chap, xxxvi. Of the Head-ach - - ------Tooth-ach ------Ear-ach - - Pain of the Stomach, &c. CHAP. XXXVII. Of Worms - - - - CHAP, xxxvin. Of the Jaundice - - 227 229 23] 233 234 235 238 - 239 - 241 - 243 - 244 - 245 - 248 CHAP. XLII. Of the Asthma • - CHAP. XLIII. Of the Apoplexy CHAP. XLIV. Of Costiveness - - — Want of Appetite — Heart-burn - - CHAP XLV. Of Nervous Diseases — Melancholy - - — the Palsy - - - — the Epilepsy, or falling Sickness..... — the Hickup - - - - — Cramp of the Stomach - — The Night Mare - - — Swoonings - - - - — Flatulencies or Wind — Low Spirits - - - - — Hysteric affections - - Hypochondriac affections The Tetanus, or Jaw - - - the Locked 254 258 260 263 265 267 269 271 273 ib. 274 277 280 281 233 284 ib. 285 286 288 289 291 I 293 CHAP. XLVI. Disorders of the Senses of the Eye A Gutta Serena A Cataract..... Short Sightedncss ... Seeing only at too great a dis tance -----., Stinting ------ Spots or Specks - - - - Bloodshot Eye - - - - Watery or Weeping Eye Of the Ear..... ------Taste and Smell ------Touch - - - . CHAP, xlvii. Of a Scirrhous and Cancer 301 chap, xlviii. Of Poisons ----- 3qj — Mineral Poisons - - - 305 Vegetable %itto - - - ib 295 ib. 296 ib. 297 tb. ib. ib. ib. ib. ib. 299 300 CONTENTS. VII Bites of poisonous auimals P. 306 .--- of the Mad Dog - - ib. ---- of the viper - - - 311 ■■ of Poisonous Insects - ib. ---- of the Rattle-Snake - 312 Ketteriug's Specific for the Hydro- phobia ......313 CHAP. XLIX. Of the Venereal Disease - ib. ----- Virulent Gonorrhoea 314 OfGleets......319 — Swelled Testicles - - 321 — Buboes......ib. — Chancres - - - - 322 — A confirmed Lues or Pox 324 General observations - - - 327 CHAP. L. Diseases of Women - - - 330 Of the Menstrual Discharge - 331 — Pregnancy.....335 — Child-birth - - - - 337 — Barrenness - - - - 341 CHAP. LI. Diseases of Children - - 342 Of the Meconium - - - 343 — The Apthee or Thrush - 344 — Acidities ----- ib. — Galling and Excoriation 345 — Stoppage of the nose - - 345 — Vomiting.....ib. — A Looseness - - - - 347 — Eruptions.....ib. — The Croup or Hives - 349 — Teething.....350 — The Rickets - - - - 352 — Convulsions - - - - 353 — Water in the head - - 354 CHAP. LII. Of Surgery . - - - - 355 — Bleeding.....356 — Inflammations and Abscess- es ...... - - 358 — Wounds.....359 — Burns and Scalds - - - 361 — Bruises..... 363 — Ulcers......364 CHAP. LIU. Of Dislocations - - - - 366 Dislocation of the Jaw - - ib. ------- of the neck - - 367 -------of the Ribs - - ib. —-----of the Shoulder - 368 ------- of the Elbow - ib. Dislocation of the Wrist and Fingers - - - Page 36 S -------of the Thigh - - ib. -------of the Knees - 369 -------of the Ancles - ib- -------of the Toes - - ib. CHAP. LIV. Of Broken Bones, &c. - ib. — Strains......371 — Ruptures.....372 CHAP. LV. Of Casualties . - - - 373 — Substances stopt between the Mouth and the Stomach - 374 — Drowned Persons - - '- 377 — Noxious Vapours - - 380 Effects of extreme Cold - - 381 ------------Heat - - 382 CHAP. LVII. Of Fainting Fits, and other Ca- ses which require immediate Assistance.....382 — Intoxication - - - - 385 — Suffocation and Strangling 386 — Persons who expire in Con- vulsion Fits - - - - 388 CHAP. LVII. Cautions concerning Cold Bath- ing, and drinking the Mineral Waters..... 390 CHAP. LVIII. Observations concerning Diet, recommendiug a method of living less expensive, and more conducive to health than the present - - - 397 General observations on Aliment 398 Of Bread.....■- 399 — Boiled Grain - - - 402 — Butter......405 — Fruits and Roots - - - 407 — Broths and Soups - - 411 Conclusion......413 APPENDIX. Introduction ----- 413 List of Simples - - - - 421 MEDICAL PREPARAflOSS. Balsams ------ 423 Boluses...... ib. Cataplasms and Sinapisms - 424 Clysters...... 425 Collyria, or Eye-waters - - 426 Vlll CONTENTS. Confections - - - Page Conserves and Preserves - Decoctions - - - - - Draughts - - - - - Electuaries..... Emulsions..... Extracts..... Fomentations - - - - Gargles ------- Infusions -..... Juleps - - - - - Mixtures ------ 426 ib 427 428 429 430 431 ib. 432 4 S3 434 435 GLOSSARY Ointments, Liniments and Ce- rates - - - - Pa°-c 435 Pills ------ 437 Plasters...... 439 Powders..... ib. Syrups...... 4 12 Tinctures, Elixirs, &c. - - ib. Vinegars......445 Waters by infusion, &c. ■ Simple distilled Waters - Spirituous distilled Waters- Wheys 446 ib. 417 ib. Wines ------- ib. 449 INDEX 451 PREFACE. WHEN I first signified my intention of publishing the fol- lowing sheets, I was told by my friends it would draw on me the re- sentment of the Faculty. As I never could entertain such an unfa- vourable idea, I was resolved to make the experiment, which indeed came out pretty much as might have been expected.^ Many whose learning and liberality of sentiments do honour to medicine, received the book in a manner which at once showed their indulgence, and the falsity of the opinion that evert/physician wishes to conceal his art; while the more selfish aud narrow-minded, generally the most numerous in every profession, have not failed to persecute both the book and its author. The reception, however, which this work has met with from the Pub- lic, merits my most grateful acknowledgments. As the best way of ex- pressing these, I have endeavoured to render it more generally useful, by enlarging the prophylaxis, or that part which treats of preventing di- seases ; and by adding many articles which had been entirely omitted in the former impressions. It is needless to enumerate these additions; I shall only say, that I hope they will be found real improvements. The observations relative to Nursing and the Management of chil- dren, were chiefly suggested by an extensive practice amoug infants, in a large branch of the Foundling Hospital, where I had an opportunity not only of treating the diseases incident to childhood, but likewise of try- ing different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and to be satisfied that they performed it, very few of them died; but when, from distance of place, and other unavoidable circumstances, the children were left to the sole care of mercenary nurses, without any person to instruct aud superintend them, scarce any of them lived. This was so apparent, as with me to amount to a proof of the follow- ing melancholy fact: That almost one half of the human species perish in infancy, by improper management or neglect: This reflection has made me often wish to be the. happy instrument of alleviating the miseries of those suffering innocents, or of rescuing them from au untimely grave. No one, who has not had an opportunity of observing them, can ima- gine what absurd and ridiculous practices still prevail in the nursing and management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to igno- rance, it is to be hoped, that when nurses are better informed, their conduct will be more proper. The application of medicine to the various occupations of life has been in general the result of observation. An extensive practice for 2 X PREFACE. several years, in one of the largest manufacturing towns in England af- forded me sufficient opportunities of observing the injuries which those useful people sustain from their particular employments, and likewise of trying various methods of obviating such injuries. The success which attended these trials was sufficient to encourage this attempt, which I hope will be of use to those who are under the necessity of eating their bread by such employments as are unfavourable to health. I do not mean to intimidate men, far less to insinuate that even those arts, the practice of which is attended w ith some degree of dan- ger, should not be carried on; but to guard the less cautious and un- wary agaiust those dangers which they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occu- pation in life disposes those who follow it to some particular diseases more than to others, it is certainly of importance to know these, in or- der that people may be upon their guard against them. It is always better to be warned of the approach, of an enemy, than to be surprised by him, especially when there is a possibility of avoiding the danger. The observations concerning Diet, Air, Exercise, &c. are of a more general nature, and have not escaped the attention of physicians in any age. They are subjects of too great importance, however, to be passed over in an attempt of this kind, and can never be sufficiently recom- mended. The man who pays a proper attention to these, will seldom need the pliysician; and he who does not, will seldom enjoy health, let him employ as many physicians as he pleases. Though we have endeavoured to point out the causes of diseases, and to put people upon their guard against them, yet it must be ac- knowledged that they are often of such a nature as to admit of being re- moved only by the diligence and activity of the public magistrate. We are sorry, indeed, to observe, that the power of the magistrate is sel- dom exerted in this country for the preservation of health. The im- portance of a proper medical police is either not understood, or little regarded. Many things highly injurious to the public health are daily practised with impunity, while others, absolutely necessary for its pre- servation, are entirely neglected. Some of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widening the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, &c.; but they are passed over in a very cursory manner. A proper attention to these would have swelled this volume to too large a size; I have therefore reserved them for the subject of a future publication. In the treatment of diseases, I have been peculiarly attentive to regimen. The generality of people lay too much stress upon Medi- cine, and trust too little to their own endeavours. It is always in the power of the patient, or of those about him, to do as much towards his recovery as can be effected by the physician. By not attending to this, the designs of medicine are often frustrated; and the patient," by pursuing a wrong plan of regimen, not only defeats the Doctor's en- deavours, but renders them dangerous. I have often known patients killed by an error in regimen, when they were using very proper me- dicines. It will be said, the physician always orders the re«nmen when he prescribes a medicine. I wish it were so, both for the ho PREFACE. XI nour of the faculty and the safety of their patients: but physicians, as well as other people, are too little attentive to this matter. Though many reckon it doubtful whether physic is beneficial or hurtful t<> mankind, yet all allow the necessity and importance of a proper regimen in diseases. Indeed the very appetites of the sick prove its propriety. No man in his senses, ever imagined that a person in a fever, for example, could eat, drink, or conduct himself in the same manner as one in perfect health. This part of medicine, therefore, is evidently founded in Nature, and is every way consistent with reason and common sense. Had men been more attentive to it, and less solicitous in hunting after secret remedies, Medicine had never become au object of ridicule. This seems to have been the first idea of Medicine. The ancient physicians acted chiefly in the capacity of nurses. They went very little beyond aliment in their prescriptions; and even this they gene- rally administered themselves, attending the sick for that purpose through the whole course of the disease; which gave them an opportu- nity not only of marking the changes of diseases with great accuracy, but likewise of observing the effects of their different applications, and adapting them to the symptoms. The learned Dr. Arbuthnot asserts, that by a proper attention to those things which are almost within the reach of every body, more good and less mischief will be done in acute diseases, than by medicines im- properly and unseasonably administered; and that great cures may be effected in chronic distempers, by a proper regimen of the diet only. So intirely do the Doctor's sentiments and mine agree, that I would advise every person, ignorant of physic, to confine his practice solely to diet, and the other parts of regimen; by which means he may often do much good, and can seldom do any hurt. This seems also to have been the opiuion of the ingenious Doctor Huxham, who observes, that we often seek from Art what all-bountiful Nature most readily, and as effectually, offers us, had we diligence and sagacity enough to observe and make use of them; that the dietetic part of Medicine is not so much studied as it ought to be; and that though less pompous, yet it is the most natural method of curing diseases. To render this book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have in most diseases, besides regimen, recommended 6ome of the most simple and approved forms of medicine, and added such cautions and directions as seemed necessary for their 6afe administration. It would no doubt have been more acceptable to many, had it abounded with pompous prescriptions, and promised great cures in consequence of their use; but this was not my plan: I think the administration of medicines always doubtful, aud often dangerous, and would much rather teach men how to avoid the necessity of using them, than how they should be used. Several medicines, and those of considerable efficacy, may be admi- nistered with great freedom and safety. Physicians generally trifle a long time with medicines before they learn their proper use. Many peasants at present know better how to use some of the most important articles in the materia medico, than physicians did a century ago; aud doubtless the same observations will hold with regard to others some XII PREFACE. time hence. Wherever I was convinced that medicine might be used with safety, or where the cure depended chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, or not very necessary, it is omitted. I have not troubled the reader with an useless parade of quotations from different authors, but have in general adopted their observations where my own were either defective, or totally wanting. Those to whom I am most obliged are, Ramizini, Arbuthnot, and Tissot; the last of which, in his Avis du Peuple, comes the nearest to my views of any author which I have seen. Had the Doctor's plan been as complete as the execution is masterly, we should have had no occasion for any new treatise of this kind soon; but by confining himself to the acute diseases, he has in my opinion omitted the most useful part of his sub- ject. People in acute diseases may sometimes be their own physicians; but in chronic cases, the cure must ever depend chiefly upon the pa- tient's own endeavours. The Doctor has also passed over the Prophy- laxis, or preventive part of medicine veiy slightly, though it is certain- ly of the greatest importance in such a work. He had no doubt his reasons for so doing, and I am so far from finding fault with him, that I think his performance does great honour both to his head and his heart. Several other foreign physicians of eminence have written on nearly the same plan with Tissot, as the Baron Van Swienten, physician to their Imperial Majesties, M. Rosen, first physician of the kingdom of Sweden, &x.; but these gentlemen's productions have never come to my hand. I cannot help wishing, however, that some of our distin- guished countrymen would follow their example. There still remains much to be done on this subject, and it does not appear to me how any man could better employ his time or talents, than in eradicating hurtful prejudices, and diffusing useful knowledge among the people. I know some of the Faculty disapprove of every attempt of this nature, imagining that it must totally destroy their influence. But this notion appears to me to be as absurd as it is illiberal. People in distress will always apply for relief to men of superior abilities, when they have it in their power; and they will do this with far greater confidence and readiness when they believe that medicine is a rational science, than when they take it to be only a matter of mere conjec- ture. Though I have endeavoured to render this Treatise plain and useful, yet I found it impossible to avoid some terms of art, but those are in general either explained, or are such as most people understand. In short, I have endeavoured to conform my style to the capacities of man- kind in general; and, if my Readers do not flatter either themselves or me, with some degree of success. On a medical subject, this is not so easy a matter as some may imagine. To make a shew of learning is easier than to write plain sense, especially in a science which has been kept at such a distance from common observation. It would however be no difficult matter to prove, that every thing valuable in the practi- cable part of medicine is within the reach of common abilities. It would be ungenerous not to express my warmest acknowledg- ments to those gentlemen who have endeavoured to extend the use- fulness of this performance; by translating it into the language of their respective countries. Most of them have not only given ele- PREFACE. 3UU gant translations of the Book, but have also enriched it with many useful observations, by which it is rendered, more complete, and better adapted to the climate and the constitutions of their countrymen. To the learned Dr. Duplanil of Paris, physician to the Count d'Artois, I lie under particular obligations; as this gentleman has not only consi- derably enlarged my treatise, but, by his very ingenious and useful notes, has rendered it so popular on the Continent, as to occasion its being translated into all the languages of modern Europe. I have only to add, that the book has not more exceeded my expecta- tions in its success, than in the effects it has produced. Some of the most pernicious practices, with regard to the treatment of the sick, have already given place to a more rational conduct; and many of the most hurtful prejudices, which seemed to be quite insurmountable, have in a great measure yielded to better information. Of this a stronger in- stance cannot be given than the inoculation of the small pox. Few mothers, some years ago, would submit to have their children inoculated even by the hand of a physician; yet nothing is more certain, than that of late many of them have performed this operation with their own hands; and as their success has been equal to that of the most dignified inoculators, there is little reason to doubt that the practice will become general. Whenever this shall be the case, more lives will be saved by inoculation alone, than are at present by all the endeavours of the Fa- culty. INTRODUCTION. TlIE improvements in Medicine, shite the revival of learn- ing have by no means kept pace with those of the other arts. Tin- reason is obvious. Medicine has been studied by few, except those who intended to live by it as a business. Such either from a mistaken zeal for the honour of Medicine, or to raise their own importance, have en- deavoured to disguise and conceal the art. Medical authors have gener- ally written in a foreign language; and those who were unequal to this task, have even valued themselves upon couching, at least, their pre- scriptions, in terms and characters unintelligible to the rest of mankind. The contentions of the clergy, which soon happened after the re- storation of learning, engaged the attention of mankind, and paved the way for that freedom of thought and enquiry, which has since prevailed in most parts of Europe with regard to religious matters. Every man took a side in those bloody disputes; and every gentleman, that he might distinguish himself on one side or other was instructed in Divinity. This taught people to think and reason for themselves in matters of reli- ion, and at last totally destroyed that complete and absolute dominion which the clergy had obtained over the minds of men. The study of Law has likewise in most civilized nations, been justly deemed a necessary part of the education of a gentleman. Every gen- tleman ought certainly to know at least the laws of his own country; and. if he were also acquainted with those of others, it might be more than barely an ornament to him. The different branches of Philosophy have also of late been very universally studied by all who pretended to a liberal education. The ad- vantages of this are manifest. It frees the mind from prejudice and su- perstition, fits it for the investigation of truth; induces habits of rea- soning and judging properly; opens an inexhaustible source of enter- tainment ; paves the way to the improvement of arts and agriculture; and qualifies men for acting with propriety in the most important sta- tions of life. Natural History is likewise become an object of general attention; and it well deserves to be so. It leads to discoveries of the greatest import- ance. Indeed agriculture, the most useful of all arts^is only a branch of Natural History, and can never arrive at a high degree of improvement where the study of that science is neglected. Medicine however, has not, as far as I know, in any countrj, been reckoned a necessary part of the education of a gentleman. But surelv no sufficient reason can be assigned for this omission. No science lays open a more extensive field of useful knowledge, or affords more ample entertainment to an inquisitive mind. Anatomy, Botany Chymistry. and the Materia Medica, are all branches of Natural Histo- ry, and are fraught with such amusement and utility, that the man who entirely neglects them has but a sorry claim either to taste or learning If a gentleman has a turn for observation, says an excellent and seusibTe INTRODUCTION. XV writer*, surely the natural history of his own species is a more interest- ing subject, aud presents a more ample field for the exertion of genius, than tlie natural history7 of spiders and cockle-shells. We do not mean that every man should become a physician. This would be an attempt as ridiculous as it is impossible. All we plead for is, that men of sense and learning'should be so far acquainted with the ge- neral principles ol Medicine, as to be in a condition to derive from it some of those advantages with which it is fraught; and at the same time to guard themselves against the destructive influences of ignorance, supersti- tion and quackery. As matters stand at present, it is easier to cheat a man out of his life than of a shilling, and almost impossible either to dectect or punish the offender. Notwithstanding this, people still shut their eyes, and take every thing upon trust that is administered by any Pretender to medicine,with- out daring to ask him a reason for any part of his conduct. Implicit faith, every where else the object of ridicule, is still sacred here. Many of the faculty are no doubt worthy of all the confidence that can be re- posed in them, but as this can never be the character of every individual in any profession, it would certainly be for the safety, as well as the hon- our, of mankind, to have some check upon the conduct of those to Avhom they entrust so valuable a treasure as health. The veil of mystery, which still hangs over Medicine, renders it not only a conjectural, but even a suspicious art. This has been long ago re- moved from the other sciences, which induces many to believe that me- dicine is a mere trick, and that it will not bear a fair and candid exami- nation. Medicine, however, needs only to be better known, in order to secure the general esteem of mankind. Its precepts are such as every wise man would chuse to observe, and it forbids nothing but what is in- compatible with true happiness. Disguising Medicine not only retards its improvement as a science, but exposes the profession to ridicule, and is injurious to the true interests of society. An art founded on observation never can arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united observations of all the ingenious and sensible part of mankind, would do more in a few years towards the improvement of Me- dicine, than those of the Faculty alone in a great many. Any man can tell when a medicine gives him ease as well as a physician; and if he only knows the name and dose of the medicine, and the name of the disease, it is sufficient to perpetuate the fact. Yet the man who adds one single fact to the stock of medical observations, does more real ser- vice to the art, than he who writes a volume in support of some favour- ite hypothesis. Veiy few of the valuable discoveries in medicine have been made by physicians. They have in general either been the effect of chance or of necessity, and have been usually opposed by the Faculty; till eyeiy one else was convinced of their importance. An implicit faith in th^ opinions of teachers, an attachment to systems and established forms, and (he dre^d of reflections, will always operate upon those who follow mc- decine as a trade. Few improvements are to be expected from * Observations on the Duties and Offices of a Phvsician. XVI INTRODUCTION. a man who might ruin his character and family by the smallest deviation from an established rule. If men of letters, says the author of the performance quoted above, were to claim their right of inquiry into a matter that so nearly con- cerns them, the good effects on medicine would soon appear. Such men would have no separate interest from that of the art. They would detect and expose assuming Ignorance under the mask of Gravity and Importance, and would be the judges and patrous of modest merit. Not having their understandings perverted in their youth by false theories, unav.cd by authority, and unbiassed by interest, they would canvass with freedom the most universally received principles in medicine, and expose the uncertainty of many of those doctrines, of which a physician dares not .-.o much as seem to doubt. No. argument, continues he, can be brought against laying open me- dicine, which does not apply with equal, if not greater, force to religion; yet experience has shown, that since the laity have asserted their right of inquiry into these subjects, Theology, considered as a science, has been improved, the interests of real reiigiou have been promoted, and the clergy have become a more learned, a more useful, and a more respectable body of men, than they ever were in the days of their great- est power and splendour. Had other medical writers been as honest as this gentleman, the art had been upon a very different footing at this day. Most of them extol the merit of those men who brought Philosophy out of the schools, and subjected it to the rules of common sense. But they never consider that medicine, at prc-cat, is in nearly the same situation as philosophy was at that time, and that it might be as much improved by being treated in the same manner. Indeed no science can either be render- ed rational or useful,, without being submitted to the common sense and reason of mankind. These alone stamp a value upon science; and what will not bear the test of these ought to be rejected. I know it will be said, that diffusing medical knowledge among the people might induce them to tamper with medicine, and to trust to their own skill instead of calling a physician. The reverse of this however is true. Persons who have the most knowledge in these matters, are commonly most ready both to ask and to follow advice, when it is ne- cessary. The ignorant are always most apt to tamper with medicine, and have the least confidence in Physicians. Instances of this are daily to be met with among the ignorant peasants, who, while they absolute- ly refuse to take a medicine which has been prescribed by a physician, will swallow with greediness any thing that is recommended to them by their credulous neighbours. Where men will act even without know- ledge, it is certainly more rational to afford them all the light we can than to leave then) entirely in the dark. It may also be alleged, that laying medicine more open to man- kind would lessen their faith in it. This would indeed be the case with regard to some; but it would have a quite contrary effect upon othens. I know many people avIio have the utmost dread and horror of every thing prescribed by a physician, but who will nevertheless very readily take a medicine which they know, and whose qualities they are in some measure acquainted with. Hence it is evident, that the dread arhes from the doctor, not from the drug. Nothing ever INTRODUCTION. Xvil can or will inspire mankind with an absolute confidence in physicians, but an open, frank, and undisguised behaviour. While the least shadow of mystery remains in the conduct of the Faculty, doubts, jealousies and suspicious, will arise in the minds of men. No doubt cases will sometimes occur, w here a prudent physician may find it expedient to disguise a medicine. The whims and humours of men must be regarded by those who mean to do them service ; but this cau never affect the general argument in favour of candour and openness. A man might as well allege, because there are knaves and fools in the world, that he ought to take every one he meets for such, and to treat him accordingly. A sensible physician will always know where disguise is necessary; but it ought never to appear on the face of his general conduct. The appearance of mystery in the conduct of physicians not only venders their art suspicious, but lays the foundations of Quackery, which is the disgrace of Medicine. No two characters can be more different than that of the honest physician and the quack; yet they have general- ly been veiy much confounded. The line between them is not sufficient. ly apparent; at least is too fine for the general eye. Few persons are able to distinguish sufficiently between the conduct of that man who ad- ministers a secret medicine, and him who writes a prescription in mystical characters and an unknown tongue. Thus the conduct of the honest physician, which needs no disguise, gives a sanction to that of the villian, whose sole consequence depends upon secrecy. No laws will ever be able to prevent quackery, while people believe that the quack is as honest a man, and as well qualified, as the physician. Avery small degree of medical knowledge, however, would be sufficient to break this spell; and nothing else can effectually undeceive them. It is the ignorance and credulity of the multitude, with regard to medicine, which renders them such an easy prey to every one who has the hardiness to attack them on this quarter. Nor can the evil be remedied by any other means but by making then; wiser. The most effectual way to destroy quackery in any art or science, is to diffuse the knowledge of it among mankind. Did physicians write their prescriptions in the common language of the country, and explain their intentions to the patient, as far as he could understand them, it would enable him to know wiicn the medicine had the desired effect; would inspire him with absolute confidence in the physician; and would make him dread and detest every man who pretended to cram a secret medi- cine down his throat Men in the different states of society, have very different views of the same object. Some time ago it was the practice of this country for every person to say his pra} ers in Latin, whether he knew any thing of that language or not. This conduct, though sacred in the eyes of our ancestors, appears ridiculous enough to u~; and doubtless some parts of ours will seem as strange to posterity. Among these we mny reckon the present mode of medical prescription, which, wre venture to affirm, will some time hence appear to haA'e been completely ridiculous-', and a very high burlesque upon the common sciiFe of mankind. But this practice is not only ridiculous, it is 1'kcArise dangerous. TIoAvever capable physicians may be of writing Latip. I am certain apothecaries are not always in a coiviition to read it, and that dangerous mistake^, in <:n;requeucp of this, often happen. Butsuppoeo the apothe- xvm IN IRODUCTIOX. caiy c\er so able to read the physician's prescription, he is generally' otherwise employed, and the business of making up prescriptions is lelt entirely to the apprentice. By tliis means the greatest man in the king- dom, even Ariicn he employs a first-rate physician, in reality trusts his life in the hands of an idle boy, who has not only the chance oi being very ignorant, but likeAvise giddy and careless. Mistakes will sometimes happen in spite of the greatest care ; but, where human lives are con- cerned, all possible methods ought certainly to be takeu to prevent them. For this reason, the prescriptions of physicians, iustead of being couched in mystical characters and a dead language, ought, in my humble opinion, to be conceived in the most plain and obvious terms imaginable. Diffusing medical knoAvledge among the people would not only tend to improve the art and to banish quackery, but likeAvise to render Medicine more universally useful, by extending its benefits to society. HoAvever long Medicine may have been knoAvn as a science, Are will veuture to say, that many of its most important purposes to society have either been overlooked, or very little attended to. The cure of diseases is doubtless a matter of great importance; but the preservation of health is of still greater. This is the concern of every man, and surely Avhat relates to it ought to be rendered as plain and obvious to all as possible. It is not to be supposed, that men can be sufficiently upon their guard against di- seases, who are totally ignorant of their causes. Neither can the Legisla- ture, in Avhose power it is to do much more for preserving the public health than can ever be done by the Faculty, exert that power with propriety, and to the greatest advantage, without some degree of medical knoAvledge. Men of every occupation and condition in life might avail themselves of a degree of medical knowledge; as it would teach them to avoid the dangers peculiar to their respective stations; which is always easier than to remove their effects. Medical knoAvledge, instead of being a check upon the enjoyments of life, only teaches men how to make the roost of, them. It has indeed been said, that to live medically, is to live miserably ; but it might with equal propriety be said, that to live ra- tionally is to live miserably. If physicians obtrude their own ridiculous whims upon mankind, or lay down rules inconsistent Avith reason or common sense, no doubt they will be despised. But this is not the fault of medicine. It proposes no rules that I knoAV, but such as are perfect- ly consistent with the true enjoyment of life, and every way condu- cive to the real happiness of mankind. We are sorry indeed to observe, that Medicine has hitherto hardly been considered as a popular science, but as a branch of knoAvledge sole- ly confined to a particular set of men, while all the rest have been taught not only to neglect, but even to dread and despise it. It will however appear, upon a more strict examination, that no science better deserves the attention, or is more capable of being rendered generally useful People are told, that if they dip the least into medical knowledge, it will render them fanciful, and make them believe they have eveiy disease of which they read. This I am satisfied will seldom be the case Avith sensible people; and suppose it were, they must soon be undeceived. A short time Avill shew them their error, aud a little more reading Avill infallibly correct it. A single instance will shew the absurdity of this notion. A sensible lady, rather than read a medical performance. which Avould fcistnict her in the management of her childrenv INTRODUCTION. XIX generally leaves them entirely to the care and conduct of the most igno- rant, credulous, and superstitious part of the human species. No part of medicine is of more general importance than that which relates to the nursing and management of children. Yet feAV parents pay a proper attention to it. They leave the sole care ©f their tender off- spring, at the very time when care and attention are most necessary, to hirelings, Avho are either too negligent to do their duty, or too ignorant to know it. We will Aenture to affirm, that more human lives are lost by the carelessness and inattention of parents and hurses, than are saved by the Faculty; and that the joint and Avell-conducted endeavours, both of private persons and the public, for the preservation of infant lives, Avonld be of more advantage to society than the whole art of medicine, upon its present footing. The benefits of medicine, as a trade, will ever be confined to those who are able to pay for them; and of course, the far greater part of man- kind Avill be every where deprived of them. Physicians, like other people, must live by their employment, and the poor must either want advice altogether, or take up with that which is Avorse than none. There are not hoArever any where wanting well-disposed people, of bet- ter sense, who are willing: to supply the defect of medical advice to the poor, did not their fear of doing ill often suppress their inclination to do good. Such people are often deterred from the most noble and praise-Avorthy actions, by the foolish alarms sounded in their ears by a set of men, who, to raise their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the sick which is not conducted by the precise rules of medicine. These gentlemen must however excuse me for say- ing, that I have often known such well-disposed persons to do much good; and that their practice, which is generally the result of good sense and observation, assisted by a little medical reading, is frequently more rational than that of the ignorant retainer of physic, who despises both reason and observation, that he may be wrong by rule; and who while he is dosing his patient with medicines, often neglects other things of far greater importance. Many things are necessary for the sick besides medicine. Nor is the person who takes care to procure these for them, of less importance than a physician. The poor oftener perish in diseases for want of proper nursing than of medicine. They are frequently in want of even the necessaries of life, and still more so of what is proper for a sick-bed. No one can imagine, who has not been a witness of there situations, how much good a Avell-disposed person may do, by only taking care to have such Avants supplied. There certainly cannot be a more necessa- ry, a more noble, or a more god-like action, than to administer to the wants of our fellow-creatures in distress.—While virtue or religion are knoAvn among mankind, this conduct will be approved; and Avhile Hea- ven is just it must be reArardedi Persons Avho do not choose to administer medicine to the sick, may nevertheless direct their regimen. An eminent medical author has said, That by diet alone all the intentions of medicine may be ansAver- fd.# No doubt a great many of them may; but there are other things * Arbuthnot. XX INTRODUCTION. besides diet, which ought by no means to be neglected. Many huvthjj and destructive prejudices, with regard to the treatment of the sick, rti» prevail anion* the people, which persons of better sense and learning alone can eradicate. To guard the poor against the influence of these preju- dices, and to instil into their minds some just ideas of the importance ot proper food, fresh air, cleanliness, and other pieces of regimen necessary in diseases,'would be a work of great merit, and productive of many happy consequences. A proper regimen, in most diseases, is at least equal to medicine, and in many of them it is greatly superior. To assist the well-meant endeavours of the humane and benevolent in relieving distress ; to eradicate dangerous and hurtful prejudices; to guard the ignorant and credulous against the frauds and impositions of quacks and impostors; and to show men what is in their oavu power, both with regard to the prevention and cure of diseases, are certainly objects worthy of the physician's attention.—These were the leading views in composing and publishing the following sheets. They were suggested by an attention to the conduct of mankind with regard to me- dicine, in the course of a pretty long practice in different parts of this island, during which the author has often had occasion to wish that his patients, or those about them, had been possessed of some such plain di- rectory for regulating their conduct. How far he has succeeded in his endeavours to supply this deficiency, must be left to others to determine: but if they be found to contribute in any measure towards alleviating the calamities of mankind, he will think his labour very well bestoAved. § " Before we enter upon the prevention or cure of diseases, it may not be improper to take a cursory view of the human body, respecting the functions immediately connected with life. So Avonderful is the structure of our frame, as displayed by anatomy, that atheistical per- sons, obdurate to every other evidence of the existence of a God, who created the universe, have, on witnessing a dissection, been instantly convinced of their mistake, and have acknowledged with equal astonish- ment and shame, that nothing less than a Being of infinite wisdom and power could have contrived and executed such a wonderfnl piece of mechanism as that of the human body. " The primary agent in the circulation of the blood is the heart, a large muscle situated in the left side of the breast (thorax, or chest) and endowed Avith great irritability. Iu the first rudiments of animal life, even before the brain is formed, the punctum saliens, as it is called, points out the embryo heart in miniature, and marks its primaeval irritability as a sure presage of its future importance in supporting the vital motions. As this singular organ exhibits irritability the first, so it never relin- quishes it till the last; Avhence it has been called the primum mobile, and ullimum moriens, that is, " the first part that moves, and the last that dies," of the animal machine. It is observable, that the motion of the heart not only survives that of the organs of voluntary motion, but con- tinues a considerable time even after it is separated from the body of many animals. Hence, in droAvning, or suffocation, though the pulse be imperceptible, and apparently extinguished, yet the heart still pre- serves this latent poAver or susceptibility of motion, and wants only to be gently excited by suitable means to reneAv its action. This organ ;s surrounded by the pericardium, or heart-purse, an INTRODUCTION. XXI exceeding strong membrane, which covers the heart, even to its basis. Its uses are to keep the heart from having auy friction with the lungs, and to contain a fluid to lubricate or moisten its surface. " From the right ventricle or cavity of the heart, the irritability of which is excited into action by the circulating fluid, the blood is pro- pelled through the lungs, which are situated on the light and left side of the heart, from Avhich they differ on appearing to be void of irritability. They are divided into two lobes, and these iu'o more divisions, three on the right side, and two on the left. The trachae, or wind-pipe, de- scends into the lungs, and forms innumerable cells, which have a com- munication with each other, aud give the whole the appearance of a honey-comb or sponge. " The blood, after passing through the lungs, arrives again at the heart, and from the left ventricle is expelled into the aorta, or great ar- tery ; Avhich dividing into tAvo branches, one upwards, and the other downwards, distributes the blood through the whole body; from the ex- tremities of which it returns, by various veins, through the ascending and descending cava,* and is transmitted again to the heart. " The heart is the grand org^n which actuates the vital functions, and to this purpose it is admirably fitted by its own irritability; but it is ne- cessarily supported iu its action by the powerful influence of the nerves, which are the ultimate instruments both of motion and sensation, and have their origin in the brain. " The diaphragm or midriff is a large broad muscle which divides the thorax from the abdomeuf or belly. In its natural state, it is con- cave or vaulted towards the abdomen, and convex towards the thorax.! Haller calls it " the most noble bovvel next to the heart;" and, like the latter, it is in constant action. At the time of inspiration it approaches towards a plane. Besides being a muscle of inspiration, it assists in vomiting, and the expulsion of the faeces.§ From the exertion of this muscle likewise proceed sighing, yawning, coughing, and laughing. It is effected by spasms, as in the hickup, &c. It is both a muscle of vo- luntary and involuntary action. We may observe in this muscle strong characters of admirable contrivance. It separates posteriorly into two slips, between which the descending aorta passes. A little above this, ami towards the left side, in the most fleshy part of the midriff, there is a di- rect opening for the passage of the azscphagus or gullet. There is also on the right side a large triangular hole for the passage of the ascending cava. " The gullet is composed both of longitudinal and circular fibres, but chiefly circular, much more so than the intestines; because this has no foreign power to assist, and because it is necessary that the food should make a shorter stay in the throat than in the boAvels. The inner sur- face is a smooth membrane, well supplied with mucilage, to sheath the organ, and render the passage of the aliment or food easy. " The stomach lies across the upper part of the abdomen, and is co- vered by the liver; when distended it presses on the spleen. It nearly * Cava is the large vein which conveys the refluent blood to the heart. j- Abdomen, from abdo, to hide, as its contents lie hidden. t Derived from the Greek, signifying the breast § This word with chymists is used to express the ingredients and settling af- ter distillation and infusion : here it means excrement. XU INTRODUCTION.. resembles in figure the pouch of a bag-pipe, its upper side bciug cfliv rave, and the lower convex. Its left end is the most capacious. On the left pide is the entrance from the gullet; on the right is the opening1, called pylorus, by which the chyle passes into the intestines. Here is a circular valve, or spincter ruuscle, which prevents a regurgitation of the aliment. The stomach has circular and longitudinal fibres, and its inner membrane is covered with a strong viscid mucus. 44 The liver, the largest gland in the body, is situated immediately under the vaulted cavity of the midriff, chiefly on the right ride, and someAriiat on the left over the stomach. Exteriorly, or anteriorly, it is convex, inwardly it is concave; very think in its superior part, and thin in its inferior. The upper side adheres to the midriff; and it is fixed to this, and the sternum, or breast-bone, by a broad ligament. It is also tied to the navel by a ligamentous band, which is the umbilical vein of the nnborn infant, degenerated into a ligament. Both these bands serve to suspend it, while lying on the back, from bearing too much on the subjacent cava ; otherwise it might press on this important returning ves- sel, stop the circulation, and put a period to life. Dogs and cats, and other animals who are designed for leaping, have their liver divided into many distinct lobules, to prevent too great a concussion of the organ. The liver is the viscus or bowel which performs the secretion of the bile. " The gall-bladder is situated under the great lobe of the liver, a little to the right. In a standing posture it lies forwards and downwards. Its bottom is raised by a fulness, and depressed by the emptying of the sto- mach. The use of the gall-bladder is to serve as a receptacle for the bile. '• The intestines are destined to receive the fowl from the stomach, and after exposing the useful part of it to the lactcals, a set of extreme- ly small vessels, to convey the remainder out of the body. The intes- < inal canal is usually five times the length of the individual: it is curi- ously convoluted in the abdomen, and is extremely irritable. Anato- mists have divided this canal, although one continued pipe, into six portions, three of which are termed the small intestines,* and the three last, the great. In the small intestines there are numerous plaits to de- rain the food, and allow a larger surface for its absorption. These are larger, and far more numerous near the stomach, where the food is thinner, than they are towards the other extremity. At the entrance of the ilium into the colon, there are two very large valves, which pre- vent the regress of the faeces into the ilium. The cacum and colon, two of the intestines toAvards the lower extremity, besides havin" stronger muscular coats than the small intestines, are furnished with three ligamentous bands, running lengthwise on their outside, dividing their surfaces into three portions nearly equal. Though appearing extremely like ligaments, they are composed in tlreir inner structure, of true muscular fibres. The ligament-like bands which in the csecum and colon are collected into three portions, are spread equally over the surface of the rectum, or lower extremity of the intestines. This is a * The three smaller are, the duodenum, (from its length being about that of the breadth of twelve fingers,) jejunum, and ilium, from the Greek, signifying to turn about, because it makes many convolutions. The three larger are, the aecum, or blind gut (so called from its lx»ing perfo- rated at one end only ;) the colon, signifying hollow, a word from the Greek .- and the rectum, or straight gut. INTRODUCTION. XX112 wise precaution of Nature, that no part of it may be weaker than ano- ther, lest it should give way in the efforts for expelling thefeces. The plaits are considerably fewer in the great intestines. They have all an inner membrane, covered with an infinite number of arteries or glands, which discharge a lubricating fluid. They are furnished with muscular fibres, both circular and longitudinal. " The spleen, or milt, is situated immediately under the edge of the midriff, above the left kidney, and between the stomach and ribs. In figure, it resembles a depressed oval, near twice as long as broad, and al- most twice as broad as thick. Cheselden informs us, that it has been taken from dogs without any observable inconvenience to them. Its use is still problematical. " The pancreas, or sAveet-bread, is situated transversely under the sto- mach. Its shape resembles a dog's tongue. Along the whole length oi' it there is.a duct, which terminates in the upper part of the intestines near the stomach. The pancreatic juice resembles the saliva, but is less viscid or slimy, and contains a larger proportion of the salts of the blood. It is probably intended for the solution of our. aliment. The kidneys are two oval bodies, situated in the loins, contiguous to the two last short ribs; the right under the liver, and the left under the spleen. The structure of the kidneys is curiously fitted for securing the urine, which is carried from each of them by canals termed the ureters, iuto the bladder, the reservoir of that fluid, situated in the lower part of the belly. They enter the bladder near its neck, running for the space of an inch obliquely between its coats, and forming, as it were, to them- selves, two valves; so that, upon the contradiction of the bladder, the urine is directed along the urethra, which is its proper passage out of the body. Over the upper part of the abdomen is spread the omentum, or caul, Consisting of two broad, thin, and transparent membranes, joined to- gether by celhdar texture, in the cells of Avhich a quantity of fat is depo- sited. The uses of it are to interpose between the peritonorum,* or lining, the intestines, and the stomach, to keep all these parts moist, Avarm, slip- pery, and to prevent their adhesion. Last of all comes the peritonaeum, a strong membrane, Avhich confines, as in an inclosure, the intestines and contents of the abdomen. Such, in a general view, are the contents of the cavities of the breast aud belly, which perform, respectively, the vital motions, and those natu- ral functions that are subservient to the support of our frame. But there, remains to be mentioned another essential cavity, with its dependent sys- tem, to the primary influence of which all the other parts of the body are indebted for their action and energy. The cavity to which I allude i* the skull, the receptacle of the brain. The brain is divided into two por» tions; namely, the cerebrum and cerebellum ;f the former situated in the upper part of the skull, and the latter under it, in the hind part. The brain is a soft pulpy substance, surrounded by two membranes; One cal- led dura, and the otherpia, matter. It has also a third, called arachnoid ^ * Signifying near to, stretching round, or about, as periosteum, j&eri-arpium, near to the bone, heart, &c. ■j- Cerebellum, the little brain as it were.: both are often called thus, when he brain is spoken of iu small animals. fcXlV INTRODUCTION. from its fineness, as b< ing similar to a spider's wed. Tf contain? sonif sinuses, which are nothing more than large veins or receptacles lor blood, and four cavities called ventricles, moistened, in a healthful state, with a fine vapour, Avluch increasing gives rise to diseases. I/ike other parts of. the body, it has a variety of arterial branches from the heart, which dif- fuses through its substance, and on the membranes. The brain is ibe great elaboratory, where the animal spirits, or nervous influences which actuate our frame, are supposed to receive their existence. The nature of this fluid, if really a fluid, has not yet been sufficiently investigated. It is certain, however that from this source the nerves derive their origin. These are white, firm, solid cords, which arise from the brain and spinal marrow, Avhich is only an elongation of the brain, and are spread over every part of the body endowed with sensibility, by innumerable filaments. Ten pair of nerves issue from the brain itself, and thirty from the spinal marrow. Those that go to the organs of sense are considerably larger than the rest, and are in part divested of their outer covering. Whether an immaterial and invisible Being can positively be said to exist in any place, it might appear presumptuous to determine; but it is a prevailing opinion in physiology, that the brain is the seat of the soul; aud the pineal gland, in the penetralia of the brain, has been assigned as the sa- cred mansion of this immortal inhabitant. Human vision can discover no signs to confirm this opinion; but the man would be blind, and utterly void of understanding, who could not tcace through the whole of the animal system the most evident marks of divine intelligence and wis- dom; of intelligence which excites admiration, and of wisdom beyond conception. The Avonderful contrivance exhibited in the human frame is, if pos- sible, still more manifest from the curious formation of the eye and ear; of which only a very imperfect idea could be conveyed by verbal de- scription. 1 shall therefore not attempt to delineate those admirable or- gans: nor need I mention the constraction of the limbs; of the arms and legs; of the hands and feet; so nicely united Avith joints, and so happily supplied Avitli muscles and tendons, with ligaments and nerves, that they are adapted to all the various purposes of convenience and utility iu mo- tion. I shall conclude this imperfect sketch of the human body with a brief account of digestion, that important process in the animal economy, by means of which the continual and unavoidable waste of the constitution is regularly supplied. The aliment being received into the mouth, the first operation it un- dergoes is to be masticated by the action of the teeth and several muscles. This mastication is of a greater moment than is generally imagined; and the good effects of it are further promoted by mixing with the food a quantity of saliva, discharged from the glands of the mouth, and \vliich is greatly conducive to digestion. When the food is carried down the gullet into the 6tomacb, it there meets with an addi- tional supply of juices, called the gastric juices, of a nature yet more efficacious than the former, besides a small portion of bile. Dur- ing i's continuance in the stomach, it experiences the effects of beat and muscular action, from the coats of that organ, and the mo- tion and warmth of the surrounding parts. It thence passes out gra- dually by the right orifice of the stomach, and there meets wi;h an INTRODUCTION. XXV additional quantity of bile from the gall-bladder and liver; besides the pancreatic juice, or that of the sweet-bread, of a nature similar to the saliva, but rather more thick, and the fluids separated by the intestines. It now receives the action of the bowels, or the peristaltic motion, by which they churn, as it were, the whole mass, minutely mixing together the food, and the different juices, collected in the passage from the mouth. A fluid is now produced called chyle, which is separated from the grosser materials, and taken up by a set of extremely small absor- bent vessels, called lacteals. These have their origin in the inner coat of the intestines, and, passing thence, discharge themselves into a duct uamed the receptacle of the chyle, whence this fluid proceeds along the thoracic* duct, which terminates in the left subclavian! Aein. In the passage from the intestines to the receptacle, there is a number of glands, which separate a watery liquid, for the purpose of giving the chyle a thinner consistence. To prevent the chyle from falling back in its pro- gress through the lacteals, the construction of these vessels is admirably contrived. They are furnished with a number of valves, which open only fonvards, and are shut by any fluid pressing backwards. From the subclavian vein, the chyle is poured into the blood, and thence imme- diately thrown into the right auricle and ventricle^ of the heart; from which, now mixed Avith the blood, it passes into the lungs. It under- goes in that organ a considerable change from the act of respiration. From the lungs it proceeds through the pulmonary vein to the left auri- cle of the heart, and then into the left ventricle: whence, at last endow- ed Avith all the qualities of blood, it passes into the aorta, and is diffused universally through the frame; the wants of which it is fitted to supply by the addition of nourishing particles. Is it possible to contemplate this admirable mechanism without breaking forth in the exclamation of the Psalmist, that " we are wonderfully made ?" I may justly add, that, considering the great variety of Arays in which the human body may be affected, both from without and within, Avith the necessity for the perpetual motion of the vital powers, and the millions of vessels, in- visible to the naked eye, through Avhich the fluids ought to pass, it is a matter of real astonishment that we should subsist a single day. And doubtless it would be impossible, were not the machine constantly sus- tained by the same Almighty and Beneficent Being who formed it. * From thorax, the breast. f A term applied to any thing under the arm-pit or shoulder. i Two muscular bags, one on each side, are termed its auricles, from tbe Latin signifying cars. 4 ■xxvi MEDICINES USED IN PRACTICE. MAjNT who peruse the Domestic Medicine, have expressed a Avisli that the catalogue of medicines contained in that book should be more extensive, and likeAvise that the dose of each article should be ascer- tained, as they are often at a loss to know how to administer even those medicines, the names of which they meet with in almost every medical author. To obviate this objection, and furnish a greater scope to those who may wish to employ more articles than are contained in the Dis- pensatory annexed to the above work, the folloAving List of Simples and Compounds, taken from the most improved Dispensatories, is now inserted. To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the order of the English alphabet, and the smallest and largest dose placed opposite to each article. The doses indeed refer to adults, but may be adapted to different ages by attending to the rules laid down in the Introduction to the Appendix, (page 420.) Short cautions are occasionally inserted under such articles as require to be used with care. Though a greater variety of medicines is contained in this than in any former edition of the Domestic Medicine, yet the author would advise those who peruse it, as far as possible, to adhere to simplicity in practice. Diseases are not cured by the multiplicity of medicines, but by their proper application. A feAvr simples, judiciously administered, and accompanied with a proper regimen, will do more good, than a farrago of medicines employed at random. A LIST OF THE MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PROPER DOSES. Acacia, the expressed juice, Acid, the acetous * ----, muriatic -----, nitrous, diluted -, vitriolic, diluted from either, vitriolic iEthiops mineral Aloes - Alum .... -----, burned Amber, prepared Ammoniac, gum ■---------, milk of Angelica, the root powdered Anise, the seeds Antimony ---------, calcined ---------, glass of Asafoetida , milk of Asarum, to provoke sneezing 1 scruple 1 scruple 10 drops 15 drops 15 drops 30 drops 10 grains 5 grains 6 grains 3 grains \ drachm 5 grains h oz- ~ drachm 10 grains 10 grains 1 scruple | grain 6" grains half oz. 3 grains to 1 drachm 1 drachm 40 drops 40 drops 40 drops 2 drachms 30 grains 30 grains 20 grains 12 grains 1 drachm 30 grains 1 ounce I j drachm 1 drachm 1 '-drachm 1 drachm 2 grains half a dra. 1 ounce i> grains MEDICINES USED IN PRACTICE. XX7I1 Balsam of capivi ------, Canadian ------, of Peru ... ------, ofTolu Bark, Peruvian, powder » Bears foot, powder Benzoin, resin of Benzoin, flowers of Bistort, powder of the root Blessed thistle ... -------------, expressed juice of Bole Armenian - ——, French - Borax..... Broom, ashes of the tops Burdock, powder of the root Calomel - Camphor - Canella alba, poAvder of Cantharides - Cardamoms - Caraway seed - Cascarilla bark Cassia, the pulp ... Castor _---/- Catechu - - . - Camomile, in powder Chalk - Cinnamon - - - - Colocynth - - Columbo - - Confection, aromatic ---------, opiate Crabs claws, prepared Conserve of roses ---------, of squills ---------, of arum Contrayerva Coriander seed Cowhage, the spiculae of one pod mixed with honey or molasses. Dandelion, expressed juice Decoction of hartshorn, half a pint repeated as often as necessary. .------, of broom, 1 oz. to a pint of water, to be taken by tea-cupsful. ------of Peruvian bark ■------of the inner bark of the elm -,-----of sarsaparilla - - — compound from 20 drops to 60 drops 2 scrupleT 10 gra'ns 4 grains 10 grains 1 scruple 10 grains 2 dra. 10 grains 2 drachms 20 grains 20 grains 20 grains 1 drachm 1 drachm 2 ounces 40 grains 10 grains 40 grains 1 scrapie 1 drachm 10 grains 1 drachm 1 gr. to 3 gr. alterative 3 do. to 12 do. purgative 2 grains to half a drachm 1 scruple 2 drachms \ grain 4 grains 5 grains 20 grains 10 grains 40 grains 10 grains 40 grains 2 dra. 1 oz. 8 grains 1 drachm 15 grains 30 grains 20 grains 1 drachm 20 grains 2 scruples 5 grains 1 elrachm 10 grains 1 drachm 10 grains 1 drachm 10 grains 2 scruples 10 grains 2 scruples 10 grains 1 drachm 1 dra. 1 oz. 20 grains 30 grains 20 grains 1 flrachm 20 grains 2 scruples 15 grains 1 drachm 1 oz. 1 oz. 4 oz, 4 oz. 3 oz. 4 oz. 16 oz. daily 16 oz. daily —«— of guiacum, 3 drachms to a pint of Abater. A pint daily, XXVili MEDICINES USED IN PRACTICE. Electuary of cassia ---—— of scammony --------lenitive, or of senna Elixir of vitriol Elecampane, powder of the root Extract of broom tops ---— of Peruvian bark ------carcarilla ------camomile ------colocynth ------gentian » — liquorice ------logwood ------black hellebore ------jalap ——— guaiacum ------Avhite poppies ------rue ' - ------savin ■ ■ senna from 1 dra. 20 grains 30 grains 15 drops 20 grains -1 dra. 10 grains 10 grains 20 grains 5 grains 10 grains 1 dra. 10 grains 3 grains 10 grains 10 grains 1 grain 10 grains 10 grains 10 grains \ dra. 20 grains h grain to Fern, powder of the root •? Fennel seed - Fox glove, powder of the leaves or a drachm infused in a pint of boiling water, of which a dose is - 1 oz. Should be administered with caution. Galbanum - - - 10 grains Galls - - - - - 10 grains Garlic, cloves of No. 1. Gentian - - - 10 grains Germander - - - 15 grains Ginger .... 5 grains Ginseng - - - - 20 grains Guaiacum, gum-resin - - 10 grains Gum arabic - - - - 15 grains ----gamboge - - - 2 grains Hartshorn, prepared 20 grains --------, spirits of - - 10 drops --------, caustic in some mucila- > _ j ginous vehicle 5 r°^S --------, salt of - 2 grains Hellebore, white - - 1 grain --------, black - - - - 5 grains Hemlock, should ahvays be begun in very small doses, of one grain or less, and gradually increased as the constitution will bear. Hiera picra - - - 10 grains Honey of squills - 10 grains -----of roses ... 1 drachm Hoffman's anodyne liquor - 20 drops Jalap, powder - - - 10 grains 1 oz. 1 drachm 6 drachms 50 drops 1 drachm 1 drachm £ drachm £ drachm 1 drachm 25 grains £ drachm I oz. $ drachm 10 grains 20 grains 20 grains 5 grains 20 grains 30 grains 30 grains h oz. 1 drachm- 3 grains 30 grains 20 grains No. 6. 40 grains 1 drachm 20 grains 30 grains 30 grains 1 drachm 12 grains 1 drachm 40 drops 25 drops 12 grains 5 grains 10 grains 20 grains 40 grains 2 drachms 60 drops 40 grains MEDICINES USED IN PRACTICE. XXIX Infusion of Gentian, poAvdcr - from ------- of roses .... -------ofsenna - Ipecacuanha - Iron, rust of Iron ammoniated - Iron tartarised - ----salt of Juniper, powder of the berries Kino, gum - Kermes, juice of Lichen, ash-coloured ------Icelandic, a strong decoction of Lime-water - - - Lixivium, of tartar Linseed, an infusion of 1 ounce to a quart of Avater; may be used at pleasure. Madder powder - Mace - Magnesia ... --------calcined - Manna .... Mastich, gum - Mercury, crude ------ calcined - - ------ with chalk ------ corrosive sublimate ------ cinnabar of - - ------ yelloAv emetic, as sternutory Mezereon, decoct, to a pint of Avater Millepedes - Musk Mustard seed ... Myrrh, gum Nitre, purified, ... Nutmeg - - - Oil of Almons ... ----Linseed ... ---- Castor ... Olibanum - - - Onion, expressed juice of a pow- > erful diuretic $ Opium .... Opopanax - Oxymel of colchicum ------ of squills •* - - Petoleum - Pills, aloetic ... ----of the gums - - - ----mercurial Pomegranate, powder of - 1 ounce to 2 ounces § ounce 10 grains 5 grains 2 grains 2 grains 2 grain 20 grains 10 grains 1 drachm 3 grains 1 ounce 4 ounces 15 drops \ drachm 10 grains h drachm 10 ounce grains \ ounce | grain 10 grains | grain 10 grains 1 grain 20 grains 5 grains 1 drachm 10 grains 10 grains 6 grains I ounce 2 drachms 5 grains | ounce | grain 10 grains \ drachm \ drachm 10 drops 10 grains 10 grains 10 grains 20 grains 3 ounces 8 ounces 2 ounces 30 grains 20 grains 10 grains 10 grains 5 grains 1 drachm 30 grains 3 drachms 40 grains '4 ounces 8 ounces 40 drops 1 drachm 20 grains 2 drachms 2 ounces 30 grains 4 ounces 2 grains 30 grains \ grain 30 grains 3 grains 2 drachms 2 drachms 40 grains 1 ounce 1 drachm 30 grains \ drachm 1 ounce 1 ounce 30 grains 2 ounces 2 ounces 30 grains 1 ounce 2 drachms 30 drops 30 grains 30 grains 20 grains 1 drachm V\X MEDICINES USED IN Powder antimonial - * # fr°m May be taken according,to-the direc- tions for James' powder, with which it nearly coincides. Powder of Contrayerv a, compound - —-----of Chalk compound ------of Chalk compound, Avith opium of Ipecacuanha, compound, or Dover's poAvder Quassia . _ - Two drachms to a pint of water for a decoction. Quince seeds, mucilage of, at pleasure, to obtund acrimony. Rhubarb, powder . - - Resin, yellow Rue powder - St. John's-Avort Saffron ... Sagapenum - Sal ammoniac - Salt, Epsom ■ • Glauber —.— Polychrest ----of Tartar - - , - Sarsaparilla, powder of «: Scammony - Seneca - - Senna .... Soap .... ----lees Scurvy-gvas?, expressed juice Snake root ... SornR, juice of, depurated Spirit of Mindcrerus •---- sweet, of vitriol ----•—— of nitre ---- of sal ammoniac ■----------compound ----------foetid Spirits, distilled Spermaceti Sponge, burned Sulphur, floAvers of ,------precipitated, of antimony Squill, dried powder ~----fresh Syrup of poppies -----of buckthorn .-----of ginger - • - Syrups iu general - Tor water. A pint daily. PRACTICE. 3 grains to 15 grains 20 grains 10 grains 10 grains 5 grains 10 graius 3 grains 20 graius 20 grains 5 grains 10 grains 10 grains 2 drachms 4 drachms 20 grains 10 grains 20 grains 5 grains 20 grains 20 grains 20 graius 10 drops 1 ounce 20 graius 4 ounces 1 drachm 15 drops 15 drops 15 drops f drachm 20 grains 20 grains 20 grains 1 gram 1 grain 5 grains ■S drachm 1 drachm 1 drachm 1 drachm 6 graiu* 30 grains 40 grains 40 graius 30 grains 30 grains 40 grains 20 grains 40 grains 1 drachm 20 grains 30 grains 30 grains 1 g ounces 2 ounces £ ounce 30 grains 40 grains 10 grains 40 grains 40 graius £ ounce 30 drops 1 ounces 40 grains 8 ounces 1 ounce 40 drops 40 drops 40 drops \ ounce 1 drachm 1 drachm 1 drachm 4 grains 3 grains 15 grains \ ounce 2 drachms k ounce 2 drachm-, MEDICINES USED IN PRACTICE. XTXXI Tartar, cream of - ———regenerated ------- soluble -------emetic, alterative --------------. as emetic Terra japonic^ Tobaco, an infusion of, 1 drachm to a pint of Avater; should be admin- istered by table spoonfuls: strong- ly diuretic. Tin, powder of Tumeric - Turpentine, spirits of Tincture of aloes ----------compound ---- of asafcetida ---- Benzoin, compound -~— of cantharides —— of cardamoms ---- of castor ---- of catechu ---- of Peruvian bark ---- of iron, muriatcd ---- of Columbo ---- of Gentian, compound ---- guaiacum Aolatile —— of black hellebore — of jalap ---- of lavander, compound ----■ of myrrh ---- of opium -------------. camphorated, ) or paregoric elixir $ —— of rhubarb ---- of sena ----of snake-root ---t- of valeriau volatile from 2 drachms to 1 ounce 20 grains 2 drachms I grain 1 grain 20 grains 1 drachm 1 ouuce | grab! 3 grains 40 grains from Tormentil, powder of Valerian powder of Vinegar, distilled ------of squills r ----——■-------as emetic Verdigrease, violent emetic Vitrol, Avhitc, as a tonic ——---------as a quickly ) operating emetic 3 blue emetic TTva ursi, in powder Water-cress, expressed juice of Water, the simple distilled, ) may generally be given 3 20 grains to 1 drachm 20 graius 1 drachm 10 drops 30 drops h nunce 1 ounce \ drachm 2 drachms 4 drachm 2 drachms 10 drops 40 drops 10 drops 40 drops 1 drachm \ drachms 1 drachm 1 k drachms 1 drachm 2 drachms 1 drachm | ounce 10 drops 60 drops 1 drachm 3 drachms 1 drachm 3 drachms 1 drachm 3 drachms 1 scruple 1 drachm 1 drachm \ ounce 20 drops 2 drachms 1 scruple 1 drachm 10 drops 40 drops 1 drachm 3 drachms | ounce 2 ounces 2 drachms 1 ounce 1 drachm 2 drachms 1 drachm 3 drachms 1 drachm 2 drachms 10 grains 1 drachm 20 grains 2 drachm* 2 drachms 1 cypce 10 drops 50 drops \ ounce 1 ounce 1 grain 2 grains 2 grains 5 grains 20 grains 1 drachm 1 grain 3 grains 20 grains 1 drachm \ ounce 2 ounces | oonce ? *>r 4 oz. XXX11 MEDICINES USED I \ PRACTICE* Wonuwood, expressed juice from £ ounce to - ounces White lead - - - 1 grain 3 grains Wine, aloetic h ouuce 1 ounce ■----antimonial 20 drops . 2 drachms ----Ipecacuanha - - - 1 drachm • v 1 £ ounce ----Rbubard \ ounce *i ^ ounces PART I. V.) ■ ■ ,.rt-rv f, OF THE GENERAL CAUSES Otf DISEASEDx ty/r CHAP. L ^ OF CHILDREN. X HE better to trace diseases from their original causes, Ave shall take a view of the common treatment of mankind in the state of infancy. In this period of our lives, the foundations of a good or bad constitution are laid; it is therefore of importance, that parents be well acquainted with the various causes Avhich may injure the health of their offspring. It appears from the annual registers of the dead, that almost one half of the children born in Great-Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but on due exami- nation, it will be found to be one of our OAvn creating. Were the death of infants a natural evil, other animals Avould be as liable to die young as man; but this Ave find is by no means the case. It may seem strange that man, notAvithstanding his superior reason, should fall so far short of other animals in the management of his young: But our surprise will soon cease, if Ave consider that brutes, guided by instinct, never err in this respect; while man, trusting solely to art, is seldom right. Were a catalogue of those infants Avho perish annually by art alone exhibited to public vieAV, it would astonish most people. If parents are above taking care of their children, others must be employed for that purpose: these will always endeavour to recommend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and destructive articles have been introduced into the diet, clothing, &c. of infants, that it is no won- der so many of them perish. Nothing can be more preposterous than a mother who thinks it beloAV her to take care of her OAvn child, or who is so ignorant as not to knoAV Avhat is proper to be done for it. If Ave search Nature throughout, we cannot find a parallel to tfiis. EATery other animal is the nurse of its own offspring, and they thrive accordingly. Were the brutes to bring up their young by proxy, they would share the same fate with those of the human species. We mean not, however, to impose it as a task upon every mother to suckle her OAvn child. This, whatever speculative Avriters may allege, is in some cases impracticable, and would inevitably prove destructive both to the mother and child. Women of delicate constitutions, sub- ject to hysteric fits, or other nervous affections, make very bad nurses :* aud these complaints are noAV so common, that it is rare to find a woman of fashion free from them; such Avomen, therefore, supposing them Avill- liug, are often unable to suckle their own children. Almost every mother would be in a condition to give suck, did man- * I have known an hysteric woman kill her child, by being seized with a fit in the night. 34 OF CHILDREN". kind live agreeably to Nature; but whoever considers how tar many mothers deviate from her dictates, will not be surprised to find some ot them unable to perform that necessary office. Mothers who do not eat a sufficient quantity of solid food, nor enjoy the benefit of fresh air and exercise, can neither have wholesome juices themselve^i^rMTord.pro- per nourishment to an infant. Hence children who areWckledby deli- cate Avomen, either die young, or continue weak and sickly alMheir#ives. When we say that mothers are not always in a condition to suckle their OAvn children, we would not be understood as discouraging that practice. Every mother who can, ought certainly to perform so tender and agreeable an office.* But suppose it to be out of her power, she may, nevertheless, be of great service to her child. The business of nursing is by no means confined to giving suck. To a Avoman Avho abounds Avith milk, this is the easiest part of it. Numberless other offices are necessary for a child, which the mother ought at least to see done. A mother who abandons the fruit of her womb, as soon as it is born, to the sole care of an hireling, hardly deserves that name. A child by being brought up under the mother's eye, not only secures her affection; but may reap all the advantages of a parent's care, though it be suckled by another. Hoav can a mother be better employed than in superin- tending the nursery ? This is at once the most delightful and impor- tant office; yet the most trivial business or insipid amusements are often*preterred to it! A strong proof both of the bad taste and wrong education of modern females. It is indeed to be regretted, that more care is not bestoAved in teach- ing the proper management of children to those whom Nature has de- signed for mothers. This, instead of being made the principal, is seldom considered as any part of female education. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to that character ? However strange it may appeal-, it is certainly true, that many mothers, and those of fashion too, are as ignorant, when they have brought a child into the world, of what is to be done for it, as the infant itself. Indeed, the most ignorant of the sex are generally reckoned most knowing in the business of nur- sing. Hence sensible people become the dupes of ignorance and super- stition ; and the nursing of children, instead of being conducted by rea- son, is the result of Avhim and caprice.f . • * Many advantages would arise to society, as well as to individuals, from mothers suckling their own children. It would prevent the temptation which poor women are laid under of abandoning their children to suckle those of the rich for the sake of gain ; by which means society loses many of its most use- ful members, and mothers become in some sense the murderers of their own offspring. I am sure I speak within the truth when I say, that not one in twenty of those children live, who are thus abandoned by their mothers. For this reason no mother should be allowed to suckle another's child, till her own is either dead, or fit to be weaned. A regulation of this kind would save many lives among the poorer sort, and could do no hurt to the rich, as most women who make good nurses are able to suckle two children in succession upon the same milk. f Tacitus, the celebrated Roman historian, complains greatly of the degen- eracy of the Roman ladies in his time, with regard to the care of their offspring. He says that, in former times, the greatest women in Rome used to account it their chief glory to keep the house and attend their children ; but that now the young infant was committed to the sole care of some poor Crecian wench, or OF CHILDREN. 35 Were the time that is generally spent by females in the acquisition of trifling accomplishments, employed in learning how to bring up their children; how to dress them so as not to hurt, cramp, or confine their motions; how to feed them with Avholesome and nourishing food; how to exercise their tender bodies so as best to promote their growth and strength: were1 these made the objects of female instruction, mankind would derive the greatest advantages from it. But while the education of females implies little more than what relates to dress and public show, we have nothing to expect from them but iguorance even in the most important concerns. Did mothers reflect on their own importance, and lay it to heart, they Avould embrace every opportunity of informing themselves of the duties Avhich they owe to their infant offspring. It is their province, not only to form the body, but also to give the mind its most early bias. They have it very much in their power to make men healthy, or valetudiua- ry, useful in life, or the pests of society. But the mother is not the only person concerned in the management of children. The father has an equal interest in their welfare, and ought to assist in every thing that respects either the improvement of the body or mind. It is pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women Avill ever be desirous to excel in such accomplishments as recommend fhem to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the affairs of the nursery, that many would reckon it an affront, Avere they supposed to know any thing of them. Not so, however, Avith the kennel or the stables: a gentleman of the first rank is not ashamed to give directions concerning the manage- ment of his dogs or horses, yet Avould blush were he surprised in perform. ing the same office for that being who derived its existence from him- self, who is the heir of his fortunes, and the future hope of his couHtry. Nor have physicians themselves been sufficiently attentive to the ma- nagement of children: this has been generally considered as the sole province of old women, while men of the first character in physic, have refused to visit infants even when sick. Such conduct in the faculty lias not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous diseases. The consequence is, that a physician is seldom called till the good women have exhausted all their skill; whqp his attendance can only serve to divide the blame, and ap- pease the disconsolate parents. Nurses should do all in their power to prevent diseases; but when a child is take.i ill, some person of skill ought immediately to be consult- ed. The diseases of children are generally acute, and the least delay is dangerpus. Were physicians more attentive to the diseases of infants, they would not only be better qualified to treat them properly Avhen sick, but like- wise to give useful directions for their management when well. The diseases of children are by no means so difficult to be understood as ma- other menial servant.—We are afraid, wherever luxury and effeminacy prevail, there will be too much ground for this complaint 36 OF CHILDREN. ny imagine. It is true, children cannot tell their complaints; but the causes of them may be pretty certainly discovered by observing the symp- toms, and putting proper questions to the nurses. Besides, the diseases of infants being less complicated, are easier cured than those of adults. ■> It is really astonishing, that so little attention should in general be paid to the preservation of infants. What labour and expense are daily bestowed to prop an old tottering carcase for a few years, while thou- sands of those who might be useful in life, perish without being regard- ed! Mankind are too apt to value things according to their present, not their future usefulness. Though this is of all others the most erroneous method of estimation; yet upon no other principle is it possible to ac- count for the general indifference Avith respect to the death of infants. Of Diseased Parents. One great source of the diseases of children is, the unhealthiness of parents. It would be as reasonable to expect a rich crop from a bar- ren soil, as that strong and healthy children should be born of parents Avhose constitutions have been worn out Avith intemperance and disease. An ingenious Avriterf observes, that on the constitution of mothers de- pends originally that of their offspring. No one who believes this, will be surprised, on a vieAv of the female world, to find diseases and death so frequent among children. A delicate female, brought up Avithin doors, an utter stranger to exercise and open air, who lives on tea and other slops, may bring a child into the world but it will hardly be fit to live. The first blast of disease "will nip the tender plant in the bud : or should it struggle through a few years existence, its feeble frame, shaken Avith convulsions from every trivial cause, will be unable to per- form the common functions of life, and prove a burden to society. If to the delicacy of mothers, Ave add the irregular lives of fathers, we shall see further cause to believe that children are ofteu hurt by the constitution of their parents. A sickly frame may be originally induced by hardships and intemperance, but chiefly by the latter. It is impossi- ble that a course of vice should not spoil the best constitution: and, did the evil terminate here, it Avoulcf be a just punishment for the folly of the sufferers; but wrhen once a disease is contracted and rivetted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the king's evil, to transmit to our offspring! Iioav happy had it been for the heir of many a great estate, had he been born a beggar, rather than to inherit his father's fortunes at the expense of in- heriting his diseases! * A person labouring under any incurable malady, ought not to marry. He thereby not only shortens his OAvn life, but transmits misery to others; but Avhen both parties are deeply tainted with the scrophula, the scurvy, or the like, the effects must still be Avorse. If such have any issue, they must be miserable indeed. Want of attention to these * The common opinion, that the diseases of infants are hard to discover and difficult to cure, has deterred many physicians from paying that attention to them which they deserve. I can, however, from experience declare that this opinion is without foundation; and that the diseases of infants are neither difficult to discover, nor so ill to cure, as those of adults. | Rousseau. OF CHILDREN. 37 things, in forming connections for life, has rooted out more families than plague, famine, or the sword; and as long as these connections are formed from mercenary vieAvs, the evil will be continued." In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know that the gene- rous courser cannot be bred out of the foundered jade, nor the sagacious spaniel out of the snarling cur. This is settled upon immutable laws. The man avIio marries a woman of a sickly constitution, and descended of unhealthy parents, Avhatever his vieAvs may be, cannot be said to act a prudent part. A diseased woman may prove fertile; should this be the case, the family must become an infirmary : what prospect of happiness the father of such a family ha^we shall leave any one to ;udge.f Such children as have the misfortune to be borne of diseased parents, will require to be nursed Avith greater care than others. This is the only way to make amends for the defects of constitution; and it will often go a great length. A healthy nurse, wholesome air, and sufficient exer- cise, will do Avonders. But when these are neglected, little is to be ex- pected from any other quarter. The defects of constitution cannot be supplied by medicine. Those avIio inherit any family disease, ought to be very circumspect in their manner of living. They should consider Avell the nature of such diseases, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one generation; and there is reason to believe, that, by persisting in the same course, such diseases might at length be Avholly eradicated. This is a subject very little regarded, though of the greatest importance. Family constitutions are as capable of improvement as family estates; and the libertine who impairs the one, dcra greater injury to his poste- rity, than the prodigal who squanders aAv^Pthe other. Of the Clothing of Children. The clothing of an infant is so simple a matter, that it is surprising bow any person should err in it; yet many children lose their lives, and others are deformed, by inattention to this article. Nature knoAvs no use of clothes to an infant, but to keep it warm. AH that is necessary for this purpose, is to wrap it in a soft loose cover- ing. Were a mother left to the dictates of Nature alone, she would certainly pursue this course. But the business of dressing an infant has long been out of the hands of mothers, and has at last become a secret which none but adepts pretend to understand. From the most early ages it has been thought necessary, that a woman in labour should have some person to attend her. Thisintime became a business; and, as in all others, those Avho Avere employed in it strove to outdo one another in the different branches of their profession. The dressing of a child came of course to be considered as the midwifes * The Lacedemonians condemned their king Archidamus for having married a weak, puny woman; because, said they, instead of propagating a race of heroes, you will fill the throne with a progeny of changelings. f The Jews, by their laws, were, in certain cases, forbid to have any manner of commerce with the diseased; and indeed to this all wise legislators ought to have a special regard. In some countries diseased persons have actually been forbid to marry. This if an evil of a complicated kind, a natural deformity, and political mischief; and therefore requires a public consideration. 38 OF CHILDREN. province, who no doubt imagined, that the more dexterity she could shew in this article, the more her skill would be admired. Her attempts were seconded by the vanity of parents, who, too often desirous ot mak.n^ a shew of the infant as soon as it Avas born, Avere ambitious to have as much finery heaped upon it as possible. Thus it came to be thought as necessary for a midwife to excel in bracing and dressing an infant, as for a surgeon to be expert in applying bandages to a broken bmb; and the poor child, as soon as it came into the Avorld, had as many rollers and wrappers applied to its body, as if every bone had been fractured in the birth; while these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary for life. In most parts of Britain, the practice oi rolling children Avith so many bandages is now, in some measure, laid aside; but it Avould still be a difficult task to persuade the generality of mankind, that the shape of an infant does not entirely depend on the care of the midwife. So far, however, are all her endeaAours to mend the shape from being success- ful, that they constantly operate the contrary way, and mankind become deformed in proportion to the means used to prevent it. How little de* formity of body is to be found among uncivilized nations ? So little in- deed, that it is vulgarly believed they put all their deformed children to death. The truth is, they hardly know such a thing as a deformed child. Neither should Ave, if Ave followed their example. Savage na- tions never think of manacling their children. They allow them the full use of every organ, carry them abroad in the open air, wash their bodies daily in cold Avater, Szc. By this management, their children become so strong and hardy, that by the time our puny infants get out of the nurse's aims, theirs are able to shift for themselves.* Among brute animals, ajfert is necessary to procure a fine shape. Though many of them are extremely delicate AA'hen they come into the world, yet we never find them grow crooked for want of swaddling bands. Is Nature less generous to the human kind ? No: but Ave take the bu- suiess out of Nature's hands. Not only the analogy of other animals, but the very feelings of infants tell us, they ought to be kept easy and free from all pressure. They cannot indeed tell their complaints; but they can shew signs of pain: and this they never fail to do, by crying when hurt by their clothes. No sooner are they freed from their bracings, than they seem pleased and happy: yet, strange infatuation! the moment they hold their peace, they are again committed to their chains. If wo consider the body of an infant as a bundle of soft pipes, replen- ished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of children, has formed their bodies soft and flexible; and lest they should receive any injury from pressure in the womb, has surrounded the foetus every where with fluids. This shews the care which Nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing tl.at might in the least cramp or confine their motions. * A friend of mine, who was several years on the coast of Africa, tells me ■ of +l-n» noiinAc rmitK/ar* nut nms rlnf npo im/\n th^ln ^Ktl,l«„_ _ _ _ . .' that the natives neither put any clothes upon their children, nor apply to their bodies bandages of any kind, but lay them on a pallet-^and suffer them to tum- ble about at pleasure j yet they are all straight, and seldom have any disease. OF CHILDREX, 39 Even the bones of an infant are so soft and cartilaginous, that they readily yield to the slightest pressure, and easily assume a bad shape which can never after be remedrcd. Hence it is, that so many people appear with high shoulders, crooked spines, and flat breasts, Avho Avere as Avell proportioned at their births as others, but had the misfortune to be squeezed out of shape by the application of stays and bandages. Pressure, by obstructing the circulation, likewise prevents the equal distribution of nourishment to the different parts of the body, by Avhich means the growth becomes unequal. One part groAvs too large, Avhile another remains too small; and thus in time the whole frame becomes dis- proportionate and misshapen. To this Ave must add, that when a child is cramped in its clothes, it naturally shrinks from the part that is hurt; and by putting its body into unnatural postures, it becomes deformed by habit. Deformity of body may indeed proceed from weakness or disease; but in general, it is the effect of improper clothing. Nine tenths, at least, of the deformity among mankind, must be imputed to this cause. A deform- ed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impair- ed. Hence few people remarkably misshapen are strong or healthy. The new motions which commence at the birth, as the circulation of the whole mass of blood through the lungs, respiration, the peristalic mo- tion, &c. afford another strong argument for keeping the body of an in- fant free from all pressure. These organs, not having been accustomed to move, are easily stopped; but when this happens, death must ensue. Hardly any method could be devised more effectually to stop these motions, than bracing the body too tight Avith rollers* and baudages. Were these to be applied in the same manner to the body of an adult for an equal length of time, they would hardly fail to hurt the digestion and make him sick. How much more hurtful they must pro\7e to the tender bodies of infants, Ave shall leave any one to judge. Whoever considers these things will not be surprised, that so many children die of convulsions soon after the birth. These fits are gene- rally attributed to some inward cause; but in fact they oftener proceed from our oavo imprudent conduct. I have knoAvn a child seized Avith convulsion-fits soon after the midwife had done SAVaddling it, who, upon taking off the rollers and bandages, Avas immediately relieved, and never had the disease aftenvards. Numerous examples of this might be given, were they necessary. It would be safer to fasten the clothes of an infant with strings than pins, as these often gall and irritate their tender skins, and occasion dis- orders. Pins have been found sticking above half an inch into the body of a child, after it had died of convulsion fits, which in all probability proceeded from that cause. ChiWren are not only hurt by the tightness of their clothes, but also by the quantity. Every child has some degree of fever after the birth; and if it be loaded with too many clothes, the fever must be increased. But this is not all; the child is generally laid in bed with the mother, who is often likeAvise feverish; to Avhich we may add the heat of the bed- * This is by no means inveighing against a thing that does not happen. In many parts of Britain at this day, a roller eight or ten feet in length, is applied tightly round the child's body as soon as it is born. 40 . OF CHILDREN. chamber, the wines, and other heating things, too frequently given to children immediately after the birth. When all these are combined, which does not seldom happen, they nmist increase the fever to sucli a degree as will endanger the life of the infant. The danger of keeping infants too hot will further appear, if we con- sider that, after they have been for some time in the situation mentioned above, they are often sent into the country to be nursed in a cold house. Is it any wonder, if a child, from such a transision, catches a mortal cold, or contracts some other fatal disease ? When an infant is kept too hot, its lungs, not being sufficiently expanded, are apt to remain weak and flaccid"for life; heuce proceed coughs, consumptions, and other diseases of the breast. It Avould answer little purpose to specify the particular species of dress proper for an infant. These will always vary in different countries, ac- cording to custom and the humour of parents. The great rule to be observed is, That a child have no more clothes than are necessary to keep it warm, and that they be quite easy for its body. Stays are the very bane of infants. A volume would not suffice to point out all the bad effects of this ridiculous piece of dress both on children and adults. The madness in favour of stays seems however, to be someAvhat abated; and it is to be hoped the world will, in time, be- come Avise enough to know, that the human shape does not solely depend upon avhale-bone and bend leather.* I shall only add with respect to the clothes of children, that they ought to be kept thoroughly clean. Children perspire more than adults; and if their clothes be not frequently changed, they become very hurt- ful. Dirty clothes not only gall and fret the tender skins of infants, but likewise occasion i;I smells; and Avhat is worse, tend to produce vermin and cutaneous diseases. Cleanliness is not only agreeable to the eye, but tends greatly to pre- serve the health of children. It promotes the perspiration, and, by that means, frees the body from superfluous humours, which, if retained, could not fail to occasion diseases. No mother or nurse can have any excuse for allowing a child to be dirty. Poverty may oblige her to give it coarse clothes; but if she does not keep them clean, it must be her own fault. Of the Food of Children. Nature not only points out the food proper for an infant, but actually prepares it. This, however is not sufficient to prevent some who think themselves wiser than Nature, from attempting to bring up their children without her provision. Nothing can show the disposition which mankind have to depart from Nature more than their endea- vouring to bring up children without the breast. The mother's milk, or that of a healthy nurse, is unquestionably the best food for a%infant. Neither art nor nature can afford a proper substitute for it. Children * Stays made of bend leather are worn by all the women of lower station in many parts of Engl. nd. I am sorry to understand, that there are still mothers mad enoutrh to lar* their daughters very tight in order to improve their shape. As reasoning- would be totally lost upon such people, I shall beg leave just to ask them Why there are ten deformed women for one man ? and likewise to recommend to their n rusal a short moral precept, which forbid* us to deform the human boot OF CHILDREN. 41 may seem to thrive for a few months without the breast; but when teething, the small-pox, and other diseases incident to childhood, come on, they generally perish. A child, soon after the birth, shows an inclination to suck; and there is no reason why it should not be gratified. It is true, the mother's milk does not always come immediately after the birth; but this is the Avay to bring it: besides, the first milk that the child can squeeze out of the breast answers the purpose of cleansing, better than all the drugs in the apothecary's shop, and at the same time prevents inflammations of the breast, fevers, and other diseases incident to mothers. It is strange how people came to think that the first thing given to a child should be drugs. This is beginning with medicine by times, and no wonder if they generally end with it. It sometimes happens, indeed, that a child does not discharge the meconium so soon as could be wish- ed; this has induced physicians, in such cases, to give something of an opening nature to cleanse the first passages. Midwives have improA'ed upon this hint, and never fail to give syrups, oils, &c. whether they be necessary or not. Cramming an infant Avith such indigestible stuff as soon as it is born, can hardly fail to make it sick, and is more likely to occasion diseases than to prevent them. Children are seldom long after the birth without having a passage both by stcol and urine; though these evacuations may be wanting for some time without any danger. But if children must have something before they be allowed the breast, let it be a little thin water pap, to which may be added an equal quan- tity of new milk; or rather water alone, with the addition of a little raw sugar. If this be given without any wines or spiceries, it will nei- ther heat the blood, load the stomach, nor occasion gripes. Upon the first sight of an infant, almost every person is struck with the idea of its being weak, feeble, and wanting support. This naturally suggests the need of cordials. Accordingly wines are universally mixed with the first food of children. Nothing can be more fallacious than this way of reasoning, or more hurtful to infants than the conduct found- ed upon it. Children require very little food for some time after the birth; and what they receive should be thin, weak, light, and of a cool- jn» quality. A very small quantity of wine is sufficient to heat and inflame the blood of an infant; but every person conversant in these matters must know, that most of the diseases of infants proceed from the heat of their humours. If the mother or nurse has enough of milk, the child will need little or no food before the third or fourth month. It will then be proper to give it, once or twice a day, a little of some food that is easy of diges- tion, as water-pap, milk-pottage, weak broth with bread in it, and such like. This will ease the mother, will accustom the child by degrees to take food, and will render the weaning both less difficult and less dan- gerous. All great and sudden transitions are to be avoided in nursing. For this purpose, the food of children ought not only to be simple, but to resemble, as nearly as possible, the properties of milk. Indeed milk itself should make a principal part of their food, not only before they are Aveancd, but for some time after. Next to milk, we would recommend good light bread. Bread may- be given to a child as soon as it shews an inclination to chew; and it may at all times be allowed as much plain bread as it will cat. The very 6" 43 OF CHILDREN. chewing of bread will promote the cutting of the teeth, and the discharge of saliva, while by mixing with the nurse's milk in the stomach, it will afford an excellent nourishment. Children discover an early inclina- tion to chew whatever is put into their hands. Parents observe the in- clination, but generally mistake the object. Instead of giving the child something which may at once exercise its gums and afford it nourish- ment, they commonly put irito its hands a piece of hard metal, or im- penetrable coral. A crust of bread is the best gum-stick. It not only answers the purpose better than any thing else, but has the additional properties of nourishing the child and carrying the saliva down to the stomach, which is too valuable a liquor to be lost. Bread, besides being used dry, may be many ways prepared into food for children. One of the best methods is to boil it in water, after- wards pouring the water off, and mixing Avith the bread a proper quan- tity of neAV milk unboiled. Milk is both more wholesome and nourish- ing this Avay than boiled, and is less apt to occasion costiveness. For a child farther advanced, bread may be mixed in veal or chicken brothr made into puddings, or the like. Bread is a proper food for children at all times, provided it be plain, made of Avholesome grain, and Avell fermented; but when enriched with fruits, sugars, or such things, it be- comes very unAvholesome. It is soon enough to allow children animal food Avhen they have got teeth to eat it. They should never taste it till after they are Aveaned, and even then they ought to use it sparingly. Indeed, Avhen children Five Avholly on vegetable food, it is apt to sour on their stomachs; but, on the other hand, too much flesh heats the body, and occasions fevers and other inflammatory diseases. This plainly points out a due mix- ture of animal and vegetable food as most proper for children. FeAV things prove mere hurtful to infants than the common method of SAveetening their food. It entices them to take more than they ought to do, Avhich makes them groAV fat and bloated. It i^ pretty certain, if the food of children were quite plain, that they Avould never take,more than enough. Their excesses are entirely owing to nurses. If a child be gorged w ith food at all hours, and enticed to take it, by making it 3Aveet and agreeable to the palate, is it any Avonder that such a child should in time be induced to crave more food than it ought to have ? Children may be hurt by too little as well as too much food. After a child is Aveaned, it ought to be fed four or five times a day; but should never be accustomed to eat in the night; neither should it have too much at a time. Children thrive best Avith small quantities of food fre- quently given. This neither overloads the stomach nor hurts the diges- tion, and is certainly most agreeable to nature. Writers on nursing have inveighed with such vehemence against giv- ing children too much food, that many parents, by endeavouring to shun that error, have run into the opposite extreme, and ruined the constitu- tions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Nature has many ways of re- lieving herself when overcharged; but a child, who is pinched Avith hunger, Avill never become a strong or healthy man. That errors are frequently committed on both sides, we are ready to acknowledge- but where one child is hurt by the quantity of its food, teu suffer from the quality. This is the principal evil, and claims our strictest attention. OF CHILDREN. 43 Many people imagine, that the food Avhicli they themselves love, cannot be bad for their children: but this notion is very absurd. In the more advanced periods of life Ave often acquire an inclination for food, which when children Ave could not endure. Besides, there are many things that by habit may agree very well with the stomach of a groAvn person, which Avould be hurtful to a child: as high-seasoned, salt, and smoke-dried provisions, &c. It would also be improper to feed children with fat meat, strong broths, rich soups, or the like. All strong liquors are hurtful to children. Some parents teach their children to guzzle ale, and other fermented liquors, at every meal. Such a practice cannot fail to do mischief. These children seldom escape the violence of the small-pox, measles, hooping-coHgh, or some inflammatory disorder. Milk, Avater, butter-milk, or Avhey, are the most proper for children to drink. If they have any thing stronger, it may be fine small beer, or a little Avine mixed with Avater. The stomach of children can ■digest well enough Avithout the assistance of Avarm stimulants: besides, being naturally hot, they are easily hurt by every thing of a heating quality. FeAV things are more hurtful to children than unripe fruits. They weaken the powers of digestion, and sour and relax the stomach, by Avhich means it becomes a proper nest for insects. Children indeed shew a great inclination for fruit, and I am apt to believe, that if good ripe fruit Avere alloAved them in proper quantity, it Avould have no bad effects. We never find a natural inclination Avrong, if properly regulated. Fruits are gen- erally of a cooling nature, and correct the heat and acrimony of the hu* mours. This is what most children require; only care should be taken lest they exceed. Indeed the best Avay to prevent children from going to excess in the use of fruit, or eating that wliich is bad, is to allow them a proper quantity of Avhat is good.* Roots which contain a crude viscid juice should be sparingly given te children. They fill the body with gross humours, and tend to produce eruptive diseases. This caution is peculiarly necessary for the poor; glad to obtain at a small price Avhat xvill fill the bellies of their children, they stuff them two or three times a day Avith crude'vegetables. Children had better eat a smaller quantity of food Avhich yields a Avholesome nourishment, than be crammed with what their digestive powers are unable properly to assimilate. Butter ought likewise to be sparingly given to children. It both relaxes the stomach, and produces gross humours. Indeed, most things that are fat or oily have this effect. Butter Avhen salted becomes still more hurtful. Instead of butter, so liberally given to children in most parts of Britain, we would recommend honey. Honey is not only Avholesome, but cooling, cleansing, and tends to sweeten the humours. Children ay ho eat honey are seldom troubled Avith worms: they are also less subject to cutaneous diseases, as itch, scabbed head, &c. Many persons err in thinking that the diet of children ought to be al- together moist. When children live entirely upon slops, it relaxes their * Children are always 6ickly in the fruit season, which may be thus account- ed for : Two-thirds of the fruit which comes to market in this country is really junripe ; and children not being in a condition to judge for themselves, eat what- ever they can lay their hands upon, which ofen proves little better than poison to their tender bowels. Servants, and others who have the care of children, should be strictly forbid to give them any fruit without the knowledge of their parents • 14 OF CHILDREN. solids, renders them Aveak, and disposes them to the rickets, scrophula, and other gla.iaulcu- disorders. Relaxation is one of the most general causes of the diseases o, children. Every thing therefore which tends to un- brace their solids, ought to be carefully avoided. We would not be understood by these observations as confining chil- dren to any particular kind of food. Their diet may be frequently va- ried, provided ahvays that sufficient regard be had to simplicity. Of the Exercise of Children. Of all the causes which conspire to render the life of mun short and miser ble, none have greater influence than the Avant of proper Exer- cise : healthy parents, Avholesome food, and proper clothing, will avail little, w here exercise is neglected. Sufficient exercise will make up for several defects in nursing ; but nothing can supply the want of it. It is absolutely necessary to the health, the growth, and the strength of children. The desire of exercise is coeval Avith life itself. Were this principle attended to, many diseases might be prevented. But, while indolence and sedentary employments prevent two-thirds of mankind from either taking sufficient exercise fciemselves, or giving it to their children, Avhat have we to expect but diseases and deformity among their offspring ? The rickets, so destructive to children, never appeared in Britain till manufactures began to flourish, and people, attracted by the love of gain, left the country to follow sedentary employments in great towns. It is amongst these people that this disease chiefly prevails, and not only de- forms but kills many of their offspring. The conduct of other young auimals sheAvsthe propriety of giving ex- ercise to children. Every other animal makes use of its organs of motion as soon as it can, and many of them, even when under no necessity of moving in quest of food, cannot be restrained without force. Tins is evidently the case Avith the calf, the lamb, and most other young animals. If these creatures were not permitted to frisk about and take exercise, they Avould soon die or become diseased. The same inclination appears very early in the human species; but as they are not able to take exercise themselves, it is the business of their parents and nurses to assist them. Children may be exercised various Avays. The best method, while they are light, is to carry them about in the nurse's arms.* This gives the nurse an opportunity of talking to the child, and of pointing out every thing that may please and delight its fancy. Besides, it is much safer than SAvinging an infant in a machine, or leaving it to the care of such as are not fit to take care of themselves. Nothing can be more absurd than to set one child to keep another; this conduct has proved fatal to many infants, and has rendered others miserable for life. When children begin to Avalk, the safest and test method of leading them about is by the hands. The common Avay, of swirling them in leading strings, fixed to their backs, has several bad consequences. It makes them throw their bodies forward, and press with their Avhole weight upon the stomach and breast; by this means the breathing is obstructed, the breast flattened, and the boAvels compressed; which must * The nurse ought to be careful to keep the child in a proper position ; as de- formity is often the consequence of inattention to this circumstance. Its situa- tion ought also to be frequently changed I have known a child's leg bent all on one side, by the nurse carrying it constanly on one arm. OF CHILDREN. 45 hurt tlie digestion, and occasion consumptions of the lungs, and other diseases. It is a common notion, that if children are set upon their feet too soon, their legs w*ill become crooked. There is reason to believe, that the very reverse of this is true. Every member acquires strength in proportion as it is exercised. The limbs of children are weak indeed, but their bo- dies are proportionably light; and had they skill to direct themselves, they Avould soon be able to support their own Aveight. Who ever heard of any other animal that became crooked by uring its legs too soon ? In- deed, if a child is not permitted to make any use of its legs till a con- siderable time after the birth, and be then set upon them with its trhole iveight at once, there may be some danger; but this proceeds entirely from the child's not having been accustomed to use its legs from the be- ginning. Mothers of the poorer sort think they are greH gainers by making their children lie or sit while they themselves work. In this they are greatly mistaken. By neglecting to give their children exercise, they are obliged to keep them a long time before they can do any thing for themselves, and to spend more on medicine than would have paid for proper care. To take care of their children, is the most useful business in Avhich even the poor can be employed: but alas! it is not always in their power. Poverty often obliges them to neglect their offspring in order to procure the necessaries of life. Whenthisisthe case, it becomes the interestas well as the duty of the public to assist them. Ten thousand times more benefit would accrue to the state, by enabling the poor to bring up their oavh children, than from all the hospitals* that ever can be erected for that purpose. Whoever considers the structure of the humau body will soon be con- vinced of the necessity of exercise for the health of children. The bo- dy is composed of an infinite number of tubes,whose fluids cannot be pushed on without the action and pressure of the muscles. But, if the fluids remain inactive, obstructions must happen, and the humours will of course be vitiated, which cannot fail to occasion diseases. Nature has furnished both the vessels which carry the blood and lymph Avith nu- merous valves, in order that the action of every muscle might push for- Avard their contents; but without action, this admirable contrivance can have no effect. This part of the animal economy proves to a demon- stration the necessity of exercise for the preservation of health. Arguments to shew the importance of exercise might be drawn from every part of the animal economy; without exercise, the circulation of the blood cannot be properly carried on, nor the different secretions duly performed; Avithout exercise, the fluids cannot be properly prepared, nor the solids rendered strong or firm. The action of the heart, the motion of the lungs, and all the vital functions are greatly assisted by exercise. * If it were made the interest of the poor to keep their children alive, we should lose very few of them. A small premium given annually to each poor family, for every child they had alive at the year's end, would save more infant lives than if the whole revenue of the nation were expended on hospitals for this purpose. This would make the poor esteem fertility a blessing; whereas many of them think it the greatest curse that can befal them ; and in place of wish- ing their children to live, so far does poverty get the better of natural affection, that they are often very happy when they die. 46 OE CHILDREN. But to point out the manner in which these effects are produced, Avould lead us further into the economy of the human body, than most of those for whom this treatise is intended Avould be able to follow. We shall therefore only add, that, Avhen exercise is neglected, none of the animal functions can be duly performed; and Avhen that is the case, the whole constitution must go to Avreck. A good constitution ought certainly to be our first object in the man- agement of children. It iays a foundation for their being useful and hap- py in life: and Avhoever neglects it, not only fails in his duty to his off- spring, but to society. One very common error of parents, by Avhich they hurt the constitu- tions of their children, is the sending them too young to school. This is often done solely to prevent trouble. When the child is at school he needs no keeper. Thus the schoolmaster is made the nurse; and the poor child is fixed to a seat seven or eight hours a-day, Avhich time ought to be spent in exercise and diversions. Sitting so long cannot fail to produce the wrorst effects upon the body: nor is the mind less injured. Early application Aveakens the faculties, and often fixes in the mind an aversion to books, which continues for life.* But suppose this were the Avay to make children scholars, it certainly ought not to be done at the expense of their constitutions. Our ancesi- tors, who seldom Avent to school veiy young, were not less learned than we. But we imagine the boys education will be quite marred, unless he be carried to school in his nurse's arms. No wonder if such hot-bed plants seldom become .ritfier scholars or men! Not only the coonuejnent of children in public schools, but their num- ber, often proves hur'/ul. Children are much injured by being kept in croAvds within doors; their breathing not only renders the place unwhole- some, but if any one of them happens to be diseased, the rest catch the infection. A single child has been often known to communicate the bloody flux, the hooping cough, the itch, or other disease, to almost every indivi- vidual in a numerous school. But, if fashion must prevail, and infants are to be sent to school, Ave would recommend it to teachers, as they value the interests of society, not to confine them two long at a time, but alloAV them to run about and play at such active diversions as may promote their growth, and strengthen then: constitutions. Were boys, instead of being whipped for stealing an hour to run, ride, swim, or the like, encouraged to employ a proper part of their time in these manly and useful exercises, it would have many ex- cellent effects. It would be of great service to boys, if, at a proper age, they were taught the military exercise. ThisAvould increase their strength, inspire them Avith courage, and w hen their country called for their ^assistance would enable them to act in her defence, AvMiout being obliged to under' go a tedious and troublesome course of instructions, at a time Avhen they are less fit to learn neAV motions, gestures, «Src.f * It is undoubtedly the duty of parents to instruct their children, at least tifl they are of an age proper to take some care of themselves. This would tend much to confirm the ties of parental tenderness and filial affection, of the want of which there are at present so many deplorable instances. Though £aw fa- thers have time to instruct their children, yet most mothers have ; and surely they cannot be better employed. f I am happy to find that the masters of academies now begin to put in prac- tice this advice. Ea.cli of them ought to keep a drill sergeant for teaching the OF CHILDREN. 47 An effeminate education will infallibly spoil the best natural constitu- tion ; and if boys are brought up in a more delicate manner than even girls ought to be, they will never be men. Nor is the common education of girls less hurtful to the constitution than that of boys. Miss is set down to her frame before she can put on her clothes ; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general esteem. It is unnecessary here to insist upon the dangerous consequences of obliging girls to sit too much. They are pretty well known, and are too often felt at a certain time of life. But supposing this critical period to be got over, greater dangers still aAvait them Avhen they come to be mothers. Wo- men Avho have been early accustomed to a sedentary life, generally run great hazard in child-bed; Avhile those Avho have been used to romp about, and take sufficient exercise, are seldom in any danger. One hardly meets Avith a girl Avho can at the same time boast of early performances by the needle, and a good constitution. Close and early confinement generally occasions indigestions, head-achs, pale complec- tions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and deformity of body. The last of these indeed is not to be Avondered at, considering the awkward postures in which girls sit at many kinds of needle-work, and the delicate flexible state of their bodies in the early periods of life. Would mothers, instead of having their daughters instructed in many trifling accomplishments, employ them in plain work and house-wifery, and alloAV them sufficient exercise in the open air, they-would both make them more healthy mothers, and more useful members of society. I am no enemy to genteel accomplishment, but Avould have them only consi- dered as secondary, and always disregarded Avhen they impair the health. Many people imagine it a great advantage for cluldren to be early- taught to earn their bread. This opinion is certainly right, provided they Avere so employed as not to hurt their health or growth: but, Avhen these suffer, society, instead of being benefitted, is a real loser by their labour. There are feAv employments, except sedentary ones, by Avhich children can earn a livelihood; and if they be set to these too soon, it ruins their constitutions. Thus, by gaining a fetv years from childhood, we generally lose twice as many in the latter period of life, and even render the person less 'jseful while he does live. In order to be satisfied of the truth of this observation, we need only look into the great manufacturing towns, where Are shall find a puny degenerate race of people, weak and sickly all their lives, seldom ex- ceeding the middle period of life ; or if they do, being unfit for busi- ness, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a country, are by no means favourable to the health of its inhabitants. Good policy Avould there- fore require, that such people as labour during life, should not be set too early to Avork. Every person conversant in the breed of horses, or other working animals, knoivs, that if they be set to hard labour too soon, they never will turn out to advantage. This is equally true Avith respect to the human species. Weakly children should always be put apprentices to trades which require their being mostly out of doors. boys the military exercise. This, besides contributing to their health and rigour of body, would have many other happy effects. 48 OF CHILDREN". There are nevertheless various ways of employiug young people, without hurting their health. The easier parts of gardening, hus- bandry, or any business carried on without doors, are most proper. These are employme its which most young people are fond of, aud some parts of them may ahvays be adapted to their age, taste, aud strength.* Such parents, hoAvever, as are under the necessity of employiug their children within doors, ought to allow them sumcieut time for active di- versions without. This would both encourage them to do more Avork, and prevent their constitutions from being hurt. Some imagine, that exercise within doors is sufficient; but they are greatly mistaken. One hour spent in running, or any other exercise Avithout doors, is worth ten within. When children cannot go abroad, they may indeed be exercised at home. The best method of doing this, is to make them run about in a large room, or dance. This last kind of exercise, if not carried to excess, is of excellent service to young peo- ple. It cheers the spirits, promotes perspiration, strengthens the limbs, &c. I know an eminent physician who used to say, that he made his children dance, instead of giving them physic. It Avere well if more people followed his example. The cold bath may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretious promo- ted, and, were it conducted with prudence, many diseases, as the rickets, scrophula, &c. might thereby be prevented. The ancients, who took every method to render children hardy aud robust, were no strangers to the use of the cold bath; and, if we may credit report, the practice of immersing children daily in cold water must have been very common among our ancestors. The greatest objection to the use of the cold bath arises from the superstitious prejudices of nurses. These are often so strong, that it is impossible to bring them to make a proper use of it. I have known some of them who would not dry a child's skin after bathing it, lest it should destroy the effects of the water. Others will even put clothes dipt in Avater upon the child, and either put it to bed, or suffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular saint; while others place their confidence in a certain number of dips, as three, seven nine, or the like; and the world could not persuade them, if these do not succeed, to try it a little longer. Thus, by the Avhims of nurses, children lose the benefit of the cold bath, and the hopes of the physician from that medicine are often frustrated. We ought not, however, entirely to set aside the cold bath, because some nurses make a wrong use of it. Every child when in health, should at least have its extremeties daily washed in cold water. This is a partial use of the cold bath, and is better than none. In Arbiter this may suffice; but, in the warm season, if a child be relaxed or seem to have a tendency to the rickets or scrophula, its whole body ought to be frequently immersed in cold water. Care however must be t.ikea not to do this when the body is hot, or the stomach full. The * I have been told that in China, where the police is the best in the world all the children are employed in the easier part of gardening and husbandry • as weeding, gathering stones off the land, and such like. OF CHILDREN. 49 child should be dipped only once at a time, should be \aken out im- mediately, and have its skin well rubbed with a dry cloth. The bad Effects of unwholesome Air upon Children, FeAv things prove more destructive to children than confined or un- Avholesome air. Tliis is one reason Avhy so few of those infants, Avho are put into hospitals, or parish workhouses, live. These places are gene- rally ciow'ded Avith old, sickly, and infirm people; by which means the air is rendered so extremely pernicious, that it becomes a poison to infants. Want of Avholesome air is likeAvise destructive to many of the children boru in great towns. There the poorer sort of inhabitants live in Ioav, dirty, confined houses, to which the fresh air has hardly any access. Though grown people, who are hardy and robust, may live in such situ- ations, yet they generally prove fatal to their offspring, feAV of whom ar- rive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad into the open air, Ave must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mo- ther goes along Avith them. Servants are often negligent in these matters, and alloAV a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as Avell as her chil- dren ; and how can she be better employed than in attending them ? A very bad custom prevails of making children sleep in small apart- ments, or crowding two or three beds in one chamber. Instead of this, the nursery ought always to be the largest and best aired room in the house. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, renders them delicate, and disposes them to colds and many other disorders. Nor is the custom of Avrapping them up too close in cradles less perni- cious. One wrould think that nurses were afraid lest children should suf- fer by breathing free air, as many of them actually cover the child's face while asleep, and others wrap a covering over the Avhole cradle, by which means the child is forced to breathe the same air over and over all the time it sleeps. Cradles indeed are on many accounts hurtful to children, and it Avould be better if the use of them Avere totally laid aside.* A child is generally laid to sleep with all its clothes on; and if a num- ber of others are heaped above them, it must be over-heated; by which means it cannot fail to catch cold on being taken out of the cradle, and * It is amazing how children escape suffocation, considering the manner in which they are often rolled up in flannels, &c. I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I betrged for a little free air to the poor babe ; but though this indulgence was granted during my stay, I found it always on my return in the same situation. Death, as might be expected, soon freed the in- fant from all its miseries : but it was not in my power to free the minds of its parents from those prejudices which proved fatal to their child. I was very lately called to see an infant which was said to be expiring in con- vulsion fits. I desired the mother to strip tire child, and wrap it in a. loose co- vering. It had no more convulsion fits. 50 OF CHILDREN. exposed to the open air Avitli only its usual clothing, w Inch is too fre*' quently the case. Children who are kept within doors all day, and sleep all night iu Ararm close apartments, may, with great propriety, be compared to plants, nursed in a hot-house, instead of the open air. Though such plants may by this means be kept alive for some time, they will never arrive at that degree of strength, vigour, and magnitude, which they Avould have acquired in the open air, nor would they be able to bear it aftenvards, should they be exposed to it. Children brought up in the country, avIio have been accustomed to open air, should not be too early sent to great toAvns, Avhere it is confined and unwholesome. This is frequently done with a view to forwrard their education, but proves very hurtful to their health. All schools and seminaries of learning ought, if possible, to be so situated as to have fresh, dry, wholesome air, and should never be too much crowded. Without entering into a detail of the particular advantages of whole- some air to children, or of the bad consequences which proceed from the Avant of it, I sin 11 only observe, that of several thousands of children Avhich have been under my care, I do not remember oue instance of a single child who coatuiued healthy in a close confined station; but have often known the most obstiuate diseases cured by removing them from such a situation to an open free air. Of Nurses. It is not here intended to lay down rules for the choice of nurses. This Avould be wasting time. Common sense will direct every one to chuse a woman Avho is healthy, and has plenty of milk.* If she be at the same time cleanly, careful, and good natured, she can hardly fail to make a proper nurse.t After all, hoAvever, the only certain proof of a good nurse, is a healthy child upon her breast. But, as the misconduct of nurses often proves fatal to children, it will be of importance to point out a fe»v of their most baneful errors, in order to rouse the attention of parents, and to make them look more strictly into the conduct of those to w horn they commit the care of their infant offspring. Though it admits of some exceptions, yet Ave may lay it down as a general rule, That every woman who nurses for hire should be carefully looked after, otherwise she will not do her duty. For this reason parents ought ahvays to have their children nursed under their own eye, if pos- ble; and Avhere this cannot be done, they should be extremely cir- * I hr.ve often known people so imposed upon, as to give an infant to a nurse to be suckled who had not one drop of milk in her breast. -f- Next of importance to a healthy, cleanly, and good-natured nurse, is her diet—On tliis subject after a close and lengthy investigation, Dr. Cullen, con- cludes. " I allege it to be a matter of experience, that nurses living entirelv, or for the most part, upon vegetable aliment, afford a greater quantity of milic, and of a more proper quality, than nurses living upon much animal food. This, 1 venture to assert, from the observation of fifty years; during which time, I bave known innumerable instances of the healthiest children reared upon the milk of nurses living entirely upon vegetable aliments; and I have known manj instances of children becoming diseased, by their being fed by the milk of nurses who had changed their diet from entirely vegetable, to their taking in a quan- tity of animal food. Nay, I have known instances of children's becoming dis- ordered from a nurse's making a sin^ meal, of an. unusually large portion of animal food.."' Ai E^ OF CHILDREN". 51 cnmspect in the choice of those persons to whom they intrust them. It is folly to imagine that any woman, avIio abandons her OAvn child to suckle another for the sake of gain, should feel all the affections of a parent to- wards her nursling; yet so necessary are the affections in a nurse, that, but for them, the human race Avould soon be extinct. One of the most common faults of those Avho nurse for hire, is dosing cliildren Avi*h stupefactives, or such things as lull them asleep. An in- dolent nurse, who does not give a ch'.ld bulbcif nt exercise hi the open air to make it sleep, and does not chuse to be disturbed by it in the night, will seldom fail to procure for it a dose of laudanum, diacodium, saffron, or Avhat answers the same purpose, a dose of spirits, or other strong liquors These, though they be certain poison to infants, are every day adminis- tered by many avIio bear the character of very good nurses.* A nurse Avho has not milk enough is apt to imagine that this defect may be supplied by giving the child wanes, cordial Avaters, or other strong liquors. This is an egregious mistake. The only thing that has any chance to supply the place of the nurse's milk, mu t be somewhat nearly of the same quality, as coav's milk, ass's milk, or beet-tea, Avith a little bread. It never can be done by the help of strong liquors. These, mstead of nourishing an infant, never fail to produce the contrary effect. Children are often hurt by nurses suffering them to cry long and ve- hemently. This strains their tender bodies, and frequently occasions rup- tures, inflammations of the throat, lungs, &c. A child never continues to cry long Avithout some cause, which might ahvays be discovered by proper attention; and the nurse who can hear an infant ciy till it has almost spent itself, without endeavouring to please it, must be cruel in- deed, and is unworthy to be intrusted with the care of an human crea- ture. Nurses who deal much in medicine are always to be suspected. They trust to it, and neglect their duty. I never knew a good nurse who had her Godfrey's cordial, Daffy's elixirs, Dalby's carminative, &c. at hand. Such generally imagine, that a dose of medicine Avill make up for all de- fects in food, air, exercise, and cleanliness. By errors of this kind, 1 Avill venture to say, that one half of the children Avho die annually in London lose their lives. AlloAving children to contiune long Avet, is another veiy pernicious cus- tom of indolent nurses. This is not only disagreeable, but galls and frets the infant, and, by relaxing the solids, occasions scrophula;, rickets, and other diseases. A dirty nurse is always to be suspected. Nature often attempts to free the bodies of children from bad humours-, by throAving them upon the skin: by this means fevers and other diseases are prevented. Nurses are apt to mistake such critical eruptions for an itch, or some other infectious disorder. Accordingly they take every method to drive them in. In this way many children lo^e their lives; and no wonder, as nature is opposed in the very method she takes to re- lieve them. It ought to be a rule, Avhich every nurse should observe, never to stop any eruption Avithout proper advice, or being well assured that it is not of a critical nature. At any rate, it is never to be done Avithout previous evacuations. * Jf a mother on visiting her child at nurse finds it always asleep, I would ad- vise li'*r to remove it immediately ; otherwise it will soon sleep its last. 52 or THE LABORIOUS, THE SEDENTARY, Loose stools i6 another method by which nature often prevents or carries off the diseases of infants. If these proceed too far, no doubt they ought to be checked; but this is never to be done Avithout the greatest caution. Nurses, upon the first appearince of loose stools, frequeutly fly to the use of astringents, or such things as bind the body. Hence inflammatory fevers, and other fatal disease.-, are occasioned. A dose of rhubarb, a gentle vomit, or some other evacuations, should always precede the use of astringent medicines. One of the greatest faults of nurses is, concealing the diseases of chil- dren from their parents. This they are extremely ready to do, especially Avhen the disease is the effect of their own negligence. Many instances might be given of persons who have been rendered lame for life by a fall from the nurse's arms, which, she through fear, concealed till the misfor- tune was past cure. Every parent who intrusts a nurse with the care of a child, ought to give her the strictest charge not to conceal the most tri- fling disorder or misforttme that may befal it. We can see no reason Avhy a nurse, who conceals any misfortune which happens to a child under her care, till it loses its life, or limbs, should not be punished. A few examples of this Avould save the lives of many in- fants ; but as there is little reason to expect that it ever will be the case, we would earnestly recommend it to all parents to look carefully after their children, and not to trust so valuable a treasure entirely in the hands of an hireling. No person ought to imagine these things uuworthy of his attention. On the proper management of children depend not only their health and use- fulness in life, but likewise the safety and prosperity of the state to which they belong. Effeminacy ever will prove the ruin of any state Avhere it prevails; and, Avhen its foundations are laid in infancy, it can never after- Avards be wholly eradicated. Parents who love their offspring, and Avish Avell to their country, ought therefore, in the mauagement of their children, to avoid every thing that may have a tendency to make them weak or ef- feminate, and to take every method in their poAver to render their constitu- tions strong and hardy. " By arts like these " Laconia nurs'd of old her hardy sons ; " And Rome's unconquer'd legions urg'd their way, " Unhurt, through every toil in every clime." Armsthouc. CHAP. II. OF THE LABORIOUS, THE SEDENTARY, AND THE STUDIOUS. X HAT men are exposed to particular diseases from the oc- cupations which they follow, is a fact Avell known; but to remedy this evil is a matter of some difficulty. Most people are under the necessity of foIloAving those employments to which they have been bred, whether they be favourable to health or not. For this reason, instead of inveigh- ing, in a general Avay, as some authors have done, against those occu- pations which are hurtful to health, we shall endeavour to p.int AND THE STUDIOUS. S3 out the circumstances in each of them from which the danger chiefly arises, and to propose the most rational methods of preventing it. Chymists, founders, forgers, glass-makers and several other artists, are hurt by the unwholesome air which they are obliged to breathe. This air is not only loaded with the noxious exhalations arising from metals and minerals, but is so charged with phlogiston as to be rendered unfit for expanding the lungs sufficiently, and answering the other important purposes of respiration. Hence proceed asthmas, coughs, and consumpr tions of the lungs, so incident to p«**sous who follow these employments. To prevent such consequences, as far as possible, the places Avhere these occupations are carried on, ought to be constructed in such a manner as to discharge the smoke and other exhalations, and admit a free current of fresh air. Such artists ought never to continue too long at work; and when they give over, they should suffer themselves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quantities of cold, weak, or Avatery liquors, while their bodies are hot, nor to indulge in raw fruits, sallads, or any thing that is cold on the stomach.* Miners, and all who work under ground, are likew ise hurt by umvhole- some air. The air, by its stagnation in deep mines, not only loses its proper spring and other qualities necessary for respiration, but is often loaded with such noxious exhalations as to become a most deadly poison. The two kinds of air which prove most destructive to miuers, are what they call i\\f; fire damp, and the choke damp. In both cases the air becomes a poison by its being loaded with phlogiston. The danger from the former may be obviated by making it explode before it accu- mulates in too great quantities; and the latter may be generally carried off by promoting a free circulation of air in the mine. Miners are not only hurt by unwholesome air, but likeAvise by the particles of metal Avhich adhere to their skin, clothes, . Surrounding houses too closely with planting of thick woods, likewise tends to render the air unwholesome. Wood not only obstructs the free current of the air, but sends forth great quantities of moist exhalations, which render it constantly damp. Wood is very agreeable at a proper distance from a house, but should never be planted too near it, especially in a flat country. Many of the gentlemen's seats in England are ren- dered very unwholesome from the great quantity of Avood which sur- rounds them. Houses situated in low marshy countries, or near large lakes ol stagnat- ing water are likewise unwholesome. Waters which stagnate not only render the air damp, but load it with putrid exhalations, which produce the most dangerous and fatal diseases. Those who are obliged to inhabit marshy countries, ought to make choice of the dryest situations they can find, to live generously, and to pay the strictest regard to cleanliness. If fresh air be necessaiy for those in health, it is still more so for the sick, who often loose their lives for want of it. The notion that sick people must be kept very hot, is so common that one can hardly enter a chamber where a patient lies, without being ready to faint, by reason of the hot suffocating smell. How this must affect the sick, any one may iudge. No medicine is so beneficial to the sick as fresh air. It is the most reviving of all cordials, if it be administered with prudence. We are not however, to throw open doors and windows at random upon the Sick. Fresh air is to be let into the chamber gradually, and if possible, by opening the windows of some other apartment. The air of a sick person's chamber may be greatly freshened,, and the patient much revived, by sprinkling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other strong vegetable acid. In places where numbers of sick are croudedinto the same house, or, which is often the case, into the same apartment, the frequent admission of fresh air becomes absolutely necessary. Infirmaries, hospitals, &c. are often rendered so noxious, for Avant of proper ventilation, that the sick run more hazard from them than from the disease. This is partial- Cularly the case when putrid fevers, dysentaries, and other infectious dlSCclSGS DTCVcllU Physicians, surgeons, and others Avho attend hospitals, ought, for their own safety, to take care that they be properly ventilated. Such persons as are obliged to spend the most of their time amongst the sick, run great hazard of being themselves infected Avhen the air is bad. All hospitals, and places of reception for the sick, ought to have an open situation^ at some distance from anv great town, and such patients as labour imdei n 82 OF EXERCISE. any infectious disease ought never to be suffered to come near the rest # CHAP. V. OF EXERCISE. IVXaNY people look upon the necessity man is under of earn- ing his bread by labour, as a curse. Be this as it may, it is evident from the structure of the body, that exercise is not less necessary than food for the preservation of health : those whom poverty obliges to la- bour for daily bread, are not only the most healthy, but generally the most happy part of mankind. Industry seldom fails to place them above want, and activity serves them instead of physic. This is peculiarly the case With those who live by the culture of the ground. The great increase of inhabitants in infant colonies, and the longevity of such as follow agriculture, every where, evidently prove it to be the most healthy as well as the most useful employment. The love of activity sheAvs itself very early in man. So strong is this principle, that a healthy youth cannot be restrained from exercise, even by the fear of punishment. Our love of motion is surely a strong proof of its utility. Nature implants no disposition in vain. It seems to be a catholic law throughout the Avhole animal creation, that no crea- ture, without exercise, should enjoy health, or be able to find subsistence. Every creature, except man, takes as much of it as is necessaiy. He alone, and such animals as are under his direction, deviate from this original law, and they suffer accordingly. Inactivity never fails to induce an universal relaxation of the solidi3 which disposes the body to innumerable diseases. When the solids are relaxed, neither the digestion nor any of the secretions can be didy per- formed. In this case, the Avorst consequences must ensue. Hoav can persons Avho loll all day in easy chairs, and sleep all night on beds of down, fail to be relaxed ? Nor do such greatly mend the matter, who never stir abroad but in a coach, sedan, or such like........These elegant pieces of luxury are become so common, that the inhabitants of great towns seem to be in some danger of losing the use of their limbs alto- gether. It is now below any one to walk, Avho can afford to be carried. How ridiculous would it seem, to a person unacquainted with modern luxury, to behold the young and healthy swinging along on the shoulders of their fellow creatures! or to see a fat carcase, over-run with diseases occasioned by inactivity, dragged through the streets by half a dozen horses.f * A year seldom passes that we do not hear of some hospital physician or surgeon having lost his life by an hospital fever, caught from his patients For this they have themselves alone to blame. Their patients are either in an im- proper situation, or they are to» careless with regard to their own conduct \ It is not necessity, but fashion, which makes the use of carnages so com- mon. There are many people who have not exercise enough to keep their hu- mours wholesome, who yet dare not venture to make a visit to their next neigh- bours, but in a coach or sedan, lest tbey should be looked down upon. Strange tliat men should be such fools as to be laughed out of the use of their limbs' er to throw away their health, in order to gratify a piece of vanitv, or to comph' with a ridiculous fashion *. 1 • OF EXERCISE. #3 Glandular obstructions, now so common, generally proceed from in- activity. These are the most obstinate maladies. So long as the liver, kidnies, and other glands, duly perform their functions, health is sel- dom impaired; but when they fail, nothing can restore it. Exercise is almost the only cure we know for glandular obstructions; indeed, it does not ahvays succeed as a remedy: but there is reason to believe that it would seldom fail to prevent these complaints, were it used in due time. One thing is certain, that amongst those avIio take sufficient exercise, glandular diseases are very little kuown; Avhereas the indolent and in- active are seldom free from them. Weak nerves are the constant companions of inactivity. Nothing but exercise and open air can brace and strengthen the nerves, or pre- vent the endless train of diseases which proceed from a relaxed state of these organs. We seldom hear the active or laborious complain of nervous diseases; these are reserved for the sons of ease and affluence. Many have been completely cured of these disorders by being reduced, from a state of opulence, to labour for their daily bread. This plai dy points out the sources from whence nervous diseases flow, and the means by which they may be prevented. It is absolutely impossible to enjoy health, Avhere the perspiration is not duly carried on : but that can never be the case where exercise is neglected. When the matter which ought to be throAvn off by perspi- ration is retained in the body, it vitiates the humours, and occasions the gout, fevers, rheumatism, &c. Exercise alone would prevent many of those diseases which cannot be cured, and would remove others where medicine proves ineffectual. A late author,* in his excellent treatise on health, says that the weak and valetudinary ought to make exercise a part of their religion. We would recommend this, not only to the weak and valetudinary, but to all whom business does not oblige them to take sufficient exercise, as sedentary artificers,! shopkeepers, studious persons, &c.....Such ought to use exercise as regularly as they take food. This might generally be done without any interruption to business or real loss of time. No piece of indolence hurts the health more than the modern custom of lying a-bed too long in a morning. This is the general practice in great toivos. The inhabitants of cities seldom rise before eight or nine o'clock; but the morning is undoubtedly the best time for exercise, while the stomach is empty, and the body refreshed with sleep. Be- sides the morning air braces aud strengthens the nerves, and, in some • Cheyne. | Sedentary occupations ought chiefly to be followed by women. They bear confinement much better than men, and are fitter for every kinjj. of business which does not require much strength. It is ridiculous enough to see a lusty fellow making pins, needles, or watch wheels, while many of|ie laborious parts of husbandry are carried on by the other sex. The fact is, wePwant men for laborious employments, while one half of the other sex are rendered useless for want of occupations suited to their strength, &c. Were girls bred to mechani- cal employments, we should not see such numbers of them prostitute them- selves for bread, nor find such a want of men for the important purposes of na- vigation, agriculture, &c An eminent silk manufacturer told me, that he found women answer better for that business than men ; and that he had lately taken a gre..t many girls apprentices »S silk weavers. I hope his example will be fol- lowed by many others,. 84 ©F EXERCISE* measure answers the purpose of a cold bath. Let any one who has been accustomed to lie a-bed till eight or nine o'clock, rise by six or seven, spend a couple of hours in walking, riding, or any active diver- sion without doors, and he will find his spirits cheerful and serene through the day, his appetite keen, and his body braced and strengthen- ed. Custom soon renders early rising agreeable, and nothing contributes more to the preservation of health. The inactive are continually complaining of pains of the stomach, flatulencies, indigestions, &c. These complaints, which pave the Avay to many others, are not to be removed by medicines. They can only be cured by a vigorous course of exercise, to wiiich indeed they seldom fail to yield. Exercise, if possible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercising the body Avithin doors, as the dumb bell, dancing, fencing, &c. It is not necessary to adhere strictly to any particular kind of exercise. The best w ay is to take them by turns, and to use that longest which is most suitable to the strength anff constitution. Those kinds of exercise which give action to most of the bodily organs, are always to be preferred, as walking, running, riding, digging, rubbing furniture, and such like. It is much to be regretted, that active and manly diversions are now so little practised. Diversions make people take more exercise than they otherwise would^do, and are of the greatest service to such as are not under the necessity of labouring for their bread. As active diver- sions lose ground, those of a sedentary kind seem to prevail. Sedentary v diversions are of no other use but to consume time. Instead of relieving the mind, they often require more thought than either study or business. Every thing that induces people to sit still, unless it be some necessary employment, ought to be avoided. The diverions Avhich afford the best exercise are, hunting, shooting, playing at cricket, haneWball, golff,* &c. These exercise the limbs, pro- mote perspiration and the flther secretions. They likewise strengthen the lungs, and give firmness and agility to the whole body. Such as can, ought to spend two or three hours a day on horseback; those Avho cannot ride, should employ the same time in walking. Ex- ercise should never be continued too long. Over fatigue prevents the benefit of exercise, and instead of strengthening the body tends to weak- en it. Every man should lay himself under some sort of necessity to take exercise. Indolence, like other vices when indulged, gains ground, and at length becomes agreeable. Heuce many who Avere fond of exercise in the early part of life, become quite averse to it afterwards. This is the case oftnost hypochondriac and gouty people, which renders their diseases in a great measure incurable. In some "countries laAvs have been made, obliging every man, of whatever rank, to learn some mechanical employment. Whether such laAvs were designed for the preservation of health, or the encou- ragement of manufacture, is a question of no importance. Certain it * Golff is a diversion very common in North Britain. It is well calulated for exercising the body, and may always be taken in such moderation, as neither to over-heat nor fatigue. It has greatly the preference over cricket, tennis, or any of those games which cannot be played without violence. OF SLEEP AND CLOTHING. 85 is, that if gentlemen were frequently to amuse and exercise themselves in this Avay; it might have many good effects. They would at least de- rive as much honour from a few masterly specimens of their OAvn work- manship, as from the character of having ruinecfmost of their compan- ions by gaming or drinking- Besides, men of lejsulfe, by applying them- selves to the mechanical arts, might improve them, to the great benefit of society. Indolence not only occasions diseases, and renders men useless to so- ciety, but promotes all manner of vice. To say a man is idle, is httle better than to call him vicious. The mind, if not engaged in some use- ful pursuit, is constantly in quest of idle pleasures, or impressed with the apprehension of some imaginary evil. From these sources proceed most of the miseries of mankind. Certainly man was never intended to be idle. Inactivity frustrates the very design of his creation ; whereas an active life is the best guardian of virtue, and the greatest preservative of health. CHAP. VI. , <-. i >.» OF SLEEP AND CLOTHING. SLEEP, as well as diet, ought to be duly regulated. Too little sleep weakens the nerves, exhausts the spirits, and occasions dis- eases; and too much renders the mind dull, the body gross, and disposes to apoplexies, lethargies, and other complaints of a similar nature. A medium ought therefore to be observed; but this is not easy to fix. Children require more sleep than grown persons, the laborious than the idle, and such as eat and drink freely, than those who live abstemious- ly. Besides the real quantity of sleep cannot be measured by time; as one person vyill be more refreshed by five or six hours sleep, than another by eight or ten. Children may always be allowed to take as much sleep as they please; but for adtritsv six or seven hours is certainly sufficient, and no one ought to exceed eight. Those who lie a-bed more than eight hours may slum- ber, but they can hardly be said to sleep; such generally toss and dream away the fore-part of the night, sink to rest towards morning, and dose till noon. The best way to make sleep sound and refreshing is to rise betimes. The custom of laying a-bed for nine or ten hours, not only makes the sleep less refreshing, but relaxes the solids, and greatly weakens the constitution. Nature points out night as the proper season for sleep. Nothing more certainly destroys the constitution than night-Avatching. It is a great pity that a practice so destructive to health should be so much in fashion. How quickly the Avant of rest in due season will blast the most blooming complexion, or ruin the best constitution, is evident from the ghastly countenances of those Avho, as the phrase is, turn day into night, and night into day. To make sleep refreshing, the folloAving things are requisite: First, to take sufficient exercise in the open air: to avoid strong tea or coffee; next, to eat a light supper; and lastly to lie down Avitji a mind as cheer- ful and serene as possible. 86 OF SLEEP AND CLOTHING. It is certain that too much exercise will prevent sleep, as well as too little. We seldom however hear the active and laborious complain ol restless nights. It is the indolent and slothful who generally have these complaints. Is it any<%onder that a bed of down should not be refresh- ing to a person who,#tsall day in an easy chair? A great part of the pleasure of life consists in alternate rest and motion; but they Avho ne- glect the latter can never relish the former. The labourer enjoys more true luxury in plain food and souud sleep, than is to be found in sumptu- ous tables and downy pillows, where exercise is wanting. That light suppers cause sound sleep, is true even to a proverb. Ma- ny persons, if they exceed the least at that meal, are sure to have un- easy nights; and, if they fall asleep, the load and oppression on their stomach and spirits occasion frightful dreams, broken and disturbed repose, the night-mare, &c Were the same persons to go to bed with a light supper, or sit up till that meal was pretty Avell digested, they would en- joy sound sleep, and rise refreshed and cheerful. There are indeed some people who cannot sleep, unless they have eat some solid food at night, but this does pot imply the necessity of a heavy supper; besides, these are generally persons who have accustomed themselves to this method, and Avho do not take a sufficient quantity of solid food and exercise. Nothing more certainly disturbs our repose than anxiety. When the mind is not at ease, one seldom eujoys souud sleep. This greatest of hu- man blessings flies the Avretched, and visits the happy, the cheerful, and the gay. This is a sufficient reason why every man should endeavour to be as easy in his mind as possible when he goes to rest. Many, by in- dulging grief and anxious thought, have banished sound sleep so long, that they could never afterwards enjoy it. Sleep, when taken in the fore-part of the night, is generally reckoned most refreshing. Whether this be the effect of habit or not, is hard to say; but as most people are accustomed to go early to bed when young, it may be presumed that sleep, at this season, Avill prove most refreshing to them ever after. Whether the fore-part of the night be best for sleep or not, surely the fore-part of the day is fittest both for business and amusement. I hardly ever knew an early riser, who did not enjoy a good state of health.* Of Clothing. The clothing ought to be suited to the climate. Custom has no doubt a very great influence in this article; but no custom can ever change the nature of things so far, as to render the same clothing fit for an inha- bitant of Nova Zembla and the island of Jamaica. It is not indeed ne- cessary to observe an exact proportion between the quantity of clothes we wear and the degree of latitude Avhich we inhabit; but, at the same time, proper attention ought to be paid to it, as Avell as to the openness of the country, the frequency and violence of storms, 6zc. In youth, while the blood is hot and the perspiration free, it is less necessary to cover the body with a great quantity of clothes; but in * Men of every occupation, and every situation of life, have lived to a good old age; nay some have enjoyel this blessing whose plan of living was by no means regular: but it consists with observation, that all very old men have been early risers. This is the •nly circumstance attending longevity to which I never knew an exception. OF SLEEP AND CLOTHING. 87 the decline of life, when the skin becomes rigid and the humours more cool, the clothing should be increased. Many diseases in the latter pe- riod of life proceed from a defect of perspiration : these may, in some measure, be prevented by a suitable addition to the clothing, or by wear- ing such as are better calculated for promoting the discharge from the skin, as clothes made of cotton, flannel, &c. The clothing ought likewise to be suited to the season of the year. Clothing may be warm enough for summer, which is by no means suffi- cient for winter. The greatest caution, however, is necessary in making these changes. We ought neither to put off our winter clothes too soon, nor to wear our summer ones too long. In this countiy, the winter often sets in very early with great rigour, and Ave have frequently cold Aveather even after the commencement of the summer months. It would like- wise be prudent not to make the change all at once, but do it gradually; and indeed the changes of apparel in this climate ought to be very in- considerable, especially among those who have passed the meridian of life* Clothes often become hurtful by their being made subservient to the purposes of pride or vanity. Mankind in all ages seem to have consider- ed clothes in this view; accordingly their fashion and figure have been continually varying, with very little regard either to health, the cli- mate, or conveniency; a farthingale, for example, may be very necessar ry in hot southern climates, but surely nothing can be more ridiculous in the cold regions of the north. Even the human shape is often attempted to be mended by dress, and those who know no better believe that mankind would be monstrous without its assistance. All attempts of this nature are highly pernicious. The most destructive of them in this country is that of squeezing the stomach and boAvels into as narrow a compass as possible, to procure, what is falsely called, a fine shaped By this practice the action of the stomach and bowels, the motion of the heart and lungs, and almost all the vital functions, are obstructed. Hence proceed indigestions, syn- copes or fainting fits, coughs, consumptions of the lungs, and other com- plaints so common among females. The feet likewise often suffer by pressure. How a small foot came to be reckoned genteel, I will not pretend to say; but certain it is, that this notion has made many persons lame. Almost nine-tenths of man- kind are troubled with corns: a disease that is seldom or never occa- sioned but by strait shoes. Corns are not only very troublesome, but by rendering people unable to Avalk, they may likewise be considered as the remote cause of other diseases-! •That colds kill more than plaguis, is an old observation : and, with regard to this country, it holds strictly true. Every person of discern- ment, however, will perceive, that most of the colds which prove so destructive to the inhabitants of Britain, are owing to their imprudence in changing clothes A few warm days in March or April induce them to throw off theit winter garments, without considering that our most penetrating colds general- ly happen in the spring -J- This madness seems to have pervaded the minds of mothers in every age »nd country. Terence, in his Gomedy of the Eunuch, ridicules the Roman matrons for attempting to mendtlie shape of their daughters $ We often see persons, who are rendered quite lame by the nails of their toes having grown into the flesh, and frequently hear of mortifications proceed- 88 OF SLEEP AND CLOTHING. The size and figure of the shoe ought certainly to be adapted to the foot. In children the feet are as well shaped as the hands, and the mo- tion of the toes as free and easv as that of the fingers; yet few persons in the advanced period of life are able to make any use ot their toes. They are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether in- capable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, but she Avill neA-er walk well in this manner. It strains her joints, distorts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion : it is entirely oAving to shoes with high heels and narrow toes, that not one female in ten can be said to walk well. In fixing on the clothes, due care should be taken to avoid all tight bandages. Garters, buckles, &c. Avhen drawn too tight, not only pre- vent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and occasions various di- seases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood in its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases are often occasioned. The perfection of dress is to be easy and clean. Nothing can be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, aud many such there are, would rather remain as fixt as a statue from morning till night, than discompose a single hair, or alter the position of a pin. Were we to recommend any particular pattern for dress, it would be that which is worn by the people called Quakers. They are always neat, clean, and often elegant, without any thing su- perfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt. We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and the period of life; but likewise to the temperature and constitution. Robust persons are able to endure either cold or heat better than the delicate; consequently may be less attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm.* -----------------------————_____________________________j ing from this cause. All these, and many other inconveniences attending the feet, must be imputed solely to the use of short and strait shoes. * The celebrated Boerhaave used to say, that nobody suffered by cold save fools and beggars; the latter not being able to procure clothes, and the former not having sense to wear them Be this as it may, I can with the strictest truth declare, that in many cases where the powers of medicine had been tried in vain, I have cured the patient by recommending thick shoes, a flannel waistcoat and drawers, a pair of under stockings, or a flannel petticoat, to be worn during the cold season at least Where w armer clothing is wanted, I would recdm-' mend the fleecy hosiery to be worn next the skin. 89 CHAP. VII. OF INTEMPERANCE. A MODERN author* observes that temperance and ex* erase are the two best physicians in the world. He might have added, that if these were duly regarded, there would be little occasion for any other. Temperance may justly be called the parent of health; yet numbers of mankind act as if they thought diseases and death too slow in their progress, and by intemperance and debauch seem as it were to solicit their approach. The danger of intemperance appears from the very construction of the human body. Health depends on that state of the solids and fluids which fits them for the due performance of the vital functions; and while these go regularly on, we are sound and well; but whatever disturbs them necessarily impairs health. Intemperance never fails to disorder the whole animal economy; it hurts the digestion, relaxes the nerves, renders the different secretions irregular, vitiates the humouiSj, and occasions numberless diseases. The analogy between the nourishment of plants and animals affords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation; yet an over-quantity of either will entirely destroy it. The best things become hurtful, nay, destructive, when carried to excess. Hence Ave learn, that the highest degree of human wisdom consists in regulating our appetites and passions so as to avoid all extremes. It is that chiefly which entitles us to the character of ra- tional beings. The slave of appetite will ever be the disgrace of hu- man nature. The Author of Nature hath endued us with various passions, for the propagation of the species, the preseivation of the individual, &c. In- temperance is the.abuse of these passions; and moderation consists in the proper regulation of them. Men, not contented with satisfying tlie sim- ple calls of Nature, create artificial wants, and are perpetually in search after something that may gratify them; but imaginary wrants can never be gratified. Nature is content with little; but luxury knows no bounds. Hence the epicure, the drunkard, and the debauchee seldom stop in their career till their money or their constitution fails: then indeed they generally see their error when too late. It is impossible to lay doAvn fixed rules with regard to diet, on accouuC of the different constitutions of mankind. The most ignorant person, however, certainly knoAvs Avhat is meant by excess; and it is in the power of eveiy man, if he chooses to avoid it. The great rule of diet is to study simplicity. Nature delights in, the most plain and simple food, and every animal, except man, folloArs her dictates. .Man alone riots at large, and ransacks the whole creation in quest of luxuries, to his OAvn destruction. An elegant writerf of the last age, speaks thus of intemperance in diet: " For my part, when I be- hold a fashionable table set out in all its magnificence, I fancy that I see gouts and dropsies, fevers and lethargies, Avith other innumerable dis- tempers, lying in ambuscade among the dishes." --------------------------------------------------------------------------------------------------------k.---------------it*,— * Rosscau. f Addison. 12 90 OF INTEMPERANCE. Nor is intemperance in other things less destructive than in diet. How quickly does the immoderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best contistution! Indeed these vices generally go hand in baud. Hence it is that we so often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and hastening with swift pace to an untimely grave. Did men reflect on the painful diseases and prema- ture deaths, which are daily occasioned by intemperance, it would be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures. Intemperance does not hurt its votaries alone; the innocent too often feel the direful effects of it. How many wretched orphans are to be seen embracing dung hills, whose parents, regardless of the future, spent in riot and debauch wliat might have served to bring up their offspring in a decent manner! How often do we behold the miserable mother, with her helpless infants, pining in w ant, while the cruel father is in- dulging his insatiate appetites! Families are not only reduced to misery, but even extirpated, by in- temperance. Nothing tends so much prevent propagation, and shorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down contented with his humble fare, can boast a numerous offspring, while his pampered lord, sunk in ease and luxury, often languishes without an heir to his ample fortunes. Even states and empires feel the influence of intemperance, and rise or fall as it prevails. Instead of mentioning the different kinds of intemperance, and point- ing out their influence upon health, Ave shall only, by way of example, make a feAv observations on one particular species of that vice, viz. the abuse of intoxicating liquors. Every act of intoxication puts nature to the expense of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That constitution must be strong indeed, which is able long to hold out under a daily fever! but fevers occasioned by drinking do not ahvays go off in a day; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects. Though the drunkard should not fall by an acute disease, he seldom escapes those of a chronic kind. Intoxicating liquors, when used to excess, weaken the boAvcls and Ispoil the digestion; they destroy the power of the nerves, and occasion paralytic and convulsive disorders; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation, and the nourishment of the body. Hence obstructions, atrophies, dropsies, and consumptions of the lungs. These are the common Avays in which drunkards make their exit. Diseases of this kind, when brought on by hard drinking, seldom admit of a cure. Many people injure their health by drinking, who seldom get drunk. The continual habit of soaking, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept con- stantly full and upon the stretch, the different digestions can nei- ther be duly performed, nor the humors properly prepared. Hence, most people of this character are afflicted Avith the gout, the gravel, ulcerous sores in the legs, &c» If these disorders do not appear, they OF INTEMPERANCE. 91 are seized Avith low spirits, hypochondriacal affections, and other symp- toms of indigestion. Consumptions are noAv so common, that it is thought one-tenth of the inhabitants of great towns die of that disease. Hard drinking is no doubt one of the causes to which we must impute the increase of con- sumptions. The great quantities of viscid malt liquor drank by the common people of England, cannot fail to render the blood sizy and unfit for circulation; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthisical: nor is that to be wondered at, considering the glutinous and almost in- digestible nature of strong ale. Those w ho drink ardent spirits or strong wines, run still greater ha- zard ; these liquors heat aud inflame the blood, and tear the tender ves- sels of the lungs to pieces; yet so great is the consumption of them in this country, that one would almost be induced to think that the inhabi- tants lived upon them.* The habit of drinking proceeds frequently from misfortunes in life. The miserable fly to it for relief. It affords them indeed a temporary ease. But, alas! this solace is short-lived; and when it is over, the spirits sink as much below their usual tone as they had before been rais- ed above it. Hence a repetition of the dose becomes necessaiy, and every fresh dose makes way for another, till the unhappy wretch becomes a slave to the bottle, and at length falls a sacrifice to what at first perhaps was taken only as a medicine. No man is so dejected as the drunkard when his debauch is gone off Hence it is, that those who have the greatest flow of spirits Avhile the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their oivn miserable existence in a fit of spleen or ill humour. Drunkenness not only proves destructive to health, but likewise to the faculties of the mind. It is strange that creatures who value them- selves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so far below them. Were such as voluntarily deprive themsehres of the use of reason, to continue ever after in that condition, it would seem but a just punishment. Though this be not the consequence of one act of intoxication, it seldom fails to succeed a course of it. By a habit of drinking, the greatest genius is often redu- ced to a mere idiot, f * We may form some notion of the immense quantity of ardent spirits con- sumed in Great-Britain from this circumstance, that in the city of Edinburg and its environs, besides the great quantity of foreign spirits duly entered, and ihe still greater quantity which is supposed to be smuggled, it is computed that above two thousand private stills are consantly employed in preparing a poisonous liquor called Molasses. The common people have got so univer- sally into the habit of drinking this base spirit, that when a porter or labourer js seen reeling along the streets, they say, he has got molassed. f It is amazing that our improvements in arts, learning and politeness, have not put the barbarous custom of drinking to excess out of fashion. It is in- deed less common in South-Britain than it was formerly ; but it still prevails very much in the North, where this relic of barbarity is mistaken for hospitali- ty. There no man is supposed to entertain his guests well, who does not make them drunk. Forcing people to drink is certainly the greatest piece of rudeness .hat any man can be guilty of. Manliness, complaisance, or mere good-nature, may induce a man to take his glass? if urged to it, at a time when he might as well take poison. The custom of drinking to excess has long been out of fa- 92 OF CLEANLINESS. Intoxication is peculiarly hurtful to young persons. It heats their blood, impairs their strength, and obstructs their growth; besides, the frequent use of strong liquors in the early part of life destroys any bene- fit that might arise from them afterwards. Those who make a practice of drinking generous liquors when young, cannot expect to reap any be- nefit from them as a cordial in the decline of life. Drunkenness is not only in itself a most abominable vice, but is an inducement to many others. There is hardly any crime so horrid that the drunkard will not perpetrate for the love of liquor. We ha\Te known mothers sell their children's clothes, the food that they should have eat, and afterwards even the infants themselves, in order to purchase the accursed draught. CHAP. VIII. OF CLEANLINESS. THE want of cleanliness is a fault Avhich admits of no excuse. Where Avater can be had for nothing, it is surely in the power of every person to be clean. The continual discharge from our bodies by per- spiratiou, renders frequent change of apparel necessary. Changing ap- parel greatly promotes the secretion from the skin, so necessaiy for health. When that matter which ought to be carried off by perspira- tion is either retained in the body, or reabsorbed from dirty clothes, it must occasion diseases. Diseases of tlie skin are chiefly owing to want of cleanliness.* They may indeed be caught by infection, or brought on by poor living, un- wholesome food, &c. but they will seldom continue long Avhere clean- liness prevails. To the same cause must we impute the various kinds of vermin which infest the human body, houses, &c. These may al- ways be banished by cleanliness alone, and w herever they abound, we have reason to believe it is neglected. One common cause of putrid and malignant fevers is the want of cleanliness. These fevers commonly begin among the inhabitants of close, dirty houses, who breathe uiiAvholesome air, take little exercise, and wear dirty clothes. There the infection is generally hatched, which often spreads far and wide, to the destruction of many. Hence cleanliness may be considered as an object of public attention. It is not sufficient that I be clean myself, while the want of it in my neigh- bour affects my health as well as his. If dirty people cannot be remo- ved as a common nuisance, they ought at least to be avoided as infec- tious. All who regard their health should keep at a distance even from their habitations. In places where great numbers of people are collected, cleanliness shio* in France ; and, as it begins to lose ground among the politer part of the English, we hope it will soon be banished from every part of this island. * Mr. Pot, in his surgical observations, mentions a disease which he calls the chimney sweeper's cancer, as it is almost peculiar to that unhappy set of peo- ple. This he attributes to neglect of cleanliness, and with great j ustness I am convinced, that if that part of the body which is the seat of this cruel disease was kept clean by frequent washing, it would never happen. The climbing boys, as they are called, are certainly the most miserable wretches on the face of the earth ; yet, for cleaning chimnies, no such persons are necessary. OF CLEANLINESS, 93 becomes of the utmost importance. It is well known that infectious di- seases are communicated by tainted air. Every thiug, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excrements of the diseased. In many great towns the streets are little better than dunghills, being frequently covered with ashes, dung, and nastiness of eveiy kind. Even slaughter-houses, or killing shambles, are often to be seen in the very cen- tre of great towns. The putrid blood, e>.elements, &c. Avith which these places are generally covered, cannot fail to taint the air, and render it unwholesome. Hoav easily might this be prevented by active magis- trates who have it ahvays in their power to make proper laws relative to things of this nature, and to enforce the observance of them! We are sorry to say, that the importance of geueral cleanliness does not seem to be sufficiently understood by the magistrates of most great towns in Britain; though health, pleasure, and delicacy, all conspire to recommend an attention to it. Nothing can be more agreeable to the senses more to the honour of the inhabitants, or more conducive to their health, than a clean town; nor can any thing impress a stranger with a more disrespectful idea of any people than its opposite. Whatever pre- tensions people may make to learning, politeness, or civilization, we will Arcnture to affirm, that while they neglect cleanliness, they are in a state of barbarity.* The peasants in most countries seem to hold cleanliness in a sort of contempt. Were it not for the open situation of the houses, they Avould often feel the bad effects of this disposition. One seldom sees a farm- house Avithout a dunghill before the door, and frequently the cattle and their masters lodge under the same roof. Peasants are likeAvise extreme- ly careless with respect to change of apparel, keeping their houses, &c. clean. This is merely the effect of indolence and a dirty disposition. Habit may indeed render it less disagreeable to them, but no habit can ever make it salutary to Avear dirty clothes or breathe unwholesome air. As many articles of diet come through the hands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. This, for example, might be done by giving a small pre- mium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c. and by punishing severely those who bring it dirty. The same method should be taken with butchers, ba- kers, brewers, and all who are employed in preparing the necessaries of life. In camps the strictest regard should be paid to cleanliness. By negli- gence in this matter, infectious diseases are often spread amongst a whole army; and frequently more die of these than by the sword. The Jew?, * In ancient Rome the greatest men did not think cleanliness an object un- worthy of their attention. Pliny says, the Cloaca:, or common sewers for the conveyance of filth and nastiness from the city, were the greatest of all the pub- lic works; and bestows higher encomiums upon Tarquinus, Agrippa, and others who made and improved them, than on those who achieved the greatest con- quests. How truly great does the emperor Trajan appear, when giving' directions to Pliny, his proconsul, concerning the making of a common sewer for the health and convenience of a conquered city ' 94 OF CLEANLINESS, during their encampments in tlie Avilderness, received particular instruc- tions with respect to cleanliness. The rules enjoined them ought to be observed by all in the like filiation.* Indeed the whole sAskm of laws delivered to that people has a manifest tendency to promote cleanliness. Whoever considers the nature of their climate, the diseases to which they were liable, and their dirty disposition, will see the propriety of such laws. It is remarkable that, in most eastern countries, cleanliness makes a great part of their religion. The Mahometan as well as the Jewish reli- gion enjoins various bathings, Avashings, and puiifications.—No doubt these might be designed to represent forward purity; but they Avere at the same time calculated for the preservation of health. However whim- sical these washings may appear to some, few things would tend more to prevent diseases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a dead body, or touching any thing that might convey infection, to wash before he went into company, or sat doivn to meat, he would run less hazard either of catching the infection himself, or of communicating it to others. Frequent washing not only removes the filth and sores which adhere to the skin, but likeAvise promotes the perspiration, braces the body, and enlivens the spirits. How refreshed, how cheerful, and agreeable does one feel on being shaved, wrashed, and shifted: especially when these of- fices have been neglected longer than usual! The easteru custom of washing the feet, though less necessary in this country, is nevertheless a veiy agreeable piece of cleanliness, aud contri- butes greatly to the preservation of health. The sweat and dirt with Avhich these parts are frequently covered, cannot fail to obstruct the per- spiration. This piece of cleanliness would often prevent colds and fe- vers. Were people careful to bathe their feet and legs in luke-Avarm water at night, after being exposed to cold or wet through the day, they Avould seldom experience the ill effects which often proceed from these causes. A proper attention, to cleanliness is no where more necessary than on ship board. If epidemical distempers break out there, no one can be safe. The best, way to prevent them, is to take care that the whole company be cleanly in their clothes, bedding, «fcc. When infectious diseases do break out, cleanliness is the most likely means to prevent their spreading: it is likewise necessary to prevent their returning afterwards, or being conveyed to other places. For this purpose the clothes, bedding, &c. of the sick ought to be carefully washed, and fumigated with brimstone. Infection Avill lodge a long time in dirty clothes, and afterwards break out in the most terrible manner. In places Avhere great numbers of sick people are collected toge- ther, cleanliness ought to be most religiously observed. The very smell in such places is often sufficient to make one sick. It is easy to imagine Avhat effect that is likely to have upon the diseased. In an hospital or infirmary, where cleanliness is neglected, a person in per- * Thou shalt have a place also without the camp, whither thou shalt go forth abroad ; and thou shalt have a paddle upon thy weapon: and it shall be when thou shalt ease thyself abroad, thou shalt dig therewith, and shall turn bark and cover that which cometh from thee, &c. Deuter. chap. xxii. rer. 12, 1.1. OF INFECTION. 95 feet health has a greater chance to become sick, than a sick person has to get well. Few things are more unaccountable than that neglect, or rather dread of cleanliness, which appears among those who have the c^re of the sick ; they think it almost criminal to suffer any thing that is clean to come near a person in a fever; for example, they would rather allow him to wallow in all manner of filth, than change the least bit of his linen. If cleanliness be necessaiy for persons in health, it is certainly more so for the sick. Many diseases may be cured by cleanliness alone; most of them might be mitigated by it; and, Avhere it is neglected, the slightest disor- ders are often changed into the most malignant. The same mistaken care Avhich prompted people to prevent the least admission of fresh air to the sick, seems to have induced them to keep them dirty. Both these destructive prejudices will, Ave hope, be soon eradicated. Cleanliness is certainly agreeable to our nature. We cannot help ap- proving it in others, even though Ave should not practice it ourselves. It sooner attracts our regard than even finery itself, and often gains es- teem where that fails. It is an ornament to the highest as Arell as to the lowest station, and cannot be dispensed with in either. Few virtues are of more importance to society than general cleanliness. It ought to be carefully cultivated every Avhere; but in populous cities it should be al- most revered.* CHAP. IX. OF INFECTION. IVlANY diseases are infectious. Every person ought ther«r fore, as far as he can, to aviod all communication with the diseased. The common practice of visiting the sick, though often Avell meant; has many ill consequences. Far be it from me to discourage any act of charity or benevolence, especially toAvards those in distress; but I cannot help blam- ing such as endanger their own or their neighbours lives, by a mistaken friendship or an impertinent curiosity'. The houses of the sick, especially in the country, are generally crowded from morning till night Avith idle visitors. It is customary in such places for servants and young people to Avait upon the sick by turns, and even to sit up Avith them all night. It Avould be a miracle indeed should such always escape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and communicate them to other% till at length they become epidemic. • As it is impossible to be thoroughly clean without a sufficient quantity of water, we would earnestly recommend it to the magistrates of great towns to be particularly attentive to this article. Most great towns in Britain are so situated as to be easily supplied with water; and those persons who will not make a proper use of it, after it is brought to their hand, certainly deserve to be severely punished. The streets of great towns, where water can be had, ought to be washed every day. This is the only effectual method for keeping them thoroughly clean; and, upon trial, we are persuaded it will be found the cheapest. Some of the most dreadful diseases incident to human nature, might, in my 6pinion, be entirely eradicated by cleanliness. 96 OF INFECTION. It would be thought highly improper for one who had not had the small-pox,to wait upon a patient in that disease ; yet many other levers are almost as infectious as tlie small-pox, and not less fatal. Some una- sine that fevers prove more fatal in villages than in great towns, lor want of proper medical assistance. This may sometimes be the case; but 1 am inclined to think it oftener proceeds from the cause above-mentioned. Were a plan to be laid doAvn for communicating infection, it could not be done more effectually than by the common method of visiting the sick. Such visitors not only endanger themselves and their connections, but likewise hurt the sick. By croAvding the house they render the air un- wholesome, and by their private whispers and dismal countenances dis- turb the imagination of the patient, and depress his spirits. Persons who are ill, especially in fevers, ought to be kept as quiet as possible. The si>r their want of care. 13 98 OF THE PASSIONS. infection may be generated at a proper distance from great towns ;* widening the streets; pulling down useless walls, and taking all methods to promote a free circulation of air through every part of the town, &c. Public hospitals, or proper places of reception for the sick, provided they were kept clean, well ventilated, and placed in an open situation, would likewise tend to prevent the spreading of infection. Such places of re- ception would prevent the poor, when sick, from being visited by their idle or officious neighbours. They Avould likeAvise render it unnecessa. ry for sick servants to be kept in their master's houses. Masters had better pay for having their servants taken care of in an hospital, than run the hazard of having an infectious disease diffused among a numer- ous family. Sick servants and poor people, when placed in hospitals, are not only less apt to diffuse infection among their neighbours, but have likeAvise the advantage of being Avell attended. We are not, hoAvever, to learn that hospitals, instead of preventing infection, may become the means of diffusing it. When they are placed in the middle of great towns; when numbers of patients are crowded to- gether in small apartments; when there is a constant communication kept up between the citizens and the patients; and when cleanliness and ventilation are neglected, they become nests for hatching diseases, and every one Avho goes into them not only runs a risk of receiving in- fection himself, but likewise of communicating it to others. This how- ever is not the fault of the hospitals, but of those Avho have the manage- ment of them. It were to be wished, that they were both more numer- ous, and upon a more respectable footing', as that would induce people to go into them with less reluctance. This is the more to be desired, because most of the putrid fevers and other infectious disorders break out among the poor, and are by them communicated to the more cleanly, and the wealthy. Were proper attention paid to the first appearances of such disorders, and the patient's early conveyance to an hospital, we should seldom see a putrid fever, which is almost as infectious as the plague, become epidemic. CHAP. X. OF THE PASSIONS. 1 HE passions have great influence both in the cause and cure of diseases. How the mind affects the body, will in all probability ever remaiu a secret. It is sufficient for us to know, that there is es- tablished a reciprocal influence betAveen the mental and corporeal parts, and that whatever injures the one disorders the other. Of Anger. The passion of anger ruffles the mind, distorts the countenance. hurries on the circulation of the blood, ami disorders the Avhole vital and animal functions. It often occasions fevers, and other acute di- seases; and sometimes even sudden death. This passion is peculiarly * The ancients would not suffer even the temples of their gods where the sick resorted, to be built within the walls of a city. OF THE PASSIONS. 99 hurtful to the delicate, and those of weak nerves. I have known such persons fiequently lose their lives by a violent fit of anger, and would ad- vise them to guard against the excess of this passion with the utmost care. It is not indeed ahvays in our poAver to prevent being angry; but Ave may surely avoid harbouring resentment in our breast. Resentment preys upon the mind, and occasions the most obstinate chronical disor- ders, which gradually Avaste the constitution. Nothing sheAvs true great- ness of mind more than to forgive injuries; it promotes the peace of so- ciety, and greatly conduces to our own ease, health, and felicity. Such as value health should avoid violent gusts of anger, as they Avould the most deadly poison. Neither ought they to indulge resent- ment, but to endeavour at all times to keep their minds calm and serene. Nothing tends so much to the health of the body as a constant tranquility of mind. Of Fear. The influence of fear, both in occasioning and aggravating diseases, is very great. No man ought to be blamed for a decent concern about life; but too great a desire to preserve it is often the cause of losing it. Fear and anxiety, by depressing the spirits, not only dispose us to tlisea- ses, but often render those diseases fatal Avhich an undaunted mind would- overcome. Sudden fear has generally violent effects. Epileptic fits, and other convulsive disorders, are often occasioned by it. Hence the danger of that practice, so common among young people of frightening one another. Many have lost their lives, and others have been rendered miserable, by frolics of this kind. It is dangerous to tamper Avith the human passions. The mind may easily be throAvn into such disorder as never again to act with regularity. But the gradual effects of fear prove most hurtfid. The constant dread of some future evil, by dwelling upon the mind, often occasions the very evil itself. Hence it comes to pass, that so many die of those very diseases of which they long had a dread, or which had been im- pressed on their minds by some accident, or foolish prediction. This, for example, is often the case with women in childbed. Many of those who die in that situation, are impressed Avith a notion of their death a long time before it happens; and there is reason to believe tliat this im- pression is often the cause of it. The methods taken to impress the minds of Avomen Avith the apprehen- sion of the great pain and peril of child-birth, are very hurtful. FeAv women die in labour, though many lose their lives after it; Avhich may be thus accounted for. A Avoman after delivery, finding herself Aveak and exhausted, immediately apprehends she is in danger; but this fear seldom fails to obstruct the necessary evacuations, upon Avhich her re- covery depends. Thus the sex often fall a sacrifice to their own imagi- nations, when there would be no danger, did they apprehend none. It seldom happens that tAvo or three women in a great toAvn die in child-bed, but their death is followed by many others. Every Avoman of their acquaintance Avho is with child dreads the same fate, and the disease becomes epidemical by the mere force of imagination. This should induce pregnant women to despise fear, and by all means to avoid those tattling gossips who are continually buzzing in their ears lOO Ol THE PASSIONS. the misfortunes of others. Every thing that may in the least alarm a pregnant or child-bed woman, ought with the greatest care to be guarcita agMany women have lost their lives in child-bed by the old supersti- tious custom, still kept up in most parts of Britain, of tolling the parish bell for every person who dies. People who think themselves in danger are very inquisitive; and if they come to knoAV that the bell tolls for one who died in the same situation with themselves, what must be the conse- quence? At any rate they are apt to suppose that this is the case, and it will often be found a very diihcult matter to persuade them of the contrary. But this custom is not pernicious to child-bed women only. It is hurtful to many other cases. When low fevers in which it is difficult to support the patient's spirits, prevail, what must be the effect of a funeral peal sounding five or six times a day in his ears : No doubt his imagina- tion will suggest that others died of the same disease under which he labours. This apprehension will have a greater tendency to depress his spirits, than all the cordials of Avhich medicine can boast, will have to raise them. If this useless piece of ceremony cannot be abolished, we ought to keep the sick as much from hearing it as possible, and from every other thing that may tend to alarm them. So far however is this from being generally attended to, that many make it their business to visit the sick, on purpose to whisper dismal stories in their ears. Such may pass for sympathizing friends, but they ought rather to be considered as enemies. All who Avish well to the sick ought to keep such persons at the greatest distance from them. A custom has long prevailed among physicians of prognosticating, as they call it, the patient's fate, or foretelling the issue of the disease. Vanity no doubt introduced this practice, and still supports it, in spite of common sense and the safety of m nkind. I have known a physician barbarous enough to boast, that he pronounced more sentences than all his majesty's judges. Would to God that such sentences Avere not often equally fatal! it may indeed be alleged, that the doctor does not declare his opinion before the patient. So much the worse. A sensible patient had better hear what the doctor says, than learn it from the disconsolate looks, the watery eyes, and the broken Avhispers of those about him. It seldom happens, when the doctor gives an unfavourable opinion, that it can be concealed from the patient. The very embarrassment which the friends and attendants shew in disguising what he has said, is gene- rally sufficient to discover the truth. Kind heaven has, for the wisest ends, concealed from mortals their fate; and we do not see what right any man has to announce the death of ano- ther, especially if such a declaration has a chance to kill him. Mankind are indeed very fond of prjing into future events, and seldom fail to so- licit the physician for his opinion. A doubtful answer, however, or one that may tend rather to encourage the hopes of the sick, is surely the most proper. This conduct could neither hurt the patient nor the phy- sician. Nothing tends more to destroy the credit of physic than those bold prognostirators, who, by the bye, are generally the most ignorant of the faculty. The mistakes which daily happen in this way are so mauv standing proofs of human vanity, and the weakness of science, OF THE PASSIONS. 101 We readily admit, that there are cases where the physician ought to give intimation of the patient's danger to some of his near connections; though even this ought always to be done with the greatest caution: but it never can be necessary in any case that the whole town and country should know immediately after the doctor has made his first visit, that he has no hopes of his patient's recovery. Persons Avhose impertinent curi- osity leads them to question the physician, with regard to the fate of his patient, certainly deserves no other than an evasive ansAver. Tin;'vanity of foretelling the fate of the sick is not peculiar to the fa- culty. Others follow their example, and those who think themselves wiser'than their neighbours, often do much hurt in this way.—Humanity surely calls upon every one to comfort the sick, and not to add to their affliction by alarming their fears. A friend, or even a physician, may often do more good by a mild and sympathising behaviour than by me- dicine, and should never neglect to administer that greatest of all cordials, Hope. , ;• ' .' j Of Grief. Grief is the most destructive of all the passions. Its effects are per- manent ; and when it sinks deep into the mind, it generally proves fatal. An«*er and fear being of a more violent nature, seldom last long; but grief ofteu changes into a fixed melancholy, which preys upon the spirits-, and wastes the constitution. This passion ought not to be indulged. It may generally be conquered at the beginning; but when it has gained strength, all attempts to remove it are vain. No person can prevent misfortunes in life; but it shews true greatness of mind to bear them with serenity. Many persons make a merit of in- dul«»in"- grief, and Avhen misfortunes happen, they obstinately refuse all consolation, till the mind, overwhelmed Avith melancholy, sinks under the load. Such conduct is not only destructive to health, but inconsistent with reason, religion, and common sense. Change of ideas is as necessaiy for health as changes of posture. When the mind dAvellslong upon one subject, especially of a disagreeable nature, it hurts the whole functions of the body. Hence grief indulged spoils the digestion and destroys the appetite; by which means the spirits are depressed, et blistering is highly necessary. Blistering-plasters may be applied at all times of the fever with great advantage. If the patient is delirious he ought to be blistered on the neclc or head, and it will be the safest course, when the insensibility continues, as soon as the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger. 1 have been more sensible of the advantage of blistering in this than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacuations, Avhich seldom happen in this kind of fever. They are most proper, however, either towards - the beginning, or after some degree of stupor has come on, in which last case it" will always be proper to blister the head. If the patient is costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, vith a little sugar, to Avhich may be added a spoonful of common salt, if the above does not operate. Should a violent looseness come on, it may be checked by small quan- tities of Venice treacle, or giving tlie patient for his ordinary drink the white decoction.+ • See Appendix, Vomiting Julep. f See Appendix, White decoction. 142 qj THE NERVOUS FK\ EK. A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen; but tlie patient should be supported by gentle cor- dials, as Aviue-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too Avarm; yet a kindly breathing sAveat should by no means be checked. Though blistering and the use of cordial liquors are the chief things (o be depended on hi this kind of fever; yet for those who may chuse to use them, Ave shall mention one or two of the forms of medicine which are commonly prescribed in it.* In desperate cases, Avhere the hickup and starting of the tendons have already come on, Ave have sdmetimes feen extraordinary effects from doses of musk frequently repeated. Musk is doubtless an antispasmodic, and may be given to the quantity of a scruple three or four times a day, or oftenrr if necessary. Sometimes it may be proper to add to the musk a few grains of camphire, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus v/ith a little syrup, aud given as above. If the fever should happen to intermit, Avhich it frequently does to- Avards the decline, or if the patient's strength should be w asted Avith col- liquative sAveats, &c. it Avill be necessary to give him the Peruvian bark. Haifa drachm, or a Avhole drachm, if the stomacli xa ill bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in powder may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, aud a glass of it taken frequently.! Some give the bark in this and other fevers, where there are no symp- toms of inflammation, vithout any regard to the remission or intermission of the fever. How fa*' future observation may tend to establish this practice, we will not pretend to say; but we have reason to believe that the bark is a very universal febrifuge, and that it may be administered Avith advantage in most feA'ers Avhere bleeding is not necessaiy, or Avhere there are no symptoms of topical inflammation. * When the patient is low, ten grains of Virginian snake-root, and the same quantity of contrayerva-root, with five grains of Russian castor, all in fine pow- der, may be made into a bolus with a little of the cordial confection of syrup of saffron. One of these may be taken every four or five hours The following powder maybe used with the same intention : Take wild Vale- rian-root in powder one scruple, saffron and cas»r each four grains. Mix these by rubbing them together in a mortar, and give one in a cup of wine-whey three or four times a-day f The bark may likewise be very properly administered, along with other cor- dials, in the following manner : Take an ounce of Peruvian bark, orange-peel half an ounce, Virginian snake-root two drachms, saffron one drachm Let all of them be powdered, and infused in a pint of die best brandy for three or four days. Afterwards the liquor may be strained, and two tea-spoonsM of it given three or four times a-day in a glass of small wine or negus< 143 CHAP. XX. OF THE MALIGNANT, PUTRID OT SPOTTED FEVER. J. HIS may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful di- sease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been Avasted by long fasting, av atching, hard la- bour, escessive venery, frequent salivations, &c. arc most liable to it. CAUSES.—This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly ventilated : from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hospitals, and infirmaries especially where such places are too much crowded, and cleanliness is neglected. A close constitution of tlie air, with long rainy or foggy Aveather, like- Avise occasions putrid fevers. They often succeed great inundations in low and marshy countries, especially when these are preceded or follow- ed by a hot and sultry season. Living too>much upon auimal food, Avithout a proper mixture of vege- tables, or eating fish or flesh that has been kept too long, are likewise apt to occasion this kind of fever. Hence sailors on long voyages, and the inhabitants of besieged cities, arc very often visited with putrid fevers. Corn that has been greatly damaged by rainy seasons, or long keep- ing, and water Avhich has become putrid by stagnation, tie. may like- wise occasion this fever. Dead carcases tainting the air, especially in hot seasons, are very apt to occasion putrid diseases. Hence this kind of fever often prevails iu countries which are the scenes of Avar and bloodshed. This shews the propriety of removing burying-grounds, slaughter-houses, &e. at a proper distance from great towns. Want of cleanliness is a very general cause of putrid fevers. Hence they prevail amongst the poor inhabitants.of large towns, who breathe a confined unwholesome air, and neglect cleanliness. Such mechanics as carry on dirty employments, and are constantly confined within doors, are likewise very liable to this disease. We shall only add, that putrid, malignant, or spotted fevers are highly infectious, and are therefore often communicated by contagion. For Avhich reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance is absolutely necessary. SYMPTOMS.—The malignant fever is generally preceded by a re- markable Aveakuess or loss of strength, Avithout any apparent cause. This i; sometimes so great, that the patient can scarce walk, or even sit upright, without being in danger of fainting away. His mind too is greatly dejected; he sighs, and is full of dreadful apprehensions. There is a nausea, and sometimes a vomiting of bile; a violent pain of the head, with a strong pulsation or throbbing of the temporal arte- ries ; the eyes often appear red and inflamed, Avith a pain at the bottom of the orbit; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh ; complaints of a pain about the region of the stomach, and in the back and loins; the tongue is" at first white, but: 144 PUTRID OR SPOTTED 1 EVER. afterwards it appears black and chaped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and downwards, is ailccted with tremours or shaking, and often become- delirious. 0> If blood is let, it appears dissolved, or with a veiy small degree of cohesion, and soon becomes putrid; the stools smell extremely feet id. and are sometimes of a greenish, black, or reddish cast. Spots of a pale purple, dun, or black colour, often appear upon the skin, and sometimes there are violent haemorrhages or discharges of blood from the mouth, eyes, nose, > H 168 OF THE SMALL-POX. three slanting incisions in the arm, so superficial as uot to pierce quiu through the skin, with a lancet wet Avith fresh matter taken from a ripe pustule; afterwards the wounds are closed up, and left without any dressing. Some make use of a lancet covered with diy matter; but this is less certain, and ought never to be used unless where fresh matter cannot be obtained: when this is the case, the matter ought to be moist- ened by holding the lancet for some time in the steam of warm water.* Indeed if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the mattef| be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of the common sticking plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease. We mention this method, be- cause many people are afraid of a AA'ound; and doubtless the more easily the operation can be performed, it has the greater chance to become ge- neral. Some people imagine, that the discharge from a wound lessens the eruption; but there is no great stress to be laid upon this notion ; be- sides, deep wounds often ulcerate, and become troublesome. We do not find that inoculation is at all considered as a medical ope- ration in those countries from whence we learned it. In Turkey it is performed by the women, and in the East-Indies by the Brachmins or priests. In this country the custom is still in its infancy; we make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, than at present they do of giving them a purge. No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend it to them not only to endeavour to remove the re- ligious objections which weak minds may have to this salutary practice. but to enjoin it as a duty, and to point out the danger of neglecting to make use of a mean which Providence has put into our poAver, for saving the lives of our offspring. Surely such parents as Avilfully neglect the means of saving their children's lives, are as guilty as those who put them to death. I wish this matter were duly weighed. No one is more ready to make allowance for human Aveakness and religious prejudices; yet I cannot help recommending it, in the Avarmest manner, to parents, to consider how great an injury they do their children, by neglecting to give them this disease in the early period of life. The numerous advantages arising from the inoculation of the small- pox have been pretty fully pointed out by the learned Dr. M'Kinzie, in his History of Health.f To those mentioned by the Doctor we * Mr. Tronchin communicates this disease by a little bit of thread dipt in the matter, which he covers with a small blistering-plaster. This method may no doubt be used with advantage in those cases where the patient is very much alarmed at the sight of any cutting instrument. f " Many and great," says thishumane author, " are the dangers attending the natural infection, from all which the inoculation is quite secure. The natu- ral infection may invade weak or distempered bodies, by no means disposed for its kindly reception. It may attack them at a season of the year either violent- ly hot or intensely cold. It may be communicated from a sort of small-pox impregnated with the utmost virulence. It may lay hold upon people unex- OF THE SMALL-POX. 169 shall only add, that such ast have not had the small-pox in the early pe- riod of life are not only rendered unhappy, but likewise in a great mea- sure unfit for sustaining many of the most useful and important cflices. Few people would chuse even to hire a servant who had not had the small-pox, far less to purchase a slave, who had the chance of dying of this diease. How could a physician or a surgeon, who had never had the small-pox himself, attend others under that malady ? Hoav deplorable is the situation of females, who arrive at mature age Avithout having had *he small-pox! A Avoman with child seldom survives this disease: and if an infant happens to be seized with the small-pox upon the mother's breast, who has not had the disease herself, the scene must be distressing! If she continue to suckle the child, it is at the peril of her own life; and if she wean it, in all probability it will perish. How of en is the af- fectionate mother forced to leave her house, and abandon her children, at the very time Avhen her care is most necessary ? Yet, should parental affection get the better of her fears, the consequences would often prove fatal. I have known the tender mother and her sucking infant laid in the same grave, both untimely victims to this dreadful malady. But these are scenes too shocking even to mention. Let parents who run away with their children to avoid the small-pox, or who refuse to inocu- late them in infancy, consider to what deplorable situations they may be reduced by this mistaken tenderness! As the small-pox is now become an epidemical disease in most parts of the known world, no other choice remains but to render the malady as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of com- municating the disease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small conse- quence, whether a disease be entirely extirpated, or rendered so mild as pectedly, when a dangerous sort is imprudently imported into amaratime place. It may surprise us soon after excesses committed in luxury, intemperance, or lewdness. It may likewise seize on the innocent after indispensable watchings, hard labour, or necessary journies. And is it a trivial advantage, that all these unhappy circumstances can be prevented by inoculation ? By inoculation num- bers are saved from deformity as well as from death. In the natural small-pox, how often are the finest features, and the most beautiful complexions, misera- bly disfigured ! whereas inoculations rarely leaves any ugly marks or scars, even where the number of pustules on the face has been very considerable, and the symptoms by no means favourable. And many other grevious complaints that are frequently subsequent to the natural sort, seldom follow the artificial. Does not inoculation also prevent those inexpressible terrors that perpetually harass persons who never had this disease, insomuch that when the small-pox is epidemical, entire villages are depopulated, markets ruined, and the face of distress spread over the whole country ? From this terror it arises, that justice is frequently postponed, or discouraged, at sessions or assizes where the small- pox rages. Witnesses and juries dare not appear : and by reason of the neces- sary absence of some gentlemen, our honourable and useful judges are not at- tended with that reverence and splendour due to their office and merit. Does not inoculation, in like manner, prevent our brave sailors from being seized with this distemper on ship-board, where they must quickly spread the infection among such of the crew who never had it befere, and where they have scarce any chance to escape, being half stifled with the closeness of their cabins, and but very indifferently nursed ? Lastly, with regard to the soldiery, the misi- ries attending these poor creatures, whan attacked by the small-pox on a march, are inconceivable, without attendance, without lodgings, without any accommo- dations ; so that one of three commonly perishes." 22 170 OF THE SMALL-POX. neither to destroy life nor hurt the constitutiou; but that this may be done by inoculation, does not now admit of a doubt. The numbeis who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the los-s of a single patient. I have often Avished to see some plan established for rendering this sa- lutary practice universal; but am afraid I shall never be so happy. The difficulties indeed are many; yet the thing is by no means impracticable. The aim is great: no less than saving the lives of one fourth part of man- kind. What ought not to be attempted in order to accomplish so desira- ble an end ? The first step towards rendering the practice universal, must be to re- move the religious prejudices against it. This, as already observed, can only be done by the clergy. They must not only recommend it as a duty to others, but likewise practise it on their own children. Exam- ple will ever ha\Te more influence than precept. The next thing requisite is to put it in the power of all. For this pur- pose we would recommend it to the faculty to inoculate the children of the poor gratis. It his hard that so useful a part of mankind should, by their poverty, be excluded from such a benefit. Should this fail, it is surely in the poAver of any state to render the practice general, at least as far as their dominion extends. We do not mean that it ought to be enforced by law. The best way to promote it would be to employ a sufficient number of operators at the public ex- pense to inoculate the children of the poor. This Avould only be ne- cessary till the practice became general; aftenvards custom, the strong- est of all laws, would oblige every individual to inoculate his children to prevent reflections. It may be objected to this scheme, that the poor would refuse to em- ploy the inoculators; this difficulty is easily removed. A small premium to enable mothers to attend their children while under the disease, would be a sufficient inducement; besides, the success attending the operation would soon banish all objections to it. Even considerations of profit Avould induce the poor to embrace this plan. They often bring up their children to the age of ten or tAvelve, and when they come to be useful, they are snatched away by this malady, to the great loss of their pa- rents, and detriment of the public. The British legislature has of late years shewn great attention to the preservation of infant lives, by supporting the foundling-hospital, &c. But Ave will venture to say, if one tenth-part of the sums laid out in sup- porting that institution, had been bestowed toAvards promoting the prac- tice of inoculation of the small-pox among the poor, that not only more useful lives had been saved, but the practice, ere now, rendered quite universal in this island. It is not to be imagined what effect example and a little money will have upon the poor; yet, if left to themselves, they would go on for ever in the old way, without thinking of any im- provement. We only mean this as a hint to the humane and public- spirited. Should such a scheme be approved, a proper plan might easi- ly be laid down for the execution of it. But as the public plans are very difficult to bring about, and often, by the selfish views and misconduct of those entrusted with the execution of them, fail of answering the noble purpose for which they were de- OF THE SMALL-POX. 171 signed; we shall therefore point out some other method by which the benefits of inoculation may be extended to the poor. There is no doubt but inoculators will daily become more numerous. We Avould therefore have every parish in Britain to allow one of them a smalt annual salary for inoculating all the children of the parish at a pro- per age. This might be done at a very trifling expense, and it would enable every one to enjoy the benefit of this salutary invention. Two things chiefly operate to prevent the progress of inoculation. The one is a wish to put the evil day as for off as possible. This is a principle in our nature; and as inoculation seems rather to be anticipa- ting a future evil, it is no wonder mankind are so averse to it. But this objection is sufficiently answered by the success. Who in his senses would not prefer a lesser evil to-day to a greater to-morrow, provided they were equally certain ? The other obstacle is the fear of reflections. This has a very great weight with the bulk of mankind Should the child die, they think the world Avould blame them. This they cannot bear. Here lies the diffi- culty ; and, till that be removed, inoculation will make but small pro- gress. Nothing however can remove it but custom. Make the practice fashionable, and all objections will soon vanish. It is fasliion alone that has lead the multitude since the beginning of the wrorld, and will lead them to the end. We must therefore call upon the more enlightened part of mankind to set a pattern to the rest. Their example, though it may for some time meet with opposition, will at length prevail. I am aware of an objection to this practice from the expense with Avhich it may be attended: this is easily obviated. We do not mean that every parish ought to employ a Sutton or a Dimsdale as inoculators. These have by their success already recommended themselves to crowned heads, and are beyond the vulgar reach; but have not others an equal chance to succeed ? They certainly have. Let them make the same trial, and the difficulties will soon vanish. There is not a parish, and hardly a village in Britain, destitute of some Avho can bleed. But this is a far more difficult operation, and requires both more skill and dexte- rhy than inoculation. The persons to Avhom Ave would chiefly recommend the performance of this operation are the clergy. Most of them knoAV something of me- „ dicine. Almost all of them bleed, and can order a purge, which are all the qualifications necessary for the practice of inoculation. The priests among the less enlightened Indians perform this office, and why should a Christian teacher think himself above it ? Surely the bodies of men, as Avell as their souls, merit a part of the pastor's care; at least the greatest teacher Avho ever appeared among men, seems to have thought so. Should all other methods fail, Ave Avould recommend it to parents to perform the operation themselves. Let them take any method of com- municating the disease they please; provided the subjects be healthy, aud of a proper age, they will seldom fail to succeed to their wish. I have known many instances even of mothers performing the operation, and never so much as heard of one bad consequence. A planter in one of the \Wt-India islands is said to havTe inoculated with his own hand, in one year, three hundred of his slaves, who, notwithstanding the warmth of the cbmate, and other unfavourable circumstances, all didovell. Com- mon mechanic* have often, to my VnoAvledgc. performed the operation 172 OF THE SMALL-POX. Avith as good success as physicians. We do not however mean to dis- courage those who have it in their power, from employing people of skill to inoculate their children, and attend them while under the disease; but only to shew, that where such cannot be had, the operation ought not upon that account to be neglected. Instead of multiplying arguments to recommend this practice, I shall just beg leave to mention the method which I took with my own son, then an only child. After giving him two gentle purges, 1 ordered the nurse to take a bit of thread which had been previously Avet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rub- bed off by accident. At the usual time the small-pox made their ap- pearance, and Avere exceedingly favourable. Surely this, which is all that is generally necessary, may be done Avithout any skill in medicine. We have been the more full on this subject because the benefits of inoculation cannot be extended to society by any other means than ma- king the practice general. While it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread, and is communicated to many Avho might otherAvise never have had the disease. Accordingly it is found that nearly the same number die of the small- pox noAV as before inoculation Avas introduced; and this important disco- very, by which alone more lives might be saved than by all the endea- vours of the Faculty, is in a great measure lost by its benefits not being extended to the Avhole community.* The spring and autumn have been usually reckoned the most proper seasons for inoculation, on account of the weather being then most tem- perate ; but it ought to be considered that these are generally the most unhealthy seasons of the whole year. Undoubtedly the best preparation for the disease is a previous good state of health. I have always obser- ved that children in particular are more sickly towards the end of spring and autumn, than at any other time of the year. On this account, as well as for the advantage of cool air, I would propose winter as the most proper season for inoculation; though on every other consideration, the spring would seem to be preferable. The most proper age for inoculation is between three and five. Many approve of inoculating on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more * liable to convulsions at this time than afterwards; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the ndlk. Children Avho have constitutional diseases, must nevertheless be ino- culated. It Avill often mend the habit of body; but ought to be perform- ed at a time when they are most healthy. Accidental diseases should always be removed before inoculation. It is generally thought necessary to regulate the diet for some time before the disease be communicated. In children, however, great alteration in diet is seldom necessary, their food being commonly of " By a well-laid plan for extending inoculation, more lives might be saved at a small expense, than are at present preserved by all the hospitals in England, which cost the public such an amazing sum. OF THE COW-POX, &C. 173 the most simple and wholesome kind, as milk, water-pap, weak broths, bread, light pudding, mild roots, and white meats. But children who have been accustomed to a richer diet, who are of a gross habit, or bound with bad humours, ought to be put upon a spare diet before they are inoculated. Their food should be of a light cool- ing nature, and their drink whey, butter-milk, and such like. We would recommend no other medicinal preparation but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the pre- paration of their patients, but on their management of them while under the disease. Their constant care is to keep them cool, and their bodies gently open, by which means the fever is kept Ioav, and the eruption greatly lessened. The danger is seldom great Avhen the pustules are few; and their number is generally in proportion to the fever Avhich precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods mentioned above. The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be fight, and his drink weak and diluting, &c. Should any bad symp- toms appear, which is seldom the case, they must be treated in the same way as directed in the natural small-pox. Purging is not less necessary after the small-pox by inoculation than in the natural way, and ought by no means to be neglected. CHAP. XXV.\ OF THE COW-POX, AND ITS INOCULATION. AN the preceding chapter, the method of inoculating for the small-pox has been retained, as having hitherto been successfully prac- tised during a number of years; but, by a fortunate discovery, it is now found, that the infection may be introduced in a manner equally suc- cessful, and the disease rendered still less considerable than by the former kind of inoculation. This is done by inoculating with matter either taken from a cow affected Avith the disease, or from some person who had received the infection originally derived from that animal. It may be proper here to give a general account of the manner in which so surprising a discovery has been made. In several parts of England, where coavs are kept for the purposes of the dairy, a peculiar eruptive disease has been occasionally observed among the herd, and which affects in particular the udders and teats of those animals. It has, therefore, pretty generally obtained tlie name of the Cow-pox, (vaccinia, or vacciola.) Till within these last two years, the knowledge of this distemper has been chiefly confined to the people employed in the dairies, and to far- riers and cow-doctors in the neighbourhood; but, by the latter, it ap- pears to have been observed with particular accuracy, and they have even employed means for its removal. It farther appears, that wherever the existence of this disease was 174 OF THE COW-VOX,' known, the fact was like wise ascertained, that the disorder was commu- nicated by the touch to the milkers who handle the teats of the diseased coavs, and from them again is often spread through a numerous herd -. that, when affecting the human species, it is not merely confined to the local disease of the hands and arms, but also occasions a general indispo- sition, often severe, but never fatal, which runs a regular course; and that the person who has once undergone the disease so communicated is ever after secure against the infection of the small-pox, either in the na- tural way by contagion, or by inoculation. AH these circumstances, however, though known, as we are told, from time immemorial in certain parts of the kingdom, still remained in obscu- rity till Avithin these three years, when Dr. Jenner, of Berkley, in Glou- cestershire, conceived the important idea of employing the cow-pox to annihilate the small-pox, and published several interesting particulars concerning this disease, which works have now made it known to the public in general. It appears, from observations made by those Avho are most conversant with cows, that several causes may produce sores upou the udder and teats of this animal, especially such as excite any irritation iu those parts, during the season when the coavs abound most in milk. The stinging of flies, or rough handling while milking, and other such external irritations, will often occasion small white blisters on the parts; which, however, never extend more than skin-deep, and are generally easy of cure. Another, and more serious disorder in those parts, is said to be some- times produced by suffering a cow, while in full milking, to remain for a day or two unmilked; in order to distend the udder when naturally small. This, it appears, is a common artifice practised at the fairs and cattle- markets, Avith the view of increasing the price of the cow, a large udder being reckoned an important circumstance in the value of that animal. By this cruel and unwarrantable artifice, the vessels that supply the ud- der are kept for an unusual length of time in a state of great distention, Avhich terminates frequently in a violent inflammation of those parts, suc- ceeded by large eruptions upon the teats and udder that sometimes leave deep and troublesome sores. The matter discharged from these ulcers will communicate a disorder, like the other, into the hands of the milkers, when the skin is broken in any part; and often produces foul and extensive ulcers, which sometimes occasion pustules on the arms and shoulders, and prove tedious and difficult of cure. The genuine cow-pox, however, is a distinct disease from those which have been just mentioned. It generally makes its appearance in the spring, and shows itself in irregular pustules on the teats or nipples of the udder. They are at first of palish blue, or rather a livid colour, and contain a thin, watery, and sharp fluid. The surrounding parts are in- flamed and hardened. These pustules, it seems are very apt to degene- rate into deep corroding ulcers, which, as the cow-doctors term it, eat in- to the flesh, and constantly discharge a matter, which commonly increase in thickness, and hardens at last into a scab. Now and then the cow be- comes evidently indisposed, loses her appetite, and gives less milk than usual; but it often happens, that the disorder, though severe, is entirely local. It appears that the cow-pox never proves latal to cows, nor is it infectious in the usual manner of contagious distempers, but can only AND ITS INOCULATION. 175 be communicated to them or to the human species by actually touching the matter which proceeds from the sores. Hence, the cows which are not iu milk escape the disease entirely, though constantly in the same field with those that are highly infected; audit seems to be only from the circumstance of the milker handling the teats of the sound cows, after touching the diseased, that the cow-pox ever spreads among the herd. We are informed that the cow-pox is familiar to the inhabitants of the hundred of Berkley in Gloucestershire. It has likewise been discover- ed in various parts of the counties of Wilts, Somerset, Buckingham, Devon, and limits: in a few places of Suffolk and Norfolk, where it is sometimes culled the pap-pox; and in Leicestershire and Staffordshire. Nor is it unfrequent in the very large milk-farms contiguous to tlie me- tropolis on the Middlesex side. It is here observed generally to attack first some cow newly introduced to the herd, and is supposed to origi- nate in a sudden change from a poor to a very rich and partly unnatural diet which it is the practice to use, in order to bring the yield of milk to its highest point. According to Dr. Jenner, the origin of the coAv-pox is ascribed to a derivation from the horse. The horse is well known to be subject to an inflammation and swelling in the heel, called the grease, from whiclf is dis-eharged a very sharp matter, capable of producing iritation and ul- cers in any other animal to the surface of which it is applied. It is sup- posed that this matter is conveyed to the coav by the men-servants of the farm, who, in several of the dairy counties, assist in milking. One of there having dressed the horse, goes immediately to his occupation of milking; and having upon his hand some particles of the discharge from the grease, he, of course, applies it to the udder of the cow, Avhere, if the animal be iu a state for receiving the infection, it produces that specific change in those parts which gives rise to the disease of the cow-pox. The origin here ascribed to this disorder is principally founded on the circumstance, that wherever the cow-pox appears, the grease is generally found to have preceded it: and the opinion of the propagation of the disease from the horse to the coav is likewise current in some of the dairy counties wh-Te the disease is known. But this opinion requires to be ascertained by further observations. This conjecture, respecting the origiu of the cow-pox, was no sooner started by Dr. Jenner, than attempts were made repeatedly, but Avithout success, to introduce the disease in the nipple of the. cow by direct ino- culation of the recent matter of the grease from the horse's heel. The consequence of this experiment, when it took any effect, Avas a slight in- flammation, and the production of a small pustule or pimple, but which disappeared in a feAv days, without exciting the specific disease of the pox. But the failure of these experiments by no means overthrows the opinion for the ascertainment of which they Avere made; since it is ad- mitted that a certain predisposition ifi the constitution of the coav to re- ceive the disease is also requisite for its production. It is remarked, that the matter discharged from the sores in the horse's heel is likewise found to occasion, at times, very troublesome ulcers on the hands of the men that dress them, attended with a very considerable degree of indisposition; both of Avhich appear to be full as severe as in the genuine cow-pox, and in many points to resemble this latter disorder *'° OF THE COW-POX, But the person who has been infected by the horse is not rendered there- by entirely secure from afterwards receiving the small-pox. The pustular sores on the udder and teats of the cow, that constitute the genuine cow-pox, whatever be the way iu which they are produced, are found by experience to possess the power of infecting the human species, when any part of the body, where the skiu is broken, or natural- ly thin, comes into actual contact with the matter which they discharge. Hence it is, that with the milkers, the hands are the parts that acquire this disorder accidentally, and it there exhibits the folloAving appearan- ces: Inflamed spots begin to appear on the hands, wrists, and especially the joints and tips of the fingers; and these spots at first resemble the small blisters of a burn, but quickly proceed to suppuration. The pus- tule is quite circular, depressed in tlie middle, and of a blueish colour, and is surrounded Avith a considerable redness. The blue colour which the pustule almost invariably assumes, when the disorder is commuuicded directly from the cow, is one of the most characteristic marks by which the cow-pox may be distinguished from other diseases which the milkers are likeAvise liable to receive from the cow. The matter of the pustule is at first thin and colourless; but, as the disorder advances, it becomes yfillower and more punilent. In a few days from the first eruption, a tenderness and swelling of the glands in the arm-pit come on, and soon after the whole constitution becomes disordered, the pulse is increased in quickness, shivering succeed, with a sense of Aveariness, and pains about the loins, vomiting, head-ach, and sometimes a slight degree of delirium. These symptoms continue with more or less violence from one day to three or four, and, Avhen they abate, they leave sores about the hands which heal very slowly; resembling, in this respect, the ulcers on the nipple of the cow, from which they derive their origin. It is to be observed, that the coAV-pox eruption, though very severe on the hands, and occasioning much general illness, never produces a crop of pustules over distant parts of the body, arising spontaneous- ly, as in the small-pox. It ofteu happens, however, that pustules arc formed in various parts which accidentally come in contact with the dis- eased hands, as on the nostrils, lips, and other parts of the face where the skiu is thin; or sometimes ou the forehead, when the milker leans with that part upon the udder of an infected cow. From this ac- count it appears, that the cow-pox as it affects the milkers, or what may be termed the casual coAV-pox in the human species, is often a severe disorder, sometimes confiuing the patient to his bed during the period of fever, and generally leaving troublesome sores, but it has never been known to prove fatal; nor are these sores, if properly attended to, followed with any lasting injury of the affected parts, though they sometimes leave scars for life. In consequence of the close investigation whichAis disorder has late- ly undergone, the following facts thay be considered as fully ascertained by the fairest experiments and most accurate observations: First.—The cow-pox, in its natural state, or Avhen propagated im- mediately from an infected cow, to the hands of the milkers, is capa- ble of affecting the human species from one to another repeatedly to an indefinitive number of times; but after the first attack, it is gene- rally much milder in its symptoms, and in particular it is much le« AND ITS INOCULATION. 17? liable to produce the fever and general indisposition Avhich ahvays attend the first infection. There are instances, however, where the second and even third attack have been as severe in every respect as the first; but these are very rare. Secondly.—The small-pox in a considerable degree secures a persoa from the infection of the cow-pox; and in this respect appears to act in a manner very similar to a previous attack of the latter disease; that is, to confine its operation to the forming of local pustules, but unattended with general fever. Hence it is, that where all the servants of the dairy take the infection from the cows, those of them who have previously undergone the small-pox are often the only persons among them able to go through the usual work. Thirdly.—The cow-pox, in its genuine state, when it has been accom- panied with general fever, and has rim its regular course, ever after pre- serves the person Avho has been infected with it from receiving the infec- tion of the small-pox. This assertion is, hoAvever, to be taken with exactly the same limitations as that of re-infection with the small-pox preventing a second attack of the same disease. No previous infection will entirely counteract the local effect on the arm, produced by the insertion of vario* lous matter in common inoculation ; this may in a few cases go so far as to induce a degree of general fever, slight indeed, but perhaps equal to that of the mildest indisposition caused by a first infection with this disor- der. By the inoculation of either disease, however, the small-pox is equally and completely disarmed of its virulence against any subsequent \ attack, which is the circumstance that so much distinguishes and so strong- ly recommends this operation. Fourthly.—A comparison of the two diseases in respect of the mildness of their symptoms, and the hazard to life which they may occasion, will show a very great advantage in favour of the covv-pox. Compared with the natural small-pox, the natural or casual cow-pox is both milder and infinitely more safe; no instance having ever been known of a fatal event in the cow-pox, so far as it affects the people employed in the dairies. When both diseases are introduced by artificial inoculation, they are each rendered much less severe; and here too the superiority of the cow- pox as a safer and milder disease is extremely evident. Fifthly.—The cow-pox, even in its most virulent state, is not commu- nicable by the air, nor by any other of the ordinary means of contagiou, but can only be propagated, by the actual contact of matter of a pustule from the coiv-pox with some part of the body of the person who receives it. It is not yet ascertained, Aiiiether in all cases an insertion of specific infec- tious matter under the skin be necessary; but in its most active state, as it is Avhen formed in the cow's udder, the skin which covers the lips and nostrils readily receives the infection without being broken. In this res- pect the contagion of the cow-pox seems to equal that of the small-pox in activity; but the striking difference betAveen the two diseases in the cow- pox not being communicated by the air, &c. is a circumstance fully and satisfactorily ascertained. In the dairy-farms, infected servants sleep with the uninfected : infants at the breast have remained with their mo- thers whilst only one of the two have had the disorder upon them; and in no instance has the disease of one been communicated by contagion to the other. It is this circumstance which gives the cow-pox its decided su- periority ; since> by adopting this disease instead of the small-pox, ail the 178 or the cow-pox, See. dread and all the mischief occasioned by the contagion of the latter arc" entirely removed. The inoculated cow-pox appears to have almost as great a superiority in point of mildness and security over the ordinary inoculation of the small-pox, as this has over the natural small-pox; so that tiie same pre- cautions Avhich would be highly requisite in communicating the latter be- comes less so where the disorder is to be introduced by iuoculation ; and still less where the cow-pox is substituted in the room of the other. With regard to the mcOwd of performing Inoculation in the Cow-pox, Dr. Woodville, whose industry, judgment, and accuracy, appear to great advantage in his observations on this subject, advises " that the lancet should be held nearly at a right angle with the skin, in order that the in- fectious fluid may gravitate to the point of the instrument, which, in this direction, should be made to scratch the cuticle repeatedly, until it reach the true skin and become tinged Avith blood." The act of inoculation having been performed, the first proof of its suc- cess is a small inflamed spot at the part Avhere the puncture has been made, which is Aery distinguishable about the third day. This continues to increase in size, becomes hard, and a small circular tumour is formed, rising a little above the skin. About the sixth day the centre of the tu- mour shows a discoloured speck, owing to the formation of a small quanti- ty of fluid; aud this continues to increase, and the pustule or pimple to fill, till about the tenth day. After the eighth day, when the pustule is fully formed, the effects on the constitution begin to shoAV themselves; the general indisposition being commonly preceded by pain at the pustule and in the arm-pit, folloAved by head-ach, some shivering, loss of appetite, pain in the limbs, and a fever- ish increase of the pulse. These continue, with more or less violence, for one or two days, and always abate of their own accord, Avithout leav- ing any unpleasant consequence behind them. During, or a little after, the general indisposition, the pustule in the arm, which had been advancing in a regular mauner, becomes sur- rounded Avith a broad circular inflamed margin, and this is a sigu that the body in general is affected. After this period, the fluid in the pus- tule gradually dries up, the surrounding redness becomes fainter, and in a day or tvvo vanishes imperceptibly; whilst the pustule no longer in- creases in extent, but on its surface a hard thick scab of a brown co- lour is formed, which, if not pulled off, remains for nearly a fortnight; till at length it falls off, leaving the skin beneath perfectly sound and un- injured. It is a circumstance of great importance in favour of this method of inoculation, that though some attention in choosing the matter for inocu- lation, and performing this slight operation in such a mauner as to insure success, be requisite, veiy little medical treatment is necessary in or- der to conduct the patient through it with perfect safety. In most cases it is attended with so httle fever as scarcely to be detected by an attentive observer. To conclude this account of the cow-pox with a repetition of the circumstances which gives it a decided superiority over the small-pox, Dr. Woodville affirms (and his authority is unquestionable) that of all the patients whom he inoculated with the variolous matter,, after OF THE MEASLES. 179 •. they had passed through the cow-pox, amounting to upwards of four hundred, not one was affected with the small-pox, though purposely and repeatedly exposed to the infection of the disease; and what is not less extraordinary, nearly a fourth part of this number were so slightly af- fected with the cow-pox, that it neither produced any perceptible iudis- position, nor pustules. From the beginning of the world, the coav has, in all countries, been esteemed a valuable animal. Besides cultivating the ground, which her species performs, she supplies us with an aliment of her own preparing, the most wholesome as well as nourishing in nature; but never be- fore was it knoAvn, except, as appears, in some particular districts in Eng- land, that, even from a disease to which she is liable, she can likewise be further useful, in preserving us from one of the most fatal calamities that ever infested human kind. CHAP. XXVI. OF THE MEASLES. J. HE measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but its con- sequences are often very troublesome. CAUSE.—This disease, like the small-pox, proceeds from infection^ and is more or less dangerous according to the constitution of the patient^ the season of the >Tear, the climate, &c. SYMPTOMS.—The measles, like other fevers, are preceded by ah ternate fits of heat and cold, with sickness and loss of appetite. The tongue is white, but generally moist. There is a short cough, heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes indeed the cough does not come before the eniption has appeared. There is an inflammation and heat in the eyes, accompanied with a de- fluxion of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in child- ren are commonly greenish ; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both be- fore and in the progress of the disease. About the fourth day, small spots resembling flea-bites, appear, first upon the face, then upon the breast, and aftenvaids on the extremities: these may be distinguihed from the small-pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small-pox, are rather increased; but the vomiting generally ceases. On the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards npoa the body ; 180 OF THE MEASLES. so that by the ninth day they entirely disappear. The fever, however, and difficulty of breathing often continue, and especially if the patient has been kept upon too hot a regimen. Petechia, or purple spots, may likewise be occasioned by this error. A violent looseness sometimes succeeds the measles, in which case the patient's life is in imminent danger. Such as die of the measles, generally expire about the ninth day from the invasion, and are commonly carried off by a peripneumony, or in- flammation of the lungs. The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine. When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great Aveakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots appearing among the measles are very unfavourable. When a con- tinual cough, Avith hoarseness, succeeds the disease, there is reason to suspect an approaching consumption of the lungs. Our business in this disease is to assist nature, by proper cordials, in throAving out the eruption, if her efforts be too languid; but Avhen they are too violent they must be restrained by evacuations, and cool diluting liquors, &c. We ought likewise to endeavour to appease the most urgent symptoms, as the cough, restlessness, and difficulty of breathing. REGIMEN.—The cool regimen is necessary here as well as in the small-pox. The food too must be light, and the drink diluting. Acids, however, do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small beer likeAvise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh-mallow roots and sarsaparella, infusions of linseed, or of the flotvers of elder, balm tea, clarified Avhey, barley- water, and such like. These, if the patient it costive, may be sweeten- ed Avith honey; or, if that should disagree, wiih the stomach, a little ma- ua may occasionally be added to them. MEDICINE.—The measles being an inflammatory disease, without any critical discharge of matter, as in the small-pox, bleeding is common- ly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted.* Bathing tlie feet and legs frequently in lukewarm Avater, both tends to abate the violence of the fever, and to promote the eruption. The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukeAvarm wa- ter, or weak camomile tea. When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of Avarm Avater, and draw the steam into his lungs. He may likeAvise lick a little spermaceti and sugar candy pounded * 1 do not know any disease wherein bleeding is more necessary than in the measles, especially when the fever runs high : in this case I have always fount! if. relieve the patient OF THE MEASLES. 181 together; or take now aud then a spoonful of the oil of sweet almonds, with sugar candy dissolved in it. These will soften the throat, and re- lieve the tickling cough. If at the turn of the disease the fever assumes new vigour, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering-plasters applied, with a view to prevent the load from being thrown on the lungs, Avhere if an inflammation should fix itself, the patient's life will be in imminent danger. In case the measles should suddenly disappear, it will be necessary to pursue the same method which we have recommended when the small- pox recede. The patient must be supported Avith wine and cordials. Blistering plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewise be applied to the feet and palms of the hands. When purple or black spots appear, the patient's drink should be sharp- ened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in the same manner as directed in the small-pox. Opiates are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is sufficient. A tea spoonful or two may be occasionally given according to the patient's age, or the violence of the symptoms. After the measles are gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small-pox. If a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night; but if these do not remove it, bleeding will seldom fail to have that effect. Patients recovering after the measles should be careful what they eat or drink. Their food for some time ought to be light, and in small quantities, and their drink diluting, and rather of an opeuing nature, as but- ter-milk, Avhey, and such like. They ought also to beware of exposing themselves too soon to the cold air, least a suffocating cartarrh, an asthma, or a consumption of the lungs, should ensue. Should a cough, with difficulty of breathing, and other symptoms of a consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as the patient's strength and consti- tution will permit. He ought likewise to drink asses milk, to remove to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables; and lastly, if these do not succeed, let him remove to a warmer climate.* * Attempts have been made to communicate the measles, as well as the small-pox, by inoculation, and we make no doubt but in time the practice may succeed. Dr. Home of Edinburgh, Bays, he communicated the disease by the blood. Others have tried this method, and have not found it succeed. Some think the disease would be more certainly communicated by rubbing the skin of the patient who has the measles with cotton, and afterwards applying the cot- ton to a wound as in the small-pox ; while others recommend a bit of flannel which had been applied to the patient's skin, all the time of the disease, to be afterwards laid upon the arm or leg of the person to whom the infection is to be communicated. There is no doubt but this disease, as well as the small-pox, may be communicated various ways; the most probable, however, is either from 182 OF THE SCARLET FEVER. THE scarlet fever is so called from the colour of the patient's skin, which appears as if it Avere tinged with red wine. It happens at any season of the year, but is most common towards the end of summer; at Avhich time it often seizes whole families; children and young persons are most subject to it. It begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spots, which are broader, more florid, and less uniform than the measles. They con- tinue tAvo or three days, and then disappear; after Avhich the cuticle,or scarf-skin, falls off. There is seldom any occasion for medicine in this disease. The pa- tient ought however to keep Avithiu doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool and diluting liquors. If the fever runs high, the I ody must be kept gently open by emollient clysters, or small doses of nitre and rhubarb. A s-eruple of the former, with five grains of the latter, may be taken thrice a day, or oftener, if ne- cessary. Children and young persons are sometimes seized at the beginning of this disease Avith a kind of stupor and epileptic fits. In this case the feet and legs should be bathed iu warm water, a large blistering-plaster applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers.* The scarlet fever hoAATevrer is not always of so mild a nature. It is sometimes attended with putrid or malignant symptoms, in which case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness and shivering, but with languor, sickness, and great oppression; to these succeed excessive heat, nausea, and vo- miting, with a soreness of the throat; the pulse is extremely quick, but small and depressed; the breathing frequent and laborious; the skin hot, but not quite dry7; the tongue moist, and covered with a Avhitish nitidis; the fo.irils inflamed and ulcerated. When the eruption appears, it bringa no relief: on the contrary, the symptoms generally grow worse, and fresh ones come on, as purging, delirium, &c. When this disease is mistaken for a simple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this case, are cordials and antiseptics, as the Peruvian bark, wine, snake-root, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throatj cotton rubbed upon the skin; as mentioned above, or by introducing a little of the sharp humour which distills from the eyes of the patient into the blood. It is agreed on all hands, that such patients as have been inoculated, had the disease very mildly ; we therefore wish the practice were more general, as the measles bave of late become very fatal. * Sydenham. f In the year 1774, during winter, a very bad species of this fever prevailed in Edinburgh. It raged chiefly among young people. The eruption was gene- rally accompanied with a quiniey, and the inflammatory symptoms were so blend'- 183 OF THE BIL10U3 FEVER. WHEN a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of summer, and ceases towards the approach of winter. It is most frequent and fatal in warm countries, especially Avhere the soil is marshy, aud when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or Avho are exposed to the night air, are most liable to this kind of fever. If there are symptoms of inflammation at the beginning of this fever, it will be necessary to bleed, and to put the patient upon the cool di- luting regimen recommended in the inflammatory fever. The saline draught may likewise be frequently administered, and the patient's body kept open by clysters or mild purgatives. But if the fever should remit or intermit, bleeding will seldom be necessary. In this case a vomit may be administered, and if the body be bound, a gentle purge; after which the Peruvian bark will generally complete the cure. In case of a violent looseness, the patient must be supported with chicken broths, jellies of hartshorn, and the like; and he may use the white decoction for his ordinary drink.* If a bloody flux should accom- pany this fever, it must be treated in the manner recommended under the article Dysentery. When there is a burning heat, and the patient does not sAveat, that evacuation may be promoted by giving him, three or four times a-day, a table-spoonful of Mindererus' spirit,! mixed in a cup of his ordinary drink. If the bilious fever be attended Avith the nervous, malignant, or putrid symptoms, Avhich is sometimes the case, the patient must be treated iu the same manner as directed under these diseases. After this fever, proper care is necessary to prevent a relapse. For this purpose the patient, especially towards the end of autumn, ought to continue the use of the Peruvian bark for some time after he is well. He should likewise abstain from all trashy fruits, neAv liquors, and every kind of flatulent aliment. CHAP. XXVII. OF THE ERYSIPELAS, OR ST. ANTHONY'S FIRE. THIS disease, which in some parts of Britain is called the rose, attacks persons at any period of life, but is most common be- tween the age of thirty and forty. Persons of a sanguine or plethoric ed with others of a putrid nature, as to render the treatment of the disease very difficult. Many of the patients, towards the decline of the fever, were afflicted with large swellings of the submaxillary glands, and not a few bad a suppura- tion in one or both ears. * See Appendix, white decoction. i Sec Appendix, Spirit of Mindtrerm. 184 OF THE ERYSIPELAS, &.C. habit are most liable to it. It often attacks young people, and pregnant women; and such as have once been afflicted with it are very liable to have it again. Sometimes it is a primary disease, and at other times only a symptom of some other malady. Every part of the body is liable to be attacked by an erysipelas, but it most frequently seizes the legs or face, especially the latter. It is most common in autumn, or when hot weather is succeeded by cold and wet. CAUSES.—The erysipelas may be occasioned by violent passions or affections of the mind; as fear, anger, Sic. When the body has been heated to a great degree, and is immediately exposed to the cold air, so that the perspiration is suddenly checked, an erysipelas Avill often ensue.* It may also be occasioned by drinking to excess, by continuing too long in a Avarm bath, or by any thing that overheats the blood. If any of the natural evacuations be obstructed, or in too small quantity, it may cause an erysipelas. The same effect will folloAV from the stoppage of artifi- cial evacuations; as issues, setous, or the like. SYMPTOMS.—The erysipelas attacks with shivering, thirst, loss of strength, pain in the head and back, heat, restlessness, and a quick pulse; to which may be added vomiting, and sometimes a delirium. On the second, third, or fourth day, the part swells, becomes red, and small pustules appear; at which time the fever generally abates. When the erysipelas seizes the foot, the parts contiguous swell, the skin shines; and, if the pain be violent, it will ascend to the leg, and will not bear to be touched. When it attacks the face, it swells, appears red, and the skin is covered with small pustules filled with clear water. One or both eyes are generally closed Avith the swelling; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the patient drowsy, there is reason to suspect an inflammation of the brain. If the erysipelas affects the breast, it sAvells aud becomes exceedingly hard, with great pain, and is apt to suppurate. There is a violent pain in the arm-pit, on the side affected, Avhere an abscess is often formed. If in a day or two the swelling subsides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over. When the erysipelas is large, deep, and affects a very sensible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a mortification. Sometimes the inflammation cannot be discussed, but comes to a suppuration; in which case fis- tulas, a gangrene, or mortification, often ensue. Such as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and sometimes with a delirium and great drowsiness. They generally die about the seventh or eighth day. * The country people in many parts of Britain call this disease a Blast, and imagine it proceeds from fowl air, or ill wind as they term it. The truth is they often lie down to rest them, when warm and fatigued, upon the damp ground, where they fall asleep, and lie so long as to catch cold, which occasions the erysipelas. This disease may indeed proceed from other causes, but we may venture to say, that nine times out of ten it is occasioned by cold caught after the body has been greatly heated or fatigtred- OF THE ERYSIPELAS, &C. 185» REGIMEN.—In the en sipelai the patient must neither be kept too hot nor cold, as either of these extremes will tend to make it retreat, ■which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by diluting liquors, Sic. The diet ought to be slender, and of a moderately cooling and moist- ening qualitv, as groat-gruel, panado, chicken or barley broth, with cooling herbs and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all other things that may heat and inflame the blood; the drink may be barley-Avater, an infusion of elder flowers, common whey, and such like. But if the pulse be low, and*the spirits sunk, the patient must be sup- ported with negus, and other things of a cordial nature* His food may be sago-gruel with a little wine and nourishing broths taken in small quantities, and often repeated. Great care however must be taken not to overheat him. MEDICINE.—In this disease much mischief is often done by medi- cine, especially by external applications. People when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary iu large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease it is neither safe to promote a suppuration, nor to repel the matter too quickly. The erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper. It is common to bleed in the erysipelas; but this likeAvise requires caution. If hoAvever the fever be high, the pulse hard and strong, and the patient \ igorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely neces- sary. Bathing the feet and legs frequently in luke-warm Avater, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to the soles of the feet, for the same purpose. Iu cases where bleeding is requisite,it is likeAvise necessaiy to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach Avhen taken in large doses. It is however one of the best medicines Avhen the fever and inflammation run high. Half a drachm of it, Avith four or five grains of rhubarb, maybe taken in the patient's ordinary drink, four times a-day. When the erysipelas leaves the extremities, and seizes the head so 24 186 TlF THE PHRENITIS, OR as to occasion a delirium or stupor, it is absolutely necessaiy to oport tlie body. If clysters and milk purgatives fail to have this effect, stron- ger ones must be given. Blistering-plasters must likewise be applied'to the neck, or behind the ears, and sharp cataplasms laid to the soles of the. feet. When the inflammation cannot be discussed, and the part has a ten- dency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like. When the black, livid, or blue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient's life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and cloths dipped in Avarm camphorated spirits of Avine, or the tincture of myrrh and aloes, may be applied to the part, and frequently reneAved. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it. In Avhat is commonly called the scorbutic erysipelas, which continues for a considerable time, it will only be necessaiy to give gentle laxatives and such things as purify the blood and promote the perspiration. Thus after the inflammation has been checked by opening medicines, the de- coction of woods ■ may be drank, after Avhich a course of bitters will be proper. Such as are liable to frequent attacks of the erysipelas ought care- fully to guard against all violent passions, to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likeAvise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs and roots, as are of a cooling quality, and their drink ought to be small- beer, tvhey, butter-milk, and such like.—They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild purgative. CHAP. XXVIII. OF THEPHRENTIS, OR INFLAMMATION OF THE BRAIN. A HIS is sometimes a primary disease, but oftener only a symp- tom of some other malady; as the inflammatory, eruptive or spotted fever, Sic. It is very common however, as a primary disease in warm climates, and is most incident to persons about th- prime or vigour of life. The passionate, the studious, and those Avhose nervous system is irritable in a high degree, are most liable to it. CAUSES.—This disease, is often occasioned by night watching, es- pecially when joined with hard study, it may likewise proceed from hard drinking, anger, grief, or anxiety. Itis often occasioned by ^ ~~~ _.- — ' * See Appendix, Decoction of Woods. INFLAMMATION OF THE BRAIN- 187 the stoppage of usual evacuations ; as the bleeding piles in men, the customaiy discharges of women, &c. Such as imprudently expose themselves to the heat of the sun, especially by sleeping without doors, in a hot season, with their heads uncovered, are often suddenly seized with an inflammation of the brain, so as to awake quite delirious. When repellents are imprudently used in an erysipelas, au inflammation of the brain is sometimes the consequence. It may likewise be occa- sioned by external injuries, as Woavs or bruises, upon the head, &c. SYMPTOMS.—The symptoms which usually precede a true inflam- mation of the brain, are pain of the head, redness of the eyes, a violent flushing of the face, disturbed sleep, or a total Avant of it, great dryness of the skin, costiveness, a retention of urine, a small dropping of blood from the nose, singing of the ears, and extreme sensibility of the ner- vous system. When the inflammation is formed, the symptoms in general are simi* lar to those of the inflammatory fever. The pulse indeed is often weak, irregular, and trembling; but some times it is hard and contracted. When the brain itself is inflamed, the pulse is always soft and low; but Avhen the inflammation only affects tlie integuments of the brain, viz. the dura, and pia matter, it is hard. A remarkable quickness of hearing is a common symptom of this disease, but that seldom continues long. Another usual symptom is a great throbbing or pulsation in the ar- teries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even.refuses driuk. The mind chiefly runs upon such objects as have before made a deep impression on it; and sometimes from a sullen silence, the patieut be* comes all of a sudden quite outrageous. A constant trembling and starting of the tendons is an unfavourable symptom, as are also a suppression of urine ; a total Avant of sleep; a con- stant spitting; a grinding of the teeth ; Avhich last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the throat, Sic. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shews the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases. The favourable symptoms are, a free perspiration, a copious discliarge of blood from the nose, the bleeding piles, a plentiful discharge of urine which lets fall a copious sediment. Sometimes the disease is carried off by a looseness, and in women by an excessive flow of the menses. As this disease often proves fatal in a feAV days, it requires the most; speedy applications. When it is prolonged, or improperly treated, it sometimes ends in madness, or a kind of stupidity Avhich continues for life. In the cure, two things are chiefly to be attended to, viz. to lessen the quantity of blood in the brain, and to retard the circulation towards the head. REGIMEN.—The patient ought to be kept very quiet Company, noise, and every thing that affects the senses, or disturbs the imagination increases the disease. Even too much light is hurtful ; for which reason the patient's chamber ought to be a little darkened, and he should neither be kept too hot nor cold. It is not however necessary to exclude the company of an agreeable friend, as this has a tendency to 188 OF THE PHRENITIS, &C. sooth and quiet the mind. Neither ought the pat'e nt to be kept too much in the dark, lest it should occasion a gloomy melancholy, which is too often the cousequence of this disease. The patient must, as far as possible, be soothed and humoured in every thing. Contradiction will ruffle his mind, and increase his malady. Even when he calls for things AA'hich are not to be obtained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promise of having them as soon as they can be obtained, or by some other excuse. A little of any thing that the mind is set upon, though not quite proper, will hurt the patient less than a positive refusal. In a word, whatever he was fond of or used to be delighted Avith, Avhen in health, may here be tried ; as pleasing sto- ries, soft music, or whatever has a tendency to sooth the passions and compose the mind. Boerhaave proposes several mechanical experi- ments for this purpose; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, &c. Any uniform sound if low and continued; has a tendency to procure sleep, and consequent- ly may be of service. The aliment ought to be light, consisting chiefly of farinaceous sub- stances ; as panado and water gruel sharpened with jelly of currants, or juice of lemons, ripe fruits roasted or boiled, jellies, pre erves, &c. The drink small, diluting, and cooling as whey, barley Avater, or decoc- tions of barley and tamarinds, which latter not only renders the liquor more palatable, but likewise more beneficial, as they are of an opening nature-. MEDICINE.—In an inflammation of the brain, nothing more cer- tainly relieves the patient than a free discharge of blood from the nose. When this comes of its own accord, it is by no means to be stopped, but rather promoted, by applying cloths cupped in warm water to the part. When bleeding at the nose does not happen spontaneously, it may be pro- voked, by putting a straw or any other sharp body up the nostril. Bleeding in the temporal arteries greatly relieves the head: but as this operation cannot always be performed, Ave would recommend in its stead, bleeding in the jugular veins. When the patient's pulse and spirits are so low that he cannot bear bleeding with the tancet, leeches may be ap- plied to the temples. These not only draAv off *he blood more gradually but by being applied nearer to the part affected, generally give more im- mediate relief. A discharge of blood from the hemorrhoidal veins is l'kewise of great service, and ought by all means to be promoted. If the patient has been subject to the bleeding piles, and that a discharge has been stopptd, every method must be tried to restore it; as the application of leeches to the parts, sitting over the steam of warm water, sharp clysters or suppo- sitories made of honey, aloes, and rock-salt. If the inflammation of the brain be occasioned by the stoppage of evacuations either natural or artificial, as the menses, issues, setons or such like, all means must be used to restore them as soon as possible or to substi ute others in their stead. The patient's body must be kept open by stimulating clysters or smart purges ; and small quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or mrre, if the case be dangerous, may be used in the space of twenty-four hour*. OF THE OPHTHALMIA, &C. 189 The head should be shaved and frequently rubbed with vinegar and rose-Avater. Cloths dipped in this mixture may likeAvise be applied to the temples. The feet ought frequently to be bated in lukewarm water, and soft poultices of bread and milk may be kept constantly applied to them. If the disease proves obstinate, and docs not yield to these medicines- it will be necessary to apply a blistering-plaster to the whole head. CHAP. XXIX. OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES. THIS disease may be occasioned by external injuries as blows, burns, bruises, and the like. It may likewise proceed from dust. quick-lime, or other substances, getting into the eyes, It is often cau- sed by the stoppage of customary evacuations; as the healing of old sores, drying up of issues, the suppressing of gentle morning sAveats, or of the sweating of the feet, &c. Long exposure to the night air, es- pecially in cold northerly winds, or whatever suddenly checks the pers- piration, especially after the body has been much heated, is very apt to cause an inflammation of the eyes—Viewing snow or other white bodies for a long time, or looking stedfasiy at the sun, aclear fire, or any bright object, will likewise occasion this malady. A sudden transition from darkness to very bright light Arill often have the same effect. Nothing more certainly occasions an inflammation of the eyes than night-watching, especially reading or writing by candle-light.—Drink- ing spirituous liquors, and excess of venery are likewise very hurtful to the eyes. The acrid fumes of metals, and of several kinds of fuel, are also pernicious. Sometimes an inflammation of the eyes proceed from a venereal taint, and often from a scrophulous or gouty habit. It may likewise be occasioned by hairs in the eyelids turning inwards, and hurting the eyes. Sometimes the disease is epidemic, especially after wet seasons; and I have frequently known it prove infectious, particu- larly to those who lived in the same house with the patient. It may be occasioned by moistair, or living in low damp houses, especially iu per- sons who are not accustomed to *uch situations. In children it often proceeds from imprudently drying up of scabbed head:?, a running be- hind the eirs, or any other discharge of that kind. Inflammations of the eyes often succeeds the smal!-pox or measles, especially in chil- dren of a scrophulous habit. SYMPTOMS.—Au inflammation of the eyes is attended with acute pain, heat, redness, and swelling. The potient is not able to bear the light, and sometimes he feels a pricking pain, as if his eyes vrere pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he sees flies dancing before him. The eyes are filled with a scalding rheum, whit h rushes forth in great quantities, whenever the patient attempts to look up. The pulse is generally quick and bard, 190 OF THE OPHTHALMIA, OR with some degree of fever. When the disease is violent, the neigh bouriug parts swell, and there is a throbbing or pulsation iu the tempo- ral arteries, &c. A slight inflammation of the eyes, especially from an external cause, is easily cured ; but when the disease is violent, and continues long, it often leaves specks upon the eyes, or dimness of sight, and sometimes total blindness. If the patient be seized with a looseness, it has a good effect; and when the inflammation passes from one eye to another as it were by in- fection, it is no unfavourable symptom. But when the disease is accom- panied with a violent pain of the head, and continues long, the patient is in danger of losing his sight. REGIMEN.—The diet, unless in scrophulous cases, can hardly be too spare, especially at the beginning. The patient must abstain from every thing of a heating nature. His food should consist chiefly Of mild vegetables, weak broths, and gruels. His drink may be barley-wa- ter, balm-tea, common whey, and such like. The patient's chamber must be darkened, or his eyes shaded by a cover so as to exclude the light, but not to press upon the eyes. He should not look at a candle, the fire or any luminous object; and ought to avoid all smoke, as the fumes of tobacco, or any thing that may cause coughing, sneezing, or vomiting. He should be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging sleep as much as possible. MEDICINE.—This is one of those diseases wherein great hurt is often done by external applications. Almost every person pretends to be possessed of a remedy for the cure of sore eyes. These remedies generally consist of eye-waters and ointments, with other external ap- plications, Avhich do mischief twenty times for once they do good. People ought therefore to be very cautious how they use such things, as even the pressure upon the eyes often increases the malady. Bleeding, in a violent inflammation of the eyes, is always necessary. This should be performed as near the part affected as possible. An a- dultmay loose ten or tAvelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the symp- toms. If it should not be convenient to bleed in the neck, the same quantity may be let from the arm, or any other part of the body. Leeches are often applied to the temples, or under the eyes, with good effect. The wounds must be suffered to bleed for some hours, and if the bleeding stop soon, it may be promoted by the application of cloths dipt hi warm water. In obstinate cases, it will be necessary to repeat this operation several times. Opening and diluting medicines are by no means to be neglected. The patient may take a small dose of Glauber's salts, and cream of tar- tar, every scecond or third day, or a decoction of tamarinds with senna. If these be not agreeable, gentle doses of rhubarb and nitre, a little of the lenitive electuary, or any other mild purgative, will answer the same end. The patient at the same time must drink freely of water-grueL tea, whey, or any other weak diluting liquor.—He ought likewise to take, at bed-time, a large draught of very weak wine-whey, in order to promote perspiration. His foot and legs must frequently be bathed hi INFLAMMATION OF THE EYES. 191 luke-warm water, and his head twice or thrice a-week. and afterwards, washed in cold water. This has often a remarkable good effect. It the inflammation does not yield to these evacuations, blistering- plasters must be applied to the temples, behind the ears, or upon the neck, and kept open for some time by the mild blistering ointment. I have seldom knoAvn these, if long enough kcrt open, fail to remove the most obstinate inflammation of the eyes; but for this purpose it is often necessary to continue the discharge for several weeks. When the disease has been of long standing, I have seen very extra- ordinary effects from a seton in the neck, or between the shoulders, es- pecially the latter. It should be put upwards and downwards, or iu the direction of the spine, and in the middle between the shoulder-blades. It may be dressed twice a day with yelloAV basilicon. I have known pa- tients, who had been blind for a considerable time, recover sight by means of a seton placed as above. When the seton is put across the neck, it soon wears out, and is both more painful and troublesome than between the shoulders; besides, it leaves a disagreeable mark; and does not dis- charge so freely. When the heat and pain of the eyes are very great, a poultice of bread and milk, softened with sAveet oil or fresh butter, may be applied to them, at least all night; and they may be bathed with lukewarm milk and water in the morning. If the patient cannot sleep, which is sometimes the case, he may take twenty or thirty drops of laudanum, or two spoonsful of the syrup of pop- pies, over night, more or less according to his age, or the violence of the symptoms. After the inflammation is gone off, if the eyes still remain weak and tender, they may be bathed every night and morning with cold water and a little brandy, six parts of the former to one of the latter. A method should be contrived by Ariiich the eye can be quite immers- ed in the brandy and water, where it should be kept for some time. I have generally found this, or cold water and vinegar, as good a strength- ener of the eyes as any of the most celebrated collyriums. When an inflammation of the eyes proceeds from a scrophulous habit, it generally proves very obstinate. In this case the patient's diet must not be too low, and he may be allowed to drink small negus, or now and then a glass of wine. The most proper medicine is the Peruvian bark, Avhich may either be given in substance, or prepared iu the foliowiag mauner: Take an ounce of the bark in powder, with two drachms of Winter's bark, and boil them iu an English quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice-root sliced. Let the liquor be strained. Two, three, or four table-spoonsful, accord- ing to the age of the patient, may be taken three or four times a-day. It is impossible to say Iioav long this medicine should be continued, as the cure is sooner performed in some than in others; but in general it re- quires a considerable time to produce any lasting effects. Dr. Cheyne says, " That ^Ethiop's mineral never fails in obstinate in- flammations of the eyes, even scrophulous ones, if given in a sufficient dose, and duly persisted in." There is no doubt but this and other pre- parations of mercury may be of singular service in ophthalmias of long continuauce, but they ought always to be administered Avith the greatest" caution, or by persons of sJuUfo phyric. 192 OF THE qUINSEY, OR It will be proper frequently to look into the eyes, to sec if any hairs be turned upwards, or pies-ing upon them.* These ought to be removed by plucking them out with a pair of small pincers. Those who are liable to frequent returns of this disease, ought con- constantly to have an issue in oue or both arms. Bleeding or purging in the spring and autumn, Avill be very beneficial to such persons. They ought likewise to live with the gieatest regularity, avoiding strong li- quors, and every thing of a heating quality. Above all let them avoid the night air and late studies-! CHAP. XXX. OF THE QUINSEY, OR INFLAMMATION OF THE THROAT. X HIS disease is very common in Britain, and is frequently attended with great danger. It prevails in the winter and spring, and is most fatal to young people of a sanguine temperament. CAUSES.—Iu general it proceeds from the same causes as other in- flammatory disorders, viz. an obstructed perspiration, or whatever heats or inflames the blood. An inflammation of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by driuking cold liquor when the body is warm, by riding or Avalkiag against a cold northerly wind, or any thing that greatly cools the throat, and parts adjicent. It may likeAvise proceed from the neglect of bleeding, purging, or any customary evacuation. Si iging, speaking loud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often knoivn the quinsey prove fatal to jovial companions, who after sitting long in a warm room, drinking warm liquors, and singing with vehemence, were so im- prudent as to go abroad in the cold night air—Sitting with Avet feet, or keeping on Avet clothes, are very apt to occasion this malady. It is likewise frequently occasioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been neAvly plastered, &c. I know people Avho never fail to have a sore throat, if they sit even but a short time in a room that has been lately washed. Acrid or irritating food may likewise inflame the throat, and occasion a quinsey. It may also proceed from bones, pins, or other sharp sub- slauces sticking in the throat, or from the caustic fumes of metals or min- erals, as arsenic, antimony, &c. taken in by the breath. This disease is sometimes epidemic and infectious. SYMPTOMS.—The inflammation of the throat is evident from inspection, the parts appearing red and swelled; besides, the patient * Any foreign body lodged in the eye may be expeditiously removed by pas- si«g a small Lair pencil between the eye-lid, and the ball of tlie eye. In some places, the peasants do this very effectually, by using their tongue in tlie same manner. f As most people are fond of using eye-waters and ointments in this and other diseases of the eyes, we have inserted some of the most approved forms of these ^edicine-s in the Appendix. See Appendix? Eyb-water and Eye-salve. INFLAMMATION OF THE THROAT. 193 complains of pains in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be let, it is generally covered Avith a tough coat of a whitish colour, and the patient spits a tough phlegm. As the SAvetling and inflammation increase, the breathing aud swallow- ing become more difficult; the pain affects the ears; the eyes general- ly appear red; and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suffocation; there is a constant nausea, or inclination to vomit, a:d the drink, instead of patting into the stomach, is often returned by the nose. The patient is sometimes starved at last, merely from an inability to swallow any kind of food. When the breathing is laborious, Avith straightness of the breast, and anx- iety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy, there is not so much danger. An external swelling is no unfavourable symptom ; but if it suddenly falls, and the disease affects the breast, tlie danger is very great. When a quinsey is the consequence of some other disease, Avhich has already weakened the patient, his situation is dangerous. A frothing at the mouth, Avith a sAvelled tongue, a pale, ghastly countenance, and coldness of the extremities, are fatal symptoms. REGIMEN.—The regimen in this disease is in all respects the same as in the pleurisy, or peripneumony. The food must be light, and in small quantity, and the drink plentiful, weak, and diluting, mixed with acids. It is highly necessary that the patient be kept easy and quiet. Vio- lent affections of the mind, or great efforts of the body, may prove fatal. He should not even attempt to speak but in a low voice. Such a degree of warmth as to promote a constant gentle sweat, is proper. When the pa- tient is in bed, his head ought to be raised a little higher than usual. It is peculiarly necessary that the neck be kept warm; for which pur- pose several folds of soft flannel may be wrapt round it. That alone will often remove a slight complaint of the throat, especially if applied in due time. We cannot here omit observing the propriety of a custom which prevails among the peasants of Scotland. When they feel any uneasiness of the throat, they wrap a stocking about it all night. So effectual is this remedy, that in many places it passes for a charm, and the stocking is ap- plied Avith particular ceremonk s: the custom however, is undoubtedly a good one, and should never be neglected. When the throat has beenthus Avrapped up all ni°ht, it must not be exposed to the cold air through the day, but a handkerchief or a piece of flannel kept about it till the inflam- mation be removed. The jelly of black currants is a medicine very much in esteem for com- plaints of the throat; and indeed it is of some use. It should be almost constantly kept in the mouth, and sAvallowed down leisurely. It may likewise be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead. Gargles for the throat are very beneficial. They may be made of 6age-tea, Avith a little vinegar and honey, or by adding to half a pint of the pectoral decoction, two or three spoonsful of honey, and the same quantity of currant jelly. This may be u?ed three or four times a-day; aud iif tha patient be troubled with tough viscid phlegm, the 194 OF THE OJJINSEY, OK gargle may be rendered more sharp and cleansing, by adding to it a tea- spoonful of the sp rit of sal ammoniac. Some recommend gargles made of a decoction of the leaves or bark of the black currant bush ; but where the jelly can be had these are unnecessary. There is no disease avherein the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought therefore never to be neglected. If people Avere careful to keep warm, to Avrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, AA'ith diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes vio- lent, more poAverful medicines are necessary. MEDICINE.—An inflammation of the throat being a most acute and dangerous distemper, v\ hich sometimes takes off the patient very sudden- ly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstan- ces require. The body should likewise be kept gently open. This may either be done by giving the paient for his ordinary drink a decoction of figs and tamarinds, or small doses of rhubarb aud nitre, as recommended in the erysipelas. These may be increased according to the age of the patient, and repeated till they have the desired effect. I have often known very good effects from a bit of sal prunel, or putri- fied nitre, held in the mouth, and swalloAved down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the dis- charge of urine, Sic. The throat ought likeAvise to be rubbed twice or thrice a-day Avith a lit- tle of the volatile liniment. This seldom fails to produce some good ef- fects. At the same time the neck ought to be carefully covered with avooI or flannel, to prevent the cold from penetrating the skin, as this ap- plication renders it very tender. Many other external applications are recommended in this disease, as a swalfow's nest, poultices made of the fungus called Jew's ears, album Graecum, &c. But as Ave do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no farther notice of them. Some recommend the gum-guaiacum as a specific in this disease. Half a drachm of the gum in powder may be made into an electuary with the rob of elder berries, or the jelly of currants for a dose, and repeated occasionally.1'1 Blistering upon the neck or behind the ears in violent inflammations of the throat is very beneficial; and in bad cases it will be necessaiy to lay a blistering-plaster quite across the throat, so as to reach from ear to ear. After the plasters are taken off, the parts ought to be kept running by the application of issue ointment, till the inflammation is gone; other- wise, upon their drying up, the patient will be in danger of a relapse. When the patient has been treated as above, a suppuration seldom happens. This however is sometimes the case, in spite of all en- deavours to prevent it. When the inflammation and swelling con- tinue, aud it is evident that a suppuration will ensue, it ou«ht to be promoted by drawing the steam of warm Avater into the throat through • Dr. Home. INFLAMMATION OF THE THROAT. 195 a tunnel or the like. Soft poultices ought likewise to be applied out- wardly, and the patient may keep a roasted fig constantly in his mouth. It sometimes happens, before the tumour breaks, that the swelling is so great, as entirely to prevent any thing from getting down iiito the sto- mach. In this case the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, &c Patients have often been supported by these for several days, till the tumour has broken ; and af- terwards they have recovered. Not only the swallowing, but the breathing, is often prevented by the tumour. In this case nothing can save the patient's life, but opening the trachea or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any directions about it. When a difficulty cf swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs Avith vinegar and honey; to wluch may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used Avhere there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, rk. A child of six or seven years of age may take seven or eight grains of castor, with fifteen grains of powdered bark, for a dose. This may be made into a mixture with two or three ounces of any simple distilled water, aud a little syrup, and taken three or four times a-day. CHAP. XXXII. INFLAMMATION OF THE STOMACH, AND OTHER VISCERA. ALL inflammations of the bowels are dangerous, and require the most speedy assistance; as they frequently end in a suppuration, and sometimes in a mortification, which is certain death. CAUSES.—An inflammation of the stomach may proceed from any of the causes Avhich produce an inflammatory fever; as cold liquor drank while the body is Avarm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and suchlike. When the s of peppermint or simple cinnamon-water, to appease the irritation and prevent the vomit- ing, Sic. Acids have often a very happy effect in staying the vomiting, and ap- peasing the other violent symptoms of this disease. It will therefore be 208 INFLAMMATION OF THE INTESTINES. of use to sharpen the patient's drink Avith cream of tartar, juice of le- mon; or, wheu these cannot be obtained, with viuegar. But it often happens that no liquid whatever will stay on the sto- mach. In this case the patient must take purging pills. I have ge- nerally found the following answer very well: Take jalap in powder, and vitriolated tartar, of each half a drachm, opium one grain, Castile soap as much as will make the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated. If a stool cannot be procured by any of the above means, it wi.l be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immersion has not the desired effect, it may be repeated as soon as the patient's strength and spirits are recruited. It is more safe for him to go frequently into the bath, tlia i to continue too long at a time, and it is often necessary to repeat it several times before it has the desired effect. It has sometimes happened, after all other means of procuring a stool had been tried to no purpose, that this was brought about by immersing the patient's lower extremities in cold water, or making him walk on a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is indeed at- tended with some danger; but a doubtful remedy is better than none. In desperate cases it is common to give quicksilver. This may be given to the quantity of several ounces, or even a pound, but should not exceed that.* When there is reason to suspect a mortification of the guts, this medicine ought not to be tried. In that case it cannot cure the patient;, and will only hasten his death. But when the obstruc- tion is occasioned by any cause that can be removed by force,quicksilver is not only a proper medicine, but the best that can be adminstered, as it is the fittest body Ave knoAV for making its way through the intestinal canal. If the disease proceeds from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure a\ ith the hand. If this, with fomentations and clysters, should not succeed, recourse might be had to a surgical operation, which may give the patient relief. Such as would avoid this excruciating and dangerous disease, must take care never to be too long without a stool. Some who have died of it had several pounds of hard dry f&ces taken out of their guts. They should likeAvise, beware of eating too freely of sour or unripe fruits, or drinkiig stale Avindy liquors, Sic. I haA7e known it brought on by liv- ing too much on baked frui's, which are seldom good. It likewise pro- ceeds frequently from cold caught by wet clothes, &c. but especially from wet feet. * When quicksilver is given in too large quantities, it defeats its own inten- tion, as it drags down the bottom of the stomach, which prevents its getting over the Pylorus. In this case the patient should be hung up by the heels, in order that the quicksilver may be discharged by his month. 209 OF THE COLIC. THE colic has a great resemblance to the two preceding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and acute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c. Colics are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, Sic. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for their relief. The flatulent, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meats of hard digestion, windy vegetables, ferment- ing liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate people, whose digestive poAvers are Aveak, are most liable to this kind of colic. The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his guts, and is generally relieved by a discharge of wind, either upAvards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another till it finds a vent. When the disease proceeds from windy liquor, green fruit, sour herbs, or the like, the best medicine on the first appearance of the symptom is a dram of brandy, gin, or any good spirits. The^atient should like- wise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels. This is the only colic wherein ardent spirits, spiceries, or any thing of a hot nature may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe, that a colic occasioned by wind or flatulent food, might always be cured by spirits and warm liquors, if they were taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the boA/els is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same man- ner as for the inflammation of the intestines. Several kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found the best method of cure for these, was to drink plentifully of small diluting liquors, as water- gruel, small posset, water with toasted bread soaked in it, &c. Colics which proceed from excess and indigestion generally cure them- selves by occasioning vomiting or purging. These discharges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gentle purge, to carry off the dregs of bis debauch. Colics Avhich are occasioned by Avet feet, or catching cold, may gene- rally be removed at the beginning, by bathing the feet and legs in warm water, and drinking such diluting liquors as will promote the perspiration, as weak whey, or water gruel, with a small quantity of spirits m it. Those flatulent colics, which prevail so much among country people. nti"ht "euerally be prevented, were they careful to change their cloth«a 210 OF THE COLIC. when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram drinking, but in this case ardent spi- rits prove a real medicine, and indeed the best that can be administered. A glass of good peppermint-water w ill have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred. The bilious colic is attended Avith very acute pains about the region of the naval. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow coloured bile, which being dis- charged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propensity to vomit sometimes increases so as to become almost continual, and the pro- per motion of the intestines is so far perverted, that there are all the symptoms of impending iliac passion. If the patient be young and strong, and the puhc full and frequent, it Avill be proper to bleed, after which clysters may be administered. Cleat- whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drank freely. Small chicken broth, with a little manna dissol- ved in it, or a slight decoction of tamarinds, are likewise very proper, or any other thin, acid, opening liquor. Besides bleeding aud plentiful dilution, it will be necessaiy to foment the belly with cloths dipped in warm water, and if this should not suc- ceed, the patient Jftyst be immersed up to the breast in warm water. In the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden mint in boiling Avater. Should these not have the desired effect, the saline draught, Avith a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice treacle may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequent- ly administered. The hysteric colic bears a great resemblance to the bilious. It is at- tended with acute pains about the region of the stomach, vomiting, &c What the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with dejection of mind and diffi- culty of breathing, which are the characteristic symptoms of this disor- der. Sometimes it is accompanied Avith the jaundice, but this generally goes off of its own accord in a few days. In this colic, all evacuations, as bleeding, purging, vomiting, &c. do hurt. Every thing that weakens the patient, or sinks the spirits, is to be avoided. If however the vomiting should prove violent, luke-Avarm Avater, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid lauda- num in a glass of cinnamon-water. This may be repeated every ten or twelve hours till the symptoms abate. The patient may likewise take four or five of the foetid pills every six hours, and drink a cup of penny-royal tea after them. If asafce- tida should prove disagreeable, which is sometimes the case, a tea- spoonful of the tincture of castor in a cup of penny-royal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf- OF THE COLIC. 211 sugar, may be taken in its stead. The anti-hysteric plaster may also be used, which has often a good effect.* The nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is supposed to be occassioned by the leaden vessels used in preparing that liquor. It is likewise a frequent disease in the West-Indies, where it is termed the dry belly-ache. No disease of the bowels is attended with more excrutiating pain than this. Nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while continuing bound iu spite of medicine, yet at length yield, and the patient recover.^ It generally however, leaves the patient weak, and often ends in a palsy. The general treatmeut of this disease is so nearly the same with that of the iliac passion, or inflammation of the guts, that we shall not insist upon it. The body is to be opened by mild purgatives given in small doses, and frequently repeated, and their operation must be assisted by soft oily clysters, fomentations, &c. The caster-oil is reckoned peculiar- ly proper in this disease. It may both be mixed with the clysters aud given by the mouth. J: The Barbadoes tar is said to be an efficacious medicine in this com- plaint. It may be taken to the quantity of two drachms three times a- day, or oftener if the stomach will bear it. This tar, mixed with an equal quantity of strong rum, is likewise proper for rubbing the spine, in case any tingling or other symptoms of the palsy, are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits, or a lit- tle oil of nutmegs, or of rosemary. If the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peruvian bark in wine. When the disease ends in a palsey, the Bath-waters are found to be extremely proper. To avoid this kind of colic, people must shun all sour fruits, acids, and austere liquors, &c. Those who work in lead ought never to go to their business fasting, and their food should be oily or fat. They may take a glass of salad oil, with a little brandy or rum, every morning, but should never take spirits alone. Liquid aliment is best for them; as fat broths, Sic. but low living is bad. They should frequently go a little out of the tainted air; and should never suffer themselves to be costive. In the West-Indies and on the coast of Guinea, It has been found of great use for preventing this colic, to wear a piece of flannel round the waist and to drink an infusion of ginger by way of tea. Sundry other kinds of this disease might be mentioned, but too many distinctions would tend only to perplex the reader. Those already men- tioned are the most material, and should indeed be attended to, as their treatment is very different. But even persons who are not in a condi- tion to distinguish veiy accurately in these matters, may nevertheless be * See Appendix. Anti-Hysteric plaster. f As the smoke of tobacco thrown into the bowels will often procure a stool when all other means have failed, an apparatus for this purpose ought to be kept by every surgeon. It may be purchased at a small expense, and will be of service in several other cases, as the recovery of drowned persons, &c. * The dose is from one table-spoonful to two or three, if necessary to open the body. £12 INFLAMMATION OF THE KIDNEYS. of great service to patients in colics of every kind, by only observing the following general rules, viz. To bathe the feet and legs in warm wa- ter, to apply bladders filled with warm water, or cloths wrong out of it, to the stomach and bowels; to make the patient drink freely of dilutiug mucilaginous liquors; and to give him an emollient clyster every two or three hours. Should these not succeed, the patient ought to be immersed ip warm water. INFLAMMATION OF THE KIDNEYS. CAUSES.—This disease may proceed from any of those causes which produce an inflammatory feAer. It may likeAvise be occasioned by wounds or bruises of the kidneys; small stones or gravel lodging within them; by strong diuretic medicines, as spirits of turpentine, tincture of cantharides, Sic. Violent motion, as hard riding or walking, especially in hot weather, or whatever drives the blood too forcibly into tlie kid- neys, may occasion the malady. It may likewise proceed from lying too soft, too much on the back, involuntary contractions, or spasms in the urinary vessels,.Sic. SYMPTOMS.—There is a sharp pain about the region of the kid- neys, with some degree of fever, and a stupor or dull pain in tlie thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most ease on the affected side, and has generally a nausea or vomiting, resembling that which happens in the colic. This disease however may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine with Avhich it is constantly attended. REGIMEN.—Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank; as clear whey, or balm-tea sweetened with ho- ney, decoction of marsh-mallow roots; with barley and liquorice, &c. The patient notwithstanding the vomiting, must constantly keep sip- ping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the obstruct- ing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain. MEDICINE.—Bleeding is generally necessaiy, especially at the beginning. Ten or twelve ounces may be let from the ami or foot with a lancet, and if the pain and inflammation continue, the oper- ation may be repeated in twenty-four hours, especially if the patient be of a full habit. Leeches may likewise be applied to the hemorrhoi- dal veins, as a discharge from these will greatly relieve the patient. Cloths dipped in warm water, or bladders filled Avith it, must be ap- plied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mallows and camomile flowers, to which a little saffron is added, and mixed w ith about a third of neAV milk, it will be still more beneficial. Emofiiept clysters ought frequently to be administered; and if these INFLAMMATION OF THE BLADDER. 213 do not open the body, a little salt and honey or manna may be added to them. The same course is to be followed where gravel or stone is lodged in the kidney, but when the gravel or stone is separated from the kidney, and lodges in the Ureter,* it will be proper, besides the fomentations, to rub the small of the back with sweet oil, and to give gentle diuretics; as juniper-Avater, sweetened Avith the syrup of marsh-malloAvs: a tea- spoonful of the sAveet spirits of nitre, with a few drops of laudanum, may hoav and then be put in a cup of the'patient's drink.—He ought likewise to take exercise on horse-back, or in a carriage, if he be able to bear it. When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of dullness, shivering, Sic. there is reason to suspect that matter is forming in the kidney, and that an abscess will ensue. When matter in the urine shews that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour and salted provisions, and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley, and common pot-herbs, &c. His drink may be whey, and butter-milk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character however, it must be drank for a considerable time. Chalybeate waters have likeAvise been found bene- ficial in this disease. This medicine is easily obtained, as it is found in every part of Great-Britain. It must likewise be used for a considerable time, in order to produce any salutary effects. Those Avho are liable to freqent returns of inflammation, or obstruc- tions of the kidneys, must abstain from wines, especially such as abound Avith tarter; and their food ought to be light, and of easy digestion. They should use moderate exercise, and should not lie too hot, nor too much on their back. INFLAMMATION OF THE BLADDER, THE inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a perpetual de- sire to make water. This disease must be treated on the same principles as the one imme- diately preceding. The diet must be light and thin, and the drink of a. cooling nature. Bleeding is very proper at the beginning, and in robust. constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented Avith Avarm water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, Sic. The patient should abstain from every thing that is of a hot, acrid * The ureters are two long and small canals, one on each side which carry the urine from the bason of the kidneys to the bladder. They are sometimes obstructed by small pieces of gravel falling down from the kidneys, and lodg- ing in them. 214 INFLAMMATION OF THE LIVER. aud stimulating quality, aud should live entirely upon small broths, gru- el*, or mild vegetables. A stoppage of urine may proceed from other causes besides an inflam- mation of the bladder; as a swelling of the hemorrhoidal veins, hard feeds lodged in the rectum, a stone in the bladder, excrescences in the urinary passages, a palsy of the bladder, hysteric affections, Sic. Each of these requires a particular treatment, which does not fall under cur present consideration. We shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritating nature, generally increase the danger. I have known some persons kill themselves by introducing probes into the nriuary passages, to remove, as they thought, somewhat that obstructed the discharge of urine, and others bring on a violent inflammation of the bladder, by Using strong diuretics, as oil of turpentine, Sic. for that pur- pose. INFLAMMATION OF THE LIVER. THE liver is less subject to inflammation than most of the other vis- cera, as in it the c'rculation is slower; but when an inflammation does happen, it is with difficulty removed, and often ends in a suppuration or scirrhus. CAUSES.—Besides the common causes of inflammation, we may here reckon the following, viz. excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust or atrabiliarian state of the blood, any thing that suddenly cools the liver after it has been greatly heated, stones obstructing the course of the bile, drinking strong Avines and spirituous liquors, using hot spicy ali- ment, obstinate hypochondriacal affections, &c. SYMPTOMS.—This disease is knoAvn by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight or fulness of the part, difficulty of breathing, loathing of food, great thirst, Avith a pale or yellowish colour of the skin and eyes. The symptoms here are various, according to the degree of inflamma- tion, and likeAvise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hickup, and a pain extending to tlie shoulder, Avith difficulty of lying on the left side, &c. This disease may be distinguished from the pleurisy, by the pain be- ing less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriac disorders by the degree of fever with Awhich it is always attended. This disease if properly treated, is seldom mortal. A constant hickuping, violent fever, and excessive thirst, are bad symptoms— If it ends in a suppuration, and the matter cannot be discharged out- wardly, the danger is great. When the scirrhus of the liver en- sues, the patient, if he observes a proper regimen, may nevertheless live a number of years tolerably easy; but if he indulges in animal INFLAMMATION OF THE LIVER. 215 food and strong liquors, or take medicines of an acrid or irritating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal. REGIMEN.—The same regimen is to be observed in this as in oth- er inflammatory disorders. AU hot things are to be as carefully avoid- ed, and cool diluting liquors, as whey, barley-ivater, &c. drauk freely. The food must be light and thin, and the body, asAvell as the mind, kept easy any quiet. MEDICINE.—Bleeding is proper at the beginning of this disease, and it Avill often be necessary, even though the pulse should not feel hard, to repeat it. All violent purgatives are to be avoided; the body how- ever must be kept gently open. A decoction of tamarinds, Avitli a little honey or manna, will answer this purpose veiy well. The side affected must be fomented in the manner directed in the foregoing disease. Mild laxative clysters should be frequently administered; and, if the pain should notwithstanding continue violent, a blistering plaster may be ap- plied over the part affected; or rather a plaster made of gum ammoniac and vinegar of squills. Medicines which promote the secretion of urine have a very good ef- fect here. For this purpose half a drachm of purified nitre, or a tea- spoonful of the sweet spirits of nitre, may be taken in a cup of the patient's drink three or four times a-day. When there is an inclination to sweat, it ought to be promoted, but not by warm sodorifics. The only thing to be used for that purpose, is plenty of diluting liquors drank about the warmth of human blood. In- deed the patieut in this case, as well as in all other topical inflammations, ought to drink nothing that is colder than the blood. If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to weaken the patient Loose stools often prove critical, and carry off the disease. If an abscess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c.—Sometimes indeed the matter of an abscess conies away in the urine, and sometimes it is dis- charged by stool, but these are efforts of nature which no means can pro- mote. When the abscess bursts into the cavity of the abdomen at large, death must ensue, nor Avill the event be more favourable when the ab- scess is opened by an incision, unless in cases where the liver adheres to the peritonaeum, so as to form a bag for the matter, and prevent it from falling into the cavity of the abdomen; in which case opening the ab- scess by a sufficiently large incision will probably save the patient's life.* If the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful, to regulate his diet, Sic. in such a manner as not to aggravate the disease. He must not indulge in fle< h. fish, strong liquors, or any highly seasoned or salted provisions; but should, for the most part, live ou mild vegetables; as fruits and roots ; taking gentle exercise, and drinking whey, barley-water, or butter-milk. If he takes any thing stronger, it srhould be fine mild ale, which is kss heating than wines or spires. * I know a gentleman who has had several abscesses of tlie liver opened, and is now a strong and healthy man, though above eighty years of age. 216 OF THE CHOLERA MORBUS, &C. We shall take no notice of inflammations of the other viscera.—They must ?n general be treated upon the same principles, as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thine that is strong, or of a heating nature, to apply warm fomentations to the parts affected, and to cause the patient to drink a suf- ficient quantity of warm diluting liquors. CHAP. XXXIII. OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH AND BOWELS. JL HE cholera morbus is a violent purging and vomiting, at- tended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper meaus are not used in due time for removing it. CAUSES.—It is occasioned by a redundancy and putrid acrimony of the bile; cold, food that easily turns rancid or sour on the stomach; as butter, bacon, sweet-meats, cucumbers, melons, cherries, and other cold fruits.* It is sometimes the effect of strong acrid purges or vomits, or of poisonous substances taken into the stomach. It may likewise pro- ceed from violent passions or affections of the mind; as fear, anger, Sic. SYMPTOMS.—It is generally preceded by a cardialgia, or heart burn, sour belchings, and flatulencies, with pain of the stomach and in- testines. To these succeed excessive vomiting and purging of green, yellow, or blackish coloured bile, with a distention of the stomach, ami violent griping pains. There is likewise a great thirst, Avith a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks so Ioav as to become quite imperceptible, the extremities grow cold or cramped, and are often co- vered with a clammy sweat, the urine is obstructed, and there is a palpi- tation of the heart. Violent hickuping, fainting, and convulsions, are the signs of approaching death. MEDICINE.—At the beginning of this disease, the efforts of Na- ture to expel the offending cause should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink freely of diluting liquors; as Avhey, butter-milk, warm water, thin water gruel, small posset, or, Avhat is perhaps preferable to any of them, very weak chicken broth. This should not only be drank plentifully to promote the vomiting, but a clyster of it given every hour in order to promote the purging. After these evacuations have been continued for some time, a de- coction of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a broAvn colour, and afterwards boil id in spring Avater. If oat-bread cannot be had, wheat-bread, or oat meal well toasted, may be used in its stead. If this does not put • I have been twice brought to the gates of death by this disease, and botb tapes it was occasioned by eating rancid bacon* v OF A DIARRHOEA, OR LOOSENESS. 217 a stop to the vomiting, two table-spoonsful of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases. The vomiting and purging however ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be alloAved to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the sinking of his pulse, Sic. recourse must immediately be had to opiates, as recommended above; to Avhich may be added strong wines, Avith spirituous cinnamon AVaters, and other generous cordials. Warm negus, or strong Avine-whey, will likewise be necessary to support the pa- tient's spirits, and promote the perspiration. His legs should be bathed in warm water, and afterwards rubbed with flannel cloths, or Avrapped in warm blankets, and Avarm bricks applied to the soles of his feet. Flan- nels wrung out of Avarm spirituous fomentations should likewise be applied to the region of the stomach. When the violence of the disease is over, to prevent a relapse, it will be necessary for some time to continue the use of small doses of lauda- num. Teu or twelve drops may be taken in a glass of wine, at least twice a-day, for eight or ten days. The patient's food ought to be nou- rishing, but taken in small quantities, and he should use moderate exer- cise. As the stomach and intestines are generally much weakened, an infusion of the bark, or other bitters, in small wine> sharpened with the elixir of vitriol, may be drank for some time. Though physicians are seldom called in due time in this disease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saiv a very striking proof iu an old man and his son, who had been both seized with it about the middle of the night. I did not see them till next morning, Avhen they had much more the appearance of dead than of living men. No pulse could be felt; the extremities were cold and rigid, the countenance was ghastly, and the strength almost quite exhausted. Yet from this deplorable condition they Avere both recovered by the use of opiates and cordial medicines. OF A DIARRHOEA, OR LOOSENESS. A LOOSENESS, in many cases, is not to be considered as a disease, but rather as a salutary evacuation. It ought therefore never to be stopped, unless when U continues too long, or evidently weak- ens the patient. As this however sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment. When a looseness is occasioned by catching cold, or an obstructed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in luke-warm water, to Avear flannel next his skin, and to take every other method to restore the perspiration. In a looseness which proceeds from excess or repletion, a vomit is the proper medicine. Vomits not only cleanse the stomach, but promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder Avill answer this purpose veiy well. A day or two after the vomit, the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness 28 218 ©F A DIARRHOEA, OR LOOSENESS. continues. The patient ought to live upon light vegetable food of ca»y digestion, and to drink whey, thin gruel, or baiiey-watcr. A looseners occasioned by the obstruction of any customary evacua- tion, generally requires bleeding. If that does not succeed, other eva- cuations may be substituted in the room of those which are obstructed. At the same time, every method is to be taken to restore the mual dis- charges, as not only the cure of the disease, but the patient's life, may- depend on this. A periodical looseness ought never to be stopped. It is ahvays an effort of Nature to cany off' some offending matter, w liich, if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is however so far from being hurtful to them, that such children generally get their teeth with least trouble. If these loose stools shculd at any time prove sour or griping, a tea-spoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a little panado, or any other food. This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools. A diarrhoea, or looseness, which proceeds from violent passions or af- fections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper. Nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and other antispas- modic medicines are most proper. Ten or twelve drops of liquid lauda- num may be taken iu a cup of valerian or penny-royal tea every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquil- ity of mind are here of the greatest importance. When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting li- quors, Avith oil or fat broths, to promote vomiting and purging. After- wards, if there be reason to suspect that the bowels are inflamed, bleed-. ing Avill be necessaiy. Small doses of laudanum may likewise be taken to remove their irritation. When the gout, repelled from the extremities, occasions a loose- ness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &*c. The perspi- ration ought at the same time to be promoted by warm diluting liquors; as wine whey with spirits of hartshorn, or a feAv drops of liquid laudanum in it. When a looseness proceeds from worms, Avhich may be knoAvn from the slirainess of the stools, mixed Avith pieces of decayed worms, Sic. medicines must be given to kill and carry off these vermin, as the powder of tin Avith purges of rhubarb and calomel. Afterwards lime- water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and prevent the new generation of worms. A looseness is often occasioned by drinking bad Avater. When this is the case, the disease generally proves epidemical. When there is reason to believe that tlr* or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quick lime, chalk. or the like. OF VOMITING. 21$ In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure -of this is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret. From whatever cause a looseness proceeds, when it is found neces- sary to check it, the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly, sago with red port; and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice-water, or weak broth made from lean veal, or with a sheep's head, as being more gelatinous than mutton, beef, or chicken-broth. Persons who, from a peculiar weakness, or too great an irritability of the bowels, are liable to frequent returns of this disease, should live tem- perately, avoiding crude summer fruits, all unAvhoIesome foods, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspiration, and should wear flannel next the skin. All violent passions, as fear, anger, &c. arc likewise care fully to be guarded against. OF VOMITING. VOMITING may proceed from various causes; as excess in eating and drinking; foulness of the stomach; the acrimony of the aliment; a translation of the morbific matter of ulcers, of the gout, the erysipelas, or other diseases, to the stomach. It may likewise proceed from a loose ness having been two suddenly stopped; from the stoppage of any cus- tomary evacuation, as the bleeding piles, the menses, &c. from a Aveak- ness of the stomach, the colic, the iliac passiou, a rupture, a fit of the gravel, worms; or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain; as contusions, com pressions, Sic. It is likewise a symptom of wounds or inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c. Vomiting may be occasioned by unusual motions, as sailing, being drawn backwards in a carriage, &c. It may likeAvise be excited by vio- lent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vomiting.—Sometimes it pro- ceeds from a regurgitation of the bile into the stomach: in this case, what tlie patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons Avho are subject to nervous affections are often sud- denly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnancy.—In this case it generally comes on about two weeks after tin stoppage of the menses, aud continues during the first three or four months. When vomiting proceeds from a foul stomach or indigestion, it is no to be considered as a disease, but as the cure of a disease. It ought there- fore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, ami worked off with Aveak camomile-tea- When the retrocession of the gout, or the obstruction ef custom. 220 Of vomting. ary evacuations, occasion vomiting, all meaus must be used to restore these discharges; or, if that cannot be effected, their place must be sup- plied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blisters, Sic. When vomiting is the effect of pregnancy, it may generally be miti- gated by bleeding, and keeping the body gently open. The bleeding however ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, steAved prunes, manna, or 6enna. Pregnant women are most apt to vomit in the morning immediately af- ter getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach.—It may generally be prevented by taking a dish of coffee, tea, or some light breakfast in bed. Pregnant women who are afflicted Avith vomiting, ought to be kept easy both in body and mind. They should neither allovv their stomachs to be quite empty, nor should they eat much at once. Cold Avater is a very proper drink in this case; if the stomach be weak, a little brandy may be added to it. If the spirits are loiv, and the person apt to faint, a spoonful of cinnamon-water, with a httle marmalade of quinces or oranges, may be taken. If vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in Avine or brandy, with as much rhu- barb as will keep the body gently open, is an excellent medicine in this case. The elixir of vitriol is also a good medicine.—It may be taken in the dose of fifteen or tAventy drops, twice or thrice a-day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet. A vomiting which proceeds from acidities in the stomach, is relieved by alkaline purges. The best medicine of this kind is the magnesia alba, a tea-spoonful of which may be taken in a dish of tea or a little milk, three or four times a-day, or oftener if necessary, to keep the body open. When vomiting proceeds from violent passions, or affectious of the mind, all evacuants must be carefully avoided, especially vomits.— These are exceedingly dangerous. The patient in tl is case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few d'ops of laudanum may occasionally be added. When vomiting proceeds from spasmodic affections of the stomach, musk, castor, and other antispasmodic medicines are of use. Warm and aromatic plasters have likeAvise a good effect. The stomach-plaster of the London or Edinburgh dispensatory may be applied to the pit of the stomach, or a plaster of theriaca, which will answer rather better. Aro- matic medicines may likewise be taken inwardly, as cinnamon or mint tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with aether, or if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patieut immersed up to the breast in a warm bath. I have always found the safne draughts taken in the act of effer- vescence, of singular use in stopping of vomiting, from whatever cau^e it proceeded. These may be prepared by dissolving a drachm of the salt of tartar in an ounce and a half of fresh lemon juice, and adding to it an ounce of pepper-mint water, the same quantity of simple cinna- mon water, aud a little Avhite sugar. This draught must be swal- OF THE DIABETES, &C. 221 lowed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach af- ter all other means had failed. As the least motion Avill often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of action. The diet must be so regulated as to sit easy upon the stomach, and nothing- should be taken that is hard of digestion. We do not however mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids. CHAP. XXXIV. OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER. THE diabetes is a frequent and excessive discharge of mine. It is seldom to be met with among young people; but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth. CAUSES.—A diabetes is often the consequence of acute diseases, ay; fevers, fluxes, &c. where the patient has suffered by excessive evacua- tions; it may ako be occasioned by great fatigue, as riding long journies upon a hard trotting horse, carrying heavy burdens, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quantities, by which mistake it often happens that they occasiou Avorse diseases than those they were intended to cure. In a word, this disease may either proceed from too great a laxity of the organ, which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quanti- ty of it run off by the urinary passages. SYMPTOMS.—In a diabetes, the urine generally exceeds in quan- tity all the liquid food which the patient takes. It is thin and pale, of a SAveetish taste, and an agreeable smell. The patient has a continued thirst, with some degree of fever; his mouth is diy, and he spits fre- quently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes aAvay till the patient is reduced to skin and bone. {There is a heat of the boAvels, and frequently the loins, and feet are swel- led. This disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected. REGIMEN.—Every thing that stimulates the urinary passage.-, or tends to relax the habit, must be avoided. For this reason the pa- tient should live chiefly on solid food. His thirst may be quenched with acids; as sorrel, juice of lemon, or vinegar. The mucilagiu- 222 OF THE DIABETES, &.C. ous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be preferred; as oysteip; crabs, &c. The drink may be Bristol-water. When that cannot be obtained, lime- water, iu which a due proportion of oak-bark has been macerated, may be used. The white decoction,* with isinglass dissolved in it, is like- Avise a very proper drink. The patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or matrass. No- thing hurts the kidneys more than lying too soft. A Avarm, dry air, the use of the flesh-brush, and every thing that promotes perspiration, is of service. For this reason the patient ought to wear flannel next his skin. A large strengthening plaster may be applied to the back ; or, what will answer better, a great part of the body may be wrapped iu plaster. MEDICINE.—Gentle purges, if the patient be not too much weak- ened by the disease, have a good effect. They may consist of rhubarb, Avith cardamum seeds, or any other spiceries, infused in wine, and may be taken in such quantities as to keep the body gently open. The patient must next have recourse to astringents and corroborants. Half a drachm of powder made of equal parts of alum and the inspissated juice commonly called Terra Japonica, maybe taken four times a-day, or oflener, if the stomach will bear it. The alum must first be melted in a crucible, afterwards they may both be pounded together. Along with every dose of this powder the patient may take a tea-cupful of the tinc- ture of roses.f If the patient's stomach cannot bear the alum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The alum whey is prepared by boiling two English quarts of milk over a sIoav fire, with three drachms of alum, till the curd sepa» rati s. Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient's drink three or four times a-day. The best corroborants which we know, are the Peruvian bark, and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more efficacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be ad- ded to each dose. Such as cannot take the bark in substance may use the decoction, mixed with an equal quantity of red wine, and sharpened as above. There is a disease incident to labouring people in the decline of life, called JNcoNtiNEscr of urine. But this is very different from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the blad- der, aud is often the effect of a pal&y. Sometimes it proceeds from hurts or injuries occasioned by blows, bruises, preternatural labours, Sic. Sometimes it is the effect of a fever. It may likewise be occa- * See Appendix, White Decoction. f See Appendix, Tincture of Ji^e- OF A SUPPRESSION OF URINE. 223 sioned by long use of strong diuretics, or of stimulating medicines in- jected into the bladder. This disease may be mitigated by the use of astringent and cor- roborating medicines, such as have been mentioned above ; but we do not remember ever to have seen it cured. In an incontinency of urine, from whatever cause, a piece of sponge ought to be worn, or a bladder applied in such a manner as to pre- vent the urine from galling and excoriating the parts.- OF A SUPPRESSION OF URINE. It has already been observed, that a suppression of urine, may proceed from various causes ; as an inflammation of the kidneys, or bladder; small stones or gravel lodging in the urinary passages, hard fceces lying in the rectum, pregnancy, a spasm or contraction of the neck of the bladder, clot- ted blood in the bladder itself, a swelling of the hemorrhoidal veins, Sic. Some of these cases require the catheter, both to remove the ob- structing matter, and to draw off the urine; but as this instrument can only be managed with safety by persons skilled in surgery, Ave shall say nothing further of its use. A bougie may be used by any cautious hand, and will often succeed better than the catheter. We would chiefly recommend, in all obstructions of urine, fo- mentations and evacuations. Bleeding, as far as the patient's strength will permit, is necessary, especially where there are symptoms of to- pical inflammation. Bleeding in this case not only abates the fever, by lessening the force of the circulation, but by relaxing the solids, it takes off the spasm or structure upon the vessels which occasioned the obstruction. After bleedings, fomentations must be used. These may either con.ist of Avarm Avater alone, or of decoctions of mild vegetables; as mallows, camomile-flowers, &c. Cloths dipped in these may either be applied to the part affected, or a large bladder filled with the deccctioa may be kept continually upon it. Some put the herbs themselves into a flannel-bag, and apply them to the part, which is far from be- ing a bad method. These continue longer warm than cloths dipped in the decoction, and at the same time keep the part equally moist. In all obstructions of urine, the body ought to be kept open. This is not however to be attempted by strong purgatives, but by emol- lient clysters, or gentle infusions of senna and manna. Clysters in this case not only open the body, but answer the purpose of an in- ternal fomentation, and greatly assist in removing the spasms of the bladder and parts adjacent. The food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mucilaginous vegeta- bles, as marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sAveet spirits of nitre, or a drachm of Castile soap, may be frequently put into the patient's drink; and if there be no inflammation, he may drink small gin-punch. Persons subject to a suppression of urine oupht to live very tempe- * A bottle" made of the Indianjfubber, and properly applied, answers this purpose besK 224 OF THE GRAVEL AND STONE. rate. Their diet should be light, and their liquor diluting. They should avoid all acids aud austere wines, should take sufficient exercise, lie hard, and avoid study and sendentaiy occupations. OF THE GRAVEL AND STONE. WHEN small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the gravel. If one of these stones happens to make a lodgment in the bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. Iu this case the patient is said to have the stone. CAUSES.—The 6tone and gravel may be occasioned by high living; the use of strong astringent wines; a sedentary life; lying too hot, soft, or too much on the back; the constant use of water impregnated with earthy or stony p Articles; aliments of an astringent or windy nature, &c. It may likewise proceed from an hereditary disposition. Persons in the decline of life, aud those who have been much afflicted with the gout or rheumatism, are most liable to it. SYMPTOMS.—Small stones or gravel in the kidneys occasion pain in the loin; sickness, and sometimes bloody urine. When the stone de- scends into the ureter, and is too large to pass along Avith ease, all the above symptoms are increased; the pain extends toAvards the bladder; the, thigh and leg of the affected side are benumbed; the testicles are draAvn upwards; and the urine is obstructed. A stone in the bladder is knoAvn from a pain, at the time, as Avell as before and after making water; from the urine coming away by drops, or stopping suddenly, when it Avas running in a full stream; by a vio- lent pain in the neck of the bladder upon motion, especially on horse- back, or in a carriage on a rough road, from a white, thick, copious, ytiuking, mucous sediment in the urine; from an itching in the top of the penis; from bloody urine; from an inclination to go to stool during the discharge of urine; from the patient's passing his urine more easily Avhen lying than in an erect posture; from a kind of a convulsive motion oc- casioned by the sharp pain in discharging the last drops of the urine; and lastly, from sounding or searching with the catheter. REGIMEN.—Persons afflicted with the gravel or stone should avoid aliments of a windy or heating nature, as salt meats, sour fruits, &c. Their diet ought chiefly to consist of such things as tend to pro- mote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, succory, purslane, turnips, potatoes, carrots, aud radishes, may be safely eaten. Onions, leeks, and cellery are, in this case, reckoned medicinal. The most proper drinks, are whey, butter-milk, milk and water, barley-water; decoctions or infusions of the roots of marsh-mallows, parsley, liquorice, or of other mild mucilaginous vegetables, as linseed, lime-tree buds or leaves, Sic. If the person has been accustomed to generous liquors, he may drink gin and water not too strong. Gentle exercise is proper; but violent motion is apt to occasion bloody urine. We would therefore advise that it should be taken in moderation. Persons, afflicted with gravel often pass a great number of stones, after riding on horseback, or in a carriage; but those who have a stone in the bladder are seldom able to bear these kinds of OF THE CRAVEL AND STONE. £25 qxercise. Where there is a hereditary tendency to this disease, a seden- tary life ought never to be indulged. Were people careful, upon the first symptoms of gravel, to observe a proper regimen of diet, and to take sufficient exercise, it might often be carried off, or at least prevented from increasing; but if the same course which occasioned the disease is persisted in, it must be aggravated. MEDICINE.—In what is called a lit of the gravel, which is com- monly occasioned by a stone sticking in the ureter, or some part of the urinary passages, the patient must be bled, warm fomentations should likeAvise be applied to the part affected, emollient clysters administered, and diluting mucilaginous liquors drank, &c. The treatment of this case has been fully pointed out under the articles, inflammation of the kidneys and bladder, to which we refer. Dr. Whyte advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morn- ing, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes, that though this quantity might be too small to have any sensible effect in dissolving a stone in the bladder, yet it may very probably prevent its growth. When a stone is formed in the bladder, the Doctor recommends Alicant soap, and oyster or cockle-shell lime-water,* to be taken in the following manner: The patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or cockle-shell lime-water. The soap is to be divided into three doses; the largest to be taken fast- ing in the morning early; the second at noon; and the third at seven iri the evening; drinking above each dose a large draught of the lime- water ; the remainder of which he may take any time betwixt dinner and supper, instead of other liquors. The patient should begin with a smaller quantity of the lime-water and soap than that mentioned above; at first an English pint of the for- mer, and three drachms of the latter, may be taken daily. This quan- tity, hoAvever, he may increase by degrees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his com- plaint, for several months; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime-water in small quantities, but to take the second or third lime-water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first Avater, but, if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells. The caustic alkali, or soap lees is the medicine chiefly in vouge at present for the stone. It is of a very acrid nature, and ought therefore to be given in some gelatinous or mucilaginous liquors; as veal broth, new-milk, linseed-tea, a solution of gum-arabic, or a decoction of marsh* malloAV roots. The patient must begin with small doses of the lees, as thirty or forty drops, and increase by degrees, as far as the stomach can bear it.f • See Appendix, Lime-mater. f The caustic alkali may be prepared by mixing two parts of quick-lime with^ one of pot-ashes, and suffering them to stand till tlie lixivium be farmed, which 23 226 INVOLUNTARY DISCHARGES, &C. Though the soap-lees and lime-water are the most powerful medicines which have hitherto been discovered for the stone; yet there are some things of a more simple nature, which in certaiu cases are found to be beneficial and therefore deserve a trial. An infusion of the seeds of daucus sylvestris, or wild carrot, siveetened with honey, has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid nature. A decoction of raw coffee-berries, taken morning and evening, to the quantity of eight or ten ounces, with ten drops of sweet spirits of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable. The only other medicine which Ave shall mention is the uva ursi. It has been greatly extolled of late both for the gravel and stone. It seems however to be in all respects inferior to the soap and lime-Avater; but it is less disagreeable, and has frequently to my knoAvledge, relieved gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a-day. It may hoAvever be taken to the quantity of seven or eight drachms a-day, with great safety and good effect. CHAP. XXXV. OF INVOLUNTARY DISCHARGES OF BLOOD. SPONTANEOUS or involuntary discharges of blood often happen from various parts of the body. These, however, are so far from being always dangerous, that they often prove salutary. When such dis- charges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor indeed is it proper at any time to stop them, un- less they be so great as to endanger the patient's life. Most people, afraid of the smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by which means an inflammation of the brain, or some other fatal disease, is occa- sioned, which, had the discharge been allowed to go on, might have been prevented. Periodical discharges of blood, from whatever part of the body they proceed, must not be stopped. They are always the effects of Nature to relieve herself; and fatal diseases have often been the consequence of obstructing them. It may indeed be sometimes necessary to check the violence of such discharges; but even this requires the greatest caution. Instances might be given where the stopping of a small periodical flux of blood, from one of the fingers, has proved fatal to the health. In the early period of life, bleeding at the nose is very common. Those who are farther advanced in years are more liable to haemop- toe, or discharge of blood from the lungs. After the middle period must be carefully filtrated before it be used. If the solution does not happen readily, a small quantity of water may be added to the mixture. OF BLEEDING AT THE NOSE.. 227 «f fife, haemorrhoidal fluxes are most common; and in the decline of life, discharges of blood from the urinary passages. Involuntary fluxes of blood may proceed from very different, and of- ten quite opposite causes. Sometimes they are owing to a particular con- struction of the body, as a sanguine temperament, a laxity of the vessels, a plethoric habit, &c. At other times they proceed from a determination of the blood, towards one particular part, as the head, the haemorrhoidal veins, &c. They may likewise proceed from an inflammatory disposi- tion of the blood, in which case there is generally some degree of fever; this likewise happens when the flux is occasioned by an obstructed per- spiration, or a structure upon the skin, the bowels, or any particular part of the system. But a dissolved state of the blood will likewise occasion haemorrhages. Thus, in putrid fevers, the dyssentery, the scurvy, the malignant small- pox, Sic. there are often very great discharges of blood from different parts of the body. They may likewise be brought on by too liberal an use of medicine, which tend to dissolve the blood, as cantharides, the volatile alkaline salts, &c. Food of an acrid or irritating quality may likewise occasion haemorrhages; as also strong purges and vomits, or any thing that greatly stimulates the bowels. Violent passions or agitations of the mind will likewise have this ef- fect. These often cause bleeding at the nose, and I have known them sometimes occasion an haemorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging the head very low, &c. The cure of an haemorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to inflammation, bleeding, with gentle purges and other evacuations, will be necessary. It will likewise be proper for the patient in this case to live chiefly upon a ve- getable diet, to avoid all strong liquors, and food that is of an acrid, hot, or stimulating quality. The body should be kept cool and the mind easy. When an haemorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acid fruits with milk, and vegetables of a nourishing nature, as sago, salop, &c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirits of vitriol. The best medicine in this case is the peruvian bark, which may be taken according to the urgency of the symptoms. When a flux of blood is the effect of acrid food, or of strong stimulat- ing medicines, the cure is to be effected by soft mucilaginous diet. The patient may likewise take frequently about the bulk of a nutmeg of Locatelli's balsam, or the same quantity of spermaceti. When an obstructed perspiration, or a stricture upon any part of the system, is the cause of an haemorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extremities in warm wa- ter, &c. OF BLEEDING AT THE NOSE. BLEEDING at the nose is commonly preceded by some degree of quickness of the pulse, flushing in the face, pulsation of the temporal ar- teries, heaviness in the head, dimness of the sight, heat and itching of the nostrils, &c. 258 OF BLEEDING AT THE NOSE? To persons who abound with blood this discharge is very salutary. It often cures a vertigo, the head-ache, a phrenzy, and even an epilepsy. In fevers, where thero is a great determination of blood towards the head, it is of the utmost service. It is likewise beneficial in inflammations of the liver and spleen, and often in he gout and rheumatism. In all di- seases where bleeding is necessary, a spontaneous discharge of blood from the nose is of much more service than the same quantity let with a lancet In a discharge of blood from the nose, the great point is to determine whether it ought to be stopped or not. It is a common practice to stop the bleeding, without considering whether it be a disease, or the cure of a disease. This conduct proceeds from fear; but it has often bad, and sometimes fatal consequences. When a discharge of blood from the nose happens in an inflammatory disease, there is always reason to believe that it may prove salutary; and therefore it should be suffered to go on, at least as long as the patient is not weakened by it. When it happens to persons in perfect health, who are full of blood, it ought not to be suddenly stopped, especially if the symptoms of plethora, mentioned above, have preceded it. In this case it cannot be stopped without risking the patient's life. In fine, whenever bleeding at the nose relieves any bad symptom, and does not proceed so far as to endanger the patient's life, it ought not to be stopped. But when it returns frequendy, or continues till the pulse becomes low, the extremities begin to grow cold, the lips pale, or the pa- tient complains of being sick or faint, it must immediately be stopped. For this purpose the patient should be set nearly upright, with his head reclining a little, and his legs immersed in water about the warmth of new milk. His hands ought likewise to be put in lukewarm water, and his garters may be tied a little tighter than usual. Ligatures nay' be applied to the arms, about the place where they are usually made for bleeding, and with nearly the same degree of tightness. These must be gradually slackened as the blood begins to stop and removed entirely as soon as it gives over. Sometimes dry lint put up the nostrils will stop the bleeding. Wheo this does not succeed, dossils of lint dipped in strong spirits of wine, may be put up the nostrils, or if that cannot be had, they may be dipped ia brandy. Blue vitriol dissolved in water may likewise be used for this purpose, or a tent dipped in the white of an egg well beat up, may be rolled in a powder made of equal parts of white sugar, burnt alum, and white vitriol and put up the nostril from whence the blood issues. Internal medicines can hardly be of use here, as they have seldom time to operate. It may not however be amiss to give the patient half an ounce of Glauber's salt, and the same quantity of manna, dissolved in four or five ounces of barley-water. This may be taken at a draught, and repeated, if it does not operate, in a few hours. Ten or twelve grains of nitre may be taken in a glass of cold water and vinegar every hour, or oftener, if the stomach will bear it. If a stronger medicine be necessary, a tea-cupful of the tincture of rosea, with twenty or thirty drops of the weak spirit of vitriol, may be taken every hour. When these things caonot be had, the patient may OF THE BLEEDING AND BLIND PILES. 229 drink water, with a little common salt in it, or equal parts of water an* vinegar.* If the genitals be immersed for some time in cold water, it will gen- erally stop a bleeding at the nose. I have not knoAvn this fail. Sometimes when the bleeding is stopped outAvardly, it continues in- wardly. This is very troublesome, and requires particular attention, as the patient is apt to be suffocated with the blood, especially if he falls asleep, which he is very ready to do after losing a great quantity of blood. When the patient is in danger of suffocation from the blood getting into his throat, the passages may be stopped by drawing threads up the nos- trils, and briuging them out at the mouth, then fastening pieces of sponge, or small rolls of linen cloth to their extremities; afterwards drawing them back, and tying them outside with a sufficient degree of tightness. After the bleeding is stopped, the patient ought to be kept as easy and quiet as possible. He should not pick his nose, nor take away the tents or clotted blood, till they fall off of their own accord, and should not lie with his head low. Those who are affected with frequent bleeding at the nose ought to bathe their feet often in warm water, and to keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible, and never to view any object ob- liquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it. But when the disease proceeds from a thin dissolved state of the bloody the diet should be rich and nourishing; as strong broths and jellies, sago-gruel, with wine and sugar, &c. Infusions of the Peruvian bark in wine ought likewise to be taken and persisted in for a considerable time. OF THE BLEEDING AND BLIND PILES. A DISCHARGE of blood from the haemorrhoidal vessels is called the bleeding piles. When the vessels only sAvell, and discharge no blood, but are exceeding painful, the disease is called the blind piles. Persons of a loose spungy fibre, of a bulky size, who live high, and lead a sedentary, inactive life, are most subject to this disease. It is oft- en owing to an hereditary disposition. Where this is the case, it attacks persons more early in life than Avhen it is accidental. Men are more li- able to it than Avomen, especially those of a sanguine, plethoric, or scor- butic habit, or of a melancholy disposition. The piles may be occasioned by an excess of blood, by strong aloetic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacuations, much riding, great costiveness, as any thing that occasions hard or difficult stools. Anger, grief, or other violent passions, will likewise occasion the piles. I have often known them brought on by sitting on the damp ground. A pair of thin breeches will excite the dis- order in a person Avho is subject to it, and sometimes even in those • From ten to twenty drops of the oil of turpentine in a little water given frequently, seldom fails to stop a bleeding at the nose, or from any other part. 230 OF THE BLEEDING AND BLIND PILES. who never had it before. Pregnant Avomen are often afflicted with the piles. A flux of blood from the anus, is not always to be treated as a disease. It is even more salutary than bleeding at the nose, and often preveuts or carries off diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondriacal complaint and often proves critical in colics, and inflammatory fevers. In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which might be excessive and prove hurtful to one, may be very moderate, and even salutary to another. That only is to be esteemed dangerous, ■which continues too long, and is in such quantity as to waste the patient's strength, hurt the digestion, nutrition, and other functions necessaiy to life. When this is the case, the discharge must be checked by a proper re- gimen, and astringent medicines. The DIET must be cool bat nourish- ing, consisting chiefly of bread, milk, cooling vegetables, and broths. The drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and mucilaginous plants, as the tormentil root, bistort, the marshmallow-roots, &c. Old conserve of roses is a very good medicine in this case. It may be mixed in new milk, and may be taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its be- ing seldom taken in such quantity as to produce any effects; but wheu taken as here directed, and duly persisted in, I have known it perform very extraordinary cures in violent haemorrhages, especially when assist- ed by the tincture of roses: a tea-spoonful of which may be taken about an hour after every dose of the conserve. The Peruvian bark is likewise proper in this case, both as a strength- enerand astringent. Haifa drachm of it may betaken in a glass of red wine, sharpened with a few drops of the elixir of vitriol, three or four times a-day. The bleeding piles are sometimes periodical, and return regularly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the haemorrhoidal veins. In the blind piles bleeding is generally of use. The diet must be light and thin, and the drink cool and diluting. It is likewise necessaiy that the body be kept gently open. This may be done by small doses of the flour of the brimstone and cream of tartar. These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftener if necessary. Or an ounce of the flour of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day. Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the anus, that they cannot be thrown up. Iu this case I have known a vomit have a very good effect. When the piles are exceeding painful aud swelled, but discharge nothing, the patient must sit over the steams of warm water. He may likewise apply a linen cloth dipped in Avarm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with SPITTING OE BLOOD. 231 butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possible, or, if they will fix upon the piles themselves so much the better. When leeches will not fix, the piles may be opened with a lancet. The operation is very easy, and is attended Avith no danger. Various ointments, and other external applications are recommended in the piles; but I do not re- member to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, Avhich may be done as well by a soft poultice, or an emollient cataplasm. When the pain how- ever is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied. SPITTING OF BLOOD. WE mean here to treat of that discharge of blood from the lungs only which is called an hamoptoe or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and strait breasts are most liable to this disease. It is most common in the spring and generally at- tacks people before they are at the prime or middle period of life. It is a common observation, that those who have been subject to bleeding at the nose when young, are afterwards most liable to an haemoptoe. CAUSES.—An haemoptoe may proceed from excess of blood, from a peculiar weakness of the lungs, or a bad conformation of the breast. It is often occasioned by excessive drinking, running, Avrestling, singing, or speaking aloud. Such as have weak lungs ought to avoid all violent exertions of that organ, as they value life. They should likeAvise guard against violent passions, excessive drinking, and every thing that occa- sions a rapid circulation of the blood. This disease may likewise proceed from wounds of the lungs.—These may either be received from without, or they may be occasioned by hard bodies getting into the wind-pipe, and so falling down upon the lungs, and hurting that tender organ. The obstruction of any custom- ary evacuation may occasion a spitting of blood; as neglect of bleeding or purging at the usual seasons, the stoppage of the bleeding piles in men, or the menses in women, &c. It may likeAvise proceed from a po- lypus, scirrhous concretions, or any thing that obstructs the circula- tion of the blood in the lungs. It is often the effect of a long and violent cough; in Avhich case it is generally the forerunner of a con- sumption. A violent degree of cold suddenly applied to the external parts of the body will occasion an haemoptoe. It may likeAvise be oc- casioned by breathing air which is too much ratified to be able proper- ly to expand the lungs. This is often the case witli those Avho work in hot places, as furnaces, glass-houses, or the like. It is likewise said to happen to such as ascend to the top of veiy high mountains, as the Peak of Teneriffe, &c. Spitting of blood is not always to be considered as a primary disease. It is often only a symptom, and iu some diseases not an unfavourable one. This is the case in pleurisies, peripneumonies, aud sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shews that the lungs are ulcerated. SYMPTOMS.—Spitting of blood is generally preceded by a 232 SPITTING OF BLOOD. sense of weight, and oppression jol the breast, a dry tickling cough, hoarseness, and a difficulty of breathii-g. Sometimes it is ushered in ■with shivering, coldness of the extremities costiveness, great 1 ,ssitude, flatulence, pain of the back and loins, &c. As these shew a general stricture upon the vessels, and a tendency of the blood to inflam- mation, they are commonly the foreruners of a very copious discharge. The above symptoms do not attend a discharge of blood from the gums or fauces, by which means these may always be distinguished from au haemoptoe. Sometimes the blood that is spit up is thin, and af a florid red colour; and at other times it is thick, and of a dark or blackish colour; nothing however can be inferred from this cir- cumstance, but that the blood has lain a longer or shorter time in the breast before it was discharged. Spitting of blood in a strong healthy person, of a sound constitution, is not very dangerous; but when it attacks the tender and delicate, or persons of a weak lax fibre, it is with difficulty removed.—When it pro- ceeds from a scirrhous or polypus of the lungs, it is bad. The dan- ger is greater when the discharge proceeds from the rupture of a large vessel than a small one. When the extravasated blood is not spit up, but lodges in the breast, it corrupts, and greatly increases the danger. When the blood proceeds from an ulcer in the lungs it is generally fatal. REGIMEN.—The patient ought to be kept cool and easy. Every thing that heats the body or quickens the circulation, increases the dan- ger. The mind ought likewise to be soothed, and every occasion of exciting the passions avoided. The diet should be soft, cooling, and; slender; as rice boiled with milk, small broths, barley-gruefs, panado, &c. The diet in this case, can scarce be too low. Even water-gruel is sufficient to support the patient for some days. All strong liquors must be avoided. The patient may drink milk and water, barley-water, Avhey, butter-milk, and such like. Every thing however should be drank cold, and in small quantities at a time. He should observe the strictest si- lence, or at least speak with a very low voice. MEDICINE.—.This, like the other involuntary discharges of blood, oUght not to be suddenly stopped by astringent medicines.—More mischief is often done by these than if it were suffered to go on. It may however proceed so far as to Aveaken the patient, and even en- danger his life; in which case proper means must be used for re- straining it. The body should be kept gently open by laxative diet; as roasted apples, stewed prunes and such like. If these should not have the de- sired effect, a tea-spoonful of the lenative electuary may be taken twice Or thrice a day, as is found necessaiy. If the bleeding proves voilent, ligatures may be applied to the extremities, as directed, for a bleeding at the nose. If the patient be hot or feverish, bleeding, and small doses of nitre will be of use; a scruple or half a drachm of nitre may be ta- ken in a cup of his ordinary drink twice or thrice a-day. His drink may likeAvise be sharpened Avith acids, as juice of lemon, or a few drops Of the spirits of Vitriol; or he may take frequently a cup of the tincture of roses. Bathing the feet and legs in lukewarm water has likewise a very good effect in this disease. Opiates, too, are sometimes beneficial; B.ut these must be administered with caution. Tea or twelve drops VOMITING OF BLOOD. 233 of laudanum may be given in a cup of barley water twice a-day, and continued for some time, provided they be found beneficial. The conserve of roses is likewise a very good medicine in this case, provided it be taken in sufficient quantity, aud long enough persisted in. It may be taken to the quantity of three or four ounces a-day; and, if the patient be troubled with a cough, it should be made into an electuary with balsamic syrup, and a little of the syrup of poppies. If stronger astringents be necessary, fifteen or twenty drops of the ! THIS is not so common as the other discharges of blood which have already been mentioned; but it is very dangerous, and requires particu- lar attention. Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea; and is accompanied with great anxiety, aud fre* quent fainting-fits. This disease is sometimes periodical; iu which case it is less danger*: ous. It often proceeds from an obstruction of the menses in women; and sometimes from the stoppage of the haemorrhoidal flux in men. It may be occasioned by any thing that greatly stimulates or wounds the stomach, as strong vomits or purges, acrid poison, sharp or hard substan- ces taken into the stomach, &c. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external violence, as blows, bruises, or from any of the causes which produced inflammation. In hysteric wo- men, vomiting of blood is a very common, but by no means a danger- ous symptom. A great part of the danger in this disease arise from the extravasated blood lodging in the bowels, and becoming putrid, by which means a dysentery or putrid fever may be occasioned. The best way of pre- venting this, is to keep the body gently open, by frequently exhibiting tmollient clysters. Purges must not be given till the discharge is stopt, otherwise they will irritate the stomach, and increase the disorder. All the food and drink must be of a mild cooling nature, and taken in small quantities. Even drinking cold water has sometimes proved a remedy, but it will succeed the better when sharpened Avith the Aveak spirits of vitriol. When there are signs of an inflammation, bleeding may be ne- cessary: but the patient's weakness will seldom permit it. Opiates may be of use; but they must be given in very small doses, as four or five drops of liquid laudanum twice or thrice a-day. After the discharge is over, as the patient is generally troubled with gripes occasioned by the acrimony of the blood lodged in the intestines, •a:ntle purges Avill ho necessarv. 30 234 OF BLOODY LRINE. THIS is a discharge of blood from the vessels of tlie kidneys oft bladder, occasioned by their being either enlarged, broken, or eroded. It is more or less dangerous according to the different circumstances which attend it. When pure blood is voided suddenly without interruption and with- out pain, it proceeds from the kidneys; but if the blood be in small quantity, of a dark colour, and emitted ivitb heat and pain about the bottom of the belly, it proceeds from the bladder. When bloodv urine is occasioned by a rough stone descending from the kidneys to the blad- der, which wounds the ureters, it is attended with a sharp pain in the back, and difficulty of making water. If the coats of the bladder are hurt by a stone, a; d the bloody urine follows, it is atteuded with the most acute pain, and a previous stoppage of urine. Bloody urine may likewise be occasioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, cr any violent motion. It may also proceed from ulcers of the bladder, from a stone lodged in the kidneys, or from violent purges, or sharp diuretic medicines, especially cantharides. Bloody urine is ahvays attended with some degree of danger : but it is peculiarly so when mixed with purulent matter, as this shews an ulcer someAvhere in the urinary passages. Somet'mes this discharge proceeds from excess of blood, in which case it is rather to be considered as a salutary evacuation than a disease. If the discharge hoAvever be very great, it may waste the patient's strength, and occasion an ill habit of body, a dropsy or a consumption. The treatment of this disorder must be varied according to the different causes from which it proceeds. When it is OAving to a stone in the bladder, the cure depends upon an operation, a description of which would be foreign to our purpose. If it be attended with a plethora, and symptoms of inflammation, bleeding will be necessary. The body must likeivise be kept open by emollient clysters, or cooling purgative medicines; as cream of tartar, rhubarb, manna; or small doses of lenitive electuary. When bloody urine proceeds from a dissolved state of the blood, it is commonly the symptom of some malignant disease; as the small-pox, a putrid fever or the like. In this case the patien*'s life depends on the liberal use of the Peruvian bark and acids, as has already been shewn. When there is reason to suspect an ulcer in the kidneys or bladder, the patient's diet must be cool, and his drink of a soft healing, balsamic qual- ity, as decoctions of marsh-mallow roots with liquorice, solutions: of gum- arabic, Sic. Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in tAvo English quarts of Avater to one; two ounces gum-arabic, and half an ounce of purified nitre may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day. The early use of astringents in this drease has often bad conse- quences. When the flux is stopped too soon, the grumous blood, by bein» confined in the vessels, may produce inflammations, abscess, and ulcers. If however the case be urgent, or the patient seems to Buffer from the loss of blood, gentle astringents may be nen -sary OF THE DYSENTERY, &C. %$5 In this case the patient may take three or four ounces of lime-water, with half an ouuce of the tincture of Peruvian bark, three times a-day. OF THE DYSENTERY, OR BLOODY FLUX. THIS disease prevails in the spring and autumn. It is most common in marshy countries, where, after hot and diy summers, it is apt to be- come epidemic. Persons are most liable to it Avho are much exposed to the night air, or who live iu places Avhere the air is confined and unwhole-* some. Hence it often proves fatal in camps, on shipboard, in jails, hos? pitals, and such like places. CAUSES.—The dysentery may be occasioned by any thing that ob- structs the perspiration, or renders the humours putrid; as damp beds, wet clothes, unwholesome diet, bad air, &c. But it is most frequently communicated by infection. This ought to make people extremely cau- tious in going near such persons as Inborn- under the disease. Even the smell of the patient's excrements has been known to communicate the in- fection. SYMPTOMS.—It is known by a flux of the belly, attended by vio- lent pains of the bowels, a constant inclination to go to stool, and generally more or less blood in the stools. It begins like other fevers, with chilli- ness, loss of strength, a quick pulse, great thirst, and au inclination to vo- mit. The stools are at first greasy and frothy, afterwards they are streaked with blood, and at last have frequently the appearance of pure blood mixed with small filaments resembling bits of skin. Worms are sometimes passed both upwards and downwards through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of the intesr tine is actually protruded, Avhich proves exceeding troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease. This disease may be distinguished from a diarrhoea or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera morbusby its not being attended with such violent and frequent fits of vomiting, Sic. When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering diseases, it generally proves fatal. Vomiting and hickuping are bad signs, as they shew an in- flammation of the stomach. When the stools are green, black, or have an exceeding disagreeable cadaverous smell, the danger is very great, as it shews the disease to be of the putrid kind. It is an unfavourable symp- tom when the clusters are immediately retmned; but still more so when the passage is so obstinately shut, that they cannot be injected, a feeble pul e, coldness of the extremities, with difficulty of swallowing, and con- vulsions, are sis;us of approaching death. REGIMEN.—Nothing is of more importance in this disease, than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness; but in no one more than this. Every thing about the pa- tient should be frequently changed. The excrements should never be £36 OF THE DYSENTERV. suffered to continue in his cliamber, but removed immediately and Liuied underground. A constant stream of fresh air should be admitted into the chamber; aud it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acid. The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is increased by fears and alarms from those whom the patient bdieves to be persons of skill, it cannot fail to have the worst effects. A flannel Avaistcoat Avorn next the skin has often a very good effect in the dysentery. This promotes the perspiration without over heating the body. Great caution however is necessary in leaving it off. I have often knoAvn a dysentery brought on by imprudently throwing off a flannel waist- coat before the season Avas sufficiently warm. For whatever purpose this piece of dress is worn, it should never be left off but in a warm season. In this disease the greatest attention must be paid to the patient's diet. Flesh, fish, and every thing that has a tendency to turn putrid or rancid, on the stomach, must be abstained from. Apples boiled in milk, water pap; and plain light pudding, with broth made of the gel.itinou:- parts of animals, may constitute the principal part of the patient's food. Gelatin- ous broth not only answers the purpore of food, but likewise of medicine. I have often known dysenteries, vhich were not of a putrid nature, cured by it, after pompous medicines had moved ineffectual. ■ Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for six or seven hours, till it be- comes as hard as starch. Two or three table spoonsful of this may be grated down, and boiled in such a quantity of new milk and water, as to be of the thickness of pap. This may be SAveetencd to the patient's taste, and taken forhis ordinary food.f * The manner of making this broth is, to take a sheep's head and feet with the skin upon them, and to burn the wool off with a hot iron ; afterwards to boil them till the broth is quite a jelly. A little cinnamon or mace may be ad- ded, to give the broth an agreeable flavour, and the patient may take a little of it warm with toasted bread three or four times a-day. A clyster of it may like- wise be given twice a-day. Such as cannot use the broth made in this way, may have the head and feet skinned ; but we have reason to believe that this injures the medicine. It is not our business here to reason upon the nature and quali- ties of medicine, otherwise this might be shewn to possess virtues every way suited to the cure of a dysentery which does not proceed from a putrid state of the humours. One thing we know, which is preferable to all reasoning, that whole families have often been cured by it, after they had used many other me- dicines in vain. It will, however, be proper that the patient take a vomit, and a dose or two »f rhubarb, before he begins to use the broth. It will likewise be necessary to continue the use of it for a considerable time, and to make it the principal food. + The learned and humane Dr. Rutherford, late professor of medicine in the university of Edinburgh, used to mention this food in his public lectures with great encomiums. He directed it to be made by tying a pound or two of the finest flour, as tight as possible, in a linen rag, afterwards to dip it fre- auently in water, and to dredge the outside with flour, till a cake or crust was ©rmed around it, which prevents the water from soaking into it while boiling.. OR BLOODY FLUX. 237 In a putrid dysentery tlie patient may be allowed to eat freely of most k nds of good ripe fruit; as apples, grapes, gooseberries, currant-berries, s-traw-berries, Sic. • These may either be eaten raw or boiled, with or without milk, as the patient chooses. Tlie prejudice against fruit in this disease is so great, that many believe it to be the common cause of dys- enteries. This however is an egregious mistake. Both reason and ex- perience show, that good fruit is one of the best mediciues, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefaction, from whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore to be allowed to eat as much fruit as he pleases, provided it be ripe.* The most proper drink in this disorder is whey. The dystentery has'often been cured by the use of clear whey aloue. It may be taken both for drink and in form of a clyster. When Avhey cannot be had, barley Avater sharpened with cream of tartar may be drank, or a decoc- tion of barley and tamarinds; two ounces of the former and one of the latter, may be boiled in two English quarts of water to one. Warm-wa- ter, Avater-gruel, or water avherein hot iron has been frequently quenched, are all very proper, and may be drank in turns. Camomile-tea, if the stomach will bear it, is an exceeding proper drink. It both strengthens the stomach, and its by antiseptic quality, tends to prevent a mortification of the bowels. MEDICINE.—At the beginning of this disease it is always necessa- ry to cleanse the first passages. For this purpose a vomit of ipecacuan- ha must be given, and wrought off with weak camomile-tea. Strong vomits are seldom necessaiy here. A scrupel, or at most half a drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very feAv grains will suffice. The day after the vomit, half a drachm, or tivo scruples of rhubarb, must be taken ; or what will answer the purpose ra- ther better, an ounce or an ounce and an half of Epsom salt. This dose may be repeated eveiy other day for tAvo or three times. After- Avards small doses of ipecacuanha may be taken for tome time. Tavo or three grains of the powder may be mixed in a table spoonful of the syrup of poppies, and taken three times a-day. These evacuations, and the regimen prescribed above, will often be sufficient to effect a cure. Should it hoAvever happen otherwise the fol- lowing astringent medicines may be used: A clyster of starch or fat mutton broth, with thirty or forty drops of It is then to be boiled till it becomes a hard dry mass, as directed above. This, when mixed with milk and water, will not only answer the purpose of food, but may likewise be given in clysters. * I lately saw a young man who had been seized with a dysentery in North America. Many things had been tried for his relief, but to no purpose. At length tired out with disappointments from medicine, and reduced to skin and bone, he came over to Britain, rather with a view to die among his relations, than with any hopes of a cure. After taking sundry medicines here with no better success than abroad, I advised him to leave off" the use of drugs, and trust en- tirely to a diet of milk and fruits, with gentle exercise. Strawberries were the only fruit he could procure at that season. These he ate with milk twice and sometimes thrice aday. The consequence was, that in a short time his stools were reduced from upwards of twenty in a day, to three or four, and sometimes not sp many. He used the other fruits as they came in, and was in a few weeks so well as to leave that part of the country where I wTas with a view to return to America. 238 OF THE DYSENTERY, &C. liquid laudanum in it may be administered twice a day. At the same time an ouuce of gum-arabic, aud half an ounce of gum-tiacacanth may be dissolved in an English pint of barley-water; over a sfow fire! and a table spoonful of it taken every hour. If these have not the desired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the Japonic Confection, drinking after it a tea-spoonful of the decoction of logwood.* Persons who have been cured of this disease are very liable to suffer a relapse; to prevent which, great circumspection Avith respect to diet is necessaiy. The patient must abstain from all fermented liquors, except now and then a glass of good wine; but he must drink no kind of malt li- quor. He should likeAvise abstain from animal food, as fish and flesh, and live principally on milk and vegetables. Gentle exercise and wholesome air are likeAvise of importance.—The pitien* should go to the country as soon as his strength will permit, and sh^ul\ take exercise daily on horseback, or in a carriage. He may like- wise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of iicav milk. When dysenteries prevail, we Avould recommend a strict attention to cleanliness, a spare use of animd food, and the free use of sound ripe frir's. aid other vegetables. The night air is to be carefully avoided, and all communications with the sick. Bad smells are likewise to be shun led, especially those which arise from putrid animal substances. The necs arie« where the sick go are carefully to be avoided. When the first symptoms of the dysentery appear, the patient ought im- mediately to take a vomit, to go to bed, and drink plentifully of weak warm 1'quor, to promote a sweat. This with a dose or two of rhubarb at the be.ri ning, would often carry off the disease. Iu countries where dysenteri >■ preva:l we would advise such as are liable to them, to take either a vomit or a purge eveiy spring or autumn, as a preventa- tive. There are sundry other fluxes of the belly, as the lientery and co- eliac passion, winch though less dangerous than the dysentery, yet merit consideration. These diseases generally proceed from a relaxed state of the stomach and intestines, which is sometimes so great, that the food pas- ses through them with hardly any sens;ble alteration; and the patieut dies merely from the Avant of nourishment. When the lie itery or cceliac passion succeeds to a dysentery, the case is bad. They are always dangerous in old age, especially when the con- stitution has been broken by excess or acute diseases. If the stools be very frequent, and qui e crude, the thir t great, wi*h little urine,the mouth ulcerated, and the face marked with spots of different colours the danger is very great. The treatment of the patient is in general the same as in the dysente- ry. In all obstinate fluxes of the belly, the cure must be attempted, by fir«t electing the stomach and bowels with gentle vomits and purges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent mediciues, will generally complete the cure. See appendix, Deletion of Logwood. OF THE HEAD-ACHT. 239 The same observation holds with respect to a tfnfsmcs, or frequent desire of goi;;g to stool. This disease resembles the dysentery so much, boih in its symptoms and method of cure, that we thfok it needless to* insist upon it. /^S-—*-*" \ < .-1 r..\ •:■/ CHAP. XXXVI. OF THE HEAD-ACH. ACHES and pains proceed from very different causes, smcl may affect any part of the body, but we shall point out those only which oc- cur most frequently, and are attended with the greatest danger. When the head-ach is slight, and affects a particular part of the head only, it is called cephalalgia; when the whole head is affected, cephaloea; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hystericus. There are also other distinctions. Sometimes the pain is internal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the pa- tient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach is sometimes attended with a degree of stupidity or folly. Whatever obstructs the free circulation of the blood through the ves- sels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at the nose, sweating of the feet, &c. It may likewise proceed from any cause that determines a great flux of blood towards the head; as coldness of the extremities, or hanging down the head for a long time. Whatever pre- vents the return of the blood from the head will likewise occasion a head- ach ; as looking long obliquely at any object, wearing any thing tight about the neck, a new hat or the like. When a head-ach proceeds from a stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore part of the head, in which there seems to be such a weight, that the patient can scarce bold it up. When it is occasioned by the caustic matter of the venereal dis- ease, it generally affects the skull, and often produces a caries of the bones. Sometimes the head-ach proceeds from the repulsion or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other erup- tive diseases. What is called a hemicrania generally proceeds from cru- dities or indigestion. Inanition, or emptiness, will often also occasion head-aebs. I have often seen instances of this in nurses who gave suck too long, or Avho did not take a sufficient quantity of solid food. There is likewise a most violent, fixed, constant, and almost intoVra- bfo head-ach, which occasions great debility both of body and mind, 240 OF THE HEAD-ACH. prevents sleep, destroys the appetite, causes a vertigo, dimness of sight. a noise in the ears, convulsions, epileptic fits, and sometimes vomiting. costiveness, coldness of the extremities, Sic. The head-ach is often symptomatic in continual and uitermHtiug fe- vers, especially quartans. It is likewise a very common symptom in hysteric and hypochondriac complaints. When a head-ach attends an acute fever, with pale urine, it is an un- favourable symptom. In excessive head-achs, coldness of the extremi- ties is a bad sign. When the disease continues long, and is very violent, it often termi- nates in blindness, an apoplexy, deafness, a vertigo, the palsy, or the epilepsy. In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as vvill correct the acrimony of the humours, and keep the body open; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-Avater, infusions of mild muGilaginous vegetables, decoctions of the sodorific woods, Sic. The feet and legs ought to be kept warm, and frequently bathed in luke-warm water; the head should be shaved, and bathed with Avater and vinegar. The patient ought as much as possible to keep in an erect posture, aud not to lie with his head too low. When the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled iu the jugular vein, and the operation repeated if there be occasion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service. Afterwards a blistering-pLster may be applied to the neck behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The bod) ought likewise to be kept open by gentle laxatives. But when the head-ach proceeds from a copious vitiated serum stag- nating in the membranes, either within or Avithout the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more poAverful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the Avhole head, and to keep the back part of the neck open for a considerable time by a perpetual blister. When the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb mastich, ground ivy, &c. A hemicrania, especially a periodical one, is generally owing to a foul- ness of the stomach, for which gentle vomits must be administered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strengthen the stomach, will be necessary. A periodical head-ach has been cured by wearing a piece of flannel over the forehead during the night. When the head-ach arises from a vitiated state of the humours, as in the scurvy and vpnereal diseases, the patient, after proper evacua- tions, must drink freely of the decoction of woods, or the decoction OF THE TOOTH-ACH. 241 of sarsaparilla, with raisins and liquorice.* These, if duly persisted in, will produce very happy effects. Wheu a collection of matter is felt under the skin, it must be discharged by an incision, otherwise it will ren- der the bone carious. When the head-ach is so intolerable as to endanger the patient's life, or is attended with continual watching and delirium, recourse must be had to opiates. These, after proper evacuations by clysters or mild purgatives, may be applied both externally and internally.—The affect- ed part may be rubbed Avith Bate's anodyne balsam, or a cloth dipped in it may be applied to the part. The patient may, at the same time, take twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice or thrice a-day. This is only to be done in case Of extreme pain. Proper evacuations ought always to accompany and follow the use of opiates.f When the patient cannot bear the loss of blood, his feet ought fre- quently to be bathed in lukewarm water, and well rubbed Avith a coarse cloth. Cataplasms with mustard or horse-radish, ought likewise to be applied to them. This course is peculiarly necessary Avhen the pain pro- ceeds from a gouty humour affecting the head. When the head-ach is occasioned by great heat, hard labour or vio* lent exercise of any kind, it may be allayed by cooling medicines, as the saline draughts Avith nitre, and the like. A little aether, dropt into the palm of the hand, and applied to the fore*. head, will sometimes remove a violent head-ach. OF THE TOOTH-ACH. THIS disease is so well knoAvn, that it needs no description. It hag great affinity with the rheumatism, and often succeeds pains of the shoul- ders and other parts of the body. It may proceed from obstructed perspiration, or any of the other causes of inflammation. I have often knoAvn the tooth-ach occasioned by neg- lecting some part of the usual coverings of the head, by sitting Avith the head bare near an open AvindoAV, or exposing it to a draught of cold air. Food or drink taken either too hot or too cold is very hurtful to the teeth. Great quantities of sugar, or other siveetmeats, are likeAvise hurtful. No- thing is more destructive to the teeth than cracking nuts, or chewing any kind of hard substances; picking the teeth with pins, needles, or any thing that may hurt the enamel with which they are covered, does great mis- chief, as the tooth is sure to be spoiled whenever the air gets into it. Breeding women are very subject to the tooth-ach, especially during the first three or four months of pregnancy. The tooth-ach often pro- ceeds from scorbutic humours affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable de- gree of pain. The more immediate cause of the tooth-ach is a rotten or carious tooth. In order to relieve the tooth-ach, Ave must first endeavour to lessen * See Appendix, Decoction of Sarsaparilla. *■ When the pain is very violent, and does not yield to small doses of lauda- num, the quantity may be increased. I have known a patient in extreme pain, take three hundred drops in twenty-four hours; but such doses ought only to b*0 administered by a person of skill. 31 242 OF THE TOOTH-ACH. the flux of humours to the part affected. This may be done by miM purgatives, scarifying the gums; or applying leeches to them, and bath- ing the feet frequently Avith Avarm water. The perspiration ought like- wise to be promoted, by drinking freely of Aveak A\ine-whey, or other diluting liquors, Avith small doses of nitre. Vomits too have often an exceeding good effect in the tooth-ach. It is seldom safe to administer opiates, or any kind of heating medicines, or even to draAv a tooth, till proper evacuations have been premised; and these alone will often ef- fect the cure. If this fails, and the pain and inflammation still increase, a suppuration may be expected; to promote which a toasted fig should be held be- tween the gum and the cheek; bags filled Avith boiled camomile-flowers, flowers of elder, or the like may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm Water into his mouth, through an inverted fanuel, or by holding his head over the mouth of a porringer filled with warm water, Ac- Such things as promote the discharge of saliva, or cause the patient to spit, are generally of service. For this purpose, bitter, hot, or pungent vegetables may be chewed; as gentian, calamus arom&ticus, or pellitory of Spain. Allen recommends the root of yellow water flower-de-luce in this case. This root may either be rubbed upon the tooth, or a little of it cheAved. Brookes says he hardly ever knew it fail to ease the tooth-ach. It ought however to be used with caution. Many other herbs, roots, and seeds, are recommended for curing the tooth-ach; as the leaves or roots or millefoil or yarrow chewed, tobacco smoked or chewed, staves-acre, or the seeds of mustard chewed, Sic. These bitter, hot, and pungent things, by occasioning a greater flow of sa- liva, frequently give ease in the tooth-ach. Opiates often relieve the tooth-ach. For this purpose a little cotton wet with laudanum, may be held between the teeth; or a piece of stick- ing-plaster, about the bigness of a shilling, -with a bit of opium in the middle of it, of a size not to prevent the sticking of the other, may be laid on the temporal artery, where the pulsation is most sen- sible. De la Motte affirms, that there are few cases wherein this will not give relief. If there be a hollow tooth, a small pill made of equal parts of camphire and opium, put into the holloAV, is often beneficial When this cannot be had, the holloiv tooth may be filled with gum mas- tich, Avax, lead, or any substance that will stick in it, and keep out the external air. Few applications give more relief in the tooth-ach than blistering-plas- ters. These, may be applied between the shoulders; but they have the best effect when put behind tlie ears, and made so large as to cover a great part of the lower jatv. After all, when a tooth is carious, it is often impossible to remove •the pain without extractbig it; and, as a spoilt tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much practised by mechanics, as well as persons of the medical profession. The operation however is not without danger, and ought always to be performed with care. b. person unacquainted with the structure of the parts Avill be in dan- OF THE EAR-ACJ*. 248 ger of hurting the jaw-bone, or of drawing a sound jfooth instead of a rotten ooe.# When the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by the bark. Some pretend to have found great benefit in the tooth-ach, from the ap- plication of an artificial magnet to the affected tooth. We shall not at- tempt to account for its mode of operation; but, ff ft be found to answer, though only in particular cases, it certainly deserves a trial, as it is at- tended with no expense, and cannot do any harm. Electricity has like- wise been recommended, and particular instruments have been inveqted for sending a shock through the affected tooth. Persons who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times. Keeping the teeth clean has no doubt a tendency to prevent the tooth- ach. The best method of doing this is to wash them.daily with salt and water, a decoction of the bark, or with cold-water alone. All brushing and scraping of the teeth is dangerous, and, unless it be performed wtyl great care, does mischief. OF THE EAR-ACH. THIS disorder chiefly affects the membrane which lines the inner ca- vity of the ear, called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even delirium.—Sometimes epi- leptic fits, and other convulsive disorders, have been brought on by ex- treme pain in the ear. The ear-ach may proceed from any of the causes which produce in- flammation. It often proceeds from a sudden suppression of perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is generally reckoned a favourable symptom. When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soou as possible. The membranes may be relaxed, by dropping into the ear, oil of sweet almonds, or olive oil. Afterwards (he patient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil. When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening me- dicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of Avarm water; or flannel bags filled with boiled mallows and camomile-flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the ear, is to apply it close to the mouth of a jug filled with warm water, or a strong decoctionrf camomile-flowers. • This may always be prevented by the operatpr striking upon the teetii with any piece of metal, as this never fails to excite the pain in the carious tootii. 244 PAIN OF THE STOMACH, &.C The patient's feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter, three times a-day—His drink may be whey, or a decoction of barley and liquorice, with figs or raisins. The parts behind the ear ought frequently to be rubbed with camphor- ated oil, or a little of the volatile liniment. When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renew- ed, till the abscess breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blisters, or issues; but, the discharge must not be suddenly dried up by any external application. PAIN OF THE STOMACH, &c. THIS may proceed from various causes, as indigestion; wind; the acrimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likeAvise be occasioned by worms; the stop- page of customary evacuations; a translation of gouty matter to the sto- mach, the bowels, &c. Women in the decline of life are very liable to pains of the stomach and bowels, especially 6uch as are afflicted with hysteric complaints. It is likeAvise very common to hypochondriac men of a sedentary and luxuri- ous life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine. When the pain of the stomach is most violent after eating, there is rea- son to suspect that it proceeds from some fault, either in the digestion or the food. In this case the patient ought to change his diet, till he finds what kind of food agrees best with his stomach, and should continue chief- ly to use it. If a change of diet does not remove the complaint, the pa- tient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage. When a pain of the stomach proceeds from flatulency, the patient is constantly belching up Arind, and feels an uneasy distention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, &c. This rule however, admits of some exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched pease, though that grain is generally supposed to be of a windy nature.* This complaint may likewise be greatfy relieved by labour, especially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with, was in a person of a sedentary occupation, whom I advised, after he had tried every kind of medicine, to turn gar- dener ; which he did, and has ever since enjoyed good health. * These are prepared by steeping1 or soaking pease in water, and afterwards frying them in a pot or kiln, till they be quite hard. They may be usetl at pleasure. OF WORMSr 245 When a pain of the stomach is occasioned by the swallowing of acrid Or poisonous substances, they must be discharged by vomit; this may be excited by butter, oils, or other soft things, Avhich sheath and defend the stomach from the acrimony of its contents. When a pain of the stomach proceeds from a translation of gouty mat- ter, Avarm cordials are necessary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feeling the stomach warmed by it. It is impossible to ascertain the quantity necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however, is not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile-flowers, or carduus benedictus. If a pain of the stomach proceed from the stoppage of customary eva- cuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives; as rhubarb or senna. When this disease affects women in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service. When the disease is occasioned by Avorms, they must be destroyed, or expelled by such means as are recommended in the following section. When the stomach is greatly relaxed, and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or Avater twice or thrice a-day. Persons afflicted Avith flatulency are generally unhappy unless they be taking some purgative medicines; these, though they may give imme- diate ease, tend to weaken and relax the stomach and bowels, and conse- quently increase the disorder. Their best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and takeu in such quantity as to keep the body gently open. CHAP. XXXVII. OF WORMS. A HESE are chiefly of three kinds, viz. the taenia, or tape-worm; the teres, or round and long Avorm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from similar causes, have nearly the same symptoms, and require almost the same method of treat- ment as these already mentioned, we shall not spend time in enumerating them. The tape-Avorm is white, very long, and full of joints. It is generally bred either iu the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms, commonly lodge in the rectum, or Avhat is called (he end gut, and occasion a disagreeable itching about the seat. 246 OF WORMS. The long round Avorms occasion squeamishness, vomiting, a disagree- able breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convul- sions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the iutestines, and get into the cavity of the belly. The effects of the tape-worm are nearly the same with those of the long and round, but rather more violent. Audry says, the following symptoms particularly attend the solium, which is a species of the tape-worm, vis. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool. CAUSE.—Worms may proceed from various causes; but they are seldom found except in weak, aud relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active and laborious. Those Avho eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally subject to worms. There seems to be an hereditary disposition in some persons to this disease. I have often seen all the children of a family subject to worms of a parti- cular kind. They seem likewise frequently to be owing to the nurse. Children of the same family, nursed by one Avoman, have ofteu worms, when those nursed by another have none. SYMPTOMS.—The common symptoms of Avorms are paleness of the countenance, and at other times, an universal flushing of the face; itching of the nose; this however is doubtful, as children pick their noses in all diseases: starting, and grinding of the teeth in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious; looseness; a sour or stinking breath; a hard swelled belly; great thirst; the urine frothy, and sometimes of a Avhitish colour; griping, or colic pains; an involuntary discharge of saliva, especially Avhen asleep; fre- quent pains of the side, with a dry cough, and unequal pulse; palpita- tions of the heart; swoonings; cold sweats; palsy; epileptic fits, with many other unaccountable nervous symptoms, Avhich were formerly at- tributed to witch-craft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber seed are symptoms of the tape-Avorm. I lately saw some very surprising effects of worms in a girl about five years of age, who use to lie for whole hours as if dead. She at last expired, and upon opening her body, a number of the teres or long round worms, were found in her guts, vrhich were considerably inflamed; and Avhat anatomists call an intus susceptio, or involving of one part of the gut within another, had taken place in no less than four different parts of the intestinal canal.* * That worms exist in the human body there can be no doubt; and that they must sometimes be considered as a disease, is equally certain; but this is not the case so often as people imagine. The idea that worms occasion many dis- eases, give an opportunity to the professed worm doctors of imposing on the credulity of mankind, and doing much mischief. They find worm9 in every case, and liberally throw in their antidotes, which generally consist of strong drastic purges. I have known these given in delicate constitutions to the de- struction of the patient, where there was not the least symptom of worms. OF WORMS. 247 MEDICINE.—Though numberless medicines are extolled for ex- pelling and killing worms,* yet no disease more frequently baffles the physician's skill. In general, the most proper medicines for their ex- pulsion are strong purgatives; and to prevent their breeding, stomach bitters, with now and then a glass of good Avine. The best purge for an adult is jalap and calomel. Five and tAventy or thirty grains of the former with six or seven of the latter, mixed in syrup, may be taken early in the morning, for a dose. It will be proper that the patient keep the house all day, and drink nothing cold. The dose may be repeated once or twice a week for a fortnight or three weeks. On the intermediate days the patient may take a drachm of tlie powder of tin, twice or thrice a-day, mixed with syrup, honey, or treacle. Those who do not chuse to take calomel, may make use of the bitter purgatives ; as aloes, hiera picra, tincture of senna, and rhubarb, Sic. Oily medicines are sometimes found beneficial for expelling Avorms. An ounce of salad oil and a table spoonful of common salt may be taken in a glass of red port wine thrice a-day, or oftener, if the stomach will bear it. But the more common form of using oil is in clysters. Oily clysters sweetened Avith sugar or honey, are very efficacious in bringing away the short round worms called ascarides, and likewise the teres. The HarroAvgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, Ave may hence infer, that sulphur alone must be a good medicine in this case; which is found to be a fact. Many practitioners give flour of sulphur in very large doses, and with great success. It should be made into an elec- tuary with honey or treacle, and taken in such quantity as to purge the pa- tient. Where Harrowgate water cannot be obtained, sea Avater may be used, which is far from being a contemptible medicine in this case. If sea Ava- ter cannot be hail, common salt dissolved in water may be drank. I have often seen this used by country nurses with very good effect. Some flour of sulphur may be taken over night, and the salt water in the morning. But Avorms though expelled, will soon breed again, if the stomach re- mains weak and relaxed; to prevent Avhich, we Avould recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glass of red port wine three or four times a-day, after the above medicines have been used. Lime-water is likewise good for this purpose, or a ta- ble-spoonful of the chalybeate wine taken twice or thrice a-day. Infu- sions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water trefoil, camomile flowers, tops of Avormwood, the lesser centaury, &c. For a child of four or five years old, six grains of rhubarb, five of ja- lap, and two of calomel, may be mixed in a spoonful of syrup or honey, and given in the morning. The child should keep the house all daA> and take nothing cold. This dose may be repeated tArice a week for three or four weeks. On the intermediate days the child may take a scruple of powdered tin and ten grains of aehiops minenl in a spoonful of treacle tArice a-day. This do;e must be increased or diminished ac- cording to the age of the patient. * A medical writer of the present age has enumerated upwards of fifty Brit- ish plants, all celebrated for killing and expelling worms. 248 OF THE JAUNDICE. Bissct says, the great bastard black hellebore, or bear s'foot, is a most powerful vermifuge for the long rouud worms. He orders the decoction of about a drachm of the green leaves, or about fifteen grains of the dri- ed leaves in powder for a dose to a child between four and seven years of age. This dose is to be repeated tivo or three times. He adds, that the green leaves made into a syrup with coarse sugar, is almost the only medicine he has used for round Avorms for three years past. Before pres- sing out the juice he moistens the bruised leaves with vinegar, which cor- rects the meaicine. The dose is a tea-spoonful at bed time, and one or two next morning. I have frequently known those big bellies, which in children are com- monly reckoned a sign of worms, quite removed by giving them Avhite soap iu their pottage, or other food. Tausy, garlic, and rue, are all good against worms, and may be used various ways. AVe might here men- tion many other plants, both for external and internal use, as the cab- bage-bark, &c. but think the powder of tin with sethiops mineral, and the purees of the rhubarb and calomel, are more to be depended on. Ball's purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, scammony, and calomel, Avith a$ much double refined sugar as is equal to the weight of all the other ingredients. These must be Avell mixed together, and reduced to a fine poivder. The dose for a child is from ten grains to twenty, once or twice a week. Aa adult may take a drachm for a dose.* Parents who would preserve their children from worms ought to alio w- them plenty of exercise in the open air; to take care that their food be wholesome and sufficiently solid; and as far as possible, to prevent their eatin^ raiv herbs, roots, or green trashy fruits. It will not be amiss to al- low a^child Avho is subject to worms, a glass of red wine after meals; as every thing that braces and strenghens the stomach is good both for pre* venting and expelling these vermin.f CHAP. XXXVIII. OF THE JAUNDICE. THIS 'disease is first observable iu the white of tlie eye, which appears yellow. Afterwards the whole skin puts on a yellow appearance. The urine too is of a saffron hue, and dies a white cloth * A powder for the tape-worm resembling this, was long kept a secret oil the continent; it was lately purchased by the French king, and will be found under the article Powder in the Appendix. f We think it necessary here to warn people of their danger who buy cakes, powders, and other worm medicines, at random, from quacks and give them to their children without proper care. The principal ingredients in most of these medicines is mercury, which is never to be trifled with. I lately saw a shocking instance of the danger of this conduct. A girl who had taken a dose of worm powder, bought of a travelling quack, went out, and perhaps was so imprudent as to drink cold water during the operation. She immediately swel- led, and died on the following day with all the symptoms of having been pois- oned. OF THE JAUNDICE. 249 ol the same colour. There is likewise a species of this disease called the Black Jaundice. CAUSES.—The immediate cause of the jaundice is an obstruction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, Sic. the bilious or hysteric colic; violent passions, as grief, anger, Sic. Strong purges or vomits will likeAvise oc- casion the jaundice. Sometimes it proceeds from obstinate agues, or from that disease being prematurely stopped by astringent medicines* In infants it is often occasioned by the meconium not being sufficiently purged off. Pregnant women are very subject to it. It is likeAvise a symptom in several kinds of fever. Catching cold, or the stoppage of customary evacuations, as the menses, the bleeding piles, issues, Sic. will occasion the jaundice. SYMPTOMS.—The patient at first complains of excessive weari- ness, and has great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The stools are of a whitish or clay colour, and the urine, as was observed above, is yelloAV. The breathing is difficult, and the patient complains of an unusual load or oppression on his breast. There is a heat in bis nostrils, a bitter taste in the moiith, loathing of food, sickness pf the stomach, vomiting, flatulency, and other symptoms of indigos* tion. If the patieut be young, and the disease complicated Avith no other ma- lady, it is seldom dangerous; but in old people, w here it continues long,« returns frequently, or is complicated with the dropsy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dan- gerous than the yellow. REGIMEN.—The diet should be cool, light, and diluting, consisting chiefly of ripe fruits and mild vegetables; as apples boiled or roasted, stewed prunes, preserved plumbs, boiled spinnage, &c. Veal or chicken broth, Avith light bread, are likeAvise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be butter-milk, Avhey sweetened with honey, or decoctions of cool opening vegetables; or marsh-maHoAV roots, with liquorice, &c. The patient should take as much exercise as he can bear, either on horseback, or in a carriage; walking, running, aud even jumping, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this di- sease by a long journey, after medicines had proved ineffectual. Amusements are likewise of great use in the jaundice. The di- sease is often occasioned by a sedentary life, joined to a dull melan- choly disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have a good effect; as dancing, laughing, singinjr, S:c. MEDICINE.—-If the patient be young, of a full sanguine habit, and complains of pain in the right side about the region of the liver, bleeding will be necessary. After this a vomit must be administer- ed, and if the disease prove obstinate, it may he repeated once or twice. No medicines are more beneficial in the jaundice than vomits, especially where it is not ottended with inflammation. Half a drachm of ipecacuanha in powder, will be a sufficient dose for an adult. It may be wrought off with avc-j k ramomih tea, or lute-warm Avater. The body mwt 250 0!F THE DROPSY. likewise be kept open by a sufficient quantity of castile soap, or the pills for the jaundice recommended iu the Appendix. Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand or flesh-brush, are likewise beneficial; but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue it as long as his strength will permit. Many dirty things are recommended for the cure of the jaundice; as lice, millepedes, &c. But these do more harm than good, as people trust to them, and neglect more valuable medicines; besides they are seldom taken in sufficient quantity to produce any effects. People always ex- pect that such things should act as charms, and consequently seldom per- sists in the use of them. Vomits, purges, fomentations, and exer- cise Avill seldom fail to cure the jaundice Avhen it is a simple disease; and when complicated Avitli the dropsy,, a scirrhous liver, or other chronic complaints, it is hardly to be cured by any means. Numberless British herbs are extolled for the cure of this disease. Tlie author of the Medicina Britannica mentions near a hundred, all fa- mous for curing the jaundice. The fact is, the disease often goes off of its OAvn accord; in Avhich case the last medicine is ahvays said to have performed the cure. I have sometimes, however, seen considerable be- nefit, in a very obstinate jaundice, from a decoction of hempseed. Four ounces of the seed may be boiled in two English quarts of ale, and sweet- ened with coarse sugar. The doses is half an English pint every morn- ing. It may be continued for eight or nine days. I have likewise known Harrowgate sulphur water cure a jaundice of very long standing. It should be used for some weeks, and the patient must both drink and bathe. The solube tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning in a cup of tea or water-gruel. If it does not open the body, the dose may be in- creased. Persons subject to the jaundice ought to take as much exercise as pos- sible, and to avoid all heating and astringent aliments. CHAP. XXXIX. OF THE DROPSY. X HE dropsy is a preternatural swelling of the Avhole body, or some part of it occasioned by a collection of watery humour. It is distinguished by different names, according to the part affected, as the anasarca, or collection of water under the skin; the ascites,ov collection of water in the belly; the hydrops pectoris, or dropsy of the breast; the hydrocephalus, or dropsy of the brain, &c. CAUSES.—The dropsy is often OAving to an hereditary disposi- tion. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, that great drinkers die of the dropsy. The Avant of exercise is also a very common cause OF THE DROPSY. 251 of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evacuations, as frequent and copious bleeding, strong purges often repeated, frequent salivations, &c. The sudden stoppage of customary or necessaiy evacuations, as the menses, the haemorrhoids, fluxes of the belly, &c. may likewise cause a dropsy. I have known the dropsy occasioned by drinking large quantities of cold, weak, Avatery liquor, when the body was heated by violent exercise. A low, damp, or marshy situation is likeAvise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may a ho be brought on by a long use of poor watery diet, or of viscious aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, ascuvhu.- of the liver, a violent ague of long continuai.ee, a diarrhoea, dy- sentary, an empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepar- ed, may occasion a dropsy, SYMPTOMS.—The anasarca generally begins with a swelling of the feet and ancles towards night, which for some time disappears in the morning. In the evening the parts, if pressed with the finger, will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes diffi- cult, the urine is in small quantity, and the thirst great; the body is bound, and the perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow Avasting fever, aud a troublesome cough. This last is generally a fatal symptom, as it shews that the lungs are af- fected. In an ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany of the weight of the sAvelling, as Avell as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple asdtes seldom admits of a radical cure. Almost all that can be done is, to let off the Avater by tapping, Avhich seldom affords more than a temporary relief. When the disease comes suddenly on, and the patient is young and strong, there is reason, however, to hope for a cure, especially if medi- cine be given early. But if the patient be old, has led an irregular or se- dentary life, or if there be reason to suspect that the liver, lungs, or any of the viscera are unsound, there* is great reason to fear that the conse- quences will prove fatal. REGIMEN.—The patient must abstain as much as possible from all drink, especially weak and watery liquors, and must quench his thirst Avith mustard-Avhey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds, or o'her Avild animals roasted; puugent and aromatic vegetables, as garlic, mus- tard, onions, cresses, horse-radish, rocambole, shalot, Sic. He may also eat sea-biscuit dipt in wine or a little brandy. This is not only nourhhing, but tends to quench thirst. Some have b^en actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient 252 Of THE DROPSY. must have drink, the Spa-water, or Rhenish wine, with diuretic medi cines infused in it, are the best. Exercise is of the greatest importance in a dropsy. If the patient be1 able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he is not able to walk or labour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, aud the air of his apartments warm and dry. If he lives in a damp coun- try, he ought to be removed into a dry one, and, if possible, into a warmer climate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it lvill like- wise be proper to rub the patient's body tAvo or three times a-day, with a hard cloth, or the flesh-brush; and he ought constantly to wear flannel next his skin. MEDICINE.—If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong vo- mits, brisk purges, and such medicines as promote a discharge by sweat and urine. For an adult, half a drachm of ipecacuanha in powder, and h df au ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is necessaiy, three or four days intervening betAveen the doses. The patient must not drink much after taking the vomit, otherwise he destroys its effect. A cup or two of camomile-tea will be sufficient to work it off. Between each vomit, on one of the intermediate days, the patient: may' take the following purge: Jalap iu powder half a drachm, cream of tartar two drachms, calomel six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken broth. The patient may likewise take every night at bed-time, the following bolus •. To four or five grains of camphor add one grain of opium, and as much syrup of orange-peal as is sufficient to make them into a bolus. This Avill generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-Avhey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following di- uretic infusion may likewise be taken every four or five hours through the day, Take juniper berries, mustard-seed, and horse-radish, of each half an ouuce, ashes of broom, half a ponnd; infuse them in a quart of Rhenish wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of sencka-root, which is both diuretic and sudorific. I have knoAvn an obstinate ana- sarca cured by an infusion of the ashes of broom in wine. The above course will often cure an incidental dropsy, if the constitu- tion be good ; but when the disease proceeds from a bad habit, or an un- sound state of the viscera, strong purges and vomits are not to be ventured upon. In this case, the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the pa- tient's strength by Avarm and nourishing cordials. The secretion of urine may be greatly promoted by nitre. Brookes says, he knew a young woman Avho was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had OF THE DROPSY. 253 been given over as incurable. The powder of squills is likeAvise a good diuretic. Six or eight grains of it, Avith a scruple of nitre, may be given twice a-day in a glass of strong cinnamon-water. Ball says, a large spoonful of unbruued mustard-teed taken every night and morning, and drinking half an English pint of the decoction of the tops of greeu broom after it, has performed a cure alter other powerful medicines had proved ineffectual. I have sometimes seen good effects from cream of tartar in this dis- ease. 11 promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by ta- king an ounce every second or third day, and may increase the quantity to tivo or even to three ounces, if the stomach will bear it. This quan- tity is not hoy ever to be taken at once, but divided into three or four doses. To promote perspiration, the patient may use the decoction of seneka- root, as directed above; or he may take two table spoonsful of Minde- rerus' spirit in a cup of wine-whey Ihree or four times a-day. To pro- mote a discharge of urine, the following infusion of the London hospi- tals Avill likewise be beneficial: Take of zedoary-root two drachms; dried squills, rhubarb, and juni- per-berries bruised, of each a drachm; cinnamon iu powder, three drachms; salt of worm-wood, a drachm and a half; infuse in an English pint and a half of old hock wine, and when fit for use, filter the liquor. A wiue-glass of it may be taken three or four times a-day. In the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged; but the operator must be cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and proper digestives, to prevent a gangrene. In an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the Avater ought to be let off by tapping. This is a very simple aud safe operation, and would often suc- ceed, if it were performed in due time; but if it be delayed till the hu- mours are vitiated, or the boAvels spoiled, by long soaking in Avater, it can hardly be expected that any permanent relief will be procured.* After the evacuation of the Avater, the patieut is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in Avine, and such like. His diet ought to be dry and nourishing, such as is recom- mended in the beginning of the chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel next his skin, and make daily use of the flesh-brush. * The very name of an operation is dreadful to rifost people, and they wish to try every thing before they have recourse to it. This is the reason why tapping so seldom succeeds to our wish. I have had a patient who was regulai'ly tap- ped once a month for several years, and who used to eat her dinner as well after the operation, as if nothing had happened. She died at last rather worn out by age than by the disease. 254 CHAP. XL. OF THE GOUT. TlIERE is no disease which shews the imperfection of medicine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources from win nee it originally sprung, and all Avho would avoid it must be active and temperate. Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in thobe who are sub ect to it; as intense study ; too free an use of acidulated liquors ; night-watch- ing ; grief or uneasiness of mind; an obstiTiction or defect of any of the customary discharges, as the menses, sweating of the feet, per- spiration. Sic. SYMPTOMS.—A fit of the gout is generally preceded by indiges- tion, drowsiness, belching of wind, a slight head-ach, sickness, and some- times vomiting. The patient complains of Aveariness and dejection of spirits, snd has often a pain in the limbs, with a sensation as if wind or cold water were pat-sing down the thigh. The appetite is often remark- ably keen a day or two before the fit, and there is a slight pain in pass- ing urine, and frequently an involuntary shedding of tears. Sometimes these symptoms are much more violent, especially upon the near ap- proach of the fit; and it has been observed, that as is the fever which ushers in the gout, so will the fit be; if the fever be short and sharp, the fit will be so likewise; if it be feeble, long, and lingering, the fit will be such also. But this observation can only hold with respect to very re- gular fits of the gout. Te regular gout generally makes its attack in the spring or beginning of winter, in the following manner : About tAvo or three in the morning, the patient is seized with a pain in his great toe, sometimes in the heel, and at other times iu the ancle or calf of the leg. This pain is accom- panied with a sensation as if cold water were poured upon the part, which is succeeded by a shivering, Avith some degree of fever. Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the different kinds of torture, as if the part were stretched, burnt, squeezed, gnawed, or torn to pieces. The part at length becomes so exquisitely sensible, that the patient cannot bear to have it touched, or even suffer any person to walk across the room. The patient is generally in exquisite torture for twenty-four hours from 'be time of the coming on of the fit; he then becomes easier, the part begins to swell, appear red, aud is covered Avith a little moisture^ ToAvards morning he drops asleep, and- generally falls into a gentle breathing sweat. This terminates the first paroxysm, a number of which constitutes a fit of the gout; which is longer or shorter, according to the patient's age, strength, the season of the year, and the disposition of the body to this disease. The patent is always Avorse towards night, and esier in the morn- ing. The paroxysms however generally grow milder every day, till at length the disease is carried off by perspiration, urine aud the OF THE GOUT. 255 other evacuations. In some patients this happens in a few days; in others it requires weeks, and in some months, to fini&h the fit.—Those Avhom age and frequent fits of the gout have greatly debilitated, seldom get free from it before the approach of summer, and sometimes not till it be pretty far advanced. REGIMEN.—As there are no mediciues yet knoAvn that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit. In the fit if the patient be yotmg and strong, his diet ought to be thin and cooling, and h;s drink of a diluting nature; but when the constitu- tion is weak and the patient has been accustomed to live high, this is not a proper time to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiratioj without greatly heating the patient. It will answer this purpose better if a tea-spoonful of sal volatile oleosum, or spirits of hartshorn, be put in a cup of it twice a-day. It will likewise be proper to give at bed-time a tea-spooaful of the volatile tincture of guaiacum in a large draught of \\ arm wine-whey. This will greatly promote perspiration through the night. As the most safe and efficacious method of discharging the gouty mat- ter, is by perspiration, this ought to be kept up by all means, especially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fur, or wool. The last is most readily obtained, and seems to answ er the purpose better than any thing else. The people of Lancashire look upon wool as a kind of specific in the gout. They wrap a great quantity of it about the leg and foot affected, and cover it with a skin of soft dressed leather. This they suffer to continue for eight or ten days, and sometimes for a fortnight or three weeks, or longer, if the pain does not cease. I never knew any external application ans- wer so well in the gout. I have often seen it applied when the swelling and inflammation were very great, Avith violent pain, and have found all these symptoms relieved by it in a few days. The wool Avhich they use is generally greased, and carded or combed. They choose the soft- est Avhich can be had, and seldom or never remove it till the fit be entire* ly gone off. The patient ought likewise to be kept quiet and easy during the fit. Every thing that affects the mind disturbs the paroxysm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They do not cure the di- sease, but remove it from a safer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is to be considered as na- ture's method of removing something that might prove destructive to the body, and all that we can do with safety, is to promote her intentions, and to assist her in expelling the enemy in her own way. Evacuation by bleeding, stool, &c. are likewise to be used with caution, they do not remove the cause of the disease, and sometimes by Aveakeuing the pa- tient, proloug the fit; but where the constitution is able to bear it, it will be of use to keep the body gently open by diet, or very mild laxative medicines. Many thuigs will indeed shorten a fit of the gout, and some will drive it off altogether; but nothing has yet been found which will do this with .25$ OF THE GOUT. safety to the patient. In pain we eagerly grasp at any thing that pro- mises immediate ease, aud even hazard life itself for a temporary relief. This is the true reason Avhy so many infallible remedies have been pro- posed for the gout, and why such numbers have lost their lives by the use of them. It would be as prudent to stop the small-pox from rising, aud to drive them into the blood, as to attempt to repel the gouty matter after it has been thrown upon the exlremites. The latter is as much an effort of nature to free herself from an offending cause as the former, and ought equally to be promoted. When the pain however is very great, and the patient is restless, thir- ty or forty (hops of laudanum, more or less according to the violence ol the symptoms, may be taken at bed-time. This will ease the pain, pro- cure rest, promote perspiration, and forward the crisis of tiie disease'. After the fit is over the patient ought to take a gentle dose or two of the bitter tincture of rhubarb, or some other worm stomachic purge. He should also drink a weak infusion of stomachic bitters iu small wine or ale, as the Peruvian bark, with, cinnamon, Virginia snake-root, aud orange-peel. The diet at this time should be light but nourishing, and gentle exercise ought to be taken ou horseback, or in a carriage. Out of the fit, it is in the patient's power to do many things towards preventing a return of the disorder, or rendering the fit, if it should re- turn, Jess severe. Tins, however, is not to be attempted by medicine, I have frequently known the gout kept off for several years, by the Peru- vian bark and ©jthejr a&tringent medicines; but in all the cases w here I had occasion to see this tried, the persons died suddenly, and to all ap- pearance, for want cf a regular fit of tlie gout. One Avould be apt, from hence, to coqclude, that a fit of the gout to some constitutions, in the de- cline of life, is rather salutary than hurtful. Though it mav be dangerous to stop a fit of the gout by medicine, yet if the constitution can be so changed by diet and exercise, as to lessen or totally prevent its return, there certainly can be no danger in folknving such a course. It is well known that the whole habit may be so altered by a proper regimen, as quite to eradicate this disease; and those only Avho have sufficient resolution to persist in such a course have reason to expect a cure. The course which Ave would recommend for preventing the gout, is as folloAvs. In the first place, universal temperance. In the next place suf- ficient exercise*. By this Ave do not mean sauntering about in an indolent manner, but labour, sweat, and toil. These only can render the humours vvholesope, and keep them go. Going early to bed, and rising betimes, are also of great importance. It is likewise proper to avoid night studies and all intense thought. The supper should be light, and taken early. AH strong liquors, especially generous Avines and sour punch, are to be avoided. We would likeAvise recommend some doses of magnesia alba, aud rhubarb to be taken every spring and autumn; and afterv.ards a course of stomachic bitters, as tansy or water-trefoil tea, an infusion * Some make a secret of curing the gout by muscular exercise. This secret, however, is as old as Celsus, who strongly recommends that mode of cure ; and whoever will submit to it, in the fullest extent, may expect to reap solid and permanent advantages. OF THE GOUT. 257 »f gentian and camomile flowers, or a decoction of burdock root, &c. Any of these, or an infusion of any wholesome bitter that is more agree- able to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathiug and drinking the water. It both promotes digestion and invigo- rates the habit. Thouglj.there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the internal parts, proper applications to recal and fix it, become absolutely necessary. When the gout affects the head, the pain of the joints ceases, and the swelling disappears, while either severe head- ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing, ensue. If it attacks the stomach, extreme sickness, vomiting, anxiety, pain in the epigastric region, and total loss of strength will suc- ceed. When the gout attacks the head or lungs, every method must be taken to fix it in the feet. They must be frequently bathed in warm water, and acrid cataplasms applied to the soles. Blistering plasters ought likewise to be applied to the ancles or calves of the legs. Bleeding in the feet or aucles is also necessary, and warm stomachic purges. The pa- tient ought to keep in bed for the most part, if there be any signs of in- flammation, and should be very careful not to catch cold. If it attack the stomach with a sense of cold, the most warm cordials are necessary; as strong wine boiled up with cinnamon or other spices; cinnamon-water; peppermint-water; and even braudy or rum.* The patient should keep his bed, and endeavour to promote a sweat, by drink- ing warm liquors;, and if he should be troubled with a nausea, or incli- nation to vomit, he may drink camomile tea, or any thing that will make him vomit freely. When the gout attacks the kidneys, and imitates gravel-pains, the pa- tient ought to drink freely of a decoction of marsh-mallows, and to have the parts fomented Avith warm water. An emollient clyster ought like- wise to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoc- tion. Persons who have had the gout should be veiy attentive to any com- plaints that may happen to them about the time when they have reason to expect a return of the fit. The gout imitates many other disorders, and by being mistaken for them, and treated improperly, is often divert- ed from its regular course, to the great danger of the patient's life. Those Avho never had the gout, but Avho, from their constitution or manner of living, have reason to expect it, ought likewise to be very circumspect with regard to its first approach. If the disease, by Avrong conduct or improper medicines, be diverted from its regu- lar course, the miserable patient has a chance to be ever after tor- mented Avith heac]-aches, coughs, paius of the stomach and intestines^ * >£ther is found to be an efficacious remedy in this case- 33 35& OF THE RHEUMATISM. and to fall at last a victim to its attack upon some of the more noble parts.* OF THE RHEUMATISM. THIS disease has often a resemblance to the gout. It generally at- tacks the joints Avith exquisite pain, and is sometimes attended with in- flammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually distinguished into acute and chronic; or the rheumatism Avith or without a fever. CAUSES.—The causes of a rheumatism are frequently the same as those of an inflammatory fever, viz. an obstructed perspiration, the im- moderate use of strong liquors, and the like. Sudden changes of the wea- ther, and all quick transitions from heat to cold, are very apt to occa- sion the rheumatism. The most extraordinary case of a rheumatism that I ever saAV, where almost every joint of the body was distorted, was a man who used to work one part of the day by fire, and the other part of it in water. Very obstinate rheumatisms, have likewise been brought on by persons not accustomed to it, allowing their feet to continue long wet. The same effects are often produced by wet clothes, damp beds, sitting or lying on the damp ground, travelling in the night, «Src. The rheumatism may likewise be occasioned by excessive evacua- tions, or the stoppage of customary discharges. It is often the effect of chronic diseases, which vitiate the humours; as the scurvy, the lues ve- nerea, obstinate autumnal agues, &c. The rheumatism prevails in cold, damp, marshy countries. It is most common among the poorer sort of peasants, who are ill clothed, live in Ioav damp houses, and eat coarse and umvholesome food, which contains but little nourishment, and is not easily digested. SYMPTOMS.—The acute rheumatism commonly begius Avith wea- riness, shivering, a quick pulse, restlessness, thirst, and other symptoms of fever. Afterwards the patient complains of flying pains, Avhich are increased by the least motion. These at length fix in the joints, which are often affected with swelling and inflammation. If blood be let in this disease, it has generally the same appearance as in the pleurisy. In this kind of rheumatism the treatment of the patient is nearly the same as in an acute or inflammatory fever. If he be young and strong, bleeding is necessary, which may be repeated according to the exigencies of the case. The body ought likewise to be kept open by emollient clysteTB, or cool opening liquors; as decoctions of tamarinds, cream of tartar, A»hey, senna-tea, and the like. The diet should be light, and in small quantity, consisting chiefly of roasted apples, groat-gruel, or weak chic- ken broth. After the feverish symptoms have abated, if the pain still continues^ the patient must keep his bed, and take such things as promote perspiration, as wine-whey, with spiritus Mindereri, Sic. He may like- wise take, for a feAv nights, at bed-time, in a cup of wine-Avhey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder. Warm bathing, after proper evacuations, has often an exceeding •-*, A late'French writer (M. Cadet de Vaux) of some celebrity, fonthe cure of this disease prescribes forty-eight glasses of warm water in twelve hours, a glass every quarter, abstaining from every thing else during the time. This practice is already generally adopted in France. A. e . OF THE RHEUMATISM. 259 good effect. The patient may either be put iuto a bath of warm water, or have clotlis wrung out of it applied to the parts affected. Great care must be taken that he do not catch cold after bathing. The chronic rheumatism i* seldom attended with any considerable degree of fever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There is seldom any in- flammation or sAvelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients it often proves extremely obstinate and sometimes incurable. In this kind of rheumatism the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chiefly of vegetable sub- stances, as stewed prunes, coddled apples, currants or gooseberries boil- ed in milk, is most proper. Arbuthnot says, " If there be a specific in aliment for the rheumatism, it is certainly whey;" and adds, " That he knew a person subject to this disease, who could never be cured by any other method but a diet of whey and bread." He likewise says, " That cream of tartar in water gruel, taken for several days, will ease rheuma- tic pains considerably." This I have often experienced, but found it always more efficacious Avhen joined with gum guaiacum, as already di- rected.—In this case the patient may take the dose formerly mentioned, twice a-day, and likewise a tea-spoonful of the volatile tincture of gum guaiacum, at bed-time, in Aviue-whey. This course may be continued for a week, or longer, if the case proves obstinate, and the patient's strength will permit. It ought then to be. omitted for a few days, and repeated again. At the same time leeches, or a blistering-plaster may be applied to the part affected. What I have generally found ansAver better than either of these, in obstinate fixed rheumatic pains, is the warm plaster.* I have likewise known a plaster of Burgundy pitch worn for some time on the part affected, give great relief in rheumatic pains. My ingenious friend, Dr. Alexander, of Edin- burgh, says, he has frequently cured very obstinate rheumatic pains, by rubbing the part affected, with tincture of .cantharides. When the com- mon tincture did not succeed, he used it of a double or treble strength. Cupping upon the part affected, is likewise often very beneficial, and so is the application of leeches. Though this disease may not seem to yield to medicines for some time, yet they ought still to be persisted in. Persons who are subject to frequent returns of the rheumatism, will often find their account in using medicines, whether they be immediately affected with the disease or not. The chronic rheumatism is similar to the gout in this respect, that the most proper time for using medicines to extirpate it, is when the patient is most free from the disorder. To those who can afford the expense, I vrould recommend the warm baths of Buxton or Matlbck in Derbyshire. These have, often, to ray knowledge, cured very obstinate rheumatisms, and are always safe either in or out of the fit. When the rheumatism is complicated with scorbutic complaints, which is not seldom the case, the Harrowgate waters, and those of Moffat, are proper. They should both be drank and used as a warm bath. There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. * See Appendix, Warm Plaster. 260 OF THE SCURVY. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of Avater or small Avine. The watertrefoil is likewise of great use in this complaint. It may be infused iu wine or ale, or drank in form of tea. The ground-ivy, camomile, and several other bit- ters, are also beneficial, and may be used in the same manner. No benefit however is to be expected from these unless they be taken lor a considerable time. Excellent medicines are often despised in this disease, because they do not perform an immediate cure; whereas nothing would be more certain than their effect, were they duly persisted in. Want of perseverance in the use of medicines, is one reason why chronic diseases are so se.dom cured. Cold bathing, especially in salt water, often cures the rheumatism. We would also recommend riding on horseback, and wearing flannel next the skin. Issues are likewise very proper, especially in chronic cases. If the pain affects the shoulders, an issue may be made in the arm; but if it affects the loins, it should be put into the leg or thigh. Persons afflicted with the scurvy are very subject to rheumatic com- plaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or together, as the patient in- clines. An ounce of Peruvian bark, and half an ounce of rhubarb in powder, may be infused in a bottle of wine; and one, two, or three Aiine- glasses of it taken daily, as shall be found necessary for keeping the body gently open. In cases where the bark itself proves sufficiently purga- tive, the rhubarb may be omitted. Such as are subject to frequent attacks of the rheumatism, ought to make choice of a dry, warm situation, to avoid the night air, wet clothes, and wet fett, as much as possible. Their clothing should be Avarm, and they should wear flannel next their skin, and make frequent use of the flesh-brush. CHAP. XLI. OF THE SCURVY. THIS disease prevails chiefly in cold northern countries, espe> -dfally in low damp situations, near large marshes, or great quantities of stagnating water. Sedentary people, of a dull melancholy disposition, are most subject to it. It proves often fatal to sailors on long voyages, particularly in ships that are not properly ventilated, have many people on board, or where cleanliness is neglected. It is not necessary to mention the different speciesinto which this dis- ease has been divided, as they differ from one another chiefly in degree. What is called the land scurvy, hoivever, is seldom attended with those highly putrid symptoms which appear in patients who have been long at sea, and which, we presume, are rather owing to confined air, Avant of exercise, and the unwholesome food eaten by sailors on long voyages, than to any specific difference in the disease. CAUSES.—The scurvy is occasioned by cold moist air; by the long use of salted or smoke dried provisions, Or any kind of food that is hard of digestion, and affords little nourishment. It may al- so proceed from the suppression of customary evacuations; as the OF THE SCURVY. 261 menses, haemofrhoidal flux, Sic. It is sometimes OAving to an hereditary taint, in Avhich case a very small cause will excite the latent disorder. Grief, fear, and other depressing passions, have a great tendency both to excite and aggravate thi3 disease. The same observation holds Avith regard to neglect of cleanliness; bad clothing; the want of prober ex- ercise; confined air; unwholesome food; or any disease which greatly weakens the body, or vitiates the humours. SYMPTOMS.—This disease may be known by unusual weariness, heaviness; and difficulty of breathing, especially after motion; rotten- ness of the gums,Avhich are apt to bleed on the slightest touch; a stink- ing breath; frequent bleeding at the nose; crackling of the joints; diffi- culty of Avalking; sometimes a swelling and sometimes a fallihg away of A the legs, on which there are livid, yellow, or violet coloured spots; the face is generally of a pale leaden colour. As the disease advances, other symptoms come on; as rottenness of the teeth, haemorrhages or dis- charges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, especially about the breast, dry scaly eruptions all over the body, , or watery humour. Other parts of the body are likewise liable to is attack, as the arm-pits, groins, feet, hands, eyes, breasts, &c. JNor are the internal parts exempt from it. It often affects the lungs, liver, or * The scrophula, as well as the ricket9, is found to prevail in largre.ftan.ufac- hiring towns, where people live gross, and lead sedentary lives. -60* OF THE SCROPHULA, spleen; and I have frequently seen the glands of the myscntery greatly enlarged by it. Those obstinate ulcers whch break out upon the feet and hands with swelling, and little or no redness, are of the scrophulous kind. They sel- dom discharge good matter, and are exceedingly difficult to cure. The white swellings oi the joints seem likewise to be of this kind. They are with difficulty brought to a suppuration, and when opened, they only dis- charge a thin ichor. There is not a more general symptom of the scro- phula than a swelling of the upper lip and nose. REGIMEN.—As this disease proceeds, in a great measure, from re- laxation, the diet ought to be generous and nourishing, but at tlie same time light aud of easy digestion: as well fermented bread, made of sound grain, the flesh andbroth of young animals, with now and then a glass of generous wine, or good ale. The air ought to be open, dry and not too cold, aud the patient should take as much exercise as he can bear. This is of the utmost importance. Children who have sufficient exercise, are seldom troubled with tlie scrophula. MEDICINE.—The vulgar are remarkably credulous with regard to the cure of the scrophula; many of them believing in the virtue of the royal touch, that of the seventh son, &c. The truth is, we know but lit- tle either of the u:iture, or cure of this disease, aud where reason or me- dicines fail, superstition always comes in their place. Hence it is, that in diseases which are the most difficult to understand, Ave generally hear of the greatest number of miraculous cures being performed. Here, however, tlie deception is easily accounted for. The scrophula, at a certain period of life, often cures of itself; and if the patient happens to be touched about this time, the cure is imputed to the touch, and not to nature, avIio is re.ily the physician. In tlie same way the insignificant nostrums of quacks and old Avomen, often gain applause when they deserve7 none. There is nothing more pernicious than the custom of plying children in the scrophula ivith strong purgative* medicines. People imagine it pro- ceeds from humours which must be purged off, without considering that these purgatives increase the debility, and aggravate the disease. It has indeed been found, that keeping the body gently open for some time, especially with sea-tvater, has a good effect; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day. Bathiug in the salt-water has likeAvise a very good effect, especially in the ivarm season. I have often known a course of bathing in salt-water, and drinking it in such quantities as to keep the body gently open, cure a scrophula, after many other medicines had been tried in vain. When Balt water cannot be obtained, the patient may be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative. Next to cold bathing, and drinking the salt water, we would recon> mend the Peruvian bark. The cold bath may be used in summer and the bark in winter. To an adult half a drachm of the bark in powder "• may be given in a glass of red Avine, four or five times a-day. Children, ind such hs cannot take it in substance, may use the decoction, made in, >;»efc-IW.iigm'ii>';' t ©P THE ICTH. 265 Boil aa ounce of Peruvian bark, and a drachm of Winter's bark, both grossly powdered, in an English quart of water to a pint: toAvardsthe end, half an ounce of sliced liquorice-root, and a handful of raisins may be added, which will both render the decoction less disagreeable, and make it take up more of the bark. The liquor must be strained, and two, three or four table spoonsful, according to the age of the patient, given three times a day. The Moffat and Harrowgate waters, especially the lattel", are likewise very proper medicines in the scrophula. They ought not, hoAvever, to be drank in large quantities, but should be taken so as to keep the body gently open, and must be used for a considerable time. The hemlock may sometimes be used with advantage in the scrophula. Some lay it doAvu as a general rule, that the sea-water is most proper be- fore there are any suppuration or symptoms of tabes; the Peruvian bark, when there are running sores, and a degree of hectic fever; and the hem- lock in old inveterate cases, approaching to the scirrhous or cancerous state. Either the extract, or the fresh juice of this plant may be used. The dose must be small at first, aud increased gradually as far as the stomach is able to bear it. External applications are of little use. Before the tumour breaks no- thing ought to be appbed to it, unless a piece of flannel, or something to keep it warm. After it breaks, the sore may be dressed with some di- gestive ointment. What I have always found to answer best, Avas the yellow bisilicon mixed with about a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed Avith this twice a-day; and if it be very fungous, and does not digest well, a large pro- portion of the precipitate may be added. Medicines which mitigate this disease, though they do not cure it, are not to be despised. If the patient, can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get Avell; but if he does not recover at this time, in all probability he never will. . There is no malady Avhich parents are so apt to communicate to their offspring as the scrophula, for whxh reason people ought to beAvare of marrying into families affected with this disease. For the means of preventing the scrophula Ave must refer the reader to the observations on nursing at the beginning of the book. OF THE ITCH. THOUGH this disease is commonly communicated by infection, yet it seldom prevails Avhere due regard is paid to cleanliness, fresh air and Avholesome diet. It generally appears in form of small watery pustules, first about the Avrists or between the fingers; afterwards it affects the arms, legs, thighs, &c. These pustules are attended with an intolerable itching, especially when the patient is warm in bed, or sits by the fire. Sometimes indeed the skin is covered with large blotches or scabs, and at other times with a white scurf, or scaly eruption. This last is called the dry i'ch, and is the mo6t difficult to cure. The itch is seldom a dangerous disease, unless when it is rendered so by neglect or improper treatment. If it be suffered to continue too long, it may vitiate the whole mass of humours; and if it be suddenly drove in, 34 266 OF THE ITCH. without proper evacuations, it may occasion fevers, inflammations of the viscera, or other internal disorders. The best medicine yet known for the itch is sulphur, which ought to be used both externally and internally. The parts most affected may be rubbed with an ointment made of the flour of sulphur, two ounces; crude sal ammoniac fiuely powdered, two drachms; hog's lard, or butter, four ounces. If a scruple or half a drachm of the essence of lemon be added, it will entirely take aAvay the disagreeable smell. About the bulk of a nutmeg of this may be rubbed upon the extremities at bed-time twice or thrice a-week. It is seldom necessaiy to rub the whole body; but when it is, it ought not to be done all at once, but by turns, as it is dangerous to stop too many pore6 at the same time. Before the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewise be proper, during the use of it, to take every night and morning, as much of the flour of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catching cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment; and such clothes as have been worn while the patient was under the disease, are not to be used again, unless they have been fu- migated with brimstone, and thoroughly cleansed, otherwise they will com- municate the infection anew.* I never knew brimstone, when used as directed above, fail to cure the itch; and I have reason to believe, that if duly persisted in, it never will fail; but if it be only used once or twice, and cleanliness neglected, it is no wonder if the disorder returns. The quantity of ointment men- tioned above will generally be sufficient for the cure of one person; but if any symptoms of the disease should appear again, the medicine must be repeated. It is both more safe and efficacious when persisted in for a considerable time than when a large quantity is applied at once. As most people dislike the smell of sulphur, they may use in its place the pow der of white hellebore root made up into an ointment, in the same manner, which will seldom fail to cure the itch. People ought to be extremely cautious lest they take other eruptions for the itch; as the stoppage of these may be attended with fatal conse- quences. Many of the eruptive disorders to which children are liable, have a near resemblance to this disease; and I have often known infants killed by being rubbed with greasy ointments that make these eruptions strike suddenly in, which nature had thrown out to preserve the patient's life, or prevent some other malady. Much mischief is likewise done by the use of mercury in this di- sease. Some persons are so fool-hardy as to wash the parts affected with a strong solution of the corrosive sublimate. Others use the mercurial ointment, Avithout taken the least care either to avoid cold, keep the body open, or observe a proper regimen. The consequences * Sir John Pringle observes, that though this disease may seem trifling, there is no one in the army that is more troublesome to cure, as the infection often lurks in clothes &c. and breaks out a second, or even a third time. The same inconveniency occurs in private families, unless particular regard is paid to the changing or cjeamngofthcfr cloth es,wttdi last is byno means aneasy operation:. OF THE ASTHMA. 267 oi such conduct may be easily guessed. I have known even the mercuri- al girdles produce bad effects, and would advise every person, as he va- lues hin health, to beware how he uses them. Mercury ought never to be used as a medicine Avithout the greatest care. Ignorant people look upon these girdles as a kind of charm, without considering that the mer- cury enters the body. It is not to be told what mischief is done by using mercurial ointment for curing the itch and killing vermin; yet it is unnecessary for either: the former may be always more certainly cured by sulphur, and the lat- ter will never be found where due regard is paid to cleanliness. Those Avho would avoid this detestable disease ought to beware of in- fected persons, to use wholesome food, and to study universal cleanliness.* Chap. xlii. OF THE ASTHMA. THE asthma is a disease of the lungs, which seldom admifl of a cure. Persons in the decline of life are most liable to it. It is distinguished into the moist and dry, or hilmoural and nervous. The former is attended with expectoration or spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing. CAUSES.—The asthma is sometimes hereditary. It may likewise proceed from a bad formation of the breast; the fumes of metals or mine- rals taken into the lungs; violent exercise, especially running; the ob- struction of customary evacuations, as the menses, haemorrhoids, &c. the sudden retrocession of the gout, or striking in of eruptions, as the small- pox, measles, &c. violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that either impedes the circulation of the blood through the lungs, or prevents their being du- ly expanded by the air. SYMPTOMS.—An asthma is known by a quick laborious breath* ing, Avhich is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obli- ged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad iu thick foggy weather, or has got wet, or continued long in a damp place under ground, or has taken some food which the stomach could not digest, as pasteries, toasted cheese, or the like. * The itch is now by cleanliness banished from every genteel family in Bri- tain. It still however prevails among the poorer sorts of peasants in Scotland, and among the manufacturers in England. These are not only sufilcient to keep the seeds of the disease alive, but to spread the infection among others. It were to be wished that some effectual method could be devised for extirpa- ting it altogether. Several country clergymen have told me, that by getting such as were infected cured, and strongly recommending an attention to cleanliness, they have banished the itch entirely out of tfcolr parish**. Why might fjTV others do the eanu-. ' 268 OF THE ASTHMA. The paroxysm is commonly ushered in with listlessness, want of 9leep, hoarseness, a cough, belching of wind, a sen^e of heaviness about the breast, aud difficulty of breathii'g. To these succeed heat, fever, pain of the head, sickness and nausea, great oppression of the breast, palpita- tion of the heart, a weak, and sometimes intermitting pulse, an involunta- ry flow of tears, bilious vomitings, Sic. All the symptoms grow worse to- wards night; the patient is easier when up than in bed, aud is very de- sirous of cool air. REGIMEJV.—The food ought to be light, and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young ani- mals to that of old. All windy food, and Avhatever is apt to swell in the stomach, is to be avoided. Light puddings, Avhite broths, and ripe fruits baked, boiled, or roasted are proper. Strong liquors of all kinds, espe- cially malt-liquor, are hurtful. The patient should eat a very light sup- per, or rather none at all, and should never suffer himself to be long cos- tive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet Avarm, and promoting the perspiration, a flannel shirt or Avaistcoat, and thick shoes, will be of singular service. But nothing is of so great importance in the asthma, as pure and mode- rately warm air. Asthmatic people can seldom bear either the close heavy ah of a large town, or the sharp, keen atmosphere of a bleak hilly country; a medium therefore, between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed, breathe easier in towm than in the country ; but this is seldom the case, especially in towns where much coal is burnt. Asthma- tic persons who are obliged to be in toAvn all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it. ought to travel into a warmer climate. Many asthmatic per- sons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it pro- motes the digestion, preparation of the blood, Sic. The blood of asthma- tic persons is seldom duly prepared, oAring to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear. MEDICINE.—Almost all that can be done by medicine in this disease, is to relieve the patient when seized with a violent fit. This indeed re- quires the greatest expedition, as the disease often proves suddenly fatal. In the paroxysm or fit, the body is generally bound; a purging clyster, with a solution of asafoetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times. The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand or dry cloth. Bleeding, unless extreme weakness or old age should forbid it, is liighly proper. If there be a violent spasm about the breast or stomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected; and Avarm cataplasms to the soles of tlie feet. The patient must drink freely of dilu- ting liquors, and may take a tea-spoonful of the tincture of castor and of saffon mixed together, in a cup of valerian tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it OP THE APOPLEXY". 269 were from the jaws of death. This however will be more safe after other evacuations have been premised. A very Btrong infusion of roasted cof fee is said to give ease in an asthmatic proxysm. In the moist asthma, such things as promote expectoration or spitting, ought to be used; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup or oxymel-of squills, mixed with an equal quantity of cinnamon-Avater, may be taken three or four times through the day, and four or five pills made of equal parts of asafcetida and gum ammoniac, at bed-time.* For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a tea-spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this case. It may be taken in substance, or infused in wine. Iu short, every thing that braces the nerves, or takes off spasm, may be of use in a nervous asthma. It is often relieved by the use of asses milk; I have likeAvise known cow's milk drank warm in the morn- ing, have a very good effect in this case. In every species of asthma, setons and issues have a good effect; they may either be set in the back or side, and should never be allowed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient's life. CHAP. XLIII. OF THE APOPLEXY. jrHE apoplexy is a sudden loss of sense and motion, during Which the patient is to all appearance dead; the heart and lungs however still continue to move. Though this disease proves often fatal, yet it may be sometimes removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in winter, especially in rainy seasons, and very low states of the barometer. CAUSES.—The immediate cause of an apoplexy is a compression of the brain, occasioned by an excess of blood, or a collection of Avatery humours. The former is called a sanguine, and the latter a serous apo- plexy. It may be occasioned by any thing that increases the circula- tion towards the brain, or prevents the return of the blood from the head; as intense study; violent passions ;f viewing objects for a long time ob- • After copious evacuations, large doses of aether have been found very effica- cious in removing a fit of the asthma. I have likewise known the following mixture produce very happy efF. cts : To four or five ounces of the solution of gum-ammoniac, add two ounces of simple cinnamon-water, the same quantity of balsamic syrup, and half an ounce of paregoric elixir. Of this, two table- spoonsful may be taken every three hours. f I knew a woman, who in a violent fit of anger was seized with a sanguine apoplexy Slu at first complained of extreme pain, " as if dajrgers had been thrust through her head," as she expressed it. Afterwards she became coma- 270 . OF THE APOPLEXY. Kquely; wearing any thing too tight kbout the neck; a rich and luxu^ rious diet; suppression of urine; suffering tlie body to cool suddenly af- ter having been greatly heated; continuing long iu a warm or cold bath; f he excessive use of spiceries, or high seasoned food; excess of venery; the sudden striking iu of any eruption; suffering issues, setons, Sic. sud- denly to dry up, or the stoppage of any customary evacuation; a mercu- rial salivation pushed too far, or suddenly checked by cold; wounds or bruises on the head; long exposure to excessive cold; poisonous exha- lations, Sic. SYMPTOMS, and method of cure.—The usual forerunners of an apoplexy are giddiness, pain and swimming of the head; loss of memoiy; drowsiness, noise in the ears, the night mare, a spontaneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet aud opening medicines. Iu the sanguine apoplexy, if the patient does not die suddenly, the countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and temples, are turgid; the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting, In this species of apoplexy every method must be taken to lessen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be raised pretty high, and his feet suffered to hang down. His clothes ought to be loosened, espe- cially about the neck, and fresh air admitted into his chamber. His garters should be tied pretty tight, by which means the motion of the blood from the lower extremities will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours. A laxative clyster, Avith plenty of sweet oil, or fresh but- ter, and a spoonful or two of common salt in it, may be administered every two hours; and blistering plasters applied between the shoulders, and to the calves of the legs. As soon as the symptoms are a little abated, and the patient is able to swallow, he ought to drink freely of some diluting opening liquor, as a decoction of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glauber's salts, manna dissolved in an infusion of senna, or the like^ All spirits and other strong liquors are to be avoided. Even vola- tile salts held to the nose do mischief. Vomits, for the same reason, ought not to be given, or any thing that may increase the motion of the blood towards the head. In the serous apoplexy, the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breath- iug less difficult. Bleeding is not so necessary here as in the former case. It may, however, generally be performed once with safety and advantage, but should not be repeated. The patient should be tose, her pulse sunk very low, and was exceeding slow. By bleeding, blistering and other evacuations, she was kept alive for about a fortnight. When her head was opened, a large quantity of extravasUed blood was found in the left ventriete of fhe bruin. OF COSTIVENESS, &C. 271 placed in the same posture as directed above, and should have blis- tering-plasters applied, and receive opening clysters in the same man- ner. Purges here are likeAvise necessary, and the patient may drink strong balm-tea. If he be inclined to sweat, it ought to be promo- ted by drinking small wine-whey, or an infusion of carduus benedic- tus. A plentiful sweat kept up for a considerable time, has often carried off a serous apoplexy. Wheii the apoplectic symptoms proceed from opium, or other nar- cotic substances taken into the stomach, vomits are necessaiy. The patient is generally relieved as soon as he has discharged the poi- son in this way. Persons of apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, aud to avoid the extremes of heat and cold. The head should be shaved, and daily washed with cold Avater. The feet ought to be kept warm, and neATer suffered to continue long Avet. The body must be kept open either by food or medicine, and a little blood may be let eveiy spring and fall. Exercise should by no means be neglected; but it ought to be taken in moderation. Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons; great care hoAvever, must be taken, not to suffer them to dry up, without opening others in their stead.—Apoplectic persons ought never to go to rest with a full stomach, or to fie Avith their heads low, or to wear any thing too tight about their necks. CHAP. XLIV. OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS. We do not here mean to treat of those astrictions of the bowels, which are the symptoms of disease, as of the colic, the iliac passion, Sic. but only to take notice of that infrequency of stools Avhich sometimes happens, and which in some particular constitutions may occasion diseases. Costiveness may proceed from drinking rough red Avines, or other astringent liquors; too much exercise, especially on horseback. It may likewise proceed from a long u?e of cold insipid food, which does not sufficiently stimulate the intestines. Sometimes it is OAving to the bile not descending to the intestines, as in the jaundice; and at other times it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumours, a cold dry state of the intestines, Sic. Excessive costivenegs is apt to occasion paius of the head, vomit- ing, colics, and other complaints of the boAvels. It is peculiarly hurtful to hypochondriac and hysteric persons, as it generates wind and other grievous symptoms. Some people however, can bear cos- tiveness to a great degree. I knoAV persons who enjoy pretty good health, yet do not go to stool above once a Aveek, and others not above 272 OP COSTIVENESS, &c. once a fortnight. Indeed I have heard of some who do not go above once a mouth. Persons Avho are generally costive, should live upon a moistening and laxative diet, as roasted or boiled apples, pears, stewed prunes, raiins, gruels with currants, butter, honey, sugar, and ^uch like. Broths v.ith epinnage, leeks, aud other soft pot herbs, are likewise proper. Rye-bread, or that which is made of a mixture of Avheat and rye together, ought to be eaten. No person troubled with costive- ness, should eat white bread alone, especially that Avhich is made of fine flour. The best bread for keeping the body 'soluble, is what in some parts of England they call meslin. It is made of a mixture of wheat aud rye, and is very agreeable to those who are accustomed to it. Costiveness is increased by keeping the body too warm, and by every thing that promotes the perspiration; as wearing flannel, ly- ing too long a-bed, &x. Intense thought, and a sedentary life, are l.kewise hurtful. All the secretion and excretions are promoted by moderate exercise Avithout doors, and by a gay, cheerful, sprightly temper of mind. The drink should be of an opening quality. All ardent spirits, austere and astringent wines, as port, claret, Sic. ought to be avoided. Malt li- quor that is fine, and of a moderate strength, is very proper. But- ter-milk, Avhey, and other Avatery liquors, are likewise proper, and may be drank in turns, as the patient's inclination directs. Those Avho are troubled Avith costiveness, ought if possible to remedy it by diet, as the constant use of medicines for that purpose is attend- ed with many inconveniencies, and often with bad consequences.* I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time the custom becomes necessary, and generally ends in a total relaxation of the bowels, in- digestion, loss of appetite, Avasting of the strength, and death. When the body cannot be kept open without medicine, we would recommend gentle doses of rhubarb to be taken twice or thrice a-week. This is not near so injurious to the stomach as aloes, jalap, or the other drastic purgatives so much in use. Infusions of senna and man- na may likewise be taken, or half an ounce of soluble tartar dissolved • The learned Dr. Arbuthnot advises those who are troubled with costiveness to use animal oils, as fresh butter, cream, marrow, fat broths, especially those made of the internal parts of animals, as the liver, heart, midriff, &c. He like- wise recommends the expressed oils of mild vegetables, as olives, almonds, pas- taches, and the fruits themselves; all oily and mild fruits, as figs; decoctions of mealy vegetables; these lubricate the intestines; some saponaceous substances which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined sugar, &c. The Doctor observes, that such lenitive substances are proper for persons of dry atrabilarian constitutions, who are subject to astriction of the belly, and the piles, and will operate when stronger medicinal substances are sometimes inef- fectual ; but that such lenitive diet hurts those whose bowels are weak and lax. He likewise observes, that all watery substances are lenitive, and that even common water, whey, sour milk, and butter-milk have tliat effect: that new milk, especially asses' milk, stimulates still more when it sours on the stomach; and that whey turned sour, will purge strongly:—That most garden fruits are likewise laxative; and that some of them, as grapes, will throw such as take fehem immoderately into a cholera morbus, or incurable diarrhoea. WANT OF APPETITE.--THE HEART-BURN. 273 in water-gruel. About the size of a nutmeg of lenitive electuary, taken twice or thrice a-day generally answers the purpose Aery well. WANT OF APPETITE. THIS may proceed from a foul stomach; indigestion; the want of free air and exercise; grief; fear; anxiety; or any of the depressing passions; excessive heat; the use of strong broths, fat meats, or any thing that palls the appetite, or is hard of digestion; the immoderate use of strong liquors, tea, tobacco, opium, Sic. The patient ought, if possible, to make choice of an open dry air; to take exercise daily on horseback or in a carriage; to rise betimes; and to avoid all intense thought. He should use a diet of easy digestion; and should avoid excessive heat and great fatigue. If want of appetite proceeds from errors in diet, or any other part of the patient's regimen, it ought to be changed. If nausea and retchings shew that the stomach is loaded Avith crudities, a vomit will be of ser- vice. After this a gentle purge or tAvo of rhubarb, or any of the bitter purging salts, may be taken. The patient ought next to use some of the stomach'c bitters infused in wine- Though gentle evacuations be neces- sary, yet strong purges and vomits are to be avoided, as they weaken the stomach and hurt digestion. Elixir of vitriol is an excellent medicine in most cases of indigestion, weakness of the stomach, or Avant of appetite. From tiventy to thirty drops of it may be taken twice or thrice a-day in a glass of wine or water. It may likewise be mixed Avith the tincture of the bark, one drachm of the former to an ounce of the latter, and two tea-spoonsful of it taken in wine and wafer, as above. The chalybeate wafers, if drank in moderation, are generally of con- siderable service in this case. The salt-wat* r h«s likewise good effects; but it must not be used too freely. The waters of Harrowgate, Scarbo- rough, Moffat, and most other spas in Britain, may be used Avith advan- tage. We Avould advise all who are afflicted Avith indigestion and want of appetite, to repair to these places of pubhc rendezvous. The veiy change of air, and the cheerful company, Avill be of service, not to men- tion the exercise, amusements, &c. OF THE HEARTBURN. WHAT is commonly called the heart-burn, is not a disease of that organ, but an uneasy sensation of heat or acrimony, about the pit of the stomnch, Avhich is sometimes attended with anxety and vomiting. It may proceed from dpbility of the stomach, indigestion, bile, the abounding of an acid in the stomach, &c. Persons who are liable to this complaint, ought to avoid stale liquors, acids, Avindy or greasy aliments, and should never tiee violent exercise soon after a hearty meal. I knoAv many persons Avho never fail to have the heart-burn if they ride soon after dinner, provi led they have drank ale, wine, or any fermented li- quor: but are never uoulixl wi'h it when they have drank rum, or brandy and water, without any sugar or acid. When the heart-burn proceeds from debi'iy of the stomach, or indi- gestion, the patieut ought to take a dose or two of rhubarb; afterwards' 35 274 OF NERVOUS DISEASES. he may use infusions of the Peruvian bark; or any other of the stoma- chic bitters, in wine or brandy. Exercise in the open air will likewise be of use, and every thing that promotes digestion. W hen bilious humours occasion the heart-burn, a tea-spoonful of tlie sweet spirit of nitre in a glass of water, or a cup of tea, Avill generally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken. If acidity or sourness of the stomach occasions the heart-burn, absor- bents are the proper medicines. In this case an ounce of powdered chalk, half an ounce of fine sugar, and a quarter of an ounce of gum- arabic, may be mixed in a quart of water, and a tea-cupful of it taken as often as is necessary. Such as do not chuse chalk may take a tea- cupful of prepared oyster-shells, or of the powder called crabs-eyes, in a glass of cinnamon or peppermint water. But the safest and best absor- bent is magnesia alba. This not only acts as an absorbent, but likewise as a purgative ; whereas chalk and other absorbents of that kind, are apt to lie in the intestines, and occasion obstructions. This powder is not disagreeable, and may be taken in a cup of tea, or a glass of mint-water. A large tea-spoonful is the usual dose; but it may be taken in a much greater quantity when there is occasion. These things are noAV general- ly made up into lozenges for the couveniency of being carried in the pocket, and taken at pleasure. If wind be the cause of this complaint, the most proper medicines are those called carminatives; as aniseeds, juniper berries, ginger, canella alba, cardamom seeds, Sic. These may either be cheAved, or infused in wine, brandy or other spirits. One of the safest medicines of this kind is the tincture made by infusing an ounce of rhubarb, and a quarter of an ounce of the lesser cardamom seeds, in an English pint of brandy. After this has digested for two or three days, it ought to be strained, and four ounces of white sugar-candy added to it. It must stand to digest a second time till the sugar be dissolved. A table-spoonful of it may be taken occasionally for a dose. I have frequently known the heart-burn cured, particularly in preg- nant Avomen, by chewing green tea. Tavo table-spoonsful of what is called the milk of gum ammoniac, taken once or tAvice a-day Avill some- times cure the heart-bnrn. CHAP. XLV. OF NERVOUS DISEASES. OF ail diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imi- tate almost every disease; and are seldom alike in two different per- sons, or even the same person at different times. Proteus-like, they are continually changing shape; and upon every fresh attack, the pa- tient thinks he feels symptoms which he never experienced before.-— Nor do they only affect the body; the mind likeAvise suffers, and is thereby rendered Atcak and peevish. The low spirits, timorousnesg, Of NE&VOUS DISEASES. 275 melancholy and fickleness of temper, which generally attend nervous disorders, induce many to believe that they are enirely diseases of the mind; but this change of temper is rathei a consequence, than the cause of nervous diseases. CAUSES.—Eveiy thing that tends to relax or weaken the body, dis- poses it to nervous diseases, as indolence, excessive veue|y, driukiug too much tea or other weak Avatery liquors warm, frequefli bleeding, purg- ing, vomitiug, Sic. Whatever hurts the digestion, or prwents the proper assimilation of the food, has like wise this effect; as long fasting, excess in eating or drinking, the use of windy, crude or unwholesome aliments, an unfavourable posture of the body, Sic. Nervous disorders often proceed from intense application to study. In- deed few studious persons are entirely free from them. Nor is this at all to be Avoudered at; intense thinking not only preys upon the spirits, but prevents the person from taking proper exercise, by which means the di- gestion is impaired, the nourishment prevented, solids relaxed, and the Avhole mass of humours vitiated. Grief and disappointment likewise produce the same effects. I have known more nervous patients who dat- ed the commencement of their disorders from the loss of a husband, a favo- rite child, or from some disappointment in life, than fronhany other cause. In a word, whatever weakens the body, or depresses the spirits, may occa- sion nervous disorders, as unwholesome air, want of sleep, great fatigue, disagreeable apprehensions, anxiety, vexation, &c. SYMPTOMS.—We shall only mention some of the most general symptoms of these disorders, as it would be both an useless and an endless task to enumerate the whole. They generally begin Avith windy infla- tions or distensions of the stomach and intestines; the appetite and di- gestion are usually bad; yet sometimes there is an uncommon craving for food, and a quick digestion. The food often turns sour on the sto- mach; and the patient is troubled with vomiting of clear water, tough phlegm, or a blackish coloured liquor resembling the grounds of coffee. Excruciating pains are often felt about the naval, attended with a rumb- ling or murmuring noise in the bowels. The body is sometimes loose, but more commonly bound, which occasions a retention of wind and great uneasiness. The urine is sometimes in small quantity, at other times very copious and quite clear. There is a great straitness of the breast, with difficulty of breathing; violent palpitations of tlie heart; sudden flushings of heat in various parts of the body; at other times a sense of cold, as if water were poured on them; flying pains in the arms and limbs, pains in the back and belly, resembling those occasioned by the gravel; the pulse very variable, sometimes uncommonly slow, and at other times veiy quick ; yawning, the hickup, frequent sighing, and a sense of suffocation, as if from a ball or lump in the throat; alternate fits of crying and convulsive laughing; the sleep is unsound, and seldom refreshing; and the patient is often troubled with the night-mare. As the disease increases, the patient is molested with head-aches, cramps, and fixed pains in various parts of the body; the eyes are cloud- ed, and often affected with pain and dryness; there is a noise in the ear9, aud often a dulners of hearing; in short the Avhole animal functions are impaired. The mind is dfrtmbed on the moc* trivial occasions, and tf 276 OF NERVOUS DISEASES. hurried into the most perverse commotions, inquietude, terror, sadness, anger, dbiidcucc. Sic. The patient is apt to entertain wild imaginations aud extravagant faucies; the memory becomes weak and the judgment fails. Nothing is more characteristic of this disease than a constant dread of death. This readers those unhappy persons who labour under t peev- ish, fickle, impatient, and apt to run from one physician to another; which is one reason why they seldom reap any benefit from medicine, as they h.ve not sufficient resolution to persist in any one course till it has time to produce its proper effects. They are likewise apt to imagine that they labour under diseases from which they are quite free; and are very angry if any one attempts to set them right, or laugh them out of their ridiculous notions. REGIMEN.—Persons afflicted Avith nervous diseases ought never to fast long. Their food should be solid and, nourishing, but of easy di- gestion. Fat meats and heavy sauces are hurtful. All excess should br carefully avoided. They ought never to eat more at a time than they can easily digest; but if they feel themselves weak and faint between meals, they ought to eat a bit of bread, aud drink a glass of Avine. Hea- vy suppers are to be avoided. Though Avine in excess enfeebles the bo- dy, and impairs the faculties of tlie mind, yet taken in moderation it strengthens the stomach, and promotes digestion. Wine and water is a Very proper drink at meals; but if wine sours on the stomach, or the pa- tient is much troubled with wind, brandy and water will answer better. Every thing that is windy or hard of digestion must be avoided. All weak and Avarm liquors are hurtful, as tea, coffee, punch, &e. People may find a temporary relief in the use of these, but they always in- crease the malady as they weaken the stomach, and hint digestion. Above all things, drams are to be avoided. Whatever immediate case the patient may feel from the use of ardent spirits, they are sure to ag- gravate the malady, and prove certain poisons at last. These cautions are the more necessaiy; as most nervous people are peculiarly fond of tea and ardent spirits, to the use of which many of them fall victims. Exercise in nervous disorders is superior to all medicines. Riding on horseback is generally esteemed the best, as it gives motion to the Avhole body Avithout fatiguing it. I have known some patients, hoAvever, with Avhom walking agreed better, and others who were most benefitted by- riding in a carriage. Every one ought to use that Avhich he finds most beneficial. Long sea voyages have an excellent effect; and to those who have sufficient resolution, we Avould by all means recommend this course. Even change of place, and the sight of new objects, by divert- ing the mind, have a great tendency to remove these complaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journies near home. A cool and dry air is proper, as it braces aud invigorates the whole body. Few things tend more to relax and enervate than hot ah, especially that which is rendered so by great fires, or stoves in small apartments. But when the stomach or bowels are weak, tlie body ought to be Avell guarded against cold, especially in winter, by- wearing a thin flannel waistcoat next the skin. This will keep up an equal perspiration, and defend the alimentary canal from many im- pressions to which it would otherwise be subject, upon every sudden change from warm to cold Aveather. Rubbing the body frequently' OF MELANCHOLY. 277 with a flesh-brush, or a coase linen cloth, is likewise beneficial, as it promotes the circulation, perspiration, &c. Persons avIio have weak nerves ought to rise early, and take exercise before breakfast, as lying too long a-bed cannot fail to relax the solids. They ought likewise to be diverted, and to be kept as easy aud cheerful as possible. There is not any thing Avhich hurts the nervous system, or weakens the digestive powers more than fear, grief or anxiety. MEDICINES.—Though nervous diseases are seldom radically cured, vet the symptoms may sometimes be alleviated, and the patient's fife rendered at least more comfortable by proper medicines. When the patient is cctive, he ought to take a little rhubarb, or some other mild purgative, and should never suffer his body to be long bound. All strong and violent purgatives are hoAvever to be avoided, as aloes, jalap, &c. I have generally seen an infusion of senna and rhubarb in brandy, ansAver very well. This may be made of any strength, and ta- ken in such quantity as the patient finds necessary. When digestion is bad or the stomach relaxed and weak, the following infusion of Peruvi- an bark and other bitters may be used with advantage : Take of Peruvian bark an ounce, gentian-root, orange-peel, and cori- ander seed, of eacli half au ounce; let these ingredients be all bruised in a morter, and infused in a bottle of trandy or rum, for the space of five or six days. A table-spoonful of the strained liquor may be taken in half a glass of Avater, an hour before breakfast, dinner and supper. Few things tend more to strengthen the nervous system than cold bathing. This practice, if duly persisted in, Avill produce very ex- traordinary effects; but Avhen the liver or other viscera are obstructed, or otherwise unsound the cold bath is improper. It is therefore to be used with very great caution. The mott proper seasons for it are summer and autumn. It Avill be sufficient, especially for persons of a spare habit, to go into the cold bath three or four times a-Aveek. If the patient be weakened by it, or feels chilly for a long time after coming out, it is improper. In patient's afflicted Avith Avind, I have always observed the greatest benefit from the elixir cf vitriol. It may be taken in the quantity of fifteen, twenty or thirty drops, twice or thrice a-day, in a glass of Ava- ter. This both expels wind, strengthens the stomach, and promotes di- gestion. Opiates are generally extolled in these maladies; but as they only palliate the symptoms and generally afterwards increases the disease, we would advise people to be extremely sparing in tlie use of them lest ha- bit render them at last absolutely necessaiy. It would be an easy matter to enumerate many medicines which have been extolled for relieving nervous disorder; but Avhoever Avishes for a thorough cure, must expect it from regimen alone; Ave shall therefore omit mentioning more medicines, and again recommend the strictest at- tention to DIET, AIR, EXERCISE, and AMUSEMENT. OF MELANCHOLY. MELANCHOLY is that state of alienation or Aveakness of mind, which lenders people incapable of enjoying the pleasures, or performing the duties of life. It is a degree of insanity, and often termiuates in ab- solute madnr*-. 278 OF MELANCHOLY. CAUSES.—It may proceed from an hereditary disposition; intense thinking, especially where the mind is long occupied by one object; vi- olent passions or affections of the mind, as love, fear, joy, grief, pride, and such like. It may also be occasioned by excessive veueiy, narcotic or stupefactive poisons; a sedentary life; solitude; the suppression of customary evacuations; acute fevers or other diseases. Violent anger Avill change melancholy into madness; and excessive cold, especially of the loAver extremities, will force the blood into the brain, and produce all the symptoms of madness. It may likewise proceed, from the use of ali- ment tliat is hard of digestion, or Avhich cannot be easily assimilated, from i* callous state of the integuments of the brain, or a dryness of the brain it- self. To all which we may add gloomy and mistaken notions of religion. SYMPTOMS.—When persons begin to be melancholy they are ti- morous; Avatchful; fond of solitude; fretful; fickle; captious and in- quisitive; solicitous about trifles; sometimes niggardly, and at other times prodigal. The body is generally bound, the urine thin, and in small quantity; the stomach and boivels inflated Avith wiud; the com- plexion pale; the pulse slow and weak. The functions of the mind are also greatly perverted, iusomuch that the patient often imagines himself dead, or changed into some other animal. Some have imagined their bodies were made of glass, or other brittle substances, and Avere afraid to move, lest they should be broken to pieces. The unhappy patient, in this case, unless carefully watched, is apt to put an end to his own mise- rable life. When tlie disease is owing to an obstruction of customary evacuations, or any bodily disorder, it is easier cured than Avhen it proceeds from af- fections of the mind, or an hereditary taint. A discharge of blood from the nose, looseness, scabby eruptions, the bleeding piles, or the menses, sometimes carry off this disease. REGIMEN.—The diet should consist chiefly of vegetables of a cool- ing and opening quality. Animal food, especially salted or smoke-dried fish or flesh, ought to be avoided. All kinds of shell-fish are bad. ,Ali- ments prepared with onions, garlic, or any thing that generates thick blood, are likewise improper. All kinds of fruits that are Avholesome may be eaten with advantage. Boerliaave gives an instance of a pa- tient who, by a long use of Avhey, Avater, and garden-fruit, recoAered, af- ter having evacuated a great quantity of black coloured matter. Strong liquors of every kind ought to be avoided as poison. The most proper drink is water, whey, or very small beer. Tea and coffee are improper. If honey agrees Avith the patient, it may be eaten freely or his drink may be sweetened with it. Infusions of balm-leaves, penny- royal, the roots of wild valerian, or the flowers of the lime-tree, may be drank freely, either by themselves, or sAveetened with honey, as the pa- tient shall chuse. The patient ought to take as much exercise as he can bear. This helps to dissolve the viscid humours, it removes obstructions, pro- motes the perspiration, and all the other secretions. Every kind of madness is attended Avith a diminished perspiration; all means ought therefore to be used to promote that necessary and salutary dis- charge. Nothing can have a more direct tendency to increase the disease than confining the patient to a close apartment. Were he forced to ride or walk a certain number of miles every day, it would OF MELANCHOLY. 279 tend greatly to alleviate his disorder; but it would have still a better effect, if he were obliged to labour a piece of ground. By digging, hoeing, planting, sowing, Sic. both the body and mind Avouid be ex- ert ised. A long journey, or a voyage, especially towards a warmer cli- mate, with agreeable companions, have often very happy effects. A plan of this kind, with a strict attention to diet, is a much more rational method of cure, than confining the patient within doors and plying him Avith me- dicines--. MEDICINE.—In the cure of this disease particular attention must be paid to the miud. When the patient is in a Ioav state, Iris mind ought to be soothed and diverted with variety of amusements, as entertaining sto- ries, pastimes, music, Sic. This seems to have been the method of curing melancholy among the Jews, as Ave learu from the story of King Saul; and indeed it is a very rational one. Nothing can remove diseases of the mind so effectually as applications to the mind itself, the most efficacious of which is music. The patient's company ought likewise to consist of such persons as are agreeable to him. People in this state are apt to con- ceive unaccountable aversions against particular persons; and the very sight of such persons is sufficient to distract their minds, and throw them into the utmost perturbation. When the patient's strength is high, or the pulse admits of it, eva- cuations are necessary. In this case he must be bled, and have his body kept open by purging medicines, as manna, rhubarb, cream of tartar, or the soluble tartar. I have seen the last have very happy effects. It may be taken in the dose of half an ounce, dissolved in water- gruel, every day, for several Aveeks, or even for months, if necessary. More or less may be given according as it operates. Vomits have like- Avise a good effect; but they must be pretty strong, otherwise they Avill not operate. Whatever increases the evacuation of urine or promotes perspiration, has a tendency to remove this disease. Both these secretions may be promoted by the use of nitre and vinegar. Haifa drachm of purified ni- tre may be given three or four times a-day, in any manner that is most agreeable to the patient; and an ounce and an half of distilled vinegar may be daily mixed with his drink. Dr. Locker seems to think vinegar the best medicine that can be given in this disease. Camphire and musk have likeAvise been used in this case with advan- tage. Ten or tivelve grains of camphire may be rubbed in a mortar, with half a drachm of nitre, and taken twice a-day, or oftener, if the stomach will bear it. If it will not sit upon the stomach in this form, it may be made into pills with gum asafcetida and Russian castor, and taken in the quantity above directed. If musk is to be administered, a scruple or twenty-five grains of it may be made into a bolus Avith a little honey or common syrup, and taken tArice or thrice a-day. We do not mean that all these medicines should be administered at once; but which ever of them is given, must be duly persisted iu, and Avhere one fails another may be fried. As it is very difficult to induce patients in this disease to take me- dicines, Ave shall mention a few outward applications Avhich some- times do good; the principal of these are issues, setons, and warm bathing. Issues may be made in any part of the body, but they ge- nerally have the best effect near the spine. The discharge from these 280 OF THE PALSY. may be greatly promoted by dressing them Avith tlie mild blistering ointment, and keeping Avhat are commonly called the orrice peH!-e in them. The most proper place for « eeton is betAveeu the shoulder-blades : and it ought to be placed upwards and doAvnwards, or in the direction of the spine. OF THE PALSY. * THE palsy is a loss or dimunitioa of sense or motion, or of both in one or more parts of the body. Of all the affections called nervous, this is the most suddenly fatal. It is more or less dangerous, according to the im- portance of the part affected. A palsy of the heart, lungs, or any part necessary to life, is mortal. When it affects the stomach, the intestines, or the bladder, it is highly dangerous. II the face be affected, the case is bad, as it shews that the disease proceeds from the brain. When the part affected feels cold, is insensible, or Avastes away, or when the judgment aud memory begin to fail, there is small hope of a cure. CAUSES.—The immediate cause of palsy is any thing that prevents the regular exertion of the nervous power upon any particular muscle or part of the body. The occasional and predisposing causes are various, as drunkenness; wounds of the brain, or spinal marrow; pressure upon the brain, or nerves; very cold or damp air; the suppression of custom- ary evacuations; suiden fear; want of exercise; or ivhatever greatly relaxes the system, as drinking much tea*, or coffee. The palsy nny likeAvise proceed from wounds of the nerves themselves, from the poison- ous fumes of metals or minerals, as mercury, lead, arsenic. In young persons of a full habit, the palsy must be treated in the same manner as the sanguine apoplexy. The patient must be bled, blistered, and have his body opened by sharp clysters or purgative medicines. But in old age, or when the disease proceeds from relaxation or debility, Avhich is geuerally the case, a quite contrary course must be pursued. The diet must be warm a id invigorating, seasoned with spicy and aromatic vegeta- bles, as mustard, horse-radish, &c. The drink may be generous Avine, mustard, whey, or brandy and water. Friction with the flesh brush or a Avarm hand, i;i extremely proper, especially on the parts affected. Blis- tering-plasters may likewise be applied to the affected parts with advan- tage. When this cannot be done, they may be rubbed with the volatile liniment, or the nerve ointment of the Edinburgh dispensatory. One of the best external applications is electricity. The shocks, or rather vi- brations, should be received on the part affected, and they ought daily to be repeated for several Aveeks. Vomits are very beneficial in this kind of palsy, and ought fre- quently to be administered. Cephalic snuff, or any thing that makes * Many people imagine that tea has no tendency to hurt the nerves, and that drinking the same quantity of warm water would be equally pernicious. This however seems to be a mistake. Many persons drink three or four cups of warm milk and water daily, without feeling any bad consequences ; yet the same quantity of tea will make their hands shake for twenty-four hours That tea affects the nerves, is likewise evident from its preventing sleep, occasioning giddiness, dimness of the sight, sickness, &o. OF THE EPILEPSY, &C. 281 the patient sneeze, is likewise of use. Some pretend to have found great benefit from rubbing the parts affected with nettles; but this does not seem to be any way preferable to blistering. If the tongue is affected-, the patient may gargle his mouth frequently with brandy and mustard; or he may hold a bit of sugar iu his mouth wet Avith the palsy drops or compound spirits of lavender. The wild valerian-root is a very proper medicine in this case. It may either be taken in an infusion with sage leaves, or half a drachm of it in powder may be given in a glass of wine three or four times a-day. If the patient cannot use the valerian, he may take of sal volatile oleosum, compound spirits of lavender, and tinc- ture of castor, each half an ounce; mix these together, and take forty or fifty drops in a glass of wine, three or four times a-day. A table- spoonful of mustard-seed taken frequently is a very good medicine. The patient ought likewise to cheAv cinnamon, bark, ginger, or other warm spiceries. Exercise is of the utmost importance in the palsy; but the patient must beware of cold, damp, and moist air. He ought to Avear flannel next his skin; and if possible, should remove into a warmer climate. OF THE EPILEPSY, OR FALLING SICKNESS. THE epilepsy is a sudden deprivation of the senses, Avberein the pas Iicnt falls suddenly down, and is affected with violent convulsive motions. Children, especially those avIio are delicately brought up, are most sub- ject to it. It more frequently attacks men than women, and is very dif- ficult to cure. When the epilepsy attacks children, there is reason to hope it may go off about the time of puberty. When it attacks any person after twenty years of age, the cure is diffi- cult; but when after forty, a cure is hardly to be expected. If the fit continues only for a small space, and returns seldom, there is reason to hope; but if it continues long, and returns frequently, the prospect is bad. It is a very unfavourable symptom Avhen tlie patient is seized with thfc fits in his sleep. CAUSES.—The epilepsy is sometimes hereditary. It may likewise proceed from blows, bruises, or wounds on the head; a collection of wa- ter, blood, or serous humours in the brain; a polypus; tumours or con- cretions within the skull; excessive drinking; intense study; excess of veneiy; worms; teething; suppression of customary evacuations; too great emptiness or repletion; violent passions or affections of the mind-, as fear, joy, &c. hysteric affections; contagion received into the body, as the infection of the small-pox, measles, Sic. SYMPTOMS.—An epileptic fit is generally preceded by unusual weariness; pain of the head; duluess; giddiness; noise in tlie ears; dim- ness ofsight; palpitation of the heart; disturbed sleep; difficult breathing; the bowels are inflated with wind; the urine is in great quantity, but thin» the complexion is pale; the extremities are cold; and the patient oftet: feels, as it Avere, a stream of cold air ascending towards his head. In the fit, the patient generally makes an unusual noise; his thumbs are drawn in towards the palms of tlie hand; his eyes are distorted; he starts, and foams at the mouth; his extremities are bent or twined various ways ; he often discharges his seed, urine, and faeces involuntarily; and is quite destitute of all sense aud reason. After the fit is over, his screes r.o 282 OF TIIE EPILEPSY, &X. gradually return, and he complains of a kind of stupor, weariness, and pain of his head; but has no remembrance of vhat happened to him during the fit. The fits are sometimes excited by violent affections of the mind, a debauch of liquor, excessive heat, cold, or the like. This disease, from the difficulty of investigating its causes, and Us strange symptoms, was formerly attributed to the wrath of the gods, or the agency of evil spirits. In modern tunes it has often, by the vulgar, been imputed to witchcraft or fascination. It depends, however, as much upon natural causes as any other malady; and its cure may often be ef- fected by persisting in the use of proper means. REGIMEN.—Epileptic patients ought, if possible, to breathe a pure and free air. Then* diet should be light but nourishing. » They ought to drink nothing strong, to avoid say ine's flesh, Avater-fowl, and likewise all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves cheerful, carefully guarding against all violent passions, as anger, fear, excessive joy, and the like. Exercise is likewise of great use; but the patient must be careful to avoid all extremes either of heat or cold, all dangerous situations, as standing upon precipices, riding, deep waters, and such like. MEDICINE.—The intentions of cure must vary according to the cause of the disease. If the patient be of a sanguine temperament, and there be reason to fear an obstruction in the brain, bleeding and other evacuations will be necessary. When the disease is occasioned by the stoppage of customary evacuations, these, if possible, must be restored; if this cannot be done, others may be substituted in their place. Issues or setons in this case have often a vrery good effect. When there is rea- son to believe that the disease proceeds from worms, proper medicines must be used to kill, or carry off these vermin. When the disease pro> ceeds from teething, the body should be kept open by emollient clysters, the feet frequently bathed in warm water, and if the fits prove obstinate, a blistering-plaster may be put between the shoulders. The same method is to be followed, when epileptic fits precede the eruption of the small- pox, or measles, &c. ' When the disease is hereditary, or proceeds from a wrong formation of the brain, a cure is not to be expected. When it is owing to a debili- ty, or too great an irritability of tlie nervous system, such medicines as tend to br tee and strengthen the nerves may be used, as the Peruvian bark, and steel; or the anti-epileptic electuaries, recommended by Fuller and Mead.* The flowers of zinc have of late been highly extolled for the cure of the epilepsy. Though this medicine will not be found to answer the ex- pectations which have been raised concerning it, yet in obstinate epileptic cases it deserves a trial. The dose is from one to three or four grains, Avhich may be taken either in pills or a bolus, as the patient inclines. The best method is to begin with a single grain four or five times a-day, and «radually to increase the dose as far as the patient can bear it. I haverknowu this medicine, when duly persisted in, prove beneficial. Musk has sometimes been found to succeed in the epilepsy. Ten or twelve grains of it, with the same quantity of factitious cinnabar, may be made up into a bolus, aud taken every night and morning. * See Appendix, Electuary for the Epilepsy. OF THE HICKUP. 283 Sometimes the epilepsy has been cured by electricity. Convulsion-fits proceed from the same cause, and must be treated in the same manner as the epilepsy. There is one particular species of convulsion-fits which commonly goes by the name of St. Vitus's dance, wherein the patient is agitated with strange motions and gesticulations, which by the common people are gen- erally believred to be the effects of witchcraft. This disease may be cured by repeated bleedings and purges; and afterwards using the medicines prescribed above for the epilepsy, viz. the Peruvian bark aud triiake root, &c. Chalybeate-Avaters are found to be beneficial in this case. The cold bath is likewise of singular service, aud ought never to be neglected Avhen the patient can bear it. OF THE HICKUP. THE hickup is a spasmodic or convulsive affection of the stomach and midriff, arising from any cause that irritates their nervous fibres. It may proceed from excess in eating or drinking; from a hurt of the stomach; poisons; inflammations or scirrhous tumours ol the stomach, in- testines, bladder, midriff, or the rest of the viscera. In gangrenes, acute and malignant fevers, a hickup is often the forerunner of death. When the hickup proceeds from the u-e of aliment that is flatulent, or hard of digestion, a draught of ge erous wine, or a dram of any spirituous liquor, Avill generally remove it. If poison be the cause, plenty of milk and oil must be drank, as has been formerly recommended. When it pro- ceeds from an inflammation of the stomach, Sic. it is very dangerous. In this case the cooling regimen ought to be strictly observed. The patient must be bled, and take frequently a few drops of the spirits of nitre in a cup of wine. His stomach should likewise be fomented with cloths dip- ped in warm water, or have bladders filled with warm milk and water ap- plied to it. When the hickup proceeds from a gangrene or mortification, the Peru- vian bark, with other antiseptics, are the only medicines which have a chance to succeed. When it is a primary disease, and proceeds from a foul stomach, loaded either with a pituitous or a bilious humour, a gentle vomit and purge, if the patient be able to bear them, will be of service. If it arises from flatulencies, the carminative medicines directed for the heart-burn must be used. When the hickup proves very obstinate, recourse must be had to the most powerful aromatic aud antispasmodic medicines. The principal of these is musk; fifteen or twenty grains of Avhich may be made into a bo- lus, and repeated occasionally. Opiates are likewise of service; but they must be used Avith caution. A bit of sugar dipped in compound spirits of lavender, or the volatile aromatic tincture, may be taken frequently. External applications are sometimes also beneficial; as the stomach plas- ter, or a cataplasm of the Venice treacle of the Edinburgh or London uL pensatory, applied to the region of the stomach. I lately attended a patient who had almost a constant hickup for above nine weeks. It was frequently stopped by the use of musk, opium, wine, and other cordial and antispasmodic medicines, but al- ways returned. Nothing however gave the patient so much ease as 284 CRAMP OF THE STOMACH, &C. brisk small beer. By drinking freely of this the hickup was often kept off for several days, which was more than could be done by the most pow- erful medicines. The patieut was at length seized with a vomiting of blood, which soon put an end to his life. Upon opening the body a large scirrhous tumour was found near the pylorus or right orifice of the sto- maThe hickup may be removed by taking vinegar; or by a few drops ol the oil of vitriol taken in water. CRAMP OF THE STOMACH. THIS disease often seizes people suddenly, is very dangerous, and re- quires immediate assistance. It is most incident to persons in the decline of life, especially the nervous, gouty, hysteric, aud hypochondriac. If the patient has any inclination to vomit, he ought to take some draughts of Avarm Avater, or weak camomile tea, to cleanse his stomach. After5 this, if he has been costive, a laxative clyster may be given. He ought then to take laudanum. The best way of administering it, is in a clyster. Sixty or seventy drops of liquid laudanum may be given in a clys- ter of warm water. This is much more certain than laudanum given by tlie mouth, which is often vomited, and in some cases increases the pain and spasms in the stomach. If the pains and cramps return with great violence, after the effects of the anodyne clyster are over, another, with an equal or larger quantity of opium, may be given; and every four or five hours a bolus, with ten or twelve grains of musk, and half a drachm of the Venice treacle. In the mean time the stomach ought to be fomented with cloths dipped in warm water, or bladders filled with warm milk and water should be ap- plied to it. I have often seen these produce the mosfhappy effects. The anodyne balsam may also be rubbed on the part affected; and an anti- hysteric plaster worn upon it for some time after the cramps are removed, to prevent their return. Iu very violent and lasting pains of the stomach, some blood ought to be let, unless the weakness of the patient forbids it. When the pains or cramps proceeds from a suppression of the menses, bleeding is of use. If they be owing to the gout, recourse must be had to spirits, or some of the warm cordial waters. Blistering-plasters ought likewise in this case to be applied to the ancles. I have often seen violent cramps and pains of the stomach removed by covering it with a large plaster qf Venice treacle. OF THE NIGHT-MARE. In this disease the patient, in time of sleep, imagines he feels an un- common oppression or weight about his breast or stomach, which he can by no means sliakc^ it*. He groans and sometimes cries out, though oft- ener he attempts to S[-eak iu vain. Sometimes he imagines himself enga- ged Avith an enemy, and in danger of being lulled, attempts to run away, but finds he cannot. Sometimes he fancies himself in a house that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dashed to pieces sud-. denly awakes him. OF SWOONINGS. 285 This disorder has been supposed to proceed from too much blood; from a stagnation of blood in the brain, lungs, Sic. But it is rather a nervous affection, and arises chiefly from indigestion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the night-mare. Nothing tends more to produce it than heavy suppers, especially when eaten late, or the pa- tient goes to bed soon after. Wind is likewise a very frequent cause of this disease; for Avhich reason those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that op- presses the mind, ought also to be avoided. As persons afflicted with the night-mare generally moan, or make some noise in the fit, they should be waked, or spoken to by such as hear them, as the uneasiness generally goes off as soon as the patient is awake. Dr. Whytt says, he generally fouud a dram of brandy, taken at bed-time, prevent this disease. That however is a bad custom, and in time loses its effects. We would rather have the patient depend upon the use of food of easy digestion, cheerfulness, exercise through the day, and a light supper taken early, than to accustom himself to drams. A glass of peppermint water will often promote digestion as much as a glass of brandy, and is much safer. After a person of weak digestion, however, has eaten flatulent food, a dram may be necessary. Persons who are young and full of blood, if troubled with the night- mare, ought to take a purge frequently, and use a spare diet. OF SWOONINGS. PEOPLE of Aveak nerves or delicate constitutions are liable to SAVoonings or fainting-fits. These indeed are seldom dangerous when duly attended to; but when wholly neglected, or improperly treated, they ofteu prove hurtful, and sometimes fatal. The general causes of swoonings are, sudden transition from cold to heat; breathing air that is deprived of its proper spring or elasticity; great fatigue; excessive weakness; loss of blood; long fasting; fearj grief, and other violent passions or affections of the mind. It is Avell known, that persons who have been long exposed to cold often faint or fall into a swoon, upon coming into the house, especially if they drink hot liquor, or sit near a large fire. This might easily be prevented by people taking care not to go into a warm room immediately after they have been exposed to the cold air, to approach the fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature. When any one, in consequence of neglecting these precautions, falls into a SAVoon, he ought immediately to be remoAred to a cooler apartment, to have ligatures applied above his knees and elbows, and to have his hands and face sprinkled with vinegar or cold Avater. He should like-r wise be made to smell to vinegar, and should have a spoonful or tAvo of water, if he can sAvallow, with about a third part of vinegar mixed with it, poured into his mouth. If these should not remove the complaint, it will be necessary to bleed the patieut, aud afterwards to give him a clys- ter. As air that is breathed frequently loses its elasticity or spring, it is no wonder if persons who respire in it often fall into a swoon or faiuting fit. 286 OF FLATULENCIES, OR WIND. They are in this case deprived of the very principle of life. Hence it is that fainting fits are so frequent in all croAvded assemblies, especially in hot seasons. Such fits, however, must be considered as a kind of tem- porary death ; and to the weak aud delicate they sometimes prove fatal. They oujdit therefore with the utmost care be guarded against. The method of doing this is obvious. Let assembly rooms, and all other places of public resort be large and well ventilated; and let the weak and delicate avoid such places, particularly in Avarm seasons. A person who faints, in such a situation, ought immediately to be car- ried into the open air; his temples should be rubbed with strong vinegar or brandy, aud volatile spirits of salts held to his nose. He should be laid upon his back with his head Ioav, and have a httle wine or some other cordial, as soon as he is able to swallow it, poured into his mouth. If the person has been subject to hysteric fit.-, castor or asafcetida should be applied to the nose, or burnt feathers, horn, or leather, &c. When fainting fits proceed from mere Aveakness or exhaustion, which is often the case after great fatigue, long fasting, loss of blood or the like, the patient must be supported with'generous cordials, as jellies, wines, spirituous liquors, &c. These however must be given at first in very small quantities, and increased gradually as the patient is able to bear them. He ought to be allowed to lie quite still and easy upon his back, with his head low, and should have fresh air admitted into his chamber. His food should consist of nourishing broths, sago-gruel, with wine-new milk, and other things of a light and cordial nature. These things are to be given out of the fit. All that can be done i:i the fit, is to let him smell to a bottle of Hungary-water, eau de luce, or spirits of hartshorn, and to rub his temples with warm brandy, or to lay a compress dipped in it to the pit of the stomach. In fainting fits that proceed from fear, grief, or other violent passions or affections of the mind, the patient mu>t be very cautiously managed. He should be suffered to remain at rest, and only made to smell some vinegar. After he is come to himself he may drink freely of Avarm lemonade, or balm-tea, Avith some orange or lemon peel in it. It will likewise be pro- per, if the fainting fits have been long and severe, to clean the boAvcls by throwing in an emollient clyster. It is common in fainting fits, from whatever cause they proceed, to bleed the patient. This practice may be very proper in strong persons, of a full habit; but in those who are weak and delicate, or subject to nervous disorders, it is dangerous. The proper method with such people is, to expose them to the free air, and to use cordial and stimulating medicines, as volatile, salts, Hungary-water, spirits of lavender, tincture of castor, and the like. OF FLATULENCIES, OR WIND. All nervous patients, without exception, are afflicted with wind or flatulencies in the stomach and bowels, which arise chiefly from the want of tone or vigour in these organs. Crude flatulent aliment, as green peas, beans, coleworts, cabbages, and such like, may in- crease this complaint; but strong and healthy people are seldom OF FLATULENCIES, OR WIND. 287 troubled Avith Avind, unless they either overload their stomachs, or drink liquors that are in a fermenting state, and consequently full of elastic air. While therefore the matter of flatulence proceeds from our aliments, the cause which makes air separate from them in such quantity as to occasion complaints, is almost always a fault of the boAvels themselves, which are too Aveak either to prevent the production of elastic air, or to expel it af- ter it is produced. To relieve this complaint, such medicines ought to be used as have a tendency to expel wind, and by strengthening the alimentary canal, to prevent its being produced tliere.* The list of medicines for expelling wind is veiy numerous; they often however disappoint the expectations of both the physician and his patient The most celebrated among the class of carminatives are juniper berries; the root of ginger and zedoary ; the seeds of anise, caraway, aud corian- der; gum asafcetida and opium ; the warm Avaters, tiuctures, and spirits, as the aromatic water, the tinctures of woodsoot, the volatile aromatic spirit, aether, &c. Dr. Whytt says, he found no medicines more efficacious in expelling wind than aether and laudanum. He generally gave the laudanum in a mixture with peppermint-water and tincture of castor, or SAveet spirits of nitre. Sometimes in place of this, he gave opium iu pills with asafcetida. He observes that the good effects of opiates are equally conspicuous, whether the flatulence be continued in the stomach or intestines; where- as those Avarm medicines, commonly called carminatives, do not often give immediate relief, except when the Avind is in the stomach. With regard to aether, the Doctor says, he has often seen very good ef- fects from it in flatulent complaints, where other medicines failed. The dose is a tea-spoonful, mixed with two table-spoonsfol of Avater.f In gouty cases he observes, that aether, a glass of French brandy, or of the aromatic Avater, or ginger, either taken in substance or infused in boiling water, are among the best medicines for expelling wind. When the case of flatulent patients is such as makes it improper to give them Avarm medicines inwardly, the Doctor recommends external applications, which are sometimes of advantage. Equal parts of the an- ti-hysteric aud stomach plaster may be spread upon a piece of soft leather, of such size as to cover the greater part of the belly. This should be kept on for a considerable time,provided the patient be able to bear it; if it should give great uneasiness it may be taken off, and the folloAving liniment used in its stead : Take of Bate's anodyne balsam, an ounce; of the expressed oil of mace, half au ounce; oil of mint, tivo drachms. Let these ingredients be mixed together, and about a tablerspoonful well rubbed on the parts at bed-time. For strengthening the stomach and bowels, and consequently for less- ening the production of flatulence, the Doctor recommends the Peruvian . * Many nervous people find great benefit from eating a dry biscuit, especially when the stomach is empty. I look upon this as one of the best carminative medicines; and would recommend it in all complaints of the stomach, arising; from flatulence, indigestion, &c. ■(• Though the patient may begin with this quantity, it will be necessary to in- crease the dose gradually as the stomach can bear it. >Ether is now given in considerably gicitcr doses tlian it was in Dr. Whytt's time. 288 OF LOW SF1RI1S. bark, bitters, chalybeates, and exercise. In flatulent ca^es, be thinks some nutmeg or ginger should be added to the tincture of the bark and bitters, and that the aromatic powder should be joined with the filings of iron. When windy complaints are attended with costiveness, Avhich is often the case, few things Avill be found to answer better than four or five of the following pills taken every night at bed-time : Take of asafcetida tAvo drachms; succotrine aloes, salt of iron, and poivdered gmger, of each, one drachm; as much of the elixir proprietors as will be sufficient to form them into pills. On the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm or two scruples of the Japonic confection, given every other evening, will have very good effects. In those flatulent complaints Avhich come on about the time the menses cease, repeated small bleedings often give more relief than any other re- medy. With regard to diet the Doctor observes, that tea, and likeAvise all fla- tulent aliments, are to be avoided; and that for drink, water with a lit- tle brandy or rum, is not only preferable to malt liquor, but in most cases also to wine. As Dr. Whytt has paid great attention to this subject, and as his senti- ments upon it in a great measure agree Avith mine, I have taken the li- berty to adopt them; and shall only add to his observations, that exer- cise is in my opinion superior to all medicine, both for preATenting the production, and likeAvise for expelling of flatulencies. These effects however are not to be expected from sauntering about, or lolling in a carriage; but from labour or such active amusements as give exercise to every part of tlie body. OF LOW SPIRITS. ALL who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise, and amusements, are the most likely means to remove this complaint. It is greatly in- creased by solitude and indulging gloomy ideas, but may often be re- lieved by cheerful company and sprightly amusements. When low spirits are owing to a Aveak relaxed state of the stomach and bowels, an infusion of Peruvian bark with cinnamon or nutmeg will be proper. Steel joined with aromatics may likewise in this case be used with advantage; but riding and a proper diet are most to be dependedon. When they arise from foulness of the stomach and intestines, or obstruc- tions in the hypochondriac viscera, aloetic purges Avill be proper. I have sometimes knoAvn the Harrowgate sulphur-Avater of service in this case. When low spirits proceed from a suppression of the menstrual or of the haemorrhoidal flux, these evacuations may either be restored or some other substituted in their place, as issues, setons or the like. Dr. VVhytt observes, that nothing has such sudden good effects in this case as bleed- ing. When Ioav spirits have been brought on by long continued grief, anxic- ty, or other distress of mind, agreeable company, variety of amusements, and change of place, especially travelling into foreign countries, will af- ford the most certain relief. OF HYSTERIC AFFECTIONS. 2-89 Persons afflicted with low spirits should avoid all kinds of excess, es- pecially of veneiy and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful; but when taken to excess they weaken the stomach, vitiate the humours, and depress the spirits. This caution is the more necessary, as the unfortunate and melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction. OF HYSTERIC AFFECTIONS. THESE likewise belong to the numerous tribe of nervous diseases, which may be justly reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose ner- vous system is extremely sensible, are most subject to hysteric complaints. Iu such persons an hysteric fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid hu- mour, or the like. A sudden suppression of the menses often give rise to hysteric fits. They may likewise be excited by violent passions or affections of the miud, as fear, grief, anger, or great disappointments. Sometimes the hysteric fit resembles a swoon or fainting fit, during which the patient lies as in a sleep, only tlie breathing is so Ioav as scarce to be perceived. At other times the patient is affected with catchings and strong convulsions. The symptoms which precede hysteric fits are likewise various in different persons. Sometimes the fits come on with coldness of the extremities, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is fere- told by a feeling, as if there were a ball at the lower part of the belly, Avhich gradually rises towards the stomach, where it occasions inflation' sickness, and sometimes vomiting; afterwards it rises into the gullet, and occasions a degree of suffocation, to which quick breathing, palpitation of the heart, giddiness of the head, dimness of the sight, loss of hearing with convulsive motions of the extremities and other parts of the body, > succeed. The hysteric paroxysm is often introduced by an immoderate fit of laughter, and sometimes it goes off by crying. Indeed there is not much difference between the laughing and crying of an highly hysteric lady. Our aim in the treatment of this disease, must be to shorten the fit or paroxysm when present, aud to prevent its return. The longer the fits continue, and the more frequently they return, the disease becomes the more obstinate. Their strength is increased by habit, and they induce so great a relaxation of the system, that it is with difficulty removed. It is customary during the hysteric fit or paroxysm, to bleed the pa- tient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper; but in weak and delicate constitutions, or Avherethe disease has been of long standing, or arises from inanition, it is not safe. The best course in such case is to rouse the patient by strong smells, as burnt feathers, asafcetida, or spirits of hartshorn, held to the nose. Hot bricks may also be applied to the soles of the feet, and the legs, arms and belly may be strongly rubbed with a warm cloth. But the best applica- tion is to put the feet and legs into warm water. This is peculiarly pro- per when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafcetida will be proper; and as soon as the pa- 290 OF HYSTERIC AFFECTIONS. tient can swallow, two table-spoonsful of a solution of asafcetida, or ol some cordial julep, may be given.* The radical cure ol this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly promoted by a proper attention to diet. A milk and vegetable diet, Avhen duly persist- ed in, will often perforin a cure. If however the patient has been ac- customed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most proper drink is water with a small quantity of spirits. A cool diy air is the best. Cold bathing, and every thing that braces the nerves and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the greatest importance to have the mind kept constantly easy and cheerful, and, if possible, to have it always engaged in some agreeable and interesting pursuit. The proper medicines are those which strengthen the alimentary canal and the Avhole nervous system, as the preparations of iron, the Peruvian bark and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken tAvice or thrice a-day. The bark and iron may likewise be taken in substance, provided the stomach can bear them; but they are generally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder. If the stomach is loaded with phlegm, vomits will be of use; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there be a tendency to costiveness, it must be removed either by diet, or by taking an opening pill as often as it shall be found necessary. To lessen the irritability of the system, antispasmodic medicines Avill be of use. The best antispasmodic medicines are musk, opium, and cas- tor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is of en successful in removing those periodical head-achs to which hysteric and hypochondriac patients arc subject. Castor has in some cases been found to procure rieep where opium failed; for Avhich reason, Dr. Whytt advises, that they should be joined together. He likewise recommends the anti-hysteric plaster to be applied to the abdomen.j Hysteric Avomen are often afflicted Avith cramps, in various parts ol the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plas- ters, and Avarm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in Avarm water, or apply- ing a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly * When hysteric fits are occasioned by sympathy, they may be cured by ex- citing an opposite passion. This is said to have been tlie case of a whole school of young ladies in Holland, who were all cured by being told, that the first who was seized should be burnt to death. But this method of cure, to my knowledge, will not always succeed. I would therefore advise, that young ladies who are subject to hysteric fits should not be sent to boarding-schools, as the disease may be caught by imitation. I have known madness itself brought on by sympathy. f Though antispasmodics and anodynes are universally recommended in thy* disease, yet all the extraordinary cures that I ever knew in hysteric cases, were performed by means of tonic and corroborating medicines. OF HYPOCHONDRIAC AFFECTIONS. 291 delicate and sensible, it will be better to omit the blistering-plaster, and- to attempt the cure by opiates, musk, camphire, and the warm bath. Cramps are often prevented or cured by compression. Thus cramps in the legs are prevented, and sometimes removed, by tight bandages; and Avhen convulsions arise from a flatulent distention of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong compression upon the abdomen by means of a broad belt. A roll of brimstone held in the hand is frequently used as a reme- dy for cramps. Though this seems to owe its effects chiefly to imagina- tion, yet, as it sometimes succeeds, it merits a trial.* When spasms or convulsive motions arise from sharp humours in the stomach or intestines, no lasting relief can be procured till these are either corrected or expel- led. Tlie Peruvian bark has sometimes cured periodic convulsions after other medicines had failed. OF HYPOCHONDRIAC AFFECTIONS. THIS disease generally attacks the indolent, the luxurious, the unfor- tunate, and the studious. It becomes daily more common in this coun- try, owing, no doubt, to the increase of luxury and sedentaiy employ- ments. It has so near a resemblance to the immediately preceding, that many authors consider them as the same disease, and treat them accord- ingly. They require however, a very different regimen; and the symp- toms of the latter, though less violent, are more permanent than those of the former. Men of a melancholy temperament, Avhose minds are capable of great attention, and whose passions are not easily moved, are in the advanced periods of life, most liable to this disease. It is usually brought ou by long and serious atteution to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous erup- tions, long continued evacuations, obstruction iu some of the viscera, as the liver, spleen, &c. Hypochondriac persons ought never to fast long, and their food should be solid and nourishing. All ascescent and windy vegetables are to be avoided. Flesh meats agree best Avith them, and their drink should be old claret, or good madeira. Should these disagree with the stomach, Avater with a little brandy or rum in it may be drank. Cheerfulness and serenity of mind are by all means to be cultivated. Exercise of every kind is useful. The cold bath is likewise beneficial; and where it does not agree with the patient, frictions with the flesh-brush or a coarse cloth may be tried. If the patient has it in his power, he ought to travel either by sea or land. A voyage or a long Journey, espe- cially towards a warmer climate, will be of more service than any medi- cine. The general intentions of cure in this disease, are to strengthen the ali- mentary canal, and to promote the secretions. These intentions will be bes-* answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations, may be taken in the same manner as directed in the preceding disease. If the patient be costive, it will be necessary to make use of some * Some persons afflicted with cramps pretend to reap great benefit from small bundles of rosemary tied all night about their feet, ancles, and knees. 292 OF HYPOCHONDRIAC AFFECTIONS. geutle opening medicines, as pills composed of equal parts of aloes, rhubarb, and asafcetida, with as much of the elixir proprietatis as is necessaiy to form the ingredients into pills. Two, three, or four of these may be taken as often as it shall be found needful, to keep the body gent- ly open. Such as cannot bear the asafcetida, may substitute Spanish soap in its place. Though a cheerful glass may have good effects in this disease, yet all manner of excess is hurtful. Intense study, and every thing that depres- ses the spirits, are likewise pernicious. Though the general symptoms and treatment of nervous disorders were pointed out in the beginning of this chapter, yet, for the benefit of the un- happy persons afflicted with those obstinate and complicated maladies, I have treated several of their capital symptoms under distinct or separate heads. These hoAvever are not to be considered as different diseases, but as A'arious modifications of the same disease. They all arise from the same general causes, and require nearly the same method of treatment. There are many other symptoms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I shall therefore omit them altogether, and conclude this chapter Avith a feiv gen- eral remarks on the most obvious means of preventing or avoiding ner- vous di orders. In all persons afflicted with nervous disorders, there is a great delica- cy, and sensibility of the whole nervous system, and an uncommon degree of weakness of the organs of digestion. These may be either natural or acquired. When owing to a defect in the constitution, they are hardly to be removed; but may be mitigated by proper care. When induced by diseases, as long or repeated fevers, profuse haemorrhages, or the like, they prove also very obstinate, and will yield only to a course of regimen calculated to restore and invigorate the habit. But nervous affections arise more frequently from causes, which it is in a great measure in our own power to avoid, than from diseases, or an original fault in the constitution, Sic. Excessive grief, in'ense study, im- proper diet, and ueglect of exercise, are the great sources of this exten- sive class of diseases. It has been already observed, that grief indulged destroys the appetite and digestion, depresses the spirits, and induces an universal relaxation and debility of the whole system. Instances of this are daily to be seen. The to; s of a near relation, or any other misfortune in life, is often suffi- cient to occasion the most complicated series of nervous symptoms. Such misfortunes indeed are not to be avoided, but surely their effects, by a vi- gorous and proper exertion of the mind, might be rendered less hurtful. For directions in this matter, we must refer the reader to the article Grief, in the chapter on the passions. The effects of intense study are pretty similar to those occasioned by grief. It preys upon the animal spirits, and destroys the appetite and digestion. To prevent these effects, studious persons ought according to the Poet, to toy with thdr books.* They should never study too lo ig at a time; nor attend lon'r to one particular subject, especially if it be of a serious nature. They ought likewise to be attentive to * Armstrong on Health TETANUS, OR THE LOCKED-JA\v> 293 their posture, and should take care frequeutly to uubend their minds by niu.-ic, diversions, or going iuto agreeable company. With regard to diet, I shall only observe, that nervous diseases may be induced either by excess or inanition. Both of these extremes hurt diges- tion, and vitiate the humours. When nature is oppressed with fresh loads of food, before she has had time to digest and assimilate the former meal, her powers are weakened, and the vessels are filled with crude humours. On the otl. r hand, Avhen the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with Avind, and the humours, for Avant of regular fresh supplies of wholesome chyle, are vitiated. These extremes are therefore with equal care to be avoided. They both tend to induce a relaxation, aud debility of the nervous system, with all its dreadful train of consequences. But the most general cause of nervous disorders, is indolence. The active and laborious are seldom troubled Avith them. They are reserv- ed for tlie children of ease and affluence, who generally feel their keen- est force. All Ave shall say to such persons, is, that the means of pre- vention and cure arc both in their own power. If the constitution of hu- man nature be such, that man must either labour or suffer diseases, sure- ly no iudividual has any right to expect an exemption from the general rule. Those however who are AA'illing to take exercise, but whose occupa- tions confine them to the house, and perhaps to an unl';- vourable posture, really deserve our pity. We have in a former part of the book, en- deavoured to lay doAvn rules for their conduct; and shall only add, that where these cannot be complied Avith, their place may, in some mea- sure, be supplied by the use of bracing and strengthening medicines, as the Peruvian bark, with other bitters; the preparations of steel; the elixir of vitriol, Sic. j OF THE TETANUS, OR THE LOCKED-JAW.9 UNDER this term may be comprehended the spasmodic affection:-, called emprosthotouos, opisthotonos, and trismus, being one disease, dif- fering only in the degree of its violence. When the body and head are bended forwards, it is called emprosthotonos, when they are carried back- wards, and immovably fixed, it bears the appellation of opisthotonos; aud when the body is sustained in an erect position, by the muscle on the fore and back part of the trunk acting with equal strength, the disease is cal- led tetanus. When the muscles of the jaw become more particularly af- fected, it is called trismus, or locked-jaw. These spasmodic complaints affect both sexes, and no age is exempted from their violence. They affect the male oftener than the female, and more particularly those people who inhabit warm climates, and every climate at the warm season of the year. Sometimes they occur in winter. independent of wound?. CAUSES.—Wouads in any part of the body are sometimes succeed- ed by this disease. But more particularly from those intendons, where a trifling injury will not unfrcqucntly produce this complaint, when it is least expected. Whereas, at other times, a wound of considerable mag- nitude, under apparently similar circumstances, will have no such effect: and, even after operations iutendenous parts, it by no means a frequent -*y* TETANUS, OR THE LOCKED-JAW. occurence; when at other times, a simple fracture of the leg i\ ill produce it mall its force. Cold, when accompanied with moisture, will produce this disease; particularly when the body is exposed while asleep on a damp pavement, or iu a damp cellar, immediately after being heated and fatigued by exercise. Children are frequently seized with this disease in a short time after delivery. SYMPTOMS.—This disease, if it is from the effects of cold, general- ly comes on of a sudden. But when from a Avound, it gradually ap- proaches about the tenth, fourteenth, or twentieth days after the accident. It often comes on at a time when the wound gives but little uneasiness, and is nearly healed.. The patient first complains of an uneasy sensation at the lower part of the breast bone, with a stiffness in the buck part of the neck and muscles, of the lower jaw, which increase with a painful sensation at the root of the tongue, and a slight difficulty in swallowing. But no appearance of swelling can be observed in the throat. The mus- cles of the back no\v becomes rigid. This rigidity in a short time ex- tends to those of the neck, attended with a pain in the direction of the spine of the back. At length the head, neck, and back bone are forcibly bent backwards.—The body becomes fixed in that position. The mus- cles of the jaw are now violently affected, attended with an impossibility of swallowing. EvTen liquids are throAvn forcibly back through the nose. These symptoms generally take place on the second or third day, when the body is frequently seized with violent convulsive spasms; and the pain at the lower part of the breast bone increases, Avhich shoots through towards the back. The muscles of the limbs hoav become rigid, and the body is so much bent backwards as forest on the back part of the head and heels. As the disease advances, the convulsive spasms become more violent. At length tetanus is produced, from the muscles on the fore and back part of the trunk, acting Avith an equal degree of vigour, sustaining the body in an erect position. The pulse is generally frequent Avith the other symp- toms of fever, particularly when the disease is the consequence of cold. The bowels are generally costive, attended with a retraction of the bel- ly. The urine is discharged with difficulty, and sometimes a suppression of that evacuation takes place.—The face appears pale, expressive of great anxiety and distress. The patient is seldom, if ever, delirious, al- though he slumbers but little, from which he frequently awakes on a sud- den, with violent spasms. At length, the muscular system becomes more generally affected, and oue universal convulsion closes the miserable ex- istence of the patient. MEDICINE.—Iu our attempt to cure this disease, the indications are nearly the same, when produced from cold or the consequence of a wound, except Avhen the Avound is without sAvelling and inflamma- tion. It should then be dilated and dressed, Avith lint dipped in warm basilicon, or any other stimulating application. After this, tAvo, three, or even four grains of opium should be given three or four times a-day, according to the urgency of the symptoms, and tendency to induce sleep; for astonishing quantities of this medicine may be given without having the least tendency to make the patient slum- ber. This remedy should be administered early, as well as large quantities of Madeira wine, before the SAvallowing becomes inter- DISORDERS OF THE SENSES. 295 *upted; and the system should be charged with mercury, with as much expedition as possible. For this purpose tAvo or three drachms of mer- curial ointment must be rubbed into the inside of the legs, thighs, and arms, morning and evening, and likewise into the muscles more particu- larly affected with spasms. To co-operate with those medicines, the cold bath must be used, or cold water throAvn over the body. The bowels should be kept open with calomel, castor-oil, and clysters. All those remedies must be used at an early period of the complaint, so as to make as formidable an attack as possible on this very formidable disease, which too frequently terminates in the death of the patient, in spite of every effort to save him. When it is about to take place in infants, the bowels must be opened with calomel or castor-oil. But where it has actually taken place, little can be done. HoAvever a similar plan may be used with that recom- mended in groAvn persons. CHAP. XLVI. DISORDERS OF THE SENSES. W E do not mean to treat of the nature of our sensations, or to give a minute description of the various organs by which they are per- formed, but to point out some of the diseases to Avhich these organs are most liable, and to shoAV Iioav they may be prevented or remedied. OF THE EYE. No organ of the body is subject to more diseases than the eye; nor i- there any one of which the diseases are more difficult to cure.—Though more ignorant persons pretend to cure these than any other class of di- seases ; yet a very superficial acquaintance Avith the structure of the eye, and the nature of vision, will be sufficient to convince any one of the dan- ger of trusting to them. These diseases often exceed the skill of the most learned physician; hence we may easily infer the danger of trusting them to ignorant quacks, Avho, without doubt put out more eyes than they cure. But, though tlie disease of the eye can seldom be cured, they might often, by due care, be prevented; and, even where the sight is to- tally lost, many things might be done, which are generally neglected, to render the unhappy person both more useful to himself and to society.* The eyes are hurt by viewing bright or luminous objects; keeping the head too long in a hanging posture; violent head-achs; excessive * It is a pity those who have the misfortune to be born blind, or who lose their sight when young, should be suffered to remain in ignorance, or to beg. This is both cruelty and want of economy. There are many employments of which blind persons are very capable, as knitting, carding, turning a wheel, teaching languages, &c. Nor are instances wanting of persons who have arrived at the highest pitch of learning, without having the leastjdea of light. Witness the late famous Nicholas Sanderson of Cambridge, and my worthy friend Dr. Tho- mas Blacklock of Edinburgh. The former was one of the first mathematicians of tlie age, and the latter, besides being a good poet and philosopher, is master »f all the learned languages and a very considerable adept in the liberal art«. 296 Or THE EYE* venery; the long use of bitters; the effluvia from acrid or volatile sub- stances; various diseases; as the small-pox, measles, &c. but above all, from night-Avatching and candle-light studies. Long fasting is likewise hurtful to the eyes, and frequent heats and cokls are no less pernicious. The eyes are often hurt by the stoppage of customary evacuations; us morning sweats; sweating of the feet; the menses in women; and the bleed'ug-piles in men. All kind of excess are likewise hurtful to the sight, particularly the immoderate use of ardent spirits, and other strong liquors. In all diseases of the eyes, especially those attended with inflammation, the cool regimen ought to be observed. The patient must abstain from all spirituous liquors. The smoke of tobacco, smoky rooms, the vapours of onions and garlic, and all vivid lights and glaring colours, are care- fully to be avoided. The drink nny be water, whey, or small beer; and the aliment must be light and of easy digestion. For preventing disorders of the eyes, issues and setons are of prime use. Every person whose eyes are tender, ought to have one or more of these in some part of the body. It will likewise be of use to keep the body gently open, and either to bleed or purge every spring and fall. All excess and night studies are to be avoided. Such as do not choose a seton or an issue, will reap benefit from wearing a small Burgundy- pitch plaster between the shoulders. A gutta serena or amaurosis is an abolition of the sight without any apparent cause or fault in the eyes. When it is owing to a decay or wasting of the optic nerve, it does not admit of a cure; but Avhen it pro- ceeds from a compression of the nerves by redundant humours, these may in some measure be drained off, and the patient relieved. For this pur- pose, the body must be kept open with the laxative mercurial pills. If the patient be young and of a sanguine habit he may be bled. Cupping, with scarifications on the back part of the head, will likewise be of use. A running at the nose may be promoted by volatile salts, stimulating poAvders, Sic. But the most likely means for relieving the patient are issues or blisters kept open for a long time on the back part of the head, behind the ears, or on the neck. I have known these restore sight, even after it had been for a considerable time lost. Should these fail, recourse must be had to mercurial salivations; 01 what will perhaps ansAver the purpose better, twelve grains of co-rosive sublimate of mercury may be dissolved in an English pint and an half of brandy, and a table-spoonful of it taken twice a-day, drinking half a pint of the decoction of sarsaparilla after it. A cataract is an obstruction of the pupil, by the interposition of some opaque substance Avhich either diminishes or totally extinguishes the sight. It is generally au opacity of crystalline humour. In a recent or beginning cataract, the same medicines are to be used as in the gutta serena; and they will sometimes succeed. But when this does not happen, and the cataract becomes firm, it must be couched, or rather extracted. I have dissolved a recent cataract by giving the patient frequent purges with calomel, keeping a poultice of fresh hemlock constantly upon the eye, and a perpetual blister on the neck.* * In both these cases electricity merits a trial. OF THE EAR.^ 5297 The myopia or short sightedness, and the presbyopia or sedng only at too great a distance, are disorders Avhich depend ou the original structure or figure of the eye, therefore admit of no cure. The inconveniences arising from them may hoAvever be, in some measure, remedied by the help of proper glasses. The former requires the aid of a concave, and the latter of a convex glass. A strabismus, or squinting, depends upon an irregular contraction of the muscles of the eye from a spasm, palsy, epilepsy, or an ill habit. Children often contract this disorder by having their eyes unequally ex- posed to the light. They may likewise acquire it by imitation from a squinting nurse or play-fellow, &c. As this disorder can hardly be cured, parents ought to be careful to prevent it. Almost the only thing which can be done for it is to contrive a mask for the child to wear, which will only permit him to see in a straight direction. Spots or specks on the eyes are generally the effect of inflammation, and often appear after the small-pox, the measles, or violent ophthalmias. They are very difficult to cure, and often occasion total blindness. If the specks are soft and thin, they may sometimes be taken off by gentle caustics and discutients; as vitriol, the juice of celandine, &c. When these do not succeed, a surgical operation may be tried: the success of this however is always very doubtful. The blood-shot eye may be occasioned by a stroke, a fall, retching, vomiting, violent coughing, &c. I have frequently knoAvn it happen to children in the hooping-cough. It appears at first like a bit of scarlet, and is afterwards of a livid or blackish colour. This disorder general- ly goes off without medicine. Should it prove obstinate, the patient may be bled, and have his eyes fomented with a decoction of cumphry roots and elder flowers. A soft poultice may be applied to the eyes; and the body should be kept open by gentle purgatives. The watery or weeping eye is generally occasioned by a relaxation or weakness of the glandular parts of that organ. These may be braced and strengthened by bathing the eye with brandy and water, Hungary- water, rose-water, with white vitriol dissolved in it, &c.—Medicines which make a revulsion are likewise proper; as mild purgatives, perpetual blisters ou the neck, bathing the feet frequently in hike-warm water, &c. When this disease proceeds from an obstruction of the lachrymal duct, or natural passage of the tears, it is called a fistula lachrymalis, and can only be cured by a surgical operation.* OF THE EAR. THE functions of the ear may be injured by wounds, ulcers, or any thing that hurts its fabric. The hearing may likewise be hurt by exces- sive noise; violent colds in the head; fevers; hard wax, or other sub- stances sticking in the cavity of the ear; too great a degree of moisture or dryness of the ear. Deafness is very often the effect of old age, and is incident to most people in the decline of life. Sometimes it is owing to an original fault in the structure or formation of the ear itself. When this is the case, it admits of no cure; and the unhappy person not only continues deaf, but generally likeAvise dumb, for life.f * A weeping or watery eye is often the mark of a scrophulous habit. ■j- Though those who have the misfortune to be born deaf are generally suffer- ed to continue dumb, and consequently are in a great measure lost to society, 33 298 Or THE EAR. When deafness is the effect of wounds or ulcers of the rars, or of old age, it is not easily removed. When it proceeds from cold of the head, the patient must be careful to keep his head warm, especially in the night; he should likewise take some gentle purges, and keep his feet warm, and bathe them frequently in luke-warm water at bed-time. When deafness is the effect of a fever, it generally goes off after the patieut recovers. If it proceeds from dry wax sticking in the ears, it may be softened by dropping oil into them; afterwards they must be syringed with warm milk and water. If deafness proceeds from dryness of the ears, Avhich may be known by looking into them, half an ounce of the oil of sweet almonds, and the same quantity of liquid opodeldoc, or tincture of asafcetida, may be mixed together, and a few drops of it put into the ear every night at bed- time, stopping them afterwards with a little wool or cotton.—Some, in- stead of oil, put a small slice of the fat of bacon into each ear, which is said to answer the purpose very Avell. When the ears abound with mois- ture, it may be drained off by an issue or seton, which should be made as near the affected parts as possible. Some, for the cure of deafness, recommend the gall of an eel, mixed with spirit of wine, to be dropped into the ear; others, equal parts of Hungary-Avater, and spirit of lavender. Etmuller extols amber and musk; and Brookes says, he has often known hardness of hearing cured, by putting a grain or two of musk into the ear with cotton-wool. But these and other applications must be varied according to the cause of the disorder.* Though such application may sometimes be of service, yet they much oftener fail, and frequently they do hurt. Neither the eyes nor ears ought to be tampered Avith; they are tender organs, and re- yet nothing is more certain than that such persons may be taught not only to read and write, but also to speak and to understand what others say to them. Teaching the dumb to speak will appear paradoxical to those who do not con- sider that the formation of sounds is merely mechanical, and may be taught without the assistance of the ear. This is not only capable of demonstration, but it is actually reduced to practice by the ingenious Mr- Thomas Braidwood of Edinburgh. This gentleman has, by the mere force of genius and applica- tion, brought the teaching of dumb persons to such a degree of perfection, that his scholars are generally more forward in their education than those of the same age who enjoy all their faculties. They not only read and write with the utmost readiness, but likewise speak, and are capable of holding conversation with any person in the light.—What a pity any of the human species should re- main in a 6tate of idiotism, who are capable of being rendered as useful and intelligent as others! We mention this not only from humanity to those who* have the misfortune to be born deaf, but-also in justice to Mr Braidwood, whose success has far exceeded all former attempts this way ; and indeed it exceeds imagination itself so far, that no person who has not seen and examin- ed his pupils, can believe what they are capable of.—As this gentleman, how- ever willing, is only able to teach a few, and as the far greater part of those who are born deaf cannot afford to attend him, it would be an act of great humani- ty, as well as of public utility, to erect an academy for their benefit. * A gentleman, on whose veracity I can depend, told me, that after using many things to no purpose for an obstinate deafness, he was at last advised to put a few drops of his own urine warm into his ears every night and morning, from which he received great benefit. It is probable that a solution of tal am ■ moniac, in water, would produce tlie same effect. OF THE TASTE AND SMELL. 299 quire a very delicate touch. For this reason, what we would chiefly re* commend in deafness, is, to keep the head Avarm. From whatever cause, the disorder proceeds, this is always proper; and I have known more benefit from it alone, in the most obstinate cases of deafness, than from all the medicines I ever used.* OF THE TASTE AND SMELL. THOUGH these senses are not of so great importance to man in a state of society, as the sight and hearing; yet, as the loss of them is attended Avith some inconveniency, they deserve our notice. They are seldom to be restored Avhen lost; which ought to make us very at- tentive to their preservation, by carefully avoiding Avhatever may in the least prove injurious. As there is a very great affinity between the organs of tasting and smelling, Avhatever hurts the one, generally affects the other. Luxury is highly injurious to these organs. When the nose and palate are frequently stimulated by fragrant and poignant dishes, they soon lose the power of distinguishing tastes and odours with any degree of nicety. Man, in a state of nature, may perhaps have these faculties as acute as any other animal. The sense of smelling may be diminished or destroyed by diseases; as, the moisture, dryness, inflammation or suppuration of that membrane which lines the inside of the nose, commonly called the olfactory mem- brane ; the compression of the nerves which supply this membrane, or some fault in the brain itself at their origin. A defect or too great a de- gree of solidity of the small spungy bones of the upper jaw, the caverns of the forehead, &c. may likewise impair the sense of smelling. It may also be injured by a collection of feetid matter in those caverns, which keeps constantly exhaling from them. FeAv thing* are more hurtful to the sense of smelling, than taking great quantities of snuff. When the nose abounds with moisture, after gentle evacuations, such things as tend to take off irritation, and coagulate the thin sharp serum, may be applied; as the oil of anise mixed Avith fine flour; camphire dis- solved in oil of almonds, &c. The vapours of amber; frankincense, gum- mastic, and benjamin, may likewise be received into the nose and mouth. For moistening the mucus when it is too dry, some recommend snuff made of the leaves of marjoram, mixed ivith the oil of amber, marjoram and aniseed; or a sternutatory of calcined white vitriol; twelve grains of which may be mixed with two ounces of marjoram- water, and filtrated. The steam or vapour of vinegar upon hot iron re- ceived up the nostril is likeAvise of use for softening the muscus, opening obstructions, &c. If there is an ulcer in the nose, it ought to be dressed with some emol- lient ointment, to Avhich if the pain be very great, a little laudanum may be added. If it be a venereal ulcer, it is not to be cured without mer- cury. In that case, the solution of the corrosive sublimate in brandy may be taken, as directed in the gutta serena. The ulcer ought likewise to be washed with it; and the fumes of cinnabar may be received up the nostrils. *----------------------—---------------------------------1—___-------- 11 »j * An obstinate deafoess has been cured by electricity. 300 OF THE TOUCH. If there be reason to suspect that the nerves which supply the organ*! of smelling are inert, or want stimulating, volatile salts, strong snuffs, and other things which occasion sneezing, may be applied to the nose. The forehead may likeAvise be anointed with balsam of Peru, to which may be added a little of the oil of amber. The taste may be diminished by crusts, filth, mucus, apthae, pellicles, warts, &c. covering the tongue: it may be depraved by a fault of the sa- liva, which being discharged into the mouth, gives the same sensations as if the food Avhich the person takes had really a bad taste; or it may be en- tirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurtful either to the sense of tasting or smelling than obstinate colds, especially those which affect the head. When the taste is diminished by filth, mucus, &c. the tongue ought to be scraped and frequently washed with a mixture of water, vinegar, and honey, or some other detergent. When the saliva is vitiated, Avhich sel- dom happens unless in fevers or other diseases, the curing of the disorder is the cure of this symptom. To relieve it however in the mean time, the following things may be of use; if there be a bitter taste, it may be taken away by vomits, purges, and other things which evacuate bile. What is called a nidorous taste, arising from putrid humours, is corrected by the juice of citrons, oranges, and other acids. A salt taste is cured by plentiful delution with watery liquors. An acid taste is destroyed by absorbents, and alkaline salts, as, powder of oyster-shells, salt of worm- wood, &c. When the sensibility of the nerves which supply the organs of taste ia diminished, the chewing of horse-radish, or other stimulating substances, will help to recover it. OF THE TOUCH. THE sense of touching may be hurt by any thing that obstructs the nervous influence, or prevents its being regularly conveyed to the organs of touching: as pressure, extreme cold, &c. It may likewise be hurt by too great a degree of sensibility, when the nerve is not sufficiently cover- ed by the cuticle or scarf-skin, or where there is too great a tension of it, or it is too delicate. Whatever disorders the functions of the brain and nerves, hurts the sense of touching. Hence it appears to proceed from the same general causes as palsy and apoplexy, and requires nearly the same method of treatment. In a stupor, or defect of touching, which arises from an obstruction of the cutaneous nerves, the patient must first be purged; afterwards such medicines as excite the action of the nerves, or stimulate the system, may be used. For this purpose, the spirit of hartshorn, sal volatile olcosum horse-radish, &c. may be taken inwardly; the disordered parts, at the same time, be frequently rubbed with fresh nettles or spirit of sal ammo- niac. Blistering-plasters and sinapisms applied to the parts will likewise be pf use, as also warm bathing, especially in the natural hot baths. 301 CHAP. XLVII. OF A SCIRRHUS AND CANCER. A SCIRRHUS is a hard indolent tumour usually seated in some of the glands; as the breasts, the arm pits, &c. If the tumour be- comes large, unequal, of a livid, blackish, or leaden colour, and is at- tended with violent pain, it gets the name of an occult cancer. When the skin is broken and a sanies or ichorus matter of an abominable foetid smell is discharged from the sore, it is called an open or ulcerated can- cer. Persons after the age of forty-five, particularly women, and those who lead an indolent sedentary life, are most subject to this disease. CAUSES.—This disease is often oAving to suppressed evacuations; hence it proves so frequently fatal to Avomen of a gross habit, particu- larly old maids and widows, about the time when the menstrual flux ceases. It may likewise be occasioned by excessive fear, grief, anger, religious melancholy, or any of the depressing passions. Hence the un- fortunate, the choleric, and those persons, who devote themselves to a re- ligious life in convents or monasteries, are often afflicted with it. It may also be occasioned by the long continued use of food that is too hard of digestion, or of an acrid nature; by barrenness ; indolence; cehbacy; cold; blows; friction; pressure; or the like. Women often suffer from the last of these by means of their stays, which squeeze and compress their breast so as to occasion great mischief. Sometimes the disease is owing to an hereditary disposition. SYMPTOMS.—This disorder seems often very trifling at the beginning. A hard tumour about the size of a hazle-nut, or perhaps smaller, is gen- erally the first symptom. This will often continue for a long time Avith- out seeming to increase or giving the patient great uneasiness; but if the constitution be hurt, or the tumour irritated by pressure or improper treatment of any kind, it begins to extend itself tow ards the neighbouring parts by pushing out a kind of roots or limbs. It then gets the name of cancer, from a fancied resemblance between these limbs and the claws, of a crab. The colour of the skin begins to change, which is first red, af- terwards purple, then bluish, livid, and at last black. The patient com- plains of heat, with a burning, gnaAving, shooting pain. The tumour is very hard, rough, and unequal, with a protuberance or rising in the mid die; its size increases daily, and the neighbouring veins become thick, knotty, and of a blackish colour. The skin at length gives way, and a thin sharp ichor begins to Aoav which corrodes the neighbouring parts till it forms a large unsightly ulser. More occult cancers arise, and communicate with the neighbouring glands. The pain and stench becomes intolerable; the appetite fails; the strength is exhausted by a continual hectic fever; at last a violent hae- morrhage, or discharge of blood, from some part of the body, Avith faint- ings, or convulsion fits, generally put an end to the miserable patient's life. REGIMEN.—The diet ought to be light, but nourishiag. All strong liquors, and high seasoned or salted provisons, are to be avoided. The 302 OF A SCIRRHUS AND CANCER. patient may take as much exercise as he can easily bear; and should use every method to divert thought, and amuse his fancy. All kinds of external injury are carefully to be guarded against, particularly of the affected part, which ought to be defended from all pressure, and cvcu from the external air, by covering it with fur or soft flannel. MEDICINE.—This is one of those diseases for which no certain re- medy is yet known. Its progress hoivever, may sometimes be retarded, -and some of its most disagreeable symptoms mitigated, by proper appli- cations. One misfortune attending the disease is, that the unhappy pa- tieut often conceals it too long. Were proper means used in due time, a cancer might often be cured; but after the disorder has arrived at a cer- tain height, it generally sets all medicine at defiance. When a scirrhus tumour is first discovered, the patient ought to ob- serve a proper regimen, and to take twice or thrice a-week a dose of the common purging mercurial pill. Some blood may also be let, and the part affected may be gently rubbed twice a-day with a little of the mer- curial ointment, and kept warm with fur or flannel. The food must be light, and a pint of the decoction of woods or sarsaparilla may be drank daily. I have sometimes discussed hard tumours, Avhich had the appear- ance of beginning cancers, by a course of this kind. Should the tumour lrowever not yield to this treatment, but, on the contrary, become larger and harder, it will be proper to extirpate it, either by the knife or caustic. Indeed, whenever this can be done with safety, the sooner it is done the better. It can answer no purpose to extirpate a cancer after the constitution is ruined, or the whole mass of humours corrupted by it. This, however, is the common way, which makes the operation so seldom scuceed. Few people will submit to the extirpation till death stares them in the face; whereas, if it Avere done early, the patient's life Avould not be endangered by the operation, and it would generally prove a radical cure. When the cancer is so situated that it cannot be cut off, or if the pa- tient will not submit to the operation, such medicines as will mitigate or relieve the most urgent symptoms may be used. Dr. Home says, that half a grain of the corrosive sublimate of mercury, dissolved in a proper quantity of brandy, and taken night and morning, will often be of ser- vice ?in cancers of the face and nose. He likewise recommends an in- fusion of the solanum or night-shade, in cancers of the breasts. But the medicine most in repute at present for this disease is hemlock. Dr. Stork, physician at Vienna, has of late recommended the extract of this plant as very efficacious in cancers of eveiy kind. The doctor says, he has given some hundred weights of it without ever hurting any body, and often with manifest advantage. He advises the patient hoAV- ever to begin Avith very small doses, as tAvo or three grains, and to in- crease the dose gradually till some good effect be perceived, and there to rest without further increase. From tAvo or three grains at first, the doctor says he has increased the dose to two, three, or four drachms a-day, and finds that such doses may be continued for several weeks without any bad consequences. The regimen which the doctor recommends during the use of the me- dicine, is to avoid farinaceous substances not fermented, and too acrid aromatics. He says, good wine Avill not be hurtful to those OF A SCIRRHUS AND CANCER. 303 who are accustomed to it, nor a moderate use of acids; and adds, that the patient should live in a pure free air, and keep his mind as quiet and cheerful as possible. The Doctor does not pretend to fix the time in which a cancer may be resolved by the use of hemlock, but says he has given it for above two years in large doses Avithout any apparent benefit; nevertheless the pa- tient has been cured by persisting in the use of it for half a year longer. This is at least encouragement to give it a fair trial. Though we are far from thinking the hemlock merits those extravagant encomiums which the Doctor has bestowed upon it, yet, in a disease which has so long baffled the boasted powers of medicine, we think it ought always to be tried. The powder of hemlock is by some preferred to the extract. They are both made of the fresh leaves, and may be used nearly in the same man- ner. Dr. Nicholson of Berwick, says, he gradually increased the dose of the powder from a few grains to half a drachm, and gave near four drachms of it in a day with remarkably good effects. The hemlock may also be used externally either as a poultice or fomentation. The sore may likewise be kept clean by injecting daily a strong decoction of the tops and leaves into it. Few things contribute more to the healing of foul sordid ulcers of any kind than keeping them thoroughly clean. This ought never to be neg- lected. The best application for this purpose seems to be the carrot poultice. The root of the common carrot may be grated, and moistened >rith as much water as will bring it to the consistence of a poultice or ca- taplasm. This must be applied to the sore, and renewed tAvice a-day. It generally cleans the sore, eases the pain, and takes away the disagreea- ble smell, which are objects of no small importance in such a dreadful disorder.* Wort, or an infusion of malt, has been recommended not only as a pro- per drink, but as a powerful medicine in this disease. It must be fre- quently made fresh, and the patient may take it at pleasure. Two, three, or even four English pints of it may be drank every day for a considerable time. No benefit can be expected from any medicine in tiiis disease, unless it be persisted in for a long time. It is of too obsti- nate a nature to be soon removed; and, when it admits of a cure at all, it must be brought about by inducing an almost total change of the habit, Avhich must always be a work of time. Setons or issues in the neighbour- hood of tlie cancer have sometimes good effects.f When all other medicines fail, recourse must be had to opium, as a kind of solace. This will not indeed cure the disease, but it will * London Medical Essays. f In a cancer which had set all medicines, and even surgery, at defiance, I lately saw remarkable effects from an obstinate perseverance in a course of an- tiseptics. 1 ordered the deep ulcers to be washed to the bottom by means of a syringe, twice or thrice a-day either with an infusion of the bark, or a decoc- tion of carrot, and that the patient should take four or five times a-day, a glass of good wine, with half a drachm of the best powdered bark in it. The. sores, after being washed, were likewise sprinkled with the same powder. When the patient began this course, her death was daily expected. She conti- nued it for above two years with manifest advantage; but being told by an emi- nent surgeon, that the bark would not cure a cancer, and that the sores ought not to be washed, she discontinued the practice, and died in a few weeks. This course was not expected to cure tlie cancer, but to prolong the patient's life, which it evidently did almost to a miracle. 304 OF POISONS. ease the patient's agony, and render life more tolerable while it con- tinues. To avoid this dreadful disorder, people ought to use wholesome food; to take sufficient exercise in the open air; to be as easy and cheerful as possible; and carefully to guard against all blows, bruises and every kind of pressure upon the breasts, or other glandular parts.* CHAP. XLVIII. OF POISONS. -Hi VERY person ought, in some measure, to be acquainted with the nature and cure of poisons. They are generally taken una- wares, and their effects are often so sudden and violent, as not to admit of delay, or allow time to procure the assistance of physicians. Happily indeed no great degree of medical knowledge is here necessary; the re- medies for most poisons being generally at hand, or easily obtained, and nothing but common prudence needful in the application of them. The vulgar notion that every poison is cured by some counter poison, as a specific, has done much hurt. People believe they can do nothing for the patieut, unless they know the particular antidote to that kind of poison which he has taken. Whereas the cure of all poisons taken into the stomach, without exception, depends chiefly on discharging them as soon as possible. There is no case wherein the indications of cure are more obvious. Poison is seldom long in the stomach before it occasions sickness, with an inclination to vomit. This shews plainly what ought to be done. In- deed common sense dictates to every one, that if any thing has been ta- ken into the stomach which endangers life, it ought immediately to be dis- charged. Were this duly regarded, the danger arising from poison might generally be avoided. The method of prevention is obvious, and the means are in the hands of every one. We shall not take up the reader's time with a detail of the ridiculous notions which have prevailed among ignorant people in different ages with regard to poisons; neither shall we mention the boasted antidotes, which have been recommended either for preventing or obviating their effects; but shall content ourselves with pointing out the poisons most common in this country, and the means of avoiding their dangerous consequences. Poisons either belong to the mineral, the vegetable, or the animal kingdom. Mineral poisons are commonly of an acrid or corrosive quality; as arsnic, cobalt, the corrosive sublimate of mercury, &c. Those of the vegetable kind are generally of a narcotic or stupe- • As hemlock is the principal medicine recommended in this disease, we would have given some directions for the gathering and preparing of that plant; but as its different preparations are now kept in the shops, we think it much safer for people to get them there, with proper directions for using them. OF POISONS. 305 foctive quality; as poppy, hemlock, henbane, berries of the deadly night-shade, &c. Poisonous animals communicate their infection either by the bite or sting. This poison is very different from the former, and only produces its effects when received into the body by a wound. MINERAL POISONS.—Arsenic is the most common of this class; and, as the Avhole of them are pretty similar both in their effects and me- thod of cure, what is said with respect to it will be applicable to every other species of corrosive poison. When a person has been taking arsenic, he soon perceives a burning heat, and a violent pricking pain in his stomach and tcAvels, with an into- lerable thirst, and an inclination to vomit. The tongue and throat feel rough and dry; and, if proper means be not soon administered, the patient is seized with great anxiety, hickuping, faintings, ano coldness of the ex- tremities. To these succeed black vomits, foetid stools, with a mortifica- tion of the stomach and intestines, which are the immediate forerunners of death. On the first appearance of these symptoms the patient should drink large quantities of new milk and salad oil till he vomits; or he may drink Avarm Avater mixed with oil. Fat broths are likewise proper, provi- ded they can be got ready in time. Where no oil is to be had, fref h butter may be melted and mixed with the milk or water. These things are to be drank as long as the inclination to vomit continues. Some have drank eight or ten English quarts before the vomiting ceased; and it is never safe to leave off drinking Avhile one particle of the pokon remains in the stomach. These oily or fat substances not only provoke vomiting, but likeAvise blunt the acrimony of the poisou, and prevent its woum ing the bovvels ; but if they should not make the person vomit, half a drachm or two scru- ples of the powder of ipecacuanha must be given, or a few spoonsful of the oxymel, or vinegar of squills may be mixed with the Avater which he drinks. Vomiting may likewise be excited by tickling the inside of the throat Avith a feather. Should these methods however fail, half a drachm of white vitriol, or five or six grains of emetic tartar, must be administered. If tormenting pains are felt in the lower belly, and there is reason to fear that the poison has got down to the intestines, clysters of milk and oil must be very frequently thrown up; and the patient must drink emol- lient decoctions of barley, oat-meal, marsh-malloAvs, and such like. He must likewise take an infusion of senna and manna, a solution of Glauber's salts, or some other purgative. After the poison has been evacuated, tlie patient ought for some time, to live upon such things as are of a healing and cooling quality ; to ab- stain from flesh and all strong liquors, and to live upon milk, broth, gru- el, light puddings, and other spoon meats of easy digestion. His drink should be barley water, linseed tea, or infusions of any of the wild muci- laginous vegetables. VEGETABLE POISONS__Besides heat and pain of the stomach, commonly occasion some degree of giddiness, and often a kind of stupi- dity or folly. Persons Avho have taken these poisons must be treated in the same manner as for the mineral or corrosive. Though the vegetable poisons, Avhen alloAved to remain in the gto- 39 306 BITES OF POISONOUS ANIMALS. mach, often proves fatal; yet the danger is gen-rally over as soon as they are discharged. Not being of such a caustic or corrosive na- ture, they are less apt to wound or inflame the bowels than the mineral substances: no time, however, ou^iit to be lost in having them dis- charged. Opium, being frequently taken by mistake, merits vai^eul.-r atten- tion. It is used as a medicine both in a solid antl liquid form, which lat- ter commo ily goes by the name of laudanum. It is indeed a valuable medicine when taken iu proper quantity ; but as an over-dose proves a strong poison, we shall point out its commou effects, together with the me- thod of cure. An over-dose of opium generally occasions great drowsiness, with stu- por and other apoplectk symptoms. Sometimes the person has so great an inclination to sleep, that it is almost impossible to keep him aAvake. Eveiy method must however be tried for this purpose. He should bo tossed, shaked and moved about. Sharp blistering-plasters should be ap- plied to his legs or arms, and stimulating medicines, as salts of hartshorn, &c. held under his nose. It will also be proper to let blood. At the same time every method must be takeu to make him discharge the poison. This may be doue in the manner directed above, viz. by the use of strouw vomits, drinking plenty of warm water with oil, Sic. Mead, besides vomits, in this case, recommends acid medicines with lixivial salts. He says, that he has often given salt of Avormivood mixed Avith juice of lemon in repeated doses with great success. If the body should remain weak aud languid after the poison has been extracted, nourishing diet and cordials will be proper; but when there is reason to fear that the stomach or bowels are inflamed, the greatest cir- cumspection is necessary both with regard to food and medicine. OF THE BITES OF POISONOUS ANIMALS. We shall begin with the bite of a mad dog, as it is both the most com- mon and dangerous animal poison in this country. The creatures naturally liable to contract this disease are, as far as we yet know, all of the dog kind, viz. foxes, wolves, an i dogs. Hence it is called the rabies canina, or dog-madnets. It so seblom happens that any person is bit by the two first, that they scarce deserve to be takeu notice of. If such a thing should happen, the method of treatment is precisely the same as for the bite of a mad dog. The symptoms of madness in a dog are as follow : At first he looks dull, sheivs an aversion to food and company; he does not bark as usual, but seems to murmur, is peevish, ami apt to bite strangers; his ears and tail droop more than usual, and he appears drowsy. Aftenvards he begins to loll out his tongue, and froth at the mouth, his eyes seeming heavy and watery. He now, if not confined, takes off, runs panting along with a ki.id of dejee'ed air, and endeavours to bite ever) oue he meets. Other dogs are said to fly from him. Some think this a certain sign of madness, supposing that they know him by the smell; but it is not to be depended on. If he (scapes being killed, he seldom runs above two or three days, till he dies exhausted Avith heat, hunger antl fatigue. BITES OF POISONOUS ANIMALS. 307 This disease is most frequent after long, dry, hot seasons; and such dogs as live upon putrid stinking carrion, Avithout having enough of fresh water, are most liable to it. Wheu any person has been bit by a dog, the strictest inquiiy ought to be made whether the animal was really mad. Many disagreeable conse- quences arise from neglecting to ascertain this point. Some people have lived in continual anxiety for many years, because they had been bit by a dog which they believed to be mad; but, as he had been killed on the spot, it was impossible to ascertain the fact. This should induce us, in- stead of killing a dog the moment he has bit any person, to do all in our power to keep him alive, at least till we be certain whether he be mad or not. Mauy circumstances may contribute to make people imagine a dog mad. He loses his master, runs about in quest of him, is set upon by other dogs, and perhaps by meu. The creature, thus frightened, beat and abused, looks wild, and lolls out his tongue as he runs along. Im- mediately a crowd is after him; while he, finding himself closely pur- sue i, aud taking every one lie meets for an enemy, naturally attempts to bite in self-defence. He soon gets knocked on the head, and it passes currently that he was mad, as it is then impossible to prove the contrary. This being the true history of, by far, the greater part of those dogs Avhich pass for mad, is it any wonder that numberless whimsical medi- cines have been extolled for preventing the effects of their bite ? This readily accounts lor the great variety of infallible remedies for the bite of a mad dog, Avhich are to be met with in almost every family. Though not one in a thousaud has any claim to merit, yet they are all supported by numberless vouchers. No wonder that imaginary diseases should be cured by imaginary remedies. In this way, credulous peopie first im- pose upon themselves, and then deceive others. The same medicines which was supposed to prevent the effects of the bite, when the dog was not mad, is recommended to a person who has had the misfortune to be bit by a clog that was really mad. He takes it, trusts to it, and is undone. To these mistakes we must impute the frequent ill success of the medi- cines used for preventing the effects of the bite of a mad dog. It is not owing so much to a defect in medicine, as to Avroug applications. I am persuaded, if proper medicines were administered immediately after the bite is received, and continued for a sufficient length of time, Ave should not lose one iu a thousand of those who have the misfortune to be bit by a mad dog. This poison is generally communicated by a wound, which neverthe- less heals as soou as a common wound : but afterwards it begins to feel painful, and as the pain spreads towards tlie neighbouring parts, the per- son becomes heavy aud listless. His sleep is unquiet with frightful dreams; he sighs, looks dull, and loves solitude. These are the fore- runners or rather the first symptoms of that dreadful disease occasioned by the bite of a mad dog. But as we do not propose to treat fully of the disease itself, but to point out the method of preventing it, we shall not take up time in shewing its progress from the first invasion to its com- monly fatal end. The common notion, that this poison may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridiculous. It must render such persous as have had the misfortune to be bit very 308 BITES Of POISONOUS ANIMALS. unhappy, and can have no good effects. If the person takes proper medietas for forty days after the time of his being bit, and feels 110 symptom of the disease, there is reason to believe him out of danger. The medicines recommended for preventing the effects of the bite of a mad dog, are chiefly such as promote the different secretions, and antispa modics. Dr. Mead recommends a preventive mediciue, which he says he never knew fail, though in the space of thirty years he had used it a thousand time.-;. The Doctor's prescription is as folloivs: " Take ash-coloured ground liver-wort, cleaned, dried, and poAvdered, half an ounce; of black pepper powdered, a quarter of an ounce. MLx these well together, and divide the poAvder into four doses ; one of Avhich must be t.ken every morning fasting, for four mornings succes- sively, in half a pint of cows milk warm. " After these four doses are taken, the patient must go into the cold bath, or a cold spring or river, every morning fasting, for a month; he must be dipped all over, but not stay in (Avith his head above water) longer than half a minute, if the water be very cold. After this he must go in three times a-Aveek for a fortnight longer. " The person must be bled before he begins to use the medicine.*" We shall next mention the famous East-India specific as it is called. This medicine is composed of cinnabar and musk. It is esteemed a great antispasmodic ; and, by many, extolled as an infallible remedy for pre- venting the effects of the bite of a mad dog. "Take native and factitious cinnabar, of each twenty-four grains, musk sixteen grains. Let these be made into a fine poAvder, and taken in a glass of arrack or brandy." This single dose is said to secure the person for thirty days, at the end of which it must be repeated ; but if he has any symptoms of the disease, it must be repeated in three hours. The following is likeivise reckoned a good antispasmodic medicine : " Take of Virginian snake-root in powder, half a drachm, gnm asa- fcetida twelve grains, gum camphire seven grains; make these into a bo- lus with a little syrup of saffron." Camphire may also be given in the following manner: " Take purified nitre half an ounce, Virginian snake-root in powder two drachms, camphire one drachm ; rub them together in a mortar, and divide the whole into ten doses." Mercuiy is likewise recommended as of great efficacy, both in the prevention and cure of this kind of madness. When uesd as a preven- tive, it will be sufficient to rub daily a drachm of the oiutment into the parts about the wouud. Vinegar is likewise of considerable service, and should be taken free- ly, either in the patient's food or drink. These are the principal medicines recommended for preventing the effects of the bite of a mad dog. We would not however advise peo- * Though we give this prescription on the credit of Dr. Mead, yet we would not advise any person, who has reason to believe that he has been bit by a dog which was really mad, to trust to it alone- Mead was an able phy- sician, but he seems to hare been no great philosopher, and was sometimes the dupe of his own credulity. BITES OF POISONOUS ANIMALS. 309 pie to trust any one of them; but from a proper combination of their dif- ferent powers, there is the greatest reason to hope for success. The great error in the use of these medicines, lies in not taking them for a sufficient length of lime. They are used mere like charms, than medicines intended to produce any change in the body. To this, and not 10 the insufficiency of the medicines, we must impute their frequent want of success. Dr. Mead says, that the virtue of his medicine consists in promoting urine. But how a poison should be expelled by urine, with only three or four doses of any medicine, however powerful, it is not easy to con- ceive. More time is certainly necessaiy, even though the medicine were more poweriul than that which the Doctor prescribes. The East-India specific is still more exceptionable on this account. As these and most other medicines, takeu singly, have frequently been found to fail, we shall recommend the folloAving course: If a person is bit iu a lleshy part, where there is no hazard of hurting any large blood-vessel, the parts adjacent to the wound may be cut away. But if this be not done soon after the bite has been received, it will be better to omit it. The wound may be dressed with salt and water, or a pickle made of vinegar . nd salt, and afterwards dressed twice a-day with yellow basili- con, mixed with red precipitate of mercury. The patient should begin to use either Dr. Mead's medicine, or some of the others mentioned above. If he takes Mead's medicine, he may use it as the Doctor directs for four days successively. Let him then omit it for tAvo or three days, and again repeat the same number of doses as before. During this course, he must rub into the parts about the Avound, daily, one drachm of the mercurial ointment. This may be done for ten or twelve days at least. When this course is over, he may take a purge or two, and wait a few days till the effect of the mercury be gone off. He must then begin to use the cold batii, into which he may go every morning for five or six iveeks. If he should feel cold and chilly for a long time after coming out of the cold bath, it will be better to use a tepid one, or to have the water a little warmed. In the meantime Ave would advise him not to leave off all internal me- dicines, but to take either oi.e of the boluses of snake-root, asafcetida, and camphire; or one of the poAvders of nitre, camphire, and snake-root, twice a-day. These may be used during the whole time he is bathing. During the use of the mercurial ointment, the patient must keep within doors, and take nothing cold. A proper regimen must be observed throughout the whole course. The patient should abstain from flesh, and all salted aud high-seasoned provi- sions. He must avoid strong liquors, and live mostly upon a light aud ra- ther spare diet. His mind should be kept as easy and cheerful as pota- ble, and all excessive heat and violent passions avoided with the utmost care. I have never seen this course of medicine, Avith proper regimen, fait to prevent the hydrophobia, and cannot help again observ ing, that the want of success must general!) be owing either to the application of improper medicines: or not nsing proper ones for a sufficient length of time. 310 BITES OF POISONOUS ANIMALS. Mankind are extremely fond of every thing that p omise.i a sudden or miraculous aire. By trusting to these they often lose their lives, \dcu a regular course of medicine Avould have rend< red them absolutely .-afe. This holds remarkably in the present case. Numbers of people, for ex- ample, believe if they or their cattle were once dipped in the sea, it is suUcient; as if the salt water ivere a charm against the effects, of the bite. This, and such like Avhims, have proved fatal to muny. It is a common notion, if a person be bit by a dog which is not mad, that, if he should go mad afterwards, the person would be affected Avith the disorder at the same time; but this notion is too ridiculous to deserve a serious consideration. It is a good rule, however, to avoid dogs as much as possible, as the disease is often upon them for tome time before its violent symptoms appeal'. The hydrophobia has been occasioned by the bite of a dog Avhich shewed no other symptoms of the disease but list- Iessness and a sullen disposition. Though we do not mean to treat fully of the cure of the hydrophobia, yet we are far from reckoning it incurable. The notion that tliis disease could not be cured, has been productive of the most horrid cousequences. It Avas usual either to abandon the unhappy persons, as soon as they Avere seized with the disease, to their fate, to bleed them to death, or to suffo- cate them between mattrassesor feather-beds, Sic. This conduct certain- ly deserved the severest punishment! We hope, for the honour of human nature, it will never again be heard of. I have never had an opportunity of treating this disease, and therefore can say nothing of it from my own experience ; but the learned Dr. Tissot says, it may be cured in the following manner: 1. The patient must be bled to a considerable quantity, and this may be repeated twice, or thrice, or even a fourth time, if circumstances re- quire it. 2. The patient should be put, if possible, into a Avarm bath: and this should be used twice a-day. 3. He should every day receive two, or even three emollient clys- ters. 4. The wound, and the parts adjoining to it, should be rubbed with the mercurial oiutment twice a-day. 5. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in au oily flannel. 6. Every three hours a dose of Cob's powder should be taken in a eup of the infusion of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a veiy fme powder of native and factitious cinnabar, each twenty-four grains; of musk, sixteen grains.* 7. The following bolus is to be given every night, and to be re- peated in the morning, if the patient is cot easy, washing it .lu-.vn with the infusion mentioned above: Take one drachm of Vigiuiau snake-root in powder; of camphire and asafcetida, ten graius each; * The Qrmskirk medicine, as it is called, seems to me to consist chiefly of cinnabar. Though it is said to be infallible, as a preventive ; yet I would not advise any one to trust to it alone. Indeed it is ordered to be taken in a manner which gives it more the appearance of a charm than of a medicine Surely if a medicine is to produce any change in the body, it must be taken for some con- siderable time, and in sufficient quantity. BITES OF POISONOUS ANIMALS. 311 of opium, one grain; and, with a sufficient quantity of conserve, or rob of elder, make a bolus. 8. If there be a great nausea at the stomach, with a bitterness iu the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be taken for a vomit. 9. The patient's food, if he takes any, must be light: as panada, soups made of farinaceous or mealy vegetables, &c. 10. If the patient should long continue weak and subject to terrors, he may take half a drachm of the Peruvian bark thrice a-day. The next poisonous animal which we shall mention is the VIPER. The grease of this animal rubbed into the wouud, is said to cure the bite. Though that is ail the viper-catchers generally do when bit, we should not think it sufficient for the bite of an enraged viper. It would surely be more safe to haAre the vvound Avell sucked,* and afterwards rubbed Avith Avarm salad-oil.f A poultice of bread and milk, softened with sa- lad-oil, should likewise be applied to the Avound; and the patient ought to drink freely of vinegar- w'hey, or water-gruel Avith vinegar in it, to make him sweat. Vinegar is one of the best medicines which can be used in any kind of poison, and ought to be taken very liber dly. If the patient be sick he may take a vomit. This course will be sufficient to cure the bite of any of the poisonous animals of this country. With regard to poisonous insects, as the bee, the wasp, the hornet, Sic. their stings are seldom attended with danger, unless when a person happens to be stung by a great number of them at the same time; in which case something should be done to abate the inflammation and sAvelling. Some, for this purpose, apply honey, others lay pounded parsley to the part. A mixture of vinegar and Venice treacle is likeAvise recommended; but I have always found rubbing the part with warm salad-oil succeed very well* Indeed, when the stings are so nu- merous as to endanger the patient's life, which is sometimes the case, he must not only have oily poultices applied to the part, but should like- wise be bled, and take some cooling medicines, as nitre, or cream of tartar, and should drink plentifully of diluting liquors. It is the happiness of this island to have very few poisonous animals, and those which we have are by no means of the most virulent kind. Nine-tenths of the effects attributed to poison or venom in this country- are really other diseases, and proceed from quite different causes. We cannot hoAvever make the same observation Avith regard to poison- ous veeetables. These abound every Avhere, and prove often fatal to the ignorant and unwary. This indeed is chiefly OAving to carelessness. Children ought early to be cautioned against eating any kind of fruit, * The practice of sucking out poisons is very ancient; and indeed nothing can be more rational. When the bite cannot be cut out, this is the most likely way for extracting the poison. There can be no danger in performing this of- fice, as the poison does no harm unless it be taken into the body by a wound. The person who sucks the wound, ought however to wash his mouth frequently with salad-oil, which will secure him from even the least inconveniency. The Psvli-i in Africa, and the Marsi in Italy, were famed for curing the bites of poisonous animals by sucking the wound ; and we are told, tliat the Indians in North-America practise the same at this day. j- Salad or sweet oil, not only applied outwardly, but taken inwardly, is not only efficacious in curing the b":tc of the Viper, but also of the rattle-snake. A. E. 312 BITES OF POISONOUS ANIMALS. roots, or berries, which they do not know; and all poisonous plants to which they can have access, ought, as far as possible, to be destroyed. This would not be so difficult a task as some people imagine. Poisonous plants have no doubt their use, and they ought to be pro- pagated in proper places; but as they often prove destructive to cattle, they should be rooted out of all pasture-grounds. They ought likewise, for the safety of the human species, to be destroyed in the neighbourhood of all toAviia aud village;; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfs-bane, aud deadly nightshade, all growing Avithin the environs of a small toAvu, where, though several persous, within the memory of those living in it, had lost their fives by oue or other of these plants, yet no method, that I could hear of, had ever been taken to root them out; though this might be done at a very trifling expense. Seldom a year passes but we have accounts of several persons poisoned by eatiug hemlock-roots instead of parsnips, or some kinds of fungus Avhich they had gathered, for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter entirely out of use. Mushrooms may be a delicate dish, but they are a dangerous one, as they are generally gathered by persons who do not know one kind of i'uigus from another, and take every thing for a mush- room which has that appearance. We might here mention many other plants and animals of a poison- ous nature Avhich are found in foreign countries; but as our observations are chie'fly intended for this island, Ave shall pass these over. It may not however be amiss to observe, for the benefit of such of our country- men as go to America, that an effectual remedy is now said to be found for the bite of the rattle-snake.—The prescription is as follows : Take of the roots of plantain and horehottnd, in summer, roots and branches together, a sufficient quantity; bruue them in a mortar, and squeeze out the juice, of which give, as soon as possible, one large spoonful; if the patient be swelled, you must force it down his throat. This generally Av'il cure; but if he finds no relief in au hour after, you may give ano- ther spoonful, which never fails.—If tlie roots are dried, they must be „ moistened with a little water. To the wouud may be applied a leaf of good tobacco moistened with rum. We give this upon the faith of Dr. Brookes, who says it was the in- vention of a negro; for the discovery of which he had his freedom pur- chased, and a hundred pounds per annum settled upon him duriug life, by the general Assembly of Carolina. It is possible there may be in nature specific remedies for every kind of poison; but as we have very little faith in any of those which have yet been pretended to be discovered, we shall beg leave again to recommend the most strict attention to the following rules, viz. That when any poi- sonous substance has been taken into the stomach, it ought as soon as possible to be discharged by vomits, clysters, and purges; and, when poison has been received into the body by a wound, that it be expelled by mpdici'ies which promote the different secretions, especially those of sweaf, urine, and insensible perspiration; to Avhich may be joined anti- spasmodics, or such meicines as take off tensio*. and irritation; the chief of which are opium, musk, camphire, and asafcetida. OF THE VENEREAL DISEASE. 313 KETTERING'S SPECIFIC FOR THE HYDROPHOBIA. Extract from the Journals of the Legislature of Pennsylvania, of March 6, 1302. " The committee appointed to hear the communication of Valentino Kettering, relative to his cure of the bite of a mad animal, Report—" That they conferred with the said Kettering on that sub- ject, who informed them, that he uses the herb called Red duckweed, which, when ripe, or in full bloom, he gathers, and dries in the shade, reduces it to a powder, and gives a small table-spoonful at one time, to a grown person, in beer or water, in weight one drachm and one scruple: for a child, an equal dose, but given at three different times, or it may be eaten on bread with butter, honey, or molasses, as the person chuses. For a beast, a large spoonful; if by weight, two drachms and one scru- ple. When used green for a beast, cut the herb fine, and mix with bran, &c. When given to swine, mix the powdered herb with meal of any kind (dose as above) in little balls. " He assures us that he has given it to persons many weeks after they Avere bitten, and never knew it fail; and never gives more than a single dose, unless to children, as above. He further says, that it is an excel- lent cure for cuts or wounds on the human body. " When green, mash it; drop of the juice into the wound, and bind the herb, so mashed, on. The proper time to 60W the seed is about the beginning of April, and it should be sown thin. " They also learn, from the Rev. Henry Muhlenberg, that it is an annual plant, known in Switzerland and Germany, by the name of Gauch- heil, Rother Meyer, or Rother Hunerdarm; in England, Red Pimper- ueil; by botanists, as he is informed, Anagallis Phcenicea. That it should be gathered in June, Avhen in full blossom. In Germany, he understands the usual dose Avas thirty grains of the powder, taken four times a-day, and continued one Aveek, in smaller doses; the wound washed with a de- coction of the herb, and some of the poAvder strewed in it. That the plant is cultivated in many gardens, and groAvs near Baltimore and Havre- de-Grace, spontaneously, in great plenty'." CHAP. XLIX. OF THE VENEREAL DISEASE. ■IN" the first edition of this book, the venereal disease was omitted. The reasons however which at tliat time induced me to leave it out, have upon more mature consideration vanished. Bad consequen- ces, no doubt, may arise from ignorant persons tampering with medicine in this disorder; but the danger from that quarter seems to be more than balanced by the great and solid advantages, which must arise to the pa- tient from aa early knowledge of his case, and an atteution to a plan of regimen, which, if it does not cure the disease, Avill be sure to render it more mild, and less hurtful to the constitution. 40 314 OF THE VIRULENT GONORRHOEA. It is peculiarly unfortunate for the unhappy persons who contract this disease, that it lies under a sort of disgrace. This renders disguise ne- cessary, and makes the patient either conceal his disorder altogether, or apply to those who promise a sudden and secret cure; but who in fact only remove the symptoms for a time, while they fix the disease deeper in the habit. By this means a slight infection, Avhich might have been easily removed, is often converted into an obstinate, and sometimes an incurable malady. Another unfavourable circumstance attending this disease is, that it asstimes a variety of different shapes, and may Avith more proprie- ty be called an assemblage of diseases, than a single one. No two diseases can require a more different method of treatment than this does in its different stages. Hence the folly of trusting to any parti- cular nostrum for the cure of it. Such nostrums are however generally administered in the same manner to all who apply for them, without the least regard to the state of the disease, the constitution of the patient, the degree of infection, and a thousand other circumstances of the ut- most importance. Though the venereal disease is generally the fruit of unlawful em- braces, yet it may be communicated to the innocent as Avell as the guilty. Infants, nurses, midwives, and married Avoinen whose husbands lead dis- solute lives, are often affected with it, and frequently lose their lives by not being aAvare of their danger in due time. The unhappy condition of such persons Avill certainly plead our excuse, if any excuse be neces- sary, for endeavouring to point out the symptoms and cure of this too common disease. To enumerate all its different symptoms, however, and to trace the disease minutely through its various stages, would require a much larger space than falls to this part of my subject; I shall therefore con- fine my observations chiefly to circumstances of importance, omitting such as are either trifling, or which occur but seldom. I shall likewise pass over the history of the disease, with the different methods of treat- ment which it has undergone since it Avas first introduced into Europe, and many other circumstances of a similar nature; all of which though they might tend to amuse the reader, yet could afford him little or no useliil knoAvledge. OF THE VIRULENT GONORRHOEA. THE virulent Gonorrhoea is an involuntary discharge of infectious matter from the parts of generation in either sex. It generally makes its appearance Avithin eight or ten days after the infection has been re- ceived; sometimes indeed it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the discharge the patient feels an itching, with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary passage, wiiich stains the linen, and occasions a small degree of titillation, parti- cularly' at the time of making water; this gradually increasing, arises at length to a degree of heat and pain, Avhich are chiefly perceived about the extremity of the urinary passage, where a slight degree of redness and inflammation likeAi ise begin to appear. As the disorder advances, the pain, heat of urine, aud running, in- OF THE VIRULENT GONORRHOEA. 315 crease, Avhile fresh symptoms daily ensue. In men, the erections become painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is Avarm in bed. The pain which was at first only perceived toAvards the extremity, now begins to reach all up the urinary passage, and is most intense just after the patient has done making water. The running gradually recedes from the colour of seed, grows yelloiv, and at length puts on the appear- ance of mucus. When the disorder has arrived at its height, all the symptoms are more intense; the heat of the urine is so great, that the patient dreads the making water; and though he feels a constant inclination this way, yet it is rendered with the greatest difficulty, and often only by drops: the involuntary erections noAV become extremely painful and frequent; there is also a pain, heat, and sense of fulness about the seat, and the run- ning is plentiful and sharp, of a broAvn, greenish, and sometimes of a bloody colour. By a proper treatment, the Violence of the symptoms gradually abates; the heat of urine goes off; the involuntary and painful erections, and the heat and pain about the seat, become easier; the running also gradually decreases, grows Avhiter and thicker, till at last it entirely dis- appears. By attending to these symptoms the gonorrhoea may be generally dis- tinguished from any other disease. There are hoAvever some few disor- ders for which it may be mistaken, as an ulcer in the kidnies or bladder, the fluor albus, or whites in women, &c. But in the former of these, the matter comes aAvay only with the urine, or Avhen the sphincter of the bladder is open; Avhereas in the gonorrhoea the discharge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects, as pain, communicating the infection, Sic. REGIMEN.—When a person has reason to expect that he has caught the venereal infection, he ought most strictly to observe a cooling regi- men, to avoid every thing of a heating nature, as Avines, spiritous liquors, rich sauces, spices, salted, high seasoned and smoke-dried provisions, &c. also all aromatic and stimulating vegetables, as onions, garlic, shallot, nut- meg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panada, gruels, Sic. His drink may be barley-water, milk and water, decoctions of marsh-mallows and liquorice, linseed tea, or clear whey. Of these he ought to drink plentifully. Violent exercise of all kinds, especially riding on horse-back, and venereal pleasures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed. MEDICINE.—A virulent gonorrhoea canuot always be cured speed- ily and effectually at the same time. The patient ought therefore not to expect, nor the physician to promise it. It ivill often continue for two or three Aveeks, and sometimes for five or six, even where the treatment has been very proper. Sometimes indeed a slight infection may be carried off in a few days, by bathing the parts in warm milk and Avater, and injecting frequently ii]> the urethra a little sweet oil or linseed tea, about the warmth of neAV milk. Should these not sucoced in carrying off the infection, they will at least have a tendencv to lessen its virulence. 316 OF THE VIRULENT GONORRHOEA. To effect a cure, however, astringent injections will be found necessa- ry. These may be various ways prepared, but I think those made with the white vitriol are both most safe and efficacious. They can be made s:rongeror weaker as circumstances may require; but it is best to begin with the more genlle, and increase their poAver if necessary. I generally order a drachm of white vitriol to be dissolved in eight or nine ounces of common or rase Avater, and an ordinary syringe full of it to be thrown up three, or four times a-day. If this quantity does not perform a cure, it may be repeated, and the dose increased.* Whether injections be used or not, cooling purges are always proper in a gonorrhoea. They ought not, hoivever, to be of the strong or drastic kind. Whatever raises a violent commotion in the body increases the danger, and ;bi'1- to drive the disease deeper into the habit. Procuring two or three stools every secend or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the run- ning, and to change its colour and consistence. It gradually becomes more white and ropy as the virulence abates.f When tiv inflammatory symptoms run high, bleeding is always necessary at the beginning. This operation, as in other topical in- flammations, must be repeated according to the strength and consti- tu on of the patient, and the vehemence and urgency of the symp- toms. Medicmes Avhich promote the secretion of urine are liketvise pro- p r i:i this sta-ie of the disorder. For this purpose an ounce of nitre and two ounces of U the misohief arising from the venereal disease. I never knew the cure at- tended with any great difficulty or da go-where be patieut Miictly after which they were stuffed with dry lint to absord the fresh matter as it was generated. The patient at the same time took every day half a grain of the corrosive sublimate of mercury, dissolved in an ounce of brandy, and drank an English quart of the decoction of sarsaparillg. By this treatment in about six weeks, he was perfectly cured ; and, what was very remarkable, a part of the penis was actually regenerated Doctor Gilchrist has given an account of the species of lues venerea which prevails in the West ofScotland, to which the natives give the name of Sibbina or Sivvint. The Doctor observes, that the spreading of this disease is chiefly owing* to the neglect of cleanliness, and seems to think, that by due attention to that virtue, it might be extirpated. The treatment of this disease is similar to that of a confirmed lues or pox The. yavis, a disease now very common both in America and the We§t-India islands, may also be cured in the. same manner. 42 330 DISEASES OF WOMEN. followed tlie physician's advice; but a volume would not be sufficient to point out the dreadful consequences which proceed from an opposite con- duct. Scirrhous testicles, ulcerous sore throats, madness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source. There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution contracts a slight degree of the disorder. He gets well without taking any great care, or using much medicine, and hence concludes that this will always be the case. The next time the disease occurs; though ten times more virulent, he pursues the same course, aud his constitution is ruined. In- deed, the different degrees of virulence in the small-pox are not greater than in this disease, though, as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ig- norant old woman cannot kill the patient in that disorder. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal con- tagion, after it has got into the habit. In this case a proper course of medicine is always indispensably necessary. Although it is impossible, on account of the different degrees of viru- lence, &c. to lay down fixed and certain rules for the cure of this di- sease, yet the following general plan will always be found safe, and often successful, viz. to bleed and administer gentle purges with diuretics during the inflammatory state, and as soon as the symptoms of inflammation are abated, to administer mercury, in any form that may be most agreeable to the patient. The same medicine, assisted by the decoetion of sarsa- parilla, and a proper regimen, will not only secure the constitution against any further progress of a confirmed pox, but will generally perform a complete cure. CHAP. L. DISEASES OF WOMEN. WOMEN in all civilized nations, have the management of do- mestic affairs, and it is very proper they should, as nature has made them less fit for the more active and laborious employments. This indulgence however, is generally carried too far; and females, instead of being benefited by it, are greatly injured from the want of exercise and free air. To be satisfied of this, one need only compare the fresh and rud- dy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though nature has made an evident distinction between the male and female with regard to bodily strength and vigour, yet she certainly never meant, either that the one should be always without, or the other always within doors. The confinement of females, besides hurting their figure and com- plexjkuv relaxes their solids, weakens their muds, aud disorders ah\ CfF THE MENSTHWAt DISCHARCE.' 331 the functions of the body. Hence proceeds obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit Avomen from being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting, the former is rarely to be found. I have always observed that women who were chiefly employed with- out doors, in the different branches of husbandry, gardening and the like, were almost as hardy as their husbands, and that their children Avere like- wise healthy. But as the bad effects of confinement and inactivity up- on both sexes have been already shewn, we shall proceed to point out those circumstances in the structure and design of females, which subject them to peculiar diseases; the chief of which are their monthly evacua- tions, pregnancy, and child-bearing. These indeed cannot properly be called diseases, but, from the delicacy of the sex, and this being often improperly managed in such situations, they become the source of nu- merous calamities. OF THE MENSTRUAL DISCHARGE. FEMALES generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most cri- tical of their lives. About the first appearance of this discharge, the con- stitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now neces- sary, as the future health and happiness of the female depends in a great measure upon her conduct at this period.* If a girl about this time of life be confined to the house, kept constant- ly sitting, and neither allowed to romp about, nor employed in any ac- tive business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan; her health, spirits, and vigour decline, and she sinks into a va- letudinarian for life. Such is the fate of numbers of those unhappy fe- males, who, either from too much indulgence, or their own narrow cir- cumstances, are, at this critical period, denied the benefit of exercise and free air. A lazy indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstructions among the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eaten up by the chlorosis, or green sickness, and other diseases of this nature. We would therefore recommend it to all who wish to escape these calamities, to avoid indolence and inactivity, as their greatest enemies, and to be as much abroad in the open air as possible. Another thing which proves very hurtful to girls about this period * It is the duty of mothers, and those who are intrusted with the education of girls, to instruct them early in the conduct and management of themselvea at this critical period of their lives False modesty, inattention ami ignorance of what is beneficial or hurtful at this time, are the sources of many diseases and misfortunes in life, which a few sensible lessons from an experienced ma- tron might have prevented. Nor is care less necessary in the subsequent re- turns of this discharge. Taking improper food, violent affections of the mind, or catching cold at this period, is often sufficient to ruin tile health, or to re»< tier the female ever after incapable of procreation. S52 OF THX MENSTRUAL DISCHAKCB, of iifr. is unwholaome food. Fond of all manner of trash, they often in- dulge m it, till their whole humours, are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of eAtil*. If tlie fluHs be not duly prepared* it is utterly impossible that the secretions should go properly on. Accordingly we find; that such girls as lead an indolent life, aud eat great quantities of trash, are not only subject to ob- struction of the menses, but likewise to glandular obstructions; as the scmi-'ifih, or kind's evil, Sic. :\ drill disposition is also very hurtful to girls at this period. It is a rrfe tiling to see a sprightly girl who does not enjoy good health, while thr utaye, mopins, melancholy creature, proves the very prey of vapours ahti i+**t.to-ics. Youth is the season for mirth and cheerfulness. Let it there'o^^be indulged. It is an absolute duty. To lay in a stock of health in time of youth, is as necessaiy a piece of prudence, as to make pro i ion against the decays of old age.—While, therefore, wise nature p*■•ompts fhe happy youth to join in sprightly amusements, let not the severe dictates of hoary a^e forbid the useful impulse, nor damp with serious s;lfeom, the season destined to mirth and innocent festivity. Another thin? very hurtful to females about this period of life, is strab clothes. They are fond of a fine shape, and foolishly imagine that tbi can be acquired by lacing themsc Ives tight. Hence, by squeezing the stomach and bowels, they hurt the digestion, and occasion many in- cureab'e maladies. This error is not indeed so common as it has been; but, as fashions change, it may come about again: we therefore think it not im/>n>per to mention it. I know many females, who, to this day; fi" 1 the direful effects of that wretched custom which prevailed some years ago, of squeezing every girl into as small a size in the middle as possible* Human invention could not possibly have devised a practice more destructive tohedth. After a female ha6 rr'ved at that period of life when the menses usu- al]* begin to Row, and they do not appear, but, ort the contrary, her b; alth and spirits begm to decline, we would advise, instead of shutting tlie r»oor girl up in the house, and dosing her with steel, asafcetida, and other nauseous drugs, to place her in a situation where she can enjoy the bfnefV of fresh air and agreeable company. There let her eat Avbp'eso!!«-• food, take sufficient exercise, and amuse herself in the most agreeable manner; and Ave have little reason to fear, but nature, thus as- sls'ed, will do her proper work.—Indeed she seldom fails, unless where the fault is on our side. Ths discharge in the beginning is seldom so instantaneous as to sur- prise females unavvares. It is generally preceded by symptoms which foretel its approach; as a sense of heat, weight, and dull pain in the loins; distension and hardness of the breasts; head-ache; loss of appetite; lassi- tude; paleness of the countenance; and sometimes a slight degree of fever. When' these symptoms appear about the age at which the men- strual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation ; and all means used to promote it; a6 sitting frequently over the steams of warm water, drinking warm diluting liquors, &c. After the menses, have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Fe. amies ought to be f\c crPng cautious of what they eat or drink at the time they are "out of order. Every thing that is cold, or apt to OF THE MENSTRUAL DISCHARGE. 333 sour on the stomach, ought to be avoided; as fruit, butter-milk, and such like. Fish, aud all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, Ave would recommend it to every female to be veiy attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the sex date their diseases from colds, caught w hile they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not in the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution. The greatest attention ought likeAvise to be paid to the mind, Avhich should be kept as easy and cheerful as possible. Every part of the ani- mal economy is influenced by the passions, but none more so thau this. Anger, fear, grief, and other affections of the mind, often occasion ob- structions of the menstrual flux, Avhich prove absolutely incurable. From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this purpose we would recommend sufficient exercise, in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine. When obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the solids, and assist the body in preparing good blood, ought to be used. The princi- pal of these are iron and tlie Peruvian bark, with other bitter and astrin- gent medicines. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks it may be filtered, and about half a wine glass of it taken twice a-day: or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the patient. When obstructions proceed from a viscid state of the blood; or from women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessaiy. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a it pare thin diet. Her drink should be whey, water, or small beer; and she ought to take sufficient exercise. A tea-spoonfiil of the tincture of black hellebore may also be taken twice a-day in a cup of Avarm water. When obstructions proceed from affections of the mind, as grief, fear, anger, &c. every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of neAv objects, has often a very happy influence in relieving it from the deepest distress. A soothing, kind, and affable behaviour t« females in this situation, is also of the last importance. An obstruction of the tnen-scs is often the effect of other maladies. When this is the case, instead of giving medicines to force that dis- charge, which might be dangerous, we ought by all means to endeavour •354 (OF TllE MENSTRUAL DISCHARGE. to restore the patient's health and strength. When that is effected, the other will return of course. But the menstrual flux may be too great as Avell as too small. When this happeus, the patient becomes Aveak, the colour pale, the appetite and digestion are bad, and cedematous sAvellings of the feet, dropsies and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted,. high-seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c. The treatment of this disease must be varied according to its cause. When it is occasioned by any error iu the patient's regimen, an opposite course to that Avhich induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flux, and counteract the morbid affections of the system from whence it proceeds. To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed, with her head low; to live upon a cool and slender diet, as veal or chicken broths Avith bread; and to drink decoctions of nettle-roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astrin- gents may be used, as Japan earth, alum, elixir of vitriol, the Peruvian bark, Sic* The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always Aviiite, but sometimes pale, yellow, green, or of a blackish colour; sometimes it is sharp and corrosive, sometimes foul and foetid, &c. It is attended Avith a pale complexion, pain in the back, loss of ap- petite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other Aveak and Avatery diet. To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret mixed with Pyrmout, "Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is necessaiy, we know none preferable to the Peruvian bark, which in this case ought al- ways to be taken in substance. In warm weather the cold bath will be of considerable service. That period of life at Avhich the menses cease to flow, is likewise very critical to the sex. The stoppage of any customary evacuation, how- * Two drachms of alum and one of Japan earth may be pounded together and divided into eight or rune doses, one of which may be taken three times a-day. Persons whose stomachs cannot bear the alum, may take two table-spoonsful •f tlie tincture of roses three or four times a-day, to each dose of which ten drops of laudanum may be added. if these should fail, half a drachm of the Peruvian bark, in powder, with ten drops of the elixir of vitriolmay be taken in a glass of red wine, four times a-day OF PREGNANCY". 335 ever small, is sufficient to disorder the whole frame, and often to de- stroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, how- ever, as survive it, without contracting any chronic disease, often be- come more healthy and hardy than they were before, and enjoy strength and vigour to a very great age. If the menses cease all of a sudden in women of a full habit, they ought to abate somewhat of their usual quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufiicient exercise, and to keep the body open. This may be done by taking, once or twice a Aveek, a little rhubarb, or an infusion of hiera picra in wine or brandy. It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ancles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open, or have artificial drains substituted in their stead. Women who will have such sores dried up, are often soon after carried off by acute diseases, or fall into those of a chronic nature. OF PREGNANCY. THOUGH pregnancy is not a disease, yet that state is often attend* ed with a variety of complaints which merit attention, and which some- times requires the assistance of medicine. Some Avomen indeed are more healthy during their pregnancy than at any other time; but this is by no means the general case; most of them breed in sorrow, aud are fre- quently indisposed during the whole time of pregnancy. Few fatal di- seases, however, happen during that period; and hardly any, except abortion, that can be called dangerous. We shall therefore pay parti- cular attention to it, as it proves generally fatal to the child, and some- times to the mother. Pregnant women are often afflicted with the heart-burn. The method of treating this complaint has been already pointed out. They are like- wise, in the more early periods of pregnancy, often harrassed Avith sick- ness and vomiting, especially in the morning. The method of relieving these complaints has also been shewn. Both the head-ach and tooth-ach are very troublesome symptoms of pregnancy. The former may gene- rally be removed by keeping tlie body pently open, by tlie use of prunes, figs, roasted apples, and such like. When the pain is very violent, bleed- ing may be necessary. For the treatment of the latter, lve must refer to that article. Several other complaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and incontinency of urine, &c; but as all ol these have been taken no- tice of before, it is needless to repeat them. Every pregnant woman is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weakens the constitution, but renders the woman liable to the same misfortune af- terwards* Abortion may happen at any period of preguaucy, but it is * Every mother who procures an abortion does it at the hazard of ber life ., yet there are not a few who run this risk merely to prevent the trouble of bear- ing and bringing up children, It is sorely a most unnatural crime, and cannot, 336 OF PREGNANCY. most common in the second or third mouth. Sometimes, however, it hap- pens in the fourth or fifth. If it happens within the first month it is usually called a false conception; if after the seventh month, the child may often be kept alive by proper care. The common causes of abortion are, the death of the child; weak- ness or relaxation of the mother; great evacuations; violent exercise; raising great weights; reaching too high; jumping or stepping from an eminence; vomiting; coughing; convulsion fits; blows on the belly; falls; fevers; disagreeable smells; excess of blood; indolence ; high living, or the contrary; violent passions or affections of the mind, as fear, grief, Sic. The signs of approaching abortion are, pain in the loms, or about the bottom of the belly; a dull heavy pain in the inside of the thigh; a slight degree of coldness, or shivering; sickness, palpitation of the heart; the breasts becomes flat and soft; the belly falls; and there is a discharge of blood or watery humours from the Avomb. To prevent abortion, Ave would advise women of a weak or relaxed habit to use solid food, avoiding great quantities of tea. and other weak and watery liquors; to rise early and go soon to bed; to shun damp houses; to take frequent exercise in the open air, but to avoid fatigue; and never to go abroad in damp foggy weather, if they can shun it. Women of a full habit ought to use a spare diet, avoiding strong li- quors, and every thing that may tend to heat the body, or increase the quantity of blood. Their diet should be of an opening nature, consists ing principally of vegetable substances. Every woman with child ought to be kept cheerful and easy in her mind. Her appetites, even though depraved, ought to be indulged as far as prudence will permit. When any sigus of abortion appear, the Avoman ought to be laid in bed on a mattress with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oat-meal and the like, all of which ought to be taken cold. If she be able to bear it, she should lose at least half a pound of blood from the arm. Her drink ought to be barley-water sharpened Avith juice of lemon; or she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the Avoman be seized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected Avith vomiting, let her take frequently two table-spoonsful of the saline mixture. In general, opiates are of service; but they should always be given with caution. Sanguine robust Avomen, who are liable to miscarry at a certain time of pregnaucy, ought ahvays to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape that misfortune. Though Ave recommend due care for preventing abortion, Ave would not be understood as restraining preguant women from their usual exercises. This woidd generally operate a quite contrary way. even in the most abandoned, be viewed without horror ; but in the decent mat- ron, it is still more unpardonable.—Those wretches who daily advertise their assistance to women in this business, deserve, in my opinion, the mo3t severe of all human punishments. OF CHILD-BIRTH. 337 Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, however, some women of so delicate a texture, that it is necessary for them to avoid almost every kind of exercise during the whole period of pregnancy. OF CHILD-BIRTH. MANY diseases proceed from the want of due care in child-bed; and the more hardy part of the sex are most apt to despise the necessary precautions iu this state. This is peculiarly the case with young Avives. Tluy think, when the labour-pains are ended, the danger is over; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the foetus; but proper care and management are certainly necessaiy for the recovery of the mother. No doubt mischief may be done by too much as Avell as by too little care. Hence females who have the greatest number of attendants in child-bed generally reco- ver worst. But this is not peculiar to the state of child-bed. Excessive care always defeats its own intention, and is generally more dangerous than none at all.* During actual labour, nothing of a heating nature ought to be given. The Avoman may noiv and then take a little panada, and her drink ought to be toast and water, or thin groat gruel. Spirits, wines, cordial-waters, and other things which are given with a view to strengthen the mother, "and promote the birth, for the most part, tend only to increase the fever, inflame tlie Avomb, and retard the labour. Besides, they endanger the Avoman afterwards, as they often occasion violent and mortal haemorrhages, or dispose her to eruptive aud other fevers. When the labour proves tedious and difficult, to prevent inflamma- tions, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered; and the patient should sit over the steams of warm water. The passage ought to be gently rubbed with a little soft pomatum or fresh butter, and cloths Avrung out of warm Avater ap- plied over the belly. If nature seems to sink, and the Avoman is greatly exhausted with fatigue, a draught of generous wine, or some other cor- dial, may be given, but not otherwise. These directions are sufficient in natural labours; and in all preternatural cases, a skilful surgeon, or man-midAvife, ought to be called as soon as possible. After delivery, the woman ought to be kept as quiet and easy as • Though the management of Avomen in child-bed has been practised as an employment since the earliest accounts of time ; yet it is still in most countriea on a very bad footing. Few women think Of following this employment till they are reduced to the necessity of doing it for bread. Hence not one in an hundred of them have any education, or proper knowledge of their business. It is true, that Nature, if left to herself, will generally expel the foetus ; but it is equally true, that most women in child-bed require to be managed with skill and attention, and that they are often hurt by the superstitious prejudices of ignorant and officious midwives. The mischief done in this way is much greater than is generally imagined; most of which might be prevented by allowing no woman to practise midwifery but such as are properly qualified. Were due at- tention paid to this, it would not only be the means of saving many lives, but would prevent the necessity of employing men in this indelicate and disagree- able branch of medicine, which is, on many other accounts, more proper for thu oUVr sox, 43 333 OF CHILD-BIRTH. possible. ■ Ifr * food should be lijiit and thin, as gruel, panada, &c. ami her drink weak and diluting. To this rule, however, there are many exception-. I have known bcvcral women, whose spirits could not be supported in child-bed without solid food and generous liquors; to such, a glass of wine and a bit of chicken must be allowed. Sometimes an excessive haemorrhage or flooding happens after delivery. In this case the patient should be laid with her head Ioav, kept cool, and he iu all respects treated as for an excessive flux of the menses. II the flooding proves violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red Avine, should be ap- plied to the belly, the loins, and tlie thighs; these must be changed as they grow dry; and may be discontinued as soon as the flooding abates.f If there be violent pains after delivery, the patient ought to drink plentifully of warm diluting liquors, as gruel or tea with a little saffron iu it; aud to take small broths, with carraway-seeds, or a bit of an orange- peel in them; an ounce of the oil of sweet almonds may likewise be fre- quently taken in a cup of any of the above liquors; aud if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed Avith a cup of her driuk. If she be hot or feverish, one of the following poAvders may be taken in a cup of her usual drink every five or six hours, j; An inflammation of the womb is a dangerous and not unfrequent dis- ease after delivery. It is known by pains in the loiver part of the belly, which are greatly increased upon touching; by the tension or tightness of the parts; great Aveakuess; change of countenance; a constant fever, Avith a Weak and hard pulse; a slight delirium or raving; sometimes incessant vomiting; a hickup; a discharge of reddish, stinking, sharp water from the womb; an inclination to go frequently to stool; a heat, and sometimes total suppression of urine. This must be treated like other inflammatory disorders, by bleeding and plentiful dilution. The drink may be thin gruel or barley-water; in a cup of which half a drachm of nitre may be dissolved, and taken three or four times a-day. Clysters of warm milk and water must be frequently administered; and the belly should be fomented by cloths Avrung out of warm Avater, or by applying bladders filled Avitli warm milk and water to it. A suppression of the lochia, or usual discharges after delivery, and the milk-fever must be treated nearly in the same manner as an in- flammation of the womb. In all these cases, the safest course is plen- * We cannot help taking notice of that ridiculous custom which still prevails in some parts of the country, of collecting a number of women together on such occasions. These, instead of being useful, serve only to crowd the house, and obstruct the necessary attendants. Besides they hurt the patient with their noise : and often, by their untimely and impertinent advice, do much mischief. f In a violent flooding after delivery, I have seen very good effects from the following mixture: Take of penny-royal water, simple cinnamon-water, and Byrup of poppies, each two ounces, elixir of vitriol a drachm. Mix, and take two table-spoonsful every two hours, or oftener, if necessary. * Take of crabs' claws prepared half an ounce, purified nitre two drachma saffron powdered half a drachm; rub them together in a mortal-, and divide the whole into eight or nine deses. When the patient is low spirited, or troubled with hysterical complaints, she ought to take frequently twelve or fifteen drops of tlie tincture of asafd-tida in a cup of penny-royal tea. __ OF CHILD-BIRTH. 339 iifol dilution, gentle evacuations, and fomentations of "the parts affected. In the milk-fever, the breasts may be embrocated with a little warm lin- seed-oil, or the leaves of red cabbage may be applied tc them. The child should be often put to the breast, or it should be drawn by some other person. Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature, and common sense, and is very hurtful both to the mother and child. Eveiy mother who has milk in her breasts, ought either to suckle her OAvn child, or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases Avhich prove fatal to women iu child-bed. When an inflammation happens in the breast, attended with redness, hardness, and other symptoms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be reneAved tAvice a-day, till the tumour be either discussed or brought to suppuration. The use of repellents, in this case, is very danger- ous ; they often occasion fevers, and sometimes cancers; whereas a sup- puration is seldom attended with any danger, and has often the most sa- lutary effects. When the nipples are fretted or chapt, they may be anointed with a mixture of oil and bees-wax, or a little powdered gum arabic may be sprinkled on them. I have seen Hungary water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cool- ing purge may be given, which generally removes it. The miliary fever is a disease incident to women in child-bed; but as it has been treated of already, we shall take no further notice of it. The celebrated Hoffman observes, that this fever of child-bed women might generally be prevented, if they, during their pregnancy, were re- gular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar; not forgetting to bleed in the first months, and to avoid all sharp air. When the labour is coming on, it is not to be hastened with forcing mediciues, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions proceed re- gularly ; and if the pulse be quick, a little nitrous poAvder, or some other cooling medicines, should be administered. The most fatal disorder consequent upon delivery is the puerperal, or child bed fever. It generally makes its attack upon the second or third day after delivery. Sometimes indeed it comes on sooner, aud at other times, though rarely, it does not appear before the fifth or sixth day. It begins like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at the sto- mach, and bilious, vomiting. The pulse is generally quick, the tongue dry, aud there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb; a sudden change in the quantity or quality of the lochia also takes place; and the patient is frequently troubled Avith a tenesmus, or con- stant inclination to go to stool. The urine, which is very high coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, aud becomes susceptibV; of pain 340 OF CHILD-BIRTH. from the slightest touch. When the fever has continued foi a k-w days, the symptoms of iuflammalion usually subside, aud the disease acquires a more putrid form. At this period, if not sooner, a bilious or putrid looseuess, of an obstinate and dangerous nature, comes on, and accom- panies the disease through all its future progress. There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. Iu women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought however to be used Avith caution, and not to be repeated unless where the signs of in- flammation rise high; in A\hich case it will also be necessary, to apply a blistering plaster to the region of the womb. During the rigour, or cold fit, proper meaus should be used to abate its violence and shorten its duration. For this purpose the patient may drink freely of warm diluting liquors, and, if Ioav, may take how and then a cup of Avine Avhey; warm applications to the extremities, as heated bricks, bottles or bladders filled with warm water, and suchlike, may al- so be used with advantage. Emollient clysters of milk and Avater, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial by promoting a discharge from the intestine, and also by act- ing as a kindly fomentation to the womb and parts adjacent. Great care lioAvever is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time. To evacuate the offending bile from the stomach, a vomit is ge- nerally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which Avill both tend to cool the body, and to procure a free discharge of the bile.* The medicine Avhich I have always found to succeed best in this di- sease, is the saline draught. This, if frequently repeated, Avill often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added. If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; and the drink may be rice-Avater, in every English pint of Avhicli half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or some other strong astringent. Though in general the food ought to be light, and the drink di- luting, yet when the disease has been long protracted, and the pa- tient is greatly spent by evacuations, it will be necessary to support her with nourishing diet and generous cordials. It was observed that this fever, after continuing for some time, of- ten acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may * Midwives ought to be very cautious in administering A'omits or purges tn women in child-bed. I have known a woman who was recovering extremely well, thrown into the most imminent danger, by a strong purge which was giver 3Lsr by an officio us midwife. OF BARRENNESS. 341 require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed Avith the tincture of roses, or other gentle astringents; or a scruple of the extract of bark with half an ounce of spi- rituous cinuainon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessaiy. When the stomach Avill not bear any kind of nourishment, the patient may be supported for some time by clysters of beef-tea, or chicken-water. To avoid this fever, every woman in child-bed ought to be kept per- fectly easy; her food should be light and simple, and her bed-chamber cool, and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too Avarm. She ought not to have her body bound too tight, nor to rise too soon from bed after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness. To prevent the milk fever, the breasts ought frequently to be drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to prevent the milk from becoming acrid and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet. We shall conclude our observations on child-bed women by recommend- ing it to them, above all things, to beAvare of cold. Poor Avomen, whose circumstances oblige them to quit their bed too soon, often contract dis- eases from cold, of Avhich they never recover. It is a pity the poor are not better taken care of in this situation. But the better sort of women run the greatest hazard from too muchN heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this con- duct must be obvious to every one. The superstitious custom of obliging women to keep the house till they go to church, is likeAvise a very common cause of catching cold. All churches are damp, and most of them cold ; consequently they are the very worst places to which a woman can go to make her first visit, after having been confined in a warm room for a month. OF BARRENNESS. BARRENNESS may be very properly reckoned among the diseases of females, as few married women who have not children enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, &c. but it is chiefly oAving to an obstruction or irregu- larity of the menstrual flux. It is very certain that high living vitiates the humours, and prevents fecundity. We seldom find a barren Avoman among the labouring poor, while nothing is more common among the rich and affluent. The in- habitants of every country are prolific iu proportion to their poverty ; and it Avould be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor 342 DISEASIS OF CHILDREN. vassals and dependants, tlie blessing of a numerous and healthy offspring while they pine in sorrow for the Avant of even a single heir to their ex- tensive domains. Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of tlie solids; a state highly unfavourable to procreation. To remove this, we would recommend the following course: first, sufficient exercise in the open air; secondly, a diet consisting chiefly of milk and vegetables*; thirdly, the use of astringent med£ cines, as steel, alum, dragon's blood, elixir of vitriol, the Spaw or Tun- bridge waters, Peruvian bark, &c.; and lastly, above all, the cold bath. Barrenness is often the consequence of grief, sudden fear, anxiety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as possible: all disagreeable ob- jects are to be avoided, and every method taken to amuse and entertain the fancy. CHAP. LI. DISEASES OF CHILDREN. .MISERABLE indeed is the lot of man in the slate of infancy J He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his parents; but, alas! this care is not always bestowed upon him ; and Avhen it is, he often suf- fers as much from improper management as he would have done from neg- lect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants!. It must be obvious to every attentive person, that the first diseases of children arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned Avith indigestible drugs and improper diet as soon as they come iuto the world. Every * Dr. Cheyne avers, that want of children is oftener the fault of the male than of the female, and strongly recommends a milk and vegetable diet to the former as well as the latter ; adding, that his friend Dr. Taylor, whom he calls the Milk-doctor of Croydon; had brought sundry opulent families in his neighbour. hood, v. ho had continued some years after marriage without progeny, to have several fine children, by keeping both parents, for a considerable time, to a milk and vegetable diet. f Of the officious and ill-judged care of midwives, wc shall adduce only one instance, viz. the common practice of torturing infants, by squeezing their breasts, to draw off the milk, as they call it Though a small quantity of mois- ture is generally found in the breasts of infants, yet, as they are certainly not in- tended to give suck, this ought never to be drawn off. I have seen this cruel operation bring on hardness, inflammation, and suppuration of the breasts ; but never knew any ill consequences from its being omicted. When the breasts are hard, the only application that we would recommend, is a soft poultice, or a lit- tle of the diachylon plaster, spread thin upon a bit of soft leather, about the size of half a crown, and applied over each nipple. These may be suffered te I'.ontinue till the hardness disappears. OF THE MECONIUM. 343 thing that the stomach cannot digest may be considered as a poison; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at l;,st convulsions and death. As these symptoms evidently arise from someAvhat that irritates the in- testines, doubtless the proper method of cure* must be to expel it as soon as possible. The most safe and efl'ectHal method of doing this is by gentle vomits. Five or six graius of the powder of ipecacuanha may be mixed in two table spoonsful of water, arid sAveetened Avith a little sugar. A tea-spoonful of this may be given to the infant every quarter of au hour till it operates; or, what will more certainly ansiver the purpose, a grain of emetic tartar may be dissolved in three ounces of water, sweet- ened with a little syrup, and given as above. Those Avho are willing to use the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred. These medicines will not only cleanse the stomach, but Avill generally likewise open the body. Should this however not happen, and if the child be costive, some gentle purge ■will be necessary; for this purpose, some manna and pulp of cassia may be dissolved in boiling Avater, and given in small quantities till it operates; or, what will answer rather bet- ter, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and continued till it has the desired effect. If these medicines be properly administered and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suffer so much. These general directions include most of what can be done for reliev- ing the internal disorders of infants. They will likewise go a considera- ble way in alleviating those which appear externally, as the rash, gum, Vr fellon, Sic. These, as was formerly observed, are principally owing to too hot a regimen, and consequently will be most effectually relieved by gentle evacuations. Indeed, evacuations of one kind or other constitute a principal part of the medicine of infants, and will seldom, if adminte- '■tercd vrith prudence, in any of their diseases, fail to give relief. OF THE MECONIUM. THE stomach and bowels of a new-born infant are filled with a black- ish coloured matter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of nature;, in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not sufficiently car- ried off, a little manna or magnesia alba may be given as mentioned above; or, if these should not be at hand, a common spoonful of whey, bwee-ened with a little honey, or raw sugar, will answer the purpose. The most proper medicine for expelling the meconium is the mother's milk, Avhich is always at first of a purgative quality. Were children al- lowed to suck as soon as they sheAV an inclination.for the breast, they ivould seldom have occasion for medicines to discharge the meconium; 344 THE APHTHjE.--OF ACIDITIES. but even where this is not allowed, they ought nevrr to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats. THE APHTHE, OR THRUSH. The aphthae are little whitish ulcers affecting tlie whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very danger- ous, and often put an end to the infant's life. If the aphthae are of a pale colour, pellucid, few in number, soft, su perficial, and fall easily off, they are not dangerous; but if opake, yel- low, broAvn, black, thick, or running together, they ought to be dreaded. It is generally thought that the aphthae owe their origin to acid hu- mours ; we have reason however to believe, that they are more frequent- ly oAving to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with Avine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion inflammatory disorders even iu adults; is it any wonder then that they should heat and inflame the ten- der bodies of infants, and set as it were the Avhole constitution in a blaze? The most proper medicines for the apfhhae are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhu- barb and half a drachm of magnesia alba may be rubbed together, and divided into six doses, one of which may be given to the infant every four or five hours till they operate. These powders may either be given in the child's food, or a little of the syrup of pale roses, and may be repeated as often as is found necessary to keep the body open. It is common in this case to administer calomel; but as that medicine some- times occasions gripes, it ought always to be given to infants with cau- tion. Many tilings have been recommended for gargling the mouth aiiK throat in this disease; but it is not easy to apply these in very young children; we would therefore recommend it to thefnurse to rub the child's mouth frequently with a little borax and honey; or with the folloAving mixture: Take fine honey an ounce, borax a drachm, burnt alum, half a drachm, rose Avater tAvo drachms; mix them together. A very pro- per application in this case, is a solution of tenor twelve grains of white vitriol in eight ounces of barley-water. These may be applied with the finger, orby means of a bit of soft rag tied to die end of a probe. OF ACIDITIES. THE food of children being for the most part of an acescent nature, it readily turns sour upon the stomach, especially if the body be any way disordered. Heuce most diseases of children are accompanied with evident signs of acidity, as greens stools, gripes, &c. These appearances have induced many to believe, that all the diseases of children were owing to an acid abounding in the stomach and bowels; but whoever considc is the matter attentively, will find that these symptoms of acidity are of- tener the effect than the cause of their diseases. CALLING AND EXCORIATION. 345 Nature evidently intended that the food of children should be aces- cent; and unless the body be disordered, or the digestion hurt, from some other cause, Ave will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, however, is often a symptom of disorders in children, and, as it is sometimes a troublesome one, we shall point out the method of relieving it. When green stools, gripes, purging, sour smells, &c. shew that the bowels abound with an acid, let the child have a little small broth, with light white bread in it; and it should have sufficient exercise in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs' eyes, and other testaceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove veiy hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines: as rhubarb, manna, and such like. The best medicine which Ave knoiv in all cases of acidity, is that fine insipid powder called magnesia alba. It purges, and at the same time corrects the acidity; by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Appendix.* When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spicerics, and other hot things; but should have its body opened with an emollient clyster, or the medicine mentioned above; and at the same time a littfo brandy may be rubbed on its belly with a warm hand before the fire. I have seldom seen this fail to ease the gripes of infants. If it should happen, however, not to succeed, a little brandy or other spirits may be mixed ivith thrice the quantity of warm water, and a tea-spoonful of it given frequently till the infant be easier. Sometimes a little peppermint water will answer this purpose very well. GALLING AND EXCORIATION. THESE are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine. As these complaints are, in a great measure, owing to want of cleanli- ness, the most effectual means of preventing them, are, to wash the parts frequently with cold water, to change the linen often, and, in a word, to keep the child in all respects thoroughly clean. When this is not suffi- cient, the excoriated parts may be sprinkled with absorbent or drying powders; as burnt hartshorn, tutty, chalk, crabs' elaAvs prepared, and the like. When the parts affected are very sore, and tend to a real ul- ceration, it will be proper to add a little sugar of lead to the powders; or to anoint the place with the camphorated ointment If the parts be washed with spring-water, in Avhich a little white vitriol has been dissol- ved, it will dry and heal them very poAverfully. One of the best appli- cations for this purpose, is to dissolve some fuller's earth in a sufficient quantity of hot water; and after it has stood till it is cold, to rub it gent- ly upon the galled parts, once or twice a-day. * See Appendix, Laxative absorbent Mixture. 44 346 STOPPAGE OF THE NOSE—OF VOMITING. STOPPAGE OF THE NOSE. THE nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, aud likewise renders it difficult for them to suck or swallow. Some in this case order, after a suitable purge, two or three grains of white vitriol dissolved in half an ounce of marjoram-water, and filtered, to be applied now and then to the nostrils with a linen rag. Wedclius says, If two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjoram-water, and ap- plied to the nose, as above directed, that it brings aAvay the mucus Avith- out sneezing. In obstinate cases these medicines may be tried; but I have never found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fre.sh butter. This resolves the filth, and rendtrs the breathiug more free.* OF VOMITING. From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irri- tates 'he nerves of the stomach or intestines. Heuce these disorders are much more common in childhood, than in the more advanced periods of lit-. They are seldom, however, dangerous, and ought never to be con- si 'ered as diseases, unless when they are violent, or continue so long as to exhaust the strenii'li of die patient. Vomiting may be excited by an over-quantity of food; by food that is of such a nature hs to irritate the nerves of the stomach too much; or by the «enribility of the uerves being so much increased as to render them unable to bear the stimulus of even the mildest element. When vomiting is occasion) i by too much food, it ought to be promo- ted, as *he cure will depend upon cleansing the stomach. This may be done eitht r by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When i1 is owing to food of an acrid or irritating qualiy, the diet ought to be changed, and aliment of a milder nature suh-titu'ed in i's stead. When vomiting proceeds from an increased degree of sensibility, or too great an irritability of the nerves of the stomach, such medi- cines a-* have a teudencv to brace and strengthen that organ, and to abate it- serisibility, must be used. The first of these intentions may be an- wered by a slirht infusion of the Peruvian bark, with the ad-' di!inn of a little rhubarb and orange-peel; and the second by the saline drr«u?hts, to which a few drops of liquid laudanum may be occasionally add^d. In obstinate vomitings the operation of internal medicines may be as ;s'et by aromatic fomentations made Avith wine, applied warm to the pit «f the stomach; or the use of the stomach-piaster, with the addition of a little Theriaca. • Some nurses remove this complaint by sucking- the child's nose. This is by no means a cleanly operation ; but when nurses have the resolution to do it, 1 am far from discouraging the practice. OF A LOOSENESS—OF ERUPTIONS, S47 OF A LOOSENESS. A LOOSENESS may generally be reckoned salutary when the stools are sour, slimy, green or curdled. It is not the discharge, but the pro- duction of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or au eruption on the skin has disappeared. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which cas-e it may also prt.ve of advantage, by carrying off a quantity oi watery humours, which Avould otherwise tend to relax the habit. As the principal intention of the cure of a looseness is to evacuate the offending matter, it is customary to give the patient a gentle a omit of ipecacuanha, and afterwards to exhibit small and frequent doses-of rhubarb; interposing absorbent medicines, to mitigate the acrimoj.y of the humours. The best purge, however, in this case, is magnesia alba. It is at the same t-me absorbent and laxitive, and operates without exciting gripes. The antimonial wine, which acts both as an emetic and purge, is also an excellent medicine in this case. By being diluted with wrater, it may be proportioned to the Aveakest constitution; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the disease, aud pave the Avay for the use of absorbents. If, however, the patient's strength will permit, the medicine ought to be repeated every six or eight houis, till the stools beg:n to assume a more natural appearance; afterwards a longer space may be allowed to intervene between the doses. When it is necessary to re- peat the medicine frequently, the dose ought ahvays to be a little in- creased, as its efficacy is generally diminished by use. Some upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be adminis- tered before the offending humours are discharged, though the disease may appear to be mitigated for a little time, it soon afterwards breaks forth with greater violence, and often proves fatal. After proper evacu- ations, however, these medicines may be administered with considerable advantage. Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of poppies may be given in a little simple cinnamon-water, three or four times a-day, till these symptoms have ceased. OF ERUPTIONS. CHILDREN, while on the breast, are seldom free from eruptions oi one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hurtful humours, Avhich, if retailed, might produce fital dis nders. The eruptions of children are chiefly owing to improper food and neg- lect of cleanliness. If a child be suffed at all hours with food that its stomach is not able to digest, such I od not being j rop'riy assimilated, instead of nourishing the body, fills it with gross humours. These must 348 OF ERUPTIONS. either break out in form of eruptions upon the skin, or remain in th' body, and occasion feviis aud other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be ob- vious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to SAiarm Avith vermin, and arc gene rail v covered with the scab, itch and other eruptions. When eruptions arc the effect of improper food, or want of cleanliness, a proper attention to the^o alone will generally be sufficient to remove them. If this should not be the case, some diy ing medicines Avill be ne- cess.ry. When they are applied, the body ought at the same time to be kept open, and cold is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sulphur, provi- ded it be prudently used. A Utile of the flour of sulphur may be mixed with fresh butter, oil, or hog's lard, and the parts affected frequently touched with it.* The most obstinate of all the eruptions incident to children, are the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceeding difficult to cure, and sometimes indeed the cure proves worse than the disease. I have frequently known children seized with internal disorders, of which they died soon after their scabbed heads had been healed by the application of drying medicines, f The cure ought always first to be attempted by keeping the head very clean, cutting off the hair, combing and brushing away the scabs, Sic. * The following method for drying and curing cutaneous eruptions, is deem- ed not unworthy of attention—It is an extract of a letter (taken from a Calcutta paper,) from a Gentleman of the Faculty, at Fort St. George, to the Doctor of the Bengal Establishment:— " Sir Paul Joddrel, from his skill in botany, has made a discovery which is likely to prove of importance to the health and ease of the Europeans in India ; and will tend to the extirpation of that cruel malady, the ringworm ; and the remedy is as simple as it is efficacious. It consists in nothing more than a fre- quent embrocation, or friction of the parts where the eruption prevails, with common mu&hroom ketchup. This remedy, simple as it appears, has never been known to fail in removing the ring-worm, itch, or any other cutaneous eruption, after every nostrum has failed. " Sir Paul accounts for this efficacy of the vegetable curative, in the known noxious propeiiy of the mushroom to all animalcula. The solution or essence of this fungus is proved, by this discovery, to bear such enmity to the minute insect which is the occult cause of this disorder, that it immediately perforates the cuticle, and totally exterminates the infection. The experiment is easy, and a trial is recommended to those afflicted with ring-worms, tetters or erup- tions of any kind." A. E. f I some time ago saw a very striking instance of the danger of substituting drying medicines in the place of cleanliness and wholesome food, in the Found- -ling Hospital at Ackworth, where the children were grievously afflicted with scabbed heads, and other cutaneous disorders. Upon inquiry it was found, that very little attention was paid either to the propriety or soundness of their pro- "visions, and that cleanliness was totally neglected; accordingly it was advised, that they should have more wholesome food, and be kept thoroughly clean. Tliis advice, however, was not followed It was too troublesome to the ser- vants, suDerintendants, &c. The business was to be done by medicine ; which was accordingly attempted, but had nearly proved fatal to the whole house. Fe- vers, and other internal disorders immediately appeared, and at length a putrid dysentery, which proved so infectious, that it carried off a great many of the children, and spread ever a considerable part of tlie neighbouring country. OF THE CROUP, OR HIVES. 349 If this is not sufficient, let the head be shaved once a-week, washed daily with soap-suds, aud gently anoiuted with a liniment made of train oil eight ouuces, red precipitate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, or sprin- kled Avith a little burnt alum. While these things are doing, tlie patient must be confined to a regular light diet, the body should be kept gently open ; and cold, as far as possible, ought to be avoided. To prevent any bad consequences from stopping this discharge, it will be proper, espe- cially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient becomes more strong, and the constitution be somewhat mended. Chilblains commonly attack children in cold weather. They are ge- nerally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This oc- casions a sudden rarefaction of the humours, and an infraction of the vessels; Avhich being often repeated, the vessels are at last overdistended, and forced to give Avay. To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and sAvell, the patient ought to be purged, and to have the affected parts frequently rubbed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and diy. Some apply warm ashes betAveen cloths, to the swelled parts, which frequently help to re- duce them. Wheu there is a sore, it must be dressed with Turner's cerate, tlie ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are indeed troublesome, but seldom dangerous. They generally heal as soon as the warm Aveather sets in. OF THE CROUP, OR HIVES. CHILDREN are often seized very suddenly with this disease, Avhich, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east coast of Scotland, it is called the croup. On the west they call it the chock or stiiffing. In some parts of England, where I have observed it, the good Avomen call it the rising of the lights, and in America, the hives. It seems to be a species of asthma, attended with very acute and violent catarrhal sa mptoms. This disease generally prevails in cold and Avet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes knoivn it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, Avet feet, thin shoes, wet clothes, or any thing that obstructs tlie perspiration, may occasion the croup. It is attended Avith a frequent pulse, quick and laborious breathing, which is performed Avith a peculiar kind of croaking noise, that must be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is of a livid colour. When a child is seized Avith the above symptoms, his feet should be immediately put into Avarm Avater. He ought likewise to be 350 OF TEETHING. hied,* and to lm'e a laxative cl\sier administered as soon as poMublr. He should be made to breathe over the steams of warm water aud vine- gar ; or an emollient decoction, and emollient cataplasms or fomentations may be applied round his neck. II the symptoms do not abate, a blis- tering-plaster must be applied round the neck, or between the shoulders, and the child may take frequently a table-spoonful of the following julep: Take pennyroyal water three ounces, syrup of althea and of poppies, each one ounce, mix them together. Asafcetida is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of asafretida may be dissolved in one ounce of Mindeienis's spirit, and three pu ices of penny-royal water. A table-spoonful of this mixture iiua be given every hour, or oftener, if the patient's stomach be able to bear it. If the chikl cannot be brought to take this medicine, two drachms of the asafcetida may be dissolved in a commou clystei, and administered every six or eight hours, till the violence of the disease abates.f To prevent a renin of the disorder, all those things which occasion it must carefully be avoided; as wet feet, cold, damp, easterly winds, &c. Children who have had frequent returns of tills disease, or whose con- stitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of digestion, and all crude, raw, trashy fruits are to be avoided. They ought likewise to have a drain~constantly kept open in s ;me p^rt of their body, by means of a seton or issue. I have sometimes known a Burgundy-pitch plaster, worn continually between the shoulders for several years, have a very happy effect jm preventing the return of this dreadful disorder. OF TEETHING. Dr. Arbuthnot observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the tender nervous parts of the jaws, occasioning inflammations, fevers, convul- sions, gangrenes, &c. These symptoms are in a great measure owing to the great delicacy, and exquisite sensibility of the nervous system at this time of life, Avhich is too often increased by an effe- minate education. Hence it comes to pass, that children who are * In this disease bleeding is not always proper; but in very full habits it cer- tainly must be of use. f I was lately favoured with a letter from Dr WiHiam Turnbull in London, a physician of great experience, and who, from his former situation on the north-east coast of England, had many opportunities of observing the symptoms and progress of this dangerous disease. I am sorry the letter came too late to be inserted at length; but as the Doctor's sentiments differ very little from my own, this misfortune is the less to be regretted. The Doctor indeed observes, that he never found blistering of any service; but recommends cataplasms of garlic, camphor and Venice treacle, to be applied both to the throat and soles of the feet. He likewise recommends bolusscs of camphor, castor, valerian root, salt of hartshorn, and musk, adapted to the age, strength, &c. of the pa- tient; after which he advises two spoonsful of the following decoction: Take of garlic and distilled vinegar each an ounce, hysop-water eight ounces; beat up the ingredients together, gradually mixing the water, and adding three ounces of how-y. Let the whole be simmered over a gentle fire, and afterwards strain- ed for use. OF TEETHING. 351 delicately brought up, always suffer most in teething, and often fall by convulsive disorders. About tlie sixth or seventh month the teeth generally begin to make their appearauce; first, the incxsores, or fore-teeth; next, thecanini, or dog-teeth; and lastly, the molares, or grinders. About the seventh year, there tomes a new set; aud about the tweutieth, the tAvo inner grinders, called dentes sapient*, the teeth of Avisdom. Children about the time of cutting their teeth, slaver much, and have generally a looseness. When the teething is difficult, especially when the dug-teeth begin to make their v\ay through the gums, the child has starlings in his sleep, tumours of the gums, Avatchings, gripes, green stools, the thrush, fever, difficult breathing, and convulsions. Difficult teething requires nearly the sanie treatment as an inflamma- tory disease. If the bouy be bound, it must be opened either by emol- lient clysters or geutle purgatives; as manna, magnesia alba, rhubarb, senna or the like. The food should be light, and in small quantity ; the drink plentiful, but weak and diluting, as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added. If the fever be high, bleeding will be necessary; but this in veiy young children ought always to be spariigly performed. It is an evacu- ation which they bear the worst of any. Purging, vomiting, or sweat- ing, agree much better Avith them, and are generally more beneficial. Harris, however, observes, that when an inflammation appears, the phy- sician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with couvulsive-fis, a blisterirg- plaster may be applied between the shoulders, or one behind each ear. Sydenham says, that in fevers occasioned by teething, he never found any remedy so effectual as two, three, or four drops of spirits of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. T he number of doses may be four, five, or six. I have of- ten prescribed this medicine with success, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, accord- ing to the age of the child, and Avhen costiveness does not forbid it, three or four drops of laudanum may be added to each dose. In Scotland, it is very commou, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoulders. This generally eases the tickling cough which attends teething, and is by no means an useless application. When the teeth are cut with diffi- culty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed at least once a fortnight. . Several tilings have been recommended for rubbing the gums, as oils, mucilages, &c. but from these, much is not to be expected. If any thing of this kind is to be used, we would recommend a lit- tle fine honey, which may be rubbed on with the finger three or four times a day. Children are generally at this time disponed to chew whatever they get into their hands. For this reason they ought mver to be without somewha* that will yield a little to the pressure of their jr-'ms as a crust of bread, a wax candle, a bit of liquorice-root, or such like. 352 OF THE RICKETS. With regard to cutting the gums, we have seldom knoivu it ol any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger nail, the edge of a six-penny piece that is worn thin, or any sharp bo.ly which can be with safety introduced into the mouth; but a lancet, in a skilful hand, is certainly the mobt proper. In order to render the teething less difficult, parents ought to take care that their children's food be light and wholesome, and that their nerves be braced by sufficient exercise Avithout doors, the use of the cold bath, &c. Were these things duly regarded, they would have a much better effect than teething necldaces, or other nonsensical amulets avotu for that purpose. OF THE RICKETS. THIS disease generally attacks children between the age of nine months and two years. It appeared first in England, about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect eitiier to take proper exercise themselves, or to give it to their children. CAUSES.—One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, Avho neglect exercise, and live upon weak wa- tery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them after they are brought forth. Accordingly we find, that the children of such Avomen generally die of the rickets, the scrophula, consumptions or such like diseases. Chil- dren begotten by men in the decline of life, who are subject to the gout, the gravel or other chronic diseases, or who have been often afflict- ed with the venereal disease iu their youth are likewise a ery liable to the rickets. Any disorder that weakens the constitution, or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, Sic. disposes them to this disease. It may likeAvise be occasioned by impro- per diet, as food that is either too Aveak and watery, or so viscid that the stomach cannot digest it. Bad nursing is the chief cause of this disease. When the nurse is cither diseased, or has not enough of milk to nourish the child, it caunot thrive. But children suffer oftener by want of care in nurses than want of food. Allowing an infant to lie or sit too much, or not keeping it tho- roughly clean in its clothes, has the most peroiciouseffects. The want of free air is likeAvise very hurtful to children in this res- pect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should ahvays be in motion, unless when asleep; if it be suffered to lie or sit, instead of being tossed and dandled about, it will not thrive. SYMPTOMS.—At the beginning of this disease the child's flesh grows soft an 1 flabby; its strength is diminished ; it loses its Avontedcheerful- ness, looks more grave and composed than is natural for its age, and does not chuse to be moved. The head and belly become too large in pro- portion to the other parts; the face appears full, and the complexion flo- jid. Afterwards the bones begin to be affected, especially in the more OF CONVULSIONS. 353 soft and spungy parts. Hence the Avrists and ancles become thicker than usual; the spine or back-bone puts on an unnatural shape; the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All these symptoms vary according to the violence of the disease- The pulse is generally quick, but feeble; the appetite and digestion for the most part bad; the teeth come slowly and with dif- ficulty, and they often rot and fall out afterwards. Iticketty children generally have great acuteness of mind, and an understanding above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatural enlargement of the brain, is not material. REGIMEN.—As this disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be to brace and strengthen the solids, and to promote digestion and the due prepa- rationof the fluids. These important ends will be best ansAvered by Avholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If tlie child has a bad nurse, Avho either neglects her duty, or does not understand it, she should be changed. If the season be cold, the child ought to be kept warm; and Avhen the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the same effect. The limbs should be rubbed frequently Avith a Avarm hand, and the child kept as cheerful as possible. The diet ought to be dry and nourishing, as good bread, roasted flesh, &c. Biscuit is generally reckoned the best bread; and pigeons, pul- lets, veal, rabbits, or mutton roasted or minced, are the most proper flesh. If the child be too young for flesh meats, he may have rice, millet, or pearl-barley boiled with raisins, to which may be added a little wine and spice. His drink may be good claret mixed with an equal quantity of water. Those who cannot afford claret, may give the child now and then a wiue-glass of mild ale, or good porter. MEDICINE.—Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may some- times be of use, but they will seldom carry off the disease; that must de- pend chiefly upon such things as brace and strengthen the system: for which purpose, besides the regimen mentioned above, Ave would recom- mend the cold bath, especially in the warm season. It mu6t however be used Avith prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be Avell rubbed Avith a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath, it must be discontinued. Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humouis. An infusion of the Peruvian bark in wine or ale would be of service, Avere it possible to bring them to take it. We might here mention many other medicines which have been recommended for the rickets; but as there is far more danger in trusting to these than in neglecting them al- together, we chuse rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on. OF CONVULSIONS. THOUGH more children are said to die of convulsions than of any other disease, yet they are for the most pajt only a symptom of some 45 354 OF WATER IN THE HEAD. other malady. Whatever greatly irritates or stimulates the nerves, may occasion convulsions. Hence infants Avhose nerves are easily af- fected, are often throAvn into convulsions by any thing that irritates the aliraeutary canal; likewise by teething; strait clothes; the approach of the small-pox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure: wherefore, if the child be costive, the be6t way will be to begin with a clyster and afterwards to give a gentle vomit, which may be repeated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed Avith the powder of crabs' claws. Convulsions Avhich precede the eruption of the small-pox or measles generally go off upon these making their appearance. The principal clanger in this case arises from the fear3 and appreheusions of those who have the care of the patient. Convulsions are very alarming, and some- thing must be done to appease the affrighted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great danger of its life, when a little time, bath- ing the feet in warm water, and throwing in a mild clyster, would have set all to rights. When convulsion-fits arise from the cutting of teeth, besides gentle evacuations, we ivould recommend blistering, and the use of antispasmo- dic medicines, as the tincture of soot, asafcetida, or castor. A few drops of any of these may be mixed in a cup of white-wine whey, and given occasionally. When convulsions proceed from any external cause, as the pressure occasioned by strait clothes or bandages, &c. These ought immediately to be removed; though in this case taking away the cause Avill not al- ways remove the effect, yet it ought to be done. It is not likely that the patient Avill recover, as long as the cause Avhich first gave rise to the disorder continues to act. When a child is seized Avith convulsions without having any complaint in the bowels, or symptoms of teething; or any rash or other discharge which has been suddenly dried up; we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as littie can be done to relieve the unhappy patient. When a disease pro- ceeds from an original fault in the formation or structure of the brain itself, Are canno* expect that it should yield to medicine. But as this is not always the cause, even of convulsions which proceed immediately from the brain, some attempts should be made to remove them. The chief intention to be pursued for this purpose, is to make some deriva- tion from the head, by blistering, purging, and the like. Should these fail issues or setons may be put in the neck, or between the shoulders. OF WATER IN THE HEAD. THOUGH water in the head, or a dropsy of the brain, may affect adults as Avell as children, yet, as the latter are more peculiarly liable to it, we thought that it would be most proper to place it among the diseases of infants. 6F SURGERY. 355 CAUSES.—A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like; it may also proceed from an original laxity or weakness of the brain; from scirrhous tumours or ex- crescences within the skull: a thin watery state of the blood : a dimin- ished secretion of urine; a sudden check of the perspiration; and lastly, from tedious and lingering diseases, which waste and consume the patient. SYMPTOMS.—This disease has at first the appearance of a slow fe- ver ; the patient complains of a pain in the crown of his head or over his eyes; he shuus the light; is sick, and sometimes vomits; his pulse is ir- regular aud generally low: though he seems heavy and dull, yet he does not sleep : he is sometimes delirious, and frequently sees objects double; towards the end of this commonly fatal disease, the pulse becomes more frequent, the pupils are generally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.*1 MEDICINE.—No medicine has hitherto been found sufficient to car- ry off a dropsy of the brain. It is laudable, however, to make some at- tempts, as time or chance may bring many things to light, of which at present we have no idea. The medicines generally used are, purges of rhubarb or jalap, with calomel or blistering-plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recom- mended in the common dropsy. A discharge from the nose ought like- wise to be promoted by causing the patient to snuff the powder of asarum, white hellebore or the like. Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any instances of a cure being performed in a confirmed dropsy of the brain ; but in so des- perate a malady every thing deserves a trial.t * CHAP. LII. OF SURGERY.J To describe all the operations of surgery, and to point out the different diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it: we must therefore confine our observations to such cases as most generally occur, and * I very lately lost a patient in[this disease, where a curious metastasis seemed to take place. The water at first appeared to be in the abdomen, afterwards in the breast, and last of all it mounted up to the brain, where it soon proved fatal. •j- One reason why this disease is seldom or never cured, may be, that it is sel- dom known till too far advanced to admit of a remedy. Did parents watch the first symptoms, and call a physician in due time, I am inclined to think that something might be done But these symptoms are not yet sufficiently known, and are often mistaken even by physicians themselves Of this I lately saw a striking instance in a patient, attended by an eminent practitioner of this city, who had all along mistaken the disease for teething. t Late Practice has fully proven, that all Surgical Instruments, except the lancet for Vaccination, dipped in oil at the instant of using, lessens the pain—It is salutary also to have all instruments at blood heat. OJO> OF BLEEDING. in which proper assistance is either not asked, or not always to be obtain- ed. Though an acquaintance with the structure of the human body is in- dispensably necessary to qualify a man for being an expert surgeon; yet many things may be done to save the lives of their fellow-men, in emer- gencies, by those who are no adepts in anatomy. It is amazing with what facility the peasants daily perform operations upon brute animals, which are not of a less difficult nature than many of those performed on the hu- man species; yet they seldom fail of success. Indeed eveiy man is in some measure a surgeon whether he will or not. He feels an inclination to assist his fellow-men in distress, and accidents happen every hour which give occasion to exercise this feeling. The feelings of the heart, hotvever, when not directed by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him; while another, for fear of doing amiss, stands still and sees his bosom friend expire Avithout so much as attempting to re- lieve him, even when the means are in his poAver. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to knoAV Avhat ought to be done upon such emergencies. OF BLEEDING. N O operation of surgery is so frequently necessaiy as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, &c. we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the sub- ject of ridicule. It is however an operation of great importance, and must, when seasonably aud properly performed, be of singular service to those in distress. Bleeding is proper at the beginning of all inflammatory fevers, as pleu- risies, peripneumonies, &c. It is likewise proper iu all topical inflam- mations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, Sic. as also in the asthma, sciatic pains, coughs, head-achs, rheuma- tisms, the apoplexy, epilepsy, and bloody-flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfor- tune to be strangled, drowned, suffocated with foul air, the fumes of metal or the like. In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings occasioned by men; weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper. Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lan- cet, it is to be preferred to any other method; but Avhere a vein cannot. be found, recourse must be had to leeches or cupping. The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child OF BLEEDINC, 357 could bear to lose as much blood as a groAvn person, or that a delicate lady should be bled to the same extent as a robust man. From Avhatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessaiy, in order to raise the vein, to make the bandage pretty tight, it will be pro- per in such cases, as soon as the blood begins to flow, to slacken it a lit- tle. The bandage ought to be applied at least an inch, or an inch and an half, from the place where the wound is intended to be made. Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whip cord under the finger. It was formerly a rule, even among those who had the character of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the Avhole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body: besides, it may often be occasioned or prevented by the manner in which the operation is performed. Children are generally bled Avith leeches. This, though sometimes necessary, is a very troublesome and uncertain practice. It is impossible to knoiv what quantity of blood is taken aAvay by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those Avho practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine. Certain hurtful prejudices with regard to bleeding still prevail among the country-people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, Avith- out considering that all the blood vessels arise from the heart and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body the blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first Weeding will perform Avonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and, when they think themselves in ex- treme danger, they fly to it for relief whether it be proper or not. Bleed- ing at certain stated periods or seasons has likewise bad effects. It is a common notion that bleeding in the feet draws the humours doAvnwards, and consequently cures diseases of the head and other supe- rior parts; but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm-water, and kept there till a sufficient quantity of blood be let. We shall not spend time in describing the manner of performing this operation: that will be better learned by example than precept. TAven- ty pages of description would not convey so just an idea of the operation as seeing it once performed by an expert hand. Neither is it necessary 358 OF INFLAMMATIONS AND ABSCESSES. to point out the different parts of the body from whence blood may be taken, as the arm, foot, forehead, temples, neck, &c. These vvill readily occur to every intelligent person, aud the foregoing observations will be sufficient for determining which of them is most proper upon any parti- cular occasion. In all cases where the intentiou is merely to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be performed. OF INFLAMMATIONS AND ABSCESSES. FROM Avhatever cause an inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is impossible to foretel with certainty in Avhich of these ways any particular inflamma- tion Avill terminate, yet a probable conjecture may be formed with regard to the event, from a knowledge of the patient's age and constitution. In- flammations happening in a slight degree upon colds, and without any previous indisposition, will most probably be dispersed; those which follow close upon a fever, or happen to persons of a gross habit of body, will generally suppurate; and those Avhich attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene. ^ If the inflammation be slight, and the constitution sound, the disper- sion ought always to be attempted. This will be best promoted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embro- cated with a mixture of three-fourths of sweet oil, and one-fourth of vine- gar, and afterwards covered with a piece of wax-plaster. If, notwithstanding these applications, the symptomatic fever in- creases, and the tumour becomes larger, with violent pain and pulsa- tion, it will be proper to promote the suppuration. The best appli- cation for this purpose is a soft poultice, which may be renewed twice a-day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, whioh may easily be known from the thinness of the skin in the most prominent part of it, a fluctuation of matter which may be felt under the finger, and, generally speaking, an abate- ment of the pain, it may be opened either with a lancet, or by means of caustic. The last way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following symptoms* the inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled Avith ichor of different colours spread all over it; the tumour subsides, and from a duskish complexion becomes black; a quick low pulse, Avith cold clammy sAieats, are the immediate forerunners of death. When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran.— Should the symptoms become Avorse, the part must be scarified and afterwards dressed ivith basilicum softened with oil of turpentine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with generous cordials, and the Peruvian OF WOUNDS. 359 bark exhibited in as large doses as the stomach Avill bear it. If the mortified parts should seperate, the wound will become a common ulcer, and must be treated accordingly. This article includes the treatment of all those diseases, which, indif- ferent parts of the country, go by the names oi biles, imposthumes, whit- loes, &c. They are all abscesses in consequence of a previous inflam- mation, which, if possible, ought to be discussed; but Avhen this cannot be done, tlie suppuration should be promoted, and the matter discharged by an incision, if necessary: afterwards the sore may be dressed with yelloAV basilicum, or some other digestive ointment. OF WOUNDS. NO part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no av ound can be cured Avithout the application of them. It is hoAvever a fact, that no external application Avhatever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defend- ing them from the external air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them. The same observation holds Avith respect to internal applications. These only promote the cure of Avounds as far as they tend to prevent a fever, or to remove any cause that might obstruct or impede the opera- tions of Nature. It is Nature alone that cures wounds ! All that art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature's efforts. With this simple view we shall consider the treatment of Avounds, and endeavour to point out such steps as ought to be taken to facilitate their cure. The first thing to be done Avhen a person has received a wound, is to examine whether any foreign body be lodged in it, as Avood, stone, iron, lead, glass, dirt, bits of cloth or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient's weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted vihen he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c. or where any considerable blood-vessel is cut, a skilful surgeon ought immediately to be called, otherwire the patient may lose his life. But sometimes the discharge of blood is so great, that if not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the Avound be in any of the limbs, bleeding may gener- ally be stopt by applying a tight ligature or bandage round the member a little above the Avound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to beput under it, Avhich must be tAvisted, in the same manner as a countryman does a cartrope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as strain 360 OF WOUNDS. ing it too much might occasion an inflammation of the parts, and endan- ger a gangrene. In parts where this bandage cannot be applied, various other me- thods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped iu a solution of blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric* of the oak as preferable to any of the other styptics; and indeed it deserves considerable eucomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above Avhich a bandage may be applied so tight as to keep it firmly on. Though spirits, tinctures, and hot bakams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote, but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flow- ing blood, by searing the mouths of the vessels; but, by rendering the parts callous they obstruct the cure. In slight wounds, Avhich do not penetrate much deeper than the sMu, the best appfication is a bit of the common black sticking-plaster. This keeps the sides of the Avound together, and prevents the air from hurting it, which is all that is necessary. When a ivound penetrates deep, it is not safe to keep its lips quite close: this keeps in the matter, and is apt to make the Avound fester. In this case the best way is to fill the wound with soft lint, Commonly called caddis. It however must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered Avith a cloth dipped in oil, or spread with the common wax-plaster ;f and the whole must be kept on by a proper bandage. We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common sen^e will generally suggest the most commodious method of applying a band- age ; beside, descriptions of this kind are not easily understood or re- membered. The first dressing ought to continue on for at least tivo days; after * Dr. Tissot, in his " Advice to the people," gives the following directions for gathering, preparing, and applying the agaric—" Gather in autumn," says lie, " while the fine weather lasts, the agaric of the oak, which is a kind of fun- gus or excresence issuing from the wood of that tree. It consists at first of four parts, which present themselves successively:—1. The outward rind, or skin, which may be thrown away. "2. The part immediately under this rind, which is the best of all. This is to be beat well with a hammar, till it becomes soft and pliable. This is the only preparation it requires, and a slice of it of a proper size is to be applied directly over the bursting open blood vessels. It constringes and brings them close togetlier, stops the bleeding, and generally falls off at the end of two days. 3. The third part adhering to the second may serve to stop the bleeding from the smaller vessels; and the fourth and last part may be reduced to powder as conducing to the same purpose."—Where the agaric cannot be had, sponge may be used in its stead. It must be applied in tlie same manner, and has nearly the same effects. f See Appendix, Wax-Plaster. OF BURNS AND SCAlfcS. 661 'Vhirii it may be removed, and fresh lint applied as "before. If any part of the first dressing sticks so close as not to be removed with ease or safe- ty to the patient, it may be allowed to continue, and fresh lint dipped in sweet oil laid over it. This will soften it so as to make it come off easily at the next dressing. Afterwards the wound may be dressed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it av ith the yellow basilicum ;* and if fungus, or what is called proud-fleshy should rise in the Avound, it may be checked, by mixing Avith the oint- ment a little burnt alum or red precipitate of mercury. When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter., i This must be applied instead of ^plaster, and should be changed twice 3 day. If the Avound be large, and there is reason to fear an inflammation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and every thing that is of a heating nature. If he be of a full habit, and has lost but little blood from the Avound, he must be bled; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the Avound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to al- low her to struggle with the disease in her own way, than to sink the pa^ tient's strength by excessive evacuations. Wounded persons ought to be kept perfectly quiet and easy. Every ihing that ruffles the mind or moA es the passions, as love, anger, fear, ex- cessive joy, Sic. are very hurtful. They ought above all things to ab- stain from veneiy. The body should be kept gently open, either by lax- ative clysters, or by a cool vegetable diet, as roasted apples, stewed prunes, boiled spinage, and such like. BURNS AND SCALDS.5 VARIOUS remedies are recommended for the treatment of these accidents; and it happens fortunately for the pressure of such an emer- ge nc), that some of tlie most common things are also the most useful on (he occasion. The pain of burns and scalds may be instantly abated by immersing the part affected in cold water, or indeed in any cold fluid, or in spirits of Avine. An excellent application likeAvise is vinegar, with or Avithout powdered chalk in it. If the injury be on the fingers or hands, \hf application may be made by immersion, but if in any part where this would be inconvenient, the vinegar may be applied by means of linen rags dipped in it. In slight injuries, the vinegar, if early and assiduously applied, will of itself soon effect a cure; but should any degree of pain return, the immersion or fomentation must be repeated. In recent burns or scalds, attended with large blisters, excoriations, or loss of substance, the vinegar ought to be applied till the pain nearly ceases, which generally happens Avithin eight hours. Many practitioners recommend spirits of turpentine instead of vinegar; onlime-Avater and * S<-q Appendix, Yeh.oav Basilicum. 362 OF BURNS AND SCALfiS. linseed-oil. The viuegar need not be employed longer tlo.n twelve hour?, except on the outside of the sores, which, while they continue to be swel- led or inflamed, should be fomented for a minute or two before they are dressed. For dressing the sores which arise from burns or scalds, one of the best applications is a poultice of bread, water, and sweet oil. This should be removed in six hours, when the sores are to be covered with chalk finely powdered, till it has absorbed the matter, and appears quite dry. A fresh poultice must be laid over the whole, which, with tlie sprinkling of the chalk, is to be repeated morning and evening till the sores are healed. After the second or third day, if the sores be on a part of the body where it is difficult to keep the poultice from shifting, a plaster of cerate thickly spread, may be used as a substitute in the day-time. When there are large blisters upon the part they should be opened with a lancet before the application of the vinegar; and the Avater they con- tain be pressed out Avith a linen cloth, that the vinegar may act more closely upon the burnt flesh, which in this case it does efficaciously. In severe cases, and in cold weather, the vinegar should be nearly blood- warm. If the patient will not suffer the vinegar to be applied immediately to the surface, on account of the pain it excites, a linen rag soaked in sweet oil may be previously laid on the part, covering the whole Avith cloths dip- ped in vinegar; and these applications are to be occasionally repeated till the pain and inflammation be entirely removed; after which the parts should be dressed, or if the burning be very deep, with mixture of that and yellow basilicum. When the burn or scald is violent, or has produced a high degree of inflammation, so that there is reason to be apprehensive of a gangrene, the same method of cure becomes necessary as in other violent inflamma- tions. The patient in this case, must be put upon a low (diet, and drink plentifully of Aveak diluting liquors. He must likewise be bled, and hi^ body be kept open. But if the burnt parts should become livid or black, with other symptoms of mortification, it will be necessaiy to apply to them camphorated spirits of wine, tincture of myrrh, and other antisep- tics, or correctors of putrefaction, mixed with a decoction of the Peru- vian bark. Iu this case, the bark must likewise be taken internally; the patient at the same time using a more generous diet, with wine, spicc- ries, &c. When burns are occasioned by the explosion of gunpowder, some of the grains of the powder are apt to be forced into the skin. At first they produce much irritation; and, if they be not removed, they com- monly leave marks which remain during life. They should therefore be picked out as soon as possible after the accident; and to prevent inflam- mation, as well a3 to dissolve any powder which may remain, the pails affected, should be covered for a day or two with emollient poultices. A strong solution of soap in water has long been in use with artificers employed in any business exposing workmen to very bad scalds. This is allowed to be an excellent remetly. But, as the soap Avould take some time in dissolving, and the solution some time in cooling, Dr. Underwood recommends a mixture of six ounces of oil to ten of wa- ter, with two drachms of the ley of kali, or pot-ash. This quantity- may be sufficiemt for a burn on the hand or foot, wliich is to be im OF BRUISES. 363 mersed, and kept about half an hour in the liquor, which will remoAc the injury, if recourse to it immediately be had; but must be repeated, as the [»ain may require, if the scald or burn be of some standing. As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occurred in my practice. A middle-aged man, of a good constitution, fell into a large vessel full of boil- ing Avater, and miserably scalded about one half of his body. • As his clothes weie on, the burning in some parts was very deep before they could be got off. For the first two days the scalded parts had been frequently anointed with a mixture of lime-Avater aud oil, which is a veiy proper ap- plication for recent burnings. On the third day, when I first saw him, his fever was high, and his body costive^ for which he was bled, and had an emollient clyster administered. Poultices of bread and milk, softened with fresh butter, Avere likewise applied to the affected parts, to abate the heat and inflammation. His fever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture Avith small doses of nitre, and had an emollient clyster adminis- tered once a-day. When the inflammation began to abate, the parts Avere dressed Avith a digestive composed of brown cerate and yellow basi- licum. Where any black spots appeared, they Avere slightly scarified, aud touched with the tincture of myrrh, and to prevent their spreading, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business. The most useful application, we are told, with which families can be provided against any emergency of this kind, is a strong brine, made by placing sliced potatoes and common salt in alternate layers in a pan, al- lowing them to remain until the whole of the salt is liquified; which must be then drained off, and kept in bottles, properly labelled, ready for imr mediate use. OF BRUISES. BRUISES are generally productive of worse consequences than Avounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is needless to give any definition of a disease so universally known; we shall therefore pro- ceed to point out the method of treating it. In slight bruises it will be sufficient to bathe the part with warm vinegar to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more pro- per than rubbing it with brandy, spirits of Avine, or other ardent spirits, which are commonly used in such cases. In some parts of the country the peasants apply to a recent bruise a ca- taplasm of fresh cow-dung. I have often seen this cataplasm applied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect. When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food should be light and cool, and his drink weak and of an opening nature; as whey sweetened Avith honey, decoctions of tamarinds, barley, cream-tartar whey, and such like. The bruised part must be bathed with vinegar and water, as di- rected above; and a poultice made by boiling crumbs of bread, elder- flowers, and camomile flowers, in equal quantities of vinegar and water, 364 OF ULCERS. applied to it. This poultice is peculiarly proper when a wouud i> joined to the bruise. It may be renewed tAvo or three times a-day. As the structure of the vessels is totally destroyed by a violent bruise, there often ensues a great loss of substance, which produces an ulcerous sore very difficult to cure. If the bone be affected, the sore will not heal before an exfoliation takes place; that is, before the diseased part of the bone separates, and comes out through the wound. This is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are frequently mistaken for the king's evil, and treated as such, though in fact they proceed solely from the' inju- ry which the solid parts received from the blow. Patients in this situation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irrita- ted with various and opposite applications, that it is often at length render- ed absolutely incurable. The best method of managing such soies is, to take care that the patient's constitution does not sutler by confinement 01 improper medicine, and to apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile floAvers, or the like, Biay be put to nourish the part, and keep it soft and Avarra. Nature, thus assisted, will generally in time operate a cure, by throwing off the diseased parts of the bone, after.Avhich the sore soon heals. OF ULCEUS. ULCERS may be the consequence of Avounds, bruises, or imposthumes improperly treated ; they may likewise proceed from an ill state of the humours, or what may be called a bad habit of body. In the latter case they ought not to be hastily dried up, otherwise it may prove fatal to the patient. Ulcer's happen most commonly iu the decline of life; and persons who neglect exercise, and live grossly, are \ most liable to them. They might often be prevented by retrenching some part of the solid food, or by opening artificial drains, as issues, setous, or the like. An ulcer may be distinguished from a wound by its discharging a thin watery humour, which is often so acrid as to inflame and corrode the skin; by the hardness and perpendicular situation of its sides or edges; by the time of its duration, Sic. It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by proper regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malignant fevers or other acute diseases, may generally be healed Avith safety after the health has been restored for some time. The cure ought not however to be attempted too soon, nor at any time Avithout the use of purging me- dicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either ac- company chronic diseases, or come in their stead, they must be cau- tiously healed. If au ulcer conduces to the patient's health, from of uicers. 365 whatever cause it proceeds, it ought not to be healed; but if, on the contrary, it Avastes the strength, and consumes the patient by a slow fever it should be healed as soon as possible. We Avould earnestly recommend a strict attention to these particulars to all Avho have the misfortune to labour under this disorder, particularly those in the decline of life; as we have frequently knoAvn people throw aAvay their lives by the want qf it, while they were extolling and gene- rously rewarding those ivhom they ought to have looked upon as their executioners. The most proper regimen for promoting the cure of ulcers, is to avoid all spices, salted and high seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxative vegetables, and by driuki g butter-milk, Avhey sweetened Avith honey, or the like. The patient ought to be kept cheerful, and should take as much exercise as he can easily bear. When the bottom and sides of an ulcer seem hard and callous, they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the yelloAV basilicum ointment. Sometimes it will be necessaiy to have the edges of the ulcer scarified with the lancet. Lime-Avater has frequently been knoAvn to have happy effects in the cure of obstinate ulcers. It may be used in the same manner as direct- ed for the stone and gravel. My late learned and ingenious friend Dr. Whytt strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill-conditioned ulcers. I have frequently found this medicine, Avhen given according to the Doctor's directions, prove very successful. The dose is a table-spoonful night and morning; at the same time Avashing the sore twice or thrice a-day with it. In a letter which I had from tlie Doctor a little before his death, he informed me, " That he observed washing the sore thrice a-day with the solution of a triple strength Avas very beneficial."* A fistulous ulcer can seldom be aired Avithout an operation. It must either be laid open so as to have its callous parts destroyed by some cor- rosive application, or they must be entirely cut away by the knife; but as this operation requires the hand of an expert surgeon, there is no oc- casion to describe it. Ulcers about the anns are most apt to become fistulous, and are very difficult to cure. Some indeed pretend to have found Ward's fistula paste very successful in this complaint. It is not a dangerous medicine, and being easily procured, it may deserve a trial; but as these ulcers generally proceed from an ill habit of body, they will seldom yield to any thing except a long course of regimen, assisted by medicines which are calculated to correct that particular habit, and to induce an almost total change in the constitution. * In ulcers of the lower limbs great benefit is often received from tight roll- ers, or wearing a laced stocking, as this prevents the flux of humours to the sores, and disposes them to heal. 366 CHAP. LIII. OF DISLOCATIONS. vvHEM a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislocated. As this often happens to persons in situations where no medical assistance can be obtained, by which means limbs, and even lives, are frequently lost, we shall endeavour to point out the method of reducing the most com- mon luxations, and those which require immediate assistance. Any per- son of common seuse and resolution, who is present when a dislocation happens, may often be of more service to the patieut, than the most ex- pert surgeon can after the swelling and inflammation have come on. When these are present, it is difficult to know the state of the joint, and dangerous to attempt a reduction, and by waiting till they are gone off, the muscles become so relaxed, aud the cavity filled up, that the bone can never afterwards be retained iu its place. A recent dislocation may generally be reduced by extension alone, Avhich must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstan- ces of the patient. When the bone has been out of its place for a con- siderable time, and a swelling or inflammation has come on, it will be necessaiy to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is at- tempted. All that is necessary after the reduction, is to apply cloths dipt in vnnegar or camphorated spirits of wine to the part, and to keep it per- fectly easy. Many bad consequences proceed from the neglect of this rule. A dislocation seldom happens without the tendons and ligaments of the joint being stretched and sometimes torn. When these are kepi easy till they recover their strength and tone, all goes on very well; but if the injury be increased by too frequent an exertion of the parts, no wonder if they be found weak and diseased ever after. DISLOCATION OF THE JAAV. THE lower jaw may be luxated by yawning, blows, falls, chewing hard substances, or the like. It is easily known from the patient's be- ing unable to shut his mouth, or to eat any thing, as the teeth of the under jaw do not correspond with those of the upper; besides, the chin either hangs down, or is throAvn toward one side, and the patient is neither able to 6peak distinctly, nor to sivallow Avithout considerable difficulty. The usual method of reducing a dislocated jaw is to set the pa- tient upon a low stool, so as an assistant may hold the head firm by pressing it against his breast. The operator is then to thrust his two thumbs, being first wrapped up with linen cloths that they may not slip, as far back into the patient's mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards by DISLOCATION OF THE NECK AND RIBS. 367 which means thefelapsed heads of the jaw may be easily pushed into their former cavities. The peasants in some part of the country have a peculiar way of per- forming tills operation. One of them puts a handkerchief under the patient's- chin then turning his back to that of the patient, pulls him up by the chin so as to suspend him from the grouud. This method often succeeds, but Ave think it a dangerous one, and therefore recommend the former. DISLOCATION OF THE NECK. THE neck may be dislocated by falls, violent Woavs or the like. In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck Avas broken; it is however, for the most part only partially dislocated, and may be reduced by almost any person Avho has resolution enough to attempt it. A complete dislocation of the neck is instantaneous death. When the neck is dislocated, the patient is immediately deprived of all seuse and motion; his neck SAvells; his countenance appears bloated; his chin lies upon his breast, and his face is generally turned towards one side. To reduce this dislocation, the unhappy person should immediately be laid upon his back on the ground, and, the operator must place himself behind him so as to be able to lay hold of his head with both hands, while he makes a resistance by placing his kuees against the patient's shoulders. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he per- ceives that the joint is replaced, Avhich may be known from the noise which the bones generally make when going in, the patient's beginning to breathe, and the head continuing in its natural posture. This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily performed even by Avomen, and often by men of no medical education. After the neck is reduced, tlie patient ought to be bled, and should be suffered to rest 4 for some days, till the parts recover their proper tone. DISLOCATION OF THE RIBS. AS the articulation of the ribs Avith the back-bone is very strong, they are not often dislocated. It does hoAvev7er sometimes happen, which is a sufficient reason for our taking notice of it. When a rib is disloca- ted either upwards or doAvn wards, in order to repiace it, the patient should be laid upon his belly on a table, and tlie operator must endeavour to push the head of the bone into its proper place. Should this method uot succeed, the arm of the disordered side may be suspended over a gate or ladder, and, while the ribs are thus stretched asunder, the heads of such as are out of placj may be thrust into their former situation. Those dislocations wherein tlie heads of the ribs are forced inwards, are both more dangerous and tlie most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient upon his belly over a cask, or ?ome gibbous body, and to move 368 DISLOCATION OF THE SHOULDERS, &C. the fore part of the rib inward towards the back, sometimes shakm* it. by this means the heads of the luxated ribs may slip into their former place. DISLOCATION OF THE SHOULDER. THE humerus or upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but veiy seldom directly upwards. From the nature of its articulation, as Avell as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression of cavity on the top of the shoulder, and an ina- bility to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm pit; but when it is backward, there appears a protuberance behind the should- er, and the arm is throivn forwards towards the breast. The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body- so that it may not give way to the extension, while another lays hold ol the arm a little above the elbow, and gradually extends it. The opera- tor then puts a napkin under the patient's arm, and causes it to be tied be- hind his own neck; by this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. Iu young aud delicate patient's I have generally found it a veiy easy mat- ter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the ex- tension, the arm ought always to be a little bent. DISLOCATION OF THE ELBOW. THE bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient's inability to bend his arm, a dislocation of this joint may easily be knoAvn. Two assistants are generally necessary for reducing a dislocation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck. Luxations of the wrist and fingers are to be reduced in the same man- ner as those of the elbow; viz. by making an extension in different di- rections, and thrusting the head of the bone into its place. DISLOCATION OF THE THIGH. WHEN the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; OF BROKEN BONES, &C. 369 but when it is displaced backward, it is usually pushed upwards at the same time, by which means the limb is shortened, and the foot is turued inwards. When the thigh bone is displaced forward and downward, the patient in order to have it reduced, must be laid u;on his back and made last by bandages, or held by assistants, Avhile by others an extension is made by means of slings fixed about the bottom of the thigh a little above the knee. While the extension is made, the operator must push the head of the bone outward, till it gets into the socket. If the dislocation be outward, the patient must be laid upon his face, and, during the extension, the head of the bone must be pushed inivard. Dislocations of the knees, ancles and toes, are reduced much in the same manner as those of the upper extremities, vis. by making an extension in opposite directions, while the operator replaces the bones. In many ca- ses, however, the extension alone is sufficient and the bone will slip into its place merely by pulling the limb with sufficient force. It is not here- by meant, that force alone is sufficient for the reduction of dislocations-. Skill and address Avill often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual. CHAP. LIV, OF BROKEN BONES, &c, X HERE is, in most villages, some person who pretends to tlie art of reducing fractures. Though in general such persons are very ig- norant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, Avill enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed: we shall therefore recommend the following hints to their consideration : When a large bone is broken, the patient's diet ought in all respects to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters; or, if these can- not be conveniently administered, by food that is of an opening quality; as steAved prunes, apples boiled in milk, boiled spiuage, and the like. It eught however to be here remarked, that persons who have been accus- tomed to live high, are not all of a sudden to be reduced to a very low di- et. This might have fatal effects. There is often a necessity for indul- ging even bad habits, in some measure, where the nature of the disease might require a different treatment. It will generally be necessaiy to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has at the same time received any bruise or contusion. This operation should not only be performed soou after the accident happens, but if the patient be very fe* verish, it may be repeated next day. AVhen several of the ribs are bro- ken, bleeding is peculiarly necessary. 47 t 370 OF BROKEN BONES, &C. If any of the large bones which support the body are broken, the pa- tient must keep his bed for several weeks. It is by no means necessary* however, that he should lie all that time, as is customary, upon his back. This situation sinks the spirits, galls and frets the patient's skin, and ren- ders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raking him up and laying him down, tliat he make no exertions himself, other* wise the action of the muscles may pull the bone out of its place.* It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I haA'e known a fractured thigh-bone, after it had beeu kept straight for above a fortnight, displaced by this means, aud continue bent for fife, in spite of all that could be done. It has been customaiy when a bone was broken, to keep the limb for five or six Aveeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure. The best situation is to keep the limb a little bent. This is the posture into Avhich every animal puts its limbs when it goes to rest, and in which fewest mus- cles are upon the stretch. It is easily effected, by either laying the pa- tient upon his side, or making the bed so as to favour this position of the limb. Bone-setters ought carefully to examine Avhether the bone be not shat- tered or broken into several pieces. In this case it will sometimes be necessaiy to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror Avhich atteuds the very idea of an amputation, often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated be- fore the third day after the accident, when the gangrene had proceeded so far as to render the operation useless. When a fracture is accompanied with a wound, it must be dressed in all respects as a common wound. All that art can do towards the cure of a broken bone, is to lay it perfectly stiught, and to keep it quite easy. All tight bandages do hurt. They had much better be wanting altogether. A great ma- ny df the bad consequences Avhich succeed to fractured bones are owing to tight bandages. This is oue of the ways in which excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which ivere ever known, happened Avhere no banda. * Various pieces of machinery have been contrived for counteracting the force of the muscles, and retaining the fragments of broken bones ; but as descrip- tions of these without drawings would be of little use, I shall refer the reader to a cheap and useful performance " on the nature and cure of fractures," lately published by my ingenious friend Mr. Aitken, surgeon in Edinburgh ; wherein that gentleman has not only given an account of the machines recommended in fractures by former authors, but has likewise added several improvements of his own, which are peculiarly useful in compound fractures, and in cases where patients with broken bones are obliged to be transported from one place to another. OF STRAINS, 371 ges were applied at all. Some method however must be taken to keep the member steady; but this maybe done many ways Avithout bracing it with a tight bandage. The best method of retention is by two or more splints made of leather or pasteboard. These if moistened before they be applied, soon as- sume the shape of the included member, and are sufficient, by the asr sistance of a very slight bandage, for all the purposes of retention. The bandage which Ave Avould recommend, is that made with twelve or eigh- teen tails. It is much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The spliuts should always be as long as the limb, with holes cut for the ancle when the fracture is in the leg. In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors. The most proper external application for a fracture is oxycrate or a mixture of vinegar and water. The bandages should be wet with this at every dressing. OF STRAINS. STRAINS are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, be- cause he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days. Country people generally immerse a strained limb in cold water. This is very proper provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one. Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels and prevents the action of the parts from increasing the disease. It should not however be applied too tight. I have frequently knoAvn bleeding near the affected part have a very good effect; but what we Avould recommend above all is case. It is more to be depended on than any medicine, and seldom fails to remove the complaint.* • A great many external applications are recommended for strains, some of which do good, and others hurt The following are such as may be used with the greatest safety, viz poultices made of stale beer or vinegar and oat-meal, camphorated spirits of wine, Mindererus's spirit, volatile liniment, volatile aromatic spirit diluted with a double quantity of water, and the common fomen* tation, with die addition of brandy or spirit of wine. 372 OF RUPTURES. CHILDREN and old people are most liable to this disease. In tlie former it is geuerally occasioned by excessive crying, coughing, vomit- ing, or the like. In the latter, it is commonly the effect of blows or vi- olent exertions of the strength, as leaping, carrying great ay eights, &c. In both a relaxed habit, indolence, and an oily or very moist diet, dig- pose the body to this disease. A rupture sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect au obstruction of the bowels, all those places were ruptures usually hap- pen ought carefully to be examined. The profusion of a very small part of the gut will occasion all these sy uiptoms, and if not returned in due time, will prove fatal. On the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. Af- ter it is returned, a piece of stirking plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considera- ble time. The method of making and applying these rupture bandages for children is pretty well known. The child must as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed. In adults, Avhen tlie gut has been forced down with great violence, or happens from any cause to be inflamed, there is often great difficulty in returning it, aud sometimes the thing is quite impracticable without an operation; a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, Avithout having recourse to any other means than what are in the power of every man, I shall briefly mention the method which 1 generally pursue. After the patient has been bled, he must be laid upon his back, with his head very Ioav, and his breech raised high Avith pilloAvs. In this sit- uation flannel clotlis wrung out of a decoction of mallows and camomile flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter aud an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pres- sure. If the tumour be very hard, considerable force will be necessary: but it is not force alone which succeeds here. T he operator, at the same time that he makes a pressure with the palms of his hands, must wi'.h his fingers artfully conduct the gut iu by the same aperture through which it came out. The - manner of doing this can be much easier con- veyed than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed. There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise sur- geons to try every method of returning the gut before they have re- course to the knife. I have once and again succeeded by persevering OF CASUALTIES. 373 in my endeavours, after eminent surgeons had declared the reduction of the gut impracticable Avithout an operation.* An adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man's estate should ever be without one of those bandages. Persons who have a rupture ought carefully to avoid all violent exer- cise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold. CHAP. LV. OF CASUALTIES. XT is certain that life, when to all appearance lost, may often, by due care be restored. Accidents frequently prove fatal, merely be- cause proper means are not used to counteract their effects. No person ought to be looked upon as killed by any accident unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far im- paired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so ; but if the body be kept warm, as soon as the injured part has recov- ered its power of acting, the fluids will again begin to move, and all the vital functions will be restored. It is a horrid custom immediately to consign over to death eveiy per- son who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person instead of being carried into a warm house, and laid by the fire or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ig- norance, supported by an ancient superstitious notion, Avhich forbids the body of any person killed by accident to be laid in an house that is in- habited. What the ground of this superstition may be, we shall not pre- * I would here beg leave to recommend it to every practitioner, when his pa- tient complains of pain in the- belly with obstinate costiveness, to examine the groins and every place where a rupture may happen, in order that it may be immediately reduced. By neglecting this, many perish who were not suspect- ed to have had ruptures till after they were dead I have known this happeq where half a dozen of the. faculty were in attendance. 374 SUBSTANCES STOPT BETWEEN tend to inquire; but surely the conduct founded upon it is contrary Id all the principles of reason, humanity, and common sense. Wheu a person seems to be suddenly deprived of life, our first business is to inquire into the cause. We ought carefully to observe whether any substance be lodged in the wind pipe or gullet; and if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm tvater, or rubbed with warm cloths, &c. to pro- mote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the pa- tient with hot cloths, or salt, and covering his body with Avarm sand, ashes or the like. I should now proceed to treat more fully of those accidents, Avhich without immediate assistance, Avould often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his ob- servations as seem to be the most important, and adding such of my OAvn as have occurred in the course of practice. OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH. THOUGH accidents of this kind are very common, and extremely d ngerous, yet they are generally the effect of carelessness. Children should be taught to cbew their food well, and to put nothing into theii iiKniths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep Avith the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substances be- fore the person is aware.% When any substance is retained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The saf- est and most certain way is to extract it; but this is not always the easi- est , it may therefore be more eligible sometimes to thrust it down, es- pecially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing opes, as bread flesh, fruits, and the like. All indigestible bodies, as cork, wood, bones' pieces of metal, and such like, ought if possible to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish bones, bits of glass, &c. When such substances have not passed in too deep, we Bhould endea- vour to extract them with our fingers which method often suc- ceeds. When they are lower, we must make use of nippers, or a * A woman in one of the hospitals of this city lately discharged a great num- ber of pins, which she had swallowed in the course of her business, through an ulcer in her side. THE MOUTH AND -STOMACH. 37S small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descend- ed far into the gullet. If the fingers and nippers fail, or cannot be duly applied, crotchets, a kiud of hooks, must be employed. These may be made at once, by bend" ing a piece of pretty strong iron wire atone end, it must be introduced in the flat way; and for the better conducting it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it; which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted iu any instrument employed on such occasions, to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator's hand. After the crotchet has passed below the substance that obstructs the passage, it is draAvn up again, and hooks up the body along with it. The crotchet is also very convenieut, when a substance somewhat flexible, as a pin or fish-bone sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them ; or, if they are veiy briU tie substances, serves to break them. When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straighten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a cir- cle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other : these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be con- ducted about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Several of these rings passed through one another maybe used, the more certainly to lay hold of the obstructing bo- dy, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extract- ed is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twisted, as to be moved every Avay, which must in many cases be a considerable advantage. Another material employed on these unhappy occasions, is the sponge. Its property of swelling considerably on being Avet is the principal founda- tion of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation; and indeed the en- largement of it may be forwarded by making the patient SAvallow a feAv drops of water. Afterivards it is to be drawn back by the handle to which it is fasteued; and as it is now too large to return through the small ca- vity by which it was conveyed in, it draws out the obstructing body along with it. The compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of spouge may be compressed or squeez- ed into a small Bize, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after the spouge lias been intra- 376 SUBSTANCES STOPT BETWEEN, &C. duced. A bit of sponge m *v likewise be compressed by a piece of whale- bone split at one end; but this can hardly be introduced in *uch a man- ner as not to hurt the patieut. I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to sivallow a bit of tough me tt tied to a thread, and drawing it quickly up again. This is saler than swallowing sponge, and will often answer the purpose equally well. When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any ser- vice, unless when such obstructing bodies are simply engaged in, and not booked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomit- ing may be excited by taking half a drachm or two scruples of ipecacuan- ha in powder made into a draught. If he is not able to swallow, an at- tempt may be made to excite vomiting, by tickling his throat with a feath- er ; and, if that should not succeed, a clyster of tobacco may be adminis- tered. It is made by boiling an ounce of tobacco in a sufficient quantity of water; this has often been found to succeed, when other attempts to ex- cite vomiting had failed. When the obstructing body is of such a nature that it may Avith safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale- bone, wire, or flexible wood, with a sponge fastened to one end. Should it be impossible to extract even those bodies which it is danger- ous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the SAvallowing of such hurtful and indigestible substances have been followed by no disor- der. Whenever it is manifest that all endeavours, either to extract or push down the substance, must prove ineffectual,they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed. While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by in- jection through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoc- tion of malloAvs. Injections of this kind not only soften and sooth the ir- ritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments. When, after all our endeavours, we are obliged to leave the obstruct- ing body in the part, the patient must be treated as if he had an inflam- matory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the pas- sages, though the obstructing body be removed. A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus a blow on the back OF DROWNED PERSONS. 377 has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind- pipe. In this case vomiting and sneezing are likewise to be excited. Pius which stuck in the gullet! have been frequently discharged by riding on horseback, or in a cairiage. When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, aud such like; and his drink should be milk and water, barley- water, or whey. When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like. When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that de-th seems at hand, if respiration be not restored; the operation of bronchotomy, or opening of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled iu surgery. OF DROWNED PERSONS. WHEN a person has remained above a quarter of an hour under wa- ter, there can be no considerable hopes of his recovery. But as several circumstances may happen to have continued life, in such an unfortunate situation, beyond the ordinaiy term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many Avell attested proofs of the recovery of persons to life and health, who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life. The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the ne- cessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw with the head a little rais- ed, and carried on a cart or men's shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms. In attempting to recover persons apparently droAvned, the principal intention to be pursued is, to restore the natural warmth, upon which all the vital functions depend; and to excite these functions by the ap- plication of stimulants, not only to the skin, but likewise to the lungs, in- testines, &c. Though cold was by no means the cause of the person's death, yet it will prove an effectual obstacle to his recovery. For this reason, stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and. a«? soon as a well-heated bed can be got ready, he may be 48 378 OF DROWNED PERSONS. laid into it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach aud bowels, and hot bricks, or bottles of warm-water, to the soles of his feet, and to tlie palms of his hands. Strong volatile spirits should be frequently applied to the nose ; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought also to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjoram, may be blown up the nostrils. To renew the breathing a strong person may blow his own breath into the patient's mouth with all the force he can, holdiug his nostril at the same time. When it can be perceived by the rising of the chest or belly- that tlie lungs are filled with air, the person ought to desist from blowing, and should press the breast and belly so as to expel the air again; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate .natural respiration. If the lungs caunot be inflated in this mauner, it may be attempted by blowing through oue of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a Avoodeu pipe fitted at one end for filling the nostril, and at the other for being blown into by a person's mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary. When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the wind-pipe for this pur- pose. It is needless, hoAvever, to spend time in describing this ope- ration, as it should not be attempted unless by persons skilled in sur- gery To stimulate the iutestines, the tume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose, which may be used when at hand; but where these cannot be obtained, the business may be done by a common tobacco pipe. The bowl of the pipe must be filled with tobacco Avell kindled, and,after the small tube has been introduced into the fundament, the smoke may be forced up by bloiving through a piece of paper full of holes ivrapped round the mouth of the pipe, or by blowing through an empty pipe, the mouth of which is applied close to that of the other. This may also be done iu the folloAving manner. A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the boAii of which tobacco is to be kindled, and the smoke blown up as di- rected above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the additiou of a little salt and some wine or spirits, may be frequently administered. This may be done by a common clyster-bag and pipe; but, as it ought to be thrown well up, a pretty large syringe will ansAver the purpose better. While these things are doing, some of the attendants ought to be preparing a warm bath, into Avhich the person should be put, if the above endeavours prove ineffectual. Where there are no conveniences for using the warm bath, the body may be covered Avith Avarm salt, sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken eut of the water, swelled. OF "DROWNED PERSONS. 379 bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her Avith others equally hot, putting a bonnet round her head, and a stocking round her neck, stuffed with tlie same, and heaving coverings over all. After she had remained half an hour in this situation; her pulse returned, she recovered speech, and cried out, I freeze; I freeze ; a little cherry-brandy was given her and she remained buried as it wrcre under the ashes for eight hours; afterwards she Avas taken out, without any other complaint except that of lassitnde or Aveariness, Avhich went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under Ava- ter, by the heat of a dunghill. Till the patient shews some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips however, and tongue, may be frequently wet with a feather dipt in warm brandy or other strong spirits; and, as soon as he has recovered the power of swalkrwing, a little warm Avine, or some other cordial, ought every uoav and then to be administered. Some recommend a vomit after the patient is a little re-animated; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be elone by tickling the throat and fauces with an oiled feather, or some other soft substance, Avhich will not injure the parts. Tissot iu this case recommends the oxymel of squills, a table- spoonful of which, diluted with water, maybe given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camomile-flowers, or carduus benedictus, sweetened with honey, or some Avarm water, with the addi- tion of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are uot expedient. We are by no means to discontinue our .assistance as soon as the pa- tients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating ap- plications are still to be continued, and small quantities of some cordial li- quor ought frequently to be administered. Lastly, though the person should be manifestly re-auimated, there sometimes remains an oppression, a cough, and feverishness, Avhich effectually constitute a disease. In this case it ivill be necessary to bleed the patient in the arm aud to cause him to drink plentifully of barley-water, elder-flower tea, or any ofhejr soft pectoral infusions. Such persons as have the misfortune to be deprived of the appearan- ces of life, by a fall, a bloAV, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, aud proper methods taken to keep up the vi- tal warmth, recovered, and in a few days was perfectly well. Dr. Alex- ander gives an instance to the same purpose in the Edinburgh Physical and Literary Essays, of a man who Avas to all appearance killed by a bloAV on the breast, but recovered upon being immersed for some time in warm water. These, and other instances of a similar nature, Avhich .night be adduced, amount to a full proof of this fact, that many of those 380 or noxious vapours. unhappy persons who lose their lives by falls, bloivs, and other accidents, might be saved by the use of proper means duly persisted in. OF NOXIOUS VAPOURS. AIR may be many ways rendered noxious or even destructive to ani- mals. This may either happen from its vivifying principles being de- stroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the danger of sleeping iu close chambers with coal fires. Some indeed suppose the danger here pro- ceeds from the sulphureous oil contained in the coal, Avhich is set at liber- ty and diffiised all over the chamber; while others imagine it is oAving to the air of the room being charged Avith phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed it is dangerous to sleep in a small apartment with a fire of any kind. I lately saAv four persons who had been suffocated by sleeping in an apartment Avhere a small fire of coal had been left burning. The vapour which exhales from wine, cyder, beer, or other liquors in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors, is in a state of fermentation, especially if they have been close 6hut up for some time. There have been many instances of persons struck dead on entering such places, and of others who have with difficulty escaped. When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emptied for sever- al years, the vapours arising from them produce the same effects as those meutioned above. For this reason no person ought to venture into a well, pit,cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, Avhen the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in; but where they are suddenly extinguished, no one ought to enter till the air has been fu>t purified by fire. The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though Avith less violence, and less suddenly. There have however been instances of people killed by the fumes of lamps Avhich had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly op- pressed in apartments illuminated with many candles. Such as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned as to have lost their feeling and understanding, the fol- loAving means must be used for their recovery. The patient should be exposed to a very pure, fresh, and open air, and volatile salts, or other stimulating substances, held to his nose. He should aext be bled in the arm, or if that does not succeed, in the EFFECTS OF EXTREME COLD. 381 neck. His legs ought to be put into Avarm water, and Avell rubbed. As soon as he can swalkrw, some lemonade, or water and vinegar with the addition of a little nitre, may be given him. Nor are sharp clysters by any means to be neglected; these may be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonsful of common salt may be put into the clyster. The same means, if necessaiy, Avhich Avere recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c. Mr. Tossach, surgeon at Alloa, relates the case of a man suffocated by the steam of burning coal, Avhom he recovered by blowing his breath into the patient's mouth, bleeding him in the arm, and causing him to be Avell rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who Avas stupified by the smoke of sea-coal, but av as recovered by being plunged into cold Avater, and aftenvards laid in a Avarm bed. The practice of plunging persons suffocated by noxious vapours in cold water, would seem to be supported by the common experiment of suffocating dogs in the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake. EFFECTS OF EXTREME COLD. WHEN cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood toAvards the brain; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The traveller, in this situation, Avho finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the im- minent danger he is exposed to. This sleep, Avhich he might consider as some alleviation of his sufferings, Avould, if indulged, prove his last. Such violent effects of cold are happily not very common in this country; it frequently happens, hoivever, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mortification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, Avhen the bands or feet are pinched with cold, to hold them to the fire; yet reason and ob- servation sheAV that this is a most dangerous and imprudent practice. Every peasant kuowTs, if frozen meat, fruits, or roots of any kind be brought near the fire, or put into warm water, they will be destroyed, by rottenness or a kind of mortification; and that the only Avay to recover them, is to immerse them for some time iu very cold Avater. The same observation holds Avith regard to animals in this condition. When the hands or feet are greatly benumbed Avith cold, they ought either to be immersed in cold water, or rubbed Avith snow, till they re- cover their natural warmth and sensibility: after which the person may be removed into an apartment a little Avarmer, and may drink some cups of tea, or an infusion of elder. floAvers sweetened Avith honey. Every person must have observed, Avhen his. hands Avere even but slightly af 382 EFFECTS OF EXTREME HEAT. fected with cold, that the best Avay to warm them Avas by Avashing them in cold water, and continuing to rub them well for some time. When a person has been so long exposed to the cold, that all appear- ances of life are "one, it will be necesssary to rub him all over with snow or cold water; or, Avhat will answer better,if. it can be obtained, to immerse him in a bath of the very coldest Avater. There is the greatest encour- agement to persist iu the use of these means, as we are assured that per- sons who had remained in the snoAV, or had been exposed to the freezing air during five or six iiicccssive days, and who had discovered no marks of life for several hours; have nevertheless been revived. I have always thought that the whitloes, kibes, chilblains, and other inflammations of tlie extremities, which are so common among the pea- sants in the cold season, Avere chiefly occasioned by their sudden transi- tions from cold to heat. After they have been exposed to an extreme de- gree of cold, thej' immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm Avater, by Avhich means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above. EFFECTS OF EXTREME HEAT. THE effects of extreme heat, though not so common in this country, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cordial can be poured into the mouth, it ought to be done. If this cannot be affected, they may be thrown up in form of a clyster. Volatile spirits and other things of a stimulating nature, may be applied to the skin, Avhich should be well rub- bed with coarse cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to haA'e restored to life persons apparently dead by beating them with rods. CHAP. LVII. <5F FAINTING FITS, AND OTHER CASES WHICH REQUIRE IMMEDIATE ASSISTANCE. STRONG and healthy persons, Avho abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking free- ly of warm or strong liquors, exposure to great heat, intense application to study, or the like. In such cases the patient should be made to smell some vinegar. His temples, forehead and Avrists, ought at the same time to be bathed with vinegar mixed with an equal quantity of Avarm water; and two or three spoonsful of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth. OF FAINTING FITS, &C, 383 If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, aud then he should be kept easy and quiet, only giving him every half hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar. When swoonings,'which arise from this cause, occur frequently in the same person, he should, iu order to escape them, confine himself to alight diet, consisting chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should sleep but moderately, and take much exercise. But fainting fits proceed much oftener from a defect than an excess of blood. Hence they are veiy ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these, an almost directly opposite course to that mentioned above must be pur- sued. The patient should be laid in bed, with his head low, and being cover- ed, should have his legs, thighs, arms, and his Avhole body rubbed strong- ly Avith flannels. Hungary-water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth must be Avet Avith a little ruin or brandy; and if he can swallow, some hot wine, mixed with sugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, aud warm bricks, or bottles filled with hot water laid to his feet. As soon as the patieut is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot spiced wine. To prevent the return of the fits, he ought to take often, but in small quanti- ties, some light yet strengthening nourishment, as panada, made with soup instead of water, ueiv laid eggs lightly poached, chocolate, light roast meats, jellies, and such like. Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen alter artificial bleeding are seldom dangerous, generally terminating as soon as the pa- tient i>- laid upon the bed ; indeed persons subject to this kind should al- ways be bled lying, in order to prevent it. Should the fainting however continue longer than usual, volatile spirits may be held to the nose, and rubbed on the temples, &e. When fainting is the effect of too strong or acrid purges or vomits, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of milk, Avarm Avater, and oil, barley Avater, or such like emollient clysters will likewise be proper and the pa- tient's strength should afterwards be recruited, by giving him generous cordials, and anodyne medicines. Faiutings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile flowers, carduus benedictus, or the like. When the disorder pro- ceeds from the nature of the food, the patient as in the case of weak- ness, must be revived by strong smells, Sic. after which he should be made to swalloAV a large quantity of light warm fluid, Avhich may serve to drown, as it were, the offending mutter, to softeu its acrimony. .584 OF FAINTING FITS, &.C. and either to effect a discharge of it by vomiting, or force it down into the intestines. Even disagreeable smells will sometimes occasion swoonings, espr cially in people of weak nerves. Wheu this happens, the patient should be carried iu the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already taken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head. Fainting-fits often happen in the progress of diseases. In the beginning of putrid diseases they generally denote an oppression at the stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, aud plenty of lemon juice and water after it. Swoonings which happen i. dis- eases accompanied Avith great evacuations, must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of au intermitting fe- ver, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and Avater. Delicate and hysteric women are very liable to sAvooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman, relates the case of a Avoman " in child-bed, who, after having beeu happily delivered, sud- " deuly fainted and lay upwards of a quarter of an hour apparently dead. " A physician Avas sent for; her own maid, in the mean Avhile, being out " of patience at his delay, attempted to assist her herself, and extending " herself upon her mistress, applied her mouth to her's, blew iu as much " breath as she possibly could, and in a very short time the exhausted wo- " man aAvaked as out of a profound sleep; when proper things being giv- '' en her", she soon recovered. " The maid being asked how she came to think of this expedient, said '• she had seen it practised at Aldenburgh, by midwives, upon children, k- Avith the happiest effect." We mention this chiefly that other midwives may be induced to follow so laudable an example. Many children are bom without any signs of life, and others expire soon after the birth, who might without all doubt, by proper care, be restored to life. From whatever cause fainting-fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this cir- cumstance, people often kill their friends while they are endeavour- ing to save them. Alarmed at the patient's situation^ they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very common among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting-fits from mere exhaustion or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely ne- OF INTOXICATION. 385 cessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air. Persons subject to frequent swoonings, or fainting-fits, should neglect ho means to remove the cause of them, as their consequences are always injurious to the constitution. Every fainting-fit leaves the person iu de- jection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagulations aud obstructions are formed, and, if the motion of the blood be totally intercepted, or veiy considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which some time mark the crisis in fevers; yet even these ought, as soon as possible, to be removed. OF INTOXICATION. THE effects of intoxication are often fatal. No kind of poison kills more certainly than an over dose of ardent spirits. Sometimes, by de- stroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors may prove fatal Avhen taken to excess, as well as ardent spirits; but they may generally be discharged by vomiting, which ought ahvays to be excited When the stomach is over-charged with liquor. More of those unhappy persons, Avho die intoxicated, lose their lives from inability to conduct themselves, than from the destructive quality of the liquor. Unable to Avalk, they tumble down, and lie in some awk- Avard posture, Avhich obstructs the circulation or breathing, and often continue in this situation till they die. No drunken person should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favourable for continuing the vital motions, dis- charging the contents of the stomach, &c. The best posture for dischar- ging the contents of the stomach is to lay the person upon his belly; when asleep he may be laid on his side, with his head a little raised, and par- ticular care must be taken that his neck be no way bent, twisted, or have any thing too tight about it. The excessive degree of thirst occasioned by drinking strong liquors, often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a de- bauch of Avine or sour punch; these acid liquors, together with the heat of the stomach, having coagulated the milk in 'tuch a manner that it could never be digested. The safest drink after a debauch is Avater with a toast, tea, infusions of balm, sage, barley-Avater, and such like. If the person wants to vomit, he may drink a Aveak i ifusion of camomile flow- ers, or lukewarm Avater and oil; but in this condition vomiting may gen- erally be excited by only tickling the throat with the finger or a feather. Instead of giving a detail of all the different symptoms ofintoxication which indicate 'hnger, aid proposing a general plan of treatment for persons in this situation, T shall briefly relate the history of a case which lately f-.-il under my own observation, whersin most of those symptoms usinlly reckoned dangerous concurred, ai:d Aiiiere the treatment was '■ucces^ful. V voung nip.n. about fifteen vears of age. had, for a hire, drauk ten 10 S86 OF SUFFOCATION AMD STRANGLING. glasses *f strong brandy. He soon after fell i:*st asleep, and continued in that situation for several hours, 'ilil. at length his uneany maninr of brealhirg, the eoldrasaof the extremtties, and otiKT tlircateninj symp- toms, alarmed bis frieiais, and made them s>inl for me. I i»uad bim still -leepb^g, his countenance ghastly, aui his skin covered with cold clammy ssreat. Almost the oalj signs of life reinaunng were, a deep la- borious breailuag, and a convulsive motion or agitation of his bowels. I tried to roui« bim, bat in vain, by pinching, shaking, applying vola- tile spirits, and other stimulating things to his nose, &c A few ouucesof blood were likewise taken from his arm, and a mixture of vim gar aud water was poured into his mouth; but, as he could not swallow, very lit- tle of this got into the stomach. None of these things having the least ef- fect, and the danger seeming to increase, I ordered his legs to be put into warm water, and a sharp clyster to be imajedialirfy administered. This gave him a stool, sad was the first tiling thai relieved bim. It «as af- terwards repeated with the same happy effect, and seemed to be the chief cause of his recovery. He then began to shew some signs of life, took drink when it was offered him and came gradually to his senses. He continued, however, for several days weak and feverish, and complained nmchof a sorenes in his bowels, which gradually went off, by means of a slender diet, aud codI mucilaginous iiqurrs. This young man would probably have been suffered to die without any assistance being called, had not a neighbour a few days before, wlio had been advised to drink a bottle of spirits, to cure bim of an ague, ex- pired under very similar circumstances. OF SUFFOCATION AND STRANGLING. THESE may some times proceed from an infraction of tlie lungs, produced by viscid clammy humours, or spasmodic affection of tlie nerve- of that organ. Persons who feed grossly, and abound in rich blood, are very liable to suffocating fib from the former of these causes. S uch ough t as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently a cup of diluting liquor with a little nitre in it. They should likewise receive the steams of hot vinegar into their lun^s by breathing. Nervous asthmatic persons are most subject to spasmodic affections of the lungs. In this case the patient's legs should be immersed in warm water, and the steams of vinegar applied as above. Warm diluting li- quors should likewise be drank; to a cup of which a tea-spoonful of the parygoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the patient's nose, and fresh air should be freely admitted to him. Is'fonts are often suffocated by the carelessness or inattention of their mir.=es*. An infant ivhen in bed should always be laid so, that it can- not tumble down with its head under the bed-clothes; and when hi a * These accidents are not always the effects of carelessness. I have known an infant overlaid by its mother being seized in th«^ night with an hysteric fit. This ought to serve as a caution against employing"bysteric women as nurses, and should likewise teach such women never to lay an infant in the same lx i with themselves, but in a small adjacent one. Of SUFFOCATION AND STB A^'GLXA'C. 387 cradle,, its face oaght never to be covered. A small ih-ptt of attention to these twosuraple swJfe* h:oo.U? save the lives of many isfasrfs, and pre- vent others from being rendered weaL and sickly *^ their days by the injuries. pocket, which he presented to Ms t».«r froas tune to time 5 ami between wMJes f ome pans of tobacco were bfewai np Ms nostrils : to fltese £ocrceded the Mowing into Ins montfe, and sqoeeziA*' tigfet Ms nose. Animal neat began thus to be excited gradually; dse pafcatioos of the tecBporal arte- ry were soonfeS:, trie breathing Became more frapsea* and free, and the eyes closed and opened altencately. At («^.c?{ sii .? cMfd defied some cries expressive of Ms want of t&e breast, wfeieli being: applied to In? mouth, he catched at it with avidity, and rocked ss if Bot&ongbad iap- pened! to Mm. Though the pulsations of the arteries were by tKs triry very well re-csfaMshedT and it was hot weather,, jet ?'Ir. Janin tfeoaght it advisable to leave his Btlle patmii three quarters of an howr longer under the asses. He was afterwards taken out, cleaned and dress«d as usual; to which a gentkr sfeep succeeded, as** he c«atKi«ed perSectfy wcE. !Mr. Janin raentkins fifeewise an example of a yoir^ nan who had hanged himself thrwign despair,, to wham he administered belp as ef- fectually as in the precedfiag case. Mr. Glover, snrgeon i»Do«£ors CoaTtaons, JLondon, relates rite case of a person who was restored to Sfc alter twenry-nine miaKtes Ilsi*&%, and continued ra good health for many yKtrs after. The principal ircep/ns used to resfore %Ms man to- Hfe were, opening the temporal artery and the external jngnlar; rabfefogthe bad:, month, and nect, with a quantity of volatile spirits and ol!; adfiiiinstering the tobacco clyster by nieaas of lighted pipes, and strong irictions ©f (he legs and arms. This ccmrse had been cautioned for about fonr honrs, when an incision was made into the wind-pipe. a?id air blown strosrgfy through a canula into the lungs. About twenty minutes after this, the blood at the artery began to rna down the face, and a ^low ptnse was just perceptible at the wrist. The frictions were cotttiaued for sproe tone longer; Ms pnlse became more fifeqneat, and his month and nose being irritated with spirits of sal amoniac, he opened his eyes. Warm cor- dials were then administered to him, and in two days he ts^s so well as jo be able to walk eight mile=. 388 OF PERSONS WHO EXPIRE These cases are sufficient to shew what may be done for the recovery of those unhappy persons who strangle themselves in a fit of despair. OF PERSONS WHO EXPIRE IN CONVULSION FITS. CO NVULSION fits often constitute the last scene of acute or chronic disorders. When this is the case there can remain but small hopes of the patient's recovery after expiring in a fit. But when a person who appears to be in perfect health, is suddenly seized with a convulsion fit, ana seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often car- ried off very suddenly by one or more fits about the time of teething. There are many well authenticated accounts of infants having been re- stored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance, mentioned by Dr. Johnson, in his pamphlet on the practicability of recovering persons visibly dead. In the parish of St. Clemens in Colchester, a child of six months old, lying upon its mother's lap, having had the breast, was seized with a ■strong convulsion fit, which lasted so long, and ended with so total a pri- vation of motion in the body, lungs, and pulse, that it was deemed abso- lutely dead. It was accordingly stripped, laid out, the passing bell ordered to be tolled, and a coffin to be made; but a neighbouring gentle- woman who used to admire the child, hearing of its sudden death, hasten- ed to the house, and upon examining the child, found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with tlie breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it iu gentle agitation. In a quarter of an hour she felt the heart begin to beat faintly; she then put a little of the mother's milk into its mouth, continued to rub its palms and soles, found the child begin to move, and the milk was swal- lowed ; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive. These means, which are certainly in the power of every person, were sufficient to restore to life an infant to all appearance dead, and who in all probability, but for the use of these simple endeavonrs, would have remained so. There are however many other things which might be done in case the above should not succeed; as rubbing the body with strong spirits, covering it with warm ashes or salt, blowing air into the lungs, throwing up warm stimulating clysters or the smoke of tobacco into the intestines, and such like. When children are dead born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in cir- cumstances similar to those mentioned above. These directions may likeAvise be extended to adults, attention being always paid to the age and other circumstances of the patieut. The foregoing cases and observations afford sufficient proof of the success which may atteud the endeavours of poisons totally ignorant of medicine, in assisting those who are suddenly deprived of life by anv accident or disuse. Many facts of a similar nature might be ad- duced, were it necessary; but these, it is hoped, will be sufficient to IN CONVULSION FITS. 389 call up the attention of the public, and to excite the humane and benevo- lent to exert their utmost endeavours for the preservation of their fellow- men. The society for the recovery of drowned persons, instituted at Amsterdam in the year 1767, had the satisfaction to find that no fewer than 150 per- sons, in the space of four years, had been saved by the means pointed out by them, many of whom owed their preservation to peasants and people of no medical knowledge. But the means used with so much efficacy in recovering drowned persons are, with equal success, applicable to a num- ber of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this consideration many persons have been committed to the grave in whom the principles of lite might have been revived. The cases wherein such endeavours are most likely to be attended with success, are all those called sudden deaths from an inevitable cause, as apoplexies, hysterics, faintings, and many other disorders wherein per- sons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations from the sulphureous damps of mines, coal-pits, &c. the uuwholesome air of long unopened wells or caverns; the noxious vapours arising from fermenting liquors; the,steams of burn- ing charcoal; sulphureous mineral acids; arsenical effluvia, Sic. The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, Sic. likewise furnish opportunities of trying such endeavours. Those perhaps who to appearance are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strougly into their lungs, &c. The means to be used for the recovery of persons suddenly deprived of life, are nearly the same in all cases; they are practicable by every one who happens to be present at the accident, and require no great ex- pense, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters and generous cordials. These must be varied according to circumstances. Common sense, and the situation of the patient, will suggest the proper manner of conducting them. Above all we would rccommoud perseverance. People ought never to despair ou account of discouraging circumstances, or to leave off their endeavours as long as there is the least hope of success. Where much good and no hurt can be done, no one ought to grudge his labour. It were greatly to be wished, that an institution similar to that of Amsterdam, was established, upon a more extensive plan, in Great Britain; and that a reward was allowed to every one who should be instrumental in restoring to life a person seemingly dead.* Men * The Witlior is happy to observe, that since the first publication of this work, several societies have been instituted in Britain with the same benevolent inten- tion as that of Amsterdam, and that their endeavours have proved no less suc- cessful He is also happy to observe, that premiums have been awarded to those who have been active in their endeavours to restore to life persons who had been drowned, or suddenly deprived of life by any accident. How much is this superior to the superstitious institution, which allows any man a premium who brings a dead person out of the water, so that he may receive Christian 390 Otf COLD BATHIITC, AND will do much for fame, but still more for money. Should no profit-, how- ever, be annexed to those benevolent offices, the heartfelt pleasure which a good man must enjoy on reflecting that be has been the happy instru- ment of saving oue of his fellow -creatures from an untimely grave, is i'oel i" a sufficient reward-. CHAP. LVII. CAUTIONS CONCERNING COLD BATHING AND DRINKING THE MINERAL WATERS. AS it is now fashionable for persons of all ranks to plunge into the sea, and drink the mineral waters, I was desirous of rendering this- work still more extensively useful, by the addition of some practical re- marks on these active and useful medicines. Finding it impossible t<> bring these observations within so narrow a compass as, not to swell the book, already too large, into an enormous size, I resolved to confine my- self to a few hints or cautions; which may be of service to persons who bathe, or drinK the mineral waters, without being able to put themselves under the care of a physician. No part of the practice of medicine is of greater importance, or merits more the attention of the physician* as many lives are lost, and numbers* ruin their health, by cold' bathing, and an imprudent use of mineral wi*- ters. On some future occasion I may probably resume this subject, as I know not any work that contains a sufficiefit number of practical observa- tions to regulate the patient's conduct in the use of these active and im- portant medicines. We have indeed many books on the mineral waters, and some of them are written with much ingenuity; but they are chiefly employed in ascer- taining the contents of the waters by chymical analysis. Thi3 nodoul' has its use, but it is by bo means of such importance as some may imagine. A man may know the chymical analysis of all the articles hi the materia medico, without being able properly to apply any one of them in tlie cure of diseases. One page of practical observations is worth a whole volume of chymical analysis. But where are such observations to be met with •' Few physicians are in a situation to make them, and fewer still are qHalifi- ed for such a task. It can only be accomplished by practitioners who re- side at tlie fountains, and who possessing minds superior to local prejudi- ces, are capable of distinguishing diseases with accuracy, and of forming a sound judgment respecting the genuine effects of medicines. Without a proper discrimination with regard to the diseases and the constitution of the patient, the most powerful medicine is more likely to do harm than good. Every one knows that die same phy- sician who, by cokl bathing, cured Augustus, by an imprudent tie of the same medicine, kilted his heir. This induced the Roman senate to make laws for regulating the baths, and preventing the numerous burial; but allows nothing'to the person who brings him out alive, or who reco- vers him after he has been to all appearance dead. URINKINC MINERAL WATERS. 3$1 r;\"us which arose from an imprudent and promiscuous use of those elegant and fashionable pieces ol' luxury. But as no such laws exist in this coun- try, every one does that which is right in his own eyes, and of course ma- fly must do wrops; • People are apt to imagine that the simple element of water can do no liurt, and that they may plunge into it anytime with impunity- In this, however, they are much mistaken. I have known apoplexies, occasioned by goinn; intothe cold bath, fevers excited by staying too long in it, and other maladies so much aggravated by its continued use, that tliey could never be wholly eradicated. Nor are examples wanting, either in ancient or modern times, of the baneful consequences which have arisen also from an injudicious application of the warm bath; but as warm baths are not so common in this country, and are seldom used but under the direction of a physician, I shall not enlarge on that part of the subject. Immersion in cold water is a custom which lays claim to the most remote antiquity: indeed it must have been coeval with man himself. The ne- cessity of water for the purpose of cleanliness, and the pleasure arriving from its application to the body in hot countries, must veiy early have re- commended it to the human species. Even the example of other animals was .sufficient to give the hint to man. Sy instinct many of them are led to apply cold water in this manner; and some, when deprived of its use, have been known to languish and even to die. But whether the practice of cold bathing arose from necessity, reasoning, or imitation, is an inquiry of no importance; our business is to point out the advantages which may be derived from it, aud to guard people against au improper use of it. The cold bath recommends itself in a variety of cases, and is pe- culiarly beneficial to the inhabitants of populous cities, who indulge in idleness, and lead sedentary lives. In persons of this description tlie action of the solids is always too weak, which induces a lan«niid circulation, a crude indigested mass of humours, and obstructions in the capillary vessels and glandular system. Cold water, from its gravity as well as its tonic power, is well calculated either to ob- viate or remove these symptoms. It accelerates the motion of the blood, promotes the different secretions, and gives permanent vigour to the solids. But all these important purposes will be more essentially answered by the application of salt water. This ought not only to he preferred on account of its superior gravity, but likewise for its greater power of stimulating the skin, which promotes the perspira- tion, and prevents the patient from catching cold. It is necessary, however, to observe, that cold bathing is more likely to prevent, than to remove obstructions of the glandular or lymphatic system. Indeed, when these have arrived at a certain pitch, they are not to be removed by any means. In tills case the cold bath will only aggravate the symptoms, and hurry the unhappy patient Into an untimely- grave. It is therefore of the utmost importance, previous to the patient's entering upon the use of the cold bath, to determine whether or not he labours under any obstinate obstructions of the lungs or other viscera ; and ?ihere this is the case cold bathing ought strictly to be prohibited.* • The late celebrated Dr. Smollet has indeed said, that if he were persuaded fcehad an ulcer in the lungs, he would jump into the cold bath; but here the Dr. 392 ON COLD BATHING, AND hi what is called a plethoric state, or too great a fullness of the body it is likewise dangerous to use the cold bath, without due preparation. In this case there is great danger of bursting a blood-vessel, or occasion- ing an inflammation of tlie brain or some of the visvera. This precaution is the more necessary to citizeus, as most of them live full, and are of a gross habit. Yet, what is very remarkable, these people resort in crowds every season to the sea-side, and plunge in the water without the least consideration. No doubt they often escape with impunity; but does this give a sanction to the practice ? Persons of this description ought by no means to bathe, unless the body has been previously prepared by suitable evacuations. Another class of patients, who stand peculiarly in need of the bracing qualities of cold water, is the nervous. This includes a great number of the male, and almost all the female inhabitants of great cities. Yet even those persons ought to be cautious in using the cold bath. Ner- vous people have often weak bowels, and may, as well as others, be subject to congestions and obstructions of the viscera; and in this case they will not be able to bear the effects of cold water. For them, and indeed for all delicate people, the best plan would be to accustom themselves to it by the most pleasing and gentie degrees. They ought to begin with the temperate bath, and gradually use it cooler, till at length the cold proves quite agreeable. Nature revolts against all great transitions; and those who do violence to her dic- tates, have often cause to repent of their temerity. Wherever cold bathing is practised, there ought likewise to be teped baths for the purpose mentioned above. Indeed it is the prac- tice of some countries to throw cold water over the patient as soon as he comes out of the warm bath; but though this may not injure a Russian peasant, we dare not recommend it to the inhabitants of this coun- try. The ancient Greeks and Romans, we are told, when covered with sweat and dust, used to plunge into rivers, without receiving the smallest injury. Though they might often escape danger from this imprudent conduct, yet it was certainly contraiy to sound reason. I have known many robust men throw away their lives by such an attempt. We would not however advise patients to go into the cold water when the body is chilly; as much exercise, at least ought to he taken, as may excite a gen- tle glow all over the body, but by no means so as to over heat it. To young people and particularly to children, cold bathing is of ♦he last importance. Their lax fibres render its tonic powers pecu- liarly proper. It promotes their growth, increases their strength*, and prevents a variety of diseases incident to childhood. Where in- evidently shews more courage than discretion; and that he was more a man of wit than a physician, every one will allow. A nervous asthma, or an atrophy may be mistaken for a pulmonary consumption; yet, in the two former, the cold bath proves often beneficial, though I never knew it so in the latter. In- deed all the phthisical patients I ever saw, who had tried the cold bath, were evidently hurt by it. * The celebrated Galen says, that immersion in cold water is fit only for the voung of lions and bears ; and recommends warm bathing, as conducive to tlie growth and strength of infants. How egregiously do the greatest men err whenever they lose sight of facts, and substitue reasoning in physic in place of observation and experience. OF DRINKING MINERAL WATERS* G°3 fahts early accustomed to the cold bath, it would seldom disagree with them; and we should see fewer instances of the scrophula, rickets, and other diseases which prove fatal to many, aud make others miserable for life. Sometimes indeed, these disorders render infants incapable of bear- ing the shock of cold water; but this is owing to their not having been early and regularly accustomed to it. It is hoAvever necessary here to caution young men against too frequent bathing, as I have known many fatal consequences result from the daily practice of plunging into rivers, and continuing there too long. The most proper time of the day for using the cold bath is no doubt the morning, or at least before dinner; and the best mode, that of quick immersion. As cold batliing has a constant tendency to propel the blood and other humours towards the head, it ought to be a rule always to wet that part as soon as possible. By due attention to this circumstance, there is reason to believe, that violent head-achs, and other complaints, which frequently proceed from cold bathing, might be often prevented. The cold bath, when too long continued in, not only occasions an ex- cessive flux of humours towards the head, but chills the blood, cramps the muscles, relaxes the nerves, and wholly defeats the intention of bathing. Hence, by not adverting to thi6 circumstance, expert swimmers are often injured, and sometimes even lose their lives. All the beneficial purpo- ses of cold bathing are answered by one immersion at a time: and the patient ought to be rubbed dry the moment he comes out of the water, and should continue to take exercise for some time after. When cold bathing occasions chilness, loss of appetite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head- achs, it ought to be discontinued. Though these hints are by no means intended to point out all the caseg where cold bathing may be hurtful, nor to illustrate its extensive utility as a medicine; yet it is hoped they may serve to guard people against some of those errors into which, from mere inattention, they are apt to fall, and thereby not only endanger their own lives, but bring an excel- lent medicine into disrepute. OF DRINKING THE MINERAL WATERS. THE internal use of water, as a medicine, is no less an object of the physician's attention than the external. Pure elementary water is indeed the most inoffensive of all liquors, and constitutes a principal part of the food of every animal. But tliis element is often impregnated with sub- stances of a very active and penetrating nature; and of such an insi- dious quality, that, while they promote certain secretions, and even alle- viate some disagreeable symptoms, they weaken the powers of life, un- dermine the constitution, and lay the foundation of worse diseases than those which they were employed to remove. Of this every practitioner must have seen instances; and physicians of eminence have more than once declared that they have known more diseases occasioned than re- moved by the use of mineral waters. This doubtless has proceeded from the abuse of these powerful medicines, which evinces the necessity of using them with caution. By examining the contents of the mineral waters which are most used hi this conntrv. we shall be enabled to form an idea of the daoger 50 394 OF DRINKING MINERAL WATERS. which may arise from an improper application of them either externally or internally, though it i* to the latter of these that the present observa- tions are chiefly confined. The waters most in use for medical purposes in Britain, are those im- pregnated with salts, sulphur, iron, and mephitic air, either separately, or variously combined. Of these the most powerful is the saline sul- phureous water of Harrowgate, of which I have had more occasion to observe the pernicious consequences, when improperly used, than of any other. To this, therefore, the following remarks will more immediately relate, though they will be found applicable to all the purging waters in the kingdom which are strong enough to merit attention.' The errors which so often defeat the intention of drinking the pur- gative miueral waters, and which so frequently prove injurious to the patient, proceed from the manner of using them, the quantity taken, the regimen pursued, or using them in cases where they are not proper. A very hurtful prejudice stills prevails in this country, that all diseases must be cured by medicines taken into the stomach, and that the more violently these medicines operate, they are the more likely to have the desired effect. This opinion has proved fatal to thousands, and will, in all probability, destroy many more before it can be wholly eradicated. Purging is often useful in acute diseases, and in chronical cases may pave the way for the operation of other medicines; but it will seldom perform a cure; and by exhausting the strength of the patient, will often leave him in a worse condition than it found him. That this is frequently the case with regard to the more active mineral waters, every person con versant in these matters Avill readily allow. Strong stimulants applied to the stomach and bowels for a length of lime, must tend to weaken and destroy their energy; and what stimulants are more active than salt and sulphur, especially when these substance? are intimately combined, and carried through the system by the pene- trating medium of water? Those bowels must be strong indeed, which can withstand the daily operation of such active principles for months together, and not be injured. This however is the plan pursued by most of those who drink the purging mineral waters, and whose circumstances will permit them to continue long enough at those fashionable places of resort. Many people imagine that every thing depends on the quantity of water takeu, and that the more they drink they will the sooner get well. This is au egregious error; for while the unhappy patient thinks he is by this means eradicating his disorder, he is often in fact undermining the powers of life, aud ruining his constitution. • Indeed nothing can do tliis so effectually as weakening the powers of digestion by the im- proper application of strong stimulants. The very essence of health • The greatest class of mineral waters In this country is the chalybeate. In many parts of Britain these are to be found in almost every field ; but those chiefly in use, for medical purposes, are the purging chalybeates, as the watcr9 of Scarborough, Cheltenham, Thorp Arch, Nevil Holt, &c. Of those which do not purge, the waters of Tunbridge stand in the highest repute. The Saline purging waters, as those of Acton, Epsom, Kilbum, &c. are also in very gene- ral esteem ; but the fountains most frequented by the sick in this country, are those to which the minerals impart a certain degree of heat, as Bath, Bristol, Buxton, &c« OF DRINKINC MINERAL WATERS. 395 depends on the digestive organs performing their due functions, and the most tedious maladies are all connected with indigestion. Drinking the water in too great quantity, not only injures the bowels and occasions indigestion, but generally defeats the intention for which it is taken. The diseases for the cure of which mineral waters are chiefly celebrated, are mostly of the chronic kind; and it is well known that such diseases can only be cured by the slow operation of alternatives, or such medicines as act by inducing a gradual change in the habit. This requires length of time, and never can be effected by medicines which run off by stool, and operate chiefly on the first passages. Those who wish for the cure of any obstinate malady from the mineral waters, ought to take them in such a manner as hardly to produce any ef- fect whatever on the bowels. With this view a half-pint glass may be drank at bed time*, and the same quantity an hour before breakfast, din- ner, and supper. The dose, however, must vary according to circum- stances. Even the quantity mentioned above will purge some persons, while others will drink twice as much without being in the least moved by it. Its operation on the bowels is the only standard for using the water as an alternative. No more ought to betaken than barely to move the body; nor is it always necessaiy to carry it this length, provided the water goes off by the other cmunctories, and does not occasion a chil- ness, or flatulency in the stomach or bowels. When the water is in- tended to purge, the quantity mentioned above may be all takeu before breakfast. I would not only caution patients who drink the purging mineral waters over night to avoid heavy suppers, but also from eating heavy meals at any time. The stimulus of water, impregnated with salts, seems to cre- ate a false appetite. I have seen a delicate person, after drinking the Harrowgate Avaters of a morning, eat a breakfast sufficient to have served two ploughmen, devour a plentiful dinner of flesh and fish, and, to crown all, eat such a supper as might have satisfied an hungry porter. All this, indeed, the stomach seemed to crave; but this craving had better remain not quite satisfied, than that the stomach should be loaded with what exceeds its powers. To starve patients was never my plan; but I am clearly of opinion, that in the use of all the purging mineral waters, a light and rather diluting diet is the most proper; and that no person, during such a course, ought to eat to the full extent to what his' appetite craves. To promote the operation of mineral waters, and to carry them through the system, exercise is indispensably necessary. This may be taken in any manner that is most agreeable to the patient; but he ought never to carry it to excess. The best kinds of exercise are those connected with amusement. Every thing that tends to exhilarate the spirits, not only promotes the operation of the waters, but acts as a medicine. All who resort to the mineral waters ought therefore to leave every care behind, * When I speak of drinking a glass of the water over-night, I must beg leave to caution those who follow this plan against eating heavy suppers. The late Dr. Daultry of York, who was the first that brought the Harrowgate waters into repute, used to advise his patients to drink a glass before they went to bed; the consequence of which was, that having eat a flesh supper, and the} wator operating in the night, they were often tormented with gripes and obli- ged to call for medical assistance. 396 OF DRINKING MINIRAL WATERS. to mix with the company, and to make themselves as cheerful and happy as possible. From this conduct, assisted by the free and wholesome air of those fashionable places of resort, and also the regular and early hours which are usually kept, the patient often receives more benefit than from using the waters. But the greatest errors in drinking the purging mineral waters arise from their being used in cases where they are absolutely improper, and adverse to the nature of the disease. When people hear of a wonderful cure having been performed by some mineral water, they immediately conclude that it will cure every thing, and accordingly swallow it down, when they might as well take poison. Patients ought to be well inform- ed, before they begin to drink the more active kinds of mineral waters, of the propriety of the course, and should never persist in using them when they are found to aggravate the disorder. In all cases where purging is indicated, the saline mineral waters will be found to fulfil this intention better than any other medicine. Their operation, if taken in proper quantity, is generally mild; and they are neither found to irritate the nerves, nor debilitate the patient so much as the other purgatives. As a purgative, these waters are chiefly recommended in diseases of the firet passages, accompanied with, or proceeding from, inactivity of the stomach and boivels, acidity, indigestion, vitiated bile, worms, putrid sores, the piles, and jaundice. In most cases of this kiud they are the best medicines that can be administered. But when used with this view, it is sufficient to take them twice, or at most three times a-week, so as to move the body three or four times; and it will be proper to continue this course for some weeks. But the operation of the more active mineral waters is not confined to the bowels. They often promote the discharge of urine, and not unfre- quently increase the perspiration. This shows that they are capable of penetriUing into every part of the body, and of stimulating the whole sys- tem. Hence arises their efficacy in removing the most obstinate of all disorders, obstructions of the glandular and lymphatic system. Under this class is comprehended the scrophula or Kings-evil, indolent tumours, obstructions of the liver, spleen, kidnies, and mesenteric glands. When these great purposes are to be effected, the waters must be used in the gradual manner mentioned above, and persisted in for a length of time. It will be proper however now and then to discontinue then use for a few days. The next great class of diseases where mineral waters are found to be beneficial, are those of the skin, as the itch, scab, tetters, ring-worms, scaly eruptions, leprosies, blotches, foul ulcers, Sic. Though these may seem superficial, yet they are often the most obstinate which the phy- sician has to encounter, and not unfrequeutly set his skill at defiance: but they will sometimes yield to the application of mineral waters for a suf- ficient length of time, and in most cases of this kind these waters deserve a trial. The saline sulphureous water, such as those of Moffat in Scot- land, and Harrowgate in England, are the most likely to succeed in dis- eases of the skin; but for this purpose it will be necessary not only to drink the waters, but likewise to use them externally. To enumerate more particularly the qualities of the different mi- neral waters, to specify those diseases in which tbey are respectively OBSERVATIONS CONCERNING DIET, &C. 397 indicated, and to point out their proper modes of application, would be an useful, and by no means a disagreeable employment; but as the limits prescribed to these remarks will not allow me to treat the subject at more length, I shall conclude by observing, that whenever the mineral waters are found to exhaust the strength, depress the spirits, take away the appetite, excite fevers, distend the bowels, or occasion a cough, they ought to be discontinued. CHAP. LVIII. OBSERVATIONS CONCERNING THE DIET OF THE COMMON PEOPLE, RE COMMENDING A METHOD OF LIVING LESS EXPENSIVE, AND MORE CONDUCIVE TO HEALTH, THAN THE PRESENT. EXPERIENCE proves that not a few of the diseases incident to the inhabitants of this country, are owing to their mode of living. The vegetable productions they consume, fall considerably short of the proportion which they ought to bear to the animal part of their food. The constant use of bread, and animal substances, excites an unnatural thirst, and leads to the immoderate use of beer and other stimulating li- quors, which generate disease and reduce the lower orders of people to a state of indigence. To teach the poor man how to live cheaper and better, is the design of the following pages. Though the common people of this country live at a greater expense than any where else, it does not follow that they live better. They are strong indeed, but by no means healthy ; and it is found that, from an attachment to a particular mode of living, they are more liable to disease and death in foreign climes, than the inhabitants of any other country. It is certainly proper that the poor man should be instructed in every thing that can make his little earnings go as far as possible, or which can add to the comfort of himself aud family. Nor can ceconomy iu living be deemed trivial, in a country where the riches depend on the cheapness of labour. It is alleged that the English are so much attached to their own modes of living, that no argument will induce them to make the smallest change. Habits are indeed obstinate things, espeically those which re- late to diet; but there are proofs that the English are not inflexible even in this matter. The mode of living among the lower orders has been greatly changed in my time, and I am sorry to say, not for the better. The people of England have too much good sense not to listen to rea- son, provided due care were taken to instruct them. But here the people may be truly said " to perish for want of knowledge." No means have been used to give them proper instruction. Hurtful customs have been suffered to prevail, till they have struck such deep roots that it will not be an easy matter to eradicate them. The difficulty, however, is not unstumountable. A few experiments of reform would have the effect to render it as agreeable as it is salutary. Adults have many old prejudices to overcome, but the cafe is different in regard to children. They may be taught to use any kind of 398 GENERAL OBSERVATIONS ON ALIMENT. food, and what they use when young, they will love when old. If I can introduce a different method of feeding children, my purposes will be- ans wered. This alone will, in time effect a total change iu the general mode of living. The late distress of the poor has called forth many publications intend- ed for their relief. Most of them however, were adapted only for tlie particular occasion, and not calculated to prevent tlie return of like evils. The following observations, it is hoped, will have a more permanent ef- fect. They are intended to recommend a plan of living, which will ren- der the people less dependent on bread and animal food for their subsist- ance, and consequently not so liable to suffer from a scarcity or dearth of either of these articles in future. Particular attention has been paid to the substitutes for bread, as the scarcity of this article proves peculiarly distressing to the poor. It will appear from the following pages, that bread is by no means so much a ne- cessary of life as generally itnagiucd, and that its place may, in many in- stances, be supplied by a variety of other farinaceous substances. GENERAL OBSERVATIONS ON ALIMENT. NO creature eats such a variety of food as man. Intended for an in- habitant of every climate, he devours the productions of them all; and if they do not suit his palate, or agree with his stomach, he calls in the aid of cookery, an art peculiar to himself; by which many things that, in a crude state, would prove hurtful, or even poisonous, are rendered wholesome and salutary. The obvious division of food is into animal and vegetable. To say (hat man was intended by nature for using cither the one or the other alone, would bo absurd. Hi%strueture and appetite prove that he was formed for both. Judgment, liowever, is requisite in adjusting the pro- portions of each, so as to avoid the inconveniences arising from an ex- treme on either hand. Though animal food is more nourishing than vegetable, it is not safe to live ou that alone. Experience has shewn that a diet consisting solely of animal food, excites thirst, and nausea, occasions putrescence in the stomach and bowels, and finally brings on violent griping pains]) with i holera and dysentery. Animal food is less adapted to the sedentary than the laborious, and least of all -to the studious, whose diet ought to consist chiefly of vegeta- ble?. Indulging in animal food renders men dull, and unfit for the pur- suits of science, especially when it is accompanied with the free use of strong liquors. The plethoric, or persons of a full habit, should eat sparingly of ani- mal food. It yields far more blood than vegetables takeu in the same quantity, and of course may induce inflammatory disorders. ^ It acts as a stimulus to tlie whole system, by which meaus the circulation of the blood is greatly accelerated. I am inclined to think, that consumptions so common in England, are .in part owing to the great use of animal food. Though the phthisis pul- monalis properly speaking, is not an inflammatory disease, yet it general- ly begins with symptoms of inflammation, aud is often accompanied with them through its whole progress. But the disease most common to this country is the scurvy. Oiia^ or BREAD. S90 Jiuds a dash of it in almost every family, and in some the taint is very deep. A disease so general must have a general cause, and there is none so obvious as the great quantity of animal food devoured by the na- tives. As a proof that scurvy arises from this cause, we are in pos- session of no remedy for that disease equal to the free use of fresh vege- tables. By the uninterrupted use of animal food a putrid diathesis is induced in the s) stem, v\ liich predisposes to a variety of disorders. I am fully con- vinced that many of thciie obstinate complaints for which we are at a less to account, and find it still more difficult to cure, arc the effects of a scorbutic taint lurking in the habit. Improper diet affects the mind as well as the body. The choleric dis- position of the Engl;sh is almost proverbial. Where I to assign a cause, it would be, their living so much on animal food. There is no doubt but this induces a ferocity of temper unknown to men whose food is chiefly taken from the vegetable kingdom. Though these and similar consequences may arise from the excess of animal diet, we are far from discouraging its use in moderation. In all cold countries it is certainly necessary; but the major part of the aliment ought nevertheless to consist of vegetable substances. There is a continu- al tendency in animal food, as well as in the human body itself, to putre- faction, which can only be counteracted by the free use of vegetables. With regard to the proportion of vegetable food to that of animal, great nicety is by no means required. It must vary according to circumstan- ces, as tlie heat of the weather, the warmth of the climate, and the like. The vegetable part, however, where nothing forbids, ought certainly to preponderate, and I think in the proportion of at least two to one. The excessive consumption of animal food is one great came of the scarcity of grain. The food that a bullock afford bears but a small pro- portion to the quantity of vegetable matter he consumes. I am no enemy to good fruit, as an article of diet; but the greater part of what is used in this country, by the lower orders of the people, is mere trash. Fruit should be eaten in the early part of the day, when Hie stomach is not loaded with food, and it never ought to be eaten raw till it be thoroughly ripe. OF BREAD. BREAD, or something resembling it, makes a part of the diet of all nations. Hence it is emphatically denominated the staff of life. It may however, be used too freely. The late Dr. Fothergill was of opinion, and I perfectly agree with him, that most people eat more bread than is conducive to {heir health. 1 do not mean to insinuate that bread is un- wholesome, but that the best things may prove hurtful when taken to ex- cess. A surfeit of bread i • more dangerous than of any other food. Omis repletio mala replctio panis pessima. The French consume vast quanti- ties of bread; but its bad effects are prevented by their copious use of soups and fruits, which have little or no share in tlie diet of the common people of England. One important use of bread is to form a mass fit for filling up the alimentary canal, aud carrying the nutritious juices along that pas- sage in s^cji a state, as to render them fit to be acte4. upon by the 400 Or BREAD. lacteal absorbents, which take up the nourishment and convey it to the blood. In this light bread may be considered as a soil from whence the nourishment is drawn. I elo not say that bread contains no nourishment but that its use, as au article of diet, does not solely depend on the quan- tity of nutriment it contains, but in some measure on its fitness as a vehi- cle for conveying the nutritious particles through the intestinal tubes. Hence it follows, that the finest bread is not always the best adapted for answering the purposes of nutrition. The richest food will not nourish an animal, unless the alimentary canal is sufficiently distended. A dog has been fed ou the richest broth, yet could not be kept alive; while another, which had only the meat boiled to chip and water, throve very well. This shews tlie folly of attempting to nourish men on alimentary powders and other concen- trated food. The great art therefore of preparing food, is to blend the nutritive part of the aliment with a sufficient quantity of some light farinaceous sub- stance, in order to fill up the canal, without overcharging it with more nutritious particles than are necessary for the support of the animal. This may be done either by bread, or other farinaceous substances, of which there is a great variety, as will appear from tlie sequel. Bread is one of the most expensive modes of using grain, and not adapted to the narrow circumstances of the lower orders of the peo- ple, as it is burthened with two heavy additional charges, in passing through the hands of both the miller and the baker. Besides, the former often grinds down extraneous matter with the wheat, and the lat- ter as frequently bakes it up with the addition of lime, chalk, alum, and other pernicious substances. Since the articles of diet have become branch- es of manufacture, the public neither know what they eat, nor what thev drink. People imagine, as the finest flour contains the greatest quantity of nou- rishment, that it must therefore be the most proper for making into bread; but this by no means follows. The finest flour comes the nearest to starch, which, though it may occasionally prove a good medicine, makes bad bread. Household bread, which is made by grinding down the whole grain, and only separating the coarser bran, is without doubt the most wholesome. The best household bread I ever remember to have eat, was in the coun- ty of York. It was what they call meslin bread, and consisted of wheal and rye ground together. I am not quite certain as to the proportion ; but I think there might be two parts of the former to one of the latter. This bread, when well fermented, eats light, is of a pleasant taste, and so- luble to the bowels. After using it for some years, I found that bread made entirely of flour was neither so agreeable to the palate, nor so con- ducive to health. Bread is often spoiled to please the eye. The artificially whitened, drying, stuffing bread, though made of the heart of the wheat, is in reali- ty the worst of any; yet this is the bread which most people prefer, and the poorer sort will eat no other. All the different kinds of grain are occasionally made into bread, some giving preference to one and some to another, according to early custom and prejudice. The people of South Britain generally prefer bread made of the finest wheat flour, while those of the no- OF BREAD. 401 them counties eat a mixture of flour and oatmeal, or ryemeal, and many give the preference to bread made of oatmeal alone. The common peo- ple of Scotland also eat a mixed bread, but more frequently bread of oatmeal only. In Germany the common bread is made of rye, and the American labourer thinks no bread so strengthening as that which is made of Indian corn; nor do I much doubt but the Laplander thinks his bread, made of the bones of fishes, is the best of any. Bread made of different kinds of grain is more wholesome than what is made of one only, as their qualities serve to correct one another. For. example, wheat flour, especially the finer kind, being of a starchy na- ture, is apt to occasion constipation. Bread made of ryemeal, on the other hand, proves often too slippery for the bowels. A due proportion of these makes the best bread. For the more active and laborious I would recommend a mixture of rye with tlie stronger grains, as peas, beans, barley, oats, Indian corn; and the like. These may be blended in many different ways; they make a hearty bread for a labouring man, and to use his own language, they lie longer on his stomach than bread made of wheat flour only. Barley bread passes too quickly through the alimentary canal to afford ♦ time for conveying the proper nourishment; but bread made of barley mixed with peas is very nourishing. When potatoes, or boiled grain, are used, bread ceases to be a neces- sary article of diet. During the late scarcity of bread, I made it a rule not to eat above one half the quantity I used to do, and I found no in- convenlcncy whatever from the change. Nay, some told me, that for a considerable time they had left off the use of bread altogether, without experiencing any change in tlie state of their health. A great part of the bread consumed iu this country is by children. It is always ready, and when the child calls for food, a piece of bread is put into its hand, to save the trouble of dressing any other kind of victuals. Of many children this is the principal food, but it iskfar from being the most proper. Children are often troubled with acidities of the stomach and bowels; and it is well known that bread mixed with water, and kept in a degree of heat equal to that of the human stomach, soon turns sour. During the late scarcity, many of the labouring men, and even artifi- cers, could not earn as much money as was sufficient to keep their fami- lies in the article of bread only. It is certain, however, that on a dif- ferent plan, such families might have lived very comfortably. Many of the articles of diet are cheaper than bread, and equally wholesome. Above one half of tlie expense of living might be saved by a due selec- tion of the article of diet. The English labourer lives chiefly on bread, which being accompa- nied with other dry, and often salt- food, fires his blood, and excites an unquenchable thirst, so that the perpetual cry is for drink. But the greatest consumption of bread is occasioned by tea. It is said that the subjects of Great-Britain consume a greater quantity of that herb, than the whole inhabitants of all the other nations of this quarter of the globe. The poorest woman in England must have her tea, and the children generally share it with her. As tea contains no nourish- ment, either for young or old, there must of course be bread and butter to eat alonir with it. The quartern loaf v.ill not go far among a family T>1 402 OF BOILED GRAIN. of hungry children, and if we add tlie cost of tea, sugar, butter, and milk, the expense of one meal will be more than would be sufficient to fill their bellies with wholesome food three times a-day. There is reason to believe that oue half tlie bread consumed in En- gland is used to tea, without one hearty meal ever being made of it. The higher ranks use tea as a luxury, while the lower orders make a diet of it. I had lately occasiou to see a striking instance of this in a family tliat was represented to me as in distress for want of bread. 1 sent them a little money, and was informed that they ran with it directly to tlie tea-shop. To a heavy, sluggish, phlegmatic man, a moderate use of tea may not prove pernicious; but where there is a debilitated stomach and an irri- tability of fibre, it never fails to do much hurt. With many it has the effect to prevent sleep. . Tea will produce a total change of constitution in the people of this country. Indeed it has gone a great way towards effecting that evil already. A debility, and consequent irritability of fibre, are become so common, that not only women, but even men, are affected with them. Tliat class of diseases which, for want of a better name, we call nervous, has made almost a complete conquest of the one sex, and is making hasty strides towards vanquishing the other. Did women know the train of diseases induced by debility, and how disagreeable these diseases render them to the other sex, they would shun tea as the most deadly poison. No man can love a woman eaten up with vapours, or washed down with diseases arising from relaxation. It is not tea taken as a beverage after a full meal, or in a crowded assembly, that I so much condemn, though I think something as elegant and less pernicious might be substituted iu its place. The mischief oc- casioned by tea, arises chiefly from its being substituted for solid food. This is so much the case at present, that, had I time to spare, I think it could not be better employed than in writing against this destructive drug. OF BOILED GRAIN. THOUGH farinaceous substances of one kind or another, make a necessary part of the food of man, yet there can be no reason why such substances should always assume the name and form of bread. Many of them are more wholesome, and not less agreeable in other forms. Bread is often used merely to save the trouble of cookery: and being portable, is the most convenient article of diet for carrying abroad. It does not, however, admit of a doubt, that more grain is eaten boiled, though not in this country, than is made into bread; and that this mode of cookery is the most wholesome. Simple boiling precludes all adultera- tion, and is an operation much less laborious and artificial than baking. The most general article of diet among mankind, is rice. This may be made into a variety of dishes; but 6implc boiling is all that is required, to render it a proper substitute for bread. It may either be eaten alone or with milk. In the east, it is used with meat, in the same manner as we do bread. The people of this country believe that rice proves injurious to the eyes, but this seems to be without foun- OF BOILED GRAIN. 463 dation; as it has no such effect on those who make it the principal part of their food. Many other kinds of grain will, when boiled, make good substitutes for bread. Even those which make a harsh and unpleasant sort of bread, are often rendered very palatable by boiling. This is the case with all the leguminous class of plants, as peas, beans, &c. Even oats and bar- ley are more agreeable, as well as more wholesome, when boiled, than made into bread. All allow that peas and beans boiled, when young, are a great luxury. But when old, they are equally wholesome, and, when properly cooked, by no means unpleasant. There are few who do not relish peas pad- ding, and even prefer it to bread. Beans are not so fit for this purpose; but the) make an excellent ingredient in the poor man's broth, and who- ever eats this broth, will find little occasion for bread. Peas and beans contain an equal quantity of sugar with wheat, oats, or barley, and at the same time a greater proportion of oil, consequently r.re more nourishing. This fact is confirmed by daily experience. On those farms where peas and beans are raised in great abundance, f.he labourers are much fed on that sort of grain; but when removed .., farms where they are fed with other kinds of grain, they soon com- >,. ■»•.: of a diminution of strength, and request a supply of peas meal as formerly. Mature seems to have pointed out the propriety of the extensive use ; eas aud beans, it being a fact, that when crops of that kind are duly ;. • ornated with crops of wheat, barley, or oats, the fertility of the soil nr-iy be maintained, without rest or manure, for many years together; whereas, if the latter be raised on the same soil for several years suc- cessively, they render it barren, so that, without rest or manure, its fer- tility caunot be preserved. The people in England are but little accustomed to the use of boiled grain, though iu many countries it is eaten as a luxury. Boiled barley is a great favourite with the Dutch, and is eaten with milk, butter, or molasses. It is the principal food of the Dutch sailors, who, in general, are both healthy and robust. Barley is one of the best ingredients in soup. Count Rumford says, it possesses the quality of lithing, or thickening soups, in a superior de- gree to any other grain. We have reason, however, to believe, that grits, or coarse oatmeal, will answer that purpose still better. Oatmeal is frequently made into bread; but it is a much more whole- some, as well as agreeable food, when made into hasty pudding, and eaten with milk. The peasants in many parts of Britain make two meals a day of it, while their children almost wholly subsist on it; and it is well known that both old and young who are thus fed, are healthy and robust. The opinion of oatmeal being heating, and occasioning skin diseases, is wholly without foundation. Bread made of oatmeal, when not leaven- ed, will sometimes occasion the heart-burn; but this is no proof of its heating quality. Unleavened bread, of Avheat or any other grain, pro- duces the same effect on a debilitated stomach. Oatmeal thoroughly boiled^seldom gives the heart-burn. Persons who are fed on oatmel bread, or hasty pudding, are not more subject to diseases of the skin, than those who live on wheat 404 OF BOILED GRAIN. meal. - Cutaneous disorders proceed more from the want of cleanli- ness, than from any particular aliment The French, so far from thinking that oatmeal is heating, speak of it as possessed of a cooling quality; and even the English give oatmeal, or grit gruel, to lying-in women, and 6ick people of every description, which shews that the) are inconsistent with themselves, in alleging that the blood is fired by the use of oatmeal. A lieutenant of the army, residing at a country village within a few miles of Edinburgh, with a wife and ten children, having no other income than his half pay, fed the whole of his children with hasty pudding and bu^er-milk only, from a conviction that it was the most wholesome and full diet, that fell within the reach of his narrow circumstances. They grew apace, and it was the universal remark of the neighbourhood, that they were as sprightly, healthy, aud robust as other children, and at the same time perfectly free from all skin diseases. Children are seldom Avell, unless when their bodies are gently open. But this is more likely to be the case when fed on oatmeal and milk, than when their bellies are crammed with a starchy substance made of the finest flour; yet this in England is the common food of children. I have seen an infant stuffed four or five times a-day with this kind of food. There needs no conjurer to tell the consequence. A late author, a man of learning, but the dupe of prejudice, has, by a ridiculous definition, endeavoured to represent oats as proper food for horses only. I wish the horses in England devoured a smaller quantity of that grain, and the people more. Few things would have a greater tendency to lessen the expense of living. The oats in North Britain are of a superior quality, aud I hope the people will long have the seuse to use them as an article of diet. Indian corn is likewise said to make the best food when boiled. Count Rumford observes, that of all things it makes the best pud- ding, and that he has made a hearty meal of it, sauce included, for five farthings. What makes good puddings will make good dump- lings, and these will, at any time, supply the place of bread. The Count also remarks, that the negroes in America prefer Indian corn to rice; and that the Bavarian peasants prefer it to wheat; that it might be imported from North America at about four or five shillings per bushel; that, when made into flour, it would cost only one penny far- thing per pound; and that it is highly nutritious, and the cheapest food known. During the late scarcity a large quantity of this grain was imported; but such is the aversion of the common people of this coun- try to every sort of food to which they are not accustomed, that they refused to purchase it, and the merchants were very great losers by the importation. On the same principle the Germans, ^till within these few years, could not be induced to eat potatoes, though now they are become extremely fond of them. The American, the Italian, and the German, all cook Indian corn in the same way as the North Britain does his oatmeal, by making it into hasty pudding. It may be eaten in a variety of ways. Some eat it with a sauce composed of butter and brown sugar, or butter and molasses. Others eat it with milk only. In either way it makes a good, cheap and wholesome diet, by no means disagreeable to those who are accustomed to it. OF BUTTER 405 The only other grain we shall mention as best when boiled, is buck- wheat: It is of a very mucilaginous nature, and of course highly nutri- tious. In several parts of Europe it constitutes a principal part of the food of the lower people. In former times it was eaten in Russia, not hy the lower classes only, even the nobility made use of it. Boiled and buttered, it was so great a favourite of the great Czar Peter, that he is said to have seldom supped on any thing else, OF BUTTER. IT has been said that the English have a thousand religions and but one sauce. It must be allowed that they use butter with almost every kind of food. Butter, though a good article of diet may be used too freely, and in this country, I am convinced, that is the case. To weak stomachs it is hurtful, even in small quantities, and when used freely it proves prejudicial to the strongest. Butter, like other things of an oily nature, has a constant tendency to turn rancid. This process, by the heat of the stomach, is greatly ac- celerated, insomuch that many people, soon after eating butter, complain of its rising in their stomach, in a state highly disagreeable. Oils of every kind are with difficulty mixed with watery fluids. This is the reason why butter floats on the stomach, and rises in such an unpleas- ant manner. Persons afflicted with bile should use butter very sparingly. Some sceptical authors doubt whether or not aliment of any kind has an effect on the bile. One thing, however, is certain, that many patients, afflicted with complaints, which were supposed to be occasioned by bile, have been completely cured by a total abstinence from butter. The most violent bilious complaints that I ever met with, were evi- dently occasioned by food that became rancid on the stomach, as the cho- lera morbus and the like. Nor can such complaints be cured, till the rancid matter is totally evacuated by vomiting and purging. But supposing butter did not possess the quality of becoming rancid on the stomach, it may nevertheless, prove hurtful to digestion. Oils of all kinds are of a relaxing quality, and tend to impede the action of digestion. Hence »he custom of giving rich broths and fat meats to persons who have a voracious appetite. The free use of butter, and other oily substances, not only tends to relax the stomach, and impede its action, but to induce a debility of the solids, whicli paves the way to many maladies. In a country where two thirds of the inhabitants lead sedentary lives, a debility of fibre must pre- dominate. Whatever increases that debility ought to be avoided. Children, without exception, are disposed to diseases arising from re- laxation. Butter, of course, ought to be given to them with a scaring hand. But is this the case ? By no means. Bread and butter consti- tute a great part of the food of children, and I am convinced that the gross humours with which they are frequently troubled, are partly owing to this food. As children abound with moisture, bread alone is, generally speaking, better for them than bread and butter. I have been astonished to see the quantities of butter eaten by gross women who lead sedentary lives. Their tea bread is generally contriv- ed so as to stick up butter like a sponge. What quantities of crumpets and 406 OF BUTTER. muffins they will devour in a morning, soaked with this oil; and after- wards complain of indigestion, when they have eateu what would over- load the stomach of a ploughman. Dr. Fothergili is of opinion, tliat butter produces the nervous or sick head-ache, so common among the women of this country. As a proof of this, it is often cured by an emetic. Oils in certain quantities, excite nausea, and even vomiting. They most of course prove unfriendly to digestion. A Dutch sailor, we are told can digest train oil. So may an English sailor; but it would be very improper food for a London lady. To some of the leauer farinaceous substances, as the potatoe and the like, butter makes a veiy proper addition; but eating it to flesh and fish of almost every description, is certainly wrong. The flesh eaten in this country is generally fat enough without the addition of butter, and the more oily kinds of fish, as salmon or herrings, are lighter on the stomach, and easier digested when eaten without it Butter is rather a gross food, aud fitter for the athletic and laborious, than the sedentaiy and delicate. It is less hurtful wheu eaten fresh than salted. Salt butter certainly tends to induce skin diseases, and I am in- inclined to think, the free use of it at sea may have some share in bringing on that dreadful malady, so destructive to our brave sailors, the sea scurvy. There is a method of rendering salt butter less hurtful, but it seems not to be known in England. What I mean is to mix it with an equal s quantity of honey, and keep it for use. In this way it may be given to children with greater freedom. In north Britain this method of mixing butter with honey is well known, and from a common proverb, I take the custom to be very ancient. Butter, in itself, is not near so hurtful, as when combined with certain other things. For example : bread made wii.ii butter is almost indigesti- ble, and pastries of every kind are little better: yet many people almost live upon pastry, and it is universally given to children. It is little bet- ter, however, than poison, and never fails to disorder their stomachs. The fond mother cannot pass a pastry shop, without treating her darling boy with some of the dainties, and then wonders how he got the cough, or cholic. I have know a man seemingly in perfect health, who, by eating a penny-worth of pastry, as he passed along the street, was seized with such an asthmatic fit, that he was obliged to be carried home, and had nearly lost his life. This occurred whenever he inadvertently ate any thing baked with butter. Every thing that proves very injurious to health ought, as far as pos- sible, to be prohibited, by laying a high duty upon it. A duty on pas- try would be serving the public in more respects thau one. It would save many lives, and lessen some tax on necessaries. Cheese, as a diet, is likewise injurious to health. It should never be eaten but as a deserf. It occasions constipation, fires the blood, and ex- cites a constant craving for drink. It is very improper for the sedenta- ry, and hardly to be digested even by the athletic. If men will live on dry bread, poor cheese, salt butter, broiled bacon and such like parching food, they will find their way to the ale- house, the bane of the lower orders, and the source of half the beggary in the nation. 407 OF FRUITS AND ROOTS. FRUITS and roots form a large class of substitutes for bread. The latter, being produced underground, are less liable to suffer from the in- clemency of the seasons than grain. Men who wish to inflame the minds of the multitude may inveigh against the substitutes for bread; but rea- son and sound sense say, the more substitutes for bread the better. When one fails, recourse can be had to another. In warm climates the inhabitants have many substitutes for bread, and as their seasons are more uniform than ours, they can generally depend on the plant, or whatever it is, proving productive. The plantain-tree, commonly called the Indian-fig, whicli has from time immemorial been cultivated in South America, bears fruit of a sweetish taste, which will dissolve in the mouth Avithout cheAving. It is eaten either raAV, fried or roasted. When intended to supply the place of bread, it is gathered be- fore it is ripe, and eaten either boiled or roasted. The banana is nearly of the same nature, but its fruit is greatly superior both in taste and fla- vour. The inhabitants of the South Sea, or Ladrone islands, are supplied with bread from a tree, Avhich has been lately imported into our West- India islands, and Avill it is hoped, be found to answer the same purpose there. It has a slight degree of sAveetness, but not much flavour. It re- sembles neAV bread, and requires to be roasted before it is eaten. Those ivho have tasted it say, that it is in no respect superior to the potatoe. In some of the West-India islands the inhabitants supply the place of grain by making bread from the root of a shrub called the cassada, or cassava. Though, to my taste, this bread is very insipid, yet the natives are fond of it to such a degree that I have knoAvn some of them eat it, during their residence in England, in preference to the finest London bread. But the most general substitutes for bread in the West-Indies are the yams. There are three different species of this plant, the roots of Avhich are promiscuously used for bread. They are said to be very nutritious, of easy digestion, and, Avhen properly dressed, are by some preferred to the best wheateu bread. The taste is somewhat like the potatoe, but more luscious. The negroes generally eat them boiled, and beaten into a mash. The Avhite people have them ground into flour, and make bread and pud- dings of them. They can be preserved for several seasons, without los- ing any of their primitive goodness. Of all the substitutes for bread in Europe, the potatoe is the most ex- tensively useful. This plant is a native of Peru, and has been in Eu- rope about two hundred years. Like most other important discoveries, it made but a sIoav progress, and is still far from being so generally culti- vated as it deserves to be. It is indeed known in most parts of Europe, but its culture is best understood in Ireland and the northern parts of England. At Harwich, hoAvevcr, the preference is given to the Dutch potatoes, brought over by the packets between that place and Helvoet Sluys. There is a light sandy soil in Holland very favourable to th.: culture of that inestimable root. As this plant thrives in every soil, and seldom suffers from the inclem- ency of seasons, Ave must blame ourselves if Ave suffer a famine to exist. Indeed no such thing ever can be, where due attention is paid to the 108 OF FRUITS ANT ROOTo. the culture of potatoes. A far greater quantity of farinaceous food can be raised on au acre of ground planted with potatoes, than sown m itJi airy kind of grain. It is not uncommon to have a return . . 20 . .30 j . . 40- J one drachm. . . 55\ . . 50 \ grains * .40) 421 A LIST OP SIMPLES, AND OP SUCH MEDICINAL PREPARATIONS, "AS OUGHT TO BE KEPT IN READINESS- FOR PRIVATE PRACTICE. AGARIC Alum Antimony, crude --------- cinnabar of ■----—— sulphur of Balsam of Capivi ------- of Peru ------- of Tolu Bark, c^scarilla -----cinnamon -----■ Mczerion —— Peruvian -----Winter's, or can ell a alba Borax Calamine stone, levigated Castor, Ruhsian Caustic, common ------- lunar Earth, Fuller's ------ Japan ■------Armenian bole ------French ditto Extract- of gentian ----- of guaiacum ---- of hellebore, black ---- of hemlock - of jalap ---- of liquorice ■---- of Peruvian bark ---- of poppies ----- of wormwood Flowers of camomile ------- colt's foot ------- elder rosemary damask and red roses Fruits, almonds -------bitter apple -------cassia fistularis -------Curassao oranges -------Figs dried -------French prunes — — Jamaica pepper -------Juniper berries -------nutmegs ——— tamarinds Gum, aloes ----- ammoniac, in tears —— arabic ----asalretida Gum camphor ----- galbanum ---- gamboge ---- guaiacum ---- kino ---- myrrh ----opium Hartshorn, calcined ----------shavings of Herbs, lesser centaury ---- peppermint ---- spearmint ---- penny-royal ---- savin ---- trefoil ---- uva ursi ---- wormwood Lead, Litharge ---- white ---- sugar of Lemon-peel Mace Magnesia alba Manna Mercury, crude ---------calcined ---------yEthiop's mineral ---------calomel ---------corrosive sublimate ---------red precipitate --------- white ditto Musk Oil, essential, of amber ------—— of anuise ———----- of cinnamon -----------of juniper -----------of lemon-peel -----------of peppermint Oil, expressed, of almonds -------------of linseed Oil of Olives, or Florence oil --------------of palms --------------of turpentine Orange-peel Oyster shells prepared Poppy-heads Resins benzoin —------------flower of ------- Burgundy pitch -------dragon's blood 422 LIST OF SIMPLES, &.C. Renins, frankincense -------liquid storax -------white, or rosin -------scammouy Roots, birthwort —— calomus aromaticus ■ contrayerva ----- garlic ■---- gentian -----ginger ----- hellebore, Wack, white -----jalap ----- ipecacuanha ----- lily, white ----- liquorice ---- marshmallow ----- mezerion ----- rhubarb ----- sarsaparilla -----seneka -----squills -----tormentil ----- tumeric -----Virginian snake ----- wild valerian ----- zedoary Saffron Sal ammoniac, crude -------.-----volatile Salt, Epsom -----of Glauber -----of hartshorn -----nitre, purified, or prunel -----Polychrest -----Rochel -----of tartar Seeds, anise -----caraway ■ cardamom ----coriander -----cummin ----mustard Seeds, sweet fennel -----wild carrot Senna Spanish flies Spermaceti Spirits, xtherial, or xlhcr -------of hartshorn -------of lavender compound -------of nitre ------ditto dulcified -------of sal ammoniac -------of sea salt -------of vinegar -------of vitriol -------of wine rectified -------volatile aromatic Steel, filings of -----rust of, prepared -----soluble, salt of Sulphur vivum -------balsam of ------- flower of Tar ---Barbadoes Tartar, cream of -------emetic -------soluble -------vitriolated Tin, prepared Tutty, levigated Turpentine, Venice Verdigrease Vitriol, green ------blue -------white Wax, white —— yellow Woods guaiacum ------logwood ------sassafras ------saunders, red Zinc, flowers of 423 MEDICINAL PREPARATIONS. BALSAMS. \ HE subject of this section is not the natural balsams, but certain compositions, which, from their being supposed to possess balsamic qualities, generally go by that name. This class of medicines was formerly very numerous, and held in great es- teem : modern practice, however, has justly reduced it to avery narrow com- pass. Anodyne Balsam. Take of white Spanish soap, one ounce ; opium unprepared, two drachms; rectified spirit of wine, nine ounces. Digest them together in a gentle heat for three days, then strain off the liquor, and add to it three drachms of camphor. This balsam, as its title expresses, is intended to ease pain. It is. of service in violent strains and rheumatic complaints, when not attended with inflammation. It must be rubbed with a warm hand on the part affecttgl; or a linen rag mois* tened with it may be applied to the part, and renewed every third or fourth hour till the pain abates. If the opium is left out, this will be the Saponaceous Balsam. LocatellVs Balsam. Take of olive oil, one pint; Strasburgh turpentine and yellow wax, of each half a pound; red saunder, six drachms. Melt the wax with some part of the oil over a gentle fire j then adding the remaining part of the oil and the turpen- tine; afterwards mix in the saunders previously reduced to a powder, ana keep them stirring together till the balsam is cold. This balsam is recommended in erosions of the intestines, the dysentery, hae- morrhages, internal bruises, and in some complaints of the breast. Outwardly it is used for healing and cleansing wounds and ulcers. The dose when taken internally, is from two scruples to two drachms. Tlie vulnerary Balsam. Take of benzoin* powdered, three ounces ; balsam of Peru, two ounces; he- patic aloes, in powder, half an ounce; rectified spirit of wine, two pints. Digest them in a gentle heat for three days, and then strain the Balsam This balsam, or rather tincture, is applied externally to heal recent wounds and bruises It is likewise employed internally to remove coughs, asthmas, and other complaints of the breast. It is said to ease the colic, cleanse the kidnies, and to heal internal ulcers, &c. The dose is from twenty to sixty drops. This, though a medicine of some value, does not deserve the extravagant en- comiums which have been bestowed on it. It has been celebrated under the different names of The Commander's Balsam, Persian Balsam, Balsam of heme, Wade's Balsam, Friar's Balsam, Jesuit's Drops, Turlington's Drops, Crc BOLUSES. AS boluses are intended for immediate use, volatile salts and other ingredi^ ents improper for being kept, are admitted into their composition. They are generally composed of powders, with a proper quantity of syrup, conserve, or mucilage. The lighter powders are commonly made up with syrup, and the more ponderous, as mercury, &c. with conserve ; but those of the lighter kind would be more conveniently made up with mucilage, as it increases their bulk less than the other additions, and likewise occasions the medicine to pass down more easily. Astringent Bolus. Take of alum, in powder, fifteen grains ; gum kino, five grains; syrup, a suf- ficient quantity to make a bolus. In an excessive flow of the menses, and other^violent discharges of blood, proceeding from relaxation, this bolus may be given every four or five hours. till the discharge abates. Diaphoretic Bolus. Take of gum guaiacum, in powder, ten grains; flowers of sulphur and cream of tartar, of each one scruple; simple syrup, a sufficient quantity. 424 APPENDIX. In rheumatic complaints and disorders of the skin, this bolus may be taken twice a-day. It will also be of service in the inflammatory qumsey. Mercurial bolus. Take of calomel, six grains; conserve of roses, half a drachm. Make a bolus. Where mercury is necessary, this bolu may be taken twice or thrice a-week. It may be taken over night; and if it does not operate, a few grains of jalap will be proper next day to carry it off. Bolus of Rhubarb and Mercury. Take of the best rhubarb in powder, from a scruple to half a drachm; of ca- lomel, from four to six grainss; imple syrup, a sufficient quantity to make a bolus- This is a proper piKge in hypochondriac constitutions ; but its principal in- tention is to expel worms. Where a stronger purge is necessary, jalap may be used instead of the rhubarb. Pectoral Bolus. Take of spermaceti, a scruple ; gum ammoniac, ten grains ; salt of hartshorn, six grains : simple syrup, as much as will make them into a bolus. This bolus is given in colds and coughs of long sanding, asthmas, and be- ginning consumptions of the lungs. It is generally proper to bleed the patient before he begins to use it. Purging Bolus. Take of jalap in powder, a scruple; cream of tartar, two scruples. Let them be rubbed together, and form 'd into a bolus, with simple syrup. Where a mild purge is wanted, this will answer the purpose very well. If a stronger dose is necessary, the jalap may be increased to half a drachm or up- CATAPLASMS AND SINAPISMS. CATAPLASMS possess few or no virtues superior to a poultice, which may be so made, as in most cases, to supply their place. They are chiefly intend- ed either to act as discutients, or to promote suppuration; and as they may be of service in some cases, we shall give a specimen of each kind. Discutient Cataplasm. Take of barley-meal, six ounces ; fresh hemlock leaves, bruised, two ounces ; vinegar, a sufficient quantity. Boil the meal and hemlock in the vinegar for a little, and then add two drachms of the sugar of lead. Ripening Cataplasm. Take of white lily root, four ounces ; fat figs and raw onions, bruised, of each one ounce; yellow basilicum ointment, two ounces, gum galbanum, half an ounce ; linseed meal, as much as necessary. Boil the roots along with the figs in a sufficient quantity of water ; then bruise and add to them tlie other ingre- dients, so as to form the whole into a soft cataplasm. The galbanum must be previously dissolved with the yolk of an egg. Where it is necessary to promote suppuration, this cataplasm may be used by those who chuse to be at the trouble and expense of making it. For my part I have never found any application more proper for this purpose than a poultice of bread and milk, with a sufficient quantity of either boiled or raw onion in it, and softened with oil or fresh butter. Sinapisms. Sinapisms are employed to recal the blood and spirits to a weak part,as in the palsv and atrophy. They are also of service in deep seated pains, as the sciati- ca,&c. When the gout seizes the head or the stomach, they are applied to the feet to bring the disorder to these parts. They are likewise appl.ed to the pa- tient's soles in the low state of fevers. They should not be suffered to he on, however, till they have raised blisters, but till the parts become red, and will continue so when pressed with the finger. f„-ii, ,Bjrffl. The sinapism is only a poultice made with vinegar instead of nnlk, and ren dered warm and stimulating by the additionof mustard horse-radish, or garlic. The common sinapism is rn.de by taking crumb of bread and mustard-seed in powder, of each equal quantities; strong vinegar, as much as is sufficient, and mixing them so as to make a poultice. u„,;Bt>A When sinapisms, of a more stimulating nature are wanted, a httle bruise* garlic may be added to the above- APPENDIX. 425 CLYSTERS. THIS class of medicines is of more importance than is generally imagined. Clysters serve not only to evacuate the contents of the belly, but also to convey very active medicines into the system Opium, for example, may be administer- ed in this way when it will not sit upon the stomach, and also in larger doses than at any time it can be taken by the mouth. The Peruvian bark may likewise be, with good effect, administered in form of clyster to persons who cannot take it by the mouth. A simple clyster can seldom do hurt, and there are many cases where it may do much good. A clyster even of warm water, by serving as a fomentation to theparls.may be of considerable service in inflammations of the bladder, and the lower intestines, &.c. Some substances, as the smoke of tobacco, may be thrown into the bowels in this way, which cannot l\v any other means whatever. This may easily be ef- fected by means of a pair of hand-bellows, with an apparatus fitted to them for that purpose. Nor is the use of clysters confined to medicines. Aliment may also be con- veyed in this way.' Persons unable to swallow, have been, for a considerable time, supported by clysters. Emollient CVs'fr. Take of linseed tea and new milk, each six ounces. Mix them, If fifty or sixty drops of laudanum be added to this, it will supply the place of the Anodyne Clyster. Laxatwe Clyster. Take of milk and water each six ounces ; sweet-oil or fresh butter, and brown sugar, of each two ounces. Mix them. If an ounce of Glauber's salt, or two table-spoonsful of common salt, be added to this, it will be the Purging Clyster. Carminative Clyster. Take of camomile flowers, an ounce; anise-seeds, half an ounce. Boil in a pint and a half of water to one pint. In hysteric and hypochondriac complaints this may be administered instead of the Fxtid Clyster, the smell of which is so disagreeable to most patients. Oily Clyster. To four ounces of the infusion of camomile flowers, add an equal quantity of Florence oil This clyster is beneficial in bringing off the small worms lodged in the lower parts of the alimentary canal. When given to children the quantity must be proportionably lessened. Starch Clyster. Take jelly of starch, four ounces; linseed oil, half an ounce. Liquify the jcl- W over a gentle fire, and then mix in the oil- In the dysentery or bloody flux, this clyster may be administered after every loose stool, to heal the ulcerated intestines and blunt the sharpness of corroding humours. Forty or fifty drops of laudanum may be added; in which case it will generally supply the place of the Astringent Clyster. Turpentine Clyster. Take of common decoction, ten ounces ; Venice turpentine, dissolved with the yolk of an egg, half an ounce ; florence oil, one ounce. Mix them. This diuretic clyster is proper in obstructions of the urinary passages, and in colicky complaints proceeding from gravel. vinegar Clyster. This clyster is made by mixing three ounces of vinegar with five of water- gruel. It answers all the purposes of a common clyster, with the peculiar advantage of being proper either in inflammatory or putrid disorders, especially in the latter. (£/* We think it unnecessary to give more examples of this class of medicines, as ingredients adapted to any particular intention may be occasionally added to one or other of the above forms. .1 426 APPENDIX. COLLYRIA, or EYE-WATERS. EYE-WATERS have been multiplied without number, almost every person pretending to be possessed of some secret preparation for the cure of sore cyts. I have examined many of them, and find that they are pretty much alike, the ba- sis of most of them being either alum, vitriol, or lead. Their effects evidently are, to' brace and restoffe the tone of the parrs : hence they are principally of service in slight inflammations ; and in that relaxed state of the part* which is- induced by obstinate ones. Camphor is commonly added to these compositions ; but as- it seldom incor- porates properly with the water, it can be of Kttle use. Boles and other earthy- substances, as they do not dissolve in water, arc likewise unfit for this purpose. Collyrium of Alum. Take of alum, half a drachm; agitate it well together with the white of one egg- This is tlie Collyrium of Riverius. It is used in inflammation of the eyes, to allay heat, and restrain the flux of humours. It must be spread upon linen, and applied to the eyes, but should not be kept on above three or four hours at a time. Vitriolic Collyrium. Take of white vitriol, half a drachm ; rose water, six ounces. Dissolve the vitriol in the water, and filter the liquor. This, though simple, is perhaps equal in virtue to most of the celebrated col- lyria. It is an useful application in weak, watery, and inflamed eyes. Though the slighter inflammations will generally yield to it, yet in those of a more .obsti- nate nature, the assistance of bleeding and blistering will often be necessary. When a strong astringent is judged proper, a double or triple quantity of the vitriol may be used. I have seen a solution of four times the strength of the above used with manifest advantage. Collyrium of Lead. Take sugar of lead, and crude sal ammoniac, of each four grains. Dissolve them in eight ounces of common water. Forty or fifty drops of laudanum may be occasionally added to this collyrium. Those who chuse may substitute instead of this the collyrium of lead recom- mended by Goulard ; which is made by putting twenty-five drops of his Extract of Lead to eight ounces of water, and adding a tea-spoonful of brandy. Indeed, common water and brandy, without any other addition, will in many casesvanswer very well as a collyrium. An ounce of the latter may be added to five or six ounces of the former ; and theeyes* if weak, bached with it night and morning; CONFECTIONS. CONFECTIONS containing above "sixty ingredients are still to be found in some of the most reformed dispensatories. As most of their intentions, how- ever, maybe more certainly, and as effectually answered by a few glasses of wine or grains of opium, we shall puss over this class of medicine very slightly. Japonic Confection. Take Japan earth, three ounces-; tormentil root, nutmeg, olibanum, of each two ounces ; opium dissolved in a sufficient quantity of Lisbon wine, a drachm and a half; simple syrup and conserve of roses, of each fourteen ounces. Mix and make them into an electuary. This supplies the place of the Diascordium. The dose ofthis electuary is from a scruple to a drachm: CONSERVES and PRESERVES. EVERY Apothecary's shop was formerly so full of these preparations, that it might have passed for a confectioner's ware-house. They possess very few me- dicinal properties, and may rather be classed among sweetmeats than medicines. They are sometimes, however, of use, for reducing into boluses or pills some ef the more ponderous powders, as the preparations of iron, mercury, and tin. Conserves are compositions of fresh vegetables and sugar, beaten together in' - APPENDIX. 427 ,-vn uniform mass. In making these preparations, the leaves of vegetables must be freed from their stocks, the flowers from their cups, and the yellow part of orange-peel taken off with a rasp. They are then to be pounded in a mar- ble mortar, with a wooden pestle, into a smooth n»ss; after which thrice their weight of fine sugar is commonly added by degrees, and the beating continued till they are uniformly mixed; but the conserve will be better if only twice its weght of sugar be added. Those who prepare large quantities of conserve generally reduce the vegeta- bles to a pulp by the means of a mill, and afterwards beat them up with the su- gar. Conserve of Red Roses. Take a nound of red rose buds, cleared of their heels; beat them well in a mortar, and, adding by degrees two pounds of double-refined sugar, in powder, make a conserve. After the same manner are prepared the conserves of orange-peel, rose- mary-flowers, sea wormwood, of the leaves of wood-sorrel, &c. The conserve of roses is one of the most agreeable and useful prepara- tions belonging to this class. A drachm or two of it, dissolved in warm milk, is ordered to be given as a gentle restringent in weakness of the sto- mach, and likewise in phthisical coughs, and spitting of blood. To have any considerable effects, however, it must be taken in larger quantities. Conserve of Sloes. This may be made by boiling the sloes gently in water, being careful to take them out before they burst; afterwards expressing the juice, and beat- ing it up with three times its weight of fine sugar. In relaxation of the uvula and glands of the throat, this makes an excel- lent gargle, and may be used at discretion. Preserves are made by steeping or boiling fresh vegetables first in water, and afterwards in syrup, or a solution of sugar. The subject is either pre- served moist in the syrup, or taken out and dried, diat the sugar may can- dy upon it. The last is the most useful method. Candied Orange-Peel. Soak Seville orange-peel in several waters, till it loses its bitterness ; then boil it in a solution°of double-refined sugar in water, till it becomes tender and transparent. Candied lemon-peel is prepared in the same manner. It is needless to add more to these preparations, as they belong rather to the art of the confectioner than that of the apothecary. DECOCTIONS. WATER readily extracts the gummy and saline parts of vegetables ; and though its action is chiefly confined to these, yet the resinous and oily being in- timately blended with the gummy and saline, and in great part taken up along with them. Hence watery decoctions and infusions of vegetables, constitute a large, and not unuseful class of medicines. Although most vegetables yield their virtues to water, as well by infusion as decoction, yet the latter is often necessa- ry, as it saves time, and does in a few minutes what the other would require hours, and sometimes days, to effect. The medicines of this class are all intended for immediate use. Decoction of Althaea. Take of the roots of marsh-mallows, moderately dried, three ounces; raisins of the sun, one ounce, water three pints. . Roil the ingredients in the water till one third of it is consumed ; afterwards strain the decoction and let it stand for some time to settle. If the roots be thoroughly dried, they must be boiled till one half the water be consumed. In coughs, and sharp defluctions upon the lungs, this decotion may be used for ordinary drink. The Common Decoction. Take of camomile flowers, one ounce ; elder flowers, and sweet fennel seeds. of each half an ounce, water, two quarts. Boil them for a little, and then strain tlie decoction. ,,.<•• .u • r . r A medicine equally good may be prepared by inhising the ingredients for some hours in boiling water. 428 APPENDIX. This decoction is chiefly intended as the basis of clysters, to which otlier in- gredients may be occasionally added It will likewise serve as a common fo- mentation, spirit of wine or other things being added in such quantity as the case may require. Dccocticn of Logwood. Boil three ounces of the shavings, or chips of logwood, in four pints of water, till one half the liquor is wasted. Two or three ounces of simple cinnamon water may be added to this decoction. In fluxes of the belh, where the stronger astringents are improper, a tca-cup- ful of this decoction may be taken with advantage three or four times a-day. Decoction of the bark. Boil an ounce of the Peruvian bark, grossly powdered, in a pint and a half of Water to one pint, then stra-.n the decoction If a tea-spoonful of the weak spi- rit of vitriol be added to this medicine, it renders it both more agreeable and efficacious. Compound Decoction of the Bark. Take of Peruvian bark and Virginian snake-root, grossly powdered, each three drachms. Boil them in a pint of water to one half. To the strained li- quor add an ounce and a half of ..romatic water. Sir John Pringle recommends this as a proper medicine towards the decline of malignant fevers, when the pulse is low, the voice weak, and the head affect- ed with a stupor but with little delirium. This dose is four spoonsful every fourth or sixth hour. Decoction of Sarsaparilla. Take of fresh sarsaparilla root, sliced and bruised, two ounces; shavings of guaiacum wood, one ounce. Boil over a slow fire, in three quarts of water, to one ; adding towards the end, half an ounce of sassafras wood, and three drachms of liquorice Strain the decoction. This may either be employed as an assistant to a course of mercurial altera- tives, or taken after die mercury has been used for some time. It strengthens the stomach, and restores flesh and vigour to habits emaciated by the venereal diseases It may also be taken in the rheumatism, and cutaneous disorders proceeding from foulness of the blood and juices. For all these intentions it is greatly preferable to the Decoction of Woods. This decoction may be taken from a pint and a half to two quarts in the day. The following decoction is said to be similar to that used by Kennedy, in tlie cure of the venereal disease, and may supply the place of Lisbon diet drink . Take of sarsaparilla, three ounces ; liquorice and mezerion root, of each half an ounce ; shavings of guaiacum and sassafras, wood, of each one ounce; crude antimony, powdered, an ounce and a half. Infuse these ingredients in eight pints of boiling water for twenty-four hours, then boil them till one half of the water is consumed: afterwards strain the decoction. This decoction may be used in the su.ne manner as the preceding. Decoction of Scneka. Take of Seneka rattle-snake root one ounce ; water, a pint and a half. Bod to one pint, and strain This decoction is recommended in the pleurisy, dropsy, rheumatism, and some obstinate disorders of the skin. The dose is two ounce* three or four times a-day, or oftener, if the stomach will bear it. White Decoction. Take of the purest chalk, in powder, two ounces; gum arabic, half an ounce; water, three pints. Boil to one qturt, and strain the decoction. This is a proper drink in acute diseases, attended with, or inclining to a loose- ness, and where acidities abound in the stomach or bowels It is peculiarly proper for children when afflicted with sourness of the stomach, and for persons who are subject to the heart-burn. It may be sweetened with sugar, as it is used, and two or tliree ounces of simple cinnamon-water added to it An ounce of powdered chalk, mixed with two pints of water, will occasional- ly supply the place of this decoction, and also of the chalk julep. DRAUGHTS. THIS" is a proper form for exhibiting such medicines as areintended to opetale immediately, and which do not need to be frequently repeated, as purges, vomits, ATPENDIX. 429 and a few others, which are to be taken at one dose. Where a medicine re- quires to be U6ed for any length of time, it is better to make up a larger quan- tity of it at once, which saves both trouble and expense. Anodyne Draught. Take of liquid laudanum, twenty-five drops; simple cinnamon-water, an ounce; common syrup, two drachms Mix them. In excessive pain, where bleeding is not necessary, and in great restlessness, this composing draught may be taken and repeated occasionally. Diuretic Draught. Take of the diuretic salt, two scruples ; syrup of poppies, two drachms ; simple cinnamon-water, and common water, of each an ounce. This draught is of service in an obstruction or deficiency of urine. Purging Draughts. Take of manna an ounce ; soluble tartar, or Rochel salt, from three to four drachms Dissolve in three ounces of boiling water ; to which add Jamaica pepper-water, half an ounce. As manna sometimes will not sit upon the stomach, an ounce or ten drachms of the bitter purging salts, dissolved in four ounces of water, may be taken in- stead of the above. Those who canrot take salts, may use the following draught: Take of j.dap in powder, a scruple ; common water, an ounce; aromatic tinc- ture, six drachms. Rub the jalap with twice its weight of sugar, and add to it the other ingredients. Swealing Draughts. Take spirit of Mindererus, two ounces ; salt of hartshorn five grains ; sim- ple cinnamon-water, and syrup of poppies, of each half an ounce. Make them into a draught In recent colds and rheumatic complaints, this draught is of service. To promote its effects, however, the patient ought to drink freely of warm water- gruel, or of some other weak diluting liquor. Vomiting Draughts. Take of ipecacuanha in powder, a scruple; water an ounce ; simple syrup a drachm. Mix them—Persons who require a stronger vomit, may add to the above half a grain, or a grain, of emetic tartar. Those who do not chuse the powder, may take ten drachms of the ipecacuanha wine; or half an ounce of the wine, and an equal quantity of the syrup of squills ELECTUARIES ELECTUARIES are generally composed of the lighter powders, mixed with syrup, honey, conserve, or mucilage into such a consistence, that the pow- ders maj neither separate by keeping, nor the mass prove too stiff for swallow- ing. The. receive chiefly the milder alterative medicines, and such as are not ungrateful to the pala e. Astringent electuaries, and such as have pulps of fruit in them, should be prepared only in small quantities ; as astringent medicines lose their virtues by being kept in this form, and the pulps of fruits are apt to ferment. , For the extraction of pulps it will be necessary to boil unripe fruits, and ripe ones if they are dried, in a small quantity of water till they become soft. The pulp is then to be pressed out Uirough a strong hair sieve, or thin cloth, and af- terwards boiled to a due consistence, in an earthen vessel, over a gentle fire, taking care to prevent the matter from burning by continually stirring it. The pulps of fruit that are both ripe and fresh, may be pressed out without any pre- vious boiling. Lenitive Electuary. Take of senna, in fine powder, eight ounces—coriander seed, also in powder, four ounces—pulp of tamarinds and French prunes, each a pound. Mix the pulps and powders together, and with a sufficient quantity of simple syrup, re- reduce the whole into an electuary. A tea-spoonful of this electuary, taken two or three times a day, generally 430 APPENDIX. proves an agreeable laxative. It likewise serves as a convenient vehicle fox ex- hibiting more active medicines, as jalaps, scamir.ony, and such like. Tiiis> may supply the place of the electuary of Cassia. Electuary for the Dysentery. Take of the Japonic confection, two ounces ; Locatelli's balsam, one Ounce; rhubarb in powder, half an ounce; syrup of marsh-mallows, enough to make an electuary. It is often dangerous in dysenteries to give opiates and astringents, without interposing purgatives. The purgative is here joined with these ingredients, which renders this a very safe and useful medicine for the purposes expressed in the title. About the bulk of a nutmeg should be taken twice or thrice a day, as the symptoms and constitution may require. ElecUf.iry for the Epilepsy. Take of Peruvian bark in powder, an ounce—of powdered tin and wild vale- rian root, each half an ounce—simple syrup, enough to make an electuary. Dr. Mead directs a drachm of an electuary similar to this to be taken even- ing and morning, in the epilepsy, for the space of three months. It will be pro- per, however, to discontinue the use of it for a few days every now and then. I have added the powdered tin, because the epilepsy often proceeds from worms. Electuary for the Gonorrhoea. Take of lenitive electuary, three ounces—jalap and rhubarb in powder, of each two drachms—nitre, half an ounce—simple syrup, enough to make an elec- tuary. During the inflammation and tension of the urinarv passages, which accom- pany a virulent gonorrhoea; this cooling laxative may be used with advantage. The dose is a drachm or about the bulk of a nutmeg, two or three times a- day—more or less, as may be necessary to keep the body gently open. An electuary made of cream of tarUr and simple syrup will occasionally supply the place of this. After the inflammation is gone off, the following electuary may be used : Taks of lenitive electuary two ounces—balsam of capevi, one ounce—gum guaicumand rhubarb, m powder, of each two drachms—simple syrup, enough to make an electuary. The dose is the same as of the preceding. Electuary of the Bark. Take of Peruvian bark, in powder, three ounces—cascarilla half an ounce__ syrup of ginger, enough to make an electuary. in the cure of obstinate intermitting fevers, the bark is assisted by the casca- rilla. In hectic habits, however, it will be better to leave out the cascarilla, and ;.ut three drachms of crude sal ammoniac in its stea d. Electuary for the Piles. Take flowers of sulphur, one ounce—cream of tartar half an ounce—treacle a sufficient quantity to form an electuary. A tea-spoonful of this may be taken three or four times a day. « Electuary lor the. palsy. Take of powdered mustard seed, and conserve of roses, each an ounce—syr- up of ginger, enough to make an electuary. A tea spoonful of this may be taken three or four times a day. Electuary for the Rheumatism. Take of conserve of roses two ounces—cinnibar of antimony, levigated, an ounce and a half; gum g uiacum in powder, an ounce—syrup of ginger, a suffi- cient q.iantity to make an electuary In obstinate rheumatisms, which are not accompanied with a fever, a tea spoonful of this electuary may be taken twice a-day with considerable advan- tage. EMULSIONS. EMULSIONS, besides their use as medicines, are also proper vehicles for certain substances, which could not otherwise be conveniently taken in a liquid form. Thus cam;)h'>r, triturated with almonds, readily unites with water into an emulsion. Pure oils, balsams, raisins, and other similar substances, are likewise rendered miscible with water by the intervention of mucilages. APPENDIX. 431 Common Emulsion. Take of sweet almonds, an ounce ; bitter almonds, a drachm ; water, two pints. Let the almonds be blanched, and beat up in a marble mortar, adding the water by a little and little, so as to make i»n emulsion, afterwards let it be strained. Arabic Emulsion-. This is made In the same manner as the above, adding to the almonds, while beating, two ounces and a half of the mucilage of gum arabic. Where soft cooling liquors are necessary, these emulsions may be used as or- dinary drink. Camphorated Emulsion. Take of camphor, half a drachm ; sweet almonds, half a dozen ; white sugar, half an ounce ; mint water, eight ounces. Grind the camphor and almonds well together in a stone mortar, and add by degrees the mint water ; then strain the liquor, and dissolve it in the sugar. In fevers, and other disorders which require the use of camphor, a table- spoonful of this emulsion may be taken every two or three hours. Emulsion of Gum Ammoniac. Take of gum ammoniac, two drachms ; water, eight ounces. Grind the gum with the water poured upon it by little and little, till it is dissolved. This emulsion is used for attenuating tough, viscid phlegm, and promoting expectoration. In obstinate coughs, two ounces of the syrup of poppies may be added to it. The dose is two table-spoonsful three or four times a-d;.y. Oily Emulsion. Take of soft water, six ounces; volatile aromatic spirit,two drachms; Florence oil, an ounce ; shake them well together, and add of simple syrup, half an ounce. In recent colds and coughs, this emulsion is generally of service ; but if the cough proves obstinate, it will succeed better when made with the paregoric elixir of the Edinburgh Dispensatory, instead of the volatile aromatic spirit A table-spoonful of it may be taken every two or three hours. EXTRACTS. EXTRACTS are prepared by boiling the subject in water, and evaporating the strained decoction to a due consistence. By this process some of the more active parts of plants are freed from the useless, indissoluble earthy matter, which makes the larger share of their bulk. Water, however, is not the only menstruum used in the preparation of extracts ; sometimes it is joined with spi- rits, and at other times rectified spirit alone is employed for that purpose. Extracts are prepared from a variety of different drugs, as the bark, gentian, jalap, &c but, as they require a troublesome and tedious operation, it will be more convenient for a private practitioner to purchase what he needs of them from a professed druggist, than to prepare them himself. Such of them as are generally used, are inserted in our list of such drugs and medicines as are to be kept for private practice. FOMENT A TIONS. FOMENTATIONS are generally intended either to ease pain, by taking off tension and spasm ; or to brace and restore the tone and vigour of those paru to which they are applied. Tlie first of these intentions may generally be au- swered by warm water, and the second by cold. Certain substances, however, are usually added to water with a view to heighten its effects, as anodynes, aromatics, astringents. &c. We shall therefore subjoin a few of the most use- fid medicated fomentations, that people may hav^ it in their power to make use of them if tliey chuse. Anodyne Fomentation. Take of white poppy-heads, two ounces ; elder flowers, half an ounce ; wa- ter, three pints. Boil till one pint is e> uporated, and strain out the liquor This fomentation, as its title expresses, is used for relieving acute pain. Aromatic Fomentation. Take of Jamaica pepper, half au ounce : red wine, a pint. Boil them for a little, and then strain the liquor. 432 APPENDIX. This is intended, not only as a topical application for external complaints, but also for relieving the internal parts, rains ol the bowels, winch accompany dysenterici and diarhosas, flatulent cholics uneasiness of the stomach, and retchings to vomit, ore frequently abated by fomenting the abdomen aud region of the stomach wilh il.e warm liquor. Common Fomentation. Take tops of wormwood and camomile flowers, dried, of each two ounces; water two quarts. After a slight boiling pour off lire liquor. Brandy or spirit of wine may be added to ibis fomentation, in such quantity ae the particular circumstances of the case shall require : but these arc not always neces- sary. Emollient Fomentation* This is the same as the common decoction. Strengthening Fomentation. Take of oak bark one ounce : granate peel, half an ounce; alum, two drachms: Smith's forge water three pints. Boil the water with the bark and peel to the consump- tion of one-third: then strain the remaining decoction and dissolve alum in it. This astringent liquor is employed as an external fomentation to weak parts: it may also be used internally. GARGLES. , HOWEVER trifling this class of medicines may appear, they are by no means with- out their use. They seldom indeed cure diseases, but they ofien alleviate very disa- greeable symptoms : as parchedness of the mouth, foulness of the tongue and lances, &c. they are peculiarly useful in fevers and sore throats. In the laiter a gargle will sometimes remove the disorder ; and in the former few things are more refreshing or agreeable to the patient, than to have his mouth frequently washed with some soft de- tergent gargle. One advantage of these medicines is, that they are easily prepared. A little barley water and honey may be had any where, and if to these be added as much vinegar ai will give them an agreeable sharpness, they will make a very useful gargle for soflenin* and cleansing the mouth. Gargles have the best effect when injected with a syringe. Attenuating Gargle. Take of water, six ounces; honey, one ounce; nitre, a drachm and a half. Mix them. This cooling gargle may be used either in the inflammatory quinsey, or in fevers, for cleaning the tongue and fauces. Common Gargle. Take of rose-water, six ounces; syrup of clove, July flowers, half an ounce; spirit of vitriol, a sufficient quantity to give it an agreeable sharpness. Mix them. This gargle, besides cleansing the tongue and fauces, acts as a gentle repellent, aud will sometimes remove a slight quinsey. Detergent Gargle. Take of the emollient gargle, a pint, tincture of myrrh, an ounce, honey, two ounces. Mix them. When exulcerations require to be cleansed, or the excretion of tough viscid saliva promoted, this gargle will be of service. Emollient Gargle. Take an ounce of marshmallow roots, and two or three figs, boil them in a quart of water till near one half of it be consumed, then strain out the liquor. If an ounce of honey, and half au ounce of spirit of sal-ammoniac, be added to the above, it will then be an exceeding good attenuating gargle. This gargle is beneficial in fevers, where the tongue and fauces are rough and parch- ed, to soften these parts, and promote the discharge of saliva. The learned and accurate Sir John Prin»le observes, that in the inflammatory quinsey, or strangulation of the fauces, little benefit arises from the common gar- gles, that such as are of an acid nature do more harm than good, by contracting the emunctories of the saliva and mucus, and thickening those humours, that a decoc- tion of figs in milk and water has a contrary effect, especially if some sal-ammo- APPENDIX. 433 wiac be added ; by which the saliva is made thinner, and the gknds brought to secrete more freely ; a circumstance always conducive to the cure. INFUSIONS. VEGETABLES yield nearly the same properties to water by infusion as by decoction ; and though they may require a longer time to give out their virtues in this way, yet it has several advantages over the other ; since boiling is found to dissipate the finer parts of many bitter and aromatic substances, without more fully extracting their medicinal principles. The author of the New Dispensatory observes, that even from those vegeta- bles whicli are weak in virtue, rich infusions may be obtained, by returning the liquor upon fresh quantities of the subject, the water loading itself more and more with the active parts ; and that these loaded infusions are applicable to> valuable purposes in medicine, as they contain in a small compass the finer, more subtle, and active principles of vegetables, in a form readily miscible with tlie fluids of the human body. Bitter Infusion. Take tops of the lesser centaury andcamomile flowers, of each half an ounce -, yellow rind of lemon and orange peel, carefully freed from the inner white part, of each two drachms. Cut them in small pieces, and infuse them in a quart of boiling water. For indigestion, weakness of the stomach, or want of appetite, a tea-cupful of this infusion may be taken twice or thrice a-day. Infusion of the Bark. To an ounce of the bark, in powder, add four or five table-spoonsful of bran- dy, and a pint of boiling water. Let them infuse for two or three days. This is one of the best preparations'of the bark for weak stomachs. In dis- orders where the corroborating virtues of that medicine are required, a tea-cup- ful of it may be taken two or three times a-day. Infusion of Cardtms. Infuse an ounce of the dried leaves of the carduus benedictus, or blessed thistle, in a pint of common water, for six hours, without heat; then filter the liquor through paper. This light infusion may be given with great benefit, in weakness of the sto- mach, where the common bitters do not agree. It may be flavoured at pleasure with cinnamon, or other aromatic materials. Infusion of Linseed. Take of linseed, two spoonsful; liquorice root sliced, half an ounce ; boiling water, three pints. Let them stand to infuse by the fire for some hours, and then strain off the liquor. If an ounce of the leaves of colt's foot be added to these ingredients, it will then be the Pectoral Infusion. Both these are emollient mucilaginous liquorR, and may be taken with advantage as ordinary drink in difficulty of making wa- ter ; and in coughs and other complaints of the breast. Infusion of Roses. Take of red-roses, dried, half an ounce ; boiling water, a quart; vitriolic acid, commonly called oil of vitriol, half a drachm ; loaf sugar, an^unce. Infuse the roses in the water four hours, in an unglazed earthen vessel : af- terwards pour in the acid, and having strained the liquor, add to it the sugar. In an excessive flow of the menses, vomiting of blood, and other haemorrha- ges, a tea-cupful of this gently astringent infusion may be taken every three or four hours. It likewise makes an exceeding good gargle. As the quantity of roses used here can have little or no effect, an equally va- luable medicine may he prepared by mixingthe acid and water without infusion. Infusion of Tamarinds and Senna. Take of tamarinds, one ounce, senna and crystals of tartar, each two drachms. Let these ingredients be infused four or five hours in a pint of boiling water, afterwards let tlie liquor be strained, and an ounce or two of the aromatic tinc- ture added to it. Persons who are easily purged may leave out either the tam- arinds or the crystals of tartar. This is an agreeable cooling purge. A tea-cupful may be given every half. 51—2 434 APPENDIX. hour till it operates. This supplies the place of the Decoction •/ Tamarinds and Senna. Spanish Infusion. Take of Spanish juice, cut into small pieces, an ounce, salt of tartar three drachms. Infuse in a quart of boiling water for a night. To the strained li- quor add an ounce and an half of the syrup of poppies In recent colds, coughs, and obstructions of the breast, a tea-cupful of this infusion may be taken with advantage, three or four times a-day. Infusion for the Palsy. : Take of horse-radish root shaved, mustard-seed bruised, each four ounces', outer rind of orange-peel, one ounce Infuse them in two quarts of boiling wa- ter, in a close vessel for twenty-four hours. In paralytic complaints, a tea-cupful of this warm stimulating medicine may i>e taken three or four times a-day It excites the action of the solids, proves diuretic, and if the patient be kept warm, promotes perspiration. If two or three ounces of the dried leaves of marsh-trefoil be used instead of mustard, it will make the Antiscorbutic Infusion. JULEPS. THE basis of juleps is generally common water, or some simple distilled wa- ier, with one-thirdorone-fourthits quantity of distilled spirituous water, and as much sugar or syrup as is sufficient to render the mixture agreeable This is sharpened with vegetable or mineral acids, or impregnated with other medi- cines suitable to the intention. Camphorated Julep. Take of camphor, one drachm ; rectified spirit of wine, ten drops ; double re- fined sugar, half an ounce ; boiling distilled water, one pint Rub the camphor lirstTvith the spirit of wine, then with the sugar ; lastly, add the water by de- grees, and strain the liquor. In hysterical and other complaints where camphor is proper, tliis julep may }ae taken in the dose of a spoonful or two as often as the stomach will bear it. Cordial Julep. Take of simple cinnamon-water, four ounces: Jamaica pepper-water, two ouhces ; volatile aromatic spirit, and compound spirit of lavender, of each two drachms ; syrup of orange-peel, an ounce. Mix them. This is given in tlie dose of two spoonsful three or four times a-day, in disor- ders accompanied with great weakness and depression of spirits. Expectorating Julep. Take of the emulsion of gum ammoniac,, six ounces ; syrup of squills, two ounces. Mix them. In coughs, asthmas, and obstructions of the breast, two table-spoonsful of tbjs julep may be taken every three or four hours. Musk Julep. Rub half a drachm of musk well together with half an ounce of sugar, and add tb it gradually, of simple cinnamon and peppermint water, each two ounces ; of the volatile aromatic spirit, two drachms. In the low state of nervous fevers, hickupping, convulsions, and other spasmo- dic affections, two table-spoonsful of this julep may be taken every two or three hours. Saline Julep. Dissolve two drachms of salt of tartar in three ounces of fresh lemon juice, strained; when the effervescence is over, add, of mint-water, and common water, each two ounces, of simple syrup, one ounce. This removes sickness iX the stomach, relieves vomiting, promotes perspira- tion, and may be of some service in fever3, especially of the inflammatory kind. Vomiting Julep. Dissolve four grains of emetic tartar in eight ounces of water, and add to it half an ounce of the syrup of clove July-flowers. In the beginning of fevers, where there is no topical inflammation, this julep may be given in the dose of one table-spoonful every quarter of an hour till it operates. Antimonial vomits serve not only to evacuate the contents of the sto- APPENDIX. 435 niach, but likewise to promote the different excretions. Hence they are found in fevers to have nearly the same effect as Dr. James' Povider. MIXTURES. A MIXTURE differs from a julep in this respect, that it receives into its composition not only salts, extracts and other substances dissoluble in water, but also earths, powders, and such substances as cannot be dissolved. A mix-. ture is seldom either an elegant or agreeable medicine. It is nevertheless ne- cessary. Many persons can take a mixture, who are not able to swallow a bo- lus or an electuary: besides, there are medicines which act better in this than in any otlier form. Astringent Mixture. Take simple cinnamon water and common water, of each three ounces « spirituous cinnamon water, an ounce and a half; Japonic confection half an oui-.ce. Mix them. In dysenteries which are not of long standing, after the necessary evacuations, a spoonful or two of this mixture may be taken every four hours, interposing every second or third day a dose of rhubarb. Diuretic Mixture. Take of mint-water, five ounces ; vinegar of squills, six drachms ; sweelr spirit of nitre, half an ounce; syrup of ginger, an ounce and an half. Mix them. In obstructions of the urinary passages, two spoonsful of this mixture may be taken twice or thrice a-day. Laxative absorbent mixture. Rub one drachm of magnesia alba in a mortar with ten or twelve grains o£ the best Turkey rhuharb, and add to them three ounces of common water j simple cinnamon water, and syrup of sugar, of each one ounce. As most diseases of infants are accompanied with acidities, this mixture may either be given with a view to correct these, or to open the body. A ta* ble-spoonful may be taken for a dose, and repeated three times a-day. To a very young child half a spoonful will be sufficient. When the mixture is intended to purge, the dose may either be increased-, or the quantity of rhubarb doubled. This is one of the most, generally useful medicines for children with which % am acquainted. Saline Mixture. Dissolve a drachm of the salt of tartar in four ounces of boiling water; and; when cold, drop into it spirit of vitriol till tlie effervescence ceases ; then add, of pepper-mint water, two ounces; simple syrup, one ounce. Where fresh lemons cannot be had, this mixture may occasionally supply the place of the saline julep. Squill Mixture. Take of simple cinnamon water, five ounces; vinegar of squills, one ouncej syrup of marshmallows, an ounce and a half. Mix them. This mixture, by promoting expectoration, and the secretion of urine, proves serviceable in asthmatic and dropsical habits. A table-spoonful of it may he taken frequently. OINTMENTS, LINIMENTS, AND CERATES. NOTWITHSTANDING the extravagant encomiums which have been be- stowed on different preparations of this kind, with regard to their efficacy in the cure of wounds, sores, &c. it is beyond a doubt, that the most proper ap- plication to a green wound is dry lint. But though ointments do not heal wounds and sores, yet tliey serve to defend them from the external air, and to retain such substances as may be necessary for drying, deterging, destroying proud flesh, and such like. For these purposes, however, it will be sufficient to insert only a few of the most simple forms, as ingredients of a more active nature caja occasionally be added to them. Yellow Basilicum Ointment. Take of yellow wax, white resin, and frankincense, each aquarter of a pound; melt them together over a gentle fire, then add of hogs' lard prepared, one pnund. Strain the oirtmen* while warm, 436 APPENDIX. This ointtnent is employed for cleansing and healing wounds and ulcer/. Ointment of Calimine. Take of olive oil, a pint and a half, white wax, and calamine stone levigated, of each half a pound. Let the calamine stone, reduced into a fine powder, be rubbed with some part of the oil, and aftenvaids added to the rest of the oil antl wax, previously melted together, continually stirring them till quite cold. This ointment which is commonly known, by the name of Turner's Cerate, is an exceeding good application in bums and excoriations from whatever cause. Emollient Ointment. Take of palm oil, two pounds, olive oil a pint and a half, yellow wax half a pound, Venice turpentine, a quarter of a pound. Melt the wax in the oils over a gentle fire, then mix in the turpentine, and strain the ointment. This supplies the place of Althcea Ointment. It may be used for anointing inflamed parts, &c. Eye Ointment. Take of hogs' lard prepared, four ounces, white wax" two drachms, tutty pre- pared, one ounce, melt the wax with the lard over a gentle fire, and then sprin- kle in the tutty, continually stirring them till the ointment is cold. This ointment will be more efficacious, and of a better consistence, if two or three drachms of camphor be rubbed up with a little oil, and intimately mixed with it, Another. Take of camphor, and calamine stone levigated, each six drachms, verdi- grease well prepared, of each two drachms, hogs' lard and mutton suet prepar- ed, of each two ounces. Rub the camphor well with the powder, afterwartb mix in the lard and suet continuing the triture till they be perfectly united. This ointment has been long in esteem for diseases of the eyes. It ought however, to be used with caution, when the eyes are much inflamed or very fender. Issue Ointment. ' Mix half an ounce of Spanish flies, finely powdered, hi six ounces of yellow basilicum ointment. This ointment is chiefly intended for dressing blisters, in order to keep them open during pleasure. Ointment of Lead. Take of olive oil half a pint, white wax two ounces, sugar of lead, three drachms. Let the sugar of lead, reduced into a fine powder, be rubbed up with some part of the oil, and afterwards added to the other ingredients, pre- viously melted together, continually stirring them till quite cold. This cooling and gentle astringent ointment may be used in all cases where the intention is to dry the skin over the part, as in scalding, &c. Mercurial Ointment. Take of quicksilver, two ounces, hogs' lard, three ounces, mutton suet, one ounce. Rub the quicksilver, with an ounce of the hogs' lard in a warm mortar. till the globules be perfectly extinguished; then rub it up with the rest of the lard and suet, previously melted together. The principal intention of this ointment is to convey mercury into the body- by being rubbed upon tlie skin. Ointment of Sulphur. Take of hogs' lard prepared, four ounces, flowers of sulphur an ounce and an half, crude sal ammoniac, two drachms, essence of lemon, ten or twelve drops. Make them into an ointment. This ointment, rubbed upon the parts affected, will generally cure the itch. It is both the safest and best application for that purpose, and when made in this way, has no disagreeable smell. White Ointment. Take of olive oil, one pint, white wax and spermaceti, of each three ounces Melt them with a gentle heat, and keep them constantly and briskly stirring to- gether, till quite cold. If two drachms of camphor, previously rubbed with a small quantity of oil, be add&d to the above, it will make the White Camphorated Ointment. APPENDIX. 437 Liniment Ointment. Take equal parts of Florence oil, or fresh drawn linseed oil, and lime-water : shake them well together in a wide mouthed bottle, so as to form a liniment. This is found to be an exceeding proper application for recent scalds or burns-. It may cither be spread upon a cloth, or the parts affected maybe anointed with it twice or thrice a-day. White Liniment. This is made in the same manner as the white ointment, two thirds of the wax being left out. „ This liniment may be applied in cases of excoriation, where, on accountot the largeness of the surface, the ointments with lead or calimine might be improper. Liniment for the Piles. Take of emollient ointment, two ounces, liquid laudanum, half an ounce. Mix these ingredients with the yolk of an eg?;, and work them well together. VoltUile Liniment. Take of Florence oil, an ounce ; spirit of hartshorn, half an ounce. Shake them together. This liniment, made with equal parts of the spirit and oil, will be more eftv> cacious, where the patient's skin is able to bear it. Sir John Priftgle observes, that in the inflammatory quinsey, a piece of flannel, moistened with this liniment, and applied to the throat, to be renewed every four or five hours, is one of the most efficacious remedies, and that 'rt seldom fails, after bleeding, either to lessen or carry off the complaint. The truth of this observation I have often experienced. Camphorated Oil. Rub an ounce of camphor, with two ounces of Florence oil, in a mortar, till the camphor be entirely dissolved. This antispasmodic liniment may be used in obstinate rheumatisms, and in some other cases accompanied with extreme pain and tension of the parts. PILLS. MEDICINES which operate in a small dose, and whose disagreeable taste, or smell, makes it necessary that they should be concealed from the palate, are most commodiously exhibited in this form. No medicine, however, that is in- tended to operate quickly, ought to be made into pills, as they often lie for a considerable time on the stomach before they are dissolved, so as to produce any effect. , . ... .. As the ingredients which enter the composition of puis are generally so con- trived, that one pill of an ordinary size may contain about five grains of the compound, in mentioning the dose we shall only specify the number of pills tp be taken, as one, two, three, &c. Composing Pill. Take of purified opium, ten grains, Castile soap, half a drachm. Beat theni together, and form the whole into twenty pills. When a quieting draught will not sit upon the stomach, one, two, or three of these pills may be taken, as occasion requires. Foetid Pill. Take of asafcetida, half an ounce; simple syrup, as much as is necessary to form it into pills. . In hysteric complaints, four or five pills, of an ordinaiy size, may be taken twice or thrice a-day. They may likewise be of service to persons afflicted with the asthma. When it is necessary to keep the body open, a proper quantity of rhubarb, aloes, or jalap, may occasionally be added to the above mass. Hemlock Pill. Take any quantity of the extract of hemlock, and adding to it about a fifth part its weight of the powder of tlie dried leaves, form it into pills of the ordina- ry size. The extract of hemlock may be taken from one grain to several drachms m the day. The be^t method, however, of using these pills, is to begin with one or two, and to increase the dose gradually, as far as the patient can bear theia, without smv remarkable degree of stupor or giddiness. 4SS APPENDIX. Mercurial Pill. Take of purified quicksilver and honey, each half an ounce. Rub them Ui' gether in a mortar, till the globules of mercury are perfectly extinguished ; then add of Castile soap, two drachms ; powdered liquorice, or crumb of bread, a sufficient quantity to give the mass a proper consistence for pills. When stronger mercurial pills are wanted, the quantity of quicksilver may be doubled. The dose of these pills is different, according to the intention with which they are given. As an alterant, two or three may be taken daily. To raise a saliva- tion, four or five will be necessary. Equal parts of the above pill and powdered rhubarb made into a mass, wiUi a sufficient quantity of simple syrup, will make a Mercurial purging Pill. Mercurial Sublimate Pill. Dissolve fifteen grains of the corrosive sublimate of mercury in two drachms of the saturated solution of crude sal-ammoniac, and make it into a paste, in a glass mortar, with a sufficient quantity of the crumb of bread. This mass must be formed into one hundred and twenty pills. This pill, which is the most agreeable form of exhibiting the sublimate, has been found efficacious, not only in curing the venereal disease, but also in kil- ling and expelling worms, after other powerful medicines had failed *. For the veneral disease, four of these pills may be taken twice a day, as an alterant three, and for worms two. Plummcrs Pill. Take of Calomel, or sweet mercury, and precipitated sulphur and antimony, each three drachms ; extract of liquorice, two drachms Rub the sulphur and mercury well together ; afterwards add tlie extract, and with a sufficient quan- tity of the mucilage of gum-arabic make them into pills. This pill has been found a powerful, yet safe, alterative in obstinate cutane- ous disorders ; and. has completed a cure after salivation had failed. In vene- real cases it has likewise produced excellent effects Two or three pills of an ordinary size may be taken night and morning, the patient keeping moderately warm, and drinking after each dose a draught of decoction of the woods, or of sarsaparilla. Purging Pills. Take of succotorine aloes, and Castile soap, each two drachms ; of simple syrup, a sufficient quantity to make them into pills. Four or five of these pills will generally prove a sufficient purge. For keep- ping the body gently open, one may be taken night and morning. They are reckoned both deobstruent and stomachic, and will be found to answer all the purposes of Dr. Anderson's pills, tlie principal ingredient of which is aloes. Where aloetic purges are improper, the following pills may be used: Take extract of jalap, vitriolated tartar of each two drachms; syrup of? ginger, as much as will make them a proper consistence for pills. These pills may be taken in the same quantity as the above. Pill for tlie Jaundice. Take of Castile soap, succotorine aloes, and rhubarb, of each one drachm. Make them into pills with a sufficient quantity of syrup or mucilage. These pills, as their title express, are chiefly intended for the jaundice, which, with the assistance of proper diet, they will often cure Five or six of them may be taken twice a-day, more or less, as is necessary to keep the body open. It will be proper, however, during their use, to interpose a vomit of ipecacuanha or tartar emetic. Stomachic Pill. Take extract of gentian, two drachms ; powdered rhubarb and vitriolated tartar, of each one drachm : oil of mint, thirty drops ; simple syrup, a sufficient quantity. Three or four of these pills may be taken twice a-day, for invigorating the stomach, and keeping the body gently open. Squill Pills. Take powder of dried squills, a drachm and a half; gum ammoniac, and car- * See a paper on this subject in the Edinburgh Physical aAfi biterary JZsao;", hy the ingeiuQus Dr, John Gardener. APPENDIX. rtamom seeds, in powder, of each three drachms, simple syrup, a sufficient quantity. , , In dropsical and asthmatic complaints, two or three of these pills may be tak- en twice a-day, or oftener, if the stomach will bear them. Strengthening Pills. Take soft extract of the bark, and salt of steel, each a drachm. Make into pills. . ■ ... In disorders arising from excessive debility, or relaxation ot the solids, as the chlorosis, or green sickness, two of these pills may be taken three times a-day. PLASTERS. PLASTERS ought to be of a different consistence, according to tlie purposes for which they are intended Such as are to be applied to the breasts or sto- mach ought to be soft and yielding ; while those designed to the limbs should be firm and adhesive. It has been supposed, that plasters might be impregnated with the virtues of different vegetable, by boiling the recent vegetables with the oil employed for the composition of the plaster; but this treatment does not communicate to the oils any valuable qualities. The calces of lead boiled with oils unite with them into a plaster of a proper consistence, which make the basis of several other plasters. In boiling these compositions, a quantity of hot water must be added from time to time to pre- vent the plaster from burning or growing black. This, however, should be done with care, lest it cause the matter to explode. Common Plaster. Take of common olive oil, six pints ; litharge reduced to a fine powder, two pounds and a half. Boil the litharge and oil together over a gentle fire, con- tinuallv stirring them, and keeping always about half a gallon of water in the vessel": after tbey have boiled about three hours, a little of the plaster may be taken out and put into cold water, to try if it be of a proper consistence ; when that is the case, the whole may be suffered to cool, and the water well pressed out of it with the hands. This plaster is generally applied in slight wounds and excoriations of the skin. It keeps the part soft and warm, and defends it from the air, which is all that is necessary in such cases. Its principal use, however, is to serve as a basis for other plasters. Adlicsive Plaster. Take of the common plaster, half a pound, of Burgundy pitch, a quarter of a pound. Melt them together. This plaster is principally used for keeping on other dressings. Anodyne Plaster. Melt an ounce of adhesive plaster, and when it is cooling, mix with it a drachm of powdered opium, and the same quantity of camphor, previously rub bed up with a little oil. • «, «■ i This plaster generally gives ease in acute pains especially of the nervous kind. Blistering Plaster. Take of Venice turpentine, six ounces; yellow wax, two ounces ; Spanish flies in fine powder, three ounces ; powdered mustard, one ounce. Melt the wax, and while it is warm, add to it the turpentine, taking care not to evaporate it by too much heat. After the turpentine and wax are.sufficiently incorpora- ted, sprinkle in the powders, continually stirring the mass till it be cold. Though this plaster is made in a variety of ways, one seldom meets with it of a proper consistence. When compounded with oils and other greasy sub- stances, its effects are blunted, and it is apt to run; while pitch and resin ren- der it too hard and very inconvenient When the blistering plaster is not at hand, its place may bp supplied by mix- ing with any soft ointment a sufficient quantity of powdered flies, or by form ing them into a paste with flour and vinegar. Gum Plaster. J TaTce of the common plaster, four pounds ; gum ammoniac and galbanum, 'strained, of each half a pound. Melt them together, and add, of Venice tur- pentine, six ounces. 440 APPENDIX. This plaster is used as a digestive, and likewise for discussing indolent tjdr mours. Mercurial. Plaster. Take of common plaster, one pound; of gum ammoniac, strained, half a ■bound. Melt them together, and when cooling, add eight ounces of quick-sil- ver, previously extinguished by triturc, with three ouucesof hogs' lard. This plaster is recommended in pains of the limbs arising from a venereal cause. Indurations of the glands, and other violent tumours, are likewise found sometimes to yield to it. Stomach Plaster. Take of gum plaster, half a pound, camphorated oil, an ounce and a-half; black pepper, or capsicum, where it can be had, one ounce. Melt the plaster, and mix with it the oil, Uien sprinkle in the pepper, previously reduced to a fine powder. An ounce or two of this plaster, spread on soft leaUicr and applied to the region of the stomach, will be of service, in flatulencies arising from hysteric and hypochondriac affections. A little of the expressed oil of mace, or a few drops of the essential oil of mint, may be rubbed upon it before it is applied. This may supply the place of the Antihysteric Plaster. Warm Plaster. Take of gum plaster, one ounce; blistering plaster, two drachms. Melt them together over a gentle fire. This plaster is useful in the sciatica and other fixed pains of the rheumatic kind: it ought, however, to be worn for some time, and to be renewed at least once a week. If this is found to blister the part, which is sometimes the case, it must be made with a smaller proportion of the blistering plaster. Wax Plaster. Take of yellow wax, one pound; white resin, half a pound; mutton suet, three quarters of a pound. Melt them together. This is generally used instead of the Melilotplaster. It is a proper applica- tion after blisters, and in other cases where a gentle digestive is necessary. POWDERS. THIS is one of the most simple forms in which medicine can be administer- ed. Many medicinal substances, however cannot be reduced into powder, and others are too disagreeable to be taken in this form. The lighter powders may be mixed in any agreeable thin liquor, as tea en- water grueb The more ponderous will require a more consistent vehicle, as syrup, conserve, jelly, or honey. Gums, and other substances which are difficult to powder, should be pounded along with the drier ones, but those which are too dry, especially aromatics, ought to be sprinkled during their pulverization, with a few drops of any pro- per water. Aromatic powders are to be prepared only in small quantities at a time, and kept in glass vessels closely stopped. Indeed no powders ought to be exposed, to the air or kept too long, otherwise their virtues will be in a great measure destroyed. Astringent Powder. Take of alum an:l japan earth, each two drachms. Pound them together, and divide the whole into ten or twelve doses. In an immediate flow of the menses, and other haemorrhages, one of these powders may be taken every hour, or every half hour, if the discharge be violent. Powder of Bole. Take of bole a?menic, or French bole, two ounces < cinnamon, one ounce; tormentil root and gum arabic, of each six drachms; long pepper, one drachm. Let all these ingredients be reduced into a powder. This warm glutinous astringent powder, is given in fluxes, and other disor- ders where medicines of that class are necessary, in the dose of a scruple, or half a drachm. If a drachm of opium be added, it will make the powder of bole with opium, which is a medicine of considerable efficacy. It may be taken in the same quantity as the former, but not above twice or thrice a-day. APPENDIX. 441 Carminative Powder. Take of eoriander-secd, £ oz.; ginger, one drachm; nutmegs, half a drachm, fine sugar, a drachm and a half Reduce them into powder for twelve doses. This powder is employed for expelling flatulencies arising from indigestion, particularly those to which hysteric and hypochondriac persons are so liable. It may, likewise be given in small quantities to children in their food, when troubled with gripes. Diuretic Powder. Take of gum arabic, four ounces ; purified nitre, one ounce. Pound them together, and divide the whole into twenty-four doses. *■ During the first stage of the venereal diseases, one of these cooling powders may be taken three times a day, with considerable advantage. Aromatic Opening Ponder. Take of the best Turkey rhubarb, cinnamon, and fine sugar, each two drachms Let the ingredients be pounded, and afterwards mixed well together. When flatulency is accompanied with costiveness. a tea-spoonful of this} powder may be taken once or twice a-day, according to circumstances. Saline Laxative Powder. Take of soluble tartar, and cream of tartar, each one drachm. Purified ni- tre, half a drachm. Make them into a powder. In fevers and other inflammatory disorders, where it is necessary to keep the body gently open, one of these cooling laxative powders, may be taken in a little gruel, and repeated occasionally Steel Powder. Take filings of steel, and loaf sugar, of each two ounces: ginger, two drachms. Pound them together. In obstructions of the menses, and other cases where steel is proper, a tea- spoonful of this powder may be taken twice a day, and washed down with a little wine or water. Sudorific Powder. Take purified nitre and vitriolated tartar, of each half an ounce ; opium and ipecacuanha, of each one drachm. Mix the ingredients and reduce them to a fine powder. This is generally known by the name of Dover's Povider. It is a powerful sudorific. In obstinate rheumatisms, and other cases where it is necessary to excite a copious sweat, this powder may be administered in tlie dose of a scru- ple or half a drachm. Some patients will require two scruples. It ought to be accompanied with the plentiful use of some warm diluting liquor. Worm Powders. Take of tin reduced into a fine powder, an ounce ; vEthiop's mineral, twa drachms. Mix them well together, and divide the whole into six doses. One of these powders may be taken in a little syrup, honey, or treacle, twice a-day. After they have been all used, tlie following anthelmintic purge may be proper. • Purging Worm Powder. Take of powdered rhubarb a scruple; scammony and calomel, of each five grains. Rub them together in a mortar for one dose. For children, the above doses must be lessened, according to their age. If the powder of tin be given alone, its dose may be considerably increased. The late Dr. Alston gave it to the amount of two ounces in three days, and says, when thus administered, that it proved an egregious anthelmintic. He purged his patients both before they took the powder, and afterwards. Powder for tlie Tape Worm. Early in the morning the patient is to take in any liquid, two or three drachms, according to his age and constitution, of the root of the male fern reduced into a fine powder. About two hours afterwards he is to take of calomel and resin of scammony, each ten grains, gum gambouge, six grains. These ingredienta must be finely powdered and given in a little syrup, honey, treacle, or any thing that is most agreeable to the patient. He is then to walk gently about, now and\ then drinking a dish of green tea, till the worm is passed. If the powder of the fern produces nausea, or sickness, it may be removed by sucking the juice ef an orange or lemon. 55 445 APPENDIX. This medicine which had been long kept a secret abroad for the cure of the tape worm, was some time ago purchased by the French King, and made pub- lic for the benefit of mankind. Not haying had an opportunity of trying it, I can say nothing from experience concerning its efficacy. It seems however, from its ingredients, to be an active medicine, and ought to be taken with care. The dose here prescribed is sufficient for the strongest patient; it must, there- fore, be reduced according to the age and constitution. SYRUPS. SYRUPS were some time ago looked upon as medicines of considerable va- lue. They are at present, however, regarded chiefly as vehicles for medicines of greater efficacy, and are used for sweetening draughts,juleps, or mixtures; and reducing the lighter powders into bohises, pills, and electuaries. As all these purposes may beanswered by the simple syrup alone, there is little occasion for any other; especially as they are seldom- found but in a;state of fermentation; and as the dose of any medicine given in this-form is very uncertain. Persons who serve the public must keep whatever their customers call for; but to the private practitioner nine-tenths of the syrups usually kept in the shops arc un- necessary. Simple Syrup, Is made by dissolving in water, either with or without heat, about double its weight of fine sugar. If twenty-five drops of laudanum be added to an ounce of the simple syrup, it will supply the place of diacodium, or the syrup of poppies, and will be found a more safe and certain medicine. The lubricating virtues of the syrup of marshmallows may likewise be applied, by adding to the common syrup a sufficient quantity of mucilage of gum arabic. Those who chuse to preserve the juice of lemons in form of syrup, may dis- solve in it, by the heat of a warm bath, nearly double its weight of fine sugar. The juiee ought to be previously strained, and suffered to stand till it settles. The syrup of ginger is sometimes of use as a warm vehicle for giving medi- cines to persons afflicted with flatulency. It may be made by infusing two ounces of bruised ginger in -two pints of boiling water for twenty-four hours. After the liquor has been strained, and has stood to settle for some time, it may be poured prf, and a little more than double its- weight of fine powdered sugar dissolved in it. TINCTURES, ELIXIRS, &c. RECTIFIED spirit is the direct menstrum of the resins and essential oils of vegetables, and totally extracts these active principles from sundry sub- stances, which yield them- to water, either not at all or only in part. It dissolves likewise those parts of animal substances in which their peculiar $mells and taste reside. Hence the tinctures prepared with rectified spirits form an useful and elegant class of medicines, possessing many of the most essential virtues of simples, without being clogged with their inert or useless parts. Water, however, being the proper menstrum of the gummy, saline, and sac- charine parts of medicinal substances, it will be necessary, in the preparation of several tinctures, to make use of a weak spirit, or a composition of rectified Spirit and water. Aromatic Tincture. Infuse two ounce* of Jamaica pepper in two pints of brandy, without heat, for a few days, then strain off the tincture. This Simple tificture will sufficiently answer all the intentions of the more Costly preparations of this kind. It is rather too hot to be taken by itself, but is very proper for mixing with such medicines as might otherwise prove too cold for tlie stomach. Compound Tincture of the Bark. Take of Peruvian bark, two ounces ; Seville orange-peel and cinnamon, of each half an ounce. Let the bark be powdered, and the other ingredient* bruised ; then infuse the whole in a pint and a half of brandy, for five or six flays, *n a close vessel, afterwards strain off the tincture. Tlie tincture is not only beneficial in intermitting fevers, but also in the slow. n«*ows mi putrid kinds, especially towards their decline. APPENDIX. 443 The dose is from one drachm to three or four, every fifth or sixth hour. It may be given in any suitable liquor, and occasionally sharpened with a few .drops of the spirit of vitriol. Volatile Foetid Tincture. Infuse two ounces of asafcetida in one pint of volatile aromatic spirit, for eight days, in a close bottle, frequently shaking it. Then strain the tincture This medicine is beneficial in' hysteric disorders, especially when attended with lowness of spirits, and faintings. A tea-spoonfiil of it may be taken in a glass of wine, or cup of penny-royal tea. 1 olitile Tincture of Gum Guaiacum. Take of gum guaiacum, four ounces ; volatile aromatic spirit, a pint. Infuse without heat in a vessel well stopped for a few days; then strain off the tinc- ture." In the rheumatic complaints, a tea-spoonful of this tincture may be taken in a cup of the infusion of water trefoil, twice or thrice a day. Tincture of Black Hellebore. Infuse two ounces of the roots of black hellebore, bruised, in a pint of proof spirit, for seven or eight days, then filter the tincture Uirough paper. A scru- ple of cochineal may be infused along with the roots, to give the tincture a co- lour. In obstructions of the menses, a tea-spoonful of this tincture may be taken in a cup of camomile or penny-royal tea twice a day. Astringent Tincture. , Digest two ounces of gum kino, in a pint and a half of brandy, for eight days ; afterwards strain it for use. # . This tincture though not generally known, is a good astringent medicine. With this view, an ounce or more of it may be takes three or four times a day. Tincture of Myrrh and Aloes. Take of gum myrrh, an ounce and a half, hepatic aloes, an ounce. Let them be reduced to a powder, and infused in two pints of rectified spirits, for six days, in a gentle heat; then strain the tincture. # # This is principally used by surgeons for cleansing foul ulcers, and restraining the progress of gangrenes. It is also, by some, recommended as a proper ap- pfication to green wounds. Tincture of Opium or, Liquid Laudanum. Take of crude opium, two ounces; spiritous aromatic water and mountain wine each ten ounces. Dissolve the opium, sliced in the wine, with a gentle heat frequently stirring it, afterwards add the spirit, and strain off tlie tincture As twenty-five drops of this tincture contain about a grain of opium, the com- mon dose may be from twenty to thirty drops. Sacred Tincture, or Tincture of Hirea Picra. Take of succotorine aloes in powder, one ounce; Virginian snake-root aud srineer. of each two drachms. Infuse in a pint of mountain wine, and half a pint of Brandy, for a week, frequently shaking the bottle, then strain off the ^Thisis a safe and useful purge for persons of a languid and phlegmatic ha: tit; but is thought to have better effects, taken in small doses as a laxative, The dose, as a purge, is from one to two ounces. Compound Tincture of Senna. Take of senna, one ounce ; jalap, coriander seeds, and cream of tartar, of each half an ounce. Infuse them in a pint and a half of French brandy for a week; then strain the tincture, and add to it four ounces of fine sugar This is an agreeable purge, and answers all the purposes of the Ehxtr salu- tis and of Daffy's Elixir. The dose is from one to two or three ouuees. Tincture of Spanish Flies. . Take of Spanish flies, reduced to a fine powder, two ounces; spirit of wine, one pint. Infuse for two or three days ; then strain off the tincture. This is intended as an acrid stimulant for external use. Parts affected luttl the palsy or chronic rheumatism may be frequently rubbed with it. " A very good tincture of guaiacum, for domestic uset may be made> infusing two ». three ounces ofthegwa} in a bottle cf rum or brandy. 444 APPENDIX. Tineture of the Balsam of Tolu. Take of the Balsam of Tolu, an ounce and a half; rectified spirit of wine, a pint. Infuse in a gentle heat until the balsam is dissolved, then strain die tinc- ture. This tincture possesses all the virtues of tlie balsam. In coughs, and other complaints of the breast, a tea-spoonful or two of it may be taken in a bit of loaf sugar. But the best way of using it is in syrup. An ounce of the tincture, properly mixed with two pounds of simple syrup, will make what is commonly called the tialsamic Syrup Tincture of Rhubarb. Take of rhubarb two ounces and a half; lesser cardamom seeds, half an ounce; brandy two pints Digest for a week, and strain the tincture. Those who chuse to have a vinous tincture of rhubarb, may infuse the above ingredients in a bottle of Lisbon wine, adding to it about two ounces of proof spirits. If half an ounce of gentian root, and a drachm of Virginian snake-root be ad- ded to the above ingredients, it will make the bitter tincture of Rhubarb. All these tinctures are designed as stomachics and corroborants as well as purgatives. In weakness of the stomach, indigestion, laxity of the intestines^ fluxes, colicky and such like complaints, they are frequently of great service. The dose is from half a spoonful to three or four spoonsful or more, according to the circumstances of the patient, and the purposes it is intended to answer. Paregwic Elixir. Take of flowers of benzoin, half an ounce ; opium two drachms. Infuse in one pound of the volatile aromatic spirit, for four or five days, frequently shak- ing the bottle ; afterwards strain the elixir. This is an agreeable and safe wav of administering opium. It eases pain, al- lays tickling coughs, relieves difficult breathing, and is useful in many disor- ders of children, particularly the hooping-cough. The dose to an adult is from fifty to a hundred drops. Sacred Elixir. Take of rhubarb, cut small, teh drachms ; succotorine aloes, in powder six drachms; lesser cardamom seeds, half an ounce; French brandy, two pints. Infuse for two or three days, and then strain the elixir. This useful stomachic purge may be taken from one ounce to an ounce and a half. Stomachic Elixir. Take of gentian root two ounces; Curassao oranges, one ounce ; Virginian snake-root half an ounce. Let the ingredients be bruised, a> d infused for three or four days in two pints of French brandy afterwards strain out the elixir. This is an ;xcellent stomachic bitter. In flatulencies, indigestion, want of appetite, and such like complaints, a small glass of it may be taken twice a day. It likewise relieves the gout in the stomach, when taken in a large dose. Acid Elixir of Vitriol. Tike of the aromatic tincture, one pint, oil of vitriol, three ounces. Mix thecn gradually, and after the fxces have subsided, filter the elixir through paper, in a glass funnel. 1 his is one of the best medicines which I know for hysteric and hypo- chondriac patients afflicted with flatulencies arising from relaxation or de- bil«ty of the stomach and intestines. It will succeed where the most cele- brated stomachic bitters have no effect The dose is from ten to forty drops, in a glass of wine or water, or a cup of any bitter infusion, twice or thrice a day. It should be taken when the stomach is most empty. Camfihorated Sfitrit of Wine. Dissolve an ounce of camphor in a pint of rectified spirits. This solution i-. chiefly employed as an embrocation in bruises, palsies, the chronic rheumatism, and for preventing gangrenes. * Th- above quantity of camphor, dissolved in half a pound of the vola- tile aromatic spirit, makes Ward's essence. Take of volatile sal ammoniac, any quantity. Pour on it gradually, distilled vinegar, till the effervescence ceases. APPENDIX. 44* Spirit of Mindererus. This medicine is useful in promoting adischarge both by the skin and urinary passages. It is also a good external application in strains and bruises. When intended to raise a sweat, half an ounce of it in a cup of warm gruel, may be given to the patient in bed, every hour, till it has the desired effect. • VINEGARS. VINEGAR is an acid produced from vinous liquors by a second fermentation. It is an useful medicine both in inflammatory and putrid disorders. Its effects are, to cool the blood, quench thirst, counteract atendeney to putrefaction, and allay inordinate motions of the system. It likewise promotes the natural secre- tions, and in some cases excites a copious sweat, where the warm medicines call- ed alexipharmic, tend rather to prevent that salutary evacuation. Weakness, faintings, vomitings, and other hysteric affections, are often re- lieved by vinegar applied to the mouth and nose, or received into the stomach. It is of excellent use also in correcting many poisonous substances, when taken into the stomach ; and in promoting their expulsion, by the different emuncto- rics, when received into the blood Vinegar is not only an useful medicine, but serves likewise to extract, in to- lerable perfection, the virtues of several other medicinal substances. Most of the odoriferous flowers impart to it their fragrance, together with a beautiful purplish or red colour. It also assists or coincides with the intention of squills, garlic, gum-ammoniac, and several other valuable medicines. These effects, however, are not to be expected from every thing that is sold under the name of vinegar, but from such as is sound and well prepared. The best vinegars are those prepared from French wines. % It is necessary for some purposes that the vinegar be distilled, but as this operation requires a particular chemical apparatus, we shall not insert it. Vinegar of Litharge. Take of litharge, half a pound ; strong vinegar two pints. Infuse them to- gether in a moderate heat for three days, frequently shaking the vessel; then filter the liquor for use. This medicine is little used, from a general notion of its being dangerous. There is reason, however, to believe, that the preparations of lead with vine- gar are possessed of some valuable properties, and that they may be used in many cases with safety and success A preparation bf a similar nature with the above has of late been extolled by Goulard, a French surgeon, as a safe and extensively useful medicine, which he calls the Extract of Saturn, and orders to be made in the following manner: Take of litharge one pound ; vinegar made of French wine, two pints. Put them together in a glazed earthen pipkin, and let them boil or rather simmer, for an hour, or an hour and a quartets, taking care to stir them all the while with a wooden spatula After the whole has stood to settle, pour off'the liquor which is upon the top into the bottles for use. With this extract Goulard makes his vegeto-mineral water*, which he recom- mends in a great variety of external disorders, as inflammations, burns, bruises, sprains, ulcers, &c. He likewise prepares with it a number of other forms of medicine, as poul- tices, plasters, ointments, powders, &c. Vinegar of Roses. Take of red roses, half a pound; strong vinegar, half a gallon. Infuse in a close vessel for several weeks, in a gentle heat; and then strain off" the liquor. This is principally used as an embrocation for head achs, &.c. Vinegar of Squills. Take of dried squills, two ounces ; distilled vinegar, two.pints. Infuse for ten days or a fortnight in a gentle degree of heat; afterwards strain off' the li- quor : add to it about a twelfth part its quantity of proof spirits. This medicine has good effects in disorders of the breast, occasioned by a load of viscid phlegm. It is also of use in hydropic cases for promoting a dis- charge of urine. The dose is from two drachms to two ounces, according to the intention for which it is given. When intended to act as a vomit, the dose ought to be large. In other cases, it must not only be exhibited in small doses, but also mixed with * Sec Collyrium of Lead. 446 ATTENrJlX. cinnamon water,T>r some other agreeable aromatic liquor, to prevent the nausea it might otherwise occasion. WATERS BY INFUSION, &c. Lime- Water. POUR two gallons of water gradually upon a pound of fresh burnt quicklime; and when tlie ebullition ceases, stir them well together ; then suff'er the whole to stand at rest, that the lime may settle, and afterwards filter the liquor through paper, which is to be kept in vessels closely stopt. The lime-water from calcined oyster Shells, is prepared in the same manner. Lime-water is principally used for the gravel i in whieh case, from a pint or two, or more of it, may be drank daily. Externally it is used for washing foid ulcers, and removing the itch, and other diseases of the skin. Compound Lime-Watcr. Take shavings of guaiacum wood, half a pound ; liquorice root, one ounce ; sassafras bark, half an ounce ; coriander seeds, three drachms; simple lime- water, six pints. Infuse, without heat, for two days, and then strain off the liquor. In the same manner may lime-water be impregnated with the virtues of other vegetable substances. Such impregnation not only renders the water more agreeable to the palate, but also a more efficacious medicine, especially in cutaneous disorders and foulness of the blood and juices. It may be taken in the same quantity as the simple water. Sublimate Water. Dissolve eight grains of the corrosive sublimate in a pint of cinnamon water, If a stronger solution be wanted, a double or triple quantity of sublimate maj be used. The principal intention of this is to cleanse foul ulcers, and consume proud flesh. Styptic Water. Take of blue vitriol and alum, each an ounce and a half; water, one pint. Boil them until the salts are dissolved ; then filter the liquor, and add to it a drachm of the oil of vitriol. This water is used for stopping a bleeding at the nose, and other hxmorrhages? for which purpose cloths or dossils dipt in it must be applied to the part. Tar Water. Pour a gallon of water on two pounds of Norway tar, and stir them strongly together with a wooden rod: after they have stood to settle for two days, pour *ff the water for use. Theugh tar water falls greatly short of the character which has been given of it, yet it possesses some medical virtues. It sensibly raises the pulse, increases the secretions, and sometimes opens the body, or occasions vomiting. A pint of it may be drank daily, or more, if the stomach can bear it. It is generally ordered to be taken on an empty stomach : viz. four ounces morning and evening, and the same quantity about two hours after breakfast and dinner. SIMPLE DISTILLED WATERS. A GREAT number of distilled waters were formerly kept in the shops, and are still retained in some dispensatories. But we consider them chiefly in the light of grateful dilulents, suitable vehicles for medicines of greater efficacy or for rendering disgustful ones more agreeable to the palate and stomach. We shall therefore insert only a few of those which are best adapted to these intentions. The management of a still being now generally understood, it is needless to «pend time in giving directions for that purpose. Cinnamon Water. Steep one pound of cinnamon bark, bruised, in a gallon and a half of water, and one pint of brandy, for two days, and then distill off one gallon. This is an agreeable aromatic water, possessing, in a high degree, the fra- grance and cordial virtues of the spice. Penny-royal Water. Take of penny-royal leaves, dried, a pound and a half; water from a gallon and a half to two gallons. Draw off by distillation one gallon. This water possesses, in a considerable degree, the smell, taste and ?lrt»u* ■ef the plant. It is given in mixtures and juleps to hysteric patients. APPENDIX. 44? An mtusion of the.herb in boiling water answers nearly the same purposes. Peppermint Water. This is made in the same manner as the preceding. Spearmint Water. This may also be prepared in the same way as the penny-royal water. Both these are useful stomachic waters, and will sometimes relieve vomiting; especially when it proceeds from indigestion, or cold viscid phlegm. They are likewise useful in some colicky complaints, the gout in the stomach, See. parti- cularly the peppermint-water. An infusion of tlie fresh plant is frequently found to have the same effect as the distilled water. Rose Water. Take of roses, fresh gathered, six pounds; water two gallons. Distil off one gallon. This water is principally valued on account of its fine flavour. Jamaica Pepper Water. Take of Jamaica pepper, half a pound ; water, a gallon and a half. Distil off one gallon. This is a very elegant distilled water, and may, in most cases, supply the place of tlie more costly spice-waters. SPIRITUOUS DISTILLED WATERS. Spirituous Cinnamon Water. TAKE of cinnamon bark, one pound; proof spirit, and common water, of each one gallon. Steep the cinnamon in the liquor for two days ; then distil off One gallon. Spirituous Jamaica Pepper Water. Take of Jamaica pepper, half a pound : proof spirit, three gallons : water, two gallons. Distil oft three gallons. This is a sufficiently agreeable cordial, and may supply the place of the Ar*~ matte Water. WHEYS.—Alum Whey. BOIL two drachms of powdered alum in a pint of milk till it is curdled; then strain out the whey. This whey is beneficial in an immoderate flow of the menses, and in a diabetes, or excessive discharge of urine. The dose is two, three or four ounces, according as the stomach will bear it, three times a-day. If it should occasion vomiting, it may be diluted. Mustard Whey. Take milk and water, of each a pint; bruised mustard seed, an dunce and a half: boil them together till the curd is perfectly separated ; afterwards strain the whey through a cloth. This is the most elegant, and by no means the least efficacious method of ex- hibiting mustard. It warms and invigorates the habit, and promotes the different Becretions. Hence, in the low state of nervous fevers, it will often supply the place of wine. It is also of use in the chronic rheumatism, palsy, dropsy, &c. The addition of a little sugar will render it more agreeable. The dose is an ordinary tea-cupful four times a-day. Scorbutic Whey. This whey is made by boiling half a pint of the scorbutic juices in a quart of cow's milk. More benefit, however, is to be expected from eating the plants, than from their expressed juices. The scorbutic plants are, bitter oranges, brooklime, garden scurvy-grass* and water cresses. A number of other wheys may be prepared nearly in the same manner, as, orange whey, cream of tartar whey, &c. These are cooling, pleasant drinks in fevers, and may be rendered cordial, when necessary, by the addition of win*. WINES. THE effects of wine are to raise the pulse, promote perspiration, warm the habit, and exhilarate the spirits. The red wines, besides these effects, have an astringent quality, by which diey strengthen the tone of the stomach and intes- tines, and by this means prove serviceable in restraining ijfioioderate secretion*- 448 APPENDIX. The thin sharp wines have a different tendency." They pass off freely by the different emunctories, and gently open the body. The effects of the full bodied wines are, however, much more durable than those of the thinner. All sweet wines contain a glutinous substance, and do not pass off freely Hence they will heat the body more than an equal quantity of any other wine, though it should contain fully as much spirit. From the obvious qualities of wine it must appear to be an excellent cordial medicine. Indeed, to say tlie truth, it is worth all the rest put together. But to answer this character, it must be sound and good. No benefit is to be expected from the common trash that is often sold by the name of wine, without possessing one drop of the juice of the grape. Perhaps no medicine is more rarely obtained genuine than wine. Wine is not only used as a medicine, but is also employed as a menstrum for extracting the virtues of other medicinal substances ; for which it is not ill adapted, being a compound of water, inflammable spirit, and acid ; by whicli means it is enabled to act upon vegetable and animal substances, and also to dissolve some bodies of the metallic kind, so as to impregnate itself with their virtues, as steel, antimony, &c. Anthelmintic Wine. Take of rhubarb, half an ounce ; worm-seed, an ounce. Bruise them, anil infuse without heat in two pints of red port wine for a few days ; then strain off the wine. As the stomachs of persons afflicted with worms are always debilitated, red wine alone will often prove serviceable. It must, however, have still better ef- fects when joined with bitter and purgative ingredients, as in the above form. A glass of this wine may be taken twice or thrice a-day. Anthnonial Wine. Take a glass of antimony, reduced to a fine powder, half an ounce. Lisbon wine, eight ounces. Digest, without heat, for three or four days, now and Uien shaking the bottle ; afterwards filter the wine through paper The dose of this wine varies according to the intention. As an alternative and diaphoretic, it may be taken from ten to fifty or sixty drops. In a large dose it generally proves cathartic, or excites vomiting. Bitter Wine. Take of gentian root, yellow rind of lemon-peel, fresh, each one ounce; long pepper, two drachms; mountain wine, two pints. Infuse withoutheat for a week, and strain out the wine for use. In complaints arising from weakness of the stomach, or indigestion, a glas9 of this wine may be taken an hour before dinner and supper. Ipecacuanha Wine. Take of ipecacuanha, in powder, one ounce ; mountain wine, a pint. Infuse for three or four days ; then filter the tincture. This is a safe vomit, and answers extremely well for such persons as cannot swallow the powder, or whose stomachs are too irritable to bear it. The dose is from one ounce to an ounce and a half. Chalybeate or Steel Wine. Take filings of iron two ounces ; cinnamon and mace, of each two drachms, Rhenish wine two pints. Infuse for three or four weeks, frequently shaking the bottle ; then pass the wine through a filter. In obstructions of the menses, this preparation of iron may be taken, in the dose of half a wine-glass twice or thrice a-day. The medicine would be as good if made with Lisbon wine, sharpened with half an ounce of the cream of tartar, or a small quantity of the vitriolic acid. Stomach Wine. Take of Peruvian bark, grossly powdered, an ounce ; cardamom seeds, and orange-peel, bruised, of each two drachms. Infuse in a bottle of white port or Lisbon wine, for five or six days ; then strain off" the wine. ' This wine is not only of service in debility of the stomach and intestinesj but may also betaken as a preventative, by persons liable to the intermittent fever or who resides in places where this disease prevails. It will be of use likew'ise to those who recover slowly after fevers of any kind, as it assists di* gestion; and helps to restore the tone and vigour of the system. A glass ef it may be taken two or three times a-day. 449 A GLOSSARY. ALTHOUGH terms of art have been sedulously avoided in the composition of this treatise, it is impossible entirely to banish technical phrases when writing on medicine, a science tliat has been less generally attended to by mankind, and continues therefore to be more infected with the jargon of the schools, than per- haps any other. Several persons having expressed their opinion that a Glossary would make this work more generally intelligible, the following concise expla- nation of the few terms of art that occur, has been added in compliance with their sentiments, and to fulfil the original intention of this treatise, by rendering it intelligible and useful to all ranks and classes of mankind. JBDOMEtf, The belly. Absorbents, Vessels that convey the nourishment from the intestines and the secreted fluids from the various cavities into the mass of blood. Acrimony, Corrosive sharpness. Acute, A disease, the symptoms of which are vielent, and tend to a speedy termination, is called acute. Adult, Of mature age. Adust, Dry, warm. Antispasmodic, Whatever tends to prevent or remove spasm. Aphthx, Small whitish ulcers appear- ing in the mouth. Astriction, A tightening or lessening. Atrabilarian, An epithet commonly applied to people of acertain tempe- rament, marked by a dark complex- ion, black hair, spare habit, &c. which the ancients supposed to arise from the atra bilis, or the black bile. BILE or G..LL, A fluid which is secreted by the liver into the gall bladder, and from thence passes in- to the intestines, in order to pro- mote digestion. CACOCHYMIS, An unhealthy state ofthe body. Caries, A rottenness of the bone. Chyle, A milky fluid separated from the aliment in the intestines, and conveyed by the absorbents into the blood to supply the waste of the animal body. Chronic, A disease whose progress is slow* in opposition to acute. Circulation, The motion of the blood, which is driven by the heart through the arteries and returns by the veins. Comatose, Sleepy. Conglobate Gland, A simple gland. Conglomerate, A compound gland. Contagion, Infectious matter. Cutis, The skin, Gutanrous, Of or belonging to '.lie skin. Crisis, A certain period in the pro- gress of a disease, from whence a decided alteration either for the better or the worse takes place. Critical, Decisive or important. Gritical Days, The fourth, fifth, se- venth, ninth, eleventh, thirteenth, fourteenth, seventeeth, and twenty- first, are by some authors denomi- nated critical days, because febrile complaints have been observed to take a decisive change at these pe-s riods DEBILITY, Weakness. Delirium, A temporary disorder of the mental faculties. Diaphragm, A membrane separating the cavity of the chest from that of the belly. Diuretic, A medicine that promotes the secretion of urine. Drastic, Is applied to such purgative medicines as are violent or harsh in their operation EMPYEMA, Acollection of purulent matter in the cavity of the breast. Endemic, A disease peculiar to a certain district of country Epidemic, A disease generally infec- tious. Exacerbations, The increase of any disease. FOECES, Excrements. Fcttid, Emitting an offensive smell. Fmtus, The child before birth, or when born before the proper period) is thus termed. Flatulent, Producing wind. Fungus, Proud flesh. GANGRENE, Mortification. Gummata,} ,r , Ganglia, $ Venereal excrescences, G'ymnasft'c,Exercise taken with a view to preserve or restore health.-—The ancient physicians reckoned this an important branch »f medicine. 5fj 450 A GLOSSARY. HECTIC FEVER, A slow consum- ing fiever, generally attending a bad habit of body, or some incureable and deep rooted disease. Hemorrhoids, The piles. Hemorrhage, Discharge of blood. Mypochondriacism, Low spirits. Hypochondriac viscera, The liver, spleen, &c. So termed from their situation in the hypochondriac or up- per and lateral parts of the belly. ICHOR, Thin bad matter. Imposthume, A collection of purulent matter. Inflammation, A surcharge of blood, and an increased action of the ves- sels, in any particular part of the body. LIGATU RE, Bandage. Ziixivium, Ley. MILIARY ERUPTION, Eruption of small pustules resembling the seeds of millet. Morbific, Causing disease, or diseased. JMumis, The matter discharged from the nose, lungs, &c. Mysentery, A double membrane which connects the intestines to the back bone. NERVOUS, Irritable. Nausea, An inclination to vomit Nodes, Enlargement of the bones pro- duced by the venereal disease. PECTORAL, Medicines adapted to cure diseases of the breast. Pelvis, The bones situated at the lower part of the trunk; thus named from their resembling in some measure a bason. Peritonaeum, A membrane lining the cavity of the belly and covering the intestines. Pericardiumt Membrape containing the heart. Perspiration, Th-. matter discharged from the pores of the skin in form of vapour or sweat. Phlogiston, Is here used to signify somewhat rendering the air unfit for the purposes of respiration. Phlegmatic, Watery, relaxed. Plethoric, Replete with blood. Polypus, A diseased excrescence, or a substance formed of coagulable lymph, frequently found in the large blood-vessels. Pus, Matter contained in a bile. REGIMEN, Regulation of diet. Rectum, The straight gut in which the fecces are contained. Respiration, The act of breathing. SALIVA, The fluids secreted by the glands of the mouth. Sanies, A thin bad matter, discharged from an ill-conditioned sore. Scirrhous, A. state of diseased hardness. 1 Slough, A part separated and thrown I off by suppuration. I Spasm, A diseased contraction. I Spine, The back bone. Styptic, A medicine for stopping the discharge of blood. Syncope, A fainting-fit attended with a complete abolition of sensation and thought. TABS, A species of consumption. Temperament, A peculiar habit of bo- dy, of which there are generally reckoned four, viz. the sanguine, the bilious, the melancholic, and the phlegmatic. VERTIGO, Giddiness. ULCER, An ill-conditioned sore. Ureters, Two long and small canak which convey the urine from the kid- nies to the blader. Urethrea, The canal which conveys the urine from the bladder. INDEX. ABLUTIONS, Jewish and Mahometan, well calculated for the preser- vation of health, 94. • o« Abortion, causes and symptoms of, 335. Means of prevention, 336. Proper treatment in the case of, ibid. Abscesses, how to be treated, 215, 358. Accidents. See Casualties. Acids, of peculiar service in consumptions, 137. In putrid fevers, 145. Not suitable to the measles, 180. Acidities in the bowels of infants, the origin of, 344. Method of cure, 345. Acksvorth, foundling hospital at, cause of the children there being afflict- ed with scabbed heads, and fatal consequences of their ill treatment, 348, note. Addison, his remark on the luxury of the table, 80. Mther, very serviceable in removing fits of the asthma, 269. Is excel- lent for flatulencies, 287. Mhiops mineral, strongly recommended by Dr. Cheyne in inflammations of the eyes, 191. Africans, their treatment of children, 38, note. Agaric of the oak, its merit as a styptic, 360. Method of gathering, preparing, and applying it, ibid, note. Agriculture, a healthful, constant, and profitable employment, 58- Is too much neglected in favour of Manufactures, ibid. Gardening the most wholesome amusement for sedentary persons, 61. Ague, a species of fever no person can mistake, and the proper medicine far, generally known, 117. Causes of, ibid. Symptoms, 118. Regi- men for, ibid. Under a proper regimen will often go off without medi- cine, ibid. Medical treatment of, ibid. Often degenerates into obsti- nate chronical diseases, if not radically cured, 121. Peruvian bark the only medicine to be relied on, ibid. Children how to be treated in, 122. Preventative medicine for those who live in marshy countries, ibid. 4ir, confined, poisonous to children. 49. A free open air will sometimes cure the most obstinate disorders in children, 50. Occupations which injure the health by unwholesome air, 52, 59. The qualities of, act more sensibly on the body than is generally imagined, 78. The seve- ral noxious qualities of, specified, ibid. In large cities, polluted by various circumstances, 79. The air in churches, how rendered un- wholesome, ibid. Houses ought to be ventilated daily, 80. The dan- ger attending small apartments, ibid. Persons whose business confines them to town ought to sleep in the country, ibid. High walls obstruct the free current of air, 81—Trees should not be planted too near to houses, ibid. Fresh air peculiarly necessary for the sick, ibid. The sick in hospitals in more danger from the want of fresh air, than from their disorders, ibid. Wholesomeness of the morning air, 83. The 452 INDEX. changeableness of, one great cause of catching cold, 100. Tliotsc whw keep most within doors, the most sensible of these changes, ibid. Of the night, to be carefully guarded against, 107. Fresh air often of more efficacy in diseases than medicine, 113. Its importance in fe- vers, 11G, 124. States of, liable to produce putrid fevers, 143. Must be kept cool and fresh in sick chambers under this disorder, 145. Change of, one of the most effectual remedies for the hooping cough, 203. The qualities of, a material consideration for asthmatic patients, 268. The various ways by which it may be rendered noxious, 380. Confined, how to try, and purify, ibid. Method of recovering persons poisoned by foul air, ibid. Fresh, of the greatest importance in faint- ing fits, 384. Aiken, Mr. his treatise on the nature and cure of fractures, recommend- ed, 370, note. Alkali, caustic, recommended in the stone, 225. How to prepare it, ibid. note. Aliment, is capable of changing the whole constitution of the body, 66. Will in many cases answer every intention in the cure of diseases, ibid. The calls of hunger and thirst, sufficient for regulating the due quanti- ty of, ibid. The quality of, how injured, ibid. Adue mixture of ve- getables necessary with our animal food, 68. To what tlie bad effects of tea are principally owing, ibid. Water, good and bad, distinguished, 69. Inquiry into the qualities of fermented liquor, with instructions for the due making of them, ibid. The qualities of good bread, and why adulterated by bakers, 70. General rules for the choice of food, ibid. Ought not to be too uniform, 71. Meals ought to be taken at regular times, ibid. Long fasting injurious both to old and young, ibid. Breakfasts and suppers, 72. Changes of diet ought to be gradually made, ibid. General observations on, 397. Amaurosis. See Gutta serena. American Indians, their method of curing the venereal disease, 326. Amusements, sedentary, improper for sedentary persons, 60. Ought al- ways to be of an active kind, 84. Anasarka. See Dropsy. Anger, violent fits of, injurious to the constitution, 98. Tranquility of mind essential to health, 99. Animal food, cautions in giving it to children, 42. Injurious effects when used by nurses, 50, note. Animals that die of themselves, unfit for food, 67. Overdriven cattle rendered unwholesome, ibid. The ar- tifices of butchers exposed, ibid. Too great a quantity of, generates the scurvy, ib d. Injurious to many habits, 398. Animals and plants, the analogy in the nourishment of, stated, 89. Anthony's fin, St. See Erysipcl ,s. Aphtha. See Thrush. Apoplexy, who most liable to this disorder, 269. Causes, ?'6i'rf—Symp- toms and method of cure, 270. Cautions to persons of an apoplectic make, 271. Apothecaries weights, a table of, 420. Apparel. See Clothing. Appetite, want of, causes and remedies for, 273. Arbuthnot, Dr. his advice in the intlammation of the lungs, 130. Hi* advice for persons troubled with costiveness, 272, note. INDEX. 453 Arsenic, the effects of, on the stomach, 305. Medical treatment when the symptoms appear, ibid. Arts. See Manufactures. Ascites. See Dropsy. Asses milk, why it seldom does any good, 134. Instructions for taking it, 135. Asthma, the different kinds of tins disorder distinguished, with its causes, 267. Symptoms, ibid. Medical treatment, 268. Remedies proper in the moist asthma, 269. Atmosphere. See Air. BALL'S purging vermifuge powder, preparation of, 248. Balsams, how to prepare, Anodyne balsam, 423. Locatelli's balsam, ibid. Vulnerary balsam, ibid. Bandages, tight, produce most of the bad consequences attending fractu- red bones, 370. Bark, Peruvian, the best antidote for sailors against disorders on a fo- reign coast, 58. How to be administered m the ague, 119. Distinc- tion between the red bark and quill bark, ibid, note. A decoction or infusion of, may be taken by those who cannot swallow it in substance, 120. Is often adulterated, ibid, note. Is the only medicine to be de- pended on in agues, 121. How it may be rendered more palatable, 122. May be administered by clysters, ibid. Cold water the best menstrum for extracting the virtues of this drug, 137. How to be administered in the putrid fever, 146; and in the erysipelas, 186. In an inflammation of the eyes, 171. Its efficacy in a malignant quinsey, 197. In the hooping cough, 205. A good medicine in vomiting, when it proceeds from weakness of the stomach, 220. Its efficacy in a diabetes, and how to take it, 222. Is good against the piles, 230; and worms, 247. Its use dangerous for preventing a fit of the gout, 256. A good remedy in the King's evil, 265, and in the jiuor albus, 334. Barley water, how made, 127. Barrenness in women, the general causes of, 341, Course of relief, 342. Dr. Cheyne's observations on, ibid, note. Bath waters good in the gout, 257. Bath, cold, the good effects of, on children, 48. Recommended to the studious, 65. Is peculiarly excellent for strengthening the nervous system, 277. Therefore should never be omitted in gleets, 320. Is good for rickety children, 353. Cautions concerning the improper use of, in adults, 390, 393. Bath, warm, of great service in an inflammation of the stomach, 206. Bathing, a religious duty under the Judaic and Mahometan laws, 93. Is conducive to health, ibid. Bears foot recommended as a powerful remedy against worms, 248. Beds, instead of being made up again as soon as persons rise from them, ought to be turned down and exposed to the air, 80. Bad effects of too great indulgence in bed, 83. Damp, the danger of, 107. Soft, are injurious to the kidneys, 222. Beer, the ill consequences of making it too weak, 69. Pernicious artifices of the dealers in, ibid. Bells, parish, the tolling them for the dead, a dangerous custom, 100. Riles, 359. Bilious colic, symptoms and treatment of, 210. 454 INDEX. Bilious fever. See Fever. Bite of a mad dog. See Dog. Bitters, warm and astringent, antidotes to agues, 120. Are serviceable in vomiting when it proceeds from weakness in the stomach, 220. Bladder, inflammation of, its geueral causes, 213. Medical treatment of, ibid. Bladder, stone in. See Stone. Blast. See Erysipelas. Bleeding, cautions for the operation of, in fevers, 116. In the ague, 119. Its importance iu the acute continual fever, 125. In the pleurisy, 127. When necessary in au inflammation of the lungs, 131. Caution against, in a nervous fever, 141. In the putrid fever, 146. In the miliary fever, 150 When necessary in the small-pox, 163. When useful in the measles, 181. When necessary in the bilious fever, 183. Under what circumstances proper in the erysipelas, 185. Mode of, proper in an inflammation of the brain, 188. Is always neci.ssary in an in- flammation of the eyes, 190. When proper and improper, in a cough, 200. When proper in the hooping cough, 203. Is almost the only thing to be depended on in an inflammation of the stomach, 206. And in an inflammation of the intestines, 207. Is necessary in au inflam- mation of the kidneys, 212. Its use in a suppression of urine, 223. Is proper in an asthma, 268. Is dangerous in fainting fits, without due caution, 286. Cautions proper in the puerperal fever, 340. Is an operation generally performed by persons who do not understand when it is proper, 356. In what cases it ought to be had recourse to, ibid. The quantity taken away, how to be regulated, ibid. General rules for the operation, 357. Objections to bleeding by leeches, ibid. Pre- vailing prejudices relating to bleeding, ibid. The arm the most com- modious part to take blood from, 358. Bleeding at the nose, spontaneous, is of more service, where bleeding is necessary, than the operation with the lancet, 228. Ought not to be stopped without due-consideration, ibid. How to stop it when neces- sary, ibid. Cautions to prevent frequent returns of, 229. Blind persons, when born so might be educated to employments suited to their capacity, 295, note. Blisters, peculiarly advantageous in the nervous fever, 141. When only to be applied iu the putrid fever, 146. When proper in the miliary fever, 150. Seldom fail to remove the most obstinate inflam- mation of the eyes, 191. A good remedy in the quinsey, 194. Pro- per for a violent hooping cough, 204. Is one of the best remedies •for an inflammation of the stomach. 207. Are efficacious in the tooth-ach, 242. Blood, involuntary discharges of, often salutary, and ought not to be rashly stopped, 226. The several kinds of these discharges, with their usual causes, ibid. Methods of cure, 227. Blood, spitting of, who most subject to, and at what seasons, 231. Its causes, ibid. Symptoms, ibid. Proper regimen in, 232. Medical treatment, ibid. Cautions for persons subject to it, 233. Blood, vomiting of, its causes and symptoms, ibid. Medical treatment, ibid. Blood-shot eye, how to cure, 297. Bloody-Cux. See Dysentery. INDEX. 45$ Bocrhaave, his observations on dress, 88, note. His mechanical expedi- ents to relieve an inflammation of the brain, 188. Bolusses, general rules for the preparing of, 423. The astringent bolus, ibid. Diaphoretic bolus, ibid. Mercurial bolus, 424. Bolus of rhu- barb and mercury, ibid. Pectoral bolus, ibid. Purging bolus, ibid. Bones, the exfoliation of, a veiy slow operation, 364. Bones, broken, oft- en successfully undertaken by ignorant operators, 369. Regimen to be adopted after the accident, ibid. Hints of conduct if the patient is confined to his bed, 370. Cleanliness to be regarded during this confinement, ibid. The limb not to be kept continually on the stretch, ibid. Cautions to be observed in setting a boue, 371. Tight banda- ges condemned, ibid. How to keep the limb steady by an easy method,. ibid. Fractures of the ribs, ibid. Bowels, inflammation of. See Stomach. Boys, the military exercise proper for them, 46. Braidwood, Mr. his skill in teaching the dumb to speak, 298, note. Brain, inflammation of, who most liable to it, with its causes and symp- toms, 186. Regimen, ibid. Medical treatment, 187. Bread, proper food for children, as soon as they can chew it, 41. Crust of, the best gum-stick, 42. The best modes of preparing it in food, for children, ibid. Good, the qualities of and for what purpose adulterat- ed by the bakers, 70, 75. Toasted, a decoction of, good to check the vomiting in a cholera morbus, 216. A surfeit of, more dangerous than any other food, 399. The finest not always the best adapted for nutri- tion, 400. Household bread the most wholesome, ibid. Wheat flour apt to occasion constipation, 401. Rye is apt to excite heart-burn, and is laxative, but excellent to prevent the scurvy, 75. Different kinds of grain make the best bread, 401. Consumption of bread increased by drinking tea, ibid. Indian corn the best food when boiled, 404, Buck- wheat highly nutritious, 405. Does not agree with all constitutions, 734 Various substitutes for bread, 407. Brimstone. See Sulphur. Broth, gelatinous, recommended in the dysentery, how to make, 236* Broths and Soups various ingredients in the composition of, 411. Gene- ral observations on, ibid. The most wholesome diet for the poor, ibid. Warmly recommended by Count Rumford, ibid. Brown soup recom- mended for breakfast in place of tea, 412. Bruises, why of worse consequence than wounds, 363. Proper treat- ment of, ibid. The exfoliation of injured bones, a very slow operation, 364. How to cure sores occasioned by, ibid. Buboes, two kinds of distinguished, with their proper treatment, 321. Burdens, heavy, injurious to the lungs, 54. Burgundy pitch, a plaster of, between the shoulders, an excellent remedy in a cough, 201. In a hooping-cough, 204. And for children in teeth- ing, 351. Burials, the dangers attending their being allowed in the midst of popu- lous towns, 79. Burns, how instantly to abate the pain, 361. Slight, how to cure, ibid. Treatment of, when violent, 362. Dr. Underwood's remedy, ibid. Extraordinary case of, 363. Linimeut for, 437. Butchers, their professional artifices explained and condemned, 67. 456 INDEX. Butter, ought to be very sparingly given to children, 43. Used in large quantities veiy injurious to the stomach, having a constant tendency to turn rancid, 405. Bread made with butter not cat-ily digested, 400. Pasties of every kind improper for children, ibid. CABBAGE leaves, topical applications of, iu a pleurisy, 128. Camphor, why of little use in eye-waters, 426. Camphorated oil, preparation of, 437. Camphorated spirits of wine, 444. Camps the great necessity of consulting cleanliness in, 93. Cancer, its different stages described, with the producing causes, 301. Symptoms, ibid. Regimen, and medicaUreatment, 302. Dr. Storck's method of treating this disorder, ibid. Cautions for avoidin* it, 304. Cancer scroti, a disorder peculiar to chimney-sweepers, owin» to want of cleanliness, 92, note. Carriages, the indulgence of, a sacrifice of health to vanity, 82. Carrot, wild, recommended in the stone, 226. Carrot poultice for cancers, how to prepare, 303. Carrot, properly manured, may supply the place of bread, 409. Casualties, which apparently put an end to life, necessaiy cautions res'* pecting, 373. --------------substances stopped in the gullet, 371. -------------- drowning, 377. --------------noxious vapours, 380. ---------—— extremity of cold, 381. ■-------------- extreme heat, 382. Cataplasms, their general intention, 424. Preparation of the discutient cataplasm, ibid. Ripening cataplasm, ibid. Cataract, the disorder and its proper treatment described, 263. Cattle, stall fed, are unwholesome food, 67. Over-driten, are killed in a high fever, ibid. The artifices of butchers exposed, ibid. Cellars, long shut, ought to be cautiously opened, 80. And 6unk stories of houses, unhealthy to live in, 108. Of liquors in a state of fermenr tation, dangerous to enter, 380. How to purify the air in, ibid. Celsus, his rules for the preservation of health, 110. Chancres, described, 322. Primary, &c. how to treat, 323. Charcoal fire, the danger of sleeping in the fume of, 380. Charity, the proper exercise of, 56. Cheese, as a diet, injurious to health, 406. Cheyne, Dr. his persuasive to the use of exercise, 84. His judgment of the due quantities of urine, not to be relied on, 105. Strongly recom- mends the ^Ethiops mineral in inflammations of the eyes, 291. His observations on barrenness, 342, note. Chilblains, cause of, 319. How to cure, ibid. Child-bed women, how to be treated under a miliary fever, 146. Child-bed fever. See Fever. Child-Birth, the season of, requires due care after the labour pains are over, 337. Medical advice to women in labour, ibid. Ill effect of collecting a number of women on such occasions,"338, note. How to guard against the miliary fever, 339. Symptoms of the puerperal fe- ver, ibid. Proper treatment of that fever, 340. General cautions for women at this season, 341. INDEX. 457 Children, their diseases generally acute, and delay dangerous, 35. Their disorders less complicated, and easier cured, than those of adults, 36. Are often the heirs of the diseases of their parents, ibid. Those born of diseased patents require peculiar care in the nursing, 37. Are often killed or deformed by injudicious clothing, ibid. How treated in Africa, 38, note. The usual causes of deformity in, explained, 39. Their cloths ought to be fastened on with strings, ibid. General rule for clothing them, 40. Cleanliness, an important article in their dress, ibid. The milk of the mother the most natural food for, ibid. Absurd- ity of giving them drugs as their first food, 41. The best method of expelling the meconium, ibid. How they ought to be weaned from the breast, ibid. A crust ofbread the best gum-stick for them, 42. How to prepare bread iu their food, ibid. Cautions as to giving them animal food, ibid. Cautions as to the quantity of the food, ibid. Errors in the quality of their food more frequent than in the quantity, 43. The food of adults improper for children, ibid. Strong liquors expose them to inflammatory disorders, ibid. Ill effects of unripe fruit, ibid. But- ter, ibid. Honey, a wholesome article of food for them, ibid. The importance of exercise to promote their growth and strength, 44. Rules for their exercise, ibid. Poverty of parents occasions their neglect of children, 45. The utility of exercise demonstrated from the organic* al structure of children, ibid. Philosophical arguments showing the necessity of exercise, ibid. Ought not. to be sent to school too soou, 46. Nor be put too soon to labour, 47. Dancing an excellent exercise for them, 48. The cold bath, ibid. Want of wholesome air destruc- tive to children, 49. To wrap them up close in cradles pernicious,ibid. Arc treated like plants in a hot house, 50. The usual faulty conduct of nurses pointed out, ibid. Are crammed with cordials by indolent nurses, 51. Eruptions ignorantly treated by nurses, ibid. Loose stools, the proper treatment of, 52. Every method ought to be taken to make them strong and hardy, ibid. Indications of the small-pox in, 159. Clun-cough. See Cough. # Cholera morbus,\he disorder defined, with its causes and symptoms, 216. Medical treatment, ibid. Churches, the several circumstances that render the air in, unwhole- some, 79. Churching of women after lying in, a dangerous custom, 341. Church-yards, the bad consequences of having them in large towns, 79. Cities, large, the air in, contaminated by various means, 79. The bad effects of burying the dead in, ibid. Houses ought to be ventilated daily, 80. The danger attending small apartments, ibid. All who can ought to sleep in the country, ibid. Disorders that large towns are peculiarly hurtful to, ibid. Cleanliness not sufficiently attended to in, 92. Should be supplied with plenty of water, 95, note. The best means to guard against iufectiftn in, 97. Clare, Mr. his method of applying saline preparations of mercury in ve- nereal cases, 325. Cleanliness, an important article of attention in the dress of children, 40. and to sedeutary artists, 60. Finery in dress often covers dirt, 88. Is necessaiy to health, 92. Disorders originating from the want of, ibid. Is not sufficiently attended to in large towns, 93. Nor by country peasants, ibid. Great attention paid to, by the ancient Romaas, ibid. 57 458 INDEX. note. Necessity of consulting cleanliness in camps, ibid. Was the principal object of the whole system of the Jewish laws, 94. Is a great part of the religion of the Eastern countries, ibid. Bathing aud washing greatly conducive to health, ibid. Cleanliness peculiarly ne- cessary on board of ships, ibid, and to the sick, ibid. General remarks on, 95. Many disorders may be cured by cleanliness alone, 113. The want of, a very general cause of putrid fevers, 143. Is a great pre- servative against venereal infection, 328; and against galling in in- fants, 345. Cutaneous disorders proceed from a want of, 404. Clergy, exhorted to remove popular prejudices against inoculation, 168. Might do great good by undertaking the practice of it themselves, 171. Clothing, the only natural use of, 37. That of children, has become a , secret art, ibid. Ought to be fastened on infants with strings instead of pins, 39. Pernicious consequences of stays, 40. Importance of cleanliness to children, ibid. The due quantity of, dictated by the climate, 86. Should be increased in the decline of life, 87 ? and adap- ted to the seasons, ibid. Is often hurtful by being made subservient to the purposes of vanity, ibid. Pernicious consequences of attempt- ing to mend the shape by dress, ibid. Stays, ibid. Shoes, ibia\ Garters, buckles, and other bandages, 88. The perfection of, to be easy and clean, ibid. General remarks on, ibid. Wet, the danger of, and how to guard against it, 107. Clysters, proper in an inflammation of the stomach, 206. And in an in- flammation of the intestines, ibid. Of tobacco smoke, its efficacy in procuring a stool, 211, note. * Of chicken broth salutary in the cholera morbus, 216. Their use in suppression of urine, 223. Ought to be frequently administered in the puerperal fever, 340. Of tobacco, to excite a vomit, 376. Of tobacco fumes, to stimulate the intestines, 378. The general intention of, 425. Preparation of the emolient clyster, ibid. Laxative clyster, ibid. Carminative clyster, ibid. Oily clyster, ibid. Starch clyster, ibid. Turpentine clyster, 426. Vine- gar clyster, ibid. Catiac passion, proper treatment for, 238. Coffee-berries, recommended iu the stone, 226. Cold, extreme, its effects on the human frame, 381. The sudden appli- cation of heat dangerous in such cases, ibid, How to recover frozen oi benumbed limbs, ibid. Cold Bath. See Bath. Colds, frequently occasioned by imprudent changes of clothes at the first approach of summer, 87 note. Various causes of, specified, 106. Their general causes, 198. Proper regimen on the symptoms of, appearing, ibid. Danger of neglecting the disorder, 199. The chief secret for avoiding, 200. Colic, different species of, 209. Medical treatment of according to their species and causes, 210. Bilious colic, ibid. Hysteric colic, ibid. Nervous colic, 211. Cautions necessary to guard against the nervous colic, ibid. General advice in colics, ibid. CoUyria. See Eye-waters. Commerce, often imports infectious disorders, 96. Means suggested to guard against this danger, ibid, note. Confections, often veiy needlessly compounded^ 426. Preparation of the Japonic confection, ibid. INDEX. ^59 Conserves and Preserves, general remarks on, and their composition, 426. Of red roses, 427. Of sloes, ibid. Candied orange-peel, ibid. Constitution, good or bad, the foundation of, generally laid during infan- cy, 33. Consumptions, the increase of this disorder may be attributed to hard drinking, 91. Who most liable to, and its causes, 132. Symptoms, 133. Regimen, ibid. Riding, ibid. Much benefit to be expected from going a long voyage, 133. Travelling, ibid. Viet, ibid. Great efficacy of milk in, ibid. Medical treatment, 136. Consumptions, nervous, defined, and the persons most liable to, 138. Pro- per treatment of, ibid. Consumptions, Symptomatic, the treatment of, must be directed to the producing cause, 139. Convulsions, why new-born infants are so liable to, 39. Those preced- ing the eruption in the small-pox, favourable symptoms, 160. The general causes of, 353. Proper treatment of, ibid. Extraordinary recovery of an infant seemingly killed by, 388. Farther instructions in like cases, ibid. ' Cook, Captain, the circumnavigator, his means of preserving the health of his men, 57, note. Cookery, the arts of, render many things unwholesome, that are not natur- ally so, 68. Roasting meat, a wasteful mode of, 412. Cordials, ought not be given to infants, 41. Are the common refuge of nurses who neglect their duty to children, 51. Are often fatal in an inflammation of the stomach, 206. When good in the colic, 209. Ought not to be given to a pregnant woman during labour, 337. Corn, damaged, will produce the putrid fever, 143. Corns in the feet, are occasioned by wearing tight shoes, 87. Cortex. See Bark. Costiveness, a frequent recourse to medicines for the prevention of, inju- rious to the constitution, 104. Is rather to be removed by diet than by drugs, ibid. Its general causes, and ill effects, 271. Regimen, 272. Remedies for, ibid. Cough, the proper remedies for, 200. A plaster of Burgundy pitch laid between the shoulders an excellent remedy for, 201. The stomach cough, and cough of the lungs, distinguished, 202.—Treatment for the nervous cough, ibid. Cough, hooping, who most liable to, with its disposing causes, 202. Re- medies, 203. Is infectious, ibid. Vomits, their use, and how to ad- minister them to children, ibid Garlic ointment, a good remedy for, 204. Cough, phthisical, incident to sedentary artificers, from their breathing confined air, 59. Cradles, on many accounts hurtful to children, 49. Cramp, proper remedies for, 291. Cramp of the stomach, who most subject to, 284. Medical treatment of, ibid. . . . . Crotchets, how to use for extracting substances detained in the gui- Crwp2lr'hives in children, described, 349. Its symptoms and proper treatment, 350. Cider, the ill consequences of making it too weak, 69. 460 INDEX. Dancing, an excellent kind of exercise for young persons, 18 Daucus sylvcstris. See Carrot. Deafness, when a favourable symptom in the putrid fever, 144, nofc. Methods of cure, according to its causes, 293. Death, the evidences of, sometimes fallacious, and ought not to be too soon credited, 373, 377, 378, 389. The means to be used for the re- covery of persons from, nearly the same in all cases, ibid. Decoctions, general remarks on, 427. Preparation of the decoction of althaea, ibid. Common decoction, ibid. Of logwood, 428. Of bark, ibid. Compound decoction of bark, ibid. Of sarsaparilla, ibid. Of senaka, ibid. White decoction, ibid. Deformity, often occasioned by the injudicious manner of dressing chil- dren, 37. Is seldom found among savage nations, 38. The usual causes of, explained, 39. Dews, night, dangerous to health, 107. Diabetes, who most liable to this disorder, 221. Its causes and symp- toms, ibid. Regimen, and medical treatment, ibid. Distinguished from the iucontinency of urine, 222. Diarrhoea. See Looseness. Diet, will often ansiver all the indications of cure in diseases, 112. Il- lustrations, 113. General observations on, 398. Improper diet affects the mind as well as the body, 399. Vegetable ought to preponderate over animal food, ibid. See Aliment. Digestion, the powers of, equally impaired by repletion, or inanitiou, 7 ]. Diseases, hereditary, cautions to persons afflicted with, 36. Peculiar disorders attending particular occupations, 52. Many of them infec- tious, 95. The knowledge of, depends more upon experience and ob- servation than upon scientific principles, 111. Are to be distinguish- ed by the most obvious and permanent symptoms, ibid. The differ- ences of sex, age, and constitution, to be considered, ibid. Of the mind, to be distinguished from those of the body, 112. Climate, situ- ation, and occupation, to be attended to, ibid. Otlier collateral cir- cumstances, ibid. Many indications of cure, to be answered by diet alone, ibid. Cures often effected by fresh air, by exercise, or by clean- liness, 113. Nervous diseases, of a complicated nature, and difficult to cure, 274. Dislocations, should be reduced before the swelling and inflammation comes on, and how, 336. Of the jaw, ibid. Of the neck, 367. Of the ribs, ibid. Of the shoulder, 368. Of the elbow ibid. Of the thigh, ibid. Of the knees, ancles, and toes, 369. Diuretic infusion for the Dropsy, how to prepare, 252. Dog, symptoms of madness in, 306. Ought to be carefully preserved after biting any person, to ascertain whether he is mad or not, 307. Is often reputed mad, when he is not so, ibid. Symptoms of the bite of a mad dog, ibid. The poison cannot be many years dormant in the body, as is supposed, ibid. Dr. Mead's recipe for the bite, 308. The famous East Indian specific for, ibid. Other recipes, ibid. Vinegar of considerable service in this disorder, ibid Medical course of treatment, recommended, 309. Regimen, ibid. Dipping in the sea not to be relied on, 310. Dr. Tissot's medical course for the cure of the hydrophobia, ibid. Remarks on the Ormskirk medicine, ibid, note. Kittering's specific for the cure of the hydrophobia, 313. INDEX. 461 Doses of medicines, the relative proportions of, for different ages, 420. Dr. Thompson's table of doses for different ages, ibid, note. Drams ought to be avoided by persons afflicted with nervous disorders, 276. Draught, is the proper form for such medicines as are intended for imme- diate operation, 428. How to prepare the anodyne draught, 129. Diuretic draught, ibid. Purging draught, ibid. Sweating draught, ibid. Vomiting draught, ibid. Dress. See Clothing. Drinking, persons who are seldom intoxicated may nevertheless injure their constitutions by, 90. The habit of drinking frequently originates from misfortunes, 91. Frequently destroys the powers of the mind, ibid. Persons often forced to it by mistaken hospitality, ibid, note. Leads to other vices, 92. Dropsy, the several distinctions of, with its causes, 250. Symptoms, 2.5 L Regimen, ibid. Medical treatment, 252. Tapping, a safe and simple operation, 253. Dropsy of the Brain. See Water in the head. Drowned persons, ought not to be rashly given up for dead, 377—Proper trials for the recovery of, ibid. Endeavours ought not to be suspended upon the first returns of life, 379. Success of the Amsterdam society for the recovery of, 389. Drunkenness. See Intoxication. Dumb persons, may be taught to read, write, and discourse, 298, note. Dysentery, where, and when most prevalent, 235. Its causes and symp- toms, ibid. Regimen, ibid. Fruit, one of the best remedies for, 237. Proper drink for, ibid. Medical treatment, ibid. Cautions to prevent a relapse, 238. EAR, the several injuries it is liable to, 297. Deafness, medical treat- ment of, according to its causes, 298. Ought uot to be tampered with, ibid. Ear-ach, its causes, and proper treatment for, 213. How to drive insects out of, ibid. Education of children, should be begun at home by the parents, 46, note. That of girls hurtful to their constitution, 47. Effluvia, putrid, will occasion the spotted fever, 143. Electricity, beneficial in the palsy, 280. Electuaries, general rules for making, 429.- Preparation of lenitive elec- tuary, 430. Electuary for the dysentery, ibid. For the epilepsy, ibid. For the gonorrhoea, ibid. Of the bark, ibid. For the-piles, ibid. For the palsy, ibid. For the rheumatism, ibid. Elixir, paregoric, how to prepare, 444. Sacred elixir, ibid. Stomachic elixir, ibid. Acid elixir of vitriol, ibid. Empirics, their gross imposition, and fatal effects, 413. Emulsions, their use, 430. Preparation of the common emulsion, 431. Arabic emulsion, ibid. Camphorated emulsion, ibid. Emulsion of gum ammoniac, ibid. Oily emulsion, ibid. Engleman, Dr. his account of the German method of recovering persons from fainting-fits, 384. Entrails. See Intestines. Epilepsy, the disorder defined, 440. Its causes and symptoms, ibid. Due rejriraeu, 111. Medical treatment, ibid. 462 INDEX. Eruptions in children often free them from bad huniouis, but *r mistaken and ill-treated by nurses, 51. Ought never to be stopped without pro- per advice, ibid. In fevers, how to be treated, 142, 140, 149, 150. In the small-pox, 161,163. In children, the causes of, 347. How to cure, 348. Erysipelas, a disorder incident to the laborious, 54. Its causes explain- ed, and who most subject to it, 183, 184. Its symptoms, ibid. Regi- men, 185. Medical treatment, ibid. The scorbutic erysipelas, 186. Instructions for those who arc subject to this disorder, 186. Evacuations of the human body, the principal, specified, 103. By stool, ibid. Urine, 105. Perspiration, 106. Exercise, the importance of, to promote the growth and strength of chil- dren, 44. All young animals exert their organs of motion as soon as they arc able, ibid The utility of, proved from anatomical considerations, 45. And from philosophical deductions, ibid. Military exercise recom- mended for boys, 46. Benefits of dancing, 48. Is better for sedentary persons under lowuess of spirits, than the tavern, 60. Gardening the best exercise for the sedentary, 61. Violent, ought not to be taken im- mediately after a full meal, 65. Is as necessary as food for the preser- vation of health, 82. Our love of activity, an evidence of its utility, ibid Indolence relaxes the solids, ibid. The indulgence of carriages as absurd as pernicious, ibid. Is almost the only cure for glandular ob- structions, 83. Will prevent and remove those disorders that medi- cine cannot cure, ibid. Is the best cure for complaints in the stomach, 84. How to be taken within doors, when not to be done in the open air, ibid. Active sports better than sedentary amusements, ibid. The goff, a better exercise than cricket, ibid, note. Exercise should not be extended to fatigue, ibid. Is as necessary for the mind as for the body, 102. Is often of more efficacy than any medicine whatever, 113. The best mode of taking it in a consumption, 133. Is of the greatest import- ance in a dropsy, 252. Muscular, for the gout, 256. Is necessary for the asthmatic, 268. Is superior to all medicine in nervous disor- ders, 276. And in the palsy, 281. Is proper for pregnant women, unless they are of a very delicate texture,'336. Want of, the occasion of rickets in children, 352. Extracts, general rules for making; but are more conveniently purcha- sed ready made, 431. Eyes, inflammation of, its general causes, 189. Symptoms, ibid. Medical treatment, 190. How to be treated wheu it proceeds from a scrophu- lous habit, 191. Advice to those who are subject to this complaint, 192- Are subject to many diseases which are difficult to cure, 295. The means by which they are frequently injured, ibid. General means of pre- vention, 296. The several disorders of, with their medical treatment, 297. Eye-waters, general remarks on, and their principal intentions, 426. Col- lyrium of alum, ibid. Vitriolic collyrium, ibid. Collyrium of lead, ibid. FAINTING FITS, how to cure, 286, 382. Cautions to persons, sub- ject to them, 385. Falling sickness. See Epilepsy. Fasting, long, injurious to those who labour hard, 55. Is hurtful both to old and young, 71.. Fathers, culpably inattentive to the management of their children, 35. Their irregular lives often injure the constitution of their children, 3tk INDEX. 463 Fear, The influence of very great, in occasioning and aggravating dis- eases, 99C Its various operations, 100. Feet, injured by wearing tight shoes, 87. The washing of, an agreeable article of cleanliness, 107. Wet, the danger of, 94. Bathing them in warm water, a good remedy in a cold, 199. And in the hooping cough, 204. Fermentation, the vapour of liquors in a state of, noxious, 380. Severs, of a bad kind, often occasioned among labourers by poor living, 55. Frequently attacks sedentary persons after hard drinking, 60. Nervous, often the consequence of intense study, 63. Putrid and malignant, often occasioned by want of cleanliness, 92. The mest general cause of, enumerated, 114. The distinguishing symptomsof, ibid. The several species of, ibid. Is an effect of nature, which ought to be assisted, 115. How this is to be done, ibid. Cordials and sweetmeats improper in, 116. Fresh air of great importance in, ibid. The mind of the patient ought not to be alarmed with religious ter- rors, ibid. Cautions as to bleeding and sweating in, ibid, 117. Long- ings in, and the calls of nature, deserve attention, ibid. Cautions to prevent a relapse, ibid. Fever, acute continual, who most liable to, 88. Causes, ibid. Symp- toms, ibid. Regimen, ibid. Medical treatment, 125. Symptoms favourable and unfavourable, ibid. Regimen to be observed during recovery, 126. Fever, bilious, general time of its appearance, 183. Proper treatment of, according to its symptoms, ibid. Fever, intermitting. See Ague. Fever, miliary, from what the name derived, and its general appearan- ces, 148. Who most liable to it, ibid. Causes, ibid. Symptoms, 149. Regimen, ibid. Account of a miliary fever at Strasburgh, 150, note. Proper medical treatmeut, ibid. Cautions for avoiding this disorder, 151. How to prevent, in child-bed-women, 339. Fever, milk. How to prevent, 339. Fever, nervous, why more common now than formerly, and who most liable to it, 139. Its causes, ibid. Symptoms and proper regimen, 140. Medical treatment, ibid. Fever, puerperal, or child-bed, the time of its attack, and symptoms, 339. Medical treatment of, 340. Cautions for tlie prevention of this fever, 341. Fever, putrid, is of a pestilential nature, and who most liable to it, 143. Its general causes, ibid. Symptoms, ibid. Other fevers may be con- verted to this, by improper treatment, 144. Favourable and unfa- vourable symptoms of, ibid. Regimen, 145. Medical treatment, 146. Cautions for the prevention of this disorder, 147. Fever, remitting, derivation of its name, 551. Its causes and symptoms, ibid. Proper regimen, 152. Medical treatment, ibid Cautions for avoiding this fever, 153. Fever, scarlet, why so named, and its usual season of attack, 182. Pro. per treatment of, ibid. Is sometimes attended with putrid and malig- nant symptoms, ibid. Medicines adapted to this stage of the malady, ibid. Histoiy of a fever of this kind at Edinburgh, ibid, note. Fever, secondary, in the small-pox, proper treatment of, 165. Fever, yellow, definition, 154. Its causes, 155. Symptom?, ibid. Re- gimen, 156. Preventative, 157. Medicine, 158, 464 INDEX. Flatulencies in the stomach, remedies against, 2 11. The several cause.-1 of, 286. Medical treatment of, 287. Flatulent colic, its causes, and seat of the disorder, 209. Remedies for. ibid. Flower-de-luce, the yellow water, tlie root of, recommended for the tooth-acli, 242. Fluor albus described, with its proper treatment, 334. Fomentations, how to make and apply, 431. General intentions of, ibid. Anodyne fomentation, ibid. Aromatic fomentation, ibid. Common fomentation, 432. Emolient fomentation, ibid. Strengthening fomen- tation, ibid. Food. See Aliment. Forgiveness of injuries, ought to be practised from a regard to our own health, 99. Fractures. See Bones, broken. Frozen limbs, how to recover, 381. Fruit, unripe, very hurtful to children, 43. Ripe, one of the best medi- cines, both for the prevention and cure of a dysentery, 237. Fruits occasional substitutes for bread, 407. The plantain tree used for that purpose in warm climates, ibid. Yams, a proper substitute for bread in the West-Indies, ibid. Funerals, the great number of visitors attending them, dangerous to their health, 96. GALLING, in infants, the cause and cure of, 445. Gangrene, proper treatment of, 358. Gardening, a wholesome amusement for sedentary persons, 61. Gargles for the throat, how to make, 193, 195. General intentions of, 432. Method of making the attenuating gargle, ibid. Common gar- gle, ibid. Detergent gargle, ibid. Emolient gargle, ibid. For the mouth of infants in the thrush, 344. Garlic ointment, a North-British remedy for the hooping-cough, how to apply it, 204. Generals of armies, how they ought to consult the health of the men they command, 56. Gilders. See Miners. Ginger, syrup of, how to prepare, 443. Girls, The common mode of education prejudicial to their constitu- tion, 47. Means of rectifying it recommended, ibid. Gleet, how occasioned, and its symptoms, 319. Method of cure, ibid. Regimen, 320. Obstinate gleets cured by mercurial inunctions, ibid. How to apply bougies, ibid Glover, Mr. his course of treatment for the recovery of a hanged man, 387. Gonorrhoea, virulent, the nature of, and its symptoms, 314. Regimen, 315. Medical treatment, ibid. Is often cured by astringent injections, 316. Cooling purges always proper in, ibid. Mercury seldom neces- sary in a gonorrhoea, 317. How to administer it when needful, ibid. Goulard, M. preparation of his celebrated extract of Saturn, 445.— His various applications of it, ibid. Gout, the general causes of, 62. How to treat a looseness occasioned by repelling it from the extremities, 318. The sources of this disorder, and its symptoms, 254. Regimen for, 255. Wool the best external application in, ibid. Why there are so many nos- Index. 465 liums for, 255, 256. Proper medicine after the fit, ibid. Proper re- gimen in the intervals between fits to keep off their returns, ibid. How to remove it from the nobler parts to the extremities, 257. General cautions to prevent danger by mistaking it for other disorders, ibid. M. Cadet de Vaux's prescription, 258, note. Grain, various kind of, when boiled a good substitute for bread, 402. Gravel, how formed in the bladder, 105. How distinguished from the stone, 224. Causes and symptoms, ibid. Regimen, ibid. Medical Treatment, 225. Green-sickness, originates in indolence, 331. Grief, its effects permanent, and often fatal, 101. Danger of the mind dwelling long upon one subject, especially of a disagreeable uature, ibid. The mind requires exercise as well as the body, 102. Innocent amuse- ments not to be neglected, ibid. Is productive of nervous diseases, 275. Gripes in infants, proper treatment of, 345. Guaiacum, gum, a good remedy for the quinsy, 194 ; and the rheuma- tism, 258. Gullet, how to remove substances detained in, 374. Cautions for the use of crotchets with this intention, 375. Other mechanical expedients, ibid. Treatment if the obstruction cannot be removed, 376. Gums of children, application to, during teething, and how to cut them, 351,352. Gutta serena, proper treatment of, 296. HMMOPTOE, spitting of blood. See Blood. Haemorrhages. See Blood. Harrowgate water, an excellent medicine for expelling worms, 247. And for the jaundice, 250. In the scurvy, 262. Head-ache, the species of, distinguished, 239. Causes of, ibid. Regimen, ibid Medical treatmeut, 240. Health of the people in general, a proper object of attention for the magis- trates, x. Ought to be attended to in matrimonial contracts, 37. Is often laboured for after it is destroyed, 65. Rules given by Celsus for the preservation of, 110. Heart-burn, the nature of this disorder, with its causes, and remedies for, 273, 274. Heat, extreme, how to recover persons overcome by, 382. Hemlock, a good remedyin the king's evil, 265. Is recommended by Dr. Storck for the cure of cancers, 302. Hemp-seed, a decoction of, good iu the jaundice, and how to prepare it. 250. Hickup, its causes, and method of treatment, 283. Hoffman, his rules for guarding child-bed women against the miliary fe- ver, 339. Honey, a wholesome ardcle of food for children, 43. Is recommended in the stone, 226. Hooping cough. See Cough. Horse-radish, the chewing of, will restore sensibility to the organs of taste when injured, 300. Hospitals, the want of fresh air in, more dangerous to the patients than their disorder?, 81. . Cleanliness peculiarly necessary in, 94. Often spread infection by being situated in the middle of populous towns, 97. How they might be rendered proper receptacles for the sick, ibid. f»3 466 INDEX. Particularly in infectious disorders, 98. The sick in, ought not to be crowded together, 162, note. Houses, iustead of contrivances to make them close and warm, ought to be regularly ventilated, 80: Iu marshy situations unwholesome, 81. Ought to be built in a diy situation, 108. Danger of inhabiting new- built houses before thoroughly dry, ibid. Arc often rendered damp by unseasonable cleanliness, ibid. Are dangerous when kept too close and hot, 110. Husbandmen, the peculiar disorders tliey are exposed to from the vicL situdes of the weather, 54. Huxham, Dr. recommends the study of the dietetic part of medicine, xi. Hydrocephalus. See Dropsy. liydrophobia, Dr. Tissot's method of curing, 310. Kittering's speci- fic, 313. Hydrops pectoris. See Dropsy. Hypochondriac affections, frequently produced bypntense study, 63. Their causes, and who most subject to them, 292. The general intentions of cure, ibid. Regimen, 293. Hysterics, a disorder produced by the habitual use of tea, 68. General causes of, 289. Symptoms, ibid. Proper treatment of, ibid. Regi- men, 290. Medicines adapted to, ibid. Hysteric colic, symptoms and treatment of, 210. Jails, why malignant fevers are often generated in them, 79. Often spread an infection by being situated in the middle of populous towns, 97. Ought to he removed, ibid. Janin, M. his relation of the recovery of an overlaid infant, 387. And of a man who had hanged himself, ibid. Jaundice, the different stages of its appearance, with the causes of this disorder, 248, 249. Symptoms, and regimen, ibid. Medical treat- ment, ibid. Jesuits bark. See Bark. Jews, the whole system of their laws tending to promote cleanliness, 94,96. Iliac passion, a particular kind of inflammation in the intestines, 206. Imposthume in the breast, in consumptions, how to make it break inwardly when not to be discharged by other means, 138. Imposthumes after the small-pox, proper treatment of, 166. Incontinency of urine, distinguished from a diabetes, 222. Experiment for relief, 223. Indigestion, is one consequence of intense study, 63. General causes, and remedies for, 271. Indolence, its bad effects on the constitution, 82. Occasions glandular obstructions, 83. Ill consequeuces of too much indulgence in bed, ibid. Is the parent of vice, 85. Cause of most nervous disorders, 293. Infancy, the foundation of a good or bad constitution, generally laid in this season of life, 33. Infants, nearly one half of those born in Great-Britain die under twelve years of age, 33. Perish mostly by art, ibid. Ought not to be suckled by delicate women, ibid. Importance of their being nursed by their mothers, 34. Often lose their lives, or become deformed, by errors io clothing them, 37. How the art of bandag- ing them became the province of the midwife, ibid. How treated Index. 467 in Africa, 38, note. Philosophical observations on their organical structure, and on the causes of deformity, ibid. Why they so fre- quently die of convulsions, 39. Why exposed to fevers, ibid. And colds, 40. Rules for their dress, ibid. Their food, ibid. Reflections on the many evils they are exposed to, 342. Why their first disor- ders are in their bowels, ibid. How to cleanse their bowels, 343. The meconium, ibid. Thrush, 344. Acidities, ibid Gripes, ibid. Galling and excoriations, 345. Stoppage of the nose, 346. Vomit- ing, ibid. Looseness, 347. Eruptions, ibid. Scabbed heads, 348. Chilblains, 349. The croup, ibid. Teething, 350. Rickets, 352. Convulsions, 353. Water in the head, 354. How to recover infants seemingly dead, 384. Ought never to sleep in the same beds with their mothers or nurses, 386, note. Case of the recovery of an over- laid infant, 387. Case of an infant seemingly killed by a strong con- vulsion fit, and recovered, 388. See Children. Infection, the danger of, incurred by injudicious or unnecessary attend- ance on the sick, 95. And on funerals, ibid. Is often communicated by clothes, 96. Is frequently imported, ibid. Is spread by hospitals and jails being situated in tlie middle of populous towns, 97. How to prevent infection in sick chambers, ibid. Physicians liable to spread infection, ibid, note. In what respects the spreading of infection might be checked by the magistrates, ibid. Bleeding and purging increase the danger of, by debilitating the body, 148. Small-pox, 160. Inflammations, how the laborious part of mankind expose themselves to, 55. Proper treatment of, 358. Inflammation of the bladder. See Bladder. ------------of the brain. See Brain. -----------of the eyes. See Eyes. ------------of the intestines. See Intestines. -----------of the kidneys. See Kidneys. -----------of the liver. See Liver. ------------of the lungs. See Peripneumony. -----------of the stomach. See Stomach. ------------of the throat. See Quinsey. ■----------- of the womb. See Womb. Infusion, advantages of, over decoctions, 433. How to obtain rich in- fusion from weak vegetables, ibid. Preparation of the bitter infusion, ibid. Infusion of the bark, ibid. Infusion of carduus, ibid. Of lin- seed, ibid. Of roses, ibid. Of tamarinds and senna, ibid Spanish infusion, 434. For the palsy, ibid. Inns, the great danger of meeting with damp beds in them, 107. The sheets in, how treated to save washing, 108. Inoculation of the small-pox, more favourably received here dian in neighbouring countries, 166. Cannot prove of general utility while kept in the hands of a few, ibid. No mystery in the process, 167. May safely be performed by parents or nurses, ibid. Various me- thods of doing it, ibid. The clergy exhorted to remove the prejudices against the operation, 168. Arguments cited from Dr. Mackenzie in favour of inoculation, ibid, note. Ought to be rendered universal, 169. Means of extending the practice of, 170. Two obstacles to the pro- gress of, stated, 171. Might be performed by clergymen, or by parents themselves, ibid. The proper seasons and age for performing it, 172. 468 INDEX. Will often mend the habit of body, ibid. Necessaiy preparation and regimen for, ibid. Inoculation of the cow-pox, 173—178. Insects, when they creep into the ear, how to force them out, 243. Poisonous, the bites of, how to be treated, 311. Intemperance, one great cause of the diseases of seamen, 57. The danger of, argued from the construction of the human body, 89. The analo- gy in the nourishment of plants and animals, ibid. Is the abuse of natural passions, ibid- In diet, ibid. Iu liquor and carnal pleasures, 90. The bad consequences of, involve whole families, ibid. Effects of drunkenness on the constitution, ibid. Persons who seldom get drunk, may nevertheless injure their constitutions by drink, ibid. The habit of drinking frequently acquired uuder misfortunes, 91. Is pe- culiarly hurtful to young persons, 92. Leads to all other vices, ibid. Intermitting fever. See Ague. Intestines, inflammation of, general causes from whence it proceeds, 206. The symptoms, regimen, and medical treatment, 207. Cautions to guard against it, 208. Intoxication produces a fever, 90. Fatal consequences of a daily repe- tition of this vice. ibid. Persons who seldom get drunk, may never- theless in ure their constitution by drinking, ibid. Getting drunk, a hazardous remedy for a cold, 199. Often produces fatal effects, 385. Proper cautions for treating persons in liquor, ibid. The safest drink after a debauch, ibid. Remarkable case, 386. Johnson, Dr. extraordinary recovery of an infant seemingly killed by a strong convulsion fit, reltted by, 388. Issues, how to make them take the best effect, 279. Itch, the nature and symptoms of this disease described, 265. Sulphur, the best remed) against, 266. Great danger of the injudicious use of mercurial preparations for, ibid. Cleaulincss the best preservative against 267 note. Juleps, the form of, explained, 434. Preparation of the camphorated ju- lep, ibid. Cordial tulep, ibid. Expectorating julep, ibid. Musk julep, ibid. Saline julep, ibid. Vomiting julep, ibid. KERMES MINERAL, recommended by Dr. Duplanil, for the hoop- ing-cough, 204. note. Kidneys, inflammation of, its general causes, 212. Its symptoms and proper regimen, ibid Medical treatment, ibid. Where it proceeds from the stone and gravel, 213. Cautions for those subject to this disorder, ibid. See Gravel. King\s evil. See Scrophula. LAP.ORIOUS EMPLOYMENTS, the peculiar disorders incident to, 54. The folly of men emulating each other in trials of strength, ibid. Disadvantages attending their diet, 55 How they expose themselves to inflammations, ibid. Danger of sleeping in the sun, ibid. Long fasting hurtful to them, ibid. Injuries arising from poor living, ibid. Many of the diseases of labourers, not only occasioned, but aggravated by poverty, 56. Labour should not be imposed too early on children, 47. Labour in child-bed, medical advice for, 337. Inconveniences of col- lecting a number of women at, 338, note. Laudanum, its efficacy in fits of an ague, 181, note. How to be ad- ministered in a cholera morbus, 217. In a looseness, 218. In a dia- INDEX. 469 betes, 222. When proper for the head-ach, 241. How to apply for the tooth-ach, 242. Will ease pain in the gout, 256. How to admin- ister for the cramp in the stomach, 284. Is good for flatulencies, 287, Effects of an over dose of, 306. Medical treatment in this case, ibid. Leading-strings, injurious to young children, 44. leeches, may be successfully applied to inflamed testicles, 321, note. And to disperse buboes, ibid, note. Are proper to apply to children where inflammations appear in teething, 351. Objecdons to bleeding with them, 357. f^cks, a proper ingredient in soups, 410. Tjcmons. See Oranges. Leprosy, why less frequent in this country now than formerly, 233— Requires the same treatment as the scurvy, ibid. Lientcry, proper treatment for, 238. Life may frequently be restored, when the appearances of it are suspend- ed by sudden casualties, 373, 377, 388. Lightning, persons apparently killed by, might possibly be recovered by the use of proper means, 389. Lime-water recommended to prevent gravel in the kidneys from degene- rating to the stone in the bladder, 225. Is a good remedy foT worms, 247. Happy effects of, in the cure of obstinate ulcers, 365. I And, Dr. his prescription to abate fits of an ague, 118, note. His di- rections for treatment of patients under putrid remitting fevers, 152, note. Liniment for burns, preparation of, 437. White liniment, ibid. For the piles, ibid. Volatile liniment, ibid. Liquors strong, expose children to inflammatory disorders, 43. Fer- mented, the qualities of, examined, 69. The bad consequences of making them too weak, ibid. Why all families ought to prepare their own liquors, ibid. Cold, the danger of drinking, when a person is hot, 109. Liver, scirrhous, produced by sedentary employments, 62. Liver, inflammation of, its causes and symptoms, 214. Regimen and me- dical treatment, 215. Abscess in, how to be treated, ibid. Cautions in the event of a scirrhous being formed, ibid. Lobelia, an American plant used by the natives in the venereal diseases, 326. Lochia, a suppression of, how to be treated, 338. Locked Jaw. See Tetanus. Longings, in diseases, are the calls of nature, and often point out what may be of real use, 117. looseness, habitual, general direction for persons subject to, 104. Its general causes, 217. A periodical looseness ought never to be stopped, 218. Medical treatment of, according to its various causes, ibid. Means of checking it when necessary, 219. In children, proper treat- ment of, 347. Love, why perhaps the strongest of all the passions, 102. Is not rapid in its progress, and may therefore be guarded against at its com- mencement, ibid. To pretend to it for amusement, cruelty to the ob- ject, ibid. Children often real martyrs between inclination and duty. 103, note. Luet. confirmed, symptoms of, 324. Mercury the only certain re- 470 INDEX. medy known in Europe for this disease, 325. Saline preparations of mercury more efficacious than the ointment, ibid. How to administer corrosive sublimate, 326. American method of curing this disease, ibid. Lungs, injured by artists working in bending postures, 59. Studious per- sons liable to consumptions of, 62. Luxury, highly injurious to the organs of taste and smell, 299. MACKENZIE, Dr. his arguments in favour of inoculating in the small- pox, 168, note. Mad Dog. See Dog. Magnesia alba, a remedy for tlie heart-bum, 274. Is the best medicine in all cases of acidity, 345. Magnets, artificial, their reputed virtue in the tooth-ach, 243. Malt liquors, hurtful in the asthma, 268. See Beer. Man, why inferior to brutes in the management of his young, 33—Was never intended to be idle, 85. Manufactures, the growth of, produced the rickets in children, 44—More favourable to riches than to health, 47. Some, injurious to health by confining artists in unwholesome air, 52. Cautions to the workmen, ibid. Compared with agriculture, 58. Are injurious to health from artists being crowded together, 59. And from their working iu con- fined postures, ibid. Cautions offered to sedentaiy artists, 60. St dentary arts better suited to women than to men, 83, note. Matrimony ought not to be contracted without a due atteution to health and form, 37. Mead, Dr. his famous recipe for the bite of a mad dog, 308. His cha racter as a physician, ibid, note. Meals ought to be taken at regular times, 71. Reasons for this uniformi- ty, ibid. Measles, have great affinity with the small-pox, 179. Cause and symp- toms, ibid. Proper regimen and medicine, 180. Inoculation of, might prove very salutary* 181, note. 3&chanics ought to employ their leisure hours in gardening, 62. Meconium, the best mode of expelling it, 41, 343. Medicine, the origin of the art of, xi. The operation of, doubtful at best, ibid. Is made a mystery of by its professors, xv. The study of, neg- lected by gentlemen, xvi. This ignorance lays men open to preten- ders, ibid. Ought to be generally understood, ibid. A diffusion of the knowledge of, would destroy quackery, xviii. Objections to the cul- tivation of medical knowledge answered, ibid— The theory of, can ne- ver supply the want of experience and observation, 33. Medicines, have more virtue attributed to them than they deserve, 112. Ought not to be administered by the ignorant, nor without caution, 114. Want of perseverance in the use of, one reason why chronic diseases are so seldom cured, 260. Many retained, which owe their reputation to credulity, 413. Are multiplied and compounded in pro- portion to ignorance of the causes and nature of diseases, ibid. Disad- vantages of compounded medicines, ibid. Are often adulterated for the sake of colour, 419. The relative proportions of, for different ages, 420. A list of medical preparations as ought to be kept for private practice, 421. Melancholy, religious, its effects, 103. Leads to suicide, ibid. De- INDEX. 474 fined, with its causes, 277, 273. Symptoms and regimen, ibid. Medical treatment, 279. Menstrual discharge in women, the commencement and decline of the most critical period of their lives, 331. Confinement injurious to growing young women, ibid, and tight lacing for a fine shape, 332. Symptoms of the first appearance of this discharge, ibid. Objects of attention in regimen at this time, ibid. Ought to be restored whenever ^ unnaturally obstructed, and how, 333. When an obstruction proceeds from another malady, the first cause is to be removed, ibid. Treat- ment under a redundency of the discharge, 334. Regimen and medi- cine proper at the final decline of the menses, 335. Mercury may be given in desperate cases of an inflammation of the in- testines, 208. Cautious for administering it, ibid, note. Great caution necessaiy in using mercurial preparations for the itch, 266. Is seldom necessaiy in a gonorrhoea, 317. How to administer it when needful in that disorder, ibid. Solution of mercury, how to make, 318 note. Is the only certain remedy known in Europe for the cure of a confirm- ed lues, 325. Saline preparations, of, more efficacious than the mer- curial ointment, ibid. How to administer corrosive sublimate in vene- rial cases, 326. Necessary cautions in the use of mercury, 327. Pro- per seasons for entering on a course of, 238. Preparations for, ibid. Regimen under a course of, ibid. Mezereon root, a powerful assistant in venereal cases, ibid. Midwifery, ought not to be allowed to be practised by any woman not properly qualified, 337, note. Midwives, historical view of the profession, 37. How they became in- trusted with the care of bandaging infants, with the ill effects of their attempts at dexterity in this office, 38. Instances of their rashness and officious ignoiance, 342, note. Miliary Fever. See Fever. Milk, that of the mother, the most natural food for an infant, 40. Cows milk, better unboiled than boiled, 42. Is a good antidote against the scurvy, 68. Of more value in consumptions than the whole Materia Medica, 134. Its great efficacy in the scurvy, 262. A milk diet proper both for men and women, in cases of barrenness, 342. Milk Fever. See Fever. Millipedes, how to administer for the hooping-cough, 204. Mind, diseases of, to be distinguished from those of the body, 112. See Passions. Miners, exposed to injuries from unwholesome air, and mineral particles, 52. Cautions to, ibid Mineral waters, the danger of drinking them in too large quantities, 221. Are of considerable service in weakness of the stomach, 273. Cautions coucerning the drinking of, 393. Mixtures, general remarks on this form of medicine, 435. Composition ol the astringent mixture, ibid. Diuretic mixture, ibid. Laxative absorbent mixture, ibid. Saline mixture, ibid. Squill mixture, ibid. Molasses, an intoxicating spirit much used by the common people at Ed- inburgh, 91, note. Mothers, preposterous, when they think it below them to nur?e their 472 INDEX. own children, 33. Under what circumstances they may be really un- fit to perform this task, ibid. Importance of their suckling their own children, 34, note. Delicate mothers produce unhealthy short lived children, 36. Their milk, the best food for children, 40. Ought to give their childreu proper exercise, 45; and air, 4'J. Mouth, cautions against putting pins or other dangerous articles into, 374. Muscular exercise a cure for the gout, 256. _ Mushrooms, a dangerous article of food, as other funguses are often gath- ered instead of them, 312. Music, the performance of, recommended as a proper amusement for stu- dious persons, 64. Musk, extraordinary effects produced by, under particular circumstances, in the nervous fever, 142. Is a good remedy in the epilepsy, 282: And for the hickup, 233. Deafness cured by, 298. Mustard, white, a good remedy in the rheumatism, 260. NATURAL history, the study of, necessaiy to the improvement of agriculture, xiv. Nervous diseases, the most complicated and difficult to cure of all others, 274. General causes of, 275. Symptoms of, ibid. Regimen, 276. Medical treatment, 277. A cure only to be expected from regimen, ibid. The several symptoms of, though differently named, all modifi- cations of the same disease, 292. Nervous colic, its causes,and symptoms, 211. Medical treatment of ibid. Nervous fever. See Fever. Night-mare, its causes and symptoms described, 284. Proper treat- ment of, 285. Nitre, purified, its good effects in a quinsey, 194. Is an efficacious re- medy for the dropsy, 252. Promotes urine and perspiration, 279. Nose, ulcer in, how to cure, 299. Stoppage of, iu children, how to cure, 346. See Bleeding at. Nurses, their superstitious prejudices in bathing of children, 48. The only certain evidence of a good one, 50. Their usual faults pointed out, 51. Administer .cordials to remedy their neglect of duty towards children, ibid. Their mistaken treatment of eruptions, ibid. And loose stools, 52. are apt to conceal the disorders of children that arise from their own negligence, ibid. Ought to be punished for the misfortunes they thus occasion, ibid. Sensible, often able to discover diseases sooner than persons bred to physic, 111. Are liable to catch the small-pox again from those they nurse in that disorder, 161, note. Nursery ought to be the largest and best aired room in a house, 49. OATS and barley, more wholesome when boiled, 403. Oatmeal, frequently made into bread, and peasants fed on it, are healthy and robust, 403, 404. Erroneously supposed to occasion skin diseases ibid. Oatmeal and milk a proper food for children, ibid. Oil, an anti- dote to the injuries arising from working in mines or metals, 53. Salad oil, the best application to the bite of a wasp or bee, 311. Camphora- ted, how to prepare, 437. Oils, essential, of vegetables, the proper menstruum for, 442. Ointment for the itch, 266. Use of ointments when applied to wounds and sores, 435. Preparation of yellow basilicum, ibid. Ointment of Calamine,ibid. Emolient ointment, 436. Eye ointment, ibid. INDEX. 473 Issue ointment, ibid. Ointment of lead, ibid. Mercurial ointment, ibid. Ointment of sulphur, ibid. White ointment, ibid. Set Liniment' Opthalmia. See Eye. Opiates, efficacious in a cholera morbus, 217. In a diabetes, 222. When proper for the head-ach, 241. Recommended for the tooth-ach, 242. Are delusive remedies in nervous diseases, 277. See Laudanum. Orange and lemon peel, how to candy, 427. How to preserve orange and lemon juice in the form of syrup, 442. Ormskirk medicine for the bite of a mad-dog, remarks on, 310, note. Orycratc, the most proper external application in a fracture, 871. Oysters of great service in consumptions, 136, note. PAINTERS. See Miners. Palsy, tlie nature of this disorder explained, 280. Its causes, ibid. Me- dical treatment, ibid. Paraphrenitis, its symptoms and treatment, 129. Parents, their interested views in the disposal of their children iu mar- riage, often a source of bitter repentance, 103, note. See Fathers and Mothers. Parsnips, a nourishing food, 409. Passions, intemperance the abuse of, 89. Have great influence both in the cause and cure of diseases, 98. Anger, ibid. Fear, 99. Grief, 101. Love, 102. Religious melancholy, 103. The best method of counteracting the violence of any of the passions, ibid. Peas, parched, good in cases of flatulency, 244. Peruvian bark. See Bark. Penis, ulcerated, cured, and partly regenerated, by a careful attention to cleanliness, 238, note. Peripneumony, who most subject to, 180. Its causes, symptoms, and proper regimen, ibid. Perspiration, insensible, the obstruction of, disorders the whole frame, 106. The various causes of its being checked, ibid. Changes in the atmosphere, ibid. Wet clothes, 107. Wet feet, ibid Night air, ibid. Damp beds, ibid. Damp houses, 108. Sudden transitions from heat to cold, 109. Philosophy, advantages resulting from the study of, xiv. Phrenitisi See Brain. Phymosis described, and how to treat, 324. Physicians, ill consequences of their inattention to the management of children, 35. Are liable to spread infection, 97, note. Their custom . of prognosticating the fate of their patients, a bad practice, 100. Are seldom called in, until medicine can give no relief, 123. Pickles, provocatives injurious to the stomach, 68. Piles, bleeding and blind, the distinction between, 229. Who most sub- ject to the disorder, ibid. General causes, ibid. Madical treatment of, 230. Periodical discharges of, ought not to be stopped, ibid. Proper treatment of the blind piles, ibid. External ointments of little use, 231. Pills, purging, proper form of, for an inflammation of the intestines, 208. The general intention of this class of medicines, 437. Preparation of the composing pill, ibid. Fcetid pill, ibid. Hemlock pill, ibid. Mercurial pill, 438. Mercurial sublimate pills, ibid. Plummet's pill, ibid. Purging pills, ibid. Pill for the Jaundice, ibid Squill pills, ibid. Strengthening pill''' 43'.». 474 INDEX. Pins ought never to be used in the dressing of children, 39. Swallowed, discharged from an ulcer in the side, 374, note. Platters, the general intentions of, and their usual basis, 439. Prepara- t on of the common plaster, ibid. Adhesive plaster, ibid. Anodyne plaster, ibid. Blistering plaster, ibid. Gum plaster, ibid. Mercu- rial plaster, 440. Stomach plaster, ibid. Warm plaster, ibid. Wax plaster, ibid. Pleurisy, the nature of the disorder explained, with its causes, 126. Symptoms, ibid. Regimen, ibid Medical treatment, 127. A de- coctiou of seneka reckoned a. specific iu, 128. Bastard pleurisy, 129. Plumbers. See Miners. Poisons, the nature and cure of, a general concern, and easily acquired, 304. Mineral poisons. 305. Vegetable poisons, ibid. Bites of poi- sonous animals, 306. Bite of a mad-dog, ibid. Bite of a viper, 311. The practice of sucking the poison out of wounds recommended, ibid, note. Poisonous plants ought to be destroyed in the neighbourhood of towns, 312. Negro remedy to cure the bite of a rattle snake, ibid. General rules for security against poisons, ibid. Poor living, the dangers of, 56. Porters subject to disorders of the lungs, 54. Postures, confined, injurious to the health of sedentaiy artists, 59. Potatoe, the best substitute for bread, 407. The mealy kind deemed most nutritious. 408. Simply boiling or roasting, the best mode of cooking them, ibid. Stewed mutton and potatoes a nourishing and palatable dish, ibid. Poverty, occasions parents to neglect giving their children proper exer- cise, 45. Destroys parental affection, ibid, note. Not only occasions, but aggravates, many of the diseases of labourers, 56. The poor great sufferers by the sale of bad provisions, 66, note. And by bad air in large cities, 79. Poultices proper for inflamed wounds, 361. Potvders, general instructions for making and administering, 440. As- tringent powder, preparation and dose of, ibid. Powder of bole, ibid. Carminative powder, 441. Diuretic powder, ibid. Aromatic pur- ging powder, ibid. Saline laxative powder, ibid. Steel powder, ibid. Sudorific powder, ibid. Worm powder, ibid. Purging worm powder, ibid. Powder for the tape-worm, ibid. Pox, small, who most liable to, and at what seasons, 159. Its causes and symptoms, 160. Favourable and unfavourable symptoms in, ibid. Regimen, 161. How tlie patient ought to be treated during the erup- tive fever, ibid. Children in this disorder ought not to lie together in the same bed, 162. Should be allowed clean linen, ibid. Patients under this disorder ought not to appear in public view, ibid. Medical treatment, 163. The secondary fever, 165. When and how to open the pustules, ibid. Of inoculation, 166. Of tlie cow-pox, 173. Pregnancy, how to treat vomiting when the effect of, 220. Rules of conduct for women under the disorders incident to, 335. Causes aud sy.nptoms of abortion, 336. How to guard against abortion, ibid. Treatment in cases of abortion, ibid. Child-birth, 337. Prescriptions, medical, patients exposed to danger by their being written in La", in, xvii. Provisions, unsound, the sale of, a public injury, 66. Puerperal fever. See Fever. INDEX. 475 Purget, the frequent taking of them renders the habitual use of them ne- cessary, 104. Their efficacy in agues, 119. Proper form of, for an inflammation of the intestines, 207. Cooling purges always proper in a gonorrhoea, 316. Midwives too rash in the giving of purges, 340, note. Form of a gentle purge for infants disordered in their bowels, 343. For the thrush, 344. Pustules, in the small-pox, favourable and unfavourable appearances of, 160. The suppuration of, to be promoted, 163. When and how to open, 165. Putrid fever. See Fever. Quacks put out more eyes than they cure, 295. See Empirics. Quackery, how to destroy, xvii. Quakers, their mode of dressing recommended, 88. Quinsey, a common and dangerous disorder, and to whom most fatal, 192. Its causes, ibid. Symptoms, ibid. Regimen, 193. Medical appli- cations, 194. How to promote suppuration, ibid. How to nourith the patient when he cannot swallow, 195. Advice to persons subject t« this disorder, ibid. -------------malignant, who most subject to, and its causes, 196. Its symptoms, ibid. Regimen and medical treatment, 197. Rattle Snake, Negro remedy for the cure of its bite, 312. Regimen ought to co-operate with medicine to accomplish the cure of dir seases, xi. Will often cure diseases without medicine, 113. See Ali- ment. Religion, true, calculated to support the mind under every affliction, 103. The instructors in, ought not to dwell too much on gloomy subjects, ibid. Remitting fever. See Fever. Repletion, impairs the digestive powers, 71. Diseases occasioned by, 72. How to treat a looseness produced by, 217. Resentment, the indulgence of, injurious to the constitution, 98. Resins, and essential oils, the proper menstruum for, 442. Respiration, how to restore in a drowned person, 377. Rheumatism, acute and chronic, distinguished, 258. Causes, ibid. Symp- toms, ibid. Medical treatment, ibid. Cautions to persons subject to this disorder, 260. Rice, contains a nutritious mucilage, 76. A general article of diet, 402. Simple boiling of, renders it a substitute for bread, ibid. Rickets, the appearance of, in Britain, dated from the growth of manufac- tures, and sedentary employments, 44. The causes of, 352. Symp- toms, ibid. Regimen and medical treatment, 353. Rollers, pernicious tendency of applying them round the bodies of in- fants, 39. Romans, ancient, their great attention to the cleanliness of their towns, 93. Roses, conserve of, its great virtue against haemorrhages, 230, 233. Ruptures, are chiefly incident to children and very old persons, 372. The causes respectively, ibid. Method of treatment, ibid. Cutting should be avoided if possible, ibid. Cautions for persons afflicted with a rupture, 373. Oftener prove fatal before discovered, ibid, note. Rutherford, Dr. his preparation for the cure of a dysentery, 236. Sailors, their health injured by change of climate, hard weather^ and 476 INDEX. bad provisions, 56, 57. Many of their disease. ^J^^^WT. ance, ibid. Ought to guard against wet clothes, ibid. How thejU effects of salt provisions might be corrected, iW Penman 1ba* the best antidote to sailors on a foreign coast, 58. Cleanliness greatly con. ducive to their health, 94. Sal-prunneltB, its good effects in a quinsey, 194. Pwn,v„:nn *&r draughts, of good use for stopping a vomiting, 220.PrepMat.on of, for this purpose, ibid. Peculiarly good in the puerperal fever,340, Salivation, not necessary in the cure of the venereal disease, 325. Sarsaparilla, a powerful assistant in venereal cases, 326. Scabbed head in children, difficult to cure and treatment, 348. Scarlet fever. See Fever. Scalds. See Burns. A School, sending children there too young, its bad consequences, 46. Uugiit to be seated in a dry air, and ought not to be too much crowded, 50. Scirrhous in the liver, proper regimen iu the case of, 215. Sec Cancer. Scrophula, nature of this disease, and its causes, 263. Symptoms, ibid. Regimen and medical treatment, 264. Scurvy, why prevalent among the English, 67. Where most prevalent, and the two distinctions of, 260. Causes of, ibid. Symptoms and cure, 261. Instructions to seafaring men, ibid. Extraordinary ef- fects of milk, 262. Proper liquors, ibid. Sedentary life includes the greater part of the human species, 58.—Few persons follow agriculture who are capable of other business, ibid. Sedentary and active employments ought to be intermixed for the sake of health ibid. Artists suffer from unwholesome air, by being crowd- ed together, 59. The postures artists are confined to, injurious to health, ibid. Disorders produced by, ibid. Cautions offered to the sedentaiy, 60. Sedentaiy amusements improper for sedentary persons, ibid Hints relating to improper food, ibid. Exercise, a surer relief for low spirits than drinking, ibid. Gardening a wholesome amuse- ment for the sedentary 61. Disorders occasioned by intense study, ibid. Dietetical advice to the sedentary, 71. Sedentary occupations better adapted to women than men, 83, note. Sea water, a good remedy in the king's evil, 264. Senses, disorders of, 29 C. Seton, has spmetimes extraordinary effects in inflammations of the eye9, 191. Is of service for preventing apoplexies, 271. The best method of making it, 280. .- uu i Shoes, tight, the bad consequences resulting from, 87. The high heels of women's shoes, 88. Sibbins, a venereal disorder so termed in the west of Scotland, how to cure, 329, note. Pick, the mutual danger incurred by unnecessary visitors to, 96.—Per- sons in health, to be kept at a distance from the sick, ibid. Proper nurses ought to be employed about them, 97. Instructions for avoid- ing infection, ibid. Physicians too ungarded in their visits to them, ibid, note. Tolling of bells for the dead very dangerous to, 100. Their fears ought not to be alarmed, ibid. Sight, injured by studying by candle-light, 63. Simples, a list of tho^e proper to be kept for private practice, 421. Sinapisms, the general intentions of, 424. Directions for making of, ibid^ INDEX. 477 Sleep, the due proportion of, not easy to fix, 85. How to make it refresh* ing, ibid. Complaints of the want of, chiefly made by the indolent, ibid. Heavy suppers cause uneasy nights, ibid. Anxiety destruc- tive of sleep, ibid. That in the fore part of the night most refreshing, ibid. Early risers the longest livers, ibid, note. Sleeping in the sun, danger of, 55. Small-pox. See Pox. Smell, injuries to which the sense of, is liable, with the remedies appli- cable to, 299. Soap, Alicant, recommended in the stone, 225. Soap-lees, how to take, ibid. Soldiers, exposed to many disorders from the hardships they undergo, 56. Ought to he employed in moderate labour in times of peace, ibid. note. Soups, See Broths. Spine, often bent by artists working in unfavourable postures, 59. Spirit, rectified, the direct menstruum for resins and essential oils of ve- getables, 442. Of wine, camphorated, how to prepare, 444. Spirit of Miudererus, ibid. Spirits, lowness of, the general forerunner of a nervous fever, 193. The proper remedies for, 288. Cautions to persons under this complaint, ibid Spirituous liquors, when good in the colic, 209. And for gouty com plaints in the stomach, 245. Should be avoided by all persons afflict- ed with nervous disorders, 276. The use of, often fatal, 385. Spitting of blood. See Blood Sponge, may be used to supply the want of agaric as a styptic, 300, note. Its use in extracting substances stopped in the gullet, 375. Sports, active, far more wholesome than sedentary amusements, 84. Golff, a better exercise than cricket, ibid, note. Spots in the eye, how to treat, 297. Squinting, how to correct the habit of, 297. Stays, a ridiculous and pernicious article of female dress, 40, 87. The wearing of, tends to produce cancers in the breast, 301. Sternutatories, preparations of, recommended for restoring lost smell, 299. Sticking-plaster is the best application for slight wounds, 360. Stomach, exercise the best cure for disorders of, 84. Inflammation of, a disorder that calls for speedy assistance, 205. Its causes, ibid. Symptoms, ibid. Regimen, ibid. Medical treatment, 206. Pain in, its causes, 244. Remedies for, ibid. Instructions for persons subject to, 245. Stone, the formation of, in the bladder, explained, 105. This disorder how distinguished from the gravel, 224. Causes and symptoms, ibid. Regimen, ibid. Medical treatment, 225. Alicant soap and lime-wa- ter, how to take for this disorder, ibid. The uva ursi, a remedy in present request for, 226. Stool, loose, the benefit of, to children, 52. Proper treatment of, when excessive, ibid. The discharge by, cannot be regular, if the mode of living be irregular, 104. One in a day generally sufficient for an adult, ibid. How to produce a regularity of, ibia\ Frequent recourse to medicines for costiveness, injurious to the constitution, ibid. 478 INDEX. Storck, Dr. his method of treating cancers, 302. Strabismus, See Squinting. Strains, proper method of treating, 371. The safest external applica- tions, ibid, note. Slranguary, from a blistering-plaster, how to guard agiinst, 128. In the small-pox, how to relieve, 163. From a venereal cause, described, with its proper treatment, 323. Strangulation, course of treatment for the recovery of persons from, 387. Strasburgh, successful treatment of a miliary fever there, 150, note. Strength, the folly of trials of, from emulation, 54. Study, intense, injurious to health, 61. The disorders occasioned by, 62. Character of a mere student, 63. Hints of advice to studious persons, 64. Danger of their having recourse to cordials, 65. Health often neglected while in possession, and laboured for after it is destroyed, ibid. No per on ought to study immediately after a full meal, ibid. Dietetical advice to the studious, 71. The general effects of, on the constitution, 275. Sublimate, corrosive, how to administer in venereal cases, 326. Suffocation, by the fumes of charcoal, liable to happen in close cham- bers, 380. General causes of suffocation, 386. Overlaying of in- fants, ibid. Sugar, an improper article in the food of children, 42. Sulplmr, a good remedy for expelling worms, 247. And for the itch, 266. Suppers, ought not to destroy the appetite for breakfast, 72. Heavy sup- pers sure to occasion uneasy nights, 86. Surgery, many of the operations of, successfully performed by persons unskilled in miatomy, 356. Humanity induces every one more or less to be a surgeon, ibid. ^■icating, generally excited in an improper manner in fevers, 117. 124. Swconings, the several causes of, described, 281.285. Proper treatment of tiiis disorder, 286, 384. Cautions to persons subject to them, ibid. Sydenham, Dr. his method of treating fevers in children from teething, 351. Symptoms, diseases better distinguished by, than by the systematical ar- rangement of, 111. The differences of sex, age, and constitution, to be considered, ibid. Diseases of the mind to be distinguished from those of the body, 112. Syncope, proper treatment in, 383. Syrup, the general intention of, 442. How to make simple syrup, and to modify it for particular purposes, ibid. TACITUS, his remarks on the degeneracy of the Roman ladies, 34, note. Tallow-chandlers, and others working on putrid animal substances, cau- tions to, 54. Tapping, for the dropsy, a safe and simple operation, 253. Tar, Barbadoes, its efficacy in the uervous colic, 211. Tartar, soluble, a good remedy for the jaundice, 250. Cream of, a good remedy in a dropsy, 253. And rheumatism, 258. Taste, how to restore the sense of, when injured, 300. Taylors, are exposed to injuries from breathing confined air, 59. Are subject to consumptions, ibid, note. Often lose the use of their legs, ibid. Hints of instruction offered to them in regard to their health, 60. INDEX. 479 Tea, the customary use of, injurious to female constitutions, 36. De- stroys their digestive powers, and produces hysterics, 68. The bad qualities of, principally owing to imprudence in the use of it, ibid. Green, chewing of, a remedy for the heart-burn, 274. Has a power- ful effect upon the nerves, 280, note. Is bad for persons troubled with flatulencies, 238. Occasions an unnecessary consumption of bread, 402. Bad effects of an immoderate use of, ibid. Teething, the disorders attending, 350. Regimen, and medical treat- ment in, 351. Applications to the gums, and how to cut them, ibid, 352. Temperance, the parent of health, 89. Testicles, swelled, the cause of 321. Regimen and medicines in, ibid. Treatment under a cancerous or scrophulous habit, ibid. Tetters, Sir Paul Joddrell's prescription for, 343, note. Tetanus, or the locked-jaw, tlie causes, 293. Symptoms and medicine, 294. Thirst, how it may be quenched when a person is hot, without danger, 109. Thought, intense, destructive of health, 61. Thrush in infants, the disorder and its causes described, 344. Medical treatment of, ibid. Tinctures and elixirs, the proper medicines to exhibit in the form of, 442. Preparations of the aromatic tincture, ibid. Compound tincture of the bark, ibid Volatile foetid tincture, 443. Volatile tincture of gum guaiacum, ibid. Tincture of black hellebore, ibid. Astringent tincture, ibid. Tincture of myrrh and aloes, ibid. T incture of opium, or liquid laudanum, ibid. Tincture of hiera picra, ibid. Compound tincture of senna, ibid. Tincture of Spanish flies, ibid. Tincture of the balsam of Tolu, 44 4. Tincture of" rhubarb, ibid. Tissot, Dr. character of his Avis aupeuple, xii. His medical course for the cure of the hydrophobia, 310. His directions for gathering, pre- paring, and applying agaric of the oak as a styptic, 360, note. In- stances from, of the recovery of drowned persons, 378, 379. Tobacco, a clyster of a decoction of, useful to excite a vomit, 376. A clyster of the fumes of, will stimulate the intestines, and produce a stool, 211, note. Toes, the free motion of, destroyed by wearing tight shoes, 87. Tooth-ach, tlie general cause of, 241. Medical treatment of, 242. When to be extracted, ibid. Directions for cleaning, 243. Towns, great, the air of, destructive to the children of the poor, ,49. Children bred in the country, ought not to be sent too early iuto towns, 50. Cleanliness not tufficiently attended to in, 92. Ought to be supplied with plenty of water for washing the streets, 95, note. The best means to guard against infection in, 97, 98. Trades, some injurious to health by making artists breathe unwholesome air, 53, 59. Transitions, suc'clcn, from heat to cold, the ill effects of, to the constitu- tion, 109. Travellers, the use of vinegar recommended to, 57. Ought to be very careful not to sleep iu damp beds, 107. Fevers why often fatal to, 11 .r>. Trees should not be planted too near to houses, 81. Trefoil water, a good remedy in the rheumatism, 260. 486 INDEX Tumours, proper treatment of, 358. Turnips, properly cultivated, afford wholesome uourishnieut, 409. Turnbull, Dr. his method of treating the croup iu children, 350, note. Turna^s cerate, preparation of, 436. VACCINATION. See Inoculation. Vapour of, fermenting liquors, noxious, 380. Vegetables, wholesome correctors of the bad qualities of animal food, 68- Their extraordinary effects in the scurvy, 262. Venereal disease, why omitted in the first edition of this work, 313. Un- favourable circumstances attending this disorder, 314. The virulent gonorrhoea, ibid. Gleets, 319. Swelled testicles, 321. Buboes, ibid. Chancres, 322. Stranguary, 323. Phymosis, 324. A confirmed lues, ibid. American method of curing this disease, 326. General observations, 327. Cleanliuess a great preservative agaiust, 328. The use of medicines ought not to be hastily dropped, 329. Is often too much disregarded, 330. Ventilator, the most useful of all modern medical improvements, 80. Vertigo often produced by intense study, 63. Vinegar, a great antidote against diseases, and ought to be used by all travellers, 57. Should be sprinkled in sick chambers, 97, 124, 145. Is of considerable service in the bite of a mad-dog, 308; and in any kind of poison, 311. Its medical properties, 445. Is of use to ex- tract the virtues of several medicinal sttbstances, ibid. How to pre- pare vinegar of litharge, ibid. Vinegar of roses, ibid. Vinegar of squills, ibid llper, the bite of, the sufficiency of the grease for the cure of, doubted, 311. Method of treatment recommended, ibid. Vitriol, elixir of, an excellent medicine in weakness of the stomach, 273. And for windy complaints, 277. Vitus, St. his dance, method of cure of, 283. Vomits, their use in agues, 119; and in the nervous fever, 141. Cautidns for administering in the putrid fever, 146. Ought by no means to be administered in an inflammation of the stomach, 206. Are useful iu cases of repletion, 213. Are powerful remedies, in the jaundice, 249; Are the first object to be pursued when poison has been received into the stomach, 305. Their use in the hooping-cough, and how to admi- nister them lo children, 203. Midwives too rash in the use of, 340, note. Form of a gentle one for infants disordered in the bowels, 343. Vomiting, the several causes of, 219. Medical treatment of, 320. Sa- line draught for stopping of, 220. Causes of, in children, 346. How to be treated, ibid. Of blood. See Blood. Voyage, a long one frequently cures a consumption, 134. Voyages have an excellent effect on persons afflicted with nervous disorders, 276. URETERS, and their use, described, 213, note. Urine, the appearauces and quality of, too uncertain to form any de- termined judgment from, 105. Dr. Cheyne's judgment as to the due quantity of, not to be relied on, ibid The secretion and dis- charge of, how obstructed, ibid. Bad consequence of retaining it too long, ibid. Too great quantity of, tends to a consumption, 106. Stoppage of, its general causes, 241. Cautions as to the treatment of, ibid. Diabetes, 221. Incontinency of, 222. Suppression of, INDEX. 481 medical treatment in, 223. Cautions to persons subject to this dis- order, ibid. Bloody, causes of, 234. Medical treatment of, ibid. An obstinate deafness cured by warm urine, 298, note. Urine doctors, their impudence, and great success from the credulity of the populace, 105, note. Uva ursi, a remedy in present request for the stone, 226. WALLS, high, unwholesome, by obstructing the free current of air, 81. Ward's essence, preparation of, 444. His fistula paste, a popular re- medy that may deserve trial 365. Wars occasion putrid fevers, by tainting the air with the effluvia of dead carcases, 143. Wasps, hornets, or bees, how the bite of, ought to be treated, 311. Water, frequently unwholesome by mineral impregnations, 63. Cautions for the choice of, 69. Cold, the danger of drinking when a person is hot, 109. Water iu the head, is a disorder chiefly incident to children, 354. Its causes, symptoms, and proper treatment, 355. The nature of the disorder seldom discovered in due time for cure, ibid, note. Waters by infusion, how to prepare ; Lime water, 446. Compound lime water, ibid. Sublimate water, ibid. Styptic water, ibid. Tar water, ibid. Waters, simple distilled, their medical uses, 446. Preparation of cina- mon water, ibid. Pennyroyal water, ibid. Peppermint water, 447. Spearmint water, ibid. Rose water, ibid. Jamaica pepper water, ibid. Waters, spirituous distilled, how to prepare. Spirituous cinnamon water, 447. Spirituous Jamaica pepper water, ibid. Watery eye, how to cure, 297. Weaning of children from the breast, the proper mode of, 41, 42. Weather, states of, which produce the putrid fever, 143. Wells, caution to persons going dow n in them, 80 note. Deep, ought not to be entered till the air in, is putrified, 380. Whey, au excellent dr>uk in a dysentery, 237, and in the rheumatism, 259. Orange whey, how to make, 123. Alum whey, 222. 447. Mustard whey, ibid. Scorbutic whey, ibid. Whitlow, 358. How to cure, ibid. Weytt,Dr. his remedies for flatulencies, 287. Wind. See Flatulencies. Windows, the danger of throwing them open on account of heat, and sitting near them, 110. Wine, good, almost the only medicine necessary in a nervous fever, 140. Wines, the medical properties of, 447. Their use in extracting the virtues of medicinal substances. 448. Preparation of anthelmintic wine, ibid. Antimonial wine, ibid. Bitter wine, ibid. Ipecacuanha wine, ibid. Chalybeate or steel wine, ibid. Stomachic wine, ibid. Womb, inflammation of, its symptoms, 338. Medical treatment of, ibid. It omen, errors in their education pointed out, 34. Why subject to hys- terics, 68. Are better adapted to follow sedentary occupations than men, 83, note. In child-bed, often die from their apprehensions of death, 99. Their disorders rendered epidemical by the force of ima- gination, ibid. Every thing that can alarm them to be carefully guarded against, 100. Evil tendency of tolling bells for tlie dead, 60 482 INDEX. ibid. How exposed to a miliary fever during pregnancy, 148. Their constitutions injured by living too much within doors, 330. Those who work in the open air almost as hardy as men, 331. Advice to, with reference to the menstrual discharge, ibid. At the commence- ment, ibid. Fluor albus, with its proper treatment, described, 334. Advice to, at the ceasing of the menses, ibid. Rules of conduct dur- ing pregnancy, 335. Causes and symptoms of abortion, 336. How to guard against abortion, ibid. Treatment in cases of abortion, ibid. Instructions at the time of child-birth, 337. Causes of the milk fever, 339. How to guard against the miliary fever, ibid. The puerperal fever, ibid. General cautions for women iu child-bed, 341. Causes of barrenness, ibid. Wool, the best external application in the gout, 255. Workhouses, poisonous to infants, 49. Worms, how to treat a looseness produced by, 218. Three principal kinds of, distinguished, 245. Causes, 246. Symptoms of, ibid. Me- dical treatment for, 247. Remedy for children, ibid. General cau- tions for preserving children from them, 248. Danger of taking quack medicines for them, ibid, note. Wort, recommended for the scurvy, and proper to drink at sea, 262. Is a powerful remedy in cancerous cases, 303. Wounds, are not cured by external applications, 359. Are cured by nature, ibid. Proper course of treatment, ibid. How to stop the bleeding, ibid. Caution against improper styptics, 360. Method of dressing them, ibid. Poultices for inflamed wounds, 361. Regimen in, ibid. Writing, hints of advice to those who are much employed in, 62. 64. YAWS, general hint for the cure of, 328, note. Young animals, all exert their organs of motion as soon as they are able, 44. ZINC, the flowers of, a popular remedy for the epilepsy, 282. FINIS? ADVICE TO MOTHER^ ON THE SUBJECT OF THEIR OWN HEALTH, AND ON THE MEANS OF PROMOTING THE HEALTH, STRENGTH, AND BEAUTY OF THEIR OFFSPRING. ..............Auditae voces, vagitus et ingens. Infantumque animae flentes in limine primo; duos dulcis vitae exsortes, et ab ubere raptos, Abstulit atra dies, et funere mersit acerbo. VIRG. «NEID VI. BY WILLIAM BUCHAN, M. D. FELLOW OF THE ROVAL COLLEGE OF PHYSICIANS, AND AUTHOR OB " DOMESTIC MEDICINE." NEW-YORK; PUBLISHED BY SAMUEL A. BURTUS, No. 19 PECK-SLIP^ CORNER OF WATER-STREET. Largin & Thompson, Printers. 1813. CONTENTS. \y and un- to. 37 41 52 59 66 INTRODUCTION. ......Page 5 CHAP. I. Hints to Women before Marriage. .... 7 CHAP. II. Rules of Conduct during Pregnancy..... 11 CHAP III. A few Remarks on Child birth...... 26 CHAP IV. Of the Nursing and Rearing of Children ... 33 Sect. I. Of the influence of Air on the^ Health and Lives of Chil- dren. ...... Sect. II. 0/ Warm and Cold Bathing. Sect. III. Of Cnildren'sDress. Sect. IV. Of" the injury done to Children by the too earl necessary use of Medicines. Sect. V. Of tlie Food proper for Children. Sect. VI. Of Exercise and Rest during Infancy. CHAP V. Of Dwarfishness and Deformity.......69 CHAP VI. Baneful effects of Parental Tenderness, or what may be called an extremely delicate aud enervating Education. ... 73 CHAP VII. Of Employments unfavourable to tlie Growth and Health of Chil- dren. .......... 82 CHAP. VIII. Of Accidents.........87 CHAP. IX. Of Foundling Hospitals, and other Charitable Institutions for the Rearing of Poor or Deserted Children.....93 CHAP X. Sketch of a Plan for the Preservation and Improvement of the Hum n Species. ..,..-.. 98 APPENDIX..........104 INTRODUCTION. THE preservation of the lives of infants was the first subject I wrote upon at the opening of my medical career; after forty years practice, I now resume it with increased zeal and pleasure,—zeal, prompted by a just sense of its importance,—and pleasure, arising from the hope of its beneficial aud lasting effects. I am sure of being listened to with kind attention by the tender and rational mother, while I am pointing out to her the certain means of preserving her own health, of securing the attachment of the man she holds de r, and of promoting the health, strength and beauty of her offspring. She will not take alarm at the idea of medical advice, when I tell her that my object is to enable her to do without medicine, and to obtain every desireable end without any painful sacrifice. The path along which I propose to conduct hei' is plain and easy, the prospects all round are delightful, and it leads to the purest sources of happiness. The more I reflect on the situation of a mother, the more I am struck with the extent of her power, and the inestimable value of her services. In the language of love, women are called angels : but this is a weak and a silly compliment; they approach nearer to our ideas of the Deity: they not only create, but sustain their creation, and hold its future des- tiny in their hands: every man is what his mother has made him, and to her he must be indebted for the greatest blessing in life, a healthy and a vigorous constitution. But while I thus speak of the dignity of the female character, it must be understood, that by a mother I do not mean the woman who merely brings a child into the world, but her who faithfully discharges the duties of a parent,—whose chief concern is the well-being of her infant,—and who feels all her cares amply repaid by its growth and activity. No subsequent endeavours can remedy or correct the evils occasioned by a mother's negligence; and the skill of the physician is exerted in vain to mend what she, through ignorance or inattention, may have unfortunate- ly marred. Several books have been written on the cure of diseases incident to children. The natural effect of such publications is to excite terror, and to prompt mothers and nurses to keep dosing poor infants with drugs on every trifling occasion, and to place more reliance on the efficacy of mediciiie than on their own best endeavours. One of the objects which I have in view is to relieve mothers from groundless fears,—to teach them how to prevent diseases that are almost always the consequences of mismanagement,—to inspire them with the fullest confidence in proper nursing, and with strong prejudices against the use of medicines, which do mischief twenty times for ouce that they do good. VI INTRODUCTION. • Quackery in die nursery is not the only error in which I shall endea- vour to undeceive mother*-. The want of proper instructions at an early period of life betrays them into a variety of fatal mistakes respecting their own health, as well as that of their children. These mistakes, and the means of rectifying them, form a considerable part of the follow- ing work. The language is adapted to every capacity, it being of con- sequence that every woman should understand it; and the rules laid down are practicable in every condition, except that of cheerless poverty. With the hope of removing this exception, I shall poiut out the most ef- fectual method of assisting women so circumstanced; and I do not know any manner, in which humanity, charity, and patriotism can be more laud- ably exerted, or even a part of the public revenue more usefully em- ployed, than in enabling mothers to bring up a healthy aud hardy race of men, fit to earn their livelihood by useful employments, and to defend their country iu the hour of danger. i ADVICE TO MOTHERS. CHAP. I. HINTS TO WOMEN BEFORE MARRIAGE. THE desire of preserving and improving personal beauty, which discovers itself at an early period in the female breast, is wisely designed by nature for the best and most important ends; it is a powerful check on excesses of every kind, and is the strongest incitement to cleanliness, temperance, moderate exercise, and habitual good humour. All that is necessary is to convince young people that these are the true means of rendering them lovely, because they are the only means of securing the enjoyment of health, the very essence of beauty; instead of sourly dis- couraging so natural a wish, let us point out the way to its full accom- plishment, and thus prevent many amiable women from taking a wrong road, and from destroying both health and beauty by an absurd pursuit of the latter alone. . Oue of the first truths to be impressed upon the minds oi young wo- men is, that beauty cannot exist without health, and that the one is ab- solutely unattainable by any practices inconsistent with the other. In vain do they hope to improve their skin, or to give a lively redness to their cheek, unless they take care to keep the blood pure, and the whole frame active and vigorous. Beauty, both of shape and countenance, is nothing more than visible health,—the outward mirror of the state of things within,—the certain effect of good air, cheerfulness, temperance and exercise. There is nothing perhaps, so pernicious to women as the use of creams, and pastes, and powders, and lotions, and numberless other contrivances to bleach the skin, or to produce an artificial white and red. All of them act with double injury, not only in destroying the surface which they were expected to beautify, but iu poisoning the habit, and causing a fatal neglect of the great preservatives of life itself. A blotch or a pim- ple however offensive to the eye, gives timely notice of the impure state of the fluids, and of the kind efforts of nature to expel the noxious mat. ter Ought not these efforts then to be assisted by a judicious plan of diet and re«nmen, instead of throwing back the impurity into the blood, and converting the very meansof health into the seeds of infection and disease? Besides fead or mercury is the chief ingredient in all those boasted cos- metics, 'and, being absorbed through the skin, cannot fail to occasion cramps, spasms, convulsions, colics, and the incurable train of nervous and consumptive complaints. Beauty is impaired, and health too often destroyed, by other absurd practices, such as drinking vinegar to produce what is called a genteel or 8 HINTS fO WOMEN slender form, and avoiding exposure to the open air, for fear of its in- juring the fancied delicacy of a fiue skin. Vinegar, used as a 3auce and in moderate quantities, serves to correct the putrescent tendency of va- rious articles of food, and is equally agreeable and wholesome; but when swallowed in draughts for the purpose of reducing plumpness, it proves highly injurious, causing excessive perspiration, relaxing the bowels im- fiarting no small degree of acrimony to the blood, and very muchenfeeb- ing the whole system. The dread of open air is still more ridiculous and detrimental. Look at the healthy texture of the milk-maid's skin, and at the roses ever blooming on her cheek, and then consider whether the open air can be unfavourable to beauty. The votaries of fashion may affect to despise these natural charms, and to call them vulgar: the heart of man feels their irresistible attraction, and his understanding con- firms him in so just a preference. Surely, the languid sickly delicacy produced by confinement, cannot be compared to the animated glow ol a face often fanned by the refreshing breeze! The woman therefore, who feels a laudable wish to look well, and to be so in reality must place no confidence in the silly doctrines, or the de- ceitful arts of fashion. She must consult nature aud reason, and seek for beauty in the temple of health ; if she looks for it elsewhere, she will experience the most mortifying disappointment: her charms will fade; her constitution will be ruined; her husbands love will vanish with her shadowy attractions, and her nuptial bed will be unfruitful, or cursed with a puny race, the hapless victims of a mother's imprudence. She cannot transmit to her children what she does not herself possess; weak- ness and disease are entailed upon her posterity; and even in the midst of wedded joys, the hopes of a healthy and vigorous issue are blasted for ever. The only way to prevent such evils is, to pay a due regard to those ra- tional means of promoting health which I have already hinted at,—tem- perance, exercise, open air, cleanliness, and good-humour. These sub- jects are pretty fully discussed in my " Domestic Medicine;" yet a few remarks may be proper on the present occasion. In laying down rules of temperance, I do not wish to impose any re- straint on the moderate use of good and wholesome food or drink : but under these heads we must not include spirituous liquors; relaxing and often repeated draughts of hot tea and coffee; salted, smoked-dried, and highly-seasoned meats; salt fish; rich gravies; heavy sauces; al- most indigestible pastry; and sour unripe fruits, of which women in general are immoderately fond. We pity the green-sick girl, whose longing for such trash is one of the causes as well as oue of the effects of her disease; but can any woman capable of the least reflection, con- tinue to gratify a perverse appetite by the use of the most pernicious crudities ? Fruit, in the season of its maturity, is no less salutary than delicious. By plucking and eating it before it is ripe, you defeat the beuignant purposes of nature, and will severely feel her resentment. The morning is the best time to eat fruit, when the stomach is not loaded with other aliment. Even in the evening I had rather see it introduced, than the enervating luxuries of the tea-table, or the still worse preparations for a supper of animal food. A meal of this sort should not be made twice in one day. After a hearty dinner, a long interval is necessaiy before nature can require, or even bear without BEFORE MARRIAGE. 9 injury, another substantial repast. Suppers are doubly prejudicial on account of the lateness of the hour, and the danger of going to bed with a full stomach. Apoplexies are often occasioned by such inconsiderate and unseasonable indulgence, but its certain effects are restless nights, frightful dreams, broken and uurefreshing slumbers, an incapacity of ear- ly rising next morning, head-achs, paleness of aspect, and general relax- ation. Whoever sets any value on health or beauty, will always make very light repasts at night, and will go to bed early; that is to say, never later than ten or eleven o'clock, in order to enjoy sweet repose, and to rise betimes, with renovated strength and alacrity, to the pleasures and duties of the cisuing day. Pure air and moderate exercise are not of less importance than food and drink, Women are much confined by their domestic employments and sedentary pursuits: for this very reason they ought to go out fre- quently, and take exercise in the open air,—not in a close carriage, but on foot or on horseback. When prevented by the weather from going abroad, dancing, provided it be not continued to fatigue, is the most cheerful and healthy amusement within doors. The only sedentary di- versions proper for women are playing on some musical instrument, singing, and reading aloud delightful pieces of poetry or eloquence. Young ladies and mothers should wholly resign the card-table to old maids, who ean only injure their own health, and who have no taste for any other mode of social intercourse. It may seem a little strange that I should think it in any sort necessa- ry to recommend cleanliness to the fair sex: I am far from intending to convey the most distant insinuation of their negligence in this respect; I only wish to heighten their idea of its utility, and to point out farther methods of increasing its benefits. They are rather too sparing of water, from an apprehension of its injuring the skin or giving it a disagreeable roughness. This is a great mistake. Pure water may be truly consi- dered as a fountain of health, and its frequent use is the best means of improving the skin and strengthening the whole frame. The offices per- formed by the skin are of greater importance than most people imagine. It is not merely a covering or shield to guard the fine organs of feeling from irritation or external injury, but one of the grand outlets admirably contrived by nature for expelling the noxious and superfluous humours of the body. The perspirable matter thus thrown out will of itself clog the pores, and relax the skin, unless care is taken to promote its easy escape by keeping the entire surface of the body perfectly clean, well- braced and elastic, which can only be done by frequent washing, and in- stantly wiping the parts dry. Those who have not a bath to plunge into, should wash the face, neck, hands, and feet, every morning and night j and experience will soon convince them, that, the more they accustom themselves even to this partial application of clean water, the more com- fortable and enlivening they will find it. If misguided tenderness has produced an extreme delicacy of habit as well as of skin, it will be pro- per to use luke-warm water for some time; and then gradually to dimi- nish its temperature, till cold Mater can be employed, not only with safe- ty, but with benefit. As a preservative of health, it is far more bracing and more invigorating than warm water, though the latter may be often advisable in cases of particular infirmity, indisposition, or disease. All women of delicacy and good sense are sufficiently attentive to 10 HINTS TO WOM11N remove any outward soil or visible dirt from their person; but they do not all know, that a vapour, too fine to be perceived by the eye, is con- stantly issuing from the pores, the little orifices or mouths of Avhich must therefore be kept clean and unobstructed. For the same reason, the liuen and interior articles of dress should be often changed, as they be- come impregnated with the perspirable matter, and, when foul, would not only prevent the escape of any more, but would even have a part of what they had received re-absorbed by the skin, and thrown back into the system. The whole dress also should be loose, and as light as may be found consistent with due warmth, so as not to increase perspiratiou too much by its heaviness, nor to check either that or the free circulation of the blood by its pressure. Among many improvements in the modern fashions of female dress, equally favourable to health, to graceful ease and elegance, the disconti- nuaace of stays is entitled to peculiar approbation. It is, indeed, im- possible to think of the old straight waistco:;t of whalebone, and of tight* lacing, without astonishment and some degree of horror. We are sur- prised and shocked at the folly and perverseness of employing, as an ar- ticle of dress, aud even as a personal ornament, what must have checked youthful growth—what must have produced distortions and deformity— besides occasioning various irregularities and diseases. I need not point out the aggravated mischief of such a pressure on the breasts and womb in a state of pregnancy; but I must notice a defect very prevalent among young women of the present day in London, who, though they have not worn stays, may be fairly presumed to inherit from their mothers some of the pernicious effects of such a custom. The injury to which I allude, is the want of nipples. This unnatural defect seems to have originated from the use of laced stays; and as chil- dren so often resemble their parents in outward form, it is not improbable that the daughter may bear this mark of a mother's imprudence, and may even transmit it to her own female children.—Where stays have never been used, the want of a nipple is as extraordinary as the want of a limb; and no mother is found thus disqualified from discharging one of her most sacred duties. But, in London, the instances are too frequent to be ascribed to accident, and cannot, perhaps, be accounted for more satisfactorily than in the manner here suggested. In my summary of the means of promoting health and beauty, cheer- fulness or good humour is mentioned the last, though certainly it is not the least in point of efficacy. It has the happiest influence on the body and mind; it gives a salutary impulse to the circulation of the blood, keeps all the vital organs in easy and agreeable play, renders the out- ward deportment highly pleasing, while the perpetual sunshine within spreads a fascinating loveliness over the countenance.—Its opposite, peevishness, or ill-humour, imbitters life, saps the constitution, and is more fatal to beauty than the small-pox, because its ravages are more certain, more disgusting, and more permanent. Such are the chief points which I wish to impress upon the minds of women before marriage. Objects of so much importance in every state or period of life, are deserving of peculiar regard when an union of the sexes is proposed. It is little short of intentional mur- der on the part of a weak, languid, nervous, or deformed woman to approach the marriage-bed. Improper passions may urge her to be- BEFORE MARRIACE. 11 come a wife; but she is wholly unfit to become a mother. She risks her own life,—-she disappoints the natural wishes of a hut-band,—and should she have children, her puny, sickly offspring, as I before observed, will have little cause to thank her for their wretched existence. The evil is not confined to her own family; society at large is materially injured; its well being depends on the vigour of the members that compose it; and universal experience has fully proved, that the frame of a hus- bandman or a hero is not to be moulded or cherished in the womb of de- bility, and that the bold eagle will never be brought forth by the timid dove. I cannot conclude these hints without adding a few words on the choice of a husband. Having endeavoured to prove that health is so indispen- sible a requisite in females before marriage, they may well suppose that I deem it no less necessary in the other sex. I am always sorry to see that precious blessing sacrificed in an alliance with infirmity, or youth and beauty consigned to the frozen arms of age. Misery must be the inevit- able consequence of such unnatural matches. But I fear that my remon- strances will have little effect in restraining the undue exercise of paren- tal authority, or in attempting to open the eyes of a woman to her certain destruction, when she suffers herself to be dazzled by the splendour of riches, or charmed by the sound of an empty title. CHAPTER II. RULES OF CONDUCT DURING PREGNANCY. AFTER what I have already said on the subject ofhealih, I hope I need not make use of any new arguments to convince women of its increased importance the moment they conceive,—a moment from which they may begin to date the real perfection of their being.—Nature has now entered upon her grandest work, and uothing is wanting but the mother's care to complete it. The exertions of this care are not left to whim, to caprice, or even to the strong impulses of parental love. The self-preservation of the mother is made dependant on the pro- per discharge of her duty, her own health, her strength, her very life are closely entwined with the well being of the embryo in her womb; nor can she be guilty of the least neglect, without equal danger and injury to both. I am sorry to think that any awful warning should be necessary to check the commission of so wicked an outrage upon nature, as an attempt to procure abortion. This can never be effected without either the pro- bable death of the mother, or the certain ruin of her constitution: the stimulants which are used to force the womb prematurely to discharge its sacred deposit, must inflame the parts so as to cause a mortification; or will convulse and enfeeble the whole system in such a manner as to leave no chance of future health or enjoyment to the destroyer of her own child. In the ancient history of the Jews, we read of two harlots warmly contending for a living child. How different is the case with our wo- meuof that description!—.Their wish, if they conceive, is to prevent i2 RULES OF CONDUCT or to destroy the life of the embryo, even at the risk of their own. Is a monster of this sort to be pitied, when, in the exccutiou of her shocking purposes, she brings on those deadly symptoms which must soon close her guilty career ? The unnatural mother, however, is not always the only monster concerned in those scenes of horror; her base seducer is too often the adviser of the desperate resolution, and crowns his guilty joys with double murder. Another ruffian, some male or female practitioner in midwifery, is also engaged in the hellish plot, and lends a hand to perpetrate the foul deed, alike regardless of the mother's danger, aud deaf to the cries of infant blood ! I never read, without shuddering, any advertisement of temporary retreats or pretended accommodations for pregnant ladies. I always view it as a wicked allurement to unfortu- nate women, and as a daring hint from some ready assassin of inno- cence. It is not long since one of those wretches was convicted of kil- ling both mother and child; and I have myself seen a great number of embryos exhibited by a man, who, I firmly believe, obtained them in this way. The dread of public shame or of private scorn, though no excuse for murder, may urge the victim of seduction to commit a crime at once 60 abominable and so dangerous. But is it possible that a married womafi should madly and wickedly attempt to procure abortion, merely from an apprehension of a large family, or to avoid the trouble of bearing and bringing up children ? Can she hope to taste the joys, and yet destroy the fruits of love ? What a frantic idea!—The same poison puts an end to both. And in vain does she flatter herself that her guilt is concealed, or that n6 law exists to punish it. The laws of nature are never violated with impunity ; and in the cases alluded to, the criminal is made at once to feel the horrors of late remorse, and the keenest pangs of a torn, disorder- ed, and incurable frame. But suppose that a miscarriage brought about by such detestable means did not endanger the health and life of the mother, suppose that an act held in such just abhorrence, both by earth and heaven, could possibly es- cape punishment: suppose a woman, deaf to the cries of nature, incapa- ble of tender emotions, and fearless of any immediate suffering in her own person,—I have one argument more to make her stop her murderous hand: perhaps the embryo, which she is now going to destroy, would, if che- rished in her womb, and afterwards reared with due attention, prove the sweetest comfort of her future years, and repay all her maternal care with boundless gratitude. It may be a daughter to nurse her in her old age, or a son to swell her heart with joy at his honourable and successful ca- reer in life. I only wish her to pause for a moment, and to consider, that by the wilful extinction of the babe in her womb, all her fairest hopes are extinguished also, and that the present danger is aggravated by the certain- ty of future despair. A wish to prevent even one act of so much horror has induced me to dwell on this unpleasant part of my subject But folly, ignorance, and carelessness, are often productive of as fatal effects as a crimi- nal design; and though I may not be able to restrain the latter, yet I hope the former may be corrected by better information. With this view, I shall make some farther remarks ou the great preservatives of health mentioned in the preceding chapter. The general rules DURING PREGNANCY. 13 there laid down hoid good in every condition of life; but a state of preg- nancy requires a greater degree of care and judgment in their practical application. Cheerfulness, or good humour, which before was placed last in the order of discussion, must now take the lead, being superior to all other considerations during pregnancy. In this state, more than in any othei> the changes of bodily health seem to be almost wholly under the influ- ence of the mind; and the mother appears well or ill, according as she gives way to pleasant or to fretful emotions. I admire that fragment of ancient history, in which we are informed, that the eastern sages, while their wives were pregnant, took care to keep them constantly tranquil and cheerful, by sweet and innocent amusements, to the eud, that, from the mother's womb, the fruit might receive no impressions but what were pleasing, mild, and agreeable to order. So fine a lesson of wisdom, and of parental, as well as conjugal love and duty, cannot be too closely studied, or too diligently carried into practice, by the husband who sets any value on his wife's health,—who wishes to secure her affection and gratitude—and who pants for the exquisite happiness of being the father of a lively, well-formed, and vigorous child. It is during pregnancy also that every woman should be doubly at- tentive to preserve the utmost sweetness and serenity of temper, to dispel the glooms of fear or melancholy, to calm the rising gusts of anger, and to keep every other unruly passion or desire under the steady controul of mildness aud reason. The joy of becoming a mother, and the antici- pated pleasure of presenting a fond husband with the dearest pledge of mutual love, ought naturally to increase her cheerfulness, and wotild certainly produce that effect, were not those emotions too often checked by a false alarm at the fancied danger of her situation. It is therefore of the utmost importance to convince her, that her terrors are groundless; that pregnancy is not a state of infirmity or danger, but affords the strong- est presumption of health and security; that the few instances she may know of miscarriage or of death, were owing to the improper conduct of the women themselves, besides being too inconsiderable to be compared with the countless millions of persons in the like condition, who enjoy both then and afterwards a greater degree of health than they ever be- fore experienced; and, lastly, that the changes which she feels in herself, and her quick perceptions of uneasiness, are not symptoms of weakness, but the consequences of an increased sensibility of her womb, and timely warnings of the.effects of indiscretion or intemperance. A late writer on this subject very justly observes, that, when such an increase of sensibility takes place in a woman of a very irritable frame and temper, it must certainly aggravate her former complaints and weak- nesses, and produce a variety of feverish effects. She grows more im- patient and fretful: her fears as well as her angry passions are more readily excited: the body necessarily suffers with the mind, debility, emaciation, and many hectic symptoms, follow. But the only rational inference to be drawn from these facts is, that the feelings are more acute in a state of pregnancy: and that any previous indisposition, either of body or mind, now requires a more than ordinary degree of care and tenderness. Though the chilling influence of fear, mil (he depression* of melas- 14 RULES OF CONDUCT choly, are very injurious to the mother's health and to the growth of the fatus in her womb; yet anger is a still more formidable enemy. It con- vulses the whole system, aud forces the blood into the foce and head with a great impetuosity. The danger is increased by the usual fullness of the habit in pregnancy. When the blood runs high and rapid, a ves» sel may burst, and in such a part as to terminate, or bring into great per- il, the existence of both the mother and the child. Cases often occur of the bursting of a blood-vessel in the brain, occasioned by a violent gust of passion. How much more likely is it to rupture those tender vessels that conuect the mother and the child! Yet to the latter this is certain death. I knew a female who had the aorta, or great artery, so distended that it forced its way through the breast bone, and rose externally to the size of a quart bottle. This extraordinary distention was chiefly owing to the violence of her temper. I have also met with a most shocking in- stance of a fighting woman, who, in the paroxysm of rage and revenge, brought forth a child, with all its bowels hanging out of its little body. There is no doubt but that passionate women are most subject to abor- tions, which are oftener owing to outward violence or internal tumult, than to any other cause. An accident of this sort is the more alarming, as the woman who once miscarries, has the greatest reason ever after to dread the repetition of the same misfortune. Cards or any kind of gaming, at all times, the worst of amusements, should be particularly avoided during pregnancy. The temper is then more liable to be ruffled by the changes of luck, and the mind to be fa- tigued by constant exertions of the judgment and memory. Old maids, as I before observed, are the only class of females who may be allowed to spend some of their tedious hours in such absurd and such unhealthy pastimes. Without entering into farther details, it will be easy for tlie sensible mother, to apply the principle here lakl down, to every passion and pro- pensity which may tend to excite painful emotions of the mind, and to impair in the same degree the health of the body. She must learn to keep even natural desires within due bounds, lest pleasure itself, if im- moderately indulged, may produce the same effect as pain. Among ma- ny excellent hints to pregnant ladies contained in a latin poem translated by Dr. Tytler, we meet with the following just admonition: Subdue desires; nor let your troubled mind, Immod'rate love, or fear, or sadness find: Give not yourselves ev'n to the nuptial joy, Or aught that may your strength or peace destroy. And again, ■ ■ Curb each loose desire, Lest added fuel quench the former fire: Lest ye should loose the fruits of pleasure gone, And love itself undo what love had done. The enjoyments of the table must also be kept under the nice con- troul of moderation, in a state of pregnancy. Any excess, or any de- ficiency of proper supplies, will now be most severely felt. The well being of both the mother and child will depend on her pursuing a hap- py medium between painful restraint or unnecessary self-denial, on DURING PREGNANCY. 15 the one hand, and the indulgence of a depraved or intemperate appetite on the other. But, as the natural desire of aliment increases with the growth and increasing wants of the child, it will be proper to consider those variations as they appear in the different stages of pregnancy: and to shew how far it may be also adviseable to gratify the involuntary, and often very wild and whimsical desires, which are known by the name of longings. Before I enter into particular details concerning the diet of pregnant ladies, I must beg leave to urge with increased earnestness my former general prohibition against strong liquors, unripe fruits, pastry, and all sorts of food that are high-seasoned, inflammatory, or hard of digestion. If these are improper before marriage, they must be doubly pernicious afterwards, when they may not only injure the mother's health, but poi- son, infect, or impoverish the fountain of life and nutriment, whence her child is to derive support. Every female, therefore, will see the impor- tance of guarding against bad habits, or the indulgence of a vitiated taste at an early period; that she may not have any painful restraints to sub- ject herself to when a mother, or be then under the necessity of making any great change from her former mode of living. I have already laid it down as a fixed principle, that a state of preg- nancy is hot a state of infirmity or disease, but of increased sensibility; and that the changes which a woman then feels in herself, though some- times accompanied with a little pain or uneasiness, are but notices of her situation, or warnings against indiscretion or intemperance. Let us now apply this principle to the regulations of diet, and we shall find it to be the most unerring guide to pregnant women in all their conduct, but more especially in the choice and quantity of their food and drink. The whole term of pregnancy may be divided into two nearly equal parts, the one comprehending the four months that immediately follow conception, and the other, the remaining five months that precede deli- very. During the first period, when there is in most women a strong tendency to an extreme fulness of the habit, nature gives the plainest cautions against improper indulgence, by a weakness of the stomach, fre- quent returns of nausea and vomiting; head-achs, costiveness; and the 4>ther symptoms and effects of indigestion. It is a very absurd and a very fatal mistake, to suppose that women are then in greater need of nourishing things; when, on the contrary, in consequence of the ceasing of the menses, and the redundancy of blood in the system, the strictest temperance is not only proper, but absolutely necessary to prevent illness. When this is neglected,—when no regard is paid to the hints of the state of the stomach and of the whole habit, so kindly given by nature,— bleeding becomes the only expedient to save the life of the thoughtless or obstinate glutton; but she should remember, that it is her own intem- perance which renders that operation adviseable. The alleged or fancied wants of the child may be urged as a plea for some little excess, or an incitement to more than ordinary gratification; but the frivolity of such an excuse will appear, upon considering, that the foetus, for the first two months, does not exceed a he;'? egg in size, and that its growth for the next two months, even to the accent of the womb, or the usual time of quickening, is so small as to require very little nourishment. This is amply supplied from the Datural fulness of 62 16 RULES OF CONDUCT the system before noticed, without the dangerous aid of the mother'* in- temperance. It requires but a moments reflection on the part of any women of common sense, to be convinced that what disorders herselt must injure the contents of her womb; and that the injury is the greater. in proportion to the delicacy and slow expansion of those contents. To overstep the bounds of temperance in the early stage of pregnancy, from an idea of the embryo's wanting such supplies, would be almost aa frantic as to drown an infant for the purpose of quenching its supposed thirst, or to gorge it even to bursting, in order to satisfy the cravings of ima- ginary hunger. But the absurd notion of the embryo's wants has been attended with incalculable mischief of another kind;—it has given a sanction to the most whimsical and the most pernicious desires. Green-sick girls do not indulge in such silly and such hurtful fancies as many pregnant women: yet the propensities-of the former are checked by the force of ridicule, of argument, or of authority, while the longings of the latter bid defiance to all control; and it is even deemed the height of cruelty not to gratify them in their wildest extent. To the candid discussion of this very in- teresting part of my subject, I hope I need not request the serious atten- tion of every female reader. One of the natural consequences of conception is the ceasing of the menses, which is accompanied with a redundancy of blood greater or less hi proportion to the previous fulness of the habit Such a swell in the vital stream gives rise to feverish appearances; such as heat iu the palms of the hands, flushings in the face, and a slight head-ach. But the sto- mach is most affected by the changes which then take place in the Momb and the whole habit. It is often disturbed by the complaints already described,—nausea, vomiting, heart-burn, and-the like. These, as I said before, are not symptoms of indisposition or disease, the most healthy woman being as subject to them in the early months of pregnancy, as those who are delicate and infirm. It is thus that every mother receives timely notice of her situation, with proper warnings not to overcharge her stomach, when its powers of digestion are so weak, and a fulness of tlie habit is so manifest. Unhappily all pregnant women are not alike disposed to attend to those kind intimations of nature: and, perhaps, many of them do not know, that the uneasiness arising from the above causes would be removed by perseverance in a temperate cooling diet. They think they ought to eat more, instead of less, in their new state, and torture their invention to find out something to conquer the squeamishness of their appetite. This ia a very fruitful source of whims and fancies, the indulgence of which is almost always injurious. It cannot indeed be otherwise; as the weak- ness or diminution of any woman's usual appetite, on such occasions, is not owing to a mere dislike of common or ordinary food, but to a real unfitness of tlie stomach to receive much of any food. What then are we to expect, when things equally improper, perhaps, both in quantity and quality, are forced upon it, to satisfy some artificial craving, or some -imaginary want? As soon as a woman begins to consult her caprice, instead of at- tending to nature, she is sure to be eucouraged in absurdity by old purses, or female gossips, who take, a delight in amusing her creduji- fy by the relation of many wonderful and alarming injuries, said ta yURING PREGNANCY. 17 have beeu done to children, through the unsatisfied desires of their md thers. Every fairy tale, however repugnant to common sense, gains im plicit belief; for reason dares not intrude into the regions of fancy: and were a man bold enough to laugh at such fictions, or to remonstrate with a pregnant woman on the danger of giving way to any of her extravagant wishes, he would certainly be considered as a conceited fool, or an unfeel- ing monster. Argument is lost, and ridicule has no force, where people pretei d to produce a host of facts in support of their opinion. Every woman, who brings into the world a marked child, can immediately as- sign the cause; yet no mother was ever able, before the birth, to say with what her child would be marked; and I believe it would be equally dif- ficult afterwards, without the aid of fancy, to discover ib a flesh-mark any resemblance to the object whence the impression had been supposed to ori- ginate. On examining various instances of flesh-marks, and other dreadful events, said to be caused by disappointed longings, it has appeared that most of them were the effects of obstructions, of pressure, or some external imury; and that none could be fairly traced to the influence of imagina- tion. Similar accidents are observable in the brute species; and even in plants unconscious of their propagation or existence. It is also well knowD, that several children are born with marks on their skin, though their mo- thers never experienced any longings; and that, in other cases, where women had been refused the indulgence of their longmgs, no effect was perceptible in the child, though the mother's imagination had continued to dwell on the subject for a considerable time. The doctrine of imagination, like every thing founded in absurdity, con- futes itself by being carried too far. The same power of marking or dis- figuring the child is ascribed to tlie sudden terrors and the ungratified cra- vings of pregnant women. The abettors of this doctriue are not even con- tent with a few specks or blemishes on the skin, but maintain that the mother's imagination may take off a leg or an arm, or even fracture eve- ry bone in the child's body. I have seen a child born without a head; but it was not alleged that the mother had been present at the beheading of any person, or had ever been frightened by the spectacle of a human body deprived of its head. If shocking sights of this kind could have produced such effects how many headless babes had been born iu France during Robespierre's reign of terror! In order to shew that the fancy, however agitated or strongly impress sed with the dread of any particular object, cannot stamp its resemblance, or even the smallest feature of it on the child in the womb, Dr. Moore re- lates the following stofy of a remarkable occurrence within the sphere of his own knowledge:— A lady* who had great aversion to monkies, happened Unfortunately, during the course of her pregnancy, to visit in a family where one of those animals was the chief favourite. On being shewed into a room, she seated herself on a chair, which stood before a table upon which the favourite was already placed: he not naturally of a reserved disposition, aud rendered more petulcnt and wanton by long indulgence, suddenly jumped on the lady's shoulder?. She screamed, and was terrified; but on perceiving who had treated her with such indecent familiarity, she ac- tually fainted; and through the remaining course of her pregnancy, she had the most painful conviction tliat her child would be deformed by 18 Rules of conduct some shocking feature, or perhaps the whole countenance of this odious monkey. ** The pangs of labour did not overcome this impression, for in the- midst of her pains she often lamented the fate of her unfortunate child, who was doomed through life to carry about a human soul in the body of an ape. When the child was born, she called to the midwife with a la- mentable voice for a sight of her unfortunate offspring, aud was equally pleased and surprised when she received a fine boy into her arms. After having enjoyed for a few minutes all the rapture of this change to ease and happiness from pain and misery, her pains returned, and the midwife informed her that there was still another child. ' Another!' exclaimed she, ' then it is as I have dreaded, and this must be the monkey after all.' She was however, once more happily undeceived, the second was as fine a boy as the first. I knew them both:—they grew to be stout comely youths, without a trace of tlie monkey in either their faces or disposi- tions." Having before enlarged on the dangerous effects of the passions, and of fear in particular during pregnancy, it cannot be supposed that I look up- on frightful objects, scenes of horror, or any other causes of a sudden shock, as matters of indifference. Ou the contrary, I would have them very carefully avoided as they have often caused abortion, or otherwise injured the health both of the mother and child,* though they cannot dis- colour the skin, derange the limbs, or alter the shape of the latter. It is from this silly apprehension, in consequence of any fright, that I wish to relieve the minds of credulous and timid poor women, who may do them- selves a real injury by the dread of an imaginary evil. It was precisely with the same view that I endeavoured to expose the absurdity of believing that fle9h-marks ou a child were the con- sequences of his mother's fancies or unsatisfied longings. This silly doctrine has been the cause of great uneasiness in many families, and has douc much mischief to several pregnant women, sometimes by giving a sanction to the indulgence of their most improper whims, and at, other times by making them pine for extravagant unattainable gratifica- tions. It is another great mistake to suppose, that the prevalence of such a belief can answer any one good purpose. Surely the fictions of igno- rance, superstition, or imposture, are not necessary to secure to women in a state of pregnancy those kind compliances, and that tenderness of treatment, which their situation requires. The fond husband will em- brace with eagerness every opportunity of supplying the real wants of the wife now doubly dear to him, and even of anticipating her silent wish for any rational enjoyment. But she should also know, tliat the tyranny of caprice will prove no less injurious to herself than disagreeable to others. Let not pregnant ladies imagine that I am for confining the sphere of indulgence within very narrow limits. I should be more inclined to enlarge than to contract its boundaries, as far as nature and rea- * I knew an instance of a mother, who not only lost the fetus through afright, but was otherwise so much affected as never to enjoy ah hour's health. I can- not therefore too strongly censure the frantic impulse which so often urgei pregnant women, and nurses with infants at the breast, to rush among crowd* at a dreadful fire, an execution, or any other shocking spectacle. DURING PREGNANCY. 19 son would allow. I would not even be particularly strict, except in cases of evident danger. While I discouraged capricious desires, or impro- per whims and fancies, I would distinguish them from real and involunta- ry longings* which are sometimes occasioned by that weakness and dis- order of the stomach so usual, as I before observed, for three or four months after conception. There can be no doubt as to the cause of such longings; for a similar effect is known to take place at other times, and not only in women, but in men, when their stomachs are weakened or dis- ordered by intemperance, illness, or any accident I have often met with cases of this kind in fevers, epilepsies, and other nervous diseases; and where the craving often recurred, or steadily continued, I have always directed that it should be indulged, though the object of desire might not appear consistent mth the regimen commonly prescribed in those com- plaints. When the longings are involuntary, and the feelings acute, a patient may suffer much from disappointment or delay; and cases fre-> quently occur of persons who recovered from the most hopeless state, af- ter having disobeyed the doctor's commands, and been freely indulged in what they had so ardently desired. I do not say that the cure was absolutely effected by the use of the forbidden food or drink; but I am convinced from repeated observations that the strong and sudden appetite for such food or driuk, however strange it might seem, was a symptom of a favourable change in the complaint, and a sure indication of returning health. On the same principle, therefore, that rigid prohibitions or denials might be attended with much pain in a state of pregnancy, a state of ex- quisite sensibility, I strongly recommend a speedy compliance not only with what may be deemed the natural and reasonable desires of the mo- ther, but even with all her involuntary longings, which do not evidently arise from caprice, and are not directed to things of a noxious quality. I would pay little regard, for instance, to the whim of such a lady as is represented by Smollet, longing for a hair from her husband's beard, and what was worse, wanting to have the pleasure of plucking it out her- self; or to the more disgusting wish of another lady, described by Addison, who longed to partake with a flock of carrion-crows, which she saw feasting on the flesh of a dead horse. It would be also carrying my plan of compliance too far to let a preg- nant woman live chiefly on unripe fruits, raw onions, or any other acid and acrimonious substances; which could not fail to injure her own health and that of her child. An opinion prevails that a woman in such a state can digest every thing she likes or longs for; but supposing this to be true, it does not follow that living on trash, or on improper articles of food or drink, will not be detrimental to the foetus in her womb. Slight or momentary deviations from the rules of wholesome diet or strict tem- perance may be occasionally allowed, but perverse habits are never to be indulged. I hope therefore it will not be deemed needlessly severe to recommend, in the early period of pregnancy, a becoming check on absurd or pernici- ous desires, and a moderate use of such things as have been always found to agree with the stomach and constitution. I do not insist upon a total change from former modes of living; but unless the appetite be very much vitiated, it will direct uomen at that time to what is most proper and salutary. They have generally a dislike to animal food; and, if in- 20 RULES OP CONDUCT duced to eat it freely, from a mistaken notion of tMir being then tit greater need of such aliment, they are sure to suffer some inconvenience. On the contrary, their natural relish for ripe fruits and boiled veugtables may be safely gratified. Milk, jellies, veal-broths, and the like liquids, which afford easy nourishment, being converted into chyle without auy great effort of the stomach, are also very allowable. Should a particu- lar desire for solid animal substances be felt at dinner, fresh meat of the young and tender kind, veal, lamb, capons, pigeons, pheasants, and pa- tridges, may now and then afford an inuoceut and grateful variety. But I must again beg, that temperance may always preside at the table; and that the refinements of cookery may never be exerted to raise a false appetite by artificial provocatives. While I am thus tracing the boundaries of rational indulgence, whicli should not be overstepped by those who have it in their power to counmnd every gratification, I kce also the necessity of some admonitions to women whose uarrow circumstances may appear to require no additional re- straint. It has beeu very truly observed, that, in the lowest classes of society, especially in great cities, we often meet with a sort of luxury more baneful than any which prevails in high life,—a luxury that con- sists in the immoderate use of strong liquors; to which the miscarriages, the fevers, and the death of so many poor married women in London and otlier populous towns must be ascribed. There is nothing, in fact, so per- nicious to the mother, and to the foetus in her womb, as drinking ardent spirits, especially when carried to excess. It is administering poison to the embryo, and is certainly a species of murder. The taste of such persons is not more depraved with regard to their drink than their food. The latter perverseness is indeed very frequently the consequence of the former. Spirituous liquors destroy the natural ap- petite, and leave no relish but for bacon, or other salted aud smoke-dried meats, salt fish, or red herrings, than which nothing can be much more sti- mulating, inflammatory, and indigestible. But suppose that their fondness for this worst of aliment is not always the effect of swallowing liquid fire, but of habit; and that tlie stomach, strengthened by the hardy employ-' ments of some of those poor women, may be able to digest any tiling; why should its powers be exerted in such unproductive efforts ? A greater quantity of food is certainly requisite, in proportion to the greater quantity of labour; but let that food be of the most Avholesome kind. Plenty of vegetables with the addition of a little fresh meat, will satisfy every natural craving, and will afford both the mother and child the purest supplies of health and vigour. After the fourth month of pregnancy, the growth of thefcelus becomes very rapid, and the demands for nourishment, made by a thriving child on the constitution of its mother, are proportionably strong and incessant. Nature now, with wonderful care, invigorates the organs of digestion to answer those increasing demands, The stomach is no longer so apt to be disordered as before; its functions are performed with ease and effect; and a more liberal mode of living is not only allowable, but necessary. All the restraint which should be imposed is a iittie attention to the quality of the food. Provided it be cooling and nutritious, it may be used freely, and as often as the appetite requires. I need not repeat what I have already said in favour of ripe fruits, boiled vegetables, milk, jellies, veal-broth, aDd animal substances of the youug and DURING PREGNANCY. 21 tender kind. The bill of fare may be enlarged rather than contracted at this time; and variety may be allowed to present her sweetest stores to the taste and fancy, but without the aid of any pernicious seasoning. I have just hinted at the propriety of indulging the appetite as often as the desire of food is strongly felt. It is even adviseable to prevent importunate cravings. Emptiness is more to be dreaded in the advan- ced stages of pregnancy than a little excess. Instead, therefore, of con- tinuing my former prohibition against suppers, I would now recommend agreeable repasts, consisting of biscuits, fruit, oysters, eggs not boiled hard, or any other light food and easy of digestion.—But meat suppers must never follow a late or hearty dinner: an unseasonable load would oppress the stomach: moderate supplies, on the contrary, are necessary to satisfy the child's strenuous demands for sustenance, which do not cease even by night. These, if neglected, will cause uneasy sensations in bed, and often prevent sleep. It is justly remarked by Dr. Dcnman, when speaking of this restlessness, which is generally troublesome towards the conclusion of pregnancy, that those women who suffer most from it, though reduced in appearance, bring forth lusty children, and have easy labours. But if the mother has little uneasiness, and grows corpulent during preg- nancy, the child is generally small; and if the child should die before the time of parturition, the inquietude entirely ceases. In the first case, as this judicious writer observes, the absorbing powers of the child seem too strong for the parent; but, in the latter, the retaining powers of the parent are stronger than the absorbing ones of the child; so that, on the whole, it appears natural that women should become thinner when they are pregnant. One direction more is necessary with regard to suppers. They should never be later than nine o'clock; after which an hour may be spent in cheerful conversation, as the best means of preparing for the enjoyment of sound repose. I hope that the custom of going to "bed early, and of rising early, which is one of the best preservatives of health at all times, will be particularly adhered to during pregnancy. Women in this con- dition should not, upon any account, be tempted to sit up after ten, and they will find no difficulty ha rising at six, though, towards the conclu- sion of their term, they may safely remain an hour longer in bed every morning. In my former liints to women before marriage, I pointed out the pe- culiar importance of open air and frequent exercise to females, who, in general, spend too much of their time in domestic and sedentary em- ployments. I recommended a variety of active diversions both without doors and within, according to the state of the weather. I would have youug ladies dance and jump about as much as they please, and as na- ture wisely prompts. But, when they become wives and mothers, their deportment must be different, or they will risk the loss of the embryo in their womb,—a loss always attended with irreparable injury to their own health. Miscarriages are often occasioned by great bodily exertions, though in the form of amusement, as well as by the straining efforts of liard labour. It was not without the justest reason tliat Hippocrates for- bade dancing and all violent exercise during pregnancy: he himself had heen witness to a foetus being dropt on the stage by a performer in the dancing line.—Let not pregnant women then attempt to vie with other female^ in the livelv dance: the former should even avoid all crowded 22 RULES OF CONDUCT assemblies, whether gay or serious; for besides the impurity of die air in such places, of the bad effects of which they are very susceptible, they are exposed to great danger from any accidental pressure. I have known a lady to suffer abortion in conse uence of an elbow at entering a church door. How much more likely is this to happen at balls, at play- houses, and other places of amusement, which are commonly more fre- quented than places of worship! When I say that violent exertions and hard labour are apt to occasion miscarriages, I do not mean to recommend indolence and inactivity to pregnant women. This would be running into the opposite extreme, which is still more dangerous than the other. Indolence in pregnancy is not only one of the great causes of abortion, but of the puerperal or child-bed fever, so fatal to delicate mothers. A woman who lives fully, and neglects exercise, cannot fail to bring on a plethora, or a fulness of the habit and redundancy of humours, which must be productive of very bad effects. The whole frame becomes languid: all the vital organs seem to lose their energy: tlie powers of the womb in particular, are enfeebled or perverted; and though a miscarriage should not take place, the labours are sure to be long, severe, and dangerous; and the offspring puny and deformed. In order, therefore, to secure the blessings of a happy delivery, and a healthy child, a pregnant woman ought to take every day a moderate degree of exercise, such as she has been most ac- customed to, only using less exertion, and guarding against fatigue. Some writers on midwifery have asserted, that in the early months of pregnancy, the exercise should be very moderate, but might be safely increased in the latter months. The absurdity of such a notion has been very ably exposed by the fairest reasoning, and the incontrovertible evi- dence of facts. The example of the brute species has first been referred to, as, in every thing that respects the preservation of life, their instinct is more unerring than the fanciful speculations of man. It is observable of Ihe quadrupeds in our fields and parks, that the most frisky of them, when pregnant, assume a grave and steady deportment: their natural fondness for going together in herds and flocks is suspended; and, if left to their own inclinations, they gradually lessen their usual exercise as they ad- vance in pregnancy. The same thing is well known to be equally true of wild animals. In a state of pregnancy, they take no more exercise than is necessary to procure their food. If forced to greater exertions in self defence, or when hard pursued, they often drop their young; and though beasts of prey have no claim to pity, yet surely the harmless and timid hare ought not in that *tate to be worried, merely to gratify a cruel or inconsiderate sportsman's fondness for the chase. It is still more inexcusable to over- load, or to strain by ill-timed hbou>\ a mare in foal, which has frequently eau.-ed a premature expulsion of her young. From these remarks on the ins'inctive conduct of brutes, a very wise lesson has been drawn for the guidance of pregnant women.— They are not, for some time after conception, more sensible of fa- tigue than at any other period, nor have they any certain proofs of their own condition. What then, it has been reasonably asked, .should direct them to make any change in their customary exercises ? \ DURING PREGNANCY. 23 These may be continued, but never to a violent or immoderate degree* for at least four months, not only with safety, but with the utmost bene- fit. When the contents of the womb begin to increase very perceptibly, the same degree of exercise, which pregnant women before enjoyed with pleasure, will now make them faint and weary; a strong hint to di- minish it. Their own feelings will direct them better than the caprice of others; and no subtlety of argument should induce them to believe, that n -ture in this case alone deviates from her uniform course of action, and requires them to exert themselves more in proportion as they are less capable of it; or, in plainer words, to ruu the faster the greater weight \ they carry. Slow, short walks in the country, or gentle motion in an opea carriage, must be far better suited to the advanced period of pregnancy, by uniting the advantages of fresh air with those of agreeable and saluta* ry exercise. Iu order to leave no doubt upon this subject, an appeal has been made to facts, and particularly to the experience of women who follow very hard occupations in the country. They feel no inconvenieuce from the usuat employments in the early months of pregnancy, aud require no indulgence, but a little abatement of their toil when they become unwieldy. They know nothing of artificial precepts whicli would teach them to invert the order of nature. Temperance and moderate exercise, p oner periods of labour and of rest, the country air, and the cheering influence of a content- ed mind, insure to them the continuance of health in every stage, an ex- emption from the common diseases of pregnancy, an easy 1) ing-in, and a speedy recovery from child-bed. The vigour also of their offspring is justly proverbial. It would be painful to contrast with this picture the enervating effects of indolence and luxury in high life, or the truly pitiable condition of poor married women in manufacturing towns, and in great cities. The confi- ned impure air which they breathe in these places, relaxes the frame and destroys its activity. What they eat, what they drink, is often improper, sometimes pernipious. Their meals and their hours of rest are equally irregular. The victims of poverty are seldom able to procure the means of scanty subsistence, without the sacrifice of necessary sleep. Their con- dition is really more distressing than that of female slaves in the West In- dies. These experience a little mercy when pregnant, their owners be- ing actuated by the double impulses of self-interest, and of humauity to- wards breeding women . but, in London, the wretchf d hireling experieo- ces no lenity on account of her pregnancy; she is even obliged to conceal her situation as much as she can, in order to get employment: and has often no alternative but to perish with famine, or t> run the risk of miscarrying, by continued exertions at the washins-tub, or at some other toilsome work, . for sixteen or eighteen hours, according to the caprice of the sordid views- of her unfeeling employer. To impose such tasks on the hungry and dis- tressed,—to cause abortion by oppressive labour,—under what pretence the inhuman mistress may strive to justify her own conduct,—is certainly murder ! Though my former remarks on dre?s may be easily applied to a state of pregnancy, yet this is a matter of so much concern to mothers and to their children, that I hope my female readers will pardon me for troubling them with some farther observations on the subject. Be- fore marriage, errors iu dros can only injure their own heahh, or 24 RULES OF CONDUCT disfigure their persons; but, after conception, the form, the health, and the very existence of tlie child, will greatly depend upon the mother's dress. Indeed, were I to assign a cause not only for die diminutiveuess, debility, and distortion of infants, but for those flesh-marks which are su- perstitiously ascribed to disappointed longings, I should be much more in- clined to impute these evils to pressure upon the womb, than to the alle- ged influence of the mother's fancy. The gradual asceut of the womb, af- ter the fourth month, is wisely designed by nature, to acquire more space for easy growth and expansion. But her benignant purposes are defeat- ed, if the body be girded by tight bandages, or squeezed within the nar- row circle of a whale-bone press. I need not stop to explain a thing in itself so obvious, as the opera- tion of such fatal checks on the increasing size of the foetus; but how they should be productive of flesh marks and deformity may require some little illustration. It is well known that young trees and plants, and, in a word, vegetables of every kind, when confined in their growth, get dis- torted, or take on a bad shape; and that the tender bark as well as the fruit will be marked, if they suffet the least compression or restraint. Why should not compression have similar effects on the ftelus in the womb, where it is almost in the state of jelly ? The great wonder is, that it should ever escape bearing the marks of a tight-laced mother's indiscre- tion. The doctrine here laid down does not rest solely even upon the fairest reasoning by analogy, but is supported by facts. Nations that go almost naked are strangers to flesh-marks and deformities, except what may arise from accidental injury, or external violence. But in proportion as men remove from a state of nature, and false refinement introduces, as personal ornaments, tight and oppressive incumbrances of dress, we see a pigmy or deformed race crawl about, to publish their mother's folly, and to reproach them with having thwarted or cramped nature in her operations. In my " Domestic Medicine," as well as in a former part of the pre- sent work, I felt great pleasure in paying a just compliment to the taste and good sense of the ladies, so admirably displayed in the present fash- ions of dress. The high-heeled shoes, in which they used to totter about as upon stilts, and the tight-laced stays, which gave them the appearance of insects cut almost asunder in the middle, are happily exploded; the E>et's fiction is realized,—the philosopher's wish is gratified, in seeing eauty arrayed by the Graces; and health, ease, and elegance, alike consulted in the dresses of our fair country-women. But as fashion is very changeable ;—as there is nothing however ri- diculous or hurtful, to which it cannot give a sanction ;-—and as the re- turn to old absurdities and old prejudices may be dreaded unless the pro- priety and importance of the present reform are strongly impressed upon the mind, I shall endeavour to heighten these by a view of the dreadful evils which arose from the former system of tight bandages, and of stiff and cumbrous clothing. It is not many years since the sugar loaf shape was universally admired, and the small waist, though contrary to nature, was looked upon as the distinguishing mark of elegance. Husbands used often to make it their boast, that, when they married their wives, they could span them round the middle. It was then thought that nothing DURrNG PRECNANCY. 25 could produce a fiue shape but tight lacing, though it never failed to have the contrary effect. Not only deformity without measure, but death it- self was often the consequence. Ladies were known to drop down life- less in the dance, when no other cause could be assigned but the tightness of the dress. Miscarriages were frequently occasioned by the same cause; and various other injuries to the fetus must have far exceeded all power of calculation. Yet, during the prevalence of so strange an infatuation, while deformi- ty was deemed beauty, all remonstrances on the subject would have prov- ed unavailing. It would then have been useless to employ such argu ments as uow carry conviction to the unprejudiced mind. We may at present observe, with the hope of being listened to, that nature when left to herself, gives every animal, except those that are formed for swiftness, a prominency about the middle. If this is not only compressed, but the belly squeezed close to the back-bone, obstructions of the viscera must ensue : and no great knowledge of the human frame is necessary to sa- tisfy any person, that such obstructions must prove fatal to health. When the vessels that take up and convey the nourishment to the body, have their functions by any means impeded, the whole system must suffer, and at length perish by a gradual decay. But nothing can so effectually impede the functions of those soft parts as pressure. The stomach becomes incapable of performing the grand office of digestion: the midriff is for- ced upwards: the cavity of the chest is thereby lessened, and sufficient room is not left for a proper play of the lungs. A difficulty of breathing, coughs, and pulmonary consumptions are the natural consequences. All those dangers occasioned by tightness round the waist, are obvious- ly increased during pregnancy, when the heart, the lungs, the stomach, and all the adjoining parts are in a state of tender sympathy with the womb; and when the growth of the factus necessarily requires more room as before observed, for easy expansion. To confine it at that period must evitably produce weakness, deformity, or abortion. " Remember," says the ingenious author of Pcedotrophia. ——Remember not to gird too tight Your swelling waist, though pleasing to the sight; Nor for a shape, within the straighten'd womb; Like Gallic mothers, the poor child entomb— But young English wives have often been guilty of the- same fatal im- prudence, not indeed, so much for the sake of " a shape," as from im- pulses of false modesty, and for fear of appearing eitiier indecent, or too proud of the happy proofs of their fecundity. I hope, however, that the days of folly and of absurdity iu those respects are past; and that the evils, which were then so frequent will operate as a warning against any possible restoration of that most awkward and most pernicious contrivance called stays. Let me also very earnestly forbid the use of tight necklaces, tight garters, or any ligatures which may restrain the easy motion of the limbs, or obstruct the free circulation of the blood and juices. I should farther observe, that it is not enough to have discontinued the high- heeled shoe, unless the shape of the foot and toes is a little attended to. Trifling as tiiis circumstance may appear, the neglect of it has often been attended not only with pain, with cramps, and with corn% 26 A FEW REMARKS but with many still more distressing consequences. Of these I shall have occasion to speak more fully in my observations on the dress of chil- dren. To sum up in a few words the chief part of my advice on this subject to pregnant women, and to the fair sex in general, I need use but a single assertion, tliat a flowing dress, sustained by the shoulders, and gently compre^sed by a zone round the middle, with only as much tightness as is necessary to keep the clothes in contact with the body, ever was, and ever will be, the most healthy, comfortable, and truly elegant habit that females can wear, or fancy invent. The hints concerning cleanliness, which are given iu the last chapter, will be found no less useful after marriage than liefore. with this single exception, that during pregnancy, lukewarm water, is preferable to cold, not only for a total immersion of the body, but also for partially bathing the upper and lower extremities, more especially the latter. I have in- deed, known many pregnant women, who always used cold water on these occasions, and who plunged into the sea two or three times a week duriig the summer mo iths, without injury. Yet I think their example too bold, and too dangerous to be recommended to general imitation. CHAP. III. A FEW REMARKS ON CHILD-BIRTH. 1 HERE is not any part of medical science whicli has been cul- tivated with greater assiduity, and finally with greater success, than mid- Wife ly. The errors of ignorance, the rashness of presumption, the amusing theories of ingenious fancy, have at length given way to the un- erring dictates of reason and experience. By these it has been clearly proved, that, in every healthy and well-formed subject, the powers of na- ture alone are fully adequate to the accomplishment of her greatest work, the preservation of the human species; and that the busy interference of a man is more likely to disturb and impede than to assist her efforts. Whatever differences of opinion may prevail on other points merely spe- culative, as weli informed practitioners are now agreed iu this, that the regular process of a labour must never be hurried on by artificial means, nor interrupted by the meddling haud of indiscretion or officiousness. It is painful to reflect on the numbers that must have perished, while a contrary method was pursued. People had taken it into their heads, that a woman in labour could not use too much exertion on her own part, nov be too much aided by others, to quickeu delivery. In the poem be- fore referred to, this notion is inculcated iu the form of medicial precept, The poor woman is there desired, " To grasp some strong support with all her pow'r, " T' increase her efforts in that painful hour." A happy revolution has now, however, taken place in the system of midwifery; and the most eminent professors have made it the first ON CHILD-BIRTH. 27 object of their public duty to reprobate the abominable custom of giving assistance, as it was called, by dilating the internal and external parts artificially; and of exciting patients, not only by the strongest persua- sions, but by the stimulus of hot cordials, to help themselves, as they term- ed it, and to exert all their voluntary force beyond the dictates of nature; " as if," says Dr. Denham, " a labour was a trick to be learned, and not a regular process of the constitution." Though the writer now quoted, and many others of no less celebrity have omitted nothing of importance in their directions both to mid- wives and lying-in women, yet as their books, from being deemed works of professional science, are seldom read by the latter, I shall se- lect a few of their most useful remarks, and exhibit them in the plain- est form I can, to guard women in labour against the fatal consequences of their own errors, on the improper advice which may be given them by others. On the first signs of approaching labour, pregnant women are too apt to take alarm, and instantly prepare as for a work of the greatest toil and danger. Their fears are as groundless as their preparation is unnecessa- ry. If they have nothing to injure their health during the previous state of pregnancy, they may rely with perfect confidence on the admirable re- sources of nature. When left to herself, her efforts are always adapted to the constitution of the patient, and to the state of those delicate and acute- ly sensible parts, which would suffer the greatest injury from sudden or ill-timed violence. All that is required of women in labour, is a becoming submission to her course of operations. The steps, by which she advan- ces to her great end, are sometimes slow, but always safe ; and she is not to be hurried or disturbed, with impunity. It is true in almost every situation, but particularly in child-birth, that those who are most patient actually suffer the least. If they are resign- ed to their pains, it is impossible for them to do wrong; but if, from too much eagerness to shorten those pains and to hasten thefi^rl effect, a wo- man should keep in her breath, and strain with all her might to increase, as she may imagine, the instinctive action of the womb, the consequences must always be injurious, and often fatal. In the first place, such improper efforts of the patient may exhaust her strength, so as to render her incapable of undergoing the necessary fatigue which attends the complete expulsion of the child. On the other hand, if the parts are not duly prepared, violence is more likely to tear than to di- late them; and accidents of this kind have often occasioned a fever, or have rendered a woman miserable for the remainder of her life. The imprudence of taking hot and cordial nourishment during labour, is no less reprehensible. In plethoric habits, it must have a feverish ef- fect: in any constitution, it is at that tune a dangerous stimulant. The nature of the principle, which should actuate the womb, is immediately changed;—the pains are rendered disorderly aud imperfect;—and the foundation of future mischief and difficulties, in some f rm or other, is in- variably laid. A labour may be so slow, or of such long duration as to ren-ler a little refreshment from time to time necessary; but this should always be of a mild and cooling quality, the very reverse of inflammatory food or spirituous liquors. I have already intimated, that, all ordinary cases, the chief duty of a midwife is to let nature take her regular course without busy in- 28 A FEW REMARKS. terference ; to restrain, rather than encourage tlie exertions of the pa- tient's strength; and, when these may be involuntarily carried too far from the impulse of acute pain, to resist them by tlie application of some equivalent force. But I am very sorry to add, that the contrary method is too often pursued, especially by practitioners in country -places, where the patients are so widely scattered, that dispatch is the first object of consideration, and the dictates of humanity are disregarded from stronger views of interest. The moment an order comes for the man-midwife, he packs up his bag of tools, which may be justly called the instruments of death; he mounts his horse, and gallops away, resolved to ha*ten the process by all practicable means, that he may be the sooner ready to at- tend to another call. At whatever stage of labour he arrives, he spurs on nature with as much eagerness as he had before spurred on his lioue, though the closely entwined lives of the mother and her offspring may be endangered by his precipitancy. Yet such, perhaps is the impatience of the poor woman herself, and such very often the ignorance of the by- standers, that the quicker he is in getting through his work, if no obvious injury be done at the moment, the greater reputation he undeservedly acquires, and the more he enlarges the sphere of his murderous practice. Instruments are sometimes necessaiy, but they should be used as seldom as possible. One method of preventing the evils whicli must always arise from the hurry of professional men, would be to pay them more liberally for their patient attendance. They have nothing but the full employment of their time to trust to for the means of support: and it is just that they should have an adequate compensation for so valuable a sacrifice. But as this cannot be generally expected, I would recommend the cheaper encouragement of female midwives, none of whom, however, ought to be permitted to practice, without a regular license, obtained—not by money —but by proofs of real qualifications. Such persons could spare more time, and would be found much fitter assistants to lying-in women than any surgeon, whatever may be his skill or talents. I do not insist on the point of delicacy, but of absolute safety, being persuaded that hundreds of lives are destroyed for one that is preserved by the use of instruments in a labour. At such times also, it is highly improper to admit any person but the midwife and a discreet nurse into the apartment. To say nothing of the noxiousness of the breath and perspiration of several people in a close room, the officious folly, the silly tattle, the inconsiderate language, the fluctuating hopes and fears of so many gossips, must be productive of the very worst effects. Let me therefore, conjure pregnant women never to comply with the request, however well-meant, of their female friends, to be sent for at the moment of labour; they are sure to (\o some harm; it is impossible they can do any good. The patient will find quietness and composure, of far greater service than the noisy rallying round her of her friends, to awaken and cherish the idea of danger. After delivery, when repose is the chief restorative of fatigued na- ture, and when the purity of the air in the patient's chamber is the hest preservative from fever, the exclusion of visitants must be still more strongly insisted upon. The whisper of fond congratulation from the man she holds dear, and whom she has made happy, is all that should be allowed even for a moment. With the same view of ON CHILD-BIRTH. 29 quieting any flutter of the spirits, and of preventing the uneasiness which a mother naturally feels from the cries of her child, the operation of washing aud dressing the infant should for a few days be performed in an adjoining room. As the pains of labour, however regular in its progress, and happy in its issue, must produce some irritation of the system, and a tendency to fever, external quietness, and perfect composure of mind as well as of body, are certainly the first objects. But our care should be extended to some other points also. Too much attention cannot be paid to clean- liness : all impurities are to be instantly removed. It is equally neces- sary to change the linen often, on account of its retaining the perspira- ble matter, which would soon be thrown back into the habit, and there produce the worst effects. Whenever the weather permits, the upper sashes of the windows are to be let down a little to admit the fresh air; yet so as not to expose the patient to its direct current, for fear of check- ing the gentle and salutary perspiration, which naturally follows the fatigue of a labour, and is designed to abate any inflammatory or febrile symptoms. It would be no less dangerous to think of increasing or of forcing this natural discharge by large fires, a load of bed-clothes, close- ly drawn curtains, or the still more pernicious heat of caudle impregna- ted with spices, wine, or spirits. A fever is almost sure to be the conse- quence of such ill-judged expedients, in whatever manner they may act. Sometimes they will put a total stop to perspiration, though they set the body on fire, and thus produce the very evil which they were foolishly employed to prevent. At other times they cause so profuse and violent a sweat, -«s must not only exhaust the strength of the patient, and fre- quently destroy the power of suckling her child, but prepare the way for the ready attacks of a fever upon the least exposure to cold. A temperate degree of warmth, therefore, will best promote that dis- position both to sleep and to perspire, which every woman feels after labour. The fires should be suited to the season, or rather to the state of the weather, and made barely sufficient to counteract the effects of cold, and of dampness or moisture. The drinks should be mild and di- luting ; and the bed-clothes should be light and porous, to favour the es- cape of the perspirable matter, while they afford a comfortable covering. A due regard to this regulation is the more necessary, as the patient must not be in a hurry to quit her bed, even when she may fancy her strength and spirits perfectly recovered. She should be informed, that the womb does not resume its natural state for two or three weeks; and that her lying in bed for that time is most conducive to so desirable a purpose. A sofa is very convenient to recline upon, Avhile her bed is at any time adjusting, or to afford some relief from a long continuance in the same position. But I would by no means advise sitting up in a chair, or remo- val into another room for the reception of company, till the end of the third week, and then only in case of the most perfect consciousness of health and vigour. The opposite extreme of too much indulgence is, indeed, more preva- lent. It is a lamentable truth, that numbeis of wompn, after having been safely brought to bed, are killed by imaginary kindness. They are smothered, iustead of being kept moderately warm. The action of heat from without, is increased within by inflammatory food and drink. Neither of these should be in any case allowed.' Women of strong and' SO A FEW REMARKS full habits have nothing to fear from emptiness or fatigue; but may be said to invite danger and disease by improper gratifications ol the palate. They should confine themselves for at least three or four days, to barley- water, gruel, aud beef-tea. Very weak and delicate women may be al- lowed something more nutritious, such as calves-feet jellies, or veal and chicken broths, which a*e much better suited 10 the weakness of tin ir stomachs, and will sooner afford the wanted nourishment than solid aui- mal substances. If the rules of temperance before laid down have been followed during pregnancy, the patient will be easily reconciled to abstemious living for a few days. In ieed the relaxed state of the stomach at this time com- monly prevents any natural craving for animal food. But, if a Avoman has been unhappily accustomed to luxuries, or if soups should disagree with her, she may be iudulged in a little fish, a little boiled veal or chick- en, and bread pudding. Every succeeding day will render such indul gence safer. Hot spices, however, and ardent spirits iu any form or mix- ture, are to be absolutely prohibited during the whole time of lying-in. Wine itself is liable to do much mischief till every symptom of fever or inflammation disappears; aud, even then, should be very sparingly used, not more than a glass or two being allowable at the principal meal only. But though quietness, repose, the admission of fresh air, strict cleanli- ness, and a temperate cooling regimen, must contribute very much to prevent fever, and to promote a Avoman's safe and speedy recovery from child-bed; yet all these prudent measures will often fail, without her own faithful discharge of one of the most sacred duties of a mother, that of suckling her inl'aut. Unless the milk, which is ready to gush from her nipples, finds the proper vent, it will not only distened and inflame the breasts, but excite a great degree of fever in the whole system. Every at- tempt to disperse it by artificial means, being an act of flagrant rebellion against nature, is as dangerous to the mother herself, to say nothing of her child, as an attempt to procure abortion. The evident determination of the blood to the breasts, for the wisest and most benignant purpose, can never be repelled with safety. It is either deposited upon some otlier part, there to produce inflammation: or, if purgatives and sudorifics are used to carry it off by different outlets, the violence of their action must be attended with dangerous shocks, even to the firmest habit. It may be said, that there are instances without number, of mothers who enjoy perfect health, though they never suckled their children. I positively deny the assertion; and maintain, on the contrary, that a mother, who is not prevented by any particular weakness or disease from discharging that duty, canuot neglect it without material injury to her constitution. The same midwives who would assist her in procuring a miscarriage, if she wanted it, may now also undertake to disperse her milk with the utmost ease and safety. Let her not trust to the wicked delusion. The mischief is not the less certain from its being perhaps unperceived at the time, and cruelty to one child, often destroys the power of procreating another. If we take a view of all animated nature, it is shocking to find, that woman should be the only monster capable of withholding the nutritive fluid from her young. Such a monster, however, does not exist among savage nations. They cannot separate the idea of bring- ing forth a child, from the necessity of giving it suck. The wives of ON CHILDBIRTH. 31 the American savages are said to extend this mark of motherly tenderness and solicitude even to infants that die upon the breast. After having be- stowed upun them the rites of burial, they come once a-day for several weeks and press from the nipple a few drops of milk upon the grave ol tlie departed suckling. I have seen a drawing taken from nature by a gentle- man at Botany Bay : it represented a female of that country, after hav- ing opened oue of her veins, and made an incision in the naval of her. sickly child, endeavouring to transfuse her blood into its body, and hop- ing thereby to restore its health, and to prolong its existence. . Observa- tion and experience had taught her that the umbilical cord, or naval- string, was the medium through which the foetus, while in the womb, re- ceived nourishment from its mother: she fancied, therefore, that she could transfuse her blood through the same channel, and renovate a life which was dearer to her than her own! Let the mother in civilized so- ciety, who, from motives of selfish ease and imaginary pleasure, denies her infant the vital stream with which she is abundantly supplied for its sustenance, think of the poor savage and start with horror at her own un- natural depravity. It is also a great mistake on the part of such selfish mothers, to fancy that they can take more pleasure by abandoning their infants to the care of hirelings. Some of them may he callous to all reproaches of conscience for the frequent diseases of those children; but leaving moral sentiment and natural tenderness out of the question, pleasure is inseparably con- nected with the enjoyment of health; and I have already shewn how much this is endangered by a mother's unwillingness to become a nurse. I need not repeat what I said of the inflammation and suppuration of the breast; but my hint on barrenness, as one of the probable conse- quences of an attempt to disperse the milk, may be farther enforced by observing, that the Avomb is the part most likely to be affected in such cases: the repelled humour has often been deposited on that delicate or- gan, and has there produced deep seated and frequently incurable ulcers. Many instances of this sort, as well as of other disorders arising from the same cause, and equally fatal to fecundity, gave rise to my former as- sertion, however harsh it may sound in the ear of fashionable perverse- ness. But I can with equal confidence assure the fond parent, faithful to her trust, and eager to cherish her infant with the vital fluid which nature has kindly given her for that purpose, that nothing else can so effectually promote her recovery from child-bed, the speedy return of good health, and the long continuation of that invaluable blessing. Besides, all nurses concur in declaring, that the act itself is attended with sweet, thrilling, and delightful sensations of which those only who have felt them can form any idea. I have already admitted, that a mother may be prevented from giving suck, by some particular weakness or disorder; and in touching on the same subject iu anotlier work, I observed that women of delicate consti- tutions, subject to hysteric fits, or other nervous affections, made very bad nurses. Lest that remark might give too great a scope to excuses, on the ground of pretended weakness or delicacy, I added, that every mother who could, ought certainly to perform so tender and agreeable *q office. I now go firther, and maintain that every woman who is not able and willing to discharge the duties of a mother, has no right to be- G-l 32 A FEW REMARKS come one. The same personal defect, or constitutional infirmity. Avhich may disqualify her for nursing, ought to be considered as an equally" strong disqualification for marrying. But if, after marriage, any subse- quent disease or accident should render the discharge of a mother's first duty impracticable or dangerous, she is, iu such cases only blameless for calling in the aid of another to suckle her child. In the next chapter, I shall have occasion to speak of the salutary effects of the mother's milk on the neAV born infant. The aim of my present observations is to conv ince lying-in Avomen, that the free and na- tural discharge of that precious current is essential to their own health and safety. But as some young mothers, hoivever Avell-inclined, may be discouraged from persevering in their attempts to give suck, by the difficulty, awkAeardness, or pain, attending the first experiments, I shall subjoin for their direction iu such cases, a feiv rules laid down by the most approved writers on midwifery. The first advice given by those eminent practitioners is, to put thechild to the breast as soon after delivery aud due repose as the strength of the mo- therwill permit, care having been previously taken to Avash the breastswith a little warm milk and water, in order to remove the bitter v iscid substance, which is furnished round the nipple to defend the parts from excoriation or soreness. When the woman has never nursed before, the nipples at first are sometimes not sufficiently prominent to afford a proper hold for the child. The ends also of the small tubes, through which the milk passes, are contracted, to prevent its flowing out spontaneously. From these circumstances, as Avell as from the inexpertness both of the mother aud the infant, some pain and difficulty may arise. But the common practice of having the breasts draAvn by au old child, or some groAvn persou is deemed improper, because the degree of violence used on these occa- sions Avill often irritate and inflame the parts, and frighten the woman against the renewal of such painful experiments. Much gentler means will produce the desired effect. The breast should be fomented with flannels dipt iu Avarm water; and then a glass or ivory cup, mounted en a bag of elastic gum, ought to be applied in such a manner to the nipple, that it Avill draAvit out gently and gradually, Avhile, by moderate pres-= sure on thesides of the breast with the hands, the milk will be pushed for- ward. In obstinate cases, instruments of more attractive poiver may be used, though Avith caution, for fear of injuring the breast. If the difficulty be not owing to a flatness of the nipple (upon the principal cause of Avhich I before hazarded a conjecture), but to a little rigidity of the milk vessels, nothing more is necessaiy than the warm fo- mentation above recommended. The stiffness or contractions of the nedsof those fine tubes will gradually yield to the natural efforts of the infant. They will soon become straight, so as no longer to impede the egress of the milk, which is draivn into them by the suction. Impatience or excessive eagerness, in these cases, as in all others, defeats its oirn end. The attempts at first should neither be too often repeated, nor too Ion* continued; and Avhenthe child is put to the breast, the mother ought to be supported by pillows iu bed, in a reclining posture, and ai ith due pre- cautions against catching cold. Such are the dictates of enlightened practice, of Avhich I am happy to avail myself, as an additional incitement to mothers not to shrink ON CHILD-BIRTH. 33 from their duty. A little pain is easily surmounted, and is followed by lasting pleasure. I must not omit another caution given by the same writers, in case of any particular soreness of the nipples, ahvays to procure the best medical assistance, as the modes of treatment pur* sued by ignorant persons are, in these instances more especially, no less injurious than absurd. CHAP. IV. OF THE NURSING AND REARING OF CHILDREN. EVERY thing is perfect, says Rosseau, as it comes out of the hands of God; but every thing degenerates in the hands of man. This is particularly true of the human species. If the mother during preg- nancy, has not suffered any injury from accident, or from her OAvn im- prudence ; and if, after the accession of labour, neither she nor the mid- wife has disturbed or impeded the efforts of nature: the offspring of strong and healthy parents is sure at the birth to be well-formed, healthy and vigorous. Any instances to the contrary are so rare and extraordi- nary, as almost to leave some doubt of the possibility of such an event: yet it appears from the best calculations, that at least one half of the children born, die before they are twelve years old. Of the surviving half at that period, how many perish before they attain to maturity! How many others are stunted in their groAvth, distorted in their figure, or too much enfeebled ever to enjoy the real siveets of life! What a train of ills seem to aAvait the precious charge, the moment it is taken out of the hands of nature! But as the most of these calamities are the consequences of mismanagement or neglect, I shall endeavour to shew how they may be prevented by tender aud rational attention. SECTION I. Of the influence of Air on the Health and Lives of Children. THE first want of a new-born infant is clearly manifested by its cries, not arising from any sense of pain, but from a stimulus or impulse to expand the lungs, and thereby open a free passage for the circulation of the blood, and for admission of air, so essential to the existence of every living creature. Wliile the child lay in the womb, its lungs Avere in a collapsed or shrivelled state : it received all its supplies through the me dium of the naval-string. But at its birth a very obvious change takes place. The pulsation or throbbing of this cord first ceases at the remo- test part, and then by slow degrees, nearer and nearer to the child, till the Avhole string becomes quite flaccid, all circulation being confined to the body of the infant. It is then that the cries of a healthy child are heard; in consequence of Avhich the air rushes into the lungs; their tubes and cellular spaces are dilated; the bosom heaves; the cavity of tlie chest is enlarged; and the blood flows with the utmost ease. But aa the air passes out, the lungs again collapse, and the course of the blood 34 OF THE NURSING AND receives a momentary check, till a fresh influx or inspiration of air in concurrence a?HIi the action of tlie heart and arteries, reuewa the former salutary process, lvhieh never ceases during life. The air thus inhaled, after imparting its vital properties to the whole frame, takes up the perspirable matter constancy issuing from the interior surface of the lungs, and carries off, on its expulsion, a considerable part of the noxious and superfluous humours of the body. Its purity is of course destroyed, and, in consequence of being frequently breathed, it becomes unfit for respiration. In a confined place, therefore, it is not an- Ave inhale, but our oavo effluvia; and every other cause, which tends te Avaste or pollute the air, renders it in some degree injurious to the strength and health of those Avho breathe it. la this account of one of the most important of the vital functions, I have avoided the minute details of anatomical science, which would, indeed, have made it more accurate, but less intelligible to the generality of my female readers. I thought it far better to explain to them, in as familiar language as I could, the cause of an infant's cry at the moment of its birth, with the hope of rendering them attentive to the purity of what nature so strenuously demands. The quality of the air we breathe, is of much greater consequence than our food or drink, at every period of life, but particularly in infancy, a state of the utmost d; licacy and weakness. Good air braces, bad air relaxes, the tender frame; the for- mer is a source of health and vigour, the latter of infirmity and disease. It should therefore be the first object of a pregnant woman's care, to secure, at least for the time of her lying-in, a wholesome situation. Instead of flying from the country to town, as many do, she should fly from town to the country. If her circumstances will not admit of this, she must fix her abode in as open and airy a street as she can, and at as great a distance as possible from Doise, from tumult, and from those nuisances which contaminate the atmosphere of great cities.—■ Let her apartments be lofty and spacious, dry rather than warm, and exposed to the suu's morning rays. I have already explained the im- portance of cleanliness, and of occasionally letting down the upper sashes of the bed-room windows in fine weather, to admit fresh air, and to pre- vent fever. An attention to these points is not less necessary on the neAV-born infant's account, than on his mother's. Let not the first air he breathes be foul from confinement, too much rarefied by heat, or char- ged with any noxious exhalations. The mild temperature to which he has been used in the womb, renders it very proper to preserve for some time the same moderate degree of warmth in his neiv place of residence. But he is not, on that account, to be roasted before a great fire, or kept pan'ing in steam and pollution. If the room be kept properly ventilated and free from impurity, the infant w'll soon get hardy enough to be taken out into the open air, not only without the least danger, but with the greatest advantage; provi ed always that the season of the year, and the state of the wea'ler, entourage such early experiments. A month spent within doors, is confinement long enough in almost every case; and the nurs ry is then to be frequently exchanged for green fieUls and sunny eminences. There your child will drink, as it were, the vital stream, pure from its source; he will draw iq at every breath fresh REARING OF CHILDREN. 35 supplies of strength aud alacrity; while the bracing action of the air on the surface of his body, Avill give a degree of firmness unattainable by any other means. In the course of a feiv months, the state of the weather need not be much regarded; and its unfavourable changes, unless the heat or cold be intense, must not operate as a check on those daily excursions from the nursery. Our climate is very fickle; A\e shall suffer much from its ra- pid variations, if we are not freely exposed to them in early life : do not therefore sacrifice the future comfort and safety of the grown man, to mis- taken tenderness for the infant. If your child be accustomed from the cradle to go out in all weather:-, he Aviil have nothing to fear from the bleak north, or the sultry south, but Aviil bear every change of season, of climate, and of atmosphere, not only without danger, but Avithout pain or inconvenience. What is here said cf the importance of fresh air, and of frequent expo- sure to all sorts of weather, in early life, must derive additional a\ eight from a consideration of iho bad effects of confinement aud ol uuAvholesome air Upon children. This part of the subject is pretty fully discutsed in n.y '; Domestic Medicine." I there explained the reason why so fe\v of the infants that are put into hospitals or parish work-houses live. Such pla- ces are generally croivdcd with old, sickly and infirm people, by which means the air is rendered so extremely pernicious, that it becomes a poison to young children. I also took notice of one of the Arorst afflictions of poverty in great towns, Avhere the poorer sort of inhabitants live in low, dirty, confined houses, to Avhich the fresh air has hardly any access. Though grown people, who are hardy and robust, may live in such situa- tions, yet they generally prove fatal to their offspring, few of whom arrive at maturity, andthose who do are weak and deformed. While I was considering the hard lot of the poor, most of whose chil- dren perish, because the wretched parents are not in a condition to take them often out into the open air, I could not but observe that the rich Avere without any excuse for neglecting so essentia! apart of their duty. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This ay ill always suc- ceed belter, if the mother goes along with them. Servants are often neg- ligent in these matters, and alloAv a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as well as her children ; and how can she be better employed than in attend- ing them ? In the same chapter I had farther occasion to censure a very bad, though a very prevailing custom, of making children sleep in small apartments, or crowding two or three beds into one chamber. Instead of this, the nur- sery and the sleepiug-rooms ought always to be the largest and most airy apartments in the house. When children are shut up in small rooms, the air not only becomes unwholesome, but the heat relaxes their solids, ren- ders them delicate, and disposes them to colds, and many other disorders, particularly of the convulsive kind. All medical men, who have had much practice in the treatment of children, agree in opinion, thatci-nvuhion-fits, of which so many infants die, are to be chiefly ascribed to a confined and impure air. I wish to impress this truth on the minds of mothers and nurses, to make them sensible of the "danger of small or close rooms, and of the pernicious folly of covering an infant's face in bed, or the front of its 36 OF THE NURSING AND cradle, and thereby nuking it breathe the same air over and over all the time it sleeps. It, may be of no less consequence to repeat and enforce my cautions to parents against sending iticir children, while very young, or indeed at any age, to crowded schools, the atmosphere of which is really a floating mass of putrid etlluvia. The breath and perspiration of so many persons in a room, even supposing them all to be ib good health, must ivaste and cor- rupt tlie air, destroy its vital properties, and of course reuder it wholly un- fit for the support of animal life. But should any one child happen to be diseased, atl the rest are very likely to catch die infection. When I see a poor baby, before it can well Avalk, carried in a nurse's arms to school, I really feel stronger emotions of pity, and of alarm for its safety, than if I had seen it conveyed to a pesi-house. In the latter place, chil- dren Avould be kept separate, and proper means would be used to prevent the spreading of contagion : in the former, all are thrown together, and there remain with relaxed lungs, open pores, and steaming bodies, so as to render it almost impossible for any to escape. As thousands of children die every year the victims of diseases caught at schools, and as the health and constitutions of still greater numbers are irretrievably ruined by the confinement and the bad air of such places, parents must not be offended at the seeming harshness of my language in reprobating so absurd, so cruel, and so unnatural a practice. I know that as soon as children begin to run about, they require the most watchful care to prevent mischief. Will any mother urge this as a reason for being ti- red of them, and for confining, as it were in stocks, that restless activity which is wisely designed by nature to promote their growth and vigour ? Will she, from a wish to save herself some trouble, or to gain time for other business infinitely less important, send her little babes to school, un- der the silly pretence of keeping them out of harm's Avay ? I hope what 1 have already said is sufficient to convince persons of common understand- ing, that they cannot be exposed to greater harm, than by being fixed to a seat in the midst of noxious steam for six or seven hours a day, Avhich should be spent in the open air and cheerful exercise. Should it be alleged, that children are sent young to school, from a becoming zeal for their early improvement, I need only reply, that learn- ing, hoArever desirable, is too dearly bought at the expense of the con- ^titution. Besides, learning can never be acquired by such preposterous means. Confinement and bad air are not less injurious to the mind, than to the body; and nothing io effectually preveuts the growth of the intel- lectual faculties, as premature application.—Sending a child to school in his nurse's arms, is the sure Avay to make him an idiot, or to give him an unconquerable disgust to books: the only book he should then look at, is tlie great volume of nature.—This is legible at every age, and is as grati- fying to a child as to a man: 1^ abounds with the most delightful and most useful information : it is equally conducive to pleasure, health, and know- ledge. A thousand absurdities in the fashionable modes of education pre- sent themselves noiv to my view; but I must only take notice of er- rors in the physical treatment of children: and surely no error of this port can be more reprehensible, than that which I have been just dsc i" ing. Debility of body aa.l mind is the certain consequence of sending very young children to school; a-:u of pending then,, a*, any REARING OF CHILDREN. 37 age, to crowded or confined schools. The terms of instruction are in general so Ioav, that a master or mistress of a school is obliged to take a great number of scholars, in order to get a living: andean seldom af- ford to rent a spacious room in an open and elevated situation. Yet not only this is as absolutely necessary for health, but a large play-ground al- so : where even day-scholars should be permitted to go out frequently to taste the freshness of the vital breeze.—The plants of geuius and of manhood cannot flourish but by frequent exposure to the enlivening rays of the sun. SECTION II. Of warm and cold Bathing. IN observing the regular succession of an infant's ivants, after the supply of air procured by it's first cries, it's seeming uncleanliness at- tracts our notice. The skin appears covered with a slippery glue Avhich soon dries and forms a kind of scurf. This should be Avashed off veiy gently with a soft spunge and Avarm water, having a little soap dissolved in it. Nurses, in general, are as eager to remove eAery speck of it, as if It was the most offensive impurity, though it is perfectly harmless, and will easily come aivay in three or four Avashings, Avithout the danger of hard rubbing, or the aid of improper, and sometimes very injurious, con- trivances. Ointments or greasy substances cannot fail to fill up the little orifices of the pores, and to put a stop to insensible perspiration. Spirits of any kind are still worse, on account of their inflammatory effect. Even Galen's advice to sprinkle the child's body with salt, that the glutinous matter may be more effectually rubbed off, is at best unnecessary. I hav^e no particular objection to the modern improvement on that hint, Avhich consists in dissolving salt in the warm bath, Avith a view of giving it the agreeable stimulus, as Avell as the cleansing and bracing properties of sea-water; but I Avould not encourage any solicitude in this respect, as the easiest and simplest mode of proceedirg will fully answer the de- sired end. In the hardy ages of antiquity, we are told that tlie Germans used to plunge their new-born infants, into the freezing waters of the Rhine, to inure them betimes to the severe cold of their native country. I need not take any pains to point out the danger of folloAving such an example in our times, Avhen mothers and nurses are too apt to run into the opposite extreme of unnerving effeminacy. In this, as in every thing else, the golden mean is the line of wisdom—the line to be pursued by rational affection. It would be extremely hazardous to dip the tender body of a child, reekino- from the womb, in cold Avater, and to keep it there during the necessary operation of washing: but the use of the cold bath may be safely brought about by degrees in five or six months after the birth, and will thenbe found not only oue of the best means of promoting health and strength, but of preventing also many of the most distressing complaints toAvhich children are subject. Tlie following method I can confidently recom- mend, having had frequent opportunities of observing its salutary effects. The temperature of the bath proper for a new-born infant, should ap- proach nearly that of the situation which she has just quitted. It is proper to acquaint these who may not have c& nium. Unfortunately, the error committed at the birth is repeated again aud again; and seldom ceases but with the poor creature's life. Opiates are deemed necessary to make it sleep; carminatives to expel wind, or to cure the gripes; laxatives and emetics, to cleanse the stomach; and ten thousand other unavailing and pernicious contrivances to relieve complaints, which are entirely the effects of bad nursing, and which ad- mit of no remedy but by a complete reform in that department. When a medical man is sent for to attend an infant, his first duty is to inquire into die conduct of the muse; and if there are faults, to have them rectified. He will seldom find occasion to prescribe any thing else. There cannot be a greater error than to suppose that the faults of nurses nvy be repaired by drugs. Medicine, however skillfully administered, 54 OF THE NURSING AND cannot supply the place of proper nursing; and Avhen giveu without skilX; which I fear is too often the case, it must be productive of much mischief. The following facts will place this matter in the clearest light. About forty years ago when I undertook the charge of a large branch of the Foundling hospital at Ackworth in Yorkshire, I found that the children at nurse had till then been attended by the country apothecaries, who, sure of being paid for their drugs, always took care to exhibit them with a liberal hand. Every cupboard and every shelf in tlie house was filled with phials and gallipots. Under such treatment half the children died auuually. As it was evideut to me, that this mortality could not be natural, I suggested to the governors, that tlie children had little or no occasion for medicines, and that with proper care they would thrive and do Avell. A new arrangement took place. The nurses were forbidden, at their peril, to give any medicine, but what should be ordered by me; and were advised to rely more on the faithful discharge of their duty than on doses of physic. The consequence was, that the expense for drugs did not amount to a hundred! part of what it had been before, and that not above one in fifty, of the children died annually. An op- portunity of making experiments on so extensive a scale seldom occurs. I had at that time the sole superintendance of an immense number of chil- dren spread over a fine healthy country, where the nurses found it their interest to do in every respect what I desired, as they lost their appoint- ment in case of the least neglect. The happy result of the plan left no doubt of its propriety. It ivas theory verified by practice. A little reflection would soon satisfy an attentive observer of nature, that she never designed the youugof any species to be brought up by the aid of medicine. Other animals, following the guidance of instinct, never fail in this important business: but man becomes in all things the creature of art, and is misled"by it. I have frequently met with instances of families, Avho had lost every child Avhile they trusted to physic and employed the faculty, but who at length becoming Avise through despair, and considering that their offspring could only die, left off the use of me- dicine altogether, and from that time never lost a single child. If we wish for a more general illustration of the effects of those two different modes of treatment, we shall find it in that part of the island where I Avas born (North Britain) and where the common people have a strong and very just aversion to giving their children medicines. The fruits of their good sense are displayed in a numerous and healthy progeny. But puniness, sickness, and death, find their way, in company with the doc- tor, into the houses of parents of higher rank. As the children of the latter are often observed not to thrive, the common remark is, No won- der ! they gave the poor things physic. It is indeed possible, that cases may occur to justify the use of medi- cines ; but this very seldom happens when children are properly nursed, unless the poor creatures may have inherited debility from the enervat- ed constitutions of their parents. I may go farther and assert, that even when the frequent or continued use of medicines is deemed necessary, a child kept hi existence by the help of drugs has little reason to thank its parents for preserving its life. It lives only to be a burthen to society; and never can be said to enjoy life so much as to render tlie possession of it a blessing. In all other cases of slight and accidental indisposition I do REARING OF CHILDREN. 55 ?»t hesitate to give a decided opinion that medicines do injure at least twenty times for once that they do good. A late writer on the management of children (Nelson) thinks it a mat- ter of regret that they can seldom be brought to take physic Without force. When I consider the almost infinite number of young martyrs to medicine, instead of lamenting the circumstance here stated, I rejoice at it, from the fullest conviction, that if children had no reluctance to SAvallow drugs, we should lose a great many more of them. I knoiv it is a common practice Avith many mothers, to lay a child on its back, to stop its nose, and force the medicine down its throat. This is adding the danger of suffocation, and the certainty of disgust, to the hazard of a dose too often in its own nature injurious. Bribing and coaxing children, as soon as they become susceptible of such impressions, are almost equal- ly bad. Telling a child, that, if it will take its physic, it shall have a reAvard, is informing it before-hand, that the potion is unpleasant; and, after that, the child is sure to refuse it, be it rendered ever so palatable. Where medicine is absolutely necessary, which, as I said before, is veiy seldom the case, it may be so contrived as to make a part of the child's food. Besides a child should be accustomed very early to refuse nothing, and it will not refuse to take medicine. It Avill act from habitual sub- mission to authority,—not from the cruel impulse of force, or the perni- cious allurement of a bribe. I could here point out many easy contrivances to make children take physic, were I not assured that they are already too often poisoned by ft. If drugs do not directly produce infirmity, diseases, or death, these arc sure to be ultimately the consequence of substituting medicine in the place of proper nursing, and foolishly supposing that the former can sup- ply the defects of the latter. Art opens all her resources in vain ; nor can the greatest efforts of human ingenuity make ameuds for the want of good air, cleanliness, healthy breast-milk, Avholesome food, and pro- per exercise. The neglect of any of these essential points is attended Avith irreparable mischief; and on the contrary, a due attention to these precludes the necessity of any medical aid. Yet so strangely addicted are some Avomen to drench infants Avith drugs, that when I employed* nurses in my OAvn family, it Avas with difficulty I could prevent them from giving medicines privately to the children. I hope that fathers will profit by this hint, to exert their utmost vigilance and authority in the. like situation. There is not any notion Avhich I have found it more difficult to root out of the minds of mothers, than that children abound With ill humours, and that these can be carried off only by purging medicines. If a spot appear on the skin, the child must have his guts scoured out, to make the offensive pimple vanish, and to sweeten his blood, as the mother calls it. They little know, aud can hardly be made to conceive,jhat all purgatives, hoAvever mild in their operation, throw the stomach into immediate dis- order, weaken its digestive powers, vitiate the juices designed for the solution of food, and thus prevent the due preparation of the chyle Avhence the blood is formed. This is the sure Avay to generate noxious humours, instead of expelling them, and to taint or impoverish the vital stream, in- stead of purifying it. The other medicines, which the fears and follies of mothers have in- troduced into the nurscw, are almost as perririoiK Had I leisure to 67 56 Ctf1 THE NURSING AND make out the long list of them, Avith a description of their effects at au early age, it Avould appear that they ought to be more pro, trly denomi- nated poisons than remedies. They ahvays do some injury; they cau- not do any good: they are administered either frivolously., or for the relief of complaints whicli are caused by bad nursing, and Avhich do not ad- mit of a medical cure. To trust to physic for Avhat physic cannot ef- fect, is aggravating the evil of former errors by a still greater one, and quickening a poor infant's career to the grave. Were a laAv to be made and strictly enforced, which should absolutely prohibit the administering of drugs to children, I am sure it Avould save the lives of thousands every year in this metropolis alone. I have elseAvhere made a few remarks on the usual conduct of Lon- don mothers, whose faith in medicine does not seem in the least abated by the most striking and the most lamentable proofs, not merely of its iuefficacy, but of its perniciousness. Whenever any of their children appear indisposed, or do not seem to thrive, Avhich must be frequently tlie case Avhere they are so badly nursed, aAvay the mothers run to the apothecary. His candor is too often checked, and even his judgment is liable to be biassed by his immediate interest. He derives his support from the sale of his drugs, and will seldom resist the temptation to send large supplies where he knows the parents are in a condition to pay. Physic, in a variety of forms, is substituted for the only rational means of restoring the child's health, some necessaiy change of air, exercise, clothing, or diet: the mischief begun by the nurse is completed by the doctor; and death comes sooner or later to put an end to the sufferings ol the tortured victim. It gives me pain to Avrite any strictures on the interested views aud reprehensible practice of even the lower orders of the faculty: but the evil is of such maguitude, aud so truly alarming, that it cannot be pas- sed over in silence, nor mentioned Avithout bursts of strong indignation. The Aveakness and the fears of mothers bring in the apothecary; and it requires an effort, to which not one in a thousand is equal, to get him out again. A bold busy man of that profession wants only a feAv timid mothers to make his fortune. But, mercy on the poor babes who, to make his chariot roll, must swallow drugs every day! Yet, such is the infatuation of mothers, that, if this be not done, they think their children neglected, and dismiss one apothecary to make Avay for another, who ad- ministers medicines Avith'a more liberal, or rather a more destructive hand. If the apothecary be a dangerous man, the quack is still more so. Yet I hardly ever kneAv a mother or nurse Avho had not by her the nostrum of some quack, with which she every now and then kept dosing the infant. Were the boasted specific, like the anodyne necklace, a mere chip in porridge, it would do no harm to the child, and would serve only to amuse the mother, and to levy a contribution on her credulity. Bu' it is very often made up of active ingredients, which ought to be adminis tered with the greatest circumspection. Most of the nostrums «iven tc children are strong opiates or purgatives, of a nature very different fron the innocent efficacy of a good nurse's lullabies. They may quiet o; compose the infant, and seem to give it ease for a time, but they uevc fail to destroy the powers of digestion, and to induce universal debilit^ with all its baneful consequences. REARING OF CHILDREN. 57 There is, however, another class or description of quack medicines, which, though tliey cannot kill with greater ultimate certainty than the former, are more sudden and violent iu their fatal mode of operation, I mean the cakes and powders, and various other compositions, which are advertised for the pretended cure of worms. A child's palelooks frighten the mother into a belief that worms are the cause ; aud she goes imme- diately to the worm-doctor, Avho administers his drastic doses, without the least regard to the delicacy of the patient's constitution. His sole aim is to expel worms ; and if any appear, lie triumphs in the show of success, though ahvays attended with great danger, and sometimes with death. I have known a nostrum of this kind to kill in twenty-four hours :—but that Avas nothing to the quacks; he had sold his medicine; and he gave himself little concern about the injury it might do in particular cases. I Avould not have said so much of this shocking indifference to mur- der, had I not seen proofs of it, and in some too, who pretended to emi- nence iu that line. I once told a lady, that her daughter was in a deep consumption, and that she ought to go into the country, to take exercise on horseback, drink asses' milk, and use a light restorative diet. But, instead of following this advice, she took her daughter to a veiy celebra- ted Avorrn-doctor, avIio soon relieved her from all her trouble. Here I cannot help lamenting that confidence in Avorm powders or worm-cakes is not confined to the weakest of the fair sex, but is discov- ered even in men of rank aud talents. I have seen, though with heart- felt concern, names of the first respectability subscribed to the certificates of the efficacy of some of these nostrums. I am far from questioning the integrity of the persons who signed such papers; but they certainly knew not what they did. They fancied they were only attesting a plain matter of fact, though the thing Avas far beyond the possible reach of their judgment or knoAvledge. They had seen a quack medicine given to a child, and had also seen Avorms afterwards voided by that child. What then ? As the same effect might be produced by very dangerous poisons, how could people, wholly ignorant of the ingredients, tell whether the operation ascribed to them was not at the risk of the child's constitution, or of its life ? Even supposing that some apparent good and no percepti- ble mischief attended the experiment in one or two cases, are they suffi- cient grounds for the general recommendation of any secret medicine, to which the lives of thousands of children yet unborn may be sacrificed ? I hope these remarks will prevent men of character from rashly giving a sanction to the possible deceptions of quackery, and will also lessen tlie respect which individuals or the public at large may feel for such incon- siderate testimonials. To resume now my detail of various instances of maternal Aveakness ; I have to observe, that the strangest, and not the least mischievous infat- uation of all, consists in giving medicines to children in good health, with the silly vieiv of preventing diseases. The spring and fall are the peri- ods consecrated to physic in the calender of mothers and nurses. At those seasons, if childern are ever so well, they must have a dose or two of what is falsely called an innocent purge, to keep them pure and hearty. Thus they are made really sick, for fear they should become so; and their constitutions are enfeebled by the perverse means em- ployed to strengthen them. I have already said so much of the bad consequences which must result from the use of laxatives, especially in 58 OF THE NURSING AND childhood, that no farther dissuasives against so absurd a practice secni necessary, except this one remark; that purging, like blecdiug, induces a habit which cannot be left off with safety. Every purge paves the way for another, till the bowels are destroyed. Such medicines, therefore, should never be administered but iu cases of actual illness, aud to expel some greater poison than themselves. As this is a point Avhich cannot be too strongly enforced, I shall lay before the reader Mr. Locke's sentiments on tlie same subject. They derive double weight from his medical skill, and from the extraordinary precision of his manner of reasoning upon any topic. As he Avas regu- larly bred to physic, he is exempt from the suspicion incurred by some later philosophers, of having Avritten under the influence of prejudice against the faculty. " Perhaps," says he, " it will be expected that I should give some directions of physic, to prevent diseases ; for which I have only this one, very sacredly to be observed, never to give children any physic for prevention. The observation of what I have already ad- vised will, I suppose, do that better, than the ladies' diet-drinks, or apoth- ecaries medicines. Have a great care of tampering that way, lest, instead of preventing, you draw on diseases. Nor even upon every little indis- position is physic to be given, or the physioian to be called to children especially if he be a busy man, that will presently fill their Avindows with gallipots, and their stomachs Avith drugs. It is safer to leave them wholly to nature, than to put them into the hands of one forward to tamper, or that thinks children are to be cured, in ordinary distempers, by any thing but diet, or a method very little differing from it; it seeming suitable both to my reason and experience, that the tender constitutions of chil- dren should have as little done to them as is possible, and as the absolute necessity of the case requires." To add any thing by way of comment or1 illustration to language at once so clear and so forcible, would betray the greatest weakness. It is enough for me to quote so unexceptionable an authority in sup- port of my favourite doctrine. The chief design of the present trea- tise is to supercede the use of medicines in early life, and to shew how health may be effectually preserved by good nursing alone. An attention to the rules here laid doAvn is the only method of preventing diseases, with which I am acquainted. A child used to the cold bath, and to the full enjoyment of fresh air, cannot be liable to coughs, colds, sore eyes, or defluxions. A clean dry skin, never relaxed by foulness or heat, will favour the escape of noxious or,redundant hu- mours, while exercise will not suffer the seeds of corruption to lurk in any part of the frame. Instead of baneful physic, let your infant have the aliment prepared for him by nature; and you may be sure that the milk of a healthy, temperate nurse, will never give him the gripes or the cholic; it will nourish, but not inflame him ; it will keep the habit pure, the action of the blood regular, and the surface of the whole body free from blotches or eruptions. Indeed. I know of no disease against Avhich a child may not be secured by the rational con- duct of his nurse. The pre-disposing causes of all the complaints of infants, are the weakness of all the digestive powers, and the irritability of the nervous system. Both are obviated by the method I propose. The stomach is supplied, but not overcharged, with such food as is suited to its strength; and every thing REARING OF CHILDREN. 59 that may irritate the nerves, or give rise to convulsions, is averted with all possible care. Even in the midst of contagion, or of epidemical dis- tempers, the purity of a well-nursed child's habit Avill correct the malig- nity of the infection, and disarm it of its ir-ual terrors. The earnestness Avith Avhich I have recommended inoculation in ano- ther work, may seem a little inconsistent Avith the doctrine here laid doAvn : but it is because very feAv children are nursed according to my plan, that I think it adviseable to guard them all against the possible dan- ger of catching the small-pox by accident. Derides, it is of importance to be able to command time, place, and circumstances, particularly as I have shcAvn in my " Domestic Medicine," with Avhat ease and safety the operation may be performed by mothers and nurses, Avithout the least occasion for any farther medical advice or assistance. SECTION V. Of the food proper for Children. THE pernicious folly of making physic precede food at an infant* birth is, I hope, sufficiently exposed in the former section; and notice is there taken of the admirable manner, in which the thin diluted, and gently opening properties of the mother's milk, are adapted to every medicinal as Avell as alimentary purpose. Nature does not afford, nor can art contrive, any effectual substitute for that delicious fluid. By degrees the milk acquires consistence, and affords greater nou- rishment to the child, as he becomes more capable of digesting it. At length, his bodily strength increasing, and his teeth bursting through the gums, he can take more solid and substantial food, Avhich requires still greater powers of digestion. These changes are so obvious, that they cannot be mistaken. Ignorance is pleaded in vain, and the least devia- tion from so plain a road to health, is punished with lasting injury. The infant after having derived its whole sustenance and growth, while in the womb, from the mother's juices, cannot without the greatest danger have its supplies totally altered at its birth. It must still be fed from the same congenial source, or the shock of a sudden and unnatural change Avill prove very trying to its tender constitution. In my advice to mothers at the time of lying-in, I endeavoured to con- vince them of the imminent danger to their own health, which Avould arise from their neglect of the most siicred of all duties, that of suckling their children. It is an obligation so strongly enforced by nature, that no woman can evade the performance of it with impunity. But cheer- ful obedience to this sovereign law is attended with the siveetest pleasure of which the human heart is susceptible. The thrilling sensations, as before observed, that accompany the act of giving suck, can be conceiv- ed only by those Avho have felt them, while the mental raptures of a fond mother at such moments are far beyond the powers of description or fan- cy. She thus also ensures the fulfilment of the promises made by the best writers on this subject—speedy recovery from child-bed, the firm establishment of good health, the exquisite sense of wedded joys, the capacity of bearing more children, the steady attachment of her husband, the esteem and respect of the public, the Avarm returns of affection and gratitude from the objects of her tender care, and, after all, the satisfac- tion to s^e her daughters follow her example, and recommend it to others. 60 OF THE NURSING AND Though 1 exposed myself pretty fully on this head iu the place above referred to, yet Avhen I consider it, new ideas arise in my mind.,. and 1 am more and more impressed Avith a sense of its importance. Peo- ple have been often amused with illusions of universal remedies. Long experience has almost destroyed my faith in the efficacy of even the best specifics. But were I called upon to point out any one remedy for the greatest part, not only of the diseases, but of the vices also of society, I Avould declare it to be the strict atteution of mothers to the nursing and rearing of their children. " Would you have mankind return all to their natural duties," says the eloquent Rosseav, in one of his fine sallies of sen- timental enthusiasm, " begin with mothers of families: you will be astou- ished at the chauge this w ill produce. Almort every kind of deprava- tion flows successively from this source: the moral order of things is broken, and nature quite subverted in our hearts : home is less cheerful and engaging: the affecting sight of a rising family no more attaches the husband, nor attracts the eyes of the 6trauger: the mother is less truly respectable, whose children are not about her: families are no longer places of residence : habit no longer enforces the ties of blood: there are no fathers, nor mothers, children, brethren, nor sisters: they hardly know, Iioav should they love, each other? each cares for no one but him- self; and when home affords only a melancholy solitude, it is natural to seek diversion elsewhere. " But," continues he, " should mothers again condescend to nurse vhejr children, manners Avould form themselves: the sentiments of nature would revive in our hearts: the state would be re-peopled : this principal point, this alone, would reunite every thing. A taste for the charms of a domestic life, is the best antidote against corruption of man- ners. The noise and bustle of children, which is generally thought troublesome, becomes hence agreeable: they render parents more neces- sary, more dear to each other, and strengthen the ties of conjugal affec- tion. When a family is all lively and animated, domestic concerns af- ford the most delightful occupation to a woman and the most agreeable amusement to a man. Hence, from the correction of this one abuse, will sooa result a general reformation: nature "will quickly re-assume all her rights: let wives but once again become mothers; aud the men will pre- sently again become fathers and husbands." To this sketch, drawn by the pencil of so great a master, I shall onr ly add, that the happy consequences of such a reform Avould be no less striking in a medical than in a moral point of vieiv. A stop would be put to the cruel ravages of death in early life. The long cata- logue of infantile afflictions would almost become a blank, or con- tain nothing. to excite alarm. Every child invigorated by his mother's milk, Avould, like tlie young Hercules, have force suffi- cient to strangle in his cradle any serpents that might assail him.— Occasional illness Avould be to him only part of a necessary course of discipline, to enure him by times to bear pain with manly fortitude.— In short, health, strength, and beauty, would take place of puniness, de- formity, and disease; society Avould be renovated; and man, instead of dwindling away, as he now docs, by a gradual degeneracy, would soon ri?e to the original perfection of his nature. If you entertain any doubt of the truth of Avhat is here advanced, look at other parts of the animated creation, and your doubts will im- REARING OF CHILDREN. 6.1 mediately vanish. Wild animals never degenerate: they bring forth aud rear their young with undiminished strength. And why ? Because the females, obedient in every'thing to the impulses of nature, nurse their oil'-pring, and Avatch over them Avith the most tender solicitude, till they can provide for themselves. Not only tlie inhabitants of the howling Avilderness, the she-Avolf and the fell tygress, but even the monsters of the great deep, draAV out their breast and give suck to their young. Will woman then suffer herself to be stigmatized as the only unfeeling mon- ster that can desert the issue of her oavii womb, and abandon it to the care of another ? Will she alone entail the curse of her unnatural con- duct on her hapless posterity ? But let me vindicate the female character from so foul a reproach. It is not so much the fault of the women, as of what is improperly cal- led civilized society. In its ruder state, this never happened. It never happens among savage nations. I have already mentioned some remar- kable instances of their paiental tenderness. The influence of so strong a principle can be weakened only by the prevalence of vice, and of ar- tificial refinement. Wherever an innocent simplicity of manners pre* vail, the children are not brought up by proxy: the Avomen are not sa- tisfied to be mothers by halves, as an old writer expresses it,—to bring forth, and then cast off their offspring. They think with him, that no- thing can be more contrary to nature, than such an imperfect sort of mo- ther, who, after having nourished in her Avomb, and with her blood, something AAhich she did not zee, refuses now her breast-milk to Avhat she , sees living, become a human creature, and imploring the assistance of its parent! In the polished, or rather the depraved circles of social life, those sentiments are either uufelt or disregarded. Women enervated by luxu- ry, allured by a false taste for mistaken pleaure, and encouraged by shameless example, are eager to get rid of their children as soon as born* in order to spend the time thus gained from the discharge of their duty in dissipation or indolence. Let not husbands be deceived : let them not expect attachment from Avives, who, in neglecting to suckle their chil- dren, rend asunder the strongest ties in nature. Neither conjugal love, fidelity, modesty, chastity, nor auy other virtue, can take deep root iu the breast of a female that is callous to the feelings of a mother. I am aAvare of the little tricks that are so often played off by ceAv-married Avomen to keep up the shoAVof a Avish to nurse their children, while every engine is secretly employed to make the deluded husband conjure her to relinquish her design, for fear of the injury it might do her constitution. If she has not injured her health by vice, nursing will not lessen, but in- crease her strength; and if any constitutional defect renders her wholly unfit for suckling her child, she ought to abstain from procreation. The woman who cannot discharge the duties of a mother, ought again and again to be told, that she has no right to become a Avife. Iu cases of accidental injury or disease, Avhere it may be impossi- ble for the mother, or highly improper on her part, to give the child the breast, she is to be pitied in being thus deprived of the greatest pleasure of life, the pleasure of feeding and rearing her own offspring. But the number of thos-e Avomen who really cannot suckle is very small. compared with those Avho will not. The latter excite our indignation—= u6t our pi1y: diey stifle every emotion of tenderness: they are deaf to 62 OF THE NtfRSING AND the Voice of nature: they sacrifice the most important duty to virion* pursuits; and madly barter ;oys that will please ou every reflection, for Such as never can bear to be recalled. Little do those dissipated mothers think of Avhat their poov infants arc likely to suffer, when committed to tlie tare of bin bigs. Ought they not to consider, tiiatthe woman who parts with her own babe to suckle one of theirs, unless she is impelled by tlie keenest distress, gives a proof iu the first instance of her not being a good mother? How then is it to be expected that she should become a good nurse ? Even should she ac- quire, in time and from habit, a tender affection for her foster chi d, ought not a mother of any sensibility to take alarm at the idea of having that child's love transferred from herself to a stranger? Indeed, the claims of the nurse who does her duty faithfully, are greatly superior to those of the parent who neglects her's. It was a saying of Scipio Af- rica x us, that he took her to be more his mother who had nursed him for two years, though she haul not brought him forth, than her mho, after she had brought him into the world, deserted and abandoned him. But I am still better pleased with the anecdote related by Van Swie*en, of a Queen of France, who gave her son suck, and would not desist from so doing even when she was taken ill of an intermitting fever. It happen- ed during one of the fits, that another matron gave her breast to the thirsty and crying child; at Avhich the queen Avas so much displeased, that she thrust her finger into the child's mouth, in order to excite a vo- miting, being unAvilling that another should perform any part of a mo- ther's office. I shall not enlarge any farther on this subject, I hope I have said enough to excite good mothers to the most assiduous observance of their duty, and to warn others of the evils inseparable from the neglect of it. Such as may resolve to obey the dictates of nature and reason, will find the following directions of some use in the prosecution of so laudable a purpose. The mother, after delivery, should be indulged Avith a few hours sleep, to recover from the fatigue which she has lately undergone, and to al- low due time for the secretion of the milk, before the infant is put to the breast. The child can suffer no inconvenience from this delay. Being replete with blood and juices, he has not the least occasion for any fresh supply of nutriment, till the mother is prepared by necessary repose to give him the grateful and spontaneous beverage. I before pointed out the means to be employed when the nipples are not sufficiently promi- nent to afford a proper hold. But whatever the form of the nipples may be, they should be washed with a little warm milk and water, in order to remove the bitter viscid substance, which is furnished round them to defend the tender parts from excoriation. I would also advise the mo- ther, during the Avhole time of her nursing, to wash the nipples, imme- diately after giving suck, iu Avarm Avater. Whenever this can be conve- niently procured; and, in case the supplies of the nutritive fluid are very copious, or seem to exceed the infant's wants, she may always press out a little of the milk before the child is put again to the breast, as the first drops issuing from the fountain at every treat are the most liable to sourness and putrescency. I need not urge a fond mother freely to give her child Avhat nature freely produces. The only check in this respect is not to suffer the in- REARING OF CHILDREN. 63 fant to sleep at the breast, or to suck till vomiting ensues. But any at- tempts to entice the baby to the u,e of spoon-meat are still more impro- per. This is a common practice, not only with hired nurses, but even with affectionate mothers, from a foolish thorgh prevalent idea of les- sening the demands on the breast, or of strengthening the child with ad- ditional nourishment. If the nurse be not irregular in ber own mamer of living, she need not fear haviiiga plentiful supply for the infant; and she may rest assured that her milk is far better suited to his young sto- mach, and will afford a greater quantity of nutritious chyle, than any pre- paration w hich art can devise. Another error no less prevalent, and more injurious than the former, is the idea that a woman, when nursing, cannot eat and drink too heartily, as it is termed, to support her own strength and tint of the nfant. On the contrary, the tainted stream of intemperance must enfeeble and dis- order the child, Avhile the nurse really lessens her own power of giving suck, aud invites the attacks of a fever by her thoughtless indulgence. The cooling regimen before recommended must be strictly complied with for the first week after delivery; aud though a more liberal diet may then be allowed, yet this allowance must not extend to gross meats or heating liquids. A pint of porter or ale twice a-day for at least a fort- night more, will be quite sufficient, and animal food should be veryspa- ingly used for a much longer period. Indeed it would be happy for the children, as well as for their nurses, if the latter would confine themselves without any painful restraint, to the salutary varieties of a milk and ve- getable diet. It is a great mistake to suppose, that a nurse is better fit- ted for her office by living on animal substances: the reverse is the truth. The milk of women who live wholly on vegetables, is more abundant in quantity, will keep longer, and is far sweeter and more wholesome than Avhat is prepared from animal food, Avhich besides its in- flammatory tendency, must subject the children to gripes and worms. These remarks are merely designed to correct some vulgar errors re- specting the quautity and quality of the aliment most proper for nurses, but not to impose upon any women the necessity of a t< tal change from her former and usual manner of living. I would have her continue the temperate use of what she has found by experience to be most conducive to her health : and that will also agree best with her chiid. Her na- tural appetite maybe safely indulged; but gluttony must be repressed, and a depraved taste for spirituous liquors, or high-seasoned food, must never be gratified. It has been just hinted that the breast-milk of a woman in good health is abundantly sufficient for an infant's support. Nothing else should en- ter his lips for at least three or four months after the birth. A little thin pap or panada may then be occasionally introduced, with a view of fa- miliarising it to the child's taste, and 'hereby lessening the difficulty and danger of a complete and sudden alteration at the time of weaning. But no spices, no wine, no sugar, should at any tim» be mixed with his food or drink. These and the like contrivances of silly women to make an infant's spoon meat what they call palatable aud nourishing, are sura to vitiate his natural taste, to inflame his blood, and to fill the stomach with slime and acidities. Sugar, in particular, has another very bad ef- fect : its frequent use not o-ly gives chiMren a disrelish for a Avholesome -;mplicity, but entices them to SAvallow more than they otherwise would. 64 OF THE NURSING AND or than they want, and thus makes gluttons of them even before they cacr be strictly said to eat. Infants are commonly deprived of the breast too soon. What people call solid food is supposed to contribute more to their growth and health. But in the first place, milk, though a fluid, is immediately converted in- to a solid substance in the stomach, where it is soon after digested, and then affords the best nutriment possible. It also appears contrary to na- ture to put solid substances into the mouth of a child, before it is fur- nished with teeth to chew them. I should therefore look upon the pre- vious cutting of the teeth as the surest indication of the proper time for weaning children. 1 do not mean to lay this down as au invariable rule. The state of the nurse's health, as well as of the child's should be duly considered. It seems only that the cutting of the teeth gives a sort of hint of the use to Avhich they may be applied. It is farther remarkable that, during the continuance of this usually sharp and painful operation, children, as it Avere instinctively, carry every thing that is put into their hands up to their mouths. Give them on such occasions crusts of bread, pieces of biscuit, dried fruits, or fresh liquorice root, which they may suck, and chew. Corals, glass, and the like hard bodies, are very im- proper, as they will either bruise the gums, and cause an inflammation, or make them hard and callous by continual rubbing, so as to render the cutting of the teeth still more difficult, and the pain more acute and las- ting. A few weeks before the intended time of weaning, that is to say, in the interval between the first symptoms of cutting the teeth and the ap- pearance of at least four of them, spoon-meat should be given more fre- quently, and in greater quantity, reducing in the like degree the propor- tion of breast-milk, till the gradual increase of the one and diminution of the other render the change almost imperceptible. The best spoon- meat that I know consists of bread aud milk, prepared in the manner pointed out in my Domestic Medicine; that is, first boiling the bread in water, afterwards pouring the water off; and then mixing with the bread a proper quantity of new milk unboiled. I there observed, that milk used this way Avas more wholesome and nourishing than when boiled, and Avas less liable to occasion costiveness. It is not necessary, however, to confine children, after they are Avean- ed, to one particular sort of food. The bill of fare may be gradually enlarged with the child's growth, provided always that it consist of an innoi*nt variety. He may have bread and milk at one time, bread pud- ding at another, and bread sliced iu broth, or in the gravy of roast meat, diluted Avith Avater, now and then, till at length his teeth being properly grown, and fit to chew meat itself, he may be allowed a little of it at dinner, with a due proportion of bread and of wholesome vegelable3. But I must forbid iu the most positive manner any artificial sweetening of his food, all spices or seasoning, except salt, all sorts of pastry, butter in every form, unripe fruits, and fermented liquors As I have great reliance on the discretion of good mothers, Avhen Avell informed of their duty, I should be sorry to tire them by too ma- ny details, or to fetter them by unnecessary restraints; I shall there- fore only add one caution more on this part of the subject, and that is,-not to adopt the penr'cious custom of giving food or drink to chil- dren during the night. Evcu in the course of the day, they should REARING OF CHILDREN. 65 not be crammed every hour, and trained up in habits of early glutto- ny. Temperance is that sure preservative of health, which they can- not be taught to practice too soon. Let them eat freely at proper inter- vals ; and the longer they are kept from the thiugs already forbidden, the more rapidly will they thrive, and the greater number of diseases will they escape. As I have admitted that cases may occur, in which it would be im- possible or improper for a mother to suckle her oavo child, I shall sug- gest a feAF hints on the choice of a nurse, and the remaining duties of the parent. From what I have said of the admirable manner in Avhich the milk of a woman nevvly delivered is adapted to the various wants of a child newly born, it will be easily inferred, that, Avhenthe mother can- not discharge that important duty, a nurse who has just lain-in ought ts be preferred. Otherwise the milk will not have the purgative qualitie proper to bring ayvay any remains of the meconium, nor will it be exact- ly suited to the infant's weak powers of digestion. Inconveniencies al- ways arise the moment we oppose the intentions of nature. This is what obliges us to have recourse to the precarious aid of art. When there is a difference of more than a week in the time of delivery be- tween the mother and the nurse, some opening medicine may be necessa- ry to cleanse the first passages : A table-spoonful of Avhcy or water, with the addition of a little honey or raAV sugar, will commonly ansAver the purpose. But the infant's stomach cannot be so easily reconciled to foreign sustenance, or made strong enough to digest the thick miJk pre- pared for an older child. On the other hand, many difficulties must attend the very expedient which I propose. It will not be easy, except in cities like London where there are several lying-in hospitals, to get nurses newly delivered for new-born infants. Then as the nurse cannot be removed to the child, the latter must be taken to the nurse, and must remain Avith her till she can go to the parent's house. If an exact coincidence as to the time of delivery be made the leading consideration, an improper person may be fixed upon from that circumstance alone, though unqualified in all other respects. Thus, as I before hinted, whatever course we take, when we deviate from nature, we shall find numberless perplexities and obstacles in our way. Almost every body is a judge of the other requisites in a nurse, such as health, plenty of breast-milk, the thriving state of her own child, cleanliness and good temper. The last quality, though of very great importance, is seldom inquired into. Parents are commonly satisfied with the healdiy appearance of the nurse and her child, or Avith amid wife's favourable account of her milk; and seem to forget that a good disposition is as essential as a good constitution. I do not say that an infant will suck in the vices of his nurse ; but he will certainly suffer from them. They are doubly injurious in spoiling her milk, and les- sening her tender care of the child that is at her mercy. The twin founders of the Roman empire were said to have been suckled by a she- wolf ; I should think it much more unlikely that au infant could be properly nursed by a passionate or ill-tempered woman. The mother is not to suppose herself relieved from all trouble by the choice of even a good nurse. The latter may give the child the breast; but she should be directed and zealously assisted by the for- 60 OF THE NURSING AND mer in the discharge of every oher duty. This will render her labour easy, and her situation comfortable. She should also have every indulgence consistent with good sense and with the rules before laid down. She should not be debarred from the occasional company of her husband : a rigorous chastity, or a told ibstineuce from wed- ded joys, is often as hurtful to the nur>-e and child as immoderate gratification. It is by humouring her that you will engage her to humour you in the strict observance of all your reasonable injunc- tions. The child's father also should pay very assiduous attention to the proper treatment of his offspring. His advice, his encouragement, his superinte >ding care, will have the happiest effect Is not our ad- miratioii of C^t'o's character increased, ai hen Ave read in Pluvarch, that the man, who governed in Rome with so much glory, Avould quit every business in order to be present wIk n the nurse washed and rub- bed his child ? Such instances are seldom to be met with in our times ; we think ourselves far above all the trifling concerns of the nursery. Yet, according to the remark I made on the same subject in another work, it is not so with the kennel or the stables: people of the first rank are not ashamed to visit these places, and to see their orders for the management of their dogs and their horses obeyed, though any of those sportsmen would blush Avhere he supplied in performing the same office for that being avIio derived its existence from himaelf, who is the heir of his fortunes, and the future hope of his country. If Cato^s wisdom and parental affection could be heightened by contrast, I might easily point to a noble duke who is more attentive to the breed of dogs than to that of the human species, and who has laid out more money upon the maguificence of a kennel, than he ever expended for the relief of poverty. I am told that his grace is very part'cular in the choice of skilful nurses to wait upon the females of his canine family, when they are sick, or in the straw. I do not blame his tenderness for brute animals; but I am sorry it should be con- fined to them, Avhen a more natural sphere lies open for the exercise of his humanity. This hint will be takeu by those for whom it is intended: quifqeit ilk capit. SECTION VI. Of Exerc'se and Rest during Infancy. I MADE use of the plainest reasoning I could in the first Chapter of my " Domestic Medicine," to shoiv how much the heal'h, the growth, and the strength of children, depended on exercise ; and to warn parents of the melancholy effects of inaction, and of sedentary emplo)ments in early life. It does not appear to me that any new argumeats on that subject are necessary; but it may be of service to mothers and nurses to be informed how the principles there laid down should be reduced to practice duriug infancy. They are otherwise apt to fall in'o great errors, not considering that as much mischief may often arise from untimely and violent exercise, as from the neglect of it when most essential. \t has been justly observed, that children require no exercise fot REARING OF CHILDREN. 67 the first and second months after their birth, but a gentle motion some- what like that to which they had been acustomedin the mother's AAomb. A frequent change of posture, however, is adviseable, lest by always laying them on the same side, or carrying them on the same arm, their soft limbs may be moulded into an improper shape. But violent agita- tions ol any sort may do them much greater injury, by deranging the fine structure of the brain, and giving rise to the focurable evils of intel- lectual or nervous Aveakness. Other par. s of the body, as well as the brain, are exposed to great danger by tossir g infants on high, or rapidly dancing them, as it is called, before their little limbs have gained tome degree of firmness. A great deal of the spi.ie is gristly, auu the breast entirely so. Consider then what may be the effect of the grasp or strong pressure of your hands against those places in order to prevent the child from falling. As he advances in age, his bones acquire solidity, and his whole body becomes able to en- dure a little shock. Brisk, lively, and frequent exercise, will then be of the greatest service to him ; aud you run no risk of laying the founda- tions of any disease, cr of destroying any part of that admirable sym- metry in the human frame on which health and beauty alike depend. In the course of a few months, a Avell-nursed child, unfettered by any check on the free moticn of his limbs, will be able to exercise him- self, and to gather strength from eveiy new effort. W hen you take him into the fields, i\hich you should do eveiy day in fine Aveather, let him roll upon the dry grass; and, when in the nursery, upon the carpet. He will soon learn the me of his legs, without the least possibility of making them crooked by the pressure of so light a body. When he be- gins to walk, you must help him a little in his first experiments: lead him about Avith the support of your hands, and then by the finger only, till you perceive he can do without your assistance. Go-carts and lea- ding strings not only retard the increase of a child's activity, and pro- duce an aukwardness of gait very hard to be corrected afterwards, but often affect the chest, lungs, and bowels, in such a manner as to pave the way for habitual indigestion or costiveness, and for asthmatic or consump- tive complaints. Nothing can be more ridiculous than the numberless contrivances of mothers to teach their children to walk, as if it was a thing to be learn- ed by their instruction; and to keep them propped up by wooden ma- chines, or suspended by back strings, as if their lives and limbs were to be endangered by the least tumble. They are too near the ground, and too light to hurt themselves by falling. Besides, the oftener they fall, the sooner they will learn, when down to get up again; and the only way to make them fure-footed, is to accustom them betimes to trust more to the proper management of their own legs, than to any artificial support. As to the best time for exercise during infancy, it admits of a very sim- ple regulation. That sort of passive exercise, which ronsits of agreeable motion in a nurse's arms, must never be omitted after the use of the bath in the morning, and cannot be too often repeated in the course of the day. But Avheu the child is able to take exercise himself, it will be easy to manage matters so as to let him have as much as he likes before meals, and never to ronze him into action upon a full stomach. If left to himself, or to nature, he will then be more inclined to stillness and repose. The subject of rest requires some farther consideration. A healthy, 68 OF THE NURSING AND thriving child sleeps mooe than two-thirds of hU time for a tew week's* after his birth. So strong a propensity must be indulged by day as well as ivy night; but, with judicious management, he will be gradually brouglu to want and to enjo) repose by night only. This is evidently the order of nature; and such a h.ibit, begun in childhood, and continued through life, will contribute more to its enjoyment and duration, than any one maxim or rule of health ever yet laid down by human wisdom. Nurses, indeed, are too apt, for their oavu eabe, or to gain time for other concerns, to cherish the slrepy disposition of infants, and to in- crease it by various things of a stupefactive quality. All these are ex- tremely pernicious. I would not suffer opiates, under the name of cor- dials or carminatives, or in any sh?ipe or form whatever, to be given to a child in health. The only composing means which art may at any time be allowed to employ, are gentle motion and soft lullabies. I very much approve of the little co's now in fashion, which being suspended by cords, are easily moved from sileto ride, and promote the desired end, without the danger which violent rocking was often attended with. Those swinging cots are in exact conformity to the suggestions of the best medical writers, ancient aud modern. Galen mentions the pro- priety of placing children to sleep in tectulis pendenlibus, or hanging little beds ; and the reason for such a contrivance is thus explained, with great clearness and simplicity, by ianSwieten : " As the fztus," says this accurate observer of nature, " hanging from the naval-string in the womb, is easily shaken this way and that, wliile the mother moves her body ; hence it has been reasonably pre- sumed, that new-born infants delight in such a vibrating motion. They have therefore been laid in crad.es, that they might enjoy this gentle ex- ercise, and b*e more and more strengthened. Daily experience teaches us, that the Avorst-tempered children are soothed by this motion, and at last sink into a sweet sleep. But the shaki.-g of the cradle should be gentle aud uniform : on which account, those cradles that hang by cords are the best of all, as they may by a slight force be moved equably, and Avithout any noise. At the same time, the motion communicated to these cradles is imperceptibly diminished, and at last ceases without any shock." In England, as well as in most other parts of Europe, cradles fixed tipon wooden rockers, have been iu use from time immemorial. No evil could arise from their continuance, wliile iu the hands of careful and affectionate mothers ; but, Avhen left to the management of impa- tient nurces, or of giddy boys and girls, the delicate texture of an in- fant's brain Avould often be exposed to great danger. The agitation of a cradle by such persons has been compared to the jolting of a stage-coach basket: and I believe that a poor child would suffer as much from the one as from the other, Avhere he not a lit'le more con- fined hi the former. Is it possible to conceive a more shocking object than an ill-tempered nurse, who, instead of soothing the accidental un- easiness or indisposition to sleep of her baby, when laid doivn to rest, is often Avakcd up to the highest pitch of rage ; and, in the excess of her folly and brutality, endeavours by loud, harsh threats, and the impetu- ous raUle of the cradle, to drown the infant's cries, and to force him into slunber!—She may sometimes gain her point, but never till the poor ▼i< 'tin's strength i^ exhausted. To guard against this evil, the transition from rocking-cradles to fixed REARING OF CHILDREN. 69 bed-steads was not necessary. The gentle moiion before described, at once so natural and so pleasing to infants, may be given them with ease and safety in little baskets suspended by cords, as used in the Highlands of Scotland under the name'of creels, or in the more elegant contrivances of swinging cots, which are now coming into fashion. I am sorry to see any of the latter surrounded with close curtains, which have almost as bad an affect as confining the infant in a room oi the same dimensions. One gree i curtain may be hung at some distance from his face, so as to intercept the light iu the day-time but not to obstruct the free communi- cation of air, or to reverberate the exhalations from his lungs and body. Green window-blinds in the sleeping-room will answer the same purpose. Care should also be taken not to expose infants either in bed or out of bed to an oblique light, or they will become squint-eyed. They should be kept facing it when up, and exactly the reverse, when laid doAvn to rest. If the light come upon them from one side, their eyes will take that di- rection, and thus they will get the habit of looking crosswise. It is of still greater moment to pay strict attention to their bedding. Nothing can have a more relaxing tendeacy, or be at the same time more unfavourable to cleanliness, than beds aud pillows stuffed with fea- thers. These absorb and retain the perspirable matter, as well as every other impurity, so that the child Avho sleeps upon them must inhale the most noxious vapour, Avhile its action on the surface of his body must de- stroy the energy of the skin, and render his whole frame both within and without the ready receiver of disease. Horse-hair cushions and mat- tresses are far preferable; but if soft bran Avere used instead of hair for the stuffing of children's beds and pillows, these would more readily let any moisture pass through them, Avould never be too much heated, and might be frequently changed or renewed without any great trouble or expense. My former hints concerning a child's dress are equally ap- plicable to his bed-clothes, which should be loose, easy, and as li«ht as may be consistent with due Ayarmth. I say the less on the subject of cold, as most mothers are too apt to run into the opposite extreme. CHAP. V. OF DWARFISHNESS AND DEFORMITY. THE chief causes of defects in the size and form of Children?- have been occasionally touched upon in the preceding chapter-, but the prevalence of such evils, and the lamentable consequences with which they are followed, require to be more fully and distinctly considered. I must not weaken the influence of important truths by suppressing any part of them, or by leaving them too widely scattered. I must shake off the restraints of false delicacy, and by candidly printing out the grand source of so many private and pubfc calamities, endeavour to prevail on parents to adopt the most effectual remedy. Let not the fairest part of the creation be offended with me for saying, that, in all cas s of dwaifishness and deformity, ninety-nine out of a hundred are owing to the folly, misconduct or neglect of mothers. The following re- marks are not written in the spirit of reproach, but v.ih a view to th^ most desirable reform. 70 Of DWARFISHNESS It would be difficult to mention any thing in which society is so deep- ly interested, as in the proper union of the sexes. This has often en- gaged the attention of legislators, and marriages have been prohibited in various diseases and personal disqualifications. We have even an in- stance upon record, Avhere the community interposed, ivhen degeneracy in the royal line was likely to be the consequence of their king's injudicious choice of a wife. History tells us, that the Lacedaunoniaus condemn- ed their king Archidamus for haviug married a weak, puny woman; "because," sail they, " instead of propagating a race of heroes, you will fill the throne Avith a progeny of changelings." I am aware that any checks on the liberty of individuals in their ma- trimonial contracts, would be deemed inconsistent with tlie freedom of the British constitution; and indeed, it is strange that laws should be ne- cessary to co.ivi ce men, that health and form are, or ought to be, pow- erful considerations in the choice of a wife. Every part of animated na- ture proclaims aloud, that like begets like; and though a puny, dwarfish, or distorted woman, may become a mother, it will often be at the risk of her own life, and always with a certainty of transmitting some of her in- firmities to her iii'iocent and ill-fated oif-pring. But the inheritance of parental weakness and deformity is one of those curses uhich argument or expostulation cannot avert. The voice of reason is disregarded, and objects of natural desire are over-looked, by avarice and pride. I shall therefore confine my observations to such evils as may be presumed to admit of a cure, because they arise rather from error and folly, than from depravity or Avilful perverseness. P seems to be the natural wish of every pregnant woman to bring forth stout, healthy, and beautiful infants. Yet, Mr. Locke did not hesitate to a?ert, that, if mothers had the formation of their own children in the womb, we should s?e nothing any where but deformity. The foetus is happily ; lace! in better hands, and under the guardian care of nnlure. But though it cannot be new-moulded, altered in its shape, or disfigured by the mere fancies and capricious desires of the mother, it may suffer no le s injury from her ignorance, her folly, or misconduct. I hope I made it sufficiently evident in my cautions to women during pregnancy, that the foetus may not oily be checked in its growth, but marked also and distorted by tight or heavy pressure on the womb,—by stays, girdles, or the like improper ligatures. In vain does nature provide for the easy and gradual enlargement of the embryo, if her benignant purposes are counteracted by the bracing restraints of a silly mother's dress. After the birth, as I before observed, still greater danger awaits the infant from attempts to mend his shape,—to keep his head and limbs in proper form,—and to secure him against accident. The worst accident that cm befal him is far les« alarming than the certain consequences of such presumptuous improvements and ill-directed care. He becomes puny, s'unted, deformed, diseased; and, though perhaps cast " in nature's happiest mould;" is sure to be sv-oiled by the disfiguring touch of man. I hnve alreidy explai ,e 1 the fa'al effects of meddling with the soft bones of an infant's skull at the birtfe ; of confining them by any check ; or cove'.is: them too wmmly. I showed how Avonderfully the pliancy of th *s- bones was contrived to yield to obstruction, for the purpose of promoting e^sy and Fafc delivery, and afterwards to remme of themselves their proper place and form, if they had been squeezed together in the AND DEFORMITY. 71 act of parturition. I alBO insisted on the importance of a thin and light cup, that the air may act upon them freely, to render them hard and com- pact, and of course fitter to defend the brain from cold or any external injury. But while midwives and nurses are suffered to pursue a con- trary plau, we need not wonder at meeting with so many instances of early convulsions, of idiotism, and of heads misshapen, infirm, or suscep- tible of cold upon exposure to the least breath of air. 1 was no less earnest in my cautions against the use of bandages, or of oppressive covering for any other part of the tender frame. I did not magnify the danger, but simply stated the result of frequent observa- tion. I never kuew a single instance of a child's attainment to full size aud vigour, after having been cruelly confined during infancy in swathes or swaddling-clothes. How, indeed, is it possible, when the action of the heart, the lungs, the arteries, and of all the vital organs, is cramped and enfeebled :—Avhen the free circulation of the blood and secretion of the humours are prevented; and when the impatience of restraint ur- ges the infant to waste all his strength in continual but unavailing efforts to burst his fetters. As I knew that external objects were more likely to make some im- pression on the minds of my female readers, than arguments draAvn from the structure of the human frame, I endeavoured to fix then: attention first on the young of brute animals, many of which, as kittens, puppies, &c. though very delicate when brought iuto the world, never want to be strengthened, kept in due form, or preserved from accidents, by means of swaddling bands. Children have as little occasion for any such defence against danger. In reply to the idle objections of mothers and nurses, fouuded on the difference in point of alertness between kittens and in- fants, it has been admitted, tliat the latter are certainly heavier than the former, but they are more feeble in the same proportion : they are inca- pable of moving with sufficient force to hurt themselves; and if their limbs «et into a wrong situation, the uneasiness they feel soon induces them to change it. Is it not absurd to put them to real pain by galling ligatures for fear of imaginary bruises ; and to distort their tender bodies effectu- ally by squeezing them into a press, lest they should grow distorted from being left at liberty to stir ? Wliile I was writing on this part of the subject last autumn, I could not help being struck with another illustration of it, Avhich presented itself every day to my view. Above three hundred cattle were grazing in a field before my window, all of them nearly of the same size, well for- med and vigorous, without the least mark of feebleness or distortion. They had not been kept panting, when young, in tight and cumbersome wrapper, nor had they been stunted in their growth by improper man- agement. They might be truly called the offspring of nature, reared and brought up in conformity to her laws. How painful and humilia- ting did I feel the contrast, when I compared them with the foster-chil- dren of art, with bipeds of various shapes and sizes,—-with the hunch- backed, crooked-legged, lame, ricketty, diminutive, and deformed human beings, whom I often saw walking through the same field ! Should it be alleged, that inferences drawn from a species so differ- ent from our own are not conclusive, let us next turn our eyes to what take= place in swage uations, who are all known to be tall, robust, and well proportioned. Indeed, any instance to the contrary is so veiy rare. 1 J 60 72 OF DWARFISHNESS and extraordinary among them, that it was vulgarly believed they put all their puny and misshapen children to death. The fact is that they have not any such, because they never thwart the purposes of nature, or dis- obey her dictates in the treatment of dieir infant progeny. The perfect form of the North American savages will be more clearly conceived from tlie following anecdote of the president of the Royal Academy, than from a whole volume of travels. This justly admired painter, who is a native of America, haviug displayed in his youth strong proofs of uncommon talents was sent to Italy, ai that time the grand school for the imitative arts. Upon his first seeing the Apollo Belvidere, he is said to have exclaimed, " O I what a fine Mohawk Indian t" Almost every body has at least heard, that the Apollo Belvidere is one of the most beautiful and exquisite pieces of statuary iu the world. I must not here omit Buffon's account of the method of bringing up their young, pursued by other unpolished nations, as we proudly call them. " The ancient Peruvians," nays he, " in loosely swathing their children, left their arms at full liberty. When they threw aside this dress, they placed them at freedom in a hollow, dug iu the earth, and lined with clothes. Here their children, unable to get out and craAvl into danger, had their arms quite loose, and could move their heads and bend their bodies, without the risk of falling or hurting themselves. As soon as they were able to stand, the nipple was shewn them at a distance, and thus they were enticed to learn to walk." The same writer observes, " that the young negroes are often in a sit- uation in Avhich it is with more difficulty they come at the breast. They cling round the hip of the mother with their knees and feet, and by that means stick so close, that they stand in no need of being supported, while they reach the breast with their hands, and thus continue to suck, Avith- out letting go their hold, or being in any danger of falling, notwithstand- ing the various motions of the mother, who all the while is employed in her usual labour. These children begin to walk at the end of the sec- ond month or rather to shuffle along on their hands and knees; an ex- ercise that gives them ever afterwards a facility of running almost as swift in that manner as on their feet." To this very interesting description, I can add, upon the testimony of a friend of mine who had been several years on the coast of Africa, that the natives neither put any clothes on their children, nor apply to their bodies bandages of any kind, but lay them on a pallet, and suffer them to tumble about at pleasure. Yet they are all straight, and seldom have any complaint. Good health, as well as a good shape, is the consequence of their free, unconfined motion during infancy : Avhile among us, on the contrary, restraint, or, what is the same thing, tight pressure, checks growth, distorts the frame, and renders it at once dimi- nutive, unsightly and infirm. There is always a close and very natural connection between deformity, weakness and disease. The more we enlarge our survey of the human species in various parts of the world, the less doubt shall we entertain of the principal cause of dw'arfishness aud deformity. We shall find that mankind are stunted and distorted in proportion to their degree of civilization; that people who go almost naked from their birth, and live in a state of nature, are well-shaped, strong, and healthy:—and that among others who boast o; AND DEFORMITY. 73 h'igher refinements, the greater attention is paid to dress, the nearer are the approaches to the stature and to the weakness of pigmies. Sterne, who knew so well hoiv to enliven the most serious subjects, represents himself as struck with the number of dwarfs he saw at Paris. I am very sony to observe, that we need not go so far as Paris to be convinced of the lamentable effects of tight clothes, bad nursing, and confined impure air. Many of these matters are not much better ordered in the English metropolis : eveiy narrow lane in London swarms with ricketty children; and though we cannot say of the people whom we meet with in the streets, that every third man is a p gmy, yet Ave may with strict truth assert, that many of the lvomen are evidently stunted in their growth, and, both in size and robustness, are below the standard of mediocrity. With regard to females, indeed, born and bred in this city, as more attention is unfortunately paid to the tightness of their dress, and to the artificial moulding or pretended improvement of their shape Avhen young, the far greater part of them must be of a diminutive stature, and numbers arc distorted either in body or limbs. CHAP. VI. SANEFX7L EFFECTS OF PARENTAL TENDERNESS, OR OF AVHAT MA* BE CALLED AN EXTREMELY DELICATE AND ENERVATING EDUCATION. XXAVING repeatedly had occasion to point out the evils that must arise from the inattention of mothers to any part of their duty, and especially from abandoning their children to the management of hired nurses. I shall now proceed to explain the bad consequences of the op- posite extreme. Too much care operates in the same manner as too ht- tle, and produces similar effects. A case or two, selected from many Avhich have occurred to me in the course of practice, will sufficiently illustrate the truth of this assertion. The grand rule of life, which reason and experience concur to re- commend is ahvays to pursue the golden mean; to steer a middle course between dangerous extremes; and to take care, in avoiding any one vice or folly, not to run into its opposite. Mothers are too apt to forget this admirable lesson, in nursing and rearing their children. They do not seem to knoAv the proper medium between cruel neglect or indifference on the one hand, and the fatal excesses of anxiety and fondness on the other. In giving Avay to the strong impulses of natural affection, they com- monly go too far, and do as much mischief to their offspring by misguid- ed tenderness, as by total insensibility. It is not my intention to combat those fine feelings of mothers, without Avhich the human race would scon be extinct. I only wish to see them kept a little more under the controulof reason. I Avish to see the most amiable of all passions, maternal love, displayed io promoting the health and fortifying the constitutions of children,—not in relaxing them by every species of softness and effeminacy. When this passion is carried beyond the proper bounds, it ceases to be love: it becomes a sort of blind infatuation, always injures, and often destroys the object of its re- gard. Mothers should never forget the fable of the monkey snatching up 74 BANEFUL EFFECTS OF one of its young in a moment of alarm, and, in order to save it from dan- ger, squeezing it with so close an embrace as tooccarion its death. What a just picture of darling children so frequently killed by kindness I Nature provides for the helpless state of infancy in the strong attach- ment of parents. A child conies into the world, chiefly dependent ou the mother's care for the preservation of its being. She is tremblingly alive to all its wants. Every tender office she perforins increases her fond solicitude, till at length it gains the full possession of her affections, and her sole wish is to make it happy. What a lamentable thing it is that she should so frequently mistake the means! Indeed there cannot be a greater mistake than to imagine that extreme tenderness or delicacy of treatment will promote the health, the growth, the present or the future happiness of a child. It must have quite a contrary effect. Instead of supplying the real calls of nature, it creates a thousand artificial Avauts: instead of guarding the infant from pain and disease, it renders him much more susceptible of both, and less capa- ble of enduring either: instead of happiness, it ensures misery in every stage of his existence, as the infirmities of body and mind, which are contracted in the cradle, will follow him with incurable obsti- nacy to tlie grave. The writer, whom I quoted on the subject of suckling, is no less forci- ble in his censure of maternal fondness. He says, the obvious paths of nature are alike forsaken by the Avoman who gives up the care of her infant to a hireling, or, in other words, who ueglects the duties of a mo- ther; and by her avIio carries these duties to excess;—who makes an idol of her child; increases his weakness, by preventing his sense of it: and, as if she could emancipate him from the laws of nature, hinders every approach of pain or distress : without thinking that, for the sake of pre- serving him at present from a few trifling inconveniences, she is accumu- lating on his head a distant load of anxieties and misfortunes ;—without thinking that it is a barbarous precaution to enervate and indulge the child at the expense of the man. He then begs of mothers to attend to nature, and follow the track she has delineated;—she continually exercises her children, and fortifies their constitution by experiments of every kind; inuring them betimes to grief and pain. In cutting their teeth, they experience the fever; griping colics throw them into convulsions; the hooping-cough suffo- , cates, and worms torment them; surfeits corrupt their blood; and the various fermentations to which their humors are subject, to cover them with troublesome eruptions; almost the whole period of childhood is sick- ness and danger. But, in passing through this course of experiments, the child gathers strength and fortitude ; and as soon as he is capable ol living, the orinciples of life become le the indulgence of one parent: in the case now before us, both concurred to prodifce that enervating effect. For some time after his birth, master Neddy was reckoned a prom- ising boy. When I first saw him, he was about eighteen years of age : but, to judge by his look, one would have supposed him to be at least eighty. His face was long, pail, and deeply furrowed with wrinkles— his eyes were sunk in their sockets—his teeth quite tlecayed—his nose and chin almost touched each other—his breast narroAv and prominenW- his body twisted—his legs like spindles—his hands and fingers approach- ing nearly to the form of birds claws—in short, his Avhole figure exhibi- ted the truly pitiable appearance of a very old man, sinking under the weight of years and infirmities into the grave. It was a Midsummer I paid my first visit. I then found him wrap- pedup iu clothing sufficient for the rigours of a Lapland winter, and so closely muffled that one could hardly see the tip of his nose. He Avore several pair of stockings; his gloves were double, and reached his el- bows ; and, to compleut the absurdity of his dress, he was tightly laced in stays. Though armed in this manner at all points, he seldom pee- ped out of doors except in the dog days, and then ventured no farther than the church, whicli Avas only forty paces from his father's house. I believe this was the most distant excursion he ever made; and the ex- traordinary attempt Avas always accompanied with peculiar care, and many additional preservatives from cold. The eye of his parents might be truly said to Avatch over him not only by day, but by night also, as he slept in the same bed with them, ha- ving never been permitted to lie alone, lest he should throw the clothes off, or feel the want of any immediate assistance. It did not once oc- cur to his father or mother, that all the inconveniences which they so much dreaded, could not be half so injurious as the relaxing atmosphere of a warm bed, surrounded by close curtains, and impregnated with the noxious effluvia from their lungs and bodies. His food and his drink Avere of the Aveakest quality, always adminis- tered warm, and by Aveight and measure. When I recommended a more nourishing diet, and a little generous wine, I Avae told that the strongest thing master Neddy had ever taken Avas chicken water, and that they durst not venture on Avine or animal food for fear of a fever. Thus was the poor lad reduced almost to a skeleton, through the silly appre- hension of a disease, of Avhich he was uot susceptible. Nature was in him too weak to spread a hectic flush even for a moment over his counte- nance, which had acquired the colour of a par-boiled chicken. All his vital powers Avere languid; and even his speech resembled the squeak- ing of a bird, more than the voice of a man. When I spoke of exercise, I was told he took a walk every fine day in the hall, and that was deemed sufficient for one of his delicate consti- tution. I mentioned a horse—the mother was frightened at the very name of so dangerous an animal. On telling her, that I oAved the firm- ness and vigour of my own constitution to riding every day, she be»an to hink there misht be something specific in it; and she therefore consented to the purchase of a little horse. But tame as the creature was, it did not quiet the mother's alarms. Master Neddy, though placed upon the PARENTAL TENDERNESS. 77 poney's back, was not entrusted with the reins. These were given iu charge to a maid-servant, who led the horse round the orchard, while the cautious rider fastened both hands on the pommel of the saddle; and the father Avalking on one side, and the mother on the other, held him fast by the legs, lest he might be brought to the grouud by any sudden start of his high mettled racer. This exhibition was too ridiculous not to excite the laughter of the neighbours : which soon put an end to mas- ter Neddy's equestrian exercise. The timidity of a youth, thus brought up is more easily conceived than described. Fearful of every thing, he would run from the most in- offensive animal, as if he had been pursued by a lion or a tiger. His weakness in this respect being known to the village boys, it was a com- mon practice Avith them, whenever they sawr him peeping through his fa- ther's gate, to frighten him into the house by calling to the pig6 to bite him. This sportive alarm had the same effect as tlie sudden rush of a mad bullock. With such excessive Aveakness both of mind and body, master Neddy had some good points about him. His parents represented him as a per- fect model of morality; and I had no right to doubt the truth of their representation, though I did not give him quite so much credit on Uiat score, because he did not possess sufficient force of constitution to be capable of any kind of vice. But I viewed, with mixed emotions of admiration and pity, some proofs of learning and abilities which he left beliiud him. I Avas the more surprised, as the incessant care bestow- ed on his person seemed to leave very little time for any mental acquire- ments. Improper food, tight or oppressive clothing and Avant of fresh air and exercise, have in their turn proved destructive to thousands. This young man fell a victim to them all; and it would have been a miracle indeed, had he survived their combined influence. He died Avithout a groan, or any mark of disease except premature old age, the machine being fairly irorn out before he completed his twenty-first year. His death proved fa- tal to both his parents, whose lives were closely bound up in that of the lad. The father had perceived his OAvn error, but not before it was too late. Onreadiugmy inaugural dissertation, which Avasthen publishedin Latin, under the title already mentioned, he sent for me, and begged I would en- deavour to save his son. The youth, alas! was far beyond the reach of my most zealous efforts: I could only Avitness the certainty of his fate. Medicine was of as little use to him as consolation to his afflicted pa- rents. The bitterness of their grief was increased by self-reproach; and friendship exerted her soothing voice in vain. The father on his death-bed con "lived me to translate my dissertation into English, as he thought it might be of infinite service to mankind. My compliance ivith his request gave rise to the " Domestic Medicine," of which that essay on the means of preserving the lives of children, constitutes the first, and in my opinion, the best chapter. The above relation may to some appear romantic; but did I suppose any one capable of questioning my veracity, I could name several perr sons of the firet respectability, Avho know, that, so far from being heigh- tened, it falls .-hort oi the truth. Indeed I might go farther, and assert. from mv own too frequent observation, that a master Neddy is not so sia- 78 BANEFUL EFFECTS OF gular a phenomenon in many other families, and that the evild of paiert* tal folly are much oftener entailed upon favourite heirs, than tlie powei of fully enjoying the estates which descend to them. But it is in the female world, more especially, that maternal fondness spreads its fatal ravages. Girls remain longer than boys under the im- mediate and almost exclusive care of their mothers; and Avhen the Ut- ter are more guided by Jove than reason, by the impulses of a tender heart instead of the dictates of an enlightened mind, the former are doom- ed to weakness and misery. I shall uot offeud my fair readers by a re- petition of the remarks already made on the acquired defects and iufir- mities of too many of our young women; nor shall I attempt to describe the longtraiu and almost endless variety of nervous diseases, from which so few of them are exempt: I shall now confine myself to a single in- stance of the effects of extreme delicacy in the education of a daughter as the counterpart of my story of a son cut off by the like means. Isabella Wilson was iu early life a very promising child, and the ob- ject of her mother's idolatry. This good Avoman had no idea that health and beauty were more likely to be destroyed than improved or preser- ved by excessive care. In the choice of diet, clothes, exercise, &c. the delicacy of her SAveet girl ivas always the ruling idea. It is easy, in- deed, to render the human frame more delicate; but to make it more ro- bust, requires a very different mode of proceeding. As the child did not seem afflicted with any particular complaint, the doting mother exulted at the happy effects of her own management, and never thought that the taper form, the fiue limbs, and the languishing softness, which she so much admired, were the sure symptoms of debility and of latent disease. Isabella's mental improvement, in Avhich she surpassed many other young girls of her age at the same school, was no less flattering to her mistaken parents. But she had scarcely attained her fourteenth year before the fond illusion vanished, and the regular functions of both mind and body were suspended by a fit of the most extraordinary nature. I cannot avoid making one remark here, Avhich may be of great practical utility. It is, that fits, though they go by different names, and are as- cribed to a great variety of causes, may all be ranked uuder the general appellation of nervous affections, aud are almost always the consequence of bad nursing or injudicious treatment in childhood. Fcav children, properly nursed, have fits; and of those who are improperly managed, few escape them. Poor Bell Wilson Avas one of the unfortunate class. On my being sent for to attend this young woman, who was then six- teen, I was informed that she had been subject to fits for about three years, and had taken a great deal of medicine by the advice of several of the faculty, but Avithout having experienced any benefit. Though the person who gave me this account made use of the word^ite, I soou found that, strictly speaking, it was only one fit, that assumed two differ- ent forms or states, which followed oue another in constant succession during the whole of the above period. In order to giye a precise idea of this singular kind of fit, I shall call its first state active, and the second passive. During tlie former, the young woman made use of the most violent exertions, springing up, throwing her arms about, and striking them against every thing Avhich came within her reach. At the same time, she uttered a sort of noise. PARENTAL TENDERNESS. 79 consisting of three notes, which was more like the cry of some wild beast than any thing human. An universal spasm succeeded those strange agitations, and every limb became as stiff'and inflexible as if it had been suddenly petrified. Her whole appearance was that of a statue made of Parian marble.—In Tliis state of rigidity she continued sometimes for one hour, sometimes two aud often three or four, but the moment it was over, she began Avith the cry and motion above described. The active convulsion never lasted so long as the rigid state; but it Avas the only time at Avhich any thing could be got down her throat. As ;he Avould not admit substances of the least solidity into her mouth, the little nutriment which she received Avas always given in a fluid form, and. chiefly consisted of small-beer, or wine and water.—Her evacuations, either by stool or urine, Avere of course very trifling, and she Avas whol- ly insensible of both. Notwithstanding the thinness of her diet, she did not appear emaciated or ghastly; on the contrary, she was tolera- bly well in flesh, and her countenance, though quite void of colour, was rather pleasing. Her figure was exquisitely fine, the disease did uot seem to have prevented her growth in height, though it had in strength, and iu bulk or expansion; she Avas very slender, but as tall as most young Avomen of the same age.—Such were the most striking peculiarities of m her situation when I paid my first visit. As all the voluntary motions Avere suspended, and the involuntary alone took place, I thought by exciting the former I might suppress the latter, Avhich had so long agitated the system. But before I had re- course to stimulants, I was induced, by the tone of confidence withi Avhich I had often heard anodynes and antispasmodics spoken of by pro- fessional men of eminence, to try them first; but the experiment, though fairly made and duly persevered in, Avas not attended with the least suc- cess. And here I must observe, that, after forty years farther practice, I have never found the effect of antispasmodics in such cases to corres- pond with the high reputation Avhich they long retained in the medical world. I knoAV it has been the usual method, when the actions of the system appeared to be inverted, to employ this class of medicines, in. order to restore regularity and to take off the supposed spasm. I am far from being inclined to question the veracity of the favourable re- ports made by others of the issue of their experiments, I candidly state the result of my own, which has wholly destroyed my reliance on that mode of proceeding. After the failure of the aboAj^ attempts, in which I Avas mote guid- ed by the example of others than by the dictates of my own mind, I resolved to try the effect of irritation on the most sensible parts, which. were often rubbed with aether, and other volatile spirits. I prescribed at the same time the internal use of tonics, particularly chalybeated wine, and the compound tincture of bark.* Appearances soon became favourable; but as the change for the better was slow, the parents were persuaded by somebody to try the cold bath; and this rash step proved almost fatal to my hopes and to their fondest wishes. * I have here omitted the detail of doses and effects, usually given in medi- cal cases, as I am not writing instructions for the treatment of diseases, but s\wfions to mothers conrrv:-,;r.jr the nursing of their chiliren. 70 80 BANEFUL EFFECTS OF The reader should be informed, that the astonishing singularity of the girl's disorder had filled the minds of the country people all arouud with the wildest aud most superstitious conjectures. The general opiuion wa?, that the complaint must be owing to evil spirits, and that the gi. I was certainly possessed. Some were for putting her into Avater, where they were sure she would sAvira. Othess said that, if she Avas laid upon the fire, she would undoubtedly fly up the chimney. One bold captain of horse, a man of more resolution than intellect, declared his readiness to expel the foul fiend by shooting the girl, if the parents would give him leave. Her mother, who was not deficient in natural good seuse, though in the education of her daughter she had suffered her fondness to get the better of her understanding, paid no regard to such absurd and ridicu- lous proposals ; but she yielded to the importunities of a frieud, avIio had described to her with great earnestness and plausibility the wonderful ef- fects of the cold bath. A single immersion convinced the parents of their dangerous error. All the symptoms ATere aggravated in the most alarming manner, The duration of the rigid state of the body Avas extended from a feAv hours to eleven days. She would then have been buried, had I not positively forbidden her mother, whatever might happen, not to have her interred, till I should give my assent. At the time of this last attack, I Avas upon a journey to a distant part of the country. On my return home I was- told that my patient was dead; but that her burial had been delayed till I should see her. When I called, I found her to all appearance Avhat the people had described her, a lifeless corpse. On examining the body, however, I thought I perceived some degree of warmth about the region of the heart. This confirmed me in my previous design to make cArery attempt to restore animation. It was a considerable time before any symptoms of life appeared : at length, the girl set up her old cry, and began to throw her arms about as usual. After having so far succeeded, the parents implicitly followed my farther directions, and did not throw any new obstacle in the way of a cure. I again had recourse to the tonics before mentioned, with such nourishment as the girl could be brought to swallow. The violence of the convulsive motions gradually abated, and the duration of the rigid state of the fit grew shorter and shorter; till, in about six months, the whole ceased, and the regular and natural actions of the system returned. The state of this girl's mind, as well as of her body, on her reco- very, was a6 extraordinary as her disease. It is common to all persons who fall into fits, to have no remembrance of what happens during the paroxysm. This young woman not only was insensible of every occurrence and of the progress of time durhg her long fit, but her malady had com- pletely blotted out all recollection of every eveut before that period, and even the traces of all knowledge which she had acquired from the moment of her birth till her illness. I have indeed known a single fit of twen- ty-four hours' duration to destroy the powers of the mind, and produce absolute idiotism; but that was not the case here. The mental faculties, after a total suspension for four years, were not destroyed, but reduced to an infant state; and though void of all knowledge, were as capable of ac- quiring it as ever. It Avas just the same with regard to speech. And to the proper man- PARENTAL TENDERNESS. 81 agement of the legs and arms, of which she knew as little at the time of her recovery as at the iustaiit of her birth. Nothing could be more cu- rious than to hear her limping for som« months the namby pamby of a child, and to trace her progress in the imitation of sounds and the use of language. As soon as she could converse, she was told hoiv long she had been ill, ehe cried, but could not believe it.—When some books which she had writteu at school, were shown to her she thought it impos- sible they could be her's and Avas positive that the whole must be a mock- ery. In the course of time, she yielded to tlie concurrent testimony of others ; but she remained uncoucious of any former state of existence. Her new attempts to walk Avere as aukward as her attempts to speak; and she required nearly as much time to recover the perfect use of her legs as of her tongue. Even after she had acquired a considerable degree of strength, she Avauted expertn«*s in her motions, and was obliged to be led about by the arms like a baby.—Whenever I called to see her, I made a point of taking her into the garden to walk Avith me; but it Avas with great difficulty that I could prevent her from falling. We often la- ment the Aveakness of infancy; yet Avere we to come full grown into the world, we should not only be as long in learning to walk as infants are, but our first essays Avould be infinitely more dangerous. It is unnecesary to trace any farther the steps by winch this young wor man advanced to the full re-establishment of her health, and te the perfect use of all her mental and corporeal faculties.—These great ends were gained by a mode of treatment the very reArerse of the enervating plan, which had been the cause of her long sufferings, but which, happily'for her, was not afterwards resumed. I shall leave tender parents to make their own reflections on this case, and shall noiv only urge it as a fur- ther caution against the too hasty interment of persons who may seem to expire in a fit. Unequivocal proofs of death should always be waited for, and every adviseable means of resuscitation persevered in, when we consider how long appearances may be deceitful, and how unexpectedly the 1 itent sparks of life may be rekindled. Besides the uncommon instance of this young woman's re-animation, as it may be called, I have heard of a young lady in Holland, Avho was restored to her desponding friends, after she had been for nine days apparently in a state of death. The day before her proposed interment, her doctor called to take his final leave of her; but fancying that he per- ceived some vital symptom, he renewed his before hopeless efforts, and had the happiness to sucteed. This girl's case differed from that of my patient in one very remarkable particular: I am told that, in her seeming- ly inanimate state, she was all the while perfectly conscious of being alive, though she could not stir, nor speak, and tha* her only terror was- lest she should be buried alive. 82" OF EMPLOYMENTS, CHAP. VII. OF EMPLOYMENTS UNFAVOURABLE TO THE GROWTH AND HEALTH OF CHILDREN. THOUGH my remarks on air and exercise render it less ne- cessary to be very minute in my detail of occupations which preclude the full enjoyment of those essential requisites, yet some little illustration in a few instances may have its use. The children of the rich and of the poor are alike sacrificed to the mistaken views of their parents, the former by confinement at home or at school, for the sake of some trifling' attainments, and the latter, by premature endeavours to get a livelihood. There is, lioivever, a very material difference betAvceti both, as the error in one case, arising from fashion or caprice, is infi- nitely less pardonable than the otlier, which is too often occasioned by want. It is strange the mothers in the higher ranks of life, who must have felt or frequently observed the debilitating effects of fashionable modes of education, should persist iu making their OAvn daughters sit for hours together at a tambour-frame, or at the needle in learning fancy works. which can never be of the least service, but must do their health and their form irreparable injury. The very postures, in which they are thus employed, not only tend to distort their pliant limbs and bodies, but to impede the action of the principal organs of life, which require above all things an expanded chest for the easy performance of their respective functions. I cannot too often repeat that personal deformities, pale complexions, head-aches, pains of the stomach, loss of appetite, in- digestion, consumptions, and numberless other enemies of youth and beauty, are the sure consequence of long continuance in a sitting or in- clining attitude. What so many young ladies suffer at a critical time of life, and the still gre.iter danger which often awaits them when they bu- come wives and mothers, are chiefly owing to the same cause,—early confinement in sedentary pursuits; and the want of frequent exercise iu the open air. To fetter the active motions of children, as soon as they get the use of their limbs, is a barbarous opposition to nature : and to do so, under a pretence of improvement, is an insult upon common sense. It may, in- deed, be the Avay to train up enervated puppets, but never to form ac- complished men or woman. I always behold, Avith much heart-felt con- cern, poor little creatures often or twelve years of age, and sometimes younger, who are exhibited by their silly parents as prodigies of learning, or distinguished for their extraordinary proficiency in languages, in elocution, in music, in drawing, or even in some frivolous acquire- ment. The strength of the mind as well as of the body is exhaust- ed, and the natural growth of both is checked by such untimely exertions. lam not for discouraging the early introduction of youth into the sweet society of the Muses and the Graces; but I would have them pay their court also to the Goddess of Health, and 6pend a considerable part of UNFAVOURABLE TO CHILDREN. 83 ^heir time, during the above period at least, inlier enlivening sports and gambols. It Avould be foreign to my immediate purpose to say any thing farther of the literary pursuits of boys, than that more frequent intervals be- tween the hours of study than are now usual, should be allowed for re- creation and active exercises. But a much greater reform is wanted in female education, the whole of which appears to be upon a wrong basis. I leave to others the moral part of this business, and shall only take a medical view of the subject. It grieves me to see health impaired by a close application to objects of very little consequence while the most im- portant qualifications are disregarded. Eveiy girl should be brought up Avith a view of being a wife and mother; or, whatever her other accom- plishments may be, she will prove totally unfit for the discharge of those duties, on which the affections cf her husband, the well-being of her pro- geny, and her own happiness, mtut depend. If she herself is languid and indolent, how can she hope to bring forth active and vigorous chil- dren; and if she knows nothing of the proper management of them. must she not have recourse to hirelings, and trust entirely to their care, to their skill, and to their fidelity, in the dearest concerns of life ? It is common to see women, who are supposed to have had a very genteel education, so ignorant, when they come to have children, of every thing with which a mother ought to be acquainted, that the infant itself is as wise in these matters as its parent. Had the time spent by such females iu the acquisition of what can never be of any rervice to them, been employed under the eye of a sagacious matron in learning domestic virtues and the art of rearing children, they would have secur- ed the attachment of their husbands, made their sons and daughters useful members of society, and been themselves an example and an ornament to the sex. If a young man be intended for the army or navy, he is sent to the academy to be instructed in those branches of science which are deemed necessary for his making a figure in the proposed department. But a young woman, Avho has got a more difficult part to act, has no such op- portunity afforded her. She is supposed to require no previous course of training,—to need no assistance but that of nature, to fit her for the discharge of her duties Avhen she comes to be a mother. Did she live in a state of nature, that idea Avould not be far wrong, but, in society, every thing is artificial, and must be learned as an art. The art in question, however, can neither be learned from books, nor from conversation. These may have their use, but they Avill not make an accomplished nurse. Indeed, nothing can form this first of characters but practice; and if such practice is not acquired under some experienced matron, it will cost many lives to learn it any Avhere else. A mother ma\ blunder on, as most of them do, till she has killed a number of children, before she is capable of rearing one. At last, perhaps, she succeeds— It is in this way we find many Avealthy citizens, who have bad seve- ral children, yet die Avithout any, or leave only one to enjoy their ample fortune. All practical things are the most difficult to learn, because they can only be learned from observation and experiment. Thus I have knoAvn a girl, Avhose mother had eighteen children, take one of them and bring it up by the hand, merely from the force of example and imitation. Had 84 OF EMPLOYMENTS this girl studied the art under the ablest medical instructor, or read the best books that ever were \v litten on the subject, she could not have done what she effected with the utmost ease, because she had so often seen it succeed under her mother's management. The inference is very plain : that acquirements of little value, or merely ornamental, ought uot to be assiduously cultivated at the ex- pense of health, or to the neglect of things of the first importance ; and that a great part of the lime inconsiderately spent by young ladies in fan- cy works, and in learning to draw, to paint, or to play upon some musical instrument; of which they will never feel the Avant, or which at best will afford them only a momentary gratification, had much better be em- ployed in practical lessons ou the duties of wives and mothers, Avhich they will be soon called upon to discharge, and their ignorance of which will cost them many an aching heart. As to the other evil before hinted at, which is owing to poverty, and which consists in putting youug children to sedentary or unwholesome employments, in order to get their bread, it is a matter of the most pain- ful consideration, Avhen viewed either by the eye of humanity or of poli- cy. The source of the sweetest pleasures is thus embittered to the pa- rent ; and society loses the valuable services of the man, through the feeble, untimely, and exhausting efforts of the child. In vain do Ave look for the full groAvn fruits of autumn, after a too early expansion of the buds of spring; and Ave never see a colt, if put too soon to hard labour, tarn out a stfong and active horse. When I touched upon this subject in the first chapter of my " Do- mestic Medicine," I thought I could not urge a stronger proof of my as- sertion, that the constitutions of children were ruined by such premature endeavours to earn a livelihood, than the immense number of rickety, serophulous, and diminutive creatures, that swarm in all our manufac- turing towns. There the infants suffer severely in the very first stage of life, for want of proper exercise and proper nursing, Avhile the distressed mothers are busy at other work. The next step, almost as soon as they feel the use of their legs and arms, is to employ them in some of the sub- ordinate or preparatory parts of the manufactures, which are the more injurious to growth and health for requiring constant confinement rather than active exertion. Very feAv of those poor objects attain to maturity, and fewer still to manly vigour. Most of them die very young, and the rest are Aveak and sickly all their lives, so that incapacity of labour at an advanced age is the sure consequence of the sorry earnings of child- hood. But there is another set of devoted beings more pitiable still than those whicli I have now described—I mean the children that are bound apprentices to chimney-sweepers. If any creature can exist in a state of greater wretchedness, or is a juster object of commiseration than a boy Avho is forced to clean chimneys in this country, I am very much mis- taken. Half naked iu the most bitter cold, he creeps aloug the streets by break of day—the ice cutting through his feet—his legs bent—and his body twisted. In this state, he is compelled to work his way up those dirty noisome passages, many of Avhich are almost too narrow for a cat to climb. In order to subdue the terror which he must feel in his first attempts, his savage master often lights up some wet straAv in the fire- place, which leaves the poor creature no alternative but that of certain UNFAVOURABLE TO CHILDREN. 85 Suffocation, or of iustantly getting to the top. I have witnessed still greater cruelty : I have more than once seen a boy, when the chimney was all iu a blaze, forced down the vent, like a bundle of wet rags, to ex- tinguish the flame. On the very day (the twenty-second of last October) when I was come to this part of my subject, an indictment for cruelty to a young chimney-sweeper happened to be tried at the Westminister sessions. The avretched sufferer had been decoyed into the house of a woman who canied on this horrid business, but who promised to employ him only as an errand-boy. He had not been long there, however, before he was put to learu the trade, as it is called. Some domestic lessons were deem- ed necessary to prepare him for public exhibition. The child not be- ing able to climb with the readiness expected, used to be stripped naked by the foreman, and whipped round the room with birch rods. His body, legs, and arms were severely bruised by the beatings he had receiv- ed. This Avas not all. Though his knees and elbows had been rendered sore by repeated trials, yet when the poor creature could not mount quick enough, his cruel instructor used to goad him (while in the chimney) in the legs and thighs, by a needle put into the end of a stick. It also came out in the course of the evidence, that unfortunate chil- dren of this sort are taught to climb by being taken to the porch of St. George's church, where, at the risk of their lives, they are obliged to mount the perpendicular Avail. I am always happy to see justice tem- pered with mercy, especially when the punishment is at the discretion of the judge or magistrate ; but after a culprit had been fully convicted of those attrocious acts, I could not help thinking that lenity toivards him Avas carried too far iu sentencing him only to six months' imprisonment. I am still more grieved to think, that any business Avhich requires such dreadfol modes of training, should be tolerated. Perhaps I shall be told, that boys so trained are necessary. I deny the assertion. Chimneys are kept clean, without such cruel and danger- ous means, not only in many countries on the continent, but even in some parts of our oavu island, where the houses are much higher than in Lon- douN In North Britain, for instance, a bunch of furze or of broom an- swers the purpose, and does the business cheaper and better. One man stands at the top and another at the bottom of the chimney, Avhen a rope is let doAvn by means of a ball; and the bunch of furze or broom, being properly fastened on, is pulled up and down till the chimney is quite clean- ed. The little trouble andexpeuse attending the operation are the strong- er: incitements to repeat itso often as to preclude the possibility of chimneys ever taking fire. Is th's the case in London, though hundreds of lives are every year sacrificed to the most barbarous methodof preventing dan- ger ? How vain shall we find the boasts that are made of mighty im- provements, in the metropolis of the British empire, if we fairly consid- er that it is at least a century behind the meanest village in the kingdom, in almost every thing that regards the preservation of human life! I have often heard the plea of necessity urged to justify doing wrong, but never more absurdly than in the employment of boys to clean chim- ney?. Experience clearly proves that it can be much better done without them; and shall we, in perverse opposition to reason and humanity, continue a practice which is equally forbidden by both ? The abolition of the slave- trade has of late years become a very popular topic among us; and the .86 OF EMPLOYMENTS, &.C. cause of the poor Africaus has been pleaded with lips of five iuour SCU' ate. But while our pride istlaltercdby the idea of relieving slaves abroad, Ave make a set of our fellow-subjects at home iuiinitely greater slaves, and far more miserable ! This is something like the fashionable chimera ol universal philanthropy, which pretends to be alive to the sufferings of the distant Hottentots, but in reality steels the heart against spectacles of much keener wretchedness iu our own streets. My late worthy friend, Jonas Ilanway, Avho literally went about, do- ing good, used all his influence to ameliorate the condition of those un- happy creatures : Avhich, in a certain degree, he effected. But there are some customs, that can be thoroughly mended, only by being com- pletely abolished. Wliile boys are forced up chimneys, they must be mis- erable, Avhatever laivs are made for their relief. A law prohibiting the practice altogether, Avould be at once laying the axe to the root of the iree ; and the evil admits of no other remedy. Had Mr. Hanway taken up the matter upon this ground, he had spirit and perseverance sufficient to have carried it through, and to have obtained an act of parliament for the effectual relief ef the most wretch- ed beings on the face of the earth. He confined his benevolent exertions to a partial alleviation of their miseries, because it had never occurred to him, that the climbing boys, as he calls them, Avhere wholly unnecessa- ry. What a pity he did not carry his views a little farther, as, in that case, he certainly would have not remained satisfied Avith any thing short of their total emancipation from such cruel and useless bondage I The situation of those children of misery is now become more hopeless in consequence of the death of Lady Montague, who used to make such of them as could go to her house, happy for at least one day in the long and lingering year. 1 often wished to see her well known talents exerted in their favour : they could not have had an abler or a better advocate. The amiableness of her character Avould have given additional force to the impressive productions of her pen; and the legislature might have been in- duced to interpose its authority in suppressing an employment at once so destructive and so degrading to the human species. But surely there is humanity enough in both houses of parliament to take up this subject, without any other appeal to their feelings than a bare representation of facts. Many touches more would be necessaiy to finish the melancholy pic- ture of the wretchedness of young chimney-sweepers. It is enough for me to sketch the principal outlines, iu hopes that some person more at lei- sure may be induced to lay on the internal colouring. In addition, how- ever, to the miseries already described, I must not omit the malignity of the disorders, Avith Avhich those poor creatures, if they live long enough, are almost sure to be afflicted. They are not only deformed and stunted in their growth, but, in consequence of having their pores clogged, and the surface ef their bodies continually covered Avith a coat of dirt composed of soot, sweat, &c. they are subject to various maladies unknown to the rest of mankind. I need only give an instance of one of those diseases, which is called by the sufferers the soot-wart, but Avhich the late Air. Pott has very prop- erly named the Chimney-sweepers' cancer. He describes it as a ragged, ill-looking sore, with hard and rising edges,—rapid in its progress, pain- ful in all its attacks, and most certainly destructive jot its event. Extb> OF ACCIDENTS. 87 pation by the knife, on its first appearance, and the immediate removal of the part affected, he looks upon as the only chance of putting a stop to, or preventing the fatal issue of the disease. His reflection on the sub- ject does equal honour to his heart and to his understanding. " The fate of these people," says he, " seems singularly hard. In their early infancy, they are most frequently treated with great brutality, and al- most starved with cold and hunger. They are thrust up narrow, and sometimes hot chimneys; where they are bruised, burned, and almost suffocated; and when they get to puberty, they become peculiarly lia- ble to a most noisome, painful, and fatal disease." CHAP. VIII. OF ACCIDENTS. V/HILDREN are not only lamed and maimed, but they often lose their lives by accidents, owing to the carlessness or inconsiderate neglect of nurses and mothers. A child should never be left alone in a place of danger, or in any situation where he may, through his own want of experience, be exposed to the destructive elements of fire and water. We daily hear of children that have been burned to death, in conse- quence of their clothes having caught fire ; and even grown people often lose their lives by similar accidents. Afflicting events of this kind often take place even under the mother's eye ; and, what is surprising, their frequency does not prepare women for the most effectual method of extinguishing the fire. Distracted by the frightful scene, and the cries of the sufferer, they rush to tear off the burning clothes. But, before this can be effected, the mischief is done. The attempt, therefore should never be made. The clothing instead of being torn off, ought to be pressed close to the body, and whatever is at hand av rapped over it, so as to exclude the air, upon which the blaze will go out. It is the action of the air that keeps it alive, and increases it* vehemence. A carpet, a table-cloth, a blanket, any close wrapper, will instantly extinguish it. Ladies, whose dress is so very liable to catch fire, should in such a case have recourse to these means, and be their oavu preservers, instead of running out of the room, fanning the flame, and uselessly screaming for help, which comes too late to save them from t rture s and from death. Our newspapers frequently contain accounts of persons, who, by run- ning about, not only accelerate their own destruction, but frighten others into an absolute incapacity of affording them any assistance. A case nearly of this sort very lately fell uuder my observation. A beautiful Avoman, Avith her clothes in a blaze, had been suffered to run out into the street before any body ventured to approach her. A hackney-coach- man, seeing her in this situation, jumped off his box, and wrapping his coat round her, extinguished the flames. Though her life was saved, no remedy could be found lor the cruel ravages of the fire on her per- son. She lost the use of some of her limbs, and was most shockinely dis- figured. Few people are ignorant of what ought to be done to extinguish .88 OF ACCIDENTS. flame: but presence of mind or courage is wanting in the moment of sud- den danger, and the consequences are of course deplorable. I admire tlie practical philosophy of the good women iu North Britain, who are employed in spuming flax, or tow as they call it. Whenever the flax round the distaff catches fire by accident, they immediately wrap their apron about it and it is out iu an instant. But where the fire aitects an animated being, especially a darling child, I am afraid few mothers would have the resolution to act in the same manner. Nor is this the case with mothers only. I have known a father stand by, and see his darling daugh- ter burned to death, without any immediate and rational effort for her re- lief ; the powers both of his mind and body were suspended by the shock; and he remained like a statue at the very crisis of the alarming catastro- phe. Nay, I have known children carried into the street, that the air might extinguish the flame. It must be evident enough, from Avhat I have said of excessive care iu the treatment of children, that I would not have mothers or nurses over- solicitous about trifles. But where exposure to danger may be attended with irreparable mischief, it cannot be too cautiously guarded against. I Avould therefore have the upper garments of children, when they can run about, made of vvoollen materials, whicli do not so readily catch fire as manufactures of flax and cotton. I would also have children taught very early to dread the fire; and I think that the best way of im- pressing their minds with the danger of coming too near it, is to suffer them to burn their fingers slightly, yet so as to give them some pain. This Avould haAre more effect than a thousand admonitious. When children are cold, they are very apt to get close to the fire: by which meaus they not only run the risk of being burned, but of indu- cing whitloes or other inflammatory disorders of the extremities. In these cases, however, I would not have the preventive care of the nur- ses or parents carried too far. The actual experience of the tingling effect will operate more powerfully than any which can be said to young people to make them avoid it: when they have ouce felt the smart, a few words to remind them of the cause will be quite sufficient : and they will easily acquire the habit of rubbing their hands and running about, rather than going to the fire to warm themselves, after having been out in the cold. I have always been glad to find those semi-circular irons, called guards, fixed up round fire-places in nurseries, and in all the apart- ments to which children had access. It gives me still greater pleasure to see wire-fenders, two or three feet in height, now frequently made use of even in parlours and drawing rooms. They are excellent preserva- tives from the danger to which grown persons, particularly ladies, as well as giddy boys and girls, may be exposed, when standing or sitting by the fire. Children are very fond of roasting things, such as chesnuts, potatoes, &c. in the fire. I knew a lady, who had nearly lost her life by an ac- cident arising from a circumstance of this sort. A little boy was poking in the fire for a potatoe, Avhich he had put in to roast; his clothes cau« ht the flame, and, though his mother Avas standing by, he Avas dreadfully burned. She, being a nurse at the time, held au infant in her arms which rendered her less capable of assisting the other child. The effect of the shock on herself was seriously alarming; it dried up her breast-milk, OF ACCIDENTS. 89 and produced a fever, the violence of Avhich left little hopes of her reco- very for three weeks; she was then seized Avith a convulsion fit, Avhich came on critically, like that Avhich often precedes the eruption of the small pox in infants, aud is far from being an unfavourable symptom. Her fit proved equally salutary; it abated the force of the fever, and she grew better every day after. This lady was attended by my excellent friend the late Dr. John Gregory and myself, who had both despaired of her recovery. The accidents from scalding are still more numerous. Children are in continual danger where victuals are cooking: and among the lower and middle ranks, the kitchen is the nursery. One of the finest boys I ever saiv, lost his life in this manner. He was dancing round the kitch- en, when a pot full of food for some domestic animals, which had been just taken off the fire, stood in his way:' he fell backwards, and Avas so scalded, that in spite of all my best endeavours, he died. Nothing hot should ever be left within a child's reach; otherwise he will very probably pull it over him : in Avhich case, before the clothes can be got off, he may be scalded to death. Children are also apt to carry every thing to the mouth; and a very small quantity of any liquid boiling hot, will occasion death, if taken into the stomach. A melancho- ly proof of this occurred not long since. A child put the spout of a tea- kettle to its mouth, and drank a little of the boiling water, which proved almost instantly fatal. Numberless instances have come to my know- ledge, of children having pulled off the table dishes full of hot victuals, with Avhich they Avere scalded in a terrible manner. Indeed, victuals, or any thick substances, in a burning hot state, are much worse than fluids as they adhere more closely to the skin. Perhaps there is not a more painful death, than tliat which is the con- sequence of scalding or burning. When instantaneous, it is nothing ; but when lingering, it is dreadful beyond imagination. We can only form some imperfect idea of it from the intense pain occasioned by scalds or burns, though not of deadly effect. I once had a patient, about one half of whose skin was scalded, by falling into a boiler. Though this man recovered, yet so great was his agony, that, every time he was dressed, he used to beg and pray to be put to death. Accidents by cold water, though not so frequent in early life as those occasioned by fire, ought nevertheless to be guarded against with due precaution. Children, who have no idea that these elements are hostile to life, are often dead before they know their danger. Wells and pieces of water near houses are frequently left open, or without any fence round them, as if they Avere designed for traps to allure the unwary to dest - uction. Is it not well known that young people are fond of looking into the water, especially when they can see their own image or likeness? And, is it au uncommon thing for them, when viewing themselves in the watery mirror, to tumble in, and to be drowned? Even to this day I shudder at the recollection of a draAV-well in my father s garden, without the least railing to keep children at a proper distance. A thousand times in plavful mood, have I sported on the margin of the abyss, and cannot novv conceive how I escaped a fatal slip. It is a weak security against the danger of open wells, or ponds, or pits, or the like cavities, to tell a child to take care. The effect of such a silly piece of advice is well ex* 90 OF ACCIDENTS. posed in Gat's fable of the old hen and the young cock: of which the moral is— " Restrain your child—you'll soon believe " The text which says we sprung from Eve." But it is not only in yards, and gardens that the least slip may some- times be fatal to children; they are often exposed to almost as much danger within doore, by falls iu various situations. I shall first mention the dark and Avinding stair-cases, which remaiu in all old houses, espe- cially in that part of London ivhich is called the city. Children must be endued with a degree of precaution far beyond their years, to avoid tum- bling upon those stairs; and if they do make a false step, they often roll from the top to the bottom. As, from the usual lightness of a child, a leg or an a m is seldom broken by such an accident, little notice is takeu of it at the time; but although it may not seem to do much hurt for the present, it often lays the foundation of future maladies. The fine or- ganization or structure of the brain may receive a dangerous shock; and there is reason to believe that the hydroscephalus internus, is sometimes the consequence of bruises, or bloivs, or other injuries done to the head. I lost a most promising boy, through an affection of his brain, which I thought was owing to a fall from a kitchen-dresser. AU children have an inclination to climb, and to get upon stools, chairs, tables, &c. A fall from one of these is more dangerous than mothers and nurses are apt to imagine. A child's head is large, and, being specifically heavier than the body, is the part most liable to strike the ground, and thus to cause a concussion of the brain, which may be attended with fa- tal consequences. All the furniture of a nursery should be low, so as to preclude at once the desire of climbing aud the danger of falling. The tables should also be made without corners, as these sharp projections of- ten do mischief. I have already declared myself a Avarm advocate for indulging the restless activity of children, on which their growth and health very much depend; but, till they acquire reason and experience to guide them, it i6 the business of their parents to take care, that they move about, and ahvays remain in a sphere of perfect safety. For the same reason, nurses should never leave any deadly weapon Within the reach of ch'ldren. Knives and sharp instruments, with which they may cut or wound themselves, are very improper play-things. Yet I remember to have read in some uewspaper a curious story, of several lives having been saved by a knife in the hand of au infant. It hap- pened near one of those extensive woods on the continent, whence hun- gry wolves often sally forth in quest of prey. The wife of a peasant, who lived in a cottage at no great distance, was gone out upon some business; leaving an infant in the cradle, under the care of three or four more of her young family, one of whom gave a knife to the baby to amuse it-— During the mother's absence, a wolf, impelled by hunger, rushed into the cottage, aud made its first snap at the infant's arm, which, being extend- ed with the knife in a playful manner, it entered the throat of the rave- nous animal, and proved its death. As the women in our happy island have no occasion to arm their children against such enemies, I do not suppose that they will be tempted, by the desire of hearing their infants cried up as heroes, to intrust them with weapons, which are far more likely to hurt than to defend them. But to return to more serious and necessary precautions: I must take OF ACCIDENTS. 91 notice of some fatal accidents which frequently occur, though they may be easily guarded against. We daily hear of children falling from win- dows and being killed : this must be OAving to the want of proper preser- vatives ; a 1'cav bars fixed across the AviudoAvs of the nursery, or of any high apartments where children are suffered to play about, would prevent such disasters. Yet easy as the remedy is, we find it too often neglected. How frequently have I seen, with mnch alarm, children hanging out of windows in a state of imminent danger, and no regard paid to them by auy person withn ! this is peculiarly the case with the children of die poor in London, who commonly live in the upper stories, and seldom or never have their Avindows secured by bars. To keep such Avindows con- stantly shut would exclude the fresh air, so necessary to health, and even to existence : Avhile, on the other hand, having them open, without the guard or defence here recommended, is exposing tlie giddy and thoughtless to certain mischief. On the least uoise in the street, a child is apt to run to the window, and, leaning fonvard in eager gaze, is often dashed against the pavement. In my former remarks on hanging cols, my chief aim Avas to shew hoAV much safer and more conducive to sleep their gentle motion Avas than the violent and dangerous rocking of a cradle. I have now an observa- tion of greater extent to make on beds in general, which is, that they of- ten prove fatal to children, instead of being places of easy and secure re- pose. It is too customary for mothers and nurses to take infants into bed with them for the whole night. This is always relaxing, and sometimes attended with the melancholly effect of suffocation. Either in France or in Holland, I am not now positive which, there is a prohibitory laAV against putting any child to sleep in the same bed Avith its mother or nurse. Though we have no such law in England, maternal care ought to supply the want of it, especially as it is not an extraordinary, or a very uncom- mon thing to hear of a child's being smothered by the accidental rolling or pressure of a groAvn person during sleep. The use of turn-up bedsteads is not less noxious or dangerous.—Thev exclude the air from the bed-clothes all day, and render them frouzy and unwholesome. Children may also be inadvertently killed in them. The servant, or perhaps the mother, turns up the bed in a hurry, Avithout ex- amining whether the child is in it or not : the infant incapable of ma- king any noise in this situation, is smothered before the mistake is found out; and tears flow in vain to remedy Avhat a little caution might haAe prevented, or Avhat could never ha\re happened iu a proper bed. Children suffocated in this manner, as well as those accidentally over- laid, might be sometimes restored to life. Yet I do not recollect any instan- ces, except the one mentioned in my " Domestic Medicine," of its hav- ing been done ; though it must be as practicable as in cases of drowning, of fits, and various o'her casualties, attended with a suspension of seem- ing extinction of all the vital poAvers. It is not my business, however, to suggest the use of very precarious restoratives, Avhen the means of pre- vention are so easy and certain. I should never have done, were I to engage in a particular description of all the dangers to which children are exposed in our streets, partly through the Avant of a good medical police, and partly through the negli- gence of their parents. The importance and the necessity of the former. I may take some other opportunity to enlarge upon; my present Aiish is. 92 OF HOSPITALS, &C. to excite the attention of mothers to the perils which await their chil- dren at almost every corner, when they are suffered to run about by themselves, or intrusted to young people who have neither sufficient strength nor experience to protect them. It always gives me great un- easiness to see infauts dandled by girls who are hardly able to hold them up, or led about by others Avhose giddiness is more likely to plunge them into danger than to keep them out of it. At least half the acci- dents that bcfal children, both within doors and without, are owing to the folly, the cruelty, I had almost said the murderous criminality of leaving one child to the care of another, who, though a little older, is not lc--s in want of a mother's or a nurse's vigilance. Let me ask any parent of common sense and tender feelings, whether it can be fairly considered as much short of murder, to let a little girl of s veu or eight years of age take an infant out in her arms, or lead a- bout younger children than herself, in a city, were carts and carriages of every description are rattling along—where horses are galloping— bullocks furiously driven—and crowds of people constantly rushing with thoughtless impetuosity ? Is it a wonder, then, to hear every day ol children run over, their legs or arms broken, their brains dashed out, or their bodies crushed to atoms, in the midst of those dangers to Avhich they arc so inconsiderately exposed ? Though the immediate authors of such disasters deserve in most cases to be hanged, yet I do not knoAV how any jury could conscientiously acquit the negligent parent of some participation in the crime. Let me therefore conjure mothers, in particular, never to permit their young children to go alone into the streets, and never to rely upon one child's protection of another. It is also a mother's duty to make her ' children, as soon as they are capable of it, aware of danger, and to in- struct them hoAvto avoid the numberless enemies that beset them on all sides, and too often prove fatal to infant life. A good police Avould rcitainly go a great way towards the prevention of many of those disas- ters which so frequently occur in our streets, but no laws can ever be made that will supercede the mother's care and attention in Avatching over the health and safety of her children. CHAP. IX. OF FOUNDLING HOSPITALS, AND OTHER CHARITABLE INSTITUTIONS FOR THE REARING OF POOR OR DESERTED CHILDREN. THE proper qualifications and indispensable duties of mothers having so far engaged our attention, I am not without hopes that the re- marks which have been made on those important subjects, will be of some service in the middling and higher ranks of life. But it gives me pain to think, that there are great numbers of poor women, who do not Avant so much to be taught, as to be enabled to discharge their duty. They would Avilfingly devote all their time and care to the nursing of their children; but the want of common necessaries forces them to be other- wise employed. They see their infants languish; but the dread of fa- OF HOSPITALS, &C. 93 mine is au object of still keener cencern. They are not dead to the im- pulses of natural affection; but its warm emotions in their hearts are soou chilled by di&tress. It is poverty, whose icy hand congeals the streams of maternal comfort, and whose withering breath blasts some of the fairest buds of human life. Vanity is more gratified than reason, by the acknowledgment that there is not any country in the known world which is so much distinguish- ed as England for its charitable institutions. Hoav mortifying is it to add, that there is not any country in Avhich charity is so much abused and perverted ! When I look at such a building as the FoundlingHos- pital, much more like a palace than a nursery for poor children; wheu I consider the vast sums laid out in raising that structure, and the still greater sums which have since been expended and continue to be expen- ded upon the most pompous aud useless parts of the establishment;—I cannot help crying out w ith Rochefoucault, that virtue or charity would never go so far, if pride did not keep her company. It is much to be lamented, that the plans for the relief both of the old and the young, in every pitiable situation, which at different times have been encouraged by the people of England, should all be connected with superb buildings, profitable jobs, and a train of offices and employments which prey upon the funds, and render their use to the public veiy small, in comparison to what it might otherwise have been. This gross misappli- cation—this waste of charitable contributions, is not the only thing to be found fault with iu the management of the Foundling Hospital. Never did any institution hold out fairer claims to the support of the benevo- lent and humane, and never was any more liberally patronised; yet, from ignorance and inexperience, instead of preserving the lives of chil- dren, it has too frequently accelerated their death. T he first suggestion of a Foundling Hospital was certainly very plau- sible ; its professed object Avas to rescue from mhery and destruction the innocent victims that would otherwise be doomed to both by the deser- tion of tliei/ parents. Thus many valuable lives would be saved to so- ciety, and such a resource Avould be opened to unfortunate mothers, as would remove, or considerably weaken, any temptation to the commis- sion of the most unnatural acts. The prude, the bigot, and the canting hypocrite, might, indeed, condemn such a supposed encouragement to the illicit union oi' the sexes; but humanity can never look upon the preser- vation of a human being as a crime. An undertaking, therefore, of so specious a tendency, could not fail to meet with the most generous support. Independently of all private contributions, sixty thousand pounds a year out of the public money were for several years appropriated by parliament to so laudable a pur- pose. A palace, as I before observed, instead of a ntusery, soon reared its head. The doors Avere throAvu open for the adm ission of deserted children from all parts, not to be nursed and educated there, but to be sent down to the distant, counties and in their conveyance numbers of the poor infants perished. I am not here making a vague or an imaginary calculatiou; I am stating what fell under my own notice, when I was physician to a very considerable branch of the Foundling Hospital. I have elsewhere described the mortality which was occasioned by the im- proper use of medicines among those who had survived the fatigues of (he journey. I have also explained the very easy means I made use of 94 OF HOSPITALS, &.C to put a stop to such afflicting ravages, while the children and their nur- ses were uuder my inspection and control. But all my remonstrances against having them dragged away from those nurses too soon, crowded into hospitals, confined in schools, or put out to unhealthy employments. were unavailing. I was told that the established rules and customs ol the hospital could not be deviated from, though their evident effect was to destroy health, and to enfeeble the minds as well as the bodies of the unfortunate victims. I have often viewed with indignation the fallacious reports of the num- bers of children said to be brought up and provided for at such places. I am very confident, that were an accurate list made out of those who perished through unseasonable removals, improper treatment, bad nursing, diseases occasioned by too early confinement in schools, as well as by infection in hospitals, and, lastly, through what I call murderous occu- pations, it Avould appear that not one in ten of the infants received there, ever lived to become a useful member of society. But, besides the evils here hinted at, there is a fundamental error iu the plan itself, not only of the Foundling Hospital, but of all parochial and other charitable institutions for the maintenance and education of poor children. Every scheme Avhich tends to separate the parent from the child, whatever imposing appearance it may Avear, is a bad one, and Avill eventually be found to do mischief. It is flying in the face of nature, a thing that never can be done Avith impunity: it is rending asunder the first and the strongest bonds of society—parental and filial affection : it is perversely attempting to blunt and destroy the finest feeling of the heart, motherly love, without Avhich the human species could not long exist. All nature points out the mother for the nurse of every thing that is brought forth alive; nor can her place be supplied by any institution. Those avIio make the experiment "will soon be convinced of their teme- rity and folly. A few years ago, I met with a letter addressed to Lord FUswilliam, theu viceroy of Ireland, on the subject of the protestant charity schools in that country. As the author's sentiments agree with mine in many points, and particularly Avith respect to the pernicious effects of sepa- rating children from their parents for the sake of education, I shall here give them in his own words. Some people may think the lan- guage too strong; but the nature of the subject required the most poin- ted energy. " My Lord, I do request that you will take the trouble of reading the account of this inveterately illiberal institution in any common almanac; and every line will, I think, carry its OAvn reprobation to au ingenuous mind. The children, as it is regulated in their unnatural system, are all placed in schools remote from their former abodes; or, in other words, they are torn from all the sweet associations that attend the interesting idea of home. This is, indeed, a charity Avhich thrives on the extinction of all the other charities of life; and the feelings of nature must be erad- icated, before they can become nurslings of the state. They are banish- ed from their vicinage to a remote quarter of the kingdom, Avhere all the traces aud ties of kindred are lost and cut off; all habitudes of the hesrt smothered in the cradle; and, Avhen sent into the world, 'hey know not the spot which ga\*e them birth, the mother that bore th 11, nor the blood that flows in their veins. I think of the speech of Loc an FOR POOR CHILDREN. 95 the Indian chief, Avhen all his kindred were murdered—There remains not a drop of my blood in the veins of any living creature." The Avriter here takes occasion to direct his remarks to the heart, as well as to the head ;—to exert all his powers of pathetic, as Avell as ar- gumentative eloquence. " It is," says he, " a cold, cheerless, and for- lorn feeling of this nature, which must freeze the young blood, aud, pla- cing the mind in a state of sullen insulation, makes its reaction upou so- ciety rather dangerous than beneficial. The ties of kindred operate as a sort of external conscience upon the conduct of men, deterring them from the commission of great crimes, for fear of the disgrace which Avould be reflected on their relations. There is a family pride, a domestic hon- our, among the very poorest and loivest of the community, that guards and sanctions, and is a sort of God for the little household. Even the the highest have such workings of nature. Lady Macbeth exclaims, had he not resembled my father when he slept, I had done it.^ The ima- gined countenance of her father Avas the only conscience left, and came between her and murder. But charter school policy makes a sort of massacre of all those domestic moralities Avhich operate upon character and conduct, without being able to put a higher and nobler principle of action in their place; and thus, I fear, the same policy has bred up many victims for the laws, while they only thought of making proselytes to religion." Though the subject is here considered only in a moral light, yet I could not resist the temptation to make a short extract from such a mas- terly letter; and I do not think that any of my readers will be displeased at the perusal of it. But I have still less occasion to make any apology, for stating tlie author's opinion of the most effectual means of remedying the evil, as the leading feature of his plan of reform exactly corresponds with what I recommended above thirty years ago. I Avas then lamenting that poverty often obliged moth- ers to neglect their offspring, in order to procure the necessaries of life. I observed, that, in such cases, it became the interest as well as the duty of the public to assist them; but I contended that ten thousand times more benefit would accrue to the state, by enabling the poor to bring up their own children, than from all the hospitals that ever could be erected with that vieAV. Iu a subsequent edition of those re- marks, I added, that, if it were made the interest of the poor to keep their children alive, we should lose but very few of them; and that a small premium given annually to each poor family, for every child they had alive at the year's end, would save more infant lives than if the whole revenue of the crown were expeuded on hospitals for that purpose. It gave me great pleasure to find, that the writer just now quoted had reasoned in the same manner on the hundreds of thousands Avhich had been expended, merely, he says, to create foundlings; the tenth part of which, if properly employed, would have been of infinitely more service to society. The proper mode of employing charitable contributions. he thinks, should consist chiefly in giving premiums to such parents as have shewn most zeal and capacity in educating their children. Thus, notwithstanding the different points of view in which we examine the abuse of so important a part ef public charities, the very means which I advised for saving the lives, and promoting the bodily health of i> 72 96 OF HOSPITALS, &C. fants, appear to him the most conducive also to the intellectual and worn! improvement. The prejudices in favour of old institutions must bfe strong, indeed, when they can resist the clearest evidence of fact?, and the plain de- ductions of fair argument. Yet, in the question before us, Iioav the public, or the state may most effectually contribute to the nursing and rearing of poor infants, one would suppose that no appeal to past ex- perience, nor any great depth of reasoning, were necessaiy to demon- strate the impropriety of separating children from their parents. Na- ture forms the chain that binds them ; and, if possible, it should never be broken. I have shewn how the lives of the mother and the child are en'wined, not only during pregnancy, but after delivery. To part them is to endanger the health and existence of both. They are equally ne- cessary to each other's well-being; and the longer they are kept togeth- er, the more sensible they become of the duties they owe to one another, which, when faithfully discharged, tend greatly to increase the sum of hum in happiness. But how are Ave to expect tiist any regard will be paid to this doctrine by narroAV-mlnded unfeeling overseers of the poor, Who make a greater merit of saving a shilling to their parish, than of saving fifty lives to the community ? We now ;.i;l then hear of such persons befog dragged in- to our courts of justice, to answer for their cruelty to pregnant Avomen ; but no account is kept, and of course no cognizance can be taken, of the immense number of infants that are torn in our parochial receptacles* from fhe arms of their riis'i'essed mothers, and are consigned to an un- timely death, or to certain debility and protracted Avretchedness. Even the sIioav of humanity in some of those places, serves only to excite our stronger indignation. It is a cobwed, through which the pene rating eye can easily see vrritten up in letters of blcod children murdered here under the sanction cf charity. At we not always shocked at reading or hearing any accounts of the barbarous policy that prevails in China, where avaricious as well as dis- tressed parents ore encouraged by the permission of the law, and by the force of example, to destroy their female children in order to avoid the expense of reirvg them ? And is there a father or a mother in Great- Britain, who would not join in a general outcry against an act of parlia- ment for th^ immediate drowmng of all infants taken to parish Avork- houses ? Yet, humanity its°lf must acknowledge that instant death is in- fin:,ely preferable to a lingering existence in a state of pain, of misery, of coninua' suffering and disease. I do-not, therefore, hesitate to assert, th i* such policy as that of the Chinese, or such an act of parliament as I have i'ow m°nttoned, would, in reality, be an act of mercy, contrasted w;'h th»' present mist barbarous, most inhuman, and most detestable me- thod of taking care, as it is falsely called, of poor infants tin-own upon the parbh. Noth'-ig was left undone by the late Jonas Hamvay to probe this sore to the boftom. He spared neither time, pains, nor expense, to procure the fullest information on the subject, before he published his " Plea for me'cy to the children of the poor!" He there states, as the result of his inquiries and cahuh'iois, that not more than one in seventy of the chil- dren consigned to the parish, ever attained to mature age; and that even that one, seldom became an useful member of the community. Among *0R POOR CHILDREN. 97 many instances of the most horrid nature, he takes notice of a memo- randum he met with in the books of a certain parish, where the names of particular nurses Avere inserted, Avith the remark of their being " ex- cellent killing nurses."—This testimonial of their expertness in murder, was deemed by the overseers, who had tried them, the strongest recom- mendation to constaut employment. Let it not be supposed, that I mean to involve all oyerseers of the poor in one general charge of infanticide. I know several of them to bo veiy amiable and tender-hearted men, Avho would do every thing in their power to promote the ends of true charity and the real interests of humanity, w "re they not tied down by the established rules of their, office. That part of the institution which relates to the nursing and rearing of children, being radically Avrcng, the most zealous exertion;- of any individual, during his short continuance in office, will operate but as a temporary palliative of an evil in its own nature incurable. It is not a partial reform, but a total change of system, that can iu such cases be productive of any good effect. The supporters of Foundling Hospitals may imagine, that a justifica- tion of their plan is implied even in my censures of parochial establish- ments for poor children. They may say, that the laudable end of their charity is not to separate infants from their mothers, but to provide for those from whom cruel and unnatural mothers have separated them- selves. I before paid the just tribute of applause to the spirit of such an institution, and to its professed objects ; but I lamented the abuses which had arisen out of it, or rather, which were inseparably connected with the execution of the scheme. Its obvious tendency and its actual effect have been to create foundlings, — to encourage the desertion of young children, Avhom many of their parents Avould never have consign- ed to a reseptacle of that sort, but from cruel necessity, and from a vain hope that due care would betaken of the poor creatures. I have shewn the extent of that care, the dreadful sweep of mortality whteh accompanied it, aud its consequent insufficiency to promote the desired end. I would not however have Foundling Hospitals entirely abolished. I Avould endeavour, in the first place, to render them less necessary, by a method which I shall folly explain iu the next chapter, and of which the great object will be to take away from poor mothers all temptation to abandon their children. But a3 some women may be prompted, by other motives than that of want, to destroy their young, let there be a receptacle ever open for the rescue of such victims, and for theprevention of such unnatural crimes. It ray plan for the relief of poverty, above hinted at, be carried into full effect, the number of foun- dlings of the latter description will always be small, and will not require fury Aery expensive establishment. There AviU be no occasion for showy buildings—110 room for lucrative jobs, offices, or appointments. Two or •three trustees without sdaiy or emolument, and a' tuatfd solely by hu- mane and cbari'abl- motives, will be tua'c'eii( to receive the money, and to lay it out according to AveH-rcgulated and maturely considered instiue- tiots. The present abuses are very great and flagrant; but the reform is very eap.y, if it be zi■ douslv undertaken and persevered in by men of talons andVrtuc. I takeit lb-granted th tsuch p rsons v'!! sbo os- eess dignity of mind enough to despise the wretched suggestions of iguo- 98 PLAN FOR PRESERVING ranee, of prejudice, of envy, malignity, sordid interest, and disappoiutcd vanity. The foregoing remarks are purposely confined to some of our most popular establishments for the nursing and rearing of children. It would lead me too far to enter into a detail of all the schemes which have as- sumed the like name of charitable institutions in the neighbourhood of London alone. The former have at least the merit of having been well intended $ but most of the latter are founded in fraud, and have no oth- er aim but to enrich some artful projector, at the expense of public credu- lity. This is an inexhaustible fund for any man who can invent a quack medicine, a new mode of faith, or the plan of some specious charity We have seen footman in the first department, coal-heavers in the se- cond, and swindlers in the third, driving their chariots with rival splen- dor and success. But the victims of the last description are most to be pitied, because they are poor, innocent, and helpless children ; while the dupes of the two first, being people of mature years and experience, cannot lay claim to any compassion for suffering not only their purses, but their very souls and bodies, to be sported Avith by ignorant and au- dacious impostors. CHAP. X. SKETCH OF A PLAN FOR THE PRESERVATION AND IMPROVEMENT OF THE HUMAN SPECIES. \VERE this subject to be discussed Avith a degree of extent suited to its importance, it would require a large volume. But I mean to touch only ou a few of the principal points, merely with the hope of exciting more general atteution to a matter, which, though of the high- est concern, has hitherto been veiy slightly considered! I shall not divell upon truths which are obvious to almost every person of com- mon understanding, that the resources and stability of a state depends up- on the number, vigour, and industry of its subjects; and, on tlie contrary that where little value is set on the increase of population, on tlie growth, health, or life of man, the political fabric, however showy, stands on a rotten foundation, and must sooner or 1 iter sink into an abyss dug out of its own inhumanity. It is enough to mention these truths, in order to se- cure the ready assent of all thinking people ; but the practical inferen- ces to be drawn from them may admit of a great diversity of opinions. The plan Avhich I am about to propose, whether approved of, or not, may be productive of one good effect at least, that of exercising the in- genuity of others, and perhaps of conducting public and private charity to more useful purposes than those to whicli they are now applied. I hope I need not go over the ground again, or repeat my former arguments, to prove that there is not any law of nature so clear, so forcible, or so sacred as that Avhich ordains every mother to be the nurse of her OAvn young. The well-being of both, as I before observed, de- pends on the faithful discharge of this duty. Every attempt to divert the breast-milk from its proper chaunels, endangers the mother's life ; and it is beyond the power of wealth to procure, or of art to devise, any THE HUMAN SPECIES, 99 nuuiment so congenial to the constitution of the infant, as the very jui- ces of Avhich it is composed, and whicli have so long sustained it iu the Avomb. It is equally impossible to supply the tender care and unweari- ed attention of a parent; and the rich, who trust to hirelings, find by woeful experience, that half their children perish in early life. Is it a wonder, then, th t a far greater mortality should await the poor infants thrown upon the parish, or consigned to an hospital, where no individual is interested in their preservation? I have faithfully stated, as a mat- ter which came within the sphere of my own knowledge, that nine out of ten of the deser'ed foundlings died before they attained to maturity; and it appears from Mr. Hallway's unquestionable account, that sixty-nine out of seventy of the poor parish children perish in the same untimely manner. Can it therefore be called charity to persevere in measures Avhich are so destructive to the population of the country ? I before suggested Avhat appeared to me the best substitute for a Found- ling Hospital, confined in its objects to the preservation of such child- ren as might otherwise perish by neglect, and of such as may be depri- ved of their mothers at an early age by the "hand of fate." Poor or- phans and deserted infants being in the same predicament, though from different causes, must be reared by strangers. The only expedient in these unavoidable deviations from nature, is to place the children under the care of nurses of unexceptionable character, in a healthy part of the country, and not to take them away till of age to be put apprentices. This very circumstance will prompt every nurse to use her best endea- vours to rear a child who is to stay Avith her, if he thrives and does well till he is fourteen years of age. It is the only chance of making a stran- ger acquire in time a maternal affection for her nursling. It is also the only chance of a poor child's acquiring a good constitution, and that kind of early education Avhich is best suited to rural employments. But, for the relief of poor women, avIio in pregnancy may be exposed to numberless afflictions, and avIio, after delivery, may often be forced to part with their children, I Avould not recommend either hospitals or pa- rish work-houses. These receptacles are little better than half-way houses, or conductors to the gmre. In their room, I would have a fund established to afford indigent mothers every necessaiy comfort and as- sistance at their own habitations, during pregnancy as well as in child- bed, and afterwards to enable them to nurse and bring up their infants themselves. By these means more lives would be preserved than by all the charitable institutions now existing in this country, Avithout costing one half of the money, or alienating the hearts of children from their parents. ,., c ^ ■ It is impossible, without heart-felt sorrow, to thmu ol the immense numbers of fine children that are lost for want of a little timely aid to mothers. How many of these poor women pine with their offspring ui obscurity, and in unavailing struggles for their support! The dread of ill treatment of diseases, of death, and (what is still more terrible to a delicate mind) the dread of shame, keeps them from work-houses and hosp:tal\ Their groans are unheard—their wants unpitied—and they nass like silent shadows to the grave! . How many others, no lees tenderly attached to their young, are driven bv extreme distress to leave them to the very uncertain care of others, ail to hire out their breasts, and their own distracted attention, to astraa- 100 PLAN FOR FRESERVINC ger! When a mother abandons her child, to suckle that of another wo- man, one of the infants is almost sure to die ; and it frequently happeus that both share the same late. There is a third class of truly pitiable objects, though too often re- garded with cruel indifference aud contempt; I mean the poor women Avhom we daily see begging with two, three or more children, aud entire- ly dependant on 60 precarious a resource for a morsel of bread. While these can lie under hedges, and get scraps of food they may live; but should a severe Arbiter overtake them, when they must cling to the rock for shelter, they will all be lost. It is not unlikely that many of those poor infants may be the issue of men Avho have fought for their country, aud that tliey were turned out of house and harbour lest they should become troublesome to the parish. Can public or private charity be better employed than in prescrvi g so many lives to the state ? And hoiv are they to be preserved ? Not by tearing the poor children from the arms of their mothers, and sending them to hospitals and Avork-houses, to be put under the care of " excel- lent killing nurses ;"—but by enabling the mothers to nurse them agreea- bly to the designs of nature, and thus rendering fertility, not ivhat it now is, a curse to the poor, but the source of the sAveetest pleasures, and the greatest of all blessings. A very small part of the vast sums collected in this kingdom by taxes, under the title of poor rates, and by voluntary contributions, would be fully sufficient for the proposed fund; and lam persuaded that the wisdom and humanity of parliament and of govern- ment could not be better exerted, than in preparing and carrying into effect eidier this, or some other more advisable plan, for saving the fives of such an incalculable number of devoted victims. Vanity, a6 I before observed, has a very great share in the erection and support of alms-houses; or the rich and the truly humane Avould rea- dily discover in the hints now given, a much more useful as well as a more charitable method of employing their superfluous wealth. I hope, however, that the conscious pleasure of doing real good, will induce many ladies, blessed with affluence, to assist poor women to nurse and «ear their children in their oavu little huts or habitatious, though not in- scribed on the outside with any vain compliment to the pride of a pat- roness or a founder. Is not the sight of a rising family, who are indebted to you for health, and even for existence, a thousand times more gratifying to the human heart, than the silly ostentation or parade of a public cha- rity? It would imply a very unbecoming doubt of the good sense and na- tural feelings of my readers, to dwell any longer on this head; but many of them may think the other part of my plan, expressed in the title of the present chapter, and having for its avoAved object tlie improvement of the human species, a little romantic. Yet I flatter myself that I shall be able to prove, that there is nothing of fanciful or impracticable theo- ry in the suggestion; and that the improvement, as Avell as the preserva- tion of the human species, may be effectually promoted by the same means—well-timed assistance, and proper encouragement to mothers. Iu the first chapter of this work I threw out some hints on the proper choice of wives and of husbands with a view to the pocreation of a healthy and vigorous issue; and I lamented that the impulses of natural iflcliuation Avere too often checked in civilized society by the meaner THE HtJMAN SPECIES. 101 passions of avarice and false pride. I also took notice of cases in which marriage had been forbidden by tlie legislators of different countries. But though it Avould be dilbcult to frame, nd to enforce any complete system of laws for regulating the union of the sexes; and though such legal restraints on marriages would be incompatible Avith the liberty of individuals in a free government like ours, yet it is in the power of every state to eucourage the rearing of fine children, by granting to every mother a premium annually, in proportion to the age and number of the healthy children she brought up. The prospect of a liberal and honourable reward at the end of eveiy year, would encourage mothers to exert all their skill, and use every endeavour to rear a numerous and healthy offspring. It would excite a general emulation among mothers; and the object of the virtuous struggle would be, avIio should have the finest children. The name of Cornelia, that famous Roman mother, Avould no longer stand alone on the records of maternal affection : But English women, when requested to sheAV their jewels or their brightest or- naments, would throw open the nurseiy, and exhibit a lovely family to the spectator's admiring gaze. Let it not be frivolously objected, that a fond mother cannot want, or cannot feel a stronger stimulus, than natural r.ffection, to make her take care of her child. Poor women are forced by keen distress to neglect their infants in order to earn a bit of bread. They require therefore present supplies, and the assurance of a future reward; not merely to in- duce them, but in fact to enable them to bestow more time and attention upon tins one important object. Again, then, I must assert, that a part of the public money, as well as of private charitable contribution^, cannot be applied to a better purpose, than to the establishment of a fund for the support and encouragement of such mothers. The good effects of this plan would far exceed any present conjecture or calculation. The po- pulation of the country would increase with almost inconceivable rapidi- ty. Instead of puniness, deformity, diseases, and early deaths, the ri- sing generation Avould be distinguished from their health, beauty and vi- gour; and we should see a stout and hardy race spring up, to repay with usury, in valuable services to the state, the sums expended in nursing and rearing them. I do not knoAV any one institution upon earth, in which humanity and enlightened policy would be found more happily united. . r , . The effects of premiums have been proved in a variety ol otlier in- stances such as the culture of vegetables, the growth of flax, of hemp, of potatoes, the planting of trees, and the improvement of the breed of cattle Is it not a matter of just surprise that no attention of this sort should ever have been paid to the personal or bodily improvement of the human species ? We know that the most tender plant is not more susceptible of any shape or form than infant man. We know that his strength and figure are certainly as improveable as those of any otlier animal were proper methods pursued for the accomplishment cf such de- sirable'purposes. Yet the breed of men is alone neglected, while every effort of ingenuity is called forth, and the resources of wealth are ex- hausted, in experiments to improve the breed ol sheep, of horses, and of °XInever met with more than one man who took up this ruhject on a se- rious ground. His plan was a good one had he possessed sufficient 102 PLAN FOR PRESERVING, &.C. means to carry it into execution. lie proposed to purchase a small isl- and, and to plant it with as many people of both sexes as it Avould very comfortably maintain. Of these, he meant to superintend, the diet, oc- cupations, marriages, and the management of their children, Avith a view to try how far the breed might be improved. It was a speculation worthy of an enlarged miud. Were every person of landed property iu the kingdom, of this gentleman's way of thinking, and could our country squires in particular be induced to pay half as much attention to the breed of men, as to that of dogs, horses, and cattle, the progress of the human species to perfection would become more rapid, and more aston- ishing, than the degeneracy so often complained of in every successive age. Nor would this progressive improvement of man be confined to the body only; it would extend itself also to the mind. Every thing great or good in future life, must be the effect of early impressions; and by whom are those impressions to be made but by mothers; Avho are most interested in the consequences ? Their instructions and example will have a lasting influence, and of course, will go farther to form the morals, than all the eloquence of the pulpit, the efforts of schoolmasters, or the corrective power of the civil magistrate, who may, indeed, punish crimes, but cannot implant the seeds of virtue. If these are not sown in child- hood, they will never take deep root; and where they are not found to grow, every vice will spring up with baneful luxuriance. In this view of the subject I could easily find a thousand arguments to enforce the political importance of the plan which I have suggested ; but I undertook only to shew tliat perfect health and growth, that per- sonal beaufy and vigour, Avere most likely to be the fruits of the well-di- rected and well-encouraged care of mothers in the nursing and rearing of their children. Other authors have enlarged ou the culture of the heart and the understanding, the first and chief part of which they all acknowledge to be the inconteslible province of mothers. The eloquent writer whom I have repeatedly quoted, and avIio has taken some pains to illustrate this point, argues with great justness, that if the early part of ed- ucation, which concerns us most, had been designed for fathers, the Author of nature would doubtless have furnished them Avith milk for the nourishmeut of their children. It is in concurrence vvith his opinion, that I have addressed this little book of instructions to females; and as he has very beautifully compared infant man to a shrub exposed to numberless injuries in the high Avay of life, I shall join him in calling on the tender and provident mother, to preserve the rising shrub from the shocks of human prejudice. I shall say to her, almost in his words, Cultivate, water the young plant before it die; so shall it* fruit be hereafter delicious to your taste. Erect an early fence round the dis- position of your child: others may delineate Us extent; but it remains with you only to raise the barrier. APPENDIX. WHEN I first turned my attention to the nursing and management of children, the late Dr. Cadogan's pamphlet on that subject fell into my hands. I perused it with great pleasure, but soon lost it : and though I have been in quest of it for above forty years, I never could set my eyes upon it till within these few days ; which makes me conclude that it is out of print. That so valuable a fragment may not be lost, I shall insert the principal part of it in this Appendix ; and I hope it will render the book more extensively useful, and at the same time, tend to corroborate my sentiments concerning mothers. " In my opinion," says the ingenious writer whom I am now quo- ting, " the business of nursing has been too long fatally left to the man- agement of women, avIio cannot be supposed to have proper knowledge to fit them for such a task, notwithstanding they look upon it to be their own province. What I mean is, a philosophic knowledge of nature, to he acquired only by learned observation and experience, and Avhich therefore the unlearned must be incapable of. They may presume upon the examples and transmitted customs of their great grandmothers, Avho were taught by the physicians, of their unenlightened days ; when phy- sicians, as appears by late discoveries, Avere mistaken iu many things, be- ing led away by hypothetical reasonings to entertain very wild conceits, in which they were greatly bewildered themselves, and misled others to believe I know not Avhat strange unaccountable powers in certain herbs, roots, and drugs; and also in some superstitious practices and ceremonies; for all which notions their being no foundation in nature, they ought to be looked upon as the effects of ignorance, or the artifices of designing quacks, who found their account by pretending to gre^t knowledge in these occult qualities, and imposing upon the credulous. The art of phy- sic has been much improved Avithin this last century : by observing and following nature more closely, many useful discoveries have been made, which help us to account for things in a natural way, that before seemed mysterious and magical, and which have consequently made the practice of it more conformable to reason and good sense. This being the case, there is great room to fear, that those nurses, who yet retain many of these traditional prejudices, are capitally mistaken in the management of chil- dren in general, and, fancying that nature has left a great deal to their skill and contrivance, often do much harm where they intend to do good* Of this I shall endeavour to convince them, by sheAving how I think chil- dren may be clothed, fed, and managed, with much less trouble to their nurses, and infinitelv greater ease, comfort, and safety, to the little ones. " When a man takes upon him to contradict received opinions and prejudices sanctified by time, it is expected he should bring valid 104 AFPEXDI-X. proof of what he advances. The truth of what I say, that the treat- ment of children in general is Avrong, unreasonable and unnatural, will in a great measure appear, if -e but consider what a puny valetudinary race most ol our people of condition are, chiefly owing to bad nursing, and bad habits contracted early. But let any one who would be fully convinced of this matter, look ever the Bills of Mortality. There he may observe, that almost half the number of those who fill up that black list, die under five years of age: so that half the people that come into the world, go out o: it again before they become of the least use to it, or* themselves. To me this seems to deserve serious consideration; and yet I cannot find that any one man of sense and public spirit has ever attend- ed to it all: notwithstanding the maxim in every one's mouth, that a multitude of inhabitants is the greatest strength and best support of a commonwealth. The misconduct, to Avhich I must impute a great part of the calamity, is too common and obvious to engage the idle and spe- culative, who are to be caught only by very refined researches; and the busy part of mankind, Avhere their immediate interest is not concerned, will always overlook what they see daily : it may be thought a natural evil, and so is submitted to Avithout examination. But this is by no means the case; and where it is entirely owing to mismanagement, and possibly may admit of a remedy, it is ridiculous to charge it upon na- ture, and suppose that infants are more subject to disease and death, than grown persons; on the contrary, they bear pain aud disease much better, fevers especially (as is plain in the case of the small-pox, gene* rally most favourable to children), and for the same reason that a twig is Ices hurt by a storm than au oak. In all the otlier productions of na- ture, we see the greatest vigour and luxuriauce of health, the nearer they are to the egg or the bud ; they are indeed most sensible of injury, and it is injury only that destroys them. When was there a lamb, a bird, or a tree that aied because it was young? These are under the immedi- ate nursing of unerring nature, and they thrive accordingly. Ought it not therefore to be the care of every nurse aud eveiy parent, not only to protect their nurslings from injury, but to be well assured that their ov. n officious services be not the greatest the helpless creatures can suffer. " In the loArer claes of mankind, especially in the country, disease and mortality are not so frequent, either among the adults or their child- ren. Health and posterity are the portion of the poor, I mean the la- borious. The ivant of superfluity confines them more within the limits of nature : hence they enjoy blessings they feel not, and are ignorant of their cause. The mother, who has" only a few rags to cover her child lco^ely, and little more than her own breast to feed it, sees it healthy and s'rong, and very soon able to shift for itself; while the puny insect, the heir and hope of a rich family, lies languishing under a load of finery tint overpov.ers bi= limbs, abhorring and rejecting the d inties he is rmmmed wi h, t'll he dies a viciim to the mVakeu care and tenderness of bis fond mother. In the course of my practice, I have had frequent occasion to be fully satisfied of th;s; and have often heard a mother anxi- ously say, the child has not been well ever since it has done puking and crying. These complaints, though not attended to, point very plainly to tbe:r cause Is it not veiy evident when a child rids its stomach several times in a day, tha* it has been overloaded ? When it cries, ftpm the incumbrance and confinement of its clothes, tliat it is hurt by APPENDIX. 105 Ihem ? While tlie natural strength lasts, (as every child is born with more health and strength than is generally imagined,) it cries at or re- jects the superfluous load, and thrives apace ; diat is, grows very fat, bloated, and distended beyond measure, like a house-iamb. But in time, the same oppressive cause continuing, the natural powers are overcome, being no longer able to throw off the unequal weight; the child, now not able to cry any more, languishes and is quiet. The misfortune is, these complaints are not understood; it is swaddled and crammed on, till, after gripes, purging, &c. it sinks under both burdens into a convulsion- fit, and escapes any farther torture. This would be the case with the lamb, were it notkilhd when full fat. " That the present mode of nursing is wrong, one would think need- ed no other proof than the frequent miscarriages attending it, the death of many, and ill-health of those that survive ****. What I am going to complain of is, that children in general are over-clothed and over- fed ; and fed and clothed improperly. To these causes I impute almost all their diseases. But to be a Itttle more explicit. The first great mis- take is, that they think a new-born infant cannot be kept too warm : from this prejudice they load and bind it with flannels, wrappers, swathes, stays, &c. which altogether are almost equal to its own weight; by which means a healthy child in a month's time is made so tender and chilh, it cannot bear the external air; and it; by any accident of a door or a window left carelessly open too long, a refreshing breeze be admit- ted into the suffocating atmosphere of the lying-in bed-chamber, the child and mother sometimes catch irrecoverable cold,: but, what is worse than this, at the end a month, if things go on apparently well, this hot-bed plant is sent out into the country to be reared in a leaky house, that lets iu wind and rain at every quarter. Is it any wonder the child never thrives afterwards ? The truth is, a new-born intant cannot well be too cool and loose in its dress: it wants less clothing than a grown per- son in proportion, because it is naturally warmer as appears by the ther- mometer, and would therefore bare the cold of a winter s night much better than any adult person whatever. There are many instances both andent and modern, & infants exposed and deserted, that have lived several days ; as it was the practice in ancient times, in many parts of S world,*to expose all whom the parents did not care to be encumber- ed avUI hat were deformed or born under evil stars; not to mention the many foundings picked up in London streets These instances may Sve toyshew, tha" nature has made children able to bear even great hardens before they are ma !e weak and sickly by their-mistaken nur- sesBut: berides tl/mischief arising from the weight and heat of these wad£e^» , * a§ ^ fibres of mf;ints arc so t„ral swellings n some h , espeaa y^ ^ ^ «.*r..r nine 'n this particular than the men. > If nurses were capable of making just observations, they might see |06 APPEND!*:. and take notice of that particular happiness, Avhich a child shews by all it6 powers of expression, when it is nearly undressed. How pleased, how delighted it is with this new liberty, wheu indulged for a lew minutes with the free use of its legs and arms ! But this is not to last long : it is waddled up as before, uotwitfotaudiug its cries and complaints. '' I Avould recommend the following dress: a little flannel waistcoat, without sleeves, made to fit the body, and tie loosely behind ; to which there should be a petticoat scAved, and over this a kind of gown of the same material, or any other that is light, thin, and flimsy. The petti- coat should not be quite so long as the child, the goAvn a lew iuches lon- ger ; Avith oue cap only on the head, which may be made double, if it be tiiought not warm enough. What I mean is, that the whole coifi'urc should be so contrived, that it might be put on at once, and neither bind nor press the head at all : the linen as usual. This I think Avould be abun- dantly sufficient (or the day ; laying aside all those swathes, bandages, stays, and contrivances, that are most ridiculously used to close and keep the head in its place, and support the body. As if natuie, exact nature, had produced her chief work, a human creature, so carelessly unfinished as to Avant those idle aids to make it perfect. Shoes and stockings are very needless incumbrances, besides that they keep the "legs Avet and nasty if they are not changed every hour, and often cramp and hurt the feet: a child would stand firmer, and learn to walk much sooner, Avithout them. I think they cannot be necessary till it runs out in the dirt. There should be a thin flannel shirt for the night which ought to be every Avay quite lose. Children in this simple, plea- sant drees, which may be readily put on and oft* without teazing them, would find themselves perfectly easy and happy, enjoying the free use of their limbs and faculties, which they Avould very soon begin to employ when thus left at liberty. I would have them put into it as soon as they are born, and continued in it till they are three years old; when it may be changed for any other more genteel and fashionable: though I could wish it was not the custom to wear stays at all; not because I see no beauty in the sugar-loaf shape, but that I am apprehensive it is often pro- cured at the expense of the health and strength of the body. There is an odd notion enough entertained about change, antl the keeping of children clean. Some imagine that clean linen and fresh clothes draw, and rob them of their nourishing juices; I cannot see that they do anything more than imbibe a little of that moisture Avhich their bodies exhale. Were it, as is supposed, it would be of service to them; since they are'always too abundantly supplied, and therefore I think they cannot be changed too often, and Avould have them clean every day; as it would free them from stinks and sournesses, which are not only offensive, but very Preiu- dicinl to the tender state of infancy. " The feeding of children properly, is of much greater importance to them than their clothing. We ought to take great care to be right in this material article and that nothing be given them but what is whole some and good for them, and in such quantity as the body calls for to- wards its support and growth; not a grain more—Let us consider what nature directs in th* case : if we follow nature, instead of loading or dmnng it, we cannot err In the business of nursiug, as well as physic art is ever des mctive, if it does not exactly copy this original. When * child is first born, thtre seems to be no provision at all made for it" APPENDIX. 107 for the mother's milk, as it is now managed, seldom comes till the third day; so that according to this appearance of nature, a child would be left a day and a hall, or two days, Avithout any food. Were this really the case, it would be a sufficient proof that it wanted none; as indeed it does not immediately; for it is born foil of blood, full of excrement, its appetites not awake, nor it senses opened; and requires some inter- mediate time of abstinence and rest to compose and recover the struggle of the birth, and the change of circulation (the blood running into neAT channels) which always put it into a little fever. However extraordina- ry this might appear, I am sure it Avould be better that the child was not fed even all that time, than as it generally is fed, for it would sleep the greatest part of the time, and, when the milk Avas ready for it, Avould be veiy hungry, and suck with more eagerness; which is often necessary for it seldom comes freely at first. But let me endeavour to reconcile ibis difficulty, that a child should be born thus apparently unprovided for : I say apparently, for in reality it is not so. Nature neither intent ded that a child should be kept so long fasting, nor that we should feed it for her. Her design is broke in upon, and a difficulty raised that is Avholly owing to mistaken management.—The child, as soon as it is born, is taken from the mother, and not; -iffered to suck till the milk comes of Itself; but is either fed Avith strange and improper things, or put to suck some other woman, whose milk flowing in a full stream, overpoAvers the neAV born-infant, that has not yet learned to SAvallow, and sets it a coughing, or gives it a hickup: the mother is left to struggle with the load of her milk, unassisted by the sucking of the child. Thus two great evils are produced, the one a prejudice to the child's health, the other the danger of the mother's lite; at least the retarding her recovery, by causing what is called a milk fever; which has been thought to be natural, but so far from it, that it is entirely owing to this misconduct. I am confi- dent from experience, that there would be no fever at all, Avere things managed rightly; Avere the child kept Avithout food of any kind till it was hungry, which it is impossible it should be just after the birth, and then applied to the mother's breast: it would suck with strength enough, after a few repeated trials, to make the milk flow gradually, in due pro- portion to the child's unexercised faculty of swallowing, and the call of its stomach. Thus the child Avould not only provide for itself the best of nourishment, but, by opening a free passage for it, would take off the mother's load, as it increased, before it could oppress or hurt her ; and therefore effectually prevent the fever, which is caused only by the painful distension of the lacteal vessels of the breasts, when the milk is injudiciously suffered to accumulate. Here let me describe a case of pure nature, in order to illustrate this material point yet farther. When a healthy young woman lies in of her first child, before the operations of nature have been perverted by any absurd practices, her labour would be strong, and, as I have chosen to instance in the case of a first child, perhaps difficult; but in a few minutes after her delivery, she and her child, if it be not injured, would fall in a SAveet sleep of six or seven hours : the mother, if no poisonous opiate has been unnecessarily given her, would awake refreshed, the child hungry. A little thin broth with bread, or some such light food, should be then given her; and soon after the child be put to suck. In one hour or two the milk would infallibly floAv; and, if nothing else be given it, the child would grow strong, and 108 APPENDIX. she recover perfectly in a few days. This is the constant course of na- ture, which is very little attended to, aud never followed. The general practice is, as soon as a child is born, to cram a dab of butter and sugar down its throat, a little oil, panada, caudle, or some such unwholesome met*. So that they set out wrong, and the child stands a fair chance of being made sick from the first hour. It is the custom of some to give a little roast pig to an infant, which, it seems, is to cure it of all the moth- er's longings. Much no.isense has been propagated, and believed, about women's longings, wUhout any foundation in truth and nature. I ivish these matters were a little more inquired into for the honour of the sex to which many imperfections of this kind are imputed, Avhich I am sure it does uot lie under. "Hence I may be asked, what is to be done with a child born sick, tliat, instead of sleeping, cries incessantly from the birth, and is hardly to oe quieted by any me.uis? Let good care be taken that it is not hurt by the dressing, or rather le: it not be dressed at ail, but wrapped up in a loose flannel. If, notwithstanding this precaution, it still continues cry- ing : instead of feeding it, for it is certainly a preposterous thing to think of feeding a child because it is sick, though possibly this may stop its mouth for a little Avhile, let it be applied to the mother's breast, perhaps it may bring the milk immediately, which would be the best mediciue for it in such a case ; or the nipple in its mouth may quiet it, though it does not bring it.—And it is certainly better it should be quieted Avithout food than with it, which must necessarily make it worse. Sometimes in- deed the child may be so very ill, that it will not even attempt to suck. In such a case, which 1 think can happen but rarely, let the physic I shall recommend a little farther on, where children are unavoidably to be dry-nursed, be given, a little every hour, till it takes effect, still attempt- ing to bring it to suck the mother's milk, which is the best physic or food it can take. " When a child sucks its own mother, which, with a very few excep- tions, would be best for every child and every mother, nature has provi- ded it with such wholesome and suitable nourishment, supposing her a temperate Avoman that makes some use of her limbs, it can hardly do amiss. The mother Avould likewise, in most hysterical nervous cases, establish her own health by it, though she Avere weak and sickly before, as Avell as that of her offspring. For these reasons I could wish, that every woman that is able, Avhose fountain are not greatly disturbed or tainted, would give suck to her child. I am very sure that forcing back the milk, which most young women must have in great abundance, may he of fatal consequence: sometimes it endangers life, aud often lays the foundation of many incurable diseases. The reasons that are given for this practice are Aery frivolous, and drawn from false premises; that some women are too weak to bear such a drain, which would rob them of their own nourishment. This is a very mistaken notion; for the first general cause of most people's diseases is, not want of nourishment, as is here imagined, but too great fulness and redundancy of humours; good at first, but being more than the body can employ or consume, they stag- nate, degenerate, and the Avhole mass becomes corrupt, and produces many diseases. This is confirmed by the general practice of physicians, ivho make holes in the skiu, perpetual blisters, isues, &c. to let out the superfluity. I would therefore leave it to be considered, whether thf APPENDIX. 1Q9 throAving back such a load of humour, as a woman^first milk be most likely to mend her constitution, or "make her compfljnt irremedia* ble. The mother's first milk is purgative, and cleanses the child of its loug-hoarded excrement; no child, therefore, can be deprived of it with- out manifest injury. By degrees it changes its property, becomes less purgative and more nourishing; and is the best and only food the child likes, or ought to have for some time. If I could prevail, no child should ever be crammed with any unnatural mixture, till the provision of nature was ready for it; nor afterwards fed with any ungeuial alien diet whatever, at least for the first three months: for it is not well able to digest and assimilate other aliments sooner. I have seen very healthy fine childreu, that never ate or drank any thing whatever but the mother's milk for the first ten or twelve months. Nature seems to direct this, by giving them no teeth till about that time. There is usually milk enough with the first child; sometimes more than it can take: it is poured forth from a.i exuberant, overflowing urn, by a bountiful hand that never provides sparingly. The call of nature should be waited for to feed it with any thing more substantial, and the appetite ever precede the food ; not only with regard to the daily meals, but those changes of diet, which opening, increasing life requires. But this is never done in either case, which is one of the greatest mistakes of all nurses. Thus far nature, if she be not interrupted, will do the whole business perfectly well ; and there seems to be nothing left for a nurse to do, but to keep the child clean and sweet, and to tumble and toss it about a good deal? play Avith it, and keep it in good humour. " When the child requires more solid sustenance, Ave are to inquire what, and how much is most proper to give it. We may be well assu- red there is a great mistake either in the quantity or quality of children's food, or both, as it is usually given them; because they are made sick by it; for to this mistake I cannot help imputing nine in ten of all their dig* eases. As to the quantity, there is a most ridiculous error in the common practice; for it is generally supposed, that, whenever a child cries, it wants victuals; and it is accordingly fed ten, twelve, or more times, in a day and night. This is so obvious a misapprehension, that I am sur- prised it should ever prevail. If a child's Avants and motions be dili- gently and judiciously attended to, it will be found that it never cries but from pain: now the first sensations of hunger are not attended with pain: accordingly a child (I mean this of a veiy young one) that is hungry, will make a hundred other signs of its want, before it will cry for food. If it be healthy and quite easy in its dress, it will hardly ever cry at all. I ideed these signs and motions I speak of are but rarely to be observed; because it seldom happens that children are ever suffered to be huugry. In a few days, very few, whom I have had the pleasure- to see reasonably nursed, that were not fed above two or three times in four and twenty hours, and yet Avere perfectly healthy, active, and hap- py, I have seen these signals, which Avere as intelligible as if they had spoken. " There are many faults in the quality of their food : it is not simple enough. Their paps, panadas, gruels, &c. are generally enriched Avith sugar, spice, and sometimes a drop of Avine, neither of which they ought ever to taste. Our bodies never Avant them : they arcAvhat luxury only has introduced, to tiie destruction of die health of mankind. It is not 110 APPENDIX. enough that their food be simple, it should be ako light. Several peo- ple I find, are mistaken in their notions of Avhatis light; and fancy that most kinds of pastry, puddiugs, custards, &c. are light, that is, light of digestion. But there is nothing heavier in this seuse than unfermented flour and eggs boiled hard, Avhich are the chief ingredients of those pre* parations. What I mean by light, to give the best idea I can of it, is any substance that is easily separated, and soluble in warm water. Good bread is the lightest tiling I know; the power of due fermentation, in which consists the Avhole art of making it, break and attenuates the tena- cious particles of the flour so as to give it these qualities I mention, and make it the fittest food for young children. Cow's milk is also simple aud light, and very good for them : but it is injudiciously prepared; it should not be boiled ; for boiling alters the taste and property of it, destroys its sweetness and makes it thicker, heavier and less fit to mix and assimilate with the blood. But the chief objection is, that their food is wiiolly veg- etable, the bad consequence of which is, that it will turn sour in their stomachs. The first and gener.d cause of all the diseases of infants is manifestly this acescent quality of all their food. If any of these veg- etable preparations I have named, be kept in a degree of heat equal to that of a child's stomach, it will become sour as vinegar in a few hours time. These things are therefore very improper to feed a child wholly with. Some part of its diet should be contrived to have a contrary ten- dency; such as Ave find only in flesh, which is the direct opposite to acid and tends to putrefaction. In a due mixture of these two extremes, cor- recting each other, consists that salubrity of aliment our nature seems to require. As we are partly carnivorous animals, a child ought not to be fed wholly upon vegetables. The mother's milk, ivhen it is perfectly good, seems to be this true mixture of the animal and vegetable proper- ties that agrees best with the constitution of a child, readily passes into good blood, requiring but a gentle exertion of the powers of circulation. to break and subdue its particles, and make them smooth and round, and easily divisible. I would advise therefore, that one half of an infant's diet, be thin light broths, with a little bread or rice boiled in them; which last is not so acescent as any other kind of meal or flour. These broths should be made with the flesh of full-groAvn animals, because their juices are more elaborate; especially if they have never been confined to be fat- ted. The juices of a young ox, taken from the plough, make the finest flavoured aikl most Avholesome soup. I believe it is for the same reason, the flesh of ail wild animals has a higher taste than that of tame, sagina- tecl ones, and is therefore most agreeable to the palate of the luxurious; but this is to be understood of those creatures that feed on corn or herbage. The other part of children's diet may be a little toasted bread and water boiled almost dry, and then mixed with fresh milk not boiled.* This, without sugar, spice, or any other pretended amendment whatever, would be perfectly light and wholesome, of sufficient nourishment, something like milk from the cow, with the additional strength and spirit of bread in it. * The London bakers are suspected of putting alum in their bread, which would be very pernicious to infants. Therefore rusks, or the biscuits called tpps-and-bottoms, or rice, may be used instead of it. These will not turn sour so soon a9 common bread ; which quality is undoubtedly an objection to using much of it, especially when children are weakly. The safest and best method in my opinion is, not to feed them at all; at least till they are six or eight months old. The finest children I ever saw lived Arholly upon sucking till after thaf age. APPENDIX. HI Twice a-day, and not oftener, a sucking child should be fed at first; once with the broth, and once with the milk thus prepared. As to the quantity at each time, its appetite must be the measure of that. Its hunger should be satisfied, but no more; for children will always eat with some eager- ness full as much as they ought: therefore it must be very wrong to go beyond that, and stuff them till they spew, as the common method is. They should not ue laid on their backs to be fed, but held in a sitting posture, that swalloAving may be easier to them, aud that they may the more readily discover when they have had enough. WThen they come to be about ten or twelve months old, and their appetite and digestion groAVS strong, they may be fed three times a-day; which I think they ought never to exceed their whole lives after. By night I would not have them fed or suckled at all, that they might at least be hungry in a morning. It is this night-feeding that makes them so over-fat and bloated. If they be not used to it at first, and, perhaps, aAvaked on purpose, tbey will never seek it; and if they are not disturbed from the birth, in a week's time they will get into a habit of sleeping all or most part of the night very quietly, aAvaking possibly once or twice for a few minutes, when they are wet, and ought to be changed. Their meals, and, in my opinion, their sucking too, ought to be at stated times, and the same every day ; that the stomach may have intervals to digest, and the appetite return. The child would soon be quite easy and satisfied in the habit; much more so than when taught to expect food at all times, and at every little fit of cry- ing or uneasiness. Let this method be observed about a twelve-month, when, aud not before, they may be weaned ; not all at once, but by in- sensible degrees, that they may neither feel, nor fret at, the want of the breast. This might be very easily managed, if they were suffered to suck only at certain times. Were this plan of nursing literally pursued, the children kept clean and SAveet, tumbled and tossed about a good deal, and carried out every day in allAveathers,I am confident, that, in six or eight months time, most children Avould become healthy and strong, would be able to sit upon the ground without support, to divert themselves an hour at a time, to the great relief of their nurses ; would readily find the use of their legs, and very soon shift for themselves. ««If it be asked, whether I mean this of children in general, and that weakly ones, born of unhealthy parents, should be treated in the same manuer, I answer, that it is not so common for children to inherit the dis- eases of their parents, as is generally imagined : there is much vulgar er- ror in this opinion; for people that are very unhealthy seldom have chil- dren, especially if the bad health be on the female side ; and it is gen- erally late in life when chronic diseases take place in most men, Avhen the business of love is pretty well over : certainly children can have no title to those infirmities which their pareuts have acquired by indolence and intemperance long after their birth. It is not common for people to complain of ails they think hereditary, till they are grownup: that is, till they have contributed to them by their own irregularities and excesses, and then are glad to throw their own faults back upon their parents, and lament a bad constitution when they have spoiled a very good one. It is very seldom that children are troubled Avith family distempers. Indeed, when we find them affected with scro- phulous or venereal complaints, we may reasonably conclude the taint (o have been transmitted to them; but these cases are very rare, in compa- 112 APPENDIX. rison of the many others that are falsely, and without the least foundation, imputed to parents: when the real cause is either in the complainants themselves, or bad nursing, that has fixed them early in bad habits. la one sense, many diseases may be said to be hereditary, perhaps all those of malformation, by which I mean not only deformity aud distortion, but all those cases where the fibres and vessels of one part are weaker in proportion than the rest; so that upon any strain of d;e body, whether of debauch or too violent exercise, the weak part fails first, and disor- ders the whole. Thus complaints may be produced similar to those of the parent, owing in some measure to the similitude of parts, Avhich pos- sibly is inherited like the features of the face; but yet these diseases might never have appeared, but for the immediate acting cause, the vio- lence done the body. Most distempers have two causes : the one, a par- ticular state of the solids and fluids of the body, which dispose it to re- ceive ceraininfections and impulses; the other, the infection or impulse itself. Now Avhat I contend for is, that though this predisponent state or habit of body be heritable, yet the diseases incident to these wretched heirs mav be avoided by preventing the active cause: which may be done in many cases by a due attention to the non-naturals, as they are called; iu plainer words, by a temperate, active life; in children, by good nursing. Therefore, 1 conclude, that, instead of indulging and en- feebling yet more by the common methods, children so unhappily born what I am recommending, together with the wholesome milk of a heal- thy nurse, is the best, the only means to remedy the evil, and by which alone they may by degrees be made healthy and strong. And thus, in a genera ion or two of reasonable temperate persons, every ta'oung, and more and better than the old. But what," he thinks, " of the utmost conse- quence is, that regard should be had to the time of their 1) ing-in, and those procured, if possible, Avho have not been brought to bed above two or three months." He justly observes, that " nature intending a child should suck about a twelve-month, the milk seldom continues good much longer;" and he adds, with a still greater degree of evidence, " that if a new-born infant be deprived of its own mother's milk, it ought undoubt- edly to have what is most like it: the newer it is, the more suitable in all respects to its tender n.xture." ****** After censuring a very common practice with poor women, who, it they can get nurse-children, will suckle two or three of them successive- ly with the same milk, he proceeds thus: " A nurse ought to have great regard to her diet: it is not enough that she be sober and temperate; her food should consist of a proper mixture of flesh and vegetables : sue should eat one hearty meal of unsalted fleeh-meat every day, w ith a good deal of garden-stuff, and a little bread. Thin broth or milk would be best for her breaVfast and supper. Her drink should be small-beer, or milk and water; but on no account should she ever touch a drop ol wine or strong drink, much less any kind of spirituous liquors: giving ale or br»ndy % a nurse is, in cflft cf. giving it to the child ; and it is^easy to conclude what Avould be the resequence. » This equallv candid and judico.is writer does not enter u; on his promised description of the trea'me:.t proper for children pit* out to nurse, without again reminding his readers, that the pl-n. which he Wild lay down, could he prevail, would be that of nature, excluding art 1T4' APPENDIX. and foreign aid entirely. "tBut," he adds, " when this is broke in upon, a little adventitious skill becomes indispensably necessary; that, if we are not perfectly right in folfovTing closely the design of nature, we may co-operate a little, and not be totally wrong in counteracting it, as is often the case. What I mean is, that every child, not allowed the mother's first milk, whether it be dry-nursed or suckled by another wo- man, should be purged in a day or two after the birth, and this purging continued for some time; not by regular doses of physic that may ope- rate all at once, but some lenient laxatives should be contrived, and given two or three times a-day, so as to keep the child's body open for the first nine days, or a night ; lessening the quantity insensibly, till it be left off. It should be so managed, that the operation of the ar- tificial physic may resemble that of the natural. This is so material, that, for want of it, most children in the first month break out in pim- ples all over : the nurses call it red-gum, and look upon it to be a natu- ral thing, and that the children Avill be unhealthy who have it not. So indeed they will be in all likelihood : and it is better that these foulnesses, which become acrid and hot by remaining too long in the body, should be discharged through the skin, than not at all: or that they should be lodged in the blood, or fall upon the vitals, to lay the foundation of numberless future evils; but it is chiefly owing to the neglect of this method at first. A child that sucks its own mother, unless it be greatly over-fed, or kept too hot, will never be troubled with this humour at all.'y The following is the form of the gentle purgative Avhich the Doctor recommends to such infants as have been deprived of the salutary opera- tion of their mother's milk : " Take manna, pulp of cassia, of each half an ounce : dissolve them iti about three ounces of thin broth. Let the child take tAvo spoonsful three times a-day, varying the quantity according to the effect; Avhich, at first, ought to be three or four stools in four-and-twenty hours." Among other rules for the conduct of hired nurses, this experienced physician particularly enjoins such women " to keep the children awake by day, as long as they are disposed to be so, and to amuse and keep them in good humour all they can ; not to lull and rock them to sleep, or to continue their sleep too long; which is only done to save their own time and trouble, to the great detriment of the children'3 health, spirits, and understanding." * # # * # Here he refers to his former ob- servations on the changes to be gradually made in the diet of children, Avhen they come to require more solid sustenance than breast-milk; and he takes occasion to introduce the following remarks : '; A child may be allowed any kind of mellow fruit, either raw, stew- ed, or baked, roots of all sorts, and all the produce of the kitchen-garden. I am sure all these things are wholesome and good for them, and every one else, notwithstanding the idle notion of their being windy, which they are only to very debauched stomachs; and so is milk: but no man's blood wants the cleansing, refreshing power of milk, more than his, whose stomach, used to inflammatory things of high relish, will not bear the first chill of it. To children, all this kind of food, taken in moderation, is perfectly grateful and salutary. Some may think that they carry into the stomach the eggs of future worms : but of this I am not very apprehensive; for I belieA'e there are few things we eat or drink that do not convey them. But then they can never be hatched in a healthy in. Ue, Avhe;e all the juices are sweet and g^od -•«*] every APPENDIX. 115 gland performs its office: the gall, in particular, would destroy them; bullock's gall has been found to be a good and safe vermifuge. It is my opinion, we swallow the eggs of many little animals, that are never brought to life within us, except where they find a fit nest or lodgment ia the acid phlegm or vitiated humours of the stomach and bowels. Were these totally discharged every day, and the food of yesterday employed in nourishment, and the superfluity thrown off to the last grain, no worms could ever breed or harbour in our vitals. As soon as the chil- dren have any teeth, at six or eight mouths, they may by degrees be used to a little flesh-meat; which they are always very fond of, much more so at first, than of any confectionary or pastry Avares, with which they should never debauch their taste." I have elsewhere enlarged on the fatal effects of these palatable poisons^ aud I am not without hopes that tender and rational mothers will pay some little attention to my warnings. A reform in this article alone__• the total disuse of pastry in the diet of young children—will go a great way towards preventing many of the worst complaints to which they are- subject. From the above remarks on the proper food of infants, the Doctor makes a very natural transition to the consideration of their diseases. He begins with exposing the absurdity of popular errors and popular preju- dices with respect to teething. " Breeding teeth," he says, " has been thought to be, and is fatal to many children; but I am confident this is not from nature, for it is no disease, or we could not be well in health till one or two-and-twenty, or later. Teeth are breeding the greatest part of that time; and it is my opinion, the last teeth give more pain than the first, as the bones and gums they are to pierce are groAvn more firm and hard. But, Avhatever fever, fits or other dangerous symptoms seem to attend this operation of nature, healthy children have sometimes bred their teeth without any 6uch bad attendants; Avhich ought to in- cline us to suspect the evil not to be natural, but rather the effect of too great a fulness, or the corrupt humours of the body put in agitation by the stimulating pain the tooth causes in breaking its Avay out. This, I believe, never happens without some pain, and possibly a little fever ; but if the blood and juices be perfectly sweet and good, and there be not too great a redundancy of them, both will be but slight, and pass off imperceptibly, Avithout any bad consequence Avhatever, The chief intention of the method I am recommending is, to preserve the humours of the body in this state; and therefore, if it succeeds, children so managed will breed their teeth with less pain and danger then are commonly observed to at- tend this work of nature." In support of this opinion, I can state from my OAvn experience that I have never known cutting the teeth, as it is called, attended with any pain, of an alarming nature, except in cases of previous disease, mis- management or bad nursing. Fevers, con vail sion-fits, and other dange- rous symptoms, are always, upon such occasions, the consequences of an extreme fulness of the habit, a vitiated state of the blood and juices-, some constitutional weakness, or a great irritability of the nervous sys-J tern. The use also of corala, and the like hard substances, by render- in"- the gums callous, must oppose additional resistance to the bursting tooth, and greatly increase the acutenes.- of the pain. But the doctor's text requires no comment. I shall therefore resume my Quotation from hfe valuable pamphltt. 116 APPENDIX. " As I have said,w continues he, " that the first and general cause of most of the diseases infants are liable to, is the acid corruption oi their food, it may not be amiss just to mentiou au easy aud certain remedy, or rather preveutive, if g ven timely, at the first appearance of predom- inating acid; whicli is veiy ubv iou-, from the v rude white or green stools, gripes and purging* occasioned by it. The common metho 1 when these symptoms appea , i* to give the pearfjulep, crabs eyes and the testace- ous powders; which, though they do absorb the acidities, have this incon- venience in their effect, that they are apt to lodge in the body, and bring on a costiveness very detrimental to iufauts, aud therefore require a liule manna, or some geutie purge, to be given frequently to carry them off. Instead of these, I would recommend a certain fine insipid powder, caied, magnesia alba, Avhich, at the same time it corrects and sweetens all sournesses rather more effectually than the testaceous pov*deis, is like- wise a lenient purgative, and keeps the body gently o^en. This is the only alkaline purge I know of, and which our dispensatories have long wanted. I have taken it myself and given it to others, for the heart- burn, and find it to be the best and most effectual remedy for thai com- plaint. It may be given to children from one to two drani6 a-day, a little at a time in all their food, till the acidities be quite overcome, and the concomitant symptoms disappear entirely. I have often given it with good and great effect, even when the children have been far gone in d seases first brought on by prevailing acid. " It is always easier to prevent diseases than to cure them; aud as neither children, nor indeed grown persons, are ever seized with chronic diseases suddenly, the progress of decaying health being perceptibly gradual, it is no difficult matter for a physician of common skill to ob- serve the first step toAvards illness, and to foretell the consequence, in all those whose habit of life is well known to him. But to parents and nur- ses in general, these observations may not occur. I will therefore point out a few certain signs and symptoms, by which they may be assured, that a child's health is decaying, even before it appears to be sick. If these are neglected, the evil increases, grows from bad to worse, and more violent aud apparent complaints will follow, and perhaps end in in- curable diseases, which, a timely remedy, or a slight change in the diet and manner of life, had infallibly prevented. The first tendency to dis- ease may be observed in a child's breath. It is not enough the breath be not offensive: it should be SAveet aud fragrant like a nosegay of fresh flowers, or a pail of new milk from a young cow that feeds upon the sweetest grass of the spring; and this as well at first waking in the morn- ing, as all day long. It is also so with children that are in perfect d