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.