THE CURE OF THE MILIARY FEVER.
THE CURE OF THE MILIARY FEVER.
To which is Annex'd, Advice to the Apothecaries.
By CHARLES HALES, Surgeon.
You, whosoever you are, insigniz'd or not insigniz'd with the Degree of Doctor, Master, or Batchelor, whether skilful in Art, or by some other Privilege promoted, pause a while, and hear what I have here to say. I will shew you the Truth, without any Mixture of Falsity. I will make you understand who proceeds rightly, and who unadvisedly.
You Apothecaries; you, I say, who hitherto have been blind, suffer a Collyrium to be poured into your Eyes, and permit them to be anointed with Balsam, that the most thick Skin of Blindness may fall from your Sight, and you behold the Truth as in a most clear Glass.
THE SECOND EDITION.
LONDON: Printed for C. SAY, in Newgate-Street.
MDCCLIV.
THE PREFACE.
THE miliary Fever, either in its simple or compound State, is the most frequent Disease that happens to Men, Women, and Children, of all Degrees, and almost all Ages, throughout all Seasons of the Year; in Child-bed Women 'tis rare to meet with any other Fever of Consequence: Notwithstanding hitherto it has been less taken Notice of by Authors in general, is less known by the Physicians and Apothecaries, and its [Page iv] right Method of Cure less understood, than any other acute Distemper that afflicts Mankind.
How to account for this general, but unpardonable Ignorance, I am much at a Loss, except the prevailing Opinion of some Physicians, That this Fever is a Creature of our own making, and that the Eruption is brought forth by the Use of too hot Medicines; I say, except that prevailing Opinion has run through the whole College, and from thence the dangerous Infection been conveyed to the Apothecaries; of whom the greatest Part are indeed so very inconsiderate and negligent, and so little inquisitive into the Nature of Distempers, that they must of Consequence be great Strangers to Observation [Page v]and Experience, the most faithful Guides to a right Practice of Physic. I would not romance, or speak with Malice, but can assert with great Confidence, that I have had an Opportunity of discoursing with some Physicians, and many Apothecaries, concerning the Nature and Treatment of this Distemper; but, good God, how great their Ignorance, how unaccountable their Stupidity and Obstinacy! I can hardly forbear blushing when I think of it, and yet all the Assurance I could give them of my Success, by Word of Mouth, had no Effect, they still resolutely persisting in their destructive Treatment, tho' half of their Patients fell under their Hands; till I had an Opportunity of convincing them by ocular [Page vi]Demonstration, with how much Safety, Ease, and Expedition, I cur'd those who were under my own Care; and almost with as much Certainty as Intermittents by the Bark; not more than one in twenty dying, except I have been called in at the last Stage of the Distemper, when I found their Mittimus already signed. During several of my younger Years, I had an Opportunity of attending one of these Gentlemen, very eminent in his Profession, and in great Practice; but, all the Time I was with him, I only once heard mention'd the Words miliary Fever, and those in so slight a Manner, as not sufficiently to attract my Attention; but knew nothing of the Nature of the Distemper, or the miliary Eruption, having [Page vii]not seen one Patient, who, it was said, had them, altho' this Gentleman had been in the Profession Twenty Years;
Monstrum horrendum, informe, ingens, cui Lumen ademptum.
And that it is a Fever sui generis, and altogether as different from other Fevers, as the Measles from the Small-Pox, is with me out of Dispute; and that it existed, long before my Time, is sufficiently recorded by the Testimonies of Sir Richard Blackmore and Sir David Hamilton; the last of whom Dr. Cheyne mentions with great Reverence and Respect (a)
That the Eruption is caus'd by the Use of too hot Medicines and Regimen, I absolutely deny, altho' such Method, I know, will prolong the Cure, if it does not soon kill the Patient; for I have often attended poor Men, Women, and Children, who have scarcely had Cloaths to cover them, and have taken no Medicines, but drank cold Water, or [Page ix]Small-Beer, four or five Days or longer, before I have been call'd to them, and yet this Fever, according to the best Account I could collect, has gone thro' its various Symptoms, but in a terrible Manner, even to a very plentiful Eruption of the crystalline Pustles; but, by the Use of too cold a Regimen, then almost ready to expire for Want of other Assistance, such as cordial and diaphoretic Medicines, to conduct them safely thro' the last Stage of the Disease, which was by such Means very soon and surprisingly effected.
In the Year 1741, this Fever in its worst Degree was more epidemical than ever I have found it within my Time, and swept away great [Page x]Numbers of People of all Degrees and Ages under Fifty, (for few above that Age were then seiz'd with it,) insomuch that the Bills of Mortality amounted weekly to twelve or fifteen Hundred, for a considerable Time: In the Beginning of this Constitution, Patients were treated, by other Practisers as well as myself, with Bleeding and Vomiting indiscriminately, Blistering early and without Mercy, Sal Nitri, or Saline Draughts, with or without Sal. Vol. C. C. which were continu'd four or five Days without real Advantage, and were then changed for Conf. Raleigh, which, doing no more Service than the former, was again chang'd in three or four Days more for Sal. C. C. Pulv. Serp. &c. which then brought on [Page xi] Delirium and Subsultus Tendinum, Symptoms which introduc'd a Succession of Blistering Plaisters from Head to Foot, which were not likely to relieve the Patient in any Degree, so long as the Causes of all this Mischief, too hot Medicines, were daily repeated, till the Scene clos'd in Death; but which did not frequently happen till the 15th, 20th, or sometimes the 25th Day; with this Satisfaction only to their surviving Relations and Friends, that they had, as they thought, done all that could be done for the Deceas'd; altho', to speak the Truth, they could not take a more effectual Method to remove them out of the World. This shocking Success, which made me almost weary of my Profession, as I could not avoid [Page xii]thinking, that we all treated this Fever after a wrong Manner, obliged me often to think seriously upon the Matter, and examine many of the best Authors, who had wrote of Fevers; I could find nothing in them that suited my Purpose, and but very few that even mention'd such a Fever; till, dipping into Allen's Synopsis, I found that Sir David Hamilton's Treatise upon that Subject was my chief Dependance (c) This I procur'd, and, after reading it over and over again with great Attention, determin'd to follow the same Method in that Case, with all the Patients who should [Page xiii]happen afterwards to fall under my sole Management; as I religiously observ'd the speculative, as well as the practical Part, so did I ever after as happily conduct my Patients thro' every Stage of the Disease; for, as before, not more than five out of ten liv'd, so now not one in ten died, and those only who had some other Disease in Conjunction with this Fever; with this Inconvenience only, that the Cure, tho' almost certain, was very tedious, even 20, 25, or 30 Days. But happy was I, that I had met with even a tedious Cure; nothing now remain'd for me to do, but farther to consider if it was not practicable to contract the Cure within a shorter Compass, by more powerful Medicines, and yet such as would by no Means aggravate [Page xiv]the Symptoms. Whilst I was thus pondering, I recollected that my Author observ'd, as a favourable Prognostic, that the drowsier Patients are, the happier they recover (d) . Reasoning with myself upon this Principle, I luckily hit upon a speedier Method, which from Time to Time, with the greatest Care and Attention, I alter'd, till I had reduc'd the Cure of this devouring Fever to as great Certainty, as almost any we can boast of in the Practice of Physic: Thus I fix'd the Rule of my Practice for the future, and which I have continu'd from that Time to this, with so [Page xv]much Success, that, for seven Years past, I confidently affirm, I have not lost above four Patients out of a Hundred, of that Fever in its simple State; nay furthermore, for one Patient that I have had under my Care fifteen Days, ten have perfectly recover'd in two Thirds of the Time, and, even in many, all dangerous Symptoms have been absolutely remov'd before the Eruption appear'd; which, altho' it may seem strange to most of our Profession, is nevertheless no more strange than true, as they themselves may prove, if they diligently observe the Nature of the Disease, and exactly follow the Method of Cure, as I have done before them.
For the present Purpose, I have abstracted from Sir David Hamilton, and Sir Richard Blackmore, all that I judge necessary in Relation to the Description and Nature of this Fever; to which I have added occasional Remarks, and my own Method of Cure, which by repeated Trials, and diligent Observation, I have prov'd to be more easy, speedy, and safe, than even theirs, or any other, that I know of; if any Body shall hereafter publish a better, I shall receive the same with as much Satisfaction as I communicate mine, having nothing more at Heart than the Service of my Profession, and the Use of all possible Means for the public Welfare. I have taken the Liberty to give Advice to the Apothecaries [Page xvii]in general, which (how much soever I may be censur'd for it) I am sure they stand much in Need of at this Time of Day, as their own Consciences must undoubtedly tell them; for it is not the Physician's Attendance and Prescriptions, on which they so much rely, that will alone cure Diseases; there are many other Requisites absolutely necessary, which of Consequence fall to the Medicaster's Share.
OF THE MILIARY FEVER.
THE PREFACE.
I Have chosen to describe, before all other Diseases, the Nature and Method of curing a Miliary Fever; because I know of none who have hitherto treated of this Fever, as of a different Sort, at least, in any satisfactory Way; when, notwithstanding, I have known it, in several, to turn either into a chronical Distemper, or in a short Time to prove fatal. For this sometimes comes to pass, in a mild Beginning of this Distemper, from a Neglect of themselves, or thro' an Impatience of the Sick at its long Continuance; and sometimes [Page xxii]also from the Ignorance of the Physicians, being deluded with its fallacious Symptoms; or, lastly, thro' an unreasonable Fear (e) of being thought greedy of Gain, they omit continuing their necessary Visits. Wherefore, I have thought it a Work worthy of my Time, if by these my Observations, being diligently collected from the daily Inspection, or Attendance upon sick Persons, I might afford some Light to young Practitioners; and by these Means stir up the more skilful to publish their own; and the Reader may assuredly believe, that I have acted with great Veracity.
OF THE MILIARY FEVER.
Of the Name, Kind, and Sorts of this Distemper.
A Miliary Fever take its Name from the Pustles, or Vesicles, in some Sort resembling the Form of Gromwel Seeds, appearing chiefly about the upper Parts; yet I think it ought rather to be called a vesicular Fever, because the Pustles are Vesicles, or little Blisters, filled at first with a limpid Serum, and afterwards with a whitish, not unlike to the Colour of Pearls.
There are some who think, that only the pestilential and spotted Fevers ought to be reckoned amongst the malign Kind; but I am of Opinion, that there are likewise others of a different Species, which may very well be referred to the malign Class.
1. What Kind of Fevers soever, which are acquired by Contact, or Breathing (Vapour) or any other Manner of Infection.
2. Also those Sorts of Fevers, which, immediately from the Beginning, are accompanied with a violent Pain, and fix'd to some Part; as to the Head, or Region of the Guts, or Kidneys, or even to the Limbs: Like as if the Patient should be affected with a Pain of the Head, or a Cholic, or a nephritic, or a gouty, or a rheumatic Pain; or even with the Pains (like those) of Child-birth, as if the same was an original Distemper; when, notwithstanding, [Page 25]such Sort are the Symptoms of a miliary Fever; they will not give Way to Remedies which are wont to be of Service, when the Diseases so nam'd are primary.
3. Also in whom the animal Spirits are suddenly oppress'd and eclips'd; and where the aforesaid Symptoms seem to depend on no evident Cause, but on a certain latent Poison, call'd, by the Antients, an occult Quality, and by the Moderns, Vapours.
Or, Lastly, where sudden Death arises from a Cause which seems to be void of Danger; all which, as they denote a Malignity, so also have I observed the same to happen in a miliary Fever.
And it is worthy of Remark, that this Fever rages with the same Malignity, as the petechial or spotted Fever in the Indies.
This Kind of Fever is two-fold, simple and compound. I call it simple, as often as no Pustles besides the miliary appear, whereof I am going to discourse; but compound, when red, papillary Pustules are interspers'd with the miliary, and which, when they are solitary, are commonly called a Rash. And it is farther to be observ'd that miliary Pustules are sometimes intermix'd with the Small-Pox, and, while the Small-Pox rises up, those gradually wither away; but remain standing, after the papillary are dried up.
A Description of the Miliary Fever.
That I may the better describe the History of a miliary Fever, I shall reckon up the Antecedents, Concomitants, and Consequences.
The Antecedents are, a weak Constitution of Body, whether the same be natural [Page 27]or adventitious, caus'd by immoderate Evacuations, or too spare Diet; a serous or wat'ry Blood; a weak and timorous Mind, and easily annoy'd by external Accidents, as in Women and effeminate Men; much and deep Study (or Thought-fulness) or Sorrow; an Obstruction, or Ulcer in any Part, attended with Pain: Whence those Persons who have been long afflicted with a Cholic Pain, Gout, or Stone, or an Ulcer of the Kidneys, are more obnoxious to this Fever. Also an inward Heat in Women, with or without Thirst, and especially about the Time of their Delivery, whereby also the Pains of Child-bearing are less severe than usual, and the Spirits, without any evident Cause, are very much depress'd, with an Oppression of the Breast, causing Sighs; wherein, as in all other Fevers, here also generally happens an external Coldness.
The Concomitants, or Symptoms accompanying this Fever, are oftentimes a Pain resembling that of the Cholic, Stone [Page 28]of the Kidneys, Pleurisy, Rheumatism, or that of Child-birth; likewise an Oppression of the Breast, with a Sinking of the Spirits: And, two or three Days after the said Pain is gone off, there comes on a Shivering of the whole Body, and then a Coldness and an Heat alternately arise. Yet this Heat is milder than in a common continual Fever, and comes nearer to that of natural; the Palms of the Hands are affected with a more intense Heat, while the Back-part is much cooler; the Pulse also is frequent, but weak; the Spirits often flag very much; and the Breast, being oppressed as it were with a great Weight, causeth Sighings; the Sleep stealing on is suddenly interrupted, the most inseparable Token of all the Symptoms; for the Patients are often without Sleep for many Days and Nights together (f) without a Delirium, or a Pain of the Head, and generally much longer than in other Fevers. I met with a very [Page 29]singular Example of this Case, in a certain Lady who was under the Care of the learned Dr. Bernard. She was a whole Month in this Fever, without Sleep; yet free of a Delirium, or any Pain in the Head.
The Tongue is sometimes cover'd over with white Aphthoe, or a Thrush, and sometimes like that of Persons in Health; the Urine is one while as pale as common Water, at others, of a natural Colour: Which Symptoms, deceiving young Physicians, make them frequently attribute this Effect to the Vapours, as they term it. They who are seized with this Fever, are some times afflicted with a Sickness at Stomach, especially after Sleep; and sometimes with a Soreness, either by their own Negligence, or a bad Practice; to wit, while heating Medicines, usual in hysteric Paroxysms, are prescrib'd, without Diaphoretics; whence in Lieu of a mild Procedure of Nature, expelling the morbific Matter by a gentle Sweating, a rapid Fermentation throws down the same into the Guts. The Belly [Page 30]is sometimes bound, and sometimes loose, with a Sickness at the Stomach, and Pains of the Bowels; one while they are thirsty, at others, very little; sometimes the Hands and Tongue, being stretched out to the Physician, tremble, and the Patient speaks in a trembling Manner; they are also often molested with convulsive Motions, a Delirium, and a difficult Respiration; the Exacerbations of which Symptoms return like the Paroxysms of an intermitting Fever. An Oppression of the Breast with Sighing, or a greater Sinking of the Spirits, without manifest Cause; Watchings, and a Commotion of the Spirits, commonly called a Hurry in the Head, as often as the Sick compose themselves to Sleep; as likewise a frequent and weak Pulse, being conjoin'd with certain other Symptoms, are always the Fore-runners of the miliary Pustles at Hand: And they are all wont to continue till the miliary Pustles break out, and then the Patients are freed from most of them.
These Pustles generally appear in the Breast, Neck, and Interstices of the Fingers, sometimes also in the whole Body; and, after a daily and gradual Increase, they at last vanish away, leaving the Skin rough in the Seats of the Pustles. They sometimes itch, especially in a complex miliary Fever; that is, where red papillary Pustles are mix'd with the miliary. And it is to be observ'd, that, by how much simpler this Fever is, by so much slighter are the Symptoms, and which for this very Reason frequently creates a Neglect, both in the unwary Physicians, and in the Patients; whereby this Fever either becomes more perilous, or another Disease often arises; for, by taking less Care at first than ought to have been used, it sometimes begins with more grievous Symptoms; as, with a Sickness of the Stomach, Loss of Appetite, an inward Heat, an Oppression of the Breast, Sinking of the Spirits, Sighing and irregular Returns of Heat and Cold, Watchings, and the like. In the Declination of this [Page 32]Fever, the upper Part of the Hands are often moisten'd with a cold Sweat.
It is very difficult to observe, whether the miliary Pustles are wont to appear on a certain Day; seeing the first Appearance of this Distemper, and the Patient's Account of the same, are so uncertain. But, as far as I can learn, I take them mostly to appear about the Tenth or Eleventh Day from the Beginning, if so be the Fever have a regular Progress, and are dried up about the Eighteenth; or, where there is Plenty of morbific Matter, about the Twenty-first or Twenty-second Day.
I have chiefly endeavour'd to observe the Time of the Eruption in those Women, to whom I have been call'd, on the Third Day after their Delivery; and have heard them complaining of a Shivering or Coldness, follow'd with an Heat: For when I found, in looking upon their Breast and Neck, the miliary Pustles there, I concluded, that they had been seiz'd many Days [Page 33]before with a miliary Fever; and, upon a strict Scrutiny made even from the Beginning of the Distemper, I understood that they had perceiv'd either a preternatural Heat, or a Pain of some Part, with or without Thirst, and a vehement Oppression of the Breast, with Sighings, and a Sinking of the Spirits before they were brought to-bed; which Symptoms being suppos'd to depend on the approaching Birth, they hop'd all wou'd be well, when it was over. Moreover, altho' they have the Pains of Childbirth milder than usual, yet the great Oppression of the Breast in such, with the Sighing and Deficiency of Spirits (called by the Midwives Fear and Vapours) and the quick and weak Pulse are sure Prognostics of the approaching miliary Pustles; to whose Eruption in Child-bed Women, a Way is made by their composing in Bed to sweat: Therefore I commonly reckon eleven Days from the first inward Heat, or Pain before the Birth, to the Eruption after the Birth. But the Ignorance, and preposterous Relation the Patients give of their [Page 34]own State, do, for the most Part, so confound the Physician's Prognostic, that even the most curious can't find out the very Day.
The Consequences of a miliary Fever, as far as my Observation reacheth, are a Swelling of the Thighs, Legs, and Feet, not always free from Pain; a Swelling and Abscess of the Breasts; an immoderate Flux of the Lochia, and of Urine; Hypocondriac or Hysteric-like Affects; an inward Heat join'd with a Weakness, Faintness; and Loss of Appetite: One or other of these, I say, are generally the Consequences, as often as this Fever, either by Reason of its own Ill-nature, or bad Treatment of the Physician, makes an unhappy Ending (g) .
Of the Prognostic Signs in this Fever.
A Prognostic is thus to be made in this Fever; if the Sick hath not observ'd a due Regimen in the Beginning, or the Physician prescrib'd heating Medicines, not raising a Sweat; altho' the Symptoms were milder from the Beginning, yet the Distemper often turns to the worse, and threatens either Death or a lingering Illness.
If some Part should be pain'd from the Beginning; or the Patient grow hot without Pain; or be sick at the Stomach; and afterwards should have irregular Returns of hot and cold Fits, and a Sinking of the Spirits, and an Oppression of the Breast, with Sighings, attended with a free Breathing, and the Pustles come out at last with a gentle and continu'd Sweating; the Case is generally hopeful. If a Delirium, convulsive Motions, a Convulsion, or an Apoplexy, should accompany the Pathognomonic Signs of the Fever, that is, a great Oppression of the Breast, with Sighing, and Sinking of the Spirits, and they should happen in the Beginning, they yield more easily to a regular and diligent Practice: But in a more advanced State of the Distemper, and in the Declination, where the Sick is weaker, and the miliary Pustles, either by catching Cold, or perhaps by an irregular Management, do not appear, a deadly Translation is made upon the Brain [Page 37]and Nerves, and Death the speedy Consequence of it.
A yellow Colour of the Urine, which suddenly turns pale, warns the Physician, that a Translation is to be feared.
A Looseness in Child-bed Women, seiz'd with this Fever, is a dangerous Symptom; for it not only hinders the Eruption of the Pustles, but also the Flowing of the Lochia.
A difficult Breathing, an intercepted Speech, and a Trembling of the Tongue, are to be rank'd amongst the perilous Symptoms, especially a nervous Dyspnaea, or Difficulty of Breathing
The drowsier the Patients are, the happier they recover.
Those who are of a milder Nature, escape more easily, than the furious and wrathful Tempers do.
If Nature and the Physician concur together, the Sick immediately recovers Strength, after the drying up of the Pustles; unless, by Reason of the Abundance of morbific Matter, the Relicks be thrown upon some certain Part.
If in a Scarlet Fever miliary Pustles should arise, dying away with a red Colour, they promise Safety.
OF THE MILIARY FEVER.
OF THE MILIARY FEVER.
THE miliary Fever, so called from the small red Eruptions that resemble Millet-seed, is the most frequent in this Country of all the malignant Kind.
The Patient often seems to himself at first only somewhat faint and indispos'd, his Strength and Appetite diminished, and his Sleep interrupted, and his Dreams disorderly and tumultuous, while he goes abroad and applies to his usual Business, and hopes his Indisposition will soon wear off, not suspecting that he nourishes a malignant Fever in his Bosom. At length after about seven or eight Days, when he [Page 42]has taken to his Bed, by Means of copious and profuse Sweats, the miliary Eruptions before mention'd appear in the Temples, the Neck and Breast, and sometimes spread over the whole Body. If the Quantity be not great, as in the distinct Kind of the Small-Pox, they generally presage a happy Event; but if they are very numerous, and cover the whole Surface of the Skin, then, like the Small-Pox of the confluent Kind, they are often fatal, and always dangerous; and they are in this too like that Sort of Small-Pox, that, as I have seen, in their Ripening, they sometimes flow or run into each other (h)
These little red Eruptions grow by Degrees to Maturity, acquire white Heads full of Matter, and then grow dry, and die away; which Course, in the more kindly Sort, is generally accomplish'd in seven [Page 43]Days; but, in the worst Sort, the Time is much farther protracted, and this happens also in the worst Sort of Small-Pox; and it is very remarkable, that it sometimes falls out, that in this Sort of Fevers, after one Eruption of a more malignant Kind has compleated its Course, and the Skin is clear'd of its putrid Crop, yet a swift, troubled Pulse, great Drought and Want of Spirits, shall continue, and the Physician may be assur'd, that either Death, or another Eruption (i) like the first is at Hand, to carry off the Matter of the Fever, which the first was unable wholly to perform: And this I have seen repeated the third Time, and even after that the Patient has recover'd, which but rarely happens.
The great and profuse Sweats, that precede the miliary Eruption, are by no Means [Page 44]such as critically discharge the Putrefaction that causes the Disease; but they arise from the violent Conflict and Agitation of the Blood, while the sound and active Parts exert their Force, to digest and expel the Matter of the Disease; and therefore they do not relieve oppress'd Nature, but sink and weaken the Spirits by an excessive Evacuation (k) ; which however is necessary, that the putrid Parts may be excluded from the Blood by the miliary Eruptions that follow, in which consists the critical Separation by which Nature is deliver'd, and the Blood recovers its healthful State; as it does by casting out the Matter of the Small-Pox, at first complicated and entangled with the Mass of Blood.
Some Physicians, too fond of the cool Method in the Management of Fevers, from their Observation of the Usefulness of that Conduct in inflammatory Distempers, such as the Small-Pox, Rheumatisms, Pleurisies, Quinsies, and St. Anthony's Fire; have injudiciously extended it to the Cure of malignant Cases, in which a considerable Quantity of the Blood is putrefied or perish'd by the Dissolution or Separation of the Parts, as before describ'd; but they seem not to act under the Guidance of Reason, but, in a mechanical Way of Practice, apply the same Method of Cure to all Sorts of Fevers, tho' their Nature be ever so much distinguish'd. And hence it is, that these Gentlemen will not allow, that the miliary Eruptions are a regular Discharge of the Feverish Matter from the Blood; but, say they, they are the Effect of an unskilful Conduct, in using Remedies of too hot a Nature, by which the Blood is put into too great a Hurry and Agitation : But this Assertion affronts all Reason and Observation. [Page 46]They may as well affirm, that the Small-Pox, Measles, and Scarlet Suffusions, Boils, and Blanes, wou'd never appear on the Skin, were they not produc'd and excluded by the Administration of too warm and active Remedies. I have often seen those Eruptions break out in great Abundance, where the cool Method has been exactly observ'd; and of this every Practiser may be soon convinc'd, if he carefully attends to the Growth and Progress of this Distemper. In this, as in the Diseases above-nam'd, the hurtful Matter, admitted into the Blood, is by Nature's Determination to be first concocted, and then separated by the Strainers of the Skin, where being entangled, and not suffered to perspire, it produces a miliary Harvest; and a Physician, being but a Servant of Nature, ought to follow her Steps, promote her Intentions, and not to turn her from her Path, and oppose her Operations (l)
When a Patient has long struggled with a Fever accompanied with Putrefaction, and, after twelve Days, no miliary Breakings [Page 48]out are observ'd, it is usual that small wat'ry Bladders, from their Transparency, call'd crystalline, appear in the Temples, Neck, and Breast, which often gradually ripen, and become full of Matter; these perform the Office of the former Eruptions, by freeing the Blood of the noxious Ferment that disturbs it, but not so safely and effectually (m) .
It is to be observ'd, that there is a Fever, which I call hypochondriacal or hysteric, tho' it be not rang'd in the Classes [Page 49]of that Disease by any Authors, as far as I know, that, by its Similitude to the malignant Kind, often imposes on Physicians, and induces them to believe that it is of that Sort. And this is the only true Fever of the Spirits, and which I have often seen. It imitates closely the malignant Sort in the greatest Parts of its Symptoms, but it differs in this, that the Exercise of their Reason is not interrupted, or suspended, during its whole Course, which runs out sometimes to more than twenty Days; whereas most commonly the Head is much, if not chiefly affected, and the Faculties of Reason and Memory are greatly disturb'd and broken, in malignant Fevers. Another Distinction is, that in the first Sort the Patient is not troubled with Looseness, or Thrush; nor do there ever appear in the Skin any miliary Eruptions, or Spots, of any Sort whatsoever. But on the contrary, in the last Kind, some putrefied Matter is always excluded from the Blood, and determin'd to the Skin, or ought to be so, if sufficient Force remains in the Blood to [Page 50]effect: it (n) . It is true, that in simple Fevers, where no Parts of the Blood are corrupted, there needs no critical Separation, but by Sweats and Transpiration, which cool the feverish Flame, carry off the offensive Matter from the Blood, and restore Nature to its regular Constitution; but, when many Parts of the Blood are actually mortified, how can Nature ordinarily be restor'd to a healthful State, without expelling them to the Skin? Can a Gangrene in the solid Parts be heal'd till the sound Flesh be freed from the mortified Fibres? No more can the Mass of Blood be cur'd, till it is clear'd and purg'd from its putrid and perish'd Portions; which usually must be done by excluding them from its Bosom by friendly Sweats, or lodging them in the Surface of the Body; I said usually, because sometimes this putrid Matter may be discharg'd by the Glands or Strainers of the Guts, tho' that does not often happen; for frequently [Page 51]the Looseness, that at the latter End attends malignant Fevers, if the Patient recovers, is taken up by a Thrush or sore Mouth; and hence it appears, that the hypochondriacal Fever, mentioned before, has not the essential Properties of the malignant, and therefore does not arise from Putrefaction; tho' it is certain, that the malignant Kind have, at their Beginning, such a Conformity of Symptoms and Appearances to hypochondriacal Passions, that it is difficult to discern, whether the Patient be attack'd by a putrid Fever, or an hysteric Disorder, or Perturbation of the Spirits: For Instance, Chilness, Shiverings, and rigorous great Inquietude, Vomitings, Dejection of Appetite, Anxiety, Sickness, and immoderate Sweats, Wakefulness, a low weak Pulse, Faintness, and great Diminution of Strength, are Symptoms common to both; and therefore for several Days a malignant Fever has so near a Resemblance to one, that is only hysteric, that many Physicians and Standers-by, [Page 52]I am apt to believe, mistake the first for the last, and look upon a great and dangerous Disease to be only the Spleen, or a Fit of the Vapours, to the great Hazard of the Patient.
OF THE CURE OF THE MILIARY FEVER.
OF THE CURE Of the SIMPLE MILIARY FEVER.
WHEN I am sent for to a Patient in a Fever, I attentively listen to the Account he gives of himself, without Interruption, and then carefully examine into the Progress of every Symptom (o) from the first Seizure; I mean, from the first Hour that he found himself in the least disorder'd [Page 56]in order to find out, with as much Certainty as possible, the Nature of the Fever; for on that depend the Hopes of an expeditious Cure; altho', for the most Part, I can certainly foretel, whether, or not, it will prove of the miliary Kind, from the Pulse alone, the Moment I touch it, which, in this Case, discovers itself to me, in a more extraordinary and distinguishing Manner, than in any other I have ever met with; for altho' in the Beginning of the Fever, in a robust Constitution, it is sometimes frequent, full and vigorous, yet it seldoms fails, in three or four Days, to become remarkably swift, weak, and depress'd; which also happens in most People at the Beginning: But these nice Distinctions are not to be acquir'd, without long Observation and Experience, arising from constant and unwearied Attendance, in a Multiplicity of Practice; so that the young Practitioner must not only content himself with forming a Judgment from the general Indications, but be particularly careful not to hazard his Patient's his Life, of his own [Page 57]own Reputation, by mistaking the Case for an inflammatory, nervous, or intermittent Fever, which may easily happen to the unexperienc'd and unwary (p) ; nay, to my certain Knowledge, hath often so happen'd, even to many old, but very eminent in the Profession, Physicians as well as Apothecaries, to the Destruction of Numbers; who might otherwise have been now living Monuments of their Knowledge and Success. I wou'd therefore by all Means advise the young Practitioners to stand upon their Guard; to study Nature (q) , and pursue her to her most intricate [Page 58]Recesses; to search out diligently the Nature and Properties of Medicines, and to attend indefatigably the Poor as well as the Rich; which will not only teach them to ward off the furious Attacks of a most potent Enemy, but may, one Time, or other, prevent themselves and Families, from falling Victims to their own Ignorance.
From what I have said, if any Body expects to see a copious and pompous Form of Remedies, he will be much disappointed; for I delight in Simplicity of Medicine, for the Cure of acute Diseases, as much as in simple Diet, for the Preservation of Health and long Life.
In my Preface, I have objected to the Method of Practice in 1741, for that the Sal Nitri and Saline Draughts are too cold, and Sal. Vol. C. C. Conf. Raleigh, &c. are of too hot a Nature, and quite inconsistent with that moderately cordial and diaphoretic Quality, necessary in this Case; therefore [Page 59]cannot by any Means he admitted into the Rank of Remedies for a miliary Fever, without manifest Hazard of prolonging the Distemper with dire Symptoms (r) , or Death itself: What a preposterous Fashion have some of our modern Physicians crept into? A sudden Transition from cold to hot, or hot to cold; either of which not having sufficient Efficacy to produce the desir'd End, they agree in Consultation, the dernier Resort, to sign a Neutrality (s) , their extreme Unction (t) : Would they not account it Madness in a Man, who not being able to endure the extreme Cold [Page 60]of Greenland, would from thence, if possible, instantly fly to the extreme Heat of the Indies? Therefore,
If I am call'd within the first three Days to a Man of a robust Constitution, with a vigorous Pulse, I immediately order eight Ounces of Blood to be taken from the Arm, and then as follows:
℞. Croc. Castor opt. pulv. ana gr. x Syr. Croc. q. s. ut f. Bol. h. s. sumend. et mane repetend. cum Haust. seq.
℞ Vin.
℞ Vin. Coccinel. (u) ʒ j. Aq. Alexet. Simp. ℥ j. ss. ejusd. Spirituos. ʒ ij. Syr. Albi ʒ j. M. F. Haust.
The next Day, if Nauseousness and Inclination to vomit indicate the Necessity of an Emetic, the following may be given:
℞. Rad. Ipecac. pulv. gr. x. vel xv. Aq. Alexet. Simp. M. F. Haust. pomerid. sumend. superbib. infus. Flor. Chamaem lb j. vel ij. pro Ratione Operationis.
Afterwards, ℞. Conf. Damocrat. ʒ. ss. Croc. gr. v. Syr. Alb. q.s. f. Bol. H. S. post Emetic. sumend. & singula nocte repetend.
℞. Pulv. Contrayerv. comp. ℈ j. Croc. gr. v. Vin. Coccinel. gut. 30. Aq. Alexet. Simp. ʒ j. ss. ejusd. Spirituos. ʒ ij. Syr. Alb. ʒ j.f. Haust. sextâ. qq. Horâ sumend. incipiend. Hor. sex. post Bolum.
But if there should be no Occasion for Bleeding or Vomiting, I begin with the Draughts and Bolus last prescrib'd, the first Time I see the Patient, and continue them till about the sixth Day, I mean, from the first Complaint; but, after that Time, prescribe thus:
℞. Conf. Damocrat. ʒ ss. Croc. Castor. ana gr. v. Syr. Alb. q. s. ut f. Bolus sexta qq. Hot. sumend. superbib. Coch. iv. Julep seq.
℞. Aq. Alexet. Simp. ℥ vj. ejusd. Spirituos. ℥ ij. Syr. Alb. ℥ ss. Vin. Coccinel. ʒ ij. M. F. Julep.
These are to be continu'd to the Appearance of the miliary or crystalline Eruption, separately or together, which if all Things have been well conducted, will generally happen, in small Quantity, about the Eighth or Tenth Day; about that Time also, the dangerous Symptoms will abate, and the Fever soon after vanish, without Danger of Relapse or more to do, than keeping out of the cold Air, observing [Page 63]a proper Diet, and taking a Bolus, with some of the Julep, Night and Morning, for a Week longer. I have often found but three or four crystalline Pustles, which, however, prove the Nature and Degree of the Disease: But if any considerable Errors have been committed by the Sick, or those about him, then will no Eruption, appear, till about the sixteenth Day, and that generally of the crystalline Kind alone, often in great Quantity, and very large; I have seen Thousands as big as the largest Pin's Head (x) , crouding all over the Body, the Extremities not excepted, like the confluent Small-Pox, portending Death. Here is an evident Mark of great Putrefaction; greatly, if I may be allow'd the Simile, tending to a Gangrene of the whole Mass of Blood; therefore here is the Touchstone of Skill; here the Field, wherein to try the Power and Efficacy of Medicine!
If by the tenth Day no Eruption appears, and the Symptoms run high, Delirium and Subsultus Tendinum beginning, a Blistering Plaister must be apply'd immediately between the Shoulders, and, the Morning after that, the whole Feet wrapt up in cephalic Plaister two Thirds, Blistering Plaister one Third, spread moderately thick; the following Prescription must also take Place:
℞. Conf. Damocrat, ʒ ss. Croc. Castor. a gr. x. Syr. Croc. q. s. ut f. Bol. sexta qq. Hor. sumend. superbib. Coch. iv. Julep praescr.
℞. Vin. Coccinel. Vin. Croc, a ʒ ss. M. cap. Gut. 40. saepe in Ser. Lact. Vin. Alterat. vel Apozem seq.
℞. Aq. Hord.lb ij ss Gum. Arabic. ℥ j. ss. M. bibat. Haustul. saepè tepidè.
If the Delirium continues very long, I have sometimes added five Grains of Camphire to every Bolus, with good Effect.
This Method, without Alteration, must be continu'd till Death, or a Recovery, turns the Scale; if Death shou'd take Place, I know of no better Method whereby to prevent it; but a Recovery will most commonly ensue, if all Things, in this Stage of the Disease also, are faithfully and rightly manag'd; and then Security from a Relapse depends, as I said before, in keeping the Room, proper Diet, and a Continuance of the Bolusses and Julep, Night and Morning, for a Week longer, when the Fever is gone off.
If, in any Stage of the Disease, a Pain of the Head becomes very troublesome, the Application of six or eight Leeches to the Temples will be not only absolutely necessary, but greatly advantageous; and so it will also be of Consequence, at any Time of the Delirium.
If Costiveness intervenes, a Clyster may be injected every third or fourth Day:
℞. Decoct. Malv. ℥8. Ol. Olivar. ℥ ij. Mel. Solutif. ℥ j ss. M. f. Enema.
I allow for Drink, always to be made warm, Mint, Baum, or Sage Teas, Barley-water, Water-gruel, White-wine Whey, Panada, Chicken-broth, Sago boil'd thin; and sometimes, if the Sick is earnestly desirous of it, half a Pint of good Small-beer, with a Toast and grated Nutmeg in it; but no Juice of Orange or Lemon in any Drink.
If profuse Sweats render the Linnen disagreeable, I allow a clean Cap, Shirt, and Sheets, well dried and warm'd; but then for this Purpose, the Sick must be wrapt up in a warm Blanket, and carefully laid on another Bed in the same Room; for I am well assur'd, that less Mischief will accrue from this Change, than from the cold Air rushing into the Bed, when all is wet, and while they tumble to and fro' with great Restlessness; these Sweats being only symptomatical.
The Plaisters upon the Feet, which I design for continuing Blisters, to avoid the Cruelty of fleaing alive from Head to Foot, the present Vogue, but not half so easy or effectual as mine, may be taken off in three or four Days, if there is is great Complaint of Soreness, snipping the Bladders, without tearing off the Skin; the Sores may be dress'd every Day with a Cerate of Wax and Oil, and a little yellow Basilicum: I us'd to order equal Parts of the Plaisters, but since the College have increas'd the Quantity of Flies in the Emp. Vesicat. I have been oblig'd to diminish the Quantity of that Plaister; for my Intention is thereby to raise Blisters very gradually, so that sometimes the Plaisters may lie on a Week, with proper Effect, and without great Uneasiness.
Women and Children, in general, may be treated, in the same Manner I have directed for Men, with this Difference only, that as they are the weaker Vessels, and of [Page 68]a more delicate Texture, less Doses of Medicine, with little or no Loss of Blood, except by Leeches, will best answer the Purpose; which any Practiser, who has but a Grain of Sense, may, I think, judge of, and proportionate according to the various Symptoms and Degrees of the Disease, and Circumstances of the Patient, without my Directions; which for every Individual wou'd render this Account too prolix and tedious, and serve only to puzzle and confound the Reader. And so much for the Cure of the simple miliary Fever; I will now proceed to that call'd compound.
Of the Cure of the compound miliary Fever.
I call this Fever compound, when it attacks Women with Child or in Child-bed; when it is consequent to Children breeding their Teeth, or having a convulsive Cough; when join'd with the confluent Small-Pox, Measles, Scarlet Fever, an Asthma, acute Rh [...]umatism or the Gout; Or when it is [Page 69]render'd so, by a wrong Method of Cure, or imprudent Management on one Side or the other.
When it attacks a Woman with Child, Bleeding, according to the Time of her Pregnancy, is absolutely necessary in the Beginning; then the Method I have prescrib'd in general, with the Omission only of the Emetic and Castor.
Women in Child-bed may omit Bleeding, and begin with the following at any Stage of the Disease:
℞. Conf. Damocrat. ℈ j. Croc. Castor. ana gr. v. Syr. Alb. q. s. ut f. Bol. sextâ qq. Horâ sumend. cum Coch. iv. Julep. seq.
℞. Aq. Puleg. ʒ vj. Alex. Spirituos. ℥ ij. Syr. Alb. ℥ ss. Vin. Coccinel. ʒ ij. M. F. Julep.
If Costiveness ensue, a Clyster may be injected once in four Days.
There is seldom Occasion for more than I have here laid down, having recover'd Scores in this Manner, without the Loss of one Patient, since I have been in Practice; but, if the Symptoms shou'd perchance become more violent, Blisters and increas'd Doses of Medicine may take Place: Some Practitioners think, that Opiates suppress or retard the Lochia, but I have always found it otherwise.
Children, breeding their Teeth, must have their Gums cut, if necessary, and take the following Mixture:
℞. Pulv, e C. C. C. ℈ j. Croc. subtiliss. pulv. gr. iv. Conf. Damocrat. gr. x. vel xv. Aq. Alexet Simp, ℥ j ss. Syr. Croc. ʒ i. f. Mist. cujus cap. Coch. parvum sextâ qq. Horâ.
Children, having a convulsive Cough, may be bled in the Arm, or with Leeches, in the Neck, at the Beginning of the Fever; may have a Blister, and take the same Mixture as above, augmenting or diminishing the Dose, according to Age, till the Fever is gone off; and then nothing will avail, but Change of Air, Asses Milk, and Manna, to keep the Body laxative; which last is generally necessary in both recited Cases, or a Clyster in its Stead, if they have not a Stool once in a Day.
When join'd with the confluent Small-Pox, in adult Age, Sydenham's Method may be follow'd, till within forty-eight Hours, that the Turn of the Pustles is expected; then;
℞. Syr. de Mecon. ℥ ss. Aq. Alexet. Simp. ℥ j ss. ejusd. spirituos. ʒ ij. M. f. Haust. Horâ sextâ matutinâ & vespertinâ sumend. quotidie.
℞. Conf. Damocrat, ℈ j. Croc. gr. x. Sulph. Aurat. Antimon, gr. iij. Syr. Alb. q. s. ut f. Bol. for. duodecimâ Meridie & mediâ nocte sumend. superbib. Coch. iv. Mist. seq.
℞. Sperm. Ceti ʒ iij. Vitel. ovi q. s. Aq. Alexet. simp. ℥ vj. ejusd. spirituos. ℥ ij. Syr. Alb. ℥ ss. f. Mist. cujus etiam cap. Coch. iv. saepe.
The Sulphur Auratum promotes Expectoration better than any Thing, I know of, and the other Medicines cause a Diaphoresis; Evacuations absolutely necessary in this Case, to remove impending Danger; I have met with great Success by this Treatment, therefore I think it my Duty to recommend it to others.
With the Measles or Scarlet Fever, my general Method of Cure for the simple miliary Fever will likewise avail here, without Alteration, as no Symptoms in these two eruptive Fevers in the least contra-indicate.
With an Asthma; Bleeding in the Beginning, and Blistering about the eighth Day, are without doubt necessary; but Opiates of every Kind must be utterly rejected; therefore,
℞. Croc. Castor. Pulv. Contrayerv. comp. ana gr. x. Syr. Alb. q. s. ut f. Bol. s. xtâ qq. Horâ sumend. superbib. Coch. iv. Mist. seq.
℞. Sperm. Ceti ʒ iij. Vitel. Ovi q. s. Aq. Alexe. simp. ℥ vj. ejusd. spirituos. ℥ ij. Syr. Alb. ℥ ss. f. Mist.
℞. Spt. Volat. Aromat. Vin. Coccinel. ana ℥ ss. f. Mist. cujus cap. Gutt. 40. bis terve die in Aq. Hord. cum Gum. Arabic.
The Cure, in this Case, will be generally more tedious and difficult, than in the others; but, for the most Part, with Care, may be safely conducted.
With an acute Rheumatism; Bleeding in the Beginning ought not to be here neglected; and the following may be prescrib'd through the whole Course of the Diseases, augmenting or diminishing the Doses, according to the Urgency of the Symptoms:
℞. Conf. Damocrat. ℈ j. Pulv. Rad. Polygal. Virgin. (Senekka Rattle-Snake Root) Cin. Antimon. Croc. Castor. ana gr. v. Syr. Croc. q. s. ut f. Bol. sextâ qq. Horâ sumend. superbib. Coch. iv. Julep, praescr. cum Vin. Coccinellae.
A Blistering-Plaister to the Back, and Leeches to the Temples, may be applied, if great Pain of the Head requires them.
Bleeding often, giving Sal. Nitri, or Gum Guajac, as usually practis'd in this Case, will generally prove fatal.
With the Gout; this Fever rarely invades People afflicted with that Opprobrium Medicorum in a regular Manner, except external Applications, imprudently apply'd, disturb the gouty Matter in the Extremities, its usual Residence, and force it to mingle again with the whole Mass of Blood; when this is the Case, it generally fixeth upon the Brain, Lungs, Stomach, or Intestines, or produceth a Fever of the miliary Kind; if the last happens alone, or is complicated with a small Degree of Pain, in any of the Parts before-nam'd; the same Method may be us'd, as directed before for this Fever, with the Rheumatism, with the Alteration only of the Doses, and Times of Administration:
℞. Conf. Damocrat. Pulv. Rad. Polygal. Virgin. Cin. Antimon. Croc. Castor. ana gr. x. Syr. Alb. q. s. ut f. Bol. quartâ qq. Horâ sumend. superbib. Coch. iv. Julep, seq.
℞. Tinct. Aromat. ʒ vj. Vin. Coccinel. ʒ ij. Aq. Alexet. simp. ℥ vj. ejusd. spirituos. ℥ ij. Syr. Alb. ℥ ss. M. f. Julep.
The Tinct. Aromatic. may be omitted, if the Stomach and Intestines are free from Pain.
It must be remark'd, that, as I have endeavour'd to be as concise as possible, in Relation to these compound Diseases, I have only directed what is necessary to be done, in the Presence of the Fever; when that is gone off, leaving the rest to be manag'd by the skilful Practitioner, as he shall think fit. And here, as an Apology for myself, I can't help quoting a Passage from the judicious Sydenham, one of the worthiest and best Men that ever liv'd:
‘"If any one shou'd here object, that others that are as much conversant in Practice as I, are not of my Mind; it does not concern me to enquire what [Page 77]others think, but to propose faithfully my own Observations, in doing which, I beg the Reader's Patience, not his Favour; for the Thing itself will shortly shew whether I have acted sincerely, or whether I have been a Man-slayer."’
Only I beg Pardon, for that I have not regarded a pure Diction, or an elegant Style, being not at all heedful of nice Matters, if I only write so as to be clearly understood.
ADVICE TO THE APOTHECARIES.
I DO not take upon me here to give Advice to all, for I know there are many of you undoubtedly honest, generous, and judicious, who scorn to be guilty of a mean or base Action, either in public or private; but a much greater Number in City and Country, of the opposite Character, are vilely industrious, ignorant, and penurious to a Sin; who set no Value upon Lives, and study nothing so much as amassing Money at any Rate; there is another Species of you Gentlemen, who are Men of good natural Parts and genteel [Page 80]Education, have been brought up regularly in Pharmacy, and by your easy Address, and engaging Behaviour, attract Esteem, and command Employment in a great Number of Families; but are, on the other Hand, so strangely attach'd to Taverns and public Diversions, that you have neither Time or Inclination to make a right Progress into the Knowledge of Diseases or their Remedies: It is to you, of these two last opposite Characters, that I present my Address: Therefore, first of all, let me intreat you to be particularly careful in the Choice of the best Drugs, and exact in the Composition of your Galenicals and Chymicals; otherwise you hazard your Reputation, deceive the Physician, and either kill your Patients, or prolong the Disease, till Nature at length forcibly gets the better. How many People suffer from bad Bark, Rhubarb, Ipecacoanha Jalap, Castor, Saffron, &c.? The Dead are past telling the Tale, but you yourselves must be conscious of it, or else confess your great Ignorance of Medicine; [Page 81]many of you, as I said before, are too generous to act so base a Part; but a great Number are penurious to such an excessive Degree, that, altho' your exorbitant Profits exceed those of any other Trade or Employment in the whole World, you wou'd not privately advance a Shilling extraordinary to save the Life of the most valuable Man in the Kingdom. How many periodical Cases bring on chronic Diseases, and enslave poor Mortals to a miserable Life, by the Use of bad Bark? How do the vital Liquids run off, in Diarhoea's and Dysenteries, from the Use of the worst Rhubarb, Ipecacoanha, Diascordium, &c.? How much deceiv'd is the Physician, when the Apothecary substitutes a cheaper Medicine for a dearer, altho' the Price of the dearest wou'd not amount to Six-pence a Dose? Lastly, How many perish in Fevers, and linger on with other Diseases, only for Want of good Drugs, Galenicals and Chymicals? For God's Sake, Gentlemen, ye Surveyors-general, I speak to now, who by Authority search the Apothecaries Shops, [Page 82]Search them narrowly from Stem to Stern, and where you see Cause, give a severe Reprimand; tho' you shou'd forfeit the Six Shillings, which are usually given you, like Bolusses, to ease the Pain of your Stomachs.
The wholesale Apothecaries and Chymists are often the Sources of these terrible Disasters, who basely sophisticate, for the Sake of a little Profit, Medicines which circulate not only through this Kingdom, but many foreign Countries, and destroy five Times more People, than wou'd die of Distempers in a natural Way; and the Druggists, whose Principles are little better, for vending bad Drugs, excuse themselves, by saying, If they buy the Devil, they must sell the Devil; but, if the Apothecaries did not purchase him from Time to Time, they wou'd soon be tir'd with exposing him to Sale.
When you have got good Medicines, I must then beseech you to learn the Use of [Page 83]them; but hold! you must first learn the Nature of Diseases, and know well how to distinguish one from another; I speak chiefly to you young Ones, tho' the old Ones, many of them, wou'd not do amiss to take my Advice: For this Purpose, search out the best Authors, which will enrich your Senses; read them over and over again, till their most remarkable Precepts are strongly impress'd on your Minds; but, in the mean time, abstain from Wine, and other strong Liquors, lest they drown all your reasonable Reflections, and hurt your Memory. Attend diligently the sick Poor, as well as the Rich; for, tho' the latter may best suit your Pockets, the former will serve you for experimental Knowledge, which in the End, if you have natural good Principles, will bring you more Satisfaction, than the Mines of Mexico; but be especially careful in your Experiments, that you do no Harm, for that shoud always be your first Principle in Practice. Whenever you venture out of the beaten Track, or even follow the old one, go on [Page 84]with Caution in giving small Doses of a doubtful Remedy, and be frequent in your Visits to see the Effect of it; then proceed gradually Step by Step, and never quit the Disease, or the Remedy, till you are Master of both. When a Physician attends your Patients, which you too often recommend, from, I am afraid, a just Sense of your own Inabilities, or to swell your Bill to a greater Bulk, don't think that your Business is then done, for it more nearly concerns you now to attend with Diligence, as you have a greater Work set before you; now your timorous Mind is set at Liberty, to inspect narrowly into the Nature of the Disease, the Remedies prescrib'd by the Physician, and to compare the Effects of them with your own Practice in the like Cases. The exorbitant Fees of the Doctor will seldom admit of more than one Visit a Day, and that at a Time when, in acute Distempers, the frightful but informing Symptoms of the Night are either going, or chiefly gone off; therefore it is your Duty, if you have any Fellow-feeling [Page 85]for your Patient, or Regard for yourself, to be constant in your Evening-Attendance, that thereby you may be ready the next Day to give a just Account of the Patient's Welfare or Sufferings, from the Disease and the Remedy, as well as to establish yourself firm in that Opinion of the Sick, by your Diligence, which coud not be brought about by your Judgment alone; this will never fail from Time to Time to advance your Reputation, till your Age and Success fix you on a more solid Foundation. But now presents the dismal Scene: To do all this, you must leave your darling Pleasures, Taverns, and Bottle Companions, Play-houses, Gaming-houses, and other public Diversions; to advance happily and successfully in your Profession, and to arrive at the Pinacle of universal good Character and Esteem, you must forego all jovial Appointments, for the Sake, sometimes, of one Patient only, and even that a poor one, to whom you must perhaps give your Advice and Medicines gratis; who, notwithstanding that, has a [Page 86] Life at Stake, as valuable in his Station as that of an Emperor; for his Family are his loving Subjects, and his Cottage is his Kingdom, which must all droop and fall to Decay, after the Demise of their only King; therefore you must absolutely attend him as diligently as the Rich, lest, by a Surmise of Neglect, you lose more Reputation in one Day, than you will be able to recover by the greatest Diligence in many Months; especially too, if you are but just tenter'd into Life: Do but succeed, tho' Nature does all, you will have all the Glory; but, if you miscarry, Shame and Confusion will be your Attendants, till, by Time and constant Rubbing, you are sufficiently burnish'd, to stand the Fire of a censorious Age: This is a long Lesson, a hard Task; but be assur'd from me, that you will not have it in your Power to make any considerable Figure in your Profession, according to the old Phrase, till you have no Teeth to eat your Bread, without you pursue the Course I have laid down; except indeed, as sometimes happens, you have the Luck [Page 87] to have the Bread put into your Mouths, by some well establish'd Practitioners, who take you into Partnership in an early Age: This is the good Fortune of some remarkable Boobies, who, from not being able to get Shoes and Stockings, if they were set on their own Legs barefoot, begin soon to get an Estate; while others of Merit, Knowledge, and Success, are oblig'd to trudge early and late, only for the Sake of a genteel Support.
Now I have explain'd the Duty which more immediately concerns the Apothecary, I will give you farther Instructions for the Benefit of your Patients, which will not altogether be useless to yourselves.
Be sure to keep a watchful Eye over the sleepy senseless Nurses, suffer no Error or Neglect in their Conduct to pass unregarded, as many of you do, to gain their Esteem, and thence their Commendation, or otherwise to avoid their weak and low Aspersions, [Page 88]and ungrounded Prejudices: Pay the same Deference also to the mighty knowing Midwives, who are only a better Sort of Locusts, that will take the Bread out of your Mouths, if you do not smother their Errors, and proclaim their Qualifications; but mind this, you must be thorough-pac'd in your Profession, and have given repeated Proofs of your Judgment, before you make this hazardous Attempt, Nothing less than a forlorn Hope; for Women are, by a Sort of Infatuation, so excessive fond of this Sort of Creatures, who from thence take such Liberties, that sometimes even in desperate Cases, they will, with an uncommon Stock of Impudence, tell you to your Face, in their Language, that sure they have not been so many Years Nurses or Midwives, but that they know what belongs to the Cure of such and such an Ailment, better than a young Apothecary. This you must irresistibly oppose, and never leave them, till you have fairly prov'd that they are Fools and Lyars; otherwise, in Return, they will, much to [Page 89]your Disadvantage, prove you to be a very ignorant Fellow, which will soon spread amongst the neighbouring Women, your Body Guards; but then, I say, you must be conscious that you certainly know how to vanquish the Disorder, which has set you at Variance, or must come to a Parley upon worse Terms. But, leaving this Digression, condescend to examine the several liquid Foods you have order'd for your Patients Subsistence; be not content with one or two Sorts only, but have Plenty where it can be admitted, that the constant Supply which is necessary not only for the Disease, but from the Quality of the Medicines, may not nauseate the Stomach, and rob you of Part of your Dependance in the Cure of the Patient; and indeed nothing contributes more to the Ease and Satisfaction of the Sick, than Choice of Liquors properly made; for weak Stomachs are soon disgusted.
As the Physician is often discharg'd, so soon as the Danger is over, the future Conduct [Page 90]of the Patient lies wholly upon your Care; therefore now is the Time to bestir yourself, to procure a perfect Recovery, by continuing the Medicines order'd by the Physician; for at your Peril do not alter them, lest by any Accident the Patient shoud grow worse, and you incur the Blame; I say, continue the Medicines, as long they are absolutely necessary, but no longer, and take upon you, with becoming Authority, to order the necessary Diet from Time to Time, and strictly scrutinize into the Execution of your Orders; which will not only always gain the Attention and Esteem of the whole Family, but convince them of your upright Intention to prevent a Relapse.
One Thing more I must add, and that is this, Revere the Profession to which you belong, and treat every Member of it, who shall deserve it, with the utmost Marks of Sincerity and Respect; be not reserv'd, but with an engaging Air and Freedom, in your [Page 91]mutual Correspondence, communicate every Thing you know for the public Welfare; let no good Thing be buried in the Grave, the Seat of Oblivion; be courteous and affable to all Mankind, especially the sick Poor, who, in their great Distress have little else to alleviate their Sorrows, than your sympathizing Nature, mild Deportment, and benevolent Hand; in short, always endeavour to act the Part of the real Gentleman, which, if you do not gain Riches, will generally procure you a contented Mind, the next Step to a happy Life.
These are the Requisites, which, I have told you in my Preface, must be join'd with the Physician and his Prescriptions, in order to a happy and successful Practice: But what with the Pride, Inability, and Self-conceit of many Physicians, the Negligence, Ignorance, and Penury of many Apothecaries, Sophistication and Villainy of many Chymists and Druggists, I must, upon [Page 92]the Whole, conclude, that we are, in general, in no proper Condition to make many great Advances or Improvements in Physick.
ERRATA.
PREFACE pag. vi, last Line, read Eruptions. p. 23. l. 1. read takes. p. 61. l. 9. after Simp. read ℥ j. omitted. p. 64. l. 14. read ana ℥ s. l. 17. read Aq. Hord.lb ij. p. 66. l. 2. read Solutiv. p. 69. l. 16. read ℥ vj. p. 73. l. 7. read sextâ.
If I have overlook'd any Errors of the Press, I hope the Reader will be careful to rectify them.