MEDICINE.——Though numberless medicines are extolled for expelling and

killing worms[135], yet no disease more frequently baffles the

physician’s skill. In general, the most proper medicines for their

expulsion are strong purgatives; and to prevent their breeding,

stomachic bitters, with now and then a glass of good wine.

The best purge for an adult is jalap and calomel. Five and twenty or

thirty grains of the former with six or seven of the latter, mixed in

syrup, may be taken early in the morning, for a dose. It will be proper

that the patient keep the house all day, and drink nothing cold. The

dose may be repeated once or twice a week, for a fortnight or three

weeks. On the intermediate days the patient may take a drachm of the

powder of tin, twice or thrice a-day, mixed with syrup, honey, or

treacle.

Those who do not chuse to take calomel may make use of the bitter

purgatives; as aloes, hiera picra, tincture of senna, and rhubarb, &c.

Oily medicines are sometimes found beneficial for expelling worms. An

ounce of sallad oil and a table-spoonful of common salt may be taken in

a glass of red port wine thrice a-day, or oftner, if the stomach will

bear it. But the more common form of using oil is in clysters. Oily

clysters, sweetened with sugar or honey, are very efficacious in

bringing away the short round worms called _ascarides_, and likewise the

_teres_.

The Harrowgate water is an excellent medicine for expelling worms,

especially the _ascarides_. As this water is impregnated with sulphur,

we may hence infer, that sulphur alone must be a good medicine in this

case; which is found to be a fact. Many practitioners give flour of

sulphur in very large doses, and with great success. It should be made

into an electuary with honey or treacle, and taken in such quantity as

to purge the patient.

Where Harrowgate water cannot be obtained, sea-water may be used, which

is far from being a contemptible medicine in this case. If sea-water

cannot be had, common salt dissolved in water may be drank. I have often

seen this used by country nurses with very good effect. Some flour of

sulphur may be taken over night, and the salt-water in the morning.

But worms, though expelled, will soon breed again, if the stomach

remains weak and relaxed; to prevent which, we would recommend the

Peruvian bark. Half a drachm of bark in powder may be taken in a glass

of red port wine three or four times a-day, after the above medicines

have been used. Lime-water is likewise good for this purpose, or a

table-spoonful of the chalybeate wine taken twice or thrice a-day.

Infusions or decoctions of bitter herbs may likewise be drank; as the

infusion of tansy, water-trefoil, camomile flowers, tops of wormwood,

the lesser centaury, &c.

For a child of four or five years old, six grains of rhubarb, five of

jalap, and two of calomel, may be mixed in a spoonful of syrup or honey,

and given in the morning. The child should keep the house all day, and

take nothing cold. This dose may be repeated twice a-week for three or

four weeks. On the intermediate days the child may take a scruple of

powdered tin and ten grains of æthiops mineral in a spoonful of treacle

twice a-day. This dose must be increased or diminished according to the

age of the patient.

Bisset says, the great bastard black hellebore, or _bear’s foot_, is a

most powerful vermifuge for the long round worms. He orders the

decoction of about a drachm of the green leaves, or about fifteen grains

of the dried leaves in powder for a dose to a child between four and

seven years of age. This dose is to be repeated two or three times. He

adds, that the green leaves made into a syrup with coarse sugar, is

almost the only medicine he has used for round worms for three years

past. Before pressing out the juice, he moistens the bruised leaves with

vinegar, which corrects the medicine. The dose is a tea-spoonful at

bed-time, and one or two next morning.

I have frequently known those big bellies, which in children are

commonly reckoned a sign of worms, quite removed by giving them white

soap in their pottage, or other food. Tansy, garlic, and rue, are all

good against worms, and may be used various ways. We might here mention

many other plants, both for external and internal use, as the

cabbage-bark, &c. but think the powder of tin with æthiops mineral, and

the purges of rhubarb and calomel, are more to be depended on.

Ball’s purging vermifuge powder is a very powerful medicine. It is made

of equal parts of rhubarb, seammony, and calomel, with as much double

refined sugar as is equal to the weight of all the other ingredients.

These must be well mixed together, and reduced to a fine powder. The

dose for a child is from ten grains to twenty, once or twice a-week. An

adult may take a drachm for a dose[136].

Parents who would preserve their children from worms ought to allow them

plenty of exercise in the open air; to take care that their food be

wholesome and sufficiently solid; and, as far as possible, to prevent

their eating raw herbs, roots, or green trashy fruits. It will not be

amiss to allow a child who is subject to worms, a glass of red wine

after meals; as every thing that braces and strengthens the stomach is

good both for preventing and expelling these vermin[137].

CHAP. XXXVI.

OF THE JAUNDICE.

This disease is first observable in the white of the eye, which appears

yellow. Afterwards the whole skin puts on a yellow appearance. The urine

too is of a saffron hue, and dies a white cloth of the same colour.

There is likewise a species of this disease called the Black Jaundice.

CAUSES.——The immediate cause of the jaundice is an obstruction of the

bile. The remote or occasional causes are, the bites of poisonous

animals, as the viper, mad dog, &c. the bilious or hysteric colic;

violent passions, as grief, anger, &c. Strong purges or vomits will

likewise occasion the jaundice. Sometimes it proceeds from obstinate

agues, or from that disease being prematurely stopped by astringent

medicines. In infants it is often occasioned by the _meconium_ not being

sufficiently purged off. Pregnant women are very subject to it. It is

likewise a symptom in several kinds of fever. Catching cold, or the

stoppage of customary evacuations, as the _menses_, the bleeding piles,

issues, &c. will occasion the jaundice.

SYMPTOMS.——The patient at first complains of excessive weariness, and

has great aversion to every kind of motion. His skin is dry, and he

generally feels a kind of itching or pricking pain over the whole body.

The stools are of a whitish or clay colour, and the urine, as was

observed above, is yellow. The breathing is difficult, and the patient

complains of an unusual load or oppression on his breast. There is a

heat in the nostrils, a bitter taste in the mouth, loathing of food,

sickness at the stomach, vomiting, flatulency, and other symptoms of

indigestion.

If the patient be young, and the disease complicated with no other

malady, it is seldom dangerous; but in old people, where it continues

long, returns frequently, or is complicated with the dropsy or

hypochondriac symptoms, it generally proves fatal. The black jaundice is

more dangerous than the yellow.

REGIMEN.——The diet should be cool, light, and diluting, consisting

chiefly of ripe fruits and mild vegetables; as apples boiled or roasted,

stewed prunes, preserved plums, boiled spinage, &c. Veal or

chicken-broth, with light bread, are likewise very proper. Many have

been cured by living almost wholly for some days on raw eggs. The drink

should be butter-milk, whey sweetened with honey, or decoctions of cool

opening vegetables; or marsh-mallow roots, with liquorice, &c.

The patient should take as much exercise as he can bear, either on

horseback, or in a carriage; walking, running, and even jumping, are

likewise proper, provided he can bear them without pain, and there be no

symptoms of inflammation. Patients have been often cured of this disease

by a long journey, after medicines had proved ineffectual.

Amusements are likewise of great use in the jaundice. The disease is

often occasioned by a sedentary life, joined to a dull melancholy

disposition. Whatever therefore tends to promote the circulation, and to

cheer the spirits, must have a good effect; as dancing, laughing,

singing, &c.

MEDICINE.——If the patient be young, of a full sanguine habit, and

complains of pain in the right side about the region of the liver,

bleeding will be necessary. After this a vomit must be administered, and

if the disease proves obstinate, it may be repeated once or twice. No

medicines are more beneficial in the jaundice than vomits, especially

where it is not attended with inflammation. Half a drachm of ipecacuanha

in powder will be a sufficient dose for an adult. It may be wrought off

with weak camomile-tea, or lukewarm water. The body must likewise be

kept open by taking a sufficient quantity of Castile soap, or the pills

for the jaundice recommended in the Appendix.

Fomenting the parts about the region of the stomach and liver, and

rubbing them with a warm hand or flesh-brush, are likewise beneficial;

but it is still more so for the patient to sit in a bath of warm water

up to the breast. He ought to do this frequently, and should continue in

it as long as his strength will permit.

Many dirty things are recommended for the cure of the jaundice; as lice,

millepedes, &c. But these do more harm than good, as people trust to

them, and neglect more valuable medicines; besides, they are seldom

taken in sufficient quantity to produce any effects. People always

expect that such _things_ should act as charms, and consequently seldom

persist in the use of them. Vomits, purges, fomentations, and exercise,

will seldom fail to cure the jaundice when it is a simple disease; and

when complicated with the dropsy, a scirrhous liver, or other chronic

complaints, it is hardly to be cured by any means.

Numberless British herbs are extolled for the cure of this disease. The

author of the _Medicina Britannica_ mentions near a hundred, all famous

for curing the jaundice. The fact is, the disease often goes off of its

own accord; in which case the last medicine is always said to have

performed the cure. I have sometimes however seen considerable benefit,

in a very obstinate jaundice, from a decoction of hempseed. Four ounces

of the seed may be boiled in two English quarts of ale, and sweetened

with coarse sugar. The dose is half an English pint every morning. It

may be continued for eight or nine days.

I have likewise known Harrowgate sulphur-water cure a jaundice of very

long standing. It should be used for some weeks, and the patient must

both drink and bathe.

The soluble tartar is a very proper medicine in the jaundice. A drachm

of it may be taken every night and morning in a cup of tea or

water-gruel. If it does not open the body, the dose may be increased.

Persons subject to the jaundice ought to take as much exercise as

possible, and to avoid all heating and astringent aliments.

CHAP. XXXVII.

OF THE DROPSY.

The dropsy is a preternatural swelling of the whole body, or some part

of it, occasioned by a collection of watery humour. It is distinguished

by different names, according to the part affected, as the _anasarca_,

or a collection of water under the skin; the _ascites_, or a collection

of water in the belly; the _hydrops pectoris_, or dropsy of the breast;

the _hydrocephalus_, or dropsy of the brain, &c.

CAUSES.——The dropsy is often owing to an hereditary disposition. It may

likewise proceed from drinking ardent spirits, or other strong liquors.

It is true almost to a proverb, that great drinkers die of a dropsy. The

want of exercise is also a very common cause of the dropsy. Hence it is

justly reckoned among the diseases of the sedentary. It often proceeds

from excessive evacuations, as frequent and copious bleedings, strong

purges often repeated, frequent salivations, &c. The sudden stoppage of

customary or necessary evacuations, as the _menses_, the hæmorrhoids,

fluxes of the belly, &c. may likewise cause a dropsy.

I have known the dropsy occasioned by drinking large quantities of cold,

weak, watery liquor, when the body was heated by violent exercise. A

low, damp, or marshy situation is likewise a frequent cause of it. Hence

it is a common disease in moist, flat, fenny countries. It may also be

brought on by a long use of poor watery diet, or of viscous aliment that

is hard of digestion. It is often the effect of other diseases, as the

jaundice, a scirrhus of the liver, a violent ague of long continuance, a

diarrhœa, a dysentery, an empyema, or a consumption of the lungs. In

short, whatever obstructs the perspiration, or prevents the blood from

being duly prepared, may occasion a dropsy.

SYMPTOMS.——The _anasarca_ generally begins with a swelling of the feet

and ancles towards night, which for some time disappears in the morning.

In the evening the parts, if pressed with the finger, will pit. The

swelling gradually ascends, and occupies the trunk of the body, the

arms, and the head. Afterwards the breathing becomes difficult, the

urine is in small quantity, and the thirst great; the body is bound, and

the perspiration is greatly obstructed. To these succeed torpor,

heaviness, a slow wasting fever, and a troublesome cough. This last is

generally a fatal symptom, as it shews that the lungs are affected.

In an _ascites_, besides the above symptoms, there is a swelling of the

belly, and often a fluctuation, which may be perceived by striking the

belly on one side, and laying the palm of the hand on the opposite. This

may be distinguished from a _tympany_ by the weight of the swelling, as

well as by the fluctuation. When the _anasarca_ and _ascites_ are

combined, the case is very dangerous. Even a simple _ascites_ seldom

admits of a radical cure. Almost all that can be done is, to let off the

water by tapping, which seldom affords more than a temporary relief.

When the disease comes suddenly on, and the patient is young and strong,

there is reason however to hope for a cure, especially if medicine be

given early. But if the patient be old, has led an irregular or a

sedentary life, or if there be reason to suspect that the liver, lungs,

or any of the viscera are unsound, there is great reason to fear that

the consequences will prove fatal.

REGIMEN.——The patient must abstain, as much as possible, from all drink,

especially weak and watery liquors, and must quench his thirst with

mustard-whey, or acids, as juice of lemons, oranges, sorrel, or such

like. His aliment ought to be dry, of a stimulating and diuretic

quality, as toasted bread, the flesh of birds, or other wild animals

roasted; pungent and aromatic vegetables, as garlic, mustard, onions,

cresses, horse-radish, rocambole, shalot, &c. He may also eat

sea-biscuit dipt in wine or a little brandy. This is not only

nourishing, but tends to quench thirst. Some have been actually cured of

a dropsy by a total abstinence from all liquids, and living entirely

upon such things as are mentioned above. If the patient must have drink,

the Spa-water, or Rhenish wine, with diuretic medicines infused in it,

are the best.

Exercise is of the greatest importance in a dropsy. If the patient be

able to walk, dig, or the like, he ought to continue these exercises as

long as he can. If he is not able to walk or labour, he must ride on

horseback, or in a carriage, and the more violent the motion so much the

better, provided he can bear it. His bed ought to be hard, and the air

of his apartments warm and dry. If he lives in a damp country, he ought

to be removed into a dry one, and, if possible, into a warmer climate.

In a word, every method should be taken to promote the perspiration, and

to brace the solids. For this purpose it will likewise be proper to rub

the patient’s body, two or three times a day, with a hard cloth, or the

flesh-brush; and he ought constantly to wear flannel next his skin.

MEDICINE.——If the patient be young, his constitution good, and the

disease has come on suddenly, it may generally be removed by strong

vomits, brisk purges, and such medicines as promote a discharge by sweat

and urine. For an adult, half a drachm of ipecacuanha in powder, and

half an ounce of oxymel of squills, will be a proper vomit. This may be

repeated as often as is found necessary, three or four days intervening

between the doses. The patient must not drink much after taking the

vomit, otherwise he destroys its effect. A cup or two of camomile-tea

will be sufficient to work it off.

Between each vomit, on one of the intermediate days, the patient may

take the following purge: Jalap in powder half a drachm, cream of

tartar, two drachms, calomel six grains. These may be made into a bolus

with a little syrup of pale roses, and taken early in the morning. The

less the patient drinks after it the better. If he be much griped, he

may now and then take a cup of chicken-broth.

The patient may likewise take every night at bed-time the following

bolus: To four or five grains of camphor add one grain of opium, and as

much syrup of orange-peel as is sufficient to make them into a bolus.

This will generally promote a gentle sweat, which should be encouraged

by drinking now and then a small cup of wine-whey, with a tea-spoonful

of the spirits of hartshorn in it. A tea-cupful of the following

diuretic infusion may likewise be taken every four or five hours through

the day:

Take juniper-berries, mustard-seed, and horse-radish, of each half an

ounce, ashes of broom half a pound; infuse them in a quart of Rhenish

wine or strong ale for a few days, and afterwards strain off the liquor.

Such as cannot take this infusion, may use the decoction of seneka-root,

which is both diuretic and sudorific. I have known an obstinate

_anasarca_ cured by an infusion of the ashes of broom in wine.

The above course will often cure an incidental dropsy, if the

constitution be good; but when the disease proceeds from a bad habit, or

an unsound state of the viscera, strong purges and vomits are not to be

ventured upon. In this case, the safer course is to palliate the

symptoms by the use of such medicines as promote the secretions, and to

support the patient’s strength by warm and nourishing cordials.

The secretion of urine may be greatly promoted by nitre. Brookes says,

he knew a young woman who was cured of a dropsy by taking a drachm of

nitre every morning in a draught of ale, after she had been given over

as incurable. The powder of squills is likewise a good diuretic. Six or

eight grains of it, with a scruple of nitre, may be given twice a-day in

a glass of strong cinnamon-water. Ball says, a large spoonful of

unbruised mustard-seed taken every night and morning, and drinking half

an English pint of the decoction of the tops of green broom after it,

has performed a cure after other powerful medicines had proved

ineffectual.

I have sometimes seen good effects from cream of tartar in this disease.

It promotes the discharges by stool and urine, and will at least

palliate, if it does not perform a cure. The patient may begin by taking

an ounce every second or third day, and may increase the quantity to two

or even to three ounces, if the stomach will bear it. This quantity is

not however to be taken at once, but divided into three or four doses.

To promote perspiration, the patient may use the decoction of

seneka-root, as directed above; or he may take two table-spoonfuls of

Mindererus’s spirit in a cup of wine-whey three or four times a-day. To

promote a discharge of urine, the following infusion of the London

hospitals will likewise be beneficial:

Take of zedoary-root two drachms; dried squills, rhubarb, and

juniper-berries bruised, of each a drachm; cinnamon in powder, three

drachms; salt of wormwood, a drachm and a half; infuse in an English

pint and a half of old hock-wine, and when fit for use, filter the

liquor. A wine-glass of it may be taken three or four times a-day.

In the _anasarca_ it is usual to scarify the feet and legs. By this

means the water is often discharged; but the operator must be cautious

not to make the incisions too deep; they ought barely to pierce through

the skin, and especial care must be taken, by spirituous fomentations

and proper digestives, to prevent a gangrene.

In an _ascites_, when the disease does not evidently and speedily give

way to purgative and diuretic medicines, the water ought to be let off

by tapping. This is a very simple and safe operation, and would often

succeed, if it were performed in due time; but if it be delayed till the

humours are vitiated, or the bowels spoiled, by long soaking in water,

it can hardly be expected that any permanent relief will be

procured[138].

After the evacuation of the water, the patient is to be put on a course

of strengthening medicines; as the Peruvian bark; the elixir of vitriol;

warm aromatics, with a due proportion of rhubarb, infused in wine, and

such like. His diet ought to be dry and nourishing, such as is

recommended in the beginning of the Chapter; and he should take as much

exercise as he can bear without fatigue. He should wear flannel next his

skin, and make daily use of the flesh-brush.

CHAP. XXXVIII.

OF THE GOUT.

There is no disease which shews the imperfection of medicine, or sets

the advantages of temperance and exercise in a stronger light, than the

gout. Excess and idleness are the true sources from whence it originally

sprung, and all who would avoid it must be _active_ and _temperate_.

Though idleness and intemperance are the principal causes of the gout,

yet many other things may contribute to bring on the disorder in those

who are not, and to induce a paroxysm in those who are subject to it; as

intense study; too free an use of acidulated liquors; night-watching;

grief or uneasiness of mind; an obstruction or defect of any of the

customary discharges, as the _menses_, sweating of the feet,

perspiration, &c.

SYMPTOMS.——A fit of the gout is generally preceded by indigestion,

drowsiness, belching of wind, a slight head-ach, sickness, and sometimes

vomiting. The patient complains of weariness and dejection of spirits,

and has often a pain in the limbs, with a sensation as if wind or cold

water were passing down the thigh. The appetite is often remarkably keen

a day or two before the fit, and there is a slight pain in passing

urine, and sometimes an involuntary shedding of tears. Sometimes these

symptoms are much more violent, especially upon the near approach of the

fit; and some observe, that as is the fever which ushers in the gout, so

will the fit be; if the fever be short and sharp, the fit will be so

likewise; if it be feeble, long, and lingering, the fit will be such

also. But this observation can only hold with respect to very regular

fits of the gout.

The regular gout generally makes its attack in the spring, or beginning

of winter, in the following manner: About two or three in the morning,

the patient is seized with a pain in his great toe, sometimes in the

heel, and at other times in the ancle or calf of the leg. This pain is

accompanied with a sensation as if cold water were poured upon the part,

which is succeeded by a shivering, with some degree of fever. Afterwards

the pain increases, and fixing among the small bones of the foot, the

patient feels all the different kinds of torture, as if the part were

stretched, burnt, squeezed, gnawed, or torn in pieces, &c. The part at

length becomes so exquisitely sensible, that the patient cannot bear to

have it touched, or even suffer any person to walk across the room.

The patient is generally in exquisite torture for twenty-four hours,

from the time of the coming on of the fit: he then becomes easier, the

part begins to swell, appears red, and is covered with a little

moisture. Towards morning he drops asleep, and generally falls into a

gentle breathing sweat. This terminates the first paroxysm, a number of

which constitutes a fit of the gout; which is longer or shorter

according to the patient’s age, strength, the season of the year, and

the disposition of the body to this disease.

The patient is always worse towards night, and easier in the morning.

The paroxysms however generally grow milder every day, till at length

the disease is carried off by perspiration, urine, and the other

evacuations. In some patients this happens in a few days; in others, it

requires weeks, and in some, months, to finish the fit. Those whom age

and frequent fits of the gout have greatly debilitated, seldom get free

from it before the approach of summer, and sometimes not till it be

pretty far advanced.

REGIMEN.——As there are no medicines yet known that will cure the gout,

we shall confine our observations chiefly to regimen, both in and out of

the fit.

In the fit, if the patient be young and strong, his diet ought to be

thin and cooling, and his drink of a diluting nature; but where the

constitution is weak, and the patient has been accustomed to live high,

this is not a proper time to retrench. In this case he must keep nearly

to his usual diet, and should take frequently a cup of strong negus, or

a glass of generous wine. Wine-whey is a very proper drink in this case,

as it promotes the perspiration without greatly heating the patient. It

will answer this purpose better if a tea-spoonful of _sal volatile

oleosum_, or spirits of hartshorn, be put into a cup of it twice a-day.

It will likewise be proper to give at bed-time a tea-spoonful of the

volatile tincture of _guaiacum_ in a large draught of warm wine-whey.

This will greatly promote perspiration through the night.

As the most safe and efficacious method of discharging the gouty matter

is by perspiration, this ought to be kept up by all means, especially in

the affected part. For this purpose the leg and foot should be wrapt in

soft flannel, fur, or wool. The last is most readily obtained, and seems

to answer the purpose better than any thing else. The people of

Lancashire look upon wool as a kind of specific in the gout. They wrap a

great quantity of it about the leg and foot affected, and cover it with

a skin of soft dressed leather. This they suffer to continue for eight

or ten days, and sometimes for a fortnight or three weeks, or longer, if

the pain does not cease. I never knew any external application answer so

well in the gout. I have often seen it applied when the swelling and

inflammation were very great, with violent pain, and have found all

these symptoms relieved by it in a few days. The wool which they use is

generally greased, and carded or combed. They chuse the softest which

can be had, and seldom or never remove it till the fit be entirely gone

off.

The patient ought likewise to be kept quiet and easy during the fit.

Every thing that affects the mind disturbs the paroxysm, and tends to

throw the gout upon the nobler parts. All external applications that

repel the matter are to be avoided as death. They do not cure the

disease, but remove it from a safer to a more dangerous part of the

body, where it often proves fatal. A fit of the gout is to be considered

as Nature’s method of removing something that might prove destructive to

the body, and all that we can do, with safety, is to promote her

intentions, and to assist her in expelling the enemy in her own way.

Evacuations by bleeding, stool, &c. are likewise to be used with

caution; they do not remove the cause of the disease, and sometimes by

weakening the patient prolong the fit: but where the constitution is

able to bear it, it will be of use to keep the body gently open by diet,

or very mild laxative medicines.

Many things will indeed shorten a fit of the gout, and some will drive

it off altogether: but nothing has yet been found which will do this

with safety to the patient. In pain we eagerly grasp at any thing that

promises immediate ease, and even hazard life itself for a temporary

relief. This is the true reason why so many infallible remedies have

been proposed for the gout, and why such numbers have lost their lives

by the use of them. It would be as prudent to stop the small-pox from

rising, and to drive them into the blood, as to attempt to repel the

gouty matter after it has been thrown upon the extremities. The latter

is as much an effort of Nature to free herself from an offending cause

as the former, and ought equally to be promoted.

When the pain however is very great, and the patient is restless, thirty

or forty drops of laudanum, more or less, according to the violence of

the symptoms, may be taken at bed-time. This will ease the pain, procure

rest, promote perspiration, and forward the crisis of the disease.

After the fit is over, the patient ought to take a gentle dose or two of

the bitter tincture of rhubarb, or some other warm stomachic purge. He

should also drink a weak infusion of stomachic bitters in small wine or

ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and

orange-peel. The diet at this time should be light, but nourishing, and

gentle exercise ought to be taken on horseback, or in a carriage.

Out of the fit, it is in the patient’s power to do many things towards

preventing a return of the disorder, or rendering the fit, if it should

return, less severe. This however is not to be attempted by medicine. I

have frequently known the gout kept off for several years by the

Peruvian bark and other astringent medicines; but in all the cases where

I had occasion to see this tried, the persons died suddenly, and, to all

appearance, for want of a regular fit of the gout. One would be apt,

from hence, to conclude, that a fit of the gout, to some constitutions,

in the decline of life, is rather salutary than hurtful.

Though it may be dangerous to stop a fit of the gout by medicine, yet if

the constitution can be so changed by diet and exercise, as to lessen or

totally prevent its return, there certainly can be no danger in

following such a course. It is well known that the whole habit may be so

altered by a proper regimen, as quite to eradicate this disease; and

those only who have sufficient resolution to persist in such a course

have reason to expect a cure.

The course which we would recommend for preventing the gout, is as

follows: In the first place, _universal temperance_. In the next place

_sufficient exercise_[139]. By this we do not mean sauntering about in

an indolent manner, but labour, sweat, and toil. These only can render

the humours wholesome, and keep them so. Going early to bed, and rising

betimes, are also of great importance. It is likewise proper to avoid

night studies, and all intense thought. The supper should be light, and

taken early. All strong liquors, especially generous wines and sour

punch, are to be avoided.

We would likewise recommend some doses of _magnesia alba_ and rhubarb to

be taken every spring and autumn; and afterwards a course of stomachic

bitters, as tansey or water-trefoil tea, an infusion of gentian and

camomile flowers, or a decoction of burdock root, &c. Any of these, or

an infusion of any wholesome bitter that is more agreeable to the

patient, may be drank for two or three weeks in March and October twice

a-day. An issue or perpetual blister has a great tendency to prevent the

gout. If these were more generally used in the decline of life, they

would not only often prevent the gout, but also other chronic maladies.

Such as can afford to go to Bath, will find great benefit from bathing

and drinking the water. It both promotes digestion, and invigorates the

habit.

Though there is little room for medicine during a regular fit of the

gout, yet when it leaves the extremities, and falls on some of the

internal parts, proper applications to recal and fix it become

absolutely necessary. When the gout affects the head, the pain of the

joints ceases, and the swelling disappears, while either severe

head-ach, drowsiness, trembling, giddiness, convulsions, or delirium

come on. When it seizes the lungs, great oppression, with cough and

difficulty of breathing, ensue. If it attacks the stomach, extreme

sickness, vomiting, anxiety, pain in the epigastric region, and total

loss of strength, will succeed.

When the gout attacks the head or lungs, every method must be taken to

fix it in the feet. They must be frequently bathed in warm water, and

acrid cataplasms applied to the soles. Blistering-plasters ought

likewise to be applied to the ancles or calves of the legs. Bleeding in

the feet or ancles is also necessary, and warm stomachic purges. The

patient ought to keep in bed for the most part, if there be any signs of

inflammation, and should be very careful not to catch cold.

If it attacks the stomach with a sense of cold, the most warm cordials

are necessary; as strong wine boiled up with cinnamon or other spices;

cinnamon-water; peppermint-water; and even brandy or rum. The patient

should keep his bed, and endeavour to promote a sweat by drinking warm

liquors; and if he should be troubled with a nausea, or inclination to

vomit, he may drink camomile-tea, or any thing that will make him vomit

freely.

When the gout attacks the kidneys, and imitates gravel-pains, the

patient ought to drink freely of a decoction of marsh-mallows, and to

have the parts fomented with warm water. An emollient clyster ought

likewise to be given, and afterwards an opiate. If the pain be very

violent, twenty or thirty drops of laudanum may be taken in a cup of the

decoction.

Persons who have had the gout should be very attentive to any complaints

that may happen to them about the time when they have reason to expect a

return of the fit. The gout imitates many other disorders, and by being

mistaken for them, and treated improperly, is often diverted from its

regular course, to the great danger of the patient’s life.

Those who never had the gout, but who, from their constitution or manner

of living, have reason to expect it, ought likewise to be very

circumspect with regard to its first approach. If the disease, by wrong

conduct or improper medicines, be diverted from its proper course, the

miserable patient has a chance to be ever after tormented with

head-achs, coughs, pains of the stomach and intestines; and to fall at

last a victim to its attack upon some of the more noble parts.

OF THE RHEUMATISM.

This disease has often a resemblance to the gout. It generally attacks

the joints with exquisite pain, and is sometimes attended with

inflammation and swelling. It is most common in the spring, and towards

the end of autumn. It is usually distinguished into acute and chronic;

or the rheumatism with and without a fever.

CAUSES.——The causes of a rheumatism are frequently the same as those of

an inflammatory fever, _viz._ an obstructed perspiration, the immoderate

use of strong liquors, and the like. Sudden changes of the weather, and

all quick transitions from heat to cold, are very apt to occasion the

rheumatism. The most extraordinary case of a rheumatism that I ever saw,

where almost every joint of the body was distorted, was a man who used

to work one part of the day by the fire, and the other part of it in the

water. Very obstinate rheumatisms have likewise been brought on by

persons not accustomed to it, allowing their feet to continue long wet.

The same effects are often produced by wet clothes, damp beds, sitting

or lying on the damp ground, travelling in the night, &c.

The rheumatism may likewise be occasioned by excessive evacuations, or

the stoppage of customary discharges. It is often the effect of chronic

diseases, which vitiate the humours; as the scurvy, the _lues venerea_,

obstinate autumnal agues, &c.

The rheumatism prevails in cold, damp, marshy countries. It is most

common among the poorer sort of peasants, who are ill clothed, live in

low damp houses, and eat coarse unwholesome food, which contains but

little nourishment, and is not easily digested.

SYMPTOMS.——The _acute_ rheumatism commonly begins with weariness,

shivering, a quick pulse, restlessness, thirst, and other symptoms of

fever. Afterwards the patient complains of flying pains, which are

increased by the least motion. These at length fix in the joints, which

are often affected with swelling and inflammation. If blood be let in

this disease, it has generally the same appearance as in the pleurisy.

In this kind of rheumatism the treatment of the patient is nearly the

same as in an acute or inflammatory fever. If he be young and strong,

bleeding is necessary, which may be repeated according to the exigencies

of the case. The body ought likewise to be kept open by emollient

clysters, or cool opening liquors; as decoctions of tamarinds, cream of

tartar whey, senna-tea, and the like. The diet should be light, and in

small quantity, consisting chiefly of roasted apples, groat-gruel, or

weak chicken-broth. After the feverish symptoms have abated, if the pain

still continues, the patient must keep his bed, and take such things as

promote perspiration; as wine-whey, with _spiritus Mindereri_, &c. He

may likewise take, for a few nights, at bed-time, in a cup of wine-whey,

a drachm of the cream of tartar, and half a drachm of gum guaiacum in

powder.

Warm bathing, after proper evacuations, has often an exceeding good

effect. The patient may either be put into a bath of warm water, or have

cloths wrung out of it applied to the parts affected. Great care must be

taken that he do not catch cold after bathing.

The _chronic_ rheumatism is seldom attended with any considerable degree

of fever, and is generally confined to some particular part of the body,

as the shoulders, the back, or the loins. There is seldom any

inflammation or swelling in this case. Persons in the decline of life

are most subject to the chronic rheumatism. In such patients it often

proves extremely obstinate, and sometimes incurable.

In this kind of rheumatism the regimen should be nearly the same as in

the acute. Cool and diluting diet, consisting chiefly of vegetable

substances, as stewed prunes, coddled apples, currants or gooseberries

boiled in milk, is most proper. Arbuthnot says, “If there be a specific

in aliment for the rheumatism, it is certainly whey,” and adds, “That he

knew a person subject to this disease, who could never be cured by any

other method but a diet of whey and bread.” He likewise says, “That

cream of tartar in water-gruel, taken for several days, will ease

rheumatic pains considerably.” This I have often experienced, but found

it always more efficacious when joined with gum guaiacum, as already

directed. In this case the patient may take the dose formerly mentioned

twice a-day, and likewise a tea-spoonful of the volatile tincture of gum

guaiacum, at bed-time, in wine-whey.

This course may be continued for a week, or longer, if the case proves

obstinate, and the patient’s strength will permit. It ought then to be

omitted for a few days, and repeated again. At the same time leeches or

a blistering-plaster may be applied to the part affected. What I have

generally found answer better than either of these, in obstinate fixed

rheumatic pains, is the _warm plaster_[140]. I have likewise known a

plaster of Burgundy pitch worn for some time on the part affected give

great relief in rheumatic pains. My ingenious friend, Dr. Alexander of

Edinburgh, says, he has frequently cured very obstinate rheumatic pains

by rubbing the part affected with tincture of cantharides. When the

common tincture did not succeed, he used it of a double or treble

strength. Cupping upon the part affected is likewise often very

beneficial, and is greatly preferable to the application of leeches.

Though this disease may not seem to yield to medicines for some time,

yet they ought still to be persisted in. Persons who are subject to

frequent returns of the rheumatism, will often find their account in

using medicines, whether they be immediately affected with the disease

or not. The chronic rheumatism is similar to the gout in this respect,

that the most proper time for using medicines to extirpate it, is when

the patient is most free from the disorder.

To those who can afford the expence, I would recommend the warm baths of

Buxton or Matlock in Derbyshire. These have often, to my knowledge,

cured very obstinate rheumatisms, and are always safe either in or out

of the fit. When the rheumatism is complicated with scorbutic

complaints, which is not seldom the case, the Harrowgate waters, and

those of Moffat, are proper. They should both be drank and used as a

warm bath.

There are several of our own domestic plants which may be used with

advantage in the rheumatism. One of the best is the white _mustard_. A

table-spoonful of the seed of this plant may be taken twice or thrice

a-day, in a glass of water or small wine. The water-trefoil is likewise

of great use in this complaint. It may be infused in wine or ale, or

drank in form of tea. The ground-ivy, camomile, and several other

bitters, are also beneficial, and may be used in the same manner. No

benefit however is to be expected from these, unless they be taken for a

considerable time. Excellent medicines are often despised in this

disease, because they do not perform an immediate cure; whereas nothing

would be more certain than their effect, were they duly persisted in.

Want of perseverance in the use of medicines is one reason why chronic

diseases are so seldom cured.

Cold bathing, especially in salt-water, often cures the rheumatism. We

would also recommend riding on horseback, and wearing flannel next the

skin. Issues are likewise very proper, especially in chronic cases. If

the pain affects the shoulders, an issue may be made in the arm; but if

it affects the loins, it should be put into the leg or thigh.

Persons afflicted with the scurvy are very subject to rheumatic

complaints. The best medicines in this case are bitters and mild

purgatives. These may either be taken separately or together, as the

patient inclines. An ounce of Peruvian bark, and half an ounce of

rhubarb in powder, may be infused in a bottle of wine; and one, two, or

three wine glasses of it taken daily, as shall be found necessary for

keeping the body gently open. In cases where the bark itself proves

sufficiently purgative, the rhubarb may be omitted.

Such as are subject to frequent attacks of the rheumatism ought to make

choice of a dry, warm situation, to avoid the night-air, wet clothes,

and wet feet, as much as possible. Their clothing should be warm, and

they should wear flannel next their skin, and make frequent use of the

flesh-brush.

CHAP. XXXIX.

OF THE SCURVY.

This disease prevails chiefly in cold northern countries, especially in

low damp situations, near large marshes, or great quantities of

stagnating water. Sedentary people, of a dull melancholy disposition,

are most subject to it. It proves often fatal to sailors on long

voyages, particularly in ships that are not properly ventilated, have

many people on board, or where cleanliness is neglected.

It is not necessary to mention the different species into which this

disease has been divided, as they differ from one another chiefly in

degree. What is called the _land-scurvy_, however, is seldom attended

with those highly putrid symptoms which appear in patients who have been

long at sea, and which, we presume, are rather owing to confined air,

want of exercise, and the unwholesome food eaten by sailors on long

voyages, than to any specific difference in the disease.

CAUSES.——The scurvy is occasioned by cold moist air; by the long use of

salted or smoke-dried provisions, or any kind of food that is hard of

digestion, and affords little nourishment. It may also proceed from the

suppression of customary evacuations; as the _menses_, the hæmorrhoidal

flux, &c. It is sometimes owing to a hereditary taint, in which case a

very small cause will excite the latent disorder. Grief, fear, and other

depressing passions, have a great tendency both to excite and aggravate

this disease. The same observation holds with regard to neglect of

cleanliness; bad clothing; the want of proper exercise; confined air;

unwholesome food; or any disease which greatly weakens the body, or

vitiates the humours.

SYMPTOMS.——This disease may be known by unusual weariness, heaviness,

and difficulty of breathing, especially after motion; rottenness of the

gums, which are apt to bleed on the slightest touch; a stinking breath;

frequent bleeding at the nose; crackling of the joints; difficulty of

walking; sometimes a swelling and sometimes a falling away of the legs,

on which there are livid, yellow, or violet-coloured spots; the face is

generally of a pale or leaden colour. As the disease advances, other

symptoms come on; as rottenness of the teeth, hæmorrhages, or discharges

of blood from different parts of the body, foul obstinate ulcers, pains

in various parts, especially about the breast, dry scaly eruptions all

over the body, &c. At last a wasting or hectic fever comes on, and the

miserable patient is often carried off by a dysentery, a diarrhœa, a

dropsy, the palsy, fainting fits, or a mortification of some of the

bowels.

CURE.——We know no way of curing this disease but by pursuing a plan

directly opposite to that which brings it on. It proceeds from a

vitiated state of the humours, occasioned by errors in diet, air, or

exercise; and this cannot be removed but by a proper attention to these

important articles.

If the patient has been obliged to breathe a cold, damp, or confined

air, he should be removed, as soon as possible, to a dry, open, and

moderately warm one. If there is reason to believe that the disease

proceeds from a sedentary life, or depressing passions, as grief, fear,

&c. the patient must take daily as much exercise in the open air as he

can bear, and his mind should be diverted by cheerful company and other

amusements. Nothing has a greater tendency either to prevent or remove

this disease, than constant cheerfulness and good humour. But this,

alas! is seldom the lot of persons afflicted with the scurvy; they are

generally surly, peevish, and morose.

When the scurvy has been brought on by a long use of salted provisions,

the proper medicine is a diet consisting chiefly of fresh vegetables; as

oranges, apples, lemons, limes, tamarinds, water-cresses, scurvy-grass,

brook lime, &c. The use of these, with milk, pot-herbs, new bread, and

fresh beer or cyder, will seldom fail to remove a scurvy of this kind,

if taken before it be too far advanced; but to have this effect, they

must be persisted in for a considerable time. When fresh vegetables

cannot be obtained, pickled or preserved ones may be used; and where

these are wanting, recourse must be had to the chymical acids. All the

patient’s food and drink should in this case be sharpened with cream of

tartar, elixir of vitriol, vinegar, or the spirit of sea-salt.

These things however will more certainly prevent than cure the scurvy;

for which reason sea-faring people, especially on long voyages, ought to

lay in plenty of them. Cabbages, onions, gooseberries, and many other

vegetables, may be kept a long time by _pickling_, _preserving_, &c. and

when these fail, the chymical acids, recommended above, which will keep

for any length of time, may be used. We have reason to believe, if ships

were well ventilated, had good store of fruits, greens, cyder, &c. laid

in, and if proper regard were paid to cleanliness and warmth, that

sailors would be the most healthy people in the world, and would seldom

suffer either from the scurvy or putrid fevers, which are so fatal to

that useful set of men; but it is too much the temper of such people to

despise all precaution; they will not think of any calamity till it

overtakes them, when it is too late to ward off the blow.

It must indeed be owned, that many of them have it not in their power to

make the provision we are speaking of; but in this case it is the duty

of their employers to make it for them; and no man ought to engage in a

long voyage without having these articles secured.

I have often seen very extraordinary effects in the land-scurvy from a

milk diet. This preparation of Nature is a mixture of animal and

vegetable properties, which of all others is the most fit for restoring

a decayed constitution, and removing that particular acrimony of the

humours, which seems to constitute the very essence of the scurvy, and

many other diseases. But people despise this wholesome and nourishing

food, because it is cheap, and devour with greediness, flesh, and

fermented liquors, while milk is only deemed fit for their hogs.

The most proper drink in the scurvy is whey or butter-milk. When these

cannot be had, sound cyder, perry, or spruce-beer, may be used. Wort has

likewise been found to be a proper drink in the scurvy, and may be used

at sea, as malt will keep during the longest voyage. A decoction of the

tops of the spruce fir is likewise proper. It may be drank in the

quantity of an English pint twice a-day. Tar-water may be used for the

same purpose, or decoctions of any of the mild mucilaginous vegetables;

as sarsaparilla, marsh-mallow roots, &c. Infusions of the bitter plants,

as ground-ivy, the lesser centaury, marsh-trefoil, &c. are likewise

beneficial. I have seen the peasants in some parts of Britain express

the juice of the last-mentioned plant, and drink it with good effect in

those foul scorbutic eruptions with which they are often troubled in the

spring season.

Harrowgate water is certainly an excellent medicine in the land-scurvy.

I have often seen patients who had been reduced to the most deplorable

condition by this disease, greatly relieved by drinking the

sulphur-water, and bathing in it. The chalybeate water may also be used

with advantage, especially with a view to brace the stomach after

drinking the sulphur-water, which, though it sharpens the appetite,

never fails to weaken the powers of digestion.

A slight degree of scurvy may be carried off by frequently sucking a

little of the juice of a bitter orange, or a lemon. When the disease

affects the gums only, this practice, if continued for some time, will

generally carry it off. We would however recommend the bitter orange as

greatly preferable to lemon; it seems to be as good a medicine, and is

not near so hurtful to the stomach. Perhaps our own sorrel may be little

inferior to either of them.

All kinds of sallad are good in the scurvy, and ought to be eaten very

plentifully, as spinage, lettuce, parsley, celery, endive, radish,

dandelion, &c. It is amazing to see how soon fresh vegetables in the

spring cure the brute animals of any scab or foulness which is upon

their skins. It is reasonable to suppose that their effects would be as

great upon the human species, were they used in proper quantity for a

sufficient length of time.

I have sometimes seen good effects in scorbutic complaints of very long

standing, from the use of a decoction of the roots of water-dock. It is

usually made by boiling a pound of the fresh root in six English pints

of water, till about one-third of it be consumed. The dose is from half

a pint to a whole pint of the decoction every day. But in all the cases

where I have seen it prove beneficial, it was made much stronger, and

drank in larger quantities. The safest way, however, is for the patient

to begin with small doses, and increase them both in strength and

quantity as he finds his stomach will bear it. It must be used for a

considerable time. I have known some take it for many months, and have

been told of others who had used it for several years, before they were

sensible of any benefit, but who nevertheless were cured by it at

length.

The leprosy, which was so common in this country long ago, seems to have

been near-akin to the scurvy. Perhaps its appearing so seldom now, may

be owing to the inhabitants of Britain eating more vegetable food than

formerly, living more upon tea and other diluting diet, using less

salted meat, being more cleanly, better lodged and clothed, &c.—For the

cure of this disease we would recommend the same course of diet and

medicine as in the scurvy.

OF THE SCROPHULA, OR KING’S EVIL.

This disease chiefly affects the glands, especially those of the neck.

Children and young persons of a sedentary life are very subject to it.

It is one of those diseases which may be removed by proper regimen, but

seldom yields to medicine. The inhabitants of cold, damp, marshy

countries are most liable to the scrophula.

CAUSES.——This disease may proceed from a hereditary taint, from a

scrophulous nurse, &c. Children who have the misfortune to be born of

sickly parents, whose constitutions have been greatly injured by the

pox, or other chronic diseases, are apt to be affected with the

scrophula. It may likewise proceed from such diseases as weaken the

habit or vitiate the humours, as the small-pox, measles, &c. External

injuries, as blows, bruises, and the like, sometimes produce scrophulous

ulcers; but we have reason to believe, when this happens, that there has

been a predisposition in the habit to this disease. In short, whatever

tends to vitiate the humours or relax the solids, paves the way to the

scrophula; as the want of proper exercise, too much heat or cold,

confined air, unwholesome food, bad water, the long use of poor, weak,

watery aliments, the neglect of cleanliness, &c. Nothing tends more to

induce this disease in children than allowing them to continue long

wet[141].

SYMPTOMS.——At first small knots appear under the chin or behind the

ears, which gradually increase in number and size, till they form one

large hard tumour. This often continues for a long time without

breaking, and when it does break, it only discharges a thin _sanies_, or

watery humour. Other parts of the body are likewise liable to its

attack, as the armpits, groins, feet, hands, eyes, breasts, &c. Nor are

the internal parts exempt from it. It often affects the lungs, liver, or

spleen; and I have frequently seen the glands of the mesentery greatly

enlarged by it.

Those obstinate ulcers which break out upon the feet and hands with

swelling, and little or no redness, are of the scrophulous kind. They

seldom discharge good matter, and are exceedingly difficult to cure. The

_white swellings_ of the joints seem likewise to be of this kind. They

are with difficulty brought to a suppuration, and when opened they only

discharge a thin ichor. There is not a more general symptom of the

scrophula than a swelling of the upper lip and nose.

REGIMEN.——As this disease proceeds, in a great measure, from relaxation,

the diet ought to be generous and nourishing, but at the same time light

and of easy digestion; as well-fermented bread, made of sound grain, the

flesh and broth of young animals, with now and then a glass of generous

wine, or good ale. The air ought to be open, dry, and not too cold, and

the patient should take as much exercise as he can bear. This is of the

utmost importance. Children who have sufficient exercise are seldom

troubled with the scrophula.

MEDICINE.——The vulgar are remarkably credulous with regard to the cure

of the scrophula; many of them believing in the virtue of the royal

touch, that of the seventh son, &c. The truth is, we know but little

either of the nature or cure of this disease, and where reason or

medicines fail, superstition always comes in their place. Hence it is,

that in diseases which are the most difficult to understand, we

generally hear of the greatest number of miraculous cures being

performed. Here, however, the deception is easily accounted for. The

scrophula, at a certain period of life, often cures of itself; and, if

the patient happens to be touched about this time, the cure is imputed

to the touch, and not to Nature, who is really the physician. In the

same way the insignificant nostrums of quacks and old women often gain

applause when they deserve none.

There is nothing more pernicious than the custom of plying children in

the scrophula with strong purgative medicines. People imagine it

proceeds from humours which must be purged off, without considering that

these purgatives increase the debility and aggravate the disease. It has

indeed been found, that keeping the body gently open for some time,

especially with sea-water, has a good effect; but this should only be

given in gross habits, and in such quantity as to procure one, or at

most two stools every day.

Bathing in the salt-water has likewise a very good effect, especially in

the warm season. I have often known a course of bathing in salt-water,

and drinking it in such quantities as to keep the body gently open, cure

a scrophula, after many other medicines had been tried in vain. When

salt-water cannot be obtained, the patient may be bathed in fresh water,

and his body kept open by small quantities of salt and water, or some

other mild purgative.

Next to cold bathing, and drinking the salt-water, we would recommend

the Peruvian bark. The cold bath may be used in summer, and the bark in

winter. To an adult half a drachm of the bark in powder may be given in

a glass of red wine four or five times a-day. Children, and such as

cannot take it in substance, may use the decoction made in the following

manner:

Boil an ounce of Peruvian bark and a drachm of Winter’s bark, both

grossly powdered, in an English quart of water to a pint: towards the

end half an ounce of sliced liquorice-root, and a handful of raisins may

be added, which will both render the decoction less disagreeable, and

make it take up more of the bark. The liquor must be strained, and two,

three, or four table-spoonfuls, according to the age of the patient,

given three times a-day.

The Moffat and Harrowgate waters, especially the latter, are likewise

very proper medicines in the scrophula. They ought not however to be

drank in large quantities, but should be taken so as to keep the body

gently open, and must be used for a considerable time.

The hemlock may sometimes be used with advantage in the scrophula. Some

lay it down as a general rule, that the sea-water is most proper before

there are any suppuration or symptoms of _tabes_; the Peruvian bark,

when there are running sores, and a degree of hectic fever, and the

hemlock in old inveterate cases, approaching to the scirrhous or

cancerous state. Either the extract or the fresh juice of this plant may

be used. The dose must be small at first, and increased gradually as far

as the stomach is able to bear it.

External applications are of little use. Before the tumour breaks,

nothing ought to be applied to it, unless a piece of flannel, or

something to keep it warm. After it breaks, the sore may be dressed with

some digestive ointment. What I have always found to answer best, was

the yellow basilicon mixed with about a sixth or eighth part of its

weight of red precipitate of mercury. The sore may be dressed with this

twice a-day; and if it be very fungous, and does not digest well, a

larger proportion of the precipitate may be added.

Medicines which mitigate this disease, though they do not cure it, are

not to be despised. If the patient can be kept alive by any means till

he arrives at the age of puberty, he has a great chance to get well; but

if he does not recover at this time, in all probability he never will.

There is no malady which parents are so apt to communicate to their

offspring as the scrophula, for which reason people ought to beware of

marrying into families affected with this disease.

For the means of preventing the scrophula, we must refer the reader to

the observations on nursing, at the beginning of the book.

OF THE ITCH.

Though this disease is commonly communicated by infection, yet it seldom

prevails where due regard is paid to cleanliness, fresh air, and

wholesome diet. It generally appears in form of small watery pustules,

first about the wrists, or between the fingers; afterwards it affects

the arms, legs, thighs, &c. These pustules are attended with an

intolerable itching, especially when the patient is warm a-bed, or sits

by the fire. Sometimes indeed the skin is covered with large blotches or

scabs, and at other times with a white scurf, or scaly eruption. This

last is called the dry itch, and is the most difficult to cure.

The itch is seldom a dangerous disease, unless when it is rendered so by

neglect, or improper treatment. If it be suffered to continue too long,

it may vitiate the whole mass of humours; and, if it be suddenly drove

in, without proper evacuations, it may occasion fevers, inflammations of

the viscera, or other internal disorders.

The best medicine yet known for the itch is sulphur, which ought to be

used both externally and internally. The parts most affected may be

rubbed with an ointment made of the flower of sulphur, two ounces; crude

sal ammoniac finely powdered two drachms; hog’s lard, or butter, four

ounces. If a scruple or half a drachm of the essence of lemon be added,

it will entirely take away the disagreeable smell. About the bulk of a

nutmeg of this may be rubbed upon the extremities at bed-time twice or

thrice a-week. It is seldom necessary to rub the whole body; but when it

is, it ought not to be done all at once, but by turns, as it is

dangerous to stop too many pores at the same time.

Before the patient begins to use the ointment, he ought, if he be of a

full habit, to bleed or take a purge or two. It will likewise be proper,

during the use of it, to take every night and morning as much of the

flower of brimstone and cream of tartar, in a little treacle or new

milk, as will keep the body gently open. He should beware of catching

cold, should wear more clothes than usual, and take every thing warm.

The same clothes, the linen excepted, ought to be worn all the time of

using the ointment; and such clothes as have been worn while the patient

was under the disease, are not to be used again, unless they have been

fumigated with brimstone, and thoroughly cleaned, otherwise they will

communicate the infection anew[142].

I never knew brimstone, when used as directed above, fail to cure the

itch; and I have reason to believe, that, if duly persisted in, it never

will fail; but if it be only used once or twice, and cleanliness

neglected, it is no wonder if the disorder returns. The quantity of

ointment mentioned above will generally be sufficient for the cure of

one person; but, if any symptoms of the disease should appear again, the

medicine may be repeated. It is both more safe and efficacious when

persisted in for a considerable time, than when a large quantity is

applied at once. As most people dislike the smell of sulphur, they may

use in its place the powder of white hellebore root made up into an

ointment, in the same manner, which will seldom fail to cure the itch.

People ought to be extremely cautious lest they take other eruptions for

the itch; as the stoppage of these may be attended with fatal

consequences. Many of the eruptive disorders to which children are

liable, have a near resemblance to this disease; and I have often known

infants killed by being rubbed with greasy ointments that made these

eruptions strike suddenly in, which Nature had thrown out to preserve

the patient’s life, or prevent some other malady.

Much mischief is likewise done by the use of mercury in this disease.

Some persons are so fool-hardy as to wash the parts affected with a

strong solution of the corrosive sublimate. Others use the mercurial

ointment, without taking the least care either to avoid cold, keep the

body open, or observe a proper regimen. The consequences of such conduct

may be easily guessed. I have known even the mercurial girdles produce

bad effects, and would advise every person, as he values his health, to

beware how he uses them. Mercury ought never to be used as a medicine

without the greatest care. Ignorant people look upon these girdles as a

kind of charm, without considering that the mercury enters the body.

It is not to be told what mischief is done by using mercurial ointment

for curing the itch and killing vermin; yet it is unnecessary for

either: the former may be always more certainly cured by sulphur, and

the latter will never be found where due regard is paid to cleanliness.

Those who would avoid this detestable disease ought to beware of

infected persons, to use wholesome food, and to study universal

cleanliness[143].

CHAP. XL.

OF THE ASTHMA.

The asthma is a disease of the lungs, which seldom admits of a cure.

Persons in the decline of life are most liable to it. It is

distinguished into the moist and dry, or humoural and nervous. The

former is attended with expectoration or spitting; but in the latter the

patient seldom spits, unless sometimes a little tough phlegm by the mere

force of coughing.

CAUSES.——The asthma is sometimes hereditary. It may likewise proceed

from a bad formation of the breast; the fumes of metals or minerals

taken into the lungs; violent exercise, especially running; the

obstruction of customary evacuations, as the menses, hæmorrhoids, &c.

the sudden retrocession of the gout, or striking in of eruptions, as the

small-pox, measles, &c. violent passions of the mind, as sudden fear or

surprise. In a word, the disease may proceed from any cause that either

impedes the circulation of the blood through the lungs, or prevents

their being duly expanded by the air.

SYMPTOMS.——An asthma is known by a quick laborious breathing, which is

generally performed with a kind of wheezing noise. Sometimes the

difficulty of breathing is so great, that the patient is obliged to keep

in an erect posture, otherwise he is in danger of being suffocated. A

fit or paroxysm of the asthma generally happens after a person has been

exposed to cold easterly winds, or has been abroad in thick foggy

weather, or has got wet, or continued long in a damp place under ground,

or has taken some food which the stomach could not digest, as pastries,

toasted cheese, or the like.

The paroxysm is commonly ushered in with listlessness, want of sleep,

hoarseness, a cough, belching of wind, a sense of heaviness about the

breast, and difficulty of breathing. To these succeed heat, fever, pain

of the head, sickness and nausea, great oppression of the breast,

palpitation of the heart, a weak and sometimes intermitting pulse, an

involuntary flow of tears, bilious vomitings, &c. All the symptoms grow

worse towards night; the patient is easier when up than in bed, and is

very desirous of cool air.

REGIMEN.——The food ought to be light, and of easy digestion. Boiled

meats are to be preferred to roasted, and the flesh of young animals to

that of old. All windy food, and whatever is apt to swell in the

stomach, is to be avoided. Light puddings, white broths, and ripe fruits

baked, boiled, or roasted, are proper. Strong liquors of all kinds,

especially malt-liquor, are hurtful. The patient should eat a very light

supper, or rather none at all, and should never suffer himself to be

long costive. His clothing should be warm, especially in the

winter-season. As all disorders of the breast are much relieved by

keeping the feet warm, and promoting the perspiration, a flannel shirt

or waistcoat, and thick shoes, will be of singular service.

But nothing is of so great importance in the asthma as pure and

moderately warm air. Asthmatic people can seldom bear either the close

heavy air of a large town, or the sharp, keen atmosphere of a bleak

hilly country; a medium therefore between these is to be chosen. The air

near a large town is often better than at a distance, provided the

patient be removed so far as not to be affected by the smoke. Some

asthmatic patients indeed breathe easier in town than in the country;

but this is seldom the case, especially in towns where much coal is

burnt. Asthmatic persons who are obliged to be in town all day, ought at

least to sleep out of it. Even this will often prove of great service.

Those who can afford it ought to travel into a warmer climate. Many

asthmatic persons who cannot live in Britain, enjoy very good health in

the south of France, Portugal, Spain, or Italy.

Exercise is likewise of very great importance in the asthma, as it

promotes the digestion, preparation of the blood, &c. The blood of

asthmatic persons is seldom duly prepared, owing to the proper action of

the lungs being impeded. For this reason such people ought daily to take

as much exercise, either on foot, horseback, or in a carriage, as they

can bear.

MEDICINE.——Almost all that can be done by medicine in this disease, is

to relieve the patient when seized with a violent fit. This indeed

requires the greatest expedition, as the disease often proves suddenly

fatal. In the paroxysm or fit, the body is generally bound; a purging

clyster, with a solution of asafœtida, ought therefore to be

administered, and if there be occasion, it may be repeated two or three

times. The patient’s feet and legs ought to be immersed in warm water,

and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless

extreme weakness or old age should forbid it, is highly proper. If there

be a violent spasm about the breast or stomach, warm fomentations, or

bladders filled with warm milk and water, may be applied to the part

affected, and warm cataplasms to the soles of the feet. The patient must

drink freely of diluting liquors, and may take a tea-spoonful of the

tincture of castor and of saffron mixed together, in a cup of

valerian-tea, twice or thrice a-day. Sometimes a vomit has a very good

effect, and snatches the patient, as it were, from the jaws of death.

This however will be more safe after other evacuations have been

premised. A very strong infusion of roasted coffee is said to give ease

in an asthmatic paroxysm.

In the moist asthma, such things as promote expectoration or spitting

ought to be used; as the syrup of squills, gum ammoniac, and such like.

A common spoonful of the syrup, or oxymel of squills, mixed with an

equal quantity of cinnamon-water, may be taken three or four times

through the day, and four or five pills made of equal parts of asafœtida

and gum-ammoniac, at bed-time[144].

For the convulsive or nervous asthma, antispasmodics and bracers are the

most proper medicines. The patient may take a tea-spoonful of the

paregoric elixir twice a-day. The Peruvian bark is sometimes found to be

of use in this case. It may be taken in substance, or infused in wine.

In short, every thing that braces the nerves, or takes off spasm, may be

of use in a nervous asthma. It is often relieved by the use of asses

milk; I have likewise known cows milk drank warm in the morning have a

very good effect in this case.

In every species of asthma, setons and issues have a good effect; they

may either be set in the back or side, and should never be allowed to

dry up. We shall here, once for all, observe, that not only in the

asthma, but in most chronic diseases, issues are extremely proper. They

are both a safe and efficacious remedy; and though they do not always

cure the disease, yet they will often prolong the patient’s life.

CHAP. XLI.

OF THE APOPLEXY.

The apoplexy is a sudden loss of sense and motion, wherein the patient

is to all appearance dead; the heart and lungs however still continue to

move. Though this disease proves often fatal, yet it may sometimes be

removed by proper care. It chiefly attacks sedentary persons of a gross

habit, who use a rich and plentiful diet, and indulge in strong liquors.

People in the decline of life are most subject to the apoplexy. It

prevails most in winter, especially in rainy seasons, and very low

states of the barometer.

CAUSES.——The immediate cause of an apoplexy is a compression of the

brain, occasioned by an excess of blood, or a collection of watery

humours. The former is called a _sanguine_, and the latter a _serous

apoplexy_. It may be occasioned by any thing that increases the

circulation towards the brain, or prevents the return of the blood from

the head; as intense study; violent passions[145]; viewing objects for a

long time obliquely; wearing any thing too tight about the neck; a rich

and luxurious diet; suppression of urine; suffering the body to cool

suddenly after having been greatly heated; continuing long in a warm or

a cold bath; the excessive use of spiceries, or high-seasoned food;

excess of venery; the sudden striking in of any eruption; suffering

issues, setons, &c. suddenly to dry up, or the stoppage of any customary

evacuation; a mercurial salivation pushed too far, or suddenly checked

by cold; wounds or bruises on the head; long exposure to excessive cold;

poisonous exhalations, &c.

SYMPTOMS, and method of cure.——The usual forerunners of an apoplexy are

giddiness, pain and swimming of the head; loss of memory; drowsiness;

noise in the ears; the night-mare; a spontaneous flux of tears, and

laborious respiration. When persons of an apoplectic make observe these

symptoms, they have reason to fear the approach of a fit, and should

endeavour to prevent it by bleeding, a slender diet, and opening

medicines.

In the sanguine apoplexy, if the patient does not die suddenly, the

countenance appears florid, the face is swelled or puffed up, and the

blood-vessels, especially about the neck and temples, are turgid; the

pulse beats strong; the eyes are prominent and fixed, and the breathing

is difficult, and performed with a snorting noise. The excrements and

urine are often voided spontaneously, and the patient is sometimes

seized with vomiting.

In this species of apoplexy every method must be taken to lessen the

force of the circulation towards the head. The patient should be kept

perfectly easy and cool. His head should be raised pretty high, and his

feet suffered to hang down. His clothes ought to be loosened, especially

about the neck, and fresh air admitted into his chamber. His garters

should be tied pretty tight, by which means the motion of the blood from

the lower extremities will be retarded. As soon as the patient is placed

in a proper posture, he should be bled freely in the neck or arm, and,

if there be occasion, the operation may be repeated in two or three

hours. A laxative clyster, with plenty of sweet oil, or fresh butter,

and a spoonful or two of common salt in it, may be administered every

two hours; and blistering-plasters applied between the shoulders, and to

the calves of the legs.

As soon as the symptoms are a little abated, and the patient is able to

swallow, he ought to drink freely of some diluting opening liquor, as a

decoction of tamarinds and liquorice, cream-tartar-whey, or common whey

with cream of tartar dissolved in it. Or he may take any cooling purge,

as Glauber’s salt, manna dissolved in an infusion of senna, or the like.

All spirits and other strong liquors are to be avoided. Even volatile

salts held to the nose do mischief. Vomits, for the same reason, ought

not to be given, nor any thing that may increase the motion of the blood

towards the head.

In the serous apoplexy, the symptoms are nearly the same, only the pulse

is not so strong, the countenance is less florid, and the breathing less

difficult. Bleeding is not so necessary here as in the former case. It

may however generally be performed once with safety and advantage, but

should not be repeated. The patient should be placed in the same posture

as directed above, and should have blistering-plasters applied, and

receive opening clysters in the same manner. Purges here are likewise

necessary, and the patient may drink strong balm-tea. If he be inclined

to sweat, it ought to be promoted by drinking small wine-whey, or an

infusion of carduus benedictus. A plentiful sweat kept up for a

considerable time has often carried off a serous apoplexy.

When apoplectic symptoms proceed from opium, or other narcotic

substances taken into the stomach, vomits are necessary. The patient is

generally relieved as soon as he has discharged the poison in this way.

Persons of an apoplectic make, or those who have been attacked by it,

ought to use a very spare and slender diet, avoiding all strong liquors,

spiceries, and high-seasoned food. They ought likewise to guard against

all violent passions, and to avoid the extremes of heat and cold. The

head should be shaved, and daily washed with cold water. The feet ought

to be kept warm, and never suffered to continue long wet. The body must

be kept open either by food or medicine, and a little blood may be let

every spring and fall. Exercise should by no means be neglected; but it

ought to be taken in moderation. Nothing has a more happy effect in

preventing an apoplexy than perpetual issues or setons; great care

however must be taken not to suffer them to dry up, without opening

others in their stead. Apoplectic persons ought never to go to rest with

a full stomach, or to lie with their heads low, or wear any thing too

tight about their necks.

CHAP. XLII.

OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS.

We do not here mean to treat of those astrictions of the bowels which

are the symptoms of diseases, as of the colic, the iliac passion, &c.

but only to take notice of that infrequency of stools which sometimes

happens, and which in some particular constitutions may occasion

diseases.

Costiveness may proceed from drinking rough red wines, or other

astringent liquors; too much exercise, especially on horseback. It may

likewise proceed from a long use of cold insipid food, which does not

sufficiently stimulate the intestines. Sometimes it is owing to the bile

not descending to the intestines, as in the jaundice; and at other times

it proceeds from diseases of the intestines themselves, as a palsy,

spasms, torpor, tumours, a cold dry state of the intestines, &c.

Excessive costiveness is apt to occasion pains of the head, vomiting,

colics, and other complaints of the bowels. It is peculiarly hurtful to

hypochondriac and hysteric persons, as it generates wind and other

grievous symptoms. Some people however can bear costiveness to a great

degree. I know persons who enjoy pretty good health, yet do not go to

stool above once a-week, and others not above once a fortnight. Indeed I

have heard of some who do not go above once a month.

Persons who are generally costive should live upon a moistening and

laxative diet, as roasted or boiled apples, pears, stewed prunes,

raisins, gruels with currants, butter, honey, sugar, and such like.

Broths with spinage, leeks, and other soft pot-herbs, are likewise

proper. Rye-bread, or that which is made of a mixture of wheat and rye

together, ought to be eaten. No person troubled with costiveness should

eat white bread alone, especially that which is made of fine flour. The

best bread for keeping the body soluble is what in some parts of England

they call _meslin_. It is made of a mixture of wheat and rye, and is

very agreeable to those who are accustomed to it.

Costiveness is increased by keeping the body too warm, and by every

thing that promotes the perspiration; as wearing flannel, lying too long

a-bed, &c. Intense thought, and a sedentary life, are likewise hurtful.

All the secretions and excretions are promoted by moderate exercise

without doors, and by a gay, cheerful, sprightly temper of mind.

The drink should be of an opening quality. All ardent spirits, austere

and astringent wines, as port, claret, &c. ought to be avoided.

Malt-liquor that is fine, and of a moderate strength, is very proper.

Butter-milk, whey, and other watery liquors, are likewise proper, and

may be drank in turns, as the patient’s inclination directs.

Those who are troubled with costiveness, ought, if possible, to

remedy it by diet, as the constant use of medicines for that purpose

is attended with many inconveniencies, and often with bad

consequences[146]. I never knew any one get into a habit of taking

medicine for keeping the body open, who could leave it off. In time

the custom becomes necessary, and generally ends in a total

relaxation of the bowels, indigestion, loss of appetite, wasting of

the strength, and death.

When the body cannot be kept open without medicine, we would recommend

gentle doses of rhubarb to be taken twice or thrice a-week. This is not

near so injurious to the stomach as aloes, jalap, or the other drastic

purgatives so much in use. Infusions of senna and manna may likewise be

taken, or half an ounce of soluble tartar dissolved in water-gruel.

About the size of a nutmeg of lenitive electuary taken twice or thrice

a-day generally answers the purpose very well.

WANT OF APPETITE.

This may proceed from a foul stomach; indigestion; the want of free air

and exercise; grief; fear; anxiety; or any of the depressing passions;

excessive heat; the use of strong broths, fat meats, or any thing that

palls the appetite, or is hard of digestion, the immoderate use of

strong liquors, tea, tobacco, opium, &c.

The patient ought, if possible, to make choice of an open dry air; to

take exercise daily on horseback or in a carriage; to rise betimes; and

to avoid all intense thought. He should use a diet of easy digestion;

and should avoid excessive heat and great fatigue.

If want of appetite proceeds from errors in diet, or any other part of

the patient’s regimen, it ought to be changed. If nausea and reachings

shew that the stomach is loaded with crudities, a vomit will be of

service. After this a gentle purge or two of rhubarb, or of any of the

bitter purging salts, may be taken. The patient ought next to use some

of the stomachic bitters infused in wine. Though gentle evacuations be

necessary, yet strong purges and vomits are to be avoided, as they

weaken the stomach, and hurt digestion.

Elixir of vitriol is an excellent medicine in most cases of indigestion,

weakness of the stomach, or want of appetite. From twenty to thirty

drops of it may be taken twice or thrice a-day in a glass of wine or

water. It may likewise be mixed with the tincture of the bark, one

drachm of the former to an ounce of the latter, and two tea-spoonfuls of

it taken in wine or water, as above.

The chalybeate waters, if drank in moderation, are generally of

considerable service in this case. The salt-water has likewise good

effects; but it must not be used too freely. The waters of Harrowgate,

Scarborough, Moffat, and most other Spas in Britain, may be used with

advantage. We would advise all who are afflicted with indigestion and

want of appetite, to repair to these places of public rendezvous. The

very change of air, and the cheerful company, will be of service; not to

mention the exercise, dissipation, amusements, &c.

OF THE HEART-BURN.

What is commonly called the _heart-burn_, is not a disease of that

organ, but an uneasy sensation of heat or acrimony about the pit of the

stomach, which is sometimes attended with anxiety, nausea, and vomiting.

It may proceed from debility of the stomach, indigestion, bile, the

abounding of an acid in the stomach, &c. Persons who are liable to this

complaint ought to avoid stale liquors, acids, windy or greasy aliments,

and should never use violent exercise soon after a plentiful meal. I

know many persons who never fail to have the heart-burn if they ride

soon after dinner, provided they have drank ale, wine, or any fermented

liquor; but are never troubled with it when they have drank rum or

brandy and water without any sugar or acid.

When the heart-burn proceeds from debility of the stomach, or

indigestion, the patient ought to take a dose or two of rhubarb;

afterwards he may use infusions of the Peruvian bark, or any other of

the stomachic bitters, in wine or brandy. Exercise in the open air will

likewise be of use, and every thing that promotes digestion.

When bilious humours occasion the heart-burn, a tea-spoonful of the

sweet spirit of nitre in a glass of water, or a cup of tea, will

generally give ease. If it proceeds from the use of greasy aliments, a

dram of brandy or rum may be taken.

If acidity or sourness of the stomach occasions the heart-burn,

absorbents are the proper medicines. In this case an ounce of powdered

chalk, half an ounce of fine sugar, and a quarter of an ounce of

gum-arabic, may be mixed in an English quart of water, and a tea-cupful

of it taken as often as is necessary. Such as do not chuse chalk may

take a tea-spoonful of prepared oyster-shells, or of the powder called

crabs eyes, in a glass of cinnamon or peppermint-water. But the safest

and bed absorbent is _magnesia alba_. This not only acts as an

absorbent, but likewise as a purgative; whereas chalk, and other

absorbents of that kind, are apt to lie in the intestines, and occasion

obstructions. This powder is not disagreeable, and may be taken in a cup

of tea, or a glass of mint-water. A large tea-spoonful is the usual

dose; but it may be taken in a much greater quantity when there is

occasion. These things are now generally made up into lozenges for the

conveniency of being carried in the pocket, and taken at pleasure.

If wind be the cause of this complaint, the most proper medicines are

those called carminatives; as anniseeds, juniper-berries, ginger,

canella alba, cardamom seeds, &c. These may either be chewed, or infused

in wine, brandy, or other spirits. One of the safest medicines of this

kind is the tincture made by infusing an ounce of rhubarb, and a quarter

of an ounce of the lesser cardamom seeds, in an English pint of brandy.

After this has digested for two or three days, it ought to be strained,

and four ounces of white sugar-candy added to it. It must stand to

digest a second time till the sugar be dissolved. A table-spoonful of it

may be taken occasionally for a dose.

I have frequently known the heart-burn cured, particularly in pregnant

women, by chewing green tea. Two table-spoonfuls of what is called the

milk of gum-ammoniac, taken once or twice a-day, will sometimes cure the

heart-burn.

CHAP. XLIII.

OF NERVOUS DISEASES.

Of all diseases incident to mankind, those of the nervous kind are the

most complicated and difficult to cure. A volume would not be sufficient

to point out their various appearances. They imitate almost every

disease; and are seldom alike in two different persons, or even in the

same person at different times. Proteus-like, they are continually

changing shape; and upon every fresh attack, the patient thinks he feels

symptoms which he never experienced before. Nor do they only affect the

body; the mind likewise suffers, and is often thereby rendered extremely

weak and peevish. The low spirits, timorousness, melancholy, and

fickleness of temper, which generally attend nervous disorders, induce

many to believe that they are entirely diseases of the mind; but this

change of temper is rather a consequence, than the cause of nervous

diseases.

CAUSES.——Every thing that tends to relax or weaken the body, disposes it

to nervous diseases, as indolence, excessive venery, drinking too much

tea, or other weak, watery liquors warm, frequent bleeding, purging,

vomiting, &c. Whatever hurts the digestion, or prevents the proper

assimilation of the food, has likewise this effect; as long fasting,

excess in eating or drinking, the use of windy, crude, or unwholesome

aliments, an unfavourable posture of the body, &c.

Nervous disorders often proceed from intense application to study.

Indeed few studious persons are entirely free from them. Nor is this at

all to be wondered at; intense thinking not only preys upon the spirits,

but prevents the person from taking proper exercise, by which means the

digestion is impaired, the nourishment prevented, the solids relaxed,

and the whole mass of humours vitiated. Grief and disappointment

likewise produce the same effects. I have known more nervous patients,

who dated the commencement of their disorders from the loss of a

husband, a favourite child, or from some disappointment in life, than

from any other cause. In a word, whatever weakens the body, or depresses

the spirits, may occasion nervous disorders, as unwholesome air, want of

sleep, great fatigue, disagreeable apprehensions, anxiety, vexation, &c.

SYMPTOMS.——We shall only mention some of the most general symptoms of

these disorders, as it would be both an useless and an endless task to

enumerate the whole. They generally begin with windy inflations or

distentions of the stomach and intestines; the appetite and digestion

are usually bad; yet sometimes there is an uncommon craving for food,

and a quick digestion. The food often turns sour on the stomach; and the

patient is troubled with vomiting of clear water, tough phlegm, or a

blackish-coloured liquor resembling the grounds of coffee. Excruciating

pains are often felt about the navel, attended with a rumbling or

murmuring noise in the bowels. The body is sometimes loose, but more

commonly bound, which occasions a retention of wind and great

uneasiness.

The urine is sometimes in small quantity, at other times very copious

and quite clear. There is a great straitness of the breast, with

difficulty of breathing; violent palpitations of the heart; sudden

flushings of heat in various parts of the body; at other times a sense

of cold, as if water were poured on them; flying pains in the arms and

limbs; pains in the back and belly, resembling those occasioned by

gravel; the pulse very variable, sometimes uncommonly slow, and at other

times very quick; yawning, the hiccup, frequent sighing, and a sense of

suffocation, as if from a ball or lump in the throat; alternate fits of

crying and convulsive laughing; the sleep is unsound and seldom

refreshing; and the patient is often troubled with the night-mare.

As the disease increases, the patient is molested with head-achs,

cramps, and fixed pains in various parts of the body; the eyes are

clouded, and often affected with pain and dryness; there is a noise in

the ears, and often a dulness of hearing; in short, the whole animal

functions are impaired. The mind is disturbed on the most trivial

occasions, and is hurried into the most perverse commotions,

inquietudes, terror, sadness, anger, diffidence, &c. The patient is apt

to entertain wild imaginations and extravagant fancies; the memory

becomes weak, and the judgment fails.

Nothing is more characteristic of this disease than a constant dread of

death. This renders those unhappy persons who labour under it peevish,

fickle, impatient, and apt to run from one physician to another; which

is one reason why they seldom reap any benefit from medicine, as they

have not sufficient resolution to persist in any one course till it has

time to produce its proper effects. They are likewise apt to imagine

that they labour under diseases from which they are quite free; and are

very angry if any one attempts to set them right, or laugh them out of

their ridiculous notions.

REGIMEN.——Persons afflicted with nervous diseases ought never to fast

long. Their food should be solid and nourishing, but of easy digestion.

Fat meats and heavy sauces are hurtful. All excess should be carefully

avoided. They ought never to eat more at a time than they can easily

digest; but if they feel themselves weak and faint between meals, they

ought to eat a bit of bread, and drink a glass of wine. Heavy suppers

are to be avoided. Though wine in excess enfeebles the body, and impairs

the faculties of the mind, yet taken in moderation, it strengthens the

stomach, and promotes digestion. Wine and water is a very proper drink

at meals; but if wine sours on the stomach, or the patient is much

troubled with wind, brandy and water will answer better. Every thing

that is windy or hard of digestion must be avoided. All weak and warm

liquors are hurtful, as tea, coffee, punch, &c. People may find a

temporary relief in the use of these, but they always increase the

malady, as they weaken the stomach and hurt digestion. Above all things,

drams are to be avoided. Whatever immediate ease the patient may feel

from the use of ardent spirits, they are sure to aggravate the malady,

and prove certain poisons at last. These cautions are the more

necessary, as most nervous people are peculiarly fond of tea and ardent

spirits; to the use of which many of them fall victims.

Exercise in nervous disorders is superior to all medicines. Riding on

horseback is generally esteemed the best, as it gives motion to the

whole body, without fatiguing it. I have known some patients, however,

with whom walking agreed better, and others who were most benefited by

riding in a carriage. Every one ought to use that which he finds most

beneficial. Long sea-voyages have an excellent effect; and to those who

have sufficient resolution, we would by all means recommend this course.

Even change of place, and the sight of new objects, by diverting the

mind, have a great tendency to remove these complaints. For this reason

a long journey, or a voyage, is of much more advantage than riding short

journeys near home.

A cool and dry air is proper, as it braces, and invigorates the whole

body. Few things tend more to relax and enervate than hot air,

especially that which is rendered so by great fires, or stoves in small

apartments. But when the stomach or bowels are weak, the body ought to

be well guarded against cold, especially in winter, by wearing a thin

flannel waistcoat next the skin. This will keep up an equal

perspiration, and defend the alimentary canal from many impressions to

which it would otherwise be subject, upon every sudden change from warm

to cold weather. Rubbing the body frequently with a flesh-brush, or a

coarse linen cloth, is likewise beneficial, as it promotes the

circulation, perspiration, &c. Persons who have weak nerves ought to

rise early, and take exercise before breakfast, as lying too long a-bed

cannot fail to relax the solids. They ought likewise to be diverted, and

to be kept as easy and cheerful as possible. There is not any thing

which hurts the nervous system, or weakens the digestive powers, more

than fear, grief, or anxiety.

MEDICINES.——Though nervous diseases are seldom radically cured, yet

their symptoms may sometimes be alleviated, and the patient’s life

rendered at least more comfortable by proper medicines.

When the patient is costive, he ought to take a little rhubarb, or some

other mild purgative, and should never suffer his body to be long bound.

All strong and violent purgatives are however to be avoided, as aloes,

jalap, &c. I have generally seen an infusion of senna and rhubarb in

brandy answer very well. This may be made of any strength, and taken in

such quantity as the patient finds necessary. When digestion is bad, or

the stomach relaxed and weak, the following infusion of Peruvian bark

and other bitters may be used with advantage:

Take of Peruvian bark an ounce, gentian root, orange-peel, and

coriander-seed, of each half an ounce; let these ingredients be all

bruised in a mortar, and infused in a bottle of brandy or whiskey, for

the space of five or six days. A table-spoonful of the strained liquor

may be taken in half a glass of water, an hour before breakfast, dinner,

and supper.

Few things tend more to strengthen the nervous system than cold bathing.

This practice, if duly persisted in, will produce very extraordinary

effects; but when the liver or other _viscera_ are obstructed, or

otherwise unsound, the cold bath is improper. It is therefore to be used

with very great caution. The most proper seasons for it are summer and

autumn. It will be sufficient, especially for persons of a spare habit,

to go into the cold bath three or four times a-week. If the patient be

weakened by it, or feels chilly for a long time after coming out, it is

improper.

In patients afflicted with wind, I have always observed the greatest

benefit from the elixir of vitriol. It may be taken in the quantity of

fifteen, twenty, or thirty drops, twice or thrice a-day in a glass of

water. This both expels wind, strengthens the stomach, and promotes

digestion.

Opiates are generally extolled in these maladies; but as they only

palliate the symptoms, and generally afterwards increase the disease, we

would advise people to be extremely sparing in the use of them, lest

habit render them at last absolutely necessary.

It would be an easy matter to enumerate many medicines which have been

extolled for relieving nervous disorders; but whoever wishes for a

thorough cure must expect it from regimen alone; we shall therefore omit

mentioning more medicines, and again recommend the strictest attention

to DIET, AIR, EXERCISE, and AMUSEMENTS.

OF MELANCHOLY.

Melancholy is that state of alienation or weakness of mind which renders

people incapable of enjoying the pleasures, or performing the duties of

life. It is a degree of insanity, and often terminates in absolute

madness.

CAUSES.——It may proceed from an hereditary disposition; intense

thinking, especially where the mind is long occupied about one object;

violent passions or affections of the mind, as love, fear, joy, grief,

over-weening pride, and such like. It may also be occasioned by

excessive venery; narcotic or stupefactive poisons; a sedentary life;

solitude; the suppression of customary evacuations; acute fevers, or

other diseases. Violent anger will change melancholy into madness; and

excessive cold, especially of the lower extremities, will force the

blood into the brain, and produce all the symptoms of madness. It may

likewise proceed from the use of aliment that is hard of digestion, or

which cannot be easily assimilated; from a callous state of the

integuments of the brain, or a dryness of the brain itself. To all which

we may add gloomy or mistaken notions of religion.

SYMPTOMS.——When persons begin to be melancholy, they are timorous;

watchful; fond of solitude; fretful; fickle; captious and inquisitive;

solicitous about trifles; sometimes niggardly, and at other times

prodigal. The body is generally bound; the urine thin, and in small

quantity; the stomach and bowels inflated with wind; the complexion

pale; the pulse slow and weak. The functions of the mind are also

greatly perverted, in so much that the patient often imagines himself

dead, or changed into some other animal. Some have imagined their bodies

were made of glass, or other brittle substances, and were afraid to

move, lest they should be broken to pieces. The unhappy patient, in this

case, unless carefully watched, is apt to put an end to his own

miserable life.

When the disease is owing to an obstruction of customary evacuations, or

any bodily disorder, it is easier cured than when it proceeds from

affections of the mind, or an hereditary taint. A discharge of blood

from the nose, looseness, scabby eruptions, the bleeding piles, or the

_menses_, sometimes carry off this disease.

REGIMEN.——The diet should consist chiefly of vegetables of a cooling and

opening quality. Animal food, especially salted or smoke-dried fish or

flesh, ought to be avoided. All kinds of shell-fish are bad. Aliments

prepared with onions, garlic, or any thing that generates thick blood,

are likewise improper. All kind of fruits that are wholesome may be

eaten with advantage. Boerhaave gives an instance of a patient who, by a

long use of whey, water, and garden-fruit, recovered, after having

evacuated a great quantity of black-coloured matter.

Strong liquors of every kind ought to be avoided as poison. The most

proper drink is water, whey, or very small beer. Tea and coffee are

improper. If honey agrees with the patient, it may be eaten freely, or

his drink may be sweetened with it. Infusions of balm-leaves,

penny-royal, the roots of wild valerian, or the flowers of the

lime-tree, may be drank freely, either by themselves, or sweetened with

honey, as the patient shall chuse.

The patient ought to take as much exercise in the open air as he can

bear. This helps to dissolve the viscid humours, it removes

obstructions, promotes the perspiration, and all the other secretions.

Every kind of madness is attended with a diminished perspiration; all

means ought therefore to be used to promote that necessary and salutary

discharge. Nothing can have a more direct tendency to increase the

disease than confining the patient to a close apartment. Were he forced

to ride or walk a certain number of miles every day, it would tend

greatly to alleviate his disorder; but it would have still a better

effect, if he were obliged to labour a piece of ground. By digging,

hoeing, planting, sowing, &c. both the body and mind would be exercised.

A long journey, or a voyage, especially towards a warmer climate, with

agreeable companions, has often very happy effects. A plan of this kind,

with a strict attention to diet, is a much more rational method of cure,

than confining the patient within doors and plying him with medicines.

MEDICINE.——In the cure of this disease particular attention must be paid

to the mind. When the patient is in a low state, his mind ought to be

soothed and diverted with variety of amusements, as entertaining

stories, pastimes, music, &c. This seems to have been the method of

curing melancholy among the Jews, as we learn from the story of King

Saul; and indeed it is a very rational one. Nothing can remove diseases

of the mind so effectually as applications to the mind itself, the most

efficacious of which is music. The patient’s company ought likewise to

consist of such persons as are agreeable to him. People in this state

are apt to conceive unaccountable aversions against particular persons;

and the very sight of such persons is sufficient to distract their

minds, and throw them into the utmost perturbation.

When the patient is high, evacuations are necessary. In this case he

must be bled, and have his body kept open by purging medicines, as

manna, rhubarb, cream of tartar, or the soluble tartar. I have seen the

last have very happy effects. It may be taken in the dose of half an

ounce, dissolved in water-gruel, every day, for sundry weeks, or even

for months, if necessary. More or less may be given according as it

operates. Vomits have likewise a good effect; but they must be pretty

strong, otherwise they will not operate.

Whatever increases the evacuation of urine or promotes perspiration, has

a tendency to remove this disease. Both these secretions may be promoted

by the use of nitre and vinegar. Half a drachm of purified nitre may be

given three or four times a-day in any manner that is most agreeable to

the patient; and an ounce and a half of distilled vinegar may be daily

mixed with his drink. Dr. Locker seems to think vinegar the best

medicine that can be given in this disease.

Camphire and musk have likewise been used in this case with advantage.

Ten or twelve grains of camphire may be rubbed in a mortar with half a

drachm of nitre, and taken twice a-day, or oftner, if the stomach will

bear it. If it will not sit upon the stomach in this form, it may be

made into pills with gum asafœtida and Russian castor, and taken in the

quantity above directed. If musk is to be administered, a scruple or

twenty-five grains of it may be made into a bolus with a little honey or

common syrup, and taken twice or thrice a-day. We do not mean that all

these medicines should be administered at once; but whichever of them is

given, must be duly persisted in, and where one fails another may be

tried.

As it is very difficult to induce patients in this disease to take

medicines, we shall mention a few outward applications, which sometimes

do good; the principal of these are issues, setons, and warm bathing.

Issues may be made in any part of the body, but they generally have the

best effect near the spine. The discharge from these may be greatly

promoted by dressing them with the mild blistering ointment, and keeping

what are commonly called the orrice pease in them. The most proper place

for a seton is between the shoulder-blades; and it ought to be placed

upwards and downwards, or in the direction of the spine.

OF THE PALSY.

The palsy is a loss or diminution of sense or motion, or of both, in one

or more parts of the body. Of all the affections called nervous, this is

the most suddenly fatal. It is more or less dangerous, according to the

importance of the part affected. A palsy of the heart, lungs, or any

part necessary to life, is mortal. When it affects the stomach, the

intestines, or the bladder, it is highly dangerous. If the face be

affected, the case is bad, as it shews that the disease proceeds from

the brain. When the part affected feels cold, is insensible, or wastes

away, or when the judgment and memory begin to fail, there is small hope

of a cure.

CAUSES.——The immediate cause of palsy is any thing that prevents the

regular exertion of the nervous power upon any particular muscle or part

of the body. The occasional and predisposing causes are various, as

drunkenness; wounds of the brain, or spinal marrow; pressure upon the

brain or nerves; very cold or damp air; the suppression of customary

evacuations; sudden fear; want of exercise; or whatever greatly relaxes

the system, as drinking much tea[147], or coffee, &c. The palsy may

likewise proceed from wounds of the nerves themselves, from the

poisonous fumes of metals or minerals, as mercury, lead, arsenic.

In young persons of a full habit, the palsy must be treated in the same

manner as the sanguine apoplexy. The patient must be bled, blistered,

and have his body opened by sharp clysters or purgative medicines. But,

in old age, or when the disease proceeds from relaxation or debility,

which is generally the case, a quite contrary course must be pursued.

The diet must be warm and invigorating, seasoned with spicy and aromatic

vegetables, as mustard, horse-radish, &c. The drink may be generous

wine, mustard-whey, or brandy and water. Friction with the flesh-brush,

or a warm hand, is extremely proper, especially on the parts affected.

Blistering-plasters may likewise be applied to the affected parts with

advantage. When this cannot be done, they may be rubbed with the

volatile liniment, or the nerve ointment of the Edinburgh dispensatory.

One of the best external applications is electricity. The shocks, or

rather vibrations, should be received on the part affected; and they

ought daily to be repeated for several weeks.

Vomits are very beneficial in this kind of palsy, and ought frequently

to be administered. Cephalic snuff, or any thing that makes the patient

sneeze, is likewise of use. Some pretend to have found great benefit

from rubbing the parts affected with nettles; but this does not seem to

be any way preferable to blistering. If the tongue is affected, the

patient may gargle his mouth frequently with brandy and mustard; or he

may hold a bit of sugar in his mouth wet with the palsy-drops or

compound spirits of lavender. The wild valerian-root is a very proper

medicine in this case. It may either be taken in an infusion with

sage-leaves, or half a drachm of it in powder may be given in a glass of

wine three times a-day. If the patient cannot use the valerian, he may

take of _sal volatile oleosum_, compound spirits of lavender, and

tincture of castor, each half an ounce; mix these together, and take

forty or fifty drops in a glass of wine three or four times a-day. A

table-spoonful of mustard-seed taken frequently is a very good medicine.

The patient ought likewise to chew cinnamon bark, ginger, or other warm

spiceries.

Exercise is of the utmost importance in the palsy; but the patient must

beware of cold, damp, and moist air. He ought to wear flannel next his

skin; and, if possible, should remove into a warmer climate.

OF THE EPILEPSY, OR FALLING SICKNESS.

The epilepsy is a sudden deprivation of all the senses, wherein the

patient falls suddenly down, and is affected with violent convulsive

motions. Children, especially those who are delicately brought up, are

most subject to it. It more frequently attacks men than women, and is

very difficult to cure. When the epilepsy attacks children, there is

reason to hope it may go off about the time of puberty. When it attacks

any person after twenty years of age, the cure is difficult; but when

after forty, a cure is hardly to be expected. If the fit continues only

for a short space, and returns seldom, there is reason to hope; but if

it continues long, and returns frequently, the prospect is bad. It is a

very unfavourable symptom when the patient is seized with the fits in

his sleep.

CAUSES.——The epilepsy is sometimes hereditary. It may likewise proceed

from blows, bruises, or wounds on the head; a collection of water,

blood, or serous humours in the brain; a polypus; tumours or concretions

within the skull; excessive drinking; intense study; excess of venery;

worms; teething; suppression of customary evacuations; too great

emptiness or repletion; violent passions or affections of the mind, as

fear, joy, &c.; hysteric affections; contagion received into the body,

as the infection of the small-pox, measles, &c.

SYMPTOMS.——An epileptic fit is generally preceded by unusual weariness;

pain of the head; dulness; giddiness; noise in the ears; dimness of

sight; palpitation of the heart; disturbed sleep; difficult breathing;

the bowels are inflated with wind; the urine is in great quantity, but

thin; the complexion is pale; the extremities are cold; and the patient

often feels, as it were, a stream of cold air ascending towards his

head.

In the fit, the patient generally makes an unusual noise; his thumbs are

drawn in towards the palms of the hands; his eyes are distorted; he

starts, and foams at the mouth; his extremities are bent or twitted

various ways; he often discharges his seed, urine, and fæces

involuntarily; and is quite destitute of all sense and reason. After the

fit is over, his senses gradually return, and he complains of a kind of

stupor, weariness, and pain of his head; but has no remembrance of what

happened to him during the fit.

The fits are sometimes excited by violent affections of the mind, a

debauch of liquor, excessive heat, cold, or the like.

This disease, from the difficulty of investigating its causes, and its

strange symptoms, was formerly attributed to the wrath of the gods, or

the agency of evil spirits. In modern times it has often, by the vulgar,

been imputed to witchcraft or fascination. It depends however as much

upon natural causes as any other malady; and its cure may often be

effected by persisting in the use of proper means.

REGIMEN.——Epileptic patients ought, if possible, to breathe a pure and

free air. Their diet should be light but nourishing. They ought to drink

nothing strong, to avoid swine’s flesh, water-fowl, and likewise all

windy and oily vegetables, as cabbage, nuts, &c. They ought to keep

themselves cheerful, carefully guarding against all violent passions, as

anger, fear, excessive joy, and the like.

Exercise is likewise of great use; but the patient must be careful to

avoid all extremes either of heat or cold, all dangerous situations, as

standing upon precipices, riding, deep waters, and such like.

MEDICINE.——The intentions of cure must vary according to the cause of

the disease. If the patient be of a sanguine temperament, and there be

reason to fear an obstruction in the brain, bleeding and other

evacuations will be necessary. When the disease is occasioned by the

stoppage of customary evacuations, these, if possible, must be restored;

if this cannot be done, others may be substituted in their place. Issues

or setons in this case have often a very good effect. When there is

reason to believe that the disease proceeds from worms, proper medicines

must be used to kill, or carry off these vermin. When the disease

proceeds from teething, the body should be kept open by emollient

clysters, the feet frequently bathed in warm water, and, if the fits

prove obstinate, a blistering-plaster may be put betwixt the shoulders.

The same method is to be followed, when epileptic fits precede the

eruption of the small-pox, or measles, &c.

When the disease is hereditary, or proceeds from a wrong formation of

the brain, a cure is not to be expected. When it is owing to a debility,

or too great an irritability of the nervous system, such medicines as

tend to brace and strengthen the nerves may be used, as the Peruvian

bark, and steel; or the _anti-epileptic_ electuaries, recommended by

Fuller and Mead[148].

The flowers of zinc have of late been highly extolled for the cure of

the epilepsy. Though this medicine will not be found to answer the

expectations which have been raised concerning it, yet in obstinate

epileptic cases it deserves a trial. The dose is from one to three or

four grains, which may be taken either in pills or a bolus, as the

patient inclines. The best method is to begin with a single grain four

or five times a day, and gradually to increase the dose as far as the

patient can bear it. I have known this medicine, when duly persisted in,

prove beneficial.

Musk has sometimes been found to succeed in the epilepsy. Ten or twelve

grains of it, with the same quantity of factitious cinnabar, may be made

up into a bolus, and taken every night and morning.

Sometimes the epilepsy has been cured by electricity.

Convulsion-fits proceed from the same causes, and must be treated in the

same manner as the epilepsy.

There is one particular species of convulsion-fits which commonly goes

by the name of St. Vitus’s dance, wherein the patient is agitated with

strange motions and gesticulations, which by the common people are

generally believed to be the effects of witchcraft. This disease may be

cured by repeated bleedings and purges; and afterwards using the

medicines prescribed above for the epilepsy, _viz._ the Peruvian bark

and snake-root, &c. Chalybeate waters are found to be beneficial in this

case. The cold bath is likewise of singular service, and ought never to

be neglected when the patient can bear it.

OF THE HICCUP.

The hiccup is a spasmodic or convulsive affection of the stomach and

midriff, arising from any cause that irritates their nervous fibres.

It may proceed from excess in eating or drinking; from a hurt of the

stomach; poisons; inflammations or scirrhous tumours of the stomach,

intestines, bladder, midriff, or the rest of the _viscera_. In

gangrenes, acute and malignant fevers, a hiccup is often the forerunner

of death.

When the hiccup proceeds from the use of aliment that is flatulent, or

hard of digestion, a draught of generous wine, or a dram of any

spirituous liquor, will generally remove it. If poison be the cause,

plenty of milk and oil must be drank, as has been formerly recommended.

When it proceeds from an inflammation of the stomach, &c. it is very

dangerous. In this case the cooling regimen ought to be strictly

observed. The patient must be bled, and take frequently a few drops of

the sweet spirits of nitre in a cup of wine-whey. His stomach should

likewise be fomented with cloths dipped in warm water, or have bladders

filled with warm milk and water applied to it.

When the hiccup proceeds from a gangrene or mortification, the Peruvian

bark, with other antiseptics, are the only medicines which have a chance

to succeed. When it is a primary disease, and proceeds from a foul

stomach, loaded either with a pituitous or a bilious humour, a gentle

vomit and purge, if the patient be able to bear them, will be of

service. If it arises from flatulencies, the carminative medicines

directed for the heart-burn must be used.

When the hiccup proves very obstinate, recourse must be had to the most

powerful aromatic and antispasmodic medicines. The principal of these is

musk; fifteen or twenty grains of which may be made into a bolus, and

repeated occasionally. Opiates are likewise of service; but they must be

used with caution. A bit of sugar dipped in compound spirits of

lavender, or the volatile aromatic tincture, may be taken frequently.

External applications are sometimes also beneficial; as the stomach

plaster, or a cataplasm of the Venice treacle of the Edinburgh or London

dispensatory, applied to the region of the stomach.

I lately attended a patient who had almost a constant hiccup for above

nine weeks. It was frequently stopped by the use of musk, opium, wine,

and other cordial and antispasmodic medicines, but always returned.

Nothing however gave the patient so much ease as brisk small-beer. By

drinking freely of this, the hiccup was often kept off for several days,

which was more than could be done by the most powerful medicines. The

patient was at length seized with a vomiting of blood, which soon put an

end to his life. Upon opening the body, a large scirrhous tumour was

found near the pylorus or right orifice of the stomach.

The hiccup may be removed by taking vinegar, or a few drops of the oil

of vitriol taken in water.

CRAMP OF THE STOMACH.

This disease often seizes people suddenly, is very dangerous, and

requires immediate assistance. It is most incident to persons in the

decline of life, especially the nervous, gouty, hysteric, and

hypochondriac.

If the patient has any inclination to vomit, he ought to take some

draughts of warm water, or weak camomile-tea, to cleanse his stomach.

After this, if he has been costive, a laxative clyster may be given. He

ought then to take laudanum. The best way of administering it is in a

clyster. Sixty or seventy drops of liquid laudanum may be given in a

clyster of warm water. This is much more certain than laudanum given by

the mouth, which is often vomited, and in some cases increases the pain

and spasms in the stomach.

If the pain and cramps return with great violence, after the effects of

the anodyne clyster are over, another, with an equal or a larger

quantity of opium, may be given; and every four or five hours a bolus,

with ten or twelve grains of musk, and half a drachm of the Venice

treacle.

In the mean time, the stomach ought to be fomented with cloths dipped in

warm water, or bladders filled with warm milk and water should be

constantly applied to it. I have often seen these produce the most happy

effects. The anodyne balsam may also be rubbed on the part affected; and

an anti-hysteric plaster worn upon it for some time after the cramps are

removed, to prevent their return.

In very violent and lasting pains of the stomach, some blood ought to be

let, unless the weakness of the patient forbids it. When the pain or

cramps proceed from a suppression of the _menses_, bleeding is of use.

If they be owing to the gout, recourse must be had to spirits, or some

of the warm cordial waters. Blistering plasters ought likewise in this

case to be applied to the ancles. I have often seen violent cramps and

pains of the stomach removed by covering it with a large plaster of

Venice treacle.

OF THE NIGHT-MARE.

In this disease the patient, in time of sleep, imagines he feels an

uncommon oppression or weight about his breast or stomach, which he can

by no means shake off. He groans, and sometimes cries out, though oftner

he attempts to speak in vain. Sometimes he imagines himself engaged with

an enemy, and in danger of being killed, attempts to run away, but finds

he cannot. Sometimes he fancies himself in a house that is on fire, or

that he is in danger of being drowned in a river. He often thinks he is

falling over a precipice, and the dread of being dashed to pieces

suddenly awakes him.

This disorder has been supposed to proceed from too much blood; from a

stagnation of blood in the brain, lungs, &c. But it is rather a nervous

affection, and arises chiefly from indigestion. Hence we find that

persons of weak nerves, who lead a sedentary life, and live full, are

most commonly afflicted with the night-mare. Nothing tends more to

produce it than heavy suppers, especially when eaten late, or the

patient goes to bed soon after. Wind is likewise a very frequent cause

of this disease; for which reason those who are afflicted with it ought

to avoid all flatulent food. Deep thought, anxiety, or any thing that

oppresses the mind, ought also to be avoided.

As persons afflicted with the night-mare generally moan, or make some

noise in the fit, they should be waked, or spoken to by such as hear

them, as the uneasiness generally goes off as soon as the patient is

awake. Dr. Whytt says, he generally found a dram of brandy, taken at

bed-time, prevent this disease. That however is a bad custom, and in

time loses its effect. We would rather have the patient depend upon the

use of food of easy digestion, cheerfulness, exercise through the day,

and a light supper taken early, than to accustom himself to drams. A

glass of peppermint-water will often promote digestion as much as a

glass of brandy, and is much safer. After a person of weak digestion,

however, has eaten flatulent food, a dram may be necessary; in this case

we would recommend it as the most proper medicine.

Persons who are young, and full of blood, if troubled with the

night-mare, ought to take a purge frequently, and use a spare diet.

OF SWOONINGS.

People of weak nerves or delicate constitutions are liable to swoonings

or fainting fits. These indeed are seldom dangerous when duly attended

to; but when wholly neglected, or improperly treated, they often prove

hurtful, and sometimes fatal.

The general causes of swoonings are, sudden transition from cold to

heat; breathing air that is deprived of its proper spring or elasticity;

great fatigue; excessive weakness; loss of blood; long fasting; fear,

grief, and other violent passions or affections of the mind.

It is well known, that persons who have been long exposed to cold, often

faint or fall into a swoon, upon coming into the house, especially if

they drink hot liquor, or sit near a large fire. This might easily be

prevented by people taking care not to go into a warm room immediately

after they have been exposed to the cold air, to approach the fire

gradually, and not to eat or drink any thing hot, till the body has been

gradually brought into a warm temperature.

When any one, in consequence of neglecting these precautions, falls into

a swoon, he ought immediately to be removed to a cooler apartment, to

have ligatures applied above his knees and elbows, and to have his hands

and face sprinkled with vinegar or cold water. He should likewise be

made to smell to vinegar, and should have a spoonful or two of water, if

he can swallow, with about a third part of vinegar mixed with it, poured

into his mouth. If these should not remove the complaint, it will be

necessary to bleed the patient, and afterwards to give him a clyster.

As air that is breathed frequently loses its elasticity or spring, it is

no wonder if persons who respire in it often fall into a swoon or

fainting fit. They are in this case deprived of the very principle of

life. Hence it is that fainting fits are so frequent in all crowded

assemblies, especially in hot seasons. Such fits however must be

considered as a kind of temporary death; and, to the weak and delicate,

they sometimes prove fatal. They ought therefore with the utmost care to

be guarded against. The method of doing this is obvious. Let

assembly-rooms, and all other places of public resort, be large and well

ventilated; and let the weak and delicate avoid such places,

particularly in warm seasons.

A person who faints, in such a situation, ought immediately to be

carried into the open air; his temples should be rubbed with strong

vinegar or brandy, and volatile spirits of salts held to his nose. He

should be laid upon his back with his head low, and have a little wine,

or some other cordial, as soon as he is able to swallow it, poured into

his mouth. If the person has been subject to hysteric fits, castor or

asafœtida should be applied to the nose, or burnt feathers, horn, or

leather, &c.

When fainting fits proceed from mere weakness or exhaustion, which is

often the case after great fatigue, long fasting, loss of blood, or the

like, the patient must be supported with generous cordials, as jellies,

wines, spirituous liquors, &c. These however must be given at first in

very small quantities, and increased gradually as the patient is able to

bear them. He ought to be allowed to lie quite still and easy upon his

back, with his head low, and should have fresh air admitted into his

chamber. His food should consist of nourishing broths, sago-gruel with

wine, new milk, and other things of a light and cordial nature. These

things are to be given out of the fit. All that can be done in the fit

is, to let him smell to a bottle of Hungary-water, _eau de luce_, or

spirits of hartshorn, and to rub his temples with warm brandy, or to lay

a compress dipped in it to the pit of the stomach.

In fainting fits that proceed from fear, grief, or other violent

passions or affections of the mind, the patient must be very cautiously

managed. He should be suffered to remain at rest, and only made to smell

to some vinegar. After he is come to himself he may drink freely of warm

lemonade, or balm-tea, with some orange or lemon-peel in it. It will

likewise be proper, if the fainting fits have been long and severe, to

clean the bowels by throwing in an emollient clyster.

It is common in fainting fits, from whatever cause they proceed, to

bleed the patient. This practice may be very proper in strong persons of

a full habit; but in those who are weak and delicate, or subject to

nervous disorders, it is dangerous. The proper method with such people

is, to expose them to the free air, and to use cordial and stimulating

medicines, as volatile salts, Hungary-water, spirits of lavender,

tincture of castor, and the like.

OF FLATULENCIES, OR WIND.

All nervous patients, without exception, are afflicted with wind or

flatulencies in the stomach and bowels, which arise chiefly from the

want of tone or vigour in these organs. Crude flatulent aliment, as

green peas, beans, coleworts, cabbages, and such like, may increase this

complaint; but strong and healthy people are seldom troubled with wind,

unless they either overload their stomachs, or drink liquors that are in

a fermenting state, and consequently full of elastic air. While

therefore the matter of flatulence proceeds from our aliments, the cause

which makes air separate from them in such quantity as to occasion

complaints, is almost always a fault of the bowels themselves, which are

too weak either to prevent the production of elastic air, or to expel it

after it is produced.

To relieve this complaint, such medicines ought to be used as have a

tendency to expel wind, and by strengthening the alimentary canal, to

prevent its being produced there[149].

The list of medicines for expelling wind is very numerous; they often

however disappoint the expectations of both the physician and his

patient. The most celebrated among the class of carminatives are juniper

berries; the roots of ginger and zedoary; the seeds of anise, caraway,

and coriander; gum asafœtida and opium; the warm waters, tinctures, and

spirits, as the aromatic water, the tincture of wood-soot, the volatile

aromatic spirit, æther, &c.

Dr. Whytt says, he found no medicines more efficacious in expelling wind

than æther and laudanum. He generally gave the laudanum in a mixture

with peppermint-water and tincture of castor, or sweet spirits of nitre.

Sometimes, in place of this, he gave opium in pills with asafœtida. He

observes that the good effects of opiates are equally conspicuous,

whether the flatulence be contained in the stomach or intestines;

whereas those warm medicines, commonly called _carminatives_, do not

often give immediate relief, except when the wind is in the stomach.

With regard to æther, the Doctor says, he has often seen very good

effects from it in flatulent complaints, where other medicines failed.

The dose is a tea-spoonful mixed with two table-spoonfuls of water[150].

In gouty cases he observes, that æther, a glass of French brandy, or of

the aromatic water, or ginger, either taken in substance or infused in

boiling water, are among the best medicines for expelling wind.

When the case of flatulent patients is such as makes it improper to give

them warm medicines inwardly, the Doctor recommends external

applications, which are sometimes of advantage. Equal parts of the

anti-hysteric and stomach plaster may be spread upon a piece of soft

leather, of such size as to cover the greater part of the belly. This

should be kept on for a considerable time, provided the patient be able

to bear it; if it should give great uneasiness, it may be taken off, and

the following liniment used in its stead:

Take of Bates’s anodyne balsam an ounce; of the expressed oil of mace

half an ounce; oil of mint two drachms. Let these ingredients be mixed

together, and about a table-spoonful well rubbed on the parts at

bed-time.

For strengthening the stomach and bowels, and consequently for lessening

the production of flatulence, the Doctor recommends the Peruvian bark,

bitters, chalybeates, and exercise. In flatulent cases, he thinks some

nutmeg or ginger should be added to the tincture of the bark and

bitters, and that the aromatic powder should be joined with the filings

of iron.

When windy complaints are attended with costiveness, which is often the

case, few things will be found to answer better than four or five of the

following pills taken every night at bed-time:

Take of asafœtida two drachms; succotorine aloes, salt of iron, and

powdered ginger, of each one drachm; as much of the _elixir

proprietatis_ as will be sufficient to form them into pills.

On the other hand, when the body is too open, twelve or fifteen grains

of rhubarb, with half a drachm or two scruples of the Japonic

confection, given every other evening, will have very good effects.

In those flatulent complaints which come on about the time the _menses_

cease, repeated small bleedings often give more relief than any other

remedy.

With regard to diet, the Doctor observes, that tea, and likewise all

flatulent aliments, are to be avoided; and that for drink, water with a

little brandy or rum is not only preferable to malt liquor, but in most

cases also to wine.

As Dr. Whytt has paid great attention to this subject, and as his

sentiments upon it in a great measure agree with mine, I have taken the

liberty to adopt them; and shall only add to his observations, that

exercise is in my opinion superior to all medicine, both for preventing

the production and likewise for expelling of flatulencies. These

effects, however, are not to be expected from sauntering about, or

lolling in a carriage; but from labour, or such active amusements as

give exercise to every part of the body.

OF LOW SPIRITS.