The fourth Precaution, is the frequent Use of very clear Whey. This

agreeable Remedy, which consists of the Juices of Herbs filtred through,

and concocted, or as it were, sweetened by the Organs of a healthy

Animal, answers every visible Indication (I am still speaking here of

sound and hearty Children). It imparts a Flexibility, or Soupleness to

the Vessels; it abates the Density, the heavy Consistence and Thickness

of the Blood; which being augmented by the Action of the poisonous Cause

of the Small-Pocks, would degenerate into a most dangerous

inflammatory [59] Viscidity or Thickness. It removes all Obstructions in

the _Viscera_, or Bowels of the lower Cavity, the Belly. It opens the

Passages which strain off the Bile; sheaths, or blunts, its Sharpness,

gives it a proper Fluidity, prevents its Putridity, and sweetens

whatever excessive Acrimony may reside throughout the Mass of Humours.

It likewise promotes Stools, Urine and Perspiration; and, in a Word, it

communicates the most favourable Disposition to the Body, not to be too

violently impressed and agitated by the Operation of an inflammatory

Poison: And with Regard to such Children as I have mentioned, for those

who are either sanguine or bilious, it is beyond all Contradiction, the

most effectual preparatory Drink, and the most proper to make them

amends for the Want of Inoculation.

[59] There may certainly be an inflammatory Acrimony or Thinness, as

well as Thickness of the Blood; and many medical Readers may think

a morbid Fusion of the red Globules to be a more frequent Effect of

this Contagion, than an increased Viscidity of them. See Analys.

Ed. 2d. p. 75 to 83. But this Translation, conforming to the Spirit

of its Original, admits very little Theory, and still less

Controversy, into its Plan. _K._

I have already observed, that it may also be used to great Advantage,

during the Course of the Disease: but I must also observe, that however

salutary it is, in the Cases for which I have directed it, there are

many others in which it would be hurtful. It would be extremely

pernicious to order it to weak, languishing, scirrhous, pale Children,

subject to Vomitings, Purgings, Acidities, and to all Diseases which

prove their Bowels to be weak, their Humours to be sharp: so that People

must be very cautious not to regard it as an universal and infallible

Remedy, towards preparing for the Small-Pocks. Those to whom it is

advised, may take a few Glasses every Morning, and even drink it daily,

for their common Drink; they may also sup it with Bread for Breakfast,

for Supper, and indeed at any Time.

If Country People will pursue these Directions, which are very easy to

observe and to comprehend, whenever the Small-Pocks rages, I am

persuaded it must lessen the Mortality attending it. Some will certainly

experience the Benefit of them; such I mean as are very sensible and

discreet, and strongly influenced by the truest Love of their Children.

Others there are Alas! who are too stupid to discern the Advantage of

them, and too unnatural to take any just Care of their Families.

__Chapter XIV.__

_Of the Measles._

__Sect.__ 221.

The Measles, to which the human Species are as generally liable, as to

the Small-Pocks, is a Distemper considerably related to it; though,

generally speaking, it is less fatal; notwithstanding which, it is not a

little destructive in some Countries. In _Swisserland_ we lose much

fewer, immediately in the Disease, than from the Consequences of it.

It happens now and then that the Small-Pocks and the Measles rage at the

same Time, and in the same Place; though I have more frequently

observed, that each of them was epidemical in different Years. Sometimes

it also happens that both these Diseases are combined at once in the

same Person; and that one supervenes before the other has finished its

Course, which makes the Case very perilous.

Sec. 222. In some Constitutions the Measles gives Notice of its Approach

many Days before its evident Invasion, by a small, frequent and dry

Cough, without any other sensible Complaint: though more frequently by a

general Uneasiness; by Successions of Shivering and of Heat; by a severe

Head-ach in grown Persons; a Heaviness in Children; a considerable

Complaint of the Throat; and, by what particularly characterizes this

Distemper, an Inflammation and a considerable Heat in the Eyes, attended

with a Swelling of the Eye-lids, with a Defluxion of sharp Tears, and so

acute a Sensation, or Feeling of the Eyes, that they cannot bear the

Light; by very frequent Sneezings, and a Dripping from the Nose of the

same Humour with that, which trickles from the Eyes.

The Heat and the Fever increases with Rapidity; the Patient is afflicted

with a Cough, a Stuffing, with Anguish, and continual Reachings to

vomit; with violent Pains in the Loins; and sometimes with a Looseness,

under which Circumstance he is less persecuted with Vomiting. At other

times, and in other Subjects, Sweating chiefly prevails, though in less

Abundance than in the Small-Pocks. The Tongue is foul and white; the

Thirst is often very high; and the Symptoms are generally more violent

than in the mild Small-Pocks.

At length, on the fourth or fifth Day, and sometimes about the End of

the third, a sudden Eruption appears and in a very great Quantity,

especially about the Face; which in a few Hours is covered with Spots,

each of which resembles a Flea-bite; many of them soon joining form red

Streaks or Suffusions larger or smaller, which inflame the Skin, and

produce a very perceivable Swelling of the Face; whence the very Eyes

are sometimes closed. Each small Spot or Suffusion is raised a little

above the Surface, especially in the Face, where they are manifest both

to the Sight and the Touch. In the other Parts of the Body, this

Elevation or Rising is scarcely perceivable by any Circumstance, but the

Roughness of the Skin.

The Eruption, having first appeared in the Face, is afterwards extended

to the Breast, the Back, the Arms, the Thighs and Legs. It generally

spreads very plentifully over the Breast and the Back, and sometimes red

Suffusions are found upon the Breast, before any Eruption has appeared

in the Face.

The Patient is often relieved, as in the Small-Pocks, by plentiful

Discharges of Blood from the Nose, which carry off the Complaints of the

Head, of the Eyes, and of the Throat.

Whenever this Distemper appears in its mildest Character, almost every

Symptom abates after Eruption, as it happens in the Small-Pocks; though,

in general, the Change for the better is not as thoroughly perceivable,

as it is in the Small-Pocks. It is certain the Reachings and Vomitings

cease almost entirely; but the Fever, the Cough, the Head-ach continue;

and I have sometimes observed that a bilious Vomiting, a Day or two

after the Eruption, proved a more considerable Relief to the Patient

than the Eruption had. On the third or fourth Day of the Eruption, the

Redness diminishes; the Spots, or very small Pustules, dry up and fall

off in very little branny Scales; the Cuticle, or superficial Skin also

shrivels off; and is replaced by one succeeding beneath it. On the ninth

Day, when the Progress of the Malady has been speedy, and on the

eleventh, when it has been very slow, no Trace of the Redness is to be

found; and the Surface immediately resumes its usual Appearance.

Sec. 223. Notwithstanding all which the Patient is not safe, except, during

the Course of the Distemper, or immediately after it, he has had some

considerable Evacuation; such as the Vomiting I have just mentioned; or

a bilious Looseness; or considerable Discharges by Urine; or very

plentiful Sweating. For when any of these Evacuations supervene, the

Fever vanishes; the Patient resumes his Strength, and perfectly

recovers. It happens sometimes too, and even without any of these

perceivable Discharges, that insensible Perspiration expels the Relics

of the poisonous Cause of this Disease, and the Patient recovers his

Health. Yet it occurs too often, that this Venom not having been

entirely expelled (or its internal Effects not having been thoroughly

effaced) it is repelled upon the Lungs, where it produces a slight

Inflammation. In Consequence of this the Oppression, the Cough, the

Anguish, and Fever return, and the Patient's Situation becomes very

dangerous. This Outrage is frequently less vehement, but it proves

tedious and chronical, leaving a very obstinate Cough behind it, with

many Resemblances of the Whooping-Cough. In 1758 there was an epidemic

State of the Measles here extremely numerous, which affected great

Numbers: Almost all who had it, and who were not very carefully and

judiciously attended, were seized in Consequence of it with that Cough,

which proved very violent and obstinate.

Sec. 224. However, notwithstanding this be the frequent Progress and

Consequence of this Disease, when left entirely to itself, or

erroneously treated, and more particularly when treated with a hot

Regimen; yet when proper Care was taken to moderate the Fever at the

Beginning, to dilute, and to keep up the Evacuations, such unhappy

Consequences have been very rare.

Sec. 225. The proper Method of conducting this Distemper is much the same

with that of the Small-Pocks.

1, If the Fever be high, the Pulse hard, the Load and Oppression heavy,

and all the Symptoms violent, the Patient must be bled once or twice.

2, His Legs must be bathed, and he must take some Glysters: the

Vehemence of the Symptoms must regulate the Number of each.

3, The Ptisans No. 3 or 4 must be taken, or a Tea of Elder and Lime-tree

Flowers, to which a fifth Part Milk may be added.

4, The Vapour, the Steam of warm Water should also be employed, as very

conducive to asswage the Cough; the Soreness of the Throat, and the

Oppression the Patient labours under.

5, As soon as the Efflorescence, the Redness becomes pale, the Patient

is to be purged with the Draught No. 23.

6, He is still to be kept strictly to his Regimen, for two Days after

this Purge; after which he is to be put upon the Diet of those who are

in a State of Recovery.

7, If during the Eruption such Symptoms supervene as occur [at the same

Term] in the Small-Pocks, they are to be treated in the Manner already

directed there.

Sec. 226. Whenever this Method has not been observed, and the Accidents

described Sec. 223 supervene, the Distemper must be treated like an

Inflammation in its first State, and all must be done as directed Sec. 225.

If the Disease is not vehement, [60] Bleeding may be omitted. If it is

of some standing in gross Children, loaded with Humours, inactive, and

pale, we must add to the Medicines already prescribed the Potion No. 8,

and Blisters to the Legs.

[60] Our Author very prudently limits this Discharge, and the Repetition

of it, in this Disease (Sec. 225) as an erroneous Excess of it has

sometimes prevailed. I have seen a very epidemical Season of the

Measles, where Bleeding was not indicated in one third of the

infected. And yet I have known such an Abuse of Bleeding in it,

that being repeated more than once in a Case before Eruption (the

Measles probably not being suspected) the Eruption was retarded

several Days; and the Patient, a young Lady of Condition, remained

exceeding low, faint and sickish; 'till after recruiting a very

little, the Measles appeared, and she recovered. In a Youth of a

lax Fibre, where the Measles had appeared, a seventh or eighth

Bleeding was ordered on a Stitch in the Side, supervening from

their too early Disappearance, and the Case seemed very doubtful.

But Nature continued very obstinately favourable in this Youth, who

at length, but very slowly, recovered. His Circulation remained so

languid, his Strength, with his Juices, so exhausted, that he was

many Weeks before he could sit upright in a Chair, being obliged to

make Use of a Cord depending from the Ceiling, to raise himself

erectly in his Seat. _K._

Sec. 227. It often happens from the Distance of proper Advice, that the

Relics, the Dregs as it were, of the Disease have been too little

regarded, especially the Cough; in which Circumstance it forms a real

Suppuration in the Lungs, attended with a slow Fever. I have seen many

Children in Country Villages destroyed by this Neglect. Their Case is

then of the same Nature with that described Sec. 68 and 82, and terminates

in the same Manner in a Looseness, (attended with very little Pain) and

sometimes a very foetid one, which carries off the Patient. In such

Cases we must recur to the Remedies prescribed Sec. 74, Article 3, 4, 5; to

the Powder No. 14; and to Milk and Exercise. But it is so very difficult

to make Children take the Powder, that it may be sometimes necessary to

trust to the Milk without it, which I have often seen in such Situations

accomplish a very difficult Cure. I must advise the Reader at the same

Time, that it has not so compleat an Effect, as when it is taken solely

unjoined by any other Aliment; and that it is of the last Importance not

to join it with any, which has the least Acidity or Sharpness. Persons

in easy Circumstances may successfully take, at the same Time,

_Pfeffer_, [61] _Seltzer_, _Peterstal_, or some other light Waters,

which are but moderately loaded with mineral Ingredients. These are also

successfully employed in all the Cases, in which the Cure I have

mentioned is necessary.

[61] Bristol Water will be no bad Substitute for any of these, in such

Cases. _K._

Sec. 228. Sometimes there remains, after the Course of the Measles, a

strong dry Cough, with great Heat in the Breast, and throughout the

whole Body, with Thirst, an excessive Dryness of the Tongue, and of the

whole Surface of the Body. I have cured Persons thus indisposed after

this Distemper, by making them breathe in the Vapour of warm Water; by

the repeated Use of warm Baths; and by allowing them to take nothing for

several Days but Water and Milk.

Before I take leave of this Subject, I assure the Reader again, that the

contagious Cause of the Measles is of an extremely sharp and acrid

Nature. It appears to have some Resemblance to the bilious Humour, which

produces the _Erisipelas_, or St. Anthony's Fire; and thence it demands

our particular Attention and Vigilance; without which very troublesome

and dangerous Consequences may be apprehended. I have seen, not very

long since, a young Girl, who was in a very languid State after the

Measles, which she had Undergone three Years before: It was at length

attended with an Ulceration in her Neck, which was cured, and her Health

finally restored by _Sarsaparilla_ with Milk and Water.

Sec. 229. The Measles have been communicated by [62] Inoculation in some

Countries, where it is of a very malignant Disposition; and that Method

might also be very advantageous in this. But what we have already

observed, with Respect to the Inoculation of the Small-Pocks, _viz._

That it cannot be extended to the general Benefit of the People, without

the Foundation of Hospitals for that very Purpose, is equally applicable

to the Inoculation of the Measles.

[62] The only Account I have read of this Practice, is in the learned

Dr. _Home's_ _Medical Facts and Experiments_, published in 1759,

which admits, that but nine out of fifteen of the Subjects of this

Practice took. Cotton dipt in the Blood of a Patient in the Measles

was inserted into the Arms of twelve; and three received the Cotton

into their Nostrils, after the Chinese Manner of infusing the

Small-Pocks; but of these last not one took, and one of those who

had taken, had the Measles again two Months after. We think the

sharp hot Lymph distilling from the inflamed Eyes of Persons in

this Disease, a likelier Vehicle to communicate it than the Blood,

especially the dry Blood, which was sometimes tried; since the

human _Serum_ seems the Fluid more particularly affected by it; and

this must have been evaporated when the Blood grew dry. A few

practical Strictures on this Work, and particularly on this

Practice described in it, appeared in the Monthly Review Vol. XXI.

P. 68 to 75. _K._

__Chapter XV.__

_Of the ardent or burning Fever._

__Sect.__ 230.

The much greater Number of the Diseases I have hitherto considered,

result from an Inflammation of the Blood, combined with the particular

Inflammation of some Part, or occasioned by some Contagion or Poison,

which must be evacuated. But when the Blood is solely and strongly

inflamed, without an Attack on any particular Part, this Fever, which we

term hot or burning, is the Consequence.

Sec. 231. The Signs which make it evident are, a Hardness and Fulness of

the Pulse in a higher Degree than happens in any other Malady; an

excessive Heat; great Thirst; with an extraordinary Dryness of the Eyes,

Nostrils, Lips, of the Tongue, and of the Throat; a violent Head-ach;

and sometimes a Raving at the Height of the Paroxysm, or Increase of the

Fever, which rises considerably every Evening. The Respiration is also

somewhat oppressed, but especially at the Return of this Paroxysm, with

a Cough now and then; though without any Pain in the Breast, and without

any Expectoration, or coughing up. The Body is costive; the Urine very

high coloured, hot, and in a small Quantity. The Sick are also liable to

start sometimes, but especially when they seem to sleep; for they have

little sound refreshing Sleep, but rather a kind of Drowsiness, that

makes them very little attentive to, or sensible of, whatever happens

about them, or even of their own Condition. They have sometimes a little

Sweat or Moisture; though commonly a very dry Skin; they are manifestly

weak, and have either little or no Smell or Taste.

Sec. 232. This Disease, like all other inflammatory ones, is produced by

the Causes which thicken the Blood, and increase its Motion; such as

excessive Labour, violent Heat, Want of Sleep, the Abuse of Wine or

other strong Liquors; the long Continuance of a dry Constitution of the

Air, Excess of every kind, and heating inflaming Food.

Sec. 233. The Patient, under these Circumstances, ought, 1, immediately to

be put upon a Regimen; to have the Food allowed him given only every

eight Hours, and, in some Cases, only twice a Day: and indeed, when the

Attack is extremely violent, Nourishment may be wholly omitted.

2, Bleeding should be performed and repeated, 'till the Hardness of the

Pulse is sensibly abated. The first Discharge should be considerable,

the second should be made four Hours after. If the Pulse is softened by

the first, the second may be suspended, and not repeated before it

becomes sufficiently hard again, to make us apprehensive of Danger: but

should it continue strong and hard, the Bleeding may be repeated on the

same Day to a third Time, which often happens to be all the Repetitions

that are necessary.

3, The Glyster No. 5 should be given twice, or even thrice, daily.

4, His Legs are to be bathed twice a Day in warm Water: his Hands may be

bathed in the same Water. Linen or Flanel Cloths dipt in warm Water may

be applied over the Breast, and upon the Belly; and he should regularly

drink the Almond Milk No. 4 and the Ptisan No. 7. The poorest Patients

may content themselves with the last, but should drink very plentifully

of it; and after the Bleeding properly repeated, fresh Air and the

plentiful Continuance of small diluting Liquors generally establish the

Health of the Patient.

5, If notwithstanding the repeated Bleedings, the Fever still rages

highly, it may be lessened by giving a Spoonful of the Potion No. 10

every Hour, till it abates; and afterwards every three Hours, until it

becomes very moderate.

Sec. 234. Haemorrhages, or Bleedings, from the Nose frequently occur in this

Fever, greatly to the Relief and Security of the Patient.

The first Appearances of Amendment are a softening of the Pulse, (which

however does not wholly lose all its Hardness, before the Disease

entirely terminates) a sensible Abatement of the Head-ach; a greater

Quantity of Urine, and that less high coloured; and a manifestly

approaching Moisture of the Tongue. These favourable Signs keep

increasing in their Degree, and there frequently ensue between the ninth

and the fourteenth Day, and often after a Flurry of some Hours

Continuance, very large Evacuations by Stool; a great Quantity of Urine,

which lets fall a palely reddish Sediment; the Urine above it being very

clear, and of a natural Colour; and these accompanied with Sweats in a

less or greater Quantity. At the same Time the Nostrils and the Mouth

grow moist: the brown and dry Crust which covered the Tongue, and which

was hitherto inseparable from it, peels off of itself; the Thirst is

diminished; the Clearness of the Faculties rises; the Drowsiness goes

off, it is succeeded by comfortable Sleep, and the natural Strength is

restored. When Things are evidently in this Way, the Patient should take

the Potion No. 23, and be put upon the Regimen of those who are in a

State of Recovery. It should be repeated at the End of eight or ten

Days. Some Patients have perfectly recovered from this Fever, without

the least Sediment in their Urine.

Sec. 235. The augmenting Danger of this Fever may be discerned, from the

continued Hardness of the Pulse, though with an Abatement of its

Strength; if the Brain becomes more confused; the Breathing more

difficult; if the Eyes, Nose, Lips and Tongue become still more dry, and

the Voice more altered. If to these Symptoms there be also added a

Swelling of the Belly; a Diminution of the Quantity of Urine; a constant

Raving; great Anxiety, and a certain Wildness of the Eyes, the Case is

in a manner desperate; and the Patient cannot survive many Hours. The

Hands and Fingers at this Period are incessantly in Motion, as if

feeling for something upon the Bed-Cloths, which is commonly termed,

their hunting for Flies.

__Chapter XVI.__

_Of putrid Fevers._

__Sect.__ 236.

Having treated of such feverish Distempers, as arise from an

Inflammation of the Blood, I shall here treat of those produced by

corrupt Humours, which stagnate in the Stomach, the Guts, or other

Bowels of the lower Cavity, the Belly; or which have already passed from

them into the Blood. These are called putrid Fevers, or sometimes

bilious Fevers, when a certain Degeneracy or Corruption of the Bile

seems chiefly to prevail in the Disease.

Sec. 237. This Distemper frequently gives Notice of its Approach, several

Days before its manifest Attack; by a great Dejection, a Heaviness of

the Head; Pains of the Loins and Knees; a Foulness of the Mouth in the

Morning; little Appetite; broken Slumber; and sometimes by an excessive

Head-ach for many Days, without any other Symptom. After this, or these

Disorders, a Shivering comes on, followed by a sharp and dry Heat: the

Pulse, which was small and quick during the Shivering, is raised during

the Heat, and is often very strong, though it is not attended with the

same Hardness, as in the preceding Fever; except the putrid Fever be

combined with an inflammatory one, which it sometimes is. During this

Time, that is the Duration of the Heat, the Head-ach is commonly

extremely violent; the Patient is almost constantly affected with

Loathings, and sometimes even with Vomiting; with Thirst, disagreeable

Risings, a Bitterness in the Mouth; and very little Urine. This Heat

continues for many Hours, frequently the whole Night; it abates a little

in the Morning, and the Pulse, though always feverish, is then something

less so, while the Patient suffers less, though still greatly dejected.

The Tongue is white and furred, the Teeth are foul, and the Breath

smells very disagreeably. The Colour, Quantity and Consistence of the

Urine, are very various and changeable. Some Patients are costive,

others frequently have small Stools, without the least Relief accruing

from them. The Skin is sometimes dry, and at other Times there is some

sensible Perspiration, but without any Benefit attending it. The Fever

augments every Day, and frequently at unexpected irregular Periods.

Besides that _great_ Paroxysm or Increase, which is perceivable in all

the Subjects of this Fever, some have also other _less_ intervening

ones.

Sec. 238. When the Disease is left to itself, or injudiciously treated; or

when it proves more powerful than the Remedies against it, which is by

no Means seldom the Case, the Aggravations of it become longer, more

frequent and irregular. There is scarcely an Interval of Ease. The

Patient's Belly is swell'd out like a Foot-ball; a _Delirium_ or Raving

comes on; he proves insensible of his own Evacuations, which come away

involuntarily; he rejects Assistance, and keeps muttering continually,

with a quick, small, irregular Pulse. Sometimes little Spots of a brown,

or of a livid Colour appear on the Surface, but particularly about the

Neck, Back and Breast. All the Discharges from his Body have a most

foetid Smell: convulsive Motions also supervene, especially in the Face;

he lies down only on his Back, sinks down insensibly towards the Foot of

the Bed, and picks about, as if catching Flies; his Pulse becomes so

quick and so small, that it cannot be perceived without Difficulty, and

cannot be counted. His Anguish seems inexpressible: his Sweats stream

down from Agony: his Breast swells out as if distended by Fullness, and

he dies miserably.

Sec. 239. When this Distemper is less violent, or more judiciously treated,

and the Medicines succeed well, it continues for some Days in the State

described Sec. 237, without growing worse, though without abating. None of

these Symptoms however appear, described Sec. 238; but, on the contrary,

all the Symptoms become milder, the Paroxysms, or Aggravations, are

shorter and less violent, the Head-ach more supportable; the Discharges

by Stool are less frequent, but more at once, and attended with Relief

to the Patient. The Quantity of Urine is very considerable, though it

varies at different Times in Colour and Consistence, as before. The

Patient soon begins to get a little Sleep, and grows more composed and

easy. The Tongue disengages itself from its Filth and Furriness, and

Health gradually, yet daily, advances.

Sec. 240. This Fever seems to have no critical Time, either for its

Termination in Recovery, or in Death. When it is very violent, or very

badly conducted, it proves sometimes fatal on the ninth Day. Persons

often die of it from the eighteenth to the twentieth; sometimes only

about the fortieth; after having been alternately better and worse.

When it happens but in a light Degree, it is sometimes cured within a

few Days, after the earliest Evacuations. When it is of a very different

Character, some Patients are not out of Danger before the End of six

Weeks, and even still later. Nevertheless it is certain, that these

Fevers, extended to this Length of Duration, often depend in a great

Measure on the Manner of treating them; and that in general their Course

must be determined, some time from the fourteenth to the thirtieth Day.

Sec. 241. The Treatment of this Species of Fevers is comprized in the

following Method and Medicines.

1, The Patient must be put into a _Regimen_; and notwithstanding he is

far from costive, and sometimes has even a small Purging, he should

receive one Glyster daily. His common Drink should be Lemonade, (which

is made of the Juice of Lemons, Sugar and Water) or the Ptisan No. 3.

Instead of Juice of Lemons, Vinegar may be occasionally substituted,

which, with Sugar and Water, makes an agreeable and very wholesome Drink

in these Fevers.

2, If there be an Inflammation also, which may be discovered by the

Strength and the Hardness of the Pulse, and by the Temperament and

Complexion of the Patient; if he is naturally robust, and has heated

himself by any of the Causes described, Sec. 232, he should be bled once,

and even a second Time, if necessary, some Hours after. I must observe

however, that very frequently there is no such Inflammation, and that in

such a Case, Bleeding would be hurtful.

3, When the Patient has drank very plentifully for two Days of these

Liquids, if his Mouth still continues in a very foul State, and he has

violent Reachings to vomit, he must take the Powder No. 34, dissolved in

half a [63] Pot of warm Water, a [64] Glass of it being to be drank

every half Quarter of an Hour. But as this Medicine vomits, it must not

be taken, except we are certain the Patient is not under any

Circumstance, which forbids the Use of a Vomit: all which Circumstances

shall be particularly mentioned in the Chapter, respecting the Use of

such Medicines, as are taken by way of Precaution, or Prevention. If the

first Glasses excite a plentiful Vomiting, we must forbear giving

another, and be content with obliging the Patient to drink a

considerable Quantity of warm Water. But if the former Glasses do not

occasion Vomiting, they must be repeated, as already directed until they

do. Those who are afraid of taking this Medicine, which is usually

called, the Emetic, may take that of No. 35, also drinking warm Water

plentifully during its Operation; but the former is preferable, as more

prevalent, in dangerous Cases. We must caution our Readers at the same

Time, that wherever there is an Inflammation of any Part, neither of

these Medicines must be given, which might prove a real Poison in such a

Circumstance; and even if the Fever is extremely violent, though there

should be no particular Inflammation, they should not be given.

[63] That is about two Ounces more than a Pint and a half of our

Measure.

[64] About three Ounces.

The Time of giving them is soon after the End of the Paroxysm, when the

Fever is at the lowest. The Medicine No. 34 generally purges, after it

ceases to make the Patient vomit: But No. 35 is seldom attended with the

same Effect.

When the Operation of the Vomit is entirely over, the Sick should return

to the Use of the Ptisan; and great Care must be taken to prohibit them

from the Use of Flesh Broth, under the Pretext of working off a Purging

with it. The same Method is to be continued on the following Days as on

the first; but as it is of Importance to keep the Body open, he should

take every Morning some of the Ptisan No. 32. Such, as this would be too

expensive for, may substitute, in the room of it, a fourth Part of the

Powder No. 34 in five or six Glasses of Water, of which they are to take

a Cup every two Hours, beginning early in the Morning. Nevertheless, if

the Fever be very high, No. 32 should be preferred to it.

4, After the Operation of the Vomit, if the Fever still continue, if the

Stools are remarkably foetid, and if the Belly is tense and distended as

it were, and the Quantity of Urine is small, a Spoonful of the Potion

No. 10 should be given every two Hours, which checks the Putridity and

abates the Fever. Should the Distemper become violent, and very

pressing, it ought to be taken every Hour.

5, Whenever, notwithstanding the giving all these Medicines as directed,

the Fever continues obstinate; the Brain is manifestly disordered; there

is a violent Head-ach, or very great Restlessness, two blistering

Plaisters No. 36 must be applied to the inside and fleshy Part of the

Legs, and their Suppuration and Discharge should be continued as long as

possible.

6, If the Fever is extremely violent indeed, there is a Necessity

absolutely to prohibit the Patient from receiving the least Nourishment.

7, When it is thought improper, or unsafe, to give the Vomit, the

Patient should take in the Morning, for two successive Days, three Doses

of the Powder No. 24, at the Interval of one Hour between each: This

Medicine produces some bilious Stools, which greatly abate the Fever,

and considerably lessen the Violence of all the other Symptoms of the

Disease. This may be done with Success, when the excessive Height of the

Fever prevents us from giving the Vomit: and we should limit ourselves

to this Medicine, as often as we are uncertain, what ever the

Circumstances of the Disease and the Patient will admit of the Vomiting;

which may thus be dispensed with, in many Cases.

8, When the Distemper has manifestly and considerably declined; the

Paroxysms are more slight; and the Patient continues without any Fever

for several Hours, the daily use of the purging opening Drinks should be

discontinued. The common Ptisans however should be still made use of;

and it will be proper to give every other Day two Doses of the Powder

No. 24, which sufficiently obviates every ill Consequence from this

Disease.

9, If the Fever has been clearly off for a long Part of the Day; if the

Tongue appears in a good healthy State; if the Patient has been well

purged; and yet one moderate Paroxysm of the Fever returns every Day, he

should take four Doses of the Powder No. 14 between the End of one

Return and the Beginning of the next, and continue this Repetition some

Days. People who cannot easily procure this Medicine, may substitute,

instead of it, the bitter Decoction No. 37. four Glasses of which may be

taken at equal Intervals, between the two Paroxysms or Returns of the

Fever.

10, As the Organs of Digestion have been considerably weakened through

the Course of this Fever, there is a Necessity for the Patient's

conducting himself very prudently and regularly long after it, with

Regard both to the Quantity and Quality of his Food. He should also use

due Exercise as soon as his Strength will permit, without which he may

be liable to fall into some chronical and languishing Disorder,

productive of considerable Languor and Weakness. *

[*] As our Jail, Hospital, and Camp Fevers may often be ranged in this

Class, as of the most putrid Kind, and not seldom occasioned by bad

Food, bad Air, unclean, unwholesome Lodging, _&c._ a judicious Use

may certainly be made of a small Quantity of genuine, and not

ungenerous, Wine in such of them, as are not blended with an

inflammatory Cause, or inflammable Constitution, or which do not

greatly result from a bilious Cause; though in these last, where

there is manifest Lowness and Dejection, perhaps a little Rhenish

might be properly interposed between the Lemonade and other Drinks

directed Sec. 241. Doubtless Dr. _Tissot_ was perfectly apprized of

this salutary Use of it in some low Fevers; but the Necessity of

its being regulated by the Presence of a Physician has probably

disposed him rather to omit mentioning it, than to leave the

Allowance of it to the Discretion of a simple Country Patient, or

his ignorant Assistants. _K._

__Chapter XVII.__

_Of malignant Fevers._

__Sect.__ 242.

Those Fevers are termed malignant, in which the Danger is more than the

Symptoms would make us apprehensive of: they have frequently a fatal

Event without appearing so very perilous; on which Account it has been

well said of this Fever, that it is a Dog which bites without barking.

Sec. 243. The distinguishing _Criterion_ or Mark of malignant Fevers is a

total Loss of the Patient's Strength, immediately on their first Attack.

They arise from a Corruption of the Humours, which is noxious to the

very Source and Principle of Strength, the Impairing or Destruction of

which is the Cause of the Feebleness of the Symptoms; by Reason none of

the Organs are strong enough to exert an Opposition sufficiently

vigorous, to subdue the Cause of the Distemper.

If, for Instance or Illustration, we were to suppose, that when two

Armies were on the Point of engaging, one of them should be nearly

deprived of all their Weapons, the Contest would not appear very

violent, nor attended with great Noise or Tumult, though with a horrible

Massacre. The Spectator, who, from being ignorant of one of the Armies

being disarmed, would not be able to calculate the Carnage of the

Battle, but in Proportion to its Noise and Tumult, must be extremely

deceived in his Conception of it. The Number of the Slain would be

astonishing, which might have been much less (though the Noise and

Clangor of it had been greater) if each Army had been equally provided

for the Combat.

Sec. 244. The Causes of this Disease are a long Use of animal Food or Flesh

alone, without Pulse, Fruits or Acids; the continued Use of other bad

Provisions, such as Bread made of damaged Corn or Grain, or very stale

Meat. Eight Persons, who dined together on corrupt Fish, were all seized

with a malignant Fever, which killed five of them, notwithstanding the

Endeavours of the most able Physicians. These Fevers are also frequently

the Consequence of a great Dearth or Famine; of too hot and moist an

Air, or an Air, which highly partakes of these two Qualities; so that

they happen to spread most in hot Years, in Places abounding with

Marshes and standing Waters. They are also the Effect of a very close

and stagnant Air, especially if many Persons are crouded together in it,

this being a Cause that particularly tends to corrupt the Air. Tedious

Grief and Vexation also contribute to generate these Fevers.

Sec. 245. The Symptoms of malignant Fevers are, as I have already observed,

a total and sudden Loss of Strength, without any evident preceding

Cause, sufficient to produce such a Privation of Strength: at the same

Time there is also an utter Dejection of the Mind, which becomes almost

insensible and inattentive to every Thing, and even to the Disease

itself; a sudden Alteration in the Countenance, especially in the Eyes:

some small Shiverings, which are varied throughout the Space of

twenty-four Hours, with little Paroxysms or Vicissitudes of Heat;

sometimes there is a great Head-ach and a Pain in the Loins; at other

Times there is no perceivable Pain in any Part; a kind of Sinkings or

Faintings, immediately from the Invasion of the Disease, which is always

very unpromising; not the least refreshing Sleep; frequently a kind of

half Sleep, or Drowsiness; a light and silent or inward Raving, which

discovers itself in the unusual and astonished Look of the Patient, who

seems profoundly employed in meditating on something, but really thinks

of nothing, or not at all: Some Patients have, however, violent Ravings;

most have a Sensation of Weight or Oppression, and at other Times of a

Binding or Tightness about, or around, the Pit of the Stomach.

The sick Person seems to labour under great Anguish: he has sometimes

slight convulsive Motions and Twitchings in his Face and his Hands, as

well as in his Arms and Legs. His Senses seem torpid, or as it were

benumbed. I have seen many who had lost, to all Appearance, the whole

five, and yet some of them recover. It is not uncommon to meet with

some, who neither see, understand, nor speak. Their Voices change,

become weak, and are sometimes quite lost. Some of them have a fixed

Pain in some Part of the Belly: this arises from a Stuffing or

Obstruction, and often ends in a Gangrene, whence this Symptom is highly

dangerous and perplexing.

The Tongue is sometimes very little altered from its Appearance in

Health; at other Times covered over with a yellowish brown Humour; but

it is more rarely dry in this Fever than in the others; and yet it

sometimes does resemble a Tongue that has been long smoaked.

The Belly is sometimes very soft, and at other Times tense and hard. The

Pulse is weak, sometimes pretty regular, but always more quick than in a

natural State, and at some Times even very quick; and such I have always

found it, when the Belly has been distended.

The Skin is often neither hot, dry, nor moist: it is frequently

overspread with petechial or eruptive Spots (which are little Spots of a

reddish livid Colour) especially on the Neck, about the Shoulders, and

upon the Back. At other Times the Spots are larger and brown, like the

Colour of Wheals from the Strokes of a Stick.

The Urine of the Sick is almost constantly crude, that is of a lighter

Colour than ordinary. I have seen some, which could not be

distinguished, merely by the Eye, from Milk. A black and stinking

Purging sometimes attends this Fever, which is mortal, except the Sick

be evidently relieved by the Discharge.

Some of the Patients are infested with livid Ulcers on the Inside of the

Mouth, and on the Palate. At other Times Abscesses are formed in the

Glands of the Groin, of the Arm-pit, in those between the Ears and the

Jaw; or a Gangrene may appear in some Part, as on the Feet, the Hands,

or the Back. The Strength proves entirely spent, the Brain is wholly

confused: the miserable Patient stretched out on his Back, frequently

expires under Convulsions, an enormous Sweat, and an oppressed Breast

and Respiration. Haemorrhages also happen sometimes and are mortal, being

almost unexceptionably such in this Fever. There is also in this, as in

all other Fevers, an Aggravation of the Fever in the Evening.

Sec. 246. The Duration and _Crisis_ of these malignant, as well as those of

putrid Fevers, are very irregular. Sometimes the Sick die on the seventh

or eighth Day, more commonly between the twelfth and the fifteenth, and

not infrequently at the End of five or six Weeks. These different

Durations result from the different Degree and Strength of the Disease.

Some of these Fevers at their first Invasion are very slow; and during a

few of the first Days, the Patient, though very weak, and with a very

different Look and Manner, scarcely thinks himself sick.

The Term or Period of the Cure or the Recovery, is as uncertain as that

of Death in this Distemper. Some are out of Danger at the End of fifteen

Days, and even sooner; others not before the Expiration of several

Weeks.

The Signs which portend a Recovery are, a little more Strength in the

Pulse; a more concocted Urine; less Dejection and Discouragement; a less

confused Brain; an equal kindly Heat; a pretty warm or hot Sweat in a

moderate Quantity, without Inquietude or Anguish; the Revival of the

different Senses that were extinguished, or greatly suspended in the

Progress of the Disease; though the Deafness is not a very threatening

Symptom, if the others amend while it endures.

This Malady commonly leaves the Patient in a very weak Condition; and a

long Interval will ensue between the End of it, and their recovering

their full Strength.

Sec. 247. It is, in the first place, of greater Importance in this

Distemper than in any other, both for the Benefit of the Patients, and

those who attend them, that the Air should be renewed and purified.

Vinegar should often be evaporated from a hot Tile or Iron in the

Chamber, and one Window kept almost constantly open.

2, The Diet should be light; and the Juice of Sorrel may be mixed with

their Water; the Juice of Lemons may be added to Soups prepared from

different Grains and Pulse; the Patient may eat sharp acid Fruits, such

as tart juicy [65] Cherries, Gooseberries, small black Cherries; and

those who can afford them, may be allowed Lemons, Oranges and

Pomgranates.

[65] The French Word is _Griettes_, which _Beyer_ englishes, _the

Agriot, the red or sour Cherry_; and _Chambaud, the sweeter large

black Cherry or Mazzard_--But as Dr. _Tissot_ was recommending the

Use of Acids, it is more probably the first of these: so that our

Morellas, which make a pleasant Preserve, may be a good Substitute

to them, supposing them not to be the same. Our Berbery Jam, and

Jelly of Red Currants, may be also employed to answer the same

Indication. _K._

3, The Patient's Linen should be changed every two Days.

4, Bleeding is very rarely necessary, or even proper, in this Fever; the

Exceptions to which are very few, and cannot be thoroughly ascertained,

as fit and proper Exceptions to the Omission of Bleeding, without a

Physician, or some other very skilful Person's seeing the Patient.

5, There is often very little Occasion for Glysters, which are sometimes

dangerous in this Fever.

6, The Patient's common Drink should be Barley Water made acid with the

Spirit No. 10, at the Rate of one Quarter of an Ounce to at least full

three Pints of the Water, or acidulated agreeably to his Taste. He may

also drink Lemonade.

7, It is necessary to open and evacuate the Bowels, where a great

Quantity of corrupt Humours is generally lodged. The Powder No. 35 may

be given for this Purpose, after the Operation of which the Patient

generally finds himself better, at least for some Hours. It is of

Importance not to omit this at the Beginning of the Disease; though if

it has been omitted at first, it were best to give it even later,

provided no particular Inflammation has supervened, and the Patient has

still some Strength. I have given it, and with remarkable Success, on

the twentieth Day.

8, Having by this Medicine expelled a considerable Portion of the bad

Humours, which contribute to feed and keep up the Fever, the Patient

should take every other Day, during the Continuance of the Disease, and

sometimes even every Day, one Dose of the Cream of Tartar and Rhubarb

No. 38. This Remedy evacuates the corrupt Humours, prevents the

Corruption of the others; expells the Worms that are very common in

these Fevers, which the Patient sometimes discharges upwards and

downwards; and which frequently conduce to many of the odd and

extraordinary Symptoms, that are observed in malignant Fevers. In short

it strengthens the Bowels, and, without checking the necessary

Evacuations, it moderates the Looseness, when it is hurtful.

9, If the Skin be dry, with a Looseness, and that by checking it, we

design to increase Perspiration, instead of the Rhubarb, the Cream of

Tartar may be blended with the Ipecacuana, No. 39, which, being given in

small and frequent Doses, restrains the Purging, and promotes

Perspiration. This Medicine, as the former, is to be taken in the

Morning; two Hours after, the Sick must begin with the Potion No. 40,

and repeat it regularly every three Hours; until it be interrupted by

giving one of the Medicines No. 38 or 39: After which the Potion is to

be repeated again, as already directed, till the Patient grows

considerably better.

10, If the Strength of the Sick be very considerably depressed, and he

is in great Dejection and Anguish, he should take, with every Draught of

the Potion, the Bolus, or Morsel No. 41. If the _Diarrhoea_, the Purging

is violent, there should be added, once or twice a Day to the Bolus, the

Weight of twenty Grains, or the Size of a very small Bean, of

_Diascordium_; or if that is not readily to be got, as much Venice

Treacle.

11, Whenever, notwithstanding all this Assistance, the Patient continues

in a State of Weakness and Insensibility, two large Blisters should be

applied to the fleshy Insides of the Legs, or a large one to the Nape of

the Neck: and sometimes, if there be a great Drowsiness, with a manifest

Embarrassment of the Brain, they may be applied with great Success over

the whole Head. Their Suppuration and Discharge is to be promoted

abundantly; and, if they dry up within a few Days, others are to be

applied, and their Evacuation is to be kept up for a considerable Time.

12, As soon as the Distemper is sufficiently abated, for the Patient to

remain some Hours with very little or no Fever, we must avail ourselves

of this Interval, to give him six, or at least five Doses of the

Medicine No. 14, and repeat the same the next Day, which may prevent the

Return of the Fever: [66] after which it may be sufficient to give daily

only two Doses for a few Days.

[66] Observation and Experience have demonstrated the Advantage of the

Bark, to obviate a Gangrene, and prevent the Putrefaction of animal

Substances. We therefore conclude it may be usefully employed in

malignant Fevers, as soon as the previous and necessary Evacuations

shall have taken Place. _E. L._--Provided there be very clear and

regular Remissions at least. _K._

13, When the Sick continue entirely clear of a Fever, or any Return,

they are to be put into the _Regimen_ of Persons in a State of Recovery.

But if his Strength returns very slowly, or not at all; in Order to the

speedier Establishment and Confirmation of it, he may take three Doses a

Day of the _Theriaca Pauperum_, or poor Man's Treacle No. 42, the first

of them fasting, and the other twelve Hours after. It were to be wished

indeed, this Medicine was introduced into all the Apothecaries Shops, as

an excellent Stomachic, in which Respect it is much preferable to Venice

Treacle, which is an absurd Composition, dear and often dangerous. It is

true it does not dispose the Patients to Sleep; but when we would

procure them Sleep, there are better Medicines than the Treacle to

answer that Purpose. Such as may not think the Expence of the Medicine

No. 14, too much, may take three Doses of it daily for some Weeks,

instead of the Medicine No. 42, already directed.

Sec. 248. It is necessary to eradicate a Prejudice that prevails among

Country People, with Regard to the Treatment of these Fevers; not only

because it is false and ridiculous, but even dangerous too. They imagine

that the Application of Animals can draw out the Poison of the Disease;

in Consequence of which they apply Poultry, or Pigeons, Cats or sucking

Pigs to the Feet, or upon the Head of the Patient, having first split

the living Animals open. Some Hours after they remove their strange

Applications, corrupted, and stinking very offensively; and then ascribe

such Corruption and horrid Stink to the Poison they suppose their

Application to be charged with; and which they suppose to be the Cause

of this Fever. But in this supposed Extraction of Poison, they are

grosly mistaken, since the Flesh does not stink in Consequence of any

such Extraction, but from its being corrupted through Moisture and Heat:

and they contract no other Smell but what they would have got, if they

had been put in any other Place, as well as on the Patient's Body, that

was equally hot and moist. Very far from drawing out the Poison, they

augment the Corruption of the Disease; and it would be sufficient to

communicate it to a sound Person, if he was to suffer many of these

animal Bodies, thus absurdly and uselessly butchered, to be applied to

various Parts of his Body in Bed; and to lie still a long Time with

their putrified Carcases fastened about him, and corrupting whatever Air

he breathed there.

With the same Intention they fasten a living Sheep to the Bed's-foot for

several Hours; which, though not equally dangerous, is in some Measure

hurtful, since the more Animals there are in a Chamber, the Air of it is

proportionably corrupted, or altered at least from its natural

Simplicity, by their Respiration and Exhalations: but admitting this to

be less pernicious, it is equally absurd. It is certain indeed, the

Animals who are kept very near the sick Person breathe in the poisonous,

or noxious Vapours which exhale from his Body, and may be incommoded

with them, as well as his Attendants: But it is ridiculous to suppose

their being kept near the Sick causes such Poison to come out of their

Bodies. On the very contrary, in contributing still further to the

Corruption of the Air, they increase the Disease. They draw a false

Consequence, and no Wonder, from a false Principle; saying, if the Sheep

dies, the Sick will recover. Now, most frequently the Sheep does not

die; notwithstanding which the Sick sometimes recover; and sometimes

they both die.

Sec. 249. The Cause of Malignant Fevers is, not infrequently, combined with

other Diseases, whose Danger it extremely increases. It is blended for

Instance, with the Poison of the Small-Pocks, or of the Measles. This

may be known by the Union of those Symptoms, which carry the Marks of

Malignity, with the Symptoms of the other Diseases. Such combined Cases

are extremely dangerous; they demand the utmost Attention of the

Physician; nor is it possible to prescribe their exact Treatment here;

since it consists in general of a Mixture of the Treatment of each

Disease; though the Malignity commonly demands the greatest Attention.

__Chapter XVIII.__

_Of intermitting Fevers._

__Sect.__ 250.

Intermitting Fevers, commonly called here, Fevers and Agues, are those,

which after an Invasion and Continuance for some Hours, abate very

perceivably, as well as all the Symptoms attending them, and then

entirely cease; nevertheless, not without some periodical or stated

Return of them.

They were very frequent with us some Years since; and indeed might even

be called epidemical: but for the five or six last Years, they have been

much less frequent throughout the greater Part of _Swisserland_:

notwithstanding they still continue in no small Number in all Places,

where the Inhabitants breathe the Air that prevails in all the marshy

Borders of the _Rhone_, and in some other Situations that are exposed to

much the same humid Air and Exhalations.

Sec. 251. There are several Kinds of intermitting Fevers, which take their

different Names from the Interval or different Space of Time, in which

the Fits return.

If the Paroxysm or Fit returns every Day, it is either a true Quotidian,

or a double Tertian Fever: The first of these may be distinguished from

the last by this Circumstance, that in the Quotidian, or one Day Fever,

the Fits are long; and correspond pretty regularly to each other in

Degree and Duration. This however is less frequent in _Swisserland_. In

the double Tertian, the Fits are shorter, and one is alternately light,

and the other more severe.

In the simple Tertian, or third Day's Fever, the Fits return every other

Day; so that three Days include one Paroxysm, and the Return of another.

In a Quartan, the Fit returns every fourth Day, including the Day of the

first and that of the second Attack: so that the Patient enjoys two

clear Days between the two sick ones.

The other kinds of Intermittents are much rarer. I have seen however one

true Quintan, or fifth Day Ague, the Patient having three clear Days

between two Fits; and one regularly weekly Ague, as it may be called,

the Visitation of every Return happening every Sunday.

Sec. 252. The first Attack of an intermittent Fever often happens, when the

Patient thought himself in perfect Health. Sometimes however it is

preceded by a Sensation of Cold and a kind of Numbness, which continue

some Days before the manifest Invasion of the Fit. It begins with

frequent Yawnings, a Lassitude, or Sensation of Weariness, with a

general Weakness, with Coldness, Shivering and Shaking: There is also a

Paleness of the extreme Parts of the Body, attended with Loathings, and

sometimes an actual Vomiting. The Pulse is quick, weak, and small, and

there is a considerable Degree of Thirst.

At the End of an Hour or two, and but seldom so long as three or four

Hours, a Heat succeeds, which increases insensibly, and becomes violent

at its Height. At this Period the whole Body grows red, the Anxiety of

the Patient abates; the Pulse is very strong and large, and his Thirst

proves excessive. He complains of a violent Head-ach, and of a Pain in

all his Limbs, but of a different sort of Pain from that he was sensible

of, while his Coldness continued. Finally, having endured this hot

State, four, five or six Hours, he falls into a general Sweat for a few

more: upon which all the Symptoms already mentioned abate, and sometimes

Sleep supervenes.

At the Conclusion of this Nap the Patient often wakes without any

sensible Fever; complaining only of Lassitude and Weakness. Sometimes

his Pulse returns entirely to its natural State between the two Fits;

though it often continues a little quicker than in perfect Health; and

does not recover its first Distinctness and Slowness, till some Days

after the last Fit.

One Symptom, which most particularly characterises these several Species

of intermitting Fevers, is the Quality of the Urines which the Sick pass

after the Fit. They are of a reddish Colour, and let fall a Sediment, or

Settling, which exactly resembles Brick-dust. They are sometimes frothy

too, and a Pellicle, or thin filmy Skin, appears on the Top, and adheres

to the Sides of the Glass that contains them.

Sec. 253. The Duration of each Fit is of no fixed Time or Extent, being

various according to the particular sort of Intermittents, and through

many other Circumstances. Sometimes they return precisely at the very

same Hour; at other Times they come one, two, or three Hours sooner, and

in other Instances as much later than the former. It has been imagined

that those Fevers, whose Paroxysms returned sooner than usual, were

sooner finally terminated: but there seems to be no general Rule in this

Case.

Sec. 254. Intermitting Fevers are distinguished into those of Spring and

Autumn. The former generally prevail from February to June: the latter

are those which reign from July to January. Their essential Nature and

Characters are the very same, as they are not different Distempers;

though the various Circumstances attending them deserve our

Consideration. These Circumstances depend on the Season itself, and the

Constitution of the Patients, during such Seasons. The Spring

Intermittents are sometimes blended with an inflammatory Disposition, as

that is the Disposition of Bodies in that Season; but as the Weather

then advances daily into an improving State, the Spring Fevers are

commonly of a shorter Duration. The autumnal Fevers are frequently

combined and aggravated with a Principle of Putrefaction; and as the Air

of that Season rather degenerates, they are more tedious and obstinate.

Sec. 255. The autumnal Fevers seldom begin quite so early as July, but much

oftner in August: and the Duration to which they are often extended, has

increased the Terror which the People entertain of Fevers that begin in

that Month. But that Prejudice which ascribes their Danger to the

Influence of August, is a very absurd Error; since it is better they

should set in then than in the following Months; because they are

obstinate in Proportion to the Tardiness, the Slowness of their

Approach. They sometimes appear at first considerably in the Form of

putrid Fevers, not assuming that of Intermittents till some Days after

their Appearance: but very happily there is little or no Danger in

mistaking them for putrid Fevers, or in treating them like such. The

Brick-coloured Sediment, and particularly the Pellicle or Film on the

Surface of the Urine, are very common in autumnal Intermittents, and are

often wanting in the Urine of putrid Fevers. In these latter, it is

generally less high coloured, and leaning rather to a yellow, a kind of

Cloudiness is suspended in the Middle of it. These also deposite a white

Sediment, which affords no bad Prognostic.

Sec. 256. Generally speaking, intermitting Fevers are not mortal; often

terminating in Health of their own Accord (without the Use of any

Medicine) after some Fits. In this last Respect Intermittents in the

Spring differ considerably from those in the Fall, which continue a long

Time, and sometimes even until Spring, if they are not removed by Art,

or if they have been improperly treated.

Quartan Fevers are always more obstinate and inveterate than Tertians;

the former sometimes persevering in certain Constitutions for whole

Years. When these Sorts of Fevers occur in boggy marshy Countries, they

are not only very chronical or tedious, but Persons infested with them

are liable to frequent Relapses.

Sec. 257. A few Fits of an Intermittent are not very injurious, and it

happens sometimes, that they are attended with a favourable Alteration

of the Habit in Point of Health; by their exterminating the Cause or

Principle of some languid and tedious Disorder; though it is erroneous

to consider them as salutary. If they prove tedious and obstinate, and

the Fits are long and violent, they weaken the whole Body, impairing all

its Functions, and particularly the Digestions: They make the Humours

sharp and unbalmy, and introduce several other Maladies, such as the

Jaundice, Dropsy, Asthma and slow wasting Fevers. Nay sometimes old

Persons, and those who are very weak, expire in the Fit; though such an

Event never happens but in the cold Fit.

Sec. 258. Very happily Nature has afforded us a Medicine, that infallibly

cures these Fevers: this is the _Kinkina_, or Jesuits Bark; and as we

are possessed of this certain Remedy, the only remaining Difficulty is

to discover, if there be not some other Disease combined with these

Fevers, which Disease might be aggravated by the Bark. Should any such

exist, it must be removed by Medicines adapted to it, before the Bark is

given. [67]

[67] This admirable Medicine was unknown in Europe, till about one

hundred and twenty Years past; we are obliged to the Spaniards for

it, who found it in the Province of Quito in Peru; the Countess of

Chinchon being the first European who used it in America, whence it

was brought to Spain, under the Name of the Countesses Powder. The

Jesuits having soon dispensed and distributed it abroad, it became

still more publick by the Name of the Jesuits Powder: and since it

has been known by that of _Kinkina_ or the Peruvian Bark. It met

with great Opposition at first; some deeming it a Poison, while

others considered it as a divine Remedy: so that the Prejudices of

many being heightened by their Animosity, it was nearly a full

Century, before its true Virtue and its Use were agreed to: and

about twenty Years since the most unfavourable Prejudices against

it pretty generally subsided. The Insufficience of other Medicines

in several Cases; its great Efficaciousness; and the many and

surprizing Cures which it did, and daily does effect; the Number of

Distempers; the different kinds of Fevers, in which it proves the

sovereign Remedy; its Effects in the most difficult chirurgical

Cases; the Comfort, the Strength and Sprits it gives those who need

and take it, have at length opened every Persons Eyes; so that it

has almost unanimously obtained the first Reputation, among the

most efficacious Medicines. The World is no longer amused with

Apprehensions of its injuring the Stomach; of its fixing, or

_shutting up_ the Fever (as the Phrase has been) without curing it;

that it shuts up the Wolf in the Sheepfold; that it throws those

who take it into the Scurvy, the Asthma, the Dropsy, the Jaundice.

On the contrary they are persuaded it prevents there very Diseases;

and, that if it is ever hurtful, it is only when it is either

adulterated, as most great Remedies have been; or has been wrongly

prescribed, or improperly taken: or lastly when it meets with some

latent, some unknown Particularities in a Constitution, which

Physicians term an _Idiosyncrasy_, and which prevent or pervert its

very general Effects. _Tissot._

Sec. 259. In the vernal, or Spring-Fevers, if the Fits are not very severe;

if the Patient is evidently well in their Intervals; if his Appetite,

his Strength, and his Sleep continue as in Health, no Medicine should be

given, nor any other Method be taken, but that of putting the Person,

under such a gentle Intermittent, upon the Regimen directed for Persons

in a State of Recovery. This is such a Regimen as pretty generally

agrees with all the Subjects of these Fevers: for if they should be

reduced to the Regimen proper in acute Diseases, they would be weakened

to no Purpose, and perhaps be the worse for it. But at the same Time if

we were not to retrench from the Quantity, nor somewhat to vary the

Quality of their usual Food in a State of Health; as there is not the

least Digestion made in the Stomach, during the whole Term of the Fit;

and as the Stomach is always weakened a little by the Disease, crude and

indigested Humours would be produced, which might afford a Fuel to the

Disease. Not the least solid Food should be allowed, for at least two

Hours before the usual Approach of the Fit.

Sec. 260. If the Fever extends beyond the sixth, or the seventh Fit; and

the Patient seems to have no Occasion for a Purge; which may be learned

by attending to the Chapter, which treats of Remedies to be taken by Way

of Precaution; [68] he may take the Bark, that is the Powder No. 14. If

it is a Quotidian, a daily Fever, or a double Tertian, six Doses,

containing three Quarters of an Ounce, should be taken between the two

Fits; and as these Intermissions commonly consist of but ten or twelve,

or at the most of fourteen or fifteen Hours, there should be an Interval

of only one Hour and a half between each Dose. During this Interval the

Sick may take two of his usual Refreshments or Suppings.

[68] It happens very seldom that intermitting Fevers require [69] no

Purge towards their Cure, especially in Places, which are disposed

to generate Putridity. There is always some material Cause

essential to these Fevers, of which Nature disembarrasses herself

more easily by Stools, than by any other Discharge: And as there is

not the least Danger to be apprehended from a gentle Purge, such at

those of No. 11 or 23, we think it would be prudent always to

premise a Dose or two of either to the Bark. _E. L._

[69] Yet I have known many in whom no Purge was necessary, and have seen

some rendered more obstinate and chronical by erroneous Purging.

But a Vomit is very generally necessary before the Bark is given.

_K._

When the Fever is a Tertian, an Ounce should be given between the two

Fits: which makes eight Doses, one of which is to be taken every three

Hours.

In a Quartan I direct one Ounce and a half, to be taken in the same

Manner. It is meer trifling to attempt preventing the Returns with

smaller Doses. The frequent Failures of the Bark are owing to over small

Doses. On such Occasions the Medicine is cried down, and censured as

useless, when the Disappointment is solely the Fault of those who do not

employ it properly. The last Dose is to be given two Hours before the

usual Return of the Fit.

The Doses, just mentioned, frequently prevent the Return of the Fit; but

whether it returns or not, after the Time of its usual Duration is past,

repeat the same Quantity, in the same Number of Doses, and Intervals,

which certainly keeps off another. For six Days following, half the same

Quantity must be continued, in the Intervals that would have occurred

between the Fits, if they had returned: and during all this Time the

Patient should inure himself to as much Exercise, as he can well bear.

Sec. 261. Should the Fits be very strong, the Pain of the Head violent, the

Visage red, the Pulse full and hard; if there is any Cough; if, even

after the Fit is over, the Pulse still is perceivably hard; if the Urine

is inflamed, hot and high-coloured, and the Tongue very dry, the Patient

must be bled, and drink plentifully of Barley Water No. 3. These two

Remedies generally bring the Patient into the State described Sec. 259: in

which State he may take on a Day, when the Fever is entirely off, three

or four Doses of the Powder No. 24, and then leave the Fever to pursue

its own Course for the Space of a few Fits. But should it not then

terminate of itself, the Bark must be recurred to.

If the Patient, even in the Interval of the Returns, has a foetid,

furred Mouth, a Loathing, Pains in the Loins, or in the Knees, much

Anxiety, and bad Nights, he should be purged with the Powder No. 21 or

the Potion No. 23, before he takes the Bark.

Sec. 262. If Fevers in Autumn appear to be of the continual kind, and very

like putrid Fevers, the Patients should drink abundantly of Barley

Water; and if at the Expiration of two or three Days, there still

appears to be a Load or Oppression at the Stomach, the Powder No. 34 or

that of 35 is to be given (but see Sec. 241): and if, after the Operation

of this, the Signs of Putridity continue, the Body is to be opened with

repeated Doses of the Powder No. 24; or, where the Patients are very

robust, with No. 21; and when the Fever becomes quite regular, with

distinct _Remissions_ at least, the Bark is to be given as directed Sec.

260.

But as autumnal Fevers are more obstinate; after having discontinued the

Bark for eight Days; and notwithstanding there has been no Return of the

Fever, it is proper to resume the Bark, and to give three Doses of it

daily for the succeeding eight Days, more especially if it was a

Quartan; in which Species I have ordered it to be repeated, every other

eight Days, for six Times.

Many People may find it difficult to comply with this Method of Cure,

which is unavoidably expensive, through the Price of the Bark. I thought

however this ought not to prevent me from averring it to be the only

certain one; since nothing can be an equivalent _Succedaneum_ or

Substitute to this Remedy, which is the only sure and safe one in all

these Cases. The World had long been prepossessed with Prejudices to the

contrary: it was supposed to be hurtful to the Stomach; to prevent which

it has been usual to make the Sick eat something an Hour after it.

Nevertheless, very far from injuring the Stomach, it is the best

Medicine in the Universe to strengthen it; and it is a pernicious

Custom, when a Patient is obliged to take it often, to eat an Hour after

it. It had also been imagined to cause Obstructions, and that it

subjected Patients to a Dropsy: but at present we are convinced, it is

the obstinate and inveterate Duration of the Intermittent, that causes

Obstructions, and paves the Way to a Dropsy. The Bark, in Consequence of

its speedily curing the Fever, does not only prevent the former Disease;

but when it continues, through an injudicious Omission of the Bark, a

proper Use of it is serviceable in the Dropsy. In a Word, if there is

any other Malady combined with the Fever, sometimes that indeed prevents

the Success of the Bark, yet without rendering it hurtful. But whenever

the intermitting Fever is simple and uncombined, it ever has, and ever

will render the Patient all possible Service. In another Place I shall

mention such Means and Methods as may in some Degree, though but

imperfectly, be substituted instead of it.

After the Patient has begun with the Bark, he must take no purging

Medicine, as that Evacuation would, with the greatest Probability,

occasion a Return of the Fever.

Sec. 263. Bleeding is never, or extremely seldom indeed necessary in a

Quartan Ague, which occurs in the Fall oftner than in the Spring; and

with the Symptoms of Putridity rather than of Inflammation.

Sec. 264. The Patient ought, two Hours before the Invasion of the Fit, to

drink a small Glass of warm Elder Flower Tea, sweetened with Honey,

every Quarter of an Hour, and to walk about moderately; this disposes

him to a very gentle Sweat, and thence renders the ensuing Coldness and

the whole Fit milder. He is to continue the same Drink throughout the

Duration of the cold Fit; and when the hot one approaches, he may either

continue the same, or substitute that of No. 2, which is more cooling.

It is not necessary however, in this State, to drink it warm, it is

sufficient that it be not over cold. When the Sweat, at the Termination

of the hot Fit, is concluded, the Patient should be well wiped and

dried, and may get up. If the Fit was very long, he may be allowed a

little Gruel, or some other such Nourishment during the Sweat.

Sec. 265. Sometimes the first, and a few successive Doses of the Bark purge

the Patient. This is no otherwise an ill Consequence, than by its

retarding the Cure; since, when it purges, it does not commonly prevent

the Return of the Fever; so that these Doses may be considered as to no

Purpose, and others should be repeated, which, ceasing to purge, do

prevent it. Should the Looseness notwithstanding continue, the Bark must

be discontinued for one entire Day, in order to give the Patient half a

Quarter of an Ounce of Rhubarb: after which the Bark is to be resumed

again, and if the Looseness still perseveres, fifteen Grains of Venice

Treacle should be added to each Dose, but not otherwise. All other

Medicines which are superadded, very generally serve only to increase

the Bulk of the Dose, while they lessen its Virtue.

Sec. 266. Before our thorough Experience of the Bark, other bitter

Medicines were used for the same Purpose: these indeed were not

destitute of Virtue in such Cases, though they were considerably less

available than the Bark. Under No. 43, some valuable Prescriptions of

that kind may be seen, whose Efficacy I have often experienced: though

at other Times I have been obliged to leave them off, and recur to the

Bark more successfully. Filings of Iron, which enter into the third

Prescription, are an excellent Febrifuge in particular Cases and

Circumstances. In the Middle of the Winter 1753, I cured a Patient of a

Quartan Ague with it, who would not be prevailed on to take the Bark. It

must be confessed he was perfectly regular in observing the _Regimen_

directed for him; and that, during the most rigid Severity of the

Winter, he got every Day on Horseback, and took such a Degree of other

Exercise in the open Air, as disposed him to perspire abundantly.

Sec. 267. Another very practicable easy Method, of which I have often

availed my Patients, under tertian Fevers (but which succeeded with me

only twice in Quartans) was to procure the Sufferer a very plentiful

Sweat, at the very Time when the Fit was to return, in its usual Course.

To effect this he is to drink, three or four Hours before it is

expected, an Infusion of Elder Flowers sweetened with Honey, which I

have already recommended Sec. 264; and one Hour before the usual Invasion

of the Shivering, he is to go into Bed, and take, as hot as he can drink

it, the Prescription No. 44.

I have also cured some Tertians and even Quartans, in 1751 and 1752, by

giving them, every four Hours between the Fits, the Powder No. 45. But I

must acknowledge that, besides its having often failed me, and its never

succeeding so speedily as the Bark, I have found it weaken some

Patients; it disorders, or disagrees with, their Stomachs: and in two

Cases, where it had removed the Fever, I was obliged to call in the Bark

for a thorough Establishment of the Patient's Health. Nevertheless, as

these Medicines are very cheap and attainable, and often do succeed, I

thought I could not properly omit them.

Sec. 268. A Multitude of other Remedies are cried up for the Cure of

Fevers: though none of them are equally efficacious with those I have

directed: and as many of them are even dangerous, it is prudent to

abstain from them. Some Years since certain Powders were sold here,

under the Name of the _Berlin_ Powders; these are nothing but the Bark

masqued or disguised (which has sometimes been publickly discovered) and

have always been sold very dear: though the Bark well chosen, and

freshly powdered when wanted, is greatly preferable.

Sec. 269. I have often known Peasants, who had laboured for several Months

under intermitting Fevers; having made Use of many bad Medicines and

Mixtures for them, and observed no Manner of Regimen. Such I have

happily treated by giving them the Remedies No. 34, or 35; and

afterwards, for some Days, that of No. 38; at the End of which Time, I

have ordered them the Bark (See Sec. 260) or other Febrifuges, as at Sec. 266,

267; and then finally ordered them for some Days, to take Morsels of the

poor Man's Treacle (See Sec. 247, _Art._ 13) to strengthen and confirm

their Digestions, which I have found very weak and irregular.

Sec. 270. Some Intermittents are distinguished as pernicious or malignant,

from every Fit's being attended with the most violent Symptoms. The

Pulse is small and irregular, the Patient exceedingly dejected, and

frequently swooning; afflicted with inexpressible Anguish, Convulsions,

a deep Drowsiness, and continual Efforts to go to Stool, or make Urine,

but ineffectually. This Disease is highly pressing and dangerous; the

Patient may die in the third Fit, and rarely survives the sixth, if he

is not very judiciously treated. Not a Moment should be lost, and there

is no other Step to be taken, but that of giving the Bark continually,

as directed Sec. 260, to prevent the succeeding Fits. These worst Kinds of

Intermittents are often combined with a great Load of putrid Humours in

the first Passages: and as often as such an aggravating Combination is

very evident, we should immediately after the End of one Fit, give a

Dose of Ipecacuana No. 35, and, when its Operation is finished, give the

Bark. But I chuse to enter into very few Details on this Species of

Intermittents, both as they occur but seldom, and as the Treatment of

them is too difficult and important, to be submitted to the Conduct of

any one but a Physician. My Intention has only been to represent them

sufficiently, that they may be so distinguished when they do occur, as

to apprize the People of their great Danger.

Sec. 271. The same Cause which produces these intermitting Fevers,

frequently also occasions Disorders, which return periodically at the

same Hour, without Shivering, without Heat, and often without any

Quickness of the Pulse. Such Disorders generally preserve the

Intermissons of quotidian or tertian Fevers, but much seldomer those of

Quartans. I have seen violent Vomittings, and Reachings to vomit, with

inexpressible Anxiety; the severest Oppressions, the most racking

Cholics; dreadful Palpitations and excessive Tooth-achs: Pains in the

Head, and very often an unaccountable Pain over one Eye, the Eyelid,

Eyebrow and Temple, on the same Side of the Face; with a Redness of that

Eye, and a continual, involuntary trickling of Tears. I have also seen

such a prodigious Swelling of the affected Part, that the Eye projected,

or stood out, above an Inch from the Head, covered by the Eyelid, which

was also extremely inflated or puffed up. All these Maladies begin

precisely at a certain Hour; last about the usual Time of a Fit; and

terminating without any sensible Evacuation, return exactly at the same

Hour, the next Day, or the next but one.

There is but one known Medicine that can effectually oppose this Sort,

which is the Bark, given as directed Sec. 260. Nothing affords Relief in

the Fit, and no other Medicine ever suspends or puts it off. But I have

cured some of these Disorders with the Bark, and especially those

affecting the Eyes, which happen oftner than the other Symptoms, after

their Duration for many Weeks, and after the ineffectual Use of

Bleeding, Purging, Baths, Waters, Blisters, and a great Number of other

Medicines. If a sufficient Dose of it be given, the next Fit is very

mild; the second is prevented; and I never saw a Relapse in these Cases,

which sometimes happens after the Fits of common Intermittents seemed

cured.

Sec. 272. In Situations where the Constitution of the Air renders these

Fevers very common, the Inhabitants should frequently burn in their

Rooms, at least in their lodging Rooms, some aromatic Wood or Herbs.

They should daily chew some Juniper Berries, and drink a fermented

Infusion of them. These two Remedies are very effectual to fortify the

weakest Stomachs, to prevent Obstructions, and to promote Perspiration.

And as these are the Causes which prolong these Fevers the most

obstinately; nothing is a more certain Preservation from them than these

cheap and obvious Assistances. [70]

[70] I have seen several Cases in very marshy maritime Countries, with

little good drinking Water, and far South of _Swisserland_, where

intermitting Fevers, with Agues at different Intervals, are

annually endemic, very popular, and often so obstinate as to return

repeatedly, whenever the weekly precautionary Doses of the Bark

have been omitted (through the Patient's nauseating the frequent

Swallowing of it) so that the Disease has sometimes been extended

beyond the Term of a full Year, and even far into a second,

including the temporary Removals of it by the Bark. Nevertheless,

in some such obstinate Intermittents, and particularly Quartans

there, wherein the Bark alone has had but a short and imperfect

Effect, I have known the following Composition, after a good Vomit,

attended with speedy and final Success, _viz._ Take of fresh

Sassafras Bark, of Virginia Snake-root, of Roch-Allom, of Nutmeg,

of diaphoretic Antimony, and of Salt of Wormwood of each one

Drachm. To these well rubbed together into fine Powder, add the

Weight of the whole, of the best and freshest Bark; then drop in

three Drops of the chemical Oil of Mint, and with Syrup of Cloves

make it into the Consistence of an Electuary or Bolus, for 12 Doses

for a grown Person, to be taken at the Distance of three or four

Hours from each other, while the Patient is awake, according to the

longer or shorter Intermission of the Fever.

I have also known, particularly in obstinate autumnal Agues there,

an Infusion of two Ounces of the best Bark in fine Powder, or two

Ounces and a half in gross Powder, in a Quart of the best Brandy,

for three or four Days (a small Wine Glass to be taken by grown

Persons at the Distance of from four to six Hours) effectually and

speedily terminate such intermittent Agues, as had given but little

Way to the Bark in Substance. This was certainly more suitable for

those who were not of a light delicate Habit and Temperament, and

who had not been remarkable for their Abstinence from strong

Liquors: the inebriating Force of the Brandy being remarkably

lessened, by the Addition and long Infusion of the Bark. These

Facts which I saw, are the less to be wondered at, as in such

inveterate, but perfectly clear and distinct Intermittents, both

the State of the Fluids and Solids seem very opposite to their

State in an acutely inflammatory Disease. _K._

__Chapter XIX.__

_Of the Erisipelas, and the Bites of Animals._

__Sect.__ 273.

The Erisipelas, commonly called in English, St. Anthony's Fire, and in

Swisserland _the Violet_, is sometimes but a very slight Indisposition

which appears on the Skin, without the Person's being sensible of any

other Disorder; and it most commonly breaks out either in the Face, or

on the Legs. The Skin becomes tense, or stiff, rough and red; but this

Redness disappears on pressing the Spot with a Finger, and returns on

removing it. The Patient feels in the Part affected a burning Heat,

which makes him uneasy, and sometimes hinders him from sleeping. The

Disorder increases for the Space of two or three Days; continues at its

Height one or two, and then abates. Soon after this, that Part of the

Skin that was affected, falls off in pretty large Scales, and the

Disorder entirely terminates.

Sec. 274. But sometimes this Malady is considerably more severe, beginning

with a violent Shivering, which is succeeded by a burning Heat, a

vehement Head-ach, a Sickness at Heart, as it is commonly termed, or

Reachings to vomit, which continue till the _Erisipelas_ appears, which

sometimes does not happen before the second, or even the third Day. The

Fever then abates, and the Sickness goes off, though frequently a less

Degree of Fever, and of Sickness or Loathing remain, during the whole

Time, in which the Disease is in its increasing State. When the Eruption

and Inflammation happen in the Face, the Head-ach continues, until the

Decline, or going off, of the Disease. The Eyelid swells, the Eye is

closed, and the Patient has not the least Ease or Tranquillity. It often

passes from one Cheek to the other, and extends successively over the

Forehead, the Neck, and the Nape of the Neck; under which Circumstance

the Disease is of a more than ordinary Duration. Sometimes also when it

exists in a very high Degree, the Fever continues, the Brain is

obstructed and oppressed; the Patient raves; his Case becomes extremely

dangerous; whence sometimes, if he is not very judiciously assisted, he

dies, especially if of an advanced Age. A violent _Erisipelas_ on the

Neck brings on a Quinsey, which may prove very grievous, or even fatal.

When it attacks the Leg, the whole Leg swells up; and the Heat and

Irritation from it is extended up to the Thigh.

Whenever this Tumour is considerable, the Part it seizes is covered with

small Pustules filled with a clear watery Humour, resembling those which

appear after a Burn, and drying afterwards and scaling off. I have

sometimes observed, especially when this Distemper affected the Face,

that the Humour, which issued from these little Pustules, was extremely

thick or glewy, and formed a thick Scurf, or Scabs nearly resembling

those of sucking Children: they have continued fast on the Face many

Days before they fell off.

When the Disease may be termed violent, it sometimes continues eight,

ten, twelve Days at the same Height; and is at last terminated by a very

plentiful Sweat, that may sometimes be predicted by a Restlessness

attended with Shiverings, and a little Anxiety of some Hours Duration.

Throughout the Progress of the Disease, the whole Skin is very dry, and

even the Inside of the Mouth.

Sec. 275. An _Erisipelas_ rarely comes to Suppuration, and when it does,

the Suppuration is always unkindly, and much disposed to degenerate into

an Ulcer. Sometimes a malignant kind of _Erisipelas_ is epidemical,

seizing a great Number of Persons, and frequently terminating in

Gangrenes.

Sec. 276. This Distemper often shifts its Situation; it sometimes retires

suddenly; but the Patient is uneasy and disordered; he has a Propensity

to vomit, with a sensible Anxiety and Heat: the _Erisipelas_ appears

again in a different Part, and he feels himself quite relieved from the

preceding Symptoms. But if instead of re-appearing on some other Part of

the Surface, the Humour is thrown upon the Brain, or the Breast, he dies

within a few Hours; and these fatal Changes and Translations sometimes

occur, without the least Reason or Colour for ascribing them either to

any Error of the Patient, or of his Physician.

If the Humour has been transferred to the Brain, the Patient immediately

becomes delirious, with a highly flushed Visage, and very quick

sparkling Eyes: very soon after he proves downright frantic, and goes

off in a Lethargy.

If the Lungs are attacked, the Oppression, Anxiety, and Heat are

inexpressible.

Sec. 277. There are some Constitutions subject to a very frequent, and, as

it were, to an habitual _Erisipelas_. If it often affects the Face, it

is generally repeated on the same Side of it, and that Eye is, at

length, considerably weakened by it.

Sec. 278. This Distemper results from two Causes; the one, an acrid sharp

Humour, which is commonly bilious, diffused through the Mass of Blood;

the other consists in that Humour's not being sufficiently discharged by

Perspiration.

Sec. 279. When this Disease is of a gentle Nature, such as it is described

Sec. 273, it will be sufficient to keep up a very free Perspiration, but

without heating the Patient; and the best Method to answer this Purpose

is putting him upon the Regimen so often already referred to, with a

plentiful Use of Nitre in Elder Tea. Flesh, Eggs and Wine are prohibited

of Course, allowing the Patient a little Pulse and ripe Fruits. He

should drink Elder Flower Tea abundantly, and take half a Drachm of

Nitre every three Hours; or, which amounts to the same Thing, let three

Drachms of Nitre be dissolved in as much Infusion of Elder Flowers, as

he can drink in twenty-four Hours. Nitre may be given too in a Bolus

with Conserve of Elder-berries. These Medicines keep the Body open, and

increase Urine and Perspiration.

Sec. 280. When the Distemper prevails in a severer Degree, if the Fever is

very high, and the Pulse, at the same Time, strong or hard, it may be

necessary to bleed once: but this should never be permitted in a large

Quantity at a Time in this Disease; it being more adviseable, if a

sufficient Quantity has not been taken at once, to bleed a second Time,

and even a third, if the Fever should prove very high, as it often does,

and that sometimes in so violent a Degree, as to render it extremely

dangerous: and in some such Cases Nature has sometimes saved the

Patients by effecting a large Hemorrhage, or Bleeding, to the Quantity

of four or five Pounds. This Conduct a very intelligent and prudent

Physician may presume to imitate; but I dare not advise the same Conduct

to that Class of Physicians, for which only I write: it being safer for

them to use repeated Bleedings in such Cases, than one in an excessive

Quantity. These erisipelatous Fevers are often excited by a Person's

being too long over-heated.

After Bleeding the Patient is to be restrained to his Regimen; Glysters

are to be given until there is a sensible Abatement of the Fever; and he

should drink the Barley Water freely, No. 3.

When the Fever is somewhat diminished, either the Purge No. 23 should be

given, or a few Doses every Morning of Cream of Tartar No. 24. Purging

is absolutely necessary to carry off the stagnant Bile, which is

generally the first Cause of the violent Degrees of this Distemper. It

may sometimes be really necessary too, if the Disease is very tedious;

if the Loathing and Sickness at Stomach is obstinate; the Mouth

ill-favoured, and the Tongue foul, (provided there be only a slight

Fever, and no Fear of an Inflammation) to give the Medicines No. 34 or

35, which, in Consequence of the Agitation, the Shaking they occasion,

remove these Impediments still better than Purges.

It commonly happens that this Disease is more favourable after these

Evacuations; nevertheless it is sometimes necessary to repeat them the

next Day, or the next but one; especially if the Malady affects the

Head. Purging is the true Evacuation for curing it, whenever it attacks

this Part. By carrying off the Cause of the Disease, they diminish it,

and prevent its worst Effects.

Whenever, even after these Evacuations, the Fever still continues to be

very severe, the Patient should take every two Hours, or occasionally,

oftner, two Spoonfuls of the Prescription No. 10, added to a Glass of

Ptisan.

It will be very useful, when this Disease is seated in the Head or Face,

to bathe the Legs frequently in warm Water; and where it is violent

there, also to apply Sinapisms to the Soles of the Feet. I have seen

this Application, in about four Hours attract, or draw down an

_Erisipelas_ to the Legs, which had spread over the Nose, and both the

Eyes. When the Distemper once begins to go off by Sweating, this should

be promoted by Elder-flower Tea and Nitre (See Sec. 279) and the Sweating

may be encouraged to Advantage for some Hours.

Sec. 281. The best Applications that can be made to the affected Part are

1st, The Herb Robert, a Kind of _Geranium_, or Crane's-Bill; or Chervil,

or Parsley, or Elder Flowers: and if the Complaint be of a very mild

Disposition, it may be sufficient to apply a very soft smooth Linen over

it, which some People dust over with a little dry Meal.

2, If there is a very considerable Inflammation, and the Patient is so

circumstanced as to be very tractable and regularly attended, Flanels

wrung out of a strong Decoction of Elder-flowers and applied warm,

afford him the speediest Ease and Relief. By this simple Application I

have appeased the most violent Pains of a St. Anthony's Fire, which is

the most cruel Species of an Erisipelas, and has some peculiar Marks or

Symptoms extraordinary.

3, The Plaister of Smalt, and Smalt itself No. 46, are also very

successfully employed in this Disease. This Powder, the farinaceous, or

mealy ones, or others cried up for it, agree best when a thin watery

Humour distills or weeps from the little Vesications attending it, which

it is convenient to absorb by such Applications; without which

Precaution it might gall, or even ulcerate the Part.

All other Plaisters, which are partly compounded of greasy, or of

resinous Substances, are very dangerous: they often repel, or strike in

the _Erisipelas_, occasioning it to ulcerate, or even to gangrene. If

People who are naturally subject to this Disease should apply any such

Plaister to their Skin, even in its soundest State, an _Erisipelas_ is

the speedy Consequence.

Sec. 282. Whenever the Humour occasioning the Distemper is repelled, and

thrown upon the Brain, the Throat, the Lungs, or any internal Part, the

Patient should be bled; Blisters must be applied to the Legs; and Elder

Tea, with Nitre dissolved in it, should be plentifully drank.

Sec. 283. People who are liable to frequent Returns of an Erisipelas,

should very carefully avoid using Milk, Cream, and all fat and viscid,

or clammy Food, Pies, brown Meat, Spices, thick and heady Liquors, a

sedentary Life, the more active Passions, especially Rage, and, if

possible, all Chagrin too. Their Food should chiefly consist of Herbage,

Fruits, of Substances inclining to Acidity, and which tend to keep the

Body open; they should drink Water, and some of the light white Wines;

by no Means omitting the frequent Use of Cream of Tartar. A careful

Conformity to these Regulations is of real Importance, as, besides the

Danger of the frequent Visitations of this Disease, they denote some

slight Indispositions of the Liver and the Gall-bladder; which, if too

little attended to, might in Time prove very troublesome and pernicious.

Such mineral Waters as are gently opening are very proper for these

Constitutions, as well as the Juice of Succory, and clarified Whey, of

which they should take about three Pints every Morning, during the five

or six Summer Months. This becomes still more efficacious, if a little

Cream of Tartar and Honey be added to it.

_Of the Stings, or little Wounds, by Animals._

Sec. 284. The Stings or little Bites of Animals, frequently producing a

kind of _Erisipelas_, I shall add a very few Words concerning them in

this Place.

Of the Serpents in this Country none but the Vipers are poisonous; and

none of these are found except at _Baume_, where there is a _Viperary_,

if we may be allowed that Word. We have no Scorpions, which are somewhat

poisonous; our Toads are not in the least so: whence the only Stings we

are exposed to, are those of Bees, Wasps, Hornets, Muskitos or Gnats,

and Dragon [71] Flies: all of which are sometimes attended with severe

Pain, a Swelling, and a very considerable erisipelatous Redness; which,

if it happens in the Face, sometimes entirely closes the Eyes up;

occasioning also a Fever, Pains of the Head, Restlessness, and Sickness

at Heart; and, when the Pains are in a violent Degree, Faintings and

Convulsions, though always without any mortal Consequence. These

Symptoms go off naturally within a few Days, without any Assistance:

Nevertheless they may either be prevented, diminished in Degree, or

shortned in Duration.

[71] These, in some Parts of America, are called Muskito Hawks; but we

do not recollect their biting there. _K._

1, By extracting the Sting of the Animal, if it is left behind.

2, By a continual Application of one of the Remedies directed Sec. 281,

Article 1 and 2, particularly the Infusion of Elder-flowers, to which a

little Venice Treacle is added; or by covering the Part affected with a

Pultice, made of Crum of Bread, Milk, Honey, and a little Venice

Treacle. [72]

[72] Pounded Parsley is one of the most availing Applications in such

Accidents. _E.L._

3, By bathing the Legs of the Person stung repeatedly in warm Water.

4, By retrenching a little of their customary Food, especially at Night,

and by making them drink an Infusion of Elder-flowers, with the Addition

of a little Nitre. Oil, if applied very quickly after the Sting,

sometimes prevents the Appearance of any Swelling, and from thence the

Pains that attend it.

__Chapter XX.__

_Of spurious, or false Inflammations of the Breast, and of spurious,

bilious, Pleurisies._

__Sect.__ 285.

The Inflammation of the Breast and that Pleurisy, which is called

_bilious_, are the same Disease. It is properly a putrid Fever, attended

with an Infarction or Stuffing of the Lungs, though without Pain; in

which Circumstance it is called a putrid or bilious Peripneumony: but

when attended with a Pain of the Side, a Stitch, it is called a spurious

or bastard Pleurisy.

Sec. 286. The Signs which distinguish these Diseases from the inflammatory

ones of the same Name, described Chap. IV and V, are a less hard and

less strong, but a quicker Pulse, though unaccompanied with the same

Symptoms which constitute the inflammatory ones (See Sec. 47 and 90). The

Mouth is foul, and has a Sensation of Bitterness; the Patient is

infested with a sharp and dry Heat; he has a Feeling of Heaviness and

Anxiety all about his Stomach, with Loathings: he is less flushed and

red in these, than in the inflammatory Diseases, but rather a little

yellow. He has a dejected wan Look; his Urine resembles that in putrid

Fevers, and not that of inflammatory ones; and he has very often a small

bilious Looseness, which is extremely offensive. The Skin is commonly

very dry in this Disease; the Humour spit up is less thick, less

reddish, and rather more yellow than in the inflammatory Diseases of the

same Names.

Sec. 287. They must be treated after the manner of putrid Fevers, as in Sec.

241. Supposing some little Degree of Inflammation to be combined with

the Disease, it may be removed by a single Bleeding. After this the

Patient is to drink Barley Water No. 3, to make Use of Glysters; and as

soon as all Symptoms of any Inflammation wholly disappear, he is to take

the vomiting and purging Draught No. 34. But the utmost Caution must be

taken not to give it, before every Appearance of any Inflammation is

totally removed; as giving it sooner would be certain Death to the Sick:

and it is dreadful but to think of agitating, by a Vomit, Lungs that are

inflamed, and overloaded with Blood, whose Vessels burst and discharge

themselves, only from the Force of Expectoration. After an Interval of

some Days, he may be purged again with the Medicine No. 23. The

Prescription No. 25 succeeds also very well as a Vomit. If the Fever is

violent, he must drink plentifully of the Potion No. 10.

Blisters to the Legs are very serviceable, when the Load and Oppression

are not considerably abated after general Evacuations.

Sec. 288. The false Inflammation of the Breast is an Overfulness or

Obstruction in the Lungs, accompanied with a Fever; and it is caused by

extremely thick and tenacious Humours; and not by a really inflammatory

Blood, or by any putrid or bilious Humour.

Sec. 289. This Distemper happens more frequently in the Spring, than in any

other Season. Old Men, puny, ill-constitutioned Children, languid Women,

feeble young Men, and particularly such as have worn their Constitutions

out by drinking, are the Subjects most frequently attacked by it;

especially if they have used but little Exercise throughout the Winter:

if they have fed on viscid, mealy and fat Aliments, as Pastry, Chesnuts,

thick Milk or Pap, and Cheese. All their Humours have contracted a thick

glutinous Quality; they are circulated with Difficulty, and when Heat or

Exercise in the Spring increases their Motion at once, the Humours,

already stuffing up the Lungs, still more augment that Plenitude, whence

these vital Organs are fatally extended, and the Patient dies.

Sec. 290. This Distemper is known to exist,

1, By the previous Existence of the Causes already mentioned.

2, By the Symptoms which precede and usher it in. For Example, the

Patient many Days before-hand has a slight Cough; a small Oppression

when he moves about; a little Restlessness, and is sometimes a little

choleric or fretful. His Countenance is higher coloured than in Health;

he has a Propensity to sleep, but attended with Confusion and without

Refreshment, and has sometimes an extraordinary Appetite.

3, When this State has continued for some Days, there comes on a cold

Shivering, though more considerable for its Duration than its Violence;

it is succeeded by a moderate Degree of Heat, but that attended with

much Inquietude and Oppression. The sick Person cannot confine himself

to the Bed; but walks to and fro in his Chamber, and is greatly

dejected. The Pulse is weak and pretty quick; the Urine is sometimes but

little changed from that in Health; at other Times it is discharged but

in a small Quantity, and is higher coloured: he coughs but moderately,

and does not expectorate, or cough up, but with Difficulty. The Visage

becomes very red, and even almost livid; he can neither keep awake, nor

sleep well; he raves for some Moments, and then his Head grows clear

again. Sometimes it happens, especially to Persons of advanced Age, that

this State suddenly terminates in a mortal Swoon or Fainting: at other

Times and in other Cases, the Oppression and Anguish increase; the

Patient cannot breathe but when sitting up, and that with great

Difficulty and Agony: the Brain is utterly disturbed and embarrassed;

this State lasts for some Hours, and then terminates of a sudden.

Sec. 291. This is a very dangerous Distemper; because, in the first Place,

it chiefly attacks those Persons whose Temperament and Constitution are

deprived of the ordinary Resources for Health and Recovery: in the

second Place, because it is of a precipitate Nature, the Patient

sometimes dying on the third Day, and but seldom surviving the seventh;

while the Cause of it requires a more considerable Term for its Removal

or Mitigation. Besides which, if some Indications present for the

Employment of a Remedy, there are frequently others which forbid it; and

all that seems to be done is, as follows;

1, If the Patient has still a pretty good Share of Health; if he is not

of too advanced an Age; if the Pulse has a perceivable Hardness, and yet

at the same Time some Strength; if the Weather is dry, and the Wind

blows from the North, he should be bled once, to a moderate Quantity.

But if the greater Part of these Circumstances are wanting, Bleeding

would be very prejudicial. Were we obliged to establish some general and

positive Rule in this Case, it were better to exclude Bleeding, than to

admit it.

2, The Stomach and the Bowels should be unloaded from their viscid

glutinous Contents; and the Medicines which succeed the best in this

Respect are No. 35, when the Symptoms shew there is a great Necessity

for vomiting, and there is no Inflammation; or the Prescription No. 25,

which after vomiting, purges by Stool, promotes Urine, breaks down and

divides the viscid Humours that occasion the Disease, and increase

Perspiration. When we are afraid of hazarding the Agitation of a Vomit

and its Consequences, the Potion, No. 11 may be given; but we must be

very cautious, in Regard to old Men, even with this; as such may expire

during the Operation of it.

3, They should, from the Beginning of the Disease, drink plentifully of

the Ptisan No. 26, which is the best Drink in this Disease; or that of

No. 12, adding half a Dram of Nitre to every Pint of it.

4, A Cup of the Mixture No. 8 must be taken every two Hours.