PART II. OF DISEASES. (continued 5)

The ear-ach may proceed from any of the causes which produce inflammation. It often proceeds from a sudden suppression of perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, 361which is generally reckoned a favourable symptom.

When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the patient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil, which is a thing they cannot bear.

When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water; or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the ear is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile flowers.

The patient’s feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter, three times a-day. His drink may be whey, or decoction of barley and liquorice with figs or raisins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment.

When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renewed, till 362the abscess breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blisters, or issues; but the discharge must not be suddenly dried up by any external application.

PAIN OF THE STOMACH, &c.

This may proceed from various causes; as indigestion; wind; the acrimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise be occasioned by worms; the stoppage of customary evacuations; a translation of gouty matter to the stomach, the bowels, &c.

Women in the decline of life are very liable to pains of the stomach and bowels, especially such as are afflicted with hysteric complaints. It is likewise very common to hypochondriac men of a sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine.

When the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change his diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage.

363When a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy distention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, &c. This rule however admits of some exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched pease, though that grain is generally supposed to be of a windy nature^[133].

This complaint may likewise be greatly relieved by labour, especially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with was in a person of a sedentary occupation, whom I advised, after he had tried every kind of medicine in vain, to turn gardener; which he did, and has ever since enjoyed good health.

When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit; this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents.

When pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feeling the stomach warmed by it. It is impossible to ascertain the quantities 364necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile flowers, or carduus benedictus.

If a pain of the stomach proceed from the stoppage of customary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives; as rhubarb or senna, &c. When this disease affects women, in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service.

When the disease is occasioned by worms, they must be destroyed, or expelled by such means as are recommended in the following section.

When the stomach is greatly relaxed and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day.

Persons afflicted with flatulency are generally unhappy unless they be taking some purgative medicines; these, though they may give immediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. Their best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open.

365

CHAP. XXXV. OF WORMS.

These are chiefly of three kinds, viz. the tænia, or tape-worm; the teres, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from similar causes, have nearly the same symptoms, and require almost the same method of treatment as these already mentioned, we shall not spend time in enumerating them.

The tape-worm is white, very long, and full of joints. It is generally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or what is called the end gut, and occasion a disagreeable itching about the seat.

The long round worms occasion squeamishness, vomiting, a disagreeable breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the intestines, and get into the cavity of the belly. The effects of the tape-worm are nearly the same with those of the long and round, but rather more violent.

Andry says, the following symptoms particularly attend the solium, which is a species of the tape-worm, viz. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool.

366CAUSES.——Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally subject to worms. There seems to be a hereditary disposition in some persons to this disease. I have often seen all the children of a family subject to worms of a particular kind. They seem likewise frequently to be owing to the nurse. Children of the same family, nursed by one woman, have often worms, when those nursed by another have none.

SYMPTOMS.——The common symptoms of worms are, paleness of the countenance, and at other times, an universal flushing of the face; itching of the nose; this however is doubtful, as children pick their noses in all diseases; starting, and grinding of the teeth in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious; looseness; a sour or stinking breath; a hard swelled belly; great thirst; the urine frothy, and sometimes of a whitish colour; griping, or colic pains; an involuntary discharge of saliva, especially when asleep; frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings; drowsiness; cold sweats; palsy; epileptic fits, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber seeds are symptoms of the tape-worm.

I lately saw some very surprising effect of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expired, and, upon opening her body, a number of the teres, or 367long round worms, were found in her guts, which were considerably inflamed; and what anatomists call an intus susceptio, or involving of one part of the gut within another, had taken place in no less than four different parts of the intestinal canal^[134].

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 368a 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 369be 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, 370and 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 371of 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 372mild 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 373hand 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. 374If 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, 375damp, 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.

376When 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 377this 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:

378Take 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 379may 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].

380After 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.

381SYMPTOMS.——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 382to 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 383volatile 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, 384stool, &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.

385Out 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 386early. 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 387of 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 388has 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 389sort 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.

390The 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 391pitch 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, 392camomile, 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.

393

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 394food; 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 395greater 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 396till 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.

397Harrowgate 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. 398The 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; 399but 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.

400REGIMEN.——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; 401but 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.

402The 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.

403

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 404it 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 405of 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 406wholesome 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 407lungs, 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 408are 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 409legs 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, 410every 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 411latter 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 412fixed, 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 413case. 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.

414

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 415currants, 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 416of 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.

417The 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.