Advices with Respect to Health (1769)

Advices with Respect to Health (1769)

ADVICES WITH RESPECT TO HEALTH:

EXTRACTED FROM A LATE A UTHOR

(1769) An Introductory Comment The next distinct publication on the topic of health care by John

Wesley, after Thoughts on the Sin of Onan (1767), was also an abridgement of a work by Samuel-Auguste Andre David Tissot (1728-97), the Swiss Calvinist who took his medical degree at Geneva in 1749 and became an honoured Professor of Medicine at Lausanne. Since

Wesley's manuscript diary for the 1760s has not survived, we cannot be sure of the order in which he encountered Tissot's writings.

Based on the dates of his published abridgments, it is likely that Wesley first stumbled upon the English version of L'Onanisme, and this drew to his attention Tissot's more substantial Avis au peuple sur sa sante] (in the form of its 1765 English translation, Advice to the People in General, with Regard to their Health * 2 3).

The Nature and Popularity of Tissot's Avis Tissot's Avis was a ground-breaking work by a physician, embodying his life-long concern for improving public health.' His first paid appointment after receiving the M.D. was as physician to the poor in Lausanne; Avis was published in 1761 to extend the range of that care. Tissot believed that the hope and wealth of a nation were based in agriculture and the people who tilled the soil.

He worried that this was endangered by their lack of access to reliable medical advice and their credulity concerning the supposed miraculous cures of quacks. He sought to counter these dangers in Avis by: 1) offering careful descriptions to help diagnose specific ailments, 2) highlighting the role of a basic regimen of diet and exercise in establishing and maintaining health, 3) providing

'(Lausanne: F. Grasset, 1761).

2 Translated by James Kirkpatrick, M.D. (London: T. Becket and P. A.

DeHondt, 1765).

3 For more details on Tissot's full body of work and impact, see Antoinette Emch-Deriaz, Tissot: Physician of the Enlightenment (New York: Peter Lang, 1992).

Medical and Health Writings instructions for preparing a collection of safe and cheap (or easily obtained) potions and treatments for ailments, and 4) peppering the book with repeated denouncements of the more dangerous treatments typically sold as panaceas.

By the end of the eighteenth century, Tissot's Avis had reached more than forty editions in French, and many more in other languages. This has led some to characterize it as the most important self-help medical manual of the eighteenth century throughout Europe.4 But, as Peter Singy has stressed, this description does not quite match Tissot's original intention.5 To begin with, while Avis was written for the masses of the populace, it was not addressed to them, since most of them could not read. Tissot is explicit in his introduction that his main audience was literate persons in the scattered villages who were either expected or inclined to be of help to their neighbours. He listed first, as the most obvious example, clergy; but he mentioned such others as landholders, educators, surgeons, and midwives.6 * As a second departure from a true selfhelp manual, Tissot stressed that Avis is designed solely for those who could not have the attendance of a physician, and readers were exhorted to lay it aside the moment a physician arrived.' Further,

Tissot limited himself in the first edition of Avis to acute diseases, omitting chronic diseases—both because he assumed that persons had time to consult physicians in these cases and because he doubted the capacity of the populace to understand or apply the cure.8

Despite his initial intention, once Avis was released Tissot came under pressure to transform it more into a self-help manual.9 A year after its appearance, an independent edition was published in Paris in 1762, in which an anonymous physician made additions totalling more than a hundred pages covering many afflictions (such as haemorrhoids) that Tissot left out. When Tissot issued his own second edition from Lausanne in 1763, he adopted many of the additions by the Parisian physician, but rejected others dealing with chronic

4 For example, see Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (New York: Oxford University Press, 1997), 452.

5 Patrick Singy, 'The Popularization of Medicine in the Eighteenth Century:

Writing, Reading, and Rewriting Samuel Auguste Tissot's Avis au peuple sur sa sante , Journal of Modern History 82 (2010): 769-800.

6 See Tissot, Avis, 21-29 {Advice, 16-22).

' Ibid., 37-38 (Advice, 28).

8 See Tissot, Advice, xxvi-xxvii; taken from the preface to Tissot's second edition (Lausanne: Franfois Grasset, 1763), xii.

This process is traced in Singy, 'Popularization'; from which this summary draws (esp. from pp. 793-94).

Advices with Respect to Health

diseases—stating explicitly the rationale mentioned above. A key problem with this rationale, as William Buchan noted in the preface to his influential self-help manual Domestic Medicine, published in 1769, was that while circumstances may sometimes force people to rely on self-help in acute diseases, 'in the chronic the cure must ever depend chiefly upon the patient's own endeavours'.10 As an initial sign of recognizing this reality, Tissot also added a new chapter in the 1763 Lausanne edition of Avis that included some chronic conditions like 'fainting caused by nervous diseases'. Meanwhile, another independent edition was published the same year, this time in Lyons, which drew upon the Parisian edition, adding further notes by another unnamed physician. This 1763 Lyon edition was the form of Tissot's that the physician James Kirkpatrick translated into English in 1765, adding yet more notes. Kirkpatrick's translation (Advice) served, in turn, as the source for Wesley's abridgement.

Building on Avis, which focussed on the health concerns of commoners, Tissot went on to publish works addressing the health concerns of academics (or 'literary people') and the upper classes.* 11

The long-reigning assumptions of humoral medicine shone through in each of these works, mixed with Tissot's attention to the latest medical discoveries of his colleagues (such as his championing of inoculation for smallpox and measles). Through these various contributions Tissot emerged as 'a main actor in the renewal of medical thought during the closing decades of the Ancien Regime', contributing particularly to the rethinking of medicine attendant upon social and economic changes.12 In this process (and somewhat against his intentions), Avis in particular raised hopes of a better life in a way that 'encouraged a disdain from the medical establishment, that dismissed as dangerous the idea of thrusting into untrained hands the means to diagnose and cure diseases'.13

Wesley's Appropriation and Transformation of Tissot's Avis When John Wesley came upon Tissot's Advice to the People in General, with Regard to their Health, he found one who shared his

10 William Buchan, Domestic Medicine (Edinburgh: Balfour, Auld & Smellie, 1769), xiii.

11 De la sante des gens de lettres (1768), Essai sur les maladies des gens du monde

(1770).

12Emch-Deriaz, Tissot, 3.

13Ibid., 67.

392 Medical and Health Writings

'tender sense of the sufferings of his fellow creatures', and who was compelled like Wesley to address the reality that a majority of those suffering lacked access—geographically and/or economically—to certified physicians.14 At the same time, Wesley could not have missed Tissot's criticism of self-help manuals prepared for the populace (like Primitive Physic) that were compendiums of remedies without accompanying descriptions of each disease.1''

It is significant that the first characteristic of Tissot's Advice that Wesley praised in the prefatory 'To the Reader' of his abridgement was that 'his descriptions of diseases are truly admirable' (§2).

Wesley apparently decided that the best way to compensate for this shortcoming of Primitive Physic was to provide his followers with a cheap abridgement of Tissot's Advice as a supplement (and insert references to it within Primitive Physic). This is why—unlike the abridged Thoughts on the Sin of Onan—Wesley included his abridgement of Tissot's Advice in his collected Works in 1773, bound together in volume 25 with Primitive Physic. And it was not uncommon for later independent printings of Primitive Physic to be bound with this abridgement of Advice as well.

There were many other aspects of Tissot's Advice that resonated with Wesley. In his prefatory comments (§2) Wesley praised Tissot for keeping remedies relatively few in number, simple in nature, inexpensive, and generally safe. He also affirmed (§3) the primacy that Tissot placed upon regimen. And in his abridgement (retitled

Advices with respect to Health) Wesley made sure to retain Tissot's specific commendation of many of Wesley's favoured elements of regimen—like horseback riding (§56), cold baths (§§90, 264), and abstaining from distilled liquor or 'drams' (§§89, 251, 359).

In Avis, as in L'Onamsme, Tissot—ever the physician—scrupulously restricted his treatment suggestions to medicines and regimen. But in his preface Tissot praised clergy for the role they played in small villages offering medical advice.16 He also compared his work of preparing Avis to that of a pastor writing a catechism for 14 See below, 'To the Reader', §1; and, more broadly for the following comments,

James G. Donat, 'The Rev. John Wesley's Extractions from Dr. Tissot: A Methodist Imprimatur', History of Science 39 (2001): 285-98.

15 See Tissot, Avis, 15 (Advice, 13). In the first edition of Primitive Physic JW assumed that recognizing disorders was typically 'very easy' (see Preface, §15 above in this vol.); encouraged by others, he added in the fourth edition short 'plain definitions' for some ailments (see Postscript I, §5), but these were far less than what Tissot provided.

'6Ibid., 21-22 (Advice, 16-17).

Advices mth Respect to Health

children1' (an analogy that Wesley used in the reverse to defend lay preaching18). Wesley took this as 'leave' to add in his prefatory comments (§9) the exhortation for 'everyone, together with all his other medicines, to use that medicine of medicines, prayer'' (echoing his preface to Primitive Physic19).

While Wesley assumed Tissot's tacit support for adding this spiritual dimension to the treatment of disease, he openly challenged

Tissot in his prefatory comments on four elements of medical advice. The first (§4) was what Wesley said might be considered a 'violent fondness for bleeding—his recommending it on the most trifling occasions, and prescribing very frequent repetitions'. As this suggests, Wesley did not question the practice of bleeding per se; he listed it as a recommended procedure for some ailments in Primitive Physic. Likewise (despite Wesley's suggestion in §8 of his prefatory remarks of the degree to which he 'retrenched' Tissot on this matter) his abridged Advices retained most of Tissot's prescriptions of bleeding. Wesley's hesitance was typically expressed quietly—as where he revised Tissot's statement that 'bleeding is never, or extremely seldom indeed necessary' in a quartan ague; to simply, 'bleeding is never necessary' in this ailment.20

The second practice that Wesley questions in his prefatory comments (§5) is Tissot's 'amazing love of clysters'. The use of enemas and suppositories was prominent in traditional humoural medicine, intended to restore or preserve balance of the humours by encouraging passage of excrement. As Wesley's comments make clear, he personally disliked this practice, which helps explain why it is relatively rare among his suggested remedies in Primitive Physic. His hesitance about the procedure is reflected in the abridged Advices, where some of Tissot's strongest exhortations to use clysters are omitted.21

(But again it is questionable whether this 'retrenching' dramatically reduced the 'abundance of clysters', as suggested in §8.)

Wesley's third area of contention (§6) concerned Tissot's Chapter XXV on 'The Itch'. In this case the least of Wesley's concerns was the malodorous ointment that Tissot prescribed for treating

17 Ibid. 15, (Advice, 13). l8E.g., JW, A Letter to a Clergyman (1748), 9:248-51 in this edn.

19 See Primitive Physic, Preface, §15 (above in this vol.); and JW's related exhortation added to Thoughts on the Sin of Onan, §§17-18.

20 Compare Tissot, Advice, §263 (p. 281) to Advices, §179, last paragraph, below.

21 Compare Tissot, Advice, §32.4 (p. 64) to Advices, §26 below (where point 4 is omitted); or Advice, §41 (pp. 70-71), which is omitted between points 3 and 4 of §30 in Advices below.

Medical and Health Writings the ailment. His main objection was to the medicines taken inter nally thatTissot (like many other physicians) prescribed.22 Invoking the authority of an article in the Philosophical Transactions, Wesley rejected the efficacy of internal medicines. Given this warrant, he entirely omitted this chapter from his abridged Advices. By default, his followers were referred back to Primitive Physic, where all of the suggested treatments were external, and a footnote had been included since the fifth edition: 'The distemper is nothing but a kind of very small lice which burrow under the skin. Therefore inward medicines are absolutely needless.'23

The final stated point of difference with Tissot in Wesley's prefatory remarks (§7) was Tissot's 'vehement recommendation of the Peruvian bark as the only infallible remedy either for mortifications or intermitting fevers'P Wesley contested both that the bark (of the Cinchona tree) was 'infallible' and that it was the only effective remedy for these ailments. Since this bark is the source of quinine, which is highly effective against malaria, Wesley's hesitance may seem wrong-headed. But the category of 'intermittent fevers' was broad, including more than cases of malaria. Moreover, Wesley's real concern was thatTissot prescribed ingesting the bark itself—a practice Wesley had tried, and suffered a negative reaction.21 This is why, on the few occasions that Peruvian bark appears in Primitive Physic, the bark itself is discarded after chewing it or infusing it in a liquid.26 Whatever his reservations, Wesley retained Tissot's remedy No. 14, composed of powdered Peruvian bark, in Advices and (despite his suggestion of removing 'much bark' §8) replicated most instances where it was prescribed. Though he did add a note on one occasion (§56) recommending that rather than drinking the powdered bark in solution one should: 'Pour upon it a coffee-cup full of boiling water. Cover this two or three minutes. Then drink the water, leaving the powder behind.'

22The ointment was Tissot's No. 52. Tissot identified a cause of the itch as a diet high in salt, and fat, sour, or spicy food. His leading prescriptions were the ptisan

No. 26, and the purge No. 21. Szz Advice, §345 (pp. 348-49).

23 See JW's note attached to Primitive Physic, §139 (above in this vol.).

24 This claim is made about intermitting fevers in Advice, §258 (p. 275); JW omits this section in the abridged Advices (would have appeared between §175 and §176).

25 His explanation in a letter to Alexander Knox, April 1, 1776, was 'I can never reconcile to common sense the introducing ounce after ounce of powdered post into an human stomach'; see Appendix C below.

26 See above Primitive Physic, §56, receipt #1; §103, receipt #2; §197, receipt #1;

receipt #1.

Advices with Respect to Health

Beyond these stated points of divergence, two other ways in which Wesley's convictions differed from those of Tissot are hinted at by the major portions of Advice omitted from Wesley's abridged version. In addition to the chapter on the itch, these include the Introduction, Chapter XXXIII, 'Of Mountebanks, Quacks, and Conjurers', and Chapter XXXIV, which detailed information a patient should convey to a physician if they were requesting advice in absentia.27 The latter three were not elided simply to reduce the length of the abridgement. They are the portions where Tissot's strong diffidence to professional physicians is most explicit. In his introduction, for example, Tissot paused to 'beg the favour' of his fellow physicians that they not censure him for betraying the profession in preparing his book.28 While in Chapter XXXIII he mounted an extended indictment of 'travelling quacks and pretended physicians in villages' as a 'dreadful scourge' who occasion more deaths than all of the ailments treated in his book combined.29 These imposters are excoriated as robbers and thieves, motivated by financial gain, and contrasted at length with 'the most genuine and excellent physicians' who had devoted themselves to years of study, sacrificing 'the best and most pleasurable days of their lives' and suffering the 'difficulty and loathsomeness of living in hospitals among thousands of patients' in order to acquire the knowledge and skill requisite for caring for human life and health.30 As Wesley made clear in his preface to Primitive Physic, he was more worried about the ways in which physicians, concerned to protect their source of income, were depriving the general populace of time-tested medical advice. As a first point of unstated divergence then, Wesley's diffidence toward physicians—if there was any—was limited to those who feared GodA The flipside of Tissot's valorization of physicians was a highly paternalistic view of the rural masses. In Chapter XXXIII in particular, Tissot characterized them as easily seduced by the travelling quacks because they were not 'capable of reasoning'.32 While Wesley was paternalistic in many ways, he did not question the intellectual capability of the lower classes—as evidenced by his efforts to 27Respectively, Tissot, Advice, 1—29, 551-78, and 579—83.

28See ibid., 15-16.

29Ibid., 551-52.

30Ibid., 558-59.

31 See Primitive Physic, Preface, §10 and §15 (above in this vol.).

32 See Tissot, Advice, §568 (p. 557).

Medical and Health Writings make education more accessible to them.3' The likelihood that this divergence played a role in Wesley omitting these larger portions of Tissot's Advice is supported by scattered elisions of other parts— like a paragraph berating the illiterate multitude for dismissing the value of regimen because 'they seldom consider anything as a remedy except they swallow it'.34

Moving beyond these larger excisions, and the divergent convictions they reflect, some other general characteristics of Wesley's abridged version of Tissot's Advice are worth noting. 1 he first, and most significant, is that Wesley broadened the audience addressed in his Advices. From the Introduction onward, Tissot had been clear that Advice spoke specifically about and to the rural masses in Switzerland (and only insofar as they had no access to a physician).

From his deletion of the Introduction onward, Wesley removed these limitations. Thus, the very first line of Chapter I, which Tissot had begun: 'The most frequent causes of diseases commonly incident to country folk are ...'; was reframed by Wesley to address

'... maladies which so often attack the inhabitants of both city and country'. For Wesley, people are people, and their health challenges were the same, wherever they live. This led him to elide sections in chapters where Tissot focussed specifically on Switzerland.3' It may also be the reason he excised a couple of sections contrasting

'country girls' with 'city girls'.36 By thus broadening the audience, and omitting the injunction to set the book aside as soon as a physician arrived, Wesley's abridged Advices became more fully a 'selfhelp' medical guide than was its original.

This is not to suggest that Wesley broadly refashioned Tissot's text. His editorial hand was more conservative than it had been in Thoughts on the Sin of Onan. He rephrased sentences to improve readability, but he seldom distilled whole paragraphs or sections to a single line. Moreover, his final product remained about a third of the length of the original (218 pp. / 600 pp.), as compared to his earlier abridgement that reduced its source by nine-tenths. Most of the reduction Wesley achieved (beyond the four major portions omitted) came by slicing the number of example cases,37 omitting

33 See the materials gathered in volume 16 of this edn.

34Tissot, Advice, §75 (p. 99).

35For examples, see ibid., §13 (pp. 43-46) and §116 (pp. 130-31).

36 See §240 below, with notes on the material elided that had been in Advice, 356-57.

37 Examples of such cases omitted include Tissot, Advice, §71 (p. 96), §§117-19 (pp. 131-38), §266 (pp. 282-83), and §300 (pp. 310-11).

Advices with Respect to Health

sections where Tissot listed (and berated) exotic remedies used by the peasants like blood of wild he-goat or the blackened portion of a rotten egg,38 and trimming instances where Tissot indicated there was no hope for particular conditions.39 Significantly, Wesley kept all seventy-one of the commended medicines in Advice.

Two small elisions by Wesley deserve some reflection. He omitted a section where Tissot praised the recent practice of inoculation for smallpox as a 'gracious dispensation of providence', and another section mentioning the potential benefit of inoculation for measles.40 In both cases, Wesley's reason for the omission was likely not an objection to inoculation, but the fact (which Tissot admitted) that this treatment was not widely available to the populace.

Two decades later, as societies were gearing up to make inoculation available to the masses in England, Wesley warmly endorsed their efforts.41

Turning from instances of reduction to addition, here again Wesley was more conservative than in the case of Thoughts on the Sin of Onan. As acknowledged in his prefatory comments (§8), Wesley added very little to Tissot in Advices. And the additions he made were placed in notes at the bottom of the page, rather than incorporated into the body of the text (that is, assuming that the footnotes found in Advices that did not appear in Advice are to be attributed to Wesley).

Presentation of Wesley's Advices in this Edition This brings us to the editorial decisions made in preparing Wesley's abridged text for this edition. The first point to make is that all comparisons between Wesley's version (Advices) andTissot's Advice are based on the first edition of Kirkpatrick's translation (1765).

The reason for this is that there are no major changes in Kirkpatrick's second edition, and internal evidence suggests strongly that Wesley was not working from the third edition of 1768.42

38 Ibid., §101 (pp. 117-18). See also §193 (pp. 198-99), §248 (pp. 266-68), and §320 (pp. 326-27).

39Ibid., §52 (p. 83) and §85 (p. 106).

40 Compare Advice §219 (p. 230) to §152 below; and Advice, §229 (p. 243) to §159.

41 See his May 29, 1788 letter (vol. 31 in this edn.) responding to Dr. William Turner (1761-1859), who sent him the Newcastle upon Tyne, Committee for General Inoculation, Report of the Committee (s.n., 1786); and William Turner, An Attempt to Alleviate the Principal Objections to Inoculation (Newcastle: T. Saint, 1787).

42 See §124 below, where Wesley replicates an error made in Kirkpatrick's first edition that was corrected in the third edition.

Medical and Health Writings One of the gifts of Kirkpatrick's translation for subsequent scholarship is that he carefully identified each of the footnotes in his text-—marking those attributable to Tissot, those inserted by the unnamed physician in the 1763 Lyon edition (which Kirkpatrick used as the source for his translation), and those added by Kirkpatrick himself. This is important because Wesley was not so thoughtful. lie selectively reproduced several of the notes (typically in an abridged form), without including Kirkpatrick's indication of their source. We have restored the identification of the original authors editorially when the notes appear. One way in which we could go beyond Kirkpatrick is that the physician who added comments anonymously to the 1763 Lyon edition has now been identified as a Dr. Rast.43 There are twenty-one footnotes in Wesley's abridged version that are not found in Kirkpatrick's text. Since these additional notes consistently take stances that Wesley advocated, we were confident in indicating him as their author.

While Wesley ignored Kirkpatrick's identification of authors, he generally replicated Kirkpatrick's text as it stood, including scattered errors about the medicine Tissot had assigned (by citing its number in the list), and some confusion in numbering the sections.44

We have corrected these instances (and Wesley's own misprints) by comparison to both the French original and Kirkpatrick's first edition.

Wesley's abridged Advices with Regard to Health went through four editions, staying in print for the remainder of his ministry. The second edition was its appearance in his collected Works. While

Wesley typically reprinted individual items with little revision, he devoted more attention to correcting and revising their text in the thirty-two volumes of Works (1771-74). Advices was no exception. There are scattered changes throughout and a few additional footnotes. Among the new notes is one in his prefatory section 'To the Reader' (§8) stating: 'I have generally lessened his doses, which were far too large for English constitutions.' This comment is not so much descriptive of the original abridgement as it is a flag that Wesley made adjustments to dosage in about a dozen places this second edition.41 (Whether this amounts to 'generally lessened' is again open to question.) The other major feature of the Works edi43I.e. Jean-Baptiste-Antoine Rast de Maupas (1732-1810); see Singy, 'Popularization', 792 n. 101.

44 For the issues in section numbering, see particularly §30 of Wesley's abridged version below.

45 See particularly §269.3, and remedies Nos. 11, 21, 23, 41, 47, 57, and 63.

Advices with Respect to Health

tion is that throughout Wesley marked particular passages that he thought worthy of attention with an asterisk. There are about fifty passages marked in this way in the Works edition of Advices,46

Unfortunately, after all of his careful work to revise the text of items included in his Works, after 1775 Wesley continued what had been his earlier practice. When it came time to issue a new printing of an individual item, he typically sent to the printer one of the last copies of a prior separate printing that he had on hand (occasionally with changes entered by hand within the text). The printer would unbind this copy and use it as their pattern. The result of this practice was that in almost every instance that Wesley issued later separate editions of items included in Works, they returned to the text of the last separate edition of the item, missing the revisions that Wesley had made for Works. Advises with Regard to Health is a case in point, as can be seen in the list of variant reading in Appendix A.

While the last two editions of Advises return to the basic text of the first edition, Wesley did modernize several spellings in them

(such as changing 'glyster' to 'clyster'). Since the practice in this edition is to modernize archaic spellings silently, we have not traced these changes in the variant readings. For a stemma showing the relation of the four editions of Advices, and the substantive variant readings arising in them, see Appendix A, pp. 644-49. For further details see Bibliography, No. 315.

46 We have not reproduced this use of the asterisk in this edition; but the Pine edition of Wesley's Works (1771-74) is now freely available online for those interested.

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Advices with Respect to Health

Advices with Respect to Health:

Extracted from a Late Author To the Reader 1. Dr. Tissot's Advice to People in General,1 published a few years since, is, I am persuaded, one of the most useful books of the kind which has appeared in the present century. It plainly speaks a person of strong understanding, extensive knowledge, and deep experience. At the same time he shows great humanity and a tender sense of the sufferings of his fellow creatures. And doubtless a desire of preventing or lessening these was at least one reason of this publication.

2. His descriptions of diseases are truly admirable, almost everywhere drawn from the life, and so clear that even common people of tolerable sense will easily know any distemper thereby. His medicines are exceeding few—so few that, at first sight, one would scarce think it possible they should suffice for so many disorders as he had treated of. And most of those few are quite simple, as simple as can be imagined. The rest are seldom compounded of more than two or three simple and well-known ingredients.

A farther recommendation of them is that the far greater part are of a moderate price. And as they are cheap, so most of them are safe; not likely to do hurt to anyone.

3. It is another mark of his excellent judgment that in all cases he lays so much stress upon regimen. And that on so many occasions he recommends outward applications, a method constantly observed by the ancient physicians. Add to this his earnest and repeated cautions against all spirituous and heating medicines, against keeping the patient too hot, and above all against keeping him in a close or foul air, whereby so many diseases are heightened or prolonged and

so many thousand lives thrown away. Add his seasonable detection of so many vulgar errors, some of which have almost universally obtained, and which nevertheless scarce any physician of note had before dared to expose.

4. Where there are so many excellent things, is there any defect?

Possibly a few such might be observed. Some would esteem as such his violent fondness for bleeding—his recommending it on the most

1 Samuel-Auguste Andre David Tissot, Advice to the People in General, with Regard to their Health, translated by James Kirkpatrick, M.D. (London: T. Becket and P. A. DeHondt, 1765).

Medical and Health Writings trifling occasions, and prescribing very frequent repetitions of it as indispensably necessary in several diseases which may be perfectly cured without ever bleeding at all. I instance in a pleurisy. Indeed, thirty years ago I was utterly astonished when I heard Dr. Cockburn (of St. James's) say, 'Sir, I never bled in a pleurisy. I know no cause. I know no one intention it answers, which I cannot answer as well or better, without thus wasting the strength of my patient.'* 2 *

But I have now seen the proof of it over and over. Nay, I will say more. I have not seen a man in a pleurisy these twenty years (and I have seen not a few) whom I could not cure, not only without bleeding, but without any internal medicine whatever. Alas, alas! How few physicians love their neighbour as themselves!

5. Might not one also rank among the less excellent things in this tract the author's amazing love of clysters? One remarked of Dr. [Jonathan] Swift, 'In all his writings he shows an uncommon affection for the last concoction of the human nutriment. '4 May not the same remark (in a little different sense) be made of Dr. Tissot?

I wonder whether he ever himself submitted to, or performed, the operation? Undoubtedly, in cases of extreme necessity, both modesty and cleanliness must give place. And either man or woman would sin against God in not permitting an injection of any kind.

But what I pray, beside extreme necessity, would induce any but a beast of a man either to prescribe to another, or admit himself, such a worse than beastly remedy?

6. Is there not an objection of the same kind to that uncleanly, stinking ointment which he prescribes for the cure of the itch?5

And what need of this, when it may be cured just as well by medicines which have no smell at all? Suppose by hellebore and cream, or by juice of lemons mixed with oil of violets. But there is another objection to all that the doctor has wrote upon this disorder. Can it be thought that so great a man as Dr. Tissot never saw the Transactions of our Royal Society? But if he has seen them, how could he forget the paper communicated by Dr. Mead, which puts it beyond all possible dispute, being a matter of ocular demonstration, that the itch is nothing but animalcule of a peculiar kind burrowing un-

William Cockburn (1669-1739), of St. James's Street, Westminster. JW repeated this quote, and cited the case of his brother Charles as an example, in his

Letter to Lloyd's Evening Post, July 29, 1776 (see Appendix D).

'I.e., medicines injected into the rectum, to empty or cleanse the bowels.

The source of this remark has not been located; but the 'last concoction of human nutriment' would be faeces.

5Tissot prescribed his ointment No. 52; see Advice, 349.

Advices with Respect to Health

der the scarf-skin?6 Yet if he had not utterly forgot this, how came he to prescribe internal medicines for it? Does any man prescribe vomits or purges to kill fleas or lice?7 8

7. May I be permitted to touch upon one point more to which I cannot fully subscribe? I am sensible it may be esteemed huge want of sense, if not of modesty likewise, to contradict the skilful in their own art; yea, some of the greatest names in Europe. But I cannot help it. When either the souls or lives of men are at stake, I dare not accept any man's person. What I refer to is his vehement recommendation of the Peruvian bark as 'the only infallible remedy either for mortifications or intermitting fevers'* He really seems transported with the theme, as do very many physicians beside. I object to this, firstly,9 it is not 'an infallible remedy', either for one or the other.

No, not even when administered by a very skilful physician, after evacuations of every kind. I have known pounds of it given to stop a mortification, yet the mortification spread, till it killed the patient.

I myself took some pounds of it when I was young for a common tertian ague, and that after vomiting. Yet it did not, would not effect a cure. And I should probably have died of it, had I not been cured unaw ares by drinking largely of lemonade. I w ill be bold to say, from my personal knowledge, there are other remedies which more seldom fail. I believe the bark has cured six agues in ten. I know cobweb pills have cured nine in ten. The bark has often stopped mortification, and sometimes it has failed. But I could never learn that Dr.

Piper's method (of Essex) has failed in a single instance3 —though one of his patients was of a gross habit, and above sixty years old; and another, above ninety. Let them philosophize upon these things who please. I urge plain matter of fact. I object, secondly, that as it is far from being an infallible remedy, so it is far from being a safe one.

Not that I affirm, as Dr. Tissot supposes the objectors do, that it occasions asthmas or dropsies. I do not think this at all improbable, however I have not observed it. But this I affirm in the face of the

a What this method is, any one may see on the last edition of the Primitive Physic

[JW; he is apparently ascribing to John Piper M.D. (1688-1766) the method of using cobweb pills prescribed for an ague in §2, receipt #8].

6 Richard Mead, 'An Abstract of part of a Letter from Dr. [Giovan Cosimo] Bonomo to Signior Redi, containing some Observations concerning the Worms of Humane Bodies', Philosophical Transactions 23 (1703), 1296-99.

7 Reflecting the degree of his objection, JW omitted Tissot's entire chapter (XXV) on the itch; cf. Advice, 347-52.

8 See (on intermitting fevers) Tissot, Advice, §258, p. 275.

9Orig., T.

Medical and Health Writings sun, it frequently turns an intermitting fever into a consumption.

By this means, a few years since, one of the most amiable young women I have known lost her life. And so did one who was before one of the healthiest and stoutest young men in Yorkshire. I could multiply instances, but I need go no farther than my own case. In the last ague which I had, the first ounce was thrown off by purging.

The second being mixed with the salt of wormwood, stayed in my stomach. And just at the hour my ague should have come, began a pain at the point of my shoulder blade. Quickly it shifted its place, began a little under my left breast and there fixed. In less than an hour I had a short cough; soon after, a small fever. From that time the cough, the pain, and the fever continued without intermission.

And every night, very soon after I lay down, came first a dry cough for forty or fifty minutes, then an impetuous one, till something seemed to burst and for half an hour more I threw up thick fetid pus. Here was expedition! What but a ball could have made quicker

dispatch than this infallible medicine? In less than six hours it obstructed, inflamed, and ulcerated my lungs, and by this summary process brought me into the third stage of true pulmonary consumption. Excuse me therefore, if having escaped with the skin of my teeth, I say to all I have any influence over, whenever you have an intermitting fever, look at me and beware of the bark! I mean the bark in substance. If you love your lives, beware of swallowing ounce after ounce of indigestible powder, though it were powder of post. To infusions or decoctions I have no objection.

8. The following pages contain the most useful parts of Dr. Tissot's book—I believe the substance of all that will stand the test of sound reason and experience. I have added little thereto, but have judged it would be of use to retrench a great deal;b in particular, much bleeding, much Peruvian bark, and abundance of clysters. It is my belief that one might retrench, without any loss, many more of the remedies he prescribes. In many cases, half; in others, three quarters; in some, eight or nine parts in ten—since a single (perhaps even outward) remedy would effect a perfect cure.

9. I have only to add (what it would not be so fashionable for a physician to believe, much less to mention) that as God is the sovereign disposer of all things, and particularly of life and death, I earnestly advise everyone, together with all his other medicines, to use

I have generally lessened his doses, which were far too large for English constitutions [JW; this note found only in the Works edition].

Advices with Respect to Health

that medicine of medicines, prayer. Dr. Tissot himself will give us leave to think this an universal medicine. At the same time then that we use all the other means which reason and experience dictate, let us seek a blessing from him who has all power in heaven and earth,10 who gives us life and breath and all things,* 11 and who cannot with5 hold from them that seek him, any manner of thing that is good.12

10 See Matt. 28:18.

11 See Acts 17:25.

12 See Ps. 84:11.

Medical and Health Writings Chapter I Of the Usual Cause of Popular Maladies §1. Fatiguing labour, too long continued, is the first cause of those maladies which so often attack the inhabitants of both city and country. Its effects, in the first place, are for the most part inflammatory diseases, such as quinsies, pleurisies, defluxions on the breast. In the second place is that state of weakness into which they fall, and from which they with difficulty recover.

There are two ways of preventing these maladies. The first is to avoid the cause that produces them. The second, to diminish their effects by drinking largely of cooling draughts, such as whey, buttermilk, or even water; to every pint of which a glass of vinegar may be added, or the juice of grapes, or gooseberries not fully ripened. These form an agreeable draught, which strengthens and sustains the labourer.

A second ordinary cause of disease is when a person overheated by labour reposes in a cold place, or on the ground. This stops perspirations and occasions quinsies, rheumatisms, inflammations of the breast, pleurisies, and inflammatory colics. As soon as the patient feels the first symptoms (which sometimes does not happen till several days after), he should immediately bathe his legs in warm water, and after being well rubbed before the fire, he should drink a good quantity of the warm infusion, No. I.13 Such remedies often prevent the disease. But, on the contrary, the evil becomes more dangerous when people try to procure a sweat by heating medicines.

A third cause of disease is drinking cold water while one is much heated. This operates as the former, but the bad effects are generally more violent. I have seen some terrible examples of this.

Violent quinsies, inflammations of the breast, colics, inflammations in the liver and in the belly, attended with swellings, vomitings, suppression of urine, and terrible anguish. The best remedies are bleeding in the beginning, drinking warm water to which a fifth part of milk has been added, and fomentations of warm water applied to the throat, breast, and belly.

A fourth cause is the inconstancy of the climate. In one day we often feel it change from hot to cold, and from cold to hot. The "In this and subsequent instances, Tissot (and Wesley) is referring to the set of remedies at the end of the volume.

Advices with Respect to Health

best precaution is to go better clothed than the weather seems to call for—to put on our winter dress early in autumn, and quit it late in spring. Labourers who throw off their clothes while at work should never strip till an hour after sunrise, and should put on their clothes immediately on ending their work, or rather an hour before sunset.

It often happens that the traveller gets wet. This may be attended with no bad consequences, provided he shifts his clothes immediately. But I have often seen deadly pleurisies the consequences of omitting this. When the body and legs have been wet, the best way is to bathe the legs in warm water. I have by this means radically cured people subject to violent colics from having their feet wetted. This bath becomes still more efficacious by dissolving some soap in it.

A fifth cause is the common custom in villages of having their ditches or dunghills directly under their windows. Corrupted vapours are continually exhaling from them, which in process of time cannot fail of being prejudicial. Those who are accustomed to the smell become insensible of it. But the cause, nevertheless, does not cease to be unwholesome; and such as are unused to it perceive the impression in all its force.

To this cause may be added the neglect of common people to air their lodgings. It is well known that too close an air occasions malignant fevers, and the poor country people respire no other in their own houses. Their lodgings, which are very small, and which notwithstanding enclose (both day and night) the father, mother, and seven or eight children, are never kept open during six months in the year, and very seldom during the other six. It is easy to prevent all the evils arising from this source by opening the windows daily.

consider drunkenness as a sixth cause of diseases. The poor wretches who abandon themselves to it are subject to frequent inflammations of the breast and to pleurisies, which often carry them off in the flower of their age. If they escape these violent maladies, they sink, a long time before the ordinary approach of old age, into all its infirmities, and especially into an asthma, which terminates in a dropsy of the breast that is incurable.

The provisions of the common people are also frequently one cause of maladies. This happens, first, whenever the corn was not well ripened, or not well got in, in bad harvests. But this may be lessened by washing and drying the grain completely, by allowing

Medical and Health Writings it a little more time to swell or rise, and by baking it a little more.

Secondly, the better saved part of the wheat is sometimes damaged in the farmer's house, either because he does not take the due care of it or because he has no convenient place to preserve it. It has often happened to me, on entering one of those houses, to be struck with the smell of wheat that has spoiled. Nevertheless, there are known and easy methods to provide against this. I hirdly, that wheat which is good is often made into bad bread by not letting it rise sufficiently, by baking it too little, and by keeping it too long. All these errors have their troublesome consequences, especially on children and weakly people.

Cakes may be considered as an abuse of bread.14 The dough is almost constantly bad, and often unleavened, ill baked, greasy, and stuffed with either fat or sour ingredients, which compound one of the most indigestible ailments imaginable. Women and children consume the most of this food, and are the very subjects for whom it is the most improper; little children especially, who are, for the greater part, unable to digest them perfectly. Hence arise obstructions in the bowels, and of a slimy viscidity throughout the mass of humours, which throws them into various diseases—slow fevers, a hectic, the rickets, the King's evil, and feebleness—for the miserable remainder of their days. Probably indeed there is nothing more unwholesome than dough not sufficiently leavened, ill-baked, greasy, and soured by the addition of fish.

We should not omit, in enumerating the causes of maladies among country people, the construction of their houses, a great many of which either are close to a higher ground or are sunk a little in the earth. Each of these situations subjects them to considerable moistness, which is not the least source of diseases, especially on women in child-bed, on children, and in persons recovering of some distemper. It would be easy to prevent this inconvenience by raising the ground on which the house stood some inches above the level by a bed of gravel, of small flints, pounded bricks, coals, or such other materials; and by avoiding to build close to, or as it were, under a much higher soil. It would still cost less trouble to give the front of the houses an exposure to the southeast. This exposure, supporting all other circumstances to be alike, is both the most wholesome and advantageous.

I41 his is the traditional use of'cake' for a small flattened sort of bread, round, oval, or otherwise regularly shaped, and usually baked hard on both sides.

Advices with Respect to Health

Chapter II Of the Causes which Aggravate Diseases §12. The causes already enumerated occasion diseases, and the bad regimen or conduct of the people render them more perplexing, and often mortal.

There is a prevailing prejudice, which is every year attended with the death of hundreds, that all distempers are cured by sweat; and that to procure sweat they must take abundance of hot and heating things, and keep themselves very hot. This is a very fatal mistake.

And it cannot be too much inculcated that, by thus endeavouring to force sweating at the very beginning of a disease, they are taking pains to kill themselves. I have seen cases in which the continual care to provoke sweating has as manifestly killed the patient as if a ball had been shot through his brains, as such an untimely discharge carries off the thinner part of the blood, leaving the mass more dry, more viscid, and inflamed. Now as in all acute diseases, except a very few, the blood is already too thick, such a discharge must evidently increase the disorder.

But suppose sweating was beneficial at the beginning of the diseases, the means they use to excite it would prove fatal. The first is to stifle the patient with a close apartment, and a load of covering. Care is taken to prevent a breath of fresh air's squeezing into the room, from which circumstance the air already in it is speedily and extremely corrupted. And such a degree of heat is procured by the weight of the bedclothes that these two causes alone are sufficient to excite a fever, even in a healthy man. More than once have I found myself seized with a difficulty of breathing on entering such chambers, from which I have been immediately relieved on obliging them to open all the windows. Let in a little fresh air on these miserable patients, and lessen the burden of their coverings, and you generally see upon the spot their fever and oppression, their anguish and raving, abate.

The second method taken to raise a sweat in these patients is to give them hot things, especially Venice treacle or wine. In all feverish disorders we should gently cool, and keep the belly moderately open—while these things both heat and bind, and hence we may easily judge of their consequences. A healthy person would certainly be seized with an inflammatory fever on taking the same quantity of wine or Venice treacle which the peasant takes when he is attacked by one of these disorders. How then should a sick person escape dying by them?

Medical and Health Writings §15. But I shall be told that diseases are often carried off by sweat.

I answer, it is true sweating cures some disorders at their very onset—for instance, those stitches that are called false pleurisies, some rheumatic pains, and some colds. But this only happens when the disorders depend solely on abated perspiration, to which such pain instantly succeeds, and where immediately, before the fever has thickened the blood and inflamed the humours, and before any internal load is formed, some warm drinks are given, which, by restoring transpiration, remove the cause of the disorder. Nevertheless, even in such a case, great care should be had not to raise too violent a commotion in the blood, which would rather restrain than promote sweat. Sweating is also of service in diseases when their causes are extinguished by plentiful dilution. Then it relieves by drawing off with itself some part of the distempered humours

(after their grosser parts have passed off by stool and by urine), and carries off that extraordinary quantity of water we were obliged to convey into the blood. Under such circumstances it is of importance not to check the sweat. As much care should be taken not to check after the evacuation, which naturally occurs towards the conclusion of diseases, as not to force it at their beginning; the former being almost constantly beneficial, the latter as constantly pernicious. Besides, were it necessary, it might be dangerous to force it violently, since by heating the patients a vehement fever is excited.

Warm water, in short, is the best sudorific.1' An able physician had long since assured his countrymen that wine was fatal in fevers. I take leave to repeat it again and again, and wish it may not be with as little success.

Their diseases are further aggravated by the food that is generally given them. They must be weak, in consequence of their being sick, and the ridiculous fear of the patients dying of weakness disposes their friends to force them to eat—which, increasing their disorder, renders the fever mortal. This fear is absolutely chimerical. Never yet did a person in a fever die merely for weakness. They may be supported, even for weeks, by water only; and are stronger at the end of that time than if they had taken more solid nourishment, since, far from strengthening them, their food increases their disease and thence increases their weakness.

From the first invasion of a fever, digestion ceases. Whatever solid food is taken corrupts and adds nothing to the strength of the sick, but greatly to that of the distemper. There are a thousand ex-

''Orig., 'sudorifics'. A sudorific promotes perspiration.

Advices with Respect to Health

amples to prove that it becomes a real poison. And we may sensibly perceive these poor creatures, who are thus compelled to eat, lose their strength and fall into anxiety and ravings, in proportion as they swallow.

They are further injured by the quality of their food. They are forced to sup strong gravy soups, eggs, biscuits, and even flesh, if they have but just strength to chew it. It is almost impossible for them to survive all this trash. Should a man in perfect health be compelled to eat stinking meat, rotten eggs, stale sour broth, he is attacked with as violent symptoms as if he had taken real poison—which, in effect, he has. He is seized with vomiting, anguish, a violent purging, and a fever with raving and eruptive spots, which we call the purple fever.16 Now when the same articles of food, in their soundest state, are given to a person in a fever, the heat and the morbid matter already in his stomach quickly putrify them, and after a few hours produce all the above-mentioned. Let any man judge, then, if the least service can be expected from them.

The most observing persons remark that when a feverish patient sups what is called good broth, the fever gathers strength and the patient weakness. The giving such a soup or broth, though of the freshest meat, to a man who has a high fever or putrid humours in his stomach, is to do him exactly the same service as if you had given him, two or three hours later, stale putrid soup.

It were happy for mankind [if] they could be thoroughly persuaded of this demonstrable truth: that the only things which can strengthen sick persons are those which weaken their disease. Out of twenty sick persons who are lost in the country, more than twothirds might have been cured if they were supplied with abundance of good water.

What further increases our horror at this enormous propensity to heat, dry up, and cram the sick is that it is totally opposite to what nature herself indicates in such circumstances. The burning heat of which they complain; the dryness of the lips, tongue, and throat; the high colour of their urine; the longing they have for cooling things; the pleasure they enjoy from fresh air, are so many proofs which cry out with a loud voice that we ought to cool them moderately by all means. Their foul tongues, which show the stomach to be in the like condition; their loathing, their propensity to vomit; their utter aversion to all solid food, and especially to flesh; the disagreeable stench of their breath; and frequently the

16 This would include typhus and scarlet fever.

Medical and Health Writings extraordinary offensiveness of their excrements, demonstrate that their bowels are full of putrid contents, which must corrupt all the aliments superadded to them, and that the only thing which can be done is to dilute them by plentiful draughts of cooling drinks. I affirm it again, and I heartily wish it may be thoroughly attended to, that as long as there is any taste of bitterness, or of putrescence; as long as there is a loathing, a bad breath, heat and feverishness with fetid stools, and little and high coloured urine; so long all flesh, flesh-soup, eggs, and all kind of food composed of them, or of any of them, and all Venice treacle, wine, and heating things are so many absolute poisons.

Neither should it be omitted that even when a patient has escaped death, the mischief is not ended—the consequences of the high aliments and heating medicines being to leave behind the principle of some chronicle disease, which increasing insensibly, bursts out at length, and finally procures his death.

I must also take notice of another common practice, which is purging, or vomiting, at the very beginning of a distemper. Infinite mischiefs are occasioned by it. There are some cases indeed in which it is necessary. But it is a general rule that they are hurtful at the beginning, always when the diseases are strictly inflammatory.

It is hoped by their assistance to remove the oppression of the stomach, a disposition to vomit, a dry mouth, thirst, and uneasiness. But the causes of these symptoms are seldom of a nature to yield to these evacuations. By the extraordinary thickness of the humours that foul the tongue, we should form our notions of those which line the stomach and the bowels. It may be washed, gargled, and even scraped to little purpose. It does not happen until the patient had drank for many days, and the heat, the fever, and the fizziness of the humours are abated, that this filth can be thoroughly removed. The state of the stomach being conformable to that of the tongue, no method can effectually scour and clean it at the beginning. But by giving diluting remedies plentifully, it gradually frees itself, and the propensity to vomit, with its other effects, go off naturally.

The vomit especially, being given in an inflammatory disease before the humours have been diminished by bleeding and diluted by plentiful small drinks, is productive of the greatest evils—of inflammations of the stomach, of the lungs and liver, of suffocations and frenzies. Purges sometimes occasion a general inflammation of the guts, which terminates with death. Some instances of each I have seen. I he effect of such medicines in these circumstances are

Advices with Respect to Health

much the same with those we might expect from the application of salt and pepper to a dry, inflamed, and foul tongue in order to moisten and clean it.

Chapter III

Of the Means that ought to be used at the Beginning of Different Diseases and of the Diet in Acute Diseases

Having clearly shown the dangers of the regimen or diet, and of the principal medicines generally made use of on these occasions, I must now point out the method they may pursue, without any risk, on the invasion of some acute diseases, and the general diet which agrees with them all. And whenever I shall say in general that a patient is to be put upon a regimen, it will signify that he is to be treated according to the method in this chapter. And all such directions are to be observed with regard to air, food, drink; except when

I expressly order something else.

The greater part of acute diseases give some notice of their approach a few weeks, and commonly some days, before their actual invasion—such as a light weariness, stiffness or numbness, less activity than usual; less appetite, a small load or heaviness at the stomach; some complaint in the head; a profounder degree of sleep, yet less composed, and less refreshing than usual; sometimes a light oppression of the breast; a less regular pulse; a propensity to be cold, and aptness to sweat; and sometimes a suppression of a former disposition to sweat. At such a term it may be practicable to prevent, or at least considerably to mitigate, the most perplexing disorders by carefully observing the following points.

1. To omit all violent work or labour, but not a gentle degree of exercise.

2. To use none, or very little, solid food; and especially to renounce flesh, flesh-broth, eggs, and wine.

3. To drink three or even four pints daily, by small glasses at a time, from half hour to half hour, of the ptisans17 No. 1 and [No.] 2.

Or even of warm water, to each quart of which may be added half a glass of vinegar. No person can be destitute of this. Those who have honey will do well to add two or three spoonfuls of it to the water. A light infusion of elder-flowers, or of those of the lime tree, may also be advantageously used, or clear sweet whey.

171.e., nourishing drinks, whose recipes are found at the end of the tract.

Medical and Health Writings §27. Very unhappily people take the directly contrary method.

From the moment these previous complaints are perceived, they eat nothing but gross meat, eggs, or strong meat soups. They leave off garden stuff and fruits, which would be proper for them. And they drink heartily (under a notion of strengthening the stomach) of wine and other liquors, which strengthen nothing but the fever, and expel what degree of health might still remain.

When the distemper is further advanced, and the patient is seized with coldness or shuddering in a greater or less degree, w hich is commonly attended with an universal oppression and pains over all the surface of the body, he should be put to bed, if he cannot keep up; or should sit down as quietly as possible, with a little more covering than usual. He should drink every quarter of an hour a small glass of some of those liquids I have recommended [in] §26.

These patients earnestly covet a great load of covering during the cold or shivering. But we should be careful to lighten them as soon as it abates, so that when the heat begins they may have no more than their usual covering. It were to be wished they had rather less. The country people lie upon a featherbed, and under a downy coverlet or quilt that is commonly extremely heavy, and the heat which is heightened and retained by feathers is particularly troublesome to persons in a fever. Nevertheless, this custom may be complied with for one season of the year. But during our heats, or

w henever the fever is violent, they should lie on a pallet (w hich w ill be infinitely better for them) and should throw aw ay their coverings of down, so as to remain covered only with sheets, or something less injurious than feather coverings. A person could scarcely believe how much comfort a patient is sensible of in being eased of his former coverings.

As soon as the heat after the shuddering approaches, we should provide for the patient's regimen. And,

1. Care should be taken that the air in the room where he lies should not be too hot, the mildest degree of warmth being sufficient; that there be as little noise as possible, and that no person speak to the sick without necessity. No external circumstance heightens the fever more, nor inclines more to raving, than the persons in the chamber, especially about the bed. They lessen the spring of the air. They prevent a succession of fresh air. And the variety of objects occupies the brain too much. Whenever the patient has been at stool, or has made urine, these excrements should be re-

18 All editions misnumber this section by repeating '29'.

Advices with Respect to Health 415

moved immediately. The windows should certainly be opened night and morning, at least for a quarter of an hour each time; when also a door should be opened, to promote an entire change of the air in the room. Nevertheless, as the patient should not be exposed to a current of air, the curtains of his bed should be drawn on such occasions. If the season be rigidly cold, it will be sufficient to keep the windows open a few minutes each time. In summer, at least one window should be let open day and night. The pouring a little vinegar upon a red-hot shovel also greatly conduces to restore the spring and correct the putridity of the air. In our greatest heats, when the sick person is sensibly incommoded by it, the floor may be sprinkled now and then by branches of willow or ash trees dipped a little in pails of water.

2.19 With respect to the patient's nourishment, he must entirely abstain from all food but the following, which is one of the wholesomest and undisputedly the simplest one. Take half a pound of bread, a morsel of the freshest butter about the size only of a hazel nut (which may be omitted too), three pints and a quarter of water.

Boil them till the bread be entirely reduced to a thin consistence.

Then strain it, and give the patient one eighth part of it every three or every four hours; but still more rarely, if the fever be vehemently high. Those who have gruts,20 barley, oatmeal, or rice may prepare them in the same manner, with some grains of salt.

The sick may be sometimes indulged, in lieu of those spoonmeats, with raw fruits in summer, or in winter with apples baked or boiled, or plums and cherries dried and boiled. Persons of knowledge will not be surprised to see fruit directed in acute diseases, the benefit of which they may have frequently seen. Such advice can only disgust those who remain still obstinately attached to old prejudices. But could they reflect a little, they must perceive that these fruits which allay thirst, which abate the fever, which correct and attemper the putrid and heated bile, which gently dispose the belly to be rather open, and promote the discharge of the urine, must prove the properest nourishment for persons in acute fevers.

We may safely allow in all continual fevers cherries (red and black), strawberries, the best cured raisins, raspberries, and mulberries; provided all of them be perfectly ripe. Apples, pears, and plums are less melting and diluting, less succulent, and rather less proper.

19 Kirkpatrick mistakenly placed a new section number prior to the series numbering (i.e. §37. 2.) throughout this section, and JW reproduced this practice. We have corrected to conform to the pattern of the full treatise.

20A type of coarse oatmeal.

Medical and Health Writings Some kinds of pears however are extremely juicy, such as the Dean or Valentia pear, different kinds of the Beurre21 pear; the St. Germain, the green sugary pear, and the Summer Royal, which may all be allowed. As well as a little juice of very ripe plums, with the addition of water to it. This last I have known to assuage thirst in a fever beyond any other liquor. Care should be taken, at the same time, that the sick should never be indulged in a great quantity of any of them at once, which would overload the stomach. But if they are given a little at a time and often, nothing can be more salutary.

China oranges or lemons may be taken likewise, but without eating any of the peel, which is hot and inflaming.

3. Their drink should be such as allays thirst and abates the fever; such as dilutes, relaxes, and promotes the evacuations by stool, urine, and perspiration. All those which I have recommended in the preceding chapters possess these qualities. A glass or a glass and an half of the juice of such fruits as I have just mentioned may also be added to three full pints of water.

The sick should drink at least twice or thrice that quantity daily, often, and a little at once; between three and four ounces every quarter of an hour. The coldness of the drink should just be taken off.

4. As long as the patient has strength for it, he should sit up out of bed one hour daily, and longer if he can bear it, but at least half an hour. It has tendency to lessen the fever, the headache, and raving.

But he should not be raised while he has a hopeful sweating, though such sweats hardly ever occur but at the conclusion of diseases, and after the sick has had several other evacuations.

5. His bed should be made daily while he sits up, and then sheets, as well as the patient's linen, should be changed every two days, if it can be done with safety. An unhappy prejudice has established a contrary practice. The people about the patient dread the very thought of rising out of bed. They let him continue there in nastylinen, loaded with putrid streams, which not only keep up the distemper but even heighten it to some degree of malignity. I again repeat it here, that nothing conduces more to continue the fever and raving than confining the sick constantly to bed and withholding him from changing his foul linen—by relieving him from both of which I have, without the assistance of any other remedy, put a stop to a continual delirium of twelve days uninterrupted duration. A man must be in nearly a dying condition not to be able to bear these small commissions which, in the very moment he permits them,

21 Orig.,'buree'; also known as Bose pear.

Advices with Respect to Health

increase his strength, and immediately after abate his complaints.

One advantage the sick gain by sitting up a little is the increasing quantity of their urine. Some have been observed to make none at all if they did not rise out of bed.

A considerable number of acute diseases have been effectually cured by this method, which mitigates them all. Where it is not used, medicines are very often of no advantage. It were to be wished the patient and his friends were made to understand that distempers were not to be expelled at once with rough usage. That they must have their course. And that the use of violent medicines might indeed abridge the course of them, by killing the patient, yet never otherwise shortened the disease; but on the contrary, rendered it more tedious and obstinate, and often entailed such unhappy consequences on the sufferer as left him feeble and languid for the rest of his life.

The term of recovery from a disease requires considerable attention, as it is always a state of feebleness. The same kind of prejudice which destroys the sick by compelling them to eat during the violence of the disease is extended also to the stage of recovery, and either renders it troublesome and tedious or produces fatal relapses.

In proportion to the abatement of the fever, the quantity of nourishment may be gradually increased. But as long as there are any remains of it, their qualities should be those I have recommended.

Whenever the fever is completely terminated, different foods may be entered upon, so that the patient may venture upon a little white meat (provided it be tender), some fish,c flesh-soup, a few eggs at times, with wine diluted. It must be observed at the same time that those very aliments which restore the strength when taken moderately, delay the perfect cure if they exceed in quantity, though but a little, because the stomach, being extremely weakened, is capable only, as yet, of a small degree of digestion.

All bad consequences are prevented by the recovering sick contenting themselves for some time with a very moderate share of proper food. We are not nourished in proportion to the quantity we swallow, but to that we digest. A person on the mending hand who eats moderately, digests it and grows strong from it. He who swallows

cThe fish that are proper in this case are whitings, flounders, plaice, dabbs, or gudgeons; salmon, eels, carp, all the skate kind, haddock, and the like, should not be permitted before the sick return to their usual state of health [Kirkpatrick (see

Advice, 73)].

22 Orig., '§35', following Kirkpatrick's misnumbering described earlier; the corrected numbering is followed from this point.

Medical and Health Writings abundantly does not digest it, and instead of being strengthened he withers insensibly away.

We may reduce, within the few following rules, all that is to be observed in order to procure a complete termination of acute diseases.

1. Let these who are recovering take very little nourishment at a time, and take it often.

2. Let them take but one sort of food at each meal, and not change their food too often.

3. Let them chew whatever solid victuals they eat very carefully.

4. Let them diminish their quantity of drink. The best for them in general is water, with a fourth or third part of white wine. Too great a quantity of liquids at this time prevents the stomach from recovering its strength, impairs digestion, increases the tendency to a swelling in the legs.

5. Let them go abroad as often as they are able, whether on foot, in a carriage, or on horseback. This last exercise is the healthiest of all. They who practise it should mount before their principal meal, which should be about noon, and never ride after it.

6. As people in this state are seldom quite as well towards night, in the evening they should take little food. Their sleep will be the less disturbed, and repair them the more and sooner.

7. They should not remain in bed above seven or eight hours.

8. The swelling of the legs and ankles which happens to most persons of this time is not dangerous, and generally disappears of itself if they live soberly and regularly, and take moderate exercise.

9. It is not necessary in this state that they should go constantly every day to stool; though they should not be without one above two or three [days]. If their costiveness exceeds this term, they should take something opening.

10. They must by no means return to their labour too soon. This prevents many from ever recovering their former strength. And makes them lose in the consequence, every following week of their lives, more time than they ever gained by their over-early resuming of their labour.

Chapter IV Of an Inflammation of the Breast

A peripneumony is an inflammation of the lungs, commonly of one only and consequently on one side. The signs are

Advices with Respect to Health

a shivering of more or less duration, during which the person affected is very restless and in great anguish—an essential symptom, and which has helped me more than once to distinguish this disease at the very instant of its invasion. A considerable degree of heat succeeds the shivering, which for a few hours is often blended with returns of chilliness. The pulse is quick, strong, moderately full, hard, and regular when the distemper is not very violent; but small, soft, and irregular when it is very dangerous. There is also a pain, but rather light and tolerable, in one side of the breast. Sometimes a kind of straitening on the heart. At other times pains through the whole body, especially along the reins. The patient finds a necessity of lying almost continually upon his back, being able to lie but rarely on either of his sides. Sometimes his cough is dry, and then attended with most pain. At other times it is accompanied with a hawking up, blended with more or less blood, and sometimes with pure blood. There is also some pain, or at least weight and heaviness in the head, and frequently a propensity to rave. The face is almost continually flushed. Though sometimes there is a degree of paleness and an air of astonishment which portend no little danger.

The lips, the tongue, the palate, the skin are all dry; the breath hot; the urine little and high coloured in the first stage, but more plentiful, less flaming, and letting fall much sediment afterwards. There is a frequent thirst, and sometimes an inclination to vomit—which, imposing on the ignorant assistants, have often inclined them to give the patient a vomit, which is mortal, especially at this juncture.

The symptoms are heightened almost every night, during which the cough is more exasperated and the spitting in less quantity. The best expectoration is of a middling consistence, neither too thin, or too hard and tough. Sometimes the inflammation ascends along the windpipe and in some measure suffocates the patient.

Whenever the disease is very violent, the patient cannot draw his breath but when he sits up. The pulse becomes very small and very quick, the countenance livid, the tongue black, the eyes stare wildly. And he suffers inexpressible anguish, attended with incessant restlessness. He raves without intermission, can neither throughly wake nor sleep. The skin of his breast and of his neck is covered (especially when the distemper is extremely violent) with livid spots. He sinks into a lethargy, and soon dies.

If the disease rushes on at once, with a violent attack; if the cold shivering last many hours, and are followed with a scorching degree of heat; if the brain is affected from the very onset; if the patient has a small purging, attended with a straining to stool; if

Medical and Health Writings he abhors the bed; if he either sweat excessively or his skin be extremely dry; and if he spits up with much difficulty, the disease is extremely dangerous.

He must directly, from the first seizure in this state, be put upon regimen. And his drink must never be given cold. It should either be the barley water (No. 2), the almond emulsion (No. 4), or that of No. 7. The juices of the plants which enter into the last of these drinks are excellent remedies, as they powerfully attenuate the viscid blood which causes the inflammation.

As soon as ever the cold assault is over, twelve ounces of blood must be taken away at once; and if the patient be young and strong, fourteen or even sixteen.11 This plentiful bleeding gives him more ease than if twenty-four ounces had been drawn at three different times.

When the disease is circumstanced as described [in] §[3323], that first bleeding makes the patient easy for some hours. But the complaint returns, and to obviate its violence we must repeat the bleeding four hours after the first, taking again twelve ounces of blood. And if, about the expiration of eight or ten hours, it appears to kindle up again, it must be repeated a third or even a fourth time.

In this, and in all other inflammatory diseases, the blood is thick and viscid. And almost immediately on its being drawn a white tough skin, somewhat like leather, is formed on its top, which is called the 'pleuritic crust'. It is thought a promising appearance when, at each bleeding, it seems less hard and less thick than it was at the preceding ones. And this is generally true if the sick feels himself, at the same time, sensibly better. But whoever shall attend solely to the appearance of the blood will find himself often deceived.

The patient's legs should every day, for half an hour, be put into a bath of warm water, wrapping him up closely, that the cold may not check that perspiration which the bath promotes.

And every two hours he should take two spoonfuls of the mixture No. 8, which promotes all the discharges, and chiefly that of expectoration.

When the oppression and straitness are considerable, and the cough dry, the patient may receive the vapour of boiling water to which a little vinegar has been added. There are two ways of effecting this: either by placing below his face, after setting him up, a

dThe applications set down in the Primitive Physic cure without bleeding at all QW], 23 Orig., '§37'; in this and subsequent instances of internal number references, the original is adjusted to the corrected numbering.

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vessel filled with such boiling hot water, and covering the patient's head and the vessel with a linen cloth that may inclose the steam; or by holding before his mouth a sponge dipped in the same boiling liquor. This last method is the least effectual, but it fatigues the patient considerably less. When this bad symptom is extremely pressing, vinegar alone should be used without water, and the vapour of it has often saved patients who seemed to have one foot in the grave.

But it should be continued for several hours.

The outward remedies directed in No. 9 are also applied with success to the breast and to the throat.

When the fever is extremely high, the sick should take every hour a spoonful of the mixture No. 10 in a cup of the ptisan, but without diminishing on this account the usual quantity of his other drinks, which may be taken immediately after it.e

As long as the patient continues equally bad, the same medicines are to be repeated. But if on the third day (though it rarely happens so soon), or fourth, or fifth, the disease takes a more favourable turn—the cough be less severe, the matter coughed up less bloody, respiration becomes easier, the head be less affected, the tongue not quite so dry, if the high colour of the urine abates and its quantity be increased—it may be sufficient then to keep the patient carefully to his regimen. The exasperation that occurs the fourth day is often the highest.

This distemper is commonly carried off by expectoration, often by urine, which on the seventh, the ninth, or the eleventh day, sometimes on the days between them, begins to let fall a plentiful sediment of a pale red colour, and sometimes red pus.24 These discharges are succeeded by sweats, which are as serviceable then as they were injurious at the beginning of the disease.

'The use of acids in inflammations of the breast requires no little consideration.

Whenever the sick person has an aversion to them; when the tongue is moist, the stomach is heavy and disordered, and the habit of the patient is mild and soft; when the cough is very sharp without great thirst, we ought to abstain from them.

But when the inflammation is joined to a dry tongue, to great thirst, heat, and fever, they are of great service. Slices of China [i.e., Mandarin] oranges sprinkled with sugar may be given first. A light lemonade may be allowed afterwards, and at last small doses of the mixture No. 10, if it becomes necessary [Rast (see Kirkpat

rick, 84)].

In the disease, and in pleurisies, more solid benefit has been received from the use of rattlesnake root than from any other medicine whatsoever. Bleeding indeed is premised to it, but it has often saved the necessity of repeated bleedings [Kirkpatrick (see Advice, 85)].

24Orig., 'real pus'; corrected by comparison toTissot.

Medical and Health Writings §[44]. Some hours before these evacuations appear there come on, not seldom, some alarming symptoms: such as great anguish, palpitations, some irregularity in the pulse, and increased oppression, convulsive motions (this being the crisis of the distemper).

But they are no ways dangerous, provided they do not occasion any improper treatment. These symptoms depend on the morbid matter which, being dislodged, circulates with the humours and irritates different parts until the discharge of it has fairly begun.

After which all such symptoms disappear and sleep generally ensues. However I cannot too strongly insist on the necessity of great prudence in such circumstances. If the absurd practice of directing particular remedies for such accidents takes place—such as spirituous cordials, Venice treacle, confections, castor and rue—the consequence is that, nature being disturbed in her operations, the crisis is not effected. The matter which should be discharged by stool, by urine, or by sweat is not discharged out of the body but is thrown upon some inward part. The patient either dies at once, or another distemper succeeds, more troublesome than the first. Should it be expelled to some outward part, as soon as ever a tumour appears, ripening poultices should be applied, after which it should immediately be opened.

In order to prevent such unhappy consequences, great care must be taken whenever such terrifying symptoms come on (about the time of the crisis) to make no change in the diet or treatment of the patient; except in applying every two hours a flannel, squeezed out, of warm water, which may cover all the belly and in a manner go round the body behind the reins. The quantity of his drink may also be increased a little, and nourishment lessened, as long as this violent state continues.

Vomits and purges are directly contrary to the nature of this disease. Anodynes or opiates are also, in general, very improper.

When the disease proceeds in a regular manner, the patient may be called safe by the fourteenth day; when he may, if he has an appetite, be put upon the diet of people who are recovering. But if he still retains an aversion to food, if his mouth is foul and furred, and he is sensible of some heaviness in his head, he should take the purging potion25 No. 11.

Bleedings from the nose occur sometimes naturally in this disease, even after repeated bleedings. These are favourable, and are

' Orig., 'portion' in all editions; corrected toTissot's 'potion'. This error occurs in a few other places, which we also correct (and note in Appendix A).

Advices with Respect to Health

commonly attended with more relief than artificial bleedings. Such voluntary discharges may sometimes be expected when the patient is sensibly mended after the use of the lancet, and yet complains of a great pain in his head accompanied with quick sparkling eyes and a redness of the nose. Nothing should be done to stop these bleedings, they will cease themselves. At other times, but more rarely, the distemper is carried off by a natural purging, attended with moderate pain and the discharge of bilious matter.

If the expectoration stops suddenly, and is not speedily attended with some other evacuation, the oppression and anguish of the patient immediately return and the danger is great and pressing. If the distemper is not of many days standing, if the patient is a strong person, if he has not as yet been plentifully bled, if there be still some blood mixed with the humour he expectorates, or if the pulse be strong and hard, he should be bled immediately in the arm.

And constantly receive the steam of hot water and vinegar by the mouth. And drink plentifully of the ptisan No. 2, something hotter than ordinary. But if his circumstances are different from these just mentioned, instead of bleeding two blisters should be applied to the legs, and he should drink plentifully of the ptisan No. 12.

The causes which oftenest produce this suppression of expectoration are: 1) a sudden cold air, 2) too hot a one, 3) over-hot medicines, 4) excessive sweating, 5) a purge ill-timed, and 6) some immoderate passion.

When the sick has not been sufficiently bled, and sometimes when he has been weakened by excessive bleeding so that the discharges have not been sufficiently made when these discharges have been confused by some other causes, then the vessels that have been inflamed do not unload the humours which oppress them— but there happens in the lung the same circumstance we see daily on the surface of the body. If an inflammatory swelling does not disperse itself, it forms an imposthume. Thus in the inflamed lung, if the inflammation is not dissipated, it forms an abscess. And the matter of that abscess, like the external ones, remains often long inclosed in its bag, without bursting its case and discharging the matter it contains.

If the inflammation was not deeply seated in the lung, but was near the ribs, the sack will burst on the surface of the lung and the matter be discharged into the cavity of the breast. But when the inflammation is considerably deeper, the imposthume bursts within the lung itself. If its orifice is so small that little can get out at once, if the quantity of matter be inconsiderable, and the patient is pretty

Medical and Health Writings strong, he coughs up the matter and is sensibly relieved. But if its orifice is wide and it throws out a great quantity at once, or if the patient is very weak, he dies the moment it bursts, and that sometimes when it is least expected. I have seen one patient expire when he was conveying a spoonful of soup to his mouth, and another while he was wiping his nose.

Whatever distemper is included within the breast of a living patient is neither an object of the sight or touch, whence these inward tumours are so often unsuspected. The evacuations that were necessary for the cure have not taken place during the first fourteen days. At the end of this term the patient is not very considerably relieved, but the fever continues pretty high, with a pulse continually quick, in general soft and weak, though sometimes pretty hard, and often fluctuating or, as it were, waving. His breathing is still difficult, with small shudderings from time to time, an exasperation of the fever, flushed cheeks, dry lips, and thirst.

The increase of these symptoms declare[s] that matter is formed.

The cough then becomes more continual, being exasperated with the least motion, or as soon as ever the patient has taken any nourishment. He can repose only on the side affected. It often happens indeed that he cannot lie down at all, but is obliged to sit up all day, sometimes even without daring to lean a little upon his loins, for fear of increasing the cough and oppression. He is unable to sleep, has a continual fever, and his pulse frequently intermits.

The fever is not only heightened every evening, but the smallest quantity of food, the gentlest motion, a little coughing, the lightest agitation of the mind, a little more than usual heat in the chamber, soup either a little too strong or a little too salt[y], increase the quickness of his pulse the moment they occur. He is restless, has some short attacks of terrible anguish, accompanied and succeeded by sweatings on his breast. He sweats sometimes the whole night. His urine is reddish, now frothy, and at other times oily, as it were. Sudden flushings, hot as flames, rise into his whole visage.

The greater number of the sick are sensible of a disagreeable taste in their mouth—some of old strong cheese, others of rotten eggs, others of stinking meat—and fall greatly away. The thirst of some is unquenchable, their mouths and lips are parched, their voice weak and hoarse, their eyes hollow, with a kind of wildness in their looks. They have a general disgust to all food, and if they should ask for some particular nourishment without seeing it, they reject it the moment it is brought them, and their strength at length seems wholly exhausted.

Advices with Respect to Health 425

When a vomica is formed, as long as it is not emptied, all these symptoms increase and the vomica grows in size. The whole side of the lung affected sometimes becomes a bag of matter. The sound side is compressed, and the patient dies after a dreadful anguish.

To avoid such fatal consequences it is necessary to procure the rupture of this abscess as soon as we are certain of its existence.

And as it is safer it should break within the lobe, whence it may be discharged by hawking up, than that it should void itself into the cavity of the breast, we must endeavour that this rupture may be effected within the lungs.

The most effectual methods to procure this are: 1) To make the patient continually receive, by his mouth, the vapour of warm water. 2) When by this means that part of the sack is softened where we wish the rupture to happen, he is to swallow a large quantity of emollient liquid, such as barley water, light veal broth, or milk and water. By this means the stomach is kept always full, so that the resistence to the lungs being considerable on that side, the abscess will be pressed towards the side of the windpipe, as it will meet with less resistence there. This fulness of the stomach will also incline the patient to cough, which may concur to produce a good event.

Hence, 3) we should endeavour to make the patient cough, by making him smell to some vinegar, or even snuff up a little, or by injecting into his throat, by means of a small syringe, a little water or vinegar. 4) He should be advised to bawl out loud, or to read loud.

5) Let him take every two hours a soup ladle of the potion No. 8.

6) He should be put into a cart, or some other carriage, but not before he has drank plentifully of those liquors. After which the jolting in the carriage has sometimes immediately procured a rupture.

Many persons afflicted with a vomica faint away the very instant it breaks. Some sharp vinegar should be directly held to their nose.

This small assistance is generally sufficient, where the bursting of it is not attended with such appearances as show it to be mortal.

If the sick person was not extremely weak before the bursting of the abscess, if the matter was white and well-conditioned, if the fever abates after the cough is less violent, if the patient recovers his sleep and appetite, if his usual strength returns, if the quantity he expectorates becomes gradually less, and if his urine is apparently better, we may have room to hope that by the assistance of these remedies I shall direct he may be completely cured.

But when his strength is exhausted before the bursting of the abscess, when the matter is too thin and transparent, brown,

Medical and Health Writings green, yellow, bloody, and of an offensive smell, if the pulse contin ues quick and weak, if the patient's appetite, strength, and sleep do not improve, there remains no hope of a cure.

1) Give every four hours a little barley or rice cream.

2) If the matter brought up is thick and gluey, so that it is difficult to be discharged, give every two hours a soup ladle of the potion

No. 8. And between the giving these two, let the patient take every half hour a cup of the drink No. 13. 3) When there is no occasion for these medicines to promote discharge, they must be omitted; though the sort and quantity of food are to be continued, but with the addition of an equal quantity of milk; or, which would be still more beneficial, instead of this mixture we should give an equal quantity of sweet milk, taken from a good cow, which in such a case may compose the whole nourishment of the patient. 4) He should take four times a day, beginning early in the morning, and at the distance of two hours, a dose of the powder No. 14. diluted in a little water.' His common drink should be almond milk, or barley water, or fresh water with a fourth part milk. 5) He should exercise every day on horseback, or in a carriage, according as his strength and circumstance allow. But of all sorts of exercise, that upon a trotting horse is beyond all comparison the best, if he can bear it.

The influence of the air is of more importance in this disorder than in any others, for which reason great care should be taken to procure the best in the patient's chamber. For this purpose it should often have an admission of fresh air, and be sweetened from time to time, though very lightly, with a little good vinegar. And in the season it should be plentifully supplied with agreeable herbs, flowers, and fruits. Should the sick be confined in an unwholesome air, there can be but little prospect of curing him.

Out of many persons affected with these disorders, some have been cured by taking nothing but buttermilk; others by melons and cucumbers only; and others again by summer fruits of every sort. Nevertheless, as such cases are singular, I advise the patient to observe the method I have directed here.

When the discharge from the breast diminishes, and the patient is perceivably mended in every respect, it is a proof that the abscess is clean and disposed to heal up. If the discharge continues in great quantity, if it seems but of an indifferent consistence, if the fever returns every evening, it may be apprehended that the wound,

1 Rather pour upon it a coffee-cup full of boiling water. Cover this two or three minutes. Then drink the water, leaving the powder behind [JW].

Advices with Respect to Health 427

instead of healing, may degenerate into an ulcer. Then the patient would fall into a confirmed hectic [fever].

I am not acquainted with any better remedy in such case than a perseverance in these already directed, with exercise on horseback.

In some of them indeed recourse may be had to the sweet vapours of some vulnerary herbs in hot water, with a little oil of turpentine, as directed [in] No. 15.1 have seen them succeed. If the cough prevents the patient from sleeping, he may take in the evening two or three tablespoonfuls of the prescription No. 16, in a glass of barley water.

The very same causes which suddenly suppress the expectoration in an inflammation of the breast may check the expectoration from a vomica—in which circumstance the patient is speedily afflicted with an oppression and anguish, a fever and evident feebleness. We should immediately endeavour to remove this stoppage by the vapour of hot water, by giving a spoonful of the mixture No. 3 every hour, by a large quantity of the ptisan No. 12, and by a proper degree of exercise. As soon as ever the expectoration returns, the other symptoms disappear. I have seen this suppression in strong habits quickly followed with an inflammation about the seat of the vomica, which has obliged me to bleed, after which the expectoration immediately returned.

Some may be surprised that in treating of an abscess of the lungs I say nothing of those remedies commonly termed 'balsamics', as turpentines, balsam of Peru, [balsam] of Mecca, frankincense, mastic, myrrh, storax, and balsam of sulphur. I never in such cases made use of these medicines, because I am convinced that their operation is hurtful. They protract the cure, and often change a slight disorder into an incurable disease. They obstruct the finest vessels of the lungs, whose obstructions we should endeavour to remove, and evidently occasion, except their dose be extremely small, heat and oppression.

If the vomica, instead of breaking within the lungs, should break without it, the pus falls into the cavity of the breast. We know when that has happened by the sensation of the patient, who perceives a singular kind of movement, generally accompanied with fainting. The oppression and anguish cease at once, the fever abates, the cough however commonly continues, though without any expectoration. But this seeming amendment is short, since from the daily augmentation of the matter, and its becoming more acrid or sharp, the lungs become oppressed, irritated, and eroded.

The difficulty of breathing, heat, thirst, wakefulness, distaste, and

Medical and Health Writings deafness, return, with frequent sinkings and weakness. The patient should be confined to his regimen to retard the increase of the disease as much as possible, notwithstanding no other effectual remedy remains except that of opening the breast between the two ribs to discharge the matter.

An inflammation may also form what we call a 'scirrhus', which is a very hard, unpainful tumour. This is known to occur when the disease is not terminated in any of those manners I have represented; and where, though the fever and the other symptoms disappear, the breathing remains a little oppressed, the patient still retains a troublesome sensation in one side of his breast, and has from time to time a dry cough, which increases after exercise and after eating. This malady is but seldom cured, though some attacked with it last many years without any other considerable complaint.

They should avoid all occasions of over-heating themselves, which might readily produce a new inflammation about this tumour, the consequences of which would be highly dangerous.

The best remedies against this disorder, and from which I have seen some good effects, are the medicated whey No. 17, and the pills No. 18. The patient may take twenty pills and a pint and half of the whey every morning for a long continuance; and receive inwardly, now and then, the vapour of hot water.

Chapter V

Of the Pleurisy §[64]. The pleurisy is chiefly known by these four symptoms: a strong fever, a difficulty of breathing, a cough, and an acute pain about the breast.

The cause of this disease is exactly the same with that of the former—that is, an inflammation of the lungs; but an inflammation that seems rather a little more external. The only considerable difference in the symptoms is that the pleurisy is accompanied with a most acute pain under the ribs. This pain is felt indifferently over every part of the breast, though more commonly about the sides and oftenest on the right side. The pain is greatly increased whenever the patient coughs or draws in the air in breathing. And hence some patients forbear to cough or respire as much as they possibly can, and that aggravates the disease by stopping the course of the blood in the lungs, which are soon overcharged with it. Hence the inflammation of the bowels becomes general, the blood mounts up

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in the head, the countenance looks deeply red or, as it were, livid.

The patient becomes nearly suffocated.

Sometimes an inflammation of the lungs is communicated also to the pleura. But this is not frequently the case.

§[65]. Spring is commonly the season productive of pleurisies.

The disease usually begins with a violent shivering, succeeded by considerable heat, with a cough, an oppression, and sometimes with a sensible straitening, as it were, all over the breast; and also with a headache, a redness of the cheeks, and with retchings to vomit. The stitch does not always happen at first; often not till after several hours, sometimes not before the second or even the third day. Sometimes the patient feels two stitches, in different parts of the side; though it seldom happens that they are equally sharp, and the lightest soon ceases. Sometimes also the stitch shifts its place, which promises well if the part first attacked by it continues free from pain; but it has a bad appearance if, while the first is present, another supervenes and both continue. There often occurs at, or quickly after, the invasion such an expectoration as happens in an inflammation of the breast. At other times there is not the least appearance of it, whence such are named 'dry pleurisies'. Sometimes the sick cough but little, or not at all. They often lie more at ease

upon the side affected than on the sound one. The progress of this disease advances exactly like that described in the preceding chapter.

This distemper is often produced by drinking cold water while a person is hot, from which cause it is sometimes so violent as to kill the patient in three hours. A young man was found dead at the side of the spring from which he had quenched his thirst.

Neither indeed is it uncommon for pleurisies to prove mortal in three days.

Sometimes the stitch disappears, whence the patient complains less; but at the same time his countenance changes, he grows pale and sad, his eyes look dull and heavy, and his pulse grows feeble.

This signifies a translation of the disease to the brain, a case which is almost constantly fatal.

There is no disease in which the critical symptoms are more violent, and more strongly marked, than in this. It is proper this should be known, as it may prevent or lessen our excessive terror.

A perfect cure supervenes, sometimes, at the very moment when death was expected.

This malady is one of the most destroying kind, as well from its own violent nature as through the pernicious treatment of it in country places. As soon as a person is afflicted with a stitch, all

Medical and Health Writings the hot medicines are set to work. This mortal error destroys more people than gunpowder.

The proper manner of treating this disease is exactly the same with that of the peripneumony. Hence the bleedings, the softening and diluting drinks, the steams, and the poultices are the real remedies. These last perhaps are still more effectual in the pleurisy, and therefore they should be continually applied over the very stitch.

If from the beginning of the disease the pulse is but a little quicker and harder than in a healthy state, if the headache and the stitches are moderate, if the cough is not too violent, bleeding may be omitted.

In those dry pleurisies in which the stitch, the fever, and the headache are strong and violent, and where the pulse is very hard and very full, and with an excessive dryness of the skin and the tongue, bleeding should be frequently repeated and at small intervals. This method commonly cures the disease effectually, without using any other evacuation.8

It has been observed that some persons, who have been once attacked by this disease, are often liable to relapses of it. Such as can confine themselves to some proper precautions may prevent these returns, even without bleeding, by a temperate regimen; by abstaining from time to time from eating flesh and drinking wine, at which times they should drink whey, or some of those diet drinks

No. 1, [No.] 2, [and No.] 4; and by bathing their legs sometimes in warm water, especially in those seasons when this disease is most likely to return.

Chapter VI Of the Diseases of the Throat

The throat is subject to many diseases. One of the most dangerous is that inflammation of it called a 'quinsy'. This in effect is a distemper of the same nature with an inflammation of the breast. But as it occurs in a different part, the symptoms are very different. They also vary according to the different parts of the throat which are inflamed.

The general symptoms of an inflammation of the throat are shivering, subsequent heat, a fever, headache, red high-coloured urine, a considerable difficulty (and sometimes an impossibility) of

So does a poultice of boiled nettles, without bleeding [JW],

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swallowing anything. If the nearest parts to the windpipe are attacked, breathing becomes excessively difficult. The patient is sensible of extreme anguish. The disease is then extended to the windpipe, and even to the substance of the lungs, whence is becomes speedily fatal.

The inflammation of the other parts is attended with less danger, and this danger becomes still less as the disease is more extended to the superficial parts. When the inflammation is general, and seizes all the internal parts of the throat, and particularly the tonsils, the uvula, and the root of the tongue, it is one of the most dangerous and dreadful maladies. The face is then swelled up and inflamed.

The whole inside of the throat is in the same condition. The patient can get nothing down. He breathes with pain and anguish, which concur with a stuffing in his brains, to throw him into a kind of furious delirium. The miserable patient is deprived of all his strength, and commonly dies the second or third day.

Sometimes the disease shifts from the internal to the external parts. The skin of the neck and breast grows very red and painful, but the patient finds himself better.

At other times the disorder quits the throat, but is transferred to the brain or the lungs. Both [of] these translations are mortal when the best advice cannot be immediately procured, and even the best is often ineffectual.

The most useful kind of this disease is that which affects only the tonsils and the palate. It generally first invades one of the tonsils, which becomes enlarged, red, and painful, and does not allow the afflicted to swallow but with great pain. Sometimes the disorder is confined to one side. But most commonly it is extended to the uvula, from whence it is extended to the other tonsil. If it be of a mild kind, the tonsil first attacked is generally better when the second is attacked. Whenever they are both affected at once, the pain and the anguish of the patient are very considerable.

The fever is sometimes very high, and the shivering often endures for many hours. It is succeeded by considerable heat and a violent headache, which yet is sometimes attended with a drowsiness. The fever is commonly pretty high in the evening, and by the morning perhaps there is none at all.

It has never happened, within my knowledge, that this sort of the disease, prudently treated, has terminated either in a mortification or a scirrhus. But I have been a witness to either of these supervening when sweating was extorted in the beginning of it by hot medicines.

Medical and Health Writings §[75]. The treatment of the quinsy, as well as of all other inflammatory diseases, is the same with that of an inflammation of the breast.h The sick is immediately to be put upon a regimen, and (in that sort described [in] §[71]) bleeding must be repeated four or five times within a few hours, and sometimes there is a necessity to recur still oftener to it. When it assaults the patient in the most vehement degree, all medicines are generally ineffectual. They should be tried however. We should give as much as can be taken of the drinks No. 2 and [No.] 4. But as the quantity they are able to swallow is often very inconsiderable, the clyster No. 5 should be repeated every three hours, and their legs should be put into a bath of warm water thrice a day.

Cupping glasses, with scarification,26 applied about the neck, after bleeding twice or thrice, have often been experienced to be highly useful. In the most desperate cases, when the neck is excessively swelled, one or two deep incisions made with a razor on this external tumour have sometimes saved a patient's life.

In that kind described [in] §[73] we must have very frequent recourse to bleeding, and it should never be omitted when the pulse is hard and full. It is of the utmost consequence to do it instantly, since it is the only means to prevent the abscess, which forms very readily if bleeding has been neglected only for a few hours. Sometimes it is necessary to repeat it a second time, but very rarely a third.

This disease is frequently so gentle and mild as to be cured without bleeding, by good management, especially if the patient drinks plentifully of the ptisan No. 2.

Besides the general remedies against inflammations, a few particular ones calculated only for this disease may be applied in each kind of it. The best are

l.27 The emollient poultices (No. 9) laid over the whole neck.' hAnd accordingly it is almost always cured in ten hours, by a poultice of boiled nettles [JW].

'The English avail themselves considerably in this disease of a mixture composed of equal parts of salad oil and the spirit of sal ammoniac, or of oil and spirit of hartshorn as a liniment and application round the neck. This remedy deserves, perhaps, the first place amongst local applications against the inflammatory quinsy

[Rast (see Advice, 125)].

26 Scarification is a practice of making several small incisions, from which the cupping glasses help draw out liquid.

270rig., 'First'.

Advices with Respect to Health

2. Of the gargarisms (No. 19) a great variety may be prepared of equal efficacy. Those I direct here are what have succeeded best with me, and they are very simple.'

3. The steam of hot water should be repeated five or six times a day. A poultice should be constantly kept on, and often renewed.

And the patient should frequently gargle.

There are some persons who cannot gargle themselves, and the pain occasioned by it makes it more difficult. In such a case, instead of gargling, the same gargarism (No. 19) may be injected with a small syringe. The injection reaches further than gargling, and often causes the patient to hawk up a considerable quantity of glary matter to his sensible relief. This injection should be often repeated.

The patient should breathe out, rather than inspire, during the injection.

Whenever the disease terminates without suppuration the fever, the headache, the heat in the throat, and the pain in swallowing begin to abate from the fourth day; sometimes from the third, often only from the fifth; and from such period that abatement increases, so that on the sixth, seventh, or eighth, the patient is entirely well.

If the inflammation does not disperse, so that an abscess is forming, then the symptoms attending the fever continue, though raging a little less after the fourth day. The throat continues red. A pain also continues, though less acute. The pulse commonly grows a little softer. And on the fifth or sixth day, and sometimes sooner, the abscess is ready to break. This may be discovered by the appearance of a small white and soft tumour when the mouth is open, which commonly appears about the middle of the inflammation.

It bursts of itself; or, should it not, it must be opened. The patient should gargle himself after the discharge of it with the cleaning gargarism No. 19.

Frequently the matter is not collected exactly in the place where the inflammation appeared, but in some less visible place.

Whence a facility of swallowing is restored, the fever abates, the patient sleeps, and imagines he is cured. But the following signs may enable him to discover that there is an abscess: a certain inquietude and general uneasiness, a pain throughout the mouth, some

'Dr. Pringle [John Pringle (1707-82)] is apprehensive of some ill effects from acids in gargarisms (which is probably from their supposed repelling property) and prefers a decoction of figs in milk and water, to which he adds a small quantity of spirit of sal ammoniac [Rast (see Advice, 126)].

Medical and Health Writings shiverings from time to time, frequently sharp but short and transient heat, a sensation of thickness and heaviness in the tongue, small white eruptions on the gums, on the inside of the cheek, on the inside and outside of the lips, and disagreeable taste and odour.

In such cases milk or warm water should frequently be retained in the mouth, the vapour of hot water should be conveyed into it, and cataplasms applied about the neck. All these concur to the softening and breaking of the abscess. The finger may also be introduced to feel for its situation, and when discovered the surgeon may easily open it. I happened once to break one under my finger without making the least effort to do it. Warm water may be injected pretty forcibly, either by the mouth or the nostrils. This sometimes occasions a kind of cough which breaks it. I have seen this happen even from laughing.

Disorders of the throat are, with respect to particular persons, an habitual disease, returning every year or oftener. They may be prevented by the same means which I have directed for the preservation from habitual pleurisies [in] §[69], and by defending the head and the neck from the cold—especially after being heated by any violent exercise, or even by singing long and loud, which may be considered as an extraordinary exercise of some of the parts affected in this disease.

Chapter VII

Of Colds §[83]. There are many prejudices with regard to colds, which may be attended with pernicious consequences. The first is that a cold is never dangerous, an error which destroys the lives of many. 'Colds destroy more than plagues' was the answer of an experienced physician to one of his friends who, being asked how he was, replied,

'Very well, I have nothing but a cold.'

A second prejudice is that colds require no medicines, and last longer for being nursed. Colds, like other disorders, have their proper remedies, and are removed with more or less facility as they are conducted better or worse.

A third mistake is that they are not only not dangerous, but even wholesome too. Not so. A cold constantly produces some disorder in the functions of some part of the body, and thus becomes the cause of a disease. It is indeed a real disorder itself, and when violent makes a very perceivable assault upon our whole machine.

Advices with Respect to Health

Colds, with their defluxions, considerably weaken the breast, and sooner or later considerably impair the health. Persons subject to frequent colds are never strong. They often sink into languid disorders. And a frequent aptitude to take cold is a proof that their perspiration may be easily checked, whence the lungs become oppressed and obstructed, which must always be attended with danger.

A cold in truth is almost constantly an inflammatory disease, a light inflammation of the lungs, of the throat, or of the membrane which lines the nostrils and the inside of certain cavities in the bones of the cheeks and forehead. These cavities communicate with the nose in such a manner that, when one part of this membrane is affected with an inflammation, it is easily communicated to the other parts.

Colds are of no certain continuance. Those of the head generally last but a few days; of the breast, longer. Some terminate in four or five days. If they extend beyond this term they prove hurtful: 1) because the violence of the cough disorders the whole machine, particularly by forcing up the blood to the head; 2) by depriving the person afflicted of his usual sleep; 3) by impairing the appetite and confusing the digestion; 4) by weakening the lungs through the continual coughing, whence all the humours being gradually determined towards them, as the weakest part, a continual cough subsists. Hence also they become overcharged with humours, which grow viscid there. The respiration is overloaded, a slow fever appears, nutrition almost ceases, the patient becomes weak, sinks into a wasting, and often dies in a short time.

Wherefore, since a cold is a disease of the same kind with quinsies and inflammations of the breast, it ought to be treated in the same manner. The drinks No. 1, [No.] 2, [No.] 3, [and No.] 4 should be very plentifully used. It is advantageous to bathe the feet in warm water every night at going to bed.k In a word, if the patient is put into a regimen, the cure is very speedily effected.

The disorder, indeed, is often so slight that it may be easily cured without any physic—by abstaining from flesh, broth, and wine; from all food that is sharp, fat, and heavy; and by dieting upon bread, pulse [i.e., legumes], fruit, and water. Particularly by eating little or no supper, and drinking, if thirsty, a simple ptisan of barley with the addition of a third or fourth part of milk. Bathing the feet, and the powder No. 20, contribute to dispose the patient to sleep.

1 It frequently happens, that the bathings alone remove the headache, and the cough too [Rast (sue Advice, 143)].

Medical and Health Writings §[88]. In colds of the head the steam of warm water alone, or that in which elder-flowers or some other mild aromatic herbs have been boiled, commonly afford a speedy relief. I hese are also serviceable in colds fallen on the breast.

It has been a practice, though of no very long standing, to give the fat of a whale in these cases. But this is a very crude indigestible kind of fat, and such oily medicines seldom agree with colds.

Besides, this is very disagreeable and rancid, so that it were better to forbear using it. I have sometimes seen ill effects from it, and rarely

any good ones.

Such persons as abate nothing of the usual quantity of their food when seized with a cold, and who swallow large quantities of hot water, ruin their health. Their digestion ceases. The cough begins to affect the stomach, without ceasing to afflict the breast.

Drams agree so little with colds that frequently a very small quantity of them revives a cold that was just expiring. There are some persons who never drink them without taking cold, which is not to be wondered at, as they occasion a light inflammation in the breast, which is equivalent to a cold or distillation.

Nevertheless, people in this disorder should not expose themselves to violent cold weather. Though they should equally guard against excessive heat. Those who enclose themselves in very hot rooms never get quite cured. And how is it possible they should?

Such rooms, abstracted from the danger of coming out of them, produce colds in the same manner that drams do, by producing a light inflammation in the breast.

Persons subject to frequent colds imagine they ought to keep themselves very hot. This is an error which thoroughly destroys their health. Such a disposition to take cold arises from two causes, either because their perspiration is easily impaired or from the weakness of the stomach or the lungs. When the complaint arises from the perspiration's being easily lessened, the hotter they keep themselves, they increase their complaint the more.

This warm air weakens the whole machine, and more particularly the lungs, where the humours, finding less resistance, are continually derived and are accumulated there. The skin, being constantly bathed in a small sweat, becomes relaxed, soft, and incapable of completing its functions. From which failure the slightest cause produces a total obstruction of perspiration, and a multitude of languid disorders.

The patients redouble their precautions against the cold, or even the coolness of the air, while their cautions are so many effectual

Advices with Respect to Health 437

means to weaken their health—and the more certainly as their dread of the free air subjects them to a sedentary life, which increases all their symptoms, while the hot drinks they indulge in complete their severity. There is but one method to cure people thus situated; that is, by accustoming them gradually to the air, to keep them out of hot chambers, to lessen their clothing by degrees, to make them sleep cool, and to let them eat or drink nothing but what is cold.

To make them use much exercise, and finally, if the disorder be inveterate, to make them use the cold bath. This method succeeds equally too with those in whom the disease originally depended on a weakness of the stomach or of the lungs. And in fact, at the end of a certain period, these three causes are always combined.

Chapter VIII

Of the Diseases of the Teeth §[91]. The diseases of the teeth depend on three principal causes:

1) on a 'caries' or rottenness of the teeth; 2) on an inflammation of the nerves of the teeth or of the membrane which covers them, and which affects the membrane of the gums; 3) a cold humour that falls on the teeth, and their nerves and membrane.

In the first of these cases, the caries having eat[en] down to and exposed the naked nerve. The air, food, and drink irritate it, and this irritation is attended with pain.

Here a little oil of cloves may be applied, by introducing a small pellet of cotton dipped in it to the rotten hollow tooth, which often affords considerable ease. Some make use of a tincture of opium, or laudanum, after the same manner; and indeed these two medicines may be used together in equal quantities. A gargarism made of silverweed or wild tansy in water frequently appeases the pain, and in such case many people have found themselves at ease under a constant use of it. It certainly is an application that cannot hurt, and is even beneficial to the gums. Others have been relieved by rubbing their cheek with honey.

The second cause is the inflammation of the nerve within the substance, or of the membrane on the outside of the tooth. They who are young, sanguine, who heat themselves much (whether by labour, by their food, their drink, by sitting up late, or by any other excess) [and] they who have been accustomed to any eruptions of blood, whether natural or artificial, and cease to have them as usual, are much exposed to the toothache from this cause.

Medical and Health Writings This pain commonly happens very suddenly. The pulse is strong and full, the countenance considerably red, the mouth extremely hot.

There is often a pretty high fever and a violent headache. The gums, or some part of them, become inflamed, swelled, and sometimes an abscess appears. At other times the humours throw themselves upon the more external parts, the cheek swells and the pain abates.

In this species of the disease we must have recourse to the general method of treating inflammatory disorders and direct bleeding, which often produces immediate ease if performed early. After bleeding, the patient should gargle with barley water, or milk and water, and apply an emollient cataplasm to the cheek. If a little imposthume appears, the ripening of it is to be promoted by holding continually in the mouth some hot milk or figs boiled in milk. And as soon as ever it seems ripe it should be opened, which may be done easily and without any pain. Otherwise he should bathe his feet in warm water for some evenings successively, taking one dose of the powder No. 20. Entire abstinence from wine and flesh, especially at night, has cured several persons of inveterate maladies of the teeth.

In this species of toothache all hot remedies are pernicious, and are so far from producing the relief expected that they aggravate the pain.

When the disease arises from a cold humour, it is commonly attended with less violent symptoms. The pulse is neither strong, full, nor quick. The mouth is less heated and less swelled.

In such cases the afflicted should be purged with the powder No.

21, which has sometimes perfectly cured very obstinate complaints.

After purging they should make use of the diet drink No. 22. This has cured toothaches which have baffled other attempts for many years. But it must be added, this drink would be hurtful in the disease from a different cause.

As this last cause is often the consequence of a weakness in the stomach, here is a necessity that such persons should make use of such medicines as are proper to strengthen the stomach. The powder No. 14 has often produced the best consequences when I have ordered it in these cases. And it never fails to dissipate the toothache very speedily which returns periodically at stated days and hours. I have also cured some persons who never drank wine, by advising them to the use of it.

But besides the diseases of the teeth that are owing to these causes, there are some that are occasioned by a sharpness of the blood, and which are never cured by any other medicines but such as correct that acrimony. When it is of a scorbutic nature, the wild

Advices with Respect to Health 439

horse-radish, pepperwort, watercresses, brooklime, sorrel, and wood sorrel cure it.

The rheumatism and the gout are sometimes transferred to the teeth, and give rise to the most excruciating pains, which must be treated like the diseases from which they arise.

From what has been said, the reader will discern why an application that relieves one person in it affords not the least relief to another. The diseases of the teeth, as well as other diseases, arise from different causes; and if these causes are not opposed by medicines suited to them, the disease, far from being cured, is aggravated.

I have cured violent toothaches of the lower jaw by applying a plaster of meal, the white of an egg, brandy, and mastic at the corner of that jaw, over the spot where the pulsation of the artery may be perceived. And I have also mitigated the most excruciating pains of the head by applying the same plaster upon the temporal artery.

Chapter IX

Of the Apoplexy §[98]. An 'apoplexy' is a sudden loss of all sense, and of all voluntary motion; the pulse at the same time being kept up, but respiration being oppressed.

This disease is distinguished into two kinds: the sanguineous and the serous apoplexy. Each of them results from an overfullness of the blood vessels of the brain, which presses upon the nerves. The difference consists in this: that the sanguineous apoplexy prevails among strong robust person, who have a rich and inflammable blood, and that in a large quantity; the serous apoplexy invades persons of a less robust constitution, whose blood is more dilute or watery, and whose vessels are in a more relaxed state.

When the first kind of this disease exists in its most violent degree, it kills instantaneously. When the assault is less violent, and we find the patient with a strong, full pulse, his visage red and bloated, and his neck swelled up, with an oppressed and loud hoarse respiration, being sensible of nothing, and capable of no other motions except some effort to vomit, the case is not equally desperate.

We must therefore immediately,

1. Entirely uncover the patient's head, covering the rest of his body but very lightly. Procure him instantly very fresh free air, and leave his neck quite unbound and open.

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2. His head should be placed as high as may be, with his feet hanging down.

3. He must lose from twelve to sixteen ounces of blood, from a free open orifice in the arm. The strength or violence with which the blood flows out should determine the surgeon to take a few ounces more or less. It should be repeated to the third or fourth time, within the space of three or four hours, if the symptoms require it, either in the arm or in the foot.

4. A clyster should be given of a decoction of the first opening herbs than can be got, with four spoonfuls of oil, one spoonful of salt. And this should be repeated every three hours.

5. If it is possible, he should force himself to swallow water plentifully, in three pints of which three drams of nitre are dissolved.

6. As soon as the violence of the pulse abates, when his breathing becomes less difficult and his countenance less inflamed, he should take the decoction No. 23; or, if it cannot be got in time, three quarters of an ounce of cream of tartar, and drink whey plentifully after it. This medicine succeeded extremely well with me in a case where

I could not readily procure the other.

7. He should abstain from all strong liquor, wine, distilled spirits, whether inwardly or by outward application, and should even avoid smelling them.

8. He should not be stirred, or even touched as little as possible.

Everything must be avoided that creates the least agitation. This advice, I am sensible, is directed opposite to the common practice; notwithstanding which, it is founded on reason and approved by experience. In fact, the whole evil results from the blood being forced up in too great a quantity to the brain. Now strong liquors, wines, spirits, volatile salts, all agitation and frictions, increase the embarrassment of the brain. Whereas, everything that calms the circulation contributes to relieve it.

9. Strong ligature should be made about the thighs under the ham. By this means the blood is prevented in its ascent from the legs, and less is carried up to the head.

When nature and art effect his recovery, his senses return; though there frequently remains a little delirium for some time, and frequently a paralytic defect, more or less, of the tongue, the arm, the leg, and the muscles of the same side of the face. This palsy sometimes goes off gradually by the help of cooling purgatives and light diet. All hot medicines are extremely hurtful in this case, and may open the way to a repeated attack. A vomit might be even fatal, and has been more than once so.

Advices with Respect to Health §[101]. The other species of apoplexy is attended with the like symptoms, excepting the pulse not being so high or strong. The countenance is also less red, sometimes even pale. The breathing less oppressed, and sometimes the sick have a facility to vomit.

As this kind of the disorder attacks persons who abound less in blood, bleeding is not often necessary. The repetition of it scarcely ever so. And should the pulse have but a small fulness, and not the least unnatural hardness, it might even be pernicious.

1. 1 he patient however should be placed as was directed in the former section.

2. He should receive a clyster, but without oil, with double the quantity of salt, and a bit of soap of the size of a small egg. It may be repeated twice a day.

3. He should be purged with the powder No. [2128].1

4. His common drink may be a strong infusion of leaves of balm.

5. The purge should be repeated the third day.

6. Blisters should immediately be applied to the fleshy part of the legs, or between the shoulder blades.

7. Should nature seem disposed to relieve herself by sweatings, it should be encouraged; and I have often known an infusion of the carduus henedictus produce this effect very successfully. If this method be entered upon, the sweat ought to be kept up (without stirring if possible) for many days. It has then sometimes happened that at the end of nine days the patient has been totally freed from the palsy which commonly succeeds this species of the apoplexy.

Persons who have been attacked with either kinds of this disorder are liable to subsequent ones, each of which is more dangerous than that preceding. Whence an endeavour to prevent such relapses becomes of the utmost importance. This is to be effected by

'Vomits, which are so pernicious in the sanguineous apoplexy, where the patient's countenance and eyes are inflamed; and which are also dangerous or useless when a person has been moderate in his meals, or is weak; are nevertheless very proper for gross feeders, more especially if such a one has a little while before indulged himself excessively. And vomits are the true specific for apoplexies occasioned by any stupifying poisons. In these last two cases, a double dose of tartar emetic should be dissolved in a cup of water, of which the patient should immediately take a large spoonful; which should be repeated every quarter of an hour, till it operates [Rast (see Advice, 163)].

28Orig., 'No. 4'. This mistake was drawn to JW's attention by John Valton, and Wesley replied in a letter of Feb. 9, 1775 (apparently without consulting the original text) that the intended number was '34'. We have instead restored the number in Tissot's original.

Medical and Health Writings a very exact diet, diminishing the usual quantity of food; the most essential precaution to be observed by any who have been once assaulted with it being entirely to leave off suppers. Indeed those who have been once attacked with the sanguineous apoplexies should be still more exact than the others. They should deny themselves whatever is rich and juicy, hot or aromatic, wine, distilled liquors and coffee. They should chiefly confine themselves to garden stuff, fruits, and acids. Should eat but little flesh, and only those called white, taking every week two or three doses of powder No. 24 in a morning fasting, in a glass of water. They should be purged twice or thrice a year with the draught No. 23. Use daily exercise. Avoid hot rooms and the violent heat of the sun. They should go to bed betimes, rise early, never lie in bed above seven or eight hours. And if it is observed that their blood increases considerably, and has a tendency towards the head, they should be bled without hesitation, and for some time confine themselves entirely to a thin and low regimen. In these circumstances warm bathings are pernicious. In the other, the serous apoplexy, instead of purging with No. 23, the patient should take the purge No. 21.

The same means that are proper to prevent a relapse might keep off a first assault, if employed in time. For notwithstanding it may happen suddenly, yet this disease foreshows itself many weeks, sometimes months, nay even years beforehand—by vertigoes, heaviness of the head, small defects of the tongue or speech, momentary palsies (sometimes of one, sometimes of another part), sometimes by loathings and retchings to vomit without any obstruction in the first passages or any other cause in the stomach.

There happens also some particular change in the looks not easy to be described, sharp and quick pains about the region of the heart, an abatement of the strength without any discernible cause.

Some persons are liable to certain symptoms which arise from the same cause as an apoplexy, and which indeed may be considered as light apoplexies, of which they sustain many attacks, yet without any considerable annoyance. The blood, all at once as it were, rushes

up to their heads. They appear heedless or blundering, and have sometimes disgusts and nauseas, and yet without any abatement of their senses or motion of any kind. Tranquillity of mind and body, once bleeding, and a few clysters usually carry this off soon after its invasion. The returns of it may be prevented by the above regimen, and especially by a frequent use of the powder No. 24. Otherwise one of these commonly degenerates into a mortal apoplexy.

Advices with Respect to Health

Chapter X Of the Violent Influence, or Strokes, of the Sun §[104]. If we consider that wood, stone, and metals, when long exposed to the sun, become so hot that they can scarcely be touched without a sensation of burning, we may easily conceive the danger a person undergoes in having his head exposed to the same degree of heat. The blood vessels grow dry, the blood itself thickened, and a real inflammation is formed. The signs of it are violent headache, attended with a very hot and dry skin. The eyes are dry and red, being neither able to remain open nor yet to bear the light, and sometimes there is a kind of involuntary motion in the eyelid, while some degree of relief is perceivable from the application of any cooling liquor. Some cannot possibly sleep; yet at other times they have a great drowsiness, but attended with violent wakenings. There is a very strong fever, a great faintness, and a total disrelish and loathing.

People may be affected thus either in the spring or during the raging heats. Country people are little liable to the former.

They chiefly affect the inhabitants of cities, and delicate persons, who have used little labour in the winter and abound with superfluous humours. If, thus circumstanced, they expose themselves to the sun, even in the spring, it acts upon their head like a blister, attracting a great quantity of humours to it. This produces tormenting pains of the head, frequently attended with quick and violent shootings, and with pains in the eyes. Notwithstanding, this degree of the malady is seldom dangerous. The summer strokes are much more troublesome to labourers and travellers, who are long exposed to them. Then it is that those who are thus struck often die upon the spot. In the hot climates this cause destroys many in the very streets, and makes dreadful havoc among armies on the march. After having marched a whole day in the sun, a man shall fall into a lethargy and die within some hours, with the symptoms of raving madness. I have seen a tiler, in a very hot day, complaining to his comrade of a violent pain in his head, and at the instant he purposed to retire out of the sun he sunk down dead. This same cause produced often some most dangerous frenzies.

The vehemence of the sun is still more dangerous to those who venture to sleep exposed to it. Two mowers who fell asleep on a haycock, being wakened by some others, immediately staggered and, pronouncing a few incoherent words, died. When the violence

Medical and Health Writings of wine and that of the sun are combined, they kill very suddenly.

And those who escape death are subject for the remainder of their live to chronical headaches. It has also been known that some persons have been struck into a delirium without a fever, and without complaining of a headache. Sometimes a gutta serena2'1 has been the consequence.

In very young children, who never should be exposed long to excessive heat, this malady discovers itself by a deep drowsiness, which lasts for several days; also by ravings mingled with rage and terror, much the same as when they are affected with violent fear; and sometimes by convulsive twitchings, by headaches which return at certain periods, and continual vomitings.

Old men who often expose themselves to the sun are little apprized of the danger. This custom (in hot weather) certainly disposes to an apoplexy, and to disorders of the head. One of the slightest effects of much solar heat upon the head is to cause a defluxion from the brain, a swelling of the glands of the neck, and a dryness of the eyes, which sometimes continues for a considerable term.

The effect of too much common fire is of the same quality with that of the sun. A man who fell asleep with his head directly opposite to the fire went off in an apoplexy during his nap.

The action of too violent a sun is not only pernicious to the head but to other parts. And those who continue long exposed to it, though their heads should not be affected, often experience a disagreeable sensation of heat and a considerable stiffness in the parts that have been parched by it—as in the legs, the knees, the thighs, reins and arms; and sometimes they prove feverish.

It is necessary to set about the cure of this disorder as soon as may be, for such as might have been easily preserved by an early application are considerably endangered by a neglect of it. The method of treating this is very much the same with that of inflammatory diseases—that is, by cooling medicines of various kinds. And:

1. If the disease be very high and urgent, a large quantity of blood should be taken away. Lewis XIV was bled nine times to prevent the fatality of a stroke of the sun which he received in hunting in 1658.

2. After bleeding, the patient's legs should be plunged into warm water. This affords the most speedy relief. When the disorder is highly dangerous, it will be necessary to treat the patient with warm

291.e., blindness.

Advices with Respect to Health

baths in which he may sit up to the hips, and in the most dangerous degrees of it even to bathe the whole body. But the water should be only sensibly warm. The use of hot would be highly pernicious.

3. The patient should drink plentifully of lemonade, which is a mixture of the juice of lemons and water (and is the best drink in this disorder), of water and vinegar (which is a very good substitute for lemonade), or of very clear whey with the addition of a little vinegar. These various drinks may all be taken cold. Linen cloths dipped in cold water may be applied to the forehead, the temples, or all over the head.

Cold baths have sometimes recovered persons out of violent symptoms from this cause. An officer who had rode post for several days successively in very hot weather swooned away immediately on his dismounting, from which he could not be recovered by the ordinary assistance used in such cases. He was saved by being plunged into a bath of freezing water. It should be observed, however, that in these cases the cold bath should never be recurred to without previous bleeding.

It is past doubt that if a person stands still in the heat of the sun he is more liable to be struck with it than if he walks about, and the use of white hats, or some folds of clean white paper under a black one, may contribute to prevent any injury from it.

Chapter XI

Of the Rheumatism §[113]. The rheumatism may exist either with or without a fever. The first [is] preceded by a shivering, a subsequent heat, hard pulse, and a headache. Sometimes indeed an extraordinary coldness, with general uneasiness, exists several days before the fever is perceived. On the second or third day, and sometimes on the first, the patient is seized with a violent pain in some part of his body, but especially about the joints, which prevents their motion, and is often accompanied with heat, redness, and swelling. The knee is often the first part attacked, and sometimes both knees at once.

When the pain is fixed, an abatement of the fever frequently happens. Though in some it continues several days, and increases every evening. The pain diminishes in one part after a duration of some days, and then invades some other. Sometimes one part is quite free from pain, when another is attacked. At other times many parts are seized nearly at the same instant. And I have sometimes seen

Medical and Health Writings every joint afflicted at once. In this case the patient is in a terrible situation, being incapable of any motion, and even dreading the assistance of his attendants, as he can scarcely admit of touching. The parts in which the pains are the most tormenting and obstinate are the region of the loins, the hips, and the nape of the neck.

This disease is often extended over the scalp and the surface of the head, and there the pains are excessive. I have seen them affect the eyelids and the teeth, with inexpressible torment. As long as the distemper is situated in the external parts, the patient is in no great danger, if he be properly treated. But if the disease be repelled upon an internal part, his case is extremely dangerous. If the brain is attacked, a raging delirium is the consequence. If it falls upon the lungs, the patient is suffocated. And if it attacks the stomach or bowels, it is attended with the most astonishing pains, caused by the inflammation, which if violent is speedily fatal.

An obstructed perspiration and an inflammatory thickness of the blood constitute the general cause of rheumatism. This last cause is that we must immediately encounter, since as long as that subsists perspiration cannot be perfectly reestablished.

As soon as it is sufficiently manifest, twelve ounces of blood should be taken from the arm. The patient is to enter upon a regimen, and drink plentifully of the ptisan No. 2, and of very clear whey sweetened with a little honey. I have known a very severe rheumatism cured, after twice bleeding, without any other food or medicine, for a space of thirteen days."1

If the distemper is not considerably assuaged by the first bleeding, it should be repeated some hours after. I have ordered it four times within the first two days, and some days after I had even directed a fifth bleeding. But in general the hardness of the pulse becomes less after the second. And notwithstanding the pains may continue, yet the patient is sensible of less inquietude. If the patient dislikes a clyster, his drinks should be made as opening as possible, and a dose of the cream of tartar (No. 24) should be given night and morning. This very medicine, with the assistance of whey, cured two persons I advised it to of rheumatic pains of which they had been infested with frequent returns for many years.

Apples coddled, prunes stewed, and well-ripened summer fruits are the properest nourishment in this disorder. mI have known it cured by living on whey, without any bleeding at all [JW; found only in Works edition].

Advices with Respect to Health

We may save the sick a great deal of pain by putting one strong towel always under their back, and another under their thighs, in order to move them the more easily. When their hands are without pain, a third towel hung upon a cord, which is fastened across the bed, will assist them in moving themselves.

When the fever entirely disappears, and the hardness of the pulse is removed, I have ordered the purge No. 23 with good effect, and if it is attended with five or six motions the patient is sensibly relieved. The day but one after it may be repeated, and a third time after an interval of two or three weeks.

When the pains are extremely violent, they admit of no application. Vapour baths, however, may be employed, and provided they are often used, and for a considerable time, they prove very efficacious. The purpose of these baths is to convey the steam of boiling water to the parts affected, which may always be effected by a variety of easy contrivances, the choice of which must depend on the different circumstances and situation of the sick.

Whenever it is possible, some of the emollient applications (No.

9) should be continually employed. A bath of warm water, in which the patient should remain an hour, after sufficient bleedings, affords the greatest relief. I have seen a patient under the most acute pains of the loins, of the hips, and of one knee, put into one. He continued still under extreme torment in the bath, and on being taken out of it. But an hour after he had been put to bed he sweated, to an incredible quantity, for thirty-six hours, and was cured. But the bath should not be made use of until after repeated bleedings, or other equivalent evacuations.

The pains are generally most severe in the night, whence it has been usual to give composing medicines. But opiates augment the cause of the disease, and destroy the efficacy of the proper remedies.

The rheumatism goes off either by stool, by turbid thick urine which drops a yellow sediment, or by sweats. And it generally happens that this last discharge prevails towards the conclusion of the disease. It may be kept up by drinking an infusion of elderflowers. At the beginning, sweating is pernicious.

It happens also, though seldom, that rheumatisms determine by depositing a sharp humour upon the legs, where it forms a kind of blisters, which burst open and form ulcers. But they heal naturally of themselves, by a regular diet, and a few gentle purges.

Sometimes again an abscess is formed either in the affected part or in some adjoining one.

Medical and Health Writings Another crisis of the rheumatism has happened by a kind of itch, which breaks out on the parts adjacent to the seat of this distemper.

Immediately after this eruption the pains vanish. But the pustules sometimes continue for several weeks.

I have never observed the pains to last, with violence, above fourteen days; though there remains a weakness, numbness, and some inflation of the adjoining parts. And it will be many weeks, sometimes months (especially in the fall), before the sick recover their strength. I have known some persons who, after a very painful rheumatism, have been troubled with a very disagreeable lassitude, which did not go off till after a great eruption, all over the body, of little blisters full of watery humour. Many of them burst, and others withered and dried up without bursting.

The return of strength into the parts affected may be promoted by frictions night and morning with flannel, by using exercise, and by conforming exactly to the directions given in the chapter on recovery from acute diseases. The rheumatism may also be prevented by the means I have pointed out in treating of pleurisies and quinsies.

Sometimes the rheumatism, with a fever, invades persons who are not abounding in blood, whose flesh and fibres are softer, and in whose humours there is more thinness and sharpness.

Bleeding proves less necessary for these though the fever should be very strong. Some constitutions require more discharges by stool.

And after they are properly evacuated, blisters may be applied, unless where the pulse is hard. The powder No. 25 answers very well in these cases.

There is another kind of rheumatism, called 'chronical'.

It is known by the following marks: 1) It is commonly unattended with a fever. 2) It continues a long time. 3) It seldom attacks many parts at once. 4) Frequently the affected part is either more hot, red, or swelled than in its healthy state; though sometimes it is.

5) The former attacks strong robust persons, this rather invades persons arrived at a certain period of life, or such as are weak and languishing.

The pain of the chronical rheumatism, when injudiciously treated, lasts sometimes many months, and even years. It is particularly obstinate when it falls on the head, the loins, or on the hip and along the thighs (when it is called the 'sciatica'). There is no part, indeed, which this pain may not invade. Sometimes it fixes itself in a small spot, as in one corner of the head, the angle of the jaw, the extremity of a finger, in one knee, on one rib, or on the breast,

Advices with Respect to Health

where it often excites pains which make the patient apprehensive of a cancer. It penetrates also to the internal parts. When it affects the lungs, a most obstinate cough is the consequence, which degenerates at length into very dangerous disorders. In the stomach and bowels it occasions violent pains like a colic. And in the bladder, symptoms so greatly resembling those of the stone that persons of experience have been more than once deceived by them.

The treatment of this rheumatism varies considerably from that of the former. Nevertheless, l)30 If the pain is very acute, and the patient robust, a single bleeding is proper. 2) The humours ought to be diluted, and their sharpness diminished, by a plentiful use of a ptisan No. 26. 3) Four or five days after drinking abundantly of this, the purging powder No. 21 may be taken with success.

When general remedies have been used and the disorder still continues, recourse should be had to such medicines as restore perspiration, and these should be persisted in for a considerable time. The pills No. 18, with a strong infusion of elder-flowers, have succeeded in this respect. And after a long continuance of diluting drinks—if the stomach exerts its functions well, the patient is no ways costive, if he is not a dry habit of body, and the part affected remains without inflammation—the patient may safely take the powder No.

[2531] at night going to bed, with a cup or two of an infusion of carduus benedictus, and a morsel of Venice treacle of the size of a hazelnut. This remedy brings on a very copious sweating, which often expels the disease." These sweats may be rendered still more effectual by wrapping up the affected part in a flannel dipped in the decoction No. 27.

But of all these pains, the sciatica is one of the most obstinate. Nevertheless I have seen the greatest success from the application of seven or eight cupping glasses on the tormented part; by which, without the assistance of any other remedy, I have cured in a few hours sciatica of many years standing. Green cerecloth,

" Gum Guaiacum, given from six to ten grains morning and evening, is often very successful in these cases. It may be made into pills or bolusses with the rob

[i.e., syrup] of elder, or with the extract of juniper [Rast (see Advice, 189)].

30Orig., 'at first'.

31Orig., '29'; This mistake was present in the first edition of Kirkpatrick's translation of Tissot. Kirkpatrick corrected it in his third edition, and we show the corrected number. Wesley's repetition of the error strongly suggests that he was not using the third edition.

Medical and Health Writings commonly called oilcloth (whether the ingredients be spread on taffeta or on linen), being applied to the diseased part, disposes it to sweat abundantly and thus discharge the sharp humour which occasions the pain. Sometimes both of these applications, but especially that spread on silk (which may be applied more exactly and closely to the part, and which is also spread with a different composition), raise a little vesication on the part. A plaster of quicklime and honey blended together has cured inveterate sciaticas.

Cold baths are the best to keep off this disease, but they cannot always be safely ventured on. Many circumstances render the use of them impracticable to particular persons. Such as are subject to this chronical rheumatism would do well to rub their whole bodies every morning, if they could, but especially the afflicted parts, with flannel. This keeps up perspiration beyond any other assistance, and indeed sometimes increases it too much.

After a violent rheumatism people should long avoid cold and moist air.

Rheumatic people have too frequent a recourse to hurtful medicines, which daily produce very bad consequences. Such are spirituous medicines, brandy, and Arquebusade water. They either render the pain more obstinate, by hardening the skin, or repel the humour to some inward part. And instances are not wanting of persons who have died suddenly from the application of spirit of w ine

upon the parts.

Sharp and greasy unctions are equally dangerous. A rottenness of the bones has ensued upon the use of a medicine called balsam of sulphur with turpentine. There are some rheumatic pains which admit of no application; almost every medicine aggravates them. In such cases the afflicted must content themselves with keeping the parts affected from the impressions of the air, by a flannel.

If the duration of the pains fixed in the same place should cause some degree of stiffness in the joint, it should be exposed twice a day to the vapour of warm water, and dried well afterwards with hot linen. Then it should be well chaffed, and lastly touched over with ointment of marsh mallows.

Very young children are sometimes subject to such violent pains that they cannot bear touching in any part without excessive crying. We must be careful to avoid mistaking these cases, and not to treat them like rheumatisms. They sometimes are owing to worms, and go off when these have been discharged.

Advices with Respect to Health

Chapter XII Of the Bite of a Mad Dog32 §[130]. When a person is bit by such a dog, the wound commonly heals up readily. But after a longer or shorter term, from three weeks to three months, commonly in about six weeks, the person bit begins to perceive in the spot that was bitten a dull pain.

The scar swells, inflames, bursts open, and weeps out a sharp, fetid, and somewhat bloody humour. At the same time the patient becomes sad. He feels a kind of insensibility and general numbness, and almost incessant coldness, a difficulty of breathing, a continual anguish, and pains in his bowels. His pulse is weak and irregular, his sleep restless and confused with ravings and with terrible frights.

His discharges by stool are often irregular, and small cold sweats appear at very short intervals. Sometimes there is also a slight pain in the throat. Such is the first degree of this distemper.

In its second degree, the patient is afflicted with a violent thirst and a pain in drinking. Soon after this he avoids all drink, particularly water, and within some hours abhors it. This horror becomes so violent that the bringing of water near his lips, or into his sight, the very name of it, or of any other drink, the sight of objects which have any resemblance of water, afflicts him with extreme anguish. Yet he continues to swallow (though not without great difficulty) a little bread or meat, and sometimes a little soup. Some even get down the liquid medicines that are prescribed, provided there be no appearance of water in them. Their urine becomes thick and high coloured, and sometimes there is a suppression of it. The voice either grows hoarse or is almost entirely abolished. They are troubled with short deliriums, which are sometimes mixed with fury. It is at such times that they spit all around them, that they attempt also to bite. Their looks are fixed, as it were, and somewhat furious, and their visage frequently red. It is common for these miserable patients to be sensible of the approach of their raging fit, and to conjure the bystanders to be upon their guard. Many of them never have an inclination to bite. The increasing anguish and pain become inexpressible. They earnestly wish for death, and some of them have destroyed themselves.

It is with the spittle, and the spittle only, that this dreadful poison unites itself. And it may be observed: l)That if the wounds

321.e., a dog infected with rabies.

Medical and Health Writings have been made through any of the patient's cloths, they are less dangerous than those afflicted on the naked skin. 2) That animals who abound in wool, or have thick hair, are often preserved from the mortal impression of the poison, because the cloths, the hair, or the wool have wiped or dried up the slaver of their teeth. 3) The bites inflicted by an infected animal very soon after he has bitten many others are less dangerous than the former bites, because their slaver is exhausted. 4) If the bite happens in the face, or in the neck, the danger is greater, and the operation of the venom is quicker too, by reason the spittle of the person so bit is sooner infected. 5) The higher the degree of the distemper is advanced, the bites become proportionably more dangerous. Hence it may be seen why, of many who have been bitten, some have been infected with this dreadful malady and others not.

There is a necessity for destroying or expelling the poison itself, which mercury effects, and is consequently the counterpoison of it. That poison produces a general irritation of the nerves, this is to be removed by antispasmodics. So that in mercury, joined to antispasmodics, consists the whole cure of this malady. There have been many instances of persons cured by these medicines in whom this distemper had been manifest in its rage and violence.

It is acknowledged, however, that they have proved ineffectual in a few cases. But what distemper is there which does not sometimes prove incurable?

The very moment after receiving the bite, if it can be effected, the part affected should be cut away. The ancients directed it to be burnt with a red-hot iron, but this requires more resolution than every patient is endued with. The wound should be washed a considerable time with warm water, with a little sea salt dissolved in it. After this, into the lips and edges of the wound, and into the surface of the part all about it, should be rubbed a quarter of an ounce of the ointment No. 28. And the wound should be dressed twice daily, with the soft lenient ointment No. 29 (but that of No.

28 is to be used only once a day).

The quantity of nourishment should be less than usual, particularly of flesh. He should abstain from wine, spirituous liquors, all sorts of spices, and hot inflaming food. He should drink only barley water, or an infusion of the flower of the lime tree. He should be guarded against costiveness by a soft relaxing diet, and bathe his legs once a day in warm water. Every third day one dose of the medicine No. 30 should be taken—which is compounded of mercury, that counterworks the poison, and of musk, which prevents

Advices with Respect to Health

the convulsive motions. I confess I have less dependence on the mercury given in this form, and think the rubbing in of its ointment considerably more efficacious, which I hope will always prevent the fatality of this dreadful disease.

If the dread of water has already appeared, and the patient is strong and abounds with blood, he should:

1. Be bled to a considerable quantity, and this may be repeated twice, thrice, or even a fourth time, if circumstances require it.

2. The patient should be put, if possible into a warm bath, and this should be used twice daily.

3. He should every day receive two, or even three, of the emollient clysters No. 5.

4. The wound, and the parts adjoining to it, should be rubbed with the ointment No. 28 twice a day.

5. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in an oily flannel.

6. Every three hours a dose of the powder No. 30 should be taken in a cup of the infusion of lime tree and elder-flowers.

7. The prescription No. 31 is to be given every night; and to be repeated in the morning, if the patient is not easy, washing it down with the same infusion.

8. If there be a great nauseousness at the stomach, with a bitterness in the mouth, give the powder No. 35, which brings up a copious discharge.

9. There is little occasion to say anything of the patient's food in such a situation. Should he ask for any, he may be allowed panada,33 bread, soups made of mealy vegetables, or a little milk.

By the use of these remedies the symptoms will lessen, and disappear by degrees.

It is certain that a boy in whom the raging symptom had appeared was perfectly cured by bathing all about the wounded part with salad oil in which some camphor and opium were dissolved.

This, with the addition of repeated frictions of the ointment No.

28, brought on a very plentiful sweat, on which all the symptoms vanished.

Dogs may be cured by rubbing in a triple quantity of the same ointment directed for men, and by giving them the bolus No.

33. But both these means should be used as soon as ever they are bit.

33 OED: 'A dish consisting of bread boiled to a pulp in water, sometimes flavoured with sugar, currants, nutmeg, or other ingredients.'

Medical and Health Writings As soon as ever dogs are bit they should be safely tied up, and not let loose again before the expiration of three or four months.

A dangerous prejudice has prevailed with regard to the bites from dogs: That if a dog who had bit any person, without being mad at the time of his biting, should become mad afterwards, the person bitten would prove mad too at the same time. Such a notion is full as absurd as it would be to affirm that if two persons had slept in the same bed, and one of them should take the itch or the small pox ten or twelve years after, the other would be infected with it and at the same time too.

It is necessary no longer to represent the horror of that cruel practice which prevailed not very long since of suffocating persons in the height of this disease. It is now prohibited in most countries.

Another cruelty of which we hope to see no repeated instance is that of abandoning those miserable patients to themselves—a most detestable custom even in those times when there was not the least hope of saving them, and still more criminal in our days when they may be recovered effectually. I again affirm that it is not often these afflicted patients are disposed to bite; and that even when they are, they are afraid of doing it, and request bystanders to keep out of their reach. So that no danger is incurred, or where there is any it may be avoided by a few precautions.

Chapter XIII

Of the Smallpox §[140], The smallpox is the most extensive of all diseases, since out of a hundred persons there are not more than two or three exempted from it. It is equally true that if it attacks almost every person, it attacks them but once; so that having escaped through it, they are always secure from it. It must be acknowledged at the same time to be one of the most destructive distempers. For if in some it proves to be of a gentle kind, in others it is almost fatal as the plague—it being demonstrated, by calculating the consequences of its most raging and its gentlest prevalence, that it kills one seventh part of the number it attacks.

This malady often gives some intimation of its approach three or four days before the appearance of the fever by a little de-

'4 The numbering '§141' was mistakenly used a second time. This reduces by one our adjustment being made to the numbering scheme.

Advices with Respect to Health

jection, less vivacity than usual, a great propensity to sweat, less appetite, a slight alternation of the countenance, and a sort of pale livid colour about the eyes.

Short vicissitudes of heat or coldness succeed, and at length a considerable shivering of one, two, three, or four hours. This is succeeded by violent heat, accompanied with pains of the head, loins, vomiting, or at least a frequent propensity to vomit.

This state continues some hours, after which the fever abates a little in a sweat. The patient then finds himself better, but is nevertheless cast down, heavy, squeamish, with a headache and pain in the back, and a disposition to be drowsy. The last symptom indeed is not very common, except in children less than seven or eight years of age.

The abatement of the fever is of short duration. Some hours after, generally towards the evening, it returns with all its attendants, and terminates again by sweats, as before.

This state lasts three or four days, at the end of which, and seldom later, the first eruptions appear among the sweat, which terminates the paroxysm of the fever. I have generally observed the earliest eruption to appear in the face, next to that on the hands, on the forepart of the arms, on the neck, and on the upper part of the breast. As soon as this eruption appears, if the distemper is of a gentle kind, the fever almost entirely vanishes. The patient continues to sweat a little. The eruptions increase, others coming out on the back, the sides, the belly, the thighs, the legs, and the feet.

Sometimes they are pushed out very plentifully, even to the soles of the feet, where, as they increase in size, they often excite very sharp pain by reason of the great thickness and hardness of the skin in these parts.

Frequently on the first and second day of eruption (speaking hitherto of the mild kind) there returns a gentle fever about the evening, which, about the termination of it, is attended with a considerable and final eruption. Though as often as the fever terminates perfectly after the earliest eruption, a small one is a pretty certain consequence. For though the eruption is moderate, the fever does not totally disappear, a small degree of it still remaining and heightening a little every evening.

These pustules, on their first appearance, are little red spots resembling a fleabite—but distinguishable by a small white point in the middle, a little raised above the rest, which gradually increases in size, with the redness extended about it. They become whiter, in proportion, as they grow larger. And generally upon the sixth

Medical and Health Writings day, including that of their first eruption, they attain their utmost magnitude, and are full of pus or matter. Some of them grow to the size of a pea, and some a little larger; but this never happens to the greatest number of them. From this time they begin to look yellowish. They gradually become dry and fall off into brown scales in ten or eleven days from their first appearance. As their eruption occurred on different days, they also wither and fall off successively.

The face is sometimes clear of them while pustules still are seen

upon the legs, not fully ripe. And those in the soles of their feet frequently remain much longer.

The skin is of course extended by the pustules, and after the appearance of a certain quantity, all the parts between the pustules are red and bright with a proportionable swelling of the skin.

The face is the first part that appears bloated, from the pustules there first attaining their full size. The like happens also to the neck, and the eyes are often closed up. The swelling of the face abates in proportion to the drying up of the pustules, and then the hands are puffed up prodigiously. This happens successively to the legs, the swelling being the consequence of the pustules attaining their utmost size.

Whenever there is a very considerable eruption, the fever is heightened at the time of suppuration, which is not to be wondered at. One boil excites a fever. How is it possible then but some hundreds, or thousands, of these little abscesses must? This fever is the most dangerous period, and occurs between the ninth and thirteenth days. At this season, then, the patient becomes very hot and thirsty. He is harassed with pain and finds it very difficult to discover a favourable easy posture. If the malady runs high, he has no sleep. He raves, becomes oppressed, is seized with drowsiness.

And if he does not survive, he dies either suffocated or lethargic, and sometimes in a state compounded of both.

The pulse, during this fever of suppuration, is sometimes of an astonishing quickness. The most dangerous time is when the swellings of the face, head, and neck are in their highest degree. Whenever the swelling begins to fall, the scabs on the face to dry, and the skin to shrivel (as it were), the danger diminishes. When the pustules are very few, this second fever is so moderate that it requires some attention to discern it.

Besides those symptoms, there are some others which require considerable attention. One of these is the soreness of the throat with which many persons in the smallpox are afflicted, as soon as the fever grows pretty strong. It continues for two or three

Advices with Respect to Health

days, feels very troublesome in the action of swallowing, and sometimes entirely prevents swallowing. It begins, most frequently, before the eruption appears. If this complaint is in a light degree, it terminates upon the eruption. And whenever it revives in the course of the distemper, it is always in proportion to the degree of the fever. As often as it is of any considerable duration, it is attended with a discharge of a great quantity of spittle. When the eruption is confluent, and the patient adult, the discharge is surprising. This often incommodes him more than any other symptom of the distemper; and so much the more as, after its continuance for some days, the lips, the inside of the cheeks, the tongue, and the roof of the mouth are, as it were, flayed. Nevertheless, however painful this discharge may be, it is very necessary and salutary.

Children, to the age of five to six years, are liable to convulsions before eruption. These however are not dangerous, if they are not accompanied with violent symptoms. But such convulsions as supervene-—either when the eruption having already occurred, strikes in; or, during the course of the fever of suppuration—are more terrifying.

Involuntary discharges of blood from the nose often occur in the first stage of this distemper, which are extremely serviceable, and commonly lessen or carry off the headache.

The smallpox is commonly distinguished into two kinds, the 'confluent' and the 'distinct'. But the treatment of each of them is the same. We may expect a confluent and dangerous pock if, at the very time of the seizure, the patient is attacked with many violent symptoms. More especially if his eyes are extremely quick, lively, and even glistening, if he vomits almost continually, if the pain of his loins be very violent, and if he suffers great anguish and inquietude. If in infants there is great stupor or heaviness, if eruption appears on the third day, or even on the second, as the hastier eruptions in this disease signify the most dangerous kind of it.

The disorder is sometimes so slight that the eruption appears with scarce any suspicion of the child's having the least ailment. And the event is equally favourable. The pustules grow large, suppurate, and attain their maturity without confining the patient to bed, or lessening either his sleep or appetite.

But wine, Venice treacle, cordial confections, hot air, and loads of bedclothes annually sweep off thousands of children who might have recovered, if they had taken nothing but warm water. And every person who is interested in the recovery of patients in this distemper ought carefully to prevent the smallest use of such drugs,

458 Medical and Health Writings

which certainly increase the severity, and annex the most unhappy consequences to it.

At the very beginning of the smallpox the patient is immediately to be put on the strict regimen, and to have his legs bathed morning and evening in warm water. This is the proper method to lessen the quantity in the face and head, and to facilitate it everywhere else. If he vomits, it is highly pernicious to stop it by any cordial confection or by Venice treacle; and still more dangerous to give a vomit or a purge, which are hurtful in the beginning of the smallpox.

If the fever be moderate, the bathing of the legs on the first day of sickening may suffice then. The patient must be restrained to his regimen, and need drink nothing but milk, diluted with two thirds of elder-flower or lime tree tea, or with balm tea, if there be no perceivable fever. Yea, or with good clear water.0 An apple, coddled or baked, may be added to it. And if they complain of hunger, a little bread may be allowed. But they must be denied any meat, or meat broth, eggs, and strong drink. In this early stage too, clear whey alone may serve them instead of every other drink, the good effects of which I have frequently been a witness to. Or buttermilk may be allowed. When the distemper is of a mild species, a perfect cure ensues without any other assistance. But we should not neglect to purge the patient as soon as the pustules are perfectly scabbed on the greater part of his face, with the prescription No. 11, which must be repeated six days after. He should not be allowed flesh till after this second purge. Though after the first he may be allowed some well boiled pulse [i.e., legumes], or garden stuff and bread, and in such a quantity as not to be pinched with hunger while he recovers from the disease.

But if the fever should be strong, the pulse hard, and the pain of the head and loins should be violent, he must:

1. Immediately lose blood from the arm, receive a clyster two hours after, and if the fever continues the bleeding must be repeated. I have directed a repetition of it even to the fourth time, within the two first days, to young people under the age of 18. And it is more especially necessary in such as, with a hard and full pulse, are also affected with drowsiness and a delirium.

2. As long as the fever continues violent, two, three, or even four clysters should be given in the 24 hours; and the legs should be bathed twice.

"There have been instances of people who have recovered by draughts of cold water [Kirkpatrick (see Advice, 221)].

Advices with Respect to Health 459

3. The patient is to be taken out of bed and supported in a chair as long as he can tolerably bear it.

4. The air of his chamber should frequently be renewed. And if it be too hot, which it often is in summer, in order to refresh it and the patient the means must be employed which are directed in §29.

5. He is to be restrained to the ptisans No. 2 or [No.] 4. And if that does not sufficiently moderate the fever, he should take every hour, or every two hours, according to the urgency of the case, a spoonful of the mixture No. 10 mixed with a cup of ptisan. After the eruption, the fever being then abated, there is less occasion for medicine. And should it entirely disappear, the patient may be regulated as directed [in] §[148].

When, after a remission or intermission of some days, the process of suppuration revives the fever, we ought particularly to keep the body very open. For this purpose:

[1.] An ounce of lenitive electuary should be added to the clysters, or they might be simply made of whey, with honey, oil, and salt. Give the patient three times every morning, at the interval of two hours between each, three glasses of the ptisan No. 32. Purge him after two days with the potion No. 23, but on that day he must not take the ptisan No. 32.

2. He must, if the distemper be very violent, take a double dose of mixture No. 10.

3. The patient should be taken out of bed, and kept up in a room well aired day and night, until the fever has abated. Many persons will be surprised at this advice. Nevertheless, it is that which I have often experienced to be the most efficacious, and without which the others are ineffectual. They will say, 'How shall the patient sleep at this rate?' To which it may be answered, sleep is not necessary in this state and stage of the disease. Besides, he is unable to sleep. The continual salivation prevents it, and it is very necessary to keep up the salivation, which is facilitated by often injecting warm water and honey into his throat. It is also of considerable service to throw some up his nostrils, and often thus to cleanse the scabs which form within them. A due regard to these circumstances contributes to lessen the patient's uneasiness, and very effectually to his cure.

4. If the face and neck are greatly swelled, emollient cataplasms are to be applied to the soles of the feet.

The eyelids are swelled when the disease runs high, so as to conceal the eyes for several days. Nothing further should be attempted with respect to this but the frequent moistening of them

Medical and Health Writings with a little warm milk and water. What chiefly conduces to prevent the inflammation of the eyes after the disease, and in general all its other bad consequences, is to be content for a considerable time with a very moderate quantity of food, and particularly to abstain from flesh and wine. In the very bad smallpox, and little children, the eyes are closed up from the beginning of the eruption.

One help which has not been made use of for a long time past, except as a means to preserve the smoothness of the face, but which has the greatest tendency to preserve life itself, is the opening of the pustules, not only upon the face but all over the body. In the first place, by opening them the retention of pus is prevented, which prevents any erosion or eating down from it—whence scars, deep pits, and other deformities are obviated. Secondly, in giving a vent to the poison the retreat of it into the blood is cut off, which removes a principal cause of the danger. Thirdly, the skin is relaxed.

The tumour of the face and neck diminish in proportion to that relaxation, and thence the return of the blood from the brain is facilitated. The pustules should be opened everywhere, successively as they ripen. The precise time of doing it is when they are entirely white, when they just begin to turn a very little yellowish, and when the red circle surrounding them is quite pale. They should be opened with very fine sharp pointed scissors. This does not give the patient the least pain. And when a certain number of them are opened, a sponge dipped in a little warm water is to be repeatedly applied to suck up and remove the pus. But as the pustules, when emptied thus, soon fill again, a discharge of this fresh matter must be obtained in the same manner some hours after; and this must sometimes be repeated five or even six times successively. Such extraordinary attention in this point may probably be considered as trivial, and is very unlikely to become a general practice. But I do again affirm it to be of much importance, and that as often as the fever attending suppuration is violent, a repeated opening, emptying, and absorbing of the ripened pustules is a remedy of the utmost efficacy.

The patient should very carefully abstain from the use of Venice treacle, laudanum, 'diacodium' (that is syrup of white poppies, or even of the wild red poppy), syrup of amber, pills of storax—and, in one word, of every medicine which produces sleep.

And their use should be entirely banished through the secondary fever.

If the eruption should suddenly strike in, heating, soporific, spirituous, and volatile remedies should carefully be avoided. But the

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patient may drink plentifully of the infusion No. 12, or rather of cold water.35

To prepare children for the smallpox the first step is an abatement of their usual food. Children commonly eat too much.

Their limitation should be in proportion to their size and growth.

But with regard to all, we may be allowed to make their supper very light and very small.

Their second advantage will consist in the choice of their food. It should be of the simplest kind, as vegetables and milk-meats. Their bread should be well baked, their pulse [i.e., legumes] dressed without bacon, and their fruits well ripened. These regulations may be sufficient.

The third article is to bathe their legs now and then in warm water before they go to bed. This promotes perspiration, cools [and] dilutes the blood, and allays the sharpness of it, as often as it is properly timed.

The fourth precaution is the frequent use of very clear whey.

This agreeable remedy, which consists of the juices of herbs filtered through, and as it were sweetened by, the organs of a healthy animal, answers every visible indication. It imparts a flexibility to the vessels. It abates the thickness of the blood, which, being augmented by the action of the poisonous cause of the smallpox, would degenerate into a dangerous thickness. It removes all obstructions in the bowels. It also promotes stools, urine, and perspiration; and, in a word, communicates the most favourable disposition of the body not to be too violently agitated by the operation of an inflammatory poison.

I have already observed that it may also be used to great advantage during the course of the distemper. But I must also observe that, however salutary it is in the cases for which I have directed it, there are others in which it would be hurtful. It would be pernicious to weak, languishing, pale children, subject to vomitings, purgings, and to all diseases which prove their bowels to be weak and their humours to be sharp. Those to whom it is advised may take a few glasses every morning, and even drink it daily for their common drink. They may also sup it with bread for breakfast, for supper, and indeed at any time.

35JW omits here a section in which Tissot commends inoculation for small pox {Advice §219, p. 230). But this was likely because, asTissot admitted, this 'gracious dispensation of providence' was currently not available to most people. See below,

§159.

Medical and Health Writings Chapter XIV Of the Measles §[154]. In some constitutions the measles give notice of its approach by a small dry cough, without any other complaint; though more frequently by a general uneasiness, by successions of shivering and of heat, by a severe headache in grown persons, a heaviness in children, a considerable complaint of the throat, and by what particularly characterizes this distemper—an inflammation and a considerable heat in the eyes, attended with a swelling of the eyelids, with a defluxion of sharp tears, and so acute a sensation of the eyes that they cannot bear the light; by very frequent sneezings, and a dripping from the nose of the same humour that trickles from the eyes.

The heat and the fever increase with rapidity; with a cough, a stuffing, and continual retchings to vomit; with violent pains in the loins, and sometimes with a looseness. In other subjects sweating chiefly prevails. The tongue is foul and white, the thirst is often very high, and the symptoms are generally more violent than in the mild smallpox.

At length, on the fourth or fifth day, and sometimes about the end of the third, a sudden eruption appears, and in a very great quantity, especially about the face—which in a few hours is covered with spots, each of which resembles a fleabite. Many of them soon joining, form red streaks, larger or smaller, which inflame the skin and produce a very perceivable swelling of the face, whence the very eyes are sometimes closed. Each small spot is raised a little above the surface, especially in the face, where they are manifest both to the sight and the touch.

The eruption is afterwards extended to the breast, the back, the arms, the thighs, and legs. It generally spreads very plentifully over the breast and back, and sometimes red suffusions are found upon the breast before any eruption has appeared in the face.

4 he patient is often relieved, as in the smallpox, by plentiful discharges of blood from the nose, which carry off the complaints of the head, of the eyes, and of the throat.

When this distemper appears in its mildest character, almost every symptom abates after eruption. Though, in general, the change for the better is not as perceivable as it is in the smallpox. The retchings cease almost entirely, but the fever, the cough, the headache continue. And I have sometimes observed that a bilious vomiting, a

Advices with Respect to Health

day or two after the eruption, proved a considerable relief to the patient. On the third or fourth day of the eruption the redness diminishes. The spots dry up and fall off in very little branny scales. The cuticle shrivels off, and is replaced by one succeeding beneath it.

On the ninth day, when the progress of the malady has been speedy, and on the eleventh, when it has been very slow, no trace of the redness is to be found and the surface resumes its usual appearance.

Notwithstanding, the patient is not safe except, during the course of the distemper or immediately after it, he has had some considerable evacuation—such as vomiting, or a bilious looseness, considerable discharges by urine, or very plentiful sweating. For when any of these evacuations supervene, the patient resumes his strength and perfectly recovers. It happens sometimes, even without any of these discharges, that insensible perspiration expels the relics of the distemper. Yet it occurs too often that this venom, not having been entirely expelled, is cast upon the lungs, where it produces a slight inflammation. In consequence the oppression, the cough [and] the fever return, and the patient's situation becomes very dangerous. This outrage is frequently less vehement, but it proves tedious and chronical, leaving a very obstinate cough behind it, with many resemblances of the whooping cough.

Though this be the frequent case when men are treated with a hot regimen, yet when proper care was taken to moderate the fever at the beginning, and to keep up the evacuations, such consequences have been very rare.

The proper method of conducting this malady is:

1. If the fever be high, the pulse hard, the oppression heavy, the patient must be bled once or twice.

2. His legs must be bathed. The vehemence of the symptoms must regulate the number of times.

3. The ptisans No. 3 or [No.] 4 must be taken, or a tea of elder and lime tree flowers, to which a fifth part milk may be added.

4. The steam of warm water should also be employed, to assuage the cough, the soreness of the throat, and the oppression.

5. As soon as the redness becomes pale, the patient is to be purged with the draught No. 23.

6. He is still to be kept strictly to his regimen for two days after this purge, after which he is to be put upon the diet of those who are in a state of recovery.

7. If, during the eruption, such symptoms supervene as occur (at the same term) in the smallpox, they are to be treated in the manner directed there.

Medical and Health Writings §[157]. Whenever this method has not been observed, and the accidents described [in] §[155] supervene, the distemper must be treated like an inflammation in its first state, and all must be done as directed [in] §[156]. If the disease is not vehement, bleeding may he omitted. If it is of some standing in gross [i.e., heavy] children, loaded with humours, inactive, and pale, we must add to the medicines already prescribed the potion No. 8.

It often happens that the dregs of the distemper have been too little regarded, especially the cough. In which circumstance it forms a real suppuration in the lungs, attended with a slow fever. I have seen many children in country villages destroyed by this neglect. Their case terminates in a looseness (attended with very little pain) which carries off the patient. In such cases we must recur to milk and exercise, which I have often seen in such situations accomplish a very difficult cure. I must advise the reader, at the same time, that milk has not so complete an effect as when it is taken solely,

unjoined by any other aliment. And that it is of the last importance not to join it with any which has the least sharpness. Persons in easy circumstances may successfully take at the same time Bristol waters.36 These are also successfully employed in all the cases in which the cure I have mentioned is necessary.

Sometimes there remains after measles a strong dry cough, with great heat in the breast and throughout the whole body, with thirst, an excessive dryness of the tongue, and of the whole surface of the body. I have cured persons thus indisposed by making them breathe in the vapour of warm water, by the repeated use of warm baths, and by allowing them to take nothing for several days but water and milk.37

Chapter XV

Of the Burning Fever §[160], Most of the distempers I have hitherto considered result from an inflammation of the blood, combined with the particular inflammation of some part, or occasioned by some poison which must be evacuated. But when the blood is strongly inflamed, without an attack upon any particular part, this fever which we term

'burning' is the consequence.

mineral water from the warm springs at Clifton, near Bristol.

17 Here too JW omits Tissot's comment about the potential of inoculation for measles {Advice, §229, p. 243), as Tissot concedes that it cannot currently be 'extended to the general benefit of the people'. See above, §152.

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The signs are: a hardness and fullness of the pulse in a higher degree than happens in any other malady, an excessive heat, great thirst, with an extraordinary dryness of the eyes, nostrils, lips, of the tongue, of the throat, a violent headache, and sometimes a raving at the height of the paroxysm, which rises considerably every evening. The respiration is also somewhat oppressed, but especially at the return of the paroxysm—with a cough now and then, though without any pain in the breast, and without any expectoration. The body is costive. The urine very high-coloured, hot, and in a small quantity. The sick are also liable to start, but especially when they seem to sleep, for they have little sound refreshing sleep, but rather a kind of a drowsiness that makes them little sensible of what happens about them, or even of their own condition. They have sometimes a little sweat or moisture, though commonly a very dry skin.

They are very weak, and have either little or no smell or taste.

This disease, like all other inflammatory ones, is produced by the causes which thicken the blood and increase its motion; such as excessive labour, violent heat, want of sleep, wine or strong liquors, the long continuance of a dry constitution of the air, excess of every kind, and heating food.

§[162]. The patient ought:

1. Immediately to be put upon a regimen, to have the food allowed him given only every eight hours, and, in some cases only twice a day. And indeed, when the attack is extremely violent, nourishment may be wholly omitted.

2. Bleeding should be repeated, until the hardness of the pulse is sensibly abated. The first discharge should be considerable, the second should be made four hours after. If the pulse is softened by the first, the second may be suspended, and not repeated before it becomes sufficiently hard again to make us apprehensive of danger.

But should it continue strong and hard, the bleeding may be repeated on the same day a third time.

3. His legs are to be bathed twice a day in warm water. His hands may be bathed in the same water. Linen or flannel cloths dipped in warm water may be applied over the breast and upon the belly.

And he should regularly drink of the almond milk No. 4, and the ptisan No. 7. The poorest patients may content themselves with the last, but should drink very plentifully of it. And after the bleeding properly repeated, fresh air and the plentiful continuance of small diluting liquors generally establish the health of the patient.

4. If, notwithstanding the repeated bleedings, the fever still rages highly, it may be lessened by giving a spoonful of the potion No. 10

Medical and Health Writings every hour, until it abates; and afterwards every three hours, until it becomes very moderate.

Bleedings from the nose frequently occur, greatly to the relief of the patient.

The first appearance of amendment are a softening of the pulse (which however does not wholly lose all its hardness), a sensible abatement of the headache, a greater quantity of urine and that less high coloured, and an evident moisture of the tongue. These favourable signs keep increasing, and there frequently ensue between the ninth and fourteenth day, and often after a flurry of some hours continuance, very large evacuations by stool, a great quantity of urine which lets fall a reddish sediment, the urine above it being of a natural colour, and these accompanied with sweats. At the same time the nostrils and the mouth grow moist. The crust which covered the tongue peels off of itself. The thirst is diminished. The drowsiness goes off. And the natural strength is restored. When things are evidently in this way the patient should take potion No.

23, and be put upon the regimen of those who are in a state of recovery. It should be repeated at the end of eight or ten days. Some patients have perfectly recovered from this fever without the least sediment in their urine.

The augmenting danger of this fever may be discerned from the continued hardness of the pulse, though with an abatement of its strength. If the brain becomes more confused, the breathing more difficult; if the eyes, nose, lips and tongue become still more dry; if to these symptoms there be added a swelling of the belly, a diminution of the quantity of urine, a constant raving, great anxiety, and a certain wildness of the eyes, the patient cannot survive many hours. The hands and fingers at this period are incessantly in motion, as if feeling for something upon the bedclothes, which is commonly termed their 'hunting for flies'.

Chapter XVI

Of Putrid Fevers §[165], Having treated of such feverish distempers as arise from an inflammation of the blood, I shall here treat of those which are produced by corrupt humours which stagnate in the stomach or bowels, or have already passed from them into the blood. These are called 'putrid fevers', or sometimes 'bilious fevers' when a corruption of the bile seems to prevail.

Advices mth Respect to Health

This distemper frequently gives notice of its approach [for] several days by a great dejection, pains of loins and knees, a foulness of the mouth in the morning, little appetite, broken slumber, and sometimes an excessive headache. After these, a shivering comes on, followed by a sharp and dry heat. The pulse, which was small and quick during the shivering, is raised during the heat, and is often very strong, though it is not attended with the same hardness as in the preceding fever—except the putrid fever be combined with an inflammatory one, which it sometimes is. During the heat, the headache is commonly extremely violent. The patient is almost constantly affected with loathings, and sometimes vomitings; with thirst, disagreeable risings, a bitterness in the mouth, and very little urine. This heat continues for many hours, frequently the whole night. It abates a little in the morning, and the pulse, though always feverish, is then something less so, while the patient suffers less, though still greatly dejected.

The tongue is white and furred, the teeth are foul, and the breath smells disagreeably. The colour, quantity, and consistence of the urine are very various and changeable. Some patients are costive, others frequently have small stools, without the least relief accruing from them. The skin is sometimes dry, and at other times there is some sensible perspiration, but without any benefit attending it.

The fever augments every day, and frequently at unexpected irregular periods. Besides that great paroxysm, which is perceivable in all subjects of this fever, some have also other less intervening ones.

When the disease is left to itself, or injudiciously treated, the aggravation of it become more frequent, longer, and irregular.

There is scarce an interval of ease. The patient's belly is swelled out like a football. A delirium comes on. He proves insensible of his own evacuations. He rejects assistance, and keeps muttering continually, with a quick, small, irregular pulse. Sometimes little spots of a brown or of a livid colour appear on the surface, but particularly about the neck, back, and breast. All the discharges from his body have a moist fetid smell. Convulsive motions also supervene, especially in the face. His sweats stream down from agony, his breast swells out, and he dies miserably.

This fever seems to have no critical time, either for its termination in recovery, or in death. When it is very violent, or very badly conducted, it proves sometimes fatal on the ninth day. Persons often die of it from the eighteenth to the twentieth, sometimes about the fortieth, after having been alternately better or worse.

Medical and Health Writings When it happens but in a light degree, it is sometimes cured in a few days. Yet some patients are not out of danger before the end of six weeks, and even still later. Nevertheless it is certain that this often depends on the manner of treating them; and that in general their course is determined some time from the fourteenth to the thirtieth day.

The treatment of this species of fevers is comprised in the following method:

1. The patient must be put into a regimen. His common drink should be lemonade; instead of juice of lemons, vinegar may be occasionally substituted.

2. If there be an inflammation, which may be discovered by the strength and hardness of the pulse and by the complexion of the patient, if he is naturally robust and has heated himself, he should be bled once, and a second time if necessary, some hours after. I must observe, however, that very frequently there is no such inflammation, and that in such a case bleeding would be hurtful.

3. When the patient has drank very plentifully for two days of these liquids, if his mouth still continues in a foul state, and he has violent retchings to vomit, he must take the powder No. 34 dissolved in a pint and half of warm water—a glass of it being to be drank every half-quarter of an hour. But as this medicine vomits, it must not be taken under any circumstance which forbids the use of a vomit. If the first glasses excite a plentiful vomiting, we must forbear giving another, and be content with obliging the patient to drink a considerable quantity of warm water. But if the former glasses do not occasion vomiting, they must be repeated until they do. Those who are afraid of taking this medicine may take that of No. 35, also drinking warm water plentifully during its operation.

But the former is preferable, as more prevalent, in dangerous cases.

We must caution our readers, at the same time, that wherever there is an inflammation of any part, neither of these medicines must be given, which might prove a real poison in such circumstances. And even if the fever is extremely violent, though there should be no particular inflammation, they should not be given.

The time of giving them is soon after the end of the paroxysm, when the fever is at the lowest. The medicine No. 34 generally purges, after it ceases to make the patient vomit. But No. 35 is seldom attended with the same effect.

When the operation of the vomit is entirely over, the sick should return to the use of the ptisan; and great care should be taken to prohibit the use of flesh broth, under the pretext of working off a

Advices with Respect to Health

purging with it. The same method is to be continued on the following days. But as it is of importance to keep the body open, he should take every morning some of the ptisan No. 32. Such as this would be too expensive for may substitute, in the room of it, a fourth part of the powder No. 34 in five or six glasses of water, of which they are to take a cup every two hours, beginning early in the morning.

Nevertheless, if the fever be high, No. 32 should be preferred to it.

4. After the operation of the vomit, if the fever still continue[s], if the stools are remarkably fetid, and if the belly is tense and distended, and the quantity of urine small, a spoonful of the potion No.

10 should be given every two hours. Should the distemper become violent, it ought to be taken every hour.

5. Whenever (notwithstanding the giving all these medicines) the fever continues obstinate, the brain is manifestly disordered, there is a violent headache, or very great restlessness, two blistering plasters (No. 36) must be applied to the fleshy part of the legs, and their discharge continued as long as possible.

6. If the fever is extremely violent, there is an absolute necessity to prohibit the patient from receiving the least nourishment.

7. When it is thought improper to give the vomit, the patient should take in the morning, for two successive days, three doses of the powder No. 24, at the interval of one hour between each. This medicine produces some bilious stools, which greatly abate the fever, and considerably lessens all the other symptoms. This may be done with success when the excessive height of the fever prevents us from giving the vomit. And we should limit ourselves to this medicine as often as we are uncertain whether the circumstances will admit of vomiting, which may also be dispensed with in many cases.

8. When the distemper has considerably declined, the paroxysms are slight, and the patient continues without any fever for several hours, the daily use of the purging drinks should be discontinued.

The common ptisans however should be still made use of, and it will be proper to give every other day two doses of the powder No.

24.

9. If the fever has been clearly off for a long part of the day, if the tongue appears in a good state, if the patient has been well purged, and yet one moderate paroxysm of the fever returns every day, he should take the bitter decoction No. 37, four glasses of which may be taken at equal intervals, between the returns of the fever.

10. As the organs of digestion have been considerably weakened through the course of this fever, there is a necessity for the patient's

Medical and Health Writings conducting himself very regularly long after it, with regard both to the quantity and quality of his food. He should also use due exercise as soon as his strength will permit, without which he may be liable to fall into some chronical disorder.

Chapter XVII Of Malignant Fevers §[169]. Those fevers are called 'malignant' in which the danger is more than the symptoms would make us apprehensive of.

They have frequently a fatal event without appearing so perilous, on which account it has been well said of this fever that it is a dog which bites without barking.

The distinguishing mark of malignant fevers is a total loss of the patient's strength, immediately on their first attack. They arise from a corruption of the humours, which is noxious to the very principle of strength, the impairing which is the cause of the feebleness of the symptoms, by reason none of the organs are strong enough to exert a vigorous opposition.

The causes of this malady are a long use of animal food alone, without pulse [i.e., legumes], fruits, or acids; the continued use of bad provisions, such as bread made of damaged corn, or very stale meat. These fevers are frequently the consequence of a great dearth or famine, of too hot and moist an air, or of a very close and stagnant air, especially if many persons are crowded together in it.

Tedious grief and vexation also contribute to generate these fevers.

The sick person seems to labour under great anguish. He has sometimes twitchings in his face and hands, as well as in his arms and legs. His senses seem torpid, or as it were benumbed. I have seen many who had lost, to all appearance, the whole five, and yet some of them recover. Their voices change, become weak, and are sometimes quite lost. Some of them have a fixed pain in some part of the belly. This arises from a stuffing and often ends in a gangrene, whence this symptom is highly dangerous.

The tongue is sometimes little altered from its appearance in health; at other times covered with a yellowish brown humour. But it is more rarely dry in this fever than in the others, and yet sometimes resembles a tongue that has been long smoked.

The skin is often neither hot, dry, nor moist. It is frequently overspread with little spots of a reddish livid colour, especially on the neck, about the shoulders, and upon the back. At other times the

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spots are larger and brown, like the colour of pustules from the strokes of a stick.

The urine of the sick is almost constantly of a lighter colour than ordinary. I have seen some which could not be distinguished, merely by the eye, from milk. A black and stinking purging sometimes attends this fever, which is mortal, except the sick be evidently relieved by the discharge.

The duration and crisis of these fevers are very irregular.

Sometimes the sick die on the seventh or eighth day, more commonly between the twelfth and the fifteenth, and not infrequently at the end of five or six weeks. Some of these fevers, at their first invasion, are very slow, and during a few of the first days the patient, though very weak and with a very different look and manner, scarcely thinks himself sick.

The period of the cure is as uncertain as that of death. Some are out of danger at the end of fifteen days or sooner, others not in several weeks.

The signs which portend a recovery are: a little more strength in the pulse, a more concocted urine, less dejection and discouragement, a less confused brain, an equal kindly heat, a pretty warm or hot sweat in a moderate quantity, the revival of the senses, though the deafness is not a very threatening symptom if the others amend.

This malady commonly leaves the patient very weak, and a long interval will ensue before he recovers his full strength.

It is, [1.] in the first place, of great importance both for the patients and those who attend them that the air be renewed and purified. Vinegar should often be evaporated from a hot tile or iron in the chamber, and one window kept almost constantly open.

2. The diet should be light, and the juice of sorrel may be mixed with their water. The juice of lemons may be added to soups prepared from different grains and pulse [i.e., legumes]. The patient may eat sharp acid fruits, such as Morelia cherries, gooseberries, small black cherries, jam of currants or barberries. And those who can afford them may be allowed lemons, oranges, and pomegranates.

3. The patient's linen should be changed every two days.

4. Bleeding and clysters are very rarely needful.

5. The patient's common drink should be barley water made acid with the spirit No. 10, at the rate of one quarter of an ounce to at least full three pints of the water, or acidulated agreeably to his taste. He may also drink lemonade.

6. It is necessary to evacuate the bowels, where a great quantity of corrupt humours is generally lodged. The powder No. 35 may be

Medical and Health Writings given for this purpose, after the operation of which the patient generally finds himself better. It is of importance not to omit this at the beginning of the disease. Though if it has been omitted at first, it were best to give it even later, provided no particular inflammation has supervened, and the patient has still some strength. I have given it, and with remarkable success, on the twentieth day.

7. Having by this medicine expelled a considerable portion of the bad humours, the patient should take every other day, and sometimes every day, one dose of the cream of tartar and rhubarb (No.

38). This expels the worms that are very common in these fevers, which the patient sometimes discharges upwards and downwards, and which frequently conduce to many of the odd symptoms that are observed in malignant fevers. In short it strengthens the bowels, and without checking the necessary evacuations, it moderates the looseness when it is hurtful.

8. If the skin be dry, with a looseness, and that by checking it we design to increase perspiration, instead of the rhubarb, the cream of tartar may be blended with the ipecacuanha No. 39, which (being given in small and frequent doses) restrains the purging and forwards perspiration. This medicine, as the former, is to be taken in the morning. Two hours after, the sick must begin with the potion

No. 40, and repeat it regularly every three hours, until it be interrupted by giving one of the medicines No. 38 or [No.] 39. After which, the potion is to be repeated till the patient grows considerably better.

9. If the strength of the sick be considerably depressed, and he is in great dejection, he should take with every draught of the potion the bolus No. 41. If the purging is violent, there should be added, once or twice a day to the bolus, 20 grains [of diascordiunv'8].

10. Whenever, notwithstanding all this, the patient continues weak and insensible, two large blisters should be applied to the insides of the legs, or a large one to the nape of the neck. Their discharge is to be promoted abundantly, and if they dry up within a few days others are to be applied, and their evacuation is to be kept up for a considerable time.

11. As soon as the malady is sufficiently abated for the patient to remain some hours with very little or no fever, we must avail ourselves of this interval to give him six or five doses of the draught

"Omitted in all editions; corrected from Tissot.

Advices with Respect to Health

No. 43,39 and repeat the same the next day, which may prevent the return of the fever. After which it may be sufficient to give daily only two doses for a few days.

12. When the sick continue entirely clear of a fever, he is to be put into the regimen of persons in a state of recovery. But if his strength returns very slowly, in order to the speedier establishment of it, he may take three doses a day of the theriaca pauperum, or 'poor man's treacle' (No. 42), the first of them fasting, and the other twelve hours after. It were to be wished this medicine was introduced into all the apothecaries shops, as an excellent stomachic, in which respect it is much preferable to Venice treacle, which is an absurd, dear, and often a dangerous composition. It is true it does not dispose the patients to sleep. But when he would procure them sleep, there are better medicines to answer that purpose.

Chapter XVIII Of Intermitting Fevers §[174]. There are various kinds of intermitting fevers, which take their different names from the different time in which the fits return.

If the fit returns every day, it is either a true 'quotidian', or a 'double tertian' fever. The first of these may be distinguished from the last by this, that in the quotidian the fits are long, and correspond nearly to each other in degree and duration. In the double tertian the fits are shorter, and one is alternately light and the other more severe.

In the simple 'tertian' (or third day's) fever the fits return every other day.

The fit in a 'quartan' returns every fourth day, including the day of the first and that of the second attack.

The other kinds of intermittents are much rarer. I have seen however one true 'quintan' (or fifth day) ague, the patient having three clear days between two fits; and one regular weekly ague, returning every Sunday.

The first attack of an intermitting fever often happens when the patient imagined himself in perfect health. Sometimes however a perception of cold, and a sort of numbness, continue

39Tissot had prescribed No. 14 (Peruvian bark); JW was possibly changing the remedy purposefully, but he does let other references to No. 14. stand (including in §177 just below).

Medical and Health Writings some days before the fit. It begins with frequent yawnings, a lassitude, a general weakness, with coldness, shivering, and shaking.

There is also a paleness of the extreme parts of the body, attended with loathings, and sometimes an actual vomiting. The pulse is quick, weak, and small.

At the end of an hour or two, sometimes three or four hours, heat succeeds, which becomes violent at its height. At this period the whole body grows red, the anxiety of the patient abates, the pulse is very strong and large, and his thirst excessive. He complains of headache and of a pain in all his limbs, but different from that he was sensible of while his coldness continued. Having endured this hot state four, five, or six hours, he falls into a general sweat. Upon which all the symptoms abate, and sometimes sleep supervenes.

At the conclusion of this nap the patient often wakes without any fever, complaining only of weakness. Sometimes his pulse returns entirely to its natural state between the two fits, though it often continues a little quicker.

One symptom which particularly characterise^] these fevers is the urines which the sick pass after the fit. They are of a reddish colour, and let fall a sediment which exactly resembles brick dust.

They are sometimes frothy too, and a thin filmy skin appears on the top.

The duration of each fit is of no fixed time. Sometimes they return precisely at the same hour. At other times they come one, two, or three hours sooner; and in other instances, as much later.

Generally speaking, intermitting fevers are not mortal, often terminating in health of their own accord after some fits. But in this respect intermittents in the spring differ from those in the fall, which continue a long time, and sometimes even until spring, if they are not removed by art.

Quartan fevers are always more obstinate than tertians, persevering in some constitutions for whole years. When these occur in marshy countries, they are not only tedious, but persons infested with them are liable to frequent relapses.

A few fits of an intermittent are not very injurious, and it happens sometimes that they are attended with a favourable alteration of the health—by their exterminating the cause of some tedious disorder.

T hough it is erroneous to consider them as salutary. If they prove obstinate, and the fits are long and violent, they weaken the whole body, impairing all its functions. They make the humours sharp, and introduce several other maladies, such as the jaundice, dropsy, asthma, and slow wasting fevers. Nay sometimes old persons, and

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those who are very weak, expire in the fit. Though such an event never happens but in the cold fit.40

In the spring fevers, if the fits are not very severe, if the patient is well in their intervals, if his appetite, his strength, and his sleep continue as in health, no medicine should be given, nor any other method taken but that of putting the person upon the regimen directed for persons in a state of recovery.

If the fever extends beyond the sixth or seventh fit, and the patient seems to have no occasion for a purge,p he may take the powder No. 14. If it is a quotidian, or a double tertian, six doses, containing three quarters of an ounce, should be taken between the two fits—and as these intermissions commonly consist of but ten or twelve, or at the most of fourteen or fifteen hours, should be an interval of only one hour and a half between each dose. During this interval the sick may take two of his usual refreshments.

When the fever is a tertian, an ounce should be given between the two fits—which makes eight doses, one of which is to be taken every three hours.

In a quartan I directed one ounce and an half to be taken in the same manner. The last dose is to be given two hours before the usual return of the fit.

The doses just mentioned frequently prevent the return of the fit. But whether it returns or not, after the time of its usual duration is past, repeat the same quantity, in the same number of doses and intervals, which certainly keeps off another. For six days following, half the same quantity must be continued, in the intervals that would have occurred between the fits if they had returned. And during all this time the patient should inure himself to as much exercise as he can bear.

Should the fits be very strong, the pain of the head violent, the visage red, the pulse full and hard; if there is any cough; if, even after the fit is over, the pulse still is hard; if the urine is inflamed, hot and high-coloured; and the tongue very dry, the patient must be bled and drink plentifully of barley water No. 3. These two remedies generally bring the patient into the state described [in]

pAs there is not the least danger from a gentle purge, such as those of No. 11 or [No.] 23, we think it would be prudent always to premise a dose or two of either to the bark. But a vomit is generally necessary before the bark is given [Kirkpatrick

(sez Advice, 227)].

40 JW omits here paragraph §258 (p. 275) in Advice, which praises Jesuit's bark as 'a medicine that infallibly cures these fevers'.

Medical and Health Writings §[176]. In which state he may take, on a day when the fever is entirely off, three or four doses of the powder No. 24, and then leave the fever to pursue its course for the space of a few fits. But should it not then terminate of itself, the bark must be recurred to.

If the patient, even in the interval of the returns, has a fetid, furred mouth, a loathing, pains in the loins or in the knees, much anxiety, and bad nights, he should be purged with the powder No.

21, or the potion No. 23, before he takes the bark.

If fevers in autumn appear to be of the continual kind, and very like putrid fevers, the patients should drink abundantly of barley water. And if at the expiration of two or three days there still appears to be a load at the stomach, the powder No. 34 or that of [No.] 35 is to be given. And if, after the operation of this, the signs of putridity continue, the body is to be opened with repeated doses of the powder No. 24; and when the fever becomes quite regular, with distinct remissions at least, the bark is to be given as directed

But as autumnal fevers are more obstinate, after having discontinued the bark for eight days, notwithstanding there has been no return of the fever, it is proper to resume the bark and to give three doses of it daily for the succeeding eight days—more especially if it was a quartan, in which species I have ordered it to be repeated every other eight days, for six times.

After the patient has begun with the bark he must take no purging medicine, as that evacuation would occasion a return of the fever.

Bleeding is never necessary in a quartan ague, which occurs with symptoms of putridity rather than of inflammation.

The patient ought, two hours before the fit, to drink a small glass of warm elder-flower tea sweetened with honey every quarter of an hour, and to walk about moderately. This disposes him to a very gentle sweat, and thence renders the ensuing fit milder.

He is to continue the same drink throughout the cold fit. And when the hot one approaches, he may either continue the same or substitute that of No. 2, which is more cooling. It is not necessary, however, to drink it warm. It is sufficient that it be not over cold. When the sweat after the hot fit is concluded, the patient should be wellwiped and dried, and may get up. If the fit was very long, he may be allowed a little gruel, or some other such nourishment during the sweat.

Sometimes the first doses of the bark purge. When it purges, it does not prevent the return of the fever, so that these doses may be considered as to no purpose, and others should be re-

Advices with Respect to Health All peated which, ceasing to purge, prevent it. Should the looseness notwithstanding continue, the bark must be discontinued for one entire day, in order to give the patient half a quarter of an ounce of rhubarb.

After which the bark is to be resumed, and if the looseness still perseveres, fifteen grains of Venice treacle should be added to each dose.

Another easy method of which I have often availed my patients under tertian fevers (but which succeeded with me only twice in quartans) was to procure the sufferer a very plentiful sweat at the very time when the fit was to return in its usual course. To effect this he is to drink, three or four hours before it is expected, an infusion of elder-flowers sweetened with honey; and one hour before the usual invasion of the shivering, he is to go into bed and take, as hot as he can drink it, the prescription No. 44.

I have also cured some tertians, and even quartans, by giving them, every four hours between the fits, the powder No. 45.41

The same causes which produce intermitting fevers frequently occasion disorders which return periodically without shivering, without heat, and often without any quickness of the pulse.

Such disorders generally preserve the intermissions of quotidian or tertian fevers, much seldomer those of quartans. I have seen violent vomitings and retchings to vomit, with inexpressible anxiety, the severest oppressions, the most racking colics, dreadful palpitations, and excessive toothaches. Pains in the head, and very often an unaccountable pain over one eye, the eyelid, eyebrow, and temple, on the same side of the face, with a redness of that eye, and a continual, involuntary trickling of tears. I have also seen such a prodigious swelling of the affected part that the eye projected, or stood out above an inch from the head, covered by the eyelid, which was also extremely inflamed. All these maladies begin precisely at a certain hour, last about the usual time of a fit, and, terminating without any sensible evacuation, return exactly at the same hour the next day, or the next but one.

There is but one known medicine that can effectually oppose this sort, which is the bark, given as directed [in] §[177]. Nothing affords relief in the fit, and no other medicine puts it off. If a sufficient dose of it be given, the next fit is very mild, the second is prevented. And I never saw a relapse in these cases, which sometimes happens after the fits of common intermittents seem cured.

In situations where the air renders these fevers very common, the inhabitants should frequently burn in their lodging

41JW reproduces Tissot here; but No. 45 is not a powder, likely meant No. 46.

478 Medical and Health Writings

rooms some aromatic wood or herbs. They should daily chew some juniper-berries, and drink a fermented infusion of them. These two remedies are very effectual to fortify the weakest stomachs, to prevent obstructions, and to promote perspiration. And, as these are the causes which prolong these fevers the most obstinately, nothing is a more certain preservation from them than these cheap and obvious assistances."1

Chapter XIX

Of the Erysipelas, and Bites of Animals §[185]. The erysipelas, commonly called 'St. Anthony's fire', is sometimes a slight indisposition which appears on the skin. It generally affects the face or the legs. The skin distends, becomes rough and red. The patient feels a burning heat, which is painful and sometimes hinders him from sleeping. The distemper increases for two or three days, remains in its height one day or two, and abates.

Then the affected skin falls off in great scales and all is over.

At other times this malady comes to a greater height. It begins by a very strong shivering, followed by a burning heat, a violent headache, sickness at heart, or retchings to vomit, which never cease till the erysipelas breaks out, and this happens the second or third day. Then the fever abates, and the sickness ceases. But often there remains a little of the fever and loathing during all the time that the erysipelas increases. When it affects the face, the headache continues till it is on the decline, the eyelid swells, the eye closes, and the patient has not the least ease. Often the eruption goes from one cheek to the other, and spreads successively on the forehead and the neck. Nay often, when the disease is severe, the brain is oppressed, the patient raves, and sometimes if he does not get proper assistance he dies.

As soon as the erysipelas is strong, it is covered with small pustules full of a clear water, such as that which comes from a tumour occasioned by a burn, and these pustules afterwards dry and scale off. I have sometimes seen, especially when the erysipelas attacks the face, that the humour that came from these pustules was very

q I have known an infusion of two ounces of the best bark in fine powder, or two ounces and a half in gross powder, in a quart of the best brandy for three or four days (a small wine glass to be taken by grown persons at the distance of from four to six hours) effectually and speedily terminate such inveterate agues as had given but little way to the bark in substance [Kirkpatrick (see Advice, 287)].

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viscous and formed thick crusty scabs like those of sucking children, and they continued several days before they went off.

When the erysipelas is violent, it continues sometimes eight, ten, twelve days, and at last goes away by a plentiful sweat. During the continuation of the malady all the skin is dry, even the inside of the mouth.

An erysipelas rarely comes to suppuration, and when it does is much disposed to degenerate into an ulcer. Sometimes a malignant kind of erysipelas is epidemical, seizing a great number of persons, and frequently terminating in gangrenes.

This distemper often shifts its situation. It sometimes retires suddenly, but the patient is uneasy, he has a propensity to vomit, with a sensible anxiety and heat. The erysipelas appears again in a different part and he feels himself quite relieved. But if instead of reappearing on some other part the humour is thrown on the brain or the breast, he dies within a few hours; and these fatal changes sometimes occur without the least apparent reason.

If the humour is transferred to the brain, the patient immediately becomes delirious, with a very flushed visage and sparkling eyes. Very soon after he proves downright frantic, and goes off in a lethargy.

If the lungs are attacked, the oppression, anxiety, and heat are inexpressible.

There are some constitutions subject to a frequent, and as it were habitual, erysipelas. If it often affects the face, it is generally on the same side, and that eye is at length considerably weakened.

This distemper results from two causes: the one, a sharp humour diffused through the mass of blood; the other, that humour's not being sufficiently discharged by perspiration.

When this disease is gentle, it will be sufficient to put a man upon the regimen so often referred to, with a plentiful use of nitre in elder tea. Flesh, eggs, and wine are prohibited of course, allowing the patient a little pulse [i.e., legumes] and ripe fruits.

He should drink elder-flower tea abundantly, and take half a dram of nitre every three hours; or, which amounts to the same thing, let three drams of nitre be dissolved in as much infusion of elderflowers as he can drink in twenty-four hours.

When the distemper prevails in a greater degree, if the fever is very high, and the pulse strong or hard, it may be necessary to bleed at once. But this should never be permitted in a large quantity; it being more advisable, if a sufficient quantity has not been taken at once, to bleed a second time, or even a third. And in

Medical and Health Writings some cases nature has sometimes saved the patients by effecting a large bleeding, to the quantity of four or five pounds.

After bleeding, the patient is to be restrained to his regimen and he should drink barley water freely (No. 3).

When the fever is diminished, either the purge No. 23 should be given, or a few doses every morning of cream of tartar No. 24.

Purging is absolutely necessary. It may sometimes be necessary too if the disease is very tedious, if the sickness at the stomach is obstinate, the mouth ill-favoured and the tongue foul (provided there be only a slight fever, and no fear of an inflammation) to give the medicines No. 34 or [No.] 35, which remove these impediments still better than purges.

It commonly happens that this disease is more favourable after these evacuations. Nevertheless it is sometimes necessary to repeat them the next day, or the next but one, especially if the malady affects the head. Purging is the true evacuation of curing it, whenever it attacks this part.

Whenever, even after these evacuations, the fever still continues to be very severe, the patient should take every two hours, or occasionally oftener, two spoonfuls of the prescription No. 10, added to the glass of ptisan.

It will be very useful when this disease is seated in the head or face to bathe the legs frequently in warm water, and where it is violent there also to apply sinapisms42 to the soles of the feet/1 have seen this application, in about four hours, draw down an erysipelas to the legs which had spread over the nose and both eyes. When the distemper begins to go off by sweating, this should be promoted by elder-flower tea and nitre, and the sweating may be encouraged for some hours.

The best applications that can be made to the affected part are: the herb Robert (a kind of crane's bill), or parsley, or elderflowers. And if the complaint be very mild, it may be sufficient to apply a very soft smooth linen over it, which some people dust over with a little dry meal.5

2. If there is a very considerable inflammation, flannels wrung out of a strong decoction of elder-flowers, and applied warm, afford

1 Rather warm treacle [JW], This application is of all others the most efficacious, and is frequently used by the common people of this country [JW], 42 A plaster of powdered mustard.

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him the speediest ease. By this simple application I have appeased the most violent pains of the most cruel species of erysipelas.

3. The plaster of smalt, and smalt itself (No. 46), are also very successfully employed in this disease. This powder, or mealy ones, agree best when a thin watery humour distils from the little vesications, which it is convenient to absorb by such applications.

All other plasters which are greasy or resinous are very dangerous. They often strike in the erysipelas occasioning it to ulcerate, or even to gangrene. If people who are naturally subject to this disease should apply any such plaster to their skin, even in its soundest state, an erysipelas is the speedy consequence.

Whenever the humour occasioning the distemper is repelled, and thrown upon any internal part, the patient should be bled, blisters applied to the legs, and elder tea with nitre dissolved in it plentifully drank.

People who are liable to frequent returns of an erysipelas should carefully avoid using cream, and all fat and viscid or clammy food, spices, thick and heady liquors, a sedentary life, the more active passions, especially rage, and if possible all chagrin too. Their food should chiefly consist of herbs, fruits, of substances inclining to acidity, and which tend to keep the body open. They should drink water, by no means omitting the frequent use of cream of tartar.

Of the stings, or small wounds, by animals.

The stings or little bites of animals frequently producing a kind of erysipelas, I shall add a very few words here concerning them.

The only stings we are exposed to are those of bees, wasps, hornets, gnats, dragonflies; some of which are attended with severe pain, a swelling, and a considerable redness. These symptoms go off naturally within a few days, without any assistance. Nevertheless they may either be prevented or shortened:

1. by extracting the sting of the animal, if it is left behind.

2. by applying oil quickly, or pounded parsley.

3. by bathing the legs of the person stung in warm water.

Chapter XX Of Inflammations of the Breast, and of False and Bilious Pleurisies

The inflammation of the heart and the pleurisy which we call 'bilious' are the very same disorder. It is properly a putrid fever

Medical and Health Writings accompanied with an oppression of the lungs, which is either without pain, and then is called a putrid or bilious 'peripneumony', or with a pain in the side, and is called a 'pleurisy'.

The signs which distinguish these disorders from the inflammatory disorders of the same name are: a pulse less hard, less strong, more quick, with a foulness or bitterness of the mouth. The heat is sharp and dry. The patient feels a heaviness, an uneasiness about his stomach and loathings. His complexion is less red, it is a little yellow.

His urine is like that in putrid fevers. He has very often a small bilious looseness and very fetid. His skin is generally very dry, the spittle less thick, less red, but more yellow than in the inflammatory kind.

These diseases are treated in the same way as the putrid fevers. If there is any inflammation, one bleeding removes it. Afterwards barley water is given (No. 3). And when the inflammation is entirely gone, the vomiting and purging potion is used (No. 34).

But the greatest care must be taken not to give it till the whole inflammatory disposition is removed. Afterwards one may employ the purging potion again at the end of some days with medicine No. 23.

The powder No. 25 succeeds also very well as a vomit.

If the fever becomes very violent, plenty of the potion No. 10 must be given.

The false inflammation of the breast is an overfullness or obstruction in the lungs, accompanied with a fever, and it is caused by thick humours—and not by inflammatory blood or by any putrid or bilious humour.

[1.] This distemper happens most frequently in the spring. Old men, puny children, languid women, feeble young men, and particularly such as have worn their constitutions by drinking, are most frequently attacked by it; especially if they have used little exercise through the winter, and have fed on viscid and fat aliments.

2. The patient many days before has a slight cough, a small oppression when he moves about, a little restlessness, and is sometimes a little choleric or fretful. His countenance is higher coloured than in health. He has a propensity to sleep, but without refreshment, and has sometimes an extraordinary appetite.

3. When this state has continued for some days there comes on a cold shivering. It is succeeded by a moderate degree of heat, attended with much inquietude and oppression. The sick person cannot confine himself to the bed, but walks to and fro in his chamber, and is greatly dejected. The pulse is weak and pretty quick. The urine is sometimes but little changed from that in health; at other times it is discharged but in a small quantity, and is higher coloured. He

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coughs but moderately, and does not expectorate but with difficulty.

Sometimes it happens, especially to persons of advanced age, that this state suddenly terminates in a mortal swoon. In other cases the oppression and anguish increase, the patient cannot breathe but when sitting up, and that with great difficulty. The brain is utterly disturbed. This state lasts for some hours, and then terminates of a sudden.

This is a very dangerous distemper, both because it chiefly attacks those persons whose constitution is weakened and because it is of a precipitate nature, the patient sometimes dying on the third day, seldom surviving the seventh.

1. If the patient has a pretty good share of health, if the pulse is of a perceivable hardness and yet at the same time some strength, if the weather is dry and the wind blows from the north, he may be bled once to a moderate quantity. But if the greater part of these circumstances are wanting, bleeding would be very prejudicial.

Were we obliged to establish some general rule in this case, it were better to exclude bleeding than to admit it.

2. The stomach and bowels should be unloaded, and the medicine which succeeds best is No. 35, when the symptoms show there is a necessity for vomiting and there is no inflammation. When we are afraid of hazarding the agitation of a vomit, the potion No. 11 may be given. But we must be very cautious in regard to old men even with this, as such may expire during the operation of it.

3. They should, from the beginning of the disease, drink plentifully of the ptisan No. 26, or that of No. 12, adding half a dram of nitre to every pint of it.

4. A cup of the mixture No. 8 must be taken every two hours.

5. Blisters are to be applied to the insides of the legs.

When the case is doubtful and perplexing, it were best to confine ourselves to the three last mentioned remedies, which can occasion no ill consequence.

When this malady invades old people, though they partly recover, they never recover perfectly. And if due precaution is not taken, they are very liable to fall into a dropsy of the breast.

The spurious pleurisy is a distemper that does not affect the lungs, but only the skin and the muscles which cover the ribs.

It is the effect of a rheumatic humour thrown upon these parts, in which, as it produces sharp pains resembling a stitch, it has been termed a 'pleurisy'.

It is generally supposed that a false pleurisy is more dangerous than a true one, but this is a mistake. It is often ushered in

Medical and Health Writings by a shivering, and almost ever attended with a little fever, a small cough, and a slight difficulty of breathing; but yet no anguish, nor the other symptoms of true pleurisies. In some patients this pain is extended almost over the whole breast and to the nape of the neck.

The sick person cannot repose himself on the side affected.

This disorder is not more dangerous than a rheumatism, except in two cases: 1) when the pain is so severe that the patient strongly endeavours not to breathe at all, which brings on a great stuffing in the lungs; 2) when this humour, like any other rheumatic one, is transferred to some internal part.

It must be treated exactly like a rheumatism.

After bleeding once or more, a blister applied to the affected part is often attended with a very good effect—this being indeed the kind of pleurisy in which it particularly agrees.

It sometimes gives way to the first bleeding; often terminating on the third, fourth, or fifth day by a very plentiful sweat, and rarely lasting beyond the seventh.

Chapter XXI

Of Colics §[202]. By a 'colic' I mean all the pains that affect the stomach or the guts.

I have proved before that in some diseases the patient is killed by forcing him into a sweat. In colics the patient is killed by endeavouring to expel the wind by spirituous liquors.

Of the inflammatory colic

I he most violent kind of colic, and the most dangerous, is that which proceeds from the inflammation of the stomach or intestines. It begins by a violent pain in the belly. The pain increases by degrees, the pulse becomes quick and hard, the patient feels a burning heat in all his belly. Sometimes he has a watery diarrhoea; at other times he is rather costive and subject to vomitings. The countenance becomes red, the belly distends, and it cannot be touched without increasing the pain. The thirst is very great, no drink can quench it. The pain extends often to the loins, where it is very sharp. The patient makes little urine, and what he makes is burning and red.

He gets no rest. Sometimes he raves. If the disease is not stopped

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till the pains come to the height, the pulse becomes less strong, less hard, but more quick. The face loses its redness. The parts around the eye become livid. The patient loses his strength entirely. His face, hands, feet, and the whole body except the belly become cold.

The skin of the belly turns bluish. Weakness ensues, and the patient dies. There happens often, a moment before death, a plentiful evacuation by stool, of matter extremely fetid, and it is during that evacuation that the patient dies, with his bowels mortified.

When the disease attacks the stomach, the symptoms are the same. The patient vomits almost all that he takes, the torment is horrible, and the ravings come very soon. This distemper kills in a few days.

§[204]. The method of cure is:

1. Take a large quantity of blood from the arm. This almost immediately diminishes the pain and allays the vomiting. It is often necessary to repeat this bleeding within the space of two hours.

2. Whether the patient has a looseness or not, a clyster of a decoction of mallows, or of barley water and oil, should be given every two hours.

3. The patient should drink very plentifully of warm almond milk (No. 4), or barley water.

4. Flannels, dipped in hot water, should be continually applied over the belly, shifting them every hour, or rather oftener.

5. If the disease, notwithstanding, continues violent, the patient should be put into a warm bath, the extraordinary success of which I have observed.

When the pains and fever are ceased, so that the patient recovers a little strength and gets a little sleep, it will be proper to give him two ounces of manna, and a quarter of an ounce of Epsom salt dissolved in a glass of clear whey. Manna alone may suffice for delicate constitutions. All sharp purges would be highly dangerous.

It is sometimes the effect of a general inflammation of the blood, and is produced like other inflammatory diseases by extraordinary labour, very great heat, heating meats or drinks. It is often the consequence of other colics which have been injudiciously treated.

During the progress of this violent disease no food is to be allowed. And we should not be too inattentive to such degrees of pain as sometimes remain after their severity is over, lest a scirrhus should be generated, which may occasion the most inveterate maladies.

An inflammation of the intestines, and one of the stomach, may also terminate in an abscess. And it may be apprehended that

Medical and Health Writings one is forming when, though the violence of the pain abates, there still remains a flow, heavy pain with general inquietude, little appetite, frequent shiverings, the patient at the same time not recovering any strength. In such cases the patient should be allowed no other drinks but what are directed in this chapter, and some soups made of pulse [i.e., legumes], or other farinaceous food.

The breaking of the abscess may sometimes be discovered by a slight fainting fit, attended with a perceivable cessation of a weight in the part where it was lately felt. And when the pus is effused into the gut the patient sometimes has retchings to vomit, a swimming in the head, and the matter appears in the next stools. In this case there remains an ulcer within the gut which, if either neglected or improperly treated, may pave the way to a slow wasting fever, and even to death. Yet this I have cured by making the patient live solely upon skimmed milk, diluted with one third part water, and by giving every other day a clyster consisting of equal parts of milk and water, with the addition of a little honey.

Of the bilious colic.

The bilious colic discovers itself by very acute pains, but is seldom accompanied with a fever, at least not until it has lasted a day or two. And even if there should be some degree of a fever, yet the pulse, though quick, is neither strong nor hard. The belly is neither tense nor burning hot. The urine comes away with more ease and is less high-coloured. Nevertheless the inward heat and thirst are considerable. The mouth is bitter. The vomiting or purging, when either of them attend it, discharge a yellowish humour or excrement. And the patient's head is often dizzy.

§[208]. The method of curing this is:

1. By injecting clysters of whey and honey; or, if whey is not readily procurable, by repeating the clyster No. 5.

2. By making the sick drink considerably of the same whey, or of a ptisan made of the root of dog's grass (the common grass) and a little juice of lemon, for want of which, a little vinegar and honey may be substituted in place of it.1

3. By giving every hour one cup of the medicine No. 32; or where Pullet (or rather chicken) broth, made very weak, may often do instead of ptisan, or serve for a little variety of drink [Rast (see Advice, 313)]. Beef tea also may be used for the same purpose [JW],

Advices with Respect to Health 487

this is not to be had, half a dram of cream of tartar at the same short intervals.

4. Fomentations of warm water and half-baths are also very proper.

5. II the pains are sharp in a robust strong person, and the pulse is strong and tense, bleeding should be used.

6. No other nourishment should be given except some thin soups, made from vegetables, and particularly of sorrel.

7. After plentiful dilution with the proper drink, if no fever supervenes, if the pain still continues and the patient discharges but little by stool, he should take a moderate purge. That directed [in]

No. 47 is a very proper one.

This bilious colic is habitual to many persons, and may be prevented by an habitual use of the powder No. 24, by submitting to a moderate retrenchment in the article of flesh-meat, and by avoiding heating and greasy food, and the use of milk.

Of colics from indigestions, and of indigestion.

Under this appellation I comprehend all those colics which are either owing to any overloading quantity of food taken at once, or to a mass of aliments formed by degrees in such stomachs as digest but imperfectly, or which result from noxious mixtures of aliment in the stomach such as that of milk and acids, or from food either not wholesome in itself or degenerated into an unwholesome condition.

This kind of colic may be known from any of these causes having preceded it, [and] by its pains, which come on by degrees, being less fixed than in the colics before treated of. These colics are also without any fever, heat, or thirst, but accompanied with giddiness and efforts to vomit.

These disorders are not dangerous in themselves, but may be made such by injudicious management, as the only thing to be done is to promote the discharges by warm drinks. There are a considerable variety of them which seem equally good, such as warm water or even cold water with a toast, a light infusion of camomile, common tea, or balm—it imports little which, provided the patient drinks plentifully. In consequence of which the offending matter is discharged, either by vomiting or a considerable purging; and the speedier and more in quantity these discharges are, the sooner the patient is relieved.

Medical and Health Writings If the belly is remarkably full and costive, clysters of warm water and salt may be injected. The expulsion of the obstructing matter is also facilitated by rubbing the belly heartily with hot cloths.

It is often found that after these plentiful discharges, and when the pains are over, there remains a very disagreeable taste in the mouth, resembling the savour of rotten eggs. This may be removed by giving some doses of the powder No. 24, and drinking largely of good w ater.

It is an essential point in these cases to take no food before a perfect recovery.

Some have been absurd enough to fly to some heating cordial, to Venice treacle, aniseed water, geneva or red wine. But there cannot be a more fatal practice, since evacuations are the only thing which can cure the complaint. And should this endeavour of stopping them succeed, the patient is either thrown into a putrid fever or some chronical malady; unless nature, wiser than such a miserable assistant, should prevail over the obstacles opposed to her recovery and restore the obstructed evacuations in the space of a few days.

Sometimes an indigestion happens with very little pain, but with violent retchings and cold sweats. And not seldom the malady begins only with a sudden and unexpected fainting. The patient immediately loses his senses, his face is pale and wan. He has some hiccups which, joined to the smallness of his pulse and to the circumstance of his being attacked very soon after a meal, makes this disorder distinguishable from a real apoplexy. Nevertheless, when it rises to this height, it sometimes kills in a few hours.

The first thing is to throw up a sharp clyster, in which salt and soap are dissolved. Next to get down as much salt and water as he can swallow. And if that is ineffectual, the powder No. [3443] is to be dissolved in three cups of water, one half of which is to be given directly; and if it does not operate in a quarter of an hour, the other half. Generally speaking, the patient's sense begins to return as soon as he begins to vomit.

Of the flatulent or windy colics.

Every particular which constitutes our food, whether solid or liquid, contains much air. If they do not digest soon

4,Orig., 'No. 4'; a mistake, because it is not a powder. Tissot had said '34'.

44The numbering '§215' is mistakenly duplicated at this point; reducing the correction needed in numbering to two.

Advices with Respect to Health

enough, or but badly; if they contain an extraordinary quantity of air; or if the guts being compressed anywhere in the course of their extent, prevent that air from being equally diffused (which must occasion a greater proportion of it in some places) then the stomach and the guts are distended.

This species of colic rarely appears alone but is often complicated with the other sorts, of which it is a consequence, and is more especially joined with the colic from indigestions. It may be known, like that, by the causes which preceded it; by its not being accompanied either with fever, heat, or thirst; the belly's being large and full, though without hardness; being unequal in its largeness, which prevails more in one part of it than in another, forming something like pockets of wind, sometimes in one part, sometimes in another; and by the patient's feeling some ease merely from the rubbing of his belly, as it moves the wind about, which escaping either upwards or downwards affords him still greater relief.

When it is combined with any different species of the colic it requires no distinct treatment and it is removed by the medicines which cure the principal disease.

Sometimes however it does exist alone, and then it depends on the windiness of the food taken by the person affected with it— such as new wine, beer, especially very new beer, certain fruits, and garden stuff. It may be cured by chaffing the belly with hot cloths, by the use of drink moderately spiced, and especially by camomile tea. When the pains are abated, and there is no fever, the patient may take a little aromatic or spiced wine, which is not to be allowed in any other kind of colic.

When a person is frequendy subject to colic pains it is a sign that the digestive faculty is impaired, the restoring of which should be carefully attended to, without which his health must suffer considerably.

Of colics occasioned by cold.

When any person has been very cold, especially in his feet, it is common for him to be attacked within a few hours with violent colic pains, in which heating and spirituous medicines are very pernicious, but which are easily cured by rubbing the legs well with hot cloths and keeping them afterwards for a considerable time in warm water, at the same time drinking freely of a light infusion of camomile, or toast and water.

Medical and Health Writings The cure will be effected the sooner if the patient is put to bed and sweats a little, especially in the legs and feet.

If the pain be excessive, it may be necessary to give a clyster of warm water, to keep the legs several hours over the steam of hot water and afterwards in the water, to drink plentifully of an infusion of camomile. If the distemper is not subdued by these means, blisters should be applied to the legs, which I have known to be highly efficacious.

It appears through the course of this chapter that we must be on our guard against heating and spirituous medicines in colics, as they may not only aggravate but even render them mortal. In short they should never be given. And when it is difficult to discover the real cause of the colic, I advise country people to confine themselves to these remedies which cannot be hurtful. Let the patient drink warm water plentifully, and let the belly be often fomented in pretty warm water, which is the best fomentation of any.

I have mentioned nothing here of the use of any oils in this disease. I advise a total disuse of them, since they may be of bad consequence in many respects.

Chronical diseases not coming within the plan of this work, I purposely forbear treating of them. But I think it my duty to admonish those subject to them that they should: 1) avoid with the greatest care the use of sharp, hot, violent medicines, vomits, strong purges, elixirs. 2) They should be thoroughly on their guard against all those who promise them a very speedy cure, by the assistance of some specific remedy. 3) They should be convinced they can entertain no reasonable hope of being cured without an exact conformity to a proper regimen, and a long perseverance in a course of mild and safe remedies. 4) They should continually reflect that there is little difficulty in doing them great mischief, and that their complaints require the greatest knowledge in those persons to whom the treatment and cure of them are committed.

Chapter XXII

Of the Iliac Passion, and the Cholera Morbus §[218]. The iliac passion is the most tormenting of all diseases.

If the intestines are closed up in any part, all the food is stopped and the continual motion which is observed in the bowels to force everything downwards is done a direct contrary manner, and forces everything towards the mouth.

Advices with Respect to Health

The disease begins sometimes after a costiveness of some days.

At other times it is preceded by pains in the belly, especially round the navel, which pains, increasing by degrees, become at last very violent. Some feel a hard tumour round the belly, as if it was a cord. Flatulencies are heard, some come out upwards. And the vomitings, which supervene soon, increase till the patient throws

up all that he has taken, with inexpressible pain. At the beginning he casts up the last food which he took with some yellowish matter, and his drink. But afterwards the matter becomes stinking. And when the disease is come to a height, the matter has a smell which is called the smell of excrement, but which is more like the smell of a corrupted dead body. Sometimes likewise, if the patient has taken injections of a strong smell, the same is found in what is vomited up. But I never saw anybody vomit up real excrements, nor the composition of clysters. During all the distemper the patient has not one stool, the belly is tense, the urine suppressed, or thick and stinking. The pulse, which at first was pretty hard, becomes quick and small.45 The strength is lost. The patients rave. There comes on almost always a hiccup, and sometimes general convulsions.

The extremities grow cold, the pains and vomitings cease, and the patient dies.

As this disease is highly dangerous, the moment it is apprehended it is necessary to oppose it. The smallest error may be of fatal consequence, and hot liquors kill the patient in a few hours.

This disease should be treated precisely in the same manner as an inflammatory colic.

1. The patient should be plentifully bled, if the physician has been called in before the sick has lost his strength.

2. He should receive opening clysters made of a decoction of barley water, with five or six ounces of oil in each.

3. We should endeavour to allay the violent efforts to vomit, by giving every two hours a spoonful of the mixture No. 48.

4. The sick should drink plentifully, in very small quantities, very often repeated, of an appeasing, diluting drink, which tends to promote both stools and urine. Nothing is preferable to the whey

No. 49, if it can be had immediately. If not, give simple clear whey sweetened with honey, and the drinks prescribed [in] §[204], art. 3.

5. The patient is to be put into a hot bath, and kept as long as he can bear it; repeating as often daily as his strength will permit.

45 Orig., 'slow'; but this contradicts 'quick'. We restore 'small', which was the word in Tissot.

Medical and Health Writings 6. After bleeding, warm bathing, repeated clysters, and fomentations, if all these have availed nothing, the smoke of tobacco may be introduced in the manner of a clyster.

I cured a person of this disease by conveying him into a bath, immediately after bleeding him, and giving him a purge on his going into the bath.

If the pain abates before the patient has quite lost his strength, if the pulse improves, if the vomitings are less, if he feels some rumbling in his bowels, if he has some little discharge by stool, and if at the same time he feels a little stronger, his cure may reasonably be expected. But if he is otherwise circumstanced, he will soon depart. It frequently happens, a single hour before death, that the pain seems to vanish and a surprising quantity of extremely fetid matter is discharged by stool. The patient is suddenly seized with a great weakness and sinking, falls into a cold sweat, and immediately expires.

Of the cholera morbus.

This disease is a sudden, abundant, and painful evacuation by vomiting and by stool.

It begins with much wind and slight pains in the belly, followed with large evacuations either by stool or by vomit at first, but whenever either of them has begun the other quickly follows. The pulse is almost constantly feverish, is sometimes strong at first, but soon sinks into weakness, in consequence of the prodigious discharge.

Some patients purge a hundred times in the compass of a few hours.

They may even be seen to fall away. After a great number of them they are afflicted with cramps in their legs, thighs, and arms. When the disease rages too highly to be assuaged, hiccups, convulsions, and a coldness of the extremities approach. There is a scarcely intermitting succession of fainting fits, the patient dying either in one of them or in convulsions.

It commonly prevails towards the end of July and in August, especially if the heats have been very violent, and there have been little or no summer fruits, which greatly conduce to allay the putrescent acrimony of the bile.

Our first endeavour should be to drown this acrid bile by

wIn original, §223 is here repeated; reducing the amount of the corrected numbering to one.

Advices with Respect to Health

the most mitigating drinks. Wherefore the patient should continually take in either barley water or pure water, with one eighth part milk. Or he may use a very light decoction of bread, which is made by gently boiling a pound of toasted bread in five or six quarts of water for half an hour.

A very light soup made of a pullet, or one pound of lean veal, in four quarts of water is very proper. Whey is also employed to good purpose. And in those places where it can be easily had, buttermilk is the best drink of any. But whichever of these drinks shall be thought preferable, it is a necessary point to drink very plentifully of it.

2. If the patient's attendants use Venice treacle, mint water, syrup of white poppies (called 'diacodium'), opium, or mithridate, it either happens that the disease and all its symptoms are heightened or, if the evacuation should actually be stopped, the patient is thrown into a more dangerous condition.

If the pains and evacuations gradually abate, it will still be proper to persevere in the medicines already directed, though somewhat less frequently. And now we may allow a few soups from mealy substances. And as soon as they are quite ceased, he must be referred to the regimen so frequently recommended to persons in a state of recovery, when the concurring use of the powder No.

24, taken twice a day, will greatly assist to hasten and establish his health.

Chapter XXIII Of the Diarrhoea §[224]. Those fluxes which attack suddenly, without any preceding distemper, which are not attended with strong pains or a fever, are rather an advantage than disadvantage. They evacuate matter that has been long amassed, which, were it not carried off, would produce some distemper.

These purgings then must not be stopped. They go away generally of themselves when all the hurtful matter is discharged, and they require no medicine. All that ought to be done is to diminish the quantity of food; to abstain from eating flesh, eggs, and wine; to live on soup, pulse [i.e., legumes], or a little fruit raw or baked; and to drink a little more than usual.

If after five or six days the distemper continue, and the pains increase, then it must be stopped. For that effect a man must

Medical and Health Writings be put into a regimen. And if the diarrhoea was accompanied with a great loathing, risings at the stomach, foulness of the tongue, and a bad taste in the mouth, the powder No. 35 must be given. If these symptoms should not happen, the powder No. 51 should be administered, and during the three hours after this medicine he should take every half hour a cup of weak broth.

If the diarrhoea, stopped by this medicine, should return at the end of some days, it would be a proof that there remains a tenacious matter which has not been discharged. In this case the medicines

No[s], 21, 23, or 4747 must be given; and afterwards, the patient must take, fasting, for two mornings, the half of the pow der No. 51.48

A purging is often neglected for a long time, from which neglect they degenerate into perpetual ones. In such cases the medicine No. 35 should be given first; then every other day for four times successively he should take No. 51. During all which time he should live on nothing but panada, or on rice boiled in weak chicken broth. A strengthening stomachic plaster has sometimes been successfully applied, which may be often moistened in a decoction of herbs boiled in wine. Cold and moisture should be avoided, which frequently occasion immediate relapses, even after the looseness had ceased for many days.

Chapter XXIV

Of the Dysentery §[227]. The dysentery is a flux, with strong gripings, and frequent inclinations to go to stool. There is commonly a little blood in the stools, but not always.

The dysentery is generally epidemical—it begins sometimes at the end of July, oftener in August, and ends when the frost begins.

It begins with a shivering for some hours, and great pains in the belly, which sometimes last many hours before the evacuations begin. The patient has vertigos, inclinations to vomit. He grows pale. His pulse however is not feverish, but generally small.

had '21, 25, or 27'; it is unclear whether JW changed purposefully or miscopied.

48Orig., '57'. This error was also drawn to JW's attention by John Valton; Wesley's quick correction in his letter of Feb. 9, 1775, was to suggest it should be '5'.

We have restored to '51', as in Tissot.

49In original §228 is duplicated, bringing the numbering in all editions back into agreement from this point.

Advices with Respect to Health 495

At last the stools come on. The first ones are often of a liquid and yellowish matter, but very soon they are mixed with glairy matter, and that glairy matter is coloured with blood. The pains increase, and the stools become so frequent that the patient has eight, ten, eleven, twelve, fifteen of them during the space of an hour. Then the fundament is irritated, the tenesmus (which is an inclination of going to stool, though there is no matter inwardly) joins to the dysentery, and occasions often a falling down of the fundament.

And this is a fresh pain for the patient, who discharges sometimes worms, thickened glairy matter which resembles pieces of the guts, and sometimes clots of blood.

A raging delirium sometimes comes on before the minute of expiration. I have seen a very unusual symptom accompany this disease in two persons, which was an impossibility of swallowing for three days before death.

Many of the sick have not the least fever, or a thirst is less common in the disease than in a simple looseness.

The most efficacious remedy is a vomit. That of No. 34, if taken on the first invasion of it, often removes it at once; and always shortens its duration. That of No. 35 is not less effectual. If the stools prove less frequent after the operation of either of them, it is a good sign; if they are no ways diminished, the disease is likefly] to be obstinate.

The patient is to be ordered to a regimen, abstaining from all flesh-meat with the greatest attention, until a perfect cure. The ptisan No. 3 is the best drink for him.

The day after the vomit he must take the powder No. 51, divided into two doses. The next day he should take no other medicine but his ptisan. On the fourth the rhubarb must be repeated, after which the violence of the disease commonly abates. His diet during the disease is nevertheless to be continued exactly for some days, after which he may be allowed to enter upon that of persons in a state of recovery.

The dysentery sometimes begins with an inflammatory fever, a feverish hard, full pulse, with a violent pain in the head and loins, and a stiff distended belly. In such a case the patient must be bled at once, and daily receive three or even four of the clysters No.

6, drinking plentifully of the drink No. 3.

When all dread of an inflammation is over, the patient is to be treated in the manner just related—though often there is no necessity for the vomit. And if the inflammatory symptoms have run high, his first purge should be that of No. 11, and the use of the rhubarb may be postponed till about the conclusion of the disease.

Medical and Health Writings I have cured many dysenteries by ordering the sick no other remedy but a cup of warm water every quarter of an hour, and it were better to rely on this simple remedy than to employ those of whose effects we are ignorant.

It sometimes happens that the dysentery is combined with a putrid fever, which makes it necessary, after vomit, to give the purges No. 23 or [No.] 47, and several doses of No. 24, before the rhubarb is given. No. 32 is excellent in this combined case.

When the dysentery is blended with symptoms of malignity, after premising the prescription No. 35, those of No. 38 and [No.] 39 may be called in successfully.

When the disease has already been of many days standing, without the patient's having taken any medicines, or only such as were injurious to him, he must be treated as if the distemper had but just commenced; unless some symptoms foreign to the nature of the dysentery had supervened upon it.

Relapses sometimes occur in dysenteries some few days after the patients appeared well, much the greater number of which are occasioned either by some error in diet, by cold air, or by being overheated. They are to be prevented by avoiding these causes of them, and may be removed by putting the patient on his regimen, and giving him one dose of the prescription No. 51.

This disease is sometimes combined too with an intermitting fever, in which case the dysentery must be removed first and the intermittent afterwards.

A prejudice which still generally prevails is that fruits are noxious in a dysentery, whereas ripe fruits of whatever species, and especially summer fruits, are the real preservatives from it. They thin and wash down the humours, especially the thick glutinous bile—ripe fruits being the true dissolvents of such, by which indeed they may bring on a purging, but such a one as is a guard against a dysentery.

We had an extraordinary abundance of fruit in 1759 and 1760, but scarcely any dysenteries. Whenever I have observed dysenteries to prevail I made it a rule to eat less flesh and plenty of fruit. I have never had the slightest attack of one, and several physicians used the same caution with the same success.

I have seen eleven patients in a dysentery in one house, of whom nine ate fruit and recovered. The grandmother and one child, whom she loved more than the rest, did not. She managed the child after her own fashion, with burnt wine and spices but no fruit. She conducted herself in the very same manner, and both died.

Advices with Respect to Health

In a country seat near Berne, in the year 1751, when these fluxes made great havoc and people were severely warned against the use of fruits, out of eleven persons in the family ten ate plentifully of plums, and not one of them was seized with it. The poor coachman alone rigidly observed that abstinence from fruit, and took a terrible dysentery.

This distemper had nearly destroyed a Swiss regiment in garrison in the south of France. The captains purchased the whole crop of several acres of vineyard, where they carried the sick soldiers and gathered the grapes for such as could not bear being carried into the vineyard, those who were well eating nothing else. After this not one more died, nor were any more even attacked with the dysentery.

A clergyman was seized with a dysentery, which was not in the least mitigated by any medicines he had taken. By mere chance he saw some red currants. He longed for them and ate three pounds of them between seven and nine o'clock in the morning. That very day he became better, and was entirely well on the next.

It is necessary that each subject of this disease should have a dose stool apart to himself, as the matter discharged is extremely infectious. And if they make use of bedpans, they should be carried immediately out of the chamber, the air of which should be continually renewed, sprinkling vinegar frequently in it.

It is also necessary to change the patient's linen frequently, without which precautions the distemper becomes more violent and attacks others who live in the same house.

It has happened, by some unaccountable fatality, that there is no disease for which a greater number of remedies are advised than for the dysentery. Of these many boasted compositions, some are only indifferent but others pernicious. The only true method of cure is that I have advised, the purpose of which is evacuating the offending matter. All those methods which have a different scope are pernicious, and the method most generally followed (which is that of stopping the stool by astringents, or by opiates) is the worst of all, and even so mortal a one as to destroy a multitude of people annually and throw others into incurable diseases.

Chapter XXV The Treatment of Diseases peculiar to Women

Besides the preceding diseases, to which women are liable in common with men, their sex also exposes them to others peculiar

Medical and Health Writings to it, and which depend upon four principal sources, which are: their monthly discharges, their pregnancy, their labours in child birth, and the consequences of their labours. It is my present design only to give some general directions on these four heads.

Nature, who intended women for the increase and the nourishment of the human race at the breast, has subjected them to a periodical discharge of blood—which circumstance constitutes the source from whence the infant is afterwards to receive nutrition and growth.

This discharge commences generally with us between the age of sixteen and eighteen. Young maidens before this are often (and many for a long time) in a state of weakness, which is termed the 'green sickness'. And when the terms are slow and backward, it occasions grievous, and sometimes mortal diseases. Nevertheless, it is improper to ascribe all the evils to which they are subject at this term of life to this cause. The fibres of women (which are intended to give way when they are extended by the growth of the child) and its inclosing membranes should necessarily be less stiff and rigid, and more lax and yielding, than the fibres of men. Hence the circulation of their blood is more slow and languid than in males. Their blood is less dense, their fluids are more liable to stagnate and to form obstructions.

The disorders to which such a constitution subjects them might, in some measure, be prevented by assisting the feebleness of their natural movement through constant exercise. But this assistance, which is more necessary for females than males, they are partly deprived of by education, as they are usually employed in managing household business and light sedentary work. They stir about but little, whence their natural tendency to weakness increases. Their blood circulates imperfectly. The humours tend to a general stagnation, and none of the vital functions are completely discharged.

From such causes they sink into a state of weakness many years before this discharge could be expected. This state disposes them to be inactive. A little exercise fatigues them, whence they take none at all. It might prove a remedy of their complaint. But as it is disagreeable to them, they reject it, and thus increase their disorders.

Their appetite declines with the other vital functions, the usual kinds of food never exciting it. Instead of which they indulge themselves with whimsical cravings, and often of the oddest and most improper substances for nutrition.

After the duration of this state for a few years, the ordinary time of their monthly evacuations approaches, which however make not

Advices with Respect to Health the least appearance, for two reasons. The first is that their health is too much impaired to accomplish this new function at a time when all the others are so languid. And the second is that, under such circumstances, the evacuations themselves are unnecessary, since their final purpose is to discharge (when the sex are not pregnant) that superfluous blood which they were intended to produce. And this superfluity of blood does not exist in women who have been long in a low and languishing state.

Their disorder however continues to increase, and this increase is attributed to the nonappearance of their monthly efflux.

Whereas the disorder is not owing to that suppression, but this is the effect of their disorder.50

50 that all the complaints of young maidens are not owing to the want of their customs. Nevertheless it is certain some are, for instance when a strong young virgin in full of health, who manifestly abounds with blood, does not obtain this discharge at the usual time. Then this superfluous blood is the fountain of very many disorders.51

These discharges are suppressed, in the circumstances mentioned [in] §238, by a continuance of the disease which was first an obstacle to their appearance. And in other cases they have been suppressed by cold, moisture, violent fear, and very strong passion; by indigestion, or too hot and irregular diet; by exercise too long continued; and by unusual watching.

The great facility with which this evacuation may be suppressed, diminished, or disordered, the terrible consequences of such interruptions, and irregularities of them are cogent reasons to engage the sex to use all possible care, in every respect, to preserve the regularity of them, by avoiding during their approach and continuance every cause that may prevent or lessen them.

50JW omits: 'Neither is it unusual to see young lads, who have received from nature and from their parents a sort of feminine constitution, education, and habitude infested with much the same symptoms as obstructed young women. Country girls, who are generally more accustomed to such hard work and exercise as country men, are less subject to these complaints than women who live in cities'

(Advice, §353, p. 356).

51 JW omits: 'If the lazy inactive city girls are more subject to the obstructions, which either arise from the weakness and languor I have formerly taken notice of or which accompany it, country girls are more subject to complaints from this latter cause (too great a retention of superfluous blood) than women who live in cities, and it is this last cause that excites those singular disorders which appear so supernatural to the common people that they ascribe them to sorcery' (Advice,

Medical and Health Writings Besides the caution with which they should avoid these general causes just mentioned, every person ought to remember what has most particularly disagreed with her during that term, and forever constantly to reject it.

There are many women whose customs visit them without the slightest impeachment of their health. Others are sensibly disordered on every return of them. And to others again they are very tormenting, by the violent colics, of a longer or shorter duration, which precede or accompany them. I have known some of these violent attacks last but some minutes, and others which continued a few hours. But some have persisted for many days, attended with vomiting, fainting, with convulsions from excessive pain, with vomiting of blood, bleedings from the nose, which have brought them to the very jaws of death. Some are subject to these symptoms every month, from the first appearance to the final termination of these discharges, except proper remedies and regimen, and sometimes a happy childbirth, remove them. Others complain but now and then, every second, third, or fourth month. And there are some again who, having suffered very severely during the first months or years, suffer no more afterwards. A fourth number, after having had their customs for a long time without the least complaint, find themselves afflicted with cruel pains at every return of them if, by imprudence, they have incurred any cause that suppressed, diminished, or delayed them.

This consideration ought to suggest a proper caution even to such as generally undergo these discharges without pain. Since all may be assured that, though they suffer no sensible disorder at that time, they are nevertheless more delicate, more easily affected by the passions of the mind, and have also weaker stomachs at these periods.

These discharges may also be sometimes too profuse in quantity. In such cases recourse may be had to the directions I shall give hereafter.

Finally, after their continuance for a certain number of years (rarely exceeding thirty-five) they go off of their own accord, and necessarily, between the ages of forty-five and fifty. And this crisis is generally very troublesome, and often very dangerous.

The evils mentioned [in] §23952 may be prevented by avoiding the causes, and:

1. By obliging young maidens to use considerable exercise, especially as soon as there is the least reason to suspect the approach of the green sickness.

520rig., '§238'; an apparent mistake.

Advices with Respect to Health 501

2. By watching them carefully, that they eat nothing unwholesome or improper. The best drink for them is water, in which red hot iron has been extinguished.

3. They must avoid hot sharp medicines, and such as are intended to force down their terms, which are frequently attended with pernicious consequences and never do any good. And they are still the more hurtful as the patient is the younger.

4. If the malady increases, it will be necessary to give them some remedies. But these should not be purges, nor diluters, and decoctions of herbs, salts, and a heap of other useless and noxious ingredients. But they should take filings of iron, which is the most certain remedy in such cases. These filings should be of true simple iron, and not steel, and care should be taken that it be not rusty, in which state it has a very little effect.

At the beginning of this distemper, and to young girls, it is sufficient to give twenty grains daily, enjoining due exercise and a suitable diet. When it prevails in a severer degree, and the patient is not so young, a quarter of an ounce may be safely ventured on.

Certain bitters or aromatics may be joined to the filings, which are numbered in the appendix 54, 55, 56, and constitute the most effectual remedies in this distemper, to be taken in the form of powder, of vinous infusion, or of electuary. When there is a just indication to bring down the discharge, the vinous infusion No.

55 must be given, and generally succeeds. But I must again repeat it (as it should carefully be considered) that the stoppage of this discharge is frequently the effect, not the cause, of this disease; and that there should be no attempt to force it down, which, in such a case, may sometimes prove more hurtful than beneficial, since it would naturally return of its own accord with the strength of the patient. There are some cases particularly in which it would be highly dangerous to use hot and active medicines. Such cases for instance as are attended with some degree of fever, a frequent coughing, a bleeding, with great leanness and considerable thirst.

All which complaints should be removed before any hot medicines are given to force this evacuation, which many very ignorantly imagine cures all other female disorders—an error that has occasioned the loss of many women's lives.

The other sort of obstructions described [in] §24153 require a very different treatment. Bleeding, which is hurtful in the former sort, has often removed this. Bathing of the feet, the powder No. 20,

53Orig., '§240'; an apparent mistake.

Medical and Health Writings the whey, have frequently succeeded. But at other times it is necessary to accommodate the remedies and the method to each particular case, and to judge of it from its own peculiar circumstances and appearances.

When these evacuations naturally cease through age, if they stop suddenly and all at once, and had formerly flowed very largely,

1. Bleeding must be directed.

2. The usual quantity of food should be somewhat diminished, especially of flesh, of eggs, and of strong drink.

3. Exercise should be increased.

4. The patient should frequently take in a morning, fasting, the powder No. 24, which is very beneficial in such cases as it moderately increases the natural excretions by stool, urine, and perspiration; and thence lessens that quantity of blood which would otherwise superabound.

Nevertheless, should this total cessation be preceded by, or attended with, any extraordinary loss of blood, which is frequently the case, bleeding is not necessary. But the regimen and powder just directed are so. To which the purge No. 23, should now and then be joined, at moderate intervals. The use of astringent medicines at this critical time might dispose the patient to a cancer of the womb.

Many women die about this age, as it is an easy matter to injure them then; a circumstance that should make them very cautious in the medicines they recur to. On the other hand, it also frequently happens that their constitutions alter for the better after this. Their fibres grow stronger. They find themselves more hearty and hardy.

Many former infirmities disappear, and they enjoy a healthy and happy old age. I have known several who threw away their spectacles at the age of fifty-two or fifty-three, which they had used five or six years before.

Of disorders attending gravidation, or the term of going with child.

In gravidation, women are subject to pains of the stomach, to vomiting in a morning, to headache and toothache. In this case once blooding will for the most part suffice, and that no very plentiful one. Especially as we may assist this principal remedy by others of a more gentle kind, such as gentle purgatives, moderate exercise, and a thin spare diet.

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Sometimes after carrying too heavy burdens, after too much or too violent work, after receiving excessive jolts, or having had a fall, they are subject to violent pains of the loins, which extend down to their thighs and terminate quite at the bottom of the belly, and which commonly import that they are in danger of miscarrying.

To prevent this consequence they should:

1. Immediately go to bed; and if they have not a mattress, they should lie upon a bed stuffed with straw, a featherbed being very improper. They should keep themselves quite still in this situation for several days.

2. They should directly lose eight or nine ounces of blood from the arm.

3. They should not eat flesh, flesh-broth, nor eggs, but live solely on soups made of mealy substances.

4. They should take every two hours half a paper of the powder No. 20, and should drink nothing but the ptisan No. 2.

Some sanguine robust women are very liable to miscarry at a certain stage of their pregnancy. This may be obviated by their bleeding some days before that time approaches, and by their observing the regimen I have advised.

Of delivery or childbirth.

The errors which are incurred during actual labour are numberless, and too often irremediable. I shall only mark one. This is the custom of giving hot irritating things whenever the labour is very painful or slow—such as castor or its tincture, saffron, sage, rue, savin, oil of amber, wine, Venice treacle, wine burnt with spices, coffee, brandy, aniseed water, walnut water, fennel water, and other drams or strong liquors. All these things, far from promoting the woman's delivery, render it more difficult by inflaming the womb

(which cannot then so well contract itself) and the parts through which the birth is to pass, in consequence of which they swell, become more straitened, and cannot yield or be dilated. Sometimes these stimulating hot medicines bring on haemorrhages, which prove mortal in a few hours.

A considerable number both of mothers and infants might be preserved by the directly opposite method. As soon as a woman who was in good health, before the approach of her labour being

Medical and Health Writings robust and well made, finds her travail come on, and that it is painful and difficult, far from encouraging those premature efforts, and from furthering them by those pernicious medicines, she should be bled in the arm, which will prevent the swelling and inflammation, assuage the pains, relax the parts, and dispose everything to a favourable issue.

During actual labour no other nourishment should be allowed except a little panada every three hours, and as much toast and water as the woman chooses.

Every fourth hour a clyster should be given, consisting of a decoction of mallows and a little oil. In the intervals between these clysters she should be set over a kind of stove, or in a pierced easy chair, containing a vessel in which there is some hot water. The passage should be gently rubbed with a little butter, and stupes wrung out of a fomentation of simple hot water, which is the most efficacious of any, should be applied over the belly.

By this method many labours, which seem difficult at first, terminate happily. And this safe manner of proceeding at least affords time to call in further assistance. Besides the consequences of such deliveries are healthy and happy. When, by pursuing the heating practice, even though the delivery be effected, both the mother and infant have been so cruelly, though undesignedly, tormented that both of them frequently perish.

I acknowledge these means are insufficient when the child is unhappily situated in the womb, or when there is an embarrassing conformation in the mother. Though at least they prevent the case from proving worse, and leave time for calling in help.

Of the consequences of labour or childbirth.

The usual consequences of childbirth are: 1) an excessive haemorrhage, 2) an inflammation of the womb, 3) a sudden suppression of the lochia or usual discharges after delivery, and 4) the fever and other accidents resulting from the milk.

Excessive bleedings or floodings should be treated according to the manner directed [in] §250. And if they are very excessive, folds of linen, which have been wrung out of a mixture of equal parts of water and vinegar, should be applied to the belly, the loins, and the thighs. These should be changed for fresh moist ones as they dry, and should be omitted as soon as the bleeding abates.

Advices with Respect to Health The inflammation of the womb is discoverable by pains in all the lower parts of the belly, by a tightness of the whole, by a sensible increase of pain upon touching it, a kind of red stain or spot that mounts to the middle of the belly as high as the navel (which spot, as the disease increases, turns black, and then is always a mortal symptom), by a very extraordinary degree of weakness, an amazing change of countenance, a light delirium, a continual fever with a weak and hard pulse, sometimes incessant vomitings, a frequent hiccup, a moderate discharge of a reddish, stinking, sharp water, frequent urgings to go to stool, a burning heat of urine, and sometimes an entire suppression of it.

This dangerous disease should be treated like inflammatory ones.

After bleeding, frequent clysters of warm water must by no means be omitted. Some should also be injected into the womb, and applied continually over the belly. The patient may also drink continually, either of simple barley water with a quarter of an ounce of nitre in every three pints of it, or of almond milk No. 4.

The total suppression of the lochia should be treated exactly in the same manner. But if, unhappily, hot medicines have been given in order to force them down, the case will generally prove a most hopeless one.

If the milk fever run[s] very high, the barley ptisan directed in §253, with a very light diet, consisting only of panada, or made of some other mealy substances, and very thin, generally remove it.

Delicate women, who have not all the attendance they want, and such as are obliged to work too soon, are exposed to many accidents. And hence, the separation of the milk in their breasts being disturbed, there are knots as it were, which are very painful and troublesome. They often happen on the thighs, in which case the ptisan No. 58 is to be drank, and the poultice No. 59 must be applied. These two remedies gradually dissipate the tumour, if that can be effected. But if matter is actually formed, a surgeon must open the abscess and treat it like any other.

Should the milk curdle in the breast, it is of the utmost importance immediately to dissolve that thickness, which would otherwise degenerate into a hardness and prove a scirrhus; and from a scirrhus, in process of time, a cancer.

This may be prevented by an application to these small tumours, as soon as ever they appear. For this purpose nothing is more effectual than the prescriptions No. 57 and [No.] 60. But under such menacing circumstances, it is prudent to take the best advice as early as possible.

Medical and Health Writings From the moment these hard tumours become obstinately so, and yet without any pain, we should abstain from every application—all are injurious, and greasy, sharp, resinous and spirituous ones often change the scirrhus into a cancer. Whenever it becomes manifestly such, all applications are equally pernicious, except that of No. 60.

Cancers have long been thought incurable. But within a few years past some have been cured by the remedy No. 57; which nevertheless is not infallible, though it should always be tried.

The nipples of women who give milk are often fretted or excoriated, which proves severely painful to them. One of the best applications is the most simple ointment, being a mixture of oil and wax melted together, or the ointment No. 66. Should the complaint prove very obstinate, the nurse ought to be purged, which generally removes it.

Chapter XXVI Directions concerning Children §258. Nearly all the children who die before they are one or two years old die with convulsions. People say they died of them, which is particularly true, as it is in effect the convulsions that have destroyed them. But then these convulsions are the consequences of other diseases, which require the utmost attention. The four principal causes are: the meconium (the excrements contained in the body of the infant at the birth), acidities (or sharp and sour humours), the cutting of the teeth, and worms. I shall treat briefly of each.

Of the meconium.

The stomach and guts of the infant, at its entrance into the world, are filled with a black sort of matter which is called the 'meconium'.

The evacuation of this excrement is procured by making them drink some water, to which a little sugar or honey is added, which will dilute this meconium and promote the discharge of it by stool, and sometimes by vomiting.

To be more certain of expelling all this matter they should take one ounce of compound syrup of succory, which should be diluted with a little water, drinking up this quantity within the space of four

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or five hours.11 This syrup is greatly preferable to all others given in such cases, and especially to oil of almonds.

Should the great weakness of the child seem to call for some nourishment, there would be no inconvenience in allowing a little biscuit well boiled in water, which is pretty commonly done, or a little very thin light panada.

Of acids or sharp humours.

Notwithstanding the bodies of children have been emptied, yet the milk very often turns sour in their stomachs, producing vomitings, violent colics, convulsions, or a looseness. There are but two purposes to be pursued in such cases: to carry off the sour humours, and to prevent the generation of more. The first of these intentions is best effected by the syrup of succory, or violets.

The generation of further acidities is prevented by giving three doses daily, if the symptoms are violent—and but two, or even one only, if they are moderate—of the powder No. 61, drinking after it balm tea.

It has been a custom to load children with oil of almonds as soon as ever they are infested with gripes.' But it is a pernicious custom, and attended with very dangerous consequences.

Infants are commonly most subject to colics during their earliest months, which abate as their stomachs grow stronger. They may be relieved in the fit by clysters of a decoction of camomile flowers, in which a bit of soap of the size of a hazelnut is dissolved, or by a piece of flannel wrung out of a decoction of camomile flowers, with the addition of some Venice treacle applied hot over the stomach and on the belly.

But a certain means to prevent these colics, which are owing to children's not digesting their milk, is to move and exercise them as much as possible, having a due regard however to their tender time of life.

"This method is used whenever the mother does not suckle her child. But when she does, these remedies seem useless. The mother should give her child the breast as soon as she can. The first milk, the 'strippings' as it is called in quadrupeds, which is very serous or watery, will be serviceable as a purgative; it will forward the expulsion of the meconium, prove gradually nourishing, and is better than biscuits or panada [Rast (see Advice, 277-78)].

VA little magnesia alba will be more proper for children than any oils whatever [Kirkpatrick (see Advice, 379)].

Medical and Health Writings §262. Before I proceed to the third cause of the diseases of children I must take notice of the first cares their birth requires, that is the washing of them the first time, merely to cleanse, and afterwards to strengthen them.

The whole body of an infant just born is covered with a gross humour, which is occasioned by the fluids in which it was suspended in the womb. There is a necessity to cleanse it directly from this, for which nothing is so proper as a mixture of one third wine and two thirds water; wine alone would be dangerous. This washing may be repeated some days successively. But it is a bad custom to continue to wash them warm, the danger of which is augmented by adding some butter to the wine in the water. If this gross humour that covers the child seems more thick and glutinous than ordinary, a decoction of camomile flowers, with a little bit of soap, may be used.

The regularity of perspiration is the great foundation of health.

To procure this the skin must be strengthened. But warm washing tends to weaken it. Therefore children should be washed, some few days after their birth, with cold water, in the state it is brought from the spring.

For this purpose a sponge is employed, with which they begin by washing first the face, the ears, the back part of the head (carefully avoiding the mould of the head), the neck, the loins, the trunk of the body, the thighs, legs and arms, and in short every spot. This method which has obtained for so many ages will appear shocking to several mothers. They would be afraid of killing their children by it. Yet they cannot give a more substantial mark of their tenderness to them than by subduing their fears and their repugnance.

Weakly infants are those who have the greatest need of being washed, and it seems scarcely credible how greatly this method conduces to their strength.

They should be washed very regularly every day, in every season, and every sort of weather. And in the fine warm season they should be plunged into a large pail of water, into a brook, a river, or a lake.

After a few days of crying they grow so well accustomed to this exercise that it becomes one of their pleasures, so that they laugh all the time of their going through it.

The first benefit of this practice is the keeping up their perspiration, and rendering them less obnoxious to the impressions of the air and weather. And it is in consequence of this that they are preserved from a great number of maladies, especially from knotty tumours, from obstructions, from diseases of the skin, and from convulsions.

Advices with Respect to Health

But care should be taken not to undo the benefit of this washing by the bad custom of keeping them too hot. There is not a more pernicious one than this, nor one that destroys more children. They should be accustomed to light clothing by day and light covering by night, to go with their heads very thinly covered, and not at all in the day time, after the age of two years.

They should not sleep in chambers that are too hot, and should live in the open air both summer and winter as much as possible.

Children who have been kept too hot are very liable to colds. They are weakly, pale, languishing, bloated. They are subject to hard knotty swellings, a consumption, all sorts of languid disorders, and either die in their infancy or only grow up into a miserable valetudinary life.

must add that infancy is not the only stage of life in which cold bathing is advantageous. I have advised it with remarkable success to persons of every age, even to that of seventy. And there are two kinds of diseases in which cold baths succeed very greatly— that is, in weakness of the nerves, and when perspiration is disordered. When persons are liable to colds, feeble and languishing, the cold bath reestablishes perspiration, restores strength to the nerves, and by that means dispels all the disorders which arise from these two causes in the animal economy. It should be used any time before dinner.

Of the cutting of the teeth.

Cutting of the teeth is often very tormenting to children. If it proves very painful, we should during that period:

1. Keep their bellies open by clysters, consisting only of a decoction of mallows.

2. Their ordinary quantity of food should be lessened for two reasons: first, because the stomach is then weaker than usual; and next, because a small fever sometimes accompanies the cutting.

3. Their usual quantity of drink should be increased a little. The best for them is an infusion of the leaves or flowers of the lime tree, to which may be added a little milk.

4. Their gums should frequently be rubbed with a mixture of equal parts of honey and mucilage of quince seeds, and a root of marsh mallows or liquorice may be given them to chew.

Medical and Health Writings Of worms.

The symptoms which make it probable they are infested with worms are slight, frequent, and irregular colics. A great quantity of spittle running off while they are fasting. A disagreeable smell of their breath, especially in the morning. A frequent itchiness of their noses, which make them scratch or rub them often. A very irregular appetite, pains at the stomach and vomitings. Sometimes a costive belly, but more frequently loose stools of indigested matter.

The belly larger than ordinary, the rest of the body meagre. A thirst which no drink allays. And often great weakness, with some degree of melancholy. Their urine is often whitish, some as white as milk.

Sometimes they are afflicted with palpitations, swoonings, convulsions, long and profound drowsiness, cold sweats which come on suddenly, fevers which have the appearances of malignity, obscurities and even loss of sight and of speech, palsies either of their hands, their arms, or their legs, and numbnesses. They have often the hiccup, a small and irregular pulse, ravings, and (what is one of the least doubtful symptoms) frequently a small dry cough.

There are a very great multitude of medicines against worms. The wormseed is a very good one. The prescription No.

62 is also a very successful one. And the powder No. 14 is one of the best. Flower of brimstone, the juice of cresses, acids, and honey water have often been serviceable. But the first three I have mentioned, succeeding by a purge, are the best. No. 63 is a purging medicine that the most difficult children may easily take.

A disposition to breed worms always shows the digestions are weak and imperfect, for which reason children liable to worms should not have food difficult to digest. A long continued use of filings of iron is the remedy that most effectually destroys this disposition.

Of convulsions.

I have already said that the convulsions of children are almost constantly the effect of some other disease, and especially of some of the four I have mentioned. Others sometimes occasion them.

The first of them is the corrupted humours that often abound in their stomachs and intestines, the consequence of too great a load

Advices with Respect to Health 511

of aliments or of such as the stomachs of children are incapable of digesting.

It may be known that the convulsions of a child are owing to this cause by a loathing stomach, by a foul tongue, a great belly, by its bad complexion, and its disturbed unrefreshing sleep.

A diminution of the quality of the food, and the purge No. 63, generally remove such convulsions.

The second cause is the bad quality of their milk. Whether it be that the nurse has fallen into a violent passion, some considerable disgust, or a great fright. Whether she has ate unwholesome food, drank too much wine, or strong drink. Whether she is seized with a descent of her monthly discharges and that has greatly disordered her health, or whether she be sick. In all these cases the milk is vitiated, and exposes the infant to violent symptoms.

The remedies for convulsions, from this cause, consist:

1. In letting the child abstain from this corrupted milk until the nurse shall have recovered her state of health and tranquillity.

2. In making the child drink plentifully of a light infusion of the lime tree flowers.™ In giving it no other nourishment for a day or two, except panada and other light spoon meat, without milk.

3. In purging the child with an ounce, or an ounce and a half, of manna.

A third cause which produces convulsions is the smallpox and the measles. Such convulsions require no other treatment but that proper for the disorder.

It is evident from what has been said that convulsions are commonly a symptom attending some other distemper, rather than an original distemper. That they depend on many different causes.

That hence there can be no general remedy for them. And that the only means which are suitable in each case are those which are proper to oppose the particular cause producing them.

The greater part of the pretended specifics which are employed in all sorts of convulsions are often useless, and oftener prejudicial.

Of this last sort are,

1. All sharp and hot medicines, spirituous liquors, oil of amber, other hot oils and essence, volatile salts, and such other medicines

Lime tree flowers have an agreeable flavour, which is communicated to water by infusion, and raises with it in distillation. These flowers may be gathered in most places in Britain in the month of July. They are considered by [Friedrich]

Floffman and several other writers as a specific in all kinds of spasms and pains, and even sometimes in the epilepsy [JW].

512 Medical and Health Writings

as by the violence of their action are likelier to produce convulsions than to allay them.

2. Astringent medicines, which are highly pernicious whenever the convulsions are caused by any sharp humour that ought to be discharged by stool, or when such convulsions are an effort of nature to effect a crisis. Besides that there is always some danger in giving them to children without mature consideration, as they often dispose them to obstructions.

3. Opiates, such as Venice treacle, mithridate, [and] syrup of poppies are also attended with the most embarrassing events in regard to convulsions, and are improper for nine-tenths of those they are advised to. It is true they often produce an apparent ease for some minutes, or hours. But the disorder returns with greater violence for this suspension, because they have augmented all the causes producing it.

Indeed there are some cases in which they are absolutely necessary, as: 1) when the convulsions continue after the original cause of them is removed; 2) when they are so violent as to threaten life, and when they prove an obstacle to the taking proper remedies; and 3) when the cause producing them is of such a nature as is apt to yield to the force of anodynes; as when, for instance, they have been the immediate consequence of a fright.

Some children are very obnoxious to convulsions. In general, cold bathing, and the powder No. 14 are serviceable in such circumstances.

General directions with respect to children.

shall conclude this chapter by such advice as may contribute to give children a more vigorous constitution, and to preserve them from many disorders.

First then, we should be careful not to cram them, and to regulate both the quantity and the set time of their meals, which is a very practicable thing even in the very earliest days of their life when the woman who nurses them will be careful to do it regularly. Perhaps indeed this is the very age when such a regulation may be the most easily effected.

Sickness is the only circumstance that can warrant any alteration in the order and intervals of their meals. And then this change should consist in a diminution of their usual quantity, notwith-

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standing a general and fatal conduct seems to establish the reverse.

And this pernicious fashion authorizes the nurses to cram these poor little creatures the more, in proportion as they have a real need of less feeding. They conclude, of course, that all their cries are the effects of hunger, and the moment an infant begins then they immediately stop his mouth with food, without once suspecting that these wailings may be occasioned by the uneasiness of an over-loaded stomach, or by pains whose cause is neither removed or mitigated by making the children eat—though the mere action of eating may render them insensible to slight pains for a few minutes.

Those who overload them with victuals, in hopes of strengthening them, are extremely deceived, there being no one prejudice equally fatal to such a number of them. Whatever unnecessary aliment a child receives weakens, instead of strengthens him. The stomach, when over-distended, suffers in its force and becomes less able to digest thoroughly. The excess of food last received impairs the concoction of the quantity that was really necessary. Which, being badly digested, is so far from yielding any nourishment to the infant that it weakens it, proves a source of diseases, and concurs to produce obstructions, rickets, the evil, slow fevers, a consumption, and death.

Another unhappy custom prevails with regard to the diet of children when they begin to receive any other food besides their nurse's milk, and that is to give them such as exceeds the digestive power of their stomachs, and to indulge them in a mixture of such things in their meals as are hurtful in themselves, and more particularly so with regard to their feeble and delicate organs.

To justify this pernicious indulgence, they affirm it is necessary to accustom their stomachs to every kind of food. But this notion is highly absurd, since their stomachs should first be strengthened, in order to make them capable of digesting every sort of food. And crowding indigestible, or very difficult digestible, materials into it is not the way to strengthen it. To make a foal sufficiently strong for future labour, he is exempted from any till he is four years old, which enables him to submit to considerable work without being the worse of it. But if, to inure him to fatigue, he should be accustomed immediately from his birth to submit to burdens above his strength, he could never prove anything but an utter jade. The application of this to the stomach of a child is obvious.

I shall add another important remark and it is this, that the too early work to which some children are forced becomes of real prejudice to the public. Hence families themselves are less numerous,

Medical and Health Writings flowers sweetened with honey. And supposing nothing else to be had, some warm water with the addition of a little salt.

7. Notwithstanding the sick discover tokens of life, we should not cease to continue our assistance, since they sometimes expire after these first appearances of recovering.

[8.] Lastly, though they should be manifestly reanimated, there sometimes remains an oppression, a coughing and feverishness.

And then it becomes necessary sometimes to bleed them in the arms, and to give them barley water plentifully.

Having thus pointed out such means as are effectual, I shall briefly mention some others which it is the custom to use.

1. These unhappy people are sometimes wrapped up in a sheep's, or calf's, or a dog's skin, immediately flayed from the animal. But their operations are more slow, and less efficacious, than the heat of a well-warmed bed.

2. The method of rolling them in an empty hogshead is dangerous, and misspends a deal of important time.

3. That also of hanging them up by the feet ought to be wholly discontinued. The froth which is one of the causes of their death is too thick and tough to discharge itself by its own weight. This must also be hurtful by its tending to increase the overfullness of the head and lungs.

At the very time of writing this, two young ducks who were drowned have been revived by a dry bath of hot ashes.' The heat of a dung heap may also be beneficial, and I have been informed, by a sensible spectator of it, that it effectually contributed to restore life to a man who had remained six hours under water.

Chapter XXVIII

Of Substances Stopped between the Mouth and the Stomach §275. The food we take in descends from the mouth through a very strait passage, the gullet, which joins to the stomach.

It happens sometimes that bodies are stopped in this channel, without being able either to descend or to return up again.

The danger of such cases does not depend so much on the nature of the obstructing substance as on its size, and of the manner in vBy much the most effectual application is common salt heated to a considerable degree [JW].

Advices with Respect to Health

which it forms the obstruction. And frequently the very food may occasion death, while substances less adapted to be swallowed are not attended with any violent consequences.

Whenever any substance is thus detained in the gullet there are two ways of removing it—that is, either by extracting it, or pushing it down. The safest is to draw it out, but this is not always the easiest. And as the efforts made for this purpose greatly fatigue the patient, if the occasion is urging, it may be eligible to thrust it down, if there is no danger from the obstructing body's reception into the stomach.

The substances which may be pushed down without danger are all common nourishing ones.

The substances we should endeavour to draw out, though it be more painful, are all those whose consequences might be dangerous if swallowed. Such are all totally indigestible bodies, as cork, linen rags, wood, stones, metals. And more especially if any further danger may be superadded to that of its indigestibility from the shape of the substance swallowed. Wherefore we should chiefly endeavour to extract pins, needles, fish bones, pointed fragments of bones, bits of glass, scissors, rings, or buckles.

When such substances have not passed in too deep, we should endeavour to extract them with our fingers. If they are lower we should make use of nippers or a small forceps. In case of necessity they might be made very readily out of two bits of wood. But this attempt to extract rarely succeeds if the substance has descended far.

If the fingers and the nippers fail, crotchets (a kind of hook) may be employed.

These may be made at once with a pretty strong iron wire, crooked at the end. It must be introduced in the flat way, and for the better conducting of it, there should be another curve or hook at the end it is held by, to serve as a kind of handle to it. Which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator's hold.

This crotchet is also very convenient whenever a substance somewhat flexible, as a pin or a fishbone, stick as it were across the gullet.

Another material employed on these occasions is the sponge.

Its property of swelling considerably, on being wet, is the foundation of its usefulness here.

If any substance is stopped in the gullet, but without filling up the whole passage, a bit of sponge is introduced, into that part that

Medical and Health Writings flowers sweetened with honey. And supposing nothing else to be had, some warm water with the addition of a little salt.

7. Notwithstanding the sick discover tokens of life, we should not cease to continue our assistance, since they sometimes expire after these first appearances of recovering.

[8.] Lastly, though they should be manifestly reanimated, there sometimes remains an oppression, a coughing and feverishness.

And then it becomes necessary sometimes to bleed them in the arms, and to give them barley water plentifully.

Having thus pointed out such means as are effectual, I shall briefly mention some others which it is the custom to use.

1. These unhappy people are sometimes wrapped up in a sheep's, or calf's, or a dog's skin, immediately flayed from the animal. But their operations are more slow, and less efficacious, than the heat of a well-warmed bed.

2. The method of rolling them in an empty hogshead is dangerous, and misspends a deal of important time.

3. That also of hanging them up by the feet ought to be w holly discontinued. The froth which is one of the causes of their death is too thick and tough to discharge itself by its own weight. This must also be hurtful by its tending to increase the overfullness of the head and lungs.

At the very time of writing this, two young ducks who were drowned have been revived by a dry bath of hot ashes.'The heat of a dung heap may also be beneficial, and I have been informed, by a sensible spectator of it, that it effectually contributed to restore life to a man who had remained six hours under water.

Chapter XXVIII

Of Substances Stopped between the Mouth and the Stomach §275. The food we take in descends from the mouth through a very strait passage, the gullet, which joins to the stomach.

It happens sometimes that bodies are stopped in this channel, without being able either to descend or to return up again.

The danger of such cases does not depend so much on the nature of the obstructing substance as on its size, and of the manner in 'By much the most effectual application is common salt heated to a considerable degree [JW].

Advices with Respect to Health

which it forms the obstruction. And frequently the very food may occasion death, while substances less adapted to be swallowed are not attended with any violent consequences.

Whenever any substance is thus detained in the gullet there are two ways of removing it—that is, either by extracting it, or pushing it down. The safest is to draw it out, but this is not always the easiest. And as the efforts made for this purpose greatly fatigue the patient, if the occasion is urging, it may be eligible to thrust it down, if there is no danger from the obstructing body's reception into the stomach.

The substances which may be pushed down without danger are all common nourishing ones.

The substances we should endeavour to draw out, though it be more painful, are all those whose consequences might be dangerous if swallowed. Such are all totally indigestible bodies, as cork, linen rags, wood, stones, metals. And more especially if any further danger may be superadded to that of its indigestibility from the shape of the substance swallowed. Wherefore we should chiefly endeavour to extract pins, needles, fish bones, pointed fragments of bones, bits of glass, scissors, rings, or buckles.

When such substances have not passed in too deep, we should endeavour to extract them with our fingers. If they are lower we should make use of nippers or a small forceps. In case of necessity they might be made very readily out of two bits of wood. But this attempt to extract rarely succeeds if the substance has descended far.

If the fingers and the nippers fail, crotchets (a kind of hook) may be employed.

These may be made at once with a pretty strong iron wire, crooked at the end. It must be introduced in the flat way, and for the better conducting of it, there should be another curve or hook at the end it is held by, to serv e as a kind of handle to it. Which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator's hold.

This crotchet is also very convenient whenever a substance somewhat flexible, as a pin or a fishbone, stick as it were across the gullet.

Another material employed on these occasions is the sponge.

Its property of swelling considerably, on being wet, is the foundation of its usefulness here.

If any substance is stopped in the gullet, but without filling up the whole passage, a bit of sponge is introduced, into that part that

Medical and Health Writings is unstopped, and beyond the substance. The sponge soon grows larger in this moist situation, and indeed the enlargement of it may be forwarded by making the patient swallow a few drops of water.

And then drawing back the sponge by the handle it is fastened to, as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body with it.

Sponge is also applied in another manner. When there is no room to convey it into the gullet, because the obstructing substance engrosses its whole cavity—and supposing it not hooked into the part, but solely detained by the straitness of the passage—a pretty large bit of sponge is to be introduced close to the obstructing substance.

Thus applied, the sponge swells, and thence dilates that part of the passage that is above this substance. The sponge is then withdrawn a little, and but a very little, and this substance being less pressed

upon above than below, it sometimes happens that the contraction of the lower part of the passage causes that substance to ascend.

And as soon as this first loosening of it has happened, the total disengagement of it easily follows.

When all these methods prove unavailable, there remains one more, which is to make the patient vomit. But this can scarcely be of service but when such obstructing bodies are simply engaged in, and not stuck into the sides of the oesophagus—since under this latter circumstance vomiting might occasion further mischief.

If the patient can swallow, a vomiting may be excited with the prescription No. 8, or with No. 34 or [No.] 35. By this operation a bone was thrown out which had stopped in the passage four and twenty hours.

When the patient cannot swallow, we may excite him to vomit by twirling about the feathery end of a quill in the bottom of the throat. But, if the obstructing body strongly compresses the whole circumference of the gullet, then no other resource is left but giving a clyster of tobacco. A certain person swallowed a large morsel of calf's lights,54 which stopped in the middle of the gullet and exactly filled up the passage. A surgeon unsuccessfully attempted various methods to extract it. But another, seeing the patient's visage becoming black and swelled, and his eyes ready to start, as it were, out of his head, caused a clyster of an ounce of tobacco boiled to be thrown up. The consequence of which was a violent vomiting, which threw up the substance that was so near killing him.

541.e., calf lung as an organ meat.

Advices with Respect to Health 519

When it is more convenient to push the obstructing body downwards, it has been usual to make use of leeks, or wax candle

(oiled and but a very little heated, so as to make it flexible), or of a piece of whalebone, or of iron wire, one extremity of which may be thickened and blunted in a minute with a little melted lead. Small sticks of some flexible wood may be as convenient for the same use, such as the birch tree, the hazel, the ash, the willow. All these substances should be very smooth, for which reason they are sometimes covered with a thin bit of sheep's gut.

Should it be impossible to extract the bodies mentioned [in] §276, we must prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few moments.

One of these four events is always the case after swallowing such things. They either 1) go off by stool, or 2) they are not discharged and kill the patient, or else 3) they are discharged by urine, or 4) are visibly extruded to the skin.

§282.1 shall add some general directions.

1. It is often usual to take a considerable quantity of blood from the arm, especially if the patient's breathing is extremely oppressed or when we cannot speedily succeed in our efforts to remove the obstructing substance, as the bleeding is adapted to prevent the inflammation which the frequent irritations from such substances occasion, and as by its disposing the whole body into a state of relaxation it might possibly procure an immediate discharge of the offending substance.

2. Whenever it is manifest that all endeavour, either to extract or to push down the substance are ineffectual, they should be discontinued, because the inflammation occasioned by persisting in them would be as dangerous as the obstruction itself.

3. While the means already advised are making use of, the patient should often swallow. Or if he cannot, he should frequently receive

(by injection through a crooked tube that may reach lower down than the glottis) warm water, either alone or mixed with milk, or a decoction of barley, of mallows, or of bran. A twofold advantage may arise from this. First, these softening liquors smooth and sooth the irritated parts. Secondly, an injection, strongly thrown in, has often been more successful in loosening the obstructing body than all attempts with instruments.

4. When after all we are obliged to leave this in the part, the patient must be treated as if he had an inflammatory disease. He must be bled, ordered to a regimen, and have his whole neck surrounded

Medical and Health Writings with emollient poultices. The like treatment must be used, though the obstructing substance be removed, if there is room to suppose any inflammation left in the passage.

5. A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. It has been experienced that a blow with the fist on the middle of the back has often disengaged such obstructing bodies. And I have known two instances of patients who had pins stopped in the passage and who, getting on horseback to ride out in search of relief at a neighbouring village, found each of them the pin disengaged after an hour's riding. One spit it out and the other swallowed it, without any ill consequence.

6. When there is an immediate dread of the patient's being suffocated, when bleeding him has been of no service, when all hope of freeing the passage in time is vanished, and death is seemingly at hand, the operation of opening the windpipe must be presently performed—an operation neither difficult to a tolerably expert surgeon, nor very painful to the patient.

7. When the substance that was stopped passes into the stomach, the patient must immediately be put into a very gentle regimen. He should avoid all sharp and inflaming food, wine, spirituous liquors, all strong drink, and coffee, taking but little nourishment at once, and no solids without their having been very well chewed. The best diet would be that of mealy soups, made of various leguminous grains, and of milk and water, which is much better than the common custom of swallowing oils.

The Author of nature has provided that in eating nothing should pass by the glottis into the windpipe. This misfortune nevertheless does sometimes happen, at which every instant there ensues an incessant cough, an acute pain, with suffocation. All the blood being forced up into the head, the patient is in great anguish, being agitated with violent motions, and sometimes dying on the spot.

In a case thus circumstanced, the patient should be struck often on the middle of the back. Some efforts to vomit should be excited.

He should be prompted to sneeze with any cephalic snuffs, which should be blown strongly up his nose.

If all these methods are ineffectual, bronchotomy must speedily be performed. By this operation some bones, a bean, and a fish bone have been extracted, and the patient has been delivered from approaching death.

When the esophagus is so fully and strongly closed that the patient can receive no food by the mouth, he is to be nourished by

Advices with Respect to Health 521

clysters of soup, jelly, and the like, or by slices of raw flesh applied to the pit of the stomach.

Chapter XXIX Of External Disorders, and such as require

Surgical Applications Of burns.

When a burn is trifling, it is sufficient to clap a compress of several folds of soft linen upon it, dipped in cold water, and to renew it every quarter of an hour till the pain is entirely removed.

But when the burn has blistered, a compress of very fine linen, spread over with the pomatum No. 64 should be applied over it, and changed twice a day.

If the true skin is burnt, and even the flesh under it be injured, the same pomatum may be applied. But instead of a compress, it should be spread upon a pledget of soft lint, to be applied very exactly over it; and over the pledget again, a slip of the simple plaster No. 65—which everybody may easily prepare; or, if they would prepare it, the plaster No. 66.

But besides this, whenever the burn has been very violent and is highly inflamed, the same means must be recurred to which are

used in violent inflammations. The patient should be bled, put into a regimen, and drink nothing but the ptisans No. 2, and [No.] 4.

If the ingredients for the ointment called 'nutritum' are not at hand to make the pomatum No. 64, one part of wax should be melted in eight parts of oil, to two ounces of which mixture the yolk of an egg should be added. A still more simple application is that of one egg, both the yolk and the white, beat up with two common spoonfuls of the sweetest oil without any rankness. When the pain of the burn and all its other symptoms have very nearly disappeared it is sufficient to apply the oil cloth No. 66.

Of wounds.

If a wound has penetrated into any of the cavities and has wounded any part contained in the breast or in the belly, or if it

Medical and Health Writings has opened some great blood vessel, or has wounded a considerable nerve, there is an absolute necessity for calling in a surgeon. But when the wound affects only the fleshy parts and the small vessels, it may be easily dressed without such assistance—since, in general, all that is necessary in such cases is to defend the wound from the impressions of the air, yet not so as to give any material obstruction to the discharge of the matter that is to issue from it.

If the blood does not flow out of any considerable vessel, but trickles almost equally from every spot of the wound, it may be permitted to bleed while some lint is speedily preparing. As soon as the lint is ready, so much of it may be introduced into the wound as will nearly fill it, without being forced in. It should be covered over with a compress dipped in sweet oil. And the whole dressing should be kept on with a bandage of two-fingers breadth, rolled on tight enough to secure the dressings, and yet so moderately as to bring on no inflammation.

This bandage with these dressings are to remain on twenty-four or forty-eight hours, wounds being healed the sooner for being less frequently dressed. At the second dressing all the lint must be removed. But if any of it should stick close, in consequence of the dried blood, it should be left behind, adding a little fresh lint to it; this dressing in other respects exactly resembling the first.

When, from the continuance of this simple dressing, the wound is become very superficial, it is sufficient to apply the plaster w ithout any lint.

When the wound is considerable, it must be expected to inflame before suppuration can ensue; which inflammation will be attended with pain, with a fever, and sometimes with raving too. In such a situation a poultice of bread and milk, with the addition of a little oil, that it may not stick too close, must be applied instead of the compress. Which poultice is to be changed, but without uncovering the wound, three or four times every day.

Should some pretty considerable blood vessel be opened by the wound, there must be applied over it a piece of agaric of the oak

(No. 6755). It is to be kept on by applying a good deal of lint over it, covering the whole with a thick compress, and then with a bandage a little tighter than usual. If this should not be sufficient to prevent bleeding, and the wound be in the leg or arm, a strong ligature must be made above the wound with a tourniquet, which is made in a moment with a skein of thread or of hemp that is passed round the

5:,Orig., '76'; corrected to '67' as inTissot.

Advices with Respect to Health

arm circularly, into the middle of which is inserted a piece of wood or stick of an inch thickness and four or five inches long; so that by turning round this piece of wood, any tightness or compression may be effected at pleasure. But care must be taken: 1) to dispose the skein in such a manner that it must always be two inches wider than the part it surrounds, and 2) not to strain it so tight as to bring on an inflammation.

All the boasted virtues of a multitude of ointments are downright nonsense or quackery.

Spirituous applications are commonly hurtful, and can be proper but in a few cases, which physicians and surgeons only can distinguish.

When wounds occur in the head, instead of the compress dipped in oil, the wound should be covered with a betony plaster; or when none is to be had in time, with a compress squeezed out of hot wine.

When the wound has penetrated to some internal part, no remedy is more certain than that of an extremely light diet. Such wounded persons as have been supposed incapable of living many hours after wounds in the breast, in the belly, or in the kidneys, have been completely recovered by living for several weeks on nothing but a barley (or other mealy) ptisans, without salt, without soup, without any medicine; and especially without the use of any ointments.

Of bruises.

In a contusion happening to any inward part the blood is either internally effused or the circulation wholly obstructed in some vital organ. This is the cause of the sudden death of person after a violent fall, or of those who have received the violent force of heavy bodies on their heads, or of some violent strokes without any evident external hurt or mark.

When the accident has occurred in a slight degree, and there has been no great nor general shock, external applications may be sufficient. They should consist of such things as are adapted: first, to attenuate and resolve the effused blood; and secondly, to restore the tone and to recover the strength of the affected vessels.

The best application is vinegar (diluted, if very sharp, with twice as much warm water), in which mixture folds of linen are to be dipped, within which the contused parts are to be involved, and these folds are to be remoistened and reapplied every two hours on the first day.

Medical and Health Writings Parsley, chervil, and houseleek leaves, lightly pounded, have also been successfully employed; and these applications are preferable to vinegar when a wound is joined to the bruise.y

It has been a common practice immediately to apply spirituous liquors, such as brandy or Arquebusade water. But these liquids, which coagulate the blood instead of resolving it, are truly pernicious.

It is still a more pernicious practice to apply in bruises plasters composed of greasy substances, rosins, gums, or earths. The most boasted of these is always hurtful, and there have been many instances of very slight contusions being aggravated into gangrenes by such plasters. Which bruises would have been entirely subdued by the economy of nature, if left to herself, in the space of four days.

Those suffusions of coagulated blood which are visible under the skin should never be opened, since they insensibly dissipate. Instead of which, by opening them, they sometimes terminate in a dangerous ulceration.

The internal treatment of contusions is exacdy the same with that of wounds, only that in these cases the best drink is the prescription No. 1, to three pints of which a dram of nitre must be added.

When any person has got a violent fall; has lost his senses, or is become stupid; when the blood starts out of his nostrils, or his ears; when he is greatly oppressed, or his belly feels very tight—which import an effusion of blood either into the head, the breast or the belly, he must first of all be bled upon the spot, and the means must be recurred to which have been mentioned [in] §289, giving the patient the least possible motion and by all means avoiding to jog or shake him, which would be directly killing him by causing a further effusion of blood. Instead of this, the whole body should be fomented with some one of the decoctions already mentioned. And when the violence has been chiefly impressed on the head, wine and water should be preferred to vinegar.

Falls attended with wounds, and even a fracture of the skull, and with the most alarming symptoms, have been cured by these internal remedies, and without any other external assistance except the use of the aromatic fomentation No. 68.

It is proper, in all considerable bruises, to open the patient's belly with a mild cooling purge such as No[s]. 11, 23, 32, 49. The prescription No. 24, and the honeyed whey, are excellent remedies.

vBut nothing is equal to electrifying [JW],

Advices with Respect to Health

In these circumstances wine, distilled spirits, and whatever has been supposed to revive, is mortal. We should not be too impatient because the patients remain some time without sense or feeling. Turpentine is more likely to do mischief than good. So is spermaceti, dragon's blood, crab's eyes, and ointments of whatever sort.

When an aged person gets a fall, though he should not seem in the least incommoded by it, if he is sanguine he should part with three or four ounces of blood. He should take immediately a few successive cups of tea sweetened with honey, and should move gently about. He must retrench a little from the usual quantity of his food, and accustom himself to very gentle, but very frequent exercise.

Sprains or wrenches should be treated as a contusion/ The best remedy in this case is absolute rest, after applying a compress moistened in vinegar and water, which is to be renewed and continued till the marks of the contusion entirely disappear.

Then indeed, and not before, a little brandy or Arquebusade water may be added to the vinegar. And the part should be strengthened and secured for a considerable time with a bandage, as it might otherwise be liable to fresh sprains, which would daily more and more enfeeble it. And if this evil is overlooked in its infancy, the part never recovers its full strength, and a small swelling often remains to the end of the patient's life.

If the sprain is moderate, a plunging of the part into cold water is excellent. But if this is not done immediately after the sprain, or if the contusion is violent, it is hurtful.

Of ulcers.

When ulcers arise from a fault of the blood, it is impossible to cure them without destroying the cause.

Rancid oils are one of the causes, which change the most simple wounds into obstinate ulcers.

What distinguishes ulcers from wounds is the dryness and hardness of the sides of ulcers, and the humours discharged from them—which instead of being ripe consistent matter is a liquid of a disagreeable scent, and so sharp that if it touch the adjoining skin it produces redness or inflammation.

z Electrifying cures all sort of sprains also [JW],

Medical and Health Writings Sometimes the hardness is so obstinate that it cannot be mollified but by scarifying the edges with a lancet. But when it may be effected by other means, let a pledget spread with the ointment No.

69 be applied all over the ulcer, and this pledget be covered again with a compress of several folds, moistened in the liquid No. 70, which should be renewed three times daily. Though it is sufficient to apply a fresh pledget only twice.

To forward the cure, salted food, spices, and strong drink should be avoided. The quantity of flesh-meat should be lessened, and the body be kept open by a regimen of pulse [i.e., legumes], of vegetables, and by the habitual use of whey sweetened with honey.

If the ulcers are in the legs, it is of great importance, as well as in wounds of the same parts, that the patient should walk about but little, and yet never stand up without walking. Negligence in this material point changes the slightest wounds into ulcers, and the most trifling ulcers into incurable ones.

Of frozen limbs.

It is common in rigorous winters for some persons to be pierced so with cold that their hands or feet are frozen just like a piece of flesh-meat exposed to the air.

If the person attempts to warm the parts that have been frozen, his case proves irrecoverable. Intolerable pains are the consequence, which are speedily attended with an incurable gangrene, and there is no means left to save the patient's life but by cutting off the gangrened limbs.

There is but one certain remedy in such cases, and this is to convey the person into some place where it does not freeze, but where it is but moderately warm. And there continually to apply to the frozen parts snow—if it be at hand; and if not, to keep washing them incessantly, but very gently (since all friction would at this juncture prove dangerous,) in ice water, as the ice thaws in the chamber. By this application the patients will be sensible of their feeling's returning very gradually to the part. In this state they may safely be moved into a place a little warmer, and drink some cups of the potion No. 13 or of another of the like quality.

Every person may be a judge of the danger of attempting to relieve such parts by heating them, and of the usefulness] of ice water, by daily experience. Frozen pears, apples, and radishes, being

Advices with Respect to Health

put into water just about to freeze, recover their former state and prove eatable. But if they are put into warm water or into a hot place, rottenness, which is a sort of gangrene, is the immediate effect.

When cold weather is extremely severe, and a person is exposed to it for a long time at once, it proves mortal in consequence of its congealing the blood and forcing too great a proportion of it up to the brain. So that the patient dies of a kind of apoplexy, which is preceded by a sleepiness. In this circumstance, the traveller who finds himself drowsy should redouble his efforts to move. For this sleep would prove his last.

The remedies in such cases are the same with those directed in frozen limbs. The patient must be conducted to an apartment rather cold than hot, and be rubbed with snow or with ice water.

And since it is known that many people have revived who had remained in the snow or had been exposed to the freezing air during five, or even six, days, and who had discovered no mark of life for several hours, the utmost endeavours should be used for the recovery of persons in the like circumstances.

Of kibes or chilblains.

These begin with a kind of swelling, which at first occasions a heat, pain, or itching. Sometimes they go off without any application. But at other times their heat, itching, and pain increase, so that the patient is often deprived of the free use of his fingers by the pain, swelling, and numbness.

Whenever the inflammation mounts to a still higher degree small blisters are formed, which are not long without bursting. They leave a rawness, as it were, which speedily ulcerates, and frequently proves a deep and obstinate ulcer.

In this case the veins, which are more superficial than the arteries, being more affected and straitened by the cold, do not carry off all the blood communicated to them by the arteries. Perhaps also the particles of cold which are admitted through the pores may act upon our fluids, as it does upon water, and occasion a congelation of them, or a considerable approach towards it.

Kibes occur most frequently to children, from their weakness and the greater tenderness of their organs. It is the frequent and strong alteration from heat to cold that contributes the most powerfully to them. And this effect of it is most considerable when the heat of the

Medical and Health Writings air is at the same time blended with moisture, whence the extreme and superficial parts pass suddenly as it were out of a hot into a cold bath. A man sixty years of age, who never before was troubled with kibes, having worn for some hours on a journey a pair of furred gloves in which his hands sweated, felt them very tender and found them swelled up with blood. This man was at that age first attacked with chilblains, which proved extremely troublesome. And he was every succeeding winter infested with them, within half an hour after he left off his gloves and was exposed to a very cold air.

Chilblains which attack the nose often leave a mark that alters the physiognomy, the aspect, of the patient for the remainder of his life.

And the hands of such as have suffered from very obstinate ones are commonly ever sensible of their consequences.

We should first do our utmost to prevent them, and next endeavour to cure such as we could not prevent.

Since they manifestly depend on the sensibility of the skin, the nature of the humours, and the changes of the weather from heat to cold, in order to prevent them: l)56 the skin must be rendered firmer, 2) that vicious quality of the temperament must be corrected, and 3) the persons so liable must guard themselves as well as possible against these changes of weather.

Now the skin of the hands, as well as that of the whole body, may be strengthened by washing or bathing in cold water. And in fact I have never seen children who had been early accustomed to this as much afflicted with chilblains as others. But a more particular regard should be had to the skin of the hands, which are more obnoxious to this disorder than the feet, by making children dip them in cold water and keep them for some moments together in it every morning, and every evening too before supper, from the very beginning of the fall. It will give the children no pain, during that season, to contract this habit. And when it is once contracted, it will give them no trouble to continue it throughout the winter. They may also be habituated to plunge their feet into cold water twice or thrice a week. And this method, which might be less adapted for grown persons, must be without objection with respect to such children as have been accustomed to it, to whom all its consequences must be useful and salutary.

But then further, 1) The children must be taught never to warm their hands before the fire. 2) They should never accustom themselves to wear muffs. They should never use gloves, unless

56Orig., 'first'.

Advices with Respect to Health

some particular circumstances require it. But if any, let the gloves be thin and smooth.

The first degree of this complaint goes off, as I have said, without the aid of medicine. But when they rise to the second degree, they must be treated like other complaints from congelation, with cold water, ice water, and snow.

No other medicine is so efficacious as very cold water, so as to be ready to freeze, in which the hands are to be dipped and retained for some minutes together, and several times daily. In short, it is the only remedy which ought to be applied when, the patient has the courage to bear it. It is the only application I have used for myself, after having been attacked with chilblains for some years past, from having accustomed myself to a muff.

There ensues a slight pain for some moments after plunging the hand into water, but it diminishes gradually. On taking the hand out, the fingers are numbed with the cold. But they presently grow warm again, and within a quarter of an hour it is entirely over.

The hands, on being taken out of the water, are to be well dried and put into thin gloves. After bathing three or four times their swelling subsides, so that the skin wrinkles. But by continuing the cold bathing it grows tight and smooth again. The cure is completed after using it three or four days, and the disorder seldom returns the same winter.

The most troublesome raging itching is certainly assuaged by plunging the hands into cold water.

The effect of snow is, perhaps, still more speedy. The hands are to be gently and often rubbed with it for a considerable time. They grow hot, and are a very high red for some moments, but perfect ease quickly succeeds.

Nevertheless, a very small number of persons, who have extremely delicate skins, do not experience the efficacy of this application.

It seems too active for them. It affects the skin like a blister, and increases instead of lessening the complaint.

When this last reason, or as some other circumstance—such as the child's want of courage, the monthly discharges in a woman, a violent cough, habitual colics—forbid this application, some others must be substituted. One of the best is to wear, day and night, without ever putting it off, a glove made of some smooth skin, such as that of a dog, which seldom fails to extinguish the disorder in some days time.

When the feet have chilblains, socks of the same skin should be worn, and the patient keep his bed for some days.

When the disorder is violent, the use of cold water prohibited, and the gloves just recommended have but a slow effect, the

Medical and Health Writings diseased parts should be moistened several times a day with some decoction rather more than warm—which, at the same time, should be dissolving and emollient. Such is that celebrated decoction of the scrapings of the peel of radishes, whose efficacy is still further increased by adding one sixth part of vinegar to the decoction.

As soon as the hands are taken out of these decoctions, they must be defended from the air by dog-skin gloves.

Vapours or steams are often more efficacious than decoctions. Whence instead of dipping the hands into these already mentioned, we may expose them to their vapours, with still more success. That of hot vinegar is one of the most powerful remedies. It may be needless to add that the affected parts must be defended from the air as well after the steams as the decoctions.

When the distemper is subdued by the use of bathings or steams, which make the skin supple and soft, then it should be strengthened by washing the parts with a little camphorated brandy, diluted with an equal quantity of water.

When the nose is affected with a chilblain, the steam of vinegar and a covering for it made of dog-skin are the most effectual applications. The same treatment is proper for the ears and chin, when infested with them. Frequently washing these parts in cold water is a good preservative.

Whenever the inflammation rises high, and brings on some degree of fever, the patient's usual quantity of strong drink and of flesh-meat must be lessened. His body should be kept open. He should take every evening a dose of nitre as prescribed [in] No. 20; and if the fever prove strong, lose some blood.

As many as are troubled with obstinate chilblains must be denied the use of strong liquor and flesh.

When the parts are ulcerated, besides keeping the patients strictly to the regimen of persons in a way of recovery, and giving them a purge of manna, the swelled parts should be exposed to the steams of vinegar. The ulcerations should be covered with a diapalma plaster, and the whole part should be enveloped in a smooth soft skin, or in thin cerecloths.

Of ruptures.

Ruptures sometimes occur at the very birth. Though more frequently they are the effects of violent crying, of a strong forcing cough, or of repeated efforts to vomit in the first months of infancy.

Advices with Respect to Health

They may happen afterwards at every age, either as consequences of particular maladies or accidents. They happen much oftener to men than women. And the most common sort, the only one of which I propose to treat, is that which consists in the descent of a part of the guts of the cawl into the scrotum.

When it occurs in little children, it is almost ever cured by making them constantly wear a bandage, which should be made only of fustian, with a little pillow or pincushion stuffed with linen rags, hair, or bran. There should be at least two of these bandages, to change them alternately. Nor should it ever be applied but when the child is laid on its back, and after being well assured that the gut or cawl has been safely returned into the cavity of the belly, since without this precaution it might occasion the worst consequences.

The good effect of the bandage may be further promoted by applying upon the skin and within the plait or fold of the groin some strengthening plaster, such as that mentioned §[975/]. Here we may observe that ruptured children should never be let on a horse, nor be carried by any person on horseback, before the rupture is perfectly cured.

In a more advanced age a bandage of fustian is not sufficient. One must be procured with a plate of steel, even so as to constrain and incommode the wearer a little at first. Nevertheless, it soon becomes habitual, and is then no longer inconvenient.

Ruptures sometimes attain a monstrous size, and a great part of the guts fall down into the scrotum. In this state the application of the truss is impracticable, and the patients are condemned to carry their burden for the remainder of their lives. Which may, however, be palliated a little by the use of a suspensory and bag, adapted to the size of the ruptures, when the part of the bowels which is fallen down inflames.

§311. The best means are:

1. As soon as ever this appears to bleed the patient very plentifully, as he lies down in his bed and upon his back, with his head a little raised and his legs somewhat bent, so that his knees may be erect. This is the posture they should always preserve as much as possible. When the malady is not too far advanced, the first bleeding often makes a complete cure, and the guts return up as soon as it is over. At other times this bleeding is less successful, and leaves a necessity for its repetition.

570rig., '144'. This is the number given inTissot, but JW failed to revise reflecting his elision of several sections. We show the proper paragraph.

Medical and Health Writings 2. A clyster must be thrown up consisting of a strong decoction of the large white beet leaves, with a small spoonful of common salt, and a piece of fresh butter of the size of an egg.

3. Folds of linen dipped in ice water must be applied all over the tumour, and renewed every quarter of an hour. This remedy, when immediately applied, has produced the most happy effects. But if the symptom has endured violently more than ten or twelve hours, it is often too late to apply it. And then it is better to make use of flannels dipped in a warm decoction of mallow and elder-flowers, shifting them frequently. It has been known however that ice water, or ice itself, has succeeded as late as the third day.3

4. When these endeavours are insufficient, clysters of tobacco smoke must be tried, which has often cured ruptures when everything else had failed.

Of boils.

Whenever their inflammation is very considerable, when there are a great many of them at once, and they prevent the patients from sleeping, it becomes necessary to enter them into a cooling regimen and to make them drink plentifully of the ptisan No. 2.

Should the inflammation be very high, a poultice of bread and milk, or of sorrel a little boiled and bruised, must be applied to it.

But if the inflammation is moderate, a plaster of the simple diachylon may be sufficient.

The boil commonly terminates in suppuration of a singular kind.

It breaks open at first on its top, when some drops of pus come out.

After which the core of it may be discerned, which may be drawn out entirely in the shape of a small cylinder. The emission of this core is commonly followed by the discharge of liquid matter. As soon as this discharge is made, the pain goes entirely off. And the swelling disappears at the end of a few days, by continuing to apply the simple diachylon.

"Pieces of ice applied between two pieces of linen, directly upon the rupture, as soon as possible after its first appearance, is one of those extraordinary remedies which we should never hesitate to make immediate use of. We may be certain by this application, if the rupture is simple and not complicated from some aggravating cause, to remove speedily and with very little pain, a disorder that might be attended with the most dreadful consequences. But the continuance of this application must be proportioned to the strength of the person ruptured, which may be sufficiently estimated by the pulse [Rast (see Advice, 478)].

Advices with Respect to Health

Of felons or whitlows.

The danger of these small tumours is much greater than is generally supposed. It is an inflammation of the end of the finger, which is often the effect of a small quantity of humour extravasated, whether this has happened in consequence of a bruise, a sting, or a bite. At other times it has resulted from no external cause, but is the effect of some inward one.

This disorder begins with a slow heavy pain, attended by a slight pulsation. But in a little time the pain, heat, and pulsation or throbbing become intolerable. The part grows large and red, the adjoining fingers and the whole hand often swelling up. In some cases a kind of red streak, beginning at the affected part, is continued almost to the elbow. Neither is it unusual for the patients to complain of a very sharp pain under the shoulder, and sometimes the whole arm is excessively inflamed and swelled. The sick have not a wink of sleep, the fever and other symptoms quickly increasing. Indeed, if the distemper rises to a violent degree, a delirium and convulsions supervene.

This inflammation of the finger determines either in suppuration or in a gangrene. When the last of these occurs, the patient is in great danger if he is not speedily relieved, and it has proved necessary more than once to cut off the arm, for the preservation of his life. When suppuration is effected, if the matter lies very deep, the bone is often carious and lost. But how gentle soever the complaint has been, the nail generally falls off.

The internal treatment in whitlows is the same with that in other inflammatory distempers. The patient must enter upon a regimen more or less strict, in proportion to the degree of the fever.

And if this runs very high, and the inflammation be very considerable, there may be a necessity for several bleedings.

The external treatment consists in allaying the inflammation, in softening the skin, and in procuring a discharge of the matter as soon as it is formed. For this purpose,

1. The finger affected is to be plunged, as soon as the disorder is manifest, in water a little more than warm. The steam of boiling water may also be admitted to it. And by doing these things almost constantly for the first day, a total dissipation of the malady has often been obtained. But unhappily it is commonly neglected till the disorder has greatly advanced, in which state suppuration becomes absolutely necessary.

2. This suppuration may be forwarded by involving the finger with a cataplasm of bread and milk. This may be rendered still more

Medical and Health Writings active by adding a few white lily roots, or a little honey. But this last must not be applied before the inflammation is somewhat abated and suppuration begins; before which term, all sharp applications are very dangerous. At this time, yeast or leaven may be advantageously used, which powerfully promotes suppuration.

A speedy discharge of the ripe matter is of considerable importance. But this particularly requires the attention of the surgeon, as it is not proper to wait till the tumour breaks. And this the rather as from the skin's proving sometimes extremely hard, the matter might be inwardly effused between the muscles, and upon their membranes, before it could penetrate through the skin.

For this reason, as soon as matter is suspected to be formed, a surgeon should be called in, to determine exactly on the time when an opening should be made—which had better be performed a little too soon than too late, and a little too deep than not deep enough.

When the orifice has been made, and the discharge effected, it is to be dressed with the plaster No. 66, spread upon linen or with the cerecloth, and these dressings are to be repeated daily.

When the whitlow is caused by a humour extravasated very near the nail, an expert surgeon cures it effectually by an incision which lets out the humour. Yet, notwithstanding this operation is in no ways difficult, all surgeons are not qualified to perform it, and but too many have no idea at all of it.

Proud flesh sometimes appears during the healing of the incision.

Such may be kept down with sprinkling a little red lead or burnt alum over it. But if a 'caries', a rottenness of the bone, should be a consequence, there is a necessity for a surgeon's attendance.

Of thorns, splinters, or other pointed substances piercing into the skin or flesh.

If such substances are immediately and entirely extracted, the accident is generally attended with no bad consequences.

Though more certainly to obviate any such, compresses of linen dipped in warm water may be applied to the part. But if any such body cannot be directly extracted, or if a part of it be left within, it causes an inflammation, which soon produces the same symptoms as a whitlow. Or if it happens in the leg, it inflames and forms a considerable abscess there.

Advices with Respect to Health

To prevent this, if the penetrating substance is still near the surface, and an expert surgeon is at hand, he must immediately make a small incision and extract it. But if the inflammation were already formed, this would be useless and even dangerous.

When the incision is improper, there should be applied to the affected parts (after conveying the steam of some hot water into it) a poultice of the crumb of bread, milk, and oil.

It is absolutely necessary that the injured part should be kept in the easiest posture, and as immoveable as possible.

If suppuration has not been prevented, the abscess should be opened as soon as ever matter is formed. I have known very troublesome events from its being too long delayed.

Of warts.

Warts are sometimes the effects of a particular fault in the blood, which extrudes a surprising quantity of them. This happens to some children from four to ten years old, and especially to those who feed most plentifully on milk. They may be removed by a moderate change of their diet, and the pills prescribed No. 18.

But they are more frequently an accidental disorder of the skin, arising from some external cause.

In this last case, if they are very troublesome in consequence of their great size, their situation, or their long standing, they may be destroyed: 1) by tying them closely with a silk thread, or with a strong flaxen one waxed; 2) by cutting them off with a sharp scissors, and applying a plaster of diachylon, with the gums, over the cut wart, which brings on a small suppuration that destroys the root of the wart; and 3) by drying or, as it were, withering them up by some moderately corroding application, such as that of the milky juice of fig leaves, or of spurge. But people who have very delicate skins should not make use of them, as they may occasion a painful swelling. Strong vinegar, charged with as much common salt as it will dissolve, is a very proper application to them. A plaster may also be composed from sal ammoniac and some galbanum, which, being kneaded up well together and applied, seldom fails of destroying them.

Wens, if of a pretty considerable size and duration, are incurable by any other remedy except amputation.

Medical and Health Writings Of corns.

The general causes of corns are shoes either too hard and stiff, or too small.

The whole cure consists in softening the corns by repeated washings and soakings of the feet in pretty hot water. Then in cutting them, when softened, with a penknife or scissors, without wounding the sound parts. And next in applying a leaf of house leek, of ground-ivy, or of purslane dipped in vinegar, upon the part. Instead of these leaves, if any person will give himself the little trouble of dressing them every day, he may apply a plaster of simple diachylon, or of gum ammoniacum softened in vinegar.

The increase or return of corns can only be prevented by avoiding the causes that produce them.

Chapter XXX

Of Swoonings §320. There are various kinds of swooning, or fainting away. The slightest is that in which the patient perceives and understands, yet without the power of speech. This happens frequently to vapourish persons, and without any observable alteration of the pulse.

If the patient totally loses sensation and understanding, with a very considerable sinking of the pulse, this is called a 'syncope', and is the second degree of swooning.

But if this syncope is so violent that the pulse seems entirely extinguished, without any perceivable breathing, with a manifest chilliness of the whole body, and a wan livid countenance, it constitutes a third degree, which is the true image of death.

Swoonings result from many different causes, of which I shall enumerate the principal; and these are: 1) too large a quantity of blood; 2) a defect of it, and a general weakness; 3) a load at, and violent disorders of, the stomach; 4) nervous maladies; 5) the passions; and 6) some kinds of diseases.

Of swoonings occasioned by excess of blood.

An excessive quantity of blood is frequently a cause of swooning, and it may be inferred that it is owing to this cause when it attacks sanguine, hearty persons. And more especially when it

Advices with Respect to Health

attacks them after being combined with any additional cause that suddenly increased the motion of the blood—such as heating meats or drinks, wine, spirituous liquors; smaller drinks (if taken very hot and plentifully) such as coffee, tea, or balm tea; a long exposure to the hot sun, or being detained in a very hot place; much and violent exercise, intense study or application; or some excessive passion.

In such cases: l.58 The patient should be made to smell, or even to snuff up, some vinegar. And his forehead, his temples, and his wrists should be bathed with it, adding an equal quantity of warm water, if at hand. Bathing them with distilled or spirituous liquids would be prejudicial in this kind of swooning.

2. The patient should be made, if possible, to swallow two or three spoonfuls of vinegar, with four or five times as much water.

3. The patient's garters should be tied very tight above his knees, as by this means a greater quantity of blood is retained in the legs, whence the heart may be less overladen with it.

4. If the fainting proves obstinate (that is, if it continues longer than a quarter of an hour), or degenerates into a syncope, an abolition of feeling and understanding, he must be bled in the arm, which quickly revives him.

5. After the bleeding the patient should be kept still and calm, only letting him drink, every half hour, some cups of elder-flower tea, with the addition of a little sugar and vinegar.

When swoonings which result from this cause occur frequently in the same person, he should, in order to escape them, pursue the directions I shall mention [in] §354.

The very same causes which occasion these swoonings frequently produce violent palpitations, preceding or following them.

Of swoonings occasioned by weakness.

If too great a quantity of blood is sometimes the cause of swooning, it is oftener the effect of a contrary cause, want of blood.

This sort of swooning happens after great discharges of blood, after sudden or excessive evacuations, or such as are more slow but of longer duration (as, for instance, after an inveterate purging, excessive sweats, a flood of urine), such excesses as tend to exhaust nature, obstinate wakefulness, a long inappetency (which, by de-

S8Orig., 'First of all'.

Medical and Health Writings priving the body of its necessary sustenance, is attended with the same consequences as profuse evacuations).

These different causes of swooning should be opposed by the remedies adapted to each. But the assistances that are necessary at the time of swooning are nearly the same for all cases of this class.

I.59 The patients should be laid down on a bed, and being covered, should have their legs and thighs, their arms and their whole bodies, rubbed pretty strongly with hot flannels. And no ligature should remain on any part of them.

2. They should have very spirituous things to smell or snuff up, such as Hungary water, spirit of sal ammoniac, strong smelling herbs as rue, sage, rosemary, mint, or wormwood.

3. These should be conveyed into their mouths, and they should be forced if possible to swallow, some drops of brandy or of some other potable liquor, mixed with a little water; while some hot wine mixed with sugar and cinnamon, which makes one of the best cordials, is getting ready.

4. A compress of flannel, dipped in hot wine, in which some aromatic herb has been steeped, must be applied to the pit of the stomach.

5. If the swooning seems likely to continue, the patient must be put into a well-heated bed, which has before been perfumed with burning sugar and cinnamon, the frictions of the whole body with hot flannels being still continued.

6. As soon as the patient can swallow he should take some soup or broth, or a little bread or biscuit soaked in the hot spiced wine.

7. Lastly, during the whole time that all precautions are taken to oppose the cause of the swooning, care must be had for some days to prevent any fainting by giving them often, and but little at a time, some light yet strengthening nourishment, such as panada made with soup instead of water, new laid eggs very lightly poached, light roast meats with sweet sauce, chocolate, and soups of the most nourishing meats.

Those swoonings which are the effect of bleeding, or of the violent operation of some purge, are to be ranged in this class.

Such as happen after artificial bleeding are generally very moderate, commonly terminating as soon as the patient is laid upon the bed. Persons subject to this kind should be bled lying down, in order to prevent it. But should the fainting continue longer than usual, some vinegar smelt to, and a little swallowed with some water, is a very good remedy.

590rig., 'First'.

Advices with Respect to Health 539

The treatment of such faintings or swoonings as are the consequences of too violent vomits or purges may be seen hereafter, §352.

Of faintings occasioned by a load or uneasiness at the stomach.

It has been already observed that indigestions were sometimes attended with swoonings, and indeed such vehement ones as require speedy succour. The indigestion is sometimes less the effect of the quantity than of the quality or the corruption of the food contained in the stomach. Thus we see there are some persons who are disordered by eating eggs, fish, or any fat meat, being thrown by them into inexpressible anguish attended with swooning. It may be supposed to depend on this cause when these very aliments have been lately eaten, and when it does not depend on the other causes

I have mentioned.

We should in this case revive the patients as in the former, by making them receive some very strong smell. But the most essential point is to make them swallow a large quantity of light warm fluid, which may serve to drown, as it were, the indigested matter.

Which may soften its acrimony, and either effect the discharge of it by vomiting or force it down into the intestines.

A light infusion of camomile flowers, of tea, of sage, of elderflowers, or of carduus benedictus operate with much the same efficacy.

The swooning ceases, or at least considerably abates in these cases, as soon as ever the vomiting commences.

When these swoonings are terminated, the patient must be kept for some days to a very light diet, and take at the same time, every morning fasting, a dose of the powder No. 38, which relieves the stomach of whatever noxious contents might remain in it and then restores its natural strength and functions.

Another kind of swooning results from a cause in the stomach, but different from this we have just been treating of. It arises from an extraordinary sensibility of this organ, and from a general weakness of the patient.

Those subject to this malady are valetudinary persons, whose stomachs are at once very feeble and sensible. They have a little uneasiness after a meal if they indulge but a little more than usual, or if they eat any food not quite so easy of digestion. Nay, should the weather only be unfavourable, and sometimes without any perceivable cause, their uneasiness terminates in a swoon.

Medical and Health Writings Patients swooning from these causes have more necessity for tranquillity and repose than for any other remedy, and it might be sufficient to lay them down on the bed. But some spirituous liquid may be held to their nose, while their temples and wrists are rubbed with it, and at the same time a little wine given.

This species of swooning is oftener attended with a little feverishness than the others.

Of those swoonings which arise from nervous disorders.

As there is no organ unprovided with nerves, and hardly any function in which the nerves have not their influence, it may be easily comprehended that the vapours being a state which arises from the nerves exerting irregular motions, and all the functions of the body depending partly on the nerves, there is no one symptom of other diseases which the vapours may not produce or imitate. It is also very conceivable that the vapours are a real malady, of which the surprising oddity of the symptoms is a necessary effect, and that no person can any more prevent his being invaded by the vapours than he can prevent the attack of a fever or of the toothache.

A few plain instances will furnish out a more complete notion of the vapours.

If an involuntary unusual motion in the nerves that are distributed through the lungs should straiten the little vesicles, or bladders, which admit the fresh air at every respiration, the patient will feel a degree of suffocation, just as if that straitening of the vesicles were occasioned by some noxious steam or vapour.

Should the nerves which are distributed throughout the whole skin, by a succession of these irregular motions, contract themselves, as they may from external cold, perspiration by the pores will be prevented. Whence the humours which should be evacuated through the pores will be thrown upon the kidneys, and the patient will make a great quantity of thin clear urine, a symptom very common to vapourish people. Or it may be diverted to the glands of the intestines, and terminate in a watery looseness, which frequently proves a very obstinate one.

Neither are swoonings the least usual symptoms attending from this source when they happen to a person subject to the vapours.

And we may be certain they spring from this source when they hap-

60 Number omitted in all four editions.

Advices with Respect to Health

pen to a person subject to the vapours, and none of the other causes have lately preceded them.

Such swoonings, however, are very rarely dangerous, and scarcely require any assistance. The patient should be laid upon a bed. The fresh air should be freely admitted to him. And in such faintings the smell of burnt leather, of feathers, or of paper have often proved of great service.

Persons also frequently faint away in consequence of fasting too long, from having eat[en] a little too much, from being confined in too hot a chamber, from having seen too much company, from smelling too overpowering a scent, from being too costive, from being forcibly affected with some discourse or sentiments; and, in a word, from a great variety of causes which make no impression on persons in perfect health but which violently operate upon them because their nerves are too acutely affected.

As soon as the particular cause is distinguished which has occasioned the present swooning, it is manifest this swooning is to be remedied by removing that cause of it.

Of swoonings occasioned by the passions.

There have been some instances of persons dying within a moment, through excessive joy; and in very short time, from rage, vexation, and dread or horror. I shall consider here such faintings as ensue from rage and vehement grief or disappointment.

Excessive rage and violent affliction are sometimes fatal, though they oftener terminate in fainting. Excessive grief is especially accompanied with this consequence, and it is very common to see persons thus affected sink into successive faintings for several hours. Very little assistance can be given in such cases. It is proper, however, they should smell to strong vinegar, and frequently take a few cups of some hot and mild drink such as balm tea, or lemonade with a little orange or lemon peel.

It is not to be supposed that swoonings or faintings from excessive passions can be cured by nourishment. The condition into which vehement grief throws the body is that, of all others, in which nourishment would be most injurious. And as long as the vehemence of the affliction endures, the sufferer should take nothing but some spoonfuls of soup or broth, or a few morsels of some light meat roasted.

Medical and Health Writings When wrath or rage has risen so high that the body, entirely exhausted by that violent effort, sinks down at once into excessive relaxation, a fainting sometimes succeeds, and even the most perilous degree of it.

It is the most that can be done here to let the patient be perfectly still a while, only making him smell to some vinegar. But when he is come to himself, he should drink plentifully of hot lemonade.

Sometimes there remain sicknesses at stomach, retchings to vomit, a bitterness in the mouth, and some vertiginous symptoms which seem to require a vomit. But such a medicine must be very carefully avoided, since it may be attended with the most fatal consequence and lemonade with clysters generally and gradually remove these swoonings. If the sickness at stomach continue, the utmost medicine we allow besides would be that of No. 23, or a few doses of No. 24.

Of symptomatical swoonings, or such as happen in the progress of other diseases.

Swoonings in the beginning of putrid diseases denote an oppression at the stomach, or a mass of corrupt humours; and they cease as soon as an evacuation supervenes, whether by vomit or stool.

When they occur at the beginning of malignant fevers they declare the high degree of their malignancy, and the great diminution of the patient's natural strength.

In each of these cases vinegar, used externally and internally, is the best remedy during the paroxysm; and plenty of lemon juice and water after it.

Swoonings which supervene in diseases, accompanied with great evacuations, are cured like those which are owing to weakness, and endeavours should be used to restrain or moderate the evacuations.

Those who have any inward imposthume are apt to swoon frequently. They may sometimes be revived a little by vinegar.

Many persons have a slighter or a deeper swooning at the end of a violent fit of a fever. A spoonful or two of light white wine, with an equal quantity of water, affords all the succour proper in such a case.

Every swooning fit leaves the patient in dejection and weakness.

The secretions from the blood are suspended, the humours dis-

Advices with Respect to Health posed to stagnation, coagulations and obstructions are formed.

And if the motion of the blood is totally intercepted, or considerably checked, polypi'1' (and these often incurable) are formed in the heart or in the larger vessels.

Of haemorrhages, or an involuntary loss of blood.

Haemorrhages of the nose, after inflammatory fevers, commonly prove a favourable crisis; which bleeding we should carefully avoid stopping, except it threatens the patient's life.

As they scarcely ever happen in health but from abundance of blood, it is improper to check them too soon, lest some internal obstructions should prove the consequence.

A swooning sometimes ensues after the loss of only a moderate quantity of blood. This swooning stops the haemorrhage, and goes off without any assistance except the smelling to vinegar. But in other cases there is a succession of fainting fits without the blood's stopping, while at the same time slight convulsive motions ensue, attended with a raving, when it becomes necessary to stop the bleeding. And without waiting till these violent symptoms appear, the following signs will sufficiently direct us: as long as the pulse is pretty full, and heat of the body equally extended to the extremities, and the countenance and lips preserve their natural redness, no ill consequence is to be apprehended from the haemorrhage, though it be very copious.

But when the pulse begins to falter, when the countenance and the lips grow pale, and the patient complains of a sickness at stomach, it is absolutely necessary to stop it. And considering the operation of remedies does not immediately follow the application of them, it is safer to begin a little too early then to delay them, though ever so little, too long.

First then, tight bandages should be applied round both arms (on the part they are applied over in order to bleeding) and round the lower part of both thighs (on the gartering place), to detain the blood in the extremities.

2. Next the legs are to be plunged in warm water up to the knees.

For by relaxing the blood vessels of the legs and feet they are dilated at the same time, and thence receive and, in consequence of the ligatures above the knees, retain the more blood.

61Orig., 'polypuses'.

Medical and Health Writings As soon however as the bleeding is stopped these ligatures (on the thighs) may be relaxed; or one of them entirely removed, allowing the others to continue on an hour or two longer. But great precaution should be taken not to slacken them entirely, nor all at once.

3. Seven or eight grains of nitre and a spoonful of vinegar, in half a glass of cool water, should be given the patient every half hour.

4. One dram of white vitriol must be dissolved in two spoonfuls of spring-water, and a tent of lint or bits of soft fine linen dipped in this solution are to be introduced into the nostrils, horizontally at first, but afterwards to be intruded upwards and as high as may be, by the assistance of a flexible bit of wood or whale bone. But should this application be ineffectual, brandy, and even spirits of wine, mixed with a third part vinegar, have answered entirely well.

The prescription No. 67 may also be serviceable on this occasion.

It must be reduced to powder and conveyed up the nostrils as high as may be, on the point of a tent of lint, which may easily be covered with it.

5. When the flux of blood is totally stopped, the patient is to be kept as still and quiet as possible, taking great care not to extract the tent which remains in the nose, nor to remove the clots of coagulated blood which fill up the passage. The removing of these should be effected very gradually and cautiously, and frequently the tent does not spring out spontaneously till after many days.

have not said anything of artificial bleeding in these cases, as I think it at best unserviceable—since, though it may sometimes have stopped the morbid loss of blood, it has at other times increased it. Neither have I mentioned anodynes here, whose constant effect is to determine a larger quantity of blood to the head.

Applications of cold water to the nape of the neck ought to be wholly disused, having sometimes been attended with the most embarrassing consequences.

In all fluxes of blood great tranquillity, ligatures, and the use of the drink No. 2 or [No.] 4 are very useful.

People who are liable to haemorrhages ought to manage themselves conformable to the directions [in] §354. They should take very little supper, avoid all spirituous liquors, apartments that are over hot, and cover their heads but very lightly.

When a patient has for a long time been subject to haemorrhages, if they cease, he should retrench his quantity of food and take some gentle opening purges, especially that No. 24, and frequently a little nitre in an evening.

Advices with Respect to Health

Of convulsion fits.

Convulsions are, in general, more terrifying than dangerous. They result from various causes, and on the removal of these their cure depends.

In the fit itself little is to be done.

As nothing shortens the duration or even lessens the violence of an epileptic fit, so nothing at all should be attempted in it—and the rather, because means often aggravate the disease. We should confine our endeavours solely to the security of the patient, by preventing him from giving himself any violent strokes, by getting something if possible between his teeth, such as a small roller of linen to prevent his tongue from being hurt or dangerously squeezed.

The only cause which requires immediate assistance in the fit is when the neck is so swelled and the face so very red that there is room to be apprehensive of an apoplexy, which we should endeavour to obviate by drawing eight or ten ounces of blood from the arm.

Some species of epilepsy are wholly incurable. And such as are susceptible of a cure require the utmost care and consideration of the most experienced physicians.

Simple convulsive fits which are not epileptic are frequently of a long continuance, persevering with very few and short intervals for days and even for weeks.

The true cause should be found as soon as possible, though nothing should be attempted in the fit. The nerves are, during that term, in so high a degree of tension sensibility that the very medicines supposed to be strongly indicated often redouble the storm.

Thin watery liquors are the most innocent things that can be given, such as balm, lime tree, and elder-flower tea. A ptisan of liquorice root only has sometimes answered better than any other.

Of suffocating, or strangling fits.

These fits (by whatever other name they may be called), whenever they suddenly attack a person whose breathing was easy just before, depend almost constantly on a contraction of the nerves in the vesicles of the lungs, or upon a stuffing of the same parts produced by clammy humours. The former go off of themselves, or may be treated like swoonings owing to the same cause (see §327).

Medical and Health Writings §338. That suffocation which is the effect of a sanguineous fulness and obstruction may be distinguished by its attacking strong, sanguine persons who are great eaters, using much juicy nutritious food, and strong wine and liquors; when the fit has come on after any inflaming cause; when the pulse is full and strong, and the countenance red.

Such are cured:

1. By a very plentiful discharge of blood from the arm, which is to be repeated if necessary.

2. By drinking plentifully of the ptisan No. 1, to three pints of which a dram of nitre is to be added. And

3. By the vapour of hot vinegar, continually received by breathing.

There is reason to think that one of these fits is owing to humours in the lungs when it attacks persons whose temperament and manner of living are opposite to those I have just described; such as valetudinary, weakly, phlegmatic, inactive persons, who feed badly or on fat, viscid, and insipid diet, and who drink much hot water, either alone or in tea-like infusions. And this cause is still more probable if the fit come on in rainy weather and during a southerly wind.

The most efficacious treatment is: 1) to give every half hour half a cup of the potion No. 8, if it can be readily had; 2) to make the patient drink very plentifully of the drink No. 12; and 3) to apply two strong blisters to the fleshy parts of his legs.

Those afflicted with this malady are commonly relieved as soon as they expectorate, and sometimes even by vomiting a little.

The medicine No. 25, a dose of which may be taken every two hours, with a cup of the ptisan No. 12, often succeeds very well.

But if neither this medicine, nor the prescription of No. 8, are at hand, an onion of moderate size should be pounded in an iron or marble mortar. Upon this a glass of vinegar is to be poured, and then strongly squeezed through a piece of linen. An equal quantity of honey is to be added to it. A spoonful of this mixture, whose remarkable efficacy I have been a witness of, is to be given every half hour.

Of the violent effects of fear.

The general effects of terror are a great contraction of all the small vessels, and a repulsion of the blood into the large and internal ones. Hence follow the suppression of perspiration, the general

Advices with Respect to Health 547

oppression, the trembling, the palpitations and anguish, from the heart and the lungs being overcharged with blood; and sometimes attended with swoonings. A heavy drowsiness and a kind of furious delirium happen in other cases, which I have frequently observed in children when the blood vessels of the neck were swelled and stuffed up, and convulsions, and even the epilepsy, have come on.

When the humours that should have passed off by perspiration are repelled to the intestines, a tedious looseness is the frequent consequence.

Our endeavours should be directed to,reestablish the disordered circulation, to restore the obstructed perspiration, and to allay the agitation of the nerves.

The custom is to give the patient some cold water directly. But when the fright is considerable, this is a very pernicious custom.

They should, on the contrary, be conveyed into some very quiet situation, leaving there but very few persons, and such only as they are thoroughly familiar with. They should take a few cups of pretty warm drink, particularly of an infusion of lime tree flowers or balm.

Their legs should be put into warm water, and remain there an hour, if they will permit it, rubbing them gently now and then, and giving them every half-quarter of an hour a small cup of the said drink. When their composure is returned a little, and their skin has recovered its warmth, care should be taken to dispose them to sleep and to perspire plentifully. For this purpose they may be allowed a few spoonfuls of wine, on putting them to bed, with one cup of the former infusion; or, which is more effectual, a few drops of [Thomas] Sydenham's liquid laudanum, No. 48.62

It sometimes happens that children do not seem at first extremely terrified, but the fright is renewed while they sleep, and with no small violence. The directions I have just given must then be observed for some successive evenings, before they are put to bed.

Their fright frequently returns at the latter end of the night, and agitates them violently every day. The same treatment should be continued in such cases, and we should endeavour to dispose them to be asleep at the usual hour of its return.

By this very method I have dissipated the dismal consequence of fear of women in child-bed, which is so commonly mortal.

If a suffocation from this cause is violent, there is sometimes a necessity for opening a vein in the arm.

62Orig., '44'; a mistake carried over fromTissot.

Medical and Health Writings These patients should gradually be inured to an almost continual, but gentle, kind of exercise.

All violent medicines render those diseases which are the consequences of great fear incurable.

Of accidents or symptoms produced by the vapours of coal and of wine.

When small coal, and especially when charcoal, is burnt in a chamber close shut, it is direct poison to a person shut up in it. The sulphurous oil which is set at liberty and diffused by the fire expands itself through the chamber, while those who are in it perceive a disorder in their heads, vertigos, sickness at stomach, a weakness, and a very unusual kind of numbness; become raving, convulsed, and trembling. And if they have not presence of mind and strength to get out of the chamber, they die within a short time.

This vapour proves mortal in consequence of its producing an apoplectic disorder, blended at the same time with something convulsive, which sufficiently appears from the closure of the mouth and the strict locking of the jaws.

Such as are sensible of the danger, and retreat seasonably from it, are generally relieved as soon as they get into open air. Or if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them speedy relief. But when they are so far poisoned as to have lost their understanding, if there be any means of reviving them, such means consist:

1. In exposing them to a very pure, fresh, and open air.

2. In making them smell to some very penetrating odour, as the volatile spirit of sal ammoniac, and afterwards surrounding them, as it were, with the steam of vinegar.

3. In taking some blood from their arm.

4. In putting their legs into warm or hot water, and chafing them well.

5. In making them swallow, if practicable, much lemonade, or water and vinegar, with the addition of nitre.

A vomit would be hurtful, and the retchings to vomit arise only from the oppression on the brain.

Hence it amounts even to a criminal degree of imprudence to sleep in a chamber while charcoal or small coal is burning in it.

The bakers who make much use of small coal often keep great quantities of it in their cellars, which frequendy abound so

Advices with Respect to Health

much with the vapour of it that it seizes them the moment they enter. They sink down at once deprived of all sensation and die, if they are not drawn out of it soon.

One certain mean[s] of preventing such fatal accidents is, upon going into the cellar, to throw some flaming paper into it, and if this continue to flame out and consume, there is no reason for dreading the vapour. If it be extinguished, no person should venture in; but after opening the vent hole, a bundle of flaming straw must be set at the door, which serves to attract the external air strongly. Soon after, the experiment of the flaming paper must be repeated, and if it goes out, more straw is to be set on fire before the cellar door.

Small coal is not so dangerous as charcoal, the danger of which arises from this, that in extinguishing it by the usual methods all those sulphurous particles of it, in which its danger consists, are concentered. Nevertheless, small coal is not entirely deprived of all its noxious quality.

The method of throwing salt on live coals before they are conveyed into a chamber, or of casting a piece of iron among them to imbibe some parts of their deadly sulphur, is not without its utility, though by no means sufficient to prevent danger.

When the most dangerous symptoms disappear, and there remains only some weakness, numbness, and a little loathing at stomach, nothing is better than lemonade with one fourth part wine, half a cup of which should frequently be taken with a small crust of bread.

The vapour which exhales from wine, and in general from all fermenting liquors, kills in the like manner with the vapour of coal. And there is always danger in going into a cellar where there is much wine in the state of fermentation, if it has been shut up close for several hours. There have been many examples of persons struck dead on entering one, and of others who have escaped out of it with difficulty.

When such accidents occur, men should not be exposed, one after another, by endeavouring to fetch out the first who sunk down upon his entrance. But the air should immediately be purified by the method already directed, or by discharging some guns into the cellar. And when the persons unfortunately affected are brought out, they are to be treated like those who were affected with the coal vapour.

When caves that have been long shut are opened, or when deep wells are cleaned that have not been emptied for several years, the vapour arising from them produce the same symptoms. I hey

Medical and Health Writings are to be purified by burning sulphur and saltpetre in them, or gunpowder, as compounded of both.

The stink of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence. Nevertheless there have been instances of people killed by the fumes of lamps fed with nut oil which had been extinguished in a close room. These last fumes prove noxious also in consequence of their greasiness, which being conveyed into the lungs, prevent their respiration. And hence we may observe that persons of delicate breasts find themselves quickly oppressed in apartments illuminated with many candles. The steam of vinegar is very serviceable in such cases.

Ofpoisons.

There are a great number of poisons. But arsenic (or ratsbane) and some particular plants are the poisons which are most frequent in country places.

It is in consequence of its acrimony that arsenic destroys by an excessive inflammation, with a burning fire as it were in the mouth, throat, stomach, guts.

The best remedy of all is pouring down whole torrents of milk, or (where there is not milk) of warm water. Nothing but a prodigious quantity of such weak liquids can avail such a miserable patient. If the cause of the disorder is immediately known, after having very speedily taken down a large quantity of warm water, vomiting may be excited with oil, or with melted butter, and by tickling the inside of the throat with a feather. But when the poison has already inflamed the stomach and the guts, we must not expect to discharge it by vomiting. Whatever is healing or emollient, decoctions of mealy pulse [i.e., legumes], of barley, of oatmeal, of marsh mallows, and butter and oil, are the most suitable.

As soon as ever the pains are felt in the belly, clysters of milk must be very frequently thrown up.

If at the very beginning the patient has a strong pulse, a very plentiful bleeding may be considerably serviceable by its delaying and diminishing the inflammation.

And even though a patient overcome the first violence of this dreadful accident, it is common for him to continue in a languid state for a long time, and sometimes all his life. The most certain

Advices with Respect to Health

method of preventing this is to live for some months solely upon milk and some new-laid eggs—just received from the hen, and blended in the milk, without boiling them.

The plants which chiefly produce these unhappy accidents are: some kinds of hemlock, whether it be the leaf or the root; the berries of the deadly nightshade, which children eat by mistake for cherries; some cherries; some kind of mushrooms; and the seed of the stinking thornapple.

All poisons of this class prove mortal rather from the stupifying than from an acrid, sharp quantity. Vertigos, faintings, retchings to vomit, and actual vomitings are the first symptoms produced by them.

The patient should immediately swallow a large quantity of water, moderately seasoned with salt or sugar. And then a vomiting should be excited as soon as possible by the prescription No. 34 or [No.]

35. Or, if neither of these is readily procurable, with radish seed, pounded to the quantity of a teaspoonful, swallowed in warm water, soon after forcing a feather or a finger into the patient's throat.

After the operation of the vomit, he must continue to take a large quantity of water, sweetened with honey or sugar, together with a considerable quantity of vinegar, which is the true antidote against those poisons.

If a person has taken too much opium, or any medicine into which it enters, he must be bled upon the spot, and treated as if he had a sanguine apoplexy, for opium in effect produces such a one.

He should snuff up the vapour of vinegar plentifully, adding it also liberally to the water he is to drink.

Of acute pains.

When a person sound and hale finds himself suddenly attacked with some excessive pain, in whatever part it occurs, without knowing either the nature or the cause of it, they may, till proper advice can be procured:

1. Part with some blood, which almost constantly assuages the pains, at least for some time.

2. Drink abundantly of some very mild temperate drink, such as the ptisan No. 2, the almond emulsion No. 4, or warm water with a fourth or fifth part milk.

3. The whole part that is affected, and the adjoining parts, should be covered with cataplasms, or soothed with the emollient fomentation No. 9.

Medical and Health Writings 4. If, notwithstanding, the pain continues violent, and the pulse is neither full nor hard, the grown patient may take an ounce of syrup of diacodium, or sixteen drops of liquid laudanum. And when neither of these are to be had, an English pint of boiling water may be poured upon three or four poppy heads with their seeds, but without the leaves, and this decoction is to be drank like tea.

Persons very subject to frequent pains, and especially to violent headaches, should abstain from all strong drink—such abstinence being often the only means of curing them. And people are mistaken in supposing wine necessary for as many as seem to have a weak stomach.

Chapter XXXI

Of giving Remedies by way of Prevention §352. The habit of taking medicines is no indifferent matter. It is dangerous, and even criminal to omit them when they are necessary, but not less to take them when they are not wanted.

Of bleeding.

Of an inflammation of the blood, I have already spoken. Here I shall point out the symptoms which manifest an excess of blood.

[l)The first63] is the general manner of the patient's living while in health—if he is a great eater and indulges in juicy nutritious food, and especially flesh-meat; if he drinks rich and nourishing wine, or other strong drink, and at the same time enjoys a good digestion; if he takes but little exercise, sleeps much, and has not been subject to any very considerable evacuation—he may well be supposed to abound in blood.

[Other symptoms include:] 2) the total stopping of some involuntary bleeding, to which he had been accustomed; 3) a full and strong pulse, and veins visibly filled with blood; 4) a florid lively ruddiness;

5) a considerable and unusual numbness, and a little oppression and heaviness from walking; 6) swimmings of the head, especially on bowing down and raising it up at once; 7) frequent pains of the head to which the person was not formerly subject, and which seem not to arise from any defects in the digestions; 8) an evident sensation

630rig., 'It is ...'; corrected to match Tissot and fit subsequent numbering.

Advices with Respect to Health

of heat over the whole body; and lastly, [9)] frequent haemorrhages, and these attended with manifest relief and more vivacity.

People should, notwithstanding, be cautious of supposing an excess of blood from any one of these symptoms only. Many of them must concur, and they should endeavour to be certain that even such a concurrence of them does not result from a different cause.

But when it is certain, from the whole appearance, that such an excess doth exist, then a single or even a second bleeding is attended with good effects.

On the other hand, when these circumstances do not exist, bleeding is in no wise necessary. Nor should it ever be practised in the following circumstances, except for some particular and strong reason: l)64 in a very advanced age, or in very early infancy; 2) when a man is naturally of a weak constitution, or has been rendered so by sickness, or accident; 3) when the pulse is small, soft, feeble, and the skin is manifestly pale; 4) when the extremities of the body are often cold, puffed up, and soft; 5) when his appetite has been small for a long time, his food but little nourishing, and his exercise great; 6) when the patient has been considerably emptied, whether by haemorrhages, a looseness, profuse urine, or sweat; 7) when he has long been afflicted with some depressing disease; 8) whenever a person is exhausted, from whatever cause; [and] 9) when the blood is in a thin, pale, and dissolved state.

Whatever be the situation of the patient, and however naturally robust, that bleeding which is unnecessary is noxious. Repeated bleedings weaken and enervate, hasten old age, diminish the force of the circulation, thence fatten and puff up the body, and next (by weakening the digestions) lead to a fatal dropsy. They disorder the perspiration by the skin, and leave the patient liable to colds and defluxions. They weaken the nervous system and render them subject to vapours and to all nervous maladies.

The quantity of blood which a grown man may part with, by way of precaution, is about ten ounces.

Persons so constituted as to breed much blood should carefully avoid all those causes which tend to augment it (see §352). And when they are sensible of the quantity augmented, they should confine themselves to a light frugal diet on pulse [i.e., legumes], fruits, bread, and water. They should often bathe their feet in warm water, taking night and morning the powder No. 20. Drink of the ptisan

No. 1. Sleep but very moderately, and take much exercise. By using

640rig., 'first'.

Medical and Health Writings these precautions they may remove all the danger that might ensue from omitting to bleed at the usual season when the habit of bleeding had been long established of him.

Ofpurges.

The stomach and bowels are emptied either by vomiting or by stools, the latter discharge being much more natural than the first. Nevertheless, there are some cases which require this artificial vomiting. But these excepted, we should rather prefer those remedies which work by stool.

The signs which indicate a necessity for purging are: 1) a disagreeable taste in the mouth in a morning and especially a bitter taste, a foul furred tongue and teeth, disagreeable eructations,65 windiness, and distension; 2) a want of appetite increasing gradually, without any fever, which degenerates into a total aversion to food; 3) retchings to vomit in a morning, fasting, and sometimes throughout the day (supposing such not to depend on a woman's pregnancy); 4) a vomiting up of bitter or corrupted humours;

5) a manifest sensation of a weight in the stomach, the loins, or the knees; 6) pains of the stomach, frequent pains of the head, or vertigos; sometimes a drowsiness, which increases after meals; 7) a pulse less regular and less strong than what is natural to the patient, and which sometimes intermits.

When these symptoms, or some of them, ascertain the necessity of purging a person not then attacked by any manifest disease, a proper purging medicine may be given him. The bad taste in his mouth, the continual belchings, the frequent retchings to vomit, the actual vomitings discover that the cause of his disorder resides in the stomach and show that a vomit will be of service. But when such symptoms are not evident, the patient should take such purging remedies as are particularly indicated by the pains.

But we should abstain from either vomiting or purging:

1) whenever the complaints of the patients are founded in their being already exhausted; 2) when there is a general dryness of the habit, some inflammation, or a strong fever; 3) whenever nature is exerting herself in some other salutary evacuation—whence purging must never be attempted in critical sweats, during the monthlydischarges, nor during a fit of the gout; 4) nor in such inveterate

651.e., belching.

Advices with Respect to Health

obstructions as purges cannot remove; 5) neither when the nervous system is considerably weakened.

There are other cases in which it may be proper to purge, but not to give vomit. These cases are: 1) when the patient abounds too much with blood, since the efforts which attend vomiting greatly augment the force of the circulation, whence the blood vessels of the head and of the breast might burst. 2) For the same reason they should not be given to persons who are subject to frequent bleeding from the nose, or to vomiting of blood; [3)]to women who are subject to excessive or unseasonable discharges of blood, nor to those who are with child; 4) nor to ruptured persons.

When any persons have taken too sharp a vomit, or a purge which operates with excessive violence, we should treat them as if they had been actually poisoned by violent corroding poisons—that is, we should fill them with draughts of warm water, milk, or barley water; and also bleed them, if their pains are excessive and their pulses strong and feverish. The super-purgation is then to be stopped by the calming medicines directed [in] §351, No. 4. Flannels dipped in hot water, in which some Venice treacle is dissolved, are very serviceable. But should the vomiting be excessive, without any purging, the patient should be placed in a warm bath.

Purges frequently repeated, without necessity, are attended with much the same ill effects as frequent bleedings. They destroy the digestions, the stomach no longer exerts its functions, the intestines prove inactive. The patient becomes liable to severe colics. Perspiration is disordered, defluxions ensue. Nervous maladies come on, and the patient proves old long before the number of his years have made him so.

It is a prejudice generally received that persons who have little or no appetite need purging. But this is often false, because most of those causes which destroy the appetite cannot be removed by purging.

To persons whose stomachs contain much viscid matter, purges prove a very slight and deceitful relief. These humours are owing to that laxity of the stomach which purges augment since, notwithstanding they carry off part of these viscid humours, after a few days there is a greater accumulation of them than before. The real cure of such cases is affected by directly opposite medicines. Those mentioned [in] §187 are highly conducive to it.

The custom of taking medicines infused in brandy, spirit of wine, or cherry water is always dangerous. For notwithstanding the present relief such infusions afford in some disorders of the stomach, they really by slow degrees impair and ruin that organ. And it

Medical and Health Writings may be observed that as many as accustom themselves to drams go off just like excessive drinkers, in consequence of their having no digestion, whence they sink into a state of depression and languor, and die dropsical.

Either vomits or purges may be often well omitted, even when they have some appearance of being necessary, by abating one meal a day for some time, by abstaining from the most nourishing sorts of food, by drinking freely of cold water, and taking extraordinary exercise. The same regimen also subdues, without the use of purges, the various complaints which often invade those who omit taking purging medicines at those seasons in which they have made it a custom to take them.

The medicines No. 34 and [No.] 35 are the most certain vomits. The powder No. 21 is a good purge when the patient is no way feverish.

The doses recommended in the table of remedies are those which are proper for a grown man, of a vigorous constitution.b Nevertheless there are some few for whom they may be too weak. In such circumstances, they may be increased. But we must be careful not to double the dose, which has sometimes killed the patient. In case of purging not ensuing, we should rather give draughts of whey sweetened with honey. Or of warm water, in three pints of which an ounce or an ounce and a half of common salt must be dissolved, and this quantity is to be taken from time to time in small cups, moving about with it.

A man should not drink after a vomit until it begins to work. But then he should drink warm water, or a light infusion of camomile flowers.c

It is usual, after purges, to take some thin broth during their operation. But warm water, sweetened with sugar or honey, or an infusion of succory flowers, would be more suitable.

The most certain preservative, and the most attainable too by every man, is to avoid all excess, and especially excess in eating and drinking. People generally eat more than thoroughly consists with health, or than permits them to attain the utmost vigour of which their natural constitutions are capable. The custom is established, and it is difficult to eradicate it. Notwithstanding, we should at least resolve not to eat but through hunger, and always under a subjection to reason. Because, except in a very few cases, reason constantly suggests to us not to eat when the stomach has an aver-

bMost of them are far too large for a common Englishman or woman [JW], cOne quart, at four times, is commonly enough [JW],

Advices with Respect to Health 557

sion to food. Sobriety of itself cures such maladies as are otherwise incurable, and may recover the most unhealthy persons.

Table Of the Prescriptions and Medicines referred to in the Foregoing Treatise: which, with the notes beneath

them, are to be read before the taking or application of any of the said medicines.

The pound which I mean, throughout all these prescriptions, is that consisting of sixteen ounces.

The drinking glass or cup contains three ounces.

A spoonful is supposed to be half an ounce.

The small spoon or teaspoon contains thirty drops. Five or six of these are equal to a common soupspoon.

The basin or porringer may be estimated at eighteen ounces. A sick person should never be allowed to take more than a third part of this quantity of nourishment at any one time.

The doses in all the following prescriptions are adjusted to grown men, from the age of eighteen to that of sixty years. From the age of twelve to eighteen, two thirds of that dose will generally be sufficient. And from twelve down to seven years one half, diminishing this still lower in proportion to the greater youth of the patient. So that not more than one eighth of the dose prescribed should be given to an infant under one year. But their different constitutions will make a considerable difference in adjusting their different doses. It were to be wished that every person would carefully observe whether a strong dose is necessary to purge him, as exactness is important in adjusting the doses of such medicines as are intended to purge, or to evacuate in any manner.

No. 1. Take a pugil or large pinch between the thumb and two fingers of elder-flowers. Put them into an earthenware mug, with two ounces of honey and an ounce and a half of good vinegar. Pour upon them three pints and one quarter of boiling water. Stir it a little with a spoon to mix and dissolve the honey. Then cover up the mug, and when the liquor is cold, strain it through a linen cloth.

No. 2. Take two ounces of whole barley. Cleanse and wash it well in hot water, throwing away this water afterwards. Then boil it in five pints of water, till the barley burst and opens. Towards the end of the boiling, throw in one dram and a half of nitre (saltpetre),

Medical and Health Writings strain it through a linen cloth, and add one ounce and a half of honey, and one ounce of vinegar.d No. 3. Take the same quantity of barley as before, and instead of nitre boil in it, as soon as the barley is put in to boil, a quarter of an ounce of cream of tartar. Strain it and add nothing else to it.e

No. 4. Take three ounces of the freshest sweet almonds, and one ounce of gourd or melon seeds. Bruise them in a mortar, adding to them by a little at a time one pint of water. Then strain it through linen. Bruise what remains again, adding gradually to it another pint of water, then straining. And adding water to the residue, till full three pints at least of water are thus used. After which it may again be poured upon the bruised mass, stirred well about, and then be finally strained off. Half an ounce of sugar may safely be bruised with the almonds and seeds at first, and delicate persons may be allowed a little orange flower water with it.

No. 5. Take two pugils of mallow leaves and flowers, cut them small, and pour a pint of boiling water upon them. After standing some time, strain it, adding one ounce of honey to it. For want of mallows, which is preferable, a similar clyster may be made of the leaves of marsh mallows, lettuce, or spinach. A few particular constitutions are not to be purged by any clyster but warm water alone.

Such should receive no other, and the water should not be very hot.

No. 6. Boil a pugil of mallow flowers in a pint of barley water for a clyster.

No. 7. Take three pints of simple barley water, add to it three ounces of the juice of sow-thistle, or of groundsel, or of the greater houseleek, or of borage/ No. 8. To one ounce of oxymel of squills, add five ounces of a strong infusion of elder-flowers.

No. 9. There are many different emollient applications which have nearly the same virtues. The following are the most efficacious. dThis makes an agreeable drink, and the notion of its being windy is idle since it is so only to those with whom barley does not agree. It may, where barley is not procurable, be made from oats [Tissot (see Advice, 587)]. cIn some cases, instead of the barley, four ounces of grass roots may be boiled in the same quantity of water for half an hour, with the cream of tartar [Tissot (see

Advice, 587)].

1 These juices are to be procured from the herbs when fresh and very young, if possible, by beating them in a marble mortar, or for want of such (or a wooden mortar) in an iron one, and then squeezing out the juice through a linen bag. It must be left to settle a little in an earthen vessel, after which the clear juice must be decanted gently off, and the sediment be left behind [Tissot (see Advice, 588-89)].

Advices with Respect to Health

1. Flannels wrung out of a hot decoction of mallow flowers.

2. Small bags filled with mallow flowers—or with those of elder, of camomile, of wild corn poppy—and boiled either in milk or water.

3. Poultices of the same flowers boiled in milk and water.

4. A poultice of boiled bread and milk.s No. 10. To one ounce of spirit of sulphur, add six ounces of spirit of violets; or, for want of the latter, as much barley water, of a thicker consistence than ordinary.

No. 11. Take two ounces of manna and half an ounce of Epsom salt, dissolving them in four ounces of hot water and straining them.

No. 12. Take of elder-flowers one pugil, of hyssop leaves half as much. Pour three pints of boiling water upon them. After infusing some time, strain, and dissolve three ounces of honey in the infusion.

No. 13. The same drink, by only omitting the hyssop and adding instead of it as much more elder-flowers.

No. 14. Let one ounce of the best Jesuit's bark in fine powder be divided into sixteen equal portions.

No. 15. Take of the flowers of St. John's-wort, of elder, and of melilot, of each a few pinches. Put them into the bottom of a vessel containing five or six English pints, with half an ounce of oil of turpentine, and fill it up with boiling water.

No. 16. The syrup of the flowers of the wild red corn poppy.

No. 17. Very clear sweet whey, in every pint of which one ounce of honey is dissolved.

No. 18. Take of hard white soap six drams, of extracts of dandelion one dram and a half, of gum ammoniacum half a dram, and with syrup of maidenhair make a mass of pills, to be formed into pills weighing three grains each.

No. 19. Gargarisms may be prepared from an infusion of the leaves of red roses, or of mallows. Two ounces of vinegar and as much honey must be added to every pint of it, and the patient should gargle with it pretty hot. The deterging, cleansing gargarism is a light infusion of the tops of sage, adding two ounces of honey to each pint of it.

No. 20. One ounce of powdered nitre, divided into sixteen equal doses.

No. 21. Take of jalap, of senna, and of cream of tartar, of each thirty grains66 finely powdered, and let them be very well mixed.

No. 22. Take of China-root and of sarsaparilla, of each one ounce and a half; of sassafras root, and of the shavings of guiacum g Boiled nettles are best of all [JW].

66JW reduced to 'twenty grains' in the Works edition.

Medical and Health Writings (otherwise called 'lignum vitae'), of each one ounce. Let the whole be cut very fine. Then put them into a glazed earthen vessel, pouring upon them about five pints of boiling water. Let them boil gently for about an hour. Then take it from the fire, and strain it off through linen. This is called 'the decoction of the woods'. More water may, after the first boiling, be poured on the same ingredients, and be boiled up into a small decoction for common drink.

No. 23. Take one ounce of the pulp of tamarinds, half a dram of nitre, and four ounces of water. Let them boil not more than one minute. Then add two ounces of manna and, when dissolved, strain the mixture off.

No. 24. An ounce of cream of tartar, divided into eight equal parts.

No. 25. The preparation of Kermes mineral, otherwise called 'Chartrusian powder'. Dr. Tissot orders but one grain for a dose. It has been directed from one to three.

No. 26. Take three ounces of the common burdock root. Boil it for half an hour, with half a dram of nitre, in three full pints of water.

No. 27. Take half a pinch of the herbs prescribed [in] No. 9, article 2, and half an ounce of hard white soap, shaved thin. Pour on these one pint and a half of boiling water, and one glass of wine.

Strain the liquor, and squeeze it strongly out.

No. 28. Take of the purest quicksilver one ounce, of Venice turpentine half a dram, of the freshest hog's lard two ounces, and let the whole be very well rubbed together into an ointment.

No. 29. The yellow basilicon.

No. 30. Take of natural and factitious (or artificial) cinnabar twenty-four grains each, of musk sixteen grains, and let the whole be reduced into fine powder and very well mixed.h

hThis medicine was brought over from the East Indies by Sir George Cobb [(1670-1762)], and published under the name of the Jonquin [i.e.,Tonquin] medicine. Its reputation was very considerable, and some success was even observed from its use in Europe. Dr. Nugent, physician in Bath, has published a case wherein its good effects were manifest; and Dr. Whytt, in his late treatise on nervous disorders, has given us a similar instance of the good effects of this medicine. It is to be observed, however, that in both these cases opium was given along with it; and in the latter, a plaster of galbanum and opium was applied to the throat [JW],

[Referring to Christopher Nugent (1698-1775), An Essay on the Hydrophobia (London: Leake and Frederic, 1753); and Robert Whytt (1714-66), Observations on the Nature, Causes, and Cure of those Disorders which have been commonly called Nervous, Hypochondriac, or Hysteric (Edinburgh: T. Becket and P. du Hondt, 1765).]

Advices with Respect to Health No. 31. Take one dram of Virginia snake-root in powder, of camphor and of asafoetida ten grains each, of opium one grain, and with a sufficient quantity of conserve or rob of elder make a bolus.'

No. 32. Take three ounces of tamarinds. Pour on them one pint of boiling water. And after letting them boil a minute or two, strain 5 the liquor through a linen cloth.

No. 33. Take seven grains of turbith mineral, and make it into a pill or bolus with a little crumb of bread.'

No. 34. Six grains of tartar emetic.k No. 35. Take thirty-five grains of ipecacuana; which, in the very 10 strongest constitutions, may be augmented to forty-five.1

No. 36. The common blistering plaster.

No. 37. Take of the tops of ground-oak, of the lesser centaury, of wormwood, and of camomile, of each one pugil. Pour on them three pints of boiling water, and suffering them to infuse until it is 15 cold, strain the liquor through a linen cloth, pressing it out strongly.

No. 38. Take forty grains of rhubarb, and as much cream of tartar in powder, mixing them well together.m No. 39. Take three drams of cream of tartar, and one dram of ipecacuanha finely powdered. Rub them well together and divide 20 them into six equal parts; or twelve, for weak people.

No. 40. Take of the simple mixture one ounce, of spirit of vitriol half an ounce, and mix them. The dose is one or two teaspoonfuls in a cup of the patient's common drink. The simple mixture is composed of five ounces of treacle water camphorated, of three 25 ounces of spirit of tartar rectified, and one ounce of spirit of vitriol.

If the patient has an insuperable aversion to the camphor, it must be 'When this is preferred to No. 30, of which musk is an ingredient, the grain of opium should be omitted, except once or at most twice in the twenty-four hours.

Two doses of quicksilver, of fifteen grains each, should be given daily in the morning, in the interval between the other boluses [Tissot (see Advice, 594)].

' This medicine makes the dogs vomit and slaver abundantly. It has effected many cures after the hydrophobia (the dread of water) was manifest. It must be given three days successively, and afterwards twice a week for fifteen days [Tissot

(see Advice, 595)]. k When people are ignorant of the strength of the tartar emetic (which is often various), or of the patient's being easy or difficult to vomit, a dose and a half may be dissolved in a quart of warm water, of which he may take a glass every quarter of an hour—whence the operation may be regulated according to the number of vomits or stools. This method, much used in Paris, seems a safe one [Tissot (see

Advice, 595)].

'In weak constitutions, ten grains are sufficient [JW]. mFor a weak constitution, fifteen grains of each are quite sufficient [JW].

Medical and Health Writings omitted, though the medicine is less efficacious without it. And if his thirst is not very considerable, the simple mixture may be given alone, without any further addition of spirit of vitriol.

No. 41. Take half a dram of Virginia snake-root, ten grains of camphor, and make them into a bolus with rob of elderberries. If the patient's stomach cannot bear so large a dose of camphor, he may take it in smaller doses and oftener—viz. three grains, every two hours. If there is a violent looseness, diascordium must be substituted instead of the rob of elderberries.

No. 42. The thenaca pauper tun, or poor man's treacle, in the dose of a quarter of an ounce. The following composition of it is the best. Take equal parts of round birthwort roots, of elecampane, of myrrh, and of rob or conserve of juniper-berries, and make them into an electuary, of a rather thin than very stiff consistence, with syrup of orange peel.

No. 43. The first of the three medicines referred to in this number is that already directed No. 37. The second is as follows.

Take equal parts of the lesser centaury, of wormwood, of myrrh, all powdered, and of conserve of juniper-berries, making them up into a pretty thick consistence with syrup of wormwood. The dose is a quarter of an ounce, to be taken at the same intervals as the bark.

For the third composition, take of the roots of calamus aromaticus and elecampane well bruised, two ounces; of the tops of the lesser centaury cut small, a pugil; of filings of unrusted iron, two ounces; of old white wine, three pints. Put them all into a widenecked bottle and set it upon embers, or on a stove, or by the chimney, that it may be always kept hot. Let them infuse twenty-four hours, shaking them well five or six times. Then let the infusion settle and strain it. The dose is a common cup every four hours, four times daily, and timing it one hour before dinner.

No. 44. Take a quarter of an ounce of cream of tartar, a pugil of common camomile. Boil them in 12 ounces of water for half an hour, and strain it off.

No. 45. Sal ammoniac, from two scruples to one dram for a dose.

Phis may be made into a bolus with rob of elder. But a delicate stomach does not well admit of this salt.

No. 46. Take one pugil of camomile flowers, and as much elderflowers, bruising them well; of fine flour, three ounces; of ceruse and of blue smalt, each half an ounce. Rub the whole, and mix them well. This powder may be applied immediately to the part.

Take of the ointment called 'nutritum' (see No. 64), made with the newest sweet oil, two ounces; of white wax, three quarters of

Advices with Respect to Health

an ounce; and one quarter of an ounce of blue smalt. Melt the wax.

Then add the nutritum to it, after the smalt finely powdered has been exactly incorporated with it. Stirring it about with an iron spatula or rod, till the whole is well-mixed and cold. This is to be smoothly spread on linen cloth.

A quarter of an ounce of smalt may also be mixed exactly with two ounces of butter or ointment of lead, to be used occasionally instead of this plaster.

No. 47. Take one ounce of Epsom salt and two ounces of tamarinds. Pour upon them eight ounces of boiling water, stirring them about to dissolve the tamarinds. Strain it off and divide it into two equal draughts, to be given at the interval of half an hour between the first and the last.

No. 48. Take of [Thomas] Sydenham's liquid laudanum, eighty drops; of balm water, two ounces and a half. If the first or second dose stops, or considerably lessens, the vomiting, this medicine should not be repeated.

No. 49. Dissolve three ounces of manna and twenty grains of nitre in twenty ounces of sweet whey.

No. 50. To two ounces of syrup of diacodium, or white poppy heads, add an equal weight of elder-flower water; or for want of it, of spring-water.

No. 51. A dram of rhubarb in powder.

No. 52. Take of sulphur vivum or of flower of brimstone, one ounce; of sal ammoniac, one dram; of fresh hog's lard, two ounces; and mix the whole very well in a mortar.

No. 53. Take two drams of crude antimony and as much nitre, both finely powdered and very well mixed; dividing the whole into eight equal doses.

No. 54.n Take of filings of iron (not the least rusty) and of sugar, each one ounce; of aniseeds powdered, half an ounce. After rubbing them very well together, divide the powder into twenty-four equal portions. One of which is to be taken three times a day, an hour before eating.

"The prescription No. 54, 55, 56 are calculated against distempers which arise from obstructions and stoppage of the monthly discharges; which No. 55 is more particularly intended to remove. Those of 54 and 56 are most convenient either when the suppression does not exist, or is not to be much regarded, if it does. This medicine may be rendered less unpalatable for persons in easy circumstances by adding as much cinnamon instead of aniseeds. And though the quantity of iron be small, it may be sufficient if given early in the complaint. One, or at the most two, of these doses daily being sufficient for a very young maiden [Tissot (see Advice, 601)].

Medical and Health Writings No. 55. Take of filings of sound iron, two ounces; of leaves of rue, and of white horehound, one pugil each; of black hellebore root, one quarter of an ounce; and infuse the whole in three pints of wine in the manner already directed [in] No. 43. The dose of this is one small cup three times a day, an hour before eating.0

No. 56. Take two ounces of filings of iron; of rue leaves and aniseeds powdered, each half an ounce. Add to them a sufficient quantity of honey to make an electuary of a good consistence. The dose is a quarter of an ounce three times daily.

No. 57. Take of the extract of the stinking hemlock with the purple spotted stalk, one ounce. Form it into pills weighing two grains each, adding as much of the powder of dry hemlock leaves as the pills will easily take up. Begin the use of this medicine by giving one pill night and morning. Some patients have been so familiarized to it as to take at length half an ounce daily.p

No. 58. Take of the roots of grass and of succory well washed, each one ounce. Boil them a quarter of an hour in a pint of water.

Then dissolve in it half an ounce of Epsom salt and two ounces of manna. And strain it off to drink one glass of it from half hour to half hour, till its effects are sufficient. It is to be repeated at the interval of two or three days.

No. 59. A poultice made of crumb of bread, with camomile flowers, boiled in milk, and the addition of some soap, so that each poultice may contain half a quarter of an ounce of it. And when the circumstances of female patients have not afforded them that regular attendance which the repetition of the poultice requires, as it should be renewed every three hours, I have successfully directed the hemlock plaster of the shops.

No. 60. Take a sufficient quantity of dry hemlock leaves. Secure them properly between two pieces of thin linen cloth, so as to make a very flexible sort of small mattress, letting it boil a few moments in water. Then squeeze it out and apply it to the affected part. It must thus be moistened and heated afresh, and reapplied, every two hours.

01 choose to repeat here, the more strongly to inculcate so important a point, that in women who have long been ill and languid our endeavours must be directed towards the restoring of the patient's health and strength, and not to forcing down the monthly discharges, which is a very pernicious practice. These will return of course, if the patient is of a proper age, as she grows better [Tissot (see Advice,

601)].

PI doubt the virtue of this medicine [JW],

Advices with Respect to Health

No. 61. Take of the true white magnesia, two drams; of cinnamon powdered, four grains. Rub them very well together, and divide the whole into eight doses. One of these is to be given in a spoonful of milk, or water, before the infant sucks.

No. 62. Take of an extract of walnuts, made in water, two drams; and dissolve it in half an ounce of cinnamon water. Fifty drops a day of this solution is to be given to a child of two years old. And after the whole has been taken, the child should be purged. This extract is to be made of the unripe nuts, when they are of a proper growth and consistence for pickling.

No. 63. Take of resin of jalap, two grains. Rub it a considerable time with twelve or fifteen grains of sugar, and afterwards with three or four sweet almonds; adding, very gradually, two common spoonfuls of water. Then strain it through clear thin linen, as the emulsion of almonds was ordered to be. Lastly, add a teaspoonful of syrup of maidenhair to it. This is no disagreeable draught, and may be given to a child of two years old. And if they are older, a grain or two more of the resin may be allowed. But under two years old, it is prudent to purge children rather with syrup of succory, or with manna.

No. 64. Take of the ointment called 'nutritum', one ounce; the entire yolk of one small egg, or the half of a large one; and mix them well together. This 'nutritum' is made by rubbing very well together, and for some time, two drams of white lead, half an ounce of vinegar, and three ounces of common oil.

No. 65. Melt four ounces of white wax. Add to it, if made in winter, two spoonfuls of oil; if in summer, none at all, or at most not above a spoonful. Dip in this slips of linen cloth not worn too thin, and let them dry. Or spread it thin and evenly over them.

No. 66. Take of oil of roses, one pound; of red lead, half a pound; of vinegar, four ounces. Boil them together nearly to the consistence of a plaster. Then dissolve in the liquid mass an ounce and a half of yellow wax, and two drams of camphor, stirring the whole about well. Remove it then from the fire, and spread it on sheets or slips of paper, of what size you think most convenient. The ointment of Chambauderie, so famous in many families on the continent, is made of a quarter of a pound of yellow wax, of the plaster of three ingredients (very nearly the same with No. 66.), of compound diachylon, and of common oil; of each the same quantity, all melted together, and then stirred about well. After it is removed from the fire, till it grows cold. To make an oil cloth, it must be melted over again with the addition of a little oil, and applied to the linen as directed at No. 65.

Medical and Health Writings No. 67. Gather in autumn, while the fine weather lasts, the agaric of the oak, which is a kind of fungus or excrescence issuing from the wood of that tree.

It consists at first of four parts, which present themselves successively: 1) The outward rind or skin, which may be thrown away.

2) That part immediately under this rind, which the best of all. It is to be beat well with a hammer, till it becomes soft and very pliable.

This is the only preparation it requires, and a slice of it a proper size is to be applied directly over the bursting open blood vessels.

It constringes and brings them close together, stops the bleedings, and generally falls off at the end of two days. 3) The third part, adhering to the second, may serve to stop the bleeding from the smaller vessels. [4)] And the fourth and last part may be reduced to powder, as conducing to the same purpose.

No. 68. Take four ounces of crumbs of bread, a pugil of elderflowers, and the same quantity of those of camomile and of St.

John's-wort. Boil them into a poultice in equal quantities of vinegar

and water.

If fomentations should be thought preferable, take the same herbs, throw them into a pint and a half of boiling water, and let them infuse some minutes. Then a pint of vinegar is to be added.

And flannels or other woollen cloths dipped in the fomentation, and wrung out, are to be applied to the part affected.

For the aromatic fomentations, take leaves of betony and of rue, flowers of rosemary or lavender, and red roses, of each a pugil and a half. Boil them for a quarter of an hour in a pot with a cover, with three pints of old white wine. Then strain off, squeezing the liquor strongly from the herbs, and apply it as already directed.

No. 69. The plaster of diapalma.q No. 70. A mixture of two parts water and one part of vinegar of litharge.

No. 71. Take of the leaves of sow-bread and of camomile tops, of each one pugil. Put them into an earthen vessel with half an ounce of soap, and as much sal ammoniac, and pour upon them three pints of boiling water.

qTo spread this upon lint, it must be melted down again with a little oil [Tissot

(see Advice, 607)].

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