CAUSES.——Remitting fevers prevail in low marshy countries abounding with

wood and stagnating water; but they prove most fatal in places where

great heat and moisture are combined, as in some parts of Africa, the

province of Bengal in the East Indies, &c. where remitting fevers are

generally of a putrid kind, and prove very fatal. They are most frequent

in close calm weather, especially after rainy seasons, great

inundations, or the like. No age, sex, or constitution, is exempted from

the attack of this fever; but it chiefly seizes persons of a relaxed

habit, who live in low dirty habitations, breathe an impure stagnating

air, take little exercise, and use unwholesome diet.

SYMPTOMS.——The first symptoms of this fever are generally yawning,

stretching, pain, and giddiness in the head, with alternate fits of heat

and cold. Sometimes the patient is affected with a delirium at the very

first attack. There is a pain, and sometimes a swelling, about the

region of the stomach; the tongue is white, the eyes and skin frequently

appear yellow, and the patient is often afflicted with bilious

vomitings. The pulse is sometimes a little hard, but seldom full, and

the blood, when let, rarely shews any signs of inflammation. Some

patients are exceedingly costive, and others are afflicted with a very

troublesome looseness.

It is impossible to describe all the symptoms of this disease, as they

vary according to the situation, the season of the year, and the

constitution of the patient. They may likewise be greatly changed by the

method of treatment, and by many other circumstances too tedious to

mention. Sometimes the bilious symptoms predominate, sometimes the

nervous, and at other times the putrid. Nor is it at all uncommon to

find a succession of each of these, or even a complication of them at

the same time, in the same person.

REGIMEN.——The regimen must be adapted to the prevailing symptoms. When

there are any signs of inflammation, the diet must be slender, and the

drink weak and diluting. But when nervous or putrid symptoms occur, it

will be necessary to support the patient with food and liquors of a more

generous nature, such as are recommended in the immediately preceding

fevers. We must however be very cautious in the use of things of a

heating quality, as this fever is frequently changed into a _continual_

by an hot regimen, and improper medicines.

Whatever the symptoms are, the patient ought to be kept cool, quiet, and

clean. His apartment, if possible, should be large, and frequently

ventilated by letting in fresh air at the doors or windows. It ought

likewise to be sprinkled with vinegar, juice of lemon, or the like. His

linen, bed-clothes, &c. should be frequently changed, and all his

excrements immediately removed. Though these things have been

recommended before, we think it necessary to repeat them here, as they

are of more importance to the sick than practitioners are apt to

imagine[87].

MEDICINE.——In order to cure this fever, we must endeavour to bring it to

a regular intermission. This intention may be promoted by bleeding, if

there be any signs of inflammation; but when that is not the case,

bleeding ought by no means to be attempted, as it will weaken the

patient and prolong the disease. A vomit however will seldom be

improper, and is generally of great service. Twenty or thirty grains of

ipecacuanha will answer this purpose very well; but, where it can be

obtained, we would rather recommend a grain or two of tartar emetic,

with five or six grains of ipecacuanha, to be made into a draught, and

given for a vomit. This may be repeated once or twice at proper

intervals, if the sickness or nausea continues.

The body ought to be kept open either by clysters or gentle laxatives,

as weak infusions of senna and manna, small doses of the lenitive

electuary, cream of tartar, tamarinds, stewed prunes, or the like; but

all strong or drastic purgatives are to be carefully avoided.

By this course the fever in a few days may generally be brought to a

pretty regular or distinct intermission, in which case the Peruvian bark

may be administered, and it will seldom fail to perfect the cure. It is

needless here to repeat the methods of giving the bark, as we have

already had occasion frequently to mention them.

The most likely way to avoid this fever is to use a wholesome and

nourishing diet, to pay the most scrupulous attention to cleanliness, to

keep the body warm, to take sufficient exercise, and in hot countries to

avoid damp situations, night air, evening dews, and the like. In

countries where it is endemical, the best preventive medicine which we

can recommend, is the Peruvian bark, which may either be chewed, or

infused in brandy or wine, &c. Some recommend smoking tobacco as very

beneficial in marshy countries, both for the prevention of this and

intermitting fevers.

CHAP. XXIII.

OF THE SMALL-POX.

This disease, which originally came from Arabia, is now become so

general, that very few escape it at one time of life or another. It is a

most contagious malady; and has for many years proved the scourge of

Europe.

The small-pox generally appear towards the spring. They are very

frequent in summer, less so in autumn, and least of all in winter.

Children are most liable to this disease; and those whose food is

unwholesome, who want proper exercise, and abound with gross humours,

run the greatest hazard from it.

The disease is distinguished into the distinct and confluent kind; the

latter of which is always attended with danger. There are likewise other

distinctions of the small-pox; as the crystalline, the bloody, &c.

CAUSES.——The small-pox is commonly caught by infection. Since the

disease was first brought into Europe, the infection has never been

wholly extinguished, nor have any proper methods, as far as I know, been

taken for that purpose; so that now it has become in a manner

constitutional. Children who have overheated themselves by running,

wrestling, &c. or adults after a debauch, are most apt to be seized with

the small-pox.

SYMPTOMS.——This disease is so generally known, that a minute description

of it is unnecessary. Children commonly look a little dull, seem

lifeless and drowsy for a few days before the more violent symptoms of

the small-pox appear. They are likewise more inclined to drink than

usual, have little appetite for solid food, complain of weariness, and,

upon taking exercise, are apt to sweat. These are succeeded by slight

fits of cold and heat in turns, which, as the time of the eruption

approaches, become more violent, and are accompanied with pains of the

head and loins, vomiting, &c. The pulse is quick, with a great heat of

the skin, and restlessness. When the patient drops asleep, he wakes in a

kind of horror, with a sudden start, which is a very common symptom of

the approaching eruption; as are also convulsion-fits in very young

children.

About the third or fourth day from the time of sickening, the small-pox

generally begin to appear; sometimes indeed they appear sooner, but that

is no favourable symptom. At first they very nearly resemble flea-bites,

and are soonest discovered on the face, arms, and breast.

The most favourable symptoms are a slow eruption, and an abatement of

the fever as soon as the pustules appear. In a mild distinct kind of

small-pox the pustules seldom appear before the fourth day from the time

of sickening, and they generally keep coming out gradually for several

days after. Pustules which are distinct, with a florid red basis, and

which fill with thick purulent matter, first of a whitish, and

afterwards of a yellowish colour, are the best.

A livid brown colour of the pustules is an unfavourable symptom; as also

when they are small and flat, with black specks in the middle. Pustules

which contain a thin watery ichor are very bad. A great number of pox on

the face is always attended with danger. It is likewise a very bad sign

when they run into one another.

It is a most unfavourable symptom when petechiæ, or purple, brown, or

black spots are interspersed among the pustules. These are signs of a

putrid dissolution of the blood, and shew the danger to be very great.

Bloody stools or urine, with a swelled belly, are bad symptoms; as is

also a continual strangury. Pale urine and a violent throbbing of the

arteries of the neck are signs of an approaching delirium, or of

convulsion-fits. When the face does not swell, or falls before the pox

come to maturity, it is very unfavourable. If the face begins to fall

about the eleventh or twelfth day, and at the same time the hands and

feet begin to swell, the patient generally does well; but when these do

not succeed to each other, there is reason to apprehend danger. When the

tongue is covered with a brown crust, it is an unfavourable symptom.

Cold shivering fits coming on at the height of the disease are likewise

unfavourable. Grinding of the teeth, when it proceeds from an affection

of the nervous system, is a bad sign; but sometimes it is occasioned by

worms, or a disordered stomach.

REGIMEN.——When the first symptoms of the small-pox appear, people are

ready to be alarmed, and often fly to the use of medicine, to the great

danger of the patient’s life. I have known children, to appease the

anxiety of their parents, bled, blistered, and purged, during the fever

which preceded the eruption of the small-pox, to such a degree, that

Nature was not only disturbed in her operation, but rendered unable to

support the pustules after they were out; so that the patient, exhausted

by mere evacuations, sunk under the disease.

When convulsions appear, they give a dreadful alarm. Immediately some

nostrum is applied, as if this were a primary disease; whereas it is

only a symptom, and far from being an unfavourable one, of the

approaching eruption. As the fits generally go off before the actual

appearance of the small-pox, it is attributed to the medicine, which by

this means acquires a reputation without any merit[88].

All that is, generally speaking, necessary during the eruptive fever, is

to keep the patient cool and easy, allowing him to drink freely of some

weak diluting liquors; as balm-tea, barley-water, clear whey, gruels,

&c. He should not be confined to bed, but should sit up as much as he is

able, and should have his feet and legs frequently bathed in lukewarm

water. His food ought to be very light; and he should be as little

disturbed with company as possible.

Much mischief is done at this period by confining the patient too soon

to his bed, and plying him with warm cordials or sudorific medicines.

Every thing that heats and inflames the blood increases the fever, and

pushes out the pustules prematurely. This has numberless ill effects. It

not only increases the number of pustules, but likewise tends to make

them run into one another; and when they have been pushed out with too

great violence, they generally fall in before they come to maturity.

The good women, as soon as they see the small-pox begin to appear,

commonly ply their tender charge with cordials, saffron, and

marigold-teas, wine, punch, and even brandy itself. All these are given

with a view, as they term it, to throw out the eruption from the heart.

This, like most other popular mistakes, is the abuse of a very just

observation, _that when there is a moisture on the skin, the pox rise

better, and the patient is easier, than when it continues dry and

parched_. But that is no reason for forcing the patient into a sweat.

Sweating never relieves unless where it comes spontaneously, or is the

effect of drinking weak diluting liquors.

Children are often so peevish, that they will not lie a-bed without a

nurse constantly by them. Indulging them in this, we have reason to

believe, has many bad effects both upon the nurse and child. Even the

natural heat of the nurse cannot fail to augment the fever of the child,

but if she too proves feverish, which is often the case, the danger must

be increased[89].

Laying several children who have the small-pox in the same bed has many

ill consequences. They ought if possible never to be in the same

chamber, as the perspiration, the heat, the smell, &c. all tend to

augment the fever, and to heighten the disease. It is common among the

poor to see two or three children lying in the same bed, with such a

load of pustules that even their skins stick together. One can hardly

view a scene of this kind without being sickened by the sight. But how

must the effluvia affect the poor patients, many of whom perish by this

usage[90]!

A very dirty custom prevails among the lower class of people, of

allowing children in the small-pox to keep on the same linen during the

whole period of that loathsome disease. This is done lest they should

catch cold; but it has many ill consequences. The linen becomes hard by

the moisture which it absorbs, and frets the tender skin. It likewise

occasions a bad smell, which is very pernicious both to the patient and

those about him; besides, the filth and sordes which adhere to the linen

being resorbed, or taken up again into the body, greatly augment the

disease.

A patient should not be suffered to be dirty in an internal disease, far

less in the small-pox. Cutaneous disorders are often occasioned by

nastiness alone, and are always increased by it. Were the patient’s

linen to be changed every day, it would greatly refresh him. Care indeed

is to be taken that the linen be thoroughly dry. It ought likewise to be

put on when the patient is most cool.

So strong is the vulgar prejudice in this country, notwithstanding all

that has been said against the hot regimen in the small-pox, that

numbers still fall a sacrifice to that error. I have seen poor women

travelling in the depth of winter, and carrying their children along

with them in the small-pox, and have frequently observed others begging

by the way-side, with infants in their arms covered with the pustules;

yet I could never learn that one of these children died by this sort of

treatment. This is certainly a sufficient proof of the safety at least,

of exposing patients in the small-pox to the open air. There can be no

reason however for exposing them to public view. It is now very common

in the environs of great towns to meet patients in the small-pox on the

public walks. This practice, however well it may suit the purposes of

boasting inoculators, is dangerous to the citizens, and contrary to the

laws of humanity and sound policy.

The food in this disease ought to be very light, and of a cooling

nature, as panado, or bread boiled with equal quantities of milk and

water, good apples roasted or boiled with milk, and sweetened with a

little sugar, or such like.

The drink may be equal parts of milk and water, clear sweet whey,

barley-water, or thin gruel, &c. After the pox are full, butter-milk,

being of an opening and cleansing nature, is a very proper drink.

MEDICINE.——This disease is generally divided into four different

periods, _viz._ the fever which precedes the eruption, the eruption

itself, the suppuration, or maturation of the pustules, and the

secondary fever.

It has already been observed, that little more is necessary during the

primary fever than to keep the patient cool and quiet, allowing him to

drink diluting liquors, and bathing his feet frequently in warm water.

Though this be generally the safest course that can be taken with

infants, yet adults of a strong constitution and plethoric habit

sometimes require bleeding. When a full pulse, a dry skin, and other

symptoms of inflammation render this operation necessary, it ought to be

performed; but, unless these symptoms are urgent, it is safer to let it

alone; if the body is bound, emollient clysters may be thrown in.

If there is a great nausea or inclination to vomit, weak camomile-tea or

lukewarm water may be drank, in order to clean the stomach. At the

beginning of a fever, Nature generally attempts a discharge, either

upwards or downwards, which, if promoted by gentle means, would tend

greatly to abate the violence of the disease.

Though every method is to be taken during the primary fever, by a cool

regimen, &c. to prevent too great an eruption; yet after the pustules

have made their appearance, our business is to promote the suppuration,

by diluting drink, light food, and, if Nature seems to flag, by generous

cordials. When a low, creeping pulse, faintishness, and great loss of

strength, render cordials necessary, we would recommend good wine, which

may be made into negus, with an equal quantity of water, and sharpened

with the juice of orange, the jelly of currants, or the like. Wine-whey,

sharpened as above, is likewise a proper drink in this case; great care

however must be taken not to overheat the patient by any of these

things. This, instead of promoting, would retard the eruption.

The rising of the small-pox is often prevented by the violence of the

fever; in this case the cool regimen is strictly to be observed. The

patient’s chamber must not only be kept cool, but he ought likewise

frequently to be taken out of bed, and to be lightly covered with

clothes while in it.

Excessive restlessness often prevents the rising and filling of the

small-pox. When this happens, gentle opiates are necessary. These

however ought always to be administered with a sparing hand. To an

infant, a tea-spoonful of the syrup of poppies may be given every five

or six hours till it has the desired effect. An adult will require a

table-spoonful in order to answer the same purpose.

If the patient be troubled with a strangury, or suppression of urine,

which often happens in the small-pox, he should be frequently taken out

of bed, and, if he be able, should walk across the room with his feet

bare. When he cannot do this, he may be frequently set on his knees in

bed, and should endeavour to pass his urine as often as he can. When

these do not succeed, a tea-spoonful of the sweet spirits of nitre may

be occasionally mixed with his drink. Nothing more certainly relieves

the patient, or is more beneficial in the small-pox, than a plentiful

discharge of urine.

If the mouth be foul, and the tongue dry and chapped, it ought to be

frequently washed, and the throat gargled with water and honey,

sharpened with a little vinegar or currant jelly.

During the rising of the small-pox, it frequently happens that the

patient is eight or ten days without a stool. This not only tends to

heat and inflame the blood, but the fæces, by lodging so long in the

body, become acrid, and even putrid; from whence bad consequences must

ensue. It will therefore be proper, when the body is bound, to throw in

an emollient clyster every second or third day, through the whole course

of the disease. This will greatly cool and relieve the patient.

When petechiæ, or purple, black, or livid spots appear among the

small-pox, the Peruvian bark must immediately be administered in as

large doses as the patient’s stomach can bear. For a child, two drachms

of the bark in powder may be mixed in three ounces of common water, one

ounce of simple cinnamon-water, and two ounces of the syrup of orange or

lemon. This may be sharpened with the spirits of vitriol, and a

table-spoonful of it given every hour. If it be given to an adult in the

same form, he may take at least three or four spoonfuls every hour. This

medicine ought not to be trifled with, but must be administered as

frequently as the stomach can bear it; in which case it will often

produce very happy effects. I have frequently seen the petechiæ

disappear, and the small-pox, which had a very threatening aspect, rise

and fill with laudable matter, by the use of the bark and acids.

The patient’s drink ought likewise in this case to be generous, as wine

or strong negus acidulated with spirits of vitriol, vinegar, the juice

of lemon, jelly of currants, or such like. His food must consist of

apples roasted or boiled, preserved cherries, plums, and other fruits of

an acid nature.

The bark and acids are not only necessary when the petechiæ or putrid

symptoms appear, but likewise in the lymphatic or crystalline small-pox,

where the matter is thin, and not duly prepared. The Peruvian bark seems

to possess a singular power of assisting Nature in preparing laudable

pus, or what is called good matter; consequently it must be beneficial

both in this and other diseases, where the crisis depends on a

suppuration. I have often observed where the small-pox were flat, and

the matter contained in them quite clear and transparent, and where at

first they had the appearance of running into one another, that the

Peruvian bark, acidulated as above, changed the colour and consistence

of the matter, and produced the most happy effects.

When the eruption subsides suddenly, or, as the good women term it, when

the small-pox _strike in_, before they have arrived at maturity, the

danger is very great. In this case blistering-plasters must be

immediately applied to the wrists and ancles, and the patient’s spirits

supported with cordials.

Sometimes bleeding has a surprising effect in raising the pustules after

they have subsided; but it requires skill to know when this is proper,

or to what length the patient can bear it. Sharp cataplasms however may

be applied to the feet and hands, as they tend to promote the swelling

of these parts, and by that means to draw the humours towards the

extremities.

The most dangerous period of this disease is what we call the secondary

fever. This generally comes on when the small-pox begin to blacken, or

turn on the face; and most of those who die of the small-pox are carried

off by this fever.

Nature generally attempts, at the turn of the small-pox, to relieve the

patient by loose stools. Her endeavours this way are by no means to be

counteracted, but promoted, and the patient at the same time supported

by food and drink of a nourishing and cordial nature.

If, at the approach of the secondary fever, the pulse be very quick,

hard, and strong, the heat intense, and the breathing laborious, with

other symptoms of an inflammation of the breast, the patient must

immediately be bled. The quantity of blood to be let must be regulated

by the patient’s strength, age, and the urgency of the symptoms.

But, in the secondary fever, if the patient be faintish, the pustules

become suddenly pale, and if there be great coldness of the extremities,

blistering plasters must be applied, and the patient must be supported

with generous cordials. Wine and even spirits have sometimes been given

in such cases with amazing success.

As the secondary fever is in great measure, if not wholly, owing to the

absorption of the matter, it would seem highly consonant to reason, that

the pustules, as soon as they come to maturity, should be opened. This

is every day practiced in other phlegmons which tend to suppuration; and

there seems to be no cause why it should be less proper here. On the

contrary, we have reason to believe, that by this means the secondary

fever might always be lessened, and often wholly prevented.

The pustules should be opened when they begin to turn of a yellow

colour. Very little art is necessary for this operation. They may either

be opened with a lancet or a needle, and the matter absorbed by a little

dry lint. As the pustules are generally first ripe on the face, it will

be proper to begin with opening these, and the others in course as they

become ripe. The pustules generally fill again, a second or even a third

time; for which cause the operation must be repeated, or rather

continued as long as there is any considerable appearance of matter in

the pustules.

We have reason to believe that this operation, rational as it is, has

been neglected from a piece of mistaken tenderness in parents. They

believe that it must give great pain to the poor child; and therefore

would rather see it die than have it thus tortured. This notion however

is entirely without foundation. I have frequently opened the pustules

when the patient did not see me, without his being in the least sensible

of it; but suppose it were attended with a little pain, that is nothing

in comparison to the advantages which arise from it.

Opening the pustules not only prevents the resorption of the matter into

the blood, but likewise takes off the tension of the skin, and by that

means greatly relieves the patient. It likewise tends to prevent the

pitting, which is a matter of no small importance. Acrid matter, by

lodging long in the pustules, cannot fail to corrode the tender skin; by

which many a handsome face becomes so deformed as hardly to bear a

resemblance to the human figure[91].

It is generally necessary, after the small-pox are gone off, to purge

the patient. If however the body has been open through the whole course

of the disease, or if butter-milk and other things of an opening nature

have been drank freely after the height of the small-pox, purging

becomes less necessary; but it ought never wholly to be neglected.

For very young children, an infusion of senna and prunes, with a little

rhubarb, may be sweetened with coarse sugar, and given in small

quantities till it operates. Those who are farther advanced must take

medicines of a sharper nature. For example, a child of five or six years

of age may take eight or ten grains of fine rhubarb in powder over

night, and the same quantity of jalap in powder next morning. This may

be wrought off with fresh broth or water-gruel, and may be repeated

three or four times, five or six days intervening between each dose. For

children further advanced, and adults, the dose must be increased in

proportion to the age and constitution[92].

When imposthumes happen after the small-pox, which is not seldom the

case, they must be brought to suppuration as soon as possible, by means

of ripening poultices; and when they have been opened, or have broke of

their own accord, the patient must be purged. The Peruvian bark and a

milk diet will likewise be useful in this case.

When a cough, a difficulty of breathing, or other symptoms of a

consumption, succeed to the small-pox, the patient must be sent to a

place where the air is good, and put upon a course of asses milk, with

such exercise as he can bear. For further directions in this case, see

the article _Consumptions_.

OF INOCULATION.

Though no disease, after it is formed, baffles the powers of medicine

more effectually than the small-pox, yet more may be done before-hand to

render this disease favourable than any one we know, as almost all the

danger from it may be prevented by inoculation. This salutary invention

has been known in Europe above half a century; but, like most other

useful discoveries, it has till of late made but slow progress. It must

however be acknowledged, to the honour of this country, that inoculation

has met with a more favourable reception here, than among any of our

neighbours. It is still however far from being general, which we have

reason to fear will be the case, as long as the practice continues in

the hands of the faculty.

No discovery can be of general utility, while the practice of it is kept

in the hands of a few. Had the inoculation of the small-pox been

introduced as a fashion, and not as a medical discovery, or had it been

practiced by the same kind of operators here, as it is in those

countries from whence we learned it, it had long ago been universal. The

fears, the jealousies, the prejudices, and the opposite interests of the

faculty, are, and ever will be, the most effectual obstacles to the

progress of any salutary discovery. Hence it is that the practice of

inoculation never became in any measure general, even in England, till

taken up by men not bred to physic. These have not only rendered the

practice more extensive, but likewise more safe, and by acting under

less restraint than the regular practitioners, have taught them that the

patient’s greatest danger arose, not from the want of care, but from the

excess of it.

They know very little of the matter, who impute the success of modern

inoculators to any superior skill, either in preparing the patient or

communicating the disease. Some of them indeed, from a sordid desire of

engrossing the whole practice to themselves, pretend to have

extraordinary secrets or nostrums for preparing persons for inoculation,

which never fail of success. But this is only a pretence calculated to

blind the ignorant and inattentive. Common sense and prudence alone are

sufficient both in the choice of the subject and management of the

operation. Whoever is possessed of these may perform this office for his

children whenever he finds it convenient, provided they be in a good

state of health.

This sentiment is not the result of theory, but of observation. Though

few physicians have had more opportunities of trying inoculation in all

its different forms, so little appears to me to depend on those,

generally reckoned important circumstances, of preparing the body,

communicating the infection by this or the other method, &c. that for

several years past I have persuaded the parents or nurses to perform the

whole themselves, and have found that method followed with equal

success, while it is free from many inconveniences that attend the

other[93].

The small-pox may be communicated in a great variety of ways with nearly

the same degree of safety and success. In Turkey, from whence we learned

the practice, the women communicate the disease to children, by opening

a bit of the skin with a needle, and putting into the wound a little

matter taken from a ripe pustule. On the coast of Barbary they pass a

thread wet with the matter through the skin between the thumb and

fore-finger; and in some of the states of Barbary, inoculation is

performed by rubbing in the variolous matter between the thumb and

fore-finger, or on other parts of the body. The practice of

communicating the small-pox, by rubbing the variolous matter upon the

skin, has been long known in many parts of Asia and Europe, as well as

in Barbary, and has generally gone by the name of _buying the

small-pox_.

The present method of inoculating in Britain is to make two or three

slanting incisions in the arm, so superficial as not to pierce quite

through the skin, with a lancet wet with fresh matter taken from a ripe

pustule; afterwards the wounds are closed up, and left without any

dressing. Some make use of a lancet covered with the dry matter; but

this is less certain, and ought never to be used unless where fresh

matter cannot be obtained: when this is the case, the matter ought to be

moistened by holding the lancet for some time in the steam of warm

water[94].

Indeed, if fresh matter be applied long enough to the skin, there is no

occasion for any wound at all. Let a bit of thread, about half an inch

long, wet with the matter, be immediately applied to the arm, midway

between the shoulder and the elbow, and covered with a piece of the

common sticking-plaster, and kept on for eight or ten days. This will

seldom fail to communicate the disease. We mention this method, because

many people are afraid of a wound; and doubtless the more easily the

operation can be performed, it has the greater chance to become general.

Some people imagine, that the discharge from a wound lessens the

eruption; but there is no great stress to be laid upon this notion;

besides, deep wounds often ulcerate, and become troublesome.

We do not find that inoculation is at all considered as a medical

operation in those countries from whence we learned it. In Turkey it is

performed by the women, and in the East Indies by the Brachmins or

priests. In this country the custom is still in its infancy; we make no

doubt, however, but it will soon become so familiar, that parents will

think no more of inoculating their children, than at present they do of

giving them a purge.

No set of men have it so much in their power to render the practice of

inoculation general as the clergy, the greatest opposition to it still

arising from some scruples of conscience, which they alone can remove. I

would recommend it to them not only to endeavour to remove the religious

objections which weak minds may have to this salutary practice, but to

enjoin it as a duty, and to point out the danger of neglecting to make

use of a mean which Providence has put in our power for saving the lives

of our offspring. Surely such parents as wilfully neglect the means of

saving their children’s lives, are as guilty as those who put them to

death. I wish this matter were duly weighed. No one is more ready to

make allowance for human weakness and religious prejudices, yet I cannot

help recommending it, in the warmest manner, to parents, to consider how

great an injury they do their children, by neglecting to give them this

disease in the early period of life.

The numerous advantages arising from the inoculation of the small-pox

have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his

History of Health[95]. To those mentioned by the Doctor we shall only

add, that such as have not had the small-pox in the early period of

life, are not only rendered unhappy, but likewise in a great measure

unfit for sustaining many of the most useful and important offices. Few

people would chuse even to hire a servant who had not had the small-pox,

far less to purchase a slave who had the chance of dying of this

disease. How could a physician or a surgeon, who had never had the

small-pox himself, attend others under that malady? How deplorable is

the situation of females, who arrive at mature age without having had

the small-pox! A woman with child seldom survives this disease: and if

an infant happen to be seized with the small-pox upon the mother’s

breast, who has not had the disease herself the scene must be

distressing! If she continue to suckle the child, it is at the peril of

her own life; and if she wean it, in all probability it will perish. How

often is the affectionate mother forced to leave her house, and abandon

her children, at the very time when her care is most necessary? Yet

should parental affection get the better of her fears, the consequences

would often prove fatal. I have known the tender mother and her sucking

infant laid in the same grave, both untimely victims to this dreadful

malady. But these are scenes too shocking even to mention. Let parents

who run away with their children to avoid the small-pox, or who refuse

to inoculate them in infancy, consider to what deplorable situations,

they may be reduced by this mistaken tenderness!

As the small-pox is now become an epidemical disease in most parts of

the known world, no other choice remains but to render the malady as

mild as possible. This is the only manner of extirpation now left in our

power; and though it may seem paradoxical, the artificial method of

communicating the disease, could it be rendered universal, would amount

to nearly the same thing as rooting it out. It is a matter of small

consequence, whether a disease be entirely extirpated, or rendered so

mild as neither to destroy life nor hurt the constitution; but that this

may be done by inoculation, does not now admit of a doubt. The numbers

who die under inoculation hardly deserve to be named. In the natural

way, one in four or five generally dies; but by inoculation not one of a

thousand. Nay, some can boast of having inoculated ten thousand without

the loss of a single patient.

I have often wished to see some plan established for rendering this

salutary practice universal; but am afraid I shall never be so happy.

The difficulties indeed are many; yet the thing is by no means

impracticable. The aim is great; no less than saving the lives of

one-fourth part of mankind. What ought not to be attempted in order to

accomplish so desirable an end?

The first step towards rendering the practice universal, must be to

remove the religious prejudices against it. This, as already observed,

can only be done by the clergy. They must not only recommend it as a

duty to others, but likewise practise it on their own children. Example

will ever have more influence than precept.

The next thing requisite is to put it in the power of all. For this

purpose we would recommend it to the Faculty to inoculate the children

of the poor _gratis_. It is hard that so useful a part of mankind should

by their poverty be excluded from such a benefit.

Should this fail, it is surely in the power of any State to render the

practice general, at least as far as their dominion extends. We do not

mean that it ought to be enforced by a law. The best way to promote it

would be to employ a sufficient number of operators at the public

expence to inoculate the children of the poor. This would only be

necessary till the practice became general; afterwards custom, the

strongest of all laws, would oblige every individual to inoculate his

children to prevent reflections.

It may be objected to this scheme, that the poor would refuse to employ

the inoculators: this difficulty is easily removed. A small premium to

enable mothers to attend their children while under the disease, would

be a sufficient inducement; besides, the success attending the operation

would soon banish all objections to it. Even considerations of profit

would induce the poor to embrace this plan. They often bring up their

children to the age of ten or twelve, and when they come to be useful,

they are snatched away by this malady, to the great loss of their

parents, and detriment of the public.

The British legislature has of late years shewn great attention to the

preservation of infant lives, by supporting the foundling hospital, &c.

But we will venture to say, if one-tenth part of the sums laid out in

supporting that institution, had been bestowed towards promoting the

practice of inoculation of the small-pox among the poor, that not only

more useful lives had been saved, but the practice ere now rendered

quite universal in this island. It is not to be imagined what effect

example and a little money will have upon the poor; yet, if left to

themselves, they would go on for ever in the old way, without thinking

of any improvement. We only mean this as a hint to the humane and

public-spirited. Should such a scheme be approved, a proper plan might

easily be laid down for the execution of it.

But as public plans are very difficult to bring about, and often, by the

selfish views and misconduct of those intrusted with the execution of

them, fail of answering the noble purposes for which they were designed;

we shall therefore point out some other method by which the benefits of

inoculation may be extended to the poor.

There is no doubt but inoculators will daily become more numerous. We

would therefore have every parish in Britain to allow one of them a

small annual salary for inoculating all the children of the parish at a

proper age. This might be done at a very trifling expence, and it would

enable every one to enjoy the benefit of this salutary invention.

Two things chiefly operate to prevent the progress of inoculation. The

one is a wish to put the evil day as far off as possible. This is a

principle in our nature; and as inoculation seems rather to be

anticipating a future evil, it is no wonder mankind are so averse to it.

But this objection is sufficiently answered by the success. Who in his

senses would not prefer a lesser evil to-day to a greater to-morrow,

provided they were equally certain?

The other obstacle is the fear of reflections. This has very great

weight with the bulk of mankind. Should the child die, they think the

world would blame them. This they cannot bear. Here lies the difficulty;

and till that be removed, inoculation will make but small progress.

Nothing however can remove it but custom. Make the practice fashionable,

and all objections will soon vanish. It is fashion alone that has led

the multitude since the beginning of the world, and will lead them to

the end. We must therefore call upon the more enlightened part of

mankind to set a pattern to the rest. Their example, though it may for

some time meet with opposition, will at length prevail.

I am aware of an objection to this practice from the expence with which

it may be attended: this is easily obviated. We do not mean that every

parish ought to employ a Sutton or a Dimsdale as inoculators. These have

by their success already recommended themselves to crowned heads, and

are beyond the vulgar reach; but have not others an equal chance to

succeed? They certainly have. Let them make the same trial, and the

difficulties will soon vanish. There is not a parish, and hardly a

village in Britain, destitute of some person who can bleed. But this is

a far more difficult operation, and requires both more skill and

dexterity than inoculation.

The persons to whom we would chiefly recommend the performance of this

operation are the clergy. Most of them know something of medicine.

Almost all of them bleed, and can order a purge, which are all the

qualifications necessary for the practice of inoculation. The priests

among the less enlightened Indians perform this office, and why should a

Christian teacher think himself above it? Surely the bodies of men, as

well as their souls, merit a part of the pastor’s care; at lead the

greatest Teacher who ever appeared among men seems to have thought so.

Should all other methods fail, we would recommend it to parents to

perform the operation themselves. Let them take any method of

communicating the disease they please; provided the subjects be healthy,

and of a proper age, they will seldom fail to succeed to their wish. I

have known many instances even of mothers performing the operation, and

never so much as heard of one bad consequence. A planter in one of the

West India islands is said to have inoculated, with his own hand, in one

year, three hundred of his slaves, who, notwithstanding the warmth of

the climate, and other unfavourable circumstances, all did well. Common

mechanics have often, to my knowledge, performed the operation with as

good success as physicians. We do not however mean to discourage those

who have it in their power, from employing people of skill to inoculate

their children, and attend them while under the disease, but only to

shew, that where such cannot be had, the operation ought not upon that

account to be neglected.

Instead of multiplying arguments to recommend this practice, I shall

just beg leave to mention the method which I took with my own son, then

an only child. After giving him two gentle purges, I ordered the nurse

to take a bit of thread which had been previously wet with fresh matter

from a pock, and to lay it upon his arm, covering it with a piece of

sticking-plaster. This remained on six or seven days, till it was rubbed

off by accident. At the usual time the small-pox made their appearance,

and were exceedingly favourable. Surely this, which is all that is

generally necessary, may be done without any skill in medicine.

We have been the more full upon this subject because the benefits of

inoculation cannot be extended to society by any other means than making

the practice general. While it is confined to a few, it must prove

hurtful to the whole. By means of it the contagion is spread, and is

communicated to many who might otherwise never have had the disease.

Accordingly it is found that more die of the small-pox now than before

inoculation was introduced; and this important discovery, by which alone

more lives might be saved than by all the endeavours of the Faculty, is

in a great measure lost by its benefits not being extended to the whole

community[96].

The spring and autumn have been usually reckoned the most proper seasons

for inoculation, on account of the weather being then most temperate;

but it ought to be considered that these are generally the most

unhealthy seasons of the whole year. Undoubtedly the best preparation

for the disease is a previous good state of health. I have always

observed that children in particular are more sickly towards the end of

spring and autumn than at any other time of the year. On this account,

as well as for the advantage of cool air, I would propose winter as the

most proper season for inoculation; though, on every other

consideration, the spring would seem to be preferable.

The most proper age for inoculation is between three and five. Many

approve of inoculating on the breast, and where no circumstances forbid

this practice, I have no objection to it. Children, however, are more

liable to convulsions at this time than afterwards; besides, the anxiety

of the mother or nurse, should the child be in danger, would not fail to

heighten it by spoiling the milk.

Children who have constitutional diseases must nevertheless be

inoculated. It will often mend the habit of body; but ought to be

performed at a time when they are most healthy. Accidental diseases

should always be removed before inoculation.

It is generally thought necessary to regulate the diet for some time

before the disease be communicated. In children, however, great

alteration in diet is seldom necessary, their food being commonly of the

most simple and wholesome kind, as milk, water-pap, weak broths, bread,

light pudding, mild roots, and white meats.

But children who have been accustomed to a hotter diet, who are of a

gross habit, or abound with bad humours, ought to be put upon a spare

diet before they are inoculated. Their food should be of a light cooling

nature, and their drink whey, butter-milk, and such like.

We would recommend no other medicinal preparation but two or three mild

purges, which ought to be suited to the age and strength of the patient.

The success of inoculators does not depend on the preparation of their

patients, but on their management of them while under the disease. Their

constant care is to keep them cool, and their bodies gently open, by

which means the fever is kept low, and the eruption greatly lessened.

The danger is seldom great when the pustules are few; and their number

is generally in proportion to the fever which precedes and attends the

eruption. Hence the chief secret of inoculation consists in regulating

the eruptive fever, which generally may be kept sufficiently low by the

methods mentioned above.

The regimen during the disease is in all respects the same as under the

natural small-pox. The patient must be kept cool, his diet should be

light, and his drink weak and diluting, &c. Should any bad symptoms

appear, which is seldom the case, they must be treated in the same way

as directed in the natural small-pox. Purging is not less necessary

after the small-pox by inoculation than in the natural way, and ought by

no means to be neglected.

CHAP. XXIV.

OF THE MEASLES.

The measles appeared in Europe about the same time with the small-pox,

and have a great affinity to that disease. They both came from the same

quarter of the world, are both infectious, and seldom attack the same

person more than once. The measles are most common in the spring season,

and generally disappear in summer. The disease itself, when properly

managed, seldom proves fatal; but its consequences are often very

troublesome.

CAUSE.——This disease, like the small-pox, proceeds from infection, and

is more or less dangerous according to the constitution of the patient,

the season of the year, the climate, &c.

SYMPTOMS.——The measles, like other fevers, are preceded by alternate

fits of heat and cold, with sickness, and loss of appetite. The tongue

is white, but generally moist. There is a short cough, a heaviness of

the head and eyes, drowsiness, and a running at the nose. Sometimes

indeed the cough does not come before the eruption has appeared. There

is an inflammation and heat in the eyes, accompanied with a defluxion of

sharp rheum, and great acuteness of sensation, so that they cannot bear

the light without pain. The eye-lids frequently swell so as to occasion

blindness. The patient generally complains of his throat; and a vomiting

or looseness often precedes the eruption. The stools in children are

commonly greenish; they complain of an itching of the skin, and are

remarkably peevish. Bleeding at the nose is common, both before and in

the progress of the disease.

About the fourth day, small spots, resembling flea-bites, appear, first

upon the face; then upon the breast, and afterwards on the extremities:

these may be distinguished from the small pox by their scarcely rising

above the skin. The fever, cough, and difficulty of breathing, instead

of being removed by the eruption as in the small pox, are rather

increased; but the vomiting generally ceases.

About the sixth or seventh day from the time of sickening, the measles

begin to turn pale on the face, and afterwards upon the body; so that by

the ninth day they entirely disappear. The fever; however, and

difficulty of breathing, often continue, especially if the patient has

been kept upon too hot a regimen. Petechiæ, or purple spots, may

likewise be occasioned by this error.

A violent looseness sometimes succeeds the measles; in which case the

patient’s life is in imminent danger.

Such as die of the measles generally expire about the ninth day from the

invasion, and are commonly carried off by a peripneumony, or

inflammation of the lungs.

The most favourable symptoms are a moderate looseness, a moist skin, and

a plentiful discharge of urine.

When the eruption suddenly falls in, and the patient is seized with a

delirium, he is in the greatest danger. If the measles turn too soon of

a pale colour, it is an unfavourable symptom, as are also great

weakness, vomiting, restlessness, and difficulty of swallowing. Purple

or black spots appearing among the measles are very unfavourable. When a

continual cough, with hoarseness, succeeds the disease, there is reason

to suspect an approaching consumption of the lungs.

Our business in this disease is to assist Nature, by proper cordials, in

throwing out the eruption, if her efforts be too languid; but when they

are too violent they must be restrained by evacuations, and cool

diluting liquors, &c. We ought likewise to endeavour to appease the most

urgent symptoms, as the cough, restlessness, and difficulty of

breathing.

REGIMEN.——The cool regimen is necessary here as well as in the

small-pox. The food too must be light, and the drink diluting. Acids

however do not answer so well in the measles as in the small-pox, as

they tend to exasperate the cough. Small beer likewise, though a good

drink in the small-pox, is here improper. The most suitable liquors are

decoctions of liquorice with marsh-mallow roots and sarsaparilla,

infusions of linseed, or of the flowers of elder, balm-tea, clarified

whey, barley-water, and such like. These, if the patient be costive, may

be sweetened with honey; or, if that should disagree with the stomach, a

little manna may occasionally be added to them.

MEDICINE.——The measles being an inflammatory disease, without any

critical discharge of matter, as in the small-pox, bleeding is commonly

necessary, especially when the fever runs high, with difficulty of

breathing, and great oppression of the breast. But if the disease be of

a mild kind, bleeding may be omitted[97].

Bathing the feet and legs frequently in lukewarm water both tends to

abate the violence of the fever, and to promote the eruption.

The patient is often greatly relieved by vomiting. When there is a

tendency this way, it ought to be promoted by drinking lukewarm water,

or weak camomile-tea.

When the cough is very troublesome, with dryness of the throat, and

difficulty of breathing, the patient may hold his head over the steam of

warm water, and draw the steam into his lungs.

He may likewise lick a little sperma-ceti and sugar-candy pounded

together; or take now and then a spoonful of the oil of sweet almonds,

with sugar-candy dissolved in it. These will soften the throat, and

relieve the tickling cough.

If at the turn of the disease the fever assumes new vigour, and there

appears great danger of suffocation, the patient must be bled according

to his strength, and blistering-plasters applied, with a view to prevent

the load from being thrown on the lungs, where if an inflammation should

fix itself, the patient’s life will be in imminent danger.

In case the measles should suddenly disappear, it will be necessary to

pursue the same method which we have recommended when the small-pox

recede. The patient must be supported with wine and cordials.

Blistering-plasters must be applied to the legs and arms, and the body

rubbed all over with warm flannels. Warm poultices may likewise be

applied to the feet and palms of the hands.

When purple or black spots appear, the patient’s drink should be

sharpened with spirits of vitriol; and if the putrid symptoms increase,

the Peruvian bark must be administered in the same manner as directed in

the small-pox.

Opiates are sometimes necessary, but should never be given except in

cases of extreme restlessness, a violent looseness, or when the cough is

very troublesome. For children, the syrup of poppies is sufficient. A

tea-spoonful or two may be occasionally given, according to the

patient’s age, or the violence of the symptoms.

After the measles are gone off, the patient ought to be purged. This may

be conducted in the same manner as directed in the small-pox.

If a violent looseness succeeds the measles, it may be checked by taking

for some days a gentle dose of rhubarb in the morning, and an opiate

over night; but if these do not remove it, bleeding will seldom fail to

have that effect.

Patients recovering after the measles should be careful what they eat or

drink. Their food for some time ought to be light, and in small

quantities, and their drink diluting, and rather of an opening nature,

as butter-milk, whey, and such like. They ought also to beware of

exposing themselves too soon to the cold air, lest a suffocating

catarrh, an asthma, or a consumption of the lungs, should ensue.

Should a cough, with difficulty of breathing, and other symptoms of a

consumption, remain after the measles, small quantities of blood may be

frequently let at proper intervals, as the patient’s strength and

constitution will permit. He ought likewise to drink asses milk, to

remove to a free air, if in a large town, and to ride daily on

horseback. He must keep close to a diet consisting of milk and

vegetables; and lastly, if these do not succeed, let him remove to a

warmer climate[98].

OF THE SCARLET FEVER.

The scarlet fever is so called from the colour of the patient’s skin,

which appears as if it were tinged with red wine. It happens at any

season of the year, but is most common towards the end of summer; at

which time it often seizes whole families; children and young persons

are most subject to it.

It begins like other fevers, with coldness and shivering, without any

violent sickness. Afterwards the skin is covered with red spots, which

are broader, more florid, and less uniform than the measles. They

continue two or three days, and then disappear; after which the cuticle,

or scarf-skin, falls off.

There is seldom any occasion for medicine in this disease. The patient

ought however to keep within doors, to abstain from flesh, strong

liquors, and cordials, and to drink freely of cool diluting liquors. If

the fever runs high, the body must be kept gently open by emollient

clysters, or small doses of nitre and rhubarb. A scruple of the former,

with five grains of the latter, may be taken thrice a-day, or oftener,

if necessary.

Children and young persons are sometimes seized at the beginning of this

disease with a kind of stupor and epileptic fits. In this case the feet

and legs should be bathed in warm water, a large blistering-plaster

applied to the neck, and a dose of the syrup of poppies given every

night till the patient recovers[99].

The scarlet fever however is not always of so mild a nature. It is

sometimes attended with putrid or malignant symptoms, in which case it

is always dangerous. In the malignant scarlet fever the patient is not

only affected with coldness and shivering, but with languor, sickness,

and great oppression, to these succeed excessive heat, nausea and

vomiting, with a soreness of the throat; the pulse is extremely quick,

but small and depressed; the breathing frequent and laborious; the skin

hot, but not quite dry; the tongue moist, and covered with a whitish

mucus; the tonsils inflamed and ulcerated. When the eruption appears, it

brings no relief: on the contrary, the symptoms generally grow worse,

and fresh ones come on, as purging, delirium, &c.

When this disease is mistaken for a simple inflammation, and treated

with repeated bleedings, purging and cooling medicines, it generally

proves fatal. The only medicines that can be depended on in this case

are cordials and antiseptics, as the Peruvian bark, wine, snake-root,

and the like. The treatment must be in general similar to that of the

putrid fever, or of the malignant ulcerous sore throat[100].

OF THE BILIOUS FEVER.

When a continual, remitting, or intermitting fever is accompanied with a

frequent or copious evacuation of bile, either by vomit or stool, the

fever is denominated bilious. In Britain the bilious fever generally

makes its appearance about the end of summer, and ceases towards the

approach of winter. It is most frequent and fatal in warm countries,

especially where the soil is marshy, and when great rains are succeeded

by sultry heats. Persons who work without doors, lie in camps, or who

are exposed to the night air, are most liable to this kind of fever.

If there are symptoms of inflammation at the beginning of this fever, it

will be necessary to bleed, and to put the patient upon the cool

diluting regimen recommended in the inflammatory fever. The saline

draught may likewise be frequently administered, and the patient’s body

kept open by clysters or mild purgatives. But if the fever should remit

or intermit, bleeding will seldom be necessary. In this case a vomit may

be administered, and, if the body be bound, a gentle purge; after which

the Peruvian bark will generally complete the cure.

In case of a violent looseness, the patient must be supported with

chicken broth, jellies of hartshorn, and the like; and he may use the

_white decoction_ for his ordinary drink[101]. If a bloody flux should

accompany this fever, it must be treated in the manner recommended under

the article _Dysentery_.

When there is a burning heat, and the patient does not sweat, that

evacuation may be promoted by giving him, three or four times a day, a

table-spoonful of Mindererus’s spirit[102] mixed in a cup of his

ordinary drink.

If the bilious fever be attended with the nervous, malignant, or putrid

symptoms, which is sometimes the case, the patient must be treated in

the same manner as directed under these diseases.

After this fever, proper care is necessary to prevent a relapse. For

this purpose the patient, especially towards the end of autumn, ought to

continue the use of the Peruvian bark for some time after he is well. He

should likewise abstain from all trashy fruits, new liquors, and every

kind of flatulent aliment.

CHAP. XXV.

OF THE ERYSIPELAS, OR ST. ANTHONY’S FIRE.

This disease, which in some parts of Britain is called _the rose_,

attacks persons at any period of life, but is most common between the

age of thirty and forty. Persons of a sanguine or plethoric habit are

most liable to it. It often attacks young people, and pregnant women;

and such as have once been afflicted with it are very liable to have it

again. Sometimes it is a primary disease, and at other times only a

symptom of some other malady. Every part of the body is liable to be

attacked by an erysipelas, but it most frequently seizes the legs or

face, especially the latter. It is most common in autumn, or when hot

weather is succeeded by cold and wet.

CAUSES.——The erysipelas may be occasioned by violent passions or

affections of the mind; as fear, anger, &c. When the body has been

heated to a great degree, and is immediately exposed to the cold air, so

that the perspiration is suddenly checked, an erysipelas will often

ensue[103]. It may also be occasioned by drinking to excess, by

continuing too long in a warm bath, or by any thing that overheats the

blood. If any of the natural evacuations be obstructed, or in too small

quantity, it may cause an erysipelas. The same effect will follow from

the stoppage of artificial evacuations; as issues, setons, or the like.

SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of

strength, pain in the head and back, heat, restlessness, and a quick

pulse; to which may be added vomiting, and sometimes a delirium. On the

second, third, or fourth day, the part swells, becomes red, and small

pustules appear at which time the fever generally abates.

When the erysipelas seizes the foot, the parts contiguous swell, the

skin shines; and, if the pain be violent, it will ascend to the leg, and

will not bear to be touched.

When it attacks the face, it swells, appears red, and the skin is

covered with small pustules filled with clear water. One or both eyes

are generally closed with the swelling; and there is a difficulty of

breathing. If the mouth and nostrils be very dry, and the patient

drowsy, there is reason to suspect an inflammation of the brain.

If the erysipelas affects the breast, it swells and becomes exceedingly

hard, with great pain, and is apt to suppurate. There is a violent pain

in the arm-pit on the side affected, where an abscess is often formed.

If in a day or two the swelling subsides, the heat and pain abate, the

colour of the part turns yellow, and the cuticle breaks and falls off in

scales, the danger is over.

When the erysipelas is large, deep, and affects a very sensible part of

the body, the danger is great. If the red colour changes into a livid or

black, it will end in a mortification. Sometimes the inflammation cannot

be discussed, but comes to a suppuration; in which case fistulas, a

gangrene, or mortification, often ensue.

Such as die of this disease are commonly carried off by the fever, which

is attended with difficulty of breathing, and sometimes with a delirium

and great drowsiness. They generally die about the seventh or eighth

day.

REGIMEN.——In the erysipelas the patient must neither be kept too hot nor

too cold, as either of these extremes will tend to make it retreat,

which is always to be guarded against. When the disease is mild, it will

be sufficient to keep the patient within doors, without confining him to

his bed, and to promote the perspiration by diluting liquors, &c.

The diet ought to be slender, and of a moderately cooling and moistening

quality, as groat-gruel, panado, chicken or barley-broth, with cooling

herbs and fruits, &c. avoiding flesh, fish, strong drink, spices,

pickles, and all other things that may heat and inflame the blood; the

drink may be barley-water, an infusion of elder-flowers, common whey,

and such like.

But if the pulse be low, and the spirits sunk, the patient must be

supported with negus, and other things of a cordial nature. His food may

be sago-gruel with a little wine, and nourishing broths taken in small

quantities, and often repeated. Great care however must be taken not to

overheat him.

MEDICINE.——In this disease much mischief is often done by medicine,

especially by external applications. People, when they see an

inflammation, immediately think that something ought to be applied to

it. This indeed is necessary in large phlegmons; but in an erysipelas

the safer course is to apply nothing. Almost all ointments, salves, and

plasters, being of a greasy nature, tend rather to obstruct and repel,

than promote any discharge from the part. At the beginning of this

disease it is neither safe to promote a suppuration, nor to repel the

matter too quickly. The erysipelas in many respects resembles the gout,

and is to be treated with the greatest caution. Fine wool, or very soft

flannel, are the safest applications to the part. These not only defend

it from the external air, but likewise promote the perspiration, which

has a great tendency to carry off the disease. In Scotland the common

people generally apply a mealy cloth to the parts affected, which is far

from being improper.

It is common to bleed in the erysipelas; but this likewise requires

caution. If however the fever be high, the pulse hard and strong, and

the patient vigorous, it will be proper to bleed; but the quantity must

be regulated by these circumstances, and the operation repeated as the

symptoms may require. If the patient has been accustomed to strong

liquors, and the disease attacks his head, bleeding is absolutely

necessary.

Bathing the feet and legs frequently in lukewarm water, when the disease

attacks the face or brain, has an excellent effect. It tends to make a

derivation from the head, and seldom fails to relieve the patient. When

bathing proves ineffectual, poultices, or sharp sinapisms, may be

applied to the soles of the feet, for the same purpose.

In cases where bleeding is requisite, it is likewise necessary to keep

the body open. This may be effected by emollient clysters, or small

doses of nitre and rhubarb. Some indeed recommend very large doses of

nitre in the erysipelas; but nitre seldom sits easy on the stomach when

taken in large doses. It is however one of the best medicines when the

fever and inflammation run high. Half a drachm of it, with four or five

grains of rhubarb, may be taken in the patient’s ordinary drink, four

times a day.

When the erysipelas leaves the extremities, and seizes the head so as to

occasion a delirium or stupor, it is absolutely necessary to open the

body. If clysters and mild purgatives fail to have this effect, stronger

ones must be given. Blistering plasters must likewise be applied to the

neck, or behind the ears, and sharp cataplasms laid to the soles of the

feet.

When the inflammation cannot be discussed, and the part has a tendency

to ulcerate, it will then be proper to promote suppuration, which may be

done by the application of ripening poultices with saffron, warm

fomentations, and such like.

When the black, livid, or blue colour of the part shews a tendency to

mortification, the Peruvian bark must be administered. It may be taken

along with acids, as recommended in the small-pox, or in any other form

more agreeable to the patient. It must not however be trifled with, as

the patient’s life is at stake. A drachm may be given every two hours,

if the symptoms be threatening, and cloths dipped in warm camphorated

spirits of wine, or the tincture of myrrh and aloes, may be applied to

the part, and frequently renewed. It may likewise be proper in this case

to apply poultices of the bark, or to foment the part affected with a

strong decoction of it.

In what is commonly called the _scorbutic erysipelas_, which continues

for a considerable time, it will only be necessary to give gentle

laxatives, and such things as purify the blood and promote the

perspiration. Thus, after the inflammation has been checked by opening

medicines, the decoction of woods[104] may be drank, after which a

course of bitters will be proper.

Such as are liable to frequent attacks of the erysipelas ought carefully

to guard against all violent passions; to abstain from strong liquors,

and all fat, viscid, and highly nourishing food. They should likewise

take sufficient exercise, carefully avoiding the extremes of heat or

cold. Their food should consist chiefly of milk, and such fruits, herbs,

and roots, as are of a cooling quality; and their drink ought to be

small-beer, whey, butter-milk, and such like. They should never suffer

themselves to be long costive. If that cannot be prevented by suitable

diet, it will be proper to take frequently a gentle dose of rhubarb,

cream of tartar, the lenitive electuary, or some other mild purgative.

CHAP. XXVI.

OF THE PHRENITIS, OR INFLAMMATION OF THE BRAIN.

This is sometimes a primary disease, but oftener only a symptom of some

other malady; as the inflammatory, eruptive, or spotted fever, &c. It is

very common however as a primary disease in warm climates, and is most

incident to persons about the prime or vigour of life. The passionate,

the studious, and those whose nervous system is irritable in a high

degree, are most liable to it.

CAUSES.——This disease is often occasioned by night-watching, especially

when joined with hard study: it may likewise proceed from hard drinking,

anger, grief, or anxiety. It is often occasioned by the stoppage of

usual evacuations; as the bleeding piles in men, the customary

discharges of women, &c. Such as imprudently expose themselves to the

heat of the sun, especially by sleeping without doors in a hot season

with their heads uncovered, are often suddenly seized with an

inflammation of the brain, so as to awake quite delirious. When

repellents are imprudently used in an erysipelas, an inflammation of the

brain is sometimes the consequence. It may likewise be occasioned by

external injuries, as blows or bruises upon the head, &c.

SYMPTOMS.——The symptoms which usually precede a true inflammation of the

brain are pain of the head, redness of the eyes, a violent flushing of

the face, disturbed sleep, or a total want of it, great dryness of the

skin, costiveness, a retention of urine, a small dropping of blood from

the nose, singing of the ears, and extreme sensibility of the nervous

system.

When the inflammation is formed, the symptoms in general are similar to

those of the inflammatory fever. The pulse indeed is often weak,

irregular, and trembling; but sometimes it is hard and contracted. When

the brain itself is inflamed, the pulse is always soft and low; but when

the inflammation only affects the integuments of the brain, viz. the

dura and pia mater, it is hard. A remarkable quickness of hearing is a

common symptom of this disease; but that seldom continues long. Another

usual symptom is a great throbbing or pulsation in the arteries of the

neck and temples. Though the tongue is often black and dry, yet the

patient seldom complains of thirst, and even refuses drink. The mind

chiefly runs upon such objects as have before made a deep impression on

it; and sometimes, from a sullen silence, the patient becomes all of a

sudden quite outrageous.

A constant trembling and starting of the tendons is an unfavourable

symptom, as are also a suppression of urine; a total want of sleep; a

constant spitting; a grinding of the teeth, which last may be considered

as a kind of convulsion. When a phrenitis succeeds an inflammation of

the lungs, of the intestines, or of the throat, &c. it is owing to a

translation of the disease from these parts to the brain, and generally

proves fatal. This shews the necessity of proper evacuations, and the

danger of repellents in all inflammatory diseases.

The favourable symptoms are, a free perspiration, a copious discharge of

blood from the nose, the bleeding piles, a plentiful discharge of urine,

which lets fall a copious sediment. Sometimes the disease is carried off

by a looseness, and in women by an excessive flow of the _menses_.

As this disease often proves fatal in a few days, it requires the most

speedy applications. When it is prolonged, or improperly treated, it

sometimes ends in madness, or a kind of stupidity which continues for

life.

In the cure, two things are chiefly to be attended to, _viz._ to lessen

the quantity of blood in the brain, and to retard the circulation

towards the head.

REGIMEN.——The patient ought to be kept very quiet. Company, noise, and

every thing that affects the senses, or disturbs the imagination,

increases the disease. Even too much light is hurtful: for which reason

the patient’s chamber ought to be a little darkened, and he should

neither be kept too hot nor cold. It is not however necessary to exclude

the company of an agreeable friend, as this has a tendency to sooth and

quiet the mind. Neither ought the patient to be kept too much in the

dark, lest it should occasion a gloomy melancholy, which is too often

the consequence of this disease.

The patient must, as far as possible, be soothed and humoured in every

thing. Contradiction will ruffle his mind, and increase his malady. Even

when he calls for things which are not to be obtained, or which might

prove hurtful, he is not to be positively denied them, but rather put

off with the promise of having them as soon as they can be obtained, or

by some other excuse. A little of any thing that the mind is set upon,

though not quite proper, will hurt the patient less than a positive

refusal. In a word, whatever he was fond of, or used to be delighted

with when in health, may here be tried, as pleasing stories, soft music,

or whatever has a tendency to sooth the passions and compose the mind.

Boerhaave proposes several mechanical experiments for this purpose; as

the soft noise of water distilling by drops into a bason, and the

patient trying to reckon them, &c. Any uniform sound, if low and

continued, has a tendency to procure sleep, and consequently may be of

service.

The aliment ought to be light, consisting chiefly of farinaceous

substances; as panado, and water-gruel sharpened with jelly of currants,

or juice of lemons, ripe fruits roasted or boiled, jellies, preserves,

&c. The drink small, diluting, and cooling; as whey, barley-water, or

decoctions of barley and tamarinds, which latter not only render the

liquor more palatable, but likewise more beneficial, as they are of an

opening nature.

MEDICINE.——In an inflammation of the brain, nothing more certainly

relieves the patient than a free discharge of blood from the nose. When

this comes of its own accord, it is by no means to be stopped, but

rather promoted, by applying cloths dipped in warm water to the part.

When bleeding at the nose does not happen spontaneously, it may be

provoked, by putting a straw, or any other sharp body, up the nostril.

Bleeding in the temporal arteries greatly relieves the head: but as this

operation cannot always be performed, we would recommend in its stead

bleeding in the jugular veins. When the patient’s pulse and spirits are

so low, that he cannot bear bleeding with the lancet, leeches may be

applied to the temples. These not only draw off the blood more

gradually, but by being applied nearer to the part affected, generally

give more immediate relief.

A discharge of blood from the hæmorrhoidal veins is likewise of great

service, and ought by all means to be promoted. If the patient has been

subject to the bleeding piles, and that discharge has been stopped,

every method must be tried to restore it; as the application of leeches

to the parts, sitting over the steams of warm water, sharp clysters, or

suppositories made of honey, aloes, and rock-salt.

If the inflammation of the brain be occasioned by the stoppage of

evacuations either natural or artificial, as the menses, issues, setons,

or such like, all means must be used to restore them as soon as

possible, or to substitute others in their stead.

The patient’s body must be kept open by stimulating clysters or smart

purges; and small quantities of nitre ought frequently to be mixed with

his drink. Two or three drachms, or more, if the case be dangerous, may

be used in the space of twenty-four hours.

The head should be shaved and frequently rubbed with vinegar and

rose-water. Cloths dipped in this mixture may likewise be applied to the

temples. The feet ought frequently to be bathed in lukewarm water, and

soft poultices of bread and milk may be kept constantly applied to them.

If the disease proves obstinate, and does not yield to these medicines,

it will be necessary to apply a blistering-plaster to the whole head.

CHAP. XXVII.

OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES.

This disease may be occasioned by external injuries; as blows, burns,

bruises, and the like. It may likewise proceed from dust, quicklime, or

other substances, getting into the eyes. It is often caused by the

stoppage of customary evacuations; as the healing of old sores, drying

up of issues, the suppressing of gentle morning sweats, or of the

sweating of the feet, &c. Long exposure to the night air, especially in

cold northerly winds, or whatever suddenly checks the perspiration,

especially after the body has been much heated, is very apt to cause an

inflammation of the eyes. Viewing snow or other white bodies for a long

time, or looking stedfastly at the sun, a clear fire, or any bright

object, will likewise occasion this malady. A sudden transition from

darkness to very bright light will often have the same effect.

Nothing more certainly occasions an inflammation of the eyes than

night-watching, especially reading or writing by candle-light. Drinking

spirituous liquors, and excess of venery, are likewise very hurtful to

the eyes. The acrid fumes of metals, and of several kinds of fuel, are

also pernicious. Sometimes an inflammation of the eyes proceeds from a

venereal taint, and often from a scrophulous or gouty habit. It may

likewise be occasioned by hairs in the eye-lids turning inwards, and

hurting the eyes. Sometimes the disease is epidemic, especially after

wet seasons; and I have frequently known it prove infectious,

particularly to those who lived in the same house with the patient. It

may be occasioned by moist air, or living in low damp houses, especially

in persons who are not accustomed to such situations. In children it

often proceeds from imprudently drying up of scabbed heads, a running

behind the ears, or any other discharge of that kind. Inflammations of

the eyes often succeed the small-pox or measles, especially in children

of a scrophulous habit.

SYMPTOMS.——An inflammation of the eyes is attended with acute pain,

heat, redness, and swelling. The patient is not able to bear the light,

and sometimes he feels a pricking pain, as if his eyes were pierced with

a thorn. Sometimes he imagines his eyes are full of motes, or thinks he

sees flies dancing before him. The eyes are filled with a scalding

rheum, which rushes forth in great quantities, whenever the patient

attempts to look up. The pulse is generally quick and hard, with some

degree of fever. When the disease is violent, the neighbouring parts

swell, and there is a throbbing or pulsation in the temporal arteries,

&c.

A slight inflammation of the eyes, especially from an external cause, is

easily cured; but when the disease is violent, and continues long, it

often leaves specks upon the eyes, or dimness of sight, and sometimes

total blindness.

If the patient be seized with a looseness, it has a good effect; and

when the inflammation passes from one eye to another, as it were by

infection, it is no unfavourable symptom. But when the disease is

accompanied with a violent pain of the head, and continues long, the

patient is in danger of losing his sight.

REGIMEN.——The diet, unless in scrophulous cases, can hardly be too

spare, especially at the beginning. The patient must abstain from every

thing of a heating nature. His food should consist chiefly of mild

vegetables, weak broths, and gruels. His drink may be barley-water,

balm-tea, common whey, and such like.

The patient’s chamber must be darkened, or his eyes shaded by a cover,

so as to exclude the light, but not to press upon the eyes. He should

not look at a candle, the fire, or any luminous object, and ought to

avoid all smoke, as the fumes of tobacco, or any thing that may cause

coughing, sneezing, or vomiting. He should be kept quiet, avoiding all

violent efforts, either of body or mind, and encouraging sleep as much

as possible.

MEDICINE.——This is one of those diseases wherein great hurt is often

done by external applications. Almost every person pretends to be

possessed of a remedy for the cure of sore eyes. These remedies

generally consist of eye-waters and ointments, with other external

applications, which do mischief twenty times for once they do good.

People ought therefore to be very cautious how they use such things, as

even the pressure upon the eyes often increases the malady.

Bleeding, in a violent inflammation of the eyes, is always necessary.

This should be performed as near the part affected as possible. An adult

may lose ten or twelve ounces of blood from the jugular vein, and the

operation may be repeated according to the urgency of the symptoms. If

it should not be convenient to bleed in the neck, the same quantity may

be let from the arm, or any other part of the body.

Leeches are often applied to the temples, or under the eyes, with good

effect. The wounds must be suffered to bleed for some hours, and if the

bleeding stop soon, it may be promoted by the application of cloths dipt

in warm water. In obstinate cases, it will be necessary to repeat this

operation several times.

Opening and diluting medicines are by no means to be neglected. The

patient may take a small dose of Glauber’s salts, and cream of tartar,

every second or third day, or a decoction of tamarinds with senna. If

these be not agreeable, gentle doses of rhubarb and nitre, a little of

the lenitive electuary, or any other mild purgative, will answer the

same end. The patient at the same time must drink freely of water-gruel,

tea, whey, or any other weak diluting liquor. He ought likewise to take,

at bed-time, a large draught of very weak wine-whey, in order to promote

perspiration. His feet and legs must frequently be bathed in lukewarm

water, and his head shaved twice or thrice a-week, and afterwards washed

in cold water. This has often a remarkably good effect.

If the inflammation does not yield to these evacuations,

blistering-plasters must be applied to the temples, behind the ears, or

upon the neck, and kept open for some time by the mild blistering

ointment. I have seldom known these, if long enough kept open, fail to

remove the most obstinate inflammation of the eyes; but for this purpose

it is often necessary to continue the discharge for several weeks.

When the disease has been of long standing, I have seen very

extraordinary effects from a seton in the neck, or between the

shoulders, especially the latter. It should be put upwards and

downwards, or in the direction of the spine, and in the middle between

the shoulder-blades. It may be dressed twice a-day with yellow

basilicon. I have known patients, who had been blind for a considerable

time, recover sight by means of a seton placed as above. When the seton

is put across the neck, it soon wears out, and is both more painful and

troublesome than between the shoulders; besides, it leaves a

disagreeable mark, and does not discharge so freely.

When the heat and pain of the eyes are very great, a poultice of bread

and milk, softened with sweet oil or fresh butter, may be applied to

them, at least all night; and they may be bathed with lukewarm milk and

water in the morning.

If the patient cannot sleep, which is sometimes the case, he may take

twenty or thirty drops of laudanum, or two spoonfuls of the syrup of

poppies, over night, more or less according to his age, or the violence

of the symptoms.

After the inflammation is gone off, if the eyes still remain weak and

tender, they may be bathed every night and morning with cold water and a

little brandy, six parts of the former to one of the latter. A method

should be contrived by which the eye can be quite immersed in the brandy

and water, where it should be kept for some time. I have generally found

this, or cold water and vinegar, as good a strengthener of the eyes as

any of the most celebrated collyriums.

When an inflammation of the eyes proceeds from a scrophulous habit, it

generally proves very obstinate. In this case the patient’s diet must

not be too low, and he may be allowed to drink small negus, or now and

then a glass of wine, The most proper medicine is the Peruvian bark,

which may either be given in substance, or prepared in the following

manner:

Take an ounce of the bark in powder, with two drachms of Winter’s bark,

and boil them in an English quart of water to a pint; when it has boiled

nearly long enough, add half an ounce of liquorice-root sliced. Let the

liquor be strained. Two, three, or four table-spoonfuls, according to

the age of the patient, may be taken three or four times a-day, It is

impossible to say how long this medicine should be continued, as the

cure is sooner performed in some than in others; but in general it

requires a considerable time to produce any lasting effects.

Dr. Cheyne says, ‘That Æthiops mineral never fails in obstinate

inflammations of the eyes, even scrophulous ones, if given in a

sufficient dose, and duly persisted in.’ There is no doubt but this and

other preparations of mercury may be of singular service in ophthalmias

of long continuance, but they ought always to be administered with the

greatest caution, or by persons of skill in physic.

It will be proper frequently to look into the eyes, to see if any hairs

be turned inwards, or pressing upon them[105]. These ought to be removed

by plucking them out with a pair of small pincers.

Those who are liable to frequent returns of this disease, ought

constantly to have an issue in one or both arms. Bleeding or purging in

the spring and autumn, will be very beneficial to such persons. They

ought likewise to live with the greatest regularity, avoiding strong

liquor, and every thing of a heating quality. Above all, let them avoid

the night-air and late studies[106].

CHAP. XXVIII.

OF THE QUINSEY, OR INFLAMMATION OF THE THROAT.

This disease is very common in Britain, and is frequently attended with

great danger. It prevails in the winter and spring, and is most fatal to

young people of a sanguine temperament.

CAUSES.——In general it proceeds from the same causes as other

inflammatory disorders, _viz._ an obstructed perspiration, or whatever

heats or inflames the blood. An inflammation of the throat is often

occasioned by omitting some part of the covering usually worn about the

neck, by drinking cold liquor when the body is warm, by riding or

walking against a cold northerly wind, or any thing that greatly cools

the throat, and parts adjacent. It may likewise proceed from the neglect

of bleeding, purging, or any customary evacuation.

Singing, speaking loud and long, or whatever strains the throat, may

likewise cause an inflammation of that organ. I have often known the

quinsey prove fatal to jovial companions, who, after sitting long in a

warm room, drinking hot liquors, and singing with vehemence, were so

imprudent as to go abroad in the cold night-air. Sitting with wet feet,

or keeping on wet clothes, are very apt to occasion, this malady. It is

likewise frequently occasioned by continuing long in a moist place,

sitting near an open window, sleeping in a damp bed, sitting in a room

that has been newly plastered, &c. I know people who never fail to have

a sore throat if they sit even but a short time in a room that has been

lately washed.

Acrid or irritating food may likewise inflame the throat, and occasion a

quinsey. It may also proceed from bones, pins, or other sharp substances

sticking in the throat, or from the caustic fumes of metals or minerals,

as arsenic, antimony, &c. taken in by the breath. This disease is

sometimes epidemic and infectious.

SYMPTOMS.——The inflammation of the throat is evident from inspection,

the parts appearing red and swelled; besides, the patient complains of

pain in swallowing. His pulse is quick and hard, with other symptoms of

a fever. If blood be let, it is generally covered with a tough coat of a

whitish colour, and the patient spits a tough phlegm. As the swelling

and inflammation increase, the breathing and swallowing become more

difficult; the pain affects the ears; the eyes generally appear red; and

the face swells. The patient is often obliged to keep himself in an

erect posture, being in danger of suffocation; there is a constant

nausea, or inclination to vomit, and the drink, instead of passing into

the stomach, is often returned by the nose. The patient is sometimes

starved at last, merely from an inability to swallow any kind of food.

When the breathing is laborious, with straitnesss of the breast, and

anxiety, the danger is great. Though the pain in swallowing be very

great, yet while the patient breathes easy, there is not so much danger·

An external swelling is no unfavourable symptom; but if it suddenly

falls, and the disease affects the breast, the danger is very great.

When a quinsey is the consequence of some other disease, which has

already weakened the patient, his situation is dangerous. A frothing at

the mouth, with a swelled tongue, a pale, ghastly countenance, and

coldness of the extremities, are fatal symptoms.

REGIMEN.——The regimen in this disease is in all respects the same as in

the pleurisy, or peripneumony. The food must be light, and in small

quantity, and the drink plentiful, weak, and diluting, mixed with acids.

It is highly necessary that the patient be kept easy and quiet. Violent

affections of the mind, or great efforts of the body, may prove fatal.

He should not even attempt to speak but in a low voice. Such a degree of

warmth as to promote a constant, gentle sweat, is proper. When the

patient is in bed, his head ought to be raised a little higher than

usual.

It is peculiarly necessary that the neck be kept warm; for which purpose

several folds of soft flannel may be wrapt round it. That alone will

often remove a slight complaint of the throat, especially if applied in

due time. We cannot here omit observing the propriety of a custom which

prevails among the peasants of Scotland. When they feel any uneasiness

of the throat, they wrap a stocking about it all night. So effectual is

this remedy, that in many places it passes for a charm, and the stocking

is applied with particular ceremonies: the custom, however, is

undoubtedly a good one, and should never be neglected. When the throat

has been thus wrapped up all night, it must not be exposed to the cold

air through the day, but a handkerchief or a piece of flannel kept about

it till the inflammation be removed.

The jelly of black currants is a medicine very much in esteem for

complaints of the throat; and indeed it is of some use. It should be

almost constantly kept in the mouth, and swallowed down leisurely. It

may likewise be mixed in the patient’s drink, or taken any other way.

When it cannot be obtained, the jelly of red currants, or of mulberries,

may be used in its stead.

Gargles for the throat are very beneficial, They may be made of

sage-tea, with a little vinegar and honey, or by adding to half an

English pint of the pectoral decoction two or three spoonfuls of honey,

and the same quantity of currant-jelly. This may be used three or four

times a-day; and if the patient be troubled with tough viscid phlegm,

the gargle may be rendered more sharp and cleansing, by adding to it a

tea-spoonful of the spirit of _sal ammoniac_. Some recommend gargles

made of a decoction of the leaves or bark of the black currant-bush; but

where the jelly can be had, these are unnecessary.

There is no disease wherein the benefit of bathing the feet and legs in

lukewarm water is more apparent: that practice ought therefore never to

be neglected. If people were careful to keep warm, to wrap up their

throats with flannel, to bathe their feet and legs in warm water, and to

use a spare diet, with diluting liquors, at the beginning of this

disease, it would seldom proceed to a great height, or be attended with

any danger; but when these precautions are neglected, and the disease

becomes violent, more powerful medicines are necessary.

MEDICINE.——An inflammation of the throat being a most acute and

dangerous distemper, which sometimes takes off the patient very

suddenly, it will be proper, as soon as the symptoms appear, to bleed in

the arm, or rather in the jugular vein, and to repeat the operation if

circumstances require.

The body should likewise be kept gently open. This may either be done by

giving the patient for his ordinary drink a decoction of figs and

tamarinds, or small doses of rhubarb and nitre, as recommended in the

erysipelas. These may be increased according to the age of the patient,

and repeated till they have the desired effect.

I have often known very good effects from a bit of _sal prunel_, or

purified nitre, held in the mouth, and swallowed down as it melted. This

promotes the discharge of _saliva_, by which means it answers the end of

a gargle, while at the same time it abates the fever, by promoting the

discharge of urine, &c.

The throat ought likewise to be rubbed twice or thrice a-day with a

little of the volatile liniment. This seldom fails to produce some good

effects. At the same time the neck ought to be carefully covered with

wool or flannel, to prevent the cold from penetrating the skin, as this

application renders it very tender. Many other external applications are

recommended in this disease, as a swallow’s nest, poultices made of the

fungus called Jew’s ears, album Græcum, &c. But as we do not look upon

any of these to be preferable to a common poultice of bread and milk, we

shall take no farther notice of them.

Some recommend the gum guaiacum as a specific in this disease. Half a

dram of the gum in powder may be made into an electuary with the rob of

elderberries, or the jelly of currants for a dose, and repeated

occasionally[107].

Blistering upon the neck or behind the ears in violent inflammations of

the throat is very beneficial; and in bad cases it will be necessary to

lay a blistering-plaster quite across the throat, so as to reach from

ear to ear. After the plasters are taken off, the parts ought to be kept

running by the application of issue ointment, till the inflammation is

gone; otherwise, upon their drying up, the patient will be in danger of

a relapse.

When the patient has been treated as above, a suppuration seldom

happens. This however is sometimes the case, in spite of all endeavours

to prevent it. When the inflammation and swelling continue, and it is

evident that a suppuration will ensue, it ought to be promoted by

drawing the steam of warm water into the throat through a tunnel, or the

like. Soft poultices ought likewise to be applied outwardly, and the

patient may keep a roasted fig constantly in his mouth.

It sometimes happens, before the tumour breaks, that the swelling is so

great, as entirely to prevent any thing from getting down into the

stomach. In this case the patient must inevitably perish, unless he can

be supported in some other way. This can only be done by nourishing

clysters of broth, or gruel with milk, &c. Patients have often been

supported by these for Several days, till the tumour has broke; and

afterwards they have recovered.

Not only the swallowing, but the breathing, is often prevented by the

tumour. In this case nothing can save the patient’s life, but opening

the _trachea_ or wind-pipe. As that has been often done with success, no

person, in such desperate circumstances, ought to hesitate a moment

about the operation; but as it can only be performed by a surgeon, it is

not necessary here to give any directions about it.

When a difficulty of swallowing is not attended with an acute pain or

inflammation, it is generally owing to an obstruction of the glands

about the throat, and only requires that the part be kept warm, and the

throat frequently gargled with something that may gently stimulate the

glands, as a decoction of figs with vinegar and honey; to which may be

added a little mustard, or a small quantity of spirits. But this gargle

is never to be used where there are signs of an inflammation. This

species of _angina_ has various names among the common people, as _the

pap of the throat_, the falling down of the _almonds of the ears_, &c.

Accordingly, to remove it, they lift the patient up by the hair of the

head, and thrust their fingers under his jaws, &c. all which practices

are at best useless, and often hurtful.

Those who are subject to inflammations of the throat, in order to avoid

that disease, ought to live temperate. Such as do not chuse to observe

this rule, must have frequent recourse to purging and other evacuations,

to discharge the superfluous humours. They ought likewise to beware of

catching cold, and should abstain from aliment and medicines of an

astringent or stimulating nature.

Violent exercise, by increasing the motion and force of the blood, is

apt to occasion an inflammation of the throat, especially if cold liquor

be drank immediately after it, or the body suffered suddenly to cool.

Those who would avoid this disease ought therefore, after speaking

aloud, singing, running, drinking warm liquor, or doing any thing that

may strain the throat, or increase the circulation of the blood towards

it, to take care to cool gradually, and to wrap some additional

coverings about their necks.

I have often known persons who had been subject to sore throats,

entirely freed from that complaint by only wearing a riband, or a bit of

flannel, constantly about their necks, or by wearing thicker shoes, a

flannel waistcoat, or the like. These may seem trifling, but they have

great effect. There is danger indeed in leaving them off after persons

have been accustomed to them; but surely the inconveniency of using such

things for life, is not to be compared with the danger which may attend

the neglect of them.

Sometimes, after an inflammation, the glands of the throat continue

swelled, and become hard and callous. This complaint is not easily

removed, and is often rendered dangerous by the too frequent application

of strong stimulating and styptic medicines. The best method is to keep

it warm, and to gargle it twice a-day with a decoction of figs sharpened

a little with the elixir or spirit of vitriol.

OF THE MALIGNANT QUINSEY, OR PUTRID, ULCEROUS SORE THROAT.

This kind of quinsey is but little known in the northern parts of

Britain, though, for some time past, it has been fatal in the more

southern counties. Children are more liable to it than adults, females

than males, and the delicate than those who are hardy and robust. It

prevails chiefly in autumn, and is most frequent after a long course of

damp or sultry weather.

CAUSES.——This is evidently a contagious distemper, and is generally

communicated by infection. Whole families, and even entire villages,

often receive the infection from one person. This ought to put people

upon their guard against going near such patients as labour under the

disorder; as by that means they endanger not only their own lives, but

likewise those of their friends and connexions. Whatever tends to

produce putrid or malignant fevers, may likewise occasion the putrid

ulcerous sore throat, as unwholesome air, damaged provisions, neglect of

cleanliness, &c.

SYMPTOMS.——It begins with alternate fits of shivering and heat. The

pulse is quick, but low and unequal, and generally continues so through

the whole course of the disease. The patient complains greatly of

weakness and oppression of the breast, his spirits are low, and he is

apt to faint away when set upright; he is troubled with a nausea, and

often with a vomiting or purging. The two latter are most common in

children. The eyes appear red and watery, and the face swells. The urine

is at first pale and crude; but, as the disease advances, it turns more

of a yellowish colour. The tongue is white, and generally moist, which

distinguishes this from an inflammatory disease. Upon looking into the

throat it appears swelled, and of a florid red colour. Pale or

ash-coloured spots, however, are here and there interspersed, and

sometimes one broad patch or spot, of an irregular figure, and pale

white colour, surrounded with florid red, only appears. These whitish

spots or sloughs cover so many ulcers.

An efflorescence, or eruption upon the neck, arms, breast, and fingers,

about the second or third day, is a common symptom of this disease. When

it appears, the purging and vomiting generally cease.

There is often a slight degree of delirium, and the face frequently

appears bloated, and the inside of the nostrils red and inflamed. The

patient complains of a disagreeable putrid smell, and his breath is very

offensive.

The putrid, ulcerous sore throat may be distinguished from the

inflammatory by the vomiting and looseness with which it is generally

ushered in; the foul ulcers in the throat covered with a white or livid

coat; and by the excessive weakness of the patient; with other symptoms

of a putrid fever.

Unfavourable symptoms are, an obstinate purging, extreme weakness,

dimness of the sight, a livid or black colour of the spots, and frequent

shiverings, with a weak, fluttering pulse. If the eruption upon the skin

suddenly disappears, or becomes of a livid colour, with a discharge of

blood from the nose or mouth, the danger is very great.

If a gentle sweat break out about the third or fourth day, and continue

with a slow, firm, and equal pulse; if the sloughs cast off in a kindly

manner, and appear clean and florid at the bottom; and if the breathing

is soft and free, with a lively colour of the eyes, there is reason to

hope for a salutary crisis.

REGIMEN.——The patient must be kept quiet, and for the most part in bed,

as he will be apt to faint when taken out of it. His food must be

nourishing and restorative; as sago-gruel with red wine, jellies, strong

broths, &c. His drink ought to be generous, and of an antiseptic

quality; as red-wine negus, white-wine whey, and such like.

MEDICINE.——The medicine in this kind of quinsey is entirely different

from that which is proper in the inflammatory. All evacuations, as

bleeding, purging, &c. which weaken the patient, must be avoided.

Cooling medicines, as nitre and cream of tartar, are likewise hurtful.

Strengthening cordials alone can be used with safety; and these ought

never to be neglected.

If at the beginning there is a great nausea, or inclination to vomit,

the patient must drink an infusion of green tea, camomile flowers, or

_carduus benedictus_, in order to cleanse the stomach. If these are not

sufficient, he may take a few grains of the powder of ipecacuanha, or

any other gentle vomit.

If the disease is mild, the throat may be gargled with an infusion of

sage and rose leaves, to a gill of which may be added a spoonful or two

of honey, and as much vinegar as will make it agreeably acid; but when

the symptoms are urgent, the sloughs large and thick, and the breath

very offensive, the following gargle may be used:

To six or seven ounces of the pectoral decoction, when boiling, add half

an ounce of contrayerva-root; let it boil for some time, and afterwards

strain the liquor; to which add two ounces of white-wine vinegar, an

ounce of fine honey, and an ounce of the tincture of myrrh. This ought

not only to be used as a gargle, but a little of it should frequently be

injected with a syringe to clean the throat, before the patient takes

any meat or drink. This method is peculiarly necessary for children, who

cannot use a gargle.

It will be of great benefit if the patient frequently receives into his

mouth, through an inverted funnel, the steams of warm vinegar, myrrh,

and honey.

But when the putrid symptoms run high, and the disease is attended with

danger, the only medicine that can be depended upon is the Peruvian

bark. It may be taken in substance, if the patient’s stomach will bear

it. If not, an ounce of bark grossly powdered, with two drachms of

Virginian snake-root, may be boiled in an English pint and a half of

water to half a pint; to which a tea-spoonful of the elixir of vitriol

may be added, and an ordinary tea-cupful of it taken every three or four

hours. Blistering-plasters are very beneficial in this disease,

especially when the patient’s pulse and spirits are low. They may be

applied to the throat, behind the ears, or upon the back part of the

neck.

Should the vomiting prove troublesome, it will be proper to give the

patient two table-spoonfuls of the saline julep every hour. Tea made of

mint and a little cinnamon will be very proper for his ordinary drink,

especially if an equal quantity of red-wine be mixed with it.

In case of a violent looseness, the size of a nutmeg of _diascordium_,

or the japonic confection, may be taken two or three times a-day, or

oftener if necessary.

If a discharge of blood from the nose happens, the steams of warm

vinegar may be received up the nostrils frequently; and the drink must

be sharpened with spirits of vitriol, or tincture of roses.

In case of a strangury, the belly must be fomented with warm water, and

emollient clysters given three or four times a-day.

After the violence of the disease is over, the body should still be kept

open with mild purgatives; as manna, senna, rhubarb, or the like.

If great weakness and dejection of spirits, or night-sweats, with other

symptoms of a consumption, should ensue, we would advise the patient to

continue the use of the Peruvian bark, with the elixir of vitriol, and

to take frequently a glass of generous wine. These, together with a milk

diet, and riding on horseback, are the most likely means for recovering

his strength.

CHAP. XXIX.

OF COLDS AND COUGHS.

It has already been observed, that colds are the effect of an obstructed

perspiration; the common causes of which we have likewise endeavoured to

point out, and shall not here repeat them. Neither shall we spend time

in enumerating all the various symptoms of colds, as they are pretty

generally known. It may not however be amiss to observe, that almost

every cold is a kind of fever, which only differs in degree from some of

those that have already been treated of.

No age, sex, or constitution, is exempted from this disease; neither is

it in the power of any medicine or regimen to prevent it. The

inhabitants of every climate are liable to catch cold, nor can even the

greatest circumspection defend them at all times from its attacks.

Indeed, if the human body could be kept constantly in an uniform degree

of warmth, such a thing as catching cold would be impossible: but as

that cannot be effected by any means, the perspiration must be liable to

many changes. Such changes, however, when small, do not affect the

health; but, when great, they must prove hurtful.

When oppression of the breast, a stuffing of the nose, unusual

weariness, pain of the head, &c. give ground to believe that the

perspiration is obstructed, or, in other words, that the person has

caught cold, he ought immediately to lessen his diet, at least the usual

quantity of his solid food, and to abstain from all strong liquors.

Instead of flesh, fish, eggs, milk, and other nourishing diet, he may

eat light bread-pudding, veal or chicken broth, panado, gruels, and such

like. His drink may be water-gruel sweetened with a little honey; an

infusion of balm, or linseed sharpened with the juice of orange or

lemon; a decoction of barley and liquorice, with tamarinds, or any other

cool, diluting, acid liquor.

Above all, his supper should be light; as small posset, or water-gruel

sweetened with honey, and a little toasted bread in it. If honey should

disagree with the stomach, the gruel may be sweetened with treacle or

coarse sugar, and sharpened with the jelly of currants. Those who have

been accustomed to generous liquors may take wine-whey instead of gruel,

which may be sweetened as above.

The patient ought to lie longer than usual a-bed, and to encourage a

gentle sweat, which is easily brought on towards morning, by drinking

tea, or any kind of warm diluting liquor. I have often known this

practice carry off a cold in one day, which in all probability, had it

been neglected, would have cost the patient his life, or have confined

him for some months. Would people sacrifice a little time to ease and

warmth, and practice a moderate degree of abstinence when the first

symptoms of a cold appear, we have reason to believe, that most of the

bad effects which flow from an obstructed perspiration might be

prevented. But, after the disease has gathered strength by delay, all

attempts to remove it often prove vain. A pleurisy, a peripneumony, or a

fatal consumption of the lungs, are the common effects of colds which

have either been totally neglected or treated improperly.

Many attempt to cure a cold, by getting drunk. But this, to say no worse

of it, is a very hazardous experiment. No doubt it may sometimes

succeed, by suddenly restoring the perspiration; but when there is any

degree of inflammation, which is frequently the case, strong liquors,

instead of removing the malady, will increase it. By this means a common

cold may be converted into an inflammatory fever.

When those who labour for their daily bread have the misfortune to catch

cold, they cannot afford to lose a day or two, in order to keep

themselves warm, and take a little medicine; by which means the disorder

is often so aggravated as to confine them for a long time, or even to

render them ever after unable to sustain hard labour. But even such of

the labouring poor as can afford to take care of themselves, are often

too hardy to do it; they affect to despise colds, and as long as they

can crawl about, scorn to be confined by what they call a _common cold_.

Hence it is, that colds destroy such numbers of mankind. Like an enemy

despised, they gather strength from delay, till at length they become

invincible. We often see this verified in travellers, who, rather than

lose a day in the prosecution of their business, throw away their lives

by pursuing their journey, even in the severest weather, with this

disease upon them.

It is certain, however, that colds may be too much indulged. When a

person, for every slight cold, shuts himself up in a warm room, and

drinks great quantities of warm liquor, it may occasion such a general

relaxation of the solids as will not be easily removed. It will

therefore be proper, when the disease will permit, and the weather is

mild, to join to the regimen mentioned above gentle exercise; as

walking, riding on horseback, or in a carriage, &c. An obstinate cold,

which no medicine can remove, will yield to gentle exercise and a proper

regimen of the diet.

Bathing the feet and legs in warm water has a great tendency to restore

the perspiration. But care must be taken that the water be not too warm,

otherwise it will do hurt. It should never be much warmer than the

blood, and the patient should go immediately to bed after using it.

Bathing the feet in warm water, lying in bed, and drinking warm

water-gruel, or other weak liquors, will sooner take off a spasm, and

restore the perspiration, than all the hot sudorific medicines in the

world. This is all that is necessary for removing a common cold; and if

this course be taken at the beginning, it will seldom fail.

But when the symptoms do not yield to abstinence, warmth, and diluting

liquors, there is reason to fear the approach of some other disease, as

an inflammation of the breast, an ardent fever, or the like. If the

pulse therefore be hard and frequent, the skin hot and dry, and the

patient complains of his head or breast, it will be necessary to bleed,

and to give the cooling powders recommended in the scarlet fever every

three or four hours, till they give a stool.

It will likewise be proper to put a blistering-plaster on the back, to

give two table-spoonfuls of the saline mixture every two hours, and in

short to treat the patient in all respects as for a slight fever. I have

often seen this course, when observed at the beginning, remove the

complaint in two or three days, when the patient had all the symptoms of

an approaching ardent fever, or an inflammation of the breast.

The chief secret of preventing colds lies in avoiding, as far as

possible, all extremes either of heat or cold, and in taking care, when

the body is heated, to let it cool gradually. These and other

circumstances relating to this important subject, are so fully treated

of under the article _Obstructed Perspiration_, that it is needless here

to resume the consideration of them.

OF A COMMON COUGH.

A cough is generally the effect of a cold, which has either been

improperly treated, or entirely neglected. When it proves obstinate,

there is always reason to fear the consequences, as this shews a weak

state of the lungs, and is often the forerunner of a consumption.

If the cough be violent, and the patient young and strong, with a hard

quick pulse, bleeding will be proper; but in weak and relaxed habits,

bleeding rather prolongs the disease. When the patient spits freely,

bleeding is unnecessary, and sometimes hurtful, as it tends to lessen

that discharge.

When the cough is not attended with any degree of fever, and the spittle

is viscid and tough, sharp pectoral medicines are to be administered; as

gum ammoniac, squills, &c. Two table-spoonfuls of the solution of gum

ammoniac may be taken three or four times a-day, more or less, according

to the age and constitution of the patient. Squills may be given various

ways; two ounces of the vinegar, the oxymel, or the syrup, may be mixed

with the same quantity of simple cinnamon water, to which may be added

an ounce of common water and an ounce of balsamic syrup. Two

table-spoonfuls of this mixture may be taken three or four times a-day.

A syrup made of equal parts of lemon-juice, honey, and sugar-candy, is

likewise very proper in this kind of cough. A table-spoonful of it may

be taken at pleasure.

But when the defluxion is sharp and thin, these medicines rather do

hurt. In this case gentle opiates, oils, and mucilages, are more proper.

A cup of an infusion of wild poppy leaves, and marsh-mallow roots, or

the flowers of coltsfoot, may be taken frequently; or a tea-spoonful of

the paregoric elixir may be put into the patient’s drink twice a-day.

Fuller’s Spanish infusion is also a very proper medicine in this case,

and may be taken in the quantity of a tea-cupful three or four times

a-day[108].

When a cough is occasioned by acrid humours tickling the throat and

_fauces_, the patient should keep some soft pectoral lozenges almost

constantly in his mouth; as the Pontefract liquorice cakes,

barley-sugar, the common balsamic lozenges, Spanish juice, &c. These

blunt the acrimony of the humours, and by taking off their stimulating

quality, help to appease the cough[109].

In obstinate coughs, proceeding from a flux of humours upon the lungs,

it will often be necessary, besides expectorating medicines, to have

recourse to issues, setons, or some other drain. In this case I have

often observed the most happy effects from a Burgundy-pitch plaster

applied between the shoulders. I have ordered this simple remedy in the

most obstinate coughs, in a great number of cases, and in many different

constitutions, without ever knowing it fail to give relief, unless where

there were evident signs of an ulcer in the lungs.

About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a

piece of soft leather, about the size of the hand, and laid between the

shoulder-blades. It may be taken off and wiped every three or four days,

and ought to be renewed once a fortnight or three weeks. This is indeed

a cheap and simple medicine, and consequently apt to be despised; but we

will venture to affirm, that the whole _materia medica_ does not afford

an application more efficacious in almost every kind of cough. It has

not indeed always an immediate effect; but, if kept on for some time, it

will succeed where most other medicines fail.

The only inconveniency attending this plaster is the itching which it

occasions; but surely this may be dispensed with, considering the

advantage which the patient may expect to reap from the application;

besides, when the itching becomes very uneasy, the plaster may be taken

off, and the part rubbed with a dry cloth, or washed with a little warm

milk and water. Some caution indeed is necessary in discontinuing the

use of such a plaster; this however may be safely done by making it

smaller by degrees, and at length quitting it altogether in a warm

season[110].

But coughs proceed from many other causes besides defluxions upon the

lungs. In these cases the cure is not to be attempted by pectoral

medicines. Thus, in a cough proceeding from a foulness and debility of

the stomach, syrups, oils, mucilages, and all kinds of balsamic

medicines do hurt. The _stomach cough_ may be known from one that is

owing to a fault in the lungs by this, that in the latter the patient

coughs whenever he inspires, or draws in his breath fully; but in the

former that does not happen.

The cure of this cough depends chiefly upon cleansing and strengthening

the stomach; for which purpose gentle vomits and bitter purgatives are

most proper. Thus, after a vomit or two, the sacred tincture, as it is

called, may be taken for a considerable time in the dose of one or two

table-spoonfuls twice a-day, or as often as it is found necessary, to

keep the body gently open. People may make this tincture themselves, by

infusing an ounce of _hiera picra_[111] in an English pint of white

wine, letting it stand a few days, and then draining it.

In coughs which proceed from a debility of the stomach, the Peruvian

bark is likewise of considerable service. It may either be chewed, taken

in powder, or made into a tincture along with other stomachic bitters.

_A nervous cough_ can only be removed by change of air and proper

exercise; to which may be added the use of gentle opiates. Instead of

the saponaceous pill, the paregoric elixir, &c. which are only opium

disguised, ten, fifteen, twenty, or twenty-five drops of liquid

laudanum, more or less, as circumstances require, may be taken at

bed-time, or when the cough is most troublesome. Immersing the feet and

hands in warm water will often appease the violence of a nervous cough.

When a cough is only the symptom of some other malady, it is in vain to

attempt to remove it without first curing the disease from which it

proceeds. Thus when a cough is occasioned by _teething_, keeping the

body open, scarifying the gums, or whatever facilitates the cutting of

the teeth, likewise appeases the cough. In like manner, when _worms_

occasion a cough, such medicines as remove these vermin will generally

cure the cough; as bitter purgatives, oily clysters, and such like.

Women, during the last months of pregnancy, are often greatly afflicted

with a cough, which is generally relieved by bleeding, and keeping the

body gently open. They ought to avoid all flatulent food, and to wear a

loose easy dress.

A cough is not only a symptom, but is often likewise the forerunner of

diseases. Thus, the gout is frequently ushered in by a very troublesome

cough, which affects the patient for some days before the coming on of

the fit. This cough is generally removed by a paroxysm of the gout,

which should therefore be promoted, by keeping the extremities warm,

drinking warm liquors, and bathing the feet and legs frequently in

lukewarm water.

OF THE HOOPING-COUGH, OR CHIN-COUGH.

This cough seldom affects adults, but proves often fatal to children.

Such children as live upon thin watery diet, who breathe unwholesome

air, and have too little exercise, are most liable to this disease, and

generally suffer most from it.

The chin-cough is so well known, even to nurses, that a description of

it is unnecessary. Whatever hurts the digestion, obstructs the

perspiration, or relaxes the solids, disposes to this disease:

consequently its cure must depend upon cleansing and strengthening the

stomach, bracing the solids, and at the same time promoting perspiration

and the different secretions.

The diet must be light, and of easy digestion; for children, good bread

made into pap or pudding, chicken-broth, with other light spoon meats,

are proper; but those who are farther advanced may be allowed

sago-gruel, and if the fever be not high, a little boiled chicken, or

other white meats. The drink may be hyssop, or penny-royal tea,

sweetened with honey or sugar-candy, small wine-whey; or, if the patient

be weak, he may sometimes be allowed a little negus.

One of the most effectual remedies in the chin-cough is change of air.

This often removes the malady, even when the change seems to be from a

purer to a less wholesome air. This may in some measure depend on the

patient’s being removed from the place where the infection prevails.

Most of the diseases of children are infectious; nor is it at all

uncommon to find the chin-cough prevailing in one town or village, when

another, at a very small distance, is quite free from it. But whatever

be the cause, we are sure of the fact. No time ought therefore to be

lost in removing the patient at some distance from the place where he

caught the disease, and, if possible, into a more pure and warm

air[112].

When the disease proves violent, and the patient is in danger of being

suffocated by the cough, he ought to be bled, especially if there be a

fever with a hard full pulse. But as the chief intention of bleeding is

to prevent an inflammation of the lungs, and to render it more safe to

give vomits, it will seldom be necessary to repeat the operation; yet if

there are symptoms of an inflammation of the lungs, a second or even a

third bleeding may be requisite.

It is generally reckoned a favourable symptom when a fit of coughing

makes the patient vomit. This cleanses the stomach, and greatly relieves

the cough. It will therefore be proper to promote this discharge, either

by small doses of ipecacuanha, or the vomiting julep recommended in the

Appendix[113].

It is very difficult to make children drink after a vomit. I have often

seen them happily deceived, by infusing a scruple or half a drachm of

the powder of ipecacuanha in a tea-pot, with half an English pint of

boiling water. If this be disguised with a few drops of milk and a

little sugar, they will imagine it tea, and drink it very greedily. A

small tea-cupful of this may be given every quarter of an hour, or

rather every ten minutes, till it operates. When the child begins to

puke, there will be no occasion for drinking any more, as the water

already on the stomach will be sufficient.

Vomits not only cleanse the stomach, which in this disease is generally

loaded with viscid phlegm, but they likewise promote the perspiration

and other secretions, and ought therefore to be repeated according to

the obstinacy of the disease. They should not however be strong; gentle

vomits frequently repeated are both less dangerous, and more beneficial

than strong ones.

The body ought to be kept gently open. The best medicines for this

purpose are rhubarb and its preparations, as the syrup, tincture, &c. Of

these a tea-spoonful or two may be given to an infant twice or thrice

a-day, as there is occasion. To such as are farther advanced, the dose

must be proportionally increased, and repeated till it has the desired

effect. Those who cannot be brought to take the bitter tincture, may

have an infusion of senna and prunes, sweetened with manna, coarse

sugar, or honey; or a few grains of rhubarb mixed with a tea-spoonful or

two of syrup, or currant jelly, so as to disguise the taste. Most

children are fond of syrups and jellies, and seldom refuse even a

disagreeable medicine when mixed with them.

Many people believe that oily, pectoral, and balsamic medicines possess

wonderful virtues for the cure of the chin-cough, and accordingly

exhibit them plentifully to patients of every age and constitution,

without considering that every thing of this nature must load the

stomach, hurt the digestion, and of course aggravate the disorder[114].

The _millepedes_, or woodlice, are greatly recommended for the cure of a

chin-cough. Those who chuse to make use of these insects, may infuse two

ounces of them bruised in an English pint of small white-wine for one

night. Afterwards the liquor may be drained through a cloth, and a

table-spoonful of it given to the patient three or four times a-day.

Opiates are sometimes necessary to allay the violence of the cough. For

this purpose a little of the syrup of poppies, or five, six, or seven

drops of laudanum, according to the age of the patient, may be taken in

a cup of hyssop or penny-royal-tea, and repeated occasionally[115].

The garlic ointment is a well-known remedy in North Britain for the

chin-cough. It is made by beating in a mortar garlic with an equal

quantity of hogs lard. With this the soles of the feet may be rubbed

twice or thrice a-day; but the best method is to spread it upon a rag,

and apply it in the form of plaster. It should be renewed every night

and morning at least, as the garlic soon loses its virtue. This is an

exceeding good medicine both in the chin-cough, and in most other coughs

of an obstinate nature. It ought not however to be used when the patient

is very hot or feverish, lest it should increase these symptoms.

The feet should be bathed once every two or three days in lukewarm

water; and a Burgundy-pitch plaster kept constantly between the

shoulders. But when the disease proves very violent, it will be

necessary, instead of it, to apply a blistering-plaster, and to keep the

part open for some time with issue ointment.

When the disease is prolonged, and the patient is free from a fever, the

Peruvian bark, and other bitters, are the most proper medicines. The

bark may either be taken in substance, or in a decoction or infusion, as

is most agreeable. For a child, ten, fifteen, or twenty grains,

according to the age of the patient, may be given three or four times a

day. For an adult, half a drachm or two scruples will be proper. Some

give the extract of the bark with cantharides; but to manage this

requires a considerable attention. It is more safe to give a few grains

of castor along with the bark. A child of six or seven years of age may

take seven or eight grains of castor, with fifteen grains of powdered

bark, for a dose. This may be made into a mixture with two or three

ounces of any simple distilled water, and a little syrup, and taken

three or four times a-day.

CHAP. XXX.

INFLAMMATION OF THE STOMACH, AND OTHER VISCERA.

All inflammations of the bowels are dangerous, and require the most

speedy assistance; as they frequently end in a suppuration, and

sometimes in a mortification, which is certain death.

CAUSES.——An inflammation of the stomach may proceed from any of the

causes which produce an inflammatory fever; as cold liquor drank while

the body is warm, obstructed perspiration, or the sudden striking in of

any eruption. It may likewise proceed from the acrimony of the bile, or

from acrid and stimulating substances taken into the stomach; as strong

vomits or purges, corrosive poisons, and such like. When the gout has

been repelled from the extremities, either by cold or improper

applications, it often occasions an inflammation of the stomach. Hard or

indigestible substances taken into the stomach, as bones, the stones of

fruit, &c. may likewise have that effect.

SYMPTOMS.——It is attended with a fixed pain and burning heat in the

stomach; great restlessness and anxiety; a small, quick, and hard pulse;

vomiting, or, at least, a nausea and sickness; excessive thirst;

coldness of the extremities; difficulty of breathing; cold clammy

sweats; and sometimes convulsions and fainting fits. The stomach is

swelled, and often feels hard to the touch. One of the most certain

signs of this disease is the sense of pain, which the patient feels upon

taking any kind of food or drink, especially if it be either too hot or

too cold.

When the patient vomits every thing he eats or drinks, is extremely

restless, has a hiccup, with an intermitting pulse, and frequent

fainting fits, the danger is very great.

REGIMEN.——All acrimonious, heating, and irritating food and drink are

carefully to be avoided. The weakness of the patient may deceive the

bystanders, and induce them to give him wines, spirits, or other

cordials; but these never fail to increase the disease, and often

occasion sudden death. The inclination to vomit may likewise impose on

the attendants, and make them think a vomit necessary; but that too is

almost certain death.

The food must be light, thin, cool, and easy of digestion. It must be

given in small quantities, and should neither be quite cold nor too hot.

Thin gruel made of barley or oatmeal, light toasted bread dissolved in

boiling water, or very weak chicken broth, are the most proper. The

drink should be clear whey, barley-water, water in which toasted bread

has been boiled, or decoctions of emollient vegetables; as liquorice and

marsh-mallow roots, sarsaparilla, &c.

MEDICINE.——Bleeding in this disease is absolutely necessary, and is

almost the only thing that can be depended on. When the disease proves

obstinate, it will often be proper to repeat this operation several

times, nor must the low state of the pulse deter us from doing so. The

pulse indeed generally rises upon bleeding, and as long as that is the

case, the operation is safe.