CHAP. I. OF FEVERS IN GENERAL.

FEVERS admit of a two-fold distinction: first, with respect to their duration; as into continued, Remittent and Intermittent Fevers.

Continued fevers go on to their end, without any very obvious change for better or worse, in a period of twenty-four hours.

Remittent fevers, either obviously abate at some pe­riod or periods during twenty-four hours, or are like a number of short continued fevers linked together, abating once in the course of two or three or more days.

Intermittents go perfectly off every day and return the next, which is called a Quotidian; or every other day, leaving an intermediate well day, called Terti­ans; or every fourth day inclusive, leaving two well days, called Quartans. In this manner they go and come till they change, or finish their course.

The second distinction respects the state of the system: as Inflammatory, Nervous, and Putrid fevers.

Inflammatory fevers show more or less the symptoms of general inflammation; strong action [...] absence of every symptom of putridity and inse [...]; they are most commonly continued.

Nervous fevers show a general debility, in [...] ­lity and irregularity, without any symptoms [...] [Page 6]tending much to dissolution; though a slight and slow tendency is observable, after they have continu­ed for some time.

Putrid fevers sometimes show signs of inflammato­ry action for a while; but these quickly give way to symptoms of putrefaction, viz. blackness of the gums and tongue; from being lined with foetid secretions: a blackness and foetor of what is discharged by vomit­ing, which usually attends: and the same appearance of many of the secretions and excretions, particular­ly the stools; to which may be added a quick suc­ceeding debility.

CHAP. II. INFLAMMATORY FEVER.

THIS fever most frequently attacks the young in the vigour of their life; such as are of a rustic sanguine athletic constitution, who indulge themselves in living freely: though sufficient causes will bring it on in some degree, in almost any constitution and way of living. It attacks at all seasons, but most frequent­ly in the spring and beginning of summer.

Causes. Heat and cold alternately, or variously ap­plied, fatigue, anger, immoderate use of spirituous liquors, watching, &c. &c.

Symptoms. It discovers itself by a lassitude, with a dull sensation of the body, debility, alternating chills and heats, tremors, pains throughout the whole body, but more particularly about the shoulders, back, knees and head. These are succeeded by an intense and burning heat, an inextinguishable thirst, inflamed eyes, tumefaction or fulness of the face, sickness and vomiting, inquietude, anxiety, full and strong pulse, dry skin, red (though sometimes watery) urine; rough, dry, yellow, or dark coloured tongue, covered with a crust; difficult breathing, costiveness, cough, watching, de­lirium, stupor; and if the fever is not checked, a co­ma, [Page 7]or constant tendency to sleep, tremors, partial convulsions as of the hands, &c. hiccough, involunta­ry discharges of the belly and bladder take place and close the scene in death. This is a description of it in its most violent degree. In the greatest number of cases, we meet with it far more moderate; a strong pulse, sick stomach and thirst being the chief symptoms.

Management. The patient should be confined to his bed, in a cool, dark and silent room; the cool­ness to be regulated by the season. He should ab­stain from all kinds of meats and strong drinks. For food; panada, barley, jellies, light unseasoned puddings and pies, may be given in small quantity. For drink; lemonade, vinegar and water, barley water, herb teas with lemon juice, apple water, tamarind water or jelly and water, may be given largely.

Cure. If the fever be violent, and the patient as de­scribed in the first paragraph of the case, from half to two thirds of a pint of blood should be taken away (according to the age and customs of the patient) as quick as possible; which may be repeated the next day in lesser quantity, if the fever has not abated. After the first bleeding let him take one ounce of Glauber salts, which will frequently exclude the necessity of another bleeding. After this the bowels should be opened daily if required, by a common clyster. if after one bleeding and a dose of salts, the fever does not go off, which it seldom does, let the pati­ent have one of the powders No. 1. every two hours, provided they will remain on his stomach: but if they will not, give the saline mixture No. 2. two table-spoon­fuls every two hours; and after this has been given some time, if the patient's skin become soft and moist, it should be continued in, otherwise lay it aside and try the powders again. If these when given for a day or two do not lessen the fever, or if they will not re­main, and the saline mixture is ineffectual, and [...] bleeding has been practised as far as prudent; it will then be necessary to put a blister to the back of the [Page 8]neck, and to soak the patient's feet in lukewarm wa­ter for an hour if he can bear it; after this try the powders, or the mixture again, and they will then have their only chance, and in many cases will be effectual.

In the slighter cases of this fever, such as I have said, we most commonly meet with. If the patient will allow of it, one bleeding will be proper, after which or in such as will not allow bleeding, give a [...]ke; two grains of tartar emetic divided into three doses and taken in half an hour, or fifteen grains of ipecacuana, or half a table-spoonful of antimonial wine will answer; after which give the powders or the mix­ture, and open the bowels with a dose of salts. After the fever has gone off, which usually is attended with a sweat, if the patient is much reduced, let him take a tea-spoonful of bark in port wine, or in water eve­ry three hours till he has taken an ounce, after which he may take one or two more at longer intervals. He should use gentle exercise in a carriage, and return gradually to his business and diet.

There is a fever which has the name of synochus, which in the first stage is of the above type, but after a while quickly changes to the putrid, to be hereafter described. In such a case all the management and cure above should be relinquished as soon as the change is observed, and the management and cure for the putrid immediately adopted.

CHAP. III. NERVOUS FEVER.

THOSE of relaxed fibres and weak nervous system, are the persons most subject to this fever.

Causes. Excessive evacuations, repeated salivations, immoderate venery, depressions of the mind from grief, watching and night study, humid stagnant air of subterraneous apartments, indigestible food, especi­ally such as is unfit for nutrition; as of cold watery fruits and vegetables; thin cloathing, rainy seasons, soft moist winter, &c.

[Page 9] Symptoms. This fever approaches with dejection of mind, loss of appetite, oppression, sleeplessness, in­voluntary groans, repeated sighs, fear, unusual lassitude after motion, and alternate successions of cold and heat.

After some days a swimming or pain in the head comes on with sick stomach and vomiting of insipid phlegm, great weakness, moderate heat, insensibility to thirst; frequent, weak, and sometimes intermitting pulse; a moist tongue, sometimes red and at other times covered with a white or yellowish tough mucus; dry lips, oppression about the breast and difficult breathing, pale watery or whey-like urine: a dull sense of pains about the breast and head, dozing, deli­rium, redness and warmth of the face, whilst the feet are c [...]ld; a tendency and disposition to be easily and frequently disturbed by dreams:—after these have taken place and continued some time, they are followed by immoderate sweats and wasting laxes, great dulness and slothfulness of the external and internal senses, anxi­ety and fainting. And now nature being exhausted by the disorder, the tongue trembles, the extremities from a coldness become cold, the nails turn livid, sight and hearing perish, the delirium turns to a coma, the b [...]lly and bladder are involuntarily evacuated, topi­cal convulsions come on, and death closes the scene, usually before the fourteenth day. The symptoms in­crease in the evening.—The delirium is only a mutter­ing continually; quite different from the delirium of the former fever: though in this there is generally a great insensibility, and towards the end a loss of sight and hearing, yet at times in the beginning there is a great and preternatural sensibility to light and noise: sometimes an eruption like millet seed appears without any alteration for better or worse. A continuance of this fever has brought on temporal idiotism, which vanished with the debility.

Management. The patient should be confined to his bed in an airy darkened room, and kept a [...]ably warm or cool, according to the season. His room, bed and body clothes, face, hands and feet should be [Page 10]kept clean. His diet should be light though nourish­ing, and given frequently, rather than in large quan­tities at once; it should be mild: chicken water and broth, or beef tea may be given if the patient desires it, and the effect proves it to be useful; but the gene­ral stock of food should consist of the various prepara­tions of mild, digestible, nourishing vegetables, suf­ficiently well known to every house-keeper; those should be suited to the patient's appetite, and chang­ed so as not to pall him with any one. Wine and water may be used from the beginning, though then it may only be given to allay the thirst, and should be made weak: five or six times a day a cup full may be given, even though the patient do not ask for it; but as the strength fails it should be made stronger and stronger, and given in as large quantity as a person in health could take. When the wine has not the effect of increasing the symptoms and rendering the pulse too quick, it may be safely continued in.—Claret is sup­posed to be the best.

Cure. A gentle vomit of 12 grains of ipecacuana in a little water may be given in the beginning, and may be repeated the next day. The bowels should be opened with thirty grains of rhubarb, and costive­ness continually prevented by small doses of the same medicine. A blister should be applied to the side early in the disease, and when it has drawn, the water let out, and the part dressed with a colewort leaf or a little Turner's cerate; after this another may be applied to the other side, or to the back of the neck, provided no bad symptoms follow the first, if they do, blisters should be laid aside till a state of insensibility comes on, when they should be applied successively, as long as they are attended with advantage. If the patient's skin be dry in the beginning, let him take three o [...] four grains of James' powder, in thick syrup three or four times a day, washing it down with snake-root tea; yet not so as to sweat the patient. If the James' powder is not to be had, one-eighth of a grain of tartar emetic may be used in its stead. When the de­bility [Page 11]increases, let the patient begin and take two table-spoonfuls of the decoction of bark No. 3. every hour or two, putting a little mint water with it, and when the patient has taken this some time, let him take the bark in substance with wine: one tea-spoon­ful of bark in two table-spoonfuls of old claret every two or three hours: this or No. 4. should be continu­ed in till the patient perfectly recovers.

When the patient has been much harassed for want of sleep, have his feet bathed at evening in tepid water, and give him ten or fifteen drops of laudanum. This practice may be continued as long as it proves effec­tual in procuring sleep. In those cases that proceed from excessive evacuations there is little hope and scarce any thing should be attempted, but the strengthening plan.

The patient should carefully shun all the causes, and use a generous diet with regular varied exercise of body and mind, and be sparing of his strength.

CHAP. IV. PUTRID FEVER.

THOSE who are of a relaxed habit and gloomy disposition; those who have been debilitated by living upon bad victuals, by venery, famine, labour, or loss of rest, &c. easily take this fever (which is caused by putrid contagion or noxious air) and diffi­cultly emerge from it.

Symptoms. An intense consuming tho' remitting heat, particularly inwards; small, frequent, and unequal pulse without strength; throbbing of the arteries that run along the neck and temples; great prostration of strength, heaviness without sleep; and when sleep does take place, little or no refreshment is gained from it; [Page 12]an anxious, dejected, and desponding mind, nausea, and vomiting of black bile, pain of the head and tem­ples, redness of the eyes, and [...]out their sockets; dusky countenance, noise in the [...] interrupted breath­ing, with sighs and foetid breath; pains about the sto­mach, joints and back, difficulty of lying in one pos­ture, trembling, delirium. At first the tongue is whit­ish but quickly changes blackish, whilst the lips, teeth and gums are beset with a tough disagreeable mucus; an inextinguishable thirst attends with a bitter mawk­ish taste, which is communicated to the drink. The urine, on the increase of the disorder, becomes blackish or red with a sediment: The sweats become foetid, the stools lived, black or bloody, and very [...]tid: and if the fever goes on, a thrust and ulcers attack the mouth and throat; blood is discharged from different parts, a hiccough and other partial convulsions come on, which death scarce ever fails to follow.

Management. The patient should have fresh air ad­mitted by keeping the door of his chamber open, if it is not too cold, and by opening his windows if it is summer time, and the weather clear. Salt petre or vinegar should be burned upon the hearth in winter, and boughs of trees and flowers thrown about the room in summer.

His hands, face and feet should be washed daily in vinegar and water, or wine and water; he should be served frequently, and shifted in bed and body clothes as frequen [...]y as can be afforded, if it is daily: in fine, the greatest attention should be paid to cleanliness.— His food should be mostly of acid vegetables, such as please his appetite and stomach best. His drink should be port wine diluted [...] this he should drink more and more of, as he becomes more debilitated, so as to make it his drink and medicine: a quart a-day may be used; this he should continue in for some time after he has recovered, though in smaller doses: A fresh air­ing every day, after recovery, will be highly useful.

Cure. An emetic of eight grains of ipecacuana and one of tartar emetic, or half a table-spoonful of anti­monial [Page 13]wine, should be given as quick as possible, be­side this, twenty-five or thirty grains of rhubarb, or two drachms of cream of tartar, should be given in a lit­tle jelly, to open the bowels, after which the decoction of bark No. 3. should be given: two table-spoonfuls with a little mint water, every hour; if the stomach bears this well, and the symptoms of putrefaction and debility increase, the bark in substance should be used: a tea-spoonful in lemon juice and mint water every hour. But if the stomach does not bear the bark, or if the heat and fever be considerable, apply a blister to the breast, and give a dose of the saline mixture or one of the following pills between the times of taking the bark, [...] Camphor beat to an impalpable powder, with com­mon spirits, twenty-four grains, powdered seneca root as much; make them up with syrup.

If the stomach still refuses the bark in the above ways, try it in triple quantities in clysters, or try the vinous tincture, No. 4. The bark is the only chance, we are therefore to persist in its use till a cure is made. Three drops of oil of vitriol in a glass of water every hour, may be tryed where the delicacy of the stomach or fever, will not admit any preparation of bark; [...] as it is apt to gripe, it should never be used when the bowels are affected.

Clysters of salt, sugar, and decoction of bitter herbs are to be used to keep the bowels regular, or some of the gentle purges mentioned above; but it will be of­ten best to use first one and then the other, according to circumstances. In case this fever should be of a re­mittent form, the remissions should be greatly attend­ed to, and a double quantity of bark given if possible. Sometimes a lax with distension of the belly comes on after a while, in such a case the belly should be foment­ed with bitter herbs, boiled and applied warm, and one grain of ipecacuana, with five drops of laudanum, given every two hours.

Sometimes spots break out in this fever, then it has been termed the Spotted Fever; at other times there is a yellowness of the skin, then it is termed the [Page 14]yellow or West India fever. In this last case the symptoms of putridity are in this country more lenient, and a considerable vomiting sometimes hinders the giv­ing of medicine: in this case a blister to the breast and the effervescing saline mixture have been found effectu­al to stop the vomiting; but in general the treatment is the same as recommended above.

In the end of these fevers, some physicians recom­mend blisters to rouse the patient: if they are applied, the skin should not be pealed off as is sometimes done, but only opened to discharge the water, and then dressed with Turner's cerate. But the beginning or first stage is the most proper for blisters.

CHAP. V. REMITTENT FEVER.

CAUSES. Exposure to the sun for hours together, or the effects of a cool evening, and other similar causes after fatigue or summer heat. Thus there is no difference in the real causes of this fever and intermit­tents, except in the degree and mode of their appli­cation.

Symptoms. Alternating cold and heat, followed by a continued heat and a fever: Sometimes a delirium comes on at the first attack.

The patient is distressed with thirst and vomiting, usually of bile; pain of the head, back and joints; the region of the stomach swells, and becomes painful; the tongue is white and moist, and the patient is harrassed with sleeplessness; the skin and eyes are of a yellow cast; the pulse is sometimes a little hard, and seldom full; the bowels are sometimes bound, sometimes loose: with these symptoms the fever usually proceeds, for 2, 3, 4, 5, 6, 7 or 8 days, at one of which times, after a little sweat it remits, and the patient becomes evidently better. After a few hours have elapsed, com­monly in the evening, the accession comes on, sometimes with, at other times without a chill, and so goes on as [Page 15]before: In this manner, that is, by accessions and re­missions, the fever goes on to its final period.

A copious sweat or discharge of blood from the nose, or an universal yellowness, commonly attend the conclusion of it.

After the fever has gone off, a great lightness of the head attends, so that the patient can scarce walk; rheu­matic pains, and dropsical swellings sometimes follow.

Management. The patient should be kept cool and airy; he should have plenty of acid drinks, as lemon­ade, jelly, tamarind water, and for food, he should have toasted bread moistened with a little tea, baked fruits, rice, sago, barley, &c. but these, though proper, will seldom have a place, as the patient can scarce ever con­tain on his stomach what his little appetite inclines him to take: but the toast has often been found to stay, when nothing else would.

Cure. If the vomiting be considerable, a little ca­momile tea may be given to promote it a moment or two, that a remission may be procured to give the sa­line mixture No. 2. one table-spoonful every hour. When this sits on the stomach pretty well, ten drops of antimonial wine and a little mint water may be ad­ded to each dose, and the medicine continued: but if the vomiting is only slight, the best way to procure a remission of the [...]ymptoms will be to give an emetic, one tea-spoonful of antimonial wine, may be given eve­ry ten minutes until it operates, or 12 grains of ipe­cacuana may be given at once, after which the mix­ture may be given in the manner directed with antimo­nial wine.

If the vomiting resists every thing given, or if a re­mission does not take place in a few days, blisters should be used; on the breast in the first case, on the back of the neck in the last. Sometimes a bundle of mint stew­ed in wine, and applied to the breast, has been found useful in checking the vomiting, therefore it may be tried before a blister.

Costiveness should be regularly obviated by taking a tea-spoonful or more of cream of tartar, or by using [Page 16]the common clysters of salts, sugar and milk occa­sionally.

When the patient has suffered for want of sleep, af­ter giving a clyster, and bathing the feet in lukewarm water for half an hour, ten or fifteen drops of lauda­num may be given in a dose of the saline mixture No. 2. and this should be done after noon before the in­crease of the fever, for it usually makes some increase towards night.

When the fever remits, the decoction of bark should be given, two table-spoonfuls every hour, and if the accession is postponed by it, the bark in substance should be given, as long as the accession is absent: in some cases it will put it off altogether; then, as well as when the fever ceases, the bark should be given in large quantities, until the patient recovers his strength.

When a lax attends, four grains of rhubarb and one of ipecacuana with two drops of laudanum, may be given every three or four hours instead of the saline mixture.

When great sweats attend in the end, it may be ne­cessary to add five drops of elixir of vitriol to each or every other dose of bark: in case a headach follows, apply a small blister behind the ear, and repeat it if necessary. The patient should be very careful in avoid­ing the causes of this fever, or he will experience a relapse.

CHAP. VI. INTERMITTENT FEVER (COMMONLY) FEVER AND AGUE.

CAUSE. The relaxing heat of summer, especially when accompanied with moisture and bad air of marshy places, will so relax the surface and expose the extreme vessels to the air, that nothing more than the usual effect of common air is necessary to bring on the fever; at other times, when the predisposition is not so great, a cool air will produce it.

[Page 17] Symptoms. A languor with yawning and stretching, coldness, sick stomach, rigors and tremors, usually at­tend the commencement; the cold with shivering con­tinues in a very considerable degree, for one, two or three hours, when it begins to give way, first to flushes, and then to a continual burning heat and fever, with a full pulse and thirst. Pain of the head and frequently of the joints, attended sometimes with delirium. Af­ter this has continued for some time, a sweat breaks out, which becomes profuse, and this is succeeded by an intermission of a part, a whole, or two days, ac­cording to the type. See page 5. In the intermis­sion, the patient is affected with scarce any thing but debility. The fever returns again in the end of the time mentioned, with the same symptoms, and so goes on to its end, unless it changes its form. Quotidians come on in the morning, and usually attack the deli­cate and irritable. Tertians come on about noon, and usually attack the more robust and vigorous. Quar­tans come on in the afternoon, and most commonly attack the aged and torpid.

Management. Sometimes the ague so reduces the patient, that it will be necessary to keep him warm and give a little wine; but this is seldom the case. In common nothing is necessary but to lie down. In time of the fever, lemonade and other acid drinks, or warm teas may be used; the former will be most grateful.

In the intermissions, port wine and water, and a strengthening easy digested diet will be proper.

Cure. In the beginning of the cold stage, if the patient is able to puke, he should take one; three grains of tartar emetic in a gill of water, may be taken in the course of forty minutes, if required to take all: or 15 grains of ipecacuana in a spoonful of water, or a tea-spoonful of antimonial wine every fif­teen minutes: either of these may be used; the tartar is the most active and effectual, but acts too rough with some. When this has been taken, and the fever [Page 18]has come on, a sweating should be encouraged by tak­ing about three pints of warm drink in the course of two hours, to which one hundred drops of antimonial wine may be added, to make it more effectual. In case the patient cannot take a puke, let him take an Anderson's pill to open his bowels before the time of the ague, and when the fever has come on, and con­tinued a while, let him take fifteen drops of laudanum and fifteen of antimonial wine, in a cup of warm tea every half hour, for three times.

But when nothing forbids a puke but the person's inclination, he may take just before the fit, or after it is over some time, the following powder; twenty grains of rhubarb, and five of calomel in a little syrup, and when the fever comes on, take the warm drink as above.

These medicines will prepare for the exhibition of bark, which should be given immediately after the sweat goes off. Any of the preparations may be given, but the powder is the best; it may be given in mint water, milk or wine; one tea-spoonful every hour, till the ague comes on again; then it should be laid aside till this is over, when it is to be given again; the pa­tient should not cease under an ounce and an half, or two ounces. If, when this has been taken, the ague does not cease, another puke should be used as before In all cases the bowels should be kept open by Ander­son's pills or rhubarb.

Sometimes twenty drops of laudanum given before the ague, will put it off, and sometimes giving it just be­fore the patient is expected to sweat, will prepare for the bark; sometimes a quantity of snake-root tea at the same time will prove effectual: and in many cases bit­ters, of horehound, dogwood, rue, &c. will do as well as bark.

The fever and ague, after it has continued for some time, is apt to associate custom with its causes of re­currence; and thus it will frequently continue through such seasons as it would not have begun in. In such cases as these almost any alteration in the system will lessen or remove it; thus keeping the patient under [Page 19]expectation; fear or joy have often removed it; and thus the impositions of old women have often been effectual, when the faith of her patient has roused his expectation and fixed his attention. Though such things may at times be allowed, yet I would caution every prudent person to keep his skin to himself, and not let ignorant quacks fill up their lack of knowledge upon him, with the virulence of an arsenical plaster, or a more dangerous bolus.

CHAP. VII. HECTIC FEVER.

CAUSES. Violent racks of the constitution from any cause, absorption of matter from ulcers, exces­sive relaxation, and delicacy of any part that is ex­posed to irritation, as the lungs, stomach and bowels; all these causes are attended with general debility, and particular relaxation of the parts that defend the ten­der extreme vessels, from the irritations which act about them.

Symptoms. The fever usually comes on in the fore­noon, sometimes with considerable chills or coldness, which last some time; this is succeeded by heat, a quick, small and weak pulse in general, though some­times there is some hardness in it, especially in those who are not much reduced, and early in the complaint; this sometimes lessens towards evening, and again in­creases at night; at other times it continues on with­out any very obvious change till towards morning, when it intermits or greatly remits with a profuse swet which lasts a considerable time; the sweats do not appear in the first stage, that is, in profusion. A headach usually attends the fever, as also a sick sto­mach, both of which grow better in the intermission or remission.

The tongue is usually clean in this fever, the belly at first is often bound, but in the end a lax almost al­ways [Page 20]attends. The patient wastes away gradually, his feet swell, particularly at night, his hair falls off, his nails become crooked and thick, his face sharp, and a general failing takes place in every thing but his ex­pectations of getting better, and his understanding, which usually remain to the last.

This is the most usual form, but there is some variety, owing to the variety of the parts affected, and the state of the patient.

Management. The patient should have the lightest and most nourishing food given him in small quantities at a time, and at such times chiefly as the fever is ab­sent or slight, thus his breakfast or dinner at ten o'clock, should contain most of what he should eat. Milk is very proper when the stomach will receive it: sometimes it may be most agreeable when diluted with water and sweetened, at other times it may sit better when boiled. Custards, light puddings, chicken wa­ter and broth, beef tea, rye mush, corn mush, with the common vegetables of the grain kind, are mostly proper. Weak wine and water in the absence of fe­ver; barley water and sage tea at other times, will be proper for drink. The patient should be kept clean, and when his strength admits, he should be aired in a chair, and at all times have access to pure air.

Cure. In many cases it will be needless to attempt any thing but a removal of the cause, when the fever will quickly cease: but in general both the one and the other are to be combated. For treating the causes I re­fer to the places where they are treated of (though some of them could not have a place in this book, as they belong to surgery) for the treatment of the fever alone, the debility should be removed and the fever in­terrupted: for the first, when nothing forbids, bitters and bark are necessary; also elixir of vitriol, which may be given to sixty drops a day. These are to be ta­ken whilst the fever is off, or when it has greatly re­mitted, just before the time when the return is expect­ed, and again after it has commenced, one of the fol­lowing powders may be given: ipecacuana two grains, [Page 21]magnesia one tea-spoonful, mix them and give it in a little camomile tea. When a lax comes on there is little hope, but the following may be given: colum­bo root one drachm, pour one gill of boiling water upon it, and in a quarter of an hour strain it off; to this twenty drops of laudanum may be added; this may be used in the course of eight hours, and repeated.— Rice will now be the best food.

CHAP. VIII. INFLAMMATION OF THE EYE.

CAUSES. These act either externally or internally, though frequently both take place in producing the affection.

The externals are, violence, dust, cold winds, changes from heat to cold, viewing minute objects or bright bodies; metallic fumes, great heat, especially when accompanied with moisture; night reading, &c. The internal causes are, checked excretions, as the menses, &c. repulsion of some eruptive disorders, long continued ulcers dried up, immoderate use of spiritu­ous liquors and spices, fevers, measles, scrophula, venereal disease, &c. &c.

Symptoms. Redness, swelling, stiffness and pain of the ball of the eye or the lids; both from an inflam­mation of the vessels that pass over and through them, being filled with too much blood, or with red blood, instead of the fine white parts of it.

When the inflammation is considerable, a fever at­tends; and in such cases there is danger of the effects, unless speedily prevented by curing the disease.

Management. In no case a cure can be hoped for unless the causes be removed, which in many cases will be followed with an immediate cure. In any bo­dy be lodged in the eye, it is to be extracted, and if another disease be the cause, it must be cured by the means directed for such disease. In every case the patient should avoid exercising his eyes any more than [Page 22]what there is necessity for:—He should confine him­self to a dark room, or apply a fold of green silk over his eyes, and use an umbrella in the summer. His food should be light and mostly vegetable, in all cases without pepper or mustard. His drink should be cooling and acid, without any mixture of spirit. His room should be cooled with sprinkling in the summer time.

Cure. If there be a fever, or if the inflammation be considerable, and the patient able to bear bleeding, he should lose half a pint of blood, which may be re­peated if necessary; this should be followed by a dose of salts, or if the patient's case does not require bleed­ing, or other circumstances prevent it, the salts then should be the first thing. All this is to be done after the cause is removed, and thus in many cases where removing the cause will be the chief means of cure, they will have no place; as where the inflammation pro­ceeds from the venereal disease, scrophula, &c. One of the fever powders No. 1. when the fever continues, or the inflammation remains obstinate, given every four hours, will be serviceable. The belly should be kept regular by cream of tartar or small doses of salts, or of jalap and nitre: as jalap fifteen grains, nitre twenty-five, mix them.—For external applications, a blister behind the ears is most effectual, and to the eyes the following: sugar of lead twelve grains to half a pint of water, or as much white vitriol to an equal quantity of water: to either of which, when the inflammation has continued, and the former re­medies have been used, may be added a table-spoon­ful of brandy.

These external applications (the blister excepted) will be proper in every case and time. The weak­ness that follows requires that the patient use either a general or topical cold bath, and avoid much ap­plication and exposure.

CHAP. IX. INFLAMMATION OF THE BRAIN.

THIS is either a symptomatic disorder, as when it follows in the course of a primary affection: or it is original, being primary itself—of this alone I shall treat, that requiring the treatment of the con­comitant disorder.

It usually attacks in the heat of summer those of an irascible disposition, who are in their youth and given to study.

Causes. Drunkenness, watching, long exposure [...] the sun, anger, excessive cogitation, g [...], care, ve­hement desires, external violence, certain poisons, and suppressions of particular discharges; as the piles, the discharge after parturition.

Symptoms. It begins with rigors, which are follow­ed by heat, pain and throbbing of the head, disturb­ed sleep, noise within the head and ears, inflammation and pain in the eyes, with inability to bear the light and noise, and a bloated countenance—the p [...] low, oppressed and quick, often weak as well as low, though sometimes it is hard: the patient continues without any sleep for a long time, sometimes till the eighth day; the arteries along the neck perceptibly throb, and blood sometimes issues by drops from the nose; great debility, anxiety and sighing attend, yet the patient is subject to anger, f [...]ce delirium, startings and convulsions. When the disorder has ceased, a swimming and heaviness of the head, weak eyes and great delicacy of hearing attend for a consi­derable time.

Management. The patient should be confined in an airy, darkened, silent and cool room; his bed should be hard, and his head somewhat raised upon it. He should have plenty of acid, cool drinks, without any mixture of spirit. His food should be of p [...]d [...], [Page 24]barley, jelly, &c. The causes of the disorder must be carefully removed.

Cure. The patient should be bled pretty freely, and this may be repeated again and again in less quantities, during the first 48 hours; provided the symptoms demand it, and the patient be able to bear it:—the pulse will usually be the best guide; for if this does not sink very low, there will be no danger from bleeding. A dose of salts should be given after the first bleeding, and it may be necessary to repeat this the next day. Clysters may be given daily, such as No. 5. one of the fever powders No 1. may be given every three hours, beginning after the operati­on of the first dose of the salts. The patient's head should be shaved and washed with cold vinegar and water. If the delirium runs on after the above eva­cuations, a large blister should be applied to the crown of the head, and when this has drawn, others, if ne­cessary, may be applied to the ankles.

When the patient has suffered some time for want of sleep, the feet should be bathed half an hour or twice as long, in water moderately warm, and if this is inef­fectual, let him have ten or fifteen drops of laudanum, one tea-spoonful of paregoric at night, with this care, that if it makes him worse, to discontinue it; but if it has the desired effect, to persist giving it every night, if required.

A nourishing diet and the use of wine should be gradually entered into, after the symptoms of danger are perfectly gone, in order to prevent the succeed­ing symptoms of debility.

Great care will be necessary to avoid the causes of this disorder, as slighter ones may cause a re­lapse or repetition.

CHAP. X. QUINCY.

CAUSES. The application of cold to the neck or throat, a stream of cool air applied with force to the very part; as in riding and running: these causes pro­duce their effect more certainly when preceded by heat.

Exercising the parts that suffer, as in singing, and loud speaking; acrids, mechanic bodies, suppressed evacuations, or artificial evacuations, that have been long used, neglected.

Symptoms. This complaint usually appears with red­ness and swelling of the glands situated on each side of the palate; one is usually most swelled in the beginning, and as this declines, the other increases; a pain that shoots towards the ear attends, with feverish symptoms, and a strong, full, quick pulse: The patient feels a disagreeable clamminess, and the tumour is usually tip­ped with whitish mucus.

In some cases the external parts are much swelled; sometimes scarce any tumour is to be perceived by look­ing into the mouth, and at the same time the difficul­ty of swallowing and pain may be very considerable: In the worst cases the breathing becomes very diffi­cult, the tumours closing up the passage almost entire­ly; then the patient sits with his mouth open, his drink regurgitates through his nostrils, and he is ready to strangle every minute for want of a free respiration, which is totally impeded when the patient dies.

What is usually termed a sore throat, is a lesser de­gree of this same affection, therefore the same reme­dies may be used, omitting the most general and pow­erful one of bleeding.

Management. The patient should be kept neither hot nor cold: he should have a light vegetable diet of a fluid preparation; his drink should be of the acid kind, and not cold or warm, but just aired. His head should be kept up in bed, or he may sit up altogether; [Page 26]speaking, and every exertion of the throat, should be avoided, and the causes should be removed.

Cure. The patient should be bled pretty freely, and this may be repeated the next day if necessary: he should take a dose of salts as soon as possible, and then a blis­ter should be applied under the throat, of a slim form, so that it may reach from ear to ear: the bowels should be regularly kept open: before the tumour has become very considerable, fifteen grains of ipecacuana will be of great service. In such patients as do not allow of bleeding, this may be the first medicine.

Warm water and vinegar should be inspired from a proper machine for the purpose, or from a funnel put over a wooden bowl of water and vinegar, the mouth should be frequently gargled with astringent washes, as sage tea and vinegar; or alum-vinegar and honey, or decoction of oak bark and salt petre. Scarifications with a lancet are necessary where there is danger of choaking; and likewise to let out the matter, when the tumours have suppurated.

If the patient is liable to frequent returns of this af­fection, I would advise him to use the cold bath daily; at any rate to wash his neck, and habituate himself to wear nothing but a very thin stock or ribband, instead of a large neckcloth.

CHAP. XI. PUTRID SORE THROAT.

THIS disorder has for its cause, specific contagion, and therefore attacks all ages and constitutions.

Symptoms. It begins with chills, which are follow­ed by an intense and burning heat, a swimming and pain of the head, a troublesome sensation in the throat, sickness and vomiting, looseness, inflamed and watery eyes, tumid and flushed face, with a stiffness of the neck, a small, frequent and irregular pulse, foetid breath and a disagreeable taste. Very soon, white spots appear on the glands each side of the palate, and [Page 27]these with the palate appear red, swoln and glossy: these spots spread and unite, covering almost all of the mouth with thick sloughs, which falling off, leave ul­cers in their places: the redness and tumour are some­times extended to the internal parts of the nose.

On the second day, or later, efflorescences appear on the skin, which are sometimes in such small emi­nences as scarcely to be seen, but more usually spread in red patches, so as to cover the whole skin; begin­ning first about the face and neck, and so extending to the extremities, which feel stiff and swelled; this usu­ally continues about four days, and then goes off with a peeling of the skin. The glands about the neck are sometimes swelled to an alarming degree. As the complaint advances, discharges of blood from different parts are frequent, and sometimes a gangrene takes place at the beginning of the windpipe or of the oeso­phagus, the channel which leads to the stomach.

The patient's voice is hoarse and flat, though his swallowing is not usually much impeded; with these symptoms it runs on from two to seven or more days, increasing every evening.

Management. For food, drinks, and general manage­ment, the same may be used as directed for the putrid fever, only a less degree of cold will be requisite in this.

Cure. Ten grains of ipecacuana should be given early in the complaint; three grains of calomel in a little honey, may be given once or twice the evenings after the puke, and if the first dose produces more than two stools, it should be checked by giving ten drops of Laudanum. This medicine will often prove very efficacious, without producing any discharge. Some of the preparations of bark, or the powder, which is best, should be given every two hours after the puke, and to the end of the complaint. The throat should be frequently washed with the following: one hundred drops of elixir of vitriol or twenty drops of oil of vitriol to half a pint of water, and one spoon­ful of honey. Spring water coloured with indigo has been found useful as a gargle. Port wine should be [Page 28]given to a pint, or quart a day, with the bark. If the tumour in the inside of the throat be considerable, a blister should be laid on the outside.

For the swelling of the legs which sometimes follows, the patient may use eight drops of elixir of vitriol with each dose of bark, four times a day.

CHAP. XII. CROUP OR HIVES.

CAUSES. Foregoing disorders, as the measles and the hooping cough: cold moist air from the water.

It most frequently happens to such as live in seaport towns; and to children, from the time they are wean­ed to their twelfth year.

Symptoms. It sometimes comes on with the symp­toms of a common cold only; but the peculiar symp­toms are a hoarseness, and ringing sound of the voice; at the same time there is an uneasiness, or pain in the throat, and a whizzing noise in breathing, as if the passage was too much straitened for the air; the patient has a cough that is either dry, or accompanied with the discharge of flakes of phlegm, like a membrane; the pulse is quickened, and an uneasy sense of heat at­tends. By looking into the throat, a redness and flakes of phlegm like those discharged, may sometimes be perceived. It has happened that the patient has been taken off without scarce any complaining, in three, four, or five days.

Management. The patient should not be kept cold, nor disagreeably warm, he should have a spare thin ve­getable diet, with light acid, or bitter drinks, as teas of various herbs. In time of coughing, he should be raised and assisted, to keep him from strangling.

Cure. The patient should take a puke as quick as possible. (If he is twelve years old, ten grains of ipe­cacuana, and half a grain of tartar emetic will not be too much, for there is a great degree of insensibi­lity in the stomach in this complaint; if he is only [Page 29]four years old, let him have half as much, or one tea-spoonful of antimonial wine, to be repeated every quarter of an hour, till it operates.) After taking the puke, he should take four grains (if twelve years) of calomel, and ten of jalap, the evening of the same day; after this for three or four days, he should take one day the puke, and the next the purge; after the first puke and purge, a blister should be laid on the back of the neck. Throughout the complaint, the steams of warm vinegar, or of water in which there is a large lump of lime slacking (which is supposed to be a solvent) may be drawn into the throat; warm teas, and soaking the feet, may be used to restore the per­spiration to the surface.

CHAP. XIII. THE MUMPS.

CONTAGION is the cause of this complaint.

Symptoms. It makes its appearance with the usual febrile symptoms, of chills succeeding heat, and quickened pulse; this is shortly followed by a swelling, at the corner of the lower jaw, of a movea­ble glandular nature; in a little time it diffuses itself over the whole neck; sometimes both sides are affect­ed. It continues increasing till about the fourth day, and then declines with the fever. As the swelling re­cedes, some tumour is apt to take place in the testes of males, and in the breasts of women. Sometimes when this has not taken place, or when it has been re­pelled by imprudent applications, the fever has conti­nued, or increased with delirium.

Management. The patient should be kept upon a low vegetable diet, and not expose himself to cold. The above in general will be sufficient, but when the cir­cumstance mentioned takes place, it will be necessary to direct something more than the above for [...]

Cure. We should apply warm stewed bitter herbs, or warm bread and milk poultices to the parts; and if [Page 30]fever and delirium be considerable, the patient should be bled if he be able to bear bleeding; otherwise a puke should be the only evacuant, viz. fifteen grains of ipecacuana, more or less, according to the patient's age. Besides this or these, it may be necessary to ap­ply a blister to the back of the neck. In slighter cases the puke and fomentations will be sufficient. In all cases, costiveness should be prevented by clysters, cas­tor oil, or salts.

CHAP. XIV. PLEURISY OR INFLAMMATION OF THE INTERNAL PARTS OF THE BREAST.

THE end of winter, spring and beginning of sum­mer are the usual times that this disease is pre­valent; all ages and most constitutions are liable to it, but the phlethoric, and those of a rustic constitution, who have seen twenty years, and not exceeded sixty, are most liable.

Causes. Cold and heat applied alternately, or un­equally, straining or injuring of the parts, &c.

Symptoms. It usually begins with chills, which are followed by heat, quick, strong and full pulse, head-ach, difficult breathing, dry cough at the beginning, though sometimes it begins moist: towards the end, or after it has continued, it is always moist, and some­times a very considerable quantity of yellow mucus is discharged: this is not unfrequently streaked with blood. Most frequently, a pungent pain attacks the side [...] about the middle of the sixth or seventh rib, but if the pain should attack any other part of the chest, and should not be so violent, yet accompanied with the other symptoms, particularly the full, strong and quick pulse, we are to consider the complaint as the same.

Management. This should be identically the same with what is directed in Chap. II. only with addition of mucilaginous and syrup drinks to allay the cough; as [Page 31]of flaxseed, and mallow tea with honey: a little lemon juice will make it very agreeable.

Cure. From half to two thirds of a pint, or more of blood, should be taken away on the first appearance, and if the symptoms continue, it may be repeated in eight hours. After the first bleeding, a dose of salts should be given, and small doses of the same, or common clysters may be given regularly to prevent costiveness. Immedi­ately after the patient's first bleeding, a blister should be applied as near as possible to the pained part, and one of the fever powders, No. 1. given every hour, be­ginning after the operation of the salts is over. If after the blister has drawn, the pulse continues up, and the pain has not considerably abated, the second bleeding should be immediately made, and if in half an hour af­ter that, the pain does not give way, a second blister should be applied on a fresh part, or on the opposite side. The powders should be continued every two hours. But in general, one bleeding, a blister, the powders, and keeping an open belly, will be sufficient. Nothing but a relaxation of the pain and fever, should induce the patient to omit any of the above remedies, for life and death are pretty certainly fixed to the narrow compass of a few days. If the pulse is strong, and bleeding has been omitted as long as six or seven days, it would be then better done than let alone; but if the pulse flags, and the patient has had a frequent shivering about the last days, it will then be better, if not the very safety, of the patient, to forbear. At such a time a blister might be applied without any injury, but if a suppuration has taken place, it will be of no service; however those who are not proper judges, had better make the application, lest there might have been an insufficient inflammation for to suppurate in that time; and with th [...] the pati­ent may use what will be proper in the last case of every pleurisy when the cough is troublesome: a tea-spoonful of paregoric in a little flaxseed, or other tea, once in four or five hours. In the latter stages, it may be ne­cessary to support the patient's strength with decoc­tions of bark, and a light nourishing diet.

[Page 32]Seneca snake root tea, the pleurisy root, or common salt petre taken to one fourth of an ounce a day, in whey or gruel, may sometimes alone, and often after a bleeding, remove a pleurisy; but they should only be tried, when the person cannot procure the above pre­scribed remedies.

CHAP. XV. BASTARD OR SPURIOUS PLEURISY.

THIS usually attacks the aged, those of a phleg­matic full habit, who have injured their constitu­tions by excess of drinking, particularly, and are liable to the vicissitudes of the weather, from being much exposed.

Cause. The long application of cold, suddenly succeeded by heat, and heating drinks; this, with the predisposition laid down above, is the chief, if not the only cause.

Symptoms. It makes its appearance with chills and flushes, which are followed by a slight fever, with a soft, not very frequent pulse. The heat of the patient is not usually much increased; a pain affects the side, or breast, which is not very pungent, but rather dull and extending; a violent pain in the head, sick stomach and sometimes vomiting, are more or less present. From the beginning, it is common for a cough, strait­ened breathing, and spitting of tough mucus to attend. An erysipelatous redness often appears on the cheeks, and a looseness attends the advanced stage of the dis­ease. The patient is apt to be heavy and drowsy; thus though there be a pain in the side, and a fever, it is easily distinguished from a true inflammatory af­fection of the breast.

Management. The patient should be kept tolerably warm, his diet should be light and nourishing, and in the beginning, if the feverish symptoms are not consi­derable, he may have weak wine and water for his drink; in the end it will always be proper, for the [Page 33]patient frequently becomes fainty, and is not able to take any thing besides. Lemonade may be used, when wine and water cannot be given for the fever; and when lemons cannot be got, vinegar and water, or cyder and water.

Cure. Bleeding though it may sometimes be pro­per, as when the patient is of a more robust habit, and better constitution than what is described above, and when he has been accustomed to bleeding, and withal the pulse and pain are not low; yet, it should be used sparingly and cautiously, otherwise, in ninety cases out of one hundred, it would be injurious. In the beginning it will be proper to give ten or twelve grains of ipecacuana; or a tea-spoonful of antimonial wine, every fifteen minutes until it operates; a blister may be put on at the same time, as near as possible to the pain; the puke may be repeated once or twice if necessary, and sometimes it will be necessary to lay on another blister close by the former; twenty grains of jalap, or thirty grains of rheubarb, or a table-spoonful of castor oil, or four or five grains of calomel, may be used to remove any costiveness that is present: this should be attended to throughout.

For the cough, two drachms of gum ammoniac, dis­solved by trituration in a mortar, with half a pint of water, may be given; one table-spoonful every hour: or an ounce of syrup (commonly called oxymel) of squills, in as much water, may be given in the same way.

Seneca snake root or pleurisy root tea may be used, if they cannot be procured; to either of these me­dicines at night a dozen drops of laudanum may be added, in order to allay the cough, that the patient may rest; and if the cough is very frequent in the day, a few drops may be taken every now and then.

Towards the end when the patient grows weak, he should use about sixty drops of elixir or vitriol a-day, and use a decoction of bark or some good bar [...]

[Page 34]Great care will be requisite to prevent the return of this disorder, when the weather is favourable to pro­duce it.

CHAP. XVI. SPASMODIC STITCH, OR INTERCOSTAL RHEUMATISM.

THIS complaint is prevalent when the changes of weather are frequent, as in the spring and fall. It usually attacks the young, those under forty years, those who are of a delicate, effeminate constitution, rather than those of a broken state of health.

Exposure to cold, more particularly after heat and damp cloudy weather are the causes.

Symptoms. It begins with a lancinating pain, most frequently about the ribs of one side; this remits a while, and then returns again, so as almost to make the patient scream out. After a while it becomes fixed, and does not abate, though it is apt to extend, and even to change its place, so that the muscles of the breast are frequently attacked, and there are pains in o­ther parts that point out a rheumatic affection: with the above a fever, sometimes pretty smart, at other times less, attends. In most cases the pulse is not strong, but easily stopped by pressing it, to what it is in true pleurisy. Frequently a cough attends, which is apt to increase towards the end of the other symptoms, at which time it is accompanied with spitting of yellow, tough mucus; some degee of costiveness usually at­tends, and most of the symptoms are worse at night.

The breathing is not in general affected so much as in pleurisy, little or no cough attends; the head is usu­ally much affected with pain, and as the pain of the side declines, the knees or back are sometimes attacked, if not before.

Management. The patient should be kept on a vegetable, moderate diet.

His drink may be warm herb teas.

[Page 35] Cure. If the patient be pretty full of blood, and his pulse tolerably strong, it will then be prudent and useful to take away half a pint or more of blood. A blister should be laid over the part, a dose of castor oil, or of fifteen grains of jalap and as much cream of tartar, should be given to open his bowels: if the pain continues, some proper sweating medicine should be given, as four grains of camphor beat up with honey into a bolus, to which two grains of ipecacuana may be added, this much should be taken every three or four hours, washing it down with seneca snake root tea, or warm baum tea: or in the place of these a tea-spoon­ful of paregoric and twenty drops of antimonial wine, may be taken every three hours; using plenty of warm tea in the intervals. This last mixture will be pro­per for the cough, taken in the same quantity and times.

CHAP. XVII. INFLAMMATION OF THE STOMACH.

CAUSES. External violence, high seasoned food, acrid medicine or poisons; hard bodies swallowed, as of glass or stone; cold drink, when the body is heat­ed; distension; from an over quantity of food that is of difficult digestion; inflammations of the adjacent parts extending to the stomach: besides these causes, a trans­lation of affection in other disorders are causes; as in the gout, small pox, measles, St. Anthony's fire; but these require a treatment connected with the primary affection, which cannot be treated of here.

Symptoms. A violent, pungent, and sometimes throbbing pain at the pit of the stomach, with burn­ing and painful vomiting; a hiccough, anxiety and difficult breathing; great weakness; after taking any thing into the stomach, the pain increases, and it is discharged by vomiting; the pulse is commonly small, hard and quick.

[Page 36] Management. The patient should be kept from swallowing any thing but mild drinks, as barley wa­ter, milk and water, &c. he should keep himself as still as possible in a dark room.

Cure. If any thing that is acrid, or that may in­jure the stomach mechanically, has been taken in, it should be evacuated as quick as possible, by taking plenty of warm water, and applying a feather to the throat, to induce immediate vomiting; but if the vo­miting is already considerable, it should not be solicit­ed after vomiting; if the cause be some acrid, it should be diluted with mucilaginous drinks, as gum arabic dissolved in water; or oils may be given, as sweet oil or almonds oil; at the same time it should be counter-acted by a proper medicine. Thus if it be vitriol, or spirit of salt or aqua fortis, let the patient take a table-spoonful of salt of tartar, or if he can get none of that, let him get a piece of chalk and eat it. If it be arse­nic, two tea-spoonfuls of precipitate sulphur may be swallowed. After this, or where these have not been required from the nature of the cause, the patient should lose a pint of blood, and in case the pain con­tinues, and the pulse does not sink and intermit, half as much more may be taken away in eight hours following; a blister after the first bleeding should be applied to the left side, and clysters of oil, sugar, milk, and a little salt petre should be injected every three hours: four grains of sugar of lead in a little water may be given every two hours the first day: nothing but the medicine mentioned should be applied by the mouth.

CHAP. XVIII. INFLAMMATION OF THE INTESTINES.

CAUSES. Besides most of the causes of the preced­ing disease, may be added, cold applied to the bel­ly: long and violent cholic, and he [...]ia, commonly termed a rupture.

[Page 37] Symptoms. A fixed pain, sometimes spreading over the belly, at other times fixed about the navel, fever, costiveness and vomiting.

Management. The patient should have light, liquid preparations of vegetables for food, and his drink should be jelly and water, or apple-water, or lemon­ade, or molasses and water with a little vinegar: these or any of them, may be taken plentifully.

Cure. He should be bled as quick as possible; the quantity should be pretty large, proportioning it to the habit of the patient; this may be repeated in eight hours, if the symptoms demand it, and the pulse al­low it. After the first bleeding, a blister should be ap­plied over the pain, and a clyster of oil, molasses, milk and Glauber salts injected: this may be repeated every three or four hours with small quantities of salts after the first time: eight grains of nitre, if it does not ex­cite vomiting, may be given in a little drink every hour. If the inflammation should suppurate and dis­charge matter downwards, nothing should be used but the mildest, nourishing spoon-diet of broths, &c.

CHAP. XIX. ACUTE INFLAMMATION OF THE LIVER.

CAUSES. External violence, from bruises and con­tusions, especially such as have occasioned a fruc­ture of the skull at the same time; violent passions, ex­cessive summer heats, too much exercise, cold applied externally or internally.

Symptoms. A pungent pain of the right side, shoot­ing up to the shoulder, a cough for the most part dry, tension of the right side over the liver, hard dry gums, vomiting, weakness, difficulty of breathing, watching, costiveness, hiccough, and a hard, full, quickened pulse.

Sometimes there is a difficulty of lying on the left side; sometimes the eyes, tongue and urine are tinged with bile.

[Page 38] Management. The causes should be attended to, and removed as far as possible. Light vegetable food, and acid drinks should compose the patient's diet. He should be kept cool and still.

Cure. The patient should be bled early in the dis­order, and this may be repeated if necessary: a dose of salts should be given to open his bowels, after which cream of tartar may be used constantly for the same purpose, or clysters may be used of No. 5. A blister should be applied over the pained part, after the first bleeding, and after that the parts around may be fre­quently fomented with warm stewed herbs, as mallows, horehound, wormwood, &c. If after the use of these, the fever continues with the pain, the following pills may be used until they affect the patient's mouth: Calomel twenty-four grains, tartar emetic two grains, make them up with syrup into twelve pills: one of which may be taken morning, noon and night.

From the beginning, if the fever be considerable, one of the fever powders, No. 1. should be given eve­ry two hours, except when other medicine is to be given.

CHAP. XX. OBSTRUCTION OF THE LIVER.

CAUSES. Intermitting and remitting fevers, ex­posure to frequent colds, fitting up of nights, obesity, &c.

Symptoms. A dull, heavy sensation and tension of the right side, little or no fever, difficulty of lying up­on the left side, yellow eyes and costiveness.

Management. Avoid or remove the causes, live upon a simple vegetable diet, and watery drinks.

Cure. If the patient be pretty full, or if accustom­ed to bleeding, blood letting may be once performed: ten grains of ipecacuana may be given at the distance of two or three days, for several times.

[Page 39]The bowels should be kept open by the pills, No. 6. taken regularly so as to answer the purpose: the side should be frequently fomented with a warm decoc­tion of bitter herbs, and one of the calomel pills, in ch. xix given every second night till they affect the gums.

CHAP. XXI. INFLAMMATION OF THE KIDNEYS.

CAUSES. External contusions, violent, long-con­tinued riding, strains of the back, Spanish flies ta­ken inwardly, or applied outwardly on a blister, stones that have formed in the cavities of the kidney passing out.

Symptoms. Fever, pain about the part, which may be distinguished from rheumatism, by the former not being much increased by motion; a retraction of the testicle on the same side, a numbness of the thigh and leg on the same side, vomiting, colic pains, costive­ness, redness of the urine, and small discharges of it at a time.

Management. The patient should have plenty of light, mucilaginous drinks, as flaxseed tea, mallow tea, and gum arabic dissolved in water; these should be drank warm. His food should be broth [...] and ve­getables.

Cure. The patient should be bled once or twice, proportioning the quantity to the age, habit and cus­tom of the patient. The small of the back should be frequently fomented with warm decoctions of bitter herbs. His bowels should be opened with a dose of castor oil; and emollient clysters of oil, molasses and mi [...]s should be injected, every two or three hours: besides these, sixty grains of Glauber salts in lemon [Page 40]juice may be given, every two hours, throughout the continuance of the heat and fever.

CHAP. XXII. ACUTE RHEUMATISM.

THIS attacks at all seasons, but rarely at any other time than the spring and fall, when the vicissitudes of weather are great.

Causes. Cold applied to the body, when unusually warm, or cold applied partially to the body.

Symptoms. A pain affects some of the joints, and sometimes the muscles, so as to extend from one joint to another. Sometimes almost every joint in the body is affected, and then the complaint comes on with chills, and fever, with a strong pulse, for the most part full. In some cases, the fever precedes the pains, at other times, it is the contrary; the joints affected become red and swelled: the fever and pains usually increase at night. If the general affection continues long the patient's senses become somewhat impaired for a while.

Management. The patient should be kept cool, ex­cept when under the operation of sweating medicine, then he should lie between blankets; he should be kept from all but light vegetable food, and cool acid or warm herb drinks, which may be given plentifully; and when the complaint has gone off, he should wear flannels till warm weather returns, and then use bathing.

Cure. The patient should be instantly bled, as free­ly as his habit and age will bear, and his complaint demands; this may be repeated in smaller quantities, for once or twice in the course of four days, if neces­sary. After the first bleeding, a dose of salts should be given, and when that has done operating, one of the powders, No. 1. should be given, every two ho [...]. If this does not answer, let him have twelve grains of Dover's powders (which may be had at the apotheca­ries [Page 41]shops) for two or three nights, lying then between blankets. If any pain still continues, it may be looked upon as verging to chronic rheumatism, and the fol­lowing may be given: one hundred drops of vola­tile tincture of guaiacum, in a little water, three times a-day.

In general nothing can be done that will be of ser­vice as an outward application; however, a little Castile soap, dissolved in water, may be used to satisfy.

In slighter cases the bleeding may be omitted, and the salts with a common sweat of seneca tea used.

CHAP. XXIII. CHRONIC RHEUMATISM.

THE former disease is apt to terminate in this; especially when the patient is advanced in years: Cold is the common cause of it.

Symptoms. A pain of some of the joints, or about the junction of the bones, with a stiffness of the part. No redness or swelling like that from inflammation affects the part, though after a long continuance, an enlargement of the joints is apt to take place. Lit­tle or no fever attends here, heat lessens the pain, and cold increases it; quite contrary to what takes place in the preceding complaint. When the pains fix about the small of the back, the affection is termed a Lumbago; when about the hip, in which case the patient becomes somewhat lame, a Sciatica.

Management. The part affected, if possible, should be constantly wrapt in flannel, the patient should use wine with any food he may chuse, which will agree with his stomach.

Cure. Ninety drops of volatile tincture of guaiacum, should be taken in a little water, four times a-day; if this does not answer, the following pills may be used till they produce some effect; twelve grains of [...] and twelve grains of opium, to be made into one do­zen [Page 42]pills, one to be taken morning and evening, wash­ing it down with a large quantity of Virginia snake root, lignum vitae, or sassafrass tea. Besides these, there are other common remedies, which are less cer­tain, as a decoction of prickly ash, mustard whey, balsams, &c. In what is called the sciatica, twelve drops of spirit of turpentine, in a little honey, taken night and morning, is particularly effectual.

The external remedies in rheumatism, are spirits of camphor, spirits of hartshorn and oil; oil and spirits of turpentine, electricity applied by insolation, and drawing sparks; the flesh brush, cold water dashed on. However, this last is more effectual in cases that are between the inflammatory and chronic, where one joint is chiefly affected.

CHAP. XXIV. TOOTH ACH.

CAUSES. A general cold, cold air applied to the cheeks in an unusual and sudden manner, acrids, sweets, or acids applied to the teeth, the acrid matter of a rotten tooth, extraordinary violence, as in break­ing hard substances, blows, &c. Besides these there are certain disposing causes, under which the usual ex­posure we are constantly liable to, is a sufficient cause; as a nerve being laid bare, by rotting or extraction of a tooth, pregnancy, hysteric dispositions, &c.

Symptoms. These are various in different circum­stances. In the tooth ach that proceeds from com­mon cold, there are frequently symptoms of a rheu­matic affection of the adjacent parts, the pain extend­ing from the tooth to the face, and along up to the [...]empl, with a throbbing of the arteries, and redness, sometimes a little swelling of the face, and withal a feverishness. In most other cases, a violent pain of the tooth, with a little inflammation of the gum, are the only symptoms, except that about the terminati­on, the [...] relaxed habits) is apt to swell.

[Page 43] Management. The patient should carefully avoid every cause, and confine himself to his room. In the case of rheumatic symptoms, his food and drink should be of the weakest and lightest kind, and a silk handkerchief should be applied over his face. In the other cases, the face should be wrapped in flannel, and no change made in the food or drink. The tooth should be stopped with lint.

Cure. In the first case it will be the best way to aim at the removal of the cold, by giving a dose of salts, and taking a sweat of weak whey, with a tea­spoonful of salt petre. After this a small blister applied to the part will be most effectual; or, instead of this, sweating the part with hot herbs, or a hot stone, wrapt in moist or dry rags, may be useful. In general, in such a case it will be of little use to apply any thing to the tooth itself, till the above has been first done, then a little laudanum and spirits may be held in the mouth. In all the other cases, topical applications are more effectual. The chief of these are opium, camphor, oil of cloves and other warm essential oils; with these electricity, burning the tooth, applying a hot iron to the ear, and many other means, have been at times ef­fectual. But it is often necessary with these to give small doses of laudanum, and apply a blister, and when these fail, extracting the tooth; which may be done at any time, by a careful trusty operator: but if this does not relieve, the pain passing to another tooth, the pa­tient should not insist upon that being drawn, but commit all to patience. The best manner of applying topicals is to insert the medicine into the hollow, and cover it with lint or wax.

CHAP. XXV. THE GOUT.

THE causes of the gout, for better comprehending them, may be placed under four heads.

1st. The prime causes; which are the use of excessive quantities of high seasoned animal food, and the libe­ral use of wine and other spirituous liquors. These are supposed to produce their effect, by causing an ac­tion in the extreme vessels (which are employed in nu­trition) in degree and constancy, above what they were constructed to bear, so that as soon as the body ceases to yield, which is at the end of growth, the vessels from being over excited, are overcome, and suffer an indirect debility, and relaxation.

2d. The predisposing causes; under which a less de­gree of the above brings on the complaint, because they aim at the same point: they are, indolence, hereditary delicacy of the parts that suffer in the gout (from a general similarity to the parent) and that tendency in the animal oeconomy which produces a robust and gross habit. These causes would, when they had proceeded to a certain extent, bring on the gout; but it is sel­dom the case, that it is not helped on by what may be called.

3d. The exciting causes; as venery, debauchery, cold applied to the feet, indigestion, much application of mind, night watching, passions, excessive evacua­tions, changing of habits, debilitating diseases, bruises or strains of the parts that suffer in gout; the use of [...] and acid fruits, &c. All these act by debilitating generally or topically, and this being always accompa­nied with a relaxation, exposes the injured parts to the irritation of the air in an uncommon manner. The irritation of the air brings about

4th. The proximate or immediate cause; which is a superabundant afflux of the nervous, or vital princi­ple, to the parts most debilitated or most exposed (to [Page 45]the common irritations); usually the extremity of the joints, or ball of the great toe. This afflux of vital principle has two effects. 1st. As there is no sen­sation without the presence of this principle, so in the abundance of it, the sensation is exquisite. 2dly. As there is no circulation without it, and the circulation is in proportion to it, so, in the abundance of it, the circulation is increased to inflammation, and the tender parts are forced, and filled faster than they can propel the blood; hence congestion, redness and pain of the joint, and in such parts as are not plentifully furnished with vessels, the muscular fibres are contracted to a spasm.

CHAP. XXVI. THE SMALL POX.

THE small pox is of two kinds; the distinct and the confluent: As they demand a very different treatment, I shall not confound them, but treat of them separately.

CHAP. XXVII. THE CHICKEN POX.

THIS disorder appears to arise from a specific con­tagion in the air: like the small pox, it never returns.

Symptoms. The patient is generally, for one or two nights, or nights and days, affected with fever, which most always is slight: at no certain person, though perhaps always before the third day, the pocks appear [Page 56]on the face, and over the body; they are never very numerous, though sometimes pretty large. In the course of four days they are at their summit, when they are about the size of a large brister shot, and much of the same form, filled with yellowish or white water. They sometimes come out successively instead of a great many at once.

Management. The patient should be kept cool, espe­cially when in bed; light vegetable food, and cooling acid drinks, should be used.

Treatment. If the fever be worthy attention, the bowels should be opened with a dose of cream of tar­tar or of salts, every day till it ceases, and the acid drinks given plentifully.

CHAP. XXVIII. THE MEASLES.

THIS disorder arises from specific contagion, and never has been known to attack the same person twice.

It usually makes its appearance about January, and again ceases at midsummer. Nevertheless, it is not al­together adherent to any particular times, for it con­tinues throughout the year, though less extensively.

Symptoms. It comes on like a common fever, with a cold stage succeeded by a hot one; a nausea, anxiety and vomiting, are pretty generally attendants. Some­times at the beginning, the fever is sharp and violent, but before the eruption it is most generally so, which happens about the fourth day; with these a hoarse­ness, cough, difficult breathing, swelling of the eye­lids, acrid discharge from the eyes and nose, with sneezing take place: generally a drowsiness attends the beginning. The eruption appears first on the face in small points like flea-bites, which soon may be ob­served by [...]ut or feeling, in clusters, spreading them­selves over the whole body; the face appears a little [Page 57]turgid during the first two days of the eruption, after this, the eruption changes its colour from a scarlet to a brown, and soon goes off very entirely, leaving [...] scurf. The fever sometimes goes off, when this [...] ­squamation takes place, but more commonly continues with the cough for some time after the disorder has gone through the stages, and not unfrequently the cough and difficulty of breathing increase towards the end, so as to mark an inflammation of the lungs. Af­ter the desquamation, a lax or sweating usually takes place, and continues for some time.

Management. The patient should avoid heat, but on the other hand, should not expose himself so much to the cool air, as in the small pox. He should live on a low vegetable diet, and cool acid demulcent drinks, such as flaxseed tea, with lemon juice: barley water boiled with prunes, is also very good, especially for the cough.

Treatment. If the fever that precedes the eruption is considerable, it will, in adult patients, be proper to bleed, but in children, a purge or two of salts will be generally sufficient. From the beginning, the drinks mentioned above and syrups may be given to allay the cough; but these are seldom sufficient; it will therefore be necessary, from the time of the eruption, to give one tea-spoonful of paregoric, twice a-day, and two at night in common drink. This treatment and keeping the bowels open regularly, with gentle me­dicine, as salts and manna, in small doses, cream of tartar, castor oil, &c. should be continued in. When the desquamation or peeling of the skin takes place, if the difficulty of breathing mentioned in the desorp­tion, comes on, with a strong pulse; then the patient should be bled freely, and a blister laid afterwards on the side, as in a pleurisy, and with these, one of the powders No. 1. may be given every two hours, or if it be a child, a sufficient quantity of antimonial wine, to be taken at intervals of two hours: during such a state the paregoric should be omitted. If the patient, is unable to bear bleeding, the case then cannot be ve­ry [Page 58]violent; then purging and blistering with the pow­ders may be used; gentle riding and bark are proper [...] restore the patient when much reduced.

CHAP. XXIX. THE SCARLET FEVER.

THIS complaint cannot possibly be separated from the putrid sore throat, as the affection of the throat, eruption of the skin, and low or putrid fever, which are the chief symptoms, are attendants on both: added to this, the same contagion will affect one per­son with what is judged to be the putrid sore throat, and another with the scarlatina. It is therefore pro­bable that the scarlatina is only an affection of less magnitude, sometimes owing to the lenity of the ge­neral contagion, and then causing scarlatina universal­ly, and at other times owing to the diversity of con­stitutions attacked. Hence, for the cure, &c. I refer to what I have said of the putrid sore throat, Chap. xi. But it frequently happens that the scarlati­na is so slight as to shew no putrid symptoms but ra­ther inflammatory; then all that will be required will be a blister to the throat and keeping the bowels open with cream of tartar.

CHAP. XXX. St. ANTHONY's FIRE.

CAUSES. A hereditary disposition thereto, or a peculiar delicacy of the membrane that suffers the inflammation; passions of the mind, a sudden cooling of the body after being heated by the sun, spirituous liquors taken freely, hot drinks or hot baths, checked evacuations, moist air, and perspiration any how stop [...], generally excite the disease in those predisposed.

[Page 59] Symptoms. It commonly comes on with shivering and succeeding heat with fever; the pulse is general­ly quick, sometimes hard and full; a confusion of the head and some degree of delirium frequently attend, but a drowsiness almost always, which sometimes in­creases to a comatose state. After these symptoms have continued from one to three days, a redness most commonly on the face appears, which increases with a swelling, that turns white, upon pressing it with the finger. This goes on to increase, though it com­monly abates in one part a little, to increase in ano­ther; in this manner it sometimes extends all over the head, and swells the eye-lids, so as to produce tempo­rary blindness.

It is not an uncommon case for blisters to arise on the swelling, filled with yellow or whitish serum, which break after awhile, and leave the part underneath blackish, and very ready to turn gangrenous; the skin between these blisters peels off; matter is sometimes discharged from the eyelids: the inflammation and fe­ver usually continue about ten days, and then go off; when the fever goes on violently, and the inflammati­on extends, it is apt to produce an apoplexy.

These are the symptoms of a perfect disease, but slighter affections are not unfrequent, even with little or no fever.

Management. The patient should be kept cool, in proportion to the greatness of the fever: acid drinks and vegetable diet should be used throughout.

Treatment. When the case agrees with what is laid down above, half a pint or more of blood should be taken away, which may be repeated, if the habit al­low, and the pulse and inflammation require it: after bleeding, cooling purgatives should be administered; one ounce of Glauber salts may be divided into four parts, one of which should be given every two hours, mixing it with lemon juice, which covers the bad taste.

This practice of administering salts may be followed for some days; they not only open the bowels, but [Page 60]temperate the heat and fever: in slighter cases bleed­ing should be laid aside, and the medicines given as directed.

Whenever there are any symptoms of putrefaction, as a low, weak pulse, dark colouring of the tongue and mouth, acrid and black spots underneath where the blisters stood; then all evacuations (except keep­ing the bowels regular, with a little rhubarb) should be laid aside, and twelve grains of columbo root given every hour; when this can be kept on the stomach well, and does not have sufficient effect, as much bark should be given, and the dose increased as necessity requires, or as it will fit on the patient: wine and water, and vitriol and water, made by putting two tea-spoonfuls of elixir of vitriol to a pint of water, may be drank alternately and freely.

The patient is most always wanting some topical application, for this physicians have thought that meal sprinkled on the part, is the only proper application; this, when the inflammation is considerable, fits agree­ably, and has some effect in softening the skin, and if sprinkled on very slightly when the blisters discharge, it dries up the humour: however patients are not con­tent with it, therefore apply either of the following with a rag moistened in it: half a pint of strong tea of camomile flowers, or wormwood tops, fifteen grains of white vitriol, and a tea-spoonful of lau­danum or a strong solution of allum.

Sometimes from neglect, the part suppurates; then it should be poulticed with bread and milk till it is ripe, when it should be opened and dressed with lint spread with wax and oil melted together; this need only be applied over the sore.

Bark and vitriol, with fresh air, gentle exercise in a carriage in fair weather, will be proper to brace up the habit in the end.

CHAP. XXXI. THE ESSERA, OR NETTLE RASH.

THIS generally attacks those of a delicate consti­tution, especially such as have a fine skin, the ex­cessive irritability of which appears to be a cause of the disease.

From the above it would appear, that women and children are the chief subjects of it; which is agree­able to observation.

Symptoms. It usually comes on in the night, pro­ducing great restlessness and itching. In the morning considerable red eminences are to be observed on some parts of the body, usually about the upper arms, neck, and breast; their forms are irregular, some being like the stroke of a whip, others like the sting of a mosque­to. It is not unfrequent for them to disappear in the course of the day, and return again at night: the time of continuance is various, as they sometimes continue for a week, and sometimes for a year or more.

They have never been known to have any dangerous effect; the itching being all that is disagreeable, which at times is so troublesome as to prevent sleep.

Management. The patient should use exercise, bathing, and every proper means to remove such a de­licacy of constitution.

Cure. This has been too little attended to, or per­haps we should ere this, have discovered some simple medicine that would remove it.

I have seen mercury recommended, and in a few cases which I have treated, it was always attended with success.

Twelve grains of calomel, and as many of sulphur of antimony, may be made into a dozen p [...]s, one of which may be taken for six nights following, after which they may be used only twice a-week; if the pa­tient's gums become sore, they should be omitted: [Page 62]AEthiops mineral is also a proper medicine, twenty grains may be used every other night for twenty days.

Perhaps if common sulphur was tried every night, it would have an equally good effect. To guard against the returns of it, bark may be used; and some weeks after using the medicines prescribed, the cold bath.

CHAP. XXXII. BLEEDING AT THE NOSE.

THOUGH this complaint attends at any age and may trouble any constitution, yet it does not make the disorder I mean to treat of, except when it attacks young people, and especially those who are full of blood.

The animal oeconomy finds it proper not to increase the different parts equally from the time of conception, but increases certain parts successively, this increase is brought about by a determination of blood to these parts: hence the different periods of life, that we see fluxes of blood making their appearance may be easily accounted for: and hence this complaint in the youth­ful, and the following complaint immediately after that period.

It requires attention, or it will soon be accompani­ed with very disagreeable circumstances.

Symptoms. A head-ach, redness of the eyes, florid countenance, and throbbing of the temporal arteries, usually precede for a while before the effusion, but im­mediately before it a fulness of the face, and itching at the nose take place: beside these, frequently more ge­ [...]toms are observable; as costiveness, pale [...] of the feet, and shivering [...] this is a de­scription which suits the most perfect state of the complaint.

The quantity of blood discharged is various.

Management. In the time the bleeding comes on the patient should be placed in a stream of cool air, [Page 63]and be supported erect; he should avoid talking, or blowing his nose.

In the intervals he should avoid heat, stooping his head, or walking fast, more especially after eating: his exercise should be gentle and constant, and this may be partly in riding and walking, and partly in the oc­cupation of his business, if that be mechanical. The cold bath may be used daily, in which he may remain some time; this has, beside a bracing property, a tendency to make the patient lean: a little care should be used in the beginning; no cap should be worn on the head to keep the water from that part. He should live upon a vegetable diet chiefly, and use cold water for his constant drink.

Cure. In beginning to treat the patient, if he has not already lost much blood, a few ounces may be tak­en from him, a little before the time of the bleeding's coming on, and ever afterward a dose of salts may be used at the same time; and it may be observed in gene­ral, that it will be necessary to keep the bowels very regular. If after the salts have been taken, the dispo­sition is not removed, one of the fever powders, No. 1. may be used every two hours, for two days, and large quantities of lemon-juice taken between each dose.

When the bleeding comes on, it may be suffered to continue till six ounces have been discharged, provided the patient be full of blood, but if otherwise, it should be stopped immediately, by pouring cold water on his head, hands and testicles, and by drinking cold water; at the same time, using dossils of lint, dip [...] a strong solution of allum and water, or in any common astringent, and applied up the nose; a piece of sponge is sometimes of service; a weak solution of bluestone has sometimes stopped the bleeding, after other things have failed. But in many cases neither of the above will answer, then the patient's life is in danger, and the following simple method may be used by any com­mon person, who has the least degree of presence of mind; take a needleful of silk, wax it and tie to one end of it a dossil of well scraped lint, about as large as [Page 64]a thumb, get a piece of cat-gut string several inches long, grease it a little, push this cat-gut through the bleeding nostril into the mouth, till you observe it come out near the throat, lay hold of it with a pair of narrow pincers or forceps, or in their stead, with a dull pair of scissars, and draw it till you have both ends in your hands; tie a knot in the end that you have drawn through, and to this knot fasten your silk and draw back the cat-gut till you have drawn the dossil of lint against the orifice of the passage that leads into the throat, then you need only stop up the nostril with another dossil of lint, which will shut up the passage altogether, and hinder any more blood from coming out. The hint should be kept in for three or four days.

The cat-gut is only for the purpose of getting the silk through, which is too limber of itself: In push­ing the cat-gut through, you are not to push it up­wards, as the nostrils apparently lead, but directly backward, aiming at the upper part of the throat [...]here it comes out; the nostrils turn at about half an inch after you have pushed it upwards. By the stated returns of this complaint, and the habit of the patient as well as by the quantity, you may easily distinguish it from what is termed, a passive flowing of blood from the nose.

In this complaint, the usual topical applications for the other kind are sufficient; but with this the cold both may be used, which is an effectual remedy, from my own experience; with this or without it, tincture [...] iron, No. 7 may be used.

CHAP. XXXIII. SPITTING OF BLOOD.

CAUSES. Besides the predisposition mentioned in the preceding chapter, we may consider, as exciting causes, suppressed evacuations, sudden changes of the [Page 65]air from heavy to lighter, violent efforts, compression in different parts, &c.

Symptoms. After some general disorder, as flatulen­cy, chills, &c. a fulness is often felt about the chest. From the blood being poured out, an irritation is made, to relieve which, the patient hawks or coughs, by which means he discharges a little frothy, reddish, and somewhat saltish spittle; this sensation often re­turns again, and the spittle is thrown out of a deeper red. In this manner the patient usually discharges the blood for some hours or days, when it ceases for that period. But it sometimes happens, that the rup­ture is more considerable, and the pure blood is dis­charged in such quantities, as to excite vomiting; in such a case the patient's life is in immediate danger. A cough usually follows the bleeding, which returns sometimes every week, and so on at every period be­tween that and a year.

Management. This should be exactly as described for the preceding disorder, only that the cold bath should not be used, as we have not sufficient experi­ence to recommend it, and the cold should be here very moderate, a [...] when it is severe, it determines the blood to the lungs, which is to be avoided.

Treatment. If the patient be able to bear it, blood should be taken away, though not in profusion. As soon as the bleeding takes place, this should be follow­ed by a dose of Glauber salts. And ever afterwards when we apprehend from the symptoms before de­scribed, that the bleeding is about to return, we should anticipate it by the repetition of the salts, which I have seen attended with the best success.

When the bleeding is copious, besides the manage­ment of exposing the patient to cool air, let him take a tea-spoonful of common salt, and repeat it when ne­cessary. This has been often effectual, and may be carried in the person's pocket, when repeated small bleedings plague him, or ten grains of allum every hour. In the intervals nitre should be given to reduce and cool the system, ten grains in flaxseed tea, may [Page 66]be given three or four times a day; after the commo­tion has ceased, the country air should be used. It is sometimes necessary to take a tea-spoonful of pare­goric elixir at night, in the morning, and at noon, to quell the cough.

CHAP. XXXIV. CONSUMPTION.

CAUSES. A hereditary, natural or acquired debi­lity of the lungs, may be looked upon as causes of this fatal disorder: under such circumstances, almost any irritation upon those parts will establish the con­sumption; and it is somewhat doubtful if any cause will do the same, without the predisposition.

Symptoms. Cough, pain about the breast, spitting of nauseous matter at all times of the day, which is sometimes streaked with blood; a fever which comes in at noon, frequently with shivering, and most al­ways with coldness, which remits towards the after­noon, to exacerbate or renew its violence at night, continuing with the other affections, and after awhile being followed in its second fit towards morning with a copious sweat.

The pulse in this fever, which is a hectic, is quick and most generally weak, though in its first attack some degree of hardness is to be felt. The fever is always kindled by taking much food at a time. To­wards the end of the consumption, a lax takes place which generally carries off the patient.

Management. The patient should live upon a light digestible diet; milk, vegetables, spoon-meats, pud­dings, pies, &c. are proper; these should be taken in small quantities at a time, and used the oftener, on that account. The teas and drinks prescribed for fe­vers, are the proper drinks to be used.

Exercise in a carriage or sailing, are almost indis­pensably necessary; the country air is so far preferable [Page 67]to the town, that the former will sometimes alone per­fect a cure, and the latter resist every means. Cold should be guarded against; and for this as well as other reasons, a flannel shirt should be worn.

Cure. If the patient is not low and thin, he should be bled every week for three or four times, taking away about a quarter of a pint of blood each time, till all signs of increased action or hardness are gone from the pulse; if they give way at the first bleeding no more is to be used. After this, or when this is not allowable, eight grains of ipecacuana should be given every four days, for as many times as they ap­pear to be beneficial: when this has been done, the patient should take twenty drops of elixir of vitriol, early in the morning, at ten o'clock, and again af­ter the noon fever has abated and before the even­ing one has come on. To allay the cough take two ounces of paregoric, two grains of tartar emetic, or when tartar does not agree, two ounces of the spirits of nitre dulcified: two small tea-spoonfuls may be used at night, and half that quantity taken at any time in the day when it is troublesome. When the pain in the breast is considerable, blisters may be used; a se­ton should be put in the side in the beginning.

The bowels should be kept regular, with small dos [...] of castor oil, sulphur, magnesia, or cream of tartar.

The above prescriptions, although the best and sim­plest that can be recommended, frequently fail, and when the disease threatens to resist them, a sea voyage should be recommended as the only refuge.

It is not unfrequent that the consumption is com­bined with other affections, then we must have regard to these affections, or no cure can be expected. But such cases are so complex, that they require the judg­ment of an able physician.

CHAP. XXXV. THE PILES.

A LAXITY of the gut affected, natural or ac­quired, disposes to this complaint, so much that slight causes bring it about.

The following are found to be the usual causes, viz. much walking or riding, costiveness, long continuance in an erect posture, strong purges, suppressed, natu­ral or artificial evacuations; falling down of the gut, drinking large quantities of watery liquors, grief, ob­structions of the liver, pregnancy, high living, &c.

Symptoms. The symptoms of this disease being not always alike, have made some variety and distinction of it. Thus there is the blind piles, when the tumour is not visible; the common piles, when tumours ap­pear without bleeding; and the bleeding piles, when they discharge blood. However, there are general symptoms which are common to all; as, a pain and swimming in the head, stupor, sick stomach with pains in the bowels and back, which frequently precede, and in some cases a fever also: a sense of fulness and itching are the local symptoms: these are soon reliev­ed in the bleeding piles, when that takes place, and frequently the establishment of the tumour is attended with an alleviation of the symptoms.

Sometimes blood only comes away with the stools; but at other times a considerable, constant discharge alarms the patient. This affection is apt to return at stated intervals, and to increase.

Management. All the causes as far as possible are to be avoided, and temperance is strictly to be observed by the [...]ethoric; light vegetable food, and cool acid drinks are proper during the affection. Much atten­tion should be given to regularity, and especially [...] [...] keeping the bowels in a proper state. In lean pa [...] a fla [...] is often necessary.

[Page 69] Cure. It is frequently the case, that this discharge is salutary, and therefore a doubt arises in the minds of some people, about administering medicines to check it. Hence, whenever the discharge is small, and attended with benefit, nothing need be done to check it; but whenever it is profuse, it then threat­ens a greater injury than it is likely to relieve; then, as well as when it returns often, it should be check­ed by applying cloths dipped in cold water or vine­gar to the neck, hands, thighs, and the part itself: if this does not relieve it, dip a sponge in allum and water, or in a decoction of galls, and apply it to the part, and if necessary, give twelve grains of ipeca­cuana in a little water immediately. When nothing but tumours are present, and they are painful or large, wash them with the following wash: to half a pint of lead-water add two tea-spoonfuls of lau­danum.

This may be used three or four times a-day. Open the bowels in all cases with sulphur, or sulphur and cream of tartar, mixed in equal quantities with honey [...] two tea-spoonfuls may be taken every two hours: in flight cases this is frequently sufficient alone.

CHAP. XXXVI. IMMODERATE FLOWING OF THE MENSES.

CAUSES. High living, excess in drink and [...]ne­ry, shocks from falls, dancing, passions, neglect­ing abstinence in time of menstruating, inflammatory fevers, other evacuations checked, costiveness, cold applied to the feet, frequent miscarriages, difficult la­bours, neglecting to nurse, living too warm, drinking much tea or coffee, purging, &c.

Symptoms. An immoderate flowing is usually preced­ed by head-ach, giddiness, and difficult breathing, a [...]ding immediately precedes the discharge, with [Page 70]this also a pain in the back, and feverishness frequently attend.

After a large discharge, a general debility ensues; the pulse becomes weak, the stomach sick, respiration difficult upon the least motion; the feet cold and swoln, especially towards evening, when a fever takes place of the hectic kind. Palpitations, fainting, fear­fulness, are not uncommon symptoms: the whites fre­quently follow.

The above symptoms take place more or less, soon­er or later, according to the profuseness and repetition of the discharge.

Management. The causes of this complaint discover to us, that it may take place in two states of the system, one when it is over-loaded or plethoric, the other when it is debilitated; ech of which require separate ma­nagement.

In the former case, cold, abstinence, and cool drinks should be used with vegetable diet in the intervals: in the latter, good nourishing food, port wine, and ex­ercise are to be used. In all cases the causes are to be removed or obviated: motion in time of flowing is to [...]e strictly avoided.

Cure. In the intervals the management prescribed will be sufficient.

In the period, the patient should be kept cool; ten grains of alum may be given every half hour; sponges dipped in cold vinegar, may be applied to the small of the back, and to the parts, and if this does not answer, ten grains of ipecacuana may be given in a little water; after this give ten drops of elixir of vitriol every hour: to correct the laxity that succeeds, ten grains of rust of iron may be taken four times a-day, and in cases of much debility, the Peruvian bark also.

When the menses return more frequently, or flow more plentifully than natural, the patient should be on her guard, look for the causes, and obviate them.

CHAP. XXXVII. THE WHITES.

SYMPTOMS. A discharge of whitish mucus flows instead of the menses, or after them, and continues longer and longer, till it becomes pretty constant.

Treatment. As when this case takes place, debility is generally present, a nourishing diet may be used, with port wine and water, more or less, in proportion to the debility, and gentle, regular exercise.

Cure. The steel, as recommended above, is one of the best remedies; with this topical applications should be made, with a syringe. Decoctions of Peruvian bark, oak-bark, or galls, are proper.

CHAP. XXXVIII. OBSTRUCTED MENSES.

CAUSES. Cold is one of the most common causes, either when applied to the body during menstrua­tion, or when it has at a preceding time brought on the complaint called a cold; diseases of much pain or action in other parts, debility, excessive evacuations, low passions of the mind, are also causes.

As the disorder is so well marked, I need not men­tion the symptoms that ensue in those who have once had the menses, but shall confine myself to the symp­toms that take place in girls who have never had them although they have passed over the proper time. This is called properly a retention of the menses.

The patient after the age of thirteen, but how long after is uncertain, is affected with a loss of appetite, sluggishness, lassitude and debility; the countenance becomes pale or swarthy, and the body universally flaccid, the legs swell, especially at night, and the bel­ly sometimes swells also, whilst pains affect the head, [Page 72]back, and other parts: respiration is generally labo­rious.

Management. It is clear, that neither the manage­ment nor the cure can be conducted on a single plan: In the plethoric, and those who have cold as a cause, low diet should be prescribed, with thin drinks, cool air, and rest: but in those emaciated, nourishing food, wine and exercise should be strenuously enforced.

Cure. In those of the former case, that is, those who are full of blood, or have much remaining strength, perhaps nothing will relieve sooner than blood-letting; with this salts may be used, and if the menses do not return at the usual period, at that very juncture let the patient take four grains of calomel, and as many of aloes, in a little honey, and repeat the dose next night if necessary. Those who are emaciated, or have a retention, should take ten grains of steel every six hours, and a couple of doses of bark daily, till the period arrives; and then, if necessary, take the bo­luses as directed. A decoction of madder has been often used with success.

CHAP. XXXIX. VOMITING OF BLOOD.

CAUSES. Obstructed menses, and other evacuations suppressed; enlargement of the spleen or liver, ero­sions of the stomach by poisons, small glass, &c. and violent straining to vomit.

Symptoms. Some pain about the stomach, anxiety and vomiting of black grumous blood, without cough­ing.

Management. The patient who is subject to this should live regularly and abstemiously, and endea­vour by every means to counteract suh causes as ad­mit of assistance, and use proper medicines for the same purpose. In time of a discharge, the patient should retire from all close places, into cool and fresh air.

[Page 73] Cure. Whatever may be the cause, we are to use the same means to stop an excessive discharge. Besides the treatment mentioned before, we may use gentle astringent medicines, as ten grains of alum dissolved in water every half hour, till the vomiting has ceased some time; after which a decoction of oak bark may be used for some days, in the same quantity, and made in the same manner as the decoction No. 3.

When an enlargement of the spleen or liver is the cause, little hope remains of a cure; but the patient should not neglect to try the Virginia sulphur springs, which are very powerful deobstruents. When sup­pressed evacuations are the cause, the means directed for them should be administered; when acrids have been taken into the stomach, they should be changed if pos­sible, by their proper antidotes, or enveloped in some mild mucilage, as mucilage of gum arabic, or in oil, or syrups. When vomiting is the cause, a few drops of laudanum in mint water, will put a stop to it.

CHAP. XL. DISCHARGE OF BLOOD FROM THE URINARY PASSAGE.

CAUSES. The passage of a stone, hard riding, blows on the small of the back, suppression of the piles, acrid medicines, as can [...]rides taken internally, or absorbed from a blister, or some putrid diseases, as the confluent small pox.

Symptoms. A quantity of red or coffee coloured blackish urine is discharged, sometimes with pieces of clodded blood, like a worm, sometimes the blood is diffused through the urine, and remains so; at other times, it is deposited in the bottom of the pot; some­times much pain attends, as when a stone is passing along the ureters, at other times there is none.

Management. The patient is to be advised to any in a reclined posture, and to avoid all stimulating [...] and drinks; the causes are to be removed, before a [Page 74]cure can be expected. Barley, rice, panada, gruel, puddings, and things of this sort, are to be his nourish­ment.

Cure. A plenty of mucilaginous drinks are to be used, as barley water, flaxseed tea, mucilage of gum arabic, mallow tea, &c. and if the discharge continues, allum whey may be used. In the case of putrid dis­eases, vitriol and bark are to be administered freely.

CHAP. XLI. COLD.

CAUSE. Cold applied partially or generally to the body, especially after an increase of heat.

Symptoms. It frequently makes its appearance with a difficulty of breathing through the nostrils, a sense of fulness and stoppage there; this is followed with a pain in the forehead, stiffness and redness of the eyes and discharge from the nose. When the affection is any worse, the patient is subject to chills and feverishness, which is considerable towards evening, a hoarseness, sore throat, cough, flying or fixed pains of different parts, and not unfrequently some difficulty of respiring.

The cough in the beginning is usually dry, but as the other Symytoms give way, it becomes moist, more easy, and attended with a discharge of whitish or [...]l­low mucus, which is most frequent; this goes [...]ff at different periods, according to the patient's age, state, &c.

Management. The patient should confine himself to the house, in a temperate room, and live upon vegeta­bles and cool acid mucilaginous drinks, as barley wa­ter or flaxseed tea sweetened and acidulated with lemon juice or vinegar.

Cure. If the feverishness and difficulty of breath­ing are considerable, bleeding should not be omitted [...] with or without this, a dose of salts should be taken, after which sweating should be practised: one of the powders No. 1. may be given every [...]r, washing it [...] [Page 75]drops of antimonial wine, and as many of paregoric every half hour for eight or ten times. The latter is a good medicine to take every night to lull the cough, for this purpose, thirty drops of the wine, and sixty of the elixir may be taken, when the patient is dispos­ed to rest.

If pains remain in the head, a blister to the temples is the surest relief; if in the limbs, a tea-spoonful of the volatile or simple tincture of guaiacum may be tak­en two or three times a-day, in a little water- Ri [...]ing in good weather, or sailing, is of great service as soon as the patient can go about.

CHAP. XLII. INFLUENZA.

THE cause of this is a specific contagion, pro­ceeding from some very general alteration in the air. There is no doubt of its being communicated from one person to another.

Symptoms. The most common symptoms are those of the common cold described above, attacking a whole town or neighbourhood at once. But that is not its constant form; for sometimes it puts on the appearance of a pleurisy, with a strong pulse, at other times a pain in the side with a weak pulse, whilst in a th [...] case it has produced all the symptoms of a low nervous fever.

Management. This is in general to be directed as in the common cold; but when it has the form of a low fever, wine and water should be the constant drink.

Cure. In some of the most violent cases, especially when the patient's habit has been full, it has been ne­cessary and useful to bleed, and blister the pained part: this latter need never be neglected, where the pain is fixed. Vomits of ipecacuana, antimonial wine, or ta [...] are always serviceable, and interrupt the disorder sooner than any other medicine. Gentle s [...]at­ing [Page 76]with whey, and a little antimonial wine is never to be neglected. This is to be used after vomiting, when that is intended.

The bowels should be kept regular by small doses of caster oil, Glauber salts, cream of tartar, or jalap. When the cough is troublesome, syrup of squills may be used, one tea-spoonful every three hours; or what in some cases answers better, the following mixture; paregoric elixir one tea-spoonful, antimonial wine twenty drops; this may be taken twice or three times, in the course of a day. Honey and vinegar boiled to­gether, spermaceti and loaf sugar, extract of liquo­rice, &c. are frequently useful to take in the mouth every quarter of an hour.

In the case of a low fever, wine and bark are to be given freely, after giving a gentle dose of ipecacuana. If the stomach refuses bark, elixir of vitriol is to be used in its stead, ten or fifteen drops every hour.

Riding or sai [...]ing is here as useful as in the former case.

CHAP. XLIII. FLUX.

SYMPTOMS. Sometimes a fever makes the at­tack, at other times the bowels are primarily af­fected; first, with costiveness and flatulency, then with gripes and frequent painful efforts to stool, when no­thing of a natural sort is discharged, but slime of a whitish, bloody, or blackish colour, in considerable quantities.

In some few instances a lax has preceded. What­ever is voided of the natural kind, is generally in small hard balls.

The stomach in general is disordered, and that from the beginning; but it goes off as the complaint proceeds downwards, which it generally does, till all is fixed in the lower end of the last gut, where it produces that [Page 77]troublesome effort of it called tenesmus. The feverish symptoms continue a considerable time, remitting and then acceding again.

Whenever the disease takes a putrid turn, which it is apt to do, it may be known by the foetor and black­ness of the discharges, a lowness of the pulse and gene­ral debility.

Management. Great attention should be paid to cleanliness, by removing the chamber furniture, and shifting the bed clothes often; the patient should live upon digestible vegetables, as rice, barley, &c. and milk preparations, as thickened milk, light puddings, chicken water, and light broths may also be used, if the patient is fond of them. And for drinks, teas, jelly and water, and apple water; which may be taken milk warm.

Cure. To procure regular natural stools, is half the cure; for which purpose, a table-spoonful of cas­tor oil is to be given every hour, till it produces that effect; this may be repeated every other day, for seve­ral times, as the patient may require; after this, if the patient is very sick, eight grains of ipecacuana may be given; after which two grains of ipecacuana may be administered every two hours, so as not to in­terfere with taking the oil, as long as the fever lasts. After the use of these medicines for some time, laudu­num may be given to relieve the pain, fifteen drops morning and night, mixed up with two grains of ipecacuana.

If the above medicines are not handy, or if there is any objection to them, the following may be used, a dose of salts and manna, once or twice in the begin­ning, after which, put two grains of tartar emetic, or a table-spoonful of antimonial wine in a quart of ap­ple tea, and take it in small quantities, every quarter of an hour, so as to consume the whole in a day; after taking it till the fever is removed, then use the laudanum. When the complaint has a putrid turn, as well as to remove the debility after a common case, twelve grains of columbo root should be taken every two or three hours.

[Page 78]If the disease leaves a looseness, a decoction of log­wood or tormentil should be used.

CHAP. XLIV. APOPLEXY.

THIS disorder most commonly attacks the aged, such as have large heads, short necks, corpu­lent habits, and indolent dispositions, who have fed high, and used much strong drink. If, in addition to these, they have had a suppression of any evacua­tion, as the piles, they can scarce expect to escape an apoplexy.

Symptoms. Sometimes a head-ach and swimming of the eyes, with other affections of the head precede; at other times, it suddenly attacks the patient as he reclines his head, or makes some effort, with a loss of internal and external sense, an almost total deprivation of voluntary motion. The patient's face often becomes flushed and swoln, his eyes red, his pulse full and slow, his breathing somewhat difficult, with snoring.

The time that this state lasts, is uncertain; some­times the patient comes to his senses in a few hours, with a vomiting and sweat, at other times he lays days, and frequently never recovers.

Management. The patient should be laid on a bed with his head raised as high as it conveniently can; his neck cloth should be stripped off, and he should be placed in a cool room. If the fit continues long, a little water may be poured down his throat, if possible, twice or three times a-day; when he is on the reco­very, his diet should be as light as possible.

There are some cases which may be termed apo­plexy, which demand treatment only from the surgeon, as when it depends upon a fracture of the skull.

Cure. The patient should be bled as freely as his constitution will allow: this may be done at different [Page 79]times, rather than at once. After bleeding, a clyster of Castile soap, dissolved in water, should be given, one drachm of soap to a pint of water, or instead of that, two table-spoonfuls of antimonial wine in as much water. These may be used every six hours, for several times.

If these do not bring him to himself, a large blister should be applied to the back of his neck, and sina­pisms made of mustard, vinegar, and crumbs of bread, applied to the soles of his feet. As soon as the pati­ent is able to swallow a pill, six grains of aloes, and as much soap made into a bolus or pills, should be giv­en him every day, so as to keep his bowels in regu­lar motion.

Gentle exercise should soon be used, and increased till the patient is perfectly well: proper exercise and abstinence are the only securities against a return. When the disorder ends in a palsy, which it sometimes does, the cure directed for palsy is to be followed.

Lethargy and Coma, which are species of this disor­der, are to be treated in the same way, having respect to the degree of the disorder and the patient's habit, and directing the evacuations in proportion to them.

CHAP. XLV. PALSY.

CAUSES. Compression of a nerve in its origin of course, certain narcotics taken internally, exhala­tions from lead and arsenic in their preparations, ex­cessive venery, old age, &c.

Symptoms. A loss of sensation or ability of motion in the part affected, which is sometimes one half of the patient, as the right side, or from the hips down­wards; at other times, only a small part is affected, as the hand, the arm, the leg.

Management. This is to be according to the pati­ent's habit: If he is full, a low diet is to be used; [Page 80]if he is low, a stimulating diet and spirituous drinks should be used. The causes are, if possible, to be removed.

Cure. In full habits it is often necessary to purge with jalap, or aloes, and sometimes even to let blood: when these have been used, and likewise when they have not been necessary, stimulating medicines are to be used. A table-spoonful of mustard-seed may be the first, which will give the patient a gentle vomiting; after this, any of the following may be tried, as they may best suit: from one to two tea-spoonfuls of vola­tile tincture of guaiacum in water, three times a-day; or ten drops of tincture of cantharides, three times a-day in broth or mucilage; ten drops of spirit of tur­pentine in honey, three times a-day; infusions of horse­radish and mustard; electricity; frictions; external applications of spirit of sal ammoniac and oil; appli­cations of flies, made by putting a lump of blister-plaister to twice as much common wax and oil plaister; and lastly, by drinking the water of Berkley springs, which is probably as effectual as any.

CHAP. XLVI. FAINTING.

CAUSES. Excessive exertions, heat, large evacuati­ons, excessive passions, as fear, anger, joy, &c. sud­denly depriving the body of any compression, disten­sion, or pain, that it has been for some time accustom­ed to, violent pain, affections of the stomach, disagree­able smells, sights, &c.

Symptoms. Sometimes a languor, an anxiety, a gid­diness and dimness precede; at other times the faint­ing comes on suddenly; the patient turns pale, sinks away, and appears dead; the pulse being either im­perceptible, or very low; the breathing in the same state.

A cold sweat often breaks out, and stands in drops upon the patient's forehead, which is as cold as a [Page 81]corpse. After lying a few minutes in that state, the patient begins to recover, and vomits, or is sick at the stomach.

Management. The patient should be laid out on a hard bed, in a stream of cool air. If the cause re­quires attention, it is to be removed as quick as pos­sible.

Cure. The patient should have his face sprinkled with cold water, and his hands, arms, and legs rub­bed in the direction of the circulation, that is, towards the heart. Hartshorn should be applied to the nose and temples, and twenty or thirty drops given inter­nally. As soon as the patient begins to recover, a lit­tle good wine should be given him, and if much de­bility remains afterwards, it should be removed by bark.

CHAP. XLVII. DYSPEPSY, OR CONFIRMED INDIGESTION.

CAUSES. The large use of coffee, tea, or any warm watery drinks, of tobacco, ardent spirits, opium, bitters, spices, and acids; putrescent food, over-eat­ing, frequent unnecessary vomiting or purging: some disorders, as intermittent fevers, fluxes, &c. An indo­lent life, much application of mind, excessive venery, long exposure, without exercise, to cold moist air.

Symptoms. The great variety of symptoms in this affection together with the causes, is the reason that no two persons are identically alike affected; but ne­vertheless the general or fundamental symptoms are al­ways alike; these I shall set down; a loss of appetite, distensions of the stomach with wind, eructations after eating especially, heart-burn, sometimes a vomiting, frequent pains about the stomach, and often a dejected mind.

Management. Avoid all the causes, use the most di­gestible meat in small quantities at a time, avoid all [Page 82]flatulent vegetables, use wine and water, brandy and water, or porter, if it will fit well on the stomach; use gentle, constant, and varied exercise, taking care to avoid exposure in cold or damp weather.

Cure. This is either palliative or radical; the lat­ter is not to be expected in a short time, nor at all, unless with great attention.

The palliative consists in removing the present dis­agreeable feelings from time to time.

The most troublesome symptoms are the wind and acid on the stomach, and the costiveness: for the wind and acid, a little magnesia, chalk or lime-water, with some essence of mint, should be taken occasionally.

For the costiveness, the patient should be provided with a box of pills made with jalap or rhubarb; or with extract of white walnut bark, these may be taken occasionally; riding over agreeble country seats, is one of the most effectual remedies against a dejected mind.

For the radical cure, we are to attempt the removal of the debility in the fibres of the stomach; for which purpose the waters of Berkley springs, or of any cha­lybeute springs, are the most promising: when these cannot be used, any of the following medicines may be used, as shall best suit. Half a wine glass full three times a day, of the tincture No. 7. or two tea-spoon­fuls of No. 8. in a little water, or in spirit and water, three times a day; or twelve grains of columbo root three or four times a-day; or a table-spoonful of the tincture of bark, No. 4. three times a-day.

CHAP. XLVIII. LOCKED JAW.

CAUSES. Sudden application of cold to the body when warm and much relaxed; lacerations of the tendons or nerves of the foot, and of some other parts; exposure of the muscles to the air, after the skin has been taken off by a gangrene or otherwise.

[Page 83] Symptoms. A stiffness of the lower jaw, and pain [...] about the breast and back generally precede, and in­crease till the jaw becomes firmly closed, and the mus­cles of the back, or of the fore-parts, are violently con­stricted, so as to bend the patient into a bow; after this state has continued for some time, he is sezied with convulsions, in which he is generally carried off.

Management, If any substance is lodged in the parts primarily affected, it should be removed immediately: the patient should be kept warm, and fed upon such food as can be got down. In some cases, it would be advisable to draw a lower tooth, to make a passage for the food; wine and water is the most proper drink.

Cure. It will be proper to remove a toe, or any small part, if that be the place of the wound, and to dress this, or whatever part may be hurt, with a strong suppurating salve, as basilicon (which is composed of rosin and wax, with a sufficiency of oil to soften it) hav­ing first sprinkled it with red precipitate: or if these things are not to be had, a little warm oil of turpentine.

The patient's bowels should be opened with castor oil, or with jalap, and kept open; after this he should have one drachm of strong mercurial ointment rubbed into his thighs and arms, morning, noon and [...], till he spits freely: after this it may be used every other day, so as just to keep up a spitting for a week or more, if the symptoms continue. A pill of one grain of opium may be given frequently to ease the pain. If the patient grows weak, he should take the bark as fre­quently as he possibly can, and in as great quantities as his stomach will bear, without raising his pulse too much. It will be proper to continue the medicines in smaller quantities, for some time after the affection has gone off.

IF the sore is brought in the beginning to suppurate, the locked Jaw need not be feared.

CHAP. XLIX. EPILEPSY, OR COMMON FITS.

CAUSES. Wounds, and bony protuberan [...]s of the skull; ossification of the membranes of the brain; acrimony of the fluids from contagion, degeneracy, &c. passions, as anger, fear; strong imagination of disagreeable objects, and the sight of such; conges­tions of blood in the brain, produced by a plethoric state, by long continued sun-heat on the head; by in­toxication, surfeit, &c. irritations proceeding from worms: teething; splinters in the flesh; fractured bones; stones in the kidney; the matter of ulcers; poisons, &c. and lastly, large evacuations of blood.

It will readily appear, that many of the above caus­es do not produce fits generally; and hence there must be a predisposition in those, in whom they will occa­sion them. A predisposition consists either in a great mobility of the muscular system, or in a relaxed state of the vessels of the brain, which allows of their being easily forced beyond their power, and admitting of [...]tion.

Symptoms. Sometimes the patient feels indisposed for some time before the attack, with head-ach, gid­diness, fulness of the head, sluggishness, &c. at other times the fit attacks without warning; the person falls down, and is variously agitated, sometimes one side more than the other; his tongue is often thrust out of his mouth, and by that means is bit almost or quite through: after continuing some minutes in this state, his convulsions cease, and he lies some time in a sleepy state, and then returns to himself, not knowing what has passed.

Management. It will be proper to hold the patient, so as to keep him from hurting himself, and to put a piece of thick leather between his teeth, to keep him from injuring his tongue. It is seldom or never neces­sary to prescribe any diet for the patient, except in [Page 85]the intervals, when it is to be suited to his state. If fulness is the cause of the fits, or he is of a full habit, a low vegetable diet, with hard exercise, should be used; but for a contrary state, a nourishing diet and constant gentle exercise is to be used. The causes should [...]possible be removed by operations or medi­cines, suited to the cause.

Cure. In full habits, a bleeding will be proper during the fit, or preceding it. However, if they fre­quently return, it will not do to bleed every time, but give a dose of salts in its stead, at the time the patient expects the return. Besides this, very little can be done, except to adhere strictly to the management directed, and to have an issue put in the back of the neck.

In those of thin habits, when several fits return quickly after one and the other, that is in one day, it will be proper to give twenty drops of laudanum; to have him bathed in warm water, and a warm milk and water clyster injected two or three times a-day. All this may be repeated if necessary, in six or eight hours after.

But the chief thing consists in removing the mobility or irritability mentioned in the cause. For this, [...], steel, and the cold bath are proper; they sh [...] used a long while, with proper exercise and die [...] fits proceeding from some of the above causes, as fr [...] irritations, the removal of the cause is all that is re­quired. But it is lamentable, that some of the causes cannot be removed; as that from bony protuberances into the brain, &c. for such there is no remedy. But it is very probable, that the number of fits will be greatly lessened by temperance, and avoiding extremes on ei­ther hand.

CHAP. L. St. VITUS's DANCE.

THIS is a convulsive affection, partly under the influence of the will: It affects the patient's leg or arm, or both. It makes him limp along, and in taking a cup of water, or applying it to his mouth, he usually performs some uncommon gestures, carrying it quickly one way and then another, before he gets it to his mouth. It is apt to terminate in palsy. Children from eight to twelve are the subjects of it.

Cure. The patient should live sparingly, and be purged if he is full. Besides this, cold bathing and a vomit of ipecacuana, taken two or three times, will be of service. Sometimes electricity is of service.

CHAP. LI. PALPITATION OF THE HEART.

[...] not when this is a symptom, but only when [...] it is a primary affection, that it belongs to this [...]d.

CAUSES. Obstructions in the large blood-vessels, excessive irritability or mobility of the heart, affections of the mind; and excessive evacuations.

Management. The patient should live on a nourish­ing diet, if he is weak habitually, or has been weaken­ed by disorder; much motion, sudden starts, straining, and all exposure should be avoided.

Cure. When it is certain that an obstruction in the large vessels is the cause, there can be no cure expected, only palliative, and that by avoiding all ex­cess and extremes.

In the other cases, strengthening the habit with bark, steel, wine, and gentle riding, are what wi [...] prove effectual to remove it; and for a temporary medicine, [Page 87]pills of asafoetida, or a few drops of laudanum, may be used.

CHAP. LII. ASTHMA.

BY this I do not mean every difficulty of breath­ing, but only that which returns periodically, de­pending upon a certain peculiar constitution of the lungs. It usually observes the changes of weather in its returns, and seldom or never goes off entirely.

Symptoms. It often begins with a tightness across the breast, flatulency, and impediment in respiration, which continues until the patient can scarcely get suf­ficient breath to live. Sometimes a large quantity of frothy spit is discharged, at other times little or none. Whenever any phlegm is discharged, which the patient generally makes many efforts to do, it is attended with relief.

Management. The patient should use light food, such as will not produce flatulency; his drink should be of the cooling kind.

He should be in a place where there is a [...] mission of air, yet not exposed to cold.

Cure. A vomit of ipecacuana should be given [...] the beginning; after which twenty drops of laudan [...] in a little mint water: this may be repeated in six or eight hours, if necessary.

The bowels should be immediately opened, and kept open with common clysters.

If much fever attends the asthma, it may be proper to take away some blood, if the patient is sufficiently able to bear it; and also to lay a blister to the back. Gentle riding is proper, after the fit has passed over. As tea and coffee are supposed to be injurious to asth­matics, they may use milk and water in their stead.

CHAP. LIII. HOOPING COUGH.

THIS often begins like a common cold, but pro­ceeds on till the cough becomes more like a con­vulsion: the patient's breath is so forced out of his lungs, that it returns with a whizzing or hoop, after which he often pukes, and finds relief. After some time there is a considerable discharge of mucus.

Management. The patient, if full, should live on a low diet for some time: milk in its various prepara­tions is proper, and should form the chief of the pa­tient's diet. Gentle riding is of service in good weather.

Cure. Gentle pukes of ipecacuana, or tartar eme­tic, should be given every two or three days for seve­ral times; after which, small doses of antimonial wine every night: the bowels should be kept open with cream of tartar, or jalap. When the cough has con­tinued for some time, and the patient grows weak, he should take bark daily.

A blister is sometimes necessary, when the patient's [...]ing becomes much interrupted, or when the re­ [...] coughing are violent and frequent.

CHAP. LIV. CHOLIC.

CAUSES. Costiveness, cold applied to the belly or feet, indigestible food, acrids, &c.

Symptoms. Pain in the belly, usually about the na­vel, with costiveness, flatulency, and often vomiting.

Cure. When much fever attends, it will be prudent to bleed; but when there is nothing but a quick or frequent pulse, we need not order bleeding, but endea­vour to open the bowels with a common clyster, or with a spoonful of castor oil given every three hour [...] [Page 89]till it operates; after which ten drops of laudanum may be given in some mint water, every hour, for four times if necessary. If the pain does not abate for this, the patient should be put into a tub of warm water for half an hour.

If the stomach does not bear the oil, let the patient take a quarter of an ounce of cream of tartar, and fif­teen or twenty grains of jalap. The opening medi­cines should be often repeated in less doses, to prevent a relapse, and remove the costiveness, which the lauda­num occasions; salts and manna, or manna and senna, are also very good purges.

The patient should use riding, to prevent returns, and avoid all food that has a tendency to flatulency, or to produce costiveness.

CHAP. LV. CHOLERA MORBUS, OR VOMITING AND PURGING OF BILE.

THIS violent disorder happens at the end of sum­mer, usually after loading the stomach with acid fruits.

Cure. The patient should take large doses of [...]momile, or balm, or sage tea, [...] sto­mach; after which he should take ten drops of lauda­num, in some mint or cinnamon water every half hour, for five or six times if necessary. If this does not have the desired effect, a blister should be laid on the breast, and a large bundle of mint, stewed in wine or spirit, laid over and about it. The patient should be kept as warm as he can, so as not to be disagreeable. Great care should be taken to avoid the night air, and acid fruits, which rather promote the secretion of bile, than correct it when secreted.

This same disorder, with very little variety, is very common to children in large towns. They should be immediately carried out into the country air, without [Page 90]waiting for an alteration of the disorder, and also dipt in water fresh from the well. For a medicine, they may have, if five years old, thirty drops of laudanum put into half of the mixture, No. 2. One tea-spoonful of this and one of weak mint water, may be taken eve­ry half hour, for three or four times: the mint as above may be immediately applied to the stomach: but the chief dependance is to be put in port wine, given every hour, and increasing the dose; one tea-spoonful is enough to begin with. After the disorder has gone off, bark or columbo, should be taken to strengthen the stomach.

CHAP. LVI. LAX, OR LOOSENESS.

CAUSES. Over-eating, bad food or water, large quantities of sweets or acids, poisons, over-purg­ing, bile in the summer time, matter discharged into the intestines, cold applied to the belly or feet, teeth­ing, passions of the mind, &c.

Management. The causes as far as possible should be [...]bind, the patient should avoid damp or cold air, by pressing warm, as with flannel next the skin; all [...] that has a laxative quality, should be avoided. Sago, rice, milk, eggs, light broths, and digestible meats should be used; for drink, wine and water, and warm teas, are proper, as sage, balm, mint, &c.

Cure. To perform this, we should keep up a free perspiration, by giving three times a-day, half a grain of opium, with one grain of ipecacuana: let the pa­tient lie down for one hour after taking this. After using this prescription for some days, astringents are to be used, as ten or fifteen grains of tormentil root twice a-day, or thirty grains of gum kino twice a-day, or oak bark; made into a decoction, and used in the same quantities as the Peruvian bark, or six grains of allum every two hours.

CHAP. LVII. HYSTERICS.

CAUSES. Passions of the mind, especially grief, large evacuations, obstructed menses, great irregu­larities of any kind. These scarce ever fail to bring it on, in those subject or predisposed to it.

Symptoms. Some disorder is generally felt in the bel­ly, which is succeeded by the sensation of a ball rising up till it gets fixed in the throat; with this, the pa­tient is also wreathed to and fro by convulsions, which cease after some minutes, to return again. In the intervals, the patient sometimes lies in a sleepy state, at other times comes to herself and talks. In this man­ner they continue for some time.

Management. The patient should be kept from hurting herself during the fit; her food should be of the lightest kinds. If she is full, nothing but water drinks should be used, but if otherwise, she should have wine and water: exercise is of material consequence to prevent relapses.

Cure. When the patient is of a full habit, or when the affection proceeds from obstructed menses pro­vided this does not proceed from debility) some blood should be taken away, after which the bowels should be opened with a common clyster. If the convulsions still continue, ten drops of laudanum should be given in some sage tea, or mint water, which may be repeat­ed three or four times if necessary. In lean pa [...]ts, a tea-spoonful of the tincture of asafoetida given three or four times a-day, is what is generally used; sometimes a small puke of ipecacuana will put an end to the fits. Those who are in this latter case, should use bark, steel or bitters, with a nourishing diet, and gentle exercise, to prevent returns; whilst those who are in the con­trary state, should live abstemiously, heap their bow­els upon, and use much exercise.

CHAP. LVIII. BITE OF A MAD DOG.

SYMPTOMS. The wound festers, and after some time, seldom under a week or two, the patient be­comes languid and dejected. He then begins to dread water, and cannot swallow it without great agonies and convulsions of the face; after some time he cannot bear the sight of it. He dozes, and every now and then starts from his slumber; and sometimes raves so as to need confinement.

Cure. The wound should be cut out, if it is on a part that admits of it; if not, let it be filled with gun powder, and this burned; after which it should be kept open for a month, by sprinkling it with red pre­cipitate, and dressing it with a salve made with wax, oil and rosin. But if this has been neglected, there is no way left, but to salivate the patient, by rubbing one drachm of mercurial ointment on him every six hours till he spits freely; after which it may be applied every other night, so as to keep up a plentiful spitting for a week or ten days. This, if done in time, will often prevent the affection.

CHAP. LIX. DROPSY.

CAUSES. Obstructions of the liver, compression of the blood-vessels from any cause, large evacuations, suppressed natural evacuations, cold and moisture long applied, hard drinking, general debility, particular debility of what is called the lymphatic system, rup­ture of a lymphatic, &c.

Symptoms. A suppression of urine, drought, swelling of the belly, or the body in general, which usually re­tains the impression of the finger; towards the end fe­vers [Page 93]come on with a looseness, which puts a period to the patient's miserable life.

Management. The patient should live upon light di­gestible food, and observe the greatest regularity: his drink should be wine and water, if he is thin or debili­tated: gentle exercise should be constantly used.

Cure. It will be very well in the beginning, if the patient's state admits of it, to give two or three small purges, composed of twenty grains of jalap, with a quarter of an ounce of cream of tartar: if this does not answer, we should try medicines that promote the uri­nary secretion; for which purpose two grains of pow­dered squills may be given, twice a-day: or half an ounce of cream of tartar dissolved in a quart of water, may be taken in the course of the morning. An infu­sion of horse-radish and garlic, in spirit, has been some­times of use; also strong cider, iron flakes, and mus­tard-seed put together.

From ten to twenty drops of an infusion of tobacco, in a little mint-water, twice a-day, have been used with success: also a tea-spoonful of salt-petre in a little gin, twice a day.

If none of the above medicines have the desired ef­fect, there is but little chance of a recovery. However, after every thing else has been tried to no purpose, rubbing the belly, when the dropsy affects that part, with warm oil for a long while, every day, before a fire, has proved effectual.

Bitters and steel are always useful, and should be taken with the other medicines, only at another hour.

There is a kind of dropsy, which affects only the ca­vity of the breast, which is known by the [...] the water makes, when the patient turns over; by its af­fecting the pulse so as to make it irregular in its strokes; by its affecting the respiration, and disturbing the pa­tient in the night with a sensation of oppression. It is to be treated as the other dropsies.

CHAP. LX. RICKETS.

SYMPTOMS. It makes its appearance generally between the ninth and twenty-fourth month, in the following manner; the child becomes sedate, and grows lean, whilst the head grows somewhat out of form; the teeth come out slowly, turn black, and fall out: in a little time the child becomes altogether mishapen, some parts growing whilst others pine away: the stools are liquid; and after a considerable time, a fever comes on, which continues till it puts an end to the pitiable object.

But when it is not so bad, the child recovers as he grows, till he recovers all but his shape.

Management. The child should not be kept longer than usual at the breast, he should have a portion of meat for his diet, much tea should be avoided: he should be carried out every day for exercise, when the weather permits, and great attention should be paid to keeping him clean

Cure. If the weather is not very cold, let the child be dipped every morning in water immediately from the well: give him a tea-spoonful of the tincture No. 7. three or four times a-day, and let him take two or three grains of rhubarb, when costive.

Bark is also a good medicine, if the child can be prevailed on to take it.

If there is much acid on the stomach, give a little crabs eyes, or magnesia.

CHAP. LXI. JAUNDICE.

CAUSES. Concretions of the bile stopping up the dust, tumours, spasms of the gut into which the [Page 95]bile is emptied, as in cholic and obstructions of the liver.

Symptoms. An universal yellowness which begins in the white of the eyes, whitish stools, and pains about the right side, and sometimes a swelling at the same place.

Management. The patient should live mostly on vegetables, except when very thin. Gentle exercise should be constantly used; the drink should be wine and water, when in the above state, but if full, no­thing but water should be used. The patient should carefully avoid cold and moisture.

Cure. A gentle emetic should be tried, and if it is of service, or does not do harm, it should be repeated; this is best suited where there are gall-stones: but if the liver be obstructed, the patient should take one grain of calomel, every night and morning, till his gums feel sore. When much pain attends, twelve or fifteen drops of laudanum may be given twice a-day.

Bitters are often useful; also elixir of vitriol, to forty drops a-day. Soap has sometimes been useful, taken in pills; but the chief dependence is to be put in diet and exercise.

When there is any fever, the saline mixture, No. 2. should be used as there directed.