intljeCttpoflfttigork College of ^ljj»s;ician£f anb ^urgeong Ilibrarp ^:^ Digitized by the Internet Arciiive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/newillustratedhoOOkenn ^^/7.J F,,^. I tt i 8g i 87 -t NEW EDITION. THE NEW ILLUSTRATED HOUSEHOLD BOOK OF MEDICINE. BEING A TREATISE IN PLAIN LANGUAGE ON THE PRE- VENTION AND CURE OF DISEASES BY REGIMEN AND SIMPLE MEDICINES, WITH FULL DIRECTIONS IN REGARD TO Air, Exercise, Bathing, Clothing, Sleep, DIET, ETC. ETC. GENERAL MANAGEMENT OF THE DISEASES OF WOMEN AND CHILDREN, TO WHICH HAS BEEN ADDED A COMPLETE FAMILY DISPENSAEY FOK THE USE OF PRIVATE PRACTITIONERS, FAMILIES, SEAFAEERS& MINERS. KEVISED FBOM BUCHAN'S FAMOUS DOMESTIC MEDICINE. OF WHICH OVER 100,000 COPIES HAVE BEEN SOLD. WM. C. KENNEDY, M. D. District Physician to the New York Lying-in Asylum for Women, Fellow of the New York Academy of Medicine, Etc. Etc. NEW YORK: FEANKLIN PUBLISHING CO. 104 Chambers Street. 1891. rr^T'^s^^^ Copyright, 1891, Franklin Publishing Co, PUBLISHER'S INTRODUCTION. In an age when the Arts and Sciences, once confined to a few, have become subjects of general inquiry; when everything in nature, above, around, below us, is searched out, analyzed, combined and applied to a practical use, it is remarkable how little of interest is manifested in the important knowledge of our physical organization, the laws of health and disease and those antidotes whereby they may be counteracted. Submerged it is true in the various pursuits of daily life, it is not to be expected that every one should find time and opportunity for the attainment of a perfect acquaintance with all the complicated details of Medical Science; but it by no means follows that the people at large should be in ignorance on a subject bearing so closely on the comforts, happiness and extension of human life. This is more inexcusable when the most prevalent forms of disease and their best established and most appropriate remedies may be brought within the compass of a single volume and made plain and familiar to the ordinary reader. Such is the merit claimed for Dr. Ken- nedy's revised Edition of the " New Household Book of Medicine." It may be urged that works of a similar nature are already before the public. This is not denied. But most of these publications are liable to objections. Many of them are old, written previous to some of the most important of modern medical discoveries ; they are behind the age, and although some are not without merit, the remedies therein proposed have been superseded by those found to be more efficacious, other works intended chiefly for the profession are too abstruse and technical to be readily understood and comprehended by the general reader, while many have been written by incompetent persons, whose assertions and theories are altogether unsustained by facts of experience or science. The work now offered to the public is free from all these objections. It has been written by an experienced practitioner in a clear and comprehensive style especially adapted to the general reader, and is a work of intrinsic merit which recommends itself to the confidence of the community. r rl I INTRODUCTION. The improvements in medicine, since the revival of learning, have only in part kept pace with those of the other arts. The reason 18 obvious. Medicine has been studied by few, except those who in- tended to live by it as a busineiss. Such, either from a mistaken zeal for the honour of medicine, or to rai; cry universally studied by all who pretended to a liberal education. The advantages of this are manifest. It frees the mind from preju- dice and superstition ; fits it for the investigation of truth ; indu- ces habits of reasoning and judging properly ; opens an inexhaust- ible source of entertainment ; paves the way to the improvement of arts and agriculture ; and qualifies men for acting with propriety in the most important stations of life. Natural History has likewise become an object of general atten* tion ; and it well deserves to be so. It leads to discoveries of the greatest importance. Indeed agriculture, the most useful of all arts, is only a branch of Natural History, and can never airive a^ a high degree of improvement where the study of that science neglected. Medicine, however, has not, as far as I know, in any countr^ been reckoned a necessary part of the education of a gentleman But surely no sufficient reason can be assigned for this omission. No science lays open a more extensive field of useful knowledge. ur affords more ample eH*^taiftteU> an inquisitive iiind. Anat ■<^^ Of AMERICA 0' LIBRA R Y fiv INTRODUCTION. It may also be alleged, that laying Medicine more open to man kind, would lessen their faith in it. This indeed would be the casii with regard to some ; but it would have a quite contrary effect upon others. I know many people who have the utmost dread and hor- ror of every thing prescribed by a physician, but who will never- theless readily take a medicine which they know, and whose q-jal- ities they are in some measure acquainted with. Hence it is evid&nt, that the dread arises from the Doctor not from the drug. Noth- mg ever can or will inspire mankind with an absolute confidence in physicians, but an open, frank, and undisguised behaviour. Whilst the least shadow of mystery remains in the conduct of the Faculty, doubts, jealousies, and suspicions, will arise in the minds of men. No doubt cases will sometimes occur, where a prudent physi- cian 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 can 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 renders their art suspicious, but lays the foundations of Quack- ery, 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 generally been very much confounded. The line between them is not sufficiently apparent ; at least it is too fine for the general eye. Few persons are able to distinguish sufficiently between the conduct of that man who administers a secret medi- cine, 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 villain, whose sole consequence depends upon secrecy. No laws will ever be able to prevent quackery, while people be- lieve that the quack is as honest a man, and as well qualified as the physician. A very small degree of medical knowledge, however, will be sufficient to break this spell ; and nothing else can effectu- ally Undeceive them. It is the ignorance and credulity of the mul- titude, 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 them wiser. The most effectual way to destroy quackery in any art or sci- ence, is to diffuse the knowledge of it among mankind. Did phy sicians 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 when the medicine had the desired effect ; would inspire him with absolute confidence in the physician ; and would make him dread and de- test every man who pretended to cram a secret medicine down his throat. Men in the different states of society, have very different views of INTRODUCTION. xv the sauit! onjoct. Some time ago it was the practice of this coun- try for every j>erson to say his prayers in Latin, whether he knew any thing of that language or not. This conduct, though sacred in the eyes of our ancestors, appears ridiculous enough to us ; and doubtless some parts of ours will seem as strange to posterity. Amono- these we may reckon the present mode of medical pre- scription, which, we venture to affirm, will sometime hence appear to have been completely ridiculous, and a very high burlesque upon the common sense of mankind. But this practice is not only ridiculous, it is likewise dangerous. However capable physicians may be of writing Latin, I am certain apothecaries are not always in a condition to read it, and that dan- gerous mistakes, in consequence of this, often happen. But sup- pose the apothecary ever so able to read the physician's prescrip- tion, he is generally otherwise employed, and the business of mak- uigup prescriptions is left entirely to the apprentice. By this means the greatest man in the kingdom, even when he employs a first-rate physician, in reality trusts his life in the hands of an idle boy, who has not only the chance of being very ignorant, but likewise giddy and careless. Mistakes will sometimes happen in spile of the greatest care ; but, where human lives are concerned, aii possible methods ought certainly to be taken to prevent them. For this reason, the prescriptions of physicians, instead of being couched in mystical characters and a dead language, ought, in iny humble opinion, to be conceived in the most plain and obvious terra? imaginable. * Diffusing medical knowledge among the people would not only tend to improve the art, and to banish quackery, but likewise tc render Medicine more universally useful, by extending its benefits to society. However long Medil^ine may have been known as a science, we will venture to say, that many of its most important purposes to society have either been overlooked, or very little at- tended to. The cure of diseases is doubtless a matter of great im- portance ; but the preservatioT of health is of still greater. This is the concern of every man, and sarely what 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 dis- eases, who are totally ignorant of their causes. Neither can the Legislature, in whose power it is to do much more for preserving the public health than can ever be done by the Faculty, exert that power with propriety, and to the greatest advantage, without some degree of medical knowledge. Men of every occupation and condition in life might avail them- selves 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 knowledge, in- stead of being a check upon the enjoyments of life, only teaches men how to make the most of them. It has indeed been said, that to live mcdicalli/, is to live miserably : but it might with equal propriety be said, that to live rationally is to live miserably. If physicians ob- trude their own ridiculous whims upon mankind, or lay down rules inconsistent with reason or common sense, no doubt they will be despised. But this is not the fault of Medicine. It propose'* n svi INTRODUCTION. rules that I know, but such as are perfectly consistent with the true enjoyment of life, and every way conducive 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 knowledge solely 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 examina- tion, that no science better deserves their attention, or is more ca- pable of being rendered generally useful. People are told, that if they dip the least into medical knowl- edge, it will render them fanciful, and make them believe they have every disease of which they read. This I am satisfied will seldom be the case with sensible people ; and suppose it were, they must soon be undeceived. A short time will show them their error, and a little more reading will infallibly correct it. A single instance will show the absurdity of this notion. A sensible lady, rather than read a medical performance, which would instruct her in the management of her children, generally leaves them entirely to the care and conduct of the most ignorant, 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 few parents pay a proper attention to it. They leave the sole care of their tender offspring, at the very time when care and attention are most necessary, to hirelings, who are either too negligent to do their duty or too ignorant to know it. We will venture to affirm, that more human lives are lost by the carelessness and inattention of parents and nurses, than are saved by the Faculty ; and that the joint and well-conducted endeavours, both of private persons and the public, for the preservation of infant lives, would be of more advantage to society than the whole art of Medicine, upon its pres- ent 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 mankind will be everywhere deprived of them. Physicians, like other people, must live by their employment, and the poor must either want advice altogether, or take up with that which is worse than none. There are not, however, anywhere wanting well-disposed people, of better 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 ileterred from the most noble and praise-worthy actions, by the foolish alarms sounded in their ears by a set of men, who, to raise theii 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 Med- icine. These gentlemen must, however, excuse me for saying, that I have often known such well-disposed persons 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 to physic, who despises both reason and observation, that he may go wrong hv rule ; and INTRODUCTION. xvn who, wliile he is dosing his patient with Medicines, often neglects other things of far greater importance. Many things are r.ecessary for the sick besides Medicine. Nor is the person who takiL-s care to procure these for them, of Jess im- portance than a physician. Tlie poor oftener perish in diseases for want of proper nursing than of Medicine. They are frequent- ly in want of even the necessaries of life, and still more so of what is proper for a sick-bed. No one can imagine, who has not been a witness of these situations, how much good a well-dispo.>^ed per- son may do, by only taking care to have such wants supplied. There certainly cannot be a more necessary, a more noble, or a more godlike action, than to administer to the wants of our fellow- creatures in distress. While virtue or religion are known among mankind, this conduct will be approved ; and while heaven is just, it must be rewarded ! Persons who do not choose to administer Medicine to the sick, may nevertheless direct their regimen. An eminent medical au- thor has said. That by diet alone all the intentions of Medicine may be answered.* No doubt a great many of them may ; but I here are other things besides diet, which ought by no means to be neglected. Many hurtful and destructive prejudices, with regard lo the treatment of the sick, still prevail among the people, which persons of better sense and learning alone can eradicate. To guard the poor against the influence of these prejudices, and to instil into their minds some just ideas of the importance of proper food, fresh air, cleanliness, and other pieces of regimen necessary in diseases, would be a work of great merit, and productive of many happy con- seees, if they could get other roots or vegetables." It is uii accessary to make any comments on this le\ er, every ine of w lich is dictated by good sense and humanity, s s well as by liberal and enlightened policy. I shall only add an earnest wish, that the example of the truly patriotic and benevolent writer may be followed by every man of landed pioperty, and by e\evy considerable farmer in the kingdom ! Some think that the potatoe, unless it be made into bread, will not keep. An accident taught me the contrary. Many years ago a friend of mine sent me a potatoe, after it had been roasted in an oven, on account of its singular figure. I laid it on a shelf among some other things of the like kind, and was surprised, on removing them many years after, to find the potatoe quite fresh, though as dry as a bone. On grating it down, it was perfectly sweet ; and as fit for making soup as the day it was roasted. I apprehend that nothing made into bread would have kept so long. Posterity will hardly believe that a scarcity of bread could bo lelt in Britain, at a time when it was known that a sufficient quan- tity of farinaceous food could be raised in one county for the inhabitants of the whole island. Let proper encouragement be given to the culture of potatoes, and set famine at defiance. Many other domestic roots, sprouts, &c. are very wholesome, and may occasionally supply the place of bread. Of these Mr. Bryant of Norwich reckons above forty, but we shall only take notice, b}- way of specimen, of the most useful and productive. It IS worthy of remark, that no nation can be very populous, which does not draw a great part of its food from under-sjround. FRUITS AND ROOTS. Si! The Jerusalem artichoke is a native of Brazil, but having been lonj^ cultivated in this country, it is too well known to need uny description. From its taste, which is like tliut of artichoke-bot- toms, it would seem to he nutritious, and is far I'rom heino- unpleas- ant to the palate. Some reckon it windy, but this may be cor- rected in the cooking, by warm spices ; and as the plant is very productive, we would recommend it to be used in the same man- ner as potatoes, and the other farinaceous roots. Of the esculent roots in this country, the parsnij) is reckoned the most nourishing. It is likewise of easy digestion, and is agreeable to most palates. Some, indeed, dislike it on account of its sweetness; but that is a proof of its nutritive quality, sugai being the most nourishing thing in nature. We aie told that, in the north of Ireland, the ])oor people make beer from this root. There is not any plant that aftbrds a more striking proof of the benefits of culture than the turnip. In its wild state it is good for little or nothing; but when properly cultivated, it not only aft'ords wholesome n mrishment for man, but furnishes the principal win- ter-food for cattle. There is a species of this plant which grows in North Britain, called the yellow turnip, which is sweet, and of a superior quality to those produced in the south, p.irticularly about London, which are bitter and stringy. The yellow turnip is the most nourishing, and also the most hardy in sustaining the winter. It is eaten with milk to cure the consumption and scurvy. Margraaf says, he could extract no sugar from the turnip, '\\hich affords ground to conclude, that it is not so nutritive as certain other roots. Not only the root of the turnip, but the tops, when young, make very pleasant greens. The sprouts, if gathered when very tender, make an excellent salad. The carrot, like the turnip, is good for little in its natural staie, being small, tough, and stringy. Manured, it grows large, succu- lent, and of a pleasant flavour. It ought, however, to be eater: Young, otherwise it lies on the stomach, and is hard of digestion, (t is an ingredient in several soups, and, being solid, may in some measure supply tne place of bread. Salsafy, skirrets, and the several kinds of beets, are all pleasant and nourishing. They are likewise of easy digestion, and may be dressed in a variety of ways. Margraaf has, by experiments, discovered, that both skirrets and beets contain a considerable quantity of sugar, 'rhough the extracting a saccharine salt from these plants may be no object while we possess the West India islands, yet it serves to show that they possess a quantity of nutri- tious matter, sufficient to give them a rank among the articles cal- culated to supply the pJace of bread. The onion, we aie told, was a great favourite in Egypt four thousand years ago, and Dr. Hasselquist says, it is not to be won- Qered at, for whoever has tasted the onions of Egypt must allow that none can be better in any part of the globe. There, he says, they are sweet, though in many countries they are strong and nau- seous. There they are soft, whereas in northern countries, they are hard, and their coats so compact, that they are difficult to digest. This very quality may, however, recommend them in countries where food is scarce. The Doctor observes, that the 34 BROTHS AND SOUPS. Turks eat them roasted with their meat as we do bread, and aro so fond of them that they wish to be indulged with this dish in Paradise. From the Doctor's account one would be induced to believe that the onion used in Egypt was of a different species from ours ; but I am rather inclined to think it may depend on the mode of cul- ture, as well as on the warmth of the climate and the difference of soil, as we find in the southern parts of Europe they are milder than in the more northerly. In Spain they are very mild, and a root weighing two pounds will grow from a single seed. Onions are dressed in a variety of ways, but, in regard of wholesomeness, there is no method better than simple boiling. By this method of cooking they are rendered mild, of easy digestion, and go off without leaving any disagreeable heat on the stomach or bowels. Many shun them on account of the strong disagreeable smell they communicate to the breath. Mr. Bryant says, this may be remedied, by eating a few raw parsley leaves immediately after, which will effectually overcome the scent of the onions, and like- wise cause them to sit more easy on the stomach. The leek is generally reckoned among pot-herbs ; but as the root is the part chiefly used, the consideration of it comes under the present head of discussion. Indeed, it is properly a root as the onion, which grows chiefly above ground. The leek, as well as the onion, is said to be a constant dish at the table of the Egyp- tians, who chop them small, and eat them with their meat. The leek is used as a pot-herb in most parts of Britain, espe- cially in Wales, where the natives are said to be fond of it. In Scotland a full-grown fowl and small piece of salt beef, stewed with a large quantity of leeks, is a very favourite dish. In my opinion the leek is not so generally used any where as it deserves to be. There is no ingredient that goes into soup that is more wholesome, or that gives it a better flavour, than leeks. They are in many respects medicinal, and, to my taste, as an ingredient in soups, they are greatly superior to the onion or any other pot-herb whatever- It is a fact worthy of observation, that the boiling of vegetable substances thoroughly, a thing seldom done in England, extricatea a considerable quantity of aii , and makes them less liable to pro- duce flatulency. I could mention a great many more esculent plants which might occasionally supply the place of bread, but the above specimen is sufHcient to show how liberal nature is in supplying man with food, provided he will take the trouble of cultivating and cooking it. Mr. Bryant, in his history of esculent plants, enumerates above four hundred and fifty, each of which affords a wholesome nourishment, and may occasionally be used in place of bread. BROTHS AND SOUPS. These may likewise be considered as substitutes for bread. If properly made, they will serve both for bread and drink. Though broth is a dish of the greatest antiquity, and may be considered as extremely delicious, vet it is not a favourite in this country. Here BROTHS AND SOUPS. 35 the people are fond of what they call solids ; yet those very solids, ihey make into broth, by swallowing as much drink after them as they can get. The only difference is, the foreigner makes his broth in a pot, and the Englishman makes his in the stomach. A very sensible anonymous writer observes, that in England a pound of meat makes simply a pound of food; whereas in any other country in Europe, that quantity of animal food, when stewed down with vegetables and Scotch barley, will produce an ample meal for lialf a dozen people. Hence he justly infers that, among the variety of schemes which may have been devised by the humane for relieving the distresses of the poor, a better and more extensive charity cannot be devised than that of instructing them in a new mode of cookery. The same author adds, that the result of his experiments on this subject had exceeded his most sanguine expectations, and that each day gave him fresh proofs of the excellencv of his plan for teaching the poor and needy to find themselves in a wholesome and palatable diet, at the cheapest rate, in which little or no bread was required. He concludes by asserting, that there is scarcely a place in this kingdom, where twenty persons may not have a wholesome, hearty, palatable meal, for three shillings. This anonymous letter is followed by one from Colonel Poynter, two from Dr. Johnson, of the royal hospital at Haslar, addressed to Admiral Waldegrave, and one from the Admiral himself, written for insertion in a public paper. They contain a variety of receipts for making cheap, wholesome, and nourishing dishes for the poor- These dishes consist chiefly of broths, soups, and stews, or what they call pottage, and are calculated to make a hearty and plenti- ful meal without bread or drink. I am inclined to pay the more attention to these letters, as they seem all to have been written by gentlemen of observation. The pamphlet is sold by Longman and De ;rett, for a charitable purpose, tit the small price of three-pence. The writer who has paid most attention to the improvement of cookery, for the benefit of the poor, is Count Rumford. In his economical and philosophical essays, he has given such a variety of forms for making wholesome, cheap, and nourishing soups, stews, and other dishes for common use, that little more seems necessary to be said on the subject. I shall only observe, that the mode of living on broths, soups, hasty-pudding, and such like, so warmly and justly recommended by the Count, has been prac- tised in the northern parts of this kingdom from time immemorial. There the food of the common people is hasty-pudding, with milk, for breakf\ist and supper, and broth, with vegetables and meat, for dinner. The poorer sort often make broth without meat; but they all use vegetables in great abundance, and sometimes they supply the place of meat with butter. As the hasty-pudding and milk make a complete meal, no bread is necessary either at supper or breakfast ; nor is much required at dinner, as the broth is made thick with barley, cabbage, and a variety of other vegetables or pot-herbs. Cabbage is a favourite ingredient in a Scotchman's broth. It is seldom made without this article, which is not eaten so early as in England. It is there suffered to grow to maturity 36 BROTHS AND SOUPS. and, when that is the case, there is no plant more productive. This the Germans know well, and make it into saur Icravt, one of the best antidotes against the scurvy with which we are ac- quainted. This kind of diet not only saves bread but drink. The labourer who lives on hasty-pudding and soups, seldom has occasion for drink ; while he who is burnt up with dry bread and cheese, or salt meat boiled, has a continual thirst, and spends the greatei part of ius earnings in liquor. This, by acting as a powerful stim- ulus, may make him do more work for some time, but it generally cuts him off in the middle of his days. The English labourer, who works hard and drinks hard, seldom lives long, and is an old man when he should be in his prime. The roasting of meat is a wasteful mode of cookery, which ought to be avoided by the poorer sort of people, as much of the substance, and the most nutritive parts, are lost by scorching and what flies off by evaporation. I know it will be said, that I recommend slops in place of solid food. They are such slops, however, as the greatest heroes of antiquity lived upon ; and though I have visited most parts of the island, I know of no better men than those who live in the manner described above, nor are the people any where more healthy, or longer lived. Broth is not only a dish of great antiquity, but one that can be made in a great variety of ways. It receives into its compositioi animal and vegetable substances of every kind that are used i? diet, and it may be seasoned so as to suit every palate. Indeed people early accustomed to eat broths properly made, are gene rally fond of them for their whole lives. It would be difficult to assign a reason why the inhabitants of South Britain should di^Uke a dish so much relished by other nations. Custom, no doubt, settles all these things ; but how cus- toms aribe, is not so clear a matter. If an alteration in diet is to be introduced with effect, it must begin with children. Whatever men are accustomed to eat when young, they generally prefer for the rest of th3ir lives. Were the children in South Britain taught to eat hasty-pudding, with milk, for breakfast and supper, and broth, with vegetables and meat boiled in it, for dinner, they would relish these dishes as long as they lived, would find little occasion for bread, and still less for drink ; and would thrive better than on their present food. What parents love themselves, they generally give to their chil- dren, without any regard to its being proper for them or not. I have seen a father, who was fond of strong beer, make his son, an infant, guzzle it at every meal ; and the mother, who delights in tea, does not fail to give it to her daughter whenever she takes it herself. By this conduct the son becomes a tippler, and the daughter sips tea in place of solid food, until she is eaten up with vapours and other nervous disorders. Count Rumford says, brown soup is the common breaKtast ol the Bavarian peasants, to which they occasionally add bread This he avers is xniinitely preferable in all respects to that perni- cious wash, tea, with which the lower classes of the inhabitants of REMARKS. 87 this island, drench their stomachs, and ruin their consimitions. He adds, that a simple infusion of this drug, dranii boiling hot, aa the poor genera, .y drink it, is certainly a poison, which, though it be sometimes slow in its operation, never fails to produce fatal effects, even in the strongest constitution, where the free use of it is continued for a considerable length of time. The German on his polenta, the American on his mush, and the North Britain on his hasty-pudding, can make a hearty breakfast for a tenth part of what a tea-breakfast would cost, while it is infinitely more wholesome. It has likewise the advantage that no bread is necessary. 1 have l>een often told, when recommending soups to the poor, that they had not time to make them, and that they could not afford fuel on account of its price, as it is dear in great towns- They can, however, find fuel twice a-day to boil a tea-kettle, and time to make the tea, which is a more tedious operation, by far, than making a mess of hasty-pudding. For a great part of the year even the poorest person must have a little fire ; and it would require no more to make a comfortable mess of soup, which is always best when made with a slow fire. Tlie mode of living that I would recommend to the lower orders of the people, with a view to save expense and improve their health, is to substitute occasionally other farinaceous substances in the place of bread, as potatoes, &c. to give up in a great meas- ure the use of roasted, baked, and broiled meats, and to supply their place with broths, soups, stews, and such like, made with a little meat and plenty of vegetables; to give it to children, and to grown people who will eat it for breakfast, milk-porridge, or hasty- pudding with milk, small-beer, or molasses. This will be found a more wholesome breakfast than tea, while it is much cheaper and requires no bread.* REMARKS. Although the place of bread may be occasionally supplied by farinaceous roots and other vegetal3les, yet we would by no means wish to discourage the culture of grain. The culture of grain is the culture of men. While the husbandman is raising * The celebrated Dr. Huffland, in his Art of prolonging Life, says the" moderate use of soups is certainly not hurtful ; and it is singular that people should imagine it tends too much to relax the stomach. Does not all our drink, even though cold, become in a few minutes a kind of warm so^p in the stomach : and does not the stomach retain the same temperature during the whole day ? Be careful only not to use it hot, in too great quantity at one time, or two watery. It is attended even with great advantages. It supplies the place of drink, particularly to men of letters, women, and all those who do not drink, or drink very little except at table, and who, when they give over soup, receive into their blood too little moisture. And it is here to be remarked, that fluids used in the form of soups unite much better and sooner with our juices than when drunk cold and raw. On this account soup is a great pire ventative of dryness and rigid- ity in the body, and, therefore, the best nourishment for old people, and those who are of an arid temperament. It even supplies the place of a medicine. After catching cold, in nervous head-aches, colics, and different kinds of cramp in the stomach, warm eoup is of excellent service. It may serve as a proof of the utility, or at least harm- lessness of soup, when I remark that our forefathers, who certainly had more strength than we have, used soup; and that it is used by rustics, who are still stronger than those in refined life ; and that all the old people with whom I ever was acquainted (verc great friends to it 38 REMARKS. food for his fellow-creatures, he is laying the foundation of health and longevity to himself and his offspring. Innumerable benefits are connected with the culture of grain. While the artificer is sit- ting in some awkward posture, breathing confined, and, perhaps, contaminated air, the cultivator of the soil rises with the sun, eats his wholesome KiCal of milk and farinaceous food, hies him to the field, where he spends the day in useful labour, inhales the fresh breezes, and at eve returns home with a keen appetite, to enjoy his simple repast and sound repose. It has been said, as artificers can earn more money than those who cultivate the ground, that arts ought to be encouraged, and grain, if necessary, imported. No manufacture is equal to the manufacture of grain. It supplies food for man and beast, while the surplus, by being exported, enriches the nation. Nor is it subject to the uncertainty of other manufactures. They often de- pend on fashion and caprice, but the necessaries of life will always find their value somewhere. Though I am convinced that some regulations are wanting for the encouragement of agriculture, I do not consider it as my province to dictate to the wisdom of the le- gislature. They know their duty, and I have reason to believe that they are incliued to pay it all due attention. I will venture, however, to assert, that if proper encouragement were given to agriculture, Britain would at all times not only have a suflficiency of grain for her own consumption, but a surplus for exportation. This would contribute more to her real wealth, the happiness of her people, and the stability of her government, than either the increase of her trade, the flourishing of her manufac- tures, or the extension of her territory. It is a matter of real regret and wonder that Britain, at a time when agriculture is cultivated as a science, should not be able to raise grain for the supply of her own inhabitants, but become every year more dependent on foreign states for even the necessaries of life. Until an adequate remedy can be found for this growing evil, the free use of the various substitutes for bread, cannot fail to alleviate the calamities of the poor, and to reduce the price of labour. The great consumption of animal food, and the immense num- ber of horses kept in this country, are to be reckoned among the causes of the scarcity of grain. Mr. Mackie computes the number of horses in this country to be about two millions, and that every horse, on an average, consumes the produce of three fertile acres, consequently the produce of six millions of fertile acres is annually consumed by horses. These would produce a quantity of grain more than sufficient to maintain half the inhabitants of Great Britain. Two hundred and sixty thousand of these animals are kept for pleasure. I shall be told that they contribute to health. That I deny. Did our ladies of fashion and fine gentlemen make use of their limbs, instead of being dragged about in carriages, they would both benefit themselves and the public. I shall conclude these remarks with the advice of the humane and benevolent Thora- on: — FOOD CONSIDERED. 80 " Ye gen'rouB Britons ! venerate the plough, And o'er your hills and long withdrawing vales Let Autumn spread her treasures to the sun. Luxuriant and unbounded. As the oea Far through his azure turbulent domain Your empire owns, and from a thousand shores Wafts all the pomp of life into your ports j So with superior boon may your rich soil Exub'rant Nature's better blessings pour O'er ev'ry land, the naked nations ciotho. And be the exhaustless gran'ry of a world." FOOD CONSIDERED IN A MEDICAL POINT OF VIEW. Under this point of consideration, the most remarkable distinc- ticm of foods is into those which are aheady assimilated with the animal nature, and into those that are not. Animal substances, generally, are of the first kind, which, although not entirely simi- lar, are nearly so to our nature. Of the second kind are vegetables, which, with much more difficulty are assimilated. But as the nourishment of all animals can be originally traced to the vceta- ble kingdom, it becomes evident that the principle of all nutrttion exists in vegetables. In the first edition of his Materiet Medica, Dr. Cullen observes, .hat though there is, perhaps, no vegetable which does not afford nourishment to some species of animals or other, yet, with reo-ard to mankind, a very considerable distinction is to be made. Those vegetables that are of a mild, bland, agreeable taste, are proper nourishment, while those of an acrid, bitter, and nauseous nature, are improper. We use, indeed, several acrid substances as food, but as spices or condiments, which answer the purpose of medi- cines, rather than any thing else; although, not unfrequently, acrid and bitter acrid vegetables are admitted as food. For instance, celery and endive are used in common food, though both are substances of considerable acrimony ; but it must be ob°served, that when we use them, they are previously blanched, which almost totally destroys their acrimony. Or, if we employ other acrid substances, we generally, in a great measure, deprive them of their acrimony by boiling. In different countries the same plants grow with different degrees of acrimony. Garlic, for example, seldom, in this country, enters our food ; but in southern countries,' where this plant grows more mild, it is frequently used. The plant which furnishes casada, which, in its recent state, is of a very poisonous and acrimonious nature, affords an instance of the necessity of preparing acrid substances, even in hot countries ; and there are other plants, such as the wake-robin, which, in their natural state, are so acrimonious, that they cannot be swallov/ed with safety ; yet, when deprived of that acrimony by boiling, afford good nourishment DIFFERENCES BETWEEN VEGETABLE AND ANIMAL FOOD. Vegetable differs from animal food in several respects. 1st, It has a greater tendency to acidity ; whilst animal food of all kinds inclines more to alkalescency and putrefaction. 2d, With regard to their difference of solution in the stomach, heaviness, as 40 ON SEDENTARY, STUDIOUS, it is called, is seldom felt from vegetables, except from tough fai- inaceous paste, or the most viscid substances ; while heaviness from animal food is more frequently noticed, especially when taken in any great quantity. 3d, With regard to mixture, there ia no instance of difficult mixture in vegetables, except in vegetable oils ; while animal food, especially the fatter meats, both from viscidity and oiliness, are in this respect refractory. 4th, When the putrescency of animal food has proceeded so far, it produces an active stimulus, causing diarrhoea, and dysentery. These eflects are, however, but of ra4-e occurrence ; whereas from vegeta- ble food and its acid, which, united with bile, proves a pretty strong stimulus, they more frequently occur ; fortunately , however, they are of less consequence, if the degree of refrigeration be not very great. 5th, Wherever neither putrefaction nor acidity has gone to any great length, animal food keeps the belly more regu- lar, «fcc. 6th, Vegetable food gives a greater proportion of succu- lent matter, and, when exsiccated by the stomach and intestines, is more apt to stagnate and produce slow belly and costiveness, than stimulating animal food, which, before it reaches the large intestines, where stoppage is made, it has obtained a putrefactive tendency, and gives a proper stimulus ; thus, those who are cos- tive from the use of vegetables, when they return to animal food, are considerably ameliorated in their natural bodily health. See " Natural and Medical Dieteticon, or Practical Rules for eating and drinking, tS^c." By J. S. Forsyth, Sfc, p. 63 — 67. Independent of the preceding observations, it is generally pretty well known, that animal food is far more nutritive than vegetable, although they both produce a blood of the same kind but different in quality. The former affords a more dense stimulating elastic blood than the latter, which stretches and causes a greater degree of resistance in the solids, as well as excites them to stronger action. CHAP. II. REMARKS ON SEDENTARY, STUDIOUS, AND LABO- RIOUS OCCUPATIONS, &c. That men are exposed to particular diseases from the occupa- itions which they follow, is a fact well known ; but to remedy this evil is a matter of some difficulty. Most people are under the necessity of following those employments to which they have been bred, whether they be favourable to health or not. Chemists, founders, forgers, glass-blowers, and several other artists, are hurt by the deleterious air they are obliged to breathe ; which is not only loaded with the noxious exhalations arising from imetals and minerals, but is so charged with phlogiston* as to bo * The inflammable principle.— A name given by Stahl to a principle which he ima- igined was pure fire, or the matter of fire fixed in combustible bodies, in ordPT to distinguioh it from fire in action, or in a state of liberty. AND LABORIOUS OCCUPATIONS, &c. 41 rendered unfit for expanding the lungs sufficiently, and answering the other important purposes of respiration. Hence proceed asth- mas, coughs, and pulmonary complaints, so incident to persons who follow these employments. To prevent such consequences as far as possible, the places where 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 long at work ; and when they give over, they should Buffer themselves to cool gradually, and put on iheir clothes before they go into the open air.- They ought never to drink large quan- tities of cold, weak, or watery liquors while their bodies are hot, nor to indulge in raw fruits, salads, or any thing that is cold on the stomach.* Miners, and all who work under-ground, are likewise hurt b> unwholesome air. The air, by its stagnation in deep mines, not only loses its proper elasticity, and other qualities necessary for respiration, but is often charged with such noxious exhalations a<< to become a most deadly poison. The two kinds of air whicii prove most destructive to miners. dre vhat they call the fire-damp, and the choak-damp.f In both cases the air becomes a poison by its being loaded with noxious gas.| The danger from the former may be obviated by making it explode before it accumulates in too great quantities ; and the latter may be generally carried off by promoting a free circulation of air in the mine. Miners are not only hurt by unwholesome air, but likewise by the particles of metal which adhere to their skin, clothes, &c. These are absorbed, or taken up into tl' ■ body, and occasion pal- ries, ver.lgoes, and other nervous afff ctions, which often prove fatal. Lead, and several other metals, are likewise very perni- cious to the health. Miners ought never to go to work fasting, nor to continue too long at work. Their food ought to be nourishing, and their liquor generous : nothing more certainly hurts them than living too low. They should by all means avoid costiveness. This may either be dene by chewing a little rhubarb, or taking a sufficient quantity of salad oil. Oil not only opens the body, but sheathes and de- fends the intestines from the ill effects of the metals. All who work in mines or metals ought to wash carefully, and to change their clothes as soon as they give over working. Nothing would * When persons heated with labour, have drunk cold liquor, they ought to continue at work for some time after. t These arc the names by which miners distinguish damps. The choak-damp ex tinguishes their candles, hovers about the bottom of the mine, and, for the most par*, consists of carbonic acid gas. Fire-damp or hydrogen gas, occupies the superior spa- ces of the mine, and does great mischief by exploding whenever it comes in contact with their lights. To subdue this gigantic power, which caused such mutilation and destruction among the miners, by the tremendous explosions that so frequently oc- curred, was the task which Sir Humphrey Davy assigned to himself, and which, had his genius been baffled, the kingdom could scarcely have hoped to have seen it achiev ed by anotiier. This, however, he was enabled to overcome: and the Safety t imj which goes by his name, will remain to after-ages a testimony of his enlightened gen ius, to which mankind are so infinitely indebted. t See ^rial Poison, under Poisons. 42 ON SEDENTARY STUDIOUS, tend more to preserve the health of such people than a strict, ami almost religious, regard to cleanliness- Plumbers, painters, gilders, smelters, makers of white lead, and many others Avho work in metals, are liable to the same diseases as miners ; and ought to observe the same directions for avoiding them. Tallow-chandlers, boilers of oil, and all who work in putrid ani- mal substances, are likewise liable to suffer from the unwholesome smells or effluvia of these substances. They ought to pay the same regard to cleanliness as miners ; and when they are affected with nausea, sickness, or indigestion, we would advise them to take an emetic or a gentle purge. Such substances ought always to be manufactured as soon as possible. When long kept, they not only become unwholesome to those who manufact:ire tliem, but likewise to people who live in the neighbourhood. It would greatly exceed the limits of this part of our subject to specify the diseases peculiar to persons of every occupation ; we shall, therefore, consider mankind under the general classes of Laborious, Sedentary , and Studious. ON VARIOUS EMPLOYMENTS, &-C. Though the working classes are in general the most healthy of all mankind, yet the nature of their occupations, and the places vvliere they are carried on, expose them more particularly to some diseases. Husbandmen, for example, are exposed to all the vicis- situdes of the weather, which, in this country, are often very great and sudden, and occasion colds, coughs, quinsies, rheumatisms, fevers and other acute disorders. They are likewise forced to work hard, and often to carry burdens above their strength, which, by overstraining the vessels, occasion asthmas, ruptures, pleuri eies, «fec. Those who labour without doors are often afflicted with inter mltting fevers or agues, occasioned by the frequent vicissitudes <»f heat and cold, poor living, bad water, sitting or lying on the damp ground, evening dews, night air, &c. to which they are frequently exposed. Such as bear heavy burdens, as porters, labourers, &c. are oblig ed to draw in the air with much greater force, and also to keep their lungs distended, with more violence than is necessary for common respiration : by this means the tender vessels of the lungs are overstretched, and often burst, insomuch that a sp'tting of blood or fever ensues, «fec. Carrying heavy burdens is generally the effect of mere laziness, which prom{)ts people to do at once what should be done at twice. Sometimes it proceeds from vanity or emulation. Hence it is, that the strongest men are most commonly hurt by heavy burdens, hard labour, or feats of activity. It is rare to find one who boasts of his strength, without a rupture, a spitting of blood, or some othei disease, which he reaps as the truit of his folly. There are, indeed, some employments which necessarily require a great exertion of strength ; as porters, blacksmilns, carpenters, ifcc None ought to fellow these but men of strong body ; and AND LABORIOUS OCCUPATIONS, &c. 43 they should never exert their strength to the utmost, nor work too long. When the muscles are violently strained, fre(juent rest is necessary, in order that they may recover their tone ; witliout this, the strength and constitution will soon be worn out, aiid a prema- ture old age be induced. St. Anthony's fire (Eresipelas,) is a disease very incident to labouring people. It is occasioned by whatever gives a sudden check to the perspiration, as drinking cold water when the body is warm, Avet feet, keeping on wet clothes, sitting or lying on the damp ground, &c. It is impossible for those who labour without doors always to guard against these inconveniences ; but it is known from experience, that their ill consequences might often be prevented by proper care. See Eresipelas, «fec. The iliac passion, the colic, and other complaints of the bowels, are often occasioned by the same causes as the eresipelas ; but they may likewise proceed from flatulent and indigestible food. Labourers generally eat unfermented bread made of peas, beans, rye, and other windy ingredients. They also devour great quan- tities of i^nripe fruits, baked, stewed, or raw, with various kinds of roots and herbs, upon which they drink sour milk stale small beer, or the like. Such a mixture cannot fail to fill the bowels v/ith wind, and occasion diseases of those parts. See Iliac Passion. Inflammations, whitloes, and other diseases of the extremities, are likewise common among those who labour witliout door>. These diseai.es are often attributed to venom, or some kind of poi- son ; but they generally proceed either from sudden heat after cold, or the contrary. When labourers, milk-maids, &c. come from the field, cold or wet, they run to the fire, and often plunge their hands in \varm water ; by which means the blood, and othei humours in those parts are suddenly expanded, and the vessels not yielding so quickly, a strangulation happens, and an inflammation or a mortification ensues. When such p^-sons come home cold, they ought to keep at a distance from the fire for some time, to wash their hands in cold water, and to rub them well with a dry cloth. It sometimes hap- pens, that people are so benumbed with cold, as to be quite depriv- ed of the use of their limbs. In this case the only remedy is to rub the parts afl*ected with snow, or, where it cannot be had, with cold water. If they be held near the fire, or plunged into warm water, a mortification will generally ensue. Labourers in the hot season are apt to lie down and sleep in the sun. This practice is so dangerous, that they often awake in a burning fever. These ardent fevers, which prove so fatal about the end of summer and beginning of autumn, are frequently occa- sioned by this means. When labourers lea^^e off work, which they ought always to do during the heat of the day, they should go home, or at least get under some cover, where they may repose them- selves in safety. Many people follow their employments in the fields from morn- ing till night, without eating any thing. This cannot fail to hurt their health. However homely their fare may be, they ought to have it at regular times ; and the harder they work, th« more frequently they should eat. 44 SOLDIERS, SAILORS, &c. Many peasants are extremely careless with respect to what they eat or drink, and often, through mere indolence, use unwholesome food, when they might, for the same expense, have that which is wholesome. In some parts of Britain the peasant^are too care- less even to take the trouble of dressing their own victuals. Such people would live upon one meal a day in indolence, rather than labour, though it were to procure them the greatest affluence. Fevers of a very bad kind are often occasioned among labourers by poor living. When the body is not sufficiently nourished, the humours become vitiated, and the solids weak, whence the most fatal consequences ensue. Poor living is likewise productive of many of those diseases of the skin so frequent among the lower class of people. It is remarkable that cattle, when pinched in their food, are generally afl'ected with diseases of the skin, whicii seldom fail to disappear when they ai'c put upon a good pasture. This shows how much a good state of the humours depends upon a sufficient quantity of proper nourishment. Poverty not only occasions, but aggravates, many of the dis- eases of the laborious. Few of them have much foresight ; and if they had, it is seldom in their power to save any thing. They are glad to make a shift to live from day to day ; and when any disease overtakes them, they are miserable indeed. Here the godlike virtue of charity ought always to exert itself. To relieve the industrious poor in distress, is surely the most exalted act of religion and humanity. They alone, who are witnejses of those scenes of calamity, can form a notion of what numbers perish diseases, for want of proper assistance, and even for want of the necessaries of life. Labourers are often hurt by a foolish emulation which prompts them to vie with one another, till they overheat themselves to such a degree as to occasion a fever, or even to drop down dead. SOLKIERS AND SAILORS, THE CONSEQUENCES OF THEIR EMPLOYMENT. The calling of a soldier, in time of war, may be ranked among the laborious employments. Soldiers suffer many hardships from the inclemency of seasons, long marches, bad provisions, hunger, watching, unwholesome climates, bad water, &c. These occa- sion fevers, fluxes, rheumatisms, and other fatal diseases which generally do greater execution than the sword, especially when campaigns are continued too late in the season. A few weeks of cold rainy weather will often prove more fatal than an engage- ment. Those who have the command of armies should take care thai their soldiers be well clothed and well fed. They ought also to finish their campaigns in due season, and to provide their men with dry and well-aired winter-quarters. These rules, taking care, at the same time, to keep the sick at a proper distance from those III hetdth, would tend greatly to preserve the lives of the soldiery. Sailors may also be numbered among the laborious. They un- dergo great hardships from change of climate, the violence of the weather, hard labour, bad provisions, &c. Sailors are if so great importance both to the trade and safety of this kingdom, that too SOLDIERS, SAILORS, &c. 4& much pains can never be bestowed in pointing out the means of preserving their health and lives. One great source of the diseases of sea-faring people is excess. When they get on shore, after having been long at sea, without regard to the climate, or their own constitutions, they plunge headlong into all manner of riot, and often persist till a fever pula an end to their lives. Thus intemperance, and not the climate, is often the cause why so many of our brave sailors die on foreign coasts. Such people ought not to live too low ; but tliey will find moderation the best defence against fevers and many other maladies. Sailors, when on duty, cannot avoid sometimes getting wet. When this happens, they should change their clothes as soon as they are relieved, and take every method to restore the perspira- tion. They should not, in this case, make too free with spirits or other strong liquors, but should rather drink them diluted with warm water, and go immediately to bed, where a sound sleep and a gentle sweat would set all to rights. But the health of sailors suffers most from unwholesome food. The constant use of salted provisions inflames their humours, and occasions the scurvy, and other obstinate maladies. It is no easy matter to prevent this disease in long voyages ; yet we cannot help thinking that much might be done towards effecting so desirable an end, were due pains bestowed for that purpose. For example, various roots, greens, and fruits, might be kept a long time at sea, as onions, potatoes, cabbages, lemons, oranges, tamarinds, apples, &c. When fruits cannot be kept, the juices of them, either fresh or fermented, may. With these all the drink, and even the food, of the ship's company ought to be acidulated in long voyages. Stale bread and beer likewise contribute to vitiate the humours. Flour will keep a long time on board, of which fresh bread might frequently be made. Malt too might be kept, and infused with boiling water at any time. This liquor, when drank even in form of wort, is very wholesome, and is found to be an antidote against the scurvy. Small wines and cider might likewise be plentifully laid in ; and should they turn sour, they would still be useful as vinegar. Vinegar is a great antidote against diseases, and should be used by all travellers, especially at sea. It may either be mix- ed with the water they drink, or taken in their food. Such animals as can be kept alive, ought likewise to be carried on board, as hens, ducks, pigs, i&c. Fresh broths made of port- able soup, and puddings made of peas or other vegetables, ought to be used plentifully. Many other things will readily occur to people conversant in these matters, which would tend to preserve the health of that brave and useful set of men.* We have reason to believe, if due attention were paid to the * Our countryman, the celebrated Captain Cook, has shown how far, by proper care and attention, the diseases formerly so fatal to seamen may be prevented. In a voy- age of three years and eighteen days, during which he was exposed to every climate, from the 52 deg. north to the 71 deg. of south latitude, of one hundred and eigh- teen men, composing the ship's company, he lost only one, who died of phthisis put- monalis. The principal means he used were, to preserve a strict attention to cleanli- ness, to procure abundanco of vegetables and fresh provisions, especially good water &ud to allow his people sufficient time for rest. 40 THE SEDENTARY. diet, air, clothing, and above all things to the cleanliness cf sea- faring people, they would be the most healthy set of men in the world ; but when these are neglected, the very reverse will happen. The best medical antidote that we can recommend to sailors or soldiers on foreign coasts, especially where dampness prevails, is the Peruvian bark. This will often prevent fevers, and other fatal diseases. About a drachm of it may be chewed every day ; or if this should prove disagreeable. Take Peruvian bark 1 ounce. Orange-peel 1-2 ounce. Snake-root 2 ounces. To be added, coarsely powdered, to an English quart of brandy and infused for fourteen days : half a wine-glassful of which is to be taken two or three times a-day, when the stomach is empty. This has been found to be an excellent antidote against fluxes, _ putrid, intermitting, and other fevers, in unhealthy climates. It is not material in what form this medicine is taken. It may either be infused in water, wine, or spirits, as recommended above, or made into an electuary with syrup of lemons, oranges, or the like. THE SEDENTARY. Though nothing can be more contrary to the nature of man than a sedentary life, yet this class comprehends by far the greater part of the species. Almost the whole female world, and in manufacturing countries, the major part of the males, may be reckoned sedentary.* Agriculture, the first and most healthful of all employments, is now followed by few who are able to carry on any other bus; ness. Though sedentary employments are necessary, yet there seems to be no reason why any person should be confined for life to these alone. Were such employments intermixed with the more active and laborious, they would never do hurt. It is constant confine- n^ent that ruins the health. A man may not be hurt by sitting five or six hours a-day ; but if he be obliged to sit ten or twelve, he will soon become diseased. But it is not want of exercise alone which hurts sedentary people ; they likewise suffer from the confined air they breathe. It is very common to see ten or a dozen tailors,t or stay-makers, for example, crowded into one small apartment, where there is hardly room for one person to breathe freely. In this situation they generally continue for many hours at a time, often wilh the * The appellation of sedentary has generally been given only to the studious: we can sec no reason, however, for restricting it to ihem alone. Many artificers mav with as much propriety, be denominated sedentary as the studious, with this particulai disadvantage, that they are often obliged to sit in very awkward postures, which the Etudious need not do, unless they please. t A person of observation, in that line of life, told me, that most tailors die of con- sumptions; which he attributed chiefly to the unfavourable postures in which thev sit, and the unwholesomeness of those places where their business is carried on. If more attention were not paid to profit than to the preservation of human lives, this evil might be easily remedied ; but while masters only mind their own interest, noth- ing will be done for the safety of their servants. INCLINED POSTURE INJURIOUS. 47 a«ltlit.ion of severj^l candles, which tend to waste the air, and render It less lit lor respiration. Air that is breathed rejieatedly, i)e(;omes unfit for expanding the lungs. This is one cause of the phthisical coughs, and other complaints of the breast, so frequent among sedentary artificers. Even the perspiration from a great number of j)ersons pent up together, renders the air unwholesome. The danger from this quarter will be greatly increased, if any of them hajijien to have bad lungs, or to be otlierwise diseased. Those who sit near the person so affected, being forced to breathe the same air, can hardly fail to be infected. It would be a rare thing, however, to find a dozen of sedentary people all in good health. The danger of crowding them together must, therefore, be evident to every one. INJUUIOUS EFFECT OF LONG INCLINED POSTURE, «fcc. Many of those who follow sedentary employments are constantly in a bending posture, as shoemakers, tailors, cutlers, &c. Such a situation is extremely hurtful. A bending posture obstructs all the vital motions, and of course must destroy the health. Accordingly we find such artificers generally complaining of indigestions, flatu- lences, head-achs, pains of the breast, «fcc. The aliment in sedentary people, instead of being pushed for- wards by an erect posture, and the action of the muscles, is in a manner confined in the bowels. Hence indigestions, costiveness, wind, and other hypochondriacal affections, are the constant com- panions of the sedentary. Indeed none of the excretions can be duly performed where exercise is wanting ; and when the matter which ought to be discharged in this way is retained too long in the body, it must have bad effects, as it is again taken up in the mass of humours. A bending posture is likewise hurtful to the lungs. When this j)rgan is compressed, the air cannot have free access into all its parts, so as to expand them properly. Hence tubercles, adhesions, &LC. are formed, which often end in consumptions. Besides, the proper action of the lungs being absolutely necessary for making good blood, when that organ fails, the humours soon become uni- versally depraved, and the whole constitution goes to wreck. Being of a soft texture, and in continual action, their functions are easily obstructed by pressure. The sedentary are not only hurt by pressure on the bowels, but nlso on their inferior extremities, which obstructs the circulation in these })arts, and renders them weak and feeble. Thus tailors, shoemakers, &c. frequently lose the use of their legs altogether: besides, the blood and humours are, by stagnation, vitiated, and the perspiration is obstructed ; whence proceed the scab, ulcerous sores, fold blotches, and other cutaneous diseases, so common among sedentary artificers. A bad figure of body is a very common consequence of close application to sedentary employments. The spine, for example, by being continually bent, puts on a crooked shape, and generally remains so ever after. But a bad figure of body has already been observed to be hurtful to heetlth, as the vital functions are thereby 48 SEDENTARY HABITS, &c. A sedentary life seldom fails to occasion an universal relaxation of the solids. This is the great source whence most of the diseases of sedentary people flow. Scrophula, (king's evil,) consumption, hysterics, and other nervous diseases, now so common, were ver^ little known in this country before sedentary artificers became sc numei'ous ; and they are very little known still among such of oui people as follow active employments without doors, though in large towns at least two thirds of the inhabitants are afflicted with them. It is very difficult to remedy those evils, because many who have been accustomed to a sedentary life, like rickety children, lose all inclination for exercise : we shall, however, throw out a few hints with respect to the most likely means for preserving the health of this useful set of people, which some of them, we hope, will be wise enough to take. It has been already observed, that sedentary artificers are often hurt by their bending posture. They ought, therefore, to stand or sit as erect as the nature of their employments will permit. They should likewise change their posture frequently, and should never sit too long at a time, but leave off work, and walk, ride, run, or do any thing that will promote the vital functions. Sedentary artificers are generally allowed too little time for exercise ; yet, short as it is, they seldom employ it properly. A journeyman tailor or weaver, for example, instead of walking abroad for exercise and fresh air, at his hours of leisure, chooses often to spend them in a public house, or in playing at some sed- entary game, by which he generally loses both his time and his money. The awkward postures in which many sedentary artificers work, seem rather to be the eflfect of custom than necessity. For exam- ple, a table might surely be contrived for ten or a dozen tailors to sit round, with liberty for their legs either to hang down, or rest upon a footboard, as they should choose. A place might like- wise be cut out for each person in such a manner that he might sit as conveniently for working as in the present mode of sitting cross-legged. All sedentary artificers ought to pay the most religious regard to cleanliness. Both their situation and occupations render this highly necessary. Nothing would contribute more to preserve their health, than a strict attention to it ; and such of tliem as neglect it, not only run the hazard of losing health, but of becoming a nuisance to their neighbours. Sedentary people ought to avoid food that is windy or hard of digestion, and should pay the strictest regard to sobriety. A person w-ho works hard Avithout doors will soon throw off* a debauch ; but one who sits, has by no means an equal chance. Hence it often happens that sedentary people are seized with fevers after hard drinking. When such persons feel their spirits low, instead of ruiining to the tavern for relief, they should ride or walk in the fields. This would remove the complaint more effectually than strong liquor, and would never hurt the constitution. AUYJCE TO THE SEDENTARY, «fcc. 49 ADVICE TO THE SEDENTARY, &C. Instead of niultiplyiiig rules for preserving the liealth of the sedentary, we shall recommend them to the following general plan, viz. That every person who follows a sedentary employment should cultivate a piece of ground with his own hands. This he might dig, plant, s solids are relaxed, neither the digestion nor any oi xhc secretioui* can be duly performed. Glandular obstructions, now so common, gtneira.ly proceed from inactivity. These are the most obstinate of. maiaJies. So long a» the liver, kidneys, and other glands, duly perform their functions, health is seldom impaired : but when they fail, nothing can restore it. Exercise is almost the only cure we know for glandular ob- structions : indeed, it does not alwrtV^ succeed as a remedy , but there is reason to believe that it would seldom fail to prevent these complaints, were it used in due timL. One thing is certain, thai amongst those who take sufficxent exercise, glandular disease! are INACTIVITY, ITS CONSEQUiiNCES, Sec. G7 very little known ; whereas the indolent and iufictive are very sel- dom free fronn them. Weak ne?'ves are the constant companions ofinactwity. Nolliinj; but exercise and open air can brace and strengthen the nerves, or prevent the endless train of diseases which proceed from a relaxed state of these organs. We seldom hear the active or laborious com- plain of nervous diseases; these are reserved for the sons of ease and affluence. Many have been completely cured of these disor- ders by being reduced, from a state of opulence, to labour for their daily bread. This plainly points out the sources from whence nervous diseases flow, and the means by which they may be pre- vented. It is absolutely impossible to enjoy health where the perspiration is not duly carried on ; but that can never be the case where ex- ercise is neglected. When the matter which ought to be thrown off by perspiiation is retained in the body, it vitiates the humours, and occasions the gout, fevers, rheumatisms, (fcc. Exercise alone would prevent many of those diseases which cannot be cured, and would remove others where medicine proves ineftectual. A late autlior,* in his excellent treatise on health, says, that the weak and valetudinary ought to make exercise a part of their re- ligion. We would recommend this, not only to the~weak and vale- tudinary, but to all whose business does not oblige tliem to take sufficient exercise, as sedentary artificers, t shopkeepers, studious persons, «S6c. Such ought to use exercise as regularly as they take food. This might generally be done without any interruption io 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 the morning. This is the gene ral practice in great towns. The inhabitants of cities seldom rise before eight or nine o'clock ; but the morning is undoubteJ.ly the best time for exercise, while the stomach is empty, and the body refreshed with sleep. Besides, the morning-air braces and strengthens the nerves, and, in some 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 diversion without doors, and he will find his spirits cheerful and serene through the day, his ap- petite keen, and his body braced and strengthened. 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, * Cheyne. t Sedentary occupations ought chiefly to be followed by women. They bear con- finement much better than men, and are fitter for every kind of business which does not require much strength. It is ridiculous enough to see a lusty fellow making pins, needles, or watch-wheols, wliile many of the laborious parts of husbandry are carriei on by the other sex. The fact is, we want men for laborious employments, while one half of the other sex are re idered useless for want of occupations suited to their strength, &-C. Were girls bred to mechanical employments, we should not see such numbers of them prostitute themselves for bread, nor find such a want of men for the important purposes of navigation, agriculture, &c. An eminent silk manufacturer told me, that he found women answer belter for that business than men ; and that he had latelv taken i great many girls apprentices as silk-weavers. I hope his example will be followed by many others. G8 EXERCISE IN THE OPEN AIR, &c, flatulencies, indigestions, S^c. These complaints, which pave thfi way to many others, are not to be removed by medicines. They can only be cured by a vigorous course of exercise, to which indeed they seldom fail to yield. Exercise, if possible, ought always to he taken in the open air. When that cannot be done, various methods may be contrived for exercising the body within doors, as the dumb bell, dancing, fenc- ing, «fcc. It is not necessary to adhere strictly to any particular kind of exercise. Tlie best way is to take them by turns, and to use that longest which is most suitable to the strength and con- stitution. 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 exer- cise than they otherwise would do, and are of the greatest service to such as are not under the necessity of labouring for their bi-ead. As active diversions lose ground, those of a sedentary kind seem to prevail. Sedentary diversions are of no other use but to con- sume time. Instead of relieving the mind, they often require more thought, than either study or business. Every thing that in- duces people to sit still, unless it be some necessary employment, ought to be avoided. The diversions which afford the best exercise are, hunting, shooting, playing at cricket, hand-ball., golff,* &c. These exer- cise the limbs, promote perspiration, and the other 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 horse- back ; those who cannot ride, should employ the same time in walking. Exercise should never be continued too long. Over- fatigue prevents the benefit of exercise, and instead of strengthen- ing the body tends to weaken 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. Ilenco many who were fond of exercise in the early part of life, become quite averse from it afterwards. This is the case of most hypochondriac and gouty people, which renders their diseases in a great measure in- curable. In some countries laws have been made, obliging every man, of A^hatever rank, to learn some mechanical employment. Whether such laws were designed for the preservation of health, or the en- couragement of manufacture, is a question of no importance. Certain it is, that if gentlemen were frequently to amuse and ex ercise themselves in this way, it might have many good effects. They would at least derive as much honour from a few masterly specimens of their own workmanship, as from the character of having ruined most of their companions by gaming or drinking. •Golff is a diversion very common in North Britain. It is well calculated for exer- cising the body, and may always be taken in such moderation as neit-her to over-heat aor fatigue. It has greatly the preference over cricket, tennis, or any of those games which cannot bo played without violence. BENEFITS OF SLEEP. C9 Besides, men of leisure, by applying themselves to the mechanic- r1 arts, might improve them, to the great benefit of society. Indolence not only occasions diseases, and renders men useless to society, but jjromotes all manner of vice. To say a man is idle, is little better than to call him vicious. The mind, if not engaged in some useful pursuit, is constantly in quest of ideal pleasures, or impressed with the apprehension of some imaginary evil. From these sources proceed most of the miseries of mankind. Certain- ly man was never intended to be idle. Inactivity frustrates the rery design of his creation ; whereas an active life is the best guar- dian of virtue, and the greatest preservative of health. It is indeed evident, that the love of motion, as well as the love of food, so observable in every living creature from the moment of its birth, are wisely designed by nature as the means of its pre- servation. The indolent man is therefore a rebel to her laws, and will certainly provoke her severest punishment. In vain does he hope for enjoyment in the lap of sloth ; its chilling influence poi- sons the source of every pleasure, and not only invites disease, but renders it almost incurable. CHAP. VI. SLEEP. The benefits resulting from sleep are sufficiently obvious, from the effects it produces. It restores both the powers of the mind and body, when exhausted by exercise, giving vigour to the one, and restoring the other to its accustomed alacrity. By means of sleep, the muscles are again rendered active and moveable ; after they have become wearied, rigid, painful, and trembling, from hard labour and severe exercise. It moderates the quickness of the pulse, which usually increases at night, and brings it back to its morning standard. It seems also to assist digestive of aliment — it diminishes both excretions and secretions ; and renders the fluids thicker than otherwise they would be, particiilarly in a body endowed with much sensibility or mobility. Sleep, therefore, is not only useful, but absolutely indispensable, for the preservation of life and health; and it contributes most essentially to the alle- viation, as well as to the total removal of disease. The want of it IS equally hurtful, and in many different ways, to the nervous sys- tem. Its absence renders the external as well as internal organs of sense, and those of every kind of motion, unfit for the perform- ance of their offices. Sleep, therefore, like diet., ouffJit 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 bod}' gross, and disposes to apoplexies, lethargies, and other complaints of a simi- lar nature. A medium ought therefore to be observed ; but this is not easy to fix. Children require more sleep than grown persons. 70 TO PROCURE REFRESHING SLEEP. the laborious than the idle, and such as eat and drink freely, than those who live abstemiously. Besides, the real quantity of sleep cannot be measured by time ; as one person will 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 tiiey please ; but for adults, six or seven hours is certainly sufficient, and no one ought to exceed eight. Those who Jie in bed more than eight hours may slumber, 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 cus- tom of lying in 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-watching. It is a great pity that a practice so destructive to health should be so much in fashion. How quickly the want of rest in due season will blast the most blooming complexion, or ruin the best constitution, is evident from the ghastly countenances of those who, as the phrase is, turn day into night, and night into day. TO PROCURE REFRESHING SLEEP, &C. To make sleep refreshing, the following 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 with a mind as cheerful and serene as possible. It is certain that too much exercise loill prevent sleep, as well as too little. We seldom, however, hear the active and laborious com- plain of restless night?. It is the indolent and slothful who gener- ally have these complaints. Is it any wonder that a bed of down should not be refreshing to a person vv'ho sits all day in an easy chair ? A great part of the pleasure of life consists in alternate rest and motion ; but they who neglect the latter can never relish the former. The labourer enjoys more true luxury in plain food and sound sleep, than is to be found in sumptuous tables and downy pillows, where exercise is wanting. That light Slippers cause sound sleep, is true even to a proverb. Many persons, if they exceed the least at that meal, are sure to have uneasy nights ; and, if they fall asleep, the load and oppres- sion on their stomach and spirits occasion frightful dreams, broken and disturbed repose, the night-mare, &c. Were the same per- sons to go to bed with a light supper, or sit up till that meal was pretty well digested, they would enjoy sound sleep, and rise refresh- ed and cheerful. There are indeed some people who cannot sleep unless they have eat some solid food at night ; but this does not imply the necessity of a heavy supper : besides, these are general- ly persons who have accustomed themselves to this method, and who do not take a sufficient degree of exercise. Nothing more certainly disturbs our repose than anxiety. When the mind is not at ease, one seldom enjoys sound sleep. This greatest of human blessings flies the wretched and visits the hap- CLOTHING, HOW TO BE REGULATED, &c. 7! py, the cheerful, and the gay. This is a sufficient reason why ev- ery man should endeavour to be as easy in his jnind as possible when he goes to rest. Many by indulging 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, will 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.* Early rising is the natural consequence of going to bed early ; and this habit implies sobriety, good order, and an exemption from many fashionable follies extremely prejudicial to health. The man, who accustoms himself to go to bed at an early hour, can seldom join the revels of Bacchus, or what are improperly called the amusements of the gay world. His rest is not disturbed by the effects of unseasonable luxury. He knows, that temperance, mod- erate exercise, composure of mind, and external tranquillity, are the best opiates. His slumbers are sound and refreshing. The waste of spirits on the preceding day is fully repaired. Every muscle, every fibre, every nerve has regained its proper tone. He rises with cheerfulness and vigour to breathe the morning air, and to enter upon the duties of the day. In short, an attention to this single point of going to bed early, and of rising betimes, will be found to supersede a variety of other precepts, and may be justly called the golden rule for the attainment of health and long life. CHAP. VII. CLOTHING. The clothing ought to he suited to the climate. Custom has, na 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 inhabitant of Nova Zembla and the Isiand of Ja- maica. It is not indeed necessary to observe an exact propor- tion between the quantity of clothes we wear, and the degree of latitude which we inhabit ; but, at the same time, proper attention ought to be paid to it, as well as to the openness of the country, the frequency and violence of storms, «fec. 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 '. * Men of every occupation, and in every situation of life, have lived to a good old* age ; nay some have enjoyed this blessing whose plan of living was by no means regu- lar ■. but it consists with observation, that all very old men have been early risers. This is the onlv circumstance attending longevity to which I never knew an exception 72 CLOTHING. but in the decline of life, when the skin becomes rigid and the hu mours more cool, the clothing should be increased. Many diseas- es in the latter period of life proceed from a defect of perspira- tion : these may, in some measure, be prevented by a suitable ad- dition to the clothing, or by wearing such as are better calculated for promoting the discharge from the skin, as clothes made of cot ton, flannel, &c. The clothing ought likewise to be suited to the season of the year. Clothing may be warm enough for summer, which is by no means sufficient for winter. The greatest caution, however, is necessary in making these changes. We ought neither to put off our winter clothes too soon, nor to wear our summer ones too long. In this country, the winter often sets in very early with great rigour, and we have frequently cold weather even after the commencement of the summer months. It would likewise be prudent not to make the change all at once, but to do it gradually ; and indeed the changes of apparel in this climate ought to be very inconsiderable, especially among those who have passed the meridian of life.* Clothes often become hurtful to the wearer by their being made sub- servient to the purposes of pride or vanity. Mankind in all ages seem to have considered clothes in this view ; accordingly their fashion and figure have been continually varying, with very little regard either to health, the climate, or conveniency : a farthingale, for example, may be very necessary in hot southern climates, but surely nothing can be more ridiculous in the cold regions of the north. Even the human shape is often attempted to be mended by dress, and those who know no better believe that mankind would be mon- sters without its assistance. All attempts of this nature are highly pernicious. The most destructive of them in this country is that of squeezing the stomach and bowels into as narrow a compass as possible, to procure what is falsely called, a fine shape. t By this practice, the action of the stomach and bowels, the motion of the heart and lungs, and almost all the vital functions, are obstructed. Hence proceed indigestions, syncopes or fainting fits, coughs, consumptions of the lungs, and other complaints so common among females. The feet likewise often suffer by pressure. How a small foot came to be reckoned genteel, I will not pretend to say ; but certain it is, that this notion has made many persons lame. Almost nine tenths •of mankind are troubled with corns; a disease that is seldom or never occasioned but by strait shoes. Corns are not only very troublesome, but by rendering people unable to walk, they may likewise be considered as the remote cause of other diseases.| * That colds kill more than plagues is an old observation ; and, with regard to this ■country, it holds strictly true. Every person of discernment, however, will perceive, that most of the colds which prove so destructive to the inhabitants of Britain, are ow- ing to their imprudence in changing clothes. A few warm days in March or April in- duce them to throw off their winter garments, without considering that our most pene- trating colds generally happen in the spring. t This madness seems to have pervaded the minds of mothers in every age and coun- itry. Terence, in his comedy of the Eunuch, ridicules the Roman matrons for at •■tempting to mend the shape of their daughters. X Wc often see persons, who are rendered quite lame by the nails of their toes haV' CLOTHliNG. 73 The size and figure of the shoe ought certainly to he adapted to the, foot. In children the feet are as well shaped as the hands, and the motion of the toes as free and easy as that of the fingers ; yet few i)ersons in the advanced period of life are able to make any use of their toos ; they are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether incapable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, but she will never walk well in this man- ner. It strains her joints, distorts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion ; it is en- tirely owing to shoes with high heels and narrow toes, that not one female in ten can be said to walk well. Infixing on the clothes, due care should be taken to avoid all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and oc- casions various diseases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood in its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases, are often occa- sioned. The perfection of dress is to be easy and clean. Nothing can be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, and many such there are, would rather re- main as fixed as a statue from morning till night, than discompose a single hair, or alter the position of a pin. Were we to recom mend any particular pattern for dress, it w^ould be that which is worn by the people called quakers. They are always neat, clean, and often elegant, without any thing superfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt. We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and the pe- riod of life, but likewise to the temperature and constitution. Ro- bust persons are able to endure either cold or heat better than the delicate, consequently may be less attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm.* ing grown into the flesh, and frequently hear of mortifications proceeding from thi« cause. All these, and many other inconveniences attending tlie feet, must be impn- ted solely to the use of short and tight shoes. Though we hear frequently of plasters, salves, ointments, &c. for eradicating corns, yet they are never known to produce that effect. The only rational moae of proceed- ing is to soften the corn a little by immersion in warm water, and then to cut it care- fully, and to renew this operation every week, till the scarf skin is reduced to its origi. nal or natural thinness, after which it must be preserved from the irritating pressure of strait shoes, which had at first occasioned the painful callosity. * The celebrated Boerhaave used to say, that nobody suffered by cold, save fools 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 Id 74 COLTHING. Since the first publication of the preceding remarks, very im- portant changes have taken place in the dress of our fair country- women, which afford the strongest proofs of their good sense and taste. The sliape is no longer distorted, nor is growth check- ed and the vital functions impeded by a whalebone press. Easj, safe, and graceful motion in a flat-heeled shoe has completely abol- ished the awkwardness and danger of former attempts to totter about, as it were upon stilts. In a word, a becoming regard to health, simplicity, and elegance, seems now to have more influence over female fashions than absurdity, caprice, or the desire of con- coaling any personal deformity. I wish I could pay my own sex the same compliment which the ladies have so well deserved. But an affectation of what is called military smartness seems to have converted their whole apparel into a system of bandages. The hat is as tight as if it was intend- ed for a helmet, and to defy ihe fury of a hurricane. Its form al- so being by no means suited to the natural shape of the head, it must be worn for a considerable time with very painful and une- qual pressure, before it can be made to fit its new block. The neck is bolstered up and swathed with the most unnatural stiff- ness. Easy motion without, and free circulation within, are alike obstructed. Blotches and eruptions in the face, head-achs, apo- .plexies, and sudden deaths, may be often traced to this cause ; and if we view its eff^ects in another light, v/e shall not be surprised at any inconsistency in the language or conduct of persons who take so much pains to suspend all intercourse between the head and the heart. The close pressure of the other articles of dress is equally re- prehensible. Narrow sleeves are a great check upon the muscular exercise of the arms. The waistcoat in its present fashionable form, may be very properly termed a strait one ; and, no doubt, is in many instances an indication of some mental derangement. The wrists and knees, but more particularly the latter, are braced with ligatures, or tight buttoning ; and the legs, which require the utmost freedom of motion, are screwed into leathern cases, as if to convey an idea that the wearer is sometimes mounted on horse- back. To complete the whole, and in order that the feet may be kept in as tight a press as the head, when shoes are to be worn, the shape of the foot, and the easy expansion of the toes are never con- sulted, but fashion regulates the form of the shoe, sometimes square toed, more frequently pointed, and always sure to produce cramp.'- and corns, the keen, the sensible announcers of every change of the weather. I have so long employed serious argument upon these subjects in vain, that I am now accustomed to view then> with pleasantry ; and when I meet with such figures, di&guised, and rendered truly awkward both in their motions and appearance, I cannot help thinking with Shakspeare, " that some of Nature's journeymen had made them and not made them well ; they imitate humanity so abominably !" many 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- Btockings, or a flannel petticoat, to be worn during the cold season at least. Where warmer clothing is wanted, I would recommend the fleecy hosiery to be worn next !lie skin INTEMPERANCE. 76 CHAP. VIII. OF INTEMPERANCE. A MODERN authoi* observes, that temperance and exercise arc llie two best physicians in the world. He might have added, tliat if these were duly regarded, tliere would be little occasion for any other. Temperance may justly be called the parent of health ; yet numbers of mankind act as if they thought diseases and death too slow in their progress, and, by intemperance and debauch, seem as it were to solicit their approach. The danger of intemperance appears from the very construction of the human body. Health depends on that state of the solids and fluids which fits them for the due performance of the vital func- tions ; and while these go regularly on, we are sound and well ; but whatever disturbs them necessarily impairs health. Intem- perance never fails to disorder the whole animal economy ; it hurts the digestion, relaxes the nerves, and renders the different secre- tions irregular, vitiates the humours, and occasions numberless diseases. The analogy between the nourishment of plants and animals af- fords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation ; yet an over-quantity of either will entirely destroy it. The best things become hurtful, nay destructive, when carried to excess. Hence we learn, that the highest degree of human wisdom consists in regulating our ap- petites and passions so as to avoid all extremes. It is that chiefly which entitles us to the character of rational beings. The slave of appetite will ever be the disgrace of human nature. The author of nature hath endued us with various passions, for the propagation of the species, the preservation of the individual, &c. Intemperance is the abuse of these passions ; and modera- tion consists in the proper regulation of them. Men, not content- ed with satisfying the simple calls of Nature, create artificial wants, and are perpetually in search after something that may gratify them ; hut imaginary wants can never be gratified. Nature is content with little ; but luxury knows no bounds. Hence the ep- icure, the drunkard, and the debauchee, seldom stop in their ca reer till their money or their constitution fails ; then indeed they generally see their error when too late. It is impossible to lay down fixed rules with regard to diet, on account of the different constitutions of mankind. The most ig- norant person, however, certainly knows what is meant by excess : and it is in the power of every man, if he chooses, to avoid It. The great rule of diet is to study simplicity. Nature delights in the most plain and simple food, and every animal, except man, follows her dictates. Man alone riots at large, and ransacks the • Rousseau. 76 INTEMPERANCE. ivhole creation in quest of luxuries, to his own destruction. An el egant writer* of the last age speaks thus of intemperance m diet: " For my part, when I behold a fashionable table set out In all its " magnificence, I fancy that I see gouts and dropsies, fevers and " lethargies, with other innumerable distempers, lying in anibus- "cade among the dishes." Nor is intemperance in other things less destructiiie than in (Het. How quickly does the immoderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best constitution ) In- deed these vices generally go hand in hand. Hence it is that we so often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and hastening with swift pace to an untimely grave. Did men reflect on the painful diseases and premature deaths which are daily oc- casioned by intemperance, it would be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures. Intemperance does not hurt its votaries alone ; the innocent too of- ten feel the direful effects of it. How many wretched orphans are to be seen embracing dung-hills, whose parents, regardless of the future, spent in riot and debauch what might have served to bring up their offspring in a decent manner ! How often do we behold the miserable mother, with her helpless infants, pin4ng in want, while the cruel father is indulging his insatiate appetites ! Families are not only rediiced to misery, hut even extirpated, hy iu' temperance. Nothing tends so much to prevent propagation, and to shorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down con- tented with his humble fare, can boast a numerous offspring, while his pampered lord, sunk in ease and luxury, often languishes with- out an heir to his ample fortunes. Even states and empires feel the influence of intemperance, and rise or fall as it prevails. Instead of mentioning the different kinds of intemperance, and pointing out their in.fluence upon health, we shall only, by way of example, make a few observations on one particular species of that vice, viz. the abuse of intoxicating liquors. Every act of intoxication puts nature to the expense of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That constitution must be strong indeed which is able long to hold out under a daily fever ; but fevers occasioned by drinking do not al- ways go off in a day ; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects. Though the drunhard should not fall hy an acute disease, hr seldom escapes those of a chronic kind. Intoxicating liquors, when used to excess, weaken the bowels and spoil the digestion ; they destroy the power of the nerves, and occasion paralytic and convulsive disorders ; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation and the nourish- ment of the body. Hence obstructions, atrophies, dropsies, and diseases of the lungs. These are the common ways in which * Addison. INTEMPERANCE. 77 drunkards make their exit. Disorders of tliis kind, when brought on by hard drinkinij, seldom admit of a cure. Many people injure their health by drinking, who seldom get drunk. The continual habit of soakhng, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept constantlv full and ujjon the stretch, the diFerent dij^estions can neither be duly jjcrformed, nor the humours properly prepared. Hence most people of this character are afflicted with the gout, the gravel, ulcerous sores in the legs, «fcc. If these disorders do not a})j)ear, they are seized with low sjnrits, hy])ochondriacal affec- tions, and other symptoms of indigestion. Hard drinking is no doubt one of the causes to which loe must im' pute the increase of consumptions. The great (|uantities of viscid malt liquor drank by the common people of England, cannot fail to render the blood sizy and unfit for circulation ; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthisical : nor is that to be wondered at, considering the glutinous and almost indigestible nature of strong ale. Those who drink ardent spirits or strong wines run still greater hazard ; these liquors heat and inflame the blood, and tear the ten- der vessels of the hmgs to pieces ; yet so great is the consump- tion of them in this country, that one would almost be induced to think that the inhabitants lived upon them. The habit of drinking proceeds fi-equently 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 il is over, the spirits sink as much below their usual tono as they had before been raised above it. Hence a repetition of the dose becomes necessary, and every fresh dose makes way for another, till the unhappy v/retch becomes a slave to the bottle, and at length falls a sacrifice to what at first perhaps was taken only as a med- icine. No man is so dejected as the drunkard when his debauch is gone off. Hence it is, that those who have the greatest flow of spirits while the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their own miser- able existence in a fit of spleen or ill-humour. Drunkcnntss not only proves destructive to health, but likewise tc the facilities of the mind. It is strange that creatures, who value themselves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so far below them. Were such as voluntarily deprive themselves of the use of reason to con- tinue ever after in that condition, it would seem but a just punish- ment. Though this be not the consequence of one act of intoxica- tion, it seldom fails to succeed a course of it. By a habit of drink- ing, the greatest genius is often reduced to a mere idiot.* * it is amazing that our improvements in arts, learning, and politeness, have not put Ihe barbarous custom of drinking to excess out of fashion. It is indeed less common m South Britain tlian it was formerly ; but it still prevails very much in the North, where this relic of barbarity is mistaken for hospitality. There no man is supposed M) entertain his guests well, who does not make them drunk. Forcing people to drint ie certainly the greatest piece of rudeness that any man can be guilty of. Manliness, eomplaisanre, or mere good-nature, may induce a man to take his glass, if urged to it 78 CLEANLINESS. Intoxication is peculiarly hurtful to young persons. It heats theii blood, impairs their strength, and obstructs their growth ; besides, the frequent use of strong hquors in the earlj part of hfe destroys any benefit that might arise from them afterwards. Those who make a practice of drinking generous hquors when young, cannot expect to reap any benefit from them as a cordial in the dechne of life. Drunkenness is not only in itself a most abominable vice, but it is an inducement to many others. There is hardly any crime so horrid that the drunkard will not perpetrate for the love of liquor. We have known mothers sell their children's clothes, the food that they should have eat, and afterwards even the infants themselves, in or- der to purchase the accursed draught. It is of the utmost importance to check the first propensities to glut tony and intoxication, or they soon becoine imcontrollable. With re spect to eating, the stomach, heing often put upon the full stretch, feels uneasiness from the least vacuity, and acquires by degrees a sort of unnatural craving, the gratifications of which are sure to be attended with a stupor, debility, and disease. The same remark is applicable to drinking. After frequent indul- gence in excess, the smallest self-denial causes a faintness and de- pression of spirits, which nothing can remove but the favourite dram or pretended cordial. Nay more, the repetition of the last night's debauch is looked upon as the best remedy for the sickners of the ensuing day. Mild diluting liquors are rejected as insipid, and some hot stimulant is required for the palate and stomach, without considering, that by such means the action of the heart and arteries is stimulated also ; that the lungs are inflamed ; and the whole system is relaxed and enfeebled. CHAP. IX. CLEANLINESS. The want of cleanliness is a fault which admits of no excuse. Where water can be had for nothing, it is surely in the power of every person to be clean. The continual discharge from our bod- ies by perspiration, renders frequent change of apparel necessary. Changing apparel greatly promotes the secretion from the skin, so necessary for health. When that matter which ought to be carried off by perspiration is either retained in the body or re-absorbed from dirty clothes, it must occasion diseases. Diseases of the skin are chiefly owing to want of cleanliness.* They it a time when he might as well take poison. The custom of drinking to excess has long been out of fashion in France ; and, as it begins to lose ground among the polita part of the English, we hope it will soon be banished from every part of this island. * Mr. Pott, in his surgical observations, was the first to notice a disease which he called the chimney-sweeper's cancer, now well known, as it is almost peculiar to thai unhappy s»t of people, and of which he has left us a concise and accurate history CLEANLINESS. ^ 79 way, Indeed, he caught by infection, or brought on by poor liviag, unwholesome food, 6lc. : but they will seldom continue long where cleanliness prevails. To the same cause must we impute the va- rious kinds of vermin which infest the human body, houses, &c. These may always be banished by cleanliness alone, and where- ever they abound, we have reason to believe it is neglected. One common cause of putrid and malignant fevers is the want of cleanliness. These fevers commonly begin among the inhabitants of close, dirty houses, who breathe unwholesome air, take little exercise, and wear dirty clothes. There the infection is general- ly hatched, which often spreads far and wide, to the destruction of many. Hence cleanliness may be considered as an object of pub- lic attention. It is not sufficient that I be clean myself, while the want of it in my neighbour afiects my health as well as his. If dirty people cannot be removed as a common nuisance, they ought at least to be avoided as infectious. All who regard their health should keep at a distance even from their habitations. In places where great numbers of people are collected, cleanliness he- comes of the utmost importance. It is well known that infectious dis- eases are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excre- ments of the diseased. In many great towns the streets are little better than dung-hills, being frequently covered with ashes, dung, and nastiness of every kind. Even slaughter-houses, or killing-shambles, are often to be seen in the very centre of great towns. The putrid blood, excre- ments, (fee. with which these places are generally covered, cannot fail to taint the air, and render it unwholesome. Hoav easily might this be prevented by active magistrates, who have it always in their power to make proper laws relative to things of this na- ture, and to enforce the observance of them ? Wl^tever pretensions people may make to learning, politeness, or civilization, we w'ill venture to affirm, that while they neglect cleanliness, they are in a state of barbarity.* The peasants in most countries seem to hold cleanliness in a sort of contempt. Were it not for the open situation of their houses, they This he attributes to neglect of cleanliness, and with great justice. I am convinced that if that part of the body which is the seat of this cruel disease were kept clean by frequent washing, it would never happen. The climbing-boys, as they are called, are certainly the most miserable wretches on the face of the earth ; yet, for cleaning chimneys, no such persons are necessary. According to the opinion of Mr. Earle, (see Medico Chirurgical Transactions, vol. xii.) it is invariably produced by the irritation of soot applied to the rugas or folds of the skin. It is not a common disease, and rarely attacks under the age of thirty, which accounts for its comparative unfrequency. * In ancient Rome the greatest men did not think cleanliness an object unv^orthy of their attention. Pliny says, the Cloaca, or common sewers for the conveyance of filth and nastiness from the city, were the greatest of all the public works ; and be- Btovi-s higher encomiums upon Tarquinius, Agrippa, and others who made and improv- ed them, than those who achieved the greatest conquests. How truly great does the Emperor Trajan appear when giving directions to Pliny his proconsul, concerning the making of a common sewer for the health and convea- ience of a conquered city ! 80 CLEANLINESS. would often feel the bad effects of this disposition. One seldom sees a farm-house without a dupg-hill before the door, and fre- quently the cattle and their masters lodge under the same roof Peasants are likewise extremely careless with respect to change of apparel, keeping their houses, &.c. clean. This is merely the af- fect of indolence and a dirty disposition. Habit may, indeed, ren- der it less disagreeable to them, but no habit can ever make it sal- utary to wear dirty clothes, or breathe unwholesome air. As many articles of diet come through the hands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. This, for example, might be done, by giving a small premium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c., and by punishing severely those who bring it dirty. The same method should be taken with butchers, bakers, brewers, and all who are employed in preparing the necessaries of life. In camps the strictest regard should be paid to cleanliness. By neg- ligence in this matter, infectious diseases are often spread amongst a whole army ; and frequently more die of these than by the sword. The Jews, during their encampments in the wilderness, received particular instructions with respect to cleanliness.* The rules en- joined them ought to be observed by all in the like situation. In- deed the whole system of laws delivered to that people has a man- ifest tendency to promote cleanliness. Whoever considers the na- ture of their climate, the diseases to which they were liable, and their dii*ty disposition, will see the propriety of such laws. It is remarkable, that in the most eastern countries, cleanliness makes a great part of their religion. The Mahometan, cs well as the Jewish religion, enjoins various bathings, washings, and purifi- cations. No doubt these might be designed to represent inward purity, but they were at the same time calculated for the preserva- tion of health. However whimsical these washings may appear to some, few things would tend more to prevent difeases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a dead body, or touchiiig any thing that might convey infection, to wash before he went into company, or sat down to meat, he would run less hazard either of catching the infection himself, or of communicating it to others. NECESSITY OF FREQUENT ABLUTIONS, e like. They ought like wise to keep the patient very clean, to sprinkle the room where he lies with vinegar or other strong acids, frequently to admit a Btream of fresh air into it, and to avoid the smell of his breath a& much as they can. They ought never to go into company without having changed their clothes and washed their hands ; otherwise, f the disease be infectious, they will in all probability carry the iontagion along with them. However trifling it may appear to inconsiderate persons, we will venture to affirm, that a due attention to those things which tend to diffuse infection would be of great importance in preventing dis- eases. As most diseases are in some degree infectious, no one should continue long with the sick, except the necessary attend- ants. I mean not, however, by this caution to deter those whose duty or office leads them to wait upon the sick, from such a lauda- ble and necessary emplo^'ment. As a disinfecting agent, either of the following simple and easily (obtained fumigations, may be carried at least once a-day througii the apartments of the sick ; or for the purpose of fumigating apart ments where sick people have been lodged : Take nitrate of potash, (nitre,) four drachms. Sulphuric acid, (oil of vitriol,) two drachms. £ ace them in a saucer upon hot sand ; or, Take muriate of soda, (common salt,) three ounces. Black oxide of man anese one ounce. AFFECTIONS OF THE MIND. 85 Sulphuric acid, one ounce. Water, two ounces. Mix the three first ingredients, and pour in the water gradually, when visible streams of gas will be elicited, capable of destroying the contagious effluvia generated in the apartment, or about the furniture, bed-clothes, «fec. The saucer, or other earthenware vessel, containing either of these, may l)e placed in the middle of the room, observing to have, during its use, the doors and windows closely shut. In a conversation with the late Sir John Pringle, for whom I had a great regard, he expressed some apprehension that the con tents of this chapter might deter people from attending their friends and relations in fevers. I told Sir John that was the very evil I meant to cure, having always found the country-people too apt to visit their friends and neighbours in fever, even so as to crowd the house, and incommode the sick. Nor could I impute this to hu- manity, but to an inquisitive disposition to learn what was likely to be the patient's fate, and to ask improper questions of those about him, or of the doctor himself, were he weak enough to an- swer them. In this case, his answer would be sure to come back to the patient, and if unfavourable, greatly magnified ; so strong is the inclination which some men feel to spread terror, even at the risk of another's life. Sir John, not having practiced in the country, was not immedi ately struck with the force of my reasoning, till I told him what had happened to a family of his own name who lived near Edin- burgh, who had nearly all perished in a fever. The family con- sisted of a father and mother, with nine or ten children, most of them grown up and in place. The mother was seized with a fever of the putrid kind, and the children came in turns to nurse her. They all caught the fever : some died ; and others narrowly escap- ed with their lives. The evil did not end there. They carried the fever into the families where they lived, and spread the infec- tion far and wide. This I have often known to happen in the country, and would advise masters and mistresses never to suflTer their servants to act as nurses or attendants on the sick, even though the latter should be their nearest relations. They had much bet- ter hire nurses, than allow their servants to act in that dangerous capacity. CHAP. XI. AFFECTIONS OF THE MIND. Mental affections have great influence both in the cause and cure of diseases. How the mind affects the body, will, in all prob- ability, ever remain a secret. It is sufficient for us to know, that there is established a reciprocal influence between the mental and 66 ANGER AND FEAR. corporeal parts ; and that whatever injures the one, disorders th* other ANGER. The passion of anger ruffles the mind, distorts the countenance, hurries on the circulation of the blood, and disorders the whole vital and animal functions. It often occasions fevers, and other acute diseases ; and sometimes even sudden death. This passion is peculiarly hurtful to the delicate, and those of weak nerves. I have known such persons frequently lose their lives by a violent fit of anger, and would advise them to guard against the excess of this passion with the utmost care. It is not, indeed, always in our power to prevent being angry •, but we may surely avoid harbouring resentment in our breast. Re- sentment preys upon the mind, and occasions the most obstinate chronical disorders, which gradually waste the constitution. No- thing shows ti"ue greatness of mind more than to forgive injuries ; it promotes the peace of society, and greatly conduces to our own ease, health, and felicity. Such as value health should avoid violent gusts of anger, as they would the most deadly poison. Neither ought they to indulge re- sentment, 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 tranquillity of mind. FEAR. The influence of fear, both in occasioning and aggravating dis- eases, is very great. No man ought to be blamed for a decent con- <;ern 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 diseases, but often render those diseases fa- tal which an undaunted mind would overcome. Sudden fear has generally violent effects. Epileptic fits, and other convulsive disorders, are often occasioned by it. Hence the Janger of that practice, so common among young people, of fright- ening one another. Many have lost their lives, and others have been rendered miserable by frolics of this kind. It is dangerous to tamper with the human passions. The mind may easily be thrown into such disorder as never again to act with regularity. THE EFFECTS OF FEAR ON CHILD-BED WOMEN. But the gradual effects of fear prove most hurtful. The con- stant 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 impressed on their minds by some accident, or foolish prediction. This, for example, is often the case with wo- aien in child-bed. Many of those who die in that situation, are Impressed with the notion of their death, a longtime before it hap REPREHENSIBLE CUSTOMS, &c. 87 pens ; and there is reason to believe that this impression is often the cause of it. The methods taken to impress the minds of women witli the n])prehensions of the great pain and peril of child-birtli, are very liiirtful. Fewf women die in labour, though many lose their lives after it ; which may be thus accounted for. A woman after deliv- ery, finding herself weak and exhausted, immediately ap]Hehends she is in danger ; but this fear seldom fails to obsti'uct the neces- sary evacuations, upon which her recovery depends. Thus the sex often fall a sacrifice to their own imagination, when there would be no danger, did they apprehend none. It seldom happens, that two or three women in a great town die in chUd-bed, but their death is followed by many others. Every woman of their acquaintance who is with child dreads the same fate, and the disease becomes epidemical, by the mere force of im- agination. This should induce pregnant women to despise fear, and by all means to avoid those tattling gossips wh are continu- ally buzzing in their ears the misfortunes of others Every thing that may in the least alarm a pregnant or child-be(i woman, ought with the greatest care to be guarded against. Many women have lost their lives in child-bed by the old super- stitious custom, still kept up in most parts of Britain, of tolling the parish-bell for every person who dies. People who think them- selves in danger, are very inquisitive ; and if they come to know that the bell tolled for one who died in the same situation with themselves, what must be the consequence 1 At any rate they are apt to suppose that this is the case, and it will often be found a very difficult matter to persuade them of the contrary. But this custom is not pernicious to child-bed women only, h is hurtful in many other cases. When low fevers, in which it is difficult to support the patient's spirits, prevail, what must be th© effect of a funeral peal sounding five or six times a-day in his ears ? No doubt his imagination will suggest that others died of the same disease under which he labours. This apprehension will have a greater tendency to depress his spirits, than all the cordials of which medicine can boast will have to raise them. The only town which has abolished this custom is Bath, 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 wish well to the sick, ought to keep such persons at the greatest distance from, them. REPREHENSIBLE CUSTOMS, &C. A CUSTOM has long prevailed among physicians, of prognosiica- ting, as they call it, the patient's fate, or foretelling the issue of the disease. Vanity, no doubt, introduced this practice, and still supports it, in spite of common sense, and the safety of mankind, 88 GRIEF. I have known a physician barbarous enough to boast, that he p/o- nounced more sentences than all His Majesty's judges. Would to God that such sentences were not often equally fatal ! It may, ii,- deed, be alleged, that the doctor does not declare his opinion bf- fore the patient. So much the worse. A sensible patient had bet- ter hear what the doctor says, than learn it from the disconsolate looks, the watery eyes, and the broken whispers of those about him. It seldom happens, when the doctor gives an unfavourable opinion that it can be concealed from the patient. The very embarrass- ment which the friends and attendants show in disguising what he ha? said, is generally 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 another, especially if such a declaration has a chance to kill him. Mankind are, indeed, very fond of prying into future events, and seldom fail to solicit the physician for his opinion. A doubtful answer, however, or one that may tend rather to encour- age the hopes of the sick, is surely the most proper. This conduct could neither hurt the patient nor the pliysician. Nothing tends more to destroy the credit of physic than those bold prognostica- tors, who, by-the-by, are generally the most ignorant of the facul- ty. The mistakes which daily happen in this way are so many standing proofs of human vanity, and the weakness of science. We readily admit, that there are cases where the physician ought to give intimation of the patient's danger to some of his near connections ; though even this ought always to be done with the greatest caution : but it never can be necessary in any case that the whole town and country should know, immediately after the doctor has made his first visit, that he has no hopes of his patienVs recovery. Persons whose impertinent curiosity leads them to ques- tion the physician with regard to the fate of his patient, certainly deserve no other than an evasive answer. The vanity of foretelling the fate of the sick is not pecuUar to the faculty. 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 add to their affliction by alarming their fears. A friend, or even a phy iician, may often do more good by a mild and sympa- thizing behaviour than by medicine, and should never neglect to ad- minister that greatest of all cordials, Hope. Grief is the most destructive of all the passions. Its effects are permanent ; and when it sinks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, sel- dom last long ; but grief often 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 shows true greatness of mind to bear them with serenity. Many persone GRIKF. m make a luerit of indulging in grief, and when misfortunes happen, they obstinately refuse all consolation, till the mind, ovorwhelinea with melancholy, sinks under the load. Such conduct is nf»t only destructive to health, but inconsistent with reason, religion, and common sense. Change of ideas is as necessary for health as change of posture. When the mind dwells long upon one subject, es])ecially of a disa- greeable nature, it hurts the whole functions of the bodv. Hence grief, indulged, spoils the digestion and destroys the appetite ; by which means the sj)irits are depressed, tlie nerves relaxed, the bow- els inflated with wind, and the liumours, for want of fresh supplies of chyle, vitiated. Thus many an excellent constitution has been ruined by a family misfortune, or any thing that occasions excess- ive grief. It is utterly impossible that any jterson of a dejected mind should en- joy health. Life may, indeed, be dragged out for a few years ; but whoever would live to a good old age, must be good-humoured and cheerful. This, indeed, is not altogether in our own power; yet our temper of mind, as well as our actions, depend greatlv upon ourselves. We can either associate with cheerful or melanclioly companions, mingle in the amusements and offices of life, or sit still and brood over our calamities as we choose. These, and ma- ny such things, are certainly in our power, and from these the mind generally takes its cast. The variety of scenes which present thernselvcs to the senses, weie ccrtairly designed to prevent our attention from being too long fixed upon any one object. N'ature abounds with variety, and the mind, unless fixed down by habit, delights in contemplating new objects. This at once points out the method of relieving the mind in distress. Turn the attention frequently to new objects. Examine tiiem for some time. When the mind begins to recoil, shift the scene. By this means a constant succession of new ideas may be kept up, till the disagreeable ones entirely disappear. Thus, travailing, the study of any art or science, reading or writing on such subjects as deeply engage the attention, will sooner expel grief than tlie most sprightly amusements. It has already been observed, that the body cannot be healthy unless it be exercised; neither can the mind. Indole-nce nourishes grief. When the mind has nothing else to think of but calamities, no wonder that it dwells there. Few people who pursue business with attention are hurt by grief. Instead, therefore, of abstract- ing ourselves from the world or business when misfortunes hap- pen, we ought to engage in it with more than usual attention, to discharge with double diligence the functiims of our station, and to mix with friends of a cheerful and social temper. Innocent amusements are by no means to be neglected. These, b^ leading the mind insensibly to the contemplation of agreeable oV jects, help to dispel the gloom which misfortunes cast over \ They make time seem less tedious, and have many other happy effects. Some persons, when overwhelmed with grief, betake themselves to drinking. This is making the cure worse than the disease. It seldom fails to end in the ruin of fortune, character, and consti tution. 90 LOVE, AND RELIGIOUS MELANCHOLY. LOVE. Love is perhaps the strongest of all the passions. At least when It becomes violent, it is less subject to the control either of the un- derstanding or will, than any of the rest. Fear, anger, and sever- al other passions, are necessary for the preservation of the ind'- vidual, but love is necessary for the continuation of the species it- self: it was therefore proper that this passion should be deeply rooted in the human breast. Though lot e he a strong passion it is seldom so rapid in its prog- ress as several of the others. Few persons fall desperately in love all at once. We would therefore advise every one, before he tam- pers with this passion, to consider well the probability of his being able to oLtain the object of his wishes. When that is not likely, he should avoid dvery occasion of increasing it. He ought imme- diately to flte the company of the beloved object ; to apply his mind attentively to business or study ; to take every kind of amuse- ment ; and above all, to endeavour, if possible, to find another ob ject which may engage his affections, and which it may be in his power to obtain. There ■»"« nn nassion ivith lohich people are so apt to tamper as love^ although none is more dangerous. Some men make love for amuse- ment, others from mere vanity, or on purpose to show their conse- quence with the fair. Til is is perhaps the greatest piece of cruelty which any one can be guilty of. What we eagerly wish for, we easily credit. Hence the too credulous fair are often betrayed into a situation which is truly deplorable, before they are able to discover that the pretend- ed lover was only in jest. But there is no jesting with this passion. When love has got to a certain height, it admits of no other cure but the possession of its object, which in this case ought always, if possible, to be obtained. RELIGIOUS MELANCHOLY. Many persons of a religious turn of mind behave as if they thought it a crime to he cheerful. They imagine the whole of religion con- sfsts in certain mortifications, or denying themselves the smallest indulgence, even in the most innocent amusements. A perpetual gloom hangs over their countenances, while the deepest melan- choly preys upon their minds. At length the fairest prospects van- ish, every thing puts on a dismal appearance, and those very ob- jects which ought to give delight, afford nothing but disgust. Life itself becomes a burden, and the unhappy wretch, persuaded that no evil can equal what he feels, often puts an end to his miserable existence. It is great pity that ever religion should he so far perverted, as to become the cause of those very evils which it was designed to cure. Nothing can be better calculated than True religion to raise and support the mind of its votaries under every affliction that can befal them. It teaches that even the sufferings of this life are pre- paratory to the happiness of the next ; and that all who persist in a course of virtue shall at length arrive at complete felicity. Persons lohose husine.': it is to recommend religion to others, should THE FiECAL EVACUATIOXa. ^1 beware of dwelling too much on gloomy subject 1'liat peace and tranquillity of mind, which true religion is calculated to inspire, ic a more powerful argument in its favour, than all the terrors that can be uttered. Terror may indeed deter men I'rom outward acts of wickedness, bvit can never inspire thein with that love of God, and real goodness of heart, in which alone true religion consist?. To conclude ; the best way to counteract the violence of any passion, is to keep the mind closely engaged in some useful pur- suit. I have often heard that the late Lord Kaimes, when he saw any literary friend sinking under the pressure of melancholy, or some other corroding passion, always gave this advice in a few emphat- ical words, "Write a book;" which he believed to be an infallible remedy. I also knew the author of a very beautiful elegy cured of his grief for a wife, whom he tenderly loved, by studying how to expi'ess the greatness of his loss, and the pungency of his sor- rows in the most plaintive and affecting strains. Indeed, the ear- nest direction of our thoughts to some important object is, as I be- fore hinted, the sui-est method of subduing passions which may stubbornly resist the control of reason. CHAP. XXI. THE NATURAL EVACUATIONS. The principal evacuations from the human body are those bj stool, wine, and insensible perspiration. None of these can be long obstructed without impairing the health. When that which ought to be thrown out of the body is too long retained, it not only occa- sions a plethora, or too great fulness of the vessels, but acquires qiialities which are hurtful to the health, as acrimony, putrescence, &;c. THE FjECAL evacuation, &C. Few things conduce more to health than keeping the body regu- lar. When \\\Q fcBces lie too long in the bowels, they vitiate the humours ; and when they are too soon discharged, the body is not sufficiently nourished. A medium is therefore to be desired which can only be obtained by regularity in diet, sleep, and exercise. Whenever the body is not regular, there is reason to suspect a fault in one or other of these. Persons who eat and drink at irregular hours, and who eat va- rious kinds of food, and drink of several different liquors at every meal, have no reason to expect either that their digestion will be good, or discharges regular. Irregularity in eating and drinking disturbs every part of the animal economy, and never fails to oc- casion diseases. Either too much or too little food will have this efiect. The former, indeed, generally occasions looseness, and the latter costiveness ; but both have a tendency to hurt the health. 95i URINE. li would be difficult to ascertain the exact number of stools which may be consistent with health, as these differ in the different periods of life, in different constitutions, and even in the same con- stitution under a different regimen of diet, exercise, «fec. It is, however, generally allowed, that one stool a-day is sufficient for an adult, and that more or less is hurtful. But this, like most gen eral rules, admits of many exceptions. I have known persons in perfect health who did not go to stool above once a week.* Such a degree of costiveness, however, is not safe ; though the person who labours under it may for some time enjoy tolerable health, yet at length it may occasion diseases. One method of procuring a stool every day is to rise betimes, and go abroad in the open air. Not only the posture in bed is un- favourable to regular stools, but also the warmth. This, by pro- moting perspiration, lessens all the other discharges. The method recommended for this purpose, by Mr. Locke, is likewise very proper, viz. to solicit nature, by going regularly to stool every morning lohether one has a call or not. Habits of this kind may be acquired, which will in time become natural. Persons who have frequent recourse to medicines for preventing costiveness seldom fail to ruin their constitution. Purging medi- cines frequently repeated weaken the bowels, hurt the digestion, and every dose makes way for another, till at length they become as necessary as daily bread. Those who are troubled with cos- tiveness ought rather, if possible, to remove it by diet than drugs. They should likewise go thinly clothed, and avoid every thing of an astringent or of an heating nature. The diet and other regi- men necessary in this case will be found under the article Costive- ness, where this state of the bowels is treated as a disease. Such persons as are troubled with an habitual looseness ought likewise to suit their diet to the nature of their complaint. They should use food which braces and strengthens the bowels, and which is rather of an astringent quality, as wheat-bread made of the finest flour, cheese, eggs, rice boiled in milk, &.c. Their drink should be red port, claret, brandy and water, in which toasted bread has been boiled, and such like. As an habitual looseness is often owing to an obstructed perspi- ration, persons affected with it ought to keep their feet warm, to wear flannel next their skin, and take every other method to promote the perspiration. Further directions with regard to the treatment of this complaint will be found under the article Looseness. URINE. »^o many things tend to change both the quantity and appear- ances of the urine, that it is very difficult to lay down any deter- mined rules for judging of either.t Dr. Cheyne says, the urine * Some persons have told me that they did not go to stool above once a month. t It has long been an observation among physicians, that the appearances of the arine are very uncertain, and very little to be depended on. No one will be surprised at this, who considers how mmy ways it may be affected, and, consequently, have ita appearance altered. The passions, the state of the atmosphere, the quantity and quali- ty 4)f thr food, the exercise, the clothing, the state of the other evacuations, and num URINE. 93 rtught to be equal .o three-fourths of the liquid part of our aliment But suppose any one were to take the trouble of measuring both, he would find that every thing which altered the degree of perspi ration would alter this proportion, and hkewise that diiierent kinds of aliment would afford very difterent quantities of urine. Though <'or these, and other reasons, no rule can be given forjudging the pre- cise quantity of urine which ought to be discharged, yet a person «tf i;ommon sense will seldom be at a loss to know when it is in either tiXtreme. As a free discharge of urine not only prevents but actually cures many diseases, it ought by all means to be promoted ; and every thing that may obstruct it should be carefully avoided. Both the secretion and discharge of urine are lessened by a sedentary life, sleeping on lieds that are too soft and warm, food of a dry and heating quality, liquor's which are astringent and heating, as red port, claret, and such like. Those who have reason to suspect that their urine is in too small quantity, or who have any symp- toms of the gravel, ought not only to avoid these things, but what- ever else they find has a tendency to lessen the quantity of their urine. When the urine is too long retained, it is not only resorbed, or taken up again into the mass of fluids, but by stagnating in the blad- der it becomes thicker, the more watery parts flying oft' first, and the more gross and earthy remaining behind. By the constant tendency which these have to concrete, the formation of stones and gravel in the bladder is promoted. Hence it comes to pass that indolent and sedentary people are much more liable to these diseases than persons of a more active life. Many persons have lost their lives, and others have brought on very tedious, and even incurable disorders, by retaining their urine too long, from a false delicacy. When the bladder has been over- distended, it often loses its power of action altogether, or becomes paralytic, by which means it is rendered unable either *to retain the urine, or expel it properly. The calls of nature ought never to be postponed. Delicacy is doubtless a virtue, but that can nev- er be reckoned true delicacy v/hich iiz.duces any one to risk his health, or hazard his life. But the urine may be in too great, as well as too small a quan- tity. This may be occasioned by drinking large quantities of weak watery liquors, by the excessive use of alkaline salts, or any thing that stimulates the kidneys, dilutes the blood, &c. This disorder very soon weakens the i)ody, and induces a consumption. It is difficult to cure, but may be mitigated by strengthening diet and astringent medicines, such as are recommended under the article Diabetes, or excessive discharge of urine. berless other causes, are sufficient to induce a change either in the quantity or appear- ance of the urine. Any one wfio attends to this will be astonished at the impudence '»f those daring quacks, who pretend to find out diseases, and prescribe to patients, from the bare inspection of their urine. These impostors, however, are very com- mon all over Britain, and, by the amazing credulity of the populace, many of them a.Tiass considerable fortunes. Of all the medical prejudices which prevail in this t«Tuntry, that in favour of urine doctors is the strongest. The common people have Btill an unlimited faith in their skill, althougli it has been demonstrated that no one of them IS able to distinguish the urine of a horse, or any other animal, f-om that of • man. 94 PERSPIRATION. THE PERSPIRATION. Insensible perspiration is generally reckoned the greatest of all the discharges from the human body.* It is of so great impor- tance to health, that few diseases attack us while it goes properlv on ; but when it is obstructed, the whole frame is soon disordered. This discharge, however, being less perceptible than any of the rest, is, consequently, less attended to. Hence it is that acute fe- vers, rheumatisms, agues, &c. often proceed from obstructed per- spiration, before we are aware of its having taken place. On examining patients, we find most of them impute their dis- eases either to violent colds which they had caught, or to slight ones which had been neglected. For this reason, instead of a crit- ical inquiry into the nature of the perspiration, its difference in dif- ferent seasons, climates, constitutions, &.c. we shall endeavour to point out the causes which most commonly obstruct it, and to show how far they may be either avoided, or have their influence coun- teracted by timely care. The want of a due attrition to these, costs Britain annually some thousands of useful lives. CAUSES OF obstructed PERSPIRATION, &.C. One of the most common causes of obstructed perspiration,! oi catching cold, in this country, is the changeableness of the weath- er, or state of the atmosphere. There is no place where such changes happen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the dif- ferent seasons of the year, but often change almost from one ex- treme to another in a i'ew days, and sometimes even in the course of one day. That such changes must affect the state of the per- spiration is obvious to every one. The besj; method of fortifying the body against the changes of the weather is, to be abroad every day. Those who keep most within doors, are most liable to catch cold. Such persons gener- ally render themselves so delicate, as to feel even the slightest * Sanctorius, an Italian physician, was the first that directed the attention of the faculty to the cutaneous and pulmonary transpiration, which he proved to exceed the other secretions considerably in weight; and he maintained that this function must have a considerable influence on the system, and was deserving of great considera- tion in the treatment of diseases. There is, doubtless, much of truth in this general observation ; but in its application to practice, he appears to have gone to an extrava- gant length, and to have considerably contributed to prolong the humoral pathology, which referred all diseases to a vitiated state of the fluids, which is now well known to be the eff'ect instead of the cause. Ed. t From the time of Sanctorius, colds, coughs, fevers, and other diseases, have been attributed, by many, to the suppression of perspiration, although there was no direct experiment to prove it. That this may sometimes act as a cause there can be little doubt, but not so frequently as has been imagined ; for we see people perspiring some- times a great deal, at. other times not at all, and without any bad effect. A man, in fine, enjoys as good health in winter as in summer ; in cold as in hot countries ; and, besides that perspiration is carried on to a great extent by the lungs, nature has also taken care to guard against obstructed perspiration, by making it a vicarious secretion with the urine ; for when the former is increased the latter is diminished, and vice versa. The matter of perspiration, nevertheless, appears to be useless to the human frame, and perhaps contains materials that might prove hurtful if retained ; hence, when obstructed, it may produce some complaints and aggravate others ; although ma- ny of the diseases attributed to retained pe'spiration arise from "nere torpor of the skin; and the effect is here taken for the cause See Diapho'-eticf Cold Bath, &c. Ed. WET CLOTHES.— WET FEET.— NIGHT Alii, &c. 95 changes in the atmosphere, and by their pains, coughs, and oppres- aions of the breast, «fec. they become a kind of Uving barometers. WET CLOTHES. Wet clothes not only by their coldness obstruct the perspira- tion, but their moisture, by being absorbed, or taken up into the body, greatly increases the danger. The most robust consti- tution is not proof against the danger arising from wet clothes ; they daily occasion fevers, rheumatisms, and other fatal disorders, even in the young and heahhy. It is impossible for people who go frequently abroad to avoid sometimes being wet. But the danger might generally be lessen- ed, if not wholly prevented, by changing their clothes soon ; when this cannot be done, they should keep in motion till they be dry. So far are many from taking this precaution, that they often sit or lie down in the fields with their clothes wet, and frequently sleep even whole nights in this condition. The frequent instances which we have of the fatal effects of this conduct, ought certainly to deter all from being guilty of it. WET FEET. Wet feet often occasion fatal diseases. The colic, inflam- mations of the breast and of the bowels, the iliac passion, cholera morbus, &c. are often occasioned by wet feet. Habit will, no doubt, render this less dangerous ; but it ought as far as possible to be avoided. The delicate, and those who are not accustomed to have their clothes or feet wet, should be peculiarly careful in this re- spect. NIGHT AIR. The perspiration is often obstructed by night air ; even in sum- mer this ought to be avoided. The dews which fall plentifully after the hottest day, make the night more dangerous than when the weather is cool. Hence in warm countries, the evening dews are more hurtful than where the climate is more temperate. It is very agreeable after a warm day to be abroad in a cool eve- ning ; but this is a pleasure to be avoided by all who value their health. The effects of evening dews are gradual, indeed, and al most imperceptible ; but they are not the less to be dreaded : we would therefore advise travellers, labourers, and all who are much heated by day, carefully to avoid them. When the perspiration has been great, these become dangerous in proportion. By nol attending to this, in flat marshy countries, where the exhalations' and dews are copious, labourers are often seized with intermittir g fevers, quinseys, and other dangerous diseases. DAMP BEDS. Beds become damp, either from their not being used, standing in damp houses, or in rooms without fire, or from the linen not be- ino- dry when laid on tb^ bed. Nothing is more to be dreaded by 96 DAMP HOUSES. travellers than damp beds, which are very common in all places where fuel is scarce. V/hen a traveller, cold and wet, arrives at an inn, he may, by means of a good fire, warm diluting liquor, and a dry bed, have the perspiration restored ; but if he be put into a cold room, and laid in a damp bed, it will be more obstructed, and the worst consequences will ensue. Travellers should avoid inns which are noted for damp beds, as they would a house infected with the plague, as no man, however robust, is proof against tho danger arising from them. But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of strangers are often equally dangerous. All kinds of linen and bedding, when not frequently used, become damp. How then is it possible that beds which are not slept in above two or three times a-year, should be safe ? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reason is ob- vious : were they careful never to sleep in a bed but what was fre- quently used, they would seldom find any ill consequences from a change. Nothing is more to be dreaded by a delicate person when on a visit, than being laid in a bed which is kept on purpose for stran- gers. That ill-judged piece of complaisance becomes a real inju- ry. All the bad consequences from this quarter might easily be prevented in private families, by causing their servants to sleep in the spare beds, and resign them to strangers when they come. In inns, where the beds are used almost every night, nothing else is necessary than to keep the rooms well seasoned by frequent fires, and the linen dry. That baneful custom, said to be practised in many inns, of damping sheets, and pressing them, in order to save washing, and afterwards laying them on the beds, ought, when discovered, to be punished with the utmost severity. It is really a species of mur- der, ai^d will often prove as fatal as poison or gun-shot. Indeed no linen, especially if it has been washed in winter, ought to be used till it has been exposed for some time to the fire ; nor is this operation less necessary for linen washed in summer, provided it has lain for any length of time. This caution is the more needful, as gentlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay no regard to a circumstance of much more importance.* DAMP HOUSES. Damp houses frequently produce the like ill consequences : for this reason those who build should be careful to choose a dry situa- tion. A house which stands on a damp marshy soil or deep clay, will never be thoroughly dry. All houses, unless where the ground is exceedingly dry, should have the first floor a little raised. Ser- vants and others, who are obliged to live in cellars and sunk sto- ries, seldom continue long in health : masters ought surely to pay *If a person suspect that liis bed is damp, the simple precaution of taking off the sheets and lying in the blanket?, with all, or most of his clothes on, will prevent all tlie danger. I have practised this for many years, and never have been hurt by damp beds, ♦iiough no constitution, without care, is proof against '.heir baneful influence. SUDDEN TRANSITIONS, &c. 97 some regard to the health of their servants, as well as to their own. Nothing is more common than for people, merely to avoid some trifling inconveniency, to hazard their lives by inhabiting a house almost as soon as the masons, plasterers, Sec. have done with it ; such houses are not only dangerous from their dampness, but like- wise from the smell of lime, paint, &c. The asthmas, consuinp- tions, and other diseases of the lungs, so incident to people who work among these articles, are sufficient proofs of their being un- wholesome. Rooms are often rendered damj) by an unseasonable piece of cleanliness ; I mean the pernicious custom of washing them imme- diately before company is put into them. Most people catch cold if they sit but a very short time in a room that has been lately washed ; the delicate ought carefully to avoid such a situation, and even the robust are not always proof against its influence.* SUDDEN TRANSITIONS FROM HEAT TO COLD. The perspiration is commonly obstructed by sudden transi- tions from heat to cold. Colds are seldom caught, unless when people have been too much heated. Heat rarifies the blood, quick- ens the circulation, and increases the perspiration ; but when these are suddenly checked, the consequences must be bad. It is, in- deed, impossible for labourers not to be too hot upon some occa- sions ; but it is generally in their power to let themselves cool gradually, to put on their clothes when they leave off work, to make choice of a dry place to rest themselves in, and to avoid sleep- ing in the open fields. These easy rules, if observed, would often prevent fevers and other fatal disorders. It is very common for people, when hot, to drink freely of cold water, or small liquors. This conduct is extremely dangerous. Thirst, indeed, is hard to bear, and the inclination to gratify that appetite frequently gets the better of reason, and makes us do what our judgment disapproves. Every peasant, however, knows, if his horse be permitted to drink his belly-full of cold water after vio- lent exercise, and be immediately put into the stable, or suffered to remain at rest, that it will kill him. This they take the utmost care to prevent. It were well if they were equally attentive to their own safety. Thirst may he quenched many ways icithout sjvallowing large quan- tities of cold liquor. The fields atford variety of acid fruits and plants, the very chewing of which would abate thirst. Water kept in the mouth for some time, and spit out again, if frequently re- peated, will have the same efi'ect. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirst more ef- fectually, and make the danger less. When a person is extremely hot, a mouthful of brandy, or other spirits, if it can be obtained, ought to be preferred to any thing else. But if any one has been "* People imagine if a good fire is made in a room after it has been washed, that there is no danger from sitting in it; but they must give me leave to say that thiB in- creases the danger. The evaporation excited by the fire generates cold, and renders the damo more active, 7 98 SUDDEN TRANSITIONS, &c. so foolish, when hot, as to drink freely of cold liquor, he ought to continue his exercise at least till what he drank be thoroughly warmed upon his stomach. It would be tedious to enumerate all the bad effects which flov from drinking cold liquors when the body is hot. Sometimes thiv has occasioned immediate death. Hoarseness, quinseys, and fever of various kinds, are its common consequences. Neither is it sat'» when warm to eat freely of raw fruits, salads or the like. These, indeed, have not so sudden an effect upon the body as cold liquors, but they are notwithstanding dangerous, and ought to be avoided Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the coW air, is extremely dan- gerous. Colds, coughs, and inflammations of the breast, are the usual consequences of this conduct ; yet nothing is more common than for people, after they have drunk warm liquors for several hours, to walk or i"ide a number of miles in the coldest night, or to ramble about in the streets.* People are very apt, when a room is hot, to throw open a win- dow, and to sit near it. This is a most dangerous practice. Any person had better sit without doors than in such a situation, as the current of air is directed against one particular part of the body. Inflammatory fevers, quinseys, and consumptions have often been occasioned by sitting or standing thinly clothed near an open win- dow. Nor is sleeping with open windows less to be dreaded. That ought never to be done, even in the hottest season, unless the window is at a distance. I have known mechanics frequently con- tract fatal diseases, by working stripped at an open window, and would advise all of them to beware of such a practicc.t Few things expose people more to catch cold than keeping theii own houses too warm : such persons may be said to live in a sort of hot-houses ; they can hardly stir abroad to visit a neighbour but at the hazard of their lives. Were there no other reason for keep- Tig houses moderately cool, that alone is suflicient ; but no house hat is too hot can be wholesome ; heat destroys the spring and elasticity of the air, and renders it less fit for expanding the lungs, ■ind the other purposes of respiration. Hence it is that consump- 'ions and other diseases of the lungs prove so fatal to people who ork in forges, glass-houses, and the like. Some are even so fool-hardy as to plunge themselves, when hot, in cold water.| Not only fevers, but madness itself, has frequent- * The tap-rooms in London and other great towns, where such numbers of people sp nd their evenings, are highly pernicious. The breath of a number of people crowd- ed into a low apartment, with the addition of fires, candles, the smoke of tobacco, and the fumes of hot liquor, &,c. must not only render it hurtful to continue in such places, i9ut dangerous to go out of them into a cold and chilly atmosphere. t Although this long uncontradicted opinion, which daily observation conhrms, baa al been contradicted by Sir Arthur Clarke, the analogies are too wide to bear coin- Da ison. It will, we believe, be universally admitted that a current of air pressing upo? ail overheated body, although it might not prove " inevitably fatal," is neither consi«'- e t with safety nor prudence, while that body is in a passive state; and in an active ne it is better to be removed some distance from a voluminous rush of air, which would e the means of keeping perspiration,in check that was labouring to be set free, there by counteracting the effects of exertion. I A modern writer (Sir Arthur Clarke) entertains, we rather suspect, an untenable opinion' on this particular subject ; nor do we conceive in what manner eudden exter- nal transitions 'should be attended with less danger than such as are internally applied. SUDDEN TRANSITIONS, «fcc. 99 ly been the effect of this conduct. Indeed it looks too hke the ac- tion of a madman to deserve a serious consideration. The result of all these observations is, that every one ought to avoid, with the utmost attention, all sudden transitions from heat to cold, and to keep the body in as uniform a temperature as pos- sil)le ; or where that cannot be done, to take care, when heated, to let it cool gradually. People may imagine that too strict an attention to these things ivould tend to render them delicate. So far, however, is this from l)eing my design, that the very first rule proposed for preventing, colds is, to harden the body, by inuring it daily to the open air. I shall put an end to what relates to this part of my subject, by giving an abstract of the justly celebrated advice of Celsus, with respect to the preservation of health: "A man," says he, " who is blessed Avith good health, should confine himself to no " particular rules either with respect to regimen or medicine. He " ought frequently to diversify his manner of living ; to be some- " times in town, som.etimes in the country ; to hunt, sail, indulgp " himself in rest, but more frequently to use exercise. He ought " to refuse no kind of food that is commonly used, but sometimes " to eat more anu' sometimes less ; sometiznes to make one at an en- " tertainment, and sometimes to forbear it ; to make rather two " meals a-day than one, and always to eat heartily, provided he " can digest it. He ought neither too eagerly to pursue, nor too " scrupulously to avoid intercourse with the fair sex : pleasures of " this kind, rarely indulged, render the body alert and active ; but " when too frequently repeated, weak and languid. He should " be careful in time of health not to destroy, by excesses of any " kind, that vigour of constitution which should support him un- " der sickness." This plain, yet elegant and judicious summary of the most useful maxims of health, confirms the justness of my former remark, that enhghtened Medicine breathes the true spirit of liberal indulgence, laying down no rules but such as a man of sense would cheerfully " It has been very commonly supposed," observes Sir Arthur, "even by medical men, that immersion in the cold-bath, when the body was considerably heated with exercise or other exertion, is a dangerous practice ; and, accordingly, it is a genera! custom with bathers who find themselves overheated, to wait till they become cool, before they plunge into the bath. This opinion and practice has been ably controverted by the late Dr. Currie, who has shown, both from theory and experience, that the opinion is erroneous, and the practice injudicious. This is so true, that for some years he has directed infirm persons to use a degree of exercise before immersion, as may produce tin increased action of the vascular, with some increase of heat, and thus secure a force of re-action under the shock, which otherwise might not always take place." We think Sir Arthur has brought Dr. Currie forward rather untimely ; for it is evident the latter alludes to infirm persons, convalescents, with whom almost invariably the heat of the body, accompanied with a sense of chillness, is below the natural standard: it 18 judicious, therefore, enough that such people should use a degree of exercise to enable them to resist the shock of the cold-bath, and to secure a re-action under it, which otherwise they could not withstand. This practice, however, applies equally to persons in health, whom we would caution never to use the cold-baih at a time when a cold sensation pervades the whole body, any more than to plunge into it at 3 time when the body is overheated ; although both of these conditions may admit of being considerably regulated by the feelings of the inoividual. "The popular opinion, therefore," says Sir Arthur Clarke, upon the preceding grounds, " that it is safest to go perfectly cool into the water is an unfounded error productive of injurious conse- quences." Practice and experience, with all deference to such an opim^Sb, kaT«' proved the reverse. F.D. 100 THE KNOWLEDGE, CURE, AND follow and forbidding nothing but what is incompatible with real hap. piness. Here the votaries of fashion and folly may learn to correct their own mistaken ideas of enjoyment ; the epicure may acquire a relish for rational gratification ; and the man of pleasure may be taught the economy of love. PART II. CHAP. Z. i-HE KNOWLEDGE AND CURE OF DISEASES. The cure of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often foresee the patient's fate sooner than many who have been bred to physic* We do not. however, mean to insinuate that a medical education is of no use r it is doubtless of the greatest importance, but it never can supplj the place of observation and experience. Definition op diseases, &c. — Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead, therefore, of giving a classical aiTangement of diseases, according to the sys- terrj^tic method, it will be more suitable, in a performance of this nature to give a full and accurate description of each partic-uhir disease as it occurs ; and, where any of the symptoms of one dis- ease have a near resemblance to those of another,t to take notice of that circumstance, and at the same time to point out the pecul- iar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine. A proper attention to the patient's age, sex, temper of mmd, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases. In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin : whereas in old age the fibres are rigid, the nerTes become almost insensible, and many of the vessels • Physicians express this prescience by the term Prognffsis, or the art of predicting th^ event of diseases from particular symptoms. ■J Physicians express these symptomatic characters by the word Diagnosit; viz. the si^tis by which one disease may be distinguished from another disease. Hemce those symptoms which distinguish such affections are termed diagnostic ngnt. DEFINITION OF DISEASES, &c. 191 mii)eivial»le. These and other peculiarities render the diseases of the young and aged very different, and of course they must re- quire a different method of treatment. See Diseases of Chu,- UKEN. Females are liable to vianij diseases which do not afflict the other sex : besides, the nervous system being more irritable in Ihem than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations ; and all stimulating medicines ought to be administered to them with a sparing hand™ See Diseases of Females. Pariicidar constitutions not only dispose persons to peculiar diseas- es, hit likewise render it necessary to treat these diseases in a peculiar manner. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, under any disease, precisely in the same manner as one w!io is hardy and robust, and one who is much exjjosed to the open air. The temper and mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When that is affected, the best medicine is to soothe the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible. See affections of the imind. Attention ought likeioise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, «fcc. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabit_ants of high countries. Those who breathe the im- pure air of cities have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and in- dulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, &.c. It has ah-eady been observed, that the different occupations and situations in life dispose men to pecuHar diseases. (See p. 47.) It is therefore necessary to enquire into the patient's occupation, manner of life, &,c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary })recisely in the same manner, even supposing them to labour un der the same disease. It will likewise be proper to enquire, whether the disease be constitutional or accidental ; whether it has been of long or short duration ; whether it proceeds from any great and sudden altera- tion in the diet, manner of life, &.c. The state of the patient's body, and of the other evacuations, ought also to be enquired into ; and likewise whether he can with ease perform all the vital an J animal functions, as breathing, digestion, &c. Lastly, it will be proper to enquire to what diseases the patient has formerly been liable, and what medicines were most beneficial to him ; if he has a strong aversion to any particular drug, &c. As many of the indications of cure may be answered by diet alone, it is always the first thing to be attended to in the treat ment of diseases. Those who know no better, imagine that every thing which goes by the name of a medicine possesses some won- 102 DEFINITION OF DISEASES, &c. derful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences ; it makes people trust to drugs, and neglect their own endeavours ; besides, it discourages all attempts to rt-.ieve the sick where medicines cannot be obtained. Medicines are no doubt useful in their places ; and when admin- istered with prudence, may do much good ; but when they are put in place of every thing else, or administiered at random, which ia not seldom the case, they must do mischief We wou'd, therefore, wish to call the attention of mankind fi'om the pursuit of secret medicines, to such things as they are acquainted with. The prop- er regulation of these may often do much good, and there is little danger of their ever doing hurt. Every disease weakens the digestive powers. The diet ought, therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even absti- nence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking. In all fevers attended with inflammation, as pleurisies, pcri- pneumonies, &.c. thin gruels, wheys, watery infusions of mucilagi- nous plants, roots, &c. are not only proper for the patient's food, btJt they are likewise the best medicines that can be fidministerei.1. In fevers of a slow, nervous, or putri-d kind, where there are no syniDtoms of inflammation, and where the patient must be sup- ported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known. Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afllicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food, and generous liquors, than from all the cordial and carminative medicines which can be ad- ministered to them. The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet than to all the boasted antiscorbutic remedies 3f the snops. In consumptions, when the humours are vitiated, and the stom- ach so much M'eakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet con- sisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed. Nor is the attention to other things of less importance than diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other (#Seases, the patient will receive more benefit from having the fresh air pru- dently admitted into his chamber, than from all the medicines which can be given him. See Air, p. 65. Exercise may likewise in many cases he considered as a medicine. Bailing, or riding on horseback, for example, will be of more ser rice in the cure of consumptions, glandular obstmc ions, &c. than DEFIISITION OF DISEASES, &c. |i)3 any medicines yet known. In diseases which proceed from a re- laxed state of the solids, the cold bath, and other parts of the gym- nastic regimen, will be found equally beneficial. See Exercise, p. 66. Fcrc things are of greater imjwrtance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the dan- ger. Many diseases may be cured by cleanliness alone ; most of them may be mitigated by it, and in all of them it is highly neces- sary both for the patient and those who attend him. See Clean- liness, p. 78. Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regi- men will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment o'f diseases, we have always given the first place to regimen. Th">se who are ignorant of medicine may con- fine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These, however, are never to be administered but by people of better understanding ; nor even by them Avithout the greatest precaution. The clearness and simplicity with which I took care to express myself on these points, would, I thought, have prevented the pos- sibility of any misrepresentation. Yet I find that a certain low clr.ss of self-appointed practitioners, who call themselves of the faculty, take no small pains to insinuate, that my observations on the prevention and cure of diseases serve only to encourage the fatal practice of domestic quackery. This is equally inconsistent with candour and truth. The obvious tendency of all my remarks is to enlighten the minds of the people on a subject of such imme- diate concern as their health, and thus to guard them against the bad eflfects of ignorance and rashness on their own part, and of impudence and deceit on the part of others. I should rather have expected to be blamed for teaching people to place very little reliance on the efficacy of any medicine ; which was, indeed, one of the objects I had in view, for the express pur- pose of directing general attention to the far more assured means of preserving health, namely, air, cleanliness, diet, exercise, and the management of the passions. Upon these subjects 1 enlarged with peculiar earnestness, well knowing how much easier it is to prevent disorders before-hand than to cure them afterwards. Even in cases of actual infirmity and disease, I have intirnated a wish, that those who are ignorant of physic would confine them- selves to regimen only, and leave the medical treatment of their complaints to persons of better information. The remedies which I have prescribed may be entrusted to such hands with perfect safety; and if the directions I give do not operate as a check upon rashness, I know of no words strong enough to produce that effect 104 GENERAL OBSERVATIONS ON FEVERS, &c. CHAP. IZ. GENERAL OBSERVATIONS ON FEVERS, &c. Fevers, ihough the most common complaints, are those in which mankind, whether professional or laical, are those by which they are most apt to be misled. It has been well observed, that " in reality, no writer seems to have been fully satisfied with his own definition, and it is not extraordinary, therefore, that he should have seldom given satisfaction to others." This difficulty proceeds from the complexity of the symptoms that enter into the charac- ter of a fever; the contrariety of many of them to each other in different stages of it ; and the occasional absence of some, that, in other instances, appear to constitute its leading features. There are also two other difficulties of no inconsiderable magnitude, which the nosologist has to contend with in laying down a clear and per- spicuous survey of fevers; namely, their division or collocation, and their generic names, — a province, on which, however, it is not our intention now to discuss. The remote cause of fever can frequently be traced ; but we are too little acquainted with the nature of several of them to be able to restrict them to a specific mode of action : of the proximate cause, but very little iS at present known, and will probably be long before we know much more. The usual division of fevers is into intermittents, and continu- ed, on account of their taking up different times in their natural duration ; some being compounded of a number of paroxysms, fol- lowing each other in a regular succession, at some distance of time, as happens in intermittents or agues ; in others, a fresh paroxism comes in, immediately as the crisis of the former, so as hardly to leave the patient wholly free from fever, as occurs in remittents ; land in others, there is such a quick succession of paroxysms, that the one comes on before there is any visible abatement of the fe- fbrile symptoms as in continued fevers. Causes of fevers, &c. — As more than one half of mankind is ■said to perish by fevers, it is of importance to be acquainted with 'their causes. The most general causes of fevers are, infection, rors in diet, unwholesome air, violent emotions of the 7nind, excess or suppression of usual evacuations, external or internal injuries, and ex- treme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shown, we shall not now resume the consideration of them, but shall only recom- mend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles. Fevers are not only the most frequent of all diseases, but they are, likewise the most complex. In the most simple species of fever there lis always a combination of several different symptoms. The dis- tinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in •dcrforming some of the vital or animal functions. The other synip- CAUSES OF FEVERS, Adc. T05 toms usually attendant on fevers, are nausea, thirst, anxietv, de- lirium, weariness, wasting of the flesh, want of sleep, or tlie sleep disturbed and not refreshing. When the fever comes on gradually, the patient generally com- plains first of languor or listlessness, soreness of the flesh or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the moutli ; after some time come on excessive heat, violent thirst, restlessness, &c. When the fever attacks suddenly, it always begins with an un- easy sensation of excessive cold, accompanied with debility and loss of appetite ; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting. Fever considered as an effort of nature, &c. — As a fever is only an effort of Nature to free herself from an offending cause,* it is the business of those who have the care of the sick io observe with diligence which way Nature points, and to endeavour to as- sist her operations. Our bodies are so framed, as to have a con- stant tendency to expel or throw oft' whatever is injurious to health. This is generally done by urine, sweat, stool, expectoration, vomit, or some other evacuation. There is reason to believe, if the efforts of Nature, at the begin- ning of a fever, were duly attended to and promoted, it would sel- dom continue long ; but when her attempts are either neglected or counteracted, it is no wonder if the disease prove fatal. There are daily instances of persons, who, after catching cold, have all the symptoms of a beginning fever; but by keeping warm, drinking diluting liquors, bathing their feet in warm water, «fcc. the symp- toms in a few hours disappear, and the danger is prevented. When fevers of a puti'id kind threaten, the best method of obviating theii effects is by repeated vomits. Our design is not to enter into a critical inquiry into the nature and immediate causes of fevers, but to mark thei'* most obvious symptoms, and to point out the proper treatment of the patient with respect to his diet, drink, air, &c. in the different stages of the diseases. In these articles the inclinations of the patient will in a great measure direct our conduct. Almost every person in a fever complains of great thirst, and calls out for drink, especially of a cooling nature. This at once * It was the opinion of Hippocrates, that fever is an effort of nature to expel some- thing noxious to the body either ingeneraled, or introduced from without. Beholding a violent commotion in the system, followed by an evacu.uion from the skin and kid- neys, with which the paroxysm terminated, he ascribed le commotion to a fermenta- tion, concoction, or ebullition, by which the noxious matter was separated from the Bound humours ; and the evacuation to a despumation or scum, which such separation produces, or rather to the discharge of this morbid scum from the emunctories that open externally. Galen supported this hypothesis with all the learning of his day, and it is the only explanation of fever to be met with in his medical writings, through the ■ocg course of tliree thousand years ; in fact till the time of Sydenham, who still adher- ed to it, and whose pages are full of the language to which it gave birth; and it ivas blended almost insensibly with the dialect of the chymists of the day. In itself, this doctrine, considered merely hypothetically, is not only innocent, but highly ingenious and plausible. It is in unison with severa' ohenomena of pyretic or febrile diseases ; and derives a strong collateral support from the general history of erupt've fever, in which we actually see a peccant matter, producing gens al commotion, multiplying • tself in a ferment, and at length separated and thrown '^* at the surface by a direct lepuration of the system. Ed. 1G6 SYMPTOMS OF FEVER- poinls out the use of water, and other cooling liquors. What is so likely to abate the heat, attenuate the humours, remove spasm? and obstructions, promote perspiration, increase the quantity of urine, and, in shoit, produce every salutary effect in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is the basis ? The ne- cessity of diluting liquors is pointed out by the dry tongue, the parched skin, and the burning lieat, as well as the unquenchable thirst of the patient. In inflammatory fevers, where the thirst is great, the following forms a grateful and cooling beverage : Take cream of tartar half an ounce. White sugar four ounces. Fresh confection of orange three ounces. Hot water three pints. Half a pint or more may be drunk as occasion requires. Many other cooling liquors, which are extremely grateful to pa- tients in a fever, may be prepared from fruits, as decoctions of tamarinds, apple-tea, orange whey, and the like. Mucilaginous liquors might also be prepared from marshmallow roots, linseed, lime-tree buds, and other mild vegetables. These liquors, espe- cially when acidulated, are highly agreeable to the patient, and should never be denied him. Symptoms of fever. — At the beginning of a fever, the patient generally complains of great lassitude or weariness, and has no in- clination to move. This evidently shows the propriety of keeping him easy, and if possible, in bed. Lying in bed relaxes the spasms,* abates the violence of the circulation, and gives nature an oppor- tunity of exerting all her force to overcome the disease. Confine- ment to bed alone would often remove a fever at the beginning ; but when the patient struggles with the disease instead of driving it oft", he only fixes it the deeper, and renders it more dangerous. This observation is too often verified in travellers, who happen when on a journey to be seized with a fever. Their anxiety to get home, induces them to travel with the fever upon them ; which con- duct seldom fails to render it fatal. In fevers, the mind as well as the body shovdd be kept easy. Company is seldom agreeable to the sick. Indeed every thing that * The hypothesis of Stahl, Hoffman, and Cullen, is founded on the doctrine of a spasm on "the extremities of the living fibre. According to the more elaborate princi- ples of this system, as improveJ by Cullen, the human body is a congeries of organs, regulated by the laws not of inani.nate matter, but of life, and superintended by a mo. bi!" and conservative power or energy, seated in the brain, but distinct from the mind or sou., acting wisetj hutnecessarily for the general health ; correcting deviations, and supplying defects, not from a knowledge and choice of the means, but by a pre-estab- lished relation between the changes produced, and the motions re'|uired for the reslo- Tation of health; and operating, therefore, through the medium of the moving fitrcs, upon whose healthy or unhealthy state depends the health or unhealthiness of the general frame, which fibres he regarded with Stahl, as simple nerves, the musculai filaments being nothing more than their extremities, and by no means possessed of »f independent vis inxita. Ed. SYMPTOMS OF FE\ER. 107 disl ii\»« the imagii.ition increases the disease : for which reason ever !• person in a fever ought to be kept perfectly quiet, and nei thei allowed to see nor hear any thing that may in the least afleti or d« ^compose his mind. Though the patient in a fever has the greatest inclination for drink, yet he seldom has any appetite for solid food : hence the impropriety of urging him to take victuals is evident. Much solid food in a fever is every way hurtful. It oppresses nature, and, in- stead of nourishing the patient, serves only to feed the disease. What food the patient takes, should be in small quantity, light, and of easy digestion. It ought to be chieHy of the vegetable kind, as panada, roasted apples, gruels, and such like. Nothing is more desired by a patient in a fever, than fresh air. It not only removes his anxiety, but cools the blood, revives the spirits, and proves every way beneficial. Many patients are in a manner stifled to death in fevers for want of fresh air; yet such is the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept in a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick cerson's chamber, so as to keep it moderately cool. Indeed, its ue-gree of warmth ought never to be greater than is agreeable to one in perfect health. Nothing spoils the air of a sick person's chamber, or hurts the patient more, than a number of peaple breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manii er poisonous to the sick. In fevers, when the patient's spirits are low and depressed, he 13 not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing his mind with the hopes and consolations of religion, frighten him with the views of hell and damnation. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct •, it often hurts the body, and there is reason to believe seldom benefits the soul. Among common people, the very name of a fever generally sug- gests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature ; but true inflammatory fevers are now seldom to be met with. Sedentary occiipations, and a difl"erent manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is ne cessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be evident signs of inflammation. Bleeding is an excellent medicine when ne- cessary, but should never be wantonly performed. It is likewise a common notion, that sweating is alwavs neccs- 108 SYMPTOMS OF FEVER. sary in the beginning of a fever. When the fever proceeds from an obstructed perspiration, this notion is not ill-founded. If the patient only lie in bed, bathe his feet and legs in warm water, and drink plentifully of warm water-gruel, or any other weak, diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever ; it will ope)\ the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c., which fire his blood, in- crease the spasms, and render the disease more dangerous. In all fevers, a proper attention should be paid to the patient's longings. These are the calls of Nature, and often point out what may be of real use. Patients are not indeed to be indulged in ev- ery thing that the sickly appetite may crave ; but it is generally right to let them have a little of what they eagerly desire, though it may not seem altogether proper. When a patient is recovering from a fever, great care is neces- sary to prevent relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and del- icate, it is necessary to guard against catching cold. Moderate exercise in the open air Avill be of use, but great fatigue is by all means to be avoided ; ag-reeable company will also have a good effect. The diet must be light, but nourishing. It should be tak- en frequently, but in small quantities. It is dangerous, at such a time, to eat as much as the stomach may crave. From the great variety of fevers that afflict the human body, it is impossible to find any medicine adapted to them all, or, in- deed, to all the symptoms of any one of them. Notwithstanding this, the people of England have, for half a century, been swal- lowing a powder said to possess wonderful virtues in the cure of fevers. Nor has the use of this powder been confined to England ; it has been carried to every part of the globe ; and great cures have been attributed .to it, with what truth I will not pretend to say. I remember bleeding to have been as much in vogue in fe- vers, though now it is seldom prescribed, unless in local inflam- mations. But there is a fashion in physic, as well as in othei things ; and it is always heresy to talk against the doctrine of the This fever-powder, like other quack medicines, is said to be good in a variety of complaints, and is used by some people in ev- ery disorder, real or imaginary. I knew a lady, who not only ad- ministered it to all the poor of the parish when ill, but likewise o-ave it to her dogs and horses ; and never failed to take it daily herself, till she destroyed her constitution. Many persons look vrfon it as panacea, or universal remedy, and keep it continually by theui in case of emergencies. The fatal consequences of such credulity must be often irreparable. This, at least, was the situa- tion of an old General of my acquaintance, whom no argument eould dissuade from taking the powder, til.' ' ■» lost the use of all his extremities. INTERMrrTENT FEVERS, &c. 109 There is not a greater solecism in language, nor a greater ab- surdity in real practice, than to pretend that any one medicine is of certain efficacy in fevers. Tiie most skilful physicians that ever existed have always found it necessary to watch attentively the progress of a fever ; and to adapt both the regimen and medicines to the different changes and symptoms as they occurred. CHAP. III. INTERMITTENT FEVERS, OR AGUES. The generic character of an intermittent fever consists of peri- ods or paroxysms, between each of wliich there is a perfect inter- val when no fever is present. They admit of several distinctions, as true, spurious, perfect, and imperfect. The true and perfect intermittents which iccur are ; 1. The quotidian or daily — having an intermission of 24 hours. 2. Tertian, or third-day, 48 hours. 3. Quartan, or fourth-day, 72 hours. When the return of an intermittent exceeds the latest of these times, it is called erratic or wandering. The other distinctions are of no practical utility, the means of cure being the same. The paroxysm of an intermittent consists of three successive stages, viz. a hot, a cold, and a sweating stage. Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally known. The several kinds of intermittent fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c. It appears to be generally acknowledged, that marsh miasmata or the effluvia arising from stagnant \vater, or marshy ground, when acted upon by heat, are the most frequent exciting cause of this fever. Exciting causes. — This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the fens of Cambridgeshire, the hundreds of Essex, &c., although we are not yet sufficiently acquainted with all the circumstances which are requisite to render marsh mias- mata productive of intermittents. In acknowledging, however, the influence of marsh effluvia to produce intermittents, they must not, at the same time, be considered as their universal cause, since it is found that persons residing constantly in the most healthy 110 INTERMITTENT FEVERS, &c. part of cities, and far remote from marshes, are not unfrequenllj attacked by them. Predisposing. — This disease may also be occasioned by debihty, however induced, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fetigue, depressing passions of the mind, &c. When the inhabitants of a high country remove to a low one, ihey are generally seized with intermittent fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circula- tion in the capillary or small vessels, disposes the body to agues. Symptoms of the cold stage. — An intermitting fever generally begins with pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting ; to which succeed shivering and vio- lent shaking. Of the hot stage. — After a longer or shorter continuance of shivering, the heat of the body gradually returns ; irregularly at first, and by transient flushes, soon, however, succeeded by a steady, dry, and burning heat, considerably augmenting above the natural standard. The skin which before was pale and constricted, be- comes now swollen, tense, and red ; and is remarkably sensible to the touch. The sensibility, diminished in the cold stages, is now preternaturally acute ; pains attack the head, and flying pains are felt over various parts of the body. The pulse is quick, strong, and hard ; the tongue white, the thirst is great, and the urine is high coloured. Of the sweating stage. — A moisture is at length observed to break out upon the face and neck, which soon becomes universal and uniform. The heat falls to its ordinary standard ; the pulse diminishes in frequency, and becomes full and free ; the urine de- posits a sediment ; the bowels are no longer confined ; respiration is free and full; all the functions are restored to their natural or- der ; when, after a specific interval, the paroxysm returns, and performs th* iame successional evolutions. Between the paroxysms, the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass sf small wine, in which gentian root, centaury, or strme other bit- *r, has been infused. As the chief intentions of cure in an ague are lo brace the sol .dp, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But >f he cannot bear that kii. '\ of exercise, he ought to take such Me INTERMITTENT FEVERS, &c. Ml Ins strength will permit. Nothing tends more to prolong an in- termitting lever, than indulging a lazy indolent disposition. Intermitting fevers, under a proper regimen, will frequently go off without medicine : and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course ; but when the patient's strength s« ems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This, however, should never be done till the disease be properly formed, that is to say, till the pa- tient has had several fits of shaking and sweating. Medical treatment. — 1. This consists during the cold stage, in endeavouring to bring on the hot, by means of artificial warmth ; putting the feet in warm water ; giving mild diluent liquids ; dia- phoretic cordials ;* opiates, &c. 2. During the hot stage, to promote perspiration, by means of cordial diaphoretics, with the means recommended in the cold stage. The principal object, therefore, in the treatment of intermittents, is to put a period to the stage which is present, by hastening that which naturally succeeds it. The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more effica- <;ious. In this disease the stomach is generally loaded with cold viscid phlegm, (sordes,) and frequently great quantities of bile are discharged by vomit ; which plainly points out the necessity of such evacuations. Emetics are, thei-efore, to be administered be- fore the patient takes any other medicine, which may be adminis- tered just before the accession of the cold fit. A dose of ipecacu- anha will generally answer this purpose very well. A scruple or half a drachm of the powder will be sufficient for an adult,t and for a younger person the dose must be less in proportion. After It begins to operate, the patient ought to drink plentifully of weak camomile-tea ; and it may be repeated at the distance of two or three days. Emetics not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of • Take Spirits of Nitric iEther, or 2 drachms. Take Peruvian Bark, 1 ounce. Camphor mixture, 4 ounces. Divide into twelve equal parts, of which Liquor of acetated Ammonia, take one every hour, or every second 1 ounce. or third hour, in a small cupful of new Syrup of Roses, 3 drachms. milk, during Die absence of the fever. Mix": and take two table-spoonsful every or fifteen minutes. Take Peruvian Bark, 1 ounce. Compound Cinnamon powder, \ Take Powder of Ipecacuanha, h. drachm 15 grains. Mix, and divide into twelve equal parts Tartarised Antimony, I grain. or Make an Emetic powder. " Take Peruvian Bark, 1 ounce. or Confection of Opium, 1 drachm. Powder of Ipecacuanha, Mix, and divide into twelve equal parts 15 grains. or Tartarized Antimony, 1 grain. Take Peruvian Bark, 1 ounce. Spearmuch water, 1 J ounce Powdered Rhubaib, 2 scruples Syrup of Saffron, 1 ounce Mix, and divide in twelve jDqual parts \[:-\e an Emetic draught to be taken as above 112 INTERMITTENT FEVERS, &c. such importance, that they often cure intermitting fevers without tlie assistance of any other medicine. Purgative medicines are hkevk^ise useful and often necessary' in mtermitting fevers. Emetics, however, are more suitable in this disease, and render purging less necessary ; but if the patient „«- afraid to take a vomit, he ought in this case to cleanse the bov els by a dose or two of Epsom salts, jalap, or rhubarb, as may ap Dear best adapted to the constitution. Bleeding may sometimes be proper at the beginniug of an in- termitting fever, when excessive heat, delirium, &:.c. g ve reason to suspect an inflammation or congestion of blood in the jxternal ves- sels of the head ; but as the blood is seldom in an inflammatory state in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease. After proper evacuations, the patient may safely use the Peruvi an bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder. It may also, as required, be advantageously combined with other sub- stances, as, confection of opium, rhubarb, cinnamon also, in any form ; c. g. in powder, electuary, tincture, decoction, extract, ifec. Two ounces of the best Peiiivian bark, finely powdered, may b divided into twenty-four doses. These may either be made intv boluses, as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or an} other drink that is more agreeable to the patient.* Quinine is considered specific. Take four three-grain doses daily. Ill an ague which returns every day, one of the above do«!«s; va'^ be taken every two hours during the interval of the fits. By tnu method, the patient will be able to take five or six doses between each paroxysm. In a tertian, or third day, ague, it will be suffi- cient to take a dose every third hour, during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, «fcc. For a young person, a smaller quantity of this medicine will be suflScient, and the dose must be adaptecl to the age, constitution, and violence of the symptoms.t The above quantity of bark will frequently cure an ague ; the patient, however, ought not to leave off taking the medicine ps soon as the paroxysms are stopped, but should continue to u-e Jt till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to pa- tients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave * It has lately been observed, that the red bark is more powerful than that which has for some time been in common use. Its superior efficacy seems to arise from its be- ing of a more perfect growth than the quill-bark, and consequently more fully impreg- nated with the medical properties of the plant. ' In intermitting fevers of an obstinate nature, I have found it necessary to throw • a (he bark much faster. Indeed, the benefits arising from ti these may sometimfe« succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose l)elter. Ihe only medicine that can he depended up- on for thoroughly curing an intermittent fever, is the Peruvian hark. It may always he used with safety ; and 1 can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in. Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeble sharpness with diluted sulphuric acid. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, a proportionate dose of the saline mixture* may be given with advantage to children. Wine-whey is a very proper drink for a child in an ague ; to half an English pint of which may be put a tea-spoonful of the spirit of hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourish- ing, and sometimes a little generous wine should be allowed. To children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm wa- ter, with the addition of half an ounce of SNi'eet oil, and six or eight drops of laudanum, is the form recommeoded by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of ex- tract and laudanum must be proportionably lessened. Children hi.:ve been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it : by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirit, or with a mixture of equal parts of the tincture of opium and the soap liniment. To prevent agues, people must endeavour to avoid their causes. These have been already pointed out in the beginning of this sec- tion : we shall, therefore, only add one preventive medicine, which may be of use to such as are obliged to live -^ ' ^ marshy coun- tries, or who are liable to frequent att<>f",ks of ihis disease. Take an ounce of the best Peruviar 'jark ; Virginian snake- root, and orange-peel, of each half an ouuce ; bruise them all to- gether, and infuse for five or six days in a bottle of brandy, Hol- land gin; or any good spirit ; afterwards pour off the <:;lear liquor, and take a wine-glass of it twice or thrice a-day. This, indeed, is recommending a dram ; but the bitter ingredients in a great meas- ure take off the ill effects of the spirit. Those who do not choose of the grey spider, is inert, and so is the web of the other, when not recent, which may be "known by its glutinous feel." See Elements of Therapeutics and Materia Shdica. By N. Chapman, M. D. In two Vols. 8vo. Vol. ii. * Take Sulphate of Magnesia, 6 drachms. Syrup of Ora.ige-peel, 1 drachm. Infusion of Senna, 1^ ounr.e. Make a purgin? Hrauyk 116 INTERMITTENT FEVERS, «fcc. it in brandy, may infuse it in wine ; and such as can bring them- selves to chew the bark, will find that method succeed very well. Gentian-root, or calamus aromaticus, may also be chewed by turns for the same purpose. All bitter tonics seem to be antidotes to agues, especially those that are warm and astringent.* Various other species of bark are found to be equally efficacious in the cure of intermiitents ; e. g. salix fragile, or crack-willow bark, cascarilla, cusparia, Jamaica bark, oak bark, &.c. Two new vegetable alkalis have been procured from the Peru- vian bark ; one from the red, or cinchona oblongifolia, called cin- chonina : the other from the grey, or cinchona cordifolia, called quinine, though this is found in both the red and yellow bark. Q,uinine,t the most distinguished in the cures of agues, is white and intensely bitter. Its success in removing intermittents has been amply confirmed by Dr. Elliot, of St. Thomas's hospital, and others ; and it possesses many advantages over the Peruvian bark in any shape ; among which the smallness of the dose is not the least important, being from five to ten grains, either in the form of syrup, pills, tincture, wine, &c. Intermittent fevers assume various types at different seasons, &-C. which it is the province of the physician to attend to. Their characler seems to depend much upon the age or peculiar habit of the body of the individual, and the temperament of the atmos- phere. It is also observed that variations are more common in the quotidian than in any other type, which, perhaps, may be at- tributed to its more frequent occurrence in early life, when the frame is more irritable, and to the debility which the constitution suffers from this type above that of any other, in consequence of the greater length of its paroxysms, and the greater brevity of its intervals, by which means the prostrated strength of the sys- tem has no time to rally or recover itself. Diet. — While the fit continues, the patient ought to drink free- ly of water-gruel, orange-whey, weak comomile-tea ; or, if his spir- its be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that will assist in bringing on the sweat, and consequently shorten the paroxysm.^ * Blessed thistle, gentian, wormwood, camomile, bitter wood, columba, St. Ignatius bean, lesser centaury, German leopard's bane. or t Take Sulphate of Quinine, 12 grains. Take Sulphate of Quinine, 15 grs. Good Madeira wine, 2^ pints. Extract of Camomile, 15 grs. Make a solution ; the dose of which may Beat up and divide into six pills ; one to be from four to twenty four ounces in be taken every third hour, the course of the day. or or Take Sulphate of Quinine, 15 grs. Take Sulphate of Quinine, 6 grs. Simple Syrup, i pint. Alcohol (specific gravity 847) 1 gr. Mix for a syrup, and take three table Make a tincture ; dose 2 to 6 drms. spoonsful three times a day. X Ur. Lind says, that twenty or twenty-five drops of laudanum put into a cup of the patient's drink, and given about half an hour after the commencement of the hot fit, promotes !he sweat, shortens the fit, relieves the head, and tends greatly to remove the ■iioease. REMITTENT FEVER. 117 CHAP. IV. REMITTENT FEVER. This fever takes its name from a remission of the sympioinf, which happens sometimes sooner and sometimes later, but gener- ally before the eighth clay. The remission is commonly preceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration : the nearer, however, that the fever approach- es to a regular intermittent, the danger is the less. Causes. — Remittent fevers prevail in low marshy countries abounding with wood and stagnating water;* but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, Bengal, in the East Indies, &c. where re- mitting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy seasons, great inundations, or the like. No age, sex, or con- stitution is exempted from the attack of this fever ; but it chiefly seizes persons of a lax habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and use un- wholesome diet. SyMPTOMS. — The first symptoms of this fever are generally yawn- ing, stretching, pain, languor, and giddiness in the head, with al- ternate fits of heat and cold. Sometimes the patient is afffected with a delirium at the very first attack. There is a pain and some- times a swelling, about the region of the stomach, the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full ; and the blood, when let, rarely shows any signs of inflammation. Some patients are exceedingly costive, and others are afflicted with a very troublesome looseness. It is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circum- stances too tedious to mention. Sometimes the bilious symptoms * Although originally produced by marsh miasma, and in its simple state not of an infectious nature, this fever under bad management, such as crowding too many sick together, neglecting proper cleanliness and a free ventilation, tliere cannot be a doubt that it may in its course engender a matter capable of occasioning a fever of a highly contagious nature ; and although remittent fever cannot be communicated at any great distance from the source of its exciting cause, however severely and epidemically it may prevail in certain situations and districts; and although the matter producing it he essantially the same, still we may conclude, " I think," says Dr. Thomas, (a) " thai A more aggravated form of the disease is occasioned by a more concentrated state of the person : hence the different deg-ees of severity of remittent fever at different pe rioda of the year, and in different climates." Ed. (a) Modern Practice of Physic. 118 REMITTENT FEVER. predominate, sometimes the nervous, and at other times the pu- trid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person. Diet. — The regimen must be adapted to the prevailing symp- toms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms prevail, it will be necessary to support the pa- tient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must, however, be very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regi- men, and improper medicines. W^hatever the symptoms are, the patient ought to be kept cool, quiet, and clean. His aptutnient, if possible, should be large, and frequently ventilated by letting in fresh air at the doors and win- dows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed clothes, &c. should be frequent- ly changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they ai-e of more importance to the sick than practitioners are apt to imagine.* Medical treatment. — In order to cure this fever, we must en- deavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation ; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. But in all protracted cases, under every climate, where the pulse is weak, but where the head is still much aff*ected, the application of cupping-glasses to the back part of the head, or of leeches to the temples, will be more advisable than venesection. As nausea usually prevails at the commencement of the disease, an emetic veil) seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well : but where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be re- peated once or twice at proper intervals, if the sickness or nausea continues. Cold aff'usion, where it can be practised with propriety, produ- ces the most agreeable effects with a tendency to sleep, fuller and more uniform pulse, moist skin, and now and then a distinct re mission. To alter the type of the fever, it may be proper to give * The patient's shirt, bed-clothes, and bedding, ought frequently to be changed, ani exposed to the air, and all his excrements immediately removed; the bed...iamber should be well ventilated, and frequently sprinkled with vinegar; in short, every at tention should be paid to the patient. I can affirm, that a physician who puts these in practice will much oftener succeed, than one who is even more skilful, but has not op portunity of using these means. Dr. LiND. REMITTENT FEVER 119 aiitnnonials,* in small and repeated doses. To allay voinitinj^, warm fomentation of camomiles, and bruised po])f)y-iieads, clear the seat of the stomach. Saline draughts in a state of efferves- cence, to each of which may be added ten drops of the tincture of (jj)ium. The body ought to be kept open either by clysters or gentle lax- atives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like ; but all strong or drastic purgatives are to be carefully avoided. In this fever, as well as in that called the yellow fever {typhti uteroclcs,) the submuriate of mercury ,t combined with rhubarb of jalap, may be regarded as a valuable remedy, where it is wished to carry off putrid feculent matter from the bowels, and there is at the same time any degree of nausea or vomiting present, as, from the smallness of the bulk, it may possibly be retained on the stom- ach when every other purgative might be rejected. In cold climates we may wait for a perfect and complete remis- sion before the bark is administered ; but in warm climates it ought to be given even in the most imperfect and shortest remis- sion ; and although it may not prove sufficiently efficacious to pre- vent a fresh attack at first, it will, nevertheless, mitigate the subse- quent return of the fever, and at last bring about regular and a per- fect remission. When this is omitted in warm climates, it is apt to assume a continued form. By this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case the Pe- ruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them. The most likely Avay to avoid this fever is to use a wholesome or nourishing diet, to pay the most scrupulous attention to cleanli- ness, to keep the body warm, to take sufficient exercise, and in hor countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which wc can recommend is the Peruvian bark, which may either be cheAved, or infused in brandy or wine, ilcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf-sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours wdll be sufficient, using some diluent drink. If the body be bound, a clyster of milk and water, with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea- spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink, or some gentle aperient may be given.* He may likewise eat tamarinds, boiled prunes, roasted apples, and the like. If there be pain in the head with delirium, oppressed breathing, or determination to any organ, leeches should be applied to the temples, or other parts, blisters, fomentations, «fec. and the treat- ment laid down for the particular organ affected should be adopted. If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish sediment, there is reason to expect a favourable issue tc the disease. But if, instead of these symptoms, the patient's spir- its grow languid, his pulse sinks, and his breathing becomes diffi- • Take Pulp of Tamarinds, h ounce. or Cream of Tartar, 2 drachms. Take Sulphate of Soda, 6 drachms. Boiling Water, 5 ounces. Infusion of Senna, 1^ ounce. Strain off the liquor and add, Syrup of Oranges, 1 drachm. Cinnamon Water, 1 ounce. Make a purging draught. Tartarised Antimony, 1 grain. or Four table spoonsful to be taken for a Take powdered Rhubarb, 25 grains, dose, to be repeated in three hours. Cream of Tartar, 1 dracnm. should no motions in that time hare Make a powder, to bo taken out of soma been obtained. appropriate vehicle. 126 INFLAMMATORY FEVER. cult, w.th a stupor, trembling of the nerves, starting of the ten- (ions, ^i. aV^' Of which, make a mixture, and let the pa- „ , Spirit of Compound Ether, 2 drs. tient take a table spoonful often. Make a mixture-two table spoonsful eve Take o' the strongest Camphor Mixture, 7 oz. ry two hours. PUTRID FEVER. 133 hy. The changes for the better are often as sudden, and unfcjre- peen, as those for tlie worse. The last gasp alone should induce IIS to give over the patient. I have left a patient twenty times and more, little expecting to see him alive next day. Yet I did not lose courage, but ordered a bottle, or perhaps two, of generous wine to be given in the course of twenty-four hours ; and that ])a- tient, to my great satisfaction, recovered, and enjoyed health for many years after. OHAF. VIII. MALIGNANT AND PUTRID, OR SPOTTED FEVER, ( Typhus gravior.) This fever, which takes its name from the malignancy of its na- ture, and the symptoms of putrefaction observed towards its close, may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease t[ie plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watchino^, bard labour, excessive venery, frequent salivations, &.c. are moat liable to it. Causes. — This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly venti- lated ; from putrid animal and vegetable effluvia, &.c. Hence it prevails in camps, jails, hospitals, and infirmaries, especially where such places are too much crowded, and cleanliness is neg- lected. A close constitution of the air, with long rainy or foggy weath- er, likewise occasions putrid fevers. They often succeed great in- undations in low and marshy countries, especially when these are preceded or followed by a hot and sultry season. Living too much upon animal food, without a proper mixture of vegetables, 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, are very often vis- ited with putrid fevers. Corn that has been greatly damaged by rainy seasons, or long keeping, and water which has become putrid by stagnation, &c. may likewise 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 in countries which are the scenes of war and blood- shed. This shows the propriety of removing burying-grounds, slaughter-houses, &c. to 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. 134 PUTRID FEVER. Such mechanics as carry on dirty employments, and are con- stantly confined within doors, are likewise very liable to this dis- ease. We shall only add, that putrid, malignant, or spotted fevers are highly infectious, and are therefore often communicated by conta- gion. For which reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance i« absolutely necessary. Symptoms. — The malignant fever is generally preceded by lan- guor, a remarkable weakness, or loss of strength, without any ap- parent cause. This is sometimes so great, that the patient can scarcely walk, or even sit upright, without being in danger of faint- ing 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 pulsa- tion or throbbing of the temporal arteries ; the eyes often appear red and inflamed, with a pain at the bottom of the orbit ; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh ; the patient complains of a pain about the region of the stomach, and in his back and loins ; his tongue is at first white, but afterwards it appears black and chapped ; and his teeth are covered with a black crust. He sometimes passes worms both up- wards and downwards, is affected with tremors or shaking, and often becomes delirious. If blood be let, it appears dissolved, or with a very small de- gree of cohesion, and soon becomes putrid ; the stools smell ex- tremely foetid, and are sometimes of a greenish, black or reddish cast. Spots of a pale, pui'ple, dun, or black colour, often appear upon the skin, and sometimes there are violent haemorrhages or discharges of blood from the mouth, eyes, nose, «fec. Putrid fevers may be distinguished from the inflammatory, by the smallness of the pulse, the great dejection of mind, the dissolv- ed state of the blood, the petechise or purple spots, and the putrid smell of the excrements. They may likewise be distinguished from the low or nervous fever, by the heat and thirst being greater, the urine of a higher colour, and the loss of strength, dejection of mind, and all the other symptoms more violent. It sometimes happens, however, that the inflammatory, nervous, and putrid symptoms are so blended together, as to render it very difficult to determine to which class the fever belongs. In this case, the greatest caution and skill are requisite. Attention must be paid to those symptoms which are most prevalent, and both the regimen and medicines adapted to them. Inflammatory and nervous fevers may be converted into malig- nant and putrid, by too hot a regimen, or improper medicines. The duration of putrid fevers is extremely uncertain ; some- times they terminate between the seventh and fourteenth day, and at other times they are prolonged for five or six weeks. Their du- ration depends greatly upon the constitution of the patient, and the manner of treating the disease. The most favourable symptoms are, a gentle looseness after the fourth or fifth day, with a warm mild sweat. These, when PUTRID FEVER. 135 continued for a considerable tinne, often carry off the fever, and sliould never be imprudently stopped. Small miliary pustules. iippearin<5 between the i)etechifE or purple spots, are likewise fa- vourable, as also hot scabby eruptions about the mouth and nose. It is a good sign when the pulse rises upon the use of wine, or oth- er cordials, and the nervous symptoms abate ; deafiiess comina on towards the decline of the fever, is likewise often a favoura- ble symptom,* as are abscesses in the groin, or parotid glands. Among the unfavourable symptoms may be reckoned an ex- cessive looseness, with a hard swelled belly ; large black or livid blotches breaking out upon the skin ; apthae in the mouth ; cold clammy sweats ; blindness; change of the voice; a wild staring of the eyes ; difficulty of swallowing ; inability to put out the tongue ; and a constant inclination to uncover the breast. When the sweat and saliva are tinged with blood, and the urine is black, or deposits a black sooty sediment, the patient is in great danger. Starting of the tendons, and fcetid, ichorous, involuntary stools, attended with coldness of the extremities, are generally the fore- runners of death. Diet. — In the treatment of this disease, we ought to endeavour, as far as possible, to counteract the putrid tendency of the hu- mours ; to support the patient's strength and spirits ; and to as- sist Nature in expelling the cause of this disease, by gently promot- ing perspiration and the other evacuations. It has been observed, that putrid fevers are often occasioned by unwholesome air, and of course they must be aggravated by it. Care should, therefore, be taken to prevent the air from stagnat- ing in the patient's chamber, to keep it cool, and renew it fre- quently, by opening the doors or windows of some adjacent apart- ment. The breath and perspiration of persons in perfect health soon render the air of a small apartment noxious ; but this will sooner happen from the perspiration and breath of a person whose whole mass of humours are in a putrid state. Besides the frequent admission of fresh air, we would recom- mend the use of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be most readily obtained- These ought frequently to be sprinkled upon the floor, the bed, and every part of the room. They may also be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons or oran- ges ought likewise to be laid in different parts of the room, and they should be frequently held to the patient's nose. The use of acids in this manner would not only prove very refreshing to the patient, but would likewise tend to prevent the infection from, spreading among those who attend him. Strong-scented herbs, as rue, tansy, rosemary, wormwood, &-c. may likewise be laid in" different parts of the house, and smelled to by those who go near the patient. The patient must not only be kept cool, but likewise quiet and easy. The least noise will affect his head, and the smallest fatigue will be apt to make him faint. * Deafness is not always a favourable symptom in this disease. Perhaps it is only to when occasioned bv abscesses formed within the ears. 136 PUTRID FEVER. Few things are of greater importance in this disease than acids, which ought to be mixed with all the patient's food as well as drink. Orange, lemon, or vinegar-whej, are all very proper, and may be drunk by turns according to the patient's inclination. They may be rendered cordial by the addition of wine in such quantity as the patient's strength seems to require. When he is very low, he may drink negus, with only one half water, and sharpened with the juice of bitter orange or lemon. In some ca- ses a glass of wine may now and then be allowed. The most proper wine is Rhenish ; but if the body be open, red port or clar- et is to be preferred. When the body is bound, a tea-spoonful of the cream of tartar may be put into a cup of the patient's di-ink, as there is occasion ; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool. If camomile-tea will sit upon his stomach, it is a very proper drink in this disease. It may be sharpened by adding to every cup of tea, ten or fifteen drops of the elixir of vitriol. The food must be light, as panado, or groat-gruel, to which a little wine may be added, if the patient be weak and low ; and they ought all to be sharpened with the juice of orange, the jelly of currants, or the like. The patient ought likewise to eat freely of ripe fruits, as roasted apples, currant or gooseberry tarts, pre- served cherries, or plums, «fec. Taking a little food or drink frequently, not only supports the spirits, but counteracts the putrid tendency of the humours ; for which reason the patient ovight frequently to be sipping small quantities of some of the acid liquors mentioned above, or any that may be more agreeable to his palate, or more readily ob- tained. If he be delirious, his feet and hands ought to be frequently fo- mented with a strong infusion of camomile flowers. This, or an infusion of the bark, to such as can afford it, cannot fail to have a good effect. Fomentations of this kind not only relieve the head, by relaxing the vessels in the extremities, but as their contents are absorbed, and taken into the system, they must assist in pre- venting the putrescency of the humours. Medical treatment. — If an emetic be given at the beginning ^of this fever, it will hardly fail to have a good effect; but if iho fever has gone on for some days, and the symptoms are vio- lent, vomits are not quite so safe. The body, however, is always to be kept gently open, by clysters, or mild laxative medicines. Bleeding is seldom necessary in putrid fevers. If there be signs of an inflammation, it may sometimes be permitted at the first on- set ; but the repetition of it generally proves hurtful. Blistering-plasters are never to be used unless in the greatest extremities. If the petechiae or spots should suddenly disappear, the patient's pulse sink remarkably, and a delirium, with other bad symptoms, come on, blistering may be permitted. In this case tiie blistering plasters are to be applied to the head, and in- side of the legs or thighs. But as they are sometimes apt to occa- sion a gangrene, we would rather recommend warm cataplasms, MALIGNANT AND PUTRID FEVER. 13: or poultices of mustard and vinegar to be applied to the feet, liav- ing recourse to blisters only in the utmost extremities. It is common in the beginning of this fever to give the emetic tartar in small doses, repeated every second or third hour, till it shall either vomit, purge, or throw the patient in a sweat. TIuh practice is very proper, provided it be not pushed so far as to weaken the patient. Much benefit has been derived from the use of the compound spirit of ether.* In the most dangerous species of this disease, when it is attend- ed with purple, livid, or black spots, the Peruvian bark must be administered. I have seen it, when joined with acids, prove very successful, even in cases where the petechise had the most threat- ening aspect. But to answer this purpose, it must not only be given in large doses, but duly persisted in. The best method of administering the bark is certainly in sub- stance. An ounce of it in powder may be mixed with half an English pint of water, and the same quantity of red wine, and sharpened with the elixir or the spirit of vitriol, (sulphuric acid,) which will both make it sit easier on the stomach, and render it more beneficial. Two or three ounces of the syrup of lemon may be added ; and two table-spoonfuls of the mixture taken every two hours, or oftener, if the stomach is able to bear it. Those who cannot take the bark in substance, may infuse it in wine, as recommended in the preceding disease ; or in any of the annexed forms t If there be a violent looseness, the bark must be boiled in red Avine with a little cinnamon, and sharpened with the elixir of vit- riol as above. Nothing can be more beneficial in this kind of looseness than plenty of acids, and such thmgs as promote a gen- tle perspiration. If the patient be troubled with vomiting, a drachm of the sub- carbonate of potash, dissolved in an ounce and a half of fresh lemon-juice, and made into a draught, with an ounce of simple cinnamon-water, and a bit of sugar, may be given and repeated as often as it is necessary. If swellings of the glands appear, their suppuration is to be pro- moted by the application of poultices, ripening cataplasms, &c. and as soon as there is any appearance of matter in them, they ought to be laid open, and the poultices continued. 1 have known large ulcerous sores break out in various parts of the body, in the decline of this fever, of a livid gangrenous ap- pearance, and a most putrid cadaverous srrtell. These gradually healed, and the patient recovered, by a plentiful use of Peruvian bark and wine, sharpened with the vitriolic acid. • Take Compound Spirit of Ether, Make a draught. — To be taken eveif 3 drs. three or four hours, or oftener. Strong Camphor mixture, 7 oz. or Make a mixture, and take three table Take soft Extract of Bark, ^ scruples, spoonsful every three hours. Decoct, of Bark, 1^ ounce. Tinct. of the same, 2 drachms \ Take decoction of Bark, U ounce. Muriatic Acid, 6 minims. Tincture of the same ^ drachm. Syrup of Orange-peel, 1 drachm. Muriatic Acid 5 minims. Make a draught.— To be taken as above. Syrup of Orange-peel, 1 drachm. 138 MALIGNANT AND PUTRID FEVER. A Imost material circumstance to be attended to both at the com- mencement of this fever, and during its whole course, is to covei the patient lightly with bed-clothes, and to keep his apartment cool and properly ventilated, by allowing a regular and free ad- mission of fresh air into it ; and in order to render it pleasant both to himself and attendants, it ought to be sprinkled several times a-day with warm vinegar and camphorated spirit. Fumiga- tions* will also be advisable. Cleanliness, in the strictest sense of the word, is to be most carefully attended to; and, therefore, the bed and body linen should be frequently changed ; and when- ever the patient has a motion, it ought to be instantaneously re- moved. For preventing putrid fevers, we would recommend a strict re- 2;ard to cleanliness ; a dry situation ; sufficient exercise in the open air ; wholesome food, and a moderate use of generous liquors. Infection ought, above all things, to be avoided. No constitution is proof against it. I have known persons seized with the putrid fever, by only making a single visit to a patient in it ; others have caught it by lodging for one night in a town where it prevailed ; and some by attending the funerals of such as died of it.t When a putrid fever seizes any person in a family, the greatest attention is necessary to prevent the disease from spreading. The sick ought to be placed in a large apartment, as remote from the rest of the family as possible ; he ought likewise to be kept ex- tremely clean, and should have fresh air frequently let into his chamber ; whatever comes from him should be immediately remov- ed, his linen should be frequently changed, and those in health ought to avoid all unnecessary communication with him. Any one who is apprehensive of having caught the infection, ought immediately to take an emetic, and to work it off by drink- ing plentifully of camomile tea. This may be repeated in a day or two, if the apprehensions still continue, or any unfavourable symptoms appear. The person ought likewise to take an infusion of the bark and camomile flowers for his ordinary drink ; and before he goes to bed, he may drink an English pint of pretty strong negus, or a few glasses of generous wine. I have been frequently obliged to * The mineral acid gases used in the apartments of the sick, have been found to possess a powerful disinfecting agency. Either the nitric acid, or the muriatic, may be used with this intention, although the latter is thought to be more diffusible than the former. When the preference is given to it, it may be used in the following man- ner : — Put one pound of common salt into an earthen vessel, and pour over it, from time to time, a small quantity of sulphuric acid, till the whole salt is moistened. If the air be foul, and peculiarly offensive, apply a gentle heat under the vessel, to ex- tricate a larger quantity of vapour ; but, in general, the simple addition of the acid to the salt will be found sufficient, unless the apartment is very large. Perhaps the most effectual way of fumigation, of all others, is the following : al- though it requires some nicety in the management of it. Take of manganese in pow- der two parts ; one part of common salt, three of sulphuric acid, and one of water. Put an ounce of the mixed manganese and salt into a basin, add a large tea-spoonful of water, tnen drop in half a teaspoonful of sulphuric acid, and ijepeat this till you have used a tea-spoonful and a half of the acid. In this manner keep up a suitable estrica- t.ion of the fumes. Ed. t The late Sir John Pringle agreed with me, in thinking that a good doctor and a careful nurse were the only necessary attendants ; and that all others not only endan- gered themselves, but generally, by their solicitude and ill-directed care, hurt the Mck. MALIGNANT AND PUTRID FEVER. 139 follow this course when malignant fevers prevailed, and have like- wise recouiniended it to others with constant success. Those wlio wait upon the sick in putrid fevers, ought always to have a piece of sponge or a handkerchief dipt in vinegar, or juice of lemon, to smell to while near the patient. They ought likewise to wash their hands, and if possible to change their clothes, before they go into company.* When hemorrhages ensue, and purple or livid spots have ap- peared on the body of the patient, recourse must be had to the most powerful antiseptics, such as vegetable and mineral acids, carbonic acid in every form, liquors in a state of fermentation, oxy- geu gas, oxygenated muriates of potash,! aerated waters, wine, cold affusion, bark. Clysters, | also, of diluted vinegar, may be administered, &c. If apthae arise, the gargles recommended in putrid sore throats. In this disease as well as in the preceding, the apjilication of cold to the head might probably be advantageously substituted for a blister in those cases where there prevails either coma or deliriunj, or where there is great pain in the head, with much anxiety and restlessness. Having shaved the head, a large towel, dipped in the coldest water, may be applied all over it, renewing this pro- cess frequently until the patient feel relieved, the heat less, and a disposition to tranquil sleep supervenes. This operation may be repeated at short intervals at first, and it will be desirable to do it with such quickness and perseverance as to produce some de- gree of shivering. In severe cases, the application of powdered ice enclosed in a bladder to the shaven scalp may be substituted. The exhibition of fixed air has been recommended in this fevei by the Rev. Dr. Cartwright, who, having read of the power of fix- ed air in preserving meat from putrefaction, was induced to make trial of it on a boy fourteen years of age, who had been ill several days of a putrid fever, for Avhich bark and wine had been adminis- tered without any apparent advantage, and where there was but little hope of a recovery. He directed two table spoonfuls of yeas) to be taken every three hours ; the boy experienced almost imme- diate relief, and recovered very quickly. The reverend Doctor re- ports, that he exhibited the same remedy to about fifty patients in this fever without losing one of them. * The above description and mode of treatment of the putrid fever are perfectly ap- plicable to what is termed the Yellow Fever, &c. of the havoc made by which in oui West India possessions during late years we have lieard so much. The yellowness of the skin, although generally considered as a fatal symptom, is an adventitious cir- cumstance, resulting from warmth of climate. In early stages of the yellow fever, smart purges of jalap and calomel, and cooling the surface of the body by ablution with sea-water, or common water mixed with vinegar, is the most efficacious m^de of treatment. Keeping the body open and general temperance are the best preven- rrake ^Oxygenated Muriate of Potash, ^ , ^mct. of Bark, 3 drachms •"= , . 1 J „ Make a draught, to be taken as above. 1 scrap, to 1 drm. ° ' Tinct. of Orange-peel, 1 drachm. | Take Common Vinegar, 3 drachms Cinnamon-water, 1^ ounce. Infusion of Camomile, 5 ounces. Syrup of Saffron, 1 drachm. Mix for a clyster. Make a draught. To be taken every third or hour. Take Common Salt, ^ ounce. or Vinegar, 2 ounces Take Oxymuriatic Acid, 20 minims. Infusion of Camomile, 6 ouncei Decoction of Bark, IJ ounce. Make a clyster. 140 MILIARY FEVER. In typhus, whatever may be the mode of action of yeast, it ap- pears to be indisputable that fixed air takes off that extreme debil- ity of the stomach, so conspicuously marked in disorders of this nature ; and in proportion as that subsides, the pulse rises, becomes slower and fuller, the burning heat on the skin disappears, and a truce is gained for the reception of nutrition. CHAP. IX. MILIARY FEVER. This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together. The whole body is sometimes covered with pustules ; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption ; but when the skin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary disease ; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ar- dent, putrid, or nervous fever, &c. In all these cases it is gener- ally the eflect of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is like- wise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and livo upon weak watery diet. Such females are ex- tremely liable to be seized with this disease in childbed, and often lose their lives by it. Causes. — The miliary fever is sometimes occasioned by violent passions or affections of the mind ; as excessive grief, anxiety, thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too freely of cold, crude, unripe fruit, as plums, cherries, cucumbers, melons, &.c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, «fcc. may likewise cause miliary fevers. They may also be occasioned by the stop- page of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women, - Btanco, or infused in wine or water, as the patient inchnes. Great sickness at the stomach is apt to precede any fresh erup- tions tliat come out in tlie course of the disease, and to prove very distressing. To allay it, small doses of camphor mixture may be frequently g^iven. Where delirium or coma comes on, blisters will be |)roper. When a retrocession of the eruption takes place, the principal object will be to bring it out again, and keep up a perspi- ration by means of powerful diaphoretics, as camphor,* ammonia, frictions to the skin, external warmth, bathing the feet in warm water, «fec. When any considerable evacuation ensues on a ret- rocession, we must be careful not to check it hastily. Should convulsions supervene thereon, musk and opium are strongly rec- ommended. The miliary fever, like other eruptive diseases, requires gentle purging, which should not be neglected, as soon as the fever is gone off, and the patient's strength will permit. To prevent this disease, a pure dry air, sufficient exercise, and wholesome food, are necessary. Pregnant women should guard against costiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things ; and when in child-bed, they ought strictly to observe a cool regimen. There is not vny fever, in which the symptoms ought to be more carefully watched than in this. The changes are frequent and rapid, and the fever itself often assumes a quite different charac- ter. It is, therefore, of the utmost importance upon such occa- sions to change the regimen and medicines, and adapt them to the new symptoms. CHAP. X. BILIOUS FEVER. When a continual, remitting or unremitting fever is accompa- nied 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 where the soil is marshy, and when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or who are exposed to the night- air, are most liable to this kind of fever. If there be symptoms of inflammation at the beginning of this fever, it will be necessary to bleed, and to put the patient upon the Take Camphor, 4 grains. Aromatic Confection, 10 grains. Compound Powder of Ipecacuanha, Make a bolus. 3 grains. 144 PLEURISY. cool diluting 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 ne- cessary. 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. If a bloody flux should accompany this fever, it must be treated in the man- ner recommended under the article Dysentery. When there is a burning heat, and the patient does not sweat, that evacuation may be promoted by giving him, three or four times a-day, a table-spoonful of the solution of acetated ammonia, formerly called Mindererus's spirit, mixed in a cupful of his ordi- nary drink. If the bilious fever be attended with nervous, malignant, or pu- trid symptoms, which is sometimes the case, the patient must be treated in 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 af- ter he is well. He should likewise abstain from all trashy fruits, new liquors, and every kind of flatulent aliment. Though few fevers bear bleeding better than that which accom- panies the measles, yet the lancet is not to be used at random, and without a strict attention to the progress of the disease. If the symptoms run high, with a full, hard pulse, and other signs of inflammation, bleeding will be proper, but not otherwise. I have looked at fevers, as well as at other disorders, for many years ; yet, were any one to ask me what was good for a fever, I could not tell him without knowing the particulars of the patient's case. There cannot be a grosser error than that of prescribing to the general name of a disease, though thousands of people in the country swallow drugs every day on no better ground. Nor are the inhabitants of Britain the only dupes to this notion. I had a patient very lately, a young man from a neighbouring kingdom, who, after consulting me for his own complaints, which were chiefly imaginary, requested that I would prescribe for his father and brother, neither of whom I had ever seen. When I told him the absurdity of doing it, he went away, seemingly much disappointed, and, I dare say, with a far lower opinion of my abil- ities than he had conceived from report. CHAP. XI. PLEURISY. {Pleuritis.) The true pleurisy is an inflammation of that membrane called the pleura, which lines the inside of the breast. It is distinguish- PLEURISY. 145 ed into the moist and dry. In the former the patient spits freely ; in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy (Peri- pneumonia Notha) in which the pain is more external, and chiefly aftects the muscles between the ribs. The jileurisy prevails among labouring people, especially such as work without doors, and are of a sanguine constitution. It is most frequent in the spring season. Causes. — The pleurisy may be occasioned by whatever obstructs the perspiration ; as cold northerly winds ; drinking cold liquors when the body is hot; sleeping without doors on the damp ground; wet clothes ; plunging the body into cold water, or exposing it to the cold air, Avhen covered with sweat, &c. It may likewise be occasioned by drinking strong liquors ; by the stojjpagc of usual evacuations, as old ulcers, issues, sweating of the feet or hands, «fec. ; the sudden striking in of any eruption, as the itch, the mea- sles, or the small-pox. Those who have been accustomed to bleed at a certain season of the year, are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, «fcc. renders it more liable to this disea^e. A pleurisy may likewise be occasioned by violent exercise, as running, wres- tling, leaping, or by supporting great weight, blows on the breast, &.C. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c. Symptoms. — This, like most other fevers, generally begins with chilliness and shivering, which are followed* by heat, thirst, and restlessness. To these succeeds a violent pricking pain in one of the sides among the ribs. Sometimes the pain extends towards the back-bone, sometimes towards the fore-part of the breast, and at other times, towards the shoulder-blades. The pain is generally most violent when the patient draws his breath. The pulse in this disease is commonly quick and hard, the urine high-coloured ; and, if blood be let, it is covered with a tough crust, or bufty coat. The patient's spittle is at first thin, but after- wards it becomes grosser, and is often streaked with blood. Diet. — Nature generally endeavours to carry off^this disease by a critical discharge of blood from some part of the body, by expec- toration, sweat, loose stools, thick urine, or the like. We ought, therefore, to second her intentions by lessening the force of the circulation, relaxing the vessels, diluting the humours, and promot- ing expectoration. For these purpose?, the diet, as in the former disease, oiight to be cool, slender, and diluting. The patient must avoid all food that is viscid, hard of digestion, or that affords much nourishment; as flesh, butter, cheese, eggs, .nilk, and also every thing that is of a heating nature. His drink may be whey, or an infusion of pec- toral and balsamic vegetables.* * See Appendix, Pectoral Infusion. 10 14« PLEURISV. Barley-water, with a little honey or jelly of currants, mixed with it, is likewise a very proper drink in this disease. It is made by boiling: an ounce of pearl-barley in three English pints of water to two, which must afterwards be strained. The decoction of figs, raisins, and barley, recommended in the preceding disease, is here likewise very proper. These and other diluting liquors are not to be drank in large quantities at a time ; but the patient ought to keep continually sipping them, so as to render his mouth and throat always moist. All his food and drink should be taken a little warm. The patient should be kept quiet, cool, and every way easy, as directed under the foregoing disease. His feet and hands ousht daily to be bathed in lukewarm water ; and he may sometimes sit up in bed for a short space, in order to relieve his head. Medicine. — Almost every person knows, when a fever is attend- ed with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better ; and the quantity at first must be pretty large, provided the patient be able to bear it. A large quantity of blood let at once in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is cer- tainly known that he is seized with a pleurisy. For a younger person, or one of a delicate constitution, the quantity must be less. If, after the first bleeding, the pain, with the other violent symptoms, should still continue, it will be necessary, at the dis- tance of twelve or eighteen hours, to take eight or nine ounces more. If the symptoms do not then abate, and the blood shows a strong buffy coat, a third or even a fourth bleeding may be requi- site. If the pain of the side abate, the pulse become softer, or the patient begin to spit freely, bleeding ought not to be repealed. This operation is seldom necessary after the third or fourth day of the fever, and ought not then to be performed, unless in the most urgent circumstances. The blood may be many ways attenuated without bleeding. There are likewise many things that may be done to ease the pain of the side without this operation, as fomenting, blistering, «&c. Fomentations may be made by boiling a handful of flowers of elder, camomile, and common mallows, or any other soft vegeta- bles, in a proper quantity of water. The herbs may be either put into a flannel bag, and applied warm to the side, or flannels may be dipped in the decoction, afterwards wrung out and applied to the part affected, with as much warmth as the patient can easily bear. As the clothes grow cool, they must be changed, and S^reat care taken that the patient do not catch cold. A bladder may be filled with warm milk and water, and applied to the side, if the above method of fomenting be found inconvenient. Fo- mentations not only ease the pain, but relax the vessels, and pre- vent tlie stagnation of the blood and other humours. The side may likewise be frequently rubbed with a little of the volatile lini- ment. Topical bhieding has often a very good effect in this disease. It PLEURISY. 147 may eillier be performed by applying a number of leeches to the part aflected, or by cujjping, which is both a more certain and ex|)editious method than the other. Leaves of various plants might likewise be ai)plied to the patient's side with advantage. I have often seen great benefit from young cabbage-leaves ajjplied warin to the side in a pleurisy. These not only relax the parts, but likewise draw off a little moisture, and may prevent the necessity of blistering-plasters ; which, however, when other things fail, must be applied. If the pain continue after repeated bleedings, fomentations, rcise did not furnish means of recovery, at least as efficacious as drugs. Cutaneous friction is most advantageously performed by means of a flesh-brush. To be of any essential use, this instrument ought to be of a much harder texture than those commonly offered for sale. The most favourable season for this practice is not immedi- ately on getting out of bed. There exists a sensibility of the skin at that time which renders the application of the brush painful and unpleasant. After the customary diurnal evacuation of the bowels has taken place, the person should strip, and applying this instru- ment to various parts of the body in succession, commencing with the chest, continue the friction until an universal redness and glow takes place over the whole surface of the body. The temporary exposure of the naked body to the air of the chamber during this operation, accustoms the skin to a certain variety of temperature, while any danger of taking cold is completely obviated by the ex- ercise, as a person ought always, if his strength permit, to rub himself. Though somewhat painful and irksome at first, this ope- ration, like all the rest of our active habits, gradually becomes pleasant, and at length necessary, so thut a person accustomed to it feels himself uncomfortable if he has omitted for a day his usual exercise. From regularly persevering for some length of time in this prrac- tice I have observed a very obvious alteration produced in the tex- ture of the skin. It appears to acquire thickness, and to become mellow and pliable, a condition very different from that of persons disposed to phthisis, whose skin is commonly thin and harsh. The muscles also seem to derive firmness from this practice. The brush will also be found daily to remove no small quantity of fur- PREVENTION OF CONSUMPTION. 1G7 furaceous matter, which, whether it be inspissated perspiration ad- hering to the surface, or particles of decaying cuticle, is certainlv better away. This practice also removes'every kind of rouo-hne-^'s and asperity from the surface of the skin, which becomes beauti- fully smooth and polished, so that even as a cosmetic, havintr no tendency to impair health, cutaneous friction may be advantacreou=- ly employed. After exposure to wet, to strip and rub the surface of the body tdl it glows, is unquestionably the best means to pre- vent taking cold. I do not presume so strenuously to recommend friction of the skin as a means of supporting the healthy action of the external surface of the body, and of promoting: 'cutaneous perspiration, without having witnessed remarkable changes for the better pro^ duced in the constitution by adopting and persevering is this prac- tice. Indeed I am disposed to attribute much of theljenefit deriv- ed from exercise on horseback, as well as the good effects of a sea- voyage towards a mild climate, to the increase of perspiration pro- duced by these modes of gestation. Every person suspicious of predisposition to- pulmonary con- sumption ought at all times, but especiallv in cold weather, to wear a quantity of woollen clothing sufficient to obviate any ap- proach to the perception of chillness ; independentlv however of the actual presence of obstinate hoarseness or cou^hj I am dispos- ed to think that the requisite quantity of flannel is'more advanta- geously worn over the usual shirt, than in immediate contact with the skin. The possibility of communicating this disease bv contagion is a point that has been much agitated."^ As a measure of pre'caution. the delreate ought to decide this question for themselves in the af- firmative. Exhalation from the lungs is the mode bv which infec- tious diseases are most generally propagated ; and 'from analo^v we might infer that air impregnated with the effluvia of these organs m a state of ulceration, would have a tendencv to excite diseased action of a similar kind if received into the lun'ss of a person pre- viously disposed to this complaint. I have seen more than one instance of a husband who appeared to have no previous disposi- tion to consumption, being afiected with a distressing cough, which continued to harass him for months while his wife Vas lingering under that disease. On one melancholy occasion I witnessed the successive deaths of three young ladies, 'two of whom, in my opin- ion, decidedly caught the disease in consequence of their .sedulous attention, during the progress of the indisposition, to her who was first affected, who evidently was of a phthisical habit, which was not apparent in either of the others. If the presence of the symptoms which have been alreadv de- scribed as characterising this disease renders its existence no lon- ger equivocal, the person so affected ought without delav to mi- grate towards a warmer climate. Should circumstance's render this expedient impracticable, the next best plan a phthisical per- son can adopt is to remove into a low and rather damp situa- tion. The fatal event of pulmonary consumption is uniformly ac- celerated by residing in an elevated region. There arc even in- stances on record of phthisis making "its a])pearance in families 168 SMALL-POX. previously unaffected by it, on changing their place of residence from a level to a hilly country* While on the contrary the inhab- itants of extensive districts in Lincolnshire and in Essex enjoy a complete immunity from this disease. In Holland, pulmonary consumption is a disease of comparatively rare occurrence. The same situations that predispose to ague are unfavourable to the attack of phthisis, as if these two states of the constitution were incompatible with each other. The physicians of ancient Rome were accustomed to send their consumptive patients to the low and marshy land of Egypt. Cicero, the celebrated orator, who, in his youth, was threatened with consumption, as the hollow temples and sharp features of his remaining busts abundantly testify, trav- elled into Egypt for the recovery of his health. In this country the choice of situation is not sufficiently attended to ; although every practitioner of medicine must have remarked that oven the soft breezes of Brompton and Chelsea have benefited invalids who were injured by the keener air of Highgate and Hampstead.* In the incipient stages of phthisis pulmonalis the dry vomit taken in a morning, fasting, I have known occasionally to be of use. Keeping up a copious discharge from the surface of the chest by the savin ointment subsequent to the application of a blistering- plaster, sometimes appears to arrest the progress of the disease. When symptoms of incipient phthisis have been accompanied by tumours commencing at the clavicle and extending upwards tov/ards the ear, I have seen much benefit from the administration of calomel combined with steel. When recovery is despaired of, a diet consisting of buttermilk and the lighter farinacea, prolongs existence, and mitigates the distress of the cough more eflfectually than the use of opium. From a medicine, which of late years has been much extolled, as diminishing the frequency of the pulse, (digitalis) I am sorry to say, I have seen no permanent benefit produced in this disease ; and notwithstanding the boast of empiricism, a remedy that will heal ulceration or resolve tubercles, I believe yet remains tc be discovered. CHAP. XIV. SMALL POX, (Variola.) This disease, which originally came from Arabia, is, since the discovery of vaccination, not so general as heretofore; nor does It appear to be of so malignant a type. It is, nevertheless, a most c ntagious malady ; and for many years proved the scourge of civ- il ized as well as uncivilized nations. It generally makes its ap- * In the islands of Guernsey and Jersey, where the climate is so iOaded with moist ure, that common salt deliquesces if exposed to the air, I am informed that coughs are very rare, and pulmonary consumptions almost unknown. Of course these islands xauflt be an excellent situation for persons of a phthisical temperament. SMALL-POX. 1 09 pearance about the spring. It is very frequent in summer, less so in aut.imin, and still less in winter. Cliildren are most liable to iiave it ; and those whose food is unwholesome, vvho want proper exercise, and abound with gross humours, run the greatest hazard of catching it. The disease is distinguished into the distinct and confluent kind ; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the chrystalline, the bloody, - tom ; as also when they are small a-nd fiat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger. It is likewise a bad sign when they run into one another. It is a most unfavourable symptom when petechiae, or purple, brown, or black spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and show the danger 170 SMALL-POX. to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms ; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an ap- proaching delirium or of convulsion-fits. When the face does not swell, or falls before the pox come to maturity, it is very unfavour- able. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well ; but when these do not succeed each other, there is reason to apprehend danger. When the tongue is cover- ed with a brown crust, it is an unfavourable symptom. Cold shiv- ering fits coming ^r\ at the height of the disease, are likewise unfa- vourable. Grinding of the teeth, when it proceeds from an nffec- tion of the nervous system, is a bad sign ; but sometimes it is occa- fiioned by worms, or a disordered stomach. Diet. — When the first symptoms of the small-pox appear, people are ready to be alarmed, and often fly to the use of medicines, to the great danger of the patient's life. I have known children, tc appease the anxiety of their parents, bled, blistered, and purged, during the fever which preceded the eruption of the small-pox, tc such a degree, that Nature was not only disturbed in her opera- tion, but rendered unable to support the pustules after they were out ; so that the patient, exhausted by mere evacuations, sunk under the disease. When convulsions appear, they give a dreadful alarm. Imme- diately some nostrum is applied, as if this were a primary disease ; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit.* All that is, generally speakmg, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors ; as balm-tea, barley-water, clear whey, gruels, !tomach can bear it ; in which case it will often produce very hap- py eff'ects. I have frequently seen the petechiae disappear, and the small-pox, which had a very threatening aspect, rise and fill with laudable matter, by the use of the bark and acids. The patient's drink ought likewise, in. this case, to be generous, as wine or strong negus, acidulated with spirits of vitriol, vinegar, vhe juice of lemon, jelly of currants, or such like. His food must n4 SMALL-POX. consist of apples, roasted or boiled, preserved cherries, plums, and other fruits of an acid nature. The bark and acids are not only necessary when the petechias, or putrid symptoms, appear, but likewise in the lymphatic or crys- tailine small-pox, where the matter is thin, and not duly prepared. The Peruvian bark seems to possess a singular power of assist- ing Nature in preparing laudable pus, or what is called good mat- ter ; consequently, it must be beneficial both in this and other dis- eases, where the crisis depends on a suppuration. I have often ob- served where the small-pox were flat, and the matter contained in them quits clear and transparent, and where at first they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and consistence of the matter, and produced the most happy effects. When the eruption subsides suddenly, or, as the good women term it, when the small-pox strike in, before they have arrived at maturity, the danger is very great. In this case blistering-plasters must be immediately applied to the wrists and ancles, and the pa- tient's spirits supported with cordials. Sometimes bleeding has a surprising effect in raising the pus- tules after they have subsided ; but it requires skill to know when this is proper, or to what length the patient can bear it. Sharp cataplasms, however, may be applied to the feet and hands, as they tend to promote the swelling of these parts, and by that means to draw the humours towards the extremities. The most dangorous period of this disease is "'hat we call the secondary fever. This generally comes on Av^jen the sp^' U-pox be- gin to blacken, or turn on the face ; and most of those who die of ihe small-pox are carried off by this fever. Nature generally attempts, at the turn of the smail-pox, to relieve the patient by loose stools. Her endeavours this way are by no means to be counteracted, but promoted, and the patient, at the same time, supported by food and drink of a nourishing and cor- dial nature. If, at the approach of the secondary fever, the pulse be very quick, hard, and strong, the heat intense, and the breathing labo- rious, with other symptoms of an inrianmiation of the breast, the patient must immediately be bled. The quantity of blood to be let must be regulated by the patient's strength, age, and the urgen- cy of the symptoms. But in the secondary fever, if the patient be faintish, the pus- tules become suddenly pale, and if there be great coldness of the extremities, blistering-plasters must be applied, and the patient must be supported with generous cordials. Wine, and even spir- its, have sometimes been given in such cases with amazing suc- cess. As the secondary fever is, in great measure, if not wholly, owing to the absorption of the matter, it would seem highly conso- nant to reason, that the pustules as soon as they come to maturity, should be opened. This is every day practised in other phlegmons which tend to suppuration ; and there seems to b3 no cause why it should be less proper here. On the contrary, we have reason to believe that by this means the secondary fever might always be lessened, and often wholly prevented. SMALL-POX. 175 The pustules should be opened when they begin to turn of a yellow colour. Very little art is necessary for this operation. They may either be opened with a lancet or a needle, and the matter absorbed by a little dry lint. As the pustules are generally first ripe on the face, it will be proper to begin with opening these, and the others of course as they become ripe. The pustules gen- erally fill again, a second, or even a third time, for which cause the operation must be repeated, or rather continued, as long as there is any considerable appearance of matter in the pustules. We have reason to believe that this operation, rational as it is, has been neglected from a piece of mistaken tenderness in parents. They believe that it must give great pain to the poor child, and, therefore, would rather see it die than have it thus tortured. This notion, however, is entirely without foundation. I have frequent- ly opened the pustules when the patient did not see me, without his being in the least sensible of it ; but suppose it were attended with a little pain, that is nothing in comparison to the advantages which may arise from it. Opening the pustules not only prevents the resorption of the matter into the blood, but likewise takes off the tension of the skin, and by that means greatly relieves the patient. It likewise tends to prevent the pitting, which is a matter of no small import- ance. Acrid matter, by lodging long in the pustules, cannot fail to corrode the tender skin, by which many a handsome face be- comes so deformed as hardly to bear a resemblance to the human figure.* It is generally necessary, after the small-pox are gone off, to purge the patient. If, however, the body has been open through the whole course of the disease, or if buttermilk and other things of an opening nature have been drunk freely, after the height of the small-pox, purging becomes less necessary ; but it ought never wholly to be neglected. For very young children, an infusion of senna and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanc- ed must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grains of fine rhubarb, in powder, over-night, and the same quantity of jalap in powder next morning. This may be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further ad- vanced, and adults, the dose must be increased in proportion to the age and constitution.! When imposthumes happen after the small-pox, which is not seldom the case, they must be brought to suppuration as soon as possible, by means of ripening pouftices ; and when they have • Thoutrh this great operation can never do bi^rm, yet it is only necessary wnen the patient ha^s a great load ot' small-pox, or when the matter which they contain is of so thin and acrid a nature that there is reason to apprehend bad consequences from its be- .iig too quickly resorbed, or taken up again into the mass of circulating humours. i 1 have of late been accustomed, after the small-pox, to give one, two, three, four, or ave "rains of calomel, according to the age of the patient, over-night, and to work .t off next morning with a suitable dose of jalap Or the jalap and calomel may be mixed together, and given in the morning. I7f) MEASLES. heen opened, or have broke of their own accord, the patient must be purged. The Peruvian bark and a milk-diet will hkewise bii useful in this case- When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patient must be sent to a place where the air is good, and put upon a course of asses' milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions. CHAP. XV. MEASLES. (Morhilli or Rubeola.) The measles appeared in Europe pbout 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 consequences are often very troublesome. Causes. — This disease, like the small-pox, proceeds from in- fection, and is more or less dangerous according to the constitu- tion of the. patient, the season of the year, the climate, &c. Symptoms. — The measles, like other fevers^ are preceded by alternate fits of heat and cold, with sickness and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes, indeed, the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, accompanied with a defluction of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without puin. Tiie eyelids frequently swell so as to occasion blindness. The patient generally complains of his throat ; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remai-kably peevish. Bleeding at the nose is common, bo^h before and in the progress of the disease. About the fourth day, small spots, resembling flea-bites, appear, first upon the face, then upon the breast, and afterwards on the extremities : these may be distinguished from the small-pox by their scarcely rising above the skin. The fever, cough, and diffi- culty of breathing, instead of being removed by the eruption, as in the small-pox, are rather increased ; but the vomiting generally ceases. About the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the br)dy ; so that by the ninth day they entirely disappear. The fe- MEASLES. J 77 ver, however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiae, or purple spots, may likewise be occasioned by tliis error. A violent looseness sometimes succeeds the measles ; in which case the patient's life is in imminent danger. Such as die of the measles generally expire about the ninth day from the invasion, and are commonly carried off by a peripneumo tiy, or inflammation of the lungs. The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine. When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swal- lowing. Purple or black spots appearing among tlie measles, are very unfavourable. When a continual cough, with hoarseness, suc- ceeds the disease, there is reason to suspect an approaching con- sumption of the lungs. Our business in this disease is to assist Nature, by proper cor- dials, in throwing out the eruption, if her efforts be too languid ; but when they are too violent, they must be restrained by evacua- tions and cool diluting liquors, &.c. We ought likewise to endeav- our to appease the most urgent symptoms, as the cough, restless- ness, and difficulty of breathing. Regimen. — The cool i-egimen is necessary here as well as in the small-pox. The food, too, must be light, and the drink diluting. Acids, however, do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small-beer, likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh- mallow roots and sarsaparilla, infusions of linseed or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey ; or, if that should disagree with the stomach, a little manna may occasionally be added to them. Medical treatment. — The measles being an inflammatory dis- ease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted.* Bathing the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption * I do not know any disease wherein bleeding is more necessary than in the mea eles, especially when the fever runs high : in this case I have always found it relieve the patient. Practitioners, however, are at variance with respect to the time blood- letting may be employed with the most advantage. Dr. Morton thinks it requisite as soon as the eruption is completed. Sydenham recommends it after the eruption has disappeared : but practice, in this respect, should be regulated by the degree of the accompanying inflammation of the lungs, w^ithout attending to the particular period of the disorder or the state of the eruption : this is the generally approved practice at the present day 12 178 ' MEASLES. The patient is often greatly relieved by vomiting. When tht.re IS a tendency this way, it ought to be promoted by drinking lake warm water, or weak camomile-tea. When the cough is very troublesome, with dryness of the throat and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the vapour into his lungs. He may likewise lick a little spermaceti and sugar-candy pound- ed together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it ; which will soften the throat, and relieve the tickling cough ; or the demulcent pectorals advised under the head of pleurisy, &c.* If at the turn of the disease the fever assumes new vigour, and there appears great danger of sufiociis. Ed. INFLAMMATION OF THE BRAIN. 185 they are of the least service, and ougJit never to be used unless where suppuration is inevitable. An absorbent, which takes up the moisture and cools the skin, answers the purpose much better. What I generally use is starch powder, spread upon a soft rag, and laid over the parts affected. This may be renewed twice or thrice a-day ; and it is not to be imagined what ease and comfort it gives to the patient every time. As the erysipelas resembles the gout in many respects, it ought not to be rashly tampered with. Should it be driven from the part affected, it may fix upon a more dangerous one. The alarm is generally greatest when it removes to or attacks the face. I have, however, known it seize upon the knee, and after laying the bones bare, prove fatal.* For the erysipelas appearing in children, see Infantine Erysi- pelas. CHAP. XVIII. INFLAMMATION OF THE BRAIN. {Phrenitis.) This is sometimes a primary disease, but oftener only a symp- tom of some other malady, as the inflammatory, eruptive, or spot- ted fever, &.c. It is very common, however, as a primary disease in warm climates, and is most incident to persons about the prime or vigour of life. The passionate, the studious, and those whose nervous system is irritable in a high degree, are most liable to it. Causes. — This disease is often occasioned by night-watchingj e&pecially when joined with hard study ; it may likewise proceed from hard drinking, anger, grief, or anxiety. It is often occasion- ed by the stoppage of usual evacuations ; as the bleeding piles in men, the customary discharges of women, «fec. Such as impru- dently 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 * There is a peculiar species of Erysipelas in this country termed Shingles, {Erysi- pelas phlycttenodes) and by the antients Zona or Zoster, from surrounding the trunk of the body like a belt. It consists of an aggregation of vesicles filled with a limpid or yellowish coloured fluid. The eruption makes its first appearance on some spot of the chest, and gradually extends literally both ways. It is a vulgar, but unfounded opinion, that if the extremities of the eruption meet so as completely to surround the body, the patient must die. As this complaint seems often to be critical, we should not be too eager to repel it by externals. If the eruption suddenly subside, or be driven jn by external applications, a paroxysm of asthma is not unfrequentiy the consequence. To remove this metastasis, stimulant applications are requisH;e, such as the ointment of yellow resin with an eighth part of the red precipitate, or the citrine ointment, by which the inflammation of the skin is reproduced, and the discharge kept up. The general treatment of this complaint consists in keeping the patient moderately warm, and giving tepid diluent fluids, till the vesicles begin spontaneously to dry. Their desicca- tion may be promoted by a lotion composed of a dram of white vitriol dissolved in eight ounces of rose water. The common people are in the habit of applying to the shin- gles, writing ink diluted with water. After the eruption is scaled off, the patient ihould take a few doses of some cooling purgative. A. P- R. 186 INFLAMMATION OF THE BRAIN lo awake quite deli/ious. When repellents are imprudently used in an erysipelas, an inflamra>vtion of the hrain is sometimes the coniiequence. It may likewise be occasioned by external injuries, as blows or bruises upon the head, &e. Symptoms. — The symptoms which usually precede a true in- flammation of the brain are, pain of the head, redness of the eyes, a violent flushing of the face, disturbed sleep, or a total want 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 nervous system. When the inflammation is formed, the symptoms in general are similar to those of the inflammatory fever. The pulse, indeed, is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the pulse is al- ways soft and low ; but when the inflammation only aff'ects the in- teguments of the brain, viz. the dura and pia mater, it is hard. A remarkable quickness of hearing is a common symptom of this disease ; but that seldom continues long. Another usual symp- tom, is a great throbbing or pulsation in the arteries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even refuses drink. The mind chiefly runs upon such objects as have before made a deep impression on it ; and sometimes, from a sullen silence, the patient becomes all of a sudden quite outrageous. A constant trembling and starting of the tendons is an unfavour- able symptom, as are also a suppression of urine, a total want of sleep, a constant spitting, a grinding of the teeth, which last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the thr.>at, •fcc. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shows the necessi- ty of proper e-sracuations, and the danger of repellents in all in • flammatory diseases. The favourable symptoms are, a free perspiration, a copious discharge of blood from the nose, the bleeding piles, a plentiful discharge of urino, which lets full a copious sediment. Sometimes the disease is carried off by a looseness, and in women by an ex- cessive flow of the menses. As this disease often proves fatal in a few days, it requires the most speedy applications. When it is prolonged or improperly treated, it sometimes ends in madness, or a kind of stupiditv which 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 afi'ects the senses, or disturbs the im- agination, 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, howev er, necessary to exclude the company of an agreeable friend, a INFLAMMATION OF THE BRAIN. 18? this has a tendency to soothe and quiet the mind. Neither ou^lit ihe patiiiHt to be ke|)t too much in tlie dark, lest it should occa- si'-.n a glijomy melanclioly, vvhicli is too often the consequence 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 which 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 tliem as soon as they can be procured, 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, what- ever he was fond of, or used to be delighted with, when in health, may here be tried ; as pleasing stories, soft music, or whatever has a tendency to soothe the passions, and compose the mind. Boerhaave proposes several mechanical experiments for this pur- pose ; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, «fec. Any uniform sound, if low, and continued, has a tendency to procure sleep, and conse- quently may be of service. The aliment ought to be light, consisting chiefly of farinaceous substances ; as panado, and water-gruel, sharpened with jelly of currants or juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The drink small, diluting and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only renders the liquor more palatable, but likewise more ben- eficial, as they are of an opening nature. Treatment. — In an inflammation of the brain, nothing more certainly 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 dipped in warm water to the part. When bleeding at the nose does no*, happen spontaneously, it may be provoked, by putting a straw, or any other sharp body up the nostril. Bleeding from the temporal arteries greatly relieves the head ; but as this operation cannot always be performed, we would rec- ommend in its stead bleeding in the jugular veins. When the pa- tient's pulse and spirits are so low that he cannot bear bleedi.ig with the lancet, leeches may be applied to the temples. These not only draw off the blood more gradually, but, by being applied nearer to the part affected, generally give more immediate relief. The next step will be to direct the head to be shaved, and to apply a large blister over it. Linen cloths wetted with vinegar and water, cold spirituous lotions, diluted Esther, or iced-water, may likewise be kept constantly to the temples and forehead ; re- newing them as they become dry. Cold applied over the seat of the brain by means of a wet towel, or other similar medium, will indeed in many cases, prove more efficacious than the application of a blister, as this has been observed occasionally not only to accelerate the pulse, but also render the patient more ungovern- able. The feet should be frequently placed in warm water ; and to assist in diminishing the determination of blood to the head, the 188 INFLAMMATION OF THE BRAIN. patient should be kept as near as possible in the erect posture as can conveniently be borne. A discharge of blood from the haemorrhoidal veins is likewise of great service, and ought by all means to be promoted. If the patient has been subject to the bleeding piles, and that discharge has been stopped, every method must be tried to restore it ; as the application of leeches to the parts, sitting over the steams of warm water, sharp clysters, or suppositories 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 substitiite 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 more, if the case be dangerous, may be used in the space of twenty-four hours. The feet ought frequently to be bathed in lukewarm water, and soft poultices of bread and milk may be kept constantly apphed to them. I must further observe, that, though this species of inflammation ought to be treated nearly as other inflammatory disorders are, yet more than ordinary care should be used to keep the patient in a state of as much ease, composure, and tranquillity as possible. A Ftrict attention to my former hints on this head will often do more good than the best medicines. It should be considered that a sore >vill not bear the touch of a feather, and that the nerves of an in- flamed brain are still more unfit to endure the least irritation, with- out toiture, and without danger. Even light, sound, or whatever may make a strong impression on the senses, is carried with such rapidity and force to the brain, as to increase the inflammation, and disorder the very organs by which it was conveyed. A docile and sensible nurse is, in such cases, of as much service, as the most enliglitened physician. When inflammation of the brain is a symptom of some other dis- ease, it will not require our using active purgatives; on the contra- ry, the body should be kept open with gentle aperients, or laxative clysters, administered from time to time as occasion may require. In most cases the application of a blister to the neck, or between the shoulders, will be proper. As a medicine, the patient may take, in both species of this inflammation, a diaphoretic bolust • Take Submuriate of Mercury, £ grs. or Extract, of Colocynth, 6 grs. Take Tartrate of Potass, 3 drs. Mako three pills for a dose- Powdered Rhubarb, ^ dr. or Infusion of Sennr., 6 oz. Take Submuriate of Mercury, 6 grs. Syrup of Orange-peel, J oz. Powdered Jalap, 1 sple. Make a mixture, and let four table-spoons- Make a cathartic powder. ful be taken every two hours, &c. y means of an eye- cup, two or three times a-day, may likewise be serviceable in pre- venting its return, or removing it after it has become haliitual. Tonics have also been adopted with this intention, and with the best effects. CHAP. XX. QUINSEY, OR INFLAMMATORY SORE THROAT. (Cynanche Tonsillaris.) This disease is very common in Britain, and is frequently at- tended with great danger, occupying the glands, such as the ton- sils, but frequently extending throughout the Avhole mucous merw- brane of the fauces, so as essentially to interrupt the speech, respi- ration, and deglutition of the patient. It prevails in the winter and spring, and is most fatal to young jDCople of a sanguine tem- perament. Causes. — In general it proceeds from the same causes as other inflammatory disorders, viz. exposui'e to cold, an obstructed per- spiration, or whatever heats or inflames the blood. An inflamma- tion of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking against a cold north- erly wind, or any thing that greatly cools the throat and parts ad- jacent. It may likewise proceed from the neglect of bleeding, purging, or stoppage of any customary evacuation. Singing, speaking loud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often kno^vn the quinsey prove fatal to jovial companions, wno, after sitting long in a warm room, drinking hot liquors, and singing with vehemence, were so imprudent as to go abroad in the cold night air. Sitting with wet feet, or keeping on wet clothes, are very apt to occasion this malady. It is likewise frequently occa- sioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been * As most people are fond of using eye-waters and ointments in this and other dis- eases of the eyes, we have inserted some of the most approve J form of theee medi- cines in the Appendix. See Appendix, Eye-water and Eye-salve. 13 194 QUINSEY, OR newly plastered, &c. I know people who never fail to have a sore throat if they sit even but a short time in a room that has been lately washed. Acrid or irritating food may likewise inflame the throat, and occasion a quinsey. It may also xiroreed from bones, pins, or other sharp substances sticking in me ihroa., or from the caustic fumes of metals or minerals, as arsenic, antimony, &c. taken in by the breath. This disease is sometimes epidemical and infec- tious. Symptoms. — The inflammation of the throat is evident from in- spection, the parts appearing red and swelled ; besides, the patient complains of pain in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be drawn, it is generally covered with a tough coat of a whitish colour, and the patient spits a viscid phlegm. As the swelling and inflammation increase, the breathi-ng and swallowing become more diflUcult ; the pain affects the ears ; the eyes generally appear red, and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suflbcation ; there is a constant nausea, or inclination to vomit, and the drink, instead of passing into the stomach, is often leturned by the nose. The patient is sometimes starved at last merely from an inability to swallow any kind of food. When the breathing is laborious, with straitness of the breast and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy there is not so much danger. An external swelling is no iinfavourable symptom ; but if it suddenly falls, and the disease affects the breast, the dan- ger is very great. When a quinsey is the consequence of some other disease, which has already weakened the patient, his situa- tion is dangerous. A frothing at the mouth, with a swelled 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 ought to be light, and in small quantity, and the drink plentiful, weak, and diluting, mixed with acids, although a rigid observance of the anti- phlogistic regimen is the most proper. It is highly necessary that the patient be kept easy and quiet. Violent 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 perspiration, is proper. When the patient is in bed, his head ought to be raised a little higher than usual. It is peculiarly necessary that the neck be kept warm ; for which purpose several folds of soft flannel may be wrapt round it. That done will often remove a slight complaint of the throat, especially if applied in due time. We cannot here omit observing the propri- ety of a custom which prevails among the peasants in 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 applied with par INFLAMMATORY SORE THROAT. lOo ticular cereinonips : the custom, however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief, or a piece of flannel, kept al)out it till the -inflammation be removed. The jelly of black currants is a medicine very much in esteem for complaints of the throat; and, indeed, it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead. Gargles for the throat are very beneficial. They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of the pectoral decoction two or three spoonsful of honey, and the same quantity of currant jelly. This may be used three or four times a-day ; and if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleans- ing, by adding to it a tea-spoonful of sal volatile, or any of the an- nexed forms:* There is no disease in which the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought, therefore, never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary. Medicine. — An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear to keep the body gently open. This may either be done by giving the patient for his ordinary drink a decoction of saline aperients, figs, and tamarinds, or small doses of rhubarb and nitre as recommended in the erysipelas. These may be increased ac- cording 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 purified nitre, held in the mouth and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, &c. At the commencement of inflammatory sore throat, and before the febrile symptoms have become any way violent, an early emetic is often of great ber^efit, and not unfrequently checks its formation • Take Confection of tbfi Red Rose, or 1 oz. Take Barley-water, 6 oz. Boiling W't?r, ij pint. Honey of Roses, 1 oz Diluted Si.'phuric Acid, 1 drm. Diluted Sulphuric Acid, 1 drm Mix for a garg e. Make a gargle. 196 QUINSEY, &c. The throat ought likewise to be rubbed twice or thrice a-day with a little of the volatile liniment. This seldom fails to produce some good effects. At the same time the neck ought to be care- fully covered with wool or flannel, to prevent the cold from pene- trating the skin, as this application renders it very tender. Many other external applications are recommended in this disease, as a swallow's nest, poultices made of the fungus called Jew's ears, album Graecum, &c. ; but as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no further notice of them. When white sloughy specks appear in the throat, the gargles^ advised in putrid sore throat may be used. If a disposition tc gangrene should manifest itself, those of an antiseptic nature should be immediately adopted, and the best are those composed of bark, myrrh,* port-wine, or of capsicum and vinegar. Some recommend the gum-guaiacum as a specific in this disease. Half a drachm of the gum in powder may be made into an electu- ary with the rob of elderberries, or the jelly of currants, for a dose, and repeated occasionally.t Blistering upon the neck, or behind the ears, in violent inflam- mations of the throat, is very beneficial ; and in bad cases, it will be necessary to lay a blister quite across the throat, so as to reach from one ear to the other ear. After the plasters are taken ofl", the parts ought to be kept discharging by the application of issue ointment, till the inflammation is gone ; otherwise, upon their dry- ing up, the patient will be in danger of a relapse. When the patient has been treated as above, a suppuration sel- dom happens. This, however, is sometimes the case, in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a funnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig con- stantly in his mouth. It sometimes happens, before the tumour breaks, that the swel- ling is so great, as entirely to prevent any thing from getting down into the stomach. In this case, the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, &,c. Patients have often been supported by these for several days, till tJie tumour has broke ; and afterwards they have recovered. Not only the swallowing, but the breathing is often prevented by the tumour. In this case nothing can save the patient's life, but opening the trachea or windpipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation ; but as it can only be per- formed by a surgeon, it is not necessary here to give any directions about it. When a difiiculty of swallowing is not attended with an acute •TaKe Infusion of Roses, G oz. Honey of Borax. 2 drs. Tincture of Myrrh, ^ oz. Mix for a gargle. t Dr. Home. MALIGNANT QUINSGY, ifcc. 197 pain or inflammation, it is generally owing to an obstruction of tJie glands about the throat, and onlj requires that the part be kepi uarm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, &.c. Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c. ; all which practices are at best use- less, and often hurtful. Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not choose to observe tliis rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature. Violent exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suftered suddenly to cool. Those who would avoid this disease ought, therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circu- lation of the blood towards it, to take care to cool gradually, and to wrap some additional covering about their necks. I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a riband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great efiect. There is danger indeed in leaving them off after persons have been accustom.ed to them; but surely the inconveniency of using such things for life, is not to be com- pared with the danger which may attend the neglect of them. Sometimes, after an inflammation, the glands of the throat con- tinue swelled, and become hard and callous. This complaint is nor easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-dav with a decoction of figs, sharpened a little with diluted sulphuric acid. Malignant Quinsey, or Putrid Ulcerous Sore Throat. (Cynanche Maligna.) This kind of sore throat is but little known in the northern parts of Britain, though for some time past it has been fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are har,dy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp or sultry weather. It is readily distinguished from the inflammatory quinsey by the soreness and white specks or aphthae covering ulcers which appear in the fauces, together with the great debility of the system, s 198 MALIGNANT QUINSEY, OR small fluttering pulse, and an eruption on the skin of the same nature with that of scarlet fever, which are to be observed in the former; whereas in the latter there is always considf^rable difficulty of breathing, a considerable degree of swelling, v/ith a tendency in the parts to suppurate, and a hard pulse. Also in the seat of the disease, which in the former is principally in the nervous mem- brane of the mouth and throat, and the accompanying fever is of the typhoid kind ; whereas, in the latter, it chiefly occupies the glandular pai'ts, and the fever is of the inflammatory type. Causes. — This is evidently a contagious distemper, and is gene- rally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder ; as by that means they endanger not only their own lives, but likewise those of their friends and connex- ions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome a:r, damaged provisions, neglect of cleanliness, &lc. In some instances the symptoms of scarlet fever and putrid sore throat are so blended, that it is frequently difficult to pronounce of vrhich the disease partakes most ; this, however, is of little im- jyortance in a practical point of view, as both require the same mode of treatment. Symptoms.— It begins with alternate fits of shivering and heat, 'rhe pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient com- 'plains greatly of weakness and oppression of the breast ; his spir- its are low, and he is apt to faint away when set upright ; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude ; but, as the disease advances, it turns more of a yellow- ish colour. The tongue is white, and generally moist, which dis- tinguishes this from an inflammatory disease. Upon looking into the throat, it appears swelled, and of a florid red colour. Pale or ash-coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded witl) florid red, only appears. These whitish spots or sloughs cover so many ulcers. An efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting gener- ally cease. There is often a slight degree of delirium, and the face frequent- ly appears bloated, and the inside of the nostrils red and inflamed. 'I'he patient complains of a disagreeable putrid smell, and his breath is very offensive. The putrid, ulcerous sore throat may be distinguished from the inflammatory, by the vomiting and looseness with which it is gen- erally ushered in ; the foul ulcers in the throat covered with ft white or livid coat ; and by the excessive weakness of the patient ; with other symptoms of a putrid fever. PUTRID ULCEROUS SORE THROAT. 199 Unfavourable symptoms are, an obstinate purging, extreme weakness, dimness of the sif^ht, a livid o-r black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, tlit danger is very great. If a gentle sweat break out about the third, or fourth day. and continue with a slow, firm, and equal pulse; if the sloughs cast off" in a kindly manner, and appear clean and florid at tlic bottom ; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis. Regimen. — The patient must be kept quiet, and for the most part in bed, as he will be apt to be faint when taken out of it. His food must be nourishing and restorative ; as sago-gruel with red- wine, jellies, strong broths, &c. His drink ought to be generous, and of an antiseptic quality ; as red-wine negus, white-wine whey, and such hke. Medicine. — The medicine in this kind of quinsey is entirely different from that which is proper in the inflammatory. All evac- uations, as bleeding, purging, &c. which weaken the patient, must be avoided. Cooling medicines, as nitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety ; and these ought never lo be neglected. If at the beginning there is a great nausea, or inclination to vomit, the patient must drink an infusion of green tea, camomile flowers, or carduus hcnedictus, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit. If the disease be mild, the throat may be gargled with an infu sion of sage and rose leaves, to a gill of which may be added a spoonful or two of honey, and as much vinegar as will make it agreeably acid ; but when the symptoms are urgent, the sloughs large and thick, and the breath very off'ensive, the following or similar* gargles may be used : To six or seven ounces of the pectoral decoction, when boiling add half an ounce of contray:rva root ; let it boil for some time, ai.d afterwards strain the liquor ; to which add two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be used as a gargle, but a little of it should frequently be injected with a syringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly necessary for children, who cannot use a gar- gle. No degree of force, however, is to be used to effect a separa- tion of the sloughs ; and if, after a continuation of the gargles for some time, the sloughs should not begin to separate, all that can * Take Decoction of P. 'Bark, 6 ounces. or Muriatic Acid, 1 drachm. Take Honey of Roses, 1 ounce. Compound Tinct. of Cinnamon, Barley Water, 10 ounces. jounce. Tincture of Myrrh, jounce. Tincture of Myrrh, 1 ounce. Vinegar, 1 ounce. Make a gargle ; to be used as above Mix, and make a gargle. 200 MALIGNANT QUINSEY, &c. safely be done is to touch them with a little alum, or the muriatic acid mixed wilh honey, and applied by means of a piece of lint, cr a hair pencil. It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, the steams of warm vine- gar, myrrh, and honey. But when the putrid symptoms run high, and the disease is at- tended with danger, the only medicine that can be depended upon IS the Peruvian bark. It may be taken in substance, if the pa- tient's stomach will bear it. If not, an ounce of bark grossly pow- dered, with two drachms of Virginian snake-root, may be boiled in an English pint and a half of water to half a pint ; to which a tea-spoonful of the diluted sulphuric acid may be added, and an ordinary teacupful of it taken every three or four hours. Blisters are very beneficial in this disease, especially when the patient's pulse and spirits are low. They may be applied to the throat, be- hind the ears, or upon the back part of the neck. Should the vomiting prove troublesome, it will be proper to give the patient two table-spornsfnl of the saline mixture in a state of effervescence by opiate joined with camphor, and cloths wetted in tincture of opium applied to the pit of the stomach. Mint tea and a little cinnamon will be very proper for the ordinary drink, especially if an equal quantity of red wine be mixed with it. If a diarrhoea should rise in the progress of the disease, power- ful astringents* must be immediately resorted to, to which may be added wine or brandy mulled up with spice. Every means must foe adopted to put an immediate stop to it, as at all periods of this disease, diarrhoea is a very dangerous symptom. If bleeding from the nose occur, the steam of warm vinegar may be frequently inhaled up the nostrils, and the drink be sharpened with sulphuric acid, or tincture of roses. And as hemorrhage from the nose is not an uncommon occur- rence in putrid sore throats, as well as from the mouth and ears, and as it never proves critical, or is attended with any salutary effect, but, on the contrary, threatens the greatest danger, it ought to be immediately stopped by administering strong antiseptics in- ternally, as advised under the head of Malignant Fever ; and by the external application of tents dipped in some powerful styptics, as a solution of the sulphate of copper.t In case of a strangury, the belly must be fomented with warm water, and emollient clysters given three or four times a-day. After the violence of the disease is over, the body should still be kept open with mild purgatives ; as manna, senna, rhubarb, or the like. If great weakness and dejection of spirits, or night-sweats, with other symptoms of a consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the ■" Take Aromr-.tic Confection, 1 drachm. f Take Sulphate of Cother, lA drachm. Chalk Mixture 2 ounces. Alum, % drachm Cinnamon Water, 1 J ounce. Water, / ouncee. Tincture of Opium, 20 to 30 dps. Rectified Spirit, 1 ounce Tincture of Catechu, 1 drachm. Make a styptic solution. "W^ake a mixture ; of which two table- spoonsful may be given everv four hours. MUMPS 201 slixir of vitriol, and to take frequently a glass of generous wine. The quantity of wine allowed ought to be in proportion to the age of the patient, the violence of the febrile symptoms, the degree of debility that exists, or the tendency there is to putrescency. These, together with a nourishing diet, and riding on horse-back, are the most likely means for recovering his strength. The quinsey, being a local disease, is generally caught by ex- posing the throat to a draught of cold air. I know many people, who are sure to be troubled with this complaint if they stand or sit near an open window, or continue for any length of time in a room lately washed. There is not a readier or more certain way to catch a quinsey, than sitting near an open window in a carriage, especially during the night, or when the \veather is cold or damp. The inflammatory sore throat, though it sometimes comes to a sup- puration, generally yields to the method of treatment recommend- ed in this chapter. Cases, however, occur, where the power of swallowing is lost, and the patient perishes from the mere want of sustenance. I lately saw a very ingenious invention of a young surgeon, by which a man's life was saved in a case of this kind. He fastened a funnel to the skin of an eel, open at both ends ; and, by means of a flexible probe, pushed one end down the gullet, till it entered the stomach. Afterwards, milk, broth, or whatever was deemed proper for nourishing the patient, was put into the funnel, and conveyed to the stomach. Though I mention tPiis chiefly with a view of directing others in the like alarming situations, yet it may also serve to confirm an opinion, often avow- ed by the late John Hunter, and well illustrated in his own prac- tice, that presence of mind, and a readiness or fertility of mechan- ical contrivance, may sometimes prove more serviceable in a crit- ical moment, than all the resources of science. But the most dangerous kind of quinsey, as I before observed, is that attended with a putrid fever, commonly called the malig- nant quinsey, or putrid ulcerous sore throat. Whenever the symp- toms of this appear, I cannot too urgently advise the patient's friends to lose no time in procuring for him the best medical as- sistance they can obtain. The delay of an hour may be attend- ed with irreparable injury. Mumps. (CynancJie Parotidma.) The Mumps is a swelling of the glands about the throat, which is occasionally observed to be epidemic in certain districts of this country. This disease generally makes its appearance in spring, and young persons of both sexes are much more liable to be at- tacked by it, than those farther advanced in life. It is preceded by heaviness, lassitude, and a general sensation of uneasiness, which continue for several days. Stifi*ness, pain, and difficulty of motion, is then perceived about the articulation of the lower ja;v. A swelling of the glands situated under the jaws, and diffiised over the neck, next takes place, which sometimes increases to so enor- mous a magnitude, as greatly to disfigure the countenance. There is a good deal of fever, as indicated by the increased frequency of the pulse. About the fourth day from the commencement of the 202 COLDS AND COITGHS. tumefaction, the disease is at the height. A gentle moisture tlieri begins to exude from the surface of the swelling, accompanied with a general perspiration of the whole body, which, if it be en- couraged by keeping warm in bed, and drinking diluent fluids, appears to form the natural crisis of the disease, and the whole terminates favourably about the sixth day. But if, from exposure to cold, or improper management, this natural process of the disease be interrupted, a singular transla- tion of the morbid action takes place. The tumours about the throat suddenly subside, and are followed by swellings of the testi- cles in the male sex, and of the breasts in the female, accompani- ed with a fi-«sh exacerbation of the fever. If the swellings of these parts be imprudently checked by exposure to cold, or if they sud- denly subside, the brain is apt to become affected, occasioning convulsions, delirium, and other dreadful symptoms, which finally terminate in death. tn the treatment of this disease, evacuations of all kinds are not only improper, but dangerous. If the bowels are much con- stipated, they may occasionally be relieved by a clyster, but active purgatives, and blood-letting, must on no account be employed. The patient ought to keep warm in bed, and encourage perspi- ration, by drinking plentifully of diluting liquors, such as mint whey, or balm-tea, with a few drops of spirit of hartshorn. The effort of nature to reso've the tumours by exudation, should be promoted by covering the parts with soft flannel. If the swellings show a disposition to subside too early, they should be covered with blistering plasters, or rubbed with the volatile liniment. Sliould the tumour, when seated in the testicles, suddenly sub- side, and any tendency to delirium manifest itself, the whole scro- tum ought, without delay, to be enveloped in a blistering cata- plasm, which is made by sprinkling a little of the powder of Span- ish ^ies o^er the surface of the common poultice. By this means tJie disease may be arrested in the part occupied by it, and the dangerous consequences of its falling on the brain prevented. It is not an uncommon sequel of this complaint to find some- times one and sometimes both testicles, after the inflammation haa ceased, gradually shrink in size, and finally wither wholly away. The mumps, which in the northern parts of the country, is termed the branks, is decidedly an infectious disease, hut there is rarely fin instance of a person being attacked by it a second time. CHAP. XXI. COLDS AND COUGHS. (Catarrhal Affections.) It has already been observed, that colds are the effect of an ob- structed perspiration ; the common causes of which we have like wise endeavoured to point out, and shall not here repeat them, Neither shall we spend tim** n enumerating all the various sym >- COLDS AND COUGHS. 203 foms of colds, as they are pretty generally known. It may not, however, be amiss to observe, that almost every cold is a kind uf (ever, which only differs in degree from some of those that have already been treated of. No age, sex, or constitution, is exempted from this disease ; neither is it in the power of any medicine or legimen to prevent it. The inhabitants of every climate are liable to cat h cold, nor can even the greatest circumspection defend them at all times from its attacks. Indeed, if the human body could be kept constantly in an uniform degree of warmth, such a thing as catching cold would be impossible : but as that cannot be effected by any means, tlie perspiration must be liable to many changes. Such changes, however, when small, do not affect the health; but when great, they must prove hurtful. When oppression of the breast, a stuffing of the nose, unusual weariness, pain of the head, &c. give ground to believe that the perspiration is obstructed, or in other words, that the person has caught cold, he ought immediately to lessen his diet, at least the usual quantity of his solid food, and to abstain from all strong liquors. Instead of flesh, fish, eggs, milk, and other nourishing diet, he may eat light bread-pudding, veal or chicken broth, pan- ado, gruels, and such like. His drink may be water-gruel sweet- ened with a little honey; an infusion of balm or linseed sharpened with the juice of bitter orange or lemon ; a decoction of barley and liquorice with tamarinds, or any other cool, diluting, acid liquor. Abo^e all, his supper should be light; as small posset, or water- gruel sweetened with honey, and a little toasted bread in it. Tf honey should disagree with the stomach, the gruel may be sweet- ened with treacle or coarse sugar, and sharpened with the jelly of currants. Those who have been accustomed to generous liquors may take wine-whey instead of gruel, which may be sweetened as above. The patient ought to lie longer than usual in b^d, and to encour- age a gentle sweat, which is easily brought on towards morning by drinking tea, or any kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which in all prob- ability, had it been neglected, would have cost the patient his life, or have confined him for some months. Would people sacrifice a little time to ease and warmth, and practise a moderate degree of abstinence when the first symptoms appear, we have reason to believe that most of the bad effects which flow from an obstructed perspiration might be prevented. But, after the disease has gath- ered strength by delay, all attempts to remove it often prove vain. A pleurisy, a peripneuraony, or a fatal consumption of the lungs, are the common effects of colds which have either been totally neg- lected, or treated improperly. Many attempt to cure a cold, by getting drunk : but this, to say no worse of it, is a very hazardous experiment. No doubt it may sometimes succeed, by suddenly restoring the perspiration ; but when there is any degree of inflammation, which is frequently the case, strong liquors, instead of removing the malady, will increjtse t. By this means a common cold may be converted into an m- flammatory fever. 204 COLDS AND COUGHS. Wnen those who labour for their dailj bread have the misforume to Cc-tch cold, they cannot afford to lose a day or two, in ordei to keep themselves warm, and take a little medicine; by which means the disorder is often so aggravated as to confine them for a long time, or to render them ever after unable to sustain hard labour But even such of the labouring poor as can afford to take cai'e of themselves, are often too hardy to do it ; they affect to despise colds, and as long as they can crawl about, scorn to be confined by what they call a common cold. Hence it is that colds destroy such numbers of mankind. Like an enemy despised, they gather strength from delay, till at length they bt-come invincible. We often see this verified in travellers, who, rather than lose a day in the prosecution of their business, throw away their lives by pursu- ing their journey, even in the severest weather, with this disease upon them. It is certain, however, that colds may be too much indulged. When a person, for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion such a general relaxation of the solids as will not be easily remov- ed. It will, therefore, be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercise ; as walking, riding on horseback, &c. An obsti- nate cold, which no medicine oan remove, will yield to gentle ex- ercise and a proper regimen of diet. Bathing the feet and legs in warm water has a great tendency to restore the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warmer than the blood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will sooner take off" a spasm, and restore a perspiration, than all the hot sudo- rific medicines in the world. This is all that is necessary for removing a common cold ; and if this course be taken at the begin- ning, it will seldom fail. But when the symptoms do not yield to abstinence, warmth, and diluting liquors, there is reason to fear the approach of some other disease, as an inflammation of the breast, an ardent fever, or the like. If the pulse, therefore, be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be necessary to bleed, and to give the cooling powders recommend d in the scarlet fever, every three or four hours, till they give a stool- It will likewise be proper to put a blistering-plaster on the ba k, to give two table-spoonsful of the saline mixture every two hou'*s, and in short to treat the patient in all respects as for a slight fever. I have often seen this course, when observed at the beginning, re- move the complaint in two or three days, when the patient had all the symptoms of an approaching ardent fever, or an inflammation of the breast. The chief secret in preventing colds lies in avoiding, as far at possible, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treat ed of under the article Obstructed Perspiration, that it is ne'^dles'- liere to resume the consideration of tlie:n COMMON COUGH. 205 Of a Common Cough. A cough is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obsti nute, there is always reason to fear the consequences, as thia shows a weak state of the lungs, and is often the forerunner of con- sumption. If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper ; but in weak and re- laxed habits, bleeding rather prolongs the disease. When the patient spits freely, bleeding is unnecessary, and sometimes hurt- ful, as it tends to lessen that discharge. When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be ad- ministered ; as gum-ammoniac, squills, &c. Two table-spoonsful of the solution of gum-ammoniac may be taken three or four times a-day, more or less, according to the age and constitution of the patient. Squills may be given various ways :* two ounces of the vinegar, the oxymel, or the syrup, may be mixed with the same quantity of simple cinnamon-water, to which may be added an ounce of common water and an ounce of balsamic syrup. Two table-spoonsful ox" this mixture may be taken three or four times a-day. A syrup made of equal parts of lemon-juice, honey, and sugar- candy, is likewise very proper in this kind of cough. A table- spoonful of it may be taken at pleasure. But when the defluxion is sharp and thin, these medicines rather do hurt. In this case, gentle opiates, combined with diaphoretics, oils, and mucilages, t are more proper. A cup of an infusion of poppy Leaves, and marsh-mallow roots, or the flowers of colts-foot, may be taken frequently; or a tea-spoonful of paregoric elixir may be put into the patient's drink twice a-day. Fuller's Spanish infu- sion is also a very proper medicine in this case, and may be taken in the quantity of a tea-cupful three or four times a-day. In obstinate coughs, proceeding from a flux of humours upon the lungs, it will often be necessary, besides expectorating medi- cines, to have recourse to issues, setons, or some other drain. In this case I have often observed the most happy effects from a Bur- gundy-pitch plaster applied between the shoulders. I have ordered this simple remedy in the most obstinate coughs, in a great number of cases, and in many different constitutions, without ever knowing it fail to give relief, unless there were evident signs of an ulcer in the lungs. *Take Mixture of Ammonia, 5A oz. t Take Solution of the Acetate of Amm> Oxymel of Squills, | oz. nia, 3 drs. Make a mixture ; of which take two des- Mucilage of G. Acacia, 1 oz. sert spoonsful often, or when the cough Syrup of Tolu, 1 dr. ia troublesome. Tincture of Opium, 25 drpe. or Make a draught; to be taken at bed-time Take Mucilage of Gum Arabic, 5 oz. or Oil of Sweet Almonds, 1 oz. Take Compound Powder of Ipecacuanha SvrupofTolu, A oz. 10 grs. Solution of Subcarbonale of Ammo- Make a diaphoretic powder, nia, A drm. Make an emulsion, of which take one table-spoonful frequently. 206 COMMON COUGH. About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a piece of soft leather, about the size rf the hand, and u-id between the shoulder-blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap and simple medicine, and consequently apt to be despised; but we will venture to affirm, that the whole materia medica does not afford an application more efficacious in almost every kind of cough. It has not indeed always an immediate effect ; but, if kept on for some time, it will succeed where most other medicines fail. The only inconvenience attending this plaster is the itching which it occasions; but surely this may be dispensed with, consid- ering the advantage which the patient may expect to reap from the application ; besides, when the itching becomes very uneasy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed with a little warm milk and water. Some caution indeed is necessary in discontinuing the use of such a plaster ; this how- ever, may be safely done by making it smaller by degrees, and at length quitting it altogether in a warm season.* But coughs proceed from many other causes besides defluxions upon the lungs. In these cases the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from the foul- ness and debility of the stomach, syrups, oils, mrcilages, and all kinds of balsamic do hurt. The stomach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he inspires, or draws in his breath fully ; but in the former that does not happen. The cure of this cough depends chiefly upon cleansing and strengthening the stomach ; for which purpose, gentle emetics and bitter purgatives are most proper. Thus, after a vomit or two, the sacred tincture, as it is called, may be taken for a considerable time in the dose of one or two table-spoonsful twice a-day, or as often as it is found necessary, to keep the body gently open. People may make this tincture themselves, by infusing an ounce of hiera picra in an English pint of white-wine, letting it stand a few days, and then straining it off for use.t In coughs which proceed from a debility of the stomach, the Peruvian bark is likewise of considerable service. It may either be chewed, taken in powder, or made into a tincture along with other stomachic bitters. A nervous cough can only be removed by change of air, and proper exercise ; to which may be added the use of gentle opiates. Instead of the saponaceous pill, the paregoric elixir, &c. which are only opium disguised, ten, fifteen, twenty, twenty-five drops of liquid laudanum, more or less, as circumstances require, may be * Some complain that the pitch plaster adheres too fast, while others find difficult) in keeping it on. This proceeds irom the different kinds of pitch made use of, and likewise from the manner of making it. I generally find it answer best when mixed with a little bees-wax, and spread as cool as possible. The clear, hard, transparent )itch answers the purpose best. t In the state of the stomach productive of this particular kind of cough, beneficial effects are derived from small doses of ipecacuanha. A person may begin with taking une grain at noon, and another at night,'gradually augmenting the dose till it occasions tome degree of nausea. Ed. HOOPING-COUGH, OR CHIN-COUGH. 207 taken at bed-time, or when the cough is most troublesome.* Im- mersing tiie feet and hands in warm water will often appease the violence of a nervous cough. When a cough is only a symptom of some other malady, it is in vain to attempt to remove it without first curing the disease from which it proceeds. Thus, when a cough is occasioned by teething, keeping the body open, scarifying the gums, or whatever facilitates the cutting of the teeth, likewise appeases the cough. In like manner, when worms occasion a cough, such medicines as remove these vermin will generally cure the cough ; as bitter purgatives, oilv clysters, and such like. Women, during the last month of pregnancy are often greatly afflicted with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose easy dress. A cough is not only a symptom, but is often likewise the fore- runner of diseases. Thus, the gout is frequently ushered in by a very troublesome cough, which affects the patient for some days before the coming on of the fit. This cough is generally removed by a paroxysm of the gout, which should therefore be promoted, bv keeping the extremities warm, drinking warm liquors, and nathing the feet and legs frequently in lukewarm water. Hooping-cough, or Chin-cough. (Pertussis.) This cough seldom affects adults, but proves often fatal to chil- dren. Such children as live upon thin watery diet, who breathe unwholesome air, and have too little exercise, are most liable to this disease, and generally suffer most from it. The chin-cough is so well known, even to nurses, that descrip- tion of it is unnecessary. Whatever hurts the digestion, obstructs the perspiration, or relaxes the solids, disposes to this disease; consequently its cure must depend upon cleansing and strengthen- ing the stomach, bracing the solids, and at the same time promot- ing [)erspiration, and the different secretions. The diet must be light, and of easy digestion; for children, good bread made into pap or pudding, chicken-broth, with other light spoon-meais, are proper; but those who are farther advanced may be allowed sago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyssop, or penny-royal tea, sweetened with honey or sugar-candy, small wine- whey, or, if the patient be weak, he may sometimes be allowed a little negus. One of the most effectual remedies in the chin-cough is change of air. This often removes the malady, even when the change seems to be from a purer to a less wholesome air. This may in some measure depend on the patient's being removed from the place where the infection prevails. Most of the diseases of chil- dren are infectious; nor is it at all uncommon to find the chin- couprh prevailing in one town or village, when another at a very srnaij distance is quite free from it. But whatever be the cause, *Takf; (Jxymel of Squills, k oz. Of which a table-spoonful may be tii>.er f'aregoric Elixir, 2 drs. three or four times a-day. 208 HOOPING-COUGH, OR CHIN-COUGH. ue are sure of the fact. No time ought therefore to be lost u. removing the patient at some distance from the place where lie caught the disease, and, if possible, into a more pure and warm air * If the patient be old enough to oe reasoned with, a few drops of spirits of chloroform can be administered on a lump of sugar, and allowed to slowly dissolve in the mouth and be slowly swal- lowed. This will often so anaesthetize the parts as to suppress the paroxysms or coughing fits, thus affording great relief. Opium should be very carefully and sparingly given to young children, as they bear it very badly. It is generally reckoned a favourable symptom when a fit of coughing makes the patient vomit. 'I'his cleanses the stomach, and greatly relieves the cough. It Avill therefore be proper to pro- mote this discharge, either by small doses of ipecacuanha, or the emetic mixture here subjoined in doses of a table-spoonful every fifteen minutes till it operates.t Emetics not only cleanse the stomach, which in this disease is generally loaded with viscid phlegm, but they likewise promote the perspiration and other secretions, and ought therefore to be repeat- ed according to the obstinacy of the disease. They should not however be strong; gentle vomits frequently repeated are both less dangerous and more beneficial than strong ones. The body ought to be kept gently open. The best medicines for this purpose are rhubarb and its preparations, as the syrup, tinct- ure, or submuriate of mercury and rhubarb, &c. Of these formei a tea-spoonful or two may be given to an infant, twice or thrice a-day, as there is occasion. To such as are further advanced, the dose must be proportionally increased, and repeated till it has the desired effect. Those who cannot be brought to take the bitter tincture, may have an infusion of senna and prunes, sweetened with manna, coarse sugar, or honey ; or a few grains of rhubarb mixed with a tea-spoonful or two of syrup, or currant jelly, so as to disguise the taste. Most children are fond of syrups and jellies, and seldom refuse even a disagreeable medicine when mixed with them. Many people believe that oily, pectoral, and balsamic medicines possess wonderful virtues for the cure of the hooping-cough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that every thing of this nature must load the stomach, hurt the digestion, and of course aggravate the disorder.^ * Some think tlie air ought not to be changed till the disease is on the decline ; but there seems to be no sufficient reason for this opinion, as patients have been known to reap benefit from a change of air at all periods of the disease. It is not sufficient to take the patient out daily in a carriage. This seldom answers any good purpose ; but often does hurt, by giving him cold. t Take Tartarized Antimony, 3 grs. Make an emetic mixture; to be taknn a? Water, 6 oz. above. Simple Syrup, 2 drs. I Dr. Duplanil says, he has seen many good effects from the kermes mineral in this complaint, the cough being frequently alleviated even by the first dose. The dose for a child of one year old is a quarter of a grain dissolved in a cup of any liquid, repeated HOOPING-COUGH, OR CHIN-COUGH. 200 Opiates are sometimes necessary to allay tlie violence of the L'ougli. For this purpose, a little of the syrup of poppies, or five, six, or seven drops of laudanum, according to the age of the patient, may be taken in a cup of hyssop or penny-royal tea, and repeated occasionally, or a hemlock has been recommended; they may be combined in the following form.* After the accumulated phlegm has been brought away by emet- ics. Dr. Pearson recommends a medicine composed of opium, ipe- cacuanha, and the carbonate of soda ;t in the subjoined pro])ortion& to a child between two and three years old, to be repeated every fourth hour, for several days, taking care to remove costivenesj. whenever it may occur, by submuriate of mercury and rhubarb (one grain of the former to four of the latter.) The superacetate of lead is said to relieve speedily the exacer- bated symptoms of the disease, without producing any bad effects on the stomach and bowels. J Stimulating or anodyne embrocations frequently afford relief; and may be rubbed along the spine, breast bone, or lower region of the stomach,^ and opium rublDed over the stomach and chest. Young children should be laid with their heads and shoulders raised, and should be cautiously watched, that, when the cough cd'hies on, they may be held up, so as to stand upon their feet, bending a little forward to guard against suffocation. The feet should be frequently bathed in lukewarm water; and a Burgundy-pitch plaster kept constantly between the shoulders. But when the disease proves very violent, it will be necessary, in- stead of it, to apply a blistering-plaster, and to keep the part open for some time with issue-ointment. When the disease is protracted, and the patient is free from a fiiver, the Peruvian bark, and other bitters and antispasmodics, are the most proper medicines. The bark may either be taken in s\ibstance, or in a decoction or infusion, as is most agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a-day. For an adult half a drachm or two scruples will be proper. Some give the ex- tract of the bark with cantharides ; but to manage this requires a considerable attention. It is more safe to give a few grains of castor along with the bark. A child of six or seven years of age may take seven or eight grains of castorr with fifteen grains of powdered bark, for a dose. This may be made into a mixture, with two or three ounces of any simple distilled water, and a little syrup, and taken three or four times a-day. two or three times a-day. For a child of two years, the dose is half a grain ; and the quantity must be thus increased in proportion to the age of the patient. • Take Extract of Hemlock, 1 to 2 grs. J Take Superacetate oflead, 2 to 5 grs. Decoction of Bark, 1 oz. Rose Water. 2 ounces. Tincture of Opium, 3 drps. Syrup of Violets, 2 drachms Make a draught; to be taken three times Make a mixture ; of which let a tea-spoon a-day. ful be taken every four or five hours. t Take Ipecacuanha Wine, 5 drps. § Take Tartarized Antimony, 1 scruple Carbonate of Soda, 2 grs. Water, 2 ounces Tincture of Opium, 1 gr. Tincture of Spanish Flics, Simple Syrup, 1 drm. i ounce Make a draught; to be taken as above. Make an embrocat'on. 14 210 INFLAMMATION OF THE STOMACH. CHAP. XXII. INFLAMMATION OF THE STOMACH. (Gastritis.^ This disease is divided into two species, viz. the phlegraonona and erysipelatous ; but it is the former that is here alluded to, tlie latter arising, for the most part, towards the termination of othei diseases, marking the certain approach to dissolution, and being unaccompanied with any marks of general inflammation, or by any burning pain in the stomach. Inflammations of the stomach 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. — Phlegmonous Inflammation of the stomach may pro- ceed from any of the causes which produce an inflammatory fever ; as cold liquor drank while the body is warm, obstructed perspira- tion, or the sudden striking-in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulat- ing substances taken into the stomach ; as strong vomits or purges, corrosive poisons, and such like. When the gout has been repel- led from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach. Hard or indi- gestible substances taken into the stomach, as bones, the stones of fruits, &c. may likewise have that effect. Symptoms. — It is attended with a fixed pain and burning heat in the stomach ; great restlessness and anxiety ; a small, quick, and hard pulse ; vomiting, or at least a nausea and sickness ; excessive thirst ; coldness of the extremities ; difficulty of breathing ; cold clammy sweats ; and sometimes convulsions and faintmg fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold. When the patient vomits every thing he eats or drinks, is ex tremely restless, has a hiccup, with an intermitting pulse, and fre quent fainting fits, the danger is very great. Regimen. — All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of tiiti patient may deceive the by-standers, and induce them to give hun wines, spirits, or other cordials ; but these never fail to increase the dis- ease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a /omit necessary ; but that too is almost certain death. The food must be light, thin, cool, and easy of digestion It must be given in small quantities, and should neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are tlie most proper The drink should be clear whey, barley-watei INFLAMMATION OF THE INTESTINES. 211 water in which toasted bread has been boiled, or decoctions f)f emollient vegetables, as liqnorice, and niarslinjallovv rools, sarsa- parilla, or tiie like. Large doses of the subnitrate of bismuth, 20 to 30 grains, mixed in large spoon witli just enough water to enable the patient to swallow it, is very beneficial to an inflamed stomach, as it forms a protective coating by adhering closely to the walls of the stomach, and is so heavy that the retching and vomiting which always accompanies this distressing disease does not dislodge it, and the excited, irritated mucous membrane is allowed to heal under its benign protection. The dose may be repeated every four or six hours. Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, and leeching, are likewise beneficial. Flan- nel cloths dipped in these must be applied to the region of the stom- ach, and removed as they grow cool. They must neither be ajjpli- ed too warm, nor be suffered to continue till they become quite cold, as either of these extremes would aggravate the disease. A number of leeches, not less than twenty, may be apj)lied, and the warm fomentations continued to promote the bleeding when they fall off. The feet and legs ought likewise to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service. In this and all other inflammations of the bowels, a large blister, applied over the part affected, is one of our best remedies. The only internal medicines which we shall venture to recom- mend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel ; and if the patient be costive, a little sweet oil, honey, or manna may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient's life may depend on them. Inflammation of the Intestines. (Enteritis.) This, like inflammation of the stomach, is of two species, viz. the phlegmonous and erysipelatous ; the first only is here noticed, as the latter is invariably symptomatic of some other disease, and is one of the most painful and dangerous diseases to which man- kind are liable. It generally proceeds from the same causes as the inflammation of the stomach ; to which may be added, costive- ness, worms, eating unripe fruits or great quantities of nuts, drink- ing hard windy malt liquors, as stale bottled beer or ale, sour wine, cider, &.c. It may hkev»^ise be occasioned by a rupture, by scir- rhous tumours of the intestines, or by their opposite sides growing together. The inflammation of the intestines is denominated Iliac j)assion, Enteritis, Sfc. according to the name of the parts affected. The treatment, however, is nearly the same, whatever i)art of the in- testinal canal be the seat of the disease ; we shall therefore omit these distinctions, lest they should perplex the reader. 212 INFLAMMATION OF THE INTESTINES. The symptoms here are nearly the same as in the foregoing dis- ease, only the pain, if possible, is more acute, and is situated lower in the abdomen. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters, are discharged by the mouth. The patient is continually belching Vi\) wind, and has often an obstruction of his urine. While the pain shifts, and the vomiting only returns at certain intervals, and while the clysters pass downwards, there is ground for hope ; but when the clysters andyceces are vomited, and the pa- tient is exceedingly weak, with a low fluttering pulse, a pale coun- tenance, and a disagreeable or stinking breath, there is great rea- son to fear the consequences will prove fatal. Clammy sweats, bhick foetid stools, with a small intermitting pulse, and a total ces- sation of pain, are the signs of a mortification already begun, and of approaching death. Regimen. — The regimen in this disease is in general the same as in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities ; his drink weak and diluting; as clear whey, barley-water, and such like. Medicixe. — Fomentations and laxative clysters are by no means to be omitted. The patient's feet and legs should frequently be bathed in warm water ; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewise be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of bar- ley-water, or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered every two or three hours, or oftener, if the patient continues costive. A blistering plaster is here likewise to be applied immediately over the part where the most violent pain is. This not only relieves the pain of the bowels, but even clysters* and purgative medicines,f which before had no effect, will operate when the blister begins to rise. If the disease does not yield to clysters and fomentations, re- course must be had to purgatives ; but as these, by irritating the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary sometimes to join them with opiates, which, by allaying the pain, and relaxing ' Take Infusion of Senna^ 10 ounces. Tinct. of Jalap, ^ drachm, Sulphate of Soda. 1 ounce. Make a draught. Castor Oil, i ounce. or M^ke a clyster. Take Infusion of Sennae, li ounce. Tincture of the same. 1 drachm. ' Take Castor Oil, 1 ounce. Epsom Salts, 3 drachra? Mint Water, ^ ounce. Make a draught. INFLAMMATION OF THE INTESTINES. 213 the spasmodic contractions of the guts, greatly assist the opeiation of purgatives in this case. Acids have often a very happy effect in staying the vomiting, and a})peasing tiie other violent symptoms of this disease ; it will therefore he of use to sharpen the patient's drink, with cream of tartar, juice of lemon, or, when these cannot be obtained, with vinegar. But it often happens that no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well : — Take jalap in powder, and vitriolated tartar, of each 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 will be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immer- sion has not the desired effect, it may be repeated as soon as the patient's strength and spirits are recruited. It is more safe for him to go frequently into the bath than to continue too long at a time ; and it is often necessary to repeat it several times before it has the desired effect. It has sometimes happened, after all other means of procuring a stool has been tried to no purpose, that this was brought about by immersing the patient's lower extremities in cold water, or making him walk upon 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, attended 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 mor- tification of the intestines, this medicine ought not to be tried. In that case it cannot cure the patient, and will only hasten his death. But when the obstruction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can be administered, as it is the fittest body we know for making its way through the intestinal canal. If the disease proceeds from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure with the hand. If this, with fomentations and clysters, should not succeed, recourse must 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, have had several pounds of hard dry fauces taken out of their intestines. They should likewise beware of eating too * When quicksilver is given in too large (quantities, it defeats its own intention, aa it drags down the bottom of the stomach, wihich prevents its getting over the Pylorus. In thi"s case the patient should be suspended by the heels, in order that the quicksi'- vcr may be discharged by his mouth. 214 COLIC. iVeely of sour or unripe fruits, or drinking stale windy liquors, &,c„ 1 liuve known it broi:ght on by living too much on baked fruitf, wliici) are seldom goo*'. It likewise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet. Colic. (CoUca.J TiiE 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 dilut- ing diet, evacuations, fomentations, &-c. Colics are variously denominated according to their causes, as the Jlatidait, the bilious, the hysteric, the nervotis, &c. And as each of these recpiires a particular method of treatment, we shall point out their most general symptoms, with the means to be used for their relief. The flatulent, or wind colic, is generally occasioned by an indis- creet use of unripe fruits, meats of hard digestion, windy vegeta- bles, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate peo- ple, whose digestive powers are weak, are most liable to this kind of colic. The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his bowels, and is generally relieved by a discharge of wind, cither upwards or dowuAvards. 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 fruits, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits, or aromatic cordials* combined with opiates. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm oricks to them ; and warm clothes may be applied to his stomach and bowels. If costiveness prevail, some gentle laxative may be given. This is the only colic in which ardent spirits, spiceries, or any thing of a hot nature may be ventured upon. Nor indeed are they lo be used here, unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe that the 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 bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines. Several kinds of food, as honey, eggs, «fec. 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, toast and water, «Stc. * Take Mint Water, 1 oz. ender, 1 drm Spirit of Caraway, J oz. Tincture of Opium, 20 drm Compound Tincture of Lav- Make a draught. Fig. 1. Fi-. 2. roue. 215 (I'olics which proceed from excess and indigestion, generally cure themselves by occasioning vomiting or purging. These dis- charges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence 18 over, the patient may take a dose of rhubarb, or any otli«r gen- tle purge, to carry off the dregs of his debauch. Colics which are occasioned by wet feet, or catching cold, may generally be removed at the beginning by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water-gruel with a small quantity of spirits in it. Those flatulent colics, which prevail so much among country- people, might generally be prevented, were they careful to change their clothes when they get wet. They ought likewise to taJte 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 spirits prove a real medicine, and indeed the best that can be administered. A glass of good pepper- mint-water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred. The bilious colic is attended with very acute pains about the region of the navel. The patient complairts of great thirst, and is generally costive. He vomits a hot, bitter, and yellow-coloured bile, which, being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the dis- temper advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intes- tines is so far perverted, that there are all the symptoms of an im- pending iliac passion. If the patient be young and strong, and the pulse full and fre- quent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drunk freely. Small chicken- broth, with a little manna dissolved in it, or a slight decoction of tamarinds, is likewise very proper, or any other thin, acid, opening Uquor. Besides administering a cathartic, it will be necessary to foment the bell}' with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water. In the bilious colic, the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted' bread, or an infusion of garden-mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice 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 frequently administered. The hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vom iting, - not, nor too much on their back, and avoid costiveness. Inflammation of the Bladder. (Cystitis.) The inflammation of the bladder proceeds, in a great measure from the same causes as that of the kidneys. It is known by ai acute pain and tension towards the bottom of the belly, and difii culty of passing urine, with some degree of fever, a constant in clination to go to stool, and a perpetual desire to make water, «fec This disease must be treated on the same principle, as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the begin- ning, and in robust constitutions it will often be necessary to re- peat it. The lower part of the belly should be fomented with warm water, or a decoction of mild vegetables ; and emollient clysters ought frequently to be administered, &c. The patient should abstain from every thing that is of a hot, acrid, and stimulating quality ; and should live entirely upon small broths, gruels, or mild vegetables. A stoppage of urine may proceed from other causes besides an inflammation of the bladder ; as a swelling of the hsemorrhoidal veins ; hardened faces lodged in the rectum ; a stone in the blad- der ; excrescences in the urinary passages, a palsy of the bladder, hysteric affections, «fcc. Each of these require^ a particular treat- ment which does not fall under our present consideration. We 220 INFLAMMATION OF THE LIVER. shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritat- ing nature, generally increase the danger. I have known some persons kill themselves by introducing probes into the urinary pas- sages, 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, &,c. for that purpose. Inflammation of the Liver. The liver is less subject to inflammation than most of the othei viscera, as in it the circulation is slower ; but when an inflamma- tion does happen, it is with difficulty removed, and often ends in 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 strorg vomits vvhen the liver was before unsound, an adust or atrabiiiarian state of the blood, any thing that suddenly cool.« the liver aftar it has been greatly heated, stones obstructing the course of the bile, drinking strong wines and spirituous liquors, using hot spicy aliment, obstinate hypo- chondriacal affections, long-continued intermittent and remittent fevers, contusions, blows, and in five cases out of six the partial application of cold or wet when the hody is heated or over fatigu- ed with exercise, &c. Symptoms. — This disease is known 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, loatJiing of food, great thirst, with a pale or yellowish colour of the skin and eyes. The syjnptoms here are various, according to the degree of in- flammation, and likewise 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 livei», the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, «fec. This disease may be distinguished from the pleurisy, by the pain being 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 distin- guished from the hysteric and hypochondriac disorders by the de- gree of fever with which it is always attended. In warm climates* this viscus is more apt to be affected with in * Inflammation of the liverj and the diseases consequent thereupon, are indeed affec {ions more frequently to be met with in warm climates than in coM ones, particularly in the East and West Indies, where few Europeans can reside for any length of time v/ilhout being attacked by them. The liver in warm climates seems to be the seat of disease, nearly in the same proportion that ilie lungs are in Great Britain. Both acute and chronic hepatitis are frequently met with in persons who come to Europe from the Ea.n and West Indies; and in those who have been affected when in tt-.ose climates thcv are verv apt to recur by the application of causes which would be lilcely to hav« a aitferert effect upon anv one el«p. Eo. INFLAMMATION OF THE LIVER. 2'il flammation than any o';her part of the body, from, in all probabil- ity, the increased secretion of bile which takes place when the blood is thrown on the internal parts by an exposure to cold ; or from tlie bile becoming acrid, and thereby exciting an irritation of the part. This disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When a scirrhus of the liver en- sues, the patient, if he observes a proper regimen, may neverthe- less live a number of years tolerably easy ; but if he indulge in an- imal food and strong liquors, or take medicines of an acrid or irri- tating 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 other inflammatory disorders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley water, &lc. drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet. Mediciste. — Topical bleeding by means of leeches applied over the seat of the pain, &c. All violent purgatives are to be avoided ; the bod}', however, must be kept gently open, and a proper dose of the submuriate of mercury and colocynth may be directed ; or the bowels may be kept open with the neutral salts* or jalap, giving the submuriate of mercury from time to time.t A decoc- tion of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed in the foregoing diseases. Mild laxative clysters should be frequently administered ; and, if the pain should notwith- standing continue violent, a blistering plaster may be applied 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 «j-ood eff'ect here. For this purpose half a drachm of purified nitre, or a teaspoonful of the sweet spirits of nitre, may be taken iu a cup of the patient's drink three or four times a-day. When there is an inchnation to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used for that purpose is plenty of diluting liquor drank about blood-warm. In- deed the patient in this case, as well as in all other topical inflam- mations, ought to drink nothing that is colder than this medium. If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent us lu Take Infusion of Senna, IJ oz. t Take Submuriate of Mercury, 3 grs Epsom Salts, 3 drs. Extract of Colocynth, 5 gri Tincture of Jalap, Make a pill for a dose. Syrup of Buckthorn, of each 1 dr. Make a draught. 822 INFLAMMATION OF THE LIVER. weaken the patient. Loose stools often prove critical, and cariv off the disease. Mercurial friction, should the disease resist the ordinary means, may be einployed, in the proportion of a drachm of the blue oint- ment rubbed over and about the affected part every night until a slight degree of salivation is excited, or rather until some obvious effect in the constitution is produced; and this may be commenced at the end of the fourth or fifth day of the disease. Should the ^riction in this part be attended with any inconvenience, it may be applied to the groins, taking care, however, not to carry it much beyond the point bordering on salivation. If it be desirable to produce some speedy effect of the mercury, it may also be inter- nally employed, combined with small doses of opium or antimony in the form of pills.* If the disease yields readily, a short course of mercury will be sufficient ; but otherwise its use must be contin- ued for, perhaps, five or six weeks. This remedy has latterly been very extensively and beneficially employed; although in all cases it may not be necessary ; particularly at the commencement of acute inflammation of the liver, which, like other visceral infiammations in Great Britain, readily yields to the ordinary plan of depletion. If an abscess or imposthume is formed in the liver, 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 comes away in the urine, and somj-oceed IVom a looseness having been too suddenly stopped; from *li3 stoppage of any customary evacuations, as the bleeding piles, rhe menses, «fec. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms, or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain ; as contusions, compressions, «fcc. It is likewise a symptom of wounds or inflammations of the dia- phragm, intestines, spleen, liver, kidneys, «fec. Vomiting may be occasioned by unusual motions, as falling, being drawn back in a carriage, &i-c.. It may likewise be excited, by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vorr.- iting. Sometimes it proceeds from a regurgitation of the bile into the stomach : in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnancy. In this case it generally comes on about two weeks after the stoppage of the menses, and continues during the first three or four months. When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as tlie cure of a disease. It ought, therefore, to be promoted, by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile tea. When the retrocession of the gout, or the obstruction of custom- ary evacuations occasion vomiting, all means must be used to restore these discharges; or, if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blis- ters, &c. When vomiting is the effect of pregnancy, it may generally be mitigated by keeping the body gentl}^ open. The pur- gatives sliould be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women are most apt to vomit in the morning immediately after getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach. It may generally be' prevented, by taking a dish of coffee, tea, or some light breakfast, in bed. Pregnant women; who are afflicted with vomiting, ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor should they eat much at once. Cold water is a very proper drink in this case ; if the stomach be weak, a little brandy may be added to it. If the spirits be low, and the person apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken. If vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent medicine in this case. Sulphuric acid is also a good medicine 230 DIABETES, &c. It may be taken in the dose of fifteen or twenty drops, twice or thrice a-day, in a glass of wine or water. Habitual voinitincs are sometimes alleviated by making oysters a principal part of diet. A vomiting which proceeds from acidities in the stomach, is re- lieved by alkaline purges. The best medicine of this kind is the magnesia alba, a teaspoonful of which may be taken in a dish of tea, or a little milk, three or four times a-day, or oftener if neces- sary, to keep the body open, or any of the cretaceous mixtures recommended in diarrhoea. When vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added. When vomiting proceeds from spasmodic affections of the stom- ach, musk, castor, and other antispasmodic medicines are of use. Warm and aromatic plasters have likewise a good effect. Aro- matic medicines may likewise be taken inwardly, as cinnamon or mint-tea, Avine with spiceries boiled in it, &c. The region of the stomach may be rubbed with aether, or if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath. I have always found the saline draughts, taken in the act of ef- fervescence, of singular use in stopping a vomiting, frora what- ever cause it proceeded. These may be prepared by dissolving a drachm of the subcarbonate of potash, in an ounce and a half of fresh lemon-juice, and adding to it an ounce of pepperrair.t-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallovv^ed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach, after all other means had failed. As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of ac- tion. The diet must be so regulated as to sit easy upon the stom ach, and nothing should be taken that is hard of digestion. We do not, however, mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids CHAP. XXIV. DIABETES, AND OTHER DISORDERS OF THE URIN- ARY ORGANS. The diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people : but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth- DIABETES, &c. iT.ay be frequently put into the patient's drink ; and, if there be no iijflainniation, he may drink small gin-punch. Persons subject to a suppression of unne ought to live very tem- j)orate. Their diet should be light, and their liquor diluting. They should avoid all acid and austere wines, should take sufficient ex- ercise, lie hard, and avoid study and sedentary occupations.* Gravel and Stone. (Lithiasis.) Thtise diseases are the consequence of a peculiar disposition of the fluids, and more particularly the secretion of the kidneys to form a calculous matter, and have been supposed to be owing to the presence of an acid principle in them, called the uric acid ; an opinion which seems to be confirmed by the benefit derived from a course of alkaline medicines. When small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the aravel. If one of these stones happen to make a lodgment in tli? bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. In this case the pa- ti^nt is said to have the stone. Causes. — The stone and gravel may be occasioned by high liv ing ; the use of astringent wines ; a sedentary life : lying too hot, soft, or too much on the back ; the constant use of water impreg- nated with earthy or stony particles ; aliments of an astringent or windy nature, &c. It may likewise proceed from an heredita- ry dispo. 'tion. Persons in the decline of life, and those who have been much afflicted with the gout or rheumatism, are most liable to it. Symptoms. — Small stones or gravel in the kidneys occasion fix- ed pain in the loins, sickness, vomiting, and sometimes bloody urine, and not unfrequently with a slight suppression of urine. When the st< ne descends into the ureter, and is too large to pass along with ea&e. all the above symptoms are increased ; the pain extends towards the bladder ; the thigh and leg of the affected side are benumbed ; the testicles are drawn upwards, and the urine is obstructed. A stone in the bladder is known from the pain at the time, as well as before and after mauing water ; from the frequent inclina- tion to void the urine ; from the urine coming away by drops, or stopping suddenly when it was running in a full stream ; by a vio- lent pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road ; or from a white, thick, copious, stinking, mucous sediment in the urine ; from an itching at the top of the penis; from bloody urine; from an inclination to go to stool during the discharge of urine ; from Jie * Rubbing the abdomen and inside of the thighs with the volatile liniment, composed of equal parts of spirits of hartshorn and oil. will sometimes relieve a suppression of u-ine ; or ten drops of the tincture of the muriate of iron, given every ten minutes, in 1 wine-glassful of water, will frequently produce the same effect, il the suppression ti*" consequence of spasm of the neck of the bladder. Ed GRAVEL AND STONE. 235 ^mtient's passing his urine more easily when lying than in an ereft posture ; from a kind of convulsive motion occasione36 GRAVEL AND STONE. the one most generally employed, and which may be used both in its caustic* and mild state.t The aerated potash is a preparation somewhat similar in its nature to the aerated alkaline water, and is now used at St. Bar- tholomew's hospital, and given in the dose of two drachms dissolv- ed in a pint of distilled water, twice a-day. It consists of half an ounce of the subcarbonate of potash, five drachms of distilled water, and one drachm of subcarbonate of ammonia. The potash being dissolved in a water-bath, the ammonia is to be added; and when the effervescence is at an end, the mixture is set aside to chrystallize. Dr. Whyte advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morning, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes that though this quantity might be too small to have any sensible efiect in dissolving a stone in the bladder, yet it may very probably prevent its growth. When a stone is formed in the .bladder, the Doctor recommends Spanish soap,t and oyster or cockle-shell lime-water, to be taken in the following manner: the patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or cockle-shell lime-water: the soap is to be divided into three doses; the largest to be taken fasting in the morning early, the second at noon, and the third at seven in the evening, drinking above each dose a large draught of the lime-water, the remainder of which he may take any time betwixt dinner and supper, instead of other liquors. The patient should begin with a smaller quantity of the lime- water and soap than that mentioned above; at first an English pint of the former, and three drachms of the latter, may be taken daily. Tills quantity, however, he may increase by degrees, and ought to persevere in the use of these medicines, especiatly if he finds any abatement of his complaints, for several months ; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime- water in small quantities, but to take the second or third lime- water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first water, but if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells. Though the caustic alkali and soap-lees, and lime-water, are the most powerful medicines which have hitherto been discovered for tlie stone, yet there are some things of a more simple nature, which •Take Solution of Potash, 20 to 30 drops, Take Lime Water, 1 pint a-day, mixed three times a-day, in a tea-cupful of with milk, veal broth, gradually increasing the or dose. Take Soda Water, ^ pint, two or three > Take (Carbonate of Soda, from ) scruple to half a diachm three times d-day. % Take Soap Pills, ten grains, for a dose times a-day. Take Soap F morning and niglit GRAVEL AND STONE 237 in certain cases are found to be beneficial, and tberefore deserve a trial. An infusion of the seeds oi' daucits sylvcslris, or wild carrot, sweetened with honey, has been found to give considerable ease in cases Avhere the stomach could not bear any thing of an acrid nature. A decoction of raw coffee-berries taken morning and eve- ning, to the quantity of eight or ten ounces, with ten drops of sweet spirit of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable. It is the opinion of Dr. Duncan that a solution of the subcarbon- ate of soda in pure water (in the proportion of a scruple to a pint) is preferable to the aerated soda water, on account of the carbonic acid gas not being disengaged on exposure to the atmosphei-e. On the addition of a small quantity of lemon-juice, or acid of tartar, a very agreeable effervescence is produced. The carbonate of soda, by being combined with an excess of carbonic acid gas in this pre- paration, is rendered not only more pleasant to the taste, but less liable to offend the stomach; and Dr. Duncan is of opinion that it is the only form in which the soda can be exhibited in sufficient doses, and for a length of time, so as to derive any benefit from its use. Muriatic acid (particularly in what is called the phosphatic* diathesis) given in doses of twenty or thirty drops, three or four times a-day, diluted with water, has been found, in several cases where gravel was expelled from the bladder, to afford considerable benefit, and to appease the pain in micturition ; and is found, moreover, to be a powerful lithontriptic. The only other medicine which we shall mention is the uvaursi. It has been greatly extolled of late, both for the gravel and stone- It seems, however, to be in all respects inferior to the soap and lime-water ; but it is less disagreeable, and has frequently, to my knowledge, relieved gravelly complaints. It is generally taken in powder, from half a drachm to a whole drachm, two or three times a-day. It may, however, be taken to the quantity of seven or eight drachms a-day, with great safety and good effect. The consistence of such stones varies so much, that there is rea- son to fear no medicine will ever be found sufficiently strong to dissolve the hardest of them, without destroying the bladder. Yet experiments on this subject ought not to be discontinued, as the object is great, and some hard substances are known to be soluble in seemingly mild ones. I have known several instances where stones, after getting into the urethra, were brousrht away by means of a bent probe, but how to get them there is the difficulty. It can only happen while they are small, though I have seen flattish stones brought away in this manner, which measured two inches round. I have sometimes thought that riding on a hard-trotting horse, or in a carriage on a rough road, might tend to bring down a small stone. Most people troubled with the stone are guilty of one grea\ * For an acconnt of four species of calculus noticed by Dr. Wollaston and Dr. G Pearson, sec Medical and Chirurgical Review, Vol. iv. p. 486. Vol. v. p. 306. Ed 238 INVOLUNTARY DISCHARGES OF BLOOD. error; they put off the operation too long. When it is certainly known that there is a stone in the bladder, and that it is too large to get along the urethra, no time ought to be lost in having it cul out, before the patient's habit becomes too irritable, or the stone is so far increased in size, that it cannot be extracted without a laceration of the parts.* CHAP. XXV. INVOLUNTARY DISCHARGES OF BLOOD. ( Hcemorrliagiai.) Spontaneous or involuntary discharges of blood often happen from various parts of the body. These, however, are so far from being always dangerous, that tljey often prove salutary. When such discharges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor, indeed, is it proper, at any time, to stop them, unless they be so great as to endanger the patient's life. Most people, afraid of the smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by v/hich means an inflammation of the brain, or some other fatal disease, is occasioned, which, had the discharge been allowed to go on, might have been prevented. Periodical discharges of blood, from whatever part of the body they pi'oceed, must not be stopped. They are always the eflbrts 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 hfe- moptoe, or discharge of blood from the lungs. After the middle period of life, hsemorrhoidal fluxes are most common, and, in the decline of life, discharges of blood from the ui-inary passages. Involuntary fluxes of blood may proceed from very different, and often from quite opposite causes. Sometimes they are owing to a particular construction of the body, as a sanguine temperament, laxity of the vessels, plethoric habit, &c. At other times they proceed from a determination of the blood towards one particular part, as the head, the hsemorrhoidal veins, &.c. They may likewise proceed from an inflammatory disposition of the blood, in which case there is generally some degree of xever : this likewise happens when the flux is occasioned by an obstructed perspiration, or a stricture upon the skin, the bowels, or any particular part of the system. But a dissolved state of the blood will likewise occasion haemor- * A tea-spoonful of pure magnesia taken two or three times a-day has of late been discovered to be a most effectual preventive of the gravel and stone, and is of service where alkalis fail to relieve the increased secretion of uric acid, and to prevent ite forming calculi in the kidneys ; it also agrees better with the stomach. BLEEDING AT THE NOSE. 239 rhajres. Tims, in putrid fevers, dysentery, scurvy, malignant timall-pox, «fcc., there are often very great discharges of blood from different parts of the body. They rnay likewise be brought on by the too liberal use of medicines whicli tend to dissolve the blood, as cantharides, the volatile alkaline salt, &-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 effect. These often cause bleeding at the nose, and I have known them sometimes occasion an haemorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging the head very low, &,c. The cure of 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 necessa- ry. It will likewise be proper for the patient in this case to live chiefly upon a vegetable diet, to avoid all strong liquors and food that is of^ an acrid, hot, or stimulating quality. The body should be kept cool, and the mind easy. When an haemorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acrid fruits with milk, and vegetables of a nourishing nature, as sago, salop, &c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirits of vitriol. The best medicine in this case is the Peruvian bark, which may be taken according to the urgency of the symptoms. When a flux of blood is the effect of acrid food, or of strong stimulating medicines, the cure is to be effected by soft and mucil- aginous diet. The patient may likewise take frequently about the bulk of a nutmeg of Locatelli's balsam, or the same quantity of spermaceti. When obstructed perspiration, or a stricture upon any part of the system, is the cause of an heemorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extremi- ties in vt^arm water, &c. Bleeding at the Nose. (Epistaxis.) Bleeding at the nose is commonly preceded by some degree of quickness of the pulse, flushing in the face, pulsation of the tem- poral arteries, heaviness in the head, dimness of the sight, heat and itching of the nostrils, &.c. To persons who abound with blood, this discharge is very saluta- ry. It often cures a vertigo, the head-ache, a phrenzy, and even an epilepsy. In fevers, where there 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 the gout and rheumatism. In all diseases where bleeding is ne cessary. a. spontaneous discharge of blood from the nose is of much more service than the same qu intitv let with a lancet. In a discharge of blood from the nose, the great point is to de 240 BLEEDING AT THE NuSE. termine whether it ought to be stopped or not. It is a common practice to si.op the bleeding, without considering whether it be a disease, or the cure of a disease. This conduct proceeds from fear ; but it has often bad, and sometimes fatal consequences. When a discharge of blood from the nose happens in an inflam- matory disease, there is always reason to believe that it may prove salutary; and therefore it should be suifered 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 symp- toms of plethora, mentioned above, have preceded it. In this case it cannot be stopped without risking the patient's life. In fine, whenever bleeding at the nose relieves any bad symp- tom, and does not proceed so far as to endanger the patient's life, it ought not to be stopped. But when it returns frequently, or con- tinues till the pulse becomes low, the extremities begin to grow cold, the lips pale, or the patient complains of being sick or faint, it must immediately be stopped. For this purpose the patient should be set nearly upright, with his head reclining a little, and his legs immersed in water about the warmth of new milk. His hands ought likewise to be put in lukewarm water, and his garters may be tied a little tighter than usual. Ligatures may be applied to the arms, about the place where they are usually made for bleeding, and with nearly the same degree of tightness. These must be gradually slackened as the blood begins to stop, and removed entirely as soon as it gives over. Sometimes dry lint put up the nostrils will stop the bleeding. W^hen this does not succeed, dossils of lint dipped in strong spirits of wine may be put up the nostrils, or if that cannot be had they may be dipped in brandy. When it arises in elderly peo- ple, or returns too frequently, or continues till the patient be- comes faint, it ought to be stopped as quick as possible : to effect this, the patient should be exposed freely to cool air, and placed nearly in the erect posture, with the head inclined somewhat back- ward ; drinking freely of cold liquor, and some saline medicine,* and living abstemiously. Besides these means, the patient may immerse his head in a pailful of cold water impregnated with the muriate of ammonia, or common salt, and snuff vinegar diluted with cold water up the nose ; or some astringent washt may frequently be thrown up the nostril from which the hsemorrhage proceeds, by means of a syringe. At the same time the body, if necessary, may be kept open, with cooling purgatives, in order to make some derivation from the blood-vessels of the head ; the pa- tient carefully avoiding all those circumstances which might either determine the blood to the head, or prevent its free return from it. • Take Acidulated Infusion of Roses, Make a draught, to be taken three or fou^ 6 oz. times a-day. Nitrate of Potash, 1 drm. f Take Powdered Alum, 2 drs. Make a mixture j of which, take three Rose Water, 6 oz. table-spoonsful every three hours. Distilled Vinegar, 1 oz. or Make an injection. Take Diluted Sulphuric Acid, 24 drps. or Water, IJ oz. Take Muriated Tincture of Iron, Ih drm Syrup of Roses, 2 drs. Distilled water, 6 03 Tincture of Opium, 13 drps. Mix, and make an injection. BLEEDING AND BLIND PILES. 241 If the genitals be immersed for some time in cold water, it will generally stop a bleeding at the nose. I have not known this fail. Sometimes, when the bleeding is stopped outwardly, it contin- ues inwardly. This is very troublesome, and requires particular attention, as the patient is apt to be suftbcated with the blood, es- pecially if he falls asleep, which he is very ready to do after losing a great quantitv of blood. When the patient is in danger of suffocation from the blood get- ting into his throat, the passages may be stopped by drawing threads up the nostrils, and bringing them out at the mouth, then las- tenin*^ pieces of sponge, or small rolls of linen cloth to their ex- tremities ; afterwards drawing them back, and tying them on the outside with a sufficient degree of tightness. 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 tentes or clotted blood till they fall off of their own ac- cord, and should not lie with his head low. Those who are affected with frequent bleeding at the nose, ought to bathe their feet often in warm water, and keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible and never to view any object obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it. /. ^ n i i • When bleeding at the nose occurs in adults of a lull plethoric habit, a frequent use of cooling purgatives, and an antiphlogistic regimen, may probably prevent a return of the complaint. When occasioned by too great a determination of blood to the head, top- ical bleeding, by means of leeches applied to the temples, will be advisable. ^Vhen it is occasioned by the suppression of some ac- customed evacuation, such as the menstrual or hemorrhoidal flux, Ihese are to be promoted, if possible, and should the attempt to restore them not succeed, some other discharge must be substitut- ed, either by means of an issue or seton, &c. But when the disease proceeds from a thin dissolved state oi the blood, the diet should be rich and nourishing ; as strong broths and jellies, sago-gruel with wine and sugar, &c. Infusion of the Peruvian bark in wine ought likewise to be taken, and persisted in for a considerable time. Bleeding and Blind Piles, (HcBmorrhois.) A DISCHARGE of blood from the haemorrhoxdal vessels is called the bleeding piles. When the vessels only swell, and discharg-i no lilood, but are exceedingly painful, the disease is called the blind Persons of a loose spongy fibre, of a bulky size, who live hxgh, and lead a sedentary, inactive life, are most subject to this disease. It is often owing to an hereditary disposition. Where this is the case, it attacks persons more early in life than when it is acciden- tal. Men are more liable to it than women, especially those of a sanguine, plethoric, or a scorbutic habit, or of n melancholy dis position. ' 13 24-2 BLEEDING AND BLIND PILES. The piles may be occasioned by an excess of blood, by strong aloetic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacua- tions, much ruling, great costiveness, or any thing that occasions nard and 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 disorder in a person who is subject to it, and sometimes even in those who never had it before. Pregnant women are often afflicted with the piles. A flux of blood from the anus is not always to be treated as a disease. It is even more salutary than bleeding at the nose, and often prevents or carries off diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondriacal complaints, and often proves critical in colics, and inflammatory fevers. In the treatment of piles due attention should be paid to the cause from which they have arisen ; and as costiveness is one of the most frequent, the bowels ought to be kept open and regular by means of gentle laxative medicines;* and as a habit may b6 acquired, the patient will do well to observe stated times in the day for endeavouring to obtain motions, but without straining. Should none be procured by the aid of the laxative medicine, the peristaltic motion may be excited by clysters of tepid water with soap and oil. In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which 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 necessary to life. When this is the case, the discharge must be checked by a proper regimen, and astringent medicines. The Diet must be cool but nourishing, consisting chiefly of bread, milk, cooling vegetables, and broths. The Drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and muci- laginous plants, as the toimentil root, bistort, the marsh-mallow roots, &,c. Old conserve of red roses is very good medicine in this case. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to pro- duce any eftects; but when taken as here directed, and duly per- sisted in, 1 have known it perform very extraordinary cures m violent haemorrhages, especially when assisted by the tincture of roses ; a tea-cupful of which may be taken about an hour after every dose of the conserve. • Take Lenitive Electuary, 2 oz. or Powdered Jalap, 2 drs. Take Castor Oil, 6 drs. to 1 oa Nitrate of Potash, 1^ drm. or Kyrup of Buckthorn, enough to form an Take Powdered Jalap, 1 scr. electuary. The bulk of a nutmeg to be Cream of Tartar, 2 scr8 taken occasionally. Make a powder for a dose BLEEDING AND BLIND PILES. 243 The Peruvian bark is likewise proper in this case, both as a i-,trengthener and astringent. Haifa drachm of it may be taken in glass of red wine, sharpened with a few drops of the elixir of vit- riol, three or four times a-day. The bleeding piles are sometimes periodical, and return regular- ly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the 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 necessary that the body be kept gently open. This may be done by small doses of the flour of brimstone and cream of tartar.* These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftener if necessary. Or an ounce of the flour of brimstone and half an ounce of purified nitre, may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day. Emollient clysters are here likewise beneficial ; but there is sometimes such an astriction of the anus, that they cannot be thrown up. In this case I have known a vomit have a very good effect. When the piles are exceedingly painful and swelled, but dis- charge nothing, the patient must sit over the steam of warm water. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possi- ble, or if they will fix upon the piles themselves, so much the bet- ter. When leeches will not fix, the piles may be opened with a lance. The operation is very easy, and is attended with no danger. Various ointments, and other external applications, are recom- mended in the piles ; but I do not remember to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, which may be done as well by a soft poultice or an emollient cataplasm. When the pain, however, is very great, some anodyne liniment may be applied.t Perhaps no other cause of the piles is so frequent as the use of iiloetic purgatives. It is to be observed that aloes forms a consid- erable share of almost all advertised purging pills. A costive habit is more effectually, and much more safely removed, by a spoonful of castor oil taken occasionally in an evening. When the piles are very painful, the best external application is a weak solution of sugar of lead with a little laudanum, or an oint- ment composed of similar ingredients. | An ointment made of one- • Take Sublimed Sulphur, 1 oz. Opium, fine powdered, 1 drm Lenitive Electuary, 2 oz. Make an ointment. Cream of Tartar, 3 drs. Syrup of Roses ; enough to make the \ Take Spermaceti Ointment, whole into an electuary. Dose, the size Cerate of Superacetate of Lead, of a nutmeg occasionally. of each, A oz. Opium in Powder, \ drra T Take Spermaceti Ointment, 'i ot. Mix for an ointment. 244 SPITTING OF BLOOD. third finely powdered galls, and two-thirds hog's lard, is very useful. When the piles are seated high, relief may frequently he obtained from the injection of lime-water, or of an infusion of galls. The pain of the piles is very often removed by an emetic, or by taking twice a-day thirty drops of balsam of copaiva on a little moist sugar. When a pile has a narrow neck, it is best extirpated by the knife. If the pile be large, or has a broad basis, a double ligature may be passed through it, and tied on each side. When piles are neglected, they are very apt to produce Ql fistula. This complaint is discovered by a stain of matter on the linen, which, on examination, will be found to proceed from a small ori- fice in the neighbourhood of the anus. Various local remedies are recommended for this complaint. The utility of all of them de- pends on their power of stimulating the sides of the ulcer into more active inflammation, so as to make them cohere together. On this principle, I think I have seen advantage from taking a wine-glass of sea-water every night for a month or six weeks. Irritating injections have been used with similar intentions, and have some- times, when duly persisted in, succeeded. The only certain radical cure for a fistula is a surgical operation, the object of which is to reduce the ulcer to the state of a simple wound, and as such to heal it. This should never be too long neglected. The disease gradually diffuses itself in various direc- tions through the cellular substance surrounding the rectum ; and new openings are formed, which render the complaint more diffi- cult to be removed. There are two ways of performing the operation. One is by passing a silk thread, or piece of flexible gold wire in at the exter- nal orifice of the fistula, and bringing it out at the anus, and then twisting the ends together, which is daily repeated till it cuts its way out. By some timid people this mode of cure. is preferred to the knife : and, though kept a secret by some pretenders to medi- cal knowledge, it is as old as the history of surgery. The incision, however, is the more certain and effectual mode of eradicating the disease ; and if suffering is to be estimated by duration, the less painful also. Spitting of Blood. (Hcumoptysis.) We mean here to treat of that discharge of blood from the lungs only w'^ich is called an hcBmoptoe, or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and strait breasts, are r-.ost liable to this disease. It is most common in the cpring, and generally attacks people before they arrive at the prime or miudle period of li^d. It is a common observation that those who have been subject to bleeding at the nose when young, ar» afterwards most liable to an hsemoptoe. Causes. — An hsemoptoe may proceed from excess of blood, from a peculiar weakness of the lungs, or a bad conformation of the breast. It is often occasioned by excessive drinking, running, wrestling, singing, or speaking aloud. Such as have weak lung's ouffht to avoid all violent exertions of that organ, as they value SPITTING OF BLOOD. 245 life. Tliey should likewise guard against violent passions, excessive drinking, and every tiling that occasions a rapid circulation of the blood. This disease may likewise proceed from wounds of the lunga. These may either be received from without, or they may be occa- sioned by liard bodies getting into the wind-pipe, and so falhng down upon the lungs, and hurting that tender organ. The obstruc- tion of any customary evacuation may occasion a spitting of blood ; as neglect of bleeding or purging at the usual seasons, the stop- page of the hleeding-piles in men, or the menses in women, &,c. It may likewise proceed from a polypus, a scirrhous concretion, or any thing that obstructs the circulation of the blood in the lungs. It is often the effect of a long and violent cough ; in which case it is generally the forerunner of a consumption. A violent degree of cold suddenly applied to the external part of the body will occasion an haemoptoe. It may likewise be occasioned by breathing air which is too much rarified to be able properly to ex- pand the lungs. This is often the case with those who 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 very high moun- tains, as the Peak of Teneriff, «fec. It arises mostly between the age of sixteen ZLiid twenty-five. Spitting of blood is not usually attended with danger, nor is it always to be considered as a primary disease. It is often only a symptom, and in some diseases not an unfavourable one. This is the case in pleurisies, peripneumonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptoui, and ehows that the lungs are ulcerated. Symptoms. — Spitting of blood is generally preceded by a sense of weight, and oppression of the breast, a dry tickling cough, hoarseness, and a difficulty of breathing. Sometimes it is ushered in with shivering, coldness of the extremities, costiveness, great lassitude, flatulence, pain of the back and loins, »fec. As these show a general stricture upon the vessels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious discharge. The above symptoms do not attend a dis- charge of blood from the gums or fauces, by which means they may always be distinguished from an hajmoptoe. Sometimes the blood that is spit up is thin, and of 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 circumstance, but that the blood has lain a longer or shorter time in the breast befoie it was dis- charged. Spitting of Mood, in a strong healthy person, of a sound con- stitution, is not very dangerous ; bat when it attacks the tender and delicate, or persons of a weak lax fibre, it is with difficulty re- moved. When it proceeds from a scirrhous or polypus of the lungs, it is bad. The danger is greater when the discharge proceeds from the rupture of a large vessel, than of a small one. When the extravasated blood is not spit up, but lodges in the breast, it cor- rupts, and greatly increases the danger. When the blood proceed? from an ulcer in the lungs, it is generally fatal. 246 SPITTING OF BLOOD. Regimen. — The patient ought to be kept cool and easy. Everj thing that heats the blood, or quickens the circulation, increases the danger. The mind ought likewise to be soothed, and every occasion of exciting the passions avoided. The diet should be st-ft, cooling and slender; as rice boiled with milk, small bioths, barley-gruels, panado, &c. The diet, in this case, can scarcely 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, whey, butter-milk and such like. Every thing, however, should be drank cold, and m small quantities at a time. He should observe the strictest silence, or at least speak with a very low voice. Medicine. — This, like the other involuntary discharges of blood, ought not to be suddenly stopped by astringent medicines. More mischief is often done by these, than if it were suffered to go on. It may, however, proceed so far as to weaken the patient, and even endanger his life ; in which case proper means must be used for restraining it. The body should be kept gently open by laxative diet ; as roast- ed apples, stewed prunes, and such like. If these should not have the desired effect, a tea-sp»onful of the lenitive electuary may be taken twice or thrice a-day, as is found necessary. If the bleed- ing proves violent, ligatures may be applied to the extremities, as directed for a bleeding at the nose ; cooling purgatives,* such as manna, tamarinds, phosphorated soda, sulphate of potash, &c. refrigerants, &,c.t 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 taken in a cup of his ordinary drink twice or thrice a-day. His drink may likewise be sharpened with acids, as juice of lemon, or a few drops of sulphuric acid, sufficiently diluted with water ; or ne may take frequently a cvip 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 benefi- cial ; but these must be administered with caution. Ten or twelve drops of laudanum may be given in a cup of barley-water twice a-day, and continued for some tinse, provided they be found bene- ficial. The conserve of roses is likewise a very good medicine in tins case, provided it be taken in sufficient quantity, and 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, or a bolus may be given in the form be- low.| * Take infusion of Roses, li^ oz. Purified Nitre, 2 drs. Epsom Salts, 3 drs. Make four powders : one to be taken every Make a draught; to be taken twice a-day. fourth hour. t Take Infusion of Roses, , 1^ oz. J Take Powdered Alum, 8 grs. Nitre, 15 grs. Extract of Catechu, JO grs. Tincture of Opium, 10 drps. Conserve of Roses, sufficient t« Make a draught; to be taken every fourth make a bolus, hour. To be taken every four hours, washing it or down with three t.ible-SjOonsful of th» *"ake Cream of Tartar. 3 drs. infusion of roses. VOMITING OF BLOOD. 247 If stronger astringents be necessary, fifteeri or twenty drops of sulphuric acid may be given in a glass of water, three or four times a-day Those who are subject to frequent returns of this disease should avoid all excess. Their diet should be light and cool, consisting chiefly of milk and vegetables. Above all, let them beware of vig- orous efforts of the body, and violent agitations of the mind.* Vomiting of Bluod. ( Hcumatemesis.) This is not so common as the other discharges of blood which have already been mentioned ; but it is very dangerous, and re- quires particular attention. Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea ; and is accompanied with great anxiety, and frequent fainting fits. This disease is sometimes periodical ; in which case it is less dangerous. 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 anything that greatly stim- ulates or wounds the stomach, as strong vomits or purges, acrid poison, sharp or hard substances taken into the stomrch, «fec. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external vio- lence, as blows or bruises, or from any of the causes which pro- duce inflammation. In hysteric women, vomiting of blood is a very common, but by no means a dangerous symptom. A great part of the danger in this disease arises from the extrav- asated blood lodging in the bowels, and becoming putrid, by which means a. dysentery or putrid fever may be occasioned. The best, way of preventing this, is to keep the body gently open, by fre- quently exhibiting emollient clysters. Purges must not be given till the discharge is stopped, otherwise they will irritate the stom- ach, and increase the disorder. All the food and drink must be of a mild cooling nature, and taken in small quantities. Even drink- ing cold water has sometimes proved a remedy, but it will succeed better when sharpened with the weak spirits of vitriol. When there are signs of an inflammation, bleeding may be necessary : but the patient's weakness will seldom permit it Opiates may be *Dr. Rush of Philadelphia has published some interesting facts concerning the utility of common salt, in curing hasmorrhage from the lungs. As this remedy may be ob- tained every where without difficulty, its effects ought to be made generally known. The following art the Docior's own words. "The mode of giving it, is to pour down from a lea to a table-spoonful of clean fine lilt, as soon as possible after the hcemorrhage begins from the lungs. This quantity generally stops it; but the dose must be repeated daily for three or four days, to pre vent a return of the disorder. If the bleeding continae? the salt must be continueif" till it is checked, but in larger doses. I have heard of severa. "stances in which two table-spoonslul ■were taken at one time for several days. ' It sometimes excites a sickness at the stomach, and never fails to produce a buru' ing 8ensati«"» in the throat in its passage into the stomach, and considerable thint afterwards " I have found this remedy to succeed equally well in haemorrhages, whether thej were dctive or passive, or whether they occurred in young or in old people. — Medicax \nq,i;iries, &c. vol. i. Ed 248 BLOODY URiJNfi. 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, gentle purges of Epsom salts, tartarized soda, &.c.. may be given in the almond mixture ; and infusion of roses and sulphur- ic acid should be given regularly every six hours.t Bloody Urine. (Hcematuria.) This is a discharge of blood from the vessels of the kidneys or 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 without pain, it proceeds from the kidneys; but if the blood be in small quantity, of a dark colour, and emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occasioned by a rough stone descending from the kidneys to the bladder, which wounds the ureter, it is attended with a sharp pain in the back, and difficulty of making water. If th'» coats of the bladder are hurt by a stone, and the bloody urine fol- lows, it is attended with the most acute pain, and a previous stop- page of urine. Bloody urine may likewise be occasioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, or 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 diu- retic medicines, especially cantharides. Bloody urine is always attended with some degree of danger : but it is peculiarly so when mixed with purulent matter, as this shows an ulcer somewhere in the urinary passages. Sometimes 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 disease, however, be very great, it may waste the patient's strength, and occasion an ill habit of body, a dropsy, or a con- sumption. The treatment of this disorder must be varied according to the different causes from which it proceeds. When it is owing to a stone in the bladder, the cure depends upon an operation, a description of which would be foreign to our purpose. If it be attended with a plethora, and symptoms of inflamma- tion, the body must 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, » Take Infusion of Roses, 1^ oz. Tincture of Opium, JO drps. Diluted Sulphuric Acid, 10 drps. Make a draught; to be taken every one oi Syrup of Roses, 1 drm. two hours. t Vomiting of blood may frequently be cured by the administration of an active p» .gative, as ten or fifteen grains of the stomach-pill at bed-time for three or four nig)i • isucfessively. Ed. DYSENTERY, OR BLOODY FLUX. 24P It is commonly the symptom of some malignant disease ; as the small-pox, a putrid fever, or the like. In this case the patient's life depends on the liberal use of the Peruvian bark, wine, and acids, as has already been shown.* When there is reason to suspect an ulcer in the kidneys or blad- der, the patient's diet must be cool, and his drink of a demulcent, healing, balsamic quality, as decoctions of marsh-mallow roots with liquorice, solutions of gum-arabic, &-c. Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in two English quarts of water to one; two ounces of gum-arabic, and half an ounce of purified nitre, may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day. The early use of astringents in this disease has often bad conse- quences. When the flux is stopped too soon, the grumous blood, by being confined in the vessels, may produce inflammations, abscess, and ulcers. If, however, the case be urgent, or the patient seems to suffer from the loss of blood, gentle astringents may be necessary. In this case the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a-day ; or he may take an ounce or two of the conserve of roses three or four times a-day, drinking a tea-cupful of the tincture of roses after it ; or, if stronger styptics be necessary, a dram of Armenian bole in a cup of whey may be taken three or four times a-day, or the annexed.t Dysentery, or Bloody Flux. (Dysenteria.) Tins disease prevails in the spring and autumn. It is most common in marshy counties, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much exposed to the night air, or who live in places where the air is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places. Causes. — The dysentery may be occasioned by any thing that obstructs 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 cautious in going near such persons as labour under the disease. Even the smell of the patient's excrements has been known to communicate the infection. Symptoms. — It is known by a flux of the belly, attended by vio- lent pain of the bowels, tenesmus, or a constant inclination to go to stool, and generally more or less blood in the stools. It begins, like other fevers, with chilness, loss of strength, a quick pulse, great thirst, and an inclination to vomit. The stools are at first * Take Confection of Red Roses, 1 oz. Make a mixture ; to be taken three times Infusion of Roses, Warm, 1 pint. a-day. Nf acerate for half an hour, and strain. or t Take Purified Alum, ^ scr. Take of this Strained Liquor, 13 drs. Kino in Powder, 5 grs. Diluted Sulphuric Acid, 10 drps. Make a powder; to be taken three Umei' a-day. 250 DYSENTERY, OR BLOODY FLUX. 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 intestine is actually protruded, which proves exceeding- ly 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, bv the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera mor- bus by its not being attended with such violent and frequent fits of vomiting, &c. When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering dis- eases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they show an inflammation of the stomach. When the stools are green, black, or have an exceedingly disagreeable cadav- erous smell, the danger is very great, as it shows the disease to be of the putrid kind. It is an unfavourable symptom Avhen clysters are immediately returned ; but still more so when the passage is so obstinately shut that they cannot be injected. A feeble pulse, coldness of the extremities, with diflSculty of swallowing, and con- vulsions, are signs of approaching death. Regimen. — Nothing is of more importance in this disease than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness, but in no one more than in this. Every thing about the patient should be frequently changed. The excre- ments should never be suffered to continue in his chamber, but removed immediately, and buried under ground. A constant stream of fresh air should be admitted into the chamber, and it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acids. 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 believes to be persons of skill, it cannot fail to have the worst effect. A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration, without overheating the body. Great caution, however, is necessary, in leaving it off. I have often known a dysentery brought on by im- prudently throwing off a flannel waistcoat before the season was sufficiently vv^arm. For whatever purpose this piece of dress la 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 iliet ; flesh, fish, and every thing that has a tendency to turn putrid DYSENTERY, OR BLOODY FLt/X. 2ol o. lancid on the stomach, must be abstained from. Apples boiled m milk, water-pap, and plain light pudding, with broth made of the jrelatinous parts of animals, may constitute the principal part of the patient's food. Gelatinous broth not only answers the pur pose of food, but likewise a medicine. I have often known dysen- teries, which were not of a jjutrid nature, cured by it, after pom- pous medicines had proved ineftectual.* 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 handsful of fine flour, tied in a cloth, for six or seven hours, till it becomes 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 sweetened to the patient's taste, and taken for his ordinary food.t In a. putrid dysentery the patient may be allowed to eat fleely of most kinds of good ripe fruit: as apples, grapes, gooseberries, cur- rant-berries, strawberries, &c. These may either be eaten raw or boiled, with or without milk, as the patient chooses. The preju- dice against fruit in this disease is so great, that many believe it to be the common cause of dysenteries. This, however, is an egre- gious mistake. Both reason and experience show, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to coun- teract that tendency to putrefaction, from whence the most danger- ous kind of dysentery proceeds. The patient in such a case ought, therefore, to be allowed to eat as much fruit as he pleases, provid- ed it be ripe. I * The manner of making this broth is, to take a sneep 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 added, 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 likewise be given twice a-day. Such as cannot use 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 qualities of medicine, otherwise this might be shown to possess virtues every way suited to the cure of a dysentery which does not proceed from a putrid slate 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 medicines in vain. It will, however, be proper that the patient take a Tomit, and a dose or two of rhubarb, before he begins to use the broth. It will like- wise be necessary to continue the use of it for a considerable time, and to make it the principal food. t The learned and humane Dr. Rutherford, late professor of medicine in the univer- sity of Edinburgh, used to mention this food in his public lectures with great encomi- ums. 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 frequently in water, and to dridge the outside with flour till a cake or crust was formed around it, which prevents the water often as people imagine. The idea that worms occasion many diseases, gives an op |K)rtunity to the professed worm-doctors of imposing on the credulity of mankind, iiii » WORMS. 263 Medicine.— Though numberless medicines are extolled for ex- jelJ.ng and lulling worms,* yet no disease more frequently baffles he physicmn's sk.ll. Jn general, the most proper medidnes for lnJ\^fn^ T" ^'^ '"""^ purgatives, and, to prevent their breed- ing, stomachic bitters, and now and then a glass of good wine. Calomel and santonine, spirits of turpeniiue and lozenees are much used, especially with children. Those who do not choose to take calomel, may make use of th< bitter purgatives; as aloes, t tincture of senna and rhubarb, (fee. Oily medicines are sometimes found beneficial for expelling worms. An ounce of salad oil and a tal)le-spoonful of common salt may be taken in a glass of red port wine thrice a day, or oftener if the stomach will bear it; but the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascaridcs,\ and likewise the teres. The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good rnedicine in this case, which is found to be a fact. Many practi- tioners give flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or trea- cle, and taken in such quantity as to purge the patient. Where Harrowgate water cannot be obtained, sea-water may be used, which is far from being a contemptible medicine in this case. If sea-water cannot be had, common salt dissolved in water may be drank. I have often seen this used by country-nurses with very good ett'ect. Some flour of sulphur may be taken over-night, and the salt-water in the morning. But worms, though expelled, will soon breed again, if the stom- ach remain weak and relaxed ; to prevent which, we would recom- mend the Peruvian bark. 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 table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water tre- foil, camomile flowers, tops of wormwood, the lesser centaury, &c. doing much mischief. They find worms in everycase. and liberally throw in their an Udctes, which generally consist of strong drastic purges. I have known these gires in delicate constitutions, to the destruction of the patient, where there was not the least symptom of worms. * A medical writer of the present age has enumerated upwards of fifty British pianU' all celebrated for killing and expelling worms. rrake Powder of Common Aloes, 1 drm. % Take Mixture of Asafoetida 3 os. Water Gruel, thin, 10 oz. Milk. 6 oe. Make a clyster — to be given occasionally. Make a clyster. 2M WORMS. The above directions are intended for adults ; but for children the medicines must be more agreeable, and in smaller doses. For a child of four or five years old, six grains of rhubarb, five of jalap, and two of calomel, may be mixed in a spoonful of syrup or hon- ey, and given in the morning. The child should keep the house all day, and take nothing cold. This dose may be repeated twice a-wtek for three or four weeks. On the intermediate days, the child may take a scruple of powdered tin, and ten grains of sethi- ops mineral, in a spoonful of treacle, twice a-day. This dose must be increased or diminished, according to the age of the patient, or the form annexed below.* Bisset says, the great bastard black hellebore, or beards foot, is a most powerful vermifuge for the long round worms. He ordtrs the decoction of about a drachm of the green leaves, or about fif- teen grains of the dried leaves in powder, for a dose to a child be- tween four and seven years of age. This dose is to be repeated two 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 worms for three years past. Before pressing out the juice, he moistens the bruised leaves with vinegar, which cor- rects the medicine. The dose is a tea-spoonful at bed-time, and one or two next morning. I have frequently known those big bellies, which in children are commonly reckoned a sign of worms, quite removed by giving them white soap in their pottage, or other food. Tansy, garlic, and rue, are all good against worms, and may be used various ways. We might here mention many other plants, both for exter- nal and internal use, as the cabbage-bark, &,c., but think the fil- ings of tin with sethiops mineral, and the purges of rhubarb and calomel, are more to be depended on. Ball's purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, scammony, and calomel, with as much double-refined sugar as is equal to the weight of all the other ingredients. These must be well mixed together, and reduc- ed to a fine powder. The dose for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dose. A powder for the tape-worm, resembling this, called Madame Nouffer's powder (the name of the proprietor, )t was long kept a secret on the Continent : it was lately purchased by the French king. Parents who would preserve their children from worms ought to allow them plenty of exe»cise in the open air ; to take care that their food be wholesome and sufficiently solid ; and, as far as pos- sible, to prevent their eating raw herbs, roots, or green trashy fruits. It will not be amiss to allow a child who is subject to • Take Powdered Tin, 3 ounces. Mint Water, 4 ounces. Confection of Hipa, 3 drachms. To be tal^en fasting in the morning, and Simple Syrup, enough to make an electu- two hours after, the following bolus : ary doee of the size of a nutmeg, in the Take Submuriate of Mercury, 6 T)r 6 grs. morning. Gamboge, in Powder, 6 to 10 grs Drinking often a cupful of the infusion of Take Male Fern Root, in Powder. green tea. 2 to 3 drms. JAUNDICE. 2Go worms a glass of red wine after meals ; as every thing lliat braces und strengthens the stomach is good both for preventing and ex- pelling these vermin.* In order to prevent any mistake of what I have here said in fa- vour of solid food, it may be proper to observe, that I only made iise of that word in opposition to slo/js of every kind ; not to ad- vise parents to cram their children with meat, two or three times fi.-d&y. This should only be allowed at dinner, and in moderate quantities, or it would create, instead of preventing worms ; for there is no substance in nature which generates so many worms as the flesh of animals, when in a state of putrefaction. Meat, there- fore, at the principal meal, should always be accompanied with plenty of good bread, and young, tender, and well-boiled vegeta- bles, especially in the spring, when these are poured forth from the bosom of the earth in such profusion. They promote the end in view, by keeping the body moderately open, without the aid of artificial physic. The ripe fruits of autumn produce the same ef- fect ; and, from their cooling, antiputrescent qualities, are as wholesome as the unripe are pernicious. I also very earnestly conjure parents not to take the alarm at every imaginary symptom of worms, and directly run for drugs to '.he quack, or apothecary. They should first try the good eft'ects ■jf proper diet and regimen, and never have recourse to medicines 'ill after unequivocal proofs of the nature of the complaint. The danger of advertised nostrums is sufficiently pointed out and exem- plified in the preceding note. CHAP. XXVIIZ. JAUNDICE. (Icterus.) This disease is first observable in the white of the eye, which appears yellow. Afterwards the whole skin puts on a yellow ap- pearance. The urine too is of a saffron hue, and dyes a white cloth, if put into it, of the same colour. There is likewise a spe- r-ies of this disease called the Black Jaundice. Causes. — The immediate cause of the jaundice is an obstruction of the bile, from biliary calculi in the gall-bladder and its ducts ; inspissated biie ; spasmodic constriction of the ducts themselves ; pressing from adjacent tumours ; scirrhosity of the liver, &.c. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, &:.c. ; the bilious or hysteric colic ; violent passions, as grief, anger, &c. Strong purges or vomits will like- wise occasion the jaundice. Sometimes it proceeds from obstin- * We think it necessary here to warn people of their danger who buy cakes, pow- ders, and other worm medicines, at random, from quacks, and give them to their chil- dren without proper care. The principal ingredients in most of these medicines m mercury, which is never to be trifled with. 1 lately saw a shocking instance of the danger of this conduct. A girl who had taken a dose of worm-powder, bought of a travel'.ing quack, went out, and perhaps was so imprudent as to drink cold water dur ing Its operation -. she immediately swelled, and died on tlie fallowing day, with ali ne svmptonse of having been poisoned. 2«6 JAUNDICE. nte agues, or from that disease being prematurely slopped by as- tringent medicines. In infants it is often occasioned by the i,.eco- nium not being sufficiently purged off. Pregnant women are very subject to it. It is hkewise a symptom in several kinds of fever. Catching cold, or the stopping of customary evacuations, a? the menses, the bleeding piles, issues, &c. will occasion the jaun- dice. SvMPTOMS. — the patient at first complains of excessive weari- ness, languor, and inactivity, and has great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itch- ing or pricking pain over the whole body. The stools are of a vfhitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load or oppression of the breast. There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness of the stomach, vomiting, flatulency,' and other symptoms of indi- gestion. If the patient be young, and the disease complicated with no other malady, it is seldom dangerous ; but in old people, where it continues long, returns frequently, or is complicated with the droj)- sy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. Regimen. — The diet should be cool, light, and diluting, consist- ing chiefly of ripe fruits and mild vegetables ; as apples boiled or roasted, stewed prunes, preserved plums, boiled spinnage, &c. Veal or chicken-broth, with light bread, are likewise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be buttermilk, whey sweetened with honey, or decoctions of cool opening vegetables; as marsh-mallow roots, with liquorice, &c. The patient should take as much exercise as he can bear, either on horseback or in a carriage ; walking, running, and even jump- ing, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines have proved ineffectual. Amusements are likewise of great use in the jaundice. The disease is often occasioned by a sedentary life, joined to a dull mel ancholy disposition. Whatever therefore tends to promote tht circulation, and to cheer the spirits, must have good effect, at dancing, laughing, singing, ifec. Medicine. — The cure of jaundice, unpromising as at times it may appear, is nevertheless to be attempted, first, by restoring the interrupted passage of the bile through the duct ; secondly, by carrying it off by the intestines; and, thirdly, by relieving the particular symptoms. Whether the passage of the bile be ob- etructed by biliary concretions, or by spasmodic constriction of the ductus communis choledochus, the same plan nearly must be adopt- ed. If the patient be young, of a full sanguine habit, and complain? of pain in the right side, about the region of the liver, bleeding will JAUNDICE. 2C: bo necessary. Aftei this an emetic must be administered ; and, if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in tlie jaundice tiian emetics, especially where it is not attended with inflammation. Half a drachm of ipecacuanha in powder will be a sufficient dose for an adult. It may be wrought off with weak camomile-tea, or luke- warm water. The body must likewise be kept open by taking a sufficient quantity of Castile soap, or the annexed j)ills.* Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand or flesh-ljrush, are likewise beneficial ; but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue in it as long as his strength will permit. Emetics, purges, fomentations, and exercise, will seldom fail to cure the jaundice when it is a simple disease ; and when coinplica- ed with the dropsy, a scirrhous liver, or other chronic complaints, is hardly to be cured by any means. Should jaundice have arisen as a consequence of an inflamma- tory affection of the liver, the usual means adopted in such cases of bringing it to a resolution must be early put in practice, viz. venesection, topical bleedings, cooling saline purgatives, and the application o-f a blister over the part, which ought to be renewed in succession if the disease does not abate : but where these have either failed or been neglected, and it has proceeded onto achroji- ic state of enlargement, or schirrosity, thereby pressing on the biliary ducts, mercury, from time to time, must be used both in- ternally and externally, as advised in chronic inflammation of the liver. In cases of this nature, and in those of jaundice arising from biliary concretions, neutral saltst have been much employed, to- gether with alkalis and other deobstruents. In jaundice, soap has indeed been looked upon a? a kind of specific, and is therefore much employed, and in considerable quantities. Hemlock has of- ten been used, and, in combination with mercury and cinchona, it might be rendered more efficacious.| Costiveness is to be removed by means of some gentle laxative, as here advised.§ I have likewise known Harrowgate sulphur-water cure jannchce of very long standing. It should be used for some weeks, and the patient must both drink and bathe. * Take Powdered Rhubarb, 1 scruple. of each, 2 drjchms. Hard Soap, ^ drachm. Simple Syrup, enough to form the mass, Submuriate of Mercury, 12 grains. to be divided in 60 pills, of which three Syrup, a sufficient quantity. — Divide the to twelve are to be taken daily, mass into 24 pills; two or three of or which are to be taken at bed lime. Take Mercurial Pill, J drachm. Extract of Hemlock, 2 drachms. t Take Compound Infusion of Gentian, Make 50 pills, of which take three morn- I^ ounce. ing and night. Tincture of Bark, 2 drachms. Tartr.ite of Potash, 15 grains. § Take Socotrine Aloes, IJ drachm. Powder of Rhubarb, 5 grains. Hard Soap, 1 drachm. Make a draught to be taken morning, Subcaibonate of Potash, J drachm noon, and evening. Symp of Buckthorn, enough to make the muss into 36 pills, of which Ibree are tq t Take Extract of Bark, bu taken at bed time. of Hemlock, 2fi8 DROPSY. Persons subject to the jaundice ought to take as nnich exerc:s£ as possible, and to avoid all heating and astringent aliments. The two last directions are of far greater importance than some people may imagine. In fact, taking exercise, and keeping the body open, are the only assured and rational means of removing a complaint which generally arises from an obstruction of the bilia- ry ducts. I knew a celebrated physician who was subject to this disease, and who, whenever it attacked him, mounted his horse, set out on a journey, and never returned till he was well. For my own part, 1 should place more reliance on the efficacy of such method, than on the whole catalogue of near a hundred specifics mentioned by the late Doctor Short of Sheffield, though I have known instances where one of them, the decoction of hemp-seed, as already intimated, was found very beneficial. CHAP. XXIX. DROPSY. (Hydrops.) The dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humour. It is distinguished by dift'erent names, according to the part affected, as anasarca, or a collection of water under the cellular membrane; ascites, or a collection of water in the belly ; hydrops pectoris, or dropsy o^ the breast ; hydrocephalus, or dropsy of the brain, &c. Causes. — The dropsy is often owing to an hereditary disposi- tion. It may likewise proceed from drinking ardent spirits, or other strong" liquors. It is true almost to a proverb, that great drinkers die of a dropsy. The want of exercise is also a very com- mon cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evac- uations, as frequent and copious bleedings, strong purges often re- peated, frequent salivations, «fec. The sudden stoppage of cus- tomary or necessary evacuations, as the menses, the haemorrhoids, alvine fluxes, &c. may likewise cause a dropsy. I have known the dropsy occasioned by drinking large quanti- ties of cold, weak watery liquor, when the body was heated by vi- olent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries It may also be brought on by a long use of poor watery diet, or o^ viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrhus of the liver, a violent ague of long continuance, scarlet fever, diar- ihcfca, dysentery, empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood n-om being duly prepared, may occasion a dropsy. Si'MFTOMS. — Anasarca generally begins with a swelling of the feet and ancles towards night, which for some time disappears ir the mornino'. In the evening the parts, if pressed with the finger DllOl'SY. 2G9 will pit. The swelling gradually ascends, and occujjies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great ; the body is bound, and perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough. Thi.-j last is generally a fatal symptom, as it shows that the lungs are affected. In the 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 by the weight of the swelling, as well as by the fluctuation. When the anasat^ca and ascites are combined, the case is very dangerous. Even a simple ascite' seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief. When the disease comes suddenly on, and the patient is young and strong, there is reason to hope for a cure, especially if me li- cine be given early. But if the patient be old, has led an irregu- lar or a sedentary life, or if there be reason to suspect that the liv- er, lungs, or any of the vi^fcera ure unsound, there is great reason to fear that the consequences will prove fatal. Regimen. — The patient must abstain, as much as possible, from all drink, especially weak and watery liquors,* and must quench his thirst with mustard whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds, or other wild animals, roasted ; pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, &,c. He may also eat sea-biscuit dipped in wine or a little brandy ; this is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If fhe patient must have drink, the Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best. Beer boiled with juniper-berries is much used as a diuretic drink by the German physicians. Exercise is of the greatest importance in a dropsy. If the pa- dent be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he be not able to walk or la- bour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If lie live in a damp country, he ought to be removed into a * A total abstinence from drink has long been considered as highly necessary in all dropsical cases ; but in several cases this practice has been carried too far without any benefit whatever. It seems, however, to have fallen considerably into disrepute, as large quantities of watery liquors, are now allowed, where diuretics, but more particu /arly the supertartrate of potash, are given. Indeed, this mode of treating dropsy is far more rational than the former, as these medicines can hardly be carried to the kid- neys without being accompanied with a large portion of water. When, upon a faij trial, the quantity of urine is not found to be increased by drinking water or other aqie' ous fluids, their use may in that case be discontinued. 270 DROPSY. dry one, and, if possible, into a warm climate. In a word, everv method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient's body two or three times a-day with a hard cloth, or a flesh-brush; and he ought constantly to wear flannel next his skin. In the treatment of dropsy, the attention should be primarily di- rected to ascertain whether the disease be idiopathic or syni[)tom- atic ; that is, whether it be an original one, or whether it prevail as a symptom of some other ; as by removing the cause we shall often be enabled to remove the effect also, and thus perform a cure. For example, should dropsy have arisen as a consequence of in- temperance, a free use of spirituous liquors, exposure to a moist atmosphere, or having had recourse to large evacuations, particu- larly bleeding; or if it have proceeded from long continued inter- mittent fevers, obstructions in the abdominal or thoracic viscera, 'k.c. ; the removal of these will be the first indications of cure. The next will be to evacuate the serous fluid already collected ; and to restore the tone of the system, and strengthen the constitution generally. Medical Treatment. — If the }vatient be young, his constitution good, and the disease has come on suddenly, it maj' generally be removed by strong emetics, brisk purges, and such medicines as promote a discharge by perspiration and urine. For an adult, lialf a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses; or of the sulphate of copper as here advised, as having less tendency to exhaust than any other commonly used. The patient must not drink much after taking the vomit, othervfise he destroys its effects. A cup or two of camomile-tea will be suffi- cient to work it off. Between each vomit, on one of the intermediate days, the patient may lake the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel, six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken- broth. The patient may likewise take every night at bed-time the fol- lowing bo-lus : — To four or five grains of camphor add one grain of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be laken every four or five hours through the day: — Take juniper berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom, half a pound ; infuse them in a quart of Rhenish wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broonj in wine DROPSY. 271 The above course will often cure an incidental dropsy, if tlie constitution he good ; hut when tiie disease proceeds from a had habit, or an unsound stivte of the viscera, strong purges and voinits are not to be ventured upon. In this case the safer course is to palliate the synij)tf»ms by the use of such medicines as promote the Kecretions, and to support the patient's strength by warm and nour- ishing cordials. The secretion of urine may be greatly j)romoted by nitre Brookes says, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scru- ple of nitre, may be given twice a-day in a glass of strong cinna- mon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English pint of the decoction of the tops of green broom after it, has performed a. cure after other powerful medicines had proved ineffectual. I have sometimes seen good effects from cream of tartar in this disease.* It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even three ounces, if the stomach will bear it. This quantity is not, liowever, 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-spoons- ful of the solution of acetated ammonia (Mindererus's spirit) in a cup of v.'ine-whey three or four times a-day. To promote a dis- charge of uri'ie, the following infusion of the London hospitals will likewise be beneficial : — Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm ; cinnamon in powder, three drachms ; subcarbonate of potash, a drachm and a half; infuse in an English pint and a half of old hock wine, and when fit for use, filter the liquor. A wine-glass of it may be taken three or f(»ur times a-day ; or, the subjoined bolus. -r As an active diuretic, the foxglove has been recommended in dropsy: but should it not answer within the first fortnight, as is not unfrequently the case, that where one remedy of this class fails another succeeds, the best way will be to substitute some other for it. It may be given in infusion, saturated tincture, or combined in the form of powder with other diuretics, as squills, cream of tartar, . GOUT. 273 CHAP. XZX. GOUT. There is no disease which shows the imperfection of medicir.e, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources whence it originally sprung, and all who would avoid it must be active and temjjerate. Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in those who are subject to it ; as intense study ; excess of venery ; too free a use of acidulated liquors; night-watching; grief or uneasi- ness of mind; an obstruction or defect of any of the customary discharges, as the menses, sweating of the feet, perspiration, &c. Symptoms. — A fit of the gout is generally preceded by indiges- tion, drowsiness, eructation, a slight head-ach, sickness, and some- times vomiting. The patient complains of weariness and dejec- tion of spirits, and has often a pain in the limbs, with a sensation as if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a slight pain in passing urine, and frequently an involuntary shedding of tears. Sometimes these symptoms are much more violent, es- pecially upon the approach of the fit ; and it has been observed, that as is the fever which ushers in the gout, so will the fit be ; if the fever be short and sharp, the fit will be so likewise ; if it be feeble, long and lingering, the fit will be such also. But this ob- servation can only hold with respect to very regular fits of the gout. The regular gout generally makes its attack in the spring or be- ginning of winter, in the following manner : About two or three in the morning, the patient is seized with a pain in his great toe, some- times in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured upon the part, which is succeeded by a shivering, with some degree of fever. Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the differ- ent kinds of torture, as if the part were stretched, burnt, squeez- ed, gnawed, or torn in pieces. The part at length becomes so ex- quisitely sensible, that the patient cannot bear to have it touched, or even suffer any person to walk across the room. The patient is generally in exquisite torture for twenty-four hours, from the time of the coming on of the fit : he then becomes easier, the part begins to swell, appears red, and is covered with a little moisture. Towards morning he droy s asleep, and generally falls into a gentle breathing sweat. This terminates the first par- oxysm, a number of which constitutes a fit of the gout ; which is longer or shorter according to the patient's age, strength, the sea- won of the year, and the disposition of the body to this disease. 18 274 GOUT. The patient is always worse towards ni^dit, and easier in the morning. The paroxysms, however, generally grow milder every day. till at length the disease is carried off by perspiration, urine, and the other evacuations. In some patients this happens in a few days ; in others, it requires weeks, and in some, months to finisl^ the fit. Those whom age and frequent fits of the gout have great- ly debilitated, seldom get free from it before the approach of sum raer, and sometimes not till it be pretty far advanced. Regimen. — As there are no medicines yet known that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit. In the fit, if the patient be young and strong, his diet ought to be thin and cooling, and his drink of a diluting nature ; but where the constitution is weak, and the patient has been accustomed to live high, this is not a proper time to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiration without greatly heating the patient. It will answer this purpose better if a tea-spoonful of spirits of hartshorn be put into a cup of it twice a-day. It will likewise be proper to give at bed-time a tea-spoonful of the volatile tincture o{ guaiacum, in a large draught of warm wine-whey. This will greatly promote perspiration through the night : equally with any of those advised below.* As the most safe and efficacious method of discharging the gouty matter is by perspiration, this ought to be kept up by all means, especially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fur, or wool. The last is most readily obtained, and seems to answer the purpose better than any thing else. The people of Lancashire look upon wool 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 answer so well in the gout. I have often seen it applied when the swelling and inflammation were very great, with violent pain, and have found all these symp- toms relieved by it in a few days. The wool which they use is generally greased, and carded or combed. They choose the soft- est which can be had, and seldom or never remove it till the fit be entirely gone oft'. The patient ought likewise to be kept quiet and easy during the fit. Every thing theit affects the mind disturbs the paroxysm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They * Take Antimonial Powder, 2 grains. 3 drachms Subcarbonatc of Anirficnia, 8 grs. Camphor Misture, 12 drachms Confection of Roses, enough to make a Solution of Tartarized Antimony, bolus, to be taken every third or fourth 12 drops, hour. Syrup of Orange-peel, 1 drachm. or Make a draught. T*ke Solution of Acetated Ammonia GOUT. 275 do not cure the disease, but remove it from a safer to a more dan- gerous part of the body, where it often proves fatal. A fit of the gout is to be considered as Nature's method of removing something that might prove destructive to the body, and all that we can do with safety, is to promote her intentions, and to assist her in ex- pelling the enemy in her own way. Evacuations by bleeding, stool, &c. are likewise to be used with caution ; they do not re- move the cause of the disease, and sometimes by weakening the patient prolong the fit ; but where the constitution is able to bear it, it will be of use to keep the body gently open by diet, or very mild laxative medicines.* The wine of colchicum, or meadow saffron, given in the quanti- ty of a fluid drachm, twice a-day, in any convenient vehicle, has been found a valuable remedy, both in gout and rheumatism ; but to render this medicine more certain and efficacious, the bowels should be particularly attended to ; and all food of a flatulent na- ture should be avoided. Many things will indeed shorten a fit of the gout, and some will drive it off altogether ; but few have yet been found which will do this with safety to the patient. In pain we eagerly grasp at any thing that promises immediate ease, and even hazard life itself for a temporary relief. This is the true reason why so many infalli- ble remedies have been pioposed for the gout, and why such num- bers have lost their lives by the use of them. When the pain, however, is very great, and tlie patient is rest- less, thirty or forty drops of laudanum, more or less, according to the violence of the symptoms, may i)e taken at bed-time. This will ease the pain, procure rest, promote perspiration, and forward the crisis of the disease. After the fit is over, the patient ought to take a gentle dose or two of the bitter tincture of rhubarb, or some other warm stomachic purge. He should also drink a weak infusion of stomachic bit- ters in small wine or ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and orange-peel. The diet at this time should be light, but nourishing, and gentle exercise ought to be taken on horseback, or in a carriage. Out of the fit, it is in the patient's power to do many things to- wards preventing a return of the disorder, or rendering the fit, if it should return, less severe. This, however, is not to be attempted by medicine. I have frequently known the gout kept off for sev- eral years by the Peruvian bark and other astringent medicines ; but in all the cases where I had occasion to see this tried, the per- sons died suddenly, and to all appearance for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to some constitutions, in the decline of life, is rath- er salutary than hurtful. Though it may be dangerous to stop a fit of the gout by medi- cine, yet if the constitution can be so changed by diet and exer- ci-se, as to lessen or totally prevent its return, there certainly can ' Take Magnesia, 1 drachm. 5 giains. Powder of Rhubarb, 8 grains. Make an aperient powder to be taker Compound Powder of Cinnamon, occasionally. 276 GOUT. be no danger in following such a course. It is well known, that the whole habit may be so altered by a proper regimen, as quito to eradicate this disease ; and those only who have sufficient reso- lution to persist in such a course have reason to expect a cure. The course which we would recommend for preventing the gout, is as follows : — In the first place, universal temperance. In the next place, sufficient exercise* By this we do not mean saunter- ing about in an indolent manner, but labour, sweat, and toil. These only can render the humours wholesome, and keep them so. Going early to bed, and rising betimes, are also of great import- ance. It is likewise proper to avoid night studies, and intense thinking. The supper should be light and taken early. The use of milk, gradually increased, till it becomes the principal part of diet, is particularly recommended. All strong liquors, especial- ly generous wines and sour punch, are to be avoided. We would likewise recommend some doses o^ magnesia alba aiid rhubarb to be taken every spring and autumn ; and afterwards a course of stomachic bitters, t as tanzy or water-trefoil tea, an infu- sion of gentian and camomile flowers, or a decoction of burdock- root, &.C. Any of these, or an infusion of any wholesome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chroiaic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the intei'nal parts, proper applications to I'ecal and fix it become absolutely necessary. When the gout affects the head, the pain of the joint ceases, and the swelling disappears, while either severe head-ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing ensue. If it attacks the stomach, ex- treme sickness, vomiting, anxiety, pain in the epigastric I'egion, and total loss of strength will succeed. When the gout attacks the head or lungs, every method must be taken to fix it in the feet. They must be frequently bathed in warm water, and acrid cataplasms ap4)lied to the soles. Blistering plasters ought likewise to be applied to the ancles or calves of the legs. Bleeding in the feet or ancles is also necessary, and warm * Some make a secret of curing the gout by tnitscular exercise. This secret, how- ever, is as old as Celsus, wno strongly recommends that mode of cure ; and whoever will submit to it in the fullest extent, may expect to reap solid and permanent advan tages. t Take Infusion of Calumba Root, 4 oz. or Compound Tincture of P. Bark, Take Subcarbonate of Iron, 2 drachms. Tincture of Cardamoms, Powder of P. Bark, 1 ounce. of each, ^ ounce. of Cinnamon, 1J drachm. Make a mixture ; of which two table- Syrup of Orange Peel, a sufficiency to spoonsful are to be taken two or three form an electuary; of which the bulk times a-day. of a nutmeg mav be taken twicp •»-ti»». RHEUMATISM. 277 stomachic purges. The patient ouglit to keep in bed for the motil part, if there be any signs of inflammation, and should be very caieful not to catch cold. If it attack the stomach, with a sense of cold, the most warm Cordials are necessary; as strong wine boiled up with cinnamon or other spices, cinnamon-water, peppermint-water, and even brandy or rum.* The patient should keep his bed, and endeavour to pro- mote a sweat by drinking warm liquors ; and if he should be troubled with a nausea, or inclination to vomit, he may drink cam- omile-tea, or any thing that will make him vomit freely. Opiates,! joined with aromatics, or with camphor, musk, or ammonia, may be of service. When the gout attacks the kidneys, and imitates gravel-pains, the patient ought to drink freely of a decoction of marsh-mallows, and to have the parts fomented with warm water. An emollient clyster ought likewise to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoction. Persons who have had the gout should be very attentive to any complaints that may happen to them about the time when they 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 diverted from its regular course, to the great danger of the patient's life. Those vv^ho never had the gout, but who, from their constitution or manner of living, have reason to expect it, ought likewise to be very circumspect with regard to its first approach. If the disease by wrong conduct or improper medicines, be diverted from its proper course, the miserable patient has a chance to be ever after tormented with head-aclis, coughs, pains of the stomach and intes- tines; and to fall at last a victim to its attack upon some of the more noble parts. Rheumatism. This disease has often a resemblance to the gout. It generally attacks the joints with exquisite pain, and is sometimes attended with inflammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually distinguished into acute and chronic : or the rheumatism with and without a fever. Causes. — The causes of a rheumatism are frequently the same as those of an inflammatory fever, viz. an obstructed perspiration, the immoderate use of strong liquors, and the like. Sudden changes of the weather, and all quick transitions from heat to cold, are very apt to occasion the rheumatism. The most extraor- * Ether is found to be an efficacious remedy in this case. t Take Opium, 1 grain. Subcarbonate of Ammonia, 10 grs. Camphor, 6 grains. Tincture of Opium, 12 drops. Aromatic Confection, 6 grains. Spirit of Sulphuric Ether, 30 drops Make a bolus, to be taken occasionally. Make a draugl. to be taken every thrpe Take Camphor Mixture IJ ounce. hours. 278 RHEUMATISM. dinarj case of a rheumatism that I ever saw, where almost ever\ joint of the body was distorted, was a man who used to work one part of the day by the fire, and the other part of it in the water. Very obstinate rheumatisms have likewise been brought on by per- sons not accustomed to it, allowing their feet to continue long wet. The same effects are often produced by wet clotlies, damp beds, sitting or lying on the damp ground, travelling in the night, se be occasioned by excessive evac- uations, or the stoppage of customary discharges. It is oftoji the effect of chronic diseases, which vitiate the humours; as the scurvy, the lues venerea, obstinate autumnal agues, &c- The rheumatism prevails i)i cold, damp, marshy countries. It is most common among the poore) sort of peasants, who are ill- clothed, live in low damp houses, and eat coarse and unwhole- some food, which contains but little nourishment, and is not easily :ligested. Symptoms. — The acute rheumatism commonly begins with wea- riness, shivering, a quick pulse, restlessnesis, thirst, and other symptoms of fever. Afterwards the patient complains of flying pains, which are increased by the least motion. These at length fix in the joints, which are often afl'ected with swelling and inflam- mation. If blood be let in this disease, it has g;enerally the same appearance as in the pleurisy. Medical Treatment. — In this kind of rheumatism the treat- ment of the patient is nearly the same as in an acute or inflamma- tory fever. If he be young and strong, bleeding is necessary, which may be repeated according to the exigencies of the case. The body ought likewise to be kept open by emollient clysters, or cool opening liquors; as decoctions of tamarinds, cream of tartar, whey, senna-tea, and the like. The diet should be light, and in small quantity, consisting chiefly of roasted apples, groat gruel, or weak chicken 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 solution of the acetated ammonia, &c.* He may likewise take, for a few nights, at bed-time, in a cup of wine-whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder. Warm bathing, after proper evacuations, has often an exceed- ingly good effect. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affected. Great care must be taken that he do not catch cold after bathinsf. *Take Camphor Mixture, 1 ounce. SimfJe Syrup, enough to make a bolus; Solution of Tartarized Antimony, to be taken every third or fourth hour, 20 drops. washing it down with three table Solution of Acetated Ammonia, spoonsful of the following mixture : 3 drachms. Take Lemon Juice, IJ ounce. Mix them for a draught, to be repeated Subcarbonate of Ammonia, 1 drm. every four or six hours. Water, 4A ounces. or Nitrate of Potash, % dr.ichm TaVe Compound powde of Ipecacuanha^ Simple Syrup | ounce. 10 grains. Make a mixture. Confection of Roses, 12 grains RHEUMATISM. 279 The chronic rheumatism is seldom attended with any conside- rable degree of lever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There ts seldom any inflammation or .swelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients, it often proves extremely obstinate and sometimes inriirable. In this kind of rheumatism, the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chief.y of vegetable substances, as stewed prunes, coddled-apples, currants oi gooseberries boiled in milk, is most proper. Arbuthnot says, "If there be a specific in alimetit 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 rheumatic pains consider- ably." This I have often experienced, but found it always more efficacious when joined with gum guaiacum, as already directed. In this case the patient may take the dose formerly mentioned twice a-day, and likewise a tea-spoonful of the volatile tincture of gum guaiacum at bed-time in wine-whey. This course may be continued for a week, or longer, if the case proves obstinate, and the patient's strength will permit. It ought then to be omitted for a few days, and repeated again. At the same time leeches or a blistering plaster may be applied to the ])art affected. What I have generally found answer better than either of these, in obstinate fixed rheumatic pains, is the warm •plaster. I have likewise known a plaster of Burgundy pitch worn for some time on the part affected give great relief in rh.eumatic pains. My ingenious friend. Dr. Alexander of Edinburgh, says, he has frequently cured very obstinate rheumatic pains, by* rub- bing the part affected with tincture of cantharides. When the common tincture did not succeed, he used it of a double or treble strength. Cupping upon the part affected is likewise often very beneficial, and so is the application of leeches. Blisters are sometimes employed in this complaint ; but they ap- pear to be most serviceable in those cases where the diseast par- takes of the nature of acute rheumatism, or where the pain is fix- ed in any particular joint ; and a repetition of fresh blisters will be preferable to keeping up a constant sore by stimulating the part with savine or other ointments ; and produce a greater effect upon the disease. Though this disease may not seem to yield to medicines for some time, yet they ought still to be persisted in. Persons who are sub- ject to frequent returns of the rheumatism will often find their ac- count in using medicines, whether 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 medi- cines to extirpate it is when the patient is most free from the dis- order. • Take Olive Oil, 2 ounces. Tincture of Cantharides, 1 drachm Camphor, 2 drachms. Solution of Ammonia, J ounce Dissolve, and add. Make a liniment. 280 RHEUMATISM. To those who can afford the expense, I would recommend the warm baths of Buxton or Matlock in Derbyshire. These have often, to my knowledge, cured very obstinate rheumatisms, and are always safe, either in or out of the fit. When the rheu matism is complicated with scorbutic complaints, which is not sel dom the case, the Harrowga'te waters, and those of Moffat, are proper. They should both be drank and used as a warm bath. There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of water or small wine. The water trefoil is likewise of great use in this complaint. It may be infused in wine or ale, or drank in form of tea. The ground-ivy, camomile, and several other bitters, are also benefi- cial, and may be used in the same manner. No benefit, however, is to be expected from these, unless they be taken for a considera- ble time. Excellent medicines are often despised in this disease^ because they do not perform an immediate cure : whereas nothing would be more certain than theij- effect, were they duly persist- ed in. Want of perseverance in the use of medicines is one rea- son why chronic diseases are so seldom cured. The internal remedies most generally recommended in chronic rheumatism are sudorifics, and medicines of a stimulating nature, which abound in essential oils and resins ; and therefore volatile alkaline salts, guaiacum, turpentine combined with Cinchona bark, and the like, may be given in any of the undermentioned forms.* Cold bathing, especially in salt water, often cures the rheuma- tism. We would also recommend exercise, and wearing flianne) 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 mto the leg or thigh. Persons afflicted with the scurvy are very subject to rheumatic complaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or together, as the patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb, in powder, may be infused in a bottle of wine, and one, two, or three wine glasses of it taken daily, as shall be found necessary for keeping the body gently open. In cases where the bark itself proves sufficiently purgative, the rhubarb may be omit- ted. • Take Oil of Turpentine, 1<^ drachm- or Yolk of an egg, enough to mix Take Guaiaeum, in Powder, 6 grains. them, Antimonial Powder 3 grjiins Then add, Syrup of Ginger, enough to form a bcrlua Compound Spirit of Juniper, 1 oz. to be taken three times a day Decoction of Bark, 5 ounces. or Make a mixture, of which take two table- Take Ammoniated Tincture of spoonsful every four hours. Guaiacum, 2 drachms. or Spirit of Cinnamon, ^ ounce. Take Rectified Oil of Turpentine, Decoction of Bark, 1 ounce. Spirit of Nitric Ether, Solution of Tartarized Antimony, of each equal parts, 1 ounce. 24 drops. A tea-spoonful to be taken three times Make a draught, to be taken two or three a-day in some appropriate vehicle. times a-day. SCUJIVV. 281 Suclj as are subject to frequent attacks of the rheumatism ought to make choice «if a dry, warm situation, to avoid the night-uir, wet clothes, and wot feet, as much as possible. Their clothing should be warm, and they should wear flannel next their skin, and make frequent use of the flesh-brush. One of the best articles of dress, not only for the prevention of the rheumatism, but for powerful co-operation in its cure, is flee- cy hosiery. A medical friend of mine, of long experience and much practice in the isle of Ely, assured me, that the introduction of that manufacture had prevented more rheumatisms, colds, and agues, than all the medicines which had ever been used there. Such of the inhabitants of marshy countries as are in easy circum- stances could not, perhaps, direct their charity and humanity to a netter object than to the supplying of their poor neighbours with so cheap and simple a preservative. I have even myself ex- perienced the good effects of such warm covering in the rheuma- tism, to which I was very subject about thirty years ago ; but have never experienced any attack of it since I took to warm clothing. When there are any suspicioLs of the disease being connected with a syphilitic taint, a long continued course of mercurial altera- tives (see Syphilis) must be entered upon. Chronic rheumatism sometimes afiVcts the lumbar region, with an acute pain shooting down into the os sacrum, so that the patient cannot stand upright without suffering considerable pain and in- convenience ; nor does he feel any ease when in bed. This affec- tion is known by the name of lumbago, and, as it frequently does, when it fixes itself in the hip-joint, it is called sciatica. Both of these affections are to be treated in the same manner as chronic rheumatism. In sciatica and local pains of the hip and loins, tur- pentine is often given with relief, as is also guaiacum combined with the essential oil of sassafras ; and the external application of the Bath waters have been recommended by Dr. W. Falconer, as affording considerable benefit. 282 SCURVY. Causes. — The scurvy is occasioned by cold Kioist 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 mav also proceed from the suppression of customary evacuations, as the menses, the hsemorrhoidal flux, &c. It is sometimes owing to an hereditary taint, in which 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 this disease. The same observation hold-s with regard to neglect of cleanliness, bad clothing, the want of proper exercise, confined air, unwhole- some food, or any disease which greatly weakens the body, or vitiates the humours. Symptoms. — This disease may be known by unusual weariness, heaviness, and diflficulty of brec.thing, especially after motion ; rot- tenness of the gums, which are apt to bleed on the slightest touch ; a stinking breath ; frequent bleeding at the nose ; crackling of the joints ; difficulty of walking ; sometimes a swelling, and sometimes a falling away of the legs, on which there are livid, yellow, or vio- let-coloured spots ; the face is generally of a pale or leaden colour. As the disease advances, other symptoms come on ; as rottenness of the teeth, haemorrhages, or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, es- pecially about the breast, dry scaly eruptions all over the body, &c. At last a wasting or hectic fever comes on, and the miserable patient is often carried off by a dysentery, a diarrhoea, a dropsy, the palsy, fainting fits, or a mortification of some of the bowels. CcRE. — We know no way of curing this disease but by pursuing a plan directly opposite to that Avhich brings it on. It proceeds from a vitiated state of the humours, occasioned by errors in diet, air, or exercise ; and this cannot be removed but by a proper at- tention to these important articles. If the patient has been obliged to breathe a cold, damp, or ccn- fined air, he should be removed, as soon as possible, to a dry, open, and moderately warm one. If there is reason to believe that the disease proceeds from a sedentary life, or depressing passions, as grief, fear, (fee, the patient must take daily as much exercise in the open air as he can bear, and his mind should be diverted by cheerful company and other amusements. Nothing has a greater tendency either to prevent or remove this disease than constant cheerfulness and good humour. But this, alas ! is seldom the lot of pers4^)ns afflicted with the scurvy ; they are generally surly, peevish, and morose. When the scurvy has been brought on by a long use of salted provisions, the proper medicine is a diet consisting chiefly of fresh vegetables ; as oranges, apples, lemons, hmes, tamarinds, water- cresses, scurvy-grass, brook-lime, &-c. The use of these, with .^]jlk, pot-herbs, new bread, and fresh beer or cider, will seldom fail to remove the scurvy of this kind, if taken before it is too faj- advanced ; but to have this effect, they must be p«;rsisted in for a considerable time. When fresh vegetables cannot be obtained. SCURVY. 283 pickled or preserved ones may be used ; and where these are want- ing', recourse must be hud to the chymical acids. All the patient's food and drink should, in this case, be sharpened with cream oC tartar, elixir of vitriol, vinegar, or the muriatic acid. These things, however, will more certainly prevent than cure the scurvy, for which reason sea-faring people, esi)ecially in lonj: voyages, ought to lay in plenty of them. Cabl)ages, onions, goose- berries, and many other vegetables, may be kept a long time l»> pickling, preserving, «fec., and when these fail, the chymical acids recommended above, which will keep for any length of time, may be used. We have reason to believe, if ships were widl ventilated, had got store of fruits, greens, cider, «S6C. laid in, and if proper regard were paid to cleanliness and warmth, tliat sailors would be the most healthy people in tlie world, and would seldom suffer either from the scurvy or putrid fevers, which are so fatal to that useful claf.s of men : but it is too much the temaer of such people to despise all precaution; they will not tbink of any calamity till it overtakes them, when it is too late to ward fiff the blow. In the course of the disease particular symptoms may arise re- quiring a separate consideration. Pains of the belly are to be re- lieved by emollients and opiates ; oppression at the chest and im- peded respiration by blisters ; for bleeding is never to be used in this disease ; contractions of the hams and calves of the legs, by fomenting the part with warm vinegar and water, and by the ap- plication of emollient poultices and frictions ; sponginess of the gums, and looseness of the teeth, by washing the mouth frequent- ly with antiseptic and astringent gargles ;* and foul ulcers are to be cleansed and healed by washing them with lemon-juice, or a tincture consisting of equal parts of the tincture of myrrh, and tlien dressing them with some kind of ointment, or a sorrel poultice. In bad cases of ulceration the charcoal or effervescent poultice may probably be serviceable. It must indeed be owned, that many of them have it not in their power to make the provision we are speaking of; but in this case it is the duty of their employers to make it for them ; and no man ought to engage in a long voyage without having these articles se- en red.t * Take Infusion of Roses, 4 ounces, Take Decoction of Bark, 6 ounces. Alum, in Powder, 1<^ ounce. Tincture of Myrrh, Ih, ounce. Honey, 1 drachm. Muriatic Acid,' 12 to 20 drops. Mix them for a gargle. Make a gargle. or t Every body knows how much easier it is to prevent than to cure any disease ; but this is particularly true with respect to the scurvy. I have therefore recommended the most assured means of preserving our seamen from its formidable attacks. Vege- table and mineral acids are certainly the best correctives of the acrimony occasioned by the long use of salted provisions. These are one of the chief causes of the scurvy not only at sea, but on land also, where salted and smoke dried meats are a favourite and very customary article of food. It appears from the reports of modern travellers, that the scurvy is almost unknown to the natives of Canada, though they live entirely on animal food, but not salted ; while the use of the latter never fails to produce the scurvy. Would it not then be worth while to make various experiments for preserv- ing meat at sea without salt? Surely the resources of human invention are not exhausted. The absorbent and antiputrescent properties of sugar are well known ; but it might be deemed too expensive a seasoning. I must leave trials of this sort to per sons of more leisure. It is enough for me to suggest the hint. I wish it may lead ta % discovery of so n ach importance. 284 SCURVY. 1 have often seen very extraordinary effects in the land-scurvy from a milk diet. This preparation of Nature is a mixture of an- imal and vegetable properties, w^hich of all others ib the most fit for restoring a decayed constitution, and removing that particular acrimony of the humours, which seems to constitute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourishing food, because it is cheap, and devour with greediness flesh and fermented liquors, while milk is only deemed fit for their hogs. The most proper drink in the scurvy is whey or buttermilk. When these cannot be had, sound cider, perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, and may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce-fir is likewise proper. It may be drank in the quantity of an English pint twice a-day. Tar-water may be used for the sama purpose, or decoctions of any of the mild mucilaginous vegetables; as sarsa- parilla, marsh-mallow roots, &c. Infusions of the bitter plants, as ground ivy, the lesser centaury, mArsh-trefoil, «&c. are likewise beneficial. I have seen the peasants in some parts of Britain express the juice of the last-mentioned plant, and drink it with good effect in tl.ose foul scorbutic eruptions with which they are often troubled in the spring season. Harrowgate-water is certainly an excellent medicine in the land-scurvy. I have often seen patients who had been reduced to the most deplorable condition by this disease, greatly relieved by drinking the sulphur-water, and bathing in it. The chalybeate- water may also be used with advantage, especially with a view to brace the stomach after drinking the sulphur-water, which, though it sharpens the appetite, never fails to weaken the powers of diges- tion. A slight degree of scurvy may be carried oif by frequently suck- ing a little of the juice of a bitter orange or a lemon. When the disease afl'ects the gums only, this practice, if continued for some time, will generally carry it oft". We would, however, recommend the bitter orange as greatly preferable to lemon; it seems to be as good a medicine, and is not near so hurtful to the stomach. Per- haps our own sorrel may be little inferior to either of them. All kinds of salad are good in the scurvy, and ought to be eaten very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, &c. It is amazing to see how soon fresh vegetables m the spring cure the brute animals of any scab or foulness which IS upon their skins. It is reasonable to suppose that their eff'ects would be as great upon the human species, were they used in proper quantity for a sufficient length of time. I have sometimes seen good effects in scorbutic complaints of very long standing, from the use of a decoction of the roots of water-dock. It is usually made by boiling a pound of the fresh root in six English pints of water, till about one-third of it be con- sumed. The dose is from half a pint to a whole pint of the decoc tion every day. But in all the cases where I have seen it prjve beneficial, it was made much stronger, and drank in laiger quan- rities. The safest way, however, is for the patient to begin with SCROFULA, OR KING'S EVIL. 285 timiill doses, and increase them both in strength and quantity, as he finds his stomach will bear it. It must be used for a conside- rable time. I have known some take it for many mont'"8, and have been told of others who had used it for several years, before they were sensible of any benefit, but who nevertheless were cured by it at length. The leprosy, which was so common in this country long ago, seems to have been near a-kin to the scurvy. Perhaps its a[)pear- ing so seldom now, may be owing to the inhabitants of Britain eating more vegetable food than formerly, living more ujjon tea and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, «fcc. — For the cure of this disease, we would recommend the same course of diet and medicine as in the scurvy. I have met with very few cases of real leprosy in the course of my practice. The dry, scaly eruptions all over the body, whicli are often the effects of the scurvy, are very liable to be considered as leprous symptoms, and certainly resemble them very much. But no evil can arise even from mistake in this particular, as the same alterative plan, which is advisable in the scurvy, will be gen- erally found efficacious in the leprosy. Perhaps in the latter com- plaint, we ought to lay a greater stress, if possible, on the benefit of good air, and of frequent changes of the linen worn next the skin. What has been peculiarly called the disease of uncleanness, can only be remedied by the practice of the opposite virtue. I have also found, that, after proper means for correcting internal impu- rities had been used for some time, the complete disappearance of the leper's sores was often safely and effectually promoted by the ointment for diseases of the. skin mentioned in the Appendix.* The medicinal virtues of the Bath waters, as well as those of Harrowgate, in the cure of the leprosy, are very highly, and I believe very justly esteemed. Scrofula, or King's Evil. This disease chiefly affects the glands, (.specially those of the neck. Children and young persons of a sedentary life, are very subject to it. It is one of those diseases which may be removed by proper regimen, but seldom yields to medicine. The inhabitants of cold, damp, marshy countries are most liable to the scrofula. Causes. — This disease may proceed from an hereditary taint, infection, a scrofulous nurse, &c. Children who have the misfor- tune to be born of sickly parents, whose constitutions have beer greatly injured by the pox, or other chronic diseases, are apt to be affected by the scrofula. It may likewise proceed from such dis- eases as weaken the habit or vitiate the humours, as the small-pox, measles, &.c. External injuries, as blows, bruises, and the like, * I have lately seen some instances of inveterate eruptions on the face, commonly termed scorbutic, removed by the use of the dulcamara. Take of the stalks of that plant, half an ounce, liquorice root, two drachms; macerate in two quarts of warm water for two hours, and then boil for ten minutes. Of the strained decoction a tea- cupful with a little milk, may be taken three times a-day. It must be persisted in foi eome time. ' A. P. B. 286 SCROFULA, OR KING'S EVIL. sometimes produce scrofulous ulcers ; but we have reason to be lieve, when this happens, that there has been a predisposition in the habit to this disease. In short, whatever tends to vitiate the humoars or relax the solids, paves the way to the scrofula ; as the want of proper exercise, too much heat or cold, confined air, un- wholesome food, bad water, the long use of poor, weak, watery aliments, the neglect of cleanliness, edes the cir- culation of the blood through the lungs, or prevents their being du- ly expanded by the air. Symptoms. — An asthma is known by a quick laborious breath ing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or con- tinued long in a damp place under ground, or has taken some food which ""he stomach could not digest, as pastries, toasted cheese, or the like. The paroxysm is commonly ushered-in with listlessness, want of sleep, hoarseness, a cough, belching of w^ind, a sense of heavi- ness about the breast, and difficulty of breathing. To these suc- ceed heat, fever, pain of the head, sickness and nausea, great op- pression of the breast, palpitation of the heart, a weak and some- times intermitting pulse, an involuntary flow of tears, bilious vom- itings, &.C. All these symptoms grow worse towards night ; the patient is easier when up than in bed, and is very desirous of cool air. After some nights passed away in this manner, the fits at length moderate, and suffer more considerable remissions, particularly when they are attended by a copious expectoration in the morn- ings, and when this continues from time to time, throughout the day ; and, the disease going off at last, the patient enjoys his usu- al rest by night without further disturbance. The pulse, during the fit, is usually not much affected, but in a few cases there is a frequency cf it, with some degree of thirst and other febrile symp- toms. Regimen. — The food ought to be light and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young 294 ASTHMA. animals to that of old. All windy food, and whatever is apt tfi swell in the stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled or roasted, are proper. Strong liquors of all kinds, especially malt liquor, are hurtful. The })a- tient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service. But nothing is of so great importance in the asthma as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp keen at- mosphere of a bleak hilly country : a medium, therefore, between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed breathe easier in town than in the country ; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good liealth in the south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it promotes the digestion, and greatly assists in the perspiration of the blood. The blood of asthmatic persons is seldom duly pre- pared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear. Medicine. — Almost all that can be done by medicine in this dis- ease, is to relieve the patient when seized with a violent fit. This indeed requires the greatest expedition, as the disease often proves suddenly fatal. During the paroxysm the body is generally bound, a purging clyster, with a solution of assafoetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times.* The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should for- bid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomentations or bladders filled with warm milk and water, may be applied to the part affected, and warm cata- plasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and saffron mixed together in a cup of yalerian-tea, twice or thrice a day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This, however, will be more safe after other evacuations have been pre- mised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm. •Take Compound Decoction of Marsh- of each, 5 ounces, mallow, Castor Oil, ^ OLice. Mixture of AssafcBtida. Mix for a clvster. ASTHMA. 294 1ti tho moist astlima, such tilings as promote expectoration oi ^pitting, ought to be used ; as the syrup of squills,* gum-ammoni uc, and such like. A ccjmmon spoonful of the syrup or oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of assafcDtida and gum-ammoniac at bed tinie.-* A combination of foxglove and opium has proved liighly ad van tageous in spasmodic asthma, when given in the dose of half a grain of each every four or five hours. In the petuitous asthma, squill and foxglove might be more advisable. | On the authority of a modern writer, galvanism was found most efficacious in reliev- ing habitual aslhma.§ For the convulsive or nervous asthma, antispasmodics and ton ics are the most j/roper 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 ii. substance or infused in wine. Bitter infusions, chalybeate waters, and preparations of iron, particularly the subcarbonate and sul- phate, in sh^rt, 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 likewise known cows' milk drank warm in tlie morning have a very good effect in this case. In addition to other tonics, exercise either in swino-insr, s 'Vms, nuing in a carriage, or on horseback, but particularly the latter, cogether with a change of air, will be beneficial to asthmatics: they should try different situations to live in, where the disease is rendered less distressing, or is entirely removed. Their clothing « iiould be warm. In the arthritic asthma, arising from the retrocession of gout, there are usually intermissions and other irregularities of the pulse, J; re at anxiety of countenance, with a bluish tinge thereon. Large uoses t)f opium, ether, camphor, and ammonia r.re the medicines most likely to afford relief. Sometimes it is necessary to bleed the patient, and often to apply a blister to the chest, assisted wilh placing the feet in warm water, &:c. In every species of asthma setons and issues have a good effect ; thev may either be set in the back or side, and should never be al- •Take Mixture of Ammoniacum, 4 oz. or Oxymel of Squills, 3 drs. Take Mixture of Amtnoniacum, 1 oz. oolution of Antimony Wine, 40 drps. Solution of Acetated Ammonia, 2 drg. Distilled Vinegar, ^ oz. Tartarized Antimony, Make a mixture ; of which two table- 15 drops, spoonsful are to be taken often, or when Syrup of Tolu, 1 d.achnv either the cough or shortness of breath Make a draught, to be taken every sii is troublesome. hours t After copious evacuations, large doses of ether have been found very efficacious ic removing a fit of the asthma. I have likewise known the following mixture pr-oduce "ery happy effects; To four or five ounces of the solution or milk of gum aiDmoniac 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. (Take Foxglove in Powder, 6 grains. Syrup of Tolu, enough to make the mass yjompound Squill Pill, 2 scruples. into 12 pills, one to be taken three o- four times a-day. $ See Experimental Inquiry into the Laws of the Vital Functions, &c. by A. P Wu on Philip, M. D. o. 329. 296 ASTHMA. lowed to dry up. We shall here, once for all, observe, that tuvf*. only in the asthma, but in most chronic diseases, issues are ex- tremely 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. This disease, though so common with us, is little known in mild climates ; and, on that account, it is always advisable to try the effect of a change of cUmate, which has generally been attended with great benefit. I have already intimated what little confidence I had in the power of any medicine to perform a radi- cal cure of the asthma; but there are many things that will give the patient ease, and, of course, tend to prolong his life. Much, also, may be done by regimen, when drugs are of little service ; and I would therefore advise asthmatic patients to procure and keep by them rules for their management both in and out of the fit, adapted to their particular cases. By a proprr attention to such rules a man may live many years, and enjoy tolerably good health. I had a patient some time ago, who v/as often carried home to his wife in an apparently dying state. She felt little alarm, well knowing what was necessary to be done ; and she always brought him about. This good woman did no more than may be done by any woman of common sense, if the doctor will deign to instruct her. General rules will not do ; they must, as before observed, be suited to the patient's case and constitution. For want of some such instructions, which a physician should take the earliest op- portunity to give, a patient may lose his life before the doctor can be sent for, or any other medical advice or assistance procured.* Apoplexy. (Apolexia.) Apoplexy is a sudJen loss of sense and motion, during which the patient is to all appearance dead ; the heart and lungs, how- ever, still con^^inue to move. Though this diseas* proves often fatal, yet it may sometimes be removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in win- ter, especially in rainy seasons, and very low states of the barome- ter. Causes.— *The immediate cause of an apoplexy is a compres- * Asthma is a disease more immediately alarming in appearance, than dangerous ip ■reality. It is well to be aware that there is hardly an instance known of a person dying during the asthmatic paroxysm. The duration of life seems even r.irely to be short- ened by this complaint. The celebrated Dr. Floyer, who wrote on asthma, although he laboured under that disease during his whole life, died upwards of eighty years of ■ ige. He was of opinion that he shortened and lightened his fits by drinking some cups of very strong coffee without milk or sugar. I have known more than one astii •matic, who never lay down in bed for a long series of years, and notwithstanding, during the intervals of the fits, enjoyed tolerable health. Much depends on adhering to a dry diet, taking regular exercise, and on abstaining from those things which are known, by individual experience, to disorder the stomach. Considerable benePt is derived, in the nervous asthma, from occasionally taking as much genuine assafcetida, ■made into pills, as is sufficient to keep the body regular. Smoking the herb Stramo- nium, shortens the duration of a fit, but does not permanently cjre the disease, not «en diminish the number of paroxysms. See "New Domestic Medical Manual," by S. Forsyth. APOPLEXY. 2% pion of the brain, occasioned by an excess of blood, or a collec- tion of watery humours. The former is called a sangitinc, and tl.c latter a serous apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of the blood from the head : as intense study ; violent passions ;• viewing objects for a long time obliquely; wearing any thing too tight about the neck ; a rich and luxurious diet ; suppression of urine ; suffering the body to cool suddenly after having been great- ly heated ; continuing long in a warm or cold bath ; the excessive use of spiceries, or high-seasoned food ; excess of venery ; the sudden striking in of any eruption ; suffering issues, setons, «Scc. sud- denly to dry up, or the stoppage of any customary evacuation ; a mercurial salivation pushed too far, or suddenly checked by cold ; wounds or bruises on the head ; long exposure to excessive cold ; poisonous exhalations, &c. Symptoms, and method of cure. — The usual forerunners of an apoplexy are giddiness, pain and swimming of the head ; loss of memory; drowsiness; noise in the ears ; the nightmare ; a spon- taneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet, and opening medicines. In the sanguine apoplexy, if the patient does not die suddenly, the countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and temples, are turgid ; the pulse beats strong ; the eyes are prominent and fixed, and the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting. In this species of apoplexy every method must be taken to les- sen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be rais- ed pretty high, and his feet suffered to hang down. His clothes ought to be loosened, especially about the neck, and fresh air ad- mitted into his chamber. His garters should be tied pretty tight, by which means the motion of the blood from the lower extremi ties will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated m two or three hours- A laxative clyster, t with plenty of sweet oil or fresh butter, and a spoonful or two of common salt in it, may be administered every two hours ; and blistering plasters applied between the shoulders, and to the calves of the legs. As soon as the symptoms are a little abated, and the patient is •I knew a woman who, in a violent fit of antoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here as in the former case. It may, however, generally be performed once with safety and advantage, but should not be repeated. '^I'he pa- tient should be placed in the same posture as directed above, and .should have blistering plasters appli-ed, an>d receive opening clys- ters in the same manner. Purges are here likewise necessary, and the patient may drink strong balm tea. If he be inclined to sweat, it ought to be promoted by drinkin-g small wine whey, or an infu- sioH of carduus henedictus. A plentiful perspiration kep4: up for a considerable time has often carried off a serous apoplexy. Out of a fit of serous apoplexy the cephalic and nervous mcdicinea recommended in palsy will be proper, taking occasionall}'^ some stomachic purgative. If the disease arise in consequence of a sup- pression of piles, leeches should be applied to the hemorrhoidal veins, fomentations must be employed, and the intestines stimulat- ed by m.eans of aloetic purges. When apoplectic symptoms proceed from opium, or other nar- cotic substances taken into the stomach, vomits are necessary. The patient is generally relieved as soon as he has discharged the poison in tins way. Persons of plethoric or apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, and to avoid the ex- tremes of heat and cold. The head should be shaved, and daily washed with cold water. The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected ; but it ought to be taken in moderation. Nothing has a more happ> effect in preventing an apoplexy than perpetual issues or setons great care, however, must be taken not to suffer them to dry up without opening others in their stead. Apoplectic persons ought never to go to rest with a full stomach, or to lie with their heads low, or to wear any thing too tight about their necks. When an attack of apoplexy is immediately threatened, blood-letting is th«; remedy most to be relied on, and the blood should be drawn either from the jugular vein or temporal artery, determining the extent of blood to be taken away by the circumstances of the case, &.c When a lethargic disposition prevails, bleeding should also be adopted, particularly topical, from the temples, by means of leech es, or from the naoe of the neck by the scarificator and cupping . OOSTIVENESS, &c. 299 the frequent use of cathartics,* and a blister applied to the head or its immediate vicinit)'. The preceding cautions are of far greater importance than sucli persons may be aware of. The circulation, which is slower dur- ing sleep than when awake, is farther clogged by a fulness of the stomach. The low posture of the head not only favours, but seems to invite stagnation ; and tight ligatures round the neck, impede the return of the blood from the vessels of the brain, so that an apoplexy, not only very naturally, but almost inevitably follows. Instead of being astonished at the number of those who go to bed in apparent health, and are found dead in tlie morning, we should consider it as a matter of much more surprise for a per- son of a plethoric habit, after unchecked indulgence in the pleas- ures of the table, to go to rest without any regard to the inclina- tion of his head or tl»e tightness of his collar, and ever to rise again.t 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 diseases, as of the cholic, the iliac pas- sion, ifcc, but only to take notice of that infrequency of stools which sometimes happens, and which in some particular constitutions may occasion diseases. Costiveness may proceed from drinking rough red wines or oth- er astringent liquors ; too much exercise, especially on horseback. It may likewise proceed from a long use of cold insipid food, which does not sufficiently stimulate the intestines. Sometimes it is owing to the bile not descending to the intestines, as in the jaun- dice ; and at other times it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumours, a cold dry state of the intestines, &c. Excessive costiveness is apt to occasion pains of the head, vomiting colics, and other complaints of the bowels. It is pecul- iarly hurtful to hypochondriac and hysteric persons, as it gener- ates wind and other grievous symptoms. Some people, hoAvever, can bear costiveness to a great degree. I know persons who en- joy pretty good health, yet do not go to stool above once a-week, and others not above once a fortnight ; indeed I have heard of some who do not go above or>ce a-mcnth. Persons who are generally costive should live upon a moisten- ing and laxative diet ; as roasted or boiled apples, pears, stewed prunes, raisins, gruels with currants, butter, honey, sugar, and such like. Broths with spinage, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, or that which is made of a mix- ture of wheat and rye together, ought to be eaten. No person troubled with costiveness should eat white bread al one, especially Take Submuriate of Mercury, 6 grains. or Compound Extract of Colocynth, Take Wine of Aloes, 2 ounces. 15 grains. Tincture of Jalap, * drachme Make t pills for a dose. '^ Infusion of Senna I ounce. Make a cathartic draught, t Persons inclined to apoplexy derive great benefit from cupping. This operatioc «.*»ould never be omitted once or twice a-year. Ed. 300 WANT OF APPETITE. that which is made of fine flour. The best bread for keeping the body soluble is what in some parts of England they call meslin. It is made of a mixture of wheat auJ rye, and is very agreeable to those who are accustomed to it. Costiveness is increased by keeping the body too warm, and by every thing that promotes the perspiration ; as wearing flannel, lying too long in bed, «&c. Intense thouglit and sedentary life are likewise hurtful. All the secretions and excretions are promoted by moderate exercise without doors, and by a gay, cheerful, sprightly temper of mind. The di'ink should be of an opening quality. All ardent spirits, austere and astringent wines, as port, claret, &c. ought to be avoided. Malt-liquor that is fine, and of a moderate strength, is very proper. Buttermilk, whey, and other watery liquors are proper, and may be drank in turns, as the patient's inclination directs. Those who are troubled with costiveness, ought, if possible, to remedy it by diet, as the constant use of medicines for that pur- pose is attended with many inconveniencies, and often with bad consequences.* I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it ofi". In time the custom becomes necessary, and generally ends in a total relaxation of the bowels, indigestion, loss of appetite, wasting of tSie strength, and death. When the body cannot be kept open without medicine, we would recommend gentle doses of rhubarb to be taken twice or thrice a- week. This is not so near injurious to the stomach as aloes, jal- ap, or the other drastic purgatives so much in use. Infusions of senna and manna may likewise he taken, or half an ounce of solu- ble tartar dissolved in water-gruel. About the size of a nutmeg of lenitive electuary taken twice or thrice a-day generally answers the purpose very well. See Diseases of Child-bed Women. Want of appetite. [Anorexia.) This may proceed from a foul stomach ; indigestion ; the want of free air and exercise ; grief, fear, anxiety, or any of the de- pressing passions ; excessive heat ; the use of strong broths, fat meats, or any thing that palls the appetite, or is hard of digestion ; tlte immoderate use of strong liquors, tea, tobacco, opium, &c. 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 * The learned Dr. Arbuthnot advises those who are troubled with costiveness to use animal oils, as fresh butler, cream, marrow, fat broths, especially those made of the internal parts of animals, as th^ liver, heart, midriff, &c. He likewise recommends the expressed oils of mild ve.getables, as olives, almonds, pistachios, and the fruits themselves; all oily and mild fruits, as figs ; decoctiofis of mealy vegetables: these lubricate the utestines; some saponaceous substances which stimulate gently, aa hoi.ey, hydromel, or boiled honey and water, unrefined sugar, &c. The doctor observes, that such lenitive substances are proper for persons of dry atrabilarir.n constitutions, who are subject to astriction of the belly, and the piles, and will operate when stronger medicinal substances are sometimes inefiectunl ; 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, snd butter-milk, have that effect: ^hat new milk, especially asses' milk, stimulates still aiore when it sours on the stomach ; and that whey turned sour will punje strongly. HEART-BURK 301 betimes ; and to avo^d all intense thought. He should use a diet of easy digestion ; and should avoid excessive heat and great fatigue. If want of appetite proceed from errors in diet, or any other part of the patient's regimen, it ought to be changed. If nausea and retchings show that the stomach is loaded with crudities, a vomit will be of service. After this a gentle purge or two of rhu- barb, or any of the bitter purging salts, may be taken. The pa- tient ought next to use some of the stomachic bitters infused in wine. Thougli gentle evacuations be necessary, yet strong purges and vomits are to be avoided, as they weaken the stomach, and hurt digestion. After proper evacuations, bitter elixirs and tinc- tures with aromatics may be used. Sulphuric acid is an excellent medicine in most cases of indiges- tion, weakness of the stomach, or want of appetite. From twentv 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 witli the tincture of the bark, one drachm of the former to an ounce of the latter, and two tea-spoonsful of it taken in wine and water, as above. The chalybeate waters, if drank in moderation, are generally of considerable service in this case. The salt water has likewise good effects ; but it must not be used too freely. The waters of Harrovvgate, Scarborough, Moffat, and most other spas in Britain, may be used with advantage. We would advise all who are af- flicted with indigestion and want of appetite, to repair to those places of public rendezvous. The very change of air and the cheerful company, will be of service; not to mention the exercise, dissipation, amusements, &c. A want of appetite and loathing of food is not usually an original affection, but prevails as a symptom of some other disease, such as indigestion, and is therefore to be obviated by aromatics, bit- ters, bark joined with chalybeates, sulphuric acid, &c., as under that head. In spontaneous anorexy or loss of appetite, where the stomach is loaded with bile, an emetic in the evening, with some kind of stomach purgative next morning, will seldom fail to effect a cure. — See Indigestion. Heart-Burx. ( Cardialgia.) What is commonly called the heart-b2ir?i is not a disease of that organ, but an uneasy sensation of heat or acrimony about the pit of the stomach, which is sometimes attended with anxiety, nausea, and vomiting. It may proceed from debility 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, windy or greasy aliments, and should never use violent exercise soon after a plentiful meal. I know many persons who never fail to have the heart-burn if they ride soon after dinner, provided they have drank ale, wine, or any fermented liquor ; but are never troubled with it when they have drank rum or brandy and water without any sugar or acid. When the heart-burn proceeds from a debility of the stomach, or indigestion, the patient ought to take a dose or two of rhubarb; afterwards he may use infusions of the Peruvian bark, or any oth- 302 HEART-BURN. er of the stomachic bitters, in wine or brandy. Drinking a cup oi camomile tea, with fifteen or twenty drops of ehxir of vitriol in it twice or thrice a day, will strengthen the stomach and promote di ^estion. Exercise in the open air will likewise be of use. When bilious humours occasion the heart-burn, a tea-spoonfui of the sweet spirits of nitre in a glass of water, or a cup of tea, will generally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken. If acidity or sourness of the stomach occasions the heart-burn, absorbents are the proper medicines. In this case an ounce of powdered chalk, half an ounce of fine sugar, and a quarter of an ounce of gum arabic, may be mixed in an English quart of water, and a tea-cupful of it taken as often as is necessary. Such as do not choose chalk, may take a tea-spoonful of prepared oyster shells, or of the powder called crabs eyes, in a glass of cinnamon or pep- permint water. But the safest and best absorbent is magnesia alba. This not only acts as an absorbent, hue likewise as a purgative ; Avhereas chalk, and other absorbents of that kind, are apt to lie in the intestines, and occasion obstructions. This powder is not dis- agreeable, and may be taken in a cup of tea, or a glass of mint water. A large tea-spoonful is the usual dose ; but it may be tak- en in a much greater quantity when there is occasion. These things are now generally made up into lozenges for the convenieri.- cy of being carried in the pocket, and taken at pleasure.* If wind be the cause of this complaint, the most proper medi- cines are those called carminatives; as aniseeds, juniper berries, ginger, canella alba, cardamom seeds, &c. These may either be chewed, or infused in wine, brandy, or other spirits ; but these ought never to be used, unless they are absolutely necessary, as they are only drams in a dry form, and very jiernicious to the stomach. 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 pregnant women, by chewing green tea. Two table-spoonsful of what is called the milk of gum ammoniac, taken once or twice a-day, will sometimes cure the heart-burn. See Diseases of Preg- nancy. As pregnant women are very subject to this uneasy sensation, they should first consider, whether it proceeds from any of the causes already explained ; in which case the medicines prescribed under each head will probably remove it. But if the internal sense of heat be owing to the hcate of pregnancy itself; if it arises from the consent between the stomach and the womb, and is not accom- panied with much spitting or any acid eructations, the white of an egg, mixed with a little sugar and water, will often affi)rd the only relief that can be expected for some time. * The heart-burn, if very troi>blesome, may be almost immediately removecj, by taking fifteen or twenty drops of the purified soap lees, the aqua kali puri o*" the sb""*- in a cup of linseed tea. or of milk A, ? NERVOUS DISEASES. 303 Nervous Diseases. (Neuroses.) Of till diseases incident to nriankind, those of the nervous kind are the most complicated and difficult to cure. A volunje would not be sufficient to point out their various apjiearances. They imitate almost every disease ; and are seldom alike in two different persons, or even the same person at different times. Proteus- like, they are continually clianginjr shape : and upon every fresh attack, the patient thinks he feels symptoms which he never expe- rienced before. Nor do they only affect the body ; the mind like- wise suffers, and is often thereby rendered extremely weak and peevish. The low spirits, timorousness, molancholy, and fickle- ness of temper, which generally attend nervous disorders, indu-ce many to believe that they are entirely diseases of the mind ; but this change of temper is rather a consequence, than the cause of nervous diseases. Causes. — Every thing that tends to relax or weaken the body, disposes it to nervous diseases, as indolence, excessive ver.ery, drinking too much tea, or other weak watery liquors v/arm, fre- quent bleeding, purging, vomiting, &c. Whatever hurts the diges- tion, or prevents the proper assimilation of the food, has likewise this effect ; as long fasting, excess in eating or drinking, the use of windy, crude, or unwholesome aliments, an unfavourable posture of the body, toms of madness. It may likewise proceed from the use of aliment that is hard of digestion, or which cannot be easily assimilated ; from a callous state of the integuments of the brain, or a dryness of tlie brain itself. To all which we may add gloomy and mistaken no- tions of religion. Symptoms. — When persons begin to be melancholy, they are dull ; dejected ; timorous ; watchful ; fond of solitude ; fretful ; fickle ; captious and inquisitive ; solicitous about trifles ; some- times niggardly, and at other times prodigal. The body is gener- hlly bound ; the urine thin and in small quantity ; the stomach and * Few days have passed for a considerable time, that I have not had occasion to rec- ommend the following tincture to some of my nervous patients, and I have seldom been disappointed with regard to its effects: — Take of compound tincture of the bark and volatile tincture of valerian each an ounce; mix them; take a tea-spoonfii^ in a glass of wine or water three or four times a-dav MELANCHOLY. 307 bowels inflated with wind ; the complexion pale ; the pulse slow and weak. The functicns of the mind are also greatly perverted, insomuch that the patient often imagines himself dead, or changed into some other animal. Some have imagined their hodies were made of glass, or other hrittle substances, and were 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 tc his own miserable life. When the disease is owing to any obstruction of customary evac- uations, or any bodily disorder, it is easier cured than when it pro- ceeds from affections of the mind, or an hereditary taint. A dis- charge of blood from the nose, looseness, scabby eruptions, the bleeding piles, or the menses, sometimes carry off this disease. RcGTMEN. — 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. Aliments prepared with onions, garlic, or any thing that generates thick blood, are likewise improper. All kinds of fruits that are wholesome may be eaten with advantage. Boerhaave gives an instance of a patient who, by a long use of whey, water, and garden-fruit, recovered, after 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 \ery small beer. Tea and coffee are improper. If honey agrees with the patient, it may be eaten freely, or his drink may be sweetened with it. Lifusions of balm-leaves, penny-royal, the roots of wild valerian, or the flow- ers of the lime-tree, may be dran'.c freely, either by themselves, or sweetened with honey, as the patient shall choose. The patient ought to take as much exercise in the open air as he can bear. This helps to dissolve viscid humours, it removes ob- structions, promotes perspiration, and all the other secretions. Eve- ry kind of madness is attended with a diminished perspiration ; all means ought therefore to be used to promote that necessary and salutary discharge. Nothing can have a more direct tendency to increase the disease, than confining the patient to a close apart- ment. Were he forced to ride or walk a certain number of miles every day, it Avould tend greatly to alleviate his disorder ; but it rt-uuld have still a better effect, if he were obliged to labour a piece 'j\ ground. By digging, hoeing, planting, sowing, «fec. both the body and mind would be exercised. A long journey, or a voyage, especially towards a warmer climate, with agreeable companions, has 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 with medicines. Medicine. — In the cure of this disease, particular attention must be paid to the inind. When the patient is in a low state, his mind ought to be soothed and diverted with variety of amusements, as entertaining stories, pastimes, music, &.c. This seems to have been the method of curing melancholy among th-e Jews, as we learn from the stcry of King Saul : and, indeed, it is a very rational 308 MELANCHOLY. one. Nothing can remove diseases of the mi:id so effectually as applications to the mind itself, the mo=t efficacious of wliicii is musiatients is such as makes it improper to give them warm medicines inwardly, the Doctor recommends external applications, which are sometimes of advantage. Equal parts of the anti-hysteric and stomach-j»laster 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, provid- ed the patient be able to bear it; if it should give great uneasiness, it may be taken off, and the following liniment used in its stead : — Take of Bate's anodyne balsam an ounce ; of the expressed oil of mace half an ounce; oil of mint two drachms. Let these in- gredients be mixed together, and about a table-spoonful well rul> bed on the parts at bed-time. For strengthening the stomach and bowels, and consequently for lessening the production of flatulence, the Doctor recommends the Peruvian bark, bitters, chalybeates, and exercise. In flatulent ca- ses, he thinks some nutmeg or ginger should be added to the tinct- ure of the bark and bitters, and that the aromatic powder should be joined with the filings of iron. When windy complaints are attended with costiveness, which is often the case, few things will be found to answer better than four or five of the following pills taken every night at bedtime : — Take of asafoetida two drachms ; succotrine aloes, salt of iron, and powdered ginger, of each one drachm ; and as much of the dixi7- proprietatis as will be sufficient to form them into pills. On the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm, or two scruples of the Jap- onic confection, given every other evening, will have very g-ood effect. In those flatulent complaints which come on about the time the menses cease, repeated small bleedings often give more relief than any other remedy. With regard to diet, the Doctor observes, that tea, and likewise all flatulent aliments, are to be avoided ; and that for drink, water with a little brandy or rum is not only preferable to malt liquor, but in most cases also to wine. As Dr. Whyte has paid great attention to this subject, and as his sentiments upon it in a great measure agree with mine, I have taken the liberty to adopt them ; and shall only add to his observa- tions, that exercise is in my opinion superior to all medicines, both for preventing the production, and likewise for expelling of flatu- lencies. These effects, however, are not to be expected from saun- tering about, or lolling in a carriage ; but from labour, or such ac tive amusements as give exercise to every part of the body. Low Spirits. (Hypochondriasis.) This disease, known also by the name of the vapours, is a cei * Though the patient may begin with this quantity, it will be necessary to in rease the dose gradually as the stomach can bear it. ^ther is now given in considsrahly greater doses than it was in Dr. Whyte's time. 31 M22 HYSTERIC AFFECTIONS. tain state of the mind accompanied Avith dyspepsy, in which the greatest evils are apprehended upon the slightest grounds, and the worst consequences imagined from any unusual feehng even of a trifling kind ; and as regards these apprehensions and feelings, there is always the most obstinfite belief and persuasion. All who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise, and amuse- ments, are the most likely means to remove this complaint. It it- greatly increased by solitude and indulging gloomy ideas, but may often be relieved by cheerful company and sprightly amusements. When low spirits are owing to a weak relaxed state of the stomach and bowels, an infusion of the Peruvian bark with cinna- mon or nutmeg will be proper. Steel joined with aromatics may likewise in this case be used with advantage ; but riding, and a proper diet, are most to be depended on. — When they arise from a foulness of the stomach and intestines, or obstructions in the hypochondriac viscera, aloetic purges will be proper. I have sometimes known th^. Harrowgate or Tunbridge water of service in these cases. — When the disease proceeds 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 is- sues, setons, or the like. Dr. Whyte observes, that nothing has such sudden good eftects in this case as bleeding. — When it has been brought on by long-continued grief, anxiety, or other distress of mind, agreeable company, variety of amusements, and change of place, especially travelling into foreign countries, will afford the most certain relief. Persons afflicted with low spirits should avoid all kinds of ex- cess, especially of venery and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful ; but when taken to excess, they weaken the stomach, vitiate the humours, and depress the spirits. This caution is the more necessary, as the unfortunate and melancholy often fly to strong liquors for re- lief, by which means they never fail to precipitate their own de- struction. Besides the usual symptoms attendant on this disease, hypo- chondriacs are apt to be troubled with pain in the head and stom ach ; to relieve which it may be proper to give such medicines as 6Bther, musk,* and opium, either separately or conjointly. Hysteric Affections. These likewise belong to the numerous tribe of nervous diseases, which may justly be reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons an hysteric tit, as it is call * Take Mus.i mixture, 1^ ounce. Spirit of Sulphuric Ether, 1 drachm. Spirit of Sulphuric Ether, 30 drps. Tincture of Opium, Make a draught to be taken three times of Lavender, a-day. of each, 30 drops. or Make a mixture ; two table-spoonsfui 'I'ake Spirit of Caraway, \ ounce. three or four times ■i.-ia.y. (Camphor Mixture. b ounces. HYSTERIC AFFECTIONS. 3-2y ed, may be brought on by an irritation of thu nerves ^f the stom- ach or intestines, by wind, acrid humour, or the Hke. A sudden suppression of the menses often gives rise to hysteric fits. Thev may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments. — It appears under such various shapes, imitates so many other diseases, and is attended with such a variety of symptoms, that it is difficult to give a just character or definition of it; and it is only by taking the aggregate of its appearances that a proper idea can be convey- ed'of it to others. Sometimes the hysteric fit resembles a swoon or faintinBr fit, during which the patient lies as in a sleep, only the breathing is so low as scarcely to be perceived. At other times the patient is af- fected with catchings and strong convulsions. The symptoms which precede hysteric fits are likewise various in different per- sons. Sometimes the fits coine on with coldness of the extremi- ties, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting ; afterwards it rises into the *throat, and occasions a degree of suffocation, to which quick breath- ing, palpitation of the heart, giddiness of the head, dimness of the 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 hysteric lady. Our aim in the treatment of this disease must be to shorten the fit or paroxysm when present, and to prevent its return. The longer fits continue, and the more frequently they return, the dis- ease becomes the more obstinate. Their strength is increased by habit, and they induce so great a relaxation of the system, that it is with difficulty removed. It is customary, during the hysteric fit or paroxysm, to bleed the patient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper ; but in weak and delicate consti- tutions, or where the disease has been of long standing, or arises from inanition, it is not safe. The best course in such cases is to rouse the patient by strong smells, as burnt feathers, asafcetida, or spirits of hartshorn, held to the nose. Hot bricks may also be ap- plied to the soles of the feet, and the legs, arms, and belly, may be strongly rubbed with a warm cloth. But the best application '.s to put the feet and legs into warm water. This is peculiarly proper when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafcetida will be proper : and as soon as the patient can swallow, two table-spoonsful of a sola tion of asafcetida, or of some cordial julep, may be given fre quently.* * When hysteric fits are occasioned by sympathy, they may be cured by exciting an opposite passion. This is said to have been the case of a whole school of young ladies in Holland, who were all cured by being told, that the first who was seized should be burned to death. But this method of cure, to my knowledge, will not alway* lucceec' 324 HYSTERIC AFFECTIONS. The radical cure of this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly pro- moted byapioper attention to diet. A milk and vegetable diet, when duly pf^rsisted in, will often perform a cure. If, however, the patient has been accustomed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most prope? drink is water wi:h a small quantity of spirits. A cool dry air is the best. Cold bathing, and every thing that braces the nerves, and invigorates the system, is beneficial ; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the great- est importance to have the mind kept constantly 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 whole nervous system, as the preparations of iron, the Peruvian bark and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a-day. The bark and iron may likewise be taken in sub- stance, provided the stomach can bear them ; but they are gener- ally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder. , If the stomach is loaded with phlegm, vomits will be of use ; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there is a tendency to costiveness, it must be removed either by diet, or by taking an open- ing pill as often as it shall be found necessary. To lessen the irritability of the system, antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opi- um, and castor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is often suc- cessful in removing those periodical head-achs to which hysteric and hypochondriac patients are subject. Castor has in some cases been found to procure sleep where opiu-m failed ; for which reason Dr. Whyte advises, that they should be joined together. He like- wise recommends the anti-hysteric plaster to be applied to the ab- domen.* Hysteric women are often afflicted with cramps in various parts of the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphor, and the Avarm bath. Cramps are often prevented or cured by compression. Thna I would therefore advise, that young ladies who are subject to hysteric fits, should not be sent to boarding-cichools, as the disease may be caught by imitation. I have knowp madness itself brought on by sympathy. * Though antispasmodics and anodynes are universally recommended in this dis- ease, yet all the extraordinary cures that I ever knew in hysteric cases, were performed by means of tonic and corroborating medicines. HYPOCHONDRIAC AFFECTIONS. 325 cramps in the legs are prevented, and sometimes removed, by tight bandages ; and when convulsions arise from a flatulent distention of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong compression up- on the abdomen by means of a broad belt. A roll of brimstone held in the hand is frequently used as a remedy for cramps. Though this seems to owe its effect chiefly to imagination, yet, as it sometimes succeeds, it merits a trial.* When spasms or convul- sive motions arise from sharp humours in the stomach or intes- tines, no lasting relief can be procured till these are either cor- rected or expelled. The Peruvian bark has sometimes cured pe- riodic convulsions after other medicines had failed. Hypochondriac Affections. (Hi/jjochondriasis.) This disease generally attacks the indolent, the luxurious, the unfortunate, and the studious. It becomes daily more common in this country, owing, no doubt, to the increase of luxury and sed- entary employments. It has so near a resemblance to the imme- diately preceding, that many authors consider them as the same disease, and treat them accordingly. They require, however, u very different regimen; and the symptoms of the latter, though less violent, are more permanent than those of the former. Men of melancholy temperament, whose minds are capable of great attention, and whose passions are not easily moved, are, in the advanced periods of life, most liable to this disease. It is usu ally brought on by long and serious attention to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous eruptions, long continued evacuations, obstructions in some of the viscera, as the liver spleen, «fcc. Hypochondriac persons ought never to fast long, and their food should be solid and nourishing. All acescent and v/indy vegeta- bles are to be avoided. Flesh-meats agree best with them, and their drink should be old claret or good madeira. Should these disagree with the stomach, water with a little brandy or rum in it may be drank. Cheerfulness and serenity of mind are by all means to be cul- tivated. Exercise of every kind is useful. The cold bath is like- wise beneficial ; and, where it does not agree with the patient, fric- tions with the flesh-brush or a coarse cloth may be tried. If the patient has it in his power, he ought to travel either by sea or land. A voyage or a long journey, especially towards a warmer climate, will be of more service than any medicine. The general intentions of cure in this disease, are to strengthen the alimentary canal, and to promote the secretions. These in- tentions will be best answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations, may be taken in the same manner as directed in the preceding disease If the patient be costive, it will be necessary to make use of some gentle opening medicine, as pills composed of equal parts of aloes, rhubarb, and asafoetida, with as much of the elixir propri- * Some persons afflicted with cramps pretend to reap great benefit from small bun dies of rosemarv tied all night about their feet, ancles, and knees. [526 HYPOCHONDRIAC AFFECTIONS. etatis as is necessary to form the ingredients into pills. Two three, or four of these may be taken as often as it shall he found needful to keep the body gently open. Such as cannot bear the asafoetida 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 depresses the spirits, are likewise pernicious. Though the general symptoms and treatment of nervous disor- ders were pointed out in the beginning of this chapter, yet, for the benefit of the unhappy persons afflicted with those obstinate and complicated maladies, I have treated several of their capital symp- toms under distinct or separate heads. These, however, are not to be considered as different diseases, but as various modifications of the same disease. They all arise from the same general caus- es, and require nearly the same method of treatment. There are many other symptoms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I shall therefore omit them altogether, and conclude this chapter with a few general remarks on the most obvious means of prevent- ing or avoiding nervous disorders. In all persons afflicted with nervous disorders, there is a great delicacy and sensibility of the whole system, and an uncommon degree of weakness of the organs of digestion. These may be ei- ther natural or acquired. When owing to a defect in the consti- tution, they are hardly to be removed ; but may be mitigated by proper care. When induced by diseases, as long or repeated fe- vers, profuse haemorrhages, or the like, they prove also very ob- stinate, and will j-ield only to a course of regimen calculated to restore and invigorate the habit. But nervous affections arise more frequently from causes, which it is in a great measure in our own power to avoid, than from dis- eases, or an original fault in the constitution, &c. Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases. It has been already observed, that grief indulged destroys the appetite and digestion, depresses the spirits, and induces an uni- versal relaxation and debility of the \<^hole system. Instances of this are daily to be seen. The loss of a near relation, or any other misfortune in life, is often sufficient to occasion the most compli- cated series of nervous symptoms. Such misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and prop- er exertion of the mind, might be rendered less hurtful. For di- rections in this matter we must refer the reader to the article Grief, in the chapter on the Passions. The effects of intense study are pretty similar to those occasion- ed by grief. It preys upon the animal spirits, and destroys the ap- petite and digestion. To prevent these effects, studious persons ought, according to the Poet, to toy toith their books.* They should never study too long at a time ; nor attend long to one partic ular subject, especially if it be of a serious nature. They ougl)l likewise to be attentive to their posture, and should take care fre * Armstrong on Health. HYPOCHONDRIAC AFFECTIONS. 327 quently to unbend their minds by music, diversions, or going intc ngreeable company. With regard to diet, I shall only observe, that nervous diseases may be induced either by excess or inanition. Both of these ex- tremes liurt the digestion, and vitiate the humours. When nature IS oppressed with fresh loads of food, before she has had time to digest and assimilate the former meal, her powers are weakened, and the vessels are filled with crude humours. On the other hand, when the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with wind, and tlie humours, for want of regular fresh supplies of wholesome chyle, are vitiated. These ex- tremes are, therefore, Avith equal care to be avoided. They both tend to induce a relaxation and debility of the nervous system, with all its dreadful train of consequences. But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is, that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labour or suffer diseases, surely no individual has any right to ex- pect an exemption from the general rule. Those, hovt^ever, who are willing to take exercise, but whose oc- cupations confine them to the house, and perhaps to an unfavoura- ble posture, really deserve our pity. We have in a former part of the book endeavoured to lay down rules for their conduct ; and shall only add, that where these cannot be complied with, their place may, in some measure, be supplied by the use of bracing and strengthening medicines, as the Peruvian bark, with other bitters ; the preparation of steel ; the elixir of vitriol, and such like. Among many remarkable cases of the nervous kind, which I have often met with, one very lately attracted my notice in a pe- culiar manner. It was written by the patient himself, a gentle- man of fortune and of liberal education; and it might be justly called a picture from nature, drawn with uncommon sensibility and force. The whole account being too long for insertion, the follow- ing extract may serve as a specimen of the writer's sufferings and descriptive talents : — " It is in vain," he says, " that I attempt to impress the Faculty with the real state of my sufferings. The symptoms of the disorders are not to be described, from their unu- sual pressure upon the mind ; nor can they be conceived, I believe, by any but those who have suffered under them. They may be said to constitute a phenomenon in the science of diseases. Since I know of no terms to express them in, or language to describe them by, I am obliged to content myself with denominating the disorder and its effects together a mental agonij, whose influence creates a real tedium vitcB. It attacks me sometimes when sitting, some- times when walking; and if I were not to throw myself on a bed during the violence of the paroxysm, I should certainly dash my self to pieces. This is accompanied with a lassitude, restlessness, and total incapacity of attending to any concerns in life." The same spirit animated every part of the aflfecting descrip- tion ; and the case was accompariied with a list of eleven eminent .32« HYPOCHONDRIAC AFFECTIONS. physicians, whom the patient had consulted at different times-, but whose names I suppress, as their prescriptions did him no good, and did them no honour. When the primary seat of the disease is in the mind, it is stooping to the lowti-icks of quackery to amuse a patient with false hopes of the efficacy of any medicine. The disappointment that follows aggravates every painful symptom, and makes the unhappy sufferer look forward to death as the only re- source. All I prescribe for him is travelling. I should also have willingly inserted here an account of some other nervous affections of an extraordinary nature, had not their length exceeded the limits I prescribed to myself in these supple- mentary observations. 'For this very prevalent and distressing class of complaints, there is not any remedy so much to be relied on as the habit of early rising, which necessarily implies that of retiring also at an early hour to rest. The energies of the nervous system become exhausted and worn out, by the impressions of external objects on the senses, as well as by the mental exertions which are perpetu- ally going on while we are awake. Sleep is the means appointed by Nature for the renovation of these wasted energies. On vi^aking from a state of sound sleep, we find ourselves, in the proper sense of the word, refreshed. Such refreshment, however, is chiefly to be expected from that sleep which takes place before midnight. After a certain hour of the evening, even the most healthy persons experience an increased quickness of the pulse. In feeble consti- tutions this nocturnal access of fever is still more strongly mark- ed ; and the repetition of it is the true cause of that worn, bagged appearance, by which the votaries, or rather the victims, of fashion may, in general, be distinguished. It is by no means advisable to curtail the natural time of sleep. The great Lord Mansfield, himself an early riser, and whose long-protracted life gives impor- tance to his opinion on any subject connected with the preservation of health, used to counsel his friends, as one of the best means of obtaining that blessinsr, " to cultivate sleep." But it must be the sound repose of temperance, which can only be found during the early hours of night, not the perturbed slumbers of the noon- day couch. Nothing, indeed, tends more to debilitate the consti- tution, and in an especial manner to aggravate every species of nervous complaint, than remaining in bed till a late hour of the morning. Could "the still small voice of reason" expect to be heard in opposition to the imperious mandates of fashion, the present cus- tom of taking the principal meal at so very late an hour of the day, might also be denounced as contributing not a little to produce diseases of the nerves. After the system has been exhausted by long fasting, the stomach is suddenly replenished with a quantity of rich food and, stimulating liquors, which the empty vessels ab- sorb with an eagerness far beyond their powers to assimilate. Of this, the immediate consequence is drowsiness, but if the flagging spirits be roused by the presence of company, or the free use of wine, the circulation is hurried ; the countenance becomes flushed, and a temporary exhilaration takes place, which must inevitably EYE. fJ2S» be compensated by an equivalent depression during some otiiei period of the natural day. Sleep is disturbed and interrupted, in consequence of the blood-vessels of the brain beinj^ irritated by the sudden influx of fresh chyle, by which they are distended ; and rendered, more particularly in the supine posture, liable to ruptuit. May we not venture, without being accused of entering too far into theoretical speculations, to attribute, in part at least, to these causes, the augmented frequency of apoplexy, and its melancholy sequel, palsy 1 The palpable increase of which complaints in this country of late years is a subject of serious alarm.' A. P. B. CHAP. XXXIZ. DISORDER OF THE SENSES. We do not mean to treat of the nature of our sensations, or to give a minute description of the various organs by which they are performed ; hut to point out some of the diseases to which these organs are more lial)le, and to show how they may be prevented or remedied. Of the Eye. No organ of tlie body is subject to more diseases than tlie eye ; nor is there any one of which the diseases are more difficult to cure. Though more ignorant persons pretend to cure these than any other class of diseases, yet a very superficial acquaintance witli the structure of the eye, and the nature of vision, will be sufficient to convince any one of the danger of trusting to them. Tliese dis- eases often exceed the skill of the most learned physician ; hence we may easily infer the danger of trusting them to ignorant quacks, who, without all peradventure, put out more eyes than they cure. But, though the diseases of the eye can seldom be cured, they might often, by due care, be prevented ; and, even where tlie sight is totally lost, many things might be done, which are generally neg- lected, to render the unhappy person both more useful to himself and to society.* The eyes are hurt by viewing bright or luminous objects ; keep- ing the head too long in a hanging posture; violent head-achs ; excessive venery ; the long use of bitters ; the effluvia from acrid or volatile substances ; various diseases, as the smallpox, measles, &c. ; but, above all, from night-watching, and candlelight-studies. Long fasting is likewise hurtful to the eyes, and frequent heats and colds are no less pernicious. The eyes are often hurt by the stop- page of customary evacuations ; as morning sweats ; sweating of the feet ; the menses in women ; and the bleeding piles in men, "There are many employments of which blind persons are very capable, as knitting, cardin certaicly merits a trial. A. P. R. 343 POISONS CHA.P. XXXIV. POISONS. Every person ought, in some measure, to be acquainted with the nature and treatment of poisons. They are not unfrequently taken unawares, and their effects are often so sudden and violent, as not to admit of delay, or allow time to procure the assistance of medi- cal men. There are four kinds of poisons; viz. mineral, vegetable, aerial, and animal. Mineral poisons are distinguished from vegetable ones by their action. The former corrode, stimulate, and inflame ; the latter generally stupify, without leaving any marks of inflammation. None of the mineral poisons prove fatal, till after a most excru- ciating operation of at least two or three hours; whereas some of the vegetable ones terminate life in a few minutes. From the ani- nial poisons the distinction is as remarkable. The aerial poisons operate still more quickly than any other classes, and their action on respiration is of so peculiar and immediate influence, that it can seldom be mistaken. Poison seldom remains long in the stomach before it occasions sickness, with an inclination to vomit. This shows plainly what ought to be done. Indeed, common sense dictates to every one, that if any thing has been taken into the stomach which endangers life, it ought immediately to be discharged. Were this duly regarded, the danger arising from poisons might often be avoided. MINERAL POISONS. These consist of corrosive metallic salts; e g. Arsenic and its preparations; Corrosive Sublimatp, &c. Symptoms. — When a medical poison has been swallowed,* the symptoms are an austere taste, fetid breath, constriction of the pharynx and gullet; hiccup; nausea and vomiting of brown or bloody matter; anxiety and faintings; heat with violent pain at the pit of the stomach; black and offensive stools; small pulse; frequent and irregular palpitations; great thirst and burning heat; breathing difliicult ; urine scanty, red and bloody ; delirium : convulsions of an epileptic type, and death. Treatment. — Vomiting to be immediately excited; and encour- aged by large and l«ng-continued draughts of sugared water, lin- seed tea, or other emollient fluids. If arsenic has been taken in solution, lime-water, or chalk and water, may be drank freely. Inflammatory symptoms are to be combated ; bleeding from the arm, and leeches to the region of the stomach ; fomentations, fre- quent emollient clysters, as symptoms may require. * In the Ptiilosophical Transactioi^s for 1811, Mr. Brodie has shown by experimentg that the external application of arsenious acid to abraded surfaces, is analogous witl its internal exhibition, but often more rapid in its effects by the latter than the forma mode. Ei<. POISONS. Sin For arsenic no specific antidote is yet known. Fat, oil, vinegar charcoal povvder, lime of sulphur, and vegetable decoctions, which have been recommended, are not to be relied on. Tests. — To ascertain when arsenic is present in any fluid, a solu- tion of the ainmoniacal sulphate of copper added to it, produces, generally, a beautiful grass green precipitate ; but if added to wine, the precipitate would be a dark-coloured blue. Sulphureted hydro- gen precipitates arsenic from tea of a beautiful yellow colour, and changes a solution of arsenic in water of a yellow colour, with- out any precipitate. From albumen, gelatine and bile, contain- ing arsenic in solution, nitrate of silver produces a white pre- cipitate. The ammoniaco-nitrate of silver produces a yellow pre- cipitate, soluble in nitric acid and ammonia ; but the presence of muriates or piiosphates, or their acids, renders this a fallacious test. Make with the suspected fluid a broad streak on writing paper, then draw a piece of lunar caustic several times over the moisten- ed part, which will become yellow if arsenic or alkaline phosphate be present. If it be arsenic, the streak will be rough, curdy, and flocculent, as if done with a crayon ; if a phosphate, homogeneous and uniform. In a few minutes the phosphoric yellow fades into a dull green, becomes darker, and ultimately black. The arsen- ical yellow remains permanent, or nearly so, for some time, when it becomes brown. These distinctions are to be viewed by reflect- ed, not transmitted light, the test being made in the shade. The most certain test to detect the presence of arsenic, is to re- duce it to its metallic state, by calcining the dried suspected mat- ter in a glass tube, with equal parts of charcoal and potash ; when, if arsenic be present, in however minute a quantity, it will be sub- limed and stick to the inside of the tube, in the form of a shining metallic coating, consisting of cubic crystals. Antimony, and its Preparations. Emetic Tartar, &c. — When an excess of emetic tartar, or any other of the preparations of antimony have been taken, we may remark the following Symptoms, viz. Those occasioned by acids, with copious and obstinate vomitings, abundant stools, constrictions of the throat, cramps, symptoms of intoxication, and prostration of strength. Treatment. — Emetic tartar generally defeats itself by the vomit- ing it soon occasions after it is taken ; but when this does net take place, it should be excited by tickling the throat with a feather or th'j finger ; and encouraged by copious draughts of mild fluids ; or when too severe, to be allayed by opium according to the effects previously produced by the poison. The best antidotes are, decoction of astringent vegetables, such as oak or willow bark, gall nuts, strong green tea, &c., which should be given freely for the purpose of diluting and decomposing the poison. Tests. — Sulphureted hydrogen, and the hydrosulphurets, precip- itate tartarized antimony from its solution of an orange or deep brownish red colour ; white, by sulphuric acid, alkalies, barytes or Ui POISONS. lime water. Alkaline and earthy neutral salts do not affect it ; but salts with excess of acid do. Infusion of gall, occasions a copicia whitish-yellow precipitate. The muriate of antimony is a dark, heavy flujd, to which, if water he added, a white precipitate is formed. The oxide i.o soluble in muriatic acid, by which the muri- ate is formed. *^* All the preparations of antimony are readily reduced to the metallic state by calcination with charcoal and potash. Copper, and its Preparations. (Sulphate of copper, or blue vit- riol; subacctate of copper, or verdigrise. Food cooked in foul copper vessels, and pickles made green by copper.) Symptoms. — Acrid and coppery taste ; tongue parched and dry ; constriction of the throat and coppery eructations ; severe vomit- ings, or fruitless efforts to vomit ; dragging at the stomach ; dread- ful colic ; frequent black bloody stools with tenesmus : abdomen distended; pulse small, hard, and quick; syncope; great thirst and anxiety ; cold sweats, scanty urine ; pain in the head, vertigo, cramps, convulsions, and death. Treatment. — Large draughts of milk and water to encourage vomiting. Whites of eggs stirred up with water, and taken freely. Inflammation to be attacked as a general principle, and the ner- vous symptoms by anodynes and antispasmodics. Sugar, as first promulgated by Orfila, is not a specific, but it may be given ad- vantageou.'^ly with coffee. Tests. — The salt,* of copper are mostly of a bright green or blue colour, and are easily reduced to their metallic state by means of charcoal, at an elevated temperature. The sulphate of copper is partly decomposed by a'kalies and alkaline earths. Potash pre- cipitates a subsulphate of a green colour from it. If the salts of copper be dissolved in coffee, port wine, or mail liquors, whicli partly decompose them, they may be detected by adding a spirituous tincture of guaiacum, which will throw down precipitate varying in shade from a greenish indigo to that of a pale green. Ammonia added to a solution of any cupreous salt, gives a blue or gr3enish precipitate, according to the quantity ; but, if added in excess, it re-dissolves the precipitate, and forms a ■deep blue transparent solution. Lead and its Preparations ; or fluids adulterated with lead. Symptoms. — When lead has been taken in large quantity, a su- ;gary astringent metallic taste is felt in the mouth ; constriction of the throat ; pain in the region of the stomach ; obstinate, painful, and often bloody vomiting hiccup ; convulsions and death. When taken in small long-continued doses, it produces Devon- shire colic (colica pictonum,) and paralytic symptoms. Treatment. — See Alkaline Earths. — In addition to which, if synjp- ■toras suggest it, bleeding must be used ; in conjunction with castor oil with or without opium, assisted by frequent emollient clysters to clean out the bowels. The warm bath, «fcc. Tests. — All the preparations of lead are easily reduced to tlieil •metallic state by calcination with charcoal. POISONS. U45 The superacetate of lead (sugar of lead) dissolved in vvalcr is precipitated white by means of sulphuric acid; of a canary cohjur hv chromate of potash and chromic acid ; both of which are easily reduced by calcination. The alkaline sulphurets precipitate the superacetate of lead of a blackish colour. Mercury, and its Preparations; e. g. Oxymnriate of mercury, or corrosive sublimate ; nitric oxide of mercury, or red precipitate ; sulphuret of mercury, or vermilion. Symptoms. — Acrid metallic taste, thirst, fulness and burning at the throat ; anxiety, teasing pains of the stomach and bowels ; nausea and vomiting of various coloured fluid, sometimes bloody ; diarrhoea and dysuria, or Jifficulty of making water. Pulse quick, small, and hard : faintings, great debility, difficult breathing, cramp, cold sweats, insensibility, death. Treatment. — Whites of eggs decompose corrosive sublimate. One mixed with water may be given every two or three minutes to promote vomiting, and to lessen the virulence of the poison ; inilk in large quantities, gum-water, or linseed-tea, sugar and wa- ter, or water itself at about 80°. Gluten, as it exists in wheat- flour, also decomposes sublimate, and should be given mixed wiih water. Inflammation to be anticipated, and treated by the usual remedies. Tests. — Mercurial preparations heated to redness in a glass tube with potash, are decomposed ; the quicksilver being volatilized. The oxymuriate or sublimate is precipitated white by ammonia ; yellow by potash ; and of an orange colour by lime-water. By ni- trate of tin, a copious dark brown precipitate is formed; and by albumen mixed with cold water, a flocctilent one. The red and nitric oxides may be dissolved in muriatic acid and converted into sublimate. Vermilion is insoluble in water or muriatic acid ; but is entirelv volatilized by heat. Silver, Nitrate of. ( Lunar caustic, j Symptoms similar to those occasioned by other corrosive poisons. Treatment. — A table-spoonful of the muriate of soda [common salt) dissolved in a pint of water, and a wine-glassful to be taken every two minutes, to decompose the poison ; after which mucila- ginous drenches or purgatives may be administered. Tests. — Nitrate of silver is precipitated white by muriate of soda; yellow by phosphate and chromate of soda. If placed on burning coals, it animates them, leaving a coating of silver; cal- cined with charcoal and potash, the silver is reduced to its metal- lic state. Zinc, Sulphate or Oxyd of. Symptoms. — A sour taste, sense of choking, nausea, vomiting, pain in the stomach, frequent stools, difficult breathing, quickened pulse, face pale, cold extremities, but seldom death from the emetic qualities of the poison. 346 POISONS. Treatment. — Vomiting is rendered easy by copious draughts of warm water, and particular symptoms to be opposed by appropri ate remedies. Tests. — Pure sulphate of zinc is precipitated white by potash and ammonia; yellowish white, by the alkaline hydrosulphurets ; and of an orange colour by the chromate of lead. — The oxide is readily reduced by calcination with charcoal and nitre, ACIDS : e. g. Sulphuric acid, or oil of vitriol. Nitric acid., or aquafortis. Bluriatic acid, or spirit of salt. Oxalic acid, or acid of sugar. Phosphoric, Fluoric, Tartaric, Prussic. General symptoms. — Acid burning taste in the mouth, acute pain in the throat, stomach, and bowels, frequent vomiting of bloody fluid, which effervesces with chalk, or alkaline carbonates, and reddens litmus paper ; hiccup ; copious stools, more or less bloody ; tenderness of tlie abdomen ; difficult breathing; irregular pulse ; excessive thirst; drink increasing the pain, and seldom staying down ; frequent but vain efforts to make water ; cold sweats ; al- tered countenance ; convulsions ; death. Treatment. — Mix an ounce of calcined magnesia with a quart of water, and give a wine-glassful every two minutes. Soap-suds or chalk and water may be used till magnesia be procured. Vom- iting to be excited by tickling the throat with a feather. Diluents to be taken after the poison is neutralized or ejected. Inflamma- tions and other consequences to be treated in the ordinary way. If the sulphuric acid, vulgarly called the oil of vitriol, has been swallowed, water alone should not be given, nor should calcined magnesia with water be given : but the common carbonate of mag- nesia maybe given freely when mixed with water. If these pre- cautions be not observed there is too much heat generated in the stomach. If oxalic acid has been taken, chalk and water is preferable to magnesia. If Prussic acid* has been taken, emetics are to be administered with as little delay as possible, and after their operation, oil of tur- pentine, ammonia, brandy, and other stimulants capable of rousing the system, should be perseveringly employed, with warmth, fric- tion, and blisters. Tests. — Sulphuric acid is known by its great weight, by its evolv- ing heat when mixed with water; by emitting no fumes. If ba- rytes be added to it, a sulphate is formed, (sulphate of barytas, • which is insoluble in water or nitric acid. Nitric acid emits orange-coloured fumes upon adding copper tc it, by which it is changed blue. If potash be added to it, a nitrate is formed (nitrate of potash) which deflagrates when thrown on burning coals. It tinges the skin yellow. Muriatic acid emits pungent fumes. If nitrate of silver be added to it, a very white precipitate is formed of muriate of silver, solu- ble in ammonia, but not in nitric acid. Oxalic acid precipitates lime and all its salts from water; the * Prussic acid is the most violent of poisons, producing almost instant death wh"' applied even in small quantities to the surface of the body. Ep. POISONS. 347 {irecipitate being soluble in nitric, but not iu an excess of oxalic acid. Exposed to heat it volatilizes, leaving hut a little residue. It IS decomposed by sulphuric acid, becoming brown ; it is dissolv- ed by heat and nitric acid, and rendered yellow. Muriatic acid dissolves and decomposes it with heat. Oxalic acid also turns it lo a light-brown led. Phosphoric acid precipitates barytes and lime-water; the pre- cipitate being soluble in nitric acid. It is decomposed by char- coal at a high temperature, evolving carbonic acid, and phosphorus being sublimed. Fluoric acid exhales white vapours, not dissimilar to those of muriatic acid ; heat is evolved with a hissing noise when water is added to it : it dissolves glass. Tartaric acid produces a precipitate from lime-water, soluble in an excess of acid, and in nitric also ; with potash it forms a neu- tral and supersalt. It does not precipitate solution of silver, but its salts do. Prussic acid has a strong odour of bitter almonds, and is con- tained in that fruit, and in the leaves of the peach and the laurel ; it is soluble in alcohol, but hardly iu water, and is precipitated in its solution by nitrate of silver. ALKALIES. (Potash, Soda, Ammonia.) Symptoms. — The symptoms of having swallowed an alkali in ex- cess are, an acid, urinous and acrid taste in the mouth ; great heat in the throat, nausea and vomiting of bloody matter, which changes syrup of violets to green, and effervesces with acids, if the carbonated form of the acid has been taken ; copious stools ; acute pain of the stomach, colic, convulsions, death. Treatment. — Give vinegar and other vegetable acids largely, to neutralize the alkali ; and treat the concomitant symptoms upon general principles. Tests. — Alkalies have many properties in common ; their solu- tions feel soapy ; they change vegetable blues to green, and yel- low to brown ; remain transparent when carbonic acid is added to them, which serves to distinguish them from the alkaline earths, barytes, strontium, and lime. JNitrate of silver is precipitated by them in form of a dark coloured oxide, soluble in nitric acid. *^* Potash and soda may be distinguished from each other by evaporating their solutions to dryness ; potash will become moist by absorbing v.-ater from the atmosphere, while soda will remain dry. Ammonia is known by its pungent smell. ALKALINE EARTHS. (Lime, Barytes, Pure Barytes, Car- htmate and Muriate of.) Symptoms. Violent vomitings, convulsions, palsy of the limbs, distressing pains in the al)domen, hiccup, alteration of the counte- nance, and very early death. Treatment. — If lime has been taken, vinegar and other vegetable bcids are tiie best antidotes. If barytes, in any of its forms, has been swallowed, a weak so- lution of Epsom or Glauber's salt should be copiously drank, to 348 HYDROPHOBIA. produce vomiting; and, at the same time, to decompose the poi- son, which it renders inert, bj forming an insoluble sulphate. Till either of the above salts can be obtained, large draughts of water alone, or made slightly sour by sulphuric acid, may be freely drank. Tests. — Solution of lime changes vegetable blues to green, and is precipitated white by carbonic and oxalic acid, while no change is produced on it by sulphuric acid ; its salts are decomposed by the fixed alkalies, which precipitate the lime, but not the ammonia. Pure barytes undergoes similar changes to lime when water is added to it, and acts like it on vegetable colours. It does not effervesce with acids. vSulphuric acids, and all the sulphates ad- ded to a solution of it, produce a white precipitate, insoluble in water and nitric acid. Carbonate of barytes is insoluble in water, but dissolves in nitric and muriatic acid in a state of effervescence. Muriate of barytes dissolved in water, is not changed by pure am- monia, but its carbonates, as well as all other alkaline carbonates, throw down a white precipitate, which is carbonate of barytes. NITRE. (Salt-petre ; Nitras Potasscc.) Symptoms. — Cardialgia, nausea, painful vomiting, purging, con- vulsions, syncope, with feeble pulse, cold extremities, teasing pains of the slomach and bowels ; difficulty of breathing, a species of in- toxication, and often death. Treatment. — Similar to that of arsenic, only that lime is not to be used. HYDROPHOBIA. The disease is most frequent after long, dry, hot seasons; and such dogs as live upon putrid staking carrion, without having enough of fresh vvater, are most liable to it. When any person has been bit by a dog, the strictest enquiry ought to be made whether the animal was really mad. Many dis- agreeable consequences 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, instead 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 can ascertain whether he be mad or not. The poison of hydrophobia is generally communicated by a wound, which nevertheless heals as soon as a common wound. Symptoms. — At an uncertain interval after the bite, generally, however, between the twentieth day and three or four months, pain or uneasiness occurs in the bitten part, though the wound may have been long healed. Anxiety, languor, spasms, horror, disturbed sleep, difficult res- piration, succeed, and are soon very much increased ; violent con- vulsions affect the whole body, hideously distorting the muscles of the face ; the eyes are red and protruded ; the tongue swells, and HYDROPHOBIA. 349 often hangs out, and viscid saliva flows from the mouth ; there 13 pain in the stomach, with hilious vomitings, a horror of fhiids, and impossihilit)' of drinking them. All these symptoms are aggra- vated till the sufterer is relieved hy death. Treatment. — The common notion, that this poison may lie in the body for many years, and afterwards prove fatal, is both hurt- ful and ridiculous. It must render such persons as have had the misfortune to be bit very unhappy, and can have no good effects. If the person takes proper medicines for forty days after the time of his being bit, and feels no symptoms of the disease, there is rea- son to believe him out of danger. Some have indeed gone mad twelve months after being bit, but seldom later. It is now well known that hydrophobia is more easily prevented than cured ; in fine, it is very doubtful if ever it has been cured. Mercury, arsenic, opium, musk, camphor, acids, wine, vegetable and mineral alkali, oil, various herbs, and many other articles, whose effects are diametrically opposite, have been employed without benefit. Large blood-lettings, injecting water into the veins, warm and cold bath, in short, every thing that could possi- bly be suggested as a remedial agent, have been adopted with no better success. To ensure effectually the person bitten by a mad dog against the consequences, it is strongly recommended, immediately or as soon after the accident as possible, to have the bitten part com- pletely cut out ; after which bleeding should be promoted by warm fomentations, and a cupping-glass applied over the part, until it give evident marks of its exhausting power. On the removal of this glass the wound is to be washed frequently with a weak solu- tion of muriatic acid (forty drops to a pint of water,) and a piece of lint or rag, moistened in the same, left on the part, and renew- ed as it becomes dry. Should some degree of inflammation ensue, as most likely will be the case, the solution may then be laid aside, the wound dressed with dry lint, and a copious suppuration pro- moted by means of warm poultices, healing afterwards the wound in the usual way. During this treatment the patient must take two of the follow- ing pills at bed-time* every night, for three weeks or a month af- ter the accident. No other plan can ensure safety. After all that has been said, and the little confidence assigned to any practice but that of early cutting out or cauterizing the part, it is nevertheless always necessary that something should be done after the actual commencement of the symptoms of hydrophobia, and every practitioner should be prepared for the adoption of some mode of treatment or other. A modern writer observes, " that ex- perience authorizes the placing confidence in bleeding till the pa- tient faints; on vomiting; and, perhaps, on the use of the deadly nightshade ; and on tobacco exhibited as a clyster. Thaf it is probable advantage would result from the combined employment of bleeding and vomiting, and purging in the early stage of the dis- * Take Mercurial Pill, 1 drachm. Extract of Hemlock, 10 grains Powdered Rhubarb, 2 scruples. Make 20 pills, to be taken as above. '150 POISONOUS ANIMALS AND PLANTS. ease. That analogy recommends tho trial of the oil of turpentine in the convulsive stage of the disease; but unfortunately, when once ihe hydrophobic symptoms have commenced, there is little or no hope of saving the patient, the disease having almost invariably l)affled every plan of treatment which the united talents of nume- rous medical generations have suggested. All the most powerful means of every class have been tried over and over again ; happi- ly, however, surgery possesses tolerably certain means of prevent- ing hydrophobia, which ought not to be delayed after the accident, and that has been already mentioned, viz. that of cutting out ef- fectually the bitten parts. How late this operation may be per- formed with a prospect of utility, we are not at present prepared to say ; but there are practitioners who deem the practice right, even when heat, irritation, or inflammation is observed in the bitten part.* The next poisonous animal which we shall mention is the Vipek. The grease of this animal rubbed into the wound, is said to cure the bite. Though that is all the viper-catchers generally do when bit, we should not think it sufficient for the bite of an enraged vi- per. It would surely be more safe to have the wound well suck- ed,! and afterwards rubbed with warm salad-oil. A poultice of bread and milk, softened with salad-oil, should likewise be applied to the wound ; and the patient ought to drink freely of vinegar- whey, or water-gruel with vinegar in it, to make him sweat. Vin- egar is one of the best medicines which can be used in any kind of poison, and ought to be taken very liberally. If the patient be sick, he may take a vomit. 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 hor- net, &.C. ; 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 swelling. Some, for this purpose, apply hon- ey ; others lay pounded parsley to the part. A mixture of vinegar and Venice treacle is likewise recommended ; but I have found rubbing the part with warm salad-oil, or frequently repeated appli- cations of pledgets dipped in laudanum, succeed very well. In- deed, when the stings are so numerous as to endanger the patient's life, which is sometimes the case, he must not only have oily poul- tices, or pledgets moistened with laudanum applied to the part, but should likewise 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 ani- mals, and those which we have are by no means of the most viru- * See Medical Repository, vol. 3. p. 54. t The practice of sucking out poisons is very ancient; and indeed notliing can be more rational. Where the bite cannot be cut out, this is the most likely way for ex tracting the poison. There can be no danger in performing this office, 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 Psyili in Africa, and the Mam in Italy, were famed for curing the bites of poisonous animals, by suckins the wound fnd we are told, that the Indians in North America practice the same at this day. BITE OF THE RATTLESNAKE, «kc. 351 lent kind. Nine-tenths of the efFects attributed to poison or ven- om in tljis country, are really other diseases, and proceed from quite different causes. We cannot, however, make the same observation witli regard to poisonous vegetables. These abound everywhere, and prove often fatal to the ignorant and unwary. This indeed is chiefly owing lo carelessness. Children ought early to be cautioned against eating any kind of fruit, 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 propagated 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 destroy- ed in the neighbourhood of all towns and villages; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfsbane, and deadly-night- shade, all growing within the environs of a small town, where, though several persons, within the memory of those living in it, had lost their lives by one 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 expence. Seldom a year passes, but we have accounts of several persona poisoned by eating hemlock-roots instead of parsnips, or some kinds of fungus which they had gathered for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter 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 fungus from another, and take every thing for a mushroom which has that ap- pearance. We might here mention many other plants and animals of a poisonous nature, which are found in foreign countries ; but, as our observations are chiefly intended for this island, we shall pass them over. It may not, however, be amiss to observe, for the benefit of such of our countrymen as go to America, that an effec- tual remedy is now said to be found for the bite of the rattlesnake. The prescription is as follows : — Take of the herbs plantain and horehound, in summer, roots and branches together, a sufficient quantity : bruise 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 will cure ; but, if he finds no relief in an hour after, you may give another spoonful, which never fails. — If the roots are dried, they must he moistened with a little water. To the wound may be ap- plied a leaf of good tobacco moistened with rum. We give tliis upon the faith of Dr. Brookes, who says it was the invention of a negro ; for the discovery of which he had his free- dom purchased, and a hundred pounds j?cr annum settled upon him during 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 352 BLEEDING. 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 poisonous 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 medicines which promote the diflerent secretions, especially those of perspiration and urine ; to which may be added antispasmodics, or such medicines as take off tension and irritation ; the chief of which are opium, musk, camphor, and asafcetida. PART III. CHAP. I. OF SURGERY. To describe all the operations of surgery, and to point out thn 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 in which proper assistance is either not asked, or not always to be obtained. Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert sur- geon ; yet many things may be done to save the lives of their fel- low-men in emergencies by those who are not adepts in anatomy. It is amazing with what facility the peasants daily perform opera- tions upon brute animals, which are not of a less difficult nature than those performed on the human species ; yet they seldom fail of success. Indeed every man is in some measure a surgeon, whether he will or not. He feels an inclination to assist his fellow-men in dis- tress, accidents happen every hour, which give occasion to exer- cise this feeling. The feelings of the heart, however, when not di- rected by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him ; while an- other, for fear of doing amiss, stands still and sees his bosom- friend expire, without so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to know what ought to be done upon such emer- gencies. Bleeding. No operation of surgery is so frequently necessary as bleeding ; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, barbers, and tooth- drawers, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It v8, however, an operation of great importance, and must, when BLEEDING. 353 seasonably and properly performed, be of singular service to those in distress. Bleeding is sometimes proper at the beginning of inflammatory fevers, as pleurisies, pneumoiiies, etc. It is likewise proj)er in some topical inflammations, as those of the intestines, womb, bladder, stomach, kidneys, throat, eyes, etc., as also in the asthma in certain cases, head-aches, acute rheumatism, apoplexy, epilepsy, and bloody flux under certain states. After falls, blows, bruises, or any violent hurt received, either externally or internally, bleeding is sometimes necessary. It is sometimes necessary for persons who have been partially strangled, drowned, suffocated with foul air, the fumes of metal, or the like. In a word, when- ever the vital motions have been suddenly stopped fronj any cause whatever, except in swoonings occasioned by mere weakness or hysteric affections, it is often proper to open a vein. But in all disorders proceeding from relaxation of the solids, and an im- poverished state of the blood, as dropsies, cacochymies, etc., bleeding is improper. Bleeding for topical inflammations ought always to be perform- ed as near the part aft'ected as possible. When this can be done with a lancet, it is to be preferred to any other method ; but where a vein cannot be found, recourse must be had to leeches or cup- ping. The quantity of blood to be taken away must always be rei!;i)l;>- ted by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous ti» suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man. The mode of bleeding most frequently practised, is that of open- ing a vein ; and it may be done in the arm, ancle, jugular vein, frontal vein, veins under the tongue, and on the back of the hand, &-C. In whatever part, however, venesection is performed, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be ap- plied at least an inch, or an inch and a half from the place where the puncture is intended to be made. Thus, the return of the blood through the vein is stopped, the vein swells, becomes con- spicuous, and vt^hen opened, bleeds much more freely than would otherwise happen. Persons not skilled in anatomy ought never to bleed with the lancet 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 charac- ter of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridicu/ous rule could not be proposed. One person will faint at the very sight of a lancet, * Persons not skilled in anatomy ought never to bleed at all. The risk is greater than the benefit ; as the advantage to be derived from such a step must depend on practical knowledge. Ed. ?M BLEEDING. uhile another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body : besides it may often be occasioned or prevented by the manner in which the operation is performed. Children are generally bled with leeches. This, though some- times necessaiy, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches ; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practise bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine. Certain vulgar prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts whence they are sup- posed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will per- form wonders. Tliis belief makes them often postpone the oper- ation when necessary, in order to reserve it for some more impor- tant occasion, and, when they think themselves in extreme danger, ihey fly to it for relief, whether it be proper or not. Bleeding al certain stated periods or seasons has likewise bad eftects. It is a common notion that bleeding in the feet draws the hu- mours downwards, and consequently cures diseases of the head and other superior parts ; but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let. All the apparatus essential for blood-letting, on the part of the patient, is a bandage or fillet, two or more small pieces of folded linen for compresses, a bason to receive the blood, and a little clean water and a towel. The bandage ought to be about a yard in length, and near two inches broad, a common riband or garter being frequently employed. The compi esses are made by doub- ling a bit of linen rag about two inches square. On the part of the surgeon, it is necessary for him to have a good lancet, of prop- er shape : for if the shoulders of the lancet be too broad, it will not readily enter the vein, and when it does enter, it invariably makes a large opening, which is not always desirable. If the lan- cet be too spear-pointed, an incautious operator would often run a risk of transfixing the vein, and wounding the artery beneath it. More, however, depends on the mode of introducing the lancet than on its shape. During the operation of bleeding, the patient may lie down, sil down, or stand up, each of which positions may be chosen, as cir- cumstances may require. If the patient be apt to faint from the loss of a small quantity of blood, and such fainting can answer no INFLAMMATION AND ABSCESSES, &c. 3o5 surgical purpose, it is best to bleed bim in a recumbent posture. But vvben the person is strong and vigorous, there is bttle occasion for this precaution, and a sitting j)(>sture is to be preferred, as the most convenient, both for the surgcoii and patient. At the bend of the arm, there are several veins in which a punc- ture may be made, viz. the basilic, cephalic, median basilic, and median cephalic. The median basilic vein being usually tlio larg- est and most conspicuous, is that in which the operation is mostly performed ; but it should never be forgotten, that it is under this vessel that the brachial artery runs, with the mere intervention of the thin aponeurotic sheath, sent off by the biceps muscle. In ve- ry thin persons, indeed, the medial basilic vein lies almost close to the artery, and nothing is then more easy than to transfix the first of these vessels and wound the last. In fat subjects, the large veins at the bend of the arm are some- times totally imperceptible, notwithstanding the fillet is tightly ap- plied, the limb is put in warm water, and every thing done to make those vessels as turgid as possible. Under these circumstances, if the surgeon has not had much experience in the practice of vene- section, he will do well to be content with opening one of the veins of the back of the hand, after putting the member for sometime in warm water, and applying a ligature round the wrist. In children, a sutficient quantity of blood cannot always be ob- tained by venesection, and, in this event, the free application of leeches, and, occasionally, the j^uncture of the temporal artery, are the only effectual methods. One of the most common ill consequences of bleeding in the arm is a thrombus, or ecchymosis, that is, a small tumour around the orifice, and occasioned by the blood insinuating itself into the ad- joining cellular substance, at the time this fluid is escaping from the vein. Changing the posture of the arm will frequently hinder the thrombus from increasing in size, so as to obstruct the evacua- tion of blood. The best applications for promoting the absorption of these tumours, are those containing spirit, vinegar, or muriate of ammonia. Compresses wetted with any lotion of this sort, may be advantageously put on the swelling, and confined there with a slack bandage. The integuments and subjacent cellular substance, the absorb- ents, the vein, &c. are all liable to inflammation, in consequence of bleeding, a nerve also may be wounded, all requiring proper surgical treatment. Topical BiiOOD-LEXTiNG. This is performed either by means of a scarificator and cupping- glass, or leeches, or by dividing the visibly distended vessels with a lancet, as is frequently done in cases of inflammation of the eye. Inflammations and Abscesses. From whatever cause inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is im- possible to foretel with certainty in which of these ways any par- ticular inflammation will terminate, yet a probable conjecture may 856 INFLAMMATION AND ABSCESSES. be formed with regard to the event, from a knowledge of the pa- tient's age and constitution. Inflammations 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 sup- purate ; and those which attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene. If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best pro- moted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax-plaster. If, notwithstanding these applications, the symptomatic fever in- creases, and the tumour becomes larger, with violent pain and pul- sation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renew- ed twice a-day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, fluctuation of matter, which may be felt under the finger, and, gen- erally speaking, an abatement of the pain, it may be opened either with a lancet, or by means of caustic. The last way in which an inflammation terminates, is in a gan- grene or mortification, the approach of which may be known by the following symptoms: — The inflammation loses its redness, and becomes duskish or livid ; the tension of the skin goes oft*, and it feels flabby; little bladders filled with ichor of different colours spread all over it ; the tumour subsides, and from a duskish com- plexion becomes black ; a quick low pulse, with cold clammy sweats, are the immediate forerunners of death. When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified, and afterwards dressed with basilicum softened with oil of turpen- tine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with generous cordials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound will become a common ulcer ; and must be treated accord- ingly. This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, irrpost- h'mcs, lohithes,* &c. They are all abscesses in consequence of a * A whitloe is a very painful complaint. It is generally caused by a small quantity of purulent matter lodged very deep, and compressed by the hard unyielding skin cov Bring the finger. The pain may be instantly relieved by making a pretty deep incision with a lancet. The skin should also be rather freely divided, which will prevent the compression of the fungous flesh that is frequently thrown out from a whitloe, and which, when girt by the skin, occasions great pain. The wound may be dressed with !i little Peruvian balsam spread on lint. An incipient whitloe may occasionally be •lispcrsed by immersing the part in water as hot as it can be borne. A. P B. WOUNDS. 367 previous inflammation, which, if possible, ought to be discussed ; but, when this cannot be done, the suppuration should be promot- ed, and the matter discharged by an incision, if necessary; after- wards, the sore may be dressed with yellow basilicum, or some other digestive ointment. 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 pow- ers, and imagine that no one can be cured without the application of them. It is, however, a fact, that no external application what- ever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the ex- ternal air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them. The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to pre- vent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature's efforts. AVith this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to fa- cilitate their cure. The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, if it can be conveniently done, ought to be extracted, and the wound cleaned before any dressings be applied. When that cannot be effected with safety, on account of the patient's weak- ness or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c., or where any considerable blood- vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the dis- charge of blood is so great, that if it be not stopped, the patient may die, even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopped by applying a tight ligature or bandage round the member, a little above the wound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart- rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endan- ger a gangrene. In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of 358 WOUNDS. styptics, astringents, &c. Cloths clipped in a solution of blue vit- riol in water, or the styptic water of the dispensatories, may be ap- plied to the wound. When these cannot be obtained, strong- spir- its of wine may be used. Some recommend the agaric* of the oak as preferable to any of the other styptics ; and indeed it de serves considerable enc-omiums. It is easily obtained, and ought to be kept in every family, in case of accidents, A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firm- ly on. Though spirits, tinctures, and hot balsams, may be used, in or- der to stop the bleeding from small vessels when it is excessive, they are improper at other times. They do not promote, but re- tard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it ; but this is only a deception. They may indeed stop the flowing blood, by searing the mouth of the vessels ; but, by rendering the parts callous, they obstruct the cui-e. In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking- plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, the edges of it, if a clean incised wound, ought to be brought in cf)ntact, and retained in that position by means of slips of adhesive plaster, when, in all probability, it will become glued together by what surgeons term the adhesive inflammation. If a deep irregular wound, from blunted instru- ments, it is not safe to keep the lips quite close ; this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It, however, must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax-plaster or poultice ; and the whole must be kept on by a proper bandage, as circumstances may point out. The first dressing ought to continue on for at least two days ; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be remov- ed with ease or safety to the patient, it may be allowed to contin- ue, and fresh lint dipped in sweet oil laid over it. This will soften it so as to make it come off' easily at next dressing. Afterwards, the wound may be dressed twice a-day in the same manner till it *Dr, Tissot, in bis Advice to the People, gives the following directions for gathering, preparing, and applying the agaric :—" Gather in autumn," says he, " while the fine veather lasts, the agaric of the oak, which is a kind of fungus or excrescence 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 hammer, till it becomes soft and very 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 together, stops the bleeding, and gene- rally 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 camel be had sponge may be used in its stead. It must be applied in the same manner, ant" has nearly the same effects. BURNS. 35fl be quite healed, Those wlio are fond of salves or ointments may, after the wound is become very superficial, dress it with the yellow hasilicum ; and if fungous, or what is caWed proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum, or red precipitate of mercury; or it may be kept down by a compress. When a wound is greatly inflamed, the most proper a])plication is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be changed twice a-day. If the vvound bo large, and there is reason to fear an inflamma- tion, the patient should be kept on a very low diet. He niust ab- stain from animal food, strong licpiors, and everything that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled ; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient's strength by excessive evacuations. Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind, or moves the passions, as love, anger, fear, excessive joy, »fcc. are very hurtful. They ought, above all things, to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegeta- ble diet, as roasted apples, stewed prunes, boiled spinage, and such like. Burns. In slight burns, which do not break the skin, it is customary to hold the part neai the fire for a competent time, to rub it with salt, or to lay a compress upon it, dipped in spirits of wine or brandy. It is, however, a preferable practice to plunge immediately the burnt or scalded part into cold water, and keeping it for some time im- mersed. Strong brandy or alcohol is particularly praised. At first the pain is increased by this remedy, but an agreeable sooth- ing sensation soon follows. The parts should be immersed in the spirit, and, when this cannot be done, soft old linen, soaked in the application, should be constantly kept on the part. A strong solution of alum and water is also useful. These applications are fre- quently made to prevent small blisters from arising, and should be continued as long as the pain remains ; and in extensive burns^ creating great irritation, opium should be prescribed, as the stu- por with which patients so circumstanced are attacked, receive* more relief from opium than any thing else. But when the burn has penetrated so deep as to blister or break the skin, it must be dressed with some of the liniments for burns mentioned in the Appendix, or with the emollient and gently-drying ointment, com- monly called Turner''s cerate.* This may be mixed with an equal quantity of fresh olive-oil, and spread upon a soft rag, and applied * See Appendix, Turner's Cerate. 360 BURNS. to the part affected. When this ointment cannot be had, an egg may be beat up with an equal quantity of the sweetest salad-oil. This will serve very well, till a proper ointment can be prepared. When the burning is very deep, after the first two or three days, it should be dressed with equal parts of yellow hasiUcum and Tiir- nej'^s cerate, mixed together. When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or mortifica- tion, the same means must be used to prevent, as are recommend- ed in other violent inflammations. The patient, in this case, must live low, and drink freely of weak diluting liquors. He must like- wise be bled and have his body kept open. But if the burnt parts should become livid or black, with other symptoms of mortification, it will be necessary to bathe them frequently with warm campho- rated spirits of wine, tincture of myrrh, or other antiseptics, mix- ed with a decoction of the bark. In this case the bark must like- wise be taken internally, and the patient's diet must be more gen- erous, with wine, &c. As example teaches better than precept, I shall relate the treat- ment 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 boiling water, and miserably scalded about one half of his body. As his clothes were 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-water and oil, which is a very proper application for recent burnings. On the third day when I first sav/ 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, were likewise applied to the af- fected 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 with small doses of nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a digestive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, and touched with the tincture of myrrh ; and to prevent their spread- ing, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business.* Equal parts of linseed-oil and lime-water form an excellent cooling emollient application to burns produced by gunpowder, or those that are less destroyed. In some cases Goulard's cerate, and a weak solution of the superacetate of lead, more quickly pro- cure ease. * This practice answers very well in scalds ; but in severe burns, such as are occa- sioned by the explosion of gunpowder, or of inflammable air in coal mines, the method recommended by Mr. Kentish, of applying to the burned part spirit of turpentine, by means of a feather, till the suppuration is fairly established, and afterwards covering .he surface with pure chalk, finely powdered, is preferable practice. The patient's -\rength must be supported by cordial medicines, and a generous diet. In slight ;burns and scalds, immersing the part in iced water, or wrapping it in cloths kept con- ■stantly moist with spirit of wine or aether, which by its evaporation occasions ccvld elieves pais., and prevents vesication. A. P. B. BURNS. 361 Mr. Cleghorn's Plan of treating Burns and Scalds. Mr. Cleghorn, a brewer in Edinburgh, was inclined to pay great attention to the effects of various modes of treating burns, on ac- count of the frequency of these accidents among his own work- men. His observations led him to prefer the immediate applica- tion of vinegar, which was to be continued for some hours, by any of tlie most convenient means, until the pain abated, and when this returned the vinegar was renewed. If the burn had been so se- vere as to have produced a destruction of parts, these, as soon as the pain had ceased, were covered with a poultice, the application of which was continued about six, or, at most, eight hours, and af- ter its removal the parts were entirely covered with finely powder- ed chalk, so as to take away every appearance of moisture on the surface of the sore. This being done, the whole burnt surface was again covered with poultice. The same mode was pursued every night and morning until the cure was complete. If the use of poultices relaxed the ulcers too much, a plaster or ointment, con- taining suhcarbonate of lead, was applied ; but the chalk was still sprinkled on the sore. Diluted sulphuric acid was found to answer as well as vineoar. In cold weather Mr. Cleghorn sometimes warmed the vinegar a little, placed the patients near the fire, gave them something warm internally, and kept them in every respect in a comfortable situa- tion. His object in so doing was to prevent the occurrence of tremblings and chillness, which, in two instances, after the em- ployment of cold vinegar, took place in an alarming degree. Sir James Em-Ws Plan. This gentleman was an advocate for the use of cold water, or rather ice ; and published several cases of extensive burns, in which this method was employed with the best success. The burnt parts may either be plunged in cold water, or they may be covered with linen dipped in the same, and renewed as often as it acquires warmth from the part. The application should be con- tinued as long as the heat and pain remain, which they will often do for a great many hours. Some caution, however, becomes necessary, in the application of cold, when the scald is of very large size, or situated upon the trunk of the body. In extensive burns, superficial as they may be, the patient is liable to be affected with cold shiverings ; and these shiverings may be greatly aggravated by exposure, and by the ap- plication of cold. Perhaps, therefore, in these examples warm applications ought to be preferred. . The sores resulting from burns are perhaps more disposed than any other ulcer, to form large granulations, which rise considera- bly above the level of the surrounding skin. At this stage no poul- tices should be used. The sores should be dressed with Turner's cerate, or basilicum mixed with a little red precipitate, and if the part will allow of the application of a roller, the pressure will be of great service in keeping down the granulations, (commonly .-ailed proud flesh,) and rendering them more healthy. 362 BRUISES.— ULCERS. Bruises. Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is need- less to give any definition of a disease so universally known ; we shall therefore proceed 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 if. This is more proper than rubbing it with brandy, spirits of wine, 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 cataplasm of fresh cow-dung. I have often seen this cata- plasm applied to violent contusions, occasioned by blows, fails, 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 ; a sufficient number of leeches ought likewise to be applied to the part. His food should be light and cool, and his drink weak, and of an opening nature : as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-vvhey, and such lilie. The bruised part must be bath- ed with vinegar and water, as directed above ; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poul- tice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day. As the structure of the vessels is totally destroyed by a violen, bruise, there often ensues a great loss of substance, which produ ces 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 injury which the solid parts received from the blow. Patients in this situation are pestered with difi'erent advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best methoa of managing such sores is, to take care that the patient's constitu- tion does not suffer by confinement or improper medicine, and H apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus assisted, will generally in time oper- ate a cure, by throwing off" the diseased parts of the bone, aftei which the sore soon heals. Ulcers. Ulcers are divided into local or constitutional ; it is only, how ever, within certain limits that this distinction is well founded ; foi ULCERS. 36:3 fin ulcer which is at lirst coni|)leteIy local, may in time affect the system so as to become constitutional ; and ulcers which derive their origin from some general affection of the system, may remain after the removal of the constitutional disorder, by which they were originally produced. Ulcers may be the consequence of wounds, bruises, or impost- humes properly 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, other wise it may prove fatal to the patienl. Ulcers happen most com- monly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to jhem. They might often be prevented by retrenching some part of the solid food, or by open- ing artificial drains, as issues, setons, 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, &.c. It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers whicli proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by prop- er regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malig- nant fevers or other acute diseases, may generally be healed with safety after the health has been restored for some time. The cure ought not, however, to be attempted too soon, nor at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be used with safety. When ulcers either accompany chronical diseases, or come in their stead, they nnist be cautiously healed. If an ul- cer conduces to the patient's health, from whatever cause it pro- ceeds, it ought not to be healed ; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible. We would earnestly recommend a strict attention to these par- ticulars to all who have the misfortune to labour under this disor- der, particularly persons in the decline of life ; as we have fre- quently known people throw away their lives by the want of it, while they were extolling and generously rewarding those whom they ought to have looked upon as their executioners. Cure of Ulcers hy Roller and Compresses, Sfc. on Mr. W]iately''s Plan. Bandages are of the most essential service in healing many kinds of ulcers ; but their efficacy is so great in curing numerous indolent sores, that they are sometimes considered the principal means of cure. Mr. Whately, who is one of the most zealous modern advocates for this mode of treating ulcers, offers the fol- lowing remarks for the application of the roller and compresses. " The best width for a flannel roller, designed for those who 364 ULCERS. have slender legs, is three inches ; but for those whose legs are of a larger size, they should always be three inches and a half in width. They must therefore, at first, be torn a little wider, that they may be of their proper width when repeatedly washed. It will likewise be found, that rollers made of fine, soft, and open flannel will answer much better than those made of coarse or hard flannel. The rollers should be often washed, as they become much softer, and of course sit easier when quite clean than when soiled. " In applying a roller (says this gentleman) the first circle should be made round the lowest part of the ancle, as near as possi- ble to the heel ; the second should be formed from thence round the foot ; the third, to be passed again round the foot quite to the toes. The roller should then be passed from the foot round the ancle and instep a second time, to make the fourth circle. In do- ing this it should be brought nearer (but not over) the point of the heel than it was at the first time of going round the part. The fifth circle should pass over the ancle again, and not more than half an inch higher up the leg than the fourth circle. The sixth, seventh, eighth, and ninth circles should ascend spirally along the small of the leg, at the exact distance of three-fourths of an inch from each other. Having proceeded thus far up the leg, we may begin to increase the distance of the circles from each other, which may now succeed each other upward to the knee, at the dis- tance of from one to two inches, according to the size and shape of the leg. At that part where the calf of the leg commences it is generally necessary to let the upper edge of the roller be once, twice, or thrice turned downwards, for about half the circumfer- e/ice of the leg, in order to make the roller lay smooth between the middle of the calf and the small of the leg. When the roller has been thus applied as far as the knee there will be a portion of it to spare, of perhaps a yard in length ; this remainder should be brought down by spiral windings, at greater distances from each other than those which were made in the ascent of the roller. The windings should in general be completed in the small of the leg, where the roller should be pinned. " In applying the compresses, it is necessary in every instance, to put them on one by one, and not all in a mass, though they be of a proper size and number. They should be crossed in diifer- ent directions; the largest of them should in no case be longer than just to meet on the opposite side of the leg to which they are applied. If the same compresses in any case be applied two days together, they should always be turned on the contrary side at each rc-application, in order to prevent wrinkles on the skin." As Mr. Whately objects to pressure being made with adhesive plaster, the following is the calamine cerate he has usually employed. Take Prepared Hog's Lard, 3 lb. Lead Plaster, 1^ lb. Prepared Calamine, 1 lb. To this formula Mr. Whately adds another for making a cerate, which nearly resembles the unguentum tripharmicum of the old dispensatory ; but being less oily, it makes a much more adhesive ULCERS. 365 plaster. It should be spread on rag or silk, as an external cover- ing to the dressing on lint, where a tow-plaster cannot be conve- niently used ; as in wounds of the face or hands, a bubo, or any other sore, where an external plaster cannot readily be retained in its situation by a bandage. This plaster is likewise so mild that it never irritates the skin. It has also been found very useful in frac- tures. The following is the formula : Take Lead Plaster, 1 lb. Hojj's Lard, Prepared, 6 ounces. Vinegar, 4 ounces. Mix. Mr. Baynton's Plan of curing old Ulcers of the Leg hij Means of Adhesive Plaster, without Rest. Mr. Baynton says that the means proposed by him will be found, in most instances, sufficient to accomplish cures in the worst cases, without pain or confinement. After having been repeatedly dis- appointed in the cure of old ulcers, Mr. Baynton determined on bringing their edges nearer together by means of slips of adhesive inastcr. To this he was chiefly led, from having frequently observ- ed, that the probability of an ulcer continuing sound depended much on the size of the cicatrix which remained after the cure ap- peared to be accomplished; and from knowing well, that the true skin was a much more substantial support and defence, as well as a better covering, than the frail one, which is obtained by the as- sistance of art. But, when he had recourse to the adhesive plaster witli a view to lessen the probability of those ulcers breaking out again, he little expected, that an application so simple would prove the easiest, most efficacious, and most agreeable means of treating ulcers. His method is as follows : " The parts should be first cleared of the hair, sometimes found in considerable quantities on the legs, by means of a razor, that none of the discharges, by being retained, may become acrid and inflame the skin, and that the dressings may be removed with ease at each time of their renewal, which, in some cases, where the discharges are profuse, and the ulcers very irritable, may, perhaps, be necessary twice in the twenty-four hours, but which I have in every instance been only under the necessity of performing onco in that space of time. " The plaster should be prepared by slowly melting, in an iron ladle, a sufficient quantity of litharge plaster, or diacvlon, which, if too brittle when cold to adhere, may be rendered adhesive by melting half a drachm of resin with every ounce of the plaster ; when melted it should be stirred till it begins to cool, and then spread thinly upon slips of smooth porous calico, of a convenient length and breadth, by sweeping it quickly from the end held by the left hand of the person who spreads it, to the other, held firmly by another person, with the common elastic spatula used by apoth- ecaries : the uneven edges must be taken off", the pieces cut into slips, about two inches in breadth, and of a length that will, after being passed round the limb, leave an end of about four or five inches. The middle of the piece so prepared is to be applied to the sound part of the limb, opposite to the inferior part of the ulcer, 3(36 ULCERS. so that the lower edge of the plaster may be placed about an mclj below the the lower edge of the sore, and the ends drawn over the ulcer with as much gradual extension as the patient can well bear; other slips are to be secured in the same waj, each above and in contact with the other, until the whole surface of the sore and the limb are completely covered, at least one inch below, and two or three above the diseased part. The whole of the leg should then be equally defended with pieces of soft calico, three or four times doubled, and a bandage of the same, about three inches in breadth, and four or five yards in length, or rather as much as will be suffi- cient to support the limb from the toes to the knee, should be ap- plied ad smoothly as can possibly be performed, and with as much firmness as can be borne by the patient, being first passed round the leg at the ancle-joint, then as many times round the foot as will cover and support every part of it, except the toes, and after- ward? up the limb till it reaches the knee, observing that each turn of the bandage should have its lower edge so placed as to be about an inch above the lower edge of the fold next below. If the parts be much inflamed, or the discharge very profuse, they should be well moistened, and kept cool with cold spring water, poured upon them as often as the heat may indicate to be necessary, or, perhaps, at least, every hour. The patient may take what exer- cise he pleases, ai^ it will always be found, that an alleviation of his pain and the promotion of his cure will follow as its conse- quence, though, under other modes of treating the disease, it ag- gravates the pain, and prevents the cure. " These means, when circumstances render it convenient, should be applied soon after rising in the morning, as the legs of perso:;s affected with this disease are then found most free from tumefac- tion, and the advantages will be greater than when they are appli- ed to limbs in a swollen state. The first applications will some- times occasion pain, which, however, subsides in a sliort time, and is less sensibly felt at eiich succeeding dressing. The force with which the ends are drawn over the limb must then be gradually increased, and when the parts are restored to their natural state of ease and sensibility, which will soon happen, as much may be applied as the calico will bear, or the surgeon can exert ; especially if the limb be in that enlarged and compressible state, which has been denominated the scorbutic, or if the edges of the wound be widely separated from each other." " Cures," adds Mr. B., " will be generally obtained without difficulty by the mere application of the slips and bandage ; but, when the parts are much inflamed, and the secretions great, or the season hot, the frequent application of cold water will be found a valuable auxiliary, and may be always safely had recourse to, where the heat of the part is greater than is natural, and the body free from perspiration. 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 laxa- tive vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, ana should take as much exercise as he can easily bear FISTULA IN ANO. 367 Wlien the bottom and sides of an ulcer seem hard and callous, tliey may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the ointment of yellow ha- silicon, or cerate of resin. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet. Limewdter has frequently been known to have very happy effects in the cure of obstinate ulcers. It may be used in the same man- ner as directed for the stone and gravel. For indolent ulcers, Sir Everard Home recommends the application of diluted nitrous acid, in the proportion of a scruple to eight ounces of water. It pro- motes, in an uncommon manner, the progress of the cure; and, although painful at first, this sensation soon ceases, and produces tlie best effects. My late learned and ingenious friend Dr. White strongly recom- mends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill-conditioned ulcers. I have frequently found tliis medicine, when given according to the Doctor's directions, prove very successful. The dose is a table-spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a letter which I had from the Doctor a lit- tle before his death, he informed me, "that he observed washing the sore thrice a-day with the solution of a triple strength was very beneficial."* The carrot poultice is found to agree with a great many irrita- ble sores ; and the decoction of poppy-heads is also found to be a good liquor for making poultices. The great objection to poulti- ces in these cases being their weight, the limb should always, if possible, rest upon the poultice, and not the poultice, upon the limb. When the weight cannot be avoided and is hurtful, a lighter application should be chosen. When poultices are employed, their use should be cojitinued as long as the granulations are small, and the ulcer rapidly diminishing in size ; and this, even until the cica- trization be complete. When the granulations become large and loose in their texture, poultices should bs left off, when a slight or necessary degree of pressure may be adopted. Of the Fistula in Ano. Ulcers in the neighbourhood of the anus are peculiarly liable to become fistulous, and when in that state are very difficult to cure. A fistula, is frequently the consequence of neglected or ill-treated piles. The presence of this complaint is discovered by the sensa- tion of a pricking pain on going to stool, which is also jjcrceived during the exertion of coughing or sneezing. On examination, a stain of a pale colour, occasionally accompanied with a little blood, will be found upon the linen ; the foeces are also slightly streaked with matter. This matter issues from a small ulcer with one or more orifices, in the neighbourhood of the anus, the other extremity of which generally communicates with the internal cav- ity of the rectum. * In ulcers of the lower limbs great benefit is often received from wearing a .-ncea rtocking, as this prevents the flux of humours to the sores, and disposes them to he)). 368 FISTULA IN ANO. When this disease is ascertained to be present, costiveness should be guarded against chiefly by means of diet, which ought to be coohng, and consist of ripe figs, roasted apples, and articles of a similar nature. Oatmeal porridge eaten with milk or beer, for breakfast or supper, rarely fails to keep the body regular. The radical cure of this complaint must depend on the proper applica- tion of topical remedies. Much may be done by strict attention to personal cleanliness. The parts should be carefully washed with a sponge and water several times a-day, and regularly after going to stool. Stimulant injections, as for example a solution of corrosive sublimate, or of common culinary salt, tincture of can- tharides, or port wine thrown into the fistula by means of a small syringe, or elastic gum-bottle, furnished with a conical point, have, when duly persisted in, effected a cure. Or, the orifice of the fis- tula may be kept open, and a free passage given to the contained matter, by means of a tent or bougie shaped like a cone, and the ulcer be thus disposed to heal. This disease has also been at- tempted to be cured by introducing a bougie, or flexible leaden probe into the fistula, passing it through the orifice that communi- cates with the rectum, and bringing it out at the anus, then twist- ing the two opposite extremities together, and occasionally tight- ening them, till they destroy the interposed substance, when the fistula, being reduced to the state of a simple ulcer, heals. Drinking any sulphureous mineral water, such as that of Har- rowgate, improves the constitution in general, and by that means tends to promote the healing of the ulcer. In cold, languid, and what are termed phlegmatic habits, tar-water may be taken with considerable advantage. I knew an instance of a fistulous sore, seated near the rectum, being almost healed up by taking regularly half a pint of sea-water morning and evening for six weeks togeth- er, and believe it might have been completely cured, had the per- son persisted in this course for a sufficient length of time. It is certainly worth while to give any of these remedies a fair trial previous to having recourse to the operation, as even that does not always succeed. Ulcerations about the rectum are frequently symptomatic of af- fections of the liver. When that is known to be the case, or when they occur about the decline of life, or in persons who have resided long in warm climates, we should not be too busy with our efforts to heal them up. In such persons they seem frequently to operate as salutary drains to the constitution, and to prevent the access of other diseases. Many examples have occurred of persons some- what advanced in life being attacked by asthma, spitting of blood, paralysis, and even insanity, within a short period of time after undergoing tlie operation for the radical cure of a fistula; while others, of apparently similar constitutions, who have submit- ted to the inconveniency of a discharge, and been attentive to keep the parts clean and warm, have lived to an advanced period of hfe. Individuals past the meridian of life, who determine to un- dergo the operation for fistula, should never omit to have an issue opened in some other part of the body, which may serve as a suc- cedaneum for the natural drain they are about to obliterate. A. P. B. / DISLOCATIONS. 369 •^* The medical treati lent of fistulaj in ano will depend on their cause. If they arise from costiveness, the remedies are obvious ; if from disease of the liver, calomel and saline purges ; if from disease of the chest, as dropsy, it is difficult to say wliut medicine ought to be recommended. It is of great importance, however, to give such medicines as will bring the fistula into a healthy state. With this view the balsam of copaiba may be given with advan- tage. If there be much irritation, give soda, which has great effi- cacy in diminishing the irritabihty of the rectum. Aromatic medi- cines should be given, especially that which used to go by the name of Wards's Paste, having been found by experience to produce ex- cellent effects in this disease : Take of Pepper 2 drachms, Ellecampane and Fennel seeds, of each half an ounoe. These are to be mixed up with honey, in the form of an electuary , of which a tea-spoonful is to be taken two or three times a-day. This soon brings the fistula into a healing state ; healthy granula- tions shoot up from the surface, and the discharge instead of being serous or bloody, consists of good pus. Calomel and saline pur- ges should be occasionally given during the use of these aromatic medicines, with a view of promoting the secretions of the liver and intestines. Ed. CHAP. II. OF DISLOCATIONS. When 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 common 1-ixations, and those which require im mediate assistance. Any person of common sense and resolution, who is present when a dislocation happens, may often be of more service to the patient than the most expert surgeon can after the sA^elling and inflammation have come on. When these are pre- sent, 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, and the cavity filled up, that the bot.e can never afterwards be retained in its place. A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has beeu out of its place for any considerable time, and a swelling or in- flammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is attempted. 24 370 DISLOCi riON OF THE JAW, &c. All tliat is necessary after the reduction, is to apply cloths (jipt m vinegar or camphorated spirits of wine to the part, and to keeu it perfectly easy. Many bad consequences proceed from the neg lect of this rule. A dislocation seldom happens without the ten- dons and ligaments of the joint being stretched, and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well ; but if the injury be increased by too fre- quent an exertion of the parts, no wonder if they be found weak and diseased ever after. Dislocation of the Jaw. The lower jaw may be luxated by yawning, blows, falls, chew- ing hard substances, or the like. It is easily known from the pa- tient's being 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 thrown towards one side, and the patient is neither able to speak distinctly, nor to swallow without considerable difficulty. The usual method of reducing a dislocated jaw, is to set the patient 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 wrapt 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 which means the elapsed heads of the jaw may be easily pushed into their former cavities. The peasants in some parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient's chin, then turning his back to that of the patient, pulls him up by the chin, so as to suspend him from the ground. This method often succeeds, but we think it a dangerous one, therefore recommend the former. Dislocation of the Neck. The neck may be dislocated by falls, violent blows, or the like.* In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck was broken ; it is, however, for the most part, only partially dislocated, and may be reduced by almost any person who 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 sense and motion ; his neck swells, his countenance appears * Tiie OS occipitis, and first cervical vertebra, are so firmly connected by ligaments that there is no instance of their being luxated from an external cause, and were the accident to happen, it would immediately prove fatal by the unavoidable compression and injury of tlie spinal marrow ; and in dislocations of the first cervical vertebra from the second, patients can hardly be expected to survive a mischief of this kind in so nigh a situation; when the transverse ligament is broken, and the dentated process is thrown directly backward against the medulla oblongata, the effect must be instant death, as happened in a case lately related by Mr. C. Bell. All dislocations of the neck in which the processus dentatus is displaced are immediately fatal, although lux ations of the oblique cervical processes lower down may be reduced. Ed. DISLOCATION OF THE RIBS, &c. 37J bloated, his chin lies upon his breast, and his face is generally turned towards one side. To reduce this dislocation, the unhappy person should immedi- ately be laid u«)on his back on the ground, and the operator must place himself behind him, so as to he able to lay hold of his head with both hands, while he makes a resistance by placing his knees against the patient's shoulder. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives tl-.at the joint i& replaced, which 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 per- formed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for some days, till the parts recover their proper tone. Dislocation of the Ribs. As the articulation of the ribs with the back-bone is very strong, they are not often dislocated. It does, however, sometimes hap- pen, which is a sufficient reason for our taking notice of it. When a rib is dislocated, either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, and the operator must endeavour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into their former situation. Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient upon his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it ; by this means the heads of the luxated ribs may slip into their former place. In a modern work* may be read the particulars of a case, where all the ribs are said to have been dislocated from the cartilages. The accident arose from the chest being violently compressed be- tween the beam of a mill and the wall. In such a case, there is no means of reduction, except the effect produced by forcible in- spiration ; nor are there any modes of relief but bleeding, and the application of a roller round the chest. Dislocation of the Shoulder. The humerus or upper-bone of the arm may be dislocated in various directions : it happens, however, most frequently down- wards, but very seldom directly upwards. From the nature of ita * C. Bell's Surg. Observations, p. 171. 372 DISLOCATION OF THE ELBOW, &c. articulation, as well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dis- location of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongat- ed, and a ball or lump is perceived under the arm-pit ; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards towards the 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 an- other lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient's arm, and causes it to be tied behind his own neck : by this, while a sufficient extension is made, he lifts up the head of the bone, and 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. In young and delicate patients, I have generally found it a very easy matter 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 extension, 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 known. Two assistants are generally necessary for reducing a dislocation of the elbow ; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Af- terwards 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 maniier as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place. Dislocation of the Clavicle or Collar-bone. The clavicle may be luxated at its sternal extremity,* forwards, backwards, and upwards, but never downwards, on ac-count of the situation of the cartilage of the first rib. The luxation forward is most frequent, and almost the only one ever met with. In reducing these dislocations of the sternal end of the clavicle, a lever is to be made of the arm, by means of which the shouWer is to be brought outwards ; and when thus brought outwards, it is to be pushed forwards, if the dislocation be in that direction ; backward, if the dislocatirn be behind; and upward, if it be above. ■* The end nearest the breast-bone. DISLOCATION OF THE PATELLA, &c 373 It IS as difficult to keep tlie bone reduced, as it is easy to reduce it, s(» smootli and oblique are the articular surfaces. Dislocations of the capsular end of the clavicle, or that nearest the shoulder joint, are much less common. The luxation upwards is the only one that ever occurs ; and this is reduced by carrying the shoulder outwards, putting a cushion in the axilla, and applying a proper bandage, as in fractures of this bone, making the turns ascend from the elbow to the shoulder, so as to press the luxated end of the bone downward, and keep it in its due situation, at the same time that the elbow is confined close to the side, and supported in a sling, by which means tije shoulder will be kept raised and in- clined outwards. Dislocation of the Patella or Knee-pan. This bone may be luxated outwards, or even inwards, when vio- lently pushed in this direction. The dislocation outwards is the most frequent. The generality of cases of this description are easily reduced by pressure, when the extensor muscles of the leg have been completely relaxed ; but owing to a lax state of the ligament of the patella, or other predisposing causes, the bone is sometimes with difficulty retained in its proper position, unless a roller be ap- plied. The inflammatory affection of the joint is to be opposed by top- ical bleeding, purging, and the use of evaporating lotions. The joint must be kept quiet a few days, and then gently moved, to jjrevent stiffness. Dislocation of the thigh. The head of the thigh-bone may be dislocated upwards (on the dorsum of the ilium,) upwards and forwards (on the body of the os pubis,) downwards, and forwards (on the foramen ovale,) and backwards (on the ischiatic notch). The dislocation upward and backward, and that downward and forward, are the most frequent. When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other ; but when it is displaced backward, it is usually pushed upwards at the same time, by which means the limb is shortened, and the foot is turned inwards. When the thigh-bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back, and made fast by bandages, or held by assistants, while by others a gradual and unremitting extension is made by means of slings, or a pulley fixed about the bottom of the thigh a little above the knee ; a sheet, folded longitudinally, being first placed under the perinseum or fork, and one end carried behind the patient, the oth- er before him : they are to be fastened to one of the legs or posts of the bed, or other more secure part. While the extension is making, the operator must push the head of the bone outward, or as the circumstances of the case may require, till it gets into the socket. If the dislocation be outward, the patient must be laid 374 BROKEN BONES. njjon his face, and during the extension the head of the bone must be pushed inward. Dishications of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an extension in opposite directions, while the operator replaces the bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocation. Skill and address will 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. When the force of the muscles in very robust persons resists e\QYy effort to reduce a dislocated limb, a grain or two of emetic tartar dissolved in water may be administered, and taking advan- tage of the general languor and debility that precedes the act of vomiting, the limb may be reduced with facility. I have known this plan successfully practised ; to which may be added bleeding and the warm bath. CHAP. III. OF BROKEN BONES, &c. There is, in most country-villages, some person who pretends to the art of reducing fractures. Though in general such persons are very ignorant, yet some of them are very successful ; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed : we shall therefore recommend the following hints to their consid- eration: — When a large bone is broken, the patient's diet ought in all re- spects 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 cannot be conveniently administered, by food that is of an opening quality ; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought, however, to be here remarked, that persons who have been accustomed to live high are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits in some measure, where the nature of the disease might require a different treatment. It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has at the same time received any bruise or contusion. This opera- tion should not only be performed soon after the accident happens, but, if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly neces sar . BROKEN BONES. 375 "The most unequivocal symptoms of fractures are, the crepitus nr grating noise distinguished on moving the limb, occasioned by tne fractured ends ; the separation and inequalities of the ends of the fracture, when the bone is superficial ; the change in the form of the limb, and the shortening of it. The treatment of fractures in general embraces three principal indications. 1. To reduce the pieces of the bones into their natu- ral situation. 2. To secure and keep them in their jjjace by proper bandages and splints. 3. To prevent unpleasant symptoms, and to relieve them, when, in spite of every effort to the contrary, they do arise." If any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time, as is customa- ry, upon his back. This situation sinks the spirits, galls and frets the patient's skin, and renders him very uneasy. After the second week, he may be gently raised up, and may sit several hours, sup- ported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up and laying him down, that he make no exertions himself, otherwise the ac- tion 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 have known a fractured thigh-bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done. It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavoura- ble to the cure. The best situation is to keep the joint a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected, by either laying the patient upon his side, or making the bed so as to favour this position of the limb. Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will some- times be necessary to have the limb immediately taken off, other- wise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being de- layed in such cases till too late. I have known this principle ope- rate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless. * Various pieces of machinery have been contrived for counteracting the force of the muscles, and retaining the fragments of broken bones ; but as descriptions of these viihout drawings would be of little use, T shall refer the reader to a cheap and usefuls performance, On the Nature and Cure of Fractures, lately published by my ingenious- friend Mr. Aitkin, surgeon, in Edinburgh ; wherein that gentleman has not only gives an account of the machines recommended in fractures by former authors, but his like- wise added several improvements of his own, which are peculiarly useful in compound', fractures, and in cases where patients with broken Viones are oblised to be transpoitoo' from one place to another. 370 STRAINS. When a fracture is accompanied with a wound, it must be dress- ed in all respects as a wound. All that art can do towards the cure of a broken bone is to lay It perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be omitted altogether. A great many of the bad consequences which succeed to fractured bonefS are owing to tight bandages. This is one of the ways in which the 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 were ever known happened where no bandages were applied at all. Some method, however, must be taken to keep the member steady ; but this may be done many ways, without bracing it with a tight bandage. The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they are ap- plied, soon assume the shape of the included member, and are suf- ficient, by the assistance of a very slight bandage, for all the pur- poses of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of reten- tion equally well. The splints should always be as long as the' limb, with holes cut for the ancles when the fracture is in the leg. In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The pa- tient in this case ought to be bled, to keep himself quite easy, avoid- ing eveiy 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 tak- ing frequently some light food, and drinking freely of weak watery liquors. When the ribs are fractured on both sides bandages are not admissible, as the patient would be in extreme danger of being suffocated, from impeded action of the chest. The most proper external application for a fracture is oxycrate, or a mixture of vinegar and water, to which some spirits of wine may be added. The bandages should be wet with this at every dressing, if the inflammation runs high. CHAP. IV. OF STRAINS. Strains are often attended with worse consequences than brok- en bones. The reason is obvious : they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because 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 RUPTURES. 377 This is very proper, provided it be done immediately, and not kept in too long. But the custom of keepinjr tlie 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 in- creasing the disease. It should not, however, be apjilied too tight. 1 have frequently known bleeding near the aftected part liave a *ery good effect; but what we would recommend above all, is ease. It is more to be depended on than ixny medicine, and sel- dom fails to remove the complaint.* Ruptures. Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is coniinonly the effect of blows or violent exertions of the strength, as leaj)ing, carryini^ great weights, &-c. In both, a relaxed habit, indolence, and ar> oily or very moist diet, dispose the body to this disease. A rupture sometimes proves fatal before it is discovered. When- ever sickness, voriiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where rup- tures usually happen ought carefully to be examined. The prutru- sion of a very small part of the gut will occasion all these sj^nip- toms ; and, if not returned in due time, will prove fatal. On the first appearance of a rupture in an infant, it ought to be laid upon its back with its head very low. While in this posture, if the gut does not return of itself it may easily be put up by gentle pres- sure. After it is returned, a piece of sticking-plaster may be appli- ed over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and apply- ing rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from cry'ng, and from all violent exertions, till the rupture is quite cured. In adults, when the gut has been forced down with great vio- lence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite im- practicable without an operation ; a description of which is for- eign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without hav- ing recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue. After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. * A great many external applications are recommended for strains, some of which rio 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 oatmeal, camphorated spirits of wine, Mindererus's spirit, volatile liniment, volatile aromatic spirit diluted with a double quantity of water, and the common fomentation, with the addition of brandy or spirit of wine. 378 CASUALTIES. In this situation flannel-cloths wrung out of a decoction of mallows and camomile-flowers, or, if tliese are not at hand, warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter, and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary ; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hands, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove inef- fectual, clysters of the smoke of tobacco may be tried. These 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. Operating for the hernia is a nice and diflicult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declar- ed the reduction of the gut impracticable without an operation.* An adult, after the gut has been returned, must wear a proper truss. It is needless to describe this, as it may always be had ready-made from the artists. Such bandages are generally uneasy to tno wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man's estate should ever be without one of these bandages. Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors ; and should carefully guard against catching cold. CHAP. V. CASUALTIES. It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects. Nc person ought to be looked upon as dead from any accident, unles>« where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The functions of these organs may be so far impaired, as even to be for some time imperceptible, when life is by no means extinct. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power * I would here beg leave to recommend it to every practitioner, when his patient complains of pain in the belly with obstinate costiveness, to examine the groins, anil every place where a rupture may happen, in order that it may be immediately reduced. By n°glecting this, many perish who were not suspected to have had ruptures till aft»T Ihey were dead. I have known this happen where half a dozen of the faculty where m attendance. SUBSTANCES STOPPED, &i,e. 379 of actinjr. Thus, when the motion of the lungs has been stopped by unwholesome vapour; the action of the heart by a stroke (Jti 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 recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored. It is a horrid custom immediately to consign ever to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. Tlie unha|)py person, insjead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to a church or a l>arn, 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 fartlier notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in a house that is inhabited. What the ground of this superstition may be, we shall not pretend to enquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense. When a person seems to be suddenly deprived of life, our first business is to enquire into the cause. "We ought carefull) to ob- serve whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &-c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or tlie like. I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy suf- ferers ; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content m \ • self with collecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice. Of Substances stopped between the Mouth and Stomach. Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Chil- dren should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swal- low. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their riouths upon every occasion, and some wlio even sleep with the former there all night. This con- liSO SUBSTANCES STOPPED BETWEEN duct is exceedingly injudicious, as a fit of coug^hing, or twenty oth er accidents, may force over the substance before tlie person is aware.* When any substance is detained in the gullet there are two ways of removing it ; viz. either by extracting it or pushing it down. The safest and most certain way is to extract it; but this is not always the easiest : it may, therefore, be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature that there is no danger from its reception into the stom- ach. ■ The substances, which may be pushed down without danger, are, all common nourishing ones, 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-point'Cd, as pins, needles, fish-bones, bits of glass, &.c. When such substances have not passed in too deep, we should endeavour to extract them with our fingers ; which method often succeeds. When they are lower we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible natui'e, and ha,s descended far into the gullet. If the fingers and pincers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be made at once, by bending a piece of pretty strong iron wire at one e:id. it must be introduced in the flat way ; and, for the better condr.cting it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it ; which has this farther use, that it may be secured by a string tied to it ; a circum- stance not to be omitted in any instrument employed on such occa- sions, to avoid such ill-accidents as have sometimes ensued from these instruments slipping out of the operator's hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient when a substance somewhat flex- ible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them. When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straighten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obstructing body, and so to extract it. More flexible rings may be mt.de of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whalebone, or any kind of flexible wood, and by this means introduced, in order to surround * A woman in one of the hospitals of this city lately discharged a great number of pins, which she had swallowed in the course of her business, through an ulcer in her liuc. THE MOUTH AND STOMACH. 381 the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the more certain- ly to Jay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twisted, as to be moved every way, which must in many cases be a considerable advantage. Another material employed on these unhappy occasions is the sponge. Its property of sweUing considerably on being wet is the principal foundation of its usefulness here. If any substance is stopped in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopped, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation ; and, indeed, the enlargement of it may be forwarded by making the patient swallow a i'ew drops of water. Afterwards it is to be drawn back by the handle to which it is fastened ; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstruct- ing body along with it. The compressibility of sponge is another foundation of its useful- ness in such cases. A pretty large piece of sponge may be com- pressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound and withdrawn, after the sponge has been introduced. A bit of sponge may like- wise be compressed by a piece of whalebone split at one end ; but this can hardly be introduced in such a manner as not to hurt the patient. I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is slifer than swallowing sponge, and will often answer the purpose equally well. When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply en- gaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion farther mischief. If the patient can swallow, vomiting may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling a drachm of tobacco in twelve ounces of water. This has often been found to succeed, when other attempts to ex- cite vomiting had failed. When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible ; or a piece of whalebone, wire, or flexible wood, with a sponge fastened to one end. . . Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least 882 SUBSTANCES STOPPED, &c. of two evils, and rather run the hazard of pushing them down, than suffer the patient to perish in a few minutes ; and we ouglit to scruple the resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances lias been followed by no disorder. Whenever it is manifest that all endeavours either to extract or push down the substance must prove ineffectual, they should be discontinued : because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the bod}^ which caused the obstruction had been entirely removed. While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection, through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and soothe the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments. When, after all our endeavours, we are obliged to leave the ob- structing bod_y in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed. A proper degree of agitation has sometimes loosened the inher- ing body more eflectually than instruments. Thus a blow on the back has often forced up a substance which stuck in the gullet ; but this is still more proper and efficacious when the substance gets into the windpipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage. When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, us wine, punch, pepper, and such like ; and his drink should be milk and water, barley-water, or whey. When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like. When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored, the operation of hronchotomy , or opening of tiie windpipe, must be directly perform- ed. 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 io mention it, though it should only be attempted by surgeons skilled in anatoiny. DROWNED PERSONS. 8S3 Suspended Animation and Resuscitation. Drowned Persons. — When a person has remained above a quar- ter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances may happen to have continued life, in such an unfortunate situation, beyond the ordin- ary term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many well-attested proofs of the re<;overy of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life. The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture, with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men's shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms. In attempting to recover persons aj^parently drowned, the prin- cipal intention to be pursued is, to restore, by gradual means, the natural warmth, upon which all the vital functions depend, and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c. A high degree of heat will not be necessary ; a moderate de- gree will be sufficient. If the weather be under the freezing point, and the body, when stripped, feel cold, and nearly in the same condition with the water that is frozen, it will be necessary at first to rub it well with snow, or wash it with cold water ; the sudden ap- plication of heat in such cases having been found very pernicious. In a short time, however, warmth must be gradually applied. Though cold was by no means the cause of the person's death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made ; and as soon as a well-heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm clothes ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm wa- ter, to the soles of his feet, and to the palms of his hands. After the restoration of heat, volatile spirits should be frequent- ly applied to the nose ; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought also to be chafed with volatile spirits ; and stimulat- ing powders, as that of tobacco or marjoram, may be blown up the nostrils. To renew the breathing, in the absence of a better apparatus, a strong person may blow his own breath into the patient's mouth with all the force he can, holding his nostrils at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desist from blow- ing, and should press the breast and belly so as to expel the air 384 DROWNED PERSONS. again ; and this operation may be repeated for some time, alter nately inflating and depressing the lungs, so as to imitate natural respiration. If the lungs cannot be inflated in this manner, it may be attempt- ed by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro, for this purpose, recommends a wooden pipe fitted at one end for filhng the nostrils, 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 windpipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery. It was the practice, some time ago, to employ the smoke of tobacco ; but this, instead of answering any good purpose, has proved injurious, by further depressing the vital principle. Instead of this, therefore, a clyster is recommended, consisting of a pint or more of water, moderately warmed, to which may be added a little volatile spirit, essence of peppermint, or rectified spirit. While these things are doing, some of the attendants ought to be preparing a warm-bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no con- veniences for using the warm-bath, the body may be covered with warm sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet upon her head, and a stocking round her neck, stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out, I freeze, I freeze: a little cher- ry brandy was given her, and she remained buried, as it were, under the ashes for eight hours: afterwards she was taken out, without any other complaint, except that of lassitude or weariness, which went off" in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.* When there is reason to suppose that the skin has, in some de- gree, recovered its sensibility, the wrists, ancles, temples, and parts over the stomach and heart may be rubbed with a little volatile liniment, which will evaporate but slowly, and produce no cold on being rubbed in. In cases of suspended animation, it has likewise been usual to stimulate the stomach and intestines; the former by means of some moderately warm liquor, such as negus highly spiced, introduced into the organ through a flexible tube, and the latter by means of injections. 'From some late experiments made by Professor Aldini, of the university of Bologna, on the body of a malefactor, it would appear that galvanism, as an auxiliary, promise" great advantages to the interests of humanity, in cases of drowning and other instances of suspended animation. With this view, also, electricity is sometimes resorted to; unless, however, employed by insulation alone, it will be more likely to do harm than good. Ed. NOXIOUS VAPOURS. 385 Till the patient show some si^ns of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather, dipped in warm brandy or other strong spirits ; and, as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be ad- ministered. Some recommend a vomit after the patient is a little reanimated ; but if he can be made to puke without the sickening draught, it will be more safe : this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot, in this case, recommends the oxymel of squills, a table-spoonful of which, diluted with wa- ter, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, &. strong infusion of sage, camomile-flowers, or cardnus henedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intejad that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics, in this situation are not expedient. We are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after tiiese first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be adminis- tered. Lastly, though the person should be manifestly reanimat- ed, there sometimes remains an oppression, a cough, and feverish- ness, which effectually constitute a disease. In this case, it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully of barley-water, elder-flower tea, or any other soft pectoral infusion. Such persons as have the misfortune to be deprived of the ap- pearance of life by a fall, a blow, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarce- ly exhibited any signs of life ; yet this mau, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Es- says, of a man who was to all appearance killed by a blew on the breast, but recovered upon being immersed for some time in warm water. These and other instances of a similar nature, which might be adduced, amount to a MX proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly per- sisted in. Of Noxious Vapours. {Aerial Poisons.) Am may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle be- ing destroyed, or from subtle exhalations with which it is impreg- 25 3S6 NOXIOUS VAPOURS. iiated. Thus ail* that has passed through burning fuel is nenhei capable of supporting fire nor the life of animals. Hence the dan- ger of sleeping in close chambers with coal fires. Some, indeed, suppose the danger here proceeds from the sulphureous oil con- tained in the coal, which is set at liberty and diffused all over the chamber ; while others imagine it is owing to the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suftbcated by sleeping in an apartment where a small fire of coal had been left burning. The vapour which exhales from wine, cider, beer, or other li- quors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instan- ces of persons struck dead on entering such places, and of others '.vho have with difficulty escaped. When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emp- tied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no per- son ought to venture into a well, pit, cellar, or ary place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in ; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire. The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. There have, however, been instances of people killed by the fumes of lamps Avhich had been extinguished in a close chamber ; and persons of weak, delicate breasts, generally find themselves quickly oppressed in apartments illuminated with many candles. Such as are sensible of their danger in these situations, and re- treat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a lit- tle water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling, and understanding, the following means must be used for their re- covery : — The patient should be exposed to a very pure, fresh, and open air ; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or, if that does not suc- ceed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallovy', some lemonade, or wa- ter 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 EFFECTS OF EXTREME COLD. 387 be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces ; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonsful of com- mon salt may be put into the clyster. The same means, if neces- sary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmtli, &c; Mr. Tossach, surgeon, at Alloa, relates tlie case of a man suffV)- Gated by the steam of burning coal, whom he recovered by blowing' nis breath into the patient's mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stujiified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed. The practice of plunging persons suffocated by noxious vapours m cold water would seem to be supported by the common experi- ment of suffocating dogs in the Grotto del Cani, and afterwards recovering them by throwing them into the neighbouring lake. When a person dies from suffocation, the symptoms are nearly the same in apoplexy. Effects of Extrejie 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 thf circulation in the extremities, and forcing too great a proportion of blood towards the brain ; so that the patient dies of a kind ot apoplexy, preceded by great sleepiness. The traveller, in thie situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some allevia- tion of his sufferings, would, if indulged, prove his last. Such violent effects of cold are happily not very common in this country : it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mor- tification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire ; yet reason and observation show, that this is a most dangerous and imprudent practice. Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed by rottenness, or a kind of mortification ; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to ani- mals in this condition. When the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility : after vrhich, the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder-flowers sweet- ened with honey. Every person must have observed, when his hands wee even but slightly affected with cold, that the best way S88 EFFECTS OF EXTREME HEAT. to warm th^enti was by washing them in cold water, and continuing to rub them well for some time. When, therefore, the hands, feet, or nose, or any other part of the body have been exposed to violent cold, so as to be frost-bitten, hey ought at first either to be well rubbed with snow, or be put into cold water, and afterwards be subjected to warmth in the most gentle and gradual manner. When a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest wa- ter. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for sev- eral hours, have nevertheless been revived. If the power of swallowing be restored, some warm and gently stimulating drink should be given, such as thin broth, with a little brandy in it, or water with some wine, administered by a spoonful at a time. While the body is cold, and the circulation and respi- ration are languid, blood-letting might be improper. If, however, after these functions, and the natural temperature are restored, the patient should remain any time in a comatose state, with a strong full pulse, the propriety and necessity of venesection can hardly be doubted. I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their Budden transitions from cold to heat. After they have been expos- ed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above. Effects of extreme Heat. The effects of extreme heat, though not so common m this coun- try, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cor- dial can be poured into the mouth, it ought to be done. If this r.annot be effected, 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, which should be well rubbed with coarse cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons appar- ently dead, by beating them with rods. Head-aches are often occasioned by exposure to intense heat ; and in warm climates, where people are very liable to what they call coups de soldi, or strokes of the sun, it is a common custom to lay lineu cloths, several times doubled, on the head, and to keep FAINTING FITS. 389 tliem moistened with very cold water for half an hour, or till the Btupor is diminished. This they term drawing the jirt out of the head. Of Fainting Fits. (Syncope.) Strong and healthy persons, who abound with blood, are often seized with sudden faintinj^ fits, after violent exercise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like. In such cases the patient ought to be made to smell to some vinegar. His temples, forehead, and wrists, ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water ; and two or three spoonsful of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth. If the fainting proves obstinate, or degenerates into a syncope, ihai is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half-hour a cup or two 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, in order to escape them, confine himself to a light diet, consisting chiefly of bi-ead, 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 cftener from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these, an almost directly opposite course to that mentioned above must be pursued. The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary-water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy ; and, if he can swallow, some hot wine mixed with sugar and cin- namon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to his feet. As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot- spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nour- ishment, as panada made with soup instead of water, newlaid eggs lightly poached, chocolate, light roast meats, jellies, and such like. Those fainting fits, which are the eftect of bleeding, or of the violent operation of purges, belong to this class. Such as happen, after artificial bleeding are seldom dangerous, generally terminat ing as soon as the patient is laid upon the bed; indeed, persona subject to this kind should always be bled lying, in order to prevent it. Should the faintinff, however, continue longer than usual, vol- 390 FAINTING FITS. aiile spirits may be held to the nose, and rubbed on the temples ery one who happens to be present at the accident, and re- quire no great expence, and less skill. The great aim is to restore tlie M armth 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 accordmg to circumstances. Common sense, and the situa- tion of the patient, will suggest the proper manner of conducting them. Above all, we would recommend perseverance. People ought never to despair on account of discouraging circumstances, or to leave off their endeavours as long as there is the least hope of success. WheKe much good and no hurt can be done, no one ought to grudge his labour. * The Royal Humane Society for the recovery of drowned persons, in London, i>» now equal, if not superior to any similar institution in Europe; and the laudable en- deavours, persevering efl'or'.s, and encouragement given by its members to promote its nlility; are at least upon the same scale, as far as the means are adapted \o the ends. Kb DISEASES OF WOMEN. 3i)7 CHAP. VI. DISEASES OF WOMEN. Women, in all civilized nations, have the management of domes- tic affairs, and it is very ])roper tiiey shonld, as iiatiire has made them less fit for the more active and laborious emjjloyments. This indulgence, however, is generally carried too far ; and fe- males, instead of being benefitted by it, are greatly injured, from the want of exei»cise and free air. To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, witli the pale complexion of those females whose whole time is spent within doors. Though nature has made an evident distinction between the male and the female with regard to bodily strength and vigour, yet she certainly never meant, either that the one should be al- ways without, or the other always within doors. The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disor- ders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting, the former is rarely to be found. I have always observed, that wcnnen who were chiefly employed without doors', in the difterent branches of husbandry, garden- ing, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shown, we shall proceed to point out those circum- stances in the structure and design of females, which subject them to peculiar diseases, the chief of which are, their monthly evacua- tions, pregnancy, and child-bearing. These, indeed, cannot prop- erly be called diseases ; but, from the delicacy of the sex, and theii being often improperly managed in such situations, they become the source of numerous calamities. The Menstrual Discharge. (Catamenia.) Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this dis- charge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and hap- piness of the female depend in a great measure upon her conduc: at 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 themselves at this critical period of their lives. False modesty, inattention, and ignorance of what is beneficial or hurtful at this time, are the sources of many diseases and misfortunes in life, whicl a few sensible lessons from an experienced matron might have prevented. Nor is care .ess necessary in the subsequent return of this discharge. Taking improper food, vio- .er.t affections of the mind, or catching cold at this period, is often sufficient to ni n '.he health, or to render the female ever after incapable of prooreation 398 THE MENSTRUAL DISCHARGE. If a girl about this time of life be confined to the house, kepi constantly sitting, and neither allowed to romp about, nor employ- ed in any active business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan ; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the state of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are at this critical period, denied the benefit of exercise and free air. A lazy, indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstruc- tions amongst the more active and industrious part of the sex ; whereas the indolent and lazy 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, recom- mend it to all who wish to escape these calamities, to avoid indo- lence and inactivity as their greatest enemies, and to be as much abroad in the open air as possible. Another thing which proves very hurtful to girls about this peri- od of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions sliould go properly on. Accordingly we find that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the 7nenses, but like- wise to glandular obstructions ; as the scrofula, or king's evil, «fec. A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature proves the very prey of vapours and hysterics. Youth is the season for mirth and cheerfulness ; let it therefore be indulged; it is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise nature prompts the happy youth to join in sprigbtly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp with serious gloom the season destined to mirth and innocent festivity. Another thing very hurtful to females about this period of life, is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeezing the stomach and bowels, they hurt the diges- tion, and occasion many incurable maladies. This error is not indeed so common as it has been, but, as fashions change, it may come about again ; we therefore think it not improper to mention it. I know many females who, to this day, ffeel the dreadful effects of that wretched custom which prevailed some years ago, of pqueezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to healtli. After a female has arrived at that period of life when the menses usually begin to flow, and they do not appear, but, on the contrary her health and spirits begin to decline, we would advise, instead of THE MENSTRUAL DISCHARGE. 39V eiJiUtting the poor girl up in the house, and dosinj^ her with steel, asaftEtida, and other nauseous drugs, to place her in a situation where she can enjoy the henefit of free air and agreeahie company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side. This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretell its approach ; as a sense of heat, weight, and dull pain in the loins; distention and hardness of the breasts; head- ache, loss of appetite, lassitude, paleness of the countenance, and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which mfiy obstruct that necessary and salutary evacuation, and all means used to promote it ; as sitting frequently over the steams of warm water, drinking warm diluting liquors, «fec. After the menses have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceedingly cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to sour on the stomach, ought to be avoided ; as fruit, butter- milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the aex date their diseases from colds caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not in the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution. The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other aff*ections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable. As far as my observation goes, there are no women in the world so inattentive to this discharge as the English ; and they suff'er accordingly, as a very great number of them are obstructed, and many prove barren in consequence. 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 sufl[icient exercise in a dry, cpen, 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. ^ hen obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace ihe 400 THE MENSTRUAL DISCHARGE. solids, and assist the body in preparing good blood, ought to be used. For this purpose, I have of late made use of pills compos- ed of prepared steel, powdered myrrh,* and the best aloes, equal parts. These must be formed into pills of the common size, and two or three of them given every night at bed-time. The principal medicines, however, are iron, and the Peruvian bai'k, with other bitters and astringents. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks, it may be filtered, and about half a wine- glass of it taken twice a-day ; or prepared steel may 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 pa- tient. Previous, however, to the use of these medicines, it may be advisable to give a gentle emetic, for the purpose of cleansing the stomach, and freeing it from acidities and inactive fluids. When obstructions proceed from a viscid state of the blood, or for women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise. A teaspoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water. When obstructions proceed from affections of the mind, as grief, fear, anger, &.c. eveiy method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influ- ence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situation is also of the last importance. An obstruction of the menses is often the effect of other maladies. When this is the case, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient's health and strength. When that is effected, the other will return of course. Immoderate Flow of the Menses. The flow of the menses is to be considered as immoderate, when it either returns more frequently than what is natural, continues longer than ordinary, or is more abundant than is usual with the * Take Myrrh, ^ drachm. two table-spoonsful of the following Subcarbonate of Soda, 15 grains. mixture: Sulphate of Iron, 1 scruple. Take Compound Infusion of Gentian, Extract of Bark, 1 scruple. 6 ounces. Syrup of Ginger, enough to form the Tincture of Bark, mass ; to be divided in 24 pills, two of of Cardamoms, of each, which are to be taken twice or three ^ ounce. ♦imes a-day ; washing them down with Make a mixture. THE MENSTRUAL DISCHARGE. 401 same person than at other times ; usually accompanied with paina in the back and belly, somewhat like those of childbirth. But the menstrual discharge may be too great as well as too small. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, to which cedematous swel- lings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life ; a full diet, consisting chiefly of salted, high seasoned, or acrid food; the use of spirituous liquors; excessive fatigue ; relaxation; a dissolved state of the blood; violent passions of the mind, «fec. The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient's regi- men, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flow, and counteract the morbid aff"ections of the sys- tem whence it proceeds. To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low ; to live upon a cool and slender diet, as veal or chicken broths with bread ; and to drink decoctions of net- tle-roots, or the greater comfrey, cooling aperients,* and refrige- rants, as small and frequent doses of nitre ;f cool acidulated liquors, as lemonade ; light covering, and lying on a mattress instead of a bed. If these be not sufficient to stop the flux, stronger astrin- gents| may be used, as Japan earth, alum, elixir of vitriol, the Peruvian bark, ifcc: e. g. two drachms of alum and one of Japan earth may be pounded "together, and divided into eight or nine doses, one of which may be taken three times a-day. Persons whose stomachs cannot bear the alum, may take two table-spoonsful of the tincture of roses three or four times a-day, to each dose of which ten drops of laudanum may be added. If these should fail, half a drachm of the Peruvian bark, in powder, with ten drops of (he elixir of vitriol, may be taken, in a glass of red wine, four times a-day, or any of the forms prescribed below. Fluor Albus. The uterine discharge may off"end in quality as well as in quan- tity. What is usually called the jluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale yellow, green^ or of a blackish colour : sometimes it is sharp and » Take Epsom Salts, 2 ounces. Make a draught, to be repeated every Warm Water, 6 ounces. third hour. Compound Tincture of Senna, ^ rp^^j^g q^^ Kino, 8 grains A ounce. Alum, in Powder, 12 grains Syrup of Roses, i drachms. Confection of Roses, enough. Mix , and take two table-spoonsful for a j^i^^e a bolus, to be taken every third oi dose. fourth hour. or t Take Infusion of Roses, 1^ ounce. Take Purified Alum, 10 grains. Nitre, 10 grains. Extract of Bark, 12 grains. Occasionally adding, if necessary, Confection of Roses, enough. Tincture of Opium, 15 drops. Make a bolus to be taken as above. 26 402 THE MENSTRUAL DISCHARGE. corrosive, sometimes foul and foetid, &c. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watei'y diet, frequent childbear- ing, &c. To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known stron;/ broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long in bed. Independent of this regimen, the proper indications of cure to be observed appear to be, to increase the action of the absorbents of the uterus and vagina, by restoring the tone of the system ; to correct the acrimony of the discharge ; diminish its quantity ; to alleviate other urgent and distressing symptoms; and to strengthen the system, when the disease is complicated with general debility and relaxation. With this view, the first of these intentions is to be effected by astringents, administered by the mouth ; and like- wise thrown up into the vagina and uterus in the form of injec- tions.* Alum, sulphate of zinc (white vitriol,) gum kino, and cat- echu, are the astringents most employed as internal remedies; and these may be given either separately or combined with some tonic, as the bark, bitters, chalybeates, and the sulphuric acid as advised beloWjf with partial cold bathing, or spunging the loins and thighs with cold water. In addition to astringents, it has been usual to employ in fluor albus such stimulating medicines as most commonly determine to the urinary passages, which, from their vicinity to the uterus, have often been found to afford considerable relief. On this occasion, turpentine and other balsams have been used.| Gentle emetics are also supposed to be of singular benefit in this complaint. When there are excoriations externally or internally, the solution of the acetate of lead, sufficiently diluted with water, may be em- ployed as a wash. * Take Decoction of Oak Bark, 1 pint. + Take Powdered Alum, 2 drachmt. Alum, 1 drachm. Nutmeg, ^ drachm. Make an injection. Catechu, 1 drachm Peruvian Bark, ^ oz. Syrup of Ginger, a sufficiency to form an Take Sulphate of Zinc, 1 drachm. electuary, of which the bulk of a smaii Super Acetate of Lead, 10 grains. walnut may be taken three times a-day Distilled Water, 1 pint. Make an injection. jTake Balsam of Copaiba, or Canada Turpentine, 2 drachms °^ The Yolk of an Egg. Take of Bruised Oak Gall, h ounce. Let them be well mixed together in a Hot Water, 2 pints. marble mortar, and gradually add, Make an injection. Water, 7 ounces. or Clarified Honey, ^ ounce. Fake Strong Infusion of Green Tea, Tincture of Spanish Fly, 1 drm. Make an injection. Mix, and take two dessert-spoonsful thrica a-day. DISEASES OF PREGNANCY. 403 Difficult Menstruation. ( Dymenorrhcea.) Besides the other deviations from the usual course of nature, al- luded to under this head, a third sometimes occurs, wherein men- struation, although not entirely sup])ressed, is nevertheless some- what difficult, and accompanied with severe pains in the hack, loins, and bottom of the belly. This disease is supposed to be ow- ing to a weak action of the vessels of the uterus, or spasm of its extreme vessels ; and is to be removed by chalyheates, warm bath- ing, both topical and general, witii the use of opiates, which should be einployed as soon as the symptoms that denote its approach are apparent. The extract of stramonium, in half grain doses, will often prove serviceable when other anodynes fail. Cessation of the Menses. {Commonly called the " Turn of Life") That period of life at which the menses cease to flow is likewise very critical to the sex. The stoppage of any customary evacua- tion, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, however, as survive it, without contracting any- chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age. If the menses cease all of a sudden, which is seldom the case, in women of a full habit, they ought to abate somewhat of their usu- al quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufficient exercise, and to keep the body open. This may be done by ta^klug, once or twice a week, a little rhubarb, or an infusion of hiera picra in wine or brandy. Should any scirrhous or cancerous afi^ection of the uterus take place on a stoppage of the menstrual flux, as sometimes happens, all that can be done in such cases is to have recourse to pallia- tives, such as opium, henbane, and hemlock, in the manner point- ed out in the diseases wherein these medicines are indicated. It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ankles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open or have artificial drains substituted in their stead. Women who will have such* sores dried up are often soon after carried ofl^" by acute diseases, or fall into those of a chronic nature. CHAP. VII. DISEASES OF PREGNANCY. Though pregnancy is not a disease, yet it is a state often at- tended with a variety of complaints which mehit attention, and which sometimes require the assistance of medicine. Some wo men, indeed, are more healthy during their pregnancy than at any 404 DISEASES OF PREGNANCY. other time ; but this is by no means generally the case ; most of them being frequently indisposed during the whole or greater pari of the time of their gestation. Few fatal diseases, however, hap^ pen, during this period ; and hardly any except abortion that can be called dangerous. During a state of pregnancy, three different stages evidently ex- ist, each of which has a distinct set of symptoms ; nor need we be surprised, when we come to consider the alteration the constitu- tion suffers as a consequence of impregnation, at the many com- plaints and irregularities which then arise. The first state of pregnancy is usually attended with a suppression of the menses, accompanied with frequent nausea and vomiting, particularly in the morning, heartburn, indigestion, peculiar longing, head-ache, gid- diness, tooth-ache, and sometimes a slight cough : the breasts be- come enlarged, shooting pains extend through them, and the cir- cle round the nipple alters to a dark brown colour. A feverish tendency, with debility, emaciation, irritability, and peevishness- of temper, and a total alteration of the countenance, every feature of whijch becomes much sharpened, also frequently occur. During the whole or greater part of the second stage of gestation, as well as the first, the vomiting will continue with some women ; this, however, does not usually happen. Partial suppressions of urine, with a frequent inclination to void it : itching about the external parts of generation, costiveness, inclination without ability to go to stool, and the piles, are what pregnant women are chiefly incommoded by during the second stage. Quickening. — Most women quicken about the sixteenth week after conception, at which time the mother becomes sensible of the slightest efforts of the child; and besides the complaints just enumerated, she will then be liable to sudden faintings, and slight hysteric affections.* During the last three months, or third stage of pregnancy, general uneasiness, restlessness (particularly by night,) costiveness, puffy swellings of the feet, ancles, and private parts, cramps in the legs and thighs, difficulty of retaining the urine for any length of time, varicose swellings of the veins of the belly and lower extremities, and the piles, are the affections which usually prove most troublesome. In delicate and weak women, of an irritable habit, convulsive fits sometimes arise, which are ever to be regarded in a dangerous point of view. Nausea and Vomiting. — These symptoms most frequently arise immediately on first getting out of bed in the morning; under such circumstances, therefore, it is advisable for the patient never to rise until she has taken a dish of tea or coffee, or whatever else she may have been accustomed to substitute for her breakfast. • According to the opinion most commonly received, quickening, thus termed, has been generally understood to commence at the time when particular sensations are perceived by the mother, supposed to be occasioned by the first motion of the child. The most usual time of feeling any such symptoms is about the latter end of the fourth or beginning of the fifth month of pregnancy: at this period the uterus filling up the pelvis slips out and rises above the rim; and from that sudden transition, women of a delicate constitution and irritable fibre are apt to faint, more particularly so if in an erect position Ed. DISEASES OF PREGNANCY. 405 Should the vomiting at any time become so severe as to threaten abortion from the violence of the straining, it njuy tlieu be advisa- ble to direct two or three table-spoonsful of tlic saline medicine t(j be taken evtiry now and then in such a manner as the effervescence shall ensue after it is swallowed. The patient also should keep the body open with some gentle laxative. Should these means not succeed, about six ounces of blood may be drawn from the arm, and, if necessary, repeated in a week's time. The sickness in such cases depends on irritation, and is only to be removed with' cer- tainty by bleeding. To abate excessive vomiting local applications have been recom- mended. For example, a piece of folded linen cloth, moistened with the tincture of opium, may be kept constantly applied to the stomach; to which, probably, the addition of a small portion of ether might increase its effect. It sometimes happens that vomit- ing continues incessantly for many days, accompanied with great prostration of strength, and constant thirst, with, at the same time, an utter impossibility of retaining any thing on the stomach. Under these circumstances the application of leeches to the pit of the stomach, and a constant attention to swallow nothing that can irri- tate, allowing the patient asses' milk, and that by a single spoonful at a time, have afforded relief. If much nausea should prevail without the possibility of throwing up, fourteen or fifteen grains of the powder of ipecacuanha may then be given, experience hav- ing proved that gentle emetics may be safely administered to preg- nant women. Heartburn. — When a pregnant woman is incommoded by heartburn, (which commonly arises from acidity in the stomach,) half a drachm of magnesia may be taken morning and evening; and, if this fail to obviate it, the absorbent mixture advised below* may be used, which Dr. Sims says he has found the most effica- cious of all remedies for the removal of this distressing complaint. Head-ache with Plethora. — When either drowsiness, a sense of fulness of the vessels of the head, or head-ache, prove trouble- some to pregnant women, taking away a few ounces of blood from the arm in robust women will most likely prove serviceable. In women of a weak irritable habit the application of a leech or two to each temple will be more advisable than bleeding from the arm, where the head-ache proves obstinate, and resists the other means employed. CosTiVENEss, Piles, &-c. — Costiveness, partial suppressions of urine, and the piles, which attend on the second stage of preg- nancy, are occasioned by the great pressure of the uterus on the rectum and bladder. The first and last of these symptoms are to be obviated by a daily use of some gentle laxative ; such as a solution of manna, or the subjoined electuary.! Pills com- * Take Magnesia, 1 drachm. table-spoonsful may be taken occasion- Pure Water, 5 ounces. ally. Spirit of Cinnamon, 3 drachms. Solution of Ammonia, 1 drachm. f Take Confection of Senna, I A ounce. Make a mixture, of which two or three Cream of Tartar, jounce The size of a nutmeg to be taken occa sionally. 406 DISEASES OF PREGNANCY. po?ed of aloes are highly improper, as being of a nature too stim- ulating, and very apt to occasion hemorrhages, and bring on the piles. When the piles are troublesome, the best applications, when they can be applied, are leeches and cold saturnine lotions, as a solution of the superacetate of lead. To allay the irritation, ten grains of the superacetate of lead, dissolved in four ounces of rose-water, to which, if necessary, a little of the vinous tincture of opium may be added, form a good lotion. Tooth-ache. — To relieve the tooth-ache a few drops of the oil of cloves, cajeput, juniper, or any other essential oil, applied to the affected tooth, will often remove it for the time. Longings. — It is always desirable to gratify the peculiar longings of pregnant women, otherwise they are apt to miscarry from the anxiety these o(;casion, when not indulged in them. But that the child in the womb can be marked by any depraved appetite of the mother, or be mutilated by any disagreeable sight that may be presented to her, cannot readily be admitted. Hysterics. — Should sudden fainting, or any other hysterical affection, arise, little more will be necessary than to expose the pa- tient to a free open air, to place her in a horizontal position, and to give her a glass of cold water, with a few drops of hartshorn, or a little wine sufficiently diluted. DiARRHCEA. — Diarrhoea during pregnancy should be treated just as at any other time ; and after the stomach and intestines are cleared astringents may be used, if there be no great degree of fever present ; but should there be fever, that must be attended to and first removed. Suppression of Urine. — To relieve the suppression of urine that frequently takes place in the advanced state of pregnancy, be- sides making use of emollient fomentations, clysters, and gentle purgatives, such as castor-oil, (fee, the patient, at the same time, drinking plentifully of diluent liquors, surgical aid will be necessa- ry to draw it off morning and evening by means of a catheter. Troublesome Itchings. — When these sensations arise about the parts of generation during the pregnant state, it will be proper to keep the body perfectly free with some cooling laxative, and to wash the parts three or four times a day with a solution of lead, or the diluted solution of the acetate of lead. If much irritation ac- company this itching, leeches may be applied to the place. Puffy Swellings of the feet, ankles, and private parts, which are aj)t to arise towards the end of pregnancy, are occasioned by the pressure of the womb on the returning vessels, which prevents the blood being carried back to the heart. Gravid women are usu- ally free from these complaints in the morning, but towards night they frequently suffer much from them. Slight scarifications from the edge of a lancet, to discharge the stagnated fluid, with the af- DISEASES OF PREGNANCY. 407 ter-application of flannels wrung out in a warm effusion of emolli- ent lierbs, have l)f;en employed in cases o^ ^reat distention. In {general, however, it will only be necessary that the patient does not keep her feet in a pendent position for any length of time. Cramps of tjie Legs and Thighs are to be relieved by rubbing the parts with cold vinegar ; camj)hor dissolved in oil, or other liniments, the person wearing stockings in bed. At an advanced period of pregnancy they are only to be relieved by labour remov- ing the cause. Proper doses of ether and tincture of opium, with the means advised in hysterical affections, will afford the greatest benefit where the stomach is affected with spasms. In such cases the patient will do well to avoid all kinds of food that are apt to prove flatulent and hard of digestion, and keep the body perfectly open. Restlessness and Want of Sleep prove troublesome complaints towards the latter end of pregnancy, obliging the patient to rise frequently throughout the course of the night, in order to expose herself to the influence of cool air. In cases of this nature noth- ing affords relief so eftectually as small bleedings, with the occa- sional use of some cooling laxative medicine. Opiates, in such conditions, are never attended with any advantage. Varicose Veins. — Considerable enlargement and distention of the veins of the legs, thighs, and abdomen often take place to an alarming extent in the last state of pregnancy. But, as no bad consequences have been observed to attend this state, the only thing necessary to be done is to empty the vascular system by moderate bleeding, gentle purging, and a spare diet. Should, how- ever, the vein of any particular part become so distended as to prove troublesome, it may be advisable to apply a bandage of a moderate tightness, so as to give the necessary support to it. Jaundice. — Pregnant women, in some instances, are afflicted with a pain in the side, excessive sickness at the stomach, and retchings, the skin assuming a deep yellow tint ; under which cir- cumstances alone the complaint proves distressing; and it is usual- ly occasioned by the formation of one or more gall-stones, and the obstructions they oppose to the usual and regular passage of the bile. The most efficient means to relieve the patient from this de- gree of the complaint are, bleeding, fomentations of the painful' part, and large doses of opium, with such laxatives as shall coun- teract the constipating effects of the latter. When jaundice or any other bilious effects prevail during pregnancy, in consequence of the pressure kept up by the womb on the gall-bladder or ducts, it is to be obviated by keeping the body open with some gentle lax atives, as nills composed of jalap and rhubarb. liSrcoNTiNENcy OF Urine is to be removed only by delivery, but may admit of being partially relieved by the horizontal posture. The bad effects of this very disagreeable complaint, may be pre- vented by a scrupulous attention to cleanliness, and the use of a 40S CONVULSIONS. thick coiTijn-ess of linen, or a sponge of considerable size, prop erly fastened. OvER-DisTENTiON OF THE Skin. — The skin of the abdomen, in the latter months of pregnancy, will sometimes become cracked and sore. In this case nothing is more effectual than the frequent use of warm oil by friction ; to which a little camphor m^y be ad- ded to give it somewhat of a medicated appearance. False Pains, resembling those attendant on actual labour, are apt to come on at a late period of pregnancy, often occasioning un- necessary alarm. Confinement in a horizontal position ; bleeding, if of a full habit ; laxative medicines if costive, and giving small and frequent doses of some opiate until the patient finds ease, will, in such cases, be necessary. CH^P. VIZI. CONVULSIONS. CoNVutsioNS may take place either during pregnancy or labour. These are of different kinds, requiring opposite treatment. One species is a consequence of great exhaustion from a tedious labour, excessive fatigue, and profuse hemorrhage ; which makes its at- tack without much previous warning, and generally alternates with faintings, or great depression of strength, and debility : the muscles about the face and chest are chiefly affected, and the pulse is small, frequent, and compressible, the face pale, the eyes sunk, the extremities cold. The fits succeed each other rapidly, and ve- ry soon terminate in a fatal syncope.* In all cases of this nature, the first object should be directed towards restraining the hemor- rhage if ])resent, or preventing any kind of exertion, thus husband- ing the remaining strength, or recruiting it by cordials. In con- junction with ether and camphor, opiates will be of considerable •service. Delivery is usually necessary. The other species of convulsions, which are those of an hysteri- cal nature, are more common during gestation than during partu- rition. In this case it may only be necessary to add to vvhat has been already said relative to hysterics (p. 390.), that if they do not speedily yield to antispasmodics, bleeding had better be resorted to : should this fail, the woman, if possible, should be delivered. Puerperal convulsions seldom happen before the sixth month, but may occur at any time between this period and the completion of labour. They may arise as the first symptom of labour, or after delivisry. This species of convulsion depends on the state of the uterus, and has been remarked to occur more frequently during the first pregnancy than in any subsequent one, particularly where the woman is unmarried. To prevent the occurrence of puerperal convulsions, as they are " It was this species of convulsion, apparently, that destroyed Her Royal Highnesf ^tiM Princess Charlotte of Wales. ABORTION. 409 in every instance to be considered liighly dang'erous, particularly at an advanced period of pregnancy, it is advisable in women oi" robust and plethoric habits to bleecl frequently during the progress of pregnancy, by abstracting a sufficient quantity of blood at dif- ferent periods ; taking care, at the same time, and particularly near the termination of pregnancy, to keep the body open by cool- ing purgatives. In women of an unstable constitution, all exciting causes should be carefully avoided, and the habit be strengthened as much as possible, and by that means rendered less susceptible of disagreeable impressions. CHAP. IX. ABORTION, too soon is apt to produce a debilitating dis- charge. Women disposed to abort should the more sedulously avoid the exciting causes of abortion at those dates of utero-gesta- tion when it is most apt to take place. CHAP. X. MANAGEMENT OF CHILDBED-WOMEN. Many diseases proceed from the want of due care in child-bed ; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case ivith young wives. They think, when the labour-pains are ended, the danger is over ; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fcetus; but proper care and management are certainly necessary for the recovery of the mother. No doubt, mischief may be done by too much as well as by too little care. Hence females who have the greatest number of attendants in child-bed generally recover worst. But this is not peculiar to the state ot child-bed. Exces- sive care always defeats its own intention, and is generally more dangerous than none at all.* • Though the management of women in child-bed has been practised as an employ- men* sincr the earliest accounts of time, yet it is still in most countries on a very bai 412 MANAGEMENT OF CHILD-BED WOMEN During actual labour, nothing of a heating nature ought to be given. The woman may now and then take a little panado, 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 pait tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, as they occasion violent and mortal hemorrhages, or dispose her to erup- tive and other fevers. Parturition. Is that natural process which, at the expiration of forty weeks from conception, is matured, and by which the womb detaches and expels its contents, and returns nearly to the same condition in which it was previous to its impregnation. Classification of Labours, &c. The division of labours, originally made by Hippocrates into natural and preternatural, is sufficiently comprehensive, whilst it forcibly recommends itself by its simplicity and perspicuity. Natural labour, of which we shall only treat here, supposes four things: \. Tliat the vertex presents. 2. That there be sufficient room in the pelvis to admit of the ready descent of the child m that direction which permits the occiput or back part of the head to emerge under the arch of the pubis. 3. That there be parturi- ent energy adequate to the expulsion of the contents of the uterus, without manual interference ; and without danger, either to the mother or child : and, 4. That the process of parturition be com- pleted within a moderate time. Stages of Labour. Certain occurrences take place during the progress of parturi- tion which may be managed under three divisions or stages; the €rst comprehends all that may occur before the complete dilatation of the OS uteri; the second includes all that takes place between the developement of the os uteri and the expulsion of the child; the third embraces every thing connected with the detachment and extension of the placenta and its adherent membranes. Symptoms preceding Labour. For several days before the actual existence of labour arrives, footing. Few women think of following this employment till they are reduced to the necessity of doing it for bread. Hence not one in a hundred of them have any edu cation, oi- proper knowledge of their business. It is true, that nature, if left to her- self, will generally expel iho. fcRtus ; 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 prevent- ed by allowing no women to practise midwifery but such as are properly qualified. Were due attention 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 disagreeable branch of medicine, which is, on many accounts, more proper for the other sex. MANAGEMENT OF CHILDBED WOMEN. 413 there are often certain premonitory symptoms, whicli, by women who have borne children, are viewed as precursors of that eventful hour which many of them so much dread. Among these are: 1. Restlessness, particularly at night, very frequently precedes parturition for days and weeks, and is rarely to be considered aa bearing unfavourably in labour. 2. Subsidence of the womb and abdomen is not an unusual monitor of the approach of suffering. It may be viewed in a favourable light, inasmuch as it indicates room in the pelvis. 3. Glairy mucuous secretion from the os uteri and vagina, popu- larly termed shew, sometimes occurs for days before the more active symptoms of labour. It is often streaked with blood, and tends to lubricate the parts concerned in parturition. 4. Ifn-itability of the bladder and rectum, demanding their frequent relief, is another occasional precursor of labour. Symptoms accompanying Labour. Owing to the resistance which the womb encounters during its contractile efforts, pain follows every such contraction ; but the pain attendant on parturition differs very materially in its nature, and in its influence in the uterus. These paroxysms of pain are either intestinal or uterine. Paroxysms of intestinal pain, or such as are termed false or spu- rious, may be distinguished from genuine labour-pains by being unconnected with uterine contraction ; by attacking different parts of the abdomen ; and by recurring irregularly. These pains usually originate in some source of intestinal irritation, and may almost always be removed by emptying the bowels, and subsequently exhibiting an opiate. By the observant practitioner, should one be present, they cannot be confounded with pain in the bowels. The true or uterine pains are either dilating or expulsive. Dilating Pains, or, as they are popularly termed, grinding paint), result from contraction of the womb. They are principally cf>n- fined to the back, and occur in the earliest stage of labour, and are often peculiarly distressing to the patient, who expresses her- self by restlessness, despondency, and moaning. They often con- tinue a long time without the intermissions being free from uneasi- ness, and appear almost exclusively to dilate the mouth of the womb, having little influence over the fundus of the uterus. It is during the existence of these dilating pains that cold shiverings most com- monly come on, and may be relieved by avoiding spiced or fer- mented fluid, and by administering any simple v/arm diluents. When the mouth of the womb is considerably dilated, expulsive pains, sometimes termed ybrcm^ or bearing down pains, commence in the loins, and gradually proceed round the abdomen, till they meet at the region of the pubes, and dart down the labia pudendi and thighs. If the accoucheur's hand be placed on the flaccid sides of the abdomen, previous to the accession of a paroxysm of expulsive pain, before the woman is aware of it, the womb may be felt contracting to a hard, tense, incompressible tumour. These pains observe regular intervals of ease, which become shorter, ivhilst the pains, in an inverse ratio, increase in their duration and iU MANAGEMENT OF CHILD-BED WOMEN. severity ; and now it is that the abdominal muscles and diaphra^u. afford their assistance. During each propulsive efibrt a larger portion of the membranes, distended with the liquor of the amnion, is forced through the mouth of the womb, performing to it, and all the parts through wliich the child is to pass, the office of an easy but powerful wedge. With these pains there is often a frequent d'lposition to empty the rectum ; and sometimes this inclination is so harassing as to justi- fy the administration of a small clyster, with half a drachm of the tincture of opium. Vomiting is a common attendant on uterine pain, and is benefi- cial by rejecting food, which, from its quality or quantity, may be a source of irritation to the stomach. It principally occurs during the dilating pains, and unquestionably assists in the relaxation and dilatation of the mouth of the womb. In a protracted labour, when vomiting continues or returns, after the mouth of the womb is fully dilated, with abdominal tension and pain, without uterine contractions, and with ejection from the stomach of fluid like dark coffee-grounds, with foul tongue, and rapid and hard pulse, it generally must be taken as indicative of inflammatory action, and as requiring immediate and most efficient interference. Besides these attendants on parturition, the pulse usually becomes quickened and full ; the countenance florid ; the whole surface of the body covered with profuse perspiration; and the lower extremities cramped. The Process of Natural Labour. The process of natural labour, to use the words of a modern writer, is at once so simple and beautiful, that it cannot fail to ex- cite the admiration of those who look beneath the surface of the operations of nature. Without repeating what has already been advanced respecting the precursory and accompanying symptoms of delivery, we shall merely recall to the mind those statements, as constituting a part of the history of this process. The symp- toms which announce the commencement of natural labour have continued for an indefinite time ; pains in the loins, darting through the pelvis, with an appearance of sheio, indicate the ap- proach of unequivocal evidences of this stage of parturition. From time to time these pains are of the dilating kind and on an examination per vaginam, will be found to be diminishing the thickness of the cervix uteri more than to be opening the mouth of the womb. When the neck of the womb becomes reduced to the thickness of the other parts of that organ, it begins to open, and as soon as it can admit the extention of any part of the membranes distended with the liquor of the amnion, the pains rather assume the expulsive character, and there will be a sensible bearing down of the whole uterine tumour. Successive pa/oxysms of pain dilate the mouth of the womb more and more, whilst the protruded mem- branes, distended like a tense bladder, fill up the opening, and perform the office of an inimitable wedge, till the womb and the enirance to it form one continuous passage. Soon after this the membranes generally burst during a strong pain, having previously MANAGEMENT OF CHILD-BED WOMEN. 415 contributed to the dilatation of the vagina ; and with the escape of the waters, or liquor of the amnion, there is sometimes a tem- porary susjjension of pain, and the head of the child falls into the superior aperture or brim of the pelvis, or descends into the cavi- '.y ; but more frequently this advance is not made until several pains have followed this occurrence. The contractions of the w/omb recurring with augmented fre- fjuency and force, gradua«lly propel the foetus along the passages, until the head presses on the perina^um or fork, which is put on :he full stretch ; and also against the soft parts which it protrudes. These by degrees dilate, and permit the back part of the head to emerge under the arch of the pubes, and with the complete extru- sion of the head, the other parts of the body are expelled, some- times by the same pain, but more frequently by one which speedily follows. The same paroxysm of pain that expels the child now and then detaches and expels the placenta, or after-burden, commonly so called; but more frequently the womb remains at rest for about a quarter of an hour, when it resumes its contractions, and throws it off with the adherent membranes. This constitutes the interest- ing process of natural labour, in which the uterus requires no offi- cious interference, but which, when forced to submit to any, she often resents, by harassing the busy meddler with some untoward occurrence. All that it becomes necessary for the accoucheur to do during this interesting process of natural labour, is to support the peri- neum by his hand, covered smoothly with a soft napkin, and s/ applied as to give equable support, without in the slightest degree resisting the exit of the head. No other interference, in natural labour, is justifiable, and too strong terms cannot be employed to rrprobate the practice of hastening the birth of the body, dragging it forcibly by the head into the woi-ld. It should be left to be ex- pelled by the unaided contraction of the uterus. As soon as the child is thus brought into the world, and manifests unequivocal signs of life, the funis or navel-string must be tied, by passing a ligature, consisting of a few threads, or a thin piece of tape, ix)und it, at about the distance of two inches from the navel, and a second at the distance of three inches from the first. The funis may then be divided by a round-pointed pair of scissors, at a point equidistant from each ligature, taking care to cut nothing but the funis. All this should be done in the most delicate manner under the bed-clothes, without exposing either the mother or child. The navel-string being thus secured, and the child separated from the mother, it is to be transferred to the nurse, whilst the bandage, previously passed round the body of the mother, should be moderately tightened, or the womb supported by gentle pressure made by an assistant, which will be found very materially to aid its efforts to detach and expel the placenta. Management of the After-burden. The management of the placenta constitutes a very important part of natural labour ; and if the womb be not permitted to il6 MANAGEMENT OF CHILD-BED WOMEN. empty itself gradually, some untoward and alarming circumstance may occur in tliis stage of parturition. Generally from twenty to thirty minutes elapse between the birth and the expulsion of t.'ie placenta. The woman then complains of a slight pain in her back or abdomen, and this secondary contraction of the uterus de- taches the placenta, although it but rarely expels it from the pass- ages ; whence, however, it may usually be easily removed by coil- ing the funis round two of the fingers of the right hand, whilst guided by the cord, the thumb and index finger of the left hand should be passed up to its insertion into the placenta, which, if it can be felt, is a pretty certain indication of the detachment of the whole mass from the sides of the womb. By this means, also, the navel-string is prevented from breaking off, and a firmer hold of the placenta is obtained. To prevent the possibility of inverting the womb, or from its oc- currence without knowing it, the placenta should be permitted to slip by the fingers of the left hand into the vagina ; and the with- drawing of the placental mass should always be in the axis of the brim, cavity, and outlet of the pelvis, as it passes those parts. The hand of the accoucheur should afterwards be laid on the abdomen, to ascertain that the utarus is well contracted : and the pulse should be felt, lest internal hemorrhage redistending the uterus may be going on to the endangering of the patient's life. It is of great importance that a bandage be passed over the re- gion of the womb : this being done, and a well-aired napkin ap- plied tc the labia pudendi, or external parts, some mild and cool nourishment may be given to the woman, who, after having been suffered to remain quiet for about half an hour, should have her soiled linen withdrawn, and, without being raised from her hori- zontal posture on any pretence, may be drawn up to the head of the bed ; whilst she herself remains perfectly passive, without tak- ing any part in this operation, lest hemorrhage or prolapsus of the womb should follow. Tedious Labours. — When the labour proves tedious and diffi- cult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered, and the patient should sit over the steams of warm water. The pas- sage ought to be gently rubbed with a little soft pomatum, or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours ; and in all preternatural cases, a skilful surgeony or man-midwife, ought to be called as soon as possible. Trkatment after Delivery. — After delivery, the woman ought to be kej)t as quiet and easy as possible.* Her food should be * We cannot help taking notice of that ridiculous custorn which still prevails in some parts of tne country, of collecting a number of women together upon such occa- sions. Those, 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 Jbeir untimely and impertinent advice, do much mischief. MANAGEMENT OF CHILD-BED WOMEN. 417 ng)it and thin, as gruel, panado, &c. and her drink weak and di- luting. To this rule, however, there are many exceptions. I have known several women, whose spirits could not he supported in child-bed without solid food and generous liquors ; to such, a glass of wine and a bit of chicken must be allowed. Sometimes an excessive hemorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flow of the menses. If the flooding prove violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, should be applied to tlie belly, the loins, and the thigh : these must be changed as they grow dry, and may be discontinued as soon as the flooding abates. In a violent flooding after delivery, 1 have seen very good effects from the following mixture : — Take of penny-royal water, simple cinnamon-water, and syrup of poppies, each tv/o ounces, elixir of vitriol, a drachm. Mix, and take two table-spoonsful every two hours, or oftener if necessary. After-Pains. — If there be violent pains after delivery, the pa tient ought to drink plentifully of warm diluting liquors, as groat- gruel, or tea with a little saffron in it ; and to take small broths, with caraway-seeds, or a bit of orange-peel in them ; an ounce of the oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors ; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink.* If she be hot or feverish, one of the follow- ing powders may be taken in a cup of her usual drink every five or six hours. Take of crabs' claws prepared, half an ounce, purified nitre two drachms, saffi-on powdered, half a drachm ; rub them together in a mortar, and divide the whole into eight or nine doses. And if she be low-spirited, or troubled with hysterical complaints, she ought to take frequently twelve or fifteen drops of the tincture of asafoetida in a cup of penny-royal tea. CosTivENEss. — Costiveness is apt to prevail after delivery, and should always be removed by a laxative clyster, or some gentle purgative, such as neutral salt and manna, or about an ounce of castor oil. Inflammation of the "Womb. — An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increas- ed upon touching ; by the tension or tightness of the parts ; great weakness ; change of countenance, a constant fever, with a weak and hard pulse ; a slight delirium, or raving ; sometimes incessant vomiting ; a hiccup ; a discharge of reddish, stinking, sharp water from the wound ; an inclination to go frequently to stool ; a heat, and sometimes total suppression of urine. • Take Cinnamon Water, 1 ounce. Tincture of Castor, ^ drachm. Tincture of Opium, Syrup of Violets, 2 drachms 27 30 to 40 drops. Make a draught, to be taken at bed-time 418 MANAGEMENT OF CHILD-BED WOMEN. This must be treated like other inflammatory disorders, by bleed mg and plentiful dilution. The drink may be thin gruel or bar- ley-water ; in a cup of which half a drachm of nitre may be dis- solved and taken three or four times a-day. Clysters of warm milk and water must be frequently administered : and the belly should be fomented by cloths wrung out of warm water, or by ap- plying bladders filled with warm milk and water to it. Suppression of the Lochia. — A suppression of the lochia or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacu- ations, and fomentations of the parts affected. In the milk-fever, the breasts may be embrocated with a little warm linseed-oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person. Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child. Every mother who has milk in her breasts ought either to suckle her own child or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed. Inflammation of the Breast. — When an inflammation happens i\\ the breast, attended with redness, hardness, and other symp- toms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to sup- puration. The use of repellents, in this case, is very dangerous ; they often occasion fevers, and sometimes cancers ; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects. Fretted or Chapped Nipples. — When the nipples are fretted or chapped, they may be anointed with a mixture of oil and bees' wax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary-water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it. Miliary Fever. — The miliary fever is a disease incident to wo- men in child-bed ; but as it has been treated of already, we shall lake no farther notice of it. The celebrated Hoffinan observes, that this fever of child-bed women might generally be prevented, if tiiey, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, riiubarb, or cream of tartar ; not forgetting to bleed in the first months, and lo avoid all sharp air. When the labour is coming on it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions pro- MANAGEMENT OF CHILD-BED WOMEN. 419 coed regularly ; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered. Puerperal Fever. — The most fatal disorder consequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Some- times, indeed, it comes on sooner, and at other times, though rarC' ly, it does not appear before the fifth or sixth day. It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at the stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb ; a sudden change in the quan- tity or quality of the lochia also takes place ; and the patient is fre- quently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease ac- quires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future progress. There is not any disease that requires to be treated with more skill and attention than this: consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning-, it ought, however, to be used with caution, and not to be repeated, unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb. During the rigour, or cold fit, proper means should be used to abate its violence and shorten its duration. For this purpose, the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of wine-whey; warm applications lo the extremities, as heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage. Emollient clysters of milk and water, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial, by promoting a discharge from the intes- tines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care, however, is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time. To evacuate the oftending bile from the stomach, a vomit is gen- erally given. But as this is apt to increase the irritability of the Btomach, already too great, it will be safer to omit it, and to give m its stead a gentle laxative, which will both tend to cool the body, and to procure a free discharge of the bile.* * Midwives ought to be very cautious in administering vomits or purges to women in child-bed. I have known a woman who was recovering extremely well, thrown in- io the most imminent danger by a strong purge whch was given her by an officious midwife. 420 MANAGEMENT OF CHILD-BED WOMEN. The medicine which I have always found to succeed best in this disease, is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added. If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require ; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or the powder of bole combined with opium. Though in general the food ought to be light, and the drink diluting, yet, when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to sup- port her with nourishing diet, and generous cordials. It was observed, that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents ; or a scruple of the extract of bark with half an ounce of spiri^tuous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary. When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef-tea or chicken-broth. To avoid this fever, every woman in child-bed ought to be kept perfectly easy ; her food should be light and simple, and her bed- chamber cool and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed after delivery ; catching cold is also to be avoided ; and a proper attention should be paid to cleanliness. Milk Fever. — To prevent the milk fever, the breasts ought to be frequently drawn ; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to pre- vent the milk from becoming acrid, and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet. We shall conclude our observations on child-bed women, by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold of which they never recover. It is a pity the poor are not better taken care of in this) situation. But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to everv one. The BARRENNESS. 421 superstitious custom of obliging women to keep the house till they go to church is Hkewise 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 v/arm room for a month. CHAP. XI. OF BARRENNESS. Barrenness may be very properly reckoned among the diseases of females, as kw married women, who have not children, enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, «fcc. ; but it is chiefly owing to an obstruction or irregularity of the menstrual flux. It is very certain that high living vitiates the humours, and pre- vents fecundity. We seldom find a barren woman among the la- bouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in propor- tion to their poverty ; and it would be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and de- pendants the blessing of a numerous and healthy offspring, while ihey pine in sorrow for the want of even a single heir to their ex- tensive domains. Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids ; a state highly un- favourable to procreation. To remove this, we would recommend the following course : — First, sufficient exercise in the open air ; secondly, a diet consisting chiefly of milk and vegetables*; thirdly, the use of astringent medicines, as steel, .alum, dragon's blood, elixir of vitriol, the Spa or Tunbridge waters, Peruvian bark, &c.; and, lastly, above all, the cold bath. Barrenness is often the consequence of grief, sudden fear, anxi- ety, or any of the passions which tend to obstruct the menstrual fiux. When barrenness is suspected to proceed from aff^ections of the mind, the person ought to be kept as easy and cheerful as pos- sible ; all disagreeable objects are to be avoided, and every meth- od taken to amuse and entertain the fancy. I believe I have never written, and I hope I never shall write. Bay thing offensive to real modesty. Yet I have not suppressed, from motives of false delicacy, what I thought might be of import- * Dr. Cheyne avers, that want of children is oftener the fault of the male than of the female ; in this the Doctor and I do not agree ; and strongly recommends a milk and vegetable diet to the former as well as the latter; adding, that his friend Dr. Taylor, whom he called the Milk-doctor of Croyden, had brought sundry opulent families in his neighbourhood, who had continued some years after marriage without progeny, to have several fine children, by keeping both parents, for a considerable time, to a milk »nd vegetable diet. 422 DISEASES OF INFANTS. ance on a subject so closely connected witli conjugal happiness, Tlie remarks here made, though few and apparently simple, con- tain all that is really known, in medical practice, of the causes and remedies of barrenness. I therefore wish to put married ladies on their guard against the fallacy of private suggestions, and of public advertisements on this head. The tilings commonly advis- ed by silly nurses, as well as the grand restoratives of quack im- postors, are all of them dangerous stimulants, that provoke desire, iDut enfeeble, instead of strengthening, the powers of nature, and render a weakness, which proper treatment might have removed, absolutely incurable. CHiLF. XII. DISEASES OF INFANTS. Miserable indeed is the lot of man in the state of infancy ! He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his pa- rents : but, alas ! this care is not always bestowed upon him ; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.* It must be obvious to every attentive person, that the first dis- eases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with in- digestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be con- sidered as a poison ; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death. As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to re- move it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonsful of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates ; or. what will more certainly answer the purpose, a grain of emetic tar- tar, may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are unwilling to use * Of the oiEcious and ill-judged care of midwives, we shall adduce only one inatan<:i'', viz. the common practice of torturing infants, by squeezing their breasts, to draw ofl' the milk, as they call it. Though a small quantity of moisture is generally found w the breasts of infants, yet, as they are certainly not intended to give suck, this cujhf. never to be drawn off. I have seen this cruel operation bring on hardness, inflamma- tion, and suppuration of the breasts; but never knew any ill consequences fron it« boing omitted. When the breasts are hard, the only application that we woald re commend is a soft poultice, or a little of the diachylon plaster, spread thin upuu a bi' of soft leather^ about the size of half a crown, and applied over each nipple. Thesr indy be suffered to continue till the hardness disappears. DISEASES OF INFANTS. 423 U?c emetic tartar, may give six or seven drops of the antimonia'. wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecftcuanha wine will be found more gentle than any of the above, and ought to he preferred. These medicines will not only cleanse the stomach, but will gen- erally likev/ise open the body. Should this, however, not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved ii! boiling water, and given in small quantities till it operates ; or, what will answer rather better, a few grains of magnesia alha may be mixed in any kind of food that is given to the child, and con- tinued till it has the desired effect. If these medicines be properly administered, and the child's belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve ^.hose affections of the stomach and bowels from which infants suf- fer so much. These general directions include most of what can be done for relieving the internal disorders of infants. They will likewise go a considerable way in alleviating those which appear externally, as the rash, gum, or fellon, «fec. These, as was formerly observed, are principally ov^ing to too hot a regimen, and consequently will be most effectually relieved by gentle evacuations. Indeed, evac- uations of one kind or other constitute a principal part of the med- icine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief. Of the Meconium. The stomach and bowels of a new-born infant are filled with a blackish-coloured matter of the consistence of syrup, commonly called the mtconium. This is generally passed soon after the birth, by the mere effort of nature ; in which case it is not necessiry to give the infant any kind of medicine. But if it should be retained, or not sufiiciently carried off, a little manna, or magnesia alba, may be given, as mentioned above ; or, if these should not be at hand, a common spoonful of whey, sweetened with a little honey, or moist sugar, will answer the purpose. The most proper medicine for expelling the meconium is the mother's milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they show an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium ; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats. The AphthjE, or Thrush. The aphthae are little whitish ulcers affecting the whole inside of t!ie mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal ; in which case they are very dangerous, and often put an end to the infant's life. If the aphlh* are of a pale colour, pellucid, ievr in number, soft superficial, and fall easily off, ihey are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ough to be dreaded. 424 DISEASES OF INFANTS. It is generally thought that the aphthaj owe their origin to acrid humours ; we have reason, however, to believe, they are more fre- quently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion in- flammatory disorders, even in adults ; is it any wonder then that they should heat and inflame the tender bodies of infants, and set, as it were, the whole constitution on a blaze ] The most proper medicines for the aphthtE are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb, and half a drachm of magnesia alba, may be rubbed together, and divided into six doses, one of which may 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 ne- cessary to keep the body open. It is common in this case to ad- minister calomel ; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution. Many things have been recommended for gargling the mouth and throat in this disease ; but it is not easy to apply these in very young children; we would therefore recommend it to the nurse to rub the child's mouth frequently with a little borax and honey ; or with the following mixture : — Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose-water two drachms ; mix them together. A very proper application in this case is a solution often or twelve grains of white vitriol in eight ounces of barley- water. These may be applied with the finger or by means of a bit of soft rag tied to the end of a probe. Hiccups. Some infants are much incommoded by hiccups, arising proba- bly, either from acidity in the stomach, or from some nervous irri- tation. In the former case, a powder composed of a little prepar- ed chalk and rhubarb (about eight grains of the former with two or three of the latter) may prove beneficial. In the latter, it may be proper to give a few drops of the aromatic spirit of ammonia, or the compound tincture of camphor (paregoric.} In some cases, a little plain vinegar has proved an effectual remedy. Where the complaint is severe, or returns frequently, it may be advisable to rub the stomach with soap liniment, to which a little tincture of opium has been added. Of Acidities. The food of children being for the most part of an acescent na- ture, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of children are ac- ■companied with evident signs of acidity, as green stools, gripes, &,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 considers the matter attentive- ly, will find that these symptoms of acidity are oftener the effect tthan the cause of their diseases. DISEASES OF INFANTS. 425 Nature evidently intended that the food of children sliould be acescent ; and unless the body be disordered, or the digestion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, how ever, is often a symptom of disorders in children ; and, as it is sometimes a troublesome one, we shall point out the method of re- lieving it. When green stools, gripes, purgings, sour smells, &lc., sliow that the bowels abound with an acid, the child should have a little small broth, with light white bread in it ; and should have sufficient exer- cise, in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs' eyes, and other tes- taceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines ; as rhubarb, manna, or such like. The best medicine which we know, in all cases of acidity, is that fine insipid powder, called magnesia alba. It purges, and at the same time corrects the acidity : by which means it not only removes the disease, but carries ott its cause. It may be given in any kind of food, or in a mixture, as recommended in the Ap- pendix.* When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things : but should have its body opened with an emollient clyster, or the medicine mentioned above ; and, at the same time, a little brandy may be rubbed on its belly with a warm hand before the fire. I have sel- dom seen this fail to ease the gripes of infants. If it should hap- pen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoon- ful of it given frequently, till the infant be easier. Sometimes a little peppermint-water will answer this purpose as well.t Galling and Excoriation. These are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine. As these complaints are, in a great measure, owing to want of cleanliness, the most efi'ectual means of preventing them are, to wash the parts frequently with cold water, to change the linen of- ten, and, in a word, to keep the child in ail respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders ; as burnt hartshorn, tutty, chalk, crabs' claws prepared, and the like. When the parts * See Appendix, Laxative absorbent Mixture. t Twenty drops of the spirits of harlsliorn given in a little linseed-tea immodiateiy relieves children affected by that acidity of the bowels which frequently attends teeth- ing. Much of the acidity of the stomachs of children arises '"rom the too free use ol' fermented bread. 42G DISEASES OF INFANTS affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders ; or tc anoir;*. the place with the camphorated ointment. If the parts be washed with spring-water, in which a little white vitriol has been dissolved, it will dry and heal them very [)Owerfully. One of the best appli- cations for this purpose is to dissolve some fuller's earth in a suffi- cient quantity of iiot water ; and after it has stood till it is cold, to rub it gently upon the galled parts once or 'twice a-day. Or to wash them gently now and then with a mixture of equal parts of rose-water and spirits of wine. Stoppage of the Nose. The nostrils of infants are often plugged up with a gross mucus^ which prevents their breathing freely, and likewise renders it diffi- cult for them to suck or swallow. Some in this case order, after a suitable purge, two or thre« grains of white vitriol, dissolved in half an ounce of marjoram wa- ter, and filtered, to be applied now and then to the nostrils with a linen-rag. Wedelius says, if two grains of white vitriol, and the same qv.antity oi elaterium, be dissolved in half an ounce of marjo- ram-water, and applied to the nose, as above directed, that it brings ftwav the mucus without sneezing. In obstinate cases these medicines may be tried ; but I have nev- er found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free.* Of Vomiting. From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are mi>ch more common in childhood than in the more advanced periods of life. They are seldom, however, dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient. Vomiting may be excited by an over-quantity of food ; by food that is of such a nature as to irritate the nerves of the stomach too much ; or by the seasibility of the nerves being so much increased as to render them unable to bear the stimulus of even the mildest aliment. When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be chang- ed, and aliment of a milder nature substituted in its stead. When vomiting proceeds from an increased degree of sensibility, * ??onie nurses remove this complaint by sucking the child's nose. This is by no means a cleanly operation ; but when nurses have the resolution to do it, I am r'ai >om discouraging the practice. DISEASES OF INFANTS. 427 or too great an irritability of the nerves of the stomach, sucr med- icines as have a tendency to brace and strengthen that orgar , and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel ; and the second by the saline draughts, to which a few drops of liquid laudanum may occasionally be added. In obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations made with wine, applied warm to the pit of tlie stomach ; or the use of the stomach-plaster, with the addition of a little i leriacn. Looseness. (Diarrkcea.) A looseness may generally be reckoned salutary, when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to he checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappear- ed. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours which would otherwise tend to relax the habit. Diarrhoea may be injurious in Medicink. — Medicines are here of little avail. The disease may often be cured l)y the nurse, hut seldom by the physician. In children of a gross habit, gentle vomits and re[)eated purges of v!iu!)arb may sometimes be of use, but they will seldom carry oflT llie disease ; that must depend chiefly upon such things as brace !ind strengthen the system ; for which purpose, besides the regimen mentioned above, we would recommend the cold bath, especially in the warm season. It must, however, be used with prud«. nee, as some ricketty children cannot bear it. The best tiirie for using the cold bath is in the morning, and the child should be well rub- bed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath it must be discon- tinued. Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would be of service, were it possible to bring children to take it. We might here mention many otiier medicines which have been recom- mended for the rickets ; but as there is far more danger in trusting Zo these than in neglecting them altogether, we choose rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on. Of Convulsions. Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves may occasion convulsions. Hence infants, whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal ; likewise by teething, strait clothes, the approach of the small-pox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure; where- fore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be re- peated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed with the powder of crabs' claws. Convulsions which precede the eruption of the small-pox or measles generally go off" upon these making their appearance. The principal danger in this case arises from the fear and apprehension of those who have the care of the patient. Convulsiotis are very alarming, and something must be done to appease the aff'righted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great dan- ger of its life, when a little time, bathing the feet in warm water, and throwing in a mild clyster, would have set all to rights. When convulsion-fits arise from the cutting of teeth, besides gen- tle evacuations we would recommend blistering, and the use of an tispasmodic medicines, as the tincture of soot, assafoetida, or cas- 436 DISEASES OF INFANTS. tor. 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 pres- sure occasioned by strait clothes or bandages, &c. these ought im- mediately to be removed ; though in this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover as long as the cause which first gave rise to the disorder continues to act. When a child is seized with convulsions without having any com- plaint in the bowels, or symptoms of teething, or any rash or other discharge which has been suddenly dried up, we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhap- py patient. When a disease proceeds from an original fault in the formation or structure of the brain itself we cannot expect that it should yield to medicine. But as this is not always the cause even of convulsions which proceed immediately from the brain, some at- tempts should be made to remove them. The chief intention to be pursued for this purpose is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders. Of Water in the Head. Though water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly lia- ble to it, we thought it would be most proper to place it among the diseases of infants. Causes. — A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like ; it may likewise pro- ceed from an original laxity or Aveakness of the brain ; from scir- rhous tumours or excrescences within the skull ; a thin watery state of the bicod; a diminished secretion of urine; a sudden check of the perspiration ; and, lastly, from tedious and lingering diseases, which waste and consume the patient. Symptoms. — This disease has at first the appearance of a slow fever ; the patient complains of a pain in the crown of his head, or over his eyes ; he shuns the light, is sick, and sometimes vomits ; his pulse is irregular and generally low ; though he seems heavy and dull, yet he does not sleep ; he is sometimes delirious, and fre- quently sees objects double ; towards the end of this commonly fa- tal disease the pulse becomes more frequent, the pupils are gener- ally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.* Medicine. — No medicine has hitherto, been found sufficient to carry oft a dropsy of the brain. It is laudable, however, to make * I have lately lost a patient in this disease where a curious metastasis seemed to take 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. DISEASES OF INFANTS. 437 3oine attempts, as time or chance may bring many things to light of wliich at present we have no idea. The medicines generally us- ed are, purges of rhubarb or jalap, with calomel, and blistering- plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white helle- bore, or the like.* Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any in- stance of a cure being performed in a confirmed dropsy of the brain ; but in so desperate a malady every thing deserves a trial. t To look over the long catalogue of infantile diseases in some medical books, one would be inclined to think that the real design of the authors, though concealed under the show of precision, was to spread alarm through every family. I have had a very dif- ferent object in view, to quiet the fears of parents, to diret;t their attention to the proper treatment of their children, and thus to ren- der the use of any medicines almost unnecessary. I have shown the folly of having recourse to physic to bring away the black, vis- cid, syrup-iike substance contained in the intestines of a new-born infant, when the purgative quality of its mother's milk is so admi- rably suited to that very purpose. The new milk is thin and wa- terish, but acquires every day greater consistenc :, and thus affords a more solid aliment to the child, as he become > more capable of digesting it. If the mother does not vitiate b/ her own improper diet the pure fountains of nourishment and health which nature has kindly given her, the child will neither be troubled with cos- tiveness nor gripes. He will escape those complaints of the sto- mach which are occasioned by swallowing crude, inflammatory trash, or still more pernicious drugs. The daily use of the cold bath and frequent exercise in the open air will not only preserve him from colds and defluxions, but from all the disorders which are the consequences of relaxation and of nervous irritability. A child brought up in the manner I have recommended will have lit- tle to fear even from external contagion. The firm texture of his skin, like a shield, will almost resist its approach, and the purity of his habit will correct its malignity. The small-pox is the only infectious disease for which I would have him prepare by any particular process, because that process * When the presence of this disease can be ascertained at a sufficiently early peri- od, I believe much benefit may be derived by taking away blood pretty freely by means of leeches applied near the temples. I lately saw an instance where a child was at- tacked with every symptom of this disease, by which its parents had previously lost children. Leeches were applied. The puncture made by one of them continued to. discharge blood during the whole night; on discovering this accident next morning the oarents were much alarmed for the consequences. From that period, however, the :hild began to recover, and is at present in good health. A. P. B. + One reason why this disease is seldom or never cured may be, that it is seldori. known till too far advanced to admit of remedy. Did parents watch the first symptoms, and call a physician in due time, I am inclined to think that something might be done. But these symptoms are not yet sufficiently known, and are often mistaken even by physicians themselves. Of this I lately saw a striking instance in a patient at tended by an eminent practitioner of this city, who had all along mistaken the disease for teething. 438 PHYSICAL MANAGEMENT ip so easy and certain, besides affording a perfect command both o.^ time and circumstances. (Hooping Cough.* See p. 207.) CHAP. XI. OBSERVATIONS ON THE MORAL AND PHYSICAL MANAGEMENT OF CHILDREN, DISEASES, «fec. It is during infancy that the foundation of a good or bad constitu- tion IS generally laid ; it is therefore of importance that parents should be well acquainted with the various causes which may in- jure the health of their offspring. It appears from the annual registers of the dead, that almost one half of the children born in Great Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but on due examination it will be found to be one of our own cre- ating. Were the death of infants a natural evil, other animals would be as liable to die young as man ; but this we find is by no means the case. It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the manage- ment of his young; but our surprise will soon jease, if we consid- er that ijrutes, guided by instinct, never err in this respect ; while man, trusting solely to art, is seldom right. Were a catalogue of those infants who perish annually by art alone exhibite-d to public view, it would astonish most people. If parents are above taking care of their children, others must be employed for that purpose ; these will always endeavour to re commend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and de- structive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder so many of them perish. Nothing can be more preposterous than a mother who thinks it below her to take care of her own child, or who is so ignorant as not to know what is proper to be done for it. If we search nature throughout, we cannot find a parallel to this. Every other animal is the nurse of its own offspring, and they thrive accor- dingly. Were the brutes to bring up their young by proxy thsj would share the same fate with those of the human species. We mean not, however, to impose it as a task upon every moth- er to suckle her own child. This, whatever speculative writers Aiiay allege, is in some cases impracticable, and would inevitably prove dee'ructive both to the mother and child. Women of deli- cate constitutions, subject to hysteric fits, or other nervous affec- tions, make very bad nurses ;t and these complaints are now so common, that it is rare to find a woman of fashion free from them ; Luch women, therefore, supposing them willing, are often unable to suckle their own children. * Small-pox, Mf.asles, Worms, &c. in the body of the work, tl have known an hysteric woniiu. kill her child by being seized with a fit in Ihfl eight OF CHILDREN. 439 Almost every mother would be in a condition to give suck, die! mankind live agreeably to nature ; but whoever considers how fur many mothers deviate from her dictates, will not he surprised to find some of them unable to perform that necessary office. Moth- ers who do not eat a sufficient quantity of solid food, nor enjoy the lienefit of free air and exercise, can neither have wholesome juices themselves, nor afford proper nourishment to an infant. Hence children who are suckled by delicate women either die young, or continue weak and sickly all their lives. When we say that mothers are not always in a condition to suckle their own children, we would not be understood as discour- aging that practice. Every mother who can. ought certainly to perform so tender and agreeable an office.* But suppose it to be out of her power, she may, nevertheless, be of great service lo her child. The business of nursing is by no means confined to giving suck. To a woman who abounds with milk, this is the easiest part of it. Numberless other offices are necessary for a child, which the mother ought at least to see done. A mother who abandons the fruit of her womb as soon as it is born to the sole care of an hireling hardly deserves that name. A child, by being brought up under the mother's eye, not only secures her afl^ection, but may reap all the adv intages of a parent's care though it be suckled by another. How can a mother be better em- ployed than in superii Unding the nursery ? This is at once the most delightful and important office ; yet the most trivial business or insipid amusements are often preferred to it ! A strong proof both of the bad taste and wrong education of modern females. It is indeed to be regretted that more care is not bestowed in teaching the proper management of children to thos« whom nature has designed for mothers. This, instead of being made the princi- pal, is seldom considered as any part of female education^ Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to that char- acter 1 However strange it may appear, it is certainly true, that many mothers, and those of fashion too, are as ignorant, when they have brought a child into the world, of what is to be done for it, as the infant itself. Indeed the most ignorant of the sex are generally reckoned most knowing in the business of nursing. Hence, sensible people become the dupes of ignorance and super- stition ; and the nursing of children, instead of being conducted by reason, is the result of whim and caprice. t * Many advantages would arise to society, as well as to individuals, from mothers Buckling their own children. It would prevent the temptation which poor women are laid under of abandoning their children to suckle those of the rich for the sake of gain ; by which means society loses many of its most useful members, and mothers becoir : in some sense the murderers of their own offspring. 1 am sure I speak within the truth when I say, that not one in twenty of those children live who are thus abandon- ed by their mothers. For this reason no mother should be allowed to suckle anoth- er's child till her own is cither dead or fit to be weaiied. A regulation of this kino would save many lives among the poorer sort, and could do no hurt to the rich, as most women who make good nurses are able to suckle two children in succession upon the same milk. t Tacitus, the celebrated Roman historian, complains greatly of the degeneracy ol 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 attPJid their children; but liial now the young infant was com 440 PHYSICAL MANAGEMENT Were the time that is generally spent by females in the acquisi- tion 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 wholesome and nourishing food ; how to exercise their tender bodies, so as best to promote their growth and strength : were these made the objects of female instruction, mankind would derive the greatest advan- tages from it. But while the education of females implies little more than what relates to dress and public show, we have nothing to expect from them but ignorance even in the most important concerns. Did mothers reflect on their own importance and lay it to heart, they would embrace every opportunity of informing themselves of the duties which they owe to their infant off"spring. It is their province, not only to form the body, but also to give the mind its most early bias. They have it very much in their power to make men healthy or valetudinary, useful in life or the pests of society. But the mother is not the only person concerned in the manage- ment of children. The father has an equal interest in their wel- fare, and ought to assist in every thing that respects either the improvement of the body or mind. It is a pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments as recommend them to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the af- fairs cf the nursery, that many would reckon it an alfront were they supposed to know any thing of them. Not so, however, with the kennel or the stables ! A gentleman of the first rank is not ashamed to give directions concerning the management of his dogs or horses, yet would blush M'^ere. he surprised in yjerforming the same office for that being who derived its existence from himself, who is the heir of his fortunes, and the future hope of his country ' Nor have physicians themselves been sufficiently attentive to the management of children. This has been generally considered as tne sole province of old women, while men cf the first character in physic have refused to visit infants even when sick. Such con- duct in the faculty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous dis- eases. The consequence is, that a physician is seldom called till the good women have exhausted all their skill ; when his attend- ance can only serve to divide the blame, and appease the discon solate parents. Nurses should do all in their power to prevent diseases ; but when a child is taken ill, some person of skill ought immediately to be consulted. The diseases of children are generally acute, and the least delay is dangerous. Were physicians more attentive to the diseases of infants, they ■.mitted to the sole care of some poor Grecian wench, or other menial servant. — We «re afraid, wherever luxury and effeminacy prevail, there will be too much ground for this complaint. OF CHILDREN. 441 w jr.Id not only be better qualified to treat tliern properly when Kick, but likewise to give useful directions for their management w)ien well. The diseases of children are by no means so difficult to be understood as many imagine. It is true, children cannot tell their complaints ; l)ut the causes of them may he pretty certainly discovered by observing the symptoms, and putting proper ques- tions to the nurses. Besides, the diseases of infants, being less complicated, are easier cured than those of adults.* It is really astonishing that so little attention should in general be paid to the preservation of infants. What labour and expense are daily bestowed to prop an old tottering carcase for a few years, while thousands of those who might be useful in life perish without being regarded ! Mankind are too apt to value things according to their present, not their future usefulness. Though this is of all others the most erroneous method of estimation, yet upon no other principle is it possible to account for the general indifference with respect to the death of infants. Of Diseased Parents. One great source of the diseases of children is the unhealthi- NEss OF PARENTS. It would be as reasonable to expect a rich crop from a barren soil, as that strong and healthy children should be born of parents whose constitutions have been worn out with in- temperance or disease. An ingenious writert observes, that on the constitution of moth- ers depends originally that of their offspring. No one who be- lieves this will be surprised, on a view of the female world, to find diseases and death so frequent among children. A delicate female, brought up within doors, an utter stranger to exercise and open air, Avho 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 throuo-h a few years' existence, its feeble frame, shaken with convulsions from every trivial cause, will be unable to perform the common functions of life, and prove a burden to society. If to the delicacy of mothers we add the irregular lives of fathers, we shall see farther cause to believe that children are often hurt by the constitution of their parents. A sickly frame may be origin- ally induced by hardships or intemperance, but chiefly by the lat- ter. It is impossible that a course of vice shall not spoil the best constitution ; and, did the evil terminate here, it would be a just punishment for the folly of the suflTerer : but when once a disease is contracted and riveted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the king's evil, to transmit to our offspring ! How happy had it been for the heir of many a great estate had he been born a beggar, rather il an The common opinion, tnat the diseases of infants are hard to discovar ana diffi cnlt to cure, has deterred many physicians, from paying that attention to thc-i wh'ch they deserve. I can, however, from experience declare, that this opinion is v/ clioui foundation ; and that the diseases of infants are neither so difficult to discover nor sc ;I1 to cure as those of adults. t Rousseau. 442 PHYSICAL MANAGEMENT to inherit his father's fortunes at the expense of inheriting his dis- eases A person labouring under any incurable malady ought not to marry. He thereby not only shortens his own life but transmits misery to others ; but when both parties are deeply tainted with the scrofula, the scurvy, or the like, the effects must be still worse. If such have anv issue they must be miserable indeed. Want of attention to these things in forming connections for life has root- ed out more families than plague, famine, or the sword ; and as long as these connections are formed from mercenary views the evil will be continued.* In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know that the generous courser cannot be bred cut of the foundered jade, nor the sagacious spaniel out of the snarling cur. This is settled upon immutable laws. The man who marric^s a woman of a sickly con- stitution, and descended of unhealthy parents, whatever his views may be, cannot be said to act a prudenl; part. A diseased wonjan may prove fertile; should this be the ca;-:e, the family must become an infirmary : what prospect of happiness the father of such a fam- ily has, we shall leave any one to judge.! Such children as have the misfortune to be born of diseased pa- rents will require to be nursed with greater care than others. This is the only vi^ay to make amends for the defects of constitution ; and it will often go a great length. A healthy nurse, wholesome air, and sufficient exercise, will do wonders. But when these are neglected, little is to be expected from any other quarter. Tiie defects of constitution cannot be supplied by medicine. Those who inherit any family-disease ought to be very circum^ spect in their manner of living. They should consider well the r.r.t'ire of such disease, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one generation ; and there is reason to believe, that, by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family-constitutions are as capable of improvement as family-estates; and the libertine who impairs the one does greater injury to his posterity than the prodigal who squanders the other. Chilling of Children. The clothing of an infant is so simple a matter, that it is sui- prising how any person should err in it ; yet many children lose their lives, and others are deformed by inattention to this article. Nature knows of no use of clothes to an infant, but to keep it warm. All that is necessary for this purpose is to wrap it in a " The Lacedemonians condemned their king, Archidamus, for having married a weak, punv woman ; because, said they, instead of propagating a race of heroes, you will fill the throne with a progeny o*" changelings. t'l'he Tews, by their laws, were, in certain cases, forbid to have any manner of coni- merce witn the diseased; and, to this all wise legislators ought to have a special re- gard. In some countries Diseased persons have actually been forbid to marry. This is an evil of a complicated kind, a natural deformity, and a political mischief; ami therefore requires a public cony'deration. OF CHILDREN. 443 ^oft loose covering. Were a inotlier left to the dictates of nature nloiie, siie vvouJtl certainly pursue this course. But the business of tiressijjfj' an infant has long been out of the hands of mothers, and has at last become a secret whicii none but adepts pretend to un- derstand. From the most early ages it has been thought necessary, that a woman in labour should have some persoji to attend her. This in time became a business ; and, as in all others, those who were em- ployed in it strove to outdo one another in the difierent branches of their profession. The dressing of a child came of course to be considered as the midwife's ]jrovince ; who, no doubt, imagined, that the more dexterity she could show in this article the more her skill should be admired. Her attempts were sect>nded by the van- ity of parents, who, too often desirous of making a show of the in- fant as soon as it was born, were ambitious to have as much finery heaped upon it as possible. Thus it came to be thought as neces- sary for a midwife to excel in bracing and dressing an infant as for a surgeon to be expert in applying bandages to a broken limb ; and the poor child, as soon as it came into the world, had as many rol- lers and wrappers applied to its body as if every bone had been fractured in the birth ; while these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary to life. In most parts of Bi-itain, the practice of rolling children with so many bandages is now, in some measure, laid aside ; but it would still be a difficult task to persuade the generality of mankind that the shape of an infant does not entirely depend on the care of the midwife. So far, however, are all her endeavours to mend the shape from being successful, that they constantly operate the con- trary way, and mankind become deformed in proportion to the means used to prevent it. How little deformity of body is to be found among uncivilized nations ! So little, indeed, that it is vul- garly believed they put all their deformed children to death. The truth is, they hardly know such a thing as a deformed child. Nei- ther should we, if we followed their example. Savage nations nev- er think of managing their children. They allow them the full use of every organ, carry them abroad in the open air, wash their bod- ies daily in cold water, &c. By this management their children become so strong and hardy, that by the time our puny infants get out of the nurse's arms, theirs are able to shift for themselves.* Among brute animals, no art is necessary to procure a fine shape. Though many of them are extremely delicate when they come into the world, yet we never find them grow crooked for want of swaddling-bands. Is nature less generous to the human kind ? No : but we take the business out of nature's hands. Not only the analogy of other animals, but the very feelings of infants tell us, they ought to be kept easy and free from pressure They cannot, indeed, tell their complaints, but they can show signs of pain ; and this they never fail to do by crying when hurt by * A friend of mine, who was several years on the coast of Africa, tells me, that the natives neither put any clothes upon their children, nor apply to their bodies bandages of any kind, but lay them on a pallet, and suffer them to tumble about at pleasure et thev are ail straight, and seldom have any disease. 144 PHYSICAL MANAGEMENT their clothes. No sooner are they freed from their bracingy than they seem pleased and happy ; yet, strange infatuation ! the moment they hold their peace they are again committed to their chains. If we consider the body of an infant as a bundle of soft pipes, replenished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of the children, has formed their bodies soft and flexible ; and lest they should receive any injury from pressure in the womb, has surrounded \he foetus everywhere with fluids. This shows the care which nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing that might in the least cramp or confine their motions. Even the bones of an infant are so soft and cartilaginous thai they readily yield to the slightest pressure, and easily assume a bad shape, which can never after be remedied. Hence it is that so many people appear with high shoulders, crooked spines, and flat breasts, who were as well-proportioned at their births as others, but who had tho misfortune to be squeezed out of shape by the ap- plication of stays and bandages. Pressure, by obstructin-g the circulation, likewise prevents the equal distrih-^tion of nourishment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, while another remains too small ; and thus in time the whole frame becomes disproportioned and misshapen. To this we must add, that when a child is cramped in its clothes it naturally shrinks from the part that is hurt ; and by putting its body into unnatural postures, it becomes deformed by habit. Deformity of body may, indeed, proceed from weakness er dis- ease ; but, in general, it is the effect of improper clothing. Nine- tenths, at least, of the deformity among mankind must be imputed to this cause. A deformed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impaired. Hence few people re- ir^arkably misshapen are strong or healthy. The new motions which commence at the birth, as the circula- tion of the whole mass of blood through the lungs, respiration, the peristaltic motion, ALEN. who said, that immersion in cold water was fit only for the 460 COLD-BATHING. young of lions and bears ; and that warm-bathing was conducive to the growth and strength of infants. How egregiously do the greatest men err, whenever they lose sight of facts, and substitute sallies of wit or specious arguments in physic for observations and experience ! By these superior excellence of the cold-bath is placed beyond the possibility of a doubt. Its tonic powers are found to be peculiarly proper for the lax fibres of young people, rendering them firm and elastic, and enabling the vital organs to perform their respective functions with ease and regularity. In other parts of this work I had occasion to describe, with greater minuteness than is now necessary, the many good effects of washing children ; and I gave a few directions as to the man- ner of employing this very salutary operation, from the moment of their birth. I showed how the use of the cold bath might be grad- ually brought about with the utmost safety ; and I am persuaded that those who give it a fair trial will readily comply with my far- ther advice to continue it ever after, except in such cases of indis- position or infirmity as I shall presently notice. Nothing contrib- utes more to the growth, vigour, and firnmess of youth, or to the activity and permanent health of manhood, than daily immersion in cold water. It steels the frame against changes of weather, against the impressions of cold or moisture, and many other exter- nal injuries. It is of course the best preventive of all those diseas- es which arise from a relaxed skin, obstructed or profuse perspira- tion, and nervous weakness. When the cold bath is used merely as a means of preserving health, in which point of view I am now considering it, a single plunge or dip of the whole body will be sufficient, though active swimmers may continue their favourite amusement for five or six minutes without injury. Any longer stay might prove dangerous, by not only occasioning a strong determination of blood to the head, but chilling the vital fluid, cramping the muscles, relaxing the nerves, and wholly defeating the intention of bathing. For want of a due regard to these circumstances, young men have of- ten endangered, and sometimes lost their lives. In all cases, it is highly necessary to be rubbed dry at the instant of coming out of the water, and to take exercise for at least half an hour after. A little exercise is also advisable before bathing, so as to excite a gentle glow or temperate degree of warmth, and thus guard against the bad consequences of a too sudden shock, when the body is either chilly or overheated. The like caution should be given against plunging into cold water after dinner, or after much fatigue. For these and many other reasons, the morning is very properly recomm.ended to per- sons in health as the best time for bathing. It is the least likely to interfere with their other pursuits or concerns : it washes away any particles of the perspirable matter that may have remained on the surface of the skin, before they can be re-absorbed ; it affords fresh supplies of vigour and alacrity, to enter upon the duties of the day ; and, as I have already hinted, it fortifies the body against any changes of weather to which it may be afterwards exposed in « far lighter element. in a state of perfect health, it may be further observed, that peo- COLD-BATHING. 46i pie need not give themselves much trouble to enjoy the advantages of sea-bathing in preference to river-water, as the grand effect of both is nearly the same, though some considerations of less mo- ment may concur to render the former more inviting. Among these we must reckon the usual resort of gay comjjany to different parib of t}ie coast in summer, the refreshing coolness of the sea-air in that season, and the agreeable stimulus which many persons expe- rience from the action of saline particles, not only in the water, but when they are floating in the atmosphere. It should also be considered, that the temperature of the sea is more uniform than that of rivers, never rising so high, or sinking so low, in any change of weather. But such points of difference are chiefly interesting to valetudinarians. What I have said of the cold-bath, when used as the means of preventing disease, will throw some light on the propriety of occa sionaliy resorting to it as an important remedy. In cases of pe- culiar delicacy and danger, it is an instrument which can only be entrusted to the most skilful hands ; but in many other less critical situations, a few plain rules may be of considerable service. The first object to be attended to in the use of the cold-bath, rs a remedy, is, whether the patient is not too much enfeebled to bear the shock. This cannot always be determined by appearances ; but a single experiment will remove all doubt. If the immersion be followed by a pleasant glow, and a sense of increasing alacrity, it is the best proof of its agreeing with the constitution, and of its being likely to have a happy influence on the whole frame, alence the cold-bath is found to be an excellent bracer and restorative in cases of languor, of habitual lassitude, and of muscular or nervous weakness, when arising from much confinement, a sedentary life, intense study, or any of the usual causes of relaxation. But it is always understood, that, in every instance of this sort, a sufiicient strength of original stamina still remains to produce a proper re- action of the heart and arteries, upon which all the salutary effects of bathing depend. The great efficacy of the cold bath, and particularly of sea- bathing, has often been experienced in scrofulous complaints, which are always attended with a relaxation of the fibres, and a strong disposition to languor and indolence. In such cases, sea-bathing is not only recommended as a tonic, or bracer, but as a powerful detergent and purifier also, especially if the sea-water be used inter- nally at the same time. No difference of opinion prevails on this heod, as far as it relates to the scrofula, but it has been alleged, that sea-bathing, though a good preventive of the scrofula, could not remove the local effects of the disease when once formed. My own practice in the treatment of scrofulous affections has not been extensive enough to enable me to speak to this point with a tone of confidence ; but the contrary doctrine appears to me supported by the fairest reasoning, and, what is more, by indisputable facts. In the first place, a weak flaccid habit, and a thin skin, very sus- ceptible of impressions from cold moist air, are the principal, if not the only predisposing causes of the scrofula. Now the cold-bath is the best remedy for both, as it renders the texture of the skin firm- nnd invigorates *he system. By being therefore so well adapted 462 COLD-BATHING. lo obviate causes, it must, according to one of the surest maxiuif of njedical practice, be very fit to remove effects. The justness of such an inference has been placed beyond a doubt, by the reports of men of professional eminence and veracity, under whose direction, and immediate inspection also, sea-bathing has been known to resolve swellings of the glands, as well us to correct the discharge of scrofulous ulcers, and to dispose them to heal. I am therefore very willing to believe, that a regular course of sea-bathing, and the internal use of sea-water, with the aid of good air, proper exercise, and a light, yet nourishing diet, are the best means hitherto discovered for checking the progress of the evil, or counteracting its morbid effects. But, in order to prevent any possible misconception of my mean- ing, it may be necessary to add, that my opinion of the efficacy of sea-water in scrofulous complaints, is confined to its probable removal of the outward symptoms of the malady, before these have arrived at a eertain pitch, or have reduced the patient to a state of extreme debility; in which case, as well as in all internal affections of the scrofula, when it has once fastened upon the lungs, or any other vital part, bathing in the sea, or drinking its waters, would be not only useless, but extremely injurious. It would also imply too great a confidence in the salutary virtues of sea-bathing, to prescribe it as a remedy for cutaneous disorders in general. To many of them the warm-bath is much better adapted ; and the proper choice of the one or the other can only be determined by a skilful physician, after a due consideration of the patient's ease. Some eruptions, if imprudently repelled by the action of cold on the skin, may carry back into the habit the seeds of disease, to be deposited, perhaps, on some vital part, in spite of Nature's kind eftbrts to throw them off. But a medical man will not prescribe sea-bathing in any case where pimples or blotches apper.r on the surface, without recommending the internal use of llie sea-water at the same time, to determine regularly and mode- rately to the bowels, so as to carry off all impurities, without the least injury to the general health, spirits, or appetite. I shall have occasion to repeat this caution, when I come to speak of some mineral waters, which are frequently resorted to for the cure of similar complaints. Though, as before observed, there may be very Iji.le diftereiice between the effects of sea-water and of river-water of the same temperature, when applied to a sound skin and healthy body, yet the gently stimulant, detergent, and healing properties of the saline impregnation of the former must give it a decisive superiority in many diseases of the surface and habit. It cleanses sores, and for- wards the progress of granulation. It often disperses tumours that have resisted the most powerful discutient medicines. Even deeply-seated ulcers, though beyond the reach of other appli- cations, sometimes yield to the penetrating action of sea-water. We must not forget, however, that its internal use is a necessary Laxiliary in all these cases, and others of a similar nature. Aboui half a pint of it, which contains somewhat more than a quarter of ac ounce of salts, taken in the morning, immediately on comino out of the sea, and the like dose in half an hour after, will com- COLD-BATHING. 463 muiily answer tlie purpose of a mild purgative. The quantity may oe augmented, or the dose repeated, if rer|uisite, with perfect safe- ty, and httle inconvenience. It excites thirst, hut seldom nausea, unless the stomach is very irritahle, or the [)atient very sfiueamish. In chronic diseases, where a cure cannot he expected hut from the long-continued use of any remedy, it is a great recommenda- tion of the sea-water, that it may be persevered in for a considera- ble time, without weakening the stomach, the .utestines, or the con- stitution in general. Instances frequently occur of persons who keep the body moderately open by its daily use for months together, and yet enjoy during the whole time a good appetite, and excellent powers of digestion, with increased vigour both of body and mind. It is always most advisable to make use of the sea-water externally and- internally, in the manner here directed, only twice or three times a-week, till the patient is encouraged by degrees to employ the salutary process every day. It should also be gradually discon tinned in the same manner, after the desired end is obtained. There are severr.l disorders, besides those already mentioned, particularly ardent fevers, and various cases of local inflammation and muscular rigidity, in which the external application of cold water may produce good effects. But many of them require great accuracy of distinction, as well as the utmost judgment and caution in the use of a remedy, which a small mistake, or a small change of circumstances, may render hazardous. In a work like this, de- signed for popular instruction, it would be improper to encourage rash experiments, by pointing out such niceties in medical practice as are safe only when under the guidance of medical skill. I do Jot know any thing in its own nature so salutary, and yet so liable iG be abused, as the cold-bath. I shall therefore proceed to touch upon the cases, where the inconsiderate or improper application of suc.i a remedy may prove injurious, and sometimes fatal. It is i.rt merely in the critical cases just alluded to, but in many slighter ii.:iispositioiis, that injudicious immersion in cold water may be attended with very serious consequences. Fevers are much oftener produced than cured by cold-bathing, if rashly re- sorted to. Disorders of the intellectual functions, palsies, apoplex- ies, and death, may Se, and are frequently occasioned by a single dip, in cases either Oi extreme nervous debility or of extreme fulness. When 1 reflect on the frantic precipitancy with which I have seen many pers ms of very weal";, and others of very plethoric habit, after a rapid journey from Lcndon to some watering-place, plunge instantly into the sea, without the least preparation, so far from being surprised at the numbers "nho sutter, I am rather astonished that any should escape. In order to prevent the ignorant and the thoughtless from falling victims 'o their indiscretion, and to guard persons afflicted with particular "omplaints against the use of an improper medicine, I shall point Out the principal indisposi- tions, in which the cold-bath would be likely to aggravate the symp- toms, and even to endanger the life of the pt-tient. Effects of Cold-Bathing, S^t. When a person in the ordinary state of healtJi is immersed i", n 464 COLD-BATHING. cold-bath, he first experiences a general sensation of cold, which IS almost immediately succeeded by a general sensation of warmth, the latter rapidly increasing, so as to cause the surrounding water to feel of an agreeable temperature. If the immersion has been sudden and momentary, and the body be immediately dried ana covered from the air, the agreeable sensation of warmth continues, the whole body feels refreshed and invigorated, and, under favour- able circumstances, the natural perspiration is increased. If, how- ever, the immersion be continued for a considerable time, and the water be not at the highest range of the temperature assigned t(. the cold-bath, the sensation of warmth goes off, and is followed by numbness and shivering, the skin becomes pale and contracted, the vessels near the surface of the body are evidently diminished in diameter, and the blood which flows through them is drawn to- wards the internal parts ; the person feels drowsy and inactive, his joints become rigid and inflexible, his limbs ai-e affected with pain and cramps, his respiration becomes quick and irregular, his pulse low and small, and his perspiration suppressed. If the im- mersion be still contin^jed, or if the water be very cold, the pulse gradually ceases, the action of the heart becomes weak and lai>- guid, a sensation of faintness and coldness of the stomach is expe- rienced, followed by a rapid diminution of the whole animal heat ; the vital energy at length becomes exhausted, and death ultimately ensues. In the preceding description, it is supposed that the body has been suddenly plunged into the v/ater ; if, as it often happens with weak or timid people, the bather enters the bath slowly, or if the water is much below sixty degrees, the sensation of cold is more striking, a shivering is produced, and as the person advances so as to make the water rise towards the belly and chest, a shuddering and convulsive sobbing takes place, sometimes attended with sick- ness and head-ache. Cautions to he Observed, S^c. When, therefore, cold-bathing occasions chillness, loss of appe- tite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head-achs, it ought to bs discontinued. These unpleasant sensations are the surest proofs, that the actual state of the patient's habit is unfit to bear the shock ; and that either the re-action of the heart and arteries is too weak to overcome the cold pressure on the surfiice, or that the determination to the .ead, or to some other vital part, is too rapidly increased. Every oody's feelings, after immersion in cold water, are the best crite- rion by which we can decide on the probability of its good or its oad effects. We might otherwise be deceived by appearances, and be induced to recommend the cold-bath in all cases that might eeem to require a tonic and stimulant plan of cure. But it may sometimes be dangerous, or at least very detriment- al, to make even a single experiment. In particular affections of !.he stomach and bowels, as well as in diseases of the lungs or ot tiie brain, and all obstinate obstructions, the effect may be fatal. The late Dr. Smollet, indeed, said, that if he were persuaded he COLD-BATHING. 4A5 Jiad an ulcer in tlie kinfjjs, lie would jump into the cold hath. In doiiiaj so, however, the Doctor would certainly show more courage than discretion ; and that he was more a man of wit than a physi- cian, every one will allow. A nervous asthma, or an atrophy, may be mistaken for a pulmonary consumjnion : yet, in the two for- mer, the cold hath proves often heneiicial, though I never knew it so in the latter. Indeed, all the phthisical patients I ever saw, who had tried the cold bath, were evidently hurt by it. Persons of very fidl habits, as I have already hinted, run a great risk of bursting a blood vessel, or of causing an inHammation of some important organ, by rushing into the cold bath, without due preparation. People of this description ought by no means to bathe, unless the body has been previously prepared by suitaWe evacuations. They will then derive the utmost benefit from what mis^ht be otherwise attended with irreparable injury to many of them. Though I recommend the cold-bath in cases of nervous weak- ness, yet the degree of that weakness should be considered, lest the shock might prove too powerful for extreme debility. Not only women of very weakly and delicate habits, but men also in the same predicament, as well as puny children, should begin with the warm-bath, at the same degree nearly as that of animal heat, about 96° of Fahrenheit's thermometer; and reduce it gradually in pro- portion to the increase of the patient's strength and internal pow- ers of re-action. The cold-bath is often very necessary to com- plete a cure, though not always advisable to begin with. This re- quires particular illustration. In hysteric and hypochondriac cases, cold-bathing at first has done the greatest mischief, though it may be finallv resorted to with good effect, after a preparatory and long continued use of the tepid or lukewarm bath. Its warmth must be diminished very slowly, and almost imperceptibly. Nature revolts against all great transitions ; and those who do violence to her dictates, have often cause to repent of their temerity. The like gradual diminution of the temperature of the water is no less proper in rheumatic complaints, and in those muscular con- tractions and convulsive motions which are called St. Vitus^s Dance. Indeed, it may be laid down as a pretty general rule in that branch of nervous disorders which includes spasms, convulsions, epilepsies, and similar consequences of the debility or irritability of the system, that we should always begin with the warm-bath, and proceed to the cold by the most pleasing and gentle grada- tions. The chief exceptions to this rule occur in the treatment of spas- modic affections of the intestines, hooping coughs, and convulsive asthmas, in which, though classed under the general head of spasms, the cold-bath would at any time be extremely improper But this prohibition is also implied in my remark on complaints o the bowels and chest in general, the latter including coughs of ev- ery description. When these are the mere consequences of slight irritation, or cold, bathing the lower extremities in warm water af- fords great relief; but immersing the whole body in either the 30 466 COLD-BATHING. warm or the cold bath, would only aggravate the symptoms, when the breathing is difficult. As palsies are often occasioned by the inconsiderate use of the cold-bath, it cannot be too strictly prohibited, where any paralytic symptoms are discoverable. There is no complaint that bears and requires a greater degree of external heat than the palsy, and there is none in which the shock of cold water is more directly opposite to every curative indication, Tlie hot-baths, therefore, wliether natural or artificial, and particularly if impregnated with salt, which increases their stimulus, arc employed as a sovereign reme- dy for paralytic affections. Friction, which should never be neg- lected after bathing, is in these cases of eminent service. In affections of the nervous coat of the stomach, and in cases of indigestion, especially when occasioned by intemperance, cold- bathing is as improper as in complaints of the bowels, before taken notice of. But it is the excess of folly, after immoderate drinking, to use the cold-bath with a view of alleviating its painful effects next day. It must increase the disorder of the stomach, the vio- lence of the head-ach, and the derangement of the circulation. It may be productive of still worse consequences. The cooling op- eration may prove far more powerful and more lasting than was expected, and may extinguish forever the remains of animal heat ; or, should nature, by extraordinary efforts, be able to resist the shock, it would probably be attended with symptoms of fever, or with very troublesome eruptions. Many painful affections of the head, as well as those which arise from intoxication, are, indeed, often relieved by what is called the shoioer-bath, or by the affusion of cold water on the part affe<'.ted, but never by the rash experi- ment of swimming, or of total immersion. I must take this opportunity to add, that the sho7ver-hath is in many other respects a valuable contrivance. It may be easily pro- cured : its actions can be regulated at pleasure ; and as the water descends like rain, it gently impels the blood towards the lower extremities, and prevents the danger which would arise from its sudden or too rapid determination to the lungs and head in some of the cases already mentioned. In uterine haemorrhages, and other fluxes of blood, when so con- siderable as to endanger the patient's life or constitution, cold wa- ter may be applied with good effect. It also forms a part of the tonic plan to be pursued in an immoderate flow of the menses ; nor is any thing more likely to prevent the return of this complaint than cold-bathing or drinking chalybeate waters in the intervals of men- struation. But when the discharge of blood is critical, as in some affections of the brain, lungs, &-c. or is become habitual, as in the piles, to check so salutary an evacuation by the use of the cold- bath would he the height of madness. This is no less true of ma- ny critical inflammations, those of the gout for instance, in which cold water or any other repellent would evidently counteract the purposes of nature, and very probably throw the disorder upon eome vital part. What is called the retrocedent gout frequently arises from some mismanagement of this sort, as well as from some partic- ular weakness or atony of tiie system. ColH-batbing is a very haz- ardous experiment to be made by persons subject to the gout, except COLD-BATHING. 467 in tlie absence of the symptoms, when no indisposition is felt in either the head or stomach, when the extremities are not threat- ened with pain ; and then only in concurrence with tlie best medi- cal advice. Bathiiii^ the lo\ver extremities in warm water is i^enerally and very properly recommended both in tlie retention and suppression of the menses, to excite the action of the uterine vessels, and, in the latter case, to remove any stricture of those vessels which may be induced by cold or fear. A skilful physician, however, will some- times meet with cases of a retention of the menses after the usual age, in which the cold-bath, if seasonal)ly used at the beginning of the disease, may contribute to restore the tone of the system. The delicacy and general irritability of the habit in a state of pregnancy, as well as the danger of too great a determination of the blood to the womb, clearly forbid the use of the cold-bath, un- less it shotdd be rendered advisable by some circumstances of a pe- culiar nature, of which a medical man of skill and experience is the only proper judge. It is a great and often a fatal mistake to rely on the tonic pow- ers of the cold-bath as the best means of repairing the injury done to the constitution by the relaxing influence of hot climates. Peo- ple, on their return to England, aftp/ having resided in the East or West Indies, would find the warm-bath not only safer, but far more conducive to the recovery of their former strength. I would not have them venture into a bath of a temperature under 90° for a considerable time, after which they may gradually diminish its warmth, as before recommended in cases of extreme clehility. I might here go into farther details, and show how much more salutary the warm-bath is than the cold in diseases of the liver and kidneys, and in numerous other cases of internal derangement; but the principles, which I have laid down, may be easily extended to them al! ; and I hope that the cautions I have given will operate as some check on the abuse of the most powerful means of preserving and restoring health, with which we are acquainted. Some years ago a foreign quack made a great deal of noise In this country with his medicated baths, but, like ether follies of the day, they are now almost sunk into oblivion. A h\v writers have also been very lavish of their panegyrics on the wonderful effects of vapour-baths as used in Russia: but I do not think that the in- habitants of these milder regions will ever have occasion to envy the rigid fibres of the north the enjoyment of such fanciful luxuries. The strength of steam is, perhaps, better known and more usefully employed in England than in any quarter of the globe; but we meet with very few cases, where its intense action on the surface of the human body can be deemed essentially necessary either for the prevention or the cure of diseases. Surely the skin of an Eng* lishman may be rendered perspirable by a much gentler stimulus, and without the aid of so troublesome and suffocating a pi-ocess. 4C8 MINERAL WATERS CHAP. XIZI. OF MINERAL WATERS. Waters holding mtnerals in solution are called mineral waters. But as all water, in a mineral state, is, either more or less impreg- nated with some mineral substances, the name mineral waters should be confined to those that are sufficiently impregnated with mineral matter to produce some sensible effects on the animal econ- omy, and either to cure or prevent some of the diseases to which the human body is liable. On which account, these waters with much more propriety might be called medicinal waters, were not the name by which they are commonly known too firmly establish- ed by long use. The mineral waters most esteemed, consequently those most fre- quently resorted to for the cure of diseases, are those of Aix, in Provence, Harrowgate, Spa, Barege, Hartfell, Sedlitz, Bath, Holywell, Sea-water, Bristol, Leamington, Seltzer, Buxton, Malvern, Tunbridge, Borset, Matlock, Vechy, and others Cheltenham, Moffat, of less note. Carlsbad, Pyrmont, Epsom, Scarborough, It is scarcely possible to read without a smile the numberleas books, essays, and pamphlets, which have been Avritten on this subject. It seems to be the favourite region for the exercise of fic- tion and fancy. The traditionary tales of ancient miracles, s>iaid to be wrought by holy wells and consecrated springs, do not much surpass in extravagance the modern cures ascribed to those favour ite haunts of valetudinarians by fraud, ignorance, and credulity. In printed Guides, as they are called, or Pocket Companions, to any of those fountains of health, it may be excusable to amuse us with a little romance ; but we are sony to find the same spirit per- vading many medical treatises which should be distinguished by the most sacred regard for truth, and a just contempt of puerile embellishments. Some allowance indeed should be made for the influence of local prejudices, and for the strong bias of interest and ambition on the mind of a professional man, who, residing near one of those springs, has, perhaps, no other means of acquiring popularity and reputa- tion, but by an encomium on its virtues, and a description, quite in the poetical style, of the beauties of the surrounding scenery. The latter is, indeed, a harmless puff"; it seldom deceives anybody; but IS viewed in the same light as an auctioneer's advertisement of an estate, where frightful chasms are often described as curious grottos, a few furze-bushes as a shrubbery laid out by the finger of Nature, and a gallows as a hanging- wood. There is another particular, in which those highly-<;oloured landscapes that form the MINERAL WATERS. 469 mtroductory part of almost every treatise on a medicinal spring, may defeat the pro]>osed end, and that is, by exciting a reasonable sus- picion that those waters are chiefly indebted for the high reputation of their efficacy to local circumstances, to the pleasant walks and rides, or the delightful prospects round them. A display of all the attractions of the favourite spot is commonly followed by very minute details of chemical analysis, which are just of as little use to the generality of readers as the description of the scenery. A knowledge of the contents of any mineral water by no means implies a knowledge of its medical properties. These are to be learned by repeated experiments. Were it not for the evidence of facts, the late discoveries in chemistry, as far as they respect the analysis of mineral waters, would only tend to lessen their credit, by showing the little difference between them and any common water of the same purity and temperature. For instance, if we confined ourselves to mere speculation on the subject, how could we suppose that a quarter of a grain of the oxyd of iron sus- pended by a little fixed air in a whole quart of Tunbridge water, the largest quantity usually taken in the course of a day, could produce any remarkable or peculiar eftects ? The same thing might be said of the most celebrated springs in the kingdom ; and many physicians of great professional eminence, arguing from this principle, have not hesitated to assert, that the cures performed by those springs were not owing to the ingredients with which they were impregnated, but to the simple elementary part, or what may be called pure water. It would not be easy therefore to determine, whether chemical analysis has furnished more arguments in favour of, or against, the boasted superiority of mineral waters. Dr. Falconer, the author of one of the ver^'^ few books relative to this subject, that contain something more than the gratification of idle curiosity, candidly confesses, that " chemical analysis, as far as it has been hitherto prosecuted, seems to give us a very imper- fect view of the methods by which these eff"ects (i. e. the medicinal effects of the Bath-waters) have been produced ; and this circum- stance has induced several persons to deny the truth of the facts altogether, or to represent them as highly exaggerated, and that such advantages (if any) as might be in truth received, were owing to collateral circumstances of uncertain and indeterminate efficacy, as change of air, diet, manner of life, and the like." It is not therefore to the landscape-painter, or to the chemist, that we must look for any useful information on those points, but to the modest and judicious practitione-r, who, like the author now quoted, watches with care, and reports with fidelity, the bad as well as the good effects of the waters he describes, the instances of their failure, as well as of their success, in various disorders. I am sorry to add, that the fund of such truly valuable materials is as yet very scanty, and that I must confine myself to general re- marks on the most frequented of our medical springs, so as to di- rect invalids to the fountain, from the use of which they may form some reasonable hopes of relief. As more particular instructions will often be necessary when they get to the spot, I feel it my duty to caution them against choosing for their medical guide any man, •however high his reputation may be, who has distinguished himself 470 MINERAL WATERS. ns the loudest or most eloquent trumpeter in the indiscriminate praise of the waters near which he resides. The like caution may prove still more serviceahle to such of our countrymen as resort to foreign springs for medicinal purposes. A popular advocate for the use of any remedy is seldom to be relied on as a good physician ; and we have always strong reason to sus- pect the skill or the integrity of a man, who speaks in a tone of confidence of the infallible efficacy of the waters which he pre- scribes. Some of those foreign waters being also frequently im- ported into this kingdom, and used here medicinally, I shall give a short account of a few of them, which are found to possess virtues superior to any of our own in the cure of certain disorders. Classification of Mineral Waters. Mineral waters are usually classed according to their sensible qualities, as perceived by the touch, sight, taste and smell, or ac- cording to some well-known ingredient, which may predominate in this or that particular spring. The most obvious division is into cold and hot fountains ; but both these, being too comprehensive, are again subdivided into chalybeate, saline, sulphureous, and calca- reous, from their being impregnated with iron, salts, sulphur, or liine. There are many still minuter distinctions, where two or more of those ingredients may be found united in the same spring, or combined with difierent sorts of air, which must have a very powerful effect in the internal use of the waters. The first class of niineral waters, which I shall notice, are those called chahjheates, from a Greek word that signifies iron, the taste of which is very perceptible in them when fresh from the spring, though they lose it on being exposed for some time to the atmos- phere. The reason is, that the small quantity of iron which they contain, being kept in solution by fixed air, when this evaporates, the iron sinks to the bottom, forming the fine ochre that lines the channel or water-course. As iron abounds in almost every part of the earth, it is no wonder that so many springs should be im- pregnated with it, in a greater or less degree, according to the quantity of fixed air they contain, by which the iron is held in a state of solution. Some of those waters have, in conjunction with the iron and fixed air, a pretty strong mixture of purgative salt, and are very difierent from the others in their efliects as well as their taste. In order to distinguish each by a specific name, the former may be called simple chahjheates, and the latter saline or -purging chalyheates. Tunbridge-Wells standing in point of repu- tation, or of fashionable resort, at the head of the one, and Chel- tenham at the head of the other ; they may be very properly chosen as examples or illustrations of the various medicinal effects of this numerous class of waters. Tunbridge-Wells. Medicinal Properties, &.c. It lias been already intimated, that the water of Tunbridge Wells is found, upon being analyzed, to diflfer from that of ce kidneys, there is the greatest probability of its proving serviceable. But if it occasions head-ach, thirst, and dryness of the tongue ; — if it sits heavy on the MINERAL WATERS. 4S3 stomach, or produces sickness, and does not pass off by urine or perspiration; — it may be fairly concluded, that its continuance would do injury, unless these symptoms can be removed. If we come next to consider the external application of those waters, we shall find, in the first place, that they unite all the me- dicinal advantages of warm-baths, from about a hundred and six degrees of heat to any inferior degree that may be desired. The extent also of the baths, which afibrds room to move about in them freely, and the permanence and uniformity of their warmth, are not unimportant recommendations. But Dr. Falconer is of opinion, that the Bath-waters possess some farther powers or specific qual- ities superior to those of common water of the same temperature. He thinks that their action on the nervous system is more stimu- lating than a common warm-bath ; — that they raise the pulse and heat of the body to a higher degree, yet are much less apt to pro- duce a violent perspiration ; — that they remarkably increase the urinary discharge ; — and that, so far from causing any relaxation or weakness, the bathers are observed to be in general more alert and vigorous, and to have a better appetite on the days of bathing than in the interval. As far as my own opportunities of observa- tion extended during a few short visits at Bath, they are in per- feet concurrence with the Doctor's opinion. The diseases, in which this eminent practitioner very accurately describes the good effects of the Bath-v.aters, are the green sick- ness, particularly before any considerable affection of the stomach takes place, or any feverish symptoms appear ; visceral obstruc- tions, when the consequences of intermittent fever, or of long res- idence in hot climates, if the disorder in these cases has not ad- vanced too far ; the palsy, from a great variety of causes ; the gout, in that stage of the complaint, when the inflammatory symp- toms, if any have preceded, have in a good measure abated, and a degree of weakness and wart of tone in the system begins to take place ; the chronic rheumatism, and the acute also, provided the feverish disposition be previously allayed by proper evacuations ; white swellings on the knee ; hip cases ; weakness of the organs of digestion ; the colic, accompanied with hysteric symptoms, or produced by the poison of lead ; the jaundice, when arising from simple obstruction of the biliary ducts ; hypochondriac and hyster- ical complaints ; St. Vitus's Dance; spasmodic afi^ections of the womb and painful menstruation ; and, lastly, in many cutaneous, bur more especially leprous eruptions. I have confined myself here to a bare outline, which may be suf- ficient for the general direction of valetudinarians, who must avail themselves of more particular advice at the fountain-head. Almost every case will require a peculiar mode of treatment ; and grea;; caution will be found necessary to prevent fatal mistakes. I can- not too often repeat, that the more powerful any remedy is, the more liable it is to abuse ; and though the efficacy of the Bath- waters has been fully established in a variety of the most stubborn and aflSicting disorders, yet their misapplication has also been often attended with very serious consequences. Even when the use of the Bath-waters may be deemed safe or proper, consideration must be had, as Dr. Falconer justly ob- 484 MINERAL WATERS. serves, to the quantity taken in, when they are drank ; and to tne time of stay in the bath, heat of the water, &c. when they are ex- ternally used. The safest method is to begin with drinking a glass, containing about a quarter of a pint, before breakfast ; and to judge from its effects how often it may be repeated, or the quantity enlarged. If it feel easy, warm, and cordial, to the stomach and spirits, and ex- cites no pain or sense of fulness in the head or eyes, a second glass of the same size may be taken the same day at noon, and this quantity gradually increased to a pint in the day, taken at two or three times, as convenience may suit. This is deemed a proper medium for the generality of people, though in some cases, where the habit is not very irritable, the daily allowance 'may be augment ed to a pint and a half, with safety and benefit. The Cross Bath- water, the temperature of which, when fresh from the spring, is 112°, is usually recommended at the commencement of a course, especially when there is any affection of the head, or when any tendency to plethora appears in the system. After some time, the more powerful water of the King's or the Hot Bath, which is four degrees higher in temperature, may be used ; and this change will prevent, in some measure, the disgust which is apt to come on after a long trial of the Bath-waters. No less regard should be paid to the proper use of the Bath. A short stay of five or six minutes is most advisable at first ; and if this trial produces no symptoms that are disagreeable, but, on the contrary, seems to improve the health, spirits, and strength, a longer stay may be gradually indulged, till it comes to half an hour, but neyer to cause lassitude, faintness, or disgust. The choice of the baths is often a matter of importance, as there is a still greater variation in the temperature of the waters when in the baths than at the pumps, the waters in the King's, or the Hot Bath, being from eight to twelve degrees warmer than those of the Cross Bath. There are also private baths of any temperature to suit the pecul- iarities of every patient's habit or complaint. The best time in general for bathing is the morning ; and it may be repeated twice, or at most thrice a-week. As the public baths are emptied soon after nine o'clock, a much earlier hour is usually chosen for bath- ing; but the private baths may be prepared at any hour of the day. Where a greater stimulus than mere immersion is thought neces- sary, or where a partial application of the water is deemed prefer- able to a general one, the part may be pumped upon, so as to in- crease the forcible action of the water on that part, and yet prove less heating to the system at large. Buxton Waters, &c. Theue are no springs in our island besides those at Bath, which can be strictly called hot, though a few others have got the name, and are referred to this class of thermal waters, from being, inva- riably in every season, and independently of the state of the at- mosphere, warmer than the general average of the heat of common springs. The temperature of Buxton-waters is only 82°, yet ap- proaches nearest to that of the hot springs at Bath, which, in their coolest state, are never lower than 90°. In other sensible proper MINERAL WATERS. 486 Jjcs tlic Buxton-water differs very little from common pump-water. The medicinal effects of the Buxton-waters, however, are far from being inconsiderable. Taken internally in small doses at dif- ferent intervals, amounting to near a pint before breakfast, and the like quantity before dinner, they afford \ery great relief in heart burn, flatulency, sickness at the stomach, and other distressing symptoms of defective digestion and derangement of the alimenta- ry organs, the sure attendants of indolence and luxury. In such cases, the body must be kept regularly open by means of medicine during the jse of the vi^aters, if these do not, as they sometimes will, produce a laxative effect which is always salutary.* They are no less serviceable in alleviating painful affections of the kid- neys and bladder ; and here also the external use of the waters is often found to promote their internal operation. But the employment of the Buxton-waters as a bath is not con- fined to the relief of gravelly complaints. They contrib'ite far more effectually to restore the healthy action of particular limbs, that may have lost their moving powers in consequence of long or violent inflammation, occasioned either by external injury, or pre- ceding acute rheumatism. But if the rigidity, weakness, or im- * paired functions of the parts affected be the consequence of a par- alytic stroke or of gouty inflammation, more benefit will be experi- enced from the warmer temperature of the Bath waters. In general, the Buxton bath is well suited to such a languid, en- feebled, or very irritable state of the habit, as cannot bear abso- lutely cold water, but may be excited to easy and salutary re-action by a milder stimulus. The slight shock, which people feel at the instant of immersion in the Buxton waters, is almost immediately followed by a pleasant glow all over the body ; and this is precisely the effect aimed at. But I have expressed myself so fully on the nature of the particular infirmities to which the lukewarm bath is adapted, as to render any farther observations on this head unne- cessary. Matlock, &c. The tepid springs at Matlock approach still nearer to cold water than those at Buxton, being sixteen degrees lower in point of tem- perature. The shock, which they give on immersion, is conse- quently stronger, and requires greater powers of re-action jn the habit ; but they form a good intermediate bath between Buxton and the sea. They are, therefore, very properly employed in pre- paring invalids for the latter, when this is necessary to complete a cure, as is often the case in the chronic rheumatism. They aro used internally as a pure diluting drink, but are not known to pos- sess any other remarkable medicinal properties. Bristol Hot Well, &c. The Hot-well, as it is improperly called, near Bristol, is not, * A dose or two of some aperient medicine is advised to be taken preliminary to the nse of these waters ; and gouty patients, to whom also they are recommended, ougnt not to begin a course unless they are well prepared, and rendered free from every discoverable sign of an acute state of the disnosition to an attack of their complaint. 456 MINERAL WATERS. indeed, so cold as the springs at Matlock, but does not nse to tlie temperature of those at Buxton, being; only 74°, or twenty-two degrees below the ordinary warmth of the blood in a state of health. The Hot-well water is not made use of to bathe in ; but, taken internally, it has acquired very high reputation for curing the incipient symptoms of consumption, and affording considera- ble relief in the more advanced stages of this disease. As the ef- fects it produces are very gradual, its agreeableness to the palate is a fortunate circumstance for a class of patients, who can only hope, by long and steady perseveiance, to check the progress of one of the most insidious destroyers of the human species. There is no doubt but they are also indebted for a part of the relief they experience to the mild, sheltered, yet sufficiently ventilated situ- ation of the Hot-wells, and to the judicious plan of diet, exercise, and amusement pursued there. The other complaints, in which the purity and temperature of the Hot-well water render it very grateful and of no small efficacy, are relaxations of the stomach and bowels, brought on by long res- idence in hot climates ; bilious diarrhoea ; slight dysentery ; and a disorder still more difficult of cure than any of these, I mean the diabetes. I do not know any natural remedy better adapted to re- lieve its various sympt«)ms ; such as the constant thirst, the imped- ed perspiration, the dryness and frequent desquamation of the skin, the feverish quickness of the pulse, and the preternatural discharge of urine. A regular course of the Hot-well water has been found to moderate this almost unquenchable thirst ; to keep the skin moist and perspirable ; to allay the fever; and to render the urinary or- gans fitter to receive benefit from the medicines usually pi'escribed to remove their debility and that of the system in general. It may be farther necessary to observe, that, as this water contains but a very small quantity of purgative salts, which are also counteracted by a larger solution of calcareous salts, it must have a stronger de- termination to the kidneys than to the bowels, so that the use of a gentle aperient medicine becomes in several cases advisable. Particular habits and complaints require variations in the quan- tity to be taken of this, as well as of any other mineral water. The full dose is half a pint, to be drank early in the morning, and repeated before breakfast, at the interval of at least half an hour speiit in gentle exercise. Two more doses of the like quantity, and with the like interposition of active amusement, are to be taken between breakfast and dinner, at the longest distance from each of those meals. As this water is also used at table and for domes- tic purposes, every invalid unavoidably takes more than the above quantity every day; but in consequence of its altered temperature, and of the loss of the fixed air it contained, it cannot be in so high a slate of medicinal perfection ai when drank fresh from the spring. The same remark must of course apply to the immense quantities that are bottled for exportation, though the almost proverbial purity and softness of the water, as well as its excellent property of keeping untainted for a great length of ; 'ne in hot climates, must render it a very valuable water for long voyages. MINERAL WATERS. 487 Continental Hot Springs, &.c. I SHALL subjoin to these observati-ons on the medicinal virtues of 3ur own thermal waters, a s-hort account of the most celebrated hot springs on the continent. There is none of the foreign watering places more resorted to than the German Spa, of which I already took notice among the cold chalybeates, and Aix-la-Chapelle, abont twenty-four miles dis- tant from the former, and equally famous for waters of a very different quality and temperature. Their celebrity is traced back even to the days of Charlemagne, who resided for a long time at A IX, and took so much delight in the use of the waters, as fre- quently to hold his levee in the bath, with all his attendants. The exact degree of the heat of these waters is given differently by different observers; but, taking the average of their accounts, it may be reckoned in the well of the hottest bath at 140°, and at the fountain where it is drank, about 120o. It requires to stand several hours in the large baths, before it is sufficiently cooled for tepid bathing, without the addition of cold water. It contains an uncom- mon quantity of sulphur, and emits a smell like that of Harrowgate water, but far more penetrating. From its heat, and its stronger impregnation of the sulphureous principle, it is also more powerful in all the diseases of the skin, for which Harrowgate is resorted to. The baths at Aix-la-Chapelle are looked upon as a cure for almost every cutaneous eruption ; but the water should be used internally at the same time, to carry off impurities, and keep up the full per- spiration promoted by the bathing. These baths are equally ser- viceable in stiffness of the joints and ligaments, which is left by the inflammation of gout and rheumatism, and in the debility of palsy, where the highest degree of heat which the skin can bear is required. In obstinate cases, the vapour-bath, formed , by the steam of those very hot waters, is recommended by the German physicians. Numberless instances serve to establish the efficacy of the waters of Aix as an internal medicine in painful affections of the kidneys and bladder, as v^'ell as in disorders of the stomach and biliary- organs occasioned by luxurious indulgence and intemperance.. The common dose is half a pint, to be repeated more or less often,, according to its sensible effects, and to the intention with which it is prescribed, either as a purgative or a diuretic. It is a striking- proof of the power of habit, that the palate and stomach are soon; reconciled to the use of such waters, though at first extremely dis- gusting and nauseous. The hot sulphureous springs at Bareges, two little hamlets on the French side of the Pyrenean mountains, are, indeed, inferior in the degrees of heat and strength of impregnation to the waters of Aix-la-Chapelle, yet are found very beneficial in the like com- plaints. Their highly detergent powers, owing perhaps to a small portion of oily or bituminous matter, added to the other medicina' properties which they possess in common with those of Aix, render them peculiarly efficacious in deep-seated ulcer?, and those morbid affections of the womb, which French ladies cail, though not with medical correctness, depots de lait. In such case» *'ie waters are 488 MINERAL WATERS. injected. They are also very frequently used in the form of douche, or by way of pumping on the part affected, as well as for general bathing. In the interior parts of France, particularly in the central prov- inces of Auvergne and the Bourbonnois, now included in the De- partment of the Loire, there are several hot springs, but of the saline chalybeate class, the efficacy of which, as an internal medi- cine, is greatly increased by their higher degree of temperature, in the disorders for which Cheltenham is resorted to in our own country. Those French springs derive another very important advantage from their heat, that of being used as a bath in all cases which may require that salutary stimulus on the surface. In many of these, the internal and external use of the waters co-operate with wonderful effect ; and particularly in the sexual complaints of women, arising from any defect or irregularity in the functions of the uterine organs. Catherine de Medicis, the mother of several French princes, is said to have been much indebted for her fertility to the waters of Bourbon Lancy, not far from the town of Moulins, a place consigned to immortal fame by Stevne's affecting story of " Maria." There is a village on the confines of Bohemia, where the waters may be said, in the strictest sense of t\\e word, to boil up with ve- hemence from the spring, and are often used for scalding hogs and fjwls, to loosen the hair and feathers, the heat being quite sufficient for these purposes. The temperature of the Prudel, or furious fountain, as it first issues forth, is as high at 165°, and keeps in- variably to the same point. Of course it requires to be very much cooled before it can be used as a bath, or even drank. Those wa« ters are said to have been resorted to, and first brought into con- siderable notice, by the Emperor Charles IV. in 1370; to which circumstance the village owes its name of Carlsbad, or Charles's bath. The natural history of its waters would afford a great vari- ety of curious and interesting- particulais ; but the limits of my present plan confine me to a short medical notice of their extraor- uinary virtues in all the diseases for the cure of which saline chaly- beates are internally or externally employed. Malvern Water. Malvern, in Worcestershire, has for many years been celebrat- r«d for a spring of such remarkable purity, that it has acquired ibe name of the Holy Well, from the reputed sanctity of its waters, and the real extensive benefit long derived in various cases from its use. The great benefit arising from the use of Malvern water as an external remedy in diseases of the skin and surface of the body, has led to its employment in some internal disorders, and often with considerable advantage. Of these the most important are painful affections of the kidneys and bladder, attended with the discharge of bloody, purulent, or fetid urine ; the hectic fever produced by scrofulous ulceration of the lungs, or very extensive and irritating .»ores of the surface of the body, and also fistulae of long standing *at have been neglected, and have become constant and trouble- MINERAL WATERS. 489 tome sores. Tliough unquestionably of benefit in many of these cases, it is in general a safe application, and may be used with the utmost freedom, both as an external dressing for sores, and as a common drink ; and this is particularly the case with common people that resort to this spring for diseases of the skin or other sores, who are in the constant habit of dipping their linen into the water, dressing with it quite wet, and renewing this application as often as it dries. The perfect safety of this practice on a preter- naturally irritated surface, has been ascertained by long experience, and is in itself an important circumstance in illustrating the effect of moisture on the surface of the body. The internal use of Malvern water is sometimes, on first begin- ning to use it, attended with a slight nausea; for the first day or two it occasions some degree of drowsiness, vertigo, or slight pain of the head, which comes on a few minutes after drinking it. These symptoms, however, subside spontaneously in a few days, or may readily be removed by some mild purgative medicine. The effects of the Malvern water on the bowels are not at all constant ; it frequently purges briskly for a few days, nor is it at all uncommon for the body to be rendered costive by its use, es- pecially with those accustomed to malt liquors. In all cases it de- cidedly increases the flow of urine, and the general health of the patient ; his appetite and spirits almost invariably improve during a course of the water, if it agree in the first instance. In addition to the benefits to be derived from the use of the Mal- vern water, the pure mountain air, added to the romantic beauty of the situation, which solicit the invalid to active exercise, con- tribute greatly to the convalescent state ; and the temperance gen- erally observed by patients of every rank in these places, assists materially in securing the advantage which has been gained from the use of this mineral spring. A course of Malvern water must vary very considerably in du- ration, on account of the different kinds of disease for which this spring is resorted to. Cases of obstinate scrofulous sores, espe- cially with caries in any bone, are always long in healing, and re- quire a residence here for a considerable time. The same may be said of very obstinate herpetic eruptions ; but where the cutaneous affection is mild, or where a tendency to it comes on at stated times, which is sometimes the case, this habit may be checked by a short use of this water ; and hence some persons who are liable to this disorder, make an annual visit to this salubrious spring. Aluminous Chalybeate Spring in the Isle of Wight. This spring, discovered by a Mr. Waterworth, is situated on tha south-west coast of the Isle of Wight, about two miles to the west- ward of Nitron, in one of those romantic spots for which that coast is so remarkable. From a tabular view of the diseases which preceded a course of this mineral spring, furnished by Dr. Lempriere, who had the op- portunity of witnessing the effects of this water upon an extensive scale, it appears that many patients, labouring under con^^inued fever, agues, pulmonic diseases, chronic dysentery, chronic rheu- 490 VEGETABLE POISONS. matism with emaciation, diseases of the abdominal viscera, dropsy &:.c. were benefited. " In giving this water," observes Dr. Lempriore, " I was verj? forcibly struck with the rapid effect it produced on the appetite and spirits, and the confidence it inspired in the mind of the patient." The improvement of the appetite was soon succeeded by an in- crease of strength, and a return of the natural complexion. The water did not appear to produce any effect upon the pulse or skin, nor did it act particularly on the kidneys; its tendency to increase the appetite and raise the spirits was the only evident effect to be observed during the early course ; and a return of strength, and general appearance of improved health, marked its later progress. In administering the water, it was a rule previously to devote one day to clearing the bowels by some suitable aperient ; and Epsom salts were the medicine generally preferred. Under this prepara- tive, the water seldom produced any disagreeable effect on the fttomach or bowels, or rendered it necessary, during the course, to take laxative medicines ; an advantage which does not attach to other chalybeate waters, unless they hold in solution a considera- ble portion of some aperient salt. It is advisable to begin the use of these waters in very small pro- portions, using it in a diluted state when, froni peculiarity of consti- tution, it appears to excite nausea, increasing it gradually when this may be done with safety, combining with its use a nutritive diet, without excess, paying strict attention to the state of the bow els, so as to avoid costiveness, early hours, particularly early ris- ing, exercise in the open air, more especially on horseback, aa sea-bathing, when not otherwise prohibited. CHAP. XIV. VEGETABLE POISONS. All vegetable poisons act upon the nervous system. Those of an irritating nature are Monkshood, Meadow Saffron, Mezere- ON, Bear's Foot, Hemlock Dropwort, Water Hemlock, Wall- Pepper, «fcc. The general symptoms they produce when taken are, an acrid pungent taste, with more or less bitterness, excessive heat, great dryness of the mouth and throat, accompanied with a sense of tightness there ; violent vomiting, and the efforts continu ed even after the stomach is emptied ; purging, with great pain ir the stomach and bowels; pulse strong, frequent, and regular; breathing often quick and difficult ; appearance of intoxication ; the pupil of the eye frequently dilated ; insensibility, resembling death ; the pulse becomes slow and loses its force, until death clos- es the scene. Externally applied, many of the vegetable poisons produce vio- lent inflammation of the skin, with vessications, or pustulary erup- Uona, Treatment. — If vomiting has been occasioned by the poison, and the efforts are still continued, they may be rendered easier by NARCOTIC POISONS. 491 fwallowing copious draughts of warm water, or thin gruel ; but should insensibihty have come on without vomiting, it ought imme- diately to be excited by some powerful emetic, as the sul[)hate of zinc, (twenty grains dissolved in half a tea-cupful of water) or sul- phate of copper, from ten to fifteen grains; after the operation of which, a brisk purgative should be given, and emollient or stim- ulating clysters administered, as the urgency of the case may re- quire. A preferable and more expeditious mode, provided it can readily be procured, of dislodging the poison, mineral or vegetable, is the stomach-pump; as this, however, requires some anatomical knowl- edge, a medical practitioner, having one of these valuable machines in his possession, should be instantly sent for, in the meantime either of the preceding, or other emetics, being given. After as much as possible of the poison is dislodged, either ijy emetics or other means, a very strong infusion of coffee, or vinegar diluted with water, may be then given with advantage.* Camphor- mixture with ether (two ounces of the former to half a drachm of the latter,) may be taken frequently; and should the insensibility increase, warmth, friction, and blisters may be employed. If in- flammation, or other dangerous consequences have arisen, these must be treated accordingly. NARCOTIC POISONS.— Among the narcotic poisons are enumerated the following: Deadly Nightshade, Hemlock, Fox- glove, Henbane, Tobacco, Opium, Woody Nightshade, t ^ken from the jugular vein, blisters applied to the neck and legs, aud the sensibility rous- ed by every possible means. If the heat of the body decline, warmth and friction must be perseveringly used to restore it. Veg- etable acids are on no account to be given before the poison is ex- pelled ; and it is even desirable that as little fluid as possible, of any description, should be given. The stomach-pump, if it can be procured and adopted without loss of time, should precede these means, as the most effective in dislodging the poison. POISONOUS MUSHROOMS.— Among these are the Pepper Agaric, Deadly Agaric, Champignon, which are frequently mis- taken for the edible mushroom. t The symptoms they produce are nausea, heat and pain in the stomach and bowels, with vomit- ing and purging ; thirst, convulsions, and faintings ; small and frequent pulse ; delirium, dilated pupil, stupor, cold sweats, and often death. Treatment. — In the first place, when any of the above symp- toms arise, after eating mushrooms, an emetic of tartarized antimo- ny, followed by frequent doses of Glauber or Epsom salts, and large stimulating clysters, are to be speedily administered. After the contents of the stomach are thoroughly evacuated, ether may be given in small quantities of brandy and water; but should in- flammatory symptoms supervene, these and other stiraiili must be laid aside, and means accordingly adopted to combat them. See Mineral Poisons, ifec. p. 342. CHAP. XV. POISONOUS FISH, &c. Of this class are the Yellow-billed Sprat, Sea Lobster, ■Take Subcarbonate of Ammonia, 1 scr. Peppermint Water, 3 ounces. Ipecacuanha Powder, ^ drachm. Mix for an emetic; to be taken immedi- Tincture of Capsicum, 2 drs. ately. t Poisonous mushrooms may be distinguished from such as are eatable, by attending 10 their botanical characters; and by the following remarks: Poisonous mushrooms grow in wet shady places ; they have a nauseous smell, are softer, more open and po rous than the edible ones. They have also a dirty-looking surface, sometimes a gaudy colour, or many very distinct hues, particularly if they have been covered with an en- velope They have soft bulbous stalks, grow rapidly, and very soon corrupt. Ed. VACCINATION. 493 Land Crab, Conger Eel, Muscle, Rock Fish, &.c. In an hour or two after eating stale fish, or often in mucli less time, a sense nf weight at the stomach conies on, with slight vertigo and head- ach, heat about the head and eyes, and consideiable thirst ; often an eruption of the skin similar to what is called the nettle rash ; and, in some instances, death has been the consequence. Treatment. — An emetic sliould be taken as soon as any of the pi-eceding symptoms, after eating any of the above fish, begin to manifest themselves ; and where it cannot readily he procured, vomiting may be excited by tickling the throat with the finger, and taking large draughts of warm water. After full vomiting an ac- tive purgative should be given to remove any of the noxious mat- ter that may have found its way into the intestines. Vinegar and water may be drank after the operation of these remedies, with which also the body may be sponged. Water made very sweet with sugar, to which some ether may be added, may be drank freely as a corrective ; and a very weak solution of alkali may be given to obviate the eflfects produced by the poison. If spasms come on after the evacuations, large doses of the tincture of opium are necessary. If inflammation arise, the usual means of remov- ing it must be employed. — See Animal Poison, p. 112, &c.* CHAP. XVI- VACCINATION. As a preventive of the small-pox, the vaccine inoculation is now universally practised. This generally produces a very mild and safe disease, consisting of a single vesicle forming on the place where the inoculation was performed. On the third day, the scratch where the vaccine matter was introduced is slightly red, and, if pressed with the finger, feels hard. Next day, the red point is a little increased, and somewhat radiated. On the fifth day, a small vesicle appears, but it is more easily seen on the sixth. This gradually increases, until it acquires the size of a split pea. The colour of the vesicle is dull white, like a pearl. Its shape is circular, or slightly oval when the inoculation has been made with a lengthened scratch, acquiring about the tenth day a diameter equal to about the third or fourth part of an inch. Till the end of the eighth day, the surface is uneven, being depressed in the cen- tre, but on the ninth day it becomes flat, or sometimes higher at the middle than at the edges. The margins are tinged and round- ed, projecting a little over the base of the vesicle. The vesicle is not simple, but cellular, and contains a clear limpid fluid, like the purest water. On the eighth or ninth day, the vesicle is surrounded with an areola or circle of intense red colour, which is hard and tumid. About this time an erythematic efflorescence sometimes takes • See New London Medical Pocket Book, p. 234, to p. 249, for an excellent hia •ory of mineral, vegetable, animal, and aerial poisons, &c. 494 SEA-SICKNESS. place near the areola, and spreads gradually to a considerable pan of the body. It consists of patches, slightly elevated, and is at- tended with symptoms of fever. On the eleventh or twelfth day, as the areola decreases, the surface of the vesicle becomes brown pt the centre, and is not so clean at the margin ; the cuticle gives way, and there is found a glassy hard scab, of a reddish brown colour, which is not detached, in general, till the twentieth day. When it falls off, a scar about half an inch in diameter is seen, and having as many pits as there were cells in the vesicles. During the progress of the vesicle, there is often some disorder of the constitution ; and occasionally a papulous eruption, like scrophulus, appears next the vesicle. As security against the small- pox is not secured by spurious vaccine vesicles, it becomes necessa- ry to study carefully the character of the genuine disease, which is here briefly described. OHAP. XVU. SEA-SICKNESS. The cause of this distressing affection is the well-known motion of a vessel on the surface of the water. Some thousands are an- nually, nay daily, prevented from going to sea, either upon busi ness, health or pleasure, in consequence of the terror of the waves. The most alarming, nay even fatal, consequences have been known to result from the violent retching and vomiting produced by the motion of the vessel, without it being in the power of any one to stop it ; for, if it be true that sea-sickness is only to be cur- ed by habit,* what hope can be held out to the afflicted that they will acquire this habit, without inconvenience, and without risk ; such as the bursting of a blood vessel, apoplexy,idiotcy, blindness, abortion, 4fcc., which have been known to result from excessive straining and vomiting ? People of delicate constitutions are known to derive considera- ble benefit from sailing on the sea; though frequently tho good they have received has been more than counterbalanced by the in- * With the exception of Dr. Stevenson's Imperial Marine Tincture, which, for the last ten or twelve years, has been privately made and sold, we never before heard of any preparation having a decided effect on this peculiar malady. It is, however, but common justice to confess, that this tincture has, in conjunction with its other virtues, every claim to the appellation of a specific for this affection, as was witnessed by us in no less than twelve passengers, male and female, from London to Leith ; and on uearly an equal number, with the same effect, from Leith to London, in the year 1817, and frequently since. It possesses also the no less singular quality of completely ar- resting the distressing vomiting to which ladies at various stages of pregnancy are lia- ble. In general debilities and relaxation from long residence in hot climates, the abuse of mercury, excessive drinking, and other species of intemperance ; excessive and debilitatiftg evacuations in women, and the concomitant nervous affections, indiges- tion, &;c. the Imperial Marine Tincture is one of the most valuable remedies that ever the ingenuity or talent of man could possibly devise for the relief of suffering hu manity. It is an elegant preparation, purely vegetable ; its properties are those of an agreeable tonic, requiring no increase of dose to reproduce or keep up its effects ; it promotes the general circulation, and communicates a congenial warmth over the whole system, which its use invigorates and enlivens, &c. Its analysis has frequentl' been attempted, but without success. SEA-SICKNESS. 495 jurious effects that have been caused by the violent sickness there- by occahioned. Those who intend to travel by sea, and are apprehensive of sick- ness, should previously use gentle aperients; and afterwards, to alleviate the nausea and vomiting, drink soda-water in a state of effervescence ; live sparingly; take up their station as near the mid- dle of the ship as possible ; sleep in a h:inunock or cot, in prefer- ence to a cabin, with their head towards the stern of the vessel ; and while they are upon deck to look always in the direction the ship is sailing. Persons of a plethoric constitution should purge, and lose a little blood from the arm. The Imperial Marine Tincture, in doses of one, two, or three tea-spoonsful every quarter of an hour, has the remarkable effect, in the course of a few doses, of completely removing all the symp- toms ; indeed, this is so valuable a medicine, of the nostrum-kind, for this and other affections, that whether by land or sea, in hot, or coW, or temperate climates, it must always prove a safe and most useful medicine to resort to on emergencies. Many persons, on the least motion of a vessel, are instantly ta- ken with nausea and vomiting. Whenever the latter occurs, it should be encouraged, until the contents of the stomach are eject- ed, by copious drafts of tepid water ; after which, a tea-spoonful or two of the Imperial Marine Tincture effectually prevents any recurrence of these unpleasant symptoms. The many flattering encomia that have been lavished upon this valuable preparation in sea-sickness and nervous affections in gen- eral, render it, from the smallness of the dose, and the safety with which it may be taken, an object of some consideration, where such a inedicine of the kind may be req^iired. APPENDIX: CONTAIJNING I A Liat ol Simples and of such Medicinil Preparations s.e ate commonly used in PraL'tiM, wiU their proper Doses. 3 Tlio Method of preparing and compounding such Medicines as are recommended in tlie forni«l Part of the Boole, with the Addition of several others of a similar Nature. 3. Remarks on the Doses, Uses, and Manner of applying the differenr Preparations. The design of the following pages is, to exhibit such a list of drugs and medicines aa may be necessary for private practice. They are considerably more numerous indeed than those recommended in the former part of the book, but are still greatly within the number contained in the most reformed dispensatories. The same medicine is seldom exhibited under different forms ; and where different medicines answer nearly the same intention, there is commonly no more than one of them retained. Multiplying forms of medicine for the same intention tends rather to bewilder than assist the young practitioner, and the experienced physician can never be at a loss to vary his prescrip- tions as occasion requires. The chemical and other difficult preparations are for the most part omitted. All of them that are used by any private practitioner are not worth preparing. He will buy them much cheaper than he can make them. Great care, however, is necessary to obtain them genuine. They are often adulterated, and ought never to be purchased unless from persons of known veracity. Such of them as are in common use are inserted in the lists of drugs and medicines. Their proper doses and manner of application are mentioned in the practical part of the book, wherever they are prescribed. Such articles of medicines as are to be found in the house or garden of almost every peasant, as badey, eggs, onions, &c. are likewise for the most part omitted. It is needless to swell a list of medicines with such things as caa be obtained whenever they are wanted, and which spoil by being kept. The preparations made and sold by distillers and confectioners are also generally left out. These people, by operating upon a larger plan, generally make things bet- ter, while it is in their power to afford them much cheaper than they can be pre- pared by any private hand. — The quantity ordered of every medicine is as small aa could well beprepared, both to prevent unnecessary expense, and that the medicine might not spoil by keeping. Almost every medicine suffers by being kept, and should be used as soon after it has been prepared as possible. Even simple drugs are apt to spoil, and should therefore be laid in in small quantities ; they either rot, are consumed by insects, or evaporate so as to lose their peculiar taste or flavour, and often become quite insignificant. > In several compositions, the ingredient on which the efficacy of the medicine prin- cipally depends is increased, while the auxiliaries, which are generally ordered in such •rifling quantities as to be of no importance, are left out, or only such of them retained s are necessary to give the medicine a proper consistence, or the like. The colouring ingredients are likewise for the most part omitted. They increase the bulk and price of the medicine ; without adding any thing to its value. It would be well if they were never used at all. Medicines are often adulterated for the sake of a colour. Acrid and even poisonous substances are, for this purpose, sometimes in- troduced into those medicines which ought to be most bland and emollient. Oint- nent of elder, for example, is often mixed with verdegrise to give it a fine green col- our, which entirely frustrates the intention of that mild ointment. Those who wish to obtain genuine medicines should pay no regard to their colour. Some regard is likewise paid to expense. Such ingredients as greatly increase the price of any composition, without adding considerably to its virtue, are generally either omitted, or somewhat less expensive substituted in their place. Medicines are Dy no means powerful in proportion to their price. The cheapest are often the best; besides, they are the least apt to be adulterated, and are always most readily obtained. With regard to the method of compounding medicines, T have generally followed that which seemed to be the most .simple and natural, mentioning the different steps 32 li APPENDIX of the process in the same order in which they ought to be taken, without paying aii •mplicit regard to the method of other dispensatories. I have followed the alphr>betical order, both with regard to the simples and prepara- tions. A more scientific method would have been agreeable to some persons, but less useful to the generality of readers. The different classes of medicine have no great dependence upon one another, and, where they have, it is hard to say which should BCand first or last; no doubt the simple preparations ought to precede the more com- pound. But all the advantages arising from this method of arrangement do not ap- pear equal to that single one, of being able, on the first opening of the book, to find out any article, which, by the alphabetical order, is rendered quite easy. The dose of every medicine is mentioned, whenever it appeared necessary. When this is omitted, it is to be understood that the medicine may be used at discretion. The dose mentioned is always for an adult, unless when the contrary is expressed. It is not an easy matter to proportion the doses of medicine exactly to the different ages, constitutions, &c. of patients j but, happily for mankind, mathematical exactness here is by no means necessary. Several attempts have been made to ascertain the proportional doses for the differ- ent ages and constitutions of patients ; but, after all that can be said upon this subject, a great deal must be left to the j-jdgment and skill of tlie person who administers the medicine. The following general proportions may be observed ; but they are by nc means intended for exact rules. A patient between twenty and fourteen may take two-thirds of the dose ordered for an adult; from fourteen to nine, one-half; from nine to six, one-third ; from six to four, one-fourth ; from four to two, one-sixth ; from two to one, a tenth ; and below one, a tweltin. To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the order of the English alphabet, and the smallest and largest dose placed opposite to the operation of each article. The doses indeed refer to adults, but may be adapted to different ages by attending to the rules laid down in the opposite page. Short cautions are occasionally inserted under such articles as require to be used with care. Though a greater variety of medicines is contained in this than in any former t'dit'^n of the Domestic medicine, yet the Author would advise those who peruse it. Rs far as po.= >ible, to adhere to simplicity in practice. Diseases are not cured by "i.iltiplicity of medicines, but by their proper application. A few eiraples, judi- ci jusly administered, and accompanied with a proper regiiT.en, will do inoTO good than 'ii arrago of vnedicines emploTea at random A LIST uH laa. MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PARTICULAR VIRTUES AND PROPER UOSES. V* Explanation of the Abbreviations used in the following Doses: scr. scruple, scrs. «cn/y«a9 dr. drachm, drs. drachms, oz. ounce, drps. drops, gr. grain, grs. grams, grad. graduallj-. Names. ACACIA, the expressed juice, from Acid, the acetous , muriatic . - - , nitrous, diluted , vitriolic, diluted ^ther, vitriolic ^thiop's mineral Agaric, med externally as a styptic, to staunch blood. Properties. Demulcent. Pi,efrigerant, Sec. Antiseptic, &c. Tonic, Febrifuge, &c. Tonic, Antiseptic. Anodyne. Alterative. Aloes Alum .... , burned . . - Amber, prepared Ammoniac, gum , milk of Angelica, the root powdered Anise, the seeds Antimony, crude , calcined , cinnabar of , glass of , tartarized Asafcetida, Aearum, lilk of Emenagogue, &-c. - Astringent. Escharotic, &c. - Antispasmodic. - Expectorant. • Expectorant. - Stimulant, &c. - Carminative. - Febrifuge, &c. - Febrifuge. - Diaphoretic. - Emetic, never used. - Emetic. C Emenagogue, Expecto- - < rant, and Aniispas- C. modic. - Antispasmodic, &c. - Emetic and Errhine. Doses. I scr. to 1 dr. . I dr. - 40 drps. - 40 drps. . 40 drps. 2 drs. - 30 grs. . 30 grs. - 20 grs. - 12 grs. - 1 dr. - 30 grs. I or U ar. - 1 dr. - 1 dr. - 1 dr. 1 scr. 2 grs. - 4 grs. Balaam of capivi Canadian of Peru — of Tolu Diuretic, &c. Diuretic, &c. Expectorant, Stimulant. Stimulant, Expectorant. Tonic, &;c. Tonic. grs. 20 drps. i scr. 15 grs. 10 grs. 1 scr. 10 grs. Bark, cascarilla , Peruvian, powder of Bear's foot, pov.'der of the leaves Narcotic. Benzoin, resin of, not employed internally, and principally for obtaining Bistort, powder of the root - Astringent. Blessed Thistle ... Tonic, Emetic. -, expressed, > . The same. juice of Bole, Armenian , French . - • Borax, rarely used internally Broom, ashes of the tops • Burdock, powder of the root Astringent. The same. Detergent. Diuretic. Sudorific, &e. 1 scr. 10 grs. 2 drs. 10 grs 10 grs. 1 scr. 10 grs. Calamine stone, levigated, tised externally in Turner's cerate. ' Alterative. 1 gr. Calomel Purgative. 3 grs. i dr. 1 oz. 6 grs. 60 drps. h dr. 2 scrs. 1 dr. 2 drs. 20 grs. Benzoic acid 1 dr. 1 dr. 2 oz 2 drs 40 grs. 1 dr. 1 dr 8gre 12 RTO IV MEDICINES USED IN PRACTICE, Names. Camphor . - - - • Canella alba, powder of - Cintharides . . . - Cardamoms ... Caraway seeds ... Carrot, seed of the wild Cascarilla bark ... Cassia, the pulp ... Castor - . . . - Caustic, lunar; used externally as to grs. ij. in epilepsy. Catechu ..... Camomile, in powder Centaury, the lesser Chalk Cinnamon .... Colocynth .... Columbo ..... Confection, aromatic , opiate ... Crab's claws, prepared Conserve of roses ... Contrayerva . . . - Coriander seed ... Cowhage, .... Cummin seed ... Dandelion, expressed juice of • Decoction of hartshorn Properties. Narcotic, Diaphoretic. 2 grs. Tonic, Carminative. 1 scr. Stimulant, Diuretic. ^ gr. Carminative. 6 grs. Carminative. 10 grs. Carminative. 1 scr. Tonic. 10 grs. Laxative. 2 drs. Antispasmodic. 8 grs. to Doses. to ^. 1 scf. 2 drs. 4 grs. 20 grs. 40 grs. 1 dr. 40 grs. 1 oz. 1 dr. an escharotic ; internally, gr. J, cautiously increased cf broom tops of Peruvian bark • of the inner bark of the elm • - ) of sarsaparilla Decoction of sarsaparilla, } compound - . ^ of guaiacum Deadly night shade ... Dragon's blood ... Earth, fuller's, use external ) in excoriations ) Electuary of cassia - . - • of scammony lenitive, or of senna - Elixir of vitriol ... Elecampane, powder of the root Extract of broom-tops Peruvian bark ■ cascarilla ... camomile ... colocynth comp. - Extract of gentian . . . hemlock ... liquorice ... logwood ... black hellebore guaiacum ... white poppies rue .... — savin .... senna — wormwood . Fern, powder of the root Astringent. Tonic. Tonic. Absorbent. Carminative. Violently Cathartic. Tonic. Cordial. Anodyne. Absorbent. Astringent. Febrifuge. Carminative. Vermifuge. Stimulant. 15 grs. 20 grs. 1 scr. 20 grs. 6 grs. 2 grs. 10 grs. 10 grs. 10 grs. 10 grs. 1 dr. 10 grs. 30 grs. . or. J dr. 2 scrs. 1 or. 10 grs. 1 or. 2 scrs. 2 scrs. 1 dr. 1 oz. 2 scrs. 1 dr. Diuretic. Demulcent. Diuretic. Tonic. Diuretic. Alterative Astringent. Lead, white , sugar of Lichen, ash-coloured, ground - Demulcent -7 Icelandic, a strong de- ) ^^^ ^^^^ coction of - - - J Lime-water .... Refrigerant. Lixivium of tartar ... Lethontriptic. Linseed Liquorice, root ot - Demulcent. - Demulcent, 10 grs. 10 grs. 30 gr« 1 dr. )■ Au libitum. I 10 grs. - ^ dr. 10 grs. - 20 grs No. 1. No. 6. 10 grs. 40 grs 15 grs. - 1 dr. 5 grs. - 20 grs 20 grs. - 30 grs 10 grs. - -iO grs 15 grs. - I dr. 2 grs. - 12 grs 20 grs. - 1 dr. 10 drps. - 40 drf-fi. 5 grs. - 10 grs. 1 gr. - 5 grs. 'Should always be begun with very small doses, as one grain or less, and gradually increased as the constitution will bear. See extract of. 10 grs. - 20 grs. 10 grs. - 40 grs. I dr. - 2 drs. 20 drps. - 60 drps. 1 oz. 2 oz. 10 grs. 1 scr. 5 grs. 2 grs. 2 grs. 3 oz. 8 oz. 2 oz. 30 grs. 1 dr. 29 grs. 10 grs. 10 grs. 10 grs. . 40 gis. 20 grs 10 grs. h §>■• 10 grs. I oz. 4 oz. • 8 oz. 15 drps. . 40 drps. ■ An infusion of 1 ounce to a quart of water, may be used at pleasure. i dr. - 1 dr 1 dr. 30 grs. 2 grs. 40 grs. 4 oz. V] MEDICINES USED IN PRACTICE, Names. Madder powder ... Mace ..... Magnesia .... , calcined - . - Manna - . - . . Marsh-mallows, root and leaves ) of . . . . > Mastich, gum Mercury, crude , calcined — , with chalk Properties. Stomachic. Antacid. The same. Aperient. Demulcent. - Carminative. It dr 10 grs. h dr. h dr. 10 grs. lfusv». - — — ^ corrosive sublimate , cinnabar of , red precipitate of , white ditto yellow emetic - Alterative. ^ gr. Alterative, Antisyphilitic. 10 grs. Mezereon Millipedes Musk . - - Mustard seed Myrrh, gum Nitre, purified - Nutmeg . . - Oil of Almonds amber, rectified anniseed . castor cinnamon juniper lemon peel linseed olive • • palm • • peppermint turpenne Onion, expressed juice of Opium . . - Opoponax Oyster-shells, prepared Oxymel of colchicum of squills Pennyroyal Peppermint Petroleum Pills, aloetic , of the gums , mercurial Pitch, Burgundy Pomegranate, powder of Poppy heads Powder, antimonial - May be taken according to the d it nearly coincides. of contrayerva, compound of chalk, compound , with opium - Powder of ipecacuanha, com- ) pound, or Dover's-powder. ^ Quaiisia . - . - Quince seeds, mucilage of. 7'Ae same. Alterative, &c. Use chiefly external. Sternutatory. Sialogogue in Decoct Expectorant. Antispasmodic. Stimulant. Emetic. Expectorant. Diuretic. Stomachic. 10 grs. 1 gr. 1 dr 20 grs. 2 drs. 2 oz. 1 dr. 30 grs. ■2 grs. 30 grs. 30 grs. 3 grs. Demulcent. • Antispasmodic • Carminative. Stimulant. ■ Diuretic. • Demulcent. Demulcent, Laxative. ■ Use external. Stimulant, &;c. 5 Diuretic. Externally, i ( stimulant. ] A powerful diuretic. Narcotic. Emenagogue. Absorbent. Expectorant. Diuretic. Emenagog,ue. Stimulant. Antispasmodic. Purgative. • Diuretic. Antisyphilitic. To a pint of water, 2 dm 20 grs - 2 drs. 5 grs • 40 grs. I dr. - 1 oz. 10 grs. . 1 dr. 10 grs. - 30 grs. 6 grs. - ^ dr. A oz. - 1 oz. 10 drps. - 30 drps. 1 drp. - 5 drps. 2 drs. - 1 oz. 1 drp. - 3 drps. 2 drps. - 10 drps. 2 drps - 5 drps. ^ oz. - 1 oz. ^ oz. • 1 oz 1 drp. . 3 drps. 10 drps. - 30 drps. i oz. - 2 oz. A gr. .2 grs. 10 grs. • 30 grs. A dr. - 2 drs. I dr. - 1 dr. A dr. - 1 dr. 10 drps. 10 grs. 10 grs. 10 grs. drps. grs. grs. grs. 20 grs. - 1 Anodyne. Febrifuge. 3 grs. . 6 irections for James's powder, with which, i dr. grs. n effenta The same. 15 grs. - 30 Absorbent. ~ 20 grs. - 40 Absorbent and anodyne. 10 grs. . 40 Diaphoretic. 10 grs. . 30 grs. grs. grs. Tonic. 6 grs. • 30 grs. (One drachm to a pint of water for an infusion Demulcent. At pleasure, to obtund acrimony. Rhubarb, powder of Resin, yellow Rue powder "iftssafras - - Purgative. - Diuretic. Emenagogue. Diaphoretic, Altera- ) tive, &,c, C 10 grs. - 40 grs. 3 grs. - 20 grs. 20 grs. - 40 grs. 1 p.rr. I dr. WITH THEIR PROPER OOSES. m Names. Savin St. John's wort Saffron Sagapenum Sal ammoniac - Salt, Epsom , Glauber - — of hartshorn — Polychrest — Rochel of tartar Saunders, red Sarsaparilla, powder of Scammony Seneka Senna Soap lees - Spearmint Senna Scurvy-grass, expressed ju Snake-root Sorrel, juice of, depurate* * Spirit of lavender of mindererus swetjt, of vitriol ■ of nitre of sal ammoniac compound fcetid Steel, filings of Spermaceti Sponge, burned Storax Sulphur , precipitated, of antimony Squill, dried powder , fresh Syrup of poppies of buckthorn - of ginger of meadow saffron of violets of poppies 's in general Proper lies. Emenagof^ue. Diaphoretic. Cordial, &c. Stimulant. Aperient. Aperient. Cordial. Aperient. Aperient. Aperient. Astringont. Alterative. Cathartic. Diaphoretic. Aperient. Lithontriptic. The same. Stimulant. Cordial. Aperient. Antiscorbutic. Diaphoretic. Antiiico'hutic. Cordia», Stimulant. Diaphoretic. Tonic. Diuretic. Diaphoretic, &e. Antispasmodic, &c. Tonic, Emenagogue. Demulcent. Deobstruent. Astringent, &c. Cathartic and diaphoretic. Alterative. Diuretic. The same. Anodyne. Cathartic. Carminative. Diuretic, &.c. Gently laxative. Anodyne. To children, 10 grs. 20 grs. 6 grs. 10 grs. 10 grs. 2 drs. 4 drs. 10 grs. 20 grs. 2 scrs. 10 grs. A dr. 20 grs. 5 grs. 20 grs. 20 grs. 20 grs. 10 drps. 10 grs. 1 scr. 1 oz. 20 grs. f oz. 1 dr. 1 dr. 15 drps. 15 drps. 15 drps. 5 grs 20 grs 20 grs, 10 grs. 20 grs, 1 gr. 1 gr. 5 grs, h dr. 1 dr, 1 dr Tar - — , water of Tartar, cream of , emetic • Terra japonica Tobacco, an infusion of, 1 drachm spoonsful ; powerfully diuretic 5 Tin, powder of ... Turmeric - - - . Turpentine, spirit of - - , Venice Tincture of aloes ... -, compound — ofasafoetida — of Benzoin, compound — of cantharides — of cardamoms — of castor ... — of catechu - • - — of Peruvian bark — of iron, muriated — of Calumbo — of gentian, compound - — of guiacum volatile — of black hellebore Pulmonary. Refrigerant and aperient. Alterative. An Emetic. Astringent. to a pint of water ; should or in form of clyster. Anthelmintic. Diuretic. The same. Purgative. The same. Antispasmodic. Vulnerary. Diuretic. Carminative. Astringent. Tonic. Tonic. Tonic, Tonic. Diaphoretic. Emenagogue. Dose*. • 30 grs - 1 dr. - 20 grs. - 30 grs. • 30 grs 1 oz. S oz. 20 grs. h °^' T oz. 30 grs. 1 dr. 40 grs. 20 grs. 40 grs. 40 grs. oz. A drps. 2 scrs 1 dr. 4 oz. 40 grs. 4 oz. 2 drs. 1 oz. 40 drps. 40 drps. 40 drps. 1 scr. 1 dr. 1 dr. h dr. ! dr. 4 grs. 3 grs. 15 grs A oz. 2 drs. i oz. 1 ur. - 5 "i- 1 dr. grad. to 1 oz. 1 dr, - '' '^'= 1 dr. 1 dr. 2 drs. 2 oz. 2 drs 6 grs. - 1 scr A pint daily. 2 drs. - 1 oz. 4 gr- • h ET- 1 gr. - 3 grs. 20 grs. - 40 grs. be administered by table 20 grs. 20 grs. ■ 10 drps. ■ grs. ■ .^lll MEDICINES fSED IN PRviOTlCE, A/C. Names. Tincture of jalap of myrrh — of opium — camphor- ated, or paregoric elixir of rhubarb - of senna of snake-root of valerian - — volatile Tormen'il, powder of Tumeric - - . - Turpentine, Venice ♦ Tutty, levigated Uva ursi, in powder - Valerian, wild, powder of Vinegar, distilled of squills Properties. Purgative. Emenagogue. Narcotic. Anodyne and antispas- ) modic ) Purgative, Stomachic. Cathartic, Stomachic. Diaphoretic, &c. Antispasmodic. The same and stimulant. Astringent. Diuretic and cathartic. 1 dr. 1 scr. 10 drps. 1 dr. i oz. 2 drs. 1 dr. 1 dr. h dr. Id grs. 1 scr. I scr. to i 1 dr 40 drps 2 drs. 2 oz. 1 oz. 2 drs. 3 drs. 2 drs. I dr. 1 dr. 1 dr. - Used externally in ointments and cerates. Verdigris - Vitriol, white , blue ... Watercress, expressed juice of - trefoil - - - - Waters, any of the simple distilled Wax, white ' ' ' \ , yellow - - - ) Wormwood, expressed juice White lead Wild cucumber . . - Wine, aloetic . • ^ , antimonial , ipecacuanha • , rhubarb ... Lithontriptic. 20 grs. Stimulant, Antispasmodic. 20 grs. Refrigerant, Antiseptic. 2 drs. Diuretic. 10 drps. As an emetic. i^ oz. Violently emetic. 1 gr. As a Tonic. 2 grs. \ As a quickly operating > wQ • emetic, \ ° Emetic. 1 gr. Antiscorbutic. I dr. Used as vehicles. \ oz. Demulcent and emollient. 20 grs Vermifuge, Tonic. Astringent. Cathartic, Hydragogue Zedoary Zinc, flowers of Purgative. Emetic. Emetic. Purgative. Stomachic. Tonic. Antispasmodic. ^ oz. 1 gr. - \ i gr. to grs { extract. h oz. 20 drps. - 1 dr. h. oz. 10 grs. 3 sun. 1 dr. 2 drs. 1 oz. 60 drps 1 oz. 2 grs 3 grs. 1 dr. 3 grs, 2 oz. 1 dr. 4 oz. 1 dr. 2 oz. 5 grs. ij. of thw 1 oz. 2 drs. A oz 2 oz. 40 grs. 10 grs. [^•] DOMESTIC PHARMACOPCEIA. MEDICINAL PREPARATIONS Balsams. The subject of this section is not the natural balsams, but certain compositions, which, from their being supposed to possess the balsamic qualities, generally go by that name. This class of medicines was formerly very numerous, and held in great esteem. Modern practice, however, has justly reduced it to a very narrow compass. Anodyne Balsam. — Take of white Spanish soap, one ounce ; opium, unprepared, two drachms ; rectified spirit of wine, nine ounces. Digest them together in a gen- tle Ireat for three days; then strain off the liquor, and add to it three drachms of cam- phor. This balsam is intended to ease pain. It is of service in violent strains and rheu- matic complaints, when not attended with inflammation. It must be rubbed with a warm hand on the part affected ; or a linen rag moisteiicd 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. Locatelli's Balsam. — Take of olive oil, one pint ; Strasburg turpentine and yellow wax, of each half a pound ; red saunders, six drachms. Melt the wax with some part of the oil, over a gentle fire ; then adding the remaining part of the oil and the turpen* tine ; afterwards mix in the saunders, previously reduced to a powder, and keep them stirring together till the balsam is cold. This balsam is recommended in erosions of the intestines, the dysentery, haemorrha- ges, internal bruises, and in some complaints of tne breast. Outwardly it is used for healing and cleansing wounds and ulcers. The dose when taken internally, is from two scruples to two drachms. The vulnerary Balsam. (Tincture of Benjamin.) — Take of benzoin, powdered, three ounces ; balsam of Peru, two ounces ; hepatic aloes, in powder, half an ounce ; rectified spirits 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 acd bruises. It is likewise employed internally to remove coughs, asthmas, and other com- plaints of the breast. It is said to ease the colic, cleanse the kidneys, and to hea' in- ternal ulcers, &c. The dose is from twenty to sixty drops. This, though a medicine of some value, does not deserve the extravagant encomi- ums which have been bestowed on it. It has been celebrated under the different names of The Commander's Balsam, Persian Balsam, Balsam of Berne, Wade's B(d- aam, F'^ar's Balsam, Jesuit's Drops, Turlington's Drops, &,c. Boluses. As boluses are intended for immediate use, volatile salts, and other in^edients im- proper for being kept, are admitted into their composition. They are generally com- posed of powders, with a proper quantity of syrup, conserve, or mucilage. The light- er powders are commonly made up with syrup, and the more ponderous, as mercury, &c., with conserve ; but those of the lighter k'nd 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 sufficient quantity to make a bolus. In an excessive flow of the menses, and other violent discharges of bloor*, proceeding f'f.m relaxation, this bol-is may be given every four or five hours, till the discharge abates. Diaphoretic Bolus. — Take of gum guaiacum, in powder, ten grains ; flowers of sul phur and cream of tartar, of each one scruple ; simple syrup, a sufficient quantity. In rheumatic eomplainis, and disorders of the sicin, this bolus may be taken twioo »-day. It virill also be of service in the inflammatory quinsey. Y CATAPLASMS AND SINAPISMS. CLYSTERS. Mercurial Bolus. — Take of calomel, six grains ; conserve of roses, half a drachiL Make a bolus. Where mercury is necessary, this bolus may be taken twice or thrice a-vveek. It may be taken over-night ; and if it does not operate, a few graine of jalap, or half aa ounce of Epsom salts, will be proper next day to carry it off. Bolus of Rhubarb and Mercury. — Take of the best rhubarb, in powder, from a scru pie to half a drachm ; of calomel, from four to six grains; simple syrup, a sufficient quantity to make a bolus. This is a proper purge in hypochondriac constitutions ; but its principal intention 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 standing, asthmas, and beginning 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 tartEW, two scruples. Let them be rubbed together, and formed 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 upwards. 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 intended either to act aR discutients, or to promote suppuration; and as they may be of service in some cases, we shall give a specimen of each kind. Dueutient Cataplasm. — Take of barleymeal, six ounces; fresh hemlock leaves^ bruised, two ounces ; vinegar, a sufficient quantity. Boil the meal and hemlock in the vinegar for a little time, 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 cne 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 the other ingredi- ents, so as to form the whole into a soft cataplasm. The galbanum must be previous- ly dissolved with the yolk of an egg. Where it is necessary to promote suppuration, this cataplasm may be used by those who choose 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 pan, as in the palsy and atrophy. They are also of service in deep-seated pains, as the sciatica, &c. When the gout seizes the head or the stomach, they are applied to the feet to bring the disorder to those parts. They are likewise applied to the patient's soles in the low state of fevers. They should not be suffered to lie on, however, till they have raised blisters, but till the parts become red, and will continue so when pressed with the finger. The sinapism is only a poultice made with vinegar instead of milk, and rendered warm and stimulating by the addition of mustard, horse-radish, or garlic. The com- mon sinapism is made 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. When sinapisms of a more stimulating nature are wanted, a little bruised garlic may be added to the above. Clysters. This class of medicines is of more importance than is generally imagined. Clys- ters serve not only to evacuate the contents of the belly, but also to convey very ac- tive medicines into the system. Opium, for example, may bo administered 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 sim- ple 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 the parts, may be of con. aiderablc 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 rOLLVRIA, OR EVfi-WATERS. Xi way, which cannot be done by any other means whatever. Th.* may be easily effect- ed by means of a pair of hand-bellows, with an apparatus fitted to them for that pur- pose. 'I'he use of clysters is not merely confined to medicines. Aliment may also be con veyed in his way. Persons unable to swallow, have been, for a considerable time.suo- Dorted by clysters. Emollient Clyster. — 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. Laxative Clyster. — Take of milk and water, each six ounces ; sweet oil or fresh but- ler, 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 Fatid 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 tlie lower parti of the alimentary canal. When given to children, the quantity must be proportionn- bly lessened. Starch Clyster. — Take jelly of starch, four ounces ; linseed oil, half an ounce Liquefy the jelly over a gentle fire, and then mix in the oil. In the dysentery or bloody flux, this clyster may be administered after every loose Btool. to heal the ulcerated intestines, and blunt the sharpness of corroding humours. Forty or fifty drops of laudanum may be occasionally added j 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 col- icky 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. COLLYRIA, OR EyE-WaTERS. Eye-waters have been multiplied without number, almost every person pret/ jd- ing to be possessed of some secret preparation for the cure of sore eyes. I hav( ex- amined many of them, and find that they are pretty much alike, the basis of mof or them being either alum, vitriol, or lead. Their effects evidently are to brace and restore the tone of the parts: hence they are principally of service in slight infl' iima,- tions ; and in that relaxed state of the parts which is induced by obstinate ones. Camphor is commonly added to these compositions; but as it seldom incorporates properly with the water, it can be of little use. Boles and other earthy substancct,, as they do not dissolve in water, are likewise unfit for this purpose. Collyrium of Alum.— Hike, of alum half a drachm; agitate it well together with the white of an egg. This is the 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 linm, and applied td the eyes ; bill, should not be kept on above three or four hours at a time. Vitriolic Collyrium. — Take of white vitriol, half a drachm; rose-vater, 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 ei v;s. 1 hough the slighter inflammations will generally yield to it, yet in those of ; .uo^fc obstinate nature the assistance of bleeding and blistering will" often be necessi'/. When a strong astringent is judged proper, a double or triple quam^V of the vitriol may be used. I have seen a solution of four times the strength of the »iM>'» ub.;d with manifest advantage. Co%rium 0/ Lead.— Take sugar of lead, and crude lal amjnonil.!, of tach foa A.H CONFECTIONS. CONSERVES AND PRESERVES. DECOCTIONS. grains. Dissolve them in eight ounces of common water : to which forty or fifty dropi ^f laudanum may be occasionally added. Those who choose, may substitute, instead of this, the collyrium of lead, recom mended by Goulard ; which is made by putting twenty five drops of his extract ofleaa to eight ounces of water, and adding a t'ca-spoonful of brandy. Indeed, common water and brandy, without any other addition, will in many cases answer very well as a col- lyrium. An ounce of the latter may be added to five or six ounces of the former ; and the eyes, if weak, bathed with it night and morning. For a rheum in the eyes, great benefit has been found by washing them frequently with rose-water. Many experience the like good effect from anointing the eye-lids with Smellom's salve. Confections. Confections, containing above sixty ingredients, are still to be found in some of the most reformed dispensatories. As most of their intentions, however, may be more certainly, and as effectually answered by a few glasses of wine or grains of opium, we shall pass over this class of medicines very slightly. Japonic Confection, or Confection of Catechu. — Take of Japan earth, three ounces; tormentil root, nutmeg, olibanum, of each two ounces ; opium dissolved in a suf- ficient 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. It supplies the place of the Diascordium. The dose is from a scruple to a drachm. Conserves and Preserves. These preparations possess very few medical properties, and may rather be classed among sweetmeats than medicines. They are sometimes, however, of use, for reduc- ing into boluses or pills some of the more ponderous powders, as the preparations of iron, mercury, and tin. Conserves are compositions of fresh vegetables and sugar, beaten together into an uniform mass. In making these preparations, the leaves of vegetables must be freed from their stalks, 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 marble mortar, with a wooden pes- tle, into a smooth mass ; after which, thrice their weight of fine sugar is commonly arided by degrees, and the beating continued till they are uniformly mixed ; but the conberve will be better if only twice its weight of sugar be added. Those who prepare large quantities of conserve generally reduce the vegetables to a pulp by the means of a mill, and afterwards beat them up with sugar. Conserve of Red Rosea.— Take a pound 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, rosemary-flowers, sea-wormwood, the leaves of wood-sorrel, -ness, and at the same time sufficiently supports the strength without stimulating the system ; thus affoiding the powers of the constitution an oppor tunity of subduing the diseased action of the lungs. Many animals become very fal while living solely on the lichen islandicus, a proof that it affords abundant nutriment. To derive any essential benefit from the use of this article, it must constitute the sole subsistence. Persons who possess sufficient resolution to persist in such a regimen will find the lichen, prepared according to the following directions, an agreeable article of fooiJ : tour ounces oi the lictien, cut in small pieces, are to oe coned in tnree pints of water, till the quantity be reduced to two. To this add a tea-spoonful of fine wheaten flour, and four ounces of refined sugar; take sixty sweet almonds, and twenty-four bit- ter ones, blanched; beat them into a paste, with aamall quantity of water, mingle this with the decoction, and then strain through a linen cloth, previously moistened with warm water. By this process, a nutritious vegetable jelly is formed, which may be poured into moulds, or glasses, and eaten alone, or with milk. The aroraiatic flavour of the almonds blends itself with, and completely conceals the peculiai bitter of tba lichen and forms a very palatable, eisily-digested, and nutritive aliment. A. P. B I Tzsiii ) CONTENTS. CHAP. I. Ohskrvations on Diet, particu- larly that of the common people - - Page 19 General Observations on Ali- ment - - - 20 Of Bread - - - 21 Boiled Grain - - 24 Butter ... 27 Fruits and Roots - 29 Broths and Soups - 34 Remarks on Food - 37 Food considered in a medical point of view - - 39 Difterences between Vegetable and Animal Food - id. CHAP. n. On Sedkntary, Stuutous, and Laborious Occupations, &c. 40 On various Employments 42 Soldiers and Sailors, the con- sequences of their Employ- ment - - - 44 The Sedentary - - 46 Injurious Effect of lonaj In- clined Posture, &c. - 47 Advice to the Sedentary, &c. 49 The Sedentary Studious 50 Diseases to which Studious People are more peculiarly liable - - - id. Advice to Studious and Intense Thinkers - - 52 Desk Occupations, &.c. 53 ftlorningbest adapted for Studv and Exercise, &.c. - id. Effects of Music on the Mind id. Hr. Buchan's Plan of invigor- ating the Spirit** - 54 Diet of tiio Studious id. 31 The Kind of Exercise recom mended to Studious Habit* 54 CHAP. III. Non-Naturals - 55 Observations on Diet - id. Vegetable Diet - - 57 Plain Rules in the Selection of Diet, «fec. - - 59 General Observations on Diet, long Fasting, its consequen- ces. Regularities, &c. 60 Suppers and Breakfasts con- trasted, «fcc. - - 61 CH4P, IV. 4iR - - - - 62 Burying witnin Churches, a reprehensible Practice 63 Stagnated Air - - 64 Air of great Towns - 65 CHAP. V. ExE&cisE - - - 66 Inactivity, its consequences 67 Exercise in the open Air 68 Indolence, its consequences 69 Sleep, its benefits, «fec. - 69 'lb procure refreshing Sleep, &c. ... 70 Early rising - - 71 CHAP. VIT. Clothing, to be suited to the cli- mnte and season of the year 71 CHAP. vni. , Intemperance, how hurtfiil 75 CHAP. IX. Cleanliness - - - 78 Necessity of frequent Ablu- tions - .. gd JCXXIV (X>NTBNTS. CHAP. X. Infection and Contagion, wliat, and liitw communicated 8'J CHAP. XI. Affections of the Mind 85 Anger - - - 86 Fear - - - id. Effects of Fear on Child-bed Women - - • h^ \ Reprehensible Cuf.t,oni3 871 Grief - - - 88] Love - - - i*(;j Religious Melancholy id CHAP. XII. Thk Natural Evacuations 91 The Fsecal Evacuations, &.c. id. Urine - - - 92 Perspiration - - 94 Causes of obstructed Perspi- ration - - id. Wet Clothes - . 95 Wet Feet - _ _ id. Night Air - - - id. Damp Beds . - id. Dhiap House? - - 96 Sudo'en Transiti uns, &,c. 07 FAirr if CHAP. 1. The Knowledge and l.-im* of Diseases - - 100 j Definition of Diseases, Alc:. id. [ CHAP. II. General Observations on Fe- vers - - - 104 Causes of Fevers - id. Fever considered as an Effort of Nature, &c. - 105 Symptoms of Fever - 106 Treatment of Fevers, &c. 108 CHAP. III. Tntrrmittent Fevers or Agues, Causes, Symptoms, Stages, Medical Treatment, Diet, &c. - - - 109 CHAP. IV. , Remittent Fever, Cause, Symp-j terns. Diet, Medical Treat- j ment - - 11"/ 1 CHAP. V. Continued Fevers - 180 Synochus or Simple Continued Fevers. Symptoms, Medical Treatment, Diet, Slc. 120—12-^ CHAP. VI. Inflammatory, Acute or Ar DENT Fever [Synocha) 122 Causes, Symptoms, Treatment, Diet, ifcc. - 122—127 CHAP. Vll. Slo;v or Nervous Fever ( Ty- phus Mitior) •■ 127 Causes, Symptoms, Diet, Med- ical Treatment, &.c. 127 — 133 CHAP. VIII. Malignant and Putrid, or Spot- ted Fever ( Typhus gravior) 133 Causes, Symptoms, Diet, Med ieal Treatment, &c. 133 — 140 CHAP. IX. Miliary Fever. Causes, Symp- toms, Regimen, Medicine, &c. 140—143 chap. X. BiLiAKY Fever, &c. - 143 chap XI. Pleurisy (Pleuritis.) Causes, Symptoms, Diet, Medicines, &c. - _ 144—148 CHAP. XII. Epidemic Influenza. (Fr. la-Grippe — The Gripp) 149—152 CHAP. xni. Phthisis, or Pulmonary Con- stinption. [Phthisis Piilmo- nalis.) Causes, Symptoms, Diet, Medicine, &;c. 152 — 160 Nervous Consumption i*iO Prevention of Consumption or Atrophv - id CONTENTS. On t!ie Means of Preventing Pulmonary Consumption JGl CHAP. XIV. Small Pox. ( Variola.) Causes, Syuiptoins, Diet, Medicine 108—176 CHAP. XV. Measles. {RTorhilli or Rubeola.) Causes, Symptoms, Regimen, Mcilical Treatment, &c. 170—179 CHAP. XVI. Scarlet Fever. [Scarlatina) 179 CHAP. XVII. Eresipelas, or St. Anthony's Fire. Causes, Symptoms, Treatment, Diet, «&c. 181 — 185 CHAP. XVIII. Inflammation of the Brain. {riircnitis.) - 185—189 CHAP. XIX. Ophthalmia, or Inflammation of the Eyes. Causes, Symptoms, Regimen, Medical Treatment 189—193 CHAP. XX. Quinsey, or Inflammatory Sore Throat. {Cyvanrhfi. Tonsilla- ris.) Causes, Symptoms, Treatment, &c. 193 — 197 Malignant Quinsey, or Putrid Ulcerous Sore Throat, {Cy- nanche Maligna.) Causes, Symptoms, Regimen, Medi- cine, ifec. - 197—201 Mumps, {Cynanche ParotidfEo) 201 CHAP. XXI. Colds and Coughs, [Catarrhal Affections) - - 202 Common Cougii - 205 IIoo[)lngCough,or Chin Cough (Pertussis) - 207—209 CHAP. XXII. Inflammation of tlie Stomach, (Gastritis.) Causes, Symp- toms, Regimen, Medicine 210 Inflammation of the Intestines, &c. - - - 211 Inflammation of the Kidaeyn Slc. - - - 217 Inflammation of the Bladder, &c. J - - 219 Inflammat*ion of the Liver, &c 220 CHAP. XXIII. Cholera IMorrus, and other ex- cessive Discliarges from the Stomach and Bowels. Caus- es, Symptoms, Medicine, 477 Harrowgate - - 478 Moffiit - - - 481 Bath Hot Springs - id. Buxton - _ - 484 Matlock - - - 485 Bristol Hot Well - id. Continental Hot Springs 487 Malvern Water - 488 Aluminous Chalybeate Spring in the Isle of Wight 489 chap. XIV. Vegetable Poisons - 490 Narcotic Poisons - 491 Poisonous Muslirooms 492 chap. XV. Poisonous Fish chap, XVI. Vaccination 492 493 CHAP. XVII. fel'A-SlCKNESS - - 494 Imperial Marine Tiacture for ... 495 APPEND [X, Medicines Used in Practice, &c. . - - - iii Domestic Pharmacopceia - ix Balsams - - id. Boluses - - - id. Cataplasms - - - x Clysters - - - id. Collyria, or Eye Water - xi Confections - - xii Conserves and Preserves id. Decoctions - - - id. Draughts - - . xiii Electuaries - - * xiv Emulsions - - ~ w Extracts - - - id. Fomentations - - xvi Gargles - - - id. Infusions - - - xvii Juleps - . - uviii Mixtures - - id. Ointments - - - xix Liniments - - id. Cerates - - - id. Pills - - - . xx: Plasters - . _ x3ii Poultices - - xxiv Powders - - id. Syrups _ - - -yjfv Tinctures - - xxvi Elixirs - - - id. Vinegars - - xxviii W'aters by Infusion - xxix Simple Distilled Waters - id. Spirituous DistiTd Waters xxx Wheys - - - id. Wines - - - xxxi Preparation of the Lichen Isliindicus - - id INDEX. AntuTioNa, the frequent ne- cessity of Page Ahortion _ - - , to prevent , signs of -, hemorrlmge, treat- ment of, in Abscesses nnd inflammations Aciilities in children Acids. Sec Mineral Poisons. Aerial poisons. See Noxious Vapours. After-burden, management of . - - Air, how it may become nox- ious - - - , in great cities , in mines, wells, cellars ■ . of great towns to be avoided ' ' ' , unwholesome, its effects upon children Aliment, general observa- tions on - - Alkalies, _ - - Alkaline earths Amaurosis. See Gutla Se- rena. Ammonia. See Alkalies. Anger, its effects upon the mind - - - Animal and vegetable food, difference between -, obser- vations on - - Animals, poisonous Animation, suspended Antidotes. See Poisons. Antimony and its prepara- tions. Set Mineral Poi- sons. Apoplexy SO 409 id. 410 id. 424 Appetite, want of Page 300 Appendix . - - Aplithae . - - Arsenic. See Mineral Poi sons. Artists, hurt by the delete- rious air they are obliged to breathe Asthma . - - 423 40 292 B. Balsams 415 02 03 64 65 454 20 347 id. 86 39 56 349 382 296 , anodyne , Locatolli's , vulnerary , Commander's , Friars , Persian , of Berne Barrenness Barytes. See Mineral sons. IX id. id. id. id. id. id. id. 421 , pure , carbonate and muri- ate of. See Alkaline Earths Bath hot-springs Bathing, cold , in fresh and salt water _ - - , warm, where useful , effects of cold , cautions to be ob- served in Bladder, inflammation of Bleeding _ _ - , topical Blind persons, capable of what _ - - , Nicholas Sanderson and Dr. Thos. Blacklock quoted in 481 451 id. id. 463 464 219 352 355 329 id INDEX. Blood, involuntary dischar- ges of - - - , vomiting of , spitting of Boluses - - - Bolus, astringent , diaphoretic , mercurial , of rhubarb and mer- cury _ _ _ , pectoral , purging - Bones, broken -, treatment of . , setting of Bowels, excessive dischar- ges from. See Cholera Morbus. Brain, dropsy of , inflammation of Bread, considered as food , often spoiled to please the eye - , made of different kinds of grain , the greatest con- sumption of, occasioned by tea - > _ Breakfasts and suppers con- trasted _ - - Breast, inflammation of Bristol hot-wells Broths and soups , a dish of great anti- quity - _ _ , Huflland, Dr. quoted on soups Bruises - _ _ Buchan, Dr. his plan of ex- ercise - - _ Buckwheat, highly nutritious Burns _ _ _ , Cleghorn, Mr. his plan of treating , Kentish, Mr. his plan , Earle, Sir James, his 238 247 244 ix id. id. id. id. id. 374 id. 375 plan Burying v'ithin churches, the practice condemned ■ , its practice among the Jews, Romans, &c. Butter, considered as food Buxton waters 43(5 185 21 22 23 id. 61 418 485 34 36 37 362 54 27 359 861 360 361 63 id. 27 484 C. Cancer Candied orange peel -^ , lemon ditto * - Carrots to be eaten young Casualties Catamenia. Heat, the effects of extreme liSS Hernia. See Ruptures. Henbane. See Poisons nar- cotic. Hiccup . _ - 315 Hiccups, of infants - - 424 Hiera picra. See Tincture sacred and sacred elixir. Hossack, Dr. of New York, quoted . - - 82 Hot-springs, continental 4b7 Humane Society, Royal - 896 Hydrophobia - - 348 Hypochondriac affections 32.5 Hypochondriacs, Cullen's description of - - 52 Hypochondriasis. See Low Spirits. Hysteria. See Hysteric af- fections. Hysteric affections - 322 Hysterics of pregnant women 406 I. Ideas, a change of, necessa- ry to health - - 89 Inactive, the, always com- plaining, of what - 67 Indolence, its consequences 69 Infants, diseases of - 422 arise chief- id. 82 ly from the bowels Infection and contagion observations and opinions on , diseases, many caused by - - -, cautions against Inflammations, &c Inflammation of the bladder. See Bladder. of the brain. id. id. 84 355 See Brain. ~ of the eyes. >S'ee Eyes. of the intes- tines. See Intestines. of the kidneys. See Kidneys. rliv INDEX. Inflammation of the liver. See Ijiver. of the lungs. See Lungs. ■ of the stom- ach. See Stomach. of the throat. See Quinsey. of the womb. See Womb. Infusions Infusion, bitter of the bark xvn id. id. Carduus Benedic- tus, or blessed thistle - id. linseed - - id. of roses - - id. tamarinds and senna id. Spanish - - xviii for the palsy - id. . antiscorbutic - id. Tntei tperance - - 75 , the danger of id. — , a striking proof of afforded, by what id. , families affect- ed by it - - - 76 Intestines, inflammation of the . - - 211 Intoxication, consequences of - - - - 76 ■ hurtful to young persons - - - 78 effects of, often falal ... 391 Itch - . . - 290 Itchings, troublesome, of pregnant women - 406 J. Jaundice - - - 265 ■ of pregnant wo- men - _ _ 407 Juleps - - - _ xviii Julep, camphorated - id. " , cordial ... id. , expectorating - id. , musk - _ _ Id, , saline - - id. ■ ■■ , vomiting - . - id. K. Kidneys, inflammation of 217 King's evil S.S5 L. Laborious occupations, &c. remarks on - 40 Labours, classification of 412 Labour, stages of - id , symptoms pieceding id , symptoms accompa- nying - - - 413 , process of, natural 414 , tedious - - 416 , treatment after id. Laugh, sardonic - 317 Lead and its preparations. See Mineral Poisons. Leeks _ _ _ 34 Lichen, islfindicus, prepara- tions of - - - XXXi Lime. See Alkaline Earths. Liniment for burns - xx , volatile - id. — , white - id. , for piles - id. Liquors, fermented - 58 , observations on .59 , hot, in warm rooms, the danger of drinking 98 Liver, inflammation of 220 Lochia, suppression of 418 Longings of pregnant wo- men - - - 406 Looseness of infants - 427 Love, perhaps the strongest of all passions - 90 Low spirits - - 321 Lungs, inflammation of 150 M. Malvern water - - 488 Marine tincture, imperial, for sea-sickness and ner- vous disorders - 495 Matlock waters - - 485 Measles - - 176 Mechanics, advice to -. 49 Meconium - - _ 423 Medicines used in private practice - - iii-viii , names of - id , properties - iiK INDEX. xlv Medicines, doses - Melancholy , reliirious 111- -Vlll 30G 90 Menses, immoderate How of 401 cessation of Menstruation, difficult Mercury and its prepara- tions. See Mineral Poi- sons. Midwives, their ill-judged care of infants Mind, the temper of in dis- eases, how to be attended to - - - - ~, affections of 403 id. 422 101 85 xxviii 468 Mindererus's spirit Mineral waters , classifica- tion of - - - 470 Mixtures - - - xviii Mixture, astringent - xix , diuretic - id. , laxative, absorbent id. , saline - - id. , squill - - id. Moffat waters - .- 481 Mouth and nose, substances stopped between - 379 Mumps - - - 201 Mushrooms, poisonous 492 Music, its effects on the mind _ - - 53 Myopia - - - 331 N. Nausea and vomiting of pregnant woman - 404 Nerves, weak, the compan- ion of inactivity - 67 Nervous diseases - 303 Night-air ... 95 Night-mare - - 317 Nipples, fretted or chapped 418 Nitre - - - - 348 Non-naturals - - 55 Nose, bleeding at - 239 , stoppage of, in chil- dren . . - 426 Nurses, the duty of - 456 O. Oatmeal frequently made into bread - - 25 Oil, camphorated Ointments Ointment, yellow basilicum , of calamine - , emollient , eye , issue , lead , mercurial , sulphur , for diseases of the skin , v/hite - See Poisons, Nar- Opium cotic. Onions how dressed P. structed - - - Pills ... - Pill, composing , deobstruent - , foetid - - - , hemlock . mercurial — -, mercurial sublimate , plummer's , purging , purgative , for the biSe - jaundice 2>:j XIX id. id. id. id. XX id. id. id. id id. 34 Pain after - - - 417 Pains false 408 Palsy 309 Paraphrenitis 149 Parents, diseased, the effect upon children - 44! Parturition 412 Peas and beans considered as food - - - 25 Perspiration. See Evacua- tions. , causes of, ob- , stomachic , squill - - - , strengthening Piles, blind and bleeding Placenta. See After Burden Plants, poisonous Plasters Plaster, common , adhesive 94 xxi id. id. id. id. id. id. id. xxii id. id. id. id. id. id. 241 , blistering 351 xxii. xjriii id sivi Plaster, gum , mercurial • , stomach , warm , wax Pleurisy , Dastard • Poisons, mineral - ■ , vegetable , animal INDEX. id. id. id. id. id. 144 149 342 342, 490 342 , aerial. See Noxious A'^apours. -, narcotic Poor living after the course of fever among labourers Posture, injurious eftect of, long inclined , figure of body, how hurt by - - - Potatoes considei-ed as a substitute for bread Potash. See Alkalies. Poultices - - - Powders _ - - Powder, astringent , of bole - , carminative , diuretic , aromatic opening, , saline laxative , steel , sudorific , worm purging -, for tape-worm Pregnancy, diseases of , during, three stages exist Preserves. See Conserves. Prognosis, what - Quickenings , opinion rela- tive to _ - - Quinsey. See Sore Throat, inflammatory. , malignant R. Rattlesnake, bite of (Resurrection. See Animation suspended. 491 44 47 id. 30 xxiv id. id. id. id. id. id. XXV id. id. id. id. id. 403 404 100 404 id. 197 Rheumatism Rickets - - - Rising, early, a consequence of what _ - - Ruptures S. Sailors and soldiers, conse- quences of their calling Saint Anthony's fire, a dis- ease incident to labouring people - _ - , iliac pas 351 433 sion, colic, and other com- plaints of the bowels often occasioned by the same cause as - Saint Vitus's dance Salsafy, skirrets, and sever- al kinds of beets, observa- tions on - - - Sanctorius, an Italian phy- sician quoted on pulmona- ry and cutaneous transpi- ration - - - Scarborough waters Scald head - - - Scenes, the variety of, why designed - - - Scirrhus - _ - Scrofula. See King's Evil. Scurvy _ _ _ Sea-sickness , imperial ma- rine tincture for Sedentary, studious, and la- borious occupations, re- marks on - - , sedentary studi- ous -, advice to -, diseases of Seltzer water Senses, disorders of Shortsightedness. *S^ee My- opia. Silver, nitrate of, iSee Min- eral Poisons. Simples, a list of. Sec Ap- pendix. Simplicity, the great rule of diet - - - Sinapisms. See Cataplasms. 44 43 id. 313 33 94 476 428 89 336 281 494 495 40 50 id. id 477 329 •3* INDEX. Sk\n, over distention of, in piegnant women - 408 Smell and taste - - 333 Slioe, the si/.e and figure how regulated - 73 — 74 Sleep, want of, and restless- ness of pregnant womca , its benefits - , like diet ought to be 407 69 duly regulated - , to procure refreshing , light suppers procure . refreshing, when id. 70 id. 71 168 Small-pox Soda. See Alkalies. Soldiers and sailors, the con- sequences of their employ- ment - - - 44 Sore throat, inflammatory 193 Spirit of wine, camphorat- ed - - - - xxviii Spring-chalybeate in the Isle of Wight - - - 489 Squinting. See Strabismus. Stale bread, its effects upon the humours - - 45 Stone and gravel - - 234 Stomach, cramp of - 316 , pain of - 2-59 , inflammation of 210 , and bowels, affec- tions of. See Costiveness. Studious and intense think- ers, advice to - - 52 , diet of - - 54 Studious occupations, re- marks on - - 40 Strabismus - - - 331 Strains _ - - 377 Strangling. See Suffocation. Study and exercise, the best time for - - - Subjects, gloomy ones, not to be inculcated Suftbcatioa from various causes _ - - of infants Suppers and breakfasts con- trasted - - - Surgery . _ _ Swellings, puffy, of the feet, of pregnant women Swooning - - - 53 91 393 id. 61 352 406 318 Syncope. See Fits, Fainting, See Sv.'ooning. Syrups - - - XXV T. Tap-rooms, highly pernicious 98 Taste and smell - - 333 Tea, the mischief of, when substituted for solid food Teething - . - Tests. See Poisons. Thrush. See Aphthae. Tinea, capitis. See Scald Head. Tinctures - - - xxvi Tincture, imperial marine, against sea-sickness, ..;.- COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED DATE BORROWED C28(i140m1OO ^vs^.^ ''U'i ^Cf/