PART II. OF DISEASES.

CHAP. XII. OF THE KNOWLEDGE AND CURE OF DISEASES.

The knowledge of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often discover a disease sooner than those who have been bred to physic. We do not however mean to insinuate that a medical education is of no use: it is doubtless of the greatest importance; but it never can supply the place of observation and experience.

Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead therefore of giving a classical arrangement of diseases, according to the systematic method, it will be more suitable, in a performance of this nature, to give a full and accurate description of each particular disease as it occurs; and, where any of the symptoms of one disease have a near resemblance to those of another, to take notice of that circumstance, and at the same time to point 136out the peculiar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine.

A proper attention to the patient’s age, sex, temper of mind, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases.

In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin; whereas in old age the fibres are rigid, the nerves become almost insensible, and many of the vessels imperviable. These and other peculiarities render the diseases of the young and aged very different, and of course they must require a different method of treatment.

Females are liable to many diseases which do not afflict the other sex: besides, the nervous system being more irritable in them than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations; and all stimulating medicines ought to be administered to them with a sparing hand.

Particular constitutions not only dispose persons to peculiar diseases, but likewise render it necessary to treat these diseases in a peculiar manner. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, under any disease, precisely in the same manner as one who is hardy and robust, and who is much exposed to the open air.

The temper of mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper, both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When it is affected, the best medicine is to sooth 137the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible.

Attention ought likewise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabitants of high countries. Those who breathe the impure air of cities, have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and indulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, &c.

It has already been observed, that the different occupations and situations in life dispose men to peculiar diseases. It is therefore necessary to inquire into the patient’s occupation, manner of life, &c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary precisely in the same manner, even supposing them to labour under the same disease.

It will likewise be proper to inquire, whether the disease be constitutional or accidental; whether it has been of long or short duration; whether it proceeds from any great and sudden alteration in the diet, manner of life, &c. The state of the patient’s body, and of the other evacuations, ought also to be inquired into; and likewise whether he can with ease perform all the vital and animal functions, as breathing, digestion, &c.

Lastly, it will be proper to inquire what diseases the patient has formerly been liable to, and what medicines were most beneficial to him; if he has a strong aversion to any particular drug, &c.

138As many of the indications of cure may be answered by diet alone, it is always the first thing to be attended to in the treatment of diseases. Those who know no better, imagine that every thing which goes by the name of a medicine possesses some wonderful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences; it makes people trust to drugs, and neglect their own endeavours; besides, it discourages all attempts to relieve the sick where medicines cannot be obtained.

Medicines are no doubt useful in their place; and, when administered with prudence, they may do much good; but when they are put in place of every thing else, or administered at random, which is not seldom the case, they must do mischief. We would therefore wish to call the attention of mankind from the pursuit of secret medicines, to such things as they are acquainted with. The proper regulation of these may often do much good, and there is little danger of their ever doing hurt.

Every disease weakens the digestive powers. The diet ought therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even abstinence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking.

In all fevers attended with inflammation, as pleurisies, peripneumonies, &c. thin gruels, wheys, watery infusions of mucilaginous plants, roots, &c. are not only proper for the patients food, but they are likewise the best medicines which can be administered.

139In fevers of a slow, nervous, or putrid kind, where there are no symptoms of inflammation, and where the patient must be supported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known.

Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afflicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food and generous liquors, than from all the cordial and carminitive medicines which can be administered to them.

The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet, than to all the boasted antiscorbutic remedies of the shops.

In consumptions, when the humours are vitiated, and the stomach so much weakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet consisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed.

Nor is an attention to other things of less importance than to diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other diseases, the patient will receive more benefit from having the fresh air prudently admitted into his chamber, than from all the medicines which can be given him.

Exercise may likewise in many cases be considered as a medicine. Sailing, or riding on horseback, for example, will be of more service in the cure of consumptions, glandular obstructions, &c. than any medicine yet known. In diseases which 140proceed from a relaxed state of the solids, the cold bath, and other parts of the gymnastic regimen, will be found equally beneficial.

Few things are of greater importance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the danger. Many diseases may be cured by cleanliness alone; most of them may be mitigated by it, and in all of them it is highly necessary both for the patient and those who attend him.

Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regimen will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment of diseases, we have always given the first place to regimen. Those who are ignorant of medicine may confine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These however are never to be administered but by people of better understanding; nor even by them without the greatest precaution.

CHAP. XIII. OF FEVERS IN GENERAL.

As more than one half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are, infection, errors in diet, unwholesome 141air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and extreme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shewn, we shall not now resume the consideration of them, but shall only recommend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles.

Fevers are not only the most frequent of all diseases, but they are likewise the most complex. In the most simple species of fever there is always a combination of several different symptoms. The distinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in performing some of the vital or animal functions. The other symptoms usually attendant on fevers are, nausea, thirst, anxiety, delirium, weariness, wasting of the flesh, want of sleep, or the sleep disturbed and not refreshing.

When the fever comes on gradually, the patient generally complains first of languor or listlessness, soreness of the flesh, or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth; after some time come on excessive heat, violent thirst, restlessness, &c.

When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting.

Fevers are divided into continual, remitting, intermitting, and such as are attended with cutaneous eruption or topical inflammation, as the small-pox, erysipelas, &c. By a continual fever is meant 142that which never leaves the patient during the whole course of the disease, or which shews no remarkable increase or abatement in the symptoms. This kind of fever is likewise divided into acute, slow, and malignant. The fever is called acute when its progress is quick, and the symptoms violent; but when these are more gentle, it is generally denominated slow. When livid or petechial spots shew a putrid state of the humours, the fever is called malignant, putrid, or petechial.

A remitting fever differs from a continual only in a degree. It has frequent increases and decreases, or exacerbations and remissions, but never wholly leaves the patient during the course of the disease. Intermitting fevers or agues are those which, during the time that the patient may be said to be ill, have evident intervals or remissions of the symptoms.

As a fever is only an effort of Nature to free herself from an offending cause, it is the business of those who have the care of the sick to observe with diligence which way Nature points, and to endeavour to assist her operations. Our bodies are so framed, as to have a constant tendency to expel or throw off whatever is injurious to health. This is generally done by urine, sweat, stool, expectoration, vomit, or some other evacuation.

There is reason to believe, if the efforts of Nature, at the beginning of a fever, were duly attended to and promoted, it would seldom continue long; but when her attempts are either neglected or counteracted, it is no wonder if the disease proves fatal. There are daily instances of persons who, after catching cold, have all the symptoms of a beginning fever; but by keeping warm, drinking diluting liquors, bathing their feet in warm water, &c. the symptoms in a few hours disappear, and the danger is prevented.

143When fevers of a putrid kind threaten, the best method of obviating their effects is by repeated vomits.

Our design is not to enter into a critical inquiry into the nature and immediate causes of fevers, but to mark their most obvious symptoms, and to point out the proper treatment of the patient with respect to his diet, drink, air, &c. in the different stages of the disease. In these articles the inclinations of the patient will in a great measure direct our conduct.

Almost every person in a fever complains of great thirst, and calls out for drink, especially of a cooling nature. This at once points out the use of water, and other cooling liquors. What is so likely to abate the heat, attenuate the humours, remove spasms and obstructions, promote perspiration, increase the quantity of urine, and in short produce every salutary effect in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is the basis? The necessity of diluting liquors is pointed out by the dry tongue, the parched skin, and the burning heat, as well as by the unquenchable thirst of the patient.

Many cooling liquors, which are extremely grateful to patients in a fever, may be prepared from fruits, as decoctions of tamarinds, apple-tea, orange-whey, and the like. Mucilaginous liquors might also be prepared from marsh-mallow roots, linseed, lime-tree buds, and other mild vegetables. These liquors, especially when acidulated, are highly agreeable to the patient, and should never be denied him.

At the beginning of a fever the patient generally complains of great lassitude or weariness, and has no inclination to move. This evidently shews the propriety of keeping him easy, and if possible 144in bed. Lying in bed relaxes the spasms, abates the violence of the circulation, and gives Nature an opportunity of exerting all her force to overcome the disease. The bed alone would often remove a fever at the beginning; but when the patient struggles with the disease, instead of driving it off, he only fixes it the deeper, and renders it more dangerous. This observation is too often verified in travellers, who happen when on a journey to be seized with a fever. Their anxiety to get home induces them to travel with the fever upon them, which conduct seldom fails to render it fatal.

In fevers the mind as well as the body should be kept easy. Company is seldom agreeable to the sick. Indeed every thing that disturbs the imagination increases the disease; for which reason every person in a fever ought to be kept perfectly quiet, and neither allowed to see nor hear any thing that may in the least affect or discompose his mind.

Though the patient in a fever has the greatest inclination for drink, yet he seldom has any appetite for solid food; hence the impropriety of urging him to take victuals is evident. Much solid food in a fever is every way hurtful. It oppresses nature, and, instead of nourishing the patient, serves only to feed the disease. What food the patient takes should be in small quantity, light, and of easy digestion. It ought to be chiefly of the vegetable kind, as panada, roasted apples, gruels, and such like.

Poor people, when any of their family are taken ill, run directly to their rich neighbours for cordials, and pour wine, spirits, &c. into the patient, who perhaps never had been accustomed to taste such liquors when in health. If there be any degree of fever, this conduct must increase it, and if there be none, this is the ready way to raise one. 145Stuffing the patient with sweetmeats and other delicacies is likewise very pernicious. These are always harder to digest than common food, and cannot fail to hurt the stomach.

Nothing is more desired by a patient in a fever than fresh air. It not only removes his anxiety, but cools the blood, revives the spirits, and proves every way beneficial. Many patients are in a manner stifled to death in fevers for want of fresh air; yet such is the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept in a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick person’s chamber, so as to keep it moderately cool. Indeed its degree of warmth ought never to be greater than is agreeable to one in perfect health.

Nothing spoils the air of a sick person’s chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manner poisonous to the sick.

In fevers, when the patient’s spirits are low and depressed, he is not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing his mind with the hopes and consolations of religion, fright him with the views of hell and damnation. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct; it often hurts the body, 146and there is reason to believe seldom benefits the soul.

Among common people, the very name of a fever generally suggests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature; but true inflammatory fevers are now seldom to be met with. Sedentary occupations, and a different manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is necessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be evident signs of inflammation. Bleeding is an excellent medicine when necessary, but should never be wantonly performed.

It is likewise a common notion, that sweating is always necessary in the beginning of a fever. When the fever proceeds from an obstructed perspiration, this notion is not ill-founded. If the patient only lies in bed, bathes his feet and legs in warm water, and drinks freely of water-gruel, or any other weak diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever; it will open the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c. which fire his blood, increase the spasms, and render the disease more dangerous.

In all fevers a proper attention should be paid to the patient’s longings. These are the calls of Nature, 147and often point out what may be of real use. Patients are not indeed to be indulged in every thing that the sickly appetite may crave; but it is generally right to let them have a little of what they eagerly desire, though it may not seem altogether proper. What the patient longs for, his stomach will generally digest; and such things have sometimes a very happy effect.

When a patient is recovering from a fever, great care is necessary to prevent a relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and delicate, it is necessary to guard against catching cold. Moderate exercise in the open air will be of use, but great fatigue is by all means to be avoided; agreeable company will also have a good effect. The diet must be light, but nourishing. It should be taken frequently, but in small quantities. It is dangerous at such a time to eat as much as the stomach may crave.

CHAP. XIV. OF INTERMITTING FEVERS, OR AGUES.

Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally known.

148The several kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c.

CAUSES.——Agues are occasioned by effluvia from putrid stagnating water. This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the Fens of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be occasioned by eating too much stone fruit, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions, and the like. When the inhabitants of a high country remove to a low one, they are generally seized with intermitting fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary or small vessels, disposes the body to agues.

SYMPTOMS.——An intermitting fever generally begins with a pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and violent shaking. Afterwards the skin becomes moist, and a profuse sweat breaks out, which generally terminates the fit or paroxysm. Sometimes indeed the disease comes on suddenly, when the person thinks himself in perfect health; but it is more commonly preceded by listlessness, loss of appetite, and the symptoms mentioned above.

REGIMEN.——While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that 149will assist in bringing on the sweat, and consequently shorten the paroxysm^[58].

Between the paroxysms the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken-broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bitter, has been infused.

As the chief intentions of cure in an ague are to brace the solids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such as his strength will permit. Nothing tends more to prolong an intermitting fever, than indulging a lazy indolent disposition.

Intermitting fevers, under a proper regimen, will often go off without medicine; and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course; but when the patient’s strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This however should never be done till the disease be properly formed, that is to say, 150till the patient has had several fits of shaking and sweating.

MEDICINE.——The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more efficacious. In this disease, the stomach is generally loaded with cold viscid phlegm, and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Vomits are therefore to be administered before the patient takes any other medicine. A dose of ipecacuanha will generally answer this purpose very well. A scruple or half a dram of the powder will be sufficient for an adult, and for a younger person the dose must be less in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit should be taken two or three hours before the return of the fit, and may be repeated at the distance of two or three days. Vomits not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of such importance, that they often cure intermitting fevers without the assistance of any other medicine.

Purging medicines are likewise useful and often necessary in intermitting fevers. A smart purge has been known to cure an obstinate ague, after the Peruvian bark and other medicines had been used in vain. Vomits however are more suitable in this disease, and render purging less necessary; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bowels by a dose or two of Glauber’s salt, jalap, or rhubarb.

Bleeding may sometimes be proper at the beginning of an intermitting fever, when excessive heat, 151a delirium, &c. give reason to suspect an inflammation; but as the blood is seldom in an inflammatory slate in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease.

After proper evacuations the patient may safely use the Peruvian bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder.

Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient^[59].

In an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or six doses between each paroxysm. In a tertian or third-day ague it will be sufficient to take a dose every third hour during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms^[60].

152The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to patients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave it off, and begin again at some distance of time; by which means the disease gathers strength, and often returns with as much violence as before. A relapse may always be prevented by the patient’s continuing to take small doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure.

An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile-flowers, and an handful of coriander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this infusion drank three or four times a day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a day. If patients drink freely of the above, or any other proper infusion of bitters, a smaller 153quantity of bark than is generally used, will be sufficient to cure an ague^[61].

Those who cannot swallow the bark in substance, may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pour off the clear liquor. A wine glass may be drank three or four times a day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drams of snake-root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, into an English pint. To the strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently.

In obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than taken alone. This I have had frequently occasion to observe in a country where intermittent fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an inflammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn 154or beginning of winter, warm and cordial medicines are absolutely necessary^[62].

As autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting fever in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds.

When agues are not properly cured, they often degenerate into obstinate chronical diseases, as the dropsy, jaundice, &c. For this reason all possible care should be taken to have them radically cured, before the constitution has been too much weakened.

Though nothing is more rational than the method of treating intermitting fevers, yet, by some strange infatuation, more charms and whimsical remedies are daily used for removing this than any other disease. There is hardly an old woman who is not in possession of a nostrum for stopping an ague; and it is amazing with what readiness their pretensions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of the disorder.

155Some indeed try bold, or rather fool-hardy experiments to cure agues, as drinking great quantities of strong liquors, jumping into a river, &c. These may sometimes have the desired effect, but must always be attended with danger^[63]. When there is any degree of inflammation, or the least tendency to it, such experiments may prove fatal. The only patient whom I remember to have lost in an intermittent fever, evidently killed himself by drinking strong liquor, which some person had persuaded him would prove an infallible remedy.

Many dirty things are extolled for the cure of intermitting fevers, as spiders, cobwebs, snuffings of candles, &c. Though these may sometimes succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended upon, for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be used with safety: and I can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in.

Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeable sharpness with the elixir or spirit of vitriol. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, the saline mixture may be given with advantage to children^[64].

156Wine-whey is a very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit of hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourishing, and sometimes a little generous wine should be allowed.

To children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm water, with the addition of half an ounce of sweet oil, and six or eight drops of laudanum, in the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of extract and laudanum must be proportionally lessened. Children have been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it; by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirits, or with a mixture of equal parts of laudanum and the saponaceous liniment.

We have been the more full upon this disease, because it is very common, and because few patients in an ague apply to physicians unless in extremities. There are, however, many cases in which the disease is very irregular, being complicated with other diseases, or attended with symptoms which are both very dangerous and very difficult to understand. All these we have purposely passed over, as they would only bewilder the generality of readers. When the disease is very irregular, or the symptoms dangerous, the patient ought immediately to apply to a physician, and strictly to follow his advice.

To prevent agues, people must endeavour to avoid their causes. These have been already pointed out 157in the beginning of this section; we shall therefore only add one preventive medicine, which may be of use to such as are obliged to live in low marshy countries, or who are liable to frequent attacks of this disease.

Take an ounce of the best Peruvian bark; Virginian snake-root, and orange-peel, of each half an ounce; bruise them all together, and infuse for five or six days in a bottle of brandy, Holland gin, or any good spirit; afterwards pour off the clear liquor; and take a wine glass of it twice or thrice a day. This indeed is recommending a dram; but the bitter ingredients in a great measure take off the ill effects of the spirit. Those who do not chuse it in brandy, may infuse it in wine; and such as can bring themselves to chew the bark, will find that method succeed very well. Gentian root, or calamus aromaticus, may also be chewed by turns for the same purpose. All bitters seem to be antidotes to agues, especially those that are warm and astringent.

CHAP. XV. OF AN ACUTE CONTINUAL FEVER.

This fever is denominated acute, ardent, or inflammatory. It most commonly attacks the young, or persons about the prime or vigour of life, especially such as live high, abound with blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year; but is most frequent in the spring and beginning of summer.

CAUSES.——An ardent fever may be occasioned by any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries, a full diet, with little exercise, &c. It may likewise be occasioned by whatever obstructs the perspiration, as 158lying on the damp ground, drinking cold liquor when the body is hot, night-watching, or the like.

SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid countenance, pains in the back, loins, &c. To these succeed difficulty of breathing, sickness, with an inclination to vomit. The patient complains of great thirst, has no appetite for solid food, is restless, and his tongue generally appears black and rough.

A delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons, hiccup, cold clammy sweats, and an involuntary discharge of urine, are very dangerous symptoms.

As this disease is always attended with danger, the best medical assistance ought to be procured as soon as possible. A physician may be of use at the beginning, but his skill is often of no avail afterwards. Nothing can be more unaccountable than the conduct of those who have it in their power, at the beginning of a fever, to procure the best medical assistance, yet put it off till things come to an extremity. When the disease, by delay or wrong treatment, has become incurable, and has exhausted the strength of the patient, it is in vain to hope for relief from medicine. Physicians may indeed assist Nature; but their attempts must ever prove fruitless, when she is no longer able to co-operate with their endeavours.

REGIMEN.—From the symptoms of this disease, it is evident, that the blood and other humours require to be diluted; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity; that the vessels are rigid, and the heat of the whole body too great: all these clearly point out the necessity of a regimen calculated to dilute 159the blood, correct the acrimony of the humours, allay the excessive heat, remove the spasmodic stricture of the vessels, and promote the secretions.

These important purposes may be greatly promoted by drinking plentifully of diluting liquors; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries, and such like: orange-whey is likewise an excellent cooling drink. It is made by boiling among milk and water a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonfuls of vinegar, will have the same effect. Two or three spoonfuls of white wine may occasionally be added to the liquor when boiling.

If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English pints of water to a quart. This makes a very pleasant drink, and may be used at discretion. The common pectoral decoction is likewise a very proper drink in this disease. A tea-cupful of it may be taken every two hours, or oftener, if the patient’s heat and thirst be very great^[65].

The above liquids must all be drank a little warm. They may be used in smaller quantities at the beginning of a fever, but more freely afterwards, in order to assist in carrying off the disease by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to chuse those which are most agreeable; and that when tired of one, he may have recourse to another.

The patient’s diet must be very spare and light. All sorts of flesh-meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, 160panado, or light bread boiled in water; to which may be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples with a little sugar, toasted bread with jelly of currants, boiled prunes, &c.

It will greatly relieve the patient, especially in an hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold.

It is too common in fevers to load the patient with bed-clothes, under the pretence of making him sweat, or defending him from the cold. This custom has many ill effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the perspiration.

Sitting upright in bed, if the patient is able to bear it, will often have a good effect. It relieves the head, by retarding the motion of the blood to the brain. But this posture ought never to be continued too long: and if the patient is inclined to sweat, it will be more safe to let him lie, only raising his head a little with pillows.

Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-water, with a little nitre dissolved in it, will greatly refresh the patient. This ought to be done frequently, especially if the weather is hot.

The patient’s mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoction of figs in barley-water. His feet and hands ought likewise frequently to be bathed in lukewarm water; especially if the head is affected.

The patient should be kept as quiet and easy as possible. Company, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that affects the senses, ought 161to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted; even the promise of what he craves will often satisfy him as much as its reality.

MEDICINE.——In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest importance. This operation ought always to be performed as soon as the symptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, must be in proportion to the strength of the patient and the violence of the disease. If after the first bleeding the fever should increase, and the pulse become more frequent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth time, which may be done at the distance of twelve, eighteen, or twenty-four hours from each other, as the symptoms require. If the pulse continues soft, and the patient is tolerably easy after the first bleeding, it ought not to be repeated.

If the heat and fever be very great, forty or fifty drops of the dulcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf-sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours will be sufficient.

If the patient be afflicted with retching, or an inclination to vomit, it will be right to assist Nature’s attempts, by giving him weak camomile-tea, or lukewarm water to drink.

If the body is bound, a clyster of milk and water with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea-spoonful of magnesia alba, or cream of tartar, may be 162frequently put into his drink. He may likewise eat tamarinds, boiled prunes, roasted apples, and the like.

If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish settlement, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient’s spirits grow languid, his pulse sinks, and his breathing becomes difficult; with a stupor, trembling of the nerves, starting of the tendons, &c. there is reason to fear that the consequences will be fatal. In this case blistering plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion; poultices of wheat-bread, mustard, and vinegar, may likewise be applied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel with wine in it, and such like.

A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body is weak after a fever, yet the diet for some time ought to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the patient should not attempt to pursue study, or any business that requires intense thinking.

If the digestion is bad, or the patient is seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the remains of the fever.

163When the patient’s strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a dram of sena may be boiled for a few minutes in an English pint of water, and an ounce of manna dissolved in the decoction; afterwards it may be strained, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening between each dose.

Those who follow laborious employments ought not to return too soon to their labour after a fever, but should keep easy till their strength and spirits are sufficiently recruited.

CHAP. XVI. OF THE PLEURISY.

The true pleurisy is an inflammation of that membrane called the pleura, which lines the inside of the breast. It is distinguished into the moist and dry. In the former the patient spits freely; in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the ribs. The pleurisy prevails among labouring people, especially such as work without doors, and are of a sanguine constitution. It is most frequent in the spring season.

CAUSES.——The pleurisy may be occasioned by whatever obstructs the perspiration; as cold northerly winds; drinking cold liquors when the body is hot; sleeping without doors on the damp ground; wet clothes; plunging the body into 164cold water, or exposing it to the cold air, when covered with sweat, &c. It may likewise be occasioned by drinking strong liquors; by the stoppage of usual evacuations; as old ulcers, issues, sweating of the feet or hands, &c. the sudden striking in of any eruption, as the itch, the measles, or the small-pox. Those who have been accustomed to bleed at a certain season of the year are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as running, wrestling, leaping, or by supporting great weight, blows on the breast, &c. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c.

SYMPTOMS.—This, like most other fevers, generally begins with chillness and shivering, which are followed by heat, thirst, and restlessness. To these succeeds a violent pricking pain in one of the sides among the ribs. Sometimes the pain extends towards the back bone, sometimes towards the fore-part of the breast, and at other times towards the shoulder blades. The pain is generally most violent when the patient draws his breath.

The pulse in this disease is commonly quick and hard, the urine high-coloured; and if blood be let, it is covered with a tough crust, or buffy coat. The patient’s spittle is at first thin, but afterwards it becomes grosser, and is often streaked with blood.

REGIMEN.——Nature generally endeavours to carry off this disease by a critical discharge of blood from some part of the body, by expectoration, sweat, loose stools, thick urine, or the like. We ought therefore to second her intentions by lessening the force of the circulation, relaxing the 165vessels, diluting the humours, and promoting expectoration.

For these purposes the diet, as in the former disease, ought to be cool, slender, and diluting. The patient must avoid all food that is viscid, hard of digestion, or that affords much nourishment; as flesh, butter, cheese, eggs, milk, and also every thing that is of a heating nature. His drink may be whey, or an infusion of pectoral and balsamic vegetables^[66].

Barley-water, with a little honey or jelly of currants mixed with it, is likewise a very proper drink in this disease. It is made by boiling an ounce of pearl-barley in three English pints of water to two, which must afterwards be strained. The decoction of figs, raisins, barley, recommended in the preceding disease, is here likewise very proper. These and other diluting liquors are not to be drank in large quantities at a time, but the patient ought to keep continually sipping them, so as to render his mouth and throat always moist. All his food and drink should be taken a little warm.

The patient should be kept quiet, cool, and every way easy, as directed under the foregoing disease. His feet and hands ought daily to be bathed in lukewarm water; and he may sometimes sit up in bed for a short space, in order to relieve his head.

MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of 166blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. For a younger person, or one of a delicate constitution, the quantity must be less.

If, after the first bleeding, the stitch, with the other violent symptoms, should still continue, it will be necessary, at the distance of twelve or eighteen hours, to let eight or nine ounces more. If the symptoms do not then abate, and the blood shews a strong buffy coat, a third or even a fourth bleeding may be requisite. If the pain of the side abates, the pulse becomes softer, or the patient begins to spit freely, bleeding ought not to be repeated. This operation is seldom necessary after the third or fourth day of the fever, and ought not then to be performed, unless in the most urgent circumstances.

The blood may be many ways attenuated without bleeding. There are likewise many things that may be done to ease the pain of the side without this operation, as fomenting, blistering, &c. Fomentations may be made by boiling a handful of the flowers of elder, camomile, and common mallows, or any other soft vegetables, in a proper quantity of water. The herbs may be either put into a flannel bag, and applied warm to the side, or flannels may be dipped in the decoction, afterwards wrung out, and applied to the part affected, with as much warmth as the patient can easily bear. As the clothes grow cool, they must be changed, and great care taken that the patient do not catch cold. A bladder may be filled with warm milk and water, and applied to the side, if the above method of fomenting be found inconvenient. Fomentations not only ease the pain, but relax the 167vessels, and prevent the stagnation of the blood and other humours. The side may likewise be frequently rubbed with a little of the volatile liniment^[67].

Topical bleeding has often a very good effect in this disease. It may either be performed by applying a number of leeches to the part affected, or by cupping, which is both a more certain and expeditious method than the other.

Leaves of various plants might likewise be applied to the patient’s side with advantage. I have often seen great benefit from young cabbage-leaves applied warm to the side in a pleurisy. These not only relax the parts, but likewise draw off a little moisture, and may prevent the necessity of blistering-plasters; which however, when other things fail, must be applied.

If the stitch continues after repeated bleedings, fomentations, &c. a blistering-plaster must be applied over the part affected, and suffered to remain for two days. This not only procures a discharge from the side, but takes off the spasm, and by that means assists in removing the cause of the disease. To prevent a strangury when the blistering-plaster is on, the patient may drink freely of the Arabic emulsion^[68].

If the patient is costive, a clyster of thin water-gruel, or of barley-water, in which a handful of mallows, or any other emollient vegetable has been boiled, may be daily administered. This will not only empty the bowels, but have the effect of a warm fomentation applied to the inferior viscera, which will help to make a derivation from the breast.

The expectoration of spitting may be promoted by sharp, oily, and mucilaginous medicines. For 168this purpose an ounce of the oxymel, or the vinegar of squills, may be added to six ounces of the pectoral decoction, and two table-spoonfuls of it taken every two hours.

Should the squill disagree with the stomach, the oily emulsion may be administered^[69]; or, in place of it, two ounces of the oil of sweet almonds, or oil of olives, and two ounces of the syrup of violets, may be mixed with as much sugar-candy powdered, as will make an electuary of the consistence of honey. The patient may take a tea-spoonful of this frequently, when the cough is troublesome. Should oily medicines prove nauseous, which is sometimes the case, two table-spoonfuls of the solution of gum ammoniac in barley-water may be given three or four times a-day^[70].

If the patient does not perspire, but has a burning heat upon his skin, and passes very little water, some small doses of purified nitre and camphire will be of use. Two drams of the former may be rubbed with five or six grains of the latter in a mortar, and the whole divided into six doses, one of which may be taken every five or six hours, in a little of the patient’s ordinary drink.

We shall only mention one medicine more, which some reckon almost a specific in the pleurisy, viz. the decoction of the seneka rattle-snake root^[71]. After bleeding and other evacuations have been premised, the patient may take two, three, or four table-spoonfuls of this decoction, according as his stomach will bear it, three or four times a-day. If it should occasion vomiting, two or three ounces of simple cinnamon-water may be mixed with the quantity of decoction here directed, or it may be taken in smaller doses. As this medicine 169promotes perspiration and urine, and likewise keeps the body easy, it may be of some service in a pleurisy, or any other inflammation of the breast.

No one will imagine that these medicines are all to be used at the same time. We have mentioned different things, on purpose that people may have it in their power to chuse; and likewise, that when one cannot be obtained, they may make use of another. Different medicines are no doubt necessary in the different periods of a disorder; and where one fails of success, or disagrees with the patient, it will be proper to try another.

What is called the crisis, or height of the fever, is sometimes attended with very alarming symptoms, as difficulty of breathing, an irregular pulse, convulsive motions, &c. These are apt to frighten the attendants, and induce them to do improper things, as bleeding the patient, giving him strong stimulating medicines, or the like. But they are only the struggles of Nature to overcome the disease, in which she ought to be assisted by plenty of diluting drink, which is then peculiarly necessary. If the patient’s strength however be much exhausted by the disease, it will be necessary at this time to support him with frequent small draughts of wine-whey, negus, or the like.

When the pain and fever are gone, it will be proper, after the patient has recovered sufficient strength, to give him some gentle purges, as those directed towards the end of the acute continual fever. He ought likewise to use a light diet, of easy digestion, and his drink should be butter-milk, whey, and other things of a cleansing nature.

Of the BASTARD PLEURISY.

That species of pleurisy which is called the bastard or spurious, generally goes off by keeping warm for 170a few days, drinking plenty of diluting liquors, and observing a cooling regimen.

It is known by a dry cough, a quick pulse, and a difficulty of lying on the affected side, which last does not always happen in the true pleurisy. Sometimes indeed this disease proves obstinate, and requires bleeding, with cupping, and scarifications of the part affected. These, together with the use of nitrous and other cooling medicines, seldom fail to effect a cure.

Of the PARAPHRENITIS.

The paraphrenitis, or inflammation of the diaphragm, is so nearly connected with the pleurisy, and resembles it so much in the manner of treatment, that it is scarce necessary to consider it as a separate disease.

It is attended with a very acute fever, and an extreme pain in the part affected, which is generally augmented by coughing, sneezing, drawing in the breath, taking food, going to stool, making water, &c. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm; is restless, anxious, has a dry cough, a hiccup, and often a delirium. A convulsive laugh, or rather a kind of involuntary grin, is no uncommon symptom of this disease.

Every method must be taken to prevent a suppuration, as it is impossible to save the patient’s life when this happens. The regimen and medicine are in all respects the same as in the pleurisy. We shall only add, that in this disease emollient clysters are peculiarly useful, as they relax the bowels, and by that means make a derivation from the part affected.

171

CHAP. XVII. OF A PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.

As this disease affects an organ which is absolutely necessary to life, it must always be attended with danger. Persons who abound with thick blood, whose fibres are tense and rigid, who feed upon gross aliment, and drink strong viscid liquors, are most liable to a peripneumony. It is generally fatal to those who have a flat breast, or narrow chest, and to such as are afflicted with an asthma, especially in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole of the organ is affected; in which case the disease can hardly fail to prove fatal.

When the disease proceeds from a viscid pituitous matter obstructing the vessels of the lungs, it is called a spurious or bastard peripneumony. When it arises from a thin acrid defluxion on the lungs, it is denominated a catarrhal peripneumony, &c.

CAUSES.——An inflammation of the lungs is sometimes a primary disease, and sometimes it is the consequence of other diseases, as a quinsey, a pleurisy, &c. It proceeds from the same causes as the pleurisy, viz. an obstructed perspiration from cold, wet clothes, &c. or from an increased circulation of the blood by violent exercise, the use of spiceries, ardent spirits, and such like. The pleurisy and peripneumony are often complicated; in which case the disease is called a pleuro-peripneumony.

SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an inflammation of the lungs; only in the latter the pulse is more soft, and the pain 172less acute; but the difficulty of breathing, and oppression of the breast, are generally greater.

REGIMEN.——As the regimen and medicine are in all respects the same in the true peripneumony as in the pleurisy, we shall not here repeat them, but refer the reader to the treatment of that disease. It may not however be improper to add, that the aliment ought to be more slender and thin in this than in any other inflammatory disease. The learned Dr. Arbuthnot asserts, that even common whey is sufficient to support the patient, and that decoctions of barley, and infusions of fennel roots in warm water with milk, are the most proper both for drink and nourishment. He likewise recommends the steam of warm water taken in by the breath, which serves as a kind of internal fomentation, and helps to attenuate the impacted humours. If the patient has loose stools, but is not weakened by them, they are not to be stopped, but rather promoted by the use of emollient clysters.

It has already been observed, that the spurious or bastard peripneumony is occasioned by a viscid pituitous matter obstructing the vessels of the lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and wet seasons.

The patient at the beginning is cold and hot by turns, has a small quick pulse, feels sense of weight upon his breast, breathes with difficulty, and sometimes complains of a pain and giddiness of his head. His urine is usually pale, and his colour very little changed.

The diet in this, as well as in the true peripneumony, must be very slender, as weak broths, sharpened with the juice of orange or lemon, and such like. His drink may be thin water-gruel sweetened with honey, or a decoction of the roots of fennel, liquorice, and quick grass. An ounce of each of these may be boiled in three English pints 173of water to a quart, and sharpened with a little currant-jelly, or the like.

Bleeding and purging are generally proper at the beginning of this disease; but if the patient’s spittle is pretty thick, or well concocted, neither of them are necessary. It will be sufficient to assist the expectoration by some of the sharp medicines recommended for that purpose in the pleurisy, as the solution of gum ammoniac with oxymel of squills, &c. Blistering plasters have generally a good effect, and ought to be applied pretty early.

If the patient does not spit, he must be bled according as his strength will permit, and have a gentle purge administered. Afterwards his body may be kept open by clysters, and the expectoration promoted, by taking every four hours two table-spoonfuls of the solution mentioned above.

When an inflammation of the breast does not yield to bleeding, blistering, and other evacuations, it commonly ends in a suppuration, which is more or less dangerous, according to the part where it is situated. When this happens in the pleura, it sometimes breaks outwardly, and the matter is discharged by the wound.

When the suppuration happens within the substance or body of the lungs, the matter may be discharged by expectoration; but if the matter floats in the cavity of the breast, between the pleura and the lungs, it can only be discharged by an incision made betwixt the ribs.

If the patient’s strength does not return after the inflammation is to all appearance removed; if his pulse continues quick though soft, his breathing difficult and oppressed; if he has cold shiverings at times, his cheeks flushed, his lips dry; and if he complains of thirst, and want of appetite, there is reason to fear a suppuration, and that a phthisis or 174consumption of the lungs will ensue. We shall therefore next proceed to consider the proper treatment of that disease.

CHAP. XVIII. OF CONSUMPTIONS.

A consumption is a wasting or decay of the whole body from an ulcer, tubercles, or concretions of the lungs, an empyema, a nervous atrophy, or a cachexy.

Dr. Arbuthnot observes, that in his time consumptions made up above one-tenth part of the bills of mortality in and about London. There is reason to believe they have rather increased since, and we know from experience, that they are not less fatal in some other towns of England than in London.

Young persons, between the age of fifteen and thirty, of a slender make, long neck, high shoulders, and flat breasts, are most liable to this disease.

Consumptions prevail more in England than in any other part of the world, owing perhaps to the great use of animal food and malt liquors, the general application to sedentary employments, and the great quantity of pit-coal which is there burnt; to which we may add the perpetual changes in the atmosphere, or variableness of the weather.

CAUSES.——It has already been observed, that an inflammation of the breast often ends in an imposthume: consequently whatever disposes people to this disease, must likewise be considered as a cause of consumption.

175Other diseases, by vitiating the habit, may likewise occasion consumptions; as the scurvy, the scrophula, or king’s evil, the venereal disease, the asthma, small-pox, measles, &c.

As this disease is seldom cured, we shall endeavour the more particularly to point out its causes, in order that people may be enabled to avoid it. These are:

——Confined or unwholesome air. When this fluid is impregnated with the fumes of metals or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender vessels of that necessary organ.

——Violent passions, exertions, or affections of the mind; as grief, disappointment, anxiety, or close application to the study of abstruse arts or sciences.

——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery, the fluor albus, an over-discharge of the menstrual flux, giving suck too long, &c.

——The sudden stoppage of customary evacuations; as the bleeding piles, sweating of the feet, bleeding at the nose, the menses, issues, ulcers, or eruptions of any kind.

——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of a phthisis occasioned by a small bone sticking in the bronchæ. It was afterwards vomited along with a considerable quantity of purulent matter, and the patient, by a proper regimen, and the use of the Peruvian bark, recovered.

——Making a sudden transition from a hot to a very cold climate, change of apparel, or whatever greatly lessens the perspiration.

——Frequent and excessive debaucheries. Late watching, and drinking strong liquors, which generally go together, can hardly fail to destroy the lungs. Hence the bon companion generally falls a sacrifice to this disease.

176——Infection. Consumptions are likewise caught by sleeping with the diseased; for which reason this should be carefully avoided. It cannot be of great benefit to the sick, and must hurt those in health.

——Occupations in life. Those artificers who sit much, and are constantly leaning forward, or pressing upon the stomach and breast, as cutlers, taylors, shoemakers, seamstresses, &c. often die of consumptions. They likewise prove fatal to singers, and all who have occasion to make frequent and violent exertions of the lungs.

——Cold. More consumptive patients date the beginning of their disorders from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all other causes.

Sharp, saline, and aromatic aliments, which heat and inflame the blood, are likewise frequently the cause of consumptions.

We shall only add, that this disease is often owing to an hereditary taint, or a scrophulous habit; in which case it is generally incurable.

SYMPTOMS.——This disease generally begins with a dry cough, which often continues for some months. If a disposition to vomit after eating be excited by it, there is still greater reason to fear an approaching consumption. The patient complains of a more than usual degree of heat, a pain and oppression of the breast, especially after motion; his spittle is of a saltish taste, and sometimes mixed with blood. He is apt to be sad; his appetite is bad, and his thirst great. There is generally a quick, soft, small pulse; though sometimes the pulse is pretty full, and rather hard. These are the common symptoms of a beginning consumption.

Afterwards the patient begins to spit a greenish, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative sweats, which mutually succeed one another, viz. the one towards 177night, and the other in the morning. A looseness, and an excessive discharge of urine, are often troublesome symptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flushes after eating; the fingers become remarkably small, the nails are bent inwards, and the hairs fall off.

At last the swelling of the feet and legs, the total loss of strength, the sinking of the eyes, the difficulty of swallowing, and the coldness of the extremities, shew the immediate approach of death, which however the patient seldom believes to be so near. Such is the usual progress of this fatal disease, which, if not early checked, commonly sets all medicine at defiance.

REGIMEN.——On the first appearance of a consumption, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a situation in the country, where the air is pure and free. Here he must not remain inactive, but take every day as much exercise as he can bear.

The best method of taking exercise is to ride on horseback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of exercise, must make use of a carriage. A long journey, as it amuses the mind by a continual change of objects, is greatly preferable to riding the same ground over and over. Care however must be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finish his ride in the morning, or at least before dinner; otherwise it will oftener do harm than good.

It is pity those who attend the sick seldom recommend riding in this disease, till the patient is either unable to bear it, or the malady has become incurable. Patients are likewise apt to trifle with everything that is in their own power. They cannot see 178how one of the common actions of life should prove a remedy in an obstinate disease, and therefore they reject it, while they greedily hunt after relief from medicine, merely because they do not understand it.

Those who have strength and courage to undertake a pretty long voyage, may expect great advantage from it. This, to my knowledge, has frequently cured a consumption after the patient was, to all appearance, far advanced in that disease, and where medicine had proved ineffectual. Hence it is reasonable to conclude, that if a voyage were undertaken in due time, it would seldom fail to perform a cure^[72].

Such as try this method of cure ought to carry as much fresh provisions along with them as will serve for the whole time they are at sea. As milk is not easily obtained in this situation, they ought to live upon fruits, and the broth of chickens, or other young animals which can be kept alive on board. It is scarce necessary to add, that such voyages should be undertaken, if possible, in the mildest season, and that they ought to be towards a warmer climate^[73].

Those who have not courage for a long voyage may travel into a more southern climate, as the south of France, Spain, or Portugal; and if they find the air of these countries agree with them, they should continue there, at least till their health be confirmed.

179Next to proper air and exercise, we would recommend a due attention to diet. The patient should eat nothing that is either heating or hard of digestion, and his drink must be of a soft and cooling nature. All the diet ought to be calculated to lessen the acrimony of the humours, and to nourish and support the patient. For this purpose he must keep chiefly to the use of vegetables and milk. Milk alone is of more value in this disease than the whole materia medica.

Asses milk is commonly reckoned preferable to any other; but it cannot always be obtained; besides, it is generally taken in a very small quantity; whereas, to produce any effects, it ought to make a considerable part of the patient’s diet. It is hardly to be expected, that a gill or two of asses milk, drank in the space of twenty-four hours, should be able to produce any considerable change in the humours of an adult; and when people do not perceive its effects soon, they lose hope, and so leave it off. Hence it happens that this medicine, however valuable, very seldom performs a cure. The reason is obvious; it is commonly used too late, is taken in too small quantities, and is not duly persisted in.

I have known very extraordinary effects from asses milk in obstinate coughs, which threatened a consumption of the lungs; and do verily believe, if used at this period, that it would seldom fail; But if it be delayed till an ulcer is formed, which is generally the case, how can it be expected to succeed?

Asses milk ought to be drank, if possible, in its natural warmth, and, by a grown person, in the quantity of half an English pint at a time. Instead of taking this quantity night and morning only, the patient ought to take it four times, or at least thrice a-day, and to eat a little light bread along with it, so as to make it a kind of meal.

180If the milk should happen to purge, it may be mixed with old conserve of roses. When that cannot be obtained, the powder of crabs claws may be used in its stead. Asses milk is usually ordered to be drank warm in bed; but as it generally throws the patient in a sweat when taken in this way, it would perhaps be better to give it after he rises.

Some extraordinary cures in consumptive cases have been performed by women’s milk. Could this be obtained in sufficient quantity, we would recommend it in preference to any other. It is better if the patient can suck it from the breast, than to drink it afterwards. I knew a man who was reduced to such a degree of weakness in a consumption, as not to be able to turn himself in bed. His wife was at that time giving suck, and the child happening to die, he sucked her breasts, not with a view to reap any advantage from the milk, but to make her easy. Finding himself however greatly benefited by it, he continued to suck her till he became perfectly well, and is at present a strong and healthy man.

Some prefer butter-milk to any other, and it is indeed a very valuable medicine, if the stomach be able to bear it. It does not agree with every person at first; and is therefore often laid aside without a sufficient trial. It should at first be taken sparingly, and the quantity gradually increased, until it comes to be almost the sole food. I never knew it succeed unless where the patient almost lived upon it.

Cows milk is most readily obtained of any, and though it be not so easily digested as that of asses or mares, it may be rendered lighter by adding to it an equal quantity of barley-water, or allowing it to stand for some hours, and afterwards taking off the cream. If it should notwithstanding prove heavy on the stomach, a small quantity of brandy 181or rum, with a little sugar, may be added, which will render it both more light and nourishing.

It is not to be wondered, that milk should for some time disagree with a stomach that has not been accustomed to digest any thing but flesh and strong liquors, which is the case with many of those who fall into consumptions. We do not however advise those have been accustomed to animal food and strong liquors, to leave them off all at once. This might be dangerous. It will be necessary for such to eat a little once a-day of the flesh of some young animal, or rather to use the broth made of chickens, veal, lamb, or such like. They ought likewise to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether.

These must be used only as preparatives to a diet consisting chiefly of milk and vegetables, which the sooner the patient can be brought to bear, the better. Rice and milk, or barley and milk, boiled with a little sugar, is very proper food. Ripe fruits roasted, baked, or boiled, are likewise proper, as goose or currant berry tarts, apples roasted, or boiled in milk, &c. The jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly of currants, conserve of roses, preserved plums, cherries, &c.

Wholesome air, proper exercise, and a diet consisting chiefly of these and other vegetables, with milk, is the only course that can be depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure.

In a populous town in England^[74], where consumptions are very common, I have frequently seen 182consumptive patients, who had been sent to the country with orders to ride, and live upon milk and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was hereditary, or far advanced; but it was the only method in which success was to be expected: where it failed, I never knew medicine succeed.

If the patient’s strength and spirits flag, he must be supported by strong broths, jellies, and such like. Some recommend shell-fish in this disorder, and with some reason, as they are nourishing and restorative^[75]. All the food and drink ought however to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circulation of the blood.

The patient’s mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always aggravated, by a melancholy cast of mind; for which reason music, cheerful company, and every thing that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render them worse.

MEDICINE.——Though the cure of this disease depends chiefly upon regimen and the patient’s own endeavours, yet we shall mention a few things which may be of service in relieving some of the more violent symptoms.

In the first stage of a consumption, the cough may sometimes be appeased by bleeding; and the expectoration may be promoted by the following medicines. Take fresh squills, gum-ammoniac, 183and powdered cardamum seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass proves too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient’s stomach will bear them.

The lac ammoniacum, or milk of gum-ammoniac, as it is called, is likewise a proper medicine in this stage of the disease. It may be used as directed in the pleurisy.

A mixture made of equal parts of lemon-juice, fine honey, and syrup of poppies, may likewise be used. Four ounces of each of these may be simmered together in a sauce-pan, over a gentle fire, and a table-spoonful of it taken at any time when the cough is troublesome.

It is common in this stage of the disease to load the patient’s stomach with oily and balsamic medicines. These, instead of removing the cause of the disease, tend rather to increase it, by heating the blood, while they pall the appetite, relax the solids, and prove every way hurtful to the patient. Whatever is used for removing the cough, besides riding and other proper regimen, ought to be medicines of a sharp and cleaning nature; as oxymel, syrup of lemon, &c.

Acids seem to have peculiarly good effects in this disease; they both tend to quench the patient’s thirst and to cool the blood. The vegetable acids, as apples, oranges, lemons, &c. appear to be the most proper. I have known patients suck the juice of several lemons every day with manifest advantage, and would for this reason recommend acid vegetables to be taken in as great quantity as the stomach will bear them.

For the patient’s drink, we would recommend infusions of the bitter plants, as ground-ivy, the 184lesser centaury, camomile flowers, or water-trefoil. These infusions may be drank at pleasure. They strengthen the stomach, promote digestion, rectify the blood, and at the same time answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spits blood, he ought to use, for his ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.^[76]

There are many other mucilaginous plants and seeds, of a healing and agglutinating nature, from which decoctions or infusions may be prepared with the same intention; as the orches, the quince-seed, coltsfoot, linseed, sasaparilla, &c. It is not necessary to mention the different ways in which these may be prepared. Simple infusion or boiling is all that is necessary, and the dose may be at discretion.

The conserve of roses is here peculiarly proper. It may either be put into the decoction above prescribed, or eaten by itself. No benefit is to be expected from trifling doses of this medicine. I never knew it of any service, unless where three or four ounces at least were used daily for a considerable time. In this way I have seen it produce very happy effects, and would recommend it wherever there is a discharge of blood from the lungs.

When the spitting up of gross matter, oppression of the breast, and the hectic symptoms, shew that an imposthume is formed in the lungs, we would recommend the Peruvian bark, that being the only drug which has any chance to counteract the general tendency which the humours then have to putrefaction.

An ounce of the bark in powder may be divided into eighteen or twenty doses, of which one may be 185taken every three hours through the day, in a little syrup, or a cup of horehound tea.

If the bark should happen to purge, it may be made into an electuary, with the conserve of roses, thus: Take old conserve of roses a quarter of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon, as much as will make it of the consistence of honey. This quantity will serve the patient four or five days, and may be repeated as there is occasion.

Such as cannot take the bark in substance, may infuse it in cold water. This seems to be the best menstruum for extracting the virtues of that drug. Half an ounce of bark in powder may be infused for twenty-four hours in half an English pint of water. Afterwards let it be passed through a fine strainer, and an ordinary tea-cupful of it taken three or four times a-day.

We would not recommend the bark while there are any symptoms of an inflammation of the breast; but when it is certainly known that matter is collected there, it is one of the best medicines which can be used. Few patients indeed have resolution enough to give the bark a fair trial at this period of the disease, otherwise we have reason to believe that some benefit might be reaped from it.

When it is evident that there is an imposthume in the breast, and the matter can neither be spit up nor carried off by absorption, the patient must endeavour to make it break inwardly, by drawing in the steams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, &c. When it happens to burst within the lungs, the matter may be discharged by the mouth. Sometimes indeed the bursting of the vomica occasions immediate death, by suffocating the patient. When the quantity of matter is great, and the patient’s 186strength exhausted, this is commonly the case. At any rate the patient is ready to fall into a swoon, and should have volatile salts or spirits held to his nose.

If the matter discharged be thick, and the cough and breathing become easier, there may be some hopes of a cure. The diet at this time ought to be light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c. the drink, butter-milk, or whey, sweetened with honey. This is likewise a proper time for using the Peruvian bark, which may be taken as directed above.

If the vomica or imposthume should discharge itself into the cavity of the breast, betwixt the pleura and the lungs, there is no way of getting the matter out but by an incision, as has already been observed. As this operation must always be performed by a surgeon, it is not necessary here to describe it. We shall only add, that it is not so dreadful as people are apt to imagine, and that it is the only chance the patient in this case has for his life.

A nervous consumption is a wasting or decay of the whole body, without any considerable degree of fever, cough, or difficulty of breathing. It is attended with indigestion, weakness, and want of appetite, &c.

Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease.

We would chiefly recommend, for the cure of a nervous consumption, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach; as the Peruvian bark, gentian root, camomile, horehound, &c. These may be infused in water or wine, and a glass of it drank frequently.

187It will greatly assist the digestion, and promote the cure of this disease, to take twice-a-day twenty or thirty drops of the elixir of vitriol in a glass of wine or water. The chalybeate wine is likewise an excellent medicine in this case. It strengthens the solids, and powerfully assists Nature in the preparation of good blood^[77].

Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recommend a long journey of pleasure, as the most likely means to restore his health.

What is called a symptomatic consumption cannot be cured without first removing the disease by which it is occasioned. Thus, when a consumption proceeds from, the scrophula or king’s evil, from the scurvy, the asthma, the venereal disease, &c. a due attention must be paid to the malady from whence it arises, and the regimen and medicine directed accordingly.

When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient’s strength must be restored by gentle exercise, nourishing diet, and generous cordials. Young and delicate mothers often fall into consumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, otherwise they cannot expect a cure.

Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptions, to take as much exercise without doors as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase 188not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of hot punch or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and spoil the appetite, but heat and inflame the blood, and set the whole constitution on fire.

CHAP. XIX. OF THE SLOW OR NERVOUS FEVER.

Nervous fevers have increased greatly of late years in this island, owing doubtless to our different manner of living, and the increase of sedentary employments; as they commonly attack persons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors.

CAUSES.——Nervous fevers may be occasioned by whatever depresses the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, unripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fatal to those who live in dirty low houses, crowded streets, hospitals, jails, or such-like places.

Persons whose constitutions have been broken by excessive venery, frequent salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease.

Keeping on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs 189the perspiration, or causes a spasmodic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so much to preserve the body in a sound state as a regular diet; nor can any thing contribute more to occasion fevers of the worst kind than its opposite.

SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chillness and flushing in turns, &c.

After some time the patient complains of a giddiness and pain of the head, has a nausea, with reachings and vomiting; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienations of mind.

If towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin; or if a suppuration happens in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis.

But if there is an excessive looseness, or wasting sweats, with frequent fainting fits; if the tongue, when put out, trembles excessively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there is a starting of the tendons, an almost total loss of sight and hearing, and an involuntary discharge by stool and urine, there is great reason to fear that death is approaching.

190REGIMEN.——It is very necessary in this disease to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient’s imagination gloomy or frightful ideas. These of themselves often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate them.

The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or small negus, sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mustard-whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine^[78].