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diff --git a/39044.txt b/39044.txt new file mode 100644 index 0000000..9af56ec --- /dev/null +++ b/39044.txt @@ -0,0 +1,17369 @@ +The Project Gutenberg EBook of Advice to the people in general, with +regard to their health, by Samuel Auguste David Tissot + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Advice to the people in general, with regard to their health + +Author: Samuel Auguste David Tissot + +Translator: J. Kirkpatrick + +Release Date: March 9, 2012 [EBook #39044] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK ADVICE TO THE PEOPLE *** + + + + +Produced by Bryan Ness, Enrico Segre and the Online +Distributed Proofreading Team at http://www.pgdp.net (This +file was produced from images generously made available +by The Internet Archive/Canadian Libraries) + + + + + + Advice to the people + + + _ADVICE_ + __to the__ + _PEOPLE_ in __General__, + __with__ + + Regard to their __Health__: + + + + +But more particularly calculated for those, who, by their Distance from +regular Physicians, or other very experienced Practitioners, are the +most unlikely to be seasonably provided with the best Advice and +Assistance, in acute Diseases, or upon any sudden inward or outward +Accident. + + _WITH_ + +A Table of the most cheap, yet effectual Remedies, and the plainest +Directions for preparing them readily. + + Translated from the _French_ Edition of + + Dr. __Tissot's__ _Avis au Peuple_, &c. + +Printed at _Lyons_; with all his own Notes; a few of his medical +Editor's at _Lyons_; and several occasional Notes, adapted to this +_English_ Translation, + + By J. _Kirkpatrick_, M. D. + + + + + _In the Multitude of the People is the Honour of a King; and for + the Want of People cometh the Destruction of the Prince._ + + Proverbs xiv, 28. + ----------------------------------------------------------------- + + + + + __LONDON:__ + + Printed for T. _Becket_ and P. A. _De Hondt_, at _Tully's_ Head, near + _Surry-Street_, in the _Strand_. + + M DCC LXV. + + + + + _the Translator's_ PREFACE. + + +Though the great Utility of those medical Directions, with which the +following Treatise is thoroughly replenished, will be sufficiently +evident to every plain and sensible Peruser of it; and the extraordinary +Reception of it on the Continent is recited in the very worthy Author's +Preface; yet something, it should seem, may be pertinently added, with +Regard to this Translation of it, by a Person who has been strictly +attentive to the Original: a Work, whose Purpose was truly necessary and +benevolent; as the Execution of it, altogether, is very happily +accomplished. + +It will be self evident, I apprehend, to every excellent Physician, that +a radical Knowledge of the Principles, and much Experience in the +Exercise, of their Profession, were necessary to accommodate such a Work +to the Comprehension of those, for whom it was more particularly +calculated. Such Gentlemen must observe, that the certain Axiom of +_Nature's curing Diseases_, which is equally true in our Day, as it was +in that of _Hippocrates_, so habitually animates this Treatise, as not +to require the least particular Reference. This _Hippocratic_ Truth as +certain (though much less subject to general Observation) as that +Disease, or Age, is finally prevalent over all sublunary Life, the most +attentive Physicians discern the soonest, the most ingenuous readily +confess: and hence springs that wholesome Zeal and Severity, with which +Dr. _Tissot_ encounters such Prejudices of poor illiterate Persons, as +either oppose, or very ignorantly precipitate, her Operations, in her +Attainment of Health. These Prejudices indeed may seem, from this Work, +to be still greater, and perhaps grosser too, in _Swisserland_ than +among ourselves; though it is certain there is but too much Room for the +Application of his salutary Cautions and Directions, even in this +Capital; and doubtless abundantly more at great Distances from it. It +may be very justly supposed, for _one_ Instance, that in most of those +Cases in the Small Pocks, in which the Mother undertakes the Cure of her +Child, or confides it to a Nurse, that Saffron, in a greater or less +Quantity, and Sack or Mountain Whey, are generally still used in the +Sickening before Eruption; to accelerate that very Eruption, whose +gradual Appearance, about the fourth Day, from that of Seizure +inclusive, is so favourable and promising to the Patient; and the +Precipitation of which is often so highly pernicious to them. Most of, +or rather all, his other Cautions and Corrections seem equally necessary +here, as often as the Sick are similarly circumstanced, under the +different acute Diseases in which he enjoins them. + +Without the least Detraction however from this excellent Physician, it +may be admitted that a few others, in many other Countries, might have +sufficient Abilities and Experience for the Production of a like Work, +on the same good Plan. This, we find, Dr. _Hirzel_, principal Physician +of _Zurich_, had in Meditation, when the present Treatise appeared, +which he thought had so thoroughly fulfilled his own Intention, that it +prevented his attempting to execute it. But the great Difficulty +consisted in discovering a Physician, who, with equal Abilities, +Reputation and Practice, should be qualified with that _much rarer_ +Qualification of caring so much more for the Health of those, who could +never pay him for it, than for his own Profit or Ease, as to determine +him to project and to accomplish so necessary, and yet so self-denying, +a Work. For as the Simplicity he proposed in the Style and Manner of it, +by condescending, in the plainest Terms, to the humblest Capacities, +obliged him to depress himself, by writing rather beneath the former +Treatises, which had acquired him the Reputation of medical Erudition, +Reasoning and Elegance; we find that the Love of Fame itself, so +stimulating even to many ingenuous Minds, was as impotent as that of +Wealth, to seduce him from so benign, so generous a Purpose. Though, +upon Reflection, it is by no Means strange to see wise Men found their +Happiness, which all [however variously and even oppositely] pursue, +rather in Conscience, than on Applause; and this naturally reminds us of +that celebrated Expression of _Cato_, or some other excellent Ancient, +"that he had rather _be_ good, than _be reputed_ so." + +However singular such a Determination may now appear, the Number of +reputable medical Translators into different Languages, which this +original Work has employed on the Continent, makes it evident, that real +Merit will, sooner or later, have a pretty general Influence; and induce +many to imitate that Example, which they either could not, or did not, +propose. As the truly modest Author has professedly disclaimed all +Applause on the Performance, and contented himself with hoping an +Exemption from Censure, through his Readers' Reflection on the peculiar +Circumstances and Address of it; well may his best, his faithfullest +Translators, whose Merit and Pains must be of a very secondary Degree to +his own, be satisfied with a similar Exemption: especially when joined +to the Pleasure, that must result from a Consciousness of having +endeavoured to extend the Benefits of their Author's Treatise, to +Multitudes of their own Country and Language. + +For my own Particular, when after reading the Introduction to the Work, +and much of the Sequel, I had determined to translate it; to be as just +as possible to the Author, and to his _English_ Readers, I determined +not to interpolate any Sentiment of my own into the Text, nor to omit +one Sentence of the Original, which, besides its being _Detraction_ in +its literal Sense, I thought might imply it in its worst, its figurative +one; for which there was no Room. To conform as fully as possible to the +Plainness and Perspicuity he proposed, I have been pretty often obliged +in the anatomical Names of some Parts, and sometimes of the Symptoms, as +well as in some pretty familiar, though not entirely popular Words, to +explain all such by the most common Words I have heard used for them; as +after mentioning the _Diaphragm_, to add, or _Midriff_--the +_Trachaea_--or _Windpipe_--_acrimonious_, or _very sharp_, and so of many +others. This may a little, though but a little, have extended the +Translation beyond the Original; as the great Affinity between the +_French_ and _Latin_, and between the former and many _Latin_ Words +borrowed from the _Greek_, generally makes the same anatomical or +medical Term, that is technical with us, vernacular or common with them. +But this unavoidable Tautology, which may be irksome to many Ears, those +medical Readers, for whom it was not intended, will readily forgive, +from a Consideration of the general Address of the Work: while they +reflect that meer Style, if thoroughly intelligible, is least essential +to those Books, which wholly consist of very useful, and generally +interesting, Matter. + +As many of the Notes of the Editor of _Lyons_, as I have retained in +this Version (having translated from the Edition of _Lyons_) are +subscribed _E. L._ I have dispensed with several, some, as evidently +less within Dr. _Tissot's_ Plan, from tending to theorize, however +justly or practically, where he must have had his own Reasons for +omitting to theorize: a few others, as manifestly needless, from what +the Author had either premised, or speedily subjoined, on the very same +Circumstance: besides a very few, from their local Confinement to the +Practice at _Lyons_, which lies in a Climate somewhat more different +from our own than that of _Lausanne_. It is probable nevertheless, I +have retained a few more than were necessary in a professed Translation +of the original Work: but wherever I have done this, I have generally +subjoined my Motive for it; of whatever Consequence that may appear to +the Reader. I have retained all the Author's own Notes, with his Name +annexed to them; or if ever the Annotator was uncertain to me, I have +declared whose Note I supposed it to be. + +Such as I have added from my own Experience or Observation are +subscribed _K_, to distinguish them from the others; and that the +Demerit of any of them may neither be imputed to the learned Author, nor +to his Editor. Their principal Recommendation, or Apology is, that +whatever Facts I have mentioned are certainly true. I have endeavoured +to be temperate in their Number and Length, and to imitate that strict +Pertinence, which prevails throughout the Author's Work. If any may have +ever condescended to consider my Way of writing, they will conceive this +Restraint has cost me at least as much Pains, as a further Indulgence of +my own Conceptions could have done. The few Prescriptions I have +included in some of them, have been so conducted, as not to give the +Reader the least Confusion with Respect to those, which the Author has +given in his Table of Remedies, and which are referred to by numerical +Figures, throughout the Course of his Book. + +The moderate Number of Dr. _Tissot's_ Prescriptions, in his Table of +Remedies, amounting but to seventy-one, and the apparent Simplicity of +many of them, may possibly disgust some Admirers of pompous and compound +Prescription. But his Reserve, in this important Respect, has been +thoroughly consistent with his Notion of Nature's curing Diseases; which +suggested to him the first, the essential Necessity of cautioning his +Readers against doing, giving, or applying any thing, that might oppose +her healing Operations (a most capital Purpose of his Work) which +important Point being gained, the mildest, simplest and least hazardous +Remedies would often prove sufficient Assistants to her. Nevertheless, +under more severe and tedious Conflicts, he is not wanting to direct the +most potent and efficacious ones. The Circumstances of the poor Subjects +of his medical Consideration, became also a very natural Object to him, +and was in no wise unworthy the Regard of the humane Translator of +_Bilguer on Amputations_, or rather _against_ the crying Abuse of them; +an excellent Work, that does real Honour to them both; and which can be +disapproved by none, who do not prefer the frequently unnecessary +Mutilation of the afflicted, to the Consumption of their own Time, or +the Contraction of their Employment. + +Some Persons may imagine that a Treatise of this Kind, composed for the +Benefit of labouring People in _Swisserland_, may be little applicable +to those of the _British_ Islands: and this, in a very few Particulars, +and in a small Degree, may reasonably be admitted. But as we find their +common Prejudices are often the very same; as the _Swiss_ are the +Inhabitants of a colder Climate than _France_, and generally, as Dr. +_Tissot_ often observes, accustomed to drink (like ourselves) more +strong Drink than the _French_ Peasantry; and to indulge more in eating +Flesh too, which the Religion of _Berne_, like our own, does not +restrain; the Application of his Advice to them will pretty generally +hold good here. Where he forbids them Wine and Flesh, all Butchers Meat, +and in most Cases all Flesh, and all strong Drink should be prohibited +here: especially when we consider, that all his Directions are confined +to the Treatment of acute Diseases, of which the very young, the +youthful, and frequently even the robust are more generally the +Subjects. Besides, in some few of the _English_ Translator's Notes, he +has taken the Liberty of moderating the Coolers, or the Quantities of +them (which may be well adapted to the great Heats and violent _Swiss_ +Summers he talks of) according to the Temperature of our own Climate, +and the general Habitudes of our own People. It may be observed too, +that from the same Motive, I have sometimes assumed the Liberty of +dissenting from the Text in a very few Notes, as for Instance, on the +Article of Pastry, which perhaps is generally better here than in +_Swisserland_ (where it may be no better than the coarse vile Trash that +is hawked about and sold to meer Children) as I have frequently, in +preparing for Inoculation, admitted the best Pastry (but not of Meat) +into the limited Diet of the Subjects of Inoculation, and constantly +without the least ill Consequence. Thus also in Note [70] Page 287, 288, +I have presumed to affirm the Fact, that a strong spirituous Infusion of +the Bark has succeeded more speedily in some Intermittents, in +particular Habits, than the Bark in Substance. This I humbly conceive +may be owing to such a _Menstruum's_ extracting the Resin of the Bark +more effectually (and so conveying it into the Blood) than the Juices of +the Stomach and of the alimentary Canal did, or could. For it is very +conceivable that the _Crasis_, the Consistence, of the fibrous Blood may +sometimes be affected with a morbid Laxity or Weakness, as well as the +general System of the muscular Fibres. + +These and any other like Freedoms, I am certain the Author's Candour +will abundantly pardon; since I have never dissented for Dissention's +Sake, to the best of my Recollection; and have the Honour of harmonizing +very generally in Judgment with him. If _one_ useful Hint or Observation +occurs throughout my Notes, his Benevolence will exult in that essential +Adherence to his Plan, which suggested it to me: While an invariable +ecchoing Assentation throughout such Notes, when there really was any +salutary Room for doubting, or for adding (with Respect to ourselves) +would discover a Servility, that must have disgusted a liberal manly +Writer. One common good Purpose certainly springs from the generous +Source, and replenishes the many Canals into which it is derived; all +the Variety and little Deviations of which may be considered as more +expansive Distributions of its Benefits. + +Since the natural Feelings of Humanity generally dispose us, but +especially the more tender and compassionate Sex, to advise Remedies to +the poor Sick; such a Knowledge of their real Disease, as would prevent +their Patrons, Neighbours and Assistants from advising a wrong Regimen, +or an improper or ill-timed Medicine, is truly essential to relieving +them: and such we seriously think the present Work is capable of +imparting, to all commonly sensible and considerate Perusers of it. A +Vein of unaffected Probity, of manly Sense, and of great Philanthropy, +concur to sustain the Work: And whenever the Prejudices of the Ignorant +require a forcible Eradication; or the crude Temerity and Impudence of +Knaves and Impostors cry out for their own Extermination, a happy +Mixture of strong Argument, just Ridicule, and honest Severity, give a +poignant and pleasant Seasoning to the Work, which renders it +occasionally entertaining, as it is continually instructive. + +A general Reader may be sometimes diverted with such Customs and Notions +of the _Swiss_ Peasants, as are occasionally mentioned here: and +possibly our meerest Rustics may laugh at the brave simple _Swiss_, on +his introducing a Sheep into the Chamber of a very sick Person, to save +the Life of the Patient, by catching its own Death. But the humblest +Peasantry of both Nations are agreed in such a Number of their absurd +unhealthy Prejudices, in the Treatment of Diseases, that it really +seemed necessary to offer our own the Cautions and Counsels of this +principal Physician, in a very respectable Protestant Republick, in +Order to prevent their Continuance. Nor is it unreasonable to presume, +that under such a Form of Government, if honestly administered upon its +justest Principles, the People may be rather more tenderly regarded, +than under the Pomp and Rage of Despotism, or the Oppression of some +Aristocracies. + +Besides the different Conditions of [1] Persons, to whom our Author +recommends the Patronage and Execution of his Scheme, in his +Introduction, it is conceived this Book must be serviceable to many +young Country Practitioners, and to great Numbers of Apothecaries, by +furnishing them with such exact and striking Descriptions of each acute +Disease and its Symptoms, as may prevent their mistaking it for any +other; a Deception which has certainly often been injurious, and +sometimes even fatal: for it is dreadful but to contemplate the +Destruction or Misery, with which Temerity and Ignorance, so frequently +combined, overwhelm the Sick. Thus more Success and Reputation, with the +Enjoyment of a better Conscience, would crown their Endeavours, by a +more general Recovery of, or Relief to, their Patients. To effect this, +to improve every Opportunity of eschewing medical Evil, and of doing +medical Good, was the Author's avowed Intention; which he informs us in +his Preface, he has heard, from some intelligent and charitable Persons, +his Treatise had effected, even in some violent Diseases. That the same +good Consequences may every where attend the numerous Translations of +it, must be the fervent Wish of all, except the Quacks and Impostors he +so justly characterizes in his thirty-third Chapter! and particularly of +all, who may be distinguishably qualified, like himself, to, + +--_Look through Nature up to Nature's GOD!_ + + [1] Of all these the Schoolmasters, _with us_, may seem the most + reasonably exempted from this Duty. + + + + + The AUTHOR's _DEDICATION._ + + +_To the most Illustrious, the most Noble and Magnificent Lords, the +Lords President and Counsellors of the Chamber of Health, of the City +and Republick of_ Berne. + +_Most honourable Lords_, + +When I first published the following Work, my utmost Partiality to it +was not sufficient to allow me the Confidence of addressing it to Your +Lordships. But Your continual Attention to all the Objects, which have +any Relation to that important Part of the Administration of the State, +which has been so wisely committed to Your Care, has induced You to take +Notice of it. You have been pleased to judge it might prove useful, and +that an Attempt must be laudable, which tends to the Extermination of +erroneous and inveterate Prejudices, those cruel Tyrants, that are +continually opposing the Happiness of the People, even under that Form +and Constitution of Government, which is the best adapted to establish +and to increase it. + +Your Lordships Approbation, and the splendid Marks of [2] Benevolence, +with which You have honoured me, have afforded me a juster Discernment +of the Importance of this Treatise, and have inclined me to hope, _most +Illustrious, most Noble, and Magnificent Lords_, that You will permit +this new Edition of it to appear under the Sanction of your Auspices; +that while the Publick is assured of Your general Goodness and +Beneficence, it may also be informed of my profoundly grateful Sense of +them, on the same Occasion. + + [2] See the Author's Preface, immediately following this Dedication. + +May the present Endeavour then, in fully corresponding to my Wishes, +effectually realize Your Lordships utmost Expectations from it; while +You condescend to accept this small Oblation, as a very unequal +Expression of that profound Respect, with which I have the Honour to be, + +_Most Illustrious, Most Noble, and Magnificent Lords,_ + + _Your most humble_ + _And most_ + _Obedient Servant_, + + _TISSOT._ + + _Lausanne_, + _Dec. 3, 1762._ + + + + + THE AUTHOR's _PREFACE._ + + +_If Vanity too often disposes many to speak of themselves, there are +some Occasions, on which a total Silence might be supposed to result +from a still higher Degree of it: And the very general Reception of the +*Advice to the People* has been such, that there would be Room to +suspect me of that most shocking Kind of Pride, which receives Applause +with Indifference (as deeming its own Merit Superior to the greatest) if +I did not appear to be strongly impressed with a just Sense of that +great Favour of the Publick, which has been so very obliging, and is so +highly agreable, to me._ + +_Unfeignedly affected with the unhappy Situation of the poor Sick in +Country Places in *Swisserland*, where they are lost from a Scarcity of +the best Assistance, and from a fatal Superfluity of the worst, my sole +Purpose in writing this Treatise has been to serve, and to comfort them. +I had intended it only for a small Extent of Country, with a moderate +Number of Inhabitants; and was greatly surprized to find, that within +five or six Months after its Publication, it was become one of the most +extensively published Books in *Europe*; and one of those Treatises, on +a scientific Subject, which has been perused by the greatest Number of +Readers of all Ranks and Conditions. To consider such Success with +Indifference, were to have been unworthy of it, which Demerit, at least +on this Account, I cannot justly be charged with; since Indifference has +not been my Case, who have felt, as I ought, this Gratification of +Self-love; and which, under just and prudent Restrictions, may perhaps +be even politically cherished; as the Delight naturally arising from +having been approved, is a Source of that laudable Emulation, which has +sometimes produced the most essential good Consequences to Society +itself. For my own particular, I can truly aver, that my Satisfaction +has been exquisitely heightened on this Occasion, as a Lover of my +Species: since judging from the Success of this Work (a Success which +has exceeded my utmost Expectations) of the Effects that may reasonably +be expected from it, I am happily conscious of that Satisfaction, or +even Joy, which every truly honest Man must receive, from rendering +essential good Offices to others. Besides which, I have enjoyed, in its +utmost Extent, that Satisfaction which every grateful Man must receive +from the Approbation and Beneficence of his Sovereign, when I was +distinguished with the precious Medal, which the illustrious Chamber of +Health of the Republick of Berne honoured me with, a few Months after +the Publication of this Treatise; together with a Letter still more +estimable, as it assured me of the extraordinary Satisfaction the +Republick had testified on the Impression of it; a Circumstance, which I +could not avoid this publick Acknowledgement of, without the greatest +Vanity and Ingratitude. This has also been a very influencing Motive +with me, to exert my utmost Abilities in perfecting this new Edition, in +which I have made many Alterations, that render it greatly preferable to +the first; and of which Amendments I shall give a brief Account, after +saying somewhat of the Editions, which have appeared elsewhere._ + +_The first is that, which Messrs. *Heidegger*, the Booksellers published +in the *German* Language at *Zurich*, about a Year since. I should have +been highly delighted with the meer Approbation of *__M. Hirzel__*, +first Physician of the Canton of *Zurich, &c.* whose superior and +universal Talents; whose profound Knowledge in the Theory of Physick; +and the Extent and Success of whose Practice have justly elevated him +among the small Number of extraordinary Men of our own Times; he having +lately obtained the Esteem and the Thanks of all *Europe,* for the +History of one of her [3] Sages. But I little expected the Honour this +Gentleman has done me, in translating the *Advice to the People* into +his own Language. Highly sensible nevertheless as I am of this Honour, I +must always reflect with Regret, that he has consumed that important +Time, in rendering my Directions intelligible to his Countrymen, which +he might have employed much more usefully, in obliging the World with +his own._ + +_He has enriched his Translation with an excellent Preface, which is +chiefly employed in a just and beautiful Portrait and Contrast of the +true, and of the false Physician; with which I should have done myself +the Pleasure to have adorned the present [4] Edition; if the Size of +this Volume, already too large, had not proved an Obstacle to so +considerable an Addition; and if the Manner, in which *Mr.* *__Hirzel__* +speaks of its Author, had permitted me with Decency to publish his +Preface. I have been informed by some Letters, that there have been two +other *German* Translation of it; but I am not informed by whom. +However, *__M. Hirzel's__* Preface, his own Notes, and some Additions +with which I have furnished him, renders his Edition preferable to the +first in *French*, and to the other *German* Translations already made._ + + [3] _Le Socrate rustique_, a Work, which every Person should read. + + [4] This Preface is indeed premised to this _French_ Edition, but a + Translation of it was omitted, to avoid extending the Bulk and + Price of the Work. Dr. _Tissot_ must then have been ignorant of + this Addition, when first published at _Lyons_. + +_The Second Edition is that, which the younger *__Didot__*, the +Bookseller, published towards the End of the Winter at *Paris*. He had +requested me to furnish him with some Additions to it, which I could not +readily comply with._ + +_The Third Edition is a *Dutch* Translation of it, which will be very +speedily published by *__M. Renier Aremberg__*, Bookseller at +*Rotterdam*. He had begun the Translation from my first Edition; but +having wrote to know whether I had not some Additions to make, I desired +him to wait for the Publication of this. I have the good Fortune to be +very happy in my Translators; it being *__M. Bikker__*, a celebrated +Physician at *Rotterdam* (so very advantagiously known in other +Countries, by his beautiful *Dissertation on Human Nature*, throughout +which Genius and Knowledge proceed Hand in Hand) who will present his +Countrymen with the *Advice to the People*, in their own Language: and +who will improve it with such Notes, as are necessary for a safe and +proper Application of its Contents, in a Climate, different from that in +which it was wrote. I have also heard, there has been an *Italian* +Translation of it._ + +_After this Account of the foreign Editions, I return to the present +one, which is the second of the original *French* Treatise. I shall not +affirm it is greatly corrected, with Respect to fundamental Points: for +as I had advanced nothing in the first, that was not established on +Truth and Demonstration, there was no Room for Correction, with Regard +to any essential Matters. Nevertheless, in this I have made, 1, a great +Number of small Alterations in the Diction, and added several Words, to +render the Work still more simple and perspicuous. 2, The typographical +Execution of this is considerably improved in the Type, the Paper and +Ink, the Spelling, Pointing, and Arrangement of the Work. 3, I have made +some considerable Additions, which are of three Kinds. Not a few of them +are new Articles on some of the Subjects formerly treated of; such as +the Articles concerning Tarts and other Pastry Ware; the Addition +concerning the Regimen for Persons, in a State of Recovery from +Diseases; the Preparation for the Small Pocks; a long Note on the +Jesuits Bark; another on acid Spirits; one on the Extract of Hemlock: +besides some new Matter which I have inserted; such as an Article with +Regard to proper Drinks; one on the Convulsions of Infants; one on +Chilblains; another on Punctures from Thorns; one upon the Reason of the +Confidence reposed in Quacks, and the thirty-first Chapter entirely: in +which I have extended the Consideration of some former Articles, that +seemed to me a little too succinct and short. There are some Alterations +of this last, this additional, Kind, interspersed almost throughout the +whole Substance of this Edition; but especially in the two Chapters +relating to Women and Children._ + +_The Objects of the XXXI Chapter are such as require immediate +Assistance, viz. Swoonings, Haemorrhages, that is, large spontaneous +Bleedings; the Attacks of Convulsions, and of Suffocations; the +Consequences of Fright and Terror; Disorders occasioned by unwholesome +or deadly Vapours; the Effects of Poison, and the sudden Invasions of +excessive Pain._ + +_The Omission of this Chapter was a very material Defect in the original +Plan of this Work. The Editor of it at Paris was very sensible of this +Chasm, or Blank, as it may be called, and has filled it up very +properly: and if I have not made Use of his Supplement, instead of +enlarging myself upon the Articles of which he has treated, it has only +been from a Purpose of rendering the whole Work more uniform; and to +avoid that odd Diversity, which seems scarcely to be avoided in a +Treatise composed by two Persons. Besides which, that Gentleman has said +nothing of the Articles, which employ the greatest Part of that Chapter, +*viz.* the Swoonings, the Consequences of great Fear, and the noxious +Vapours._ + +_Before I conclude, I ought to justify myself, as well as possible, to a +great Number of very respectable Persons both here and abroad, (to whom +I can refuse nothing without great Chagrine and Reluctance) for my not +having made such Additions as they desired of me. This however was +impossible, as the Objects, in which they concurred, were some chronical +Distempers, that are entirely out of the Plan, to which I was strictly +attached, for many Reasons. The first is, that it was my original +Purpose to oppose the Errors incurred in Country Places, in the +Treatment of acute Diseases; and to display the best Method of +conducting such, as do not admit of waiting for the Arrival of distant +Succour; or of removing the Patients to Cities, or large Towns. It is +but too true indeed, that chronical Diseases are also liable to improper +Treatment in small Country Places: but then there are both Time and +Convenience to convey the Patients within the Reach of better Advice; or +for procuring them the Attendance of the best Advisers, at their own +Places of Residence. Besides which, such Distempers are considerably +less common than those to which I had restrained my Views: and they will +become still less frequent, whenever acute Diseases, of which they are +frequently the Consequences, shall be more rationally and safely +conducted._ + +_The second Reason, which, if alone, would have been a sufficient one, +is, that it is impossible to subject the Treatment of chronical +Distempers to the Capacity and Conduct of Persons, who are not +Physicians. Each acute Distemper generally arises from one Cause; and +the Treatment of it is simple and uniform; since those Symptoms, which +manifest the Malady, point out its Cause and Treatment. But the Case is +very differently circumstanced in tedious and languid Diseases; each of +which may depend on so many and various Causes (and it is only the real, +the true Cause, which ought to determine us in selecting its proper +Remedies) that though the Distemper and its Appellation are evidently +known, a meer By-stander may be very remote from penetrating into its +true Cause; and consequently be incapable of chusing the best Medicines +for it. It is this precise and distinguishing Discernment of the real +particular Cause *[or of the contingent Concurrence of more than one]* +that necessarily requires the Presence of Persons conversant in the +Study and the Practice of all the Parts of Physick; and which Knowledge +it is impossible for People, who are Strangers to such Studies, to +arrive at. Moreover, their frequent Complexness; the Variety of their +Symptoms; the different Stages of these tedious Diseases [not exactly +attended to even by many competent Physicians] the Difficulty of +ascertaining the different Doses of Medicines, whose Activity may make +the smallest Error highly dangerous, &c. &c. are really such trying +Circumstances, as render the fittest Treatment of these Diseases +sufficiently difficult and embarrassing to the most experienced +Physicians, and unattainable by those who are not Physicians._ + +_A third Reason is, that, even supposing all these Circumstances might +be made so plain and easy, as to be comprehended by every Reader, they +would require a Work of an excessive Length; and thence be +disproportioned to the Faculties of those, for whom it was intended. One +single chronical Disease might require as large a Volume as the present +one._ + +_But finally, were I to acknowledge, that this Compliance was both +necessary and practicable, I declare I find it exceeds my Abilities; and +that I am also far from having sufficient Leisure for the Execution of +it. It is my Wish that others would attempt it, and may succeed in +accomplishing it; but I hope these truly worthy Persons, who have +honoured me by proposing the Achievement of it to myself, will perceive +the Reasons for my not complying with it, in all their Force; and not +ascribe a Refusal, which arises from the very Nature of the thing, +either to Obstinacy, or to any Want of an Inclination to oblige them._ + +_I have been informed my Citations, or rather References, have puzzled +some Readers. It was difficult to foresee this, but is easy to prevent +it for the future. The Work contains Citations only of two Sorts; one, +that points to the Remedies prescribed; and the other, which refers to +some Passage in the Book itself, that serves to illustrate those +Passages in which I cite. Neither of these References could have been +omitted. The first is marked thus, *No.* with the proper Figure to it, +as 1, 2, &c. This signifies, that the Medicine I direct is described in +the Table of Remedies, according to the Number annexed to that +Character. Thus when we find directed, in any Page of the Book, the warm +Infusion *No. 1*; in some other, the Ptisan *No. 2*; or in a third, the +Almond Milk, or Emulsion *No. 4*, it signifies, that such Prescriptions +will be found at the Numbers 1, 2, and 4; and this Table is printed at +the End of the Book._ + +_If, instead of forming this Table, and thus referring to the +Prescriptions by their Numbers, I had repeated each Prescription as +often as I directed it, this Treatise must have been doubled in Bulk, +and insufferably tiresome to peruse. I must repeat here, what I have +already said in the former Edition, that the [5] Prices of the +Medicines, or of a great Number of them, are those at which the +Apothecaries may afford them, without any Loss, to a Peasant in humble +Circumstances. But it should be remembered, they are not set down at the +full Prices which they may handily demand; since that would be unjust +for some to insist on them at. Besides, there is no Kind of Tax in +*Swisserland*, and I have no Right to impose one._ + + [5] The Reasons for omitting the Prices _here_, may be seen Page 23 of + this Translation. + +_The Citations of the second Kind are very plain and simple. The whole +Work is divided into numbered Paragraphs distinguished by the Mark Sec.. +And not to swell it with needless Repetitions, when in one Place I might +have even pertinently repeated something already observed, instead of +such Repetition at Length, I have only referred to the Paragraph, where +it had been observed. Thus, for Example when we read Page 81, Sec. 50 +--*When the Disease is so circumstanced as we have described*, Sec. 46,-- +this imports that, not to repeat the Description already given, I refer +the Reader to that last Sec. for it._ + +_The Use of these Citations is not the least Innovation, and extremely +commodious and easy: but were there only a single Reader likely to be +puzzled by them, I ought not to omit this Explanation of them, as I can +expect to be generally useful, only in Proportion as I am clear: and it +must be obvious, that a Desire of being extensively useful is the sole +Motive of this Work. I have long since had the Happiness of knowing, +that some charitable and intelligent Persons have applied the Directions +it contains, with extraordinary Success, even in violent Diseases: And I +shall arrive at the Height of my Wishes, if I continue to be informed, +that it contributes to alleviate the Sufferings, and to prolong the +Days, of my rational Fellow Creatures._ + +_N. B._ A Small Blank occurring conveniently here in the Impression, the +Translator of this Work has employed it to insert the following proper +Remark, _viz._ + +Whenever the Tea or Infusion of the Lime-tree is directed in the Body of +the Book, which it often is, the _Flowers_ are always meant, and not the +_Leaves_; though by an Error of the Press, or perhaps rather by an +Oversight of the Transcribers of this Version, it is printed _Leaves_ +instead of _Flowers_ P. 392, as noted and corrected in the _Errata_. +These Flowers are easily procurable here, meerly for gathering, in most +Country Places in _July_, as few Walks, Vistas, &c. are without these +Trees, planted for the pleasant Shade they afford, and to keep off the +Dust in Summer, though the Leaf drops rather too early for this Purpose. +Their Flowers have an agreeable Flavour, which is communicated to Water +by Infusion, and rises with it in Distillation. They were, to the best +of my Recollection, an Ingredient in the antiepileptic Water of +_Langius_, omitted in our late Dispensatories of the College. They are +an Ingredient in the antiepileptic Powder, in the List of Medicines in +the present Practice of the _Hotel Dieu_ at _Paris_: and we think were +in a former Prescription of our _Pulvis de Gutteta_, or Powder against +Convulsions. Indeed they are considered, by many medical Writers, as a +Specific in all Kinds of Spasms and Pains; and __Hoffman__ affirms, he +knew a very tedious Epilepsy cured by the Use of an Infusion of these +Flowers. + +I also take this Opportunity of adding, that as this Translation is +intended for the Attention and the Benefit of the Bulk of the +Inhabitants of the _British_ Empire, I have been careful not to admit +any Gallicisms into it; as such might render it either less +intelligible, or less agreeable to its Readers. If but a single one +occurs, I either have printed it, or did intend it should be printed, +distinguishably in Italics. _K._ + + + + + __Introduction.__ + + +The Decrease of the Number of Inhabitants, in most of the States of +Europe, is a Fact, which impresses every reflecting Person, and is +become such a general Complaint, as is but too well established on plain +Calculations. This Decrease is most remarkable in Country Places. It is +owing to many Causes; and I shall think myself happy, if I can +contribute to remove one of the greatest of them, which is the +pernicious Manner of treating sick People in Country Places. This is my +sole Object, tho' I may be excused perhaps for pointing out the other +concurring Causes, which may be all included within these two general +Affirmations; That greater Numbers than usual emigrate from the Country; +and that the People increase less every where. + +There are many Sorts of Emigration. Some leave their Country to enlist +in the Service of different States by Sea and Land; or to be differently +employ'd abroad, some as Traders, others as Domestics, _&c._ + +Military Service, by Land or Sea, prevents Population in various +Respects. In the first Place, the Numbers going abroad are always less, +often _much_ less, than those who return. General Battles, with all the +Hazards and Fatigues of War; detached Encounters, bad Provisions, Excess +in drinking and eating, Diseases that are the Consequences of Debauches, +the Disorders that are peculiar to the Country; epidemical, pestilential +or contagious Distempers, caused by the unwholsome Air of Flanders, +Holland, Italy and Hungary; long Cruises, Voyages to the East or West +Indies, to Guinea, &c. destroy a great Number of Men. The Article of +Desertion also, the Consequences of which they dread on returning home, +disposes many to abandon their Country for ever. Others, on quitting the +Service, take up with such Establishments, as it has occasionally thrown +in their Way; and which necessarily prevent their Return. But in the +second Place, supposing they were all to come back, their Country +suffers equally from their Absence; as this very generally happens +during that Period of Life, when they are best adapted for Propagation; +since that Qualification on their Return is impaired by Age, by +Infirmities and Debauches: and even when they do marry, the Children +often perish as Victims to the Excesses and Irregularities of their +Fathers: they are weak, languishing, distempered, and either die young, +or live incapable of being useful to Society. Besides, that the +prevailing Habit of Libertinage, which many have contracted, prevents +several of them from marrying at all. But notwithstanding all these +inconvenient Consequences are real and notorious; yet as the Number of +those, who leave their Country on these Accounts, is limited, and indeed +rather inconsiderable, if compared with the Number of Inhabitants which +must remain at home: as it may be affirmed too, that this relinquishing +of their Country, may have been even necessary at some Times, and may +become so again, if the Causes of Depopulation should cease, this kind +of Emigration is doubtless the least grievous of any, and the last which +may require a strict Consideration. + +But that abandoning of their Country, or _Expatriation_, as it may be +termed, the Object of which is a Change of the Emigrants Condition, is +more to be considered, being more numerous. It is attended with many and +peculiar Inconveniencies, and is unhappily become an epidemical Evil, +the Ravages of which are still increasing; and that from one simple +ridiculous Source, which is this; that the Success of one Individual +determines a hundred to run the same Risque, ninety and nine of whom may +probably be disappointed. They are struck with the apparent Success of +one, and are ignorant of the Miscarriage of others. Suppose a hundred +Persons might have set out ten Years ago, to _seek their Fortune_, as +the saying is, at the End of six Months they are all forgotten, except +by their Relations; but if one should return the same Year, with more +Money than his own Fortune, more than he set out with; or if one of them +has got a moderate Place with little Work, the whole Country rings with +it, as a Subject of general Entertainment. A Croud of young People are +seduced by this and sally forth, because not one reflects, that of the +ninety nine, who set out with the hundredth Person, one half has +perished, many are miserable, and the Remainder come back, without +having gained any thing, but an Incapacity to employ themselves usefully +at home, and in their former Occupations: and having deprived their +Country of a great many Cultivaters, who, from the Produce of the Lands, +would have attracted considerable Sums of Money, and many comfortable +Advantages to it. In short, the very small Proportion who succeed, are +continually talked of; the Croud that sink are perpetually forgot. This +is a very great and real Evil, and how shall it be prevented? It would +be sufficient perhaps to publish the extraordinary Risque, which may be +easily demonstrated: It would require nothing more than to keep an exact +yearly Register of all these Adventurers, and, at the Expiration of six, +eight, or ten Years, to publish the List, with the Fate, of every +Emigrant. I am greatly deceived, or at the End of a certain Number of +Years, we should not see such Multitudes forsake their native Soil, in +which they might live comfortably by working, to go in Search of +Establishments in others; the Uncertainty of which, such Lists would +demonstrate to them; and also prove, how preferable their Condition in +their own Country would have been, to that they have been reduced to. +People would no longer set out, but on almost certain Advantages: fewer +would undoubtedly emigrate, more of whom, from that very Circumstance, +must succeed. Meeting with fewer of their Country-men abroad, these +fortunate few would oftner return. By this Means more Inhabitants would +remain in the Country, more would return again, and bring with them more +Money to it. The State would be more populous, more rich and happy; as +the Happiness of a People, who live on a fruitful Soil, depends +essentially on a great Number of Inhabitants, with a moderate Quantity +of pecuniary Riches. + +But the Population of the Country is not only necessarily lessened, in +Consequence of the Numbers that leave it; but even those who remain +increase less, than an equal Number formerly did. Or, which amounts to +the same Thing, among the same Number of Persons, there are fewer +Marriages than formerly; and the same Number of Marriages produce fewer +Christenings. I do not enter upon a Detail of the Proofs, since merely +looking about us must furnish a sufficient Conviction of the Truth of +them. What then are the Causes of this? There are two capital ones, +Luxury and Debauchery, which are Enemies to Population on many Accounts. + +Luxury compells the wealthy Man, who would make a Figure; and the Man of +a moderate Income, but who is his equal in every other Respect, and who +_will_ imitate him, to be afraid of a numerous Family; the Education of +which must greatly contract that Expence he had devoted to Parade and +Ostentation: And besides, if he must divide his Estate among a great +many Children, each of them would have but a little, and be unable to +keep up the State and the Train of the Father's. Since Merit is unjustly +estimated by exterior Shew and Expence, one must of Course endeavour to +attain for himself, and to leave his Children in, a Situation capable of +supporting that Expence. Hence the fewer Marriages of People who are not +opulent, and the fewer Children among People who marry. + +Luxury is further prejudicial to the Increase of the People, in another +Respect. The irregular Manner of Life which it introduces, depresses +Health; it ruins the Constitutions, and thus sensibly affects +Procreation. The preceding Generation counted some Families with more +than twenty Children: the living one less than twenty Cousins. Very +unfortunately this Way of thinking and acting, so preventive of +Increase, has extended itself even into Villages: and they are no longer +convinced there, that the Number of Children makes the Riches of the +Countryman. Perhaps the next Generation will scarcely be acquainted with +the Relation of Brotherhood. + +A third Inconvenience of Luxury is, that the Rich retreat from the +Country to live in Cities; and by multiplying their Domestics there, +they drain the former. This augmented Train is prejudicial to the +Country, by depriving it of Cultivaters, and by diminishing Population. +These Domestics, being seldom sufficiently employed, contract the Habit +of Laziness; and they prove incapable of returning to that Country +Labour, for which Nature intended them. Being deprived of this Resource +they scarcely ever marry, either from apprehending the Charge of +Children, or from their becoming Libertines; and sometimes, because many +Masters will not employ married Servants. Or should any of them marry, +it is often in the Decline of Life, whence the State must have the fewer +Citizens. + +Idleness of itself weakens them, and disposes them to those Debauches, +which enfeeble them still more. They never have more than a few +Children, and these sickly; such as have not Strength to cultivate the +Ground; or who, being brought up in Cities, have an Aversion to the +Country. + +Even those among them who are more prudent, who preserve their Morals, +and make some Savings, being accustomed to a City Life, and dreading the +Labour of a Country one (of the Regulation of which they are also +ignorant) chuse to become little Merchants, or Tradesmen; and this must +be a Drawback from Population, as any Number of Labourers beget more +Children than an equal Number of Citizens; and also by Reason, that out +of any given Number, more Children die in Cities, than in the Country. + +The same Evils also prevail, with Regard to female Servants. After ten +or twelve Years Servitude, the Maid-Servants in Cities cannot acquit +themselves as good Country Servants: and such of them as chuse this +Condition, quickly fail under that Kind or Quantity of Work, for which +they are no longer constituted. Should we see a Woman married in the +Country, a Year after leaving Town, it is easy to observe, how much that +Way of living in the Country has broke her. Frequently their first +Child-bed, in which Term they have not all the Attendance their Delicacy +demands, proves the Loss of their Health; they remain in a State of +Languor, of Feebleness, and of Decay: they have no more Children; and +this renders their Husbands unuseful towards the Population of the +State. + +Abortions, Infants carried out of their Country after a concealed +Pregnancy, and the Impossibility of their getting Husbands afterwards, +are frequently the Effects of their Libertinage. + +It is to be apprehended too these bad Effects are rather increasing with +us; since, either for want of sufficient Numbers, or from oeconomical +Views, it has become a Custom, instead of Women Servants, to employ +Children, whose Manners and whole Constitutions are not yet formed; and +who are ruined in the same Manner, by their Residence in Town, by their +Laziness, by bad Examples, and bad Company. + +Doubtless much remains still unsaid on these important Heads; but +besides my Intention not to swell this Treatise immoderately, and the +many Avocations, which prevent me from launching too far into what may +be less within the Bounds of Medicine, I should be fearful of digressing +too far from my Subject. What I have hitherto said however, I think +cannot be impertinent to it; since in giving Advice to the People, with +Regard to their Health, it was necessary to display to them the Causes +that impaired it: though what I might be able to add further on this +Head, would probably be thought more remote from the Subject. + +I shall add then but a single Hint on the Occasion. Is it not +practicable, in Order to remedy those Evils which we cannot prevent, to +select some particular Part or Canton of the Country, wherein we should +endeavour by Rewards, _1st._ Irremoveably to fix all the Inhabitants. +_2dly._ To encourage them by other Rewards to a plentiful and legitimate +Increase. They should not be permitted to go out of it, which must +prevent them from being exposed to the Evils I have mentioned. They +should by no means intermarry with any Strangers, who might introduce +such Disorders among them. Thus very probably this Canton, after a +certain Time, would become even over-peopled, and might send out +Colonies to the others. + +One Cause, still more considerable than those we have already mention'd, +has, to this very Moment, prevented the Increase of the People in +France. This is the Decay of Agriculture. The Inhabitants of the +Country, to avoid serving in the Militia; to elude the Days-Service +impos'd by their Lords, and the Taxes; and being attracted to the City +by the Hopes of Interest, by Laziness and Libertinage, have left the +Country nearly deserted. Those who remain behind, either not being +encouraged to work, or not being sufficient for what there is to do, +content themselves with cultivating just as much as is absolutely +necessary for their Subsistence. They have either lived single, or +married but late; or perhaps, after the Example of the Inhabitants of +the Cities, they have refused to fulfil their Duty to Nature, to the +State, and to a Wife. The Country deprived of Tillers, by this +Expatriation and Inactivity, has yielded nothing; and the Depopulation +of the State has daily increased, from the reciprocal and necessary +Proportion between Subsistence and Population, and because Agriculture +alone can increase Subsistence. A single Comparison will sufficiently +evince the Truth and the Importance of these Principles, to those who +have not seen them already divulged and demonstrated in the Works of +the [6] Friend of Man. + + [6] The Marquis of Mirabeau. + +"An old Roman, who was always ready to return to the Cultivation of his +Field, subsisted himself and his Family from one Acre of Land. A Savage, +who neither sows nor cultivates, consumes, in his single Person, as much +Game as requires fifty Acres to feed them. Consequently _Tullus +Hostilius_, on a thousand Acres, might have five thousand Subjects: +while a Savage Chief, limited to the same Extent of Territory, could +scarcely have twenty: such an immense Disproportion does Agriculture +furnish, in Favour of Population. Observe these two great Extremes. A +State becomes dispeopled or peopled in that Proportion, by which it +recedes from one of these Methods, and approaches to the other." Indeed +it is evident, that wherever there is an Augmentation of Subsistence, an +Increase of Population will soon follow; which again will still further +facilitate the Increase of Provisions. In a State thus circumstanced Men +will abound, who, after they have furnished sufficient Numbers for the +Service of War, of Commerce, of Religion, and for Arts and Professions +of every kind, will further also furnish a Source for Colonies, who will +extend the Name and the Prosperity of their Nation to distant Regions. +There will ensue a Plenty of Commodities, the Superfluity of which will +be exported to other Countries, to exchange for other Commodities, that +are not produced at home; and the Balance, being received in Money, will +make the Nation rich, respectable by its Neighbours, and happy. +Agriculture, vigorously pursued, is equal to the Production of all these +Benefits; and the present Age will enjoy the Glory of restoring it, by +favouring and encouraging Cultivaters, and by forming Societies for the +Promotion of Agriculture. + +I proceed at length to the fourth Cause of Depopulation, which is the +Manner of treating sick People in the Country. This has often affected +me with the deepest Concern. I have been a Witness, that Maladies, +which, in themselves, would have been gentle, have proved mortal from a +pernicious Treatment: I am convinced that this Cause alone makes as +great a Havock as the former; and certainly it requires the utmost +Attention of Physicians, whose Duty it is to labour for the Preservation +of Mankind. While we are employing our assiduous Cares on the more +polished and fashionable Part of them in Cities, the larger and more +useful Moiety perish in the Country; either by particular, or by highly +epidemical, Diseases, which, within a few Years past, have appeared in +different Villages, and made no small Ravages. This afflicting +Consideration has determined me to publish this little Work, which is +solely intended for those Patients, who, by their Distance from +Physicians, are deprived of their Assistance. I shall not give a Detail +of my Plan, which is very simple, in this Part; but content myself with +affirming, I have used my utmost Care to render it the most useful I +possibly could: and I dare hope, that if I have not fully displayed its +utmost Advantages, I have at least sufficiently shewn those pernicious +Methods of treating Diseases, that should incontestably be avoided. I am +thoroughly convinced, the Design might be accomplished more compleatly +than I have done it; but those who are so capable of, do not attempt, +it: I happen to be less timid; and I hope that thinking Persons will +rather take it in good part of me, to have published a Book, the +composing of which is rather disagreeable from its very Facility; from +the minute Details, which however are indispensable; and from the +Impossibility of discussing any Part of it (consistently with the Plan) +to the Bottom of the Subject; or of displaying any new and useful +Prospect. It may be compared, in some Respects, to the Works of a +spiritual Guide, who was to write a Catechism for little Children. + +At the same time I am not ignorant there have already been a few Books +calculated for Country Patients, who are remote from Succour: but some +of these, tho' published with a very good Purpose, produce a bad Effect. +Of this kind are all Collections of Receipts or Remedies, without the +least Description of the Disease; and of Course without just Directions +for the Exhibition, or Application, of them. Such, for Example, is the +famous Collection of Madam _Fouquet_, and some more in the same manner. +Some others approach towards my Plan; but many of them have taken in too +many Distempers, whence they are become too voluminous. Besides, they +have not dwelt sufficiently upon the Signs of the Diseases; upon their +Causes; the general Regimen in them, and the Mismanagement of them. +Their Receipts are not generally as simple, and as easy to prepare, as +they ought to be. In short, the greater Part of their Writers seem, as +they advanced, to have grown tired of their melancholy Task, and to have +hurried them out too expeditiously. There are but two of them, which I +must name with Respect, and which being proposed on a Plan very like my +own, are executed in a superior Manner, that merits the highest +Acknowlegements of the Publick. One of these Writers is M. _Rosen_, +first Physician of the Kingdom of _Sweden_; who, some Years since, +employed his just Reputation to render the best Services to his Country +Men. He has made them retrench from the Almanacs those ridiculous Tales; +those extraordinary Adventures; those pernicious astrological +Injunctions, which there, as well as here, answer no End, but that of +keeping up Ignorance, Credulity, Superstition, and the falsest +Prejudices on the interesting Articles of Health, of Diseases, and of +Remedies. He has also taken Care to publish simple plain Treatises on +the most popular Distempers; which he has substituted in the Place of +the former Heap of Absurdities. These concise Works however, which +appear annually in their Almanacs, are not yet translated from the +_Swedish_, so that I was unqualified to make any Extracts from them. The +other is the Baron _Van Swieten_, first Physician to their Imperial +Majesties, who, about two Years since, has effected for the Use of the +Army, what I now attempt for sick People in the Country. Though my Work +was greatly advanced, when I first saw his, I have taken some Passages +from it: and had our Plans been exactly alike, I should imagine I had +done the Publick more Service by endeavouring to extend the Reading of +his Book, than by publishing a new one. Nevertheless, as he is silent on +many Articles, of which I have treated diffusively; as he has treated of +many Distempers, which did not come within my Plan; and has said nothing +of some others which I could not omit; our two Works, without entering +into the Particulars of the superior Merit of the Baron's, are very +different, with Regard to the Subject of the Diseases; tho' in such as +we have both considered, I account it an Honour to me to find, we have +almost constantly proceeded upon the same Principles. + +The present Work is by no means addressed to such Physicians, as are +thoroughly accomplished in their Profession; yet possibly, besides my +particular medical Friends, some others may read it. I beg the Favour of +all such fully to consider the Intention, the Spirit, of the Author, and +not to censure him, as a Physician, from the Composition of this Book. I +even advise them here rather to forbear perusing it; as a Production, +that can teach them nothing. Such as read, in order to criticize, will +find a much greater Scope for exercising that Talent on the other +Pamphlets I have published. It were certainly unjust that a Performance, +whose sole abstracted Object is the Health and Service of my Countrymen, +should subject me to any disagreeable Consequences: and a Writer may +fairly plead an Exemption from any Severity of Censure, who has had the +Courage to execute a Work, which cannot pretend to a Panegyric. + +Having premised thus much in general, I must enter into some Detail of +those Means, that seem the most likely to me, to facilitate the +beneficial Consequences, which, I hope, may result to others, from my +present Endeavours. I shall afterwards give an Explanation of some Terms +which I could not avoid using, and which, perhaps, are not generally +understood. + +The Title of _Advice to the People_, was not suggested to me by an +Illusion, which might persuade me, this Book would become a Piece of +Furniture, as it were, in the House of every Peasant. Nineteen out of +twenty will probably never know of its Existence. Many may be unable to +read, and still more unable to understand, it, plain and simple as it +is. I have principally calculated it for the Perusal of intelligent and +charitable Persons, who live in the Country; and who seem to have, as it +were, a Call from Providence, to assist their less intelligent poor +Neighbours with their Advice. + +It is obvious, that the first Gentlemen I have my Eye upon, are the +Clergy. There is not a single Village, a Hamlet, nor even the House of +an Alien in the Country, that has not a Right to the good Offices of +some one of this Order; And I assure myself there are a great Number of +them, who, heartily affected with the Distress of their ailing Flocks, +have wished many hundred Times, that it were in their Power to give +their Parishioners some bodily Help, at the very Time they were +disposing them to prepare for Death; or so far to delay the Fatality of +the Distemper, that the Sick might have an Opportunity of living more +religiously afterwards. I shall think myself happy, if such truly +respectable Ecclesiastics shall find any Resources in this Performance, +that may conduce to the Accomplishment of their beneficent Intentions. +Their Regard, their Love for their People; their frequent Invitations to +visit their principal Neighbours; their Duty to root out all +unreasonable Prejudices, and Superstition; their Charity, their +Learning; the Facility, with which their general Knowlege in Physics, +qualifies them to comprehend thoroughly all the medical Truths, and +Contents of this Piece, are so many Arguments to convince me, that they +will have the greatest Influence to procure that Reformation, in the +Administration of Physick to poor Country People, which is so necessary, +so desirable, an Object. + +In the next Place, I dare assure myself of the Concurrence of Gentlemen +of Quality and Opulence, in their different Parishes and Estates, whose +Advice is highly regarded by their Inferiors; who are so powerfully +adapted to discourage a wrong, and to promote a right Practice, of which +they will easily discern all the Advantages. The many Instances I have +seen of their entering, with great Facility, into all the Plan and +Conduct of a Cure; their Readiness and even Earnestness to comfort the +Sick in their Villages; and the Generosity with which they prevent their +Necessities, induce me to hope, from judging of these I have not the +Pleasure to know, by those whom I have, that they will eagerly embrace +an Opportunity of promoting a new Method of doing good in their +Neighbourhood. Real Charity will apprehend the great Probability there +is of doing Mischief, tho' with the best Intention, for want of a proper +Knowledge of material Circumstances; and the very Fear of that Mischief +may sometimes suspend the Exercise of such Charity; notwithstanding it +must seize, with the most humane Avidity, every Light that can +contribute to its own beneficent Exertion. + +Thirdly, Persons who are rich, or at least in easy Circumstances, whom +their Disposition, their Employments, or the Nature of their Property, +fixes in the Country, where they are happy in doing good, must be +delighted to have some proper Directions for the Conduct and +Effectuation of their charitable Intentions. + +In every Village, where there are any Persons, of these three +Conditions, they are always readily apprized of the Distempers in it, by +their poor Neighbours coming to intreat a little Soup, Venice Treacle, +Wines, Biscuits, or any thing they imagine necessary for their sick +Folks. In Consequence of some Questions to the Bystanders, or of a Visit +to the sick Person, they will judge at least of _what kind_ the Disease +is; and by their prudent Advice they may be able to prevent a Multitude +of Evils. They will give them some Nitre instead of Venice Treacle; +Barley, or sweet Whey, in lieu of Soup. They will advise them to have +Recourse to Glysters, or Bathings of their Feet, rather than to Wine; +and order them Gruel rather than Biscuits. A man would scarcely believe, +'till after the Expiration of a few Years, how much Good might be +effected by such proper Regards, so easily comprehended, and often +repeated. At first indeed there may be some Difficulty in eradicating +old Prejudices, and inveterately bad Customs; but whenever these were +removed, good Habits would strike forth full as strong Roots, and I hope +that no Person would be inclined to destroy them. + +It may be unnecessary to declare, that I have more Expectation from the +Care and Goodness of the Ladies, than from those of their Spouses, their +Fathers, or Brothers. A more active Charity, a more durable Patience, a +more domestic Life; a Sagacity, which I have greatly admired in many +Ladies both in Town and Country, that disposes them to observe, with +great Exactness; and to unravel, as it were, the secret Causes of the +Symptoms, with a Facility that would do Honour to very good Practioners, +and with a Talent adapted to engage the Confidence of the Patient:--All +these, I say, are so many characteristical Marks of their Vocation in +this important and amicable Duty; nor are there a few, who fulfil it +with a Zeal, that merits the highest Commendation, and renders them +excellent Models for the Imitation of others. + +Those who are intrusted with the Education of Youth, may also be +supposed sufficiently intelligent to take some Part in this Work; and I +am satisfied that much Good might result from their undertaking it. I +heartily wish, they would not only study to _distinguish the Distemper_ +(in which the principal, but by no means an insuperable Difficulty +consists; and to which I hope I have considerably put them in the Way) +but I would have them learn also the Manner of applying Remedies. Many +of them have; I have known some who bleed, and who have given Glysters +very expertly. This however all may easily learn; and perhaps it would +not be imprudent, if the Art of bleeding well and safely were reckoned a +necessary Qualification, when they are examined for their Employment. +These Faculties, that of estimating the Degree of a Fever, and how to +apply and to dress Blisters, may be of great Use within the +Neighbourhood of their Residence. Their Schools, which are not +frequently over-crouded, employ but a few of their daily Hours; the +greater part of them have no Land to cultivate; and to what better Use +can they apply their Leisure, than to the Assistance and Comfort of the +Sick? The moderate Price of their Service may be so ascertained, as to +incommode no Person; and this little Emolument might render their own +Situation the more agreeable: besides which, these little Avocations +might prevent their being drawn aside sometimes, by Reason of their +Facility and frequent Leisure, so as to contract a Habit of drinking too +often. Another Benefit would also accrue from accustoming them to this +kind of Practice, which is, that being habituated to the Care of sick +People, and having frequent Occasions to write, they would be the better +qualify'd, in difficult Cases, to advise with those, who were thought +further necessary to be consulted. + +Doubtless, even among Labourers, there may be many, for some such I have +known, who being endued with good natural Sense and Judgment, and +abounding with Benevolence, will read this Book with Attention, and +eagerly extend the Maxims and the Methods it recommends. + +And finally I hope that many Surgeons, who are spread about the Country, +and who practice Physic in their Neighbourhood, will peruse it; will +carefully enter into the Principles established in it, and will conform +to its Directions; tho' a little different perhaps from such as they may +have hitherto practiced. They will perceive a Man may learn at any Age, +and of any Person; and it may be hoped they will not think it too much +Trouble to reform some of their Notions in a Science, which is not +properly within their Profession (and to the Study of which they were +never instituted) by those of a Person, who is solely employed in it, +and who has had many Assistances of which they are deprived. + +Midwives may also find their Attendance more efficacious, as soon as +they are thoroughly disposed to be better informed. + +It were heartily to be wished, that the greater Part of them had been +better instructed in the Art they profess. The Instances of Mischief +that might have been avoided, by their being better qualify'd, are +frequent enough to make us wish there may be no Repetition of them, +which it may be possible to prevent. Nothing seems impossible, when +Persons in Authority are zealously inclined to prevent every such Evil; +and it is time they should be properly informed of one so essentially +hurtful to Society. + +The Prescriptions I have given consist of the most simple Remedies, and +I have adjoined the Manner of preparing them so fully, that I hope no +Person can be at any Loss in that Respect. At the same time, that no one +may imagine they are the less useful and efficacious for their +Simplicity, I declare, they are the same I order in the City for the +most opulent Patients. This Simplicity is founded in Nature: the +Mixture, or rather the Confusion, of a Multitude of Drugs is ridiculous. +If they have the very same Virtues, for what Purpose are they blended? +It were more judicious to confine ourselves to that, which is the most +effectual. If their Virtues are different, the Effect of one destroys, +or lessens, the Effect of the other; and the Medicine ceases to prove a +Remedy. + +I have given no Direction, which is not very practicable and easy to +execute; nevertheless it will be discernible, that some few are not +calculated for the Multitude, which I readily grant. However I have +given them, because I did not lose Sight of some Persons; who, tho' not +strictly of the Multitude, or Peasantry, do live in the Country, and +cannot always procure a Physician as soon, or for as long a Time, as +they gladly would. + +A great Number of the Remedies are entirely of the Country Growth, and +may be prepared there; but there are others, which must be had from the +Apothecaries. I have set down the Price [7] at which I am persuaded all +the Country Apothecaries will retail them to a Peasant, who is not +esteemed a rich one. I have marked the Price, not from any Apprehension +of their being imposed on in the Purchase, for this I do not apprehend; +but, that seeing the Cheapness of the Prescription, they may not be +afraid to buy it. The necessary Dose of the Medicine, for each Disease, +may generally be purchased for less Money than would be expended on +Meat, Wine, Biscuits, and other improper things. But should the Price of +the Medicine, however moderate, exceed the Circumstances of the Sick, +doubtless the Common Purse, or the Poors-Box will defray it: moreover +there are in many Country Places Noblemens Houses, some of whom +charitably contribute an annual Sum towards buying of Medicines for poor +Patients. Without adding to which Sum, I would only intreat the Favour +of each of them to alter the Objects of it, and to allow their sick +Neighbours the Remedies and the Regimen directed here, instead of such +as they formerly distributed among them. + + [7] This oeconomical Information was doubtless very proper, where our + judicious and humane Author published it; but notwithstanding his + excellent Motives for giving it, we think it less necessary here, + where many Country Gentlemen furnish themselves with larger or + smaller Medicine Chests, for the Benefit of their poor sick + Neighbours; and in a Country, where the settled parochial Poor are + provided with Medicines, as well as other Necessaries, at a + parochial Expence. Besides, tho' we would not suppose our Country + Apothecaries less considerate or kind than others, we acknowledge + our Apprehension, that in such Valuation of their Drugs (some of + which often vary in their Price) might dispose a few of them, + rather to discountenance the Extension of a Work, so well intended + and executed as Dr. _Tissot's_; a Work, which may not be wholly + unuseful to some of the most judicious among them, and will be + really necessary for the rest. _K._ + +It may still be objected, that many Country Places are very distant from +large Towns; from which Circumstance a poor Peasant is incapable of +procuring himself a seasonable and necessary Supply in his Illness. I +readily admit, that, in Fact, there are many Villages very remote from +such Places as Apothecaries reside in. Yet, if we except a few among the +Mountains, there are but very few of them above three or four Leagues +from some little Town, where there always lives some Surgeon, or some +Vender of Drugs. Perhaps however, even at this Time, indeed, there may +not be many thus provided; but they will take care to furnish themselves +with such Materials, as soon as they have a good Prospect of selling +them, which may constitute a small, but new, Branch of Commerce for +them. I have carefully set down the Time, for which each Medicine will +keep, without spoiling. There is a very frequent Occasion for some +particular ones, and of such the School-masters may lay in a Stock. I +also imagine, if they heartily enter into my Views, they will furnish +themselves with such Implements, as may be necessary in the Course of +their Attendance. If any of them were unable to provide themselves with +a sufficient Number of good Lancets, an _Apparatus_ for Cupping, and a +Glyster Syringe (for want of which last a Pipe and Bladder may be +occasionally substituted) the Parish might purchase them, and the same +Instruments might do for the succeeding School-master. It is hardly to +be expected, that all Persons in that Employment would be able, or even +inclined, to learn the Way of using them with Address; but one Person +who did, might be sufficient for whatever Occasions should occur in this +Way in some contiguous Villages; with very little Neglect of their +Functions among their Scholars. + +Daily Instances of Persons, who come from different Parts to consult me, +without being capable of answering the Questions I ask them, and the +like Complaints of many other Physicians on the same Account, engaged me +to write the last Chapter of this Work. I shall conclude this +Introduction with some Remarks, necessary to facilitate the Knowledge of +a few Terms, which were unavoidable in the Course of it. + +The Pulse commonly beats in a Person in good Health, from the Age of +eighteen or twenty to about sixty six Years, between sixty and seventy +Times in a Minute. It sometimes comes short of this in old Persons, and +in very young Children it beats quicker: until the Age of three or four +Years the Difference amounts at least to a third; after which it +diminishes by Degrees. + +An intelligent Person, who shall often touch and attend to his own +Pulse, and frequently to other Peoples, will be able to judge, with +sufficient Exactness, of the Degree of a Fever in a sick Person. If the +Strokes are but one third above their Number in a healthy State, the +Fever is not very violent: which it is, as often as it amounts to half +as many more as in Health. It is very highly dangerous, and may be +generally pronounced mortal, when there are two Strokes in the Time of +one. We must not however judge of the Pulse, solely by its Quickness, +but by its Strength or Weakness; its Hardness or Softness; and the +Regularity or Irregularity of it. + +There is no Occasion to define the strong and the feeble Pulse. The +Strength of it generally affords a good Prognostic, and, supposing it +too strong, it may easily be lowered. The weak Pulse is often very +menacing. + +If the Pulse, in meeting the Touch, excites the Notion of a dry Stroke, +as though the Artery consisted of Wood, or of some Metal, we term it +_hard_; the opposite to which is called _soft_, and generally promises +better. If it be strong and yet soft, even though it be quick, it may be +considered as a very hopeful Circumstance. But if it is strong and hard, +that commonly is a Token of an Inflammation, and indicates Bleeding and +the cooling Regimen. Should it be, at the same time, small, quick and +hard, the Danger is indeed very pressing. + +We call that Pulse regular, a continued Succession of whole Strokes are +made in equal Intervals of Time; and in which Intervals, not a single +Stroke is wanting (since if that is its State, it is called an +intermitting Pulse.) The Beats or Pulsations are also supposed to +resemble each other so exactly in Quality too, that one is not strong, +and the next alternately feeble. + +As long as the State of the Pulse is promising; Respiration or Breathing +is free; the Brain does not seem to be greatly affected; while the +Patient takes his Medicines, and they are attended with the Consequence +that was expected; and he both preserves his Strength pretty well, and +continues sensible of his Situation, we may reasonably hope for his +Cure. As often as all, or the greater Number of these characterizing +Circumstances are wanting, he is in very considerable Danger. + +The Stoppage of Perspiration is often mentioned in the Course of this +Work. We call the Discharge of that Fluid which continually passes off +through the Pores of the Skin, _Transpiration_; and which, though +invisible, is very considerable. For if a Person in Health eats and +drinks to the Weight of eight Pounds daily, he does not discharge four +of them by Stool and Urine together, the Remainder passing off by +insensible Transpiration. It may easily be conceived, that if so +considerable a Discharge is stopt, or considerably lessened; and if this +Fluid, which ought to transpire through the Skin, should be transfered +to any inward Part, it must occasion some dangerous Complaint. In fact +this is one of the most frequent Causes of Diseases. + +To conclude very briefly--All the Directions in the following Treatise +are solely designed for such Patients, as cannot have the Attendance of +a Physician. I am far from supporting, they ought to do instead of one, +even in those Diseases, of which I have treated in the fullest Manner; +and the Moment a Physician arrives, they ought to be laid aside. The +Confidence reposed in him should be entire, or there should be none. The +Success of the Event is founded in that. It is his Province to judge of +the Disease, to select Medicines against it; and it is easy to foresee +the Inconveniences that may follow, from proposing to him to consult +with any others, preferably to those he may chuse to consult with; only +because they have succeeded in the Treatment of another Patient, whose +Case they suppose to have been nearly the same with the present Case. +This were much the same, as to order a Shoemaker to make a Shoe for one +Foot by the Pattern of another Shoe, rather than by the Measure he has +just taken. + +_N. B._ Though a great Part of this judicious Introduction is less +applicable to the political Circumstances of the British Empire, than to +those of the Government for which it was calculated; we think the good +Sense and the unaffected Patriotism which animate it, will supersede any +Apology for our translating it. The serious Truth is this, that a +thorough Attention to Population seems never to have been more expedient +for ourselves, than after so bloody and expensive, though such a +glorious and successful War: while our enterprizing Neighbours, who will +never be our Friends, are so earnest to recruit their Numbers; to +increase their Agriculture; and to force a Vent for their Manufactures, +which cannot be considerably effected, without a sensible Detriment to +our own. Besides which, the unavoidable Drain from the People here, +towards an effectual Cultivation, Improvement, and Security of our +Conquests, demands a further Consideration. _K._ + + + + + _ADVICE_ _TO THE_ _PEOPLE_, + + + With Respect to their _HEALTH._ + + *__Chapter I.__* + + + + _Of the most usual Causes of popular Maladies._ + + + __Sect.__ 1. + +The most frequent Causes of Diseases commonly incident to Country People +are, 1. Excessive Labour, continued for a very considerable Time. +Sometimes they sink down at once in a State of Exhaustion and Faintness, +from which they seldom recover: but they are oftener attacked with some +inflammatory Disease; as a Quinsey, a Pleurisy, or an Inflammation of +the Breast. + +There are two Methods of preventing these Evils: one is, to avoid the +Cause which produces them; but this is frequently impossible. Another +is, when such excessive Labour has been unavoidable, to allay their +Fatigue, by a free Use of some temperate refreshing Drink; especially by +sweet Whey, by Butter-milk, or by [8] Water, to a Quart of which a +Wine-glass of Vinegar may be added; or, instead of that, the expressed +Juice of Grapes not fully ripe, or even of Goosberries or Cherries: +which wholesome and agreeable Liquors are refreshing and cordial. I +shall treat, a little lower, of inflammatory Disorders. The Inanition or +Emptiness, though accompanied with Symptoms different from the former, +have yet some Affinity to them with Respect to their Cause, which is a +kind of general Exsiccation or Dryness. I have known some cured from +this Cause by Whey, succeeded by tepid Baths, and afterwards by Cow's +Milk: for in such Cases hot Medicines and high Nourishment are fatal. + + [8] This supposes they are not greatly heated, as well as fatigued, by + their Labour or Exercise, in which Circumstance free and sudden + Draughts of cooling Liquors might be very pernicious: and it + evidently also supposes these Drinks to be thus given, rather in + Summer, than in very cold Weather, as the Juice of the unripe + Grapes, and the other fresh Fruits sufficiently ascertain the + Season of the Year. We think the Addition of Vinegar to their Water + will scarcely ever be necessary in this or the adjoining Island, on + such Occasions. The Caution recommended in this Note is abundantly + enforced by Dr. _Tissot_, Sec. 4: but considering the Persons, to whom + this Work is more particularly addressed, we were willing to + prevent every Possibility of a Mistake, in so necessary, and + sometimes so vital a Point. _K._ + +Sec. 2. There is another Kind of Exhaustion or Emptiness, which may be +termed real Emptiness, and is the Consequence of great Poverty, the Want +of sufficient Nourishment, bad Food, unwholesome Drink, and excessive +Labour. In Cases thus circumstanced, good Soups and a little Wine are +very proper. Such happen however very seldom in this Country: I believe +they are frequent in some others, especially in many Provinces of +_France_. + +Sec. 3. A second and very common Source of Disorders arises, from Peoples' +lying down and reposing, when very hot, in a cold Place. This at once +stops Perspiration, the Matter of which being thrown upon some internal +Part, proves the Cause of many violent Diseases, particularly of +Quinseys, Inflammations of the Breast, Pleurisies, and inflammatory +Cholics. These Evils, from this Cause, may always be avoided by avoiding +the Cause, which is one of those that destroy a great Number of People. +However, when it has occurred, as soon as the first Symptoms of the +Malady are perceiveable, which sometimes does not happen till several +Days after, the Patient should immediately be bled; his Legs should be +put into Water moderately hot, and he should drink plentifully of the +tepid Infusion marked No. 1. Such Assistances frequently prevent the +Increase of these Disorders; which, on the contrary, are greatly +aggravated, if hot Medicines are given to sweat the Patient. + +Sec. 4. A third Cause is drinking cold Water, when a Person is extremely +hot. This acts in the same Manner with the second; but its Consequences +are commonly more sudden and violent. I have seen most terrible Examples +of it, in Quinseys, Inflammations of the Breast, Cholics, Inflammations +of the Liver, and all the Parts of the Belly, with prodigious Swellings, +Vomitings, Suppressions of Urine, and inexpressible Anguish. The most +available Remedies in such Cases, from this Cause, are, a plentiful +Bleeding at the Onset, a very copious Drinking of warm Water, to which +one fifth Part of Whey should be added; or of the Ptisan No. 2, or of an +Emulsion of Almonds, all taken warm. Fomentations of warm Water should +also be applied to the Throat, the Breast and Belly, with Glysters of +the same, and a little Milk. In this Case, as well as in the preceding +one, (Sec. 3.) a _Semicupium_, or Half-bath of warm Water has sometimes +been attended with immediate Relief. It seems really astonishing, that +labouring People should so often habituate themselves to this pernicious +Custom, which they know to be so very dangerous to their very Beasts. +There are none of them, who will not prevent their Horses from drinking +while they are hot, especially if they are just going to put them up. +Each of them knows, that if he lets them drink in that State, they might +possibly burst with it; nevertheless he is not afraid of incurring the +like Danger himself. However, this is not the only Case, in which the +Peasant seems to have more Attention to the Health of his Cattle, than +to his own. + +Sec. 5. The fourth Cause, which indeed affects every Body, but more +particularly the Labourer, is, the Inconstancy of the Weather. We shift +all at once, many times a Day, from Hot to Cold, and from Cold to Hot, +in a more remarkable Manner, and more suddenly, than in most other +Countries. This makes Distempers from Defluxion and Cold so common with +us: and it should make us careful to go rather a little more warmly +cloathed, than the Season may seem to require; to have Recourse to our +Winter-cloathing early in Autumn, and not to part with it too early in +the Spring. Prudent Labourers, who strip while they are at Work, take +care to put on their Cloaths in the Evening when they return home. [9] +Those, who from Negligence, are satisfied with hanging them upon their +Country Tools, frequently experience, on their Return, the very unhappy +Effects of it. There are some, tho' not many Places, where the Air +itself is unwholsome, more from its particular Quality, than from its +Changes of Temperature, as at _Villeneuve_, and still more at _Noville_, +and in some other Villages situated among the Marshes which border on +the _Rhone_. These Countries are particularly subject to intermitting +Fevers; of which I shall treat briefly hereafter. + + [9] This good Advice is enforced in a Note, by the Editor of _Lyons_, + who observes, it should be still more closely attended to, in + Places, where Rivers, Woods or Mountains retain, as it were, a + considerable Humidity; and where the Evenings are, in every Season, + cold and moist.--It is a very proper Caution too in our own + variable Climate, and in many of our Colonies in North _America_. + _K._ + +Sec. 6. Such sudden Changes are often attended with great Showers of Rain, +and even cold Rain, in the Middle of a very hot Day; when the Labourer +who was bathed, as it were, in a hot Sweat, is at once moistened in cold +Water; which occasions the same Distempers, as the sudden Transition +from Heat to Cold, and requires the same Remedies. If the Sun or a hot +Air succeed immediately to such a Shower, the Evil is considerably +lighter: but if the Cold continues, many are often greatly incommoded by +it. + +A Traveller is sometimes thoroughly and unavoidably wet with Mud; the +ill Consequence of which is often inconsiderable, provided he changes +his Cloaths immediately, when he sets up. I have known fatal Pleurisies +ensue from omitting this Caution. Whenever the Body or the Limbs are +wet, nothing can be more useful than bathing them in warm Water. If the +Legs only have been wet, it may be sufficient to bath them. I have +radically, thoroughly, cured Persons subject to violent Cholics, as +often as their Feet were wet, by persuading them to pursue this Advice. +The Bath proves still more effectual, if a little Soap be dissolved in +it. + +Sec. 7. A fifth Cause, which is seldom attended to, probably indeed because +it produces less violent Consequences, and yet is certainly hurtful, is +the common Custom in all Villages, of having their Ditches or Dunghills +directly under their Windows. Corrupted Vapours are continually exhaling +from them, which in Time cannot fail of being prejudicial, and must +contribute to produce putrid diseases. Those who are accustomed to the +Smell, become insensible of it: but the Cause, nevertheless, does not +cease to be unwholesomly active; and such as are unused to it perceive +the Impression in all its Force. + +Sec. 8. There are some Villages, in which, after the Curtain Lines are +erased, watery marshy Places remain in the Room of them. The Effect of +this is still more dangerous, because that putrify'd Water, which +stagnates during the hot Season, suffers its Vapours to exhale more +easily, and more abundantly, than that in the Curtain Lines did. Having +set out for _Pully le Grand_, in 1759, on Account of an epidemical +putrid Fever which raged there, I was sensible, on traversing the +Village, of the Infection from those Marshes; nor could I doubt of their +being the Cause of this Disease, as well as of another like it, which +had prevailed there five Years before. In other Respects the Village is +wholesomly situated. It were to be wished such Accidents were obviated +by avoiding these stagnated Places; or, at least, by removing them and +the Dunghils, as far as possible from the Spot, where we live and lodge. + +Sec. 9. To this Cause may also be added the Neglect of the Peasants to air +their Lodgings. It is well known that too close an Air occasions the +most perplexing malignant Fevers; and the poor Country People respire no +other in their own Houses. Their Lodgings, which are very small, and +which notwithstanding inclose, (both Day and Night) the Father, Mother, +and seven or eight Children, besides some Animals, are never kept open +during six Months in the Year, and very seldom during the other six. I +have found the Air so bad in many of these Houses, that I am persuaded, +if their Inhabitants did not often go out into the free open Air, they +must all perish in a little Time. It is easy, however, to prevent all +the Evils arising from this Source, by opening the Windows daily: so +very practicable a Precaution must be followed with the happiest +Consequences. + +Sec. 10. I consider Drunkenness as a sixth Cause, not indeed as producing +epidemical Diseases, but which destroys, as it were, by Retail, at all +times, and every where. The poor Wretches, who abandon themselves to it, +are subject to frequent Inflammations of the Breast, and to Pleurisies, +which often carry them off in the Flower of their Age. If they sometimes +escape through these violent Maladies, they sink, a long Time before the +ordinary Approach of old Age, into all its Infirmities, and especially +into an Asthma, which terminates in a Dropsy of the Breast. Their +Bodies, worn out by Excess, do not comply and concur, as they ought, +with the Force or Operation of Remedies; and Diseases of Weakness, +resulting from this Cause, are almost always incurable. It seems happy +enough, that Society loses nothing in parting with these Subjects, who +are a Dishonour to it; and whose brutal Souls are, in some Measure, +dead, long before their Carcases. + +Sec. 11. The Provisions of the common People are also frequently one Cause +of popular Maladies. This happens 1st, whenever the Corn, not well +ripened, or not well got in, in bad [10] _Harvests_, has contracted an +unwholesome Quality. Fortunately however this is seldom the Case; and +the Danger attending the Use of it, may be lessened by some Precautions, +such as those of washing and drying the Grain completely; of mixing a +little Wine with the Dough, in kneading it; by allowing it a little more +Time to swell or rise, and by baking it a little more. 2dly, The fairer +and better saved Part of the Wheat is sometimes damaged in the Farmers +House; either because he does not take due Care of it, or because he has +no convenient Place to preserve it, only from one Summer to the next. It +has often happened to me, on entering one of these bad Houses, to be +struck with the Smell of Wheat that has been spoiled. Nevertheless, +there are known and easy Methods to provide against this by a little +Care; though I shall not enter into a Detail of them. It is sufficient +to make the People sensible, that since their chief Sustenance consists +of Corn, their Health must necessarily be impaired by what is bad. 3dly, +That Wheat, which is good, is often made into bad Bread, by not letting +it rise sufficiently; by baking it too little, and by keeping it too +long. All these Errors have their troublesome Consequences on those who +eat it; but in a greater Degree on Children and Valetudinarians, or +weakly People. + +[10] Thus I have ventured to translate _Etes_ (_Summers_) to apply it to + this and the neighbouring Islands. Their Harvests in _Swisserland_ + perhaps are earlier, and may occur in _August_, and that of some + particular Grain, probably still earlier. _K._ + +Tarts or Cakes may be considered as an Abuse of Bread, and this in some +Villages is increased to a very pernicious Height. The Dough is almost +constantly bad, and often unleavened, ill baked, greasy, and stuffed +with either fat or sour Ingredients, which compound one of the most +indigestible Aliments imaginable. Women and Children consume the most of +this Food, and are the very Subjects for whom it is the most improper: +little Children especially, who live sometimes for many successive Days +on these Tarts, are, for the greater Part, unable to digest them +perfectly. Hence they receive a [11] Source of Obstructions in the +Bowels of the Belly, and of a slimy Viscidity or Thickishness, +throughout the Mass of Humours, which throws them into various Diseases +from Weakness; slow Fevers, a Hectic, the Rickets, the King's Evil, and +Feebleness; for the miserable Remainder of their Days. Probably indeed +there is nothing more unwholesome than Dough not sufficiently leavened, +ill-baked, greasy, and soured by the Addition of Fruits. Besides, if we +consider these Tarts in an oeconomical View, they must be found +inconvenient also for the Peasant on that Account. + +[11] The Abuse just mentioned can scarcely be intended to forbid the + moderate Use of good Pastry, the Dough of which is well raised and + well baked, the Flower and other Ingredients sound, and the Paste + not overcharged with Butter, even though it were sweet and fresh. + But the Abuse of Alum and other pernicious Materials introduced by + our Bakers, may too justly be considered as one horrible Source of + those Diseases of Children, &c. which our humane and judicious + Author mentions here. What he adds, concerning the Pastries being + rendered still more unwholesome by the sour Fruits sometimes baked + in it, is true with Respect to those Children and others, who are + liable to Complaints from Acidities abounding in the Bowels; and + for all those who are ricketty or scrophulous, from a cold and + viscid State of their Humours. But as to healthy sanguine Children, + who are advanced and lively, and others of a sanguine or bilious + Temperament, we are not to suppose a moderate Variety of this Food + injurious to them; when we consider, that the Sharpness and Crudity + of the Fruit is considerably corrected by the long Application of + Fire; and that they are the Produce of Summer, when bilious + Diseases are most frequent. This suggests however no bad Hint + against making them immoderately sweet. _K._ + +Some other Causes of Maladies may also be referred to the Article of +Food, tho' less grievous and less frequent, into a full Detail of which +it is very difficult to enter: I shall therefore conclude that Article +with this general Remark; that it is the Care which Peasants usually +take in eating slowly, and in chewing very well, that very greatly +lessens the Dangers from a bad Regimen: and I am convinced they +constitute one of the greatest Causes of that Health they enjoy. We may +further add indeed the Exercise which the Peasant uses, his long abiding +in the open Air, where he passes three fourths of his Life; besides +(which are also considerable Advantages) his happy Custom of going soon +to Bed, and of rising very early. It were to be wished, that in these +Respects, and perhaps on many other Accounts, the Inhabitants of the +Country were effectually proposed as Models for reforming the Citizens. + +Sec. 12. We should not omit, in enumerating the Causes of Maladies among +Country People, the Construction of their Houses, a great many of which +either lean, as it were, close to a higher Ground, or are sunk a little +in the Earth. Each of these Situations subjects them to considerable +Humidity; which is certain greatly to incommode the Inhabitants, and to +spoil their Provisions, if they have any Quantity in Store; which, as we +have observed, is another, and not the least important, Source of their +Diseases. A hardy Labourer is not immediately sensible of the bad +Influence of this moist and marshy Habitation; but they operate at the +long Run, and I have abundantly observed their most evident bad Effects, +especially on Women in Child-bed, on Children, and in Persons recovering +of a preceding Disease. It would be easy to prevent this Inconvenience, +by raising the Ground on which the House stood, some, or several, Inches +above the Level of the adjacent Soil, by a Bed of Gravel, of small +Flints, pounded Bricks, Coals, or such other Materials; and by avoiding +to build immediately close to, or, as it were, under a much higher Soil. +This Object, perhaps, may well deserve the Attention of the Publick; and +I earnestly advise as many as do build, to observe the necessary +Precautions on this Head. Another, which would cost still less Trouble, +is to give the Front of their Houses an Exposure to the South-East. This +Exposure, supposing all other Circumstances of the Building and its +Situation to be alike, is both the most wholesome and advantageous. I +have seen it, notwithstanding, very often neglected, without the least +Reason being assigned for not preferring it. + +These Admonitions may possibly be thought of little Consequence by three +fourths of the People. I take the Liberty of reminding them, however, +that they are more important than they may be supposed; and so many +Causes concur to the Destruction of Men, that none of the Means should +be neglected, which may contribute to their Preservation. + +Sec. 13. The Country People in _Swisserland_ drink, either 1, pure Water, +2, some Wine, 3, Perry, made from wild Pears, or sometimes Cyder from +Apples, and, 4, a small Liquor which they call _Piquette_, that is +Water, which has fermented with the Cake or Husks of the Grapes, after +their Juice has been expressed. Water however is their most general +Drink; Wine rarely falling in their Way, but when they are employed by +rich Folks; or when they can spare Money enough for a Debauch. Fruit +Wines and the [12] _Piquettes_ are not used in all Parts of the Country; +they are not made in all Years; and keep but for some Months. + +[12] This Word's occurring in the plural Number will probably imply, the + _Swiss_ make more than one Species of this small Drink, by pouring + Water on the Cake or Remainder of their other Fruits, after they + have been expressed; as our People in the Cyder, and perhaps in the + Perry, Counties, make what they call _Cyderkin_, _Perkin_, _&c._ It + should seem too from this Section, that the laborious Countrymen in + _Swisserland_ drink no Malt Liquor, though the Ingredients may be + supposed to grow in their Climate. Now Beer, of different Strength, + making the greater Part of our most common Drink, it may be proper + to observe here, that when it is not strong and heady, but a + middling well-brewed Small-beer, neither too new, nor hard or sour, + it is full as wholesome a Drink for laborious People in Health as + any other, and perhaps generally preferable to Water for such; + which may be too thin and light for those who are unaccustomed to + it; and more dangerous too, when the labouring Man is very hot, as + well as thirsty. The holding a Mouthful of any weak cold Liquor in + the Mouth without swallowing 'till it becomes warm, there, and + spurting it out before a Draught is taken down would be prudent; + and in Case of great Heat, to take the requisite Quantity rather at + two Draughts, with a little Interval between them, than to swallow + the Whole precipitately at one, would be more safe, and equally + refreshing, though perhaps less grateful. _K._ + +Our Waters in general, are pretty good; so that we have little Occasion +to trouble ourselves about purifying them; and they are well known in +those Provinces where they are chiefly and necessarily used. [13] The +pernicious Methods taken to improve or meliorate, as it is falsely +called, bad Wines, are not as yet sufficiently practiced among us, for +me to treat of them here: and as our Wines are not hurtful, of +themselves, they become hurtful only from their Quantity. The +Consumption of made Wines and _Piquettes_ is but inconsiderable, and I +have not hitherto known of any ill Effects from them, so that our +Liquors cannot be considered as Causes of Distempers in our Country; but +in Proportion to our Abuse of them by Excess. The Case is differently +circumstanced in some [14] other Countries; and it is the Province of +Physicians who reside in them, to point out to their Country-Men the +Methods of preserving their Health; as well as the proper and necessary +Remedies in their Sickness. + +[13] The bad Quality of Water is another common Cause of Country + Diseases; either where the Waters are unwholesome, from the Soils + in which they are found, as when they flow through, or settle, on + Banks of Shells; or where they become such, from the Neighbourhood + of, or Drainings from Dunghills and Marshes. + + When Water is unclear and turbid, it is generally sufficient to let + it settle in order to clear itself, by dropping its Sediment. But + if that is not effected, or if it be slimy or muddy, it need only + be poured into a large Vessel, half filled with fine Sand, or, for + want of that, with Chalk; and then to shake and stir it about + heartily for some Minutes. When this Agitation is over, the Sand, + in falling to the Bottom of the Vessel, will attract some of the + Foulness suspended in the Water. Or, which is still better, and + very easy to do, two large Vessels may be set near together, one of + which should be placed considerably higher than the other. The + highest should be half filled with Sand. Into this the turbid, or + slimy muddy Water is to be poured; whence it will filter itself + through the Body of Sand, and pass off clear by an Opening or + Orifice made at the Bottom of the Vessel; and fall from thence into + the lower one, which serves as a Reservoir. When the Water is + impregnated with Particles from the Beds of Selenites, or of any + Spar (which Water we call hard, because Soap will not easily + dissolve in it, and Puls and other farinaceous Substances grow hard + instead of soft, after boiling in it) such Water should be exposed + to the Sun, or boiled with the Addition of some Puls, or leguminous + Vegetables, or Bread toasted, or untoasted. When Water is in its + putrid State, it may be kept till it recovers its natural sweet + one: but if this cannot be waited for, a little Sea Salt should be + dissolved in it, or some Vinegar may be added, in which some + grateful aromatic Plant has been infused. It frequently happens, + that the publick Wells are corrupted by foul Mud at the Bottom, and + by different Animals which tumble in and putrify there. Drinking + Snow-water should be avoided, when the Snow is but lately fallen, + as it seems to be the Cause of those swelling wenny Throats in the + Inhabitants of some Mountains; and of endemic Cholics in many + Persons. As Water is so continually used, great Care should be + taken to have what is good. Bad Water, like bad Air, is one of the + most general Causes of Diseases; that which produces the greater + Number of them, the most grieveous ones; and often introduces such + as are epidemical. _E. L. i.e._ the Editor of Lyons. + +[14] Many Persons, With a Design to preserve their Wines, add Shot to + them, or Preparations of Lead, Alum, &c. The Government should + forbid, under the most severe Penalties, all such Adulterations, as + tend to introduce the most painful Cholics, Obstruction, and a long + Train of Evils, which it sometimes proves difficult to trace to + this peculiar Cause; while they shorten the lives of, or cruelly + torment, such over credulous Purchasers, as lay in a Stock of bad + Wines, or drink of them, without distinction, from every Wine + Merchant or Tavern. _E. L._ + + _This Note, from the Editor at_ Lyons, _we have sufficient Reason + for retaining here. K._ + + + + + __Chapter II.__ + + + _Of the Causes which aggravate the Diseases of the People. General + Considerations._ + + + __Sect.__ 14. + +The Causes already enumerated in the first Chapter occasion Diseases; +and the bad Regimen, or Conduct of the People, on the Invasion of them, +render them still more perplexing, and very often mortal. + +There is a prevailing Prejudice among them, which is every Year attended +with the Death of some Hundreds in this Country, and it is this--That +all Distempers are cured by Sweat; and that to procure Sweat, they must +take Abundance of hot and heating things, and keep themselves very hot. +This is a Mistake in both Respects, very fatal to the Population of the +State; and it cannot be too much inculcated into Country People; that by +thus endeavouring to force Sweating, at the very Beginning of a Disease, +they are with great Probability, taking Pains to kill themselves. I have +seen some Cases, in which the continual Care to provoke this Sweating, +has as manifestly killed the Patient, as if a Ball had been shot through +his Brains; as such a precipitate and untimely Discharge carries off the +thinner Part of the Blood, leaving the Mass more dry, more viscid and +inflamed. Now as in all acute Diseases (if we except a very few, and +those too much less frequent) the Blood is already too thick; such a +Discharge must evidently increase the Disorder, by co-operating with its +Cause. Instead of forcing out the watery, the thinner Part of the Blood, +we should rather endeavour to increase it. There is not a single Peasant +perhaps, who does not say, when he has a Pleurisy, or an Inflammation of +his Breast, that his Blood is too thick, and that it cannot circulate. +On seeing it in the Bason after Bleeding, he finds it _black, dry, +burnt_; these are his very Words. How strange is it then, that common +Sense should not assure him, that, far from forcing out the _Serum_, the +watery Part, of such a Blood by sweating, there is a Necessity to +increase it? + +Sec. 15. But supposing it were as certain, as it is erroneous, that +Sweating was beneficial at the Beginning of Diseases, the Means which +they use to excite it would not prove the less fatal. The first +Endeavour is, to stifle the Patient with the Heat of a close Apartment, +and a Load of Covering. Extraordinary Care is taken to prevent a Breath +of fresh Air's squeezing into the Room; from which Circumstance, the Air +already in it is speedily and extremely corrupted: and such a Degree of +Heat is procured by the Weight of the Patient's Bed-cloaths, that these +two Causes alone are sufficient to excite a most ardent Fever, and an +Inflammation of the Breast, even in a healthy Man. More than once have I +found myself seized with a Difficulty of breathing, on entering such +Chambers, from which I have been immediately relieved, on obliging them +to open all the Windows. Persons of Education must find a Pleasure, I +conceive, in making People understand, on these Occasions, which are so +frequent, that the Air being more indispensably necessary to us, if +possible, than Water is to a Fish, our Health must immediately suffer, +whenever that ceases to be pure; in assuring them also, that nothing +corrupts it sooner than those Vapours, which continually steam from the +Bodies of many Persons inclosed within a little Chamber, from which the +Air is excluded. The Absurdity of such Conduct is a self-evident +Certainty. Let in a little fresh Air on these miserable Patients, and +lessen the oppressing Burthen of their Coverings, and you generally see +upon the Spot, their Fever and Oppression, their Anguish and Raving, to +abate. + +Sec. 16. The second Method taken to raise a Sweat in these Patients is, to +give them nothing but hot things, especially Venice Treacle, Wine, or +some [15] _Faltranc_, the greater Part of the Ingredients of which are +dangerous, whenever there is an evident Fever; besides Saffron, which is +still more pernicious. In all feverish Disorders we should gently cool, +and keep the Belly moderately open; while the Medicines just mentioned +both heat and bind; and hence we may easily judge of their inevitable +ill Consequences. A healthy Person would certainly be seized with an +inflammatory Fever, on taking the same Quantity of Wine, of Venice +Treacle, or of _Faltranc_, which the Peasant takes now and then, when he +is attacked by one of these Disorders. How then should a sick Person +escape dying by them? Die indeed he _generally_ does, and sometimes with +astonishing Speed. I have published some dreadful Instances of such +Fatality some Years since, in another Treatise. In fact they still daily +occur, and unhappily every Person may observe some of them in his own +Neighbourhood. + +[15] This Word, which must be of German, not of French Extraction, + strictly signifies, _Drink for a Fall_, as we say _Pulvis ad + Casum_, &c. Powder for a Fall, or a supposed inward Bruise. Dr. + _Tissot_ informs me, it is otherwise called the vulnerary Herbs, or + the Swiss Tea; and that it is an injudicious _Farrago_ or Medley of + Herbs and Flowers, blended with Bitters, with stimulating, harsh + and astringent Ingredients, being employed indiscriminately in all + their Distempers by the Country People in _Swisserland_. _K._ + +Sec. 17. But I shall be told perhaps, that Diseases are often carried off +by Sweat, and that we ought to be guided by Experience. To this I +answer, it is very true, that Sweating cures some particular Disorders, +as it were, at their very Onset, for Instance, those Stitches that are +called spurious or false Pleurisies, some rheumatic Pains, and some +Colds or Defluxions. But this only happens when the Disorders depend +solely and simply on stopt or abated Perspiration, to which such Pain +instantly succeeds; where immediately, before the Fever has thickened +the Blood, and inflamed the Humours; and where before any internal +Infarction, any Load, is formed, some warm Drinks are given, such as +_Faltranc_ and Honey; which, by restoring Transpiration, remove the very +Cause of the Disorder. Nevertheless, even in such a Case, great Care +should be had not to raise too violent a Commotion in the Blood, which +would rather restrain, than promote, Sweat, to effect which +Elder-flowers are in my Opinion preferable to _Faltranc_. Sweating is +also of Service in Diseases, when their Causes are extinguished, as it +were, by plentiful Dilution: then indeed it relieves, by drawing off, +with itself, some Part of the distempered Humours; after which their +grosser Parts have passed off by Stool and by Urine: besides which, the +Sweat has also served to carry off that extraordinary Quantity of Water, +we were obliged to convey into the Blood, and which was become +superfluous there. Under such Circumstances, and at such a Juncture, it +is of the utmost Importance indeed, not to check the Sweat, whether by +Choice, or for Want of Care. There might often be as much Danger in +doing this, as there would have been in endeavouring to force a Sweat, +immediately upon the Invasion of the Disorder; since the arresting of +this Discharge, under the preceding Circumstances, might frequently +occasion a more dangerous Distemper, by repelling the Humour on some +inward vital Part. As much Care therefore should be taken not to check, +imprudently, that Evacuation by the Skin, which naturally occurs towards +the Conclusion of Diseases, as not to force it at their Beginning; the +former being almost constantly beneficial, the latter as constantly +pernicious. Besides, were it even necessary, it might be very dangerous +to force it violently; since by heating the Patients greatly, a vehement +Fever is excited; they become scorched up in a Manner, and the Skin +proves extremely dry. Warm Water, in short, is the best of Sudorifics. + +If the Sick are sweated very plentifully for a Day or two, which may +make them easier for some Hours; these Sweats soon terminate, and cannot +be excited again by the same Medicines. The Dose thence is doubled, the +Inflammation is increased, and the Patient expires in terrible Anguish, +with all the Marks of a general Inflammation. His Death is ascribed to +his Want of Sweating; when it really was the Consequence of his Sweating +too much at first; and of his taking Wine and hot Sudorifics. An able +Swiss Physician had long since assured his Countrymen, that Wine was +fatal to them in Fevers; I take leave to repeat it again and again, and +wish it may not be with as little Success. + +Our Country Folks, who in Health, naturally dislike red Wine, prefer it +when Sick; which is wrong, as it binds them up more than white Wine. It +does not promote Urine as well; but increases the Force of the +circulating Arteries, and the Thickness of the Blood, which were already +too considerable. + +Sec. 18. Their Diseases are also further aggravated by the Food that is +generally given them. They must undoubtedly prove weak, in Consequence +of their being sick; and the ridiculous Fear of the Patients' dying of +Weakness, disposes their Friends to force them to eat; which, increasing +their Disorder, renders the Fever mortal. This Fear is absolutely +chimerical; never yet did a Person in a Fever die merely from Weakness. +They may be supported, even for some Weeks, by Water only; and are +stronger at the End of that Time, than if they had taken more solid +Nourishment; since, far from strengthening them, their Food increases +their Disease, and thence increases their Weakness. + +Sec. 19. From the first Invasion of a Fever, Digestion ceases. Whatever +solid Food is taken corrupts, and proves a Source of Putridity, which +adds nothing to the Strength of the Sick, but greatly to that of the +Distemper. There are in fact a thousand Examples to prove, that it +becomes a real Poison: and we may sensibly perceive these poor +Creatures, who are thus compelled to eat, lose their Strength, and fall +into Anxiety and Ravings, in Proportion as they swallow. + +Sec. 20. They are also further injured by the Quality, as well as the +Quantity, of their Food. They are forced to sup strong Gravey Soups, +Eggs, Biscuits, and even Flesh, if they have but just Strength and +Resolution to chew it. It seems absolutely impossible for them to +survive all this Trash. Should a Man in perfect Health be compelled to +eat stinking Meat, rotten Eggs, stale sour Broth, he is attacked with as +violent Symptoms, as if he had taken real Poison, which, in Effect, he +has. He is seized with Vomiting, Anguish, a violent Purging, and a +Fever, with Raving, and eruptive Spots, which we call the Purple Fever. +Now when the very same Articles of Food, in their soundest State, are +given to a Person in a Fever, the Heat, and the morbid Matter already in +his Stomach, quickly putrify them; and after a few Hours produce all the +abovementioned Effects. Let any Man judge then, if the least Service can +be expected from them. + +Sec. 21. It is a Truth established by the first of Physicians, above two +thousand Years past, and still further ratified by his Successors, that +as long as a sick Person has a bad Humour or Ferment in his Stomach, his +Weakness increases, in Proportion to the Food he receives. For this +being corrupted by the infected Matter it meets there, proves incapable +of nourishing, and becomes a conjunct or additional Cause of the +Distemper. + +The most observing Persons constantly remark, that whenever a feverish +Patient sups, what is commonly called some good Broth, the Fever gathers +Strength and the Patient Weakness. The giving such a Soup or Broth, +though of the freshest soundest Meat, to a Man who has a high Fever, or +putrid Humours in his Stomach, is to do him exactly the same service, as +if you had given him, two or three Hours later, stale putrid Soup. + +Sec. 22. I must also affirm, that this fatal Prejudice, of keeping up the +Patients' Strength by Food, is still too much propagated, even among +those very Persons, whose Talents and whose Education might be expected +to exempt them from any such gross Error. It were happy for Mankind, and +the Duration of their Lives would generally be more extended, if they +could be thoroughly persuaded of this medical, and so very demonstrable, +Truth;--That the only things which can strengthen sick Persons are +those, which are able to weaken their Disease; but their Obstinacy in +this Respect is inconceivable: it is another Evil superadded to that of +the Disease, and sometimes the more grievous one. Out of twenty sick +Persons, who are lost in the Country, more than two Thirds might often +have been cured, if being only lodged in a Place defended from the +Injuries of the Air, they were supplied with Abundance of good Water. +But that most mistaken Care and Regimen I have been treating of, +scarcely suffers one of the twenty to survive them. + +Sec. 23. What further increases our Horror at this enormous Propensity to +heat, dry up, and cram the sick is, that it is totally opposite to what +Nature herself indicates in such Circumstances. The burning Heat of +which they complain; the Dryness of the Lips, Tongue and Throat; the +flaming high Colour of their Urine; the great Longing they have for +cooling things; the Pleasure and sensible Benefit they enjoy from fresh +Air, are so many Signs, or rather Proofs, which cry out with a loud +Voice, that we ought to attemperate and cool them moderately, by all +means. Their foul Tongues, which shew the Stomach to be in the like +Condition; their Loathing, their Propensity to vomit, their utter +Aversion to all solid Food, and especially to Flesh; the disagreeable +Stench of their Breath; their Discharge of fetid Wind upwards and +downwards, and frequently the extraordinary Offensiveness of their +Excrements, demonstrate, that their Bowels are full of putrid Contents, +which must corrupt all the Aliments superadded to them; and that the +only thing, which can prudently be done, is to dilute and attemper them +by plentiful Draughts of refreshing cooling Drinks, which may promote an +easy Discharge of them. I affirm it again, and I heartily wish it may be +thoroughly attended to, that as long as there is any Taste of +Bitterness, or of Putrescence; as long as there is a _Nausea_ or +Loathing, a bad Breath, Heat and Feverishness with fetid Stools, and +little and high-coloured Urine; so long all flesh, and Flesh-Soup, Eggs, +and all kind of Food composed of them, or of any of them, and all Venice +Treacle, Wine, and all heating things are so many absolute Poisons. + +Sec. 24. I may possibly be censured as extravagant and excessive on these +Heads by the Publick, and even by some Physicians: but the true and +enlightened Physicians, those who attend to the Effects of every +Particular, will find on the contrary, that far from exceeding in this +Respect, I have rather feebly expressed their own Judgment, in which +they agree with that of all the good ones, who have existed within more +than two thousand Years; that very Judgment which Reason approves, and +continual Experience confirms. The Prejudices I have been contending +against have cost _Europe_ some Millions of Lives. + +Sec. 25. Neither should it be omitted, that even when a Patient has very +fortunately escaped Death, notwithstanding all this Care to obtain it, +the Mischief is not ended; the Consequences of the high Aliments and +heating Medicines being, to leave behind the Seed, the Principle, of +some low and chronical Disease; which increasing insensibly, bursts out +at length, and finally procures him the Death he has even wished for, to +put an End to his tedious Sufferings. + +Sec. 26. I must also take Notice of another dangerous common Practice; +which is that of purging, or vomiting a Patient, at the very Beginning +of a Distemper. Infinite Mischiefs are occasioned by it. There are some +Cases indeed, in which evacuating Medicines, at the Beginning of a +Disease, are convenient and even necessary. Such Cases shall be +particularly mentioned in some other Chapters: but as long as we are +unacquainted with them, it should be considered as a general Rule, that +they are hurtful at the Beginning; this being true very often; and +always, when the Diseases are strictly inflammatory. + +Sec. 27. It is hoped by their Assistance, at that Time, to remove the Load +and Oppression of the Stomach, the Cause of a Disposition to vomit, of a +dry Mouth, of Thirst, and of much Uneasiness; and to lessen the Leaven +or Ferment of the Fever. But in this Hope they are very often deceived; +since the Causes of these Symptoms are seldom of a Nature to yield to +these Evacuations. By the extraordinary Viscidity or Thickness of the +Humours, that foul the Tongue, we should form our Notions of those, +which line the Stomach and the Bowels. It may be washed, gargled and +even scraped to very little good Purpose. It does not happen, until the +Patient has drank for many Days, and the Heat, the Fever and the great +Siziness of the Humours are abated, that this Filth can he thoroughly +removed, which by Degrees separates of itself. The State of the Stomach +being conformable to that of the Tongue, no Method can effectually scour +and clean it at the Beginning: but by giving refreshing and diluting +Remedies plentifully, it gradually frees itself; and the Propensity to +vomit, with its other Effects and Uneasinesses, go off naturally, and +without Purges. + +Sec. 28. Neither are these Evacuations only negatively wrong, merely from +doing no Good; for considerable Evil positively ensues from the +Application of those acrid irritating Medicines, which increase the Pain +and Inflammation; drawing the Humours upon those Parts that were already +overloaded with them; which by no means expel the Cause of the Disease, +that not being at this time fitted for Expulsion, as not sufficiently +concocted or ripe: and yet which, at the same Time, discharge the +thinnest Part of the Blood, whence the Remainder becomes more thick; in +short which carry off the useful, and leave the hurtful Humours behind. + +Sec. 29. The Vomit especially, being given in an inflammatory Disease, and +even without any Distinction in all acute ones, before the Humours have +been diminished by Bleeding, and diluted by plentiful small Drinks, is +productive of the greatest Evils; of Inflammations of the Stomach, of +the Lungs and Liver, of Suffocations and Frenzies. Purges sometimes +occasion a general Inflammation of the Guts, which [16] terminates in +Death. Some Instances of each of these terrible Consequences have I +seen, from blundering Temerity, Imprudence and Ignorance. The Effect of +such Medicines, in these Circumstances, are much the same with those we +might reasonably expect, from the Application of Salt and Pepper to a +dry, inflamed and foul Tongue, in Order to moisten and clean it. + +[16] It is pretty common to _hear_ of Persons recovering from + Inflammations of the Bowels, or Guts, which our Author more justly + and ingenuously considers as general Passports to Death: for it is + difficult to conceive, that a real and _considerable_ Inflammation + of such thin, membranous, irritable Parts, lined with such + putrescent Humours and Contents, and in so hot and close a + Situation, could be restored to a sound and healthy State _so + often_ as Rumour affirms it. This makes it so important a Point, to + avert every Tendency to an Inflammation of these feculent Parts, as + to justify a Bleeding directed, solely, from this Precaution, and + which might have been no otherwise indicated by a Disease, attended + with any Symptom, that threatened such an Inflammation. But when a + Person recovers, there can be no anatomical Search for such + Inflammations, or its Effects, the real or imaginary Cure of which + may well amaze the Patient, and must greatly redound to the Honour + of his Prescriber; so that there may be Policy sometimes in giving + a moderate Disease a very bad Name. _K._ + +Sec. 30. Every Person of sound plain Sense is capable of perceiving the +Truth of whatever I have advanced in this Chapter: and there would be +some Degree of Prudence, even in those who do not perceive the real good +Tendency of my Advice, not to defy nor oppose it too hardily. The +Question relates to a very important Object; and in a Matter quite +foreign to themselves, they undoubtedly owe some Deference to the +Judgment of Persons, who have made it the Study and Business of their +whole Lives. It is not to myself that I hope for their Attention, but to +the greatest Physicians, whose feeble Instrument and Eccho I am. What +Interest have any of us in forbidding sick People to eat, to be stifled, +or to drink such heating things as heighten their Fever? What Advantage +can accrue to us from opposing the fatal Torrent, which sweeps them off? +What Arguments can persuade People, that some thousand Men of Genius, of +Knowledge, and of Experience, who pass their Lives among a Croud and +Succession of Patients; who are entirely employed to take Care of them, +and to observe all that passes, have been only amusing and deceiving +themselves, on the Effects of Food, of Regimen and of Remedies? Can it +enter into any sensible Head, that a Nurse, who advises Soup, an Egg, or +a Biscuit, deserves a Patient's Confidence, better than a Physician who +forbids them? Nothing can be more disagreeable to the latter, than his +being obliged to dispute continually in Behalf of the poor Patients; and +to be in constant Terror, lest this mortally officious Attendance, by +giving such Food as augments all the Causes of the Disease, should +defeat the Efficacy of all the Remedies he administers to remove it; and +should fester and aggravate the Wound, in Proportion to the Pains he +takes to dress it. The more such absurd People love a Patient, the more +they urge him to eat, which, in Effect, verifies the Proverb of _killing +one with Kindness_. + + + + + __Chapter III.__ + + + _Of the Means that ought to be used, at the Beginning of Diseases; and + of the Diet in acute Diseases._ + + + __Sect.__ 31. + +I have clearly shewn the great Dangers of the Regimen, or Diet, and of +the principal Medicines too generally made Use of by the Bulk of the +People, on these Occasions. I must now point out the actual Method they +may pursue, without any Risque, on the Invasion of some acute Diseases, +and the general Diet which agrees with them all. As many as are desirous +of reaping any Benefit from this Treatise, should attend particularly to +this Chapter; since, throughout the other Parts of it, in Order to avoid +Repetitions, I shall say nothing of the Diet, except the particular +Distemper shall require a different one, from that of which I am now to +give an exact Detail. And whenever I shall say in general, that a +Patient is to be put upon a Regimen, it will signify, that he is to be +treated according to the Method prescribed in this Chapter; and all such +Directions are to be observed, with Regard to Air, Food, Drink and +Glysters; except when I expressly order something else, as different +Ptisans, Glysters, &c. + +Sec. 32. The greater Part of Diseases (by which I always understand acute +and feverish ones) often give some Notice of their Approach a few Weeks, +and, very commonly, some Days before their actual Invasion; such as a +light Lassitude, or Weariness, Stiffness or Numbness; less Activity than +usual, less Appetite, a small Load or Heaviness at Stomach; some +Complaint in the Head; a profounder Degree of Sleep, yet less composed, +and less refreshing than usual; less Gayety and Liveliness; sometimes a +light Oppression of the Breast, a less regular Pulse; a Propensity to be +Cold; an Aptness to sweat; and sometimes a Suppression of a former +Disposition to sweat. At such a Term it may be practicable to prevent, +or at least considerably to mitigate, the most perplexing Disorders, by +carefully observing the four following Points. + +1. To omit all violent Work or Labour, but yet not so, as to discontinue +a gentle easy Degree of Exercise. + +2. To bring the Complainant to content himself without any, or with very +little, solid Food; and especially to renounce all Flesh, Flesh-broth, +Eggs and Wine. + +3. To drink plentifully, that is to say, at least three Pints, or even +four Pints daily, by small Glasses at a Time, from half hour to half +hour, of the Ptisans No. 1 and 2, or even of warm Water, to each Quart +of which may be added half a Glass of Vinegar. No Person can be +destitute of this very attainable Assistance. But should there be a Want +even of Vinegar, a few Grains of common [17] Salt may be added to a +Quart of warm Water for Drink. Those who have Honey will do well to add +two or three Spoonfuls of it to the Water. A light Infusion of Elder +Flowers, or of those of the Linden, the Lime-tree, may also be +advantageously used, and even well settled and clear sweet Whey. + +[17] This Direction of our Author's, which may surprize some, probably + arises from his preferring a small Quantity of the marine Acid to + no Acid at all: For though a great Proportion of Salt, in saving + and seasoning Flesh and other Food, generally excites Thirst, yet a + little of it seems to have rather a different Effect, by gently + stimulating the salivary Glands: And we find that Nature very + seldom leaves the great diluting Element wholly void of this + quickening, antiputrescent Principle. _K._ + +4. Let the Person, affected with such previous Complaints, receive +Glysters of warm Water, or the Glyster No. 5. By pursuing these +Precautions some grievous Disorders have often been happily rooted out: +and although they should not prove so thoroughly efficacious, as to +prevent their Appearance, they may at least be rendered more gentle, and +much less dangerous. + +Sec. 33. Very unhappily People have taken the directly contrary Method. +From the Moment these previous, these forerunning Complaints are +perceived, they allow themselves to eat nothing but gross Meat, Eggs, or +strong Meat-Soups. They leave off Garden-Stuff and Fruits, which would +be so proper for them; and they drink heartily (under a Notion of +strengthening the Stomach and expelling Wind) of Wine and other Liquors, +which strengthen nothing but the Fever, and expel what Degree of Health +might still remain. Hence all the Evacuations are restrained; the +Humours causing and nourishing the Diseases are not at all attempered, +diluted, nor rendered proper for Evacuation. Nay, on the very contrary, +they become more sharp, and more difficult to be discharged: while a +sufficient Quantity of diluting refreshing Liquor, asswages and +separates all Matters foreign to the Blood, which it purifies; and, at +the Expiration of some Days, all that was noxious in it is carried off +by Stool, by Urine, or by Sweat. + +Sec. 34. When the Distemper is further advanced, and the Patient is already +seized with that Coldness or Shuddering, in a greater or less Degree, +which ushers in all Disease; and which is commonly attended with an +universal Oppression, and Pains over all the Surface of the Body; the +Patient, thus circumstanced, should be put to Bed, if he cannot keep up; +or should sit down as quietly as possible, with a little more Covering +than usual: he should drink every Quarter of an Hour a small Glass of +the Ptisan, No. 1 or 2, warm; or, if that is not at Hand, of some one of +those Liquids I have recommended Sec. 32. + +Sec. 35. These Patients earnestly covet a great Load of covering, during +the Cold or Shivering; but we should be very careful to lighten them as +soon as it abates; so that when the succeeding Heat begins, they may +have no more than their usual Weight of Covering. It were to be wished +_perhaps_, they had rather less. The Country People lie upon a +Feather-bed, and under a downy Coverlet, or Quilt, that is commonly +extremely heavy; and the Heat which is heightened and retained by +Feathers, is particularly troublesome to Persons in a Fever. +Nevertheless, as it is what they are accustomed to, this Custom may be +complied with for one Season of the Year: but during our Heats, or +whenever the Fever is very violent, they should lie on a Pallet (which +will be infinitely better for them) and should throw away their +Coverings of Down, so as to remain covered only with Sheets, or +something else, less injurious than Feather-Coverings. A Person could +scarcely believe, who had not been, as I have, a Witness of it, how much +Comfort a Patient is sensible of, in being eased of his former +Coverings. The Distemper immediately puts on a different Appearance. + +Sec. 36. As soon as the Heat after the _Rigor_, or Coldness and Shuddering, +approaches, and the Fever is manifestly advanced, we should provide for +the Patient's _Regimen_. And + +1, Care should be taken that the Air, in the Room where he lies, should +not be too hot, the mildest Degree of Warmth being very sufficient; that +there be as little Noise as possible, and that no Person speak to the +Sick, without a Necessity for it. No external Circumstance heightens the +Fever more, nor inclines the Patient more to a _Delirium_ or Raving, +than the Persons in the Chamber, and especially about the Bed. They +lessen the Spring, the elastic and refreshing Power, of the Air; they +prevent a Succession of fresh Air; and the Variety of Objects occupies +the Brain too much. Whenever the Patient has been at Stool, or has made +Urine, these Excrements should be removed immediately. The Windows +should certainly be opened Night and Morning, at least for a Quarter of +an Hour each Time; when also a Door should be opened, to promote an +entire Renovation or Change of the Air in the Room. Nevertheless, as the +Patient should not be exposed at any Time to a Stream or Current of Air, +the Curtains of his Bed should be drawn on such Occasions; and, if he +lay without any, Chairs, with Blankets or Cloaths hung upon them, should +be substituted in the Place of Curtains, and surround the Bed; while the +Windows continued open, in Order to defend the Patient from the Force of +the rushing Air. If the Season, however, be rigidly cold, it will be +sufficient to keep the Windows open, but for a few Minutes, each Time. +In Summer, at least one Window should be set open Day and Night. The +pouring a little Vinegar upon a red-hot Shovel also greatly conduces to +restore the Spring, and correct the Putridity, of the Air. In our +greatest Heats, when that in the Room seems nearly scorching, and the +sick Person is sensibly and greatly incommoded by it, the Floor may be +sprinkled now and then; and Branches of Willow or Ash-trees dipt a +little in Pails of Water may be placed within the Room. + +Sec. 37. 2. With Respect to the Patient's Nourishment, he must entirely +abstain from all Food; but he may always be allowed, and have daily +prepared, the following Sustenance, which is one of the wholesomest, and +indisputably the simplest one. Take half a Pound of Bread, a Morsel of +the freshest Butter about the Size only of a Hazel Nut (which may even +be omitted too) three Pints and one quarter of a Pint of Water. Boil +them 'till the Bread be entirely reduced to a thin Consistence. Then +strain it, and give the Patient one eighth Part of it every three, or +every four, Hours; but still more rarely, if the Fever be vehemently +high. Those who have Groats, Barley, Oatmeal, or Rice, may boil and +prepare them in the same Manner, with some Grains of Salt. + +Sec. 38. The Sick may also be sometimes indulged, in lieu of these +different Spoon-Meats, with raw Fruits in Summer, or in Winter with +Apples baked or boiled, or Plumbs and Cherries dried and boiled. Persons +of Knowledge and Experience will be very little, or rather not at all, +surprized to see various Kinds of Fruit directed in acute Diseases; the +Benefit of which they may here have frequently seen. Such Advice can +only disgust those, who remain still obstinately attached to old +Prejudices. But could they prevail on themselves to reflect a little, +they must perceive, that these Fruits which allay Thirst; which cool and +abate the Fever; which correct and attemper the putrid and heated Bile; +which gently dispose the Belly to be rather open, and promote the +Secretion and Discharge of the Urine, must prove the properest +Nourishment for Persons in acute Fevers. Hence we see, as it were by a +strong Admonition from Nature herself, they express an ardent Longing +for them; and I have known several, who would not have recovered, but +for their eating secretly large Quantities of those Fruits they so +passionately desired, and were refused. As many however, as are not +convinced by my Reasoning in this Respect, may at least make a Tryal of +my Advice, on my Affirmation and Experience; when I have no doubt but +their own will speedily convince them of the real Benefit received from +this Sort of Nourishment. It will then be evident, that we may safely +and boldly allow, in all continual Fevers, Cherries red and black, +Strawberries, the best cured Raisins, Raspberries, and Mulberries; +provided that all of them be perfectly ripe. Apples, Pears and Plumbs +are less melting and diluting, less succulent, and rather less proper. +Some kinds of Pears however are extremely juicy, and even watery almost, +such as the Dean or Valentia Pear, different Kinds of the Buree Pear; +the St. Germain, the Virgoleuse; the green sugary Pear, and the Summer +Royal, which may all be allowed; as well as a little Juice of very ripe +Plumbs, with the Addition of Water to it. This last I have known to +asswage Thirst in a Fever, beyond any other Liquor. Care should be +taken, at the same Time, that the Sick should never be indulged in a +great Quantity of any of them at once, which would overload the Stomach, +and be injurious to them; but if they are given a little at a Time and +often, nothing can be more salutary. Those whose Circumstances will +afford them China Oranges, or Lemons, may be regaled with the Pulp and +Juice as successfully; but without eating any of their Peel, which is +hot and inflaming. + +Sec. 39. 3. Their Drink should be such as allays Thirst, and abates the +Fever; such as dilutes, relaxes, and promotes the Evacuations by Stool, +Urine and Perspiration. All these which I have recommended in the +preceding Chapters, jointly and severally possess these Qualities. A +Glass or a Glass and a half of the Juice of such Fruits as I have just +mentioned, may also be added to three full Pints of Water. + +Sec. 40. The Sick should drink at least twice or thrice that Quantity +daily, often, and a little at once, between three or four Ounces, every +Quarter of an Hour. The Coldness of the Drink should just be taken off. + +Sec. 41. 4. If the Patient has not two Motions in the 24 Hours; if the +Urine be in small Quantity and high coloured; if he rave, the Fever +rage, the Pain of the Head and of the Loins be considerable, with a Pain +in the Belly, and a Propensity to vomit, the Glyster No. 5 should be +given at least once a Day. The People have generally an Aversion to this +kind of Remedy; notwithstanding there is not any more useful in feverish +Disorders, especially in those I have just recounted; and one Glyster +commonly gives more Relief, than if the Patient had drank four or five +Times the Quantity of his Drinks. The Use of Glysters, in different +Diseases, will be properly ascertained in the different Chapters, which +treat of them. But it may be observed in this Place, that they are never +to be given at the very Time the Patient is in a Sweat, which seems to +relieve him. + +Sec. 42. 5. As long as the Patient has sufficient Strength for it, he +should sit up out of Bed one Hour daily, and longer if he can bear it; +but at least half an Hour. It has a Tendency to lessen the Fever, the +Head-ach, and a Light-headiness, or Raving. But he should not be raised, +while he has a hopeful Sweating; though such Sweats hardly ever occur, +but at the Conclusion of Diseases, and after the Sick has had several +other Evacuations. + +Sec. 43. 6. His Bed should be made daily while he sits up; and the Sheets +of the Bed, as well as the Patient's Linen, should be changed every two +Days, if it can be done with Safety. An unhappy Prejudice has +established a contrary, and a really dangerous, Practice. The People +about the Patient dread the very Thought of his rising out of Bed; they +let him continue there in nasty Linen loaden with putrid Steams and +Humours; which contribute, not only to keep up the Distemper, but even +to heighten it into some Degree of Malignity. I do again repeat it here, +that nothing conduces more to continue the Fever and Raving, than +confining the Sick constantly to Bed, and witholding him from changing +his foul Linen: by relieving him from both of which Circumstances I +have, without the Assistance of any other Remedy, put a Stop to a +continual Delirium of twelve Days uninterrupted Duration. It is usually +said, the Patient is too weak, but this is a very weak Reason. He must +be in very nearly a dying Condition, not to be able to bear these small +Commotions, which, in the very Moment when he permits them, increase his +Strength, and immediately after abate his Complaints. One Advantage the +Sick gain by sitting up a little out of Bed, is the increased Quantity +of their Urine, with greater Facility in passing it. Some have been +observed to make none at all, if they did not rise out of Bed. + +A very considerable Number of acute Diseases have been radically, +effectually, cured by this Method, which mitigates them all. Where it is +not used, as an Assistance at least, Medicines are very often of no +Advantage. It were to be wished the Patient and his Friends were made to +understand, that Distempers were not to be expelled at once with rough +and precipitate Usage; that they must have their certain Career or +Course; and that the Use of the violent Methods and Medicines they chuse +to employ, might indeed abridge the Course of them, by killing the +Patient; yet never otherwise shortened the Disease; but, on the +contrary, rendered it more perplexing, tedious and obstinate; and often +entailed such unhappy Consequences on the Sufferer, as left him feeble +and languid for the rest of his Life. + +Sec. 44. But it is not sufficient to treat, and, as it were, to conduct the +Distemper properly. The Term of Recovery from a Disease requires +considerable Vigilance and Attention, as it is always a State of +Feebleness, and, thence, of Depression and Faintness. The same Kind of +Prejudice which destroys the Sick, by compelling them to eat, during the +Violence of the Disease, is extended also into the Stage of +Convalescence, or Recovery; and either renders it troublesome and +tedious; or produces fatal Relapses, and often chronical Distempers. In +Proportion to the Abatement, and in the Decline, of the Fever, the +Quantity of Nourishment may be gradually increased: but as long as there +are any Remains of it, their Qualities should be those I have already +recommended. Whenever the Fever is compleatly terminated, some different +Foods may be entered upon; so that the Patient may venture upon a little +white Meat, provided it be tender; some [18] Fish; a little Flesh-Soup, +a few Eggs at times, with Wine property diluted. It must be observed at +the same Time, that those very proper Aliments which restore the +Strength, when taken moderately, delay the perfect Cure, if they exceed +in Quantity, tho' but a little; because the Action of the Stomach being +extremely weakened by the Disease and the Remedies, is capable only, as +yet, of a small Degree of Digestion; and if the Quantity of its Extents +exceed its Powers, they do not digest, but become putrid. Frequent +Returns of the Fever supervene; a continual Faintishness; Head-achs; a +heavy Drowsiness without a Power of Sleeping comfortably; flying Pains +and Heats in the Arms and Legs; Inquietude; Peevishness; Propensity to +Vomit; Looseness; Obstructions, and sometimes a slow Fever, with a +Collection of Humours, that comes to Suppuration. + +All these bad Consequences are prevented, by the recovering Sick +contenting themselves, for some Time, with a very moderate Share of +proper Food. We are not nourished in Proportion to the Quantity we +swallow, but to that we digest. A Person on the mending Hand, who eats +moderately, digests it and grows strong from it. He who swallows +abundantly does not digest it, and instead of being nourished and +strengthened, he withers insensibly away. + +[18] The most allowable of these are Whitings, Flounders, Plaice, Dabbs, + or Gudgeons; especially such of the last as are taken out of clear + current Streams with gravelly Bottoms. Salmon, Eels, Carp, all the + Skate kind, Haddock, and the like, should not be permitted, before + the Sick return to their usual Diet when in Health. _K._ + +Sec. 45. We may reduce, within the few following Rules, all that is most +especially to be observed, in Order to procure a compleat, a perfect +Termination of acute Diseases; and to prevent their leaving behind them +any Impediments to Health. + +1. Let these who are recovering, as well as those who are actually sick, +take very little Nourishment at a time, and take it often. + +2. Let them take but one sort of Food at each Meal, and not change their +Food too often. + +3. Let them chew whatever solid Victuals they eat, very carefully. + +4. Let them diminish their Quantity of Drink. The best for them in +general is Water, [19] with a fourth or third Part of white Wine. Too +great a Quantity of Liquids at this time prevents the Stomach from +recovering its Tone and Strength; impairs Digestion; keeps up Weakness; +increases the Tendency to a Swelling of the Legs; sometimes even +occasions a slow Fever; and throws back the Person recovering into a +languid State. + +[19] We have known many who had an Aversion to Water, and with whom, on + that very Account, it might probably agree less, find Water very + grateful, in which a thoroughly baked and hot, not burnt, Slice of + Bread had been infused, untill it attained the Colour of fine clear + Small-beer, or light Amber coloured Beer, and we never saw any + Inconvenience result from it. Doubtless pure, untoasted elemental + Water may be preferable for those who like, and have been + accustomed to it. _K._ + +5. Let them go abroad as often as they are able, whether on Foot, in a +Carriage, or on Horseback. This last Exercise is the healthiest of all, +and three fourths of the labouring People in this Country, who have it +in their Power to procure it without Expense, are in the wrong to +neglect it. They, who would practice it, should mount before their +principal Meal, which should be about Noon, and never ride after it. +Exercise taken before a Meal strengthens the Organs of Digestion, which +is promoted by it. If the Exercise is taken soon after the Meal, it +impairs it. + +6. As People in this State are seldom quite as well towards Night, in +the Evening they should take very little Food. Their Sleep will be the +less disturbed for this, and repair them the more, and sooner. + +7. They should not remain in Bed above seven, or eight Hours. + +8. The Swelling of the Legs and Ancles, which happens to most Persons at +this time, is not dangerous, and generally disappears of itself; if they +live soberly and regularly, and take moderate Exercise. + +9. It is not necessary, in this State, that they should go constantly +every Day to Stool; though they should not be without one above two or +three. If their Costiveness exceeds this Term, they should receive a +Glyster the third Day, and even sooner, if they are heated by it, if +they feel puffed up, are restless, and have any Pains in the Head. + +10. Should they, after some time, still continue very weak; if their +Stomach is disordered; if they have, from time to time, a little +irregular Fever, they should take three Doses daily of the Prescription +No. 14. which fortifies the Digestions, recovers the strength, and +drives away the Fever. + +11. They must by no means return to their Labour too soon. This +erroneous Habit daily prevents many Peasants from ever getting perfectly +well, and recovering their former Strength. From not having been able to +confine themselves to Repose and Indolence for some Days, they never +become as hearty hardy Workmen as they had been: and this premature +hasty Labour makes them lose in the Consequence, every following Week of +their Lives, more time than they ever gained, by their over-early +resuming of their Labour. I see every Day weakly Labourers, Vineroons, +and other Workmen, who date the Commencement of their Weakness from that +of some acute Disease, which, for want of proper Management through the +Term of their Recovery, was never perfectly cured. A Repose of seven or +eight Days, more than they allowed themselves, would have prevented all +these Infirmities; notwithstanding it is very difficult to make them +sensible of this. The Bulk, the Body of the People, in this and in many +other Cases, look no further than the present Day; and never extend +their Views to the following one. They are for making no Sacrifice to +Futurity; which nevertheless must be done, to render it favourable to +us. + + + + + __Chapter IV.__ + + + _Of an Inflammation of the Breast._ + + + __Sect.__ 46. + +The Inflammation of the Breast, or Peripneumony, or a Fluxion upon the +Breast, is an Inflammation of the Lungs, and most commonly of one only, +and consequently on one Side. The Signs by which it is evident, are a +Shivering, of more or less Duration, during which the Person affected is +sometimes very restless and in great Anguish, an essential and +inseparable symptom; and which has helped me more than once to +distinguish this Disease certainly, at the very Instant of its Invasion. +Besides this, a considerable Degree of Heat succeeds the Shivering, +which Heat, for a few ensuing Hours, is often blended as it were, with +some Returns of Chilliness. The Pulse is quick, pretty strong, +moderately full, hard and regular, when the Distemper is not very +violent; but small, soft and irregular, when it is very dangerous. There +is also a Sensation of Pain, but rather light and tolerable, in one Side +of the Breast; sometimes a kind of straitning or Pressure on the Heart; +at other times Pains through the whole Body, especially along the Reins; +and some Degree of Oppression, at least very often; for sometimes it is +but very inconsiderable. The Patient finds a Necessity of lying almost +continually upon his Back, being able to lie but very rarely upon either +of his Sides. Sometimes his Cough is dry, and then attended with the +most Pain; at other times it is accompanied with a Spitting or Hawking +up, blended with more or less Blood, and sometimes with pure sheer +Blood. There is also some Pain, or at least a Sensation of Weight and +Heaviness in the Head: and frequently a Propensity to rave. The Face is +almost continually flushed and red: though sometimes there is a Degree +of Paleness and an Air of Astonishment, at the Beginning of the Disease, +which portend no little Danger. The Lips, the Tongue, the Palate, the +Skin are all dry; the Breath hot; the Urine little and high coloured in +the first Stage: but more plentiful, less flaming, and letting fall much +Sediment afterwards. There is a frequent Thirst, and sometimes an +Inclination to vomit; which imposing on the ignorant Assistants, have +often inclined them to give the Patient a Vomit, which is mortal, +especially at this Juncture. The Heat becomes universal. The Symptoms +are heightened almost every Night, during which the Cough is more +exasperated, and the Spitting or Expectoration in less Quantity. The +best Expectoration is of a middling Consistence, neither too thin, nor +too hard and tough, like those which are brought up at the Termination +of a Cold; but rather more yellow, and mixed with a little Blood, which +gradually becomes still less, and commonly disappears entirely, before +the seventh Day. Sometimes the Inflammation ascends along the Wind-pipe, +and in some Measure suffocates the Patient, paining him considerably in +Swallowing, which makes him think he has a sore Throat. + +Sec. 47. Whenever the Disease is very violent at first, or increases to be +such, the Patient cannot draw his Breath, but when he sits up. The Pulse +becomes very small and very quick; the Countenance livid, the Tongue +black; the Eyes stare wildly; and he suffers inexpressible Anguish, +attended with incessant Restlessness and Agitation in his Bed. One of +his Arms is sometimes affected with a sort of Palsy; he raves without +Intermission; can neither thoroughly wake nor sleep. The Skin of his +Breast and of his Neck is covered (especially in close sultry Weather, +and when the Distemper is extremely violent) with livid Spots, more or +less remarkable, which should be called _petechial_ ones, but are +improperly termed the _pourpre_, or purple. The natural Strength becomes +exhausted; the Difficulty of breathing increases every Moment; he sinks +into a Lethargy, and soon dies a terrible Death in Country Places, by +the very Effects of the inflaming Medicines they employ on such +Occasions. It has been known in Fact, that the Use of them has raised +the Distemper to such a Height, that the very Heart has been rent open, +which the Dissection of the Body has demonstrated. + +Sec. 48. If the Disease rushes on at once, with a sudden and violent +Attack; if the Horror, the Cold and Shivering last many Hours, and are +followed with a nearly scorching Degree of Heat; if the Brain is +affected from the very Onset; if the Patient has a small Purging, +attended with a _Tenesinus_, or straining to Stool, often termed a +_Needy_; if he abhors the Bed; if he either sweat excessively, or if his +Skin be extremely dry; if his natural Manner and Look are considerably +changed; and if he spits up with much Difficulty, the Disease is +extremely dangerous. + +Sec. 49. He must directly, from the first Seizure in this State, be put +upon a Regimen, and his Drink must never be given cold. It should either +be the Barley Water No. 2, the Almond Emulsion No. 4, or that of No. 7. +The Juices of the Plants, which enter into the last of these Drinks, are +excellent Remedies in this Case; as they powerfully attenuate, or melt +down, the viscid thick Blood, which causes the Inflammation. + +The Advantage of Bleeding: + +As long as the Fever keeps up extremely violent; while the Patient does +not expectorate sufficiently; continues raving; has a violent Head-ach, +or raises up pure Blood, the Glyster No. 5 must be given thrice, or at +least twice, in twenty four Hours. However the principal Remedy is +Bleeding. As soon as ever the preceding cold Assault is over, twelve +Ounces of Blood must be taken away at once; and, if the Patient be young +and strong, fourteen or even sixteen. This plentiful Bleeding gives him +more Ease, than if twenty four Ounces had been drawn, at three different +Times. + +Sec. 50. When the Disease is circumstanced as described (Sec. 46) that first +Bleeding makes the Patient easy for some Hours; but the Complaint +returns; and to obviate its Violence, as much as possible, we must, +except things promise extremely well, repeat the Bleeding four Hours +after the first, taking again twelve Ounces of Blood, which pretty often +proves sufficient. But if, about the Expiration of eight or ten Hours, +it appears to kindle up again, it must be repeated a third, or even a +fourth Time. Yet, with the Assistance of other proper Remedies, I have +seldom been obliged to bleed a fourth Time, and have sometimes found the +two first Bleedings sufficient. + +If the Disease has been of several Days Duration, when I have first been +called; if the Fever is still very high; if there be a Difficulty of +Breathing; if the Patient does not expectorate at all, or brings up too +much Blood; without being too solicitous about the Day of the Disease, +the Patient should be bled, though it were on the tenth. [20] + +Sec. 51. In this, and in all other inflammatory Diseases, the Blood is in a +very thick viscid State: and almost immediately on its being drawn, a +white tough Skin, somewhat like Leather, is formed on its Top, which +most People have seen, and which is called the _pleuritic Crust_. It is +thought a promising Appearance, when at each Bleeding it seems less +hard, and less thick, than it was at the preceding ones: and this is +very generally true, if the Sick feels himself, at the same Time, +sensibly better: but whoever shall attend _solely_ to the Appearance of +the Blood, will find himself often deceived. It will happen, even in the +most violent Inflammation of the Breast, that this Crust is not formed, +which is supposed to be a very unpromising Sign. There are also, in this +Respect, many odd Appearances, which arise from the smallest +Circumstances; so that we must not regulate the Repetitions of our +bleeding, solely by this Crust: and in general we must not be over +credulous in supposing, that the Appearances in the Blood, received into +the Bason, can enable us to determine, with Certainty, of its real State +in the Body. + +[20] We should however, with the greater Circumspection (of how much the + longer standing the Disease has been, and by how much the more + difficult the viscous Humours are to be melted down and dislodged) + attend to the Coction of the Matter of Expectoration; which Nature + does not often easily effect, and which she effects the more + imperfectly and slowly, the weaker he is. Her last Efforts have + often been attended with such high Paroxysms, as have imposed even + upon very competent Physicians, and have made them open a Vein a + few Hours before the Patients' Death, from their Pulses being + strong, hard and frequent. Excessive Weakness is the Sign, by which + we may discover such unavailing Efforts to be the last. _E. L._ + +Sec. 52. When the sick Person is in the Condition described (Sec. 47) the +Bleeding is not only unattended with Ease; but sometimes it is also +pernicious, by the sudden Weakness to which it reduces him. Generally in +such a Case all Medicines and Means are insignificant: and it is a very +bad Sign in this Disease, when this Discharge is not attended with Ease +and Benefit to the Sick; or when there are some Circumstances, which +oblige us to be sparing of it. + +Sec. 53. The Patient's Legs should every Day, for one half Hour, be put +into a Bath of warm Water, wrapping him up closely; that the Cold may +not check that Perspiration, which the Bath promotes. + +Sec. 54. Every two Hours he should take two Spoonfuls of the Mixture No. 8, +which promotes all the Discharges, and chiefly that of Expectoration. + +Sec. 55. When the Oppression and Straitness are considerable, and the Cough +dry, the Patient may receive the Vapour of boiling Water, to which a +little Vinegar has been added. There are two ways of effecting this; +either by placing below his Face, after setting him up, a Vessel filled +with such boiling hot Water, and covering the Patient's Head and the +Vessel with a Linen Cloth, that may inclose the Steam; or else by +holding before his Mouth a Spunge dipped in the same boiling Liquor. +This last Method is the least effectual, but it fatigues the Patient +considerably less. When this bad Symptom is extremely pressing, Vinegar +alone should be used without Water; and the Vapour of it has often saved +Patients, who seemed to have one Foot in the Grave: but it should be +continued for several Hours. + +Sec. 56. The outward Remedies directed in No. 9. are also applied with +Success to the Breast, and to the Throat. + +Sec. 57. When the Fever is extremely high, the Sick should take every Hour, +a Spoonful of the Mixture No. 10. in a Cup of the Ptisan [21] but +without diminishing on this Account the usual Quantity of his other +Drinks, which may be taken immediately after it. + +[21] The Use of Acids, in Inflammations of the Breast, requires no + little Consideration. Whenever the sick Person has an Aversion to + them; when the Tongue is moist, the Stomach is heavy and + disordered, and the Habit and Temperament of the Patient is mild + and soft; when the Cough is very sharp without great Thirst, we + ought to abstain from them. But when the Inflammation is joined to + a dry Tongue, to great Thirst, Heat and Fever, they are of great + Service. Slices of China Oranges sprinkled with Sugar may be given + first; a light Limonade may be allowed afterwards; and at last + small Doses of the Mixture, No. 10. if it becomes necessary. _E. + L._--I have chosen to retain this Note of the Editor of _Lyons_, + from having frequently seen the Inefficacy, and sometimes, I have + even thought, the ill Effects of Acids in Peripneumonies and + Pleurisies, in a Country far South of _Swisserland_; and where + these Diseases are very frequent, acute and fatal. On the other + hand I shall add the Substance of what Dr. _Tissot_ says on this + Head in a Note to his Table of Remedies, wherein he affirms, that + he has given in this Disease very large Doses of them, rising + gradually from small ones, and always with great Success; + intreating other Physicians to order this Acid (the Spirit of + Sulphur) in the same large Doses which he directs in this Chapter, + and assuring himself of their thanks, for its good + Consequences--Now the only ill Effect I can surmize here, from + shewing this Diversity of Opinion in these two learned Physicians, + and my own Doubts, is, that the Subjects of this Disease in Country + Places may prove somewhat confused and irresolute by it, in their + Conduct in such Cases. But as all of us certainly concur in the + great Intention of doing all possible Good, by the extensive + Publication of this Treatise, I shall take leave to observe that in + this Disease, and in Pleurisies, more solid Benefit has been + received in _Carolina_, _Virginia_, &c. from the Use of the + _Seneka_ Rattle-snake Root, than from any other Medicine whatever. + Bleeding indeed is necessarily premised to it; but it has often + saved the Necessity of many repeated Bleedings. This Medicine, + which is termed in Latin, the _Polygala Virginiana_, is certainly + rather of a saponaceous attenuating Quality, and betrays not any + Marks of Acidity, being rather moderately acrid. There will be + Occasion to mention it more particularly in the subsequent Chapter, + as such a Liberty can need no Apology to any philosophical + Physician. _K._ + +Sec. 58. As long as the Patient shall grow worse, or only continue equally +bad, the same Medicines are to be repeated. But if on the third Day +(tho' it rarely happens so soon) or fourth, or fifth, the Disease takes +a more favourable Turn; if the Exasperation returns with less Violence; +the Cough be less severe; the Matter coughed up less bloody: if +Respiration becomes easier; the Head be less affected; the Tongue not +quite so dry; if the high Colour of the Urine abates, and its Quantity +be increased, it may be sufficient then to keep the Patient carefully to +his Regimen, and to give him a Glyster every Evening. The Exasperation +that occurs the fourth Day is often the highest. + +Sec. 59. This Distemper is most commonly terminated and carried off by +Expectoration, and often by Urine, which on the seventh, the ninth, or +the eleventh Day, and sometimes on the Days between them, begins to let +fall a plentiful Sediment, or Settling, of a pale red Colour, and +sometimes real _Pus_ or ripe Matter. These Discharges are succeeded by +Sweats, which are as serviceable then, as they were injurious at the +Beginning of the Disease. + +Sec. 60. Some Hours before these Evacuations appear, there come on, and not +seldom, some very alarming Symptoms, such as great Anguish; +Palpitations, some Irregularity in the Pulse; an increased Oppression; +convulsive Motions (this being what is called the _Crisis_, the Height, +or Turn of the Distemper) but they are no ways dangerous, provided they +do not occasion any improper Treatment. These Symptoms depend on the +morbid and purulent Matter, which, being dislodged, circulates with the +Humours, and irritates different Parts, until the Discharge of it has +fairly begun; after which all such Symptoms disappear, and Sleep +generally ensues. However I cannot too strongly insist on the Necessity +of great Prudence in such Circumstances. Sometimes it is the Weakness of +the Patient, and at other times Convulsions, or some other Symptoms, +that terrify the By-standers. If, which is most generally the Case, the +absurd Practice of directing particular Remedies for such Accidents +takes place, such as spirituous Cordials, Venice Treacle, Confections, +Castor and Rue; the Consequence is, that Nature being disturbed in her +Operations, the _Crisis_ or Turn is not effected; the Matter which +should be discharged by Stool, by Urine, or by Sweat, is not discharged +out of the Body; but is thrown upon some internal or external part of +it. Should it be on some inward part, the Patient either dies at once; +or another Distemper succeeds, more troublesome and incurable than the +first. Should it be expelled to some outward part, the Danger indeed is +less; and as soon as ever such a Tumour appears, ripening Pultices +should be apply'd to bring it to a Head, after which it should +immediately be opened. + +Sec. 61. In order to prevent such unhappy Consequences, great Care must be +taken, whenever such terrifying Symptoms come on, [about the Time of the +_Crisis_] to make no Change in the Diet, nor in the Treatment of the +Patient; except in giving him the loosening Glyster No. 5; and applying +every two Hours a Flannel, squeezed out of warm Water, which may cover +all the Belly, and in a Manner go round the Body behind the Reins. The +Quantity of his Drink may also be increased a little; and that of his +Nourishment lessened, as long as this high and violent State continues. + +Sec. 62. I have not spoken of Vomits or Purges, as being directly contrary +to the Nature of this Disease. Anodynes, or Opiates, to procure Sleep +are also, in general, very improper. In a few Cases, however, they may +possibly be useful; but these Cases are so very difficult to be +sufficiently distinguished, that Opiates should never be admitted in +this Disease, without the Presence and Advice of a Physician. I have +seen many Patients, who have been thrown into an incurable Hectic, by +taking them improperly. When the Disease is not received in a mortal +Degree, nor has been injudiciously treated, and proceeds in a benign +regular Manner, the Patient may be called very well and safe by the +fourteenth Day; when he may, if he has an Appetite, be put upon the Diet +of People who are recovering. But if he still retains an Aversion to +Food; if his Mouth is foul and furred, and he is sensible of some +Heaviness in his Head, he should take the purging Potion No. 11. + +Sec. 63. Bleedings from the Nose occur sometimes naturally in this Disease, +even after repeated Bleedings by Art; these are very benign and +favourable, and are commonly attended with more Ease and Relief than +artificial Bleedings. Such voluntary Discharges may sometimes be +expected, when the Patient is sensibly mended in many Respects after the +Use of the Lancet; and yet complains of a great Pain in his Head, +accompanied with quick sparkling Eyes, and a Redness of the Nose. +Nothing should be done to stop these voluntary Bleedings, since it would +be very dangerous: For when Nature has fulfilled her Intention by them, +they cease of themselves. At other times, but more rarely, the Distemper +is carried off by a natural Purging, attended with moderate Pain, and +the Discharge of bilious Matter. + +Sec. 64. If the Expectoration, or hawking up of Matter, stops very +suddenly, and is not speedily attended with some other Evacuation; the +Oppression and Anguish of the Patient immediately return, and the Danger +is great and pressing. If the Distemper, at this Juncture, is not of +many Days standing; if the Patient is a strong Person; if he has not as +yet been plentifully bled; if there be still some Blood mixed with the +Humour he expectorates; or if the Pulse be strong and hard, he should be +bled immediately in the Arm; and constantly receive the Steam of hot +Water and Vinegar by the Mouth, and drink plentifully of the Ptisan No. +2, something hotter than ordinary. But if his Circumstances, after this +Suppression, are different from these just mentioned; instead of +bleeding him, two Blisters should be applied to the Legs; and he should +drink plentifully of the Ptisan No. 12. + +The Causes which oftenest produce this Suppression of his Expectoration +are, 1, a sharp and sudden cold Air. 2, too hot a one. 3, over hot +Medicines. 4, excessive Sweating. 5, a Purge prematurely and +injudiciously timed. and 6, some immoderate Passion of the Mind. + +Sec. 65. When the Sick has not been sufficiently bled, or not soon enough; +and even sometimes, which I have seen, when he has been greatly weakened +by excessive Bleeding; so that the Discharges by Stool, Urine, +Expectoration and Perspiration, have not been sufficiently made; when +these Discharges have been confused by some other Cause; or the Disease +has been injudiciously treated; then the Vessels that have been +inflamed, do not unload themselves of the Humours, which stuff up and +oppress them: but there happens in the Substance of the affected Lung, +the same Circumstance we see daily occur on the Surface of the Body. If +an inflammatory Tumour or Swelling does not disperse itself, and +disappears insensibly, it forms an Imposthume or Abscess. Thus exactly +also in the inflamed Lung, if the Inflammation is not dissipated, it +forms an Abscess, which, in that part, is called a _Vomica:_ and the +Matter of that Abscess, like the external ones, remains often long +inclosed in its Sac or Bag, without bursting open its Membrane or Case, +and discharging the Matter it contains. + +Sec. 66. If the Inflammation was not very deeply seated in the inward +Substance of the diseased Lung; but was extended to its Surface, that +is, very near the Ribs, the Sac will burst on the Surface of the Lung; +and the Matter contained in it must be discharged into the Cavity, or +Hollowness of the Breast, between the Lung, the Ribs, and the Diaphragm +or Midriff, which is the Membrane that divides the Breast and the Belly. +But when the Inflammation is considerably deeper, the Imposthume bursts +withinside of the Lung itself. If its Orifice, or Opening is so small, +that but little can get out at once; if the Quantity of all the Matter +be inconsiderable, and the Patient is at the same Time pretty strong, he +coughs up the Matter, and is very sensibly relieved. But if this +_Vomica_ be large, or if its Orifice is wide, and it throws out a great +Quantity of Matter at once; or if the Patient is very weak, he dies the +Moment it bursts, and that sometimes when it is least expected. I have +seen one Patient so circumstanced expire, as he was conveying a Spoonful +of Soup to his Mouth; and another, while he was wiping his Nose. There +was no present Symptom in either of these Cases, whence a Physician +might suppose them likelier to die at that Instant, than for some Hours +before. The _Pus_, or Matter, is commonly discharged through the Mouth +after Death, and the Bodies very soon become putrified. + +Sec. 67. We call that _Vomica_ which is not burst, an _occult_ or hidden, +and that which is, an evident or open one. It is of considerable +Importance to treat exactly and clearly of this Topic; as a great Number +of Country People die of these Imposthumes, even without a Suspicion of +the Cause of their Death. I had an Instance of it some Days since, in +the School-master of a Village. He had an occult and very considerable +_Vomica_ in the left Lung, which was the Consequence of an Inflammation +of the Breast, that had been treated improperly at the Beginning. He +seemed to me not likely to live twenty four Hours; and really died in +the Night, after inexpressible Anguish. + +Sec. 68. Whatever Distemper is included within the Breast of a living +Patient, is neither an Object of the Sight or Touch whence these +_Vomicas_, these inward Tumours, are so often unknown, and indeed +unsuspected. The Evacuations that were necessary for the Cure, or +sometimes for the Prevention, of them, have not taken place, during the +first fourteen Days. At the End of this Term, the Patient, far from +being cured, is not very considerably relieved; but, on the contrary, +the Fever continues to be pretty high, with a Pulse continually quick; +in general soft and weak; though sometimes pretty hard, and often +fluctuating, or, as it were, waving. His Breathing is still difficult +and oppressed; with small cold Shudderings from Time to Time; an +Exasperation of the Fever; flushed Cheeks, dry Lips, and Thirst. + +The Increase of these Symptoms declare, that _Pus_ or Matter is +thoroughly formed: the Cough then becomes more continual; being +exasperated with the least Motion; or as soon as ever the Patient has +taken any Nourishment. He can repose only on the Side affected. It often +happens indeed, that he cannot lie down at all; but is obliged to be set +up all Day; sometimes even without daring to lean a little upon his +Loins, for fear of increasing the Cough and Oppression. He is unable to +sleep; has a continual Fever, and his Pulse frequently intermits. + +The Fever is not only heightened every Evening; but the smallest +Quantity of Food, the gentlest Motion, a little Coughing, the lightest +Agitation of the Mind, a little more than usual Heat in the Chamber, +Soup either a little too strong, or a little too salt, increase the +Quickness of his Pulse the Moment they occur, or are given. He is quite +restless, has some short Attacks of the most terrible Anguish, +accompanied and succeeded by Sweatings on his Breast, and from his whole +Countenance. He sweats sometimes the whole Night; his Urine is reddish, +now frothy, and at other times oily, as it were. Sudden Flushings, hot +as Flames, rise into his whole Visage. The greater Number of the Sick +are commonly sensible of a most disagreeable Taste in their Mouth; some +of old strong Cheese; others of rotten Eggs; and others again of +stinking Meat, and fall greatly away. The Thirst of some is +unquenchable; their Mouths and Lips are parched; their Voice weak and +hoarse; their Eyes hollow, with a kind of Wildness in their Looks. They +have a general Disgust to all Food; and if they should ask for some +particular Nourishment without seeing it, they reject it the Moment it +is brought them; and their Strength at length seems wholly exhausted. + +Besides these Symptoms, a little Inflation, or _Bloatedness_, as it +were, is sometimes observed on the Breast, towards the Side affected; +with an almost insensible Change of Colour. If the _Vomica_ be situated +at the Bottom of the affected Lobe of the Lungs, and in its internal +Part, that is, nearly in the Middle of the Breast, some _Puffiness_ or +light Swelling may be perceived in some Bodies, by gently pressing the +Pit of the Stomach; especially when the Patient coughs. In short, +according to the Observations of a German Physician, if one strike the +open Hand on the Breast, covered only with a Shirt, it retains in the +Spot, which is directly opposite to the _Vomica_, a flat heavy Sound, as +if one struck a Piece of Flesh; while in striking on the other Side it +gives a clear loud Sound, as from a Drum. I still doubt however, whether +this Observation will generally hold true; and it would be hazardous to +affirm there is no Abscess in a Breast, which does not return this heavy +Sound. + +Sec. 69. When a _Vomica_ is formed, as long as it is not emptied, all the +Symptoms I have already enumerated increase, and the _Vomica_ grows in +Size: the whole Side of the Lung affected sometimes becomes a Bag or Sac +of Matter. The sound Side is compressed; and the Patient dies after +dreadful Anguish, with the Lung full of _Pus_, and without having ever +brought up any. + +To avoid such fatal Consequences, it is necessary to procure the Rupture +and Discharge of this inward Abscess, as soon as we are certain of its +Existence: And as it is safer it should break within the Lobe affected, +from whence it may be discharged by hawking up; than that it should +burst and void itself into the Cavity of the Breast, for Reasons I shall +give hereafter, we must endeavour, that this Rupture may be effected +within the internal Substance of the Lungs. + +Sec. 70. The most effectual Methods to procure this are, 1. To make the +Patient continually receive, by his Mouth, the Vapour of warm Water. 2. +When by this Means that part of the Sac or Abscess is softened, where we +could wish the Rupture of it to happen, the Patient is to swallow a +large Quantity of the most emollient Liquid; such as Barley Water, +Almond Milk, light Veal Broth, or Milk and Water. By this Means the +Stomach is kept always full: so that the Resistance to the Lungs being +considerable on that Side, the Abscess and its Contents will naturally +be pressed towards the Side of the Wind-pipe, as it will meet with less +Resistance there. This fulness of the Stomach will also incline the +Patient to cough, which may concur to produce a good Event. Hence, 3, we +should endeavour to make the Patient cough, by making him smell to some +Vinegar, or even snuff up a little; or by injecting into his Throat, by +the Means of a small Syringe or Pipe, such as Children make out of short +Pieces of Elder-Boughs, a little Water or Vinegar. 4. He should be +advised to bawl out aloud, to read loud, or to laugh heartily; all which +Means contribute to burst open the Abscess, as well as those two +following ones. 5. Let him take every two Hours a Soup-Ladle of the +Potion No. 8. 6. He should be put into a Cart, or some other Carriage; +but not before he has drank plentifully of such Liquors as I have just +mentioned: after which the Shaking and Jolting in the Carriage have +sometimes immediately procured that Rupture, or breaking of the Bag or +Abscess, we wished for. + +Sec. 71. Some Years since I saw a Country Maid Servant, who was left in a +languishing Condition after an Inflammation of the Breast; without any +Person's suspecting her Ailment. This Woman being put into a Cart, that +was sent for a Load of Hay; one of the Wheels run violently against a +Tree: she swooned away, and at the same Time brought up a great Quantity +of digested Matter. She continued to bring up more; during which I was +informed of her Case, and of the Accident, which effectually cured her. + +A _Swiss_ Officer, who served in _Piedmont_, had been in a languid State +of Health for some Months; and returned home to set himself down as +easily as he could, without conceiving any considerable Hopes of +Recovery. Upon entering into his own Country, by the Way of _Mount +Bernard_; and being obliged to go some Paces on Foot, he fell down; and +remained in a Swoon above a Quarter of an Hour: during which Time he +threw up a large Quantity of Matter, and found himself that very Moment +very greatly relieved. I ordered him a proper Diet, and suitable +Medicines: his Health became perfectly established; and the Preservation +of his Life was principally owing to this lucky Fall. + +Many Persons afflicted with a _Vomica_, faint away the very Instant it +breaks. Some sharp Vinegar should be directly held to their Nose. This +small Assistance is generally sufficient, where the bursting of it is +not attended with such Appearances as shew it to be mortal, in which +Case every Application is insignificant. + +Sec. 72. If the sick Person was not extremely weak before the Bursting of +the Abscess; if the Matter was white, and well conditioned; if the Fever +abates after it; if the Anguish, Oppression and Sweats terminate; if the +Cough is less violent; if the Patient is sensibly easier in his +Situation or Posture; if he recovers his Sleep and Appetite; if his +usual Strength returns; if the Quantity he expectorates, or brings up, +becomes daily and gradually less; and if his Urine is apparently better, +we may have Room to hope, that by the Assistance of these Remedies I +shall immediately direct, he may be radically, compleatly cured. + +Sec. 73. But if on the contrary; when his Strength is exhausted before the +bursting of the Abscess; when the Matter is too thin and transparent, +brown, green, yellow, bloody and of an Offensive Smell; if the Pulse +continues quick and weak; if the Patient's Appetite, Strength and Sleep +do not improve, there remains no hope of a Cure, and the best Medicines +are ineffectual: Nevertheless we ought to make some Tryal of them. + +Sec. 74. They consist of the following Medicines and Regulations. 1. Give +every four Hours a little Barley or Rice Cream. 2. If the Matter brought +up is thick and glewy, so that it is very difficult to be loosened and +discharged, give every two Hours a Soup-ladle of the Potion No. 8; and +between the giving these two, let the Patient take every half Hour a Cup +of the Drink No. 13. 3. When the Consistence of the Matter is such, that +there is no Occasion for these Medicines to promote the Discharge of it, +they must be omitted; tho' the same Sort and Quantity of Food are to be +continued; but with the Addition of an equal Quantity of Milk; or, which +would be still more beneficial, instead of this Mixture, we should give +an equal Quantity of sweet Milk, taken from a good Cow, which, in such a +Case, may compose the whole Nourishment of the Patient. 4. He should +take four Times a Day, beginning early in the Morning, and at the +Distance of two Hours, a Dose of the Powder No. 14, diluted in a little +Water, or made into a _Bolus_, or Morsel, with a little Syrup or Honey. +His common Drink should be Almond Emulsion, commonly called Almond Milk, +or Barley Water, or fresh Water with a fourth part Milk. 5. He should +air and exercise every Day on Horseback, or in a Carriage, according as +his Strength and his Circumstances will allow him. But of all Sorts of +Exercise, that upon a trotting Horse is, beyond all Comparison, the very +best, and the easiest to be procured by every Body; provided the Disease +be not too far advanced; since in such a Situation, any Exercise, that +was only a little violent, might prove pernicious. + +Sec. 75. The Multitude, who are generally illiterate, seldom consider any +thing as a Remedy, except they swallow it. They have but little +Confidence in _Regimen_, or any Assistance in the Way of Diet, and +consider Riding on Horseback as wholly useless to them. This is a +dangerous Mistake, of which I should be glad to undeceive them: since +this Assistance, which appears so insignificant to them, is probably the +most effectual of any: it is that in Fact, without which they can +scarcely expect a Cure, in the highest Degrees of this Disease: it is +that, which perhaps alone may recover them, provided they take no +improper Food. In brief it is considered, and with Reason, as the real +Specific for this Disease. + +Sec. 76. The Influence of the Air is of more Importance in this Disorder, +than in any others; for which Reason great Care should be taken to +procure the best, in the Patient's Chamber. For this Purpose it should +often be ventilated, or have an Admission of fresh Air, and be sweetened +from Time to Time, tho' very lightly, with a little good Vinegar; and in +the Season it should be plentifully supplied with agreeable Herbs, +Flowers and Fruits. Should the Sick be unfortunately situated, and +confined in an unwholsome Air, there can be but little Prospect of +curing him, without altering it. + +Sec. 77. Out of many Persons affected with these Disorders, some have been +cured by taking nothing whatsoever but Butter-milk; others by Melons and +Cucumbers only; and others again by Summer Fruits of every Sort. +Nevertheless, as such Cases are singular, and have been but few, I +advise the Patient to observe the Method I have directed here, as the +surest. + +Sec. 78. It is sufficient if he have a Stool once in two, or even in three, +Days. Hence, there is no Reason for him, in this Case, to accustom +himself to Glysters: they might excite a Looseness, which may be very +dangerous. + +Sec. 79. When the Discharge of the Matter from the Breast diminishes, and +the Patient is perceivably mended in every Respect, it is a Proof that +the Wound in the Abscess is deterged, or clean, and that it is disposed +to heal up gradually. If the Suppuration, or Discharge, continues in +great Quantity; if it seems but of an indifferent Consistence; if the +Fever returns every Evening, it may be apprehended, that the Wound, +instead of healing, may degenerate into an Ulcer, which must prove a +most embarrassing Consequence. Under such a Circumstance, the Patient +would fall into a confirmed Hectic, and die after some Months Sickness. + +Sec. 80. I am not acquainted with any better Remedy, in such a dangerous +Case, than a Perseverance in these already directed, and especially in +moderate Exercise on Horseback. In some of them indeed Recourse may be +had to the sweet Vapours of some vulnerary Herbs in hot Water, with a +little Oil of Turpentine, as directed No. 15. I have seen them succeed; +but the safest Way is to consult a Physician, who may examine and +consider, if there is not some particular Circumstance combined with the +Disease, that proves an Obstacle to the Cure of it. If the Cough +prevents the Patient from Sleeping, he may take in the Evening two or +three Table Spoonfuls of the Prescription No. 16, in a Glass of Almond +Milk or Barley Water. + +Sec. 81. The very same Causes which suddenly suppress the Expectoration, in +an Inflammation of the Breast, may also check the Expectoration from a +_Vomica_ already begun: in which Circumstance the Patient is speedily +afflicted with an Oppression and Anguish, a Fever and evident +Feebleness. We should immediately endeavour to remove this Stoppage, by +the Vapour of hot Water; by giving a Spoonful of the Mixture No. 3 every +Hour; by a large Quantity of the Ptisan No. 12, and by a proper Degree +of Motion or Exercise. As soon as ever the Expectoration returns, the +Fever and the other Symptoms disappear. I have seen this Suppression in +strong Habits quickly followed with an Inflammation about the Seat of +the _Vomica_, which has obliged me to bleed, after which the +Expectoration immediately returned. + +Sec. 82. It happens sometimes, that the _Vomica_ is entirely cleansed; the +Expectoration is entirely finished, or drained off, the Patient seems +well, and thinks himself compleatly cured: but soon after, the +Uneasiness, Oppression, Cough and Fever are renewed, because the +Membrane or Bag of the _Vomica_ fills again: again it empties itself, +the Patient expectorates for some Days, and seems to recover. After some +Time however, the same Scene is repeated; and this Vicissitude, or +Succession, of moderate and of bad Health, often continues for some +Months and even some Years. This happens when the _Vomica_ is emptied, +and is gradually deterged; so that its Membranes, or Sides touch or +approach each other; but without cicatrizing or healing firmly; and then +there drops or leaks in very gradually fresh Matter. For a few Days this +seems no ways to incommode the Patient; but as soon as a certain +Quantity is accumulated, he is visited again with some of the former +Symptoms, 'till another Evacuation ensues. People thus circumstanced, in +this Disease, sometimes appear to enjoy a tolerable Share of Health. It +may be considered as a kind of internal Issue, which empties and +cleanses itself from Time to Time; pretty frequently in some +Constitutions, more slowly in others; and under which some may attain a +good middling Age. When it arrives however at a very considerable +Duration, it proves incurable. In its earliest State, it gives way +sometimes to a Milk-diet, to riding on Horseback; and to the Medicine +No. 14. + +Sec. 83. Some may be surprized, that in treating of an Abscess of the +Lungs, and of the Hectic, which is a Consequence of it, I say nothing of +those Remedies, commonly termed _Balsamics_, and so frequently employed +in them, for Instance, Turpentines, Balsam of Peru, of Mecca, +Frankincense, Mastich, Myrrh, Storax and Balsam of Sulphur. I shall +however say briefly here (because it is equally my Design to destroy the +Prejudice of the People, in favour of improper Medicines, and to +establish the Reputation of good ones) that I never in such Cases made +use of these Medicines; because I am convinced, that their Operation is +generally hurtful in such Cases; because I see them daily productive of +real Mischief; that they protract the Cure, and often change a slight +Disorder into an incurable Disease. They are incapable of perfect +Digestion, they obstruct the finest Vessels of the Lungs, whose +Obstructions we should endeavour to remove; and evidently occasion, +except their Dose be extremely small, Heat and Oppression. I have very +often seen to a Demonstration, that Pills compounded of Myrrh, +Turpentine and Balsam of Peru, have, an Hour after they were swallowed, +occasioned a Tumult and Agitation in the Pulse, high Flushings, Thirst +and Oppression. In short it is demonstrable to every unprejudiced +Person, that these Remedies, as they have been called, are truly +prejudicial in this Case; and I heartily wish People may be disabused +with Respect to them, and that they may lose that Reputation so +unhappily ascribed to them. + +I know that many Persons, very capable in other Respects, daily make use +of them in these Distempers: such however cannot fail of disusing them, +as soon as they shall have observed their Effects, abstracted from the +Virtues of the other Medicines to which they add them, and which +mitigate the Danger of them. I saw a Patient, whom a foreign Surgeon, +who lived at _Orbe_, attempted to cure of a Hectic with melted Bacon, +which aggravated the Disease. This Advice seemed, and certainly was, +absurd; nevertheless the Balsamics ordered in such Cases are probably +not more digestible than fat Bacon. The Powder No. 14 possesses whatever +these Balsamics pretend to: it is attended with none of the +Inconveniencies they produce; and has all the good Qualities ascribed to +them. Notwithstanding which, it must not be given while the Inflammation +exists; nor when it may revive again; and no other Aliment should be +mixed with the Milk. + +The famous Medicine called the _Antihectic_, (_Antihecticum Poterii_) +has not, any more than these Balsamics, the Virtues ascribed to it in +such Cases. I very often give it in some obstinate Coughs to Infants +with their Milk, and then it is very useful: but I have seldom seen it +attended with considerable Effects in grown Persons; and in the present +Cases I should be fearful of its doing Mischief. + +Sec. 84. If the _Vomica_, instead of breaking within the Substance of the +Lungs affected, should break without it, the Pus must be received into +the Cavity of the Breast. We know when that has happened, by the +Sensation or Feeling of the Patient; who perceives an uncommon, a +singular kind of Movement, pretty generally accompanied with a Fainting. +The Oppression and Anguish cease at once; the Fever abates; the Cough +however commonly continues, tho' with less Violence, and without any +Expectoration. But this seeming Amendment is of a short Duration, since +from the daily Augmentation of the Matter, and its becoming more acrid +or sharp, the Lungs become oppressed, irritated and eroded. The +Difficulty of Breathing, Heat, Thirst, Wakefulness, Distaste, and +Deafness, return, with many other Symptoms unnecessary to be enumerated, +and especially with frequent Sinkings and Weakness. The Patient should +be confined to his _Regimen_, to retard the Increase of the Disease as +much as possible; notwithstanding no other effectual Remedy remains, +except that of opening the Breast between two of the Ribs, to discharge +the Matter, and to stop the Disorder it occasions. This is called the +Operation for the _Empyema_. I shall not describe it here, as it should +not be undertaken but by Persons of Capacity and Experience, for whom +this Treatise was not intended. I would only observe, it is less painful +than terrifying; and that if it is delayed too long, it proves useless, +and the Patient dies miserably. + +Sec. 85. We may daily see external Inflammations turn gangrenous, or +mortify. The same Thing occurs in the Lungs, when the Fever is +excessive, the Inflammation either in its own Nature, extremely violent, +or raised to such a Height by hot Medicines. Intolerable Anguish, +extreme Weakness, frequent Faintings, Coldness of the Extremities, a +livid and foetid thin Humour brought up instead of concocted Spitting, +and sometimes blackish Stripes on the Breast, sufficiently distinguish +this miserable State. I have smelt in one Case of this Kind, where the +Patient had been attacked with this Disease (after a forced March on +Foot, having taken some Wine with Spices to force a Sweat) his Breath so +horribly stinking, that his Wife had many Sinkings from attending him. +When I saw him, I could discern neither Pulse nor Intellect, and ordered +him nothing. He died an Hour afterwards, about the Beginning of the +third Hour. + +Sec. 86. An Inflammation may also become hard, when it forms what we call a +_Scirrhus_, which is a very hard Tumour, indolent, or unpainful. This is +known to occur, when the disease has not terminated in any of those +Manners I have represented; and where, tho' the Fever and the other +Symptoms disappear, the Respiration, or Breathing, remains always a +little oppressed; the Patient still retains a troublesome Sensation in +one Side of his Breast; and has from Time to Time a dry Cough, which +increases after Exercise, and after eating. This Malady is but seldom +cured; though some Persons attacked with it last many Years, without any +other considerable Complaint. They should avoid all Occasions of +over-heating themselves; which might readily produce a new Inflammation +about this Tumour, the Consequences of which would be highly dangerous. + +Sec. 87. The best Remedies against this Disorder, and from which I have +seen some good Effects, are the medicated Whey No. 17, and the Pills No. +18. The Patient may take twenty Pills, and a Pint and a half of the Whey +every Morning for a long Continuance; and receive inwardly, now and +then, the Vapour of hot Water. + +Sec. 88. Each Lung, in a perfect State of Health, touches the _Pleura_, the +Membrane, that lines the Inside of the Breast; though it is not +connected to it. But it often happens, after an Inflammation of the +Breast, after the Pleurisy, and in some other Cases, that these two +Parts adhere closely to each other, and are never afterwards separated. +However this is scarcely to be considered as a Disease; and remains +commonly unknown, as the Health is not impaired by it, and nothing is +ever prescribed to remove it. Nevertheless I have seen a few Cases, in +which this Adhesion was manifestly prejudicial. + + + + + __Chapter V.__ + + + _Of the Pleurisy._ + + + __Sect.__ 89. + +The Pleurisy, which is chiefly known by these four Symptoms, a strong +Fever, a Difficulty of Breathing, a Cough, and an acute Pain about the +Breast; the Pleurisy, I say, is not a different Malady from the +Peripneumony, or Inflammation of the Breast, the Subject of the +preceding Chapter; so that I have very little to say of it, +particularly, or apart. + +Sec. 90. The Cause of this Disease then is exactly the same with that of +the former, that is, an Inflammation of the Lungs; but an Inflammation, +that seems rather a little more external. The only considerable +Difference in the Symptoms is, that the Pleurisy is accompanied with a +most acute Pain under the Ribs, and which is commonly termed a _Stitch_. +This Pain is felt indifferently over every Part of the Breast; though +more commonly about the Sides, under the more fleshy Parts of the +Breast, and oftenest on the right Side. The Pain is greatly increased +whenever the Patient coughs or draws in the Air in breathing; and hence +a Fear of increasing it, by making some Patients forbear to cough or +respire, as much as they possibly can; and that aggravates the Disease, +by stopping the Course of the Blood in the Lungs, which are soon +overcharged with it. Hence the Inflammation of this Bowel becomes +general; the Blood mounts up to the Head; the Countenance looks deeply +red, or as it were livid; the Patient becomes nearly suffocated, and +falls into the State described Sec. 47. + +Sometimes the Pain is so extremely violent, that if the Cough is very +urgent at the same Time, and the Sick cannot suppress or restrain it, +they are seized with Convulsions, of which I have seen many Instances, +but these occur almost always to Women; though they are much less +subject than Men to this Disease, and indeed to all inflammatory ones. +It may be proper however to observe here, that if Women should be +attacked with it, during their monthly Discharges, that Circumstance +should not prevent the repeated and necessary Bleedings, nor occasion +any Alteration in the Treatment of the Disease. And hence it appears, +that the Pleurisy is really an Inflammation of the Lungs, accompanied +with acute Pain. + +Sec. 91. I am sensible that sometimes an Inflammation of the Lungs is +communicated also to that Membrane, which lines the Inside of the +Breast; and which is called the _Pleura_; and from thence to the +Muscles, the fleshy Parts, over and between the Ribs. This however is +not very frequently the Case. + +Sec. 92. Spring is commonly the Season most productive of Pleurisies: in +general there are few in Summer: notwithstanding that in the Year 1762, +there were a great many during the hottest Season, which then was +excessively so. The Disease usually begins with a violent Shivering, +succeeded by considerable Heat, with a Cough, an Oppression, and +sometimes with a sensible Straitning, or Contraction, as it were, all +over the Breast; and also with a Head-ach, a Redness of the Cheeks, and +with Reachings to vomit. The Stitch does not always happen at the very +first Onset; often not 'till after several Hours from the first +Complaint; sometimes not before the second, or even the third Day. +Sometimes the Patient feels two Stitches, in different Parts of the +Side; though it seldom happens that they are equally sharp, and the +lightest soon ceases. Sometimes also the Stitch shifts its Place, which +promises well, if the Part first attacked by it continues perfectly free +from Pain: but it has a bad Appearance, if, while the first is present, +another also supervenes, and both continue. The Pulse is usually very +hard in this Distemper; but in the dreadful Cases described Sec. 47 and 90, +it becomes soft and small. There often occur at, or very quickly after, +the Invasion, such an Expectoration, or hawking up, as happens in an +Inflammation of the Breast; at other Times there is not the least +Appearance of it, whence such are named dry Pleurisies, which happen +pretty often. Sometimes the Sick cough but little, or not at all. They +often lie more at Ease upon the Side affected, than on the sound one. +The Progress of this Disease advances exactly like that described in the +preceding Chapter: for how can they differ considerably? and the +Treatment of both is the same. Large Haemorrhages, or Bleedings from the +Nose, frequently happen, to the great Relief of the Patient; but +sometimes such Discharges consist of a kind of corrupted Blood, when the +Patient is very ill, and these portend Death. + +Sec. 93. This Distemper is often produced by drinking cold Water, while a +Person is hot; from which Cause it is sometimes so violent, as to kill +the Patient in three Hours. A young Man was found dead at the Side of +the Spring, from which he had quenched his Thirst: neither indeed is it +uncommon for Pleurisies to prove mortal within three Days. + +Sometimes the Stitch disappears, whence the Patient complains less; but +at the same Time his Countenance changes; he grows pale and sad; his +Eyes look dull and heavy, and his Pulse grows feeble. This signifies a +Translation of the Disease to the Brain, a Case which is almost +constantly fatal. + +There is no Disease in which the critical Symptoms are more violent, and +more strongly marked, than in this. It is proper this should be known, +as it may prevent or lessen our excessive Terror. A perfect Cure +supervenes sometimes, at the very Moment when Death was expected. + +Sec. 94. This Malady is one of the most common and the most destroying +kind, as well from its own violent Nature, as through the pernicious +Treatment of it in Country Places. That Prejudice, which insists on +curing all Diseases by Sweating, entirely regulates their Conduct in +treating a Pleurisy; and as soon as a Person is afflicted with a Stitch, +all the hot Medicines are immediately set to Work. This mortal Error +destroys more People than Gunpowder; and it is by so much the more +hurtful, as the Distemper is of the most violent kind; and because, as +there is commonly not a Moment to be lost, the whole depends on the +Method immediately recurred to. + +Sec. 95. The proper Manner of treating this Disease, is exactly the same in +all Respects, with that of the Peripneumony; because, I again affirm, it +is the very same Disease. Hence the Bleedings, the softening and +diluting Drinks, the Steams, the Glysters, the Potion No. 8, and the +emollient Poultices are the real Remedies. These last perhaps are still +more effectual in the Pleurisy; and therefore they should be continually +applied over the very Stitch. + +The first Bleeding, especially if there has been a considerable +Discharge, almost constantly abates the Stitch, and often entirely +removes it: though it more commonly returns, after an Intermission of +some Hours, either in the same Spot, or sometimes in another. This +shifting of it is rather favourable, especially if the Pain, that was +first felt under the Breast, shifts into the Shoulders, to the Back, the +Shoulder-blade, or the Nape of the Neck. + +When the Stitch is not at all abated, or only a little; or if, after +having abated, it returns as violently as at first, and especially if it +returns in the same Spot, and the Height of the other Symptoms continue, +Bleeding must be repeated. But if a sensible Abatement of the Stitch +continues; and if, though it returns, it should be in a smaller Degree, +and by Intervals, or in these Places I have mentioned above; if the +Quickness, or the Hardness of the Pulse, and all the other Symptoms are +sensibly diminished, this repeated Bleeding may sometimes be omitted. +Nevertheless, in a very strong Subject, it seems rather prudent not to +omit it, since in such Circumstances it can do no Mischief; and a +considerable Hazard may sometimes be incurred by the Omission. In very +high and dangerous Pleurisies a frequent Repetition of bleeding is +necessary; except some Impediment to it should arise from the particular +Constitution of the Patient, or from his Age, or some other +Circumstances. + +If, from the Beginning of the Disease, the Pulse is but a little quicker +and harder than in a healthy State; if it is not manifestly strong; if +the Head-ach and the Stitch are so moderate as to prove supportable; if +the Cough is not too violent; if there is no sensible Oppression or +Straitness, and the Patient expectorate, or cough up, Bleeding may be +omitted. + +With Respect to the administering of other Remedies, the same Directions +are to be exactly followed, which have been already given in the +preceding Chapter, to which the Reader is referred from Sec. 53 to 66. + +Sec. 96. When the Disease is not very acute and pressing, I have often +cured it in a very few Days by a single Bleeding, and a large Quantity +of a Tea or Infusion of Elder-flowers, sweetened with Honey. It is in +some Cases of this kind, that we often find the Water _Faltranc_ +succeed, with the Addition of some Honey, and even of Oil: though the +Drink I have just directed is considerably preferable. That Drink which +is compounded of equal Quantities of Wine and Water, with the Addition +of much Venice Treacle, annually destroys a great Number of People in +the Country. + +Sec. 97. In those dry Pleurisies, in which the Stitch, the Fever, and the +Head-ach are strong and violent; and where the Pulse is very hard and +very full, with an excessive Dryness of the Skin and of the Tongue, +Bleeding should be frequently repeated, and at small Intervals from each +other. This Method frequently cures the Disease effectually, without +using any other Evacuation. + +Sec. 98. The Pleurisy terminates, like any other inward Inflammation, +either by some Evacuation; by an Abscess; in a Mortification; or in a +Scirrhosity or hard Tumour; and it often leaves Adhesions in the Breast. + +The Gangrene or Mortification sometimes appears on the third Day, +without having been preceded by very vehement Pains. In such Cases the +dead Body often looks very black, especially in the Parts near the Seat +of the Disease: and in such the more superstitious ascribe it to some +supernatural Cause; or draw some unhappy Presage from it, with Respect +to those who are yet unattacked by it. This Appearance however is purely +a natural Consequence, quite simple, and cannot be otherwise; and the +hot Regimen and Medicines are the most prevailing Causes of it. I have +seen it thus circumstanced in a Man in the Flower of his Age, who had +taken Venice Treacle in Cherry Water, and the Ingredients of _Faltranc_ +infused in Wine. + +Sec. 99. _Vomicas_ are sometimes the Consequences of Pleurisies; but their +particular Situation disposes them more to break [22] outwardly; which +is the most frequent Cause of an _Empyema_ Sec. 84. "To prevent this, it is +highly proper to apply, at the first Invasion of the Disease, to the +Spot where the Pain chiefly rages, a small Plaister, which may exactly +fit it; since if the Pleurisy should terminate in an Abscess or +Imposthume, the purulent Matter will be determined to that Side. + +[22] That is, into the Cavity of the Breast, rather than within the + Substance of the Lungs. + +"As soon then as it is foreseen that an Abscess is forming (see Sec. 68) we +should erode, by a light Caustic, the Place where it is expected; and as +soon as it is removed, Care should be taken to promote Suppuration +there. By this Means we may entertain a reasonable Hope, that the Mass +of Matter will incline its Course to that Spot, where it will meet with +the least Resistance, and be discharged from thence. For this Heap of +Matter is often accumulated between the _Pleura_, and the Parts which +adhere to it." + +This is the Advice of a very [23] great Physician; but I must inform the +Reader, there are many Cases, in which it can be of no Service; neither +ought it to be attempted, but by Persons of undoubted Abilities. + +[23] This is, undoubtedly, Baron _Van Swieten_, with whom he had + premised, he agreed considerably, in all the Diseases they had both + treated of. _K._ + +With Regard to the Scirrhosity, or Hardness, and to the Circumstances of +Adhesions, I can add nothing to what I have said in Sec. 86 and 87. + +Sec. 100. It has been observed that some Persons, who have been once +attacked by this Disease, are often liable to Relapses of it, especially +such as drink hard. I knew one Man, who reckoned up his Pleurisies by +Dozens. A few Bleedings, at certain proper Intervals, might prevent +these frequent Returns of it; which, joined to their excessive Drinking, +make them languid and stupid, in the very Flower of their Age. They +generally fall into some Species of an Asthma, and from that into a +Dropsy, which proves the melancholy, though not an improper, Conclusion +of their Lives. Such as can confine themselves to some proper +Precautions, may also prevent these frequent Returns of this Disease, +even without bleeding; by a temperate Regimen; by abstaining from Time +to Time, from eating Flesh and drinking Wine; at which Times they should +drink Whey, or some of those Diet-Drinks No. 1, 2, 4; and by bathing +their Legs sometimes in warm Water; especially in those Seasons, when +this Disease is the most likely to return. + +Sec. 101. Two Medicines greatly esteemed in this Disease among the +Peasantry, and even extolled by some Physicians, are the Blood of a wild +He Goat, and the [24] Soot in an Egg. I do not contest the Cure or +Recovery of many Persons, who have taken these Remedies; notwithstanding +it is not less true, that both of them, as well as the Egg in which the +Soot is taken, are dangerous: For which Reason it is prudent, at least, +never to make use of them; as there is great Probability, they may do a +little Mischief; and a Certainty that they can do no Good. The _Genipi_, +or [25] Wormwood of the Alps, has also acquired great Reputation in this +Disease, and occasioned many Disputes between some very zealous +Ecclesiastics, and a justly celebrated Physician. It seems not difficult +however to ascertain the proper Use of it. This Plant is a powerful +Bitter; it heats and excites Sweat: it seems clear, that, from such +Consequences, it should never be employed in a Pleurisy, while the +Vessels are full, the Pulse hard, the Fever high, and the Blood +inflamed. In all such Circumstances it must aggravate the Disease; but +towards the Conclusion of it, when the Vessels are considerably emptied, +the Blood is diluted, and the Fever abated, it may then be recurred to; +but with a constant Recollection that it is hot, and not to be employed +without Reflection and Prudence. [26] + +[24] This, with great Probability, means that small black Substance + often visible in a rotten Egg, which is undoubtedly of a violent, + or even poisonous Quality. Dr. _Tissot_ terms it expressly--_la + suie dans un Oeuf_. K. + +[25] Dr. _Lewis_, who has not taken Notice of this Species of Wormwood + in his Improvement of _Quincy's_ Dispensatory, has mentioned it in + his late _Materia Medica_. K. + +[26] This being a proper Place for directing the Seneka Rattle Snake + Root, I shall observe, that the best Way of exhibiting it is in + Decoction, by gradually simmering and boiling two Ounces of it in + gross Powder, in two Pints and a half of Water, to a Pint and a + quarter; and then giving three Spoonfuls of it to a grown Person, + every six Hours. If the Stitch should continue, or return, after + taking it, Bleeding, which should be premised to it, must be + occasionally repeated; though it seldom proves necessary, after a + few Doses of it. It greatly promotes Expectoration, keeps the Body + gently open, and sometimes operates by Urine and by Sweat; very + seldom proving at all emetic in Decoction. The Regimen of Drinks + directed here in Pleurisies are to be given as usual. Dr. + _Tennant_, the Introducer of this valuable Medicine, confided + solely in it, in Bastard Peripneumonies, without Bleeding, + Blistering, or any other Medicines. _K._ + + + + + __Chapter VI.__ + + + _Of the Diseases of the Throat._ + + + __Sect.__ 102. + +The Throat is subject to many Diseases: One of the most frequent and the +most dangerous, is that Inflammation of it, commonly termed a Quinsey. +This in Effect is a Distemper of the same Nature with an Inflammation of +the Breast; but as it occurs in a different Part, the Symptoms, of +Course, are very different. They also vary, not a very little, according +to the different Parts of the Throat which are inflamed. + +Sec. 103. The general Symptoms of an Inflammation of the Throat are, the +Shivering, the subsequent Heat, the Fever, the Head-ach, red +high-coloured Urine, a considerable Difficulty, and sometimes even an +Impossibility, of swallowing any thing whatever. But if the nearer Parts +to the _Glottis_, that is, of the Entrance into the Windpipe, or Conduit +through which we breathe, are attacked, Breathing becomes excessively +difficult; the Patient is sensible of extreme Anguish, and great +Approaches to Suffocation; the Disease is then extended to the +_Glottis_, to the Body of the Wind-pipe, and even to the Substance of +the Lungs, whence it becomes speedily fatal. + +The Inflammation of the other Parts is attended with less Danger; and +this Danger becomes still less, as the Disease is more extended to the +outward and superficial Parts. When the Inflammation is general, and +seizes all the internal Parts of the Throat, and particularly the +Tonsils or Almonds, as they are called, the _Uvula_, or Process of the +Palate, and the _Basis_, or remotest deepest Part of the Tongue, it is +one of the most dangerous and dreadful Maladies. The Face is then +swelled up and inflamed; the whole Inside of the Throat is in the same +Condition; the Patient can get nothing down; he breathes with a Pain and +Anguish, which concur, with a Stuffing or Obstruction in his Brains, to +throw him into a kind of furious _Delirium_, or Raving. His Tongue is +bloated up, and is extended out of his Mouth; his Nostrils are dilated, +as tho' it were to assist him in his Breathing; the whole Neck, even to +the Beginning of the Breast, is excessively tumified or swelled up; the +Pulse is very quick, very weak, and often intermits; the miserable +Patient is deprived of all his Strength, and commonly dies the second or +third Day. Very fortunately this Kind, or Degree of it, which I have +often seen in _Languedoc_, happens very rarely in _Swisserland_, where +the Disease is less violent; and where I have only seen People die of +it, in Consequence of its being perniciously treated; or by Reason of +some accidental Circumstances, which were foreign to the Disease itself. +Of the Multitude of Patients I have attended in this Disorder, I have +known but one to fail under it, whose Case I shall mention towards the +Close of this Chapter. + +Sec. 104. Sometimes the Disease shifts from the internal to the external +Parts: the Skin of the Neck and Breast grows very red, and becomes +painful, but the Patient finds himself better. + +At other Times the Disorder quits the Throat; but is transferred to the +Brain, or upon the Lungs. Both these Translations of it are mortal, when +the best Advice and Assistance cannot be immediately procured; and it +must be acknowledged, that even the best are often ineffectual. + +Sec. 105. The most usual kind of this Disease is that which affects only +the Tonsils (the Almonds) and the Palate; or rather its Process, +_commonly called_ the Palate. It generally first invades one of the +Tonsils, which becomes enlarged, red and painful, and does not allow the +afflicted to swallow, but with great Pain. Sometimes the Disorder is +confined to one Side; but most commonly it is extended to the _Uvula_, +(the Palate) from whence it is extended to the other Tonsil. If it be of +a mild kind, the Tonsil first affected is generally better, when the +second is attacked. Whenever they are both affected at once, the Pain +and the Anguish of the Patient are very considerable; he cannot swallow, +but with great Difficulty and Complaint; and the Torment of this is so +vehement, that I have seen Women affected with Convulsions, as often as +they endeavoured to swallow their Spittle, or any other Liquid. They +continue, even for several Hours sometimes, unable to take any thing +whatever; all the upper inward Part of the Mouth, the Bottom of the +Palate, and the descending Part of the Tongue become lightly red, or +inflamed. + +A considerable Proportion of Persons under this Disease swallow Liquids +more difficultly than Solids; by Reason that Liquids require a greater +Action of some Part of the Muscles, in order to their being properly +directed into their Conduit or Chanel. The Deglutition (the Swallowing) +of the Spittle is attended with still more Uneasiness than that of other +Liquids, because it is a little more thick and viscid, and flows down +with less Ease. This Difficulty of swallowing, joined to the Quantity +thence accumulated, produces that almost continual hawking up, which +oppresses some Patients so much the more, as the Inside of their Cheeks, +their whole Tongue, and their Lips are often galled, and even flead as +it were. This also prevents their Sleeping, which however seems no +considerable Evil; Sleep being _sometimes_ but of little Service in +Diseases attended with a Fever; and I have often seen those, who thought +their Throats almost entirely well in the Evening, and yet found them +very bad after some Hours Sleep. + +The Fever, in this Species of the Disease, is sometimes, very high; and +the Shivering often endures for many Hours. It is succeeded by +considerable Heat, and a violent Head-ach, which yet is sometimes +attended with a Drowsiness. The Fever is commonly pretty high in the +Evening, though sometimes but inconsiderable, and by the Morning perhaps +there is none at all. + +A light Invasion of this Disease of the Throat often precedes the +Shivering; though most commonly it does not become manifest 'till after +it, and at the same Time when the Heat comes on. + +The Neck is sometimes a little inflated, or puffed up; and many of the +Sick complain of a pretty smart Pain in the Ear of that Side, which is +most affected. I have but very seldom observed that they had it in both. + +Sec. 106. The Inflammation either disappears by Degrees, or an Abscess is +formed in the Part which was chiefly affected. It has never happened, at +least within my Knowledge, that this Sort of the Disease, prudently +treated, has ever terminated either in a Mortification, or a Scirrhus: +but I have been a Witness to either of these supervening, when Sweating +was extorted in the Beginning of it, by hot Medicines. + +It is also very rare to meet with those highly dangerous Translations of +this Disease upon the Lungs, such as are described in that Species of it +from Sec. 103, 104. It is true indeed it does not occur more frequently, +even in that Species, whenever the Disease is thrown out upon the more +external Parts. + +Sec. 107. The Treatment of the Quinsey, as well as of all other +inflammatory Diseases, is the same with that of an Inflammation of the +Breast. + +The Sick is immediately to be put upon a Regimen; and in that Sort +described Sec. 103, Bleeding must be repeated four or five Times within a +few Hours; and sometimes there is a Necessity to recur still oftner to +it. When it assaults the Patient in the most vehement Degree, all +Medicines, all Means, are very generally ineffectual; they should be +tried however. We should give as much as can be taken of the Drinks No. +2 and 4. But as the Quantity they are able to swallow is often very +inconsiderable; the Glyster No. 5 should be repeated every three Hours; +and their Legs should be put into a Bath of warm Water, thrice a Day. + +Sec. 108. Cupping Glasses, with Scarification, applied about the Neck, +after bleeding twice or thrice, have often been experienced to be highly +useful. In the most desperate Cases, when the Neck is excessively +swelled, one or two deep Incisions made with a Razor, on this external +Tumour, have sometimes saved a Patient's Life. + +Sec. 109. In that kind, and those Circumstances, of this Disease described +Sec. 105 we must have very frequent Recourse to Bleeding; and it should +never be omitted, when the Pulse is very perceivably hard and full. It +is of the utmost Consequence to do it instantaneously; since it is the +only Means to prevent the Abscess, which forms very readily, if Bleeding +has been neglected, only for a few Hours. Sometimes it is necessary to +repeat it a second Time, but very rarely a third. + +This Disease is frequently so gentle and mild, as to be cured without +Bleeding, by the Means of much good Management. But as many as are not +Masters of their own Time, nor in such an easy Situation, as to be +properly attended, ought, without the least Hesitation, to be bled +directly, which is sometimes sufficient to remove the Complaint; +especially if, after Bleeding, the Patient drinks plentifully of the +Ptisan No. 2. + +In this light Degree of the Disease, it may suffice to bathe the Legs, +and to receive a Glyster, once a Day each; the first to be used in the +Morning, and the last in the Evening. Besides the general Remedies +against Inflammations, a few particular ones, calculated precisely for +this Disease, may be applied in each kind or Degree of it. The best are, +first the emollient Poultices, No. 9, laid over the whole Neck. [27] +Some have highly extolled the Application of Swallows Nests in this +Disease; and though I make no Objection to it, I think it certainly less +efficacious than any of those which I direct. + +[27] The _English_ avail themselves considerably, in this Disease, of a + Mixture of equal Parts of Sallad Oil, and Spirit of Sal Ammoniac; + or of Oil and Spirit of Hartshorn, as a Liniment and Application + round the Neck. This Remedy corresponds with many Indications; and + deserves, perhaps, the first Place amongst local Applications + against the inflammatory Quinsey. _E. L._ + +2. Of the Gargarisms (No. 19) a great Variety may be prepared, of pretty +much the same Properties, and of equal Efficacy. Those I direct here are +what have succeeded best with me and they are very simple. [28] + +[28] Dr. _Pringle_ is apprehensive of some ill Effects from Acids in + Gargarisms [_which is probably from their supposed repelling + Property_] and prefers a Decoction of Figs in Milk and Water, to + which he adds a small Quantity of Spirit of Sal Ammoniac. _E. L._ + +3. The Steam of hot Water, as directed Sec. 55, should be repeated five or +six Times a Day; a Poultice should be constantly kept on, and often +renewed; and the Patient should often gargle. + +There are some Persons, besides Children, who cannot gargle themselves: +and in fact the Pain occasioned by it makes it the more difficult. In +such a Case, instead of gargling, the same Gargarism (No. 19) may be +injected with a small Syringe. The Injection reaches further than +Gargling, and often causes the Patient to hawk up a considerable +Quantity of glarey Matter (which has grown still thicker towards the +Bottom of the Throat) to his sensible Relief. This Injection should be +often repeated. The little hollowed Pipes of Elder Wood, which all the +Children in the Country can make, may be conveniently employed for this +Purpose. The Patient should breathe out, rather than inspire, during the +Injection. + +Sec. 110. Whenever the Disease terminates without Suppuration, the Fever, +the Head-ach, the Heat in the Throat, and the Pain in swallowing, begin +to abate from the fourth Day, some times from the third, often only from +the fifth; and from such Period that Abatement increases at a great +Rate; so that at the End of two, three, or four Days, on the sixth, +seventh, or eighth, the Patient is entirely well. Some few however +continue to feel a light Degree of Pain, and that only on one Side, four +or five Days longer, but without a Fever, or any considerable +Uneasiness. + +Sec. 111. Sometimes the Fever and the other Symptoms abate, after the +Bleeding and other Remedies; without any subsequent Amendment in the +Throat, or any Signs of Suppuration. In such Cases we must chiefly +persist in the Gargarisms and the Steams; and where an experienced and +dexterous Surgeon can be procured, it were proper he should scarify the +inflamed Tonsils. These discharge, in such Cases, a moderate Quantity of +Blood; and this Evacuation relieves, very readily, as many as make use +of it. + +Sec. 112. If the Inflammation is no ways disposed to disperse, so that an +Abscess is forming, which almost ever happens, if it has not been +obviated at the Invasion of the Disease; then the Symptoms attending the +Fever continue, though raging a little less after the fourth Day: the +Throat continues red, but of a less florid and lively Redness: a Pain +also continues, though less acute, accompanied sometimes with +Pulsations, and at other Times intirely without any; of which it is +proper to take Notice: the Pulse commonly grows a little softer; and on +the fifth or sixth Day, and sometimes sooner, the Abscess is ready to +break. This may be discovered by the Appearance of a small white and +soft Tumour, when the Mouth is open, which commonly appears about the +Centre or Middle of the Inflammation. It bursts of itself; or, should it +not, it must be opened. This is effected by strongly securing a Lancet +to one End of a small Stick or Handle, and enveloping, or wrapping up +the whole Blade of it, except the Point and the Length of one fourth or +a third of an Inch, in some Folds of soft Linnen; after which the +Abscess is pierced with the Point of this Lancet. The Instant it is +opened, the Mouth is filled with the Discharge of a Quantity of _Pus_, +of the most intolerable Savour and Smell. The Patient should gargle +himself after the Discharge of it with the detersive, or cleansing +Gargarism No. 19. It is surprising sometimes to see the Quantity of +Matter discharged from this Imposthumation. In general there is but one; +though sometimes I have seen two of them. + +Sec. 113. It happens, and not seldom, that the Matter is not collected +exactly in the Place, where the Inflammation appeared, but in some less +exposed and less visible Place: whence a Facility of swallowing is +almost entirely restored; the Fever abates; the Patient sleeps; he +imagines he is cured, and that no Inconvenience remains, but such as +ordinarily occurs in the earliest Stage of Recovery. A Person who is +neither a Physician, nor a Surgeon, may easily deceive himself, when in +this State. But the following Signs may enable him to discover that +there is an Abscess, viz. A certain Inquietude and general Uneasiness; a +Pain throughout the Mouth; some Shiverings from Time to Time; frequently +sharp, but short and transient, Heat: a Pulse moderately soft, but not +in a natural State; a Sensation of Thickness and Heaviness in the +Tongue; small white Eruptions on the Gums, on the Inside of the Cheek, +on the Inside and Outside of the Lips, and a disagreeable Taste and +Odour. + +Sec. 114. In such Cases Milk or warm Water should frequently be retained in +the Mouth; the Vapour of hot Water should be conveyed into it; and +emollient Cataplasms may be applied about the Neck. All these Means +concur to the softening and breaking of the Abscess. The Finger may also +be introduced to feel for its Situation; and when discovered, the +Surgeon may easily open it. I happened once to break one under my +Finger, without having made the least Effort to do it. Warm Water may be +injected pretty forcibly, either by the Mouth or the Nostrils: this +sometimes occasions a kind of Cough, or certain Efforts which tend to +break it. I have seen this happen even from laughing. As to the rest, +the Patient should not be too anxious or uneasy about the Event. I never +saw a single Instance of a Person's dying of a Quinsey of this kind, +after the Suppuration is truly effected; neither has it happened perhaps +after the Time it is forming for Suppuration. + +Sec. 115. The glairy Matter with which the Throat is over-charged, and the +very Inflammation of that Part, which, from its Irritation, produces the +same Effect, as the Introduction of a Finger into it, occasions some +Patients to complain of incessant Propensities to vomit. We must be upon +our Guard here, and not suppose that this Heart-Sickness, as some have +called it, results from a Disorder of, or a Load within, the Stomach, +and that it requires a Vomit for its Removal. The giving one here would +often prove a very unfortunate Mistake. It might, in a high +Inflammation, further aggravate it; or we might be obliged (even during +the Operation of the Vomit) to bleed, in order to lessen the Violence of +the Inflammation. Such Imprudence with its bad Consequences, often +leaves the Patient, even after the Disease is cured, in a State of +Languor and Weakness for a considerable Time. Nevertheless, there are +some particular Disorders of the Throat, attended with a Fever, in which +a Vomit may be prudently given. But this can only be, when there is no +Inflammation, or after it is dispersed; and there still remains some +putrid Matter in the first Passages. Of such Cases I shall speak +hereafter. [29] + +[29] In Diseases of the Throat, which have been preceded by such + Excesses in Food or strong Drink, as occur too often in many + Countries, when the Patient has very strong Reachings to vomit, and + the Tongue is moist at the same Time; we should not hesitate, after + appeasing the first Symptoms of the Inflammation [by sufficient + Bleedings, &c.] to assist the Efforts of Nature, and to give a + small Dose of Tartar emetic, dissolved in some Spoonfuls of Water. + This Remedy in this Case, promotes the Dispersion of the + Inflammation, beyond any other. _E. L._ + +Sec. 116. We often see in _Swisserland_ a Disorder different from these of +the Throat, of which we have just treated; though, like these, attended +with a Difficulty of swallowing. It is termed in French the _Oreillons_, +and often the _Ourles_, or swelled Ears. It is an Overfulness and +Obstruction of those Glands and their Tubes, which are to furnish the +_Saliva_ or Spittle; and particularly of the two large Glands which lie +between the Ear and the Jaw; which are called the _Parotides_; and of +two under the Jaw, called the _Maxillares_. All these being considerably +swelled in this Disease, do not only produce a great Difficulty of +swallowing; but also prevent the Mouth from opening; as an Attempt to do +it is attended with violent Pain. Young Children are much more liable to +this Disease than grown Persons. Being seldom attended with a Fever, +there is no Occasion for Medicines: It is sufficient to defend the Parts +affected from the external Air; to apply some proper Poultice over them; +to lessen the Quantity of their Food considerably, denying them Flesh +and Wine; but indulging them plentifully in some light warm Liquid, to +dilute their Humours and restore Perspiration. I cured myself of this +Disorder in 1754, by drinking nothing, for four Days, but Balm Tea, to +which I added one fourth part Milk, and a little Bread. The same +_Regimen_ has often cured me of other light Complaints of the Throat. + +Sec. 117. In the Spring of 1761, there were an astonishing Number of +Persons attacked with Disorders of the Throat, of two different Kinds. +Some of them were seized with that common Sort which I have already +described. Without adding any thing more particularly, in Respect to +this Species, it happened frequently to grown Persons, who were +perfectly cured by the Method already recited. The other Species, on +which I shall be more particular in this Place (because I know they have +abounded in some Villages, and were very fatal) invaded Adults, or grown +Persons also, but especially Children, from the Age of one Year, and +even under that, to the Age of twelve or thirteen. + +The first Symptoms were the same with those of the common Quinsey, such +as the Shivering, the ensuing Heat or Fever, Dejection, and a Complaint +of the Throat: but the following Symptoms distinguished these from the +common inflammatory Quinseys. + +1. The Sick had often something of a Cough, and a little Oppression. + +2. The Pulse was quicker, but less hard, and less strong, than generally +happens in Diseases of the Throat. + +3. The Patients were afflicted with a sharp, stinging and dry Heat, and +with great Restlessness. + +4. They spat less than is usual in a common Quinsey; and their Tongues +were extremely dry. + +5. Though they had some Pain in swallowing, this was not their principal +Complaint, and they could drink sufficiently. + +6. The Swelling and Redness of the Tonsils, of the Palate, and of its +Process were not considerable; but the parotid and maxillary Glands, and +especially the former, being extremely swelled and inflamed, the Pain +they chiefly complained of, was this outward one. + +7. When the Disease proved considerably dangerous, the whole Neck +swelled; and sometimes even the Veins, which return the Blood from the +Brain, being overladen, as it were, the Sick had some Degree of +Drowsiness, and of a _Delirium_, or Raving. + +8. The Paroxysms, or Returns, of the Fever were considerably irregular. + +9. The Urine appeared to be less inflamed, than in other Diseases of the +Throat. + +10. Bleeding and other Medicines did not relieve them, as soon as in the +other kind; and the Disease itself continued a longer Time. + +11. It did not terminate in a Suppuration like other Quinsies, but +sometimes the Tonsils were ulcerated. + +12. [30] Almost every Child, and indeed a great many of the grown +Persons assaulted with this Disease, threw out, either on the first Day, +or on some succeeding one, within the first six Days, a certain +Efflorescence, or Eruptions, resembling the Measles considerably in +some, but of a less lively Colour, and without any Elevation, or rising +above the Skin. It appeared first in the Face, next in the Arms, and +descended to the Legs, Thighs and Trunk; disappearing gradually at the +End of two or three Days, in the same Order it had observed in breaking +out. A few others (I have seen but five Instances of it) suffered the +most grievous Symptoms before the Eruption; and threw out the genuine +_purpura_, or white miliary Eruption. + +[30] This seems to have been the same kind of Quinsey, of which Drs. + _Huxham_, _Fothergil_, _Cotton_ and others wrote, though under + different Appellations. _K._ + +13. As soon as these Efflorescences or Eruptions appeared, the Sick +generally found themselves better. That, last mentioned, continued four, +five, or six Days, and frequently went off by Sweats. Such as had not +these Ebullitions, which was the Case of many Adults, were not cured +without very plentiful Sweats towards the Termination of the Disease: +those which occurred at the Invasion of it being certainly unprofitable, +and always hurtful. + +14. I have seen some Patients, in whom the Complaint of the Throat +disappeared entirely, without either Eruptions or Sweats: but such still +remained in very great Inquietude and Anguish, with a quick and small +Pulse. I ordered them a sudorific Drink, which being succeeded by the +Eruption, or by Sweating, they found themselves sensibly relieved. + +15. But whether the Sick had, or had not, these external Rednesses or +Eruptions, every one of them parted with their Cuticle or Scarf Skin, +which fell off, in large Scales, from the whole Surface of the Body: so +great was the Acrimony or Sharpness of that Matter, which was to be +discharged through the Skin. + +16. A great Number suffered a singular Alteration in their Voice, +different from that which occurs in common Quinsies, the Inside of their +Nostrils being extremely dry. + +17. The Sick recovered with more Difficulty after this, than after the +common Quinsies: and if they were negligent or irregular, during their +Recovery; particularly, if they exposed themselves too soon to the Cold, +a Relapse ensued, or some different Symptoms; such as a Stuffing with +Oppression, a Swelling of the Belly, windy Swellings in different Parts; +Weakness, Loathings, Ulcerations behind the Ears, and something of a +Cough and Hoarseness. + +18. I have been sent for to Children, and also to some young Folks, who, +at the End of several Weeks, had been taken with a general Inflammation +of the whole Body, attended with great Oppression, and a considerable +Abatement of their Urine, which was also high-coloured and turbid, or +without Separation. They seemed also in a very singular State of +Indifference, or Disregard, with Respect to any Object, or Circumstance. +I recovered every one of them entirely by Blisters, and the Powder No. +25. The first Operation of this Medicine was to vomit them: to this +succeeded a Discharge by Urine, and at last very plentiful Sweating, +which compleated the Cure. Two Patients only, of a bad Constitution, who +were a little ricketty, and disposed to glandular Scirrhosity or +Knottiness, relapsed and died, after being recovered of the Disease +itself for some Days. + +Sec. 118. I have bled some adult Persons, and made Use of the cooling +Regimen, as long as there was an evident Inflammation: it was necessary +after this to unload the first Passages; and at last to excite moderate +Sweats. The same Powders No. 25 have often effected both these +Discharges, and with entire Success. In other Cases I have made Use of +Ipecacuanha, as directed No. 35. + +In some Subjects there did not appear any inflammatory Symptom; and the +Distemper resulted solely from a Load of putrid Matter in the first +Passages. Some Patients also discharged Worms. In such Cases I never +bled; but the Vomit had an excellent Effect, at the very Onset of the +Disease; it produced a perceivable Abatement of all the Symptoms; +Sweating ensued very kindly and naturally, and the Patient recovered +entirely a few Hours after. + +Sec. 119. There were some Places, in which no Symptom or Character of +Inflammation appeared; and in which it was necessary to omit Bleeding, +which was attended with bad Consequences. + +I never directed Infants to be bled. After opening the first Passages, +Blisters and diluting Drinks proved their only Remedies. A simple +Infusion of Elder Flowers, and those of the Lime Tree, has done great +Service to those who drank plentifully of it. + +Sec. 120. I am sensible that in many Villages a great Number of Persons +have died, with a prodigious Inflation or Swelling of the Neck. Some +have also died in the City, and among others a young Woman of twenty +Years of Age, who had taken nothing but hot sweating Medicines and red +Wine, and died the fourth Day, with violent Suffocations, and a large +Discharge of Blood from the Nose. Of the great Number I have seen in +Person, only two died. One was a little Girl of ten Months old. She had +an Efflorescence which very suddenly disappeared: at this Time I was +called in; but the Humour had retreated to the Breast, and rendered her +Death inevitable. The other was a strong Youth from sixteen to seventeen +Years old, whose sudden Attack from the Disease manifested, from the +very Beginning, a violent Degree of it. Nevertheless, the Symptoms +subsiding, and the Fever nearly terminating, the Sweats which approached +would probably have saved him. But he would not suffer them to have +their Course, continually stripping himself quite naked. The +Inflammation was immediately repelled upon the Lungs, and destroyed him +within the Space of thirty Hours. I never saw a Person die with so very +dry a Skin. The Vomit affected him very little upwards, and brought on a +purging. His own bad Conduct seems to have been the Occasion of his +Death; and may this serve as one Example of it. + +Sec. 121. I chose to expatiate on this Disease, as it may happen to reach +other Places, where it may be useful to have been apprized of its Marks, +and of its Treatment, which agrees as much with that of putrid Fevers, +of which I shall speak hereafter, as with that of the inflammatory +Diseases I have already considered: since in some Subjects the Complaint +of the Throat has evidently been a Symptom of a putrid Fever, rather +than of the chiefly apparent Disease, a Quinsey. [31] + +Sec. 122. Disorders of the Throat are, with Respect to particular Persons, +an habitual Disease returning every Year, and sometimes oftner than once +a Year. They may be prevented by the same Means, which I have directed +for the Preservation from habitual Pleurisies Sec. 100; and by defending +the Head and the Neck from the Cold; especially after being heated by +Hunting, or any violent Exercise, or even by singing long and loud, +which may be considered as an extraordinary Exercise of some of the +Parts affected in this Disease. + +[31] I reserve some other interesting Reflections on this Disease, for + the second Edition of my Treatise on Fevers; and the Editor at + _Paris_ has very well observed, that it has some Relation to the + gangrenous sore Throat, which has been epidemical these twenty + Years past, in many Parts of _Europe_.----This Note is from Dr. + _Tissot_ himself. + + + + + __Chapter VII.__ + + + _Of Colds._ + + + __Sect.__ 123. + +There are many erroneous Prejudices, with Regard to Colds, all of which +may be attended with pernicious Consequences. The first is, that a Cold +is never dangerous; an Error which daily destroys the Lives of many. I +have already complained of it for many Years past; and I have since +beheld a Multitude of such Examples of it, as have but too sufficiently +warranted my Complaints. + +No Person however, it is certain, dies merely of a Cold, as long as it +is nothing but a Cold simply; but when, from Inattention and Neglect, it +is thrown upon, and occasions Distempers of the Breast, it may, and +often does, prove mortal. _Colds destroy more than Plagues_, was the +Answer of a very sagacious and experienced Physician to one of his +Friends, who, being asked, how he was in Health, replied, Very well, I +have nothing but a Cold. + +A second erroneous Prejudice is, that Colds require no Means, no +Medicines, and that they last the longer for being nursed, or tampered +with. The last Article may be true indeed, with Respect to the Method, +in which the Person affected with them treats them; but the Principle +itself is false. Colds, like other Disorders, have their proper +Remedies; and are removed with more or less Facility, as they are +conducted better or worse. + +Sec. 124. A third Mistake is, that they are not only considered as not +dangerous, but are even supposed wholesome too. Doubtless a Man had +better have a Cold than a more grievous Disease; though it must be still +better to have neither of them. The most that can reasonably be said and +admitted on this Point, is, that when a checked, or an obstructed +Perspiration becomes the Cause of a Distemper, it is fortunate that it +produces rather a Cold, than any very dreadful Disease, which it +frequently does: though it were to be wished, that neither the Cause, +nor its Effect existed. A Cold constantly produces some Disorder or +Defect in the Functions of some Part or Parts of the Body, and thus +becomes the Cause of a Disease. It is indeed a real Disorder itself, and +which, when in a violent Degree, makes a very perceivable Assault upon +our whole Machine. Colds, with their Defluxions, considerably weaken the +Breast, and sooner or later considerably impair the Health. Persons +subject to frequent Colds are never robust or strong; they often sink +into languid Disorders; and a frequent Aptitude to take Cold is a Proof, +that their Perspiration may be easily checked and restrained; whence the +Lungs become oppressed and obstructed, which must always be attended +with considerable Danger. + +Sec. 125. We may be convinced of the Weakness and Fallacy of these +Prejudices, by considering attentively the Nature of Colds; which are +nothing else than the very Diseases already described in the three +preceding Chapters, though in their greatest Degree only. + +A Cold in Truth is almost constantly an inflammatory Disease; a light +Inflammation of the Lungs, or of the Throat; of the Membrane or very +thin Skin, which lines the Nostrills, and the Inside of certain Cavities +in the Bones of the Cheeks and Forehead. These Cavities communicate with +the Nose, in such a Manner, that when one Part of this Membrane is +affected with an Inflammation, it is easily communicated to the other +Parts. + +Sec. 126. It is scarcely necessary to describe the Symptoms of a Cold, and +it may be sufficient to remark, 1. That their chief Cause is the same +with that, which most commonly produces the Diseases already treated of, +that is, an obstructed Perspiration, and a Blood somewhat inflamed. 2. +That whenever these Diseases affect great Numbers, many Colds prevail at +the same Time. 3. That the Symptoms which manifest a violent Cold, +greatly resemble those which precede or usher in these Diseases. People +are rarely attacked by great Colds, without a shivering and Fever; which +last sometimes continues for many Days. There is a Cough, a dry Cough, +for some Time; after which some Expectoration ensues; which allays the +Cough, and lightens the Oppression; at which Time the Cold may be said +to be maturated, or ripe. There are pretty often slight Stitches, but +unfixed or flying about, with a little Complaint of the Throat. When the +Nostrills happen to be the Seat of the Disorder, which is then very +improperly termed a Cold of the Brain, it is often attended with a +vehement Head-ach; which sometimes depends on an Irritation of the +Membrane, that lines the Cavities in the Bone of the Forehead, or the +maxillary Sinusses, that is, the Cavities in the Jaws: At first the +Running from the Nose is very clear; thin and sharp; afterwards, in +Proportion to the Abatement of the Inflammation, it becomes thicker; and +the Consistence and Colour of it resemble those of what others cough up. +The Smell, the Taste and the Appetite are commonly impaired by it. + +Sec. 127. Colds seem to be of no certain Duration or Continuance. Those of +the Head or Brain generally last but a few Days; of the Breast longer. +Some Colds nevertheless terminate in four or five Days. If they extend +beyond this Term they prove really hurtful. 1. Because the Violence of +the Cough disorders the whole Machine; and particularly, by forcing up +the Blood to the Head. 2. By depriving the Person afflicted of his usual +Sleep, which is almost constantly diminished by it. 3. By impairing the +Appetite, and confusing the Digestion, which is unavoidably lessened by +it. 4. By weakening the very Lungs, by the continual Agitations from +Coughing; whence all the Humours being gradually determined towards +them, as the weakest Part, a continual Cough subsists. Hence also they +become overcharged with Humours, which grow viscid there; the +Respiration is overloaded and oppressed; a slow Fever appears; Nutrition +almost ceases; the Patient becomes very weak; sinks into a Wasting; an +obstinate Wakefulness and Anguish, and often dies in a short Time. 5. By +Reason that the Fever, which almost constantly accompanies great Cold, +concurs to wear the body down. + +Sec. 128. Wherefore, since a Cold is a Disease of the same kind with +Quinsies, Peripneumonies and Inflammations of the Breast, it ought to be +treated in the same Manner. If it is a violent one, Blood should be +taken from the Arm, which may considerably shorten its Duration: and +this becomes most essentially necessary, whenever the Patient is of a +sanguineous ruddy Complexion, abounds with Blood, and has a strong +Cough, and great Head-ach. The Drinks No. 1, 2, 3, 4, should be very +plentifully used. It is advantagious to bathe the Feet in warm Water +every Night at going to Bed. [32] In a Word, if the Patient is put into +a Regimen, the Cure is very speedily effected. + +[32] It frequently happens, that the Bathings alone remove the Head-ach, + and the Cough too, by relaxing the lower Parts, and the entire + Surface of the Body. If the Patient is costive, he should receive + Glysters of warm Water, in which some Bran has been boiled, with + the Addition of a little common Soap or Butter. _E. L._ + +Sec. 129. The Disorder indeed, however, is often so very slight, that it +may be thought to require very little, if any, medical Treatment, and +may be easily cured without Physick, by abstaining from Flesh, Eggs, +Broth, and Wine; from all Food that is sharp, fat and heavy; and by +dieting upon Bread, Pulse, Fruit, and Water; particularly by eating +little or no Supper; and drinking, if thirsty, a simple Ptisan of +Barley, or an Infusion of Elder Flowers, with the Addition of a third or +fourth Part of Milk. Bathing the Feet, and the Powder No. 20 contribute +to dispose the Patient to sleep. Five Tea-Cups of an Infusion of the +Red, or wild Poppy Leaves may also be ventured on safely. + +Sec. 130. When the Fever, Heat and Inflammation wholly disappear; when the +Patient has kept to his Regimen for some Days, and his Blood is well +diluted, if the Cough and Want of Sleep still continues, he may take in +the Evening a Dose of Storax [33] Pill, or of Venice Treacle with Elder +Flower Tea, after bathing his Feet. These Remedies by stilling the +Cough, and restoring Perspiration, frequently cure the Cold in the Space +of one Night. I confess at the same Time, I have seen bad Consequences +from such Opiates, when given too early in the Complaint. It is also +necessary, when they are given, that the Patient should have supt but +very moderately, and that his Supper should be digested. + +[33] Under these Circumstances of a tickling Cough from a Cold, without + a Fever, and with very little Inflammation, I have known great and + very frequent Success, from a Dose of _Elixir paregoricum_, taken + at Bed-time, after a very light thin Supper. If the Patient be + sanguine, strong and costive, Bleeding in a suitable Quantity, and + a gently opening Potion, or purging Glyster, may be prudently + premised to it. Grown Persons may take from 30 to 80, or even 100 + Drops of it, in Barley Water, or any other pectoral Drink; and + Children in the Chincough from five to twenty Drops; half an Ounce + of it by Measure containing about one Grain of Opium, which is the + Quantity contained in less than quite six Grains of the Storax + Pill; this last being a very available pectoral Opiate too in + Coughs from a Distillation, in more adult Bodies, who may also + prefer a Medicine in that small Size, and Form. _K._ + +Sec. 131. An immense Number of Remedies are cried up for the Cure of Colds; +such as Ptisans of Apples or Pippins, of Liquorice, of dry Raisins, of +Figs, of Borage, of Ground-Ivy, of _Veronica_ or Speedwell, of Hysop, of +Nettles, _&c. &c._ I have no Design to depreciate them; as all of them +may possibly be useful: But unfortunately, those who have seen any +particular one of them succeed in one Case, readily conclude it to be +the most excellent of them all; which is a dangerous Error, because no +one Case is a sufficient Foundation to decide upon: which besides none +are qualified to do, who have not often seen a great Number of such +Cases; and who do not so attentively observe the Effects of different +Medicines, as to determine on those which most frequently agree with the +Disorder; and which, in my Judgment, are those I have just enumerated. I +have known a Tea or Infusion of Cherry Stalks, which is not a +disagreeable Drink, to cure a very inveterate Cold. + +Sec. 132. In Colds of the Head or Brain, the Steam of warm Water alone, or +that in which Elder Flowers, or some other mild aromatic Herbs, have +been boiled, commonly afford a pretty speedy Relief. These are also +serviceable in Colds fallen on the Breast. See Sec. 55. + +It has been a Practice, though of no very long standing, to give the Fat +of a Whale in these Cases; but this is a very crude indigestible kind of +Fat, and greasy oily Medicines seldom agree with Colds. Besides, this +Whales' Fat is very disagreeable and rancid, that is rank; so that it +were better to forbear using it: I have sometimes seen ill Effects from +it, and rarely any good ones. [34] + +[34] This seems but too applicable to the very popular Use of + _Spermaceti_, &c. in such Cases, which can only grease the Passage + to the Stomach; must impair its digestive Faculty, and cannot + operate against the Cause of a Cold; though that Cure of it, which + is effected by the Oeconomy of Nature in due Time, is often + ascribed to such Medicines, as may rather have retarded it. _K._ + +Sec. 133. Such Persons as abate nothing of the usual Quantity of their +Food, when seized with a Cold, and who swallow down large Quantities of +hot Water, ruin their Health. Their Digestion ceases; the Cough begins +to affect the Stomach, without ceasing to afflict the Breast; and they +incur a Chance of sinking into the Condition described Sec. 127, No. 4. + +Burnt Brandy and spiced Wine are very pernicious in the Beginning of +Colds, and the Omission of them must be a very prudent Omission. If any +good Effects have ever been known to attend the Use of them, it has been +towards the going off of the Cold; when the Disorder maintained its +Ground, solely from the Weakness of the Patient. Whenever this is the +Case, there is not the least Room for farther Relaxation; but the +Powders No. 14, should be taken every Day in a little Wine; and should +the Humours seem likely to be thrown upon the Lungs, Blisters ought to +be applied to the fleshy Part of the Legs. + +Sec. 134. Drams, or _Liqueurs_, as they are called in _French_, agree so +very little in this last State, that frequently a very small Quantity of +them revives a Cold that was just expiring. There really are some +Persons who never drink them without taking Cold, which is not to be +wondered at, as they occasion a light Inflammation in the Breast, which +is equivalent to a Cold or Distillation. + +Nevertheless, People in this Disorder should not expose themselves to +violent cold Weather, if there is a Possibility of avoiding it: though +they should equally guard too against excessive Heat. Those, who inclose +themselves in very hot Rooms, never get quite cured; and how is it +possible they should be cured in such a Situation? Such Rooms, +abstracted from the Danger of coming out of them, produce Colds in the +same Manner that Drams do, by producing a light inflammation in the +Breast. + +Sec. 135. Persons subject to frequent Colds, which Habits are sometimes +termed _fluxionary_, or liable to Distillations, imagine, they ought to +keep themselves very hot. This is an Error which thoroughly destroys +their Health. Such a Disposition to take Cold arises from two Causes; +either because their Perspiration is easily impaired; or sometimes from +the Weakness of the Stomach or the Lungs, which require particular +Remedies. When the Complaint arises from the Perspiration's being easily +disturbed and lessened, the hotter they keep themselves, the more they +sweat, and increase their Complaint the more. This incessantly warm Air +lets down and weakens the whole Machine, and more particularly the +Lungs; where the Humours finding less Resistance, are continually +derived, and are accumulated there. The Skin, being constantly bathed in +a small Sweat, becomes relaxed, soft, and incapable of compleating its +Functions: from which Failure the slightest Cause produces a total +Obstruction of Perspiration; and a Multitude of languid Disorders ensue. + +These Patients thus circumstanced, redouble their Precautions against +the Cold, or even the Coolness of the Air, while their utmost Cautions +are but so many effectual Means to lower their Health; and this the more +certainly, as their Dread of the free Air necessarily subjects them to a +sedentary Life, which increases all their Symptoms; while the hot Drinks +they indulge in, compleat their Severity. There is but one Method to +cure People thus situated; that is, by accustoming them gradually to the +Air; to keep them out of hot Chambers; to lessen their Cloathing by +Degrees; to make them sleep cool; and to let them eat or drink nothing +but what is cold, Ice itself being wholesome in their Drink: to make +them use much Exercise; and finally, if the Disorder be inveterate, to +give them for a considerable Time the Powder No. 14, and make them use +the cold Bath. This Method succeeds equally too with those, in whom the +Disease originally depended on a Weakness of the Stomach, or of the +Lungs: and in fact, at the End of a certain Period, these three Causes +are always combined. Some Persons who have been subject, for many Years, +to catch Colds throughout the Winter; and who, during that Season, never +went out, and drank every thing warm, have been evidently the better, +during the Winter of 1761, and 1762, for the Direction I have given +here. They now walk out every Day; drink their Liquids cold; and by this +Means entirely escape Colds, and enjoy perfect Health. + +Sec. 136. It is more customary indeed in Town, than in the Country, to have +different Troches, and Compositions in the Mouth. I am not for excluding +this Habit; though I think nothing is so efficacious as Juice of +Liquorice; and provided a sufficient Dose be taken, it affords certain +Relief. I have taken an Ounce and a half in one Day, and have felt the +good Consequences of it very remarkably. + + + + + __Chapter VIII.__ + + + _Of Diseases of the Teeth._ + + + __Sect.__ 137. + +The Diseases of the Teeth, which are sometimes so tedious and so +violent, as to cause obstinate Wakefulness, a considerable Degree of +Fever, Raving, Inflammations, Abscesses, Rottenness of the Bones, +Convulsions and Faintings, depend on three principal Causes. 1. On a +_Caries_ or Rottenness of the Teeth. 2. On an Inflammation of the Nerves +of the Teeth, or of the Membrane which invests and covers them; and +which affects the Membrane of the Gums. 3. A cold Humour or Defluxion +that is determined to the Teeth, and to their Nerves and Membrane. + +Sec. 138. In the first of these Cases, the _Caries_ having eat down to, and +exposed the naked Nerve, the Air, Food and Drink irritate, or, as it +were sting it; and this irritation is attended with Pain more or less +violent. Every thing that increases the Motion or Action of the affected +Part, as Exercise, Heat or Food, will be attended with the same +Consequence. + +When the Tooth is greatly decayed, there is no other Cure besides that +by extracting it, without which the Pain continues; the Breath becomes +very offensive; the Gum is eat down; the other Teeth, and sometimes even +the Jaw-bone, are infected with the Rottenness: besides, that it +prevents the Use of the other Teeth, which are infected with a kind of +tartarous Matter, and decay. + +But when the Disorder is less considerable, the Progress of it may +sometimes be restrained, by burning the Tooth with a hot Iron, or by +filling it with Lead, if it is fitted to receive and to retain it. +Different corroding Liquids are sometimes used on these Occasions, _Aqua +fortis_ itself, and Spirit of Vitriol: but such Applications are highly +dangerous, and ought to be excluded. When the Patients, from Dread, +reject the Operations just mentioned, a little Oyl of Cloves may be +applied, by introducing a small Pellet of Cotton, dipt in it, to the +rotten hollow Tooth; which often affords considerable Ease, and Respite. +Some make use of a Tincture of Opium, or Laudanum, after the same +Manner; and indeed these two Medicines may be used together in equal +Quantities. I have often succeeded with _Hoffman's_ mineral anodyne +Liquor; which seemed indeed, for a few Moments, to increase the Pain; +but Ease generally ensues after spitting a little Time. A Gargarism made +of the Herb _Argentina_; that is Silver-weed or wild Tansey, in Water, +frequently appeases the Pain that results from a _Caries_ of the Teeth: +and in such Cases many People have found themselves at Ease, under a +constant Use of it. It certainly is an Application that cannot hurt, and +is even beneficial to the Gums. Others have been relieved by rubbing +their Faces over with Honey. + +Sec. 139. The second Cause is the Inflammation of the Nerve within the +Substance, or of the Membrane on the Outside, of the Tooth. This is +discovered by the Patient's Temperament, Age and Manner of living. They +who are young, sanguine, who heat themselves much, whether by Labour, by +their Food, their Drink, by sitting up late, or by any other Excess: +they who have been accustomed to any Discharges or Eruptions of Blood, +whether natural or artificial, and who cease to have them as usual, are +much exposed to the Tooth-ach, from this Cause. + +This Pain, or rather Torment, if in an acute Degree, commonly happens +very suddenly, and often after some heating Cause. The Pulse is strong +and full; the Countenance considerably red; the Mouth extremely hot: +there is often a pretty high Fever, and a violent Head-ach. The Gums, or +some Part of them, become inflamed, swelled, and sometimes an Abscess +appears. At other times the Humours throw themselves upon the more +external Parts; the Cheek swells, and the Pain abates. When the Cheek +swells, but without any Diminution of the Pain, it then becomes an +Augmentation, but no essential Change, of the Disorder. + +Sec. 140. In this Species of the Disease, we must have Recourse to the +general Method of treating inflammatory Disorders, and direct Bleeding, +which often produces immediate Ease, if performed early. After Bleeding, +the Patient should gargle with Barley Water, or Milk and Water; and +apply an emollient Cataplasm to the Cheek. If an Abscess or little +Imposthume appears, the Suppuration or ripening of it is to be promoted, +by holding continually in the Mouth some hot Milk, or Figs boiled in +some Milk: and as soon as ever it seems ripe, it should be opened, which +may be done easily, and without any Pain. The Disorder, when depending +on this Cause, is sometimes not so violent, but of a longer Duration, +and returns whenever the Patient heats himself; when he goes to Bed; +when he eats any heating Food, or Drink, Wine or Coffee. In this Case he +should be bled, without which his other Medicines will have little +Effect; and he should bathe his Feet in warm Water for some Evenings +successively, taking one Dose of the Powder No. 20. Entire Abstinence +from Wine and Meat, especially at Night, has cured several Persons of +inveterate and obstinate Maladies of the Teeth. + +In this Species of Tooth-ach, all hot Remedies are pernicious; and it +often happens that Opium, Venice Treacle, and Storax Pills, are so far +from producing the Relief expected from them, that they have aggravated +the Pain. + +Sec. 141. When the Disease arises from a cold Distillation, or Humour, +tending to these Parts, it is commonly (though equally painful) attended +with less violent Symptoms. The Pulse is neither strong, full nor quick; +the Mouth is less heated, and less swelled. In such Cases, the afflicted +should be purged with the Powder No. 21, which has sometimes perfectly +cured very obstinate Complaints of this Sort. After purging they should +make Use of the Diet Drink of the Woods No. 22. This has cured +Tooth-achs, which have baffled other Attempts for many Years; but it +must be added, this Drink would be hurtful in the Disease from a +different Cause. Blisters to the Nape of the Neck, or [35] elsewhere, it +matters not greatly where, have often extraordinary good Effects, by +diverting the Humour, and restoring a compleat Perspiration. In short in +this Species, we may employ, not only with Safety, but with Success +(especially after due purging) Pills of Storax, Opium and Venice +Treacle. Acrid sharp Remedies, such as hard spun [35] Tobacco, Root of +Pellitory of _Spain_, &c. by exciting much Spitting, discharge part of +the Humour which causes the Disease, and hence diminish the Pain. The +Smoke of Tobacco also succeeds now and then in this Disorder, whether +this happens from the Discharge of the Rheum or Spittle it occasions; or +whether it is owing to any anodyne Efficacy of this Plant, in which it +resembles Opium. + +[35] A small Blister behind the Ear of the affected Side, or both Ears, + has very often removed the Pain, when from a Defluxion. It is + pretty common for the Subjects of this Disease to be very costive, + during the Exacerbations of it, which I have sometimes experienced + to be pretty regularly and severely quotidian, for a Week or two. + The Custom of smoking Tobacco very often, which the Violence of + this Pain has sometimes introduced, often disposes to a Blackened + and premature Decay of the Teeth, to which the Chewers of it are + less obnoxious: and this Difference may result from some particles + of its chemical Oil rising by Fumigation, and being retained in the + Teeth, which Particles are not extracted by Mastication. But with + Regard to the habitual Use of this very acrid and internally + violent Herb, for, but chiefly after, this Disease, it should be + considered well, whether in some Constitutions it may not pave the + Way to a more dangerous one, than it was introduced to remove. _K._ + +Sec. 142. As this last Cause is often the Consequence of a Weakness in the +Stomach, it daily happens that we see some People, whose Disorder from +this Cause is augmented, in Proportion as they indulge in a cooling, +refreshing Way of living. The Increase of the Disorder disposes them to +increase the Dose of what they mistake for its Remedy, in Proportion to +which their Pain only increases. There is a Necessity that such Persons +should alter this Method; and make use of such Medicines as are proper +to strengthen the Stomach, and to restore Perspiration. The Powder No. +14. has often produced the best Consequences, when I have ordered it in +these Cases; and it never fails to dissipate the Tooth-ach very +speedily, which returns periodically at stated Days and Hours. I have +also cured some Persons who never drank Wine, by advising them to the +Use of it. + +Sec. 143. But besides the Diseases of the Teeth, that are owing to these +three principal Causes, which are the most common ones; there are some +very tedious and most tormenting Disorders of them, that are occasioned +by a general Acrimony, or great Sharpness, of the Mass of Blood, and +which are never cured by any other Medicines but such, as are proper to +correct that Acrimony. When it is of a scorbutic Nature, the wild +Horse-radish (Pepperwort) Water Cresses, Brooklime, Sorrel, and +Wood-sorrell correct and cure it. If it is of a different Nature, it +requires different Remedies. But very particular Details do not come +within the Plan of this Work. As the Malady is of the chronical or +tedious kind, it allows Time to consider and consult more particularly +about it. + +The Gout and the Rheumatism are sometimes transferred to the Teeth, and +give Rise to the most excruciating Pains; which must be treated like the +Diseases from which they arise. + +Sec. 144. From what has been said on this Disorder, the Reader will +discern, in what that imaginary Oddness may consist, which has been +ascribed to it, from the same Application's relieving one Person in it, +and not affording the least Relief to another. Now the plain Reason of +this is, that these Applications are always directed, without an exact +Knowledge of the particular Cause of the Disease, in different Subjects +and Circumstances; whence the Pain from a rotten Tooth, is treated like +that from an Inflammation; that from an Inflammation, like the Pain from +a cold Humour or Fluxion; and this last like a Pain caused by a +scorbutic Acrimony: so that the Disappointment is not in the least +surprizing. Perhaps Physicians themselves do not always attend +distinctly enough to the Nature of each particular Disorder: and even +when they do, they content themselves with directing some of the less +potent Medicines, which may be inadequate to accomplish the necessary +Effect. If the Distemper truly be of an inflammatory Disposition, +Bleeding is indispensible to the Cure. + +It happens in Fact, with Regard to the Diseases of the Teeth, as well as +to all other Diseases, that they arise from different Causes; and if +these Causes are not opposed by Medicines suited to them, the Disease, +far from being cured, is aggravated. + +I have cured violent Tooth-achs, of the lower Jaw, by applying a +Plaister of Meal, the White of an Egg, Brandy and Mastich, at the Corner +of that Jaw, over the Spot where the Pulsation of the Artery may be +perceived: and I have also mitigated the most excruciating Pains of the +Head, by applying the same Plaister upon the temporal Artery. + + + + + __Chapter IX.__ + + + _Of the Apoplexy._ + + + __Sect.__ 145. + +Every Person has some Idea of the Disease termed an Apoplexy, which is a +sudden Privation or Loss of all Sense, and of all voluntary Motion; the +Pulse at the same Time being kept up, but Respiration or Breathing, +being oppressed. I shall treat of this Disease only in a brief Manner, +as it is not common in our Country Villages; and as I have expatiated on +it in a different Manner in a Letter to Dr. _Haller_, published in 1761. + +Sec. 146. This Disease is generally distinguished into two Kinds, the +sanguineous and serous Apoplexy. Each of them results from an +Overfulness of the Blood Vessels of the Brain, which presses upon, and +prevents or impairs the Functions of the Nerves. The whole Difference +between these two Species consists in this, that the sanguineous +Apoplexy prevails among strong robust Persons, who have a rich, heavy, +thick and inflammable Blood, and that in a large Quantity; in which +Circumstance it becomes a genuine inflammatory Distemper. The serous, or +humoral Apoplexy invades Persons of a less robust Constitution; whose +Blood is more dilute or watery; and rather viscid, or lightly +gelatinous, than heavy or rich; whole Vessels are in a more relaxed +State; and who abound more in other Humours than in red Blood. + +Sec. 147. When the first kind of this Disease exists in its most violent +Degree, it is then sometimes termed, an apoplectic Stroke, or thundering +Apoplexy, which kills in a Moment or instantaneously, and admits of no +Remedies. When the Assault is less violent, and we find the Patient with +a strong, full and raised Pulse, his Visage red and bloated, and his +Neck swelled up; with an oppressed and loud hoarse Respiration; being +sensible of nothing, and capable of no other Motions, except some +Efforts to vomit, the Case is not always equally desperate. We must +therefore immediately, + +1. Entirely uncover the Patient's Head, covering the rest of his Body +but very lightly; procure him instantly very fresh free Air, and leave +his Neck quite unbound and open. + +2. His Head should be placed as high as may be, with his Feet hanging +down. + +3. He must lose from twelve to fifteen Ounces of Blood, from a free open +Orifice in the Arm: the Strength or Violence with which the Blood +sallies out, should determine the Surgeon to take a few Ounces more or +less. It should be repeated to the third or fourth Time, within the +Space of three or four Hours; if the Symptoms seem to require it, either +in the Arm, or in the Foot. + +4. A Glyster should be given of a Decoction of the first emollient +opening Herbs that can be got, with four Spoonfuls of Oil, one Spoonful +of Salt: and this should be repeated every three Hours. + +5. If it is possible, he should be made to swallow Water plentifully, in +each Pot of which three Drams of Nitre are to be dissolved. + +6. As soon as the Height and Violence of the Pulse abates; when his +Breathing becomes less oppressed and difficult, and his Countenance less +inflamed, he should take the Decoction No. 23; or, if it cannot be got +ready in Time, he should take three Quarters of an Ounce of Cream of +Tartar, and drink Whey plentifully after it. This Medicine succeeded +extremely well with me in a Case, where I could not readily procure any +other. + +7. He should avoid all strong Liquor, Wine, distilled Spirit, whether +inwardly or by outward Application, and should even be prevented +from [36] smelling them. + +[36] I have been very authentically assured of the Death of a hale Man, + which happened in the very Act of pouring out a large Quantity of + distilled Spirits, by Gallons or Bucketfulls, from one Vessel into + another. _K._ + +8. The Patient should be stirred, moved, or even touched, as little as +it is possible: in a Word every Thing must be avoided that can give him +the least Agitation. This Advice, I am sensible, is directly contrary to +the common Practice; notwithstanding which it is founded in Reason, +approved by Experience, and absolutely necessary. In Fact, the whole +Evil results from the Blood being forced up with too much Force, and in +too great a Quantity, to the Brain; which being thence in a State of +Compression, prevents every Movement and every Influence of the Nerves. +In Order, therefore, to re-establish these Movements, the Brain must be +unloaded, by diminishing the Force of the Blood. But strong Liquors, +Wines, Spirits, volatile Salts, all Agitation and Frictions augment it, +and by that very Means increase the Load, the Embarrassment of the +Brain, and thus heighten the Disease itself. On the contrary, every +Thing that calms the Circulation, contributes to recall Sensation and +voluntary Motion the sooner. + +9. Strong Ligatures should be made about the Thighs under the Ham: By +this Means the Blood is prevented in its Ascent from the Legs, and less +is carried up to the Head. + +If the Patient seems gradually, and in Proportion as he takes proper +Medicines, to advance into a less violent State, there may be some +Hopes. But if he rather grows worse after his earliest Evacuations, the +Case is desperate. + +Sec. 148. When Nature and Art effect his Recovery, his Senses return: +though there frequently remains a little _Delirium_ or Wandering for +some Time; and almost always a paralytic Defect, more or less, of the +Tongue, the Arm, the Leg, and the Muscles of the same Side of the Face. +This Palsy sometimes goes off gradually, by the Help of cooling Purges +from Time to Time, and a Diet that is but very moderately and lightly +nourishing. All hot Medicines are extremely hurtful in this Case, and +may pave the Way to a repeated Attack. A Vomit might be even fatal, and +has been more than once so. It should be absolutely forbidden; nor +should we even promote, by Draughts of warm Water, the Efforts of the +Patient to vomit. They do not any ways depend on any Humour or Mass in +the Stomach; but on the Oppression and Embarrassment of the Brain: and +the more considerable such Efforts are, the more such Oppression is +increased: by Reason that as long as they continue, the Blood cannot +return from the Head, by which Means the Brain remains overcharged. + +Sec. 149. The other Species of Apoplexy is attended with the like Symptoms, +excepting the Pulse not being so high nor strong; the Countenance being +also less red, sometimes even pale; the Breathing seems less oppressed; +and sometimes the Sick have a greater Facility to vomit, and discharge +more upwards. + +As this Kind of the Disease attacks Persons who abound less in Blood; +who are less strong, and less heated or inflamed, Bleeding is not often +at all necessary: at least the Repetition of it is scarcely ever so: and +should the Pulse have but a small Fulness, and not the least unnatural +Hardness, Bleeding might even be pernicious. + +1. The Patient however should be placed as was directed in the former +Mode of this Disease; though it seems not equally necessary here. + +2. He should receive a Glyster, but without Oil, with double the +Quantity of Salt, and a Bit of Soap of the Size of a small Egg; or with +four or five Sprigs of Hedge Hyssop. It may be repeated twice a Day. + +3. He should be purged with the Powder No. 4. [37] + +[37] Vomits which are so pernicious in the sanguineous Apoplexy, where + the Patient's Countenance and Eyes are inflamed; and which are also + dangerous or useless, when a Person has been very moderate in his + Meals, or is weakened by Age or other Circumstances, and whole + Stomach is far from being overloaded with Aliment, are nevertheless + very proper for gross Feeders, who are accustomed to exceed at + Table, who have Indigestions, and have a Mass of viscid glairy + Humours in their Stomachs; more especially, if such a one has a + little while before indulged himself excessively, whence he has + vomited without any other evident Cause, or at least had very + Strong _Nauseas_, or Loathings. In brief, Vomits are the true + Specific for Apoplexies, occasioned by any narcotic or stupifying + Poisons, the pernicious Effects of which cease, the Moment the + Persons so poisoned vomit them up. An attentive Consideration of + what has occurred to the Patient before his Seizure; his small + natural Propensity to this Disease, and great and incessant + Loathings, render it manifest, whether it has been caused by such + Poisons, or such poisonous Excesses. In these two Last Cases a + double Dose of Tartar emetic should be dissolved in a Goblet or Cup + of Water, of which the Patient should immediately take a large + Spoonful; which should be repeated every Quarter of an Hour, till + it operates. _E. L._ + +4. His common Drink may be a Strong Infusion of Leaves of Balm. + +5. The Purge should be repeated the third Day. + +6. Blisters should immediately be applied to the fleshy Part of the +Legs, or between the Shoulder Blades. [38] + +[38] These Blisters may be preceded by Cupping with Scarification on the + Nape of the Neck. This Remedy, often used by the ancient + Physicians, but too little practiced in France, is one of the most + speedy, and not the least efficacious, Applications in both + sanguine and serous Apoplexies. _E. L._ + +7. Should Nature seem disposed to relieve herself by Sweatings, it +should be encouraged; and I have often known an Infusion of the _Carduus +benedictus_, or blessed Thistle, produce this Effect very successfully. +If this Method be entered upon, the Sweat ought to be kept up (without +stirring if possible) for many Days. It has then sometimes happened, +that at the End of nine Days, the Patient has been totally freed from +the Palsy, which commonly succeeds this Species of the Apoplexy, just as +it does the other. + +Sec. 150. Persons who have been attacked with either kinds of this Disease +are liable to subsequent ones; each of which is more dangerous than that +preceding: whence an Endeavour to obviate or prevent such Relapses +becomes of the utmost Importance. This is to be effected in each Sort by +a very exact, and rather severe Diet, even to diminishing the usual +Quantity of the Patient's Food; the most essential Precaution, to be +observed by any who have been once assaulted with it, being entirely to +leave off Suppers. Indeed those, who have been once attacked with the +_first_, the _sanguineous Apoplexies_, should be still more exact, more +upon their Guard, than the others. They should deny themselves whatever +is rich and juicy, hot or aromatic, sharp, Wine, distilled Liquors and +Coffee. They should chiefly confine themselves to Garden-Stuff, Fruits +and Acids; such should eat but little Flesh, and only those called +white; taking every Week two or three Doses of the Powder No. 24, in a +Morning fasting, in a Glass of Water. They should be purged twice or +thrice a Year with the Draught No. 23; use daily Exercise; avoid very +hot Rooms, and the violent Heat of the Sun. They should go to Bed +betimes, rise early, never lie in Bed above eight Hours: and if it is +observed that their Blood increases considerably, and has a Tendency +towards the Head, they should be bled without Hesitation: and for some +Days restrain themselves entirely to a thin and low Regimen, without +taking any solid Food. In these Circumstances warm Bathings are hurtful. +In the other, the serous, Apoplexy, instead of purging with No. 23, the +Patient should take the Purge No. 21. + +Sec. 151. The same Means, that are proper to prevent a Relapse, might also +obviate or keep off a primary or first Assault, if employed in Time: for +notwithstanding it may happen very suddenly, yet this Disease foreshews +itself many Weeks, sometimes many Months, nay even Years beforehand, by +Vertigos, Heaviness of the Head; small Defects of the Tongue or Speech; +short and momentary Palsies, sometimes of one, sometimes of another, +Part: sometimes by Loathings and Reachings to vomit; without supposing +any Obstruction or Load in the first Passages, or any other Cause in the +Stomach, or the adjoining Parts. There happens also some particular +Change in the Looks and Visage not easy to be described: sharp and short +Pains about the Region of the Heart; an Abatement of the Strength, +without any discernible Cause of it. Besides there are still some other +Signs, which signify the Ascent of the Humours too much to the Head, and +shew, that the Functions of the Brain are embarrassed. + +Some Persons are liable to certain Symptoms and Appearances, which arise +from the same Cause as an Apoplexy; and which indeed may be considered +as very light benign Apoplexies, of which they sustain many Attacks, and +yet without any considerable Annoyance of their Health. The Blood, all +at once as it were, flushes up to their Heads: they appear heedless or +blundering; and have sometimes Disgusts and _Nauseas_, and yet without +any Abatement of their Understanding, their Senses, or Motion of any +Sort. Tranquillity of Mind and Body, once Bleeding, and a few Glysters +usually carry it off soon after its Invasion. The Returns of it may be +prevented by the Regimen directed Sec. 150; and especially by a frequent +Use of the Powder No. 24. At the long Run however, one of these Attacks +commonly degenerates into a mortal Apoplexy: though this may be retarded +for a very long Time by an exact Regimen, and by avoiding all strong +Commotions of the Mind, but especially that of Anger or violent Rage. + + + + + __Chapter X.__ + + + _Of the violent Influence, or Strokes, of the Sun._ + + + __Sect.__ 152. + +This Appellation is applied to those Disorders, which arise from too +violent an Influence of the Heat of the Sun, immediately upon the Head; +and which in one Word may be termed _Insolation_. + +If we consider that Wood, Stone and Metals, when long exposed to the +Sun, become very hot, and that even in temperate Climates, to such a +Degree, that they can scarcely be touched without some Sensation of +burning, we may easily conceive the Risk a Person undergoes, in having +his Head exposed to the same Degree of Heat. The Blood-Vessels grow dry, +the Blood itself becomes condensed or thickened, and a real Inflammation +is formed, which has proved mortal in a very little Time. It was this +Distemper, a Stroke of the Sun, which killed _Manasses_ the Husband of +_Judith_. 'For as he was among the Labourers who bound up the Sheafs in +the Fields, the Heat struck upon his Head, and he was taken ill; he went +to Bed and he died.' The Signs which precede and attend this Disease +are, being exposed in a Place where the Sun shines forth with great +Force and Ardour; a violent Head-ach, attended with a very hot and +extremely dry Skin: the Eyes are also dry and red, being neither able to +remain open, nor yet to bear the Light; and sometimes there is a kind of +continual and involuntary Motion in the Eyelid; while some Degree of +Relief is perceivable from the Application of any cooling Liquor. It +often happens that some cannot possibly sleep; and at other times they +have a great Drowsiness, but attended with outrageous Wakenings: there +is a very strong Fever; a great Faintness, and a total Disrelish and +Loathing. Sometimes the Patient is very thirsty, and at other times not +at all: and the Skin of his Face often looks as though it were burnt. + +Sec. 153. People may be affected with the Disease from this Cause, at two +different Seasons of the Year; that is, either in the Spring, or during +the very raging Heats; but their Events are very different. Country +People and Labourers are but little liable to the former. They chiefly +affect the Inhabitants of Cities, and delicate Persons, who have used +very little Exercise in the Winter, and abound with superfluous Humours. +If thus circumstanced they expose themselves to the Sun, as even in the +Spring he attains a considerable Force; and, by the Course of Life they +have led, their Humours are already much disposed to mount to the Head; +while the Coolness of the Soil, especially when it has rained, prevents +their Feet from being so easily warmed; the Power of the Sun acts upon +their Head like a Blister, attracting a great Quantity of Humours to it. +This produces excruciating Pains of the Head, frequently accompanied +with quick and violent Shootings, and with Pain in the Eyes; +notwithstanding this Degree of the Malady is seldom dangerous. Country +People, and even such Inhabitants of Cities and Towns, as have not +forbore to exercise themselves in Winter, have no Sort of Dread of these +Strokes of the Sun, in the Spring of the Year. Its Summer Strokes are +much more vehement and troublesome, and assault Labourers and +Travellers, who are for a long Time exposed to the Fervour of it. Then +it is that the Disease is aggravated to its highest Pitch, those who are +thus struck often dying upon the Spot. In the hot Climates this Cause +destroys many in the very Streets, and makes dreadful Havock among +Armies on the March, and at Sieges. Some tragical Effects of it, on such +Occasions, are seen even in the temperate Countries. After having +marched a whole Day in the Sun, a Man shall fall into a Lethargy, and +die within some Hours, with the Symptoms of raving Madness. I have seen +a Tyler in a very hot Day, complaining to his Comrade of a violent Pain +in his Head, which increased every Moment almost; and at the very +Instant when he purposed to retire out of the Sun, he sunk down dead, +and fell down from the House he was slating. This same Cause produces +very often in the Country some most dangerous Phrenzies, which are +called there hot or burning Fevers. Every Year furnishes but too many of +them. + +Sec. 154. The Vehemence of the Sun is still more dangerous to those, who +venture to sleep exposed to it. Two Mowers who fell asleep on a Haycock, +being wakened by some others, immediately on waking, staggered, and +pronouncing a few incoherent unmeaning Words, died. When the Violence of +Wine and that of the Sun are combined, they kill very suddenly: nor is +there a single Year in which Peasants are not found dead on the +Highroads; who being drunk endeavoured to lie down in some Corner, where +they perished by an Apoplexy, from the Heat of the Sun and of strong +Drink. Those of them who escape so speedy and premature a Death, are +subject for the Remainder of their Lives, to chronical, or tedious +Head-achs; and to suffer some little Disorder and Confusion in their +Ideas. I have seen some Cases, when after violent Head-achs of some Days +Continuance, the Disease has been transferred to the Eyelids, which +continued a long Time red and distended, so that they could not be kept +asunder or open. It has also been known, that some Persons have been +struck by the Sun into a _Delirium_ or Raving, without a Fever, and +without complaining of a Head-ach. Sometimes a _Gutta Serena_ has been +its Consequence; and it is very common to see People, whose long +Continuance under the strong Light and Influence of the Sun, has made +such an Impression upon the Eyes, as presents them with different Bodies +flying about in the Air, which distract and confuse their Sight. + +A Man of forty two Years of Age, having been exposed for several Hours +to the violent Heat of the Sun, with a very small Cap or Bonnet; and +having past the following Night in the open Air, was attacked the next +Day with a most severe Head-ach, a burning Fever, Reachings to vomit, +great Anguish, and red and sparkling Eyes. Notwithstanding the best +Assistance of several Physicians, he became phrenitic on the fifth Day, +and died on the ninth. Suppurated Matter was discharged from his Mouth, +one of his Nostrils, and his right Ear, a few Hours before his Death; +upon Dissection a small Abscess was found within the Skull; and the +whole Brain, as well as all the Membranes inclosing it, were entirely +corrupted. + +Sec. 155. In very young Children, who are not, or never should be, exposed +for any long Time to such excessive Heat (and whom a slight Cause will +often affect) this Malady discovers itself by a heavy deep Drowsiness, +which lasts for several Days; also by incessant Ravings mingled with +Rage and Terror, much the same as when they are affected with violent +Fear: and sometimes by convulsive Twitchings; by Head-achs which +returned at certain Periods, and continual Vomitings. I have seen +Children, who, after a Stroke of the Sun, have been harrassed a long +Time with a little Cough. + +Sec. 156. Old Men who often expose themselves imprudently to the Sun, are +little apprized of all the Danger they incur by it. A certain Person, +who purposely sunned himself for a considerable Time, in the clear Day +of an intermitting tertian Fever, underwent the Assault of an Apoplexy, +which carried him off the following Day. And even when the Disease may +not be so speedy and violent, yet this Custom (of sunning in hot +Weather) certainly disposes to an Apoplexy, and to Disorders of the +Head. One of the slightest Effects of much solar Heat upon the Head is, +to cause a Defluxion from the Brain, a Swelling of the Glands of the +Neck, and a Dryness of the Eyes, which sometimes continues for a +considerable Term after it. + +Sec. 157. The effect of too much culinary, or common Fire, is of the same +Quality with that of the Sun. A Man who fell asleep with his Head +directly opposite, and probably, very near to the Fire, went off in an +Apoplexy, during his Nap. + +Sec. 158. The Action of too violent a Sun is not only pernicious, when it +falls upon the Head; but it is also hurtful to other Parts; and those +who continue long exposed to it, though their Heads should not be +affected, experience violent Pains, a disagreeable Sensation of Heat, +and a considerable Stiffness in the Parts that have been, in some +Manner, parched by it; as in the Legs, the Knees, the Thighs, Reins and +Arms; and sometimes they prove feverish. + +Sec. 159. In contemplating the Case of a Patient, _Sun-struck_, as we may +term it, we must endeavour to distinguish, whether there may not be also +some other joint Causes concurring to the Effect. A Traveller, a +labouring Man, is often as much affected by the Fatigue of his Journey, +or of his Labour, as he is by the Influence of solar Heat. + +Sec. 160. It is necessary to set about the Cure of this Disease, as soon as +ever we are satisfied of its Existence: for such as might have been +easily preserved by an early Application, are considerably endangered by +a Neglect of it. The Method of treating this is very much the same, with +that of the inflammatory Diseases already mentioned; that is, by +Bleeding, and cooling Medicines of various Kinds in their Drinks, by +Bathings, and by Glysters. And 1. If the Disease be very high and +urgent, a large Quantity of Blood should be taken away, and occasionally +repeated. _Lewis_ the XIV. was bled nine Times to prevent the Fatality +of a Stroke of the Sun, which he received in Hunting in 1658. + +2. After Bleeding, the Patient's Legs should be plunged into warm Water. +This is one of the Applications that affords the most speedy Relief; and +I have seen the Head-ach go off and return again, in Proportion to the +Repetition, and the Duration, of these Bathings of the Legs. When the +Disorder is highly dangerous, it will be necessary to treat the Patient +with _Semicupia_, or warm Baths, in which he may sit up to his Hips; and +in the most dangerous Degrees of it, even to bathe the whole Body: but +the Water in this Case, as well as in Bathings of the Feet, should be +only sensibly warm: the Use of hot would be highly pernicious. + +3. Glysters made from a Decoction of any of the emollient Herbs are also +very effectual. + +4. The Patient should drink plentifully of Almond Emulsion No. 4; of +Limonade, which is a Mixture of the Juice of Lemons and Water, (and is +the best Drink in this Disease) of Water and Vinegar, which is a very +good Substitute for Limonade; and of, what is still more efficacious, +very clear Whey, with the Addition of a little Vinegar. These various +Drinks may all be taken cold; Linen Cloths dipt in cold Water and +Vinegar of Roses may be applied to the Forehead, the Temples, or all +over the Head, which is equivalent to every other Application used upon +such Occasions. Those which are the most cried up, are the Juice of +Purslain, of Lettuce, of Houseleek, and of Vervain. The Drink No. 32 is +also serviceable, taken every Morning fasting. + +Sec. 161. Cold Baths have sometimes recovered Persons out of such violent +Symptoms, from this Cause, as have been almost quite despaired of. + +A Man twenty Years of Age, having been a very long Time exposed to the +scorching Sun, became violently delirious, without a Fever, and proved +really mad. After repeated Bleedings, he was thrown into a cold Bath, +which was also frequently repeated; pouring cold Water, at the same +Time, upon his Head. With such Assistance he recovered, though very +gradually. + +An Officer who had rode Post for several Days successively, in very hot +Weather, swooned away, immediately on dismounting; from which he could +not be recovered by the ordinary Assistance in such Cases. He was saved +however, in Consequence of being plunged into a Bath of freezing Water. +It should be observed however, that in these Cases the cold Bath should +never be recurred to, without previous Bleeding. + +Sec. 162. It is past Doubt, that if a Person stands still in the violent +Heat of the Sun, he is more liable to be struck with it, than if he +walks about; and the Use of white Hats, or of some Folds of clean white +Paper under a black one, may sensibly contribute to prevent any Injury +from the considerable Heat of the Sun; though it is a very incompetent +Defence against a violent Degree of it. + +The natural Constitution, or even that Constitution, which has been +formed from long Custom and Habit, make a very great Difference between +the Effects of solar Heat on different Persons. People insensibly +accustom themselves to the Impressions of it, as they do to those of all +the other Bodies and Elements, which are continually acting upon us; and +by Degrees we arrive at a Power of sustaining his violent Heat with +Impunity: just as others arrive at the Hardiness of bearing the most +rigid Colds, with very little Complaint or Inconvenience. The human Body +is capable of supporting many more Violences and Extremes, than it +commonly does. Its natural Force is scarcely ever ascertained among +civilized Nations; because their Education generally tends to impair and +lessen it, and always succeeds in this Respect. If we were inclined to +consider a purely natural, a simply physical Man, we must look for him +among savage Nations; where only we can discover what we are able to be, +and to bear. We certainly could not fail of being Gainers, by adopting +their corporal Education; neither does it seem as yet to have been +infallibly demonstrated, that we should be great Losers in commuting our +moral Education for theirs. [39] + +[39] As some may think an Apology necessary for a Translation of this + Chapter on a Disease, which never, or very seldom, exists in this + or the adjacent Island, I shall observe here, that, abstracted from + the Immorality of a narrow and local Solicitude only for ourselves, + we are politically interested as a Nation always in Trade, and + often at War (and whose Subjects are extended into very distant and + different Climates) to provide against a sudden and acute + Distemper, to which our Armies, our Sailors and Colonies are + certainly often exposed. A Fatality from this Cause is not + restrained to our Islands within the Tropic, where several + Instances of it have occurred during the late War: but it has also + been known to prevail as far Northward as _Pensylvania_, in their + Summers, and even in their Harvests. I once received a sensible + Scald on the Back of my Thumb, from the Sun suddenly darting out + through a clear Hole, as it were, in a Cloud, after a short and + impetuous Shower in Summer; which Scald manifestly blistered within + some Minutes after. Had this concentrated Ray been darted on my + bare Head, the Consequence might have been more dangerous; or + perhaps as fatal as some of the Cases recorded by Dr. _Tissot_, in + this Chapter. _K._ + + + + + __Chapter XI.__ + + + _Of the Rheumatism._ + + + __Sect.__ 163. + +The Rheumatism may exist either with or without a Fever. The first of +these may be classed among the Diseases, of which I have already +treated; being an Inflammation which is manifested by a violent Fever, +preceded by Shivering, a subsequent Heat, hard Pulse, and a Head-ach. +Sometimes indeed an extraordinary Coldness, with general Uneasiness and +Inquietude, exists several Days before the Fever is perceived. On the +second or third Day, and sometimes even on the first, the Patient is +seized with a violent Pain in some Part of his Body, but especially +about the Joints, which entirely prevents their Motion, and which is +often accompanied with Heat, Redness and a Swelling of the Part. The +Knee is often the first Part attacked, and sometimes both the Knees at +once. When the Pain is fixed, an Abatement of the Fever frequently +happens; though in some other Persons it continues for several Days, and +increases every Evening. The Pain diminishes in one Part after a +Duration of some Days, and then invades some other. From the Knee it +descends to the Foot, or mounts to the Hip, to the Loins, the +Shoulder-blades, Elbow, Wrist, the Nape of the Neck, and frequently is +felt in the intermediate Parts. Sometimes one Part is quite free from +Pain, when another is attacked; at other Times many Parts are seized +nearly at the same Instant; and I have sometimes seen every Joint +afflicted at once. In this Case the Patient is in a very terrible +Situation, being incapable of any Motion, and even dreading the +Assistance of his Attendants, as he can scarcely admit of touching, +without a sensible Aggravation of his Pains. He is unable to bear even +the Weight of the Bed-clothes, which must be, as it were, arched over +his Limbs by a proper Contrivance, to prevent their Pressure: and the +very walking across the Chamber increases his Torments. The Parts in +which they are the most excruciating, and obstinate, are the Region of +the Loins, the Hips, and the Nape or hinder Part of the Neck. + +Sec. 164. This Disease is also often extended over the Scalp and the +Surface of the Head; and there the Pains are excessive. I have seen them +affect the Eyelids and the Teeth with inexpressible Torment. As long as +the Distemper is situated in the more external Parts, the Patient, +however painful his Situation may prove, is in no great Danger, if he be +properly treated: but if by some Accident, some Error, or by any latent +Cause, the Disease be repelled upon an internal Part or Organ, his Case +is extremely dangerous. If the Brain is attacked, a frantic raging +_Delirium_ is the Consequence; if it falls upon the Lungs, the Patient +is suffocated: and if it attacks the Stomach or the Bowels, it is +attended with the most astonishing Pains, which are caused by the +Inflammation of those Parts, and which Inflammation, if violent, is [40] +speedily fatal. About two Years since I was called to a robust Man, +whose Guts were already in a gangrenous State, which was the Consequence +of a Rheumatism, that first attacked one Arm and one Knee; the Cure of +which had been attempted by sweating the Patient with some hot Remedies. +These indeed brought on a plentiful Sweat; but the inflammatory Humour +seized the Intestines, whose Inflammation degenerated into a Gangrene, +after a Duration of the most acute Pain for thirty-six Hours; his +Torments terminating in Death two Hours after I saw him. + +[40] See Note [16] to Page 59. + +Sec. 165. This Malady however is often in a less violent Degree; the Fever +is but moderate, and ceases entirely when the Pain begins; which is also +confined to one, or not more than two Parts. + +Sec. 166. If the Disease continues fixed, for a considerable Time, in one +Joint, the Motion of it is impaired for Life. I have seen a Person, who +has now a wry Neck, of twenty Years standing, in Consequence of a +Rheumatism in the Nape of the Neck; and I also saw a poor young Man from +_Jurat_, who was Bed-ridden, and who had lost the Motion of one Hip and +both Knees. He could neither stand nor sit, and there were but a few +Postures in which he could even lie in Bed. + +Sec. 167. An obstructed Perspiration, an inflammatory Thickness of the +Blood, constitute the most general Cause of the Rheumatism. This last +concurring Cause is that we must immediately encounter; since, as long +as that subsists, Perspiration cannot be perfectly re-established, which +follows of Course, when the Inflammation is cured. For which Reason this +Distemper must be conducted like the other inflammatory ones, of which I +have already treated. + +Sec. 168. As soon as it is sufficiently manifest, the Glyster No. 5, should +be injected; and twelve Ounces of Blood be taken from the Arm an Hour +after. The Patient is to enter upon a Regimen, and drink plentifully of +the Ptisan No. 2, and of Almond Milk or Emulsion No. 4. As this last +Medicine may be too costly in Country Places for the poor Peasantry; +they may drink, in Lieu of it, very clear Whey, sweetened with a little +Honey. I have known a very severe Rheumatism cured, after twice +bleeding, without any other Food or Medicine, for the Space of thirteen +Days. The Whey also may be happily used by Way of Glyster. + +Sec. 169. If the Distemper is not considerably asswaged by the first +Bleeding, it should be repeated some Hours after. I have ordered it four +Times within the first two Days; and some Days after I have even +directed a fifth Bleeding. But in general the Hardness of the Pulse +becomes less after the second: and notwithstanding the Pains may +continue as severe as before, yet the Patient is sensible of less +Inquietude. The Glyster must be repeated every Day, and even twice a +Day, if each of them is attended only with a small Discharge; and +particularly if there be a violent Head-ach. In such Cases as are +excessively painful, the Patient can scarcely dispose himself into a +proper Attitude or Posture to receive Glysters: and in such +Circumstances his Drinks should be made as opening as possible; and a +Dose of the Cream of Tartar No. 24 should be given Night and Morning. +This very Medicine, with the Assistance of Whey, cured two Persons I +advised it to, of rheumatic Pains, of which they had been infested with +frequent Returns for many Years, and which were attended with a small +Fever. + +Apples coddled, Prunes stewed, and well ripened Summer Fruits are the +properest Nourishment in this Disease. + +We may save the Sick a good deal of Pain, by putting one strong Towel +always under their Back, and another under their Thighs, in order to +move them the more easily. When their Hands are without Pain, a third +Towel hung upon a Cord, which is fastened across the Bed, must +considerably assist them in moving themselves. + +Sec. 170. When the Fever entirely disappears, and the Hardness of the Pulse +is removed, I have ordered the Purge No. 23 with a very good Effect; and +if it is attended with five or six Motions, the Patient is very sensibly +relieved. The Day but one after it may be repeated successfully, and a +third Time, after an Interval of a greater Number of Days. + +Sec. 171. When the Pains are extremely violent, they admit of no +Application: Vapour-Baths however may be employed, and provided they are +often used, and for a considerable Time, they prove very efficacious. +The Purpose of these Baths is only to convey the Steam of boiling Water +to the Parts affected; which may always easily be effected, by a Variety +of simple and easy Contrivances; the Choice of which must depend on the +different Circumstances and Situation of the Sick. + +Whenever it is possible, some of the emollient Applications No. 9, +should be continually employed. A half Bath, or an entire Bath of warm +Water, in which the Patient should remain an Hour, after sufficient +Bleedings and many Glysters, affords the greatest Relief. I have seen a +Patient, under the most acute Pains of the Loins, of the Hips, and of +one Knee, put into one. He continued still under extreme Torment in the +Bath, and on being taken out of it: but an Hour after he had been put to +Bed, he sweated, to an incredible Quantity, for thirty six Hours, and +was cured. The Bath should never be made use of, until after repeated +Bleedings, or at least other equivalent Evacuations: for otherwise +timed, it would aggravate the Disease. + +Sec. 172. The Pains are generally most severe in the Night; whence it has +been usual to give composing soporific Medicines. This however has been +very erroneous, as Opiates really augment the Cause of the Disease, and +destroy the Efficacy of the proper Remedies: and, even not seldom, far +from asswaging the Pains, they increase them. Indeed they agree so +little in this Disease, that even the Patient's natural Sleep at the +Invasion of this Complaint, is rather to his Detriment. They feel, the +very Moment they are dropping asleep, such violent Jirks as awaken them +with great Pain: or if they do sleep a few Minutes, the Pains are +stronger when they awake. + +Sec. 173. The Rheumatism goes off either by Stool, by turbid thick Urine +which drops a great Proportion of a yellowish Sediment, or by Sweats: +and it generally happens that this last Discharge prevails towards the +Conclusion of the Disease. It may be kept up by drinking an Infusion of +Elder Flowers. At the Beginning however Sweating is pernicious. + +Sec. 174. It happens also, though but very seldom, that Rheumatisms +determine by depositing a sharp Humour upon the Legs; where it forms +Vesications, or a kind of Blisterings; which burst open and form Ulcers, +that ought not to be healed and dried up too hastily; as this would +occasion a speedy Return of the rheumatic Pains. They are disposed to +heal naturally of themselves, by the Assistance of a temperate regular +Diet, and a few gentle Purges. + +Sec. 175. Sometimes again, an Abscess is formed either in the affected +Part, or in some neighbouring one. I have seen a Vineyard Dresser, who +after violent Pains of the Loins, had an Abscess in the upper Part of +the Thigh, which he neglected for a long Time. When I saw him, it was of +a monstrous Size. I ordered it to be opened, when at once above three +Pots of [41] Matter rushed out of it: but the Patient, being exhausted, +died some Time after it. + +[41] This, according to our Author's Estimation of the Pot-Measure at + _Berne_, which is that he always means, and which he says contains + exactly (of Water we suppose) fifty one Ounces and a Quarter + (though without a material Error it may be computed at three Pounds + and a Quarter) will amount at least to nine Pounds and three + Quarters of Matter, supposing this no heavier than Water. By + Measure it will want but little of five of our Quarts: a very + extraordinary Discharge indeed of _Pus_ at once, and not unlikely + to be attended by the Event which soon followed. _K._ + +Another Crisis of the Rheumatism has happened by a kind of Itch, which +breaks out upon all the Parts adjacent to the Seat of this Disease. +Immediately after this Eruption the Pains vanish; but the Pustules +sometimes continue for several Weeks. + +Sec. 176. I have never observed the Pains to last, with considerable +Violence, above fourteen Days, in this Species of the Rheumatism; though +there remains a Weakness, Numbness, and some Inflation, or Puffing, of +the adjoining Parts: and it will also be many Weeks, and sometimes even +Months; especially if the Distemper attacked them in the Fall, before +the Sick recover their usual Strength. I have known some Persons, who, +after a very painful Rheumatism, have been troubled with a very +disagreeable Sensation of Lassitude; which did not go off till after a +great Eruption, all over the Body, of little Vesications or Blisterings, +full of a watery Humour; many of them burst open, and others withered +and dried up without bursting. + +Sec. 177. The Return of Strength into the Parts affected may be promoted by +Frictions Night and Morning, with Flannel or any other woollen Stuff; by +using Exercise; and by conforming exactly to the Directions given in the +Chapter on Convalescence, or Recovery from acute Diseases. The +Rheumatism may also be prevented by the Means I have pointed out, in +treating of Pleurisies and Quinsies. + +Sec. 178. Sometimes the Rheumatism, with a Fever, invades Persons who are +not so sanguine, or abounding in Blood; or whose Blood is not so much +disposed to Inflammation; those whose Flesh and Fibres are softer; and +in whose Humours there is more Thinness and Sharpness, than Viscidity +and Thickness. Bleeding proves less necessary for Persons so +constituted, notwithstanding the Fever should be very strong. Some +Constitutions require more Discharges by Stool; and after they are +properly evacuated, some Blisters should be applied, which often afford +them a sensible Relief as soon as ever they begin to operate. +Nevertheless they should never be used where the Pulse is hard. The +Powder No. 25 answers very well in these Cases. + +Sec. 179. There is another Kind of Rheumatism, called chronical, or +lasting. It is known by the following Characters or Marks. 1. It is +commonly unattended with a Fever. 2. It continues a very long Time. 3. +It seldom attacks so many Parts at once as the former. 4. Frequently no +visible Alteration appears in the affected Part, which is neither more +hot, red, or swelled than in its healthy State; though sometimes one or +other of these Symptoms is evident. 5. The former, the inflammatory, +Rheumatism assaults strong, vigorous, robust Persons: but this rather +invades People arrived at a certain Period of Life, or such as are weak +and languishing. + +Sec. 180. The Pain of the chronical Rheumatism, when left to itself, or +injudiciously treated, lasts sometimes many Months, and even Years. It +is particularly and extremely obstinate, when it is exerted on the Head, +the Loins, or on the Hip, and along the Thighs, when it is called the +_Sciatica_. There is no Part indeed which this Pain may not invade; +sometimes it fixes itself in a small Spot, as in one Corner of the Head; +the Angle of the Jaw; the Extremity of a Finger; in one Knee; on one +Rib, or on the Breast, where it often excites Pains, which make the +Patient apprehensive of a Cancer. It penetrates also to the internal +Parts. When it affects the Lungs, a most obstinate Cough is the +Consequence; which degenerates at length into very dangerous Disorders +of the Breast. In the Stomach and Bowels it excites most violent Pains +like a Cholic; and in the Bladder, Symptoms so greatly resembling those +of the Stone, that Persons, who are neither deficient in Knowlege nor +Experience, have been more than once deceived by them. + +Sec. 181. The Treatment of this chronical Rheumatism does not vary +considerably from that of the former. Nevertheless, in the first Place, +if the Pain is very acute, and the Patient robust, a single Bleeding at +the Onset is very proper and efficacious. 2. The Humours ought to be +diluted, and their Acrimony or Sharpness should be diminished, by a very +plentiful Use of a Ptisan of [42] Burdock Roots No. 26. 3. Four or five +Days after drinking abundantly of this, the purging [43] Powder No. 21 +may be taken with Success. In this Species of the Rheumatism, a certain +Medicine is sometimes found serviceable. This has acquired some +Reputation, particularly in the Country, where they bring it from, +_Geneva_; under the Title of the Opiate for the Rheumatism, tho' I +cannot say for what Reason; as it is indeed neither more nor less than +the Electuary _Caryocostinum_, which may be procured at our +Apothecaries. I shall observe however, that this Medicine has done +Mischief in the inflammatory Rheumatism, and even in this, as often as +the Persons afflicted with it are feeble, thin and of a hot Temperament; +and either when they have not previously taken diluting Drinks, or when +it has been used too long. For, in such a Circumstance, it is apt to +throw the Patient into an irrecoverable Weakness. The Composition +consists of the hottest Spices, and of very sharp Purgatives. + +[42] Half a Pint of a pretty strong Infusion of the Leaves of Buckbean, + which grows wild here, taken once a Day rather before Noon, has + also been found very serviceable in that Species of a chronical + Rheumatism, which considerably results from a scorbutic State of + the Constitution. _K._ + +[43] Another very good Purge, in this Kind of Rheumatism, may also be + compounded of the best Gum Guiacum in Powder from 30 to 40 Grains; + dissolved in a little Yolk of a fresh Egg; adding from 6 to 10 + Grains of Jallap powdered, and from 3 to 5 Grains of powdered + Ginger, with as much plain or sorrel Water, as will make a purging + Draught for a stronger or weaker grown Patient. Should the Pains + frequently infest the Stomach, while the Patient continues costive, + and there is no other Fever than such a small symptomatic one, as + may arise solely from Pain, he may safely take, if grown up, from + 30 to 45 Drops of the volatile Tincture of Gum Guiacum, in any + diluting Infusion, that may not coagulate or separate the Gum. It + generally disposes at first to a gentle _Diaphoresis_ or Sweat, and + several Hours after to one, and sometimes to a second Stool, with + little or no Griping. _K._ + +Sec. 182. When general Remedies have been used, and the Disorder still +continues, Recourse should be had to such Medicines, as are available to +restore Perspiration; and these should be persisted in for a +considerable Time. The Pills No. 18, with a strong Infusion of Elder +Flowers, have often succeeded in this Respect: and then after a long +Continuance of diluting Drinks, if the Fever is entirely subdued; if the +Stomach exerts its Functions well; the Patient is no ways costive; if he +is not of a dry Habit of Body; and the Part affected remains without +Inflammation, the Patient may safely take the Powder No. 29, at Night +going to Bed, with a Cup or two of an Infusion of _Carduus benedictus_, +or the blessed Thistle, and a Morsel of Venice Treacle of the Size of a +Hazel Nut, or a Filberd. This Remedy brings on a very copious Sweating, +which often expells the [44] Disease. These Sweats may be rendered full +more effectual, by wrapping up the affected Part in a Flanel dipt in the +Decoction No. 27. + +[44] Gum Guaiacum, given from six to ten Grains Morning and Night, is + often very successful in these Cases. It may be made into Pills or + Bolusses with the Rob of Elder, or with the Extract of Juniper. _E. + L._ + +Sec. 183. But of all these Pains, the Sciatica is one of the most tedious +and obstinate. Nevertheless I have seen the greatest Success, from the +Application of seven or eight Cupping-Glasses on the tormented Part; by +which, without the Assistance of any other Remedy, I have cured, in a +few Hours, Sciaticas of many Years standing, which had baffled other +Remedies. Blisters, or any such stimulating Plaisters, as bring on a +Suppuration and Discharge from the afflicted Part, contribute also +frequently to the Cure; tho' less effectually than Cupping, which should +be repeated several Times. Green Cere-cloth, commonly called Oil-cloth, +(whether the Ingredients be spread on Taffety or on Linen) being applied +to the diseased Part, disposes it to sweat abundantly, and thus to +discharge the sharp Humour which occasions the Pain. Sometimes both +these Applications, but especially that spread on Silk (which may be +applied more exactly and closely to the Part, and which is also spread +with a different Composition) raise a little Vesication on the Part as +Blisters do. A Plaister of Quicklime and Honey blended together has +cured inveterate Sciaticas. Oil of Eggs has sometimes succeeded in such +Cases. A Seton has also been successfully made in the lower Part of the +Thigh. Finally some Pains, which have not yielded to any of these +Applications, have been cured by actual burning, inflicted on the very +Spot, where the most violent Pain has been felt; except some particular +Reason, drawn from an anatomical Knowlege of the Part, should determine +the Surgeon not to apply it there. The Scull or Head should never be +cauterized with a burning Iron. + +Sec. 184. The hot Baths of _Bourbon_, _Plombiers_, _Aix-la-Chapelle_ and +many others are often very efficacious in these chronical Pains: +notwithstanding I really think, there is no rheumatic Pain that may not +be cured without them. The common People substitute to these a Bath made +of the Husk of Grapes, after their Juice is expressed, which cures some +by making them sweat abundantly. Cold Baths however are the best to keep +off this Disease; but then they cannot always be safely ventured on. +Many Circumstances render the Use of them impracticable to particular +Persons. Such as are subject to this chronical Rheumatism, would do very +well to rub their whole Bodies every Morning, if they could, but +especially the afflicted Parts, with Flanel. This Habit keeps up +Perspiration beyond any other Assistance; and indeed sometimes even +increases it too much. It would be serviceable too, if such Subjects of +this cruel Disease wore Flanel all over their Skin, during the Winter. + +After a violent Rheumatism, People should long be careful to avoid that +cold and moist Air, which disposes them to relapse. + +Sec. 185. Rheumatic People have too frequent a Recourse to very improper +and hurtful Medicines, in this Distemper, which daily produce very bad +Consequences. Such are spirituous Medicines, Brandy, and Arquebusade +Water. They either render the Pain more obstinate and fixed, by +hardening the Skin; or they repell the Humour to some inward Part. And +Instances are not wanting of Persons who have died suddenly, from the +Application of Spirit of Wine upon the Parts, that were violently +afflicted with the Rheumatism. It also happens sometimes that the +Humour, having no Outlet through the Skin, is thrown internally on the +Bone and affects it. A very singular Fact occurred in this Respect, an +Account of which may be serviceable to some Persons afflicted with the +Disease. A Woman at Night was chaffing the Arm of her Husband, who had +the Rheumatism there, with Spirit of Wine; when a very lucky Accident +prevented the Mischief she might have occasioned by it. The Spirit of +Wine took Fire from the Flame of the Candle she made use of, and burned +the diseased Part. It was drest of Course, and the Suppuration that +attended it, entirely cured the Rheumatism. + +Sharp and greasy Unctions or Ointments produce very bad Effects, and are +equally dangerous. A _Caries_, a Rottenness of the Bones, has ensued +upon the Use of a Medicine called, The Balsam of Sulphur with +Turpentine. I was consulted in 1750, three Days before her Decease, +about a Woman, who had long endured acute rheumatic Pains. She had taken +various Medicines, and, among the rest, a considerable Quantity of a +Ptisan, in which Antimony was blended with some purging Medicines, and a +greasy spirituous Balsam had been rubbed into the Part. The Fever, the +Pains, and the Dryness of the Skin soon increased; the Bones of the +Thighs and Arms became carious: and in moving the Patient no more than +was necessary for her Relief and Convenience, without taking her out of +her Bed, both Thighs and one Arm broke. So dreadful an Example should +make People cautious of giving or applying Medicines inconsiderately, +even in such Diseases, as appear but trifling in themselves. I must also +inform the Readers, there are some rheumatic Pains, which admit of no +Application; and that almost every Medicine aggravates them. In such +Cases the afflicted must content themselves with keeping the Parts +affected from the Impressions of the Air, by a Flanel, or the Skin of +some Animal with the Fur on. + +It is also more advisable sometimes to leave a sufferable and inveterate +Pain to itself, especially in old or weakly People, than to employ too +many Medicines, or such violent ones, as should affect them more +importantly than the Pains did. + +Sec. 186. If the Duration of the Pains fixed in the same Place, should +cause some Degree of Stiffness in the Joint affected, it should be +exposed twice a Day to the Vapour of warm Water, and dried well +afterwards with hot Linen: then it should be well chaffed, and lastly +touched over with Ointment of Marsh-mallows. Pumping, if superadded to +this Vapour, considerably increases its Efficacy. I directed, for a Case +of this Sort, a very simple Machine of white Tin, or Lattin, which +combined the Application of the Steam and the Pump. + +Sec. 187. Very young Children are sometimes subject to such violent and +extended Pains, that they cannot bear touching in any Part, without +excessive Crying. We must be careful to avoid mistaking these Cases, and +not to treat them like Rheumatisms. They sometimes are owing to Worms, +and go off when these have been discharged. + + + + + __Chapter XII.__ + + + _Of the Bite of a mad Dog._ + + + __Sect.__ 188. + +Men may contract the particular and raging Symptom, which is very +generally peculiar to this Disease from this Cause, and even without any +Bite; but this happens very rarely indeed. It is properly a Distemper +belonging to the canine _Genus_, consisting of the three Species of +Dogs, Wolves, and Foxes, to whom only it seems inherent and natural; +scarcely ever arising in other Animals, without its being inflicted by +them. Whenever there occurs one of them who breeds it, he bites others, +and thus the Poison, the Cause of this terrible Disease, is diffused. +Other Animals besides the canine Species, and Men themselves being +exposed to this Accident, do sometimes contract the Disease in all its +Rage and Horror: though it is not to be supposed, that this is always an +unfailing Consequence. + +Sec. 189. If a Dog who used to be lively and active, becomes all at once +moapish and morose; if he has an Aversion to eat; a particular and +unusual Look about his Eyes; a Restlessness, which appears from his +continually running to and fro, we may be apprehensive he is likely to +prove mad; at which very Instant he ought to be tied up securely, that +it may be in our Power to destroy him as soon as the Distemper is +evident. Perhaps it might be even still safer to kill him at once. + +Whenever the Malady is certain, the Symptoms heighten pretty soon. His +Aversion to Food, but especially to Drink, grows stronger. He no longer +seems to know his Master, the Sound of his Voice changes; he suffers no +Person to handle or approach him; and bites those who attempt it. He +quits his ordinary Habitation, marching on with his Head and his Tail +hanging downwards; his Tongue lolling half out, and covered with Foam or +Slaver, which indeed not seldom happens indifferently to all Dogs. Other +Dogs scent him, not seldom at a considerable Distance, and fly him with +an Air of Horror, which is a certain Indication of his Disease. +Sometimes he contents himself with biting only those who happen to be +near him: while at other Times becoming more enraged, he springs to the +right and left on all Men and Animals about him. He hurries away with +manifest Dread from whatever Waters occur to him: at length he falls +down as spent and exhausted; sometimes he rises up again, and drags +himself on for a little Time, commonly dying the third, or, at the +latest, on the fourth Day after the manifest Appearance of the Disease, +and sometimes even sooner. + +Sec. 190. When a Person is bit by such a Dog, the Wound commonly heals up +as readily, as if it was not in the least poisonous: but after the +Expiration of a longer or shorter Term, from three Weeks to three +Months; but most commonly in about six Weeks, the Person bitten begins +to perceive, in the Spot that was bit, a certain dull obtuse Pain. The +Scar of it swells, inflames, bursts open, and weeps out a sharp, foetid, +and sanious, or somewhat bloody Humour. At the same Time the Patient +becomes sad and melancholy: he feels a kind of Indifference, +Insensibility, and general Numbness; an almost incessant Coldness; a +Difficulty of breathing; a continual Anguish, and Pains in his Bowels. +His Pulse is weak and irregular, his sleep restless, turbid, and +confused with Ravings; with starting up in Surprize, and with terrible +Frights. His Discharges by Stool are often much altered and irregular, +and small cold Sweats appear at very short Intervals. Sometimes there is +also a slight Pain or Uneasiness in the Throat. Such is the first Degree +of this Disease, and it is called by some Physicians the dumb Rage, or +Madness. + +Sec. 191. Its second Degree, the confirmed or downright Madness, is +attended with the following Symptoms. The Patient is afflicted with a +violent Thirst, and a Pain in drinking. Soon after this he avoids all +Drink, but particularly Water, and within some Hours after, he even +abhors it. This Horror becomes so violent, that the bringing Water near +his Lips, or into his Sight, the very Name of it, or of any other Drink; +the Sight of Objects, which, from their Transparence, have any +Resemblance of Water, as a Looking Glass, _&c._ afflicts him with +extreme Anguish, and sometimes even with Convulsions. They continue +however still to swallow (though not without violent Difficulty) a +little Meat or Bread, and sometimes a little Soup. Some even get down +the liquid Medicines that are prescribed them, provided there be no +Appearance of Water in them; or that Water is not mentioned to them, at +the same Time. Their Urine becomes thick and high-coloured, and +sometimes there is a Suppression or Stoppage of it. The Voice either +grows hoarse, or is almost entirely abolished: but the Reports of the +bitten barking like Dogs are ridiculous and superstitious Fictions, void +of any Foundation; as well as many other Fable, that have been blended +with the History of this Distemper. The Barking of Dogs however is very +disagreeable to them. They are troubled with short _Deliriums_ or +Ravings, which are sometimes mixed with Fury. It is at such times that +they spit all around them; that they attempt also to bite, and sometimes +unhappily effect it. Their Looks are fixed, as it were, and somewhat +furious, and their Visage frequently red. It is pretty common for these +miserable Patients to be sensible of the Approach of their raging Fit, +and to conjure the Bystanders to be upon their Guard. Many of them never +have an Inclination to bite. The increasing Anguish and Pain they feel +become inexpressible: they earnestly wish for Death; and some of them +have even destroyed themselves, when they had the Means of effecting it. + +Sec. 192. It is with the Spittle, and the Spittle only, that this dreadful +Poison unites itself. And here it may be observed, 1, That if the Wounds +have been made through any of the Patient's Cloaths, they are less +dangerous than those inflicted immediately on the naked Skin. 2, That +Animals who abound in Wool, or have very thick Hair, are often preserved +from the mortal Impression of the Poison; because in these various +Circumstances, the Cloaths, the Hair, or the Wool have wiped, or even +dried up, the Slaver of their Teeth. 3, The Bites inflicted by an +infected Animal, very soon after he has bitten many others, are less +dangerous than the former Bites, because their Slaver is lessened or +exhausted. 4, If the Bite happens in the Face, or in the Neck, the +Danger is greater, and the Operation of the Venom is quicker too; by +Reason the Spittle of the Person so bit is sooner infected. 5, The +higher the Degree of the Disease is advanced, the Bites become +proportionably more dangerous. From what I have just mentioned here it +may be discerned, why, of many who have been bitten by the same +Sufferer, some have been infected with this dreadful Disease, and others +not. + +Sec. 193. A great Number of Remedies have been highly cried up, as famous +in the Cure of this Disease; and, in _Swisserland_ particularly, the +Root of the Eglantine or wild Rose, gathered at some particular times, +under the favorable Aspects of the Moon, and dried with some +extraordinary Precautions. There is also the Powder of _Palmarius_ of +calcined Egg Shells, that of the _Lichen terrestris_, or Ground +Liverwort, with one third Part of Pepper, a Remedy long celebrated in +_England_; Powder of Oyster-Shells; of Vervain; bathing in Salt Water; +St. Hubert's Key, _&c. &c._ But the Death of a Multitude of those who +have been bitten, notwithstanding their taking the greatest Part of all +these boasted Antidotes; and the Certainty of no one's escaping, who had +been attacked with the high raging Symptom, the _Hydrophobia_, have +demonstrated the Inefficacy of them all, to all _Europe_. It is +incontestable that to the Year 1730, not a single Patient escaped, in +whom the Disease was indisputably manifest; and that every Medicine then +employed against it was useless. When Medicines had been given before +the great Symptom appeared, in some of those who took them, it +afterwards appeared, in others not. The same different Events occurred +also to others who were bitten, and who took not the least Medicine; so +that upon the whole, before that Date, no Medicine seemed to be of any +Consequence. Since that Time, we have had the Happiness to be informed +of a certain Remedy, which is Mercury, joined to a few others. + +Sec. 194. In short there is a Necessity for destroying or expelling the +Poison itself, which Mercury effects, and is consequently the +Counter-poison of it. That poison produces a general Irritation of the +Nerves; this is to be removed or asswaged by Antispasmodics: so that in +Mercury, or Quicksilver, joined to Antispasmodics, consists the whole +that is indicated in the Cure of this Disease. There really have been +many Instances of Persons cured by these Medicines, in whom the +Distemper had been manifest in its Rage and Violence; and as many as +have unfortunately received the Cause of it in a Bite, should be firmly +persuaded, that in taking these Medicines, and using all other proper +Precautions, they shall be entirely secured from all its ill +Consequences. Those also in whom the Rage and Fury of this Distemper is +manifest, ought to use the same Medicines, with entire [45] Hope and +Confidence, which may justly be founded on the many Cures effected by +them. It is acknowledged however, that they have proved ineffectual in a +few Cases; but what Disease is there, which does not sometimes prove +incurable? + +[45] This Advice is truly prudent and judicious; Hope, as I have + observed on a different Occasion, being a powerful, though + impalpable, Cordial: and in such perilous Situations, we should + excite the most agreeable Expectations we possibly can in the + Patient; that Nature, being undepressed by any desponding + melancholy ones, may exert her Functions the more firmly, and + co-operate effectually with the Medicines, against her internal + Enemy. _K._ + +Sec. 195. The very Moment after receiving the Bite, is it happens to be in +the Flesh, and if it can safely be effected, all the Part affected +should be cut [46] away. The Ancients directed it to be cauterized, or +burnt with a red hot Iron (meer Scarification being of very little +Effect) and this Method would very probably prove effectual. It requires +more Resolution, however, than every Patient is endued with. The Wound +should be washed and cleansed a considerable Time with warm Water, with +a little Sea-Salt dissolved in it. After this into the Lips and Edges of +the Wound, and into the Surface of the Part all about it, should be +rubbed a Quarter of an Ounce of the Ointment No. 28; and the Wound +should be dressed twice daily, with the soft lenient Ointment No. 29, to +promote Suppuration; but that of No. 28 is to be used only once a Day. + +[46] I knew a brave worthy Gentleman abroad, who above forty Years past + thus preserved his Life, after receiving the Bite of a large + Rattle-Snake, by resolutely cutting it and the Flesh surrounding it + out, with a sharp pointed Penknife.--Perhaps those who would not + suffer the Application of the actual Cautery, that is, of a red hot + Iron (which certainly promises well for a Cure) might be persuaded + to admit of a potential Cautery, where the Bite was inflicted on a + fleshy Part. Though even this is far from being unpainful, yet the + Pain coming on more gradually, is less terrifying and horrid. And + when it had been applied quickly after, and upon the Bite, and kept + on for 3 or 4 Hours, the Discharge, after cutting the _Eschar_, + would sooner ensue, and in more Abundance, than that from the + actual Cautery; the only Preference of which seems to consist in + its being capable perhaps of absorbing, or otherwise consuming, all + the poisonous _Saliva_ at once. This Issue should be dressed + afterwards according to our Author's Direction; and in the gradual + healing of the Ulcer, it may be properly deterged by adding a + little Praecipitate to the Digestive. Neither would this interfere + with the Exhibition of the _Tonquin_ Powder No. 30, nor the + antispasmodic _Bolus_ No. 31, if they should be judged necessary. + And these perhaps might prove the most certain Means of preventing + the mortal Effects of this singular animal Poison, which it is so + impossible to analyze, and so extremely difficult to form any + material Idea of; but which is not the Case of some other Poisons. + _K._ + +In point of Regimen, the Quantity of Nourishment should be less than +usual, particularly in the Article of [47] Flesh: he should abstain from +Wine, spirituous Liquors, all Sorts of Spices and hot inflaming Food. He +should drink only Barley-Water, or an Infusion of the Flowers of the +Lime-tree. He should be guarded against Costiveness by a soft relaxing +Diet, or by Glysters, and bathe his Legs once a Day in warm Water. Every +third Day one Dose of the Medicine No. 30 should be taken; which is +compounded of Mercury, that counterworks the Poison, and of Musk which +prevents the Spasms, or convulsive Motions. I confess at the same Time +that I have less Dependance on the Mercury given in this Form, and think +the rubbing in of its Ointment considerably more efficacious, which I +should hope may always prevent the Fatality of this dreadful, surprizing +Disease. [48] + +[47] It seems not amiss to try the Effects of a solely vegetable Diet + (and that perhaps consisting more of the acescent than alcalescent + Herbs and Roots) in this Disease, commencing immediately from the + Bite of a known mad Dog. These carnivorous Animals, who naturally + reject all vegetable Food, are the only primary Harbingers or + Breeders of it; though they are capable of transmitting it by a + Bite to graminivorous and granivorous ones. The Virtue of Vinegar + in this Disease, said to have been accidentally discovered on the + Continent, seems not to have been hitherto experienced amongst us; + yet in Case of such a morbid Accident it may require a Tryal; tho' + not so far, as to occasion the Omission of more certainly + experienced Remedies, with some of which it might be improper. _K._ + +[48] The great Usefulness of mercurial Frictions, we may even say, the + certain Security which they procure for the Patients, in these + Cases, provided they are applied very soon after the Bite, have + been demonstrated by their Success in _Provence_, at _Lyons_, at + _Montpellier_, at _Pondacherry_, and in many other Places. Neither + have these happy Events been invalidated by any Observations or + Instances to the contrary. It cannot therefore be too strongly + inculcated to those who have been bitten by venomous Animals, to + comply with the Use of them. They ought to be used in such a + Quantity, and after such a Manner, as to excite a moderate + Salivation, for fifteen, twenty, or even thirty Days. _E. L._ + Though this Practice may justly be pursued from great Caution, when + no Cautery had been speedily applied to, and no such Discharge had + been obtained from, the bitten Part; yet wherever it had, this long + and depressing Salivation, I conceive, would be very seldom + necessary; and might be hurtful to weak Constitutions. _K._ + +Sec. 196. If the raging Symptom, the Dread of Water, has already appeared, +and the Patient is strong, and abounds with Blood, he should, 1, be bled +to a considerable Quantity, and this may be repeated twice, thrice, or +even a fourth Time, if Circumstances require it. + +2, The Patient should be put, if possible, into a warm Bath; and this +should be used twice daily. + +3, He should every Day receive two, or even three of the emollient +Glysters No. 5. + +4, The Wound and the Parts adjoining to it should be rubbed with the +Ointment No. 28, twice a Day. + +5, The whole Limb which contains the Wound should be rubbed with Oil, +and be wrapped up in an oily Flanel. + +6, Every three Hours a Dose of the Powder No. 30, should be taken in a +Cup of the Infusion of Lime-tree and Elder Flowers. + +7, The Prescription No. 31, is to be given every Night, and to be +repeated in the Morning, if the Patient is not easy, washing it down +with the same Infusion. + +8, If there be a great Nauseousness at Stomach, with a Bitterness in the +Mouth, give the Powder No. 35, which brings up a copious Discharge of +glewy and bilious Humours. + +9, There is very little Occasion to say any thing relating to the +Patient's Food, in such a Situation. Should he ask for any, he may be +allowed Panada, light Soup, Bread, Soups made of farinaceous or mealy +Vegetables, or a little Milk. + +Sec. 197. By the Use of these Remedies the Symptoms will be observed to +lessen, and to disappear by Degrees; and finally Health will be +re-established. But if the Patient should long continue weak, and +subject to Terrors, he may take a Dose of the Powder No. 14, thrice a +Day. + +Sec. 198. It is certain that a Boy, in whom the raging Symptom of This +Disease had just appeared, was perfectly cured, by bathing all about the +wounded Part with Sallad-Oil, in which some Camphire and Opium were +dissolved; with the Addition of repeated Frictions of the Ointment No. +28, and making him take some _Eau de luce_ with a little Wine. This +Medicine, a Coffee-Cup of which may be given every four Hours, allayed +the great Inquietude and Agitation of the Patient; and brought on a very +plentiful Sweat, on which all the Symptoms vanished. + +Sec. 199. Dogs may be cured by rubbing in a triple Quantity of the same +Ointment directed for Men, and by giving them the Bolus No. 33. But both +these Means should be used as soon as ever they are bit. When the great +Symptom is manifest, there would be too much Danger in attempting to +apply one, or to give the other; and they should be immediately killed. +It might be well however to try if they would swallow down the Bolus, on +its being thrown to them. + +As soon as ever Dogs are bit, they should be safely tied up, and not let +loose again, before the Expiration of three or four Months. + +Sec. 200. A false and dangerous Prejudice has prevailed with Regard to the +Bites from Dogs, and it is this--That if a Dog who had bit any Person, +without being mad at the Time of his biting, should become mad +afterwards, the Person so formerly bitten, would prove mad too at the +same Time. Such a Notion is full as absurd, as it would be to affirm, +that if two Persons had slept in the same Bed, and that one of them +should take the Itch, the Small-Pocks, or any other contagious Disease, +ten or twelve Years afterwards, that the other should also be infected +with that he took, and at the same Time too. + +Of two Circumstances, whenever a Person is bit, one must certainly be. +Either the Dog which gives the Bite, is about to be mad himself, in +which Case this would be evident in a few Days; and then it must be said +the Person was bitten by a mad Dog: Or else, that the Dog was absolutely +sound, having neither conceived, or bred in himself, nor received from +without the Cause, the Principle, of Madness: in which last Case I ask +any Man in his Senses, if he could communicate it. No Person, no Thing +imparts what it has not. This false and crude Notion excites those who +are possessed with it to a dangerous Action: they exercise that Liberty +the Laws unhappily allow them of killing the Dog; by which Means they +are left uncertain of his State, and of their own Chance. This is a +dreadful Uncertainty, and may be attended with embarrassing and +troublesome Consequences, independant of the Poison itself. The +reasonable Conduct would be to secure and observe the Dog very closely, +in Order to know certainly whether he is, or is not, mad. + +Sec. 201. It is no longer necessary to represent the Horror, the Barbarity +and Guilt of that cruel Practice, which prevailed, not very long since, +of suffocating Persons in the Height of this Disease, with the +Bed-cloaths, or between Matrasses. It is now prohibited in most +Countries; and doubtless will be punished, or, at least ought to be, +even in those where as yet it is not. + +Another Cruelty, of which we hope to see no repeated Instance, is that +of abandoning those miserable Patients to themselves, without the least +Resource or Assistance: a most detestable Custom even in those Times, +when there was not the least Hope of saving them; and still more +criminal in our Days, when they may be recovered effectually. I do again +affirm, that it is not very often these afflicted Patients are disposed +to bite; and that even when they are, they are afraid of doing it; and +request the Bystanders to keep out of their Reach: So that no Danger is +incurred; or where there is any, it may easily be avoided by a few +Precautions. + + + + + __Chapter XIII.__ + + + _Of the Small-Pocks._ + + + __Sect.__ 202. + +The Small-Pocks is the most frequent, the most extensive of all +Diseases; since out of a hundred Persons there are not more than [49] +four or five exempted from it. It is equally true however, that if it +attacks almost every Person, it attacks them but once, so that having +escaped through it, they are always secure from [50] it. It must be +acknowleged, at the same Time, to be one of the most destructive +Diseases; for if in some Years or Seasons, it proves to be of a very +mild and gentle Sort, in others it is almost as fatal as the Plague: it +being demonstrated, by calculating the Consequences of its most raging, +and its gentlest Prevalence, that it kills one seventh of the Number it +attacks. + +[49] As far as the Number of inoculated Persons, who remained entirely + uninfected (some very few after a second Inoculation) has enabled + me, I have calculated the Proportion naturally exempted from this + Disease, though residing within the Influence of it, to be full 25 + in 1000. See Analysis of Inoculation, Ed. 2d. P. 157. Note *. _K._ + +[50] It has sometimes been observed (and the Observation has been such, + as not to be doubted) that a very mild distinct Small-Pocks has + sometimes invaded the same Person twice: But such Instances are so + very rare, that we may very generally affirm, those who have once + had it, will never have it again. _E. L._----In Deference to a few + particular Authorities, I have also supposed such a repeated + Infection. (Analysis of Inoculation, Ed. 2d. P. 43.) though I have + really never seen any such myself; nor ever heard more than two + Physicians affirm it, one at _Versailles_, and another in _London_; + the last of whom declared, he took it upon the Credit of a Country + Physician, thoroughly acquainted with this Disease, and a Witness + to the Repetition of it. Hence we imagine the Editor of this Work + at _Lyons_ might have justly termed this Re-infection _extremely_ + rare, which would have a Tendency to reconcile the Subjects of the + Small-Pocks, more generally, to the most salutary Practice of + Inoculation. Doubtless some other eruptive Fevers, particularly, + the Chicken Pocks, Crystals, _&c._ have been often mistaken for the + real Small-Pocks by incompetent Judges, and sometimes even by + Persons better qualified, yet who were less attentive to the + Symptoms and Progress of the former. But whoever will be at the + Pains to read Dr. _Paux' Parallele de la petite verole naturalle + avec l'artificielle_, or a practical Abstract of Part of it in the + Monthly Review. Vol. XXV. P. 307 to 311, will find such a just, + clear and useful Distinction of them, as may prevent many future + Deceptions on this frequently interesting Subject. _K._ + +Sec. 203. People generally take the Small-Pocks in their Infancy, or in +their Childhood. It is very seldom known to attack only one Person in +one Place: its Invasions being very generally epidemical, and seizing a +large Proportion of those who have not suffered it. It commonly ceases +at the End of some Weeks, or of some Months, and rarely ever appears +again in the same Place, until four, five or six Years after. + +Sec. 204. This Malady often gives some Intimation of its Approach, three or +four Days before the Appearance of the Fever, by a little Dejection; +less Vivacity and Gaiety than usual; a great Propensity to sweat; less +Appetite; a slight Alteration of the Countenance, and a kind of pale +livid Colour about the Eyes: Notwithstanding which, in Children of a lax +and phlegmatic Constitution, I have known a moderate Agitation of their +Blood, (before their Shivering approached) give them a [51] Vivacity, +Gaiety, and a rosy Improvement of their Complexion, beyond what Nature +had given them. + +[51] The same Appearances very often occur in such Subjects by + Inoculation, before actual Sickening, as I have observed and + instanced, Ed. 1st. P. 62, Ed. 2. P. 75, 76. _K._ + +Certain short Vicissitudes of Heat or Coldness succeed the former +introductory Appearances, and at length a considerable Shivering, of the +Duration of one, two, three or four Hours: This is succeeded by violent +Heat, accompanied with Pains of the Head, Loins, Vomiting, or at least +with a frequent Propensity to vomit. + +This State continues for some Hours, at the Expiration of which the +Fever abates a little in a Sweat, which is sometimes a very large one: +the Patient then finds himself better, but is notwithstanding cast down, +torpid or heavy, very squeamish, with a Head-ach and Pain in the Back, +and a Disposition to be drowsy. The last Symptom indeed is not very +common, except in Children, less than seven or eight Years of Age. + +The Abatement of the Fever is of small Duration; and some Hours after, +commonly towards the Evening, it returns with all its Attendants, and +terminates again by Sweats, as before. + +This State of the Disease lasts three or four Days; at the End of which +Term, and seldom later, the first Eruptions appear among the Sweat, +which terminates the Paroxysm or Return of the Fever. I have generally +observed the earliest Eruption to appear in the Face, next to that on +the Hands, on the fore Part of the Arms; on the Neck, and on the upper +Part of the Breast. As soon as this Eruption appears, if the Distemper +is of a gentle Kind and Disposition, the Fever almost entirely vanishes: +the Patient continues to sweat a little, or transpire; the Number of +Eruptions increases, others coming out on the Back, the Sides, the +Belly, the Thighs, the Legs, and the Feet. Sometimes they are pushed out +very numerously even to the Soles of the Feet; where, as they increase +in Size, they often excite very sharp Pain, by Reason of the great +Thickness and Hardness of the Skin in these Parts. + +Frequently on the first and second Day of Eruption (speaking hitherto +always of the mild Kind and Degree of the Disease) there returns again a +very gentle Revival of the Fever about the Evening, which, about the +Termination of it, is attended with a considerable and final Eruption: +though as often as the Fever terminates perfectly after the earliest +Eruption, a very distinct and very small one is a pretty certain +Consequence. For though the Eruption is already, or should prove only +moderate, the Fever, as I have before said, does not totally disappear; +a small Degree of it still remaining, and heightening a little every +Evening. + +These Pustules, or Efflorescences, on their first Appearance, are only +so many very little red Spots, considerably resembling a Flea-bite; but +distinguishable by a small white Point in the Middle, a little raised +above the rest, which gradually increases in Size, with the Redness +extended about it. They become whiter, in Proportion as they grow +larger; and generally upon the sixth Day, including that of their first +Eruption, they attain their utmost Magnitude, and are full of _Pus_ or +Matter. Some of them grow to the Size of a Pea, and some still a little +larger; but this never happens to the greatest Number of them. From this +Time they begin to look yellowish, they gradually become dry, and fall +off in brown Scales, in ten or eleven Days from their first Appearance. +As their Eruption occurred on different Days, they also wither and fall +off successively. The Face is sometimes clear of them, while Pustules +still are seen upon the Legs, not fully ripe, or suppurated: and those +in the Soles of the Feet often remain much longer. + +Sec. 205. The Skin is of Course extended or stretched out by the Pustules; +and after the Appearance of a certain Quantity, all the Interstices, or +Parts between the Pustules, are red and bright, as it were, with a +proportionable Inflation or Swelling of the Skin. The Face is the first +Part that appears bloated, from the Pustules there first attaining their +utmost Size: and this inflation is sometimes so considerable, as to look +monstrous; the like happens also to the Neck, and the Eyes are entirely +closed up by it. The Swelling of the Face abates in Proportion to the +scabbing and drying up of the Pustules; and then the Hands are puffed up +prodigiously. This happens successively to the Legs, the Tumour or +Swelling, being the Consequence of the Pustules attaining their utmost +Size, which happens by Succession, in these different Parts. + +Sec. 206. Whenever there is a very considerable Eruption, the Fever is +heightened at the Time of Suppuration, which is not to be wondered at; +one single Boil excites a Fever: How is it possible then that some +hundred, nay some thousand of these little Abscesses should not excite +one? This Fever is the most dangerous Period, or Time of the Disease, +and occurs between the ninth and the thirteenth Days; as many +Circumstances vary the Term of Suppuration, two or three Days. At this +painful and perilous Season then, the Patient becomes very hot, and +thirsty: he is harrassed with Pain; and finds it very difficult to +discover a favourable easy Posture. If the Malady runs very high, he has +no Sleep; he raves, becomes greatly oppressed, is seized with a heavy +Drowsiness; and when he dies, he dies either suffocated or lethargic, +and sometimes in a State compounded of both these Symptoms. + +The Pulse, during this Fever of Suppuration, is sometimes of an +astonishing Quickness, while the Swelling of the Wrists makes it seem, +in some Subjects, to be very small. The most critical and dangerous Time +is, when the Swellings of the Face, Head and Neck are in their highest +Degree. Whenever the Swelling begins to fall, the Scabs on the Face to +dry [_supposing neither of these to be too sudden and premature, for the +visible Quantity of the Pustules_] and the Skin to shrivel, as it were, +the Quickness of the Pulse abates a little, and the Danger diminishes. +When the Pustules are very few, this second Fever is so moderate, that +it requires some Attention to discern it, so that the Danger is next to +none. + +Sec. 207. Besides those Symptoms, there are some others, which require +considerable Attention and Vigilance. One of these is the Soreness of +the Throat, with which many Persons in the Small-Pocks are afflicted, as +soon as the Fever grows pretty strong. It continues for two or three +Days; feels very strait and troublesome in the Action of Swallowing; and +whenever the Disease is extremely acute, it entirely prevents +Swallowing. It is commonly ascribed to the Eruption of Pustules in the +Throat; but this is a Mistake, such Pustules being almost +constantly [52] imaginary. It begins, most frequently, before the +Eruption appears; if this Complaint is in a light Degree, it terminates +upon the Eruption; and whenever it revives again in the Course of the +Disease, it is always in Proportion to the Degree of the Fever. Hence we +may infer it does not arise from the Pustules, but is owing to the +Inflammation; and as often as it is of any considerable Duration, it is +almost ever attended with another Symptom, the Salivation, or a +Discharge of a great Quantity of Spittle. This Salivation rarely exists, +where the Disease is very gentle, or the Patient very young; and is full +as rarely absent, where it is severe, and the Patient is past seven or +eight Years old: but when the Eruption is very confluent, and the +Patient adult, or grown up, the Discharge is surprizing. Under these +Circumstances it flows out incessantly, allowing the afflicted Patient +no Rest or Respite; and often incommodes him more than any other Symptom +of the Distemper; and so much the more, as after its Continuance for +some Days, the Lips, the Inside of the Cheeks, the Tongue, and the Roof +of the Mouth are entirely peeled or flead, as it were. Nevertheless, +however painful and embarrassing this Discharge may prove, it is very +important and salutary. Meer Infants are less subject to it, some of +them having a Looseness, in Lieu of it: and yet I have observed even +this last Discharge to be considerably less frequent in them, than a +Salivation is in grown People. + +[52] As Pustules are, and not very seldom, visible on the Tongue, and + sometimes on the Roof, even to its Process called the Palate, which + I have plainly seen; it seems not very easy to assign any + insuperable Obstacle to the Existence of a few within the Throat; + though this scarcely ever occurs, in the distinct Small-Pocks. + Doubtless however, a considerable Inflammation of that Part will be + as likely to produce the great Difficulty of Swallowing, as the + Existence of Pustules there; which our learned Author does not + absolutely reject, and consequently will forgive this Supposition + of them; especially if he credits the ocular Testimony of Dr. + _Violante_, cited in the Analysis, Ed. 2d. p 71. _K._ + +Sec. 208. Children, to the Age of five or six Years, are liable to +Convulsions, before Eruption: these however are not dangerous, if they +are not accompanied with other grievous and violent Symptoms. But such +Convulsions as supervene, either when Eruption having already occurred, +suddenly retreats, or _strikes in_, according to the common Phrase; or +during the Course of the Fever of Suppuration, are greatly more +terrifying. + +Involuntary Discharges of Blood from the Nose often occur, in the first +Stage of this Distemper, which are extremely serviceable, and commonly +lessen, or carry off, the Head-ach. Meer Infants are less subject to +this Discharge; though they have sometimes a little of it: and I have +known a considerable _Stupor_ or Drowsiness, vanish immediately after +this Bleeding. + +Sec. 209. The Small-Pocks is commonly distinguished into two Kinds, the +confluent and the distinct, such a Distinction really existing in +Nature: but as the Treatment of each of them is the same; and as the +Quantity or Dose of the Medicines is only to be varied, in Proportion to +the Danger of the Patient (not to enter here into very tedious Details, +and such as might exceed the Comprehension of many of our Readers; as +well as whatever might relate particularly to the malignant Small-Pocks) +I shall limit myself within the Description I have premised, which +includes all the Symptoms common to both these Kinds of the Small-Pocks. +I content myself with adding here, that we may expect a very confluent +and dangerous Pock, is, at the very Time of seizure, the Patient is +immediately attacked with many violent Symptoms; more especially if his +Eyes are extremely quick, lively, and even glistening, as it were; if he +vomits almost continually; if the Pain of his Loins be violent; and if +he suffers at the same Time great Anguish and Inquietude: If in Infants +there is great _Stupor_ or Heaviness; if Eruption appears on the third +Day, and sometimes even on the second: as the hastier Eruptions in this +Disease signify the most dangerous Kind and Degree of it; and on the +contrary, the slower Eruption is, it is the safer too; supposing this +Slowness of the Eruption not to have been the Consequence of great +Weakness, or of some violent inward Pain. + +Sec. 210. The Disorder is sometimes so very mild and slight, that Eruption +appears with scarcely any Suspicion of the Child's having the least +Ailment, and the Event is as favourable as the Invasion. The Pustules +appear, grow large, suppurate and attain their Maturity, without +confining the Patient to his Bed, or lessening either his Sleep, or +Appetite. + +It is very common to see Children in the Country (and they are seldom +more than Children who have it so very gently) run about in the open +Air, through the whole Course of this Disease, and feeding just as they +do in Health. Even those who take it in a somewhat higher Degree, +commonly go out when Eruption is finished, and give themselves up, +without Reserve, to the Voracity of their Hunger. Notwithstanding all +this Neglect, many get perfectly cured; though such a Conduct should +never be proposed for Imitation, since Numbers have experienced its +pernicious Consequences, and several of these Children have been brought +to me, especially from _Jurat_, who after such Neglect, in the Course of +the mild and kindly Sort of this Distemper, have contracted Complaints +and Infirmities of different Kinds, which have been found very difficult +to subdue. + +Sec. 211. This still continues to be one of these Distempers, whose Danger +has long been increased by its improper Treatment, and especially by +forcing the Patients into Sweats; and it still continues to be +increased, particularly among Country People. They have seen Eruption +appear, where the Patient sweats, and observed he found himself better +after its Appearance: and hence they conclude that, by quickening and +forcing out this Eruption, they contribute to his Relief; and suppose, +that by increasing the Quantity of his Sweats, and the Number of his +Eruptions, the Blood is the better cleared and purified from the Poison. +These are mortal Errors, which daily Experience has demonstrated, by +their tragical Consequences. + +When the Contagion or Poison, which generates this Disease, has been +admitted into the Blood, it requires a certain Term to produce its usual +Effects: at which Time the Blood being tainted by the Venom it has +received, and by that which such Venom has formed or assimilated from +it, Nature makes an Effort to free herself of it, and to expell it by +the Skin, precisely at the Time when every Thing is predisposed for that +Purpose. This Effort pretty generally succeeds, being very often rather +too rapid and violent, and very seldom too weak. Hence it is evident, +that whenever this Effort is deficient, it ought not to be heightened by +hot Medicines or Means, which make it too violent and dangerous: for +when it already exceeds in this Respect, a further Increase of such +Violence must render it mortal. There are but few Cases in which the +Efforts of Nature, on this Occasion, are too languid and feeble, +especially in the Country; and whenever such rare Cases do occur, it is +very difficult to form a just and proper Estimation of them: for which +Reason we should be very reserved and cautious in the Use of heating +Medicines, which are so mortally pernicious in this Disease. + +Wine, Venice Treacle, cordial Confections, hot Air, and Loads of +Bed-cloths, annually sweep off Thousands of Children, who might have +recovered, if they had taken nothing but warm Water: and every Person +who is interested in the Recovery of Patients in this Distemper, ought +carefully to prevent the smallest Use of such Drugs; which, if they +should not immediately aggravate it to a fatal Degree, yet will +certainly increase the Severity and Torment of it, and annex the most +unhappy and tragical Consequences to it. + +The Prejudice in this Point is so strongly rooted, that a total +Eradication of it must be very difficult: but I only desire People would +be convinced by their own Eyes, of the different Success of the hot +Regimen, and of that I shall propose. And here indeed I must confess, I +found more Attention and Docility, on this Point, among the Inhabitants +of the City, and especially in the last epidemical spreading of the +Small-Pocks, than I presumed to hope for. Not only as many as consulted +me on the Invasion of it, complied exactly with the cooling Regimen I +advised them; but their Neighbours also had Recourse to it, when their +Children sickened: and being often called in when it had been many Days +advanced, I observed with great Pleasure, that in many Houses, not one +heating Medicine had been given; and great Care had been taken to keep +the Air of the Patient's Chamber refreshingly cool and temperate. This +encourages me to expect, that this Method hereafter will become general +here. What certainly ought most essentially to conduce to this is, that +notwithstanding the Diffusion or spreading of this Disease was as +numerous and extensive as any of the former, the Mortality, in +Consequence of it, was evidently less. + +Sec. 212. At the very Beginning of the Small-Pocks (which may be reasonably +suspected, from the Presence of the Symptoms I have already described; +supposing the Person complaining never to have had it, and the Disease +to prevail near his Residence) the Patient is immediately to be put on a +strict Regimen, and to have his Legs bathed Night and Morning in warm +Water. This is the most proper and promising Method to lessen the +Quantity of Eruption in the Face and Head, and to facilitate it every +where else on the Surface. Glysters also greatly contribute to abate the +Head-ach, and to diminish the Reachings to vomit, and the actual +Vomitings, which greatly distress the Patient; but which however it is +highly absurd and pernicious to stop by any stomachic cordial +Confection, or by Venice Treacle; and still more dangerous to attempt +removing the Cause of them, by a Vomit or Purge, which are hurtful in +the beginning of the Small-Pocks. + +If the Fever be moderate, the Bathings of the Legs on the first Day of +sickening, and one Glyster may suffice then. The Patient must be +restrained to his Regimen; and instead of the Ptisan No. 1, 2, 4, a very +young Child should drink nothing but Milk diluted with two thirds of +Elder Flower or Lime-tree Tea, or with Balm Tea, if there be no +perceivable Fever; and in short, if they have an Aversion to the Taste +of them all, with only the same Quantity of good clear [53] Water. An +Apple coddled or baked may be added to it; and if they complain of +Hunger, a little Bread may be allowed; but they must be denied any Meat, +or Meat Broth, Eggs and strong Drink; since it has appeared from +Observations frequently repeated, that Children who had been indulged +with such Diet proved the worse for it, and recovered more slowly than +others. In this early Stage too, clear Whey alone may serve them instead +of every other Drink, the good Effects of which I have frequently been a +Witness to; or some Buttermilk may be allowed. When the Distemper is of +a mild Species, a perfect Cure ensues, without any other Assistance or +Medicine: but we should not neglect to purge the Patient as soon as the +Pustules are perfectly scabbed on the greater Part of his Face, with the +Prescription No. 11, which must be repeated six Days after. He should +not be allowed Flesh 'till after this second Purge; though after the +first he may he allowed some well-boiled Pulse, or Garden-stuff and +Bread, and in such a Quantity, as not to be pinched with Hunger, while +he recovers from the Disease. + +[53] A Negro Girl, about five or six Years old, under a coherent Pock, + stole by Night out of the Garret where she lay, into a Kitchen out + of Doors, where she drank plentifully of cold Water. How often she + repeated these nightly cooling Potions I never could certainly + learn, though they occurred in my own House in _South-Carolina_ in + Summer. But it is certain the Child recovered as speedily as + others, whose Eruption was more distinct, and who drank + Barley-Water, very thin Rice or Indian Corn Gruel, Balm Tea, or the + like. In fact, throughout the Course of this Visitation from the + Small Pocks in _Carolina_ in 1738, we had but too many + Demonstrations of the fatal Co-operation of violent Heat with their + Contagion; and not a very few surprizing Instances of the salutary + Effects of being necessarily and involuntarily exposed to same very + cooling Accidents after Infection, and in some Cases after Eruption + too: which I then more particularly mentioned is a small + controversial Tract printed there. _K._ + +Sec. 213. But if the Fever should be strong, the Pulse hard, and the Pain +of the Head and Loins should be violent, he must, 1. immediately lose +Blood from the Arm; receive a Glyster two Hours after; and, if the Fever +continues, the Bleeding must be repeated. I have directed a Repetition +of it even to the fourth Time, within the two first Days, to young +People under the Age of eighteen; and it is more especially necessary in +such Persons as, with a hard and full Pulse, are also affected with a +heavy Drowsiness and a _Delirium_, or Raving. + +2. As long as the Fever continues violently, two, three, and even four +Glysters should be given in the 24 Hours; and the Legs should be bathed +twice. + +3. The Patient is to be taken out of Bed, and supported in a Chair as +long as he can tolerably bear it. + +4. The Air of his Chamber should frequently be renewed, and if it be too +hot, which it often is in Summer, in Order to refresh it, and the +Patient, the Means must be employed which are directed Sec. 36. + +5. He is to be restrained to the Ptisans No. 2 or 4; and if that does +not sufficiently moderate the Fever, he should take every Hour, or every +two Hours, according to the Urgency of the Case, a Spoonful of the +Mixture No. 10; mixed with a Cup of Ptisan. After the Eruption, the +Fever being then abated, there is less Occasion for Medicine; and should +it even entirely disappear, the Patient may be regulated, as directed, Sec. +212. + +Sec. 214. When, after a Calm, a Remission or Intermission of some Days, the +Process of Suppuration revives the Fever, we ought first, and +especially, to keep the [54] Body very open. For this Purpose, _a_ an +Ounce of _Catholicon_ should be added to the Glysters; or they might be +simply made of Whey, with Honey, Oil and Salt. _b_ Give the Patient +three times every Morning, at the Interval of two Hours between each, +three Glasses of the Ptisan No. 32. _c_ Purge him _after_ two Days, with +the Potion No. 23, but on that Day he must not take the Ptisan No. 32. + +[54] We must remember that Dr. _Tissot_ is treating _here_ of the higher + or confluent Degrees of this Disease; for in the distinct + Small-Pocks, it is common to find Persons for several Days without + a Stool, and without the least perceiveable Disorder for Want of + one (their whole Nourishment being very light and liquid) in which + Cases, while Matters proceeded well in all other Respects, there + seems little Occasion for a great Solicitude about Stools: But if + one should be judged necessary after four or five Days Costiveness, + accompanied with a Tightness or Hardness of the Belly, doubtless + the Glyster should be of the lenient Kind (as those directed by our + Author are) and not calculated to produce more than a second Stool + at the very most. Indeed, where there is Reason to apprehend a + strong secondary Fever, from the Quantity of Eruption, and a + previously high Inflammation, it is more prudent to provide for a + Mitigation of it, by a moderately open Belly, than to suffer a long + Costiveness; yet so as to incur very little Hazard of abating the + Salivation, or retarding the Growth or Suppuration of the Pustules, + by a Superpurgation, which it may be too easy to excite in some + Habits. If the Discharge by spitting, and the Brightness and + Quantity of Suppuration, have been in Proportion to the Number of + Eruptions; though the Conflict from the secondary Fever, where + these have been numerous, is often acute and high; and the Patient, + who is in great Anguish, is far from being out of Danger, yet + Nature pretty generally proves stronger than the Disease, in such + Circumstances. As the _Elect. Catholicon_, is little used, or made + here, the lenitive Electuary of our Dispensatory may be substituted + for it, or that of the _Edinburgh_ Dispensatory, which was + calculated particularly for Glysters. _K._ + +2. He must, if the Distemper be very violent, take a double Dose of the +Mixture No. 10. + +3. The Patient should be taken out of Bed, and kept up in a Room well +aired Day and Night, until the Fever has abated. Many Persons will +probably be surprized at this Advice; nevertheless it is that which I +have often experienced to be the most efficacious, and without which the +others are ineffectual. They will say, how shall the Patient sleep at +this Rate? To which it may be answered, Sleep is not necessary, nay, it +is hurtful in this State and Stage of the Disease. Besides, he is really +unable to sleep: the continual Salivation prevents it, and it is very +necessary to keep up the Salivation; which is facilitated by often +injecting warm Water and Honey into his Throat. It is also of +considerable Service to throw some up his Nostrils, and often thus to +cleanse the Scabs which form within them. A due Regard to these +Circumstances not only contributes to lessen the Patient's Uneasiness, +but very effectually also to his Cure. + +4. If the Face and Neck are greatly swelled, emollient Cataplasms are to +be applied to the Soles of the Feet; and if these should have very +little Effect, Sinapisms should be applied. These are a kind of Plaister +or Application composed of Yeast, Mustard-flower, and some Vinegar. They +sometimes occasion sharp and almost burning Pain, but in Proportion to +the Sharpness and Increase of these Pains, the Head and Neck are +remarkably relieved. + +Sec. 215. The Eyelids are puffed up and swelled when the Disease runs high, +so as to conceal the Eyes, which are closed up fast for several Days. +Nothing further should be attempted, with Respect to this Circumstance, +but the frequent moistening of them with a little warm Milk and Water. +The Precautions which some take to stroke them with Saffron, a gold +Ducat, or Rose-water are equally childish and insignificant. What +chiefly conduces to prevent the Redness or Inflammation of the Eyes +after the Disease, and in general all its other bad Consequences, is to +be content for a considerable Time, with a very moderate Quantity of +Food, and particularly to abstain from Flesh and Wine. In the very bad +Small Pocks, and in little Children, the Eyes are closed up from the +Beginning of the Eruption. + +Sec. 216. One extremely serviceable Assistance, and which has not been made +use of for a long Time past, except as a Means to preserve the +Smoothness and Beauty of the Face; but yet which has the greatest +Tendency to preserve Life itself, is the Opening of the Pustules, not +only upon the Face, but all over the Body. In the first Place, by +opening them, the Lodgment or Retention of _Pus_ is prevented, which may +be supposed to prevent any Erosion, or eating down, from it; whence +Scars, deep Pitts and other Deformities are obviated. Secondly, in +giving a Vent to the Poison, the Retreat of it into the Blood is cut +off, which removes a principal Cause of the Danger of the Small-Pocks. +Thirdly, the Skin is relaxed; the Tumour of the Face and Neck diminish +in Proportion to that Relaxation; and thence the Return of the Blood +from the Brain is facilitated, which must prove a great Advantage. The +Pustules should be opened every where, successively as they ripen. The +precise Time of doing it is when they are entirely white; when they just +begin to turn but a very little yellowish; and when the red Circle +surrounding them is quite pale. They should be opened with very fine +sharp-pointed Scissars; this does not give the Patient the least Pain; +and when a certain Number of them are opened, a Spunge dipt in a little +warm Water is to be repeatedly applied to suck up and remove that _Pus_, +which would soon be dried up into Scabs. But as the Pustules, when +emptied thus, soon fill again, a Discharge of this fresh Matter must be +obtained in the same Manner some Hours after; and this must sometimes be +repeated five or even six Times successively. Such extraordinary +Attention in this Point may probably be considered as minute, and even +trivial, by some; and is very unlikely to become a [55] general +Practice: but I do again affirm it to be of much more Importance than +many may imagine; and that as often as the Fever attending Suppuration +is violent and menacing, a very general, exact and repeated opening, +emptying, and absorbing of the ripened Pustules, is a Remedy of the +utmost Importance and Efficacy; as it removes two very considerable +Causes of the Danger of this Disease, which are the Matter itself, and +the great Tension and Stiffness of the Skin. + +[55] This Practice which I had heard of, and even suggested to myself, + but never seen actually enterprized, seems so very rational as + highly to deserve a fair Trial in the confluent Degrees of the + Small-Pocks [for in the distinct it can scarcely be necessary] + wherein every probable Assistance should be employed, and in which + the most potent Medicines are very often unsuccessful. We have but + too many Opportunities of trying it sufficiently; and it certainly + has a more promising Aspect than a Practice so highly recommended + many Years ago, of covering all the Pustules (which is sometimes + the whole Surface of the Patient) in Melilot, or suppose any other + suppurating, Plaister; which will effectually prevent all + Perspiration, and greatly increase the Soreness, Pain and + Embarrassment of the Patient, at the Height of the Disease. I can + conceive but one bad Consequence that might possibly sometimes + result from the former; but this (besides the Means that may be + used to avert it) is rather remote, and so uncertain, until the + Trial is repeatedly made, that I think it ought not to be named, in + Competition with the Benefits that may arise from it in such Cases, + as seem, otherwise, too generally irrecoverable. _K._ + +Sec. 217. In the Treatment of this Disease, I have said nothing with +Respect to Anodynes, or such Medicines as procure Sleep, which I am +sensible are pretty generally employed in it, but which I scarcely ever +direct in this violent Degree of the Disease, and the Dangers of which +Medicine in it I have demonstrated in the Letter to Baron _Haller_, +which I have already mentioned. For which Reason, wherever the Patient +is not under the Care and Direction of a Physician, they should very +carefully abstain from the Use of Venice Treacle, Laudanum, _Diacodium_, +that is the Syrup of white Poppies, or even of the wild red Poppy; Syrup +of Amber, Pills of Storax, of _Cynoglossum_ or Hounds-tongue, and, in +one Word, of every Medicine which produces Sleep. But still more +especially should their Use be entirely banished, throughout the +Duration of the secondary Fever, when even natural Sleep itself is +dangerous. One Circumstance in which their Use may sometimes be +permitted, is in the Case of weakly Children, or such as are liable to +Convulsions, where Eruption is effected not without Difficulty. But I +must again inculcate the greatest Circumspection, in the Use of such +Medicines, whose Effects are fatal, [56] when the Blood-vessels are +turgid or full; whenever there is Inflammation, Fever, a great +Distension of the Skin; whenever the Patient raves, or complains of +Heaviness and Oppression; and when it is necessary that the Belly should +be open; the Urine plentifully discharged; and the Salivation be freely +promoted. + +[56] The Use of Opiates in this Disease undoubtedly requires no Small + Consideration, the great _Sydenham_ himself not seeming always + sufficiently guarded in the Exhibition of them; as far as + Experience since his Day has enabled Physicians to judge of this + Matter. In general our Author's Limitations of them seem very just; + though we have seen a few clear Instances, in which a light Raving, + which evidently arose from Want of Sleep (joined to some Dread of + the Event of the Disease by Inoculation) was happily removed, with + every other considerable Complaint, by a moderate Opiate. In sore + and fretful Children too, under a large or middling Eruption, as + the Time gained to Rest is taken from Pain, and from wasting their + Spirits in Crying and Clamour, I have seen Suppuration very + benignly promoted by _Diacodium_. But in the _Crisis_ of the + secondary Fever in the confluent or coherent Pock, when there is a + morbid Fulness, and Nature is struggling to unload herself by some + other Outlets than those of the Skin, which now are totally + obstructed (and which seems the only Evacuation, that is not + restrained by Opiates) the giving and repeating them then, as has + too often been practised, seems importantly erroneous; for I think + Dr. _Swan_ has taken a judicious Liberty of dissenting from the + great Author he translates, in forbidding an Opiate, if the + Spitting abates, or grows so tough and ropy, as to endanger + Suffocation. As the Difference of our Oeconomy in the + Administration of Physic from that in _Swisserland_, and Dr. + _Tissot's_ just Reputation may dispose many Country Practitioners + to peruse this Treatise, I take the Liberty of referring such + Readers, for a Recollection of some of my Sentiments of Opiates, + long before the Appearance of this Work in French, to the second + Edition of the Analysis from P. 94 to 97, _&c._ _K._ + +Sec. 218. If Eruption should suddenly retreat, or strike in, heating, +soporific, spirituous and volatile Remedies should carefully be avoided: +but the Patient may drink plentifully of the Infusion No. 12 pretty hot, +and should be blistered on the fleshy Part of the Legs. This is a very +embarrassing and difficult Case, and the different Circumstances +attending it may require different Means and Applications, the Detail +and Discussion of which are beyond my Plan here. Sometimes a single +Bleeding has effectually recalled Eruption at once. + +Sec. 219. The only certain Method of surmounting all the Danger of this +Malady, is to inoculate. But this most salutary Method, which ought to +be regarded as a particular and gracious Dispensation of Providence, can +scarcely be attainable by, or serviceable to, the Bulk of the People, +except in those Countries, where Hospitals [57] are destined +particularly for Inoculation. In these where as yet there are none, the +only Resource that is left for Children who cannot be inoculated at +home, is to dispose them happily for the Distemper, by a simple easy +Preparation. + +[57] That I have long since had the Honour of agreeing with our learned + Author, in this Consideration for the Benefit of the Body of the + People, which is the Benefit of the State, will appear from p. 288 + of Analys. Ed. 1st. and from p. 371, 372 of the Second. _K._ + +Sec. 220. This Preparation consists, upon the whole, in removing all Want +of, and all Obstructions to, the Health of the Person subject to this +Disease, if he have any such; and in bringing him into a mild and +healthy, but not into a very robust and vigorous, State; as this +Distemper is often exceedingly violent in this last. + +It is evident, that since the Defects of Health are very different in +different Bodies, the Preparations of them must as often vary; and that +a Child subject to some habitual Disorder, cannot be prepared in the +same Method with another who has a very opposite one. The Detail and +Distinctions which are necessary on this important Head, would be +improper here, whether it might be owing to their unavoidable Length; or +to the Impossibility of giving Persons, who are not Physicians, +sufficient Knowlege and Information to qualify them for determining on, +and preferring, the most proper Preparation in various Cases. +Nevertheless I will point out some such as may be very likely to agree, +pretty generally, with Respect to strong and healthy Children. [58] + +[58] The Substance of this Section flows from the Combination of an + excellent Understanding with great Experience, mature Reflection, + and real Probity; and fundamentally exposes both the Absurdity of + such as universally decry any Preparation of any Subject previous + to Inoculation, (which is said to be the Practice of a present very + popular Inoculator in _Paris_) and the opposite Absurdity of giving + one and the very same Preparation to all Subjects, without + Distinction; though this was avowed to have been successfully fully + practised in _Pensylvania_, some Years since; which the Reader may + see Analys. Ed. 2d, from p. 329 to 331 and the Note there. _K._ + +The first Step then is an Abatement of their usual Quantity of Food. +Children commonly eat too much. Their Limitation should be in Proportion +to their Size and Growth, where we could exactly ascertain them: but +with Regard to all, or to much the greater Number of them, we may be +allowed to make their Supper very light, and very small. + +Their second Advantage will consist in the Choice of their Food. This +Circumstance is less within the Attainment of, and indeed less necessary +for, the common People, who are of Course limited to a very few, than to +the Rich, who have Room to make great Retrenchments on this Account. The +Diet of Country People being of the simplest Kind, and almost solely +consisting of Vegetables and of Milk-meats, is the most proper Diet +towards preparing for this Disease. For this Reason, such Persons have +little more to attend to in this Respect, but that such Aliments be +sound and good in their Kind; that their Bread be well baked; their +Pulse dressed without Bacon, or rancid strong Fat of any sort; that +their Fruits should be well ripened; that their Children should have no +Cakes or Tarts, [But see Note [11], P. 40, 41.] and but little Cheese. +These simple Regulations may be sufficient, with Regard to this Article +of their Preparation. + +Some Judgment may be formed of the good Consequences of their Care on +these two Points, concerning the Quantity and Quality of the Childrens +Diet, by the moderate Shrinking of their Bellies; as they will be +rendered more lively and active by this Alteration in their living; and +yet, notwithstanding a little less Ruddiness in their Complexion, and +some Abatement of their common Plight of Body, their Countenances, upon +the whole, will seem improved. + +The third Article I would recommend, is to bathe their Legs now and then +in warm Water, before they go to Bed. This promotes Perspiration, cools, +dilutes the Blood, and allays the Sharpness of it, as often as it is +properly timed. + +The fourth Precaution, is the frequent Use of very clear Whey. This +agreeable Remedy, which consists of the Juices of Herbs filtred through, +and concocted, or as it were, sweetened by the Organs of a healthy +Animal, answers every visible Indication (I am still speaking here of +sound and hearty Children). It imparts a Flexibility, or Soupleness to +the Vessels; it abates the Density, the heavy Consistence and Thickness +of the Blood; which being augmented by the Action of the poisonous Cause +of the Small-Pocks, would degenerate into a most dangerous +inflammatory [59] Viscidity or Thickness. It removes all Obstructions in +the _Viscera_, or Bowels of the lower Cavity, the Belly. It opens the +Passages which strain off the Bile; sheaths, or blunts, its Sharpness, +gives it a proper Fluidity, prevents its Putridity, and sweetens +whatever excessive Acrimony may reside throughout the Mass of Humours. +It likewise promotes Stools, Urine and Perspiration; and, in a Word, it +communicates the most favourable Disposition to the Body, not to be too +violently impressed and agitated by the Operation of an inflammatory +Poison: And with Regard to such Children as I have mentioned, for those +who are either sanguine or bilious, it is beyond all Contradiction, the +most effectual preparatory Drink, and the most proper to make them +amends for the Want of Inoculation. + +[59] There may certainly be an inflammatory Acrimony or Thinness, as + well as Thickness of the Blood; and many medical Readers may think + a morbid Fusion of the red Globules to be a more frequent Effect of + this Contagion, than an increased Viscidity of them. See Analys. + Ed. 2d. p. 75 to 83. But this Translation, conforming to the Spirit + of its Original, admits very little Theory, and still less + Controversy, into its Plan. _K._ + +I have already observed, that it may also be used to great Advantage, +during the Course of the Disease: but I must also observe, that however +salutary it is, in the Cases for which I have directed it, there are +many others in which it would be hurtful. It would be extremely +pernicious to order it to weak, languishing, scirrhous, pale Children, +subject to Vomitings, Purgings, Acidities, and to all Diseases which +prove their Bowels to be weak, their Humours to be sharp: so that People +must be very cautious not to regard it as an universal and infallible +Remedy, towards preparing for the Small-Pocks. Those to whom it is +advised, may take a few Glasses every Morning, and even drink it daily, +for their common Drink; they may also sup it with Bread for Breakfast, +for Supper, and indeed at any Time. + +If Country People will pursue these Directions, which are very easy to +observe and to comprehend, whenever the Small-Pocks rages, I am +persuaded it must lessen the Mortality attending it. Some will certainly +experience the Benefit of them; such I mean as are very sensible and +discreet, and strongly influenced by the truest Love of their Children. +Others there are Alas! who are too stupid to discern the Advantage of +them, and too unnatural to take any just Care of their Families. + + + + + __Chapter XIV.__ + + + _Of the Measles._ + + + __Sect.__ 221. + +The Measles, to which the human Species are as generally liable, as to +the Small-Pocks, is a Distemper considerably related to it; though, +generally speaking, it is less fatal; notwithstanding which, it is not a +little destructive in some Countries. In _Swisserland_ we lose much +fewer, immediately in the Disease, than from the Consequences of it. + +It happens now and then that the Small-Pocks and the Measles rage at the +same Time, and in the same Place; though I have more frequently +observed, that each of them was epidemical in different Years. Sometimes +it also happens that both these Diseases are combined at once in the +same Person; and that one supervenes before the other has finished its +Course, which makes the Case very perilous. + +Sec. 222. In some Constitutions the Measles gives Notice of its Approach +many Days before its evident Invasion, by a small, frequent and dry +Cough, without any other sensible Complaint: though more frequently by a +general Uneasiness; by Successions of Shivering and of Heat; by a severe +Head-ach in grown Persons; a Heaviness in Children; a considerable +Complaint of the Throat; and, by what particularly characterizes this +Distemper, an Inflammation and a considerable Heat in the Eyes, attended +with a Swelling of the Eye-lids, with a Defluxion of sharp Tears, and so +acute a Sensation, or Feeling of the Eyes, that they cannot bear the +Light; by very frequent Sneezings, and a Dripping from the Nose of the +same Humour with that, which trickles from the Eyes. + +The Heat and the Fever increases with Rapidity; the Patient is afflicted +with a Cough, a Stuffing, with Anguish, and continual Reachings to +vomit; with violent Pains in the Loins; and sometimes with a Looseness, +under which Circumstance he is less persecuted with Vomiting. At other +times, and in other Subjects, Sweating chiefly prevails, though in less +Abundance than in the Small-Pocks. The Tongue is foul and white; the +Thirst is often very high; and the Symptoms are generally more violent +than in the mild Small-Pocks. + +At length, on the fourth or fifth Day, and sometimes about the End of +the third, a sudden Eruption appears and in a very great Quantity, +especially about the Face; which in a few Hours is covered with Spots, +each of which resembles a Flea-bite; many of them soon joining form red +Streaks or Suffusions larger or smaller, which inflame the Skin, and +produce a very perceivable Swelling of the Face; whence the very Eyes +are sometimes closed. Each small Spot or Suffusion is raised a little +above the Surface, especially in the Face, where they are manifest both +to the Sight and the Touch. In the other Parts of the Body, this +Elevation or Rising is scarcely perceivable by any Circumstance, but the +Roughness of the Skin. + +The Eruption, having first appeared in the Face, is afterwards extended +to the Breast, the Back, the Arms, the Thighs and Legs. It generally +spreads very plentifully over the Breast and the Back, and sometimes red +Suffusions are found upon the Breast, before any Eruption has appeared +in the Face. + +The Patient is often relieved, as in the Small-Pocks, by plentiful +Discharges of Blood from the Nose, which carry off the Complaints of the +Head, of the Eyes, and of the Throat. + +Whenever this Distemper appears in its mildest Character, almost every +Symptom abates after Eruption, as it happens in the Small-Pocks; though, +in general, the Change for the better is not as thoroughly perceivable, +as it is in the Small-Pocks. It is certain the Reachings and Vomitings +cease almost entirely; but the Fever, the Cough, the Head-ach continue; +and I have sometimes observed that a bilious Vomiting, a Day or two +after the Eruption, proved a more considerable Relief to the Patient +than the Eruption had. On the third or fourth Day of the Eruption, the +Redness diminishes; the Spots, or very small Pustules, dry up and fall +off in very little branny Scales; the Cuticle, or superficial Skin also +shrivels off; and is replaced by one succeeding beneath it. On the ninth +Day, when the Progress of the Malady has been speedy, and on the +eleventh, when it has been very slow, no Trace of the Redness is to be +found; and the Surface immediately resumes its usual Appearance. + +Sec. 223. Notwithstanding all which the Patient is not safe, except, during +the Course of the Distemper, or immediately after it, he has had some +considerable Evacuation; such as the Vomiting I have just mentioned; or +a bilious Looseness; or considerable Discharges by Urine; or very +plentiful Sweating. For when any of these Evacuations supervene, the +Fever vanishes; the Patient resumes his Strength, and perfectly +recovers. It happens sometimes too, and even without any of these +perceivable Discharges, that insensible Perspiration expels the Relics +of the poisonous Cause of this Disease, and the Patient recovers his +Health. Yet it occurs too often, that this Venom not having been +entirely expelled (or its internal Effects not having been thoroughly +effaced) it is repelled upon the Lungs, where it produces a slight +Inflammation. In Consequence of this the Oppression, the Cough, the +Anguish, and Fever return, and the Patient's Situation becomes very +dangerous. This Outrage is frequently less vehement, but it proves +tedious and chronical, leaving a very obstinate Cough behind it, with +many Resemblances of the Whooping-Cough. In 1758 there was an epidemic +State of the Measles here extremely numerous, which affected great +Numbers: Almost all who had it, and who were not very carefully and +judiciously attended, were seized in Consequence of it with that Cough, +which proved very violent and obstinate. + +Sec. 224. However, notwithstanding this be the frequent Progress and +Consequence of this Disease, when left entirely to itself, or +erroneously treated, and more particularly when treated with a hot +Regimen; yet when proper Care was taken to moderate the Fever at the +Beginning, to dilute, and to keep up the Evacuations, such unhappy +Consequences have been very rare. + +Sec. 225. The proper Method of conducting this Distemper is much the same +with that of the Small-Pocks. + +1, If the Fever be high, the Pulse hard, the Load and Oppression heavy, +and all the Symptoms violent, the Patient must be bled once or twice. + +2, His Legs must be bathed, and he must take some Glysters: the +Vehemence of the Symptoms must regulate the Number of each. + +3, The Ptisans No. 3 or 4 must be taken, or a Tea of Elder and Lime-tree +Flowers, to which a fifth Part Milk may be added. + +4, The Vapour, the Steam of warm Water should also be employed, as very +conducive to asswage the Cough; the Soreness of the Throat, and the +Oppression the Patient labours under. + +5, As soon as the Efflorescence, the Redness becomes pale, the Patient +is to be purged with the Draught No. 23. + +6, He is still to be kept strictly to his Regimen, for two Days after +this Purge; after which he is to be put upon the Diet of those who are +in a State of Recovery. + +7, If during the Eruption such Symptoms supervene as occur [at the same +Term] in the Small-Pocks, they are to be treated in the Manner already +directed there. + +Sec. 226. Whenever this Method has not been observed, and the Accidents +described Sec. 223 supervene, the Distemper must be treated like an +Inflammation in its first State, and all must be done as directed Sec. 225. +If the Disease is not vehement, [60] Bleeding may be omitted. If it is +of some standing in gross Children, loaded with Humours, inactive, and +pale, we must add to the Medicines already prescribed the Potion No. 8, +and Blisters to the Legs. + +[60] Our Author very prudently limits this Discharge, and the Repetition + of it, in this Disease (Sec. 225) as an erroneous Excess of it has + sometimes prevailed. I have seen a very epidemical Season of the + Measles, where Bleeding was not indicated in one third of the + infected. And yet I have known such an Abuse of Bleeding in it, + that being repeated more than once in a Case before Eruption (the + Measles probably not being suspected) the Eruption was retarded + several Days; and the Patient, a young Lady of Condition, remained + exceeding low, faint and sickish; 'till after recruiting a very + little, the Measles appeared, and she recovered. In a Youth of a + lax Fibre, where the Measles had appeared, a seventh or eighth + Bleeding was ordered on a Stitch in the Side, supervening from + their too early Disappearance, and the Case seemed very doubtful. + But Nature continued very obstinately favourable in this Youth, who + at length, but very slowly, recovered. His Circulation remained so + languid, his Strength, with his Juices, so exhausted, that he was + many Weeks before he could sit upright in a Chair, being obliged to + make Use of a Cord depending from the Ceiling, to raise himself + erectly in his Seat. _K._ + +Sec. 227. It often happens from the Distance of proper Advice, that the +Relics, the Dregs as it were, of the Disease have been too little +regarded, especially the Cough; in which Circumstance it forms a real +Suppuration in the Lungs, attended with a slow Fever. I have seen many +Children in Country Villages destroyed by this Neglect. Their Case is +then of the same Nature with that described Sec. 68 and 82, and terminates +in the same Manner in a Looseness, (attended with very little Pain) and +sometimes a very foetid one, which carries off the Patient. In such +Cases we must recur to the Remedies prescribed Sec. 74, Article 3, 4, 5; to +the Powder No. 14; and to Milk and Exercise. But it is so very difficult +to make Children take the Powder, that it may be sometimes necessary to +trust to the Milk without it, which I have often seen in such Situations +accomplish a very difficult Cure. I must advise the Reader at the same +Time, that it has not so compleat an Effect, as when it is taken solely +unjoined by any other Aliment; and that it is of the last Importance not +to join it with any, which has the least Acidity or Sharpness. Persons +in easy Circumstances may successfully take, at the same Time, +_Pfeffer_, [61] _Seltzer_, _Peterstal_, or some other light Waters, +which are but moderately loaded with mineral Ingredients. These are also +successfully employed in all the Cases, in which the Cure I have +mentioned is necessary. + +[61] Bristol Water will be no bad Substitute for any of these, in such + Cases. _K._ + +Sec. 228. Sometimes there remains, after the Course of the Measles, a +strong dry Cough, with great Heat in the Breast, and throughout the +whole Body, with Thirst, an excessive Dryness of the Tongue, and of the +whole Surface of the Body. I have cured Persons thus indisposed after +this Distemper, by making them breathe in the Vapour of warm Water; by +the repeated Use of warm Baths; and by allowing them to take nothing for +several Days but Water and Milk. + +Before I take leave of this Subject, I assure the Reader again, that the +contagious Cause of the Measles is of an extremely sharp and acrid +Nature. It appears to have some Resemblance to the bilious Humour, which +produces the _Erisipelas_, or St. Anthony's Fire; and thence it demands +our particular Attention and Vigilance; without which very troublesome +and dangerous Consequences may be apprehended. I have seen, not very +long since, a young Girl, who was in a very languid State after the +Measles, which she had Undergone three Years before: It was at length +attended with an Ulceration in her Neck, which was cured, and her Health +finally restored by _Sarsaparilla_ with Milk and Water. + +Sec. 229. The Measles have been communicated by [62] Inoculation in some +Countries, where it is of a very malignant Disposition; and that Method +might also be very advantageous in this. But what we have already +observed, with Respect to the Inoculation of the Small-Pocks, _viz._ +That it cannot be extended to the general Benefit of the People, without +the Foundation of Hospitals for that very Purpose, is equally applicable +to the Inoculation of the Measles. + +[62] The only Account I have read of this Practice, is in the learned + Dr. _Home's_ _Medical Facts and Experiments_, published in 1759, + which admits, that but nine out of fifteen of the Subjects of this + Practice took. Cotton dipt in the Blood of a Patient in the Measles + was inserted into the Arms of twelve; and three received the Cotton + into their Nostrils, after the Chinese Manner of infusing the + Small-Pocks; but of these last not one took, and one of those who + had taken, had the Measles again two Months after. We think the + sharp hot Lymph distilling from the inflamed Eyes of Persons in + this Disease, a likelier Vehicle to communicate it than the Blood, + especially the dry Blood, which was sometimes tried; since the + human _Serum_ seems the Fluid more particularly affected by it; and + this must have been evaporated when the Blood grew dry. A few + practical Strictures on this Work, and particularly on this + Practice described in it, appeared in the Monthly Review Vol. XXI. + P. 68 to 75. _K._ + + + + + __Chapter XV.__ + + + _Of the ardent or burning Fever._ + + + __Sect.__ 230. + +The much greater Number of the Diseases I have hitherto considered, +result from an Inflammation of the Blood, combined with the particular +Inflammation of some Part, or occasioned by some Contagion or Poison, +which must be evacuated. But when the Blood is solely and strongly +inflamed, without an Attack on any particular Part, this Fever, which we +term hot or burning, is the Consequence. + +Sec. 231. The Signs which make it evident are, a Hardness and Fulness of +the Pulse in a higher Degree than happens in any other Malady; an +excessive Heat; great Thirst; with an extraordinary Dryness of the Eyes, +Nostrils, Lips, of the Tongue, and of the Throat; a violent Head-ach; +and sometimes a Raving at the Height of the Paroxysm, or Increase of the +Fever, which rises considerably every Evening. The Respiration is also +somewhat oppressed, but especially at the Return of this Paroxysm, with +a Cough now and then; though without any Pain in the Breast, and without +any Expectoration, or coughing up. The Body is costive; the Urine very +high coloured, hot, and in a small Quantity. The Sick are also liable to +start sometimes, but especially when they seem to sleep; for they have +little sound refreshing Sleep, but rather a kind of Drowsiness, that +makes them very little attentive to, or sensible of, whatever happens +about them, or even of their own Condition. They have sometimes a little +Sweat or Moisture; though commonly a very dry Skin; they are manifestly +weak, and have either little or no Smell or Taste. + +Sec. 232. This Disease, like all other inflammatory ones, is produced by +the Causes which thicken the Blood, and increase its Motion; such as +excessive Labour, violent Heat, Want of Sleep, the Abuse of Wine or +other strong Liquors; the long Continuance of a dry Constitution of the +Air, Excess of every kind, and heating inflaming Food. + +Sec. 233. The Patient, under these Circumstances, ought, 1, immediately to +be put upon a Regimen; to have the Food allowed him given only every +eight Hours, and, in some Cases, only twice a Day: and indeed, when the +Attack is extremely violent, Nourishment may be wholly omitted. + +2, Bleeding should be performed and repeated, 'till the Hardness of the +Pulse is sensibly abated. The first Discharge should be considerable, +the second should be made four Hours after. If the Pulse is softened by +the first, the second may be suspended, and not repeated before it +becomes sufficiently hard again, to make us apprehensive of Danger: but +should it continue strong and hard, the Bleeding may be repeated on the +same Day to a third Time, which often happens to be all the Repetitions +that are necessary. + +3, The Glyster No. 5 should be given twice, or even thrice, daily. + +4, His Legs are to be bathed twice a Day in warm Water: his Hands may be +bathed in the same Water. Linen or Flanel Cloths dipt in warm Water may +be applied over the Breast, and upon the Belly; and he should regularly +drink the Almond Milk No. 4 and the Ptisan No. 7. The poorest Patients +may content themselves with the last, but should drink very plentifully +of it; and after the Bleeding properly repeated, fresh Air and the +plentiful Continuance of small diluting Liquors generally establish the +Health of the Patient. + +5, If notwithstanding the repeated Bleedings, the Fever still rages +highly, it may be lessened by giving a Spoonful of the Potion No. 10 +every Hour, till it abates; and afterwards every three Hours, until it +becomes very moderate. + +Sec. 234. Haemorrhages, or Bleedings, from the Nose frequently occur in this +Fever, greatly to the Relief and Security of the Patient. + +The first Appearances of Amendment are a softening of the Pulse, (which +however does not wholly lose all its Hardness, before the Disease +entirely terminates) a sensible Abatement of the Head-ach; a greater +Quantity of Urine, and that less high coloured; and a manifestly +approaching Moisture of the Tongue. These favourable Signs keep +increasing in their Degree, and there frequently ensue between the ninth +and the fourteenth Day, and often after a Flurry of some Hours +Continuance, very large Evacuations by Stool; a great Quantity of Urine, +which lets fall a palely reddish Sediment; the Urine above it being very +clear, and of a natural Colour; and these accompanied with Sweats in a +less or greater Quantity. At the same Time the Nostrils and the Mouth +grow moist: the brown and dry Crust which covered the Tongue, and which +was hitherto inseparable from it, peels off of itself; the Thirst is +diminished; the Clearness of the Faculties rises; the Drowsiness goes +off, it is succeeded by comfortable Sleep, and the natural Strength is +restored. When Things are evidently in this Way, the Patient should take +the Potion No. 23, and be put upon the Regimen of those who are in a +State of Recovery. It should be repeated at the End of eight or ten +Days. Some Patients have perfectly recovered from this Fever, without +the least Sediment in their Urine. + +Sec. 235. The augmenting Danger of this Fever may be discerned, from the +continued Hardness of the Pulse, though with an Abatement of its +Strength; if the Brain becomes more confused; the Breathing more +difficult; if the Eyes, Nose, Lips and Tongue become still more dry, and +the Voice more altered. If to these Symptoms there be also added a +Swelling of the Belly; a Diminution of the Quantity of Urine; a constant +Raving; great Anxiety, and a certain Wildness of the Eyes, the Case is +in a manner desperate; and the Patient cannot survive many Hours. The +Hands and Fingers at this Period are incessantly in Motion, as if +feeling for something upon the Bed-Cloths, which is commonly termed, +their hunting for Flies. + + + + + __Chapter XVI.__ + + + _Of putrid Fevers._ + + + __Sect.__ 236. + +Having treated of such feverish Distempers, as arise from an +Inflammation of the Blood, I shall here treat of those produced by +corrupt Humours, which stagnate in the Stomach, the Guts, or other +Bowels of the lower Cavity, the Belly; or which have already passed from +them into the Blood. These are called putrid Fevers, or sometimes +bilious Fevers, when a certain Degeneracy or Corruption of the Bile +seems chiefly to prevail in the Disease. + +Sec. 237. This Distemper frequently gives Notice of its Approach, several +Days before its manifest Attack; by a great Dejection, a Heaviness of +the Head; Pains of the Loins and Knees; a Foulness of the Mouth in the +Morning; little Appetite; broken Slumber; and sometimes by an excessive +Head-ach for many Days, without any other Symptom. After this, or these +Disorders, a Shivering comes on, followed by a sharp and dry Heat: the +Pulse, which was small and quick during the Shivering, is raised during +the Heat, and is often very strong, though it is not attended with the +same Hardness, as in the preceding Fever; except the putrid Fever be +combined with an inflammatory one, which it sometimes is. During this +Time, that is the Duration of the Heat, the Head-ach is commonly +extremely violent; the Patient is almost constantly affected with +Loathings, and sometimes even with Vomiting; with Thirst, disagreeable +Risings, a Bitterness in the Mouth; and very little Urine. This Heat +continues for many Hours, frequently the whole Night; it abates a little +in the Morning, and the Pulse, though always feverish, is then something +less so, while the Patient suffers less, though still greatly dejected. + +The Tongue is white and furred, the Teeth are foul, and the Breath +smells very disagreeably. The Colour, Quantity and Consistence of the +Urine, are very various and changeable. Some Patients are costive, +others frequently have small Stools, without the least Relief accruing +from them. The Skin is sometimes dry, and at other Times there is some +sensible Perspiration, but without any Benefit attending it. The Fever +augments every Day, and frequently at unexpected irregular Periods. +Besides that _great_ Paroxysm or Increase, which is perceivable in all +the Subjects of this Fever, some have also other _less_ intervening +ones. + +Sec. 238. When the Disease is left to itself, or injudiciously treated; or +when it proves more powerful than the Remedies against it, which is by +no Means seldom the Case, the Aggravations of it become longer, more +frequent and irregular. There is scarcely an Interval of Ease. The +Patient's Belly is swell'd out like a Foot-ball; a _Delirium_ or Raving +comes on; he proves insensible of his own Evacuations, which come away +involuntarily; he rejects Assistance, and keeps muttering continually, +with a quick, small, irregular Pulse. Sometimes little Spots of a brown, +or of a livid Colour appear on the Surface, but particularly about the +Neck, Back and Breast. All the Discharges from his Body have a most +foetid Smell: convulsive Motions also supervene, especially in the Face; +he lies down only on his Back, sinks down insensibly towards the Foot of +the Bed, and picks about, as if catching Flies; his Pulse becomes so +quick and so small, that it cannot be perceived without Difficulty, and +cannot be counted. His Anguish seems inexpressible: his Sweats stream +down from Agony: his Breast swells out as if distended by Fullness, and +he dies miserably. + +Sec. 239. When this Distemper is less violent, or more judiciously treated, +and the Medicines succeed well, it continues for some Days in the State +described Sec. 237, without growing worse, though without abating. None of +these Symptoms however appear, described Sec. 238; but, on the contrary, +all the Symptoms become milder, the Paroxysms, or Aggravations, are +shorter and less violent, the Head-ach more supportable; the Discharges +by Stool are less frequent, but more at once, and attended with Relief +to the Patient. The Quantity of Urine is very considerable, though it +varies at different Times in Colour and Consistence, as before. The +Patient soon begins to get a little Sleep, and grows more composed and +easy. The Tongue disengages itself from its Filth and Furriness, and +Health gradually, yet daily, advances. + +Sec. 240. This Fever seems to have no critical Time, either for its +Termination in Recovery, or in Death. When it is very violent, or very +badly conducted, it proves sometimes fatal on the ninth Day. Persons +often die of it from the eighteenth to the twentieth; sometimes only +about the fortieth; after having been alternately better and worse. + +When it happens but in a light Degree, it is sometimes cured within a +few Days, after the earliest Evacuations. When it is of a very different +Character, some Patients are not out of Danger before the End of six +Weeks, and even still later. Nevertheless it is certain, that these +Fevers, extended to this Length of Duration, often depend in a great +Measure on the Manner of treating them; and that in general their Course +must be determined, some time from the fourteenth to the thirtieth Day. + +Sec. 241. The Treatment of this Species of Fevers is comprized in the +following Method and Medicines. + +1, The Patient must be put into a _Regimen_; and notwithstanding he is +far from costive, and sometimes has even a small Purging, he should +receive one Glyster daily. His common Drink should be Lemonade, (which +is made of the Juice of Lemons, Sugar and Water) or the Ptisan No. 3. +Instead of Juice of Lemons, Vinegar may be occasionally substituted, +which, with Sugar and Water, makes an agreeable and very wholesome Drink +in these Fevers. + +2, If there be an Inflammation also, which may be discovered by the +Strength and the Hardness of the Pulse, and by the Temperament and +Complexion of the Patient; if he is naturally robust, and has heated +himself by any of the Causes described, Sec. 232, he should be bled once, +and even a second Time, if necessary, some Hours after. I must observe +however, that very frequently there is no such Inflammation, and that in +such a Case, Bleeding would be hurtful. + +3, When the Patient has drank very plentifully for two Days of these +Liquids, if his Mouth still continues in a very foul State, and he has +violent Reachings to vomit, he must take the Powder No. 34, dissolved in +half a [63] Pot of warm Water, a [64] Glass of it being to be drank +every half Quarter of an Hour. But as this Medicine vomits, it must not +be taken, except we are certain the Patient is not under any +Circumstance, which forbids the Use of a Vomit: all which Circumstances +shall be particularly mentioned in the Chapter, respecting the Use of +such Medicines, as are taken by way of Precaution, or Prevention. If the +first Glasses excite a plentiful Vomiting, we must forbear giving +another, and be content with obliging the Patient to drink a +considerable Quantity of warm Water. But if the former Glasses do not +occasion Vomiting, they must be repeated, as already directed until they +do. Those who are afraid of taking this Medicine, which is usually +called, the Emetic, may take that of No. 35, also drinking warm Water +plentifully during its Operation; but the former is preferable, as more +prevalent, in dangerous Cases. We must caution our Readers at the same +Time, that wherever there is an Inflammation of any Part, neither of +these Medicines must be given, which might prove a real Poison in such a +Circumstance; and even if the Fever is extremely violent, though there +should be no particular Inflammation, they should not be given. + +[63] That is about two Ounces more than a Pint and a half of our + Measure. + +[64] About three Ounces. + +The Time of giving them is soon after the End of the Paroxysm, when the +Fever is at the lowest. The Medicine No. 34 generally purges, after it +ceases to make the Patient vomit: But No. 35 is seldom attended with the +same Effect. + +When the Operation of the Vomit is entirely over, the Sick should return +to the Use of the Ptisan; and great Care must be taken to prohibit them +from the Use of Flesh Broth, under the Pretext of working off a Purging +with it. The same Method is to be continued on the following Days as on +the first; but as it is of Importance to keep the Body open, he should +take every Morning some of the Ptisan No. 32. Such, as this would be too +expensive for, may substitute, in the room of it, a fourth Part of the +Powder No. 34 in five or six Glasses of Water, of which they are to take +a Cup every two Hours, beginning early in the Morning. Nevertheless, if +the Fever be very high, No. 32 should be preferred to it. + +4, After the Operation of the Vomit, if the Fever still continue, if the +Stools are remarkably foetid, and if the Belly is tense and distended as +it were, and the Quantity of Urine is small, a Spoonful of the Potion +No. 10 should be given every two Hours, which checks the Putridity and +abates the Fever. Should the Distemper become violent, and very +pressing, it ought to be taken every Hour. + +5, Whenever, notwithstanding the giving all these Medicines as directed, +the Fever continues obstinate; the Brain is manifestly disordered; there +is a violent Head-ach, or very great Restlessness, two blistering +Plaisters No. 36 must be applied to the inside and fleshy Part of the +Legs, and their Suppuration and Discharge should be continued as long as +possible. + +6, If the Fever is extremely violent indeed, there is a Necessity +absolutely to prohibit the Patient from receiving the least Nourishment. + +7, When it is thought improper, or unsafe, to give the Vomit, the +Patient should take in the Morning, for two successive Days, three Doses +of the Powder No. 24, at the Interval of one Hour between each: This +Medicine produces some bilious Stools, which greatly abate the Fever, +and considerably lessen the Violence of all the other Symptoms of the +Disease. This may be done with Success, when the excessive Height of the +Fever prevents us from giving the Vomit: and we should limit ourselves +to this Medicine, as often as we are uncertain, what ever the +Circumstances of the Disease and the Patient will admit of the Vomiting; +which may thus be dispensed with, in many Cases. + +8, When the Distemper has manifestly and considerably declined; the +Paroxysms are more slight; and the Patient continues without any Fever +for several Hours, the daily use of the purging opening Drinks should be +discontinued. The common Ptisans however should be still made use of; +and it will be proper to give every other Day two Doses of the Powder +No. 24, which sufficiently obviates every ill Consequence from this +Disease. + +9, If the Fever has been clearly off for a long Part of the Day; if the +Tongue appears in a good healthy State; if the Patient has been well +purged; and yet one moderate Paroxysm of the Fever returns every Day, he +should take four Doses of the Powder No. 14 between the End of one +Return and the Beginning of the next, and continue this Repetition some +Days. People who cannot easily procure this Medicine, may substitute, +instead of it, the bitter Decoction No. 37. four Glasses of which may be +taken at equal Intervals, between the two Paroxysms or Returns of the +Fever. + +10, As the Organs of Digestion have been considerably weakened through +the Course of this Fever, there is a Necessity for the Patient's +conducting himself very prudently and regularly long after it, with +Regard both to the Quantity and Quality of his Food. He should also use +due Exercise as soon as his Strength will permit, without which he may +be liable to fall into some chronical and languishing Disorder, +productive of considerable Languor and Weakness. * + + [*] As our Jail, Hospital, and Camp Fevers may often be ranged in this + Class, as of the most putrid Kind, and not seldom occasioned by bad + Food, bad Air, unclean, unwholesome Lodging, _&c._ a judicious Use + may certainly be made of a small Quantity of genuine, and not + ungenerous, Wine in such of them, as are not blended with an + inflammatory Cause, or inflammable Constitution, or which do not + greatly result from a bilious Cause; though in these last, where + there is manifest Lowness and Dejection, perhaps a little Rhenish + might be properly interposed between the Lemonade and other Drinks + directed Sec. 241. Doubtless Dr. _Tissot_ was perfectly apprized of + this salutary Use of it in some low Fevers; but the Necessity of + its being regulated by the Presence of a Physician has probably + disposed him rather to omit mentioning it, than to leave the + Allowance of it to the Discretion of a simple Country Patient, or + his ignorant Assistants. _K._ + + + + + __Chapter XVII.__ + + + _Of malignant Fevers._ + + + __Sect.__ 242. + +Those Fevers are termed malignant, in which the Danger is more than the +Symptoms would make us apprehensive of: they have frequently a fatal +Event without appearing so very perilous; on which Account it has been +well said of this Fever, that it is a Dog which bites without barking. + +Sec. 243. The distinguishing _Criterion_ or Mark of malignant Fevers is a +total Loss of the Patient's Strength, immediately on their first Attack. +They arise from a Corruption of the Humours, which is noxious to the +very Source and Principle of Strength, the Impairing or Destruction of +which is the Cause of the Feebleness of the Symptoms; by Reason none of +the Organs are strong enough to exert an Opposition sufficiently +vigorous, to subdue the Cause of the Distemper. + +If, for Instance or Illustration, we were to suppose, that when two +Armies were on the Point of engaging, one of them should be nearly +deprived of all their Weapons, the Contest would not appear very +violent, nor attended with great Noise or Tumult, though with a horrible +Massacre. The Spectator, who, from being ignorant of one of the Armies +being disarmed, would not be able to calculate the Carnage of the +Battle, but in Proportion to its Noise and Tumult, must be extremely +deceived in his Conception of it. The Number of the Slain would be +astonishing, which might have been much less (though the Noise and +Clangor of it had been greater) if each Army had been equally provided +for the Combat. + +Sec. 244. The Causes of this Disease are a long Use of animal Food or Flesh +alone, without Pulse, Fruits or Acids; the continued Use of other bad +Provisions, such as Bread made of damaged Corn or Grain, or very stale +Meat. Eight Persons, who dined together on corrupt Fish, were all seized +with a malignant Fever, which killed five of them, notwithstanding the +Endeavours of the most able Physicians. These Fevers are also frequently +the Consequence of a great Dearth or Famine; of too hot and moist an +Air, or an Air, which highly partakes of these two Qualities; so that +they happen to spread most in hot Years, in Places abounding with +Marshes and standing Waters. They are also the Effect of a very close +and stagnant Air, especially if many Persons are crouded together in it, +this being a Cause that particularly tends to corrupt the Air. Tedious +Grief and Vexation also contribute to generate these Fevers. + +Sec. 245. The Symptoms of malignant Fevers are, as I have already observed, +a total and sudden Loss of Strength, without any evident preceding +Cause, sufficient to produce such a Privation of Strength: at the same +Time there is also an utter Dejection of the Mind, which becomes almost +insensible and inattentive to every Thing, and even to the Disease +itself; a sudden Alteration in the Countenance, especially in the Eyes: +some small Shiverings, which are varied throughout the Space of +twenty-four Hours, with little Paroxysms or Vicissitudes of Heat; +sometimes there is a great Head-ach and a Pain in the Loins; at other +Times there is no perceivable Pain in any Part; a kind of Sinkings or +Faintings, immediately from the Invasion of the Disease, which is always +very unpromising; not the least refreshing Sleep; frequently a kind of +half Sleep, or Drowsiness; a light and silent or inward Raving, which +discovers itself in the unusual and astonished Look of the Patient, who +seems profoundly employed in meditating on something, but really thinks +of nothing, or not at all: Some Patients have, however, violent Ravings; +most have a Sensation of Weight or Oppression, and at other Times of a +Binding or Tightness about, or around, the Pit of the Stomach. + +The sick Person seems to labour under great Anguish: he has sometimes +slight convulsive Motions and Twitchings in his Face and his Hands, as +well as in his Arms and Legs. His Senses seem torpid, or as it were +benumbed. I have seen many who had lost, to all Appearance, the whole +five, and yet some of them recover. It is not uncommon to meet with +some, who neither see, understand, nor speak. Their Voices change, +become weak, and are sometimes quite lost. Some of them have a fixed +Pain in some Part of the Belly: this arises from a Stuffing or +Obstruction, and often ends in a Gangrene, whence this Symptom is highly +dangerous and perplexing. + +The Tongue is sometimes very little altered from its Appearance in +Health; at other Times covered over with a yellowish brown Humour; but +it is more rarely dry in this Fever than in the others; and yet it +sometimes does resemble a Tongue that has been long smoaked. + +The Belly is sometimes very soft, and at other Times tense and hard. The +Pulse is weak, sometimes pretty regular, but always more quick than in a +natural State, and at some Times even very quick; and such I have always +found it, when the Belly has been distended. + +The Skin is often neither hot, dry, nor moist: it is frequently +overspread with petechial or eruptive Spots (which are little Spots of a +reddish livid Colour) especially on the Neck, about the Shoulders, and +upon the Back. At other Times the Spots are larger and brown, like the +Colour of Wheals from the Strokes of a Stick. + +The Urine of the Sick is almost constantly crude, that is of a lighter +Colour than ordinary. I have seen some, which could not be +distinguished, merely by the Eye, from Milk. A black and stinking +Purging sometimes attends this Fever, which is mortal, except the Sick +be evidently relieved by the Discharge. + +Some of the Patients are infested with livid Ulcers on the Inside of the +Mouth, and on the Palate. At other Times Abscesses are formed in the +Glands of the Groin, of the Arm-pit, in those between the Ears and the +Jaw; or a Gangrene may appear in some Part, as on the Feet, the Hands, +or the Back. The Strength proves entirely spent, the Brain is wholly +confused: the miserable Patient stretched out on his Back, frequently +expires under Convulsions, an enormous Sweat, and an oppressed Breast +and Respiration. Haemorrhages also happen sometimes and are mortal, being +almost unexceptionably such in this Fever. There is also in this, as in +all other Fevers, an Aggravation of the Fever in the Evening. + +Sec. 246. The Duration and _Crisis_ of these malignant, as well as those of +putrid Fevers, are very irregular. Sometimes the Sick die on the seventh +or eighth Day, more commonly between the twelfth and the fifteenth, and +not infrequently at the End of five or six Weeks. These different +Durations result from the different Degree and Strength of the Disease. +Some of these Fevers at their first Invasion are very slow; and during a +few of the first Days, the Patient, though very weak, and with a very +different Look and Manner, scarcely thinks himself sick. + +The Term or Period of the Cure or the Recovery, is as uncertain as that +of Death in this Distemper. Some are out of Danger at the End of fifteen +Days, and even sooner; others not before the Expiration of several +Weeks. + +The Signs which portend a Recovery are, a little more Strength in the +Pulse; a more concocted Urine; less Dejection and Discouragement; a less +confused Brain; an equal kindly Heat; a pretty warm or hot Sweat in a +moderate Quantity, without Inquietude or Anguish; the Revival of the +different Senses that were extinguished, or greatly suspended in the +Progress of the Disease; though the Deafness is not a very threatening +Symptom, if the others amend while it endures. + +This Malady commonly leaves the Patient in a very weak Condition; and a +long Interval will ensue between the End of it, and their recovering +their full Strength. + +Sec. 247. It is, in the first place, of greater Importance in this +Distemper than in any other, both for the Benefit of the Patients, and +those who attend them, that the Air should be renewed and purified. +Vinegar should often be evaporated from a hot Tile or Iron in the +Chamber, and one Window kept almost constantly open. + +2, The Diet should be light; and the Juice of Sorrel may be mixed with +their Water; the Juice of Lemons may be added to Soups prepared from +different Grains and Pulse; the Patient may eat sharp acid Fruits, such +as tart juicy [65] Cherries, Gooseberries, small black Cherries; and +those who can afford them, may be allowed Lemons, Oranges and +Pomgranates. + +[65] The French Word is _Griettes_, which _Beyer_ englishes, _the + Agriot, the red or sour Cherry_; and _Chambaud, the sweeter large + black Cherry or Mazzard_--But as Dr. _Tissot_ was recommending the + Use of Acids, it is more probably the first of these: so that our + Morellas, which make a pleasant Preserve, may be a good Substitute + to them, supposing them not to be the same. Our Berbery Jam, and + Jelly of Red Currants, may be also employed to answer the same + Indication. _K._ + +3, The Patient's Linen should be changed every two Days. + +4, Bleeding is very rarely necessary, or even proper, in this Fever; the +Exceptions to which are very few, and cannot be thoroughly ascertained, +as fit and proper Exceptions to the Omission of Bleeding, without a +Physician, or some other very skilful Person's seeing the Patient. + +5, There is often very little Occasion for Glysters, which are sometimes +dangerous in this Fever. + +6, The Patient's common Drink should be Barley Water made acid with the +Spirit No. 10, at the Rate of one Quarter of an Ounce to at least full +three Pints of the Water, or acidulated agreeably to his Taste. He may +also drink Lemonade. + +7, It is necessary to open and evacuate the Bowels, where a great +Quantity of corrupt Humours is generally lodged. The Powder No. 35 may +be given for this Purpose, after the Operation of which the Patient +generally finds himself better, at least for some Hours. It is of +Importance not to omit this at the Beginning of the Disease; though if +it has been omitted at first, it were best to give it even later, +provided no particular Inflammation has supervened, and the Patient has +still some Strength. I have given it, and with remarkable Success, on +the twentieth Day. + +8, Having by this Medicine expelled a considerable Portion of the bad +Humours, which contribute to feed and keep up the Fever, the Patient +should take every other Day, during the Continuance of the Disease, and +sometimes even every Day, one Dose of the Cream of Tartar and Rhubarb +No. 38. This Remedy evacuates the corrupt Humours, prevents the +Corruption of the others; expells the Worms that are very common in +these Fevers, which the Patient sometimes discharges upwards and +downwards; and which frequently conduce to many of the odd and +extraordinary Symptoms, that are observed in malignant Fevers. In short +it strengthens the Bowels, and, without checking the necessary +Evacuations, it moderates the Looseness, when it is hurtful. + +9, If the Skin be dry, with a Looseness, and that by checking it, we +design to increase Perspiration, instead of the Rhubarb, the Cream of +Tartar may be blended with the Ipecacuana, No. 39, which, being given in +small and frequent Doses, restrains the Purging, and promotes +Perspiration. This Medicine, as the former, is to be taken in the +Morning; two Hours after, the Sick must begin with the Potion No. 40, +and repeat it regularly every three Hours; until it be interrupted by +giving one of the Medicines No. 38 or 39: After which the Potion is to +be repeated again, as already directed, till the Patient grows +considerably better. + +10, If the Strength of the Sick be very considerably depressed, and he +is in great Dejection and Anguish, he should take, with every Draught of +the Potion, the Bolus, or Morsel No. 41. If the _Diarrhoea_, the Purging +is violent, there should be added, once or twice a Day to the Bolus, the +Weight of twenty Grains, or the Size of a very small Bean, of +_Diascordium_; or if that is not readily to be got, as much Venice +Treacle. + +11, Whenever, notwithstanding all this Assistance, the Patient continues +in a State of Weakness and Insensibility, two large Blisters should be +applied to the fleshy Insides of the Legs, or a large one to the Nape of +the Neck: and sometimes, if there be a great Drowsiness, with a manifest +Embarrassment of the Brain, they may be applied with great Success over +the whole Head. Their Suppuration and Discharge is to be promoted +abundantly; and, if they dry up within a few Days, others are to be +applied, and their Evacuation is to be kept up for a considerable Time. + +12, As soon as the Distemper is sufficiently abated, for the Patient to +remain some Hours with very little or no Fever, we must avail ourselves +of this Interval, to give him six, or at least five Doses of the +Medicine No. 14, and repeat the same the next Day, which may prevent the +Return of the Fever: [66] after which it may be sufficient to give daily +only two Doses for a few Days. + +[66] Observation and Experience have demonstrated the Advantage of the + Bark, to obviate a Gangrene, and prevent the Putrefaction of animal + Substances. We therefore conclude it may be usefully employed in + malignant Fevers, as soon as the previous and necessary Evacuations + shall have taken Place. _E. L._--Provided there be very clear and + regular Remissions at least. _K._ + +13, When the Sick continue entirely clear of a Fever, or any Return, +they are to be put into the _Regimen_ of Persons in a State of Recovery. +But if his Strength returns very slowly, or not at all; in Order to the +speedier Establishment and Confirmation of it, he may take three Doses a +Day of the _Theriaca Pauperum_, or poor Man's Treacle No. 42, the first +of them fasting, and the other twelve Hours after. It were to be wished +indeed, this Medicine was introduced into all the Apothecaries Shops, as +an excellent Stomachic, in which Respect it is much preferable to Venice +Treacle, which is an absurd Composition, dear and often dangerous. It is +true it does not dispose the Patients to Sleep; but when we would +procure them Sleep, there are better Medicines than the Treacle to +answer that Purpose. Such as may not think the Expence of the Medicine +No. 14, too much, may take three Doses of it daily for some Weeks, +instead of the Medicine No. 42, already directed. + +Sec. 248. It is necessary to eradicate a Prejudice that prevails among +Country People, with Regard to the Treatment of these Fevers; not only +because it is false and ridiculous, but even dangerous too. They imagine +that the Application of Animals can draw out the Poison of the Disease; +in Consequence of which they apply Poultry, or Pigeons, Cats or sucking +Pigs to the Feet, or upon the Head of the Patient, having first split +the living Animals open. Some Hours after they remove their strange +Applications, corrupted, and stinking very offensively; and then ascribe +such Corruption and horrid Stink to the Poison they suppose their +Application to be charged with; and which they suppose to be the Cause +of this Fever. But in this supposed Extraction of Poison, they are +grosly mistaken, since the Flesh does not stink in Consequence of any +such Extraction, but from its being corrupted through Moisture and Heat: +and they contract no other Smell but what they would have got, if they +had been put in any other Place, as well as on the Patient's Body, that +was equally hot and moist. Very far from drawing out the Poison, they +augment the Corruption of the Disease; and it would be sufficient to +communicate it to a sound Person, if he was to suffer many of these +animal Bodies, thus absurdly and uselessly butchered, to be applied to +various Parts of his Body in Bed; and to lie still a long Time with +their putrified Carcases fastened about him, and corrupting whatever Air +he breathed there. + +With the same Intention they fasten a living Sheep to the Bed's-foot for +several Hours; which, though not equally dangerous, is in some Measure +hurtful, since the more Animals there are in a Chamber, the Air of it is +proportionably corrupted, or altered at least from its natural +Simplicity, by their Respiration and Exhalations: but admitting this to +be less pernicious, it is equally absurd. It is certain indeed, the +Animals who are kept very near the sick Person breathe in the poisonous, +or noxious Vapours which exhale from his Body, and may be incommoded +with them, as well as his Attendants: But it is ridiculous to suppose +their being kept near the Sick causes such Poison to come out of their +Bodies. On the very contrary, in contributing still further to the +Corruption of the Air, they increase the Disease. They draw a false +Consequence, and no Wonder, from a false Principle; saying, if the Sheep +dies, the Sick will recover. Now, most frequently the Sheep does not +die; notwithstanding which the Sick sometimes recover; and sometimes +they both die. + +Sec. 249. The Cause of Malignant Fevers is, not infrequently, combined with +other Diseases, whose Danger it extremely increases. It is blended for +Instance, with the Poison of the Small-Pocks, or of the Measles. This +may be known by the Union of those Symptoms, which carry the Marks of +Malignity, with the Symptoms of the other Diseases. Such combined Cases +are extremely dangerous; they demand the utmost Attention of the +Physician; nor is it possible to prescribe their exact Treatment here; +since it consists in general of a Mixture of the Treatment of each +Disease; though the Malignity commonly demands the greatest Attention. + + + + + __Chapter XVIII.__ + + + _Of intermitting Fevers._ + + + __Sect.__ 250. + +Intermitting Fevers, commonly called here, Fevers and Agues, are those, +which after an Invasion and Continuance for some Hours, abate very +perceivably, as well as all the Symptoms attending them, and then +entirely cease; nevertheless, not without some periodical or stated +Return of them. + +They were very frequent with us some Years since; and indeed might even +be called epidemical: but for the five or six last Years, they have been +much less frequent throughout the greater Part of _Swisserland_: +notwithstanding they still continue in no small Number in all Places, +where the Inhabitants breathe the Air that prevails in all the marshy +Borders of the _Rhone_, and in some other Situations that are exposed to +much the same humid Air and Exhalations. + +Sec. 251. There are several Kinds of intermitting Fevers, which take their +different Names from the Interval or different Space of Time, in which +the Fits return. + +If the Paroxysm or Fit returns every Day, it is either a true Quotidian, +or a double Tertian Fever: The first of these may be distinguished from +the last by this Circumstance, that in the Quotidian, or one Day Fever, +the Fits are long; and correspond pretty regularly to each other in +Degree and Duration. This however is less frequent in _Swisserland_. In +the double Tertian, the Fits are shorter, and one is alternately light, +and the other more severe. + +In the simple Tertian, or third Day's Fever, the Fits return every other +Day; so that three Days include one Paroxysm, and the Return of another. + +In a Quartan, the Fit returns every fourth Day, including the Day of the +first and that of the second Attack: so that the Patient enjoys two +clear Days between the two sick ones. + +The other kinds of Intermittents are much rarer. I have seen however one +true Quintan, or fifth Day Ague, the Patient having three clear Days +between two Fits; and one regularly weekly Ague, as it may be called, +the Visitation of every Return happening every Sunday. + +Sec. 252. The first Attack of an intermittent Fever often happens, when the +Patient thought himself in perfect Health. Sometimes however it is +preceded by a Sensation of Cold and a kind of Numbness, which continue +some Days before the manifest Invasion of the Fit. It begins with +frequent Yawnings, a Lassitude, or Sensation of Weariness, with a +general Weakness, with Coldness, Shivering and Shaking: There is also a +Paleness of the extreme Parts of the Body, attended with Loathings, and +sometimes an actual Vomiting. The Pulse is quick, weak, and small, and +there is a considerable Degree of Thirst. + +At the End of an Hour or two, and but seldom so long as three or four +Hours, a Heat succeeds, which increases insensibly, and becomes violent +at its Height. At this Period the whole Body grows red, the Anxiety of +the Patient abates; the Pulse is very strong and large, and his Thirst +proves excessive. He complains of a violent Head-ach, and of a Pain in +all his Limbs, but of a different sort of Pain from that he was sensible +of, while his Coldness continued. Finally, having endured this hot +State, four, five or six Hours, he falls into a general Sweat for a few +more: upon which all the Symptoms already mentioned abate, and sometimes +Sleep supervenes. + +At the Conclusion of this Nap the Patient often wakes without any +sensible Fever; complaining only of Lassitude and Weakness. Sometimes +his Pulse returns entirely to its natural State between the two Fits; +though it often continues a little quicker than in perfect Health; and +does not recover its first Distinctness and Slowness, till some Days +after the last Fit. + +One Symptom, which most particularly characterises these several Species +of intermitting Fevers, is the Quality of the Urines which the Sick pass +after the Fit. They are of a reddish Colour, and let fall a Sediment, or +Settling, which exactly resembles Brick-dust. They are sometimes frothy +too, and a Pellicle, or thin filmy Skin, appears on the Top, and adheres +to the Sides of the Glass that contains them. + +Sec. 253. The Duration of each Fit is of no fixed Time or Extent, being +various according to the particular sort of Intermittents, and through +many other Circumstances. Sometimes they return precisely at the very +same Hour; at other Times they come one, two, or three Hours sooner, and +in other Instances as much later than the former. It has been imagined +that those Fevers, whose Paroxysms returned sooner than usual, were +sooner finally terminated: but there seems to be no general Rule in this +Case. + +Sec. 254. Intermitting Fevers are distinguished into those of Spring and +Autumn. The former generally prevail from February to June: the latter +are those which reign from July to January. Their essential Nature and +Characters are the very same, as they are not different Distempers; +though the various Circumstances attending them deserve our +Consideration. These Circumstances depend on the Season itself, and the +Constitution of the Patients, during such Seasons. The Spring +Intermittents are sometimes blended with an inflammatory Disposition, as +that is the Disposition of Bodies in that Season; but as the Weather +then advances daily into an improving State, the Spring Fevers are +commonly of a shorter Duration. The autumnal Fevers are frequently +combined and aggravated with a Principle of Putrefaction; and as the Air +of that Season rather degenerates, they are more tedious and obstinate. + +Sec. 255. The autumnal Fevers seldom begin quite so early as July, but much +oftner in August: and the Duration to which they are often extended, has +increased the Terror which the People entertain of Fevers that begin in +that Month. But that Prejudice which ascribes their Danger to the +Influence of August, is a very absurd Error; since it is better they +should set in then than in the following Months; because they are +obstinate in Proportion to the Tardiness, the Slowness of their +Approach. They sometimes appear at first considerably in the Form of +putrid Fevers, not assuming that of Intermittents till some Days after +their Appearance: but very happily there is little or no Danger in +mistaking them for putrid Fevers, or in treating them like such. The +Brick-coloured Sediment, and particularly the Pellicle or Film on the +Surface of the Urine, are very common in autumnal Intermittents, and are +often wanting in the Urine of putrid Fevers. In these latter, it is +generally less high coloured, and leaning rather to a yellow, a kind of +Cloudiness is suspended in the Middle of it. These also deposite a white +Sediment, which affords no bad Prognostic. + +Sec. 256. Generally speaking, intermitting Fevers are not mortal; often +terminating in Health of their own Accord (without the Use of any +Medicine) after some Fits. In this last Respect Intermittents in the +Spring differ considerably from those in the Fall, which continue a long +Time, and sometimes even until Spring, if they are not removed by Art, +or if they have been improperly treated. + +Quartan Fevers are always more obstinate and inveterate than Tertians; +the former sometimes persevering in certain Constitutions for whole +Years. When these Sorts of Fevers occur in boggy marshy Countries, they +are not only very chronical or tedious, but Persons infested with them +are liable to frequent Relapses. + +Sec. 257. A few Fits of an Intermittent are not very injurious, and it +happens sometimes, that they are attended with a favourable Alteration +of the Habit in Point of Health; by their exterminating the Cause or +Principle of some languid and tedious Disorder; though it is erroneous +to consider them as salutary. If they prove tedious and obstinate, and +the Fits are long and violent, they weaken the whole Body, impairing all +its Functions, and particularly the Digestions: They make the Humours +sharp and unbalmy, and introduce several other Maladies, such as the +Jaundice, Dropsy, Asthma and slow wasting Fevers. Nay sometimes old +Persons, and those who are very weak, expire in the Fit; though such an +Event never happens but in the cold Fit. + +Sec. 258. Very happily Nature has afforded us a Medicine, that infallibly +cures these Fevers: this is the _Kinkina_, or Jesuits Bark; and as we +are possessed of this certain Remedy, the only remaining Difficulty is +to discover, if there be not some other Disease combined with these +Fevers, which Disease might be aggravated by the Bark. Should any such +exist, it must be removed by Medicines adapted to it, before the Bark is +given. [67] + +[67] This admirable Medicine was unknown in Europe, till about one + hundred and twenty Years past; we are obliged to the Spaniards for + it, who found it in the Province of Quito in Peru; the Countess of + Chinchon being the first European who used it in America, whence it + was brought to Spain, under the Name of the Countesses Powder. The + Jesuits having soon dispensed and distributed it abroad, it became + still more publick by the Name of the Jesuits Powder: and since it + has been known by that of _Kinkina_ or the Peruvian Bark. It met + with great Opposition at first; some deeming it a Poison, while + others considered it as a divine Remedy: so that the Prejudices of + many being heightened by their Animosity, it was nearly a full + Century, before its true Virtue and its Use were agreed to: and + about twenty Years since the most unfavourable Prejudices against + it pretty generally subsided. The Insufficience of other Medicines + in several Cases; its great Efficaciousness; and the many and + surprizing Cures which it did, and daily does effect; the Number of + Distempers; the different kinds of Fevers, in which it proves the + sovereign Remedy; its Effects in the most difficult chirurgical + Cases; the Comfort, the Strength and Sprits it gives those who need + and take it, have at length opened every Persons Eyes; so that it + has almost unanimously obtained the first Reputation, among the + most efficacious Medicines. The World is no longer amused with + Apprehensions of its injuring the Stomach; of its fixing, or + _shutting up_ the Fever (as the Phrase has been) without curing it; + that it shuts up the Wolf in the Sheepfold; that it throws those + who take it into the Scurvy, the Asthma, the Dropsy, the Jaundice. + On the contrary they are persuaded it prevents there very Diseases; + and, that if it is ever hurtful, it is only when it is either + adulterated, as most great Remedies have been; or has been wrongly + prescribed, or improperly taken: or lastly when it meets with some + latent, some unknown Particularities in a Constitution, which + Physicians term an _Idiosyncrasy_, and which prevent or pervert its + very general Effects. _Tissot._ + +Sec. 259. In the vernal, or Spring-Fevers, if the Fits are not very severe; +if the Patient is evidently well in their Intervals; if his Appetite, +his Strength, and his Sleep continue as in Health, no Medicine should be +given, nor any other Method be taken, but that of putting the Person, +under such a gentle Intermittent, upon the Regimen directed for Persons +in a State of Recovery. This is such a Regimen as pretty generally +agrees with all the Subjects of these Fevers: for if they should be +reduced to the Regimen proper in acute Diseases, they would be weakened +to no Purpose, and perhaps be the worse for it. But at the same Time if +we were not to retrench from the Quantity, nor somewhat to vary the +Quality of their usual Food in a State of Health; as there is not the +least Digestion made in the Stomach, during the whole Term of the Fit; +and as the Stomach is always weakened a little by the Disease, crude and +indigested Humours would be produced, which might afford a Fuel to the +Disease. Not the least solid Food should be allowed, for at least two +Hours before the usual Approach of the Fit. + +Sec. 260. If the Fever extends beyond the sixth, or the seventh Fit; and +the Patient seems to have no Occasion for a Purge; which may be learned +by attending to the Chapter, which treats of Remedies to be taken by Way +of Precaution; [68] he may take the Bark, that is the Powder No. 14. If +it is a Quotidian, a daily Fever, or a double Tertian, six Doses, +containing three Quarters of an Ounce, should be taken between the two +Fits; and as these Intermissions commonly consist of but ten or twelve, +or at the most of fourteen or fifteen Hours, there should be an Interval +of only one Hour and a half between each Dose. During this Interval the +Sick may take two of his usual Refreshments or Suppings. + +[68] It happens very seldom that intermitting Fevers require [69] no + Purge towards their Cure, especially in Places, which are disposed + to generate Putridity. There is always some material Cause + essential to these Fevers, of which Nature disembarrasses herself + more easily by Stools, than by any other Discharge: And as there is + not the least Danger to be apprehended from a gentle Purge, such at + those of No. 11 or 23, we think it would be prudent always to + premise a Dose or two of either to the Bark. _E. L._ + +[69] Yet I have known many in whom no Purge was necessary, and have seen + some rendered more obstinate and chronical by erroneous Purging. + But a Vomit is very generally necessary before the Bark is given. + _K._ + +When the Fever is a Tertian, an Ounce should be given between the two +Fits: which makes eight Doses, one of which is to be taken every three +Hours. + +In a Quartan I direct one Ounce and a half, to be taken in the same +Manner. It is meer trifling to attempt preventing the Returns with +smaller Doses. The frequent Failures of the Bark are owing to over small +Doses. On such Occasions the Medicine is cried down, and censured as +useless, when the Disappointment is solely the Fault of those who do not +employ it properly. The last Dose is to be given two Hours before the +usual Return of the Fit. + +The Doses, just mentioned, frequently prevent the Return of the Fit; but +whether it returns or not, after the Time of its usual Duration is past, +repeat the same Quantity, in the same Number of Doses, and Intervals, +which certainly keeps off another. For six Days following, half the same +Quantity must be continued, in the Intervals that would have occurred +between the Fits, if they had returned: and during all this Time the +Patient should inure himself to as much Exercise, as he can well bear. + +Sec. 261. Should the Fits be very strong, the Pain of the Head violent, the +Visage red, the Pulse full and hard; if there is any Cough; if, even +after the Fit is over, the Pulse still is perceivably hard; if the Urine +is inflamed, hot and high-coloured, and the Tongue very dry, the Patient +must be bled, and drink plentifully of Barley Water No. 3. These two +Remedies generally bring the Patient into the State described Sec. 259: in +which State he may take on a Day, when the Fever is entirely off, three +or four Doses of the Powder No. 24, and then leave the Fever to pursue +its own Course for the Space of a few Fits. But should it not then +terminate of itself, the Bark must be recurred to. + +If the Patient, even in the Interval of the Returns, has a foetid, +furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much +Anxiety, and bad Nights, he should be purged with the Powder No. 21 or +the Potion No. 23, before he takes the Bark. + +Sec. 262. If Fevers in Autumn appear to be of the continual kind, and very +like putrid Fevers, the Patients should drink abundantly of Barley +Water; and if at the Expiration of two or three Days, there still +appears to be a Load or Oppression at the Stomach, the Powder No. 34 or +that of 35 is to be given (but see Sec. 241): and if, after the Operation +of this, the Signs of Putridity continue, the Body is to be opened with +repeated Doses of the Powder No. 24; or, where the Patients are very +robust, with No. 21; and when the Fever becomes quite regular, with +distinct _Remissions_ at least, the Bark is to be given as directed Sec. +260. + +But as autumnal Fevers are more obstinate; after having discontinued the +Bark for eight Days; and notwithstanding there has been no Return of the +Fever, it is proper to resume the Bark, and to give three Doses of it +daily for the succeeding eight Days, more especially if it was a +Quartan; in which Species I have ordered it to be repeated, every other +eight Days, for six Times. + +Many People may find it difficult to comply with this Method of Cure, +which is unavoidably expensive, through the Price of the Bark. I thought +however this ought not to prevent me from averring it to be the only +certain one; since nothing can be an equivalent _Succedaneum_ or +Substitute to this Remedy, which is the only sure and safe one in all +these Cases. The World had long been prepossessed with Prejudices to the +contrary: it was supposed to be hurtful to the Stomach; to prevent which +it has been usual to make the Sick eat something an Hour after it. +Nevertheless, very far from injuring the Stomach, it is the best +Medicine in the Universe to strengthen it; and it is a pernicious +Custom, when a Patient is obliged to take it often, to eat an Hour after +it. It had also been imagined to cause Obstructions, and that it +subjected Patients to a Dropsy: but at present we are convinced, it is +the obstinate and inveterate Duration of the Intermittent, that causes +Obstructions, and paves the Way to a Dropsy. The Bark, in Consequence of +its speedily curing the Fever, does not only prevent the former Disease; +but when it continues, through an injudicious Omission of the Bark, a +proper Use of it is serviceable in the Dropsy. In a Word, if there is +any other Malady combined with the Fever, sometimes that indeed prevents +the Success of the Bark, yet without rendering it hurtful. But whenever +the intermitting Fever is simple and uncombined, it ever has, and ever +will render the Patient all possible Service. In another Place I shall +mention such Means and Methods as may in some Degree, though but +imperfectly, be substituted instead of it. + +After the Patient has begun with the Bark, he must take no purging +Medicine, as that Evacuation would, with the greatest Probability, +occasion a Return of the Fever. + +Sec. 263. Bleeding is never, or extremely seldom indeed necessary in a +Quartan Ague, which occurs in the Fall oftner than in the Spring; and +with the Symptoms of Putridity rather than of Inflammation. + +Sec. 264. The Patient ought, two Hours before the Invasion of the Fit, to +drink a small Glass of warm Elder Flower Tea, sweetened with Honey, +every Quarter of an Hour, and to walk about moderately; this disposes +him to a very gentle Sweat, and thence renders the ensuing Coldness and +the whole Fit milder. He is to continue the same Drink throughout the +Duration of the cold Fit; and when the hot one approaches, he may either +continue the same, or substitute that of No. 2, which is more cooling. +It is not necessary however, in this State, to drink it warm, it is +sufficient that it be not over cold. When the Sweat, at the Termination +of the hot Fit, is concluded, the Patient should be well wiped and +dried, and may get up. If the Fit was very long, he may be allowed a +little Gruel, or some other such Nourishment during the Sweat. + +Sec. 265. Sometimes the first, and a few successive Doses of the Bark purge +the Patient. This is no otherwise an ill Consequence, than by its +retarding the Cure; since, when it purges, it does not commonly prevent +the Return of the Fever; so that these Doses may be considered as to no +Purpose, and others should be repeated, which, ceasing to purge, do +prevent it. Should the Looseness notwithstanding continue, the Bark must +be discontinued for one entire Day, in order to give the Patient half a +Quarter of an Ounce of Rhubarb: after which the Bark is to be resumed +again, and if the Looseness still perseveres, fifteen Grains of Venice +Treacle should be added to each Dose, but not otherwise. All other +Medicines which are superadded, very generally serve only to increase +the Bulk of the Dose, while they lessen its Virtue. + +Sec. 266. Before our thorough Experience of the Bark, other bitter +Medicines were used for the same Purpose: these indeed were not +destitute of Virtue in such Cases, though they were considerably less +available than the Bark. Under No. 43, some valuable Prescriptions of +that kind may be seen, whose Efficacy I have often experienced: though +at other Times I have been obliged to leave them off, and recur to the +Bark more successfully. Filings of Iron, which enter into the third +Prescription, are an excellent Febrifuge in particular Cases and +Circumstances. In the Middle of the Winter 1753, I cured a Patient of a +Quartan Ague with it, who would not be prevailed on to take the Bark. It +must be confessed he was perfectly regular in observing the _Regimen_ +directed for him; and that, during the most rigid Severity of the +Winter, he got every Day on Horseback, and took such a Degree of other +Exercise in the open Air, as disposed him to perspire abundantly. + +Sec. 267. Another very practicable easy Method, of which I have often +availed my Patients, under tertian Fevers (but which succeeded with me +only twice in Quartans) was to procure the Sufferer a very plentiful +Sweat, at the very Time when the Fit was to return, in its usual Course. +To effect this he is to drink, three or four Hours before it is +expected, an Infusion of Elder Flowers sweetened with Honey, which I +have already recommended Sec. 264; and one Hour before the usual Invasion +of the Shivering, he is to go into Bed, and take, as hot as he can drink +it, the Prescription No. 44. + +I have also cured some Tertians and even Quartans, in 1751 and 1752, by +giving them, every four Hours between the Fits, the Powder No. 45. But I +must acknowledge that, besides its having often failed me, and its never +succeeding so speedily as the Bark, I have found it weaken some +Patients; it disorders, or disagrees with, their Stomachs: and in two +Cases, where it had removed the Fever, I was obliged to call in the Bark +for a thorough Establishment of the Patient's Health. Nevertheless, as +these Medicines are very cheap and attainable, and often do succeed, I +thought I could not properly omit them. + +Sec. 268. A Multitude of other Remedies are cried up for the Cure of +Fevers: though none of them are equally efficacious with those I have +directed: and as many of them are even dangerous, it is prudent to +abstain from them. Some Years since certain Powders were sold here, +under the Name of the _Berlin_ Powders; these are nothing but the Bark +masqued or disguised (which has sometimes been publickly discovered) and +have always been sold very dear: though the Bark well chosen, and +freshly powdered when wanted, is greatly preferable. + +Sec. 269. I have often known Peasants, who had laboured for several Months +under intermitting Fevers; having made Use of many bad Medicines and +Mixtures for them, and observed no Manner of Regimen. Such I have +happily treated by giving them the Remedies No. 34, or 35; and +afterwards, for some Days, that of No. 38; at the End of which Time, I +have ordered them the Bark (See Sec. 260) or other Febrifuges, as at Sec. 266, +267; and then finally ordered them for some Days, to take Morsels of the +poor Man's Treacle (See Sec. 247, _Art._ 13) to strengthen and confirm +their Digestions, which I have found very weak and irregular. + +Sec. 270. Some Intermittents are distinguished as pernicious or malignant, +from every Fit's being attended with the most violent Symptoms. The +Pulse is small and irregular, the Patient exceedingly dejected, and +frequently swooning; afflicted with inexpressible Anguish, Convulsions, +a deep Drowsiness, and continual Efforts to go to Stool, or make Urine, +but ineffectually. This Disease is highly pressing and dangerous; the +Patient may die in the third Fit, and rarely survives the sixth, if he +is not very judiciously treated. Not a Moment should be lost, and there +is no other Step to be taken, but that of giving the Bark continually, +as directed Sec. 260, to prevent the succeeding Fits. These worst Kinds of +Intermittents are often combined with a great Load of putrid Humours in +the first Passages: and as often as such an aggravating Combination is +very evident, we should immediately after the End of one Fit, give a +Dose of Ipecacuana No. 35, and, when its Operation is finished, give the +Bark. But I chuse to enter into very few Details on this Species of +Intermittents, both as they occur but seldom, and as the Treatment of +them is too difficult and important, to be submitted to the Conduct of +any one but a Physician. My Intention has only been to represent them +sufficiently, that they may be so distinguished when they do occur, as +to apprize the People of their great Danger. + +Sec. 271. The same Cause which produces these intermitting Fevers, +frequently also occasions Disorders, which return periodically at the +same Hour, without Shivering, without Heat, and often without any +Quickness of the Pulse. Such Disorders generally preserve the +Intermissons of quotidian or tertian Fevers, but much seldomer those of +Quartans. I have seen violent Vomittings, and Reachings to vomit, with +inexpressible Anxiety; the severest Oppressions, the most racking +Cholics; dreadful Palpitations and excessive Tooth-achs: Pains in the +Head, and very often an unaccountable Pain over one Eye, the Eyelid, +Eyebrow and Temple, on the same Side of the Face; with a Redness of that +Eye, and a continual, involuntary trickling of Tears. I have also seen +such a prodigious Swelling of the affected Part, that the Eye projected, +or stood out, above an Inch from the Head, covered by the Eyelid, which +was also extremely inflated or puffed up. All these Maladies begin +precisely at a certain Hour; last about the usual Time of a Fit; and +terminating without any sensible Evacuation, return exactly at the same +Hour, the next Day, or the next but one. + +There is but one known Medicine that can effectually oppose this Sort, +which is the Bark, given as directed Sec. 260. Nothing affords Relief in +the Fit, and no other Medicine ever suspends or puts it off. But I have +cured some of these Disorders with the Bark, and especially those +affecting the Eyes, which happen oftner than the other Symptoms, after +their Duration for many Weeks, and after the ineffectual Use of +Bleeding, Purging, Baths, Waters, Blisters, and a great Number of other +Medicines. If a sufficient Dose of it be given, the next Fit is very +mild; the second is prevented; and I never saw a Relapse in these Cases, +which sometimes happens after the Fits of common Intermittents seemed +cured. + +Sec. 272. In Situations where the Constitution of the Air renders these +Fevers very common, the Inhabitants should frequently burn in their +Rooms, at least in their lodging Rooms, some aromatic Wood or Herbs. +They should daily chew some Juniper Berries, and drink a fermented +Infusion of them. These two Remedies are very effectual to fortify the +weakest Stomachs, to prevent Obstructions, and to promote Perspiration. +And as these are the Causes which prolong these Fevers the most +obstinately; nothing is a more certain Preservation from them than these +cheap and obvious Assistances. [70] + +[70] I have seen several Cases in very marshy maritime Countries, with + little good drinking Water, and far South of _Swisserland_, where + intermitting Fevers, with Agues at different Intervals, are + annually endemic, very popular, and often so obstinate as to return + repeatedly, whenever the weekly precautionary Doses of the Bark + have been omitted (through the Patient's nauseating the frequent + Swallowing of it) so that the Disease has sometimes been extended + beyond the Term of a full Year, and even far into a second, + including the temporary Removals of it by the Bark. Nevertheless, + in some such obstinate Intermittents, and particularly Quartans + there, wherein the Bark alone has had but a short and imperfect + Effect, I have known the following Composition, after a good Vomit, + attended with speedy and final Success, _viz._ Take of fresh + Sassafras Bark, of Virginia Snake-root, of Roch-Allom, of Nutmeg, + of diaphoretic Antimony, and of Salt of Wormwood of each one + Drachm. To these well rubbed together into fine Powder, add the + Weight of the whole, of the best and freshest Bark; then drop in + three Drops of the chemical Oil of Mint, and with Syrup of Cloves + make it into the Consistence of an Electuary or Bolus, for 12 Doses + for a grown Person, to be taken at the Distance of three or four + Hours from each other, while the Patient is awake, according to the + longer or shorter Intermission of the Fever. + + I have also known, particularly in obstinate autumnal Agues there, + an Infusion of two Ounces of the best Bark in fine Powder, or two + Ounces and a half in gross Powder, in a Quart of the best Brandy, + for three or four Days (a small Wine Glass to be taken by grown + Persons at the Distance of from four to six Hours) effectually and + speedily terminate such intermittent Agues, as had given but little + Way to the Bark in Substance. This was certainly more suitable for + those who were not of a light delicate Habit and Temperament, and + who had not been remarkable for their Abstinence from strong + Liquors: the inebriating Force of the Brandy being remarkably + lessened, by the Addition and long Infusion of the Bark. These + Facts which I saw, are the less to be wondered at, as in such + inveterate, but perfectly clear and distinct Intermittents, both + the State of the Fluids and Solids seem very opposite to their + State in an acutely inflammatory Disease. _K._ + + + + + __Chapter XIX.__ + + + + _Of the Erisipelas, and the Bites of Animals._ + + + __Sect.__ 273. + +The Erisipelas, commonly called in English, St. Anthony's Fire, and in +Swisserland _the Violet_, is sometimes but a very slight Indisposition +which appears on the Skin, without the Person's being sensible of any +other Disorder; and it most commonly breaks out either in the Face, or +on the Legs. The Skin becomes tense, or stiff, rough and red; but this +Redness disappears on pressing the Spot with a Finger, and returns on +removing it. The Patient feels in the Part affected a burning Heat, +which makes him uneasy, and sometimes hinders him from sleeping. The +Disorder increases for the Space of two or three Days; continues at its +Height one or two, and then abates. Soon after this, that Part of the +Skin that was affected, falls off in pretty large Scales, and the +Disorder entirely terminates. + +Sec. 274. But sometimes this Malady is considerably more severe, beginning +with a violent Shivering, which is succeeded by a burning Heat, a +vehement Head-ach, a Sickness at Heart, as it is commonly termed, or +Reachings to vomit, which continue till the _Erisipelas_ appears, which +sometimes does not happen before the second, or even the third Day. The +Fever then abates, and the Sickness goes off, though frequently a less +Degree of Fever, and of Sickness or Loathing remain, during the whole +Time, in which the Disease is in its increasing State. When the Eruption +and Inflammation happen in the Face, the Head-ach continues, until the +Decline, or going off, of the Disease. The Eyelid swells, the Eye is +closed, and the Patient has not the least Ease or Tranquillity. It often +passes from one Cheek to the other, and extends successively over the +Forehead, the Neck, and the Nape of the Neck; under which Circumstance +the Disease is of a more than ordinary Duration. Sometimes also when it +exists in a very high Degree, the Fever continues, the Brain is +obstructed and oppressed; the Patient raves; his Case becomes extremely +dangerous; whence sometimes, if he is not very judiciously assisted, he +dies, especially if of an advanced Age. A violent _Erisipelas_ on the +Neck brings on a Quinsey, which may prove very grievous, or even fatal. + +When it attacks the Leg, the whole Leg swells up; and the Heat and +Irritation from it is extended up to the Thigh. + +Whenever this Tumour is considerable, the Part it seizes is covered with +small Pustules filled with a clear watery Humour, resembling those which +appear after a Burn, and drying afterwards and scaling off. I have +sometimes observed, especially when this Distemper affected the Face, +that the Humour, which issued from these little Pustules, was extremely +thick or glewy, and formed a thick Scurf, or Scabs nearly resembling +those of sucking Children: they have continued fast on the Face many +Days before they fell off. + +When the Disease may be termed violent, it sometimes continues eight, +ten, twelve Days at the same Height; and is at last terminated by a very +plentiful Sweat, that may sometimes be predicted by a Restlessness +attended with Shiverings, and a little Anxiety of some Hours Duration. +Throughout the Progress of the Disease, the whole Skin is very dry, and +even the Inside of the Mouth. + +Sec. 275. An _Erisipelas_ rarely comes to Suppuration, and when it does, +the Suppuration is always unkindly, and much disposed to degenerate into +an Ulcer. Sometimes a malignant kind of _Erisipelas_ is epidemical, +seizing a great Number of Persons, and frequently terminating in +Gangrenes. + +Sec. 276. This Distemper often shifts its Situation; it sometimes retires +suddenly; but the Patient is uneasy and disordered; he has a Propensity +to vomit, with a sensible Anxiety and Heat: the _Erisipelas_ appears +again in a different Part, and he feels himself quite relieved from the +preceding Symptoms. But if instead of re-appearing on some other Part of +the Surface, the Humour is thrown upon the Brain, or the Breast, he dies +within a few Hours; and these fatal Changes and Translations sometimes +occur, without the least Reason or Colour for ascribing them either to +any Error of the Patient, or of his Physician. + +If the Humour has been transferred to the Brain, the Patient immediately +becomes delirious, with a highly flushed Visage, and very quick +sparkling Eyes: very soon after he proves downright frantic, and goes +off in a Lethargy. + +If the Lungs are attacked, the Oppression, Anxiety, and Heat are +inexpressible. + +Sec. 277. There are some Constitutions subject to a very frequent, and, as +it were, to an habitual _Erisipelas_. If it often affects the Face, it +is generally repeated on the same Side of it, and that Eye is, at +length, considerably weakened by it. + +Sec. 278. This Distemper results from two Causes; the one, an acrid sharp +Humour, which is commonly bilious, diffused through the Mass of Blood; +the other consists in that Humour's not being sufficiently discharged by +Perspiration. + +Sec. 279. When this Disease is of a gentle Nature, such as it is described +Sec. 273, it will be sufficient to keep up a very free Perspiration, but +without heating the Patient; and the best Method to answer this Purpose +is putting him upon the Regimen so often already referred to, with a +plentiful Use of Nitre in Elder Tea. Flesh, Eggs and Wine are prohibited +of Course, allowing the Patient a little Pulse and ripe Fruits. He +should drink Elder Flower Tea abundantly, and take half a Drachm of +Nitre every three Hours; or, which amounts to the same Thing, let three +Drachms of Nitre be dissolved in as much Infusion of Elder Flowers, as +he can drink in twenty-four Hours. Nitre may be given too in a Bolus +with Conserve of Elder-berries. These Medicines keep the Body open, and +increase Urine and Perspiration. + +Sec. 280. When the Distemper prevails in a severer Degree, if the Fever is +very high, and the Pulse, at the same Time, strong or hard, it may be +necessary to bleed once: but this should never be permitted in a large +Quantity at a Time in this Disease; it being more adviseable, if a +sufficient Quantity has not been taken at once, to bleed a second Time, +and even a third, if the Fever should prove very high, as it often does, +and that sometimes in so violent a Degree, as to render it extremely +dangerous: and in some such Cases Nature has sometimes saved the +Patients by effecting a large Hemorrhage, or Bleeding, to the Quantity +of four or five Pounds. This Conduct a very intelligent and prudent +Physician may presume to imitate; but I dare not advise the same Conduct +to that Class of Physicians, for which only I write: it being safer for +them to use repeated Bleedings in such Cases, than one in an excessive +Quantity. These erisipelatous Fevers are often excited by a Person's +being too long over-heated. + +After Bleeding the Patient is to be restrained to his Regimen; Glysters +are to be given until there is a sensible Abatement of the Fever; and he +should drink the Barley Water freely, No. 3. + +When the Fever is somewhat diminished, either the Purge No. 23 should be +given, or a few Doses every Morning of Cream of Tartar No. 24. Purging +is absolutely necessary to carry off the stagnant Bile, which is +generally the first Cause of the violent Degrees of this Distemper. It +may sometimes be really necessary too, if the Disease is very tedious; +if the Loathing and Sickness at Stomach is obstinate; the Mouth +ill-favoured, and the Tongue foul, (provided there be only a slight +Fever, and no Fear of an Inflammation) to give the Medicines No. 34 or +35, which, in Consequence of the Agitation, the Shaking they occasion, +remove these Impediments still better than Purges. + +It commonly happens that this Disease is more favourable after these +Evacuations; nevertheless it is sometimes necessary to repeat them the +next Day, or the next but one; especially if the Malady affects the +Head. Purging is the true Evacuation for curing it, whenever it attacks +this Part. By carrying off the Cause of the Disease, they diminish it, +and prevent its worst Effects. + +Whenever, even after these Evacuations, the Fever still continues to be +very severe, the Patient should take every two Hours, or occasionally, +oftner, two Spoonfuls of the Prescription No. 10, added to a Glass of +Ptisan. + +It will be very useful, when this Disease is seated in the Head or Face, +to bathe the Legs frequently in warm Water; and where it is violent +there, also to apply Sinapisms to the Soles of the Feet. I have seen +this Application, in about four Hours attract, or draw down an +_Erisipelas_ to the Legs, which had spread over the Nose, and both the +Eyes. When the Distemper once begins to go off by Sweating, this should +be promoted by Elder-flower Tea and Nitre (See Sec. 279) and the Sweating +may be encouraged to Advantage for some Hours. + +Sec. 281. The best Applications that can be made to the affected Part are +1st, The Herb Robert, a Kind of _Geranium_, or Crane's-Bill; or Chervil, +or Parsley, or Elder Flowers: and if the Complaint be of a very mild +Disposition, it may be sufficient to apply a very soft smooth Linen over +it, which some People dust over with a little dry Meal. + +2, If there is a very considerable Inflammation, and the Patient is so +circumstanced as to be very tractable and regularly attended, Flanels +wrung out of a strong Decoction of Elder-flowers and applied warm, +afford him the speediest Ease and Relief. By this simple Application I +have appeased the most violent Pains of a St. Anthony's Fire, which is +the most cruel Species of an Erisipelas, and has some peculiar Marks or +Symptoms extraordinary. + +3, The Plaister of Smalt, and Smalt itself No. 46, are also very +successfully employed in this Disease. This Powder, the farinaceous, or +mealy ones, or others cried up for it, agree best when a thin watery +Humour distills or weeps from the little Vesications attending it, which +it is convenient to absorb by such Applications; without which +Precaution it might gall, or even ulcerate the Part. + +All other Plaisters, which are partly compounded of greasy, or of +resinous Substances, are very dangerous: they often repel, or strike in +the _Erisipelas_, occasioning it to ulcerate, or even to gangrene. If +People who are naturally subject to this Disease should apply any such +Plaister to their Skin, even in its soundest State, an _Erisipelas_ is +the speedy Consequence. + +Sec. 282. Whenever the Humour occasioning the Distemper is repelled, and +thrown upon the Brain, the Throat, the Lungs, or any internal Part, the +Patient should be bled; Blisters must be applied to the Legs; and Elder +Tea, with Nitre dissolved in it, should be plentifully drank. + +Sec. 283. People who are liable to frequent Returns of an Erisipelas, +should very carefully avoid using Milk, Cream, and all fat and viscid, +or clammy Food, Pies, brown Meat, Spices, thick and heady Liquors, a +sedentary Life, the more active Passions, especially Rage, and, if +possible, all Chagrin too. Their Food should chiefly consist of Herbage, +Fruits, of Substances inclining to Acidity, and which tend to keep the +Body open; they should drink Water, and some of the light white Wines; +by no Means omitting the frequent Use of Cream of Tartar. A careful +Conformity to these Regulations is of real Importance, as, besides the +Danger of the frequent Visitations of this Disease, they denote some +slight Indispositions of the Liver and the Gall-bladder; which, if too +little attended to, might in Time prove very troublesome and pernicious. + +Such mineral Waters as are gently opening are very proper for these +Constitutions, as well as the Juice of Succory, and clarified Whey, of +which they should take about three Pints every Morning, during the five +or six Summer Months. This becomes still more efficacious, if a little +Cream of Tartar and Honey be added to it. + + + + _Of the Stings, or little Wounds, by Animals._ + + +Sec. 284. The Stings or little Bites of Animals, frequently producing a +kind of _Erisipelas_, I shall add a very few Words concerning them in +this Place. + +Of the Serpents in this Country none but the Vipers are poisonous; and +none of these are found except at _Baume_, where there is a _Viperary_, +if we may be allowed that Word. We have no Scorpions, which are somewhat +poisonous; our Toads are not in the least so: whence the only Stings we +are exposed to, are those of Bees, Wasps, Hornets, Muskitos or Gnats, +and Dragon [71] Flies: all of which are sometimes attended with severe +Pain, a Swelling, and a very considerable erisipelatous Redness; which, +if it happens in the Face, sometimes entirely closes the Eyes up; +occasioning also a Fever, Pains of the Head, Restlessness, and Sickness +at Heart; and, when the Pains are in a violent Degree, Faintings and +Convulsions, though always without any mortal Consequence. These +Symptoms go off naturally within a few Days, without any Assistance: +Nevertheless they may either be prevented, diminished in Degree, or +shortned in Duration. + +[71] These, in some Parts of America, are called Muskito Hawks; but we + do not recollect their biting there. _K._ + +1, By extracting the Sting of the Animal, if it is left behind. + +2, By a continual Application of one of the Remedies directed Sec. 281, +Article 1 and 2, particularly the Infusion of Elder-flowers, to which a +little Venice Treacle is added; or by covering the Part affected with a +Pultice, made of Crum of Bread, Milk, Honey, and a little Venice +Treacle. [72] + +[72] Pounded Parsley is one of the most availing Applications in such + Accidents. _E.L._ + +3, By bathing the Legs of the Person stung repeatedly in warm Water. + +4, By retrenching a little of their customary Food, especially at Night, +and by making them drink an Infusion of Elder-flowers, with the Addition +of a little Nitre. Oil, if applied very quickly after the Sting, +sometimes prevents the Appearance of any Swelling, and from thence the +Pains that attend it. + + + + + __Chapter XX.__ + + + _Of spurious, or false Inflammations of the Breast, and of spurious, + bilious, Pleurisies._ + + + __Sect.__ 285. + +The Inflammation of the Breast and that Pleurisy, which is called +_bilious_, are the same Disease. It is properly a putrid Fever, attended +with an Infarction or Stuffing of the Lungs, though without Pain; in +which Circumstance it is called a putrid or bilious Peripneumony: but +when attended with a Pain of the Side, a Stitch, it is called a spurious +or bastard Pleurisy. + +Sec. 286. The Signs which distinguish these Diseases from the inflammatory +ones of the same Name, described Chap. IV and V, are a less hard and +less strong, but a quicker Pulse, though unaccompanied with the same +Symptoms which constitute the inflammatory ones (See Sec. 47 and 90). The +Mouth is foul, and has a Sensation of Bitterness; the Patient is +infested with a sharp and dry Heat; he has a Feeling of Heaviness and +Anxiety all about his Stomach, with Loathings: he is less flushed and +red in these, than in the inflammatory Diseases, but rather a little +yellow. He has a dejected wan Look; his Urine resembles that in putrid +Fevers, and not that of inflammatory ones; and he has very often a small +bilious Looseness, which is extremely offensive. The Skin is commonly +very dry in this Disease; the Humour spit up is less thick, less +reddish, and rather more yellow than in the inflammatory Diseases of the +same Names. + +Sec. 287. They must be treated after the manner of putrid Fevers, as in Sec. +241. Supposing some little Degree of Inflammation to be combined with +the Disease, it may be removed by a single Bleeding. After this the +Patient is to drink Barley Water No. 3, to make Use of Glysters; and as +soon as all Symptoms of any Inflammation wholly disappear, he is to take +the vomiting and purging Draught No. 34. But the utmost Caution must be +taken not to give it, before every Appearance of any Inflammation is +totally removed; as giving it sooner would be certain Death to the Sick: +and it is dreadful but to think of agitating, by a Vomit, Lungs that are +inflamed, and overloaded with Blood, whose Vessels burst and discharge +themselves, only from the Force of Expectoration. After an Interval of +some Days, he may be purged again with the Medicine No. 23. The +Prescription No. 25 succeeds also very well as a Vomit. If the Fever is +violent, he must drink plentifully of the Potion No. 10. + +Blisters to the Legs are very serviceable, when the Load and Oppression +are not considerably abated after general Evacuations. + +Sec. 288. The false Inflammation of the Breast is an Overfulness or +Obstruction in the Lungs, accompanied with a Fever; and it is caused by +extremely thick and tenacious Humours; and not by a really inflammatory +Blood, or by any putrid or bilious Humour. + +Sec. 289. This Distemper happens more frequently in the Spring, than in any +other Season. Old Men, puny, ill-constitutioned Children, languid Women, +feeble young Men, and particularly such as have worn their Constitutions +out by drinking, are the Subjects most frequently attacked by it; +especially if they have used but little Exercise throughout the Winter: +if they have fed on viscid, mealy and fat Aliments, as Pastry, Chesnuts, +thick Milk or Pap, and Cheese. All their Humours have contracted a thick +glutinous Quality; they are circulated with Difficulty, and when Heat or +Exercise in the Spring increases their Motion at once, the Humours, +already stuffing up the Lungs, still more augment that Plenitude, whence +these vital Organs are fatally extended, and the Patient dies. + +Sec. 290. This Distemper is known to exist, + +1, By the previous Existence of the Causes already mentioned. + +2, By the Symptoms which precede and usher it in. For Example, the +Patient many Days before-hand has a slight Cough; a small Oppression +when he moves about; a little Restlessness, and is sometimes a little +choleric or fretful. His Countenance is higher coloured than in Health; +he has a Propensity to sleep, but attended with Confusion and without +Refreshment, and has sometimes an extraordinary Appetite. + +3, When this State has continued for some Days, there comes on a cold +Shivering, though more considerable for its Duration than its Violence; +it is succeeded by a moderate Degree of Heat, but that attended with +much Inquietude and Oppression. The sick Person cannot confine himself +to the Bed; but walks to and fro in his Chamber, and is greatly +dejected. The Pulse is weak and pretty quick; the Urine is sometimes but +little changed from that in Health; at other Times it is discharged but +in a small Quantity, and is higher coloured: he coughs but moderately, +and does not expectorate, or cough up, but with Difficulty. The Visage +becomes very red, and even almost livid; he can neither keep awake, nor +sleep well; he raves for some Moments, and then his Head grows clear +again. Sometimes it happens, especially to Persons of advanced Age, that +this State suddenly terminates in a mortal Swoon or Fainting: at other +Times and in other Cases, the Oppression and Anguish increase; the +Patient cannot breathe but when sitting up, and that with great +Difficulty and Agony: the Brain is utterly disturbed and embarrassed; +this State lasts for some Hours, and then terminates of a sudden. + +Sec. 291. This is a very dangerous Distemper; because, in the first Place, +it chiefly attacks those Persons whose Temperament and Constitution are +deprived of the ordinary Resources for Health and Recovery: in the +second Place, because it is of a precipitate Nature, the Patient +sometimes dying on the third Day, and but seldom surviving the seventh; +while the Cause of it requires a more considerable Term for its Removal +or Mitigation. Besides which, if some Indications present for the +Employment of a Remedy, there are frequently others which forbid it; and +all that seems to be done is, as follows; + +1, If the Patient has still a pretty good Share of Health; if he is not +of too advanced an Age; if the Pulse has a perceivable Hardness, and yet +at the same Time some Strength; if the Weather is dry, and the Wind +blows from the North, he should be bled once, to a moderate Quantity. +But if the greater Part of these Circumstances are wanting, Bleeding +would be very prejudicial. Were we obliged to establish some general and +positive Rule in this Case, it were better to exclude Bleeding, than to +admit it. + +2, The Stomach and the Bowels should be unloaded from their viscid +glutinous Contents; and the Medicines which succeed the best in this +Respect are No. 35, when the Symptoms shew there is a great Necessity +for vomiting, and there is no Inflammation; or the Prescription No. 25, +which after vomiting, purges by Stool, promotes Urine, breaks down and +divides the viscid Humours that occasion the Disease, and increase +Perspiration. When we are afraid of hazarding the Agitation of a Vomit +and its Consequences, the Potion, No. 11 may be given; but we must be +very cautious, in Regard to old Men, even with this; as such may expire +during the Operation of it. + +3, They should, from the Beginning of the Disease, drink plentifully of +the Ptisan No. 26, which is the best Drink in this Disease; or that of +No. 12, adding half a Dram of Nitre to every Pint of it. + +4, A Cup of the Mixture No. 8 must be taken every two Hours. + +5. Blisters are to be applied to the Insides of the Legs. + +When the Case is very doubtful and perplexing, it were best to confine +ourselves to the three last-mentioned Remedies, which have often been +successful in severe Degrees of this Disease; and which can occasion no +ill Consequence. + +Sec. 292. When this Malady invades old People, though they partly recover, +they never recover perfectly, entirely, from it: and if due Precaution +is not taken, they are very liable to fall into a Dropsy of the Breast +after it. + +Sec. 293. The spurious or false Pleurisy is a Distemper that does not +affect the Lungs, but only the Teguments, the Skin, and the Muscles +which cover the Ribs. It is the Effect of a rheumatic Humour thrown upon +these Parts, in which, as it produces very sharp Pains resembling that +which is called a _Stitch_, it has from this Circumstance, been termed a +Pleurisy. + +It is generally supposed by the meer Multitude, and even by some of a +different Rank, that a false Pleurisy is more dangerous than a genuine, +a true one; but this is a Mistake. It is often ushered in by a +Shivering, and almost ever attended with a little Fever, a small Cough, +and a slight Difficulty of breathing; which, as well as the Cough, is +occasioned from the Circumstance of a Patient's (who feels Pain in +Respiration, or Breathing) checking Breathing as much as he can; this +accumulates a little too much Blood in the Lungs; but yet he has no +Anguish, nor the other Symptoms of acute true Pleurisies. In some +Patients this Pain is extended, almost over the whole Breast, and to the +Nape of the Neck. The sick Person cannot repose himself on the Side +affected. + +This Disorder is not more dangerous than a Rheumatism, except in two +Cases; 1, When the Pain is so very severe, that the Patient strongly +endeavours not to breathe at all, which brings on a great Infarction or +Stoppage in the Lungs. 2, When this Humour, like any other rheumatic +one, is transferred to some internal Part. + +Sec. 294. It must be treated exactly like a Rheumatism. See Sec. 168 and 169. + +After bleeding once or more, a Blister applied to the affected Part is +often attended with a very good Effect: This being indeed the Kind +of [73] Pleurisy, in which it particularly agrees. + +[73] The Seneka Rattle-Snake root, already recommended in true + Pleurisies, will, with the greatest Probability, be found not less + effectual in these false ones, in which the Inflammation of the + Blood is less. The Method of giving it may be seen P. 118, + N. ([26].) By Dr. _Tissot's_ having never mentioned this valuable + Simple throughout his Work, it may be presumed, that when he wrote + it, this Remedy had not been admitted into the Apothecaries Shops + in _Swisserland_. _K._ + +Sec. 295. This Malady sometimes gives Way to the first Bleeding; often +terminating on the third, fourth or fifth Day, by a very plentiful +Sweat, and rarely lasting beyond the seventh. Sometimes it attacks a +Person very suddenly, after a Stoppage of Perspiration; and then, if at +once before the Fever commences, and has had Time to inflame the Blood, +the Patient takes some _Faltrank_, it effects a speedy Cure by restoring +Perspiration. They are such Cases as these, or that mentioned Sec. 96, +which have given this Composition the Reputation it has obtained in this +Disease: a Reputation nevertheless, which has every Year proved tragical +in its Consequences to many Peasants, who being deceived by some +misleading Resemblances in this Distemper, have rashly and ignorantly +made Use of it in true inflammatory Pleurisies. + + + + + __Chapter XXI.__ + + + + _Of the Cholic and its different Kinds._ + + + __Sect.__ 296. + +The Appellation of a Cholic is commonly given to all Pains of the Belly +indiscriminately; but I apply it in this Place only to such as attack +the Stomach, or the Intestines, the Guts. + +Cholics may and do result from very many Causes; and the greater Number +of Cholics are chronical or tedious Complaints, being more common among +the inactive Inhabitants of Cities, and Workmen in sedentary Trades, +than among Country People. Hence I shall treat here only of the small +Variety of Cholics, which happen the most usually in Villages. I have +already proved that the fatal Events of some Distempers were occasioned +by endeavouring to force the Patients into Sweats; and the same unhappy +Consequences have attended Cholics, from accustoming the Subjects of +this Disease to Drams, and hot inflaming spirituous Liquors, with an +Intention to expel the Wind. + + + + _Of the inflammatory Cholic._ + + +Sec. 297. The most violent and dangerous kind of Cholic is that, which +arises from an Inflammation of the Stomach, or of the Intestines. It +begins most commonly without any Shivering, by a vehement Pain in the +Belly, which gradually becomes still more so. The Pulse grows quick and +hard; a burning Pain is felt through the whole Region of the Belly; +sometimes there is a watery _Diarrhoea_, or Purging; at other Times the +Belly is rather costive, which is attended with Vomiting, a very +embarrassing and dangerous Symptom: the Countenance becomes highly +flushed; the Belly tense and hard; neither can it be touched scarcely +without a cruel Augmentation of the Patient's Pain, who is also +afflicted with extreme Restlessness; his Thirst is very great, being +unquenchable by Drink; the Pain often extends to the Loins, where it +proves very sharp, and severe; little Urine is made, and that very red, +and with a kind of burning Heat. The tormented Patient has not a +Moment's Rest, and now and then raves a little. If the Disease is not +removed or moderated, before the Pains rise to their utmost Height and +Violence, the Patient begins at length to complain less; the Pulse +becomes less strong and less hard than before, but quicker: his Face +first abates of its Flush and Redness, and soon after looks pale; the +Parts under the Eyes become livid; the Patient sinks into a low stupid +Kind of _Delirium_, or Raving; his Strength entirely deserts him; the +Face, Hands, Feet, and the whole Body, the Belly only excepted, become +cold: the Surface of the Belly appears bluish; extreme Weakness follows, +and the Patient dies. There frequently occurs, just a Moment before he +expires, an abundant Discharge of excessively foetid Matter by Stool; +and during this Evacuation he dies with his Intestines quite gangrened, +or mortified. + +When the Distemper assaults the Stomach, the Symptoms are the very same, +but the Pain is felt higher up, at the Pit of the Stomach. Almost every +thing that is swallowed is cast up again; the Anguish of the tortured +Patient is terrible, and the Raving comes on very speedily. This Disease +proves mortal in a few Hours. + +Sec. 298. The only Method of succeeding in the Cure of it is as follows: + +1, Take a very large Quantity of Blood from the Arm; this almost +immediately diminishes the Violence of the Pains, and allays the +Vomiting: besides its contributing to the greater Success of the other +Remedies. It is often necessary to repeat this Bleeding within the Space +of two Hours. + +2, Whether the Patient has a Looseness, or has not, a Glyster of a +Decoction of Mallows, or of Barley Water and Oil, should be given every +two Hours. + +3, The Patient should drink very plentifully of Almond Milk No. 4; or a +Ptisan of Mallow Flowers, or of Barley, all which should be warm. + +4, Flanels dipt in hot, or very warm Water should be continually applied +over the Belly, shifting them every Hour, or rather oftner; for in this +Case they very quickly grow dry. + +5, If the Disease, notwithstanding all this, continues very obstinate +and violent, the Patient should be put into a warm Water Bath, the +extraordinary Success of which I have observed. + +When the Distemper is over, that is to say, when the Pains have +terminated, and the Fever has ceased, so that the Patient recovers a +little Strength, and gets a little Sleep, it will be proper to give him +a Purge, but a very gentle one. Two Ounces of Manna, and a Quarter of an +Ounce of Sedlitz [74] Salt dissolved in a Glass of clear Whey is +generally sufficient, at this Period, to purge the most robust and hardy +Bodies. Manna alone may suffice for more delicate Constitutions: as all +acrid sharp Purges would be highly dangerous, with Regard to the great +Sensibility and tender Condition of the Stomach, and of the Intestines +after this Disease. + +[74] Glauber or Epsom Salt may be substituted, where the other is not to + be readily procured. _K._ + +Sec. 299. It is sometimes the Effect of a general Inflammation of the +Blood; and is produced, like other inflammatory Diseases, by +extraordinary Labour, very great Heat, heating Meats or Drinks, _&c._ It +is often the Consequence of other Cholics which have been injudiciously +treated, and which otherwise would not have degenerated into +inflammatory ones; as I have many Times seen these Cholics introduced +after the Use of heating Medicines; one Instance of which may be seen Sec. +164. + +Sec. 300. Ten Days after I had recovered a Woman out of a severe Cholic, +the Pains returned violently in the Night. She, supposing them to arise +only from Wind, hoped to appease them by drinking a deal of distilled +Walnut Water; which, far from producing any such Effect, rendered them +more outrageous. They soon were heightened to a surprising Degree, which +might reasonably be expected. Being sent for very early in the Morning, +I found her Pulse hard, quick, short; her Belly was tense and hard; she +complained greatly of her Loins: her Urine was almost entirely stopt. +She past but a few Drops, which felt as it were scalding hot, and these +with excessive Pain. She went very frequently to the Close-stool, with +scarcely any Effect; her Anguish, Heat, Thirst, and the Dryness of her +Tongue were even terrifying: and her wretched State, the Effect of the +strong hot Liquor she had taken, made me very apprehensive for her. One +Bleeding, to the Quantity of fourteen Ounces, somewhat abated all the +Pains; she took several Glysters, and drank off a few Pots of _Orgeat_ +in a few Hours. By these Means the Disease was a little mitigated; by +continuing the same Drink and the Glysters the Looseness abated; the +Pain of the Loins went off, and she passed a considerable Quantity of +Urine, which proved turbid, and then let fall a Sediment, and the +Patient recovered. Nevertheless I verily believe, if the Bleeding had +been delayed two Hours longer, this spirituous Walnut Water would have +been the Death of her. During the Progress of this violent Disease, no +Food is to be allowed; and we should never be too inattentive to such +Degrees of Pain, as sometimes remain after their Severity is over; lest +a _Scirrhus_, an inward hard Tumour, should be generated, which may +occasion the most inveterate and tedious Maladies. + +Sec. 301. An Inflammation of the Intestines, and one of the Stomach, may +also terminate in an Abscess, like an Inflammation of any other Part; +and it may be apprehended that one is forming, when, though the Violence +of the Pains abates, there still remains a slow, obtuse, heavy Pain, +with general Inquietude, little Appetite, frequent Shiverings; the +Patient at the same Time not recovering any Strength. In such Cases the +Patient should be allowed no other Drinks, but what are already directed +in this Chapter, and some Soops made of Pulse, or other farinaceous +Food. + +The Breaking of the Abscess may sometimes be discovered by a slight +Swoon or fainting Fit; attended with a perceivable Cessation of a Weight +or Heaviness in the Part, where it was lately felt: and when the _Pus_, +or ripe Matter, is effused into the Gut, the Patient sometimes has +Reachings to vomit, a _Vertigo_, or Swimming in the Head, and the Matter +appears in the next Stools. In this Case there remains an Ulcer within +the Gut, which, if either neglected, or improperly treated, may pave the +Way to a slow wasting Fever, and even to Death. Yet this I have cured by +making the Patient live solely upon skimmed Milk, diluted with one third +Part Water, and by giving every other Day a Glyster, consisting of equal +Parts of Milk and Water, with the Addition of a little Honey. + +When the Abscess breaks on the Outside of the Gut, and discharges its +Contents into the Cavity of the Belly, it becomes a very miserable Case, +and demands such further Assistance as cannot be particularized here. + + + + _Of the bilious Cholic._ + + +Sec. 302. The bilious Cholic discovers itself by very acute Pains, but is +seldom accompanied with a Fever; at least not until it has lasted a Day +or two. And even if there should be some Degree of a Fever, yet the +Pulse, though quick, is neither strong nor hard: the Belly is neither +tense or stretched as it were, nor burning hot, as in the former Cholic: +the Urine comes away with more Ease, and is less high-coloured: +Nevertheless the inward Heat and Thirst are considerable; the Mouth is +bitter; the Vomiting or Purging, when either of them attend it, +discharge a yellowish Humour or Excrement; and the Patient's Head is +often vertiginous or dizzy. + +Sec. 303. The Method of curing this is, + +1, By injecting Glysters of Whey and Honey; or, if Whey is not readily +procurable, by repeating the Glyster, No. 5. + +2, By making the Sick drink considerably of the same Whey, or of a +Ptisan made of the Root of Dog's-Grass (the common Grass) and a little +Juice of Lemon, for want of which, a little Vinegar and Honey may be +substituted instead of it. [75] + +[75] Pullet, or rather Chicken Water, but very weak, may often do + instead of Ptisan, or serve for a little Variety of Drink to some + Patients. _E. L._--K. + +3, By giving every Hour one Cup of the Medicine No. 32; or where this is +not to be had, half a Drachm of Cream of Tartar at the same short +Intervals. + +4, Fomentations of warm Water and Half-baths are also very proper. + +5, If the Pains are sharp and violent, in a robust strong Person, and +the Pulse is strong and tense, Bleeding should be used to prevent an +Inflammation. + +6, No other Nourishment should be given, except some maigre Soops, made +from Vegetables, and particularly of Sorrel. + +7, After plentiful Dilution with the proper Drink, if no Fever +supervenes; if the Pains still continue, and the Patient discharges but +little by Stool, he should take a moderate Purge. That directed No. 47 +is a very proper one. + +Sec. 304. This bilious Cholic is habitual to many Persons; and may be +prevented or greatly mitigated by an habitual Use of the Powder No. 24; +by submitting to a moderate Retrenchment in the Article of Flesh-meat; +and by avoiding heating and greasy Food, and the Use of Milk. + + + + _Of Cholics from Indigestions, and of Indigestion._ + + +Sec. 305. Under this Appellation I comprehend all those Cholics, which are +either owing to any overloading Quantity of Food taken at once; or to a +Mass or Accumulation of Aliments formed by Degrees in such Stomachs, as +digest but very imperfectly; or which result from noxious Mixtures of +Aliment in the Stomach, such as that of Milk and Acids; or from Food +either not wholesome in its self, or degenerated into an unwholesome +Condition. + +This kind of Cholic may be known from any of these Causes having +preceded it; by its Pains, which are accompanied with great +Restlessness, and come on by Degrees, being less fixed than in the +Cholics before treated of. These Cholics are also without any Fever, +Heat or Thirst, but accompanied with a Giddiness of the Head, and +Efforts to vomit, and rather with a pale, than a high-coloured Visage. + +Sec. 306. These Disorders, from these last Causes, are scarcely ever +dangerous in themselves; but may be made such by injudicious Management, +and doing more than is necessary or proper: as the only Thing to be done +is to promote the Discharges by warm Drinks. There are a considerable +Variety of them, which seem equally good, such as warm Water, or even +cold Water with a Toast, with the Addition either of a little Sugar, or +a little Salt: a light Infusion of Chamomile, or of Elder-flowers, +common Tea, or Baum, it imports little which, provided the Patient drink +plentifully of them: in Consequence of which the offending Matter is +discharged, either by vomiting, or a considerable purging; and the +speedier and more in Quantity these Discharges are, the sooner the +Patient is relieved. + +If the Belly is remarkably full and costive, Glysters of warm Water and +Salt should be injected. + +The Expulsion of the obstructing Matter is also facilitated, by rubbing +the Belly heartily with hot Cloths. + +Sometimes the Humours, or other retained Contents of the Belly, are more +pernicious from their Quality, than their Quantity; and then the Malady +may be dissipated without the former Discharges, by the irritating sharp +Humour being diluted, or even drowned, as it were, in the Abundance of +small watery Drinks. When the Pains invade first in the Stomach, they +become less sharp, and the Patient feels less Inquietude, as soon as the +Cause of the Pain has descended out of the Stomach into the Intestines, +whose Sensations are something less acute than, or somewhat different +from, those of the Stomach. + +It is often found that after these plentiful Discharges, and when the +Pains are over, there remains a very disagreeable Taste in the Mouth, +resembling the Savour of rotten Eggs. This may be removed by giving some +Doses of the Powder No. 24, and drinking largely of good Water: + +It is an essential Point in these Cases, to take no Food before a +perfect Recovery. + +Sec. 307. Some have been absurd enough in them, to fly at once to some +heating Cordial Confection, to Venice Treacle, Aniseed Water, Geneva, or +red Wine to stop these Evacuations; but there cannot be a more fatal +Practice: since these Evacuations are the only Thing which can cure the +Complaint, and to stop them is to deprive the Person, who was in Danger +of drowning, of the Plank which might save him. Nay should this +Endeavour of stopping them unhappily succeed, the Patient is either +thrown into a putrid Fever, or some chronical tedious Malady; unless +Nature, much wiser than such a miserable Assistant, should prevail over +the Obstacles opposed to her Recovery, and restore the obstructed +Evacuations by her own Oeconomy, in the Space of a few Days. + +Sec. 308. Sometimes an Indigestion happens, with very little Pain or +Cholic, but with violent Reachings to vomit, inexpressible Anguish, +Faintings, and cold Sweats: and not seldom also the Malady begins, only +with a very sudden and unexpected Fainting: the Patient immediately +loses all his Senses, his Face is pale and wan: he has some Hickups +rather than Reachings to vomit, which joined to the Smallness of his +Pulse, to the Easiness of his respiring, or breathing, and to the +Circumstance of his being attacked immediately, or very soon, after a +Meal, makes this Disorder distinguishable from a real Apoplexy. +Nevertheless, when it rises to this Height, with these terrible +Symptoms, it sometimes kills in a few Hours. The first thing to be done +is to throw up a sharp Glyster, in which Salt and Soap are to be +dissolved; next to get down as much Salt and Water as he can swallow; +and if that is ineffectual, the Powder No. 34 is to be dissolved in +three Cups of Water; one half of which is to be given directly; and, if +it does not operate in a Quarter of an Hour, the other half. Generally +speaking the Patient's Sense begins to return, as soon as he begins to +vomit. + + + + _Of the flatulent or windy Cholic._ + + +Sec. 309. Every Particular which constitutes our Food, whether solid or +liquid, contains much Air, but some of them more than others. If they do +not digest soon enough, or but badly, which occasions a sensible Escape +of such Air; if they are such as contain an extraordinary Quantity of +Air; or if the Guts being straitened or compressed any where in the +Course of their Extent, prevent that Air from being equally diffused +(which must occasion a greater Proportion of it in some Places) then the +Stomach and the Guts are distended by this Wind; and this Distention +occasions these Pains, which are called flatulent, or windy. + +This Sort of Cholic rarely appears alone and simple; but is often +complicated with, or added, as it were, to the other Sorts, of which it +is a Consequence; and is more especially joined with the Cholic from +Indigestions, whose Symptoms it multiplies and heightens. It may be +known, like that, by the Causes which have preceded it, by its not being +accompanied either with Fever, Heat, or Thirst; the Belly's being large +and full, though without Hardness, being unequal in its Largeness, which +prevails more in one Part of it than in another, forming something like +Pockets of Wind, sometimes in one Part, sometimes in another; and by the +Patient's feeling some Ease merely from the rubbing of his Belly, as it +moves the Wind about; which escaping either upwards or downwards affords +him still a greater Relief. + +Sec. 310. When it is combined with any different Species of the Cholic, it +requires no distinct Treatment from that Species; and it is removed or +dissipated by the Medicines which cure the principal Disease. + +Sometimes however it does happen to exist alone, and then it depends on +the Windiness of the solid and liquid Food of the Person affected with +it, such as the _Must_ or new Wine, Beer, especially very new Beer, +certain Fruits and Garden-stuff. It may be cured by a Glyster; by +chaffing the Belly with hot Cloths; by the Use of Drink moderately +spiced; and especially by Camomile Tea, to which a little cordial +Confection, or even Venice Treacle, may be added. When the Pains are +almost entirely vanished, and there is no Fever, nor any unhealthy +Degree of Heat; and if the Patient is sensible of a Weakness at Stomach, +he may take a little aromatic, or spiced Wine, or even a small cordial +stomachic Dram. It should be observed, that these are not to be allowed +in any other Kind of Cholic. + +Sec. 311. When any Person is frequently subject to cholic-like Pains, it is +a Proof that the digestive Faculty is impaired; the restoring of which +should be carefully attended to; without which the Health of the Patient +must suffer considerably, and he must be very likely to contract many +tedious and troublesome Disorders. + + + + _Of Cholics from Cold._ + + +Sec. 312. When any Person has been very cold, and especially in his Feet, +it is not uncommon for him to be attacked, within a few Hours after it, +with violent Cholic Pains, in which heating and spirituous Medicines are +very pernicious: but which are easily cured by rubbing the Legs well +with hot Cloths; and keeping them afterwards for a considerable Time in +warm Water; advising them at the same Time to drink freely of a light +Infusion of Chamomile or Elder-flowers. + +The Cure will be effected the sooner, if the Patient is put to Bed and +sweats a little, especially in the Legs and Feet. + +A Woman who had put her Legs into a pretty cool Spring, after travelling +in the Height of Summer, was very quickly after attacked with a most +violent Cholic. She took different hot Medicines; she became still +worse; she was purged, but the Distemper was still further aggravated. I +was called in on the third Day, a few Hours before her Decease. + +In such Cases, if the Pain be excessive, it may be necessary to +bleed; [76] to give a Glyster of warm Water; to keep the Legs several +Hours over the Steam of hot Water, and afterwards in the Water; to drink +plentifully of an Infusion of the Flowers of the Lime-tree, with a +little Milk; and if the Distemper is not subdued by these Means, +Blisters should be applied to the Legs, which I have known to be highly +efficacious. + +[76] Bleeding should not be determined on too hastily in this Sort of + Cholic, but rather be omitted, or deferred at least, till there be + an evident Tendency to an Inflammation. _E. L._ + + The Propriety or Impropriety of Bleeding in a Cholic from this + Cause should be determined, I think, from the State of the Person + it happens to: So that Bleeding a strong Person with a firm Fibre, + and a hard Pulse, may be very prudent and precautionary: But if it + be a weakly lax Subject with a soft and low Pulse, there may be + Room either for omitting, or for suspending it. _K._ + +Sec. 313. It appears, through the Course of this Chapter, that it is +necessary to be extremely on our Guard, against permitting the Use of +heating and spirituous Medicines in Cholics, as they may not only +aggravate, but even render them mortal. In short they should never be +given, and when it is difficult to discover the real Cause of the +Cholic, I advise Country People to confine themselves to the three +following Remedies, which cannot be hurtful in any Sort of Cholic, and +may remove as many as are not of a violent Nature. First then, let +Glysters be frequently repeated. 2, Let the Patient drink warm Water +plentifully, or Elder Tea. 3, Let the Belly be often fomented in pretty +warm Water, which is the most preferable Fomentation of any. + +Sec. 314 I have said nothing here of the Use of any Oils in this Disease, +as they agree but in very few Species of Cholics, and not at all in +those of which I have been treating. For this Reason I advise a total +Disuse of them, since they may be of bad Consequence in many Respects. + +Sec. 315. Chronical Diseases not coming within the Plan of this Work, I +purposely forbear treating of any Kind of those tedious Cholics, which +afflict some People for many Years: but I think it my Duty to admonish +such, that their Torments being very generally occasioned by +Obstructions in the _Viscera_, or different Bowels of the Belly, or by +some other Fault, and more particularly in those Organs, which are +intended to prepare the Bile, they should, 1, avoid with the greatest +Care, the Use of sharp, hot, violent Medicines, Vomits, strong Purges, +Elixirs, _&c._ 2, They should be thoroughly on their Guard against all +those, who promise them a very speedy Cure, by the Assistance of some +specific Remedy; and ought to look upon them as Mountebanks, into whose +Hands it is highly dangerous to trust themselves. 3, They should be +persuaded, or rather convinced, that they can entertain no reasonable +Hope of being cured, without an exact Conformity to a proper and +judicious Regimen, and a long Perseverance in a Course of mild and safe +Remedies. 4, They should continually reflect with themselves, that there +is little Difficulty in doing them great Mischief; and that their +Complaints are of that Sort, which require the greatest Knowledge and +Prudence in those Persons, to whom the Treatment and Cure of them are +confided. + + + + + __Chapter XXII.__ + + + + _Of the Iliac Passion, and of the Cholera-morbus._ + + + __Sect.__ 316. + +These violent Diseases are fatal to many Country People, while their +Neighbours are frequently so ignorant of the Cause of their Death, that +Superstition has ascribed it to Poison, or to Witchcraft. + +Sec. 317. The first of these, the _Miserere_, or Iliac Passion, is one of +the most excruciating Distempers. If any Part of the Intestines, the +Cavity of the Guts is closed up, whatever may have occasioned it, the +Course or Descent of the Food they contain is necessarily stopped; in +which Case it frequently happens, that that continual Motion observed in +the Guts of a living Animal dissected, and which was intended to +detrude, or force their Contents downwards, is propagated in a directly +contrary Manner, from the Guts towards the Mouth. + +This Disease sometimes begins after a Constipation, or Costiveness, of +some Days; at other Times without that Costiveness having been preceded +by Pains in any Part of the Belly, especially around the Navel; but +which Pains, gradually increasing after their Commencement, at length +become extremely violent, and throw the Patient into excessive Anguish. +In some of these Cases a hard Tumour may be felt, which surrounds the +Belly like a Cord. The Flatulences within become very audible, some of +them are discharged upwards; in a little Time after, Vomitings come on, +which increase till the Patient has thrown up all he had taken in, with +a still further Augmentation of the excessive Pain. With the first of +his Vomitings he only brings up the last Food he had taken, with his +Drink and some yellowish Humour: but what comes up afterwards proves +stinking; and when the Disease is greatly heightened, they have what is +called the Smell of Excrement or Dung; but which rather resembles that +of a putrid dead Body. It happens too sometimes, that if the Sick have +taken Glysters composed of Materials of a strong Smell, the same Smell +is discernible in the Matter they vomit up. I confess however I never +saw either real Excrements, or the Substance of their Glysters, brought +up, much less the Suppositories that were introduced into the Fundament: +and were it credible that Instances of this Kind had occurred, they must +be allowed very difficult to account for. Throughout this whole Term of +the Disease, the Patient has not a single Discharge by Stool; the Belly +is greatly distended; the Urine not seldom suppressed, and at other +Times thick and foetid. The Pulse, which at first was pretty hard, +becomes quick and small; the Strength entirely vanishes; a Raving comes +on; a Hiccup almost constantly supervenes, and sometimes general +Convulsions; the Extremities grow cold, the Pulse scarcely perceivable; +the Pain and the Vomiting cease, and the Patient dies very quickly +after. + +Sec. 318. As this Disease is highly dangerous, the Moment it is strongly +apprehended, it is necessary to oppose it by proper Means and Remedies: +the smallest Error may be of fatal Consequence, and hot inflaming +Liquids have been known to kill the Patient in a few Hours. I was called +in the second Day of the Disease to a young Person, who had taken a good +deal of Venice Treacle: Nothing could afford her any Relief, and she +died early on the third Day. + +This Disease should be treated precisely in the same Manner as an +inflammatory Cholic; the principal Difference being, that in the former +there are no Stools, but continual Vomitings. + +1, First of all then the Patient should be plentifully bled, if the +Physician has been called in early enough, and before the Sick has lost +his Strength. + +2, He should receive opening Glysters made of a Decoction of Barley +Water, with five or six Ounces of Oil in each. + +3, We should endeavour to allay the violent Efforts to vomit, by giving +every two Hours a Spoonful of the Mixture No. 48. + +4, The Sick should drink plentifully, in very small Quantities, very +often repeated, of an appeasing, diluting, refreshing Drink, which tends +at the same Time to promote both Stools and Urine. Nothing is preferable +to the Whey No. 49, if it can be had immediately: if not, give simple +clear Whey sweetened with Honey, and the Drinks prescribed Sec. 298, Art. +3. + +5, The Patient is to be put into a warm Bath, and kept as long as he can +bear it, repeating it as often daily too, as his Strength will permit. + +6, After Bleeding, warm Bathing, repeated Glysters and Fomentations, if +each and all of these have availed nothing; the Fume or Smoak of Tobacco +may be introduced in the Manner of a Glyster, of which I shall speak +further, in the Chapter on Persons drowned. + +I cured a Person of this Disease, by conveying him into a Bath, +immediately after bleeding him, and giving him a Purge on his going into +the Bath. + +Sec. 319. If the Pain abates before the Patient has quite lost his +Strength; if the Pulse improves at the same Time; if the Vomitings are +less in Number, and in the Quantity of the Matter brought up; if that +Matter seems in a less putrid offensive State; if he feels some +Commotion and Rumbling in his Bowels; if he has some little Discharge by +Stool; and if at the same Time he feels himself a little stronger than +before, his Cure may reasonably be expected; but if he is otherwise +circumstanced he will soon depart. It frequently happens, a single Hour +before Death, that the Pain seems to vanish, and a surprising Quantity +of extremely foetid Matter is discharged by Stool: the Patient is +suddenly seized with a great Weakness and Sinking, falls into a cold +Sweat, and immediately expires. + +Sec. 320. This is the Disease which the common People attribute to, and +term, the _Twisting of the Guts_; and in which they make the Patients +swallow Bullets, or large Quantities of Quick-silver. This twisting, +tangling, or Knoting of the Guts is an utter, an impossible Chimera; for +how can they admit of such a Circumstance, as one of their Extremities, +their Ends, is connected to the Stomach, and the other irremoveably +fastened to the Skin of the Fork or Cleft of the Buttocks? In Fact this +Disease results from a Variety of Causes, which have been discovered on +a Dissection of those who have died of it. It were to be wished indeed +this prudent Custom, so extremely conducive to enrich, and to perfect, +the Art of Physick, were to prevail more generally; and which we ought +rather to consider as a Duty to comply with, than a Difficulty to submit +to; as it is our Duty to contribute to the Perfection of a Science, on +which the Happiness of Mankind so considerably depends. I shall not +enter into a Detail of these Causes; but whatever they are, the Practice +of swallowing Bullets in the Disease is always pernicious, and the like +Use of Mercury must be often so. Each of these pretended Remedies may +aggravate the Disease, and contribute an insurmountable Obstacle to the +Cure--Of that Iliac Passion, which is sometimes a Consequence of +Ruptures, I shall treat in another Place. + + + + _Of the Cholera-morbus._ + + +Sec. 321. This Disease is a sudden, abundant, and painful Evacuation by +vomiting and by Stool. + +It begins with much Flatulence, or Wind, with Swelling and slight Pains +in the Belly, accompanied with great Dejection; and followed with large +Evacuations either by Stool or by Vomit at first, but whenever either of +them has begun, the other quickly follows. The Matter evacuated is +either yellowish, green, brown, whitish, or black; the Pains in the +Belly violent; the Pulse, almost constantly feverish, is sometimes +strong at first, but soon sinks into Weakness, in Consequence of the +prodigious Discharge. Some Patients purge a hundred Times in the Compass +of a few Hours: they may even be seen to fall away; and if the Disease +exists in a violent Degree, they are scarcely to be known within three +or four Hours from the Commencement of these Discharges. After a great +Number of them they are afflicted with Spasms, or Cramps, in their Legs, +Thighs, and Arms, which torment them as much as the Pains in the Belly. +When the Disease rages too highly to be asswaged, Hiccups, Convulsions +and a Coldness of the Extremities approach; there is a scarcely +intermitting Succession of fainting, or swooning Fits, the Patient dying +either in one of them, or in Convulsions. + +Sec. 322. This Disease, which constantly depends on a Bile raised to the +highest Acrimony, commonly prevails towards the End of July and in +August: especially if the Heats have been very violent, and there have +been little or no Summer Fruits, which greatly conduce to attempt: and +allay the putrescent Acrimony of the Bile. + +Sec. 323. Nevertheless, however violent this Distemper may be, it is less +dangerous, and also less tormenting than the former, many Persons +recovering from it. + +1, Our first Endeavour should be to dilute, or even to drown this acrid +Bile, by Draughts, by Deluges, of the most mitigating Drinks; the +irritation being so very great, that every Thing having the least +Sharpness is injurious. Wherefore the patient should continually take +in, by Drink, and by Way of Glyster, either Barley-Water, Almond-Milk, +or pure Water, with one eighth Part Milk, which has succeeded very well +in my Practice. Or he may use a very light Decoction, or Ptisan, as it +were, of Bread, which is made by gently boiling a Pound of toasted +Bread, in three or four Pots of Water for half an Hour. In _Swisserland_ +we prefer Oat bread. We also successfully use pounded Rye, making a +light Ptisan of it. + +A very light thin Soup made of a Pullet, a Chicken, or of one Pound of +lean Veal, in three Pots of Water, is very proper too in this Disease. +Whey is also employed to good Purpose; and in those Places, where it can +easily be had, Butter-milk is the best Drink of any. But, whichever of +these Drinks shall be thought preferable, it is a necessary Point to +drink very plentifully of it; and the Glysters should be given every two +Hours. + +2, If the Patient is of a robust Constitution, and sanguine Complexion, +with a strong Pulse at the Time of the Attack, and the Pains are very +severe, a first, and in some Cases, a second Bleeding, very early in the +Invasion, asswages the Violence of the Malady, and allows more Leisure +for the Assistance of other Remedies. I have seen the Vomiting cease +almost entirely, after the first Bleeding. + +The Rage of this Disease abates a little after a Duration of five or six +Hours: we must not however, during this Remission or Abatement, forbear +to throw in proper Remedies; since it returns soon after with great +Force, which Return however indicates no Alteration of the Method +already entered upon. + +3, In general the warm Bath refreshes the Patient while he continues in +it; but the Pains frequently return soon after he is taken out, which, +however, is no Reason for omitting it, since it has frequently been +found to give a more durable Relief. The Patient should continue in it a +considerable Time, and, during that Time, he should take six or seven +Glasses of the Potion No. 32, which has been very efficacious in this +Disease. By these Means the Vomiting has been stopt; and the Patient, +upon going out of the Bath, has had several large Stools, which very +considerably diminished the Violence of the Disease. + +4, If the Patient's Attendants are terrified by these great Evacuations, +and determine to check them (however prematurely) by Venice Treacle, +Mint Water, Syrup of white Poppies, called Diacodium, by Opium or +Mithridate, it either happens, that the Disease and all its Symptoms are +heightened, to which I have been a Witness; or, if the Evacuations +should actually be stopt, the Patient, in Consequence of it, is thrown +into a more dangerous Condition. I have been obliged to give a Purge, in +order to renew the Discharges, to a Man, who had been thrown into a +violent Fever, attended with a raging _Delirium_, by a Medicine composed +of Venice Treacle, Mithridate and Oil. Such Medicines ought not to be +employed, until the Smallness of the Pulse, great Weakness, violent and +almost continual Cramps, and even the Insufficience of the Patient's +Efforts to vomit, make us apprehensive of his sinking irrecoverably. In +such Circumstances indeed he should take, every Quarter or half Quarter +of an Hour, a Spoonful of the Mixture No. 50, still continuing the +diluting Drinks. After the first Hour, they should only be given every +Hour, and that only to the Extent of eight Doses. But I desire to insist +upon it here, that this Medicine should not be given too early in this +Distemper. + +Sec. 324. If the Patient is likely to recover, the Pains and the +Evacuations gradually abate; the Thirst is less; the Pulse continues +very quick, but it becomes regular. There have been Instances of their +Propensity to a heavy kind of Drowsiness at this Time; for perfect +refreshing Sleep advances but slowly after this Disease. It will still +be proper to persevere in the Medicines already directed, though +somewhat less frequently. And now we may begin to allow the Patient a +few Soups from farinaceous mealy Substances; and as soon as the +Evacuations accompanying this Disease are evidently ceased, and the +Pains are vanished; though an acute Sensibility and great Weakness +continues, beside such Soups, he may be allowed some new-laid Eggs, very +lightly boiled, or even raw, for some Days. After this he must be +referred to the Regimen so frequently recommended to Persons in a State +of Recovery: when the concurring Use of the Powder No. 24, taken twice a +Day, will greatly assist to hasten and to establish his Health. + + + + + __Chapter XXIII.__ + + + _Of a Diarrhoea, or Looseness._ + + + __Sect.__ 325. + +Every one knows what is meant by a Looseness or Purging, which the +Populace frequently call a Flux, and sometimes a Cholic. + +There are certain very chronical, or tedious and obstinate ones, which +arise from some essential Fault in the Constitution. Of such, as foreign +to my Plan, I shall say nothing. + +Those which come on suddenly, without any preceding Disorder, except +sometimes a slight Qualm or short Loathing, and a Pain in the Loins and +Knees; which are not attended with smart Pains nor a Fever (and +frequently without any Pain, or any other Complaint) are oftener of +Service than prejudicial. They carry off a Heap of Matter that may have +been long amassed and corrupted in the Body; which, if not discharged, +might have produced some Distemper; and, far from weakening the Body, +such Purgings as these render it more strong, light and active. + +Sec. 326. Such therefore ought by no Means to be stopped, nor even speedily +checked: they generally cease of themselves, as soon as all the noxious +Matter is discharged; and as they require no Medicine, it is only +necessary to retrench considerably from the ordinary Quantity of +Nourishment; to abstain from Flesh, Eggs and Wine or other strong Drink; +to live only on some Soups, on Pulse, or on a little Fruit, whether raw +or baked, and to drink rather less than usual. A simple Ptisan with a +little Syrup of _Capillaire_, or Maiden-hair, is sufficient in these +Purgings, which require no Venice Treacle, Confection, nor any Drug +whatever. + +Sec. 327. But should it continue more than five or six Days, and manifestly +weaken the Patient; if the Pain attending it grows a little severe; and +especially if the Irritation, the urging to Stool, proves more frequent, +it becomes seasonable to check, or to stop, it. For this Purpose the +Patient is to be put into a Regimen; and if the Looseness has been +accompanied with a great Loathing, with Risings or Wamblings at Stomach, +with a foul furred Tongue, and a bad Taste in the Mouth, he must take +the Powder No. 35. But if these Symptoms do not appear, give him that of +No. 51: and during the three following Hours, let him take, every half +Hour, a Cup of weak light Broth, without any Fat on it. + +If the Purging, after being restrained by this Medicine, should return +within a few Days, it would strongly infer, there was still some tough +viscid Matter within, that required Evacuation. To effect this he should +take the Medicines No. 21, 25 or 27; and afterwards take fasting, for +two successive Mornings, half the Powder, No. 51. + +On the Evening of that Day when the Patient took No. 35, or No. 51, or +any other Purge, he may take a small Dose of Venice Treacle. + +Sec. 328. A Purging is often neglected for a long Time, without observing +the least Regimen, from which Neglect they degenerate into tedious and +as it were habitual, perpetual ones, and entirely weaken the Patient. In +such Cases, the Medicine No. 35 should be given first; then, every other +Day for four Times successively, he should take No. 51: during all which +Time he should live on nothing but Panada (See Sec. 57) or on Rice boiled +in weak Chicken-broth. A strengthing stomachic Plaister has sometimes +been successfully applied, which may be often moistened in a Decoction +of Herbs boiled in Wine. Cold and Moisture should be carefully avoided +in these Cases, which frequently occasion immediate Relapses, even after +the Looseness had ceased for many Days. + + + + + __Chapter XXIV.__ + + + _Of the Dysentery, or Bloody-flux._ + + + __Sect.__ 329. + +The Dysentery is a Flux or Looseness of the Belly, attended with great +Restlessness and Anguish, with severe Gripings, and frequent +Propensities to go to Stool. There is generally a little Blood in the +Stools, though this is not a constant Symptom, and is not essential to +the Existence of a Dysentery; notwithstanding it may not be much less +dangerous, for the Absence of this Symptom. + +Sec. 330. The Dysentery is often epidemical; beginning sometimes at the End +of July, though oftner in August, and going off when the Frosts set in. +The great preceding Heats render the Blood and the Bile acrid or sharp; +and though, during the Continuance of the Heat, Perspiration is kept up +(See Introduct. P. 28) yet as soon as the Heat abates, especially in the +Mornings and Evenings, that Discharge is diminished; and by how much the +more Viscidity or Thickness the Humours have acquired, in Consequence of +the violent Heats, the Discharge of the sharp Humour by Perspiration +being now checked, it is thrown upon the Bowels which it irritates, +producing Pains in, and Evacuations from them. + +This Kind of Dysentery may happen at all Times, and in all Countries; +but if other Causes, capable of producing a Putridity of the Humours, be +complicated with it; such as the crouding up a great Number of People +into very little Room, and very close Quarters, as in Hospitals, Camps, +or Prisons, this introduces a malignant Principle into the Humours, +which, co-operating with the simpler Cause of the Dysentery, renders it +the more difficult and dangerous. + +Sec. 331. This Disease begins with a general Coldness rather than a +Shivering, which lasts some Hours; the Patient's Strength soon abates, +and he feels sharp Pains in his Belly, which sometimes continue for +several Hours, before the Flux begins. He is affected with _Vertigos_, +or Swimmings in the Head, with Reachings to vomit, and grows pale; his +Pulse at the same Time being very little, if at all, feverish, but +commonly small, and at length the Purging begins. The first Stools are +often thin, and yellowish; but in a little Time they are mixt with a +viscid ropy Matter, which is often tinged with Blood. Their Colour and +Consistence are various too, being either brown, greenish or black, +thinner or thicker, and foetid: The Pains increase before each of the +Discharges, which grow very frequent, to the Number of eight, ten, +twelve or fifteen in an Hour: then the Fundament becomes considerably +irritated, and the _Tenesmus_ (which is a great Urgency to go to Stool, +though without any Effect) is joined to the Dysentery or Flux, and often +brings on a Protrusion or falling down of the Fundament, the Patient +being now most severely afflicted. Worms are sometimes voided, and +glairy hairy Humours, resembling Pieces or Peelings of Guts, and +sometimes Clots of Blood. + +If the Distemper rises to a violent Height, the Guts become inflamed, +which terminates either in Suppuration or in Mortification; the +miserable Patient discharges _Pus_, or black and foetid watery Stools: +the Hiccup supervenes; he grows delirious; his Pulse sinks; and he falls +into cold Sweats and Faintings which terminate in Death. + +A kind of Phrenzy, or raging _Delirium_, sometimes comes on before the +Minute of Expiration. I have seen a very unusual Symptom accompany this +Disease in two Persons, which was an Impossibility of swallowing, for +three Days before Death. + +But in general this Distemper is not so extremely violent; the +Discharges are less frequent, being from twenty-five to forty within a +Day and Night. Their Contents are less various and uncommon, and mixed +with very little Blood; the Patient retains more Strength; the Number of +Stools gradually decrease; the Blood disappears; the Consistence of the +Discharges improves; Sleep and Appetite return, and the Sick recovers. + +Many of the Sick have not the least Degree of Fever, nor of Thirst, +which perhaps is less common in this Disease, than in a simple Purging +or Looseness. + +Their Urine sometimes is but in a small Quantity; and many Patients have +ineffectual Endeavours to pass it, to their no small Affliction and +Restlessness. + +Sec. 332. The most efficacious Remedy for this Disease is a Vomit. That of +No. 34, (when there is no present Circumstance that forbids the giving a +Vomit) if taken immediately on the first Invasion of it, often removes +it at once; and always shortens its Duration. That of No. 35 is not less +effectual; it has been considered for a long Time, even as a certain +Specific, which it is not, though a very useful Medicine. If the Stools +prove less frequent after the Operation of either of them, it is a good +Sign; if they are no Ways diminished, we may apprehend the Disease is +like to be tedious and obstinate. + +The Patient is to be ordered to a Regimen, abstaining from all +Flesh-meat with the strictest Attention, until the perfect Cure of the +Disease. The Ptisan No. 3 is the best Drink for him. + +The Day after the Vomit, he must take the Powder No. 51 divided into two +Doses: the next Day he should take no other Medicine but his Ptisan; on +the fourth the Rhubarb must be repeated; after which the Violence of the +Disease commonly abates: His Diet during the Disease is nevertheless to +be continued exactly for some Days; after which he may be allowed to +enter upon that of Persons in a State of Recovery. + +Sec. 333. The Dysentery sometimes commences with an inflammatory Fever; a +feverish, hard, full Pulse, with a violent Pain in the Head and Loins, +and a stiff distended Belly. In such a Case the Patient must be bled +once; and daily receive three or even four of the Glysters No. 6, +drinking plentifully of the Drink No. 3. + +When all Dread of an Inflammation is entirely over, the Patient is to be +treated in the Manner just related; though often there is no Necessity +for the Vomit: and if the inflammatory Symptoms have run high, his first +Purge should be that of No. 11, and the Use of the Rhubarb may be +postponed, till about the manifest Conclusion of the Disease. + +I have cured many Dysenteries, by ordering the Sick no other Remedy, but +a Cup of warm Water every Quarter of an Hour; and it were better to rely +only on this simple Remedy, which must be of some Utility, than to +employ those, of whose Effects Country People are ignorant, and which +are often productive of very dangerous ones. + +Sec. 334. It sometimes happens that the Dysentery is combined with a putrid +Fever, which makes it necessary, after the Vomit, to give the Purges No. +23 or 47, and several Doses of No. 24, before the Rhubarb is given. No. +32 is excellent in this combined Case. + +There was in _Swisserland_ in the Autumn of 1755, after a very numerous +Prevalence of epidemical putrid Fevers had ceased, a Multitude of +Dysenteries, which had no small Affinity with, or Relation to, such +Fevers. I treated them first, with the Prescription No. 34, giving +afterwards No. 32; and I directed the Rhubarb only to very few, and that +towards the Conclusion of the Disease. By much the greater Number of +them were cured at the End of four or five Days. A small Proportion of +them, to whom I could not give the Vomit, or whose Cases were more +complicated, remained languid a considerable Time, though without +Fatality or Danger. + +Sec. 335. When the Dysentery is blended with Symptoms of Malignity (See Sec. +245) after premising the Prescription No. 35, those of No. 38 and 39 may +be called in successfully. + +Sec. 336. When the Disease has already been of many Days standing, without +the Patient's having taken any Medicines, or only such as were injurious +to him, he must be treated as if the Distemper had but just commenced; +unless some Symptoms, foreign to the Nature of the Dysentery, had +supervened upon it. + +Sec. 337. Relapses sometimes occur in Dysenteries, some few Days after the +Patients appeared well; much the greater Number of which are occasioned +either by some Error in Diet, by cold Air, or by being considerably +over-heated. They are to be prevented by avoiding these Causes of them; +and may be removed by putting the Patient on his Regimen, and giving him +one Dose of the Prescription No. 51. Should it return even without any +such discoverable Causes, and if it manifests itself to be the same +Distemper renewed, it must be treated as such. + +Sec. 338. This Disease is sometimes combined too with an intermitting +Fever; in which Case the Dysentery must be removed first, and the +intermittent afterwards. Nevertheless if the Access, the Fits of the +Fever have been very strong, the Bark must be given as directed Sec. 259. + +Sec. 339. One pernicious Prejudice, which still generally prevails is, that +Fruits are noxious in a Dysentery, that they even give it, and aggravate +it; and this perhaps is an extremely ill-grounded one. In truth bad +Fruits, and such as have not ripened well, in unseasonable Years, may +really occasion Cholics, a Looseness (though oftner a Costiveness) and +Disorders of the Nerves, and of the Skin; but never can occasion an +epidemical Dysentery or Flux. Ripe Fruits, of whatever Species, and +especially Summer Fruits, are the real Preservatives from this Disease. +The greatest Mischief they can effect, must result from their thinning +and washing down the Humours, especially the thick glutinous Bile, if +they are in such a State; good ripe Fruits being the true Dissolvents of +such; by which indeed they may bring on a Purging, but such a one, as is +rather a Guard against a Dysentery. + +We had a great, an extraordinary Abundance of Fruit in 1759 and 1760, +but scarcely any Dysenteries. It has been even observed to be more rare, +and less dangerous than formerly; and if the Fact is certain, it cannot +be attributed to any thing more probably, than to the very numerous +Plantations of Trees, which have rendered Fruit very plenty, cheap and +common. Whenever I have observed Dysenteries to prevail, I made it a +Rule to eat less Flesh, and Plenty of Fruit; I have never had the +slightest Attack of one; and several Physicians use the same Caution +with the same Success. + +I have seen eleven Patients in a Dysentery in one House, of whom nine +were very tractable; they eat Fruit and recovered. The Grandmother and +one Child, whom she loved more than the rest, were carried off. She +managed the Child after her own Fashion, with burnt Wine, Oil, and some +Spices, but no Fruit. She conducted herself in the very same Manner, and +both died. + +In a Country Seat near _Berne_, in the Year 1751, when these Fluxes made +great Havock, and People were severely warned against the Use of Fruits, +out of eleven Persons in the Family, ten eat plentifully of Prunes, and +not one of them was seized with it: The poor Coachman alone rigidly +observed that Abstinence from Fruit injoined by this Prejudice, and took +a terrible Dysentery. + +This same Distemper had nearly destroyed a Swiss Regiment in Garrison in +the South of _France_; the Captains purchased the whole Crop of several +Acres of Vineyard; there they carried the sick Soldiers, and gathered +the Grapes for such as could not bear being carried into the Vineyard; +those who were well eating nothing else: after this not one more died, +nor were any more even attacked with the Dysentery. + +A Clergyman was seized with a Dysentery, which was not in the least +mitigated by any Medicines he had taken. By meer Chance he saw some red +Currans; he longed for them, and eat three Pounds of them between seven +and nine o'Clock in the Morning; that very Day he became better, and was +entirely well on the next. + +I could greatly enlarge the Number of such Instances; but these may +suffice to convince the most incredulous, whom I thought it might be of +some Importance to convince. Far from forbidding good Fruit, when +Dysenteries rage, the Patients should be encouraged to eat them freely; +and the Directors of the Police, instead of prohibiting them, ought to +see the Markets well provided with them. It is a Fact of which Persons, +who have carefully informed themselves, do not in the least doubt. +Experience demonstrates it, and it is founded in Reason, as good Fruit +counter-operates all the Causes of Dysenteries. [77] + +[77] The Experience of all Countries and Times so strongly confirms + these important Truths, that they cannot be too often repeated, too + generally published, whenever and wherever this Disease rages. The + Succession of cold Showers to violent Heats; too moist a + Constitution of the Air; an Excess of animal Food; Uncleanliness + and Contagion, are the frequent Causes of epidemical Fluxes. _E. + L._ + + I have retained the preceding Note, abridged from this Gentleman, + as it contains the Suffrage of another experienced Physician, + against that Prejudice of ripe Fruits occasioning Fluxes, which is + too popular among ourselves, and probably more so in the Country + than in _London_. I have been also very credibly assured, that the + Son of a learned Physician was perfectly cured of a very obstinate + Purging, of a Year's Continuance (in Spite of all the usual + officinal Remedies) by his devouring large Quantities of ripe + Mulberries, for which he ardently longed, and drinking very freely + of their expressed Juice. The Fact occurred after his Father's + Decease, and was affirmed to me by a Gentleman intimately + acquainted with them both. _K._ + +Sec. 340. It is important and even necessary, that each Subject of this +Disease should have a Close-stool or Convenience apart to himself, as +the Matter discharged is extremely infectious: and if they make Use of +Bed-pans, they should be carried immediately out of the Chamber, the Air +of which should be continually renewed, burning Vinegar frequently in +it. + +It is also very necessary to change the Patient's Linen frequently; +without all which Precautions the Distemper becomes more violent, and +attacks others who live in the same House. Hence it is greatly to be +wished the People in general were convinced of these Truths. + +It was _Boerhaave's_ Opinion, that all the Water which was drank, while +Dysenteries were epidemical, should be _stummed_, as we term it, or +sulphurized. [78] + +[78] Our learned Author, or his medical Editor at _Lyons_, observes + here, 'that in the Edition of this Treatise at _Paris_, there was + an essential Mistake, by making _Boerhaave_ recommend the Addition + of Brandy, _Eau de vie_, instead of stumming or sulphurizing it,' + for which this Note, and the Text too use the Verb _branter_, which + Word we do not find in any Dictionary. We are told however, it + means to impregnate the Casks in which the Water is reserved, with + the Vapour of Sulphur, and then stopping them; in the same Manner + that Vessels are in some Countries, for the keeping of Wine. He + observes the Purpose of this is to oppose Corruption by the acid + Steams of the Sulphur. _K._ + +Sec. 341. It has happened, by some unaccountable Fatality, that there is no +Disease, for which a greater Number of Remedies are advised, than for +the Dysentery. There is scarcely any Person but what boasts of his own +Prescription, in Preference to all the rest, and who does not boldly +engage to cure, and that within a few Hours, a tedious severe Disease, +of which he has formed no just Notion, with some Medicine or +Composition, of whose Operation he is totally ignorant: while the poor +Sufferer, restless and impatient, swallows every Body's Recommendation, +and gets poisoned either through Fear, downright Disgust or Weariness, +or through entire Complaisance. Of these many boasted Compositions, some +are only indifferent, but others pernicious. I shall not pretend to +detail all I know myself, but after repeatedly affirming, that the only +true Method of Cure is that I have advised here, the Purpose of which is +evacuating the offending Matter; I also affirm that all those Methods, +which have a different Scope or Drift, are pernicious; but shall +particularly observe, that the Method most generally followed, which is +that of stopping the Stools by Astringents, or by Opiates, is the worst +of all, and even so mortal a one, as to destroy a Multitude of People +annually, and which throws others into incurable Diseases. By preventing +the Discharge of these Stools, and inclosing the Wolf in the Fold, it +either follows, 1, that this [79] retained Matter irritates and inflames +the Bowels from which Inflammation excruciating Pains arise, an acute +inflammatory Cholic, and finally a Mortification and Death; or a +_Schirrhus_, which degenerates into a _Cancer_, (of which I have seen a +dreadful Instance) or else an Abscess, Suppuration and Ulcer. Or 2, this +arrested Humour is repelled elsewhere, producing a _Scirrhus_ in the +Liver, or Asthmas, Apoplexy, Epilepsy, or Falling Sickness; horrible +rheumatic Pains, or incurable Disorders of the Eyes, or of the +Teguments, the Skin and Surface. + +[79] A first or second Dose of Glauber Salt has been known to succeed in + the epidemical Summer Fluxes of the hotter Climates, when repeated + Doses of Rhubarb and Opiates had failed. Such Instances seems a + collateral Confirmation of Dr. _Tissot's_ rational and successful + Use of cooling opening Fruits in them. _K._ + +Such are the Consequences of all the astringent Medicines, and of those +which are given to procure Sleep in this Disease, as Venice Treacle, +Mithridate and Diascordium, when given too early in Dysenteries. + +I have been consulted on Account of a terrible Rheumatism, which ensued +immediately after taking a Mixture of Venice Treacle and Plantain, on +the second Day of a Dysentery. + +As those who advise such Medicines, are certainly unaware of their +Consequences, I hope this Account of them will be sufficient, to prevent +their Repetition. + +Sec. 342. Neither are Purges without their Abuse and Danger; they determine +the Course of all the Humours more violently to the tender afflicted +Parts; the Body becomes exhausted; the Digestions fail; the Bowels are +weakened, and sometimes even lightly ulcerated, whence incurable +_Diarrhoeas_ or Purgings ensue, and prove fatal after many Years +Affliction. + +Sec. 343. If the Evacuations prove excessive, and the Distemper tedious, +the Patient is likely to fall into a Dropsy; but if this is immediately +opposed, it may be removed by a regular and drying Diet, by +Strengthners, by Friction and proper Exercise. + + + + + __Chapter XXV.__ + + + _Of the Itch._ + + + __Sect.__ 344. + +The Itch is an infectious Disorder contracted by touching infected +Persons or Cloaths, but not imbibed from the Air: So that by carefully +avoiding the _Medium_, or Means of Contagion, the Disorder may be +certainly escaped. + +Though any Part of the Body may be infested with the Itch, it commonly +shews itself on the Hands, and chiefly between the Fingers. At first one +or two little Pimples or Pustules appear, filled with a kind of clear +Water, and excite a very disagreeable Itching. If these Pustules are +broke by scratching them, the Water oozing from them infects the +neighbouring Parts. At the Beginning of this Infection it can scarcely +be distinguished, if a Person is not well apprized of its Nature; but in +the Progress of it, the little Pustules increase both in Number and +Size; and when they are opened by scratching, a loathsome kind of Scab +is formed, and the Malady extends over the whole Surface. Where they +continue long, they produce small Ulcers, and are at that Time highly +contagious. + +Sec. 345. Bad Diet, particularly the Use of Salt Meat, bad unripe Fruit, +and Uncleanliness occasion this Disease; though it is oftnest taken by +Contagion. Some very good Physicians suppose it is never contracted +otherwise; but I must take Leave to dissent, as I have certainly seen it +exist without Contagion. + +When it happens to a Person, who cannot suspect he has received it by +Contact, his Cure should commence with a total Abstinence from all Salt, +sour, fat and spicy Food. He should drink a Ptisan of wild and bitter +Succory, or that of No. 26, five or six Glasses of which may be daily +taken; at the End of four or five Days, he may be purged with No. 21, or +with an Ounce of _Sedlitz_ [or _Epsom_] Salt. His Abstinence, his +Regimen is to be continued; the Purge to be repeated after six or seven +Days; and then all the Parts affected, and those very near them, are to +be rubbed in the Morning fasting, with a fourth Part of the Ointment No. +52. The three following Days the same Friction is to be repeated, after +which the same Quantity of Ointment is to be procured, and used in the +same Proportion; but only every other Day. It happens but seldom that +this Method fails to remove this disagreeable Malady; sometimes however +it will return, in which Case, the Patient must be purged again, and +then recur to the Ointment, whose good Effects I have experienced, and +continually do. + +If the Disease has been very lately contracted, and most certainly by +Contact, the Ointment may be fearlessly employed, as soon as it is +discovered, without taking any Purge before it. But if, on the contrary, +the Disease has been long neglected, and has rose to a high Degree, it +will be necessary to restrain the Patient a long Time to the Regimen I +have directed; he must be repeatedly purged, and then drink plentifully +of the Ptisan No. 26, before the Ointment is rubbed in. When the Malady +is thus circumstanced, I have always begun with the Ointment No. 28, +half a Quarter of which is to be used every Morning. I have also +frequently omitted the Use of that No. 52, having always found the +former as certain, but a little slower in its Effects. + +Sec. 346. While these Medicines are employed, the Patient must avoid all +Cold and Wet, especially if he makes Use of No. 28, [80] in which there +is Quick-silver; which, if such Precautions were neglected, might bring +on a Swelling of the Throat and Gums, and even rise to a Salivation. Yet +this Ointment has one Advantage in its having no Smell, and being +susceptible of an agreeable one; while it is very difficult to disguise +the disagreeable Odour of the other. + +The Linen of a Person in this Disease ought to be often changed; but his +upper Cloaths must not be changed: because these having been infected, +might, when worn again, communicate the Itch to the Wearer again, after +he had been cured. + +Shirts, Breeches and Stockings may be fumigated with Sulphur, before +they are put on; and this Fumigation should be made in the open Air. + +[80] I have seen a pretty singular Consequence from the Abuse of + mercurial Unction for the Itch; whether it happened from the + Strength or Quantity of the Ointment, or from taking Cold after + applying it, as this Subject, a healthy Youth of about sixteen, + probably did, by riding three or four Miles through the Rain. But + without any other previous Complaint, he awoke quite blind one + Morning, wondering, as he said, when it would be Day. His Eyes were + very clear, and free from Inflammation, but the Pupil was wholly + immoveable, as in a _Gutta serena_. I effected the Cure by some + moderate Purges repeated a few Times; by disposing him to sweat by + lying pretty much in Bed (it being towards Winter) and by promoting + his Perspiration, chiefly with Sulphur: after which the shaved + Scalp was embrocated with a warm nervous Mixture, in which Balsam + of _Peru_ was a considerable Ingredient. In something less than + three Weeks he could discern a glowing Fire, or the bright Flame of + a Candle. As his Sight increased, he discerned other Objects, which + appeared for some Days inverted to him, with their Colours + confused; but Red was most distinguishable. He discovered the Aces + sooner than other Cards; and in about six or seven Weeks recovered + his full Sight in all its natural Strength, which he now enjoys. + _K._ + +Sec. 347. If this Disorder becomes very inveterate and tedious, it exhausts +the Patient, in Consequence of its not suffering him to sleep at Nights, +as well as by his restless Irritation; and sometimes even brings on a +Fever, so that he falls away in Flesh, and his Strength abates. + +In such a Case he must take, 1, a gentle Purge. + +2, Make Use frequently of warm Baths. + +3, He must be put on the Regimen of Persons in a State of Recovery. + +4, He must take Morning and Evening, fifteen Days successively, the +Powder No. 53, with the Ptisan No. 26. + +This Malady is often very obstinate, and then the Medicines must be +varied according to the Circumstances, the Detail of which I avoid here. + +Sec. 348. After giving repeated Purges in such obstinate Cases, mineral +Waters abounding with Sulphur, such as [81] those of _Yverdun_, &c. +often effect a Cure; and simple cold Bathings in Rivers or Lakes have +sometimes succeeded in very inveterate Cases of this Disorder. + +[81] Sea water, and those of _Dulwich_, _Harrigate_, _Shadwell_, &c. + will be full as effectual. _K._ + +Nothing conduces more to the long Continuance of this Malady, than the +Abuse of hot Waters, such as infusions of Tea, &c. + +Sec. 349. I shall conclude this Chapter, with a repeated Injunction not to +be too free or rash in the Use of the Ointment No. 52, and other outward +Remedies for extinguishing the Itch. There is hardly any Complaint, but +what has been found to be the Consequence of too sudden a Removal of +this Disorder by outward Applications, before due Evacuations have been +made, and a moderate Abatement of the Sharpness of the Humours has been +effected. + + + + + __Chapter XXVI.__ + + + + _The Treatment of Diseases peculiar to Women._ + + + __Sect.__ 350. + +Besides all the preceding Diseases, to which Women are liable in common +with Men, their Sex also exposes them to others peculiar to it, and +which depend upon four principal Sources; which are their monthly +Discharges, their Pregnancy, their Labours in Child-birth, and the +Consequences of their Labours. It is not my present Design to treat +professedly on each of the Diseases arising from these Causes, which +would require a larger Volume than I have proposed; but I shall confine +myself to certain general Directions on these four Heads. + +Sec. 351. Nature, who intended Women for the Increase, and the Nourishment +of the human Race at the Breast, has subjected them to a periodical +Efflux, or Discharge, of Blood: which Circumstance constitutes the +Source, from whence the Infant is afterwards to receive his Nutrition +and Growth. + +This Discharge generally commences, with us, between the Age of sixteen +and eighteen. Young Maidens, before the Appearance of this Discharge, +are frequently, and many for a long Time, in a State of Weakness, +attended with various Complaints, which is termed the _Chlorosis_, or +Green Sickness, and Obstructions: and when their Appearance is extremely +slow and backward, it occasions very grievous, and sometimes even mortal +Diseases. Nevertheless it is too usual, though very improper, to ascribe +all the Evils, to which they are subject at this Term of Life, solely to +this Cause; while they really often result from a different Cause, of +which the Obstructions themselves are sometimes only the Effect; and +this is the natural, and, in some Degree, even necessary Feebleness of +the Sex. The Fibres of Women which are intended to be relaxed, and to +give Way, when they are unavoidably extended by the Growth of the Child, +and its inclosing Membranes (which frequently arise to a very +considerable Size) should necessarily be less stiff and rigid, less +strong, and more lax and yielding than the Fibres of Men. Hence the +Circulation of their Blood is more slow and languid than in Males; their +Blood is less compact and dense, and more watery; their Fluids are more +liable to stagnate in their different Bowels, and to form Infarctions +and Obstructions. + +Sec. 352. The Disorders to which such a Constitution subjects them might, +in some Measure, be prevented, by assisting that Languor or Feebleness +of their natural Movements, by such an Increase of their Force, as +Exercise might contribute to: But this Assistance, which in some Manner +is more necessary for Females than Males, they are partly deprived of, +by the general Education and Habitude of the Sex; as they are usually +employed in managing Household Business, and such light sedentary Work, +as afford them less Exercise and Motion, than the more active +Occupations of Men. They stir about but little, whence their natural +Tendency to Weakness increases from Habit, and thence becomes morbid and +sickly. Their Blood circulates imperfectly; its Qualities become +impaired; the Humours tend to a pretty general Stagnation; and none of +the vital Functions are completely discharged. + +From such Causes and Circumstances they begin to sink into a State of +Weakness, sometimes while they are very young, and many Years before +this periodical Discharge could be expected. This State of Languor +disposes them to be inactive; a little Exercise soon fatigues them, +whence they take none at all. It might prove a Remedy, and even effect a +Cure, at the Beginning of their Complaint; but as it is a Remedy, that +is painful and disagreeable to them, they reject it, and thus increase +their Disorders. + +Their Appetite declines with the other vital Functions, and gradually +becomes still less; the usual salutary Kinds of Food never exciting it; +instead of which they indulge themselves in whimsical Cravings, and +often of the oddest and most improper Substances for Nutrition, which +entirely impair the Stomach with its digestive Functions, and +consequently Health itself. + +But sometimes after the Duration of this State for a few Years, the +ordinary Time of their monthly Evacuations approaches, which however +make not the least Appearance, for two Reasons. The first is, that their +Health is too much impaired to accomplish this new Function, at a Time +when all the others are so languid: and the second is, that under such +Circumstances, the Evacuations themselves are unnecessary; since their +final Purpose is to discharge (when the Sex are not pregnant) that +superfluous Blood, which they were intended to produce, and whose +Retention would be unhealthy, when not applied to the Growth of the +Foetus, or Nourishment of the Child: and this Superfluity of Blood does +not exist in Women, who have been long in a very low and languishing +State. + +Sec. 353. Their Disorder however continues to increase, as every one daily +must, which does not terminate. This Increase of it is attributed to the +Suppression or Non-appearance of their monthly Efflux, which is often +erroneous; since the Disorder is not always owing to that Suppression, +which is often the Effect of their Distemperature. This is so true, that +even when the Efflux happens, if their Weakness still continues, the +Patients are far from being the better for it, but the reverse. Neither +is it unusual to see young Lads, who have received from Nature, and from +their Parents, a sort of feminine Constitution, Education and Habitude, +infested with much the same Symptoms, as obstructed young Women. + +Country Girls, who are generally more accustomed to such hardy Work and +Exercise as Country Men, are less subject to these Complaints, than +Women who live in Cities. + +Sec. 354. Let People then be careful not to deceive themselves on this +important Account; since all the Complaints of young Maidens are not +owing to the Want of their Customs. Nevertheless it is certain there are +some of them, who are really afflicted from this Cause. For Instance, +when a strong young Virgin in full Health, who is nearly arrived to her +full Growth, and who manifestly abounds with Blood, does not obtain this +Discharge at the usual Time of Life, then indeed this superfluous Blood +is the Fountain of very many Disorders, and greatly more violent ones +than those, which result from the contrary Causes already mentioned. + +If the lazy inactive City Girls are more subject to the Obstructions, +which either arise from the Weakness and Languor I have formerly taken +Notice of, or which accompany it; Country Girls are more subject to +Complaints from this latter Cause (too great a Retention of superfluous +Blood) than Women who live in Cities: and it is this last Cause that +excites those singular Disorders, which appear so supernatural to the +common People, that they ascribe them to Sorcery. + +Sec. 355. And even after these periodical Discharges have appeared, it is +known that they have often been suppressed, without the least unhealthy +Consequence resulting from that Suppression. They are often suppressed, +in the Circumstances mentioned Sec. 351, by a Continuance of the Disease, +which was first an Obstacle or Retardment to their Appearance; and in +other Cases, they have been suppressed by other Causes, such as Cold, +Moisture, violent Fear, any very strong Passion; by too chilly a Course +of Diet, with Indigestion; or too hot and irritating Diet; by Drinks +cooled with Ice, by Exercise too long continued, and by unusual +Watching. The Symptoms, occasioned by such Suppressions, are sometimes +more violent than those, which preceded the first Appearance of the +Discharge. + +Sec. 356. The great Facility with which this Evacuation may be suppressed, +diminished, or disordered, by the Causes already assigned; the terrible +Evils which are the Consequences of such Interruptions and +Irregularities of them, seem to me very cogent Reasons to engage the Sex +to use all possible Care, in every Respect, to preserve the Regularity +of them; by avoiding, during their Approach and Continuance, every Cause +that may prevent or lessen them. Would they be thoroughly persuaded, not +solely by my Advice, but by that of their Mothers, their Relations, +their Friends, and by their own Experience, of what great Importance it +is to be very attentive to themselves, at those critical Times, I think +there is not one Woman, who from the first, to the very last Appearance +of them, would not conduct herself with the most scrupulous Regularity. + +Their Demeanour, in these Circumstances, very fundamentally interests +their own Health, as well as that of their Children; and consequently +their own Happiness, as well as that of their Husbands and Families. + +The younger and more delicate they are, Caution becomes the more +necessary for them. I am very sensible a strong Country Girl is too +negligent in regulating herself at those critical Seasons, and sometimes +without any ill Consequence; but at another Time she may suffer severely +for it: and I could produce a long List of many, who, by their +Imprudence on such Occasions, have thrown themselves into the most +terrible Condition. + +Besides the Caution with which Females should avoid these general +Causes, just mentioned in the preceding Section, every Person ought to +remember what has most particularly disagreed with her during that Term, +and for ever constantly to reject it. + +Sec. 357. There are many Women whose Customs visit them without the +slightest Impeachment of their Health: others are sensibly disordered on +every Return of them; and to others again they are very tormenting, by +the violent Cholics, of a longer or a shorter Duration, which precede or +accompany them. I have known some of these violent Attacks last but some +Minutes, and others which continued a few Hours. Nay some indeed have +persisted for many Days, attended with Vomiting, Fainting, with +Convulsions from excessive Pain, with Vomiting of Blood, Bleedings from +the Nose, _&c._ which, in short, have brought them to the very Jaws of +Death. So very dangerous a Situation requires the closest Attention; +though, as it results from several and frequently very opposite Causes, +it is impossible within the present Plan, to direct the Treatment that +may be proper for each Individual. Some Women have the Unhappiness to be +subject to these Symptoms every Month, from the first Appearance, to the +final Termination, of these Discharges; except proper Remedies and +Regimen, and sometimes a happy Child-birth, remove them. Others complain +but now and then, every second, third, or fourth Month; and there are +some again, who having suffered very severely during the first Months, +or Years, after their first Eruptions, suffer no more afterwards. A +fourth Number, after having had their Customs for a long Time, without +the least Complaint, find themselves afflicted with cruel Pains, at +every Return of them; if by Imprudence, or some inevitable Fatality, +they have incurred any Cause, that has suppressed, diminished, or +delayed them. This Consideration ought to suggest a proper Caution even +to such, as generally undergo these Discharges, without Pain or +Complaint: since all may be assured, that though they suffer no sensible +Disorder at that Time, they are nevertheless more delicate, more +impressible by extraneous Substances, more easily affected by the +Passions of the Mind, and have also weaker Stomachs at these particular +Periods. + +Sec. 358. These Discharges may also be sometimes too profuse in Quantity, +in which Case the Patients become obnoxious to very grievous Maladies; +into the Discussion of which however I shall not enter here, as they are +much less frequent than those, arising from a Suppression of them. +Besides which, in such Cases, Recourse may be had to the Directions I +shall give hereafter, when I treat of that Loss of Blood, which may be +expedient, during the Course of Gravidation or Pregnancy. See Sec. 365. + +Sec. 359. Finally, even when they are the most regular, after their +Continuance for a pretty certain Number of Years (rarely exceeding +thirty-five) they go off of their own Accord, and necessarily, between +the Age of forty-five and fifty; sometimes even sooner, but seldom +continuing longer: and this _Crisis_ of their ceasing is generally a +very troublesome, and often a very dangerous, one for the Sex. + +Sec. 360. The Evils mentioned Sec. 352 may be prevented, by avoiding the +Causes producing them; and, 1, by obliging young Maidens to use +considerable Exercise; especially as soon as there is the least Reason +to suspect the Approach of this Disorder, the _Chlorosis_, or Green +Sickness. + +2, By watching them carefully, that they eat nothing unwholesome or +improper; as there are scarcely any natural Substances, even among such +as are most improper for them, and the most distasteful, which have not +sometimes been the Objects of their sickly, their unaccountable +Cravings. Fat Aliments, Pastry, farinaceous or mealy, and sour and +watery Foods are pernicious to them. Herb-Teas, which are frequently +directed as a Medicine for them, are sufficient to throw them into the +Disorder, by increasing that Relaxation of their Fibres, which is a +principal Cause of it. If they must drink any such Infusions, as +medicated Drinks, let them be taken cold: but the best Drink for them is +Water, in which red hot Iron has been extinguished. + +3, They must avoid hot sharp Medicines, and such as are solely intended +to force down their Terms, which are frequently attended with very +pernicious Consequences, and never do any good: and they are still the +more hurtful, as the Patient is the younger. + +4, If the Malady increases, it will be necessary to give them some +Remedies; but these should not be Purges, nor consist of Diluters, and +Decoctions of Herbs, of Salts, and a Heap of other useless and noxious +Ingredients; but they should take Filings of Iron, which is the most +certain Remedy in such Cases. These Filings Should be of true simple +Iron, and not from Steel; and Care should be taken that it be not rusty, +in which State it has very little Effect. + +At the Beginning of this Distemper, and to young Girls, it is sufficient +to give twenty Grains daily, enjoining due Exercise and a suitable Diet. +When it prevails in a severer Degree, and the Patient is not so young, a +Quarter of an Ounce may be safely ventured on: Certain Bitters or +Aromatics may be advantageously joined to the Filings, which are +numbered in the Appendix, 54, 55, 56, and constitute the most effectual +Remedies in this Distemper, to be taken in the Form of Powder, of vinous +Infusion, or of Electary. [82] When there is a just Indication to bring +down the Discharge, the vinous Infusion No. 55 must be given, and +generally succeeds: but I must again repeat it (as it should carefully +be considered) that the Stoppage or Obstruction of this Discharge is +frequently the Effect, not the Cause, of this Disease; and that there +should be no Attempt to force it down, which in such a Case, may +sometimes prove more hurtful than beneficial; since it would naturally +return of its own Accord, on the Recovery, and with the Strength, of the +Patient: as their Return should follow that of perfect Health, and +neither can precede Health, nor introduce it. There are some Cases +particularly, in which it would be highly dangerous to use hot and +active Medicines, such Cases for Instance, as are attended with some +Degree of Fever, a frequent Coughing, a Haemorrhage, or Bleeding, with +great Leanness and considerable Thirst: all which Complaints should be +removed, before any hot Medicines are given to force this Evacuation, +which many very ignorantly imagine cures all other female Disorders; an +Error, that has prematurely occasioned the Loss of many Womens' Lives. + +[82] The _French_ Word here, _Opiat_, is sometimes used by them for a + compound Medicine of the Consistence of an Electary; and cannot be + supposed, in this Place, to mean any Preparation, into which + _Opium_ enters. _K._ + +Sec. 361. While the Patient is under a Course of these Medicines, she +should not take any of those I have forbidden in the preceding Sections; +and the Efficacy of these should also be furthered with proper Exercise. +That in a Carriage is very healthy; Dancing is so too, provided it be +not extended to an Excess. In Case of a Relapse in these Disorders, the +Patient is to be treated, as if it were an original Attack. + +Sec. 362. The other Sort of Obstructions described Sec. 354 requires a very +different Treatment. Bleeding, which is hurtful in the former Sort, and +the Use, or rather Abuse, of which has thrown several young Women into +irrecoverable Weaknesses, has often removed this latter Species, as it +were, in a Moment. Bathing of the Feet, the Powders No. 20, and Whey +have frequently succeeded: but at other Times it is necessary to +accommodate the Remedies and the Method to each particular Case, and to +judge of it from its own peculiar Circumstances and Appearances. + +Sec. 363. When these Evacuations naturally cease through Age (See Sec. 359) if +they stop suddenly and all at once, and had formerly flowed very +largely, Bleeding must, 1, necessarily be directed, and repeated every +six, every four, or even every three Months. + +2, The usual Quantity of Food should be somewhat diminished, especially +of Flesh, of Eggs and of strong Drink. + +3, Exercise should be increased. + +4, The Patient should frequently take, in a Morning fasting, the Powder +No. 24, which is very beneficial in such Cases; as it moderately +increases the natural Excretions by Stool, Urine and Perspiration; and +thence lessens that Quantity of Blood, which would otherwise +superabound. + +Nevertheless, should this total Cessation of the monthly Discharge be +preceded by, or attended with, any extraordinary Loss of Blood, which is +frequently the Case, Bleeding is not so necessary; but the Regimen and +Powder just directed are very much so; to which the Purge No. 23 should +now and then be joined, at moderate Intervals. The Use of astringent +Medicines at this critical Time might dispose the Patient to a Cancer of +the Womb. + +Many Women die about this Age, as it is but too easy a Matter to injure +them then; a Circumstance that should make them very cautious and +prudent in the Medicines they recur to. On the other Hand it also +frequently happens, that their Constitutions alter for the better, after +this critical Time of Life; their Fibres grow stronger; they find +themselves sensibly more hearty and hardy; many former slight +Infirmities disappear, and they enjoy a healthy and happy old Age. I +have known several who threw away their Spectacles at the Age of +fifty-two, or fifty-three, which they had used five or six Years before. + +The Regimen I have just directed, the Powder No. 24, and the Potion No. +32, agree very well in almost all inveterate Discharges (I speak of the +female Peasantry) at whatever Time of Life. + + + + _Of Disorders attending Gravidation, or the Term of going with Child._ + + +Sec. 364. Gravidation is generally a less ailing or unhealthy State in the +Country, than in very populous Towns. Nevertheless Country Women are +subject, as well as Citizens, to Pains of the Stomach, to vomiting in a +Morning, to Head-ach and Tooth-ach; but these Complaints very commonly +yield to Bleeding, which is almost the only Remedy necessary [83] for +pregnant Women. + +[83] Too great a Fulness of Blood is undoubtedly the Cause of all these + Complaints; but as there are different Methods of opposing this + Cause, the gentlest should always be preferred; nor should the + Constitution become habituated to such Remedies, as might either + impair the Strength of the Mother, or of her Fruit. Some Expedients + therefore should be thought of, that may compensate for the Want of + Bleeding, by enjoining proper Exercise in a clear Air, with a less + nourishing, and a less juicy Diet. _E. L._ + + This Note might have its Use sometimes, in the Cases of such + delicate and hysterical, yet pregnant Women, as are apt to suffer + from Bleeding, or any other Evacuation, though no ways immoderate. + But it should have been considered, that Dr. _Tissot_ was + professedly writing here to hearty active Country Wives, who are + very rarely thus constituted; and whom he might be unwilling to + confuse with such multiplied Distinctions and Directions, as would + very seldom be necessary, and might sometimes prevent them from + doing what was so. Besides which, this Editor might have seen, our + Author has hinted at such Cases very soon after. _K._ + +Sec. 365. Sometimes after carrying too heavy Burthens; after too much or +too violent Work; after receiving excessive Jolts, or having had a Fall, +they are subject to violent Pains of the Loins, which extend down to +their Thighs, and terminate quite at the Bottom of the Belly; and which +commonly import, that they are in Danger of an Abortion, or Miscarrying. + +To prevent this Consequence, which is always dangerous, they should, 1, +immediately go to Bed; and if they have not a Mattrass, they should lie +upon a Bed stuffed with Straw, a Feather-bed being very improper in such +Cases. They should repose, or keep themselves quite still in this +Situation for several Days, not stirring, and speaking as little as +possible. + +2, They should directly lose eight or nine Ounces of Blood from the Arm. + +3, They should not eat Flesh, Flesh-broth, nor Eggs; but live solely on +Soups made of farinaceous or mealy Substances. + +4, They should take every two Hours half a Paper of the Powder No. 20; +and should drink nothing but the Ptisan No. 2. + +Some sanguine robust Women are very liable to miscarry at a certain +Time, or Stage, of their Pregnancy. This may be obviated by their +bleeding some Days before that Time approaches, and by their observing +the Regimen I have advised. But this Method would avail very little for +delicate Citizens, who miscarry from a very different Cause; and whose +Abortions are to be prevented by a very different Treatment. + + + + _Of Delivery, or Child-birth._ + + +Sec. 366. It has been observed that a greater Proportion of Women die in +the Country in, or very speedily after, their Delivery, and that from +the Scarcity of good Assistance, and the great Plenty of what is bad; +and that a greater Proportion of those in Cities die after their Labours +are effected, by a Continuance of their former bad Health. + +The Necessity there is for better instructed, better qualified Midwives, +through a great Part of _Swisserland_, is but too manifest an +Unhappiness, which is attended with the most fatal Consequences, and +which merits the utmost Attention of the Government. + +The Errors which are incurred, during actual Labour, are numberless, and +too often indeed are also irremediable. It would require a whole Book, +expressly for that Purpose (and in some Countries there are such) to +give all the Directions that are necessary, to prevent so many +Fatalities: and it would be as necessary to form a sufficient Number of +well-qualified Midwives to comprehend, and to observe them; which +exceeds the Plan of the Work I have proposed. I shall only mark out one +of the Causes, and the most injurious one on this Occasion: This is the +Custom of giving hot irritating Things, whenever the Labour is very +painful, or is slow; such as Castor, or its Tincture, Saffron, Sage, +Rue, Savin, Oil of Amber, Wine, Venice Treacle, Wine burnt with Spices, +Coffee, Brandy, Aniseed-Water, Walnut-Water, Fennel-Water, and other +Drams or strong Liquors. All these Things are so many Poisons in this +Respect, which, very far from promoting the Woman's Delivery, render it +more difficult by inflaming the Womb (which cannot then so well contract +itself) and the Parts, through which the Birth is to pass, in +Consequence of which they swell, become more straitened, and cannot +yield or be dilated. Sometimes these stimulating hot Medicines also +bring on Haemorrhages, which prove mortal in a few Hours. + +Sec. 367. A considerable Number, both of Mothers and Infants, might be +preserved by the directly opposite Method. As soon as a Woman who was in +very good Health, just before the Approach of her Labour, being robust +and well made, finds her Travail come on, and that it is painful and +difficult; far from encouraging those premature Efforts, which are +always destructive; and from furthering them by the pernicious Medicines +I have just enumerated, the Patient should be bled in the Arm, which +will prevent the Swelling and Inflammation; asswage the Pains; relax the +Parts, and dispose every thing to a favourable Issue. + +During actual Labour no other Nourishment should be allowed, except a +little Panada every three Hours, and as much Toast and Water, as the +Woman chuses. + +Every fourth Hour a Glyster should be given, consisting of a Decoction +of Mallows and a little Oil. In the Intervals between these Glysters she +should be set over a kind of Stove, or in a pierced easy Chair, +containing a Vessel in which there is some hot Water: the Passage should +be gently rubbed with a little Butter; and Stapes wrung out of a +Fomentation of simple hot Water, which is the most efficacious of any, +should be applied over the Belly. + +The Midwives, by taking this Method, are not only certain of doing no +Mischief, but they also allow Nature an Opportunity of doing Good: as a +great many Labours, which seem difficult at time, terminate happily; and +this safe and unprecipitate Manner of proceeding at least affords Time +to call in further Assistance. Besides, the Consequences of such +Deliveries are healthy and happy; when by pursuing the heating +oppressing Practice, even though the Delivery be effected, both Mother +and Infant have been so cruelly, though undesignedly, tormented, that +both of them frequently perish. + +Sec. 368. I acknowledge these Means are insufficient, when the Child is +unhappily situated in the Womb; or when there is an embarrassing +Conformation in the Mother: though at least they prevent the Case from +proving worse, and leave Time for calling in Men-Midwives, or other +female ones, who may be better qualified. + +I beg leave again to remind the Midwives, that they should be very +cautious of urging their Women to make any forced Efforts to forward the +Birth, which are extremely injurious to them, and which may render a +Delivery very dangerous and embarrassing, that might otherwise have been +happily effected: and I insist the more freely on the Danger attending +these unreasonable Efforts, and on the very great Importance of +Patience, as the other very pernicious Practice is become next to +universal amongst us. + +The Weakness, in which the labouring Woman appears, makes the +By-standers fearful that she will not have Strength enough to be +delivered; which they think abundantly justifies them in giving her +Cordials; but this Way of Reasoning is very weak and chimerical. Their +Strength, on such Occasions, is not so very speedily dissipated: the +small light Pains sink them, but in Proportion as the Pains become +stronger, their Strength arises; being never deficient, when there is no +extraordinary and uncommon Symptom; and we may reasonably be assured, +that in a healthy, well formed Woman, meer Weakness never prevents a +Delivery. + + + + _Of the Consequences of Labour, or Childbirth._ + + +Sec. 369. The most usual Consequences of Childbirth in the Country are, 1, +An excessive Haemorrhage. 2, An Inflammation of the Womb. 3, A sudden +Suppression of the _Lochia_, or usual Discharges after Delivery. And, 4, +the Fever and other Accidents, resulting from the Milk. + +Excessive Bleedings or Floodings, should be treated according to the +Manner directed Sec. 365: and if they are very excessive, Folds of Linen, +which have been wrung out of a Mixture of equal Parts of Water and +Vinegar, should be applied to the Belly, the Loins, and the Thighs: +these should be changed for fresh moist ones, as they dry; and should be +omitted, as soon as the Bleeding abates. + +Sec. 370. The Inflammation of the Womb is discoverable by Pains in all the +lower Parts of the Belly; by a Tension or Tightness of the whole; by a +sensible Increase of Pain upon touching it; a kind of red Stain or Spot, +that mounts to the Middle of the Belly, as high as the Navel; which +Spot, as the Disease increases, turns black, and then is always a mortal +Symptom; by a very extraordinary Degree of Weakness; an astonishing +Change of Countenance; a light _Delirium_ or Raving; a continual Fever +with a weak and hard Pulse; sometimes incessant Vomitings; a frequent +Hiccup; a moderate Discharge of a reddish, stinking, sharp Water; +frequent Urgings to go to Stool; a burning kind of Heat of Urine; and +sometimes an entire Suppression of it. + +Sec. 371. This most dangerous and frequently mortal Disease should be +treated like inflammatory ones. After Bleeding, frequent Glysters of +warm Water must by no Means be omitted; some should also be injected +into the Womb, and applied continually over the Belly. The Patient may +also drink continually, either of simple Barley-Water, with a Quarter of +an Ounce of Nitre in every Pot of it, or of Almond Milk No. 4. + +Sec. 372. The total Suppression of the _Lochia_, the Discharges after +Labour, which proves a Cause of the most violent Disorders, should be +treated exactly in the same Manner: but if unhappily hot Medicines have +been given, in order to force them down, the Case will very generally +prove a most hopeless one. + +Sec. 373. If the Milk-fever run very high, the Barley Ptisan directed Sec. +371, and Glysters, with a very light Diet, consisting only of Panada, or +made of some other farinaceous Substances, and very thin, very generally +remove it. + +Sec. 374. Delicate infirm Women, who have not all the requisite and +necessary Attendance they want; and such as from Indigence are obliged +to work too soon, are exposed to many Accidents, which frequently arise +from a Want of due Perspiration, and an insufficient Discharge of the +_Lochia_; and hence, the Separation of the Milk in their Breasts being +disturbed, there are milky Congestions, or Knots as it were, which are +always very painful and troublesome, and especially when they are formed +more inwardly. They often happen on the Thighs, in which Case the Ptisan +No. 58 is to be drank, and the Pultices No. 59 must be applied. These +two Remedies gradually dissipate and remove the Tumour, if that may be +effected without Suppuration. But if that proves impossible, and _Pus_, +or Matter, is actually formed, a Surgeon must open the Abscess, and +treat it like any other. + +Sec. 375. Should the Milk coagulate, or curdle as it were, in the Breast, +it is of the utmost Importance immediately to attenuate or dissolve that +Thickness, which would otherwise degenerate into a Hardness and prove a +_Scirrhus_; and from a _Scirrhus_ in Process of Time a Cancer, that most +tormenting and cruel Distemper. + +This horrible Evil however may be prevented by an Application to these +small Tumours, as soon as ever they appear, For this Purpose nothing is +more effectual than the Prescriptions No. 57 and 60; but under such +menacing Circumstances, it is always prudent to take the best Advice, as +early as possible. + +From the Moment these hard Tumours become excessively and obstinately +so, and yet without any Pain, we should abstain from every Application, +all are injurious; and greasy, sharp, resinous and spirituous ones +speedily change the _Scirrhus_ into a Cancer. Whenever it becomes +manifestly such, all Applications are also equally pernicious, except +that of No. 60. Cancers have long been thought and found incurable; but +within a few Years past some have been cured by the Remedy No. 57; which +nevertheless is not infallible, though it should always be tried. [84] + +[84] The Use of Hemlock, which has been tried at _Lyons_, by all who + have had cancerous Patients, having been given in very large Doses, + has been attended with no Effect there, that merited the serious + Attention of Practitioners. Many were careful to obtain the Extract + from _Vienna_, and even to procure it from Dr. _Storck_ himself. + But now it appears to have had so little Success, as to become + entirely neglected. _E. L._ + + Having exactly translated in this Place, and in the Table of + Remedies, our learned Author's considerable Recommendation of the + Extract of Hemlock in Cancers, we think it but fair, on the other + Hand, to publish this Note of his Editor's against it; that the + real Efficacy or Inefficacy of this Medicine may at length be + ascertained, on the most extensive Evidence and Experience. As far + as my own Opportunities and Reflections, and the Experience of many + others, have instructed me on this Subject, it appears clear to + myself, that though the Consequences of it have not been constantly + unsuccessful with us, yet its Successes have come very short of its + Failures. Nevertheless, as in all such Cancers, every other + internal Medicine almost universally fails, we think with Dr. + _Tissot_ it should always be tried (from the meer Possibility of + its succeeding in some particular Habit and Circumstances) at least + till longer Experience shall finally determine against it. _K._ + +Sec. 376. The Nipples of Women, who give Milk, are often fretted or +excoriated, which proves very severely painful to them. One of the best +Applications is the most simple Ointment, being a Mixture of Oil and Wax +melted together; or the Ointment No. 66. Should the Complaint prove very +obstinate, the Nurse ought to be purged, which generally removes it. + + + + + __Chapter XXVII.__ + + + + _Medical Directions concerning Children._ + + + __Sect.__ 377. + +The Diseases of Children, and every Thing relating to their Health, are +Objects which generally seem to have been too much neglected by +Physicians; and have been too long confided to the Conduct of the most +improper Persons for such a Charge. At the same Time it must be admitted +their Health is of no little Importance; their Preservation is as +necessary as the Continuance of the human Race; and the Application of +the Practice of Physick to their Disorders is susceptible of nearer +Approaches to Perfection, than is generally conceived. It seems to have +even some Advantage over that Practice which regards grown Persons; and +it consists in this, that the Diseases of Children are more simple, and +less frequently complicated than those of Adults. + +It may be said indeed, they cannot make themselves so well understood, +and meer Infants certainly not at all. This is true in Fact to a certain +Degree, but not rigidly true; for though they do not speak our Language, +they have one which we should contrive to understand. Nay every +Distemper may be said, in some Sense, to have a Language of its own, +which an attentive Physician will learn. He should therefore use his +utmost Care to understand that of Infants, and avail himself of it, to +increase the Means of rendering them healthy and vigorous, and to cure +them of the different Distempers to which they are liable. I do not +propose actually to compleat this Task myself, in all that Extent it may +justly demand; but I shall set forth the principal Causes of their +Distempers, and the general Method of treating them. By this Means I +shall at least preserve them from some of the Mischiefs which are too +frequently done them; and the lessening such Evils as Ignorance, or +erroneous Practice, occasions, is one of the most important Purposes of +the present Work. + +Sec. 378. Nearly all the Children who die before they are one Year, and +even two Years, old, die _with_ Convulsions: People say they died _of_ +them, which is partly true, as it is in Effect, the Convulsions that +have destroyed them. But then these very Convulsions are the +Consequences, the Effects, of other Diseases, which require the utmost +Attention of those, who are entrusted with the Care and Health of the +little Innocents: as an effectual Opposition to these Diseases, these +morbid Causes, is the only Means of removing the Convulsions. The four +principal known Causes are, the _Meconium_; the Excrements contained in +the Body of the Infant, at the Birth; _Acidities_, or sharp and sour +Humours; the Cutting of the Teeth, and Worms. I shall treat briefly of +each. + + + + _Of the Meconium._ + + +Sec.379. The Stomach and Guts of the Infant, at its Entrance into the +World, are filled with a black Sort of Matter, of a middling +Consistence, and very viscid or glutinous, which is called the +_Meconium_. It is necessary this Matter should be discharged before the +Infant sucks, since it would otherwise corrupt the Milk, and, becoming +extremely sharp itself, there would result from their Mixture a double +Source of Evils, to the Destruction of the Infant. + +The Evacuation of this Excrement is procured, 1, By giving them no Milk +at all for the first twenty-four Hours of their Lives. 2, By making them +drink during that Time some Water, to which a little Sugar or Honey must +be added, which will dilute this _Meconium_, and promote the Discharge +of it by Stool, and sometimes by vomiting. + +To be the more certain of expelling all this Matter, they should take +one Ounce of Compound Syrup [85] of Succory, which should be diluted +with a little Water, drinking up this Quantity within the Space of four +or five Hours. This Practice is a very beneficial one, and it is to be +wished it were to become general. This Syrup is greatly preferable to +all others, given in such Cases, and especially to Oil of Almonds. + +[85] This Method (says the Editor and Annotator of _Lyons_) is useful, + whenever the Mother does not suckle her Child. Art is then obliged + to prove a Kind of Substitute to Nature, though always a very + imperfect one. But when a Mother, attentive to her own true + Interest, as well as her Infant's, and, listening to the Voice of + Nature and her Duty, suckles it herself, these Remedies [he adds] + seem hurtful, or at least, useless. The Mother should give her + Child the Breast as soon as she can. The first Milk, the + _Colostrum_, or _Strippings_, as it is called in Quadrupeds, which + is very serous or watery, will be serviceable as a Purgative; it + will forward the Expulsion of the _Meconium_, prove gradually + nourishing, and is better than Biscuits, or Panada, which (he + thinks) are dangerous in the first Days after the Birth. _E. L._ + + This Syrup of Succory being scarcely ever prepared with us, though + sufficiently proper for the Use assigned it here, I have retained + the preceding Note, as the Author of it directs these _Strippings_, + for the same Purpose, with an Air of certain Experience; and as + this Effect of them seems no Ways repugnant to the physical Wisdom + and Oeconomy of Nature, on such important Points. Should it in fact + be their very general Operation, it cannot be unknown to any Male + or Female Practitioner in Midwifery, and may save poor People a + little Expence, which was one Object of our humane Author's Plan. + The Oil Of _Ricinus_, corruptly called _Castor_ Oil (being + expressed from the Berries of the _Palma Christi_) is particularly + recommended by some late medical Writers from _Jamaica_, _&c._ for + this Purpose of expelling the _Meconium_, to the Quantity of a + small Spoonful. These Gentlemen also consider it as the most + proper, and almost specific Opener, in the dry Belly-ach of that + torrid Climate, which tormenting Disease has the closest Affinity + to the _Miserere_, or Iliac Passion, of any I have seen. The + Annotator's Objection to our Author's very _thin light_ Panada, + seems to be of little Weight. _K._ + +Should the great Weakness of the Child seem to call for some +Nourishment, there would be no Inconvenience in allowing a little +Biscuit well boiled in Water, which is pretty commonly done, or a little +very thin light Panada. + + + + _Of Acidities, or sharp Humours._ + + +Sec. 380. Notwithstanding the Bodies of Children have been properly emptied +speedily after their Birth, yet the Milk very often turns sour in their +Stomachs, producing Vomitings, violent Cholics, Convulsions, a +Looseness, and even terminating in Death. There are but two Purposes to +be pursued in such Cases, which are to carry off the sour or sharp +Humours, and to prevent the Generation of more. The first of these +Intentions is best effected by the Syrup of Succory [86] just mentioned. + +[86] Or, for Want of it, the solutive Syrup of Roses. _K._ + +The Generation of further Acidities is prevented, by giving three Doses +daily, if the Symptoms are violent, and but two, or even one only, if +they are very moderate, of the Powder No. 61, drinking after it Bawm +Tea, or a Tea of Lime-tree Leaves. + +Sec. 381. It has been a Custom to load Children with Oil of Almonds, [87] +as soon as ever they are infested with Gripes: but it is a pernicious +Custom, and attended with very dangerous Consequences. It it very true +that this Oil sometimes immediately allays the Gripes, by involving, or +sheathing up, as it were, the acid Humours, and somewhat blunting the +Sensibility of the Nerves. But it proves only a palliative Remedy, or +asswaging for a Time, which, far from removing, increases the Cause, +since it becomes sharp and rancid itself; whence the Disorder speedily +returns, and the more Oil the Infant takes, it is griped the more. I +have cured some Children of such Disorders, without any other Remedy, +except abstaining from Oil, which weakens their Stomachs, whence their +Milk is less perfectly, and more slowly digested, and becomes more +easily soured. Besides this Weakness of the Stomach, which thus +commences at that very early Age, has sometimes an unhealthy Influence +on the Constitution of the Child, throughout the Remainder of his Life. + +[87] The _Magnesia_ is an excellent Substitute in Children, for these + Oils Dr. _Tissot_ so justly condemns here. _K._ + +A free and open Belly is beneficial to Children; now it is certain that +the Oil very often binds them, in Consequence of its diminishing the +Force and Action of the Bowels. There is scarcely any Person, who cannot +observe this Inconvenience attending it; notwithstanding they all +continue to advise and to give it, to obtain a very different Purpose: +But such is the Power of Prejudice in this Case, and in so many others; +People are so strongly pre-possessed with a Notion, that such a Medicine +must produce such an Effect; that its never having produced it avails +nothing with them, their Prejudice still prevails; they ascribe its Want +of Efficacy to the Smallness of the Doses; these are doubled then, and +notwithstanding its bad Effects are augmented, their obstinate Blindness +continues. + +This Abuse of the Oil also disposes their Child to knotty hard Tumours, +and at length often proves the first Cause of some Diseases of the Skin, +whose Cure is extremely difficult. + +Hence it is evident, this Oil should be used on such Occasions but very +seldom; and that it is always very injudicious to give it in Cholics, +which arise from sharp and sour Humours in the Stomach, or in the +Bowels. + +Sec. 382. Infants are commonly most subject to such Cholics during their +earliest Months; after which they abate, in Proportion as their Stomachs +grow stronger. They may be relieved in the Fit by Glysters of a +Decoction of Chamomile Flowers, in which a Bit of Soap of the Size of a +Hazel Nut is dissolved. A Piece of Flanel wrung out of a Decoction of +Chamomile Flowers, with the Addition of some Venice Treacle, and applied +hot over the Stomach and on the Belly, is also very beneficial, and +relieving. + +Children cannot always take Glysters, the Continuance of which +Circumstance might be dangerous to them; and every one is acquainted +with the common Method of substituting Suppositories to them, whether +they are formed of the smooth and supple Stalks of Vines, _&c._ of Soap, +or of Honey boiled up to a proper Consistence. + +But one of the most certain Means to prevent these Cholics, which are +owing to Children's not digesting their Milk, is to move and exercise +them as much as possible; having a due Regard however to their tender +Time of Life. + +Sec. 383. Before I proceed to the third Cause of the Diseases of Children, +which is, the Cutting of their Teeth, I must take Notice of the first +Cares their Birth immediately requires, that is the Washing of them the +first Time, meerly to cleanse, and afterwards, to strengthen them. + + + + _Of washing Children._ + + +Sec. 384. The whole Body of an Infant just born is covered with a gross +Humour, which is occasioned by the Fluids, in which it was suspended in +the Womb. There is a Necessity to cleanse it directly from this, for +which nothing is so proper as a Mixture of one third Wine, and two +thirds Water; Wine alone would be dangerous. This Washing may be +repeated some Days successively; but it is a bad Custom to continue to +wash them thus warm, the Danger of which is augmented by adding some +Butter to the Wine and Water, which is done too often. If this gross +Humour, that covers the Child, seems more thick and glutinous than +ordinary, a Decoction of Chamomile Flowers, with a little Bit of Soap, +may be used to remove it. The Regularity of Perspiration is the great +Foundation of Health; to procure this Regularity the Teguments, the +Skin, must be strengthened; but warm Washing tends to weaken it. When it +is of a proper Strength it always performs its Functions; nor is +Perspiration disordered sensibly by the Alteration of the Weather. For +this Reason nothing should be omitted, that may fix it in this State; +and to attain so important an Advantage, Children should be washed, some +few Days after their Birth, with cold Water, in the State it is brought +from the Spring. + +For this Purpose a Spunge is employed, with which they begin, by washing +first the Face, the Ears, the back Part of the Head (carefully avoiding +the [88] _Fontanelle_, or Mould of the Head) the Neck, the Loins, the +Trunck of the Body, the Thighs, Legs and Arms, and in short every Spot. +This Method which has obtained for so many Ages, and which is practised +at present by many People, who prove very healthy, will appear shocking +to several Mothers; they would be afraid of killing their Children by +it; and would particularly fail of Courage enough to endure the Cries, +which Children often make, the first Time they are washed. Yet if their +Mothers truly love them, they cannot give a more substantial Mark of +their Tenderness to them, than by subduing their Fears and their +Repugnance, on this important Head. + +[88] That Part of the Head where a Pulsation may be very plainly felt, + where the Bones are less hard, and not as yet firmly joined with + those about them. + +Weakly Infants [89] are those who have the greatest Need of being +washed: such as are remarkably strong may be excused from it; and it +seems scarcely credible (before a Person has frequently seen the +Consequences of it) how greatly this Method conduces to give, and to +hasten on, their Strength. I have had the Pleasure to observe, since I +first endeavoured to introduce the Custom among us, that several of the +most affectionate and most sensible Mothers, have used it with the +greatest Success. The Midwives, who have been Witnesses of it; the +Nurses and the Servants of the Children, whom they have washed, publish +it abroad; and should the Custom become as general, as every thing seems +to promise it will, I am fully persuaded, that by preserving the Lives +of a great Number of Children, it will certainly contribute to check the +Progress of Depopulation. + +[89] There is however a certain Degree of Weakness, which may very + reasonably deter us from this Washing; as when the Infant + manifestly wants Heat, and needs some Cordial and frequent + Frictions, to prevent its expiring from downright Feebleness; in + which Circumstances Washing must be hurtful to it. _Tissot._ + +They should be washed very regularly every Day, in every Season, and +every Sort of Weather; and in the fine warm Season they should be +plunged into a large Pail of Water, into the Basins around Fountains, in +a Brook, a River, or a Lake. + +After a few Days crying, they grow so well accustomed to this Exercise, +that it becomes one of their Pleasures; so that they laugh all the Time +of their going through it. + +The first Benefit of this Practice is, as I have already said, the +keeping up their Perspiration, and rendering them less obnoxious to the +Impressions of the Air and Weather: and it is also in Consequence of +this first Benefit, that they are preserved from a great Number of +Maladies, especially from knotty Tumours, often called Kernels; from +Obstructions; from Diseases of the Skin, and from Convulsions, its +general Consequence being to insure them firm, and even robust Health. + +Sec. 385. But Care should be taken not to prevent, or, as it were to undo, +the Benefit this Washing procures them, by the bad Custom of keeping +them too hot. There is not a more pernicious one than this, nor one that +destroys more Children. They should be accustomed to light Cloathing by +Day, and light Covering by Night, to go with their Heads very thinly +covered, and not at all in the Day-time, after their attaining the Age +of two Years. They should avoid sleeping in Chambers that are too hot, +and should live in the open Air, both in Summer and Winter, as much as +possible. Children who have been kept too hot in such Respects, are very +often liable to Colds; they are weakly, pale, languishing, bloated and +melancholy. They are subject to hard knotty Swellings, a Consumption, +all Sorts of languid Disorders, and either die in their Infancy, or only +grow up into a miserable valetudinary Life; while those who are washed +or plunged into cold Water, and habitually exposed to the open Air, are +just in the opposite Circumstances. + +Sec. 386. I must further add here, that Infancy is not the only Stage of +Life, in which cold Bathing is advantagious. I have advised it with +remarkable Success to Persons of every Age, even to that of seventy: and +there are two Kinds of Diseases, more frequent indeed in Cities than in +the Country, in which cold Baths succeed very greatly; that is, in +Debility, or Weakness of the Nerves; and when Perspiration is +disordered, when Persons are fearful of every Breath of Air, liable to +Defluxions or Colds, feeble and languishing, the cold Bath +re-establishes Perspiration; restores Strength to the Nerves; and by +that Means dispels all the Disorders, which arise from these two Causes, +in the animal Oeconomy. They should be used before Dinner. But in the +same Proportion that cold Bathing is beneficial, the habitual Use, or +rather Abuse, of warm Bathing is pernicious; they dispose the Persons +addicted to them to the Apoplexy; to the Dropsy; to Vapours, and to the +hypochondriacal Disease: and Cities, in which they are too frequently +used, become, in some Measure, desolate from such Distempers. + + + + _Of the Cutting of the Teeth._ + + +Sec. 387. Cutting of the Teeth is often very tormenting to Children, some +dying under the severe Symptoms attending it. If it proves very painful, +we should during that Period, 1, Keep their Bellies open by Glysters +consisting only of a simple Decoction of Mallows: but Glysters are not +necessary, if the Child, as it sometimes happens then, has a Purging. + +2, Their ordinary Quantity of Food should be lessened for two Reasons; +first, because the Stomach is then weaker than usual; and next, because +a small Fever sometimes accompanies the Cutting. + +3, Their usual Quantity of Drink should be increased a little; the best +for them certainly is an Infusion of the Leaves or Flowers, of the Lime +or Linden-tree, to which a little Milk may be added. + +4, Their Gums should frequently be rubbed with a Mixture of equal Parts +of Honey, and Mucilage of Quince-seeds; and a Root of March-Mallows, or +of Liquorice, may be given them to chew. + +It frequently happens, that during Dentition, or the Time of their +toothing, Children prove subject to Knots or Kernels. + + + + _Of Worms._ + + +Sec. 388. The _Meconium_, the Acidity of the Milk, and Cutting of the Teeth +are the three great Causes of the Diseases of Children. There is also a +fourth, Worms, which is likewise very often pernicious to them; but +which, nevertheless, is not, at least not near so much, a general Cause +of their Disorders, as it is generally supposed, when a Child exceeding +two Years of Age proves sick. There are a great Variety of Symptoms, +which dispose People to think a Child has Worms; though there is but one +that demonstrates it, which is discharging them upwards or downwards. +There is great Difference among Children too in this Respect, some +remaining healthy, though having several Worms, and others being really +sick with a few. + +They prove hurtful, 1, by obstructing the Guts, and compressing the +neighbouring Bowels by their Size. 2, By sucking up the Chyle intended +to nourish the Patient, and thus depriving him of his very Substance as +well as Subsistence: and, 3, by irritating the Guts and even [90] +gnawing them. + +[90] I have seen a Child about three Years old, whose Navel, after + swelling and inflaming, suppurated, and through a small Orifice + (which must have communicated with the Cavity of the Gut or the + Belly) discharged one of these Worms we call _teretes_, about three + Inches long. He had voided several by Stool, after taking some + vermifuge Medicines. The Fact I perfectly remember; and to the best + of my Recollection, the Ulcer healed some Time after, and the + Orifice closed: but the Child died the following Year of a putrid + Fever, which might be caused, or was aggravated, by Worms. _K._ + +Sec. 389. The Symptoms which make it probable they are infested with Worms, +are slight, frequent and irregular Cholics; a great Quantity of Spittle +running off while they are fasting; a disagreeable Smell of their +Breath, of a particular Kind, especially in the Morning; a frequent +Itchiness of their Noses which makes them scratch or rub them often; a +very irregular Appetite, being sometimes voracious, and at other Times +having none at all: Pains at Stomach and Vomitings: sometimes a costive +Belly; but more frequently loose Stools of indigested Matter; the Belly +rather larger than ordinary, the rest of the Body meagre; a Thirst which +no Drink allays; often great Weakness, and some Degree of Melancholy. +The Countenance has generally an odd unhealthy Look, and varies every +Quarter of an Hour; the Eyes often look dull, and are surrounded with a +Kind of livid Circle: the White of the Eye is sometimes visible while +they sleep, their Sleep being often attended with terrifying Dreams or +_Deliriums_, and with continual Startings, and Grindings of their Teeth. +Some Children find it impossible to be at Rest for a single Moment. +Their Urine is often whitish, I have seen it from some as white as Milk. +They are afflicted with Palpitations, Swoonings, Convulsions, long and +profound Drowsiness; cold Sweats which come on suddenly; Fevers which +have the Appearances of Malignity; Obscurities and even Loss of Sight +and of Speech, which continue for a considerable Time; Palsies either of +their Hands, their Arms, or their Legs, and Numbnesses. Their Gums are +in a bad State, and as though they had been gnawed or corroded: they +have often the Hickup, a small and irregular Pulse, Ravings, and, what +is one of the least doubtful Symptoms, frequently a small dry Cough; and +not seldom a Mucosity or Sliminess in their Stools: sometimes very long +and violent Cholics, which terminate in an Abscess on the Outside of the +Belly, from whence Worms issue. (See Note [90] p. 388.) + +Sec. 390. There are a great Multitude of Medicines against Worms. The [91] +_Grenette_ or Worm-seed, which is one of the commonest, is a very good +one. The Prescription No. 62, is also a very successful one; and the +Powder No. 14 is one of the best. Flower of Brimstone, the Juice of +_Nasturtium_, or Cresses, Acids and Honey Water have often been very +serviceable; but the first three I have mentioned, succeeded by a Purge, +are the best. No. 63 is a purging Medicine, that the most averse and +difficult Children may easily take. But when, notwithstanding these +Medicines, the Worms are not expelled, it is necessary to take Advice of +some Person qualified to prescribe more efficacious ones. This is of +considerable Importance, because, notwithstanding a great Proportion of +Children may probably have Worms, and yet many of them continue in good +Health, there are, nevertheless, some who are really killed by Worms, +after having been cruelly tormented by them for several Years. + +[91] This Word occurs in none of the common Dictionaries; but suspecting + it for the _Semen Santonici_ of the Shops, I find the learned Dr. + _Bikker_ has rendered it so, in his very well received Translation + of this valuable Work into _Low Dutch_. _K._ + +A Disposition to breed Worms always shews the Digestions are weak and +imperfect; for which Reason Children liable to Worms should not be +nourished with Food difficult to digest. We should be particularly +careful not to stuff them with Oils, which, admitting such Oils should +immediately kill some of their Worms, do yet increase that Cause, which +disposes them to generate others. A long continued Use of Filings of +Iron is the Remedy, that most effectually destroys this Disposition to +generate Worms. + + + + _Of Convulsions._ + + +Sec. 391. I have already said, Sec. 378, that the Convulsions of Children are +almost constantly the Effect of some other Disease, and especially of +some of the four I have mentioned. Some other, though less frequent +Causes, sometimes occasion them, and these may be reduced to the +following. + +The first of them is the corrupted Humours, that often abound in their +Stomachs and Intestines; and which, by their Irritation, produce +irregular Motions throughout the whole System of the Nerves, or at least +through some Parts of them; whence those Convulsions arise, which are +merely involuntary Motions of the Muscles. These putrid Humours are the +Consequence of too great a Load of Aliments, of unsound ones, or of +such, as the Stomachs of Children are incapable of digesting. These +Humours are also sometimes the Effect of a Mixture and Confusion of +different Aliments, and of a bad Distribution of their Nourishment. + +It may be known that the Convulsions of a Child are owing to this Cause, +by the Circumstances that have preceded them, by a disgusted loathing +Stomach; by a certain Heaviness and Load at it; by a foul Tongue; a +great Belly; by its bad Complexion, and its disturbed unrefreshing +Sleep. + +The Child's proper Diet, that is, a certain Diminution of the Quantity +of its Food; some Glysters of warm Water, and one Purge of No. 63, very +generally remove such Convulsions. + +Sec. 392. The second Cause is the bad Quality of their Milk. Whether it be +that the Nurse has fallen into a violent Passion, some considerable +Disgust, great Fright or frequent Fear: whether she has eat unwholesome +Food, drank too much Wine, spirituous Liquors, or any strong Drink: +whether she is seized with a Descent of her monthly Discharges, and that +has greatly disordered her Health; or finally whether she prove really +sick: In all these Cases the Milk is vitiated, and exposes the Infant to +violent Symptoms, which sometimes speedily destroy it. + +The Remedies for Convulsions, from this Cause, consist, 1, In letting +the Child abstain from this corrupted Milk, until the Nurse shall have +recovered her State of Health and Tranquillity, the speedy Attainment of +which may be forwarded by a few Glysters; by gentle pacific Medicines; +by an entire Absence of whatever caused or conduced to her bad Health; +and by drawing off all the Milk that had been so vitiated. + +2, In giving the Child itself some Glysters: in making it drink +plentifully of a light Infusion of the Lime-tree Flowers, in giving it +no other Nourishment for a Day or two, except Panada and other light +Spoon-meat, without Milk. + +3, In purging the Child (supposing what has been just directed to have +been unavailable) with an Ounce, or an Ounce and a Half, of compound +Syrup of Succory, or as much Manna. These lenient gentle Purges carry +off the Remainder of the corrupted Milk, and remove the Disorders +occasioned by it. + +Sec. 393. A third Cause which also produces Convulsions, is the feverish +Distempers which attack Children, especially the Small-pocks and the +Measles; but in general such Convulsions require no other Treatment, but +that proper for the Disease, which has introduced them. + +Sec. 394. It is evident from what has been said in the Course of this +Chapter, and it deserves to be attended to, that Convulsions are +commonly a Symptom attending some other Disease, rather than an original +Disease themselves: that they depend on many different Causes; that from +this Consideration there can be no general Remedy for removing or +checking them; and that the only Means and Medicines which are suitable +in each Case, are those, which are proper to oppose the particular Cause +producing them, and which I have already pointed out in treating of each +Cause. + +The greater Part of the pretended Specifics, which are indiscriminately +and ignorantly employed in all Sorts of Convulsions, are often useless, +and still oftner prejudicial. Of this last Sort and Character are, + +1, All sharp and hot Medicines, spirituous Liquors, Oil of Amber,--other +hot Oils and Essences, volatile Salts, and such other Medicines, as, by +the Violence of their Action on the irritable Organs of Children, are +likelier to produce Convulsions, than to allay them. + +2, Astringent Medicines, which are highly pernicious, whenever the +Convulsions are caused by any sharp Humour, that ought to be discharged +from the Body by Stool; or when such Convulsions are the Consequences of +an [92] Effort of Nature, in Order to effect a _Crisis_: And as they +almost ever depend on one or the other of these Causes, it follows that +Astringents can very rarely, if ever, be beneficial. Besides that there +is always some Danger in giving them to Children without a mature, a +thorough Consideration of their particular Case and Situation, as they +often dispose them to Obstructions. + +[92] This very important Consideration, on which I have treated pretty + largely, in the _Analysis_, seems not to be attended to in + Practice, as frequently as it ought. _K._ + +3, The over early, and too considerable Use of Opiates, either not +properly indicated, or continued too long, such as Venice Treacle, +Mithridate, Syrup of Poppies (and it is very easy to run upon some of +these Sholes) are also attended with the most embarrassing Events, in +Regard to Convulsions; and it may be affirmed they are improper, for +nine Tenths of those they are advised to. It is true they often produce +an apparent Ease and Tranquillity for some Minutes, and sometimes for +some Hours too; but the Disorder returns even with greater Violence for +this Suspension, by Reason they have augmented all the Causes producing +it; they impair the Stomach; they bind up the Belly; they lessen the +usual Quantity of Urine; and besides, by their abating the Sensibility +of the Nerves, which ought to be considered as one of the chief +Centinels appointed by Nature, for the Discovery of any approaching +Danger, they dispose the Patient insensibly to such Infarctions and +Obstructions, as tend speedily to produce some violent and mortal Event, +or which generate a Disposition to languid and tedious Diseases: and I +do again repeat it, that notwithstanding there are some Cases, in which +they are absolutely necessary, they ought in general to be employed with +great Precaution and and Prudence. To mention the principal Indications +for them in convulsive Cases, they are proper, + +1, When the Convulsions still continue, after the original Cause of them +is removed. + +2, When they are so extremely violent, as to threaten a great and very +speedy Danger of Life; and when they prove an Obstacle to the taking +Remedies calculated to extinguish their Cause; and, + +3, When the Cause producing them is of such a Nature, as is apt to yield +to the Force of Anodynes; as when, for Instance, they have been the +immediate Consequence of a Fright. + +Sec. 395. There is a very great Difference in different Children, in +Respect to their being more or less liable to Convulsions. There are +some, in whom very strong and irritating Causes cannot excite them; not +even excruciating Gripes and Cholics; the most painful Cutting of their +Teeth; violent Fevers; the Small Pocks; Measles; and though they are, as +it were, continually corroded by Worms, they have not the slightest +Tendency to be convulsed. On the other Hand, some are so very obnoxious +to Convulsions, or so easily _convulsible_, if that Expression may be +allowed, that they are very often seized with them from such very slight +Causes, that the most attentive Consideration cannot investigate them. +This Sort of Constitution, which is extremely dangerous, and exposes the +unhappy Subject of it, either to a very speedy Death, or to a very low +and languid State of Life, requires some peculiar Considerations; the +Detail of which would be the more foreign to the Design of this +Treatise, as they are pretty common in Cities, but much less so in +Country Places. In general cold Bathing and the Powder No. 14 are +serviceable in such Circumstances. + + + + _General Directions, with Respect to Children._ + + +Sec. 396. I shall conclude this Chapter by such farther Advice, as may +contribute to give Children a more vigorous Constitution and +Temperament, and to preserve them from many Disorders. + +First then, we should be careful not to cram them too much, and to +regulate both the Quantity and the set Time of their Meals, which is a +very practicable Thing, even in the very earliest Days of their Life; +when the Woman who nurses them, will be careful to do it regularly. +Perhaps indeed this is the very Age, when such a Regulation may be the +most easily attempted and effected; because it is that Stage, when the +constant Uniformity of their Way of living should incline us to suppose, +that what they have Occasion for is most constantly very much the same. + +A Child who has already attained to a few Years, and who is surrendered +up more to his own Exercise and Vivacity, feels other Calls; his Way of +Life is become a little more various and irregular, whence his Appetite +must prove so too. Hence it would be inconvenient to subject him over +exactly to one certain Rule, in the Quantity of his Nourishment, or the +Distance of his Meals. The Dissipation or passing off of his Nutrition +being unequal, the Occasions he has for repairing it cannot be precisely +dated and regular. But with Respect to very little Children in Arms, or +on the Lap, a Uniformity in the first of these Respects, the Quantity of +their Food, very consistently conduces to a useful Regularity with +Respect to the second, the Times of feeding them. Sickness is probably +the only Circumstance, that can warrant any Alteration in the Order and +Intervals of their Meals; and then this Change should consist in a +Diminution of their usual Quantity, notwithstanding a general and fatal +Conduct seems to establish the very Reverse; and this pernicious Fashion +authorizes the Nurses to cram these poor little Creatures the more, in +Proportion as they have real Need of less feeding. They conclude of +Course, that all their Cries are the Effects of Hunger, and the Moment +an Infant begins, then they immediately stop his Mouth with his Food; +without once suspecting, that these Wailings may be occasioned by the +Uneasiness an over-loaded Stomach may have introduced; or by Pains whose +Cause is neither removed nor mitigated, by making the Children eat; +though the meer Action of eating may render them insensible to slight +Pains, for a very few Minutes; in the first Place, by calling off their +Attention; and secondly, by hushing them to sleep, a common Effect of +feeding in Children, being in fact, a very general and constant one, and +depending on the same Causes, which dispose so many grown Persons to +sleep after Meals. + +A Detail of the many Evils Children are exposed to, by thus forcing too +much Food upon them, at the very Time when their Complaints are owing to +Causes, very different from Hunger, might appear incredible. They are +however so numerous and certain, that I seriously wish sensible Mothers +would open their Eyes to the Consideration of this Abuse, and agree to +put an End to it. + +Those who overload them with Victuals, in Hopes of strengthening them, +are extremely deceived; there being no one Prejudice equally fatal to +such a Number of them. Whatever unnecessary Aliment a Child receives, +weakens, instead of strengthening him. The Stomach, when over-distended, +suffers in its Force and Functions, and becomes less able to digest +thoroughly. The Excess of the Food last received impairs the Concoction +of the Quantity, that was really necessary: which, being badly digested, +is so far from yielding any Nourishment to the Infant, that it weakens +it, and proves a Source of Diseases, and concurs to produce +Obstructions, Rickets, the Evil, slow Fevers, a Consumption and Death. + +Another unhappy Custom prevails, with Regard to the Diet of Children, +when they begin to receive any other Food besides their Nurse's Milk, +and that is, to give them such as exceeds the digestive Power of their +Stomachs; and to indulge them in a Mixture of such Things in their +Meals, as are hurtful in themselves, and more particularly so, with +Regard to their feeble and delicate Organs. + +To justify this pernicious Indulgence, they affirm it is necessary to +accustom their Stomachs to every Kind of Food; but this Notion is highly +absurd, since their Stomachs should first be strengthened, in Order to +make them capable of digesting every Food; and crouding indigestible, or +very difficultly digestible Materials into it, is not the Way to +strengthen it. To make a Foal sufficiently strong for future Labour, he +is exempted from any, till he is four Years old; which enables him to +submit to considerable Work, without being the worse for it. But if, to +inure him to Fatigue, he should be accustomed, immediately from his +Birth, to submit to Burthens above his Strength, he could never prove +any Thing but an utter Jade, incapable of real Service. The Application +of this to the Stomach of a Child is very obvious. + +I shall add another very important Remark, and it is this, that the too +early Work to which the Children of Peasants are forced, becomes of real +Prejudice to the Publick. Hence Families themselves are less numerous, +and the more Children that are removed from their Parents, while they +are very young, those who are left are the more obliged to Work, and +very often even at hard Labour, at an Age when they should exercise +themselves in the usual Diversions and Sports of Children. Hence they +wear out in a Manner, before they attain the ordinary Term of Manhood; +they never arrive at their utmost Strength, nor reach their full +Stature; and it is too common to see a Countenance with the Look of +twenty Years, joined to a Stature of twelve or thirteen. In fact, they +often sink under the Weight of such hard involuntary Labour, and fall +into a mortal Degree of Wasting and Exhaustion. + +Sec. 397. Secondly, which indeed is but a Repetition of the Advice I have +already given, and upon which I cannot insist too much, they must be +frequently washed or bathed in cold Water. + +Sec. 398. Thirdly, they should be moved about and exercised as much as they +can bear, after they are some Weeks old: the earlier Days of their +tender Life seeming consecrated, by Nature herself, to a nearly total +Repose, and to sleeping, which seems not to determine, until they have +Need of Nourishment: so that, during this very tender Term of Life, too +much Agitation or Exercise might be attended with mortal Consequences. +But as soon as their Organs have attained a little more Solidity and +Firmness, the more they are danced about (provided it is not done about +their usual Time of Repose, which ought still to be very considerable) +they are so much the better for it; and by increasing it gradually, they +may be accustomed to a very quick Movement, and at length very safely to +such, as may be called hard and hearty Exercise. That Sort of Motion +they receive in Go-Carts, or other Vehicles, particularly contrived for +their Use, is more beneficial to them, than what they have from their +Nurses Arms, because they are in a better Attitude in the former; and it +heats them less in Summer, which is a Circumstance of no small +Importance to them; considerable Heat and Sweat disposing them to be +ricketty. + +Sec. 399. Fourthly, they should be accustomed to breathe in the free open +Air as much as possible. + +If Children have unhappily been less attended to than they ought, whence +they are evidently feeble, thin, languid, obstructed, and liable to +Scirrhosities (which constitute what is termed a ricketty or consumptive +State) these four Directions duly observed retrieve them from that +unhappy State; provided the Execution of them has not been too long +delayed. + +Sec. 400. Fifthly, If they have any natural Discharge of a Humour by the +Skin, which is very common with them, or any Eruption, such as Tetters, +white Scurf, a Rashe, or the like, Care must be taken not to check or +repel them, by any greasy or restringent Applications. Not a Year passes +without Numbers of Children having been destroyed by Imprudence in this +Respect; while others have been reduced to a deplorable and weakly +Habit. + +I have been a Witness to the most unhappy Consequences of external +Medicines applied for the Rashe and white Scurf; which, however +frightful they may appear, are never dangerous; provided nothing at all +is applied to them, without the Advice and Consideration of a truly +skilful Person. + +When such external Disorders prove very obstinate, it is reasonable to +suspect some Fault or Disagreement in the Milk the Child sucks; in which +Case it should immediately be discontinued, corrected, or changed. But I +cannot enter here into a particular Detail of all the Treatment +necessary in such Cases. + + + + + __Chapter XXVIII.__ + + + _Directions with Respect to drowned Persons._ [93] + + +[93] The Misfortune of a young Man drowned in bathing himself, at the + Beginning of the Season, occasioned the Publication of this Chapter + by itself in _June_, 1761. A few Days after, the like Misfortune + happened to a labouring Man; but he was happily taken out of the + water sooner than the first (who had remained about half an Hour + under it) and he was recovered by observing Part of the Advice this + Chapter contains; of which Chapter several Bystanders had + Copies.--This Note seems to be from the Author himself. + + __Sect.__ 401. + +Whenever a Person who has been drowned, has remained a Quarter of an +Hour under Water, there can be no considerable Hopes of his Recovery: +the Space of two or three Minutes in such a Situation being often +sufficient to kill a Man irrecoverably. Nevertheless, as several +Circumstances may happen to have continued Life, in such an unfortunate +Situation, beyond the ordinary Term, we should always endeavour to +afford them the most effectual Relief, and not give them up as +irrecoverable too soon: since it has often been known, that until the +Expiration of two, and sometimes even of three Hours, such Bodies have +exhibited some apparent Tokens of Life. + +Water has sometimes been found in the Stomach of drowned Persons; at +other times none at all. Besides, the greatest Quantity which has ever +been found in it has not exceeded that, which may be drank without any +Inconvenience; whence we may conclude, the meer Quantity was not mortal; +neither is it very easy to conceive how drowned Persons can swallow +Water. What really kills them is meer Suffocation, or the Interception +of Air, of the Action of breathing; and the Water which descends into +the Lungs, and which is determined there, by the Efforts they +necessarily, though involuntarily make, to draw Breath, after they are +under Water: for there absolutely does not any Water descend, either +into the Stomach or the Lungs of Bodies plunged into Water, after they +are dead; a Circumstance, which serves to establish a legal Sentence and +Judgment in some criminal Cases, and Trials: This Water intimately +blending itself with the Air in the Lungs, forms a viscid inactive Kind +of Froth, which entirely destroys the Functions of the Lungs; whence the +miserable Sufferer is not only suffocated, but the Return of the Blood +from the Head being also intercepted, the Blood Vessels of the Brain are +overcharged, and an Apoplexy is combined with the Suffocation. This +second Cause, that is, the Descent of the Water into the Lungs, is far +from being general, it having been evident from the Dissection of +several drowned Bodies, that it really never had existed in them. + +Sec. 402. The Intention that should be pursued, is that of unloading the +Lungs and the Brain, and of reviving the extinguished Circulation. For +which Purpose we should, 1, immediately strip the Sufferer of all his +wet Cloaths; rub him strongly with dry coarse Linnen; put him, as soon +as possible, into a well heated Bed, and continue to rub him well a very +considerable Time together. + +2, A strong and healthy Person should force his own warm Breath into the +Patient's Lungs; and the Smoke of Tobacco, if some was at Hand, by Means +of some Pipe, Chanel, Funnel or the like, that may be introduced into +the Mouth. This Air or Fume, being forcibly blown in, by stopping the +Sufferer's Nostrils close at the same Time, penetrates into the Lungs, +and there rarifies by its Heat that Air, which blended with the Water, +composed the viscid Spume or Froth. Hence that Air becomes disengaged +from the Water, recovers its Spring, dilates the Lungs; and, if there +still remains within any Principle of Life, the Circulation is renewed +again that Instant. + +3, If a moderately expert Surgeon is at Hand, he must open the jugular +Vein, or any large Vein in the Neck, and let out ten or twelve Ounces of +Blood. Such a Bleeding is serviceable on many Accounts. First, merely as +Bleeding, it renews the Circulation, which is the constant Effect of +Bleeding in such Swoonings, as arise from an intercepted or suffocated +Circulation. Secondly, it is that particular Bleeding, which most +suddenly removes, in such Cases, the Infarction or Obstruction of the +Head and Lungs; and, thirdly, it is sometimes the only Vessel, whence +Blood will issue under such Circumstances. The Veins of the Feet then +afford none; and those of the Arms seldom; but the Jugulars almost +constantly furnish it. + +Fourthly, the Fume of Tobacco should be thrown up, as speedily and +plentifully as possible, into the Intestines by the Fundament. There are +very commodious Contrivances devised for this Purpose; but as they are +not common, it may be effected by many speedy Means. One, by which a +Woman's Life was preserved, consisted only in introducing the small Tube +of a Tobacco Pipe well lighted up: the Head or Bowl of it was wrapped up +in a Paper, in which several Holes were pricked, and through these the +Breath was strongly forced. At the fifth Blast a considerable Rumbling +was heard in the Woman's Belly; she threw up a little Water, and a +Moment afterwards came to her Senses. Two Pipes may be thus lighted and +applied, with their Bowls covered over; the Extremity of one is to be +introduced into the Fundament; and the other may be blown through into +the Lungs. + +Any other Vapour may also be conveyed up, by introducing a _Canula_, or +any other Pipe, with a Bladder firmly fixed to it. This Bladder is +fastened at its other End to a large Tin Funnel, under which Tobacco is +to be lighted. This Contrivance has succeeded with me upon other +Occasions, in which Necessity compelled me to invent and apply it. + +Fifthly, the strongest Volatiles should be applied to the Patient's +Nostrils. The Powder of some strong dry Herb should be blown up his +Nose, such as Sage, Rosemary, Rue, Mint, and especially Marjoram, or +very well dried Tobacco; or even the Fume, the Smoke of these Herbs. But +all these Means are most properly employed after Bleeding, when they are +most efficacious and certain. + +Sixthly, as long as the Patient shews no Signs of Life, he will be +unable to swallow, and it is then useless, and even dangerous, to pour +much Liquid of any kind into his Mouth, which could do nothing but keep +up, or increase Suffocation. It is sufficient, in such Circumstances, to +instil a few Drops of some irritating Liquor, which might also be +cordial and reviving. But as soon as ever he discovers any Motion, he +should take, within the Space of one Hour, five or six common Spoonfuls +of Oxymel of Squills diluted with warm Water: or if that Medicine was +not to be had very speedily, a strong Infusion of the blessed Thistle, +or _Carduus benedictus_, of Sage, or of Chamomile Flowers sweetened with +Honey, might do instead of it: and supposing nothing else to be had, +some warm Water, with the Addition of a little common Salt, should be +given. Some Persons are bold enough to recommend Vomits in such Cases; +but they are not without their Inconvenience; and it is not as a Vomit +that I recommend the Oxymel of Squills in them. + +Seventhly, Notwithstanding the Sick discover some Tokens of Life, we +should not cease to continue our Assistance; since they sometimes +irrecoverably expire, after these first Appearances of recovering. + +And lastly, though they should be manifestly re-animated, there +sometimes remains an Oppression, a Coughing and Feverishness, which +effectually constitute a Disease: and then it becomes necessary +sometimes to bleed them in the Arms; to give them Barley Water +plentifully, or Elder-flower Tea. + +Sec. 403. Having thus pointed out such Means as are necessary, and truly +effectual, in such unfortunate Accidents, I shall very briefly mention +some others, which it is the general Custom to use and apply in the +first Hurry. + +1, These unhappy People are sometimes wrapped up in a Sheep's, or a +Calf's, or a Dog's Skin, immediately flead from the Animal: these +Applications have sometimes indeed revived the Heat of the Drowned; but +their Operations are more slow, and less efficacious, than the Heat of a +well-warmed Bed; with the additional Vapour of burnt Sugar, and long +continued Frictions with hot Flanels. + +2, The Method of rolling them in an empty Hogshead is dangerous, and +mispends a deal of important Time. + +3, That also of hanging them up by the Feet is attended with Danger, and +ought to be wholly discontinued. The Froth or Foam, which is one of the +Causes of their Death, is too thick and tough to discharge itself, in +Consequence of its own Weight. Nevertheless, this is the only Effect +that can be expected, from this Custom of suspending them by the Feet; +which must also be hurtful, by its tending to increase the Overfulness +of the Head and of the Lungs. + +Sec. 404. It is some Years since a Girl of eighteen Years old was recovered +[though it is unknown whether she remained under Water only a little +Time or some Hours] who was motionless, frozen as it were, insensible, +with her Eyes closed, her Mouth wide open, a livid Colour, a swoln +Visage, a Tumour or bloating of the whole Body, which was overladen as +it were, or Water-soaked. This miserable Object was extended on a Kind +of Bed, of hot or very warm Ashes, quickly heated in great Kettles; and +by laying her quite naked on these Ashes; by covering her with others +equally hot; by putting a Bonnet round her Head, with a Stocking round +her Neck stuffed with the same, and heaping Coverings over all this, at +the End of half an Hour her Pulse returned, she recovered her Speech, +and cried out, _I freeze, I freeze_: A little Cherry-Brandy was given +her, and then she remained buried, as it were, eight Hours under the +Ashes; being taken out of them afterwards without any other Complaint, +except that of great Lassitude or Weariness, which went entirely off the +third Day. This Method was undoubtedly so effectual, that it well +deserves Imitation; but it should not make us inattentive to the others. +Heated Gravel or Sand mixed with Salt, or hot Salt alone, would have +been equally efficacious, and they have been found so. + +At the very Time of writing this, two young Ducks, who were drowned, +have been revived by a dry Bath of hot Ashes. The Heat of a Dung-heap +may also be beneficial; and I have just been informed, by a very +creditable and sensible Spectator of it, that it effectually contributed +to restore Life to a Man, who had certainly remained six Hours under +Water. + +Sec. 405. I shall conclude these Directions with an Article printed in a +little Work at _Paris_, about twenty Years since, by Order of the King, +to which there is not the least Doubt, but that any other Sovereign will +readily accede. + + "Notwithstanding the common People are very generally disposed + to be compassionate, and may wish to give all Assistance to + drowned Persons, it frequently happens they do not, only because + they dare not; imagining they expose themselves by it to + Prosecutions. It is therefore necessary, that they should know, + and it cannot be too often repeated, in order to eradicate such + a pernicious Prejudice, that the Magistrates have never + interposed to prevent People from trying every possible Means to + recover such unfortunate Persons, as shall be drowned and taken + out of the Water. It is only in those Cases, when the Persons + are known to be absolutely and irrecoverably dead, that Justice + renders it necessary to seize their Bodies." + + + + + __Chapter XXIX.__ + + + _Of Substances stopt between the Mouth and the Stomach._ + + + __Sect.__ 406. + +The Food we take in descends from the Mouth through a very strait +Passage or Chanel, called the _Oesophagus_, the Gullet, which, going +parallel with the Spine or Backbone, joins to, or terminates at, the +Stomach. + +It happens sometimes that different Bodies are stopt in this Chanel, +without being able either to descend or to return up again; whether this +Difficulty arises from their being too large; or whether it be owing to +their having such Angles or Points, as by penetrating into, and adhering +to the Sides of this membranous Canal, absolutely prevent the usual +Action and Motion of it. + +Sec. 407. Very dangerous Symptoms arise from this Stoppage, which are +frequently attended with a most acute Pain in the Part; and at other +Times, with a very incommodious, rather than painful, Sensation; +sometimes a very ineffectual Commotion at, or rising of, the Stomach, +attended with great Anguish; and if the Stoppage be so circumstanced, +that the _Glottis_ is closed, or the Wind-pipe compressed, a dreadful +Suffocation is the Consequence: the Patient cannot breathe, the Lungs +are quite distended; and the Blood being unable to return from the Head, +the Countenance becomes red, then livid; the Neck swells; the Oppression +increases, and the poor Sufferer speedily dies. + +When the Patient's Breathing is not stopt, nor greatly oppressed; if the +Passage is not entirely blocked up, and he can swallow something, he +lives very easily for a few Days, and then his Case becomes a particular +Disorder of the _Oesophagus_, or Gullet. But if the Passage is +absolutely closed, and the Obstruction cannot be removed for many Days, +a terrible Death is the Consequence. + +Sec. 408. The Danger of such Cases does not depend so much on the Nature of +the obstructing Substance, as on its Size, with Regard to that of the +Passage of the Part where it stops, and of the Manner in which it forms +the Obstruction; and frequently the very Food may occasion Death; while +Substances less adapted to be swallowed are not attended with any +violent Consequences, though swallowed. + +A Child of six Days old swallowed a Comfit or Sugar Plumb, which stuck +in the Passage, and instantly killed it. + +A grown Person perceived that a Bit of Mutton had stopt in the Passage; +not to alarm any Body he arose from Table; a Moment afterwards, on +looking where he might be gone, he was found dead. Another was choaked +by a Bit of Cake; a third by a Piece of the Skin of a Ham; and a fourth +by an Egg, which he swallowed whole in a Bravo. + +A Child was killed by a Chesnut swallowed whole. Another died suddenly, +choaked (which is always the Circumstance, when they die instantly after +such Accidents) by a Pear which he had tossed up, and catched in his +Mouth. A Woman was choaked with another Pear. A Piece of a Sinew +continued eight Days in the Passage, so that it prevented the Patient +from getting down any Thing else; at the Expiration of that Time it fell +into the Stomach, being loosened by its Putridity: The Patient +notwithstanding died soon after, being killed by the Inflammation, +Gangrene and Weakness it had occasioned. Unhappily there occur but too +many Instances of this Sort, of which it is unnecessary to cite more. + +Sec. 409. Whenever any Substance is thus detained in the Gullet, there are +two Ways of removing it; that is either by extracting it, or pushing it +down. The safest and most certain Way is always to extract or draw it +out, but this is not always the easiest: and as the Efforts made for +this Purpose greatly fatigue the Patient, and are sometimes attended +with grievous Consequences; and yet if the Occasion is extremely urging, +it may be eligible to thrust it down, if that is easier; and if there is +no Danger from the obstructing Bodies Reception into the Stomach. + +The Substances which may be pushed down without Danger, are all common +nourishing ones, as Bread, Meat, Cakes, Fruits, Pulse, Morsels of Tripe, +and even Skin of Bacon. It is only very large Morsels of particular +Aliments, that prove very difficult to digest; yet even such are rarely +attended with any Fatality. + +Sec. 410. The Substances we should endeavour to extract or draw out, though +it be more painful and less easy than to push them down, are all those, +whose Consequences might be highly dangerous, or even mortal, if +swallowed. Such are all totally indigestible Bodies, as Cork, +Linen-Rags, large Fruit Stones, Bones, Wood, Glass, Stones, Metals; and +more especially if any further Danger may be superadded to that of its +Indigestibility, from the Shape, whether rough, sharp, pointed, or +angular, of the Substance swallowed. Wherefore we should chiefly +endeavour to extract Pins, Needles, Fish-bones, other pointed Fragments +of Bones, Bits of Glass, Scissars, Rings, or Buckles. + +Nevertheless it has happened, that every one of these Substances have at +one Time or another been swallowed, and the most usual Consequences of +them are violent Pains of the Stomach, and in the Guts; Inflammations, +Suppurations, Abscesses, a slow Fever, Gangrene, the _Miserere_ or Iliac +Passion; external Abscesses, through which the Bodies swallowed down +have been discharged; and frequently, after a long Train of Maladies, a +dreadful Death. + +Sec. 411. When such Substances have not passed in too deep, we should +endeavour to extract them with our Fingers, which often succeeds. If +they are lower, we should make use of Nippers or a small _Forceps_; of +which Surgeons are provided with different Sorts. Those which some +Smoakers carry about them might be very convenient for such Purposes; +and in Case of Necessity they might be made very readily out of two Bits +of Wood. But this Attempt to extract rarely succeeds, if the Substance +has descended far into the _Oesophagus_, and if the Substance be of a +flexible Nature, which exactly applies itself to, and fills up the +Cavity or Chanel of it. + +Sec. 412. If the Fingers and the Nippers fail, or cannot be duly applied, +Crotchets, a Kind of Hooks, must be employed. + +These may be made at once with a pretty strong iron Wire, crooked at the +End. It must be introduced in the flat Way, and for the better +conducting of it, there should be another Curve or Hook at the End it is +held by, to serve as a Kind of Handle to it, which has this further Use, +that it may be secured by a String tied to it; a Circumstance not to be +omitted in any Instrument employed on such Occasions, to avoid such ill +Accidents as have sometimes ensued, from these Instruments slipping out +of the Operators Hold. After the Crotchet has passed beyond and below +the Substance, that obstructs the Passage, it is drawn up again, and +hooks up with it and extracts that Impediment to swallowing. + +This Crotchet is also very convenient, whenever a Substance somewhat +flexible, as a Pin or a Fishbone stick, as it were, across the Gullet: +the Crotchet in such Cases seizing them about their middle Part, crooks +and thus disengages them. If they are very brittle Substances, it serves +to break them; and if any Fragments still stick within, some other Means +must be used to extract them. + +Sec. 413. When the obstructing Bodies are small, and only stop up Part of +the Passage; and which may either easily elude the Hook, or straiten it +by their Resistance, a Kind of Rings may be used, and made either solid +or flexible. + +The solid ones are made of iron Wire, or of a String of very fine brass +Wire. For this Purpose the Wire is bent into a Circle about the middle +Part of its Length, the Sides of which Circle do not touch each other, +but leave a Ring, or hollow Cavity, of about an Inch Diameter. Then the +long unbent Sides of the Wire are brought near each other; the circular +Part or Ring is introduced into the Gullet, in order to be conducted +about the obstructing Body, and so to extract it. Very flexible Rings +may be made of Wool, Thread, Silk, or small Packthread, which may be +waxed, for their greater Strength and Consistence. Then they are to be +tied fast to a Handle of Iron-Wire, of Whale-bone, or of any flexible +Wood; after which the Ring is to be introduced to surround the +obstructing Substance, and to draw it out. + +Several of these Rings passed through one another are often made use of, +the more certainly to lay hold of the obstructing Body, which may be +involved by one, if another should miss it. This Sort of Rings has 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 +be a considerable Advantage in many such Cases. + +Sec. 414. A fourth Material employed on these unhappy Occasions is the +Sponge. Its Property of swelling considerably, on being wet, is the +Foundation of its Usefulness here. + +If any Substance is stopt in the Gullet, but without filling up the +whole Passage, a Bit of Sponge is introduced, into that Part that is +unstopt, 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 few Drops of Water; and then +drawing back the Sponge by the Handle it is fastened to, as it is now +too large to return through the small Cavity, by which it was conveyed +in, it draws out the obstructing Body with it, and thus unplugs, as it +were, and opens the Gullet. + +As dry Sponge may shrink or be contracted, this Circumstance has proved +the Means of squeezing a pretty large Piece of it into a very small +Space. It becomes greatly compressed by winding a String or Tape very +closely about it, which Tape may be easily unwound and withdrawn, after +the Sponge has been introduced. It may also be inclosed in a Piece of +Whalebone, split into four Sticks at one End, and which, being endued +with a considerable Spring, contracts upon the Sponge. The Whalebone is +so smoothed and accommodated, as not to wound; and the Sponge is also to +be safely tied to a strong Thread; that after having disengaged the +Whalebone from it, the Surgeon may also draw out the Sponge at Pleasure. + +Sponge is also applied on these Occasions in another Manner. When there +is no Room to convey it into the Gullet, because the obstructing +Substance ingrosses its whole Cavity; and supposing it not hooked into +the Part, but solely detained by the Straitness of the Passage, a pretty +large Bit of Sponge is to be introduced towards the Gullet, and close to +the obstructing Subtance: Thus applied, the Sponge swells, and thence +dilates that Part of the Passage that is above this Substance. The +Sponge is then withdrawn a little, and but a very little, and this +Substance being less pressed upon above than below, it sometimes +happens, that the greater Staitness and Contraction of the lower Part of +the Passage, than of its upper Part, causes that Substance to ascend; +and as soon as this first Loosening or Disengagement of it has happened, +the total Disengagement of it easily follows. + +Sec. 415. Finally, when all these Methods prove unavailable, there remains +one more, which is to make the Patient vomit; but this can scarcely be +of any Service, but when such obstructing Bodies are simply engaged in, +and not hooked or stuck into the Sides of the _Oesophagus_; since under +this latter Circumstance vomiting might occasion further Mischief. + +If the Patient can swallow, a Vomiting may be excited with the +Prescription No. 8, or with No. 34, or 35. By this Operation a Bone was +thrown out, which had stopt in the Passage four and twenty Hours. + +When the Patient cannot swallow, an Attempt should be made to excite him +to vomit by introducing into, and twirling about the feathery End of a +Quill in, the Bottom of the Throat, which the Feather however will not +effect, if the obstructing Body strongly compresses the whole +Circumference of the Gullet; and then no other Resource is left, but +giving a Glyster of Tobacco. A certain Person swallowed a large Morsel +of Calf's Lights, which stopt in the Middle of the Gullet, and exactly +filled up the Passage. A Surgeon unsuccessfully attempted various +Methods to extract it; but another seeing how unavailable all of them +were; and the Patient's Visage becoming black and swelled; his Eyes +ready to start, as it were, out of his Head; and falling into frequent +Swoonings, attended with Convulsions too, he caused a Glyster of an +Ounce of Tobacco boiled to be thrown up; the Consequence of which was a +violent Vomiting, which threw up the Substance that was so very near +killing him. + +Sec. 416. A sixth Method, which I believe has never hitherto been +attempted, but which may prove very useful in many Cases, when the +Substances in the Passage are not too hard, and are very large, would be +to fix a Worm (used for withdrawing the Charge of Guns that have been +loaded) fast to a flexible Handle, with a waxed Thread fastened to the +Handle, in Order to withdraw it, if the Handle slipt from the Worm; and +by this Contrivance it might be very practicable, if the obstructing +Substance was not too deep in the Passage of the Gullet, to extract +it--It has been known that a Thorn fastened in the Throat, has been +thrown out by laughing. + +Sec. 417. In the Circumstances mentioned Sec. 409, when it is more easy and +convenient to push the obstructing Body downwards, it has been usual to +make Use of Leeks, which may generally be had any where (but which +indeed are very subject to break) or of a Wax-candle oiled, and but a +very little heated, so as to make it flexible; or of a Piece of +Whale-bone; or of Iron-Wire; one Extremity of which may be thickened and +blunted in a Minute with a little melted Lead. Small Sticks of some +flexible Wood may be as convenient for the same Use, such as the +Birch-tree, the Hazel, the Ash, the Willow, a flexible Plummet, or a +leaden Ring. All these Substances should be very smooth, that they may +not give the least Irritation; for which Reason they are sometimes +covered over with a thin Bit of Sheep's Gut. Sometimes a Sponge is +fastened to one End of them, which, completely filling up the whole +Passage, pushes down whatever Obstacle it meets with. + +In such Cases too, the Patient may be prompted to attempt swallowing +down large Morsels of some unhurtful Substance, such as a Crust of +Bread, a small Turnep, a Lettuce Stalk, or a Bullet, in Hopes of their +carrying down the obstructing Cause with them. It must be acknowledged, +however, that these afford but a feeble Assistance; and if they are +swallowed without being well secured to a Thread, it may be apprehended +they may even increase the Obstruction, by their own Stoppage. + +It has sometimes very happily, though rarely, occurred, that those +Substances attempted to be detruded or thrust downwards, have stuck in +the Wax-Candle, or the Leek, and sprung up and out with them: but this +can never happen except in the Case of pointed Substances. + +Sec. 418. Should it be impossible to extract the Bodies mentioned Sec. 410, +and all such as it must be dangerous to admit into the Stomach, we must +then prefer the least of two Evils, and rather run the Hazard of pushing +them down, than suffer the Patient to perish dreadfully in a few +Moments. And we ought to scruple this Resolution the less, as a great +many Instances have demonstrated, that notwithstanding several bad +Consequences, and even a tormenting Death, have often followed the +swallowing of such hurtful or indigestible Substances; yet at other +times they have been attended with little or no Disorder. + +Sec. 419. One of these four Events is always the Case, after swallowing +such Things. They either, 1, go off by Stool; or, 2, they are not +discharged and kill the Patient. Or else, 3, they are discharged by +Urine; or, 4, are visibly extruded to the Skin. I shall give some +Instances of each of these Events. + +Sec. 420. When they are voided by Stool, they are either voided soon after +they have been swallowed, and that without having occasional scarce any +troublesome Symptom; or the voiding of them has not happened till a long +Time after swallowing, and is preceded with very considerable Pain. It +has been seen that a Bone of the Leg of a Fowl, a Peach-stone, the Cover +of a small Box of Venice Treacle, Pins, Needles, and Coins of different +Sorts, have been voided within a few Days after they had slipt down into +the Stomach; and that with little or no Complaint. A small Flute, or +Pipe also, four Inches long, which occasioned acute Pains for three +Days, has been voided happily afterwards, besides, Knives, Razors, and +one Shoe-buckle. I have seen but a few Days since a Child between two +and three Years old, who swallowed a Nail above an Inch long, the Head +of which was more than three Tenths of an Inch broad: it stopt a few +Moments about the Neck, but descended while its Friends were looking for +me; and was voided with a Stool that Night, without any bad Consequence. +And still more lately I have known the entire Bone of a Chicken's Wing +thus swallowed, which only occasioned a slight Pain in the Stomach for +three or four Days. + +Sometimes such Substances are retained within for a long Time, not being +voided till after several Months, and even Years, without the least ill +Effect: and some of them have never either appeared, nor been complained +of. + +Sec. 421. But the Event is not always so happy; and sometimes though they +are discharged through the natural Passages, the Discharges have been +preceded by very acute Pains in the Stomach, and in the Bowels. A Girl +swallowed down some Pins, which afflicted her with violent Pains for the +Space of six Years; at the Expiration of which Term she voided them and +recovered. Three Needles being swallowed brought on Cholics, Swoonings +and Convulsions for a Year after: and then being voided by Stool, the +Patient recovered. Another Person who swallowed two, was much happier in +suffering but six Hours from them; when they were voided by Stool, and +he did well. + +It sometimes happens that such indigestible Substances, after having +past all the Meanders, the whole Course of the Intestines, have been +stopt in the Fundament, and brought on very troublesome Symptoms; but +such however, as an expert Surgeon may very generally remove. If it is +practicable to cut them, as it is when they happen to be thin Bones, the +Jaw-bones of Fish, or Pins, they are then very easily extracted. + +Sec. 422. The second Event is, when these fatal Substances are never +voided, but cause very embarrassing Symptoms which finally kill the +Patient; and of these Cases there have been but too many Examples. + +A young Girl having swallowed some Pins, which she held in her Mouth, +some of them were voided by Stool; but others of them pricked and +pierced into her Guts, and even into the Muscles of her Belly, with the +severest Pain; and killed her at the End of three Weeks. + +A Man swallowed a Needle, which pierced through his Stomach, and into +his Liver, [94] and ended in a mortal Consumption. + +[94] I saw a very similar Instance and Event in a Lady's little + favourite Bitch, whole Body she desired to be opened, from + suspecting her to have been poisoned. But it appeared that a small + Needle with fine Thread, which she had swallowed, had passed out of + the Stomach into the _Duodenum_ (one of the Guts) through which the + Point had pierced and pricked and corroded the concave Part of the + Liver, which was all rough and putrid. The whole Carcase was + greatly bloated and extremely offensive, very soon after the poor + Animal's Death, which happened two or three Months after the + Accident, and was preceded by a great Wheezing, Restlessness and + Loss of Appetite. The Needle was rusty, but the Thread entire, and + very little altered. _K._ + +A Plummet which slipt down, while the Throat of a Patient was searching, +killed him at the End of two Years. + +It is very common for different Coins, and of different Metals, to be +swallowed without any fatal or troublesome Effects. Even a hundred +Luidores [95] have been swallowed, and all voided. Nevertheless these +fortunate Escapes ought not to make People too secure and incautious on +such Occasions, since such melancholy Consequences have happened, as may +very justly alarm them. One single Piece of Money that was swallowed, +entirely obstructed the Communication between the Stomach and the +Intestines, and killed the Patient. Whole Nuts have often been +inadvertently swallowed; but there have been some Instances of Persons +in whom a Heap [96] of them has been formed, which proved the Cause of +Death, after producing much Pain and Inquietude. + +[95] I knew a Man of the Name of _Poole_, who being taken in the same + Ship with me, 1717 or 18, by Pirates, had swallowed four Ginueas, + and a gold Ring, all which he voided some Days after without any + Injury or Complaint, and saved them. I forget the exact Number of + Days he retained them, but the Pirates staid with us from Saturday + Night to Thursday Noon. _K._ + +[96] Many fatal Examples of this Kind may be seen in the _Philosophical + Transactions_; and they should caution People against swallowing + Cherry-stones, and still more against those of Prunes, or such as + are pointed, though not very acutely. _K._ + +Sec. 423. The third Issue or Event is, when these Substances, thus +swallowed down, have been discharged by Urine: but these Cases are very +rare. + +A Pin of a middling Size has been discharged by Urine, three Days after +it slipt down; and a little Bone has been expelled the same Way, besides +Cherry-stones, Plumb-stones, and even one Peach-stone. + +Sec. 424. Finally, the fourth Consequence or Event is, when the +indigestible Substances thus swallowed, have pierced through the Stomach +or Intestines, and even to the Skin itself; and occasioning an Abscess, +have made an Outlet for themselves, or have been taken out of the +Abscess. A long Time is often required to effect this extraordinary +Trajection and Appearance of them; sometimes the Pains they occasion are +continual; in other Cases the Patient complains for a Time, after which +the Pain ceases, and then returns again. The Imposthume, or Gathering, +is formed in the Stomach, or in some other Part of the Belly: and +sometimes these very Substances, after having pierced through the Guts, +make very singular Routs, and are discharged very remotely from the +Belly. One Needle that had been swallowed found its Way out, at the End +of four Years, through the Leg; another at the Shoulder. + +Sec. 425. All these Examples, and many others of cruel Deaths, from +swallowing noxious Substances, demonstrate the great Necessity of an +habitual Caution in this Respect; and give in their Testimony against +the horrid, I had almost said, the criminal Imprudence, of People's +amusing themselves with such Tricks as may lead to such terrible +Accidents; or even holding any such Substance in their Mouths, as by +slipping down through Imprudence or Accident, may prove the Occasion of +their Death. Is it possible that any one, without shuddering, can hold +Pins or Needles in their Mouths, after reflecting on the dreadful +Accidents, and cruel Deaths, that have thus been caused by them. + +Sec. 426. It has been shewn already, that Substances obstructing the +Passage of the Gullet sometimes suffocate the Patient; that at other +Times they can neither be extracted nor thrust down; but that they stop +in the Passage, without killing the Patient, at least not immediately +and at once. This is the Case when they are so circumstanced, as not to +compress the _Trachaea_, the Wind-pipe, and not totally to prevent the +swallowing of Food; which last Circumstance can scarcely happen, except +the Obstruction has been formed by angular or pointed Bodies. The +Stoppage of such Bodies is sometimes attended, and that without much +Violence, with a small Suppuration, which loosens them; and then they +are either returned upwards through the Mouth, or descend into the +Stomach. But at other Times an extraordinary Inflammation is produced, +which kills the Patient. Or if the Contents of the Abscess attending the +Inflammation tend outwardly, a Tumour is formed on the external Part of +the Neck, which is to be opened, and through whose Orifice the +obstructing Body is discharged. In other Instances again they take a +different Course, attended with little or no Pain, and are at length +discharged by a Gathering behind the Neck, on the Breast, the Shoulder, +or various other Parts. + +Sec. 427. Some Persons, astonished at the extraordinary Course and +Progression of such Substances, which, from their Size, and especially +from their Shape, seem to them incapable of being introduced into, and +in some Sort, circulating through the human Body, without destroying it, +are very desirous of having the Rout and Progression of such intruding +Substances explained to them. To gratify such Inquirers, I may be +indulged in a short Digression, which perhaps is the less foreign to my +Plan; as in dissipating what seems marvelous, and has been thought +supernatural in such Cases, I may demolish that superstitious Prejudice, +which has often ascribed Effects of this Sort to Witchcraft; but which +admit of an easy Explanation. This very Reason is the Motive that has +determined me to give a further Extent to this Chapter. + +Wherever an Incision is made through the Skin, a certain Membrane +appears, which consists of two Coats or _Laminae_, separated from each +other by small Cells or Cavities, which all communicate together; and +which are furnished, more or less, with Fat. There is not any Fat +throughout the human Body, which is not inclosed in, or enveloped with, +this Coat, which is called the adipose, fatty, or cellular Membrane. + +This Membrane is not only found under the Skin, but further plying and +insinuating itself in various Manners, it is extended throughout the +whole Body. It distinguishes and separates all the Muscles; it +constitutes a Part of the Stomach, of the Guts, of the Bladder, and of +all the _Viscera_ or Bowels. It is this which forms what is called the +Cawl, and which also furnishes a Sheath or Envelopement to the Veins, +Arteries, and Nerves. In some Parts it is very thick, and is abundantly +replenished with Fat; in others it is very thin and unprovided with any; +but wherever it extends, it is wholly insensible, or void of all +Sensation, all Feeling. + +It may be compared to a quilted Coverlet, the Cotton, or other Stuffing +of which, is unequally distributed; greatly abounding in some Places, +with none at all in others, so that in these the Stuff above and below +touch each other. Within this Membrane, or Coverlet, as it were, such +extraneous or foreign Substances are moved about; and as there is a +general Communication throughout the whole Extent of the Membrane, it is +no ways surprizing, that they are moved from one Part to another very +distant, in a long Course and Duration of Movement. Officers and +Soldiers very often experience, that Bullets which do not pass through +the Parts where they have entered, are transferred to very different and +remote ones. + +The general Communication throughout this Membrane is daily demonstrated +by Facts, which the Law prohibits; this is the Butchers inflating, or +blowing up, the cellular Membrane throughout the whole Carcase of a +Calf, by a small Incision in the Skin, into which they introduce a Pipe +or the Nozzle of a small Bellows; and then, blowing forcibly, the Air +evidently puffs up the whole Body of the Calf into this artificial +Tumour or Swelling. + +Some very criminal Impostors have availed themselves of this wicked +Contrivance, thus to bloat up Children into a Kind of Monsters, which +they afterwards expose to View for Money. + +In this cellular Membrane the extravasated Waters of hydropic Patients +are commonly diffused; and here they give Way to that Motion, to which +their own Weight disposes them. But here I may be asked--As this +Membrane is crossed and intersected in different Parts of it, by Nerves, +Veins, Arteries, _&c._ the wounding of which unavoidably occasions +grievous Symptoms, how comes it, that such do not ensue upon the +Intrusion of such noxious Substances? To this I answer, 1, that such +Symptoms do sometimes really ensue; and 2, that nevertheless they must +happen but seldom, by Reason that all the aforesaid Parts, which +traverse and intersect this Membrane, being harder than the Fat it +contains; such foreign Substances must almost necessarily, whenever they +rencounter those Parts, be turned aside towards the Fat which surrounds +them, whose Resistance is very considerably less; and this the more +certainly so, as these Nerves, _&c._ are always of a cylindrical +Form.----But to return from this necessary Digression. + +Sec. 428. To all these Methods and Expedients I have already recommended on +the important Subject of this Chapter, I shall further add some general +Directions. + +1. It is often useful, and even necessary, to take a considerable +Quantity of Blood from the Arm; but especially if the Patient's +Respiration, or Breathing, is extremely oppressed; or when we cannot +speedily succeed in our Efforts to remove the obstructing Substance; as +the Bleeding is adapted to prevent the Inflammation, which the frequent +Irritations from such Substances occasion; and as by its disposing the +whole Body into a State of Relaxation, it might possibly procure an +immediate Discharge of the offending Substance. + +2. Whenever it is manifest that all Endeavours, either to extract, or to +push down the Substance stopt in the Passage, are ineffectual, they +should be discontinued; because the Inflammation occasioned by +persisting in them, would be as dangerous as the Obstruction itself; as +there have been Instances of People's dying in Consequence of the +Inflammation; notwithstanding the Body, which caused the Obstruction, +had been entirely removed. + +3. While the Means already advised 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 lower down than +the _Glottis_, some very emollient Liquor, as warm Water, either alone +or mixed with Milk, or a Decoction of Barley, of Mallows, or of Bran. A +two-fold Advantage may arise from this; the first is, that these +softening Liquors smooth and sooth the irritated Parts; and secondly, an +Injection, strongly thrown in, has often been more successful in +loosening the obstructing Body, than all Attempts with Instruments. + +4. When after all we are obliged to leave this in the Part, the Patient +must be treated as if he had an inflammatory Disease; he must be bled, +ordered to a Regimen, and have his whole Neck surrounded with emollient +Pultices. The like Treatment must also be used, though the obstructing +Substance be removed; if there is Room to suppose any Inflammation left +in the Passage. + +5. A proper Degree of Agitation has sometimes loosened the inhering +Body, more effectually than Instruments. It has been experienced that a +Blow with the Fist on the Spine, the Middle of the Back, has often +disengaged such obstructed and obstructing Bodies; and I have known two +Instances of Patients who had Pins stopt in the Passage; and who getting +on Horseback to ride out in Search of Relief at a neighbouring Village, +found each of them the Pin disengaged after an Hour's riding: One spat +it out, and the other swallowed it, without any ill Consequence. + +6. When there is an immediate Apprehension of the Patient's being +suffocated; when bleeding him has been of no Service; when all Hope of +freeing the Passage in time is vanished, and Death seems at Hand, if +Respiration be not restored; the Operation of _Bronchotomy_, or opening +of the Wind-pipe, must be directly performed; an Operation neither +difficult to a tolerably knowing and expert Surgeon, nor very painful to +the Patient. + +7. When the Substance that was stopt passes into the Stomach, the +Patient must immediately be put into a very mild and smooth Regimen. He +should avoid all sharp, irritating, inflaming Food; Wine, spirituous +Liquors, all strong Drink, and Coffee; taking but little Nourishment at +once, and no Solids, without their having been thoroughly well chewed. +The best Diet would be that of farinaceous mealy Soups, made of various +leguminous Grains, and of Milk and Water, which is much better than the +usual Custom of swallowing different Oils. + +Sec. 429. The Author of Nature has provided, that in eating, nothing should +pass by the _Glottis_ into the Wind-pipe. This Misfortune nevertheless +does sometimes happen; at which very Instant there ensues an incessant +and violent Cough, an acute Pain, with Suffocation; all the Blood being +forced up into the Head, the Patient is in extreme Anguish, being +agitated with violent and involuntary Motions, and sometimes dying on +the Spot. A _Hungarian_ Grenadier, by Trade a Shoemaker, was eating and +working at the same time. He tumbled at once from his Seat, without +uttering a single Word. His Comrades called out for Assistance; some +Surgeons speedily arrived, but after all their Endeavours he discovered +no Token of Life. On opening the Body, they found a Lump, or large +Morsel, of Beef, weighing two Ounces, forced into the Windpipe, which it +plugged up so exactly, that not the least Air could pass through it into +the Lungs. + +Sec. 430. In a Case so circumstanced, the Patient should be struck often on +the Middle of the Back; some Efforts to vomit should be excited; he +should be prompted to sneeze with Powder of Lilly of the Valley, Sage, +or any cephalic Snuffs, which should be blown strongly up his Nose. + +A Pea, pitched into the Mouth in playing, entered into the Wind-pipe, +and sprung out again by vomiting the Patient with Oil. A little Bone was +brought up by making another sneeze, with powdered Lilly of the Valley. + +In short, if all these Means of assisting, or saving the Patient are +evidently ineffectual, _Bronchotomy_ must be speedily performed (See No. +6, of the preceding Section.) By this Operation, some Bones, a Bean, and +a Fish-bone have been extracted, and the Patient has been delivered from +approaching Death. + +Sec. 431. Nothing should be left untried, when the Preservation of human +Life is the Object. In those Cases, when an obstructing Body can neither +be disengaged from the Throat, the Passage to the Stomach, nor be +suffered to remain there without speedily killing the Patient, it has +been proposed to make an Incision into this Passage, the _Oesophagus_, +through which such a Body is to be extracted; and to employ the like +Means, when a Substance which had slipt even into the Stomach itself, +was of a Nature to excite such Symptoms, as must speedily destroy the +Patient. + +When the _Oesophagus_ is so fully and strongly closed, that the Patient +can receive no Food by the Mouth, he is to be nourished by Glysters of +Soup, Gelly, and the like. + + + + + __Chapter XXX.__ + + + _Of external Disorders, and such as require chirurgical + Application. Of Burns, Wounds, Contusions or Bruises: Of + Sprains, Ulcers, frostbitten Limbs, Chilblains, Ruptures, Boils. + Of Fellons, Thorns or Splinters in the Fingers or Flesh; of + Warts, and of Corns._ + + + __Sect.__ 432. + +Labouring Countrymen are exposed in the Course of their daily Work, to +many outward Accidents, such as Cuts, Contusions, _&c_. which, however +considerable in themselves, very generally end happily; and that chiefly +in Consequence of the pure and simple Nature of their Blood, which is +generally much less acrimonious, or sharp, in the Country, than in great +Towns or Cities. Nevertheless, the very improper Treatment of such +Accidents, in the Country, frequently renders them, however light in +themselves, very troublesome; and indeed, I have seen so many Instances +of this, that I have thought it necessary to mark out here the proper +Treatment of such Accidents, as may not necessarily require the Hand or +Attendance of a Surgeon. I shall also add something very briefly, +concerning some external Disorders, which at the same Time result from +an inward Cause. + + + + _Of Burns._ + + +Sec. 433. When a Burn is very trifling and superficial, and occasions no +Vesication or Blister, it is sufficient to clap a Compress of several +Folds of soft Linen upon it, dipt in cold Water, and to renew it every +Quarter of an Hour, till the Pain is entirely removed. But when the Burn +has blistered, a Compress of very fine Linen, spread over with the +Pomatum, No. 64, should be applied over it, and changed twice a Day. + +If the true Skin is burnt, and even the Muscles, the Flesh under it, be +injured, the same Pomatum may be applied; but instead of a Compress, it +should be spread upon a Pledget of soft Lint, to be applied very exactly +over it, and over the Pledget again, a Slip of the simple Plaister No. +65, which every Body may easily prepare; or, if they should prefer it, +the Plaister No. 66. + +But, independently of these external Applications, which are the most +effectual ones, when they are directly to be had; whenever the Burn has +been very violent, is highly inflamed, and we are apprehensive of the +Progress and the Consequences of the Inflammation, the same Means and +Remedies must be recurred to, which are used in violent Inflammations: +the Patient should be bled, and, if it is necessary, it should be +repeated more than once, and he should be put into a Regimen; drink +nothing but the Ptisans No. 2 and 4, and receive daily two simple +Glysters. + +If the Ingredients for the Ointment, called _Nutritum_, are not at Hand +to make the Pomatum No. 64; one Part of Wax should be melted in eight +such Parts of Oil, to two Ounces of which Mixture the Yolk of an Egg +should be added. A still more simple and sooner prepared Application, is +that of one Egg, both the Yolk and the White, beat up with two common +Spoonfuls of the sweetest Oil, without any Rankness. When the Pain of +the Burn, and all its other Symptoms have very nearly disappeared, it is +sufficient to apply the Sparadrap, or Oil-cloth No. 66. + + + + _Of Wounds._ + + +Sec. 434. If a Wound has penetrated into any of the Cavities, and has +wounded any Part contained in the Breast, or in the Belly: Or if, +without having entered into one of the Cavities, it has opened some +great Blood-vessel; or if it has wounded a considerable Nerve, which +occasions Symptoms much more violent, than would otherwise have +happened; if it has penetrated even to and injured the Bone: in short, +if any great and severe Symptom supervenes, there is an absolute +Necessity for calling in a Surgeon. But whenever the Wound is not +attended with any of these Circumstances; when it affects only the Skin, +the fat Membrane beneath it, the fleshy Parts and the small Vessels, it +may be easily and simply dressed without such Assistance; since, in +general, all that is truly necessary in such Cases is, to defend the +Wound from the Impressions of the Air; and yet not so, as to give any +material Obstruction to the Discharge of the Matter, that is to issue +from the Wound. + +Sec. 435. If the Blood does not particularly flow out of any considerable +Vessel, but trickles almost equally from every Spot of the Wound, it may +very safely be permitted to bleed, while some Lint is speedily +preparing. As soon as the Lint is ready, so much of it may be introduced +into the Wound as will nearly fill it, without being forced in; which is +highly improper, and would be attended with the same Inconveniences as +Tents and Dossils. It should be covered over with a Compress dipt in +sweet Oil, or with the Cerecloth No. 65; though I prefer the Compress +for the earliest Dressings: and the whole Dressing should be kept on, +with a Bandage of two Fingers Breadth, and of a Length proportioned to +the Size of the Part it is to surround: This should be rolled on tight +enough to secure the Dressings, and yet so moderately, as to bring on no +Inflammation. + +This Bandage with these Dressings are to remain on twenty-four or +forty-eight Hours; Wounds being healed the sooner, for being less +frequently drest. At the second Dressing all the Lint must be removed, +which can be done with Ease, and with reasonable Speed, to the Wounded; +and if any of it should stick close, in Consequence of the clogged and +dried Blood, it should be left behind, adding a little fresh Lint to it; +this Dressing in other Respects exactly resembling the first. + +When, from the Continuance of this simple Dressing, the Wound is become +very superficial, it is sufficient to apply the Cerecloth, or Plaister, +without any Lint. + +Such as have conceived an extraordinary Opinion of any medical Oils, +impregnated with the Virtues of particular Plants, may, if that will +increase their Satisfaction, make use of the common Oil of Yarrow, of +Trefoil, of Lilies, of Chamomile, of Balsamines, or of red Roses; only +being very careful, that such Oils are not become stale and rank. + +Sec. 436. When the Wound is considerable, it must be expected to inflame +before Suppuration (which, in such a Case, advances more slowly) can +ensue; which Inflammation will necessarily be attended with Pain, with a +Fever, and sometimes with a Raving, or Wandering, too. In such a +Situation, a Pultice of Bread and Milk, with the Addition of a little +Oil, that it may not stick too close, must be applied instead of the +Compress or the Plaister: which Pultice is to be changed, but without +uncovering the Wound, thrice and even four times every Day. + +Sec. 437. Should some pretty considerable Blood-vessel be opened by the +Wound, there must be applied over it, a Piece of Agaric of the Oak, No. +67, with which no Country place ought to be unprovided. It is to be kept +on, by applying a good deal of Lint over it; covering the whole with a +thick Compress, and then with a Bandage a little tighter than usual. If +this should not be sufficient to prevent the Bleeding from the large +Vessel, and the Wound be in the Leg or Arm, a strong Ligature must be +made above the Wound with a _Turniquet_, which is made in a Moment with +a Skain of Thread, or of Hemp, that is passed round the Arm circularly, +into the Middle of which is inserted a Piece of Wood or Stick of an Inch +Thickness, and four or five Inches long; so that by turning round this +Piece of Wood, any Tightness or Compression may be effected at Pleasure; +exactly as a Country-man secures a Hogshead, or a Piece of Timber on his +Cart, with a Chain and Ring. But Care must be taken, 1, to dispose the +Skain in such a Manner, that it must always be two Inches wider than the +Part it surrounds: and, 2, not to strain it so tight as to bring on an +Inflammation, which might terminate in a Gangrene. + +Sec. 438. All the boasted Virtues of a Multitude of Ointments are downright +Nonsense or Quackery. Art, strictly considered, does not in the least +contribute to the healing of Wounds; the utmost we can do amounting only +to our removing those Accidents, which are so many Obstacles to their +Re-union. On this Account, if there is any extraneous Body in the Wound, +such as Iron, Lead, Wood, Glass, Bits of Cloth or Linen, they must be +extracted, if that can be very easily done; but if not, Application must +be made to a good Surgeon, who considers what Measures are to be taken, +and then dresses the Wound, as I have already advised. + +Very far from being useful, there are many Ointments that are pernicious +on these Occasions; and the only Cases in which they should be used, are +those in which the Wounds are distinguished with some particular +Appearances, which ought to be removed by particular Applications: But a +simple recent Wound, in a healthy Man, requires no other Treatment but +what I have already directed, besides that of the general Regimen. + +Spirituous Applications are commonly hurtful, and can be suitable and +proper but in a few Cases, which Physicians and Surgeons only can +distinguish. + +When Wounds occur in the Head, instead of the Compress dipt in Oil, or +of the Cerecloth, the Wound should be covered with a Betony Plaister; +or, when none is to be had in time, with a Compress squeezed out of hot +Wine. + +Sec. 439. As the following Symptoms, of which we should be most +apprehensive, are such as attend on Inflammations, the Means we ought to +have Recourse to are those which are most likely to prevent them; such +as Bleeding, the usual Regimen, moderate Coolers and Glysters. + +Should the Wound be very inconsiderable in its Degree, and in its +Situation, it may be sufficient to avoid taking any Thing heating; and +above all Things to retrench the Use of any strong Drink, and of +Flesh-meat. + +But when it is considerable, and an Inflammation must be expected, there +is a Necessity for Bleeding; the Patient should be kept in the most +quiet and easy Situation; he should be ordered immediately to a Regimen; +and sometimes the Bleeding also must be repeated. Now all these Means +are the more indispensably necessary, when the Wound has penetrated to +some internal Part; in which Situation, no Remedy is more certain than +that of an extremely light Diet. Such wounded Persons as have been +supposed incapable of living many Hours, after Wounds in the Breast, in +the Belly, or in the Kidnies, have been completely recovered, by living +for the Course of several Weeks, on nothing but a Barley, or other +farinaceous mealy, Ptisans, without Salt, without Soup, without any +Medicine; and especially without the Use of any Ointments. + +Sec. 440. In the same Proportion that Bleeding, moderately and judiciously +employed, is serviceable, in that very same an Excess of it becomes +pernicious. Great Wounds are generally attended with a considerable Loss +of Blood, which has already exhausted the wounded Person; and the Fever +is often a Consequence of this copious Loss of Blood. Now if under such +a Circumstance, Bleeding should be ordered and performed, the Patient's +Strength is totally sunk; the Humours stagnate and corrupt; a Gangrene +supervenes, and he dies miserably, at the End of two or three Days, of a +_Series_ of repeated Bleedings, but not of the Wound. Notwithstanding +the Certainty of this, the Surgeon frequently boasts of his ten, twelve, +or even his fifteen Bleedings; assuring his Hearers of the insuperable +Mortality of the Wound, since the letting out such a Quantity of Blood +could not recover the Patient; when it really was that excessive +artificial Profusion of it, that downright dispatched him.------The +Pleasures of Love are very mortal ones to the Wounded. + +Sec. 441. The Balsams and vulnerary Plants, which have often been so highly +celebrated for the Cure of Wounds, are very noxious, when taken +inwardly; because the Introduction of them gives or heightens the Fever, +which ought to have been abated. + + + + _Of Contusions, or Bruises._ + + +Sec. 442. A Contusion, which is commonly called a Bruise, is the Effect of +the forcible Impression or Stroke of a Substance not sharp or cutting, +on the Body of a Man, or any Animal; whether such an Impression be +violently made on the Man, as when he is struck by a Stick, or by a +Stone thrown at him; or whether the Man be involuntarily forced against +a Post, a Stone, or any hard Substance by a Fall; or whether, in short, +he is squeezed and oppressed betwixt two hard Bodies, as when his Finger +is squeezed betwixt the Door and the Door-Post, or the whole Body jammed +in betwixt any Carriage and the Wall. These Bruises, however, are still +more frequent in the Country than Wounds, and commonly more dangerous +too; and indeed the more so, as we cannot judge so exactly, and so soon, +of the whole Injury that has been incurred; and because all that is +immediately visible of it is often but a small Part of the real Damage +attending it: since it frequently happens that no Hurt appears for a few +successive Days; nor does it become manifest, until it is too late to +admit of an effectual Cure. + +Sec. 443. It is but a few Weeks since a Cooper came to ask my Advice. His +Manner of breathing, his Aspect, the Quickness, Smallness, and +Irregularity of his Pulse, made me apprehensive at once, that some +Matter was formed within his Breast. Nevertheless he still kept up, and +went about, working also at some Part of his Trade. He had fallen in +removing some Casks or Hogsheads; and the whole Weight of his Body had +been violently impressed upon the right Side of his Breast. +Notwithstanding this, he was sensible of no Hurt at first; but some Days +afterwards he began to feel a dull heavy Pain in that Part, which +continued and brought on a Difficulty of Breathing, Weakness, broken +Sleep and Loss of Appetite. I ordered him immediately to Stillness and +Repose, and I advised him to drink a Ptisan of Barley sweetened with +Honey, in a plentiful Quantity. He regularly obeyed only the latter Part +of my Directions: yet on meeting him a few Days after, he told me he was +better. The very same Week, however, I was informed he had been found +dead in his Bed. The Imposthume had undoubtedly broke, and suffocated +him. + +Sec. 444. A young Man, run away with by his Horse, was forced with Violence +against a Stable-Door, without being sensible of any Damage at the Time. +But at the Expiration of twelve Days, he found himself attacked by some +such Complaints, as generally occur at the Beginning of a Fever. This +Fever was mistaken for a putrid one, and he was very improperly treated, +for the Fever it really was, above a Month. In short, it was agreed at a +Consultation, that Matter was collected in the Breast. In Consequence of +this, he was more properly attended, and at length happily cured by the +Operation for an _Empyema_, after languishing a whole Year. I have +published these two Instances, to demonstrate the great Danger of +neglecting violent Strokes or Bruises; since the first of these Patients +might have escaped Death; and the second a tedious and afflicting +Disorder, if they had taken, immediately after each Accident, the +necessary Precautions against its Consequences. + +Sec. 445. Whenever any Part is bruised, one of two Things always ensues, +and commonly both happen together; especially if the Contusion is pretty +considerable: Either the small Blood-vessels of the contused Part are +broken, and the Blood they contained is spread about in the adjoining +Parts; or else, without such an Effusion of it, these Vessels have lost +their Tone, their active Force, and no longer contributing to the +Circulation, their Contents stagnate. In each of these Cases, if Nature, +either without or with the Assistance of Art, does not remove the +Impediment, an Inflammation comes on, attended with an imperfect, +unkindly Suppuration, with Putrefaction and a Gangrene; without +mentioning the Symptoms that arise from the Contusion of some particular +Substance, as a Nerve, a large Vessel, a Bone, _&c._ Hence we may also +conceive the Danger of a Contusion, happening to any inward Part, from +which the Blood is either internally effused, or the Circulation wholly +obstructed in some vital Organ. This is the Cause of the sudden Death of +Persons after a violent Fall; or of those who have received the violent +Force of heavy descending Bodies on their Heads; or of some violent +Strokes, without any evident external Hurt or Mark. + +There have been many Instances of sudden Deaths after one Blow on the +Pit of the Stomach, which has occasioned a Rupture of the Spleen. + +It is in Consequence of Falls occasioning a general slight Contusion, as +well internal as external, that they are sometimes attended with such +grievous Consequences, especially in old Men, where Nature, already +enfeebled, is less able to redress such Disorders. And thus in Fact has +it been, that many such, who had before enjoyed a firm State of Health, +have immediately lost it after a Fall (which seemed at first to have +affected them little or not at all) and languished soon after to the +Moment of their Death, which such Accidents very generally accelerate. + +Sec. 446. Different external and internal Remedies are applicable in +Contusions. When the Accident has occurred in a slight Degree, and there +has been no great nor general Shock, which might produce an internal +Soreness or Contusion, external Applications may be sufficient. They +should consist of such Things as are adapted, first, to attenuate and +resolve the effused and stagnant Blood, which shews itself so +apparently; and which, from its manifest Blackness very soon after the +Contusion, becomes successively brown, yellow, and greyish, in +Proportions as the Magnitude of the Suffusion or Sealing decreases, till +at last it disappears entirely, and the Skin recovers its Colour, +without the Blood's having been discharged through the external Surface, +as it has been insensibly and gradually dissolved, and been taken in +again by the Vessels: And secondly, the Medicines should be such as are +qualified to restore the Tone, and to recover the Strength of the +affected Vessels. + +The best Application is Vinegar, diluted, if very sharp, with twice as +much warm Water; in which Mixture Folds of Linnen are to be dipt, within +which the contused Parts are to be involved; and these Folds are to be +remoistened and re-applied every two Hours on the first Day. + +Parsley, Chervil, and Houseleek Leaves, lightly pounded, have also been +successfully employed; and these Applications are preferable to Vinegar, +when a Wound is joined to the Bruise. The Pultices, No. 68, may also be +used with Advantage. + +Sec. 447. It has been a common Practice immediately to apply spirituous +Liquors, such as Brandy, Arquebussade and [97] Alibour Water, and the +like; but a long Abuse ought not to be established by Prescription. +These Liquids which coagulate the Blood, instead of resolving it, are +truly pernicious; notwithstanding they are sometimes employed without +any visible Disadvantage on very slight Occasions. Frequently by +determining the settled Blood towards the Insterstices of the Muscles, +the fleshy Parts; or sometimes even by preventing the Effusion, or +visible Settling of the Blood, and fixing it, as it were, within the +bruised Vessels, they seem to be well; though this only arises from +their concentring and concealing the Evil, which, at the End of a few +Months, breaks forth again in a very troublesome Shape. Of this I have +seen some miserable Examples, whence it has been abundantly evinced, +that Applications of this Sort should never be admitted; and that +Vinegar should be used instead of them. At the utmost it should only be +allowed, (after there is Reason to suppose all the stagnant Blood +resolved and resorbed into the Circulation) to add a third Part of +Arquebusade Water to the Vinegar; with an Intention to restore some +Strength to the relaxed and weakened Parts. + +[97] This, Dr. _Tissot_ informs me, is a Solution of white Vitriol and + some other Drugs in Spirit of Wine, and is never used in regular + Practice now. It has its Name from the Author of the Solution. _K._ + +Sec. 448. It is still a more pernicious Practice to apply, in Bruises, +Plaisters composed of greasy Substances, Rosins, Gums, Earths, _&c._ The +most boasted of these is always hurtful, and there have been many +Instances of very slight Contusions being aggravated into Gangrenes by +such Plaisters ignorantly applied; which Bruises would have been +entirely subdued by the Oeconomy of Nature, if left to herself, in the +Space of four Days. + +Those Sacs or Suffusions of coagulated Blood, which are visible under +the Skin, should never be opened, except for some urgent Reason; since +however large they may be, they insensibly disappear and dissipate; +instead of which Termination, by opening them, they sometimes terminate +in a dangerous Ulceration. + +Sec. 449. The internal Treatment of Contusions is exactly the same with +that of Wounds; only that in these Cases the best Drink is the +Prescription, No. 1, to each Pot of which a Drachm of Nitre must be +added. + +When any Person has got a violent Fall; has lost his Senses, or is +become very stupid; when the Blood starts out of his Nostrils, or his +Ears; when he is greatly oppressed, or his Belly feels very tight and +tense, which import an Effusion of Blood either into the Head, the +Breast or the Belly, he must, first of all, be bled upon the Spot, and +all the Means must be recurred to, which have been mentioned Sec. 439, +giving the wretched Patient the least possible Disturbance or Motion; +and by all means avoiding to jog or shake him, with a Design to bring +him to his Senses; which would be directly and effectually killing him, +by causing a further Effusion of Blood. Instead of this the whole Body +should be fomented, with some one of the Decoctions already mentioned: +and when the Violence has been chiefly impressed on the Head, Wine and +Water should be prefered to Vinegar. + +Falls attended with Wounds, and even a Fracture of the Skull, and with +the most alarming Symptoms, have been cured by these internal Remedies, +and without any other external Assistance, except the Use of the +aromatic Fomentation, No. 68. + +A Man from _Pully-petit_ came to consult me some Months ago, concerning +his Father, who had a high Fall out of a Tree. He had been twenty-four +Hours without Feeling or Sense, and without any other Motion than +frequent Efforts to vomit; and Blood had issued both from his Nose and +Ears. He had no visible outward Hurt neither on his Head, nor any other +Part; and, very fortunately for him, they had not as yet exerted the +least Effort to relieve him. I immediately directed a plentiful Bleeding +in the Arm; and a large Quantity of Whey sweetened with Honey to be +drank, and to be also injected by Way of Glyster. This Advice was very +punctually observed; and fifteen Days after the Father came to +_Lausanne_, which is four Leagues from _Pully-petit_, and told me he was +very well. It is proper, in all considerable Bruises, to open the +Patient's Belly with a mild cooling Purge, such as No. 11, 23, 32, 49. +The Prescription No. 24, and the honyed Whey are excellent Remedies, +from the same Reason. + +Sec. 450. In these Circumstances, Wine, distiled Spirits, and whatever has +been supposed to revive and to rouse, is mortal. For this Reason People +should not be too impatient, because the Patients remain some Time +without Sense or Feeling. The giving of Turpentine is more likely to do +Mischief than Good; and if it has been sometimes serviceable, it must +have been in Consequence of its purging the Patient, who probably then +needed to be purged. The Fat of a Whale, (_Sperma caeti_) Dragons Blood, +Crabs-Eyes, and Ointments of whatsoever Sort are at least useless and +dangerous Medicine, if the Case be very hazardous; either by the +Mischief they do, or the Good they prevent from being done. The proper +Indication is to dilute the Blood, to render it more fluid and disposed +to circulate; and the Medicines just mentioned produce a very contrary +Effect. + +Sec. 451. When an aged Person gets a Fall, which is the more dangerous in +Proportion to his Age and Grossness; notwithstanding he should not seem +in the least incommoded by it, if he is sanguine and still somewhat +vigorous, he should part with three or four Ounces of Blood. He should +take immediately a few successive Cups of a lightly aromatic Drink, +which should be given him hot; such, for Instance, as an Infusion of Tea +sweetened with Honey, and he should be advised to move gently about. He +must retrench a little from the usual Quantity of his Food, and accustom +himself to very gentle, but very frequent, Exercise. + +Sec. 452. Sprains or Wrenches, which very often happen, produce a Kind of +Contusion, in the Parts adjoining to the sprained Joint. This Contusion +is caused by the violent Friction of the Bone against the neighbouring +Parts; and as soon as the Bones are immediately returned into their +proper Situation, the Disorder should be treated as a Contusion. Indeed +if the Bones should not of themselves return into their proper natural +Position, Recourse must be had to the Hand of a Surgeon. + +The best Remedy in this Case is absolute Rest and Repose, after applying +a Compress moistened in Vinegar and Water, which is to be renewed and +continued, till the Marks of the Contusion entirely disappear; and there +remains not the smallest Apprehension of an Inflammation. Then indeed, +and not before, a little Brandy or Arquebusade Water may be added to the +Vinegar; and the Part (which is almost constantly the Foot) should be +strengthened and secured for a considerable Time with a Bandage; as it +might otherwise be liable to fresh Sprains, which would daily more and +more enfeeble it: and if this Evil is overlooked too much in its +Infancy, the Part never recovers its full Strength; and a small Swelling +often remains to the End of the Patient's Life. + +If the Sprain is very slight and moderate, a Plunging of the Part into +cold Water is excellent; but if this is not done at once immediately +after the Sprain, or if the Contusion is violent, it is even hurtful. + +The Custom of rolling the naked Foot upon some round Body is +insufficient, when the Bones are not perfectly replaced; and hurtful, +when the Sprain is accompanied with a Contusion. + +It happens continually almost that Country People, who encounter such +Accidents, apply themselves either to ignorant or knavish Imposters, who +find, or are determined to find, a Disorder or Dislocation of the Bones, +where there is none; and who, by their violent Manner of handling the +Parts, or by the Plaisters they surround them with, bring on a dangerous +Inflammation, and change the Patient's Dread of a small Disorder, into a +very grievous Malady. + +These are the very Persons who have created, or indeed rather imagined, +some impossible Diseases, such as the Opening, the Splitting of the +Stomach, and of the Kidnies. But these big Words terrify the poor +Country People, and dispose them to be more easily and effectually +duped. + + + + _Of Ulcers._ + + +Sec. 453. Whenever Ulcers arise from a general Fault of the Blood, it is +impossible to cure them, without destroying the Cause and Fuel of them. +It is in Fact imprudent to attempt to heal them up by outward Remedies; +and a real Misfortune to the Patient, if his Assistant effectually heals +and closes them. + +But, for the greater Part, Ulcers in the Country are the Consequence of +some Wound, Bruise, or Tumour improperly treated; and especially of such +as have been dressed with too sharp, or too spirituous Applications. +Rancid Oils are also one of the Causes, which change the most simple +Wounds into obstinate Ulcers, for which Reason they should be avoided; +and Apothecaries should be careful, when they compound greasy Ointments, +to make but little at a Time, and the oftner, as a very considerable +Quantity of any of them becomes rank before it is all sold; +notwithstanding sweet fresh Oil may have been employed in preparing +them. + +Sec. 454. What serves to distinguish Ulcers from Wounds, is the Dryness and +Hardness of the Sides or Borders of Ulcers, and the Quality of the +Humour discharged from them; which, instead of being ripe consistent +Matter, is a Liquid more thin, less white, sometimes yielding a +disagreable Scent, and so very sharp, that if it touch the adjoining +Skin, it produces Redness, Inflammation, or Pustules there; sometimes a +serpiginous, or Ring-worm like Eruption, and even a further Ulceration. + +Sec. 455. Such Ulcers as are of a long Duration, which spread wide, and +discharge much, prey upon the Patient, and throw him into a slow Fever, +which melts and consumes him. Besides, when an Ulcer is of a long +Standing, it is dangerous to dry it up; and indeed this never should be +done, but by substituting in the Place of one Discharge that is become +almost natural, some other Evacuation, such as Purging from Time to +Time. + +We may daily see sudden Deaths, or very tormenting Diseases, ensue the +sudden drying up such Humours and Drains as have been of a long +Continuance: and whenever any Quack (and as many as promise the speedy +Cure of such, deserve that Title) assures the Patient of his curing an +inveterate Ulcer in a few Days, he demonstrates himself to be a very +dangerous and ignorant Intermeddler, who must kill the Patient, if he +keeps his Word. Some of these impudent Impostors make use of the most +corrosive Applications, and even arsenical ones; notwithstanding the +most violent Death is generally the Consequence of them. + +Sec. 456. The utmost that Art can effect, with Regard to Ulcers, which do +not arise from any Fault in the Humours, is to change them into Wounds. +To this End, the Hardness and Dryness of the Edges of the Ulcer, and +indeed of the whole Ulcer, must be diminished, and its Inflammation +removed. But sometimes the Hardness is so obstinate, that this cannot be +mollified any other Way, than by scarifying the Edges with a Lancet. But +when it may be effected by other Means, let a Pledget spread with the +Ointment, No. 69, be applied all over the Ulcer; and this Pledget be +covered again with a Compress of several Folds, moistened in the Liquid, +No. 70, which should be renewed three times daily; though it is +sufficient to apply a fresh Pledget only twice. + +As I have already affirmed that Ulcers were often the Consequence of +sharp and spirituous Dressings, it is evident such should be abstained +from, without which Abstinence they will prove incurable. + +To forward the Cure, salted Food, Spices, and strong Drink should be +avoided; the Quantity of Flesh-meat should be lessened; and the Body be +kept open by a Regimen of Pulse, of Vegetables, and by the habitual Use +of Whey sweetened with Honey. + +If the Ulcers are in the Legs, a very common Situation of them, it is of +great Importance, as well as in Wounds of the same Parts, that the +Patient should walk about but little; and yet never stand up without +walking. This indeed is one of these Cases, in which those, who have +some Credit and Influence in the Estimation of the People, should omit +nothing to make them thoroughly comprehend the Necessity of confining +themselves, some Days, to undisturbed Tranquillity and Rest; and they +should also convince them, that this Term of Rest is so far from being +lost Time, that it is likely to prove their most profitable Time of +Life. Negligence, in this material Point, changes the slightest Wounds +into Ulcers, and the most trifling Ulcers into obstinate and incurable +ones: insomuch that there is scarcely any Man, who may not observe some +Family in his Neighbourhood, reduced to the Hospital, [98] from their +having been too inattentive to the due Care of some Complaint of this +Sort. + +[98] This seems just the same as _coming on the Parish_, or being + received into an Alms house here; in Consequence of such an + incurable Disability happening to the poor working Father of a + Family. _K._ + +I conclude this Article on Ulcers with repeating, that those which are +owing to some internal Cause; or even such as happen from an external +one, in Persons of a bad Habit of Body, frequently require a more +particular Treatment. + + + + _Of Frozen Limbs._ + + +Sec. 457. It is but too common, in very rigorous Winters, for some Persons +to be pierced with so violent a Degree of Cold, that their Hands or +Feet, or sometimes both together are frozen at once, just like a Piece +of Flesh-meat exposed to the Air. + +If a Person thus pierced with the Cold, dispose himself to walk about, +which seems so natural and obvious a Means to get warm; and especially, +if he attempts to [99] warm the Parts that have been frozen, his Case +proves irrecoverable. Intolerable Pains are the Consequence, which Pains +are speedily attended with an incurable Gangrene; and there is no Means +left to save the Patient's Life, but by cutting off the gangrened Limbs. + +[99] The Reason of the Fatality of Heat, in these Cases, and of the + Success of an opposite Application, (See Sec. 459) seems strictly and + even beautifully analogous to what _Hippocrates_ has observed of + the Danger, and even Fatality, of all great and sudden Changes in + the human Body, whether from the Weather or otherwise. Whence this + truly great Founder of Physick, when he observes elsewhere, that + Diseases are to be cured by something contrary to their Causes, + very consistently advises, not a direct and violent Contrariety, + but a gradual and regulated one, a _Sub-contrariety_. _K._ + +There was a very late and terrible Example of this, in the Case of an +Inhabitant at _Cossonay_, who had both his Hands frozen. Some greasy +Ointments were applied hot to them, the Consequence of which was, the +Necessity of cutting off six of his Fingers. + +Sec. 458. In short, there is but one certain Remedy in such Cases, and this +is to convey the Person affected into some Place where it does not +freeze, but where, however, it is but very moderately hot, and there +continually to apply, to the frozen Parts, Snow, if it be at hand; and +if not, to keep washing them incessantly, but very gently (since all +Friction would at this Juncture prove dangerous) in Ice-water, as the +Ice thaws in the Chamber. By this Application the Patients will be +sensible of their Feeling's returning very gradually to the Part, and +that they begin to recover their Motion. In this State they may Safely +be moved into a Place a little warmer, and drink some Cups of the Potion +No. 13, or of another of the like Quality. + +Sec. 459. Every Person may be a competent judge of the manifest Danger of +attempting to relieve such Parts by heating them, and of the Use of +Ice-water, by a common, a daily Experience. Frozen Pears, Apples, and +Radishes, being put into Water just about to freeze, recover their +former State, and prove quickly eatable. But if they are put into warm +Water, or into a hot Place, Rottenness, which is one Sort of Gangrene, +is the immediate Effect. The following Case will make this right Method +of treating them still more intelligible, and demonstrate its Efficacy. + +A Man was travelling to the Distance of six Leagues in very cold +Weather; the Road being covered with Snow and Ice. His Shoes, not being +very good, failed him on his March, so that he walked the three last +Leagues bare-footed; and felt, immediately after the first Half League, +sharp Pains in his Legs and Feet, which increased as he proceeded. He +arrived at his Journey's End in a Manner nearly deprived of his lower +Extremities. They set him before a great Fire, heated a Bed well, and +put him into it. His Pains immediately became intolerable: he was +incessantly in the most violent Agitations, and cried out in the most +piercing and affecting Manner. A Physician, being sent for in the Night, +found his Toes of a blackish Colour, and beginning to lose their +Feeling. His Legs and the upper Part of his Feet, which were excessively +swelled, of a purplish Red, and varied with Spots of a violet Colour, +were still sensible of the most excruciating Pains. The Physician +ordered in a Pail of Water from the adjoining River, adding more to it, +and some Ice withal. In this he obliged the Patient to plunge his Legs; +they were kept in near an Hour, and within that Time, the Pains became +less violent. After another Hour he ordered a second cold Bath, from +which the Patient perceiving still further Relief, prolonged it to the +Extent of two Hours. During that Time, some Water was taken out of the +Pail, and some Ice and Snow were put into it. Now his Toes, which had +been black, grew red; the violet Spots in his Legs disappeared; the +Swelling abated; the Pains became moderate, and intermitted. The Bath +was nevertheless repeated six times; after which there remained no other +Complaint, but that of a great Tenderness or extraordinary Sensibility +in the Soles of his Feet, which hindered him from walking. The Parts +were afterwards bathed with some aromatic Fomentations; and he drank a +Ptisan of Sarsaparilla [one of Elder Flowers would have answered the +same Purpose, and have been less expensive.] On the eighth Day from his +Seizure he was perfectly recovered, and returned home on Foot on the +fifteenth. + +Sec. 460. When cold Weather is extremely severe, and a Person is exposed to +it for a long Time at once, it proves mortal, in Consequence of its +congealing the Blood, and because it forces too great a Proportion of +Blood up to the Brain; so that the Patient dies of a Kind of Apoplexy, +which is preceded by a Sleepiness. In this Circumstance the Traveller, +who finds himself drowsy, should redouble his Efforts to extricate +himself from the eminent Danger he is exposed to. This Sleep, which he +might consider as some Alleviation of his Sufferings, if indulged, would +prove his last. + +Sec. 461. The Remedies in such Cases are the same with those directed in +frozen Limbs. The Patient must be conducted to an Apartment rather cold +than hot, and be rubbed with Snow or with Ice-water. There have been +many well attested Instances of this Method; and as such Cases are still +more frequent in more northern Climates, a Bath of the very coldest +Water has been found the surest Remedy. + +Since it is known that many People have been revived, who had remained +in the Snow, or had been exposed to the freezing Air during five, or +even six successive Days, and who had discovered no one Mark of Life for +several Hours, the utmost Endeavours should be used for the Recovery of +Persons in the like Circumstances and Situation. + + + + _Of Kibes, or Chilblains._ + + +Sec. 462. These troublesome and smarting Complaints attack the Hands, Feet, +Heels, Ears, Nose and Lips, those of Children especially, and mostly in +Winter; when these Extremities are exposed to the sudden Changes from +hot to cold, and from cold to hot Weather. They begin with an Inflation +or kind of Swelling, which, at first, occasions but little Heat, Pain or +Itching. Sometimes they do not exceed this first State, and go off +spontaneously without any Application: But at other Times (which may be +termed the second Degree of the Disorder, whether it happens from their +being neglected, or improperly treated) their Heat, Redness, Itching and +Pain increase considerably; so that the Patient is often deprived of the +free Use of his Fingers by the Pain, Swelling and Numbness: in which +Case the Malady is still aggravated, if effectual Means are not used. + +Whenever the Inflammation mounts to a still higher Degree, small +Vesications or Blisters are formed, which are not long without bursting; +when they leave a slight Excoriation, or Rawness, as it were, which +speedily ulcerates, and frequently proves a very deep and obstinate +Ulcer, discharging a sharp and ill-conditioned Matter. + +The last and most virulent Degree of Chilblains, which is not infrequent +in the very coldest Countries, though very rare in the temperate ones, +is, when the Inflammation degenerates into a Gangrene. + +Sec. 463. These Tumours are owing to a Fulness and Obstruction of the +Vessels of the Skin, which occurs from this Circumstance, that the +Veins, which are more superficial than the Arteries, being +proportionably more affected and straitened by the Cold, do not carry +off all the Blood communicated to them by the Arteries; and perhaps also +the Particles or Atoms of Cold, which are admitted through the Pores of +the Skin, may act upon our Fluids, as it does upon Water, and occasion a +Congelation of them, or a considerable Approach towards it. + +If these Complaints are chiefly felt, which in Fact is the Case, rather +on the extreme Parts than on others, it arises from two Causes, the +principal one being, that the Circulation's being weaker at the +Extremities than elsewhere, the Effect of those Causes, that may impair +it, must be more considerably felt there. The second Reason is, because +these Parts are more exposed to the Impressions from without than the +others. + +They occur most frequently to Children, from their Weakness and the +greater Tenderness and Sensibility of their Organs, which necessarily +increases the Effect of external Impressions. It is the frequent and +strong Alteration from Heat to Cold, that seems to contribute the most +powerfully to the Production of Chilblains; and this Effect of it is +most considerable, when the Heat of the Air is at the same Time blended +with Moisture; whence the extreme and superficial Parts pass suddenly as +it were, out of a hot, into a cold, Bath. A Man sixty Years of Age, who +never before was troubled with Kibes, having worn, for some Hours on a +Journey, a Pair of furred Gloves, in which his Hands sweated, felt them +very tender, and found them swelled up with Blood: as the common Effect +of the warm Bath is to soften and relax, and to draw Blood abundantly to +the bathed Parts, whence it renders them more sensible. + +This Man, I say, thus circumstanced, was at that Age first attacked with +Chilblains, which proved extremely troublesome; and he was every +succeeding Winter as certainly infested with them, within Half an Hour +after he left off his Gloves, and was exposed to a very cold Air. + +It is for this Reason, that several Persons are never infested with +Chilblains, but when they use themselves to Muffs, which are scarcely +known in hot Countries; nor are they very common among the more northern +ones, in which the extraordinary Changes from Cold to Heat are very rare +and unusual. + +Some People are subject to this troublesome Complaint in the Fall; while +others have it only in the Spring. The Child of a labouring Peasant, who +has a hard Skin, and one inured to all the Impressions of the Seasons +and of the Elements, is, and indeed necessarily must be, less liable to +Kibes, than the Child of a rich Citizen, whose Skin is often cherished, +at the Expence of his Constitution. But even among Children of the same +Rank in Life and Circumstances, who seem pretty much of the same +Complexion, and live much in the same Manner; whence they might of +Course be supposed equally liable to the same Impressions, and to the +like Effects of them, there is, nevertheless, a very great Difference +with Respect to their constitutional Propensity to contract Chilblains. +Some are very cruelly tormented with them, from the setting in of +Autumn, to the very End of the Spring: others have either none at all, +or have them but very slightly, and for a very short Time. This +Difference undoubtedly arises from the different Quality of their +Humours, and the Texture of their whole Surface, but particularly from +that of the Skin of their Hands; though we readily confess it is by no +Means easy to determine, with Certainty and Precision, in what this +Difference essentially consists. + +Children of a sanguine Complexion and delicate Skin are pretty generally +subject to this Disorder, which is often regarded much too slightly, +though it is really severe enough to engage our Attention more; since, +even abstracted from the sharp Pains which smart these unhappy Children +for several Months; it sometimes gives them a Fever, hinders them from +sleeping, and yet confines them to their Bed, which is very prejudicial +to their Constitutions. It also breaks in upon the Order of their +different Duties and Employments; it interrupts their innocent salutary +Pleasures; and sometimes, when they are obliged to earn their daily +Bread by doing some Work or other, it sinks them down to Misery. I knew +a young Man, who from being rendered incapable by Chilblains, of serving +out his Apprenticeship to a Watch-maker, is become a lazy Beggar. + +Chilblains which attack the Nose, often leave a Mark that alters the +Physiognomy, the Aspect of the Patient, for the Remainder of his Life: +and the Hands of such as have suffered from very obstinate ones, are +commonly ever sensible of their Consequences. + +Sec. 464. With Respect, therefore, to these afflicting Tumours and +Ulcerations, we should, in the first Place, do our utmost to prevent +them; and next exert our best Endeavours to cure such as we could not +prevent. + +Sec. 465. Since they manifestly depend on the Sensibility of the Skin, the +Nature of the Humours, and the Changes of the Weather from Heat to Cold, +in Order to prevent them, in the first Place, the Skin must be rendered +firmer or less tender. 2, That vicious Quality of the Temperament, which +contributes to their Existence, must be corrected; and, 3, the Persons +so liable must guard themselves as well as possible, against these +Changes of the Weather. + +Now the Skin of the Hands, as well as that of the whole Body, may be +strengthened by that Habit of washing or bathing in cold Water, which I +have described at large, Sec. 384; and in Fact I have never seen Children, +who had been early accustomed and inured to this Habit, as much +afflicted with Chilblains as others. But still a more particular Regard +should be had to fortify the Skin of the Hands, which are more obnoxious +to this Disorder than the Feet, by making Children dip them in cold +Water, and keep them for some Moments together in it every Morning, and +every Evening too before Supper, from the very Beginning of the Fall. It +will give the Children no Sort of Pain, during that Season, to contract +this Habit; and when it is once contracted, it will give them no Trouble +to continue it throughout the Winter, even when the Water is ready to +freeze every where. They may also be habituated to plunge their Feet +into cold Water twice or thrice a Week: and this Method, which might be +less adapted for grown Persons, who had not been accustomed to it, must +be without Objection with Respect to such Children, as have been +accustomed to it; to whom all its Consequences must be useful and +salutary. + +At the same Time Care must be taken not to defeat or lessen the Effect +of the cold bathing, by suffering the Bather or Washer, to grow too warm +between two Baths or Dippings; which is also avoiding the too speedy +Successions of Heat and Cold. For this Purpose, 1, the Children must be +taught never to warm their Hands before the Fire at such Times, and +still less before the Stoves, which very probably are one of the +principal Causes of Chilblains, that are less usual in Countries which +use no such Stoves, and among those Individuals who make the least Use +of them, where they are. Above all, the Use of _Cavettes_ (that is, of +Seats or little Stairs, as it were, contrived between the Stove and the +Wall) is prejudicial to Children, and even to grown People, upon several +Accounts. 2, They should never accustom themselves to wear Muffs. 3, It +would be also proper they should never use Gloves, unless some +particular Circumstances require it; and I recommend this Abstinence +from Gloves, especially to young Boys: but if any should be allowed +them, let the Gloves be thin and smooth. + +Sec. 466. When Chilblains seem to be nourished by some Fault in the +Temperament or Humours, the Consideration of a Physician becomes +necessary, to direct a proper Method of removing or altering it. I have +seen Children from the Age of three, to that of twelve or thirteen +Years, in whom their Chilblains, raw and flead, as it were, for eight +Months of the Year, seemed to be a particular Kind of Issue, by which +Nature freed herself of an inconvenient Superfluity of Humours, when the +Perspiration was diminished by the Abatement of the violent Heats. In +such Cases I have been obliged to carry them through a pretty long +Course of Regimen and Remedies; which, however, being necessarily +various from a Variety of Circumstances, cannot be detailed here. The +milder Preparations of Antimony are often necessary in such Cases; and +some Purges conduce in particular ones to allay and to abridge the +Disorder. + +Sec. 467. The first Degree of this Complaint goes off, as I have already +said, without the Aid of Medicine; or should it prove somewhat more +obstinate, it may easily be dissipated by some of the following +Remedies. But when they rise to the second Degree, they must be treated +like other Complaints from Congelation, or Frost-biting (of which they +are the first Degree) with cold Water, Ice-water and Snow. + +No other Method or Medicine is nearly as efficacious as very cold Water, +so as to be ready to freeze, in which the Hands are to be dipt and +retained for some Minutes together, and several Times daily. In short it +is the only Remedy which ought to be applied, when the Hands are the +Parts affected; when the Patient has the Courage to bear this Degree of +Cold; and when he is under no Circumstance which may render it +prejudicial. It is the only Application I have used for myself, after +having been attacked with Chilblains for some Years past, from having +accustomed myself to too warm a Muff. + +There ensues a slight Degree of Pain for some Moments after plunging the +Hand into Water, but it diminishes gradually. On taking the Hand out, +the Fingers are numbed with the Cold, but they presently grow warm +again; and within a Quarter of an Hour, it is entirely over. + +The Hands, on being taken out of the Water, are to be well dried, and +put into Skin Gloves; after bathing three or four Times, their Swelling +subsides, so that the Skin wrinkles: but by continuing the cold Bathing, +it grows tight and smooth again; the Cure is compleated after using it +three or four Days; and, in general, the Disorder never returns again +the same Winter. + +The most troublesome raging Itching is certainly assuaged by plunging +the Hands into cold Water. + +The Effect of Snow is, perhaps, still more speedy: the Hands are to be +gently and often rubbed with it for a considerable Time; they grow hot, +and are of a very high Red for some Moments, but entire Ease very +quickly succeeds. + +Nevertheless, a very small Number of Persons, who must have extremely +delicate and sensible Skins, do not experience the Efficacy of this +Application. It seems too active for them; it affects the Skin much like +a common blistering Plaister; and by bringing on a large flow of Humours +there, it increases, instead of lessening the Complaint. + +Sec. 468. When this last Reason indeed, or some other Circumstance exists; +such as the Child's Want of Courage, or its Affliction; the monthly +Discharges in a Woman; a violent Cough; habitual Colics; and some other +Maladies, which have been observed to be renewed or aggravated by the +Influence of Cold at the Extremities, do really forbid this very cold +Application, some others must be substituted. + +One of the best is to wear Day and Night, without ever putting it off, a +Glove made of some smooth Skin, such as that of a Dog; which seldom +fails to extinguish the Disorder in some Days time. + +When the Feet are affected with Chilblains, Socks of the same Skin +should be worn; and the Patient keep close to his Bed for some Days. + +Sec. 469. When the Disorder is violent, the Use of cold Water prohibited, +and the Gloves just recommended have but a slow Effect, the diseased +Parts should be gently fomented or moistened several times a Day, with +some Decoction, rather more than warm; which at the same time should be +dissolving and emollient. Such is that celebrated Decoction of the +Scrapings, the Peel of Radishes, whose Efficacy is still further +increased, by adding one sixth Part of Vinegar to the Decoction. + +Another Decoction, of whose great Efficacy I have been a Witness, but +which dies the Hands yellow for a few Days, is the Prescription No. 71. +Many others may be made, of nearly the same Virtues, with all the +vulnerary Herbs, and even with the _Faltranc_. + +Urine, which some boast of in these Cases, from their having used it +with Success; and the Mixture of Urine and Lime-water have the like +Virtues with the former Decoctions. [100] + +[100] Chilblains may also be advantageously washed with Water and Flower + of Mustard, which will concur, in a certain and easy Manner, both + to cleanse and to cure them. _E. L._ + +As soon as the Hands affected are taken out of these Decoctions, they +must be defended from the Air by Gloves. + +Sec. 470. Vapours or Steams are often more efficacious than Decoctions; +whence instead of dipping the Hands into these already mentioned, we may +expose them to their Vapours, with still more Success. That of hot +Vinegar is one of the most powerful Remedies; those of [101] _Asphalt_, +or of Turpentine have frequently succeeded too. It may be needless to +add that the affected Parts must be defended from the Air, as well after +the Steams as the Decoctions; since it is from this Cause of keeping off +the Air, that the Cerecloths are of Service; and hence also the +Application of Suet has sometimes answered. + +[101] This is or should be, the same with the _Bitumen Judaicum_, + formerly kept in the Shops; but which is never directed, except in + that strange Medley the _Venice_ Treacle, according to the old + Prescription. The best is found in _Egypt_, and on the _Red Sea_: + but a different Sort, from _Germany_, _France_, and _Swisserland_, + is now generally substituted here. _K._ + +When the Distemper is subdued by the Use of Bathings or Steams, which +make the Skin supple and soft, then it should be strengthened by washing +the Parts with a little camphorated Brandy, diluted with an equal +Quantity of Water. + +Sec. 471. When the Nose is affected with a Chilblain, the Steam of Vinegar, +and an artificial Nose, or Covering for it, made of Dog-skin, are the +most effectual Applications. The same Treatment is equally proper for +the Ears and the Chin, when infested with them. Frequently washing these +Parts in cold Water is a good Preservative from their being attacked. + +Sec. 472. Whenever the Inflammation rises very high, and brings on some +Degree of a Fever, the Patient's usual Quantity of strong Drink and of +Flesh-meat must be lessened; his Body should be kept open by a few +Glysters; he should take every Evening a Dose of Nitre as prescribed, +No. 20; and if the Fever proved strong, he should lose some Blood too. + +As many as are troubled with obstinate Chilblains, should always be +denied the Use of strong Liquor and Flesh. + +Sec. 473. When this Distemper prevails in its third Degree, and the Parts +are ulcerated; besides keeping the Patients strictly to the Regimen of +Persons in a Way of Recovery, and giving them a Purge of Manna, the +swelled Parts should be exposed to the Steams of Vinegar; the +Ulcerations should be covered with a Diapalma Plaister; and the whole +Part should be enveloped in a smooth soft Skin, or in thin Cerecloths. + +Sec. 474. The fourth Degree of this Disease, in which the Parts become +gangrenous, must be prevented by the Method and Medicines which remove +an Inflammation; but if unhappily a Gangrene has already appeared, the +Assistance of a Surgeon proves indispensably necessary. + + + + _Of Ruptures._ + + +Sec. 475. _Hernias_ or Ruptures, which Country-People term _being bursten_, +are a Disorder which sometimes occurs at the very Birth; though more +frequently they are the Effects of violent crying, of a strong forcing +Cough, or of repeated Efforts to vomit, in the first Months of Infancy. + +They may happen afterwards indiscriminately at every Age, either as +Consequences of particular Maladies, or Accidents, or from Peoples' +violent Exertions of their Strength. They happen much oftner to Men than +Women; and the most common Sort, indeed the only one of which I propose +to treat, and that but briefly, is that which consists in the Descent of +a Part of the Guts, or of the Cawl, into the Bag or Cod-piece. + +It is not difficult to distinguish this Rupture. When it occurs in +little Children, it is almost ever cured by making them constantly wear +a Bandage which should be made only of Fustian, with a little Pillow or +Pincushion, stuffed with Linen Rags, Hair or Bran. There should be at +least two of these Bandages, to change them alternately; nor should it +ever be applied, but when the Child is laid down on its Back, and after +being well assured that the Gut or Cawl, which had fallen down, has been +safely returned into the Cavity of the Belly; since without this +Precaution it might occasion the worst Consequences. + +The good Effect of the Bandage may be still further promoted, by +applying upon the Skin, and within the Plait or Fold of the Groin (under +which Place the Rings, or Passage out of the Belly into the Bag lie) +some pretty astringent or strengthening Plaister, such as that commonly +used for Fractures, or that I have already mentioned, Sec. 144. Here we may +observe by the Way, that ruptured Children should never be set on a +Horse, nor be carried by any Person on Horseback, before the Rupture is +perfectly cured. + +Sec. 476. In a more advanced Age, a Bandage only of Fustian is not +sufficient; one must be procured with a Plate of Steel, even so as to +constrain and incommode the Wearer a little at first: nevertheless it +soon becomes habitual, and is then no longer inconvenient to them. + +Sec. 477. Ruptures sometimes attain a monstrous Size; and a great Part of +the Guts fall down in to the _Scrotum_ or Bag, without any Symptom of an +actual Disease. This Circumstance, nevertheless, is accompanied with +very great Inconvenience, which disables Persons affected with it to +work; and whenever the Malady is so considerable, and of a long Standing +too, there are commonly some Obstacles that prevent a compleat Return of +the Guts into the Belly. In this State indeed, the Application of the +Bandage or Truss is impracticable, and the miserable Patients are +condemned to carry their grievous Burthen for the Remainder of their +Lives; which may however, be palliated a little by the Use of a +Suspensory and Bag, adapted to the Size of the Rupture. This Dread of +its increasing Magnitude is a strong Motive for checking the Progress of +it, when it first appears. But there is another still stronger, which +is, that Ruptures expose the Patient to a Symptom frequently mortal. +This occurs when that Part of the Intestines fallen into the _Scrotum_ +inflames; when still increasing in its Bulk, and being extremely +compressed, acute Pains come on: for now from the Increase of the +Rupture's Extent, the Passage which gave Way to its Descent, cannot +admit of its Return or Ascent; the Blood-vessels themselves being +oppressed, the Inflammation increases every Moment; the Communication +between the Stomach and the Fundament is often entirely cut off; so that +nothing passes through, but incessant Vomitings come on [this being the +Kind of _Miserere_, or Iliac Passion I have mentioned, Sec. 320] which are +succeeded by the Hickup, Raving, Swooning, cold Sweats, and Death. + +Sec. 478. This Symptom supervenes in Ruptures, when the Excrements become +hard in that Part of the Guts fallen into the _Scrotum_; when the +Patient is overheated with Wine, Drams, an inflammatory Diet, _&c._ or +when he has received a Stroke on the ailing Part, or had a Fall. + +Sec. 479. The best Means and Remedies are, 1, as soon as ever this Symptom +or Accident is manifest, to bleed the Patient very plentifully, as he +lies down in his Bed and upon his Back, with his Head a little raised, +and his Legs somewhat bent, so that his Knees may be erect. This is the +Attitude or Posture they should always preserve as much as possible. +When the Malady is not too far advanced, the first Bleeding often makes +a compleat Cure; and the Guts return up as soon as it is over. At other +Times this Bleeding is less successful, and leaves a Necessity for its +Repetition. + +2, A Glyster must be thrown up consisting of a strong Decoction of the +large white Beet Leaves, with a small Spoonful or Pinch of common Salt, +and a Bit of fresh Butter of the Size of an Egg. + +3, Folds of Linen dipt in Ice-water must be applied all over the Tumour, +and constantly renewed every Quarter of an Hour. This Remedy, when +immediately applied, has produced the most happy Effects; but if the +Symptom has endured violently more than ten or twelve Hours, it is often +too late to apply it; and then it is better to make Use of Flanels dipt +in a warm Decoction of Mallow and Elder Flowers, shifting them +frequently. It has been known however, that Ice-water, or Ice itself has +succeeded as late as the third Day. [102] + +[102] Pieces of Ice applied between two Pieces of Linen, directly upon + the Rupture, as soon as possible after its first Appearance, is one + of those extraordinary Remedies, which we should never hesitate to + make immediate Use of. We may be certain by this Application, if + the Rupture is simple, and not complicated from some aggravating + Cause, to remove speedily, and with very little Pain, a Disorder, + that might be attended with the most dreadful Consequences. But the + Continuance of this Application must be proportioned to the + Strength of the Person ruptured, which may be sufficiently + estimated by the Pulse. _E. L._ + +4, When these Endeavours are insufficient, Glysters of Tobacco Smoke +must be tried, which has often redressed and returned Ruptures, when +every Thing else had failed. + +5, And lastly, if all these Attempts are fruitless, the Operation must +be resolved on, without losing a Moment's Time; as this local Disease +proves sometimes mortal in the Space of two Days; but for this Operation +an excellent Surgeon is indispensably necessary. The happy Consequence +with which I have ordered it, in a most desperate Case since the first +Edition of this Work, on the sixth Day after a Labour, has convinced me, +still more than any former Observation I had made, that the Trial of it +ought never to be omitted, when other Attempts have been unavailing. It +cannot even hasten the Patient's Death, which must be inevitable without +it, but it rather renders that more gentle, where it might fail to +prevent it. When it is performed as Mr. _Levade_ effected it, in the +Case I have just referred to, the Pain attending it is very tolerable +and soon over. + +I shall not attempt to describe the Operation, as I could not explain +myself sufficiently to instruct an ignorant Surgeon in it; and an +excellent and experienced one must be sufficiently apprized of all I +could say concerning it. + +A certain Woman in this Place, but now dead, had the great and impudent +Temerity to attempt this Operation, and killed her Patients after the +most excruciating Torments, and an Extirpation, or cutting away of the +Testicle; which Quacks and ignorant Surgeons always do, but which a good +Surgeon never does in this Operation. This is often the Custom too (in +Country Places) of those Caitiffs, who perform this Operation without +the least Necessity; and mercilessly emasculate a Multitude of Infants; +whom Nature, if left to her own Conduct, or assisted only by a simple +Bandage, would have perfectly cured; instead of which, they absolutely +kill a great many, and deprive those of their Virility, who survive +their Robbery and Violence. It were religiously to be wished such +Caitiffs were to be duly, that is, severely punished; and it cannot be +too much inculcated into the People, that this Operation (termed the +_Bubonocele_) in the Manner it is performed by the best Surgeons, is not +necessary; except in the Symptoms and Circumstances I have mentioned, +and that the cutting off the Testicle never is so. + + + + _Of Phlegmons or Boils._ + + +Sec. 480. Every Person knows what Boils are at Sight, which are +considerably painful when large, highly inflamed, or so situated as to +incommode the Motions, or different Positions of the Body. Whenever +their Inflammation is very considerable; when there are a great many of +them at once, and they prevent the Patients from sleeping, it becomes +necessary to enter them into a cooling Regimen; to throw up some opening +Glysters; and to make them drink plentifully of the Ptisan, No. 2. +Sometimes it is also necessary to bleed the Patient. + +Should the Inflammation be very high indeed, a Pultice of Bread and +Milk, or of Sorrel a little boiled and bruised, must be applied to it. +But if the Inflammation is only moderate, a Mucilage Plaister, or one of +the simple Diachylon, may be sufficient. Diachylon with the Gums is more +active and efficacious; but it so greatly augments the Pain of some +Persons afflicted with Boils, that they cannot bear it. + +Boils, which often return, signify some Fault in the Temperament, and +frequently one so considerable, that might dispose a Physician to be so +far apprehensive of its Consequences, as to enquire into the Cause, and +to attempt the Extinction of it. But the Detail of this is no Part nor +Purpose of the present Work. + +Sec. 481. The Phlegmon, or Boil, commonly terminates in Suppuration, but a +Suppuration of a singular Kind. It breaks open at first on its Top, or +the most pointed Part, when some Drops of a _Pus_ like that of an +Abscess comes out, after which the Germ, or what is called the Core of +it may be discerned. This is a purulent Matter or Substance, but so +thick and tenacious, that it appears like a solid Body; which may be +drawn out entirely in the Shape of a small Cylinder, like the Pith of +Elder, to the Length of some Lines of an Inch; sometimes to the Length +of a full Inch, and even more. The Emission of this Core is commonly +followed by the Discharge of a certain Quantity, according to the Size +of the Tumour, of liquid Matter, spread throughout the Bottom of it. As +soon as ever this Discharge is made, the Pain goes entirely off; and the +Swelling disappears at the End of a few Days, by continuing to apply the +simple Diachylon, or the Ointment No. 66. + + + + _Of Fellons or Whitlows._ + + +Sec. 482. The Danger of these small Tumours is much greater than is +generally supposed. It is an Inflammation at the Extremity or End of a +Finger, which is often the Effect of a small Quantity of Humour +extravasated, or stagnant, in that Part; whether this has happened in +Consequence of a Bruise, a Sting, or a Bite. At other times it is +evident that it has resulted from no external Cause, but is the Effect +of some inward one. + +It is distinguished into many Kinds, according to the Place in which the +Inflammation begins; but the essential Nature of the Malady is always +the same, and requires the same Sort of Remedies. Hence such as are +neither Physicians nor Surgeons, may spare themselves the Trouble of +enquiring into the Divisions of this Distemper; which, though they vary +the Danger of it, and diversify the Manner of the Surgeons Operation, +yet have no Relation to the general Treatment of it; the Power and +Activity of which must be regulated by the Violence of the Symptoms. + +Sec. 483. This Disorder begins with a slow heavy Pain, attended by a slight +Pulsation, without Swelling, without Redness, and without Heat; but in a +little Time the Pain, Heat, and Pulsation or Throbbing becomes +intolerable. The Part grows very large and red; the adjoining Fingers +and the whole Hand swelling up. In some Cases a Kind of red and inflated +Fuse or Streak may be observed, which, beginning at the affected Part, +is continued almost to the Elbow; neither is it unusual for the Patients +to complain of a very sharp Pain under the Shoulder; and sometimes the +whole Arm is excessively inflamed and swelled. The Sick have not a Wink +of Sleep, the Fever and other Symptoms quickly increasing. If the +Distemper rises to a violent Degree indeed, a _Delirium_ and Convulsions +supervene. + +This Inflammation of the Finger determines, either in Suppuration, or in +a Gangrene. When the last of these occurs, the Patient is in very great +Danger, if he is not very speedily relieved; and it has proved necessary +more than once to cut off the Arm, for the Preservation of his Life. +When Suppuration is effected, if the Matter lies very deep and sharp, or +if the Assistance of a Surgeon has arrived too late, the Bone of the +last _Phalanx_, or Row of Bones of the Finger, is generally carious and +lost. But how gentle soever the Complaint has been, the Nail is very +generally separated and falls off. + +Sec. 484. The internal Treatment in Whitlows, is the same with that in +other inflammatory Distempers. The Patient must enter upon a Regimen +more or less strict, in Proportion to the Degree of the Fever; and if +this runs very high, and the Inflammation be very considerable, there +may be a Necessity for several Bleedings. + +The external Treatment consists in allaying the Inflammation; in +softening the Skin; and in procuring a Discharge of the Matter, as soon +as it is formed. For this Purpose, + +1, The Finger affected is to be plunged, as soon as the Disorder is +manifest, in Water a little more than warm: the Steam of boiling Water +may also by admitted into it; and by doing these Things almost +constantly for the first Day, a total Dissipation of the Malady has +often been obtained. But unhappily it has been generally supposed, that +such slight Attacks could have but very slight Consequences, whence they +have been neglected until the Disorder has greatly advanced; in which +State Suppuration becomes absolutely necessary. + +2, This Suppuration therefore may be forwarded, by continually involving +the Finger, as it were, in a Decoction of Mallow Flowers boiled in Milk, +or with a Cataplasm of Bread and Milk. This may be rendered still more +active and ripening, by adding a few white Lilly Roots, or a little +Honey. But this last must not be applied before the Inflammation is +somewhat abated, and Suppuration begins; before which Term, all sharp +Applications are very dangerous. At this Time, Yeast or Leaven may be +advantagiously used, which powerfully promotes Suppuration. The Sorrel +Pultice, mentioned Sec. 480, is also a very efficacious one. + +Sec. 485. A speedy Discharge of the ripe Matter is of considerable +Importance, but this particularly requires the Attention of the Surgeon; +as it is not proper to wait till the Tumour breaks and discharges of +itself; and this the rather, as from the Skin's proving sometimes +extremely hard, the Matter might be inwardly effused between the +Muscles, and upon their Membranes, before it could penetrate through the +Skin. For this Reason, as soon as Matter is suspected to be formed, a +Surgeon should be called in, to determine exactly on the Time, when an +Opening should be made; which had better be performed a little too soon +than too late; and a little too deep, than not deep enough. + +When the Orifice has been made, and the Discharge is effected, it is to +be dressed up with the Plaister No. 66, spread upon Linen, or with the +Cerecloth; and these Dressings are to be repeated daily. + +Sec. 486. When the Whitlow is caused by a Humour extravasated very near the +Nail, an expert Surgeon speedily checks its Progress, and cures it +effectually by an Incision which lets out the Humour. Yet, +notwithstanding this Operation is in no wise difficult, all Surgeons are +not qualified to perform it, and but too many have no Idea at all of it. + +Sec. 487. Fungous, or, as it is commonly called, proud Flesh sometimes +appears during the incarning or healing of the Incision. Such may be +kept down with sprinkling a little _Minium_ (red Lead) or burnt Alum +over it. + +Sec. 488. If a _Caries_, a Rottenness of the Bone, should be a Consequence, +there is a Necessity for a Surgeon's Attendance, as much as if there was +a Gangrene; for which Reason, I shall add nothing with Respect to either +of these Symptoms; only observing, there are three very essential +Remedies against the last; _viz._ the Bark, No. 14, a Drachm of which +must be taken every two Hours; Scarifications throughout the whole +gangrened Part; and Fomentations with a Decoction of the Bark, and the +Addition of Spirit of Sulphur. This Medicine is certainly no cheap one; +but a Decoction of other bitter Plants, with the Addition of Spirit of +Salt, may sometimes do instead of it. And here I take leave to insist +again upon it, that in most Cases of gangrened Limbs, it is judicious +not to proceed to an Amputation of the mortified Part, till the Gangrene +stops, which may be known by a very perceivable Circle, (and easily +distinguished by the most ignorant Persons) that marks the Bounds of the +Gangrene, and separates the living from the mortified Parts. + + + + _Of Thorns, Splinters, or other pointed Substances piercing into the + Skin, or Flesh._ + + +Sec. 489. It is very common for the Hands, Feet or Legs, to be pierced by +the forcible Intrusion of small pointed Substances, such as Thorns or +Prickles, whether of Roses, Thistles or Chestnuts, or little Splinters +of Wood, Bone, _&c._ + +If such Substances are immediately and entirely extracted, the Accident +is generally attended with no bad Consequences; though more certainly to +obviate any such, Compresses of Linen dipt in warm Water may be applied +to the Part, or it may be kept a little while in a warm Bath. But if any +such pointed penetrating Body cannot be directly extracted, or if a Part +of it be left within, it causes an Inflammation, which, in its Progress, +soon produces the same Symptoms as a Whitlow: or if it happens in the +Leg, it inflames and forms a considerable Abscess there. + +Sec. 490. To prevent such Consequences, if the penetrating Substance is +still near the Surface, and an expert Surgeon is at Hand, he must +immediately make a small Incision, and thence extract it. But if the +Inflammation were already formed, this would be useless, and even +dangerous. + +When the Incision, therefore, is improper; there should be applied to +the affected Part, (after conveying the Steam of some hot Water into it) +either some very emollient Pultices of the Crumb of Bread, Milk and Oil, +or some very emollient unctuous Matter alone, the Fat of a [103] Hare +being generally employed in such Cases, and being indeed very effectual +to relax and supple the Skin; and, by thus diminishing its Resistance, +to afford the offensive penetrating Body an Opportunity of springing +forth. Nothing however, but the grossest Prejudice, could make any one +imagine, that this Fat attracted the Splinter, Thorn, or any other +intruded Substance by any sympathetic Virtue; no other Sympathy in +Nature being clearly demonstrated, except that very common one between +wrong Heads, and absurd extravagant Opinions. + +[103] These Creatures perhaps are fatter in _Swisserland_, than we often + see them here. _K._ + +It is absolutely necessary that the injured Part should be kept in the +easiest Posture, and as immoveable as possible. + +If Suppuration has not been prevented by an immediate Extraction of the +offending Substance, the Abscess should be opened as soon as ever Matter +is formed. I have known very troublesome Events from its being too long +delayed. + +Sec. 491. Sometimes the Thorn, after having very painfully penetrated +through the Teguments, the Skin, enters directly into the Fat; upon +which the Pain ceases, and the Patient begins to conclude no sharp +prickling Substance had ever been introduced into the Part; and of +Course supposes none can remain there. Nevertheless some Days after, or, +in other Instances, some Weeks, fresh Pains are excited, to which an +Inflammation and Abscess succeed, which are to be treated as usual, with +Emollients, and seasonably opened. + +A Patient has been reduced to lose his Hand, in Consequence of a sharp +Thorn's piercing into his Finger; from its having been neglected at +first, and improperly treated afterwards. + + + + _Of Warts._ + + +Sec. 492. Warts are sometimes the Effects of a particular Fault in the +Blood, which feeds and extrudes a surprizing Quantity of them. This +happens to some Children, from four to ten Years old, and especially to +those who feed most plentifully on Milk or Milk-meats. They may be +removed by a moderate Change of their Diet, and the Pills prescribed No. +18. + +But they are more frequently an accidental Disorder of the Skin, arising +from some external Cause. + +In this last Case, if they are very troublesome in Consequence of their +great Size, their Situation or their long Standing, they may be +destroyed, 1, by tying them closely with a Silk Thread, or with a strong +flaxen one waxed. 2, By cutting them off with a sharp Scissars or a +Bistory, and applying a Plaister of Diachylon, with the Gums, over the +cut Wart, which brings on a small Suppuration that may destroy or +dissolve the Root of the Wart: and, 3, By drying, or, as it were, +withering them up by some moderately corroding Application, such as that +of the milky Juice of [104] Purslain, of Fig-leaves, of _Chelidonium_ +(Swallow-wort) or of Spurge. But besides these corroding vegetable Milks +being procurable only in Summer, People who have very delicate thin +Skins should not make Use of them, as they may occasion a considerable +and painful Swelling. Strong Vinegar, charged with as much common Salt +as it will dissolve, is a very proper Application to them. A Plaister +may also be composed from Sal Ammoniac and some Galbanum, which being +kneaded up well together and applied, seldom fails of destroying them. + +[104] Our Garden Purslain, though a very juicy Herb, cannot strictly be + termed milky. In the hotter Climates where it is wild, and grows + very rankly, they sometimes boil the Leaves and Stalks (besides + eating them as a cooling Salad) and find the whole an insipid + mucilaginous Pot-herb. But Dr. _Tissot_ observes to me, that its + Juice will inflame the Skin; and that some Writers on Diet, who + disapprove it internally, affirm they have known it productive of + bad Effects. Yet none such have ever happened to myself, nor to + many others, who have frequently eaten of it. Its Seeds have + sometimes been directed in cooling Emulsions. The Wart Spurge is a + very milky and common Herb, which flowers in Summer here. _K._ + +The most powerful Corrosives should never be used, without the Direction +of a Surgeon; and even then it is full as prudent not to meddle with +them, any more than with actual Cauteries. I have lately seen some very +tedious and troublesome Disorders and Ulcerations of the Kidnies, ensue +the Application of a corrosive Water, by the Advice of a Quack. Cutting +them away is a more certain, a less painful, and a less dangerous Way of +removing them. + +Wens, if of a pretty considerable Size, and Duration, are incurable by +any other Remedy, except Amputation. + + + + _Of Corns._ + + +Sec. 493. The very general or only Causes of Corns, are Shoes either too +hard and stiff, or too small. + +The whole Cure consists in softening the Corns by repeated Washings and +Soakings of the Feet in pretty hot Water; then in cutting them, when +softened, with a Penknife or Scissars, without wounding the sound Parts +(which are the more sensible, in Proportion as they are more extended +than usual) and next in applying a Leaf of House-leek, of Ground-ivy, or +of Purslain dipt in Vinegar, upon the Part. Instead of these Leaves, if +any Person will give himself the little Trouble of dressing them every +Day, he may apply a Plaister of simple Diachylon, or of Gum Ammoniacum +softened in Vinegar. + +The Increase or Return of Corns can only be prevented, by avoiding the +Causes that produce them. + + + + + __Chapter XXXI.__ + + + _Of some Cases which require immediate Assistance; such as + Swoonings; Haemorrhages, or involuntary Loss of Blood; Convulsion + Fitts, and Suffocations; the sudden Effects of great Fear; of + Disorders caused by noxious Vapours; of Poisons, and of acute + Pains._ + + + + _Of Swoonings._ + + + __Sect.__ 494. + +There are many Degrees of Swooning, or fainting away: the slightest is +that in which the Patient constantly perceives and understands, yet +without the Power of speaking. This is called a Fainting, which happens +very often to vapourish Persons, and without any remarkable Alteration +of the Pulse. + +If the Patient entirely loses Sensation, or Feeling, and Understanding, +with a very considerable Sinking of the Pulse, this is called a +_Syncope_, and is the second Degree of Swooning. + +But if this _Syncope_ is so violent, that the Pulse seems totally +extinguished; without any discernible Breathing; with a manifest +Coldness of the whole Body; and a wanly livid Countenance, it +constitutes a third and last Degree, which is the true Image of Death, +that in Effect sometimes attends it, and it is called an _Asphixy_, +which may signify a total Resolution. + +Swoonings result from many different Causes, of which I shall only +enumerate the principal; and these are, 1, Too large a Quantity of +Blood. 2, A Defect or insufficient Proportion of it, and a general +Weakness. 3, A Load at and violent Disorders of the Stomach. 4, Nervous +Maladies. 5, The Passions; and, 6, some Kinds of Diseases. + + + + _Of Swoonings occasioned by Excess of Blood._ + + +Sec. 495. An excessive Quantity of Blood is frequently a Cause of Swooning; +and it may be inferred that it is owing to this Cause, when it attacks +sanguine, hearty and robust Persons; and more especially when it attacks +them, after being combined with any additional or supervening Cause, +that suddenly increased the Motion of the Blood; such as heating Meats +or Drinks, Wine, spirituous Liquors: smaller Drinks, if taken very hot +and plentifully, such as Coffee, Indian Tea, Bawm Tea and the like; a +long Exposure to the hot Sun, or being detained in a very hot Place; +much and violent Exercise; an over intense and assiduous Study or +Application, or some excessive Passion. + +In such Cases, first of all the Patient should be made to smell to, or +even to snuff up, some Vinegar; and his Forehead, his Temples and his +Wrists should be bathed with it; adding an equal Quantity of warm Water, +if at Hand. Bathing them with distilled or spirituous Liquids would be +prejudicial in this Kind of Swooning. + +2, The Patient should be made, if possible, to swallow two or three +Spoonfuls of Vinegar, with four or five Times as much Water. + +3, The Patient's Garters should be tied very tightly above his Knees; as +by this Means a greater Quantity of Blood is retained in the Legs, +whence the Heart may be less overladen with it. + +4, If the Fainting proves obstinate, that is, if it continues longer +than a Quarter of an Hour, or degenerates into a _Syncope_, an Abolition +of Feeling and Understanding, he must be bled in the Arm, which quickly +revives him. + +5, After the Bleeding, the Injection of a Glyster will be highly proper; +and then the Patient should be kept still and calm, only letting him +drink, every half Hour, some Cups of Elder Flower Tea, with the Addition +of a little Sugar and Vinegar. + +When Swoonings which result from this Cause occur frequently in the same +Person, he should, in Order to escape them, pursue the Directions I +shall hereafter mention, Sec. 544, when treating of Persons who superabound +with Blood. + +The very same Cause, or Causes, which occasion these Swoonings, also +frequently produce violent Palpitations, under the same Circumstances; +the Palpitation often preceding or following the _Deliquium_, or +Swooning. + + + + _Of Swoonings occasioned by Weakness._ + + +Sec. 496. If too great a Quantity of Blood, which may be considered as some +Excess of Health, is sometimes the Cause of Swooning, this last is +oftener the Effect of a very contrary Cause, that is, of a Want of +Blood, or an Exhaustion of too much. + +This Sort of Swooning happens after great Haemorrhages, or Discharges of +Blood; after sudden or excessive Evacuations, such as one of some Hours +Continuance in a _Cholera Morbus_ (Sec. 321) or such as are more slow, but +of longer Duration, as for Instance, after an inveterate _Diarrhoea_, or +Purging; excessive Sweats; a Flood of Urine; such Excesses as tend to +exhaust Nature; obstinate Wakefulness; a long Inappetency, which, by +depriving the Body of its necessary Sustenance, is attended with the +same Consequence as profuse Evacuations. + +These different Causes of Swooning should be opposed by the Means and +Remedies adapted to each of them. A Detail of all these would be +improper here; but the Assistances that are necessary at the Time of +Swooning, are nearly the same for all Cases of this Class; excepting for +that attending a great Loss of Blood, of which I shall treat hereafter: +first of all, the Patients should be laid down on a Bed, and being +covered, should have their Legs and Thighs, their Arms, and their whole +Bodies rubbed pretty strongly with hot Flanels; and no Ligature should +remain on any Part of them. + +2, They should have very spirituous Things to smell or snuff up, such as +the Carmelite Water, Hungary Water, the [105] _English_ Salt, Spirit of +Sal Ammoniac, strong smelling Herbs, such as Rue, Sage, Rosemary, Mint, +Wormwood, and the like. + +[105] Dr. _Tissot_ informs me, that in _Swisserland_, they call a + volatile Salt of Vipers, or the volatile Salt of raw Silk, _Sel. + d'Angleterre_, of which one _Goddard_ made a Secret, and which he + brought into Vogue the latter End of the last Century. But he + justly observes at the same Time, that on the present Occasion + every other volatile Alkali will equally answer the Purpose; and + indeed the Smell of some of them, as the Spirit of Sal Ammoniac + with Quicklime, _Eau de Luce_, _&c._ seem more penetrating. _K._ + +3, These should be conveyed into their Mouths; and they should be +forced, if possible, to swallow some Drops of Carmelite Water, or of +Brandy, or of some other potable Liquor, mixed with a little Water; +while some hot Wine mixed with Sugar and Cinnamon, which makes one of +the best Cordials, is getting ready. + +4, A Compress of Flanel, or of some other woollen Stuff, dipt in hot +Wine, in which some aromatic Herb has been steeped, must be applied to +the Pit of the Stomach. + +5, If the Swooning seems likely to continue, the Patient must be put +into a well heated Bed, which has before been perfumed with burning +Sugar and Cinnamon; the Frictions of the whole Body with hot Flanels +being still continued. + +6, As soon as the Patient can swallow, he should take some Soup or +Broth, with the Yolk of an Egg; or a little Bread or Biscuit; soaked in +the hot spiced Wine. + +7, Lastly, during the whole Time that all other Precautions are taken to +oppose the Cause of the Swooning, Care must be had for some Days to +prevent any _Deliquium_ or Fainting, by giving them often, and but +little at a time, some light yet strengthening Nourishment, such as +Panada made with Soup instead of Water, new laid Eggs very lightly +poached, light roast Meats with sweet Sauce, Chocolate, Soups of the +most nourishing Meats, Jellies, Milk, _&c._ + +Sec. 497. Those Swoonings, which are the Effect of Bleeding, or of the +violent Operation of some Purge, are to be ranged in this Class. + +Such as happen after artificial Bleeding, are generally very moderate, +commonly terminating as soon as the Patient is laid upon the Bed: and +Persons subject to this Kind, should be bled lying down, in Order to +prevent it. But should the Fainting continue longer than usual, some +Vinegar smelt to, and a little swallowed with some Water, is a very good +Remedy. + +The Treatment of such Faintings or Swoonings, as are the Consequences of +too violent Vomits or Purges, may be seen hereafter Sec. 552. + + + + _Of Faintings occasioned by a Load, or Uneasiness, at Stomach._ + + +Sec. 498. It has been already observed, Sec. 308, that Indigestions were +sometimes attended with Swoonings, and indeed such vehement ones, as +required speedy and very active Succour too, such as that of a Vomit. +The Indigestion is sometimes less the Effect of the Quantity, than of +the Quality, or the Corruption of the Food, contained in the Stomach. +Thus we see there are some Persons, who are disordered by eating Eggs, +Fish, Craw Fish, or any fat Meat; being thrown by them into +inexpressible Anguish attended with Swooning too. It may be supposed to +depend on this Cause, when these very Aliments have been lately eaten; +and when it evidently neither depends on the other Causes I have +mentioned; nor on such as I shall soon proceed to enumerate. + +We should in Cases of this Sort, excite and revive the Patients as in +the former, by making them receive some very strong Smell, of whatever +Kind is at hand; but the most essential Point is to make them swallow +down a large Quantity of light warm Fluid; which may serve to drown, as +it were, the indigested Matter; which may soften its Acrimony; and +either effect the Discharge of it by vomiting, or force it down into the +Chanel of the Intestines. + +A light Infusion of Chamomile Flowers, of Tea, of Sage, of Elder +Flowers, or of _Carduus Benedictus_, operate with much the same +Efficacy; though the Chamomile and Carduus promote the Operation of +vomiting rather more powerfully; which warm Water alone will sometimes +sufficiently do. + +The Swooning ceases, or at least, considerably abates in these Cases, as +soon as ever the Vomiting commences. It frequently happens too, that, +during the Swooning, Nature herself brings on certain _Nausea_, a +Wambling and sickish Commotion of the Stomach, that revives or rouses +the Patient for a Moment; but yet not being sufficient to excite an +actual Vomiting, lets him soon sink down again into this temporary +Dissolution, which often continues a pretty considerable Time; leaving +behind it a Sickness at Stomach, Vertigos, and a Depression and Anxiety, +which do not occur in the former Species of this Malady. + +Whenever these Swoonings from this Cause are entirely terminated, the +Patient must be kept for some Days to a very light Diet, and take, at +the same Time, every Morning fasting, a Dose of the Powder, No. 38, +which relieves and exonerates the Stomach of whatever noxious Contents +might remain in it; and then restores its natural Strength and +Functions. + +Sec. 499. There is another Kind of Swooning, which also results from a +Cause in the Stomach; but which is, nevertheless, very different from +this we have just been treating of; and which requires a very different +Kind of Assistance. It arises from an extraordinary Sensibility of this +important Organ, and from a general Weakness of the Patient. + +Those subject to this Malady are valetudinary weakly Persons, who are +disordered from many slight Causes, and whose Stomachs are at once very +feeble and extremely sensible. They have almost continually a little +Uneasiness after a Meal, though they should indulge but a little more +than usual; or if they eat of any Food not quite so easy of Digestion, +they have some Qualm or Commotion after it: Nay, should the Weather only +be unfavourable, and sometimes without any perceivable assignable Cause, +their Uneasiness terminates in a Swoon. + +Patients swooning, from these Causes, have a greater Necessity for great +Tranquillity and Repose, than for any other Remedy; and it might be +sufficient to lay them down on the Bed: But as the Bystanders in such +Cases find it difficult to remain inactive Spectators of Persons in a +Swoon, some spirituous Liquid may be held to their Nose, while their +Temples and Wrists are rubbed with it; and at the same Time a little +Wine should be given them. Frictions are also useful in these Cases. + +This Species of Swooning is oftener attended with a little Feverishness +than the others. + + + + _Of those Swoonings, which arise from nervous Disorders._ + + +Sec. 500. This Species of Swooning is almost wholely unknown to those +Persons, for whom this Treatise is chiefly intended. Yet as there are +some Citizens who pass a Part of their Lives in the Country; and some +Country People who are unhappily afflicted with the Ailments of the +Inhabitants of large Towns and Cities, it seemed necessary to treat +briefly of them. + +By Disorders of the Nerves, I understand in this Place, only that Fault +or Defect in them, which is the Cause of their exciting in the Body, +either irregular Motions, that is, Motions without any external Cause, +at least any perceivable one; and without our Will's consenting to the +Production of them: or such Motions, as are greatly more considerable +than they should be, if they had been proportioned to the Force of the +Impression from without. This is very exactly that State, or Affection +termed the _Vapours_; and by the common People, the _Mother_: And as +there is no Organ unprovided with Nerves; and none, or hardly any +Function, in which the Nerves have not their Influence; it may be easily +comprehended, that the Vapours being a State or Condition, which arises +from the Nerves exerting irregular involuntary Motions, without any +evident Cause, and all the Functions of the Body depending partly on the +Nerves; there is no one Symptom of other Diseases which the Vapours may +not produce or imitate; and that these Symptoms, for the same Reason, +must vary infinitely, according to those Branches of the Nerves which +are disordered. It may also hence be conceived, why the Vapours of one +Person have frequently no Resemblance to those of another: and why the +Vapours of the very same Person, in one Day, are so very different from +those in the next. It is also very conceivable that the Vapours are a +certain, a real Malady; and that Oddity of the Symptoms, which cannot be +accounted for, by People unacquainted with the animal Oeconomy, has been +the Cause of their being considered rather as the Effect of a depraved +Imagination, than as a real Disease. It is very conceiveable, I say, +that this surprizing Oddity of the Symptoms is a necessary Effect of the +Cause of the Vapours; and that no Person can any more prevent his being +invaded by the Vapours, than he can prevent the Attack of a Fever, or of +the Tooth-ach. + +Sec. 501. A few plain Instances will furnish out a more compleat Notion of +the Mechanism, or Nature, of Vapours. An Emetic, a vomiting Medicine, +excites the Act, or rather the Passion, the Convulsion of Vomiting, +chiefly by the Irritation it gives to the Nerves of the Stomach; which +Irritation produces a Spasm, a Contraction of this Organ. Now if in +Consequence of this morbid or defective Texture of the Nerves, which +constitutes the Vapours, those of the Stomach are excited to act with +the same Violence, as in Consequence of taking a Vomit, the Patient will +be agitated and worked by violent Efforts to vomit, as much as if he had +really taken one. + +If an involuntary unusual Motion in the Nerves, that are distributed +through the Lungs, should constrain and straiten the very little +Vesicles, or Bladders, as it were, which admit the fresh Air at every +Respiration, the Patient will feel a Degree of Suffocation; just as if +that Straitening or Contraction of the Vesicles were occasioned by some +noxious Steam or Vapour. + +Should the Nerves which are distributed throughout the whole Skin, by a +Succession of these irregular morbid Motions, contract themselves, as +they may from external Cold, or by some stimulating Application, +Perspiration by the Pores will be prevented or checked; whence the +Humours, which should be evacuated through the Pores of the Skin, will +be thrown upon the Kidnies, and the Patient will make a great Quantity +of thin clear Urine, a Symptom very common to vapourish People; or it +may be diverted to the Glands of the Intestines, the Guts, and terminate +in a watery _Diarrhoea_, or Looseness, which frequently proves a very +obstinate one. + +Sec. 502. Neither are Swoonings the least usual Symptoms attending the +Vapours: and we may be certain they spring from this Source, when they +happen to a Person subject to the Vapours; and none of the other Causes +producing them are evident, or have lately preceded them. + +Such Swoonings, however, are indeed very rarely dangerous, and scarcely +require any medical Assistance. The Patient should be laid upon a Bed; +the fresh Air should be very freely admitted to him; and he should be +made to smell rather to some disagreeable and fetid, than to any +fragrant, Substance. It is in such Faintings as these that the Smell of +burnt Leather, of Feathers, or of Paper, have often proved of great +Service. + +Sec. 503. Patients also frequently faint away, in Consequence of fasting +too long; or from having eat a little too much; from being confined in +too hot a Chamber; from having seen too much Company; from smelling too +over-powering a Scent; from being too costive; from being too forcibly +affected with some Discourse or Sentiments; and, in a Word, from a great +Variety of Causes, which might not make the least Impression on Persons +in perfect Health; but which violently operate upon those vapourish +People, because, as I have said, the Fault of their Nerves consists in +their being too vividly, too acutely affected; the Force of their +Sensation being nowise proportioned to the external Cause of it. + +As soon as that particular Cause is distinguished from all the rest, +which has occasioned the present Swooning; it is manifest that this +Swooning is to be remedied by removing that particular Cause of it. + + + + _Of Swoonings occasioned by the Passions._ + + +Sec. 504. There have been some Instances of Persons dying within a Moment, +through excessive Joy. But such Instances are so very rare and sudden, +that Assistance has seldom been sought for on this Occasion. The Case is +otherwise with Respect to those produced from Rage, Vexation, and Dread +or Horror. I shall treat in a separate Article of those resulting from +great Fear; and shall briefly consider here such as ensue from Rage, and +vehement Grief or Disappointment. + +Sec. 505. Excessive Rage and violent Affliction are sometimes fatal in the +Twinkling of an Eye; though they oftener terminate in fainting only. +Excessive Grief or Chagrine is especially accompanied with this +Consequence; and it is very common to see Persons thus affected, sink +into successive Faintings for several Hours. It is plainly obvious that +very little Assistance can be given in such Cases: it is proper, +however, they should smell to strong Vinegar; and frequently take a few +Cups of some hot and temperately cordial Drink, such as Bawm Tea, or +Lemonade with a little Orange or Lemon-peel. + +The calming asswaging Cordial, that has seemed the most efficacious to +me, is one small Coffee Spoonful of a Mixture of three Parts of the +Mineral Anodyne Liquor of _Hoffman_, [106] and one Part of the +spirituous Tincture of Amber, which should be swallowed in a Spoonful of +Water; taking after it a few Cups of such Drinks as I shall presently +direct. + +[106] Our sweet Spirit of Vitriol is a similar, and as effectual a + Medicine. _K._ + +It is not to be supposed that Swoonings or Faintings, from excessive +Passions, can be cured by Nourishment. The physical State or Condition, +into which vehement Grief throws the Body, is that, of all others, in +which Nourishment would be most injurious to it: and as long as the +Vehemence of the Affliction endures, the Sufferer should take nothing +but some Spoonfuls of Soup or Broth, or a few Morsels of some light Meat +roasted. + +Sec. 506. When Wrath or Rage has risen to so high a Pitch, that the human +Machine, the Body, entirely exhausted, as it were, by that violent +Effort, sinks down at once into excessive Relaxation, a Fainting +sometimes succeeds, and even the most perilous Degree of it, a +_Syncope_. + +It is sufficient, or rather the most that can be done here, to let the +Patient be perfectly still a while in this State; only making him smell +to some Vinegar. But when he is come to himself, he should drink +plentifully of hot Lemonade, and take one or more of the Glysters No. 5. + +Sometimes there remain in these Cases Sicknesses at Stomach, Reachings +to vomit, a Bitterness in the Mouth, and some vertiginous Symptoms which +seem to require a Vomit. But such a Medicine must be very carefully +avoided, since it may be attended with the most fatal Consequence; and +Lemonade with Glysters generally and gradually remove these Swoonings. +If the _Nausea_ and Sickness at Stomach continue, the utmost Medicine we +should allow besides, would be that of No. 23, or a few Doses of No. 24. + + + +_Of symptomatical Swoonings, or such, as happen in the Progress of other + Diseases._ + + +Sec. 507. Swoonings, which supervene in the Course of other Diseases, never +afford a favourable Prognostic; as they denote Weakness, and Weakness is +an Obstacle to Recovery. + +In the Beginning of putrid Diseases, they also denote an Oppression at +Stomach, or a Mass of corrupt Humours; and they cease as soon as an +Evacuation supervenes, whether by Vomit or Stool. + +When they occur at the Beginning of malignant Fevers, they declare the +high Degree of their Malignancy, and the great Diminution of the +Patient's natural Strength. + +In each of these Cases Vinegar, used externally and internally, is the +best Remedy during the Exacerbation or Height of the Paroxysm; and +Plenty of Lemon Juice and Water after it. + +Sec. 508. Swoonings which supervene in Diseases, accompanied with great +Evacuations, are cured like those which are owing to Weakness; and +Endeavours should be used to restrain or moderate the Evacuations. + +Sec. 509. Those who have any inward Abscess or Imposthume are apt to swoon +frequently. They may sometimes be revived a little by Vinegar, but they +prove too frequently mortal. + +Sec. 510. Many Persons have a slighter or a deeper Swooning, at the End of +a violent Fit of an intermitting Fever, or at that of each Exacerbation +of a continual Fever; this constantly shews the Fever has run very high, +the Swooning having been the Consequence of that great Relaxation, which +has succeeded to a very high Tension. A Spoonful or two of light white +Wine, with an equal Quantity of Water, affords all the Succour proper in +such a Case. + +Sec. 511. Persons subject to frequent Swoonings, should neglect nothing +that may enable them to remove them when known; since the Consequences +of them are always detrimental, except in some Fevers, in which they +seem to mark the _Crisis_. + +Every swooning Fit leaves the Patient in Dejection and Weakness; the +Secretions from the Blood are suspended; the Humours disposed to +Stagnation; Grumosities, or Coagulations, and Obstructions are formed; +and if the Motion of the Blood is totally intercepted, or considerably +checked, _Polypus's_, and these often incurable, are formed in the +Heart, or in the larger Vessels; the Consequences of which are dreadful, +and sometimes give Rise to internal Aneurisms, which always prove +mortal, after long Anxiety and Oppression. + +Swoonings which attack old People, without any manifest Cause, always +afford an unfavourable Prognostic. + + + + _Of Haemorrhages, or an involuntary Loss of Blood._ + + +Sec. 512. Haemorrhages of the Nose, supervening in inflammatory Fevers, +commonly prove a favourable _Crisis_; which Bleeding we should carefully +avoid stopping; except it becomes excessive, and seems to threaten the +Patient's Life. + +As they scarcely ever happen in very healthy Subjects, but from a +superfluous Abundance of Blood, it is very improper to check them too +soon; lest some internal Stuffings and Obstructions should prove the +Consequence. + +A Swooning sometimes ensues after the Loss of only a moderate Quantity +of Blood. This Swooning stops the Haemorrhage, and goes off without any +further Assistance, except the smelling to Vinegar. But in other Cases +there is a Succession of fainting Fits, without the Blood's stopping; +while at the same time slight convulsive Motions and Twitchings ensue, +attended with a Raving, when it becomes really necessary to stop the +Bleeding: and indeed, without waiting till these violent Symptoms +appear, the following Signs will sufficiently direct us, when it is +right to stop the Flux of Blood, or to permit its Continuance--As long +as the Pulse is still pretty full; while the Heat of the Body is equally +extended to the very Extremities; and the Countenance and Lips preserve +their natural Redness, no ill Consequence is to be apprehended from the +Haemorrhage, though it has been very copious, and even somewhat profuse. + +But whenever the Pulse begins to faulter and tremble; when the +Countenance and the Lips grow pale, and the Patient complains of a +Sickness at Stomach, it is absolutely necessary to stop the Discharge of +Blood. And considering that the Operation of Remedies does not +immediately follow the Exhibition or Application of them, it is safer to +begin a little too early with them, than to delay them, though ever so +little too long. + +Sec. 513. First of all then, tight Bandages, or Ligatures, should be +applied round both Arms, on the Part they are applied over in order to +Bleeding; and round the lower Part of both Thighs, on the gartering +Place; and all these are to be drawn very tight, with an Intention to +detain and accumulate the Blood in the Extremities. + +2, In Order to increase this Effect, the Legs are to be plunged in warm +Water up to the Knees; for by relaxing the Blood-vessels of the Legs and +Feet, they are dilated at the same time, and thence receive, and, in +Consequence of the Ligatures above the Knees, retain the more Blood. If +the Water were cold, it would repel the Blood to the Head; if hot, it +would increase the Motion of it; and, by giving a greater Quickness to +the Pulse, would even contribute to increase the Haemorrhage. + +As soon however, as the Haemorrhage is stopt, these Ligatures [on the +Thighs] may be relaxed a little, or one of them be entirely removed; +allowing the others to continue on an Hour or two longer without +touching them: but great Precaution should be taken not to slacken them +entirely, nor all at once. + +3, Seven or eight Grains of Nitre, and a Spoonful of Vinegar, in half a +Glass of cool Water, should be given the Patient every half Hour. + +4, One Drachm of white Vitriol must be dissolved in two common Spoonfuls +of Spring Water; and a Tent of Lint, or Bits of soft fine Linen dipt in +this Solution, are to be introduced into the Nostrils, horizontally at +first, but afterwards to be intruded upwards, and as high as may be, by +the Assistance of a flexible Bit of Wood or Whale-bone. But should this +Application be ineffectual, the Mineral Anodyne Liquor of _Hoffman_ is +certain to succeed: and in the Country, where it often happens that +neither of these Applications are to be had speedily, Brandy, and even +Spirit of Wine, mixt with a third Part Vinegar, have answered entirely +well, of which I have been a Witness. + +The Prescription No. 67, which I have already referred to, on the +Article of Wounds, may also be serviceable on this Occasion. It must be +reduced to Powder, and conveyed up the Nostrils as high as may be, on +the Point or Extremity of a Tent of Lint, which may easily be covered +with it. Or a Quill, well charged with the Powder, may be introduced +high into the Nostrils, and its Countents be strongly blown up from its +other Extremity: though after all the former Method is preferable. + +5, When the Flux of Blood is totally stopt, the Patient is to be kept as +still and quiet as possible; taking great Care not to extract the Tent +which remains in the Nose; nor to remove the Clots of coagulated Blood +which fill up the Passage. The loosening and removing of these should be +effected very gradually and cautiously; and frequently the Tent does not +spring out spontaneously, till after many Days. + +Sec. 514. I have not, hitherto, said any thing of artificial Bleeding in +these Cases, as I think it at best unserviceable; since, though it may +sometimes have stopt the morbid Loss of Blood, it has at other times +increased it. Neither have I mentioned Anodynes here, whose constant +Effect is to determine a larger Quantity of Blood to the Head. + +Applications of cold Water to the Nape of the Neck ought to be wholly +disused, having sometimes been attended with the most embarrassing +Consequences. + +In all Haemorrhages, all Fluxes of Blood, great Tranquillity, Ligatures, +and the Use of the Drinks No. 2 or 4, are very useful. + +Sec. 515. People who are very liable to frequent Haemorrhages, ought to +manage themselves conformably to the Directions contained in the next +Chapter, Sec. 544. They should take very little Supper; avoid all sharp and +spirituous Liquors; Apartments that are over hot, and cover their Heads +but very lightly. + +When a Patient has for a long time been subject to Haemorrhages, if they +cease, he should retrench from his usual Quantity of Food; accustom +himself to artificial Bleedings at proper Intervals; and take some +gentle opening Purges, especially that of No. 24, and frequently a +little Nitre in an Evening. + + + + _Of Convulsion Fits._ + + +Sec. 516. Convulsions are, in general, more terrifying than dangerous; they +result from many and various Causes; and on the Removal or Extirpation +of these, their Cure depends. + +In the very Fit itself very little is to be done or attempted. + +As nothing does shorten the Duration, nor even lessen the Violence, of +an epileptic Fit, so nothing at all should be attempted in it; and the +rather, because Means and Medicines often aggravate the Disease. We +should confine our Endeavours solely to the Security of the Patient, by +preventing him from giving himself any violent Strokes; by getting +something, if possible, between his Teeth, such as a small Roller of +Linen to prevent his Tongue from being hurt, or very dangerously +squeezed and bruised, in a strong Convulsion. + +The only Case which requires immediate Assistance in the Fit, is, when +it is so extremely violent, the Neck so swelled, and the Face so very +red, that there is Room to be apprehensive of an Apoplexy, which we +should endeavour to obviate, by drawing eight or ten Ounces of Blood +from the Arm. + +As this terrible Disease is common in the Country, it is doing a real +Service to the unfortunate Victims of it, to inform them how very +dangerous it is to give themselves blindly up to take all the Medicines, +which are cried up to them in such Cases. If there be any one Disease, +which requires a more attentive, delicate, and exquisite Kind of +Treatment, it is this very Disease. Some Species of it are wholly +incurable: and such as may be susceptible of a Cure, require the utmost +Care and Consideration of the most enlightned and most experienced +Physicians: while those who pretend to cure all epileptic Patients, with +one invariable Medicine, are either Ignorants, or Impostors, and +sometimes both in one. + +Sec. 517. Simple Convulsion Fits, which are not epileptic, are frequently +of a long Continuance, persevering, with very few and short Intervals, +for Days and even for Weeks. + +The true genuine Cause should be investigated as strictly as possible, +though nothing should be attempted in the Fit. The Nerves are, during +that Term, in so high a Degree of Tension and Sensibility, that the very +Medicines, supposed to be strongly indicated, often redouble the Storm +they were intended to appease. + +Thin watery Liquors, moderately imbued with Aromatics, are the least +hurtful, the most innocent Things that can be given; such as Bawm, +Lime-tree, and Elder Flower Tea. A Ptisan of Liquorice Root only has +sometimes answered better than any other. + + + + _Of suffocating, or strangling Fits._ + + +Sec. 518. These Fits (by whatever other Name they may be called) whenever +they very suddenly attack a Person, whose Breathing was easy and natural +just before, depend almost constantly on a Spasm or Contraction of the +Nerves, in the Vesicles of the Lungs; or upon an Infarction, a Stuffing +of the same Parts, produced by viscid clammy Humours. + +That Suffocation which arises from a Spasm is not dangerous, it goes off +of itself, or it may be treated like Swoonings owing to the same Cause. +See Sec. 502. + +Sec. 519. That Suffocation, which is the Effect of a sanguineous Fulness +and Obstruction, may be distinguished by its attacking strong, vigorous, +sanguine Persons, who are great Eaters, using much juicy nutritious +Food, and strong Wine and Liquors, and who frequently eat and inflame +themselves; and when the Fit has come on after any inflaming Cause; when +the Pulse is full and strong, and the Countenance red. + +Such are cured, 1, by a very plentiful Discharge of Blood from the Arm, +which is to be repeated, if necessary. + +2, By the Use of Glysters. + +3, By drinking plentifully of the Ptisan No. 1; to each Pot of which, a +Drachm of Nitre is to be added; and, + +4, By the Vapour of hot Vinegar, continually received by Respiration or +Breathing. See Sec. 55. + +Sec. 520. There is Reason to think that one of these Fits is owing to a +Quantity of tough viscid Humours in the Lungs, when it attacks Persons, +whose Temperament, and whose Manner of living are opposite to those I +have just described; such as valetudinary, weakly, phlegmatic, +pituitous, inactive, and squeamish Persons, who feed badly, or on fat, +viscid, and insipid Diet, and who drink much hot Water, either alone, or +in Tea-like Infusions. And these Signs of Suffocation, resulting from +such Causes, are still more probable, if the Fit came on in rainy +Weather, and during a southerly Wind; and when the Pulse is soft and +small, the Visage pale and hollow. + +The most efficacious Treatment we can advise, is, 1, To give every half +Hour half a Cup of the Potion, No. 8, if it can be readily had. 2, To +make the Patient drink very plentifully of the Drink No. 12; and, 3, to +apply two strong Blisters to the fleshy Parts of his Legs. + +If he was strong and hearty before the Fit, and the Pulse still +continues vigorous, and feels somewhat full withall, the Loss of seven +or eight Ounces of Blood is sometimes indispensably necessary. A Glyster +has also frequently been attended with extraordinary good Effects. + +Those afflicted with this oppressing Malady are commonly relieved, as +soon as they expectorate, and sometimes even by vomiting a little. + +The Medicine No. 25, a Dose of which may be taken every two Hours, with +a Cup of the Ptisan No. 12, often succeeds very well. + +But if neither this Medicine, nor the Prescription of No. 8 are at Hand, +which may be the Case in Country Places; an Onion of a moderate Size +should be pounded in an Iron or Marble Mortar; upon this, a Glass of +Vinegar is to be poured, and then strongly squeezed out again through a +Piece of Linen. An equal Quantity of Honey is then to be added to it. A +Spoonful of this Mixture, whose remarkable Efficacy I have been a +Witness of, is to be given every half Hour. + + + + _Of the violent Effects of Fear._ + + +Sec. 521. Here I shall insert some Directions to prevent the ill +Consequences of great Fear or Terror, which are very prejudicial at +every Term of Life, but chiefly during Infancy. + +The general Effects of Terror, are a great Straitening or Contraction of +all the small Vessels, and a Repulsion of the Blood into the large and +internal ones. Hence follows the Suppression of Perspiration, the +general Seizure or Oppression, the Trembling, the Palpitations and +Anguish, from the Heart and the Lungs being overcharged with Blood; and +sometimes attended with Swoonings, irremediable Disorders of the Heart, +and Death itself. A heavy Drowsiness, Raving, and a Kind of furious or +raging _Delirium_ happen in other Cases, which I have frequently +observed in Children, when the Blood-vessels of the Neck were swelled +and stuffed up; and Convulsions, and even the Epilepsy have come on, all +which have proved the horrible Consequence of a most senseless and +wicked Foolery or Sporting. One half of those Epilepsies which do not +depend on such Causes, as might exist before the Child's Birth, are +owing to this detestable Custom; and it cannot be too much inculcated +into Children, never to frighten one another; a Point which Persons +intrusted with their Education, ought to have the strictest Regard to. + +When the Humours that should have passed off by Perspiration, are +repelled to the Intestines, a tedious and very obstinate Looseness is +the frequent Consequence. + +Sec. 522. Our Endeavours should be directed, to re-establish the disordered +Circulation; to restore the obstructed Perspiration; and to allay the +Agitation of the Nerves. + +The popular Custom in these Cases has been to give the terrified Patient +some cold Water directly; but when the Fright has been considerable, +this is a very pernicious custom, and I have seen some terrible +Consequences from it. + +They should, on the contrary, be conveyed into some very quiet +Situation, leaving there but very few Persons, and such only as they are +thoroughly familiar with. They should take a few Cups of pretty warm +Drink, particularly of an Infusion of Lime-tree Flowers and Bawm. Their +Legs should be put into warm Water, and remain there an Hour, if they +will patiently permit it, rubbing them gently now and then, and giving +them every half-quarter of an Hour, a small Cup of the said Drink. When +their Composure and Tranquillity are returned a little, and their Skin +seems to have recovered its wonted and general Warmth, Care should be +taken to dispose them to sleep, and to perspire plentifully. For this +Purpose they may be allowed a few Spoonfuls of Wine, on putting them +into Bed, with one Cup of the former Infusion; or, which is more certain +and effectual, a few Drops of _Sydenham's_ Liquid Laudanum, No. 44; but +should that not be near at Hand, a small Dose of _Venice_ Treacle. + +Sec. 523. It sometimes happens that Children do not seem at first extremely +terrified; but the Fright is renewed while they sleep, and with no small +Violence. The Directions I have just given must then be observed, for +some successive Evenings, before they are put to Bed. + +Their Fright frequently returns about the latter End of the Night, and +agitates them violently every Day. The same Treatment should be +continued in such Cases; and we should endeavour to dispose them to be +a-sleep at the usual Hour of its Return. + +By this very Method, I have dissipated the dismal Consequences of Fear +of Women in Child-bed, which is so commonly, and often speedily, mortal. + +If a Suffocation from this Cause is violent, there is sometimes a +Necessity for opening a Vein in the Arm. + +These Patients should gradually be inured to an almost continual, but +gentle, Kind of Exercise. + +All violent Medicines render those Diseases, which are the Consequences +of great Fear, incurable. A pretty common one is that of an Obstruction +of the Liver, which has been productive of a Jaundice. [107] + +[107] I have seen this actually verified by great and disagreeable + Surprize, attended indeed with much Concern, in a Person of + exquisite Sensations. _K._ + + + +_Of Accidents or Symptoms produced by the Vapours of Coal, and of Wine._ + + +Sec. 524. Not a single Year passes over here, without the Destruction of +many People by the Vapour of Charcoal, or of small Coal, and by the +Steam or Vapour of Wine. + +The Symptoms by Coal occur, when [108] small Coal, and especially +when [109] Charcoal is burnt in a Chamber close shut, which is direct +Poison to a Person shut up in it. The sulphureous Oil, which is set at +Liberty and diffused by the Action of Fire, expands itself through the +Chamber; while those who are in it perceive a Disorder and Confusion in +their Heads; contract Vertigos, Sickness at Stomach, a Weakness, and +very unusual Kind of Numbness; become raving, convulsed and trembling; +and if they fail of Presence of Mind, or of Strength, to get out of the +Chamber, they die within a short Time. + +[108] _La Braise._ + +[109] _Charbon._ Dr. _Tissot_ informs me, their Difference consists in + this, that the Charcoal is prepared from Wood burnt in a close or + stifled Fire; and that the small Coal is made of Wood (and of + smaller Wood) burnt in an open Fire, and extinguished before it is + reduced to the State of a Cinder. He says the latter is smaller, + softer, less durable in the Fire, and the Vapour of it less + dangerous than that of Charcoal. + +I have seen a Woman who had vertiginous Commotions in her Head for two +Days, and almost continual Vomitings, from her having been confined less +than six Minutes in a Chamber (and that notwithstanding, both one Window +and one Door were open) in which there was a Chafing-dish with some +burning Coals. Had the Room been quite close, she must have perished by +it. + +This Vapour is narcotic or stupefying, and proves mortal in Consequence +of its producing a sleepy or apoplectic Disorder, though blended, at the +same time, with something convulsive; which sufficiently appears from +the Closure of the Mouth, and the strict Contraction or Locking of the +Jaws. + +The Condition of the Brain, in the dissected Bodies of Persons thus +destroyed, proves that they die of an Apoplexy: notwithstanding it is +very probable that Suffocation is also partly the Cause of their Deaths; +as the Lungs have been found stuffed up with Blood and livid. + +It has also been observed in some other such Bodies, that Patients +killed by the Vapour of burning Coals, have commonly their whole Body +swelled out to one third more than their Magnitude, when living. The +Face, Neck, and Arms are swelled out, as if they had been blown up; and +the whole human Machine appears in such a State, as the dead Body of a +Person would, who had been violently strangled; and who had made all +possible Resistance for a long time, before he was overpowered. + +Sec. 525. Such as are sensible of the great Danger they are in, and retreat +seasonably from it, are generally relieved as soon as they get into the +open Air; or if they have any remaining Uneasiness, a little Water and +Vinegar, or Lemonade, drank hot, affords them speedy Relief. But when +they are so far poisoned, as to have lost their Feeling and +Understanding, if there be any Means of reviving them, such Means +consist, + +1, In exposing them to a very pure, fresh and open Air. + +2, In making them smell to some very penetrating Odour, which is +somewhat stimulating and reviving, such as the volatile Spirit of Sal +Ammoniac, the [110] _English_ Salt; and afterwards to surround them, as +it were, with the Steam of Vinegar. + +[110] See Note [105] Page 495. + +3, In taking some Blood from their Arm. + +4, In putting their Legs into warm or hot Water, and chafing them well. + +5, In making them swallow, if practicable, much Lemonade, or Water and +Vinegar, with the Addition of Nitre: and, + +6, In throwing up some sharp Glysters. + +As it is manifest there is something spasmodic in these Cases, it were +proper to be provided with some antispasmodic Remedies, such as the +Mineral Anodyne Liquid of _Hoffman_. Even Opium has sometimes been +successfully given here, but it should be allowed to Physicians only to +direct it in such Cases. + +A Vomit would be hurtful; and the Reachings to vomit arise only from the +Oppression on the Brain. + +It is a common but erroneous Opinion, that if the Coal be suffered to +burn for a Minute or so in the open Air, or in a Chimney, it is +sufficient to prevent any Danger from the Vapour of it. + +Hence it amounts even to a criminal Degree of Imprudence, to sleep in a +Chamber while Charcoal or small Coal is burning in it; and the Number of +such imprudent Persons, as have never awaked after it, is so +considerable, and so generally known too, that the Continuance of this +unhappy Custom is astonishing. + +Sec. 526. The Bakers, who make Use of much small Coal, often keep great +Quantities of it in their Cellars, which frequently abound so much with +the Vapour of it, that it seizes them violently the Moment they enter +into the Cellar. They sink down at once deprived of all Sensation, and +die if they are not drawn out of it soon enough to be assisted, +according to the Directions I have just given. + +One certain Means of preventing such fatal Accidents is, upon going into +the Cellar to throw some flaming Paper or Straw into it, and if these +continue to flame out and consume, there is no Reason for dreading the +Vapour: but if they should be extinguished, no Person should venture in. +But after opening the Vent-hole, a Bundle of flaming Straw must be set +at the Door, which serves to attract the external Air strongly. Soon +after the Experiment of the flaming Paper must be repeated, and if it +goes out, more Straw is to be set on Fire before the Cellar Door. + +Sec. 527. Small Coal, burnt in an open Fire, is not near so dangerous as +_Charcoal_, properly so called, the Danger of which arises from this, +that in extinguishing it by the usual Methods, all those sulphureous +Particles of it, in which its Danger consists, are concentred. +Nevertheless, small Coal is not entirely deprived of all its noxious +Quality, without some of which it could not strictly be Coal. + +The common Method of throwing some Salt on live Coals, before they are +conveyed into a Chamber; or of casting a Piece of Iron among them to +imbibe some Part of their deadly narcotic Sulphur, is not without its +Utility; though by no means sufficient to prevent all Danger from them. + +Sec. 528. When the most dangerous Symptoms from this Cause disappear, and +there remains only some Degree of Weakness, of Numbness, and a little +Inappetency, or Loathing at Stomach, nothing is better than Lemonade +with one fourth Part Wine, half a Cup of which should frequently be +taken, with a small Crust of Bread. + +Sec. 529. The Vapour which exhales from Wine, and in general from all +fermenting Liquors, such as Beer, Cyder, _&c._ contains something +poisonous, which kills in the like Manner with the Vapour of Coal; and +there is always some Danger in going into a Cellar, where there is much +Wine in the State of Fermentation; if it has been shut up close for +several Hours. There have been many Examples of Persons struck dead on +entering one, and of others who have escaped out of it with Difficulty. + +When such unhappy Accidents occur, Men should not be successively +exposed, one after another, to perish, by endeavouring to fetch out the +first who sunk down upon his Entrance; but the Air should immediately be +purified by the Method already directed, or by discharging some Guns +into the Cellar; after which People may venture in with Precaution. And +when the Persons unfortunately affected are brought out, they are to be +treated like those, who were affected with the Coal-Vapour. + +I saw a Man, about eight Years since, who was not sensible of the +Application of Spirit of Sal Ammoniac, till about an Hour after he was +struck down, and who was entirely freed at last by a plentiful Bleeding; +though he had been so insensible, that it was several Hours before he +discovered a very great Wound he had, which extended from the Middle of +his Arm to his Armpit, and which was made by a Hook intended to be used, +in Case of a House catching Fire, to assist Persons in escaping from the +Flames. + +Sec. 530. When subterraneous Caves that have been very long shut are +opened; or when deep Wells are cleaned, that have not been emptied for +several Years, the Vapours arising from them produce the same Symptoms I +have mentioned, and require the same Assistance. They are to be cleansed +and purified by burning Sulphur and Salt Petre in them, or Gunpowder, as +compounded of both. + +Sec. 531. The offensive Stink of Lamps and of Candles, especially when +their Flames are extinguished, operate like other Vapours, though with +less Violence, and less suddenly. Nevertheless there have been Instances +of People killed by the Fumes of Lamps fed with Nut Oil, which had been +extinguished in a close Room. These last Smells or Fumes prove noxious +also, in Consequence of their Greasiness, which being conveyed, together +with the Air, into the Lungs, prevent their Respiration: And hence we +may observe, that Persons of weak delicate Breasts find themselves +quickly oppressed in Chambers or Apartments, illuminated with many +Candles. + +The proper Remedies have been already directed, Sec. 525. The Steam of +Vinegar is very serviceable in such Cases. + + + + _Of Poisons._ + + +Sec. 532. There are a great Number of Poisons, whose Manner of acting is +not alike; and whose ill Effects are to be opposed by different +Remedies: But Arsenic, or Ratsbane, and some particular Plants are the +Poisons which are the most frequently productive of Mischief, in Country +Places. + +Sec. 533. It is in Consequence of its excessive Acrimony, or violent Heat +and Sharpness, which corrodes or gnaws, that Arsenic destroys by an +excessive Inflammation, with a burning Fire as it were, most torturing +Pains in the Mouth, Throat, Stomach, Guts; with rending and often bloody +Vomitings, and Stools, Convulsions, Faintings, _&c._ + +The best Remedy of all is pouring down whole Torrents of Milk, or, where +there is not Milk, of warm Water. Nothing but a prodigious Quantity of +such weak Liquids can avail such a miserable Patient. If the Cause of +the Disorder is immediately known, after having very speedily taken down +a large Quantity of warm Water, Vomiting may be excited with Oil, or +with melted Butter, and by tickling the Inside of the Throat with a +Feather. But when the Poison has already inflamed the Stomach and the +Guts, we must not expect to discharge it by vomiting. Whatever is +healing or emollient, Decoctions of mealy Pulse, of Barley, of Oatmeal, +of Marsh-mallows, and Butter and Oil are the most suitable. + +As soon as ever the tormenting Pains are felt in the Belly, and the +Intestines seem attacked, Glysters of Milk must be very frequently +thrown up. + +If at the very Beginning of the Attack, the Patient has a strong Pulse, +a very large Bleeding may be considerably serviceable by its delaying +the Progress, and diminishing the Degree of Inflammation. + +And even though it should happen that a Patient overcomes the first +Violence of this dreadful Accident, it is too common for him to continue +in a languid State for a long Time, and sometimes for all the Remainder +of his Life. The most certain Method of preventing this Misery, is to +live for some Months solely upon Milk, and some very new laid Eggs, just +received from the Hen, and dissolved or blended in the Milk, without +boiling them. + +Sec. 534. The Plants which chiefly produce these unhappy Accidents are some +Kinds of Hemlock, whether it be the Leaf or the Root, the Berries of the +_Bella Donna_, or deadly Nightshade, which Children eat by mistake for +Cherries; some Kind of Mushrooms, the Seed of the _Datura_, or the +stinking Thorn-Apple. + +All the Poisons of this Class prove mortal rather from a narcotic, or +stupefying, than from an acrid, or very sharp Quality. Vertigos, +Faintings, Reachings to vomit, and actual Vomitings are the first +Symptoms produced by them. + +The Patient should immediately swallow down a large Quantity of Water, +moderately seasoned with Salt or with Sugar; and then a Vomiting should +be excited as soon as possible by the Prescription No. 34 or 35: or, if +neither of these is very readily procurable, with Radish-seed pounded, +to the Quantity of a Coffee Spoonful, swallowed in warm Water, soon +after forcing a Feather or a Finger into the Patient's Throat, to +expedite the Vomiting. + +After the Operation of the Vomit, he must continue to take a large +Quantity of Water, sweetened with Honey or Sugar, together with a +considerable Quantity of Vinegar, which is the true Specific, or +Antidote, as it were, against those Poisons: the Intestines must also be +emptied by a few Glysters. + +Thirty-seven Soldiers having unhappily eaten, instead of Carrots, of the +Roots of the _Oenanthe_; or Water-hemlock, became all extremely sick; +when the Emetic, No. 34, with the Assistance of Glysters, and very +plentiful drinking of warm Water, saved all but one of them, who died +before he could be assisted. + +Sec. 535. If a Person has taken too much Opium; or any Medicine into which +it enters, as _Venice_ Treacle, Mithridate, Diascordium, _&c._ whether +by Imprudence, Mistake, Ignorance, or through any bad Design, he must be +bled upon the Spot, and treated as if he had a sanguine Apoplexy, (See Sec. +147) by Reason that Opium in Effect produces such a one. He should snuff +up and inhale the Vapour of Vinegar plentifully, adding it also +liberally to the Water he is to drink. + + + + _Of acute Pains._ + + +Sec. 536. It is not my Intention to treat here of those Pains, that +accompany any evident known Disease, and which should be conducted as +relating to such Diseases; nor of such Pains as infirm valetudinary +Persons are habitually subject to; since Experience has informed such of +the most effectual Relief for them: But when a Person sound and hale, +finds himself suddenly attacked with some excessive Pain, in whatever +Part it occurs, without knowing either the Nature, or the Cause of it, +they may, till proper Advice can be procured, + +1, Part with some Blood, which, by abating the Fulness and Tension, +almost constantly asswages the Pains, at least for some Time: and it may +even be repeated, if, without weakening the Patient much, it has +lessened the Violence of the Pain. + +2, The Patient should drink abundantly of some very mild temperate +Drink, such as the Ptisan No. 2, the Almond Emulsion No. 4, or warm +Water with a fourth or fifth Part Milk. + +3, Several emollient Glysters should be given. + +4, The whole Part that is affected, and the adjoining Parts should be +covered with Cataplasms, or soothed with the emollient Fomentation, No. +9. + +5, The warm Bath may also be advantagiously used. + +6, If notwithstanding all these Assistances, the Pain should still +continue violent, and the Pulse is neither full nor hard, the grown +Patient may take an Ounce of Syrup of Diacodium, or sixteen Drops of +liquid Laudanum; and when neither of these are to be had, [111] an +_English_ Pint of boiling Water must be poured upon three or four +Poppy-heads with their Seeds, but without the Leaves, and this Decoction +is to be drank like Tea. + +[111] _Une Quartette._ + +Sec. 537. Persons very subject to frequent Pains, and especially to violent +Head-achs, should abstain from all strong Drink; such Abstinence being +often the only Means of curing them: And People are very often mistaken +in supposing Wine necessary for as many as seem to have a weak Stomach. + + + + + __Chapter XXXII.__ + + + + _Of Medicines taken by Way of Precaution, or Prevention._ + + + __Sect.__ 538. + +I Have pointed out, in some Parts of this Work, the Means of preventing +the bad Effects of several Causes of Diseases; and of prohibiting the +Return of some habitual Disorders. In the present Chapter I shall adjoin +some Observations, on the Use of the principal Remedies, which are +employed as general Preservatives; pretty regularly too at certain +stated Times, and almost always from meer Custom only, without knowing, +and often with very little Consideration, whether they are right or +wrong. + +Nevertheless, the Use, the Habit of taking Medicines, is certainly no +indifferent Matter: it is ridiculous, dangerous, and even criminal to +omit them, when they are necessary, but not less so to take them when +they are not wanted. A good Medicine taken seasonably, when there is +some Disorder, some _Disarrangement_ in the Body, which would in a short +time occasion a Distemper, has often prevented it. But yet the very same +Medicine, if given to a Person in perfect Health, if it does not +directly make him sick, leaves him at the best in a greater Propensity +to the Impressions of Diseases: and there are but too many Examples of +People, who having very unhappily contracted a Habit, a Disposition to +take Physick, have really injured their Health, and impaired their +Constitution, however naturally strong, by an Abuse of those Materials +which Providence has given for the Recovery and Re-establishment of it; +an Abuse which, though it should not injure the Health of the Person, +would occasion those Remedies, when he should be really sick, to be less +efficacious and serviceable to him, from their having been familiar to +his Constitution; and thus he becomes deprived of the Assistance he +would have received from them, if taken only in those Times and +Circumstances, in which they were necessary for him. + + + + _Of Bleeding._ + + +Sec. 539. Bleeding is necessary only in these four Cases. 1, When there is +too great a Quantity of Blood in the Body. 2, When there is any +Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, +or is about to supervene, in the Constitution, which would speedily +produce an Inflammation, or some other dangerous Symptom, if the Vessels +were not relaxed by Bleeding. It is upon this Principle that Patients +are bled after Wounds, and after Bruises; that Bleeding is directed for +a pregnant Woman, if she has a violent Cough; and that Bleeding is +performed, by Way of Precaution, in several other Cases. 4, We also +advise Bleeding sometimes to asswage an excessive Pain, though such Pain +is not owing to Excess of Blood, nor arises from an inflamed Blood; but +in Order to appease and moderate the Pain by Bleeding; and thereby to +obtain Time for destroying the Cause of it by other Remedies. But as +these two last Reasons are in Effect involved or implied in the two +first; it may be very generally concluded, that an Excess of Blood, and +an inflamed State of it, are the only two necessary Motives for +Bleeding. + +Sec. 540. An Inflammation of the Blood is known by the Symptoms +accompanying those Diseases, which that Cause produces. Of these I have +already spoken, and I have at the same time regulated the Practice of +Bleeding in such Cases. Here I shall point out those Symptoms and +Circumstances, which manifest an Excess of Blood. + +The first, then, is the general Course and Manner of the Patient's +living, while in Health. If he is a great Eater, and indulges in juicy +nutritious Food, and especially on much Flesh-meat; if he drinks rich +and nourishing Wine, or other strong Drink, and at the same time enjoys +a good Digestion; if he takes but little Exercise, sleeps much, and has +not been subject to any very considerable Evacuation, he may well be +supposed to abound in Blood. It is very obvious that all these Causes +rarely occur in Country People; if we except only the Abatement of their +Exercise, during some Weeks in Winter, which indeed may contribute to +their generating more Blood than they commonly do. + +The labouring Country-man, for much the greater part of his Time, lives +only on Bread, Water and Vegetables; Materials but very moderately +nourishing, as one Pound of Bread probably does not make, in the same +Body, more Blood than one Ounce of Flesh; though a general Prejudice +seems to have established a contrary Opinion. 2, The total Stopping or +long Interruption of some involuntary Bleeding or Haemorrhage, to which +he had been accustomed. 3, A full and strong Pulse, and Veins visibly +filled with Blood, in a Body that is not lean and thin, and when he is +not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual +Numbness; Sleep more profound, of more Duration, and yet less tranquil +and calm, than at other times; a greater Propensity than ordinary to be +fatigued after moderate Exercise or Work; and a little Oppression and +Heaviness from walking. 6, Palpitations, accompanied sometimes with very +great Dejection, and even with a slight fainting Fit; especially on +being in any hot Place, or after moving about considerably. 7, Vertigos, +or Swimmings of the Head, especially on bowing down and raising it up at +once, and after sleeping. 8, Frequent Pains of the Head, to which the +Person was not formerly subject; and which seem not to arise from any +Defect in the Digestions. 9, An evident Sensation of Heat, pretty +generally diffused over the whole Body. 10, A smarting Sort of Itching +all over, from a very little more Heat than usual. And lastly, frequent +Haemorrhages, and these attended with manifest Relief, and more Vivacity. + +People should, notwithstanding, be cautious of supposing an unhealthy +Excess of Blood, from any one of these Symptoms only. Many of them must +concur; and they should endeavour to be certain that even such a +Concurrence of them does not result from a very different Cause, and +wholly opposite in Effect to that of an Excess of Blood. + +But when it is certain, from the whole Appearance, that such an Excess +doth really exist, then a single, or even a second Bleeding is attended +with very good Effects. Nor is it material, in such Cases, from what +Part the Blood is taken. + +Sec. 541. On the other Hand, when these Circumstances do not exist, +Bleeding is in no wise necessary: nor should it ever be practised in +these following Conditions and Circumstances; except for some particular +and very strong Reasons; of the due Force of which none but Physicians +can judge. + +First, when the Person is in a very advanced Age, or in very early +Infancy. 2, When he is either naturally of a weakly Constitution, or it +has been rendered such by Sickness, or by some other Accident. 3, When +the Pulse is small, soft, feeble, and intermits, and the Skin is +manifestly pale. 4, When the Limbs, the Extremities of the Body, are +often cold, puffed up and soft. 5, When their Appetite has been very +small for a long time; their Food but little nourishing, and their +Perspiration too plentiful, from great Exercise. 6, When the Stomach has +long been disordered, and the Digestion bad, whence very little Blood +could be generated. 7, When the Patient has been considerably emptied, +whether by Haemorrhages, a Looseness, profuse Urine or Sweat: or when the +_Crisis_ of some Distemper has been effected by any one of these +Evacuations. 8, When the Patient has long been afflicted with some +depressing Disease; and troubled with many such Obstructions as prevent +the Formation of Blood. 9, Whenever a Person is exhausted, from whatever +Cause. 10, When the Blood is in a thin, pale, and dissolved State. + +Sec. 542, In all these Cases, and in some others less frequent, a single +Bleeding often precipitates the Patient into an absolutely incurable +State, an irreparable Train of Evils. Many dismal Examples of it are but +too obvious. + +Whatever, therefore, be the Situation of the Patient, and however +naturally robust, that Bleeding, which is unnecessary, is noxious. +Repeated, re-iterated Bleedings, weaken and enervate, hasten old Age, +diminish the Force of the Circulation, thence fatten and puff up the +Body; and next by weakening, and lastly by destroying, the Digestions, +they lead to a fatal Dropsy. They disorder the Perspiration by the Skin, +and leave the Patient liable to Colds and Defluxions: They weaken the +nervous System, and render them subject to Vapours, to the hypochondriac +Disorders, and to all nervous Maladies. + +The ill Consequence of a single, though erroneous Bleeding is not +immediately discernible: on the contrary, when it was not performed in +such a Quantity, as to weaken the Patient perceivably, it appears to +have been rather beneficial. Yet I still here insist upon it, that it is +not the less true that, when unnecessary, it is prejudicial; and that +People should never bleed, as sometimes has been done, for meer Whim, +or, as it were, for Diversion. It avails nothing to affirm, that within +a few Days after it, they have got more Blood than they had before it, +that is, that they weigh more than at first, whence they infer the Loss +of Blood very speedily repaired. The Fact of their augmented Weight is +admitted; but this very Fact testifies against the real Benefit of that +Bleeding; hence it is a Proof, that the natural Evacuations of the Body +are less compleatly made; and that Humours, which ought to be expelled, +are retained in it. There remains the same Quantity of Blood, and +perhaps a little more; but it is not a Blood so well made, so perfectly +elaborated; and this is so very true, that if the thing were otherwise; +if some Days after the Bleeding they had a greater Quantity of the same +Kind of Blood, it would amount to a Demonstration, that more re-iterated +Bleedings must necessarily have brought on an inflammatory Disease, in a +Man of a robust Habit of Body. + +Sec. 543. The Quantity of Blood, which a grown Man may Part with, by Way of +Precaution, is about ten Ounces. + +Sec. 544. Persons so constituted as to breed much Blood, should carefully +avoid all those Causes which tend to augment it, (See Sec. 540, No. 1) and +when they are sensible of the Quantity augmented, they should confine +themselves to a light frugal Diet, on Pulse, Fruits, Bread and Water; +they should often bathe their Feet in warm Water, taking Night and +Morning the Powder No. 20; drink of the Ptisan No. 1; sleep but very +moderately, and take much Exercise. By using these Precautions they may +either prevent any Occasion for Bleeding, or should they really be +obliged to admit of it, they would increase and prolong its good +Effects. These are also the very Means, which may remove all the Danger +that might ensue from a Person's omitting to bleed, at the usual Season +or Interval, when the Habit, the Fashion of Bleeding had been +inveterately established in him. + +Sec. 545. We learn with Horror and Astonishment, that some have been bled +eighteen, twenty and even twenty-four times in two Days; and some +others, some [112] hundred times, in the Course of some Months. Such +Instances irrefragably demonstrate the continual Ignorance of their +Physician or Surgeon; and should the Patient escape, we ought to admire +the inexhaustible Resources of Nature, that survived so many murderous +Incisions. + +[112] How shocking is this! and yet how true in some Countries! I have + been most certainly assured, that Bleeding has been inflicted and + repeated in the last sinking and totally relaxing Stage of a + Sea-Scurvy, whose fatal Termination it doubtless accelerated. This + did not happen in our own Fleet; yet we are not as yet Wholly + exempt on Shore, from some Abuse of Bleeding, which a few raw + unthinking Operators are apt to consider as a meer Matter of + Course. I have in some other Place stigmatized the Madness of + Bleeding in Convulsions, from manifest Exhaustion and Emptiness, + with the Abhorrence it deserves. _K._ + +Sec. 546. The People entertain a common Notion, which is, that the first +Time of bleeding certainly saves the Life of the Patient; but to +convince them of the Falsity of this silly Notion, they need only open +their Eyes, and see the very contrary Fact to this occur but too +unhappily every Day; many People dying soon after their first Bleeding. +Were their Opinion right, it would be impossible that any Person should +die of the first Disease that seized him, which yet daily happens. Now +the Extirpation of this absurd Opinion is really become important, as +the Continuance of it is attended with some unhappy Consequences: their +Faith in, their great Dependance on, the extraordinary Virtue of this +first Bleeding makes them willing to omit it, that is, to treasure it up +against a Distemper, from which they shall be in the greatest Danger; +and thus it is deferred as long as the Patient is not extremely bad, in +Hopes that if they can do without it then, they shall keep it for +another and more pressing Occasion. Their present Disease in the mean +time rises to a violent Height; and then they bleed, but when it is too +late, and I have seen Instances of many Patients, who were permitted to +die, that the first Bleeding might be reserved for a more important +Occasion. The only Difference between the first Bleeding, and any +subsequent one is, that the first commonly gives the Patient an Emotion, +that is rather hurtful than salutary. + + + + _Of Purges._ + + +Sec. 547. The Stomach and Bowels are emptied either by Vomiting, or by +Stools, the latter Discharge being much more natural than the first, +which is not effected without a violent Motion, and one indeed to which +Nature is repugnant. Nevertheless, there are some Cases, which really +require this artificial Vomiting; but these excepted (some of which I +have already pointed out) we should rather prefer those Remedies, which +empty the Belly by Stool. + +Sec. 548. The Signs, which indicate a Necessity for Purging, are, 1, a +disagreeable Tast or Savour of the Mouth in a Morning, and especially a +bitter Tast; a foul, furred Tongue and Teeth, disagreable Eructations or +Belchings, Windiness and Distension. + +2, A Want of Appetite which increases very gradually, without any Fever, +which degenerates into a Disgust or total Aversion to Food; and +sometimes communicates a bad Tast to the very little such Persons do +eat. + +3, Reachings to vomit in a Morning fasting, and sometimes throughout the +Day; supposing such not to depend on a Woman's Pregnancy, or some other +Disorder, in which Purges would be either useless or hurtful. + +4, A vomiting up of bitter, or corrupted, Humours. + +5, A manifest Sensation of a Weight, or Heaviness in the Stomach, the +Loins, or the Knees. + +6, A Want of Strength sometimes attended with Restlessness, ill Humour, +or Peevishness, and Melancholy. + +7, Pains of the Stomach, frequent Pains of the Head, or Vertigos; +sometimes a Drowsiness, which increases after Meals. + +8, Some Species of Cholics; irregular Stools which are sometimes very +great in Quantity, and too liquid for many Days together; after which an +obstinate Costiveness ensues. + +9, A Pulse less regular, and less strong, than what is natural to the +Patient, and which sometimes intermits. + +Sec. 549. When these Symptoms, or some of them, ascertain the Necessity of +purging a Person, not then attacked by any manifest Disease (for I am +not speaking here of Purges in such Cases) a proper purging Medicine may +be given him. The bad Tast in his Mouth; the continual Belchings; the +frequent Reachings to vomit; the actual Vomitings and Melancholy +discover, that the Cause of his Disorder resides in the Stomach, and +shew that a Vomit will be of Service to him. But when such Signs or +Symptoms are not evident, the Patient should take such purging or +opening Remedies, as are particularly indicated by the Pains, whether of +the Loins; from the Cholic; or by a Sensation of Weight or Heaviness in +the Knees. + +Sec. 550. But we should abstain from either vomiting or purging, 1, +Whenever the Complaints of the Patients are founded in their Weakness, +and their being already exhausted, 2, When there is a general Dryness of +the Habit, a very considerable Degree of Heat, some Inflammation, or a +strong Fever. 3, Whenever Nature is exerting herself in some other +salutary Evacuation; whence purging must never be attempted in critical +Sweats, during the monthly Discharges, nor during a Fit of the Gout. 4, +Nor in such inveterate Obstructions as Purges cannot remove, and really +do augment. 5, Neither when the nervous System is considerably weakened. + +Sec. 551. There are other Cases again, in which it may be proper to purge, +but not to give a Vomit. These Cases are, 1, When the Patient abounds +too much with Blood, (See Sec. 540) since the Efforts which attend +vomiting, greatly augment the Force of the Circulation; whence the +Blood-vessels of the Head and of the Breast, being extremely distended +with Blood, might burst, which must prove fatal on the Spot, and has +repeatedly proved so. 2, For the same Reason they should not be given to +Persons, who are subject to frequent Bleeding from the Nose, or to +coughing up or vomiting of Blood; to Women who are subject to excessive +or unseasonable Discharges of Blood, _&c._ from the _Vagina_, the Neck +of the Womb; nor to those who are with Child. 3, Vomits are improper for +ruptured Persons. + +Sec. 552. When any Person has taken too acrid, too sharp, a Vomit, or a +Purge, which operates with excessive Violence; whether this consists in +the most vehement Efforts and Agitations, the Pains, Convulsions, or +Swoonings, which are their frequent Consequences; or whether that +prodigious Evacuation and Emptiness their Operation causes, (which is +commonly termed a _Super-purgation_) and which may hurry the Patient +off; Instances of which are but too common among the lower Class of the +People, who much too frequently confide themselves to the Conduct of +ignorant Men-slayers: In all such unhappy Accidents, I say, we should +treat these unfortunate Persons, as if they had been actually poisoned, +by violent corroding Poisons, (See Sec. 533) that is, we should fill them, +as it were, with Draughts of warm Water, Milk, Oil, Barley-water, Almond +Milk, emollient Glysters with Milk, and the Yolks of Eggs; and also +bleed them plentifully, if their Pains are excessive, and their Pulses +strong and feverish. + +The Super-purgation, the excessive Discharge, is to be stopt, after +having plied the Patient plentifully with diluting Drinks, by giving the +calming Anodyne Medicines directed in the Removal of acute Pains, Sec. 536, +No. 6. + +Flanels dipt in hot Water, in which some _Venice_ Treacle is dissolved, +are very serviceable: and should the Evacuations by Stool be excessive, +and the Patient has not a high Fever, and a parching Kind of Heat, a +Morsel of the same Treacle, as large as a Nutmeg, may be dissolved in +his Glyster. + +But should the Vomiting solely be excessive, without any Purging, the +Number of the emollient Glysters with Oil and the Yolk of an Egg must be +increased; and the Patient should be placed in a warm Bath. + +Sec. 553. Purges frequently repeated, without just and necessary +Indications, are attended with much the same ill Effects as frequent +Bleedings. They destroy the Digestions; the Stomach no longer, or very +languidly, exerts its Functions; the Intestines prove inactive; the +Patient becomes liable to very severe Cholics; the Plight of the Body, +deprived of its salutary Nutrition, falls off; Perspiration is +disordered; Defluxions ensue; nervous Maladies come on, with a general +Languor; and the Patient proves old, long before the Number of his Years +have made him so. + +Much irreparable Mischief has been done to the Health of Children, by +Purges injudiciously given and repeated. They prevent them from +attaining their utmost natural Strength, and frequently contract their +due Growth. They ruin their Teeth; dispose young Girls to future +Obstructions; and when they have been already affected by them, they +render them still more obstinate. + +It is a Prejudice too generally received, that Persons who have little +or no Appetite need purging; since this is often very false, and most of +those Causes, which lessen or destroy the Appetite, cannot be removed by +purging; though many of them may be increased by it. + +Persons whose Stomachs contain much glairy viscid Matter suppose, they +may be cured by Purges, which seem indeed at first to relieve them: but +this proves a very slight and deceitful Relief. These Humours are owing +to that Weakness and Laxity of the Stomach, which Purges augment; since +notwithstanding they carry off Part of these viscid Humours generated in +it, at the Expiration of a few Days there is a greater Accumulation of +them than before; and thus, by a Re-iteration of purging Medicines, the +Malady soon becomes incurable, and Health irrecoverably lost. The real +Cure of such Cases is effected by directly opposite Medicines. Those +referred to, or mentioned, Sec. 272, are highly conducive to it. + +Sec. 554. The Custom of taking stomachic Medicines infused in Brandy, +Spirit of Wine, Cherry Water, _&c._ is always dangerous; for +notwithstanding the present immediate Relief such Infusions afford in +some Disorders of the Stomach, they really by slow Degrees impair and +ruin that Organ; and it may be observed, that as many as accustom +themselves to Drams, go off, just like excessive Drinkers, in +Consequence of their having no Digestion; whence they sink into a State +of Depression and Languor, and die dropsical. + +Sec. 555. Either Vomits or Purges may be often beneficially omitted, even +when they have some Appearance of seeming necessary, by abating one Meal +a Day for some time; by abstaining from the most nourishing Sorts of +Food; and especially from those which are fat; by drinking freely of +cool Water, and taking extraordinary Exercise. The same Regimen also +serves to subdue, without the Use of Purges, the various Complaints +which often invade those, who omit taking purging Medicines, at those +Seasons and Intervals, in which they have made it a Custom to take them. + +Sec. 556. The Medicines, No. 34 and 35, are the most certain Vomits. The +Powder, No. 21, is a good Purge, when the Patient is in no wise +feverish. + +The Doses recommended in the Table of Remedies are those, which are +proper for a grown Man, of a vigorous Constitution. Nevertheless there +are some few, for whom they may be too weak: in such Circumstances they +may be increased by the Addition of a third or fourth Part of the Dose +prescribed. But should they not operate in that Quantity, we must be +careful not to double the Dose, much less to give a three-fold Quantity, +which has sometimes been done, and that even without its Operation, and +at the Risque of killing the Patient, which has not seldom been the +Consequence. In Case of such purging not ensuing, we should rather give +large Draughts of Whey sweetened with Honey, or of warm Water, in a Pot +of which an Ounce, or an Ounce and a half of common Salt must be +dissolved; and this Quantity is to be taken from time to time in small +Cups, moving about with it. + +The Fibres of Country People who inhabit the Mountains, and live almost +solely on Milk, are so little susceptible of Sensation, that they must +take such large Doses to purge them, as would kill all the Peasantry in +the Vallies. In the Mountains of _Valais_ there are Men who take twenty, +and even twenty-four Grains of Glass of Antimony for a single Dose; a +Grain or two of which were sufficient to poison ordinary Men. + +Sec. 557. Notwithstanding our Cautions on this important Head, whenever an +urgent Necessity commands it, Purging must be recurred to at all Times +and Seasons: but when the Season may be safely selected, it were right +to decline Purging in the Extremities of either Heat or Cold; and to +take the Purge early in the Morning, that the Medicines may find less +Obstruction or Embarrassment from the Contents of the Stomach. Every +other Consideration, with Relation to the Stars and the Moon, is +ridiculous, and void of any Foundation. The People are particularly +averse to purging in the Dog-days; and if this were only on Account of +the great Heat, it would be very pardonable: but it is from an +astrological Prejudice, which is so much the more absurd, as the real +Dog-days are at thirty-six Days Distance from those commonly reckoned +such; and it is a melancholy Reflection, that the Ignorance of the +People should be so gross, in this Respect, in our enlightened Age; and +that they should still imagine the Virtue and Efficacy of Medicines to +depend on what Sign of the Zodiac the Sun is in, or in any particular +Quarter of the Moon. Yet it is certain in this Point, they are so +inveterately attached to this Prejudice, that it is but too common to +see Country-People die, in waiting for the Sign or Quarter most +favourable to the Operation and Effect of a Medicine, which was truly +necessary five or six Days before either of them. Sometimes too that +particular Medicine is given, to which a certain Day is supposed to be +auspicious and favourable, in Preference to that which is most prevalent +against the Disease. And thus it is, than an ignorant Almanack Maker +determines on the Lives of the human Race; and contracts the Duration of +them with Impunity. + +Sec. 558. When a Vomit or a Purge is to be taken, the Patient's Body should +be prepared for the Reception of it twenty-four Hours beforehand; by +taking very little Food, and drinking some Glasses of warm Water, or of +a light Tea of some Herbs. + +He should not drink after a Vomit, until it begins to work; but then he +should drink very plentifully of warm Water, or a light Infusion of +Chamomile Flowers, which is preferable. + +It is usual, after Purges, to take some thin Broth or Soup during their +Operation; but warm Water sweetened with Sugar or Honey, or an Infusion +of Succory Flowers, would sometimes be more suitable. + +Sec. 559. As the Stomach suffers, in some Degree, as often as either a +Vomit, or a Purge, is taken, the Patient should be careful how he lives +and orders himself for some Days after taking them, as well in Regard to +the Quantity as Quality of his Food. + +Sec. 560. I shall say nothing of other Articles taken by Way of Precaution, +such as Soups, Whey, Waters, _&c._ which are but little used among the +People; but confine myself to this general Remark, that when they take +any of these precautionary Things, they should enter on a Regimen or Way +of living, that may co-operate with them, and contribute to the same +Purpose. Whey is commonly taken to refresh and cool the Body; and while +they drink it, they deny themselves Pulse, Fruits, and Sallads. They eat +nothing then, but the best and heartiest Flesh-meats they can come at; +such Vegetables as are used in good Soups, Eggs, and good Wine; +notwithstanding this is to destroy, by high and heating Aliments, all +the attemperating cooling Effects expected from the Whey. + +Some Persons propose to cool and attemperate their Blood by Soups and a +thin Diet, into which they cram Craw-fish, that heat considerably, or +_Nasturtium_, Cresses which also heat, and thus defeat their own +Purpose. Happily, in such a Case, the Error in one Respect often cures +that in the other; and these Kinds of Soup, which are in no wise +cooling, prove very serviceable, in Consequence of the Cause of the +Symptoms, which they were intended to remove, not requiring any Coolers +at all. + +The general physical Practice of the Community, which unhappily is but +too much in Fashion, abounds with similar Errors. I will just cite one, +because I have seen its dismal Effects. Many People suppose Pepper +cooling, though their Smell, Taste, and common Sense concur to inform +them of the contrary. It is the very hottest of Spices. + +Sec. 561. The most certain Preservative, and the most attainable too by +every Man, is to avoid all Excess, and especially Excess in eating and +in drinking. People generally eat more than thoroughly consists with +Health, or permits them to attain the utmost Vigour, of which their +natural Constitutions are capable. The Custom is established, and it is +difficult to eradicate it: notwithstanding we should at least resolve +not to eat, but through Hunger, and always under a Subjection to Reason; +because, except in a very few Cases, Reason constantly suggests to us +not to eat, when the Stomach has an Aversion to Food. A sober moderate +Person is capable of Labour, I may say, even of excessive Labour of some +Kinds; of which greater Eaters are absolutely incapable. Sobriety of +itself cures such Maladies as are otherwise incurable, and may recover +the most shattered and unhealthy Persons. + + + + + __Chapter XXXIII.__ + + + _Of Mountebanks, Quacks, and Conjurers._ + + + __Sect.__ 562. + +One dreadful Scourge still remains to be treated of, which occasions a +greater Mortality, than all the Distempers I have hitherto described; +and which, as long as it continues, will defeat our utmost Precautions +to preserve the Healths and Lives of the common People. This, or rather, +these Scourges, for they are very numerous, are Quacks; of which there +are two Species: The Mountebanks or travelling Quacks, and those +pretended Physicians in Villages and Country-Places, both male and +female, known in _Swisserland_ by the Name of Conjurers, and who very +effectually unpeople it. + +The first of these, the Mountebanks, without visiting the Sick, or +thinking of their Distempers, sell different Medicines, some of which +are for external Use, and these often do little or no Mischief; but +their internal ones are much oftener pernicious. I have been a Witness +of their dreadful Effects, and we are not visited by one of these +wandering Caitiffs, whose Admission into our Country is not mortally +fatal to some of its Inhabitants. They are injurious also in another +Respect, as they carry off great Sums of Money with them, and levy +annually some thousands of Livres, amongst that Order of the People, who +have the least to spare. I have seen, and with a very painful Concern, +the poor Labourer and the Artisan, who have scarcely possessed the +common Necessaries of Life, borrow wherewithal to purchase, and at a +dear Price, the Poison that was to compleat their Misery, by increasing +their Maladies; and which, where they escaped with their Lives, has left +them in such a languid and inactive State, as has reduced their whole +Family to Beggary. + +Sec. 563. An ignorant, knavish, lying and impudent Fellow will always +seduce the gross and credulous Mass of People, incapable to judge of and +estimate any thing rightly; and adapted to be the eternal Dupes of such, +as are base enough to endeavour to dazzle their weak Understandings; by +which Method these vile Quacks will certainly defraud them, as long as +they are tolerated. But ought not the Magistrates, the Guardians, the +Protectors, the political Fathers of the People interpose, and defend +them from this Danger, by severely prohibiting the Entrance of such +pernicious Fellows into a Country, where Mens' Lives are very estimable, +and where Money is scarce; since they extinguish the first, and carry +off the last, without the least Possibility of their being in anywise +useful to it. Can such forcible Motives as these suffer our Magistrates +to delay _their_ Expulsion any longer, _whom_ there never was the least +Reason for admitting? + +Sec. 564. It is acknowledged the Conjurers, the residing Conjurers, do not +carry out the current Money of the Country, like the itinerant Quacks; +but the Havock they make among their Fellow Subjects is without +Intermission, whence it must be very great, as every Day in the Year is +marked with many of their Victims. Without the least Knowledge or +Experience, and offensively armed with three or four Medicines, whose +Nature they are as thoroughly ignorant of, as of their unhappy Patients +Diseases; and which Medicines, being almost all violent ones, are very +certainly so many Swords in the Hands of raging Madmen. Thus armed and +qualified, I say, they aggravate the slightest Disorders, and make those +that are a little more considerable, mortal; but from which the Patients +would have recovered, if left solely to the Conduct of Nature; and, for +a still stronger Reason, if they had confided to the Guidance of her +experienced Observers and Assistants. + +Sec. 565. The Robber who assassinates on the High-way, leaves the Traveller +the Resource of defending himself, and the Chance of being aided by the +Arrival of other Travellers: But the Poisoner, who forces himself into +the Confidence of a sick Person, is a hundred times more dangerous, and +as just an Object of Punishment. + +The Bands of Highwaymen, and their Individuals, that enter into any +Country or District, are described as particularly as possible to the +Publick. It were equally to be wished, we had also a List of these +physical Impostors and Ignorants male and female; and that a most exact +Description of them, with the Number, and a brief Summary of their +murderous Exploits, were faithfully published. By this Means the +Populace might probably be inspired with such a wholesome Dread of them, +that they would no longer expose their Lives to the Mercy of such +Executioners. + +Sec. 566. But their Blindness, with Respect to these two Sorts of +maleficent Beings, is inconceivable. That indeed in Favour of the +Mountebank is somewhat less gross, because as they are not personally +acquainted with him, they may the more easily credit him with some Part +of the Talents and the Knowledge he arrogates. I shall therefore inform +them, and it cannot be repeated too often, that whatever ostentatious +Dress and Figure some of these Impostors make, they are constantly vile +Wretches, who, incapable of earning a Livelyhood in any honest Way, have +laid the Foundation of their Subsistence on their own amazing Stock of +Impudence, and that of the weak Credulity of the People; that they have +no scientific Knowledge; that their Titles and Patents are so many +Impositions, and inauthentic; since by a shameful Abuse, such Patents +and Titles are become Articles of Commerce, which are to be obtained at +very low Prices; just like the second-hand laced Cloaks which they +purchase at the Brokers. That their Certificates of Cures are so many +Chimeras or Forgeries; and that in short, if among the prodigious +Multitudes of People who take their Medicines, some of them should +recover, which it is almost physically impossible must not sometimes be +the Case, yet it would not be the less certain, that they are a +pernicious destructive Set of Men. A Thrust of a Rapier into the Breast +has saved a Man's Life by seasonably opening an Imposthume in it, which +might otherwise have killed him: and yet internal penetrating Wounds, +with a small Sword, are not the less mortal for one such extraordinary +Consequence. Nor is it even surprizing that these Mountebanks, which is +equally applicable to Conjurers, who kill thousands of People, whom +Nature alone, or assisted by a Physician, would have saved, should now +and then cure a Patient, who had been treated before by the ablest +Physicians. Frequently Patients of that Class, who apply to these +Mountebanks and Conjurers (whether it has been, that they would not +submit to the Treatment proper for their Distempers; or whether the real +Physician tired of the intractable Creatures has discontinued his Advice +and Attendance) look out for such Doctors, as assure them of a speedy +Cure, and venture to give them such Medicines as kill many, and cure one +(who has had Constitution enough to overcome them) a little sooner than +a justly reputable Physician would have done. It is but too easy to +procure, in every Parish, such Lists of their Patients, and of their +Feats, as would clearly evince the Truth of whatever has been said here +relating to them. + +Sec. 567. The Credit of this Market, this Fair-hunting Doctor, surrounded +by five or six hundred Peasants, staring and gaping at him, and counting +themselves happy in his condescending to cheat them of their very scarce +and necessary Cash, by selling them, for twenty times more than its real +Worth, a Medicine whose best Quality were to be only a useless one; the +Credit, I say, of this vile yet tolerated Cheat, would quickly vanish, +could each of his Auditors be persuaded, of what is strictly true, that +except a little more Tenderness and Agility of Hand, he knows full as +much as his Doctor; and that if he could assume as much Impudence, he +would immediately have as much Ability, would equally deserve the same +Reputation, and to have the same Confidence reposed in him. + +Sec. 568. Were the Populace capable of reasoning, it were easy to disabuse +them in these Respects; but as it is, their Guardians and Conductors +should reason for them. I have already proved the Absurdity of reposing +any Confidence in Mountebanks, properly so called; and that Reliance +some have on the Conjurers is still more stupid and ridiculous. + +The very meanest Trade requires some Instruction: A Man does not +commence even a Cobler, a Botcher of old Leather, without serving an +Apprenticeship to it; and yet no Time has been served, no Instruction +has been attended to, by these Pretenders to the most necessary, useful +and elegant Profession. We do not confide the mending, the cleaning of a +Watch to any, who have not spent several Years in considering how a +Watch is made; what are the Requisites and Causes of its going right; +and the Defects or Impediments that make it go wrong: and yet the +preserving and rectifying the Movements of the most complex, the most +delicate and exquisite, and the most estimable Machine upon Earth, is +entrusted to People who have not the least Notion of its Structure; of +the Causes of its Motions; nor of the Instruments proper to rectify +their Deviations. + +Let a Soldier discarded from his Regiment for his roguish Tricks, or who +is a Deserter from it, a Bankrupt, a disreputable Ecclesiastic, a +drunken Barber, or a Multitude of such other worthless People, advertize +that they mount, set and fit up all Kinds of Jewels and Trinkets in +Perfection; if any of these are not known; if no Person in the Place has +ever seen any of their Work; or if they cannot produce authentic +Testimonials of their Honesty, and their Ability in their Business, not +a single Individual will trust them with two Pennyworth of false Stones +to work upon; in short they must be famished. But if instead of +professing themselves Jewellers, they post themselves up as Physicians, +the Croud purchase, at a high Rate, the Pleasure of trusting them with +the Care of their Lives, the remaining Part of which they rarely fail to +empoison. + +Sec. 569. The most genuine and excellent Physicians, these extraordinary +Men, who, born with the happiest Talents, have began to inform their +Understandings from their earliest Youth; who have afterwards carefully +qualified themselves by cultivating every Branch of Physic; who have +sacrificed the best and most pleasurable Days of their Lives, to a +regular and assiduous Investigation of the human Body; of its various +Functions; of the Causes that may impair or embarrass them, and informed +themselves of the Qualities and Virtues of every simple and compound +Medicine; who have surmounted the Difficulty and Loathsomness of living +in Hospitals among thousands of Patients; and who have added the medical +Observations of all Ages and Places to their own; these few and +extraordinary Men, I say, still consider themselves as short of that +perfect Ability and consummate Knowledge, which they contemplate and +wish for, as necessary to guarding the precious _Depositum_ of human +Life and Health, confided to their Charge. Nevertheless we see the same +inestimable Treasures, intrusted to gross and stupid Men, born without +Talents; brought up without Education or Culture; who frequently can +scarcely read; who are as profoundly ignorant of every Subject that has +any Relation to Physic, as the Savages of _Asia_; who awake only to +drink away; who often exercise their horrid Trade merely to find +themselves in strong Liquor, and execute it chiefly when they are drunk: +who, in short, became Physicians, only from their Incapacity to arrive +at any Trade or Attainment! Certainly such a Conduct in Creatures of the +human Species must appear very astonishing, and even melancholy, to +every sensible thinking Man; and constitute the highest Degree of +Absurdity and Extravagance. + +Should any Person duly qualified enter into an Examination of the +Medicines they use, and compare them with the Situation and Symptoms of +the Patients to whom they give them, he must be struck with Horror; and +heartily deplore the Fate of that unfortunate Part of the human Race, +whose Lives, so important to the Community, are committed to the Charge +of the most murderous Set of Beings. + +Sec. 570. Some of these Caitiffs however, apprehending the Force and Danger +of that Objection, founded on their Want of Study and Education, have +endeavoured to elude it, by infusing and spreading a false, and indeed, +an impudent impious Prejudice among the People, which prevails too much +at present; and this is, that their Talents for Physic are a +supernatural Gift, and, of Course, greatly superior to all human +Knowledge. It were going out of my Province to expatiate on the +Indecency, the Sin, and the Irreligion of such Knavery, and incroaching +upon the Rights and perhaps the Duty of the Clergy; but I intreat the +Liberty of observing to this respectable Order of Men, that this +Superstition, which is attended with dreadful Consequences, seems to +call for their utmost Attention: and in general the Expulsion of +Superstition is the more to be wished, as a Mind, imbued with false +Prejudices, is less adapted to imbibe a true and valuable Doctrine. +There are some very callous hardened Villains among this murdering Band, +who, with a View to establish their Influence and Revenue as well upon +Fear as upon Hope, have horridly ventured so far as to incline the +Populace to doubt, whether they received their boasted Gift and Power +from Heaven or from Hell! And yet these are the Men who are trusted with +the Health and the Lives of many others. + +Sec. 571. One Fact which I have already mentioned, and which it seems +impossible to account for is, that great Earnestness of the Peasant to +procure the best Assistance he can for his sick Cattle. At whatever +Distance the Farrier lives, or some Person who is supposed qualified to +be one (for unfortunately there is not one in _Swisserland_) if he has +considerable Reputation in this Way, the Country-man goes to consult +him, or purchases his Visit at any Price. However expensive the +Medicines are, which the Horse-doctor directs, if they are accounted the +best, he procures them for his poor Beast. But if himself, his Wife or +Children fall sick, he either calls in no Assistance nor Medicines; or +contents himself with such as are next at Hand, however pernicious they +may be, though nothing the cheaper on that account: for certainly the +Money, extorted by some of these physical Conjurers from their Patients, +but oftner from their Heirs, is a very shameful Injustice, and calls +loudly for Reformation. + +Sec. 572. In an excellent Memoir or Tract, which will shortly be published, +on the Population of _Swisserland_, we shall find an important and very +affecting Remark, which strictly demonstrates the Havock made by these +immedical Magicians or Conjurers; and which is this: That in the common +Course of Years, the Proportion between the Numbers and Deaths of the +Inhabitants of any one Place, is not extremely different in City and +Country: but when the very same epidemical Disease attacks the City and +the Villages, the Difference is enormous; and the Number of Deaths of +the former compared with that of the Inhabitants of the Villages, where +the Conjurer exercises his bloody Dominion, is infinitely more than the +Deaths in the City. + +I find in the second Volume of the Memoirs of the oeconomical Society of +_Berne_, for the Year 1762, another Fact equally interesting, which is +related by one of the most intelligent and sagacious Observers, +concerned in that Work. "Pleurisies and Peripneumonies (he says) +prevailed at _Cottens a la Cote_; and some Peasants died under them, who +had consulted the Conjurers and taken their heating Medicines; while of +those, who pursued a directly opposite Method, almost every one +recovered." + +Sec. 573. But I shall employ myself no longer on this Topic, on which the +Love of my Species alone has prompted me to say thus much; though it +deserves to be considered more in Detail, and is, in Reality, of the +greatest Consequence. None methinks could make themselves easy with +Respect to it so much as Physicians, if they were conducted only by +lucrative Views; since these Conjurers diminish the Number of those poor +People, who sometimes consult the real Physicians, and with some Care +and Trouble, but without the least Profit, to those Gentlemen. But what +good Physician is mean and vile enough to purchase a few Hours of Ease +and Tranquillity at so high, so very odious a Price? + +Sec. 574. Having thus clearly shewn the Evils attending this crying +Nusance, I wish I were able to prescribe an effectual Remedy against it, +which I acknowledge is far from being easy to do. + +The first necessary Point probably was to have demonstrated the great +and public Danger, and to dispose the State to employ their Attention on +this fatal, this mortal Abuse; which, joined to the other Causes of +Depopulation, has a manifest Tendency to render _Swisserland_ a Desert. + +Sec. 575. The second, and doubtless the most effectual Means, which I had +already mentioned is, not to admit any travelling Mountebank to enter +this Country; and to set a Mark on all the Conjurers: It may probably +also be found convenient, to inflict corporal Punishment on them; as it +has been already adjudged in different Countries by sovereign Edicts. At +the very least they should be marked with public Infamy, according to +the following Custom practised in a great City in _France_. "When any +Mountebanks appeared in _Montpellier_, the Magistrates had a Power to +mount each of them upon a meagre miserable Ass, with his Head to the +Ass's Tail. In this Condition they were led throughout the whole City, +attended with the Shouts and Hooting of the Children and the Mob, +beating them, throwing Filth and Ordure at them, reviling them, and +dragging them all about." + +Sec. 576. A third conducive Means would be the Instructions and Admonition +of the Clergy on this Subject, to the Peasants in their several +Parishes. For this Conduct of the common People amounting, in Effect, to +Suicide, to Self-murder, it must be important to convince them of it. +But the little Efficacy of the strongest and repeated Exhortations on so +many other Articles, may cause us to entertain a very reasonable Doubt +of their Success on this. Custom seems to have determined, that there is +nothing in our Day, which excludes a Person from the Title and +Appellation of an honest or honourable Man, except it be meer and +convicted Theft; and that for this simple and obvious Reason, that we +attach ourselves more strongly to our Property, than to any Thing else. +Even Homicide is esteemed and reputed honourable in many Cases. Can we +reasonably then expect to convince the Multitude, that it is criminal to +confide the Care of their Health to these Poisoners, in Hopes of a Cure +of their Disorders? A much likelier Method of succeding on this Point +would certainly be, to convince the deluded People, that it will cost +them less to be honestly and judiciously treated, than to suffer under +the Hands of these Executioners. The Expectation of a good and cheap +Health-market will be apt to influence them more, than their Dread of a +Crime would. + +Sec. 577. A fourth Means of removing or restraining this Nusance would be +to expunge, from the Almanacs, all the astrological Rules relating to +Physick; as they continually conduce to preserve and increase some +dangerous Prejudices and Notions in a Science, the smallest Errors in +which are sometimes fatal. I had already reflected on the Multitude of +Peasants that have been lost, from postponing, or mistiming a Bleeding, +only because the sovereign Decision of an Almanac had directed it at +some other Time. May it not also be dreaded, to mention it by the Way, +that the same Cause, the Almanacs, may prove injurious to their rural +Oeconomy and Management; and that by advising with the Moon, who has no +Influence, and is of no Consequence in Vegetation or other Country +Business, they may be wanting in a due Attention to such other +Circumstances and Regulations, as are of real Importance in them? + +Sec. 578. A fifth concurring Remedy against this popular Evil would be the +Establishment of Hospitals, for the Reception of poor Patients, in the +different Cities and Towns of _Swisserland_. + +There may be a great many easy and concurring Means of erecting and +endowing such, with very little new Expence; and immense Advantages +might result from them: besides, however considerable the Expenses might +prove, is not the Object of them of the most interesting, the most +important Nature? It is incontestably our serious Duty; and it would +soon be manifest, that the Performance of it would be attended with more +essential intrinsic Benefit to the Community, than any other Application +of Money could produce. We must either admit, that the Multitude, the +Body of the People is useless to the State, or agree, that Care should +be taken to preserve and continue them. A very respectable _English_ +Man, who, after a previous and thorough Consideration of this Subject, +had applied himself very assiduously and usefully on the Means of +increasing the Riches and the Happiness of his Country-men, complains +that in _England_, the very Country in which there are the most +Hospitals, the Poor who are sick are not sufficiently assisted. What a +deplorable Deficience of the necessary Assistance for such must then be +in a Country, that is not provided with a single Hospital? That Aid from +Surgery and Physic, which abounds in Cities, is not sufficiently +diffused into Country-places: and the Peasants are liable to some simple +and moderate Diseases, which, for Want of proper Care, degenerate into a +State of Infirmity, that sinks them into premature Death. + +Sec. 579. In fine, if it be found impossible to extinguish these Abuses +(for those arising from Quacks are not the only ones, nor is that Title +applied to as many as really deserve it) beyond all Doubt it would be +for the Benefit and Safety of the Public, upon the whole, entirely to +prohibit the Art, the Practice of Physic itself. When real and good +Physicians cannot effect as much Good, as ignorant ones and Impostors +can do Mischief, some real Advantage must accrue to the State, and to +the whole Species, from employing none of either. I affirm it, after +much Reflection, and from thorough Conviction, that Anarchy in Medicine +is the most dangerous Anarchy. For this Profession, when loosed from +every Restraint, and subjected to no Regulations, no Laws, is the more +cruel Scourge and Affliction, from the incessant Exercise of it; and +should its Anarchy, its Disorders prove irremediable, the Practice of an +Art, become so very noxious, should be prohibited under the severest +Penalties: Or, if the Constitution of any Government was inconsistent +with the Application of so violent a Remedy, they should order public +Prayers against the Mortality of it, to be offered up in all the +Churches; as the Custom has been in other great and general Calamities. + +Sec. 580. Another Abuse, less fatal indeed than those already mentioned +(but which, however, has real ill Consequences, and at the best, carries +out a great deal of Money from us, though less at the Expense of the +common People, than of those of easy Circumstances) is that Blindness +and Facility, with which many suffer themselves to be imposed upon, by +the pompous Advertisements of some _Catholicon_, some universal Remedy, +which they purchase at a high Rate, from some foreign Pretender to a +mighty Secret or _Nostrum_. Persons of a Class or two above the Populace +do not care to run after a Mountebank, from supposing they should +depretiate themselves by mixing with the Herd. Yet if that very Quack, +instead of coming among us, were to reside in some foreign City; if, +instead of posting up his lying Puffs and Pretentions at the Corners of +the Streets, he would get them inserted in the Gazettes, and +News-papers; if, instead of selling his boasted Remedies in Person, he +should establish Shops or Offices for that Purpose in every City; and +finally, if instead of selling them twenty times above their real Value, +he would still double that Price; instead of having the common People +for his Customers, he would take in the wealthy Citizen, Persons of all +Ranks, and from almost every Country. For strange as it seems, it is +certain, that a Person of such a Condition, who is sensible in every +other Respect; and who will scruple to confide his Health to the Conduct +of such Physicians as would be the justest Subjects of his Confidence, +will venture to take, through a very unaccountable Infatuation, the most +dangerous Medicine, upon the Credit of an imposing Advertisement, +published by as worthless and ignorant a Fellow as the Mountebank whom +he despises, because the latter blows a Horn under his Window; and yet +who differs from the former in no other Respects except those I have +just pointed out. + +Sec. 581. Scarcely a Year passes, without one or another such advertized +and vaunted Medicine's getting into high Credit; the Ravages of which +are more or less, in Proportion to its being more or less in Vogue. +Fortunately, for the human Species, but few of these _Nostrums_ have +attained an equal Reputation with _Ailbaud_'s Powders, an Inhabitant of +_Aix_ in _Provence_, and unworthy the Name of a Physician; who has +over-run _Europe_ for some Years, with a violent Purge, the Remembrance +of which will not be effaced before the Extinction of all its Victims. I +attend now, and for a long time past, several Patients, whose Disorders +I palliate without Hopes of ever curing them; and who owe their present +melancholy State of Body to nothing but the manifest Consequences of +these Powders; and I have actually seen, very lately, two Persons who +have been cruelly poisoned by this boasted Remedy of his. A French +Physician, as eminent for his Talents and his Science, as estimable from +his personal Character in other Respects, has published some of the +unhappy and tragical Consequences which the Use of them has occasioned; +and were a Collection published of the same Events from them, in every +Place where they have been introduced, the Size and the Contents of the +Volume would make a very terrible one. + +Sec. 582. It is some Comfort however, that all the other Medicines thus +puffed and vended have not been altogether so fashionable, nor yet quite +so dangerous: but all posted and advertized Medicines should be judged +of upon this Principle (and I do not know a more infallible one in +Physics, nor in the Practice of Physic), that whoever advertises any +Medicine, as a universal Remedy for all Diseases, is an absolute +Impostor, such a Remedy being impossible and contradictory. I shall not +here offer to detail such Proofs as may be given of the Verity of this +Proposition: but I freely appeal for it to every sensible Man, who will +reflect a little on the different Causes of Diseases; on the Opposition +of these Causes; and on the Absurdity of attempting to oppose such +various Diseases, and their Causes, by one and the same Remedy. + +As many as shall settle their Judgments properly on this Principle, will +never be imposed upon by the superficial Gloss of these Sophisms +contrived to prove, that all Diseases proceed from one Cause; and that +this Cause is so very tractable, as to yield to one boasted Remedy. They +will perceive at once, that such an Assertion must be founded in the +utmost Knavery or Ignorance; and they will readily discover where the +Fallacy lies. Can any one expect to cure a Dropsy, which arises from too +great a Laxity of the Fibres, and too great an Attenuation or Thinness +of the Blood, by the same Medicines that are used to cure an +inflammatory Disease, in which the Fibres are too stiff and tense, and +the Blood too thick and dense? Yet consult the News-papers and the +Posts, and you will see published in and on all of them, Virtues just as +contradictory; and certainly the Authors of such poisonous +Contradictions ought to be legally punished for them. + +Sec. 583. I heartily wish the Publick would attend here to a very natural +and obvious Reflection. I have treated in this Book, but of a small +Number of Diseases, most of them acute ones; and I am positive that no +competent well qualified Physician has ever employed fewer Medicines, in +the Treatment of the Diseases themselves. Nevertheless I have prescribed +seventy-one, and I do not see which of them I could retrench, or +dispense with the Want of, if I were obliged to use one less. Can it be +supposed then, that any one single Medicine, compound or simple, shall +cure thirty times as many Diseases as those I have treated of? + +Sec. 584. I shall add another very important Observation, which doubtless +may have occurred to many of my Readers; and it is this, that the +different Causes of Diseases, their different Characters; the +Differences which arise from the necessary Alterations that happen +throughout their Progress and Duration; the Complications of which they +are susceptible; the Varieties which result from the State of different +Epidemics, of Seasons, of Sexes, and of many other Circumstances; that +these Diversities, I say, oblige us very often to vary and change the +Medicines; which proves how very ticklish and dangerous it is to have +them directed by Persons, who have such an imperfect Knowledge of them, +as those who are not Physicians must be supposed to have. And the +Circumspection to be used in such Cases ought to be proportioned to the +Interest the Assistant takes in the Preservation of the Patient; and +that Love of his Neighbour with which he is animated. + +Sec. 585. Must not the same Arguments and Reflections unavoidably suggest +the Necessity of an entire Tractability on the Part of the Patient, and +his Friends and Assistants? The History of Diseases which have their +stated Times of Beginning, of manifesting and displaying themselves; of +arriving at, and continuing in their Height, and of decreasing; do not +all these demonstrate the Necessity of continuing the same Medicines, as +long as the Character of the Distemper is the same; and the Danger of +changing them often, only because what has been given has not afforded +immediate Relief? Nothing can injure the Patient more than this +Instability and Caprice. After the Indication which his Distemper +suggests, appears to be well deduced, the Medicine must be chosen that +is likeliest to resist the Cause of it; and it must be continued as long +as no new Symptom or Circumstance supervenes, which requires an +Alteration of it; except it should be evident, that an Error had been +incurred in giving it. But to conclude that a Medicine is useless or +insignificant, because it does not remove or abate the Distemper as +speedily, as the Impatience of the Sick would naturally desire it; and +to change it for another, is as unreasonable, as it would be for a Man +to break his Watch, because the Hand takes twelve Hours, to make a +Revolution round the Dial-plate. + +Sec. 586. Physicians have some Regard to the State of the Urine of sick +Persons, especially in inflammatory Fevers; as the Alterations occurring +in it help them to judge of the Changes that may have been made in the +Character and Consistence of the Humours in the Mass of Blood; and +thence may conduce to determine the Time, in which it will be proper to +dispose them to some Evacuation. But it is gross Ignorance to imagine, +and utter Knavery and Imposture to persuade the Sick, that the meer +Inspection of their Urine solely, sufficiently enables others to judge +of the Symptoms and Cause of the Disease, and to direct the best +Remedies for it. This Inspection of the Urine can only be of Use when it +is duly inspected; when we consider at the same time the exact State and +the very Looks of the Patient; when these are compared with the Degree +of the Symptoms of the Malady; with the other Evacuations; and when the +Physician is strictly informed of all external Circumstances, which may +be considered as foreign to the Malady; which may alter or affect the +Evacuations, such as particular Articles of Food, particular Drinks, +different Medicines, or the very Quantity of Drink. Where a Person is +not furnished with an exact Account of these Circumstances, the meer +Inspection of the Urine is of no Service, it suggests no Indication, nor +any Expedient; and meer common Sense sufficiently proves, and it may be +boldly affirmed, that whoever orders any Medicine, without any other +Knowledge of the Disease, than what an Inspection of the Urine affords, +is a rank Knave, and the Patient who takes them is a Dupe. + +Sec. 587. And here now any Reader may very naturally ask, whence can such a +ridiculous Credulity proceed, upon a Subject so essentially interesting +to us as our own Health? + +In Answer to this it should be observed, that some Sources, some Causes +of it seem appropriated merely to the People, the Multitude. The first +of these is, the mechanical Impression of Parade and Shew upon the +Senses. 2, The Prejudice they have conceived, as I said before, of the +Conjurers curing by a supernatural Gift. 3, The Notion the Country +People entertain, that their Distemper and Disorders are of a Character +and Species peculiar to themselves, and that the Physicians, attending +the Rich, know nothing concerning them. 4, The general Mistake that +their employing the Conjurer is much cheaper. 5, Perhaps a sheepish +shame-faced Timidity may be one Motive, at least with some of them. 6, A +Kind of Fear too, that Physicians will consider their Cases with less +Care and Concern, and be likely to treat them more cavalierly; a Fear +which increases that Confidence which the Peasant, and which indeed +every Man has in his Equal, being sounded in Equality itself. And 7, the +Discourse and Conversation of such illiterate Empirics being more to +their Tast, and more adapted to their Apprehension. + +But it is less easy to account for this blind Confidence, which Persons +of a superior Class (whole Education being considered as much better are +regarded as better Reasoners) repose in these boasted Remedies; and even +for some Conjurer in Vogue. Nevertheless even some of their Motives may +be probably assigned. + +The first is that great Principle of _Seity_, or _Selfness_, as it may +be called, innate to Man, which attaching him to the Prolongation of his +own Existence more than to any other thing in the Universe, keeps his +Eyes, his utmost Attention, continually fixed upon this Object; and +compels him to make it the very Point, the Purpose of all his Advances +and Proceedings; notwithstanding it does not permit him to distinguish +the safest Paths to it from the dangerous ones. This is the surest and +shortest Way says some Collector at the Turnpike, he pays, passes, and +perishes from the Precipices that occur in his Route. + +This very Principle is the Source of another Error, which consists in +reposing, involuntarily, a greater Degree of Confidence in those, who +flatter and fall in the most with us in our favourite Opinions. The well +apprised Physician, who foresees the Length and the Danger of a Disease; +and who is a Man of too much Integrity to affirm what he does not think, +must, from a necessary Construction of the human Frame and Mind, be +listened to less favourably, than he who flatters us by saying what we +wish. We endeavour to elongate, to absent ourselves, from the +Sentiments, the Judgment of the first; we smile, from Self-complacency, +at those of the last, which in a very little time are sure of obtaining +our Preference. + +A third Cause, which results from the same Principle is, that we give +ourselves up the most readily to his Conduct, whose Method seems the +least disagreeable, and flatters our Inclinations the most. The +Physician who enjoins a strict Regimen; who insists upon some Restraints +and Self-denials; who intimates the Necessity of Time and Patience for +the Accomplishment of the Cure, and who expects a thorough Regularity +through the Course of it, disgusts a Patient who has been accustomed to +indulge his own Tast and Humour; the Quack, who never hesitates at +complying with it, charms him. The Idea of a long and somewhat distant +Cure, to be obtained at the End of an unpleasant and unrelaxing Regimen, +supposes a very perilous Disease; this Idea disposes the Patient to +Disgust and Melancholy, he cannot submit to it without Pain; and he +embraces, almost unconsciously, merely to avoid this, an opposite System +which presents him only with the Idea of such a Distemper, as will give +Way to a few Doses of Simples. + +That Propensity to the New and Marvellous, which tyrannizes over so +large a Proportion of our Species, and which has advanced so many absurd +Persons and Things into Reputation, is a fourth and a very powerful +Motive. An irksome Satiety, and a Tiresomeness, as it were, from the +same Objects, is what our Nature is apt to be very apprehensive of; +though we are incessantly conducted towards it, by a Perception of some +Void, some Emptiness in ourselves, and even in Society too: But new and +extraordinary Sensations rousing us from this disagreeable State, more +effectually than any Thing else, we unthinkingly abandon ourselves to +them, without foreseeing their Consequences. + +A fifth Cause arises from seven Eighths of Mankind being managed by, or +following, the other Eighth; and, generally speaking, the Eighth that is +so very forward to manage them, are the least fit and worthy to do it; +whence all must go amiss, and absurd and embarrassing Consequences ensue +from the Condition of Society. A Man of excellent Sense frequently sees +only through the Eyes of a Fool, of an intriguing Fellow, or of a Cheat; +in this he judges wrong, and his Conduct must be so too. A man of real +Merit cannot connect himself with those who are addicted to caballing; +and yet such are the Persons, who frequently conduct others. + +Some other Causes might be annexed to these, but I shall mention only +one of them, which I have already hinted, and the Truth of which I am +confirmed in from several Years Experience; which is, that we generally +love those who reason more absurdly than ourselves, better than those +who convince us of our own weak Reasoning. + +I hope the Reflexions every Reader will make on these Causes of our ill +Conduct on this important Head, may contribute to correct or diminish +it; and to destroy those Prejudices whose fatal Effects we may +continually observe. + + +[N. B. _The Multitude of_ all _the Objects of this excellent Chapter in +this Metropolis, and doubtless throughout_ England, _were strong +Inducements to have taken a little wholesome Notice of the Impostures of +a few of the most pernicious. But on a second Perusal of this Part of +the Original and its Translation, I thought it impossible (without +descending to personal, nominal Anecdotes about the Vermin) to add any +Thing material upon a Subject, which the Author has with such Energy +exhausted. He even seems, by some of his Descriptions, to have taken +Cognizance of a few of our most self-dignified itinerant Empirics; as +these Genius's find it necessary sometimes to treat themselves with a +little Transportation. In reality Dr._ _Tissot_ _has, in a very masterly +Way, thoroughly dissected and displayed the whole_ Genus, _every Species +of Quacks. And when he comes to account for that Facility, with which +Persons of very different Principles from them, and of better +Intellects, first listen to, and finally countenance such Caitiffs, he +penetrates into some of the most latent Weaknesses of the human Mind; +even such as are often Secrets to their Owners. It is difficult, +throughout this Disquisition, not to admire the Writer; but impossible +not to love the Man, the ardent Philanthropist. His Sentiment that--"A +Man of real Merit cannot connect himself with those who are addicted to +caballing,"--is exquisitely just, and so liberal, that it never entered +into the Mind of any disingenuous Man, however dignified, in any +Profession. Persons of the simplest Hearts and purest Reflections must +shrink at every Consciousness of Artifice; and secretly reproach +themselves for each Success, that has redounded to them at the Expence +of Truth._] K. + + + + + __Chapter XXXIV.__ + + + _Containing Questions absolutely necessary to be answered + exactly by the Patient, who consults a Physician._ + + + __Sect.__ 588. + +Great Consideration and Experience are necessary to form a right +Judgment of the State of a Patient, whom the Physician has not +personally seen; even though he should receive the best Information it +is possible to give him, at a Distance from the Patient. But this +Difficulty is greatly augmented, or rather changed into an +Impossibility, when his Information is not exact and sufficient. It has +frequently happened to myself, that after having examined Peasants who +came to get Advice for others, I did not venture to prescribe, because +they were not able to give me a sufficient Information, in order to my +being certain of the Distemper. To prevent this great Inconvenience, I +subjoin a List of such Questions, as indispensably require clear and +direct Answers. + + + + _General Questions._ + + +What is the Patient's Age? + +Is he generally a healthy Person? + +What is his general Course of Life? + +How long has he been sick? + +In what Manner did his present Sickness begin, or appear? + +Has he any Fever? + +Is his Pulse hard or soft? + +Has he still tolerable Strength, or is he weak? + +Does he keep his Bed in the Day Time, or quit it? + +Is he in the same Condition throughout the whole Day? + +Is he still, or restless? + +Is he hot, or cold? + +Has he Pains in the Head, the Throat, the Breast, the Stomach, the +Belly, the Loins, or in the Limbs, the Extremities of the Body? + +Is his Tongue dry? does he complain of Thirst? of an ill Tast in his +Mouth? of Reachings to vomit, or of an Aversion to Food? + +Does he go to stool often or seldom? + +What Appearance have his Stools, and what is their usual quantity? + +Does he make much Urine? What Appearance has his Urine, as to Colour and +Contents? Are they generally much alike, or do they change often? + +Does he sweat? + +Does he expectorate, or cough up? + +Does he get Sleep? + +Does he draw his Breath easily? + +What Regimen does he observe in his Sickness? + +What Medicines has he taken? + +What Effects have they produced? + +Has he never had the same Distemper before? + +Sec. 589. The Diseases of Women and Children are attended with peculiar +Circumstances; so that when Advice is asked for them, Answers must be +given, not only to the preceding Questions, which relate to sick Persons +in general; but also to the following, which regard these particularly. + + + + _Questions with Respect to Women._ + + +Have they arrived at their monthly Discharges, and are these regular? + +Are they pregnant? Is so, how long since? + +Are they in Child-bed? + +Has their Delivery been happily accomplished? + +Has the Mother cleansed sufficiently? + +Has her Milk come in due Time and Quantity? + +Does she suckle the Infant herself? + +Is she subject to the Whites? + + + + _Questions relating to Children._ + + +What is the Child's exact Age? + +How many Teeth has he cut? + +Does he cut them painfully? + +Is he any-wise ricketty, or subject to Knots or Kernels? + +Has he had the Small Pocks? + +Does the Child void Worms, upwards or downwards? + +Is his Belly large, swelled, or hard? + +Is his Sleep quiet, or otherwise? + +Sec. 590. Besides these general Questions, common in all the Diseases of +the different Sexes and Ages, the Person consulting must also answer to +those, which have a close and direct Relation to the Disease, at that +very Time affecting the Sick. + +For Example, in the Quinsey, the Condition of the Throat must be exactly +inquired into. In Diseases of the Breast, an Account must be given of +the Patient's Pains; of his Cough; of the Oppression, and of his +Breathing, and Expectoration. I shall not enter upon a more particular +Detail; common Sense will sufficiently extend this Plan or Specimen to +other Diseases; and though these Questions may seem numerous, it will +always be easy to write down their Answers in as little Room, as the +Questions take up here. It were even to be wished that Persons of every +Rank, who occasionally write for medical Advice and Directions, would +observe such a Plan or Succession, in the Body of their Letters. By this +Means they would frequently procure the most satisfactory Answers; and +save themselves the Trouble of writing second Letters, to give a +necessary Explanation of the first. + +The Success of Remedies depends, in a very great Measure, on a very +exact Knowledge of the Disease; and that Knowledge on the precise +Information of it, which is laid before the Physician. + + + + + __FINIS.__ + + + + + _TABLE_ + + + _Of the Prescriptions and Medicines, referred to in the + foregoing Treatise: Which, with the Notes beneath them, are to + be read before the taking, or Application, of any of the said + Medicines._ + + +As in Order to ascertain the Doses of Medicines, I have generally done +it by Pounds, Ounces, Half-Ounces, _&c. &c._ and as this Method, +especially to the common People, might prove a little too obscure and +embarrassing, I have specified here the exact Weight of Water, contained +in such Vessels or liquid Measures, as are most commonly used in the +Country. + +The Pound which I mean, throughout all these Prescriptions, is that +consisting of sixteen Ounces. These Ounces contain eight Drachms, each +Drachm consisting of three Scruples, and each Scruple of twenty Grains; +the medical Scruple of _Paris_ solely containing twenty-four Grains. + +The liquid Measure, the _Pot_ used at _Berne_, being that I always speak +of, may be estimated, without any material Error, to contain three +Pounds and a Quarter, which is equal to three Pints, and eight common +Spoonfuls English Measure. But the exact Weight of the Water, contained +in the Pot of _Berne_, being fifty-one Ounces and a Quarter only, it is +strictly equal but to three Pints and six common Spoonfuls _English_. +This however is a Difference of no Importance, in the usual Drinks or +Aliments of the Sick. + +The small drinking Glass we talk of, filled so as not to run over, +contains three Ounces and three Quarters. But filled, as we propose it +should for the Sick, it is to be estimated only at three Ounces. + +The common middle sized Cup, though rather large than little, contains +three Ounces and a Quarter. But as dealt out to the Sick, it should not +be estimated, at the utmost, above three Ounces. + +The small Glass contains seven common Spoonfuls; so that a Spoonful is +supposed to contain half an Ounce. + +The small Spoon, or Coffee Spoon, when of its usual Size and Cavity, may +contain thirty Drops, or a few more; but, in the Exhibition of +Medicines, it may be reckoned at thirty Drops. Five or six of these are +deemed equal in Measure, to a common Soup-Spoon. + +The Bason or Porrenger, mentioned in the present Treatise, holds, +without running over, the Quantity of five Glasses, which is equivalent +to eighteen Ounces and three Quarters. It may be estimated however, +without a Fraction, at eighteen Ounces: and a sick Person should never +be allowed to take more than a third Part of this Quantity of +Nourishment, at any one Time. + +The Doses in all the following Prescriptions are adjusted to the Age of +an Adult or grown Man, from the Age of eighteen to that of sixty Years. +From the Age of twelve to eighteen, two thirds of that Dose will +generally be sufficient: and from twelve down to seven Years one half, +diminishing this still lower, in Proportion to the greater Youth of the +Patient: so that not more than one eighth of the Dose prescribed should +be given to an infant of some Months old, or under one Year. But it must +also be considered, that their different Constitutions will make a +considerable Difference in adjusting their different Doses. It were to +be wished, on this Account, that every Person would carefully observe +whether a strong Dose is necessary to purge him, or if a small one is +sufficient; as Exactness is most important in adjusting the Doses of +such Medicines, as are intended to purge, or to evacuate in any other +Manner. + + + + No. 1. + + +Take a Pugil or large Pinch between the Thumb and Fingers of Elder +Flowers; put them into an earthen-ware Mug or Porrenger, with two Ounces +of Honey, and an Ounce and a half of good Vinegar. Pour upon them three +Pints and one Quarter of boiling Water. Stir it about a little with a +Spoon to mix and dissolve the Honey; then cover up the Mug; and, when +the Liquor is cold, strain it through a Linen Cloth. + + + + No. 2. + + +Take two Ounces of whole Barley, cleanse and wash it well in hot Water, +throwing away this Water afterwards. Then boil it in five Chopins or +_English_ Pints of Water, till the Barley bursts and opens. Towards the +End of the boiling, throw in one Drachm and a half of Nitre [Salt Petre] +strain it through a Linen Cloth, and then add to it one Ounce and a half +of Honey, and one Ounce of Vinegar. [113] + +[113] This makes an agreeable Drink; and the Notion of its being windy is + idle; since it is so only to those, with whom Barley does not + agree. It may, where Barley is not procurable, be made from Oats. + + + + No. 3. + + +Take the same Quantity of Barley as before, and instead of Nitre, boil +in it, as soon as the Barley is put in to boil, a Quarter of an Ounce of +Cream of Tartar. Strain it, and add nothing else [114] to it. + +[114] In those Cases mentioned Sec. 241, 262, 280, instead of the Barley, + four Ounces of Grass Roots may be boiled in the same Quantity of + Water for half an Hour, with the Cream of Tartar. + + + + No. 4. + + +Take three Ounces of the freshest sweet Almonds, and one Ounce of Gourd +or Melon Seed; bruise them in a Mortar, adding to them by a little at a +time, one Pint of Water, then strain it through Linen. Bruise what +remains again, adding gradually to it another Pint of Water, then +straining; and adding Water to the Residue, till full three Pints at +least of Water are thus used: after which it may again be poured upon +the bruised Mass, stirred well about, and then be finally strained off. +Half an Ounce of Sugar may safely be bruised with the Almonds and Seeds +at first, though some weakly imagine it too heating; and delicate +Persons may be allowed a little Orange Flower Water with it. + + + + No. 5. + + +Take two Pugils of Mallow Leaves and Flowers, cut them small, and pour a +Pint of boiling Water upon them. After standing some time strain it, +adding one Ounce of Honey to it. For Want of Mallows, which is +preferable, a similar Glyster may be made of the Leaves of Mercury, +Pellitory of the Wall, the Marsh-Mallows, the greater Mallows, from +Lettuce, or from Spinage. A few very particular Consititutions are not +to be purged by any Glyster but warm Water alone; such should receive no +other, and the Water should not be very hot. + + + + No. 6. + + +Boil a Pugil of Mallow Flowers, in a Pint of Barley Water for a Glyster. + + + + No. 7. + + +Take three Pints of simple Barley Water, add to it three Ounces of the +Juice of Sow-thistle, or of Groundsel, or of the greater Houseleek, or +of Borage. [115] + +[115] These Juices are to be procured from the Herbs when fresh and very + young, if possible, by beating them in a Marble Mortar, or for Want + of such [or a wooden Mortar] in an Iron one, and then squeezing out + the Juice through a Linen Bag. It must be left to settle a little + in an earthen Vessel, after which the clear Juice must be decanted + gently off, and the Sediment be left behind. + + + + No. 8. + + +To one Ounce of Oxymel of Squills, add five Ounces of a strong Infusion +of Elder Flowers. + + + + No. 9. + + +There are many different emollient Applications, which have very nearly +the same Virtues. The following are the most efficacious. + +1, Flanels wrung out of a hot Decoction of Mallow Flowers. + +2, Small Bags filled with Mallow Flowers, or with those of Mullein, of +Elder, of Camomile, of wild Corn Poppy, and boiled either in Milk or +Water. + +3, Pultices of the same Flowers boiled in Milk and Water. + +4, Bladders half filled with hot Milk and Water, or with some emollient +Decoction. + +5, A Pultice of boiled Bread and Milk, or of Barley or Rice boiled till +thoroughly soft and tender. + +6, In the Pleurisy (See Sec. 89) the affected Part may be rubbed sometimes +with Ointment of Marsh-mallows. + + + + No. 10. + + +To one Ounce of Spirit of Sulphur, add six Ounces of Syrup of Violets, +or for want of the latter, as much Barley Water, of a thicker +Consistence than ordinary. [116] + +[116] Some Friends, says Dr. _Tissot_, whose judgment I greatly respect, + have thought the Doses of acid Spirit which I direct extremely + strong; and doubtless they are so, if compared with the Doses + generally prescribed, and to which I should have limited myself, if + I had not frequently seen their Insufficience. Experience has + taught me to increase them considerably; and, augmenting the Dose + gradually, I now venture to give larger Doses of them than have + ever been done before, and always with much Success; the same Doses + which I have advised in this Work not being so large as those I + frequently prescribe. For this Reason I intreat those Physicians, + who have thought them excessive, to try the acid Spirits in larger + Doses than those commonly ordered; and I am persuaded they will see + Reason to congratulate themselves upon the Effect. [117] + +[117] Our Author's _French_ Annotator has a Note against this Acid, which + I have omitted; for though I have given his Note Page 84 [with the + Substance of the immediately preceding one] to which I have also + added some Doubts of my own, from Facts, concerning the Benefit of + Acids in inflammatory Disorders of the Breast; yet with Regard to + the ardent, the putrid, the malignant Fever, and _Erisipelas_, in + which Dr. _Tissot_ directs this, I have no Doubt of its Propriety + (supposing no insuperable Disagreement to Acids in the + Constitution) and with Respect to their Doses, I think we may + safely rely on our honest Author's Veracity. Dr. _Fuller_ assures + us, a Gentleman's Coachman was recovered from the Bleeding Small + Pocks, by large and repeated Doses of the Oil of Vitriol, in + considerable Draughts of cold Water. _K._ + + + + No. 11. + + +Take two Ounces of Manna, and half an Ounce of Sedlitz Salt, or for want +of it, as much Epsom Salt; dissolving them in four Ounces of hot Water, +and straining them. + + + + No. 12. + + +Take of Elder Flowers one Pugil, of Hyssop Leaves half as much. Pour +three Pints of boiling Water upon them. After infusing some time, +strain, and dissolve three Ounces of Honey in the Infusion. + + + + No. 13. + + +Is only the same Kind of Drink made by omitting the Hyssop, and adding +instead of it as much more Elder Flowers. + + + + No. 14. + + +Let one Ounce of the best Jesuits Bark in fine Powder be divided into +sixteen equal Portions. + + + + No. 15. + + +Take of the Flowers of St. _John's_ Wort, of Elder, and of Melilot, of +each a few Pinches; put them into the Bottom of an Ewer or Vessel +containing five or six _English_ Pints, with half an Ounce of Oil of +Turpentine, and fill it up with boiling Water. + + + + No. 16. + + +Is only the Syrup of the Flowers of the wild red Corn Poppy. + + + + No. 17. + + +Is only very clear sweet Whey, in every Pint of which one Ounce of Honey +is to be dissolved. + + + + No. 18. + + +Take of Castile or hard white Soap six Drachms; of Extract of Dandelion +one Drachm and a half; of Gum Ammoniacum half a Drachm, and with Syrup +of Maidenhair make a Mass of Pills, to be formed into Pills, weighing +three Grains each. + + + + No. 19. + + +Gargarisms may be prepared from a Decoction, or rather an Infusion, of +the Leaves of Periwinkle, or of Red Rose-Leaves, or of Mallows. Two +Ounces of Vinegar and as much Honey must be added to every Pint of it, +and the Patient should gargle with it pretty hot. The deterging, +cleansing Gargarisin referred to Sec. 112, is a light Infusion of the Tops +of Sage, adding two Ounces of Honey to each Pint of it. + + + + No. 20. + + +Is only one Ounce of powdered Nitre, divided into sixteen equal Doses. + + + + No. 21. + + +Take of Jalap, of Senna, and of Cream of Tartar of each thirty Grains +finely powdered; and let them be very well mixed. [118] + +[118] This, our Author observes, will work a strong Country-man very + well: by which however he does not seem to mean an Inhabitant of + the Mountains in _Valais_. See P. 547. + + + + No. 22. + + +Take of _China_ Root, and of Sarsaparilla of each one Ounce and a half, +of Sassafras Root, and of the Shavings of Guiacum, otherwise called +_Lignum vitae_, of each one Ounce. Let the whole be cut very fine. Then +put them into a glazed earthen Vessel; pouring upon them about five +pints of boiling Water. Let them boil gently for an Hour; then take it +from the Fire, and strain it off through Linen. This is called the +Decoction of the Woods, and is often of different Proportions of these +Ingredients, or with the Addition of a few others. More Water may, after +the first boiling, be poured on the same Ingredients, and be boiled up +into a small Decoction for common Drink. + + + + No. 23. + + +Take one Ounce of the Pulp of Tamarinds, half a Drachm of Nitre, and +four Ounces of Water; let them boil not more than one Minute, then add +two Ounces of Manna, and when dissolved strain the Mixture off. + + + + No. 24. + + +Is only an Ounce of Cream of Tartar, divided into eight equal Parts. + + + + No. 25. + + +This Prescription is only the Preparation of Kermes mineral, otherwise +called the Chartreusian Powder. Dr. _Tissot_ orders but one Grain for a +Dose. It has been directed from one to three. + + + + No. 26. + + +Take three Ounces of the common Burdock Root; boil it for half an Hour, +with half a Drachm of Nitre, in three full Pints of Water. + + + + No. 27. + + +Take half a Pinch of the Herbs prescribed No. 9, Article 2, and half an +Ounce of hard white Soap shaved thin. Pour on these one Pint and a half +of boiling Water, and one Glass of Wine. Strain the Liquor and squeeze +it strongly out. + + + + No. 28. + + +Take of the purest Quicksilver one Ounce; of Venice Turpentine half a +Drachm, of the freshest Hog's Lard two Ounces, and let the whole be very +well rubbed together into an Ointment. [119] + +[119] This Ointment should be prepared at the Apothecaries; the Receipt + of it being given here, only because the Proportions of the + Quicksilver and the Lard are not always the same in different + Places. + + + + No. 29. + + +This Prescription is nothing but the yellow Basilicon. + + + + No. 30. + + +Take of natural and factitious, or artificial Cinnabar, twenty-four +Grains each; of Musk sixteen Grains, and let the whole be reduced into +fine Powder, and very well mixed. [120] + +[120] This Medicine is known by the Name of _Cob's_ Powder; and as its + Reputation is very considerable, I did not chuse to omit it; though + I must repeat here what I have said Sec. 195--That the Cinnabar is + probably of little or no Efficacy; and there are other Medicines + that have also much more than the Musk; which besides is extremely + dear for poor People, as the requisite Doses of it, in very + dangerous Cases, would cost ten or twelve Shillings daily. The + Prescription, No. 31, is more effectual than the Musk; and instead + of the useless Cinnabar, the powerful Quicksilver may be given to + the Quantity of forty-five Grains. I have said nothing hitherto in + this Work of the red blossomed Mulberry Tree, which passes for a + real Specific, among some Persons, in this dreadful Malady. An + Account of it may be seen in the first Volume of the Oeconomical + Journal of _Berne_. It is my Opinion however, that none of the + Instances related there are satisfactory and decisive; its Efficacy + still appearing to me very doubtful. + + + + No. 31. + + +Take one Drachm of _Virginia_ Snake Root in Powder; of Camphor and of +Assa-foetida ten Grains each; of Opium one Grain, and with a sufficient +Quantity of Conserve, or Rob of Elder, make a Bolus. [121] + +[121] When this is preferred to No. 30, of which Musk is an Ingredient, + the Grain of Opium should be omitted, except once or at most twice + in the twenty-four Hours. Two Doses of Quicksilver, of fifteen + Grains each, should be given daily in the Morning, in the Interval + between the other Bolus's. + + + + No. 32. + + +Take three Ounces of Tamarinds. Pour on them one Pint of boiling Water, +and after letting them boil a Minute or two, strain the Liquor through a +Linen Cloth. + + + + No. 33. + + +Take seven Grains of Turbith Mineral; and make it into a Pill or Bolus +with a little Crumb of Bread. [122] + +[122] This Medicine makes the Dogs vomit and slaver abundantly. It has + effected many Cures after the _Hydrophobia_, the Dread of Water, + was manifest. It must be given three Days successively, and + afterwards twice a Week, for fifteen Days. + + + + No. 34. + + +This is nothing but a Prescription of six Grains of Tartar [123] emetic. + +[123] When People are ignorant of the Strength of the Tartar emetic + (which is often various) or of the Patient's being easy or hard to + vomit, a Dose and a half may be dissolved in a Quart of warm Water, + of which he may take a Glass every Quarter of an Hour, whence the + Operation may be forwarded, or otherwise regulated, according to + the Number of Vomits or Stools. This Method, much used in _Paris_, + seems a safe and eligible one. + + + + No. 35. + + +Take thirty-five Grains of Ipecacuanna, which, in the very strongest +Constitutions, may be augmented to forty-five, or even to fifty Grains. + + + + No. 36. + + +Prescribes only the common blistering Plaister; and the Note observes +that very young Infants who have delicate Skins may have Sinapisms +applied instead of Blisters; and made of a little old Leaven, kneaded up +with a few Drops of sharp Vinegar. + + + + No. 37. + + +Take of the Tops of _Chamaedrys_ or Ground Oak, of the lesser Centaury, +of Wormwood and of Camomile, of each one Pugil. Pour on them three Pints +of boiling Water; and suffering them to infuse until it is cold, strain +the Liquor through a Linen Cloth, pressing it out strongly. + + + + No. 38. + + +Take forty Grains of Rhubarb, and as much Cream of Tartar in Powder, +mixing them well together. + + + + No. 39. + + +Take three Drachms of Cream of Tartar, and one Drachm of Ipecacuanna +finely powdered. Rub them well together, and divide them into six equal +Parts. + + + + No. 40. + + +Take of the simple Mixture one Ounce, of Spirit of Vitriol half an +Ounce, and mix them. The Dose is one or two Tea Spoonfuls in a Cup of +the Patient's common Drink. The simple Mixture is composed of five +Ounces of Treacle Water camphorated, of three Ounces of Spirit of Tartar +rectified, and one Ounce of Spirit of Vitriol. If the Patient has an +insuperable Aversion to the Camphor, it must be omitted, though the +Medicine is less efficacious without it. And if his Thirst is not very +considerable, the simple Mixture may be given alone, without any further +Addition of Spirit of Vitriol. + + + + No. 41. + + +Take half a Drachm of _Virginia_ Snake-root, ten Grains of Camphor, and +make them into a Bolus with Rob of Elder-Berries. If the Patient's +Stomach cannot bear so large a Dose of Camphor, he may take it in +smaller Doses and oftner, _viz._ three Grains, every two Hours. If there +is a violent Looseness, Diascordium must be substituted instead of the +Rob of Elder-berries. + + + + No. 42. + + +Prescribes only the _Theriaca pauperum_, or poor Man's Treacle, in the +Dose of a Quarter of an Ounce. The following Composition of it is that +chiefly preferred by our Author. Take equal Parts of round Birthwort +Roots, of Elecampane, of Myrrh, and of Rob or Conserve of +Juniper-berries, and make them into an Electuary of a rather thin, than +very stiff Consistence, with Syrup of Orange-peel. + + + + No. 43. + + +The first of the three Medicines referred to in this Number, is that +already directed, No. 37. The second is as follows. + +Take equal Parts of the lesser Centaury, of Wormwood, of Myrrh, all +powdered, and of Conserve of Juniper-berries, making them up into a +pretty thick Consistence with Syrup of Wormwood. The Dose is a Quarter +of an Ounce; to be taken at the same Intervals as the Bark. + +For the third Composition--Take of the Roots of Calamus Aromaticus and +Elecampane well bruised, two Ounces; of the Tops of the lesser Centaury +cut small, a Pugil; of Filings of unrusted Iron two Ounces, of old white +Wine, three Pints. Put them all into a wide necked Bottle, and set it +upon Embers, or on a Stove, or by the Chimney, that it may be always +kept hot. Let them infuse twenty-four Hours, shaking them well five or +six Times; then let the Infusion settle, and strain it. The Dose is a +common Cup every four Hours, four Times daily, and timing it one Hour +before Dinner. + + + + No. 44. + + +Take a Quarter of an Ounce of Cream of Tartar, a Pugil of common +Camomile; boil them in twelve Ounces of Water for half an Hour, and +strain it off. + + + + No. 45. + + +Directs only the common Sal Ammoniac, from two Scruples to one Drachm +for a Dose. The Note to it adds, that it may be made into a Bolus with +Rob of Elder; and observes, that those feverish Patients, who have a +weak delicate Stomach, do not well admit of this Salt; no more than of +several others, which affect them with great Disorder and Anxiety. + + + + No. 46. + + +The Powder. Take one Pugil of Camomile Flowers, and as much Elder +Flowers, bruising them well; of fine Flour or Starch three Ounces; of +Ceruss and of blue Smalt each half an Ounce. Rub the whole, and mix them +well. This Powder may be applied immediately to the Part. + +The Plaister. Take of the Ointment called _Nutritum_, made with the +newest sweet Oil, two Ounces; of white Wax three Quarters of an Ounce, +and one Quarter of an Ounce of blue Smalt. Melt the Wax, then add the +_Nutritum_ to it, after the Smalt finely powdered has been exactly +incorporated with it; stirring it about with an Iron Spatula or Rod, +till the whole is well mixed and cold. This is to be smoothly spread on +Linen Cloth. + +A Quarter of an Ounce of Smalt may also be mixed exactly with two Ounces +of Butter or Ointment of Lead, to be used occasionally instead of the +Plaister. + + + + No. 47. + + +Take one Ounce of Sedlitz, or for want of that, as much Epsom Salt, and +two Ounces of Tamarinds: pour upon them eight Ounces of boiling Water, +stirring them about to dissolve the Tamarinds. Strain it off; and divide +it into two equal Draughts, to be given at the Interval of Half an Hour +between the first and last. + + + + No. 48. + + +Take of _Sydenham_'s Liquid Laudanum eighty Drops; of Bawm Water two +Ounces and a half. If the first, or the second, Dose stops or +considerably lessens the Vomiting, this [124] Medicine should not be +further repeated. + +[124] The medical Editor at _Lyons_ justly notes here, that these eighty + Drops are a very strong Dose of liquid Laudanum; adding that it is + scarcely ever given at _Lyons_ in a greater Dose than thirty Drops; + and recommending a Spoonful of Syrup of Lemon-peel to be given with + it--But we must observe here in answer to this Note, that when Dr. + _Tissot_ directs this Mixture in the Iliac Passion Sec. 318, to + appease the Vomitings, Art. 3, he orders but one spoonful of this + Mixture to be taken at once, and an Interval of two Hours to be + observed between the first and second Repetition, which reduces + each Dose to sixteen Drops, and which is not to be repeated without + Necessity. + + + + No. 49. + + +Dissolve three Ounces of Manna and twenty Grains of Nitre in twenty +Ounces, or six Glasses, of sweet Whey. + + + + No. 50. + + +To two Ounces of Syrup of Diacodium, or white Poppy Heads, add an equal +Weight of Elder Flower Water, or, for want of it, of Spring Water. + + + + No. 51. + + +Directs nothing but a Drachm of Rhubarb in Powder. + + + + No. 52. + + +Take of _Sulphur vivum_, or of Flower of Brimstone, one Ounce; of Sal +Ammoniac, one Drachm; of fresh Hogs Lard, two Ounces; and mix the whole +very well in a Mortar. + + + + No. 53. + + +Take two Drachms of crude Antimony and as much Nitre, both finely +powdered and very well mixed; dividing the whole into eight equal +Doses. [125] + +[125] This Medicine, which often occasions Cholics in some Persons of a + weakly Stomach, is attended with no such Inconvenience in strong + Country People; and has been effectual in some Disorders of the + Skin, which have baffled other Medicines--The Remainder of this + Note observes the great Efficacy of Antimony in promoting + Perspiration, and the extraordinary Benefit it is of to Horses in + different Cases. + + + + No. 54. + + +Take of Filings of Iron, not the least rusty, and of Sugar, each one +Ounce; of Aniseeds Powdered, half an Ounce. After rubbing then very well +together, divide the Powder into twenty-four equal Portions; one of +which is to be taken three times a Day an Hour before eating. [126] + +[126] The Prescriptions No. 54, 55, 56, are calculated against Distempers + which arise from Obstructions, and a Stoppage of the monthly + Discharges; which No. 55 is more particularly intended to remove; + those of 54 and 56 are most convenient, either when the Suppression + does not exist, or is not to be much regarded, if it does. This + Medicine may be rendered less unpalatable for Persons in easy + Circumstances, by adding as much Cinamon instead of Aniseeds; and + though the Quantity of Iron be small, it may be sufficient, if + given early in the Complaint; one, or at the most, two of these + Doses daily, being sufficient for a very young Maiden. + + + + No. 55. + + +Take of Filings of sound Iron two Ounces; of Leaves of Rue, and of white +Hoar-hound one Pugil each; of black Hellebore Root, one Quarter of an +Ounce, and infuse the whole in three Pints of Wine in the Manner already +directed, No. 43. The Dose of this is one small Cup three times a Day, +an Hour before eating. [127] + +[127] I chuse to repeat here, the more strongly to inculcate so important + a Point, that in Women who have long been ill and languid, our + Endeavours must be directed towards the restoring of the Patient's + Health and Strength, and not to forcing down the monthly + Discharges, which is a very pernicious Practice. These will return + of Course, if the Patient is of a proper Age, as she grows better. + Their Return succeeds the Return of her Health, and should not, + very often cannot, precede it. + + + + No. 56. + + +Take two Ounces of Filings of Iron; of Rue Leaves and Aniseed powdered, +each half an Ounce. Add to them a sufficient Quantity of Honey to make +an Electuary of a good Consistence. The Dose is a Quarter of an Ounce +three times daily. + + + + No. 57. + + +Take of the Extract of the stinking Hemlock, with the purple spotted +Stalk, one Ounce. Form it into Pills weighing two Grains each; adding as +much of the Powder of dry Hemlock Leaves, as the Pills will easily take +up. Begin the Use of this Medicine by giving one Pill Night and Morning. +Some Patients have been so familiarized to it, as to take at length Half +an Ounce daily. [128] + +[128] Our learned and candid Author has a very long Note in this Place, + strongly in Favour of _Storck's_ Extract of Hemlock, in which it is + evident he credits the greater Part of the Cures affirmed by Dr. + _Storck_ to have been effected by it. He says he made some himself, + but not of the right Hemlock, which we think it very difficult to + mistake, from its peculiar rank fetid Smell, and its purple spotted + Stalk. After first taking this himself, he found it mitigated the + Pain of Cancers, but did not cure them. But then addressing himself + to Dr. _Storck_, and exactly following his Directions in making it, + he took of Dr. _Storck's_ Extract, and of his own, which exactly + resembled each other, to the Quantity of a Drachm and a half daily; + and finding his Health not in the least impaired by it, he then + gave it to several Patients, curing many scrophulous and cancerous + Cases, and mitigating others, which he supposes were incurable. So + that he seems fully persuaded Dr. _Storck's_ Extract is always + innocent [which in Fact, except in a very few Instances, none of + which were fatal, it has been] and he thinks it a Specific in many + Cases, to which nothing can be substituted as an equivalent Remedy; + that it should be taken with entire Confidence, and that it would + be absurd to neglect its Continuance. + + The Translator of this Work of Dr. _Tissot's_ has thought it but + fair to give all the Force of this Note here, which must be his + own, as his Editor at _Lyons_ seems to entertain a very different + Opinion of the Efficacy of this Medicine; for which Opinion we + refer back to his Note, Sec. 375, of this Treatise, which the Reader + may compare with this of our Author's. _K._ + + + + No. 58. + + +Take of the Roots of Grass and of Succory well washed, each one Ounce. +Boil them a Quarter of an Hour in a Pint of Water. Then dissolve in it +Half an Ounce of Sedlitz, or of _Epsom_ Salt, and two Ounces of Manna; +and strain it off to drink one Glass of it from Half Hour, to Half Hour, +till its Effects are sufficient. It is to be repeated at the Interval of +two or three Days. + + + + No. 59. + + +Is a Cataplasm or Pultice made of Crumb of Bread, with Camomile Flowers +boiled in Milk, with the Addition of some Soap, so that each Pultice may +contain half a Quarter of an Ounce of this last Ingredient. And when the +Circumstances of female Patients have not afforded them that regular +Attendance, which the Repetition of the Pultice requires, as it should +be renewed every three Hours, I have successfully directed the Hemlock +Plaister of the Shops. + + + + No. 60. + + +Take a sufficient Quantity of dry Hemlock Leaves. Secure them properly +between two Pieces of thin Linen Cloth, so as to make a very flexible +Sort of small Matrass, letting it boil a few Moments in Water, then +squeeze it out and apply it to the affected Part. It must thus be +moistened and heated afresh, and re-applied every two Hours. + + + + No. 61. + + +Take of the Eyes of the Craw-fish, or of the true white Magnesia, two +Drachms; of Cinnamon powdered four Grains. Rub them very well together, +and divide the whole into eight Doses. One of these is to be given in a +Spoonful of Milk, or of Water, before the Infant sucks. + + + + No. 62. + + +Take of an Extract of Walnuts, made in Water, two Drachms; and dissolve +it in half an Ounce of Cinnamon Water. Fifty Drops a Day of this +Solution is to be given to a Child of two Years old; and after the whole +has been taken, the Child should be purged. This Extract is to be made +of the unripe Nuts, when they are of a proper Growth and Consistence for +pickling. + + + + No. 63. + + +Take of Rezin of Jalap two Grains. Rub it a considerable time with +twelve or fifteen Grains of Sugar, and afterwards with three or four +sweet Almonds; adding, very gradually, two common Spoonfuls of Water. +Then strain it through clear thin Linen, as the Emulsion of Almonds was +ordered to be. Lastly, add a Tea Spoonful of Syrup of Capillaire to it. +This is no disagreable Draught, and may be given to a Child of two Years +old: and if they are older, a Grain or two more of the Rezin may be +allowed. But under two Years old, it is prudent to purge Children rather +with Syrup of Succory, or with Manna. + + + + No. 64. + + +Take of the Ointment called _Nutritum_ one Ounce; the entire Yolk of one +small Egg, or the Half of a large one, and mix them well together. This +_Nutritum_ may be readily made by rubbing very well together, and for +some time, two Drachms of Ceruss [white Lead] half an Ounce of Vinegar, +and three Ounces of common Oil. + + + + No. 65. + + +Melt four Ounces of white Wax; add to it, if made in Winter two +Spoonfuls of Oil; if in Summer none at all, or at most, not above a +Spoonful. Dip in this Slips of Linen Cloth not worn too thin, and let +them dry: or spread it thin and evenly over them. + + + + No. 66. + + +Take of Oil of Roses one Pound; of red Lead half a Pound; of Vinegar +four Ounces. Boil them together nearly to the Consistence of a Plaister; +then dissolve in the liquid Mass an Ounce and a Half of yellow Wax, and +two Drachms of Camphor, stirring the whole about well. Remove it then +from the Fire, and spread it on Sheets or Slips of Paper, of what Size +you think most convenient. The Ointment of _Chambauderie_, so famous in +many Families on the Continent, is made of a Quarter of a Pound of +yellow Wax, of the Plaister of three Ingredients (very nearly the same +with No. 66) of compound Diachylon and of common Oil, of each the same +Quantity, all melted together, and then stirred about well, after it is +removed from the Fire, till it grows cold. To make a Sparadrap, or Oil +Cloth, which is Linen, covered with, or dipt in an emplastic Substance +or Ointment, it must be melted over again with the Addition of a little +Oil, and applied to the Linen as directed at No. 65. + + + + No. 67. + + +Gather in Autumn, while the fine Weather 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, +That 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 Bleedings; and +generally falls off at the End of two Days. 3, The third Part, adhering +to the second may serve to stop the Bleeding from the smaller Vessels; +and the fourth and last Part may be reduced to Powder, as conducing to +the same Purpose. [129] + +[129] Our Author attests his seeing the happiest Consequences from this + Application, which M. _Brossard_, a very eminent _French_ Surgeon, + first published; and declared his Preference of that Agaric which + sprung from those Parts of the Tree, from whence large Boughs had + been lopped. + + + + No. 68. + + +Take four Ounces of Crumbs of Bread, a Pugil of Elder Flowers, and the +same Quantity of those of Camomile, and of St. _John's_ Wort. Boil them +into a Pultice in equal Quantities of Vinegar and Water. + +If Fomentations should be thought preferable, take the same Herbs, or +some Pugils of the Ingredients for _Faltrank_: throw them into a Pint +and a Half of boiling Water: and let them infuse some Minutes. Then a +Pint of Vinegar is to be added, and Flanels or other woollen Cloths dipt +in the Fomentation, and wrung out, are to be applied to the Part +affected. + +For the aromatic Fomentations recommended Sec. 449, take Leaves of Betony +and of Rue, Flowers of Rosemary or Lavender, and red Roses, of each a +Pugil and a Half. Boil them for a Quarter of an Hour in a Pot with a +Cover, with three Pints of old white Wine. Then strain off, squeezing +the Liquor strongly from the Herbs, and apply it as already directed. + + + + No. 69. + + +Directs only the Plaister of Diapalma. [130] + +[130] To spread this upon Lint as directed, Sec. 456, it must be melted down + again with a little Oil. + + + + No. 70. + + +Directs only a Mixture of two Parts Water, and one Part of Vinegar of +Litharge. + + + + No. 71. + + +Take of the Leaves of Sow-bread, and of Camomile Tops, of each one +Pugil. Put them into an earthen Vessel with half an Ounce of Soap, and +as much Sal Ammoniac, and pour upon them three Pints of boiling Water. + +_N. B._ I conceive all the Notes to this Table, in which I have not +mentioned the Editor at _Lyons_, nor subscribed with my initial Letter +_K_, to come from the Author, having omitted nothing of them, but the +Prices. + + + + + ERRATA. + + +Page 4, Line 6, for _os_ read _of_. p. 16, l. 16, for _be_ read _me_. p. +29, l. 12, after _it_ add . p. 49, l. 12, dele _and_ at the End of it. +p. 51, in the running Title, for _Causss_ read _Causes_. ib. l. 2, dele +_and_. ib. l. 7, dele _and_. p. 57, last line, for _hurtsul_ read +_hurtful_. p. 67, l. 17, after _Water_, add, _may be placed within the +Room_. p. 74, line last but two, after _never_, dele , p. 96, l. 11, for +_Aiiment_ read _Ailment_. p. 106, l. 23, for the second _is_ read _has_. +p. 126, l. 21, for _breath_ read _breathe_. p. 137, l. 13, for +_Efflorescene_ read _Efflorescence_, p. 145, l. 1, for _Water_ read +_Tea_. p. 148, l. 19, for _beomes_ read _becomes_. p. 163, l. 30. in the +Note, for _occured_ read _occurred_; p. 171, l. 20, dele _and_. p. 189, +l. 28, dele _of_. p. 199, l. 6, for _Paulmier_ read _Palmarius_, being +the _Latinized_ Name of that _Physician_; as we say for _Fernel +Fernelius, Holler Hollerius, &c._ _N. B._ His Powder for the Bite of a +mad Dog consisted of equal Parts of Rue, Vervain, Plantain, Polypody, +common Wormwood, Mugwort, Bastard Baum, Betony, St. _John's_ Wort, and +lesser Centaury Tops, to which _Default_ adds Coraline.----p. 237, l. 2, +for _Streakes_ read _Streaks_. p. 256, first line of the Note * _dele_ +the first _often_. p. 261, l. 15, for _happens_ read _happen_. p. 270, +l. 12, dele _t_ in _Switsserland_. p. 282, l. 23, for _enters_ read +_enter_. p. 283, l. 23, for _Stomach_ read _Stomachs_. p. 284, l. 12, +for _it_ read _them_. p. 287, Note * l. 25, for _here_ read _there_. p. +303, l. 14, for _doubtsul_ read _doubtful_. p. 311, l. 18, for _abate_ +read _abates_. p. 337, l. 7, for _glary_ read _glairy_. N. B. In the +first Page that is folio'd 445 read 345. p. 346, l. 19, for _two_ read +_too_. p. 351, l. 25, after Waters add, _such as Infusions of Tea, &c._ +p. 375, l. 7, for _two_ read _too_. p. 392, last line, for _Leaves_ read +_Flowers_. p. 393, l. 26, after _them_, insert _and_. p. 397, l. 1 and +2, for Temparrament read _Temperament_. p. 422, l. 6, between _several_ +and _Consequences_ insert _bad_. p. 454, l. 5, for _Diflocation_ read +_Dislocation_. p. 459, l. 17, in _Ice-thaws_ dele - p. 466, l. 16, to +_Constitution_ add _s_. p. 486, l. 29, after _or_ add _if_. p. 487, l. +12, for _Parts_ read _Part_. p. 511, l. 12, for _not_ read _nor_. p. +533, l. 12, for _arrives_ read _arises_. p. 542, l. 22, for _Patient_ +read _Patients_. p. 562, l. 14, for _fays_ read _says_. p. 573, l. 10, +after _Cause_, dele _Comma_. + + + + + _Table_ _of the several Chapters, and their principal Contents._ + + +Introduction ---- Page 1 +The first Cause of Depopulation, Emigrations ---- _ib._ +The second Cause, Luxury ---- 6 +Third Cause, Decay of Agriculture ---- 10 +Fourth Cause, the pernicious Treatment of Diseases ---- 12 +Means for rendering this Treatise useful ---- 15 +Explanation of certain physical Terms, and Phrases ---- 26 + + _Chapter I._ + +_The most common Causes of popular Sickness_ ---- 31 +First Cause, excessive Labour ---- _ib._ +Second Cause, the Effect of cold Air, when a Person is hot ---- 33 +Third Cause, taking cold Drink, when in a Heat ---- _ib._ _&_ 34 +Fourth Cause, the Inconstancy and sudden Change of the Weather ---- 35 +Fifth Cause, the Situation of Dunghills, and Marshes, near inhabited +Houses, and the bad confined Air in the Houses ---- 37 +Sixth Cause, Drunkenness ---- 38 +Seventh Cause, the Food of Country People ---- 39 +Eighth Cause, the Situation, or Exposure of Houses ---- 42 +Concerning the Drink of Country People ---- 43 + + _Chap. II._ + +_Of Causes which increase the Diseases of the People, with general +Considerations_ ---- 47 +First Cause, the great Care employed to force the Sick to sweat, and the +Methods taken for that Purpose ---- _ib._ _&_ 48 +The Danger of hot Chambers ---- 49 +The Danger of hot Drinks and heating Medicines ---- 50 +Second Cause, the Quantity and Quality of the Food given sick Persons +---- 53 +Third Cause, the giving Vomits and Purges at the Beginning of the +Disease ---- 57 + + _Chap. III._ + +_Concerning what should be done in the Beginning of Diseases, and the +Diet in acute Diseases_ ---- 61 +Signs which indicate approaching Diseases; with Means to prevent them +---- 62 +The common Regimen, or Regulations, for the Sick ---- 64 +The Benefits of ripe sound Fruits ---- 68 +Cautions and Means to be used, on Recovery ---- 73, 74 + + _Chap. IV._ + +_Of the Inflammation of the Breast_ ---- 77 +The Signs of this Disease ---- _ib._ _&_ 78 +The Advantage of Bleeding ---- 81 +Signs of Recovery ---- 85 +Of _Crises_, and the Symptoms that precede them ---- 86 +The Danger of Vomits, of Purges, and of Anodynes ---- 88 +Of the Suppression of Expectoration, and the Means to restore it. +---- 89 +Of the Formation of _Vomicas_, or Imposthumes in the Lungs, and the +Treatment of them ---- 90 +Of the Danger of Remedies, termed Balsamics ---- 103 +The Inefficacy of the Antihectic of _Poterius_ ---- 104 +Of an _Empyema_ ---- 105 +Of a Gangrene of the Lungs ---- 106 +Of a _Scirrhus_ of the Lungs ---- _ib._ + + _Chap. V._ + +_Of the Pleurisy_ ---- 108 +The Danger of heating Remedies ---- 112 to 115 +Of frequent, or habitual, Pleurisies ---- 116 +Of Goats Blood; the Soot of a stale Egg, and of the Wormwood of the +Alps, in Pleurisies ---- 117, 118 + + _Chap. VI._ + +_Of Diseases of the Throat_ ---- 119 +Of their proper Treatment ---- 124 +Of the Formation of an Abscess there ---- 127 +Of swelled Ears, from the Obstruction of the parotid and maxillary +Glands ---- 131 +Of the epidemic and putrid Diseases of the Throat, which prevailed in +1761 at _Lausanne_ ---- 132 + + _Chap. VII._ + +_Of Colds_ ---- 139 +Different Prejudices concerning Colds ---- _ib._ _&_ 140 +The Danger of drinking much hot Water, and of strong spirituous Liquors, +_&c._ ---- 146 +Means for strengthening and curing Persons very subject to Colds +---- 148 + + _Chap. VIII._ + +_Of Diseases of the Teeth_ ---- 150 + + _Chap. IX._ + +_Of the Apoplexy_ ---- 158 +Of sanguine Apoplexy ---- _ib._ _&_ 159 +Of a serous, or watery, Apoplexy ---- 162 +Means to prevent relapsing into them ---- 164 _& seq._ + + _Chap. X._ + +_Of morbid Strokes of the Sun_ ---- 167 + + _Chap. XI._ + +_Of the Rheumatism_ ---- 177 +Of the acute Rheumatism, attended with a Fever ---- _ib._ +Of the flow, or chronical, without a Fever ---- 186 +The Danger of spirituous and greasy Remedies ---- 191, 192 + + _Chap. XII._ + +_Of the Bite of a mad Dog_ ---- 194 + + _Chap. XIII._ + +_Of the Small Pocks._ ---- 207 +Of the preceding Symptoms of this Disease ---- 209 +--The Danger of sweating Medicines ---- 217 +--The Treatment of the benign distinct Small Pocks ---- 220 +--The Use of Bleeding ---- 222 +--The Fever of Suppuration ---- 223 +--The Necessity of opening the ripe Pustules ---- 226 +--The Danger of Anodynes ---- 228 +Of the striking in of the Eruptions ---- 229 +Preparations for receiving it favorably ---- 230 + + _Chap. XIV._ + +_Of the Measles_ ---- 235 +Of their Treatment and the Means to prevent any of their bad +Consequences, to ---- 243 + + _Chap. XV._ + +_Of the hot, or burning, Fever_ ---- 244 + + _Chap. XVI._ + +_Of putrid Fevers_ ---- 248 + + _Chap. XVII._ + +_Of malignant Fevers_ ---- 257 +The Danger of applying living Animals in them ---- 267 + + _Chap. XVIII._ + +_Of intermitting Fevers_ ---- 269 +--Spring and Autumn Intermittents ---- 272 +Method of Cure by the Bark ---- 275 +Method of treating the Patient in the Fit ---- 277 +Of other Febrifuges, besides the Bark ---- 278 +The Treatment of long and obstinate Intermittents ---- 279 +Of some very dangerous Intermittents ---- 284 +Of some periodical Disorders, which may be termed, Fevers disguised +---- 285 +Of Preservatives from unwholesome Air ---- 286 + + _Chap. XIX._ + +_Of an_ Erisipelas, _or St._ Anthony's _Fire._ ---- 288 +Of a frequent or habitual _Erisipelas_ ---- 295 +Of the Stings or Bites of Animals ---- 296 + + _Chap. XX._ + +_Of Inflammations of the Breast, and of Bastard and bilious Pleurisies_ +---- 298 +--Of the false Inflammation of the Breast ---- 300 +--The false Pleurisy ---- 303 + + _Chap. XXI._ + +_Of Cholics_ ---- 306 +Of the inflammatory Cholic ---- 307 +--the bilious Cholic ---- 312 +--the Cholic from Indigestion, and of Indigestions ---- 314 +--the flatulent, or windy, Cholic ---- 317 +--the Cholic, from taking Cold ---- 319 + + _Chap. XXII._ + +_Of the_ Miserere, _or Iliac Passion, and of the_ Cholera Morbus +---- 322 +The _Miserere_ ---- _ib._ _&_ 323 +The _Cholera Morbus_ ---- 327 + + _Chap. XXIII._ + +_Of a_ Diarrhoea, _or Looseness_ ---- 332 + + _Chap. XXIV._ + +_Of a Dysentery, or Bloody-Flux_ ---- 335 +The Symptoms of the Disease ---- 336 +The Remedies against it ---- 338 +Of the beneficial Use of ripe Fruits ---- 341 +Of the Danger of taking a great Number of popular Remedies in it +---- 345 + + _Chap. XXV._ + +_Of the Itch_ ---- 347 + + _Chap. XXVI._ + +_Directions peculiar to the Sex_ ---- 352 +Of the monthly Customs ---- 353 +Of Gravidation, or going with Child ---- 365 +Of Labours or Deliveries, ---- 367 +Of their Consequences ---- 371 +Of a Cancer ---- 373 + + _Chap. XXVII._ + +_Directions with Regard to Children_ ---- 375 +Of the first Cause of their Disorders, the _Meconium_ ---- 377 +--the second, the souring of their Milk ---- 379 +--the Danger of giving them Oil ---- _ib._ +--Disorders from their Want of Perspiration, the Means of keeping it up, +and of washing them in cold Water ---- 381 _&_ 382 +--the third Cause, the cutting of their Teeth ---- 386 +--the fourth Cause, Worms ---- 387 +Of Convulsions ---- 391 +Methods necessary to make them strong and hardy, with general Directions +about them ---- 396 _& seq._ + + _Chap. XXVIII._ + +_Of Assistances for drowned Persons_ ---- 403 + + _Chap. XXIX._ + +_Of Substances stopt between the Mouth and the Stomach_ ---- 411 + + _Chap. XXX._ + +_Of Disorders requiring the Assistance of a Surgeon_ ---- 435 +Of Burns ---- 436 +Of Wounds ---- 437 +Of Bruises, and of Falls ---- 444 +Of Ulcers ---- 454 +Of frozen Limbs, or Joints ---- 458 +Of Chilblains ---- 462 +Of Ruptures ---- 474 +Of Phlegmons, or Boils ---- 480 +Of Fellons, or Whitlows ---- 481 +Of Thorns, Splinters, _&c._ in the Skin or Flesh ---- 486 +Of Warts ---- 488 +Of Corns ---- 490 + + _Chap. XXXI._ + +_Of some Cases which require immediate Assistance_ ---- 491 +Of Swoonings, from Excess of Blood ---- 492 +Of Swoonings, from great Weakness ---- 494 +Of Swoonings, occasioned by a Load on the Stomach ---- 497 +Of Swoonings, resulting from Disorders of the Nerves 500 +Of Swoonings, occasioned by the Passions ---- 504 +Of the Swoonings, which occur in Diseases ---- 506 +Of Haemorrhages, or Fluxes of Blood ---- 508 +Of Convulsion Fits ---- 512 +Of suffocating, or strangling Fits ---- 514 +Of the violent Effects of great Fear ---- 516 +Of Accidents produced by the Vapours of Charcoal, and of Wine ---- 519 +Of Poisons ---- 526 +Of acute and violent Pains ---- 529 + + _Chap. XXXII._ + +_Of giving Remedies by Way of Precaution_ ---- 531 +Of Bleeding ---- 532 +Of Purges ---- 540 +Remedies to be used after excessive Purging ---- 544 +Reflections on some other Remedies ---- 546, _&c._ + + _Chap. XXXIII._ + +_Of Quacks, Mountebanks, and Conjurers_ ---- 551 + + _Chap. XXXIV._ + +_Questions necessary to be answered by any Person, who goes to consult a +Physician_ ---- 579 +The Table of Remedies ---- 584 + + + + + Transcription note + + +Old and variant spellings, like _surprising_ / _surprizing_, Buttermilk +/ _Butter-milk_, _Blood-vessels_ / _Blood-Vessels_, _Faltranc_ / +_Faltrank_, _wholesome_ / _wholsome_, _fetid_ / _foetid_, _public_ / +_publick_, _Physic_ / _Physick_, etc. have been preserved in the present +transcription. + +In some cases of doubt, the present edition has been compared with scans +of the 1766 edition printed by Donaldson, which differs slightly in +setting, for instance having all names not capitalized, and corrects +many typographic mistakes. + +Corrections listed in the Errata at the end of the book have been +carried into this transcription (excepting those which are not relevant +for the transcription, like those in running titles). + +Typographic errors, occurring at the following pages and lines in the +original, have been corrected (negative numbers indicate lines from the +bottom of the page): + + - *p. 23, note *, l. -6* their Druggs --> their Drugs + - *p. 29, l. 12* thorough Attentention --> thorough Attention + - *p. 39, l. 2* btutal Souls --> brutal Souls + - *p. 48, l. 12-13* thick, and and that --> thick, and that + - *p. 55, l. -5* increases our Horrour --> increases our Horror + - *p. 61, l. 3-4* deserves a Patients Confidence --> deserves a + Patient's Confidence + - *p. 62, l. 16* Drink and Glisters --> Drink and Glysters + - *p. 87, l. -8* the loosening Glyster No. 5 --> the loosening Glyster + No. 5 + - *p. 106, l. 1* Inflammamations --> Inflammations + - *p. 148, l. 21-22* Perspiraration --> Perspiration + - *p. 182, l. 19* Applications N. 9 --> Applications No. 9 + - *p. 189, l. 1* the Powder No. 29 --> the Powder No. 29 + - *p. 223, note *, l. 4* without the least peceiveable --> without the + least perceiveable + - *p. 226, l. 17-18* Relax-tion --> Relaxation + - *p. 244, l. 4-5* Dis-seases --> Diseases + - *p. 261, l. 15* Haemmorrhages --> Haemorrhages + - *p. 283, l. 14-15* Pre-Precription --> Prescription + - *p. 344, note +, l. -2* _missing closing quote conjecturally + inserted after_ instead of stumming or sulphurizing it,' + - *p. 353, l. 1* stance constitutes --> Circumstance constitutes + - *p. 355, l. 18* not pregant --> not pregnant + - *p. 383, l. 6* the back Bart of the Head --> the back Part of the + Head + - *p. 485, l. 13* checks it Progress --> checks its Progress + - *p. 495, l. 19* strong swelling Herbs --> strong smelling Herbs + - *p. 506, l. 15* Weakness is an Obstable --> Weakness is an Obstacle + - *p. 506, l. 19* an Evacution supervenes --> an Evacuation supervenes + - *p. 525, l. -2,-1* Never-vertheless --> Nevertheless + - *p. 560, l. -7* Villians --> Villains + - *p. 573, l. 6* some Evacution --> some Evacuation + - *p. 608. l. -7* Temparrament --> Temperrament + - *p. 611, col. 2, l. 4* _Of a_ Diarrhaea --> _Of a_ Diarrhoea + +So has been corrected the punctuation: + + - *p. xxii, last line, note* published at _Lyons_. [missing period] + - *p. xxix, l. 10* _Infusion_ No. 1; [missing dot] + - *p. xxix, l. 13-14* Numbers 1. 2, and 4 --> Numbers 1, 2, and 4 + - *p. 63, l. 15* of the Ptisans No. 1 [missing dot] + - *p. 84, l. -7, note* the Mixture, No. 10 [missing dot] + - *p. 88, l. 21* the purging Potion No. 11 [missing dot] + - *p. 89, l. 12* and drink plentifully of the Ptisan No. 2 [missing + dot] + - *p. 89, l. -7* should drink plentifully of the Ptisan No. 12 + [missing dot] + - *p. 117, l. 12-13* or some of those Diet-Drinks No. 1, 2, 4; [dots + instead of commas] + - *p. 118, note *, l. 3* it in his late _Materia Medica._ K. [missing + period] + - *p. 173, l. -8* in Hunting in 1658. [additional comma] + - *p. 198, l. 16* 3. The Bites --> 3, The Bites + - *p. 203, note, l. 5* in many other Places. [missing period] + - *p. 231, note, l- 1* and the Note there. [comma instead of period] + - *p. 233, l. 10* sound and hearty Children). [missing period] + - *p. 265, l. -6* 12, As soon as the Distemper [period instead of + comma] + - *p. 320, last line of the note* or for suspending it. _K._ [missing + dot] + - *p. 371, l. 7* 2, An Inflammation [period instead of comma] + - *p. 531, l. -6* or wrong. [missing period] + - *p. 538, l. -9* Powder No. 20 [missing dot] + - *p. 601, first line of the note* The Prescriptions No. 54, 55, 56 + [missing dot after No and periods instead of commas] + +The footnotes, marked in the text mostly by asterisks, symbols and +alphabetic letters on a page by page basis, have been renumbered +progressively throughout the book. The footnote * on page 256 does not +appear to be referenced at any specific point on the printed page, and +has been treated as footnote to the last word of the paragraph. + +Italics markup of abbreviations like _&c._, _K._, which was not always +consistent in the original, has been retained as printed. + +The Greek letters _{alpha}_, _{beta}_, _{gamma}_ enumerating the +prescriptions of Sec. 214 have been replaced by the Latin letters _a_, _b_, +_c_ for better character set portability. + + + + + +End of the Project Gutenberg EBook of Advice to the people in general, with +regard to their health, by Samuel Auguste David Tissot + +*** END OF THIS PROJECT GUTENBERG EBOOK ADVICE TO THE PEOPLE *** + +***** This file should be named 39044.txt or 39044.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/3/9/0/4/39044/ + +Produced by Bryan Ness, Enrico Segre and the Online +Distributed Proofreading Team at http://www.pgdp.net (This +file was produced from images generously made available +by The Internet Archive/Canadian Libraries) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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